(Circulation. 2001;103:2339.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation
From the Department of Cardiology (J.H., M.H., A.S., H.W., C.v.B., H.E., D.B., R.E.), the Department of Clinical Chemistry (L.V.), and the Department of Pathophysiology (R.S., G.H.), University Clinic Essen, Essen, Germany; the Department of Cardiology (J.G.), Zhongshan Hospital, Shanghai, China; and the Division of Cardiovascular Diseases (A.L.), Mayo Clinic, Rochester, Minn.
Correspondence to Prof R. Erbel, MD, FESC, FACC, Department of Cardiology, University of Essen, Hufelandstraße 55, 45122 Essen, Germany. E-mail erbel{at}uni-essen.de
Background—Residual reduction of relative coronary flow velocity reserve (rCVR) after successful coronary intervention has been related to microvascular impairment. However, the incidence of cardiac enzyme elevation as a surrogate marker of an underlying embolic myocardial injury in these cases has not been studied.
Methods and Results—A series of 55 consecutive patients with successful coronary stenting, periprocedural intracoronary Doppler analysis, and determination of creatine kinase (CK; upper limit of normal [ULN] for women 70 IU/L, for men 80 IU/L) and cardiac troponin T (cTnT; bedside test, threshold 0.1 ng/mL) before and 6, 12, and 24 hours after intervention were studied. Postprocedural rCVR was the only intracoronary Doppler parameter that independently correlated with cTnT (r=-0.498, P<0.001) and CK outcome (r=-0.406, P=0.002). Receiver operating characteristic analysis identified a postprocedural rCVR of 0.78 as the best discriminating value, with a sensitivity of 83.3% and 69.2% and a specificity of 79.1% and 76.2% for detection of cTnT and CK elevation, respectively. Stratified according to this cutoff value, the incidence of cTnT elevation was 52.6% in patients with (n=19) and 5.6% in patients without (n=36) a postprocedural rCVR <0.78 (P<0.001), associated with a CK elevation >1 times the ULN in 36.8% and 5.6% (P=0.005) of patients, respectively.
Conclusions—Cardiac marker elevation can frequently be found after coronary procedures that are associated with a persistent reduction of rCVR, indicating procedural embolization of atherothrombotic debris with microvascular impairment and myocardial injury as a potential underlying mechanism.
Key Words: blood flow • creatine kinase • myocardial infarction • stents
This article has been cited by other articles:
 |
|
 |
|
  G. Heusch and R. Schulz Neglect of the coronary circulation: some critical remarks on problems in the translation of cardioprotection Cardiovasc Res, July 7, 2009; (2009) cvp210v2. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Carlsson, M. Wilson, A. J. Martin, and M. Saeed Myocardial Microinfarction after Coronary Microembolization in Swine: MR Imaging Characterization Radiology, March 1, 2009; 250(3): 703 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nassenstein, F. Breuckmann, C. Bucher, G. Kaiser, T. Konorza, L. Schafer, I. Konietzka, A. de Greiff, G. Heusch, R. Erbel, et al. How Much Myocardial Damage Is Necessary to Enable Detection of Focal Late Gadolinium Enhancement at Cardiac MR Imaging? Radiology, December 1, 2008; 249(3): 829 - 835. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kawamoto, H. Okura, Y. Koyama, I. Toda, H. Taguchi, K. Tamita, A. Yamamuro, Y. Yoshimura, Y. Neishi, E. Toyota, et al. The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1635 - 1640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Selvanayagam, A. S.H. Cheng, M. Jerosch-Herold, K. Rahimi, I. Porto, W. van Gaal, K. M. Channon, S. Neubauer, and A. P. Banning Effect of Distal Embolization on Myocardial Perfusion Reserve After Percutaneous Coronary Intervention: A Quantitative Magnetic Resonance Perfusion Study Circulation, September 25, 2007; 116(13): 