Assessment of no-reflow phenomenon after acute myocardial infarction with harmonic angiography and intravenous pump infusion with Levovist: Comparison with intracoronary contrast injection

Agati, Luciano; Funaro, Stefania; Bilotta, Federico

doi:10.1067/mje.2001.113235

Cited by 25 publications

(31 citation statements)

References 26 publications

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“…Recent studies of intracoronary or intravenous myocardial contrast echocardiography have shown that approximately one-quarter or one-third of patients with acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty have inadequate tissue perfusion (no-reflow phenomenon) despite angiographically successful coronary recanalization. 21,22 Profound microvascular dysfunction can persist for several days or months and be accompanied by a myocardial perfusion defect even in patients with either a nearly normal epicardial coronary artery or insignificant stenosis in the chronic stage. Our results further support the clinical potential of HPDI for detecting functionally significant coronary arterial stenosis or microvascular dysfunction in the corresponding territory.…”

Section: Hpdi and Coronary Angiographymentioning

confidence: 99%

Assessment of Myocardial Perfusion by Harmonic Power Doppler Imaging at Rest and During Adenosine Triphosphate Stress

Takeuchi

Yoshitani

Miyazaki

et al. 2002

Circ J

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armonic power Doppler imaging (HPDI) is a novel method of evaluating myocardial perfusion after intravenous administration of transpulmonary contrast agents. [1][2][3][4][5][6] The technique is most suitable for use with air-filled first generation contrast agents, such as Levovist, which are easily destroyed by the ultrasound energy; the rapid dissolution of the agents in the blood after their destruction creates a stronger signal in the myocardium. 7 Although recent studies have shown that HPDI can reliably identify myocardial perfusion defects at rest and during pharmacological stress, 8,9 the relationship of the perfusion defects to functionally significant epicardial coronary stenosis or microvascular dysfunction is not known. Measuring coronary flow velocity reserve (CFVR) is the current method of choice for evaluating the integrity of the coronary microcirculation, 10,11 and recent advances in transthoracic Doppler echocardiography have made the noninvasive measurement of coronary flow velocity in the left anterior descending coronary artery (LAD) feasible and with a high success rate. [12][13][14][15][16][17][18] The purpose of the present study was to determine whether the myocardial perfusion Circulation Journal Vol.66, February 2002 abnormalities observed on HPDI at rest and during hyperemia are related to a decrease in CFVR in the LAD territory. Methods Patient PopulationThe institutional Ethical Committee on Human Research approved the study protocol and all participants gave informed consent. A total of 75 patients with known or suspected coronary artery disease that could be adequately visualized on echocardiographic apical views were included in the study group. Exclusion criteria included myocardial infarction within 2 weeks of examination, unstable angina, valvular heart disease, second-or third-degree atrioventricular block, or systolic blood pressure less than 90 mmHg. Myocardial Contrast EchocardiographyThe contrast agent used in this study was Levovist (Tanabe Seiyaku, Inc, Tokyo, Japan and Schering AG, Germany). The addition of 7 ml of sterile water into the 2.5 g Levovist vial reconstituted a 7-8 ml Levovist solution (300 mg/ml), and a 2-2.5 ml bolus of Levovist was slowly administered intravenously followed by continuous infusion (2-2.5 ml/min using infusion pump) through a stopcock placed just proximal to a 20-gauge intravenous catheter inserted into the antecubital vein.HPDI was performed with a broadband harmonic transducer (S4, SONOS 5500, Philips Medical Systems, Andover, MA, USA) transmitting and receiving at a mean frequency To clarify whether the myocardial perfusion abnormalities observed on harmonic power Doppler imaging (HPDI) during hyperemia are related to a decrease in coronary flow velocity reserve (CFVR), HPDI and CFVR were measured in the left anterior descending coronary artery (LAD) territory of 75 patients. During continuous infusion of Levovist, dual-frame triggered apical 4-chamber views were obtained at rest and during adenosine triphosphate (ATP) infusion. The...

