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CLINICAL STUDY: CARDIAC ULTRASOUND

Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve

^* Cardiovascular Division, University of Virginia, Charlottesville, Virginia, USA

Manuscript received May 14, 2002; revised manuscript received July 29, 2002, accepted September 13, 2002.

^* Reprint requests and correspondence: Dr. Jonathan R. Lindner, Cardiovascular Division, Box 800158, Medical Center, University of Virginia, Charlottesville, Virginia 22908, USA.
jlindner{at}virginia.edu

OBJECTIVES: We sought to determine whether myocardial contrast echocardiography (MCE) performed before and early after primary coronary stenting (PCS) in patients with acute myocardial infarction (AMI) could predict recovery of resting left ventricular systolic function and contractile reserve.

BACKGROUND: Myocardial contrast echocardiography can be used to assess perfusion within the risk area before PCS and the extent of necrosis soon after PCS.

METHODS: In 30 patients with AMI, MCE and two-dimensional echocardiography were performed before PCS and 3 to 5 days and 4 weeks after PCS. Contractile reserve was assessed by dobutamine echocardiography at four weeks in patients with persistent severe wall-motion abnormalities.

RESULTS: Of segments without perfusion at 3 to 5 days, 95% had severe hypokinesis to akinesis at 4 weeks. Of segments with normal perfusion at 3 to 5 days, 90% had normal wall motion or mild hypokinesis at 4 weeks, whereas those with partial perfusion at 3 to 5 days were evenly divided between normal wall motion, hypokinesis, and akinesis. In segments with persistent severe wall-motion abnormalities at four weeks, contractile reserve was found in >80% of segments with perfusion, compared with only 10% of segments without detectable perfusion (p < 0.01). The presence of myocardial perfusion by MCE before PCS was associated with maintained or improved perfusion at 3 to 5 days and eventual recovery of resting wall motion.

CONCLUSIONS: Myocardial contrast echocardiography performed early after PCS provides information on the extent of infarction, and hence the likelihood for recovery of resting systolic function or contractile reserve. The presence of perfusion before PCS, from either collateral or antegrade flow, predicts the maintenance of perfusion and recovery of systolic function.

Abbreviations and Acronyms   AMI   acute myocardial infarction   IRA   infarct-related artery   MCE   myocardial contrast echocardiography   PCS   primary coronary stenting   PI   pulsing interval   PSI-RA   perfusion score index in the risk area   TIMI   Thrombolysis In Myocardial Infarction   2-D   two-dimensional   WMSI-RA   wall motion score in the risk area

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