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Quantitative assessment of myocardial perfusion during graded coronary artery stenoses by intravenous myocardial contrast echocardiography

Elisabeth Leistad, MD, PhD^* , Koji Ohmori, MD, PhD^*, Thomas A. Peterson, BSC^*, Geir Christensen, MD, PhD^* and Anthony N. DeMaria, MD, FACC, MACC^*

^* Cardiovascular Division, University of California at San Diego, San Diego, California, USA
Department of Medicine, Lovisenberg Hospital, Oslo, Norway

View larger version (8K): [in a new window]   Figure 1 The outline of the study protocol. MCE = myocardial contrast echocardiography; MBF = myocardial blood flow assessed with fluorescent microspheres; NFLS + Vasodilation = non-flow-limiting stenosis at rest in conjunction with vasodilation.

View larger version (48K): [in a new window]   Figure 2 Representative echocardiogram illustrating left anterior descending (region in solid line) and left circumflex (region in dotted line) coronary artery perfusion territories (left panel) and the time-intensity curves derived from these regions during a flow-limiting stenosis (right panel).

View larger version (102K): [in a new window]   Figure 3 Echocardiograms during specific interventions in a representative experiment. End-diastolic echocardiographic images of the anterior half of the left ventricle in short-axis are shown. Upper left: Precontrast, prior to contrast injection; upper right: Baseline, after contrast injection; middle left: Vasodilation, during pharmacological vasodilation; Middle right: NFLS + Vasodilation, a non-flow-limiting LAD stenosis at rest in conjunction with pharmacological vasodilation; lower left: FLS, a flow limiting stenosis that reduces coronary blood flow by 50% at rest; lower right: Total Occ; total occlusion of the LAD. Arrows depict the border between the LAD and LCx region. LAD = left anterior descending coronary artery; LCx = left circumflex coronary artery.

View larger version (32K): [in a new window]   Figure 4 Graph showing left anterior descending coronary artery (LAD) flow measured by transit-time flowmeter during the various interventions. NFLS + Vasodilation = non-flow-limiting stenosis at rest in conjunction with vasodilation; FLS = flow-limiting stenosis; Total Occ = total occlusion. *p < 0.05 vs. baseline; p < 0.05 vs. vasodilation.

View larger version (17K): [in a new window]   Figure 5 Graph showing the ratio between left anterior descending (LAD) and left circumflex (LCx) coronary artery background-subtracted peak video intensity and regional myocardial blood flow during various flow states. Abbreviations as in Figure 3. *p < 0.05 vs. baseline; p < 0.05 vs. vasodilation.

View larger version (20K): [in a new window]   Figure 6 Graphs showing relation between the ratio of left anterior descending and left circumflex coronary artery (LAD/LCx) background-subtracted peak video intensity (x-axis) and regional myocardial blood flow measured by fluorescent microspheres (y-axis) before (left panel) and after normalization to the baseline values for each animal (right panel).