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Published on: June 28, 2019
Coronary vasomotor function in infarcted and remote myocardium after primary percutaneous coronary intervention
Paul F A Teunissen1, Stefan A J Timmer1, Ibrahim Danad1
1Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
Insights
Coronary flow reserve (CFR) is impaired after acute myocardial infarction (AMI), but partially recovers within 3 months. However, myocardial blood flow remains reduced compared to controls, indicating persistent vasomotor dysfunction.
Area of Science:
- Cardiovascular Research
- Nuclear Cardiology
- Myocardial Perfusion Imaging
Background:
- Coronary vasomotor function is compromised in both the infarcted area and remote regions following acute myocardial infarction (AMI).
- Successful percutaneous coronary intervention (PCI) aims to restore blood flow but does not fully address underlying vasomotor abnormalities.
Purpose of the Study:
- To investigate the temporal changes in coronary vasodilatory reserve after AMI and successful PCI.
- To assess the recovery of coronary flow reserve (CFR) in both infarcted and remote myocardial territories using [(15)O]H2O positron emission tomography (PET).
Main Methods:
- 44 patients with AMI underwent [(15)O]H2O PET scans 1 week and 3 months post-PCI to measure CFR.
- CFR was calculated as the ratio of hyperemic to resting myocardial blood flow (MBF).
- 45 healthy controls underwent similar PET scans for comparison.
Main Results:
- One week after AMI, CFR was significantly lower in both infarcted (1.81±0.66) and remote (2.51±0.81) myocardium compared to controls (4.16±1.45).
- At 3 months, CFR improved in both infarcted (2.74±0.85) and remote (2.85±0.70) territories, primarily due to increased hyperemic MBF.
- Despite recovery, CFR and MBF remained impaired in both territories compared to control subjects.
Conclusions:
- Coronary vasomotor function is significantly impaired in the early phase after AMI, affecting both culprit and remote myocardial regions.
- Partial recovery of CFR is observed by 3 months post-PCI, suggesting some improvement in vasomotor function.
- Persistent impairment in myocardial blood flow compared to controls highlights long-term consequences of AMI on coronary microvascular function.
Objective:
In patients with acute myocardial infarction (AMI), coronary vasomotor function is impaired in the myocardial territory supplied by the culprit artery and in remote myocardium supplied by angiographically normal vessels. The aim was to investigate the temporal evolution of coronary vasodilatory reserve in patients with AMI by use of [(15)O]H2O positron emission tomography, after successful percutaneous coronary intervention.
Methods:
44 patients with AMI and successful revascularisation by percutaneous coronary intervention were included. Subjects were examined 1 week and 3 months after AMI with [(15)O]H2O positron emission tomography to assess the coronary flow reserve (CFR). CFR was defined as the ratio of myocardial blood flow (MBF) during hyperaemia and rest. Additionally, 45 age-matched and sex-matched subjects underwent similar scanning procedures and served as controls.
Results:
At baseline, CFR averaged 1.81±0.66 in infarcted myocardium versus 2.51±0.81 in remote myocardium (p<0.01). In comparison, CFR in the control group averaged 4.16±1.45 (p=0.001 vs both). During follow-up, the CFR increased to 2.74±0.85 in infarcted myocardium (p<0.01), and to 2.85±0.70 in remote myocardium (p<0.01). This was predominantly due to an increase in hyperaemic MBF, from 1.62±0.54 mL/min/g to 2.19±0.68 mL/min/g in infarcted myocardium (p<0.001), and 2.17±0.54 mL/min/g to 2.60±0.65 mL/min/g in remote myocardium (p<0.001).
Conclusions:
CFR in infarcted and remote myocardium is impaired 1 week after AMI. After 3 months vasomotor function partially recovers. However, as compared with control patients, MBF remains impaired in culprit and reference territories in patients with AMI.
Clinical Trial Registration:
NTR3164.
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