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Contrast echocardiography can assess risk area and infarct size during coronary occlusion and reperfusion:
Stéphane Lafitte1, Aya Higashiyama, Hisashi Masugata
1Cardiovascular Division, University of California at San Diego, San Diego, California 92103-8411, USA.
Insights
Real-time myocardial contrast echocardiography (MCE) can estimate risk area (RA) and infarct area (IA) during coronary occlusion and reperfusion. Specific defect sizes and refilling parameters accurately predict these areas, validating MCE for cardiac assessment.
Area of Science:
- Cardiovascular imaging
- Echocardiography
- Myocardial perfusion imaging
Background:
- Myocardial contrast echocardiography (MCE) accuracy in determining risk area (RA) and infarct area (IA) size is not established.
- Hypothesized that MCE identifies RA as a perfusion defect early, collateral flow to viable myocardium late, and IA as absent opacification during coronary occlusion.
Purpose of the Study:
- To validate real-time MCE measures for estimating RA and IA during coronary occlusion and reperfusion.
- To assess the ability of opacification defect and contrast refilling parameters to predict cardiac damage.
Main Methods:
- Real-time MCE performed in 11 dogs during 3 hours of coronary occlusion and reperfusion.
- Acquired early (BEGIN) and late (LATE) refilling images, and late refilling images (LATE) 1 min after FLASH.
- Compared MCE defect size and refilling parameters with RA and IA determined by tissue staining.
Main Results:
- During occlusion, BEGIN images correlated best to RA, and LATE images to IA.
- During reperfusion, BEGIN images correlated to RA, and END images to IA.
- Peak plateau intensity and refilling slope parameters predicted IA size during reperfusion.
Conclusions:
- Real-time MCE defect size varies with microbubble refilling.
- Selected defect sizes and refilling parameters accurately estimate RA and IA during coronary occlusion and reperfusion.
Objectives:
We sought to validate the ability of real-time myocardial contrast echocardiography (MCE) measures of opacification defect and contrast refilling parameters to estimate risk area (RA) and infarct area (IA) during coronary occlusion and reperfusion.
Background:
No data exist establishing the accuracy of MCE in determining RA and IA size. We hypothesized that in the setting of coronary occlusion, MCE should identify RA as a perfusion defect early after bubble destruction, collateral flow to viable myocardium as opacification late during refilling and IA as absent opacification.
Methods:
Three hours of coronary occlusion and reperfusion were each produced in 11 dogs in which real-time MCE was performed during intravenous infusion of Sonovue (Bracco). Real-time contrast echocardiography was performed at baseline, during occlusion and reperfusion. Early (BEGIN) and end (END) images from a FLASH refilling sequence were acquired, as well as late refilling images (LATE) 1 min after FLASH. Real-time contrast echocardiography defect size and quantitative refilling parameters were compared with RA and IA determined by tissue staining.
Results:
During occlusion, defect size varied with refilling time; defects from BEGIN images correlated best to RA and those from LATE images to IA. Refilling parameters, but not LATE peak intensity, did not predict the IA size during occlusion. During reperfusion, defects from BEGIN images were well correlated to RA and END images to IA, whereas peak plateau intensity and refilling slope parameters predicted IA size.
Conclusions:
Real-time contrast echocardiography defect size varies throughout microbubble refilling. Appropriately selected defect sizes and refilling parameters provide estimates of RA and IA during coronary occlusion and reperfusion.