Coronary artery diseaseComparison Between Contrast Echocardiography and Magnetic Resonance Imaging to Predict Improvement of Myocardial Function After Primary Coronary Intervention
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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Cited by (17)
Cardiac Magnetic Resonance Evaluation of Myocardial Viability and Ischemia
2008, Seminars in RoentgenologyCitation Excerpt :When the delayed enhancement accounted for more than half the myocardial thickness, improvement was seen in less than 10% of segments.16 Similar results showing an inverse relationship between the transmural extent of delayed enhancement and post revascularization functional recovery in chronic IHD patients have been obtained in other studies.17-20 Similarly, in patients with reperfused acute myocardial infarction (MI), the transmural extent of infarction as seen on DE-MRI following revascularization predicts improvement in contractility.21
Prediction of improvement in left ventricular function during a 1-year follow-up after acute myocardial infarction by the degree of acute resolution of electrocardiographic changes
2007, Journal of ElectrocardiologyCitation Excerpt :Lots of studies have reported impaired tissue reperfusion in many patients despite patent IRA and that patients with impaired tissue reperfusion have a worse outcome.28,29 This discrepancy is thought to be secondary to low microvascular reflow and tissue damage not quantifiable by epicardial flow alone30; this hypothesis has been supported by myocardial contrast echocardiography,31 nuclear scintigraphy,32,33 and magnetic resonance imaging studies.34,35 This study showed that rapid evolution of ECG stages during the first 2 days of AMI is a sign of sufficient myocardial reperfusion after mechanical, thrombolytic, or spontaneous recanalization, and predicts the improvement in LV function at follow-up.
Three-Dimensional Echocardiographic Evaluation of Myocardial Perfusion
2007, Cardiology ClinicsCitation Excerpt :Importantly, myocardial contrast echocardiography, with or without quantification, proved useful in multiple clinical scenarios. Beyond the obvious detection of resting perfusion defects [1,3,21–30] and evaluation of severity and extent of perfusion deficit [24,30,50–54], it was found useful in detecting stress-induced myocardial ischemia [55–60] and diagnosing acute coronary events in patients presenting with atypical chest pain in the emergency department [61–63], as well as evaluation of myocardial reperfusion after coronary revascularization [56,64–67]. Nevertheless, it has been recognized that the ability of conventional contrast-enhanced echocardiographic imaging to provide accurate information on the extent and severity of perfusion abnormalities is limited by its 2D nature, similar to the assessment of LV volume and function (see the article on chamber quantification elsewhere in this issue).
Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion. The Evidence So Far
2006, Journal of the American College of CardiologyCitation Excerpt :Patients without microvascular dysfunction on MCE have less enzymatic elevation, better functional performance, better recovery of global and regional wall motion, less remodeling, and better survival independent of other predictors (47–49). The ability of MCE to predict functional recovery is summarized in Table 4(50–63) and is comparable to that of cardiovascular magnetic resonance imaging (64,65) (Fig. 8). Thus the existing literature suggests that MCE has important additional value for diagnosis and risk stratification in patients with acute ischemic heart disease.