title: Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size.
abstract: OBJECTIVE
  We tested the hypothesis that the reperfusion syndrome (RS), defined as an additional elevation of the ST segment upon reperfusion, may be a marker of microcirculatory reperfusion injury during acute myocardial infarction (AMI).
  
  
  BACKGROUND
  The pathophysiology of the RS is unknown, and its prognostic implications are controversial.
  
  
  METHODS
  Twenty-one patients with an anterior AMI treated < or =12 h after onset by primary coronary angioplasty (PTCA) were studied. Coronary velocity reserve (CVR), an index of microcirculatory function, was measured using a Doppler guidewire. Left ventricular (LV) ejection fraction, infarct size (percent defect) and LV end-systolic volume index (LVESVi) were evaluated by radionuclide ventriculography, 201T1 single-photon emission computed tomography and contrast ventriculography, respectively.
  
  
  RESULTS
  Baseline ST elevation and pain-to-TIMI 3 time were similar in patients with and without RS. Patients with RS (10/21) had a lower post-PTCA CVR than patients without RS (median [95% confidence interval]: 1.2 [1-1.3] vs. 1.6 [1.5-1.7], p < 0.005). Even though predischarge CVR was similar in the two groups, infarct size at six weeks (26 [21 to 37] vs. 14 [10-17]% 201T1 defect, p = 0.001) and predischarge LVESVi (45% [40 to 52] vs. 30% [29 to 38] mL/m2, p = 0.001) were larger, and LV ejection fraction at six weeks (40% [37 to 46] vs. 55% [50 to 60], p = 0.004) was lower in patients with RS than in patients without RS.
  
  
  CONCLUSIONS
  Patients with RS during primary PTCA for an anterior AMI have a transiently lower CVR than patients without RS, but sustained LV dysfunction and larger infarct size, suggesting that RS is a marker of microcirculatory reperfusion injury.
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France. laurent.feldman@bch.ap-hop-paris.fr
authors.forename: L J
authors.initials: LJ
authors.lastname: Feldman
authors.forename: D
authors.initials: D
authors.lastname: Himbert
authors.forename: J M
authors.initials: JM
authors.lastname: Juliard
authors.forename: G J
authors.initials: GJ
authors.lastname: Karrillon
authors.forename: H
authors.initials: H
authors.lastname: Benamer
authors.forename: P
authors.initials: P
authors.lastname: Aubry
authors.forename: O
authors.initials: O
authors.lastname: Boudvillain
authors.forename: P
authors.initials: P
authors.lastname: Seknadji
authors.forename: M
authors.initials: M
authors.lastname: Faraggi
authors.forename: G
authors.initials: G
authors.lastname: Steg
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000209:etiology* / Q000503:physiopathology*; D011379:Prognosis; D015635:Radionuclide Ventriculography; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers