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Index of microcirculatory resistance as predictor for microvascular functional recovery in patients with anterior myocardial infarction

Authors
Yoo, SH; Yoo, TK; Lim, HS; Kim, MY; Koh, JH
Citation
Journal of Korean medical science, 27(9):1044-1050, 2012
Journal Title
Journal of Korean medical science
ISSN
1011-89341598-6357
Abstract
IMR is useful for assessing the microvascular dysfunction after primary percutaneous coronary intervention (PCI). It remains unknown whether index of microcirculatory resistance (IMR) reflects the functional outcome in patients with anterior myocardial infarction (AMI) with or without microvascular obstruction (MO).This study was performed to evaluate the clinical value of the IMR for assessing myocardial injury and predicting microvascular functional recovery in patients with AMI undergoing primary PCI. We enrolled 34 patients with first anterior AMI. After successful primary PCI, the mean distal coronary artery pressure (P(a)), coronary wedge pressure (P(cw)), mean aortic pressure (P(a)), mean transit time (T(mn)), and IMR (P(d)* hyperemic T(mn)) were measured. The presence and extent of MO were measured using cardiac magnetic resonance image (MRI). All patients underwent follow-up echocardiography after 6 months. We divided the patients into two groups according to the existence of MO (present; n = 16, absent; n = 18) on MRI. The extent of MO correlated with IMR (r = 0.754; P < 0.001), P(cw) (r = 0.404; P = 0.031), and P(cw)/P(d) of infarct-related arteries (r = 0.502; P = 0.016). The IMR was significantly correlated with the ΔRegional wall motion score index (r = -0.61, P < 0.01) and ΔLeft ventricular ejection fraction (r = -0.52, P < 0.01), implying a higher IMR is associated with worse functional improvement. Therefore, Intracoronary wedge pressures and IMR, as parameters for specific and quantitative assessment of coronary microvascular dysfunction, are reliable on-site predictors of short-term myocardial viability and Left ventricle functional recovery in patients undergoing primary PCI for AMI.
MeSH terms
AdultAgedAged, 80 and overAnterior Wall Myocardial Infarction/*physiopathologyArterial Pressure/physiologyCoronary Occlusion/pathologyFemaleHumansMagnetic Resonance ImagingMaleMicrocirculation/*physiologyMiddle AgedPercutaneous Coronary Intervention*Predictive Value of TestsProspective StudiesRecovery of FunctionRisk Factors
DOI
10.3346/jkms.2012.27.9.1044
PMID
22969250
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Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
임, 홍석
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