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European Heart Journal 2004 25(17):1526-1533; doi:10.1016/j.ehj.2004.06.029
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices

Katsuomi Iwakura, Hiroshi Ito*, Shigeo Kawano, Atsushi Okamura, Koji Tanaka, Yuya Nishida, Yoshihiro Maekawa and Kenshi Fujii

Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan

Received December 6, 2003; revised June 5, 2004; accepted June 10, 2004 * Corresponding author. Tel.: +81-6-6341-8651; fax: +81-6-6341-0785 (E-mail: itomd{at}osk4.3web.ne.jp).

See page 1480 for the editorial comment on this article (doi:10.1016/j.ehj.2004.06.029)

AIMS: Doppler guidewire studies demonstrated that the no-reflow phenomenon in acute myocardial infarction is associated with characteristic coronary blood flow pattern. We investigated the potential of coronary flow measurement with transthoracic Doppler technique to detect the no-flow in the patients with reperfused infarction, and compared it to that of other modalities.

METHODS AND RESULTS: We performed intracoronary myocardial contrast echocardiography after successful primary coronary intervention in the 94 patients with first, anterior wall infarction. Coronary blood flow in the left anterior descending artery was detected with transthoracic Doppler echocardiography within 24 h after reperfusion in 83 patients (88.3%). Twenty-two patients with the no-reflow had significantly lower systolic peak velocity (5.1±4.2 vs. 8.1±6.2 cm/s, p=0.04), higher diastolic peak velocity (38.2±10.3 vs. 30.8±15.7 cm/s; p=0.04), and shorter diastolic deceleration time (134±41 vs. 424±202 ms; p<0.0001) than those with good-reflow. Systolic flow reversal was more frequently observed in those with no-reflow (18.2% vs. 3.3%, p=0.02). Diastolic deceleration time <185 ms detected the no-reflow with far higher sensitivity/specificity (95.5%/95.1%) than TIMI frame count (45.5%/91.8%), ST resolution (54.5%/73.8%) and creatinine kinase-MB (54.5%/88.5%).

CONCLUSION: Analysing coronary blood flow pattern can detect the no-reflow after anterior infarction better than other angiographic, electrocardiographic and enzymatic modalities.


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