Pressure-derived fractional collateral blood flow: a primary determinant of left ventricular recovery after reperfused acute myocardial infarction.

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  • Additional Information
    • Source:
      Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Print ISSN: 0735-1097 (Print) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
    • Subject Terms:
      Blood Pressure/*physiology ; Coronary Circulation/*physiology ; Myocardial Infarction/*physiopathology ; Myocardial Reperfusion Injury/*physiopathology ; Ventricular Dysfunction, Left/*physiopathology ; Ventricular Function, Left/*physiology; Adult ; Aged ; Angioplasty, Balloon, Coronary ; Collateral Circulation/physiology ; Creatine Kinase/blood ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Contraction/physiology ; Myocardial Infarction/therapy ; Myocardial Reperfusion Injury/therapy ; Prognosis ; Prospective Studies ; Treatment Outcome ; Ventricular Dysfunction, Left/therapy
    • Abstract:
      Objectives: We evaluated the relation between pressure-derived fractional collateral flow (PDCF) and left ventricular (LV) recovery after reperfused acute myocardial infarction (AMI).
      Background: The functional significance of collateral flow remains uncertain in AMI.
      Methods: The PDCF was measured in 70 patients with first AMI (pain onset <12 h) treated with primary angioplasty (PA), being determined by simultaneous measurement of mean aorta pressure (Pa), distal coronary pressure during the balloon occlusion (Poc), and central venous pressure (CVP): (Poc - CVP)/(Pa - CVP)*100. Sufficient collateral (group I) was defined as PDCF index >24% and insufficient collateral (group II) as PDCF index <24%. Echocardiography was performed before, and on day 3, day 7, and day 30 after PA. Wall-motion recovery index (RI) was obtained by dividing the number of improved wall-motion segments (>grade 1) at follow-up by the number of abnormal wall-motion segments within the infarct zone at baseline.
      Results: Baseline characteristics were similar between both groups. Peak levels of creatine kinase were lower in group I than in group II (2,600+/-1,900 U/liter vs. 4,100+/-3,000, p < 0.05). At one month, infarct zone wall-motion score index (1.65+/-0.54 vs. 2.31+/-0.46, p < 0.01) and LV volume indexes were smaller in group I than in group II, whereas, LV ejection fraction was higher in group I than in group II (52.8+/-8.3 vs. 45.9+/-9.0, p < 0.01). The PDCF index was the strongest predictor of RI at one month (r = 0.61, p < 0.01). Time to reperfusion was not related to RI at one month. However, it was significantly related to RI in group II (r = -0.34, p < 0.05).
      Conclusions: The LV recovery after reperfused AMI is primarily determined by PDCF and is less dependent on time to reperfusion in patients with sufficient collaterals.
    • Accession Number:
      EC 2.7.3.2 (Creatine Kinase)
    • Publication Date:
      Date Created: 20000325 Date Completed: 20000331 Latest Revision: 20190708
    • Publication Date:
      20240627
    • Accession Number:
      10.1016/s0735-1097(99)00649-x
    • Accession Number:
      10732893