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Wang J, Yang M, Yang Z, Ye L, Luo H, Guo Y. Long-Term Prognostic Value of Myocardial Viability by Myocardial Contrast Echocardiography in Patients after Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. Medicina (B Aires) 2022; 58:medicina58101429. [PMID: 36295589 PMCID: PMC9611281 DOI: 10.3390/medicina58101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: According to recent guidelines, myocardial contrast echocardiography (MCE) is recommended for detecting residual myocardial viability (MV). However, the long-term prognostic value of MV as assessed by MCE in identifying major adverse cardiac events (MACE) after acute myocardial infarction (AMI) remains undefined. Materials and Methods: We searched multiple databases, including PubMed, EMBASE, and Web of Science for studies on the prognostic value of MCE for clinical outcomes in AMI patients. The primary endpoints were MACEs during follow-up. Six studies that evaluated a total of 536 patients with a mean follow-up of 36.8 months were reviewed. Results: The pooled sensitivity and specificity of MCE for predicting MACEs were 0.80 and 0.78, respectively, and the summary operating receiver characteristics achieved an area under the curve of 0.84. The pooled relative risks demonstrated that the MV evaluated by MCE after AMI was correlated with a high risk for total cardiac events (pooled relative risk: 2.07; 95% confidence interval: 1.28–3.37) and cardiac death (pooled relative risk: 2.48; 95% confidence interval: 1.03–5.96). MV evaluated by MCE was a highly independent predictor of total cardiac events (pooled hazard ratio: 2.09, 95% confidence interval: 1.14–3.81) in patients after AMI. Conclusions: Residual MV evaluated by MCE may be an effective long-term prognostic tool for predicting MACE in patients after AMI that can provide moderate predictive accuracy. The assessment of MV by MCE may become an alternative technique with the potential to rapidly provide important information for improving long-term risk stratification in patients after AMI, at the bedside in clinical practice, especially for patients who cannot tolerate prolonged examinations. The PROSPERO registration number is CRD42020167565.
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Affiliation(s)
- Jingxin Wang
- Department of Ultrasound, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Mengxi Yang
- Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi Yang
- Department of Radiology, Chengdu Fifth People’s Hospital, Chengdu 611130, China
| | - Lu Ye
- Department of Ultrasound, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Hong Luo
- Department of Ultrasound, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (H.L.); (Y.G.); Tel.: +86-28-8550-3275 (Y.G.)
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu 610041, China
- Correspondence: (H.L.); (Y.G.); Tel.: +86-28-8550-3275 (Y.G.)
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Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2832-2842. [PMID: 30894317 DOI: 10.1016/j.jacc.2019.03.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 ± 22 g high MI/PCI vs. 40 ± 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 ± 11% vs. 43 ± 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF ≤30%) was reduced in the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330).
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Lenz CJ, Abdelmoneim SS, Anavekar NS, Foley TA, Nhola LF, Huang R, Oh JK, Mulvagh SL. A comparison of infarct mass by cardiac magnetic resonance and real time myocardial perfusion echocardiography as predictors of major adverse cardiac events following reperfusion for ST elevation myocardial infarction. Echocardiography 2016; 33:1539-1545. [DOI: 10.1111/echo.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Charles J Lenz
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
| | - Sahar S Abdelmoneim
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
- Department of Radiology; Mayo Clinic Rochester; Rochester Minnesota
| | - Thomas A Foley
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
- Department of Radiology; Mayo Clinic Rochester; Rochester Minnesota
| | - Lara F Nhola
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
| | - Runqing Huang
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
| | - Jae K Oh
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
| | - Sharon L Mulvagh
- Department of Cardiovascular Diseases; Mayo Clinic Rochester; Rochester Minnesota
