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Low Quantitative Blush Evaluator score predicts larger infarct size and reduced left ventricular systolic function in
Katarzyna Nabrdalik1,2, Andrzej Tomasik3, Krzysztof Irlik4
1Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. knabrdalik@sum.edu.pl.
Insights
Diminished myocardial perfusion after ST-elevation myocardial infarction (STEMI) treatment with primary percutaneous coronary intervention (pPCI) is linked to larger infarct size and reduced left ventricular ejection fraction (LVEF). This effect is observed regardless of type 2 diabetes mellitus (T2DM) status.
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Type 2 diabetes mellitus (T2DM) and poor myocardial perfusion are known risk factors for heart failure and mortality post-ST-elevation myocardial infarction (STEMI).
- Optimal reperfusion after primary percutaneous coronary intervention (pPCI) is crucial for preserving myocardial function and improving outcomes in STEMI patients.
Purpose of the Study:
- To investigate the impact of myocardial perfusion on infarct size and left ventricular ejection fraction (LVEF) in STEMI patients with and without T2DM undergoing pPCI.
- To identify predictors of LVEF in this patient cohort.
Main Methods:
- An ancillary analysis of an observational cohort study involving 406 STEMI patients (104 with T2DM).
- Myocardial perfusion assessed using Quantitative Myocardial Blush Evaluator (QUBE).
- Infarct size measured by creatine kinase myocardial band (CK-MB) and troponin levels; LVEF assessed by echocardiography.
Main Results:
- Patients with T2DM and diminished perfusion (QUBE below median) exhibited the highest CK-MB levels and lowest LVEF.
- Diminished myocardial perfusion (QUBE < median) was a significant predictor of lower LVEF.
- Older age, diminished perfusion, and elevated maximal CK-MB activity independently predicted lower LVEF.
Conclusions:
- Reduced myocardial perfusion, as assessed by QUBE, is a strong predictor of larger infarct size and impaired LVEF in STEMI patients treated with pPCI.
- These findings hold true irrespective of the presence or absence of type 2 diabetes mellitus.
Abstract:
Type 2 diabetes mellitus (T2DM) and diminished myocardial perfusion increase the risk of heart failure (HF) and/or all-cause mortality during 6-year follow up following primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI). The aim of the present study was to evaluate the impact of myocardial perfusion on infarct size and left ventricular ejection fraction (LVEF) in patients with T2DM and STEMI treated with pPCI. This is an ancillary analysis of an observational cohort study of T2DM patients with STEMI. We enrolled 406 patients with STEMI, including 104 with T2DM. Myocardial perfusion was assessed with the Quantitative Myocardial Blush Evaluator (QUBE) and infarct size with the creatine kinase myocardial band (CK-MB) maximal activity and troponin area under the curve. LVEF was measured with biplane echocardiography using Simpson's method at admission and hospital discharge. Analysis of covariance was used for modeling the association between myocardial perfusion, infarct size and left ventricular systolic function. Patients with T2DM and diminished perfusion (QUBE below median) had the highest CK-MB maximal activity (252.7 ± 307.2 IU/L, P < 0.01) along with the lowest LVEF (40.6 ± 10.0, P < 0.001). Older age (p = 0.001), QuBE below median (p = 0.026), and maximal CK-MB activity (p < 0.001) were independent predictors of LVEF. Diminished myocardial perfusion assessed by QuBE predicts significantly larger enzymatic infarct size and lower LVEF among patients with STEMI treated with pPCI, regardless of diabetes status.
