Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: A myocardial contrast echocardiographic study

Agati, Luciano; Voci, Paolo; Bilotta, Federico; Luongo, Roberto; Autore, Camillo; Penco, María; Iacoboni, Carlo; Fedele, Francesco; Dagianti, A

doi:10.1016/0735-1097(94)90285-2

Cited by 92 publications

(39 citation statements)

References 39 publications

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“…This prognosis is even as poor as ir the vessels never had been opened [15]. Using contrast echocardiography, ir has been demonstrated, that despite reopening of coronary vessels in acute myocardial infarction full restoration of myocardial perfusion is incomplete in part of the patients [5,117,120,121,239]. Areas with incomplete restoration of flow reduced of no contrast enhancement of the myocardium in echocardiography have less improvement of ventricular function than areas with complete opacification.…”

Section: Acute Myocardial Infarctionmentioning

confidence: 92%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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The diagnosis coronary artery disease is classically based on patient's symptoms and morphology, as analyzed by angiography. The importance of risk factors for the development of coronary atherosclerosis and disturbance of coronary vasomotion is clearly established. However, microembolization of the coronary circulation has also to be taken into account. Microembolization may occur as a single or as multiple, repetitive events, and it may induce inflammatory responses. Spontaneous microembolization may occur, when the fibrous cap of an atheroma or fibroatheroma (Stary i.v. and Va) ruptures and the lipid pool with or without additional thrombus formation is washed out of the atheroma into the microcirculation. Such events with progressive thrombus formation are known as cyclic flow variations. Plaque rupture occurs more frequently than previously assumed, i.e. in 9% of patients without known heart disease suffering a traffic accident and in 22% of patients with hypertension and diabetes. Also, in patients dying from sudden death microembolization is frequently found. Patients with stable and unstable angina show not only signs of coronary plaque rupture and thrombus formation, but also microemboli and microinfarcts, the only difference between those with stable and unstable angina being the number of events. Appreciation of microembolization may help to better understand the pathogenesis of ischemic cardiomyopathy, diabetic cardiomyopathy and acute coronary syndromes, in particular in patients with normal coronary angiograms, but plaque rupture detected by intravascular ultrasound. Also, the benefit from glycoprotein IIb/IIIa receptor antagonist is better understood, when not only the prevention of thrombus formation in the epicardial atherosclerotic plaque, but also that of microemboli is taken into account. Microembolization also occurs during PTCA, inducing elevations of troponin T and I and elevations of the ST segment in the EKG. Elevated baseline coronary blood flow velocity, as a potential consequence of reactive hyperemia in myocardium surrounding areas of microembolization, is more frequent in patients with high frequency rotablation than in patients with stenting and in patients with PTCA. The hypothesis of iafrogenic microembolization during coronary interventions is now supported by the use of aspiration and filtration devices, where particles with a size of up to 700 microns have been retrieved. In the experiment, microembolization is characterized by perfusion-contraction mismatch, as the proportionate reduction of flow and function seen with an epicardial stenosis is lost and replaced by contractile dysfunction in the absence of reduced flow. The analysis of the coronary microcirculation, in addition to that of the morphology and function of epicardial coronary arteries, and in particular appreciation of the concept of microembolization will further improve the understanding of the pathophysiology and clinical symptoms of coronary artery disease.

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Section: Acute Myocardial Infarctionmentioning

confidence: 92%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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“…A rapid definition of the efficacy of reperfusion therapy as well as the extent of its residual microvascular damage has important implications for the treatment of acute myocardial infarction. It has been previously demonstrated that the presence of preserved microvascular flow in the post-reperfusion period is associated with a lower rate of fibrous scar and less ventricular remodeling (32)(33)(34)(35). Thus the differentiation between stunned and infarcted myocardium by RTMCE has important clinical and prognostic implications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of stunned and infarcted canine myocardium by real time myocardial contrast echocardiography

Dourado

Tsutsui

Mathias

et al. 2003

Braz J Med Biol Res

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Differentiation between stunned and infarcted myocardium in the setting of acute ischemia is challenging. Real time myocardial contrast echocardiography allows the simultaneous assessment of myocardial perfusion and function. In the present study we evaluated infarcted and stunned myocardium in an experimental model using real time myocardial contrast echocardiography. Sixteen dogs underwent 180 min of coronary occlusion followed by reperfusion (infarct model) and seven other dogs were submitted to 20 min of coronary occlusion followed by reperfusion (stunned model). Wall motion abnormality and perfusional myocardial defect areas were measured by planimetry. Risk and infarct areas were determined by tissue staining. In the infarct model, the wall motion abnormality area during coronary occlusion (5.52 ± 1.14 cm 2 ) was larger than the perfusional myocardial defect area (3.71 ± 1.45 cm 2 ; P < 0.001). Reperfusion resulted in maintenance of wall motion abnormality (5.45 ± 1.41 cm 2 ; P = 0.43 versus occlusion) and reduction of perfusional myocardial defect (1.51 ± 1.29 cm 2 ; P = 0.004 versus occlusion). Infarct size determined by contrast echocardiography correlated with tissue staining (r = 0.71; P = 0.002). In the stunned model, the wall motion abnormality area was 5.49 ± 0.68 cm 2 during occlusion and remained 5.1 ± 0.63 cm 2 after reperfusion (P = 0.07). Perfusional defect area was 2.43 ± 0.79 cm 2 during occlusion and was reduced to 0.2 ± 0.53 cm 2 after reperfusion (P = 0.04). 2,3,5-Triphenyl tetrazolium chloride staining confirmed the absence of necrotic myocardium in all dogs in the stunned model. Real time myocardial contrast echocardiography is a noninvasive technique capable of distinguishing between stunned and infarcted myocardium after acute ischemia.

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“…The most significant advantage is that it can be applied in the setting of AMI. The no-reflow phenomenon is detected by contrast echocardiography in 16% of patients with TIMI grade 3 flow (29). Contrast echocardiography was chosen by Agati et al (29) as a tool to prove superiority of primary PCI over thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The no-reflow phenomenon is detected by contrast echocardiography in 16% of patients with TIMI grade 3 flow (29). Contrast echocardiography was chosen by Agati et al (29) as a tool to prove superiority of primary PCI over thrombolytic therapy. Kamp et al (12) carried out serial MCE in patients after primary PCI, showing that a significant reduction in size of the initial perfusion defect predicts functional recovery after four weeks; these findings underscore the potential diagnostic value of the method.…”

Section: Discussionmentioning

confidence: 99%

Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty

Tomaszuk‐Kazberuk

Sobkowicz

Kamiński

et al. 2008

Canadian Journal of Cardiology

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Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: A myocardial contrast echocardiographic study

Abstract: Among patients with a predischarge patent infarct-related artery, further improvement in regional and global function may be expected during follow-up when residual perfusion in the infarct zone is present.

Cited by 92 publications

References 39 publications

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Evaluation of stunned and infarcted canine myocardium by real time myocardial contrast echocardiography

Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty

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