Author + information
- Received February 4, 1985
- Revision received May 23, 1985
- Accepted May 31, 1985
- Published online September 1, 1985.
- Linda D. Gillam, MD, FACCa,
- Sanjiv Kaul, MD,
- John T. Fallon, MD, PhD,
- Robert A. Levine, MD,
- E. Tessa Hedley-Whyte, MD,
- J. Luis Guerrero and
- Arthur E. Weyman, MD, FACC
- ↵aAddress for reprints: Linda D. Gillam, MD, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.
Myocardial contrast echocardiography can define in vivo the area at risk for necrosis after coronary occlusion. However, if this technique is to be used, it cannot be intrinsically toxic to the heart or other critical organs. To determine the functional and pathologic effects of contrast echocardiography, six intracoronary, six intrarenal and six intracarotid artery injections of 2 to 6 cc of a commonly employed contrast agent (agitated Renografin-saline solution) were performed in five dogs. A sixth dog served as a sham to assess any deleterious effects of the model preparation. Two-dimensional echocardiographic images and electrocardiograms were recorded during intracoronary injections, and heart rate, blood pressure, left ventricular end-diastolic pressure and rate of rise of left ventricular pressure (dP/dt) were continuously monitored. At 24 hours, echocardiographic and hemodynamic measurements were repeated, the dogs were killed and the heart, brain and kidneys were removed and prepared for light microscopic examination. Quantitative analysis of left ventricular wall motion was performed on control, peak contrast, post-contrast and 24 hour studies.
With each intracoronary injection, there were transient decreases in blood pressure (p = 0.05 versus control) and increases in left ventricular end-diastolic pressure (p = 0.04 versus control). These were associated with depression of wall motion in contrast-enhanced regions (p = 0.01 versus control) and ST-T segment changes on the electrocardiogram. No significant change in heart rate or left ventricular dP/dt was noted. All variables normalized with the clearance of the contrast effect and remained normal to 24 hours. Light microscopic examination revealed no myocardial or cerebral changes attributable to the contrast agent injections. In three kidneys there were nonspecific changes consistent with an osmotic diuresis.
It is concluded that repeated injections of echocardiographic contrast medium do not appear to cause permanent cardiac functional disturbances or light microscopic evidence of cardiac, renal or cerebral injury, despite dramatic acute depression of regional myocardial function at the time of contrast effect.
This study was presented in part at the 57th Annual Scientific Sessions of the American Heart Association, November 1984, Miami Beach, Florida.
- Received February 4, 1985.
- Revision received May 23, 1985.
- Accepted May 31, 1985.
- American College of Cardiology Foundation