Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction.
OBJECTIVE
To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI).


BACKGROUND
Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven.


METHODS
Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency.


RESULTS
Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for near-normal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001).


CONCLUSIONS
MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a management strategy.
Schnell
Gregory B
GB
Department of Cardiac Sciences and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.
Kryski
Albert J
AJ
Mann
Luana
L
Anderson
Todd J
TJ
Belenkie
Israel
I
D000208:Acute Disease; D017115:Catheter Ablation; D003097:Collateral Circulation / Q000502:physiology; D003287:Contrast Media; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology
D003287:Contrast Media