Skip to main content
SpringerLink
Log in

Echocardiography and coronary artery disease: Current and future applications

  • Review Article
  • Published:
The International Journal of Cardiac Imaging Aims and scope Submit manuscript

Abstract

Echocardiographic techniques are becoming more widespread for evaluating patients with known or suspected coronary artery disease. Because it affords an excellent overall view of the heart, two-dimensional echocardiography, rather than M-mode echocardiography, is the imaging procedure of choice when dealing with coronary artery disease. This technique can be used to make the initial diagnosis of acute myocardial infarction, diagnose complications, and assess prognosis following myocardial infarction. Additionally by combining this test with stress testing, latent coronary artery disease can be detected. Recovery of wall motion can be assessed following interventions such as thrombolysis or balloon angioplasty. Investigational and future uses include tissue characterization, which may allow detection of ischemic but potentially viable myocardium, direct coronary visualization for detection of atherosclerotic involvement of the proximal coronary arteries and myocardial contrast echocardiography. The latter technique allows visualization of perfusion by way of injecting contrast material into the coronary circulation. This has been demonstrated to be an accurate means of determining myocardial infarction size in an animal model and is currently being used in a number of centers in patients at the time of cardiac catheterization. In summary two-dimensional echocardiography currently allows assessment of patients with myocardial infarction from the time of their presentation through their convalescent period with respect to diagnosis, prognosis and presence of complications. Exercise echocardiography can diagnose latent coronary artery disease. The newer investigational techniques show promise for furthering our ability to evaluate patients with coronary artery disease using echocardiography.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tennant R, Wiggers CJ. The effect of coronary occlusion on myocardial contraction. Amer J Physiol 1935; 112: 351–361.

    Google Scholar 

  2. Kisslo JA, Robertson D, Gilbert BW, vonRamm O, Behar VS. A comparison of real-time, two-dimensional echocardiography and cineangiography in detecting left ventricular asynergy. Circulation 1977; 55: 134–141.

    PubMed  Google Scholar 

  3. Erbel R, Schweizer P, Meyer J, Krebs W, Yalkinoglu O, Effert S. Sensitivity of cross-sectional echocardiography in detection of impaired global and regional left ventricular function: prospective study. Int J Cardiol 1985; 7: 375–389.

    PubMed  Google Scholar 

  4. Hecht HS, Taylor R, Wong M, Shah PM. Comparative evaluation of segmental asynergy in remote myocardial infarction by radionuclide angiography, two-dimensional echocardiography, and contrast ventriculography. Amer Heart J 1981; 101: 740–749.

    PubMed  Google Scholar 

  5. Nixon JV, Narahara KA, Smitherman TC. Estimation of myocardial involvement in patients with acute myocardial infarction by two-dimensional echocardiography. Circulation 1980; 62: 1248–1255.

    PubMed  Google Scholar 

  6. Weiss JL, Bulkley BH, Hutchins GM, Mason SJ. Twodimensional echocardiographic recognition of myocardial injury in man: comparison with postmortem studies. Circulation 1981; 63: 401–408.

    PubMed  Google Scholar 

  7. Heger JJ, Weyman AE, Wann LS, Rogers EW, Dillon JC, Feigenbaum H. Cross-sectional echocardiographic analysis of the extent of left ventricular asynergy in acute myocardial infarction. Circulation 1980; 61: 1113–1118.

    PubMed  Google Scholar 

  8. Mann DL, Gillam LD, Weyman AE. Cross-sectional echocardiographic assessment of regional left ventricular performance and myocardial perfusion. Prog Cardiovasc Dis 1986; 29: 1–52.

    Google Scholar 

  9. Horowitz RS, Morganroth J, Parrotto C, Chen CC, Soffer J, Pauletto FJ. Immediate diagnosis of acute myocardial infarction by two-dimensional echocardiography. Circulation 1982; 65: 323–329.

