Invasive Physiologic Assessment of Myocardial Viability After Primary Angioplasty in Acute Myocardial Infarction: Comparison With FDG-PET Imaging

BACKGROUND & PURPOSE: The state of coronary microcirculaton is an important determinant of myocardial viability and clinical outcomes in acute myocardial infarction(AMI). However, to date, there has been lacking in comparative studies on the most reliable invasive, on-site measurement for assessing the microvascular integrity and myocardial viability in AMI. The aim of this study is to evaluate the usefulness of coronary physiologic parameters as a predictor for myocardial viability after primary percutaneous coronary intervention (PCI) in AMI. MATERIALS & METHODS: Nineteen patients (17 male, mean age 60±13 years) underwent primary PCI for AMI (LAD:13, RCA:5, LCX:1)were enrolled. After successful PCI, Doppler-derived coronary flow reserve (CFRDoppler), microvascular resistance index (MVRI) and phasic coronary flow velocity patterns were evaluated. Using a pressure-temperature sensor-tipped coronary wire, thermodilution-derived CFR (CFRthermo), fractional flow reserve (FFR) and coronary wedge pressure (Pcw) were measured and the ratio of Pcw and mean aortic pressure (Pcw/Pa) was calculated, along with index of microcirculatory resistance (IMR), 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 in 7 days to evaluate myocardial viability by regional percentage uptake of FDG in infarct-related segments. RESULTS: Among Doppler-derived parameters, regional FDG-uptake was associated with baseline average peak velocity (bAPV)(r=0.530, p=0.020), hyperemic APV (hAPV)(r=0.675, p=0.002) and hyperemic MVRI (hMVRI)(r=-0.534, p=0.018). All parameters derived from phasic coronary flow velocity patterns showed good correlations with regional FDG-uptake (baseline deceleration time of diastolic flow velocity (bDDT), r=0.533, p=0.019; hyperemic DDT (hDDT), r=0.513 p=0.025; systolic bAPV (bSAPV), r=0.592, p=0.008). In the group of coronary pressure measurements, a fair correlations existed between IMR, Pcw/Pa and regional FDG uptake (r=-0.660, p=0.002; r=-0.601, p=0.007, respectively). Regional FDG uptake had no association with CFRDoppler, CFRthermo, FFR and Pcw. The largest area under receiver operating characteristics (ROC) curve was acquired by the analysis between IMR and myocardial viability as defined by the 50% FDG PET threshold value (0.856, 95% CI [0.620-0.970]). Cut-off value of IMR for the prediction of myocardial viability was 22 (sensitivity of 78%, specificity of 90% and accuracy of 86%). CONCLUSIONS: Coronary physiologic assessment provides useful informations for the prediction of myocardial viability immediately after primary PCI. IMR, a novel index representing the microvascular integrity, is a reliable parameter for the invasive, on-site assessment of myocardial viability after primary PCI in AMI.

Author dc:creator

• 임, 홍석

Contributors dc:contributor

• 탁, 승제
• 대학원 의학과
• 102815

• 급성 심근 경색증
• 일차 중재시술
• 관상동맥 혈류 역학 지표
• 심근 생존능
• 미세혈류 저항 지수
• IMR

Language dc:language

en

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000001942
000000001942

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1280