1
|
LeBlanc AJ, Hoying JB. Adaptation of the Coronary Microcirculation in Aging. Microcirculation 2016; 23:157-67. [DOI: 10.1111/micc.12264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Amanda J. LeBlanc
- Department of Physiology; Cardiovascular Innovation Institute; University of Louisville; Louisville Kentucky USA
| | - James B. Hoying
- Department of Physiology; Cardiovascular Innovation Institute; University of Louisville; Louisville Kentucky USA
| |
Collapse
|
2
|
Echavarría-Pinto M, Serruys PW, Garcia-Garcia HM, Broyd C, Cerrato E, Macaya C, Escaned J. Use of intracoronary physiology indices in acute coronary syndromes. Interv Cardiol 2015. [DOI: 10.2217/ica.15.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
3
|
Leblanc AJ, Nguyen QT, Touroo JS, Aird AL, Chang RC, Ng CK, Hoying JB, Williams SK. Adipose-derived cell construct stabilizes heart function and increases microvascular perfusion in an established infarct. Stem Cells Transl Med 2013; 2:896-905. [PMID: 24106337 DOI: 10.5966/sctm.2013-0046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We have previously shown that myocardial infarction (MI) immediately treated with an epicardial construct containing stromal vascular fraction (SVF) from adipose tissue preserved microvascular function and left ventricle contractile mechanisms. In order to evaluate a more clinically relevant condition, we investigated the cardiac recovery potential of an SVF construct implanted onto an established infarct. SVF cells were isolated from rat adipose tissue, plated on Vicryl, and cultured for 14 days. Fischer-344 rats were separated into MI groups: (a) 6-week MI (MI), (b) 6-week MI treated with an SVF construct at 2 weeks (MI SVF), (c) 6-week MI with Vicryl construct at 2 weeks (MI Vicryl), and (d) MI 2wk (time point of intervention). Emax, an indicator of systolic performance and contractile function, was lower in the MI and MI Vicryl versus MI SVF. Positron emission tomography imaging ((18)F-fluorodeoxyglucose) revealed a decreased percentage of relative infarct volume in the MI SVF versus MI and MI Vicryl. Total vessel count and percentage of perfusion assessed via immunohistochemistry were both increased in the infarct region of MI SVF versus MI and MI Vicryl. Overall cardiac function, percentage of relative infarct, and percentage of perfusion were similar between MI SVF and MI 2wk; however, total vessel count increased after SVF treatment. These data suggest that SVF treatment of an established infarct stabilizes the heart at the time point of intervention by preventing a worsening of cardiac performance and infarcted volume, and is associated with increased microvessel perfusion in the area of established infarct.
Collapse
|
4
|
van de Hoef TP, Bax M, Meuwissen M, Damman P, Delewi R, de Winter RJ, Koch KT, Schotborgh C, Henriques JP, Tijssen JG, Piek JJ. Impact of Coronary Microvascular Function on Long-term Cardiac Mortality in Patients With Acute ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2013; 6:207-15. [DOI: 10.1161/circinterventions.112.000168] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tim P. van de Hoef
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Matthijs Bax
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Martijn Meuwissen
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Peter Damman
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Ronak Delewi
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Robbert J. de Winter
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Karel T. Koch
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Carl Schotborgh
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - José P.S. Henriques
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan G.P. Tijssen
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan J. Piek
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| |
Collapse
|
5
|
Leblanc AJ, Touroo JS, Hoying JB, Williams SK. Adipose stromal vascular fraction cell construct sustains coronary microvascular function after acute myocardial infarction. Am J Physiol Heart Circ Physiol 2011; 302:H973-82. [PMID: 22140045 DOI: 10.1152/ajpheart.00735.2011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A three-dimensional tissue construct was created using adipose-derived stromal vascular fraction (SVF) cells and evaluated as a microvascular protection treatment in a myocardial infarction (MI) model. This study evaluated coronary blood flow (BF) and global left ventricular function after MI with and without the SVF construct. Fischer-344 rats were separated into four groups: sham operation (sham), MI, MI Vicryl patch (no cells), and MI SVF construct (MI SVF). SVF cells were labeled with green fluorescent protein (GFP). Immediately postinfarct, constructs were implanted onto the epicardium at the site of ischemia. Four weeks postsurgery, the coronary BF reserve was significantly decreased by 67% in the MI group and 75% in the MI Vicryl group compared with the sham group. The coronary BF reserve of the sham and MI SVF groups in the area at risk was not significantly different (sham group: 83 ± 22% and MI SVF group: 57 ± 22%). Griffonia simplicifolia I and GFP-positive SVF immunostaining revealed engrafted SVF cells around microvessels in the infarct region 4 wk postimplant. Overall heart function, specifically ejection fraction, was significantly greater in MI SVF hearts compared with MI and MI Vicryl hearts (MI SVF: 66 ± 4%, MI: 37 ± 8%, and MI Vicryl: 29 ± 6%). In conclusion, adipose-derived SVF cells can be used to construct a novel therapeutic modality for treating microvascular instability and ischemia through implantation on the epicardial surface of the heart. The SVF construct implanted immediately after MI not only maintains heart function but also sustains microvascular perfusion and function in the infarct area by sustaining the coronary BF reserve.
