Plain computed tomography for assessment of early coronary microcirculatory damage after revascularization therapy in acute myocardial infarction.
BACKGROUND
Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The relationship between myocardial contrast enhancement and coronary microcirculatory damage was investigated in the present study.


RESULTS
Thirteen patients with acute anterior MI underwent successful coronary revascularization within 6 h of symptom onset were enrolled. The coronary flow velocity pattern was measured using a Doppler guidewire and chest CT assessments were performed immediately after coronary revascularization. The ratio of mean CT number of the highest-enhanced myocardial area and the lumen of the left ventricle was defined as a relative CT number. The relative CT number significantly correlated with coronary diastolic deceleration time (r=-0.78, p<0.002) and coronary diastolic deceleration rate (r=0.74, p<0.04). It also correlated with peak myocardial enzyme release in plasma.


CONCLUSIONS
Myocardial contrast enhancement detected using plain CT just after coronary reperfusion therapy implies coronary microcirculatory damage in acute MI. The relative CT number is useful in evaluating the impaired coronary microcirculatory state.
Kato
Masaya
M
Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima 731-0221, Japan. ms-katou@asa-hosp.city.hiroshima.jp
Dote
Keigo
K
Sasaki
Shota
S
Ueda
Kentaro
K
Goto
Kenji
K
Takemoto
Hiroaki
H
Habara
Seiji
S
Hasegawa
Daiji
D
Matsuda
Osamu
O
Nakano
Yoshinori
Y
Naganuma
Toru
T
D000208:Acute Disease; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000503:physiopathology*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media