This Article Full Text Full Text (PDF) All Versions of this Article: 108/22/2763    most recent 01.CIR.0000103625.15944.62v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, S. Articles by Tei, C. Search for Related Content PubMed PubMed Citation Articles by Lee, S. Articles by Tei, C. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC Acute myocardial infarction

(Circulation. 2003;108:2763.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

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; 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.

Correspondence to Souki Lee, MD, Division of Cardiology, Kagoshima City Hospital, 20-17 Kajiya, Kagoshima City, 890-8580, Japan. E-mail lee{at}ml.kch.kagoshima.kagoshima.jp

Received March 27, 2003; de novo received July 1, 2003; revision received September 11, 2003; accepted September 12, 2003.

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 AMI in the acute phase before emergent coronary intervention.

Key Words: echocardiography • myocardial infarction • reperfusion

This article has been cited by other articles:

				P. Meimoun and C. Tribouilloy Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world Eur J Echocardiogr, July 1, 2008; 9(4): 449 - 457. [Abstract] [Full Text] [PDF]

				G. Karatasakis, E. Leontiadis, E. Papadakis, N. Koutsogiannis, G. Athanassopoulos, K. Spargias, D. Poldermans, S. E. Karagiannis, and D. V. Cokkinos Transthoracic Doppler echocardiography assessment of left anterior descending artery flow in patients with previous anterior myocardial infarction Eur J Echocardiogr, May 1, 2008; 9(3): 363 - 367. [Abstract] [Full Text] [PDF]

				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]

				Doppler Echo Can Assess Coronary Reperfusion Journal Watch Cardiology, February 20, 2004; 2004(220): 3 - 3. [Full Text]