Document Detail

Contrast echocardiographic mapping of collateralized myocardium in humans before and after coronary angioplasty.
MedLine Citation:
PMID:  2254543     Owner:  NLM     Status:  MEDLINE    
Conventional coronary arteriography is able to demonstrate the presence of coronary collateral vessels but cannot delineate the specific region of myocardium to which they supply blood. To test the hypothesis that contrast echocardiography can specifically identify collateralized myocardium, contrast echocardiographic perfusion "maps" were compared in patients with (n = 12) and without (n = 12) angiographic evidence of coronary collateral flow, both before and after coronary angioplasty. Contrast echocardiographic images of the mid-left ventricle in the short-axis view at end-diastole were obtained after separate injections of a sonicated contrast agent into both the right and the left coronary arteries. A computer-based contouring system was used to determine the individual areas of myocardium perfused by each of the two coronary arteries and then to superimpose the images of the two perfusion beds. The resulting area of overlapping perfusion represented myocardium receiving blood flow from both coronary systems and was defined as collateralized myocardium. To normalize for heart size, overlap area was expressed as a percent of total myocardial area, which was the area between endocardium and epicardium in the short-axis view. To adjust for differences in vascular distribution, overlap area was expressed as a percent of the perfusion area of the recipient vessel. In patients with angiographic collateral flow, the recipient vessel was that vessel receiving the collateral flow. In patients without angiographic collateral flow, the right coronary artery was considered the recipient vessel. Overlap area was 1.3 +/- 0.4% of total myocardial area and 6.6 +/- 1.7% of recipient vessel area in patients without angiographic evidence of collateral flow compared with 30.6 +/- 2.5% and 89.2 +/- 6.4%, respectively, in patients with angiographic collateral flow (p less than 0.001 for both). In four patients in whom angiographic collateral flow was abolished by angioplasty, overlap area decreased from 30.3 +/- 5.3% to 6.8 +/- 2.7% of total myocardial area and from 100% to 18.5 +/- 5.4% of recipient vessel area (p less than 0.05 for both). Thus, contrast echocardiography is able to map the specific myocardial territory perfused by coronary collateral flow and document an immediate reduction in perfusion in this territory when collateral flow is abolished by angioplasty.
H P Grill; J A Brinker; J C Taube; G D Walford; M G Midei; J T Flaherty; J L Weiss
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  16     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1991-01-24     Completed Date:  1991-01-24     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1594-600     Citation Subset:  AIM; IM    
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Collateral Circulation / physiology*
Coronary Circulation / physiology*
Coronary Disease / therapy,  ultrasonography*
Coronary Vessels / ultrasonography*
Image Processing, Computer-Assisted*
Middle Aged
Grant Support
Comment In:
J Am Coll Cardiol. 1990 Dec;16(7):1601-2   [PMID:  2254544 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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