Power Doppler dual-frame triggering of myocardial contrast echocardiography: a quantitative video intensity analysis

AIM

The purpose of this study was to define the pattern of myocardial contrast observed during triggered dual-frame power Doppler imaging.

METHODS AND RESULTS

Ten patients with no previous history of myocardial infarction underwent a continuous intravenous infusion of Optison at 0.5 ml/min. Triggered, sequential dual-frame power Doppler imaging was performed from an apical four-chamber view using a prototype Acuson Sequoia imaging system. The average triggering interval was once every four cardiac cycles, and the average interval between sequential frames was 50 msec. Video intensity analysis was performed in five myocardial regions of interest, and the percent decrease in video intensity of the destruction frames in each region of interest was determined by subtracting the destruction frame video intensity from the fill frame video intensity. The percent decrease in video intensity varied significantly by myocardial location (P < 0.001), with greater destruction seen in the apical than in the basal regions.

CONCLUSION

This preliminary study demonstrates that power Doppler dual-frame triggering produces nonuniform decreases in video intensity, which likely represent nonuniform microbubble destruction. These results have important implications for the interpretation of myocardial perfusion patterns using this technique.

Doppler-derived dP/dt and -dP/dt predict survival in congestive heart failure

OBJECTIVES

The purpose of this study was to evaluate the ability of novel Doppler indices of left ventricular (LV) systolic and diastolic function to predict survival in patients with congestive heart failure (CHF).

BACKGROUND

Congestive heart failure is associated with an increased risk of death or cardiac transplantation, yet techniques to predict survival are limited.

METHODS

Doppler-derived dP/dt and - dP/dt were determined prospectively from the continuous-wave Doppler spectrum of the mitral regurgitation jet (dP/dt = 32/time between 1 and 3 m/s; -dP/dt = 32/time between 3 and 1 m/s) in 56 patients with chronic CHF (age, 60 +/- 15 years; LV ejection fraction, 23 +/- 9%). Baseline clinical and echocardiographic variables were also obtained, and clinical follow-up was performed in all patients.

RESULTS

Twenty-four patients experienced a primary event of cardiac death (n = 15), United Network for Organ Sharing status I (inotrope-dependent) heart transplant (n = 3) or urgent implantation of a LV assist device (n = 6). Doppler-derived dP/dt (dichotomized to > or = or <600 mm Hg/s; p = 0.0002) and -dP/dt (trichotomized to <450, 450 to 550 and >550 mm Hg/s; p = 0.0001) predicted event-free survival, as did Doppler-derived risk groups determined by the combination of the two (low risk, dP/dt > or = 600; intermediate risk, dP/dt < 600 and -dP/dt > or = 450; high risk, dP/dt < 600 and -dP/dt < 450; p = 0.0001). Multivariable analysis revealed Doppler-derived risk groups, intravenous inotrope requirement and blood urea nitrogen as significant independent predictors of outcome.

CONCLUSION

New Doppler indices of dP/dt, - dP/dt and risk groups defined by the combination of dP/dt and -dP/dt predict event-free survival in patients with CHF.

Potassium channel antagonists and vascular reactivity in stroke-prone spontaneously hypertensive rats

The goal of this study was to characterize differences in contractile responsiveness to several potassium channel antagonists in vascular smooth muscle from stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar-Kyoto normotensive rats (WKY). Helically-cut strips of carotid arteries (endothelium removed) from SHRSP and WKY were mounted in muscle baths for measurement of isometric force generation. Contractile responses to tetraethylammonium (10(-4) to 3 x 10(-2) mol/L) and barium (3 x 10(-5) mol/L), blockers of the voltage-dependent and large conductance, calcium activated potassium channels, were greater in carotid arteries from SHRSP than in those from WKY. In contrast, contractile responses to the voltage-dependent potassium channel blockers 3,4-diamino-pyridine (10(-6) to 3 x 10(-3) mol/L) and sparteine (10(-6) to 3 x 10(-2) mol/L) in arteries from SHRSP did not differ from WKY values. Carotid arteries from SHRSP and WKY did not contract to apamin (10(-9) to 10(-6) mol/L), an antagonist of the small conductance, calcium activated potassium channel. Furthermore, relaxation responses to diazoxide (3 x 10(-4) mol/L), an activator of the ATP-sensitive potassium channel, and subsequent contractions to the ATP-sensitive potassium channel blocker glyburide (10(-8) to 3 x 10(-6) mol/L) in arteries from SHRSP did not differ from WKY values. Carotid artery segments from SHRSP were more sensitive to the contractile effects of elevated potassium than those from WKY. We conclude that altered activity of the large conductance, calcium activated potassium channel may play a role in the increased responsiveness observed in arteries from SHRSP.