Assessment of left ventricle diastolic function in myocardial infarction patients treated with primary angioplasty
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Published on: April 25, 2014
Marcin Misztal1, Katarzyna Stopyra, Andrzej Gackowski
1Coronary Artery Disease Department, Institute of Cardiology, Jagiellonian University, Kraków, Poland. mamis@interia.pl
Insights
Diastolic heart failure is common after ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). Left ventricle diastolic dysfunction persists for months, influenced by reperfusion, inflammation, and infarct size.
Area of Science:
- Cardiology
- Cardiovascular Research
- Internal Medicine
Background:
- Diastolic heart failure affects over 5% of patients over 65, often with preserved systolic function.
- Diastolic heart failure presents a significant clinical and epidemiological challenge.
- Left ventricular diastolic dysfunction is increasingly recognized in heart failure patients.
Purpose of the Study:
- To investigate the prevalence and influencing factors of left ventricle diastolic dysfunction after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients.
- To analyze the relationship between diastolic dysfunction and atherosclerosis risk factors, cardiac biomarkers, and reperfusion parameters.
Main Methods:
- Prospective study of 99 STEMI patients undergoing primary PCI.
- Serial evaluations at 24 hours, 7 days, and 3 months post-PCI.
- Analysis of diastolic dysfunction severity, cardiac biomarkers (troponin I, CPK, CK-MB), CRP levels, and reperfusion parameters (TIMI, TMPG).
Main Results:
- Left ventricle diastolic dysfunction was prevalent in most STEMI patients within 24 hours post-PCI, persisting at 3 months.
- Higher cardiac biomarker levels (troponin I, CPK, CK-MB) were associated with restrictive filling patterns.
- Inflammatory response (CRP levels) and infarct extension significantly correlated with diastolic abnormalities.
Conclusions:
- Left ventricle diastolic dysfunction is common in STEMI patients post-PCI and remains present long-term.
- Reperfusion time/effectiveness, inflammatory markers, cardiac biomarkers, and ejection fraction influence diastolic dysfunction development.
- Infarct size is a significant contributor to the progression of diastolic dysfunction.
Background:
More than 5% of patients over the age of 65 have been found to develop heart failure, and over half of them preserve normal left ventricular systolic function. In the last few years, diastolic heart failure has become a serious clinical and epidemiological problem.
Methods:
This prospective study was carried out on 99 patients. Patients were evaluated up to three months after primary percutaneous coronary intervention (PCI). Evaluation was performed three times: within the first 24 hours after primary PCI, on day seven after PCI and at three months after PCI. We analyzed the relationship between the severity of left ventricle diastolic dysfunction and atherosclerosis risk factors, infarction site, maximum levels of cardiac biomarkers such as troponin I, CPK and CK-MB, CRP protein levels, angioplasty effectiveness, reperfusion time, TIMI and TMPG grade.
Results:
Most patients with ST elevation myocardial infarction (STEMI) treated with primary PCI demonstrated left ventricle diastolic dysfunction on the first day of myocardial infarction. Levels of cardiac biomarkers were significantly higher in patients with restrictive filling pattern. The inflammatory response (CRP levels) was found to have an important role in the development of diastolic abnormalities. There was a close relationship between diastolic and systolic function. Average values of left ventricular ejection fraction in patients with restrictive filling pattern were significantly lower than in those with impaired relaxation (44.7 vs. 52.7%; p < 0.001) and normal filling (54.2%; p = 0.002).
Conclusions:
More than half of patients with a first STEMI have left ventricle diastolic dysfunction within the first day after PCI, and these abnormalities are still present three months after PCI. Time and effectiveness of reperfusion, CRP level, troponin I, max, CPK max and CK-MB max levels as well as left ventricular ejection fraction have an important influence on the development of diastolic dysfunction. Infarct extension contributes significantly to the process.
