Postinfarctional remodeling: increased dye intensity in the myocardial risk area after angioplasty of infarct-related coronary artery is associated with reduction of ventricular volumes.
OBJECTIVE
We sought to evaluate if angiographic dye videointensity of the risk area during percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery (IRA) relates to remodeling.


BACKGROUND
Poor reflow after myocardial infarction (MI) predicts worse ventricular remodeling.


METHODS
Fifty-three patients with a first anterior MI and isolated disease of the left anterior descending (LAD), who underwent "primary" (n = 14), "rescue" (n = 7) or "late" (after 10 +/- 4 days, n = 32) PTCA, were retrospectively selected. In 10 patients prospectively collected, we assessed Doppler flow velocities and Doppler flow reserve (DFR), relating them to the videointensity technique. Coronary stenosis and TIMI flow were determined, and echocardiographic volumes (end-diastolic and end-systolic volume indexes) and regional asynergy were computed before hospital discharge (baseline) and at six months. Assuming higher peak videointensity reflects greater myocardial blood volume, a 1- to 5-point (poor-optimal) perfusion scale was devised.


RESULTS
The correlation of Doppler peak velocity and DFR with videointensity was significant (r = 0.58, p = 0.007 and r = 0.71, p < 0.001, respectively). Patients were subdivided into group A (increased videointensity post-PTCA > or = 1.5 points, n = 29) and group B (unchanged videointensity, n = 24). Analysis of variance showed a time-group interaction for end-diastolic volume index (-4.6 +/- 23% vs. +22 +/- 22%, p = 0.003) and end-systolic volume index (-3.05 +/- 11.1% vs. +4.1 +/- 12.5%, p = 0.027). There was no interaction for changes in LAD stenosis (p = 0.39) and TIMI flow after PTCA (p = 0.27), or regional asynergy at six months (p = 0.31).


CONCLUSIONS
Angiographic dye videointensity in the risk area correlates with Doppler peak velocity and DFR, and its increase after PTCA of IRA has a limiting effect on ventricular volumes, independent of coronary stenosis resolution, changes in Thrombolysis In Myocardial Infarction (TIMI) flow or extent of regional asynergy.
Destro
G
G
Division of Cardiology, University of Verona, Italy.
Marino
P
P
Barbieri
E
E
Zorzi
A
A
Brighetti
G
G
Maines
M
M
Carletti
M
M
Zardini
P
P
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D003131:Combined Modality Therapy; D003287:Contrast Media / Q000493:pharmacokinetics*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007479:Iopamidol / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000378:metabolism; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015912:Thrombolytic Therapy; D020257:Ventricular Remodeling / Q000502:physiology*
D003287:Contrast Media; D007479:Iopamidol