title: Repeated assessment of coronary flow velocity pattern in patients with first acute myocardial infarction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the coronary blood flow velocity pattern immediately and 24 h after percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) in relation to myocardial reperfusion and follow-up left ventricular (LV) function.
  
  
  BACKGROUND
  Analysis of coronary blood flow velocity pattern after AMI may provide information about microvascular damage and the occurrence of a reperfusion injury.
  
  
  METHODS
  Measurement of coronary blood flow velocity pattern was performed immediately after PTCA and after 24 h in 25 patients with first AMI using a Doppler guidewire. Measurements were related to reperfusion determined by intravenous myocardial contrast echocardiography (MCE) performed before PTCA and at 24 h and to LV function at four weeks.
  
  
  RESULTS
  Using MCE, 13 patients showed reperfusion and 12 patients showed nonreperfusion. Compared with patients with reperfusion, patients with MCE nonreperfusion had a lower systolic peak flow velocity immediately after PTCA (10.0 +/- 0.3 cm/s vs. 19.3 +/- 0.8 cm/s, respectively) and after 24 h (12.3 +/- 0.4 cm/s vs. 21.3 +/- 0.1 cm/s, respectively, p = 0.0022), more frequent early systolic retrograde flow (6/12 vs. 0/13, p = 0.0052 immediately after PTCA and 24 h later) and a shorter diastolic deceleration time immediately after PTCA (483 +/- 6 ms vs. 737 +/- 0 ms, respectively) and after 24 h (551 +/- 9 ms vs. 823 +/- 2 ms, respectively, p = 0.0091). Similarly, patients with impaired LV function at four weeks had altered coronary flow pattern compared with patients with preserved function. The coronary flow velocity pattern showed a tendency for improvement after 24 h in the reperfusion and the nonreperfusion groups.
  
  
  CONCLUSIONS
  The coronary flow velocity pattern immediately and 24 h after PTCA for AMI relates to myocardial perfusion determined by MCE and LV function at four weeks. The flow velocity pattern shows slight improvement during the first 24 h after revascularization, indicating the absence of a major reperfusion injury.
authors.affiliation: Medical Clinic I, University Hospital RWTH, Aachen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lepper
authors.forename: Gertjan Tj
authors.initials: GT
authors.lastname: Sieswerda
authors.forename: Andreas
authors.initials: A
authors.lastname: Franke
authors.forename: Nicole
authors.initials: N
authors.lastname: Heussen
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Carel C
authors.initials: CC
authors.lastname: de Cock
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
authors.forename: Paolo
authors.initials: P
authors.lastname: Voci
authors.forename: Cees A
authors.initials: CA
authors.lastname: Visser
authors.forename: Peter
authors.initials: P
authors.lastname: Hanrath
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology; D015331:Cohort Studies; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D015425:Myocardial Reperfusion; D013223:Statistics as Topic; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology