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(Circulation. 2001;103:2021.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Assessment of Myocardial Postreperfusion Viability by Intravenous Myocardial Contrast Echocardiography

Analysis of the Intensity and Texture of Opacification

Koji Ohmori, MD, PhD; Bruno Cotter, MD; Elisabeth Leistad, MD, PhD; Valmik Bhargava, PhD; Paul L. Wolf, MD; Katsufumi Mizushige, MD, PhD; Anthony N. DeMaria, MD

From the Division of Cardiology (K.O., B.C., E.L., V.B., K.M., A.N.D.) and Department of Pathology (P.L.W.), University of California at San Diego, School of Medicine, and Veterans Affairs Medical Center, La Jolla, Calif. Drs Ohmori and Mizushige are now at the Second Department of Internal Medicine, Kagawa Medical University, Kagawa, Japan.

Correspondence to Anthony N. DeMaria, MD, Division of Cardiology, UCSD Medical Center, 200 W Arbor Dr, San Diego, CA 92103-8411. E-mail ademaria{at}ucsd.edu

Background—Although defects on intracoronary myocardial contrast echocardiography (MCE) indicate loss of viability after reperfusion, opacified segments may also exhibit persistent dyssynergy. Therefore, we related the intensity and texture of opacification produced by an intravenous contrast agent to histological findings to determine the characteristics of necrotic tissue by postreperfusion MCE.

Methods and Results—MCE was performed by intravenous injection of 0.15 mL/kg QW7437 in 14 dogs who underwent 3-hour coronary occlusion followed by 3-hour reperfusion. At baseline and 3 hours after reperfusion, midventricular short-axis images were digitized and segmented. Infarction fraction (IF) for each segment was determined by triphenyltetrazolium chloride stain. Of 224 segments, 140 showed no or small infarction and served as a control group. Of 84 segments with significant infarction (IF>30%), 52 exhibited a defect on MCE, and 32 exhibited no defect. Echo texture was quantified by computing entropy based on the co-occurrence matrix analysis of gray-level pairs within each segment. Three hours after reperfusion, average and maximal entropies in the infarct segments without opacification defects were significantly higher than control levels. Histologically, the degree of intracapillary erythrocyte stasis was less in this group than in the infarcted segments with MCE defects with similar magnitude of tissue injuries.

Conclusions—Opacification defects by MCE may be present or absent in myocardium with histologically confirmed infarction. The texture of MCE from opacified but infarcted myocardium differed significantly from control segments and may assist in determination of segmental viability after reperfusion.

Key Words: echocardiography • reperfusion • coronary disease • myocardial infarction

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