Collapse
Affiliation(s)
- Amanda J Leblanc
- Cardiovascular Innovation Institute, Jewish Hospital and University of Louisville, Louisville, KY 40202, USA
| | | | | | | |
Collapse
|
6
|
Sadauskiene E, Zakarkaite D, Ryliskyte L, Celutkiene J, Rudys A, Aidietiene S, Laucevicius A. Non-invasive evaluation of myocardial reperfusion by transthoracic Doppler echocardiography and single-photon emission computed tomography in patients with anterior acute myocardial infarction. Cardiovasc Ultrasound 2011; 9:16. [PMID: 21619676 PMCID: PMC3123269 DOI: 10.1186/1476-7120-9-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/28/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The study was designed to evaluate whether the preserved coronary flow reserve (CFR) 72 hours after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction and is predictive of left ventricular (LV) functional recovery and the final infarct size at follow-up. METHODS In our study, CFR was assessed by transthoracic Doppler echocardiography (TDE) in 44 patients after the successful percutaneous coronary intervention during the acute AMI phase. CFR was correlated with contractile reserve assessed by low-dose dobutamine echocardiography and with the total perfusion defect measured by single-photon emission computed tomography 72 hours after reperfusion and at 5 months follow-up. The ROC analysis was performed to determine test sensitivity and specificity based on CFR. Categorical data were compared by an χ² analysis, continuous variables were analysed with the independent Student's t test. In order to analyse correlation between CFR and the parameters of LV function and perfusion, the Pearson correlation analysis was conducted. The linear regression analysis was used to assess the relationship between CFR and myocardial contractility as well as the final infarct size. RESULTS We estimated the CFR cut-off value of 1.75 as providing the maximal accuracy to distinguish between patients with preserved and impaired CFR during the acute AMI phase (sensitivity 91.7%, specificity 75%). Wall motion score index was better in the subgroup with preserved CFR as compared to the subgroup with reduced CFR: 1.74 (0.29) vs. 1.89 (0.17) (p < 0.001) during the acute phase and 1.47 (0.30) vs. 1.81 (0.20) (p < 0.001) at follow-up, respectively. LV ejection fraction was 47.78% (8.99) in preserved CFR group vs. 40.79% (7.25) in impaired CFR group (p = 0.007) 72 hours after reperfusion and 49.78% (8.70) vs. 40.36% (7.90) (p = 0.001) after 5 months at follow-up, respectively. The final infarct size was smaller in patients with preserved as compared to patients with reduced CFR: 5.26% (6.14) vs. 23.28% (12.19) (p < 0.001) at follow-up. CONCLUSION The early measurement of CFR by TDE can be of high value for the assessment of successful reperfusion in AMI and can be used to predict LV functional recovery, myocardial viability and the final infarct size.
Collapse
Affiliation(s)
- Egle Sadauskiene
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Diana Zakarkaite
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Ligita Ryliskyte
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Jelena Celutkiene
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Alfredas Rudys
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Sigita Aidietiene
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Aleksandras Laucevicius
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| |
Collapse
|
7
|
Persistent Abnormal Coronary Flow Reserve in Association with Abnormal Glucose Metabolism Affects Prognosis in Acute Myocardial Infarction. Echocardiography 2010; 28:210-8. [DOI: 10.1111/j.1540-8175.2010.01303.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
8
|
Innocenti F, Caldi F, Meini C, Agresti C, Baldereschi GJ, Marchionni N, Masotti G, Pini R. Left ventricular remodeling in the elderly with acute anterior myocardial infarction treated with primary coronary intervention. Intern Emerg Med 2010; 5:311-9. [PMID: 20640535 DOI: 10.1007/s11739-010-0425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 06/16/2010] [Indexed: 11/30/2022]
Abstract
We compared left ventricular (LV) remodeling following a first time acute anterior ST-elevation myocardial infarction (aSTEMI) treated with primary coronary intervention (pPCI) in different age groups. A total of 116 patients, 61 aged <65 and 55 aged >or=65 years, who survived after a recent aSTEMI treated with pPCI, underwent dobutamine stress-echocardiography (DSE) and non-invasive measurement of left anterior descending coronary artery flow reserve (CFR) during intravenous adenosine infusion. Baseline LV dimensions and systolic function were similar between the two groups; wall motion score indices during all DSE stages and CFR were also similar. In both groups, the LV ejection fraction was positively affected by the presence of viability in the necrosis area and by a higher CFR, but negatively influenced by viability in a remote area, an indirect sign of an extensive infarction size. This study demonstrates that PCI in the geriatric population with aSTEMI is as equally effective as in younger subjects, in terms of LV remodeling and function.
Collapse
Affiliation(s)
- Francesca Innocenti
- Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 1, 50141, Florence, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Tahk SJ, Choi BJ, Choi SY, Yoon MH, Gwon HC, Hong GR, Kim YJ, Hur SH, Kim KB, Koo BK, Lee SH, Yoon J. Distal protection device protects microvascular integrity during primary percutaneous intervention in acute myocardial infarction: A prospective, randomized, multicenter trial. Int J Cardiol 2008; 123:162-8. [PMID: 17490759 DOI: 10.1016/j.ijcard.2007.03.124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 03/08/2007] [Accepted: 03/30/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND Distal protection during primary angioplasty in acute myocardial infarction (AMI) is the subject of recent controversy. The present study was designed to determine whether the distal embolic protection preserves myocardial microvascular integrity and improves clinical outcomes in patients with AMI. METHODS A total of 116 AMI patients presenting within 12 h of onset of symptoms were enrolled at 7 angioplasty centers. They were randomly assigned to either primary angioplasty with distal protection group (DP; n=60) or angioplasty alone group (Controls; n=56). RESULTS After primary angioplasty, achievement of final Thrombolysis In Myocardial Infarction (TIMI) grade 3 and TIMI Myocardial Perfusion (TMP) grade 3 were more frequent in the DP group than in the control group [58/60 (96%) vs. 43/56 (81%), p=0.016; and 39/60 (65%) vs. 20/56 (38%), p=0.001, respectively]. After primary angioplasty, the baseline and hyperemic averaged peak velocities were significantly higher (23.2+/-11.5 vs. 18.0+/-6.9 cm/s, p=0.029; and 39.2+/-16.7 vs. 30.6+/-10.8 cm/s, p=0.014, respectively) and the baseline and hyperemic microvascular resistance indices were significantly lower (4.18+/-2.22 vs. 5.34+/-2.25 mm Hg cm(-1) s, p=0.036; and 2.38+/-1.39 vs. 3.11+/-1.32 mm Hg cm(-1) s, p=0.030, respectively) in the DP group. Patients in the DP group showed more favorable phasic coronary flow pattern in diastolic deceleration time (679+/-262 vs. 519+/-289 ms, p=0.035; and 751+/-246 vs. 616+/-269 ms, p=0.035, respectively). Major adverse cardiac events at 6 months occurred with similar frequency in both groups (8.7% vs. 11.1%, p=0.400). CONCLUSIONS Distal protection device effectively preserves microvascular integrity during primary angioplasty in AMI. Distal protection, however, did not improve clinical outcomes.
