title: Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion.
abstract: OBJECTIVE
  We aimed to validate contrast-enhanced echocardiography (CE) in the quantification of microvascular obstruction (MO) against magnetic resonance imaging (MRI) and the histopathologic standards of radioactive microspheres and thioflavin-S staining. We also determined the time course of MO at days 2 and 9 after infarction and reperfusion.
  
  
  BACKGROUND
  Postinfarction MO occurs because prolonged ischemia produces microvessel occlusion at the infarct core, preventing adequate reperfusion. Microvascular obstruction expands up to 48 h after reperfusion; the time course beyond 2 days is unknown. Though used to study MO, CE has not been compared with MRI and thioflavin-S, which yield precise visual maps of MO.
  
  
  METHODS
  Ten closed-chest dogs underwent 90-min coronary artery occlusion and reperfusion. Both CE and MRI were performed at 2 and 9 days after reperfusion. The MO regions by both methods were quantified as percent left ventricular (% LV) mass. Radioactive microspheres were injected for blood flow determination. Postmortem, the myocardium was stained with thioflavin-S and 2,3,5-triphenyltetrazolium chloride.
  
  
  RESULTS
  Expressed as % total LV, MO by MRI matched in size MO by microspheres using a flow threshold of <40% remote (4.96+/-3.52% vs. 5.32+/-3.98%, p=NS). For matched LV cross sections, MO by CE matched in size MO by microspheres using a flow threshold of <60% remote (13.27+/-4.31% vs. 13.5+/-4.94%, p=NS). Both noninvasive techniques correlated well with microspheres (MRI vs. CE, r=0.87 vs. 0.74; p=NS). Microvascular obstruction by CE corresponded spatially to MRI-hypoenhanced regions and thioflavin-negative regions. For matched LV slices at 9 days after reperfusion, MO measured 12.94+/-4.51% by CE, 7.11+/-3.68% by MRI and 9.18+/-4.32% by thioflavin-S. Compared to thioflavin-S, both noninvasive techniques correlated well (CE vs. MRI, r=0.79 vs. 0.91; p=NS). Microvascular obstruction size was unchanged at 2 and 9 days (CE: 13.23+/-4.11% vs. 12.69+/-4.97%; MRI: 5.53+/-4.94% vs. 4.68+/-3.44%; p=NS for both).
  
  
  CONCLUSIONS
  Both CE and MRI can quantify MO. Both correlate well with the histopathologic standards. While MRI can detect regions of MO with blood flow <40% of remote, the threshold for MO by CE is <60% remote. The extent of MO is unchanged at 2 and 9 days after reperfusion.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Wu
authors.forename: R J
authors.initials: RJ
authors.lastname: Kim
authors.forename: D A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: C E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: E A
authors.initials: EA
authors.lastname: Zerhouni
authors.forename: L C
authors.initials: LC
authors.lastname: Becker
authors.forename: J A
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000818:Animals; D052160:Benzothiazoles; D004396:Coloring Agents; D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology*; D004285:Dogs; D004452:Echocardiography; D005456:Fluorescent Dyes; D008279:Magnetic Resonance Imaging; D008833:Microcirculation / Q000502:physiology; D008863:Microspheres; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging*; D013778:Tetrazolium Salts; D013844:Thiazoles; D013997:Time Factors
chemical_list: D052160:Benzothiazoles; D004396:Coloring Agents; D003287:Contrast Media; D005456:Fluorescent Dyes; D013778:Tetrazolium Salts; D013844:Thiazoles; C009462:thioflavin T; C009591:triphenyltetrazolium