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Abstract
Background and Objectives
Some reports have suggested that coronary microvascular dysfunction plays a role in the recovery of myocardial function in patients with obstructive coronary artery disease. Thrombolysis in myocardial infarction (TIMI) frame count (TFC) is regarded as a simple, reliable method for evaluating microvascular function. We evaluated microvascular function using TFC immediately after coronary intervention and compared TFC with left ventricular systolic function eight months later.
Subjects and Methods
We studied 68 patients with obstructive coronary artery disease who underwent coronary intervention. Just after intervention, TFC was calculated with the standard method. Left ventricular systolic function was assessed with left ventricular diastolic dimension (LVEDd), ejection fraction (EF), and wall motion score index (WMSI). Eight months after intervention, we completed follow-up coronary angiography and echocardiography. We defined high TFC (HTFC) as a TFC greater than 18.
Results
Ten patients were in the HTFC group, and 58 patients were in the low TFC (LTFC) group. There was no difference between the two groups with regard to baseline cardiovascular characteristics and angiographic findings. Just after intervention, the HTFC group showed significantly higher LVEDd (56.6±8.9 mm) and WMSI (1.60±0.65) compared to the LTFC group (50.3±5.9 mm, p<0.05; 1.34±0.29, p<0.05, respectively), but there was no significant difference in EF between the groups (49.3±18.6% vs. 56.2±14.8%, p>0.05). Eight months after intervention, there was also a significant decrease in the WMSI in the LTFC group (1.23±0.25, p<0.05), but not in the HTFC group (1.57±0.62, p>0.05).
Conclusion
Increased TFC immediately after coronary intervention is an important poor prognostic factor related to myocardial systolic function eight months after coronary intervention. Coronary microvascular dysfunction may influence myocardial recovery in the setting of obstructive coronary artery disease.
Figures and Tables
Fig. 1
Comparison of left ventricular end diastolic dimension immediately after percutaneous coronary intervention and 8 month later. Left ventricular end diastolic dimension in high TIMI frame count group was significantly increased compared to that in low TIMI frame count group. However, there were no significant interval changes after 8 month later in both groups. LVEDd: left ventricular end diastolic dimension, LTFC: low TIMI frame count, HTFC: high TIMI frame count, PCI: percutaneous coronary intervention, NS: not significant, TIMI: thrombolysis in myocardial infarction.
Fig. 2
Interval changes of wall motion score index in both groups. The wall motion score index in low TIMI frame count group significantly decreased after 8 month of percutaneous coronary intervention. However, there was no significant change in high TIMI frame count groups. WMSI: wall motion score index, LTFC: low TIMI frame count, HTFC: high TIMI frame count, PCI: percutaneous coronary intervention, NS: not significant, TIMI: thrombolysis in myocardial infarction.
Fig. 3
Interval changes of TIMI frame count in both groups. Eight month later, the TIMI frame count in low TIMI frame count group significantly increased, however this findings was not observed in high TIMI frame count group. TFC: TIMI frame count, LTFC: low TIMI frame count, HTFC: high TIMI frame count, PCI: percutaneous coronary intervention, NS: not significant, TIMI: thrombolysis in myocardial infarction.
Table 1
Baseline characteristics of patients
*NS: not significant (p>0.05). LTFC: low TIMI frame count, HTFC: high TIMI frame count, DM: diabetes mellitus, TFC: TIMI frame count, LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, NSTEMI: non ST segment elevation myocardial infarction, STEMI: ST segment elevation myocardial infarction, TIMI: thrombolysis in myocardial infarction
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