title: Comparison of two- versus three-dimensional myocardial contrast echocardiography for assessing subendocardial perfusion abnormality after percutaneous coronary intervention in patients with acute myocardial infarction.
abstract: Myocardial contrast echocardiography (MCE) visualizes myocardial perfusion abnormalities after acute myocardial infarction. However, the limited view of 2-dimensional echocardiography reduces its ability to estimate perfusion abnormalities, especially in the subendocardial region. Three-dimensional echocardiography provides images of the left ventricular endocardium directly. This study was conducted to evaluate the ability of 3-dimensional MCE to assess abnormalities of subendocardial perfusion. Intracoronary 2- and 3-dimensional MCE was performed after primary percutaneous coronary intervention in 47 patients with acute myocardial infarction. Myocardial perfusion within the risk area was evaluated as good, poor, or no reflow on 2-dimensional MCE or as good, poor, or no myocardial opacification in endocardium on 3-dimensional MCE. The 2 methods showed different distributions of perfusion patterns: good, poor, and no reflow on 2-dimensional MCE in 31 (66%), 9 (19%), and 7 (15%) patients and good, poor, and no myocardial opacification in endocardium on 3-dimensional MCE in 17 (36%), 16 (34%), and 14 (20%) patients, respectively. Although only 19 patients (61%) with good reflow on 2-dimensional MCE showed myocardial perfusion grade 3 on angiography, 16 of 17 patients (94%) with good myocardial opacification in endocardium on 3-dimensional MCE showed myocardial perfusion grade 3. Although there were no significant differences in peak creatine kinase among the 3 subsets classified by 2-dimensional MCE, peak creatine kinase showed significant differences not only among the 3 groups but also among the subsets classified by 3-dimensional MCE. Classification by 3-dimensional MCE also predicted regional wall motion after 4.6 +/- 2.7 months, with significant differences between each pair of groups, whereas there was significant overlap of these values between the group with poor reflow and other 2 groups by 2-dimensional MCE. In conclusion, 3-dimensional MCE is a feasible way to assess subendocardial perfusion and predicts infarct size and functional recovery more precisely than 2-dimensional MCE.
authors.affiliation: Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan. iwakura@mac.com
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okamura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kurotobi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Koyama
authors.forename: Motoo
authors.initials: M
authors.lastname: Date
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagai
authors.forename: Michio
authors.initials: M
authors.lastname: Imai
authors.forename: Yo
authors.initials: Y
authors.lastname: Arita
authors.forename: Yuko
authors.initials: Y
authors.lastname: Toyoshima
authors.forename: Makito
authors.initials: M
authors.lastname: Ozawa
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media; D003326:Coronary Circulation; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D004699:Endocardium / Q000000981:diagnostic imaging; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D003402:Creatine Kinase