THE CLINICAL IMPLICATIONS OF NO-REFLOW DEMONSTRATED WITH INTRAVENOUS PERFLUOROCARBON CONTAINING MICROBUBBLES FOLLOWING RESTORATION OF THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) 3 FLOW IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Intravenous injections or infusions of perfluorocarbon-exposed sonicat ed dextrose albumin microbubbles were given 2.4 +/- 1.6 days following acute myocardial infarction to 45 consecutive patients. Patients were divided into 3 groups: patients with Thrombolysis In Myocardial Infar ction (TIMI) grade 3 angiographic flow but persistent myocardial contr ast defects by echocardiography (no reflow), patients with TIMI 3 flow and myocardial contrast enhancement (reflow), and patients with TIMI grade 0 to 2 flow in the infarct vessel. Thirty five patients had TIMI 3 flow at the time of contrast study, Of these, 25 held evidence of r eflow with intravenous contrast, whereas 10 (29%) still had contrast d efects. At follow-up, end-systolic volume index decreased significantl y in patients who exhibited reflow (21 +/- 8 ml/m(2) at baseline to 18 +/- 8 ml/m(2) at follow-up; p = 0.04), whereas those with no reflow h ad a significant increase (26 +/- 9 ml/m(2) at baseline to 32 +/- 9 ml /m(2) at follow-up; p = 0.006). A persistent contrast defect in the in farct zone demonstrated with intravenous ultrasound contrast following restoration of TIMI grade 3 flow in the infarct vessel identified pat ients likely to have deterioration in both regional and global systoli c function. (C) 1998 by Excerpta Medica, Inc.