Fleishman, Craig E.

Kisslo, Joseph

Li, Jennifer

Ohazama, Chikai

Ota, Takahiro

Stetten, George

von Ramm, Olaf

Elsevier - Publisher Connector 

Real-time, three dimensional echocardiography with saline contrast enhancement: Methods and possibilities 

JACC Felmmzy 1996 
Contrast Echocardlography; Clinical 
Applications 
Wednesday, March 27,1996, 3:OO p.m.--5:O0 p.m. 
Orange County Convention Center, Hail E 
Presentation Hour: 4:00 p.m.-5:00 p.m. 
F~0"~ Real-Tlme, Three Oimensionel Eehocardlography 
With Saline (;onlraat Enhancement: Methods end 
Possibi l i t ies 
l"akabiro Ofa, Craig E. Relshman, Jennifer U, George Stetfan, 
Chikal Ohazama, Olaf yon Ramm, Joseph Kisalo. Duke University Medical 
Center, Durham, NC 
To test the by.thesis that real-time, three-dimensional ecbecamiography 
(RT3D) images of the right veofricular chamber (RV) could be obtained with 
echo contrast, paripheml intmvenoue injections of agitated saline were made 
into 14 volunteers using the second generation successor to the Duke RT3D 
system. The device uses a matrix phased array transducer (2.2 MHz: 40 
x 40 elements) and a 16:1 recalve/trsnsmR parallel processing schema to 
develop a 4,096 line scan which interrogates everywhere in a 60 degree 
pyramidal volume at 22 frame~ses, images am simultaneously comprised 
of two steerable, Imrsecting conventional B-scan sector arcs with multiple 
(usually three) C-euan planes parallel to the transducer face and adjustable 
anywhere in range within the scan volume. This requires no gating of ECG 
and respiration or off line reconstruction techniques. The added capability to 
capture an entire pyramidal scan volume allows retrospective xamination of 
any target within the volume by adjusting B and/or C scans. Contrast I,~ges 
were readily made in all 14 subjects (29 Injections) and the fight cil~bom 
and RV outflow tract were identified in all. 
A previously unsuspected patent foremen ovale was detected In one sub- 
Ject. Calculation of RV volumes were attempted by outlining the areas of 
contrast within the C-scan (vedably adjusted in the captured volume). Voh 
urnss ranged from 68.0 to 94.5 ml, These data indicated that RT3D contrast 
injections am possible and opens the opportunity for mere precise testing 
and ap"~.,atton of contrast methods for the development of new descdpfors 
of cardiac flow or volume. 
~ ContraeUia Versus Ml©rovascular Reserve for  the 
Determination of  the Extent o f  Myocardial 
Salvage After Reperlueion: The Effect of  Residual 
Stenosle 
Jid Sklanar, Gusteve Camareno, Sued Ismall, N. Craig Goodman, 
Sanjiv Kaui. University cf Virgin/& Charlottesville, VA 
To test the hypothesis that microvaecuter reserve is a better indicator of 
the extent of viable n~.'ocardtum postinfarction than the presence of con- 
tractile resonre, we studied 15 opon-chest dogs undergoing coronap/occlu- 
sion followed by mperfualon. Contractile reserve was measured using two- 
dimensional echocardlography and microvescular msenm was measured 
using myocardial contraet echocardiography, both before and after place- 
ment of a etenosis, infarct size was measured using triphenyl tetrazollum 
chloride. In the absence of a stenosis, the ralationshtp between infarct size 
and wall thickening Improved with increasing doses of debutemlns (r = 0.62, r 
- 0.88, and r = 0.92 for 5,10, and 15 p.g/kg/mln, rsspe~lvely). In the presence 
of a stenceis, however, the ralallonehip became worse with increasing deees 
of do~zfa~,lne (r = 0,53, r = 0.53, and r ,, 0.38 for 5, 10, and 15/,tg/kg/mln, 
respectively). Them was a fair correlation between infarct alze and parfuslon 
defact eb'e on myocardial contrast echoc~rdiography after reperfualon (r = 
0.82) vL'th .'he detect size underestimating interct size by approximately 20%. 
Thl=; .'~latlonshlp improved slgnltiuantly during fafusione of beth adenosine (r 
= 0.99) and debufamlne (r = 0,94) in the absence of stenosls. The corrate- 
tione remained good (r., 0.95 for edanoalne and r = 0.81 for dobutemlna) 
also In the presence of etenosls. It is concluded that mtnmvescular reso=ve 
is superior to contractile reserve for defining the spatial topography of necro- 
sis and hence, the extent of viable myouardium within the infarct bed after 
reperlualon, particularly when a stenoeis Is present on .the Infamt-relatad 
arten/. 
~ Intramyocardial Fiatm'ogeneiclty of Integmtod 
Beck,scatter Cyclic Vedatlone Blunting Induced 
by Atrial Pacing in CAD Patients 
Paoio Coloana, Lannarde Galiute, Venanzio F, Nopoli, Sablno iticoto, 
Paoio Rizzan. Institute of C~rdiofo~y, 8ar~ ~d c,~r~rf Univ., 
Integrated backsuatter cyclic variations (IBScv) reflect regional myocardial 
