Quantitative contrast echocardiographic assessment of collateral derived myocardial perfusion during elective coronary angioplasty
| Autor: | Markus Schwerzmann, Martin Fleisch, Christian Seiler, Michael Billinger, S F de Marchi, Bernhard Meier |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Contrast Media Coronary Disease Anterior Descending Coronary Artery Sensitivity and Specificity Coronary circulation Polysaccharides Coronary Circulation medicine.artery Angioplasty Internal medicine Image Processing Computer-Assisted medicine Humans Angioplasty Balloon Coronary Aged business.industry Mean Aortic Pressure Interventional Cardiology Surgery medicine.disease Collateral circulation Coronary arteries Stenosis medicine.anatomical_structure Echocardiography Right coronary artery Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart. 86:324-329 |
| ISSN: | 0007-0769 |
| DOI: | 10.1136/heart.86.3.324 |
| Popis: | OBJECTIVE—To determine whether myocardial contrast echocardiography can be used to quantify collateral derived myocardial flow in humans. METHODS—In 25 patients undergoing coronary angioplasty, a collateral flow index (CFI) was determined using intracoronary wedge pressure distal to the stenosis to be dilated, with simultaneous mean aortic pressure measurements. During balloon occlusion, echo contrast was injected into both main coronary arteries simultaneously. Echocardiography of the collateral receiving myocardial area was performed. The time course of myocardial contrast enhancement in images acquired at end diastole was quantified by measuring pixel intensities (256 grey units) within a region of interest. Perfusion variables, such as background subtracted peak pixel intensity and contrast transit rate, were obtained from a fitted γ variate curve. RESULTS—16 patients had a left anterior descending coronary artery stenosis, four had a left circumflex coronary artery stenosis, and five had a right coronary artery stenosis. The mean (SD) CFI was 19 (12)% (range 0-47%). Mean contrast transit rate was 11 (8) seconds. In 17 patients, a significant collateral contrast effect was observed (defined as peak pixel intensity more than the mean + 2 SD of background). Peak pixel intensity was linearly related to CFI in patients with a significant contrast effect (p = 0.002, r = 0.69) as well as in all patients (p = 0.0003, r = 0.66). CONCLUSIONS—Collateral derived perfusion of myocardial areas at risk can be demonstrated using intracoronary echo contrast injections. The peak echo contrast effect is directly related to the magnitude of collateral flow. Keywords: collateral circulation; quantitative myocardial contrast echocardiography; intracoronary pressure; myocardial perfusion |
| Databáze: | OpenAIRE |
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