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Discrepant myocardial microvascular perfusion and mechanics after acute myocardial infarction: Characterization of the 'Tako-tsubo effect' with real-time myocardial perfusion contrast echocardiograph
- Source :
- International Journal of Cardiology. 276:1-7
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background In patients with acute anterior myocardial infarction (MI), sometimes an “apical ballooning” contractile dysfunction pattern that exceeds factual myocardial injury is identified in the ventriculography and bedside echocardiography. The hemodynamic consequences/sequela of this “Tako-tsobu effect” has not been well delineated. Of note, this anatomic imaging finding often misleads frontline physicians who assume reciprocal causation of persistent cardiac pump failure and ventricular pressure overload. Methods and results Using real-time myocardial perfusion contrast echocardiography (MCE), we investigated myocardial (microvascular) perfusion in 60 patients after acute MI and coronary revascularization. Twenty-eight percent of the studied patients showed significantly mismatched myocardial perfusion and contractile defects. In these patients, an integrated imaging assessment with coronary angiography/ventriculography, deformation echocardiography, and MCE proved that the myocardial mechanic abnormalities significantly exceeded the defected perfusion areas. Compared with 72% of the patients without perfusion-contractility mismatch, apparently worse systolic functions (left ventricular ejection, wall motion score, and systolic longitudinal strain) in these patients did not change diastolic ventricular filling pressures (E/E′ and E/A) or hemodynamic consequences/adverse events. Both systolic and diastolic functions in patients with perfusion-contractility mismatch appeared to be comparable with those in patients with Tako-tsubo syndrome. Conclusions Real-time MCE identifies discrepant myocardial microvascular perfusion and mechanics in patients with acute MI. The “Tako-tsubo effect” in patients with perfusion-contractility mismatch does not cause diastolic filling pressure change or worse hemodynamic consequence/cardiac event.
- Subjects :
- Male
Myocardial Infarction
Diastole
Hemodynamics
Pilot Projects
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Takotsubo Cardiomyopathy
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Aged
business.industry
Microcirculation
Cardiogenic shock
Myocardial Perfusion Imaging
Sequela
Mechanics
Middle Aged
medicine.disease
Echocardiography, Doppler
Heart failure
Ventricular pressure
Female
Cardiology and Cardiovascular Medicine
business
Perfusion
Follow-Up Studies
Subjects
Details
- ISSN :
- 01675273
- Volume :
- 276
- Database :
- OpenAIRE
- Journal :
- International Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....40586e822dde48f4ed633b926146c13d