American Heart Journal
Volume 157, Issue 5 , Pages 882.e1-882.e8, May 2009

Real-time 3-dimensional echocardiography early after acute myocardial infarction: Incremental value of echo-contrast for assessment of left ventricular function

  • Gaetano Nucifora, MD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • Department of Cardiopulmonary Sciences, University Hospital “Santa Maria della Misericordia,” Udine, Italy
    • Gaetano Nucifora, MD, and Nina Ajmone Marsan, MD, contributed equally to this article and are shared first authors.
    • ,
  • Nina Ajmone Marsan, MD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • Gaetano Nucifora, MD, and Nina Ajmone Marsan, MD, contributed equally to this article and are shared first authors.
    • ,
  • Eduard R. Holman, MD, PhD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Hans-Marc J. Siebelink, MD, PhD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Jacob M. van Werkhoven, MSc

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Arthur J. Scholte, MD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Ernst E. van der Wall, MD, PhD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • The Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
    • ,
  • Martin J. Schalij, MD, PhD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Jeroen J. Bax, MD, PhD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
    • Corresponding Author InformationReprint requests: Jeroen J. Bax, MD, PhD, Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Received 22 November 2008; accepted 3 February 2009. published online 26 March 2009.

Background

Accurate and reproducible assessment of left ventricular (LV) systolic function is important in patients with acute myocardial infarction (AMI). Real-time 3-dimensional echocardiography (RT3DE) is an accurate technique, but it relies heavily on good image quality. The aim of the present study was to evaluate the incremental value of contrast-enhanced RT3DE.

Methods

A total of 140 consecutive patients (58 ± 11 years, 78% men) with ST-elevation AMI clinically underwent nonenhanced and contrast-enhanced RT3DE within 24 hours from AMI to evaluate global and regional LV systolic function. Endocardial border definition was graded for each of the 16 LV segments as follows: 0 = border invisible, 1 = border visualized only partially, and 2 = complete visualization of the border. Three image-quality groups (good, fair, and uninterpretable) were identified. Left ventricular volumes and ejection fraction were measured off-line. Wall motion was graded for each visible segment as follows: 1 = normal, 2 = hypokinetic, 3 = akinetic, and 4 = dyskinetic.

Results

During contrast-enhanced RT3DE, as compared with nonenhanced RT3DE, the number of segments with complete visualization of the endocardial border increased from 66% to 84% (P < .001); and the number of patients with a good-quality echocardiogram increased from 59% to 94% (P < .001). Intra- and interobserver agreement for assessment of global and regional LV systolic function improved during contrast-enhanced RT3DE, as compared with nonenhanced RT3DE.

Conclusions

Assessment of LV systolic function in AMI patients with RT3DE is frequently hampered by suboptimal echocardiographic quality. Contrast-enhanced RT3DE is of incremental value, improving the endocardial border visualization and the reproducibility of LV function assessment.

 

PII: S0002-8703(09)00126-4

doi:10.1016/j.ahj.2009.02.002

American Heart Journal
Volume 157, Issue 5 , Pages 882.e1-882.e8, May 2009

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