Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography.

Armstrong, William F.; Mueller, Timothy I.; Kinney, Evlin L.; Tickner, E. Glenn; Dillon, James C.; Feigenbaum, Harvey

doi:10.1161/01.cir.66.1.166

Cited by 212 publications

(38 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Contrast echocardiography using sonicated agents (microbubbles) injected into the coronary arteries during coronary angiography is a new technique that can be used to demonstrate perfusion in the coronary artery territory [1][2][3][4][5][6] and therefore, to detect perfusion abnormalities due to coronary artery obstructions [7][8][9][10][11][12] .…”

Section: Original Articlementioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

See 1 more Smart Citation

Myocardial perfusion by contrast echocardiography. Establishment of normal pattern of intracoronary injection and safety in humans

Morcerf¹,

Cantisano²,

Mendonça³

et al. 1999

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Original ArticleContrast echocardiography using sonicated agents (microbubbles) injected into the coronary arteries during coronary angiography is a new technique that can be used to demonstrate perfusion in the coronary artery territory [1][2][3][4][5][6] and therefore, to detect perfusion abnormalities due to coronary artery obstructions [7][8][9][10][11][12] .Although there are several studies on the use of this technique to evaluate myocardium at risk 2, 13-14 , myocardial viability [15][16][17][18] , presence of collaterals [19][20][21] , the results of angioplasty 22,23 , and of myocardial revascularization surgeries 24 , few studies have been performed to define the normal pattern of the appearance and distribution of contrast in humans without significant obstruction of the epicardial arteries. As far as we know from the literature reviewed at the time of the present study, studies performed to establish the normal perfusion pattern and the safety of this technique involved only a small number of patients. Feinstein et al 25 studied 14 patients to establish the normal pattern of the method and Moore et al 26 studied 10 patients to determine its safety. It is evident that both studies are limited in their conclusion due to the small number of patients.Therefore, the purpose of this study was to determine what the normal pattern of myocardial perfusion was when analyzed by echocardiogaphic contrast with microbubbles, as well as its safety in a significant number of patients who underwent routine coronary angiography to evaluate chest pain. MethodsThree hundred and ten contrast echocardiograms with microbubbles were performed in 277 nonconsecutive patients who underwent coronary angiography to investigate chest pain. Sixty-seven patients without valvar, myocardial, pericardial or hypertensive disease and who also had normal coronary arteries or less than a 50% obstruction by Objective -To establish the normal pattern and safety of echocardiographic contrast in patients with no significant obstruction of epicardial coronary arteries. Methods -67 patients with normal coronary arteries or obstructions < 50% were selected from 277 patients who underwent coronary angiography (CA). Mean age was 56 ± 11years and 36 were males. At the end CA, echocardiographic contrast was selectively injected into each coronary artery. The parasternal short axis of the left ventricle (LV) was divided into six segments: anterior (A), antero-lateral (AL), postero-lateral (PL), posterior (P), infero-septal (IS) and antero-septal (AS). Anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were also considered. The pattern and intensity of the appearance of the myocardial contrast was visually analyzed.Results

show abstract

Section: Original Articlementioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Myocardial perfusion by contrast echocardiography. Establishment of normal pattern of intracoronary injection and safety in humans

Morcerf¹,

Cantisano²,

Mendonça³

et al. 1999

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

show abstract

“…8 The latter determinant is related to the compression of intramural vessels due to intramyocardial pressure and is characterized by both spatial and temporal heterogeneity.19-21 In fact, compressive resistance is three to four times higher during systole than in diastole, and it increases progressively from outer to the inner myocardial layers. As a result of compressive resistance, systolic perfusion would be anticipated to be predominantly subepicardial, and blood flow could even cease during systole in the inner portion of subendocardial layers.…”

Section: Heterogeneity Of Myocardial Perfusion By Labeled Microspheresmentioning

confidence: 99%

Nonuniformity of the transmural distribution of coronary blood flow during the cardiac cycle. In vivo documentation by contrast echocardiography.

et al. 1989

View full text Add to dashboard Cite

This study was performed to examine the transmural (endocardial vs. epicardial) heterogeneity of myocardial blood flow during the cardiac cycle (systole vs. diastole). Twenty-four contrast echocardiographic injections were performed in seven open-chest anesthetized dogs either into left anterior descending or circumflex coronary artery or into the aortic root. Two-dimensional echocardiography in short-axis view was performed and was digitized off-line into a 256 x 256 pixel matrix with 256 gray levels/pixel. All end-diastolic and end-systolic frames before and to peak contrast were analyzed. A region of interest corresponding to the most intensely opacified myocardial segment was traced, the mean videodensity measured, and the frame of initial contrast appearance detected. The region of interest was divided into three equal parallel layers corresponding to the endocardial, midcardial, and epicardial myocardium. When the echocardiographic contrast effect initially appeared in diastole, the increment in videodensity was greater for the endocardium (131±48%) than for the epicardium (71±37% of the increment in videodensity of the entire wall) (p < 0.05). This inhomogeneity subsequently disappeared in the following end-systolic frame. When the initial echocardiographic contrast effect appeared in systole, intensity was higher in epicardium (136±83%) than in endocardium (60±60%) (p < 0.05). However, in the following diastole, intensity was not significantly different for the two layers. Thus, myocardial contrast echocardiography demonstrates that coronary blood flow is primarily subendocardial in distribution during diastole and subepicardial during systole. (Circulation 1989;79:179-187) B lood flow at the inlet of the coronary system varies during the specific phases of the cardiac cycle because of the generation of intramyocardial pressure by cardiac contraction.1 It is well recognized that arterial coronary blood flow is higher during diastole, when myocardial tension is low, than during systole. It has been proposed that the transmural distribution of coronary blood flow From the CNR Clinical Physiology Institute and the University of Pisa, Pisa, Italy, and the Division of Cardiovascular Medicine

show abstract

“…More recently, contrast echocardiography gained renewed interest in experimental studies indicating its potential to assess myocardial perfusion. Using intracoronary or intraaortic injections, contrast agents have been used to identify myocardial perfusion defects (Armstrong et al 1982) and areas at risk (Kaul et al 1984), and to indicate coronary blood flow Ten Cate et al 1984a) or flow reserve (Cheirifet al 1988;Keller et al 1988a). However, in order to accurately measure perfusion, a contrast agent must satisfy several criteria.…”

Section: Introductionmentioning

confidence: 99%

Quantification of transpulmonary echocontrast effects

Jong

Cate

Vletter

et al. 1993

Ultrasound in Medicine & Biology

View full text Add to dashboard Cite

Abstract--Videodensity of left heart and right heart were studied after intravenous injection of increasing dosages of 0.01-0.02 and 0.04 mL/kg bodyweight of Albunex ® in 10 healthy volunteers. The increase in videodensity in the left ventricle was always lower than in the right ventricle. Possible explanations are diffusion of gases caused by ambient pressures changes and change in microspheres distribution due to the sieving effect of the lung capillary bed. These phenomena were studied in vitro and were consistent with clinical observations. These limitations restrict a quantitative assessment of left heart echocontrast after intravenous injection.

show abstract

Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography.

Cited by 212 publications

References 11 publications

Myocardial perfusion by contrast echocardiography. Establishment of normal pattern of intracoronary injection and safety in humans

Myocardial perfusion by contrast echocardiography. Establishment of normal pattern of intracoronary injection and safety in humans

Nonuniformity of the transmural distribution of coronary blood flow during the cardiac cycle. In vivo documentation by contrast echocardiography.

Quantification of transpulmonary echocontrast effects

Contact Info

Product

Resources

About