The Index of Microcirculatory Resistance as a Predictor of Echocardiographic Left Ventricular Performance Recovery in Patients With ST‐Elevation Acute Myocardial Infarction Undergoing Successful Primary Angioplasty

Faustino, Mariana; Baptista, Sérgio Bravo; Freitas, António; Monteiro, Célia; Leal, Paulo Roberto Lacerda; Nédio, Maura; Antunes, Cláudia; Abreu, Pedro Farto e; Gil, Víctor; Morais, Carlos

doi:10.1111/joic.12278

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…Overwhelming evidences suggest that IMR can accurately predict the size of myocardial infarction and remodeling of the left ventricle and microvascular obstruction in patients with STEMI treated by PCI [ 22 – 27 ]. Furthermore, IMR following PCI has the potential to predict left ventricular recovery at 3 months post-STEMI in patients managed with primary angioplasty and pharmacoinvasive strategies [ 3 , 4 ]. It has also been found that the patients with a post-PCI mean IMR greater than 40 U have a higher rate of death or rehospitalization due to heart failure at 1 year in a multicenter study assessing 253 patients with STEMI [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Coronary Angiography-Derived Index of Microcirculatory Resistance Predicts Left Ventricular Performance Recovery in Patients with ST-Segment Elevation Myocardial Infarction

Chao-zhen

Guo

et al. 2022

Journal of Interventional Cardiology

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Objectives. The present study is designed to investigate the impact of coronary angiography-derived index of microcirculatory resistance (caIMR) on left ventricular performance recovery. Background. IMR has been established as a gold standard for coronary microvascular assessment and a predictor of left ventricular recovery after ST-segment elevation myocardial infarction (STEMI). CaIMR is a novel and accurate alternative of IMR. Methods. The present study retrospectively included 80 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). We offline performed the post-PCI caIMR analysis of the culprit vessel. Echocardiography was performed within the first 24 hours and at 3 months after the index procedure. Left ventricular recovery was defined as the change in left ventricular ejection fraction (LVEF) more than zero. Results. The mean age of the patients was 58.0 years with 80.0% male. The average post-PCI caIMR was 43.2. Overall left ventricular recovery was seen in 41 patients. Post-PCI caIMR (OR: 0.948, 95% CI: 0.916–0.981, p = 0.002), left anterior descending as the culprit vessel (OR: 3.605, 95% CI: 1.23–10.567, p = 0.019), and male (OR: 0.254, 95% CI: 0.066–0.979, p = 0.047) were independent predictors of left ventricular recovery at 3 months follow-up. A predictive model was established with the best cutoff value for the prediction of left ventricular recovery 2.33 (sensitivity 0.610, specificity 0.897, and area under the curve 0.765). In patients with a predictive model score less than 2.33, the LVEF increased significantly at 3 months. Conclusions. The post-PCI caIMR can accurately predict left ventricular functional recovery at 3 months follow-up in patients with STEMI treated by primary PCI, supporting its use in clinical practice.

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Section: Discussionmentioning

confidence: 99%

The Coronary Angiography-Derived Index of Microcirculatory Resistance Predicts Left Ventricular Performance Recovery in Patients with ST-Segment Elevation Myocardial Infarction

Chao-zhen

Guo

et al. 2022

Journal of Interventional Cardiology

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“…Bulluck revisou a literatura e relatou que um limiar pós-procedimento de 40 U era válido na identificação de OCM para aqueles que realizaram medições de IRM. 16 Além de estar diretamente relacionado ao estado de perfusão do tecido miocárdico, o IRM também mostrou ter uma forte associação com os níveis de pico de creatina quinase, prognóstico do paciente e recuperação do desempenho ventricular no contexto de IAMCST, [17][18][19][20] que lançou as bases para desenvolvimento do ATI. O escore ATI foi introduzido pela primeira vez por De Maria et al consistindo principalmente de três características, incluindo idade, escore de trombo e valor de IRM pré-stent., 5 O escore ATI também foi considerado uma ferramenta promissora para prever reperfusão miocárdica subótima em pacientes com IAMCST e está correlacionado com a área de infarto medida por ressonância magnética (RM) cardíaca em estudos subsequentes.…”

Section: Discussionunclassified

Comparação entre Dois Escores de Risco quanto à Predição de Obstrução Microvascular Coronariana durante a Intervenção Percutânea Primária

