Page 137 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Elevated glucose levels impact microvascular function in STEMI
to standard clinical practice. The exclusion criteria were reported previously.4 The study protocol was approved by the local ethics committee and all patients gave informed consent.
Cardiac catheterisation and periprocedural measurements
After successful reperfusion, intracoronary blood flow velocity was measured in the infarct-related artery (IRA) and an angiographic normal reference vessel (diameter stenosis <30% on visual estimation) using a 0.014-inch sensor equipped guide wire (Volcano Corp., San Diego, CA). Reference vessel measurements were performed in the left circumflex coronary artery, or the right coronary artery if a stenosis of >30% was present. At 1-week and 6-month follow-up, patients underwent repeat angiography with assessment of intracoronary Doppler flow velocity. Hyperaemia was induced by an intracoronary bolus of 20–40 μg adenosine. Before and after PCI, coronary angiography suitable for quantitative coronary angiographic analysis was performed for offline analysis of thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade. Left ventricular function was evaluated by means of echocardiographic 16-segment Wall Motion Score Index (WMSI) performed immediately before PPCI.
Haemodynamic data analysis
Coronary flow velocity reserve (CFVR) was calculated as the ratio of hyperaemic 8 average peak flow velocity (hAPV) to baseline average peak velocity (bAPV).
In the absence of significant epicardial disease in the reference vessels, microvascular resistance was calculated at baseline and during hyperaemia, respectively the ratio between mean aortic pressure and mean distal flow
velocity at baseline (baseline microvascular resistance—BMR), and during hyperaemia (hyperaemic microvascular resistance—HMR). The delta microvascular resistance from resting to hyperaemic conditions (dMR) was determined by calculating the absolute difference between BMR and HMR.
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