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European Heart Journal Advance Access published online on October 5, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi585
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received June 13, 2005
Revised July 28, 2005
Accepted September 22, 2005

Clinical research

Collateral-flow measurements in humans by myocardial contrast echocardiography: validation of coronary pressure-derived collateral-flow assessment

Rolf Vogel 1, Rainer Zbinden 1, Andreas Indermühle 1, Stephan Windecker 1, Bernhard Meier 1, and Christian Seiler 1*

1 Department of Cardiology, University Hospital Bern, CH-3010 Bern, Switzerland

* To whom correspondence should be addressed.
Christian Seiler, E-mail: christian.seiler.cardio{at}insel.ch


  Abstract

Aims Myocardial blood flow (MBF) is the gold standard to assess myocardial blood supply and, as recently shown, can be obtained by myocardial contrast echocardiography (MCE). The aims of this human study are (i) to test whether measurements of collateral-derived MBF by MCE are feasible during elective angioplasty and (ii) to validate the concept of pressure-derived collateral-flow assessment.

Methods and results Thirty patients with stable coronary artery disease underwent MCE of the collateral-receiving territory during and after angioplasty of 37 stenoses. MCE perfusion analysis was successful in 32 cases. MBF during and after angioplasty varied between 0.060-0.876 mL min-1 g-1 (0.304 ± 0.196 mL min-1 g-1) and 0.676-1.773 mL min-1 g-1 (1.207 ± 0.327 mL min-1 g-1), respectively. Collateral-perfusion index (CPI) is defined as the rate of MBF during and after angioplasty varied between 0.05 and 0.67 (0.26 ± 0.15). During angioplasty, simultaneous measurements of mean aortic pressure, coronary wedge pressure, and central venous pressure determined the pressure-derived collateral-flow index (CFIp), which varied between 0.04 and 0.61 (0.23 ± 0.14). Linear-regression analysis demonstrated an excellent agreement between CFIp and CPI (y = 0.88x + 0.01; r2 = 0.92; P < 0.0001).

Conclusion Collateral-derived MBF measurements by MCE during angioplasty are feasible and proved that the pressure-derived CFI exactly reflects collateral relative to normal myocardial perfusion in humans.

Keywords: Coronary circulation; Collateral circulation; Collateral flow index; Myocardial blood flow; Myocardial perfusion; Myocardial contrast echocardiography.
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