Feasibility of Prediction of Myocardial Viability With Doppler Tissue Imaging Following Percutaneous Coronary Intervention for ST Elevation Anterior Myocardial Infarction

Seong-Mi Park, Chinami Miyazaki, Abhiram Prasad, Charles J. Bruce, Krishnaswamy Chandrasekaran, Charanjit Rihal, Malcolm R. Bell, Jae K. Oh

Research output: Contribution to journalArticle

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Abstract

Background: In patients with acute ST elevation myocardial infarction (STEMI), it is clinically important to determine the viability of akinetic segments soon after acute reperfusion therapy. The purpose of this study was to determine whether Doppler tissue imaging can predict myocardial viability in this clinical setting. Methods: Twenty-four consecutive patients with the first acute anterior STEMI with akinetic apical segments were enrolled. Color-coded Doppler tissue imaging was performed. Myocardial velocity and strain values were determined from the septal and lateral walls at the normal basal and akinetic apical levels of the left ventricle on day 1 after percutaneous coronary intervention. The presence of isovolumic contraction of tissue velocity (TVivc) and strain rate (SRivc) were also determined. Results: Twenty patients (mean age 62 ± 15 years; 11 men) returned for follow-up echocardiography to assess wall motion recovery and viability. Ten patients who had recovery of akinetic segments showed lower baseline E/e′ ratios than those without recovery (13.4 ± 5.9 vs 19.1 ± 5.7; P = .04). There was no difference between 19 recovered and 21 nonrecovered apical segments in all TV, SR, and strain values except early diastolic SR (SRe; 0.64 ± 0.35 vs 0.43 ± 0.25 s-1; P = .04) at day 1. With a cutoff value of 0.32 s-1 for SRe, the receiver operating characteristic curve for the prediction of recovery showed the highest sensitivity of 84%. The presence of TVivc had sensitivity and specificity of 79% and 33%, respectively, and for SRivc, sensitivity and specificity were 84% and 63%, respectively. With the combination of SRe and SRivc, specificity was increased to 78%. Conclusion: Patients with functional recovery from anterior STEMI showed better diastolic function, better SRe, and more isovolumic contraction. These parameters appear to be promising predictors for myocardial viability, and SR imaging was found to be a better method than TV imaging for the identification of viable myocardium in patients with STEMIs who underwent percutaneous coronary intervention.

Original languageEnglish
Pages (from-to)183-189
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume22
Issue number2
DOIs
Publication statusPublished - 2009 Feb 1

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Percutaneous Coronary Intervention
Sensitivity and Specificity
ROC Curve
Reperfusion
Heart Ventricles
Echocardiography
ST Elevation Myocardial Infarction
Myocardium
Color

Keywords

  • Diastolic function
  • Isovolumic contraction
  • Myocardial infarction
  • Tissue Doppler
  • Viability

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Feasibility of Prediction of Myocardial Viability With Doppler Tissue Imaging Following Percutaneous Coronary Intervention for ST Elevation Anterior Myocardial Infarction. / Park, Seong-Mi; Miyazaki, Chinami; Prasad, Abhiram; Bruce, Charles J.; Chandrasekaran, Krishnaswamy; Rihal, Charanjit; Bell, Malcolm R.; Oh, Jae K.

In: Journal of the American Society of Echocardiography, Vol. 22, No. 2, 01.02.2009, p. 183-189.

Research output: Contribution to journalArticle

Park, Seong-Mi ; Miyazaki, Chinami ; Prasad, Abhiram ; Bruce, Charles J. ; Chandrasekaran, Krishnaswamy ; Rihal, Charanjit ; Bell, Malcolm R. ; Oh, Jae K. / Feasibility of Prediction of Myocardial Viability With Doppler Tissue Imaging Following Percutaneous Coronary Intervention for ST Elevation Anterior Myocardial Infarction. In: Journal of the American Society of Echocardiography. 2009 ; Vol. 22, No. 2. pp. 183-189.
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AU - Miyazaki, Chinami

AU - Prasad, Abhiram

AU - Bruce, Charles J.

