Echocardiography In Acute Myocardial Infarction Research Articles

Prognostic Impact of Peak Aortic Jet Velocity on Patients With Acute Myocardial Infarction.

Aortic valve stenosis (AS) leads to increased cardiovascular mortality and morbidity, and recent studies reported that even mild-to-moderate AS was associated with poor prognosis in the general population. This study investigated the prognostic impact of mild or moderate AS, defined as 2.0 m/s ≤ peak aortic jet velocity (Vmax) ≤3.9 m/s using echocardiography in acute myocardial infarction (AMI) patients.Methods and Results: This study enrolled 3,049 AMI patients using data from the Mie ACS registry. Patients were divided into 2 groups according to Vmax: Group 1: Vmax <2.0 m/s and/or visually intact aortic valve in which all 3 leaflets are fully and evenly open; Group 2: 2.0 m/s ≤ Vmax ≤ 3.9 m/s. There were 2,976 patients in Group 1and 73 patients in Group 2. The Group 2 patients were older, had a higher percentage of males and had lower body mass index and Killip ≥2 than the Group 1 patients. Angiographic data, door-to-balloon time, and mechanical support were not different between the 2 groups. The Group 2 patients demonstrated a significantly higher all-cause mortality rate (P<0.01) and composite of cardiovascular death and heart failure hospitalization (P<0.01), and Kaplan-Meier analysis showed the same tendency in propensity score-matched patients. The present study revealed that mild or moderate AS based on Vmax is associated with poor prognosis following AMI.

P654 Prognostic evaluation of simplified echocardiographic parameters in acute myocardial infarction

Abstract Introduction In an era where prognostic evaluation is increasingly being improved by echocardiography in acute myocardial infarction (MI), there are also classic 2D echocardiographic parameters that may have potential and practical utility in this area. The aim of this study was to evaluate the prognostic impact of left ventricular end-diastolic diameter (LVEDD), indexed left atrium volume (VOL) and indexed left ventricular mass (LVM) in ST-segment elevation myocardial infarction (STEMI) patients. Methods Retrospective study of consecutive patients with nonfatal STEMI who underwent percutaneous coronary intervention between January/2015 and December/2017. VOL was calculated by the "Area-Length" and LVM by "Cube formula", both indexed to the body surface area. High parameters were considered when: LVEDD &amp;gt;58mm in man or &amp;gt;52mm in woman; VOL &amp;gt;34mL/m2; LVM &amp;gt;115g/m2 in man or &amp;gt;95g/m2 in woman. At a median follow-up of 46 months (IQR 38-58), the endpoints evaluated were acute myocardial infarction (AMI), decompensated heart failure (DHF), and overall mortality. The analysis of events was adjusted for possible confounding factors. Results A total of 200 patients were identified, 72% of whom were men and the mean age was 63.7 ± 13.0 years. There was an increase of the LVEDD in 17.5%, VOL in 42% and LVM in 16.5%. In the multivariate analysis, LVEDD was able to predict significant DHF (HR 2.4, 95% CI 1.2-4.9) and AMI (HR 6.4, CI 95% 1.6-26.0) and VOL only AMI (HR 6.1, 95% CI 1.2-30.1), but not DHF (HR 1.3, 95% CI 0.7-2.6). The presence of increased LVM was not associated with more events of DHF (HR 1.4, IC95% 0.7-3.0) or AMI (HR 3.7, 95% CI 0.9-14.5). None of these parameters reached statistical significance for mortality (LVEDD: HR 1.0, 95% CI 0.3-3.0, VOL: HR 1.9, 95% CI 0.8-4.4, LVM: HR 1.3, 95% CI 0.5-3.5). In the ROC curve analysis, LVEDD showed an area under the curve (AUC) of 0.7 (95% CI 0.6-0.8) for DHF and 0.6 (95% CI 0.5-0.8) for AMI, whereas VOL demonstrated an AUC of 0.7 (95% CI 0.5-0.9) for AMI. CONCLUSION In patients with nonfatal STEMI who underwent percutaneous coronary intervention, LVEDD and VOL are echocardiographic parameters that may still play some role in prognostic evaluation. The presence of elevated LVM was not associated with a significant increase in cardiovascular events.

