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Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size

Laurent J. Feldman, MD, PhD^*, Dominique Himbert, MD^*, Jean-Michel Juliard, MD^*, Gaëtan J. Karrillon, MD^*, Hakim Benamer, MD^*, Pierre Aubry, MD^*, Olivier Boudvillain, MD^*, Patrick Seknadji, MD^*, Marc Faraggi, MD, PhD and Ph Gabriel Steg, MD, FACC^*

^* Department of Cardiology, Bichat Hospital, Paris, France
Department of Nuclear Medicine, Bichat Hospital, Paris, France

View larger version (65K): [in a new window]   Figure 1 ECG and coronary flow patterns in a patient with reperfusion syndrome. Primary PTCA of the mid-LAD was performed 245 min after the onset of chest pain. Panel A: Electrocardiogram pattern. Thirty s after reperfusion, the patient complained of increased chest pain. The ECG obtained at that moment shows additional elevation of ST segment in leads V2 to V4: sum of ST segment elevation (ST) increased from 13 to 31 mm. Panel B: Flow velocity pattern in the distal LAD 10 min after successful PTCA. On-line flow velocity spectrum and time-averaged peak velocity (APV) are displayed on the top screen. Bottom left and right screens indicate base (BAPV = 19 cm/s) and adenosine-induced hyperemic (PAPV = 26 cm/s) APVs, respectively. Residual coronary velocity reserve (RATIO) is 1.3. ECG = electrocardiogram; LAD = left anterior descending coronary artery; PTCA = percutaneous transluminal coronary angioplasty.

View larger version (62K): [in a new window]   Figure 2 Electrocardiogram and coronary flow patterns in a patient without reperfusion syndrome. Primary PTCA of the mid-LAD was performed 255 min after the onset of chest pain. Panel A: Electrocardiogram pattern. The patient experienced a gradual decline of chest pain. The ECG obtained 1 min after reperfusion shows a partial resolution of ST segment elevation in leads V1 to V4: sum of ST segment elevation (ST) decreased from 14 to 4 mm. Panel B: Flow velocity pattern in the distal LAD 10 min after successful PTCA. On-line flow velocity spectrum and time-averaged peak velocity (APV) are displayed on the top screen. Bottom left and right screens indicate base (BAPV = 17 cm/s) and adenosine-induced hyperemic (PAPV = 35 cm/s) APVs, respectively. Residual coronary velocity reserve (RATIO) is 2.0. ECG = electrocardiogram; LAD = left anterior descending coronary artery; PTCA = percutaneous transluminal coronary artery.

View larger version (22K): [in a new window]   Figure 3 Variation in individual flow velocities over time. Individual time-averaged peak velocities (APVs) under basal conditions (base) and adenosine-induced hyperemia (peak), after PTCA and at predischarge follow-up. Panel A: In patients with reperfusion syndrome (RS), basal APV is stable over time whereas hyperemic APV improves significantly. Panel B: Basal APV is stable over time, whereas peak APV does not increase significantly in patients without RS. Each box displays median and 95% confidence interval. *p < 0.005.

View larger version (23K): [in a new window]   Figure 4 Infarct size and LV function. Six weeks after AMI, patients with RS (hatched boxes) had a larger infarct size (% 201T1 defect) and a lower radionuclide LV ejection fraction (LVEF) than patients without RS (open boxes). Patients with RS had also a larger predischarge LV end-systolic volume index (LVESVi). Each box displays median and 95% confidence interval. *p = 0.001; p = 0.004.