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Impaired coronary flow reserve after a recent myocardial infarction: correlation with infarct size and extent of
P L Van Herck1, B P Paelinck, S E Haine
1Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. Paul.Van.Herck@UZA.be
Insights
Coronary flow reserve (CFR) in both infarcted and remote heart muscle is inversely related to heart attack size. A CFR of 2 or less in the infarct-related artery can help detect microvascular obstruction after myocardial infarction.
Area of Science:
- Cardiology
- Cardiovascular Research
- Myocardial Infarction
Background:
- The relationship between coronary flow reserve (CFR) and myocardial infarction (MI) size is not fully understood.
- Assessing CFR in both infarcted and remote myocardium is crucial for understanding post-MI cardiac function.
- The predictive value of CFR for microvascular obstruction (MO) requires further investigation.
Purpose of the Study:
- To investigate the relationship between CFR in infarcted and remote myocardium and infarct size.
- To evaluate the diagnostic utility of CFR in predicting the extent of microvascular obstruction (MO).
Main Methods:
- Prospective study involving 30 patients post-MI.
- CFR measurement using a Doppler guide wire 6 ± 3 days after MI.
- Infarct size and MO determined by magnetic resonance imaging.
Main Results:
- CFR showed an inverse relationship with infarct size in both infarcted (r=-0.60) and remote (r=-0.62) myocardium.
- Microvascular obstruction (MO) in the infarcted myocardium was strongly linked to infarct size and significantly determined CFR and hyperemic flow.
- A CFR value ≤ 2 in the infarct-related artery demonstrated 65% sensitivity and 71% specificity for detecting MO.
Conclusions:
- CFR in both infarcted and remote myocardium is inversely proportional to infarct size following MI.
- A CFR threshold of ≤ 2 in the infarct-related artery serves as a predictor of MO with moderate accuracy.
Background:
The exact relationship between the coronary flow reserve (CFR) and infarct size remains unknown. In this prospective study the relationship between the CFR both in the infarcted and remote myocardium and infarct size was investigated. Furthermore, the diagnostic value of the CFR to predict the extent of microvascular obstruction (MO) was evaluated.
Methods:
In thirty patients the CFR was measured with a Doppler guide wire 6 ± 3 days after a first myocardial infarction (MI) in the infarct related and in a reference coronary artery. MO and infarct size were determined with magnetic resonance imaging.
Results:
The CFR was inversely related to infarct size in the infarcted and remote myocardium (respectively, r=-0.60, p<0.01 and r=-0.62, p<0.01). In the infarcted myocardium the extent of MO was strongly related to the infarct size and was in a multivariate analysis the single significant determinant of the CFR and the hyperaemic flow. In the remote myocardium no relationship was present between infarct size and hyperaemic flow, but the baseline flow increased as the infarct size became larger (r=0.58, p<0.01). In a receiver operator characteristic (ROC) analysis, a CFR value ≤ 2 in the infarct related coronary artery offered the best sensitivity (65%) and specificity (71%) to detect the presence of MO (p<0.05).
Conclusions:
After MI, the CFR both in the infarcted and remote myocardium is inversely related to infarct size. In the infarcted myocardium, a CFR value ≤ 2 predicts the presence of MO with moderate sensitivity and specificity.
