Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction

Objective-To evaluate the combined assessment of reflow and collateral bloo d flour by myocardial contrast echocardiography after myocardial infarction . Design-Myocardial contrast echocardiography was performed in patients with acute myocardial infarction shortly after successful coronary reperfusion ( TIMI 3 patency) by direct angioplasty. Collateral flow was assessed before coronary angioplasty, and contrast reflow was evaluated 15 minutes after re perfusion. The presence of contractile reserve tvas assessed by lour dose d obutamine echocardiography (5 to 15 mu g/kg/min) at (mean (SD)) 3 (2) days after myocardial infarction. Recovery of segmental function (myocardial via bility) was evaluated by resting echocardiography at a two month follow up. The study was prospective. Patients-35 consecutive patients referred for acute transmural myocardial i nfarction. Results-Contrast reflow was observed in 20 patients (57%) and collateral fl our in 14 (40%). Contrast reflow and collateral contrast flow were both cor related with reversible dysfunction on initial dobutamine echocardiography and at follow up (p < 0.05). The presence of reflow or collateral flow on m yocardial contrast echocardiography was a highly sensitive (100%) but weakl y specific (60%) indicator of segmental dysfunction recovery. Simultaneous presence of contrast reflow and collateral flow was more specific of revers ible dysfunction than reflow alone (90% upsilon 60%). Conclusions-Combined assessment of reflow and collateral blood flow enhance d the sensitivity of myocardial contrast echocardiography in predicting myo cardial viability after acute, reperfused myocardial infarction. The simult aneous presence of reflow and collateral blood flow was highly specific of recovery of segmental dysfunction.