Early Assessment of Coronary Flow Reserve by Transthoracic Doppler Echocardiography Predicts Late Remodeling in Reperfused Anterior Myocardial Infarction

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Abstract

Background

Microvascular integrity is an essential determinant of favorable late outcome in reperfused myocardial infarction. Coronary flow reserve (CFR) can be assessed by transthoracic Doppler echocardiography and provides a functional estimate of microvascular integrity downstream from the patent infarct-related vessel.

Objective

We sought to assess the effects of CFR in predicting late left ventricular (LV) remodeling in patients with reperfused acute anterior myocardial infarction treated with primary angioplasty.

Methods

In all, 31 patients admitted with acute anterior myocardial infarction underwent primary angioplasty of the infarct-related vessel. After angioplasty, angiographic thrombosis in myocardial infarction (TIMI) grade and myocardial blush were scored. On the first day, all underwent stress echocardiography and CFR evaluation of left anterior descending coronary artery by transthoracic Doppler. All patients had resting 2-dimensional echocardiography at 1, 3, and 6 months for assessment of LV function.

Results

CFR could be successfully assessed in 31 patients. After 6 months 5 patients showed LV dilatation (group I), whereas 26 patients did not show significant variation (group II). On day 1, CFR was higher (group I = 1.43 ± 0.11 vs group II = 1.67 ± 0.26, P = .005) and the deceleration time of diastolic left anterior descending coronary artery flow velocity was longer (group I = 212 ± 41.4 milliseconds vs group II = 286 ± 106.7 milliseconds, P < .02) in patients without, compared with those with LV remodeling, whereas there was no difference in angiographic parameters.

Conclusion

Early assessment of CFR and the pattern of baseline diastolic coronary flow velocity by transthoracic Doppler echocardiography is feasible, safe, and more useful than angiographic indices in identifying patients at high risk of remodeling in spite of successful primary angioplasty.

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