Collapse
Affiliation(s)
- Seung-Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, San 5 Wonchun-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Woo SI, Tahk SJ, Yoon MH, Choi SY, Choi BJ, Lim HS, Yang HM, Hwang GS, Shin JH, Kang SJ, Choi UJ, Hwang JW, Seo GW, Kim JW, Park JS. Correlation between Thrombolysis in Myocardial Infarction, the Myocardial Perfusion Grade and the Myocardial Viability Indices after Primary Percutaneous Coronary Intervention in ST Segment Elevation Myocardial Infarction. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.11.581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Seong-Ill Woo
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Seung-Jea Tahk
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - So-Yeon Choi
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Byoung-Joo Choi
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Hong-Seok Lim
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Joon-Han Shin
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Soo-Jin Kang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Un Jung Choi
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Jung-Won Hwang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Gyeong-Woo Seo
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Jin-Woo Kim
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| |
Collapse
|
11
|
Kern MJ, Lerman A, Bech JW, De Bruyne B, Eeckhout E, Fearon WF, Higano ST, Lim MJ, Meuwissen M, Piek JJ, Pijls NHJ, Siebes M, Spaan JAE. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology. Circulation 2006; 114:1321-41. [PMID: 16940193 DOI: 10.1161/circulationaha.106.177276] [Citation(s) in RCA: 397] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.
Collapse
|
12
|
Montisci R, Chen L, Ruscazio M, Colonna P, Cadeddu C, Caiati C, Montisci M, Meloni L, Iliceto S. Non-invasive coronary flow reserve is correlated with microvascular integrity and myocardial viability after primary angioplasty in acute myocardial infarction. Heart 2006; 92:1113-8. [PMID: 16449513 PMCID: PMC1861096 DOI: 10.1136/hrt.2005.078246] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To test whether preserved coronary flow reserve (CFR) two days after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction (" no-reflow" phenomenon) and is predictive of myocardial viability. DESIGN 24 patients with anterior AMI underwent CFR assessment in the left anterior descending coronary artery (LAD) with transthoracic echocardiography and myocardial contrast echocardiography (MCE) 48 h after primary angioplasty in the LAD (mean 4 (SD 2) and 3 (1) days, respectively). Low-dose dobutamine echocardiography was performed 6 (3) days after AMI and follow-up echocardiography at three months. RESULTS No-reflow extent was greater in patients with impaired CFR (< 2.5) than in those with preserved CFR (> 2.5) (55 (35)% v 11 (25)%, p < 0.001). MCE reflow was more common in patients with preserved CFR (8/12) than in those with reduced CFR (1/12, p < 0.05). Wall motion score index in the LAD territory (A-WMSI) was similar at the first echocardiography (2.14 (0.39) v 2.32 (0.47), NS), although it was better in patients with preserved CFR at dobutamine (1.38 (0.45) v 1.97 (0.67), p < 0.05) and follow-up echocardiography (1.36 (0.40) v 1.97 (0.64), p < 0.05). An inverse correlation was found between CFR and A-WMSI at dobutamine and follow-up echocardiography (r = -0.49, p = 0.016 and r = -0.55, p = 0.005) and between MCE and A-WMSI at dobutamine and follow-up echocardiography (r = -0.75, p < 0.001 and r = -0.75, p < 0.001). By multivariate analysis MCE reflow remained the only predictor of recovery at both dobutamine and follow-up echocardiography (odds ratio 1.06, 95% CI 1 to 1.1, p = 0.009). CONCLUSION CFR is inversely correlated with the extent of microvascular dysfunction at MCE two days after reperfused AMI. CFR and MCE reflow early after AMI are correlated with myocardial viability at follow up.
Collapse
Affiliation(s)
- R Montisci
- Department of Cardiovascular and Neurological Sciences, University of Cagliari, Ospedale S Giovanni di Dio, via Ospedale 46, 09124, Cagliari, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Ohara Y, Hiasa Y, Hosokawa S, Miyazaki S, Ogura R, Miyajima H, Yuba K, Suzuki N, Takahashi T, Kishi K, Ohtani R. Reduced Coronary Flow Reserve of the Non-infarct Related Artery in Patients With Acute Myocardial Infarction Assessed by Transthoracic Doppler Echocardiography. J Echocardiogr 2006. [DOI: 10.2303/jecho.4.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
14
|
Yoon MH, Tahk SJ, Choi SY, Choi TY, Choi BJ, Choi JH, Yoo SY, Ahn SG, Zheng ZG, Hwang GS, Shin JH. Effect of Distal Protection Device on the Microvascular Integrity in Acute Myocardial Infarction During Primary Percutaneous Coronary Intervention. Circ J 2006; 70:1284-9. [PMID: 16998260 DOI: 10.1253/circj.70.1284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The use of a distal protection device during primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) may preserve the microvascular integrity of the myocardium. METHODS AND RESULTS A total of 58 consecutive patients with AMI, who had undergone primary PCI within 24 h after onset, were enrolled (30 patients with the PercuSurge GuardWire System, 28 without). The coronary flow velocity reserve was not different between the 2 groups. In patients with a distal protection device, the post-PCI Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMP) were more favorable (TMP 0/1: 13.3%, TMP 2: 23.3%, TMP 3: 63.4% vs TMP 0/1: 35.7%, TMP 2: 35.7%, TMP 3: 28.6%, p=0.023). These patients also exhibited lower basal and hyperemic microvascular resistance index levels (4.33+/-2.22 vs 5.55+/-2.36 mmHg . cm(-1) . s, p=0.047; 2.39+/-1.40 vs 3.14+/-1.36 mmHg . cm(-1) . s, p=0.045, respectively), and longer basal diastolic deceleration time (679+/-273 vs 519+/-289 ms, p=0.035) after PCI. CONCLUSION Distal protection with the PercuSurge GuardWire system may effectively preserve the microvascular integrity of the myocardium during primary PCI in AMI patients.
