Pressure-derived fractional collateral blood flow: a primary determinant of left ventricular recovery after reperfused acute myocardial infarction

J Am Coll Cardiol. 2000 Mar 15;35(4):949-55. doi: 10.1016/s0735-1097(99)00649-x.

Abstract

Objectives: We evaluated the relation between pressure-derived fractional collateral flow (PDCF) and left ventricular (LV) recovery after reperfused acute myocardial infarction (AMI).

Background: The functional significance of collateral flow remains uncertain in AMI.

Methods: The PDCF was measured in 70 patients with first AMI (pain onset <12 h) treated with primary angioplasty (PA), being determined by simultaneous measurement of mean aorta pressure (Pa), distal coronary pressure during the balloon occlusion (Poc), and central venous pressure (CVP): (Poc - CVP)/(Pa - CVP)*100. Sufficient collateral (group I) was defined as PDCF index >24% and insufficient collateral (group II) as PDCF index <24%. Echocardiography was performed before, and on day 3, day 7, and day 30 after PA. Wall-motion recovery index (RI) was obtained by dividing the number of improved wall-motion segments (>grade 1) at follow-up by the number of abnormal wall-motion segments within the infarct zone at baseline.

Results: Baseline characteristics were similar between both groups. Peak levels of creatine kinase were lower in group I than in group II (2,600+/-1,900 U/liter vs. 4,100+/-3,000, p < 0.05). At one month, infarct zone wall-motion score index (1.65+/-0.54 vs. 2.31+/-0.46, p < 0.01) and LV volume indexes were smaller in group I than in group II, whereas, LV ejection fraction was higher in group I than in group II (52.8+/-8.3 vs. 45.9+/-9.0, p < 0.01). The PDCF index was the strongest predictor of RI at one month (r = 0.61, p < 0.01). Time to reperfusion was not related to RI at one month. However, it was significantly related to RI in group II (r = -0.34, p < 0.05).

Conclusions: The LV recovery after reperfused AMI is primarily determined by PDCF and is less dependent on time to reperfusion in patients with sufficient collaterals.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon, Coronary
  • Blood Pressure / physiology*
  • Collateral Circulation / physiology
  • Coronary Circulation / physiology*
  • Creatine Kinase / blood
  • Echocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Contraction / physiology
  • Myocardial Infarction / physiopathology*
  • Myocardial Infarction / therapy
  • Myocardial Reperfusion Injury / physiopathology*
  • Myocardial Reperfusion Injury / therapy
  • Prognosis
  • Prospective Studies
  • Treatment Outcome
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Dysfunction, Left / therapy
  • Ventricular Function, Left / physiology*

Substances

  • Creatine Kinase