Assessment of coronary flow velocity pattern during no-reflow phenomenon by transthoracic Doppler echocardiography combined with administration of Albunex

Abstract

Abstract: AIM: To validate the alternations of flow velocity patterns in the infarct-related artery (IRA) during no-reflow phenomenon in a canine model of acute myocardial ischemia and reperfusion by transthoracic Doppler echocardiography (TTDE) combined with myocardial contrast echocardiography (MCE) by means of administration of Albunex.METHODS: Nineteen dogs first underwent 60 min myocardial ischemia and then followed by 60 min, 120 min and 180 min reperfusion (n=6, 6 and 7, respectively).The perfusion defect area determined by MCE at 60 min myocardial ischemia was regarded as risk area (RA_MCE).The perfusion defect area defined by MCE after reperfusion was considered as no-reflow area (NRA_MCE).The ratio between NRA_MCE and RA_MCE ≥25% was regarded as the development of no-reflow phenomenon and the ratio of NRA_MCE to RA_MCE <25% was considered as the myocardial reflow.The coronary flow velocity parameters in IRA were determined through TTDE.RESULTS: Two dogs died during experiment and the remaining seventeen dogs completed throughout the procedure. There were seven dogs in reflow group and ten dogs in noreflow group.No significant difference was present in reflow group between at baseline and at 60 min reperfusion in systolic peak velocity (PVs), systolic velocity time integral (VTIs), corrected systolic flow duration (cFDs), diastolic peak velocity (PVd), diastolic velocity time integral (VTId), corrected diastolic flow duration (cFDd), diastolic deceleration rate (DDR), corrected diastolic deceleration duration (cDDD) (P>0.05), however, a significant difference was found in no-reflow group between at baseline and at 60 min reperfusion in PVs, VTIs, cFDs, PVd, VTId and cFDd (P<0.05).The most marked alterations during diastolic phase were the increase of DDR and reduction of cDDD.CONCLUSION: The impaired microvasculature may profoundly affect the coronary flow velocity pattern in the IRA.The increase in microvascular resistance and decrease in coronary perfused pressure can contribute to the changes. Transthoracic Doppler echocardiography combined with MCE has the capability of noninvasive assessment of coronary flow velocity pattern in the IRA during no-reflow phenomenon.

Key words: Doppler, echocardiography, infarct-related artery, no-reflow, Albunex

CLC Number:

CHEN Li-xin, WANG Xin-fang, XIE Ming-xing, ZHU Xiang-ming, WU Ying. Assessment of coronary flow velocity pattern during no-reflow phenomenon by transthoracic Doppler echocardiography combined with administration of Albunex[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2005, 10(3): 270-275.

References

1 Schofer J, Mont R, Mathey DG.Scintigraphic evidence of the “no reflow” phenomenon in human beings after coronary thrombolysis[J].J Am Coll Cardiol, 1985;5:593-8
2 Bates ER, Krell MJ, Dean EN, O'Neill WW, Vogel RA. Demonstration of the “ no-reflow” phenomenon by digital coronary arteriography[J].Am J Cardiol, 1986;57:177-8
3 Nicklas JM, Diltz EA, O'Neill WW, Bourdillon PDV, Walton JA Jr, Pitt B.Quantitative measurement of coronary flow during medical revascularization (thrombolysis or angioplasty) in patients with acute infarction[J].J Am Coll Cardiol, 1987;10: 284-9
4 Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, et al.Lack of myocardial perfusion immediately after successful thromboly sis:a predictor of poor recovery of left ventricular function in anterior myocardial infarction [J].Circulation, 1992;85:1699-705
5 Ragosta M, Camarano G, Kaul S, Powers ER, Sarembock ER, Gimple LW.Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction:new insights using myocardial contrast echocardiography [J].Circulation, 1994;89:2562-9
6 Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, et al.Incidence and treatment of‘no-reflow'after percutaneous coronary intervention[J].Circulation, 1994;89:2514-8
7 Shani J, Feld H, Frankel R, Hollander G.Reversal of the noreflow phenomenon with intracoronary verapamil during coronary angioplasty for acute myocardial infarction[J].Circulation, 1992;86:I-852
8 Ito H, Okamura A, Iwakura K, Masuyama T, Hori M, Takiuchi S, et al.Myocardial perfusion patterns related to Thrombolysis In Myocardial Infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction [J].Circulation, 1996;93:1993-9
9 Kloner RA, Ganote CE, Jennings RB.The “ no-reflow” phenomenon after temporary coronary occlusion in the dog[J].J Clin Invest, 1974;54:1496-508
10 Reffelmann T, Hale SL, Li GH, Kloner RA.Relationship between no re flow and infarct size as influenced by the duration of ischemia and reperfusion[J].Am J Physiol Heart Circ Physiol, 2002;282:H766-72
11 Reffelmann T, Kloner RA.Microvascular reperfusion injury: rapid expansion of anatomic no reflow during reperfusion in the rabbit[J].Am J Physiol Heart Circ Physiol, 2002;283: H1099-107
12 Nicklas JM, Diltz EA, O'Neill WW, Bourdillon PD, Walton JA Jr, Pitt B.Quantitative measurement of coronary flow during medical revascularization (thromboly sis or angioplasty) in patients with acute infarction[J].J Am Coll Cardiol, 1987;10: 284-9
13 Engler RL, Schmid-Schoenbein G, Pavelec SR.Leukocyte capillary plugging in myocardial ischemia and reperfusion in the dog[J].Am J Pathol, 1983;111:98-111
14 Frame LH, Powell WJ Jr.Progressive perfusion impairment during prolonged in myocardial ischemia in canine myocardium [J].Circ Res, 1976;39:269-76
15 Gorman MW, Sparks HVJ.Progressive coronary vasoconstriction during relative ischemia in dogs[J].Circ Res, 1982;51: 411-20
16 Iwakura K, Ito H, Takiuchi S, Taniyama Y, Nakatsuchi Y, Negoro S, et al.Alteration in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction[J].Circulation, 1996;94:1269-75
17 Eleuteri E, Scapellato F, Temporelli PL, Giannuzzi P.Evaluation of the left anterior descending artery flow velocity by transthoracic echo-Doppler without contrast enhancement[J].Ital Heart J, 2002;3:520-4
18 Hozumi T, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Akasaka T, et al.Coronary flow velocity analysis during short term follow up after coronary reperfusion:use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction[J].Heart, 2003;89:1163-8

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