HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Feldman, L. J. Articles by Steg, P. G. Search for Related Content PubMed PubMed Citation Articles by Feldman, L. J. Articles by Steg, P. G.

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

This article has been cited by other articles:

				J. Zalewski, A. Undas, J. Godlewski, E. Stepien, and K. Zmudka No-Reflow Phenomenon After Acute Myocardial Infarction Is Associated With Reduced Clot Permeability and Susceptibility to Lysis Arterioscler. Thromb. Vasc. Biol., October 1, 2007; 27(10): 2258 - 2265. [Abstract] [Full Text] [PDF]

				C. J. Terkelsen, B. L. Norgaard, J. F. Lassen, S. H. Poulsen, J. C. Gerdes, E. Sloth, L. B.-H. Gotzsche, F. K. Romer, L. Thuesen, T. T. Nielsen, et al. Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study) Eur. Heart J., February 1, 2006; 27(3): 267 - 275. [Abstract] [Full Text] [PDF]

				P. Johanson, Y. Fu, S. G. Goodman, M. Dellborg, P. W. Armstrong, M. W. Krucoff, L. Wallentin, and G. S. Wagner A dynamic model forecasting myocardial infarct size before, during, and after reperfusion therapy: an ASSENT-2 ECG/VCG substudy Eur. Heart J., September 1, 2005; 26(17): 1726 - 1733. [Abstract] [Full Text] [PDF]

				L. J. Feldman, P. Coste, A. Furber, P. Dupouy, M. S. Slama, J.-P. Monassier, C. Tron, A. Lafont, M. Faraggi, D. Le Guludec, et al. Incomplete Resolution of ST-Segment Elevation Is a Marker of Transient Microcirculatory Dysfunction After Stenting for Acute Myocardial Infarction Circulation, June 3, 2003; 107(21): 2684 - 2689. [Abstract] [Full Text] [PDF]

				P. Voci, E. Mariano, F. Pizzuto, P. E. Puddu, and F. Romeo Coronary recanalization in anterior myocardial infarction: The open perforator hypothesis J. Am. Coll. Cardiol., October 2, 2002; 40(7): 1205 - 1213. [Abstract] [Full Text] [PDF]

				Y Ueno, Y Nakamura, M Kinoshita, T Fujita, T Sakamoto, and H Okamura Can coronary flow velocity reserve determined by transthoracic Doppler echocardiography predict the recovery of regional left ventricular function in patients with acute myocardial infarction? Heart, August 1, 2002; 88(2): 137 - 141. [Abstract] [Full Text] [PDF]