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(Circulation. 1996;93:223-228.)
© 1996 American Heart Association, Inc.
Articles |
Clinical Implications of the `No Reflow' Phenomenon
A Predictor of Complications and Left Ventricular Remodeling inReperfused Anterior Wall Myocardial Infarction
From the Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan, and the First Department of Medicine, Osaka University School of Medicine (T.M., M.H.).
Correspondence to Hiroshi Ito, MD, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530, Japan.
Background Recent studies demonstrated that the "no reflow" phenomenon after coronary reflow implies the presence of advanced myocardial damage. In this study, we verified the prognostic value of the detection of this phenomenon by studying complications, left ventricular morphology, and in-hospital survival after acute myocardial infarction (AMI).
Methods and Results The study population consisted of 126 patients with a first anterior AMI. All patients received coronary reflow within 24 hours of onset of symptoms and underwent myocardial contrast echocardiography (MCE) before and shortly after coronary reflow with an intracoronary injection of sonicated microbubbles. From contrast reperfusion patterns, patients were divided into two subsets: those with MCE no reflow (47 patients, 37%) and those with MCE reflow (79 patients). There was no difference in the frequency of arrhythmia or coronary events between the two subsets. Pericardial effusion and early congestive heart failure were observed more frequently in patients with MCE no reflow than in those with MCE reflow (26% versus 4%, P<.05; 45% versus 15%, P<.05, respectively). Congestive heart failure tended to be prolonged in those with MCE no reflow, and 3 patients (7%) of this subset died of pump failure. Left ventricular end-diastolic volume progressively increased in the convalescent stage in patients with MCE no reflow (early versus late, 145±43 versus 169±60 mL, P<.001), whereas it decreased in those with MCE reflow (154±42 versus 144±44 mL, P<.01).
Conclusions The substantial size of the MCE no reflow phenomenon at coronary reflow conveys useful information about an outcome of coronary intervention and left ventricular remodeling in individual patients with anterior wall AMI, although these are suggestive results in a limited number of patients.
Key Words: echocardiography • contrast media • myocardial infarction • reperfusion • microcirculation • prognosis • remodeling
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A. P. Furber, F. Prunier, H. C. P. Nguyen, S. Boulet, S. Delepine, and P. Geslin Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events Circulation, December 7, 2004; 110(23): 3527 - 3533. [Abstract] [Full Text] [PDF]
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K. Iwakura, H. Ito, S. Kawano, A. Okamura, K. Tanaka, Y. Nishida, Y. Maekawa, and K. Fujii Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices Eur. Heart J., September 1, 2004; 25(17): 1526 - 1533. [Abstract] [Full Text] [PDF]
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A. Hansen, A. Kumar, D. Wolf, K. Frankenbergerova, A. Filusch, M.-L. Gross, S. Mueller, H. Katus, and H. Kuecherer Evaluation of cardioprotective effects of recombinant soluble P-selectin glycoprotein ligand-immunoglobulin in myocardial ischemia-reperfusion injury by real-time myocardial contrast echocardiography J. Am. Coll. Cardiol., August 18, 2004; 44(4): 887 - 891. [Abstract] [Full Text] [PDF]
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C. F. Azevedo, L. C. Amado, D. L. Kraitchman, B. L. Gerber, N. F. Osman, C. E. Rochitte, T. Edvardsen, and J. A.C. Lima Persistent diastolic dysfunction despite complete systolic functional recovery after reperfused acute myocardial infarction demonstrated by tagged magnetic resonance imaging Eur. Heart J., August 2, 2004; 25(16): 1419 - 1427. [Abstract] [Full Text] [PDF]
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C. O. Costantini, G. W. Stone, R. Mehran, E. Aymong, C. L. Grines, D. A. Cox, T. Stuckey, M. Turco, B. J. Gersh, J. E. Tcheng, et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction J. Am. Coll. Cardiol., July 21, 2004; 44(2): 305 - 312. [Abstract] [Full Text] [PDF]
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G. K. Lund, A. Stork, M. Saeed, M. P. Bansmann, J. H. Gerken, V. Muller, J. Mester, C. B. Higgins, G. Adam, and T. Meinertz Acute Myocardial Infarction: Evaluation with First-Pass Enhancement and Delayed Enhancement MR Imaging Compared with 201Tl SPECT Imaging Radiology, July 1, 2004; 232(1): 49 - 57. [Abstract] [Full Text] [PDF]
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C. M. Gibson and A. Schomig Coronary and Myocardial Angiography: Angiographic Assessment of Both Epicardial and Myocardial Perfusion Circulation, June 29, 2004; 109(25): 3096 - 3105. [Full Text] [PDF]
