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Detection of residual tissue viability within the infarct zone in patients with acute myocardial infarction:ultrasonic integrated backscatter analysis versus dobutamine stress echocardiography
No full textAbstract
OBJECTIVES:
The goals of this study were to analyze temporal changes in cardiac cyclic variation of integrated backscatter (CVIB) in acute myocardial infarction (AMI) and to investigate the predictive value of CVIB normalization compared with that of dobutamine stress echocardiography (DSE) in the assessment of functional recovery after revascularization.
BACKGROUND:
The normal CVIB is blunted by ischemia and recovers early after reperfusion, faster than wall motion improvement. Analysis of CVIB has been widely investigated for its potential to detect viable myocardium in the early stage of infarction. No studies have compared CVIB analysis with other techniques for viability assessment in patients with acute ischemic. Methods and Results: Integrated backscatter images were obtained in 12 patients with AMI on days 1, 3, and 7 after admission and 1 month after revascularization. On day 7, DSE was performed in all patients. On admission, 22 of 144 segments were dyssynergic. On day 1, CVIB was abnormal in all 22 infarcted segments, on day 3, in 16, and on day 7, in only 10 infarcted segments. Eight of 10 segments nonviable by CVIB (CVIB-nonviable) were also nonrespondent by DSE; whereas 12 of 14 segments viable by DSE (DSE-viable) were also CVIB-viable. At follow-up, 10 CVIB-viable segments and 1 CVIB-nonviable segment showed functional recovery; whereas 10 of 14 DSE-viable segments showed functional recovery. Thus the positive predictive value of CVIB and DSE was 83% and 72%, respectively, with a diagnostic agreement between techniques in 77% of segments.
CONCLUSIONS:
Our data suggest that the normalization in CVIB in the first week after AMI accurately predicts residual tissue viability within the infarct zone. We also observed that the initial pattern of cyclic variation may be predictive of functional recovery. Finally, we found a good correlation between the recovery of a normal CVIB in segments that were still dysfunctional and a more validated method to assess tissue viability, such as the dobutamine test
Assessment of myocardial viability during dobutamine stress echocardiography in patients with post-ischemic left ventricular dysfunction using intravenous Levovist and harmonic Power Doppler
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Noninvasive assessment of myocardial perfusion: preliminary results in patients with acute myocardial infarction
No full textClinical utility of contrast echocardiography in the management of patients with acute myocardial infarction
No full textRight-to-eft Shunt detection sensitivity with air-saline and air-succinilgelatin transcranial doppler
No full textBACKGROUND: Air-saline transcranial Doppler is nowadays the first-choice examination to identify right-to-left shunt. To increase right-to-left shunt detection in echocardiography, cardiologists also use air-gelatin mixtures, which are more stable, more echogenic, and easier to be prepared.
AIM: We assessed the sensitivity of air-gelatin compared with air-saline for transcranial Doppler right-to-left shunt detection.
METHODS: Air-saline transcranial Doppler, during unilateral middle cerebral artery monitoring at rest and after Valsalva maneuver, was performed in patients referred to our neurosonology laboratory for right-to-left shunt detection. The same transcranial Doppler protocol was repeated with air-gelatin. To consider transcranial Doppler positive for cardiac right-to-left shunt, at least one embolic signal had to be detected within 20′′ from contrast injection. Later signals were interpreted of pulmonary origin. Trans-thoracic echocardiography was repeated with both air-saline and air-gelatin.
RESULTS: A total of 97 patients were enrolled; 46 had negative transcranial Doppler for cardiac right-to-left shunt with both air-saline and air-gelatin; out of these, four patients with air-saline plus two more patients with air-gelatin presented late, isolated microemboli, slightly more numerous with air-gelatin: these were interpreted as pulmonary shunts and confirmed with trans-thoracic echocardiography. In 28 patients with already early positive air-saline transcranial Doppler at rest, air-gelatin induced a marked right-to-left shunt increase, facilitating its visualization at trans-thoracic echocardiography. In 23 patients in whom air-saline transcranial Doppler was negative at rest and positive for cardiac right-to-left shunt only after Valsalva maneuver, air-gelatin was able to reveal shunt also at rest.
CONCLUSIONS: Air-gelatin increases right-to-left shunt detection sensitivity with transcranial Doppler in particular at rest, even in patients in whom air-saline mixture fails to identify the shunt. The choice of air-gelatin mixture should be considered for multicentric, clinical, and research trials
Accuracy of transesophageal dobutamine stress echocardiography using color kinesis in the assessment of coronary artery disease.
No full textRight-to-Left Shunt detection sensitivity with Transcranial Doppler and saline or succinil-gelatin air mixture
No full textCOLOR KINESIS DURING LOW DOSE DOBUTAMINE STRESS ECHOCARDIOGRAPHY TO DETECT MYOCARDIAL VIABILITY IN PATIENTS WITH CHRONIC ISCHEMIC REGIONAL DYSSYNERGY
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