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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
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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.
Keywords
acute myocardial infarction, time to reperfusion, left ventricular filling pressure
About this articleTitle
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
Issue
Pages
357-363
Published online
2014-08-29
Page views
1902
Article views/downloads
1587
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
