Acute effect of primary PCI on diastolic dysfunction recovery in anterior wall STEMI – A non-invasive evaluation by echocardiography

Abstract

BackgroundIt is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required.Methods61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24 h of PPCI and then on day 15, 3 months and 6 months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6 months along with effect of duration of chest pain on diastolic function.Results54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6 months (p value < 0.001). Diastolic function indices like deceleration time, isovolumic relaxation time, E wave, A wave, E/A ratio, left atrial volume and index improved statistically from baseline to 6 months except mitral E/e′ ratio. As time required to achieve reperfusion increases (chest pain duration and D to B time) the incidence of residual diastolic dysfunction also increases (p value < 0.001). Patients with TIMI flow < III had more diastolic dysfunction (p value < 0.001).ConclusionsPrimary PCI improves diastolic dysfunction in patients with anterior wall STEMI over a period of 6 months. Time to achieve reperfusion and effectiveness of reperfusion have significant effect on diastolic dysfunction.

The long-term prognostic value of E/e’ in patients with ST segment elevation myocardial infarction

“…Compared to prior studies in which the follow-up period ranged from six months to two years, we only included patients with at least a three-year follow-up, which was the longest duration among previous studies. 1 , 6 , 25 , 28 Therefore, the results of our study may provide a powerful consensus that the role of the initial E/e’ ratio as a predictor for MACE or cardiac death does not end in the short term but is maintained for a long time.…”

“…Certain factors have previously been reported as predictors of adverse clinical outcomes after STEMI, which have been related to decreased LVEF, deterioration of LVEF, and left anterior descending artery (LAD) as the culprit vessel. 28 , 29 Hospitalization due to adverse cardiac events may be associated with such issues. However, although higher percentages of decreased LVEF and LAD involvement were observed in the abnormal E/e’ ratio group, this result did not influence the overall MACEs.…”

“…showed no significant improvement in the E/e’ ratio after PCI in patients with STEMI, which supported that PCI is not the only factor affecting the E/e’ ratio. 28 …”

Evolution of Diastolic Dysfunction in Patients with Coronary Slow Flow Phenomenon and Acute Non-ST Segment Elevation Myocardial Infarction

“…In their work, Subramaniyan et al, 30) showed that DD in STEMI patients was more likely to improve after primary PCI with shorter total ischemic times. This means more salvaged myocardium by early reperfusion and hence less myocardial necrosis.…”

Left atrial diastasis strain slope is a marker of hemodynamic recovery in post-ST elevation myocardial infarction: the Laser Atherectomy for STemi, Pci Analysis with Scintigraphy Study (LAST-PASS)

“…LA function and deformation assessment in post-ST elevation myocardial infarction (STEMI) may provide insights into impaired LV mechanics and its hemodynamic recovery. LV diastolic dysfunction is a common feature in post-STEMI ( 10 ), and its impaired recovery ( 11 , 12 ) is an independent predictor of poor prognosis in post-STEMI. LA reservoir strain, a marker of LV diastolic dysfunction ( 5 , 13 ), has been proposed as a prognostic factor in post-STEMI; however, controversy regarding its dependency over and above LV dysfunction remains ( 14 , 15 ).…”