Xiao¹,

Chen²,

Liu³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Para pacientes com infarto do miocárdio com elevação do segmento ST (IAMCST) que sofrem de obstrução coronariana microvascular funcional e estrutural (OCM) subsequente, nenhuma abordagem terapêutica específica e definitiva de atenuação foi comprovada como válida em testes de larga escala atuais, o que destaca a necessidade de abordar seu reconhecimento precoce. Objetivos: Este estudo teve como objetivo comparar o desempenho de dois escores de risco clínico com uma medida objetiva de OCM durante intervenção coronária percutânea (ICP) em casos de IAMCST Métodos: A medição do índice de resistência microcirculatória (IRM) foi realizada e os parâmetros clínicos e angiográficos basais também foram registrados. Os pacientes foram divididos em entre os grupos OM (obstrução microvascular) e NOM (não-obstrução microvascular), de acordo com o valor de IRM pós-procedimento. O risco de OCM foi avaliado para todos os participantes pelos escores preditivos SAK e ATI, respectivamente. Cada sistema foi calculado somando-se as pontuações de todas as variáveis. As curvas de características do operador receptor (ROC) e a área sob a curva (AUC) de dois modelos de risco foram utilizadas para avaliar o desempenho discriminatório. Um ecocardiograma foi realizado sete dias após o procedimento para avaliar a fração de ejeção do ventrículo esquerdo (FEVE). Um valor P bicaudal de <0,05 foi considerado estatisticamente significativo. Resultados: Entre os 65 pacientes elegíveis com IAMCST, 48 foram alocados no grupo NOM e 17 no grupo OM, com uma incidência de OCM de 26,15%. Não houve diferença significativa na AUC entre os dois escores. A FEVE avaliada para o grupo NOM foi maior do que para o grupo OM. Conclusão: Os escores SAK e ATI tiveram bom desempenho para estimar o risco de OCM após ICP primário para pacientes com IAMCST. (Arq Bras Cardiol. 2021; 116(5):959-967) Palavras-chave: Infarto do Miocárdio; Intervenção Coronária Percutânea; Obstrução Coronariana; Previsões; Indicador de Risco.

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“…e index of microcirculatory resistance (IMR) can provide a quantitative assessment of the microvascular function of epicardial stenosis and hemodynamic condition independently. IMR is considered an independent, powerful predictor of microvascular damage in STEMI [11][12][13][14][15]. Recent studies demonstrated that IMR assessed immediately after primary PCI is well correlated with the recovery of left ventricular function in STEMI [1,7].…”

Section: Introductionmentioning

confidence: 99%

Mechanical and Pharmacological Revascularization Strategies for Prevention of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction: Analysis from Index of Microcirculatory Resistance Registry Data

Jang

Lee

et al. 2020

Journal of Interventional Cardiology

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Objectives. We aimed to identify mechanical and pharmacological revascularization strategies correlated with the index of microcirculatory resistance (IMR) in ST-elevation myocardial infarction (STEMI) patients. Background. Microvascular dysfunction (MVD) after STEMI is correlated with infarct size and poor long-term prognosis, and the IMR is a useful analytical method for the quantitative assessment of MVD. However, therapeutic strategies that can reliably reduce MVD remain uncertain. Methods. Patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled. The IMR was measured with a pressure sensor/thermistor-tipped guidewire immediately after primary PCI. High IMR was defined as values ≥66th percentile of IMR in enrolled patients (IMR > 30.9 IU). Results. A total of 160 STEMI patients were analyzed (high IMR = 54 patients). Clinical factors for Killip class P=0.006, delayed hospitalization from symptom onset P=0.004, peak troponin-I level P=0.042, and multivessel disease P=0.003 were associated with high IMR. Achieving final thrombolysis in myocardial infarction myocardial perfusion grade 3 tended to be associated with low IMR P=0.119, whereas the presence of distal embolization was significantly associated with high IMR P=0.034. In terms of therapeutic strategies that involved adjusting clinical and angiographic factors associated with IMR, preloading of third-generation P2Y12 inhibitors correlated with reducing IMR value (β = −10.30, P<0.001). Mechanical therapeutic strategies including stent diameter/length, preballoon dilatation, direct stenting, and thrombectomy were not associated with low IMR value (all P>0.05), and postballoon dilatation was associated with high IMR (β = 8.30, P=0.020). Conclusions. In our study, mechanical strategies were suboptimal in achieving myocardial salvage. Preloading of third-generation P2Y12 inhibitors revealed decreased IMR value, indicative of MVD prevention.

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The Index of Microcirculatory Resistance as a Predictor of Echocardiographic Left Ventricular Performance Recovery in Patients With ST‐Elevation Acute Myocardial Infarction Undergoing Successful Primary Angioplasty

Abstract: Lower IMR was associated with better myocardial GLS acutely after STEMI, and with a significantly higher recovery of the LVEF, WMSI, E/E' ratio and GLS, suggesting that IMR is an early marker of cardiac recovery, after acute myocardial infarction.

Cited by 12 publications

References 25 publications

The Coronary Angiography-Derived Index of Microcirculatory Resistance Predicts Left Ventricular Performance Recovery in Patients with ST-Segment Elevation Myocardial Infarction

The Coronary Angiography-Derived Index of Microcirculatory Resistance Predicts Left Ventricular Performance Recovery in Patients with ST-Segment Elevation Myocardial Infarction

Comparação entre Dois Escores de Risco quanto à Predição de Obstrução Microvascular Coronariana durante a Intervenção Percutânea Primária

Mechanical and Pharmacological Revascularization Strategies for Prevention of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction: Analysis from Index of Microcirculatory Resistance Registry Data

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