open access

Vol 13, No 7 (2006): Folia Cardiologica
Original articles
Published online: 2006-09-15
Submitted: 2013-01-14
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Prediction of left ventricular function in patients after acute myocardial infarction treated with primary angioplasty

Iwona Świątkiewicz, Arkadiusz Grubecki, Tomasz Białoszyński, Tomasz Fabiszak, Marek Koziński, Marek Woźnicki, Anna Król, Adam Sukiennik, Maria Bogdan, Ryszard Dobosiewicz, Wacław Kochman, Maciej Chojnicki, Grzegorz Grześk, Władysław Sinkiewicz, Jacek Kubica
Folia Cardiol 2006;13(7):605-619.

open access

Vol 13, No 7 (2006): Folia Cardiologica
Original articles
Published online: 2006-09-15
Submitted: 2013-01-14

Abstract

Background: Despite a substantial reduction in in-hospital mortality, the long-term outcomes of patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous transluminal coronary angioplasty (PTCA) remain uncertain. The main causes include progressive left ventricle (LV) remodelling and impaired LV systolic function with a decreased ejection fraction (EF). B-type natriuretic peptide testing has recently emerged as an innovative approach that might enhance the echocardiography-based risk stratification after STEMI. The aims of the study included long-term echocardiographic assessment of LV function and remodelling in patients with STEMI treated with PTCA. Additionally, evaluation of the N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level utility was performed to identify factors at patient discharge which would enable to predict LV dysfunction and remodelling after STEMI at 6-month follow-up.
Methods: Echocardiography was performed in 98 patients at discharge and at 6-month follow-up. The diameters of the heart chambers and indices of LV systolic and diastolic function were measured. Plasma levels of NT-proBNP were measured before PTCA and at 6 months.
Results: Primary PTCA successfully restored normal epicardial blood flow in the infarctrelated Artery (IRA) in 96 patients. At 6 months preserved LV systolic function (median EF 47.5%), decreased LV diastolic function with relaxation abnormalities (E/A < 1.0 and IVRT > 105 ms) and no significant increase in left ventricular end-diastolic diameter (LVEDD) were observed in study population. Multivariate analysis identified low baseline NT-proBNP level, low peak creatine phosphokinase (CPKmax) activity and high EF at discharge as powerful independent predictors of preserved EF at 6 months. LVEDD at discharge, baseline NT-proBNP level and CPKmax correlated with LVEDD at 6 months in the multiple regression model. In multivariate analysis a high NT-proBNP level on admission and low LVEDD at discharge were independent predictors of LVEDD change. Patient groups with reperfusion obtained < and > 3.2 h from symptom onset (the median delay) did not differ with respect to IRA blood flow, infarct size assessed as CPKmax and LVEDD at 6 months. A significant increase in EF was noted only in patients with chest pain duration < 3.2 h. Time-to-treatment correlated with NT-proBNP level at 6 months.
Conclusions: Successful primary PTCA in STEMI influences LV systolic function improvement and effectively prevents LV remodelling at the 6-month follow-up. Low baseline NT-proBNP, low CPKmax and high EF at discharge are powerful independent predictors of preserved EF after 6 months. A high NT-proBNP level on admission and low LVEDD at discharge predict a propensity for LV remodelling. A prolonged time-to-treatment of STEMI results in a lack of significant long-term improvement in LV systolic function and does not seem to have an impact on the occurrence of LV remodelling.

Abstract

Background: Despite a substantial reduction in in-hospital mortality, the long-term outcomes of patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous transluminal coronary angioplasty (PTCA) remain uncertain. The main causes include progressive left ventricle (LV) remodelling and impaired LV systolic function with a decreased ejection fraction (EF). B-type natriuretic peptide testing has recently emerged as an innovative approach that might enhance the echocardiography-based risk stratification after STEMI. The aims of the study included long-term echocardiographic assessment of LV function and remodelling in patients with STEMI treated with PTCA. Additionally, evaluation of the N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level utility was performed to identify factors at patient discharge which would enable to predict LV dysfunction and remodelling after STEMI at 6-month follow-up.
Methods: Echocardiography was performed in 98 patients at discharge and at 6-month follow-up. The diameters of the heart chambers and indices of LV systolic and diastolic function were measured. Plasma levels of NT-proBNP were measured before PTCA and at 6 months.
Results: Primary PTCA successfully restored normal epicardial blood flow in the infarctrelated Artery (IRA) in 96 patients. At 6 months preserved LV systolic function (median EF 47.5%), decreased LV diastolic function with relaxation abnormalities (E/A < 1.0 and IVRT > 105 ms) and no significant increase in left ventricular end-diastolic diameter (LVEDD) were observed in study population. Multivariate analysis identified low baseline NT-proBNP level, low peak creatine phosphokinase (CPKmax) activity and high EF at discharge as powerful independent predictors of preserved EF at 6 months. LVEDD at discharge, baseline NT-proBNP level and CPKmax correlated with LVEDD at 6 months in the multiple regression model. In multivariate analysis a high NT-proBNP level on admission and low LVEDD at discharge were independent predictors of LVEDD change. Patient groups with reperfusion obtained < and > 3.2 h from symptom onset (the median delay) did not differ with respect to IRA blood flow, infarct size assessed as CPKmax and LVEDD at 6 months. A significant increase in EF was noted only in patients with chest pain duration < 3.2 h. Time-to-treatment correlated with NT-proBNP level at 6 months.
Conclusions: Successful primary PTCA in STEMI influences LV systolic function improvement and effectively prevents LV remodelling at the 6-month follow-up. Low baseline NT-proBNP, low CPKmax and high EF at discharge are powerful independent predictors of preserved EF after 6 months. A high NT-proBNP level on admission and low LVEDD at discharge predict a propensity for LV remodelling. A prolonged time-to-treatment of STEMI results in a lack of significant long-term improvement in LV systolic function and does not seem to have an impact on the occurrence of LV remodelling.
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Keywords

primary percutaneous transluminal coronary angioplasty; echocardiography; post-infarct left ventricle remodelling; left ventricular systolic and diastolic function; N-terminal pro-brain natriuretic peptide

About this article
Title

Prediction of left ventricular function in patients after acute myocardial infarction treated with primary angioplasty

Journal

Cardiology Journal

Issue

Vol 13, No 7 (2006): Folia Cardiologica

Pages

605-619

Published online

2006-09-15

Bibliographic record

Folia Cardiol 2006;13(7):605-619.

Keywords

primary percutaneous transluminal coronary angioplasty
echocardiography
post-infarct left ventricle remodelling
left ventricular systolic and diastolic function
N-terminal pro-brain natriuretic peptide

Authors

Iwona Świątkiewicz
Arkadiusz Grubecki
Tomasz Białoszyński
Tomasz Fabiszak
Marek Koziński
Marek Woźnicki
Anna Król
Adam Sukiennik
Maria Bogdan
Ryszard Dobosiewicz
Wacław Kochman
Maciej Chojnicki
Grzegorz Grześk
Władysław Sinkiewicz
Jacek Kubica

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