Photo Credit: Pitchayanan Kongkaew

The following is a summary of “Low-dose dobutamine stress myocardial contrast echocardiography for evaluating myocardial microcirculation perfusion and predicting long-term prognosis in ST-segment elevation myocardial infarction after percutaneous coronary intervention,” published in the February 2025 issue of the Journal of Cardiothoracic Surgery by Li et al.

Percutaneous coronary intervention (PCI) is a widely utilized and effective treatment for restoring myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI). However, despite successful revascularization, some patients experience the “no-reflow” phenomenon, which can significantly impact myocardial recovery and long-term outcomes. This study aims to evaluate the clinical utility of low-dose dobutamine stress myocardial contrast echocardiography (MCE) in assessing myocardial microcirculation perfusion and predicting long-term prognosis in patients with STEMI following PCI.

A total of 70 patients with STEMI who underwent PCI were enrolled in this study. Low-dose dobutamine stress MCE was performed 72 hours post-PCI to assess myocardial viability and quantitatively analyze myocardial microcirculation perfusion at both 72 hours and six months post-procedure. Based on the findings from patients with dobutamine stress echocardiography (DSE) were classified into DSE-positive and DSE-negative groups, and left ventricular ejection fraction (LVEF) was compared between these groups. Additionally, the three-year survival rate of patients following PCI was analyzed to assess the prognostic value of MCE.

The study reported no adverse reactions during low-dose dobutamine stress MCE, confirming its safety for clinical use. The technique demonstrated high accuracy in detecting viable myocardium at 72 hours post-PCI, with an area under the curve (AUC) of 0.849. Furthermore, quantitative analysis revealed significant improvements in myocardial perfusion over time, with the parameters A, β, and A × β showing significantly higher values at six months compared to 72 hours post-PCI. Under stress conditions, A and A × β values at six months were markedly higher than in the basal state, indicating improved myocardial microcirculation. Additionally, LVEF and long-term survival rates were significantly greater in the DSE-positive group than in the DSE-negative group, suggesting that the presence of viable myocardium detected by MCE is associated with better cardiac function recovery and long-term prognosis.

In conclusion, low-dose dobutamine stress MCE serves as an effective and reliable method for evaluating myocardial microcirculation perfusion, predicting left ventricular function recovery, and identifying patients at risk for poor long-term outcomes following PCI in STEMI. This non-invasive imaging technique may provide valuable prognostic insights, aiding clinicians in optimizing post-PCI management and improving patient outcomes.

Source: cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-024-03216-6