Yonsei Med J.  2014 Jul;55(4):904-911. 10.3349/ymj.2014.55.4.904.

Coronary Flow Reserve in the Remote Myocardium Predicts Left Ventricular Remodeling Following Acute Myocardial Infarction

• Cheng R
• Wei G
• Yu L
• Su Z
• Wei L
• Bai X
• Tian J
• Li X

• KMID: 2130813
• DOI: http://doi.org/10.3349/ymj.2014.55.4.904

Abstract

PURPOSE
Coronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI.
MATERIALS AND METHODS
We enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration.
RESULTS
CFR was 1.55+/-0.11 in the infarcted zone and 2.05+/-0.31 in the remote zone (p<0.01) at one week following AMI. According to CFR values in the remote zone, all patients were divided into two groups: Group I (CFR <2.05) and Group II (CFR >2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty.
CONCLUSION
Microvascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

Keyword

Myocardial infarction; microvascular dysfunction; left ventricular remodeling

MeSH Terms

Aged
Coronary Angiography
Coronary Circulation/physiology
Female
Humans
Male
Middle Aged
Myocardial Infarction/*physiopathology/radiography
Myocardium/*pathology
Ventricular Remodeling/*physiology

Figure

• 

  Fig. 1 MBF and CFR in the infarcted and remote regions. (A) Both at baseline and after low dose dobutamine administration, MBF in remote region was significantly higher than in the infarcted region. (B) Comparison of CFR in infarcted and remote regions. Mean CFR of the remote region was significantly higher than the infarcted region. MBF, myocardial blood flow; CFR, coronary flow reserve.

• 

  Fig. 2 MBF and CFR in the remote and normal regions. (A) No difference was observed in MBF between the remote regions in normal subjects at baseline. At peak stress, MBF in normal subjects was significantly increased compared to the remote region. (B) Correlation between CFR in the remote and normal regions. Mean CFR was higher than in the remote region. MBF, myocardial blood flow; CFR, coronary flow reserve.

• 

  Fig. 3 Correlation analyses of CFR in the remote region. (A) There was a significant negative correlation between CFR in the remote region and LVEDV at six months. Impaired CFR leads to a significant increase in LVEDV at follow up. (B) Correlation between CFR and LVESV. There was a significant negative correlation between CFR in the remote region and LVESV. (C) Correlation between CFR and LVEF. There was a positive correlation between CFR and LVEF at follow up. CFR, coronary flow reserve; LVEDV, left ventricular end diastolic volume; LVESV, left ventricular end systolic volume; LVEF, left ventricular ejection fraction.

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