The prognostic value of contrast echocardiography in the prediction of the recovery of left ventricular function in patients with acute anterior myocardial infarction.

Introduction: The immediate and complete restoration of perfusion in patients with acute myocardial infarction (MI) leads to the survival of myocardial cells in the initially ischaemic risk area and makes the recovery of left ventricular contractile function possible.
Aim: The goal of the study was to assess the utility of contrast echocardiography (CE) in the prediction of left ventricular function recovery in patients with AMI treated by percutaneous coronary intervention (PCI).
Methods: Eighty six patients (aged 58.4+/-11.2) with anterior AMI, treated by PCI of the left anterior descending coronary artery, were included in the study. Two-dimensional and contrast (Optison) echocardiography were performed immediately before and after PCI, and three days post-PCI. Myocardial contrasting was assessed using the following criteria: 0 -- lack of perfusion; 0.5 -- partial perfusion; 1 -- normal perfusion. On the third day post-PCI, the regional myocardial contrast index was evaluated as the mean value in dyssynergic left ventricular segments (LVRCstI). After three months, the left ventricular regional contractility index (LVRCtrctI) was calculated as the sum of points in the segments which were dyssynergic in the initial study, divided by their number.
Results: 90% of segments with perfusion defects three days post-PCI demonstrated contractility defects (hypokinesia or akinesia) three months post-PCI. LVRCstI three days post-PCI correlated strongly with LVRCtrctI three months post-PCI (R2=0.7696). The sensitivity, specificity and accuracy of EC three days post-PCI in the prediction of recovery of left ventricular function were 88%, 80% and 86%, respectively.
Conclusions: The presence of myocardial perfusion in the region supplied by the infarct-related artery three days post-MI is indicative of myocardial survival and predicts the recovery of contractile function in this region in long-term observation.