Background
Microvascular dysfunction (MVD) after acute myocardial infarction (AMI) may predict progressive left ventricular (LV) dilatation. A dual-sensor (pressure and Doppler velocity) guidewire has an ability to evaluate MVD quantitatively. The aim of this study was to investigate the relationship between MVD assessed by a dual-sensor guidewire and LV remodeling after successful primary percutaneous coronary intervention (PCI) in AMI patients.
Methods and results
Twenty-four consecutive patients with TIMI 3 flow after primary PCI for a first anterior AMI were enrolled. Immediately after primary PCI, using a dual-sensor guidewire, microvascular resistance index (MVRI) was calculated as the ratio of mean distal pressure to average peak flow velocity during maximal hyperemia. According to the median value of MVRI, patients were divided into two groups (MVRI>median and ≤median). LV remodeling was defined as an increase in LV end-diastolic volume (LVEDV) of ≥20%. Cardiovascular magnetic resonance was performed to determine LV volumes, global function and infarct size at baseline and 8-month follow-up. LVEDV (146.5±21.4 ml vs. 111.6±29.9 ml, P =.0039), % change in LVEDV (27.7%±23.8% vs. 3.3%±19.6%, P =.0115) and infarct size (29.1%±9.8% vs. 18.0%±12.1%, P =.0233) at 8-month follow-up were significantly greater in the group with a MVRI >2.96 mmHg·cm -1 ·s compared with ≤2.96 mmHg·cm -1 ·s, and the frequency of LV remodeling was significantly higher in the group with a MVRI>2.96 mmHg·cm -1 ·s (64% vs. 15%, P =.0327). Furthermore, there was a positive correlation between LVEDV at 8-month follow-up and MVRI ( r =0.54, P =.0068).
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