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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative contrast echocardiographic assessment of collateral derived myocardial perfusion during elective
S F de Marchi1, M Schwerzmann, M Fleisch
1Swiss Cardiovascular Centre Bern, University Hospital, CH-3010 Bern, Switzerland.
Insights
Myocardial contrast echocardiography can quantify collateral blood flow in humans. This technique accurately measures perfusion in areas at risk, correlating with collateral flow index.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Myocardial Perfusion Imaging
Background:
- Assessing collateral circulation is crucial in coronary artery disease.
- Quantifying collateral flow aids in understanding myocardial viability and guiding interventions.
Purpose of the Study:
- To evaluate myocardial contrast echocardiography for quantifying collateral-derived myocardial flow in humans.
- To establish the relationship between echocardiographic contrast enhancement and collateral flow index.
Main Methods:
- 25 patients undergoing coronary angioplasty had collateral flow index (CFI) measured via intracoronary wedge pressure.
- Echocardiography with simultaneous biventricular contrast injection was performed during balloon occlusion.
- Myocardial contrast enhancement was quantified by pixel intensity and fitted to a gamma variate curve.
Main Results:
- A significant collateral contrast effect was observed in 17 patients.
- Peak pixel intensity showed a linear relationship with CFI in patients with significant contrast (p=0.002, r=0.69) and overall (p=0.0003, r=0.66).
- Mean contrast transit rate was 11 (8) seconds.
Conclusions:
- Intracoronary echo contrast injections can demonstrate collateral perfusion in at-risk myocardial areas.
- The peak echo contrast effect directly correlates with the magnitude of collateral flow.
- Myocardial contrast echocardiography is a viable tool for quantifying collateral myocardial perfusion.
Objective:
To determine whether myocardial contrast echocardiography can be used to quantify collateral derived myocardial flow in humans.
Methods:
In 25 patients undergoing coronary angioplasty, a collateral flow index (CFI) was determined using intracoronary wedge pressure distal to the stenosis to be dilated, with simultaneous mean aortic pressure measurements. During balloon occlusion, echo contrast was injected into both main coronary arteries simultaneously. Echocardiography of the collateral receiving myocardial area was performed. The time course of myocardial contrast enhancement in images acquired at end diastole was quantified by measuring pixel intensities (256 grey units) within a region of interest. Perfusion variables, such as background subtracted peak pixel intensity and contrast transit rate, were obtained from a fitted gamma variate curve.
Results:
16 patients had a left anterior descending coronary artery stenosis, four had a left circumflex coronary artery stenosis, and five had a right coronary artery stenosis. The mean (SD) CFI was 19 (12)% (range 0-47%). Mean contrast transit rate was 11 (8) seconds. In 17 patients, a significant collateral contrast effect was observed (defined as peak pixel intensity more than the mean + 2 SD of background). Peak pixel intensity was linearly related to CFI in patients with a significant contrast effect (p = 0.002, r = 0.69) as well as in all patients (p = 0.0003, r = 0.66).
Conclusions:
Collateral derived perfusion of myocardial areas at risk can be demonstrated using intracoronary echo contrast injections. The peak echo contrast effect is directly related to the magnitude of collateral flow.
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