Related Experiment Video
Updated: Aug 18, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardial perfusion in excessively trabeculated hearts: Insights from imaging and histological studies
Bjarke Jensen1, Steffen E Petersen2, Bram F Coolen3
1Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
Insights
Myocardial perfusion in the heart
Area of Science:
- Cardiology
- Cardiac Physiology
- Medical Imaging
Background:
- The coronary circulation develops in the compact layer during gestation and expands to trabeculations during fetal development.
- Conflicting data exist regarding relative hypoperfusion of the trabecular layer versus the compact wall postnatally.
- This potential hypoperfusion may contribute to poor pump function in left ventricular noncompaction.
Purpose of the Study:
- To review and reconcile conflicting data on myocardial perfusion in normal and excessively trabeculated hearts.
- To evaluate various imaging and histological methods used to assess myocardial perfusion in different cardiac layers.
- To determine if trabecular hypoperfusion contributes to the pathophysiology of left ventricular noncompaction.
Main Methods:
- Review of direct and indirect assessments of myocardial perfusion.
- Inclusion of in vivo imaging techniques: magnetic resonance imaging (MRI), positron emission tomography (PET)/single photon emission computed tomography (SPECT), and echocardiography.
- Inclusion of ex vivo and animal studies: histology and injections of labelled microspheres.
Main Results:
- Imaging studies (PET/SPECT) suggest trabecular hypoperfusion due to tracer uptake.
- Imaging studies (MRI, echocardiography) suggest trabecular hyperperfusion due to blood volume measurements.
- Histology and animal studies indicate similar capillary density and perfusion between trabecular and compact myocardium.
- Reconciliation of conflicting results suggests opposite biases in imaging techniques related to intertrabecular spaces.
Conclusions:
- Trabecular and compact myocardial layers are likely equally perfused in normal hearts.
- Equal perfusion is probable in most cases of excessive trabeculation (left ventricular noncompaction).
- The conflicting imaging data can be explained by technical biases rather than true perfusion differences.
Abstract:
In gestation, the coronary circulation develops initially in the compact layer and it expands only in fetal development to the trabeculations. Conflicting data have been published as to whether the trabecular layer is hypoperfused relative to the compact wall after birth. If so, this could explain the poor pump function in patients with left ventricular excessive trabeculation, or so-called noncompaction. Here, we review direct and indirect assessments of myocardial perfusion in normal and excessively trabeculated hearts by in vivo imaging by magnetic resonance imaging (MRI), positron emission tomography (PET)/single photon emission computed tomography (SPECT), and echocardiography in addition to histology, injections of labelled microspheres in animals, and electrocardiography. In MRI, PET/SPECT, and echocardiography, flow of blood or myocardial uptake of blood-borne tracer molecules are measured. The imaged trabecular layer comprises trabeculations and blood-filled intertrabecular spaces whereas the compact layer comprises tissue only, and spatio-temporal resolution likely affects measurements of myocardial perfusion differently in the two layers. Overall, studies measuring myocardial uptake of tracers (PET/SPECT) suggest trabecular hypoperfusion. Studies measuring the quantity of blood (echocardiography and MRI) suggest trabecular hyperperfusion. These conflicting results are reconciled if the low uptake from intertrabecular spaces in PET/SPECT and the high signal from intertrabecular spaces in MRI and echocardiography are considered opposite biases. Histology on human hearts reveal a similar capillary density of trabecular and compact myocardium. Injections of labelled microspheres in animals reveal a similar perfusion of trabecular and compact myocardium. In conclusion, trabecular and compact muscle are likely equally perfused in normal hearts and most cases of excessive trabeculation.
