scholarly journals Pre-revascularization coronary wedge pressure as marker of adverse long-term left ventricular remodelling in patients with acute ST-segment elevation myocardial infarction

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Mãdãlin Constantin Marc ◽  
Adrian Corneliu Iancu ◽  
Camelia Diana Ober ◽  
Cãlin Homorodean ◽  
Şerban Bãlãnescu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Wedge Pressure

Novel role of platelet reactivity in adverse left ventricular remodelling after ST-segment elevation myocardial infarction: The REMODELING Trial

2017 ◽  
Vol 117 (05) ◽  
pp. 911-922 ◽  
Author(s):  
Yongwhi Park ◽  
Udaya Tantry ◽  
Jin-Sin Koh ◽  
Jong-Hwa Ahn ◽  
Min Kang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Reactivity ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Hs Crp

SummaryThe role of platelet-leukocyte interaction in the infarct myocardium still remains unveiled. We aimed to determine the linkage of platelet activation to post-infarct left ventricular remodelling (LVR) process. REMODELING was a prospective, observational, cohort trial including patients (n = 150) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were given aspirin plus clopidogrel therapy (600 mg loading and 75 mg daily). Platelet reactivity (PRU: P2Y12 Reaction Units) was assessed with VerifyNow P2Y12 assay on admission. Transthoracic echocardiography was performed on admission and at one-month follow-up. The primary endpoint was the incidence of LVR according to PRU-based quartile distribution. LVR was defined as a relative ≥ 20 % increase in LV end-diastolic volume (LVEDV) between measurements. Adverse LVR was observed in 36 patients (24.0 %). According to PRU quartile, LVR rate was 10.8 % in the first, 23.1 % in the second, 27.0 % in the third, and 35.1 % in the fourth (p = 0.015): the optimal cut-off of PRU was ≥ 248 (area under curve: 0.643; 95 % confidence interval: 0.543 to 0.744; p = 0.010). LVR rate also increased proportionally according to the level of high sensitivity-C reactive protein (hs-CRP) (p = 0.012). In multivariate analysis, the combination of PRU (≥ 248) and hs-CRP (≥ 1.4 mg/l) significantly increased the predictive value for LVR occurrence by about 21-fold. In conclusion, enhanced levels of platelet activation and inflammation determined the incidence of adverse LVR after STEMI. Combining the measurements of these risk factors increased risk discrimination of LVR. The role of intensified antiplatelet or anti-inflammatory therapy in post-infarct LVR process deserves further study.

scholarly journals Value of C-Reactive Protein in Predicting Left Ventricular Remodelling in Patients with a First ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Iwona Swiatkiewicz ◽  
Marek Kozinski ◽  
Przemyslaw Magielski ◽  
Tomasz Fabiszak ◽  
Adam Sukiennik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
C Reactive Protein ◽  
Left Ventricular Remodelling ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Objective. To assess the value of C-reactive protein (CRP) in predicting postinfarct left ventricular remodelling (LVR).Methods.We measured in-hospital plasma CRP concentrations in patients with a first ST-segment elevation myocardial infarction (STEMI).Results. LVR was present at 6 months in 27.8% of 198 patients. CRP concentration rose during the first 24 h, mainly in LVR group. The prevalence of LVR was higher in patients from the highest quartile of CRP concentrations at 24 h as compared to those from any other quartile (odds ratio (OR) 3.48, 95% confidence interval (95% CI) 1.76–6.88). Multivariate analysis identified CRP concentration at 24 h (OR for a 10 mg/L increase 1.29, 95% CI 1.04–1.60), B-type natriuretic peptide at discharge (OR for a 100 pg/mL increase 1.21, 95% CI 1.05–1.39), body mass index (OR for a 1 kg/m2increase 1.10, 95% CI 1.01–1.21), and left ventricular end-diastolic volume (OR for a 1 mL increase 0.98, 95% CI 0.96-0.99) as independent predictors of LVR. The ROC analysis revealed a limited discriminative value of CRP (area under the curve 0.61; 95% CI 0.54–0.68) in terms of LVR prediction.Conclusions. Measurement of CRP concentration at 24 h after admission possesses a significant but modest value in predicting LVR after a first STEMI.

scholarly journals Left ventricular remodelling after ST‐segment elevation myocardial infarction: sex differences and prognosis

2020 ◽  
Vol 7 (2) ◽  
pp. 474-481
Author(s):  
Pieter Bijl ◽  
Rachid Abou ◽  
Laurien Goedemans ◽  
Bernard J. Gersh ◽  
David R. Holmes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sex Differences ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Microvascular Obstruction in Acute Myocardial Infarction

2017 ◽  
Vol 3 (4) ◽  
pp. 197-202
Author(s):  
Ioana Dregoesc ◽  
Adrian Iancu ◽  
Simona Manole ◽  
Şerban Bălănescu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pressure Wave ◽  
Microvascular Obstruction ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Left Anterior Descending Artery ◽  
St Segment ◽  
Wedge Pressure

Abstract Introduction: The no-reflow phenomenon has been described in 20–40% of patients with acute ST-segment elevation myocardial infarction, despite restoration of TIMI 3 myocardial flow. It is associated with adverse left ventricular remodeling and an unfavorable long-term prognosis. Case presentation: A 45-year-old gentleman was admitted one hour after the onset of an acute anterior ST-segment elevation myocardial infarction. Emergency coronary angiography was performed, and a severe stenosis of the left anterior descending artery was identified. The lesion was crossed with a pressure-wire, and a drug-eluting stent was directly implanted, with restoration of TIMI 3 epicardial flow. Predilatation was not performed. Coronary wedge pressure was measured during stent deployment. The mean pressure value was 27 mmHg. However, a tall systolic wave was identified in the morphology of the pressure curve. Myocardial blush grade and ST-segment resolution were concordant with early micro-vascular obstruction. Similarly, at transthoracic Doppler echocardiography, the flow in the left anterior descending artery revealed the same pattern. An apical left ventricular aneurysm was echocardiographically detected. The MRI described extensive interstitial edema that affected the anterior, septal, and apical regions of the left ventricle. Areas of intramyocardial hemorrhage and microvascular obstruction were also detected. According to recent literature data, the morphology of the coronary wedge pressure wave suggested at least the presence of pre-procedural distal embolization. Conclusions: In the setting of acute myocardial infarction, the integrity of coronary microvasculature is an important issue. The distal coronary pressure wave pattern before primary percutaneous revascularization can be a deciding factor for an early therapeutic approach.

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