Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction: implications for the assessment of myocardial hibernation.
BACKGROUND
Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants.


RESULTS
MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak myocardial contrast intensity (MCI) and the rate of increase in MCI (beta) were quantitated. Thirty-six transmural myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 microm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and inversely correlated with percent collagen content (r=-0.45, P=<0.01). The best relation was observed when the ratio of peak MCI in the 2 biopsied segments in each patient was compared with the ratio of microvascular density and capillary area (r=0.84 and 0.87, respectively; P<0.001). A significant overlap in microvascular density was seen between segments with and without recovery of function. The new MCE indices of blood velocity (beta) and flow (peak MCIxbeta) better identified recovery of function compared with microvascular density and the sole use of peak MCI.


CONCLUSIONS
Microvascular integrity is a significant determinant of maximal MCI in humans. MCE indices of blood velocity and flow are important parameters that predict recovery of function after revascularization.
Shimoni
Sarah
S
Section of Cardiology, Department of Medicine, Baylor College of Medicine and the DeBakey Heart Center, Houston, Tex 77030, USA.
Frangogiannis
Nikolaos G
NG
Aggeli
Constadina J
CJ
Shan
Kesavan
K
Quinones
Miguel A
MA
Espada
Rafael
R
Letsou
George V
GV
Lawrie
Gerald M
GM
Winters
William L
WL
Reardon
Michael J
MJ
Zoghbi
William A
WA
D000368:Aged; D001706:Biopsy; D002196:Capillaries / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005355:Fibrosis; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009206:Myocardium / Q000473:pathology; D015588:Observer Variation; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery