Comparison between myocardial contrast echocardiography and single-photon emission computed tomography for predicting transmurality of acute myocardial infarction.
Contrast-enhanced cardiovascular magnetic resonance imaging (CMR) has been shown to accurately assess transmural extent of infarction, which is an excellent predictor of long-term improvement in contractile function. We assessed the relative accuracy of myocardial contrast echocardiography (MCE) and single-photon emission computed tomography (SPECT) to predict transmural extent of infarction after acute myocardial infarction. MCE, SPECT, and CMR were performed in 40 patients with acute myocardial infarction 7 to 10 days after thrombolysis. CMR was used to divide the transmural extent of infarction into 5 groups: 0%, 1% to 25%, 26% to 50%, 51% to 75%, and 76% to 100% in dysfunctional segments. MCE and SPECT were compared with assessment grades of transmural extent of infarction. There was a significant relation (p<0.0001) between decreasing contrast intensity as assessed qualitatively by MCE and increasing transmural extent of infarction on CMR as was the case for SPECT. The accuracy of MCE (77%) to predict>50% transmural extent of infarction (nonviable myocardium) was significantly (p=0.02) superior to that of SPECT (70%). Absence of uptake on MCE and SPECT virtually ruled out <or=50% of the transmural extent of infarction (negative predictive values 93% and 89%, respectively). MCE was significantly more sensitive than SPECT in differentiating between <or=25% and>25% transmural extent of infarction (84% vs 76%, p=0.03). MCE and SPECT correlate well with the transmural extent of infarction. However, MCE is significantly more accurate in predicting >50% of the transmural extent of infarction and more sensitive in identifying <or=25% of the transmural extent of infarction than SPECT.
Hayat
Sajad A
SA
Department of Cardiology, Northwick Park Hospital, Harrow, United Kingdom.
Janardhanan
Rajesh
R
Moon
James C C
JC
Pennell
Dudley J
DJ
Senior
Roxy
R
D015331:Cohort Studies; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D015899:Tomography, Emission-Computed, Single-Photon
D003287:Contrast Media; D019786:Gadolinium DTPA