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Prognostic value of myocardial contrast echocardiography in acute anterior wall ST-segment elevation myocardial infarction with successful epicardial recanalization

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Abstract

Although myocardial contrast echocardiography (MCE) can evaluate microvascular perfusion abnormalities, its prognostic value is uncertain in acute anterior wall ST-Segment elevation myocardial infarction (STEMI) with successful epicardial recanalization. Therefore, the study aims to investigate the prognostic role of qualitative and quantitative MCE in acute anterior wall STEMI with successful epicardial recanalization. 153 STEMI patients were assessed by MCE within 7 days after successful epicardial recanalization. Qualitative perfusion parameters (microvascular perfusion score index, MPSI) and quantitative perfusion parameters (A, β, and Aβ) were acquired using a 17-segment model. And corrected A and Aβ were calculated. Patients were all followed for major adverse cardiovascular events (MACEs). During median follow-up of 27 (4) months, 39 (25.49%) patients experienced MACEs, while 114 (74.51%) were free from MACEs. Patients with MACEs had higher MPSI (1.65 ± 0.13 vs. No-MACEs 1.35 ± 0.20, P < 0.001), lower β (1.09 ± 0.19 s−1 vs. No-MACEs 1.34 ± 0.30 s−1, P < 0.001), corrected A (0.17 ± 0.03 dB vs. No-MACEs 0.19 ± 0.04 dB, P = 0.039) and lower corrected Aβ (0.19 ± 0.06 dB/s vs. No-MACEs 0.25 ± 0.08 dB/s, P < 0.001). MPSI of 1.44 provided an area under the curve (AUC) of 0.872, while β of 1.18 s−1 and corrected Aβ of 0.22 dB/s provided AUCs of 0.759 and 0.724, respectively. The combination of MPSI, β and corrected Aβ provided an increased AUC of 0.964 (all P < 0.05). Time-dependent ROC analysis showed that the AUCs of the MPSI, β, corrected Aβ and the combination at 1, 1.5 and 2 years indicated a strong predictive power for MACEs (AUC = 0.900/0.894/0.881 for MPSI, 0.648/0.704/0.732 for β, 0.674/0.686/0.722 for corrected Aβ, and 0.947/0.962/0.967 for the combination, respectively). Patients with MPSI < 1.44, β > 1.18 s−1, or corrected Aβ > 0.22 dB/s had lower event rate (all Log Rank P ≤ 0.001). MPSI, β, corrected Aβ, GLS and WBC were independent predictors of MACEs with adjusted hazard ratio of 34.41 (8.18–144.87), P < 0.001 for MPSI; 39.29 (27.46–65.44), P < 0.001 for β; 8.93 (1.46–54.55), P = 0.018 for corrected Aβ; 10.88 (2.83–41.86), P = 0.001 for GLS; and 1.43 (1.16–1.75), P = 0.001 for WBC. Qualitative and quantitative MCE can accurately predict MACEs in acute anterior wall STEMI with successful epicardial recanalization, and their combined predictive value is higher.

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Funding

This study was supported by “the Fundamental Research Funds for the Central Universities” (2042021kf0121).

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  1. Yan-xiang Zhou and Yu-gang Hu have contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People’s Republic of China

    Yan-xiang Zhou, Yu-gang Hu, Sheng Cao, Ye Xiong, Jia-rui Lei, Wen-yue Yuan, Jin-ling Chen & Qing Zhou

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  1. Yan-xiang Zhou
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Contributions

YXZ and YGH carried out the studies, participated in data collection, established the framework of this study, performed the statistical analysis, and drafted the manuscript under the supervision of QZ and JLC. The MCE examination was performed by SC, JRL and YX. WYY helped to proofread the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jin-ling Chen or Qing Zhou.

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All authors declare that there is no conflict of interest.

Ethical approval

The study protocol was approved by the local medical ethics committee (WDRY2020- K189).

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Informed consent was obtained from all patients participants included in the study.

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All patients signed informed consent regarding publishing their anonymized data.

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Zhou, Yx., Hu, Yg., Cao, S. et al. Prognostic value of myocardial contrast echocardiography in acute anterior wall ST-segment elevation myocardial infarction with successful epicardial recanalization. Int J Cardiovasc Imaging 38, 1487–1497 (2022). https://doi.org/10.1007/s10554-022-02545-8

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