Author + information
- Received March 4, 1996
- Revision received July 3, 1996
- Accepted August 19, 1996
- Published online December 1, 1996.
- Leonardo Bolognese, MD, FESC1,⁎ (, )
- David Antoniucci, MD1,
- Daniele Rovai, MD, FESC1,*,
- Piergiovanni Buonamici, MD1,
- Giampaolo Cerisano, MD1,
- Giovanni M. Santoro, MD1,
- Cecilia Marini, MD1,*,
- Antonio L'Abbate, MD, FESC, FACC1,* and
- Pier Filippo Fazzini, MD1
- ↵⁎Address for correspondence: Dr. Leonardo Bolognese, Division of Cardiology, Careggi Hospital, Viale Morgagni 85, 50134 Florence, Italy.
Objectives We sought to compare myocardial contrast echocardiography with low dose dobutamine echocardiography for predicting 1-month recovery of ventricular function in acute myocardial infarction treated with primary coronary angioplasty.
Background The relation between myocardial perfusion and contractile reserve in patients with acute myocardial infarction, in whom anterograde flow is fully restored without significant residual stenosis, is still unclear.
Methods Thirty patients with acute myocardial infarction treated successfully with primary coronary angioplasty underwent intracoronary contrast echocardiography before and after angioplasty and dobutamine echocardiography 3 days after the index infarction. One month later, two-dimensional echocardiography and coronary angiography were repeated in all patients and contrast echocardiography in 18 patients.
Results After coronary recanalization, 26 patients showed myocardial reperfusion within the risk area, although 4 did not. At 1-month follow-up, all patients had a patent infarct-related artery without significant restenosis. Both left ventricular ejection fraction and wall motion score index within the risk area significantly improved in the patients with reperfusion ([mean ± SD] 38 ± 8% vs. 48 ± 12%, p < 0.005; and 2.35 ± 0.5 vs. 2 ± 0.6, p < 0.001, respectively), but not in those with no reflow. Of the 72 nonperfused segments before angioplasty, 27 showed functional improvement at follow-up. Myocardial contrast echocardiography had a sensitivity and a negative predictive value similar to dobutamine echocardiography in predicting late functional recovery (96% vs. 89% and 89% vs. 93%, respectively), but a lower specificity (18% vs. 91%, p < 0.001), positive predictive value (41% vs. 86%, p < 0.001) and overall accuracy (47% vs. 90%, p < 0.001).
Conclusions Microvascular integrity is a prerequisite for myocardial viability after acute myocardial infarction. However, contrast enhancement shortly after recanalization does not necessarily imply a late functional improvement. Thus, contractile reserve elicited by low dose dobutamine is a more accurate predictor of regional functional recovery after reperfused acute myocardial infarction than microvascular integrity.
- Received March 4, 1996.
- Revision received July 3, 1996.
- Accepted August 19, 1996.
- American College of Cardiology