CARDIOVASCULAR MEDICINE

Persistence of systolic coronary flow reversal predicts irreversible dysfunction after reperfused anterior myocardial infarction

Y Nohtomi¹, M Takeuchi², K Nagasawa¹, K Arimura¹, K Miyata¹, K Kuwata¹, T Yamawaki¹, S Kondo¹, A Yamada¹ and S Okamatsu¹

¹ Department of Cardiovascular Medicine, Cardiovascular Centre, Iizuka Hospital, Iizuka, Japan
² Department of Internal Medicine, Tane General Hospital, Osaka, Japan

Correspondence to:
Correspondence to:
Dr Masaaki Takeuchi, Department of Internal Medicine, Tane General Hospital, 1-2-31, Sakaigawa, Nishi-ku, Osaka 550-0024, Japan;
masaaki_takeuchi{at}hotmail.com

Objective: To investigate serial assessments of systolic coronary flow reversal in the infarct related artery for predicting poor left ventricular functional recovery after reperfused acute myocardial infarction.

Setting: Regional hospital.

Patients and methods: 49 patients with anterior acute myocardial infarction had transthoracic Doppler echocardiography to record coronary flow velocity in the left anterior descending coronary artery immediately after successful primary coronary angioplasty (day 0), and at 48 hours, one week, and three weeks.

Main outcome measures: Coronary flow velocity at each time point; regional wall motion score index (RWMSI) at day 0 and at three weeks. Irreversible dysfunction was defined as a decrease in RWMSI to < 0.22.

Results: Measurements of coronary flow velocity could be made in 45 patients. Patients were divided into three groups: no systolic flow reversal (group 1, n = 27), systolic flow reversal observed only on day 0 (group 2, n = 8), and systolic flow reversal persisting until 48 hours (group 3, n = 10). Although baseline RWMSI was similar among the three groups, the value at three weeks was significantly higher in group 3 than in the other two groups. In predicting irreversible dysfunction, the persistence of systolic flow reversal up to 48 hours had a higher positive predictive value (100%) than the presence of systolic flow reversal on day 0 (67%, p < 0.04). The negative predictive value of systolic flow reversal at 48 hours (83%) was comparable in accuracy to the presence of systolic flow reversal on day 0 (85%, NS).

Conclusions: In reperfused anterior acute myocardial infarction, serial assessment of coronary flow velocity in the left anterior descending coronary artery is feasible using transthoracic Doppler echocardiography, and the persistence of systolic flow reversal at 48 hours is a more specific marker of irreversible dysfunction than peak creatine kinase or diastolic deceleration time.

Keywords: myocardial infarction; echocardiography; coronary blood flow

Abbreviations: APDV, time averaged peak diastolic coronary flow velocity; APSV, time averaged peak systolic coronary flow velocity; PTCA, percutaneous transluminal coronary angioplasty; RWMSI, regional wall motion score index; SFR, systolic coronary flow reversal; TIMI, thrombolysis in myocardial infarction trial; RWMSI, RWMSI at day 0 minus RWMSI at three weeks

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