Why the study?
To investigate the effect of prior angina on the development and severity of ischemic mitral regurgitation at 3 months in patients with STEMI.
Does prior angina within 72 hours before STEMI reduce the severity of ischemic mitral regurgitation at 3 months in patients revascularized by PCI?
Does prior angina within 72 hours before STEMI reduce the severity of ischemic mitral regurgitation at 3 months in patients revascularized by PCI?
Prior angina within 72 hours before STEMI is associated with reduced severity of ischemic mitral regurgitation and improved ejection fraction at 3 months, suggesting a protective role of ischemic preconditioning.
Answers are grounded in this paper and cite their sources.
May indicate ischemic preconditioning benefit in STEMI; hypothesis-generating and should not change practice without prospective trials.
BackgroundMitral regurgitation may develop due to left ventricular (LV) remodeling within 3 months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR). Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3 rd month in patients with ST elevation MI (STEMI).MethodsFourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According to presence of prior angina within 72 hours before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at 1 st , 3 rd days and 3 rd month. IMR was evaluated by proximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson’s method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups.ResultsAlthough PISA-r, EROA and Rvol were similar in both groups at 1 st and 3 rd days, all were significantly decreased (p=0.012, p=0.007, p=0.011, respectively) and EF was significantly increased (p< 0.001) in angina (+) group at 3 rd month. NTpro-BNP and hs-TnT levels at 1 st day and 3 rd month were similar, however CK-MB level at 3 rd month was found to be significantly lower in the angina (+) group (p=0.034).ConclusionAt the end of the 3 rd month, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72 hours prior to STEMI, suggesting a relation with IPC.
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Özel et al. (2021) studied this question.
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