Prognostic value of myocardial viability detected by myocardial contrast echocardiography early after acute myocardial infarction.
OBJECTIVE
This study sought to determine whether residual myocardial viability determined by myocardial contrast echocardiography (MCE) after acute myocardial infarction (AMI) can predict hard cardiac events.


BACKGROUND
Myocardial viability detected by MCE has been shown to predict recovery of left ventricular (LV) function in patients with AMI. However, to date no study has shown its value in predicting major adverse outcomes in AMI patients after thrombolysis.


METHODS
Accordingly, 99 stable patients underwent low-power MCE at 7 +/- 2 days after AMI. Contrast defect index (CDI) was obtained by adding contrast scores (1 = homogenous; 2 = reduced; 3 = minimal/absent opacification) in all 16 LV segments divided by 16. At discharge, 65 (68%) patients had either undergone or were scheduled for revascularization independent of the MCE result. The patients were subsequently followed up for cardiac death and nonfatal AMI.


RESULTS
Of the 99 patients, 95 were available for follow-up. Of these, 86 (87%) underwent thrombolysis. During the follow-up time of 46 +/- 16 months, there were 15 (16%) events (8 cardiac deaths and 7 nonfatal AMIs). Among the clinical, biochemical, electrocardiographic, echocardiographic, and coronary arteriographic markers of prognosis, the extent of residual myocardial viability was an independent predictor of cardiac death (p = 0.01) and cardiac death or AMI (p = 0.002). A CDI of < or = 1.86 and < or = 1.67 predicted survival and survival or absence of recurrent AMI in 99% and 95% of the patients, respectively.


CONCLUSIONS
The extent of residual myocardial viability predicted by MCE is a powerful independent predictor of hard cardiac events in patients after AMI.
Department of Cardiovascular Medicine, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, Middlesex, United Kingdom.
Girish
G
Dwivedi
Rajesh
R
Janardhanan
Sajad A
SA
Hayat
John M
JM
Swinburn
Roxy
R
Senior
D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D016019:Survival Analysis; D014022:Tissue Survival; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology