| Title | Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve. | | Author(s) | Balcells E, Powers ER, Lepper W, Belcik T, Wei K, Ragosta M, Samady H, Lindner JR | | Institution | Cardiovascular Division, University of Virginia, Charlottesville, Virginia 22908, USA. | | Source | J Am Coll Cardiol 2003 Mar 5; 41(5):827-33. | | MeSH | Aged
Angioplasty, Transluminal, Percutaneous Coronary
Comparative Study
Contrast Media
Coronary Circulation
Dobutamine
Echocardiography, Doppler
Female
Humans
Male
Middle Aged
Myocardial Contraction
Myocardial Infarction
Predictive Value of Tests
Prognosis
Prospective Studies
Radiographic Image Enhancement
Recovery of Function
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Sampling Studies
Sensitivity and Specificity
Severity of Illness Index
Stents
Systole
Treatment Outcome
Ventricular Function, Left
| | Abstract | OBJECTIVES: We sought to determine whether myocardial contrast echocardiography (MCE) performed before and early after primary coronary stenting (PCS) in patients with acute myocardial infarction (AMI) could predict recovery of resting left ventricular systolic function and contractile reserve.
BACKGROUND: Myocardial contrast echocardiography can be used to assess perfusion within the risk area before PCS and the extent of necrosis soon after PCS.
METHODS: In 30 patients with AMI, MCE and two-dimensional echocardiography were performed before PCS and 3 to 5 days and 4 weeks after PCS. Contractile reserve was assessed by dobutamine echocardiography at four weeks in patients with persistent severe wall-motion abnormalities.
RESULTS: Of segments without perfusion at 3 to 5 days, 95% had severe hypokinesis to akinesis at 4 weeks. Of segments with normal perfusion at 3 to 5 days, 90% had normal wall motion or mild hypokinesis at 4 weeks, whereas those with partial perfusion at 3 to 5 days were evenly divided between normal wall motion, hypokinesis, and akinesis. In segments with persistent severe wall-motion abnormalities at four weeks, contractile reserve was found in >80% of segments with perfusion, compared with only 10% of segments without detectable perfusion (p < 0.01). The presence of myocardial perfusion by MCE before PCS was associated with maintained or improved perfusion at 3 to 5 days and eventual recovery of resting wall motion.
CONCLUSIONS: Myocardial contrast echocardiography performed early after PCS provides information on the extent of infarction, and hence the likelihood for recovery of resting systolic function or contractile reserve. The presence of perfusion before PCS, from either collateral or antegrade flow, predicts the maintenance of perfusion and recovery of systolic function. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 12628729 |
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