Observation of the ischemic cascade in humans using contrast echocardiography during dobutamine stress.

Experimental studies have postulated the ischemic cascade and the present study was designed to elucidate whether it can be observed in the clinical setting. Fifty-three patients suspected of having coronary artery disease were studied. Myocardial perfusion abnormalities (MPA) and wall motion abnormalities (WMA) were assessed simultaneously by infusion of Levovist during dobutamine stress echocardiography. Time - intensity data of myocardial opacification were fitted for Y=A (1-e(-)(beta) (t)) from which the rate of increase (beta) of intensity were derived both at rest and during stress. Wall motion was also given a score. Bright opacification was observed in 50 patients: 25 showed significant stenosis (>50%) in the left anterior descending artery (group II) on coronary angiography and 25 did not (group I). Significant differences were found in the beta ratio (stress/rest) between the 2 groups at a low-dose (2.0+/-0.3 vs 1.5+/-0.5, p<0.05) and at a high-dose of dobutamine (2.7+/-1.0 vs 1.1+/-0.5, p<0.001), whereas the wall motion score differed only at a high-dose. Of the 25 patients in group II, MPA preceded WMA in 12, both occurred at the same stage in 12, and neither MPA nor WMA was seen in 1. These data prove the ischemic cascade clinically, using contrast echocardiography, by demonstrating that MPA precede WMA during dobutamine stress in patients with coronary stenosis.

[1]  M. Yoshiyama,et al.  Lipoprotein (a) is not part of the acute phase response , 2003, Heart.

[2]  J Yoshikawa,et al.  Changes in transmural distribution of myocardial perfusion assessed by quantitative intravenous myocardial contrast echocardiography in humans , 2002, Heart.

[3]  A. DeMaria,et al.  Assessment of coronary stenoses of graded severity by myocardial contrast echocardiography. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  S. Kaul,et al.  Perfusion Versus Function: The Ischemic Cascade in Demand Ischemia: Implications of Single-Vessel Versus Multivessel Stenosis , 2002, Circulation.

[5]  T. Porter,et al.  Endocardial Border Delineation during Dobutamine Infusion Using Contrast Echocardiography , 2002, Echocardiography.

[6]  T. Sakuma,et al.  Quantification of myocardial perfusion and determination of coronary stenosis severity during hyperemia using real-time myocardial contrast echocardiography. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[7]  M. Kern,et al.  Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients. , 2001, American heart journal.

[8]  Jeroen J. Bax,et al.  Clinical and angiographic correlates of dobutamine-induced wall motion patterns after myocardial infarction. , 2001, The American journal of cardiology.

[9]  D. Burkhoff,et al.  Assessment of left ventricular systolic function using contrast two-dimensional echocardiography with a high-frequency transducer in the awake murine model of myocardial infarction. , 2001, Japanese circulation journal.

[10]  S. Kaul,et al.  Noninvasive Quantification of Coronary Blood Flow Reserve in Humans Using Myocardial Contrast Echocardiography , 2001, Circulation.

[11]  New developments in echocardiography: impact on coronary artery disease. , 2001, Japanese circulation journal.

[12]  A. DeMaria,et al.  Quantitative assessment of myocardial perfusion during graded coronary stenosis by real-time myocardial contrast echo refilling curves. , 2001, Journal of the American College of Cardiology.

[13]  P. Steg,et al.  Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery , 1999, Heart.

[14]  U. Deligonul,et al.  Correlation between quantitative angiographic lesion severity and myocardial contrast intensity during a continuous infusion of perfluorocarbon-containing microbubbles. , 1998, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[15]  Relation of Contrast Echo Intensity and Flow Velocity to the Amplification of Contrast Opacification Produced by Intermittent Ultrasound Transmission , 1998 .

[16]  A R Jayaweera,et al.  Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. , 1998, Circulation.

[17]  S. Kaul.  Myocardial contrast echocardiography: 15 years of research and development. , 1997, Circulation.

[18]  S. Kaul,et al.  Relation between air-filled albumin microbubble and red blood cell rheology in the human myocardium. Influence of echocardiographic systems and chest wall attenuation. , 1996, Circulation.

[19]  J. Seward,et al.  Second harmonic imaging of an intravenously administered echocardiographic contrast agent: Visualization of coronary arteries and measurement of coronary blood flow. , 1996, Journal of the American College of Cardiology.

[20]  T. Marwick,et al.  Dobutamine-induced wall motion abnormalities: correlations with myocardial fractional flow reserve and quantitative coronary angiography. , 1996, Journal of the American College of Cardiology.

[21]  R. Senior,et al.  Enhanced detection of myocardial ischemia by stress dobutamine echocardiography utilizing the "biphasic" response of wall thickening during low and high dose dobutamine infusion. , 1995, Journal of the American College of Cardiology.

[22]  S. Kaul,et al.  In vivo myocardial kinetics of air-filled albumin microbubbles during myocardial contrast echocardiography. Comparison with radiolabeled red blood cells. , 1994, Circulation research.

[23]  J. Roelandt,et al.  Akinesis becoming dyskinesis during high-dose dobutamine stress echocardiography: a marker of myocardial ischemia or a mechanical phenomenon? , 1994, The American journal of cardiology.

[24]  Stephen E. Brown,et al.  Echocardiographic Detection of Coronary Artery Disease During Dobutamine Infusion , 1991, Circulation.

[25]  R. Nesto,et al.  The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. , 1987, The American journal of cardiology.

[26]  G. Timmis,et al.  Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. , 1985, Journal of the American College of Cardiology.