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European Heart Journal Advance Access originally published online on August 14, 2009
European Heart Journal 2009 30(23):2854-2860; doi:10.1093/eurheartj/ehp313
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Usefulness of the index of microcirculatory resistance for invasively assessing myocardial viability immediately after primary angioplasty for anterior myocardial infarction

Hong-Seok Lim1, Myeong-Ho Yoon1, Seung-Jea Tahk1,*, Hyoung-Mo Yang1, Byoung-Joo Choi1, So-Yeon Choi1, Seung-Soo Sheen2, Gyo-Seung Hwang1, Soo-Jin Kang1 and Joon-Han Shin1

1 Department of Cardiology, Ajou University Medical Center, San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, Republic of Korea
2 Section of Clinical Epidemiology and Biostatistics, Regional Clinical Trial Center, Ajou University Medical Center, Suwon, Republic of Korea

Received 22 January 2009; revised 31 May 2009; accepted 20 July 2009; online publish-ahead-of-print 14 August 2009.

* Corresponding author. Tel: +82 31 219 5712, Fax: +82 31 219 5708, Email: sjtahk{at}ajou.ac.kr

Aims: The aim of this study is to evaluate the usefulness of the index of microcirculatory resistance (IMR) for predicting myocardial viability and left ventricular (LV) function recovery in acute myocardial infarction (AMI).

Methods and results: After successful primary percutaneous coronary intervention in 40 patients with anterior AMI, IMR was measured using a pressure-temperature sensor-tipped coronary guidewire. Myocardial viability was quantified by 18F-fluorodeoxyglucose (FDG) positron emission tomography in 38 patients. Echocardiographic regional wall motion was analysed to calculate the anterior wall motion score (A-WMS) and percent change in A-WMS after revascularization and at 6-month follow-up. IMR correlated significantly with regional myocardial FDG uptake (r = –0.738, P < 0.001) and it demonstrated significant correlation with percent change in A-WMS (r = –0.464, P = 0.003). The area under the receiver operating curve of IMR for predicting LV function recovery was 0.89 [95% CI 0.888–0.894].

Conclusion: Index of microcirculatory resistance, a new index representing microvascular integrity, is a reliable early on-site determinant of myocardial viability and LV recovery after primary stenting for AMI.

Key Words: Myocardial viability • Acute myocardial infarction • Microvascular integrity • Index of microcirculatory resistance • FDG PET


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