Coronary artery-left ventricular fistula with apical hypertrophic cardiomyopathy

We describe two patients with coronary artery-left ventricularfistulae in association with apical hypertrophic cardiomyopathywho presented with chest pain.     

Coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy.

We describe an unusual case of coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy in a 63-year-old man who had a 2-year history of angina pectoris without significant coronary atherosclerosis. It is important to recognize this anomaly as it may be the source of angina in patients without angiographic evidence of major atherosclerotic coronary artery disease.     

Detection of recent myocardial ischaemia by molecular imaging of P-selectin with targeted contrast echocardiography.

AIMS: We hypothesized that molecular imaging of endothelial P-selectin expression with targeted myocardial contrast echocardiography (MCE) could identify recently ischaemic myocardium without infarction. METHODS AND RESULTS: The microvascular behaviour of P-selectin-targeted (MB(p)) and control (MB(c)) microbubbles was assessed by intravital microscopy of the cremaster muscle in mice. Targeted MCE imaging with MB(p) and MB(c) was performed in mice after brief left anterior descending (LAD) occlusion and reperfusion and in open- and closed-chest controls. Regional wall motion and perfusion by MCE were assessed during occlusion and after reperfusion. On intravital microscopy, ischaemia-reperfusion produced a 10-fold increase (P < 0.01) in venular attachment for MB(p). Attachment for MB(c) was rare. With myocardial ischaemia-reperfusion, LAD occlusion produced hypoperfusion and wall motion abnormalities that resolved after 45 min of reperfusion. At 45 min, signal enhancement in the post-ischaemic region was four-fold greater (P < 0.05) for MB(p) vs. MB(c). MB(p) produced low-level enhancement in non-ischaemic myocardium in all open-chest animals, suggesting P-selectin expression from surgical cardiac exposure. CONCLUSION: Molecular imaging of P-selectin with targeted MCE can identify the presence of recently ischaemic myocardium in the absence of necrosis and after resolution of hypoperfusion and post-ischaemic stunning. This technique can potentially provide a method for risk stratifying patients with acute chest pain.     

心肌声学造影对冠状动脉血运重建术心肌灌注的评价研究

目的探讨心肌声学造影（MCE）评估缺血心肌血运重建后心肌灌注的价值。方法 36例缺血性心肌病患者分别予以冠状动脉支架置入术或冠状动脉旁路移植术进行血运重建,在术前、术后早期（〈1个月）、及术后晚期（6～12）个月分别行实时MCE检查,根据造影剂的充盈程度进行评分。将其结果与相应阶段造影（CAG）和（或）冠脉增强CT成像（CTA）结果进行对照分析。结果按16段心肌节段法进行分段分析测量。36例患者576个节段中,运动异常节段247个,MCE结果与治疗前冠脉造影吻合率为89.89%。冠脉血管再通术后早期共有172个节段有改善,与冠状动脉支架置入术或冠状动脉旁路移植术靶血管供血支配区吻合率为78.00%。术后晚期,MCE与冠脉影像结果吻合率为80.56%。结论实时MCE可随访观察冠状动脉再通血运重建缺血心肌血流灌注改善的情况,可尝试用于冠心病血管重建术后的临床随访。     

Collateral vessels assessed by myocardial contrast echocardiography in patients with coronary artery lesions after Kawasaki disease

Summary Using myocardial contrast echocardiography (MCE), coronary arteriography, and thallium-201 myocardial imaging (TMI), we examined the characteristics and the role of collateral vessels in 35 patients with coronary artery lesions after Kawasaki disease. The male/female ratio was 25∶10. The patients' ages at examination ranged from 1.0 to 20.3 years (mean, 10.8 years). The age at onset of Kawasaki disease ranged from 0.3 to 11.6 years (mean, 2.6 years). The coronary artery lesions were: dilated lesions without coexistent stenotic lesions in 5 patients (14%), localized stenosis with less than 50% narrowing in 5 patients (14%), localized stenosis with 50% or more narrowing in 4 patients (11%), and obstructive lesions, such as occlusion and/or segmental stenosis, in 21 patients (60%). In the group with no stenotic lesions and the group with less than 50% localized stenosis, the perfusion area of the right coronary artery was 32.6±8.4% and that of the left coronary artery was 76.3±7.9%. The total perfusion area of the right and the left coronary arteries was 108.9±2.6%, which value was inversely correlated with age at examination (r=0.716,P=0.020). In the group with more than 50% localized stenosis, an increase in overlap areas detected by MCE, where a perfusion defect was seen on TMI, was not found, except in 1 patient with 99% stenosis. In the patients with obstructive lesions, development of collateral channels was better in the perfusion area of the occluded right coronary artery than in that of the occluded left coronary artery, and well developed collateral channels were significantly correlated with good wall motion. We conclude that overlapping perfusion occurs in younger rather than in older children without stenotic coronary systems and this may contribute to the good development of collateral circulation in infants and young children with coronary artery lesions after Kawasaki disease.     

Collateral-flow measurements in humans by myocardial contrast echocardiography: validation of coronary pressure-derived collateral-flow assessment.

AIMS: Myocardial blood flow (MBF) is the gold standard to assess myocardial blood supply and, as recently shown, can be obtained by myocardial contrast echocardiography (MCE). The aims of this human study are (i) to test whether measurements of collateral-derived MBF by MCE are feasible during elective angioplasty and (ii) to validate the concept of pressure-derived collateral-flow assessment. METHODS AND RESULTS: Thirty patients with stable coronary artery disease underwent MCE of the collateral-receiving territory during and after angioplasty of 37 stenoses. MCE perfusion analysis was successful in 32 cases. MBF during and after angioplasty varied between 0.060-0.876 mL min(-1) g(-1) (0.304+/-0.196 mL min(-1) g(-1)) and 0.676-1.773 mL min(-1) g(-1) (1.207+/-0.327 mL min(-1) g(-1)), respectively. Collateral-perfusion index (CPI) is defined as the rate of MBF during and after angioplasty varied between 0.05 and 0.67 (0.26+/-0.15). During angioplasty, simultaneous measurements of mean aortic pressure, coronary wedge pressure, and central venous pressure determined the pressure-derived collateral-flow index (CFI(p)), which varied between 0.04 and 0.61 (0.23+/-0.14). Linear-regression analysis demonstrated an excellent agreement between CFI(p) and CPI (y=0.88 x +0.01; r(2)=0.92; P<0.0001). CONCLUSION: Collateral-derived MBF measurements by MCE during angioplasty are feasible and proved that the pressure-derived CFI exactly reflects collateral relative to normal myocardial perfusion in humans.     

小剂量多巴酚丁胺超声心动图联合心肌声学造影对心肌梗死后存活心肌的诊断价值

目的前瞻性评价小剂量多巴酚丁胺超声心动图(LDDE)联合心肌声学造影(MCE)对心肌梗死后存活心肌的诊断价值。方法对24例心肌梗死者进行静态MCE、LDDE及3个月后静态超声心动图随访分析。MCE和室壁运动均用16段划分法进行目测半定量计分。心肌造影计分(MCS)回声均匀性增强为1分,回声低淡不均匀为0.5分,缺损为0分。室壁运动计分(WMS)用常规计分法。结果随访时,运动改善的心肌节段中MCS1分占49.4%、0.5分占50.6%,对LDDE均有反应;运动无改善的节段MCS0.5分占9.5%,0分占90.5%,对LDDE有反应者占13.3%,无反应占86.7%。预测存活心肌的敏感性、特异性及准确率分别为LDDE86%、86.7%、86.4%;MCE100%、89.7%、94.6%;LDDE联合MCE86.1%、100%、94.0%。结论心肌微血管结构与功能的完善是心肌存活的基本条件。MCE灌注正常和低灌注,且对多巴酚丁胺有反应的心肌有收缩力储备;而对多巴酚丁胺无反应的低灌注或无灌注心肌则多不能恢复收缩功能。LDDE联合MCE能提高检测存活心肌的特异性及准确率。     

经静脉心肌声学造影评价心肌梗死后存活心肌的价值

目的　探讨经静脉心肌声学造影 (MCE)对心肌梗死后存活心肌的诊断价值。方法　 2 4例心肌梗死患者用二维超声评价室壁运动情况 ,同时经静脉进行MCE ,以 3个月后静态超声心动图左室心肌节段性运动改善为依据评价MCE对心肌梗死后存活心肌的诊断价值。结果　在 2 4例病人的 384个心肌节段中 ,运动异常节段 184个。在运动异常的 184个节段中 ,MCE1分 39段 ,0 5分 5 0段 ,0分 95段。 3个月复查 79个节段有运动改善 ,其中 39段来自MCE1分的心肌 ,4 0段来自MCE0 5分的心肌。MCE对预测心肌梗死后室壁运动改善的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为 :10 0 %、89 7%、84 8%、10 0 %和 94 6 %。结论　MCE能比较准确地预测心肌梗死后心肌的存活性     

Myocardial contrast echocardiography of coronary artery lesions due to Kawasaki disease

Summary In addition to coronary arteriography, myocardial contrast echocardiography (MCE) was performed in 25 patients with coronary artery lesions due to Kawasaki disease, in order to investigate its validity in the evaluation of these lesions and its safety in children. The patients' ages ranged from 1.0 to 15.9 years (mean, 8.6 years). Their coronary artery lesions included occlusion in 9 branches (9 patients), segmental stenosis in 9 (8 patients), localized stenosis in 16 (12 patients), and dilated lesions without coexistent stenotic lesions in 5 patients. Seven patients had coronary artery bypass grafts. Myocardial perfusion patterns of the stenotic lesions and coronary artery bypass grafts could be clearly demonstrated by MCE. For the assessment of safety, electrocardiograms obtained at the time of MCE and coronary arteriography in 14 patients showed no significant difference in the findings between MCE and coronary arteriography. Serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase, and creatine phosphokinase levels were measured before and 1 day after the procedure in 14 patients who underwent MCE and coronary arteriography, and in a group of 14 patients who underwent coronary arteriography alone. No significant difference was noted between the values of the two groups. These results suggested that MCE can be utilized in the assessment of coronary artery lesions due to Kawasaki disease, and confirmed the safety of the procedure even in young children.     

Analysis of myocardial perfusion or myocardial function for detection of regional myocardial abnormalities. An echocardiographic multicenter comparison study using myocardial contrast echocardiography and 2D echocardiography.

BACKGROUND: Echocardiography based myocardial perfusion imaging and regional wall motion analysis are used for evaluation of coronary artery disease and regional myocardial abnormalities. AIM: This study sought to compare myocardial contrast echocardiography (MCE) and 2D echocardiography with regard to interobserver variability and detection of regional myocardial abnormalities. METHODS: In 70 patients evenly distributed between three ejection fraction groups based on biplane cineventriculography ( > 55%, 35-55%, < 35%), unenhanced and contrast enhanced 2D echocardiography and myocardial contrast echocardiography (MCE; SonoVue; Bracco) were performed. Regional wall motion and myocardial perfusion were assessed referring to a 16 segment model. Interobserver agreement (IOA) among 2 readers was determined within each imaging modality. To define a standard of truth for the presence of segmental myocardial disease an independent expert-panel decision was obtained based on clinical data, ECG, coronary angiography and blinded information from the imaging modalities. RESULTS: Regional wall motion assessment was possible in 98.1% of segments using contrast enhanced 2D echocardiography and in 87.2% using unenhanced 2D echocardiography (p < 0.001), while perfusion assessment was possible in 90.1% of segments (p < 0.001). IOA on presence of any regional wall motion abnormality expressed as Kappa coefficient was 0.71 (95% CI 0.53-0.89) for contrast enhanced echocardiography and 0.37 (95% CI 0.14-0.59) for unenhanced echocardiography. IOA on presence of any perfusion abnormality was 0.53 (95% CI 0.34-0.73). For MCE there was high IOA for the apical segments (kappa = 0.57) and lower IOA for the basal segments (kappa=0.14), while no such gradient was found for the IOA on wall motion abnormalities. Mean accuracy to detect expert-panel defined myocardial abnormalities was 80.6% for unenhanced echocardiography, 85.0% for contrast enhanced 2D echocardiography and 80.6% for MCE. CONCLUSIONS: MCE is inferior to contrast enhanced 2D echocardiography with regard to visibility of all LV segments and appears slightly inferior with regards to IOA, while both are superior to unenhanced 2D echocardiography. The methods demonstrated high accuracy in detection of panel defined regional myocardial abnormalities.     

