open access

Vol 21, No 4 (2014)
Original articles
Published online: 2014-08-29
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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

Yacov Shacham, Arie Steinvil, Eran Leshem-Rubinow, Eyal Ben Assa, Gad Keren, Arie Roth, Yan Topilsky
DOI: 10.5603/CJ.a2013.0129
·
Cardiol J 2014;21(4):357-363.

open access

Vol 21, No 4 (2014)
Original articles
Published online: 2014-08-29

Abstract

 

Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure fol­lowing acute myocardial infarction are associated with adverse outcomes. Although time to reperfusion is a powerful prognostic marker following acute myocardial infarction, little is known about its impact on diastolic function and LV filling pressure. We hypothesized that delayed time to reperfusion will be associated with worse diastolic function.

Methods: This study included 180 consecutive patients with first ST elevation myocardial in­farction (STEMI) treated by primary percutaneous coronary intervention (PCI). They presen­ted of chest pain within 24 h and underwent echocardiography within 3 days of primary PCI.

Results: Median time to reperfusion, defined as the time from symptom onset to reperfusion at the end of primary PCI, was 185 min (interquartile range 120–660). Patients with reperfu­sion time > 185 min (n = 92) had a significantly higher E/septal e’ (13.3 ± 5.0 vs. 9.7 ± 2.3, p < 0.001) and E/lateral e’ (9.8 ± 3.5 vs. 7.8 ± 2.2, p < 0.001) ratios, and more advanced diastolic grade (p < 0.001) compared to those having early reperfusion (n = 88). There were no significant differences in LV ejection fraction and left atrial volume between the two groups. Time to reperfusion was an independent predictor of early E/average e’ ratio. The adverse ef­fect of late reperfusion on diastolic dysfunction was more prominent in patients with anterior myocardial infarction.

Conclusions: Longer time to reperfusion is associated with early elevated LV diastolic pres­sure in primary PCI-treated patients with STEMI.

Abstract

 

Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure fol­lowing acute myocardial infarction are associated with adverse outcomes. Although time to reperfusion is a powerful prognostic marker following acute myocardial infarction, little is known about its impact on diastolic function and LV filling pressure. We hypothesized that delayed time to reperfusion will be associated with worse diastolic function.

Methods: This study included 180 consecutive patients with first ST elevation myocardial in­farction (STEMI) treated by primary percutaneous coronary intervention (PCI). They presen­ted of chest pain within 24 h and underwent echocardiography within 3 days of primary PCI.

Results: Median time to reperfusion, defined as the time from symptom onset to reperfusion at the end of primary PCI, was 185 min (interquartile range 120–660). Patients with reperfu­sion time > 185 min (n = 92) had a significantly higher E/septal e’ (13.3 ± 5.0 vs. 9.7 ± 2.3, p < 0.001) and E/lateral e’ (9.8 ± 3.5 vs. 7.8 ± 2.2, p < 0.001) ratios, and more advanced diastolic grade (p < 0.001) compared to those having early reperfusion (n = 88). There were no significant differences in LV ejection fraction and left atrial volume between the two groups. Time to reperfusion was an independent predictor of early E/average e’ ratio. The adverse ef­fect of late reperfusion on diastolic dysfunction was more prominent in patients with anterior myocardial infarction.

Conclusions: Longer time to reperfusion is associated with early elevated LV diastolic pres­sure in primary PCI-treated patients with STEMI.

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Keywords

acute myocardial infarction, time to reperfusion, left ventricular filling pressure

About this article
Title

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

Journal

Cardiology Journal

Issue

Vol 21, No 4 (2014)

Pages

357-363

Published online

2014-08-29

DOI

10.5603/CJ.a2013.0129

Bibliographic record

Cardiol J 2014;21(4):357-363.

Keywords

acute myocardial infarction
time to reperfusion
left ventricular filling pressure

Authors

Yacov Shacham
Arie Steinvil
Eran Leshem-Rubinow
Eyal Ben Assa
Gad Keren
Arie Roth
Yan Topilsky

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