Correlation Between Distal Left Anterior Descending Artery Flow Velocity by Transthoracic Doppler Echocardiography and Corrected TIMI Frame Count Before Mechanical Reperfusion in Patients With Anterior Acute Myocardial Infarction

Abstract

uick and accurate evaluation of coronary reperfusion in patients with acute myocardial infarction (AMI) is essential to determine whether thrombolysis and/or percutaneous coronary intervention (PCI) is required to achieve reperfusion. [1][2][3][4][5][6][7] Recent advancements in transthoracic Doppler echocardiography (TTDE) have enabled direct visualization and evaluation of coronary blood flow velocity, especially in the distal left anterior descending coronary artery (LAD). [8][9][10][11][12][13][14][15][16][17][18] This technique has been applied for noninvasive evaluation of Thrombolysis in Myocardial Infarction (TIMI) flow grade, which is widely used as a valuable index of coronary reperfusion. 19 Our previous study demonstrated that preserved coronary artery flow velocity as determined by TTDE enables differentiation of TIMI 3 from TIMI 0-2 in patients with anterior AMI before PCI. 20 However, the conventional TIMI classification is a semi-quantitative grading of coronary reperfusion after AMI and is thereby limited by its subjective and categorical nature. TIMI frame count by angiography is a simple, objective, reproducible and quantitative measure of coronary reperfusion 21 that allows for better prediction of clinical outcomes after AMI. 22 An intracoronary Doppler guidewire study has demonstrated that distal coronary flow velocity inversely correlates with the TIMI frame count before PCI. 23 Therefore, we hypothesized that the measurement of LAD flow velocity by TTDE would enable quantitative evaluation of the TIMI frame count by angiography in patients with anterior AMI. To test this hypothesis, we prospectively compared reperfused distal LAD flow velocity by TTDE with the TIMI frame count by angiography in patients with anterior AMI before mechanical reperfusion therapy. Methods Study GroupBetween August 2001 and November 2003, 56 consecutive patients at the Department of Cardiology, Kagoshima City Hospital with a first anterior AMI before mechanical reperfusion were enrolled in the study. Inclusion criteria were: (1) typical chest pain lasting >30 min and <12 h from onset; (2) ST-segment elevation >0.2 mV in precordial leads; (3) subsequent increase in serum creatine kinase ≥2- Methods and ResultsColor and pulsed TTDE was performed to evaluate distal left anterior descending coronary artery (LAD) reperfusion in 56 consecutive patients with a first anterior AMI before coronary intervention, and these findings were compared with the corrected TIMI frame count (cTFC) by subsequent angiography. Twenty-four of the 56 patients had LAD reperfusion (TIMI 2 or 3) by angiography. Visual antegrade distal LAD flow by color TTDE was detected in 21 of these 24 patients. In the 21 patients, diastolic peak velocity of the distal LAD flow by pulsed TTDE showed a significant correlation with cTFC by angiography (r=-0.74, p<0.001). The diagnosis of high risk with angiographic cTFC >40 by distal LAD peak velocity <21 cm/s using TTDE had a sensitivity, specificity, and accuracy of 82%, 93%, and 91%, respectively. Concl...

Effect of Enhanced External Counterpulsation on Coronary Slow Flow and Its Relation with Endothelial Function and Inflammation: A Mid-Term Follow-Up Study

“…More recently, in a preliminary study on EECP and CSF, we showed that coronary flow indices by TTDE correlated well with angiographic estimation of coronary flow [12]. The present study demonstrated that there was an excellent inverse correlation between resting DPFV and TFC for LAD (r = –0.821, p < 0.001), and CFR was inversely correlated with the mean TFC (r = –0.549, p < 0.001), which is consistent with our previous report and the results reported by Lee et al [18] and Caliskan et al [19]. These results suggested that CFV and CFR measured by TTDE could be reliable indices for assessing coronary flow in patients with CSF.…”

“…In these patients, coronary blood flow has often been quantitatively evaluated by TFC on coronary angiography [1,13,14], which is invasive and expensive, limiting its use in the clinical setting. TTDE is a noninvasive, relatively inexpensive and widely used method for measuring CFV and CFR in the distal LAD [18,19,20]. To our knowledge, however, the correlations between CFV measured by TTDE and angiographic TFC have not been fully elucidated in patients with CSF, although in a previous study in patients with anterior acute myocardial infarction before mechanical reperfusion [18], DPFV of the distal LAD by TTDE showed a significant correlation with corrected TFC by angiography (r = –0.74, p < 0.001), and Caliskan et al [19] reported a strong inverse correlation between TFC and CFR in patients with CSF (r = –0.62, p < 0.001).…”

“…TTDE is a noninvasive, relatively inexpensive and widely used method for measuring CFV and CFR in the distal LAD [18,19,20]. To our knowledge, however, the correlations between CFV measured by TTDE and angiographic TFC have not been fully elucidated in patients with CSF, although in a previous study in patients with anterior acute myocardial infarction before mechanical reperfusion [18], DPFV of the distal LAD by TTDE showed a significant correlation with corrected TFC by angiography (r = –0.74, p < 0.001), and Caliskan et al [19] reported a strong inverse correlation between TFC and CFR in patients with CSF (r = –0.62, p < 0.001). More recently, in a preliminary study on EECP and CSF, we showed that coronary flow indices by TTDE correlated well with angiographic estimation of coronary flow [12].…”

Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15 years

“…The CTFC method yields results that are concordant with other diagnostic modalities including transthoracic Doppler echocardiography (TTDE), single photon emission computerized tomography (SPECT), magnetic resonance imaging (MRI), intravascular ultrasound (IVUS) and intracoronary Doppler and pressure measurements [29][30][31][32]. Diastolic peak velocity of the distal LAD flow measured by pulsed TTDE has demonstrated a significant correlation with the CTFC (r = -0.74, P \ 0.001).…”

Non-Invasive Assessment of Coronary Arterial Tone Using Trans-Thoracic Doppler Echocardiography

“…Recently, the transthoracic Doppler echocardiography (TTDE) technique has emerged to take reliable measurements of the CFV and CFV reserve (CFVR) in the left anterior descending artery (LAD) using intravenous administration of adenosine 5'-triphosphate (ATP). [7][8][9] Accordingly, we evaluated the usefulness of TTDE for the non-invasive assessment of the coronary arterial tone in human LAD.…”