    PubMed  Google Scholar 

  10. Heger JJ, Weyman AE, Wann LS, Dillon JC, Feigenbaum H. Cross-sectional echocardiography in acute myocardial infarction: Detection and localization of regional left ventricular asynergy. Circulation 1979; 60: 531–538.

    PubMed  Google Scholar 

  11. Stamm RB, Gibson RS, Bishop HL, Carabello BA, Beller GA, Martin RP. Echocardiographic detection of infarctlocalized asynergy and remote asynergy during acute myocardial infarction: Correlation with the extent of angiographic coronary disease. Circulation 1983; 67: 233–244.

    PubMed  Google Scholar 

  12. Gibson RS, Bishop HL, Stamm RB, Crampton RS, Beller GA, Martin RP. Value of early two dimensional echocardiography in patients with acute myocardial infarction. Amer J Cardiol 1982; 49: 1110–1119.

    PubMed  Google Scholar 

  13. Arvan S, Varat MA. Two-dimensional echocardiography versus surface electrocardiography for the diagnosis of acute non-Q wave myocardial infarction. Amer Heart J 1985; 110: 44–49.

    PubMed  Google Scholar 

  14. Pierard LA, Albert A, Henrard L, Lempereur P, Sprynger M, Carlier J, Kulbertus HE. Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography. J Amer Coll Cardiol 1986; 8: 517–520.

    Google Scholar 

  15. Matsumoto M, Watanabe F, Goto A, Hamano Y, Minamino KYT, Abe H, Kamada T. Left ventricular aneurysm and the prediction of left ventricular enlargement studied by two-dimensional echocardiography: Quantitative assessment of aneurysm size in relation to clinical course. Circulation 1985; 72: 280–286.

    PubMed  Google Scholar 

  16. Visser CA, Kan G, David GK, Lie KI, Durrer D. Echocardiographic — cineangiographic correlation in detecting left ventricular aneurysm: A prospective study of 422 patients. Amer J Cardiol 1982; 50: 337–341.

    PubMed  Google Scholar 

  17. Ryan T, Petrovic O, Armstrong WF, Dillon JC, Feigenbaum H. Quantitative two-dimensional echocardiographic assessment of patients undergoing left ventricular aneurysmectomy. Amer Heart J 1986; 111: 714–720.

    PubMed  Google Scholar 

  18. Visser CA, Kan G, Meltzer RS, Moulijn AC, David GK, Dunning AJ. Assessment of left ventricular aneurysm resectability by two-dimensional echocardiography. Amer J Cardiol 1985; 56: 857–860.

    PubMed  Google Scholar 

  19. Eaton LW, Wciss JL, Bulkley BH, Garrison JB, Weisfeldt ML. Regional cardiac dilatation after acute myocardial infarction. N Engl J Med 1979; 300: 57–62.

    PubMed  Google Scholar 

  20. Gatewood RP, Nanda NC. Differentiation of left ventricular pseudoaneurysm from true aneurysm with two dimensional echocardiography. Amer J Cardiol 1980; 46: 869–878.

    PubMed  Google Scholar 

  21. Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. N Engl J Med 1981; 305: 297–302.

    PubMed  Google Scholar 

  22. Weinreich DJ, Burke JF, Pauletto FJ. Left ventricular mural thrombi complicating acute myocardial infarction. Ann Intern Med 1984; 100: 789–794.

    PubMed  Google Scholar 

  23. Gianrossi R, Marruzzo M, Torrielli A, Azzolini A, Nizzo MC, Montemanni M, Mottola G. Left ventricular thrombus and myocardial infarction. Acta Cardiol 1985; 40: 599–612.

    PubMed  Google Scholar 

  24. Visser CA, Kan G, Meltzer RS, Dunning AJ, Roelandt J. Embolie potential of left ventricular thrombus after myocardial infarction: A two-dimensional echocardiographic study of 199 patients. J Amer Coll Cardiol 1985; 5: 1276–1280.

    Google Scholar 

  25. Mintz GS, Victor MF, Kotler MN, Parry WR, Segal BL. Two-dimensional echocardiographic identification of surgically correctable complications of acute myocardial infarction. Circulation 1981; 64: 91–96.