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Section: Hpdi and Coronary Angiographymentioning

confidence: 99%

Assessment of Myocardial Perfusion by Harmonic Power Doppler Imaging at Rest and During Adenosine Triphosphate Stress

Takeuchi

Yoshitani

Miyazaki

et al. 2002

Circ J

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“…implies an area with extremely low myocardial blood volume, the no reflow phenomenon (Figure 8) [25,35,36]. In particular, pixel-by-pixel analysis is capable of demonstrating subendocardial microangiopathy (subendocardial infarction).…”

Section: Volumetric Imagingmentioning

confidence: 99%

Quantitative Myocardial Contrast Echocardiography in Coronary Artery Disease

Ito

2006

J Echocardiogr

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SummaryIt is now possible to perform myocardial contrast echocardiography (MCE) at the bedside with intravenous injection of commercially available contrast media. Detecting coronary stenosis and myocardial viability in patients is the major aim of anMCE study, but its diagnosis has relied largely on subjective interpretation of regional perfusion by experienced readers. Thus, quantifying MCE data and displaying comprehensive images have been be necessary for its routine application. In this review, two methods for quantifying and displaying MCE parameters will be introduced: 1) parametric imaging that separately displays the parameters of myocardial blood volume, blood flow velocity, and myocardial blood flow; and 2) volumetric imaging that displays a color-coded map of myocardial blood volume fraction. Both methods of analysis provide quantitative and easy-to-understand images even to unexperienced observers. (J Echocardiogr 2006; 4: 99-109)

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“…We depicted apical 4-and 2-chamber views with harmonic power Doppler (HPD) mode [18][19][20], and ultrasound was transmitted at 1.8 MHz and received at 3.6 MHz. The focus was placed at the mitral level, and the mechanical index and dynamic range were set to the maximum, 1.6 and 40 dB, respectively.…”

Section: Study Protocolmentioning

confidence: 99%

“…Overall gain was adjusted to minimize artifacts in the baseline study. A solution of Levovist TM (concentration of 300 mg/mL, Schering AG) [19][20][21] was administrated as bolus (3 mL) at a rate of 0.5 mL/s with a volumetric pump (PULSAR, Medrad). MCE images were recorded for at least 180 seconds after the contrast injection.…”

Section: Study Protocolmentioning

confidence: 99%

Tissue Inflammation Impairs Tissue-Level Perfusion and Promotes Left Ventricular Remodeling in Patients With Acute Myocardial Infarction

et al. 2005

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Background. C-reactive protein (CRP) level and monocytosis are associated with left ventricular (LV) remodeling in patients with AMI.Methods. One hundred twenty-nine consecutive patients with the first acute myocardial infarction (AMI) underwent myocardial contrast echocardiography (MCE) 2 weeks after successful reperfusion.Results. LV end-diastolic volume index (LVEDVI) at pre-discharge was significantly higher in the no-reflow group than the reflow group (64 17 vs. 58 11 mL/m 2 , p< 0.01). The no-reflow group had a higher CRP level and peak monocyte counts than the reflow group (9.5 5.2 vs. 5.

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Assessment of no-reflow phenomenon after acute myocardial infarction with harmonic angiography and intravenous pump infusion with Levovist: Comparison with intracoronary contrast injection

Cited by 25 publications

References 26 publications

Assessment of Myocardial Perfusion by Harmonic Power Doppler Imaging at Rest and During Adenosine Triphosphate Stress

Assessment of Myocardial Perfusion by Harmonic Power Doppler Imaging at Rest and During Adenosine Triphosphate Stress

Quantitative Myocardial Contrast Echocardiography in Coronary Artery Disease

Tissue Inflammation Impairs Tissue-Level Perfusion and Promotes Left Ventricular Remodeling in Patients With Acute Myocardial Infarction

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