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(Circulation. 1999;99:E15.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Myocardial Perfusion in Acute Coronary Syndrome

Jörg Horcher, MD; Rudolf Blasini, MD; Stefan Martinoff, MD; Markus Schwaiger, MD; Albert Schömig, MD; Christian Firschke, MD

From the 1. Medizinische Klinik, Klinikum rechts der Isar und Deutsches Herzzentrum, Technische Universität München, Germany.

Correspondence to Christian Firschke, MD, Deutsches Herzzentrum, Technische Universität München, Lazarettstraße 36, 80636 München, Germany. E-mail cfirschke{at}t-online.de

	Introduction

Top Introduction

 
Venous myocardial contrast echocardiography is a new method for myocardial perfusion imaging. It has been shown to accurately evaluate risk area and infarct size in the experimental setting of acute myocardial infarction and has recently become clinically available. We used this method to assess myocardial salvage after coronary reperfusion in a patient with acute coronary syndrome.

A 68-year-old man with known single-vessel coronary artery disease presented with 6 hours of moderate chest pain typical of unstable angina. Four years earlier, a percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery had been performed; the patient was asymptomatic throughout the following years. On admission, the 12-lead ECG showed atrial fibrillation and descending ST-segment depression up to 0.25 mV in leads V₃ through V₆. Cardiac enzymes, including troponin I, were normal at that time. After medical treatment with heparin, nitroglycerin, ß-blocker, and aspirin, the chest pain and ECG changes resolved completely. Eight hours later, the patient reported reoccurrence of mild chest pain; by then, troponin I was elevated, at 0.8 ng/mL. Cardiac imaging at rest with venous myocardial contrast echocardiography (digitally processed and color-coded echocardiographic images, Figure, A) and ^99mTc-sestamibi single photon emission computed tomography (SPECT; B) showed perfusion defects of the basal inferior left ventricular wall. On cardiac catheterization, a subtotal occlusion of the left circumflex coronary artery (C) was seen, and uncomplicated stenting of the lesion was performed (F). Creatine kinase reached a maximum of 256 U/L (MB fraction, 34 U/L) during the next day. After 7 days, venous myocardial contrast echocardiography (D) and ^99mTc-sestamibi SPECT (E) were repeated and demonstrated almost complete reperfusion of the inferior left ventricular wall. The patient was discharged 10 days after admission.

View larger version (79K): [in this window] [in a new window]   Figure 1. A, Venous myocardial contrast echocardiography before reperfusion; apical 2-chamber view; contrast defect (arrows) of basal inferior left ventricular myocardium. Precontrast images were digitally subtracted from contrast-enhanced images, and resulting image was color-coded, with gradual transition from red to orange to yellow and white representing increasing contrast enhancement. B, 99mTc-sestamibi SPECT before reperfusion (99mTc-sestamibi injected simultaneously with A); vertical long-axis slice; reduced tracer uptake of basal inferior left ventricular myocardium (arrows). C, Coronary angiography; right anterior oblique angulation; subtotal occlusion (arrow) of left circumflex coronary artery. D, Venous myocardial contrast echocardiography 7 days after stenting of left circumflex coronary artery; almost normal contrast enhancement (arrows) of inferior myocardium. E, 99mTc-sestamibi SPECT 7 days after stenting of left circumflex coronary artery; nearly normal tracer uptake of basal inferior left ventricular myocardium. F, Coronary angiography; result after successful stenting of left circumflex coronary artery.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Google Scholar Google Scholar Articles by Horcher, J. Articles by Firschke, C. Search for Related Content PubMed PubMed Citation Articles by Horcher, J. Articles by Firschke, C. Related Collections Cardiovascular imaging agents/Techniques