The Doppler flow wire in acute myocardial infarction
Bimmer E P M Claessen1, Matthijs Bax, Ronak Delewi
1Department of Cardiology, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.
Heart (British Cardiac Society)
|April 2, 2010
Summary
Successful reperfusion therapy for heart attacks doesn't always restore blood flow to heart tissue. A Doppler flow guidewire can detect impaired microcirculation after percutaneous coronary intervention (PCI), identifying patients needing further treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Mechanical reperfusion therapy aims for complete myocardial perfusion in acute myocardial infarction.
- Restored epicardial blood flow post-percutaneous coronary intervention (PCI) does not always ensure myocardial tissue-level reperfusion.
- Inadequate reperfusion after primary PCI affects 15-70% of patients, depending on diagnostic methods.
Purpose of the Study:
- To evaluate the utility of intracoronary Doppler flow guidewire immediately after primary PCI.
- To identify patients with impaired myocardial reperfusion despite restored epicardial flow.
- To assess Doppler findings indicative of microvascular obstruction.
Main Methods:
- Utilized Doppler flow guidewire immediately following primary PCI in acute myocardial infarction patients.
- Measured intracoronary Doppler flow velocity parameters, including coronary flow velocity reserve, systolic flow velocity, and diastolic deceleration time.
- Correlated Doppler findings with the presence of microvascular obstruction.
Main Results:
- Doppler flow guidewire detected impaired myocardial reperfusion in patients with restored epicardial flow.
- Reduced coronary flow velocity reserve, systolic flow velocity reversal, and short diastolic deceleration time were characteristic of microvascular obstruction.
- These Doppler findings identified patients with suboptimal tissue-level reperfusion post-PCI.
Conclusions:
- Intracoronary Doppler flow guidewire is valuable for assessing myocardial reperfusion immediately after primary PCI.
- Doppler assessment can identify microvascular obstruction, a cause of inadequate reperfusion.
- Detection of microvascular obstruction can guide the need for adjunctive therapies to improve outcomes in acute myocardial infarction.
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