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Three-Dimensional Myocardial Perfusion Maps by Contrast Echocardiography
Aric A. Aiazian1, Dila Ataoullakhanova, Wim Vletter
1Erasmus University, Rotterdam, Thoraxcenter Bd 406, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Insights
This study demonstrates a 3-D myocardial perfusion mapping system using myocardial contrast echocardiography (MCE). The system effectively visualizes coronary artery blood flow distribution before and after intervention, aiding in treatment assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Assessing myocardial perfusion is crucial for diagnosing and managing coronary artery disease.
- Traditional methods may lack detailed spatial resolution for evaluating coronary artery territories.
Purpose of the Study:
- To evaluate the clinical applicability of a novel 3-D perfusion mapping system using myocardial contrast echocardiography (MCE).
- To assess the system's ability to visualize left ventricular (LV) myocardial perfusion from major coronary arteries before and after intervention.
Main Methods:
- A 3-D perfusion mapping system was applied to 12 patients undergoing chronic total coronary occlusion intervention.
- Three-dimensional perfusion maps were reconstructed from standard apical views following left coronary artery (LCA) and right coronary artery (RCA) injections.
- Myocardial segments were classified based on their vascular supply from major coronary arteries and collaterals.
Main Results:
- The 3-D system successfully reconstructed perfusion maps of the 16 standard LV segments.
- Myocardial segments were categorized into those supplied by one artery, collaterals, or neither.
- Post-intervention, the system visualized blood flow redistribution by each major coronary artery in 3-D.
Conclusions:
- The 3-D MCE perfusion mapping system is clinically applicable and feasible with current ultrasound equipment.
- This approach provides an estimate of each major coronary artery's contribution to LV perfusion.
- The system aids in evaluating the impact of coronary angioplasty on myocardial blood flow distribution.
Abstract:
We evaluated the clinical applicability of a system for three-dimensional (3-D) display of a perfusion map following myocardial contrast echocardiography (MCE). The system was used in 12 patients (9 males and 3 females, mean age 52 +/- 10 years) undergoing interventional treatment of chronic total coronary occlusion. In each patient three standard apical views were acquired at baseline with sonicated Iopamidol(R) injections into the left coronary artery (LCA) and into the right coronary artery (RCA). Following successful recanalization of the occluded artery MCE was repeated. The patients tolerated the procedure well. Acquisition of three standard apical views provided sufficient information for the reconstruction of 3-D perfusion maps containing the 16 standard left ventricular (LV) segments. Side-by-side display of the perfusion maps obtained following LCA and RCA echocontrast injections allowed us to classify the myocardial segments (192) into three groups: (1) those supplied by one major artery (124); (2) those supplied by collaterals from contralateral or both major arteries (58); and (3) segments supplied by none of the major arteries (10). Decreased opacification was observed in 50 segments of group 2. Following successful intervention we were able to visualize the redistribution of blood flow delivered to the LV myocardium by each major coronary artery in 3-D format. We conclude that this 3-D approach, which can easily be performed with currently available ultrasound equipment, allows an estimate of the contribution of each major coronary artery to LV perfusion before and after coronary angioplasty.