Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction

OBJECTIVES We aimed to ascertain whether triggered intravenous myocardial c ontrast echocardiography (MCE) can predict functional recovery in patients with acute myocardial infarction (AMI) and to determine the optimal trigger ing interval in this setting. BACKGROUND Detection of myocardial viability early after AMI has both thera peutic and prognostic implications. Myocardial contrast echocardiography us ing intracoronary injections of contrast can detect viable myocardium, but there is little data on the use of recently developed intravenous MCE techn iques for this purpose METHODS Ninety-six patients with recent AMI (4.8 +/- 1.7 days) underwent ec hocardiography at baseline and six months later or three months after revas cularization to determine regional function (score 1 = normal to 3 = akinet ic). Myocardial contrast echocardiography was performed at baseline using i ntravenous injections of Optison. Triggering intervals of 1:1 (early) and 1 :10 (delayed) cardiac cycles were used. Segments were deemed viable if they demonstrated homogeneous contrast opacification. RESULTS Of 400 akinetic segments at baseline, 109 (27%) improved during the follow-up period, and 375 (94%) were adequately visualized with MCE, of wh ich 59 (16%) were homogeneously opacified by early and 125 (33%) by delayed MCE (negative predictive value for recovery of contractile function 74% an d 84%, positive predictive value 29% and 47%, respectively). Independent pr edictors of functional recovery were delayed MCE (odds ratio [OR]: 4.0, p < 0.001), revascularization (OR: 6.0, p < 0.001), and log creatine kinase (O R: 0.5, p = 0.03). However, the presence or absence of >90% stenosis of the infarct-related artery did not influence the ability of triggered MCE to p redict functional recovery. CONCLUSIONS Intravenous delayed triggered MCE can independently detect myoc ardial viability early after AMI. (J Am Cell Cardiol 2001;38:19-25) (C) 200 1 by the American College of Cardiology.