Abstract 2802: Real-time Imaging of Myocardial Microcirculation by Fluorescence Cardioscopy in Patients with Coronary Artery Disease Who Underwent PCI
Background: Cardiac pump function is directly dependent on myocardial microcirculation and does not necessarily correlate with blood flow in large epicardial coronary artery. Therefore, assessment of myocardial microcirculation is essential for evaluation of severity of myocardial ischemia and the effects on it of medical and interventional therapies. We devised a fluorescence cardioscope for real-time imaging of subendocardial microcirculation. Aim: To examine subendocardial microcirculation by fluorescence cardioscope in patients with coronary artery disease.
Subjects and Methods:
Fluorescence cardioscope system is composed of a fiberscope incorporated in 9F balloon guiding catheter, fluorescence exciter (470nm), fluorescence emitter (515nm), ICCD and DVD.
Twenty-five patients [ 7 with chest pain syndrome (CPS), 11 with vasospastic angina (VSA) and 7 with significant organic coronary stenoses (OCS)] underwent fluorescence cardioscopy of the left ventricle during catheterization. The cardioscope was gently pushed against the endocardium of the left ventricular apical segment, 2.5ml of 10% fluorescein solution was injected intravenously, and fluorescence of subendocardial myocardium was observed by flushing saline at 30sec, 1, 3 and 6 min.
Results: In patients with CPS, myocardium was uniformly stained by fluorescein and fluorescence peak intensity was attained at 30sec to 1min. In patients with VSA, staining was not uniform in 6 patients and peak fluorescence intensity was attained at 1 to 3min. In patients with OCS, patchy or no fluorescence staining was observed in 5 patients. In the remaining 2 patients, peak fluorescence intensity was attained at 6min. Five of OCS underwent successful PCI. However, patchy fluorescence staining and delayed peak intensity remained in 3.
Conclusion: Subendocardial myocardial microcirculation is disturbed not only in patients with OCS but also in those with VSA and angiographic successful PCI does not necessarily indicate normalization of myocardial microcirculation.