Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction
Michael L. Main, MD, FACC*,a,
Anthony Magalski, MD, FACCa,
Nicholas K. Chee, DOa,
Michael M. Coen, MAa,
David G. Skolnick, MD, FACCa and
Thomas H. Good, MD, FACCa
a the Mid America Heart Institute, Kansas City, Missouri, USA
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Figure 1 Myocardial contrast echocardiogram (apical four-chamber view) in a 61-year-old woman with an anterior wall MI. Two-dimensional imaging revealed akinesis of the mid- and distal septum. (A) Baseline power Doppler image. A small amount of contrast from a previous injection is visible in the LV cavity. (B) Bolus injection of contrast, opacifying the right ventricular cavity. (C) Several cardiac cycles later, the LV cavity is fully opacified. (D) Dense myocardial opacification throughout the septum, apex and lateral walls, indicating perfusion within the zone of akinesis ("perfusion-contraction mismatch"). At follow-up echocardiography, wall motion was normal. (E) Flash imaging with high mechanical index. (F) Immediately after flash imaging, the myocardium is no longer opacified, secondary to microbubble destruction. Note continued LV cavity opacification due to much higher contrast agent concentration.
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Figure 2 Myocardial contrast echocardiogram in a 67-year-old woman with a recent anterior wall myocardial infarction (apical four-chamber view). Two-dimensional imaging revealed akinesis of the mid- and distal left anterior descending coronary artery (LAD) territory. Despite normal antegrade flow in the LAD, there is a large perfusion defect in the akinetic zone, indicating necrosis (arrow).
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Figure 3 Comparison of mean wall motion score at follow-up in initially akinetic segments. Perfused segments demonstrated a significantly lower wall motion score at follow-up compared with segments with a perfusion defect. x axis = akinetic segments on baseline study; y axis = wall motion score index at follow-up.
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Figure 4 Follow-up assessment of myocardial function in initially dyssynergic segments. A total of 90% of perfused segments improved, while the majority of nonperfused segments remained unchanged.
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