Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography

W. F. Armstrong, T. M. Mueller, E. L. Kinney, E. G. Tickner, J. C. Dillon, Harvey Feigenbaum

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

A new echocardiographic contrast agent, gelatin-encapsulated microbubbles, that produces an intramyocardial contrast effect, was evaluated as a marker for the detection of regions of abnormal myocardial perfusion in 9 open-chest dogs. The gelatin-encapsulated microbubbles were injected into the aortic root under control conditions and during circumflex coronary artery occlusion. Myocardial perfusion was simultaneously assessed with radioactive microspheres. Echocardiographic contrast enhancement (ECE) was measured in footlamberts (Ft-L) from the videoscreen of an off-line playback system, using a commercially available light meter. A single short-axis section of the left ventricle was divided into octants to analyze myocardial perfusion. The equivalent regions of the echocardiographic image were analyzed for contrast enhancement and wall motion. An ECE > 0.3 Ft-L was seen in all 120 octants analyzed before circumflex coronary artery occlusion and in 48 of 51 (94%) octants with > 50% of the normal zone flow during circumflex artery occlusion. An ECE ≤ 0.3 Ft-L identified 19 of 21 octants (90%) with ≤ 50% normal zone flow and all 13 octants with ≤ 25% normal zone flow during coronary artery occlusion. In contrast, wall motion abnormalities (akinesis or dyskinesis) were seen in 13 of 51 octants (25%) with > 50% normal zone flow, and normal wall motion was seen in 2 of 21 octants (10%) with blood flow ≤ 50% of normal zone flow during circumflex coronary artery occlusion. We could not demonstrate a linear correlation between ECE and the absolute level of myocardial blood flow. We feel this was due to the limitations imposed by imaging an open-chest animal preparation, variation in the number of gelatin-encapsulated microbubbles used for each injection and variations in the echocardiographic gain settings among experiments. We conclude that contrast-enhanced two-dimensional echocardiography with gelatin-encapsulated microbubbles can accurately identify ischemic regions of the left ventricular myocardium. This technique is more accurate than wall motion analysis for detecting myocardial ischemia.

Original languageEnglish (US)
Pages (from-to)166-173
Number of pages8
JournalCirculation
Volume66
Issue number1
StatePublished - 1982
Externally publishedYes

Fingerprint

Microbubbles
Coronary Occlusion
Gelatin
Echocardiography
Coronary Vessels
Perfusion
Thorax
Microspheres
Contrast Media
Heart Ventricles
Myocardial Ischemia
Myocardium
Arteries
Dogs
Light
Injections

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Armstrong, W. F., Mueller, T. M., Kinney, E. L., Tickner, E. G., Dillon, J. C., & Feigenbaum, H. (1982). Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography. Circulation, 66(1), 166-173.

Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography. / Armstrong, W. F.; Mueller, T. M.; Kinney, E. L.; Tickner, E. G.; Dillon, J. C.; Feigenbaum, Harvey.

In: Circulation, Vol. 66, No. 1, 1982, p. 166-173.

Research output: Contribution to journalArticle

Armstrong, WF, Mueller, TM, Kinney, EL, Tickner, EG, Dillon, JC & Feigenbaum, H 1982, 'Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography', Circulation, vol. 66, no. 1, pp. 166-173.
Armstrong, W. F. ; Mueller, T. M. ; Kinney, E. L. ; Tickner, E. G. ; Dillon, J. C. ; Feigenbaum, Harvey. / Assessment of myocardial perfusion abnormalities with contrast-enhanced two-dimensional echocardiography. In: Circulation. 1982 ; Vol. 66, No. 1. pp. 166-173.
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abstract = "A new echocardiographic contrast agent, gelatin-encapsulated microbubbles, that produces an intramyocardial contrast effect, was evaluated as a marker for the detection of regions of abnormal myocardial perfusion in 9 open-chest dogs. The gelatin-encapsulated microbubbles were injected into the aortic root under control conditions and during circumflex coronary artery occlusion. Myocardial perfusion was simultaneously assessed with radioactive microspheres. Echocardiographic contrast enhancement (ECE) was measured in footlamberts (Ft-L) from the videoscreen of an off-line playback system, using a commercially available light meter. A single short-axis section of the left ventricle was divided into octants to analyze myocardial perfusion. The equivalent regions of the echocardiographic image were analyzed for contrast enhancement and wall motion. An ECE > 0.3 Ft-L was seen in all 120 octants analyzed before circumflex coronary artery occlusion and in 48 of 51 (94{\%}) octants with > 50{\%} of the normal zone flow during circumflex artery occlusion. An ECE ≤ 0.3 Ft-L identified 19 of 21 octants (90{\%}) with ≤ 50{\%} normal zone flow and all 13 octants with ≤ 25{\%} normal zone flow during coronary artery occlusion. In contrast, wall motion abnormalities (akinesis or dyskinesis) were seen in 13 of 51 octants (25{\%}) with > 50{\%} normal zone flow, and normal wall motion was seen in 2 of 21 octants (10{\%}) with blood flow ≤ 50{\%} of normal zone flow during circumflex coronary artery occlusion. We could not demonstrate a linear correlation between ECE and the absolute level of myocardial blood flow. We feel this was due to the limitations imposed by imaging an open-chest animal preparation, variation in the number of gelatin-encapsulated microbubbles used for each injection and variations in the echocardiographic gain settings among experiments. We conclude that contrast-enhanced two-dimensional echocardiography with gelatin-encapsulated microbubbles can accurately identify ischemic regions of the left ventricular myocardium. This technique is more accurate than wall motion analysis for detecting myocardial ischemia.",
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