    PubMed  Google Scholar 

  26. Bishop HL, Gibson RS, Stamm RB, Beller GA, Martin RP. Role of two-dimensional echocardiography in the evaluation of patients with ventricular septal rupture postmyocardial infarction. Amer Heart J 1981; 102: 965–971.

    PubMed  Google Scholar 

  27. Loperfido F, Biasucci LM, Pennestri' F, Laurenzi F, Gimigliano F, Vigna C, Rossi E, Favuzzi A, Santarelli P, Manzoli U. Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction. Amer J Cardiol 1986; 58: 692–697.

    PubMed  Google Scholar 

  28. Baigrie RS, Haq A, Morgan CD, Rakowski H, Drobac M, McLaughlin P. The spectrum of right ventricular involvement in inferior wall myocardial infarction: A clinical, hemodynamic and noninvasive study. J Amer Coll Cardiol 1983; 6: 1396–1404.

    Google Scholar 

  29. Horowitz RS, Morganroth J. Immediate detection of early high-risk patients with acute myocardial infarction using two-dimensional echocardiographic evaluation of left ventricular regional wall motion abnormalities. Amer Heart J 1982; 103: 814–822.

    PubMed  Google Scholar 

  30. Kan G, Visser CA, Lie KI, Durrer D. Serial left ventricular ejection fraction in acute myocardial infarction by crosssectional echocardiography: Correlation of changing ejection fraction with clinical course. Eur Heart J 1984; 5: 470–476.

    PubMed  Google Scholar 

  31. Nishimura RA, Tajik AJ, Shub C, Miller FA Jr, Ilstrup DM, Harrison CE. Role of two-dimensional echocardiography in the prediction of in-hospital complications after acute myocardial infarction. J Amer Coll Cardiol 1984; 4: 1080–1087.

    Google Scholar 

  32. Nishimura RA, Reeder GS, Miller FA, Ilstrup DM, Shub C, Seward JB, Tajik AJ. Prognostic value of predischarge 2-dimensional echocardiogram after acute myocardial infarction. Amer J Cardiol 1984; 53: 429–432.

    PubMed  Google Scholar 

  33. Bhatnagar SK, Moussa MAA, AlYusuf AR. The role of prehospital discharge two-dimensional echocardiography in determining the prognosis of survivors of first myocardial infarction. Amer Heart J 1985; 109: 472–477.

    PubMed  Google Scholar 

  34. Charuzi Y, Beeder C, Marshall LA, Sasaki H, Pack NB, Geft I, Ganz W. Improvement in regional and global left ventricular function after intracoronary thrombolysis: Assessment with two-dimensional echocardiography. Amer J Cardiol 1984; 53: 662–665.

    PubMed  Google Scholar 

  35. Topol EJ, Weiss JL, Brinker JA, Brin KP, Gottlieb SO, Becker LC, Bulkley BH, Chandra N, Flaherty JT, Gerstenblith G, Gottlieb SH, Guerci AD, Ouyang P, Llewellyn MP, Weisfeldt ML, Shapiro EP. Regional wall motion improvement after coronary thrombolysis with recombinant tissue plasminogen activator: importance of coronary angioplasty. J Amer Coll Cardiol 1985; 6: 426–433.

    Google Scholar 

  36. Presti CF, Gentile R, Armstrong WF, Dillon JC, Rose GC, Feigenbaum H. Demonstration of myocardial salvage by percutaneous transluminal coronary angioplasty using twodimensional echocardiography (Abstract). Clin Res 1987; 35: 315A.

    Google Scholar 

  37. Lambertz H, Schewizer P, Krebs W, Merx W, Erbel R, vonEssen R, Uebis R, vonErckelenz H, Meyer J, Effert S. Echokardiographische Verlaufskontrolle des akuten myokardinfarktes nach intrakoronarer streptolysebehandlung. Z Kardiol 1984; 73: 321–326.

