Page 183 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

The same cohort of patients was used to study the course of the coronary (including microvascular) hemodynamics after the first anterior wall infarct and thus indirectly the autoregulation in both the IRA and the non-IRA. In chapter 3 it is described that the microvascular function, determined by the microvascular resistance, improves in both territories over time after the acute infarct. As a result, the rate-pressure corrected baseline flow rate decreases slightly and the hyperemic flow rate increases significantly. The adjusted baseline microvascular resistance in the infarct vessel, decreased in the acute phase, increased by approximately 28% in 6 months of follow-up. The same development (an increase of approximately 31%) was documented in the non-IRA. Hyperemic (or minimal) microvascular resistance in the acute phase of myocardial infarction is higher than usual in both the IRA and non-IRA and declines rapidly in both areas in the first week after AMI. In non-IRA this value drops to normal in the first week, in IRA it takes longer, and recovery is complete at 6 months. The minimum resistance in the infarct area decreases by approximately 44% and in the non-IRA area by 18%. This study provides a time perspective for the restoration of microvascular function for both the infarct area and the distant areas.
Chapter 4 reviews briefly how the Doppler-tipped guidewire functions and how it can be used in the setting of PPCI, for example. The value of the various parameters, obtained in the setting of acute infarct angioplasty, are described such as coronary flow velocity reserve (CFR), diastolic deceleration time (DDT), systolic flow velocity reversal and is put into perspective with myocardial contrast echocardiography (MCE) and cardiac magnetic resonance imaging (CMR). In the setting of PPCI, the Doppler wire technique can be easily applied to assess microvascular obstruction and dysfunction and yields information to predict recovery of the left ventricular function following anterior wall infarction.
We showed that in the acute phase of the anterior wall infarct the microcirculation in remote areas was also disturbed. It was unknown whether this altered microcirculation in non-obstructive regions yields prognostic information. Chapter 5 describes the mortality after 10 years in the patients from the cohort discussed earlier. For this analysis, the patient cohort was divided into post-procedural CFR values in the non-IRA below or above 2.1. We
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Summary - Samenvatting
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