Relation between Perfusion Status of Dysfunctional Myocardium and Coronary Flow Reserve in Acute Myocardial Infarction

Lim, Do Sun; Kim, Young Hoon; Lee, Hyun Su; Lim, Hong Euy; Kim, Byung Hoe; Lee, Seung Jin; Lee, Eun Mi; Ahn, Jeong Cheon; Song, Woo Hyuck; Park, Chang Gyu; Seo, Hong Seog; Shim, Wan Joo; Oh, Dong Joo; Ro, Young Moo

Abstract

BACKGROUND
Dydfunction of microvasculature was frequently observed despite of successful revascularization with alteration of coronary flow dynamics flow dynamics in acute myocardial infarction (AMI). Reduction of coronary vasodilatory reserve was found in poorly perfused infarcted myocardium. The objectives of this study was to evaluate the vasodilatory reserve in infarcted myocardium and determind its relationship to perfusion status of myocardium in early recovery phase of acute myocardial infarction.
METHODS
The study subjects consisted of 14 patients with anterior AMI&and 6 controls with atypical chest pain and have normal coronary artery. The coronary flow pattern was assessed using intracoronary Doppler wire and vasodilatory reserve was measured after injection of 18ug of adenosine to infarct-related artery after successful revascularization by percutaneous angioplasty at average 11 days post-AMI After measurement of coronary blood flow pattern, myocardial perfusion status was evaluated by myocardial contrast echocardiography (MCE). Perfusion status by MCE was analysed semiquantitatively and compared to various parameters of coronary flow and vasodilatory reserve of infarct-related artery.
RESULTS
After successful revascularization, perfusion defect by MCE was observed in 50% (n=7) of patients. The vasodilatory reserve was lower in patients with perfusion defect by MCE than those of patients without perfusion defect (p<0.05) and control (p<0.05). There was no difference in coronary flow reserve between patients with no perfusion defect and controls (p=0.54). Coronary flow reserve was more than 2.0 in patients with no perfusion defect and was below 2.0 in patients with perfusion defect except one patients. Coronary flow reserve correlated well with the degree of contrast opacification of left anterior descending artery territory (r=0.80, p=0.005). The increments of peak distolic velocity (r=0.63, p=0.016 vs r=0.3, p=0.29).
CONCLUSIONS
These data showed a good correlation of coronary flow reserve with the degree of myocardial perfusion in patients of reperfused acute myocardial infarction. The increments of peak diastolic velocity was important to maintain the coronary flow than that of systolic peak velocity. This suggest that the measurement of vasodilatory reserve by intracoronary Doppler wire is a good method to assess the perfusion status of infarcted myocardium in early recovery phase of AMI.