Usefulness of Coronary Flow Reserve Immediately After Primary Coronary Angioplasty for Acute Myocardial Infarction in Predicting Long-Term Adverse Cardiac Events

Takahashi, Takefumi; Hiasa, Yoshikazu; Ohara, Yoshikazu; Miyazaki, Shôzo; Ogura, Riyo; Miyajima, Hitoshi; Yuba, Kenichiro; Suzuki, Naoki; Hosokawa, Shinobu; Kishi, Koichi; Ohtani, Ryuji

doi:10.1016/j.amjcard.2007.04.015

Cited by 25 publications

(20 citation statements)

References 27 publications

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“…[16][17][18][19][20] Bax et al 21 studied 73 patients with an acute anterior myocardial infarction, who were successfully treated by primary PCI. Using echocardiography, recovery of left ventricular function was measured and immediately after PCI, intracoronary CFR, cTFC, TIMI flow, and MBG were assessed.…”

Section: Measurements Of Coronary Flow and Microvascular Resistance Imentioning

confidence: 99%

Doppler-Derived Intracoronary Physiology Indices Predict the Occurrence of Microvascular Injury and Microvascular Perfusion Deficits After Angiographically Successful Primary Percutaneous Coronary Intervention

Teunissen

Waard

Hollander

et al. 2015

Circ: Cardiovascular Interventions

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Background-A total of40% to 50% of patients with ST-segment-elevation myocardial infarction develop microvascular injury (MVI) despite angiographically successful primary percutaneous coronary intervention (PCI). We investigated whether hyperemic microvascular resistance (HMR) immediately after angiographically successful PCI predicts MVI at cardiovascular magnetic resonance and reduced myocardial blood flow at positron emission tomography (PET). Methods and Results-Sixty patients with ST-segment-elevation myocardial infarction were included in this prospective study. Immediately after successful PCI, intracoronary pressure-flow measurements were performed and analyzed off-line to calculate HMR and indices derived from the pressure-velocity loops, including pressure at zero flow. Cardiovascular magnetic resonance and H 2 15O PET imaging were performed 4 to 6 days after PCI. Using cardiovascular magnetic resonance, MVI was defined as a subendocardial recess of myocardium with low signal intensity within a gadoliniumenhanced area. Myocardial perfusion was quantified using H 2 15 O PET. Reference HMR values were obtained in 16 stable patients undergoing coronary angiography. Complete data sets were available in 48 patients of which 24 developed MVI. Adequate pressure-velocity loops were obtained in 29 patients. HMR in the culprit artery in patients with MVI was significantly higher than in patients without MVI (MVI, 3.33±1.50 mm Hg/cm per second versus no MVI, 2.41±1.26 mm Hg/cm per second; P=0.03). MVI was associated with higher pressure at zero flow (45.68±13.16 versus 32.01±14.98 mm Hg; P=0.015). Multivariable analysis showed HMR to independently predict MVI (P=0.04). The optimal cutoff value for HMR was 2.5 mm Hg/cm per second. High HMR was associated with decreased myocardial blood flow on PET (myocardial perfusion reserve <2.0, 3.18±1.42 mm Hg/cm per second versus myocardial perfusion reserve ≥2.0, 2.24±1.19 mm Hg/cm per second; P=0.04). 1 CMRdefined MVI is assessed by T2-weighted imaging and late gadolinium enhancement. MVI refers to the areas within the infarcted myocardium where wash-in of contrast medium is severely impaired, as opposed to the wash-in (and delayed wash-out) of the contrast medium in the remaining areas of the infarct. It has been postulated that within these areas devoid of contrast, the microvasculature is obstructed, hence the term microvascular obstruction. Recently, however, it was shown that CMR-defined microvascular obstruction actually contains intramyocardial hemorrhage and complete microvascular destruction. Conclusions-Doppler2 Therefore, the term MVI seems to be more appropriate.The occurrence of MVI is linked to negative remodeling and left ventricular dysfunction, leading to decreased longterm survival, increased morbidity, and reduced quality of life as compared with patients with ST-segment-elevation myocardial infarction (STEMI) without MVI.3 MVI is related to ischemia-reperfusion damage and can potentially be reversed by pharmacological treatment in addition to the stand...

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Section: Measurements Of Coronary Flow and Microvascular Resistance Imentioning

confidence: 99%

Doppler-Derived Intracoronary Physiology Indices Predict the Occurrence of Microvascular Injury and Microvascular Perfusion Deficits After Angiographically Successful Primary Percutaneous Coronary Intervention

Teunissen

Waard

Hollander

et al. 2015

Circ: Cardiovascular Interventions

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“…16 Furthermore, MBFR has been shown to be an independent predictor of CVM in diabetic and nondiabetic patients with normal stress echocardiograms and in patients after acute coronary syndromes. [17][18][19] We hypothesized that hypoglycemia would decrease the MBFR (measured by MCE) using a 1-step hyperinsulinemic clamp technique to induce hypoglycemia in patients with type 1 DM and in healthy control subjects. …”

mentioning

confidence: 99%

Acute Hypoglycemia Decreases Myocardial Blood Flow Reserve in Patients With Type 1 Diabetes Mellitus and in Healthy Humans

