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In ST ‐segment elevation myocardial infarction, the echocardiographic parameters of microvascular obstruction are not associated with left ventricular remodeling at five years of follow‐up
Author(s) -
Dregoesc Mihaela Ioana,
Iancu Adrian Corneliu,
Ober Camelia Diana,
Homorodean Cãlin,
Bãlãnescu Şerban,
Bolboacã Sorana
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14371
Subject(s) - cardiology , medicine , myocardial infarction , ventricular remodeling , revascularization , adverse effect , coronary flow reserve , coronary artery disease
Objective The correlation between the echocardiographic Doppler flow parameters of microvascular obstruction ( MVO ) and coronary wedge pressure ( CWP ) measured as a marker of severe compressive microvascular dysfunction and a predictor of adverse left ventricular remodeling was evaluated in a group of high‐risk acute anterior myocardial infarction survivors. Methods Twenty‐four patients with mechanically reperfused anterior STEMI were divided into two groups based on the 38 mm Hg CWP cutoff for adverse left ventricular remodeling. Diastolic deceleration time ( DDT ), coronary flow reserve ( CFR ), systolic retrograde flow, peak systolic and peak diastolic velocities in the infarct‐related artery were determined 3–5 days after revascularization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling. Results No significant differences were recorded between groups with regard to the echocardiographic parameters of MVO . No significant correlation was identified between CWP on one side and DDT ( P = 0.30) and CFR ( P = 0.39) on the other, irrespective of total ischemic time and extracted thrombus length. No difference in 5 years of follow‐up left ventricular remodeling was detected in patients with DDT <900 msec as compared to those with DDT ≥900 msec. The medium increase in left ventricular end‐systolic volume in patients with low CWP was 24.78%, while it reached 127.27% ( P = 0.03) in patients with CWP >38 mm Hg. Conclusions Coronary wedge pressure did not correlate with the surrogate parameters for MVO , but it was a predictor of left ventricular remodeling. None of the echocardiographic MVO parameters was associated with adverse remodeling at 5 years of follow‐up.