Page 22 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Chapter 1
Thesis outline
Chapter 2 reports a prospective clinical study of a homogenous group of 100 consecutive patients with monovascular coronary artery disease suffering a first anterior STEMI, treated with PPCI. Standard methods to determine treatment efficacy as TIMI flow grade, corrected TIMI frame count and myocardial blush grade, being surrogates for tissue reperfusion are compared to Doppler derived flow velocity values. These Doppler determinants, together with patient and procedure characteristics are related to potential recovery of the left ventricle during follow-up. Left ventricular function is evaluated by means of echocardiography in the course of the infarction until 6-months of follow- up. Early determinants of recovery of left ventricular function are identified in the acute phase of the myocardial infarction.
Thus far, the post infarct changes over time of microvascular function and autoregulation in terms of flow velocity reserve and resistances in infarcted and remote areas were unclear. Chapter 3 details unique data of Doppler derived flow velocity characteristics obtained directly after reperfusion in patients with an acute anterior myocardial infarction and at follow-up at 1-week and 6-months. This concerns the first published data reporting the intracoronary measured flow rates and microvascular resistances in the course of myocardial infarction and follow-up, not only in the infarct-related vessel but also in the non-infarct-related artery.
Chapter 4 presents a review regarding the value of using the Doppler flow-wire in the setting of acute myocardial infarction. This treatise not only describes the value of performing CFR measurements at the time of PPCI but also the typical properties of Doppler signals in microvascular dysfunction due to obstruction or injury and how it can be used to predict recovery of left ventricular function. Finally, this Doppler technique is compared to other invasive and non-invasive techniques to assess microvascular function.
Chapter 5 describes the importance of knowledge of the microvascular function, especially in the coronary arteries remote from the infarcted artery, and its relation to long-term (10 years) mortality. Furthermore, the relation between CFR in the reference vessel at 6-months following the de index procedure and also long-term mortality is evaluated.
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