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CLINICAL STUDY: DETECTION OF MYOCARDIAL VIABILITY AND STUNNING

Combined assessment of microvascular integrity and contractile reserve improves differentiation of stunning and necrosis after acute anterior wall myocardial infarction

^* Mid America Heart Institute, Kansas City, Missouri, USA

Manuscript received February 26, 2002; revised manuscript received May 8, 2002, accepted May 23, 2002.

^* 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: We sought to determine the relative accuracy of myocardial contrast echocardiography (MCE) and low-dose dobutamine echocardiography (LDDE) in predicting recovery of left ventricular (LV) function in patients with a recent anterior wall myocardial infarction (MI).

BACKGROUND: Left ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Myocardial contrast echocardiography allows real-time echocardiographic perfusion assessment from a venous injection of a fluorocarbon-based contrast agent. Although this technique is promising, it has not been compared with LDDE.

METHODS: Forty-six patients underwent baseline wall motion assessment, MCE, and LDDE two days after admission, as well as follow-up echocardiography after a mean period of 53 days.

RESULTS: Perfusion by MCE predicted recovery of segmental function with a sensitivity of 69%, specificity of 85%, positive predictive value of 74%, negative predictive value of 81%, and overall accuracy of 78%. Contractile reserve by LDDE predicted recovery of segmental function with a sensitivity of 50%, specificity of 88%, positive predictive value of 72%, negative predictive value of 73%, and overall accuracy of 73%. Concordant test results occurred in 74% of segments and further increased the overall accuracy to 85%. The mean wall motion score at follow-up was significantly better in perfused versus nonperfused segments (1.9 vs. 2.6, p < 0.0001) and in segments with contractile reserve, compared with segments lacking contractile reserve (1.9 vs. 2.5, p < 0.0001).

CONCLUSIONS: Myocardial contrast echocardiography compares favorably with LDDE in predicting recovery of regional LV dysfunction after acute anterior wall MI. Concordant contractile reserve and myocardial perfusion results further enhance the diagnostic accuracy.

Abbreviations and Acronyms   IRA   infarct-related artery   LAD   left anterior descending coronary artery   LDDE   low-dose dobutamine echocardiography   LV   left ventricular   MCE   myocardial contrast echocardiography   MI   myocardial infarction   TIMI   Thrombolysis In Myocardial Infarction trials

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