EXPERIMENTAL STUDIES
Evaluation of dynamic changes in microvascular flow during ischemia-reperfusion by myocardial contrast echocardiography
Leonarda Galiuto, MD*,1,
Anthony N. DeMaria, MD, FACC*,
Karen May-Newman, PhD ,
Ughetta del Balzo, PhD,
Koji Ohmori, MD*,
Valmik Bhargava, PhD, FACC*,
Stephen F. Flaim, PhD, FACC and
Sabino Iliceto, MD, FACC
* Division of Cardiovascular Medicine, University of California, San Diego, California, USA
Alliance Pharmaceutical Corp., San Diego, California, USA
Institute of Cardiology, University of Cagliari, Cagliari, Italy
Manuscript received March 12, 1998;
revised manuscript received June 2, 1998,
accepted June 17, 1998.
Address for correspondence: Anthony N. DeMaria, MD, Division of Cardiovascular Medicine, University of California at San Diego, 200 West Arbor Drive, San Diego, California, 92103-8411
ademaria{at}ucsd.edu
Background. Dynamic changes of myocardial blood flow have been observed after reperfusion of an occluded coronary artery. MCE performed by intracoronary contrast injection can provide an estimate of microvascular flow. We hypothesized that MCE performed using intravenous infusion of a new generation contrast agent and electrocardiogram-gated harmonic imaging would be able to assess serial changes of microvascular perfusion.
Objective. To study the potential of myocardial contrast echocardiography (MCE) to assess serial changes of microvascular flow during ischemia-reperfusion.
Methods. Sixteen dogs underwent 90 or 180 min of left anterior descending coronary occlusion, followed by 180 min of reperfusion. Regional blood flow (RBF) was measured with fluorescent microspheres at baseline, during coronary occlusion, and at 5, 30, 90, and 180 min during reperfusion. At the same time points, MCE was performed with intravenous infusion of AF0150 (4 mg/min). Gated end-systolic images in short axis were acquired in harmonic mode and digitized on-line. Background-subtracted videointensity measured from MCE and RBF obtained from fluorescent microspheres were calculated for the risk area and for a control area, and were expressed as the ratio of the two areas.
Results. After initial hyperemia, a progressive reduction in flow was observed during reperfusion. MCE correctly detected the time course of changes in flow during occlusion-reperfusion. Videointensity ratio significantly correlated with RBF data (r = 0.79; p < 0.0001).
Conclusions. The progressive reduction in blood flow occurring within the postischemic microcirculation was accurately detected by MCE. This approach has potential application in the evaluation and management of postischemic reperfusion in humans.
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Abbreviations and Acronyms
| | LAD | = left anterior descending artery | | LCx | = left circumflex artery | | LV | = left ventricular | | MCE | = myocardial contrast echocardiography | | RBF | = regional blood flow |
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