Circulation, Vol 85, 2080-2089, Copyright © 1992 by American Heart Association
PJ Sabia, ER Powers, AR Jayaweera, M Ragosta and S Kaul
BACKGROUND. We hypothesized that myocardial contrast echocardiography (MCE)
can be used to both measure collateral blood flow as well as assess the
functional significance of collaterals in patients with acute myocardial
infarction (AMI). METHODS AND RESULTS. MCE was performed in 33 patients
with recent AMI (12 +/- 7 days) and an occluded infarct-related artery
(IRA), both before and after attempted percutaneous transluminal coronary
angioplasty (PTCA). The size of the occluded bed was defined in patients
with successful PTCA by injecting contrast directly into the opened IRA and
expressed as a percent of the myocardium in the short-axis view. The
percent of the perfusion bed supplied by collaterals before PTCA was
determined. Transit rates of the microbubbles within the collateralized
regions were also measured and were expressed as a percent of the transit
rates in the normal adjacent beds. Regional function within the occluded
bed was assessed using echocardiography and was graded as 1 (normal) to 5
(dyskinetic). Collaterals were graded on coronary angiography as 0 (none)
to 3 (abundant). The perfusion bed size was larger for the left anterior
descending (LAD) than for the right (RCA) and left circumflex (LCx)
coronary arteries (37 +/- 6% versus 27 +/- 12% of the myocardium, p =
0.02). The percent of the occluded bed supplied by collateral flow was
greater for RCA and LCx compared with the LAD (87 +/- 30% versus 72 +/-
22%, p less than 0.01). There was poor correlation between MCE-defined
percent of occluded bed supplied by collaterals and angiographic collateral
grade (r = 0.13). Regions supplied by collaterals were less likely to show
confluent hypoperfused zones after reperfusion compared with those not
supplied by collaterals. Similarly, the percent of myocardium not perfused
by either anterograde or collateral flow correlated well (r = 0.67, p less
than 0.01) with peak creatine kinase levels and was more likely to be
associated with Q waves. Finally, although there was poor correlation
between angiographic collaterals and regional function (r = 0.20), there
was a significant negative correlation between MCE-defined spatial extent
of collateral flow and regional function (r = -0.57, p less than 0.01).
CONCLUSION. MCE can be used to measure collateral flow in patients with
recent AMI and to assess the functional significance of collaterals in
these patients. This technique may be ideally suited for the assessment of
collateral perfusion in patients undergoing cardiac catheterization.
ARTICLES
Functional significance of collateral blood flow in patients with recent acute myocardial infarction. A study using myocardial contrast echocardiography
Department of Medicine, University of Virginia School of Medicine, Charlottesville.
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