Page 181 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Introduction
The purpose of this thesis was to evaluate coronary microvascular function during and after reperfusion of an anterior ST-elevation myocardial infarction using coronary blood flow velocity characteristics. In addition, we wanted to investigate the association of the post-reperfusion microcirculatory function to left ventricular function recovery and long-term mortality.
Coronary microvascular integrity determines the effectiveness of the function of the myocardium. At the time of myocardial infarction, microvascular function in the area subtended by the infarct-related artery (IRA) is abnormal. It was unclear how fast and to what extent microvascular function will recover after reperfusion therapy. Microvascular dysfunction in the non-infarct-related arteries (non-IRA) was a virtually unknown area at the time that the studies described in this thesis were performed.
The microvascular function cannot be directly visualized with standard techniques in the catheterization laboratory. The measurement methods developed so far are still in their infancy due to difficult or time-consuming use in daily clinical practice and interpretation requires consideration of potentially confounding coronary and patient-related disorders. In addition, the understanding of the coronary microvasculature is not facilitated by the use of numerous abbreviations of indices to estimate the hemodynamics of the coronary microcirculation.
Chapter 1 briefly provides the development of ST-elevation myocardial infarction (STEMI) with the potential consequences of impaired left ventricular function and cardiac death. Although the current treatment consists of timely mechanical reperfusion in addition to medical therapy, the effects of this reperfusion are not only favorable for the microvascular integrity know as reperfusion injury that partly determines the ultimate outcome of the treatment of the myocardial infarction. Many experimental and clinical studies of complementary therapies intended to prevent, or limit reperfusion injury did not reveal promising results. In order to further improve the outcomes of myocardial infarction treatment, more in-depth knowledge is needed about the mechanisms that play a role in the microvascular recovery phase
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Summary - Samenvatting
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