Collapse
Affiliation(s)
- Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
|
16
|
Gick M, Jander N, Bestehorn HP, Kienzle RP, Ferenc M, Werner K, Comberg T, Peitz K, Zohlnhöfer D, Bassignana V, Buettner HJ, Neumann FJ. Randomized evaluation of the effects of filter-based distal protection on myocardial perfusion and infarct size after primary percutaneous catheter intervention in myocardial infarction with and without ST-segment elevation. Circulation 2005; 112:1462-9. [PMID: 16129793 DOI: 10.1161/circulationaha.105.545178] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In acute myocardial infarction, distal embolization of debris during primary percutaneous catheter intervention may curtail microvascular reperfusion of the infarct region. Our randomized trial investigated whether distal protection with a filter device can improve microvascular perfusion and reduce infarct size after primary percutaneous catheter intervention. METHODS AND RESULTS We enrolled 200 patients who had angina within 48 hours after onset of pain plus at least 1 of 3 additional criteria: ST-segment elevation, elevated myocardial marker proteins, and angiographic evidence of thrombotic occlusion. Among the patients included (83% men; mean age, 62+/-12 years), 100 were randomly assigned to the filter-wire group and 100 to the control group. The primary end point was the maximal adenosine-induced Doppler flow velocity in the recanalized infarct artery; the secondary end point was infarct size estimated by the volume of delayed enhancement on nuclear MRI. ST-segment elevation myocardial infarction was present in 68.5% of the patients; the median time from onset of pain was 6.9 hours. In the filter-wire group, maximal adenosine-induced flow velocity was 34+/-17 compared with 36+/-20 cm/s in the control group (P=0.46). Infarct sizes, assessed in 82 patients in the filter-wire group and 78 patients in the control group, were 11.8+/-9.3% of the left ventricular mass in the filter-wire group and 10.4+/-9.4% in the control group (P=0.33). Thirty-day mortality was 2% in filter-wire group and 3% in the control group. CONCLUSIONS The filter wire as an adjunct to primary percutaneous catheter intervention in myocardial infarction with and without ST-segment elevation did not improve reperfusion or reduce infarct size.
Collapse
Affiliation(s)
- Michael Gick
- Herz-Zentrum Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Werner GS, Emig U, Bahrmann P, Ferrari M, Figulla HR. Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion. Heart 2004; 90:1303-9. [PMID: 15486127 PMCID: PMC1768535 DOI: 10.1136/hrt.2003.024620] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the potential for recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion and the determinants of this recovery. PATIENTS AND DESIGN 120 patients underwent a successful recanalisation of a chronic total coronary occlusion (duration > 2 weeks) and a follow up angiography after a mean (SD) of 5.0 (1.2) months. The coronary flow velocity reserve (CFVR) and the fractional flow reserve were measured after recanalisation and at follow up. Global and regional left ventricular (LV) function were analysed by quantitative angiography. RESULTS Microvascular dysfunction, defined by a CFVR < 2.0 and a fractional flow reserve > or = 0.75, was observed in 55 (46%) patients after recanalisation. Microvascular function improved during follow up in 24 (20%). The CFVR increased during follow up from 2.01 (0.58) to 2.50 (0.79) (p < 0.001), due to a decrease in basal average peak velocity from 30.7 (14.9) cm/s to 25.5 (13.3) cm/s (p = 0.001). Improved microvascular function was associated with an improved regional LV function, shown by a correlation between increased wall motion severity index and increased CFVR (r = 0.38, p = 0.003). The major determinant of microvascular dysfunction at baseline was the presence of diabetes mellitus (odds ratio 4.3, 95% confidence interval 1.8 to 10.2), which remained so at follow up (odds ratio 4.1, 95% confidence interval 1.3 to 13.4). Improvement of LV function was not impaired by the presence of microvascular dysfunction after recanalisation. CONCLUSIONS The frequently observed microvascular dysfunction after recanalisation of a chronic total coronary occlusion is a transient phenomenon in most patients and is influenced by the presence of diabetes mellitus. It does not impede the recovery of LV function. Improved regional LV function is associated with improved microvascular function.
Collapse
Affiliation(s)
- G S Werner
- Clinic for Internal Medicine I, Friedrich Schiller University Jena, Jena, Germany.
| | | | | | | | | |
Collapse
|
18
|
Takahashi T, Hiasa Y, Ohara Y, Yamaguchi K, Tomokane T, Ogura R, Ogata T, Yuba K, Suzuki N, Hosokawa S, Kishi K, Ohtani R. Usefulness of coronary flow reserve immediately after primary coronary stenting in predicting wall motion recovery in patients with anterior wall acute myocardial infarction. Am J Cardiol 2004; 94:1033-7. [PMID: 15476619 DOI: 10.1016/j.amjcard.2004.06.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Revised: 06/25/2004] [Accepted: 06/25/2004] [Indexed: 11/25/2022]
Abstract
This study examined whether coronary flow reserve (CFR) measured immediately after primary coronary stenting could predict wall motion recovery in patients who have acute myocardial infarction. CFR significantly correlated with the change of wall motion score (r = 0.68, p <0.0001), and the optimal cut-off value of CFR for predicting wall motion recovery was 1.4 (sensitivity 85%, specificity 94%).
