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(Circulation. 2002;105:157.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Determination of Successful Reperfusion After Thrombolysis for Acute Myocardial Infarction

A Noninvasive Method Using Ultrasonic Tissue Characterization That Can Be Applied Clinically

J. E. Hancock, MB ChB, MRCP, PhD; J. C. Cooke, MB ChB, FRACP; D. T. Chin, MB ChB, MRCP; M. J. Monaghan, PhD

From the Cardiology Department, King’s College Hospital, London, UK.

Correspondence to Dr J.E. Hancock, Cardiology Department, Wythenshawe Hospital, Southmoor Rd, Manchester M23 9LT, UK. E-mail janehancock{at}hotmail.com

Background— The aim of the present study was to determine the use of cyclic variation in ultrasonic integrated backscatter (IBS), which is reduced in ischemic myocardium, to predict an occluded infarct-related artery (IRA) after thrombolysis for acute myocardial infarction (AMI). This is important, because patency of the IRA 90 minutes after thrombolysis has been shown to predict outcome.

Methods and Results— One hundred thirteen patients with AMI had peak-to-peak cyclic IBS measured in the myocardial territory supplied by their IRA as well as a remote territory with normal function from the parasternal long- or short-axis view. This analysis took 5 to 10 minutes. Wall motion score index was assessed, and coronary angiography, to determine patency of the IRA, was performed in all patients. Cyclic IBS in the IRA territory was much lower in segments supplied by an occluded IRA (3.3 versus 4.6 dB, P<0.00001). Using a difference in cyclic IBS between infarcted and normal segments of 15% (or 1.5 dB) as a cutoff, the sensitivity, specificity, positive and negative predictive values to determine an occluded IRA were 92%, 75%, 81%, and 89%, respectively.

Conclusions— The difference in cyclic IBS between IRA and remote normal segments, which can be analyzed rapidly, can be used to predict patency of the IRA in patients with AMI. This provides a noninvasive method to determine those patients who may require urgent invasive investigation.

Key Words: reperfusion • thrombolysis • myocardial infarction • ultrasonics

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