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(Circulation. 1996;93:1993-1999.)
© 1996 American Heart Association, Inc.
Articles |
Myocardial Perfusion Patterns Related to Thrombolysis in Myocardial Infarction Perfusion Grades After Coronary Angioplasty in Patients With Acute Anterior Wall Myocardial Infarction
From the Division of Cardiology (H.I., A.O., K.I., S.T., S.N., Y.N., Y.T., Y.H., K.F., T. Minamino), Sakurabashi Watanabe Hospital, and The First Department of Medicine (T. Masuyama, M.H.), Osaka University School of Medicine, Osaka, Japan.
Correspondence to Hiroshi Ito, MD, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530, Japan.
Background Epicardial coronary flow is occasionally reduced even after coronary intervention despite the absence of vessel obstruction in patients with acute myocardial infarction. Our aim was to clarify the cause and outcomes of radiocontrast slow filling in patients with reperfused acute anterior myocardial infarction by assessing microvascular damage with the use of myocardial contrast echocardiography (MCE) and functional outcomes.
Methods and Results We carefully reviewed the cineangiograms of 86 patients who achieved coronary revascularization within 12 hours of the onset and underwent MCE before and soon after recanalization with the intracoronary injection of sonicated microbubbles. Antegrade coronary flow after recanalization was graded by two observers based on Thrombolysis in Myocardial Infarction (TIMI) trial flow grades. Left ventricular ejection fraction was measured on the day of infarction and 1 month later. TIMI grade 2 was observed in 18 patients (21%), and the other 68 patients manifested TIMI grade 3 after recanalization. All patients with TIMI 2 showed substantial MCE no reflow, whereas only 11 patients (16%) with TIMI 3 showed MCE no reflow. Functional improvement was worse in patients with TIMI 2 than in those with TIMI 3 (TIMI 2, 38±8% versus 40±8%, P=NS [acute versus late]; TIMI 3, 44±13% versus 55±13%, P<.001). Among patients with TIMI 3, significant functional improvement was observed only in patients with MCE reflow (MCE reflow, 46±13% versus 57±12%, P<.001; MCE no reflow, 35±11% versus 45±12%, P=NS).
Conclusions Despite no obstructive lesion of the vessel, TIMI 2 is caused by advanced microvascular damage and is a highly specific, although not sensitive, predictor of poor functional outcomes in patients with acute myocardial infarction. TIMI 3 does not necessarily indicate myocardial salvage, and detection of MCE no reflow in these patients is particularly useful for the prediction of functional outcome.
Key Words: angioplasty • myocardial infarction • echocardiography • microcirculation • reperfusion
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T. Kawamoto, K. Yoshida, T. Akasaka, T. Hozumi, T. Takagi, S. Kaji, and Y. Ueda Can Coronary Blood Flow Velocity Pattern After Primary Percutaneous Transluminal Coronary Angiography Predict Recovery of Regional Left Ventricular Function in Patients With Acute Myocardial Infarction? Circulation, July 27, 1999; 100(4): 339 - 345. [Abstract] [Full Text] [PDF]
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R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
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I. Tritto and G. Ambrosio Spotlight on microcirculation: an update Cardiovasc Res, June 1, 1999; 42(3): 600 - 606. [Full Text] [PDF]
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L. Gregorini, J. Marco, M. Kozakova, C. Palombo, G. B. Anguissola, I. Marco, M. Bernies, B. Cassagneau, A. Distante, I. M. Bossi, et al. {alpha}-Adrenergic Blockade Improves Recovery of Myocardial Perfusion and Function After Coronary Stenting in Patients With Acute Myocardial Infarction Circulation, February 2, 1999; 99(4): 482 - 490. [Abstract] [Full Text] [PDF]
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S. KAUL Myocardial contrast echocardiography in acute myocardial infarction: time to test for routine clinical use? Heart, January 1, 1999; 81(1): 2 - 5. [Full Text]
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D Czitrom, D Karila-Cohen, E Brochet, J M Juliard, M Faraggi, M-C Aumont, P Assayag, and P G Steg Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery Heart, January 1, 1999; 81(1): 12 - 16. [Abstract] [Full Text]
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E. Brochet, D. Czitrom, D. Karila-Cohen, P. Seknadji, M. Faraggi, H. Benamer, P. Aubry, P. G. Steg, and P. Assayag Early changes in myocardial perfusion patterns after myocardial infarction: relation with contractile reserve and functional recovery J. Am. Coll. Cardiol., December 1, 1998; 32(7): 2011 - 2017. [Abstract] [Full Text] [PDF]
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M. Kondo, A. Nakano, D. Saito, and Y. Shimono Assessment of "microvascular no-reflow phenomenon" using technetium-99m macroaggregated albumin scintigraphy in patients with acute myocardial infarction J. Am. Coll. Cardiol., October 1, 1998; 32(4): 898 - 903. [Abstract] [Full Text] [PDF]
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S. Kaul Assessing the Myocardium After Attempted Reperfusion : Should We Bother? Circulation, August 18, 1998; 98(7): 625 - 627. [Full Text] [PDF]
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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]
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H. Okada, J. Woodcock-Mitchell, J. Mitchell, T. Sakamoto, K. Marutsuka, B. E. Sobel, and S. Fujii Induction of Plasminogen Activator Inhibitor Type 1 and Type 1 Collagen Expression in Rat Cardiac Microvascular Endothelial Cells by Interleukin-1 and Its Dependence on Oxygen-Centered Free Radicals Circulation, June 2, 1998; 97(21): 2175 - 2182. [Abstract] [Full Text] [PDF]
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K. C. Wu, E. A. Zerhouni, R. M. Judd, C. H. Lugo-Olivieri, L. A. Barouch, S. P. Schulman, R. S. Blumenthal, and J. A. C. Lima Prognostic Significance of Microvascular Obstruction by Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction Circulation, March 3, 1998; 97(8): 765 - 772. [Abstract] [Full Text] [PDF]
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D. KARILA-COHEN, D. CZITROM, E. BROCHET, and P. G. STEG Lessons from myocardial contrast echocardiography studies during primary angioplasty Heart, October 1, 1997; 78(4): 331 - 332. [Full Text] [PDF]
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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]
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T. Reffelmann, S. L. Hale, G. Li, and R. A. Kloner Relationship between no reflow and infarct size as influenced by the duration of ischemia and reperfusion Am J Physiol Heart Circ Physiol, February 1, 2002; 282(2): H766 - H772. [Abstract] [Full Text] [PDF]
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A. Tanaka, T. Kawarabayashi, Y. Nishibori, T. Sano, Y. Nishida, D. Fukuda, K. Shimada, and J. Yoshikawa No-Reflow Phenomenon and Lesion Morphology in Patients With Acute Myocardial Infarction Circulation, May 7, 2002; 105(18): 2148 - 2152. [Abstract] [Full Text] [PDF]
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