Real-time 3-dimensional echocardiography early after acute myocardial infarction: Incremental value of echo-contrast for assessment of left ventricular function - 07/08/11

Doi : 10.1016/j.ahj.2009.02.002

Gaetano Nucifora, MD ^a,^b,^{^{1
Gaetano Nucifora, MD, and Nina Ajmone Marsan, MD, contributed equally to this article and are shared first authors.}}, Nina Ajmone Marsan, MD ^a,^{^{1
Gaetano Nucifora, MD, and Nina Ajmone Marsan, MD, contributed equally to this article and are shared first authors.}}, Eduard R. Holman, MD, PhD ^a, Hans-Marc J. Siebelink, MD, PhD ^a, Jacob M. van Werkhoven, MSc ^a, Arthur J. Scholte, MD ^a, Ernst E. van der Wall, MD, PhD ^a,^c, Martin J. Schalij, MD, PhD ^a, Jeroen J. Bax, MD, PhD ^a,^⁎
^a Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
^b Department of Cardiopulmonary Sciences, University Hospital “Santa Maria della Misericordia,” Udine, Italy
^c The Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands

^⁎Reprint requests: Jeroen J. Bax, MD, PhD, Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Résumé

Background

Accurate and reproducible assessment of left ventricular (LV) systolic function is important in patients with acute myocardial infarction (AMI). Real-time 3-dimensional echocardiography (RT3DE) is an accurate technique, but it relies heavily on good image quality. The aim of the present study was to evaluate the incremental value of contrast-enhanced RT3DE.

Methods

A total of 140 consecutive patients (58 ± 11 years, 78% men) with ST-elevation AMI clinically underwent nonenhanced and contrast-enhanced RT3DE within 24 hours from AMI to evaluate global and regional LV systolic function. Endocardial border definition was graded for each of the 16 LV segments as follows: 0 = border invisible, 1 = border visualized only partially, and 2 = complete visualization of the border. Three image-quality groups (good, fair, and uninterpretable) were identified. Left ventricular volumes and ejection fraction were measured off-line. Wall motion was graded for each visible segment as follows: 1 = normal, 2 = hypokinetic, 3 = akinetic, and 4 = dyskinetic.

Results

During contrast-enhanced RT3DE, as compared with nonenhanced RT3DE, the number of segments with complete visualization of the endocardial border increased from 66% to 84% (P < .001); and the number of patients with a good-quality echocardiogram increased from 59% to 94% (P < .001). Intra- and interobserver agreement for assessment of global and regional LV systolic function improved during contrast-enhanced RT3DE, as compared with nonenhanced RT3DE.

Conclusions

Assessment of LV systolic function in AMI patients with RT3DE is frequently hampered by suboptimal echocardiographic quality. Contrast-enhanced RT3DE is of incremental value, improving the endocardial border visualization and the reproducibility of LV function assessment.

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Plan

Methods

Study population

Echocardiography

Echocardiographic analysis

Advantages and limitations of RT3DE

Incremental value of contrast-enhanced RT3DE

Study limitations

Disclosures

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Vol 157 - N° 5

P. 882.e1-882.e8 - mai 2009 Retour au numéro

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Real-time 3-dimensional echocardiography early after acute myocardial infarction: Incremental value of echo-contrast for assessment of left ventricular function - 07/08/11

Résumé

Background

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Results

Conclusions

Plan

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