Collapse
Affiliation(s)
- Takefumi Takahashi
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Shimada Y, Yoshiyama M, Tanaka H, Sato H, Yoshida K, Jissho S, Uchida E, Kamimori K, Nakamura Y, Iida H, Takeuchi K, Yoshikawa J. Convalescent stage coronary flow reserve and late myocardial morphologic outcomes in patients with first anterior acute myocardial infarction. Circ J 2004; 68:208-13. [PMID: 14993774 DOI: 10.1253/circj.68.208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Microvascular damage immediately after reperfusion therapy is an independent predictor of left ventricular function in patients with acute myocardial infarction (AMI). However, its recovery may vary among individuals and the relationship between convalescent stage microvasculature and late myocardial morphologic change is unclear. METHODS AND RESULTS Patients treated with coronary angioplasty within 12 h of their first anterior AMI were enrolled in this study. Coronary flow reserve (CFR) was measured 3 weeks post AMI, in both branches of the left coronary artery: culprit (left anterior descending artery: LAD) and non-culprit (left circumflex artery: LCX). Left ventriculography was performed at 3 weeks and 6 months post AMI and compared. Seventeen patients showed abnormal CFR in the LAD (Group 1: CFR<2), whereas 20 patients showed normal CFR (Group 2: CFR >/=2). Percent changes of end-diastolic volume tended to be higher in Group 1 than in Group 2 (11.8+/-21.6% vs -1.3+/-14.4%, p=0.056), and %changes of end-systolic volume was significantly smaller in Group 2 (11.8+/-22.1% vs -8.7+/-25.1%, p<0.05). A statistically significant correlation was found between absolute and relative CFR in the LAD and %change of end-systolic volume (r=-0.58: p<0.001, and r=0.40: p<0.05, respectively). CONCLUSIONS Microvascular function in the convalescent stage may be related to these favorable changes.
Collapse
|
20
|
Hoffmann R, Lepper W, Heussen N, Elkelini M, Sieswerda GT, Kamp O, de Cock CC, Voci P, Visser CA, Hanrath P. Impact of flow level on coronary flow velocity pattern. A doppler flow study in patients with first acute myocardial infarction. Int J Cardiovasc Imaging 2004; 20:27-35. [PMID: 15055818 DOI: 10.1023/b:caim.0000013157.14656.9e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Analysis of coronary flow velocity pattern has been used to assess microvascular function post acute myocardial infarction (AMI). This study sought to analyze whether the flow level has an impact on parameters of coronary flow velocity pattern. Parameters of coronary flow velocity pattern were determined at baseline and during increased flow due to maximal hyperemia induced by adenosine in 25 patients after PTCA for first AMI using Doppler flow wires. Patients were divided into those with depressed (global wall motion index (GWMI) > or = 1.5; n = 14) and those with preserved (GWMI < 1.5; n = 11) left ventricular (LV) function at 4 weeks. Coronary flow velocity pattern at rest was different between patients with depressed and patients with preserved LV function at follow-up. A difference in flow pattern between the groups remained at increased flow level. However, increase of flow altered parameters of flow pattern. Diastolic deceleration rate (DSR) increased for patients with preserved LV function (53.7+/-25.6 at baseline vs. 67.0+/-29.8 cm/s2 with adenosine) and depressed LV function (95.3+/-58.6 vs. 110.7+/-61.4 cm/s2, respectively, p = 0.0012). Induction of hyperemia resulted also in increased systolic and diastolic peak flow velocity and diastolic deceleration time (DDT). Higher flow had no impact on early systolic retrograde flow, systolic flow duration and diastolic-systolic velocity ratio (DSVR). The coronary flow velocity pattern allows prediction of LV function at 4 weeks after AMI. However, it should be considered that some parameters of the flow velocity pattern are affected by the coronary flow level.
Collapse
|
21
|
Bax M, de Winter RJ, Schotborgh CE, Koch KT, Meuwissen M, Voskuil M, Adams R, Mulder KJJ, Tijssen JGP, Piek JJ. Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction. J Am Coll Cardiol 2004; 43:534-41. [PMID: 14975460 DOI: 10.1016/j.jacc.2003.08.055] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Revised: 07/23/2003] [Accepted: 08/05/2003] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine predictors of left ventricular (LV) function recovery at the time of primary percutaneous coronary intervention (PCI). BACKGROUND Angiographic, intracoronary Doppler flow, and electrocardiographic variables have been reported to be predictors of recovery of LV function after acute myocardial infarction (MI). We directly compared the predictive value of Thrombolysis In Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (cTfc), myocardial blush grade, coronary Doppler flow velocity analysis, and resolution of ST-segment elevation for recovery of LV function in patients undergoing primary PCI for acute MI. METHODS We prospectively studied 73 patients who underwent PCI for an acute anterior MI. Recovery of global and regional LV function was measured using an echocardiographic 16-segment wall motion index (WMI) before PCI, at 24 h, at one week, and at six months. Directly after successful PCI, coronary flow velocity reserve (CFR), cTfc, TIMI flow grade, and myocardial blush grade were assessed. RESULTS Mean global and regional WMI improved gradually over time from 1.86 +/- 0.23 before PCI to 1.54 +/- 0.34 at six-month follow-up (p < 0.0001) and from 2.39 +/- 0.30 before PCI to 1.87 +/- 0.48 at six-month follow-up (p < 0.0001), respectively. Multivariate analysis revealed CFR as the only independent predictor for global and regional recovery of LV function at six months. CONCLUSIONS Doppler-derived CFR is a better prognostic marker for LV function recovery after anterior MI than other currently used parameters of myocardial reperfusion.
Collapse
Affiliation(s)
- Matthijs Bax
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Herrmann SC, El-Shafei A, Kern MJ. Current concepts in coronary physiology for the interventionalist. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 5:109-31. [PMID: 12959728 DOI: 10.1080/14628840310017357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Coronary angiography remains the 'gold standard' for the diagnosis of epicardial coronary disease. However, precise quantification of stenosis severity is limited because of the complex three-dimensional geometry of epicardial plaques. To assist the angiographer in lesion assessment, several physiologic measurements have been developed to evaluate stenosis severity, including coronary flow reserve, relative coronary flow reserve and fractional flow reserve. Physiologic lesion assessment can also be an invaluable tool in coronary intervention, evaluating efficacy of angioplasty and stent deployment.
Collapse
|
23
|
Hoffmann R, Haager P, Lepper W, Franke A, Hanrath P. Relation of coronary flow pattern to myocardial blush grade in patients with first acute myocardial infarction. Heart 2003; 89:1147-51. [PMID: 12975402 PMCID: PMC1767877 DOI: 10.1136/heart.89.10.1147] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Analysis of myocardial blush grade (MBG) and coronary flow velocity pattern has been used to obtain direct or indirect information about microvascular damage and reperfusion injury after percutaneous transluminal coronary angiography for acute myocardial infarction. OBJECTIVE To evaluate the relation between coronary blood flow velocity pattern and MBG immediately after angioplasty plus stenting for acute myocardial infarction. DESIGN The coronary blood flow velocity pattern in the infarct related artery was determined immediately after angioplasty in 35 patients with their first acute myocardial infarct using a Doppler guide wire. Measurements were related to MBG as a direct index of microvascular function in the infarct zone. RESULTS Coronary flow velocity patterns were different between patients with absent myocardial blush (n = 14), reduced blush (n = 7), or normal blush (n = 14). The following variables (mean (SD)) differed significantly between the three groups: systolic peak flow velocity (cm/s): absent blush 10.9 (4.2), reduced blush 14.2 (6.4), normal blush 19.2 (11.2); p = 0.036; diastolic deceleration rate (ms): absent blush 103 (58), reduced blush 80 (65), normal blush 50 (19); p = 0.025; and diastolic-systolic velocity ratio: absent blush 4.06 (2.18), reduced blush 2.02 (0.55), normal blush 1.88 (1.03); p = 0.002. In a multivariate analysis MBG was the only variable with a significant impact on the diastolic deceleration rate (p = 0.034,) while age, infarct location, time to revascularisation, infarct vessel diameter, and maximum creatine kinase had no significant impact. CONCLUSIONS The coronary flow velocity pattern in the infarct related epicardial artery is primarily determined by the microvascular function of the dependent myocardium, as reflected by MBG.
Collapse
Affiliation(s)
- R Hoffmann
- Medical Clinic I, University Hospital RWTH Aachen, Germany.
| | | | | | | | | |
Collapse
|
24
|
Garot P, Pascal O, Simon M, Monin JL, Dupouy P, Elbaz N, Teiger E, Garot J, Guéret P, Dubois-Randé JL. Time course and relation to local viability of microvascular function and volume after reperfused acute myocardial infarction. Am J Cardiol 2002; 89:1341-6. [PMID: 12062725 DOI: 10.1016/s0002-9149(02)02344-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We assessed the time course of the alterations of microvascular function and myocardial perfusion, as well their relation to local inotropic reserve (IR), in 21 patients who underwent successful primary coronary angioplasty for acute myocardial infarction and in whom local myocardial dysfunction persisted at hospital discharge. Coronary flow reserve (CFR) and myocardial perfusion were assessed immediately after angioplasty, and on day 1 and day 8 by intracoronary Doppler and myocardial contrast echocardiography, respectively. Dobutamine echocardiography was performed on day 7 for assessment of local IR. After angioplasty, CFR was severely altered in patients with (n = 14) and without (n = 7) IR (1.44 +/- 0.26 and 1.36 +/- 0.21, respectively; p = NS). Among patients with IR, CFR increased significantly at day 1 (2.26 +/- 0.62, p <0.005 vs acute stage) compared with those without IR (p = NS vs acute). In contrast, the extent of microvascular obstruction as defined by contrast echocardiography remained unchanged in all patients at day 1 compared with acute measurements. Microvascular obstruction decreased at day 8 in the sole subset of patients with local IR (p <0.05 vs acute stage). In patients treated by immediate coronary angioplasty for acute myocardial infarction, subsequent improvement of myocardial perfusion is associated with preexistent recruitable microvascular function in the infarct-related artery. The presence of reversible microvascular dysfunction at the early stage after acute myocardial infarction is associated with local tissue viability in humans.
