[Usefulness of diastolic deceleration time assessed by transthoracic Doppler measurement in the detection of sustained microvascular obstruction in STEMI patients treated by primary PTCA]

M Messas; A Trinh; L Jesel; B Radulescu; P Germain; P Ohlmann; P Bareiss; O Morel

doi:10.1016/j.ancard.2010.12.024

[Usefulness of diastolic deceleration time assessed by transthoracic Doppler measurement in the detection of sustained microvascular obstruction in STEMI patients treated by primary PTCA]

Ann Cardiol Angeiol (Paris). 2011 Jun;60(3):119-26. doi: 10.1016/j.ancard.2010.12.024. Epub 2011 Jan 20.

[Article in French]

Authors

M Messas¹, A Trinh, L Jesel, B Radulescu, P Germain, P Ohlmann, P Bareiss, O Morel

Affiliation

¹ Pôle d'activité médicochirurgicale des Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, université de Strasbourg, France.

PMID: 21570057
DOI: 10.1016/j.ancard.2010.12.024

Abstract

Aims: To assess the value of coronary flow measurement by transthoracic Doppler technique in the detection of "no-reflow" phenomenon.

Methods: Fourteen patients with first anterior wall infarction treated by successful (TIMI3) primary percutaneous angioplasty and left descending coronary artery stenting were investigated. Myocardial perfusion following PCI was assessed by (i) ST-segment resolution, (ii) MRI-detected microvascular obstruction (early hypoenhancement), (iii) coronary flow pattern measurement by transthoracic Doppler technique.

Results: Sustained impairment of myocardial perfusion following PCI was observed in a large proportion of the cohort (36% by MRI, 43% by ST regression analysis). Patients with a diastolic deceleration time inferior to 482 ms had higher troponin and CK peak value, higher wall motion index score, lower ST resolution and lower LVEF assessed by MRI. The concordance of the three methods was 80%.

Conclusion: The measurement of diastolic deceleration time by transthoracic Doppler technique is a reliable technique to identify microvascular obstruction following PCI in acute anterior STEMI. A DDT inferior to 482 ms is associated with sustained "no-reflow" phenomenon.

MeSH terms

Adult
Aged
Angioplasty, Balloon, Coronary
Anterior Wall Myocardial Infarction / diagnostic imaging*
Anterior Wall Myocardial Infarction / therapy*
Blood Flow Velocity / physiology
Diastole / physiology*
Echocardiography, Doppler, Color*
Electrocardiography
Female
Heart Rate / physiology*
Humans
Image Processing, Computer-Assisted*
Magnetic Resonance Imaging
Male
Microvessels* / diagnostic imaging
Microvessels* / physiopathology
Middle Aged
No-Reflow Phenomenon / diagnostic imaging*
No-Reflow Phenomenon / physiopathology
Prospective Studies
Sensitivity and Specificity
Statistics, Nonparametric
Systole / physiology
Ventricular Dysfunction, Left / diagnostic imaging
Ventricular Dysfunction, Left / physiopathology