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CARDIAC ULTRASOUND

Ultrasound energy improves myocardial perfusion in the presence of coronary occlusion

Robert J. Siegel, MD, FACC^*,*, Valentina N. Suchkova, MD, Takashi Miyamoto, MD^*, Huai Luo, MD^*, Raymond B. Baggs, DVM, PhD, Yoram Neuman, MD^*, Michael Horzewski, BS^*, Veijo Suorsa, PhD^*, Sergio Kobal, MD^*, Todd Thompson, BS^*, Debra Echt, MD^* and Charles W. Francis, MD

^* Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
Hematology/Oncology Unit, Department of Medicine
Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine, Rochester, New York

Manuscript received January 7, 2004; revised manuscript received April 21, 2004, accepted June 21, 2004.

^* Reprint requests and correspondence: Dr. Robert J. Siegel, Division of Cardiology, Room #5335, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048 (Email: siegel{at}cshs.org).

OBJECTIVES: We evaluated whether ultrasound improves myocardial tissue perfusion in 14 animals with coronary artery occlusion.

BACKGROUND: A recent study demonstrated that low-frequency ultrasound improves tissue perfusion in the rabbit ischemic limb, but there are no data on ultrasound enhancement of myocardial perfusion.

METHODS: Fourteen animals (9 dogs, 5 pigs) underwent thoracotomy and occlusion of a diagonal branch of the left anterior descending coronary artery. Myocardial tissue perfusion units (TPUs) and pH were measured before coronary occlusion, after occlusion, and after direct exposure of the ischemic myocardium in thepresence of fixed occlusion to low-frequency ultrasound (27 kHz).

RESULTS: The TPU decreased from 100.9 ± 13 at baseline to 71.1 ± 13 (p < 0.01) after 60 min occlusion but rose by 19.7% to 85.1 ± 8 (p < 0.01) after ultrasound exposure for 60 min. After 60-min coronary occlusion, myocardial pH fell from 7.43 ± 14 to 7.05 ± 0.15 (p < 0.01) but then improved to normal (7.46 ± 0.32) after ultrasound for 60 min. Administration of L-N-nitro-arginine methyl esther (L-NAME), an inhibitor of nitric oxide synthase, before ultrasound exposure, blocked improvement in myocardial tissue perfusion and pH by ultrasound. Quantitative histomorphology showed a significant increase in the capillary area of myocardium exposed to ultrasound versus non-exposed myocardium (16.2 ± 7.9 vs. 8.2 ± 2.1, p < 0.02).

CONCLUSIONS: Low-frequency, low-intensity ultrasound improves myocardial tissue perfusion and pH in the presence of a fixed coronary artery occlusion.

Abbreviations and Acronyms   L-NAME = N-N-nitro-arginine methyl esther   NO = nitric oxide   NOS = nitric oxide synthase   TPU = tissue perfusion unit

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