Key result
Diastolic deceleration time (DDT) was the most reliable hemodynamic microvascular index for predicting viable myocardium in AMI patients following primary PCI (AUC 0.802, p=0.011).
Why the study?
Do microvascular indexes assessed by intracoronary pressure/Doppler wire predict viable myocardium in patients with first AMI following primary PCI?
Observational (n=35)
Do microvascular indexes assessed by intracoronary pressure/Doppler wire predict viable myocardium in patients with first AMI following primary PCI?
Diastolic deceleration time assessed by intracoronary Doppler wire immediately after primary PCI is a reliable predictor of myocardial viability in AMI patients.
Background and Objectives：Microvascular integrity has been associated with the clinical outcomes in acute myocardial infarction (AMI). The present study was conducted to determine the value of many microvascular indexes assessed by an intracoronary (IC) pressure/Doppler wire in AMI following primary PCI for detecting viable myocardium by comparing with the 18 F-fluorodeoxyglucose uptake rate (%FDG uptake) on positron-emission tomography (PET). Subjects and Methods：We studied 35 patients who had their first AMI (age: 56± 12, male: 30). After primary PCI, the TMPG (TIMI myocardial perfusion grade) was assessed. We measured the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the coronary wedge pressure (Pcw), the Pcw/ Pa (mean aortic pressure) and the hyperemic microvascular resistance index (hMVRI) by an IC Doppler/ pressure wire. 18 FDG PET scan was obtained at 7 days after the primary PCI; viable myocardium was defined that the %FDG uptake was more than 50% in infarct-related myocardium. Results：There were significant correlations between TMPG, CFR, Pcw, Pcw/Pa, DDT, hMVRI and %FDG uptake (r=0.651, p<0.001; r=0.386, p=0.020; r=-0.388, p=0.021; r=-0.473, p=0.004; r=0.589, p<0.001; r=-0.442, p=0.008, respectively). The best cutoff values and area under curves (AUC) of the CFR, Pcw, Pcw/Pa, DDT and hMVRI for 50% FDG uptake were 1.8 (0.737), 27 mmHg (0.600), 0.33 (0.660), 600 msec (0.802) and 2.55 mmHg·cm -1 ·sec (0.768), respectively. The DDT had a significantly higher AUC than that of Pcw (p=0.029) and it was an independent index to predict the myocardial viability (p=0.011). Conclusion：DDT was the most reliable hemodynamic microvascular index that was assessed within 24 hours following primary PCI for predicting the viable myocardium in AMI patients. (Korean Circulation J 2006;36:701-709)
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Yoon et al. (2006) conducted an observational in Acute myocardial infarction (AMI) (n=35). Intracoronary pressure/Doppler wire microvascular indexes (CFR, DDT, Pcw, Pcw/Pa, hMVRI) vs. 18F-FDG uptake on PET was evaluated on Prediction of viable myocardium (>50% FDG uptake in infarct-related myocardium) (AUC 0.802, p=0.011). Diastolic deceleration time (DDT) was the most reliable hemodynamic microvascular index for predicting viable myocardium in AMI patients following primary PCI (AUC 0.802, p=0.011).
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