MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY IN ACUTE ST ELEVATION MYOCARDIAL INFARCTION
Abstract
Background. Tissue myocardial perfusion is an important prognostic factor in patients after acute ST elevation myocardial infarction (STEMI) and early reperfusion treatment. Simple clinical methods for tissue perfusion assessment are unreliable. Myocardial contrast echocardiography (MCE) was developed recently as an upgrade of standard ultrasound examination of the heart. By using gas microbubbles as a contrast agent, it enables a direct visualization of myocardial microvascular integrity and tissue perfusion.
Methods. Two case reports of MCE use in patients with STEMI are presented. The first patient was treated with systemic thrombolysis, MCE study was performed four hours after it has been finished. The second patient was treated with primary percutaneous transluminal coronary angioplasty (PTCA) in Clinical centre. MCE was performed on the second day, after the patient had been transferred to our hospital.
Results. In both patients MCE showed abnormal tissue perfusion that was conclusive with incomplete reperfusion. In the first patient subacute rupture of free left ventricular wall with cardiac tamponade and death occurred on the next day. The location of the rupture could have been the area of myocardium with unsuccessful reperfusion. In the second patient the area of incomplete reperfusion was connected with a permanent functional damage.
Conclusions. MCE is a non-invasive method for assessing tissue myocardial perfusion. In clinical practice it can be used in patients with STEMI treated with systemic thrombolysis or PTCA. MCE offers an excellent tool for judging reperfusion success and has important implications on future treatment of those patients.
Downloads
References
Ito H, Tomooka T, Sakai N et al. Lack of myocardial perfusion immediately after successful thrombolysis a predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 1992; 85: 1699–705.
Kloner RA, Ganote CE, Jennings RB. The »no-reflow« phenomenon after temporary coronary occlusion in the dog. J Clin Invest 1974; 54: 1496–508.
Schofer J, Montz R, Mathey DG. Scintigraphic evidence of the »no-reflow« phenomenon in human beings after coronary thrombolysis. J Am Coll Cardiol 1985; 5: 593–8.
Remškar M, Kranjec I, Horvat M, Noč M. Pojav zadržanega pretoka pri bolniku z akutnim miokardnim infarktom. Zdrav Vestn 2000; 69: 249–51.
Tanasijevic MJ, Cannon CP, Antman ME, Wybenga DR et al. Myoglobin, creatine-kinase-MB and cardiac troponin-I 60-minute ratios predict patency after thrombolysis for acute myocardial infarction. J Am Coll Cardiol 1999; 34: 739–47.
Matetzky S, Freimark D, Chouraqui P et al. The distinction between coronary and myocardial reperfusion after thrombolytic therapy by clinical markers of reperfusion. J Am Coll Cardiol 1998; 32: 1326–60.
Krucoff WM, Croll MA, Pope JE et al. Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Circulation 1993; 88: 437–46.
Shah A, Wagner GS, Granger CB et al. Prognostic implications of TIMI flow grade in the infarct related artery compared with continuous 12-lead STsegment resolution analysis. Reexamining the »gold standard« for myocardial reperfusion assessment. J Am Coll Cardiol 2000; 35: 666–72
Callif RM, O’Neill W, Stack RS et al. Failure of simple measurements to predict perfusion status after intravenous thrombolysis. Ann Intern Med 1988; 108: 658–62.
Ragosta M, Camarano GP, Kaul S, Powers E, Sarembock IJ, Gimple LW. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction: new insights using myocardila contrast echocardiography. Circulation 1994; 89: 2262–9.
Keller MW, Segal SS, Kaul S et al. The behavior of sonicated albumin microbubbles within the microcirculation: A bAMIs for their use during myocardial contrast echocardiography. Circ Res 1989; 24: 739–49.
Kaul S. Myocardial contrast echocardiography in acute myocardial infarction: time to test for routine clinical use? Heart 1999; 81: 2–5.
Becher H, Burns PN. Handbook of contrast echocardiography. Berlin: Springer, 2000: 81–151.
Markež J. Kontrastna ehokardiografija. Med Razgl 1999; 38: Suppl 6: 12–9.
Grayburn PA. Assessment of myocardial »reperfusion« by contrast echocardiography. Am J Med Sci 1998; 315: 124–32.
Galiuto L, Iliceto S. Myocardial contrast echocardiography in the evaluation of viable myocardium after acute myocardial infarction. Am J Cardiol 1998; 81(12A): 29G–32G.
Verjans JW, Narula N, Loyd A, Narula J, Vannan MA. Myocardial contrast echocardiography in acute myocardial infarction. Curr Opin Cardiol 2003; 18: 346–50.
Villanueva FS. Myocardial contrast echocardiography in acute myocardial infarction. Am J Cardiol 2002; 90: 38J–47J.
Agati L, Funaro S, Madonna M, Volponi C, Veneroso G, Tonti G. Clinical utility of contrast echocardiography in the management of patients with acute myocardial infarction. Eur Heart J Supplements 2002; 4: C27–C34.
Lindner JR, Villanueva FS, Dent JM, Wei K, Sklenar J, Kaul S. Assessment of resting perfusion with myocardial contrast echocardiography: Theoretical and practical considerations. Am Heart J 2000; 139: 231–40.
Bolognese L, Antoniucci D, Rovai D et al. Myocardial contrast echocardiography versus dobutamine echocardiography for predicting functional recovery after acute myocardial infarction treated with primary coronary angiography. J Am Coll Cardiol 1996; 28: 1677–83.
Swinburn JM, Senior R. Real time contrast echocardiography—a new bedside technique to predict contractile reserve early after acute myocardial infarction. Eur J Echocardiogr 2002; 3: 95–9.
Agati L, Funaro S, Bilotta F. Assessment of no-reflow phenomenon after acute myocardial infarction with harmonic angiography and intravenous pump infusion with Levovist: comparison with intracoronary contrast injection. J Am Soc Echocardiogr 2001; 14: 773–81.
Santoro GM, Valenti R, Buonamici P et al. Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty. Am J Cardiol 1998; 82: 932–7.
Lepper W, Sieswerda GT, Vanoverschelde JL et al. Predictive value of markers of myocardial reperfusion in acute myocardial infarction for followup left ventricular function. Am J Cardiol 2001; 88: 1358–63.
Greaves K, Dixon SR, Fejka M et al. Myocardial contrast echocardiography is superior to other known modalities for assessing myocardial reperfusion after acute myocardial infarction. Heart 2003; 89: 139–44.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
