Serial evaluation of perfusion defects in patients with a first acute myocardial infarction referred for primary PTCA using intravenous myocardial contrast echocardiography.

AIMS To investigate whether myocardial contrast echocardiography using Sonazoid could be used for the serial evaluation of the presence and extent of myocardial perfusion defects in patients with a first acute myocardial infarction treated with primary PTCA, and specifically, (1) to evaluate safety and efficacy of myocardial contrast echocardiography to detect TIMI flow grade 0--2, (2) to evaluate the success of reperfusion and (3) to predict left ventricular recovery after 4 weeks follow-up. METHODS AND RESULTS Fifty-nine patients underwent serial myocardial contrast echocardiography, immediately before primary PTCA (MCE1), 1 h (MCE2) and 12--24 h after PTCA (MCE3). A perfusion defect was observed in 21 of 24 patients (88%) with anterior acute myocardial infarction. All but one had TIMI flow grade 0--2 prior to PTCA. Nine of 31 patients (29%) with inferior acute myocardial infarction showed a perfusion defect and all had TIMI flow grade 0-2 prior to PTCA. Restoration of TIMI flow grade 3 was achieved in 73% of the patients by primary PTCA. A reduction in size of the initial perfusion defect of at least one segment (16 segment model) or no defect vs persistent defect in patients with anterior acute myocardial infarction was associated with improved global left ventricular function at 4 weeks; mean global wall motion score index 1.29+/-0.21 vs 1.66+/-0.31 (P=0.009). Multiple regression analysis in patients with an anterior acute myocardial infarction revealed that the extent of the perfusion defect at MCE3 was a significant (P=0.0005) independent predictor for left ventricular recovery at 4 weeks follow-up. The only other independent predictor was TIMI flow grade 3 post PTCA (P=0.007). CONCLUSION Intravenous myocardial contrast echocardiography immediately prior to primary PTCA seems safe and is capable of detecting the presence of a perfusion defect and its subsequent dynamic changes, particularly in patients with a first anterior acute myocardial infarction. A significant reduction in size of the initial perfusion defect using serial myocardial contrast echocardiography predicts functional recovery after 4 weeks and these findings underscore the potential diagnostic value of intravenous myocardial contrast echocardiography.

[1]  J. Ferrières,et al.  Treatment of acute myocardial infarction by primary coronary angioplasty or intravenous thrombolysis in the "real world": one-year results from a nationwide French survey. , 1999, Circulation.

[2]  L. Branco.  Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice. Comparison with wall motion and technetium--99m sestamibi single--photon emission computed tomography. , 1999, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[3]  A. Distante,et al.  Myocardial Perfusion Abnormalities by Intravenous Administration of the Contrast Agent NC100100 in an Experimental Model of Coronary Artery Thrombosis and Reperfusion , 1998, Echocardiography.

[4]  S. Kaul.  Myocardial contrast echocardiography: 15 years of research and development. , 1997, Circulation.

[5]  A. Distante,et al.  Stress echocardiography and myocardial contrast echocardiography in viability assessment. , 1997, European heart journal.

[6]  T. Porter,et al.  Detection of myocardial perfusion in multiple echocardiographic windows with one intravenous injection of microbubbles using transient response second harmonic imaging. , 1997, Journal of the American College of Cardiology.

[7]  P. Colonna,et al.  Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography. , 1996, The American journal of cardiology.

[8]  M. Hori,et al.  Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. , 1996, Circulation.

[9]  P. Grayburn,et al.  Peripheral intravenous myocardial contrast echocardiography using a 2% dodecafluoropentane emulsion: identification of myocardial risk area and infarct size in the canine model of ischemia. , 1995, Journal of the American College of Cardiology.

[10]  S. Kaul,et al.  Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. , 1994, Circulation.

[11]  Gusto Angiographic Investigators.  The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. , 1993, The New England journal of medicine.

[12]  S. Kaul,et al.  Assessment of Risk Area During Coronary Occlusion and Infarct Size After Reperfusion With Myocardial Contrast Echocardiography Using Left and Right Atrial Injections of Contrast , 1993, Circulation.

[13]  Eric J. Topol,et al.  Illusion of Reperfusion Does Anyone Achieve Optimal Reperfusion During Acute Myocardial Infarction? , 1993, Circulation.

[14]  J. Reiber,et al.  A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. , 1993, The New England journal of medicine.

[15]  K. Bailey,et al.  Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. The Mayo Coronary Care Unit and Catheterization Laboratory Groups. , 1993, The New England journal of medicine.

[16]  J O'Keefe,et al.  A Comparison of Immediate Angioplasty with Thrombolytic Therapy for Acute Myocardial Infarction , 1993 .

[17]  S. Kaul,et al.  An association between collateral blood flow and myocardial viability in patients with recent myocardial infarction. , 1992, The New England journal of medicine.

[18]  S. Kaul,et al.  Functional Significance of Collateral Blood Flow in Patients With Recent Acute Myocardial Infarction: A Study Using Myocardial Contrast Echocardiography , 1992, Circulation.

[19]  A. Kitabatake,et al.  Lack of Myocardial Perfusion Immediately After Successful Thrombolysis: A Predictor of Poor Recovery of Left Ventricular Function in Anterior Myocardial Infarction , 1992, Circulation.

[20]  S. Kaul,et al.  Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. , 1991, Circulation.

[21]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[22]  T. Force,et al.  Topographic correspondence of contrast echocardiographic perfusion mapping and myocardial infarct extent after varying durations of coronary occlusion. , 1988, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[23]  A. Weyman,et al.  The importance of defining left ventricular area at risk in vivo during acute myocardial infarction: an experimental evaluation with myocardial contrast two-dimensional echocardiography. , 1987, Circulation.

[24]  R. Kloner,et al.  Acute myocardial infarction: diagnostic and prognostic applications of two-dimensional echocardiography. , 1987, Circulation.

[25]  H. S. Mueller,et al.  The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. , 1985, The New England journal of medicine.

[26]  G M Pohost,et al.  Contrast echocardiography in acute myocardial ischemia: I. In vivo determination of total left ventricular "area at risk". , 1984, Journal of the American College of Cardiology.

[27]  H. Feigenbaum,et al.  Assessment of location and size of myocardial infarction with contrast-enhanced echocardiography. , 1983, Journal of the American College of Cardiology.

[28]  J. Willerson.  Echocardiography after acute myocardial infarction. , 1979, The New England journal of medicine.

[29]  J. B. Garrison,et al.  Regional cardiac dilatation after acute myocardial infarction: recognition by two-dimensional echocardiography. , 1979, The New England journal of medicine.