Improved Accuracy of Low-Power Contrast Echocardiography for the Assessment of Left Ventricular Remodeling Compared With Unenhanced Harmonic Echocardiography After Acute Myocardial Infarction: Comparison With Cardiovascular Magnetic Resonance Imaging Tiong Keng Lim, MBBS, MRCP, Leah Burden, BSc, Rajesh Janardhanan, MD, MRCP, Chai Ping, MBBS, MRCP, James Moon, MBBS, MRCP, Dudley Pennell, FRCP, FESC, FACC, and Roxy Senior, MD, DM, FRCP, FESC, FACC, Harrow and London, UK Background: Assessment of left ventricular (LV) re- modeling after acute myocardial infarction (AMI) has both therapeutic and prognostic implications. Low-power contrast echocardiography (CE) has the advantage of simultaneously assessing myocardial perfusion and LV remodeling. Objective: This study aimed to evaluate the accuracy of low-power CE to assess LV remodeling after AMI compared with unenhanced harmonic echocardiog- raphy (HE). Methods: A total of 36 consecutive patients under- went HE, CE (SonoVue), and cardiovascular mag- netic resonance (CMR) imaging 7 to 10 days after AMI. Left ventricular ejection fraction (LVEF), end- systolic volume (LVESV), and end-diastolic volume (LVEDV) were assessed. Results: Absolute differences for LVESV and LVEDV between CMR and CE were significantly smaller than those between CMR and HE. CE estimate of LVEF more accurately classified patients into LVEF < 35%, 35% to 45%, and > 45% (agreement, 83%; kappa  0.66 with CMR) compared with HE (agreement, 69%; kappa  0.33 with CMR). Conclusions: Low-power CE is more accurate than HE for estimating LV remodeling after AMI. (J Am Soc Echocardiogr 2005;18:1203-1207.) Left ventricular (LV) remodeling after acute myo- cardial infarction (AMI) is a process resulting in altered LV size, shape, and function. 1,2 Altered LV volume is a recognized feature of LV remodeling. Assessment of LV remodeling after AMI has both therapeutic 3-5 and prognostic implications. 1,6-8 Therefore, accurate measurement of LV volume and function is a requirement for assessing and monitor- ing LV remodeling post-AMI. Tissue harmonic echo- cardiography (HE) is now widely used to assess LV volume and function. 9 Recently, contrast echocardiography (CE) has been shown to improve LV function assessment. 10 Low-power CE is a new technique that has the advantage of simultaneously assessing myocardial perfusion and LV volume and function. However, there are limited data on the accuracy of low-power CE in assessing LV volume and function compared with HE early after AMI. The aim of the present study is to evaluate whether low-power CE is superior to HE for evaluating LV remodeling post-AMI, using cardiovascular magnetic resonance (CMR) imaging as a reference standard. METHODS Patient Selection Stable patients after thrombolysis therapy following the first presentation of AMI with acute ST segment elevation were recruited into the study. The patients underwent baseline HE, low-power CE, and CMR 7  2 days after From the Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, U.K. and Centre for Advanced Magnetic Reso- nance in Cardiology, Royal Brompton Hospital, London, UK Reprint requests: Roxy Senior, MD, DM, FRCP, FESC, FACC, Consultant Cardiologist and Director of Cardiac Research, De- partment of Cardiovascular Medicine, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, UK (E-mail: roxy.senior@ virgin.net). 0894-7317/$30.00 Copyright 2005 by the American Society of Echocardiography. doi:10.1016/j.echo.2005.03.019 1203