Assessment of Coronary Artery Flow Velocity Pattern as a Long-Term Predictor of Left Ventricular Function and Cardiac Events after Percutaneous Coronary Intervention in Anterior Acute Myocardial Infarction

Abstract

Background Coronary flow velocity (CFV) can be used to assess short-term left ventricular function recovery and the clinical prognosis of patients with acute myocardial infarction (AMI). We evaluated CFV as a predictor of long-term left ventricular function recovery and cardiac events in patients with anterior wall AMI. Methods and Results CFV pattern of the distal left anterior descending (LAD), wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) were recorded at the points of time within 24 hours, 3 days, 6 months, and 3 years after percutaneous coronary intervention (PCI) in 50 consecutive patients with anterior wall AMI. The clinical data were collected. Patients were divided into two groups based on diastolic deceleration time (DDT) 3 days after PCI. Compared with 3 days, LVEF and WMSI in group A (DDT>600 ms, n=20) improved in 6 months and 3 years (p<0.01), but they were unchanged in group B (DDT!600 ms, n=30). The incidence of cardiac events was higher in group B than in group A during 6 months (p<0.01). With a 3-year follow up, the incidence of chronic heart failure was higher in group B than in group A (p= 0.009). Conclusion CFV could be used as a predictor of long-term left ventricular function recovery and cardiac events in patients with anterior wall AMI.

Clinical significance of early systolic reverse flow in left anterior descending coronary artery on transthoracic echocardiography in patients with acute myocardial infarction

“…From the coronary flow velocity obtained in this way (Figure 1), we evaluated the presence or absence of ESRF. Early systolic reversal flow (ESRF) was defined as a coronary flow reversal showing a peak velocity 10 cm/s and duration 60 msec at early systole 3,4 (Figure 1). We also recorded diastolic deceleration time (DDT) with TTE.…”

“…Previous studies have reported that visualization of coronary flow velocity of LAD was possible in 97% of patients. 4 A learning curve is needed to visualize coronary flow velocity of distal LAD. In addition, it is necessary to be aware that in obese patients and chronic obstructive pulmonary disease patients, it is difficult to visualize coronary flow velocity of distal LAD.…”

Η Συσχέτιση Των Μεταβολών Της Στεφανιαίας Ροής Και Των Φλεγμονωδών Δεικτών Με Τις Βλάβες Της Μυοκαρδιακής Μικρο-Κυκλοφορίας Και Την Αναδιαμόρφωση Της Αριστερής Κοιλίας Σε Πειραματικό Μοντέλο Ισχαιμίας-Επαναιμάτωσης

“…[279] Αντίστοιχα και σε άλλη μελέτη με τακτική παρακολούθηση από 24 ώρες έως 3 χρόνια, η DDT αποτέλεσε προγνωστικό παράγοντα της λειτουργικότητας του μυοκαρδίου. [280] Οι Iwakura Κ και συν, καθόρισαν τα κυριότερα χαρακτηριστικά της στεφανιαίας ροής σε ασθενείς με no-reflow φαινόμενο, όπως είναι η αναστροφή και η μείωση της συστολική ροής καθώς και η ταχεία κλίση της διαστολικής ροής, που αποδόθηκαν στην αύξηση της αντίστασης στη μικροκυκλοφορίας και στη μείωση του μυοκαρδιακού όγκου αίματος. [281][282][283] Παρόμοια ευρήματα παρουσίασαν και οι Lepper W συν, μελετώντας τη στεφανιαία ροή αμέσως μετά την πρωτογενή αγγειοπλαστική και σε 24 ώρες.…”