Collapse
Affiliation(s)
- Philippe Garot
- Fédération de Cardiologie, Hôpital Henri Mondor, INSERM U400, Créteil, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Lepper W, Sieswerda GT, Vanoverschelde JL, Franke A, de Cock CC, Kamp O, Kühl HP, Pasquet A, Voci P, Visser CA, Hanrath P, Hoffmann R. Predictive value of markers of myocardial reperfusion in acute myocardial infarction for follow-up left ventricular function. Am J Cardiol 2001; 88:1358-63. [PMID: 11741552 DOI: 10.1016/s0002-9149(01)02113-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study evaluated recently suggested invasive and noninvasive parameters of myocardial reperfusion after acute myocardial infarction (AMI), assessing their predictive value for left ventricular function 4 weeks after AMI and reperfusion defined by myocardial contrast echocardiography (MCE). In 38 patients, angiographic myocardial blush grade, corrected Thrombolysis In Myocardial Infarction frame count, ST-segment elevation index, and coronary flow reserve (n = 25) were determined immediately after primary percutaneous transluminal coronary angioplasty (PTCA) for first AMI, and intravenous MCE was determined before, and at 1 and 24 hours after PTCA to evaluate myocardial reperfusion. Results were related to global wall motion index (GWMI) at 4 weeks. MCE 1 hour after PTCA showed good correlation with GWMI at 4 weeks (r = 0.684, p <0.001) and was in an analysis of variance the best parameter to predict GWMI 4 weeks after AMI. The ST-segment elevation index was close in its predictive value. Considering only invasive parameters of reperfusion myocardial blush grade was the best predictor of GWMI at 4 weeks (R(2) = 0.3107, p <0.001). A MCE perfusion defect size at 24 hours of > or =50% of the MCE perfusion defect size before PTCA was used to define myocardial nonreperfusion. In a multivariate analysis, low myocardial blush grade class was the best predictor of nonreperfusion defined by MCE. Thus, intravenous MCE allows better prediction of left ventricular function 4 weeks after AMI than other evaluated parameters of myocardial reperfusion. Myocardial blush grade is the best predictor of nonreperfusion defined by MCE and is the invasive parameter with the greatest predictive value for left ventricular function after AMI. Coronary flow parameters are less predictive.
Collapse
Affiliation(s)
- W Lepper
- Medical Clinic I, University Hospital RWTH Aachen, Aachen, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kern MJ. Curriculum in interventional cardiology: coronary pressure and flow measurements in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2001; 54:378-400. [PMID: 11747168 DOI: 10.1002/ccd.1303] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M J Kern
- J. Gerard Mudd Cardiac Catheterization Laboratory, St. Louis University Health Sciences Center, St. Louis, Missouri 63110, USA.
| |
Collapse
|
27
|
Affiliation(s)
- S R Dixon
- Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | |
Collapse
|
28
|
Albertal M, Regar E, Piek JJ, Van Langenhove G, Carlier SG, Thury A, Sianos G, Boersma E, de Bruyne B, di Mario C, Serruys PW. Value of coronary stenotic flow velocity acceleration on the prediction of long-term improvement in functional status after angioplasty. Am Heart J 2001; 142:81-6. [PMID: 11431661 DOI: 10.1067/mhj.2001.115590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The coronary flow velocity acceleration at the stenotic site (SVA), defined as a > or = 50% increase in resting stenotic velocity when compared with the reference segment, has been shown to be highly sensitive and specific for the diagnosis of a hemodynamically significant stenosis. In this study, we describe the value of postprocedural SVA for the prediction of a lack of improvement in functional activity at long-term follow-up balloon angioplasty (BA). METHODS We investigated the improvement in functional activity in patients undergoing single native vessel angioplasty and intracoronary Doppler (before BA, after BA, and again at 6-month follow-up) as part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) I trial. Lack of improvement was defined as no change in Duke Activity Status Index (DASI) at 6-month follow-up, whereas SVA was defined as > or = 50% elevation in resting velocity at the treated area compared with the distal measurement. RESULTS SVA was found more frequently in patients without improvement in DASI (45% vs 31%, P =.03). Similar percent diameter stenosis and coronary flow velocity reserve were observed in patients with and those without improvement in DASI at follow-up. By multivariate regression analysis, the presence of SVA (P = .029; odds ratio, 1.97; 95% confidence interval, 1.07 to 3.63) and an elevated DASI at baseline (P < .001; odds ratio, 1.05; 95% confidence interval, 1.03 to 1.07) were associated with a lack of improvement at follow-up. CONCLUSIONS The detection of SVA was associated with failure of improvement in functional activity at follow-up after coronary intervention.
Collapse
Affiliation(s)
- M Albertal
- Thoraxcenter, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Destro G, Marino P, Barbieri E, Zorzi A, Brighetti G, Maines M, Carletti M, Zardini P. Postinfarctional remodeling: increased dye intensity in the myocardial risk area after angioplasty of infarct-related coronary artery is associated with reduction of ventricular volumes. J Am Coll Cardiol 2001; 37:1239-45. [PMID: 11300429 DOI: 10.1016/s0735-1097(01)01122-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to evaluate if angiographic dye videointensity of the risk area during percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery (IRA) relates to remodeling. BACKGROUND Poor reflow after myocardial infarction (MI) predicts worse ventricular remodeling. METHODS Fifty-three patients with a first anterior MI and isolated disease of the left anterior descending (LAD), who underwent "primary" (n = 14), "rescue" (n = 7) or "late" (after 10 +/- 4 days, n = 32) PTCA, were retrospectively selected. In 10 patients prospectively collected, we assessed Doppler flow velocities and Doppler flow reserve (DFR), relating them to the videointensity technique. Coronary stenosis and TIMI flow were determined, and echocardiographic volumes (end-diastolic and end-systolic volume indexes) and regional asynergy were computed before hospital discharge (baseline) and at six months. Assuming higher peak videointensity reflects greater myocardial blood volume, a 1- to 5-point (poor-optimal) perfusion scale was devised. RESULTS The correlation of Doppler peak velocity and DFR with videointensity was significant (r = 0.58, p = 0.007 and r = 0.71, p < 0.001, respectively). Patients were subdivided into group A (increased videointensity post-PTCA > or = 1.5 points, n = 29) and group B (unchanged videointensity, n = 24). Analysis of variance showed a time-group interaction for end-diastolic volume index (-4.6 +/- 23% vs. +22 +/- 22%, p = 0.003) and end-systolic volume index (-3.05 +/- 11.1% vs. +4.1 +/- 12.5%, p = 0.027). There was no interaction for changes in LAD stenosis (p = 0.39) and TIMI flow after PTCA (p = 0.27), or regional asynergy at six months (p = 0.31). CONCLUSIONS Angiographic dye videointensity in the risk area correlates with Doppler peak velocity and DFR, and its increase after PTCA of IRA has a limiting effect on ventricular volumes, independent of coronary stenosis resolution, changes in Thrombolysis In Myocardial Infarction (TIMI) flow or extent of regional asynergy.
