Objective To study whether flow velocity profile in the left anterior descending (LAD) coronary artery measured by transthoracic Doppler echocardiography (TTDE) predicts myocardial viability after reperfused anterior acute myocardial infarction (AMI).
Setting Tertiary referral cardiac centre.
Patients and methods Fifteen patients who had their first anterior ST elevation AMI and were successfully reperfused by coronary angioplasty and five controls without coronary artery disease. Blood flow velocity spectrum was measured from the mid LAD by TTDE three days after coronary angioplasty. Myocardial viability in the LAD region was quantified three months after AMI by relative uptake of 18F-fluorodeoxygluocose (FDG) imaged with positron emission tomography (PET). Myocardium was graded as viable, partially viable or non-viable (relative FDG uptake >85%, 67-85% and <67%, respectively).
Main outcome measures Diastolic deceleration time (DDT) of LAD flow velocity three days after AMI and myocardial viability three 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 ± 76ms, n=3) than partially viable (356 ± 89ms, n=6, p<0.01), or non-viable myocardium (128 ± 13ms, 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 jeopardized myocardium.
- acute myocardial infarction
- myocardial viability
- percutaneous coronary angioplasty
- positron emission tomography
- transthoracic Doppler echocardiography
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