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Effect of Intracoronary Estradiol on Postischemic Microvascular Damage in a Porcine Model: A Myocardial Contrast Echocardiographic Study

Division of Cardiology, University of California, San Francisco, CA.

Ho-Joong Youn, MD

Division of Cardiology, University of California, San Francisco, CA.

Dorina Gheorghevici, MD

Division of Cardiology, University of California, San Francisco, CA.

Christian Zellner, MD

Division of Cardiology, University of California, San Francisco, CA.

Tony M. Chou, MD, FACC

Division of Cardiology, University of California, San Francisco, CA.

Krishnankutty Sudhir, MD, PhD, FRACP, FACC

Division of Cardiology, University of California, San Francisco, CA.

Rita F. Redberg, MD, MSc, FACC

Division of Cardiology, University of California, San Francisco, CA.

Coronary microvascular damage can occur in the presence of myocardial ischemia even if epicardial vessels are patent, a phenomenon known as "no-reflow." Estrogens have favorable effects on coronary conductance and resistance arteries, and may have therapeutic value in ischemic syndromes. Myocardial contrast echocardiography (MCE) is a promising method for evaluating microvascular damage. In this study, the authors hypothesized that acute intra coronary 17β-estradiol administration can reduce postischemic microvascular damage, which is evaluated by MCE, in a porcine model. Sixteen male pigs were randomized into 2 groups: the treatment group (n = 9) received intracoronary estradiol in increasing doses, and the control group (n = 7) received intracoronary vehicle (dimethylsulfoxide, DMSO). Microvascular damage was induced by balloon catheter occlusion followed by reperfusion of the left circumflex coronary artery (LCX). MCE using Levovist with harmonic imaging was performed before and during 15-minute balloon occlusion of the proximal LCX to determine perfusion areas of the left anterior descending artery (LAD) and LCX. MCE was performed immediately postocclusion and after each injection of estradiol (1, 10, and 100 nmol/L) or DMSO. Videodensitometry measure ments were performed as a quantitative marker for myocardial microvascular damage. Videodensitometry results were expressed as peak intensity ratios. Intracoronary estradiol induced a significant reduction in myocardial microvascular damage after ischemic episode by videodensitometry measurements when compared to intracoronary DMSO. The authors conclude that intracoronary injection of estradiol reduces postischemic microvascular damage measured by MCE in a porcine model.

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