Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction

• Published in: Journal of the American College of Cardiology Vol. 38; no. 1; pp. 19 - 25
• Main Authors: Swinburn, Jonathan M.A, Lahiri, Avijit, Senior, Roxy
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2001; Elsevier Science
• Subjects: Aged; Albumins; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiovascular system; Contrast Media; Female; Fluorocarbons; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Microspheres; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Predictive Value of Tests; Recovery of Function; Sensitivity and Specificity; Ultrasonic investigative techniques; Ultrasonography - methods; Ventricular Function; OR; NPV; CI; PPV; PTCA; CK; CK-MB; ECG; IRA; LV; AMI; MCE; Sonography; Human; Cardiac performance; Echocardiography; Intravenous administration; Infarct; Cardiovascular disease; Exploration; Coronary heart disease; Myocardial disease; Myocardium; Diagnosis; Technique; Contrast media
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(01)01317-1

OBJECTIVES
We aimed to ascertain whether triggered intravenous myocardial contrast echocardiography (MCE) can predict functional recovery in patients with acute myocardial infarction (AMI) and to determine the optimal triggering interval in this setting.
BACKGROUND
Detection of myocardial viability early after AMI has both therapeutic and prognostic implications. Myocardial contrast echocardiography using intracoronary injections of contrast can detect viable myocardium, but there is little data on the use of recently developed intravenous MCE techniques for this purpose.
METHODS
Ninety-six patients with recent AMI (4.8 ± 1.7 days) underwent echocardiography at baseline and six months later or three months after revascularization to determine regional function (score 1 = normal to 3 = akinetic). Myocardial contrast echocardiography was performed at baseline using intravenous injections of Optison. Triggering intervals of 1:1 (early) and 1:10 (delayed) cardiac cycles were used. Segments were deemed viable if they demonstrated homogeneous contrast opacification.
RESULTS
Of 400 akinetic segments at baseline, 109 (27%) improved during the follow-up period, and 375 (94%) were adequately visualized with MCE, of which 59 (16%) were homogeneously opacified by early and 125 (33%) by delayed MCE (negative predictive value for recovery of contractile function 74% and 84%, positive predictive value 29% and 47%, respectively). Independent predictors of functional recovery were delayed MCE (odds ratio [OR]: 4.0, p < 0.001), revascularization (OR: 6.0, p < 0.001), and log creatine kinase (OR: 0.5, p = 0.03). However, the presence or absence of >90% stenosis of the infarct-related artery did not influence the ability of triggered MCE to predict functional recovery.
CONCLUSIONS
Intravenous delayed triggered MCE can independently detect myocardial viability early after AMI.