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ARTICLE

Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size

Laurent J. Feldman, MD, PhD^*, Dominique Himbert, MD^*, Jean-Michel Juliard, MD^*, Gaëtan J. Karrillon, MD^*, Hakim Benamer, MD^*, Pierre Aubry, MD^*, Olivier Boudvillain, MD^*, Patrick Seknadji, MD^*, Marc Faraggi, MD, PhD and Ph Gabriel Steg, MD, FACC^*

^* Department of Cardiology, Bichat Hospital, Paris, France
Department of Nuclear Medicine, Bichat Hospital, Paris, France

Manuscript received September 29, 1998; revised manuscript received October 28, 1999, accepted December 15, 1999.

Reprint requests and correspondence: Dr. Laurent J. Feldman, Service de Cardiologie, Hôpital Bichat, 46 Rue H. Huchard, 75877 Paris Cedex 18, France
laurent.feldman{at}bch.ap-hop-paris.fr

OBJECTIVES

We tested the hypothesis that the reperfusion syndrome (RS), defined as an additional elevation of the ST segment upon reperfusion, may be a marker of microcirculatory reperfusion injury during acute myocardial infarction (AMI).

BACKGROUND

The pathophysiology of the RS is unknown, and its prognostic implications are controversial.

METHODS

Twenty-one patients with an anterior AMI treated 12 h after onset by primary coronary angioplasty (PTCA) were studied. Coronary velocity reserve (CVR), an index of microcirculatory function, was measured using a Doppler guidewire. Left ventricular (LV) ejection fraction, infarct size (percent defect) and LV end-systolic volume index (LVESVi) were evaluated by radionuclide ventriculography, ²⁰¹T1 single-photon emission computed tomography and contrast ventriculography, respectively.

RESULTS

Baseline ST elevation and pain-to-TIMI 3 time were similar in patients with and without RS. Patients with RS (10/21) had a lower post-PTCA CVR than patients without RS (median [95% confidence interval]: 1.2 [1–1.3] vs. 1.6 [1.5–1.7], p < 0.005). Even though predischarge CVR was similar in the two groups, infarct size at six weeks (26 [21 to 37] vs. 14 [10–17] % ²⁰¹T1 defect, p = 0.001) and predischarge LVESVi (45% [40 to 52] vs. 30% [29 to 38] mL/m², p = 0.001) were larger, and LV ejection fraction at six weeks (40% [37 to 46] vs. 55% [50 to 60], p = 0.004) was lower in patients with RS than in patients without RS.

CONCLUSIONS

Patients with RS during primary PTCA for an anterior AMI have a transiently lower CVR than patients without RS, but sustained LV dysfunction and larger infarct size, suggesting that RS is a marker of microcirculatory reperfusion injury.

Abbreviations and Acronyms   AMI = acute myocardial infarction   APV = time-averaged peak velocity   CVR = coronary velocity reserve   ECG = electrocardiogram   LAD = left anterior descending coronary artery   LV = left ventricular   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   RS = reperfusion syndrome   TIMI = Thrombolysis in Myocardial Infarction

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