Author + information
- Received October 27, 1982
- Revision received February 16, 1983
- Accepted February 16, 1983
- Published online July 1, 1983.
- William F. Armstrong, MD, FACC*,1,
- Steven R. West, MD,
- Thomas M. Mueller, MD, FACC,
- James C. Dillon, MD, FACC and
- Harvey Feigenbaum, MD, FACC
- ↵*Address for reprints: William F. Armstrong, MD, Indiana University School of Medicine, University Hospital N562, 926 West Michigan Street, Indianapolis, Indiana 46223.
The ability of contrast-enhanced echocardiography to localize and quantify myocardial infarction was studied in 16 open chest dogs. Both routine and contrast-enhanced two-dimensional echocardiograms were recorded at baseline and 4 hours after occlusion of the left anterior descending (n = 11) or circumflex (n = 5) coronary artery. Ultrasound contrast was produced by injection into the aortic root of 3 ml of 0.3% hydrogen peroxide mixed with 6 ml blood. Systolic wall thickening was also measured and quantified as a marker of myocardial infarction. Dogs were sacrificed after 4 hours of coronary occlusion. The slice of the left ventricle that corresponded to the two-dimensional echocardiogram was stained with nitro-blue tetrazolium to localize the infarct. The size of the myocardial infarct was determined by planimetry.
The oxygen bubbles produced by mixing hydrogen peroxide with blood produced an excellent intramyo-cardial ultrasound contrast effect. Complete data were available in 12 dogs. Contrast echocardiography accurately localized the infarction in all 11 dogs with an infarct documented by nitro-blue tetrazolium. The area of the infarct, determined by planimetry and expressed as a fraction of total myocardial area from the nitro-blue tetrazolium study, correlated well with the size of the infarct determined with contrast echocardiography (correlation coefficient [r] = 0.92, standard error of the estimate [SEE] = 0.05, probability [p] < 0.001). Intra-and interobserver correlations were excellent for the determination of fraction of infarcted myocardium by contrast echocardiography (r = 0.93, p < 0.001, SEE = 0.04; r = 0.89, p < 0.001, SEE = 0.07, respectively). Absence of systolic wall thickening also accurately localized myocardial infarction, but correlated poorly with the extent of infarction (r = 0.29, p = not significant).
It is concluded that contrast-enhanced two-dimensional echocardiography, using a combination of hydrogen peroxide and blood to provide ultrasound contrast, accurately and reproducibly localizes and quantifies myocardial infarction.
↵1 Dr. Armstrong is a recipient of a Clinical Investigator Award from the National Heart, Lung, and Blood Institute.
This study was supported in part by the Herman C. Krannert Fund, Indianapolis; Grants HL-06308 and HL-07182 from the National Heart, Lung, and Blood Institute. National Institutes of Health, Bethesda, Maryland; the American Heart Association, Marion County Chapter and Indiana Affiliate, Indianapolis; and a Grant-in-Aid from the Whitaker Foundation, Camp Hill, Pennsylvania.
- Received October 27, 1982.
- Revision received February 16, 1983.
- Accepted February 16, 1983.
- American College of Cardiology Foundation