1. Tissue Level Perfusion By Myocardial Contrast Echo (MCE) and AMI Outcomes
No Reflow
Reflow P
value
Arrhythmia
40%
18%
0.005
Lecture Notes
Myocardial contrast ECHO (MCE) utilizes microscopic bubbles injected in the coronary artery to determine if reperfusion has been reestablished at the tissue level. In the left panel, tissue level has not been reestablished, a state referred to as “no reflow”. In the right panel, tissue level reperfusion has been reestablished as demonstrated by the appearance of bubbles (indicated by the 4 arrows) . Patients with reflow have a lower risk of arrhythmia, CHF and tend to have a lower risk of in-hospital mortality. While this is an elegant tool that can be used to assess tissue level perfusion, it is limited by the difficulty encountered in applying the technology and the need for an ultrasound technician at the time of the procedure.
References
1. Porter, et al. Am J Cardiol. 1998;82:
2. Ito H, et al. Circulation. 1996;93:
CHF
21%
12%
0.001
In-Hospital Death 6% 1%
0.15
No Reflow
Reflow
Porter, et al. Am J Cardiol. 1998;82:
Ito H, et al. Circulation. 1996;93:

2. Relationship Between Blush Grade and MCE and Wall Motion in AMI PCI Patients
P value
MCE (mm)
144 ± 54
58 ± 58
8 ± 17
0.0002
Regional wall motion index
2.67 ± 0.33
2.00 ± 0.59
2.00 ± 0.47
Lecture Notes
In 25 patients with their first AMI, Lepper et al (2000) compared myocardial blush immediately and 24 hours following primary PTCA and stent placement with myocardial contrast echocardiography (MCE) and coronary reserve flow (CRF) at 24 hours. (Lepper et al, 2000)
Myocardial blush was graded as 1 (none or minimal), 2 ( moderate blush), and 3 (normal blush).
The authors concluded that myocardial reperfusion by myocardial blush grading is strongly correlated with MCE and CRF.
Global wall motion index
1.97 ± 0.30
1.44 ± 0.26
1.40 ± 0.23
0.0003
Lepper W, et al. J Am Coll Cardiol. 2000;35:397A.

3. Prior Studies Linking GP IIbIIIa Inhibition and Improved Myocardial Perfusion
GP IIbIIIa Inhibition was Associated with a More Rapid Rate of Rise in Myocardial Contrast ECHO (MCE) Intensity Following Reperfusion in Animal Model
Kunichika, … Demaria A et al, J Am Coll Cardiol 2004;43:276–83