Usefulness of quantitative intravenous myocardial contrast echocardiography to analyze microvasculature perfusion in patients with a recent myocardial infarction and an open infarct-related artery: comparison with intracoronary myocardial contrast echocardiography

doi:10.1016/j.euje.2004.08.008

European Journal of Echocardiography 2005 6(3):164-174; doi:10.1016/j.euje.2004.08.008

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Usefulness of quantitative intravenous myocardial contrast echocardiography to analyze microvasculature perfusion in patients with a recent myocardial infarction and an open infarct-related artery: comparison with intracoronary myocardial contrast echocardiography

Vicent Bodí^a^,*, Juan Sanchis^a, Antonio Losada^a, María P. López-Lereu^b, Diego García^a, Mauricio Pellicer^a, Francisco J. Chorro^a and Àngel Llàcer^a

^a Cardiology Department, Hospital Clínic i Universitari, Blasco Ibáñez Avenue 17, 46010 Valencia, Spain
^b ERESA, Blasco Ibáñez Avenue 17, 46010 Valencia, Spain

Received 14 April 2004; received in revised form 6 August 2004; accepted after revision 6 August 2004.

^* This work was supported by the ‘Instituto de Salud Carlos III’ (Spanish Public Health System) with grant no. PI030013 and by the Spanish Society of Cardiology with the grant ‘Bayer’ 2004.

^* Corresponding author. Tel./fax: +34 96 3862658. vicentbodi{at}hotmail.com

Abstract

Aims: We analyzed the usefulness of quantitative intravenousmyocardial contrast echocardiography to study microvasculatureperfusion after infarction in comparison with intracoronarymyocardial contrast echocardiography.

Methods and results: Thirty-two patients with a first ST elevationmyocardial infarction, single-vessel disease and an open artery(TIMI 3) were studied before discharge. Myocardial perfusionin the risk area was quantified with intracoronary and intravenousmyocardial contrast echocardiography. Perfusion was normal (intracoronarycontrast echocardiography normalized videointensity > 0.75)in 78 out of 97 dysfunctional segments (80%). Sensitivity andspecificity of intravenous contrast echocardiography to predictnormal perfusion were 87% and 63% for ‘first-pass myocardialblood flow’ (upslope of contrast arrivalxpeak intensityafter intravenous bolus injection of contrast) and 91% and 89%for end-systolic single-triggered images captured every 6 cycles,respectively. In an analysis per patients, normal perfusion(0 or 1 hypoperfused segments with intracoronary contrast echocardiography)was observed in 22 cases (69%). End-systolic single-triggeredimages showed a strong correlation with intracoronary contrastechocardiography (R²=0.82, p = 0.0001).

Conclusions: Intravenous contrast echocardiography is a usefultechnique to analyze microvasculature perfusion soon after infarction.A quantitative analysis of single-triggered images is an easy-to-obtainand reliable method to define perfusion when compared with intracoronarycontrast echocardiography.

Keywords: Microcirculation; Myocardial contrast echocardiography; Perfusion

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