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Updated: Oct 22, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Combination of dobutamine and myocardial contrast echocardiography to differentiate postischemic from infarcted
M F Meza1, M A Kates, R W Barbee
1Ochsner Medical Institutions, Department of Internal Medicine, New Orleans, Louisiana 70121, USA.
Insights
Combining dobutamine echocardiography (DE) and myocardial contrast echocardiography (MCE) is superior for identifying non-necrotic myocardium. This combined approach enhances diagnostic accuracy for postischemic heart muscle compared to using either technique alone.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Myocardial Viability Assessment
Background:
- Wall motion abnormalities in postischemic myocardium can indicate infarction, stunning, or hibernation.
- Dobutamine echocardiography (DE) and myocardial contrast echocardiography (MCE) have been proposed for assessing myocardial viability.
Purpose of the Study:
- To evaluate if combined DE and MCE is superior to individual techniques for identifying postischemic myocardium.
- To differentiate between viable and necrotic myocardium using combined echocardiographic methods.
Main Methods:
- 53 mongrel dogs underwent coronary occlusion, reperfusion, and dobutamine administration.
- Myocardial contrast echocardiography (MCE) and dobutamine echocardiography (DE) were performed.
- Postmortem triphenyltetrazolium chloride (TTC) staining assessed myocardial necrosis.
Main Results:
- Combined DE and MCE showed 88% sensitivity for detecting myocardial viability.
- MCE changes correlated with blood flow (r = 0.67, p < 0.0001).
- Regional function improved with dobutamine in ischemic regions; however, specificity was 61%.
Conclusions:
- Contractile reserve and perfusion data are complementary for assessing postischemic myocardium.
- DE alone cannot distinguish postischemic from infarcted myocardium; perfusion data is essential.
- Combined DE and MCE is superior to individual techniques for identifying absence of necrosis.
Objectives:
This study tested whether the combination of dobutamine echocardiography (DE) and myocardial contrast echocardiography (MCE) was superior to either technique alone in identifying postischemic myocardium and in differentiating it from necrotic myocardium.
Background:
Wall motion abnormalities at rest occur in postischemic myocardium in the presence of infarction, stunning or hibernation, alone or in combination. Various investigators have suggested that either DE or MCE can be used to identify the presence of myocardial viability.
Methods:
We studied a total of 53 mongrel dogs in an open chest model of coronary occlusion of various durations followed by reperfusion and dobutamine administration (10 microg/kg body weight per min). MCE with aortic root injections of Albunex (area under the curve) and DE (percent thickening fraction) were performed at the different stages. Postmortem triphenyltetrazolium chloride (TTC) staining was used to identify myocardial necrosis.
Results:
Thirteen dogs underwent brief (15 min) occlusions and developed no necrosis (Group I). Of 40 dogs that underwent prolonged (30 to 360 min) occlusions, 14 had no infarction (Group II), whereas 26 did (Group III: 12 papillary muscle, 7 subendocardial, 7 transmural). MCE (expressed as percent change from baseline) demonstrated changes that paralleled the blood flow changes observed by radiolabeled microspheres at all interventions (r = 0.67, p < 0.0001). Regional ventricular function improved with dobutamine administration in the ischemic region in all three groups. The sensitivity (88%) for detecting myocardial viability was superior when the two techniques were combined; however, a poor specificity (61%) was observed.
Conclusions:
Contractile reserve and perfusion data are complementary when assessing regional wall motion abnormalities in postischemic myocardium. DE alone cannot differentiate postischemic from infarcted myocardium; simultaneous data on myocardial perfusion are required. The combination of DE and MCE is superior to either technique alone for identifying the absence of myocardial necrosis.
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