Prognostic Value of Microvascular Resistance Index Immediately After Primary Percutaneous Coronary Intervention on Left Ventricular Remodeling in Patients With Reperfused Anterior Acute ST-Segment Elevation Myocardial Infarction

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• 作者：Hironori Kitabata ; Takashi Kubo ; Kohei Ishibashi ; Kenichi Komukai ; Takashi Tanimoto ; Yasushi Ino ; Manabu Kashiwagi ; Yuichi Ozaki ; Yasutsugu Shiono ; Kunihiro Shimamura ; Makoto Orii ; Kumiko Hirata ; Atsushi Tanaka ; Toshio Imanishi ; Takashi Akasaka
• 关键词：acute myocardial infarction ; left ventricular remodeling ; microvascular dysfunction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：October, 2013
• 年：2013
• 卷：6
• 期：10
• 页码：1046-1054
• 全文大小：934 K

文摘

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Objectives

This study sought to investigate the relationship between the degree of microvascular dysfunction assessed by a dual-sensor guidewire (pressure and Doppler velocity) and left ventricular (LV) remodeling after successful primary percutaneous coronary intervention (PPCI) for a first anterior acute myocardial infarction (AMI).

Background

Microvascular dysfunction after AMI is associated with progressive LV dilation.

Methods

In 24 consecutive patients, the microvascular resistance index (MVRI) immediately after PPCI was calculated as the ratio of the mean distal pressure to average peak flow velocity during maximal hyperemia. Cardiac magnetic resonance was performed to determine LV volumes at baseline and 8-month follow-up. LV remodeling was defined as an increase in left ventricular end-diastolic volume (LVEDV) of聽鈮?0%.

Results

In patients with an MVRI greater than the median value of 2.96 mm Hg路cm^鈭?路s, the LVEDV increased significantly from 117.1 卤 20.7 ml at baseline to 146.5 卤 21.4 ml (p聽= 0.006) at 8 months, whereas it did not change between baseline and 8 months (108.2 卤 21.2 ml vs. 111.6 卤 29.9 ml, p聽=聽0.620) in patients with an MVRI 鈮?.96 mm Hg路cm^鈭?路s. LV remodeling was more frequent in the group with an MVRI >2.96 mm Hg路cm^鈭?路s (64% vs. 15%, p聽= 0.033). Furthermore, there was a positive correlation between MVRI and the percentage of increase or decrease in LVEDV (r聽= 0.42, p聽= 0.042). Logistic regression analysis showed that MVRI was the strongest univariate predictor of LV remodeling. The best cutoff value of MVRI was 2.96 mm Hg路cm^鈭?路s with a sensitivity of 78% and a specificity of聽73%.

Conclusions

MVRI immediately after PPCI predicts LV remodeling in patients with reperfused anterior AMI.