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(Circulation. 2007;115:292-293.)
© 2007 American Heart Association, Inc.

Editorial

Cardiovascular Imaging of Remote Myocardial Ischemia

Detecting a Molecular Trace of Evidence Left Behind

Thomas R. Porter, MD

From the University of Nebraska Medical Center, Omaha.

Reprint requests to Dr Thomas R. Porter, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198–2265.

Key Words: Editorials • ischemia • imaging

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Intravenous microbubbles currently are approved by the Food and Drug Administration solely for the purpose of enhancing left ventricular cavity opacification. However, intravenous microbubbles also have been used in several clinical studies to detect myocardial perfusion. Ultrasound imaging of myocardial contrast to detect perfusion abnormalities has significant advantages over other imaging techniques in that it has higher resolution, does not require ionizing radiation, and can be performed at the patient’s bedside. Clinical studies have demonstrated that myocardial contrast echocardiography is useful for detecting coronary artery disease both in the emergency room setting and during stress echocardiography. In these settings, the intravenous microbubbles function as pure intravascular tracers and are not adherent to the vessel wall or taken up by the myocytes.

Article p 345

Ligands can be attached to the surface of microbubbles, which results in their binding to specific epitopes upregulated on the endothelial surface. Such binding was used in the study by Villanueva et al¹ in the present issue of Circulation. In a rat model, these investigators were able to successfully attach the selectin-targeting tetrasaccharide sialyl Lewis^x to phospholipid-shelled microbubbles and to detect myocardial regions that were previously ischemic with a sensitive ultrasound detection scheme. Detection of contrast enhancement from retained microbubbles within the remotely ischemic perfusion bed was evident at both 30 minutes and 1 hour after relief of the ischemic episode. These findings have significant implications in that detection of remote ischemic events may be possible in the emergent evaluation of patients with a history . . . [Full Text of this Article]