Accuracy of dipyridamole myocardial contrast echocardiography for the detection of residual stenosis of the infarct-related artery and multivessel disease early after acute myocardial infarction.
OBJECTIVE
We aimed to evaluate the ability of vasodilator myocardial contrast echocardiography (MCE) to detect significant infarct-related artery (IRA) stenosis and multivessel disease (MVD) after thrombolysis.


BACKGROUND
The detection of residual IRA stenosis subtending significant viable myocardium and the identification of MVD may help to triage patients who may benefit from mechanical revascularization after acute myocardial infarction (AMI) and thrombolysis.


METHODS
Patients with AMI underwent low-power MCE at rest and after dipyridamole stress during SonoVue infusion seven to 10 days after thrombolysis.


RESULTS
Of the 73 patients, 61 demonstrated significant myocardial viability, of whom 57 (93%) showed significant IRA stenosis. Sensitivities to detect >50% IRA stenosis and MVD were 88% and 72%, respectively. The accuracy of detecting significant coronary stenosis in the anterior (left anterior descending coronary artery) versus inferoposterior (right coronary artery/left circumflex artery) circulation was similar for both IRA (85% vs. 91%) and remote territories (91% vs. 81%). Quantitative peak contrast intensity (p = 0.02), microbubble velocity (p = 0.0001), and myocardial blood flow (p < 0.0001) were significantly lower in patients with significant coronary stenosis during dipyridamole compared with rest. Only beta reserve discriminated various grades of coronary stenosis.


CONCLUSIONS
Use of MCE accurately predicted significant IRA stenosis and MVD after thrombolysis. This information is valuable for identifying patients who may benefit from mechanical revascularization.
Janardhanan
Rajesh
R
Cardiology Department, Northwick Park Hospital, Harrow, United Kingdom.
Senior
Roxy
R
D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D004176:Dipyridamole; D004452:Echocardiography; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013997:Time Factors; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole