Intravenous versus intracoronary myocardial contrast echocardiography for evaluation of no-reflow after primary percutaneous coronary intervention

Jong Min Song, Jae Hwan Lee, Young Hak Kim, Duk Hyun Kang, Jae Kwan Song, Myeong Ki Hong, Seong Wook Park, Seung Jung Park, You Ho Kim

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Abstract

Objective: We sought to compare intravenous myocardial contrast echocardiography (IV-MCE) with intracoronary myocardial contrast echocardiography (IC-MCE) in detecting no-reflow and predicting the short-term outcome of left ventricular function after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: IC-MCE and IV-MCE were performed immediately after PCI (D1) of 28 patients with anterior wall AMI. IV-MCE was repeated at the next day of PCI (D2), and left ventricular systolic function was evaluated at D2 and 30 days later (D30). Results: There was good agreement between IC-MCE and IV-MCE at D1 in determining no-reflow (κ= 0.78, P < 0.001) as well as between IV-MCE at D1 and D2 (κ= 0.93, P < 0.001). The patients with no-reflow on IC-MCE (n = 13) and those on IV-MCE at D2 (n = 11) showed no improvement in left ventricular ejection fraction (LVEF) after 1 month (49 ± 9% to 48 ± 7%, P = 0.55, and 51 ± 6% to 49 ± 7%, P = 0.20). However, the patients with reflow on IC-MCE (n = 15) and those on IV-MCE at D2 (n = 17) demonstrated significant improvement in LVEF (55 ± 6% to 62 ± 5%, P < 0.005, and 53 ± 7% to 60 ± 8%, P < 0.005). In predicting segmental functional recovery after 1 month, sensitivity and specificity of IC-MCE were 85% and 67%, respectively, and those of IV-MCE at D2 were 95% and 40%, respectively. Conclusion: IV-MCE at D2 might be substituted for IC-MCE performed immediately after PCI for the evaluation of no-reflow and prediction of left ventricular systolic function after 1 month in patients with anterior wall AMI.

Original languageEnglish
Pages (from-to)818-825
Number of pages8
JournalEchocardiography
Volume22
Issue number10
DOIs
Publication statusPublished - 2005 Nov 1

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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