title: Myocardial perfusion in real-time using power modulation. In vivo evidence for microcirculatory damage after acute myocardial infarction.
abstract: OBJECTIVE
  In addition to the myocardium, the microvasculature may be also damaged in acute myocardial infarction. The aim was to evaluate the capability of myocardial contrast echocardiography in the detection of microvasculature damage after myocardial infarction.
  
  
  METHODS
  Twelve patients with recent acute myocardial infarction and five control subjects with normal coronary arteries and without history of myocardial infarction were studied. Myocardial contrast echocardiography with power modulation was performed, and quantitative data were measured off-line. Power modulation uses a combination of low (0.1) and high (1.7) mechanical indexes, allowing a real-time evaluation of myocardial perfusion. Contrast agent was administered as a 3-min bolus. The quantitative analysis was performed off-line by a different blinded investigator. The refilling velocity was calculated as the difference between the peak myocardial refilling value and the value at 1 s after the impulse divided by the time from the first second after the impulse to the peak refilling value.
  
  
  RESULTS
  Eighty-one myocardial segments (75%) were analysed qualitatively and quantitatively in AMI patients, and 18 (60%) in control subjects (P=NS). The peak refilling intensity was not significantly different in patients and control subjects (6.62+/-5.85 vs. 7.53+/-4.06 dB, respectively). However, time to peak refilling intensity was significantly longer (5.25+/-1.57 vs. 4.00+/-0.53, P=0.004) and the velocity of refilling was significantly lower (2.74+/-5.34 vs. 6.58+/-8.02, P=0.028) in patients with myocardial infarction.
  
  
  CONCLUSIONS
  There is microvasculature damage after myocardial infarction that is reflected as a delayed velocity of refilling in myocardial contrast echocardiography.
authors.affiliation: Hospital Clínico San Carlos, Plaza Cristo Rey, s/n, 28040 Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Zamorano
authors.forename: Viviana
authors.initials: V
authors.lastname: Serra
authors.forename: Carlos
authors.initials: C
authors.lastname: Almería
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Rodrigo
authors.forename: Dionisio
authors.initials: D
authors.lastname: Herrera
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Pérez de Isla
authors.forename: Luis
authors.initials: L
authors.lastname: Mataix
authors.forename: Adalia
authors.initials: A
authors.lastname: Aubele
authors.forename: Esther
authors.initials: E
authors.lastname: de Marco
authors.forename: Luis
authors.initials: L
authors.lastname: Sánchez-Harguindey
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome