The clinical implications of no reflow demonstrated with intravenous perfluorocarbon containing microbubbles following restoration of thrombolysis in myocardial infarction (TIMI) 3 flow in patients with acute myocardial infarction

Intravenous injections or infusions of perfluorocarbon-exposed sonicated dextrose albumin microbubbles were given 2.4 +/- 1.6 days following acute myocardial infarction to 45 consecutive patients. Patients were divided into 3 groups: patients with Thrombolysis In Myocardial Infarction (TIMI) grade 3 angiographic flow but persistent myocardial contrast defects by echocardiography (no reflow), patients with TIMI 3 flow and myocardial contrast enhancement (reflow), and patients with TIMI grade 0 to 2 flow in the infarct vessel. Thirty five patients had TIMI 3 flow at the time of contrast study, Of these, 25 held evidence of reflow with intravenous contrast, whereas 10 (29%) still had contrast defects. At follow-up, end-systolic volume index decreased significantly in patients who exhibited reflow (21 +/- 8 ml/m(2) at baseline to 18 +/- 8 ml/m(2) at follow-up; p = 0.04), whereas those with no reflow had a significant increase (26 +/- 9 ml/m(2) at baseline to 32 +/- 9 ml/m(2) at follow-up; p = 0.006). A persistent contrast defect in the infarct zone demonstrated with intravenous ultrasound contrast following restoration of TIMI grade 3 flow in the infarct vessel identified patients likely to have deterioration in both regional and global systolic function. (C) 1998 by Excerpta Medica, Inc.