Coronary microvascular dysfunction beyond microvascular obstruction in ST‐elevation myocardial infarction: Functional and clinical correlates

Abstract

Objectives: To retrospectively characterize clinical predictors and impact on left ventricular (LV) ejection fraction (EF) of microvascular dysfunction (MVD) beyond microvascular obstruction (MVO), in 49 consecutive patients (58 ± 11 years), with successfully treated ST-elevation myocardial infarction. Methods: By myocardial contrast echocardiography, MVD was considered as myocardial segments with delayed/patchy opacification, while MVO as areas without any opacification. Both MVD and MVO were planimetered and expressed as percentage of total LV wall area. Patients were divided into tertiles of MVO: I (MVO 0%), II (MVO 4-17%), and III (MVO 18-38%) groups. Cardiac troponin T (cTnT) values obtained at admission and at peak were considered for analysis.Results: MVD correlated inversely with EF in groups I and II (p = 0.025, p = 0.019, respectively), but not in group III. MVD was independently predicted by cTnT on admission (β = 1.85; 95%CI = 0.46-3.24, p = 0.011) and female sex (β for male sex = −14.46;

Subclinical dysfunction of remote myocardium is related to high NT-proBNP and affects global contractility at follow-up, independently of infarct area

“…It may be due to the widespread inflammatory activation ( 20 , 21 ) with maladaptive changes of the extracellular matrix ( 5 ), resulting in diffuse fibrosis ( 22 , 23 ). The finding that rLS correlates with LVEF similarly to iLS and bLS confirms that structural and functional changes, occurring outside the infarcted area ( 24 – 27 ), might contribute to impair contractility ( 28 ). Regional LS can be affected independently of CAD extent, as well as perfusion abnormalities can be present outside infarct area in patients without multi-vessel CAD ( 29 ).…”