Microbubble contrast agent use during invasive coronary microvascular assessment
File(s)
Published version (in press)
Author(s)
Type
Journal Article
Abstract
Background
Coronary microvascular function assessment with invasive Doppler-derived coronary flow reserve (CFR) has challenges related to Doppler signal quality, limiting clinical adoption. We investigated whether the use of ultrasound microbubble contrast agents can improve coronary flow signals and reduce measurement variability during invasive CFR measurement.
Methods
Participants underwent assessment of coronary flow velocity using a Doppler sensor-tipped coronary wire. Baseline signal quality was determined by expert clinicians, and signals were categorized into good or poor quality. Doppler quality was then assessed at predetermined time periods after administration of SonoVue (Bracco): baseline, first pass, and subsequent discrete 20-second time periods, following this up to 260 seconds after first pass. For each time period, several parameters were assessed: signal-to-noise ratio, Doppler envelope quality (analyzed by a previously validated artificial intelligence–based score), and the coefficient of variation of tracked flow velocity.
Results
Fifteen cases were included. In the group with poor quality baseline Doppler signal (N = 10), signal-to-noise ratio, Doppler envelope quality score, and coefficient of variation significantly improved with microbubble contrast (signal-to-noise ratio: P < .05 for all periods after first pass; Doppler envelope quality score: P < .05 for all periods; coefficient of variation: P < .05 for all periods). In the group with a good quality baseline Doppler signal (N = 5), there were no changes in these parameters. Microbubble administration did not cause significant coronary hyperemia (P = .875 when compared to baseline).
Conclusions
Ultrasound microbubble contrast agents can enhance Doppler signal quality during invasive CFR measurements. These agents could be used to improve the reliability of flow measurements in clinical practice and facilitate the adoption of coronary microvascular assessment.
Coronary microvascular function assessment with invasive Doppler-derived coronary flow reserve (CFR) has challenges related to Doppler signal quality, limiting clinical adoption. We investigated whether the use of ultrasound microbubble contrast agents can improve coronary flow signals and reduce measurement variability during invasive CFR measurement.
Methods
Participants underwent assessment of coronary flow velocity using a Doppler sensor-tipped coronary wire. Baseline signal quality was determined by expert clinicians, and signals were categorized into good or poor quality. Doppler quality was then assessed at predetermined time periods after administration of SonoVue (Bracco): baseline, first pass, and subsequent discrete 20-second time periods, following this up to 260 seconds after first pass. For each time period, several parameters were assessed: signal-to-noise ratio, Doppler envelope quality (analyzed by a previously validated artificial intelligence–based score), and the coefficient of variation of tracked flow velocity.
Results
Fifteen cases were included. In the group with poor quality baseline Doppler signal (N = 10), signal-to-noise ratio, Doppler envelope quality score, and coefficient of variation significantly improved with microbubble contrast (signal-to-noise ratio: P < .05 for all periods after first pass; Doppler envelope quality score: P < .05 for all periods; coefficient of variation: P < .05 for all periods). In the group with a good quality baseline Doppler signal (N = 5), there were no changes in these parameters. Microbubble administration did not cause significant coronary hyperemia (P = .875 when compared to baseline).
Conclusions
Ultrasound microbubble contrast agents can enhance Doppler signal quality during invasive CFR measurements. These agents could be used to improve the reliability of flow measurements in clinical practice and facilitate the adoption of coronary microvascular assessment.
Date Issued
2025-07-31
Date Acceptance
2025-07-03
Citation
Journal of the Society for Cardiovascular Angiography & Interventions, 2025
ISSN
2772-9303
Publisher
Elsevier
Journal / Book Title
Journal of the Society for Cardiovascular Angiography & Interventions
Copyright Statement
© 2025 The Author(s). Published by Elsevier Inc. on behalf of the Society for Cardiovascular Angiography & Interventions Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
10.1016/j.jscai.2025.103857
Subjects
CFR, coronary flow reserve angina with non-obstructed coronary arteries
coronary flow reserve
coronary microvascular dysfunction
coronary physiology
microvascular angina
Publication Status
Published online
Article Number
103857
Date Publish Online
2025-07-31