**3.3 LAD velocity profiles**

Early systolic flow reversal did not occur with eptifibatide while it was noticed in 6 (17%) in those without, p<0.05 (table 2).


Table 2. LAD Systolic Flow Reversal

discharge was normal. In figure 7, an example of a patient with unfavorable LAD blood velocity profile after primary angioplasty and bare metal stent implantation in a patient with acute anterior STEMI. Short diastolic deceleration time (less than 600msec) and early systolic flow reversal are demonstrated. In this patient left ventricular ejection fraction was

Fig. 6. Favourable LAD blood velocity profile with prolonged diastolic deceleration time

Fig. 7. Unfavourable LAD blood velocity profile with reduced diastolic deceleration time

Early systolic flow reversal did not occur with eptifibatide while it was noticed in 6 (17%) in

ESFR 48 Hr. ESFR 5 Days

reduced at admission and did not improve later.

and forward systolic flow.

and early systolic flow reversal.

those without, p<0.05 (table 2).

Table 2. LAD Systolic Flow Reversal

ESFR

Early

EPT-Yes 0 0 0 EPT-No 6 4 2

**3.3 LAD velocity profiles** 

Diastolic deceleration time of LAD flow averaged 629±238 msec in patients treated with eptifibatide and 593±344 msec in those without, p=0.7 (figure 8). Short (<600msec) diastolic deceleration time occurred in 6 (40%) of those treated with eptifibatide, compared to 12 (39%) in those not treated, p=ns (figure 8).

Fig. 8. Histogram of diastolic deceleration time and pressure half time of LAD blood velocity profiles in patients with and those without eptifibatide treatment.

Patients treated with eptifibatide had higher diastolic velocities, 39±11 cm/sec, vs 31±9 cm/sec, p=0.043 and tended to have higher diastolic LAD flows, 49±26 ml/min, vs 35±17 ml/min, p=0.09 (figure 9).

Fig. 9. Histogram of diastolic and systolic velocities of LAD blood velocity profiles in patients with and those without eptifibatide treatment.

Effects of Eptifibatide on the Microcirculation After Primary Angioplasty in

in both treatment groups, early after PCI and pre-discharge.

**4.4 Validity of LAD blood velocities and flow calculations** 

**4.2 Applicability of sampling of LAD blood velocities** 

units.

et al, 1993).

not needed.

Acute ST-Elevation Myocardial Infarction: A Trans-Thoracic Coronary Artery Doppler Study 69

evidenced by absence of early systolic flow reversal in subjects treated with epitifibatide; however, less severe dysfunction of the microcirculation was not different between the groups since diastolic deceleration times by Doppler, and myocardial blush grades were similar. Moreover, diastolic maximal blood velocities early after PCI were higher in patients treated with eptifibatide but similar later on. Eptfibatide treatment was associated with a tendency of larger diastolic blood flow through the LAD but not later. All these changes with eptifibatide treatment did not affect left ventricular systolic function which was similar

Transthoracic Doppler sampling of coronary blood velocities is not mentioned or not stressed sufficiently in most textbooks of echocardiography. Thus, the importance of this study is related not only to the treatment of patients with acute STEMI. We found that sampling of LAD blood velocities was possible in all the patients and at all occasions. We believe that sampling of LAD blood velocities should be applied widely and repeated when needed and in all echocardiographic studies. In fact, electrocardiographic recording is performed when patients have chest pain, and in a similar fashion, echocardiography and sampling of coronary blood velocity may be performed in such patients in coronary care

**4.3 Transthoracic Doppler sampling of LAD blood velocities and other methods** 

Measurement of coronary flow velocities using Doppler wire and pressure recordings to assess severity of coronary artery and microcirculation are invasive procedures in addition to other disadvantage (Iliceto et al 1991; Erbel et al, 1991; Kozakova et al, 1994; Donohue et al, 1993; Miller et al, 1994; Di Carli et al, 1995). Normal peak diastolic velocities in the present study were similar to those reported previously by invasive Doppler flowires (Ofili

Trans-esophageal echocardiography visualizes only the proximal coronary arteries and Doppler sampling is feasible in less than 70% of patients (Joye et al, 1994; Kern et al 1995; Abizaid et al, 1998). Recent technologic advances in trans-thoracic echocardiography made Doppler sampling of coronary artery velocities possible (Voci et al, 1998; Caiati et al, 1999; Hildick-Smith et al, 2000; Higashiue et al, 2001; Pizzuto et al, 2001; Takeuchi et al, 2001). Contrast agents may enhance the detection rate of coronary velocities (Abizaid et al, 1998; Caiati et al, 1999), however, with increasing experience of the operator contrast agents are

The range of the value of LAD blood velocities and time velocity integrals (Sharif et al, 2010) is similar to those found through cardiac valves with similar reproducibility and applicability. The diameter of the LAD and of the colour jet of blood flow through the vessel is in the range of diameter of vena contracta of regurgitant jets through cardiac valves. Moreover, LAD-colour jet diameter is similar to that of proximal iso-velocity surfaces of regurgitant jets through the mitral valve, so it can be applied in a similar fashion and
