Assessment of regional myocardial blood flow with myocardial contrast two-dimensional echocardiography

Department of Medicine, University of Virginia School of Medicine, Charlottesville.

It was hypothesized that regional myocardial blood flow could be measured using myocardial contrast echocardiography. Accordingly, arterial blood was perfused into the coronary circulation in 16 dogs. In Group 1 dogs (n = 8), blood flow to the cannulated left circumflex artery was controlled with use of a roller pump, whereas in Group 2 dogs (n = 8) blood flow to the left anterior descending coronary artery was controlled by a hydraulic occluder placed around it. Sonicated microbubbles (mean size 4 microns) were used as the contrast agent. In Group 1 dogs the microbubbles were injected subselectively into the left circumflex artery, whereas in Group 2 dogs they were injected selectively into the left main coronary artery and two-dimensional echocardiographic images were recorded. Computer-generated time-intensity curves were derived from these images and variables of these curves correlated with transmural blood flow measured with radiolabeled microspheres. A gamma-variate function (y = Ate-alpha t) best described the curves, and alpha (a variable of curve width) correlated well with transmural blood flow at different flow rates in all Group 1 and Group 2 dogs (mean r = 0.81 and 0.97, respectively). Other variables of the curve width also correlated well with myocardial blood flow, but peak intensity had a poor correlation with myocardial blood flow in both groups of dogs (r = 0.39 and r = 0.63, respectively). When data from all dogs were pooled, Group 1 dogs still showed good correlation between variables of curve width and myocardial blood flow (r = 0.81); Group 2 dogs did not (r = 0.45). The difference between the two sets of dogs was related to the site of contrast agent injection. It is concluded that measurement of the transit time of microbubbles through the myocardium with two-dimensional echocardiography accurately reflects regional myocardial blood flow. Although injection of contrast agent selectively into the left main coronary artery only allows measurement of relative flow, it may be feasible to measure absolute flow by injecting contrast agent subselectively into a coronary artery. Myocardial contrast echocardiography may, therefore, offer the unique opportunity of simultaneously assessing regional myocardial perfusion and function in vivo.

This article has been cited by other articles:

				F. Veronesi, E. G. Caiani, E. Toledo, C. Corsi, K. A. Collins, G. Lammertin, C. Lamberti, R. M. Lang, and V. Mor-Avi Semi-automated analysis of dynamic changes in myocardial contrast from real-time three-dimensional echocardiographic images as a basis for volumetric quantification of myocardial perfusion Eur J Echocardiogr, June 1, 2009; 10(4): 485 - 490. [Abstract] [Full Text] [PDF]

				L. Xiong, Y.-B. Deng, Y. Zhu, Y.-N. Liu, and X.-J. Bi Correlation of Carotid Plaque Neovascularization Detected by Using Contrast-enhanced US with Clinical Symptoms Radiology, May 1, 2009; 251(2): 583 - 589. [Abstract] [Full Text] [PDF]

				P Andrassy, M Zielinska, R Busch, A Schomig, and C Firschke Myocardial blood volume and the amount of viable myocardium early after mechanical reperfusion of acute myocardial infarction: prospective study using venous contrast echocardiography Heart, April 1, 2002; 87(4): 350 - 355. [Abstract] [Full Text] [PDF]

				S F de Marchi, M Schwerzmann, M Fleisch, M Billinger, B Meier, and C Seiler Quantitative contrast echocardiographic assessment of collateral derived myocardial perfusion during elective coronary angioplasty Heart, September 1, 2001; 86(3): 324 - 329. [Abstract] [Full Text] [PDF]

				C. Teupe, M. Takeuchi, J. Yao, E. Avelar, and N. Pandian Detection of Viable Myocardium by Transvenous Myocardial Contrast Echocardiography Using Harmonic Power Doppler : Canine Model of Acute Coronary Occlusion and Reperfusion Chest, August 1, 2001; 120(2): 567 - 572. [Abstract] [Full Text] [PDF]

				U. Sechtem Imaging myocardial area at risk and final infarct size Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C36 - C46. [PDF]

				K. Ohmori, B. Cotter, E. Leistad, V. Bhargava, P. L. Wolf, K. Mizushige, and A. N. DeMaria Assessment of Myocardial Postreperfusion Viability by Intravenous Myocardial Contrast Echocardiography : Analysis of the Intensity and Texture of Opacification Circulation, April 17, 2001; 103(15): 2021 - 2027. [Abstract] [Full Text] [PDF]

				L. Galiuto, A. N. DeMaria, U. del Balzo, K. May-Newman, S. F. Flaim, P. L. Wolf, M. Kirchengast, and S. Iliceto Ischemia-Reperfusion Injury at the Microvascular Level : Treatment by Endothelin A-Selective Antagonist and Evaluation by Myocardial Contrast Echocardiography Circulation, December 19, 2000; 102(25): 3111 - 3116. [Abstract] [Full Text] [PDF]

				F. F. Immer, A. M. Seiler, B. C. Aeschbacher, F. Mahler, H. Saner, and H. Saner Influence of the Ultrasound Contrast Agent Levovist(R) on Human Nailfold Capillary Microcirculation Angiology, February 1, 2000; 51(2): 123 - 129. [Abstract] [PDF]