Prediction of infarct size using two-dimensional speckle tracking echocardiography in acute myocardial infarction.

This study aimed to determine the myocardial damage (infarct size provided by cardiac single-photon emission tomography) in early stages of the infarction using longitudinal strain and rotational parameters of the left ventricle. The study included 66 patients with anterior myocardial infarction (AMI) and 62 patients with inferior myocardial infarction (IMI) who underwent primary percutaneous intervention as well as a control group consisting of 50 healthy subjects. LV rotational parameters based on parasternal short-axis views in basal and apical planes and global longitudinal strain were measured with apical four-chamber, apical two-chamber, and apical long-axis views. There was a significant positive correlation between infarct size and GLPSavg (r=-.55 <.001), GTOR angle (r=-.52, P<.001), apical rotation angle (r=-.40 <.001, and EF (r=-.43, <.001). While cutoff values were GLPSavg: 11.9 (AUC=0.78), GTOR angle: 11.4° (AUC=0.77), apical rotation angle: 7.1° (AUC=0.76) for patients with an infarct size greater than 20%, the cutoff values were GLPSavg: 10.7 (AUC=0.75), GTOR angle: 8.7° (AUC=0.86), apical rotation angle: 4.35° (AUC=0.87) for those with an infarct size greater than 40%. GLPSavg, GTOR angle, and apical rotation angle values may be used to determine the extent of infarction in early post-MI period, thereby allowing precautions to be taken for remodeling in early stages.

Assessment of IL-10 levels and LV global longitudinal strain by speckle tracking echocardiography in acute myocardial infarction

Assessment of IL-10 levels and LV global longitudinal strain by speckle tracking echocardiography in acute myocardial infarction

3D speckle-tracking echocardiography in acute myocardial infarction: Relationship between contrast-enhanced magnetic resonance imaging and myocardial deformation

3D speckle-tracking echocardiography in acute myocardial infarction: Relationship between contrast-enhanced magnetic resonance imaging and myocardial deformation

Young Investigator Award session - Clinical * Clinical applications

Young Investigator Award session - Clinical * Clinical applications

Role of echocardiography in acute myocardial infarction

Echocardiography is a valuable tool in diagnosing acute coronary syndrome in patients presenting with chest pain in the emergency department. After acute myocardial infarction (MI), echocardiography provides substantial information regarding risk stratification, hemodynamic assessment, detection of mechanical complications related to acute MI, and long-term prognosis. It also helps in guiding therapy in patients after MI. However, it provides limited value in less than 10% of patients because of poor image quality. Contrast agent can and should be used to improve the accuracy of echocardiographic assessment.

How Many Planes Are Required to Get an Accurate and Timesaving Measurement of Left Ventricular Volume and Function by Real-Time Three-Dimensional Echocardiography in Acute Myocardial Infarction?

To derive the optimal cutting planes of real-time 3-D echocardiography (RT-3DE) for measuring left ventricular volume and ejection fraction (EF) in the presence of left ventricular regional wall motion abnormalities, 14 open-chest dogs were studied with RT-3DE full volume imaging and 2-D echocardiography (2DE) after left anterior descending coronary arteries were occluded for 90 min. Left ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and EF were measured off-line with 2DE and RT-3DE (2-, 4- and 8-plane) methods. The autopsy EDV was estimated by the volume of saline solution injected into the excised heart and served as the reference volume (RefV) for comparison with EDV measured by 2DE and RT-3DE. Agreement analysis was performed according to the method of Bland and Altman. There were excellent correlations between 2DE, RT-3DE (2-plane) and RT-3DE (4-plane) methods on one hand, and RT-3DE (8-plane) method on the other in the measurements of EDV, ESV and SV (r = 0.84–0.99). However, 2DE and RT-3DE (2-plane) measurements significantly underestimated RT-3DE (8-plane) ( p < 0.01), whereas no significant differences between RT-3DE (4-plane) and RT-3DE (8-plane) were found in terms of EDV, ESV and SV measurements. The values of EF determined by 2DE, RT-3DE (2-plane) and RT-3DE (4-plane) methods correlated highly with that by RT-3DE (8-plane) (r = 0.82–0.98) and there was no significant difference between the two measurements. EDV values determined by 2DE, RT-3DE (2-plane), RT-3DE (4-plane) and RT-3DE (8-plane) correlated highly with RefV (r = 0.84, r = 0.92, r = 0.94 and r = 0.97, respectively) and there was no significant difference between RefV and EDV by RT-3DE (4-plane) and RT-3DE (8-plane). In contrast, EDV measured by 2DE and RT-3DE (2-plane) methods underestimated RefV significantly ( p < 0.01). In conclusion, RT-3DE allows reliable and reproducible measurement of left ventricular volume and EF, even in the presence of left ventricular regional wall motion abnormalities. RT-3DE (4-plane) is the method of choice for an accurate and timesaving quantification of left ventricular volume and function. (E-mail: zhangyun@sdu.edu.cn)

総説 急性心筋梗塞における心筋コントラストエコー法の有用性 最近の話題から

総説 急性心筋梗塞における心筋コントラストエコー法の有用性 最近の話題から

Microvasculature in acute myocardial ischemia: part II: evolving concepts in pathophysiology, diagnosis, and treatment.

In the setting of suspected acute myocardial infarction (AMI), a cardiologist needs to know three things: (1) whether there is actually an ongoing infarction, (2) whether reperfusion therapy has succeeded, and (3) how much myocardium was salvaged by reperfusion. Myocardial contrast echocardiography (MCE) can answer the first question by demonstrating the presence of a perfusion defect resulting from reduced microvascular flow because of the presence of a thrombus in an epicardial coronary artery. In a recent multicenter study of 203 patients without ST-segment elevation who presented to the emergency department with chest pain, 21 had AMI, and MCE only missed 1 such patient (sensitivity of 95%).1 Panel A in Figure 1 demonstrates a MCE perfusion defect in a patient presenting to the emergency department with chest pain who was subsequently ruled in for an AMI. The success of reperfusion and degree of myocardial salvage are equally important to know in patients even with ST-elevation AMI. Coronary angiography is not reliable in this regard.2 Figure 1. MCE images of a patient with coronary occlusion (left panel) and reperfusion (right panel) after intravenous administration of microbubbles. Arrows indicate the extent of perfusion defect. Reprinted from Kaul S, Myocardial contrast echocardiography in acute myocardial infarction. In Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . Update 1, vol 2, No. 4). Philadelphia, Pa: WB Saunders Co; 2000. Used with permission. The success of attempted reperfusion can also be accurately assessed with MCE. Most currently used clinical and electrocardiographic parameters are accurate in ≈75% of the cases, whereas MCE has an almost 100% accuracy. Panel B in Figure 1 depicts MCE images that were obtained immediately after thrombolysis and showed that most of the myocardium was reperfused. A small region in the apex showed no reflow and failed to exhibit …

Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction

Mitral regurgitation (MR) complicating acute myocardial infarction (AMI) is associated with increased mortality. The prognostic significance of only mild MR detected by echocardiography in patients with AMI is unknown. This study assessed the long-term risk associated with mild MR detected by color Doppler echocardiography within the first 48 hours of admission in 417 consecutive patients with AMI. No MR was detected in 271 patients (65%), mild MR was seen in 121 patients (29%), and moderate or severe MR was noted in 25 patients (6%). One-year mortality rates were 4.8%, 12.4%, and 24%, respectively (p <0.001). Multivariate analysis revealed that mild MR was independently associated with increased 1-year mortality (p <0.05) after adjustment for age, gender, previous myocardial infarction, diabetes mellitus, systemic hypertension, Killip grade ≥2 on admission, and left ventricular ejection fraction ≤40%. The hazard ratio for 1-year mortality was 2.31 (95% confidence interval 1.03 to 5.20) for mild MR and 2.85 (95% confidence interval 0.95 to 8.51) for moderate or severe MR. Thus, mild MR detected by color Doppler echocardiography within the first 2 days of admission in patients with AMI is a significant independent risk predictor for 1-year all-cause mortality.

