Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve
Eduardo Balcells, MD*,
Eric R. Powers, MD, FACC*,
Wolfgang Lepper, MD*,
Todd Belcik, RDCS*,
Kevin Wei, MD, FACC*,
Michael Ragosta, MD, FACC*,
Habib Samady, MD* and
Jonathan R. Lindner, MD, FACC*,*
* Cardiovascular Division, University of Virginia, Charlottesville, Virginia, USA
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Figure 1 Perfusion scores for segments within the risk area assessed by myocardial contrast echocardiography 3 to 5 days after primary coronary stenting (PCS) according to their perfusion scores assessed immediately before PCS. p < 0.01 for differences between the groups by chi-square analysis. Perfusion score at 3 to 5 days: white bar = 0; striped bar = 1; black bar = 2.
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Figure 2 Examples of myocardial contrast echocardiography images in the apical four-chamber plane illustrating near complete myocardial reperfusion in a patient undergoing successful primary coronary stenting (PCS) of a totally occluded left anterior descending coronary artery (LAD). Images were obtained at a pulsing interval of 10 cardiac cycles and demonstrate little perfusion in the LAD territory before PCS (left image) and restoration of perfusion except for a small portion of the distal septum at 3 to 5 days (right image).
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Figure 3 Wall-motion scores in segments within the risk area 4 weeks after primary coronary stenting (PCS) according to (A) perfusion score at 3 to 5 days, and (B) perfusion score before PCS. p < 0.01 for differences between all groups by chi-square analysis for both A and B. Wall-motion score at 4 weeks: white bar = 1 to 2; black bar = 3 to 5.
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Figure 4 Relationship between the perfusion score index in the risk area (PSI-RA) assessed by myocardial contrast echocardiography 3 to 5 days after primary coronary stenting and the wall motion score index in the risk area (WMSI-RA) at 4 weeks.
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Figure 5 End-systolic myocardial contrast echocardiography images in the apical four-chamber view obtained 3 to 5 days after primary coronary stenting illustrating a subendocardial perfusion defect (arrows) in a region with akinesis at rest. The background image (left image) was obtained before contrast administration whereas the contrast-enhanced image (right image) was obtained at a pulsing interval of every eight cardiac cycles.
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Figure 6 Percent of segments demonstrating a positive inotropic response to dobutamine at 4 weeks according to perfusion score at 3 to 5 days. p < 0.01 for differences between all groups by chi-square analysis.
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