Serial evaluation of perfusion defects in patients with a first acute myocardial infarction referred for primary PTCA using intravenous myocardial contrast echocardiography

Aims To investigate whether myocardial contrast echocardiography using Sona zoid(R) could be used for the serial evaluation of the presence and extent of myocardial perfusion defects in patients with a first acute myocardial i nfarction treated with primary PTCA, and specifically, (1) to evaluate safe ty and efficacy of myocardial contrast echocardiography to detect TIMI flow grade 0-2, (2) to evaluate the success of reperfusion and (3) to predict l eft ventricular recovery after 4 weeks follow-up. Methods and Results Fifty-nine patients underwent serial myocardial contras t echocardiography, immediately before primary PTCA (MCE1), 1 h (MCE2) and 12-24 h after PTCA (MCE3). A perfusion defect was observed in 21 of 24 pati ents (88%) with anterior acute myocardial infarction. All but one had TIMI flow grade 0-2 prior to PTCA. Nine of 31 patients (29%) with inferior acute myocardial infarction showed a perfusion defect and all had TIMI flow grad e 0-2 prior to PTCA. Restoration of TIMI flow grade 3 was achieved in 73% o f the patients by primary PTCA. A reduction in size of the initial perfusio n defect of at least one segment (16 segment model) or no defect vs persist ent defect in patients with anterior acute myocardial infarction was associ ated with improved global left ventricular function at 4 weeks; mean global wall motion score index 1.29 +/- 0.21 vs 1.66 +/- 0.31 (P=0.009). Multiple regression analysis in patients with an anterior acute myocardial infarcti on revealed that the extent of the perfusion defect at MCE3 was a significa nt (P=0.0005) independent predictor for left ventricular recovery at 4 week s follow-up. The only other independent predictor was TIMI flow grade 3 pos t PTCA (P=0.007). Conclusion Intravenous myocardial contrast echocardiography immediately pri or to primary PTCA seems safe and is capable of detecting the presence of a perfusion defect and its subsequent dynamic changes, particularly in patie nts with a first anterior acute myocardial infarction. A significant reduct ion in size of the initial perfusion defect using serial myocardial contras t echocardiography predicts functional recovery after 4 weeks and these fin dings underscore the potential diagnostic value of intravenous myocardial c ontrast echocardiography.