Real Time 3D Contrast Echocardiography for Assessment of Perfusion Defects

用于评估灌注缺陷的实时 3D 超声心动图对比

• 批准号: 6228025
• 负责人: JULIO PANZA
• 金额: --
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6228025
• 关键词: bioimaging /biomedical imaging; cardiovascular imaging /visualization; contrast media; coronary artery; coronary disorder; diagnosis design /evaluation; disease /disorder model; echocardiography; heart dimension /size; heart disorder diagnosis; myocardial ischemia /hypoxia; noninvasive diagnosis; sheep

Non-invasive assessment of perfusion defects with myocardial contrast echocardiography can potentially be a valuable tool in the evaluation of patients with coronary artery disease. However, quantification of under-perfused myocardium with two-dimensional echocardiography has intrinsic limitations due to the restricted number of standard imaging planes. Real-time three-dimensional echocardiography (RT3D echo) is a novel technique that provides volumetric images without ECG or respiratory gating. The aim of this study was to validate the use of RT3D echo for the quantitative assessment of myocardial perfusion defects in an in vivo model of acute coronary occlusion. To this end, 20 sheep underwent acute ligation of the left anterior descending (n=14) or the posterior branch of the circumflex (n=6) artery under general anesthesia. RT3D echo images were obtained after coronary occlusion and left atrial injection of a contrast agent (perflenapent emulsion or Echogen?; 0.8-1 ml). After image acquisition, Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of under-perfused myocardium. The mass of the entire left ventricle (LV) and of the under-perfused myocardial region were directly measured following euthanasia. Blinded off-line calculation of LV mass and perfusion defect mass from RT3D echo images were performed using an interactive aided manual tracing technique based on a Silicon Graphics workstation with customized software. Total LV mass ranged from 68 to 141 g (mean+/-SD: 92+/-24). The mass of the perfusion defect ranged from 0 to 43 g (mean+/-SD: 16+/-9) or 0 to 36% of total LV mass (mean+/-SD: 18+/-9%). RT3D echo estimation of total LV mass strongly correlated with the anatomic measurement (r=0.91; y=- 2.54+1.04x; SEE= 11.9 g). RT3D echo calculation of the mass of under- perfused myocardium also strongly correlated with the anatomic measurement, both in absolute (r=0.96; y= 2.01+0.87x; SEE= 2.2g) and percent (r=0.96; y= 0.11+1.02x; SEE= 2.8%) terms. Thus, RT3D echo with myocardial contrast opacification accurately predicts the amount of under-perfused myocardium in an animal model of acute coronary occlusion. This technique may therefore be useful for the quantitative assessment of myocardial perfusion defects in patients with coronary artery disease. - three-dimensional echocardiography; myocardial perfusion; coronary circulation

心肌造影超声心动图无创评估灌注缺陷可能是评估冠状动脉疾病患者的一种有价值的工具。然而，由于标准成像平面的数量有限，二维超声心动图对灌注不足心肌的定量存在固有的局限性。实时三维超声心动图（RT3D回声）是一种不需要心电图或呼吸门控就能提供体积图像的新技术。本研究的目的是验证RT3D回声在急性冠状动脉闭塞模型心肌灌注缺陷定量评估中的应用。为此，在全身麻醉下对20只羊进行了左前降支（n=14）或旋动脉后支（n=6）的急性结扎。冠状动脉闭塞后左心房注射造影剂（渗透乳剂或Echogen? 0.8 ~ 1ml），获得RT3D回声图像。图像采集完成后，将Evans蓝色染料注射到闭塞的冠状动脉中，对灌注不足的心肌进行解剖鉴定。在安乐死后直接测量整个左心室（LV）和心肌灌注不足区域的质量。采用基于Silicon Graphics工作站的交互式辅助人工跟踪技术，使用定制软件，对RT3D回波图像进行盲法离线计算左室质量和灌注缺陷质量。左室总质量为68 ~ 141 g（平均±sd: 92±24）。灌注缺损的质量范围为0 ~ 43g（平均+/-SD: 16+/-9）或占左室总质量的0 ~ 36%（平均+/-SD: 18+/-9%）。RT3D回声估计的左室总质量与解剖测量有很强的相关性（r=0.91; y=- 2.54+1.04x； SEE= 11.9 g）。RT3D回声计算灌注不足心肌的质量与解剖测量也有很强的相关性，无论是绝对（r=0.96; y= 2.01+0.87x； SEE= 2.2g）还是百分比（r=0.96; y= 0.11+1.02x； SEE= 2.8%）。因此，在急性冠状动脉闭塞动物模型中，RT3D回声与心肌造影剂混浊可以准确预测灌注不足心肌的数量。因此，该技术可用于冠状动脉疾病患者心肌灌注缺陷的定量评估。-三维超声心动图；心肌灌注;冠状循环