Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angioplasty [correction of angiography] in patients with acute myocardial infarction.
BACKGROUND
This study investigated whether the extent of perfusion defect determined by intravenous myocardial contrast echocardiography (MCE) in patients with acute myocardial infarction (AMI) treated by primary percutaneous transluminal coronary angioplasty (PTCA) relates to coronary flow reserve (CRF) for assessment of myocardial reperfusion and is predictive for left ventricular recovery.


RESULTS
Twenty-five patients with first AMI underwent intravenous MCE with NC100100 with intermittent harmonic imaging before PTCA and after 24 hours. MCE before PTCA defined the risk region and MCE at 24 hours the "no-reflow" region. The no-reflow region divided by the risk region determined the ratio to the risk region. CFR was assessed immediately after PTCA and 24 hours later. Left ventricular wall motion score indexes were calculated before PTCA and after 4 weeks. CFR at 24 hours defined a recovery (CFR >/=1.6; n=17) and a nonrecovery group (CFR <1.6; n=8). Baseline CFR did not differ between groups. MCE ratio to the risk region was smaller in the recovery group compared with the nonrecovery group (34+/-49% vs 81+/-46%, P=0.009). A ratio to the risk region of </=50% defined an MCE reperfusion group. It was associated with improvement of CFR from 1.67+/-0.47 at baseline to 2. 15+/-0.53 at 24 hours (P<0.001) and of regional wall motion score index from 2.6+/-0.5 to 1.9+/-0.5 at 4 weeks (P<0.001).


CONCLUSIONS
Intravenous MCE can be used to define perfusion defects after AMI. Assessment of microcirculation by MCE corresponds to evaluation by CFR. Serial intravenous MCE has the potential to identify patients likely to have improved left ventricular function after AMI.
Lepper
W
W
Medical Clinic I, University RWTH, Aachen, Germany. wlep@pcserver.mk1.rwth-aachen.de
Hoffmann
R
R
Kamp
O
O
Franke
A
A
de Cock
C C
CC
Kühl
H P
HP
Sieswerda
G T
GT
Dahl
J v
Jv
Janssens
U
U
Voci
P
P
Visser
C A
CA
Hanrath
P
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017322:Clinical Trials, Phase II as Topic; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011379:Prognosis; D018084:Ultrasonography, Interventional; D014664:Vasodilation
D003287:Contrast Media