Prognostic Value of Real Time Myocardial Contrast Echocardiography after Percutaneous Coronary Intervention

Abstract

Real time myocardial contrast echocardiography (RTMCE) is a cost-effective and simple method to quantify coronary flow reserve (CFR). We aimed to determine the value of RTMCE to predict cardiac events after percutaneous coronary intervention (PCI). We have studied myocardial blood volume (A), velocity (β), flow indexes (MBF, A × β), and vasodilator reserve (stress-to-rest ratios) in 36 patients with acute coronary syndrome (ACS) who underwent PCI. CFR (MBF at stress/MBF at rest) was calculated for each patient. Perfusion scores were used for visual interpretation by MCE and correlation with TIMI flow grade. In qualitative RTMCE assessment, post-PCI visual perfusion scores were higher than pre-PCI (Z = -7.26, P < 0.01). Among 271 arteries with TIMI flow grade 3 post-PCI, 72 (36%) did not reach visual perfusion score 1. The β- and A × β-reserve of the abnormal segments supplied by obstructed arteries increased after PCI comparing to pre-PCI values (P < 0.01). Patients with adverse cardiac events had significantly lower β- and lower A × β-reserve than patients without adverse cardiac events. In the former group, the CFR was ≥ 1.5 both pre- and post-PCI. CFR estimation by RTMCE can quantify myocardial perfusion in patients with ACS who underwent PCI. The parameters β-reserve and CFR combined might predict cardiac events on the follow-up.

Coronary Flow Reserve in Non-Infarcted Myocardium Predicts Long-Term Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

“…Alterations in CFR in the non-infarcted myocardium had important clinical implications after revascularization. 19 Furthermore, some relevant biomarkers and other easily available clinical parameters have also been studied to predict the incidence of MACE, such as mean platelet volume and neutrophil counts. 20 …”

Postoperative Assessment of Myocardial Function and Microcirculation in Patients with Acute Coronary Syndrome by Myocardial Contrast Echocardiography

“…MCE allows both myocardial perfusion and function to be evaluated at the bedside, and is more accurate in ACS assessment than conventional ECG criteria, troponin I, and myocardial perfusion imaging (MPI) [26]. PCI has recently become one of the most effective treatments for ACS, and can improve MBF and decrease the incidence of complications [23]. Thus, assessment of PCI postoperative status is necessary, and MCE is considered to be a good choice for this assessment.…”

“…CFR is an increased coronary blood flow from elemental status to the status of maximal coronary vasodilation, and therefore effectively indicates microcirculation [23]. In a previous study, CFR was used to assess microcirculatory disturbance after PCI [34].…”

“…Myocardial contrast score (MCS) [23] was: 1 point, good perfusion and the contrast medium of full uniform filling in myocardial; 0.5s point, the decrease of perfusion and uneven shade of contrast medium; and 0 points, non-perfusion and no contrast medium filling. The contrast score index (CSI) [24] is defined as the sum of the myocardial contrast score in revascularization-related segments divided by the sum of segments, and the definition of CSI <0.5 was no-reflow (NR).…”

The value of real-time myocardial contrast echocardiography for detecting coronary microcirculation function in coronary artery disease patients

“…Segments with a score of 0.5 on RT-MCE associated with coronary artery stenosis in CAG were defined as ischemic segments. The end-systolic frames (end of T wave) were selected in all cardiac cycles of the replenishment sequence using offline electrocardiographically triggered analysis software ( 21 , 22 ). The mean signal intensity (SI) was measured automatically at regions of interest (ROIs).…”