Document Detail


Prognostic value of microvascular resistance index immediately after primary percutaneous coronary intervention on left ventricular remodeling in patients with reperfused anterior acute ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  24156965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to investigate the relationship between the degree of microvascular dysfunction assessed by a dual-sensor guidewire (pressure and Doppler velocity) and left ventricular (LV) remodeling after successful primary percutaneous coronary intervention (PPCI) for a first anterior acute myocardial infarction (AMI).
BACKGROUND: Microvascular dysfunction after AMI is associated with progressive LV dilation.
METHODS: In 24 consecutive patients, the microvascular resistance index (MVRI) immediately after PPCI was calculated as the ratio of the mean distal pressure to average peak flow velocity during maximal hyperemia. Cardiac magnetic resonance was performed to determine LV volumes at baseline and 8-month follow-up. LV remodeling was defined as an increase in left ventricular end-diastolic volume (LVEDV) of ≥20%.
RESULTS: In patients with an MVRI greater than the median value of 2.96 mm Hg·cm(-1)·s, the LVEDV increased significantly from 117.1 ± 20.7 ml at baseline to 146.5 ± 21.4 ml (p = 0.006) at 8 months, whereas it did not change between baseline and 8 months (108.2 ± 21.2 ml vs. 111.6 ± 29.9 ml, p = 0.620) in patients with an MVRI ≤2.96 mm Hg·cm(-1)·s. LV remodeling was more frequent in the group with an MVRI >2.96 mm Hg·cm(-1)·s (64% vs. 15%, p = 0.033). Furthermore, there was a positive correlation between MVRI and the percentage of increase or decrease in LVEDV (r = 0.42, p = 0.042). Logistic regression analysis showed that MVRI was the strongest univariate predictor of LV remodeling. The best cutoff value of MVRI was 2.96 mm Hg·cm(-1)·s with a sensitivity of 78% and a specificity of 73%.
CONCLUSIONS: MVRI immediately after PPCI predicts LV remodeling in patients with reperfused anterior AMI.
Authors:
Hironori Kitabata; Takashi Kubo; Kohei Ishibashi; Kenichi Komukai; Takashi Tanimoto; Yasushi Ino; Manabu Kashiwagi; Yuichi Ozaki; Yasutsugu Shiono; Kunihiro Shimamura; Makoto Orii; Kumiko Hirata; Atsushi Tanaka; Toshio Imanishi; Takashi Akasaka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  6     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-25     Completed Date:  2014-06-16     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1046-54     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anterior Wall Myocardial Infarction / diagnosis,  physiopathology,  therapy*
Blood Flow Velocity
Coronary Circulation*
Echocardiography, Doppler
Female
Humans
Logistic Models
Magnetic Resonance Imaging
Male
Microcirculation*
Middle Aged
Odds Ratio
Percutaneous Coronary Intervention* / adverse effects
Predictive Value of Tests
Risk Factors
Time Factors
Treatment Outcome
Vascular Resistance*
Ventricular Function, Left*
Ventricular Remodeling*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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