title: Myocardial contrast echocardiography: relation of collateral perfusion to extent of injury and severity of contractile dysfunction in a canine model of coronary thrombosis and reperfusion.
abstract: OBJECTIVE
  This study sought to determine whether myocardial contrast echocardiography could be used to detect and quantitate collateral blood flow capable of limiting the effects of ischemia in an experimental model of coronary thrombosis and reperfusion.
  
  
  BACKGROUND
  Myocardial contrast echocardiography has been used to assess collateral blood flow in humans, but this technique has not been extensively validated in the experimental laboratory.
  
  
  METHODS
  Myocardial ischemia occurred after electrically induced left circumflex coronary artery thrombosis in a canine model. Ischemia was intensified by administration of vasodilators. Reperfusion was induced with recombinant tissue-type plasminogen activator. Myocardial perfusion was assessed with contrast echocardiography and radiolabeled microspheres. Infarct size was determined by histochemical staining methods. Myocardial samples were evaluated histologically.
  
  
  RESULTS
  The dogs were classified into two groups on the basis of contrast echocardiographic detection of perfusion in the ischemic region: those with (n = 13) and without collateral flow (n = 10). Collateral perfusion detected by contrast echocardiography paralleled changes detected by radiolabeled microspheres during thrombosis and vasodilator administration. A 91% agreement was observed between the two techniques in detecting collateral flow > 0.3 ml/min per g (p < 0.0001). Collateral perfusion correlated directly with radial shortening fractions of the ischemic myocardium (p < 0.01). Recovery of function after reperfusion was faster, infarct size was smaller (mean [+/- SD] 4 +/- 1% vs. 11 +/- 3%, p = 0.05), and histopathologic injury was less in dogs with than without collateral flow, respectively (p < 0.05).
  
  
  CONCLUSIONS
  Myocardial contrast echocardiography can identify physiologically significant collateral vessels capable of limiting the degree of ischemic damage during coronary thrombosis. The magnitude of collateral flow and the change in flow induced by vasodilators can be assessed and compares favorably with the microsphere standard.
authors.affiliation: Section of Cardiology, Veterans Affairs Medical Center, Houston, Texas 77030, USA.
authors.forename: J
authors.initials: J
authors.lastname: Cheirif
authors.forename: J B
authors.initials: JB
authors.lastname: Narkiewicz-Jodko
authors.forename: H K
authors.initials: HK
authors.lastname: Hawkins
authors.forename: J S
authors.initials: JS
authors.lastname: Bravenec
authors.forename: M A
authors.initials: MA
authors.lastname: Quinones
authors.forename: J K
authors.initials: JK
authors.lastname: Mickelson
mesh_terms: D000818:Animals; D003097:Collateral Circulation / Q000502:physiology; D015986:Confounding Factors, Epidemiologic; D003326:Coronary Circulation / Q000502:physiology*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004285:Dogs; D004452:Echocardiography / Q000379:methods; D006439:Hemodynamics / Q000502:physiology; D015601:Injury Severity Score; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000503:physiopathology