Acute Change in Left Ventricle End-diastolic Pressure after Primary Percutaneous Coronary Intervention in Patients with ST Segment Elevation Myocardial Infarction

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Abstract

ST segment elevation myocardial infarction (STEMI) causes decreasing left ventricle compliance, increasing left ventricle end-diastolic pressure (LVEDP), and diastolic dysfunctioning. It is known that primary percutaneous coronary intervention (PCI) has an acute effect on left ventricle compliance. Aims: This study aims to determine whether left ventricle diastolic function improves and LVEDP decreases post-PCI in patients with STEMI. Methods:Twenty-nine patients (21 male, mean age 62±12) diagnosed with a first anterior or inferior STEMI and hospitalized in the first six hours were enrolled. Coronary angiography (CAG) showed occlusion of the right coronary artery (RCA), circumflex (Cx), or left anterior descending (LAD) coronary artery. Aortic pressure and LVEDP were measured and compared before and after PCI. Results: After successful reperfusion, left ventricle diastolic function improved and LVEDP decreased significantly. Decrease in mean LVEDP was 5.7±2.9mmHg (p=0.0005) and 4.9±6.5mmHg (p=0.026) in inferior and anterior MI, respectively. Clinical and electrocardiographic (ECG) findings improved quickly. Conclusion: Primary PCA provides rapid improvement of LVEDP and diastolic functions in both anterior and inferior MI. Left ventricular pressure (before and after PCI) can be measured during the procedure without any complication, so it can be used for quick evaluation of left ventricular diastolic function improvement. Keywords: percutaneous coronary intervention, acute myocardial infarction, measurement of left ventricle end-diastolic pressure.

Correspondence
Ömer Şatiroglu, MD, Rize Universitesi Tip Fakultesi Kardiyoloji bölümü, 53100, Rize, Turkey. E: omersatiroglu@yahoo.com
Citation
American Heart Hospital Journal 2010;8(2):86–90
DOI
https://doi.org/10.15420/ahhj.2010.8.2.86

Pages

In acute myocardial infarction (MI), decreasing compliance of the left ventricle is directly associated with prognosis.1 In patients with ST segment elevation MI (STEMI), left ventricular filling pressure increases.2,3 Early improvement of perfusion after MI will improve left ventricle function and decrease the infarction area, thus decreasing mortality.4,5 The main goal of reperfusion treatment is not only to open epicardial vessels but also to improve cardiac cell and left ventricle function.6 The efficacy of reperfusion treatment may be shown indirectly with electrocardiography (ECG), by regression of ST elevation, but there is a need for methods to demonstrate left ventricle and microvascular function improvement.7–9 Primary percutaneous coronary intervention (PCI) is regarded as the best reperfusion model in STEMI. PCI may be used to show hemodynamic changes in the left ventricle or to measure left ventricle end-diastolic pressure (LVEDP) for evaluation of reperfusion efficacy and success.
In this study, we investigated the effect of reperfusion treatment on left ventricle function, measurement of left ventricle pressure, and changes in STEMI with PCI.

Materials and Methods
Patients

Twenty-nine patients (21 male, mean age 62±12 years) diagnosed with first anterior and inferior STEMI and hospitalized within six hours, and assigned to undergo PCI, were enrolled (see Table 1). Patients with cardiogenic shock, refractory ventricular arrhythmia, congestive heart insufficiency, previous MI history, advanced valve disease, or left ventricle thrombus were excluded. Before PCI, patients gave informed consent and the study was conducted in accordance with the Helsinki declaration and ethical rules.

Study Protocol

Prior to PCI, patients took aspirin, clopidogrel, and heparin. Cardiac thrombus and function of the left ventricle and valves were checked by echocardiography (VingMed Vivid 3 with 2.5MHz prop, GE Medical Systems, Hortan, Norway) in the intensive coronary unit. Patients were monitored.

Pages

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