title: Index of microcirculatory resistance as predictor for microvascular functional recovery in patients with anterior myocardial infarction.
abstract: IMR is useful for assessing the microvascular dysfunction after primary percutaneous coronary intervention (PCI). It remains unknown whether index of microcirculatory resistance (IMR) reflects the functional outcome in patients with anterior myocardial infarction (AMI) with or without microvascular obstruction (MO).This study was performed to evaluate the clinical value of the IMR for assessing myocardial injury and predicting microvascular functional recovery in patients with AMI undergoing primary PCI. We enrolled 34 patients with first anterior AMI. After successful primary PCI, the mean distal coronary artery pressure (P(a)), coronary wedge pressure (P(cw)), mean aortic pressure (P(a)), mean transit time (T(mn)), and IMR (P(d)* hyperemic T(mn)) were measured. The presence and extent of MO were measured using cardiac magnetic resonance image (MRI). All patients underwent follow-up echocardiography after 6 months. We divided the patients into two groups according to the existence of MO (present; n = 16, absent; n = 18) on MRI. The extent of MO correlated with IMR (r = 0.754; P < 0.001), P(cw) (r = 0.404; P = 0.031), and P(cw)/P(d) of infarct-related arteries (r = 0.502; P = 0.016). The IMR was significantly correlated with the ΔRegional wall motion score index (r = -0.61, P < 0.01) and ΔLeft ventricular ejection fraction (r = -0.52, P < 0.01), implying a higher IMR is associated with worse functional improvement. Therefore, Intracoronary wedge pressures and IMR, as parameters for specific and quantitative assessment of coronary microvascular dysfunction, are reliable on-site predictors of short-term myocardial viability and Left ventricle functional recovery in patients undergoing primary PCI for AMI.
authors.affiliation: Department of Cardiology, Kwandong University School of Medicine, Goyang, Korea.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Yoo
authors.forename: Tae-Kyung
authors.initials: TK
authors.lastname: Yoo
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000503:physiopathology*; D062186:Arterial Pressure / Q000502:physiology; D054059:Coronary Occlusion / Q000473:pathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors