Acute Left Ventricular Dynamic Effects of Primary Percutaneous Coronary Intervention. From Occlusion to Reperfusion

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Abstract

Objectives: We studied the left ventricular (LV) dynamic effects of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) by directly obtaining pressure-volume (PV) loops during the procedure. Background: An acute myocardial infarction causes a decrease in LV compliance. The instantaneous effects of primary PCI on LV compliance are unknown. Methods: We studied 15 consecutive patients (10 males, ages 59 ± 12 years), who presented with their first acute anterior STEMI within 6 h after onset of symptoms, and in whom coronary angiography revealed an occluded left anterior descending coronary artery. Before performing primary PCI, we inserted a pressure-conductance catheter in the LV to continuously obtain PV loops. Results: Immediately after successful reperfusion, significant improvements were observed in LV diastolic function, as indicated by an increased end-diastolic compliance with a 6.0 ± 2.8 mm Hg (p < 0.0001) downward shift of the compliance curve. There was a decrease in end-diastolic pressure of 24 ± 18% (p = 0.0002), in stiffness of 27 ± 18% (p = 0.0003), and in wall stress of 20 ± 24% (p = 0.004). Systolic function mainly showed an immediate improvement in apical contractility from 40 ± 17% to 54 ± 15% (p = 0.01). Conclusions: Primary PCI in anterior STEMI patients causes an immediate improvement in diastolic function, assessed by online PV loop measurements. © 2009 American College of Cardiology Foundation.

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Remmelink, M., Sjauw, K. D., Henriques, J. P. S., Vis, M. M., van der Schaaf, R. J., Koch, K. T., … Baan, J. (2009). Acute Left Ventricular Dynamic Effects of Primary Percutaneous Coronary Intervention. From Occlusion to Reperfusion. Journal of the American College of Cardiology, 53(17), 1498–1502. https://doi.org/10.1016/j.jacc.2008.12.058

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