title: Coronary flow velocity pattern assessed by transthoracic Doppler echocardiography predicts adverse clinical events and myocardial recovery after successful primary angioplasty.
abstract: BACKGROUND
  Doppler guidewire studies demonstrated that specific velocity patterns in the left anterior descending coronary artery (LAD) after primary percutaneous coronary intervention (PCI) predict myocardial recovery and clinical outcome. The present study assessed whether similar results can be achieved by transthoracic Doppler echocardiography (TTDE).
  
  
  METHODS
  Coronary flow velocities of LAD were evaluated by TTDE in 35 consecutive patients with anterior acute myocardial infarction who were treated with successful primary PCI plus stenting, performed within 6 h after the onset of symptoms or within 6-12 h if there was evidence of continuing ischaemia. Coronary-flow velocity of the LAD was achieved after 12 h and within 48 h after the PCI; TTDE standard examination was repeated after 2 months of follow-up.
  
  
  RESULTS
  Three patterns were found: (i) 'pattern A' with good antegrade systolic flow and slow diastolic deceleration rate (63.7%); (ii) 'pattern B' with reduced or absent systolic flow and rapid diastolic deceleration rate (9.1%); and (iii) 'pattern C' with protosystolic retrograde flow and rapid diastolic deceleration rate (27.2%). The clinical characteristics and echocardiographic data were compared: wall-motion-score-index (WMSI), ejection fraction, end-diastolic volume (EDV) after PCI (T1) and after 2 months (T2). Patients with pattern A demonstrated recovery of contractile function (WMSI-T1 1.48 + or - 0.42/WMSI-T2 1.29 + or - 0.29, P < 0.05) and better clinical outcome; patients with patterns B and C ran into ventricular remodelling (EDV-T1 89 + or - 6.3 ml/EDV-T2 123 + or - 25 ml, P = 0.002) and more early and late complications.
  
  
  CONCLUSIONS
  TTDE is a reliable method to achieve coronary flow velocities in LAD after an anterior acute myocardial infarction and it could be useful to evaluate no-reflow phenomenon at bedside and thus clinical outcome.
authors.affiliation: Division of Cardiology, Carlo Poma Hospital, via Albertoni, no. 1, 46100 Mantua, Italy. f_agostini@hotmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Agostini
authors.forename: Maria Alessandra
authors.initials: MA
authors.lastname: Iannone
authors.forename: Raffaele
authors.initials: R
authors.lastname: Mazzucco
authors.forename: Francesca
authors.initials: F
authors.lastname: Cionini
authors.forename: Nicola
authors.initials: N
authors.lastname: Baccaglioni
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.forename: Divo
authors.initials: D
authors.lastname: Belfanti
authors.forename: Luca
authors.initials: L
authors.lastname: Tomasi
authors.forename: Antonio
authors.initials: A
authors.lastname: Izzo
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Ferrari
authors.forename: Maria Cristiana
authors.initials: MC
authors.lastname: Brunazzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Zanini
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001783:Blood Flow Velocity; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011336:Probability; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome