Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction

Bax, Matthijs; Winter, Robbert J. de; Schotborgh, Carl E.; Koch, Karel T.; Meuwissen, Martijn; Voskuil, Michiel; Adams, Rob; Mulder, K.; Tijssen, Jan G.P.; Piek, Jan J.

doi:10.1016/j.jacc.2003.08.055

Cited by 94 publications

(79 citation statements)

References 22 publications

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“…Some reperfusion parameters can be obtained by myocardial contrast echocardiography, Doppler flow wire, myocardial scintigraphy, and magnetic resonance imaging; however, their application is difficult and time consuming. [1][2][3][4] On the other hand, the resolution of ST-segment elevation, 5,6 the angiographic myocardial blush grade (MBG), 6,7 and the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC) 8 are early and easily obtainable during the acute stage of AMI treated with primary coronary intervention (PCI) .…”

Section: Introductionmentioning

confidence: 99%

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Bellandi

Leoncini

Maioli

et al. 2004

Clinical Cardiology

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SummaryBackground: Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion.Hypothesis: We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).Methods: In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase ≥ 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion.Results: Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p = 0.0001), and ST-segment elevation index at 1 h (r = Ϫ0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade ≥ 2 and STsegment elevation index reduction had the same accuracy

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Section: Introductionmentioning

confidence: 99%

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Bellandi

Leoncini

Maioli

et al. 2004

Clinical Cardiology

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“…1,2 Until recently, however, it has been difficult to establish the anatomic correlate of these changes because of a lack of an accurate in vivo method for infarct visualization.…”

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confidence: 99%

Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone

Engblom

Hedström

Heiberg

et al. 2009

Circ: Cardiovascular Imaging

114

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Background-The time course and magnitude of infarct involution, functional recovery, and normalization of infarctrelated electrocardiographic (ECG) changes after acute myocardial infarction (MI) are not completely known in humans. We sought to explore these processes early after MI and during infarct-healing using cardiac MRI. Methods and Results-Twenty-two patients with reperfused first-time MI were examined by MRI and ECG at 1,7, 42, 182, and 365 days after infarction. Global left ventricular function and regional wall thickening were assessed by cine MRI, and injured myocardium was depicted by delayed contrast-enhanced MRI. Infarct size by ECG was estimated by QRS scoring. The reduction of hyperenhanced myocardium occurred predominantly during the first week after infarction (64% of the 1-year reduction). Furthermore, during the first week the amount of nonhyperenhanced myocardium increased significantly (PϽ0.001), although the left ventricular mass remained unchanged. Left ventricular ejection fraction increased gradually, whereas the greater the regional transmural extent of hyperenhancement at day 1, the later the recovery of regional wall thickening. Regional wall thickening decreased progressively with increasing initial transmural extent of hyperenhancement (P trend Ͻ0.0001). The time course and magnitude of decrease in QRS score corresponded with the reduction of hyperenhanced myocardium. Conclusions-The early reduction of hyperenhanced myocardium may reflect recovery of hyperenhanced, reversibly injured myocardium, which must be considered when predicting functional recovery from delayed contrast-enhanced MRI findings early after infarction. Also, the time course and magnitude for reduction of hyperenhanced myocardium were associated with normalization of infarct-related ECG changes. (Circ Cardiovasc Imaging. 2009;2:47-55.)

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“…42 The lack of STR Coronary microvascular obstruction raised the risk of total mortality after 30 days but failed to predict adverse left ventricular remodelling. 36 The combination of poor MBG (0-1) and lack of STR exhibited an additive effect on the risk of total mortality after 1 year, thus suggesting that angiographic and ECG indexes of CMVO may emblematize different pathogenetic mechanisms. 43 …”

Section: Prognosis Of Coronary Microvascular Obstructionmentioning

confidence: 99%

“…21,[36][37][38][39][40][41][42][43] In particular, TIMI flow ≤2 is associated with an increased risk of adverse remodelling at 6 months 36 and of 5-year mortality. 37 MBG 0-1 raised the risk of adverse remodelling at 6 months 38 and of total mortality after 16 months of follow-up.…”

Section: Prognosis Of Coronary Microvascular Obstructionmentioning

confidence: 99%

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

2016

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Restoring blood flow to ischemic but viable myocardium and reducing infarct size constitute the goals of reperfusion therapy with fibrinolytic drugs or primary percutaneous intervention in patients with ST-segment elevation myocardial infarction (STEMI). However, in a sizable proportion of patients, this intervention gains to reopen the obstructed epicardial coronary artery but does not achieve myocardial reperfusion because of coronary microvascular obstruction phenomenon (CMVO). In the last years, consistent evidence has pointed out how CMVO has a negative impact on outcome in patients with acute STEMI. Of note, most of the trials in this setting, mainly targeting reperfusion damage, have failed to show beneficial effects. In this article we provide a revision of mechanisms, diagnosis and prognosis of CMVO in acute STEMI, also pointing out the need of an integrated approach in order to prevent and treat CMVO in the different time windows of the acute event.

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Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction

Abstract: Doppler-derived CFR is a better prognostic marker for LV function recovery after anterior MI than other currently used parameters of myocardial reperfusion.

Cited by 94 publications

References 22 publications

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

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