Microvascular integrity demonstrated by myocardial contrast echocardiography(MCE) predicts functional recovery after an acute myocardial infarction(AMI). Recently, parametric imaging-based quantitative MCE has been de...Microvascular integrity demonstrated by myocardial contrast echocardiography(MCE) predicts functional recovery after an acute myocardial infarction(AMI). Recently, parametric imaging-based quantitative MCE has been developed. Our aim was to assess the usefulness of parametric imaging-based quantitative MCE parameters to predict the functional recovery of akinetic segments after primary percutaneous transluminal coronary angioplasty(PTCA). Fifty-three consecutive patients with a first AMI were enrolled. They underwent primary PTCA. Standard echocardiography and real-time MCE were performed. Qualitative analysis and parametric imaging-based quantitative parameters were measured offline by different blinded investigators. Dobutamine stress echocardiography was performed 1 month later. A new standard echocardiogram to assess the functional status of the akinetic segments and coronary angiography to evaluate the presence of restenosis at the level of the culprit lesion were performed 6 months later. The mean patient age was 62.9±14 years, and 42 were men(79%); 170 segments were akinetic. Of these, 105(62%) recovered their function. The best parameter to predict functional recovery was the myocardial blood flow velocity(β). These results were better than those obtained using dobutamine stress echocardiography and qualitative MCE to predict functional recovery. In conclusion, parametric imaging-based quantitative MCE is an accurate diagnostic tool to detect stunned myocardium after AMI. Its diagnostic accuracy in predicting the functional recovery of akinetic segments after primary PTCA is better than the accuracy of dobutamine stress echocardiography and qualitative MCE.展开更多
Background Emerging evidence suggests that stem cells and progenitor ce lls der ived from bone marrow can be used to improve cardiac function in patients after acute myocardial infarction. In this randomised trial, we...Background Emerging evidence suggests that stem cells and progenitor ce lls der ived from bone marrow can be used to improve cardiac function in patients after acute myocardial infarction. In this randomised trial, we aimed to assess whethe r intracoronary transfer of autologous bone-marrow cells could improve global l eft-ventricular ejection fraction (LVEF) at 6 months’follow-up. Methods After successful percutaneous coronary intervention (PCI) for acute ST-segment eleva tion myocardial infarction, 60 patients were randomly assigned to either a contr ol group (n=30) that received optimum postinfarction medical treatment, or a bon e-marrow-cell group (n=30) that received optimum medical treatment and intraco ronary transfer of autologous bone-marrow cells 4.8 days (SD 1.3) after PCI. Pr imary endpoint was global left-ventricular ejection fraction (LVEF) change from baseline to 6 months’follow-up, as determined by cardiac MRI. Image analyses were done by two investigators blinded for treatment assignment. Analysis was pe r protocol. Findings Global LVEF at baseline (determined 3.5 days <<SD 1.5>> after PCI) was 51.3 (9.3%) in controls and 50.0(10.0%) in the bone-marrow cell group (p=0.59). After 6 months, mean global LVEF had increased by 0.7 percentage points in the c ontrol group and 6.7 percentage points in the bone-marrow-cell group (p=0.0026 ). Transfer of bone-marrow cells enhanced left-ventricular systolic function p rimarily in myocardial segments adjacent to the infarcted area. Cell transfer di d not increase the risk of adverse clinical events, in-stent restenosis, or pro arrhythmic effects. Interpretation Intracoronary transfer of autologous bone-ma rrow-cells promotes improvement of left-ventricular systolic function in patie nts after acute myocardial infarction.展开更多
We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viabi...We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability ininfarct areas.W e prospectively studied 35patients(age60±8.6years)in the chronic phase of Q wave anteriorM I.Spontaneous TW N (group A,n =23)were defined asnegative T waves thatbecam e upright(≥0.15m V )in ≥2IRLs.The presence ofnegative T waves(group B,n =12)was defined assym m etric orbiphasic negative T wave of≥0.15m V.Allpatients underwentsam e day rest201TI-stress99m Tc sestam ibi dual-isotope m yocardial perfusion SPECTand 24-hour 201TI reinjection im aging for ischem ia and vi-ability analysis.On scintigraphic exam ination,ischecm icor viable m yocardial segm ents were found in 18patients(78%)with TW N and 4patients(33%)ofgroup B (p =0.013).The use of TW N as a param eter had a m arkedinfluence on the sensitivity(82% ),specificity(62% ),positive(78%)and negative(67%)predictive values andaccuracy(74%)ofthe diagnosis ofviable m yocardium .Ifwe add the criterion ofpositive T waves in aVR with neg-ative T waves to our criteria,we found that sensitivity(90% ),positive(80% )and negative(80% )predictivevalues and accuracy(80% )increased.The results of ourstudy suggestthatanalysis ofTW N on IRLs is an accuratem arker of residual viability and /or persistent periinfarctischem ia in patients in the chronic stage ofQ wave anteriorM I,and therefore optim izes the diagnostic and therapeuticstrategies afterM I.展开更多
