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Detection of myocardial viability

The evidence for use of contrast in clinical echocardiography: Myocardial Contrast Echocardiography – MCE


Myocardial viability in dysfunctional LV segments is dependent upon maintenance/presence of an intact microcirculation [46]. It has been shown that, in such segments, peak contrast intensity reflects microvascular density and is inversely related to collagen content (i.e. fibrotic scar) [47]. MCE can predict functional recovery following acute MI [48] and is comparable to CMR imaging in this regard [49].

Myocardial response to dobutamine (i.e. contractile reserve) requires presence of both intact contractile proteins but also coronary flow reserve and thus it may be a less sensitive technique than MCE for detection of hibernating myocardium [16]. Initial studies have indicated that MCE may be more sensitive – and as specific – as low-dose DSE for detection of myocardial hibernation [50-51].

Study Imaging technique Patients (n) MCE Sensitivity MCE Specificity
Sbano et al [52] High MI 50 95 52
Senior et al [53] High MI 96 62 83
Aggeli et al [54] High MI 34 88 61
Hillis et al [55] Low MI 33 86 44
Main et al [56] Low MI 46 69 85
Swinburn et al [57] Low MI 19 68 88
Hillis et al [58] High MI 35 80 67
Lepper et al [59] High MI 35 94 87
Janardhanan et al [49] Low MI 42 82 83
Hickman et al [60] Low MI 56 83 78
Greaves et al [61] Low MI 15 88 74
Janardhanan et al [48] Low MI 50 92 75
Shimoni et al [50] High MI 18 90 63
Hickman et al [51] Low MI 23 87 67
Agati et al [62] High MI 23 100 90
Huang et al [63] Low MI 34 83 82
Bolognese et al [64] High MI 30 96 18
Abe et al [65] High MI 31 98 32
Kousouglou et al [66] Low MI 32 81 88
MEAN     85 70

Table 2: A summary of the published evidence for use of resting MCE for prediction of myocardial viability – from Senior et al [16].

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16. Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, et al. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. Eur J Echocardiogr 2009;10(2):194-212
46. Ragosta M, Camarano G, Kaul S, Powers ER, Sarembock IJ, Gimple LW. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation 1994;89(6):2562-9
47. Shimoni S, Frangogiannis NG, Aggeli CJ, Shan K, Quinones MA, Espada R, et al. Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction: implications for the assessment of myocardial hibernation. Circulation 2002;106(8):950-6
48. Janardhanan R, Swinburn JM, Greaves K, Senior R. Usefulness of myocardial contrast echocardiography using low-power continuous imaging early after acute myocardial infarction to predict late functional left ventricular recovery. Am J Cardiol 2003;92(5):493-7
49. Janardhanan R, Moon JC, Pennell DJ, Senior R. Myocardial contrast echocardiography accurately reflects transmurality of myocardial necrosis and predicts contractile reserve after acute myocardial infarction. Am Heart J 2005;149(2):355-62
50. Shimoni S, Frangogiannis NG, Aggeli CJ, Shan K, Verani MS, Quinones MA, et al. Identification of hibernating myocardium with quantitative intravenous myocardial contrast echocardiography: comparison with dobutamine echocardiography and thallium-201 scintigraphy. Circulation 2003;107(4):538-44
51. Hickman M, Chelliah R, Burden L, Senior R. Resting myocardial blood flow, coronary flow reserve, and contractile reserve in hibernating myocardium: implications for using resting myocardial contrast echocardiography vs. dobutamine echocardiography for the detection of hibernating myocardium. Eur J Echocardiogr 2010