Transthoracic doppler coronary flow patterns in patients with anterior myocardial infarction undergoing rescue percutaneous coronary intervention: angiographic, function recovery short and long term clinical correlates

ABSTRACT

Noninvasive Transthoracic Doppler [TTD] recording is a feasible attractive method to characterize different coronary flow velocity [CFV] patterns, however, its clinical application in the setting of percutaneous coronary intervention [PCI] need to be emphasized. To correlate CFV patterns of left anterior descending artery [LAD] with angiographic data, and to determine its impact on left ventricular [LV] function recovery and clinical outcomes following rescue PCI in patients with anterior myocardial infarction. Forty consecutive patients were studied 12 hours after PCI with stenting using high frequency transducer and 2nd harmonic imaging of LAD, to measure diastolic flow data [peak and mean diastolic velocities [PDV and MDV], deceleration time [DEC], pressure half time [P1/2]], and to record retrograde systolic wave [RSW]. Coronary angiographic data included epicardial flow grade [TIMI], and myocardial blush grade [MB]. LV function recovery was determined by percent changes of Tissue Doppler peak systolic myocardial velocity of middle septum [TDMV]. Clinical outcomes included short term [in hospital-three months], and long term [two years] major cardiac events [MACES]. Following PCI 32 pts achieved TIMI flow grade III flow [80%], while 26 patients had MB grade III [65%]. PDV and MDV were significantly higher in TIMI grade III [43.7 +/- 10.2 vs. 19.9 +/- 4.4 cm/sec p<0.014, and 20.41 +/- 7.8 vs. 11.32 +/- 4.92 cm/sec p<0.007 respectively], while DEC time and P1/2 time were significantly longer in MB grade III [383.96 +/- 82.36 vs. 174.24 +/- 62.92 msec p<0.001, and 134.1 +/- 38.18 vs. 76.9 +/- 15.49 msec p<0.001 respectively]. RSW was recorded in 22 pts [55%]. RSW correlated to lower MB grades than TIMI [14/22 vs. 0/18 P<0.0001 and 4/22 vs. 4/18 p=0.75 respectively], and associated with lower percent changes of TDMV [41.18 +/- 57.81% vs. 160.25 +/- 109.69% p<0.01]. All patients achieved 24 months follow up. Survival free events correlated more to higher grade of myocardial blush and absences of RSW but not correlated with TIMI flow grade [Kaplan-meier survival curve. p=0.0004, 0.007, and 0.32 respectively]. Noninvasive Transthoracic Doppler study of coronary flow provides intimate correlation to essential angiographic, functional, and clinical data in the setting of rescue PCI. Coronary flow velocities correlated with epicardial flow grade while time intervals related to myocardial blush grade. Clear recording of systolic retrograde Have is associated with impaired left ventricular function and poor clinical outcome: