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Published on: May 28, 2019
Coronary Thermodilution Waveforms After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to
Shu Ning Yew1, David Carrick1,2, David Corcoran1,2
11 British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom.
Insights
Coronary thermodilution waveforms can predict outcomes after ST-segment-elevation myocardial infarction. A bimodal waveform is linked to increased risk of death and heart failure hospitalization, aiding prognosis.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Invasive assessment of microvascular resistance in acute ST-segment-elevation myocardial infarction (STEMI) aids risk stratification.
- Coronary thermodilution offers a diagnostic method to evaluate microvascular function.
Purpose of the Study:
- To investigate the pathological and prognostic significance of coronary thermodilution waveforms after percutaneous coronary intervention (PCI) in STEMI patients.
- To assess the association between thermodilution waveform patterns and myocardial injury, and their predictive value for clinical outcomes.
Main Methods:
- Coronary thermodilution was performed post-PCI in 278 STEMI patients.
- Contrast-enhanced cardiac magnetic resonance imaging (MRI) assessed left ventricular (LV) function and pathology.
- Patients were followed for major adverse cardiovascular events, including all-cause death and heart failure hospitalization.
Main Results:
- Thermodilution waveforms were classified as narrow unimodal (51%), wide unimodal (36%), or bimodal (13%).
- Bimodal waveforms were associated with increased microvascular obstruction and myocardial hemorrhage (P=0.007 and P=0.011, respectively).
- A bimodal waveform independently predicted all-cause death and heart failure hospitalization (OR=2.70; P=0.031), irrespective of other factors.
Conclusions:
- The coronary thermodilution waveform is a valuable prognostic biomarker in STEMI.
- This waveform pattern can aid in risk stratification immediately following reperfusion therapy.
Abstract:
Background Invasive measures of microvascular resistance in the culprit coronary artery have potential for risk stratification in acute ST-segment-elevation myocardial infarction. We aimed to investigate the pathological and prognostic significance of coronary thermodilution waveforms using a diagnostic guidewire. Methods and Results Coronary thermodilution was measured at the end of percutaneous coronary intervention, (PCI) and contrast-enhanced cardiac magnetic resonance imaging (MRI) was intended on day 2 and 6 months later to assess left ventricular (LV) function and pathology. All-cause death or first heart failure hospitalization was a pre-specified outcome (median follow-up duration 1469 days). Thermodilution recordings underwent core laboratory assessment. A total of 278 patients with acute ST-segment elevation myocardial infarction EMI (72% male, 59±11 years) had coronary thermodilution measurements classified as narrow unimodal (n=143 [51%]), wide unimodal (n=100 [36%]), or bimodal (n=35 [13%]). Microvascular obstruction and myocardial hemorrhage were associated with the thermodilution waveform pattern ( P=0.007 and 0.011, respectively), and both pathologies were more prevalent in patients with a bimodal morphology. On multivariate analysis with baseline characteristics, thermodilution waveform status was a multivariable associate of microvascular obstruction (odds ratio [95% confidence interval]=5.29 [1.73, 16.22];, P=0.004) and myocardial hemorrhage (3.45 [1.16, 10.26]; P=0.026), but the relationship was not significant when index of microvascular resistance (IMR) >40 or change in index of microvascular resistance (5 per unit) was included. However, a bimodal thermodilution waveform was independently associated with all-cause death and hospitalization for heart failure (odds ratio [95% confidence interval]=2.70 [1.10, 6.63]; P=0.031), independent of index of microvascular resistance>40, ST-segment resolution, and TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade. Conclusions The thermodilution waveform in the culprit coronary artery is a biomarker of prognosis and may be useful for risk stratification immediately after reperfusion therapy.
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