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MYOCARDIAL INFARCTION

Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction

^a the Mid America Heart Institute, Kansas City, Missouri, USA

Manuscript received March 23, 2001; revised manuscript received June 25, 2001, accepted July 16, 2001.

^* Reprint requests and correspondence: Dr. Michael L. Main, Cardiovascular Consultants, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111 USA
mmain{at}cc-pc.com

OBJECTIVES

The goal of this study was to determine, in patients with a recent myocardial infarction (MI) and residual wall motion abnormalities within the distribution of the infarct-related artery, whether normal perfusion by myocardial contrast echocardiography (MCE) would accurately predict recovery of segmental left ventricular (LV) function.

BACKGROUND

Left ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Recent technical innovations in contrast echocardiography, including pulse inversion imaging and power Doppler, now allow full-motion echocardiographic perfusion assessment from a venous injection of fluorocarbon-based contrast agent.

METHODS

Thirty-four patients with recent MI underwent baseline wall motion assessment and MCE two days after admission and follow-up echocardiography a mean of 55 days later.

RESULTS

Perfusion by MCE predicted recovery of segmental function with a sensitivity of 77%, specificity of 83%, positive predictive value of 90% and overall accuracy of 79%. The mean wall motion score at follow-up was significantly better in perfused, compared with nonperfused, segments (1.4 vs. 2.2, p < 0.0001). Additionally, 90% of perfused segments improved, while the majority of nonperfused segments remained unchanged.

CONCLUSIONS

Full-motion MCE utilizing an intravenous fluorocarbon-based agent and pulse inversion power Doppler techniques, identifies stunned myocardium, and accurately predicts recovery of segmental LV function in patients with recent MI.

Abbreviations and Acronyms   BSE = baseline echocardiography   FUE = follow-up echocardiography   IRA = infarct-related artery   LAD = left anterior descending coronary artery   LV = left ventricle or left ventricular   MCE = myocardial contrast echocardiography   MI = myocardial infarction   RCA = right coronary artery   SVG = saphenous vein graft

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