Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size

Ping Zeng; Lijun Qian; John Lof; Elizabeth Stolze; Soufiane El Kadi; Thomas Bargar; Jiri Sklenar; Terry Matsunaga; Feng Xie; Thomas R Porter

doi:https://doi.org/10.1016/j.echo.2021.02.019

Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size

Ping Zeng, Lijun Qian, John Lof, Elizabeth Stolze, Soufiane El Kadi, Thomas Bargar, Jiri Sklenar, Terry Matsunaga, Feng Xie, Thomas R Porter

Research output: Contribution to journal › Article › Academic › peer-review

4 Citations (Scopus)

Abstract

BACKGROUND: Perfluoropropane droplets formulated from commercial microbubbles exhibit different acoustic characteristics than their parent microbubbles, most likely from enhanced endothelial permeability. This enhanced permeability may permit delayed echo-enhancement imaging (DEEI) similar to delayed enhancement magnetic resonance imaging (DE-MRI). We hypothesized this would allow detection and quantification of myocardial scar.

METHODS: In 15 pigs undergoing 90 minutes of left anterior descending ischemia by either balloon (n = 13) or thrombotic occlusion (n = 2), DE-MRI was performed at 2-24 days postocclusion. Delayed echo-enhancement imaging was performed at 2-4 minutes following an intravenous injection of 1 mL of 50% Definity (Lantheus Medical) compressed into 180 nm droplets; DEEI was attempted in all pigs with single-pulse harmonic imaging at 1.7 transmit/3.4 MHz receive. Myocardial defects observed with DEEI were quantified (percentage of infarct area) and compared with DE-MRI as well as postmortem staining. In six pigs, multipulse low-mechanical index (MI) fundamental nonlinear imaging (FNLI) with intermittent high-MI impulses was performed to determine whether droplet activation within the infarct zone was achievable with a longer pulse duration.

RESULTS: The range of infarct size area by DE-MRI ranged from 0% to 46% of total left ventricular area. Single-pulse harmonic imaging detected a contrast defect that correlated closely with infarct area by DE-MRI (r = 0.81, P = .0001). The FNLI high-MI impulses resulted in droplet activation in both the infarct and normal zones. Harmonic subtraction of the FNLI images resulted in infarct zone enhancement that also correlated closely with infarct size (r = 0.83; P = .04). Droplets were observed on postmortem transmission electron microscopy within myocytes of the infarct and remote normal zone.

CONCLUSION: Intravenously Definity nanodroplets can be utilized to detect and quantify infarct zone at the bedside using DEEI techniques.

Original language	English
Pages (from-to)	898-909
Number of pages	12
Journal	Journal of the American Society of Echocardiography
Volume	34
Issue number	8
DOIs	https://doi.org/10.1016/j.echo.2021.02.019
Publication status	Published - Aug 2021

Keywords

Contrast
Imaging
Mechanical index
Myocardial infarction

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@article{a31d659d832646f8839ee2c310f7f7c3,

title = "Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size",

abstract = "BACKGROUND: Perfluoropropane droplets formulated from commercial microbubbles exhibit different acoustic characteristics than their parent microbubbles, most likely from enhanced endothelial permeability. This enhanced permeability may permit delayed echo-enhancement imaging (DEEI) similar to delayed enhancement magnetic resonance imaging (DE-MRI). We hypothesized this would allow detection and quantification of myocardial scar.METHODS: In 15 pigs undergoing 90 minutes of left anterior descending ischemia by either balloon (n = 13) or thrombotic occlusion (n = 2), DE-MRI was performed at 2-24 days postocclusion. Delayed echo-enhancement imaging was performed at 2-4 minutes following an intravenous injection of 1 mL of 50% Definity (Lantheus Medical) compressed into 180 nm droplets; DEEI was attempted in all pigs with single-pulse harmonic imaging at 1.7 transmit/3.4 MHz receive. Myocardial defects observed with DEEI were quantified (percentage of infarct area) and compared with DE-MRI as well as postmortem staining. In six pigs, multipulse low-mechanical index (MI) fundamental nonlinear imaging (FNLI) with intermittent high-MI impulses was performed to determine whether droplet activation within the infarct zone was achievable with a longer pulse duration.RESULTS: The range of infarct size area by DE-MRI ranged from 0% to 46% of total left ventricular area. Single-pulse harmonic imaging detected a contrast defect that correlated closely with infarct area by DE-MRI (r = 0.81, P = .0001). The FNLI high-MI impulses resulted in droplet activation in both the infarct and normal zones. Harmonic subtraction of the FNLI images resulted in infarct zone enhancement that also correlated closely with infarct size (r = 0.83; P = .04). Droplets were observed on postmortem transmission electron microscopy within myocytes of the infarct and remote normal zone.CONCLUSION: Intravenously Definity nanodroplets can be utilized to detect and quantify infarct zone at the bedside using DEEI techniques.",

keywords = "Contrast, Imaging, Mechanical index, Myocardial infarction",

author = "Ping Zeng and Lijun Qian and John Lof and Elizabeth Stolze and {El Kadi}, Soufiane and Thomas Bargar and Jiri Sklenar and Terry Matsunaga and Feng Xie and Porter, {Thomas R}",

note = "Funding Information: This study was supported by National Institutes of Health, United States Application 1 RO1 HL 146489-01A1 with additional support from the Theodore F. Hubbard Foundation . Publisher Copyright: {\textcopyright} 2021 American Society of Echocardiography",

year = "2021",

month = aug,

doi = "https://doi.org/10.1016/j.echo.2021.02.019",

language = "English",

volume = "34",

pages = "898--909",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

publisher = "Mosby Inc.",

number = "8",

}

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T1 - Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size

AU - Zeng, Ping

AU - Qian, Lijun

AU - Lof, John

AU - Stolze, Elizabeth

AU - El Kadi, Soufiane

AU - Bargar, Thomas

AU - Sklenar, Jiri

AU - Matsunaga, Terry

AU - Xie, Feng

AU - Porter, Thomas R

N1 - Funding Information: This study was supported by National Institutes of Health, United States Application 1 RO1 HL 146489-01A1 with additional support from the Theodore F. Hubbard Foundation . Publisher Copyright: © 2021 American Society of Echocardiography

PY - 2021/8

Y1 - 2021/8

N2 - BACKGROUND: Perfluoropropane droplets formulated from commercial microbubbles exhibit different acoustic characteristics than their parent microbubbles, most likely from enhanced endothelial permeability. This enhanced permeability may permit delayed echo-enhancement imaging (DEEI) similar to delayed enhancement magnetic resonance imaging (DE-MRI). We hypothesized this would allow detection and quantification of myocardial scar.METHODS: In 15 pigs undergoing 90 minutes of left anterior descending ischemia by either balloon (n = 13) or thrombotic occlusion (n = 2), DE-MRI was performed at 2-24 days postocclusion. Delayed echo-enhancement imaging was performed at 2-4 minutes following an intravenous injection of 1 mL of 50% Definity (Lantheus Medical) compressed into 180 nm droplets; DEEI was attempted in all pigs with single-pulse harmonic imaging at 1.7 transmit/3.4 MHz receive. Myocardial defects observed with DEEI were quantified (percentage of infarct area) and compared with DE-MRI as well as postmortem staining. In six pigs, multipulse low-mechanical index (MI) fundamental nonlinear imaging (FNLI) with intermittent high-MI impulses was performed to determine whether droplet activation within the infarct zone was achievable with a longer pulse duration.RESULTS: The range of infarct size area by DE-MRI ranged from 0% to 46% of total left ventricular area. Single-pulse harmonic imaging detected a contrast defect that correlated closely with infarct area by DE-MRI (r = 0.81, P = .0001). The FNLI high-MI impulses resulted in droplet activation in both the infarct and normal zones. Harmonic subtraction of the FNLI images resulted in infarct zone enhancement that also correlated closely with infarct size (r = 0.83; P = .04). Droplets were observed on postmortem transmission electron microscopy within myocytes of the infarct and remote normal zone.CONCLUSION: Intravenously Definity nanodroplets can be utilized to detect and quantify infarct zone at the bedside using DEEI techniques.

AB - BACKGROUND: Perfluoropropane droplets formulated from commercial microbubbles exhibit different acoustic characteristics than their parent microbubbles, most likely from enhanced endothelial permeability. This enhanced permeability may permit delayed echo-enhancement imaging (DEEI) similar to delayed enhancement magnetic resonance imaging (DE-MRI). We hypothesized this would allow detection and quantification of myocardial scar.METHODS: In 15 pigs undergoing 90 minutes of left anterior descending ischemia by either balloon (n = 13) or thrombotic occlusion (n = 2), DE-MRI was performed at 2-24 days postocclusion. Delayed echo-enhancement imaging was performed at 2-4 minutes following an intravenous injection of 1 mL of 50% Definity (Lantheus Medical) compressed into 180 nm droplets; DEEI was attempted in all pigs with single-pulse harmonic imaging at 1.7 transmit/3.4 MHz receive. Myocardial defects observed with DEEI were quantified (percentage of infarct area) and compared with DE-MRI as well as postmortem staining. In six pigs, multipulse low-mechanical index (MI) fundamental nonlinear imaging (FNLI) with intermittent high-MI impulses was performed to determine whether droplet activation within the infarct zone was achievable with a longer pulse duration.RESULTS: The range of infarct size area by DE-MRI ranged from 0% to 46% of total left ventricular area. Single-pulse harmonic imaging detected a contrast defect that correlated closely with infarct area by DE-MRI (r = 0.81, P = .0001). The FNLI high-MI impulses resulted in droplet activation in both the infarct and normal zones. Harmonic subtraction of the FNLI images resulted in infarct zone enhancement that also correlated closely with infarct size (r = 0.83; P = .04). Droplets were observed on postmortem transmission electron microscopy within myocytes of the infarct and remote normal zone.CONCLUSION: Intravenously Definity nanodroplets can be utilized to detect and quantify infarct zone at the bedside using DEEI techniques.

KW - Contrast

KW - Imaging

KW - Mechanical index

KW - Myocardial infarction

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U2 - https://doi.org/10.1016/j.echo.2021.02.019

DO - https://doi.org/10.1016/j.echo.2021.02.019

M3 - Article

C2 - 33711458

SN - 0894-7317

VL - 34

SP - 898

EP - 909

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

IS - 8

ER -

Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size

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Keywords

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