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

Hiroshi Wada; Takanori Yasu; Hiroyuki Kotsuka; Yuhki Hayakawa; Yoshiaki Tsukamoto; Nobuhiko Kobayashi; Takeshi Ishida; Yasuyuki Kobayashi; Norifumi Kubo; Masanobu Kawakami; Muneyasu Saito

doi:10.1253/circj.69.1041

Clinical Investigation

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

Hiroshi Wada, Takanori Yasu, Hiroyuki Kotsuka, Yuhki Hayakawa, Yoshiaki Tsukamoto, Nobuhiko Kobayashi, Takeshi Ishida, Yasuyuki Kobayashi, Norifumi Kubo, Masanobu Kawakami, Muneyasu Saito

Author information

Hiroshi Wada
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Takanori Yasu
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Hiroyuki Kotsuka
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Yuhki Hayakawa
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Yoshiaki Tsukamoto
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Nobuhiko Kobayashi
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Takeshi Ishida
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Yasuyuki Kobayashi
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Norifumi Kubo
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Masanobu Kawakami
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School
Muneyasu Saito
First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School

Keywords: Acute myocardial infarction, Computed tomography, Contrast echocardiography, Myocardial perfusion

JOURNAL FREE ACCESS

2005 Volume 69 Issue 9 Pages 1041-1046

DOI https://doi.org/10.1253/circj.69.1041

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Abstract

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 Results The 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 epicardial region at the mid-septal level. Regional wall motion (RWM) of the infarcted anterior wall and global LV function were assessed by 2-dimensional echocardiography and left ventriculography in both the acute and chronic phase. The transmural distribution of myocardial perfusion by MCE demonstrated a significant relation with RWM score index (r=0.75, p=0.0004). Recovery of RWM and LV ejection fraction (LVEF) at 6 months after reperfusion was significantly greater in the group with good perfusion of the epicardium according to MCE than in the poor perfusion group [RWM (SD/cord); -1.23±0.91 vs -3.51±0.84, p=0.001, LVEF (%); 63.8±10.4 vs 47.0±3.4, p=0.04]. Conclusions Assessing the transmural distribution of myocardial perfusion by MCE can predict the long-term recovery of LV function after a reperfused AMI. (Circ J 2005; 69: 1041 - 1046)

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