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Mathias W, Tsutsui JM, Tavares BG, Xie F, Aguiar MO, Garcia DR, Oliveira MT, Soeiro A, Nicolau JC, Lemos PA, Rochitte CE, Ramires JA, Kalil R, Porter TR. Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles. J Am Coll Cardiol 2016; 67:2506-15. [DOI: 10.1016/j.jacc.2016.03.542] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
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Yang L, Xia C, Mu Y, Guan L, Wang C, Tang Q, Verocai FG, Fonseca LMBD, Shih MC. Prognostic Value of Real Time Myocardial Contrast Echocardiography after Percutaneous Coronary Intervention. Echocardiography 2015; 33:421-30. [PMID: 26411872 DOI: 10.1111/echo.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Real time myocardial contrast echocardiography (RTMCE) is a cost-effective and simple method to quantify coronary flow reserve (CFR). We aimed to determine the value of RTMCE to predict cardiac events after percutaneous coronary intervention (PCI). We have studied myocardial blood volume (A), velocity (β), flow indexes (MBF, A × β), and vasodilator reserve (stress-to-rest ratios) in 36 patients with acute coronary syndrome (ACS) who underwent PCI. CFR (MBF at stress/MBF at rest) was calculated for each patient. Perfusion scores were used for visual interpretation by MCE and correlation with TIMI flow grade. In qualitative RTMCE assessment, post-PCI visual perfusion scores were higher than pre-PCI (Z = -7.26, P < 0.01). Among 271 arteries with TIMI flow grade 3 post-PCI, 72 (36%) did not reach visual perfusion score 1. The β- and A × β-reserve of the abnormal segments supplied by obstructed arteries increased after PCI comparing to pre-PCI values (P < 0.01). Patients with adverse cardiac events had significantly lower β- and lower A × β-reserve than patients without adverse cardiac events. In the former group, the CFR was ≥ 1.5 both pre- and post-PCI. CFR estimation by RTMCE can quantify myocardial perfusion in patients with ACS who underwent PCI. The parameters β-reserve and CFR combined might predict cardiac events on the follow-up.
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Affiliation(s)
- Lixia Yang
- Department of Image Center, Shanghai Xuhui Central Hospital, Shanghai, China.,Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chunmei Xia
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuming Mu
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Lina Guan
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chunmei Wang
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qi Tang
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Flavia Gomes Verocai
- Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Image Diagnostics (CDPI) and Hospital Samaritano, Rio de Janeiro, Brazil
| | | | - Ming Chi Shih
- Department of Radiology, The University of Chicago, Chicago, Illinois.,Federal University of São Paulo, São Paulo, SP, Brazil
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Trindade MLZHD, Vieira MLC, Rodrigues ACT, Francisco Neto MJ, Fischer CH, Morhy SS. Contrast echocardiography in myocardial infarction. EINSTEIN-SAO PAULO 2014; 11:392-7. [PMID: 24136771 PMCID: PMC4878603 DOI: 10.1590/s1679-45082013000300023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/09/2013] [Indexed: 12/11/2022] Open
Abstract
The contrast agents used in ultrasound are approved for several clinical situations. New echocardiographic techniques, such as harmonic imaging and power pulse inversion imaging, can improve the visualization of microbubbles. In this article we discuss the early development of contrast echocardiography, new technologies that help improve image acquisition and its practical role in the assessment of myocardial infarction.
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Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, Di Monaco A, Sestito A, Novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown) 2013; 14:1-18. [DOI: 10.2459/jcm.0b013e328351680f] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Galiuto L, Locorotondo G, Paraggio L, De Caterina AR, Leone AM, Fedele E, Barchetta S, Porto I, Natale L, Rebuzzi AG, Bonomo L, Crea F. Characterization of microvascular and myocardial damage within perfusion defect area at myocardial contrast echocardiography in the subacute phase of myocardial infarction. Eur Heart J Cardiovasc Imaging 2011; 13:174-80. [PMID: 22001191 DOI: 10.1093/ejechocard/jer190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Leonarda Galiuto
- Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A Gemelli, Largo A Gemelli 8, 00168 Rome, Italy.
