December 10, 2004
Starkweather, B.S. and Asher Kimchi M.D.
Angers, France -
Doppler guidewire assessment of coronary flow velocity (CFV) in
recanalized infarct-related coronary artery has long-term
prognostic value for fatal and nonfatal cardiac events. This
article published by Alain P. Furber M.D., PhD., et. al, from
the Department of Cardiology of Angers University Hospital in
Angers, France shows that average peak velocity (APV) <10cm/s
and average systolic peak velocity (ASPV) < 5cm/s were
associated with a significantly higher risk of CHF and of
reaching the combined end point (cardiac death and or
reinfarction and/or CHF). Both in-hospital and long-term adverse
clinical events can be predicted by the CFV pattern immediately
after primary and rescue PRCA, establishing a relationship
between the risk of adverse clinical events and microcirculatory
function measured by intracoronary Doppler examination.
Analysis of CFV in the recanalized infarct-related coronary
artery (IRA) has been shown useful for
predicting recovery of regional left ventricular function,
in-hospital complications and survival. This article postulated
that the CFV pattern after IRA reperfusion for acute myocardial
infarction (AMI) would predict long-term adverse cardiac events.
Sixty-eight consecutive patients underwent
direct or rescue coronary angioplasty within 6
to 24 hours after chest pain. At the end of the
angioplasty procedure, CFV’s were recorded with
the Doppler guidewire that had been positioned
with a tracking catheter. APV (the
time-averaged peak velocity normalized to the
cardiac cycle, which is the time average of the
spectral peak velocity waveform of 2 cardiac
cycles) and ASPV (average systolic peak
velocity) were significantly lower in patients
with cardiac events than in the other patients.
APV values were 12.1 +/- 8.1cm/s in patients
with cardiac events versus 18.8 +/- 9.0 cm/s in
other patients (P=0.014.) ASPV values were 6.0
+/- 4.2 cm/s in patients with cardiac events
and 10.9 +/- 6.4 cm/s (P=0.002). APV > 10 cm/s
and ASPV > 5 cm/s were associated with a
significantly lower risk of CHF and of reaching
the combined end point of cardiac death,
reinfarction and/or CHF.
had early retrograde systolic flow and 31 patients had a rapid
deceleration in diastole. Patients with early retrograde
systolic flow had an increased risk of cardiac death (P=0.02)
and CHF (not statistically significant) during the entire
follow-up period, whereas patients with a rapid diastolic
deceleration time had an increased risk of CHF (P=0.09).
analysis showed that the following factors were predictive of an
end point combining cardiac death, recurrent MI and congestive
heart failure: hypertension, age>65 years, time from onset of
chest pain to PTCA > 6 hours, peak creatinine kinase >4000 IU/L,
ejection fraction < 50%, proximal left anterior descending
artery occlusion, resting peak velocity <10cm/s, average
systolic peak velocity < 5 cm/s, a rapid diastolic deceleration
time and early retrograde systolic flow.
P. Furber, M.D, PhD; Fabrice Prunier, M.D.; Hoang Cuong Phan
Nguyen, M.D.; Stephane Boulet, M.D.; Stephane Delepine, M.D;
Philippe Geslin, M.D.