The comparison of contrast echocardiography and tissue Doppler imaging for evaluation of reperfused myocardium in patients with acute anterior myocardial infarction.

Background: Prediction of functional myocardial recovery post acute myocardial infarction should be based not only on flow patency of the infarct related artery (IRA) but also on the quality of microcirculation in at-risk segments. Myocardial blush grade (MBG) is a method of perfusion assessment which has an established value in prediction of both ventricular remodelling and prognosis. However, its invasive character encourages the search for other methods able to reflect myocardial recovery following successful reperfusion. Echocardiography is an imaging modality which has the potential to assess, noninvasively, myocardial perfusion and, quantitatively, the loss of contractile function. The aim of this study was to compare the values of myocardial contrast echocardiography (MCE), MBG and tissue Doppler imaging (TDI) in the assessment of microcirculation in patients with first acute myocardial infarction of the anterior wall.

Methods: The study group consisted of 39 patients (15 female and 24 male, mean age 58.8 +/- 12.2 years) with first anterior infarction within 6 hours of chest pain onset. All patients underwent angioplasty of the anterior descending artery (LAD). Myocardial blush grade was assessed directly after angioplasty, whereas MCE using SonoView contrast accompanied by TDI study was performed 4 days thereafter.

Results: Neither of the quantitative MCE parameters showed significant correlation with perfusion assessed by MBG. Significant negative correlation of MBG was found with maximal systolic strain ( e) (R = -0.51, p = 0.003) and post systolic shortening (R = -0.49, p = 0.007) in infarcted segments, but this was not the case with the unaffected segments.

Conclusions: Use of MCE in the assessment of myocardial perfusion in myocardial infarction is limited, as shown by poor correlation with MBG. The presence of impaired contractile function by TDI corresponds better with myocardial perfusion than MCE does.