Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction

Abstract

The presence of ED assessed by PAT 24 h after P-PCI in patients with STEMI is associated with larger infarcts, lower LVEF, higher WMSI and higher prevalence of MVO.

Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study

“…RH-PAT was also correlated with disease severity when measured by APACHE-II, SAPS-II and SOFA scores, which is supported by the findings of other authors in sepsis and septic shock [10,25], dengue fever [32], malaria [33,34] and ST-elevation myocardial infarctions [14]. Vasopressors such as epinephrine and norepinephrine are widely used in critical care to treat life-threatening hypotension, especially in patients who do not respond to fluid resuscitation.…”

“…RH-PAT is considered an accurate marker of endothelial dysfunction and an independent predictor of cardiovascular disease (CVD) and mortality in patients with chronic inflammatory diseases [13]. Recently, evidence that RH-PAT may correlate with disease severity and mortality, in patients with sepsis and ST-elevation myocardial infarction, suggests that RH-PAT may also be used for accessing prognosis in the critically ill patient [10,14]. However, it is not known to what extent RH-PAT predicts organic dysfunction or mortality, if these changes in RH are also present in acute conditions in the critically ill patient other than sepsis and myocardial infarction, if the acute RH impairment is reversible, nor the prognostic implications of RH reversibility.…”

Coronary microvascular dysfunction beyond microvascular obstruction in ST‐elevation myocardial infarction: Functional and clinical correlates

“…This may explain why the risk associated with elevated admission cTnT is almost independent of longer time intervals from onset of symptoms to admission. 18 Our finding that MVD is predicted by female sex is not surprising, as most of cardiovascular diseases, relying on coronary microvascular impairment, occur mainly in women. 20,21 If a pre-existing condition of coronary microvascular impairment exists in women that develop large MVD during MI is a fascinating hypothesis that needs further verification.…”

“…While values of peak cTnT are already commonly used to indirectly measure infarct size and provide a non-invasive estimation of reperfusion quality, 16,17 in the last decade, admission cTnT has also gained clinical significance, 18,19 as it has been demonstrated that elevated admission cTnT reflects large perfusion defect independently of infarct size, assessed by gadolinium-enhanced cardiac magnetic resonance (CMR). 19 By expanding previous results, in our study MVD and MVO were differently predicted by admission cTnT and peak cTnT, respectively.…”

“…Individual predisposition plays a key role in post-ischemic microvascular impairment: Larger coronary microvascular damage and lower LVEF have been found in patients with than without peripheral endothelial dysfunction early after MI. 18 MVD can be predicted by elevated admission cTnT: Some patients would be more prone than others to have large ischemic damage of coronary microvasculature, which is at risk for reperfusion injury. Thus, MVD would represent portion of coronary microcirculation "salvaged" by reperfusion injury.…”