Transthoracic Doppler Echocardiographic Assessment of Coronary Flow Velocity Pattern in Patient with Acute Myocardial Infarction Implies Progression of Myocardial Damage

Yoshiaki Ueda,Takashi Akasaka,Takeshi Hozumi,Tsutomu Takagi,Atsushi Yamamuro,Koichi Tamita,Kenji Yamabe,Shigefumi Morioka,Kiyoshi Yoshida

doi:10.1016/j.echo.2005.04.002

Abstract

Coronary flow velocity (CFV) pattern with a rapid deceleration time of diastolic flow velocity and small average systolic peak velocity immediately after reperfusion implies poor wall-motion recovery in patients with acute myocardial infarction. Microvascular injury has been demonstrated to progress after coronary reperfusion. The purpose of this study was to assess whether CFV 1 day after reperfusion (day 1) may reflect accurately the degree of myocardial damage. In the left anterior descending coronary artery in 29 patients with anterior acute myocardial infarction, CFV was measured immediately and 1 day after recanalization using transthoracic Doppler echocardiography, respectively. Regional wall motion was estimated as anterior wall-motion score index (AWMSI) by echocardiography before recanalization and 1 month after the onset of acute myocardial infarction. Although significant correlation was observed among deceleration time of diastolic flow velocity, average systolic peak velocity, and average peak velocity immediately after reperfusion and 1-month AWMSI (r = -0.62, P < .001; r = -0.61, P < .001; and r = -0.55, P < .01, respectively), much better correlation was demonstrated between those at day 1 and 1-month AWMSI (r = -0.72, P < .0001; r = -0.68, P < .0001; and r = -0.60, P < .001, respectively). Deceleration time of diastolic flow velocity, average systolic peak velocity, and average peak velocity in poor wall-motion recovery group (1-month AWMSI > 2.0, n = 14) were significantly smaller (P < .01, P < .05, and P < .05, respectively) at day 1 compared with those immediately after reperfusion. CFV pattern assessed by transthoracic Doppler echocardiography at day 1 provides the degree of myocardial damage much more accurately than that immediately after reperfusion. These results may suggest that myocardial damage progresses after reperfusion.

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