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Published on: September 19, 2019
Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial
Ya V Alekseeva1, E V Vyshlov1, E N Pavlyukova1
1Cardiology Research Institute, Tomsk National Research Medical Centre; Siberian State Medical University, Tomsk.
Insights
Microvascular injury, specifically myocardial రక్తనాళాల గాయం (MVO) and intramyocardial hemorrhage (IMH), significantly impacts left ventricular function after ST-segment elevation myocardial infarction (STEMI). The combination of MVO and IMH predicts reduced ejection fraction long-term.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Infarction Research
Background:
- Primary ST-segment elevation myocardial infarction (STEMI) can lead to microvascular injury.
- Assessing the long-term impact of different types of microvascular injury on left ventricular (LV) structure and function is crucial.
Purpose of the Study:
- To analyze the long-term effects of myocardial రక్తనాళాల గాయం (MVO) and intramyocardial hemorrhage (IMH) on LV parameters post-STEMI.
- To correlate microvascular injury characteristics with echocardiographic findings.
Main Methods:
- Included 60 primary STEMI patients treated with stenting.
- Assessed MVO and IMH using cardiac magnetic resonance (CMR) imaging on day 2 post-STEMI.
- Performed echocardiography on day 7 and 3 months post-MI.
Main Results:
- Patients with combined MVO and IMH showed significantly lower LV ejection fraction (LVEF) compared to those without.
- A moderate inverse correlation was found between MVO area and LV contractile function (R=-0.60, p=0.000002).
- Isolated IMH did not correlate with LV function deterioration.
Conclusions:
- Combined MVO and IMH predict reduced LVEF and increased LV volumes at 3 months post-MI.
- Isolated MVO is associated with lower LVEF, and MVO size correlates with decreased LV function.
- Isolated IMH does not appear to impair LV function in the long term.
Aim:
To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI).
Materials And Methods:
The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI.
Results:
We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002).
Conclusions:
The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.
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