Myocardial contrast echocardiography and contrast magnetic resonance imaging to assess reversible myocardial dysfunction after percutaneous coronary intervention in acute myocardial infarction

Background: The ability of myocardial contrast echocardiography (MCE) to predict contractile reserve after acute myocardial infarction (AMI) is still controversial. Given the possible reversibility of no-reflow after 30 days, we tested whether MCE predictive value depends on the timing of the test. Methods: 32 patients presenting with their first AMI and successfully recanalized IRA by either rt-PA (n=18) or primary angioplasty (n=14) underwent MCE at 24 hours and 30 days after symptom onset. MCE was performed by intermittent Harmonic Power Doppler and i.v. PESDA. Regional wall motion was evaluated by 2D echo 24 hours and 3 months later. Results: 24 hours after AMI, 231 myocardial segments were defined as a-kinetic or hypo-kinetic. Contractile recovery was observed in 105 segments, 101 perfused at 24 hours MCE and all 105 at 30 days MCE. Among the 126 dysfunctioning segments that did non show any contractile improvement, 28 were perfused at 24 hours, and 70 at 30 days. Within 46 dysfunctioning segments non perfused at 24 hours, perfusion was restored at 30 days but contraction improved in only 4 segments (9%). Dignostic potential and predictive value of MCE 24 hours and 30 days MCE in the evaluation of contractile recovery of post-AMI dysfunctioning myocardium are shown in the table.