Assessment of no-reflow phenomenon after acute myocardial infarction with harmonic angiography and intravenous pump infusion with Levovist: Comparison with intracoronary contrast injection

Myocardial contrast echocardiography (intracoronary application) has emerge d as an accurate method to detect the "no-reflow phenomenon." To investigat e the diagnostic value of harmonic angiography after intravenous infusion o f Levovist in assessing "no-reflow," both intracoronary and intravenous con trast injections were performed in a group of patients with acute myocardia l infarction. Seventeen consecutive patients with a successfully reperfused acute myocardial infarction within 6 hours of symptom onset were selected for this study. All patients underwent contrast echocardiography with harmo nic angiography with Levovist (400 mg/mL, intravenous pump infusion, trigge r intervals 1:4 to 1:8) and sonicated albumin (0.5 to 1 mL, intracoronary b olus) on day 1 after the achievement of a sustained coronary reflow. Myocar dial perfusion was qualitatively assessed with a 12-segment model. The endo cardial length of the residual contrast defect after reflow was also calcul ated. Forty-four of 204 segments were not analyzed after intravenous contra st echocardiography and 37 after intracoronary contrast echocardiography be cause of artifacts. Intracoronary and intravenous injections showed a perfu sion defect in 31 (19%) segments, with a concordance of 89% (kappa coeffici ent, 0.72). Concordance in anteroseptal, anterolateral, and inferolateral s egments was 95% (kappa = 0.92), 88% (kappa = 0.66), and 83% (kappa = 0.57), respectively. With intracoronary injection used as the reference method, i ntravenous injection had a sensitivity of 74% and a specificity of 93% for diagnosing contrast defects. The endocardial extent of no-reflow was 18 +/- 19 after intravenous and 21 +/- 17 after intracoronary contrast echocardio graphy (P = not significant). Intravenous contrast echocardiography with Le vovist reliably identifies the no-reflow phenomenon after successful reperf usion, especially in acute anteroseptal myocardial infarction.