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CLINICAL STUDY

Postinfarctional remodeling: increased dye intensity in the myocardial risk area after angioplasty of infarct-related coronary artery is associated with reduction of ventricular volumes

Gianni Destro, MD^*, Paolo Marino, MD, Enrico Barbieri, MD, FACC^*, Andrea Zorzi, MD^*, Giovanna Brighetti, MD^*, Massimiliano Maines, MD^*, Monica Carletti, MD^* and Piero Zardini, MD^*

^* Division of Cardiology, University of Verona, Verona, Italy
Cardiology Service, University of Verona, Verona, Italy

Manuscript received August 7, 2000; revised manuscript received November 22, 2000, accepted December 21, 2000.

Reprint requests and correspondence: Dr. Gianni Destro, Division of Cardiology, University of Verona, P. le Stefani, 1, 37126 Verona, Italy

OBJECTIVES

We sought to evaluate if angiographic dye videointensity of the risk area during percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery (IRA) relates to remodeling.

BACKGROUND

Poor reflow after myocardial infarction (MI) predicts worse ventricular remodeling.

METHODS

Fifty-three patients with a first anterior MI and isolated disease of the left anterior descending (LAD), who underwent "primary" (n = 14), "rescue" (n = 7) or "late" (after 10 ± 4 days, n = 32) PTCA, were retrospectively selected. In 10 patients prospectively collected, we assessed Doppler flow velocities and Doppler flow reserve (DFR), relating them to the videointensity technique. Coronary stenosis and TIMI flow were determined, and echocardiographic volumes (end-diastolic and end-systolic volume indexes) and regional asynergy were computed before hospital discharge (baseline) and at six months. Assuming higher peak videointensity reflects greater myocardial blood volume, a 1- to 5-point (poor-optimal) perfusion scale was devised.

RESULTS

The correlation of Doppler peak velocity and DFR with videointensity was significant (r = 0.58, p = 0.007 and r = 0.71, p < 0.001, respectively). Patients were subdivided into group A (increased videointensity post-PTCA 1.5 points, n = 29) and group B (unchanged videointensity, n = 24). Analysis of variance showed a time-group interaction for end-diastolic volume index (–4.6 ± 23% vs. +22 ± 22%, p = 0.003) and end-systolic volume index (–3.05 ± 11.1% vs. +4.1 ± 12.5%, p = 0.027). There was no interaction for changes in LAD stenosis (p = 0.39) and TIMI flow after PTCA (p = 0.27), or regional asynergy at six months (p = 0.31).

CONCLUSIONS

Angiographic dye videointensity in the risk area correlates with Doppler peak velocity and DFR, and its increase after PTCA of IRA has a limiting effect on ventricular volumes, independent of coronary stenosis resolution, changes in Thrombolysis In Myocardial Infarction (TIMI) flow or extent of regional asynergy.

Abbreviations and Acronyms   ANOVA = analysis of variance   CK-MB = creatine kinase-MB   CPK-MB = creatine phosphokinase-MB   DFR = Doppler flow reserve   IRA = infarct-related coronary artery   LAD = left anterior descending   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   ROI = region of interest   SD = standard deviation   TIMI = Thrombolysis In Myocardial Infarction

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