Intravenous myocardial contrast echocardiography predicts left ventricular remodeling in patients with acute myocardial infarction.
BACKGROUND
This study evaluated the ability of intravenous myocardial contrast echocardiography (MCE) performed in the setting of acute myocardial infarction for prediction of left ventricular (LV) remodeling.


METHODS
Intravenous MCE was performed immediately before, 1 hour, and 24 hours after primary percutaneous transluminal coronary angioplasty (PTCA) in 35 patients with a first myocardial infarction. The MCE was used to define the relative perfusion defect size (in %; relMCD). Two-dimensional echocardiography was performed directly after angioplasty and after 4 weeks to determine LV end-diastolic volumes (LVEDV). The increase in LVEDV at 4 weeks defined a remodeling (> 15% increase) and a nonremodeling group (< or = 15% increase).


RESULTS
Patients with remodeling had larger relMCD before (22.0 +/- 16.1 vs 8.0 +/- 11.9, P =.015), 1 hour (20.0 +/- 13.0 vs 4.9 +/- 11.6, P =.001), and 24 hours after PTCA (22.9 +/- 14.1 vs 1.2 +/- 2.8, P <.001). There was a significant correlation between relMCD 24 hours after PTCA and the increase in LVEDV at 4 weeks (r = 0.648; P <.001). Receiver operating characteristic (ROC) curve analysis revealed a relMCD at 24 hours of 5.1% or more to predict remodeling with a sensitivity of 94% and a specificity of 87% (area under ROC curve = 0.917; SE = 0.054). Multivariate analysis demonstrated relMCD at 24 hours to be the only predictor of remodeling (odds ratio = 173.4; P =.022).


CONCLUSIONS
The size of the persistent MCE perfusion defect after revascularization for acute myocardial infarction has a high predictive value for LV remodeling during a 4-week follow-up period.
Lepper
Wolfgang
W
Medical Clinic I, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
Kamp
Otto
O
Vanoverschelde
Jean Louis
JL
Franke
Andreas
A
Sieswerda
Gertjan Tj
GT
Pasquet
Agnes
A
Kühl
Harald P
HP
Voci
Paolo
P
Visser
Cees A
CA
Hanrath
Peter
P
Hoffmann
Rainer
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D015588:Observer Variation; D010087:Oxides; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D020257:Ventricular Remodeling / Q000502:physiology*
D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron