Published Online
on November 24, 2003

A more recent version of this article appeared on December 2, 2003

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Submitted on March 27, 2003
Revised on September 11, 2003
Accepted on September 12, 2003

Noninvasive Evaluation of Coronary Reperfusion by Transthoracic Doppler Echocardiography in Patients With Anterior Acute Myocardial Infarction Before Coronary Intervention

Souki Lee MD^*, Yutaka Otsuji MD, Shinichi Minagoe MD, Shuichi Hamasaki MD, Koichi Toyonaga MD, Midori Negishi MD, Masanori Tsurugida MD, Hitoshi Toda MD, and Chuwa Tei MD

From the Division of Cardiology (S.L., K.T., M.N., M.T., H.T.), Kagoshima City Hospital, and the First Department of Internal Medicine (Y.O., S.M., S.H., C.T.), Kagoshima University School of Medicine, Kagoshima, Japan.

^* To whom correspondence should be addressed. E-mail: lee{at}ml.kch.kagoshima.kagoshima.jp.

Background--Transthoracic Doppler echocardiography (TTDE) enables evaluation of distal left anterior descending coronary artery (LAD) flow. The purpose of this study was to test whether TTDE can differentiate coronary reperfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade 2 in patients with anterior acute myocardial infarction (AMI).

Methods and Results--In 46 consecutive patients with a first anterior AMI in the acute phase before emergent coronary intervention, the presence of antegrade distal LAD flow and its diastolic peak velocity were evaluated by color and pulsed TTDE and compared with TIMI grades by subsequent coronary angiography performed 29±12 minutes later. Nineteen patients had TIMI 0 reperfusion, 4 had TIMI 1, 10 had TIMI 2, and 13 had TIMI 3. Visual antegrade distal LAD flow was present in 22 of the 46 patients. TIMI 2 and 3 reperfusions were both generally visualized by color TTDE. However, peak distal LAD flow velocity by pulsed TTDE was significantly greater in patients with TIMI 3 compared with those with TIMI 2 (40±10 vs 20±6 cm/s, P<0.0001). The diagnosis of TIMI 3 based on diastolic peak distal LAD flow velocity 25 cm/s by TTDE had a sensitivity, specificity, and accuracy of 77%, 94%, and 89%, respectively.

Conclusion--TTDE enables noninvasive differentiation of TIMI 3 from TIMI 2 coronary reperfusion in patients with anterior AMI in the acute phase before emergent coronary intervention.

Key words: echocardiography • myocardial infarction • reperfusion

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