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PubMed2006

Sources of heterogeneities in estimating the prevalence of endometriosis in infertile and previously fertile women.

OBJECTIVE: To identify possible sources of heterogeneity in estimates of the prevalence of endometriosis in previously fertile women and in women with infertility. DESIGN: A pooled analysis of previously published studies reporting prevalence estimates. SETTING: Academic. PATIENTS: None. INTERVENTIONS: None. MAIN OUTCOME MEASURES: None. RESULTS: There were tremendous heterogeneities in prevalence estimates for both the fertile and infertile groups. In addition, the prevalence estimates increased with the year of publication, but decreased with sample size. For previously fertile women, the heterogeneity in prevalence estimates was no longer significant after the effects of sample size and year of publication on estimates were taken into account. In the infertile group, however, there was still a sizeable heterogeneity unaccounted for after both sample size and year of publication were taken into account. CONCLUSIONS: A single prevalence estimate for the entire fertile or infertile group may be too simplistic at best. More precise prevalence estimates, likely to be age-dependent, await carefully designed and executed studies that will also record covariates such as age at surgery and referral patterns.

Adolescent↗
PubMed2004

Quantifying intrachromosomal GC heterogeneity in prokaryotic genomes.

The sequencing of prokaryotic genomes covering a wide taxonomic range has sparked renewed interest in intrachromosomal compositional (GC) heterogeneity, largely in view of lateral transfers. We present here a brief overview of some methods for visualizing and quantifying GC variation in prokaryotes. We used these methods to examine heterogeneity levels in sequenced prokaryotes, for a range of scales or stringencies. Some species are consistently homogeneous, whereas others are markedly heterogeneous in comparison, in particular Aeropyrum pernix, Xylella fastidiosa, Mycoplasma genitalium, Enterococcus faecalis, Bacillus subtilis, Pyrobaculum aerophilum, Vibrio vulnificus chromosome I, Deinococcus radiodurans chromosome II and Halobacterium. As we discuss here, the wide range of heterogeneities calls for reexamination of an accepted belief, namely that the endogenous DNA of bacteria and archaea should typically exhibit low intrachromosomal GC contrasts. Supplementary results for all species analyzed are available at our website: http://bioinfo2.ugr.es/prok.

Algorithms↗
PubMed2006

Contrasting patterns in the small-scale heterogeneity of human helminth infections in urban and rural environments in Brazil.

Marked heterogeneity exists in the patterns of parasitic infection between individuals, households and communities. Analysis of parasite distributions within populations is complicated by the fact that parasite distributions are highly aggregated and few studies have explicitly incorporated this distribution when investigating small-scale spatial heterogeneities. This study aimed to quantify the small-scale (within- and between-household) heterogeneity of helminth infection in an area of Minas Gerais State, Brazil, with rural and urban sectors. Parasitological data from a cross-sectional survey of 1,249 individuals aged 0-86 years from 242 households were analysed. Within-household clustering of infection was assessed using random effect logistic regression models and between-household spatial heterogeneity was assessed using a Bayesian negative binomial spatial model. The overall prevalence of hookworm (Necator americanus) was 66.9%, the prevalence of Schistosoma mansoni was 44.9% and the prevalence of Ascaris lumbricoides was 48.8%. Statistical analysis indicated significant (within) household and (between household) spatial clustering of hookworm in both rural and urban areas and of S. mansoni in rural areas. There was no evidence of either household or spatial clustering of S. mansoni in urban areas. The spatial correlation of S. mansoni was estimated to reduce by half over a distance of 700 m in the rural area. Rural hookworm had a much smaller half-distance (28 m) and urban hookworm showed an even smaller half-distance (12 m). We suggest that such species-specific differences in patterns of infection by environment are primarily due to variation in exposure and parasite life cycle, although host genetic factors cannot be ruled out.

Adolescent↗
PubMed2005

Dose heterogeneity in the target volume and intensity-modulated radiotherapy to escalate the dose in the treatment of non-small-cell lung cancer.

