Myocardial contrast echocardiography for assessment of papaverine vasodilator response in patients with angiographically normal coronary arteries and in patients after orthotopic heart transplantation
Klauss, V.; Mudra, H.; Sbarouni, E.; Meissner, O.; Metz, J.; Theisen, K.
Zeitschrift für Kardiologie 84(10): 852-859
1995
ISSN/ISBN: 0300-5860 PMID: 7502573 Document Number: 443431
Myocardial contrast echocardiography has the potential for assessing changes in regional myocardial perfusion. We used this method to compare papaverine vasodilator response in 10 patients after orthotopic heart transplantation without acute rejection of left ventricular hypertrophy (HTX) and in 15 patients with angiographically normal coronary arteries (control group). Injections of 2 ml of sonicated iopromid (9 paired injections in HTX and 24 paired injections in the control group) were performed before and after intracoronary application of papaverine (8 or 10 mg) into the left or right coronary artery. From regional time-intensity curves, alpha (variable of curve width), area under the curve (area), peak contrast intensity (Imax) and contrast decay half-time (T1/2) were derived by from a gamma variate function. T1/2 increased from 4.2 +- 1.2 to 7.2 +- 4.0 s (p lt 0.01) after papaverine in HTX compared to a change from 4.8 +- 1.0 to 6.0 +- 1.7 s (p lt 0.001) in normal subjects. Alpha decreased in HTX from 0.44 +- 0.15 to 0.27 +- 0.10 s-1 (p lt 0.0I) after intracoronary papaverine injection. In the control aroup alpha was 0.37 +- 0.08 s-1 at rest compared to 0.30 +- 0.08 s-1 at hyperemic conditions (p lt 0.002). Area increased in HTX from 444 +- 261 to 910 +- 732 U cntdot s (p lt 0.01) and in normal subjects from 352 +- 171 to 585 +- 262 U cntdot s (p lt 0.001). Hyperemic to baseline flow ratios for area varied from 0.9 to 3.8 (mean 2.17 +- 1.11) in HTX compared to 1.76 +- 0.52 (1.03 to 2.71) in normal subjects. The papaverine induced increase in Imax was 28 +- 56% in HTX (from 64 +- 28 U to 74 +- 29 U, NS) compared to 41 +- 37% in the control group (from 45 +- 17 U to 61 +- 19 U, p lt 0.001). Parameters of time-intensity curves between the two patient groups were not significantly different. In conclusion, papaverine vasodilator response in patients after orthotopic heart transplantation, as assessed by myocardial contrast echocardiography, is comparable to patients without angiographically documented coronary artery disease, indicating a normal myocardial flow reserve in heart transplant recipients without acute rejection or left ventricular hypertrophy.