Estimation of infarct size using transthoracic Doppler echocardiographic measurement of coronary flow reserve in infarct related and reference coronary artery

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• 作者：Vojislav Giga ; Milan Dobric ; Branko Beleslin ; Dragana Sobic-Saranovic ; Milorad Tesic ; Ana Djordjevic-Dikic ; Jelena Stepanovic ; Ivana Nedeljkovic ; Vera Artiko ; Vladimir Obradovic ; Petar M. Seferovic ; Miodrag Ostojic
• 关键词：CFR ; coronary flow reserve ; CK ; creatine kinase ; EDV ; end-diastolic volume of the left ventricle ; ESV ; end-systolic volume of the left ventricle ; IRA ; infarct related artery ; LAD ; left anterior descending artery ; LV ; left ventricle ; MI ; myocardial infarct
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：20 September, 2013
• 年：2013
• 卷：168
• 期：1
• 页码：169-175
• 全文大小：501 K

文摘

Background

Patients in chronic phase of myocardial infarction (MI) have decreased coronary flow reserve (CFR) in infarct related artery (IRA) that is proportional to the extent of microvascular/myocardial damage. We proposed a novel model for the assessment of microvascular damage and infarct size using Doppler echocardiography evaluation of CFRs of the IRA (LAD) and reference artery (RCA).

Methods

Our study included 34 consecutive patients (28 men, mean age 50 ¡À 11 years) with first anterior STEMI and single vessel disease successfully treated with primary PCI. All patients underwent SPECT MPI for the assessment of infarct size (expressed as a percentage of myocardium with fixed perfusion abnormalities) and CFR evaluation of LAD and RCA. CFR derived percentage of microvascular damage (CFR PMD) was calculated as: CFR PMD = (CFR RCA ? CFR LAD) / (CFR RCA ? 1) ¡Á 100 ( % ).

Results

CFR PMD correlated significantly with all parameters evaluating the severity of myocardial damage including: peak CK activity (r = 0.632, p < 0.001), WMSI (r = 0.857, p < 0.001), ejection fraction (r = ? 0.820, p < 0.001), left ventricular end diastolic (r = 0.757, p < 0.001) and end systolic volume (r = 0.794, p < 0.001). Most importantly, CFR PMD (22 ¡À 17 % ) correlated significantly with infarct size by SPECT MPI (21 ¡À 17 % ) (r = 0.874, p < 0.001).

Conclusions

CFR PMD derived from the proposed model was significantly related to echocardiographic and enzymatic parameters of infarct size, as well as to myocardial damage assessed by SPECT MPI in patients with successfully reperfused first anterior STEMI.