This Article Full Text (PDF) 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 Rogers, W. J. Articles by Nath, H. P. Search for Related Content PubMed PubMed Citation Articles by Rogers, W. J. Articles by Nath, H. P.

Circulation, Vol 69, 338-349, Copyright © 1984 by American Heart Association

ARTICLES

Return of left ventricular function after reperfusion in patients with myocardial infarction: importance of subtotal stenoses or intact collaterals

WJ Rogers, WP Hood Jr, JA Mantle, WA Baxley, JK Kirklin, GL Zorn and HP Nath

To determine whether subsequent improvement in left ventricular ejection fraction can be predicted from preintervention coronary arteriograms, we divided 63 patients with acute myocardial infarction into two groups based on findings at emergency coronary arteriography at a mean of 7 hr after onset of symptoms: (1) a "no-flow" group with an occluded infarct-related artery and no easily visible collaterals (n = 36) and (2) a "limited-flow" group with either subtotal stenosis or total occlusion of the infarct-related vessel with intact collaterals (n = 27). Of the 63 patients, 61 underwent emergency procedures to establish reperfusion. At follow-up angiography (contrast or radionuclide) performed 12 +/- 7 days after infarction, global ejection fraction had increased significantly in patients with limited flow to the infarct zone and "successful" early reperfusion intervention due primarily to a significant increase in the regional ejection fraction in the infarct zone. Global ejection fraction fell significantly between baseline and follow-up in patients with no flow to the infarct zone and "unsuccessful" early reperfusion intervention due primarily to a fall in the regional ejection fraction of the noninfarct zone. Global and regional ejection fractions did not change significantly in patients with no flow to the infarct zone and successful early reperfusion or in patients with limited flow to the infarct zone and unsuccessful early reperfusion intervention. The elapsed time before reperfusion did not relate significantly to the change in either regional or global ejection fraction. However, the magnitude of improvement in both global and regional ejection fraction at follow-up was greater among patients with anterior infarcts than among those with inferior infarcts, possibly because baseline ejection fraction was lower in patients with anterior infarcts. These data indicate that among patients with acute myocardial infarction undergoing emergency coronary arteriography at a mean of 7 hr after onset of symptoms, improvement in global ejection fraction is unlikely to occur even after a successful early reperfusion intervention in the absence of preserved flow to the infarct area. However, among patients with subtotally occluded infarct-related arteries or significant collateral blood flow to the infarct zone, subsequent improvement in global and regional ejection fraction in the zone of myocardial infarction frequently occurs. Improvement in both global and regional ejection fraction may be more readily demonstrated in patients initially having more severe depression of these parameters.

This article has been cited by other articles:

				D. Kumbasar, O. Akyurek, I. Dincer, Y. Atmaca, M. Kilickap, C. Erol, and D. Oral Good Collaterals Predict Viable Myocardium Angiology, November 1, 2007; 58(5): 550 - 555. [Abstract] [PDF]

				C.-W. Cheng, M.-J. Hung, L.-T. Kuo, and W.-J. Cherng Appearance of Collateral Circulation in the Absence of Total Occlusive Spastic Coronary Artery: A Case Report Angiology, May 1, 2005; 56(3): 331 - 334. [Abstract] [PDF]

				A. N. Carr, M. G. Davis, E. Eby-Wilkens, B. W. Howard, B. A. Towne, T. E. Dufresne, and K. G. Peters Tyrosine phosphatase inhibition augments collateral blood flow in a rat model of peripheral vascular disease Am J Physiol Heart Circ Physiol, July 1, 2004; 287(1): H268 - H276. [Abstract] [Full Text] [PDF]

				J. Rockstroh and B. G. Brown Coronary Collateral Size, Flow Capacity, and Growth: Estimates From the Angiogram in Patients With Obstructive Coronary Disease Circulation, January 15, 2002; 105(2): 168 - 173. [Abstract] [Full Text] [PDF]

				R. A. M. van Liebergen, J. J. Piek, K. T. Koch, R. J. de Winter, C. E. Schotborgh, and K. I. Lie Quantification of collateral flow in humans: a comparison of angiographic, electrocardiographic and hemodynamic variables J. Am. Coll. Cardiol., March 1, 1999; 33(3): 670 - 677. [Abstract] [Full Text] [PDF]

				B. R. Brodie, T. D. Stuckey, T. C. Wall, G. Kissling, C. J. Hansen, D. B. Muncy, R. A. Weintraub, and T. A. Kelly Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1312 - 1319. [Abstract] [Full Text] [PDF]

				T. Tsunoda, M. Nakamura, T. Wakatsuki, T. Nishida, T. Asahara, H. Anzai, H. Touma, K. Mitsuo, Y. Soumitsu, H. Sakatani, et al. The pattern of alteration in flow velocity in the recanalized artery is related to left ventricular recovery in patients with acute infarction and successful direct balloon angioplasty J. Am. Coll. Cardiol., August 1, 1998; 32(2): 338 - 344. [Abstract] [Full Text] [PDF]

				S. Carmel, M. Gueron, and R. Ilia Patients with Coronary Collaterals and Normal Left Ventricular Systolic Function: Clinical, Hemodynamic, and Angiographic Characteristics Angiology, August 1, 1998; 49(8): 631 - 635. [Abstract] [PDF]