[Detection of myocardial viability with venous contrast echocardiography immediately after reperfusion therapy in patients with acute myocardial infarction].

Introduction: After reperfusion therapy of acute myocardial infarction not only the patency of infarct related artery (IRA) but uncompromised myocardial perfusion are essential for recovery of myocardial contractile function.

Aim: The authors sought to evaluate the relation between the status of myocardial microvasculature early after successful mechanical reperfusion therapy of AMI and contractile function at rest two weeks later.

Methods: Sixty-three patients with first acute myocardial infarction underwent venous myocardial contrast echocardiography (VMCE) 3 hours after successful percutaneous coronary intervention. The myocardial contrast intensity of akinetic segments was evaluated according to a semiquantitative score (1 = normal; 2 = moderate contrast defect; 3 = serious contrast defect; 4 = no contrast at all). Two weeks later the resting contractile function of previously akinetic segments (n = 218) was re-evaluated.

Results: The semiquantitative contrast score was significantly different between differential functional groups observed after two weeks: normokinesia (1.21 +/- 0.47); hypokinesia (1.65 +/- 0.77); akinesia (2.75 +/- 0.85). Sensitivity and the specificity of semiquantitative venous myocardial contrast echocardiography for early prediction of functional recovery is 90% and 69%, respectively (chi 2 = 76.2; p < 0.001). The global wall motion score index improved in contrast positive patients (more than 50% of initial akinetic segments show score 1 or 2) (1.607 +/- 0.30 vs. 1.295 +/- 0.25; p < 0.001), but did not change in the contrast negative patients (1.702 +/- 0.38 vs. 1.603 +/- 0.33; p = NS).

Conclusion: Functional recovery after AMI can be predicted with VMCE immediately after successful reopening of IRA. The post-PTCA contrast intensity of an infarcted segment is closely related to its subsequent functional status.