Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction

Abstract

Objective-To evaluate the combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after myocardial infarction. Design-Myocardial contrast echocardiography was performed in patients with acute myocardial infarction shortly after successful coronary reperfusion (TIMI 3 patency) by direct angioplasty. Collateral flow was assessed before coronary angioplasty, and contrast reflow was evaluated 15 minutes after reperfusion. The presence of contractile reserve was assessed by low dose dobutamine echocardiography (5 to 15 µg/kg/min) at (mean (SD)) 3 (2) days after myocardial infarction. Recovery of segmental function (myocardial viability) was evaluated by resting echocardiography at a two month follow up. The study was prospective. Patients-35 consecutive patients referred for acute transmural myocardial infarction. Results-Contrast reflow was observed in 20 patients (57%) and collateral flow in 14 (40%). Contrast reflow and collateral contrast flow were both correlated with reversible dysfunction on initial dobutamine echocardiography and at follow up (p < 0.05). The presence of reflow or collateral flow on myocardial contrast echocardiography was a highly sensitive (100%) but weakly specific (60%) indicator of segmental dysfunction recovery. Simultaneous presence of contrast reflow and collateral flow was more specific of reversible dysfunction than reflow alone (90% v 60%). Conclusions-Combined assessment of reflow and collateral blood flow enhanced the sensitivity of myocardial contrast echocardiography in predicting myocardial viability after acute, reperfused myocardial infarction. The simultaneous presence of reflow and collateral blood flow was highly specific of recovery of segmental dysfunction. (Heart 1999;82:62-67)

Myocardial blood volume and the amount of viable myocardium early after mechanical reperfusion of acute myocardial infarction: prospective study using venous contrast echocardiography

“…Depending on the strictness of criteria for the positive contrast effect, sensitivities for prediction of subsequent functional recovery were found between 66% 7 and 100%. 8 Specificity, however, was only between 18% 9 and 60% 7 in most studies. We found higher diagnostic accuracy of venous contrast echocardiography for prediction of recovery of contractile function or the presence of contractile reserve after acute myocardial infarction.…”

“…6 Identification of viable myocardium after reperfusion following acute myocardial infarction, through contrast enhancement after intracoronary injection of microbubbles, was, however, limited in most studies by low specificity for the binary prediction of recovery of resting contractile function. [7][8][9] We expected that the more physiological intramyocardial distribution of the contrast agent after venous administration would result in a precise image of differential degrees of myocardial microvascular damage. We therefore hypothesised that measuring the transmural contrast signal from the myocardium would correlate with the extent of myocardial viability and functional recovery after mechanical reperfusion of acute myocardial infarction.…”

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

“…Angiographic TIMI grading is regarded to be a simple method to establish no-reflow (3). Myocardial contrast echocardiography can establish no-reflow as it demonstrates tissue perfusion level clearly (13,14). However, contrast echocardiography is a complicated procedure to perform.…”

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

“…17) Although myocardial contrast echocardiography, which can demonstrate tissue perfusion, may be beneficial in detecting the frequency of no-reflow, [8][9][10] its unpractical application limits its efficacy. However, TIMI flow grade is accepted as a simple alternative with which to detect no-reflow without an additional method or extra time.…”