P854Resting qualitative and quantitative myocardial contrast echocardiography to predict cardiac events in patients with acute myocardial infarction and coronary revascularization


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Abstract

Purpose: To evaluate role of qualitative and quantitative myocardial contrast echocardiography (MCE) to predict cardiac events in STEMI patients undergoing reperfusion by percutaneous coronary intervention (PCI) and/or thrombolytic therapy.Methods: Bedside resting real time MCE was performed within a median of 21.4 hrs of PCI using a continuous infusion of diluted contrast agent (Definity). Qualitative MCE was graded: 1 homogenous;2 patchy;3 absent. Perfusion score index (PSI) was calculated by sum of perfusion scores in all segments divided by number of evaluable segments. Quantitative perfusion parameters [A, dB; β, sec-1; and Aβ] were analyzed. Patients were followed for cardiac events [death, nonfatal MI, revascularization; re-hospitalization for arrhythmias, unstable angina, or heart failure]. Cox regression analysis and ROC curves were generated.Results: From Jun-Oct 2007, 37 patients [mean age 64 (40-86 years)] were enrolled. All were followed for median 1.4 [range 0.65, 1.54] years. Cardiac events occurred in 22 patients, who demonstrated higher PSI, and lower A, β and Aβ than patients without events [1.84±.36 vs 1.39±.17 for PSI, P< 0.001; 0.57±0.24 vs 0.85±0.30 for A, P= 0.03; 0.34±0.15 vs 0.53±0.17 for β, P= 0.002; and 0.21±0.12 vs 0.49±0.32, for Aβ, P= .003]. ROC curves showed that PSI > 1.583 provided AUC of 0.873, while β < 0.423 and Aβ < 0.323 provided AUC of 0.858 and 0.842, respectively. By multivariate hazard models, PSI and Aβ were independent predictors of cardiac events with adjusted hazard ratio (HR) of 3.41 (1.19-12.27) and 4.19 (1. 3-19.09), respectively (Table). No contrast-related side effects were reported.Conclusions: Myocardial perfusion assessed acutely in patients with reperfused STEMI can be done safely at the bedside using real-time MCE, and is predictive of subsequent cardiac events.

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