This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Toledo, E. Articles by Mor-Avi, V. Search for Related Content PubMed PubMed Citation Articles by Toledo, E. Articles by Mor-Avi, V.

CLINICAL RESEARCH: CARDIAC ULTRASOUND

Imaging and Quantification of Myocardial Perfusion Using Real-Time Three-Dimensional Echocardiography

Eran Toledo, PhD^_*, Roberto M. Lang, MD^_*, Keith A. Collins, MS^_*, Georgeanne Lammertin, BS^_*, Ursula Williams, BS, Lynn Weinert, BS^_*, Gil Bolotin, MD, PhD, Patrick D. Coon, BS^_*, Jai Raman, MD, PhD, Lawrence D. Jacobs, MD^_* and Victor Mor-Avi, PhD^_*,_*

^_* Noninvasive Cardiac Imaging Laboratory, University of Chicago, Chicago, Illinois
Section of Cardiothoracic Surgery, University of Chicago, Chicago, Illinois

Manuscript received May 10, 2005; revised manuscript received August 4, 2005, accepted August 8, 2005.

^_* Reprint requests and correspondence: Dr. Victor Mor-Avi, University of Chicago, MC5084, 5841 South Maryland Avenue, Chicago, Illinois 60637. (Email: vmoravi{at}medicine.bsd.uchicago.edu).

OBJECTIVES: We tested the feasibility of real-time three-dimensional echocardiographic (RT3DE) perfusion imaging and developed and validated an algorithm for volumetric analysis of myocardial contrast inflow. The study included three protocols wherein perfusion was measured: 1) in an ex-vivo model of controlled global coronary flow, 2) in an in-vivo model during regional perfusion variations, and 3) in humans during pharmacologically induced hyperemia.

BACKGROUND: The RT3DE technology offers an opportunity for myocardial perfusion imaging without multi-slice reconstruction and repeated contrast maneuvers.

METHODS: Electrocardiographically triggered harmonic RT3DE datasets were acquired (Philips 7500) while infusion of Definity was initiated and reached a steady state. Protocol 1 was performed in nine isolated rabbit hearts and included three coronary flow levels. In protocol 2, changes in regional perfusion caused by partial left anterior descending artery occlusion were measured in five pigs. In protocol 3, adenosine-induced changes in perfusion were measured in eight normal volunteers. Myocardial video-intensity (MVI) was measured over time in three-dimensional (3D) slices to calculate peak contrast inflow rate (PCIR). In pigs, PCIR was measured on a regional basis and validated against microspheres.

RESULTS: The RT3DE imaging allowed selection of slices for perfusion analysis in rabbit hearts, pigs, and humans. Administration of contrast resulted in clearly visible and quantifiable changes in MVI. In rabbits, The PCIR progressively decreased with coronary flow (p < 0.0001). In pigs, coronary occlusion caused a 59 ± 26% decrease in PCIR exclusively in the left anterior descending artery territory (p < 0.05) in agreement with microspheres. In humans, adenosine increased PCIR to 198 ± 57% of baseline (p < 0.05).

CONCLUSIONS: Contrast-enhanced RT3DE imaging provides the basis for volumetric imaging and quantification of myocardial perfusion.

Abbreviations and Acronyms   2D = two-dimensional   3D = three-dimensional   BL = baseline   LAD = left anterior descending   LV = left ventricular   MVI = myocardial video-intensity   PCIR = peak contrast inflow rate   RT3DE = real-time three-dimensional echocardiographic   TCI = transient contrast inflow

This article has been cited by other articles:

				A. Bhan, S. Kapetanakis, B.S. Rana, E. Ho, K. Wilson, P. Pearson, S. Mushemi, J. Deguzman, J. Reiken, M.D. Harden, et al. Real-time three-dimensional myocardial contrast echocardiography: is it clinically feasible? Eur J Echocardiogr, November 1, 2008; 9(6): 761 - 765. [Abstract] [Full Text] [PDF]

				L. Sugeng, V. Mor-Avi, and R. M Lang Three-dimensional echocardiography: coming of age Heart, September 1, 2008; 94(9): 1123 - 1125. [Full Text] [PDF]

				F. Veronesi, E. G. Caiani, E. Toledo, C. Corsi, K. A. Collins, G. Lammertin, C. Lamberti, R. M. Lang, and V. Mor-Avi Semi-automated analysis of dynamic changes in myocardial contrast from real-time three-dimensional echocardiographic images as a basis for volumetric quantification of myocardial perfusion Eur J Echocardiogr, September 1, 2008; (2008) jen209v1. [Abstract] [Full Text] [PDF]

				P. A. Dijkmans, R. Senior, H. Becher, T. R. Porter, K. Wei, C. A. Visser, and O. Kamp Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion: The Evidence So Far J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2168 - 2177. [Abstract] [Full Text] [PDF]

				R. M. Lang, V. Mor-Avi, L. Sugeng, P. S. Nieman, and D. J. Sahn Three-Dimensional Echocardiography: The Benefits of the Additional Dimension J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2053 - 2069. [Abstract] [Full Text] [PDF]