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Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction

^b Second Department of Internal Medicine, University of Tokushima, Tokushima, Japan
^* the Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan

View larger version (102K): [in a new window]   Figure 1 Coronary flow velocity configuration immediately after successful primary coronary stenting in a representative patient (a 64-year-old man) with normal DSVR and without early systolic reverse flow. This patient had an obstructed lesion at the proximal left anterior descending coronary artery, was treated with direct coronary angioplasty and stenting and showed satisfactory dilation of the offending lesion angiographically during the acute phase (top panels). His coronary flow velocity pattern (bottom panel) improved distinctly after angioplasty and stenting (DSVR = 2.1). ACC = maximum acceleration of the instantaneous peak velocity; APV = averaged peak velocity; BAPV = baseline APV; DSVR = diastolic to systolic velocity ratio of coronary flow; MPV = maximum peak velocity; PAPV = hyperemic (peak) APV.

View larger version (101K): [in a new window]   Figure 2 Coronary flow velocity configuration in a representative patient (a 55-year-old man) with ESRF and an extremely high DSVR immediately after successful primary coronary stenting. An obstructed lesion is present at the same site in the left anterior descending coronary artery as in Figure 1 (top panels). He was also treated with primary coronary stenting and showed satisfactory dilation of the culprit lesion angiographically in the acute phase. However, his coronary flow velocity pattern (bottom panel) distinctly differed from that seen in Figure 1. He had almost no systolic antegrade flow, ESRF (arrows) and an extremely high DSVR (= 32). DSVR = diastolic to systolic velocity ratio of coronary flow; ESRF = early systolic reverse flow.

View larger version (31K): [in a new window]   Figure 3 The change in RWM between discharge and admission. The RWM is significantly larger in the non-ESRF group than it is in the ESRF group. ESRF = early systolic reverse flow; RWM = regional wall motion; SD = standard deviation.

View larger version (29K): [in a new window]   Figure 4 The change in EF between discharge and admission. The EF is significantly larger in the non-ESRF group than it is in the ESRF group. EF = ejection fraction; ESRF = early systolic reverse flow.

View larger version (11K): [in a new window]   Figure 5 Correlation between DSVR and the changes in RWM and EF for the patients with infarcts in the left anterior descending coronary artery territory. The DSVR correlated positively with the RWM (left panel) and with the EF (right panel) in the range of DSVR values <3.0. This correlation for RWM is stronger than that for EF. DSVR = diastolic to systolic velocity ratio of coronary flow; EF = ejection fraction; RWM = regional wall motion.