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Relation between coronary arterial dominance and left ventricular ejection fraction after ST-segment elevation acute
Caroline E Veltman1, Georgette E Hoogslag2, Rohit K Kharbanda2
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
Insights
Left dominant coronary artery systems are linked to lower early left ventricular ejection fraction after ST-segment elevation myocardial infarction (STEMI). However, these differences in LV function resolve by 12-month follow-up.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Left dominant coronary artery systems are linked to poorer outcomes post-ST-segment elevation myocardial infarction (STEMI).
- The impact of coronary dominance on long-term left ventricular (LV) function after STEMI remains unclear.
Purpose of the Study:
- To investigate the relationship between coronary arterial dominance and LV ejection fraction (LVEF) after STEMI.
- To assess LVEF at baseline and 12-month follow-up in relation to coronary dominance.
Main Methods:
- Retrospective analysis of 741 STEMI patients undergoing primary percutaneous coronary intervention.
- Two-dimensional echocardiography for LVEF assessment at baseline and 12-month follow-up.
- Coronary arterial dominance determined from angiographic images.
Main Results:
- A left dominant system was present in 8% of patients.
- Patients with left dominant systems showed lower baseline LVEF compared to right or balanced systems (45% vs. 48-50%).
- No significant differences in LVEF or LV volumes were observed among dominance groups at 12-month follow-up.
Conclusions:
- Left dominant coronary artery systems are associated with reduced LVEF early after STEMI.
- LV function differences related to coronary dominance are transient and resolve by 12 months post-STEMI.
Abstract:
The presence of a left dominant coronary artery system is associated with worse outcome after ST-segment elevation myocardial infarction (STEMI) compared with right dominance or a balanced coronary artery system. However, the association between coronary arterial dominance and left ventricular (LV) function at follow-up after STEMI is unclear. The present study aimed at evaluating the relation between coronary arterial dominance and LV ejection fraction (LVEF) shortly after STEMI and at 12-month follow-up. A total of 741 patients with STEMI (mean age 60 ± 11 years and 77% men) were evaluated with 2-dimentional echocardiography within 48 hours of admission (baseline) and at 12-month follow-up after STEMI. Coronary arterial dominance was assessed on the angiographic images obtained during primary percutaneous coronary intervention. A right, left, and balanced dominant coronary artery system was noted in 640 (86%), 58 (8%), and 43 (6%) patients, respectively. At baseline, significant difference in LV function was observed, with slightly lower LVEF in patients with a left dominant coronary artery system (LVEF 45 ± 8% vs 48 ± 9% and 50 ± 9%, for left dominant, right dominant, and balanced coronary artery system respectively, p = 0.03). However, at 12-month follow-up no differences in LV function or volumes were observed among the different coronary arterial dominance groups. In conclusion, patients with a left dominant coronary artery system had lower LVEF early after STEMI. At 12-month follow-up, differences in LVEF were no longer present among the different coronary arterial dominance groups.
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