Prediction of wall motion recovery from the left anterior descending coronary artery velocity pattern recorded by transthoracic Doppler echocardiography in patients with anterior wall myocardial infarction - Retrospective and prospective studies

The diastolic deceleration slope of coronary flow velocity is steeper in pa tients with substantial 'no reflow' phenomenon than in those without it. Th is study investigated whether functional outcomes in patients with anterior wall acute myocardial infarction (AMI) can be predicted by analyzing the c oronary flow velocity pattern recorded with transthoracic Doppler (TTD) ech ocardiography. Coronary blood flow velocity in the distal. left anterior de scending coronary artery was recorded with TTD at day-2 after primary percu taneous transluminal coronary angioplasty/Stent in 51 patients with anterio r AMI and the diastolic deceleration half time DHT, ms) was measured. The w all motion score index (WMSI) was measured at day-1 and -21. In the retrosp ective study, the DHT was much shorter in those with a poor outcome than in those with good outcome (152 +/- 109 vs 395 +/- 128 ms, p <0.05). Receiver -operating characteristic analysis documented that DHT greater than or equa l to 300ms is a suitable cut-off point (sensitivity of 83% and specificity of 93%). In the prospective study (n=30), Delta WMSI(d1-d21) was significan tly higher in those with a DHT greater than or equal to 300 ins than those without (0.3 +/-0.5 vs 1.6 +/-0.7, p <0.001). DHT correlated significantly with AWMSI(d1-d21) (r=0.76, p <0.001). Patients with a shorter DHT of diast olic coronary flow velocity have a poorer functional outcome among patients with anterior AML The TTD-determined DHT is a useful predictor of myocardi al viability after an anterior AMI.