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CLINICAL RESEARCH: CARDIAC IMAGING

Prognostic Value of Myocardial Viability Detected by Myocardial Contrast Echocardiography Early After Acute Myocardial Infarction

Department of Cardiovascular Medicine, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, Middlesex, United Kingdom.

Manuscript received January 16, 2007; revised manuscript received March 1, 2007, accepted March 12, 2007.

^_* Reprint requests and correspondence: Prof. Roxy Senior, Department of Cardiology, Northwick Park Hospital, Harrow, Middlesex, HA1 3UJ, Hon. Professor, Middlesex University, United Kingdom. (Email: roxysenior{at}cardiac-research.org).

Objectives: This study sought to determine whether residual myocardial viability determined by myocardial contrast echocardiography (MCE) after acute myocardial infarction (AMI) can predict hard cardiac events.

Background: Myocardial viability detected by MCE has been shown to predict recovery of left ventricular (LV) function in patients with AMI. However, to date no study has shown its value in predicting major adverse outcomes in AMI patients after thrombolysis.

Methods: Accordingly, 99 stable patients underwent low-power MCE at 7 ± 2 days after AMI. Contrast defect index (CDI) was obtained by adding contrast scores (1 = homogenous; 2 = reduced; 3 = minimal/absent opacification) in all 16 LV segments divided by 16. At discharge, 65 (68%) patients had either undergone or were scheduled for revascularization independent of the MCE result. The patients were subsequently followed up for cardiac death and nonfatal AMI.

Results: Of the 99 patients, 95 were available for follow-up. Of these, 86 (87%) underwent thrombolysis. During the follow-up time of 46 ± 16 months, there were 15 (16%) events (8 cardiac deaths and 7 nonfatal AMIs). Among the clinical, biochemical, electrocardiographic, echocardiographic, and coronary arteriographic markers of prognosis, the extent of residual myocardial viability was an independent predictor of cardiac death (p = 0.01) and cardiac death or AMI (p = 0.002). A CDI of 1.86 and 1.67 predicted survival and survival or absence of recurrent AMI in 99% and 95% of the patients, respectively.

Conclusions: The extent of residual myocardial viability predicted by MCE is a powerful independent predictor of hard cardiac events in patients after AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   CDI = contrast defect index   DSE = dobutamine stress echocardiography   LV = left ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   MCE = myocardial contrast echocardiography

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