Document Detail


Coronary microvascular resistance index immediately after primary percutaneous coronary intervention as a predictor of the transmural extent of infarction in patients with ST-segment elevation anterior acute myocardial infarction.
MedLine Citation:
PMID:  19356570     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to investigate whether microvascular resistance index (MVRI) immediately after primary percutaneous coronary intervention (PCI) can predict the transmural extent of infarction (TEI) defined by contrast-enhanced cardiac magnetic resonance (ce-CMR) in patients with anterior acute myocardial infarction (MI). BACKGROUND: The degree of microvascular damage is an important determinant of myocardial viability and clinical outcomes in acute MI. A novel dual-sensor (pressure and Doppler velocity) guidewire has the ability to evaluate microvascular damage. ce-CMR can accurately discriminate transmural from nontransmural MI, and the TEI by ce-CMR can predict future improvement in contractile function. METHODS: In 27 patients immediately after primary PCI for a first anterior acute MI, MVRI, coronary flow reserve (CFR), deceleration time of diastolic velocity (DDT), and zero flow pressure (Pzf) were measured with a dual-sensor guidewire. TEI was graded from 1 to 4 based on the transmural extent of hyperenhanced tissue (1 = 0% to 25% of left ventricular wall thickness, 2 = 26% to 50%, 3 = 51% to 75%, and 4 = 76% to 100%). Infarct size by ce-CMR was also calculated. RESULTS: Peak creatine kinase-myocardial band values were significantly correlated with MVRI (r = 0.77, p < 0.0001), CFR (r = -0.69, p < 0.0001), DDT (r = -0.75, p = 0.0001), and Pzf (r = 0.75, p < 0.0001). Also, infarct size by ce-CMR was significantly correlated with MVRI (r = 0.78, p < 0.0001), CFR (r = -0.67, p < 0.0001), DDT (r = -0.70, p < 0.0001), and Pzf (r = 0.72, p = 0.0002). Receiver-operating characteristic curve analyses of MVRI, CFR, DDT, and Pzf for predicting transmural MI (TEI-grade 4) demonstrated that the area under the curve tended to be higher for MVRI (0.885) than those for CFR (0.848), DDT (0.862), and Pzf (0.853). The best cut-off value for MVRI was 3.25 mm Hg x cm(-1) x s (sensitivity 75%, specificity 89%). Moreover, increased MVRI was significantly related to increased TEI-grade (p < 0.0001). CONCLUSIONS: MVRI measured immediately after primary PCI is a useful predictor for the TEI in patients with anterior acute MI.
Authors:
Hironori Kitabata; Toshio Imanishi; Takashi Kubo; Shigeho Takarada; Manabu Kashiwagi; Hiroki Matsumoto; Hiroto Tsujioka; Hideyuki Ikejima; Yu Arita; Keishi Okochi; Akio Kuroi; Satoshi Ueno; Hideaki Kataiwa; Takashi Tanimoto; Takashi Yamano; Kumiko Hirata; Nobuo Nakamura; Atsushi Tanaka; Masato Mizukoshi; Takashi Akasaka
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-07-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  263-72     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Biological Markers / blood
Contrast Media / diagnostic use
Coronary Circulation*
Creatine Kinase, MB Form / blood
Echocardiography, Doppler* / instrumentation
Equipment Design
Female
Gadolinium DTPA / diagnostic use
Humans
Magnetic Resonance Imaging*
Male
Microcirculation*
Middle Aged
Myocardial Infarction / diagnosis,  physiopathology,  therapy*
Myocardium / pathology*
Predictive Value of Tests
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
Time Factors
Treatment Outcome
Vascular Resistance*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Contrast Media; 80529-93-7/Gadolinium DTPA; EC 2.7.3.2/Creatine Kinase, MB Form

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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