Murat ÇAP, Emrah ERDOĞAN, Ali KARAGÖZ, Cem DOĞAN, Rezzan Deniz ACAR, Tuba UNKUN, Çetin GEÇMEN, Flora OZKALAYCI, Büşra GUVENDI ŞENGÖR, Zübeyde BAYRAM, Cihangir KAYMAZ, Nihal OZDEMIR

The Association of Left Ventricular End-Diastolic Pressure and Acute Left Ventricular End-Diastolic Pressure Change with Miyocardial Blush Grade and ST Segment Resolution in STEMI Patients Undergoing Primary Percutaneous Intervention

Elevated left ventricular end-diastolic pressure (LVEDP) is associated with adverse outcomes among those patients with ST-elevation myocardial infarction (STEMI).We aim to investigate the acute change of LVEDP in patients with STEMI and the relationship between LVEDP and early reperfusion parameters, such as ST-segment resolution (STR%) and myocardial blush grade (MBG). A total of 51 consecutive patients with STEMI who had undergone successful primary percutaneous coronary intervention (pPCI) with TIMI flow grade 3 were included in the study. LVEDP measurements were performed at the beginning (pre-pPCI LVEDP) and end of (post-pPCI LVEDP) the pPCI. MBG was defined after a successful pPCI; STR% was calculated 60 minutes after pPCI. The mean pre-pPCI LVEDP was 22.1 ± 4.8 mmHg and the post-pPCI LVEDP was 19.4 ± 4.8 mmHg. There was a mean 2.7±1.8 mmHg decrease in LVEDP values after pPCI which was statistically significant (95% CI -3.2, -2.2, p value< 0.001). Post-pPCI LVEDP median value was 19 mmHg. The patients were divided into two groups according to median value: there were 26 (51%) patients with post-pPCI LVEDP≤ 19 mmHg and 25 (49%) patients with post-pPCI LVEDP> 19 mmHg. STR% and MBG were significantly different between the two groups (p= 0.03 and p= 0.01). Post-pPCI LVEDP had a moderate negative correlation with MBG (r= -0.438) and STR% (r= -0.501). In this study, we demonstrated that primary PCI might substantially reduce the LVEDP level. Moreover, the LVEDP levels achieved after PCI might be associated with myocardial reperfusion, assessed by STR% on ECG and MBG during angiography.

PDF

___

Kristensen SD, Laut KG, Fajadet J, et al. European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J 2014; 35: 1957-1970.

Diamond G, Forrester JS. Effect of coronary artery disease and acute myocardial infarction on left ventricular compliance in man. Circulation 1972; 45: 11-19.

Bagai A, Armstrong PW, Stebbins A, et al. Prognostic implications of left ventricularend-diastolic pressure during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: Findings from the Assessment of Pexelizumab in Acute Myocardial Infarction study. Am Heart J 2013; 166: 913-919.

Bergstra A, Svilaas T, van Veldhuisen DJ, van den Heuvel AF, van der Horst IC, Zijlstra F. Haemodynamic patterns in ST-elevation myocardial infarction:incidence and correlates of elevated filling pressures. Neth Heart J 2007; 15: 95-99.

Van Herck PL, Carlier SG, Claeys MJ, et al. Coronary microvascular dysfunction after myocardial infarction:increased coronary zero flow pressure both in the infarcted and in the remote myocardium is mainly related to left ventricular filling pressure. Heart. 2007; 93: 1231-1237.

Planer D, Mehran R, Witzenbichler B, et al. Prognostic utility of left ventricular end-diastolic pressure in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2011; 108: 1068-1074.

Brienesse SC, Davies AJ, Khan A, Boyle AJ. Prognostic Value of LVEDP in Acute Myocardial Infarction: a Systematic Review and Meta-Analysis. J Cardiovasc TranslRes 2018; 11: 33-35.

Ndrepepa G, Cassese S, Emmer M, et al. Relation of Ratio of Left Ventricular Ejection Fraction to Left Ventricular End-Diastolic Pressure to Long-Term Prognosis After ST-Segment Elevation Acute Myocardial Infarction. Am J Cardiol 2019; 123: 199-205.

Henriques JP, Zijlstra F, van 't Hof AWet, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation 2003; 107: 2115-2119.

Johanson P, Jernberg T, Gunnarsson G, Lindahl B, Wallentin L, Dellborg M. Prognostic value of ST-segment resolution-when and what to measure. Eur Heart J 2003; 24: 337-345.

Satıroğlu O, Ciçek Y, Bostan M, Cetin M, Bozkurt E. Acute change in leftventricle end-diastolic pressure after primary percutaneous coronary interventionin patients with ST segment elevation myocardial infarction. Am Heart Hosp J 2010; 8: 86-90.

Kirtane AJ, Bui A, Murphy SA, et al. TIMI Study Group. Association of epicardial and tissue-level reperfusion with leftventricular end-diastolic pressures in ST-elevation myocardial infarction. JThromb Thrombolysis 2004; 17: 177-184.

Thygesen K, Alpert JS, Jaffe AS, et al. ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J 2012; 33: 2551-2567.

Kern MJ, Christopher T. Hemodynamic rounds series II: the LVEDP. CathetCardiovasc Diagn 1998; 44: 70-74.

TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial.Phase I findings. N Engl J Med 1985; 312: 932-936.

Ndrepepa G, Alger P, Kufner S, Mehilli J, Schömig A, Kastrati A. ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Cardiol J 2012; 19: 61-69.

Michael G, McLaughlin MG, Stone GW Gardner G, et al. Controlled Abciximab and Device Investigation to Lower LateAngioplasty Complications trial. Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acutemyocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. J Am Coll Cardiol 2004; 44: 1215-1223.

Teixeira R, Lourenço C, Baptista R Jorge E, et al. Prognostic implications of left ventricular end-diastolic pressure in acute coronary syndromes with left ventricular ejection fraction of 40% or over. Rev Port Cardiol 2011; 30: 771-779.

Ndrepepa G, Cassese S, Hashorva D, et al. Relationship of left ventricular end-diastolic pressure with extent of myocardial ischemia, myocardial salvage and long-term outcome in patients with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2019; 93: 901-909.