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Coronary artery flow velocity profile measured by transthoracic Doppler echocardiography predicts myocardial viability after acute myocardial infarction
  1. Antti Saraste2,
  2. Juha W Koskenvuo1,
  3. Markku Saraste1,
  4. Jussi Pärkkä1,
  5. Jyri Toikka1,
  6. Alexandru Naum3,
  7. Heikki Ukkonen2,3,
  8. Juhani Knuuti3,
  9. Juhani Airaksinen2,
  10. Jaakko Hartiala1
  1. 1Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
  2. 2Department of Medicine, Turku University Hospital, Turku, Finland
  3. 3Turku PET centre, Turku, Finland
  1. Correspondence to:
    Dr A Saraste
    Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Kiinamyllynkatu 6–8, 20520 Turku, Finland; antti.saraste{at}utu.fi

Abstract

Objective: To study whether flow velocity profile in the left anterior descending coronary artery (LAD) measured by transthoracic Doppler echocardiography (TTDE) predicts myocardial viability after reperfused anterior acute myocardial infarction (AMI).

Patients and methods: 15 patients who had their first anterior ST elevation AMI and were successfully reperfused by coronary angioplasty and five controls without coronary artery disease were selected. Blood flow velocity spectrum was measured from the mid-LAD by TTDE 3 days after coronary angioplasty. Myocardial viability in the LAD region was quantified 3 months after AMI by relative uptake of 18F-fluorodeoxyglucose (FDG) imaged with positron emission tomography. Myocardium was graded as viable, partially viable or non-viable (relative FDG uptake >85%, 67–85% and <67%, respectively). Main outcome measures were diastolic deceleration time (DDT) of LAD flow velocity 3 days after AMI and myocardial viability 3 months after AMI.

Results: DDT of LAD flow velocity correlated with myocardial FDG uptake in the LAD region (r = 0.91, p<0.01). DDT was markedly longer in patients with viable myocardium (876±76 ms, n = 3) than partially viable (356±89 ms, n = 6, p<0.01), or non-viable myocardium (128±13 ms, n = 6, p<0.01). In controls, DDT was comparable (909±76 ms, n = 5) to patients with viable myocardium. DDT <190 ms was always associated with non-viable myocardium.

Conclusions: DDT of LAD flow velocity is strongly associated with myocardial viability after reperfused anterior AMI. Non-invasive TTDE of the LAD may be used in the acute phase to predict long-term viability of the jeopardised myocardium.

  • AMI, acute myocardial infarction
  • DDT, diastolic deceleration time
  • EF, ejection fraction
  • FDG, fluorodeoxyglucose
  • LAD, left anterior descending coronary artery
  • PET, positron emission tomography
  • TTDE, transthoracic Doppler echocardiography

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Footnotes

  • Published Online First 28 November 2006

  • Funding: The study has been financially supported by clinical research funds of the Turku University Hospital, Turku, Finland.

  • Competing interests: None.

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