CORONARY FLOW RESERVE MAY PREDICT MYOCARDIAL RECOVERY AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH TIMI GRADE-3 FLOW

Background The aim of the study was to determine whether the recovery of global and regional left ventricular function after successful perc utaneous transluminal angioplasty (PTCA) could be predicted by measuri ng coronary flow reserve before performing the intervention. Methods a nd Results Thirty-two patients underwent PTCA 6.9 +/- 3.4 days after a recent myocardial infarction. Coronary flow reserve was determined in the infarct-related artery before PTCA by using an intracoronary Dopp ler tipped wire. Global and regional wail motion were determined by 2- dimensional echocardiography before the Flowire study and again 7 week s after the angioplasty. Whereas the global and regional wall motion s care indices improved in 20 patients (recovery group), they deteriorat ed or did not change in 9 patients (nonrecovery group). Coronary flow reserve distal to the lesion in the infarct-related artery was signifi cantly higher in the recovery group (1.43 +/- 0.57 vs 0.98 +/- 0.70, P = .0001). Coronary flow reserve distal to the lesion in the infarct-r elated artery was <1.1 in patients whose global or regional left ventr icular function did not improve ai follow-up, whereas flow reserve ran ged between 1.1. and 1.8 while patients in whom left ventricular funct ion improved. Conclusions These results suggest that the absence of in ducible coronary flow reserve may predict failure of left ventricular systolic function to improve between the first and sixth week after in farction. Measurement of flow reserve with a Flowire at the time of di agnostic angiography after recent myocardial infarction may ultimately prove helpful in deciding whether to proceed with revascularization.