Detter Christian, Wipper Sabine, Russ Detlef, Iffland Andre, Burdorf Lars, Thein Eckart, Wegscheider Karl, Reichenspurner Hermann, Reichart Bruno
Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistr 52, D-20246 Hamburg, Germany.
Circulation. 2007 Aug 28;116(9):1007-14. doi: 10.1161/CIRCULATIONAHA.106.655936. Epub 2007 Aug 7.
The purpose of the present study was to examine whether the effect of coronary stenoses of variable severity on myocardial perfusion can be quantitatively assessed in vivo by analysis of fluorescent cardiac imaging (FCI) compared with the gold standard, the fluorescent microsphere method. FCI is a novel technology to visualize coronary vessels and myocardial perfusion intraoperatively using the indocyanine green dye with an infrared-sensitive imaging device.
Graded stenoses and total vessel occlusion of the left anterior descending coronary artery were created in 11 open-chest pigs. Stenoses were graded to reduce resting left anterior descending coronary artery flow by 25%, 50%, 75%, and 100% of baseline flow measured by transit-time flowmeter. FCI images were analyzed with a digital image processing system. The impairment of myocardial perfusion was quantified by background-subtracted peak fluorescence intensity and slope of fluorescence intensity obtained with FCI and compared with myocardial blood flow assessed by fluorescent microsphere. All stenoses resulted in an impairment of myocardial perfusion visualized by FCI. Occlusion of the left anterior descending coronary artery resulted in a total perfusion defect (no fluorescence intensity) of the corresponding anterior myocardial wall. During graded stenosis and total vessel occlusion, normalized background-subtracted peak fluorescence intensity and slope of fluorescence intensity decreased significantly (P<0.0001). Both background-subtracted peak fluorescence intensity (r=0.92, P<0.0001) and slope of fluorescence intensity (r=0.93, P<0.0001) analyzed by FCI demonstrated good linear correlation with fluorescent microsphere-derived myocardial blood flow.
The impairment of myocardial perfusion in response to increased coronary stenosis severity and total vessel occlusion can be quantitatively assessed by FCI and correlates well with results obtained by fluorescent microsphere.
本研究的目的是通过荧光心脏成像（FCI）分析，与金标准荧光微球法相比，探讨是否能在体内定量评估不同严重程度的冠状动脉狭窄对心肌灌注的影响。FCI是一种利用吲哚菁绿染料和红外敏感成像设备在术中可视化冠状动脉血管和心肌灌注的新技术。
在11只开胸猪身上制造左前降支冠状动脉的分级狭窄和完全血管闭塞。通过渡越时间流量计测量，将狭窄分级以减少左前降支冠状动脉静息血流至基线血流的25%、50%、75%和100%。使用数字图像处理系统分析FCI图像。通过FCI获得的背景扣除后的峰值荧光强度和荧光强度斜率对心肌灌注损伤进行定量，并与荧光微球评估的心肌血流进行比较。所有狭窄均导致FCI可见的心肌灌注损伤。左前降支冠状动脉闭塞导致相应前壁心肌完全灌注缺损（无荧光强度）。在分级狭窄和完全血管闭塞期间，背景扣除后的标准化峰值荧光强度和荧光强度斜率显著降低（P<0.0001）。FCI分析的背景扣除后的峰值荧光强度（r=0.92，P<0.0001）和荧光强度斜率（r=0.93，P<0.0001）与荧光微球衍生的心肌血流均显示出良好的线性相关性。
FCI可定量评估冠状动脉狭窄严重程度增加和完全血管闭塞时心肌灌注的损伤，且与荧光微球法获得的结果相关性良好。