1458 - 1464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Lerman, D. R. Holmes, J. Herrmann, and B. J. Gersh Microcirculatory dysfunction in ST-elevation myocardial infarction: cause, consequence, or both? Eur. Heart J., April 1, 2007; 28(7): 788 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Bahrmann, G. S. Werner, G. Heusch, M. Ferrari, T. C. Poerner, A. Voss, and H. R. Figulla Detection of Coronary Microembolization by Doppler Ultrasound in Patients With Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Interventions Circulation, February 6, 2007; 115(5): 600 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Porto, J. B. Selvanayagam, W. J. Van Gaal, F. Prati, A. Cheng, K. Channon, S. Neubauer, and A. P. Banning Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention: Insights From Delayed-Enhancement Magnetic Resonance Imaging, Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade Analysis, and Intravascular Ultrasound Circulation, August 15, 2006; 114(7): 662 - 669. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Thielmann, P. Massoudy, M. Neuhauser, K. Tsagakis, G. Marggraf, M. Kamler, K. Mann, R. Erbel, and H. Jakob Prognostic Value of Preoperative Cardiac Troponin I in Patients Undergoing Emergency Coronary Artery Bypass Surgery With Non-ST-Elevation or ST-Elevation Acute Coronary Syndromes Circulation, July 4, 2006; 114(1_suppl): I-448 - I-453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Babuin and A. S. Jaffe Troponin: the biomarker of choice for the detection of cardiac injury Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Thielmann, P. Massoudy, A. Schmermund, M. Neuhauser, G. Marggraf, M. Kamler, U. Herold, I. Aleksic, K. Mann, M. Haude, et al. Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery Eur. Heart J., November 2, 2005; 26(22): 2440 - 2447. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Thielmann, P. Massoudy, M. Neuhauser, S. Knipp, M. Kamler, J. Piotrowski, K. Mann, and H. Jakob Prognostic Value of Preoperative Cardiac Troponin I in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery Chest, November 1, 2005; 128(5): 3526 - 3536. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Bahrmann, H R Figulla, M Wagner, M Ferrari, A Voss, and G S Werner Detection of coronary microembolisation by Doppler ultrasound during percutaneous coronary interventions Heart, September 1, 2005; 91(9): 1186 - 1192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Thielmann, P. Massoudy, M. Neuhauser, S. Knipp, M. Kamler, G. Marggraf, J. Piotrowski, and H. Jakob Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 861 - 869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.-J. Verhoeff, M. Siebes, M. Meuwissen, B. Atasever, M. Voskuil, R. J. de Winter, K. T. Koch, J. G.P. Tijssen, J. A.E. Spaan, and J. J. Piek Influence of Percutaneous Coronary Intervention on Coronary Microvascular Resistance Index Circulation, January 4, 2005; 111(1): 76 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G S Werner, U Emig, P Bahrmann, M Ferrari, and H R Figulla Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion Heart, November 1, 2004; 90(11): 1303 - 1309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Skyschally, M. Haude, H. Dorge, M. Thielmann, A. Duschin, A. van de Sand, I. Konietzka, A. Buchert, S. Aker, P. Massoudy, et al. Glucocorticoid Treatment Prevents Progressive Myocardial Dysfunction Resulting From Experimental Coronary Microembolization Circulation, May 18, 2004; 109(19): 2337 - 2342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. O. Williams A twist in our understanding of enzyme elevation after coronary intervention J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1906 - 1908. [Full Text] [PDF]
|
|
|
|
|
|
G Heusch and R Schulz Pathophysiology of coronary microembolisation Heart, September 1, 2003; 89(9): 981 - 982. [Full Text] [PDF]
