[Real time myocardial contrast echocardiography to predict left ventricular wall motion recovery after reperfused acute myocardial infarction].
OBJECTIVE
Real time myocardial contrast echocardiography (RTMCE) is a recently developed method. We sought to determine: a) whether RTMCE predicts recovery of left ventricular function after acute myocardial infarction (AMI), and b) whether data obtained with this method are comparable to those obtained with 99mTc-sestamibi single photon emission computed tomography (SPECT) and magnetic resonance.


METHODS
We studied 85 patients with AMI who underwent angioplasty. RTMCE was performed 7 (4) days after AMI. Two-dimensional echocardiography was performed at the time of the RTMCE study and at follow-up (10 [4] weeks). SPECT and magnetic resonance were performed after AMI in 18 and 32 patients, respectively.


RESULTS
Follow-up two-dimensional echocardiography results were available for 82 patients, who were subdivided into 2 groups: recovery (n=49) and no recovery (n=33). Regional (AMI-related) wall motion score index improved from 1.75 (0.49) to 1.32 (0.36) (P< .001) in the recovery group, and worsened from 1.85 (0.39) to 1.95 (0.36) in the no recovery group (P< .001). RTMCE perfusion score was 0.8 (0.3) in the recovery group, and 0.6 (0.4) in the no recovery group (P< .001). Concordance between RTMCE and SPECT in a segmental analysis was 78% (P< .001; kappa=0.49), whereas concordance between RTMCE and hyperenhancement with delayed contrast magnetic resonance findings was 70% (P< .001; kappa =0.35). Independent predictors of recovery were peak creatine kinase (OR=1.4 per 1000 UI; 95% CI, 1.0-1.9; P< .05) and RTMCE score (OR=8.8; 95% CI, 1.9-39.3; P< .01). A RTMCE score > or = 0.60 had a positive predictive value of 73% and a negative predictive value of 69% (P< .001; area under the curve 0.70).


CONCLUSIONS
RTMCE showed a modest predictive value for recovery of left ventricular function after reperfused AMI.
Peteiro
Jesús
J
Servicio de Cardiología, Hospital Juan Canalejo, Coruña, Spain. pete@canalejo.org
Soler
Rafaela
R
Monserrat
Lorenzo
L
Rodríguez
Esther
E
Garrido
Iris
I
Pérez
Ruth
R
Pais
Paulino
P
Vázquez
José M
JM
Calviño
Ramón
R
Salgado
Jorge
J
Castro-Beiras
Alfonso
A
D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media; D015150:Echocardiography, Doppler / Q000379:methods*; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
D003287:Contrast Media
Ecocardiografía de perfusión miocárdica en tiempo real para la predicción de la recuperación de la función ventricular después del infarto agudo de miocardio reperfundido.