				S. Firoozan, K. Wei, A. Linka, D. Skyba, N. C. Goodman, and S. Kaul A canine model of chronic ischemic cardiomyopathy: characterization of regional flow-function relations Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H446 - H455. [Abstract] [Full Text] [PDF]

				L. Galiuto, A. N. DeMaria, K. May-Newman, U. del Balzo, K. Ohmori, V. Bhargava, S. F. Flaim, and S. Iliceto Evaluation of dynamic changes in microvascular flow during ischemia-reperfusion by myocardial contrast echocardiography J. Am. Coll. Cardiol., October 1, 1998; 32(4): 1096 - 1101. [Abstract] [Full Text] [PDF]

				T. Postert, A. Muhs, S. Meves, J. Federlein, H. Przuntek, and T. Buttner Transient Response Harmonic Imaging : An Ultrasound Technique Related to Brain Perfusion Stroke, September 1, 1998; 29(9): 1901 - 1907. [Abstract] [Full Text] [PDF]

				S. Kaul Myocardial Contrast Echocardiography : 15 Years of Research and Development Circulation, November 18, 1997; 96(10): 3745 - 3760. [Full Text]

				T. Asanuma, K. Tanabe, K. Ochiai, H. Yoshitomi, K. Nakamura, Y. Murakami, K. Sano, T. Shimada, R. Murakami, S. Morioka, et al. Relationship Between Progressive Microvascular Damage and Intramyocardial Hemorrhage in Patients With Reperfused Anterior Myocardial Infarction : Myocardial Contrast Echocardiographic Study Circulation, July 15, 1997; 96(2): 448 - 453. [Abstract] [Full Text]

				Q. Caretta, P. Voci, M. C. Acconcia, and F. Chiarotti COLLATERAL FLOW PREVENTS UNINTENTIONAL MYOCARDIAL ISCHEMIA DURING ANTEGRADE CARDIOPLEGIA IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., March 1, 1997; 113(3): 585 - 593. [Abstract] [Full Text]

				J. Sklenar, G. Camarano, N. C. Goodman, S. Ismail, A. R. Jayaweera, and S. Kaul Contractile Versus Microvascular Reserve for the Determination of the Extent of Myocardial Salvage After Reperfusion: The Effect of Residual Coronary Stenosis Circulation, September 15, 1996; 94(6): 1430 - 1440. [Abstract] [Full Text]

				F. S. Villanueva, G. Camarano, S. Ismail, N. C. Goodman, J. Sklenar, and S. Kaul Coronary Reserve Abnormalities in the Infarcted Myocardium: Assessment of Myocardial Viability Immediately Versus Late After Reflow by Contrast Echocardiography Circulation, August 15, 1996; 94(4): 748 - 754. [Abstract] [Full Text]

				S. Ismail, A. R. Jayaweera, G. Camarano, L. W. Gimple, E. R. Powers, and S. Kaul Relation Between Air-Filled Albumin Microbubble and Red Blood Cell Rheology in the Human Myocardium: Influence of Echocardiographic Systems and Chest Wall Attenuation Circulation, August 1, 1996; 94(3): 445 - 451. [Abstract] [Full Text]

				C. R. deFilippi, D. L. Willett, W. N. Irani, E. J. Eichhorn, C. E. Velasco, and P. A. Grayburn Comparison of Myocardial Contrast Echocardiography and Low-Dose Dobutamine Stress Echocardiography in Predicting Recovery of Left Ventricular Function After Coronary Revascularization in Chronic Ischemic Heart Disease Circulation, November 15, 1995; 92(10): 2863 - 2868. [Abstract] [Full Text]

				H. Ito, K. Iwakura, H. Oh, T. Masuyama, M. Hori, Y. Higashino, K. Fujii, and T. Minamino Temporal Changes in Myocardial Perfusion Patterns in Patients With Reperfused Anterior Wall Myocardial Infarction : Their Relation to Myocardial Viability Circulation, February 1, 1995; 91(3): 656 - 662. [Abstract] [Full Text]

				S. Ismail, A. R. Jayaweera, N. C. Goodman, G. P. Camarano, D. M. Skyba, and S. Kaul Detection of Coronary Stenoses and Quantification of the Degree and Spatial Extent of Blood Flow Mismatch During Coronary Hyperemia With Myocardial Contrast Echocardiography Circulation, February 1, 1995; 91(3): 821 - 830. [Abstract] [Full Text]

				N. Hirata, Y. Shimazaki, S. Nakano, K. Sakai, S. Sakaki, and H. Matsuda Evaluation of regional myocardial perfusion in areas of old myocardial infarction after revascularization by means of intraoperative myocardial contrast echocardiography J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1119 - 1124. [Abstract] [Full Text]

				A. D. Waggoner, V. G. Davila-Roman, B. Barzilai, and J. E. Perez Contrast Two-Dimensional Echocardiography Provides Clinical Information Not Available with Color Flow Imaging Journal of Diagnostic Medical Sonography, January 1, 1992; 8(1): 2 - 13. [Abstract] [PDF]