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Coronary collaterals assessed with myocardial contrast echocardiography in healed myocardial infarction
1Cardiology Division, Kawachi General Hospital, Osaka, Japan.
Insights
Myocardial contrast echocardiography (MCE) effectively assesses coronary collateral function in myocardial infarction patients. MCE enhancement in infarct areas correlates with collateral vessel grades, offering insights into myocardial perfusion.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Myocardial Perfusion Assessment
Background:
- Coronary angiography visualizes collateral vessels but lacks myocardial perfusion data.
- Assessing collateral function is crucial for managing myocardial infarction.
- Existing methods have limitations in evaluating collateral blood supply.
Purpose of the Study:
- To evaluate the utility of myocardial contrast echocardiography (MCE) for assessing coronary collateral function.
- To compare MCE findings with coronary angiographic collateral grading.
- To determine if MCE can quantify myocardial perfusion through collaterals.
Main Methods:
- Myocardial contrast echocardiography (MCE) performed in 29 patients with old myocardial infarction.
- Intracoronary injection of agitated amidotrizoate sodium meglumine.
- Quantification of peak background-subtracted gray level (PGL) in infarct areas from digitized echocardiographic images.
Main Results:
- MCE-derived PGL in infarct areas was significantly lower in patients with poor collaterals compared to those with moderate to good collaterals (5 +/- 4 vs 18 +/- 8 U, p < 0.01).
- Patients with severe asynergy despite moderate to good collateral supply showed PGL < 10 U, indicating insufficient collateral activity for effective wall motion preservation.
- A strong correlation was observed between MCE enhancement and coronary angiographic collateral grades.
Conclusions:
- Myocardial contrast echocardiography (MCE) enhancement in infarct areas generally corresponds to collateral grades assessed by coronary angiography.
- MCE provides a valuable quantitative measure of collateral blood flow and myocardial perfusion.
- MCE is a promising tool for functional assessment of coronary collateral circulation.
Abstract:
The epicardial coronary collateral vessels are visualized with coronary angiography, but this method does not provide significant information about the myocardial perfusion supplied with the collaterals. In this study, myocardial contrast echocardiography (MCE) was performed to assess the coronary collaterals in 29 patients with old myocardial infarction. MCE was performed by intracoronary injection of 2 ml agitated amidotrizoate sodium meglumine. The peak background-subtracted gray level (PGL) in the infarct area was determined from the digitized echocardiographic images obtained before and after injection into the noninfarct and donor artery. PGL was compared with the 3-point coronary angiographic grades of collaterals. PGL in the infarct area was significantly lower in patients with poor collaterals than in patients with moderate to good collaterals (5 +/- 4 vs 18 +/- 8 U mean +/- standard deviation, p less than 0.01). PGL in the infarct area was less than 10 U in the 3 patients with severe asynergy despite the moderate to good collateral supply, suggesting that activity of the collaterals was not good enough to preserve the wall motion effectively. It is concluded that (1) the degree of MCE enhancement in the infarct area generally corresponded to the collateral grades assessed with coronary angiography, and (2) MCE may provide a measure of the collateral perfusion.