Relation between the assessment of microvascular injury by cardiovascular magnetic resonance and coronary Doppler flow velocity measurements in patients with acute anterior wall myocardial infarction.
OBJECTIVE
We studied the relation between presence and severity of microvascular obstruction (MO), measured by cardiovascular magnetic resonance (CMR) and intracoronary Doppler flow measurements, for assessment of myocardial reperfusion in patients with acute anterior myocardial infarction (MI) treated by primary percutaneous coronary intervention (PCI).


BACKGROUND
Cardiovascular magnetic resonance has been used to detect and quantify MO in patients after acute MI but has never been compared with coronary blood flow velocity patterns.


METHODS
Twenty-seven patients with first anterior ST-segment elevation MI successfully treated with primary PCI were included. Coronary blood flow velocity was measured during recatheterization 4 to 8 days after primary PCI. These measurements were related to MO determined by late gadolinium-enhanced (LGE) CMR performed the day before recatheterization.


RESULTS
Early systolic retrograde flow was observed in 0 of 8 patients without MO on LGE CMR and in 10 (53%) of 19 patients with MO (p = 0.01). The extent of MO correlated with the diastolic-systolic velocity ratio (r = 0.44; p = 0.02), diastolic deceleration time (r = -0.61; p = 0.001), diastolic deceleration rate (r = 0.75; p < 0.0001), and coronary flow velocity reserve of the infarct-related artery (r = -0.44; p = 0.02). Furthermore, multivariate regression analyses, including extent of MO, infarct size, and transmural necrosis on LGE CMR, revealed that extent of MO was the only independent factor related to early systolic retrograde flow and diastolic deceleration rate.


CONCLUSIONS
Assessment of microvascular injury by LGE CMR corresponds well to evaluation by intracoronary Doppler flow measurements. By means of CMR, quantification of myocardial function, infarct size, and microvascular injury can accurately be performed with a single noninvasive technique in patients with acute MI.
Hirsch
Alexander
A
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. a.hirsch@amc.uva.nl
Nijveldt
Robin
R
Haeck
Joost D E
JD
Beek
Aernout M
AM
Koch
Karel T
KT
Henriques
José P S
JP
van der Schaaf
Rene J
RJ
Vis
Marije M
MM
Baan
Jan
J
de Winter
Robbert J
RJ
Tijssen
Jan G P
JG
van Rossum
Albert C
AC
Piek
Jan J
JJ
D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003971:Diastole; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D018608:Ultrasonography, Doppler
D005682:Gadolinium