Index of Microcirculatory Resistance as Predictor for Microvascular Functional Recovery in Patients with Anterior Myocardial Infarction.
10.3346/jkms.2012.27.9.1044
- Author:
Seung Hoon YOO
1
;
Tae Kyung YOO
;
Hong Seok LIM
;
Mi Young KIM
;
Jong Hoon KOH
Author Information
1. Department of Cardiology, Kwandong University School of Medicine, Goyang, Korea. heartkoh1518@naver.com
- Publication Type:Original Article
- Keywords:
Acute Anterior Wall Myocardial Infarction;
Coronary Occlusion;
Capillary Resistance;
Magnetic Resonance Imaging
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Anterior Wall Myocardial Infarction/*physiopathology;
Arterial Pressure/physiology;
Coronary Occlusion/pathology;
Echocardiography;
Female;
Humans;
Magnetic Resonance Imaging;
Male;
Microcirculation/*physiology;
Middle Aged;
Percutaneous Coronary Intervention;
*Predictive Value of Tests;
Prospective Studies;
Recovery of Function;
Risk Factors
- From:Journal of Korean Medical Science
2012;27(9):1044-1050
- CountryRepublic of Korea
- Language:English
-
Abstract:
IMR is useful for assessing the microvascular dysfunction after primary percutaneous coronary intervention (PCI). It remains unknown whether index of microcirculatory resistance (IMR) reflects the functional outcome in patients with anterior myocardial infarction (AMI) with or without microvascular obstruction (MO).This study was performed to evaluate the clinical value of the IMR for assessing myocardial injury and predicting microvascular functional recovery in patients with AMI undergoing primary PCI. We enrolled 34 patients with first anterior AMI. After successful primary PCI, the mean distal coronary artery pressure (Pa), coronary wedge pressure (Pcw), mean aortic pressure (Pa), mean transit time (Tmn), and IMR (Pd * hyperemic Tmn) were measured. The presence and extent of MO were measured using cardiac magnetic resonance image (MRI). All patients underwent follow-up echocardiography after 6 months. We divided the patients into two groups according to the existence of MO (present; n = 16, absent; n = 18) on MRI. The extent of MO correlated with IMR (r = 0.754; P < 0.001), Pcw (r = 0.404; P = 0.031), and Pcw/Pd of infarct-related arteries (r = 0.502; P = 0.016). The IMR was significantly correlated with the DeltaRegional wall motion score index (r = -0.61, P < 0.01) and DeltaLeft ventricular ejection fraction (r = -0.52, P < 0.01), implying a higher IMR is associated with worse functional improvement. Therefore, Intracoronary wedge pressures and IMR, as parameters for specific and quantitative assessment of coronary microvascular dysfunction, are reliable on-site predictors of short-term myocardial viability and Left ventricle functional recovery in patients undergoing primary PCI for AMI.
