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A Novel Index of Microcirculatory Resistance for Invasively Assessing Myocardial Viability after Primary Angioplasty for Treating Acute Myocardial Infarction: Comparison with FDG-PET Imaging

Other Title
급성 심근경색증에서 일차적 중재시술 후 Index of Microcirculatory Resistance를 이용한 심근 생존능의 평가: FDG-PET와의 비교
Authors
임, 홍석; 탁, 승제; 윤, 명호; 우, 성일; 최, 운정; 황, 정원; 이, 동호; 서, 경우; 박, 진선; 김, 진우; 강, 수진; 최, 병주; 최, 소연; 황, 교승; 신, 준한
Citation
Korean circulation journal, 37(7):318-326, 2007
Journal Title
Korean circulation journal
ISSN
1738-55201738-5555
Abstract
Background and Objectives:The state of the coronary microcirculation is an important determinant of the myocardial viability and clinical outcomes for patients suffering with acute myocardial infarction (AMI). However, there are scant comparative studies on the most reliable invasive, on-site measurement for assessing the microvascular integrity and myocardial viability in AMI patients. The aim of this study is to evaluate the usefulness of a novel index of microcirculatory resistance (IMR) and the coronary physiologic parameters for predicting the myocardial viability after primary percutaneous coronary intervention (PCI) in AMI patients.



Subjects and Methods:Twenty-four patients (21 males, mean age: 55±11 years) underwent primary PCI for AMI (LAD: 17, RCA: 6, LCX: 1) were enrolled. After successful PCI, using a pressure-temperature sensor-tipped coronary wire, the thermodilution-derived CFR (CFRthermo) and coronary wedge pressure (Pcw) were measured and the ratio of the Pcw and the mean aortic pressure (Pcw/Pa) was calculated, along with the IMR, which was defined as the distal coronary pressure divided by the inverse of the hyperemic mean transit time. 18F-fluorodeoxyglucose (FDG) PET was performed after primary PCI at 7 days post-AMI to evaluate the myocardial viability by the regional percentage of FDG uptake in the infarct-related segments.



Results:There were good correlations between all the coronary pressure measurements and the regional FDG uptake (CFRthermo, r=0.454, p=0.026; Pcw, r=-0.407, p=0.048; Pcw/Pa, r=-0.480, p=0.018; IMR, r=-0.696, p<0.001, respectively). Multiple logistic regression analysis demonstrated that the IMR was an adjusted predictor for myocardial viability as defined by the 50% FDG-PET threshold value among all the coronary pressure measurements (OR=0.884, p=0.021). The cut-off value of IMR for predicting myocardial viability was 22 U (a sensitivity of 82%, a specificity of 85% and an accuracy of 85%).



Conclusion:Intracoronary pressure wire-based indexes are useful for on-site assessment of myocardial viability after primary PCI. IMR is a novel index that represents the microvascular integrity, and it is a better predictor of myocardial damage than the current techniques for evaluating the microvasculature after primary PCI.
Keywords
Myocardial infarctionPressureViabilityPositron-emmission tomography
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
임, 홍석탁, 승제윤, 명호우, 성일최, 운정황, 정원강, 수진최, 병주최, 소연황, 교승신, 준한
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