Circulation, Vol 89, 1109-1117, Copyright © 1994 by American Heart Association
H Suryapranata, F Zijlstra, DC MacLeod, M van den Brand, PJ de Feyter and PW Serruys
BACKGROUND: The objective of the study was to determine the coronary
vasodilatory reserve in reperfused myocardium in patients with acute
myocardial infarction and its relation to regional myocardial function.
METHODS AND RESULTS: The study population consisted of 22 patients with
acute myocardial infarction who underwent successful coronary angioplasty.
The vasodilatory reserve in the reperfused myocardium was assessed
quantitatively using computer-assisted digital subtraction cine-angiography
immediately after angioplasty and at follow-up angiography before hospital
discharge. Myocardial contrast medium appearance time and density were
determined before and after pharmacological hyperemia induced by an
intracoronary injection of 12.5 mg papaverine. Global and regional left
ventricular functions were determined from contrast angiography. After
papaverine, the mean contrast medium appearance time decreased
significantly from 3.5 +/- 0.7 to 2.7 +/- 0.7 cardiac cycles (P <
.000005) immediately after successful coronary angioplasty and from 3.8 +/-
0.7 to 2.7 +/- 0.9 cardiac cycles (P < .000005) at angiography before
hospital discharge. The mean contrast medium density increased
significantly from 48.7 +/- 13.8 to 61.0 +/- 19.0 pixels (P < .003) and
from 49.6 +/- 19.7 to 80.3 +/- 29.6 pixels (P < .000005), respectively.
As a consequence, the calculated coronary flow reserve increased
significantly from 1.8 +/- 0.7 to 2.6 +/- 1.0 (P < .0008). The global
ejection fraction increased significantly from 52 +/- 12% to 58 +/- 14% (P
< .03), primarily because of a significant improvement in the regional
myocardial function of the infarct zone from 20.8 +/- 9.0% to 26.0 +/-
10.5% (P < .001). Coronary flow reserve correlated well with regional
myocardial function both during the acute phase (R = .79, P < .002) and
at follow- up angiography (R = .82, P < .000004). Interestingly,
coronary flow reserve measurement on reperfusion, immediately after
angioplasty, correlated significantly with regional myocardial function at
follow-up angiography (R = .81, P < .00003). CONCLUSIONS: The results
indicate that there is a pharmacologically inducible vasodilatory reserve
in reperfused ischemic myocardium after successful coronary angioplasty in
patients with acute myocardial infarction and that this is increased at
10-day follow-up angiography. More important, the degree of reactive
hyperemic response on reperfusion has a predictive value regarding the
ultimate degree of recovery of regional myocardial function. Quantitative
assessment of reperfusion may be useful in investigating the role of
coronary reperfusion and salvage of myocardial function.
ARTICLES
Predictive value of reactive hyperemic response on reperfusion on recovery of regional myocardial function after coronary angioplasty in acute myocardial infarction
Thoraxcenter, Erasmus University Hospital Rotterdam, The Netherlands.
This article has been cited by other articles:
 |
|
 |
|
  H. Kitabata, T. Imanishi, T. Kubo, S. Takarada, M. Kashiwagi, H. Matsumoto, H. Tsujioka, H. Ikejima, Y. Arita, K. Okochi, et al. Coronary Microvascular Resistance Index Immediately After Primary Percutaneous Coronary Intervention as a Predictor of the Transmural Extent of Infarction in Patients With ST-Segment Elevation Anterior Acute Myocardial Infarction. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 263 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P L Van Herck, S G Carlier, M J Claeys, S E Haine, P Gorissen, H Miljoen, J M Bosmans, and C J Vrints Coronary microvascular dysfunction after myocardial infarction: increased coronary zero flow pressure both in the infarcted and in the remote myocardium is mainly related to left ventricular filling pressure Heart, October 1, 2007; 93(10): 1231 - 1237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Ikeno, K. Inagaki, M. Rezaee, and D. Mochly-Rosen Impaired perfusion after myocardial infarction is due to reperfusion-induced {delta}PKC-mediated myocardial damage Cardiovasc Res, March 1, 2007; 73(4): 699 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Montisci, L Chen, M Ruscazio, P Colonna, C Cadeddu, C Caiati, M Montisci, L Meloni, and S Iliceto Non-invasive coronary flow reserve is correlated with microvascular integrity and myocardial viability after primary angioplasty in acute myocardial infarction Heart, August 1, 2006; 92(8): 1113 - 1118. [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]
|
|
|
|
 |
|
