(Circulation. 1999;100:339-345.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Can Coronary Blood Flow Velocity Pattern After Primary Percutaneous Transluminal Coronary Angiography Predict Recovery of Regional Left Ventricular Function in Patients With Acute Myocardial Infarction?
From the Department of Cardiology, Kobe General Hospital, Kobe, Japan.
Correspondence to Kiyoshi Yoshida, MD, Department of Cardiology, Kawasaki Medical School, 577, Matsushima, Kurashiki 701-0192, Japan. E-mail kyoshida{at}med.kawasaki-m.ac.jp
Background—In the era of primary percutaneous transluminal coronary angioplasty (PTCA), it is important to judge whether myocardium within acute ischemic injury is viable. This study sought to investigate parameters derived from the coronary blood flow velocity spectrum immediately after primary PTCA in patients with acute myocardial infarction and to elucidate the clinical value of coronary blood flow measurement in predicting myocardial viability.
Methods and Results—Using a Doppler guidewire, we measured
coronary blood flow velocity after successful completion of
primary PTCA in 23 consecutive patients with acute anterior myocardial
infarction. Regional wall motion was analyzed to estimate
anterior wall motion score index (A-WMSI) by
echocardiography before PTCA and 1 month after the
onset of symptoms. Average systolic peak velocity (ASV) and
deceleration time of diastolic flow velocity (DDT)
significantly correlated to 1-month A-WMSI (r=-0.54,
P=0.007 and r=-0.62,
P=0.002, respectively), and optimal cutoff values to
predict viable myocardium (defined as 1-month A-WMSI 
2.0)
were 6.5 cm/s for ASV and 600 ms for DDT (sensitivity=0.79,
specificity=0.89 and sensitivity=0.86, specificity=0.89, respectively).
ASV and DDT also correlated weakly to the change in A-WMSI
(r=0.46, P=0.03 and
r=0.49, P=0.02, respectively).
Conclusions—Low ASV and rapid DDT of coronary blood flow spectrum immediately after primary PTCA reflects a greater degree of microvascular damage in the risk area. Analysis of coronary blood flow spectrum immediately after primary PTCA by use of a Doppler guidewire is useful in predicting recovery of regional left ventricular function.
Key Words: angioplasty • microcirculation • myocardial infarction • prognosis • reperfusion
This article has been cited by other articles:
 |
|
 |
|
  H.-S. Lim, M.-H. Yoon, S.-J. Tahk, H.-M. Yang, B.-J. Choi, S.-Y. Choi, S.-S. Sheen, G.-S. Hwang, S.-J. Kang, and J.-H. Shin Usefulness of the index of microcirculatory resistance for invasively assessing myocardial viability immediately after primary angioplasty for anterior myocardial infarction Eur. Heart J., December 1, 2009; 30(23): 2854 - 2860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kitabata, T. Imanishi, T. Kubo, S. Takarada, M. Kashiwagi, H. Matsumoto, H. Tsujioka, H. Ikejima, Y. Arita, K. Okochi, et al. Coronary Microvascular Resistance Index Immediately After Primary Percutaneous Coronary Intervention as a Predictor of the Transmural Extent of Infarction in Patients With ST-Segment Elevation Anterior Acute Myocardial Infarction. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 263 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Takahashi, Y Hiasa, Y Ohara, S Miyazaki, K Mahara, R Ogura, H Miyajima, K Yuba, N Suzuki, S Hosokawa, et al. Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction Heart, November 1, 2008; 94(11): 1402 - 1406. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Hirsch, R. Nijveldt, J. D.E. Haeck, A. M. Beek, K. T. Koch, J. P.S. Henriques, R. J. van der Schaaf, M. M. Vis, J. Baan Jr, R. J. de Winter, et al. Relation between the assessment of microvascular injury by cardiovascular magnetic resonance and coronary Doppler flow velocity measurements in patients with acute anterior wall myocardial infarction. J. Am. Coll. Cardiol., June 10, 2008; 51(23): 2230 - 2238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. F. Fearon, M. Shah, M. Ng, T. Brinton, A. Wilson, J. A. Tremmel, I. Schnittger, D. P. Lee, R. H. Vagelos, P. J. Fitzgerald, et al. Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction. J. Am. Coll. Cardiol., February 5, 2008; 51(5): 560 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kawamoto, H. Okura, Y. Koyama, I. Toda, H. Taguchi, K. Tamita, A. Yamamuro, Y. Yoshimura, Y. Neishi, E. Toyota, et al. The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1635 - 1640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Kern, A. Lerman, J.-W. Bech, B. De Bruyne, E. Eeckhout, W. F. Fearon, S. T. Higano, M. J. Lim, M. Meuwissen, J. J. Piek, et al. Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology Circulation, September 19, 2006; 114(12): 1321 - 1341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Kato, K Dote, S Sasaki, K Goto, H Takemoto, S Habara, and D Hasegawa Myocardial performance index for assessment of left ventricular outcome in successfully recanalised anterior myocardial infarction Heart, May 1, 2005; 91(5): 583 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y Ohara, Y Hiasa, T Takahashi, K Yamaguchi, R Ogura, T Ogata, K Yuba, K Kusunoki, S Hosokawa, K Kishi, et al. Relation between the TIMI frame count and the degree of microvascular injury after primary coronary angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2005; 91(1): 64 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
M. Bax, R. J. de Winter, C. E. Schotborgh, K. T. Koch, M. Meuwissen, M. Voskuil, R. Adams, K. J. J. Mulder, J. G. P. Tijssen, and J. J. Piek Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction J. Am. Coll. Cardiol., February 18, 2004; 43(4): 534 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
R Hoffmann, P Haager, W Lepper, A Franke, and P Hanrath Relation of coronary flow pattern to myocardial blush grade in patients with first acute myocardial infarction Heart, October 1, 2003; 89(10): 1147 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Hozumi, Y Kanzaki, Y Ueda, A Yamamuro, T Takagi, T Akasaka, S Homma, K Yoshida, and J Yoshikawa Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction Heart, October 1, 2003; 89(10): 1163 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Garot Prognostic significance of coronary blood flow velocity patterns in patients with reperfused acute myocardial infarction and TIMI-2 flow J. Am. Coll. Cardiol., July 2, 2003; 42(1): 182 - 182. [Full Text] [PDF]
|
|
|
|
|
|
Y Nohtomi, M Takeuchi, K Nagasawa, K Arimura, K Miyata, K Kuwata, T Yamawaki, S Kondo, A Yamada, and S Okamatsu Persistence of systolic coronary flow reversal predicts irreversible dysfunction after reperfused anterior myocardial infarction Heart, April 1, 2003; 89(4): 382 - 388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Abe, M. Kondo, R. Matsuoka, M. Araki, K. Dohyama, and H. Tanio Assessment of clinical features in transient left ventricular apical ballooning J. Am. Coll. Cardiol., March 5, 2003; 41(5): 737 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Yamamuro, T. Akasaka, K. Tamita, K. Yamabe, M. Katayama, T. Takagi, and S. Morioka Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction Circulation, December 10, 2002; 106(24): 3051 - 3056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yamamoto, H. Ito, K. Iwakura, S. Kawano, M. Ikushima, T. Masuyama, T. Ogihara, and K. Fujii Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction: Insight into mechanisms of microvascular dysfunction J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1755 - 1760. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Lepper, G. T. j Sieswerda, A. Franke, N. Heussen, O. Kamp, C. C. de Cock, E. R. Schwarz, P. Voci, C. A. Visser, P. Hanrath, et al. Repeated assessment of coronary flow velocity pattern in patients with first acute myocardial infarction J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1283 - 1289. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Dixon, A. L. Bartorelli, P. A. Marcovitz, R. Spears, S. David, I. Grinberg, M. A. Qureshi, M. Pepi, D. Trabattoni, F. Fabbiocchi, et al. Initial experience with hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction: Results of a pilot study utilizing intracoronary aqueous oxygen therapy J. Am. Coll. Cardiol., February 6, 2002; 39(3): 387 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Van de Werf New aspects of pharmacological reperfusion: from macro- to microlysis Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C62 - C68. [Abstract] [PDF]
|
|
|
|
|
|
C. M. Kramer, W. J. Rogers Jr., S. Mankad, T. M. Theobald, D. L. Pakstis, and Y.-L. Hu Contractile reserve and contrast uptake pattern by magnetic resonance imaging and functional recovery after reperfused myocardial infarction J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1835 - 1840. [Abstract] [Full Text] [PDF]
|
|