Myocardial Contrast Echocardiographic Estimates of Infarct Size Predict Likelihood of Left Ventricular Remodeling After Acute Anterior Wall Myocardial Infarction

Prognostic Value of Longitudinal Strain After Primary Reperfusion Therapy in Patients with Anterior-wall Acute Myocardial Infarction

“…Follow-up echocardiography was performed at least 3 months later after AMI (14.7 Ϯ 8.4 months, mean Ϯ SD; range 3-47 months) for LV volume measurement, and LV remodeling was defined as an increase in LV end-diastolic volume of greater than or equal to 15%. 7,9 In case of multiple follow-up echocardiograms, the last one was taken as a representative study. Any episode of clinical events of death or development of AMI or heart failure were recorded by attending cardiologists or clinical nurse specialists: development of heart failure was defined as worsening of exertional dyspnea with typical chest radiograph findings of progressive cardiomegaly or pulmonary edema, which required hospital admission or administration of new or different diuretics.…”

“…1 To distinguishing these two entities, myocardial contrast echocardiography for estimating microvascular integrity and dobutamine stress echocardiography for evaluating contractile reserve are currently popular in routine clinical practice [2][3][4][5][6][7][8][9] and these two techniques are best regarded as complementary. 10 Predicting functional recovery or remodeling based on quantification of regional contractility remains an elusive goal of echocardiography.…”

Prediction of left ventricular remodeling in patients with STEMI treated with primary PCI

“…According to the most recent trials, this procedure reduces the occurrence of no reflow phenomenon and improves myocardial perfusion [14,15]. Main et al [16] found remodeling in 40% of patients with the first anterior wall STEMI; however, in this study a post-PCI TIMI 3 flow grade was not achieved in all enrolled patients, as some cases presented TIMI 0, 1, or 2 flow grade. However, they assumed that the increase in LVEDV of only more than 15% was a cut-off value.…”

“…Among many potential factors, those contributing to remodeling are anterior wall MI, consecutive MI, lack of reperfusion therapy, necrosis of more than 10% of LV myocardium, increased LV pressure, use of nonsteroid inflammatory drugs during index event, IRA restenosis, lack of b-blockers, and angiotensin-converting enzyme inhibitors in therapy, as well as reduced tissue perfusion after successful PCI [12,[16][17][18]. In this study, independent predictors of remodeling of LV were poor perfusion in MBG scale, lower ejection fraction on the discharge day, as well as poor tissue perfusion in quantitative contrast echocardiography.…”

Myocardial perfusion imaging with contrast echocardiography

“…These studies also provide evidence that establishing Thrombolysis in Myocardial Infarction 3 flow after primary PCI does not necessarily confer adequate microvascular reflow. Recently, multiple studies demonstrated that MCE using intravenously administered microbubbles provides similar prognostic information regarding the recovery of LV function, risk for adverse LV remodeling, and serious cardiac events, such as death and congestive heart failure [25,[31][32][33]. It should be noted, however, that recovery of resting function cannot be guaranteed if there is evidence of partial microvascular reflow in a segment, largely because contraction depends on viability of the subendocardial layer.…”