contractility and are Bunted dudng myocardial Ischemla Experimental studies 
have shown that euben¢locmdlal thickening is greater than the subeplcardlal 
ABSTRACTS-Poster 405A 
one and that acute myocardial ischemla mainly impair the former. Accordingly, 
we hypothesized that stress induced myocardial iscbemla mainly afe~'ts 
subandeeardlal IBSev. To verify this hYpothesis multiplane transesophageal 
echocard i~ and simultaneous atrial pacing were performed in 5 normal 
subjects and in 9 pts with significant (>_. 50% coronary narrowing) CAD. 
28 myocardial segments with adequate image quality were considered for 
analysis: 12 in normal subjects and 16, supplied by a narrowed coronary 
artery, in pte with CAD. In each lot a tmnsges~c two-chamber view was 
acquired and IBScv were calculated in subende- and subepicardlum both 
at rest (74 4. 9 b/re') and at peak-pacing (136 4. 15 b/re'). A prototype (AD 
system, Hewistt-Packa~l Co.) was used to acquire and analyse densitometric 
images. Results: 
Rest (dB) Peak-pacing WB) 
Norma~ SubendocardJum . r7.7±2.2 . ir7.8±2.5 
(12 segments) Sube~lum L 5.3.4- 3.1 L5.5±3. 0 
CAD Subendoc~dlum . [ 7.7 ± 1.6 ns [ 5.9.4- 2.0'* 
(I 6 segments) 8ubeplca~x~um • 5.2 ± 3,0 60,  1.8 
*p < 0.05; **p < 0.005 vs rest. 
Conclusion: IBScv am greater in the subandocardium than in the subapl- 
cardism. Atrial pacing stress test does n~t affect IBScv in normals, while it 
blunts them in CAD pts; blunting exclusively OCCURS in the subendocardium. 
Hetemgenalcity of IBScv intrarnyoca,-cliai changes caused by stress induced 
Ischemia must be taken into account when using IBScv for investigating 
myousrdial iSchemis. 
~ F_ullher Evidence That the Myocardial Transit 
Rate of  Mlcrobubbias Reflect Endothelial 
Function: An Evaluation In e Reperfuslon Model 
With a Constant Row Rate 
Sued ismall, William Spothitz, Danny Skyba, N. Craig Goodman, 
Ananda Jayaweera0 San|iv KauL University of Virginia, Charlottesville, VA 
We have previously shown that the transit rate of sonicated albumin mi- 
crobubbles (AM) is slowed in the presence of c~stalloid ce,'dioptegla (CC) 
and we have hypothesized that this is because of microbul0ble adherence 
to the endothallum which become dysfunctional in the presence of (3C. To 
further explore this issue, we studied myocardial AM and red blood cell (RBC) 
transit rates in an arrested heart pedussd at a constant flow rate alternating 
with mtedal blood and CC. AM transit rate was derived using myocardial 
contrast echocardiography (MCI:) in 8 open-chest dogs where the AM were 
injected as a belus into the cress-clamped aorta. RBC tmnalt rates were 
dedved from time-activity craves oMalned from the myocen:lium using a Csi2 
miniature y-detector. The AM transit rote was 1.5 4- 0.5 during baseline blood 
perfuslon and slowed to 0.3 4- 0.2 dedng CC infusion. Although it iroproved 
dudng blood reperfusicn compared to CC (1.0 4- 0.2), itwes markedly slower 
(p < 0.001) compared to baseline blood pedusicn. In comparison, the transit 
into of radloisbalad RBCs remained unchanged (0.20 ± 0.09, 0.19 :l: 0.07, 
0.16 4. 0.03. p = 0A0). AM transit rate was not influenced by the total protein 
content, osmolality, pH, pO2, pCO2. K + concentration, or tomperafure of ei- 
ther the pedusate or the dog blood. We conclude that the transit rate of AM 
can be used for in-vivo real.time measurement of microv'csculer ndothelial 
function. This potential application of MCE appears to be without parallel In 
cardiac imaging. 
Coronary Row Velocib7 Immodlately After 
Reperfuslon Reflects Myocardial Mlcroclrcuiatlon 
In Canlne Acute Myocardial Infarction Models  
Kolchl Sakabe, Tetsuzo Wakatsukt, Hlsaneri Shinohara, Aklyoshl Nlshikado, 
Hlmtsugu Yamada, Tomofaugu Tel)ate, Amte luchi, Takashl Old, 
Susumu Ito, Tokush/ma Un/vem/t~, To/rash/me, Japan 
To examine the mlalioushtp between coronary blood flow patfam immedi- 
ately after repedualon of acute myocezdial infarction (AMI) and myocardiM 
mlcreclrculafory In]ury,.sorona~y flow velocity variables were compared with 
myocardial contrast echocardlngraphio images in 10 canine AMI mndals 
(LCX 4 hrs. clamp procodure), We messt~l coronarj flow velocity 10 min- 
utes after reperlualon using Doppler guide wire (FloWlm). Averaged peak 
velocity was 14.6 4. 6.3 era/s, averaged aysfolic peak velocity was 9.0 4- 3.5 
cnVs, averaged iastolic peak velocity was 19,9 4- 6.9 emf.q and diastolic to 
1,0 • p < ~,05 
!°p, 
0 1 2 3 4 5 6 7 
OSVR 


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Real-time, three dimensional echocardiography with saline contrast enhancement: Methods and possibilities

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