PURPOSE: To quantify the dose escalation achievable in the treatment of non-small-cell lung cancer (NSCLC) by allowing dose heterogeneity in the target volume or using intensity-modulated radiotherapy (IMRT), or both. METHODS AND MATERIALS: Computed tomography data and contours of 10 NSCLC patients with limited movements of the tumor and representing a broad spectrum of clinical cases were selected for this study. Four irradiation techniques were compared: two conformal (CRT) and two IMRT techniques, either prescribing a homogeneous dose in the planning target volume (PTV) (CRT(hom) and IMRT(hom)) or allowing dose heterogeneity (CRT(inhom) and IMRT(inhom)). The dose heterogeneity was allowed only toward high doses, i.e., the minimum dose in the target for CRT(inhom) and IMRT(inhom) could not be lower than for the corresponding homogeneous plan. The dose in the PTV was escalated (fraction size of 2.25 Gy) until either an organ at risk reached the maximum allowed dose or the mean PTV dose reached a maximum level set at 101.25 Gy. RESULTS: When small and convex tumors were irradiated, CRT(hom) could achieve the maximum dose of 101.25 Gy, whereas for bigger and/or concave PTVs the dose level achievable with CRT(hom) was significantly lower, in 1 case even below 60 Gy. The CRT(inhom) allowed on average a 6% dose escalation with respect to CRT(hom). The IMRT(hom) achieved in all except 1 case a mean PTV dose of at least 75 Gy. The gain in mean PTV dose of IMRT(hom) with respect to CRT(hom) ranged from 7.7 to 14.8 Gy and the IMRT(hom) plans were always more conformal than the corresponding CRT(hom) plans. The IMRT(inhom) provided an additional advantage over IMRT(hom) of at least 5 Gy. For all CRT plans the achievable dose was determined by the lung dose threshold, whereas for more than half of the IMRT plans the esophagus was the dose-limiting organ. The IMRT plans were deliverable with 10-12 segments per beam and did not produce an increase of lung volume irradiated at low doses (<20 Gy). CONCLUSIONS: The dose in NSCLC treatments can be escalated by loosening the constraints on maximum dose in the target volume or using IMRT, or both. For large and concave tumors, an average dose escalation of 6% and 17% was possible when dose heterogeneity and IMRT were applied alone. When they were combined, the average dose increase was as high as 35%. Intensity-modulated RT delivered in a static mode can produce homogeneous dose distributions in the target and does not lead to an increase of lung volume receiving (very) low doses, even down to 5 Gy.

Carcinoma, Non-Small-Cell Lung↗
PubMed2004

Characterization of the heterogeneous binding site affinity distributions in molecularly imprinted polymers.

Molecularly imprinted polymers (MIPs) are polymers that can be tailored with affinity and selectivity for a molecule of interest. Offsetting the low cost and ease of preparation of MIPs is the presence of binding sites that vary widely in affinity and selectivity. Presented is a review of methods that take into account binding site heterogeneity when calculating the binding properties of MIPs. These include the bi-Langmuir, Freundlich, and Langmuir-Freundlich binding models. These methods yield a measure of heterogeneity in the form of binding site affinity distributions and the heterogeneity index. Recent developments have made these methods surprisingly easy to use while also yielding more accurate measures of the binding properties of MIPs. These have allowed for easier comparison and optimization of MIPs. Heterogeneous binding models have also led to a better understanding of the imprinting process and of the advantages and limitations of MIPs in chromatographic and sensor applications.

Binding Sites↗
PubMed2005

Particle deposition onto micropatterned charge heterogeneous substrates: trajectory analysis.

