Objectives: We sought the value of the extent of microvasculkar damage as assessed with myocardial contrast echocardiography (MCE) in the prediction of left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) as compared with established clinical and angiographic parameters of reperfusion. Background: Early identification of post-percutaneous coronary intervention microvascular dyysfunction may help in tailoring appropriate pharmacologoical interventions in high-risk patients. The ideal method to establish effective microvascular reperfusion after percutaneous coronary intervention remains to be determined. Methods: A total of 110 patients with first successfully reperfused STEMI were enrolled in the AMICI (Acute Myocardial Infarction Contrast Imaging) multicenter study. Afetr reperfusion, peak creatine kinase, ST-segment reduction, and Thrombolysis in Myocardial Infarction (TIMI) and myocardial blush grade were calculated. We evaluate reperfusion defects with MCE by using continous infusion of SONOVUE (Bracco, Milan, Italy) in real-time imaging. The endocardial lenght of contrast defect (CD) on day 1 after reperfusion was calculated. Wall motion score index, the extent of wall motion abnormalities, LV end-diastolic volume, and ejection fraction after reperfusion and at follow-up also were calculated. Results: Of 110 patients, 25% evolved in LV remodeling and 75% did not. Although peak cretine kinase, ST-segment reduction > 70%, and myocardial blush grade were not different between groups, in patients exhibiting LV remodeling, TIMI grade 3 flow was less frequent (p<0.001), wall motion score index was greater (p<0.001), and CD was greater (p<0.001). At multivariate analysis, only TIMI flow grade < 3 and CD with a cutoff of >25% were independently assocoated with LV remodeling. Among patients with grade 3 TIMI flow, CD was the only independent variable associated with LV remodeling. Conclusions: Among opatients with grade 3 TIMI flow, the extent of microvascular damage, detected and quantitated by MCE, is the most powerful independent predictor of LV remodeling after STEMI as compared with persistent ST-segmnet elevation and myocardial blush grade.
Galiuto, L., Garramone, B., Scarà, A., Rebuzzi, A. G., Crea, F., La Torre, G., Funaro, S., Madonna, M., Fedele, F., Agati, L., The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Know Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling, <<JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY>>, 2008; (Febbraio): 552-559 [http://hdl.handle.net/10807/32704]
The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Know Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling
Galiuto, Leonarda;Garramone, Barbara;Rebuzzi, Antonio Giuseppe;Crea, Filippo;La Torre, Giuseppe;Funaro, Stefania;
2008
Abstract
Objectives: We sought the value of the extent of microvasculkar damage as assessed with myocardial contrast echocardiography (MCE) in the prediction of left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) as compared with established clinical and angiographic parameters of reperfusion. Background: Early identification of post-percutaneous coronary intervention microvascular dyysfunction may help in tailoring appropriate pharmacologoical interventions in high-risk patients. The ideal method to establish effective microvascular reperfusion after percutaneous coronary intervention remains to be determined. Methods: A total of 110 patients with first successfully reperfused STEMI were enrolled in the AMICI (Acute Myocardial Infarction Contrast Imaging) multicenter study. Afetr reperfusion, peak creatine kinase, ST-segment reduction, and Thrombolysis in Myocardial Infarction (TIMI) and myocardial blush grade were calculated. We evaluate reperfusion defects with MCE by using continous infusion of SONOVUE (Bracco, Milan, Italy) in real-time imaging. The endocardial lenght of contrast defect (CD) on day 1 after reperfusion was calculated. Wall motion score index, the extent of wall motion abnormalities, LV end-diastolic volume, and ejection fraction after reperfusion and at follow-up also were calculated. Results: Of 110 patients, 25% evolved in LV remodeling and 75% did not. Although peak cretine kinase, ST-segment reduction > 70%, and myocardial blush grade were not different between groups, in patients exhibiting LV remodeling, TIMI grade 3 flow was less frequent (p<0.001), wall motion score index was greater (p<0.001), and CD was greater (p<0.001). At multivariate analysis, only TIMI flow grade < 3 and CD with a cutoff of >25% were independently assocoated with LV remodeling. Among patients with grade 3 TIMI flow, CD was the only independent variable associated with LV remodeling. Conclusions: Among opatients with grade 3 TIMI flow, the extent of microvascular damage, detected and quantitated by MCE, is the most powerful independent predictor of LV remodeling after STEMI as compared with persistent ST-segmnet elevation and myocardial blush grade.
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