Relationship between Left Ventricular Diastolic Function and Time to Reperfusion by Primary Percutaneous Coronary Intervention in ST Segment Elevation Myocardial Infarction Patients
Fatma Ezzat Azzab *
Ministry of Health, Faculty of Medicine, Tanta University, Egypt.
Dina Abdelsalam Mostafa
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Egypt.
Hanan Kamel Kassem
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Egypt.
Hatem Mohamed El Sokkary
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: The therapy and prognosis of acute myocardial infarction (MI) have been modified by primary percutaneous coronary intervention (PPCI). Delayed time to reperfusion in STEMI patients is risk predictor fo left ventricular diastolic dysfunction and linked to increase risk of heart failure. AMI-associated adverse remodeling, a higher possibility of heart failure, and reduced survival are all linked to echocardiographic indicators of diastolic dysfunction.
Aims: The aim of this study was to determine the relationship between left ventricular diastolic functioning and time-to-reperfusion by PPCI for individuals with STEMI.
Patients and Methods: The current study included 50 patients admitted with STEMI & underwent primary PCI in Cardiology Department in Tanta University Hospitals.
They were divided into two groups: Group 1 early reperfusion (<6h) and group 2 delayed reperfusion (>6h).
They presented by chest pain within 24 hours and conducted echocardiography within 72-hours of PPCI.
Results: The median time-to-reperfusion, which is the time from the onset of symptoms to reperfusion at the end of PPCI, was 240 minutes (interquartile range: 120-720 minutes). LV ejection fraction and E/septal e' did not vary significantly between both groups. The current research found that those with delayed time to reprfusion were troponin (+), CKMB (+), CRP (+), high LVDd, high E/e` average, high LA volume, high LA volume index and had high grade diastolic dysfunction compared to patients with early time to reperfusion. This study showed that group ІІ was significantly higher than group І regarding to time to reperfusion & diastolic dysfunction.
Conclusion: In PPCI-treated individuals who have STEMI, earlier increased LV diastolic pressure is linked to a longer time-to-reperfusion. We also found that creatine kinase, troponin and CRP were significantly higher in the late reperfusion group compared to early reperfusion group. Time to reperfusion and CRP were significantly associated with LVDD grade. CK, LVDs, LVDd, e´ Lateral, E/e´ Lateral, E/e´ average, LA volume index and Diastolic dysfunction grade were identified as independent predictors for LVDD.
Keywords: Primary percutaneous coronary intervention, left ventricular diastolic, ST segment, myocardial infarction
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References
Hartley A, Marshall DC, Salciccioli JD, et al. Trends in mortality from ischemic heart disease and cerebrovascular disease in Europe: 1980 to 2009. Circulation 2016; 133(20):1916–1926.
Townsend N, Wilson L, Bhatnagar P, et al. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;37(42):3232–3245.
Sugiyama T, Hasegawa K, Kobayashi Y, et al. Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001-2011. J Am Heart Assoc. 2015;4(3):e001445.
McManus DD, Gore J, Yarzebski J, et al. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med. 2011;124(1):40–47.
Jernberg T. Swedeheart Annual Report 2015. In: Karolinska University Hospital, Huddinge, 14186 Stockholm; 2016.
Widimsky P, Wijns W, Fajadet J, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010;31(8):943–957.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2015 update: areport from the American Heart Association. Circulation. 2015;131(4):e29–322.
Khera S, Kolte D, Gupta T, et al. Temporal trends and sex differences in revascularization and outcomes of st-segment elevation myocardial infarction in younger adults in the United States. J Am Coll Cardiol. 2015; 66(18):1961–1972.
Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month post discharge death in an international registry. JAMA. 2004;291: 2727–33.
Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37(3):267–315.
Thiemann DR, Coresh J, Oetgen WJ, et al. The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med 1999; 340(21):1640–1648.
West RM, Cattle BA, Bouyssie M, et al. Impact of hospital proportion and volume on primary percutaneous coronary intervention performance in England and Wales. Eur Heart J 2011; 32(6):706–711.
Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation. 1990;81: 1161–72.
Moller JE, Sondergaard E, Poulsen SH, et al. Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: A serial color M-mode Doppler echocardiographic study. J Am Coll Cardiol. 2000;36:1841–1846.
Nagueh SF, Middleton KJ, Kopelen HA, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol, 1997;30: 1527–1533.
Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventriculardiastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107-33.
Iwahashi N, Kimura K, Kosuge M, et al. E/e’ two weeks after onset is a powerful predictor of cardiac death and heart failure in patients with a first-time ST elevation acute myocardial infarction J Am Soc Echocardiogr. 2012;25:1290–1298.
O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;61:e78–e140.
White HD. Thrombolytic therapy in the elderly. Lancet. 2000;356(9247):2028–30.
Chou R. For the high value care task force of the american college of physicians. Cardiac screening with electrocardio-graphy, stress echocardio-graphy, or myocardial perfusion imaging: advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162 (6):438-47.
Chen X, Liu F, Xu H, et al. Left ventricular diastolic dysfunction in patients with ST-elevation myocardial infarction following early and late reperfusion by coronary intervention. International Journal of Cardiology. 2017;228:886-889.
Shacham Y, Steinvil A, Leshem-Rubinow E, et al. Association between time to reperfusion and echocardiography assessed left ventricular filling pressure in patients with first ST-segment elevation myocardial infarction undergoing primary coronary intervention. Cardiology Journal. 2014;21(4):357-63.
Prasad SB, See V, Brown P, et al. Impact of duration of ischemia on left ventricular diastolic properties following reperfusion for acute myocardial infarction. The American Journal of Cardiology. 2011; 108(3):348-54.
Kane GC, Karon BL, Mahoney DW, et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA. 2011;306(8):856-63.
Banai A, Levit D, Morgan S, et al. Association between C-Reactive Protein level and Left Ventricular Function in Patients with ST-Elevated Myocardial Infarction. J Clin Med. 2022;11(2): 401.
Shariati A, Afsargharehbagh R, Isfandyari P. Relationship between serum CRP level and left ventricular function in patients with acute ST-elevation myocardial infarction: A cross-sectional study. Journal of Acute Disease. 2020;9(2):61.