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A. J. Taylor, N. Al-Saadi, H. Abdel-Aty, J. Schulz-Menger, D. R. Messroghli, and M. G. Friedrich Detection of Acutely Impaired Microvascular Reperfusion After Infarct Angioplasty With Magnetic Resonance Imaging Circulation, May 4, 2004; 109(17): 2080 - 2085. [Abstract] [Full Text] [PDF]
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L. C. Amado, D. L. Kraitchman, B. L. Gerber, E. Castillo, R. C. Boston, J. Grayzel, and J. A. C. Lima Reduction of "no-reflow" phenomenon by intra-aortic balloon counterpulsation in a randomized magnetic resonance imaging experimental study J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1291 - 1298. [Abstract] [Full Text] [PDF]
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H. F.J Mannaerts, J. A van der Heide, O. Kamp, M. G Stoel, J. Twisk, and C. A Visser Early identification of left ventricular remodelling after myocardial infarction, assessed by transthoracic 3D echocardiography Eur. Heart J., April 2, 2004; 25(8): 680 - 687. [Abstract] [Full Text] [PDF]
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L. Bolognese, N. Carrabba, G. Parodi, G. M. Santoro, P. Buonamici, G. Cerisano, and D. Antoniucci Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction Circulation, March 9, 2004; 109(9): 1121 - 1126. [Abstract] [Full Text] [PDF]
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M. T Dirksen, G. Laarman, A. W.J van 't Hof, G. Guagliumi, W. A.L Tonino, L. Tavazzi, D. J.G.M Duncker, M. L Simoons, and on behalf of the PARI-MI Investigators The effect of ITF-1697 on reperfusion in patients undergoing primary angioplasty: Safety and efficacy of a novel tetrapeptide, ITF-1697 Eur. Heart J., March 1, 2004; 25(5): 392 - 400. [Abstract] [Full Text] [PDF]
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M. Takeuchi, Y. Nohtomi, H. Yoshitani, C. Miyazaki, K. Sakamoto, and J. Yoshikawa Enhanced coronary flow velocity during intra-aortic balloon pumping assessed by transthoracic doppler echocardiography J. Am. Coll. Cardiol., February 4, 2004; 43(3): 368 - 376. [Abstract] [Full Text] [PDF]
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J. Cortadellas, J. Figueras, M. Missorici, E. Domingo, J. Rodes, J. Castell, and J. Soler Soler ST segment elevation at 72 hours in patients with a first anterior myocardial infarction best correlates with pre-discharge and 1-year regional contractility and ventricular dilatation Eur. Heart J., February 1, 2004; 25(3): 224 - 231. [Abstract] [Full Text] [PDF]
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L Galiuto Optimal therapeutic strategies in the setting of post-infarct no reflow: the need for a pathogenetic classification Heart, February 1, 2004; 90(2): 123 - 125. [Full Text] [PDF]
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S. Kaul and H. Ito Microvasculature in Acute Myocardial Ischemia: Part II: Evolving Concepts in Pathophysiology, Diagnosis, and Treatment Circulation, January 27, 2004; 109(3): 310 - 315. [Full Text] [PDF]
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H. Kunichika, O. Ben-Yehuda, S. Lafitte, N. Kunichika, B. Peters, and A. N. DeMaria Effects of glycoprotein iib/iiia inhibition on microvascular flow after coronary reperfusion: A quantitative myocardial contrast echocardiography study J. Am. Coll. Cardiol., January 21, 2004; 43(2): 276 - 283. [Abstract] [Full Text] [PDF]
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R. A. Kloner and W. Dai Glycoprotein IIb/IIIa inhibitors and no-reflow J. Am. Coll. Cardiol., January 21, 2004; 43(2): 284 - 286. [Full Text] [PDF]
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R. H. Mehta, K. J. Harjai, D. Cox, G. W. Stone, B. Brodie, J. Boura, W. O'Neill, C. L. Grines, and Primary Angioplasty in Myocardial Infarction (PAMI Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1739 - 1746. [Abstract] [Full Text] [PDF]
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M. Nishino, H.-J. Youn, D. Gheorghevici, C. Zellner, T. M. Chou, K. Sudhir, and R. F. Redberg Effect of Intracoronary Estradiol on Postischemic Microvascular Damage in a Porcine Model: A Myocardial Contrast Echocardiographic Study Angiology, November 1, 2003; 54(6): 701 - 709. [Abstract] [PDF]
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C Coletta, A Sestili, F Seccareccia, R Rambaldi, R Ricci, A Galati, R Bigi, N Aspromonte, M Renzi, and V Ceci Influence of contractile reserve and inducible ischaemia on left ventricular remodelling after acute myocardial infarction Heart, October 1, 2003; 89(10): 1138 - 1143. [Abstract] [Full Text] [PDF]
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