[Assessment of no-reflow phenomenon in patients with acute ST-elevation myocardial infarction]
D V Krinochkin1, I S Bessonov1, E I Iaroslavskaia1
1Tyumen Cardiological Scientific Centre, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia.
Insights
Contrast-enhanced echocardiography effectively identifies myocardial perfusion disorders after ST-elevation myocardial infarction revascularization. Impaired perfusion is linked to worse left-ventricular function and more severe coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Ultrasound Technology
Background:
- Assessing myocardial perfusion after acute ST-elevation myocardial infarction (STEMI) revascularization remains crucial.
- Contrast-enhanced echocardiography (CEE) shows promise for diagnosing the no-reflow phenomenon, a critical post-revascularization complication.
Purpose of the Study:
- To evaluate echocardiographic and angiographic features of the no-reflow phenomenon using CEE in STEMI patients.
Main Methods:
- Forty-three patients (40-82 years) with acute myocardial infarction were studied.
- Patients were categorized into two groups based on CEE findings: satisfactory reperfusion (32 patients) and impaired perfusion (11 patients).
Main Results:
- Impaired perfusion correlated with increased left ventricular (LV) asynergy, dilatation, reduced contractility (ejection fraction), and mitral regurgitation.
- Patients with impaired perfusion showed more single-vessel disease, anterior interventricular artery lesions, acute occlusions, and higher SYNTAX scores.
- Coronary angiography revealed no perfusion issues in over a quarter of patients with impaired perfusion by CEE.
Conclusions:
- Perfusion disorders identified by CEE in STEMI patients post-revascularization are associated with significant LV dysfunction.
- Higher SYNTAX scores and more frequent anterior interventricular artery lesions characterize patients with impaired perfusion.
Background:
The problems concerning assessment of the state of myocardial perfusion in patients with acute ST elevation myocardial infarction after successful revascularization still remain of current importance. Contrast-enhanced echocardiography remains the least studied and most promising ultrasound technology for the diagnosis of the no-reflow phenomenon.
Aim:
The study was aimed at evaluating echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by means of contrast-enhanced echocardiography in patients with ST-segment elevation myocardial infarction.
Patients And Methods:
The study included a total of forty-three 40-to-82-year-old patients in acute period of myocardial infarction. The patients were divided into two groups: 32 patients with satisfactory myocardial reperfusion after revascularization according to the findings of contrast-enhanced echocardiography and 11 patients with impaired perfusion.
Results:
The patients in the group 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), more frequent LV dilatation (LV end-systolic volume 67.3±20.3 ml vs 51.8±17.2 ml, p=0.015), decreased LV contractility (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) were more often detected in this group. Coronary angiography showed no perfusion disorders after revascularization in more than a quarter of these patients. In the group with impaired perfusion, more frequently revealed were single-vascular lesions (46.9% vs 9.1%, p=0.033), lesions of the anterior interventricular artery (90.9% vs 40.6%, p=0.004), and acute occlusion (100% vs 68.8%, p=0.043); compliance by the SYNTAX score in this group was higher (18.9±3.7 vs 9.9±5.7, p<0.001).
Conclusion:
In patients with acute myocardial infarction after successfully performed revascularization, perfusion disorders revealed by the findings of contrast-enhanced echocardiography were accompanied by more pronounced echo signs of left-ventricular dysfunction, higher values of the SYNTAX score and significantly more frequently revealed lesions of the anterior interventricular septum as compared with the patients with recovered perfusion.
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