Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction

Main, Michael L.; Magalski, Anthony; Chee, Nicholas K.; Coen, Michael M; Skolnick, David G.; Good, Thomas H.

doi:10.1016/s0735-1097(01)01574-1

Cited by 75 publications

(41 citation statements)

References 19 publications

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“…In the experimental animal, 18 F-fluorodeoxyglucose also shows persistent glucose metabolism derangement after ischemia [27]. Using an approach quite similar to ours, Main et al identified the stunned, reperfused myocardium after AMI as perfusion-contraction mismatch in real-time myocardial contrast echocardiography performed in a mean of 2.2 days after hospital admission [28]. In this instance, the total extent of abnormal contraction would be the expression of the risk area and the contrast defect of the final infarct size.…”

Section: Discussionmentioning

confidence: 77%

Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

Sotgia

Sciagrà

Parodi

et al. 2007

Eur J Nucl Med Mol Imaging

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Purpose We hypothesized that, because of persistent stunning, the extent of post-treatment functional abnormalities detected using gated single-photon emission computed tomography (SPECT) could be representative of the initial risk area in acute myocardial infarction (AMI) treated by reperfusion therapy. Materials and methods In 48 AMI patients, we acquired two 99m Tc-sestamibi gated SPECT studies (at admission with tracer injection before treatment and at discharge 5 to 10 days later). We assessed the myocardial salvage defined by the admission minus predischarge summed rest score, and we compared it with the value obtained by subtracting the extent of perfusion defect from the extent of wall motion or wall thickening abnormalities in predischarge gated SPECT. Myocardial salvage was expressed as salvage index (salvaged myocardium divided by initial risk area). Results There was a good correlation between summed rest score salvage index and wall motion (Spearman's ρ=0.754, p<0.0001) or wall thickening salvage index (Spearman's ρ=0.798, p<0.0001). The wall thickening salvage index was able to classify correctly the patients that had a summed rest score salvage index≥0.10 with 73% sensitivity, 88% specificity, and 83% accuracy. The wall motion salvage index was highly sensitive (91%) but poorly specific (13%, p<0.002 vs wall thickening salvage index) and less accurate (69%, p<0.05 vs wall thickening salvage index). Conclusions 99m Tc-sestamibi gated SPECT allows assessing myocardial salvage using only post-treatment data. The salvage index derived using wall thickening as surrogate of admission perfusion defect correlates well with the salvage index measured by comparing pre-and post-treatment perfusion defects.

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Section: Discussionmentioning

confidence: 77%

Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

Sotgia

Sciagrà

Parodi

et al. 2007

Eur J Nucl Med Mol Imaging

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“…Main and his colleagues [30] demonstrated the usefulness of MCE using pulse inversion power Doppler technique in patients with a recent myocardial infarction. In 34 patients, perfusion by MCE predicted recovery of segmental wall function with a sensitivity of 77%, specificity of 83%, positive predictive value of 90%, and overall accuracy of 79%.…”

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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“…20 In addition, recent clinical reports suggest that MCE may be able to differentiate stunning from necrosis and predict recovery of LV function. 21,22 Ultraharmonic imaging produces low precontrast tissue signals and high post-contrast myocardial opacification, and MCE has a greater sensitivity for detecting microbubbles and can readily distinguish bubble signals from those generated by tissue. 20 Compared with harmonic power Doppler imaging, gray-scale ultraharmonic imaging provides high resolution and the ability to avoid motion artifacts.…”

Section: Advantage Of Intravenous Mcementioning

confidence: 99%

Evaluation of Transmural Myocardial Perfusion by Ultra-Harmonic Myocardial Contrast Echocardiography in Reperfused Acute Myocardial Infarction

Wada¹,

Yasu²,

Kotsuka³

et al. 2005

Circ J

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pproximately 20-35% of angiographically successful recanalizations of the infarct-related artery in patients with acute myocardial infarction (AMI) fail to salvage ischemic myocardium because of a discrepancy between an open epicardial coronary artery and no blood flow in the damaged distal microvessels. [1][2][3][4] Regions with no-reflow show no improvement in regional function over time despite recanalization of the epicardial coronary vessels. These patients also have poorer global left ventricular (LV) systolic function, malignant ventricular arrhythmias, intractable congestive heart failure, progressive LV remodeling, cardiac rupture, and higher mortality. 2,3,5,6 Bogaert et al reported that functional recovery of viable subepicardial tissue is a mechanism of late improvement in the regional and global LV fraction after a so-called transmural myocardial infarction (MI). 7 Furthermore, our recent Circulation Journal Vol.69, September 2005 study in patients with AMI showed that assessing the microcirculation in the transmural myocardial layers by multidetector computed tomography (MDCT) predicted progressive LV remodeling and the long-term recovery in contraction. 8 Myocardial contrast echocardiography (MCE) has been proposed as a powerful modality for assessing transmural myocardial perfusion, on the basis of bedside safely, economy and repeated performance compared with other imaging modalities, because of its superior resolution in time and space without exposure to radiation. [9][10][11][12][13][14] The aims of the present study were to assess transmural myocardial perfusion by MCE and compare the results with those of MDCT and to determine whether MCE can predict the long-term recovery of LV function in patients with AMI. Methods Patient PopulationTwenty patients who had experienced their first anterior AMI during the period 2001 to 2002, had total occlusion (TIMI 0) of the proximal left anterior descending artery (LAD) and who had undergone successful balloon reperfusion therapy (TIMI 3) within 24 h of onset were investigated. The average age was 66±13 years, the male:female ratio was 17:3, the average maximum creatine kinase was 2,509±2,003 IU/ml. None showed collateral flow to the Background The transmural distribution of myocardial perfusion is important for predicting the contractile reverse of an infarcted wall in reperfused acute myocardial infarction (AMI). Evaluating transmural myocardial perfusion by myocardial contrast echocardiography (MCE) could predict the long-term recovery of left ventricular (LV) function. Methods and ResultsThe study group comprised 20 consecutive patients with a first-episode anterior AMI with total occlusion of the proximal left anterior descending artery, who underwent successful percutaneous coronary intervention within 24 h of onset. MCE was performed on the 15th day after the onset, using ultraharmonic gray-scale imaging with intermittent end-systolic triggering every 4 beats or every 6 beats. Regions of interest were placed over both the endocardial and epica...

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Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction

Abstract: Full-motion MCE utilizing an intravenous fluorocarbon-based agent and pulse inversion power Doppler techniques, identifies stunned myocardium, and accurately predicts recovery of segmental LV function in patients with recent MI.

Cited by 75 publications

References 19 publications

Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

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

Evaluation of Transmural Myocardial Perfusion by Ultra-Harmonic Myocardial Contrast Echocardiography in Reperfused Acute Myocardial Infarction

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