Detection of coronary stenosis andmyocardial viability using a singleintravenous bolus injection of BR14
Nicholas G. Fisher, MBBS*,
Howard Leong-Poi, MD*,
Tadamichi Sakuma, MD*,
Se-Joong Rim, MD*,
Jian Ping Bin, MD* and
Sanjiv Kaul, MD, FACC*,*
* Cardiovascular Imaging Center, Cardiovascular Division, University of Virginia, Charlottesville, Virginia, USA
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Figure 1 Example from a Group I dog. (A) Parametric image obtained from microsphere-derived flow during maximal hyperemia indicating hypoperfusion in the left circumflex coronary artery (LCx) territory distal to a non-critical stenosis. The myocardial contrast echocardiography (MCE) image taken early after injection matches this image (B), but the late MCE image (C) matches the infarction (D). In this instance a stenosis was first created and then infarction produced by total occlusion of the artery at the site of stenosis. Reflow was then established with the stenosis remaining unchanged. See text for details.
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Figure 2 Changes in acoustic intensity (AI) values from the left anterior descending (LAD) and left circumflex coronary artery (LCx) beds (denoted on the images in Fig. 1) following the injection of BR14 during maximal hyperemia. The LCx has a residual non-critical stenosis, whereas the LAD bed is normal. Although a flow mismatch is seen early after injection, AI in all viable tissue is similar at a later point in time, indicating redistribution. Where infarction had occurred a persistent perfusion defect remained. See text for details.
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Figure 3 Example from a Group II dog that had reduced resting myocardial blood flow (MBF). (A) Parametric image obtained from microsphere derived-MBF indicating an ischemic LCx territory. The MCE image taken early after injection matches this image (B), but the late MCE image (C) matches the infarction (D). See text for details. The preparation of this animal was the same as in Figure 1 except that hyperemia was not used. Other abbreviations as in Figure 1.
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Figure 4 Changes in AI values from the LAD and LCx beds (denoted on the images in Figure 3) following the injection of BR14. The LCx has a residual critical stenosis, whereas the LAD bed is normal. Although a flow mismatch is seen early after injection, AI in all viable tissue is similar at a later point in time, indicating redistribution. Where infarction had occurred, a persistent perfusion defect remained. See text for details. Abbreviations as in Figure 2.
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Figure 5 Correlation between radiolabeled-microsphere derived hypoperfused territory and myocardial contrast echocardiography-derived risk area and in all 10 dogs. See text for details. LV = left ventricular; MCE = myocardial contrast echocardiography.
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Figure 6 Correlation between triphenyl tetrazolium chloride-determined infarct and myocardial contrast echocardiography-derived perfusion defect sizes on late imaging and in all 10 dogs. See text for details. LV = left ventricular; MCE = myocardial contrast echocardiography; TTC = triphenyl tetrazolium chloride.
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