A trajectory analysis of particles near a micropatterned charged substrate under radial impinging jet flow conditions is presented to investigate the effect of surface charge heterogeneity on particle trajectory and deposition efficiency. The surface charge heterogeneity is modeled as concentric bands of specified width and pitch having positive and negative surface potentials. The flow distribution is obtained using finite element analysis of the governing Navier-Stokes equations. The particle trajectory analysis takes into consideration the hydrodynamic interactions, gravity, van der Waals and electrostatic double layer interactions. The presence of surface charge heterogeneity on the substrate gives rise to an oscillating particle trajectory near the collector surface due to repulsive and attractive forces. As a result of the coupled effects of hydrodynamic and colloidal forces, the particle trajectories and deposition efficiencies are increasingly affected by surface charge heterogeneity as one moves radially away from the stagnation point. The results indicate that it is possible to render collectors with up to 50% favorable surface fraction completely unfavorable by modifying the ratio of the radial to normal fluid velocity. Utilizing the real favorable area fraction of the collector, the patch model expression for calculating the deposition efficiency is modified for impinging jet flow geometry.

Journal Article↗
PubMed2005

Experiments on vertical transverse mixing in a large-scale heterogeneous model aquifer.

Vertical transverse mixing is known to be a controlling factor in natural attenuation of extended biodegradable plumes originating from continuously emitting sources. We perform conservative and reactive tracer tests in a quasi two-dimensional 14 m long sand box in order to quantify vertical mixing in heterogeneous media. The filling mimics natural sediments including a distribution of different hydro-facies, made of different sand mixtures, and micro-structures within the sand lenses. We quantify the concentration distribution of the conservative tracer by the analysis of digital images taken at steady state during the tracer-dye experiment. Heterogeneity causes plume meandering, leading to distorted concentration profiles. Without knowledge about the velocity distribution, it is not possible to determine meaningful vertical dispersion coefficients from the concentration profiles. Using the stream-line pattern resulting from an inverse model of previous experiments in the sand box, we can correct for the plume meandering. The resulting vertical dispersion coefficient is approximately approximately 4 x 10(-)(9) m(2)/s. We observe no distinct increase in the vertical dispersion coefficient with increasing travel distance, indicating that heterogeneity has hardly any impact on vertical transverse mixing. In the reactive tracer test, we continuously inject an alkaline solution over a certain height into the domain that is occupied otherwise by an acidic solution. The outline of the alkaline plume is visualized by adding a pH indicator into both solutions. From the height and length of the reactive plume, we estimate a transverse dispersion coefficient of approximately 3 x 10(-)(9) m(2)/s. Overall, the vertical transverse dispersion coefficients are less than an order of magnitude larger than pore diffusion coefficients and hardly increase due to heterogeneity. Thus, we conclude for the assessment of natural attenuation that reactive plumes might become very large if they are controlled by vertical dispersive mixing.

Coloring Agents↗
PubMed2006

Upscaling heterogeneity in aquifer reactivity via exposure-time concept: forward model.

Reactive properties of aquifer solid phase materials play an important role in solute fate and transport in the natural subsurface on time scales ranging from years in contaminant remediation to millennia in dynamics of aqueous geochemistry. Quantitative tools for dealing with the impact of natural heterogeneity in solid phase reactivity on solute fate and transport are limited. Here we describe the use of a structural variable to keep track of solute flux exposure to reactive surfaces. With this approach, we develop a non-reactive tracer model that is useful for determining the signature of multi-scale reactive solid heterogeneity in terms of solute flux distributions at the field scale, given realizations of three-dimensional reactive site density fields. First, a governing Eulerian equation for the non-reactive tracer model is determined by an upscaling technique in which it is found that the exposure time of solution to reactive surface areas evolves via both a macroscopic velocity and a macroscopic dispersion in the artificial dimension of exposure time. Second, we focus on the Lagrangian approach in the context of a streamtube ensemble and demonstrate the use of the distribution of solute flux over the exposure time dimension in modeling two-dimensional transport of a solute undergoing simplified linear reversible reactions, in hypothetical conditions following prior laboratory experiments. The distribution of solute flux over exposure time in a given case is a signature of the impact of heterogeneous aquifer reactivity coupled with a particular physical heterogeneity, boundary conditions, and hydraulic gradient. Rigorous application of this approach in a simulation sense is limited here to linear kinetically controlled reactions.

