[Does left ventricular wall motion of akinetic segment improve after reperfusion therapy in patients with acute myocardial infarction?:  assessment by myocardial contrast echocardiography]. 
The relationship between myocardial perfusion and left ventricular wall motion was studied by myocardial contrast echocardiography in 22 patients with acute myocardial infarction treated by successful direct percutaneous transluminal coronary angioplasty (PTCA).  Myocardial contrast echocardiography was performed 4 times to assess the serial changes of wall motion score and opacification score, before and immediately after PTCA, and 2 weeks and 3 months after the onset of infarction, by injecting 2 ml Albunex into the infarct-related artery.  Two-dimensional echocardiography was visualized at the level of the papillary muscle on the short-axis view or apical long-axis view.  Wall motion score was graded visually as grade 0: dyskinesis/akinesis, to 3: normokinesis/hyperkinesis and opacification score was graded as grade 0: no opacification, to 2: homogeneous opacification using the 6-segment model of the short-axis view or 5-segment model of the apical long-axis view.  Immediately after PTCA, we observed 30 segments with the dyskinesis/akinesis, which were divided into 3 groups (no opacification group, partial opacification group and homogeneous opacification group) by opacification score immediately after PTCA.  The recovery of left ventricular wall motion in the partial opacification group (10 segments) and homogeneous opacification group (7 segments) were significantly better than the no opacification group (13 segments).  Six (46%) of 13 segments in the no opacification group had improved contrast enhancement 3 months later, and 4 of these 6 segments showed improved left ventricular wall motion.  The area opacified immediately after PTCA showed recovery of left ventricular wall motion in the chronic stage.  However, some segments of the no-opacified area immediately after PTCA also showed improved myocardial opacification as well as improved left ventricular wall motion in the chronic stage.  The results suggest that myocardial contrast echocardiography is an important method to predict myocardial viability, but it is difficult to assess the viability by contrast enhancement performed only in the acute stage of acute myocardial infarction.