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Evaluation of myocardial Viability after myocardial Infarction with Intravenous Real-time myocardial contrast echocardiography

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2008年第3期28卷 291-294页

作者：申屠伟慧邓又斌黄润青黎鹏魏翔杨好意张芸熊莉余芬伍玉晗 Department of Medical Ultrasound Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of Cardiothoracic Surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.

关键词： myocardial infarction viability myocardial contrast echocardiography perfusion

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Quantitative Analysis of Myocaridal Perfusion in Rabbits by Tansthoracic Real-time myocardial contrast echocardiography

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2009年第6期29卷 795-799页

作者：邓荷萍谢明星王新房吕清李松南鲍玉婷王静卢晓芳杨亚利陆博 Department of Ultrasonography Union Hospital Tongji Medical College Huazhong University of Science and Technology Hubei Province Key Laboratary of Molecular Imaging Department of Ultrasonography the Third Affiliated Hospital of Hebei Medical University

To evaluate the feasibility of real-time myocardial contrast echocardiography （RTMCE） by quantitative analysis of myocardial perfusion in rabbits, transthoracic RTMCE was performed in 10 healthy rabbits by using continuous infusion of SonoVue into the auricular vein. The short axis view at the papillary muscle level was obtained. The duration of the time that the contrast took to appear in right heart, left heart and myocardium was recorded. The regional myocardial signal intensity （SI） versus re-filling time plots were fitted to an exponential function： y（t） =A（1–e–β（t–t0））＋ C, where y is SI at any given time, A is the SI plateau that reflects myocardial blood volume, and β is the slope of the refilling curve that reflects myocardial microbubble velocity. The A, β and A×β values at different infusion rate of SonoVue were analyzed and the A, β and A×β values in each segment in the short axis view at the papillary muscle level were compared. All the animal experiments were successful and high-quality im-ages were obtained. The best intravenous infusion rate for SonoVue was 30 mL/h. The contrast appeared in right heart, left heart and myocardium at 7.5±2.2 s, 9.1±2.4 s and 12.2±1.6 s respectively. After 16.6±2.3s, myocardial opacification reached a steady state. The mean A, β and A×β value in the short axis view at the papillary muscle level were 9.8±3.0 dB, 1.4±0.5 s-1 and 13.5±3.6 dB×s-1 respectively. A, β and A×β values showed no significant differences among 6 segments. It was suggested that RTMCE was feasible for quantitative analysis of myocardial perfusion in rabbits. It provides a non-invasive method to evaluate the myocardial perfusion in rabbit disease models.

关键词： myocardial contrast echocardiography real-time myocardial perfusion rabbit

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Assessment of myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by myocardial contrast echocardiography and Two-dimensional Strain echocardiography

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2009年第5期29卷 664-668页

作者：刘蓉邓又斌毕小军刘娅妮熊莉陈刘平 Department of Medical Ultrasound Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology

The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography （RT-MCE） combined with two-dimensional strain echocardiography was assessed. Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months after coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu- dinal strain three months after bypass surgery was significantly higher than that before operation [（-15.78±5.91）% vs （-10.45±8.31）%, P〈0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [（-10.33±6.53）% vs （-9.41±6.09）%, P〉0.05]. It was concluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of regional systolic function. The combination of myocardial perfusion with two-dimensional strain echocardiography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

关键词： two-dimensional strain myocardial contrast echocardiography myocardial perfusion ventricular function coronary artery disease

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Effects of hypoxia on coronary flow reserve as determined by myocardial contrast echocardiography in swine

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Chinese Medical Journal 2004年第10期117卷 1453-1458页

作者：杨源李树清 Barry Peters Anthony N DeMari Department of Cardiology First Affiliated Hospital of Kunming Medical College Kunming 650032 China Department of Cardiology University of California San Diego USA

Background Time-intensity curves derived from microbubble destruction/refilling sequences and recorded using myocardial contrast echocardiography (MCE) can provide parameters that correlate with coronary blood flow. The response of these parameters to adenosine vasodilatation correlates with coronary flow reserve (CFR) measured by fluorescent microsphere techniques (FMT). Currently, no data exist regarding the effect of physiological variables, such as hypoxia, on the determination of CFR by MCE. The purpose of this study was to define the effects of decreases in blood partial pressure of oxygen (PO_2) on CFR as measured by MCE. Methods Studies were performed in 9 closed chest swine. Low-energy, real-time MCE was performed with commercial instruments in short axis view at papillary muscle level while infusing BR_1 at 30 ml/h. High-energy ultrasound bursts (referred to as FLASH frames) destroyed the bubbles every 15 cardiac cycles, and resultant time-intensity curves derived from these sequences were fitted to the exponential function y = A (1-e -bt) +c, from which the rate of signal rise (b) was obtained. CFR was calculated as the ratio of b values after adenosine infusion to baseline and was obtained during the control period and after decreasing blood PO_2 by giving nitrogen via a respirator to create artificial hypoxic conditions. CFR was independently determined by FMT. Results Nitrogen led to significant decreases in mean PO_2, from (120.6±18.9) mmHg to (51.8±15.9) mmHg (Pmyocardial blood flow (MBF) (both P<0.05). In addition, values decreased in response to adenosine using both techniques: 1.05±0.35 to 0.82±0.27 for b and (4.30±3.16) ml·min -1·g -

