CLINICAL RESEARCH
Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction
Matthijs Bax, MD*,
Robbert J. de Winter, MD, PhD*,
Carl E. Schotborgh, MD*,
Karel T. Koch, MD, PhD*,
Martijn Meuwissen, MD, PhD*,
Michiel Voskuil, MD*,
Rob Adams, RN*,
Karla J. J. Mulder*,
Jan G. P. Tijssen, PhD* and
Jan J. Piek, MD, PhD, FACC*,*
* Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Manuscript received June 16, 2003;
revised manuscript received July 23, 2003,
accepted August 5, 2003.
* Reprint requests and correspondence: Dr. Jan J. Piek, Department of Cardiology B2-125, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
j.j.piek{at}amc.uva.nl
OBJECTIVES: The aim of this study was to determine predictors of left ventricular (LV) function recovery at the time of primary percutaneous coronary intervention (PCI).
BACKGROUND: Angiographic, intracoronary Doppler flow, and electrocardiographic variables have been reported to be predictors of recovery of LV function after acute myocardial infarction (MI). We directly compared the predictive value of Thrombolysis In Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (cTfc), myocardial blush grade, coronary Doppler flow velocity analysis, and resolution of ST-segment elevation for recovery of LV function in patients undergoing primary PCI for acute MI.
METHODS: We prospectively studied 73 patients who underwent PCI for an acute anterior MI. Recovery of global and regional LV function was measured using an echocardiographic 16-segment wall motion index (WMI) before PCI, at 24 h, at one week, and at six months. Directly after successful PCI, coronary flow velocity reserve (CFR), cTfc, TIMI flow grade, and myocardial blush grade were assessed.
RESULTS: Mean global and regional WMI improved gradually over time from 1.86 ± 0.23 before PCI to 1.54 ± 0.34 at six-month follow-up (p < 0.0001) and from 2.39 ± 0.30 before PCI to 1.87 ± 0.48 at six-month follow-up (p < 0.0001), respectively. Multivariate analysis revealed CFR as the only independent predictor for global and regional recovery of LV function at six months.
CONCLUSIONS: Doppler-derived CFR is a better prognostic marker for LV function recovery after anterior MI than other currently used parameters of myocardial reperfusion.
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Abbreviations and Acronyms
| | APV | = average peak flow velocity | | CFR | = coronary flow velocity reserve | | cTfc | = corrected TIMI frame count | | ECG | = electrocardiogram/electrocardiographic/electrocardiography | | IRA | = infarct-related artery | | LAD | = left anterior descending | | LV | = left ventricle/left ventricular | | MI | = myocardial infarction | | PCI | = percutaneous coronary intervention | | TIMI | = Thrombolysis In Myocardial Infarction | | WMI | = wall motion score index |
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