Coronary flow reserve is reflective of myocardial perfusion status in acute anterior myocardial infarction

Our objective was to determine whether coronary vasodilatory reserve (CVR) correlates with the perfusion state of infarct zone in early recovery phase of acute anterior myocardial infarction (AMI). We studied 14 patients (11 males; mean age, 46 years) who had AMI and 6 control subjects who had chest pain but normal coronary angiograms. All patients underwent successful per cutaneous revascularization of left anterior descending (LAD) coronary arte ry. Coronary flow velocity was measured using intracoronary (IC) Doppler at baseline and following IC injection of 18 mug of adenosine. Myocardial per fusion was evaluated by myocardial contrast echocardiography (MCE). CVR was higher in patients without a perfusion defect on MCE than in those with (2 .48 +/- 0.21 vs. 1.66 +/- 0.13, P = 0.001). Subjects with a perfusion defec t had a lower CVR than controls (1.66 +/- 0.13 vs.2.40 +/- 0.18, P < 0.05). CVR was > 2.0 in all subjects without a perfusion defect. There was a stro ng correlation between the magnitude of myocardial opacification in the LAD territory and CVR (r = 0.80, P < 0.01). Increase in peak diastolic flow ve locity after adenosine infusion, but not systolic flow velocity, correlated with myocardial opacification index (r = 0.63, P = 0.016). CVR of infarct- related artery correlated closely with the perfusion status of the myocardi um in infarct zone and those with a CVR > 2.0 had normal myocardial perfusi on. These data suggest that CVR may be used to determine the perfusion stat e of the myocardium in the infarct zone, which is a known predictor of myoc ardial viability. Cathet Cardiovasc. Intervent 51:281-286 2000. (C) 2000 Wi ley-Liss, Inc.