Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography

Iliceto, Sabino; Galiuto, Leonarda; Marchese, Alfredo; Cavallari, Daniela; Colonna, Paolo; Biasco, G; Rizzon, Paolo

doi:10.1016/s0002-9149(97)89334-4

Cited by 88 publications

(22 citation statements)

References 21 publications

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“…23 With more rapid imaging, more myocardial regions could be sampled, and 2-and 3-dimensional analysis 24,25 of the tagged MR images could be performed, yielding important information with regard to the direction of intramyocardial strains although sacrificing the transmural resolution of the 1-dimensional technique. The combination of quantitative assessment of functional reserve and assessment of myocardial perfusion by either myocardial contrast echocardiography 17,26 or MR contrast imaging may be superior to either technique alone. Our group and others have recently demonstrated the utility of MR contrast infusion to evaluate patients with MI 27,28 and predict return of function on the basis of contrast uptake patterns.…”

Section: Future Directionsmentioning

confidence: 99%

Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging

et al. 1998

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Background-The assessment of return of function within dysfunctional myocardium after acute myocardial infarction (MI) using contractile reserve has been primarily qualitative. Magnetic resonance (MR) myocardial tagging is a novel noninvasive method that measures intramyocardial function. We hypothesized that MR tagging could be used to quantify the intramyocardial response to low-dose dobutamine and relate this response to return of function in patients after first MI. Methods and Results-Twenty patients with a first reperfused MI (age, 53Ϯ12 years; 16 male; 11 inferior MIs) were studied. Patients underwent breath-hold MR-tagged short-axis imaging on day 4Ϯ2 after MI at baseline and during dobutamine infusion at 5 and 10 g ⅐ kg Ϫ1 ⅐ min

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Section: Future Directionsmentioning

confidence: 99%

Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging

et al. 1998

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“…The absence of microvascular perfusion detected by contrast echocardiography, recognized all the irreversibly damaged myocardial segments (100% sensitivity). As other authors have demonstrated [18] , when echocardiographic enhancement is not present there will be lack of motion improvement at follow-up. In our experience, the contrast echocardiographic intermediate scores gave a poor predictive value.…”

Section: Myocardial Viabilitymentioning

confidence: 67%

“…The development of a collateral network offers, at rest, adequate flow to the left ventricular segments previously perfused by the infarct artery, but this mechanism may not be adequate when myocardial needs increase, resulting in development of provocable ischaemia and ischaemia-related symptoms. This clinical syndrome results in either chronic left ventricular ischaemia with the presence of viable (hibernating) or non-viable myocardium [18] . Coronary angiography can demonstrate the presence of anatomical pathways between the controlateral artery and the occluded infarct artery [19] .…”

Section: Discussionmentioning

confidence: 99%

Coronary collateral circulation behaviour and myocardial viability in chronic total occlusion treated with coronary angioplasty

Petronio

Baglini

Limbruno

et al. 1998

European Heart Journal

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AimsWe explored the role of microcirculation integrity following the chronic occlusion of an infarct-related artery to assess the behaviour of collateral circulation during and after reperfusion by coronary angioplasty Methods and ResultsEighteen patients with a proximally occluded left anterior descending artery and firm evidence of intercoronary collateral circulation were studied with selective coronary angiography and selective intracoronary myocardial contrast echocardiography, before coronary angioplasty, and at 5 and 15 min and 12 h later. Myocardial enhancement during myocardial contrast echocardiography was evaluated with a semiquantitative score (0-3), which was correlated to basal and 6 months' regional left ventricular wall motion results. 16/18 procedures were successfully performed; four patients with an inadequate acoustic window were excluded. Restenosis was evident at the 6 months' follow-up in two patients. Basal myocardial contrast echocardiography indicated that 81/192 segments from the left anterior descending coronary artery and 90/192 from the right coronary artery were perfused; no perfusion was observed in 21 segments either before or after coronary angioplasty. After coronary angioplasty, the angiographic intercoronary collateral circulation immediately disappeared, and myocardial contrast echocardiography revealed that there was a progressive reduction of segments perfused by the right coronary artery and an increase in segments perfused by the left anterior descending coronary artery. Regional left ventricular wall motion analysis demonstrated that there was abnormal motion in 51/192 segments. There was no improvement in segments with score 0 and abnormal motion after 6 months (100% sensitivity), but 16/17 segments with score 3 did show an improvement (98% specificity). The predictive value of intermediate scores (1-2) in detecting long-term improvement, was only 43%.Conclusion These data show that the adaptive mechanism observed in the behaviour of epicardial and microvascular circulation after reperfusion of a chronic occluded infarctrelated artery can vary. In addition, this study clearly shows that microvascular integrity detected by myocardial contrast echocardiography can provide myocardial viability

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“…Previous studies using direct intracoronary contrast injection have shown that failure to produce myocardial opacification by MCE nearly always indicates necrotic tissue. [1][2][3][4][5][6][7] Although dense enhancement generally indicates normal perfusion and viable myocardium, contractile performance failed to improve in Ͼ50% of the segments that manifested normal opacification after reperfusion therapy. 5,6 The results of the present study document that necrotic myocardium can be opacified by an intravenous contrast agent early after coronary reperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] From MCE produced by direct coronary injection, patterns of opacification consisting of absent, partial/patchy, 3,6 and normal uptake [1][2][3][4][5][6][7] have been observed in the reperfused zone shortly after recanalization. The absence of myocardial opacification after reperfusion has been associated with necrosis, as evidenced by a failure to recover function at follow-up.…”

mentioning

confidence: 99%

Assessment of Myocardial Postreperfusion Viability by Intravenous Myocardial Contrast Echocardiography

et al. 2001

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Background-Although defects on intracoronary myocardial contrast echocardiography (MCE) indicate loss of viability after reperfusion, opacified segments may also exhibit persistent dyssynergy. Therefore, we related the intensity and texture of opacification produced by an intravenous contrast agent to histological findings to determine the characteristics of necrotic tissue by postreperfusion MCE. Methods and Results-MCE was performed by intravenous injection of 0.15 mL/kg QW7437 in 14 dogs who underwent 3-hour coronary occlusion followed by 3-hour reperfusion. At baseline and 3 hours after reperfusion, midventricular short-axis images were digitized and segmented. Infarction fraction (IF) for each segment was determined by triphenyltetrazolium chloride stain. Of 224 segments, 140 showed no or small infarction and served as a control group. Of 84 segments with significant infarction (IFϾ30%), 52 exhibited a defect on MCE, and 32 exhibited no defect. Echo texture was quantified by computing entropy based on the co-occurrence matrix analysis of gray-level pairs within each segment. Three hours after reperfusion, average and maximal entropies in the infarct segments without opacification defects were significantly higher than control levels. Histologically, the degree of intracapillary erythrocyte stasis was less in this group than in the infarcted segments with MCE defects with similar magnitude of tissue injuries. Conclusions-Opacification defects by MCE may be present or absent in myocardium with histologically confirmed infarction. The texture of MCE from opacified but infarcted myocardium differed significantly from control segments and may assist in determination of segmental viability after reperfusion.

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Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography

Cited by 88 publications

References 21 publications

Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging

Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging

Coronary collateral circulation behaviour and myocardial viability in chronic total occlusion treated with coronary angioplasty

Assessment of Myocardial Postreperfusion Viability by Intravenous Myocardial Contrast Echocardiography

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