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Hansen C, Hüttebräuker N, Wilkening W, Ermert H. A method to expedite data acquisition for multiple spatial-temporal analyses of tissue perfusion by contrast-enhanced ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2009; 56:507-519. [PMID: 19411210 DOI: 10.1109/tuffc.2009.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
For semiquantitative analyses of tissue perfusion using contrast-enhanced ultrasound the acquisition and processing of time intensity curves (TIC) is required. These TICs can be computed for each pixel of an image plane, yielding parametric images of classification numbers like "blood volume" and "flow rate." The expenditure of time for data acquisition and analysis typically limits semiquantitative perfusion imaging to a single image plane in 2-D. 3-D techniques, however, provide a higher diagnostic value since more information (e.g., of an entire lesion) is obtained. Moreover, spatial compounding, being a 2-D-technique where an object is imaged from different viewing angles, is known to improve image quality by reducing artifacts and speckle noise. Both techniques, 3-D and compounding, call for optimized acquisition and processing of TICs in several image planes (3-D) or in several (overlapping) sections of the same image plane (compounding) to decrease the time needed for data acquisition. Here, an approach of interleaved imaging is presented which is applicable, among others, to contrast perfusion imaging using the replenishment method. The total acquisition time is decreased by sequentially scanning image planes twice for short time spans - first, immediately after microbubble destruction to record the initial rise of the TICs, and second, a sufficient time thereafter to assess final values of the TIC. Data from both periods are combined to fit a model function from which parameters are extracted such as perfusion rate and blood volume. This approach was evaluated by in vitro measurements on a perfusion-mimicking phantom for both, individual images such as would be used for volume reconstruction in 3-D and compound images obtained from full angle spatial compounding (FASC, 360 degrees ). An error analysis is conducted to derive the deviation of the extracted parameters of the proposed method compared with the conventional one. These deviations are entailed by a reduction in acquisition time of the proposed method, which can be adjusted by several parameters, depending on the prevailing flow. Optimization strategies are proposed to find optimal values for those settings.
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Affiliation(s)
- Christian Hansen
- Institute for High Frequency Engineering, Ruhr-University, Bochum, Germany.
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Wasmeier GH, Asmussen S, Voigt JU, Flachskampf FA, Daniel WG, Nixdorff U. Real-time myocardial contrast stress echocardiography using bolus application. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1724-1731. [PMID: 18485566 DOI: 10.1016/j.ultrasmedbio.2008.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 10/25/2007] [Accepted: 03/19/2008] [Indexed: 05/26/2023]
Abstract
In myocardial contrast echocardiography (MCE), power modulation technique may quantify myocardial perfusion in real-time. However, constant infusion of the contrast agent (CA) complicates handling. This pilot study sought for the clinical feasibility of quantitative MCE by a CA bolus application during Adenosine stress echocardiography to diagnose coronary artery disease (CAD). Twenty-four consecutive patients (pts) with contemporary coronary angiography underwent rest and maximum Adenosine stress. Signal intensity could be calculated in 316/348 left ventricular (LV) segments (91%) (18-segment model). At rest, gamma-variate (alpha) as well as saturation function (beta) was not significantly different in healthy men (n = 268) as well as CAD pts (n = 48) (alpha: 0.34 s(-1) versus 0.40 s(-1), n.s.; beta: 0.31 s(-1) versus 0.35 s(-1), n.s.). During Adenosine infusion both values increased in healthy men (alpha: 0.34 +/- 0.37 s(-1) versus 0.44 +/- 0.45 s(-1), p < 0.05; beta: 0.31 +/- 0.33 s(-1) versus 0.40 +/- 0.40 s(-1), p < 0.01), but not in CAD (alpha: 0.40 +/- 0.35 s(-1) versus 0.29 +/- 0.29 s(-1), n.s.; beta: 0.35 +/- 0.32 s(-1) versus 0.27 +/- 0.30 s(-1), n.s.). Sensitivity of alpha/beta reserve <or=1 was 65%/67% (specificity 66%/67%) and improved to 88% in both if also wall motion analysis was considered (specificity 59%/65%). A very high negative predictive value of 96%/97% favours the method for excluding CAD. Bolus administration of CA is feasible in quantitative real-time MCE. However, additional consideration of wall motion analysis is required for reasonable sensitivity. Very high negative predictive values favour the potential of the method in excluding the diagnosis. Further need of research work may be encouraged by those findings.
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Affiliation(s)
- Gerald H Wasmeier
- The 2nd Medical Clinic, University of Erlangen-Nuremberg, Erlangen, Germany
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