Assessment of no-reflow phenomenon by myocardial contrast echocardiography in patients with acute myocardial infarction with ST-segment elevation
Abstract Funding Acknowledgements Type of funding sources: None. Background The noninvasive assessment of myocardial perfusion by echo contrast agents in patients with acute myocardial infarction with ST-segment elevation (STEMI) after successful revascularization is becoming a relevant clinical reality. Perfusion imaging techniques with myocardial contrast echocardiography (MCE) remains the least studied and most promising ultrasound technology for the diagnosis of no-reflow phenomenon. Purpose To study the echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by MCE in patients with STEMI. Methods The study included 43 patients aged from 40 to 82 years in acute stage of myocardial infarction. Patients were divided into two groups: 32 patients characterized by sufficient myocardial reperfusion after revascularization according to MCE results and 11 patients were with the impaired perfusion. Results The patients with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1 ± 2.2% vs 27.4 ± 8.5%, p < 0.001). LV dilatation (LV end-systolic volume 67.3 ± 20.3 ml vs 51.8 ± 17.2 ml, p = 0.015), impaired LV ejection fraction (39.5 ± 3.4% vs 47.2 ± 4.9%, p < 0.001), and significant mitral regurgitation (45.5% vs 3.1%, p = 0.011) with a decrease in DP/DT (979.9 ± 363.4 mmHg/s vs 1565.7 ± 502.8 mmHg/s, p < 0.001) was more often detected in this group. In more than a quarter of these patients, coronary angiography showed no perfusion disorders after revascularization. In the group with impaired perfusion by MCE, the single-vascular lesions (46.9% vs 9.1%, p = 0.033), the lesions of the anterior interventricular artery (90.9% vs 40.6%, p = 0.004), and acute occlusion (100% vs 68.8%, p = 0.043) were more often determined. Conclusion According to the results of MCE, the echo signs of LV dysfunction were more pronounced after successful revascularization in patients with STEMI and myocardial perfusion disorders. The SYNTAX score was twice higher in these patients compared to the patients with recovered perfusion. In addition, no-reflow phenomenon by MCE was observed in the most patients with anterior interventricular artery lesion.
