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CLINICAL STUDIES

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

^a Third Department of Internal Medicine, Ohashi Hospital, Toho University Faculty of Medicine, Tokyo, Japan

Manuscript received November 11, 1997; revised manuscript received April 1, 1998, accepted April 17, 1998.

Address for correspondence: Dr. Taro Tsunoda, Third Department of Internal Medicine, Ohashi Hospital, Toho University Faculty of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153 Japan
taro{at}oha.toho-u.ac.jp

Objectives. We evaluated the relationship between alterations in coronary flow velocity during the acute phase of acute myocardial infarction (AMI) and the recovery of left ventricular wall motion in patients who underwent successful primary angioplasty.

Background. The status of the coronary microcirculation is the major determinant of the prognosis of patients who have had successful reperfusion after AMI. Animal studies have shown that dynamic changes in regional flow are associated with the extent of infarction. Evaluation of alterations in coronary flow velocity in infarcted arteries may provide information about microcirculatory damage.

Methods. Flow velocity of the distal anterior descending artery was continuously monitored with the use of a Doppler guide wire immediately after recanalization for 18 ± 4 h in 19 patients who underwent successful primary angioplasty after anterior AMI. Subjects were divided into two groups on the basis of the time course of alterations in average peak velocity (APV). Group D consisted of patients who had progressive decreases in APV through the next day (n = 9), and Group I comprised patients with an increase in APV after a transient decline (n = 10). Ejection fraction (EF) and regional wall motion (RWM) were assessed by left ventriculography performed on admission and at discharge.

Results. The APV at the end of monitoring was greater in group I than in group D. In group I, EF and RWM were significantly improved at discharge. The change in EF was greater in group I than in group D (17 ± 9% vs. 4 ± 9%, p = 0.007), as was the change in RWM (0.96 ± 0.23 vs. 0.13 ± 0.36 SD/chord, p < 0.0001).

Conclusions. The alteration in flow velocity in recanalized infarcted arteries is related to left ventricular recovery. A progressive decrease in velocity after angioplasty implies no reflow, which is associated with a poor recovery of left ventricular function. Reperfusion injury may account in part for this phenomenon.

Abbreviations and Acronyms   AMI = acute myocardial infarction   APV = average peak velocity   EF = ejection fraction   IABP = intraaortic balloon pump   PTCA = percutaneous transluminal coronary angioplasty   RWM = regional wall motion

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