Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction: Implications for the assessment of myocardial hibernation

Sarah Shimoni, Nikolaos G. Frangogiannis, Constadina J. Aggeli, Kesavan Shan, Miguel A. Quinones, Rafael Espada, George V. Letsou, Gerald M. Lawrie, William L. Winters, Michael J. Reardon, William A. Zoghbi

Research output: Contribution to journalArticle

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Abstract

Background - Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results - MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and inversely correlated with percent collagen content (r= -0.45, P= <0.01). The best relation was observed when the ratio of peak MCI in the 2 biopsied segments in each patient was compared with the ratio of microvascular density and capillary area (r=0.84 and 0.87, respectively; P<0.001). A significant overlap in microvascular density was seen between segments with and without recovery of function. The new MCE indices of blood velocity (β) and flow (peak MCIXβ) better identified recovery of function compared with microvascular density and the sole use of peak MCI. Conclusions - Microvascular integrity is a significant determinant of maximal MCI in humans. MCE indices of blood velocity and flow are important parameters that predict recovery of function after revascularization.

Original languageEnglish (US)
Pages (from-to)950-956
Number of pages7
JournalCirculation
Volume106
Issue number8
DOIs
StatePublished - Aug 20 2002
Externally publishedYes

Fingerprint

Myocardial Stunning
Left Ventricular Dysfunction
Echocardiography
Coronary Artery Disease
Recovery of Function
Blood Flow Velocity
Collagen
Ventricular Dysfunction
Biopsy
Transesophageal Echocardiography
Perfusion
Immunohistochemistry

Keywords

  • Coronary disease
  • Echocardiography
  • Hibernation
  • Ischemia
  • Perfusion

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction : Implications for the assessment of myocardial hibernation. / Shimoni, Sarah; Frangogiannis, Nikolaos G.; Aggeli, Constadina J.; Shan, Kesavan; Quinones, Miguel A.; Espada, Rafael; Letsou, George V.; Lawrie, Gerald M.; Winters, William L.; Reardon, Michael J.; Zoghbi, William A.

In: Circulation, Vol. 106, No. 8, 20.08.2002, p. 950-956.

Research output: Contribution to journalArticle

Shimoni, Sarah ; Frangogiannis, Nikolaos G. ; Aggeli, Constadina J. ; Shan, Kesavan ; Quinones, Miguel A. ; Espada, Rafael ; Letsou, George V. ; Lawrie, Gerald M. ; Winters, William L. ; Reardon, Michael J. ; Zoghbi, William A. / Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction : Implications for the assessment of myocardial hibernation. In: Circulation. 2002 ; Vol. 106, No. 8. pp. 950-956.
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abstract = "Background - Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results - MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and inversely correlated with percent collagen content (r= -0.45, P= <0.01). The best relation was observed when the ratio of peak MCI in the 2 biopsied segments in each patient was compared with the ratio of microvascular density and capillary area (r=0.84 and 0.87, respectively; P<0.001). A significant overlap in microvascular density was seen between segments with and without recovery of function. The new MCE indices of blood velocity (β) and flow (peak MCIXβ) better identified recovery of function compared with microvascular density and the sole use of peak MCI. Conclusions - Microvascular integrity is a significant determinant of maximal MCI in humans. MCE indices of blood velocity and flow are important parameters that predict recovery of function after revascularization.",
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T1 - Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction

T2 - Implications for the assessment of myocardial hibernation

AU - Shimoni, Sarah

AU - Frangogiannis, Nikolaos G.

AU - Aggeli, Constadina J.

AU - Shan, Kesavan

AU - Quinones, Miguel A.

AU - Espada, Rafael

AU - Letsou, George V.

AU - Lawrie, Gerald M.

AU - Winters, William L.

AU - Reardon, Michael J.

AU - Zoghbi, William A.

PY - 2002/8/20

Y1 - 2002/8/20

N2 - Background - Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results - MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and inversely correlated with percent collagen content (r= -0.45, P= <0.01). The best relation was observed when the ratio of peak MCI in the 2 biopsied segments in each patient was compared with the ratio of microvascular density and capillary area (r=0.84 and 0.87, respectively; P<0.001). A significant overlap in microvascular density was seen between segments with and without recovery of function. The new MCE indices of blood velocity (β) and flow (peak MCIXβ) better identified recovery of function compared with microvascular density and the sole use of peak MCI. Conclusions - Microvascular integrity is a significant determinant of maximal MCI in humans. MCE indices of blood velocity and flow are important parameters that predict recovery of function after revascularization.

AB - Background - Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results - MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and inversely correlated with percent collagen content (r= -0.45, P= <0.01). The best relation was observed when the ratio of peak MCI in the 2 biopsied segments in each patient was compared with the ratio of microvascular density and capillary area (r=0.84 and 0.87, respectively; P<0.001). A significant overlap in microvascular density was seen between segments with and without recovery of function. The new MCE indices of blood velocity (β) and flow (peak MCIXβ) better identified recovery of function compared with microvascular density and the sole use of peak MCI. Conclusions - Microvascular integrity is a significant determinant of maximal MCI in humans. MCE indices of blood velocity and flow are important parameters that predict recovery of function after revascularization.

KW - Coronary disease

KW - Echocardiography

KW - Hibernation

KW - Ischemia

KW - Perfusion

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