Page 23 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax
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General introduction and outline of the thesis
 Chapter 6 is the only chapter in this thesis not reporting about patients with 1 acute myocardial infarction. As in Chapter 5 the usefulness of measuring CFR
in angiographical normal arteries is evaluated during elective PCI. However, evaluation in this chapter deals with stable patients with chronic coronary syndromes. Again, the relationship between abnormal microvascular function
and long-term mortality is researched.
Chapter 7 reports the prognostic value of microvascular dysfunction, assessed by CFR, in the subacute phase of STEMI in relation to CMR derived left ventricular function in a subgroup analysis of the HEBE trial (designed to assess the effect of bone marrow mononuclear cell therapy on cardiac improvement in STEMI patients).
In several non-diabetic patients presenting with STEMI, high levels of serum glucose are measured. Chapter 8 evaluates the relation between high blood glucose levels during STEMI and the microvascular function in infarct related and remote arteries.
Several limitations may apply to the use of CFR in assessing ischemic heart disease and microvascular function, such as factors influencing resting or hyperemic flow. The concept of the coronary flow capacity (CFC) was recently developed, based on the assumption that myocardial ischemia originates when both maximal coronary flow and the reserve capacity of the coronary circulation are below ischemic thresholds and that myocardial ischemia is unlikely once CFR or maximal flow is among normal values.68, 69 Since CFC should be less prone to alterations in hemodynamics than CFR, in Chapter 9 is CFC used to document the time course of microvascular function in the setting of anterior wall STEMI in both the infarct as well as the remote regions.
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