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The prognostic value of contrast echocardiography, electrocardiographic and angiographic perfusion indices for prediction of left ventricular function recovery in patients with acute myocardial infarction treated by percutaneous coronary intervention
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Abstract
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial infarction. These were treated with primary PCI, after which PCI myocardial blush grading was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction of > 50% in the sum of ST-segment elevation (ΣST 50%) was assessed as an indicator of perfusion restoration. During the first 24 hours continuous ECG monitoring recorded reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50% in the single lead with the highest ST elevation (Δt ST 50%). On the next day of MI, after LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional segment perfusion score was determined. Regional and global LV function was assessed again one month after MI. An LVEF increase of over 5% divided the patients into two groups: group A with LVEF improvement (72 pts) and group B without LVEF improvement (42 pts).
Results: In group A baseline LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS). The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more often in group A (64%) than in group B (34%) p < 0.001. Σ ST50% and Δt ST 50%, after determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in group A and 17 and 16 patients in group B respectively. The accuracy of the tests under discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG, SST50% and Δt ST 50% respectively.
Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction of LV global function improvement. It turned out to be the best predictor among the other angiographic, echocardiographic and electrocardiographic markers.
Abstract
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial infarction. These were treated with primary PCI, after which PCI myocardial blush grading was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction of > 50% in the sum of ST-segment elevation (ΣST 50%) was assessed as an indicator of perfusion restoration. During the first 24 hours continuous ECG monitoring recorded reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50% in the single lead with the highest ST elevation (Δt ST 50%). On the next day of MI, after LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional segment perfusion score was determined. Regional and global LV function was assessed again one month after MI. An LVEF increase of over 5% divided the patients into two groups: group A with LVEF improvement (72 pts) and group B without LVEF improvement (42 pts).
Results: In group A baseline LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS). The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more often in group A (64%) than in group B (34%) p < 0.001. Σ ST50% and Δt ST 50%, after determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in group A and 17 and 16 patients in group B respectively. The accuracy of the tests under discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG, SST50% and Δt ST 50% respectively.
Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction of LV global function improvement. It turned out to be the best predictor among the other angiographic, echocardiographic and electrocardiographic markers.
Keywords
myocardial contrast echocardiography; myocardial perfusion; acute myocardial infarction
About this articleTitle
The prognostic value of contrast echocardiography, electrocardiographic and angiographic perfusion indices for prediction of left ventricular function recovery in patients with acute myocardial infarction treated by percutaneous coronary intervention
Journal
Issue
Vol 13, No 4 (2006): Folia Cardiologica
Pages
293-301
Published online
2006-04-24
Page views
687
Article views/downloads
1251
DOI
10.5603/cj.21813
Bibliographic record
Folia Cardiol 2006;13(4):293-301.
Keywords
myocardial contrast echocardiography
myocardial perfusion
acute myocardial infarction
Authors
Krystian Wita
Artur Filipecki
Wojciech Wróbel
Agnieszka Drzewiecka-Gerber
Przemysław Węglarz
Maciej Turski
Anna Rybicka-Musialik
Zbigniew Tabor
Mariola Nowak
Jolanta Krauze
Jan Szczogiel
Janusz Drzewiecki
Maria Trusz-Gluza
