Abstract
After acute myocardial infarction (AMI), the most significant prognostic determinants
of myocardial viability and function are deterioration degree of the distal myocardial
microcirculation and collateral flow. Quantification of coronary collateral circulation
is possible by using intracoronary pressure measurement techniques. We hypothesized
that quantitatively determined coronary wedge pressure (CWP) and collateral flow index
(CFI) may be useful in order to designate regional left ventricular function and indirectly
viability after MI. In this study, we investigated the relationships between angiographically
quantified wall motion scores and CWP and CFI in patients with recent AMI and treated
with thrombolytic therapy. Forty patients early after myocardial infarction with ≥60%
residual stenosis in infarct related artery (IRA) after thrombolysis, who underwent
PTCA and/or stent implantation for this culprit lesion, were included in this study.
None of the patients had significant stenosis in other coronary arteries. Angiographic
ventricular wall motion scoring (WMS) was performed semi quantitatively according
to coronary artery surgery study criteria. After angiography, fiberoptic pressure
monitoring guide wire (pressure wire, Radi) was positioned distal to the stenosis
to be dilated. During complete occlusion with balloon inflation distal pressure recorded
as CWP. CFI was determined as the ratio of simultaneously measured CWP to aortic pressure.
The mean values of CWP, CFI and mean WMS were 18.1 ± 7.9 mmHg, 0.18 ± 0.09 and 3.15
± 0.8, respectively. The CWP (r: −0.86) and CFI (r: −0.84) values correlated well
with WMS determined in the infarcted territory. We concluded that collateral circulation
in the infarcted region is related to the left ventricular regional function. Presence
of adequate and intact collateral network in the infarct related segments diminishes
microvascular damage translating into preserved left ventricular regional functions.
