Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction: Insight into mechanisms of microvascular dysfunction

Koichi Yamamoto, Hiroshi Itoh, Katsuomi Iwakura, Shigeo Kawano, Masashi Ikushima, Tohru Masuyama, Toshio Ogihara, Kenshi Fujii

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

OBJECTIVES: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI). BACKGROUND: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown. METHODS: Data on 105 patients with AMI (57 with anterior and 48 with nonanterior cases) who underwent a coronary, intervention were analyzed. The CBFV was recorded by a Doppler guide wire, and tissue perfusion was assessed with myocardial contrast echocardiography (MCE). RESULTS: Study patients were classified into three groups according to TIMI grade and the presence or absence of SFR: 1) TIMI-3 flow (n = 80); 2) TIMI-2 flow with SFR (SFR[+], n = 14); and 3) TIMI-2 flow without SFR (SFR[-], n = 11). Diastolic CBFV was the lowest in SFR(-) (TIMI-3 vs. SFR[+] vs. SFR[-]: 34 vs. 31 vs. 9 cm/s), and the systolic to diastolic CBFV ratio was also the highest in SFR(-) (0.43 vs. -0.18 vs. 0.66). The no-reflow phenomenon documented by MCE was found in all patients in the SFR(+) group, but in only one patient (10%) in the SFR(-) group. Intracoronary thrombus was more frequently found in SFR(-) than in SFR(+) (91% vs. 14%, p <0.05). CONCLUSIONS: At least two different CBFV patterns are noted in patients with reperfused AMI who have TIMI-2 flow. Capillary damage is mostly responsible for SFR(+), and SFR(-) is seen in thromboemboli possibly due to increased coronary arterial resistance.

Original languageEnglish
Pages (from-to)1755-1760
Number of pages6
JournalJournal of the American College of Cardiology
Volume40
Issue number10
DOIs
Publication statusPublished - Nov 20 2002
Externally publishedYes

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Blood Flow Velocity
Myocardial Infarction
No-Reflow Phenomenon
Echocardiography
Thrombosis
Perfusion

ASJC Scopus subject areas

  • Nursing(all)

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Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction : Insight into mechanisms of microvascular dysfunction. / Yamamoto, Koichi; Itoh, Hiroshi; Iwakura, Katsuomi; Kawano, Shigeo; Ikushima, Masashi; Masuyama, Tohru; Ogihara, Toshio; Fujii, Kenshi.

In: Journal of the American College of Cardiology, Vol. 40, No. 10, 20.11.2002, p. 1755-1760.

Research output: Contribution to journalArticle

Yamamoto, Koichi ; Itoh, Hiroshi ; Iwakura, Katsuomi ; Kawano, Shigeo ; Ikushima, Masashi ; Masuyama, Tohru ; Ogihara, Toshio ; Fujii, Kenshi. / Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction : Insight into mechanisms of microvascular dysfunction. In: Journal of the American College of Cardiology. 2002 ; Vol. 40, No. 10. pp. 1755-1760.
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abstract = "OBJECTIVES: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI). BACKGROUND: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown. METHODS: Data on 105 patients with AMI (57 with anterior and 48 with nonanterior cases) who underwent a coronary, intervention were analyzed. The CBFV was recorded by a Doppler guide wire, and tissue perfusion was assessed with myocardial contrast echocardiography (MCE). RESULTS: Study patients were classified into three groups according to TIMI grade and the presence or absence of SFR: 1) TIMI-3 flow (n = 80); 2) TIMI-2 flow with SFR (SFR[+], n = 14); and 3) TIMI-2 flow without SFR (SFR[-], n = 11). Diastolic CBFV was the lowest in SFR(-) (TIMI-3 vs. SFR[+] vs. SFR[-]: 34 vs. 31 vs. 9 cm/s), and the systolic to diastolic CBFV ratio was also the highest in SFR(-) (0.43 vs. -0.18 vs. 0.66). The no-reflow phenomenon documented by MCE was found in all patients in the SFR(+) group, but in only one patient (10{\%}) in the SFR(-) group. Intracoronary thrombus was more frequently found in SFR(-) than in SFR(+) (91{\%} vs. 14{\%}, p <0.05). CONCLUSIONS: At least two different CBFV patterns are noted in patients with reperfused AMI who have TIMI-2 flow. Capillary damage is mostly responsible for SFR(+), and SFR(-) is seen in thromboemboli possibly due to increased coronary arterial resistance.",
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T1 - Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction

T2 - Insight into mechanisms of microvascular dysfunction

AU - Yamamoto, Koichi

AU - Itoh, Hiroshi

AU - Iwakura, Katsuomi

AU - Kawano, Shigeo

AU - Ikushima, Masashi

AU - Masuyama, Tohru

AU - Ogihara, Toshio

AU - Fujii, Kenshi

PY - 2002/11/20

Y1 - 2002/11/20

N2 - OBJECTIVES: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI). BACKGROUND: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown. METHODS: Data on 105 patients with AMI (57 with anterior and 48 with nonanterior cases) who underwent a coronary, intervention were analyzed. The CBFV was recorded by a Doppler guide wire, and tissue perfusion was assessed with myocardial contrast echocardiography (MCE). RESULTS: Study patients were classified into three groups according to TIMI grade and the presence or absence of SFR: 1) TIMI-3 flow (n = 80); 2) TIMI-2 flow with SFR (SFR[+], n = 14); and 3) TIMI-2 flow without SFR (SFR[-], n = 11). Diastolic CBFV was the lowest in SFR(-) (TIMI-3 vs. SFR[+] vs. SFR[-]: 34 vs. 31 vs. 9 cm/s), and the systolic to diastolic CBFV ratio was also the highest in SFR(-) (0.43 vs. -0.18 vs. 0.66). The no-reflow phenomenon documented by MCE was found in all patients in the SFR(+) group, but in only one patient (10%) in the SFR(-) group. Intracoronary thrombus was more frequently found in SFR(-) than in SFR(+) (91% vs. 14%, p <0.05). CONCLUSIONS: At least two different CBFV patterns are noted in patients with reperfused AMI who have TIMI-2 flow. Capillary damage is mostly responsible for SFR(+), and SFR(-) is seen in thromboemboli possibly due to increased coronary arterial resistance.

AB - OBJECTIVES: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI). BACKGROUND: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown. METHODS: Data on 105 patients with AMI (57 with anterior and 48 with nonanterior cases) who underwent a coronary, intervention were analyzed. The CBFV was recorded by a Doppler guide wire, and tissue perfusion was assessed with myocardial contrast echocardiography (MCE). RESULTS: Study patients were classified into three groups according to TIMI grade and the presence or absence of SFR: 1) TIMI-3 flow (n = 80); 2) TIMI-2 flow with SFR (SFR[+], n = 14); and 3) TIMI-2 flow without SFR (SFR[-], n = 11). Diastolic CBFV was the lowest in SFR(-) (TIMI-3 vs. SFR[+] vs. SFR[-]: 34 vs. 31 vs. 9 cm/s), and the systolic to diastolic CBFV ratio was also the highest in SFR(-) (0.43 vs. -0.18 vs. 0.66). The no-reflow phenomenon documented by MCE was found in all patients in the SFR(+) group, but in only one patient (10%) in the SFR(-) group. Intracoronary thrombus was more frequently found in SFR(-) than in SFR(+) (91% vs. 14%, p <0.05). CONCLUSIONS: At least two different CBFV patterns are noted in patients with reperfused AMI who have TIMI-2 flow. Capillary damage is mostly responsible for SFR(+), and SFR(-) is seen in thromboemboli possibly due to increased coronary arterial resistance.

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