Adsorption↗
PubMed2006

Modeling solute transport in one-dimensional homogeneous and heterogeneous soil columns with continuous time random walk.

In this paper, we used the continuous time random walk (CTRW) framework to characterize the transport process in 1250-cm long one-dimensional homogenous and heterogeneous soil columns at the experiments conducted by Huang et al. [Huang, K., Toride, N., van Genuchten, M.Th., 1995. Experimental investigation of solute transport in large, homogeneous and heterogeneous, saturated soil columns. Trans. Porous Media. 18, 283-302]. The transport process was also simulated by using the advection-dispersion equation (ADE) and the spatial fractional advection-dispersion equation (FADE) for comparison. In the homogeneous soil column, the non-Fickian behavior is found at the distances less than 1000cm with beta values larger than 1.60, but less than 2, and Fickian form transport is obtained at distances larger than 1000cm with beta values larger than 2. In the heterogeneous soil column, we found the most anomalous behavior at distances from 200cm to 700cm with beta values ranging from 0.894 to 0.958, and non-Fickian transport process is observed at distances larger than 800cm with beta values in the range between 1 and 1.3. More significant non-Fickian behavior is found for transport in the heterogeneous soil column than that in the homogeneous soil column. The CTRW fits to the breakthrough curves (BTCs) have lower values of root mean square error (RMSE) and higher values of determination coefficient (r(2)), with respect to the fits of ADE and FADE. The CTRW model also is better captures the full evolution of BTCs, and especially their tails.

Models, Chemical↗
PubMed2005

Understanding foraging behaviour in spatially heterogeneous environments.

The role of stochasticity and spatial heterogeneity in foraging systems is investigated. We formulate a spatially explicit model which describes the behaviour of grazing animals in response to local information using simple stochastic rules. In particular the model reflects the biology in that decisions to move to a new location are based on visual assessment of the sward height in a surrounding neighbourhood, whilst the decision to graze the current location is based on the residual sward height and olfactory assessment of local faecal contamination. It is assumed that animals do not interact directly, but do so through modification of, and response to a common environment. Spatial heterogeneity is shown to have significant effects including reducing the equilibrium intake rate and increasing the optimal stocking density, and must therefore be taken into account by resource managers. We demonstrate the relationship between the stochastic spatial model and its non-spatial deterministic counterpart, and in the process derive a moment-closure approximation to the full process, which can be regarded as an intermediate, or pseudo-spatial model. The role of spatial heterogeneity is emphasized, and better understood by comparing the results obtained from each approach. The relative efficiency of random and directed searching behaviour in spatially heterogeneous environments is explored for both clean and contaminated pastures, and the impact of faecal avoidance behaviour assessed.

Animals↗
PubMed2005

Results of unilateral lung volume reduction surgery in patients with distinct heterogeneity of emphysema between lungs.