文摘Microvascular integrity demonstrated by myocardial contrast echocardiography(MCE) predicts functional recovery after an acute myocardial infarction(AMI). Recently, parametric imaging-based quantitative MCE has been developed. Our aim was to assess the usefulness of parametric imaging-based quantitative MCE parameters to predict the functional recovery of akinetic segments after primary percutaneous transluminal coronary angioplasty(PTCA). Fifty-three consecutive patients with a first AMI were enrolled. They underwent primary PTCA. Standard echocardiography and real-time MCE were performed. Qualitative analysis and parametric imaging-based quantitative parameters were measured offline by different blinded investigators. Dobutamine stress echocardiography was performed 1 month later. A new standard echocardiogram to assess the functional status of the akinetic segments and coronary angiography to evaluate the presence of restenosis at the level of the culprit lesion were performed 6 months later. The mean patient age was 62.9±14 years, and 42 were men(79%); 170 segments were akinetic. Of these, 105(62%) recovered their function. The best parameter to predict functional recovery was the myocardial blood flow velocity(β). These results were better than those obtained using dobutamine stress echocardiography and qualitative MCE to predict functional recovery. In conclusion, parametric imaging-based quantitative MCE is an accurate diagnostic tool to detect stunned myocardium after AMI. Its diagnostic accuracy in predicting the functional recovery of akinetic segments after primary PTCA is better than the accuracy of dobutamine stress echocardiography and qualitative MCE.
文摘Background Emerging evidence suggests that stem cells and progenitor ce lls der ived from bone marrow can be used to improve cardiac function in patients after acute myocardial infarction. In this randomised trial, we aimed to assess whethe r intracoronary transfer of autologous bone-marrow cells could improve global l eft-ventricular ejection fraction (LVEF) at 6 months’follow-up. Methods After successful percutaneous coronary intervention (PCI) for acute ST-segment eleva tion myocardial infarction, 60 patients were randomly assigned to either a contr ol group (n=30) that received optimum postinfarction medical treatment, or a bon e-marrow-cell group (n=30) that received optimum medical treatment and intraco ronary transfer of autologous bone-marrow cells 4.8 days (SD 1.3) after PCI. Pr imary endpoint was global left-ventricular ejection fraction (LVEF) change from baseline to 6 months’follow-up, as determined by cardiac MRI. Image analyses were done by two investigators blinded for treatment assignment. Analysis was pe r protocol. Findings Global LVEF at baseline (determined 3.5 days <<SD 1.5>> after PCI) was 51.3 (9.3%) in controls and 50.0(10.0%) in the bone-marrow cell group (p=0.59). After 6 months, mean global LVEF had increased by 0.7 percentage points in the c ontrol group and 6.7 percentage points in the bone-marrow-cell group (p=0.0026 ). Transfer of bone-marrow cells enhanced left-ventricular systolic function p rimarily in myocardial segments adjacent to the infarcted area. Cell transfer di d not increase the risk of adverse clinical events, in-stent restenosis, or pro arrhythmic effects. Interpretation Intracoronary transfer of autologous bone-ma rrow-cells promotes improvement of left-ventricular systolic function in patie nts after acute myocardial infarction.
文摘We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability ininfarct areas.W e prospectively studied 35patients(age60±8.6years)in the chronic phase of Q wave anteriorM I.Spontaneous TW N (group A,n =23)were defined asnegative T waves thatbecam e upright(≥0.15m V )in ≥2IRLs.The presence ofnegative T waves(group B,n =12)was defined assym m etric orbiphasic negative T wave of≥0.15m V.Allpatients underwentsam e day rest201TI-stress99m Tc sestam ibi dual-isotope m yocardial perfusion SPECTand 24-hour 201TI reinjection im aging for ischem ia and vi-ability analysis.On scintigraphic exam ination,ischecm icor viable m yocardial segm ents were found in 18patients(78%)with TW N and 4patients(33%)ofgroup B (p =0.013).The use of TW N as a param eter had a m arkedinfluence on the sensitivity(82% ),specificity(62% ),positive(78%)and negative(67%)predictive values andaccuracy(74%)ofthe diagnosis ofviable m yocardium .Ifwe add the criterion ofpositive T waves in aVR with neg-ative T waves to our criteria,we found that sensitivity(90% ),positive(80% )and negative(80% )predictivevalues and accuracy(80% )increased.The results of ourstudy suggestthatanalysis ofTW N on IRLs is an accuratem arker of residual viability and /or persistent periinfarctischem ia in patients in the chronic stage ofQ wave anteriorM I,and therefore optim izes the diagnostic and therapeuticstrategies afterM I.
