title: Noninvasive evaluation of coronary reperfusion by transthoracic Doppler echocardiography in patients with anterior acute myocardial infarction before coronary intervention.
abstract: BACKGROUND
  Transthoracic Doppler echocardiography (TTDE) enables evaluation of distal left anterior descending coronary artery (LAD) flow. The purpose of this study was to test whether TTDE can differentiate coronary reperfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade < or =2 in patients with anterior acute myocardial infarction (AMI).
  
  
  RESULTS
  In 46 consecutive patients with a first anterior AMI in the acute phase before emergent coronary intervention, the presence of antegrade distal LAD flow and its diastolic peak velocity were evaluated by color and pulsed TTDE and compared with TIMI grades by subsequent coronary angiography performed 29+/-12 minutes later. Nineteen patients had TIMI 0 reperfusion, 4 had TIMI 1, 10 had TIMI 2, and 13 had TIMI 3. Visual antegrade distal LAD flow was present in 22 of the 46 patients. TIMI 2 and 3 reperfusions were both generally visualized by color TTDE. However, peak distal LAD flow velocity by pulsed TTDE was significantly greater in patients with TIMI 3 compared with those with TIMI 2 (40+/-10 vs 20+/-6 cm/s, P<0.0001). The diagnosis of TIMI 3 based on diastolic peak distal LAD flow velocity > or =25 cm/s by TTDE had a sensitivity, specificity, and accuracy of 77%, 94%, and 89%, respectively.
  
  
  CONCLUSIONS
  TTDE enables noninvasive differentiation of TIMI 3 from TIMI < or =2 coronary reperfusion in patients with AMI in the acute phase before emergent coronary intervention.
authors.affiliation: Division of Cardiology, Kagoshima City Hospital, 20-17 Kajiya, Kagoshima City, 890-8580, Japan. lee@ml.kch.kagoshima.kagoshima.jp
authors.forename: Souki
authors.initials: S
authors.lastname: Lee
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.forename: Shinichi
authors.initials: S
authors.lastname: Minagoe
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hamasaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Toyonaga
authors.forename: Midori
authors.initials: M
authors.lastname: Negishi
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsurugida
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Toda
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003971:Diastole; D004452:Echocardiography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity