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Gepubliceerd in: Netherlands Heart Journal 5/2013

Open Access 01-05-2013 | Original Article

Coronary microcirculatory dysfunction is associated with left ventricular dysfunction during follow-up after STEMI

Auteurs: M. Remmelink, K. D. Sjauw, Z. Y. Yong, J. D. E. Haeck, M. M. Vis, K. T. Koch, J. G. P. Tijssen, R. J. de Winter, J. P. S. Henriques, J. J. Piek, J. Baan Jr.

Gepubliceerd in: Netherlands Heart Journal | Uitgave 5/2013

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Abstract

Background

Coronary microvascular resistance is increased after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), which may be related in part to changed left ventricular (LV) dynamics. Therefore we studied the coronary microcirculation in relation to systolic and diastolic LV function after STEMI.

Methods

The study cohort consisted of 12 consecutive patients, all treated with primary PCI for a first anterior wall STEMI. At 4 months, we assessed pressure-volume loops. Subsequently, we measured intracoronary pressure and flow velocity and calculated coronary microvascular resistance. Infarct size and LV mass were assessed using magnetic resonance imaging.

Results

Patients with an impaired systolic LV function due to a larger myocardial infarction showed a higher baseline average peak flow velocity (APV) than the other patients (26 ± 7 versus 17 ± 5 cm/s, p = 0.003, respectively), and showed an impaired variable microvascular resistance index (2.1 ± 1.0 versus 4.1 ± 1.3 mmHg cm−1∙s−1, p = 0.003, respectively). Impaired diastolic relaxation time was inversely correlated with hyperaemic APV (r = −0.56, p = 0.003) and positively correlated with hyperaemic microvascular resistance (r = 0.48, p = 0.01). LV dilatation was associated with a reduced variable microvascular resistance index (r = 0.78, p = 0.006).

Conclusion

A larger anterior myocardial infarction results in impaired LV performance associated with reduced coronary microvascular resistance variability, in particular due to higher coronary blood flow at baseline in these compromised left ventricles.
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Metagegevens
Titel
Coronary microcirculatory dysfunction is associated with left ventricular dysfunction during follow-up after STEMI
Auteurs
M. Remmelink
K. D. Sjauw
Z. Y. Yong
J. D. E. Haeck
M. M. Vis
K. T. Koch
J. G. P. Tijssen
R. J. de Winter
J. P. S. Henriques
J. J. Piek
J. Baan Jr.
Publicatiedatum
01-05-2013
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 5/2013
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-013-0382-2

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