Usefulness of impairment of coronary microcirculation in predicting left ventricular dilation after acute myocardial infarction
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Published on: April 25, 2014
Yasunori Shintani1, Hiroshi Ito, Katsuomi Iwakura
1Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
Persistence of impaired coronary blood flow velocity patterns up to 7 days after reperfusion in acute myocardial infarction patients predicts left ventricular remodeling. Early microvascular dysfunction is a key indicator.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- Left ventricular (LV) remodeling is a significant complication following acute myocardial infarction (AMI).
- Predicting LV remodeling early is crucial for timely intervention and improved patient outcomes.
- Coronary blood flow velocity (CBFV) patterns may reflect microvascular function post-AMI.
Purpose of the Study:
- To assess serial changes in CBFV patterns using transthoracic Doppler echocardiography.
- To determine the optimal timing for predicting LV remodeling in anterior AMI patients.
- To investigate the relationship between diastolic deceleration time (DDT) and LV remodeling.
Main Methods:
- Transthoracic Doppler echocardiography was used to record CBFV in the left anterior descending (LAD) coronary artery.
- Diastolic deceleration time (DDT) was measured on days 2, 7, and 21 in 52 anterior AMI patients post-primary angioplasty.
- Patients were categorized based on DDT values (> /=600 ms or <600 ms) at different time points.
Main Results:
- On day 2, 31 patients had DDT <600 ms. Of these, 19 (group B2) still had DDT <600 ms on day 7.
- Group B2 patients showed significant chronic LV dilation at 6 months compared to other groups (LV end-diastolic volume index: 100 +/- 22 ml/m(2)).
- DDT <600 ms on day 7 was the sole independent predictor of LV remodeling via multivariate analysis.
Conclusions:
- CBFV patterns normalize over time post-AMI, but the normalization rate varies.
- Persistent microvascular dysfunction, indicated by DDT <600 ms on day 7, is a strong predictor of LV remodeling.
- Transthoracic Doppler echocardiography and DDT measurement provide valuable insights into microvascular function and remodeling risk post-AMI.
Abstract:
The goals of this study were to assess the serial change in coronary blood flow velocity (CBFV) patterns with transthoracic Doppler echocardiography and to decide optimal timing to predict left ventricular (LV) remodeling in patients with anterior acute myocardial infarction. We recorded CBFV of the left anterior descending (LAD) coronary artery with transthoracic Doppler echocardiography and measured diastolic deceleration time (DDT, measured in milliseconds) on days 2, 7, and 21 in 52 patients with anterior acute myocardial infarction treated with primary coronary angioplasty. On day 2, DDT was >/=600 ms in 21 patients (group A) and <600 ms in the other 31 patients (group B). In group B, DDT increased to >/=600 ms in 12 patients on day 7 (group B1), and DDT was still <600 ms in the other 19 patients (group B2). However, DDT became comparable among 3 groups on day 21. Group B2 patients had significant chronic LV dilation (LV end-diastolic volume index in groups A, B1, and B2 at 6 months: 74 +/- 16 vs 81 +/- 17 vs 100 +/- 22. ml/m(2), respectively; p <0.05 vs other groups). Multivariate analysis revealed that DDT <600 ms on day 7 was the only independent variable related to LV remodeling. In conclusion, the CBFV pattern changed toward normalization with time in patients with acute myocardial infarction. Time taken for normalization varied among patients. Persistence of microvascular dysfunction up to 7 days after reperfusion predicted LV remodeling.
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