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Contrast echocardiography during coronary arteriography in humans: perfusion and anatomic studies
S B Feinstein1, R M Lang, C Dick
1Section of Cardiology, University of Chicago Medical Center, Illinois 60637.
Insights
This study used contrast echocardiography to map myocardial perfusion in healthy individuals. Findings establish a baseline for understanding blood flow in coronary artery disease patients.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- The relationship between myocardial blood flow and coronary artery anatomy is not well understood.
- Advancements in sonicated microbubble contrast agents enable contrast echocardiography for assessing myocardial perfusion.
- This technique allows correlation of blood flow with coronary artery anatomy.
Purpose of the Study:
- To determine myocardial perfusion patterns in patients without significant coronary artery disease.
- To establish a reference for analyzing myocardial blood flow in patients with coronary artery disease.
Main Methods:
- Used sonicated meglumine sodium diatrizoate solution (Renografin-76) as an echocardiographic contrast agent.
- Administered intracoronary injections during elective coronary arteriography in 14 patients without significant coronary artery disease.
- Assessed perfusion by visually analyzing two-dimensional echocardiographic images post-injection.
Main Results:
- The left coronary system consistently supplied anteroseptal, anterior, anterolateral, and posterior left ventricular regions.
- The right coronary artery system perfused the inferior and inferoseptal regions in 89% of patients with right dominance.
- The anterolateral papillary muscle received supply from the left coronary system in all cases, while the posteromedial papillary muscle had dual supply (58% left, 42% right).
Conclusions:
- Established normal myocardial perfusion patterns in relation to coronary anatomy using contrast echocardiography.
- Provides a crucial reference dataset for future studies on myocardial blood flow in coronary artery disease.
- Demonstrates the utility of sonicated microbubbles in contrast echocardiography for detailed perfusion analysis.
Abstract:
In humans, the physiologic relation between myocardial blood flow and epicardial coronary artery anatomy remains poorly defined. With the recent development of sonicated microbubble contrast agents, it is now possible to use contrast echocardiography to assess myocardial perfusion and to correlate blood flow with angiographically identified coronary artery anatomy. The purpose of the current study was to determine myocardial perfusion patterns in patients without significant coronary artery disease. The results may be used as a reference to analyze myocardial blood flow in patients with coronary artery disease. Sonicated meglumine sodium diatrizoate solution (Renografin-76), which contains microbubbles measuring 4.5 +/- 2.8 micrograms in diameter by laser analysis, was used as the echocardiographic contrast agent during elective coronary arterriography in 14 patients without significant coronary artery disease. Patients received intracoronary injections of 1.5 to 2 ml of sonicated Renografin-76 without complications. Perfusion characteristics were studied by visual assessment of the two-dimensional echocardiographic images obtained after individual injections. In patients found to be free of significant coronary artery disease by arteriography, the left coronary system always supplied the anteroseptal, anterior, anterolateral and posterior regions of the left ventricle at the mid-papillary, cross-sectional level. The right coronary artery system perfused the inferior and inferoseptal regions in 89% of the patients identified with a right dominant system. The anterolateral papillary muscle was perfused from the left coronary system in all cases. The posteromedial papillary muscle was perfused from the left coronary system in 58% of the patients and from the right system in 42% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)