Vol 13, No 4 (2006): Folia Cardiologica
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Published online: 2006-04-24

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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

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
Folia Cardiol 2006;13(4):293-301.

Abstract

Background: Fast and effective culprit artery patency restoration is important in acute myocardial infarction (MI) but does not ensure that tissue perfusion related to a better prognosis in the long-term follow-up is achieved. In this study we compared the prognostic value of myocardial perfusion contrast echocardiography with other well-known electrocardiographic and angiographic indices of preserved tissue perfusion.
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.

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