Article

Intravenous myocardial contrast echocardiography predicts regional and global left ventricular remodelling after acute myocardial infarction: comparison with low dose dobutamine stress echocardiography.

Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
Heart (British Cardiac Society) (impact factor: 4.22). 12/2005; 91(12):1578-83. DOI:10.1136/hrt.2004.057521 pp.1578-83
Source: PubMed

ABSTRACT To assess the role of intravenous myocardial contrast echocardiography (MCE) in predicting functional recovery and regional or global left ventricular (LV) remodelling after acute myocardial infarction (AMI) compared with low dose dobutamine stress echocardiography (LDSE).
21 patients with anterior AMI and successful primary angioplasty underwent MCE and LDSE during the subacute stage (2-4 weeks after AMI). Myocardial perfusion and contractile reserve were assessed in each segment (12 segment model) with MCE and LDSE. The 118 dyssynergic segments in the subacute stage were classified as recovered, unchanged, or remodelled according to wall motion at six months' follow up. Percentage increase in LV end diastolic volume (%DeltaEDV) was also calculated.
The presence of perfusion was less accurate than the presence of contractile reserve in predicting regional recovery (55% v 81%, p < 0.0001). However, the absence of perfusion was more accurate than the absence of contractile reserve in predicting regional remodelling (83% v 48%, p < 0.0001). The number of segments without perfusion was an independent predictor of %DeltaEDV, whereas the number of segments without contractile reserve was not. The area under the receiver operating characteristic curve showed that the number of segments without perfusion predicted substantial LV dilatation (%DeltaEDV > 20%) more accurately than did the number of segments without contractile reserve (0.88 v 0.72).
In successfully revascularised patients with AMI, myocardial perfusion assessed by MCE is predictive of regional and global LV remodelling rather than of functional recovery, whereas contractile reserve assessed by LDSE is predictive of functional recovery rather than of LV remodelling.

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Keywords

118 dyssynergic segments
 
12 segment model
 
2-4 weeks
 
21 patients
 
acute myocardial infarction
 
contractile reserve
 
global LV remodelling
 
independent predictor
 
intravenous myocardial contrast echocardiography
 
low dose dobutamine stress echocardiography
 
LV end diastolic volume
 
LV remodelling
 
myocardial perfusion
 
regional remodelling
 
remodelled
 
revascularised patients
 
segments
 
subacute stage
 
substantial LV dilatation
 
successful primary angioplasty