Peripheral intravenous myocardial contrast echocardiography using a 2% dodecafluoropentane emulsion: Identification of myocardial risk area and infarct size in the canine model of ischemia

Objectives.: This study assessed the accuracy of 2% dodecafluoropentane (EchoGen), an intravenous echocardiographic contrast agent, in identifying myocardial area at risk and infarct size in the canine model of myocardial ischemia. Background.: Myocardial contrast echocardiography allows determination of myocardial area at risk and infarct size but requires intracoronary injection in humans. The development of agents that can be delivered by peripheral intravenous injection could enable bedside myocardial contrast echocardiographic assessment of risk area, infarct size and reperfusion. Methods.: Two protocols were used. Protocol 1 assessed the accuracy of myocardial contrast echocardiography using intravenous dodecafluoropentane in defining myocardial area at risk and infarct size in the canine model of regional myocardial ischemia versus gross pathologic specimens stained with monastral blue to determine area at risk and triphenyltetrazolium chloride to determine the area of necrosis. Protocol 2 assessed the effects of repeated injections of dodecafluoropentane (0.5 ml/kg body weight, four doses 30 min apart or eight doses 10 min apart) on myocardial blood How and hemodynamic variables. Results.: Myocardial contrast echocardiography accurately defined area at risk and infarct size (r = 0.96 vs. triphenyltetrazolium chloride). Myocardial blood flow remained stable after multiple serial injections of dodecafluoropentane. However, a significant increase in pulmonary artery pressure and pulmonary vascular resistance, along with a decrease in arterial oxygen saturation and cardiac output, was seen in dogs that received eight injections at 10-min intervals. Conclusions.: Myocardial contrast echocardiography using intravenous dodecafluoropentane accurately defined myocardial area at risk and infarct size. Hemodynamic variables and regional myocardial blood flows remained stable when dodecafluoropentane was injected at 30-min intervals for up to four doses; more frequent administration led to cardiopulmonary deterioration. Dodecafluoropentane offers the potential for reliable, noninvasive assessment of reperfusion after therapeutic interventions.