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CLINICAL STUDY: MYOCARDIAL INFARCTION

Repeated assessment of coronary flow velocity pattern in patients with first acute myocardial infarction

Wolfgang Lepper, MD^*, Gertjan T. j Sieswerda, MD, Andreas Franke, MD^*, Nicole Heussen, Otto Kamp, MD, PhD, Carel C. de Cock, MD, Ernst R. Schwarz, MD^*, Paolo Voci, MD, PhD, Cees A. Visser, MD, PhD, FACC, Peter Hanrath, MD, FACC^* and Rainer Hoffmann, MD^*,*

^* Medical Clinic I, University Hospital RWTH Aachen, Germany
Department of Cardiology, University Hospital VU, Amsterdam, The Netherlands
Department of Biomedical Statistics, University RWTH, Aachen, Germany
Core Laboratory (CLIP), Pisa, Italy

Manuscript received June 11, 2001; revised manuscript received January 14, 2002, accepted January 28, 2002.

^* Reprint requests and correspondence: Dr. Rainer Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany
rhoffmann{at}ukaachen.de

OBJECTIVES: The aim of this study was to evaluate the coronary blood flow velocity pattern immediately and 24 h after percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) in relation to myocardial reperfusion and follow-up left ventricular (LV) function.

BACKGROUND: Analysis of coronary blood flow velocity pattern after AMI may provide information about microvascular damage and the occurrence of a reperfusion injury.

METHODS: Measurement of coronary blood flow velocity pattern was performed immediately after PTCA and after 24 h in 25 patients with first AMI using a Doppler guidewire. Measurements were related to reperfusion determined by intravenous myocardial contrast echocardiography (MCE) performed before PTCA and at 24 h and to LV function at four weeks.

RESULTS: Using MCE, 13 patients showed reperfusion and 12 patients showed nonreperfusion. Compared with patients with reperfusion, patients with MCE nonreperfusion had a lower systolic peak flow velocity immediately after PTCA (10.0 ± 0.3 cm/s vs. 19.3 ± 0.8 cm/s, respectively) and after 24 h (12.3 ± 0.4 cm/s vs. 21.3 ± 0.1 cm/s, respectively, p = 0.0022), more frequent early systolic retrograde flow (6/12 vs. 0/13, p = 0.0052 immediately after PTCA and 24 h later) and a shorter diastolic deceleration time immediately after PTCA (483 ± 6 ms vs. 737 ± 0 ms, respectively) and after 24 h (551 ± 9 ms vs. 823 ± 2 ms, respectively, p = 0.0091). Similarly, patients with impaired LV function at four weeks had altered coronary flow pattern compared with patients with preserved function. The coronary flow velocity pattern showed a tendency for improvement after 24 h in the reperfusion and the nonreperfusion groups.

CONCLUSIONS: The coronary flow velocity pattern immediately and 24 h after PTCA for AMI relates to myocardial perfusion determined by MCE and LV function at four weeks. The flow velocity pattern shows slight improvement during the first 24 h after revascularization, indicating the absence of a major reperfusion injury.

Abbreviations and Acronyms   AMI   acute myocardial infarction   ECG   electrocardiographic/electrocardiogram   GWMI   global wall motion index   LV   left ventricle/ventricular   MCE   myocardial contrast echocardiography   PTCA   percutaneous transluminal coronary angioplasty   TIMI   Thrombolysis In Myocardial Infarction

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