Coronary sinus filling time at a cutoff of 3.73 seconds independently predicted early left ventricular recovery in STEMI patients after PPCI, correlating negatively with LV-GLS (r = -0.643).
Cohort (n=142)
Does coronary microvascular dysfunction, assessed by CSFT and MBG, predict early left ventricular recovery in STEMI patients following primary percutaneous coronary intervention?
Coronary sinus filling time and myocardial blush grade, combined with global longitudinal strain, can independently predict early left ventricular recovery in STEMI patients after primary PCI.
Effect estimate: r = -0.643
Abstract Background Coronary microvascular dysfunction (CMD) is a key predictor for recovery in the left ventricle (LV) following acute ST-elevation myocardial infarction (STEMI). Even when epicardial flow is restored after primary percutaneous coronary intervention (PPCI), CMD is still a key contributor to incomplete reperfusion. The current investigation discusses coronary sinus filling time (CSFT) and myocardial blush grade (MBG) as predictors for recovery in the LV following PPCI and utilizes non-invasive speckle-tracking echocardiography (STE) for measuring LV function. Purpose The primary objective in this study is to evaluate if CMD, as evaluated based on CSFT and MBG, influences early recovery in STEMI patients who have undergone PPCI. Secondary outcomes are to quantify CMD and major adverse cardiovascular events (MACE) and mortality in STEMI patients who have undergone PPCI. Methods We evaluated a total of 142 STEMI patients who had undergone PPCI and grouped them as optimal and non-optimal coronary flow based on MBG. Two-dimensional echocardiography (2DE) and STE were used for assessing LV function before and after PPCI. The main outcomes were LVEF and GLS at 3 and 6 months. Secondary outcomes included MACE and mortality. The parameters derived from coronary angiography (TIMI flow, MBG, and CSFT) before and after PPCI were compared. The statistical analyses involved Pearson’s correlation and multiple regression for predicting recovery in LV. Results CSFT at a cutoff level of 3.73 seconds properly identified early recovery in LV and had a negative correlation (r = -0.643) with LV-GLS. A cutoff level in LV-GLS at -16.6% also accurately identified recovery. Elevated risk for mortality was related to LV end-systolic volume index (LVESVI) at 40-45 mL/m². Multivariate regression analysis identified GLS and CSFT as independent predictors for early recovery in LV. Receiver operating characteristic (ROC) analysis identified suitable cutoff values for early recovery in LV based on GLS and CSFT. Conclusions The combined application of TIMI flow, MBG, CSFT, and GLS provides a simple and reproducible method for assessing coronary microvascular function and predicting early LV recovery in STEMI patients following PPCI. The findings are clinically useful for better patient stratification, monitoring, and intervention following PCI. Further validation in larger cohorts and long-term follow-up studies is recommended to confirm these findings.Speckle tracking shows average longitudi LAD opacification at the origin of D1
Shehata et al. (Sat,) conducted a cohort in Acute ST-elevation myocardial infarction (STEMI) (n=142). Coronary microvascular dysfunction (evaluated by CSFT and MBG) vs. Optimal coronary flow was evaluated on Early recovery in the left ventricle (evaluated by LVEF and GLS at 3 and 6 months) (r = -0.643). Coronary sinus filling time at a cutoff of 3.73 seconds independently predicted early left ventricular recovery in STEMI patients after PPCI, correlating negatively with LV-GLS (r = -0.643).