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EXPERIMENTAL STUDY

Detection of coronary stenosis andmyocardial viability using a singleintravenous bolus injection of BR14

^* Cardiovascular Imaging Center, Cardiovascular Division, University of Virginia, Charlottesville, Virginia, USA

Manuscript received June 20, 2001; revised manuscript received October 26, 2001, accepted November 7, 2001.

^* Reprint requests and correspondence: Dr. Sanjiv Kaul, Cardiovascular Division, Box 158, Medical Center, University of Virginia, Charlottesville, Virginia 22908, USA.
sk{at}virginia.edu

OBJECTIVES: The aim of the study was to determine whether coronary stenosis can be detected and myocardial viability assessed after myocardial infarction from a single venous bolus injection of BR14, a new ultrasound contrast agent.

BACKGROUND: BR14 is an ultrasound contrast agent that, like ²⁰¹Tl, demonstrates redistribution. Whether this principle can be used to determine myocardial viability is not known.

METHODS: Non-critical (n = 6) or flow-limiting (n = 4) stenoses were placed on coronary arteries of 10 open-chest dogs, which then underwent 2 h of coronary occlusion followed by reperfusion through the stenosis. Hyperemia was induced to create flow mismatch in the dogs with non-critical stenosis. Hyperemia was not induced in dogs with reduced resting coronary blood flow. All dogs were given 2 ml of BR14 as a bolus injection and serial images were obtained. Myocardial blood flow (MBF) was measured using radiolabeled microspheres. At the end of the experiment, tissue staining was performed to determine infarct size and topography.

RESULTS: Initial images demonstrated flow mismatch between the normal bed and that subtended by the stenosis (during hyperemia in dogs without critical stenosis and during rest in those with reduced resting MBF). The perfusion defect size correlated well with radiolabeled microsphere-derived hypoperfused zone (r = 0.89). Regions within the hypoperfused zone that had not undergone necrosis showed redistribution, whereas the necrotic regions showed a persistent defect, the size of which correlated well with infarct size (r = 0.80).

CONCLUSIONS: Because of its ability to redistribute, BR14 can define regions of relative hypoperfusion and also discriminate between infarcted and viable tissue within the hypoperfused zone after a single venous injection. This property lends itself to assessing myocardial perfusion during exercise stress.

Abbreviations and Acronyms   MCE   AI   acoustic intensity   CBF   coronary blood flow   LAD   left anterior descending coronary artery   LCx   left circumflex coronary artery   LV   left ventricle, left ventricular   MBF   myocardial blood flow   MCE   myocardial contrast echocardiography   TTC   triphenyl tetrazolium chloride

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