CLINICAL STUDIES
Early changes in myocardial perfusion patterns after myocardial infarction: relation with contractile reserve and functional recovery
Eric Brochet, MD*,
Daniel Czitrom, MD*,
Daniel Karila-Cohen, MD*,
Patrick Seknadji, MD*,
Marc Faraggi, MD, PhD ,
Hakim Benamer, MD*,
Pierre Aubry, MD*,
Philippe Gabriel Steg, MD, FACC* and
Patrick Assayag, MD*
* Department of Cardiology, Hopital Bichat, Paris, France
Department of Nuclear Medicine, Hopital Bichat, Paris, France
Manuscript received December 11, 1997;
revised manuscript received July 9, 1998,
accepted August 6, 1998.
Address for correspondence: Dr. Eric Brochet, Department of Cardiology, B, Hopital Bichat, 46, rue Henri Huchard, 75018 Paris, France
eric.brochet{at}bch.ap-hop-paris.fr
Objectives. The purpose of this study was to assess early temporal changes in myocardial perfusion pattern by myocardial contrast echocardiography (MCE) and their relation to myocardial viability in patients with reperfused acute myocardial infarction (AMI).
Background. Myocardial contrast echocardiography no-reflow is associated with poor contractile recovery after AMI. However, little is known regarding early reversibility of microvascular dysfunction and its relation to myocardial viability.
Methods. Intracoronary MCE was performed immediately after reflow and 9 days later in 28 patients with a first AMI and successful coronary recanalization (Thrombolysis in Myocardial Infarction trial grade 3 flow). Semiquantitative contrast score and wall motion score (WMS) were assessed in each initially asynergic segment at initial and repeat MCE study. Low dose dobutamine echocardiography (DE) was performed at day 10, and follow-up (FU) rest echocardiography was performed 6 weeks later.
Results. Among 200 initially asynergic segments, 49% exhibited no or heterogeneous contrast enhancement at initial MCE versus 24% at restudy (p < 0.001). Three groups of segments were defined according to early changes in contrast pattern: group A, "sustained no-reflow" (n = 17); group B, improved contrast score (n = 68), and group C, "sustained reflow" (n = 112). Group A segments showed no improvement in WMS at FU. In contrast, group B segments showed significant improvement in WMS at FU (p < 0.0001), and exhibited more frequently contractile reserve at DE (36% vs. 6%, p = 0.02) and contractile recovery at FU (34% vs. 7%, p = 0.03) than group A segments. Group C segments exhibited contractile reserve and contractile recovery in 47% and 51% of segments respectively.
Conclusions. Improvement in MCE perfusion pattern may occur after initial no-reflow in the days following reperfused AMI and is associated with preservation of contractile reserve and gradual regional functional recovery.
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Abbreviations and Acronyms
| | CK | = creatine kinase | | CSI | = contrast score index | | ECG | = electrocardiographic | | FU | = follow-up | | IRA | = infarct-related artery | | LDDE | = low dose dobutamine echocardiography | | MCE | = myocardial contrast echocardiography | | TIMI | = Thrombolysis in Myocardial Infarction trial | | WMS | = wall motion score | | WMSI | = wall motion score index |
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