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CLINICAL RESEARCH: CARDIAC MR IN INFARCTION

Relation Between the Assessment of Microvascular Injury by Cardiovascular Magnetic Resonance and Coronary Doppler Flow Velocity Measurements in Patients With Acute Anterior Wall Myocardial Infarction

Alexander Hirsch, MD^_*,,_*, Robin Nijveldt, MD^,, Joost D.E. Haeck, MD^_*, Aernout M. Beek, MD, Karel T. Koch, MD, PhD^_*, José P.S. Henriques, MD, PhD^_*, Rene J. van der Schaaf, MD^_*, Marije M. Vis, MD^_*, Jan Baan, Jr, MD, PhD^_*, Robbert J. de Winter, MD, PhD^_*, Jan G.P. Tijssen, PhD^_*, Albert C. van Rossum, MD, PhD and Jan J. Piek, MD, PhD^_*

^_* Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.

Manuscript received November 12, 2007; revised manuscript received December 30, 2007, accepted January 26, 2008.

^_* Reprint requests and correspondence: Dr. Alexander Hirsch, Department of Cardiology, Academic Medical Center, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands. (Email: a.hirsch{at}amc.uva.nl).

Objectives: We studied the relation between presence and severity of microvascular obstruction (MO), measured by cardiovascular magnetic resonance (CMR) and intracoronary Doppler flow measurements, for assessment of myocardial reperfusion in patients with acute anterior myocardial infarction (MI) treated by primary percutaneous coronary intervention (PCI).

Background: Cardiovascular magnetic resonance has been used to detect and quantify MO in patients after acute MI but has never been compared with coronary blood flow velocity patterns.

Methods: Twenty-seven patients with first anterior ST-segment elevation MI successfully treated with primary PCI were included. Coronary blood flow velocity was measured during recatheterization 4 to 8 days after primary PCI. These measurements were related to MO determined by late gadolinium-enhanced (LGE) CMR performed the day before recatheterization.

Results: Early systolic retrograde flow was observed in 0 of 8 patients without MO on LGE CMR and in 10 (53%) of 19 patients with MO (p = 0.01). The extent of MO correlated with the diastolic-systolic velocity ratio (r = 0.44; p = 0.02), diastolic deceleration time (r = –0.61; p = 0.001), diastolic deceleration rate (r = 0.75; p < 0.0001), and coronary flow velocity reserve of the infarct-related artery (r = –0.44; p = 0.02). Furthermore, multivariate regression analyses, including extent of MO, infarct size, and transmural necrosis on LGE CMR, revealed that extent of MO was the only independent factor related to early systolic retrograde flow and diastolic deceleration rate.

Conclusions: Assessment of microvascular injury by LGE CMR corresponds well to evaluation by intracoronary Doppler flow measurements. By means of CMR, quantification of myocardial function, infarct size, and microvascular injury can accurately be performed with a single noninvasive technique in patients with acute MI.

Abbreviations and Acronyms   CFVR = coronary flow velocity reserve   CMR = cardiovascular magnetic resonance   DDR = diastolic deceleration ratio   LGE = late gadolinium-enhanced   LV = left ventricular   MI = myocardial infarction   MO = microvascular obstruction   PCI = percutaneous coronary intervention   SRF = early systolic retrograde flow   TIMI = Thrombolysis in Myocardial Infarction

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