Relationship between microcirculatory dysfunction and resolution of ST-segment elevation in the early phase after primary angioplasty in patients with ST-segment elevation myocardial infarction

• Published in: International journal of cardiology Vol. 159; no. 2; pp. 144 - 149
• Main Authors: Amaya, Naoki, Nakano, Akira, Uzui, Hiroyasu, Mitsuke, Yasuhiko, Geshi, Toru, Okazawa, Hidehiko, Ueda, Takanori, Lee, Jong-Dae
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 23.08.2012; Elsevier
• Subjects: Aged; Aged, 80 and over; Angioplasty - methods; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary Circulation - physiology; Coronary heart disease; Coronary microcirculation; Diseases of the cardiovascular system; Female; Heart; Humans; Male; Medical sciences; Microcirculation - physiology; Middle Aged; Multimodal Imaging - methods; Myocardial flow reserve; Myocardial infarction; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Reperfusion - methods; Myocarditis. Cardiomyopathies; Positron emission tomography; Positron-Emission Tomography - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); ST-segment resolution; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; N-PET; Myocardial infarction; SDS; STE; CK; K; ACE-I; Coronary microcirculation; Myocardial flow reserve; LVEDP; LVEDVI; MBF; STR; ARB; TIMI; PCI; ST-segment resolution; MFR; IRA; LVG; MI; ATP; Positron emission tomography; PET; thrombolysis in myocardial infarction; 13N ammonia-positron emission tomography; ST-segment elevation resolution; myocardial infarction; left-ventricular end-diastolic pressure; percutaneous coronary intervention; myocardial blood flow; myocardial flow reserve; creatine kinase; angiotensin-converting enzyme inhibitors; summed defect score; left-ventricular end-diastolic volume index; influx rate constants; ST-segment elevation; angiotensin II receptor blockers; infarct-related area; left ventriculography; adenosine triphosphate; positron emission tomography; Radionuclide study; Reserve; Angioplasty; Cardiovascular disease; Myocardial disease; ST elevation; Microcirculation; Primary; Cardiology; Human; Early phase; Coronary artery; ST interval; Instrumentation therapy; Patient; Instrumental dilatation; Coronary heart disease; Dysfunction; Myocardium; Emission tomography
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2011.02.045

The aim of this study was to evaluate relationships between the degree of resolution of the ST-segment elevation (ST segment resolution; STR) and the extent of microcirculatory dysfunction in infarct-related area (IRA) in patients with ST-segment elevation myocardial infarction (STEMI) using 13N-ammonia positron emission tomography (N-PET). The subjects comprised 33 patients with STEMI who underwent successful reperfusion. Serial 12-lead electrocardiography (ECG) was performed at the baseline and at 100min after reperfusion to calculate STR. The myocardial flow reserve (MFR) was assessed quantitatively using N-PET at 2weeks after the onset. The summed defect score (SDS) of 99mTc-tetrofosmin myocardial perfusion imaging was used as an index of the severity of myocardial infarction. To assess the extent of post-infarct left ventricular remodeling, the changes in the LVEDVI (ΔEDVI) were also calculated. A significant correlation of the STR to the MFR in IRA (r=0.68, p<0.0001) was observed. A significant correlation was also identified between the SDS and the baseline sum ST-segment elevation (r=0.65, p<0.0001), while no correlation was observed between the SDS and the STR. Furthermore, a significant inverse correlation of the STR with the ΔEDVI was also recognized (r=−0.58, p<0.01). These data indicate that STR after successful reperfusion in STEMI is closely related to the extent of microcirculatory disturbance; in other words, incomplete STR may be a marker of persistent microcirculatory dysfunction after reperfusion therapy.