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

Lepper, W.; Hoffmann, Rainer; Kamp, Otto; Franke, Andreas; Cock, Carel C. de; Kühl, Harald P.; Sieswerda, Gertjan T.; Dahl, Jürgen vom; Janssens, Uwe; Voci, Paolo; Visser, Cees A.; Hanrath, Peter

doi:10.1161/01.cir.101.20.2368

Cited by 216 publications

(128 citation statements)

References 33 publications

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“…This finding conflicts with other reports that used intracoronary Doppler ultrasound during myocardial infarction. 21,22 Lepper et al 21 found a CFR of Ն1.6 even in the infarct-related artery immediately after successful primary percutaneous coronary intervention, followed by good reperfusion as assessed by myocardial contrast echocardiography. Neumann et al 22 obtained a similar CFR (1.56 Ϯ 0.51) in the infarctrelated artery after primary percutaneous coronary intervention, which increased to 2.04 Ϯ 0.65 at 1 hour and to 2.66 Ϯ 0.72 at 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Pizzuto

Voci

Mariano

et al. 2004

The American Journal of Cardiology

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Coronary artery disease (CAD) has been suggested to alter coronary flow reserve (CFR; the ratio between hyperemic and baseline coronary flow velocities) not only in territories supplied by stenotic arteries but also in angiographically normal, remote regions. However, few data exist regarding the left anterior descending (LAD) coronary artery as the normal index artery. The influence of remote CAD on CFR of the angiographically normal LAD was evaluated with transthoracic Doppler ultrasound to measure CFR in the LAD during 90 seconds of venous adenosine infusion (140 g/kg/min) in 122 subjects who were assigned to 1 group; group 1 comprised 49 controls without angiographically detectable CAD, and group 2 consisted of 73 patients with an angiographically normal LAD and remote CAD. Experimental and clinical reports have suggested that acute myocardial infarction decreases coronary flow reserve (CFR; the ratio between hyperemic and baseline flow velocities) not only in the infarctrelated artery but also in remote, angiographically normal coronary arteries. 1-5 Discordant results have been reported in patients without previous myocardial infarction, 6 -8 and it is unclear what the interaction is when the normal vessel is the left anterior descending (LAD) coronary artery. Recent advances in color Doppler technology have allowed imaging of the distal LAD 9,10 by transthoracic echocardiography, thereby opening the way to the noninvasive detection of recanalization in acute anterior myocardial infarction, 11 diagnosis of LAD disease by measurement of CFR, 12-15 and monitoring of changes in CFR after stenting. 16,17 The aim of this study was to assess whether CFR in an angiographically normal LAD is preserved in patients with remote coronary artery disease (CAD), including those with myocardial infarction. CFR was prospectively measured by transthoracic coronary Doppler ultrasound. METHODSStudy population: Patients were selected from a population undergoing diagnostic or therapeutic cardiac catheterization at our institution. The requisite to be enrolled in this study was the presence of an angiographically normal LAD with or without remote CAD. From June 2002 to August 2003, 122 consecutive subjects (105 men and 17 women; mean age 58 Ϯ 10, range 31 to 77) were recruited and assigned to 1 of 2 groups; group 1 comprised 49 controls with chest pain but no angiographically detectable CAD (i.e., coronary arteries with angiographically smooth silhouettes), and group 2 consisted of 73 patients with an angiographically normal LAD and remote CAD. Group 2 was further divided into 4 subgroups: 16 patients with remote percutaneous coronary intervention but no evidence of myocardial infarction (group 2A); 13 patients without remote myocardial infarction but significant (Ն70%) remote coronary stenosis (group 2B); 23 patients with remote myocardial infarction and previous remote percutaneous coronary intervention (group 2C); and 21 patients with remote myocardial infarction but no remote percutaneous coronary intervention (group 2D)....

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Section: Discussionmentioning

confidence: 99%

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Pizzuto

Voci

Mariano

et al. 2004

The American Journal of Cardiology

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“…MCE has been proven to be an excellent method for the detection of microvascular dysfunction following angioplasty during infarction and for predicting subsequent recovery of function (6,8,9,12,13). TIMI grade 2 flow may be a less accurate indicator of ineffective perfusion than myocardial contrast perfusion (49); a recent study (50) suggested that MCE is superior to other modalities for assessing myocardial reperfusion after infarction.…”

Section: Previous Studiesmentioning

confidence: 99%

“…MCE can be used to reliably assess myocardial reperfusion following primary percutaneous coronary intervention (PCI) for AMI and to predict improvement in left ventricular (LV) function, as well as to assess the degree of collateral support to the infarcted territory (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven.…”

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confidence: 99%

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

Schnell

Kryski

Mann

et al. 2007

Canadian Journal of Cardiology

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O ptimal therapy during acute myocardial infarction (AMI) includes prompt re-establishment of flow in the infarct-related artery (IRA) and effective reperfusion (1-3). Early, spontaneous reperfusion occurs in a small but significant proportion of IRAs (4,5), and the majority are reperfused with thrombolytic therapy. It is difficult to determine whether patency has been achieved at a given time in most patients without cardiac catheterization. The availability of a noninvasive method to rapidly assess myocardial perfusion has important implications in the emergency management of patients presenting with a known or suspected AMI, or after administration of a thrombolytic agent. However, no technique has yet been demonstrated to quickly and reliably predict the effectiveness of reperfusion or status of the IRA.Myocardial contrast echocardiography (MCE) uses an injection of microbubbles to assess myocardial perfusion. MCE can be used to reliably assess myocardial reperfusion following primary percutaneous coronary intervention (PCI) for AMI and to predict improvement in left ventricular (LV) function, as well as to assess the degree of collateral support to the infarcted territory (6-17). However, due to time constraints and the technical demands of OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for nearnormal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a manag...

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“…Recently, Lepper and his colleagues [29] investigated whether the extent of perfusion defects detected by intravenous MCE in patients with AMI treated by primary PTCA related to coronary flow reserve for assessment of myocardial reperfusion and was predictive for left ventricular recovery. Twenty-five patients with AMI underwent MCE with intermittent harmonic imaging before PTCA and after 24 hours.…”

Section: Assessment Of Myocardial Viability In Acute St Elevation Myomentioning

confidence: 99%

Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications

Chung

2006

J Echocardiogr

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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

Abstract: 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.

Cited by 216 publications

References 33 publications

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications

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