关键词： anoxia coronary flow reserve myocardial contrast echocardiography

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Real-time three-dimensional myocardial contrast echocardiography in assessment of myocardial perfusion defects

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Chinese Medical Journal 2004年第3期117卷 337-341页

作者：陈立新王新房 Navin C anda Andrew P Miller 谢明星庄磊杨娅王静黄润青杨颖费洪文王良玉 Department of echocardiography Union Hospital Tongji Medical College Huazhong University of Science and Technology Division of Cardiovascular Disease University of Alabama at Birmingham Birmingham

Background Both real-time three-dimensional echocardi ography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C 3F 8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and righ t coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals’ hearts were used as control s. Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g [mean, (54.6±9.6) g] before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass [range, 38.9-71.1 g; mean, (55.6±9.3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36.7-68.9 g; mean, (51.3±12.5) g. Or range, 38.9-71. 1 g; mean, (53.7±12.3) g, respectively] and under-perfused mass [range, 0-21.4 g; mean, (12.0±6.9) g. Or range, 0-19.8 g; mean, (10.8±6.3) g, respectively] after th e LAD ligation (P>0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50.1-65.4 g; mean, (57.5±5.9 ) g. Or range, 51.5-65.8 g; mean, (57.3±6.4) g, respectively] and under-perfused m ass [range, 0-25.6 g; mean, (13.3±9.6) g. Or range, 0-22.7 g; mean, (12.8±8.1 ) g, respectively] after the LCX ligation (P>0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g [mean, (54.8±10.0) g] a n

关键词： real-time three-dimensional echocardiography myocardial contrast echocardiography perfusion defects myocardial infarction

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ATP Stress myocardial contrast echocardiography Assessment of Coronary Microvascular Disease with Spasmodic Characteristics: A Case Report

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Cardiology Discovery 2023年第3期3卷 221-225页

作者： Xuebing Liu Chunmei Li Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduSichuan 610072China.

Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion d... 详细信息

Here, a patient with chest pain and myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of "reverse redistribution" of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.

关键词： echocardiography stress myocardial contrast echocardiography Coronary microvascular disease Spasm Coronary artery blood flow reserve Case report

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Quantitative Evaluation of myocardial Perfusion and Function in a Rabbit Model of Coronary Artery Atherosclerosis by contrast echocardiography and Tissue Doppler Imaging

Quantitative Evaluation of Myocardial Perfusion and Function...

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中国超声医学工程学会第十四届全国超声心动图学术会议

作者： Heping Deng Li Zhang Xinfang Wang Qing Lv Mingxing Xie Department of Ultrasound Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Hubei Provincial Key Laboratory of Molecular Imaging Department of Ultrasound The third affiliated Hospital of Hebei Medical University

Background:Coronary artery atherosclerosis would result in blood flow decrease,and then myocardial perfusion and function *** abnormalities of myocardial perfusion and function sensitively is important for identifying ***:The aim of our study was to compare the merits of quantitatively analyzing left ventricularfLV]myocardial perfusion using real-time myocardial contrast echocardiography(RTMCE)and myocardial function using quantitative tissue velocity imaging(QTVI) in detecting ischemic changes in a rabbit model of coronary artery ***:Twenty rabbits were divided into the atherosclerosis group(AS group) and the control *** echocardiography was *** was used to measure peak systolic and early diastolic velocity at the mitral valve annulus(Sa and Ea,respectively) and the middle segments(Sm and Em,respectively) of the LV septal,anterolateral,anterior and inferior *** was performed in the anterolateral short axis view at the papillary muscle level with an intravenous infusion of *** curve of regional myocardial signal intensity(SI) versus refilling time plots was obtained in 6 segments.A,β and A×β values were ***:Conventional EF,FS and E value were not significantly different between two *** and RTMCE showed global left ventricular(LV) myocardial function and perfusion deterioration in AS group in with Sa and Ea decreased,increased E/Ea,and decreased average β and average A×β of the 6 *** LV myocardial function deterioration was observed in the AS group with decreased Em in the middle segments of LV anterior and inferior wall and decreased Sm in the inferior *** myocardial perfusion deterioration was observed in the AS group with decreased β and A×β in the LV inferoseptal,anterior and inferior segments,with the spatial extent exceeding the functional ***:QTVI and RTMCE are both sensitive techniques for identify

关键词： myocardial contrast echocardiography Tissue Doppler echocardiography myocardial perfusion Atherosclerosis