OBJECTIVE: This study was undertaken to analyze the comprehensive outcome of unilateral lung volume reduction in patients with distinct heterogeneity of emphysema between lungs assessed by a visual radiologic scoring system. METHODS: Ninety-seven patients who underwent intentional unilateral lung volume reduction because of distinct heterogeneity of emphysema between lungs (asymmetric ratio of emphysema >/=1.1) between 1995 and 2003 were evaluated. Baseline median measures were 0.83 L for forced expiratory volume in 1 second, 5.0 L for residual volume, 380 m for 6-minute walking test distance, 0.50 for maximal incremental treadmill test score, and 25 for physical functioning domain score assessed by the Short Form-36 Quality of Life questionnaire. RESULTS: Median follow-up was 34 months. Significant improvements occurred for as long as 36 months in forced expiratory volume in 1 second (+24%), residual volume (-12%), Short Form-36 Quality of Life questionnaire physical functioning domain score (+100%), 6-minute walking test distance (+18%), and maximal incremental treadmill test score (+200%). A direct correlation was found between asymmetric ratio of emphysema and change in forced expiratory volume in 1 second ( r = 0.65, P < .00001). At 60 months, residual volume (-6.2%), maximal incremental treadmill test score (+100%), and Short Form-36 Quality of Life questionnaire physical functioning domain score (+70%) were still significantly improved. Five-year survival was 82%; 5-year freedom from contralateral lung volume reduction was 70%. CONCLUSIONS: In this series, significant, long-lasting improvements and satisfactory survival were seen after intentional unilateral lung volume reduction. Heterogeneity of emphysema between lungs was directly correlated with improvement at 36 months in forced expiratory volume in 1 second. Our results suggest that unilateral lung volume reduction is a suitable option for patients with distinct heterogeneity of emphysema between lungs.

Adult↗
PubMed2006

Effects of transmural electrical heterogeneities and electrotonic interactions on the dispersion of cardiac repolarization and action potential duration: A simulation study.

It has been shown in the literature that myocytes isolated from the ventricular walls at various intramural depths have different action potential durations (APDs). When these myocytes are embedded in the ventricular wall, their inhomogeneous properties affect the sequence of repolarization and the actual distribution of the APDs in the entire wall. In this article, we implement a mathematical model to simulate the combined effect of (a) the non-homogeneous intrinsic membrane properties (in particular the non-homogeneous APDs) and (b) the electrotonic currents that modulate the APDs when the myocytes are embedded in the ventricular myocardium. In particular, we study the effect of (a) and (b) on the excitation and repolarization sequences and on the distribution of APDs in the ventricles. We implement a Monodomain tissue representation that includes orthotropic anisotropy, transmural fiber rotation and homogeneous or heterogeneous transmural intrinsic membrane properties, modeled according to the phase I Luo-Rudy membrane ionic model. Three-dimensional simulations are performed in a cartesian slab with a parallel finite element solver employing structured isoparametric trilinear finite elements in space and a semi-implicit adaptive method in time. Simulations of excitation and repolarization sequences elicited by epicardial or endocardial pacing show that in a homogeneous slab the repolarization pathways approximately follow the activation sequence. Conversely, in the heterogeneous cases considered in this study, we observed two repolarization wavefronts that started from the epi and the endocardial faces respectively and collided in the thickness of the wall and in one case an additional repolarization wave starting from an intramural site. Introducing the heterogeneities along the transmural epi-endocardial direction affected both the repolarization sequence and the APD dispersion, but these effects were clearly discernible only in transmural planes. By contrast, in planes parallel to epi- and endocardium the APD distribution remained remarkably similar to that observed in the homogeneous model. Therefore, the patterns of the repolarization sequence and APD dispersion on the epicardial surface (or any other intramural surface parallel to it) do not reveal the uniform transmural heterogeneity.

Action Potentials↗
PubMed2005

Changes in intratumor heterogeneity in blood perfusion in intradermal human melanoma xenografts during tumor growth assessed by DCE-MRI.

The purpose of this study was to use dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to search for systematic intratumor heterogeneity in blood perfusion in human melanoma xenografts growing intradermally in BALB/c-nu/nu mice. Six xenografted tumors of an amelanotic human melanoma line (A-07) were included in the study. DCE-MRI was performed daily for 5 days by using spoiled-gradient recalled sequences. Tumor images of E.F (E is initial extraction fraction and F is perfusion) were produced by subjecting DCE-MRI data to Kety analysis. E.F was used as a measure of tumor blood perfusion, since comparative studies have shown that E.F is closely related to blood perfusion in A-07 tumors. The E.F images indicated that the intratumor heterogeneity in blood perfusion was similar in all investigated tumors. The blood perfusion was low in the center of the tumors and increased toward the tumor periphery in the dorsal and ventral direction by a factor of 3-4, but not in the lateral and medial direction. The magnitude of the heterogeneity increased by a factor of approximately 2 during tumor growth. In conclusion, intradermal human melanoma xenografts show significant systematic intratumor heterogeneity in blood perfusion.

