title: Intravenous myocardial contrast echocardiography predicts left ventricular remodeling in patients with acute myocardial infarction.
abstract: 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.
authors.affiliation: Medical Clinic I, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lepper
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Andreas
authors.initials: A
authors.lastname: Franke
authors.forename: Gertjan Tj
authors.initials: GT
authors.lastname: Sieswerda
authors.forename: Agnes
authors.initials: A
authors.lastname: Pasquet
authors.forename: Harald P
authors.initials: HP
authors.lastname: Kühl
authors.forename: Paolo
authors.initials: P
authors.lastname: Voci
authors.forename: Cees A
authors.initials: CA
authors.lastname: Visser
authors.forename: Peter
authors.initials: P
authors.lastname: Hanrath
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: 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*
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron