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European Heart Journal Advance Access originally published online on July 26, 2007
European Heart Journal 2007 28(19):2320-2325; doi:10.1093/eurheartj/ehm309
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Hyperaemic microvascular resistance is not increased in viable myocardium after chronic myocardial infarction

Koen M. Marques1,2,*, Paul Knaapen1,2, Ronald Boellaard2,3, Nico Westerhof4, Adriaan A. Lammertsma2,3, Cees A. Visser1,2,{dagger} and Frans C. Visser1,2

1 Department of Cardiology, VU University Medical Centre, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands
2 ICaR-VU, VU University Medical Centre, Amsterdam, The Netherlands
3 Department of Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, The Netherlands
4 Department of Pulmonary Diseases and Physiology, VU University Medical Centre, Amsterdam, The Netherlands

Received 23 April 2007; revised 1 June 2007; accepted 14 June 2007; online publish-ahead-of-print 26 July 2007.

* Corresponding author. Tel: +31 20 4442244; fax: +31 20 4442446. E-mail address: km.marques{at}vumc.nl

See page 2301 for the editorial comment on this article (doi:10.1093/eurheartj/ehm333)

Aims: The present study compared microvascular resistance (MR) of viable myocardium in infarct areas with those in reference areas in patients with chronic myocardial infarction (MI).

Methods and results: In 27 patients, MR (ratio distal coronary pressure and flow) of reference and viable infarct areas was calculated at baseline and during hyperaemia. H2 15O positron emission tomography (PET) was used to provide myocardial blood flow measurements. In infarct regions, H2 15O PET solely measures flow in viable myocardium, excluding flow in scar tissue. Distal coronary pressure was measured with a pressure wire in the infarct-related and reference artery. The average time between PET study and infarction was 3.3 ± 4.4 years. Mean hyperaemic distal coronary pressure was significantly lower in the infarct-related artery. MR varied considerably between patients and was significantly higher in infarct areas at baseline (135 ± 38 vs. 118 ± 29 mmHg mL min/mL; P < 0.05), but not during hyperaemia (39 ± 18 vs. 35 ± 11 mmHg mL min/mL). The correlation between MR in infarct and reference areas was significant.

Conclusion: To determine MR, distal coronary pressure measurements should be used. Hyperaemic MR in viable myocardium within the infarcted area is not higher when compared with the reference area. This supports the application of the established fractional flow reserve cut-off value in the setting of chronic MI.

Key Words: Microcirculation • Physiology • Infraction • Regional myocardial blood flow

{dagger} Deceased


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Related articles in EHJ:

Fractional flow reserve after previous myocardial infarction
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EHJ 2007 28: 2301-2302. [Extract] [Full Text]  



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