Page 186 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax
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Chapter 11
up. It is noteworthy that these associations were not found in the IRA, possibly less detectable due to other (patho)physiological mechanisms.
Since the effect of increased admission glucose levels on baseline microvascular resistance was more pronounced than on the hyperemic resistance in non-IRA, it suggests that the autoregulatory function is negatively affected by elevated blood glucose levels. The disappearance of the associations at follow-up suggests, at least in part, recovery of the autoregulation in non-IRA.
Coronary flow capacity (CFC) has recently been developed as a tool for diagnosis, prognosis, and risk stratification in patients with stable ischemic heart disease with known coronary flow and resistance values. CFC depicts the relationship between hyperemic flow and CFR, is less prone to alteration in hemodynamics as it corrects for variation in baseline flow. Chapter 9 describes the evaluation of CFC in patients with acute anterior wall myocardial infarction. Patients were divided into 4 groups based on their CFC (normal and mild, moderate, or severely abnormal). A significant association was found with infarct size based on peak troponin value across the 4 categories for both IRA and non-IRA. CFC improved during follow-up for both IRA and non-IRA. A moderately and severely reduced CFC of IRA was present in 61% of the patients at the time of PPCI, 28% at 1 week, and 11% at 6 months. For the non-IRA, this was 28%, 3%, and 0% respectively. This illustrates the usefulness of CFC to assess the hemodynamics of the coronary microcirculation in the setting of an acute anterior wall STEMI.
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