Transthoracic Doppler Echocardiographic Assessment of Left Anterior Descending Coronary Artery and Intramyocardial Artery Predicts Left Ventricular Remodeling and Wall-motion Recovery After Acute Myocardial Infarction

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

BACKGROUND

Predicting the cardiac function in chronic phase of acute myocardial infarction (AMI) patients is important. Previous studies showed that the presence of early systolic reverse flow (ESRF) in coronary flow measured with a Doppler guide wire is a predictor of worsening chronic phase function in patients with anterior AMI. We routinely examined the coronary flow velocity (CFV) of the distal left anterior descending artery (LAD) using transthoracic echocardiography (TTE) in AMI patients. The aim of this study is to investigate whether the ESRF in TTE is associated with the chronic cardiac function, recovery of cardiac function, and the incidence of major adverse cardiac events (MACE) in patients with anterior AMI.

METHODS

We enrolled 84 patients with their first anterior AMI. Using TTE, we recorded the CFV of distal LAD within 5 days after primary percutaneous coronary intervention. Patients were divided into two groups, ESRF + group (ESRF was detected in TTE: 21 cases) and ESRF- group (ESRF was not detected in TTE: 63 cases). We compared chronic cardiac function in TTE, changes in cardiac function in acute and chronic phase (ΔLVEF, ΔLVDd), and the incidence of MACE.

RESULTS

The incidence of MACE in ESRF-group was lower than that in ESRF + group (3.3% vs 19.1% P = .02). LVEF in chronic phase in ESRF- group was higher than that in ESRF + group (54.1 ± 5.6% vs 40.4 ± 6.2% P < .001). ΔLVDd was smaller in ESRF-group than ESRF + group (-0.62 ± 4.0 mm vs +5.06 ± 3.4 mm P = .003).

CONCLUSION

Early systolic reverse flow in TTE is a predictor of chronic cardiac function and incidence of MACE in patients with anterior AMI.

[Usefulness of diastolic deceleration time assessed by transthoracic Doppler measurement in the detection of sustained microvascular obstruction in STEMI patients treated by primary PTCA]

AIMS

To assess the value of coronary flow measurement by transthoracic Doppler technique in the detection of "no-reflow" phenomenon.

METHODS

Fourteen patients with first anterior wall infarction treated by successful (TIMI3) primary percutaneous angioplasty and left descending coronary artery stenting were investigated. Myocardial perfusion following PCI was assessed by (i) ST-segment resolution, (ii) MRI-detected microvascular obstruction (early hypoenhancement), (iii) coronary flow pattern measurement by transthoracic Doppler technique.

RESULTS

Sustained impairment of myocardial perfusion following PCI was observed in a large proportion of the cohort (36% by MRI, 43% by ST regression analysis). Patients with a diastolic deceleration time inferior to 482 ms had higher troponin and CK peak value, higher wall motion index score, lower ST resolution and lower LVEF assessed by MRI. The concordance of the three methods was 80%.

CONCLUSION

The measurement of diastolic deceleration time by transthoracic Doppler technique is a reliable technique to identify microvascular obstruction following PCI in acute anterior STEMI. A DDT inferior to 482 ms is associated with sustained "no-reflow" phenomenon.

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

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< or =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.

Non-invasive coronary flow reserve after successful primary angioplasty for acute anterior myocardial infarction is an independent predictor of left ventricular recovery and in-hospital cardiac events

BACKGROUND

The prediction of left ventricular (LV) recovery and adverse cardiac events after reperfused acute myocardial infarction (AMI) is challenging. The aim of this study was to assess the usefulness of noninvasive coronary flow reserve (CFR) to predict LV recovery and in-hospital adverse cardiac events after AMI by comparison with other available tools.

METHODS

Fifty-five consecutive patients (mean age, 59 +/- 13 years; 33% women) with first reperfused ST-elevation anterior AMIs and sustained Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow underwent prospectively, < 24 hours after successful primary coronary angioplasty, standard echocardiography and noninvasive CFR assessment in the distal part of the left anterior descending coronary artery, using intravenous adenosine infusion, while in a stable hemodynamic situation. CFR was defined as peak hyperemic left anterior descending coronary artery flow velocity divided by baseline flow velocity. LV ejection fraction (LVEF) was measured using the biplane Simpson's rule. A no-reflow pattern was defined as diastolic deceleration time of basal diastolic coronary flow velocity < 600 ms and/or systolic flow reversal and recovery of LV function as an absolute increase of LVEF >or= 10% at 3-month follow-up. Adverse events were defined as the composite of death, recurrent AMI, and acute heart failure.

RESULTS

In the whole population, the mean LVEF was 46 +/- 5% at baseline and 55 +/- 9% at follow-up. Patients without LV recovery had more severely impaired CFR compared with those with LV recovery (2.1 +/- 0.55 vs 1.46 +/- 0.2, P < .001), as did patients with adverse events compared with those without events (P = .01). Furthermore, CFR was significantly correlated with 3-month LVEF and regional wall motion score (both P values < .01). On multivariate analysis, CFR was an independent predictor of global and regional LV function at follow-up (both P values <or= .01) and of in-hospital cardiac events (P = .02). Receiver-operating characteristic curve analysis demonstrated that a cutoff value of 1.7 for CFR yielded sensitivity of 76% and specificity of 96% to predict LV recovery at follow-up (P < .01).

CONCLUSION

Noninvasive CFR determined < 24 hours after AMI was an independent predictor of LV recovery at 3-month follow-up and of in-hospital adverse cardiac events.