Intérêt de la mesure du temps de décélération diastolique par Doppler transthoracique dans l’évaluation du phénomène de no-reflow au cours de l’infarctus du myocarde antérieur traité par angioplastie primaire

Abstract

Aims To assess the value of coronary flow measurement by transthoracic Doppler technique in the detection of “no-reflow” phenomenon. Methods Fourteen patients with first anterior wall infarction treated by successful (TIMI3) primary percutaneous angioplasty and left descending coronary artery stenting were investigated. Myocardial perfusion following PCI was assessed by (i) ST-segment resolution, (ii) MRI-detected microvascular obstruction (early hypoenhancement), (iii) coronary flow pattern measurement by transthoracic Doppler technique. Results Sustained impairment of myocardial perfusion following PCI was observed in a large proportion of the cohort (36% by MRI, 43% by ST regression analysis). Patients with a diastolic deceleration time inferior to 482 ms had higher troponin and CK peak value, higher wall motion index score, lower ST resolution and lower LVEF assessed by MRI. The concordance of the three methods was 80%. Conclusion The measurement of diastolic deceleration time by transthoracic Doppler technique is a reliable technique to identify microvascular obstruction following PCI in acute anterior STEMI. A DDT inferior to 482 ms is associated with sustained “no-reflow” phenomenon.