Intravenous versus intracoronary myocardial contrast echocardiography for evaluation of no-reflow after primary percutaneous coronary intervention.
OBJECTIVE
We sought to compare intravenous myocardial contrast echocardiography (IV-MCE) with intracoronary myocardial contrast echocardiography (IC-MCE) in detecting no-reflow and predicting the short-term outcome of left ventricular function after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).


METHODS
IC-MCE and IV-MCE were performed immediately after PCI (D1) of 28 patients with anterior wall AMI. IV-MCE was repeated at the next day of PCI (D2), and left ventricular systolic function was evaluated at D2 and 30 days later (D30).


RESULTS
There was good agreement between IC-MCE and IV-MCE at D1 in determining no-reflow (kappa= 0.78, P < 0.001) as well as between IV-MCE at D1 and D2 (kappa= 0.93, P < 0.001). The patients with no-reflow on IC-MCE (n = 13) and those on IV-MCE at D2 (n = 11) showed no improvement in left ventricular ejection fraction (LVEF) after 1 month (49 +/- 9% to 48 +/- 7%, P = 0.55, and 51 +/- 6% to 49 +/- 7%, P = 0.20). However, the patients with reflow on IC-MCE (n = 15) and those on IV-MCE at D2 (n = 17) demonstrated significant improvement in LVEF (55 +/- 6% to 62 +/- 5%, P < 0.005, and 53 +/- 7% to 60 +/- 8%, P < 0.005). In predicting segmental functional recovery after 1 month, sensitivity and specificity of IC-MCE were 85% and 67%, respectively, and those of IV-MCE at D2 were 95% and 40%, respectively.


CONCLUSIONS
IV-MCE at D2 might be substituted for IC-MCE performed immediately after PCI for the evaluation of no-reflow and prediction of left ventricular systolic function after 1 month in patients with anterior wall AMI.
Song
Jong-Min
JM
Division of Cardiology, Department of Internal Medicine, Asan [corrected] Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jmsong@amc.seoul.kr
Lee
Jae-Hwan
JH
Kim
Young-Hak
YH
Kang
Duk-Hyun
DH
Song
Jae-Kwan
JK
Hong
Myeong-Ki
MK
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
Kim
You-Ho
YH
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage*; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion; D011134:Polysaccharides / Q000008:administration & dosage; D011237:Predictive Value of Tests; D015642:Radiology, Interventional / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508