    PubMed  Google Scholar 

  38. Robertson WS, Feigenbaum H, Armstrong WF, Dillon JC, O'Donnell J, McHenry PW. Exercise echocardiography: A clinically practical addition in the evaluation of coronary artery disease. J Amer Coll Cardiol 1983; 2: 1085–1091.

    Google Scholar 

  39. West SR, Vasey CG, Armstrong WF, Siddiqui AR, Schauwecker DS, Ryan T, Dillon JC, Feigenbaum H. Comparison of continuous loop exercise echocardiography and thallium scintigraphy for detection of coronary artery disease (Abstract). Circulation 1985; 72: III-58.

    Google Scholar 

  40. Armstrong WF, O'Donnell J, Dillon JC, McHenry PL, Morris SN, Feigenbaum H. Complimentary value of twodimensional exercise echocardiography to routine treadmill exercise testing. Ann Intern Med 1986; 105: 829–835.

    PubMed  Google Scholar 

  41. Armstrong WF, O'Donnell J, Ryan T, Feigenbaum H. Exercise echocardiography: Effect on accuracy of prior myocardial infarction and extent and location of coronary disease. J Amer Coll Cardiol (in press).

  42. Limacher MC, Quinones MA, Poliner LR, Nelson JG, Winters WL, Waggoner AD. Detection of coronary artery disease with exercise two-dimensional echocardiography. Circulation 1983; 67: 1211–1218.

    PubMed  Google Scholar 

  43. Ginzton LE, Laks MM, Brizendine M, Conant R, Mena I. Noninvasive measurement of the rest and exercise peak systolic pressure/end-systolic volume ratio: Sensitive twodimensional echocardiographic indicator of left ventricular function. J Amer Coll Cardiol 1984; 4: 509–516.

    Google Scholar 

  44. Ginzton LE, Conant R, Brizendine M, Lee F, Mena I, Laks MM. Exercise subcostal two-dimensional echocardiography: A new method of segmental wall motion analysis. Amer J Cardiol 1984; 53: 805–811.

    PubMed  Google Scholar 

  45. Picano E, Distante A, Masini M, Morales MA, Lattanzi F, L'Abbate A. Dipyridamole-echocardiography test in effort angina pectoris. Amer J Cardiol 1985; 56: 452–456.

    PubMed  Google Scholar 

  46. Chapman PD, Doyle TP, Troup PJ, Gross CM, Wann LS. Stress echocardiography with transesophageal atrial pacing: Preliminary report of a new method for detection of ischemic wall motion abnormalities. Circulation 1984; 70: 445–450.

    PubMed  Google Scholar 

  47. Iliceto S, D'Ambrosio G, Sorino M, Papa A, Amico A, Ricci A, Rizzon P. Comparison of postexercise and transesophageal atrial pacing two-dimensional echocardiography for detection of coronary artery disease. Amer J Cardiol 1986; 57: 547–553.

    PubMed  Google Scholar 

  48. Jaarsma W, Visser CA, Funke Kupper AJ, Res JCJ, Van Eenige MJ, Roos JP. Usefulness of two-dimensional exercise echocardiography shortly after myocardial infarction. Amer J Cardiol 1986; 57: 86–90.

    PubMed  Google Scholar 

  49. Ryan T, Armstrong WF, O'Donnell J, Feigenbaum H. Risk stratification following myocardial infarction using exercise echocardiography (Abstract). Circulation 1986; 74: II-12.

    Google Scholar 

  50. Glueck RM, Mottley JG, Miller JG, Sobel BE, Perez JE. Effects of coronary artery occlusion and reperfusion on cardiac cycle-dependent variation of myocardial ultrasonic backscatter. Circ Res 1985; 56: 683–689.

    PubMed  Google Scholar 

  51. Mimbs JW, O'Donnell M, Miller JG, Sobel BE. Changes in ultrasonic attenuation indicative of early myocardial ischemic injury. Amer J Physiol 1979; 236: H340-H344.

    PubMed  Google Scholar 

  52. Rasmussen S, Lovelace DE, Knoebel SB, Ransburg R, Corya BC. Echocardiographic detection of ischemic and infarcted myocardium. J Amer Coll Cardiol 1984; 3: 733–743.

    Google Scholar 

  53. Skorton DJ, Melton HE Jr, Pandian NG, Nichols J, Koyanagi S, Marcus ML, Collins SM, Kerber RE. Detection of acute myocardial infarction in closed-chest dogs by analysis of regional two-dimensional echocardiographic gray-level distributions. Circ Rest 1983; 52: 36–44.

    Google Scholar 

  54. Haendchen RV, Ong K, Fishbein MC, Zwehl W, Meerbaum S, Corday E. Early differentiation of infarcted and noninfarcted reperfused myocardium in dogs by quantitative analysis of regional myocardial echo amplitudes. Circ Res 1985; 57: 718–728.

    PubMed  Google Scholar 

  55. Schnittger I, Vieli A, Heiserman JE, Director BA, Billingham ME, Ellis SG, Kernoff RS, Takamoto T, Popp RL. Ultrasonic tissue characterization: detection of acute myocardial ischemia in dogs. Circulation 1985; 72: 193–199.

    PubMed  Google Scholar 

  56. Fujii J, Sawada H, Aizawa T, Kato K, Onoe M, Kuno Y. Computer analysis of cross sectional echocardiogram for quantitative evaluation of left ventricular asynergy in myocardial infarction. Br Heart J 1984; 51: 139–148.

    PubMed  Google Scholar 

  57. Oliver L, Geiser E, Zhang L, Gardin J, Parisi A, Reichek N, Weyman A, Werner J, Kerber R, Conti R. Evaluation of an automated border detection algorithm in 2D echo images of varying quality: Observer vs computer variability (Abstract). J Amer Coll Cardiol 1984; 3: 564.

    Google Scholar 

  58. Weyman AE, Feigenbaum H, Dillon JC, Johnston KW, Eggleton RC. Noninvasive visualization of the left main coronary artery by cross-sectional echocardiography. Circulation 1976; 54: 169–174.

    PubMed  Google Scholar 

  59. Ryan T, Armstrong WF, Feigenbaum H. Prospective evaluation of the left main coronary artery using digital twodimensional echocardiography. J Amer Coll Cardiol 1986; 7: 807–812.

    Google Scholar 

  60. McPherson DD, Armstrong M, Rose E, Kieso RA, Megan M, Hunt M, Hite P, Marcus ML, Kerber RE. High frequency epicardial echocardiography for coronary artery evaluation: In vitro and in vivo validation of arterial lumen and wall thickness measurements. J Amer Coll Cardiol 1986; 8: 600–606.

    Google Scholar 

  61. McPherson DD, Kerber RE. High frequency epicardial echocardiography for the intraoperative demonstration and evaluation of coronary atherosclerosis. Echocardiography 1986; 3: 371–381.

    Google Scholar 

  62. Armstrong WF, Mueller TM, Kinney EL, Tickner EG, Dillon JC, Feigenbaum H. Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography. Circulation 1982; 66: 166–173.

    PubMed  Google Scholar 

  63. Tei C, Sakamaki T, Shah PM, Meerbaum S, Shimoura K, Kondo S, Corday E. Myocardial contrast echocardiography: A reproducible technique of myocardial opacification for identifying regional perfusion deficits. Circulation 1983; 67: 585–593.

    PubMed  Google Scholar 

  64. Armstrong WF, West SR, Mueller TM, Dillon JC, Feigenbaum H. Assessment of location and size of myocardial infarction with contrast-enhanced echocardiography. J Amer Coll Cardiol 1983; 2: 63–69.

    Google Scholar 

  65. Armstrong WF, West SR, Dillon JC, Feigenbaum H. Assessment of location and size of myocardial infarction with contrast-enhanced echocardiography. II. Application of digital imaging techniques. J Amer Coll Cardiol 1984; 4: 141–148.

    Google Scholar 

  66. Armstrong WF, West SR, Dillon JC, Feigenbaum H. Digital subtraction contrast echocardiography for quantification of myocardial infarction size (Abstract). Circ Res 1984; 32: 218A.

    Google Scholar 

  67. Kemper AJ, O'Boyle JE, Sharma S, Cohen CA, Kloner RA, Shuri S, Parisi AF. Hydrogen peroxide contrastenhanced two-dimensional echocardiography: Real-time in vivo delineation of regional myocardial perfusion. Circulation 1983; 68: 603–611.

    PubMed  Google Scholar 

  68. Kemper AJ, O'Boyle JE, Cohen CA, Taylor A, Parisi AF. Hydrogen peroxide contrast echocardiography: quantification in vivo of myocardial risk area during coronary occlusion and of the necrotic area remaining after myocardial reperfusion. Circulation 1984; 70: 309–317.

    PubMed  Google Scholar 

  69. Kaul S, Pandian NG, Okada RD, Pohost GM, Weyman AE. Contrast echocardiography in acute myocardial ischemia: I. In vivo determination of total left ventricular “area at risk”. J Amer Coll Cardiol 1984; 6: 1272–1282.

    Google Scholar 

  70. Kemper AJ, Force T, Kloner R, Gilfoil M, Perkins L, Hale S, Alker K, Parisi AF. Contrast echocardiographic estimation of regional myocardial blood flow after acute coronary occlusion. Circulation 1985; 72: 1115–1124.

    PubMed  Google Scholar 

  71. Ten Cate FJ, Drury JK, Meerbaum S, Noordsy J, Feinstein S, Shah PM, Corday E. Myocardial contrast two-dimensional echocardiography: Experimental examination at different coronary flow levels. J Amer Coll Cardiol 1984; 3: 1219–1226.

    Google Scholar 

  72. Gage S, Vasey CG, Dillon JC, Feigenbaum H, Armstrong WF. Reactive hyperemia: Evaluation with myocardial contrast echocardiography (Abstract). J Amer Coll Cardiol 1986; 7: 189A.

    Google Scholar 

  73. Santoso T, Roelandt J, Mansyoer H, Abdurahman N, Meltzer RS, Hugenholtz PG. Myocardial perfusion imaging in humans by contrast echocardiography using polygelin colloid solution. J Amer Coll Cardiol 1985; 6: 612–620.

    Google Scholar 

  74. Moore CA, Smucker ML, Kaul S. Myocardial contrast echocardiography in humans: I. Safety — a comparison with routine coronary arteriography. J Amer Coll Cardiol 1986; 8: 1066–1072.

    Google Scholar 

  75. Lang RM, Feinstein SB, Feldman T, Neumann A, Chua KG, Borow KM. Contrast echocardiography for evaluation of myocardial perfusion: Effects of coronary angioplasty. J Amer Coll Cardiol 1986; 8: 232–235.

    Google Scholar 

  76. Feinstein SB, Ten Cate FJ, Zwehl W, Ong K, Maurer G, Tei C, Shah PM, Meerbaum S, Corday E. Two-dimensional contrast echocardiography. I. In vitro development and quantitative analysis of echo contrast agents. J Amer Coll Cardiol 1984; 3: 14–20.

    Google Scholar 

  77. Feinstein SB, Keller MW, Dick CD, Bridenstine TR, Wissler RW. Successful transpulmonary contrast echocardiography in monkeys (Abstract). J Amer Coll Cardiol 1987; 9: 111A.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Krannert Institute of Cardiology, Indiana University School of Medicine and Research Associate, 1001 West 10th Street, 46202, Indianapolis, IN, USA

    William F. Armstrong

Authors
  1. William F. Armstrong
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Armstrong, W.F. Echocardiography and coronary artery disease: Current and future applications. Int J Cardiac Imag 2, 241–258 (1987). https://doi.org/10.1007/BF01784780

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01784780

Key words

Search

Navigation