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MCE for viability assessment in ischaemic cardiomyopathy

Patient with previously undiagnosed anterior MI who comes for the first time to medical attention because of heart failure symptoms.
Angiography shows 70% LAD stenosis, in the absence of ischaemic symptoms,  and revascularisation will be performed only if tissue in the LAD territory is viable.


 

Contrast Echo Box : Atlas Contrast Echo Box : Atlas Contrast Echo Box : Atlas

 

Contrast Echo Box : Atlas Contrast Echo Box : Atlas Contrast Echo Box : Atlas
Contrast Echo Box : Atlas


Rest perfusion, assessed as late replenishment (10 seconds after flash) is significantly reduced (but not completely absent) in the true apex and distal part of apical segments in 4-chamber, whereas in 2 and 3-chamber hypoperfusion does not extend beyond true apex; anterior mid and basal segments show normal perfusion while basal lateral is not interpretable.
Revascularization will be indicated, since viability is substantially absent only in the true apex ( 1 segment).

Contrast Echo Box : Atlas
  Contrast Echo Box : Atlas

Quantitative Analysis of MCE 
Replenishment velocity is blunted in the apical segments(red lower curves)-for comparison see the green normal curve sampled in the basal-mid septum.