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Impact of flow level on coronary flow velocity pattern. A doppler flow study in patients with first acute myocardial
Rainer Hoffmann1, Wolfgang Lepper, Nicole Heussen
1Medical Clinic I, University Hospital RWTH Aachen, Germany. rhoffmann@ukaachen.de
Insights
Coronary flow velocity patterns can predict left ventricular function after acute myocardial infarction (AMI). However, flow levels influence some pattern parameters, requiring careful interpretation for microvascular function assessment.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Coronary flow velocity patterns assess microvascular function post-acute myocardial infarction (AMI).
- The impact of varying flow levels on these patterns requires further investigation.
Purpose of the Study:
- To determine if coronary flow levels affect parameters of coronary flow velocity patterns.
- To assess the predictive value of these patterns for left ventricular (LV) function post-AMI.
Main Methods:
- Doppler flow wires used in 25 post-PTCA AMI patients to measure coronary flow velocity patterns at rest and during adenosine-induced hyperemia.
- Patients categorized by LV function (Global Wall Motion Index) at 4 weeks: depressed (>=1.5) vs. preserved (<1.5).
Main Results:
- Resting coronary flow patterns differed between depressed and preserved LV function groups.
- Hyperemia altered flow patterns, increasing Diastolic Deceleration Rate (DSR), peak systolic/diastolic flow velocity, and Diastolic Deceleration Time (DDT).
- Early systolic retrograde flow, systolic flow duration, and Diastolic-Systolic Velocity Ratio (DSVR) remained unaffected by increased flow.
Conclusions:
- Coronary flow velocity patterns predict LV function at 4 weeks post-AMI.
- Certain flow velocity parameters are sensitive to changes in coronary flow levels, necessitating consideration during analysis.
Abstract:
Analysis of coronary flow velocity pattern has been used to assess microvascular function post acute myocardial infarction (AMI). This study sought to analyze whether the flow level has an impact on parameters of coronary flow velocity pattern. Parameters of coronary flow velocity pattern were determined at baseline and during increased flow due to maximal hyperemia induced by adenosine in 25 patients after PTCA for first AMI using Doppler flow wires. Patients were divided into those with depressed (global wall motion index (GWMI) > or = 1.5; n = 14) and those with preserved (GWMI < 1.5; n = 11) left ventricular (LV) function at 4 weeks. Coronary flow velocity pattern at rest was different between patients with depressed and patients with preserved LV function at follow-up. A difference in flow pattern between the groups remained at increased flow level. However, increase of flow altered parameters of flow pattern. Diastolic deceleration rate (DSR) increased for patients with preserved LV function (53.7+/-25.6 at baseline vs. 67.0+/-29.8 cm/s2 with adenosine) and depressed LV function (95.3+/-58.6 vs. 110.7+/-61.4 cm/s2, respectively, p = 0.0012). Induction of hyperemia resulted also in increased systolic and diastolic peak flow velocity and diastolic deceleration time (DDT). Higher flow had no impact on early systolic retrograde flow, systolic flow duration and diastolic-systolic velocity ratio (DSVR). The coronary flow velocity pattern allows prediction of LV function at 4 weeks after AMI. However, it should be considered that some parameters of the flow velocity pattern are affected by the coronary flow level.
