Abstract
Backgrounds: No-reflow phenomenon observed after percutaneous coronary intervention (PCI) determines clinical and functional outcomes in patients with acute myocardial infarction (AMI). Myocardial contrast echocardiography (MCE) is one of the established methods to detect no-reflow after AMI. However, MCE using 2D echocardiography has only limited view of left ventricle, and it might evaluate myocardial perfusion inappropriately. We investigated the feasibility of MCE using three-dimensional echocardiography (3D-MCE) to assess myocardial perfusion after AMI. Methods and Results: We performed MCE study in 50 patients with AMI 15 minutes after successful primary PCI, using iE33 (Philips Medical Systems). We injected 3 mL of sonicated contrast agent containing microbubbles into a culprit coronary artery, and recorded an apical 2D-MCE image. Then, we recorded a full-volume 3D-MCE image with another injection of contrast agent. We obtained 7 short axis (SAX) images from one 3D data set, as shown in Figure. Myocardial perfusion in each segment was scored as good=0, poor=1, no-reflow=2, and sum of the score was calculated as a perfusion defect (PD) score. We determined ejection fraction (EF) and wall motion score index (WMSI), as an average of segmental score (0=normokinesis to 4=dyskinesis), on echocardiography recorded at 7.4±4.6 month later. Myocardial perfusion was successfully evaluated in 673/767 (87.7%) segments within risk area in SAX images on 3D-MCE. PD score in 2D-MCE showed no correlation with CK-MB (R 2 =0.08, p=0.06), EF (R 2 =0.03, p=0.26) and WMSI (R 2 =0.04, p=0.19) on follow-up echocardiography. On the other hand, PD score on 3D-MCE was significantly correlated with CK-MB (R 2 =0.56, p<0.0001), WMSI (R 2 =0.40, p<0.0001). It was also weakly but significantly correlated with EF (R 2 =0.10, p=0.02). Conclusions: 3D-MCE detected no-reflow after PCI and predicted functional recovery in patients with AMI more precisely than 2D-MCE.
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