Pulsatile flow
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Vanessa Cherniauskas, M.D. [3]
Synonyms and keywords: Pulsatile blood flow pattern; pulsatile pattern; systolic flow reversal
Overview
A pulsatile flow pattern with retrograde or reversed flow during systole is associated with impaired myocardial perfusion and worse cardiovascular outcome which can be used for risk stratification on coronary angiography.
Definition
Pulsatile flow is defined as flow reversal with intermttent cessation of antegrade contrast-dye motion or frank reversal of contrast-dye motion during systole.[1] It is coded as yes (present) or no (absent).
Clinical Significance
- Pulsatile flow pattern can be considered as a marker of heightened microvascular resistance. It may also be observed in other conditions such as ventricular hypertrophy. Patients with TIMI flow grade 2 were shown to have a greater incidence of pulsatile flow compared to those with TIMI flow grade 3.[2]
- The presence of pulsatile pattern in the infarct related artery is reported to be associated with an increased incidence of pulsatile flow in nonculprit arteries and also with a slower nonculprit flow.[3]
- In a pooled retrospective cohort study on patients with acute myocardial infarction, pulsatile flow pattern was associated with higher corrected TIMI frame counts (TFC), lower TIMI myocardial perfusion grades (TMPG), less complete ST-segment resolution, and elevated risk of reinfarction and death at 30 days.[1]
References
- ↑ 1.0 1.1 Gibson, CM.; Karha, J.; Murphy, SA.; de Lemos, JA.; Morrow, DA.; Giugliano, RP.; Roe, MT.; Harrington, RA.; Cannon, CP. (2004). "Association of a pulsatile blood flow pattern on coronary arteriography and short-term clinical outcomes in acute myocardial infarction". J Am Coll Cardiol. 43 (7): 1170–6. doi:10.1016/j.jacc.2003.11.035. PMID 15063425. Unknown parameter
|month=ignored (help) - ↑ Gibson, CM.; Murphy, S.; Menown, IB.; Sequeira, RF.; Greene, R.; Van de Werf, F.; Schweiger, MJ.; Ghali, M.; Frey, MJ. (1999). "Determinants of coronary blood flow after thrombolytic administration. TIMI Study Group. Thrombolysis in Myocardial Infarction". J Am Coll Cardiol. 34 (5): 1403–12. PMID 10551685. Unknown parameter
|month=ignored (help) - ↑ Gibson, CM.; Ryan, KA.; Murphy, SA.; Mesley, R.; Marble, SJ.; Giugliano, RP.; Cannon, CP.; Antman, EM.; Braunwald, E. (1999). "Impaired coronary blood flow in nonculprit arteries in the setting of acute myocardial infarction. The TIMI Study Group. Thrombolysis in myocardial infarction". J Am Coll Cardiol. 34 (4): 974–82. PMID 10520778. Unknown parameter
|month=ignored (help)