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CLINICAL STUDY: CARDIOVASCULAR IMAGING

Spontaneous echo contrast videodensity isflow-related and is dependent on the relative concentrations of fibrinogen and red blood cells

^* Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA

Manuscript received April 12, 2002; revised manuscript received June 20, 2002, accepted July 17, 2002.

^* Reprint requests and correspondence: Dr. Martin E. Goldman, Mount Sinai Medical Center, Box 1030, One Gustave L. Levy Place, New York, New York 10029-6574, USA.
martin.goldman{at}mssm.edu

OBJECTIVES: The purposes of the present study were to: 1) determine whether fibrinogen (Fg) is the plasma protein responsible for spontaneous echo contrast (SEC), and 2) investigate modulators of SEC.

BACKGROUND: Spontaneous echo contrast has been linked to the development of thromboemboli. The blood products and their interaction responsible for SEC formation have not been fully elucidated.

METHODS: Blood echogenicity was examined with the use of quantitative videodensitometry over a controlled range of flow velocities in an in vitro model. Human blood samples were analyzed in a manner to methodically eliminate individual blood components from whole blood to determine which components are responsible for the formation of SEC.

RESULTS: The videodensity (VD) of whole blood was found to be flow-dependent, with higher VD at lower flow rates, and correlated with visually dense SEC. The following blood products produced faint VD values: washed red blood cells (wRBCs), platelet-depleted plasma, Fg, defibrinated plasma, wRBCs plus defibrinated plasma, and physiologic saline. The VD of wRBCs increased incrementally as increasing concentrations of Fg were added. At each hematocrit (Hct) range, as Fg concentration increased, the SEC became denser, and the VD level also increased until a plateau level was reached that was distinct for each Hct. The addition of sialic acid, which inhibits RBC-RBC aggregation, decreased the amount of SEC, even in the presence of Fg.

CONCLUSIONS: These results demonstrated that Fg-mediated RBC aggregation may be responsible for SEC generation. Furthermore, a unique stoichiometric relationship exists between Fg and RBC concentrations that is necessary for blood echogenicity.

Abbreviations and Acronyms   Fg   fibrinogen   Hct   hematocrit   plt   platelet   RBC   red blood cell   SEC   spontaneous echo contrast   VD   videodensity   WBC   white blood cell   wRBC   washed red blood cell

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