Value of myocardial contrast echocardiography for predicting left ventricular remodeling and segmental functional recovery after anterior wall acute myocardial infarction

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• 作者：Má ; rcia A. Caldas ; MD^a ; Jeane M. Tsutsui ; MD^a ; Ingrid Kowatsch ; MD^a ; José ; L. Andrade ; MD^a ; José ; C. Nicolau ; MD^a ; José ; F. Ramires ; MD ; FACC^a ; Wilson Mathias Jr ; MD ; FACC^a ; ^{wmathias@incor.usp.br}
• 刊名：Journal of the American Society of Echocardiography
• 出版年：2004
• 出版时间：September 2004
• 年：2004
• 卷：17
• 期：9
• 页码：923-932
• 全文大小：269 K

文摘

Objective

We sought to study the value of microvascular perfusion assessed by myocardial contrast echocardiography in predicting left ventricular remodeling after anterior wall acute myocardial infarction.

Methods

In 31 patients myocardial contrast echocardiography was performed up to 48 hours after acute myocardial infarction with determination of end-diastolic and end-systolic volumes, wall-motion score index, and myocardial perfusion score index (MPSI) at rest and under dobutamine stress at 6 months. Patients were classified into remodeling group (RG) (n = 19) and non-RG (n = 12), and, according to number of segments without opacification, reflow (? segments, n = 15) and no-reflow (>2 segments, n = 16) groups.

Results

Wall-motion score index (1.84 ¡À 0.22 vs 1.64 ¡À 0.3; P = .049), MPSI (1.53 ¡À 0.25 vs 1.26 ¡À 0.17; P = .006), and number of segments without contrast (3.11 ¡À 2.23 vs 1.08 ¡À 1.38; P = .018) were higher in RG than in non-RG. End-diastolic and end-systolic volumes, and wall-motion score index, increased significantly in RG at 6 months and decreased in non-RG. MPSI increased in RG (1.53 ¡À 0.25-1.66 ¡À 0.21; P = .011) and was the only independent predictor of left ventricular remodeling (odds ratio = 1.8; 95 % confidence interval = 1.15-2.82; P = .010). No-reflow group presented 27.8 ¡À 19.9 % of segments with resting functional recovery or contractile reserve, and reflow group presented 69.9 ¡À 31.2 % (P < .001).

Conclusion

MPSI obtained 48 hours after acute myocardial infarction is an independent predictor of left ventricular remodeling. Patients with two or fewer segments without opacification revealed a better prognosis of resting ventricular function and contractile reserve.