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Updated: Aug 15, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Correlation between endocardial voltage mapping and myocardial perfusion: implications for the assessment of
1Catheterization Laboratory, Cardiology Department, Rabin Medical Center, Tel-Aviv University, Israel. shmuelf@clait.org.il
Insights
Reduced myocardial blood flow in chronic ischemia significantly lowers endocardial unipolar voltage (UpV) potentials. This study in pigs demonstrates a direct correlation between reduced perfusion and decreased UpV, aiding in understanding hibernating myocardium.
Area of Science:
- Cardiology
- Electrophysiology
- Myocardial Perfusion Imaging
Background:
- Non-fluoroscopic 3D left ventricular (LV) mapping systems show reduced endocardial voltage in ischemic/infarcted zones.
- The direct link between myocardial perfusion and endomyocardial voltage amplitudes remains unclear.
Purpose of the Study:
- To investigate the relationship between myocardial perfusion and endocardial voltage amplitudes in chronic myocardial ischemia.
- To assess if reduced endomyocardial blood flow (MBF) correlates with decreased unipolar voltage (UpV) in ischemic myocardium.
Main Methods:
- Utilized a pig model (n=20) with chronic myocardial ischemia induced by ameroid constrictor.
- Performed LV endocardial unipolar voltage (UpV) mapping using a 3D navigation system.
- Assessed myocardial wall thickening (MT) via echocardiography and quantified regional MBF using fluorescent microspheres.
Main Results:
- Ischemic zones showed significantly reduced UpV (9.9+/-3.3 mV) compared to non-ischemic zones (13.3+/-3.3 mV, P=0.03).
- Reduced MBF (0.50+/-0.16 ml/g/min) and MT (26.1+/-12.0%) were observed in ischemic areas (P=0.001 and P=0.003, respectively).
- A positive linear correlation was found between resting UpV and endocardial MBF (r=0.32, P=0.05).
Conclusions:
- Chronic myocardial ischemia, characterized by reduced resting perfusion and function (hibernating myocardium), is associated with a significant (approx. 25%) reduction in endocardial UpV.
- This reduction in UpV directly correlates with diminished endomyocardial blood flow and tissue perfusion.
- Findings support UpV as a potential indicator of myocardial perfusion status in ischemic conditions.
Background:
Recent clinical studies using a non-fluoroscopic three-dimensional (3D) left ventricular (LV) mapping system suggested reduced endocardial voltage amplitudes measured in zones sustaining myocardial ischemia or infarction. However, the direct relationship between myocardial perfusion and endomyocardial voltage amplitudes has not been fully elucidated.
Methods:
In a pig model of chronic myocardial ischemia (n = 20), LV endocardial unipolar voltage (UpV) mapping was performed using the Biosense 3D navigation system (Johnson and Johnson, Warren, New Jersey, USA) 4 weeks after ameroid constrictor placement around the left circumflex coronary artery. Echocardiography was used to assess regional changes in myocardial wall thickening (MT) and fluorescent microspheres (4 x 10/injection) were used to quantify rest regional myocardial blood flow (MBF) in ischemic (left circumflex) and remote non-ischemic (left anterior descending) regions.
Results:
UpV measurements were reduced in ischemic compared to non-ischemic zones (9.9+/-3.3 compared with 13.3+/-3.3 mV, P = 0.03). This corresponded to changes in endocardial MBF and MT, which were both noted to be significantly reduced in the ischemic compared to the non-ischemic area (MBF, 0.50+/-0.16 compared with 0.74+/-0.15 ml/g per min, P = 0.001; MT, 26.1+/-12.0 compared with 37.4+/-10.1%, P=0.003). A positive linear correlation was found between UpV at rest and endomyocardial (but not epicardial) perfusion: UpV (mV) = 7.8+5.9xMBFendocardial (r = 0.32, P = 0.05).
Conclusions:
Chronic myocardial ischemia, resulting in reduced perfusion and function at rest (that is, hibernating myocardium), is characterized by a significant reduction ( approximately 25%) in endocardial UpV potentials, which correlates with reduced endomyocardial blood flow and tissue perfusion at rest.
