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CLINICAL RESEARCH: ECHOCARDIOGRAPHY

Myocardial contrast echocardiography with a new calibration method can estimate myocardial viabilityin patients with myocardial infarction

Akio Yano, MD^*, Hiroshi Ito, MD, FACC^*,*, Katsuomi Iwakura, MD^*, Ryusuke Kimura, MD^*, Kouji Tanaka, MD^*, Atsunori Okamura, MD^*, Shigeo Kawano, MD^*, Tohru Masuyama, MD, FACC and Kenshi Fujii, MD^*

^* Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
Department of Internal Medicine and Therapeutics, Graduate School of Medicine, Osaka University, Osaka, Japan

Manuscript received February 23, 2003; revised manuscript received September 24, 2003, accepted October 20, 2003.

^* Reprint requests and correspondence: Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
itomd{at}osk4.3web.ne.jp

OBJECTIVES: We have developed a novel calibration technique applicable for myocardial contrast echocardiography (MCE). We assessed the value of this technique in the recognition of myocardial infarction (MI) and its spatial extent, and we also performed a validation study in normal subjects.

BACKGROUND: The heterogeneity of contrast intensity (CI) among myocardial segments limits the clinical use of MCE.

METHODS: We performed MCE with a slow-bolus injection of Levovist and recorded end-systolic harmonic power Doppler images at intervals of four heart beats in 15 normal volunteers and 30 patients with MI. We divided the left ventricular (LV) wall into 12 segments and placed the region of interest in the subendocardial region in each segment and in the adjacent LV cavity. We measured calibrated CI (dB) by subtracting the cavity CI from myocardial CI.

RESULTS: The mean intersegmental difference in myocardial CI was 15.8 dB at baseline, whereas it was reduced to 6.3 dB after calibration (p < 0.01). Calibrated CI was higher in the kinetic segments than in the akinetic segments (–14.5 ± 2.3 dB [range –18.7 to –9.9 dB] vs. –22.5 ± 2.6 dB [–27.8 to –17.7 dB], p < 0.001), and –18.0 dB was the optimal cutoff point to discriminate these from each other. Color-coded mapping of calibrated CI may identify the spatial extent of persistently akinetic myocardium as areas of calibrated CI of –18.0 dB.

CONCLUSIONS: This new calibration method reduces the intersegmental difference in CI in normal subjects. Calibrated CI provides an estimate of persistently akinetic myocardium in patients with MI, and its color-coded mapping is comprehensive and identifies the spatial extent of MI.

Abbreviations and Acronyms   CI = contrast intensity   HPD = harmonic power Doppler   LV = left ventricular   MBV = myocardial blood volume   MCE = myocardial contrast echocardiography   MI = myocardial infarction   PCI = percutaneous coronary intervention   ROI = region of interest

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