scholarly journals Natural History and Prognostic Implications of Left Ventricular End-Diastolic Pressure in Reperfused ST-Segment Elevation Myocardial Infarction – An Analysis of the Thrombolysis in Myocardial Infarction (TIMI) II Randomized Controlled Trial.

2021 ◽  
Author(s):  
Arshad A Khan ◽  
Mohammed S Al-Omary ◽  
Nicholas J Collins ◽  
John Attia ◽  
Andrew Boyle
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Natural History ◽  
Hospital Discharge ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction II study. Methods A total of 3,339 patients were randomized to either an invasive (n = 1,681) or a conservative (n = 1,658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) [p = 0.01] from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis.

scholarly journals Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arshad A. Khan ◽  
Mohammed S. Al-Omary ◽  
Nicholas J. Collins ◽  
John Attia ◽  
Andrew J. Boyle
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Natural History ◽  
Hospital Discharge ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study. Methods A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) (p = 0.01) from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. Graphic abstract

scholarly journals B-type natriuretic peptide levels and its correlation with left ventricular functions and heart failure in patients of acute coronary syndromes

2021 ◽  
Vol 9 (4) ◽  
pp. 1112
Author(s):  
Rajinder Kumar ◽  
Muzaffar Majeed Khujwal ◽  
Isha Sharma ◽  
Amit Varma
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Entire Spectrum ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Clinical Heart Failure

Background: This study was designed to measure levels of B-type natriuretic peptide (BNP) across entire spectrum of acute coronary syndrome (ACS) and to find its correlation with left ventricular functions and heart failure.Methods: We measured BNP levels at baseline in 100 consecutive patients between 24-96 hours after the onset of ischemic symptoms in patients of ACS. Echocardiography was performed in all patients between day 2-5 after the index diagnosis and stabilizing the patients.Results: The BNP levels were raised across the entire spectrum of ACS, with levels (>80 pg/ml) in 32.2% of patients with ST segment-elevation myocardial infarction (STEMI), in 24% with non-ST segment-elevation myocardial infarction (NSTEMI), and in 16.6% with unstable angina (UA) respectively. High BNP levels were associated with greater increase in LV end-systolic volumes (r=+0.545, p<0.001) (LVESV) and end-diastolic volumes (LVEDV) (r=+0.336, p<0.001). There was a negative correlation between BNP levels and left ventricular ejection fraction (LVEF) (r=-0.394, p<0.002). BNP levels were significantly raised (156.0±45.1 vs 57.7±18.3 pg/ml, p<0.02) in patients developing symptomatic clinical heart failure, irrespective of LVEF ≤40%.Conclusions: Integrated use of echocardiography and BNP levels provide powerful incremental assessment of cardiac functions, clinical status, and outcome across the entire spectrum of acute coronary syndromes (ACS). Increased BNP levels are associated with progressive ventricular dilatation, LV-dysfunction, development of clinical heart failure and is associated with poor prognosis in patients of ACS.

scholarly journals HEART FAILURE PREDICTION MARKERS IN PATIENTS OF ACUTE MYOCARDIAL INFARCTION

2020 ◽  
Vol 76 (4) ◽  
pp. 56-61
Author(s):  
E.V. Khorolets ◽  
◽  
S.V. Shlyk ◽  
L.A. Khaisheva ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Growth Factor ◽  
Left Ventricular ◽  
Ventricular Failure ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

The article is devoted to the study of the patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by acute heart failure (AHF). Clinical data were assessed, including the level of stimulating growth factor (ST-2) and growth differentiation factor (GDF-15), depending on the degree of AHF classification of T. Killip. It has been established that ST-2 is a marker of AHF prognosis in STEMI patients at the hospital stage of treatment. GDF-15 reaches high valuesт in acute left ventricular failure.

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