Animals↗
PubMed2005

Hypoxia-induced dedifferentiation of tumor cells--a mechanism behind heterogeneity and aggressiveness of solid tumors.

Histopathological examination of solid tumors frequently reveals pronounced tumor cell heterogeneity with regards to cell organization, cell morphology, cell size, nuclei morphology, etc. Analyses of gene expression patterns by immunohistochemistry or in situ hybridization techniques further strengthen the actual presence of phenotypic heterogeneity, often demonstrating substantial diversity within a given tumor. The molecular mechanisms underlying the phenotypic heterogeneity are very complex with genetic, epigenetic and environmental components. Hypoxia, shortage in oxygen, greatly influences cellular phenotypes by altering the expression of specific genes, and is an important contributor to intra- and inter-tumor cell diversity as revealed by the pronounced but non-uniform expression of hypoxia-driven genes in solid tumors (reviewed in [Semenza GL. Targeting HIF-1 for cancer therapy. Nat Rev Cancer 2003;3:721-32; Harris AL. Hypoxia--a key regulatory factor in tumour growth. Nat Rev Cancer 2002;2:38-47.]). The oxygen pressure in solid tumors is generally lower than in the surrounding non-malignant tissues, and tumors exhibiting extensive hypoxia have been shown to be more aggressive than corresponding tumors that are better oxygenized [Vaupel P. Oxygen transport in tumors: characteristics and clinical implications. Adv Exp Med Biol 1996;388:341-51; Vaupel P, Thews O, Hoeckel M. Treatment resistance of solid tumors: role of hypoxia and anemia. Med Oncol 2001;18:243-59.]. We recently observed that hypoxic neuroblastoma cells and breast cancer cells lose their differentiated gene expression patterns and develop stem cell-like phenotypes [Jögi A, Øra I, Nilsson H, Lindeheim A, Makino Y, Poellinger L, et al. Hypoxia alters gene expression in human neuroblastoma cells toward an immature and neural crest-like phenotype. Proc Natl Acad Sci USA 2002;99:7021-6; Helczynska K, Kronblad A, Jögi A, Nilsson E, Beckman S, Landberg G, et al. Hypoxia promotes a dedifferentiated phenotype in ductal breast carcinoma in situ. Cancer Res 2003;63:1441-4.]. As low stage of differentiation in neuroblastoma and in breast cancer is linked to poor prognosis, hypoxia-induced dedifferentiation will not only contribute to tumor heterogeneity but could also be one mechanism behind increased aggressiveness of hypoxic tumors. The effect(s) of hypoxia on tumor cell differentiation status is the focus of this review.

Animals↗
PubMed2004

Heterogeneity and inaccuracy in protein structures solved by X-ray crystallography.

Proteins are dynamic molecules, exhibiting structural heterogeneity in the form of anisotropic motion and discrete conformational substates, often of functional importance. In protein structure determination by X-ray crystallography, the observed diffraction pattern results from the scattering of X-rays by an ensemble of heterogeneous molecules, ordered and oriented by packing in a crystal lattice. The majority of proteins diffract to resolutions where heterogeneity is difficult to identify and model, and are therefore approximated by a single, average conformation with isotropic variance. Here we show that disregarding structural heterogeneity introduces degeneracy into the structure determination process, as many single, isotropic models exist that explain the diffraction data equally well. The large differences among these models imply that the accuracy of crystallographic structures has been widely overestimated. Further, it suggests that analyses that depend on small differences in the relative positions of atoms may be flawed.

Crystallography, X-Ray↗
PubMed2006

Changes in mumps virus neurovirulence phenotype associated with quasispecies heterogeneity.

