Prediction of Myocardial Functional Recovery by Noninvasive Evaluation of Basal and Hyperemic Coronary Flow in Patients with Previous Myocardial Infarction

Djordjevic‐Dikic, Ana; Beleslin, Branko; Stepanović, Jelena; Tešić, Milorad; Dobrić, Milan; Stojković, Siniša; Nedeljković, Milan; Vukčević, Vladan; Dikić, Nenad; Petrasinovic, Zorica; Nedeljkovic, I.; Tomasević, M; Vujisić-Tešić, Bosiljka; Ostojić, Miodrag

doi:10.1016/j.echo.2011.01.004

Cited by 17 publications

(17 citation statements)

References 32 publications

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“…Generally, CFR>2 is taken for the normal cut-off in the most clinical situations. CFR during adenosine induced hyperemia and diastolic deceleration time provide prognostic information to standard clinical and echocardiography data for infarct size prediction and myocardial functional recovery [ 19 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

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The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI

Kostic¹,

Djordjevic‐Dikic

Dobrić

et al. 2015

Cardiovasc Ultrasound

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BackgroundNicorandil, as a selective potassium channel opener, has dual action including coronary and peripheral vasodilatation and cardioprotective effect through ischemic preconditioning. Considering those characteristics, nicorandil was suggested to reduce the degree of microvascular dysfunction.MethodsThirty-two patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI) were included in the study. Index of microvascular resistance (IMR) was measured in all patients immediatelly after pPCI before the after administration of Nicorandil. ST segment resolution was monitored before intervention and 60 min after terminating the procedure. Echocardiographic evaluation of myocardial function and transthoracic Doppler derived Coronary flow reserve (CFR) of infarct related artery (IRA) was performed during hospitalization and 3 months later.ResultsIMR was significantly lower after administration of Nicorandil (9.9 ± 3.7 vs. 14.1 ± 5.1, p < 0.001). There was significant difference in ST segment elevation before and after primary PCI with administration of Nicorandil (6.9 ± 3.7 mm vs. 1.6 ± 1.6 mm, p < 0.001). Transthoracic Doppler CFR measurement improved after 3 months (2.69 ± 0.38 vs. 2.92 ± 0.54, p = 0.021), as well as WMSI (1.14 ± 0.17 vs. 1.07 ± 0.09, p = 0.004).ConclusionIntracoronary Nicorandil administration after primary PCI significantly decreases IMR, resulting in improved CFR and ventricular function in patients with STEMI undergoing primary PCI.

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Section: Discussionmentioning

confidence: 99%

“…Flow velocity recordings were performed with the stable transducer position at rest and maximal hyperemia, which was induced by administration of intravenous adenosine (140 mcg/kg over 2 min). CFR was obtained as the ratio of peak diastolic flow velocity during vasodilation and diastolic flow velocity at baseline [ 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI

Kostic¹,

Djordjevic‐Dikic

Dobrić

et al. 2015

Cardiovasc Ultrasound

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“…All studies were digitally recorded and stored for off-line analysis by two experienced examiners blinded to patient clinical data. The intraobserver and interobserver variability for CFR LAD measurements in our laboratory is <10% [ 40 ].…”

Section: Methodsmentioning

confidence: 99%

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Trifunović

Stanković

Šobić-Šaranović

et al. 2014

Cardiovasc Diabetol

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BackgroundInsulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI).MethodsIn 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices.ResultsIR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026).ConclusionIR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.

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“…The cutoff value of 2 for CFR at a time point is useful but it probably less sensitive than its evolution over time to detect restenosis after angioplasty. Therefore, a reference value of CFR should be established in a patient to assess the follow-up value in this setting [22]. For postinfarction CFR assessment, the decreased CFR <1.5 predicts an increase in left ventricular volume (i.e., remodeling) after reperfused myocardial infarction [23].…”

Section: Clinical Applications Of Tde Cfr Angiographically Obstructivmentioning

confidence: 99%

Clinical Applications of Transthoracic Doppler Echocardiographic Coronary Flow Reserve Measurements in the Left Anterior Descending Coronary Artery

Hung

Cherng

2011

Journal of Medical Ultrasound

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KEY WORDScoronary flow reserve, left anterior descending coronary artery, Transthoracic Doppler echocardiography Transthoracic Doppler echocardiography (TDE) is a noninvasive tool for measuring coronary flow reserve in the epicardial coronary arteries. In the absence of stenosis in the epicardial coronary artery, TDE can detect impaired microvascular vasodilatation associated with diseases, including reperfused myocardial infarct, systemic arterial hypertension, diabetes mellitus, coronary vasospasm, microvascular angina, and hypertrophic cardiomyopathy by demonstrating a decrease in the coronary flow reserve. Because it is noninvasive, TDE allows for serial coronary flow reserve evaluations to explore the effect of various therapies. This noninvasive imaging technique expands the field of diagnostic echocardiography and brings new insight into the pathophysiology of ischemic heart disease. This review outlines rationale of TDE to evaluate coronary flow reserve in the left anterior descending coronary artery and discusses its clinical applications. ª

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Prediction of Myocardial Functional Recovery by Noninvasive Evaluation of Basal and Hyperemic Coronary Flow in Patients with Previous Myocardial Infarction

Cited by 17 publications

References 32 publications

The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI

The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Clinical Applications of Transthoracic Doppler Echocardiographic Coronary Flow Reserve Measurements in the Left Anterior Descending Coronary Artery

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