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Updated: Feb 15, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Pre-revascularization coronary wedge pressure as marker of adverse long-term left ventricular remodelling in patients
Mãdãlin Constantin Marc1,2, Adrian Corneliu Iancu3,4, Camelia Diana Ober2
1"Iuliu Haţieganu'' University of Medicine and Pharmacy, 8 Victor Babeş, Cluj-Napoca, Romania.
Insights
High coronary wedge pressure (CWP) in ST-segment elevation myocardial infarction (STEMI) patients indicates microvascular obstruction and predicts long-term left ventricular remodelling and reduced ejection fraction.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- Microvascular obstruction is a key determinant of infarct healing and left ventricular (LV) remodelling post-myocardial infarction.
- Coronary wedge pressure (CWP) is a potential pre-procedural marker for assessing microvascular obstruction.
- Left ventricular remodelling significantly impacts long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients.
Purpose of the Study:
- To investigate the relationship between pre-procedural coronary wedge pressure (CWP) and left ventricular remodelling in high-risk STEMI patients.
- To determine if CWP can predict long-term adverse LV remodeling and functional changes.
- To assess the association between CWP, microvascular obstruction, and thrombus burden.
Main Methods:
- Coronary wedge pressure (CWP) was measured pre-revascularization in 25 high-risk anterior STEMI patients.
- Left ventricular volumes and ejection fraction were assessed via echocardiography at discharge and 60-month follow-up.
- Left ventricular remodelling was defined as a 20% increase in LV volumes.
Main Results:
- Patients with CWP > 38 mmHg exhibited progressive LV remodelling, with significant increases in end-systolic and end-diastolic volumes at 60 months.
- Elevated CWP was associated with a significant decrease in left ventricular ejection fraction over the follow-up period.
- Increased CWP and larger extracted thrombus length (≥2 mm) were independent predictors of severe left ventricular enlargement and adverse remodeling.
Conclusions:
- Pre-revascularization elevated coronary wedge pressure is a significant predictor of adverse left ventricular remodelling and functional decline in STEMI patients.
- CWP serves as a valuable marker for identifying high-risk patients prone to progressive left ventricular enlargement and reduced ejection fraction.
- Microvascular obstruction, indicated by CWP, plays a crucial role in the long-term structural and functional consequences of STEMI.
Abstract:
The aim of this study was to investigate the relationship between coronary wedge pressure (CWP), measured as a marker of pre-procedural microvascular obstruction, and left ventricular remodelling in high-risk ST-segment elevation myocardial infarction (STEMI) patients. Pre-revascularization CWP was measured in 25 patients with high-risk anterior STEMI. Left ventricular volumes and ejection fraction were echocardiographically measured at discharge and at follow-up. A 20% increase in left ventricular volumes was used to define remodelling. Patients with CWP ≤ 38 mmHg were characterized by late ventricular remodelling. Patients with CWP > 38 mmHg developed a progressive remodelling process which was associated with a significant 60 months increase in left ventricular volumes (P = 0.01 for end-systolic volume and 0.03 for end-diastolic volume) and a significant decrease in left ventricular ejection fraction (P = 0.05). A significant increase in both left ventricular end-systolic (P = 0.009) and end-diastolic volume (P = 0.02) from baseline to 60 months follow-up was recorded in patients with extracted thrombus length ≥2 mm. Pre-revascularization elevated CWP was associated with increased left ventricular volumes and decreased ejection fraction at long-term follow-up. CWP was a predictor of severe left ventricular enlargement, besides extracted thrombus quantity.
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