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

dc.contributor.authorBaptista, SB
dc.contributor.authorFaustino, M
dc.contributor.authorBrízida, L
dc.contributor.authorLoureiro, J
dc.contributor.authorAugusto, J
dc.contributor.authorAbecasis, J
dc.contributor.authorMonteiro, C
dc.contributor.authorLeal, P
dc.contributor.authorNédio, M
dc.contributor.authorAbreu, PF
dc.contributor.authorGil, V
dc.contributor.authorMorais, C
dc.date.accessioned2018-10-31T15:35:37Z
dc.date.available2018-10-31T15:35:37Z
dc.date.issued2017
dc.description.abstractINTRODUCTION 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Port Cardiol. 2017 Oct;36(10):731-742.pt_PT
dc.identifier.doi10.1016/j.repc.2017.01.006pt_PT
dc.identifier.issn2174-2030
dc.identifier.urihttp://hdl.handle.net/10400.10/2037
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSociedade Portuguesa de Cardiologiapt_PT
dc.relation.publisherversionfile://u_share/users/arminda.m.sustelo/Downloads/S217420491730291X%20(1).pdfpt_PT
dc.subjectMyocardial infarctionpt_PT
dc.subjectVascular diseasespt_PT
dc.titleEarly peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction.pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceLisboapt_PT
oaire.citation.endPage742pt_PT
oaire.citation.startPage731pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologiapt_PT
oaire.citation.volume36pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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