Mumps virus is a highly neurotropic virus with evidence of central nervous system invasion (CNS) in approximately half of all cases of infection. In countries where live attenuated mumps virus vaccines were introduced, the number of mumps cases declined dramatically; however, recently, the safety of some vaccine strains has been questioned. For example, one of the most widely used vaccines, the Urabe AM9 strain, was causally associated with meningitis, leading to the withdrawal of this product from the market in several countries. This highlights the need for a better understanding of the attenuation process and the identification of markers of attenuation. To this end, we further attenuated the Urabe AM9 strain by serial passage in cell culture and compared the complete nucleotide sequences of the parental and passaged viruses. Interestingly, despite a dramatic decrease in virus virulence (as assayed in rats), the only genomic changes were in the form of changes in the level of genetic heterogeneity at specific genome sites, i.e., either selection of one nucleotide variant at positions where the starting material exhibited nucleotide heterogeneity or the evolution of an additional nucleotide to create a heterogenic site. This finding suggests that changes in the level of genetic heterogeneity at specific genome sites can have profound neurovirulence phenotypic consequences and, therefore, caution should be exercised when evaluating genetic markers of virulence or attenuation based only on a consensus sequence.

Animals↗
PubMed2005

Effects of target and distractor heterogeneity on search for a color target.

Experiments were designed to investigate the effects of target and distractor heterogeneity on the threshold for detection of a color target in a search task. In the first two experiments stimuli were chosen so that the target and distractor stimuli varied along one Cardinal axis in color space, while the target differed from distractors along another Cardinal axis. The Cardinal axis signaling the relevant target-distractor difference was consistent from trial to trial within an experiment. When observers searched for a color target among homogeneous distractors but the color of the target and distractors changed from trial to trial there was a small increase in threshold. When the distractors within a display were heterogeneous, and the target color varied from trial to trial there was a larger and more consistent increase in threshold. Varying stimuli along a Cardinal axis other than the Cardinal axis that differentiates target and distractors can impair performance in visual search tasks. Further experiments showed that the presence of heterogeneous distractors had little or no effect on thresholds when location or color cues indicated that these stimuli were irrelevant to the task. Results suggest that the effect of heterogeneity in these experiments is attentional in nature rather than sensory.

Adult↗
PubMed1995

Regional heterogeneity on myocardial contrast echocardiography without severe obstructive coronary artery disease.

Myocardial contrast echocardiography (MCE) has been used successfully during cardiac catheterization to assess regional perfusion in patients with coronary artery disease (CAD), although heterogeneity on MCE has been observed without underlying CAD. This study was undertaken to assess regional perfusion patterns on visual assessment of MCE when interpreted without knowledge of coronary anatomy, and to define potential sources of contrast heterogeneity not related to underlying CAD. Forty patients underwent intracoronary or aortic root MCE, or both, with use of 5% sonicated human serum albumin (Albunex) at the time of left heart catheterization. A single observer without knowledge of angiographic coronary anatomy reviewed all contrast echocardiographic studies for evidence of heterogeneous or collateral-dependent perfusion that was believed to be predictive of CAD. Of 110 vessels with paired echocardiographic and quantitative coronary angiographic data, 10 had lesions with > 70% luminal diameter stenosis and 6 of these were occluded. Of 100 vessels without significant stenosis, blinded analysis of MCE identified 36 regions with abnormal contrast considered predictive of CAD (false-positive results). False-positive studies occurred most often (incidence 46%) in the distribution of the left circumflex artery. Myocardial contrast in a coronary perfusion territory was completely absent after > or = 1 injection in 56 of 100 vessels without significant disease, although contrast was visualized on a subsequent injection in 51 of 56 vessels (91%). The low prevalence of disease among the population studied precluded meaningful estimation of test sensitivity for the detection of CAD. However, regional contrast heterogeneity was frequently observed on MCE in the absence of CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