Prognostic value of myocardial contrast echocardiography in acute anterior wall ST-segment elevation myocardial infarction with successful epicardial recanalization.

Abstract

Although myocardial contrast echocardiography (MCE) can evaluate microvascular perfusion abnormalities, its prognostic value is uncertain in acute anterior wall ST-Segment elevation myocardial infarction (STEMI) with successful epicardial recanalization. Therefore, the study aims to investigate the prognostic role of qualitative and quantitative MCE in acute anterior wall STEMI with successful epicardial recanalization. 153 STEMI patients were assessed by MCE within 7days after successful epicardial recanalization. Qualitative perfusion parameters (microvascular perfusion score index, MPSI) and quantitative perfusion parameters (A, β, and Aβ) were acquired using a 17-segment model. And corrected A and Aβ were calculated. Patients were all followed for major adverse cardiovascular events (MACEs). During median follow-up of 27 (4) months, 39 (25.49%) patients experienced MACEs, while 114 (74.51%) were free from MACEs. Patients with MACEs had higher MPSI (1.65 ± 0.13 vs. No-MACEs 1.35 ± 0.20, P < 0.001), lower β (1.09 ± 0.19s-1 vs. No-MACEs 1.34 ± 0.30s-1, P < 0.001), corrected A (0.17 ± 0.03dB vs. No-MACEs 0.19 ± 0.04dB, P = 0.039) and lower corrected Aβ (0.19 ± 0.06dB/s vs. No-MACEs 0.25 ± 0.08dB/s, P < 0.001). MPSI of 1.44 provided an area under the curve (AUC) of 0.872, while β of 1.18s-1 and corrected Aβ of 0.22dB/s provided AUCs of 0.759 and 0.724, respectively. The combination of MPSI, β and corrected Aβ provided an increased AUC of 0.964 (all P < 0.05). Time-dependent ROC analysis showed that the AUCs of the MPSI, β, corrected Aβ and the combination at 1, 1.5 and 2years indicated a strong predictive power for MACEs (AUC = 0.900/0.894/0.881 for MPSI, 0.648/0.704/0.732 for β, 0.674/0.686/0.722 for corrected Aβ, and 0.947/0.962/0.967 for the combination, respectively). Patients with MPSI < 1.44, β > 1.18s-1, or corrected Aβ > 0.22dB/s had lower event rate (all Log Rank P ≤ 0.001). MPSI, β, corrected Aβ, GLS and WBC were independent predictors of MACEs with adjusted hazard ratio of 34.41 (8.18-144.87), P < 0.001 for MPSI; 39.29 (27.46-65.44), P < 0.001 for β; 8.93 (1.46-54.55), P = 0.018 for corrected Aβ; 10.88 (2.83-41.86), P = 0.001 for GLS; and 1.43 (1.16-1.75), P = 0.001 for WBC. Qualitative and quantitative MCE can accurately predict MACEs in acute anterior wall STEMI with successful epicardial recanalization, and their combined predictive value is higher.