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Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction.
Open accessAbstract
BACKGROUND: We investigated myocardial perfusion dynamics after thrombolysis and its clinical implications. METHODS AND RESULTS: We studied 39 patients with acute anterior myocardial infarction (AMI). Myocardial contrast echocardiography (MCE) was performed before and immediately after successful reflow with intracoronary injection of sonicated Ioxaglate. The average segmental score by two-dimensional echocardiography (graded 0, normal, to 3, akinetic/dyskinetic) and global ejection fraction (left ventricular ejection fraction, LVEF%) by left ventriculography were measured at 1 day and at 4 weeks after reflow. Hypokinesis in the infarct region was assessed by the centerline method and expressed in terms of standard deviations (regional wall motion [RWM]: SD/chord) of normal. Immediately after reflow, 30 of 39 patients (group A) showed significant contrast enhancement within the risk area. The other nine patients (23%, group B), however, showed the residual contrast defect in the risk area (myocardial no reflow). There were no significant differences in the elapsed time, angiographic collateral grade, and degree of residual stenosis between group A and group B. Before reflow, both groups exhibited similar levels of global and regional left ventricular function. Improvement in global (LVEF, average segmental score) and regional left ventricular function was greater in group A than in group B (average segmental score, 0.44 +/- 0.41 versus 0.97 +/- 0.36, p less than 0.01; LVEF, 56.4 +/- 13.4 versus 42.7 +/- 8.9, p less than 0.05; RWM, -1.87 +/- 0.85 versus -3.18 +/- 0.52, p less than 0.005). CONCLUSIONS: MCE demonstrates that angiographically successful reflow cannot be used as an indicator of successful myocardial reperfusion in AMI patients. The residual contrast defect in the risk area demonstrated immediately after reflow is a predictor of poor functional recovery of the postischemic myocardium.
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Cited by
Myocardial ischemia-reperfusion injury: a neglected therapeutic target
Hausenloy, D. J., & Yellon, D. M. (2013) · Journal of Clinical Investigation · doi:10.1172/jci62874 · Cited by 2,357
JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome
Kimura, K., Kimura, T., Ishihara, M., Nakagawa, Y., Nakao, K., Miyauchi, K., Sakamoto, T., Tsujita, K., Hagiwara, N., Miyazaki, S., et al. (2019) · Circulation Journal · doi:10.1253/circj.cj-19-0133 · Cited by 565
Chandrashekhar, Y., Sen, S., Anway, R., Shuros, A., & Anand, I. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.09.026 · Cited by 149
Weir, R. A. P., Murphy, C. A., Petrie, C. J., Martin, T. N., Balmain, S., Clements, S., Steedman, T., Wagner, G. S., Dargie, H. J., & McMurray, J. J. V. (2010) · Circulation Cardiovascular Imaging · doi:10.1161/circimaging.109.897439 · Cited by 86
Myocardial ‘no-reflow’ — diagnosis, pathophysiology and treatment.
Wong, D. T. L., Puri, R., Richardson, J. D., Worthley, M. I., & Worthley, S. G. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2012.12.049 · Cited by 66
Metadata
- Authors
- Ito, H., Tomooka, T., Sakai, N., Yu, H., Higashino, Y., Fujii, K., Masuyama, T., Kitabatake, A., & Minamino, T.
- Venue
- Circulation
- Published
- 1992-05
- Volume
- 85
- Issue
- 5
- Pages
- 1699-1705
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2075499032
- Cited by
- 1,054
- References
- 0
- FWCI
- 24.06
- Type
- journal article
- Language
- en
- Open access
- bronze
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- CoChat. (2026). Citation check: Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. https://app.cochat.ai/papers/10.1161/01.cir.85.5.1699
- The paper
- Ito, H., Tomooka, T., Sakai, N., Yu, H., Higashino, Y., Fujii, K., Masuyama, T., Kitabatake, A., & Minamino, T. (1992). Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation. https://doi.org/10.1161/01.cir.85.5.1699
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