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Background —This study investigated whether the extent of perfusion defect determined by intravenous myocardial contrast echocardiography (MCE) in patients with acute myocardial infarction (AMI) treated by primary percutaneous transluminal coronary angioplasty (PTCA) relates to coronary flow reserve (CRF) for assessment of myocardial reperfusion and is predictive for left ventricular recovery. Methods and Results —Twenty-five patients with first AMI underwent intravenous MCE with NC100100 with intermittent harmonic imaging before PTCA and after 24 hours. MCE before PTCA defined the risk region and MCE at 24 hours the “no-reflow” region. The no-reflow region divided by the risk region determined the ratio to the risk region. CFR was assessed immediately after PTCA and 24 hours later. Left ventricular wall motion score indexes were calculated before PTCA and after 4 weeks. CFR at 24 hours defined a recovery (CFR ≥1.6; n=17) and a nonrecovery group (CFR P =0.009). A ratio to the risk region of ≤50% defined an MCE reperfusion group. It was associated with improvement of CFR from 1.67±0.47 at baseline to 2.15±0.53 at 24 hours ( P P Conclusions —Intravenous MCE can be used to define perfusion defects after AMI. Assessment of microcirculation by MCE corresponds to evaluation by CFR. Serial intravenous MCE has the potential to identify patients likely to have improved left ventricular function after AMI.

We highly appreciate the consideration on differential diagnoses that Pieroni et al put forward regarding our recently published article1 on the clinical, morphological, and ultrastructural features of a patient with chloroquine-induced cardiomyopathy, a disease in which lysosomal trapping of the amphiphilic drug chloroquine seems to be the underlying pathophysiological mechanism. As emphasized by Pieroni et al, cardiomyopathy associated with Fabry disease, …

A 41-year-old man presented with recurrent syncope since the age of 10, along with tachyarrhythmia and angina pectoris during exercising. The patient had undergone x-ray angiography in a foreign country where a single coronary artery was seen, and he was sent to our hospital for further evaluation and therapy. Standard coronary MRA with navigator-gated free-breathing cardiac-triggered T2-prepared 3D gradient echo imaging and cartesian k-space sampling (Figure, A; Movie I) was performed, demonstrating major motion artifacts due to tachyarrhythmia (heart frequency varying between 72 and 105 bpm [mean 92]). Thus, this …

To the Editor: The article by Schulz-Menger et al 1 describes the value of MRI for evaluation of the left ventricular outflow tract (LVOT) after septal artery embolization in patients with hypertrophic obstructive cardiomyopathy (HOCM). The concept of using imaging techniques for follow-up after therapeutic intervention in HOCM patients is not new and has been investigated previously using 2D2 as well as 3D echocardiography.3,4 Because MRI for analysis of LVOT area changes differs substantially from echocardiography, we would like to add some further comments. The method applied by Schulz-Menger et al is an indirect visualization of the residual LVOT area, measuring the smallest cross-sectional area of the turbulent flow (“vena contracta”) at only 1 preselected timepoint of the cardiac cycle. The vena contracta is known to underestimate the true anatomic orifice area …