Coronary Flow Reserve in the Remote Myocardium Predicts Left Ventricular Remodeling Following Acute Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Purpose: Coronary flow reserve (CFR) in the non-infarcted myocardium is often impairedfollowing acute myocardial infarction (AMI). However, the clinical significanceof CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI. Materials and Methods: We enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months aftercoronary angioplasty. Ten subjects were enrolled as the control group and were examinedusing the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration. Results: CFR was 1.55±0.11 in the infarcted zone and 2.05±0.31 in the remote zone (p<0.01) at one week following AMI. According to CFR values in the remote zone, all patients were divided into two groups: Group I (CFR <2.05) and Group II (CFR >2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty. Conclusion: Microvasculardysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

참고문헌 (Reference)

1 Armstrong WF, "Stress echocardiography: current methodology and clinical applications" 45 : 1739-1747, 2005

2 Cerqueira MD, "Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association" 18 : 539-542, 2002

3 Geshi T, "Relationship between impaired microvascular function in the non-infarct-related area and left-ventricular remodeling in patients with myocardial infarction" 126 : 366-373, 2008

4 Kurita T, "Regional myocardial perfusion reserve determined using myocardial perfusion magnetic resonance imaging showed a direct correlation with coronary flow velocity reserve by Doppler flow wire" 30 : 444-452, 2009

5 Laser A, "Regional biochemical remodeling in non-infarcted tissue of rat heart post-myocardial infarction" 28 : 1531-1538, 1996

6 Wita K, "Prediction of left ventricular remodeling in patients with STEMI treated with primary PCI: use of quantitative myocardial contrast echocardiography" 22 : 171-178, 2011

7 Neizel M, "Predicting microvascular obstruction with cardiac troponin T after acute myocardial infarction: a correlative study with contrast-enhanced magnetic resonance imaging" 98 : 555-562, 2009

8 박성미, "Predicting Myocardial Functional Recovery After Acute Myocardial Infarction: Relationship Between Myocardial Strain and Coronary Flow Reserve" 대한심장학회 40 (40): 639-644, 2010

9 Wita K, "Microvascular damage prevention with thrombaspiration during primary percutaneous intervention in acute myocardial infarction" 20 : 51-57, 2009

10 Coser A, "Intravenous contrast echocardiography after myocardial infarction: relationship among residual myocardial perfusion, contractile reserve and long-term remodelling" 8 : 1012-1019, 2007

11 Funaro S, "Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study" 30 : 566-575, 2009

12 Bolognese L, "Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction" 109 : 1121-1126, 2004

13 Pacella JJ, "Effect of coronary stenosis on adjacent bed flow reserve: assessment of microvascular mechanisms using myocardial contrast echocardiography" 114 : 1940-1947, 2006

14 Mathias W Jr, "Dynamic changes in microcirculatory blood flow during dobutamine stress assessed by quantitative myocardial contrast echocardiography" 28 : 993-1001, 2011

15 Wei K, "Detection and quantification of coronary stenosis severity with myocardial contrast echocardiography" 44 : 81-100, 2001

16 Anantharam B, "Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure" 12 : 69-75, 2011

17 Lepper W, "Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angioplasty [correction of angiography] in patients with acute myocardial infarction" 101 : 2368-2374, 2000

18 Grayburn PA, "Advances in the assessment of no-reflow after successful primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: now that we can diagnose it, what do we do about it?" 51 : 566-568, 2008

19 Bodí V, "Abnormal myocardial perfusion after infarction in patients with persistent TIMI grade-3 flow. Only an acute phenomenon?" 60 : 486-492, 2007