Korean Circ J.  2007 Nov;37(11):581-589. 10.4070/kcj.2007.37.11.581.

Correlation between Thrombolysis in Myocardial Infarction, the Myocardial Perfusion Grade and the Myocardial Viability Indices after Primary Percutaneous Coronary Intervention in ST Segment Elevation Myocardial Infarction

• Woo SI
• Tahk SJ
• Yoon MH
• Choi SY
• Choi BJ
• Lim HS
• Yang HM
• Hwang GS
• Shin JH
• Kang SJ
• Choi UJ
• Hwang JW
• Seo GW
• Kim JW
• Park JS

• KMID: 1909620
• DOI: http://doi.org/10.4070/kcj.2007.37.11.581

Abstract

BACKGROUND AND OBJECTIVES: The thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) is associated with the long term clinical outcomes. This study compared the TMPG with the myocardial viability as determined by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and with improvement of the left ventricular (LV) function on echocardiography.
SUBJECTS AND METHODS
We enrolled 44 consecutive patients (37 men: age 56+/-11 years) who underwent primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). We assessed the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the coronary wedge pressure (Pcw) and the coronary wedge pressure/mean aortic pressure (Pcw/Pa). All the patients underwent FDG-PET scans on the 7th day after primary PCI. The patients were divided into 3 groups according to the TMPG (TMPG 0/1: n=18, TMPG 2: n=14, TMPG 3: n=12).
RESULTS
There was a significant correlation between the TMPG and the CFR, DDT, Pcw and Pcw/Pa (r=0.367, p=0.017; r=0.587, p<0.001; r=-0.513, p<0.001; r=-0.614, p<0.001, respectively). There was a significant correlation between the TMPG and the % of FDG uptake (r=0.587, p<0.001) and the patients with TMPG 3 had the most favorable % of FDG uptake (TMPG 0/1 vs TMPG 2 vs TMPG 3; 42.0+/-12.3% vs 53.9+/-11.2% vs 59.3+/-13.3%, p=0.001). On echocardiography, the patients with TMPG 3 revealed an improvement of the LV ejection fraction (53.4+/-9.9% vs 60.0+/-7.0%, p=0.004) and the patients with TMPG 2 and TMPG 3 revealed improvement of their regional wall motion abnormality (RWMA) index (1.44+/-0.26 vs 1.24+/-0.18, p=0.022; 1.35+/-0.26 vs 1.15+/-0.18, p=0.018, respectively).
CONCLUSION
The angiographically determined TMPG might be clinically useful for the assessment of myocardial viability and it might be a useful predictor for improvement of the LV function in patients suffering with STEMI.

Keyword

Myocardial infarction; Perfusion; Left ventricular function; Angioplasty

MeSH Terms

Angioplasty
Arterial Pressure
DDT
Deceleration
Echocardiography
Humans
Male
Myocardial Infarction*
Percutaneous Coronary Intervention*
Perfusion*
Positron-Emission Tomography
Pulmonary Wedge Pressure
Ventricular Function, Left
DDT

Figure

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  Fig. 1 The correlation between TMPG and microvascular indices. There were significant correlation between TMPG and CFR, DDT, Pcw, Pcw/Pa. TMPG: TIMI myocardial perfusion grade, CFR: coronary flow reserve, DDT: diastolic deceleration time, Pcw: coronary wedge pressure, Pa: mean aortic pressure.

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  Fig. 2 The relationship between TMPG and % FDG uptake. There was a significant correlation between TMPG and % FDG uptake. FDG: 18F-fluorodeoxyglucose, TMPG: TIMI myocardial perfusion grade.

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  Fig. 3 Comparison of left ventricular function between at admission and at follow-up. There was a significant improvement of EF (A) in the group 3 and a significant improvement of RWMA (B) in the group 2, 3. EF: ejection fraction, RWMA: regional wall motion abnormality.

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