EXPERIMENTAL STUDIES
Basis for detection of stenosis using venous administration of microbubbles during myocardial contrast echocardiography: bolus or continuous infusion?
Kevin Wei, MD, FACCa,
Ananda R. Jayaweera, PhDa,
Soroosh Firoozan, MDa,
Andre Linka, MDa,
Danny M. Skyba, PhDa and
Sanjiv Kaul, MD, FACCa
a Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, Virginia, USA
Manuscript received October 21, 1997;
revised manuscript received March 13, 1998,
accepted April 8, 1998.
Address for correspondence: Dr. Sanjiv Kaul, Cardiovascular Division, Box 158, University of Virginia Medical Center, Charlottesville, Virginia 22908
sk{at}virginia.edu
Objectives. This study sought to determine the basis of detection of stenosis by myocardial contrast echocardiography using venous administration of microbubbles and to define the relative merits of bolus injection versus continuous infusion.
Background. The degree of video intensity (VI) disparity in myocardial beds supplied by stenosed and normal coronary arteries can be used to quantify stenosis severity after venous administration of microbubbles. However, the comparative merits of administering microbubbles as a bolus injection or continuous infusion has not been studied.
Methods. Coronary stenoses of varying severity were created in either the left anterior descending or the left circumflex coronary artery in 18 dogs. Imagent US (AF0150) was given as a bolus injection in 10 dogs (Group I) and as both a bolus injection and a continuous infusion in 8 dogs (Group II). For bolus injections, peak VI was derived from time–intensity plots. During continuous infusion, microbubble velocity and microvascular cross-sectional area were derived from pulsing interval versus VI plots. Myocardial blood flow (MBF) was determined using radiolabeled microspheres.
Results. During hyperemia, VI ratios from the stenosed versus normal beds correlated with radiolabeled microsphere–derived MBF ratios from those beds for both bolus injections (r = 0.81) and continuous infusion (r = 0.79). The basis for detection of stenosis common to both techniques was the decrease in myocardial blood volume distal to the stenosis during hyperemia. The advantage of continuous infusion over bolus injection was the abolition of posterior wall attenuation and the ability to quantify MBF.
Conclusions. Both bolus injection and continuous infusion provide quantitative assessment of relative stenosis severity. Compared with bolus injection, continuous infusion also allows quantification of MBF and data acquisition without attenuation of any myocardial bed.
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Abbreviations and Acronyms
| | CBF | = coronary blood flow | | CBV | = coronary blood volume | | CSA | = cross-sectional area | | MBF | = myocardial blood flow | | MBV | = myocardial blood volume | | MCE | = myocardial contrast echocardiography (echocardiographic) | | LAD | = left anterior descending coronary artery | | LCx | = left circumflex coronary artery | | VI | = video intensity | | PI | = pulsing interval |
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