Usefulness of Myocardial Contrast Echocardiography Early After Acute Myocardial Infarction

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 23; no. 3; pp. 208 - 217
• Main Authors: Cianciulli, Tomás F., Lax, Jorge A., Beck, Martín A., Masoli, Osvaldo H., Redruello, Marcela F., Saccheri, María C., Guevara, Eduardo, Gagliardi, Juan A., Dorelle, Adriana N., Prezioso, Horacio A.
• Format: Journal Article
• Language: English
• Published: 350 Main St , Malden , MA 02148 , USA , and PO Box 1354, Garsington Rd , Oxford OX4 2DQ , UK and PO Box 378 Carlton South , 3053 Victoria , Australia Blackwell Publishing Inc 01.03.2006
• Subjects: acute myocardial infarction; Adult; Aged; Aged, 80 and over; Albumins; Case-Control Studies; Contrast Media; Echocardiography; Female; Fluorocarbons; Humans; Male; microcirculation; Middle Aged; myocardial contrast echocardiography; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Myocardial Reperfusion; Myocardial Stunning - diagnostic imaging; Necrosis; Prospective Studies; reperfusion; stunning; Thrombolytic Therapy; Time Factors
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/j.1540-8175.2006.00190.x

Objectives: (1) Evaluate wall motion and perfusion abnormalities after reperfusion therapy of the culprit lesion, (2) delineate the ability of myocardial contrast echocardiography (MCE) to evaluate the microvasculature after reperfusion, in order to distinguish between stunning and necrosis in the risk area. Methods: We analyzed 446 segments from 28 patients, 10 normal controls (160 segments), and 18 with a first AMI (286 segments). MCE was obtained with Optison and a two‐dimensional echocardiography was performed at 3 months post acute myocardial infarction (AMI). Results: In the group with AMI, we analyzed 286 segments, of which 107 had wall motion abnormalities (WMA) related to the culprit artery. Two subgroups were identified: Group I with WMA and normal perfusion (50 segments, 47%) and Group II with WMA and perfusion defects (57 segments, 53%). According to the 2D echocardiogram at 3 months, they were further subdivided into: Group IA: with wall motion improvement (stunning): 18 segments, 36%, Group IB: without wall motion improvement: 32 segments, 64%, Group IIA: with wall motion improvement: 12 segments, 21%, Group IIB: without wall motion improvement (necrosis): 45 segments, 79%. Conclusions: (1) The presence of myocardial perfusion in segments with WMA immediately after AMI reperfusion therapy predicts viability in most patients. Conversely, the lack of perfusion is not an absolute indicator of the presence of necrosis. (2) Perfusion defects allow to detect patients with thrombolysis in myocardial infarction (TIMI) 3 flow and “no‐reflow” phenomenon who will not show improved wall motion in the 2D echocardiogram. However, some patients with initial no‐reflow could have microvascular stunning and their regional contractile function will normalize after a recovery period.