| [ Background ] Restoration of TIMI 3 grade anterior flow of infarct-related artery (IRA) does not necessarily mean appropriate myocardial microvessel perfusion, thus close attention has been paid to myocardial microcirculation perfusion in clinical setting. Up to date, the state of coronary microcirculation after IRA reopening is less known.[Objective] To investigate the serial changes of myocardial microvascular perfusion using real-time intravenous myocardial contrast echocardiography (MCE) and their clinical implications after reperfusion therapy in acute myocardial infarction (AMI) patients.[Methods] 32 patients with first anterior wall AMI which the time of the onset of symptoms was within 12 hours underwent percautenos coronary intervention (PCI), including primary percautenos transluminal coronary angioplasty (PTCA) and stent implantation, and TIMI 3 grade flow of IRA was obtained in allpatients after PCI. Real-time intravenous MCE was performed at the 12th hour, 1st, 2nd, 4th week and 3rd month after recanalization of IRA. Ventricular wall motion score (VWMS), VWMS index (VWMSI), abnormal wall motion length (AWML), MCE score (MCES), MCES index (MCESI), perfusion defect length (PDL), left ventricular (LV) end diastolic volume (LVEDV), LV ejection fraction (LVEF) and the normalized A ?3 value in risk area were calculated. ST segment changes were analyzed before and after interventional procedure and just before MCE. according to regional MCES and the normalized A ?3 value, the patients were classed into reflow group (defined as MCES=1 ,or MCES=2 but the normalized A ?3 value more than 0.5) and no-reflow group (defined as MCES=3, or MCES=2 but the normalized A ?3 value less than 0.5).[Results] At the 12th hour after recanalization of IRA, MCE no-reflow phenomenon was appeared in 11 patients and MCE reflow was seen 21 patients. VWMSI, AWML, MCESI, PDL and LVEDV were significantly higher, but LVEF and the A ?3 value were significantly lower in no-reflow group than in reflow group, at the 12th hour, 1st, 2nd, 4th week and 3rd month after recanalization of IRA, in reflow group, the normalized A ?3 value was 0.82+0.08, 0.8510.06, 0.8410.04, 0.8410.06 and 0.8710.05 (?>0.05). PDL was 0.2410.03, 0.2410.03, 0.2310.04, 0.2310.03 and 0.2510.04 (P>0.05). AWML was 0.22+0.02, 0.2110.03, 0.2110.01, 0.2010.03 and 0.1710.04 (vs 12h /)<0.05). LVEDV was 84.112.4 ml, 83.712.7 ml, 83.613.0 ml, 83.2+3.4 ml and 82.513.3 ml(? > 0.05). LVEF was 0.5710.04, 0.59+0.05, 0.6010.07, 0.6410.05 and 0.68+0.06 (vs 12h P<0.05). In no-reflow group, the normalized A ?3 value was 0.17+0.11, 0.1710.10, 0.1810.10, 0.1710.11 and 0.18+0.11 (P>0.05). PDL was 0.3710.03, 0.3810.02, 0.3910.03, 0.4010.03 and 0.4010.03 (P>0.05). AWML was 0.2310.02, 0.2610.03, 0.30+0.02, 0.3810.04 and0.3710.03 (vs 12h P<0.05). LVEDV was 82.812.4 ml, 84.212.5 ml, 89.412.9 ml, 143.5112.8 ml and 149.6111.8 ml(P>0.05). LVEF was 0.5810.03, 0.5010.02, 0.4710.03, 0.3910.02 and 0.3410.03 (vs 12h P <0.05). There was positive relationship between LVEDV and PDL and negative relationship between LVEDV and the normalized A ?β value ( P<0.05). There was positive relationship between AWML and PDL and negative relationship between AWML and the normalized A ?β value ( P<0.05). And there was negative relationship between LVEF and PDL and positive relationship between LVEF and the normalized A ?β value ( P<0.05). ST segment was persist elevation in no-reflow group and decreased quickly more than 50 percent of the pre-PCI value in the reflow group early after PCI. There were high sensitivity and specificity in predicting myocardial perfusion with the sum of ST segment index( STI). Sensitivity, specificity, positive and negative predictive values, and accuracy of reducetion of STI for predicting myocardial microvascular reflow were 85.7%, 81.8%, 90%, 75% and 84.5%, respectively; Sensitivity, specificity, positive and negative predictive values, and accuracy of additional increase of STI for predicting myocardial microvascular no-reflow were 88.9%,...
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