Assessment of no-reflow phenomenon in patients with acute ST-elevation myocardial infarction

Krinochkin D.V., Bessonov I.S., Yaroslavskaya E.I., Kuznetsov V.A.

Tyumen Cardiological Scientific Centre, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia

Background. The problems concerning assessment of the state of myocardial perfusion in patients with acute ST elevation myocardial infarction after successful revascularization still remain of current importance. Contrast-enhanced echocardiography remains the least studied and most promising ultrasound technology for the diagnosis of the no-reflow phenomenon.

Objective. The study was aimed at evaluating echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by means of contrast-enhanced echocardiography in patients with ST-segment elevation myocardial infarction.

Patients and methods. The study included a total of forty-three 40-to-82-year-old patients in acute period of myocardial infarction. The patients were divided into two groups: 32 patients with satisfactory myocardial reperfusion after revascularization according to the findings of contrast-enhanced echocardiography and 11 patients with impaired perfusion.

Results. The patients in the group with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1±2.2% vs 27.4±8.5%, p<0.001), more frequent LV dilatation (LV end-systolic volume 67.3±20.3 ml vs 51.8±17.2 ml, p=0.015), decreased LV contractility (LV ejection fraction 39.5±3.4% vs 47.2±4.9%, p<0.001), and significant mitral regurgitation (45.5% vs 3.1%, p=0.011) with a decrease in DP/DT (979.9±363.4 mmHg/s vs 1565.7±502.8 mmHg/s, p<0.001) were more often detected in this group. Coronary angiography showed no perfusion disorders after revascularization in more than a quarter of these patients. In the group with impaired perfusion, more frequently revealed were single-vascular lesions (46.9% vs 9.1%, p=0.033), lesions of the anterior interventricular artery (90.9% vs 40.6%, p=0.004), and acute occlusion (100% vs 68.8%, p=0.043); compliance by the SYNTAX score in this group was higher (18.9±3.7 vs 9.9±5.7, p<0.001).

Conclusions. In patients with acute myocardial infarction after successfully performed revascularization, perfusion disorders revealed by the findings of contrast-enhanced echocardiography were accompanied by more pronounced echo signs of left-ventricular dysfunction, higher values of the SYNTAX score and significantly more frequently revealed lesions of the anterior interventricular septum as compared with the patients with recovered perfusion.

KEY WORDS: acute myocardial infarction, myocardial perfusion, no-reflow phenomenon, contrast-enhanced echocardiography, percutaneous coronary intervention.

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