Effect of pre-reperfusion residual flow on recovery from myocardial stunning: A myocardial contrast echocardiography study

Young Jae Lim, Tohru Masuyama, Masayoshi Mishima, On Fukui, Daisaku Nakatani, Shigeo Kawano, Yasuhiko Sakata, Kazuhisa Kodama, Masatsugu Hori

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Myocardial contrast echocardiography (MCE) may be used to assess coronary microvasculature in patients with myocardial infarction. Myocardial contrast echocardiography-no reflow suggests poor functional outcome; however, MCE with reflow does not necessarily indicate good myocardial salvage or sufficient functional recovery from myocardial stunning. In this study, MCE was performed to assess the effect of pre- reperfusion residual flow (PRF) on the recovery from myocardial stunning. Methods and Results: The size of the occluded bed, an area supplied with an infarct-related artery, was determined by comparing pre- and post-reperfusion MCE images in 40 patients with first acute myocardial infarction. Myocardial contrast echocardiography-no reflow was observed after reperfusion in 8 patients. Significant PRF was not recognizable in any of the 8 patients. The other patients with MCE reflow were subdivided into 2 groups on the basis of the ratio of the area perfused by PRF to that of the occluded bed: 14 patients with the ratio of more than 10% (PRF[+]), and the other 18 patients (PRF[-]). The wall motion score (0, normal to 4, dyskinetic) was obtained in the convalescent stage. Results: (1) Wall motion of the infarct area after day 3 was better in patients with PRF than in patients without PRF. (2) Left ventricular functional improvement in the long term was remarkable in patients with good reflow and PRF(+), modest in patients with good reflow but PRF(-), and not detectable in patients with MCE-no reflow. No significant correlation was found between angiographic collateral grades and PRF. Conclusions: The presence of residual flow within the infarct area before reperfusion results in not only good myocardial salvage but also rapid functional recovery from myocardial stunning.

Original languageEnglish
Pages (from-to)18-25
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume13
Issue number1
DOIs
Publication statusPublished - 2000 Jan 1
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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