Collapse
Affiliation(s)
- G Destro
- Division of Cardiology, University of Verona, Italy
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Ragosta M, Powers ER, Samady H, Gimple LW, Sarembock IJ, Beller GA. Relationship between extent of residual myocardial viability and coronary flow reserve in patients with recent myocardial infarction. Am Heart J 2001; 141:456-62. [PMID: 11231445 DOI: 10.1067/mhj.2001.113074] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The presence of viability in an infarct zone implies an intact microvasculature. We hypothesized that coronary flow reserve (CFR), which assesses the microcirculation, would correlate with the extent of viability in infarction zones. METHODS CFR was measured after stenting in 17 patients with single vessel disease >48 hours from infarction. Viability was determined with use of single-photon emission computed tomography sestamibi imaging. RESULTS Sestamibi uptake in the infarct zone correlated with CFR in the infarct artery (r = 0.62, P =.008) and sestamibi uptake in the infarct zone was greater in patients with normal CFR than in patients with abnormal CFR (61.9 +/- 9.1% vs 46.3 +/- 9.6%, P =.004). In addition, CFR was greater in patients with viability compared with patients without viability (2.4 +/- 1.3 vs 1.4 +/- 0.4, P =.015). CONCLUSIONS CFR correlates with the extent of viability after infarction. Preserved CFR in an infarct-related artery implies preserved viability.
Collapse
Affiliation(s)
- M Ragosta
- Cardiovascular Division, Department of Medicine, University of Virginia Health Sciences Center, Charlottesville, VA 22098, USA.
| | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Lepper W, Hoffmann R, Kamp O, Franke A, de Cock CC, Kühl HP, Sieswerda GT, Dahl JV, Janssens U, Voci P, Visser CA, Hanrath P. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angioplasty [correction of angiography] in patients with acute myocardial infarction. Circulation 2000; 101:2368-74. [PMID: 10821812 DOI: 10.1161/01.cir.101.20.2368] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study investigated whether the extent of perfusion defect determined by intravenous myocardial contrast echocardiography (MCE) in patients with acute myocardial infarction (AMI) treated by primary percutaneous transluminal coronary angioplasty (PTCA) relates to coronary flow reserve (CRF) for assessment of myocardial reperfusion and is predictive for left ventricular recovery. METHODS AND RESULTS Twenty-five patients with first AMI underwent intravenous MCE with NC100100 with intermittent harmonic imaging before PTCA and after 24 hours. MCE before PTCA defined the risk region and MCE at 24 hours the "no-reflow" region. The no-reflow region divided by the risk region determined the ratio to the risk region. CFR was assessed immediately after PTCA and 24 hours later. Left ventricular wall motion score indexes were calculated before PTCA and after 4 weeks. CFR at 24 hours defined a recovery (CFR >/=1.6; n=17) and a nonrecovery group (CFR <1.6; n=8). Baseline CFR did not differ between groups. MCE ratio to the risk region was smaller in the recovery group compared with the nonrecovery group (34+/-49% vs 81+/-46%, P=0.009). A ratio to the risk region of </=50% defined an MCE reperfusion group. It was associated with improvement of CFR from 1.67+/-0.47 at baseline to 2. 15+/-0.53 at 24 hours (P<0.001) and of regional wall motion score index from 2.6+/-0.5 to 1.9+/-0.5 at 4 weeks (P<0.001). CONCLUSIONS Intravenous MCE can be used to define perfusion defects after AMI. Assessment of microcirculation by MCE corresponds to evaluation by CFR. Serial intravenous MCE has the potential to identify patients likely to have improved left ventricular function after AMI.
Collapse
Affiliation(s)
- W Lepper
- Medical Clinic I, University RWTH, Aachen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Kuriki S, Nasu M, Fukami Ki KI, Hiramori K. Noninvasive Measurement of Left Coronary Blood Flow Reserve by Transthoracic Doppler Echocardiography: Comparison with Doppler Guidewire Ultrasonography. Echocardiography 1999; 16:547-557. [PMID: 11175187 DOI: 10.1111/j.1540-8175.1999.tb00103.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The development of new ultrasound instrumentation has made epicardial coronary artery blood flow imaging easier with the use of transthoracic coronary Doppler echocardiography (TCDE). This study was performed to investigate the accuracy of coronary blood flow reserve (CFR) measurement by TCDE. In 15 patients with ischemic heart disease in the absence of valvular disease or atrial fibrillation, coronary flow at rest and flow with hyperemia induced by intravenous dipyridamole infusion were recorded by TCDE and Doppler guidewire ultrasonography. The CFR was determined as the ratio of the maximum hyperemic diastolic time-averaged peak velocity to the velocity at rest in the proximal or distal left anterior descending coronary artery. It was found that the CFR of the left anterior descending coronary artery measured by TCDE was comparable in accuracy with CFR measured by invasive methods (r = 0.87, P < 0.0001, n = 15).
Collapse
Affiliation(s)
- Satoshi Kuriki
- The Second Department of the Iwate Medical University, 19-1 Uchimaru Morioka, 020-0021, Japan
| | | | | | | |
Collapse
|