Objective: To study whether flow
velocity profile in the left anterior descending coronary artery (LAD)
measured by transthoracic Doppler echocardiography (TTDE) predicts
myocardial viability after reperfused anterior acute myocardial
infarction (AMI).

Patients and methods: 15 patients
who had their first anterior ST elevation AMI and were successfully
reperfused by coronary angioplasty and five controls without coronary
artery disease were selected. Blood flow velocity spectrum was measured
from the mid-LAD by TTDE 3 days after coronary angioplasty. Myocardial
viability in the LAD region was quantified 3 months after AMI by
relative uptake of 18F-fluorodeoxyglucose (FDG) imaged with positron
emission tomography. Myocardium was graded as viable, partially viable
or non-viable (relative FDG uptake >85%, 67–85% and <67%,
respectively). Main outcome measures were diastolic deceleration time
(DDT) of LAD flow velocity 3 days after AMI and myocardial viability 3
months after AMI.

Results: DDT of LAD flow velocity
correlated with myocardial FDG uptake in the LAD region (r = 0.91,
p<0.01). DDT was markedly longer in patients with viable myocardium
(876±76 ms, n = 3) than partially viable (356±89 ms, n = 6, p<0.01),
or non-viable myocardium (128±13 ms, n = 6, p<0.01). In controls, DDT
was comparable (909±76 ms, n = 5) to patients with viable myocardium.
DDT <190 ms was always associated with non-viable myocardium.

Conclusions: DDT of LAD flow
velocity is strongly associated with myocardial viability after
reperfused anterior AMI. Non-invasive TTDE of the LAD may be used in the
acute phase to predict long-term viability of the jeopardised
myocardium.