Published Online
on July 29, 2002

A more recent version of this article appeared on August 20, 2002

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Submitted on February 11, 2002
Revised on May 24, 2002
Accepted on May 31, 2002

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

From the Sections of Cardiology (S.S., C.J.A., K.S., M.A.Q., W.L.W., W.A.Z.) and Cardiovascular Sciences (N.G.F.), Department of Medicine, and the Department of Surgery (R.E., G.V.L., G.M.L., M.J.R.), Baylor College of Medicine and the DeBakey Heart Center, Houston, Tex.

^* To whom correspondence should be addressed. E-mail: wzoghbi{at}bcm.tmc.edu.

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 (ß) 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 (ß) and flow (peak MCIxß) 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.

Key words: perfusion • echocardiography • hibernation • ischemia • coronary disease

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