Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction.
OBJECTIVE
The goal of this study was to determine, in patients with a recent myocardial infarction (MI) and residual wall motion abnormalities within the distribution of the infarct-related artery, whether normal perfusion by myocardial contrast echocardiography (MCE) would accurately predict recovery of segmental left ventricular (LV) function.


BACKGROUND
Left ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Recent technical innovations in contrast echocardiography, including pulse inversion imaging and power Doppler, now allow full-motion echocardiographic perfusion assessment from a venous injection of fluorocarbon-based contrast agent.


METHODS
Thirty-four patients with recent MI underwent baseline wall motion assessment and MCE two days after admission and follow-up echocardiography a mean of 55 days later.


RESULTS
Perfusion by MCE predicted recovery of segmental function with a sensitivity of 77%, specificity of 83%, positive predictive value of 90% and overall accuracy of 79%. The mean wall motion score at follow-up was significantly better in perfused, compared with nonperfused, segments (1.4 vs. 2.2, p < 0.0001). Additionally, 90% of perfused segments improved, while the majority of nonperfused segments remained unchanged.


CONCLUSIONS
Full-motion MCE utilizing an intravenous fluorocarbon-based agent and pulse inversion power Doppler techniques, identifies stunned myocardium, and accurately predicts recovery of segmental LV function in patients with recent MI.
Main
M L
ML
Mid America Heart Institute, Kansas City, Missouri 64111, USA. mmain@cc-pc.com
Magalski
A
A
Chee
N K
NK
Coen
M M
MM
Skolnick
D G
DG
Good
T H
TH
D000368:Aged; D000418:Albumins; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology / Q000628:therapy; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D009336:Necrosis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D016037:Single-Blind Method; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology
D000418:Albumins; C099458:FS 069; D005343:Fibrinolytic Agents; D005466:Fluorocarbons; D014283:Triiodobenzoic Acids; C044834:iodixanol