Demonstration of functional border zone with myocardial contrast echocardiography in human hearts. Simultaneous analysis of myocardial perfusion and wall motion abnormalities.

Abstract

BACKGROUND Although the presence of a functional border zone (FBZ), defined as the nonischemic but asynergic myocardium adjacent to the ischemic area, has been demonstrated in animal hearts, it is not known whether this zone exists in humans. METHODS AND RESULTS Myocardial contrast echocardiography (MCE) was performed before and during balloon inflation in the area of coronary stenosis by injecting contrast medium through the guiding catheter in 13 patients with effort angina who underwent successful coronary angioplasty. The area showing MCE defect during balloon inflation was determined with reference to the preangioplasty MCE and was regarded as an ischemic area. The size of the FBZ was assessed by measuring the length of the endocardium that showed asynergy in the echo-enhanced (nonischemic) area. The FBZ measured was 13 +/- 4 mm in the short-axis view (n = 5) and 16 +/- 9 mm in the long-axis view (n = 8). CONCLUSIONS Nonischemic contractile dysfunction exists even in human hearts. The presence of an FBZ may limit the use of wall motion analysis in assessing the risk or ischemic area in patients with myocardial infarction. MCE appears to be a unique technique for assessing the risk or ischemic area.