Pressure-derived collateral flow index as a parameter of microvascular dysfunction in acute myocardial infarction.

  • Yamamoto K
  • Ito H
  • Iwakura K
 et al. 
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Abstract

OBJECTIVES: The goal of this study was to examine the implications of the pressure-derived collateral flow index (CFIp) in acute myocardial infarction (AMI). BACKGROUND: Higher CFIp is associated with less severe myocardial ischemia during angioplasty in the non-infarcted heart. It remains unknown whether CFIp also identifies collateral function in AMI patients with and without no-reflow phenomenon. METHODS: The study population included 48 patients with a first AMI. After successful percutaneous transluminal coronary angioplasty (PTCA) stent, we measured mean aortic pressure (Pa), central venous pressure (Pv) and coronary wedge pressure (Pcw) of the infarct-related artery to calculate: CFIp = (Pcw - Pv)/(Pa - Pv). Myocardial contrast echocardiography (MCE) was performed with the intracoronary injection of microbubbles to assess myocardial perfusion. Left ventriculograms at days 1 and 28 were provided for the measurement of the regional wall motion (RWM, SD/chord). RESULTS: There was no difference in CFIp among subsets based on angiographic collateral grades (grade 0, 1, 2, 3; 0.28 +/- 0.07, 0.27 +/- 0.09, 0.27 +/- 0.08, 0.23 +/- 0.08, p = NS). The CFIp was significantly higher in patients with MCE no-reflow (n = 16) than in those with MCE reflow (n = 32) (0.34 +/- 0.07 vs. 0.23 +/- 0.06, p < 0.01). There was a significant inverse correlation between the extent of functional improvement (DeltaRWM[28 d-1 d]) and CFIp (r = 0.56, p < 0.01), implying that higher CFIp is associated with worse functional improvement. CONCLUSIONS: In AMI, CFIp is unlikely to reflect collateral function but seems to increase with the severity of microvascular dysfunction. Because higher CFIp was associated with poorer functional recovery, it provides a simple and useful estimate of clinical outcomes in AMI.

Author-supplied keywords

  • Aged
  • Analysis of Variance
  • Angioplasty
  • Balloon
  • Blood Flow Velocity
  • Blood Pressure
  • Central Venous Pressure
  • Collateral Circulation
  • Coronary
  • Coronary Angiography
  • Coronary Circulation
  • Echocardiography
  • Female
  • Fibrinolytic Agents
  • Fibrinolytic Agents: therapeutic use
  • Humans
  • Male
  • Microcirculation
  • Middle Aged
  • Myocardial Infarction
  • Myocardial Infarction: classification
  • Myocardial Infarction: diagnosis
  • Myocardial Infarction: physiopathology
  • Myocardial Infarction: therapy
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Pulmonary Wedge Pressure
  • Recovery of Function
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Vascular Patency

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Authors

  • K Yamamoto

  • H Ito

  • K Iwakura

  • Y Shintani

  • T Masuyama

  • M Hori

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