 M. Bax, R. J. de Winter, C. E. Schotborgh, K. T. Koch, M. Meuwissen, M. Voskuil, R. Adams, K. J. J. Mulder, J. G. P. Tijssen, and J. J. Piek 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., February 18, 2004; 43(4): 534 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P.S. Henriques, F. Zijlstra, A. W.J. van 't Hof, M.-J. de Boer, J.-H. E. Dambrink, M. Gosselink, J. C.A. Hoorntje, and H. Suryapranata Angiographic Assessment of Reperfusion in Acute Myocardial Infarction by Myocardial Blush Grade Circulation, April 29, 2003; 107(16): 2115 - 2119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K. Haager, P. Christott, N. Heussen, W. Lepper, P. Hanrath, and R. Hoffmann Prediction of clinical outcome after mechanical revascularization in acute myocardial infarction by markers of myocardial reperfusion J. Am. Coll. Cardiol., February 19, 2003; 41(4): 532 - 538. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Beygui, C Le Feuvre, G Helft, C Maunoury, and J P Metzger Myocardial viability, coronary flow reserve, and in-hospital predictors of late recovery of contractility following successful primary stenting for acute myocardial infarction Heart, February 1, 2003; 89(2): 179 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Shimada, Y Sakanoue, Y Kobayashi, S Ehara, M Hirose, Y Nakamura, D Fukuda, H Yamagishi, M Yoshiyama, K Takeuchi, et al. Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2003; 89(1): 71 - 76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Beygui, C. Le Feuvre, C. Maunoury, G.e. Helft, and J. P. Metzger Coronary vasodilator reserve: a clue to the explanation of 201Tl redistribution patterns early after successful primary stenting for acute myocardial infarction J. Am. Coll. Cardiol., September 4, 2002; 40(5): 877 - 881. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y Ueno, Y Nakamura, M Kinoshita, T Fujita, T Sakamoto, and H Okamura Can coronary flow velocity reserve determined by transthoracic Doppler echocardiography predict the recovery of regional left ventricular function in patients with acute myocardial infarction? Heart, August 1, 2002; 88(2): 137 - 141. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Poli, R. Fetiveau, P. Vandoni, G. del Rosso, M. D'Urbano, G. Seveso, F. Cafiero, and S. De Servi Integrated Analysis of Myocardial Blush and ST-Segment Elevation Recovery After Successful Primary Angioplasty: Real-Time Grading of Microvascular Reperfusion and Prediction of Early and Late Recovery of Left Ventricular Function Circulation, July 16, 2002; 106(3): 313 - 318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. De Bruyne, N. H.J. Pijls, J. Bartunek, K. Kulecki, J.-W. Bech, H. De Winter, P. Van Crombrugge, G. R. Heyndrickx, and W. Wijns Fractional Flow Reserve in Patients With Prior Myocardial Infarction Circulation, July 10, 2001; 104(2): 157 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Roe, E. M. Ohman, A. C. P. Maas, R. H. Christenson, K. W. Mahaffey, C. B. Granger, R. A. Harrington, R. M. Califf, and M. W. Krucoff Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion J. Am. Coll. Cardiol., January 1, 2001; 37(1): 9 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Feldman, D. Himbert, J.-M. Juliard, G. J. Karrillon, H. Benamer, P. Aubry, O. Boudvillain, P. Seknadji, M. Faraggi, and P. G. Steg Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1162 - 1169. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Karila-Cohen, D Czitrom, E Brochet, M Faraggi, P Seknadji, D Himbert, J.-M Juliard, P Assayag, and P.G Steg Decreased no-reflow in patients with anterior myocardial infarction and pre-infarction angina Eur. Heart J., December 1, 1999; 20(23): 1724 - 1730. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Hattori, H. Matsui, M. Kitano, Y. Ichihara, S. Ogawa, M. Hirai, H. Hayashi, and H. Saito Staged Reperfusion Preserves the Coronary Flow Reserve, Especially in the Regions Not Severely Damaged by Ischemic Injury in the Canine Heart Angiology, December 1, 1998; 49(12): 991 - 1004. [Abstract] [PDF]
|
|
|
|
|
|
T. Tsunoda, M. Nakamura, T. Wakatsuki, T. Nishida, T. Asahara, H. Anzai, H. Touma, K. Mitsuo, Y. Soumitsu, H. Sakatani, et al. The pattern of alteration in flow velocity in the recanalized artery is related to left ventricular recovery in patients with acute infarction and successful direct balloon angioplasty J. Am. Coll. Cardiol., August 1, 1998; 32(2): 338 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W.J. van `t Hof, A. Liem, H. Suryapranata, J. C.A. Hoorntje, M.-J. de Boer, and F. Zijlstra Angiographic Assessment of Myocardial Reperfusion in Patients Treated With Primary Angioplasty for Acute Myocardial Infarction : Myocardial Blush Grade Circulation, June 16, 1998; 97(23): 2302 - 2306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Kern, J. A. Moore, F. V. Aguirre, R. G. Bach, E. A. Caracciolo, T. Wolford, A. F. Khoury, C. Mechem, and T. J. Donohue Determination of Angiographic (TIMI Grade) Blood Flow by Intracoronary Doppler Flow Velocity During Acute Myocardial Infarction Circulation, October 1, 1996; 94(7): 1545 - 1552. [Abstract] [Full Text]
|
|
|
|
|
|
K. Iwakura, H. Ito, S. Takiuchi, Y. Taniyama, Y. Nakatsuchi, S. Negoro, Y. Higashino, A. Okamura, T. Masuyama, M. Hori, et al. Alternation in the Coronary Blood Flow Velocity Pattern in Patients With No Reflow and Reperfused Acute Myocardial Infarction Circulation, September 15, 1996; 94(6): 1269 - 1275. [Abstract] [Full Text]
|
|