Quantitative assessment of the immediate results of coronary angioplasty by myocardial contrast echocardiography

Abstract

A low pressure gradient across the residual lesion and a minimal percent residual stenosis are markers of a successful coronary angioplasty. A more physiologic method of assessing the results of coronary angioplasty would involve assessment of myocardial perfusion in the affected coronary bed. Contrast two-dimensional echocardiography provides information about regional myocardial perfusion. To assess the correlation between pre- to postcoronary angioplasty changes in gradient or percent stenosis and the increase in peak contrast intensity, 23 consecutive patients were studied during coronary angioplasty. In 19 of the 23 patients, the coronary angioplasty was successful and in 15 (79%) of the 19, an adequate echocardiographic study was obtained. Mild and transient side effects of echo contrast were observed in 3 of the 15 patients. The gradient across the residual lesions decreased from 52 +/- 12 to 11 +/- 4 mm Hg (mean +/- SD), the diameter of the stenotic lesion decreased from 89 +/- 10 to 25 +/- 16% and corrected peak contrast intensity (peak contrast - baseline contrast in gray level U/pixel) increased from 15 +/- 16 to 50 +/- 26. All these differences were significant at the p less than 0.001 level. Corrected peak contrast intensity correlated exponentially with the decrease in pressure gradient (r = 0.82, p less than 0.001). The correlation curve had a greater increase in peak contrast intensity at gradient decreases greater than 45 mm Hg. Corrected peak contrast intensity did not correlate with decrease in diameter of the stenotic lesion (r = 0.19).

Echocontrast enhancers — how safe are they?

“…The results showed that intramyocardial blood flow varied between individuals, and the authors suggested that the highly viscous and hyperosmolar solution of "Renograffin-76" may have produced an autoregulatory vascular response. Reisner et al [42] used sonicated meglumine to obtain immediate quantitative assessment of the results of coronary angioplasty in 19 patients. Three patients experienced mild side-effects.…”

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

“…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.…”

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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.

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Efficacy and Adverse Effects of Transpulmonary Contrast Echocardiography Using Sonicated Albumin.

“…Left heart contrast echocardiography has been performed by injecting contrast agents directly into the aortic root (1,2), the left ventricle (3,4) or the coronary artery (2,(5)(6)(7)(8). Although this technique has been helpful to identify abnormal cardiac structure (1 , 3), determine valvular regurgitation (4), demonstrate left-to-right shunts (4,9) and evaluate myocardial perfusion (2,(5)(6)(7)(8), the insertion of arterial catheters was required.…”

“…Although this technique has been helpful to identify abnormal cardiac structure (1 , 3), determine valvular regurgitation (4), demonstrate left-to-right shunts (4,9) and evaluate myocardial perfusion (2,(5)(6)(7)(8), the insertion of arterial catheters was required. Recently, several investigators have reported left heart contrast echocardiography following intrapulmonary, right atrial or peripheral venous injection of contrast agents capable of transpulmonary passage (10)(11)(12)(13)(14)(15)(16).…”