Usefulness of contrast echocardiography in evaluation of myocardial reperfusion in patients with acute anterior myocardial infarction treated with PCI

Background: The assessment of microvasculature damage after myocardial infarction (MI) has crucial implications.

Objective: The aim of the study was to assess the efficacy of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with MI compared with the results of 99mTc MIBI SPECT study.

Methods: 42 patients (9 F; 33 M, mean age 55.6 +/- 9.6) underwent primary percutaneous coronary (PCI) for acute anterior MI. TIMI grade flow, corrected TIMI frame count (cTFC), myocardial blush grade (TMPG), wall motion score index (WMSI), ST-segment resolution and segmental perfusion were estimated in real time before and immediately after PCI. MCE was performed after 0.3-0.5 ml bolus injections of intravenous Optison. MCE was done befor, immedietly after and on the third day after PCI. All patients underwent a rest 99mTc MIBI SPECT study (SPECT) on the third day after PCI.

Results: A MCE perfusion defect size after PCI >50% of the MCE perfusion defect size before PCI was used to define myocardial non-reperfusion. Based on MCE, 24 patients had reperfusion and 18 had non-reperfusion. Patients from the non-reperfusion group showed a higher creatine kinase peak (p = 0.006), higher kinase-MB (p = 0.018) and higher troponine level (p = 0.002), longer time span between the onset of pain and reperfusion (p < 0.001). All angiographic parameters were worse in this group before as well as after PCI. The agreement between MCE and SPECT for detecting perfusion abnormality was 86%.

Conclusions: MCE yields vital information about the outcome of coronary intervention in patients with anterior wall AMI. Development of no-reflow phenomenon is correlated with the severity of myocardial damage. MCE correlated very well with SPECT images in assessing perfusion defect.