Myocardial contrast echocardiography: 15 Years of research and development

It has taken 15 years to move MCE from bench to bedside. In the meantime, we have gained important and fascinating insights into human coronary pathophysiology. We have also learned that any functional differences in myocardial perfusion between humans with chronic CAD and acute canine models are only quantitative. Despite structural differences in their coronary systems, clinically important qualitative differences do not exist at the functional level. We can, therefore, continued to learn a great deal about coronary pathophysiology from canines that is pertinent to humans. We have gained new knowledge regarding microbubble and ultrasound interactions. Developments based in this knowledge are accelerating in the fields of ultrasound physics and engineering with newer and better clinical systems being manufactured. We are beginning to launch multicenter studies using venous contrast agents and intermittent harmonic imaging to assess myocardial perfusion at rest and during exogenous hyperemia in patients with known and suspected CAD, including those with AMI. It is possible in the future that contrast echocardiography will become the leading tool for assessing organ perfusion in humans. The work in progress relating to endothelial function- site, and pathology-specific microbubble adherence and local drug delivery are exciting. If all goes well, we may be able to report on these advances 15 years from now!.