MYOCARDIAL INFARCTION
Pressure-derived collateral flow index as a parameter of microvascular dysfunction in acute myocardial infarction
Kouichi Yamamoto, MD*,
Hiroshi Ito, MD*,*,
Katsuomi Iwakura, MD*,
Yasunori Shintani, MD*,
Tohru Masuyama, MD ,
Masatsugu Hori, MD,
Shigeo Kawano, MD*,
Yorihiko Higashino, MD* and
Kenshi Fujii, MD*
* Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
Department of Internal Medicine and Therpaeutics, Graduate School of Medicine, Osaka University, Osaka, Japan
Manuscript received February 6, 2001;
revised manuscript received June 26, 2001,
accepted July 16, 2001.
* Reprint requests and correspondence: Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
itomd{at}osk4.3web.ne.jp
OBJECTIVES
The goal of this study was to examine the implications of the pressure-derived collateral flow index (CFIp) in acute myocardial infarction (AMI).
BACKGROUND
Higher CFIp is associated with less severe myocardial ischemia during angioplasty in the non-infarcted heart. It remains unknown whether CFIp also identifies collateral function in AMI patients with and without no-reflow phenomenon.
METHODS
The study population included 48 patients with a first AMI. After successful percutaneous transluminal coronary angioplasty (PTCA) stent, we measured mean aortic pressure (Pa), central venous pressure (Pv) and coronary wedge pressure (Pcw) of the infarct-related artery to calculate: CFIp = (Pcw – Pv)/(Pa – Pv). Myocardial contrast echocardiography (MCE) was performed with the intracoronary injection of microbubbles to assess myocardial perfusion. Left ventriculograms at days 1 and 28 were provided for the measurement of the regional wall motion (RWM, SD/chord).
RESULTS
There was no difference in CFIp among subsets based on angiographic collateral grades (grade 0, 1, 2, 3; 0.28 ± 0.07, 0.27 ± 0.09, 0.27 ± 0.08, 0.23 ± 0.08, p = NS). The CFIp was significantly higher in patients with MCE no-reflow (n = 16) than in those with MCE reflow (n = 32) (0.34 ± 0.07 vs. 0.23 ± 0.06, p < 0.01). There was a significant inverse correlation between the extent of functional improvement ( RWM[28 d–1 d]) and CFIp (r = 0.56, p < 0.01), implying that higher CFIp is associated with worse functional improvement.
CONCLUSIONS
In AMI, CFIp is unlikely to reflect collateral function but seems to increase with the severity of microvascular dysfunction. Because higher CFIp was associated with poorer functional recovery, it provides a simple and useful estimate of clinical outcomes in AMI.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CFIp | = pressure-derived collateral flow index | | LVEDP | = left ventricular end-diastolic pressure | | LVEF | = left ventricular ejection fraction | | MCE | = myocardial contrast echocardiography | | Pa | = mean aortic pressure | | Pcw | = coronary wedge pressure | | Pv | = central venous pressure | | PCI | = percutaneous coronary intervention | | RWM | = regional wall motion | | TIMI | = Thrombolysis In Myocardial Infarction trial |
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