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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

View larger version (114K): [in a new window]   Figure 1 Example is shown of a MCE study and the corresponding anatomic myocardial slice. a, The LV short axis recorded at baseline during the infusion of AF0150 and ECG-gated harmonic imaging. b, During coronary occlusion, the LAD risk area was delineated by MCE as an area of absent videointensity (solid outline) and, d, corresponded to the anatomic risk area defined by the unstained area at Monastral blue dye. b, The control area in the circumflex perfusion territory is outlined in dots. c, After 3 h of reperfusion, the videointensity within the risk area decreased relative to its baseline value.

View larger version (16K): [in a new window]   Figure 2 This graph displays the changes over time of risk area/control area ratios of videointensity obtained from MCE and RBF in this study. Values are reported at baseline (BSL), during LAD occlusion (OCC), and at 5, 30, 90, and 180 min of reperfusion (RP). Both MCE and RBF ratios follow the same trend and their values are identical at each time point. Both parameters decreased significantly during coronary occlusion and increased over baseline at 5 min of reperfusion (*p < 0.0001 vs. baseline). At 30 min of reperfusion, both MCE and RBF ratios returned to baseline values and then progressively decreased at 90 and 180 min of reperfusion to a level lower than baseline (*p < 0.0001 vs. baseline for RBF).

View larger version (120K): [in a new window]   Figure 3 This figure shows a representative MCE case demonstrating the progressive changes in videointensity observed within the risk area during coronary occlusion and reperfusion. a, The contrast-enhanced LV short axis at baseline. The infusion of the contrast agent and the ECG-gated harmonic imaging yielded uniform myocardial opacification with no attenuation of the posterior wall. b, The risk area is delineated by absent contrast enhancement during LAD occlusion (between arrows). c, Five min after the release of the coronary occlusion, an increase in videointensity is noted within the postischemic myocardium, which correlated with the hyperemic flow detected by microspheres. d, e, and f, The MCE images acquired at 30, 90, and 180 min of reperfusion, respectively. A clear progressive reduction in videointensity can be observed within the risk area.

View larger version (17K): [in a new window]   Figure 4 Linear correlation between MCE ratio and RBF ratio for all the data points in this study.