Coronary Artery DiseaseEarly temporal changes in coronary flow velocity patterns in patients with acute myocardial infarction demonstrating the “no-reflow” phenomenon
Section snippets
Study population
Between October 1993 and March 1996, 144 patients with first AMI underwent PTCA of an occluded coronary artery (Thrombolysis In Myocardial Infarction trial grade 0 or 1) and underwent MCE and Doppler guidewire examination in the catheterization laboratory. The diagnosis of AMI was based on chest pain prolonged for ≥30 minutes, ST-segment elevation of ≥2 mm in at ≥2 contiguous electrocardiographic leads, and a more than threefold increase in serum creatine kinase levels. Twenty-nine patients
Clinical backgrounds
We found MCE no reflow in 36 of 144 study patients (25%). The early systolic retrograde flow was observed at the end of Doppler guidewire study in patients with MCE no reflow with the exception of 1, who was excluded from further analysis. We could not record coronary blood flow velocity at the moment of coronary reperfusion in 2 patients, and these patients were also excluded. The remaining 33 patients with MCE no reflow were used for further analysis (median 61 ± 10 years; range 34 to 79), of
Discussion
Several possible mechanisms have been postulated to explain the development of ischemic microvascular dysfunction. In canine studies, Kloner et al8, 9 found that no-reflow phenomenon is located well within the areas of necrosis, and suggested that no-reflow phenomenon is the consequence of ischemic microvascular and myocardial damages and established in the infarct myocardium before reperfusion. On the other hand, there are some reports suggesting that no-reflow phenomenon may develop mainly
Acknowledgements
We greatly acknowledge the excellent technical assistance of Yuzo Sakagami, Masakazu Ueda, Naoki Jonishi, and Hideshi Shimokawa, and the excellent secretarial assistance of Hideko Masuda.
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Novel insights into an "old" phenomenon: The no reflow
2015, International Journal of CardiologyCitation Excerpt :They suggested that intramyocardial blood pool in patients with NR is markedly reduced by severe CMD thus explaining the rapid diastolic flow deceleration. The increased microvascular resistance caused by CMD also explains the retrograde systolic flow [68] visualized by intracoronary Doppler. More recently myocardial contrast echocardiography (MCE) has been suggested as a diagnostic method for NR.
Relation Between the Assessment of Microvascular Injury by Cardiovascular Magnetic Resonance and Coronary Doppler Flow Velocity Measurements in Patients With Acute Anterior Wall Myocardial Infarction
2008, Journal of the American College of Cardiology