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Usefulness of the Index of Microcirculatory Resistance for Predicting Late Left Ventricular Remodeling and Recovery Immediately after Primary Angioplasty in Anterior Myocardial Infarction

Lim, Hong-Seok; Yoon, Myeong-Ho; Tahk, Seung-Jea; Yang, Hyoung-Mo; Seo, Kyoung-Woo; Choi, Byoung-Joo; Choi, So-Yeon; Park, Jin-Sun; Hwang, Gyo-Seung; Shin, Joon-Han
Department of Cardiology, Ajou University Hospital
BACKGROUND: Microvascular integrity is an essential determinant of favorable late outcome in reperfused myocardial infarction and quantitative assessment of microvascular injury immediately after reperfusion is useful to predict left ventricular (LV) functional recovery after acute myocardial infarction (AMI). The purpose of this study was to assess the usefulness of the index of microcirculatory resistance (IMR) for predicting late LV remodeling and recovery in patients with reperfused AMI treated with primary angioplasty.
METHODS: After successful primary percutaneous coronary intervention (PCI) in 43 patients (age 55 ± 12 years, 38 men) with first anterior AMI, IMR was measured using a pressure-temperature sensor-tipped coronary guidewire. Echocardiography was performed at 6 months in all patients and at 3 years in 39 patients for assessment of the percent change in anterior wall motion score (A-WMS) and LV remodeling.
RESULTS: IMR correlated significantly with percent change in A-WMS, LV end-diastolic volume index and LV end-systolic volume index at 6 months (r = -0.430, p = 0.004; r = 0.402, p = 0.008; r = 0.475, p = 0.001, respectively) and at 3 years (r = -0.451, p = 0.004; r = 0.532, p < 0.001; r = 0.483, p = 0.002, respectively). The area under the receiver operating curve of IMR for predicting LV remodeling defined as increase in end-diastolic volume > 20% at 6 months and at 3 years were 0.74 [95% CI 0.587-0.864] and 0.76 [95% CI 0.597-0.882], respectively. An optimal cut-off value of 33U for IMR was chosen to predict 3-year LV remodeling (sensitivity = 85%, specificity = 77%, positive predictive value = 65%, negative predictive value = 91%).
CONCLUSIONS: IMR, a quantitative microvascular index, is a reliable early on-site predictor of late LV function recovery after primary PCI and provides useful information in identifying patients at high risk of late LV remodeling in spite of successful revascularization.
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