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Coronary wave energy: a novel predictor of functional recovery after myocardial infarction.
- Source :
-
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2013 Apr; Vol. 6 (2), pp. 166-75. Date of Electronic Publication: 2013 Mar 10. - Publication Year :
- 2013
-
Abstract
- Background: Revascularization after acute coronary syndromes provides prognostic benefit, provided that the subtended myocardium is viable. The microcirculation and contractility of the subtended myocardium affect propagation of coronary flow, which can be characterized by wave intensity analysis. The study objective was to determine in acute coronary syndromes whether early wave intensity analysis-derived microcirculatory (backward) expansion wave energy predicts late viability, defined by functional recovery.<br />Methods and Results: Thirty-one patients (58±11 years) were enrolled after non-ST elevation myocardial infarction. Regional left ventricular function and late-gadolinium enhancement were assessed by cardiac magnetic resonance imaging, before and 3 months after revascularization. The backward-traveling (microcirculatory) expansion wave was derived from wave intensity analysis of phasic coronary pressure and velocity in the infarct-related artery, whereas mean values were used to calculate hyperemic microvascular resistance. Twelve-hour troponin T, left ventricular ejection fraction, and percentage late-gadolinium enhancement mass were 1.35±1.21 µg/L, 56±11%, and 8.4±6.0%, respectively. The infarct-related artery backward-traveling (microcirculatory) expansion wave was inversely correlated with late-gadolinium enhancement infarct mass (r=-0.81; P<0.0001) and strongly predicted regional left ventricular recovery (r=0.68; P=0.001). By receiver operating characteristic analysis, a backward-traveling (microcirculatory) expansion wave threshold of 2.8 W m(-2) s(-2)×10(5) predicted functional recovery with sensitivity and specificity of 0.91 and 0.82 (AUC 0.88). Hyperemic microvascular resistance correlated with late-gadolinium enhancement mass (r=0.48; P=0.03) but not left ventricular recovery (r=-0.34; P=0.07).<br />Conclusions: The microcirculation-derived backward expansion wave is a new index that correlates with the magnitude and location of infarction, which may allow for the prediction of functional myocardial recovery. Coronary wave intensity analysis may facilitate myocardial viability assessment during cardiac catheterization.
- Subjects :
- Aged
Blood Pressure physiology
Cardiac Catheterization statistics & numerical data
Female
Gadolinium
Hemodynamics physiology
Humans
Hyperemia physiopathology
Magnetic Resonance Angiography statistics & numerical data
Male
Middle Aged
Myocardial Infarction diagnosis
Myocardial Infarction physiopathology
Myocardial Infarction therapy
Observer Variation
Predictive Value of Tests
Prognosis
Recovery of Function physiology
Vascular Resistance physiology
Ventricular Remodeling physiology
Acute Coronary Syndrome diagnosis
Acute Coronary Syndrome physiopathology
Acute Coronary Syndrome therapy
Cardiac Catheterization methods
Coronary Circulation physiology
Magnetic Resonance Angiography methods
Microcirculation physiology
Percutaneous Coronary Intervention
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7632
- Volume :
- 6
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 23476044
- Full Text :
- https://doi.org/10.1161/CIRCINTERVENTIONS.112.973081