Clinical significance of early systolic reverse flow in left anterior descending coronary artery on transthoracic echocardiography in patients with acute myocardial infarction

Background Predicting the cardiac function in chronic phase of acute myocardial infarction (AMI) patients is important. Previous studies showed that the presence of early systolic reverse flow (ESRF) in coronary flow measured with a Doppler guide wire is a predictor of worsening chronic phase function in patients with anterior AMI. We routinely examined the coronary flow velocity (CFV) of the distal left anterior descending artery (LAD) using transthoracic echocardiography (TTE) in AMI patients. The aim of this study is to investigate whether the ESRF in TTE is associated with the chronic cardiac function, recovery of cardiac function, and the incidence of major adverse cardiac events (MACE) in patients with anterior AMI. Methods We enrolled 84 patients with their first anterior AMI. Using TTE, we recorded the CFV of distal LAD within 5 days after primary percutaneous coronary intervention. Patients were divided into two groups, ESRF + group (ESRF was detected in TTE: 21 cases) and ESRF- group (ESRF was not detected in TTE: 63 cases). We compared chronic cardiac function in TTE, changes in cardiac function in acute and chronic phase (Delta LVEF, Delta LVDd), and the incidence of MACE. Results The incidence of MACE in ESRF-group was lower than that in ESRF + group (3.3% vs 19.1% P = .02). LVEF in chronic phase in ESRF- group was higher than that in ESRF + group (54.1 +/- 5.6% vs 40.4 +/- 6.2% P < .001). Delta LVDd was smaller in ESRF-group than ESRF + group (-0.62 +/- 4.0 mm vs +5.06 +/- 3.4 mm P = .003). Conclusion Early systolic reverse flow in TTE is a predictor of chronic cardiac function and incidence of MACE in patients with anterior AMI.