Combined use of dobutamine echocardiography and myocardial contrast echocardiography in predicting regional dysfunction recovery after coronary revascularization in patients with recent myocardial infarction

BACKGROUND: Myocardial contrast echocardiography and dobutamine echocardiographyhave recently emerged as potentially useful clinical tools todetect reversible myocardial dysfunction. However, the relativeaccuracy of these two techniques in predicting regional wallmotion improvement after coronary interventions is still unclear.The aim of the present study was to compare their diagnosticvalue in predicting functional recovery after coronary revascularizationin patients with recent acute myocardial infarction. METHODS AND RESULTS: Twenty-four patients with acute myocardial infarction underwentmyocardial contrast echocardiography and dobutamine echocardiographywithin 2 weeks of hospital admission. Infarct zone contrastscore and wall motion score indexes were derived in each patient.Infarct-related artery revascularization was performed beforehospital discharge in all selected patients. Resting echocardiographywas repeated 3 months after revascularization, and regionalfunction recovery was analysed. The degree of wall motion scoreimprovement at 3-month follow-up and the percentage of positiveresponses to dobutamine echo were greater (P<0·001and P<0·002, respectively) in patients with a higherbaseline contrast score (0·50). Conversely, no significantchanges were observed either during dobutamine echo or afterrevascularization in the group of patients without residualperfusion within the infarct area. Diagnostic agreement betweenboth techniques in predicting reversible dysfunction was high(81% of segments). The sensitivity and negative predictive valuein predicting functional outcome were 100% (95% confidence interval[CI], 87% to 100%) and 100% (95% CI, 93% to 100%) by contrastecho, and 85% (95% CI, 66% to 96%) and 93% (95% CI, 84% to 98%)by dobutamine echo. The specificity and positive predictivevalue were 90% (95% CI, 80% to 96%) and 81% (95% CI, 64% to93%) by contrast echo, and 88% (95% CI, 78% to 95%) and 76%(95% CI, 58% to 90%) by dobutamine echo. The combination ofmyocardial contrast and dobutamine echocardiography positiveresponses improved specificity and positive predictive valuein detecting functional recovery after revascularization to100% (95% CI, 94% to 100%) and 100% (95% CI, 85% to 100%), respectively.However, the sensitivity and negative predictive value slightlydecreased with the use of both methods (85% [95% CI, 66% to96%)] and (93% [95% CI, 85% to 98%)], respectively. CONCLUSIONS: In patients with recent myocardial infarction, reversible dysfunctionafter coronary revascularization and the response to dobutamineinfusion are strictly dependent on microvascular integrity.However, microvascular perfusion does not always imply functionalrecovery after coronary revascularization. The integration withdob utamine echo results seems particularly helpful to furtherimprove myocardial contrast echo specificity and positive predictivevalues.     

Myocardial contrast echocardiography: influence of ischaemia and hyperaemia in an animal model.

To evaluate changes in myocardial contrast echocardiography during ischaemia and hyperaemia, contrast studies were performed in 16 open chest dogs. Time-intensity curves were generated using videodensitometry after contrast injections to demonstrate ischaemic and non-ischaemic areas of interest during a wide range of coronary blood flow levels. For each time-intensity curve, the peak contrast intensity (PCI), washout halftime (T1/2) and area under the curve (AUC) were calculated. PCI and AUC decreased significantly only with severe ischaemia (90% or more reduction in flow), and increased significantly with hyperaemia of more than 2.5 times baseline flow. Both ischaemia and hyperaemia were found to prolong the T1/2. There was only a moderate linear correlation between the magnitude of hyperaemia and myocardial contrast echocardiographic parameters. There was significantly less increase in myocardial contrast echocardiographic parameters during hyperaemia in segments supplied by a stenosed coronary artery.     

Detection of resting myocardial perfusion defects by SonoVue myocardial contrast echocardiography

