Abstract 4562: Long-Term Clinical Outcome and Left Ventricular Remodeling in AMI Patients With Insufficient Myocardial Reperfusion After Recanalization
Background Myocardial contrast echocardiography (MCE) is effective in predicting myocardial viability and functional recovery on a segmental level in patients with acute myocardial infarction (AMI). In this study, we aimed to investigate whether insufficient myocardial reperfusion plays an important role in left ventricular (LV) remodeling and the prognosis for functional recovery in patients with thrombolysis in TIMI3 and perfect recanalization of infarct-related artery.
Method Patients underwent intracoronary injection of microbubbles for echocardiographic assessment of myocardial microvascular perfusion, wall motion score, LV volume and ejection function (EF) at baseline, 30 minutes after recanalization, 1 month and 6 months. The patients with MCESI<1 were considered to have insufficient myocardial reperfusion (group A, n=11), while the patients with MCESI≥1 were considered to have sufficient myocardial reperfusion (group B, n=47) after AMI recanalization.
Results The wall motion score index (WMSI) and LVEF were significantly improved at 1 month and 6 months in patients in group B, but only at 6 months in group A. LVESV and LVEDV were significantly decreased at 1 and 6 months in group B. WMSI, LVESV, LVEDV and LVEF were significantly improved in patients in group B compared to those in group A at 1 month and 6 months (P<0.01). The correlations were significant between MCESI and changes in LVESV (r2=−0.69), LVEDV (r2=−0.70) and LVEF (r2=0.62) at 6 months in all patients. Similar correlations were observed between the myocardial regional blood flow (Q) and the changes in LVESV (r2=−0.69), LVEDV (r2=−0.64) and LVEF (r2=0.65) at 6 months in all patients.
Conclusion Insufficient myocardial reperfusion was a powerful independent predictor of LV remodeling and functional recovery in AMI patients with TIMI flow grade 3 and perfect angiographic results after recanalization. MCE has important additional value for prognosis and risk stratification in patients with acute myocardial infarction after recanalization by primary PCI.