Intracoronary adenosine as an adjunct to primary coronary intervention in acute myocardial infarction

Primary percutaneous coronary intervention [PCI] has resulted in marked reduction in the incidence of reinfarction death and stroke in the setting of acute myocardial infarction. However, its beneficial effects are limited by reperfusion injury. Adenosine limits reperfusion injury in animal models. The aim of this study was to evaluate the feasibility safety and value of intracoronary adenosine as an adjunct to primary PCI in acute myocardial infarction. The study included 60 patients with acute ST-elevation myocardial infarction within 6 hours of the onset of chest pain referred for primary PCI. Patients were divided into two groups, the adenosine group, included 20 patients who received intracoronary adenosine as an adjunct to primary PCI; and the control group, included 40 patients, who received saline instead. All patients had 12-lead ECG before and after intervention cardiac enzynes estimation and detailed assessment of angiographic data during PCI emphasizing on post-intervention TIMI flow and TIMI myocardial perfusion grading [TMP]. Conventional and pulsed tissue Doppler examinations were done within 24 hours after PCI and one week later to evaluate wall motion and myocardial velocities within the reperfused segments. Both groups were matched in teens of age sex risk factors, infarct location and distribution of coronary artery disease. Though the mean time from onset of chest pain to PCI was significantly shorter in the control group, the adenosine group demonstrated significantly lower enzymatic peaks [1880.3 +/- 1020.4 versus 2806 +/- 1379.8; P < 0.01], significantly higher incidence of TIMI III flow [95% versus 65%; P < 0.03]. significantly higher incidence of TMP III grace [85% versus 40%; P < 0.007], significantly lower TIMI frame count [11.5 +/- 3.1 versus 23.1 +/- 9.8 frames: P < 0.0001] and markedly lower incidence of no-reflow compared to the control group [10% versus 45% P < 0.006] at day 7, only adenosine group demonstrated significant improvement in ejection fraction, systolic wall motion score indices with striking improvement in the annular and segmental S wave velocities recorded by tissue Doppler. Adenosine administration in the setting of primary PCI for ecute myocardial infarction is safe, significantly limits reperfusion injury and improves myocardial perfusion thus optimizing the results of PCI

Remote non-infarct segment kinesis. Influence of clinical and angiographic findings "a tissue doppler study"

Regional wall motion is closely related to the status of the myocardium. Two-dimension tissue Doppler imaging provides a valuable quantitative assessment of wall motion in normal and ischemic dysfunctioning myocardium. The aim of this study was to evaluate the contractile status of the remote non-infarct segment in setting of myocardial infarction and to clarify the influence of patients clinical profile and extent of coronary artery disease on the myocardial kinetics in remote segments. Using pulsed tissue Doppler imaging in short axis parasternal view, at the mid-papillary muscle level, the peak myocardial systolic velocities [S waves] were assessed in the anteroseptum and posterior wall in 30 patients with acute inferior myocardial infarction with marked asynergy observed in the infracted wall. Similar measurements were obtained in 15 matched healthy controls. In patients with inferior wall myocardial infarction, the peak systolic myocardial velocities were significantly higher in the anteroseptum wail when compared to controls [21 +/- 2.4 versus 19.34 +/- 2.6; P <0.05]. conversely, the peak systolic myocardial velocities in the posterior wall were significantly lower in patients than controls [11.48 +/- 6.2 versus 21.86 +/- 2.1; p <0.01]. Compensatory remote, non-infarct segment hyperkinesis was significantly reduced or blunted in patients with the metabolic syndrome compared with patients without [21.32 +/- 2.1 versus 24.22 +/- 2.1; p <0.05]. Patients with the metabolic syndrome had higher prevalence of multi-vessel disease and jeopardized remote non-infarct segment and tended to have lower overall left ventricular ejection fraction [LVEF] [42 +/- 3.2 versus 48 +/- 5.1; P = 0.05]. Patients with single vessel disease in infarct related vessel had the highest values of peak systolic myocardial velocities in the remote non-infarct segment compared to patients with two or three vessel disease [25.11 +/- 2.2 versus 19 +/- 3.7; P <0.05] representing a preserved hyperkinesis in the remote segment. Compensatory hyperkinesis in remote non-infarct segment can be easily identified using pulsed tissue Doppler imaging as significant increase in peak systolic myocardial velocity which would have an impact on overall LVEF in sitting of acute myocardial infarction. Patients with high risk clinical profile, higher plaque burden and multivessel coronary artery disease had blunted or reduced hyperkinetic response in the remote non-infarct segments due to remote jeopardized myocardium

Altered left ventricular diastolic indices as an iscremic response to dipyridamole stress echocardiography: a comparative study with exercise ECG and coronary angiography

The most commonly used provocative test for IHD remains treadmill exercise testing. Echocardiography is one of the several techniques which have been used in conjunction with that test to enhance its diagnostic accuracy. In this study we used a pharmacological stressor [dipyridamole] rather than exercise to overcome the difficulty to maintain adequate views during exercise. Thirty patients coming for coronary angiography were subjected to both exercise EGG and dipyridamole echo before angigraphy. By dipyridamole echo, regional wall motion, wall motion score index [WMSI] and LV diastolic indices by Doppler were assessed before and after dipyridamole infusion [high dose]. According to the result of coronary angiography, the patients were classified to group I [nine patients with normal coronaries] and group II [21 patients with CAD]. The overall sensitivity and specificity of exercise ECG in patients with CAD were 71% and 78%, respectively while the sensitivity and specificity of dipyridamole echo were 86% and 100%. respectively. Our study revealed a significant increase in mean WMSI in group II with a positive correlation to the extent of CAD. Dipyridamoie echo also had the ability to predict LAD and RCA lesions with good sensitivity *86% and 83% respectively] but less for LCX [70%]. All patients with CAD arid positive dipyridamole echo showed a significant change in LV diastolic indices denoting acute relaxation abnormality during ischemia. We concluded that dipyridamole echo is more sensitive than the exercise ECG in the diagnosis and detecting the extent of CAD