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Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion.

Publication ,  Journal Article
Wu, KC; Kim, RJ; Bluemke, DA; Rochitte, CE; Zerhouni, EA; Becker, LC; Lima, JA
Published in: J Am Coll Cardiol
November 15, 1998

OBJECTIVES: 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.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 15, 1998

Volume

32

Issue

6

Start / End Page

1756 / 1764

Location

United States

Related Subject Headings

  • Time Factors
  • Thiazoles
  • Tetrazolium Salts
  • Myocardial Reperfusion Injury
  • Myocardial Infarction
  • Microspheres
  • Microcirculation
  • Magnetic Resonance Imaging
  • Fluorescent Dyes
  • Echocardiography
 

Citation

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Wu, K. C., Kim, R. J., Bluemke, D. A., Rochitte, C. E., Zerhouni, E. A., Becker, L. C., & Lima, J. A. (1998). Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. J Am Coll Cardiol, 32(6), 1756–1764. https://doi.org/10.1016/s0735-1097(98)00429-x
Wu, K. C., R. J. Kim, D. A. Bluemke, C. E. Rochitte, E. A. Zerhouni, L. C. Becker, and J. A. Lima. “Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion.J Am Coll Cardiol 32, no. 6 (November 15, 1998): 1756–64. https://doi.org/10.1016/s0735-1097(98)00429-x.
Wu, K. C., et al. “Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion.J Am Coll Cardiol, vol. 32, no. 6, Nov. 1998, pp. 1756–64. Pubmed, doi:10.1016/s0735-1097(98)00429-x.
Wu KC, Kim RJ, Bluemke DA, Rochitte CE, Zerhouni EA, Becker LC, Lima JA. Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. J Am Coll Cardiol. 1998 Nov 15;32(6):1756–1764.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 15, 1998

Volume

32

Issue

6

Start / End Page

1756 / 1764

Location

United States

Related Subject Headings

  • Time Factors
  • Thiazoles
  • Tetrazolium Salts
  • Myocardial Reperfusion Injury
  • Myocardial Infarction
  • Microspheres
  • Microcirculation
  • Magnetic Resonance Imaging
  • Fluorescent Dyes
  • Echocardiography