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Observational Study
. 2018 Jan 30;8(1):1897.
doi: 10.1038/s41598-018-20276-6.

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

Mãdãlin Constantin Marc  1   2 , Adrian Corneliu Iancu  3   4 , Camelia Diana Ober  2 , Cãlin Homorodean  1 , Şerban Bãlãnescu  5 , Adela Viviana Sitar  1 , Sorana Bolboacã  1 , Ioana Mihaela Dregoesc  1   2
Affiliations
Observational Study

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

Mãdãlin Constantin Marc et al. Sci Rep. .

Abstract

The aim of this study was to investigate the relationship between coronary wedge pressure (CWP), measured as a marker of pre-procedural microvascular obstruction, and left ventricular remodelling in high-risk ST-segment elevation myocardial infarction (STEMI) patients. Pre-revascularization CWP was measured in 25 patients with high-risk anterior STEMI. Left ventricular volumes and ejection fraction were echocardiographically measured at discharge and at follow-up. A 20% increase in left ventricular volumes was used to define remodelling. Patients with CWP ≤ 38 mmHg were characterized by late ventricular remodelling. Patients with CWP > 38 mmHg developed a progressive remodelling process which was associated with a significant 60 months increase in left ventricular volumes (P = 0.01 for end-systolic volume and 0.03 for end-diastolic volume) and a significant decrease in left ventricular ejection fraction (P = 0.05). A significant increase in both left ventricular end-systolic (P = 0.009) and end-diastolic volume (P = 0.02) from baseline to 60 months follow-up was recorded in patients with extracted thrombus length ≥2 mm. Pre-revascularization elevated CWP was associated with increased left ventricular volumes and decreased ejection fraction at long-term follow-up. CWP was a predictor of severe left ventricular enlargement, besides extracted thrombus quantity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flowchart. CWP = coronary wedge pressure; LAD = left anterior descending artery.
Figure 2
Figure 2
Receiver operating characteristic curves for coronary wedge pressure in predicting left ventricular end-systolic volume ≥75 ml at 60 months follow-up. AUC = area under the curve.
Figure 3
Figure 3
Left ventricular end-systolic volume evolution in the two groups from baseline to 60 months follow-up. 95% CI = 95% confidence interval; CWP = coronary wedge pressure; LVESV = left ventricular end-systolic volume.
Figure 4
Figure 4
Left ventricular end-diastolic volume evolution in the two groups from baseline to 60 months follow-up. 95% CI = 95% confidence interval; CWP = coronary wedge pressure; LVEDV = left ventricular end-diastolic volume.
Figure 5
Figure 5
Left ventricular ejection fraction evolution in the two groups from baseline to 60 months follow-up. 95% CI = 95% confidence interval; CWP = coronary wedge pressure; LVEF = left ventricular ejection fraction.
Figure 6
Figure 6
Left ventricular end-systolic (Panel a) and end-diastolic volume (Panel b) evolution from baseline to 60 months follow-up, according to extracted thrombus length. LVESV = left ventricular end-systolic volume; LVEDV = left ventricular end-diastolic volume.
Figure 7
Figure 7
Left ventricular end-systolic volume (Panel a) and left ventricular end-diastolic volume (Panel b) progression in the two groups, from baseline to 60 months follow-up, with left ventricular remodelling criteria. Horizontal blue line −20% increase limit in Group A; horizontal red line −20% increase limit in Group B; LVESV = left ventricular end-systolic; LVEDV = left ventricular end-diastolic volume.
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