Page 125 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax
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∆ CFR absolute: Baseline-4 months
∆ CFR (%):
Baseline-4 months
HMRI infarct-related artery
1.0±0.97 51.1±50.5
1.8±0.3
1.3±0.6 0.26
Baseline 1.9±0.5
2.1±0.7 0.24 -0.3±0.7 0.21 -5.7±38.8 0.47
∆ HMRI absolute: Baseline-4 months
∆ HMRI (%):
Baseline-4 months
-0.04±0.6 2.6±43.1
Recovery of microvascular dysfunction following STEMI
Impaired microvascular function and left ventricular function
An impaired coronary microvascular function (CFR <2) in the subacute phase was observed in 36 patients (58%) with a mean CFR of 1.67±0.19. These patients had a larger infarct size than patients with a CFR >2 (25.3±7.7% LV vs. 19.5±11.3% LV; p=0.04).
As shown in Figure 1, patients with a CFR <2 had a lower LVEF at baseline (41.0±8.2% vs. 45.6±8.8%, p=0.04) and at two years (46.1±8.8% vs. 54.3±8.1%, p<0.001). Patients with a CFR <2 experienced a larger increase in LVEDV and LVESV between baseline and two years in comparison to patients with a CFR ≥2, respectively 8.5±15.1 ml/m2 vs. –1.5±13.9 ml/m2 (p=0.02) and 0.71±12.5 ml/m2 vs. –6.7±11.0 ml/m2 (p=0.03).
Change in coronary microvascular function and left ventricular function
Changes in CFR and HMRI were investigated in two groups, stratified to median
infarct size (24.2% LV) at baseline. Patients with large infarct sizes (>median
infarct size) had a lower CFR at baseline. However, these patients had more improvement in CFR within the initial four months compared to patients with
smaller infarct sizes (Table 5). In these patients, absolute CFR improvement was 7 concordantly associated with LVEF improvement within four months (β=5.09,
 SE=1.86, p=0.01) (Figure 1).
Table 5. Intracoronary flow parameters in two stratified infarct size groups.
 Small IS (n=27)
Infarct size (% LV) 14.9±6.2 CFR Infarct-related artery
Baseline 2.3±0.57
Large IS (n=28)
30.4±5.7
p-value
<0.001
 76.9±40.6
<0.001 0.049
  Small and large infarct size groups were stratified according to median infarct size at baseline. * DCFR and DHMRI in IRA were missing in three patients in the large infarct size group. CFR: coronary flow reserve; HMRI hyperaemic microvascular resistance index; IRA: infarct-related artery; IS: infarct size; LV: left ventricle.
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