|
|
|
|
|
|
R Erbel Spontaneous and interventional coronary microembolisation Heart, September 1, 2003; 89(9): 986 - 989. [Full Text] [PDF]
|
|
|
|
|
|
G. S. Werner, P. Bahrmann, O. Mutschke, U. Emig, S. Betge, M. Ferrari, and H. R. Figulla Determinants of target vessel failure in chronic total coronary occlusions after stent implantation: The influence of collateral function and coronary hemodynamics J. Am. Coll. Cardiol., July 16, 2003; 42(2): 219 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. K. Lund, N. Watzinger, M. Saeed, G. P. Reddy, M. Yang, P. A. Araoz, D. Curatola, M. Bedigian, and C. B. Higgins Chronic Heart Failure: Global Left Ventricular Perfusion and Coronary Flow Reserve with Velocity-encoded Cine MR Imaging: Initial Results Radiology, April 1, 2003; 227(1): 209 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mohlenkamp, P. E Beighley, E. A Pfeifer, T. R Behrenbeck, P. F Sheedy II, and E. L Ritman Intramyocardial blood volume, perfusion and transit time in response to embolization of different sized microvessels Cardiovasc Res, March 1, 2003; 57(3): 843 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Gregorini, J. Marco, B. Farah, M. Bernies, C. Palombo, M. Kozakova, I. M. Bossi, B. Cassagneau, J. Fajadet, C. Di Mario, et al. Effects of Selective {alpha}1- and {alpha}2-Adrenergic Blockade on Coronary Flow Reserve After Coronary Stenting Circulation, December 3, 2002; 106(23): 2901 - 2907. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Herrmann, A. Lerman, D. Baumgart, L. Volbracht, R. Schulz, C. von Birgelen, M. Haude, G. Heusch, and R. Erbel Preprocedural Statin Medication Reduces the Extent of Periprocedural Non-Q-Wave Myocardial Infarction Circulation, October 22, 2002; 106(17): 2180 - 2183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Bonz, B. Lengenfelder, J.o. Strotmann, S. Held, O. Turschner, K. Harre, C. Wacker, C. Waller, N. Kochsiek, M. Meesmann, et al. effect of additional temporary glycoprotein IIb/IIIa receptor inhibition on troponin release in elective percutaneous coronary interventions after pretreatment with aspirin and clopidogrel (TOPSTAR trial) J. Am. Coll. Cardiol., August 21, 2002; 40(4): 662 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. C. Wong, D. A. Morrow, S. Murphy, N. Kraimer, R. Pai, D. James, D. H. Robertson, L. A. Demopoulos, P. DiBattiste, C. P. Cannon, et al. Elevations in Troponin T and I Are Associated With Abnormal Tissue Level Perfusion: A TACTICS-TIMI 18 Substudy Circulation, July 9, 2002; 106(2): 202 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Thielmann, H. Dorge, C. Martin, S. Belosjorow, U. Schwanke, A. van de Sand, I. Konietzka, A. Buchert, A. Kruger, R. Schulz, et al. Myocardial Dysfunction With Coronary Microembolization: Signal Transduction Through a Sequence of Nitric Oxide, Tumor Necrosis Factor-{alpha}, and Sphingosine Circ. Res., April 19, 2002; 90(7): 807 - 813. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.J. Brener and E.J. Topol Epicardial versus microcirculatory dissociation Eur. Heart J., February 2, 2002; 23(4): 274 - 276. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Skyschally, R. Schulz, R. Erbel, and G. Heusch Reduced coronary and inotropic reserves with coronary microembolization Am J Physiol Heart Circ Physiol, February 1, 2002; 282(2): H611 - H614. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Thielmann, H. Dorge, C. Martin, S. Belosjorow, U. Schwanke, A. van de Sand, I. Konietzka, A. Buchert, A. Kruger, R. Schulz, et al. Myocardial Dysfunction With Coronary Microembolization: Signal Transduction Through a Sequence of Nitric Oxide, Tumor Necrosis Factor-{alpha}, and Sphingosine Circ. Res., April 19, 2002; 90(7): 807 - 813. [Abstract] [Full Text] [PDF]
|
|