Visualization and quantification of myocardial mass at risk using three- dimensional contrast echocardiography

Objective: Three-dimensional echocardiographic assessment of myocardial ischemia using contrast echocardiography has been hampered by limitations of available contrast agents and analytic software. In the study presented, a three-dimensional perfusion imaging method was evaluated in the porcine model of myocardial ischemia using a novel contrast agent. Methods: Three- dimensional echocardiography was performed in eight open-chested pigs before, during and after left anterior descending (six animals) or circumflex (two animals) coronary artery occlusion. The intramyocardial contrast effect was obtained by left atrial injection of Myomap(TM), a deposit contrast agent. Results: Myocardial opacification was visible in all studies and retained in all three-dimensional-datasets. Threedimensional intensity analysis demonstrated a significant difference, exceeding 20 intensity units in every animal (in 127-level scale), between perfused and non-perfused myocardium. Reperfusion followed by contrast reinjection resulted in homogenous myocardial enhancement. Myocardial mass at risk was clearly delineated in all studies and measured with a mean error of -0.1±2.0 g against real mass (p=non-significant). Spatial extent of ischemia could be displayed in volume- rendered reconstruction of separate perfusion territories. Conclusions: Quantitative analysis of myocardial contrast enhancement from three- dimensional datasets is feasible and allows accurate measurement of myocardial mass at risk.

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