title: Prediction of the no-reflow phenomenon with ultrasonic tissue characterization in patients with anterior wall acute myocardial infarction.
abstract: The no-reflow phenomenon after acute myocardial infarction seems to be related to ischemic injury before reperfusion. Analyzing cardiac cycle-dependent variation of integrated backscatter (IBS) is a unique method to assess myocardial viability. In this study, the ability of ultrasonic tissue characterization with IBS to predict the no-reflow phenomenon was investigated in 90 patients with first anterior wall infarction who underwent successful primary percutaneous coronary intervention. IBS images were recorded on admission (before reperfusion), and the magnitude of the cyclic variation of IBS within the infarct zone was expressed as phase-corrected magnitude (PCM) by giving positive and negative values when it showed synchronous and asynchronous contraction, respectively. Myocardial contrast echocardiography was performed soon after reperfusion, and 21 patients showed substantial no-reflow. They had smaller PCM before reperfusion than patients without no-reflow (-1.6 +/- 1.9 vs 0.7 +/- 2.7 dB, respectively; p = 0.0002). Multivariate logistic regression analysis revealed that PCM before reperfusion and the number of Q waves were the independent predictors of no reflow. Using -1.0 dB as the cut-off point, PCM predicted no reflow with 66.7% sensitivity and 81.2% specificity. These results indicate that the analysis of myocardial IBS could predict the no-reflow phenomenon before reperfusion.
authors.affiliation: Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Shigeo
authors.initials: S
authors.lastname: Kawano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okamura
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yuya
authors.initials: Y
authors.lastname: Nishida
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hori
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007485:Ioxaglic Acid; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D007485:Ioxaglic Acid