Hydrogen peroxide contrast--enhanced two-dimensional echocardiography: real-time in vivo delineation of regional myocardial perfusion.

Kemper, Andrew J.; O'Boyle, J E; Sharma, Shrestha; Cohen, Carol; Kloner, Robert A.; Khuri, Shukri F.; Parisi, Alfred F.

doi:10.1161/01.cir.68.3.603

Cited by 103 publications

(16 citation statements)

References 19 publications

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“…The echocardiographically defined region at risk, or the echo contrast defect (ECD), is that myocardium which fails to enhance with ultrasonic contrast. In our laboratory, the size of the ECD has been shown to be highly correlated to region at risk determined by monastral blue (r = .93, SEE = 7.7%) or autoradiographic techniques (r = .89, SEE = 4.5%) 21,22 We have shown previously23 that amount of echo contrast enhancement, assessed qualitatively or quantitatively, accurately reflects the amount of regional myocardial blood flow measured by radioactive microspheres. In the Appendix we have expanded these observations.…”

Section: Methodsmentioning

confidence: 86%

Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures.

Force¹,

Kemper²,

Perkins³

et al. 1986

Circulation

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116

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Analyses of regional left ventricular systolic wall motion or thickening overestimate infarct size. We used quantitative two-dimensional echocardiographic analysis of systolic thickening and contrast two-dimensional echocardiography to evaluate causes for that overestimation. The following possibilities were considered: (1) "tethering," defined as dysfunction of contrast-enhancing myocardium adjacent to ischemic or contrast-negative regions, and (2) the role of standard center of mass analysis algorithms, which may overestimate wall motion abnormalities because of the axis shift produced by simultaneous systolic expansion of the ischemic segment and systolic contraction of the nonischemic segment. In the short-axis view in 12 animals, the echo contrast defect (ECD) occupied 32 + 7% of the left ventricular circumference. Extent of dysfunction by the center of mass analysis was 39 + 5% of the left ventricular circumference and correlation with ECD size was .68 (SEE = 5.2%). Thus 8 -+-6% of the circumference of the left ventricle was assessed to be dysfunctional yet enhanced with contrast. Tethering accounted for only half of this (4 + 4% of left ventricular circumference) and involved less than 1 cm on either side of the ECD. The remaining overestimation by the center of mass analysis correlated significantly (r = .89, p < .01) with the amount of systolic expansion of the ECD. This expansion of the ECD (increase in angle subtended by the ECD of 11 ± 8%) was produced by the systolic shift in the center of mass toward the dysfunctional segment from contraction of the opposite, nonischemic segment, since true systolic lengthening of the ischemic (contrast-negative) segment was minimal (increase of only 3 + 5%; p < .01 vs increase in angle subtended by ECD). When systolic function was analyzed independent of a center of mass with the ECD as an internal reference, the correlation between extent of dysfunction and ECD size improved to .84 (SEE = 3.8%). In conclusion, two-dimensional echocardiography has exaggerated the importance of tethering because of flaws in standard analysis algorithms. Tethering does lead to an unavoidable overestimation of infarct size, but the amount of myocardium involved is small and relatively predictable. The remainder of the overestimation of infarct size by two-dimensional echocardiography is critically dependent on systolic function of the opposite, nonischemic wall. Since this is variable, it accounts in large part for the suboptimal correlation between infarct size and extent of dysfunction by standard two-dimensional echocardiographic analyses. Circulation 73, No. 6, 1360-1368, 1986 TWO-DIMENSIONAL echocardiography could in theory be an ideal technique for studying the effects of interventions to limit infarct size. However, two-dimensional echocardiographic analyses of either regional left ventricular systolic wall motion or thickening consistently overestimate infarct size. '-13

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Section: Methodsmentioning

confidence: 86%

Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures.

Force¹,

Kemper²,

Perkins³

et al. 1986

Circulation

Self Cite

116

View full text Add to dashboard Cite

show abstract

“…In our hamster cheek pouch studies, we used albumin microbubbles with a mean diameter of 4.9 ,um, which approximated the size of the hamster RBC. In the present study, we used albumin microbubbles with a mean diameter of 4 …”

Section: In Vivo Kinetics Of Microbubblesmentioning

confidence: 99%

In vivo myocardial kinetics of air-filled albumin microbubbles during myocardial contrast echocardiography. Comparison with radiolabeled red blood cells.

Jayaweera

Edwards

Glasheen

et al. 1994

Circulation Research

244

111

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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

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“…This was achieved by injecting a solution of hydrogen peroxide (0.3/1,000) as a contrast medium into the main right coronary artery using a U-40 insulin syringe. The procedure allowed identifi cation of the size of the myocardial area supplied by right coronary blood [ 12].…”

Section: E Xperim Ental Protocolmentioning

confidence: 99%

The Effect of Pure Right Ventricular Ischemia on Right and Left Ventricular Performance in the Anesthetized Dog

Gattullo

Casalucci²,

Gastaldi³

et al. 1993

Cardiology

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This study was planned to investigate the effect of ischemic dysfunction of the free wall of the right ventricle on right and left ventricular performance in the presence of a normally contracting interventricular septum. The experiments were performed in 6 anesthetized dogs in which echocardiogram, electrocardiogram, aortic blood pressure and left and right ventricular pressure were recorded. In the dog, the contractility of the septum is not affected by the occlusion of the right coronary artery which does not perfuse this part of the myocardium. Complete occlusion of the major individual ventricular branches and partial occlusion of the main right coronary artery did not impair right ventricular performance. Only complete occlusion of the main artery affected right and left ventricular function as revealed by echocardiogram. Reduced output by the ischemic right ventricle caused a reduction in left ventricular diastolic and systolic dimensions and in left ventricular developed pressure without any effect on left ventricular end-diastolic pressure.

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Hydrogen peroxide contrast--enhanced two-dimensional echocardiography: real-time in vivo delineation of regional myocardial perfusion.

Cited by 103 publications

References 19 publications

Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures.

Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures.

In vivo myocardial kinetics of air-filled albumin microbubbles during myocardial contrast echocardiography. Comparison with radiolabeled red blood cells.

The Effect of Pure Right Ventricular Ischemia on Right and Left Ventricular Performance in the Anesthetized Dog

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