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Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction.

2017Artigo científico Acesso aberto
http://hdl.handle.net/10400.10/2037
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Autores

Baptista, SB
Faustino, M
Brízida, L
Loureiro, J
Augusto, J
Abecasis, J
Monteiro, C
Leal, P
Nédio, M
Abreu, PF

Orientador(es)

Resumo(s)

INTRODUCTION AND OBJECTIVES: The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. METHODS: ED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI <1.67. Infarct extension was assessed by troponin I (TnI) release and contrast-enhanced cardiac magnetic resonance (ceCMR). MVO was assessed by ceCMR and by indirect angiographic and ECG indicators. An echocardiogram was also performed in the first 12 h. RESULTS: We included 38 patients (mean age 60.0±13.7 years, 29 male). Mean RHI was 1.87±0.60 and 16 patients (42.1%) had ED. Peak TnI (median 118 mg/dl, IQR 186 vs. 67/81, p=0.024) and AUC of TnI (median 2305, IQR 2486 vs. 1076/1042, p=0.012) were significantly higher in patients with ED, who also showed a trend for more transmural infarcts (63.6% vs. 22.2%, p=0.06) and larger infarct mass on ceCMR (median 17.5%, IQR 15.4 vs. 10.1/10.3, p=0.08). Left ventricular ejection fraction (LVEF) was lower and wall motion score index (WMSI) was higher on both echocardiogram and ceCMR in patients with ED. On ceCMR, MVO was more frequent in patients with RHI <1.67 (54.5% vs. 11.1%, p=0.03). ECG and angiographic indicators of MVO all showed a trend toward worse results in these patients. CONCLUSIONS: The presence of ED assessed by PAT 24 h after P-PCI in patients with STEMI is associated with larger infarcts, lower LVEF, higher WMSI and higher prevalence of MVO.

Descrição

Palavras-chave

Myocardial infarction Vascular diseases

URI

http://hdl.handle.net/10400.10/2037

Contexto Educativo

Citação

Rev Port Cardiol. 2017 Oct;36(10):731-742.

Projetos de investigação

Unidades organizacionais

Fascículo

Editora

Sociedade Portuguesa de Cardiologia

DOI

10.1016/j.repc.2017.01.006

Coleções

CAR - Artigos publicados em revistas indexadas

Licença CC

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