Feasability of wall motion analysis plus coronary flow reserve, and myocardial perfusion analysis during dobutamine stress echocardiography

Abstract

Background

The 2024 ESC guidelines highlights the importance of myocardial perfusion (class 1, level B) and coronary flow reserve (CFR) (class 2b, level B) in stress echocardiography. However, these remain under-utilized in France, likely due to the predominant use of Dobutamine. This study assesses the feasibility of CFR and myocardial perfusion evaluation during Dobutamine stress echocardiography.

Objectives

To assess CFR measurement and myocardial perfusion feasibility during Dobutamine stress echocardiography.

Methods

Three years monocentric open interventional study. All consecutive patients receiving Dobutamine stress echocardiography were included. The test was performed following EAE guidelines. Sonovue® contrast was used for myocardial perfusion. CFR was calculated as the ratio of peak to resting diastolic velocity in the left anterior descending (LAD) artery. Myocardial perfusion was assessed using the Flash/Replenishment method before peak stress.

Results

Among 196 patients (mean age 71 years, 56% men), the target heart rate was achieved in 97%. CFR measurement was feasible in 90%, and myocardial perfusion in 98% (assessing ≥ 80% of myocardial segments). Triple modality assessment (wall motion, CFR, and myocardial perfusion) was successful in 90% (Fig. 1). Median CFR was 2.55, lower in patients with wall motion abnormalities in the LAD territory (2.00, Fig. 2), and even lower in left ventricular dysfunction (1.61, Figure 2, Figure 3).

Conclusion

A multiparametric approach integrating WMA, CFR, and myocardial perfusion during Dobutamine stress echocardiography is highly feasible. CFR measurement was feasible in 90%, and myocardial perfusion in 98%, despite small attenuation artifacts. The lower CFR in patients with regional wall motion abnormalities and LV dysfunction suggests a strong link with myocardial ischemia. This supports CFR's role in refining ischemia assessment beyond wall motion analysis alone. Further studies are needed to evaluate its diagnostic impact.