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Comparison of the veracity of real-time perfusion, harmonic angio, and ultraharmonic myocardial contrast imaging modes in evaluation of acute myocardial infarction area

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Chinese Medical Journal 2006年第3期119卷 179-184页

作者： XING Yan-qiu ZHANG Yun LI Da-qing LIU Xiang-qun LI Xiu-qin ZHAO Chang-qin CHEN Mei GAO Hai-qing Cardiology Unit of Senior Care Department Qilu HospitalShandong University Ji＇nan 250012 China

Background Innovative advancements in ultrasound instrumentation present a number of imaging modalities for myocardial contrast echocardiography （MCE） in ischemic syndromes. How well they compare to each other in diagnostic accuracy in the detection of acute myocardial infarction is unclear. The purpose of this study was to assess the relative accuracy of 3 different imaging modes of MCE, low mechanical index （MI） real-time perfusion imaging （RTPI）, triggered harmonic angio mode （HA）, and ultraharmonic imaging mode （UH） in the detection of acute experimental myocardial infarction within the time frame suitable for potential reperfusion. Methods MCE was performed in 10 open-chest dogs using RTPI, triggered HA and triggered UH modes at baseline and one hour after occlusion of left anterior descending coronary artery. Presence or absence of peffusion defects, and the perfusion defect size when present, were analyzed and compared with the infarct size delineated by triphenyltetrazolium chloride （TTC） staining. Results The infarct area was （15.8-2.4）% by TTC staining; Peffusion defect area by MCE was similar to anatomic infarct area in all the three MCE approaches：（16.1-2.7）% by RTPI mode, （15.5-2.9）% by HA mode, and （15.5-3.0）% by UH mode. The sensitivity, specificity and overall diagnostic accuracy in the detection of myocardial infarction were 100%, 88%, and 94% for RTPI mode, 88%, 100%, and 94 % for HA mode, and 100%, 75%, and 88% for UH mode. Conclusion All modes of MCE, RTPI, triggered HA mode and triggered UH mode have excellent diagnostic accuracy in the immediate hour of acute coronary occlusion within the optimal time frame suitable for reperfusion therapy.

关键词： myocardial contrast echocardiography myocardial infarction ultraharmonic imaging harmonic angio imaging real-time perfusion imaging

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Combination therapy reduces the incidence of no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction

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Journal of Geriatric Cardiology 2015年第2期12卷 135-142页

作者： Shan-Shan ZHOU Feng TIAN Yun-Dai CHEN Jing WANG Zhi-Jun SUN Jun GUO Qin-Hua JIN Department of Cardiology Chinese PLA General Hospital

Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction(STEMI) who undergo percutaneous coronary intervention(PCI) and is considered a dynamic process characterized by multiple pathogenetic *** aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction(AMI) undergoing primary *** A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this *** with high risk of no-reflow(no-flow score > 10,by using a no-flow risk prediction model,n = 216) were randomly divided into a controlled group(n = 108) and a combination therapy group(n = 108).Patients in the controlled group received conventional treatment,while patients in combination therapy group received high-dose(80 mg) atorvastatin pre-treatment,mtracoronary administration of adenosine(140 μg/min per kilogram) during PCI procedure,platelet membrane glycoproteinⅡb/Ⅲa receptor antagonist(tirofiban,10μg/kg bolus followed by 0.15 μg/kg per minute) and thrombus *** contrast echocardiography was performed to assess the myocardial perfusion 72 h after *** adverse cardiac events(MACE) were followed up for six *** Incidence of no-reflow in combination therapy group was 2.8%,which was similar to that in low risk group 2.7%and was significantly lower than that in control group(35.2%,P myocardial perfusion(A ×β) values were higher in combination therapy group than that in control group 72 h after *** 6 months,there were six(6.3%) MACE events(one death,two non-fatal MIs and three revascularizations) in combination therapy group and 12(13.2%)(four deaths,three non-fatal MIs and five revascularizations,P < 0.05) in control *** Combination of thrombus aspiration,high-dose statin pre-treatment,intracoronary administration of a

关键词： Acute myocardial infarction myocardial contrast echocardiography No-reflow phenomenon Percutaneous coronary intervention ST-elevation myocardial infarction

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Combination therapy reduces the percutaneous coronary intervention acute myocardial infarction incidence of no-reflow after primary in patients with ST-segment elevation

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Journal of Geriatric Cardiology 2015年第2期12卷 135-142页

作者： Shan-Shan ZHOU Feng TIAN Yun-Dai CHEN Jing WANG Zhi-Jun SUN Jun GUO Qin-Hua JIN Department of Cardiology Chinese PLA General Hospital Fuxing Road 28 Haidian District Beij'ing 100853 China

Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, ***/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%）（four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose stat

关键词： Acute myocardial infarction myocardial contrast echocardiography No-reflow phenomenon Percutaneous coronary interven-tion ST-elevation myocardial infarction

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