Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices.
OBJECTIVE
Doppler guidewire studies demonstrated that the no-reflow phenomenon in acute myocardial infarction is associated with characteristic coronary blood flow pattern. We investigated the potential of coronary flow measurement with transthoracic Doppler technique to detect the no-flow in the patients with reperfused infarction, and compared it to that of other modalities.


RESULTS
We performed intracoronary myocardial contrast echocardiography after successful primary coronary intervention in the 94 patients with first, anterior wall infarction. Coronary blood flow in the left anterior descending artery was detected with transthoracic Doppler echocardiography within 24 h after reperfusion in 83 patients (88.3%). Twenty-two patients with the no-reflow had significantly lower systolic peak velocity (5.1 +/- 4.2 vs. 8.1 +/- 6.2 cm/s, p = 0.04), higher diastolic peak velocity (38.2 +/- 10.3 vs. 30.8 +/- 15.7 cm/s; p = 0.04), and shorter diastolic deceleration time (134 +/- 41 vs. 424 +/- 202 ms; p < 0.0001) than those with good-reflow. Systolic flow reversal was more frequently observed in those with no-reflow (18.2% vs. 3.3%, p = 0 .02). Diastolic deceleration time < 185 ms detected the no-reflow with far higher sensitivity/specificity (95.5%/95.1%) than TIMI frame count (45.5%/91.8%), ST resolution (54.5%/73.8%) and creatinine kinase-MB (54.5%/88.5%).


CONCLUSIONS
Analysing coronary blood flow pattern can detect the no-reflow after anterior infarction better than other angiographic, electrocardiographic and enzymatic modalities.
Iwakura
Katsuomi
K
Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
Ito
Hiroshi
H
Kawano
Shigeo
S
Okamura
Atsushi
A
Tanaka
Koji
K
Nishida
Yuya
Y
Maekawa
Yoshihiro
Y
Fujii
Kenshi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015425:Myocardial Reperfusion
D015415:Biomarkers; D003402:Creatine Kinase