title: Pressure-derived fractional collateral blood flow: a primary determinant of left ventricular recovery after reperfused acute myocardial infarction.
abstract: OBJECTIVE
  We evaluated the relation between pressure-derived fractional collateral flow (PDCF) and left ventricular (LV) recovery after reperfused acute myocardial infarction (AMI).
  
  
  BACKGROUND
  The functional significance of collateral flow remains uncertain in AMI.
  
  
  METHODS
  The PDCF was measured in 70 patients with first AMI (pain onset <12 h) treated with primary angioplasty (PA), being determined by simultaneous measurement of mean aorta pressure (Pa), distal coronary pressure during the balloon occlusion (Poc), and central venous pressure (CVP): (Poc - CVP)/(Pa - CVP)*100. Sufficient collateral (group I) was defined as PDCF index >24% and insufficient collateral (group II) as PDCF index <24%. Echocardiography was performed before, and on day 3, day 7, and day 30 after PA. Wall-motion recovery index (RI) was obtained by dividing the number of improved wall-motion segments (>grade 1) at follow-up by the number of abnormal wall-motion segments within the infarct zone at baseline.
  
  
  RESULTS
  Baseline characteristics were similar between both groups. Peak levels of creatine kinase were lower in group I than in group II (2,600+/-1,900 U/liter vs. 4,100+/-3,000, p < 0.05). At one month, infarct zone wall-motion score index (1.65+/-0.54 vs. 2.31+/-0.46, p < 0.01) and LV volume indexes were smaller in group I than in group II, whereas, LV ejection fraction was higher in group I than in group II (52.8+/-8.3 vs. 45.9+/-9.0, p < 0.01). The PDCF index was the strongest predictor of RI at one month (r = 0.61, p < 0.01). Time to reperfusion was not related to RI at one month. However, it was significantly related to RI in group II (r = -0.34, p < 0.05).
  
  
  CONCLUSIONS
  The LV recovery after reperfused AMI is primarily determined by PDCF and is less dependent on time to reperfusion in patients with sufficient collaterals.
authors.affiliation: Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: C W
authors.initials: CW
authors.lastname: Lee
authors.forename: S W
authors.initials: SW
authors.lastname: Park
authors.forename: G Y
authors.initials: GY
authors.lastname: Cho
authors.forename: M K
authors.initials: MK
authors.lastname: Hong
authors.forename: J J
authors.initials: JJ
authors.lastname: Kim
authors.forename: D H
authors.initials: DH
authors.lastname: Kang
authors.forename: J K
authors.initials: JK
authors.lastname: Song
authors.forename: H J
authors.initials: HJ
authors.lastname: Lee
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001794:Blood Pressure / Q000502:physiology*; D003097:Collateral Circulation / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology*; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology* / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D003402:Creatine Kinase