Abstract 12943: Assessment of Both Coronary Microvascular Damage and Left Ventricular Chamber Stiffness After Successful Percutaneous Coronary Intervention Predicts Left Ventricular Aneurysm in ST-Segment Elevation Myocardial Infarction
Background: In ST-segment elevation myocardial infarction (STEMI), the short deceleration time of left ventricular (LV) early filling by Doppler is a powerful independent predictor of LV remodeling. On the other hand, recent studies have shown that even if successful reperfusion is achieved in epicardial coronary arteries, microvascular obstruction results in insufficient reperfusion of the infarcted myocardium, leading to LV dysfunction. The purpose of this study was to examine the effects of both microvascular damage and LV chamber stiffness on the risk of LV aneurysm after successful percutaneous coronary intervention (PCI) in STEMI patients.
Methods: Two hundred and twenty-one consecutive patients with first anterior STEMI were studied following successful PCI. Microvascular damage was evaluated on the basis of coronary flow velocity patterns using Doppler guidewires. We defined the presence of microvascular obstruction as diastolic deceleration time of ≤600ms and the presence of systolic flow reversal. LV filling patterns were determined by LV inflow pulsed-wave Doppler examination on day 3 after STEMI. Deceleration time ≤130 ms was defined as restrictive. We classified patients into three categories: without restrictive and microvascular obstruction (group 1, n=125), with restrictive or microvascular obstruction (group 2, n= 43), and with restrictive and microvascular obstruction (group 3, n=53). Left ventriculogram obtained 6 months after the infarction was analyzed to measure the LV volume. True LV aneurysm was defined as a deformity of the infarct segment that was apparent during diastole as well as during systole, and demonstrated diastolic contour abnormality.
Results: Group 3 was at the highest risk of true LV aneurysm, while group 1 was at the lowest (2/125 [2%], 15/43 [35%], and 30/53 [57%]; P<0.01). The assessment of both examinations was related to the LV volume index at 6 months after the infarction: patients in a poor group had a larger end-diastolic volume index (65±22 vs 91±28 vs 128±31ml/m2; P<0.01).
Conclusions: Assessment of both microvascular damage and LV chamber stiffness can accurately predict the risk of LV aneurysm in STEMI patients who underwent successful reperfusion, identifying a subset of high risk patients.
Author Disclosures: A. Yamamuro: None. K. Tamita: None. J. Yoshikawa: None. S. Kaji: None. Y. Furukawa: None.
- © 2015 by American Heart Association, Inc.