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.
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Figure 1 Examples of Coronary Flow Velocity Recordings and Corresponding LGE Images of Patients Without and With the Presence of Microvascular Injury
The coronary flow velocity spectrum (A) of Patient #1 shows antegrade systolic flow without early systolic retrograde flow (SRF) and a normal diastolic deceleration time (DDT). A corresponding short-axis late gadolinium-enhanced (LGE) image (B) shows transmurally infarcted myocardium (white arrows) in the anteroseptal wall without signs of microvascular injury. The flow velocity pattern (C) of Patient #2 demonstrates SRF followed by rapid deceleration of the diastolic flow, resulting in a high diastolic deceleration rate and short DDT. In the short-axis LGE image (D), the transmurally infarcted myocardium (white arrows) was complicated by an important area with microvascular injury (black arrows). LAD = left anterior descending coronary artery.
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Figure 2 Relationship Between DDR and the Extent of Microvascular Obstruction as Measured by CMR
Patients with (open triangles) or without (solid triangles) SRF are separately indicated. CMR = cardiovascular magnetic resonance; other abbreviations as in Figure 1.
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