The Role of Echocardiography in Acute Myocardial Infarction

The indications for echocardiography in the setting of acute myocardial infarction are to identify wall motion abnormalities, to evaluate left and right ventricular function, and to exclude complications such as pericarditis, mitral regurgitation, and ventricular rupture. Doppler echocardiography can provide important hemodynamic information. In the near future, contrast echocardiography can be expected to delineate myocardial perfusion and three-dimensional echocardiography to better define infarct size.

Usefulness of Echocardiography in Acute Myocardial Infarction: 1998 and Beyond

Usefulness of Echocardiography in Acute Myocardial Infarction: 1998 and Beyond

Usefulness of Echocardiography in Acute Myocardial Infarction: 1998 and Beyond

Usefulness of Echocardiography in Acute Myocardial Infarction: 1998 and Beyond

Myocardial viability assessed by Dobutamine echocardiography in acute myocardial infarction after successful primary coronary angioplasty

Dobutamine echocardiography (5 and 10 μg/kg/ min) was performed in 40 patients 4 ± 1 days after acute myocardial infarction reperfused by primary coronary angioplasty. The left ventricle was divided into 11 segments. Reversible myocardial dysfunction was indicated by a decrease in at least 2 grades in the total segmental score. Follow-up echocardiography was performed 2 months later. Contractile reserve was documented in 18 patients with dobutamine echocardiography (45%). Sensitivity, specificity, positive, and negative predictive value of dobutamine echocardiography in predicting improvement in contractile function at follow-up were 82%, 83%, 78%, and 86%, respectively. Negative predictive value was high in all dyssynergic segments (86%). Positive predictive value was higher in hypokinetic than in akinetic segments (73% vs 21%; p < 0.05). Recovery of wall motion at follow-up was statistically associated with higher left ventricular ejection fraction (p < 0.04), collateral blood flow before reperfusion (p = 0.007), and dobutamine responsiveness (p = 0.0001), and was more frequently observed in hypokinetic than in akinetic segments (p < 0.05). Thus, low-dose dobutamine echocardiography accurately predicts the extent of irreversibly damaged myocardium early after successful direct coronary angioplasty in acute myocardial infarction.

Myocardial Contrast Echocardiography in Acute Myocardial Infarction Using Aortic Root Injections of Microbubbles in Conjunction With Harmonic Imaging: Potential Application in the Cardiac Catheterization Laboratory

Objectives. The aim of this study was to evaluate myocardial contrast echocardiography using aortic root injections with harmonic imaging in experimental acute myocardial infarction to determine the potential of this approach in the cardiac catheterization laboratory.Background. It would be desirable to have an adjunctive procedure that could evaluate myocardial perfusion at the time of cardiac catheterization in patients with acute myocardial infarction. A single injection of contrast medium in the aortic root would provide complete information on myocardial perfusion in a cross section of the heart. High quality images would provide on-line assessment of myocardial perfusion without recourse to image processing. These data could be very valuable for determining patient management.Methods. Perfusion defects on myocardial contrast echocardiography were measured during coronary occlusion and reflow, using fundamental and harmonic imaging in both continuous and intermittent modes in nine open chest dogs. These defects were compared with risk area on technetium-99m autoradiography and infarct size on tissue staining.Results. Whereas harmonic imaging increased myocardial video intensity by more than twofold (p < 0.001) compared with fundamental imaging after aortic root injection of contrast medium, intermittent imaging was not superior to continuous imaging. The improved signal to noise ratio of harmonic imaging allowed on-line definition of risk area (r = 0.98) and infarct size (r = 0.93) without recourse to off-line processing. Similar results could be obtained with fundamental imaging only after off-line processing.Conclusions. Aortic root injections of contrast medium coupled with harmonic imaging can be used to provide accurate on-line assessment of risk area and infarct size during acute myocardial infarction. These results have important implications for the catheterization laboratory.(J Am Coll Cardiol 1997;29:207–16)>