BACKGROUND: SonoVue is a new microbubble contrast agent containing sulfur hexafluoride. We assessed the efficacy of SonoVue myocardial contrast echocardiography (MCE) to detect resting perfusion abnormalities. Methods: Nineteen adult patients with a wall motion abnormality in a screening echocardiogram were studied. Each patient received up to four bolus injections of 2.0 mL SonoVue (Bracco Diagnostics, Inc.) during echocardiographic examination using either B-mode(n = 12)or power Doppler(n = 7)imaging. Each patient also had SPECT nuclear perfusion imaging performed. Segmental assessment of myocardial perfusion from SonoVue MCE images were compared with corresponding SPECT nuclear images. RESULTS: Using B-mode imaging, the mean number of views obtained with a single SonoVue injection ranged from 1.4 to 1.9, with 2 or 3 injections required for a complete examination. Ninety-four percent of segments were scored as diagnostic. Agreement between B-mode and SPECT images was 72% for segments with a perfusion defect, 86% for normal perfusion, and 80% for segments with either perfusion defect or normal perfusion (all views combined). Using power Doppler imaging, the mean number of views obtained with a single SonoVue injection ranged from 1.0 to 1.3, with 2 to 4 injections required for a complete examination. Sixty-eight percent of segments were scored as diagnostic. Agreement between power Doppler and SPECT images was 67% for perfusion defects, 53% for segments with normal perfusion, and 59% for segments with either perfusion defect or normal perfusion (all views combined). CONCLUSIONS: SonoVue MCE has the potential to assess myocardial perfusion at rest. B-mode imaging was more accurate than power Doppler imaging when compared with SPECT nuclear imaging.     

Stress Doppler echocardiography using dobutamine in coronary patients with and without ischaemia induction.

To examine the effects of dobutamine on pulsed-Doppler left ventricular ejection dynamics and its utility for evaluation of coronary disease (CAD) we studied 10 patients with normal coronaries (Group 1) and 24 patients with significant CAD (greater than or equal to 70% diameter stenosis) using a graded stress infusion (5 to 20 micrograms.kg-1.min-1). Two-dimensional echocardiography was performed to detect regional asynergy and analysed using an 11-segment model. Patients with CAD were divided into those with (Group 3, n = 14) and without (Group 2, n = 10) inducible ischaemia; six patients had reversible involvement of greater than or equal to three segments (subset 3A). Groups were well matched for baseline left ventricular function and all studies were carried out while the patients were not taking cardioactive therapy. Hyperkinetic wall motion was typical and exaggerated hyperkinesis of normal segments was commonly seen in those with baseline (n = 9) or reversible asynergy (n = 14). Normals and CAD patients showed comparable changes in heart rate and blood pressure (P = NS between groups).(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of myocardial viability using myocardial contrast echocardiography

Myocardial contrast echocardiography (MCE) is a technique that uses microbubbles as a tracer during simultaneous ultrasound of the heart. The microbubbles can be used to provide quantitative information regarding the adequacy of myocardial blood flow (MBF), as well as the spatial extent of microvascular integrity. In acute myocardial infarction, MCE can identify the presence of collateral flow within the risk area, and can therefore predict preservation of myocardial viability and ultimate infarct size even prior to reperfusion. After reperfusion, the extent of microvascular no-reflow can be determined, and has significant implications for recovery of left ventricular function. In chronic ischemic heart disease, MCE has also been shown to successfully differentiate viable from necrotic myocardium. This technique can accurately predict recovery of function after revascularization. More importantly, MCE can be used to identify viable segments that may help to prevent infarct expansion and remodeling, and thus improve patient outcomes.     

冠状动脉循环时间与心肌缺血关系的初步研究

目的:初步研究冠状动脉循环时间(CCT)与心肌缺血之间的关系及其临床应用。方法:将84例患者分成无心肌缺血(C组,26例)和心肌缺血组(58例),应用数字减影血管造影术分别测定C组和心肌缺血患者的CCT,比较C组及心肌缺血组内各亚组间CCT(A组:CAG阳性组,39例;B组:CAG阴性组,19例)。结果:C组CCT为(4.4168±0.7782)s,B组CCT为(5.3453±0.6901)s,A组CCT为(5.4190±1.0061)s。C组较心肌缺血组CCT短,两者之间有显著性差异(P<0.01);A、B组间CCT的差异无显著性(P>0.05)。C组CCT的95％CI:4.0418～4.7919s。如果以CCT≥5.00s为心肌缺血,其诊断敏感性为65.5％,特异性为65.4％,准确性为65.5％。结论:CCT可以作为判断心肌缺血的一个指标。     

Recognition of residual ventricular septal defect by intraoperative contrast echocardiography

Intraoperative two-dimensional contrast echocardiography wasused to detect a residual shunt in 50 patients after surgicalrepair of ventricular septal defect. Contrast injections wereperformed following termination of the extracorporeal circulation.In the presence of a shunt the intensity of opacification ofboth left and right ventricular cavities was compared. In 40patients no ventricular shunting was observed; insignificantshunting was noted in five patients. Follow-up of these 45 patientsproved uneventful. Significant opacification of the right ventricle was noted infive patients. This finding, however, does not necessarily indicatea residual shunt of significant volume. In two patients theresidual shunt was confirmed postoperatively by pulsed Dopplerechocardiography but clinically there was no need for surgery.Three other patients subsequently required reoperation and partialpatch dehiscence was confirmed in all. Thus, intraoperativetwo-dimensional contrast echocardiography is a sensitive techniqueto detect a residual ventricular septal defect, an observationwhich may warrant reoperation before chest closure.     

