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Early changes in myocardial perfusion patterns after myocardial infarction: relation with contractile reserve and functional recovery

Eric Brochet, MD^*, Daniel Czitrom, MD^*, Daniel Karila-Cohen, MD^*, Patrick Seknadji, MD^*, Marc Faraggi, MD, PhD, Hakim Benamer, MD^*, Pierre Aubry, MD^*, Philippe Gabriel Steg, MD, FACC^* and Patrick Assayag, MD^*

^* Department of Cardiology, Hopital Bichat, Paris, France
Department of Nuclear Medicine, Hopital Bichat, Paris, France

View larger version (79K): [in a new window]   Figure 1 Myocardial contrast echocardiograms (apical four chamber view) at day 0 (left) and day 9 (right) in a patient with anterior myocardial infarction. Left: Immediately after successful angioplasty of the left anterior descending artery (TIMI grade 3 flow), significant "no-reflow" phenomenon is observed in the risk area after injection of contrast medium in the left main coronary artery. Right: At day 9, a marked improvement in contrast pattern is observed in the area of initial no-reflow.

View larger version (16K): [in a new window]   Figure 2 Temporal changes in individual segmental contrast pattern in the risk area between day 0 and day 9.

View larger version (34K): [in a new window]   Figure 3 Bar graph showing serial changes in mean segmental wall motion score between day 0 (solid bars), day 9 (hatched bars) and follow-up (open bars) in the three groups of segments defined on the basis of changes in myocardial contrast echocardiographic pattern between day 0 and day 9.

View larger version (19K): [in a new window]   Figure 4 Pie charts comparing the frequency of functional recovery at follow-up (A) or contractile improvement with dobutamine (B) in the three groups of segments defined on the basis of changes in myocardial contrast echocardiographic pattern between day 0 and day 9. CR+ (CR–) = presence (absence) of contractile reserve. (A) Open = recovery; solid = no recovery. (B) Open = CR+; solid = CR–.

View larger version (19K): [in a new window]   Figure 5 Plots of contrast score index at day 0 and day 9 in the 28 patients (left). Plots of wall motion score index between day 0 and follow-up (right) in the 24 patients with follow-up studies. Mean values (circles) ±SD (vertical bars) are also shown.