Myocardial contrast echocardiography in acute myocardial infarction combining aortic root injections of albunex R with harmonic imaging: Potential applications in the cardiac catheterization laboratory : Christian Firschke, MD, Jonathan R. Lindner, MD, Kevin Wei, MD, N. Craig Goodman, BS, Sanjiv Kaul, MD. University of Virginia, Charlottesville, Virginia

Myocardial contrast echocardiography in acute myocardial infarction combining aortic root injections of albunex R with harmonic imaging: Potential applications in the cardiac catheterization laboratory : Christian Firschke, MD, Jonathan R. Lindner, MD, Kevin Wei, MD, N. Craig Goodman, BS, Sanjiv Kaul, MD. University of Virginia, Charlottesville, Virginia

Myocardial contrast echocardiography in acute myocardial infarction. Pathophysiological background and clinical applications.

Myocardial contrast echocardiography is a technique used in experimental and clinical settings in order to visualize the pattern of intramyocardial perfusion. In the acute phase of myocardial infarction, regional absence of flow during myocardial contrast echocardiography delineates the area at risk of necrosis, while the definitive non-perfused area expresses infarct size. Reopening the infarct-related artery, which may be achieved spontaneously by thrombolysis or percutaneous transluminal coronary angioplasty, is not a reliable indicator of intramyocardial reperfusion. If myocardial ischaemia due to coronary occlusion has been sufficiently prolonged and severe, not only myocyte viability, but also microvascular integrity is lost. Myocardial contrast echocardiography, using intracoronary injection of sonicated contrast medium, gives information about microvascular integrity and the effective presence of intramyocardial reflow. Anatomical integrity of microvasculature does not necessarily imply preserved function, and thus the microvessel vasodilating reserve may also be impaired. Myocardial contrast echocardiography has the potential to assess alterations in microvascular function, showing, in the myocardial area with reduced coronary reserve, a relatively reduced increase in echocontrast signal intensity when an intravenous vasodilator agent is administered.

Contrast three-dimensional echocardiography in acute myocardial infarction: 3-D reconstruction of perfusion defects yields accurate estimate of infarct mass and extent

Contrast three-dimensional echocardiography in acute myocardial infarction: 3-D reconstruction of perfusion defects yields accurate estimate of infarct mass and extent

Direct visualization of left ventricular free wall rupture by transesophageal echocardiography in acute myocardial infarction

clinical significance in the majority of cases, it has been reportedly related to putative embolic events, systolic clicks, and atrial arrhythmias. 4 ASA may also masquerade as a right atrial mass. 5 The presence of ASA in our patient with symptomatic severe mitral stenosis was clearly clinically relevant, and it presented a therapeutic dilemma and challenge. In view of her young age and pliable, noncalcified mitral valve, the patient was an ideal candidate for PTMC. 6 On the other hand, PTMC requires passage of a large-caliber 12F balloon catheter across the interatrial septum, and it may thus cause extensive tear of the thin septum if atrial septal puncture is made in the fossa ovale where ASA is located. With the aid of biplane follow-through right atrial angiograms, which well delineated the relationship between the atria and ASA, puncture of the latter was avoided. The puncture was made cephalid and dorsal to the ASA, and after PTMC there was no atrial septal shunt demonstrated by oximetry or color Doppler echocardiography. The PTMC resulted in a marked improvement of the patient 's hemodynamic and clinical status.