Circulation, Vol 88, 596-604, Copyright © 1993 by American Heart Association
FS Villanueva, WP Glasheen, J Sklenar and S Kaul
BACKGROUND. Myocardial opacification during echocardiography has been
demonstrated after left (LA) and right (RA) atrial injections of contrast,
and microvascular damage with reduced blood flow and impaired flow reserve
has been documented in necrotic myocardial tissue. Therefore, we
hypothesized that because of its ability to depict capillary perfusion,
myocardial contrast echocardiography (MCE) can be used to define risk area
during coronary occlusion and infarct size after reperfusion with LA and RA
injections of contrast in the presence of pharmacologically induced
coronary hyperemia. METHODS AND RESULTS. Eighteen open-chest anesthetized
dogs with 3 to 6 hours of left anterior descending artery occlusion and 15
minutes of reflow were studied in the presence of either dipyridamole (0.56
mg/kg over a period of 4 minutes) or dobutamine (15 micrograms.kg-1.min-1).
Technetium autoradiography was performed for risk area assessment; infarct
size was measured with triphenyl tetrazolium chloride; and in 11 dogs,
myocardial blood flow was measured with radiolabeled microspheres. A close
linear relation was noted between the MCE defect size and autoradiographic
risk area during coronary occlusion both during LA (y = 0.95x-0.25, r =
.97, P < .001) and RA (y = 0.90x+0.98, r = .86, P < .001) injections
of contrast. During reperfusion, the contrast defect size on MCE was always
less transmural than during occlusion and correlated closely with infarct
size during both LA (y = 1.07x-2.37, r = .98, P < .001) and RA (y =
1.02x-0.61, r = .95, P < .001) injections of contrast. In the 11 dogs in
whom radiolabeled microsphere-derived blood flow was measured during
reperfusion, an inverse relation was noted between infarct size and
transmural blood flow (y = -1.12x+121, r = -.95, P = .001), implying that
MCE defects after reperfusion indicate necrotic regions with reduced blood
flow or impaired microvascular flow reserve. A close linear relation (y =
0.79x- 0.001, r = .98, P < .001) was also noted between
endocardial/epicardial ratio of background-subtracted peak video intensity
on MCE and endocardial/epicardial blood flow ratio in the eight dogs with
infarction who underwent this measurement after reperfusion. CONCLUSIONS.
MCE performed with LA and RA injections of contrast in the presence of
pharmacologically induced coronary hyperemia can be used to determine, in
vivo, the risk area during coronary occlusion and infarct size after
reperfusion. These results could have important implications in this era of
myocardial reperfusion.
ARTICLES
Assessment of risk area during coronary occlusion and infarct size after reperfusion with myocardial contrast echocardiography using left and right atrial injections of contrast
Department of Medicine, University of Virginia School of Medicine, Charlottesville 22908.
This article has been cited by other articles:
 |
|
 |
|
  S. A. Hayat and R. Senior Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Eur. Heart J., February 1, 2008; 29(3): 299 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology Eur. Heart J., May 2, 2004; 25(10): 815 - 836. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Senior Role of myocardial contrast echocardiography in the clinical evaluation of acute myocardial infarction Heart, December 1, 2003; 89(12): 1398 - 1400. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Balcells, E. R. Powers, W. Lepper, T. Belcik, K. Wei, M. Ragosta, H. Samady, and J. R. Lindner Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve J. Am. Coll. Cardiol., March 5, 2003; 41(5): 827 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Reffelmann and R. A. Kloner Microvascular reperfusion injury: rapid expansion of anatomic no reflow during reperfusion in the rabbit Am J Physiol Heart Circ Physiol, September 1, 2002; 283(3): H1099 - H1107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. t. Lafitte, A. Higashiyama, H. Masugata, B. Peters, M. Strachan, O. i L. Kwan, and A. N. DeMaria Contrast echocardiography can assess risk area and infarct size during coronary occlusion and reperfusion: experimental validation J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1546 - 1554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Coggins, J. Sklenar, D. E. Le, K. Wei, J. R. Lindner, and S. Kaul Noninvasive Prediction of Ultimate Infarct Size at the Time of Acute Coronary Occlusion Based on the Extent and Magnitude of Collateral-Derived Myocardial Blood Flow Circulation, November 13, 2001; 104(20): 2471 - 2477. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O Kamp, W Lepper, J.-L Vanoverschelde, B.C Aeschbacher, D Rovai, P Assayag, P Voci, Y Kloster, A Distante, and C.A Visser Serial evaluation of perfusion defects in patients with a first acute myocardial infarction referred for primary PTCA using intravenous myocardial contrast echocardiography Eur. Heart J., August 2, 2001; 22(16): 1485 - 1495. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Teupe, M. Takeuchi, J. Yao, E. Avelar, and N. Pandian Detection of Viable Myocardium by Transvenous Myocardial Contrast Echocardiography Using Harmonic Power Doppler : Canine Model of Acute Coronary Occlusion and Reperfusion Chest, August 1, 2001; 120(2): 567 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Sechtem Imaging myocardial area at risk and final infarct size Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C36 - C46. [PDF]
|
|
|
|
|
|
I Jucquois, P Nihoyannopoulos, A-M D'Hondt, V Roelants, A Robert, J A Melin, D Glass, and J-L J Vanoverschelde Comparison of myocardial contrast echocardiography with NC100100 and 99mTc sestamibi SPECT for detection of resting myocardial perfusion abnormalities in patients with previous myocardial infarction Heart, May 1, 2000; 83(5): 518 - 524. [Abstract] [Full Text]
|
|
|
|
|
|
A. Z. Linka, J. Sklenar, K. Wei, A. R. Jayaweera, D. M. Skyba, and S. Kaul Assessment of Transmural Distribution of Myocardial Perfusion With Contrast Echocardiography Circulation, November 3, 1998; 98(18): 1912 - 1920. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Wei, A. R. Jayaweera, S. Firoozan, A. Linka, D. M. Skyba, and S. Kaul Quantification of Myocardial Blood Flow With Ultrasound-Induced Destruction of Microbubbles Administered as a Constant Venous Infusion Circulation, February 10, 1998; 97(5): 473 - 483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaul Myocardial Contrast Echocardiography : 15 Years of Research and Development Circulation, November 18, 1997; 96(10): 3745 - 3760. [Full Text]
|
|
|
|
|
|
F. S. Villanueva, G. Camarano, S. Ismail, N. C. Goodman, J. Sklenar, and S. Kaul Coronary Reserve Abnormalities in the Infarcted Myocardium: Assessment of Myocardial Viability Immediately Versus Late After Reflow by Contrast Echocardiography Circulation, August 15, 1996; 94(4): 748 - 754. [Abstract] [Full Text]
|
|
|
|
|
|
H. Ito, A. Maruyama, K. Iwakura, S. Takiuchi, T. Masuyama, M. Hori, Y. Higashino, K. Fujii, and T. Minamino Clinical Implications of the `No Reflow' Phenomenon : A Predictor of Complications and Left Ventricular Remodeling inReperfused Anterior Wall Myocardial Infarction Circulation, January 15, 1996; 93(2): 223 - 228. [Abstract] [Full Text]
|
|
|
|
|
|
P. Voci, F. Bilotta, Q. Caretta, C. Mercanti, and B. Marino Papillary Muscle Perfusion Pattern : A Hypothesis for Ischemic Papillary Muscle Dysfunction Circulation, March 15, 1995; 91(6): 1714 - 1718. [Abstract] [Full Text]
|
|
|
|
|
|
H. Ito, K. Iwakura, H. Oh, T. Masuyama, M. Hori, Y. Higashino, K. Fujii, and T. Minamino Temporal Changes in Myocardial Perfusion Patterns in Patients With Reperfused Anterior Wall Myocardial Infarction : Their Relation to Myocardial Viability Circulation, February 1, 1995; 91(3): 656 - 662. [Abstract] [Full Text]
|
|
|
|
|
|
S. Ismail, A. R. Jayaweera, N. C. Goodman, G. P. Camarano, D. M. Skyba, and S. Kaul Detection of Coronary Stenoses and Quantification of the Degree and Spatial Extent of Blood Flow Mismatch During Coronary Hyperemia With Myocardial Contrast Echocardiography Circulation, February 1, 1995; 91(3): 821 - 830. [Abstract] [Full Text]
|
|