Detection of TIMI-3 flow before mechanical reperfusion with ultrasonic tissue characterization in patients with anterior wall acute myocardial infarction.
BACKGROUND
Spontaneous coronary reperfusion with TIMI-3 flow is associated with favorable clinical outcomes in patients with acute myocardial infarction (AMI). We investigated the ability of analyzing cardiac cycle-dependent variation of myocardial integrated backscatter (IBS) for predicting spontaneous reperfusion in anterior AMI.


RESULTS
We recorded IBS images on admission in 104 patients with first anterior wall AMI and subsequently performed coronary angiography and coronary intervention. We measured the cyclic variation of IBS within the infarct zone and expressed its magnitude as phase-corrected magnitude (PCM) by giving positive and negative values when it showed synchronous and asynchronous contraction, respectively. Twenty-three patients showing TIMI-3 flow at the initial coronary angiography had smaller peak creatine kinase value than 57 patients with initial TIMI-0/1 flow (864+/-961 versus 2358+/-1757 IU/L; P=0.0002) and better percent wall thickening within risk area (36.1+/-15.1%) than those with TIMI-2 (16.7+/-12.8%, P<0.0001) or TIMI-0/1 (5.1+/-11.6, P<0.0001). The patients with initial TIMI-3 had higher PCM (2.7+/-1.3 dB) than those with TIMI-2 (-0.3+/-2.2 dB, P<0.0001) or those with TIMI-0/1 (-1.1+/-2.4 dB, P<0.0001). Using PCM=1.0 dB as the cutoff point, PCM detected TIMI-3 flow with 95.7% sensitivity and 90.1% specificity. Multivariable logistic regression analysis revealed that only PCM is an independent predictor for spontaneous reperfusion among the hemodynamic, echocardiographic, and electrocardiographic variables.


CONCLUSIONS
Analysis of myocardial IBS could detect spontaneous reperfusion noninvasively in the emergent stage of anterior AMI.
Iwakura
Katsuomi
K
Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
Ito
Hiroshi
H
Kawano
Shigeo
S
Okamura
Atsushi
A
Asano
Katsuaki
K
Kuroda
Tadashi
T
Tanaka
Koji
K
Masuyama
Tohru
T
Hori
Masatsugu
M
Fujii
Kenshi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D015425:Myocardial Reperfusion; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D015203:Reproducibility of Results; D016896:Treatment Outcome