No abstract

BACKGROUND We investigated myocardial perfusion dynamics after thrombolysis and its clinical implications. METHODS AND RESULTS We studied 39 patients with acute anterior myocardial infarction (AMI). Myocardial contrast echocardiography (MCE) was performed before and immediately after successful reflow with intracoronary injection of sonicated Ioxaglate. The average segmental score by two-dimensional echocardiography (graded 0, normal, to 3, akinetic/dyskinetic) and global ejection fraction (left ventricular ejection fraction, LVEF%) by left ventriculography were measured at 1 day and at 4 weeks after reflow. Hypokinesis in the infarct region was assessed by the centerline method and expressed in terms of standard deviations (regional wall motion [RWM]: SD/chord) of normal. Immediately after reflow, 30 of 39 patients (group A) showed significant contrast enhancement within the risk area. The other nine patients (23%, group B), however, showed the residual contrast defect in the risk area (myocardial no reflow). There were no significant differences in the elapsed time, angiographic collateral grade, and degree of residual stenosis between group A and group B. Before reflow, both groups exhibited similar levels of global and regional left ventricular function. Improvement in global (LVEF, average segmental score) and regional left ventricular function was greater in group A than in group B (average segmental score, 0.44 +/- 0.41 versus 0.97 +/- 0.36, p less than 0.01; LVEF, 56.4 +/- 13.4 versus 42.7 +/- 8.9, p less than 0.05; RWM, -1.87 +/- 0.85 versus -3.18 +/- 0.52, p less than 0.005). CONCLUSIONS MCE demonstrates that angiographically successful reflow cannot be used as an indicator of successful myocardial reperfusion in AMI patients. The residual contrast defect in the risk area demonstrated immediately after reflow is a predictor of poor functional recovery of the postischemic myocardium.

We used a pulsed Doppler technique to examine the flow velocity pattern in the right ventricular outflow tract in 33 adults. In the patients with normal pulmonary artery pressure (mean pressure < 20 mm Hg, 16 patients), ejection flow reached a peak level at midsystole (137 + 24 msec, mean + SD), producing a domelike contour of the flow velocity pattern during systole. In contrast, the flow velocity pattern in patients with pulmonary hypertension (mean pressure ¢ 20 mm Hg,17 patients) was demonstrated to accelerate rapidly and to reach a peak level sooner (97 + 20 msec, p < .01); in 10 of the pulmonary hypertensive patients a secondary slower rise in flow velocity was observed during a deceleration, resulting in the midsystolic notching. The time to peak flow (acceleration time, AcT) and right ventricular ejection time (RVET) were measured from the flow velocity pattern. Either AcT or AcT/RVET decreased with increase in mean pulmonary artery pressure, and a very high correlation (r = -.90) was found between AcT/RVET and log,0 (mean pulmonary artery pressure). The use of this technique permitted the noninvasive estimation of the pulmonary artery pressure. Circulation 68, No. 2, 302-309, 1983. NONINVASIVE evaluation of pulmonary hypertension has been an important clinical problem for many years. The presence of pulmonary hypertension has been assessed by abnormalities in heart sounds,' in electrocardiographic tracings, or in chest x-rays,2 but to date, the accurate measurement of the pulmonary artery pressure requires the use of cardiac catheterization procedures. The development of echocardiographic techniques has allowed the investigation of pulmonic valve motion,3 which represents some characteristic abnormalities associated with pulmonary hypertension, such as rapid opening slope in systole,j5 attenuation or absence of the "a" dip,' prolongation of the ratio of right ventricular preejection period (RPEP) to right ventricular ejection time (RVET),57 and midsystolic semiclosure of pulmonic valve.)6 A recent experimental study8 emphasized that these abnormalities of the pulmonic valve motion were determined by abnormal flow changes in the pulmonary artery. However, flow characteristics with regard to pulmonary artery pressure either in the pulmonary artery or in the right ventricular outflow tract have not been successfully studied in man. Our objectives were to study the blood flow characteristics in the right ventricular outflow tract in patients with pulmonary hypertension by a pulsed Doppler technique9-I and to develop an index that would permit quantitative evaluation of pulmonary hypertension by noninvasive methods. Materials and methodsPatient selection. Thirty-eight patients admitted for diagnostic catheterization were examined by a pulsed Doppler technique. Five patients were excluded in whom Doppler recordings of flow velocity in the right ventricular outflow tract were not satisfactorily obtained because of poor penetration of ultrasound through the chest wall. Doppler examination was perfor...

Hyperglycemia might be associated with impaired microvascular function after AMI, resulting in a larger infarct size and worse functional recovery.

In 1990, takotsubo cardiomyopathy (TCM) was first discovered and reported by a Japanese cardiovascular specialist. Since then, this heart disease has gained worldwide acceptance as an independent disease entity. TCM is an important entity that differs from acute myocardial infarction. It occurs more often in postmenopausal elderly women, is characterized by a transient hypokinesis of the left ventricular (LV) apex, and is associated with emotional or physical stress. Wall motion abnormality of the LV apex is generally transient and resolves within a few days to several weeks. Its prognosis is generally good. However, there are some reports of serious TCM complications, including hypotension, heart failure, ventricular rupture, thrombosis involving the LV apex, and torsade de pointes. It has been suggested that coronary spasm, coronary microvascular dysfunction, catecholamine toxicity and myocarditis might contribute to the pathogenesis of TCM. However, its pathophysiology is not clearly understood.