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

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.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.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.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; p0.001). 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; p0.001), but did not change in the contrast negative patients (1.702 +/- 0.38 vs. 1.603 +/- 0.33; p = NS).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.