Use of echocardiography for predicting myocardial viability in patients with reperfused anterior wall myocardial infarction

Dobutamine stress echocardiography (DSE), myocardial contrast echocardiogra phy (MCE), and ultrasonic tissue characterization with integrated backscatt er are useful methods for assessing myocardial viability in acute myocardia l infarction. In this study, we compared the potential of 3 methods for pre dicting myocardial viability in 38 patients with reperfused anterior wall a cute myocardial infarction. We performed MCE shortly after coronary reperfu sion with an intracoronary injection of microbubbles. We recorded 2-dimensi onal integrated backscatter images at rest and, then, performed lowdose (10 mu g/kg/min) DSE 3 days later. In integrated backscatter images, we placed the region of interest in the midwall of the myocardial segment to reconst ruct the cyclic variation of myocardial integrated backscatter. The myocard ial segment wets judged viable when it showed active contraction 3 months l ater. Among 74 segments analyzed, 34 were judged viable. Presence of contra ctile response during DSE predicted segmental viability with 91% sensitivit y and 78% specificity. Intense and homogenous contrast enhancement: with MC E predicted viability with 82% sensitivity and 73% specificity. The presenc e of synchronous contraction of cyclic variation predicted myocardial viabi lity with 79% sensitivity and 83% specificity, There were no differences in sensitivity and specificity among the 3 methods, Thus, MCE and ultrasonic tissue characterization can predict myocardial viability as accurately as D SE in patients with acute myocardial infarction, The logistics of the metho ds may determine clinical application. (C)2000 by Excerpta Medica, Inc.