AU - Chandrasekaran, Krishnaswamy

AU - Rihal, Charanjit

AU - Bell, Malcolm R.

AU - Oh, Jae K.

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N2 - Background: In patients with acute ST elevation myocardial infarction (STEMI), it is clinically important to determine the viability of akinetic segments soon after acute reperfusion therapy. The purpose of this study was to determine whether Doppler tissue imaging can predict myocardial viability in this clinical setting. Methods: Twenty-four consecutive patients with the first acute anterior STEMI with akinetic apical segments were enrolled. Color-coded Doppler tissue imaging was performed. Myocardial velocity and strain values were determined from the septal and lateral walls at the normal basal and akinetic apical levels of the left ventricle on day 1 after percutaneous coronary intervention. The presence of isovolumic contraction of tissue velocity (TVivc) and strain rate (SRivc) were also determined. Results: Twenty patients (mean age 62 ± 15 years; 11 men) returned for follow-up echocardiography to assess wall motion recovery and viability. Ten patients who had recovery of akinetic segments showed lower baseline E/e′ ratios than those without recovery (13.4 ± 5.9 vs 19.1 ± 5.7; P = .04). There was no difference between 19 recovered and 21 nonrecovered apical segments in all TV, SR, and strain values except early diastolic SR (SRe; 0.64 ± 0.35 vs 0.43 ± 0.25 s-1; P = .04) at day 1. With a cutoff value of 0.32 s-1 for SRe, the receiver operating characteristic curve for the prediction of recovery showed the highest sensitivity of 84%. The presence of TVivc had sensitivity and specificity of 79% and 33%, respectively, and for SRivc, sensitivity and specificity were 84% and 63%, respectively. With the combination of SRe and SRivc, specificity was increased to 78%. Conclusion: Patients with functional recovery from anterior STEMI showed better diastolic function, better SRe, and more isovolumic contraction. These parameters appear to be promising predictors for myocardial viability, and SR imaging was found to be a better method than TV imaging for the identification of viable myocardium in patients with STEMIs who underwent percutaneous coronary intervention.

AB - Background: In patients with acute ST elevation myocardial infarction (STEMI), it is clinically important to determine the viability of akinetic segments soon after acute reperfusion therapy. The purpose of this study was to determine whether Doppler tissue imaging can predict myocardial viability in this clinical setting. Methods: Twenty-four consecutive patients with the first acute anterior STEMI with akinetic apical segments were enrolled. Color-coded Doppler tissue imaging was performed. Myocardial velocity and strain values were determined from the septal and lateral walls at the normal basal and akinetic apical levels of the left ventricle on day 1 after percutaneous coronary intervention. The presence of isovolumic contraction of tissue velocity (TVivc) and strain rate (SRivc) were also determined. Results: Twenty patients (mean age 62 ± 15 years; 11 men) returned for follow-up echocardiography to assess wall motion recovery and viability. Ten patients who had recovery of akinetic segments showed lower baseline E/e′ ratios than those without recovery (13.4 ± 5.9 vs 19.1 ± 5.7; P = .04). There was no difference between 19 recovered and 21 nonrecovered apical segments in all TV, SR, and strain values except early diastolic SR (SRe; 0.64 ± 0.35 vs 0.43 ± 0.25 s-1; P = .04) at day 1. With a cutoff value of 0.32 s-1 for SRe, the receiver operating characteristic curve for the prediction of recovery showed the highest sensitivity of 84%. The presence of TVivc had sensitivity and specificity of 79% and 33%, respectively, and for SRivc, sensitivity and specificity were 84% and 63%, respectively. With the combination of SRe and SRivc, specificity was increased to 78%. Conclusion: Patients with functional recovery from anterior STEMI showed better diastolic function, better SRe, and more isovolumic contraction. These parameters appear to be promising predictors for myocardial viability, and SR imaging was found to be a better method than TV imaging for the identification of viable myocardium in patients with STEMIs who underwent percutaneous coronary intervention.

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KW - Isovolumic contraction

KW - Myocardial infarction

KW - Tissue Doppler

KW - Viability

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