While the performance of the tool with purely ICD-10 data has yet to be evaluated, this updated tool makes assessment of diabetes patient severity and complications possible in the interim.

Background. Papillary muscle dysfunction (PMD) has been implicated in the pathogenesis of ischemic mitral regurgitation (MR). We hypothesized that ischemic MR is not caused by PMD and/or dysfunction of the myocardial regions from where the papillary muscles arise but is related to reduction in global left ventricular (LV) function. To test this hypothesis, three groups of dogs were studied.Methods and Results. In group 1 dogs (n=8), varying degrees of regional and global LV

stages) demonstrated that removing the effect by deconvolution of the bolus spread before reaching the myocardium is not necessary to maintain the relation between mean myocardial transit rate and LAD blood flow if the duration and site of the tracer injection are constant. Additionally, the coefficient of variation for determining the mean microbubble transit rate during MCE was 21% in these dogs (five injections at a single flow in each dog). We conclude that the transit rates of microbubbles during MCE can be used to assess regional myocardial blood flow in the in vivo beating heart as long as the blood volume remains constant. (Circ Res. 1994;74: 1157-1165 rates and hence regional myocardial blood flow. For this purpose, the myocardial transit rates of sonicated albumin microbubbles were compared with those of technetium-99m-labeled RBCs at different coronary blood flows in the dog. We also evaluated two additional issues in the present study: (1) whether, despite its theoretical advantages, fitting a lagged normal density function13 to the time-intensity plots provides better results than a gamma-variate function,14 which is simpler and less computer intensive, and (2) whether deconvolution of timeintensity curves using an input function is necessary when microbubble injection duration and site are constant. Materials and MethodsEighteen adult mongrel dogs were used for the study. The 12 group I dogs were used to (1) derive the relation between left anterior descending coronary artery (LAD) blood flow and mean RBC transit rate, (2) determine the correlation between mean microbubble and RBC transit rates, and (3) determine which function, lagged normal density or gamma variate, best describes the myocardial time-intensity data. The six group II dogs were used to (1) determine whether removing the effect by deconvolution of the bolus spread before reaching the myocardium is necessary to maintain the relation between mean myocardial transit rate and blood flow if the rate and site of tracer injection into a coronary artery are constant and (2) estimate the coefficient of variation for the mean myocardial

MCE revealed striking temporal heterogeneity in the spatial distribution of myocardial perfusion during postischemia reflow and either significantly underestimated or did not correlate with infarct size during reperfusion. Because of abnormalities in coronary vascular reserve specific to infarcted tissue, MCE in conjunction with intravenous dipyridamole depicted, in vivo, the actual topography of the infarct with remarkable accuracy.

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