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Non-infarct related artery microvascular obstruction is associated with worse persistent diastolic dysfunction in

Michel T Corban1, Reza Khorramirouz1, Shi-Wei Yang1

  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

International Journal of Cardiology
|October 16, 2019
PubMed

Insights

Microvascular obstruction (MVO) outside the infarct-related artery (nonIRA MVO) in STEMI patients is linked to worse diastolic dysfunction (DD) long-term. This finding highlights the impact of MVO extent on heart function after myocardial infarction.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Heart Failure Research

Background:

  • Microvascular obstruction (MVO) in the infarct-related artery (IRA) is known to correlate with diastolic dysfunction (DD) in ST-elevation myocardial infarction (STEMI) patients.
  • The association between MVO in non-infarct-related arteries (nonIRA MVO) and DD in STEMI patients has not been previously established.
  • This study investigates the impact of concurrent IRA and nonIRA MVO on diastolic function in STEMI patients.

Purpose of the Study:

  • To determine if STEMI patients with both IRA and nonIRA MVO exhibit worse diastolic dysfunction (DD) compared to those with only IRA MVO.
  • To assess the prevalence and grade of DD at presentation and long-term follow-up in STEMI patients with varying MVO extents.
  • To evaluate changes in diastolic function parameters over time in relation to MVO presence.

Main Methods:

  • Eighty-seven STEMI patients undergoing IRA revascularization were assessed using cardiac MRI for MVO and echocardiography for DD within one week of presentation.
  • Diastolic function was reassessed via echocardiography at an average follow-up of approximately 4 years.
  • Patients were categorized into two groups: those with IRA and nonIRA MVO (IRA+nonIRA+) versus those with only IRA MVO (IRA+nonIRA-).

Main Results:

  • The IRA+nonIRA+ group (54 patients) showed significantly higher DD prevalence at baseline (40.7% vs. 6.1%, P=0.006) and follow-up (50.0% vs. 13.0%, P=0.05) compared to the IRA+nonIRA- group (33 patients).
  • IRA+nonIRA+ patients exhibited worsening diastolic function markers at follow-up, including increased mitral medial E/e' and a trend towards increased mitral E/A, alongside greater left atrial volume index and reduced deceleration time.
  • While Grade 1 DD increased and severe DD decreased in the IRA+nonIRA- group, the IRA+nonIRA+ group showed a decrease in Grade 1 DD and an increase in severe DD (Grades 2/3) at follow-up.

Conclusions:

  • Concurrent IRA and nonIRA MVO in revascularized STEMI patients is associated with a higher prevalence of diastolic dysfunction.
  • The presence of nonIRA MVO is linked to a worse grade of diastolic dysfunction at long-term follow-up.
  • These findings underscore the prognostic significance of MVO extent beyond the infarct artery in STEMI patients.
Abstract

Keywords:
Coronary microvascular obstructionDiastolic dysfunctionNon-infarct related coronary arteryST-elevation myocardial infarction

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