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Published on: July 2, 2018
Acute left ventricular dynamic effects of primary percutaneous coronary intervention from occlusion to reperfusion
Maurice Remmelink1, Krischan D Sjauw, José P S Henriques
1Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands.
Insights
Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) immediately improves left ventricular (LV) diastolic function. This study used pressure-volume (PV) loops to assess LV compliance changes after reperfusion therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Physiology
Background:
- Acute myocardial infarction (MI) reduces left ventricular (LV) compliance.
- The immediate impact of primary percutaneous coronary intervention (PCI) on LV compliance is not well understood.
Purpose of the Study:
- To investigate the dynamic effects of primary PCI on LV function in ST-segment elevation myocardial infarction (STEMI) patients.
- To directly measure changes in LV compliance using pressure-volume (PV) loops during primary PCI.
Main Methods:
- Studied 15 patients with anterior STEMI undergoing primary PCI.
- Utilized a pressure-conductance catheter to obtain continuous LV pressure-volume (PV) loops.
- Analyzed LV diastolic and systolic function before and immediately after reperfusion.
Main Results:
- Successful reperfusion via primary PCI significantly improved LV diastolic function.
- Observed increased end-diastolic compliance, decreased end-diastolic pressure, reduced stiffness, and lower wall stress.
- Demonstrated an immediate improvement in apical contractility, indicating enhanced systolic function.
Conclusions:
- Primary PCI in anterior STEMI patients leads to prompt improvements in LV diastolic function.
- Online PV loop measurements provide real-time assessment of these functional changes.
Objectives:
We studied the left ventricular (LV) dynamic effects of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) by directly obtaining pressure-volume (PV) loops during the procedure.
Background:
An acute myocardial infarction causes a decrease in LV compliance. The instantaneous effects of primary PCI on LV compliance are unknown.
Methods:
We studied 15 consecutive patients (10 males, ages 59 +/- 12 years), who presented with their first acute anterior STEMI within 6 h after onset of symptoms, and in whom coronary angiography revealed an occluded left anterior descending coronary artery. Before performing primary PCI, we inserted a pressure-conductance catheter in the LV to continuously obtain PV loops.
Results:
Immediately after successful reperfusion, significant improvements were observed in LV diastolic function, as indicated by an increased end-diastolic compliance with a 6.0 +/- 2.8 mm Hg (p < 0.0001) downward shift of the compliance curve. There was a decrease in end-diastolic pressure of 24 +/- 18% (p = 0.0002), in stiffness of 27 +/- 18% (p = 0.0003), and in wall stress of 20 +/- 24% (p = 0.004). Systolic function mainly showed an immediate improvement in apical contractility from 40 +/- 17% to 54 +/- 15% (p = 0.01).
Conclusions:
Primary PCI in anterior STEMI patients causes an immediate improvement in diastolic function, assessed by online PV loop measurements.
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