Contrast echocardiography using intravenous octafluoropropane and real-time perfusion imaging predicts functional recovery after acute myocardial infarction.
Akinesia after acute myocardial infarction (MI) may be reversible, secondary to stunning, or irreversible, as a result of extensive myocyte necrosis. Distinguishing these 2 entities soon after MI is difficult, but has important clinical implications. The current study assessed the use of intravenous myocardial contrast echocardiography (MCE) in this setting. A total of 35 patients were studied 2 (+/- 1) days after an acute MI. Of these, 31 (91%) underwent myocardial revascularization. Perfusion was assessed using real-time MCE and an intravenous infusion of octafluoropropane microbubbles. Repeated echocardiograms were obtained 56 (+/- 29) days later. Normal perfusion predicted functional recovery with a positive predictive value of 66% and a negative predictive value of 81%. The accuracy of the technique was superior in myocardial segments supplied by the left anterior descending coronary artery (positive and negative predictive value: 70% and 90%, respectively). In multivariable analysis, the mean MCE perfusion score in akinetic segments was the most powerful independent predictor of functional recovery (odds ratio 8.6, P =.02). These data suggest that real-time intravenous MCE is a useful predictor of functional recovery of akinetic myocardium after acute MI.
Hillis
Graham S
GS
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Mulvagh
Sharon L
SL
Gunda
Madhavi
M
Hagen
Mary E
ME
Reeder
Guy S
GS
Oh
Jae K
JK
D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren