Myocardial contrast echocardiography versus dobutamine echocardiography for predicting functional recovery after acute myocardial infarction treated with primary coronary angioplasty
L Bolognese,
D Antoniucci,
D Rovai,
P Buonamici,
G Cerisano,
GM Santoro,
C Marini,
A L'Abbate,
and
PF Fazzini
Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@mbox.vol.it
OBJECTIVES: We sought to compare myocardial contrast echocardiography with low dose dobutamine echocardiography for predicting 1-month recovery of ventricular function in acute myocardial infarction treated with primary coronary angioplasty. BACKGROUND: The relation between myocardial perfusion and contractile reserve in patients with acute myocardial infarction, in whom anterograde flow is fully restored without significant residual stenosis, is still unclear. METHODS: Thirty patients with acute myocardial infarction treated successfully with primary coronary angioplasty underwent intracoronary contrast echocardiography before and after angioplasty and dobutamine echocardiography 3 days after the index infarction. One month later, two-dimensional echocardiography and coronary angiography were repeated in all patients and contrast echocardiography in 18 patients. RESULTS: After coronary recanalization, 26 patients showed myocardial reperfusion within the risk area, although 4 did not. At 1-month follow-up, all patients had a patient infarct-related artery without significant restenosis. Both left ventricular ejection fraction and wall motion score index within the risk area significantly improved in the patients with reperfusion ([mean +/- SD] 38 +/- 8% vs. 48 +/- 12%, p < 0.005; and 2.35 +/- 0.5 vs. 2 +/- 0.6, p < 0.001, respectively), but not in those with no reflow. Of the 72 nonperfused segments before angioplasty, 27 showed functional improvement at follow-up. Myocardial contrast echocardiography had a sensitivity and a negative predictive value similar to dobutamine echocardiography in predicting late functional recovery (96% vs. 89% and 89% vs. 93%, respectively), but a lower specificity (18% vs. 91%, p < 0.001), positive predictive value (41% vs. 86%, p < 0.001) and overall accuracy (47% vs. 90%, p < 0.001). CONCLUSIONS: Microvascular integrity is a prerequisite for myocardial viability after acute myocardial infarction. However, contrast enhancement shortly after recanalization does not necessarily imply a late functional improvement. Thus, contractile reserve elicited by low dose dobutamine is a more accurate predictor of regional functional recovery after reperfused acute myocardial infarction than microvascular integrity.
This article has been cited by other articles:
|
|
|
|
 
F. Liistro, S. Grotti, P. Angioli, G. Falsini, K. Ducci, S. Baldassarre, A. Sabini, R. Brandini, E. Capati, and L. Bolognese
Impact of Thrombus Aspiration on Myocardial Tissue Reperfusion and Left Ventricular Functional Recovery and Remodeling After Primary Angioplasty
Circ Cardiovasc Interv,
October 1, 2009;
2(5):
376 - 383.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Habis, A. Capderou, S. Ghostine, B. Daoud, C. Caussin, J.-Y. Riou, P. Brenot, C. Y. Angel, B. Lancelin, and J.-F. Paul
Acute Myocardial Infarction Early Viability Assessment by 64-Slice Computed Tomography Immediately After Coronary Angiography: Comparison With Low-Dose Dobutamine Echocardiography
J. Am. Coll. Cardiol.,
March 20, 2007;
49(11):
1178 - 1185.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Dijkmans, R. Senior, H. Becher, T. R. Porter, K. Wei, C. A. Visser, and O. Kamp
Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion: The Evidence So Far
J. Am. Coll. Cardiol.,
December 5, 2006;
48(11):
2168 - 2177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, G. Falsini, F. Liistro, P. Angioli, K. Ducci, T. Taddei, R. Tarducci, F. Cosmi, S. Baldassarre, and A. Burali
Randomized Comparison of Upstream Tirofiban Versus Downstream High Bolus Dose Tirofiban or Abciximab on Tissue-Level Perfusion and Troponin Release in High-Risk Acute Coronary Syndromes Treated With Percutaneous Coronary Interventions: The EVEREST Trial
J. Am. Coll. Cardiol.,
February 7, 2006;
47(3):
522 - 528.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y Abe, T Muro, Y Sakanoue, R Komatsu, M Otsuka, T Naruko, A Itoh, M Yoshiyama, K Haze, and J Yoshikawa
Intravenous myocardial contrast echocardiography predicts regional and global left ventricular remodelling after acute myocardial infarction: comparison with low dose dobutamine stress echocardiography
Heart,
December 1, 2005;
91(12):
1578 - 1583.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, K. Ducci, P. Angioli, G. Falsini, F. Liistro, S. Baldassarre, and A. Burali
Elevations in Troponin I After Percutaneous Coronary Interventions Are Associated With Abnormal Tissue-Level Perfusion in High-Risk Patients With Non-ST-Segment-Elevation Acute Coronary Syndromes
Circulation,
September 21, 2004;
110(12):
1592 - 1597.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, N. Carrabba, G. Parodi, G. M. Santoro, P. Buonamici, G. Cerisano, and D. Antoniucci
Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction
Circulation,
March 9, 2004;
109(9):
1121 - 1126.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B Cosyns, P El Haddad, H Lignian, C Daniels, C Weytjens, D Schoors, and G Van Camp
Contrast harmonic imaging improves the evaluation of left ventricular function in ventilated patients: comparison with transesophageal echocardiography
Eur J Echocardiogr,
March 1, 2004;
5(2):
118 - 122.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T Muro, T Hozumi, H Watanabe, H Yamagishi, M Yoshiyama, K Takeuchi, and J Yoshikawa
Assessment of myocardial perfusion abnormalities by intravenous myocardial contrast echocardiography with harmonic power Doppler imaging: comparison with positron emission tomography
Heart,
February 1, 2003;
89(2):
145 - 149.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A.S Petronio, D Rovai, G Musumeci, R Baglini, C Nardi, U Limbruno, C Palagi, D Volterrani, and M Mariani
Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty
Eur. Heart J.,
January 1, 2003;
24(1):
67 - 76.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, A. N. Neskovic, G. Parodi, G. Cerisano, P. Buonamici, G. M. Santoro, and D. Antoniucci
Left Ventricular Remodeling After Primary Coronary Angioplasty: Patterns of Left Ventricular Dilation and Long-Term Prognostic Implications
Circulation,
October 29, 2002;
106(18):
2351 - 2357.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. Main, A. Magalski, B. A. Morris, M. M. Coen, D. G. Skolnick, and T. H. Good
Combined assessment of microvascular integrity and contractile reserve improves differentiation of stunning and necrosis after acute anterior wall myocardial infarction
J. Am. Coll. Cardiol.,
September 18, 2002;
40(6):
1079 - 1084.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y Ueno, Y Nakamura, M Kinoshita, T Fujita, T Sakamoto, and H Okamura
Can coronary flow velocity reserve determined by transthoracic Doppler echocardiography predict the recovery of regional left ventricular function in patients with acute myocardial infarction?
Heart,
August 1, 2002;
88(2):
137 - 141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P Andrassy, M Zielinska, R Busch, A Schomig, and C Firschke
Myocardial blood volume and the amount of viable myocardium early after mechanical reperfusion of acute myocardial infarction: prospective study using venous contrast echocardiography
Heart,
April 1, 2002;
87(4):
350 - 355.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Agati, S. Funaro, M. Madonna, C. Volponi, G. Veneroso, and G. Tonti
Clinical utility of contrast echocardiography in the management of patients with acute myocardial infarction
Eur. Heart J. Suppl.,
March 1, 2002;
4(suppl_C):
C27 - C34.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. H. Rezkalla and R. A. Kloner
No-Reflow Phenomenon
Circulation,
February 5, 2002;
105(5):
656 - 662.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Sciagra, S. Sestini, L. Bolognese, G. Cerisano, P. Buonamici, and A. Pupi
Comparison of Dobutamine Echocardiography and 99mTc-Sestamibi Tomography for Prediction of Left Ventricular Ejection Fraction Outcome After Acute Myocardial Infarction Treated with Successful Primary Coronary Angioplasty
J. Nucl. Med.,
January 1, 2002;
43(1):
8 - 14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. A. Swinburn, A. Lahiri, and R. Senior
Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction
J. Am. Coll. Cardiol.,
July 1, 2001;
38(1):
19 - 25.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.P Ottervanger, A.W.J Van't Hof, S Reiffers, J.C.A Hoorntje, H Suryapranata, M.J de Boer, and F Zijlstra
Long-term recovery of left ventricular function after primary angioplasty for acute myocardial infarction
Eur. Heart J.,
May 1, 2001;
22(9):
785 - 790.
