This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mor-Avi, V. Articles by Lang, R. M. Search for Related Content PubMed PubMed Citation Articles by Mor-Avi, V. Articles by Lang, R. M. Related Collections Echocardiography Acute myocardial infarction

(Circulation. 2001;104:352.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Combined Assessment of Myocardial Perfusion and Regional Left Ventricular Function by Analysis of Contrast-Enhanced Power Modulation Images

Victor Mor-Avi, PhD; Enrico G. Caiani, PhD; Keith A. Collins, MS; Claudia E. Korcarz, DVM; James E. Bednarz, BS; Roberto M. Lang, MD

From the Noninvasive Cardiac Imaging Laboratory, University of Chicago, Chicago, Ill; and the Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy (E.G.C.).

Correspondence to Victor Mor-Avi, PhD, and Roberto M. Lang, MD, University of Chicago, MC 5084, 5841 S Maryland Ave, Chicago, IL 60637. E-mail vmoravi{at}medicine.bsd.uchicago.edu

Background— Echocardiographic contrast media have been used to assess myocardial perfusion and to enhance endocardial definition for improved assessment of left ventricular (LV) function. These methodologies, however, have been qualitative or have required extensive offline image analysis. Power modulation is a recently developed imaging technique that provides selective enhancement of microbubble-generated reflections. Our goal was to test the feasibility of using power modulation for combined quantitative assessment of myocardial perfusion and regional LV function in an animal model of acute ischemia.

Methods and Results— Coronary balloon occlusions were performed in 18 anesthetized pigs. Transthoracic power modulation images (Agilent 5500) were obtained during continuous intravenous infusion of the contrast agent Definity (DuPont) at baseline and during brief coronary occlusion and reperfusion and were analyzed with custom software. At each phase, myocardial perfusion was assessed by calculation, in 6 myocardial regions of interest, of mean pixel intensity and the rate of contrast replenishment after high-power ultrasound impulses. LV function was assessed by calculation of regional fractional area change from semiautomatically detected endocardial borders. All ischemic episodes caused detectable and reversible changes in perfusion and function. Perfusion defects, validated with fluorescent microspheres, were visualized in real time and confirmed by a significant decrease in pixel intensity in the left anterior descending coronary artery territory after balloon inflation and reduced rate of contrast replenishment. Fractional area change decreased significantly in ischemic segments and was restored with reperfusion.

Conclusions— Power modulation allows simultaneous online assessment of myocardial perfusion and regional LV wall motion, which may improve the echocardiographic diagnosis of myocardial ischemia.

Key Words: ultrasonics • imaging • echocardiography • ischemia • perfusion • ventricles

This article has been cited by other articles:

				F. Veronesi, E. G. Caiani, E. Toledo, C. Corsi, K. A. Collins, G. Lammertin, C. Lamberti, R. M. Lang, and V. Mor-Avi Semi-automated analysis of dynamic changes in myocardial contrast from real-time three-dimensional echocardiographic images as a basis for volumetric quantification of myocardial perfusion Eur J Echocardiogr, June 1, 2009; 10(4): 485 - 490. [Abstract] [Full Text] [PDF]

				P. A. Dijkmans, R. Senior, H. Becher, T. R. Porter, K. Wei, C. A. Visser, and O. Kamp Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion: The Evidence So Far J. Am. Coll. Cardiol., November 8, 2006; (2006) j.jacc.2006.05.079v1. [Abstract] [Full Text] [PDF]

				E. Toledo, L. D. Jacobs, J. A. Lodato, J. M. DeCara, P. Coon, V. Mor-Avi, and R. M. Lang Quantitative diagnosis of stress-induced myocardial ischemia using analysis of contrast echocardiographic parametric perfusion images Eur J Echocardiogr, June 1, 2006; 7(3): 217 - 225. [Abstract] [Full Text] [PDF]

				E. Toledo, R. M. Lang, K. A. Collins, G. Lammertin, U. Williams, L. Weinert, G. Bolotin, P. D. Coon, J. Raman, L. D. Jacobs, et al. Imaging and Quantification of Myocardial Perfusion Using Real-Time Three-Dimensional Echocardiography J. Am. Coll. Cardiol., January 3, 2006; 47(1): 146 - 154. [Abstract] [Full Text] [PDF]

				P Tousek, M Orban, S Martinoff, and C Firschke Assessment of infarcted myocardium with real time myocardial contrast echocardiography: comparison with technetium-99m sestamibi single photon emission computed tomography Heart, December 1, 2005; 91(12): 1568 - 1572. [Abstract] [Full Text] [PDF]

				M J Monaghan Stress myocardial contrast echocardiography Heart, December 1, 2003; 89(12): 1391 - 1393. [Full Text] [PDF]

				H-D Liang and M J K Blomley The role of ultrasound in molecular imaging Br. J. Radiol., December 1, 2003; 76(suppl_2): S140 - S150. [Abstract] [Full Text] [PDF]

				A.S Petronio, D Rovai, G Musumeci, R Baglini, C Nardi, U Limbruno, C Palagi, D Volterrani, and M Mariani Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty Eur. Heart J., January 1, 2003; 24(1): 67 - 76. [Abstract] [Full Text] [PDF]