Quantitative myocardial contrast echocardiography for prediction of thrombolysis in myocardial infarction flow in acute myocardial infarction

Moir, Stuart, Haluska, Brian, Leung, Dominic, Lim, Richard, Garrahy, Paul and Marwick, Thomas H. (2004) Quantitative myocardial contrast echocardiography for prediction of thrombolysis in myocardial infarction flow in acute myocardial infarction. American Journal of Cardiology, 93 10: 1212-1217. doi:10.1016/j.amjcard.2004.02.010


Author Moir, Stuart
Haluska, Brian
Leung, Dominic
Lim, Richard
Garrahy, Paul
Marwick, Thomas H.
Title Quantitative myocardial contrast echocardiography for prediction of thrombolysis in myocardial infarction flow in acute myocardial infarction
Journal name American Journal of Cardiology   Check publisher's open access policy
ISSN 0002-9149
1879-1913
Publication date 2004-05-15
Sub-type Article (original research)
DOI 10.1016/j.amjcard.2004.02.010
Volume 93
Issue 10
Start page 1212
End page 1217
Total pages 6
Editor W. C. Roberts
Place of publication New York
Publisher Excerpta Medica/Elsevier
Collection year 2004
Language eng
Subject C1
110201 Cardiology (incl. Cardiovascular Diseases)
110299 Cardiovascular Medicine and Haematology not elsewhere classified
Abstract Clinical evaluation of arterial potency in acute ST-elevation myocardial infarction (STEMI) is unreliable. We sought to identify infarction and predict infarct-related artery potency measured by the Thrombolysis In Myocardial Infarction (TIMI) score with qualitative and quantitative intravenous myocardial contrast echocardiography (MCE). Thirty-four patients with suspected STEMI underwent MCE before emergency angiography and planned angioplasty. MCE was performed with harmonic imaging and variable triggering intervals during intravenous administration of Optison. Myocardial perfusion was quantified offline, fitting an exponential function to contrast intensity at various pulsing intervals. Plateau myocardial contrast intensity (A), rate of rise (beta), and myocardial flow (Q = A x beta) were assessed in 6 segments. Qualitative assessment of perfusion defects was sensitive for the diagnosis of infarction (sensitivity 93%) and did not differ between anterior and inferior infarctions. However, qualitative assessment had only moderate specificity (50%), and perfusion defects were unrelated to TIMI flow. In patients with STEMI, quantitatively derived myocardial blood flow Q (A x beta) was significantly lower in territories subtended by an artery with impaired (TIMI 0 to 2) flow than those territories supplied by a reperfused artery with TIMI 3 flow (10.2 +/- 9.1 vs 44.3 +/- 50.4, p = 0.03). Quantitative flow was also lower in segments with impaired flow in the subtending artery compared with normal patients with TIMI 3 flow (42.8 +/- 36.6, p = 0.006) and all segments with TIMI 3 flow (35.3 +/- 32.9, p = 0.018). An receiver-operator characteristic curve derived cut-off Q value of <11.3, representing impaired myocardial flow, was 73% sensitive and 67% specific for TIMI <3 flow at angiography. Thus, qualitative MCE identifies patients with STEMI but provides no information regarding infarct-related artery potency, whereas quantitative MCE can predict impaired flow in patients with acute STEMI. (C) 2004 by Excerpta Medica, Inc.
Keyword Cardiac & Cardiovascular Systems
Tissue-plasminogen-activator
Blood-flow
Reperfusion
Streptokinase
Therapy
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 03:31:28 EST