Intraoperative assessment of myocardial perfusion using contrast echocardiography

Myocardial contrast echocardiography is a new technique capable of assessing regional myocardial perfusion in vivo in real time. This article reviews the background, principles, experimental validation, and clinical uses of intraoperative myocardial contrast echocardiography. Data can be derived both for online visual and computer analyses. The technique can be useful in determining the sequence of bypass graft placement and the success of graft anastamoses. Anastamoses can be revised immediately if needed. It is hoped that this technique will improve intraoperative myocardial preservation and will diminish the rate of perioperative myocardial infarction.     

心肌声学造影定量心肌血流判断存活心肌的实验研究

目的　评价经静脉心肌声学造影 (MCE)判断存活心肌的可行性。方法　建立急性心肌梗死犬模型 ,经外周静脉持续滴注微泡造影剂 ,通过计算A·β值测定心肌相对血流量。以放射性微球法测定的心肌血流量 (MBF)为标准 ,了解A·β值测定MBF的准确性。通过A·β值估测心肌存活与否 ,病理检查验证其可靠性。结果　放射性微球法所测的正常区、缺血区、坏死区的MBF分别为 ( 1 5± 0 3)、( 0 7± 0 3)、( 0 3± 0 2 )ml·min-1·g-1;MCE测得的A·β值分别为 5 2 46± 15 0 9、2 4 36±3 89、3 74± 3 80 ;正常区、缺血区、坏死区的MBF和A·β值“标化”后分别为 1 0± 0 0、0 44± 0 17、0 17± 0 11和 1 0± 0 0、0 48± 0 0 9、0 0 7± 0 0 8,二者的相关性良好 (r=0 81,P =0 0 0 1)。MCE对坏死心肌的判定结果与病理结果吻合。结论　心肌声学造影可用于活体状态下评价存活心肌 ,“标化”后的A·β值 <0 2 3提示心肌坏死。     

Intravenous versus intracoronary myocardial contrast echocardiography for evaluation of no-reflow after primary percutaneous coronary intervention

OBJECTIVE: We sought to compare intravenous myocardial contrast echocardiography (IV-MCE) with intracoronary myocardial contrast echocardiography (IC-MCE) in detecting no-reflow and predicting the short-term outcome of left ventricular function after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). METHODS: IC-MCE and IV-MCE were performed immediately after PCI (D1) of 28 patients with anterior wall AMI. IV-MCE was repeated at the next day of PCI (D2), and left ventricular systolic function was evaluated at D2 and 30 days later (D30). RESULTS: There was good agreement between IC-MCE and IV-MCE at D1 in determining no-reflow (kappa= 0.78, P < 0.001) as well as between IV-MCE at D1 and D2 (kappa= 0.93, P < 0.001). The patients with no-reflow on IC-MCE (n = 13) and those on IV-MCE at D2 (n = 11) showed no improvement in left ventricular ejection fraction (LVEF) after 1 month (49 +/- 9% to 48 +/- 7%, P = 0.55, and 51 +/- 6% to 49 +/- 7%, P = 0.20). However, the patients with reflow on IC-MCE (n = 15) and those on IV-MCE at D2 (n = 17) demonstrated significant improvement in LVEF (55 +/- 6% to 62 +/- 5%, P < 0.005, and 53 +/- 7% to 60 +/- 8%, P < 0.005). In predicting segmental functional recovery after 1 month, sensitivity and specificity of IC-MCE were 85% and 67%, respectively, and those of IV-MCE at D2 were 95% and 40%, respectively. CONCLUSION: IV-MCE at D2 might be substituted for IC-MCE performed immediately after PCI for the evaluation of no-reflow and prediction of left ventricular systolic function after 1 month in patients with anterior wall AMI.