To evaluate the role of myocardial contrast echocardiography (MCE) in the assessment of myocardial perfusion in patients with Takayasu arteritis with coronary artery involvement.

Fifteen patients with Takayasu arteritis with coronary artery involvement at Department of Ultrasound of Shanxi Provincial People′s Hospital and Department of Ultrasound of General Hospital of Tisco from June 2017 to July 2019 were selected as a study group, and 15 healthy persons with suspected coronary artery disease but normal coronary angiography were selected as a control group. All of the subjects underwent coronary angiography examination. The degree and location of coronary artery stenosis in the study group were observed based on the results of coronary angiography. The left ventricular ejection fraction (LVEF) was obtained by Simpson′s method. Then, MCE was performed in both groups. The parameters reflecting myocardial microcirculation were measured, including time to start, time to peak, amplitude of peak intensity (A), slope of curve (β), and A×β. The independent sample t-test was used to compare the differences of myocardial perfusion parameters between the two groups. The receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) of each parameter was calculated to determine the optimal critical value.

Twenty-two branches of coronary arteries were involved in the 15 patients with Takayasu arteritis; 13.6% (3/22) of the stenosed coronary artery branches had a stenosis rate of 50%-69%, 81.8% (18/22) had a stenosis rate of 70%-99%, and one was completely occluded, accounting for 4.5% (1/22). Proximal coronary artery stenosis was the most common, with an incidence of 86.4% (19/22). Approximately 9% (2/22) of branches showed segmental changes and were located in the middle or distal segment of the coronary artery. Only one patient presented with a diffuse stenosis of the coronary artery, accounting for 4.5% (1/22). Based on the results of coronary angiography, 60% (9/15) of patients in the study group had a single coronary artery branch involved, 33.3% (5/15) had two coronary artery branches involved, and 6.7% (1/15) had three coronary artery branches involved. The values of A [(6.55±1.48) dB vs (8.09±1.35) dB], β [(0.45±0.13)/s vs (0.64±0.07)/s], and A×β [(2.75±1.03) dB/s vs (5.23±0.51) dB/s] in the study group were significantly lower than those of the control group (t=9.978, 15.178, and 25.260, respectively; P<0.001). Time to start [(2.74±0.78) s vs (2.55±0.63) s] and time to peak [(12.43±0.79) s vs (7.53±0.93) s] were significantly longer in the study group than in the control group (t=2.059, P=0.013; t=50.068, P<0.001). LVEF was significantly lower in the study group than in the control group (t=19.969, P<0.001). With a cut-off value of 4.0017 dB/s, the AUC of A×β was 0.949, with a sensitivity of 94.2% and specificity of 81.5%.

Coronary artery involvement in Takayasu arteritis can cause disturbance of myocardial microcirculation and thus lead to a decrease of cardiac systolic function. MCE can accurately and quantitatively evaluate the myocardial perfusion in patients with Takayasu arteritis with coronary artery involvement.