Related Experiment Video
Updated: Sep 1, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Early changes in myocardial perfusion patterns after myocardial infarction: relation with contractile reserve and
E Brochet1, D Czitrom, D Karila-Cohen
1Department of Cardiology, Hopital Bichat, Paris, France. eric.brochet@bch.ap-hop-paris.fr
Objectives:
The purpose of this study was to assess early temporal changes in myocardial perfusion pattern by myocardial contrast echocardiography (MCE) and their relation to myocardial viability in patients with reperfused acute myocardial infarction (AMI).
Background:
Myocardial contrast echocardiography no-reflow is associated with poor contractile recovery after AMI. However, little is known regarding early reversibility of microvascular dysfunction and its relation to myocardial viability.
Methods:
Intracoronary MCE was performed immediately after reflow and 9 days later in 28 patients with a first AMI and successful coronary recanalization (Thrombolysis in Myocardial Infarction trial grade 3 flow). Semiquantitative contrast score and wall motion score (WMS) were assessed in each initially asynergic segment at initial and repeat MCE study. Low dose dobutamine echocardiography (DE) was performed at day 10, and follow-up (FU) rest echocardiography was performed 6 weeks later.
Results:
Among 200 initially asynergic segments, 49% exhibited no or heterogeneous contrast enhancement at initial MCE versus 24% at restudy (p < 0.001). Three groups of segments were defined according to early changes in contrast pattern: group A, "sustained no-reflow" (n = 17); group B, improved contrast score (n = 68), and group C, "sustained reflow" (n = 112). Group A segments showed no improvement in WMS at FU. In contrast, group B segments showed significant improvement in WMS at FU (p < 0.0001), and exhibited more frequently contractile reserve at DE (36% vs. 6%, p = 0.02) and contractile recovery at FU (34% vs. 7%, p = 0.03) than group A segments. Group C segments exhibited contractile reserve and contractile recovery in 47% and 51% of segments respectively.
Conclusions:
Improvement in MCE perfusion pattern may occur after initial no-reflow in the days following reperfused AMI and is associated with preservation of contractile reserve and gradual regional functional recovery.
Insights
Early improvements in myocardial contrast echocardiography (MCE) perfusion after acute myocardial infarction (AMI) indicate preserved heart function. This suggests that microvascular dysfunction can be reversible, leading to gradual recovery of heart muscle movement.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Perfusion Imaging
Background:
- Microvascular dysfunction after acute myocardial infarction (AMI) is linked to poor heart muscle recovery.
- Early reversibility of microvascular dysfunction and its impact on myocardial viability remain under-investigated.
Purpose of the Study:
- To evaluate early temporal changes in myocardial perfusion using myocardial contrast echocardiography (MCE).
- To determine the relationship between these perfusion changes and myocardial viability in patients post-AMI.
Main Methods:
- Intracoronary MCE performed immediately after reperfusion and 9 days later in 28 patients with successful AMI recanalization.
- Semiquantitative contrast and wall motion scores assessed in asynergic segments.
- Low-dose dobutamine echocardiography (DE) and follow-up echocardiography at 6 weeks.
Main Results:
- 49% of initially asynergic segments showed no/heterogeneous enhancement at baseline MCE, decreasing to 24% at restudy (p < 0.001).
- Segments with improved perfusion (Group B) showed significant wall motion recovery (p < 0.0001) and higher rates of contractile reserve (36% vs. 6%, p = 0.02) and recovery (34% vs. 7%, p = 0.03) compared to "sustained no-reflow" segments (Group A).
- "Sustained reflow" segments (Group C) demonstrated contractile reserve in 47% and recovery in 51%.
Conclusions:
- Myocardial perfusion patterns can improve in the days following reperfused AMI, even after initial "no-reflow."
- Early MCE perfusion improvement correlates with preserved contractile reserve and gradual regional functional recovery.
Related Concept Videos
01:29Pathophysiology of Cardiac Performance
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...