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Relation of coronary flow pattern to myocardial blush grade in patients with first acute myocardial infarction
R Hoffmann1, P Haager, W Lepper
1Medical Clinic I, University Hospital RWTH Aachen, Germany. rhoffmann@ukaachen.de
Insights
Myocardial blush grade (MBG) directly reflects microvascular function after acute myocardial infarction angioplasty. Coronary flow velocity patterns correlate with MBG, indicating its importance in assessing reperfusion injury and microvascular damage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Microvascular Physiology
Background:
- Myocardial blush grade (MBG) and coronary flow velocity patterns are used to assess microvascular damage and reperfusion injury post-percutaneous transluminal coronary angiography.
- These parameters are crucial in managing acute myocardial infarction.
Purpose of the Study:
- To evaluate the relationship between coronary blood flow velocity patterns and MBG immediately after angioplasty with stenting for acute myocardial infarction.
Main Methods:
- Coronary blood flow velocity patterns were analyzed in 35 patients with first acute myocardial infarction using a Doppler guide wire immediately post-angioplasty.
- Measurements were correlated with MBG as a direct index of microvascular function.
Main Results:
- Significant differences in systolic peak flow velocity, diastolic deceleration rate, and diastolic-systolic velocity ratio were observed across different MBG groups (absent, reduced, normal).
- Multivariate analysis identified MBG as the sole significant predictor of the diastolic deceleration rate, independent of patient age, infarct characteristics, or time to revascularization.
Conclusions:
- The coronary flow velocity pattern in the infarct-related epicardial artery is primarily dictated by the microvascular function of the myocardium.
- MBG serves as a key determinant of coronary blood flow dynamics, reflecting the extent of microvascular impairment and recovery post-intervention.
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.
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