title: Coronary flow of the infarct artery assessed by transthoracic Doppler after primary percutaneous coronary intervention predicts final infarct size.
abstract: Coronary microcirculatory function after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction is important determinant of infarct size (IS). Our aim was to investigate the utility of coronary flow reserve (CFR) and diastolic deceleration time (DDT) of the infarct artery (IRA) assessed by transthoracic Doppler echocardiography after pPCI for final IS prediction. In 59 patients, on the 2nd day after pPCI for acute anterior myocardial infarction, transthoracic Doppler analysis of IRA blood flow was done including measurements of CFR, baseline DDT and DDT during adenosine infusion (DDT adeno). Killip class, myocardial blush grade, resolution of ST segment elevation, peak creatine kinase-myocardial band and conventional echocardiographic parameters were determined. Single-photon emission computed tomography myocardial perfusion imaging was done 6 weeks later to define final IS (percentage of myocardium with fixed perfusion abnormality). IS significantly correlated with CFR (r = -0.686, p < 0.01), DDT (r = -0.727, p < 0.01), and DDT adeno (r = -0.780, p < 0.01). CFR and DDT adeno in multivariate analysis remained independent IS predictors after adjustment for other covariates and offered incremental prognostic value in models based on conventional clinical, angiographic, electrocardiographic and enzymatic variables. In predicting large infarction (IS > 20 %), the best cut-off for CFR was <1.73 (sensitivity 65 %, specificity 96 %) and for DDT adeno ≤720 ms (sensitivity 81 %, specificity 96 %). CFR and DDT during adenosine are independent and powerful early predictors of final IS offering incremental prognostic information over conventional parameters of myocardial and microvascular damage and tissue reperfusion.
authors.affiliation: Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia, danijelatrif@yahoo.com.
authors.forename: Danijela
authors.initials: D
authors.lastname: Trifunovic
authors.forename: Dragana
authors.initials: D
authors.lastname: Sobic-Saranovic
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.forename: Sanja
authors.initials: S
authors.lastname: Stankovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
authors.forename: Dejan
authors.initials: D
authors.lastname: Orlic
authors.forename: Bosiljka
authors.initials: B
authors.lastname: Vujisic-Tesic
authors.forename: Milan
authors.initials: M
authors.lastname: Petrovic
authors.forename: Ivana
authors.initials: I
authors.lastname: Nedeljkovic
authors.forename: Marko
authors.initials: M
authors.lastname: Banovic
authors.forename: Nina
authors.initials: N
authors.lastname: Djukanovic
authors.forename: Olga
authors.initials: O
authors.lastname: Petrovic
authors.forename: Marija
authors.initials: M
authors.lastname: Petrovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Stepanovic
authors.forename: Ana
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.forename: Milorad
authors.initials: M
authors.lastname: Tesic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojic
mesh_terms: D000241:Adenosine; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D052279:Creatine Kinase, MB Form / Q000097:blood; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055771:Serbia; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D015415:Biomarkers; D014665:Vasodilator Agents; D052279:Creatine Kinase, MB Form; D000241:Adenosine
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