Circulation, Vol 85, 1699-1705, Copyright © 1992 by American Heart Association
H Ito, T Tomooka, N Sakai, H Yu, Y Higashino, K Fujii, T Masuyama, A Kitabatake and T Minamino
BACKGROUND. We investigated myocardial perfusion dynamics after
thrombolysis and its clinical implications. METHODS AND RESULTS. We studied
39 patients with acute anterior myocardial infarction (AMI). Myocardial
contrast echocardiography (MCE) was performed before and immediately after
successful reflow with intracoronary injection of sonicated Ioxaglate. The
average segmental score by two-dimensional echocardiography (graded 0,
normal, to 3, akinetic/dyskinetic) and global ejection fraction (left
ventricular ejection fraction, LVEF%) by left ventriculography were
measured at 1 day and at 4 weeks after reflow. Hypokinesis in the infarct
region was assessed by the centerline method and expressed in terms of
standard deviations (regional wall motion [RWM]: SD/chord) of normal.
Immediately after reflow, 30 of 39 patients (group A) showed significant
contrast enhancement within the risk area. The other nine patients (23%,
group B), however, showed the residual contrast defect in the risk area
(myocardial no reflow). There were no significant differences in the
elapsed time, angiographic collateral grade, and degree of residual
stenosis between group A and group B. Before reflow, both groups exhibited
similar levels of global and regional left ventricular function.
Improvement in global (LVEF, average segmental score) and regional left
ventricular function was greater in group A than in group B (average
segmental score, 0.44 +/- 0.41 versus 0.97 +/- 0.36, p less than 0.01;
LVEF, 56.4 +/- 13.4 versus 42.7 +/- 8.9, p less than 0.05; RWM, -1.87 +/-
0.85 versus -3.18 +/- 0.52, p less than 0.005). CONCLUSIONS. MCE
demonstrates that angiographically successful reflow cannot be used as an
indicator of successful myocardial reperfusion in AMI patients. The
residual contrast defect in the risk area demonstrated immediately after
reflow is a predictor of poor functional recovery of the postischemic
myocardium.
ARTICLES
Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction
Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
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