Relation between Coronary Flow Reserve and Myocardial Perfusion State and Change of Coronary Flow Reserve in Acute Myocardial Infarction

ABSTRACT

BACKGROUND AND OBJECTIVES: The state of the coronary microcirculation is one of the major determinants of the prognosis of patients who have had successful reperfusion for acute myocardial infarction (AMI). We investigated whether the vasodilatory reserve in the infarcted myocardium correlated with the perfusion state at early recovery phase in 12 anterior wall AMI patients. MATERIALS AND METHOD: We measured coronary flow variables with Doppler wire, after successful revascularizaiton by PTCA within 2 weeks following AMI and 13+/-0.5 months later, in the infarct related artery of AMI pts who received successful thrombolytic therapy. Myocardial perfuison state was evaluated by semiquantitative method (opacification score and opacification index) with myocardial contrast echocardiography (MCE) at the same time. Patients were divided into two groups according to initial perfusion status (perfusion defect group (PD (+), n=7), no-perfusion defect group (PD (-), n=5)). RESULTS: 10 minutes after completion of the intervention, the coronary flow reserve (CFR) was 2.0+/-0.4 (mean+/-SD) it increased to 2.7+/-0.7 (p=0.002) at follow up. The difference of initial CFR was not significant between PD (+) and PD(-) group. However, it significantly improved in the PD (-) group compared to PD (+) group at follow up (3.19+/-0.39 vs. 2.39+/-0.7, p=0.046). Opacification index and initial CFR were significantly correlated (r=0.79, p<0.05). CONCLUSION: The perfusion state of infarcted myocardium was significantly correlated with coronary flow reserve in anterior wall AMI and CFR was significantly improved in patients with relatively preserved myocardial perfusion.