CLINICAL STUDY
Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction
Jonathan M. A. Swinburn, MA, MBBS, MRCPa,
Avijit Lahiri, MB, BS, MSc, MRCP, FACC, FESCa and
Roxy Senior, MBBS, MD, DM, FRCPa
a Department of Cardiac Research, Northwick Park Hospital, Harrow, UK
Manuscript received October 18, 2000;
revised manuscript received March 12, 2001,
accepted March 26, 2001.
Reprint requests and correspondence: Dr. Roxy Senior, Consultant Cardiologist, Cardiology Department, Northwick Park Hospital, Watford Road, Harrow, HA13UJ, United Kingdom
roxy.senior{at}virgin.net
OBJECTIVES
We aimed to ascertain whether triggered intravenous myocardial contrast echocardiography (MCE) can predict functional recovery in patients with acute myocardial infarction (AMI) and to determine the optimal triggering interval in this setting.
BACKGROUND
Detection of myocardial viability early after AMI has both therapeutic and prognostic implications. Myocardial contrast echocardiography using intracoronary injections of contrast can detect viable myocardium, but there is little data on the use of recently developed intravenous MCE techniques for this purpose.
METHODS
Ninety-six patients with recent AMI (4.8 ± 1.7 days) underwent echocardiography at baseline and six months later or three months after revascularization to determine regional function (score 1 = normal to 3 = akinetic). Myocardial contrast echocardiography was performed at baseline using intravenous injections of Optison. Triggering intervals of 1:1 (early) and 1:10 (delayed) cardiac cycles were used. Segments were deemed viable if they demonstrated homogeneous contrast opacification.
RESULTS
Of 400 akinetic segments at baseline, 109 (27%) improved during the follow-up period, and 375 (94%) were adequately visualized with MCE, of which 59 (16%) were homogeneously opacified by early and 125 (33%) by delayed MCE (negative predictive value for recovery of contractile function 74% and 84%, positive predictive value 29% and 47%, respectively). Independent predictors of functional recovery were delayed MCE (odds ratio [OR]: 4.0, p < 0.001), revascularization (OR: 6.0, p < 0.001), and log creatine kinase (OR: 0.5, p = 0.03). However, the presence or absence of >90% stenosis of the infarct-related artery did not influence the ability of triggered MCE to predict functional recovery.
CONCLUSIONS
Intravenous delayed triggered MCE can independently detect myocardial viability early after AMI.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CI | = confidence interval | | CK | = creatine kinase | | CK-MB | = creatine kinase isoenzyme | | ECG | = electrocardiogram | | IRA | = infarct-related artery | | LV | = left ventricle or left ventricular | | MCE | = myocardial contrast echocardiography | | NPV | = negative predictive value | | OR | = odds ratio | | PPV | = positive predictive value | | PTCA | = percutaneous transluminal coronary angioplasty |
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