CLINICAL RESEARCH: ECHOCARDIOGRAPHY
Accuracy of dipyridamole myocardial contrast echocardiography for the detection of residual stenosis of the infarct-related artery and multivessel disease early after acute myocardial infarction
Rajesh Janardhanan, MD, MRCP* and
Roxy Senior, MD, DM, FRCP, FESC, FACC*,*
* Cardiology Department, Northwick Park Hospital, Harrow, United Kingdom
Manuscript received September 29, 2003;
revised manuscript received February 5, 2004,
accepted February 17, 2004.
* Reprint requests and correspondence: Dr. Roxy Senior, Consultant Cardiologist and Director of Cardiac Research, Northwick Park Hospital, Harrow HA1 3UJ, United Kingdom.
roxy.senior{at}virgin.net
This study was presented in part at the Annual Scientific Session of the American Heart Association, November 2003, Orlando, Florida.
OBJECTIVES: We aimed to evaluate the ability of vasodilator myocardial contrast echocardiography (MCE) to detect significant infarct-related artery (IRA) stenosis and multivessel disease (MVD) after thrombolysis.
BACKGROUND: The detection of residual IRA stenosis subtending significant viable myocardium and the identification of MVD may help to triage patients who may benefit from mechanical revascularization after acute myocardial infarction (AMI) and thrombolysis.
METHODS: Patients with AMI underwent low-power MCE at rest and after dipyridamole stress during SonoVue infusion seven to 10 days after thrombolysis.
RESULTS: Of the 73 patients, 61 demonstrated significant myocardial viability, of whom 57 (93%) showed significant IRA stenosis. Sensitivities to detect >50% IRA stenosis and MVD were 88% and 72%, respectively. The accuracy of detecting significant coronary stenosis in the anterior (left anterior descending coronary artery) versus inferoposterior (right coronary artery/left circumflex artery) circulation was similar for both IRA (85% vs. 91%) and remote territories (91% vs. 81%). Quantitative peak contrast intensity (p = 0.02), microbubble velocity (p = 0.0001), and myocardial blood flow (p < 0.0001) were significantly lower in patients with significant coronary stenosis during dipyridamole compared with rest. Only beta reserve discriminated various grades of coronary stenosis.
CONCLUSIONS: Use of MCE accurately predicted significant IRA stenosis and MVD after thrombolysis. This information is valuable for identifying patients who may benefit from mechanical revascularization.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CAD | = coronary artery disease | | CFR | = coronary flow reserve | | IRA | = infarct-related artery | | LAD | = left anterior descending coronary artery | | LCx | = left circumflex artery | | MBF | = myocardial blood flow | | MCE | = myocardial contrast echocardiography | | MVD | = multivessel disease | | RCA | = right coronary artery |
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