Document Detail


Real time contrast echocardiography--a new bedside technique to predict contractile reserve early after acute myocardial infarction.
MedLine Citation:
PMID:  12114092     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Power pulse inversion echocardiography is a new technique by which contrast microbubbles can be visualised in real time within the myocardium, enabling simultaneous assessment of myocardial function and microvascular integrity, which is a prerequisite for myocardial viability. We aimed to determine whether microvascular integrity using power pulse inversion can be used to predict contractile reserve early after myocardial infarction. METHODS AND RESULTS: We studied 19 stable patients 5.1(1.6) days after presentation using low dose dobutamine stress echocardiography and power pulse inversion using slow bolus intravenous injections of Optison. A 16-segment left ventricular model was used to define wall thickening at baseline and following low dose dobutamine infusion (1, normal; 2, reduced; 3, absent), and contrast opacification (1, homogeneous; 2, heterogenous or reduced; 3, absent). The techniques were compared on a segment-by-segment basis to determine whether microvascular integrity (contrast opacification score of 1 or 2) could predict contractile reserve (any improvement during low dose dobutamine infusion) in segments that were akinetic at rest. Follow-up echocardiography was performed one month later. RESULTS: Ninety-four (31%) of the 304 segments were akinetic at rest, and 22 (23%) of these demonstrated contractile reserve. In 87 (92%) of the resting akinetic segments contrast opacification could be adequately determined, and of these 20 (23%) showed microvascular integrity. The negative and positive predictive value of microvascular integrity for determining contractile reserve was 90% and 65%, respectively, and 92% and 59% respectively for predicting recovery of function. CONCLUSION: Power pulse inversion can be used at rest to determine myocardial function and simultaneously to predict contractile reserve of akinetic segments in patients early after myocardial infarction. This technique has the potential to provide a bedside assessment of myocardial viability.
Authors:
J M A Swinburn; R Senior
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  3     ISSN:  1525-2167     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-07-12     Completed Date:  2002-11-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  95-9     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Circulation
Echocardiography / methods*
Female
Humans
Microcirculation
Middle Aged
Myocardial Contraction*
Myocardial Infarction / physiopathology,  ultrasonography*
Predictive Value of Tests
Rest
Comments/Corrections
Comment In:
Eur J Echocardiogr. 2002 Jun;3(2):87-8   [PMID:  12114090 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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