[Abstract]
[PDF]
|
|
|
|
|
|
|
K. Ohmori, B. Cotter, E. Leistad, V. Bhargava, P. L. Wolf, K. Mizushige, and A. N. DeMaria
Assessment of Myocardial Postreperfusion Viability by Intravenous Myocardial Contrast Echocardiography : Analysis of the Intensity and Texture of Opacification
Circulation,
April 17, 2001;
103(15):
2021 - 2027.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Kramer, W. J. Rogers Jr., S. Mankad, T. M. Theobald, D. L. Pakstis, and Y.-L. Hu
Contractile reserve and contrast uptake pattern by magnetic resonance imaging and functional recovery after reperfused myocardial infarction
J. Am. Coll. Cardiol.,
November 15, 2000;
36(6):
1835 - 1840.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Reilly, P. A. Tunick, R. J. Timmermans, B. Stein, B. P. Rosenzweig, and I. Kronzon
Contrast echocardiography clarifies uninterpretable wall motion in intensive care unit patients
J. Am. Coll. Cardiol.,
February 1, 2000;
35(2):
485 - 490.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Matetzky, M. Novikov, L. Gruberg, D. Freimark, M. Feinberg, D. Elian, I. Novikov, E. Di Segni, O. Agranat, Y. Har-Zahav, et al.
The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA
J. Am. Coll. Cardiol.,
December 1, 1999;
34(7):
1932 - 1938.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. L'Abbate, G. Sambuceti, S. Haunso, and J. Schneider-Eicke
Methods for evaluating coronary microvasculature in humans
Eur. Heart J.,
September 2, 1999;
20(18):
1300 - 1313.
[PDF]
|
|
|
|
|
|
|
T. Kawamoto, K. Yoshida, T. Akasaka, T. Hozumi, T. Takagi, S. Kaji, and Y. Ueda
Can Coronary Blood Flow Velocity Pattern After Primary Percutaneous Transluminal Coronary Angiography Predict Recovery of Regional Left Ventricular Function in Patients With Acute Myocardial Infarction?
Circulation,
July 27, 1999;
100(4):
339 - 345.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Leclercq, P Messner-Pellenc, Q Descours, J-P Daures, J-L Pasquie, F-X Hager, J-M Davy, and R Grolleau-Raoux
Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction
Heart,
July 1, 1999;
82(1):
62 - 67.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D Czitrom, D Karila-Cohen, E Brochet, J M Juliard, M Faraggi, M-C Aumont, P Assayag, and P G Steg
Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery
Heart,
January 1, 1999;
81(1):
12 - 16.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. Brochet, D. Czitrom, D. Karila-Cohen, P. Seknadji, M. Faraggi, H. Benamer, P. Aubry, P. G. Steg, and P. Assayag
Early changes in myocardial perfusion patterns after myocardial infarction: relation with contractile reserve and functional recovery
J. Am. Coll. Cardiol.,
December 1, 1998;
32(7):
2011 - 2017.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, G. Cerisano, P. Buonamici, A. Santini, G. M. Santoro, D. Antoniucci, and P. F. Fazzini
Influence of Infarct-Zone Viability on Left Ventricular Remodeling After Acute Myocardial Infarction
Circulation,
November 18, 1997;
96(10):
3353 - 3359.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. F. Meza, S. Ramee, T. Collins, D. Stapleton, R. V. Milani, J. P. Murgo, and J. Cheirif
Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization : A Study Using the Combination of Myocardial Contrast Echocardiography and Dobutamine Echocardiography
Circulation,
November 18, 1997;
96(10):
3459 - 3465.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
D. KARILA-COHEN, D. CZITROM, E. BROCHET, and P. G. STEG
Lessons from myocardial contrast echocardiography studies during primary angioplasty
Heart,
October 1, 1997;
78(4):
331 - 332.
[Full Text]
[PDF]
|
|
|
|
