Optimal Time for Predicting Left Ventricular Remodeling After Successful Primary Coronary Angioplasty in Acute Myocardial Infarction Using Serial Myocardial Contrast Echocardiography and Magnetic Resonance Imaging

• Published in: Circulation Journal 2002, Vol.66(7), pp.685-690
• Main Authors: Sakuma, Tadamichi, Okada, Takenori, Hayashi, Yasuhiko, Otsuka, Masaya, Hirai, Yuukou
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Collateral Circulation; Contrast echocardiography; Coronary Angiography; Coronary heart disease; Echocardiography - methods; Female; Heart; Humans; Left ventricular remodeling; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Prospective Studies; ROC Curve; Time Factors; Ventricular Remodeling
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.66.685

The objective of this study was to determine the optimal time to assess microvascular integrity within the risk area for myocardial infarction in order to predict unfavorable left ventricular remodeling (LVR) after successful primary coronary angioplasty. Fifty-three patients who underwent myocardial contrast echocardiography (MCE) just before recanalization, shortly after and 1 day (Day 2) and 3 weeks after recanalization were studied. The no- and low-reflow ratio (LR ratio) was analyzed at each stage. The wall-thinning ratio within the risk area was determined using magnetic resonance imaging performed 3-4 weeks after the recanalization. Thirteen of the 53 patients showed LVR 3-8 months after recanalization. The optimal time to predict LVR was found to be Day 2 based on the receiver operating characteristic curves. The LR ratio on Day 2 (χ2=7.39, p=0.007) and the collateral circulation before recanalization (χ2=4.57, p=0.03) were chosen as independent variables for predicting LVR. Patients with greater than 0.43 in the LR ratio on Day 2 showed a lower wall-thinning ratio (58±19% vs 72±20%, p=0.05). This study shows that the optimal time to estimate the microvascular integrity for predicting LVR is 1 day after recanalization, which is neither shortly after recanalization nor during the convalescent stage. (Circ J 2002; 66: 685 - 690)