Coronary Microvascular Resistance Index Immediately After Primary Percutaneous Coronary Intervention as a Predictor of the Transmural Extent of Infarction in Patients With ST-Segment Elevation Anterior Acute Myocardial Infarction
Hironori Kitabata, MD,
Toshio Imanishi, MD, PhD,
Takashi Kubo, MD, PhD,
Shigeho Takarada, MD, PhD,
Manabu Kashiwagi, MD,
Hiroki Matsumoto, MD,
Hiroto Tsujioka, MD,
Hideyuki Ikejima, MD,
Yu Arita, MD,
Keishi Okochi, MD,
Akio Kuroi, MD,
Satoshi Ueno, MD,
Hideaki Kataiwa, MD,
Takashi Tanimoto, MD,
Takashi Yamano, MD,
Kumiko Hirata, MD, PhD,
Nobuo Nakamura, MD,
Atsushi Tanaka, MD, PhD,
Masato Mizukoshi, MD, PhD,
Takashi Akasaka, MD, PhD*
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Figure 2 Representative Images of Each TEI-Grade in a Short-Axis View
Transmural extent of infarction (TEI) by contrast-enhanced cardiac magnetic resonance (ce-CMR) was graded from 1 to 4 based on the transmural extent of hyperenhanced tissue: 1 = 0% to 25% of left ventricular wall thickness; 2 = 26% to 50%; 3 = 51% to 75%; and 4 = 76% to 100%.
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Figure 3 Correlations Between Each Index and Enzymatic Infarct Size
Peak creatine kinase-myocardial band (CK-MB) values were significantly correlated with microvascular resistance index (MVRI) (r = 0.77, p < 0.0001), coronary flow reserve (CFR) (r = –0.69, p < 0.0001), diastolic deceleration time (DDT) (r = –0.75, p = 0.0001), and zero flow pressure (Pzf) (r = 0.75, p < 0.0001).
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Figure 4 Correlations Between Each Index and Infarct Size by ce-CMR
Infarct size by contrast-enhanced cardiac magnetic resonance (ce-CMR) was significantly correlated with MVRI (r = 0.78, p < 0.0001), CFR (r = –0.67, p < 0.0001), DDT (r = –0.70, p < 0.0001), and Pzf (r = 0.72, p = 0.0002). LV = left ventricle; other abbreviations as in Figure 3.
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Figure 5 Correlations Between MVRI and the Other 3 Indices
MVRI was significantly correlated with CFR (r = –0.62, p = 0.0004) and DDT (r = –0.68, p < 0.0001). Also, there was a significant positive correlation between MVRI and Pzf (r = 0.75, p < 0.0001). Abbreviations as in Figure 3.
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Figure 6 ROC-Analysis for the 4 Measured Hemodynamic Parameters
The areas under the curve (AUC) for predicting transmural extent of infarction grade 4 of MVRI, CFR, DDT, and Pzf were 0.885, 0.848, 0.862, and 0.853, respectively. In direct comparison of the AUCs, there were no significant differences between MVRI and the other 3 hemodynamic variables (MVRI vs. CFR, p = 0.68; MVRI vs. DDT, p = 0.80; MVRI vs. Pzf, p = 0.47). The best cut-off value for MVRI was determined as 3.25 mm Hg·cm–1·s (sensitivity 75%, specificity 89%). Abbreviations as in Figure 3.
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Figure 7 Relationship Between MVRI and TEI-grade
In Spearman's rank correlation analysis, there was a significant positive correlation between MVRI and the transmural extent of infarction grade (p < 0.0001). CMR = cardiac magnetic resonance; other abbreviation as in Figure 3.
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