Evaluation of coronary microcirculation by myocardial contrast echocardiography in patients of ST elevation myocardial infarction
DOI:
https://doi.org/10.18203/2320-6012.ijrms20204019Keywords:
MCE, Myocardial contrast echocardiography, No reflow, Contrast score indexAbstract
Background: No reflow phenomenon observed during catheter intervention has been associated with poor cardiovascular outcomes. Assessment of filling defect by myocardial contrast echocardiography (MCE) correlates with no reflow. Limited studies are available for the same. This study was designed to look for impact of type of therapy for revascularization (whether percutaneous coronary intervention or thrombolysis) and its evaluation by MCE and follow up echocardiography parameters.
Methods: Total 50 consecutive patients of ST-elevation myocardial infarction (STEMI) were taken study including recent STEMI (within 7 days). After all routine investigations patient underwent coronary angiography and percutaneous coronary intervention (PCI) procedure. Following completion of procedure, thrombolysis in myocardial infarction (TIMI) flow, TIMI frame count, and myocardial blush grade were calculated and noted. Post revascularization contrast echocardiography was done after patient stabilization. Findings were correlated with cath-lab parameters applying appropriate statistical tests. Follow up was planned after 30 days.
Results: 50 consecutive patients admitted with acute myocardial infarction (MI) or recent MI (0-7 day) who underwent primary PCI - 82% (n=41) or thrombolysed with various thrombolytic agents - 18% (n=9). Mean age of the study group was 55.02±12.65 years. There was significant association in between TIMI 3 flow and absence of filling defect in MCE (p=0.03), but no significant association found in between revascularization therapy (Either PCI or Thrombolysis) and filling defect in MCE (p=0.08).
Conclusions: Our study found good correlation between myocardial contrast score with angiographically measured TIMI flow and improved echocardiographic findings on follow up.
References
Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med. 2002;346(13):957-66.
Kastrati A, Pache J, Dirschinger J, Neumann FJ, Walter H, Schmitt C, et al. Primary intracoronary stenting in acute myocardial infarction: long-term clinical and angiographic follow-up and risk factor analysis. Am Heart J. 2000;139(2 pt 1):208-16.
Lepper W, Hoffmann R, Kamp O, Franke A, de Cock CC, Kuhl HP, et al. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angioplasty [correction of angiography] in patients with acute myocardial infarction. Circulation. 2000;101(20):2368-74.
Ito H, Okamura A, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al. Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation. 1996;93(11):1993-9.
Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54(4):281-92.
Gibson CM, Murphy SA, Rizzo MJ, Ryan KA, Marble SJ, McCabe CH, et al. Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Thrombolysis In Myocardial Infarction (TIMI) Study Group. Circulation. 1999;99(15):1945-50.
Gibson CM, Cannon CP, Murphy SA, Ryan KA, Mesley R, Marble SJ, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation. 2000;101(2):125-30.
van 't Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998;97(23):2302-6.
Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97(8):765-72.
Galiuto L, Garramone B, Scarà A, Rebuzzi AG, Crea F, et al. The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Known Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling. J Am Coll Cardiol. 2008;51(5):552-9.
Park SM, Miyazaki C, Prasad A, Bruce CJ, Chandrasekaran K, Rihal C, et al. Feasibility of prediction of myocardial viability with Doppler tissue imaging following percutaneous coronary intervention for ST elevation anterior myocardial infarction. J Am Soc Echocardiogr. 2009;22(2):183-9.
Rinkevich D, Belcik T, Gupta NC, Cannard E, Alkayed NJ, Kaul S. Coronary autoregulation is abnormal in syndrome X: insights using myocardial contrast echocardiography. J Am Soc Echocardiogr. 2013;26(3):290-6.
Mor-Avi V, Koch R, Holper EM, Goonewardena S, Coon PD, Min JK, et al. Value of vasodilator stress myocardial contrast echocardiography and magnetic resonance imaging for the differential diagnosis of ischemic versus nonischemic cardiomyopathy. J Am Soc Echocardiogr. 2008;21(5):425-32.
De Luca G, Ernst N, Zijlstra F, van 't Hof AW, Hoorntje JC, Dambrink JH, et al. Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2004;43(8):1363-7.
Bodi V, Sanchis J, Losada A, Garcia D, Nunez J, Pellicer M, et al. [Study of post-infarction coronary perfusion using quantitative analysis of myocardial echocardiography with intravenous injection of contrast]. Rev Esp Cardiol. 2005;58(2):137-44.
Tomaszuk-Kazberuk A, Sobkowicz B, Kaminski K, Gugala K, Mezynski G, Dobrzycki S, et al. Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty. Can J Cardiol. 2008;24(8):633-9.
Yang L, Mu Y, Quaglia LA, Tang Q, Guan L, Wang C, et al. Effectiveness of myocardial contrast echocardiography quantitative analysis during adenosine stress versus visual analysis before percutaneous therapy in acute coronary pain: a coronary artery TIMI grading comparing study. J Biomed Biotechnol. 2012;806731.
