Doppler echocardiographic myocardial stunning index predicts recovery of left ventricular systolic function after primary percutaneous coronary intervention

Sharif, Dawod; Matanis, Wisam; Sharif-Rasslan, Amal; Rosenschein, Uri

doi:10.1111/echo.13305

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…Stunning in the clinic Pure stunning, i.e., fully reversible contractile dysfunction following an episode of myocardial ischemia, occurs clinically following percutaneous coronary intervention (PCI) [ 102 , 161 , 211 ] or a protocol of exercise-induced ischemia [ 4 , 61 , 135 ] but rarely poses a clinical problem, notably does not cause heart failure per se. [ 87 ] However, stunning may contribute to other myocardial ischemia-related heart failure scenarios, e.g., recovery from myocardial infarction (see above [ 24 , 210 , 240 ]) or from cardioplegic ischemic cardiac arrest. Unfortunately, sequential measurements of coronary blood flow and its relation to contractile function during the recovery from myocardial infarction or cardioplegia are not available.…”

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

Coronary blood flow in heart failure: cause, consequence and bystander

Heusch

2022

Basic Res Cardiol

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Heart failure is a clinical syndrome where cardiac output is not sufficient to sustain adequate perfusion and normal bodily functions, initially during exercise and in more severe forms also at rest. The two most frequent forms are heart failure of ischemic origin and of non-ischemic origin. In heart failure of ischemic origin, reduced coronary blood flow is causal to cardiac contractile dysfunction, and this is true for stunned and hibernating myocardium, coronary microembolization, myocardial infarction and post-infarct remodeling, possibly also for the takotsubo syndrome. The most frequent form of non-ischemic heart failure is dilated cardiomyopathy, caused by genetic mutations, myocarditis, toxic agents or sustained tachyarrhythmias, where alterations in coronary blood flow result from and contribute to cardiac contractile dysfunction. Hypertrophic cardiomyopathy is caused by genetic mutations but can also result from increased pressure and volume overload (hypertension, valve disease). Heart failure with preserved ejection fraction is characterized by pronounced coronary microvascular dysfunction, the causal contribution of which is however not clear. The present review characterizes the alterations of coronary blood flow which are causes or consequences of heart failure in its different manifestations. Apart from any potentially accompanying coronary atherosclerosis, all heart failure entities share common features of impaired coronary blood flow, but to a different extent: enhanced extravascular compression, impaired nitric oxide-mediated, endothelium-dependent vasodilation and enhanced vasoconstriction to mediators of neurohumoral activation. Impaired coronary blood flow contributes to the progression of heart failure and is thus a valid target for established and novel treatment regimens.

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Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

Coronary blood flow in heart failure: cause, consequence and bystander

Heusch

2022

Basic Res Cardiol

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“…Sharif et al . [ 9 ] concluded that LV WMS index improves with early restoration of blood flow through coronary arteries. We also studied WMSI, which showed similar consistent improvement of −0.09 ± 0.08 and −0.13 ± 0.09 at 3 and 6 months respectively.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Functional Remodeling after Primary Percutaneous Coronary Intervention

Batra

Malik²,

Khan

et al. 2022

Journal of Cardiovascular Echography

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Background: Improvement in left ventricular (LV) function after revascularization is an important determinant of long-term prognosis in a patient with acute myocardial infarction (AMI). However, data on the changes of LV function after revascularization are scarce in our population. Hence, this study was conducted to evaluate the changes in LV function and dimensions by echocardiography at 3 and 6 months after primary percutaneous coronary intervention (PCI). Materials and Methods: A total of 188 patients were recruited in this study who had undergone primary PCI. Patients with preexistent LV dysfunction, prior PCI, or with congenital heart disease were excluded. Echocardiography was performed at baseline (within 24 h of intervention), 3 months, and 6 months of intervention. Remodeling in terms of change in LV ejection fraction (LVEF), LV end-diastolic dimension (LVEDD), LV end-systolic dimension, and wall motion score index (WMSI) was evaluated. Results: Out of the 188 patients, 90.4% were male, and mean age was 53.94 ± 9.12 years. Baseline mean LVEF was 39.79 ± 6.2% with mean improvement of 5.11 ± 3.87 (P < 0.001) at 3 months and 6.38 ± 4.29 (P < 0.001) at 6 months. Baseline LVEDD was 46.23 ± 3.86 mm which improved to 44.68 ± 2.81 mm at 6 months. Basal WMSI decreased by -0.09 ± 0.08 and -0.13 ± 0.09 at 3 and 6 months, respectively, after revascularization. Conclusions: Primary PCI is the recommended mode of reperfusion in patients with AMI. It reduces infarct size, maintains microvascular integrity and preserves LV systolic function hence improving LV function.

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“…The degree of LV dysfunction during the acute phase of AMI is not only the result of the irreversibly myocardial loss but may be greater due to the contribution of myocardial “stunning,” regions of depressed cardiac function following the reperfusion of an occluded artery that gradually recover over the course of a days following a successful reperfusion [ 15 ]. The underlying mechanisms involve oxygen radical damage following reperfusion and altered calcium flux with calcium overload that then desensitizes the myofilaments [ 16 ].…”

Section: Determinants Of Left Ventricular Dysfunction In Ischemic Car...mentioning

confidence: 99%

Ischemic Cardiomyopathy and Heart Failure After Acute Myocardial Infarction

et al. 2022

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Purpose of Review Ischemic cardiomyopathy refers to systolic left ventricular dysfunction in the setting of obstructive coronary artery disease and represents the most common cause of heart failure worldwide. It is often the combination of an irreversible loss of viable mass following an acute myocardial infarction (AMI) with a dysfunctional, but still viable, myocardium in the context of a chronically reduced myocardial blood flow and reduced coronary reserve. Medical treatments aiming at modulating neurohumoral response and restoring blood flow to the ischemic cardiomyocytes were shown to dramatically abate the occurrence of ventricular dysfunction and adverse remodeling in ischemic cardiomyopathy. Recent Findings Novel therapeutic approaches, such as mechanical unloading and modulation of the inflammatory response, appear to be promising. Furthermore, the understanding of the mechanisms by which, despite optimal treatment, heart failure ensues after AMI, with or without adverse remodeling and systolic dysfunction, is a critical step in the search for novel ways to tackle heart failure risk beyond preservation of left ventricular volumes and systolic function. Summary In this review article, we explore the principal pathophysiological mechanisms and pathways of heart failure in ischemic cardiomyopathy, therapeutic opportunities, and knowledge gaps in this area.

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Doppler echocardiographic myocardial stunning index predicts recovery of left ventricular systolic function after primary percutaneous coronary intervention

Abstract: LV stunning indices measured as early LAD flow to LVEF, LVWMSI, and LADWMSI ratios well predicted late LVEF and the change in LVEF. Thus, greater early coronary artery flow to LV systolic function parameter ratios predict a better improvement in late LV systolic function after PPCI.

Cited by 11 publications

References 30 publications

Coronary blood flow in heart failure: cause, consequence and bystander

Coronary blood flow in heart failure: cause, consequence and bystander

Left Ventricular Functional Remodeling after Primary Percutaneous Coronary Intervention

Ischemic Cardiomyopathy and Heart Failure After Acute Myocardial Infarction

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