Coronary artery disease
Comparison Between Contrast Echocardiography and Magnetic Resonance Imaging to Predict Improvement of Myocardial Function After Primary Coronary Intervention

https://doi.org/10.1016/j.amjcard.2005.08.053Get rights and content

The relative merits of myocardial contrast echocardiography (MCE) and magnetic resonance imaging (MRI) to predict myocardial function improvement after percutaneous coronary intervention have not been evaluated until now. We studied 35 consecutive patients with acute myocardial infarction who underwent percutaneous coronary intervention using MCE and MRI and first-pass imaging for evaluation of myocardial perfusion. Delayed-enhanced MRI was included as another method to differentiate viable from infarcted tissue. MCE was performed by power modulation and intravenous Sonovue. A 16-segment model of the left ventricle was used to analyze all myocardial contrast echocardiograms and magnetic resonance images. At 60 days of follow-up, MCE showed improvement of function in 115 of 192 (60%) dysfunctional segments. The sensitivity, specificity, and accuracy for the prediction of functional improvement were comparable among MCE (87%, 90%, and 88%), first-pass MRI (87%, 60%, and 79%), and delayed-enhancement MRI (75%, 100%, and 82%, respectively, all p = NS). In conclusion, MCE and MRI allowed for prediction of myocardial function improvement after percutaneous coronary intervention. MCE had a comparable accuracy and, as a bedside technique, may be an alternative tool in the acute phase of acute myocardial infarction.

Section snippets

Patients and study protocol

This prospective study comprised 42 consecutive patients with ST-elevation AMI who underwent PCI within 6 hours of symptom onset. The diagnosis of AMI was made on the basis of symptoms consistent with myocardial ischemia for ≥30 minutes and ≥2 mm ST-segment elevation in ≥2 contiguous electrocardiographic leads. The infarct-related artery was identified by the site of coronary occlusion during coronary angiography and electrocardiographic criteria. Stent implantation was performed in all

Patient characteristics and perfusion/enhancement pattern at baseline

The baseline characteristics of the 35 patients (30 men; mean age 52 ± 12 years) are listed in Table 1. The mean time from symptom onset to the first balloon inflation was 4.1 ± 1.8 hours. In 3 of the 35 patients (8%), the infarct-related coronary artery was suboccluded with a Thrombolysis In Myocardial Infarction grade 3 flow when angiography was performed. No residual angiographic stenosis was found in the target coronary vessel. In 241 segments related to the acute infarct territory, 72

Discussion

In patients who underwent PCI for AMI, MCE and contrast-enhanced MRI allowed early assessment of microvascular integrity and prediction of improvement of myocardial function. The main finding of the present study was that these modalities provided a comparable sensitivity, specificity, and accuracy for the assessment of recovery of contractile function after PCI.

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