15) The focus was set at the level of the mitral annulus and was moved to an appropriate level

when necessary. According to each coronary artery territory, the position of the transducer was adjusted to locate the region of interest in the center of the image sector, and MCE was repeated by adjusting the triggering interval. If perfusion defects were consistent with a typical ischemic FK506 in vivo territory of a coronary artery, observed in the subendocardial area, or associated Inhibitors,research,lifescience,medical with wall motion abnormalities of the same area, or if the severity of perfusion defects improved according to the lengthening triggering interval, perfusion defects were regarded as true myocardial perfusion defects and not artifacts.16) Myocardial perfusion defects present in at least one coronary territory were considered positive (Fig. 1A). MCE results were interpreted by different reviewers blinded to the clinical data. Fig. 1 Myocardial contrast echocardiography using power Inhibitors,research,lifescience,medical harmonic Doppler imaging with a dual-frame triggering (A). Left, perfusion frame

was generated when the first packet of pulses encountered microbubbles in the myocardium and destroyed them. Right, post-destruction … Myocardial perfusion imaging with technetium-99m sestamibi As soon as possible after Inhibitors,research,lifescience,medical MCE, all patients underwent resting MPI with technetium-99m sestamibi. For SPECT imaging, 64 projections were obtained for 20 seconds, each at >180° using a dual-head rotating gamma camera. Image reconstruction was performed using standard back-projection algorithms. Short-axis slices of the left ventricles were normalized to peak heart rate. Circumferential Inhibitors,research,lifescience,medical count profiles were generated for five short-axis slices from apex to base. Scintigraphic results were analyzed by an experienced

nuclear medicine Inhibitors,research,lifescience,medical physicians who were blinded to patients’ clinical and laboratory data. Perfusion images were evaluated without gating in 35 (36%) patients and with gating in 63 (64%) patients, allowing assessment of regional function. Positive MPI was defined as a mild or definite perfusion defect on SPECT MPI performed Phosphoprotein phosphatase without gating, and a definite perfusion defect with associated abnormality in wall motion and thickening on gated MPI. Quantitative coronary angiography Coronary angiography was performed in all patients by standard techniques. Quantitative analysis of coronary angiography was done by experienced investigators using a quantitative analyzer (Ancor 2.0, Siemens, Erlangen, Germany). Significant stenosis that required urgent revascularization was defined as critical stenosis (diameter stenosis ≥90%) with the potential to affect coronary blood flow at rest and stenosis associated with ulceration or thrombus (Fig. 1B). Statistical analysis Continuous variables are presented as mean±SD.