Computerized analysis of myocardial echocardiographic enhancement during coronary revascularization by high-speed rotational atherectomy

A previous report demonstrated transient myocardial echocardiographic contr ast (MEC) enhancement following high-speed rotational atherectomy (HSRA). T his phenomenon was found to be correlated to the speed and duration of rota tion and related to creation of cavitations. To determine other correlation s and the significance of MEC, continuous echocardiographic recording was p erformed in 10 patients undergoing HSRA. Images were digitized and videoint ensity-time curves generated. Curve parameters were calculated and correlat ed with procedural variables, plaque mass, and side effects. Twenty-nine ab lation passes in 10 patients were analyzed. Videointensity peaked 9-44 sec from initiation of ablation and decayed to a higher baseline level after ea ch consecutive ablation. Increase in peak contrast intensity (PCI) from bas eline and the percentage of the left ventricle undergoing enhancement were highest (33 +/- 31 gray level/pixel and 32% +/- 8%, mean +/- SD, respective ly) after the second rotation and were not influenced by the duration of ro tation. PCI, side effects, and transient left ventricular wall motion abnor malities were positively correlated with plaque mass, defined by the produc t of lesion length, diameter, and percent stenosis. HSRA resulted in signif icant myocardial echocardiographic contrast PCI is related to ablation sequ ence and plaque mass. Plaque debris embolization is probably responsible fo r myocardial echocardiographic contrast and transient wail motion abnormali ties. (C) 2000 Wiley-Liss, Inc.