Approaches to the detection of coronary artery disease using myocardial contrast echocardiography

In the presence of an epicardial coronary stenosis, changes in microvascular hemodynamics after the administration of pharmacologic stress agents result in a decrease in myocardial blood volume (MBV) from capillary derecruitment. Because capillaries provide the greatest resistance to flow during maximal hyperemias, changes in capillary volume are closely coupled to changes in hyperemic myocardial blood flow (MBF). A wide array of imaging techniques are now available with myocardial contrast echocardiography to assess both the spatial and temporal aspects of myocardial perfusion, providing many options for the detection of coronary stenosis by evaluating changes in MBV, MBF, or both.