Rana¹,

Byrne²,

Kerr³

et al. 2011

Circulation

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Background-Hypoglycemia is associated with increased cardiovascular mortality, but the reason for this association is poorly understood. We tested the hypothesis that the myocardial blood flow reserve (MBFR) is decreased during hypoglycemia using myocardial contrast echocardiography in patients with type 1 diabetes mellitus (DM) and in healthy control subjects. Methods and Results-Twenty-eight volunteers with DM and 19 control subjects underwent hyperinsulinemic clamps with maintained sequential hyperinsulinemic euglycemia (plasma glucose, 90 mg/dL [5.0 mmol/L]) followed by hyperinsulinemic hypoglycemia (plasma glucose, 50 mg/dL [2.8 mmol/L]) for 60 minutes each. Low-power real-time myocardial contrast echocardiography was performed with flash impulse imaging using low-dose dipyridamole stress at baseline and during hyperinsulinemic euglycemia and hyperinsulinemic hypoglycemia. In control subjects, MBFR increased during hyperinsulinemic euglycemia by 0.57 U (22%) above baseline (B coefficient, 0.57; 95% confidence interval, 0.38 to 0.75; PϽ0.0001) and decreased during hyperinsulinemic hypoglycemia by 0.36 U (14%) below baseline values (B coefficient, Ϫ0.36; 95% confidence interval, Ϫ0.50 to Ϫ0.23; PϽ0.0001). Although MBFR was lower in patients with DM at baseline by 0.37 U (14%; B coefficient, Ϫ0.37; 95% confidence interval, Ϫ0.55 to Ϫ0.19; Pϭ0.0002) compared with control subjects at baseline, the subsequent changes in MBFR during hyperinsulinemic euglycemia and hyperinsulinemic hypoglycemia in DM patients were similar to that observed in control subjects. Finally, the presence of microvascular complications in the patients with DM was associated with a reduction in MBFR of 0.52 U (24%; B coefficient, Ϫ0.52; 95% confidence interval, Ϫ0.70 to Ϫ0.34; PϽ0.0001). Conclusions-Hypoglycemia decreases MBFR in both healthy humans and patients with DM. This finding may explain the association between hypoglycemia and increased cardiovascular mortality in susceptible individuals. (Circulation. 2011;124:1548-1556.)Key Words: diabetes mellitus Ⅲ echocardiography Ⅲ hypoglycemia Ⅲ insulin Ⅲ regional blood flow S everal studies have shown that hypoglycemia is associated with an increase in cardiovascular mortality (CVM). [1][2][3][4][5][6] This association has been demonstrated in people with and without established coronary artery disease. [1][2][3] Importantly, patients with acute coronary syndromes appear to have worse short-and long-term outcomes if they experience hypoglycemia in the acute phase of their presentation. [2][3][4] For example, in patients with diabetes mellitus (DM) and acute coronary syndromes, hypoglycemia within 48 hours of their admission was associated with a 2-fold increase in all-cause mortality over a 2-year follow-up. 2 Similarly, Pinto et al 3 showed that patients with ST-segment-elevation myocardial infarction and an admission blood glucose Ͻ4.5 mmol/L had a 3-fold increased rate of adverse outcomes (defined as 30-day mortality and myocardial infarction). Furthermore, in the same study, patients w...

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“…The improvement in left ventricular ejection fraction measured by echocardiogram in this study was not significant, but improvement of CFR measurements was significant, implying that a subtle improvement in left ventricular function could not be differentiated from the use of a conventional echocardiogram. 5 A follow-up CFR measurement with an intracoronary Doppler wire might be a more sensitive method for detecting the restoration of microvascular integrity and myocardial function. Because decreased CFR value was related to increased cardiovascular risk status, and the higher CFR group showed fewer unfavorable risks, measuring CFR shows significance in predicting cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Because coronary angiography does not adequately reflect the degree of microvascular integrity, coronary flow reserve (CFR) is often measured in the assessment of microvascular function after AMI. 5 CFR is the degree of increase in coronary flow that is achieved between basal coronary perfusion and maximal coronary vasodilatation. 6 CFR, which is assessed with an intracoronary Doppler wire, is measured by blood flow ultrasonographically following the Doppler principle, and reflects the integrity of the coronary microvascular system.…”

mentioning

confidence: 99%

“…Baseline CFR has been used as a predictor of improvement in left ventricular function after AMI. 5 In circumstances with vascular injuries or after therapies like HMG-CoA reductase inhibitors, angiogenic cells are mobilized into peripheral circulation and incorporate at sites of injury. 7 These cells, part of the mononuclear cell fraction within the peripheral blood, have angiogenic potential or are able to stimulate neoangiogenesis.…”

mentioning

confidence: 99%

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Correlation Between Circulating Angiogenic Cell Mobilizations and Recovery of Coronary Flow Reserve in Patients With Acute Myocardial Infarction

Jeong

Hong

Park

et al. 2012

Circ J

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Usefulness of Coronary Flow Reserve Immediately After Primary Coronary Angioplasty for Acute Myocardial Infarction in Predicting Long-Term Adverse Cardiac Events

Cited by 25 publications

References 27 publications

Doppler-Derived Intracoronary Physiology Indices Predict the Occurrence of Microvascular Injury and Microvascular Perfusion Deficits After Angiographically Successful Primary Percutaneous Coronary Intervention

Doppler-Derived Intracoronary Physiology Indices Predict the Occurrence of Microvascular Injury and Microvascular Perfusion Deficits After Angiographically Successful Primary Percutaneous Coronary Intervention

Acute Hypoglycemia Decreases Myocardial Blood Flow Reserve in Patients With Type 1 Diabetes Mellitus and in Healthy Humans

Correlation Between Circulating Angiogenic Cell Mobilizations and Recovery of Coronary Flow Reserve in Patients With Acute Myocardial Infarction

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