(Circulation. 2000;101:2368.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Assessment of Myocardial Reperfusion by Intravenous Myocardial Contrast Echocardiography and Coronary Flow Reserve After Primary Percutaneous Transluminal Coronary Angiography in Patients With Acute Myocardial Infarction
From Medical Clinic I, University RWTH, Aachen, Germany (W.L., R.H., A.F., H.P.K., J.v.D., U.J., P.H.); the Department of Cardiology, University Hospital VU, Amsterdam, The Netherlands (O.K., C.C.d.C., G.T.S., C.A.V.); and Core Laboratory (CLIP), Pisa, Italy (P.V.).
Correspondence to Dr Med Wolfgang Lepper, Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany. E-mail wlep{at}pcserver.mk1.rwth-aachen.de
Background—This study investigated whether the extent of perfusion defect determined by intravenous myocardial contrast echocardiography (MCE) in patients with acute myocardial infarction (AMI) treated by primary percutaneous transluminal coronary angioplasty (PTCA) relates to coronary flow reserve (CRF) for assessment of myocardial reperfusion and is predictive for left ventricular recovery.
Methods and Results—Twenty-five patients with first AMI underwent
intravenous MCE with NC100100 with intermittent harmonic
imaging before PTCA and after 24 hours. MCE before PTCA defined the
risk region and MCE at 24 hours the "no-reflow" region. The
no-reflow region divided by the risk region determined the ratio to the
risk region. CFR was assessed immediately after PTCA and 24 hours
later. Left ventricular wall motion score indexes were
calculated before PTCA and after 4 weeks. CFR at 24 hours defined a
recovery (CFR 
1.6; n=17) and a nonrecovery group (CFR <1.6; n=8).
Baseline CFR did not differ between groups. MCE ratio to the risk
region was smaller in the recovery group compared with the nonrecovery
group (34±49% vs 81±46%, P=0.009). A ratio to the
risk region of 
50% defined an MCE reperfusion group. It was
associated with improvement of CFR from 1.67±0.47 at baseline to
2.15±0.53 at 24 hours (P<0.001) and of regional wall
motion score index from 2.6±0.5 to 1.9±0.5 at 4 weeks
(P<0.001).
Conclusions—Intravenous MCE can be used to define perfusion defects after AMI. Assessment of microcirculation by MCE corresponds to evaluation by CFR. Serial intravenous MCE has the potential to identify patients likely to have improved left ventricular function after AMI.
Key Words: echocardiography • blood flow • microcirculation • myocardial infarction
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