Abstract 4473: Coronary Flow Velocity Pattern Immediately after Percutaneous Coronary Intervention Predicts True Left Ventricular Aneurysm in Patients with Acute Anterior Myocardial Infarction

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Aggressive management of acute myocardial infarction (AMI), including prompt reperfusion, may diminish the incidence of true left ventricular (LV) aneurysm; however, it has been reported that even if successful reperfusion is achieved in epicardial coronary arteries, microvascular dysfunction causes insufficient reperfusion of the infracted myocardium, leading to LV dysfunction. Recent studies have shown that microvascular damage can be assessed quantitatively from coronary flow velocity (CFV) patterns immediately after successful reperfusion. The purpose of this study was to examine whether the CFV patterns may predict the risk of true LV aneurysm formation following successful percutaneous coronary intervention (PCI). Two hundred and one consecutive patients with first anterior AMI who underwent successful PCI were subjected to CFV measurement immediately after PCI with Doppler guidewires. The CFV spectrum provided systolic peak velocity (cm/s, SPV) and diastolic deceleration time (ms, DDT). Left ventriculogram obtained 6 months after the infarction was analyzed to measure the LV volume index. True LV aneurysm was defined as a deformity of the infarct segment that was apparent during diastole as well as during systole, and demonstrated diastolic contour abnormality. Patients were divided into the two groups: those subsequently complicated by true LV aneurysm (n=42; group 1) and those without true LV aneurysm (n=159; group 2) CFV analysis immediately after PCI showed significantly lower SPV (−29 ± 17 vs. 5 ± 22 cm/s; p<0.001) and shorter DDT (317 ± 156 vs. 665 ± 204 ms; p<0.001) in group 1 than in group 2. The optimal cutoff values to predict true LV aneurysm formation were −20 cm/s for SPV and 400 ms for DDT (sensitivity=0.83, specificity=0.82; and sensitivity=0.81, specificity=0.87, respectively). SPV and DDT correlated to the LV end-diastolic volume index obtained 6 months after AMI (r= −0.67; p<0.001 and r = −0.78; p<0.001, respectively). CFV pattern of infarct-related coronary artery immediately after PCI predicts true LV aneurysm formation, and enables accurate risk stratification in patients with anterior AMI.