Χ.Τρίκκα Καρδιολογική Κλινική Νοζοκομείο Ερρίκος Νησνάν

Transcription

1 Χ.Τρίκκα Καρδιολογική Κλινική Νοζοκομείο Ερρίκος Νησνάν

2 Efficacy of Myocardial Contrast Echocardiography in the Diagnosis and Risk Stratification of Acute Coronary Syndrome Am J Cardiol 2005;96:

3 Usefulness of Real-Time Myocardial Perfusion Imaging in the Evaluation of Patients With First Time Chest Pain Detection of Acute Coronary Syndromes by Echocardiography Am J Cardiol 2004;94:

4 Usefulness of Real-Time Myocardial Perfusion Imaging in the Evaluation of Patients With First Time Chest Pain Am J Cardiol 2004;94:

5 Usefulness of Real-Time Myocardial Perfusion Imaging in the Evaluation of Patients With First Time Chest Pain Am J Cardiol 2004;94:

6 Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation prediction of early events determining risk of all events European Heart Journal (2005) 26,

7 Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: A multicenter study Predictive value of single variables for determining adverse events Percent incremental value of tests performed in hierarchical order after clinical, demographic, and electrocardiographic variables are known Am Heart J 2004;148:129 36

8 Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Determination of ultimate infarct size at the time of acute myocardial infarction Circulation. 2001;104:

9 Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Determination of ultimate infarct size at the time of acute myocardial infarction Circulation. 2001;104:

10 Assessment of reperfusion Following thrombolysis Greaves K, Dixon SR, Fejka M, O Neill WW, Redwood SR, Marber MS, Senior R. Myocardial contrast echocardiography is superior to other known modalities for assessing myocardial reperfusion after acute myocardial infarction. Heart 2003;89: Bolognese L, Ducci K, Angioli P, Falsini G, Liistro F, Baldassarre S, Burali A. Elevations in troponin I after percutaneous coronary interventions are associated with abnormal tissue-level perfusion in high-risk patients with non-st-segment-elevation acute coronary syndromes. Circulation 2004;110: European Heart Journal (2008) 29,

11 No-reflow Phenomenon in Patients with Acute Myocardial Infarction:Its Pathophysiology and Clinical Implications

12 Myocardial contrast echocardiography is superior to other known modalities for assessing myocardial reperfusion after acute myocardial infarction Peason product moment correlation matrix of different methods of reperfusion assessment Heart 2003;89:

13 European Heart Journal (2008) 29, Assessment of reperfusion Following percutaneous coronary intervention

14 Summary of studies indicating effect of MCE determined reflow vs. no-reflow on LVEF European Heart Journal (2008) 29,

15 Determination of myocardial viability there is a close association between microvascular and myocellular integrity the optimal timing for determining residual myocardial viability after AMI and reperfusion is at least 48 h after AMI hyperaemic response dynamic changes in resting tissue perfusion The lack of perfusion 15 s after replenishment whether during low or high MI imaging virtually rules out myocardial viability.

16 Determination of myocardial viability recent AMI and occluded IRAs lack of contrast opacification of the dysynergic segments, even at 15 cardiac cycles European Heart Journal (2008) 29,

17 Determination of myocardial viability Myocardial replenishment within 15 cardiac cycles following destruction replenishment imaging signifies intact microvasculature, and preserved residual myocardial viability J Am Coll Cardiol 2001;38:19 25.

18 Prognostic Value of Myocardial Viability Detected by Myocardial Contrast Echocardiography Early After Acute Myocardial Infarction Cardiac death EF > 50% EF < 50% Cardiac death/non fatal MI J Am Coll Cardiol 2007;50:327 34

19 Accuracy of resting intravenous MCE and DSE for the prediction of myocardial viability following AMI MCE performed prior to hospital discharge has been shown to accurately differentiate stunning from necrosis, delineate transmural extent of infarction predict recovery of regional and global LV systolic function in the recuperative phase, provide incremental viability data and finally predicts outcome independent of clinical markers of prognosis including LV dysfunction

20 Myocardial contrast echocardiography accurately reflects transmurality of myocardial necrosis and predicts contractile reserve after acute myocardial infarction Accuracy of MCE to differentiate >50% versus <50% TEI on CMR Accuracy of MCE and CMR to predict contractile reserve Am Heart J 2005;149:355-62

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22 Relationship between myocardial perfusion with myocardial contrast echocardiography and function early after acute myocardial infarction for the prediction of late recovery of function Receiver operator characteristic curve for the prediction of recovery of LV function for baseline CPI and SWTI A CPI value of 1.5 or above provided the best cut-off for predicting improvement in global LV function.

23 The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Known Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling J Am Coll Cardiol 2008;51:552 9

24 Determinants of microvascular damage recovery after acute myocardial infarction: results from the acute myocardial infarction contrast imaging (AMICI) multi-centre study European Journal of Echocardiography (2011) 12,

25 Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study European Heart Journal (2009) 30, 566 5

26 Proposed role of MCE in assessment of patients in the acute phase of STEMI European Heart Journal (2008) 29,

27 Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation European Heart Journal (2008) 29,