Elevated myocardial wall stress after percutaneous coronary intervention in acute ST elevation myocardial infraction is associated with increased mortality

Kattel, Sharma; Bhatt, Hardik; Gurung, Sharda; Karthikeyan, Badri; Sharma, Umesh C

doi:10.1111/echo.15131

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…In the study conducted by Kattel et al [1] , Patients with acute STEMI requiring urgent PCI and a high ESWS were studied in 2021. linked to a higher rate of adverse outcomes in patients who received primary PCI for STEMI. They discovered that an ESWS of over 62.…”

Section: Discussionmentioning

confidence: 99%

“…Even though early percutaneous catheter intervention [PCI] was used to try to save the heart at risk, changes in myocardial wall stress [MWS] cause ventricular dilatation and dysfunction after an acute ST-segment elevation myocardial infarction [STEMI]. Whether this is temporary or has bad effects that last for a long time [1] . Myocardial remodeling caused by MI has been implicated in approximately two-thirds of the 5 million annual cases of heart failure [HF] [2] .…”

Section: Introductionmentioning

confidence: 99%

“…At the moment, there aren't enough imagingbased data to help risk-stratify post-STEMI patients for clinical results, such as follow-up after they leave the hospital [1] . Because of this, there is a pressing need for improvements in echocardiography to find echocardiographic parameters that can be measured in an objective way to help with risk stratification [5] .…”

Section: Introductionmentioning

confidence: 99%

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Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Moussa,

Bashandy,

EL-bahnasy

et al. 2023

International Journal of Medical Arts

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Article informationBackground: Acute ST-segment elevation myocardial infarction [STEMI] results in left ventricular adverse remodeling [LVR]. Increased left ventricular wall stress [LVWS] after Myocardial infarction [MI] initiates this process. Predicting the risk of future major adverse cardiovascular events [MACE] after STEMI has been a subject of great interest. There is a lack of imaging-based data for risk stratifying post-STEMI patients' clinical outcomes at this time. As a result, improvements in echocardiography are urgently needed to identify objectively measurable echocardiographic markers for improved risk stratification. The Aim of the work:This study aimed to study the relation between echocardiography-derived LVWS in non-diabetic patients presented with first acute anterior STEMI who underwent primary percutaneous coronary intervention with the MACE. Patients and Methods:The current study was a prospective cohort study that took place between January 2022 and November 2022 and included 78 nondiabetic patients who presented with acute anterior STEMI treated by primary PCI. LVWS was calculated within 72 hours by pre-discharge echocardiogram using volume-based formulas. Patients were divided into two groups based on their three months follow-up data following primary PCI; Group I: MACE-negative, and Group II: MACE-positive. Results: MACE-positive patients [n=18] had significantly higher end-systolic wall stress [ESWS] levels 94.95 ± 31.27 vs 77.20 ± 24.37 in MACEnegative patients [P value = 0.013*]. A receiver operating characteristics [ROC] curve was performed for the ESWS [KPa] as a predictor for MACE. The findings revealed an area under the curve of 0.674, the cut-off value for predicting MACE = 85.35 [KPa], with 66.97% sensitivity, 65% specificity, 86.7% Negative predictive value, 36.4 % positive predictive Value [P value = 0.026]. Conclusion: Echocardiography-based left ventricular systolic wall stress is a possibly useful prognostic tool for risk-stratifying non-diabetic STEMI patients early after MI and predicting MACE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Moussa,

Bashandy,

EL-bahnasy

et al. 2023

International Journal of Medical Arts

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“…In the distal side of the coronary artery, LV support can reduce LV diastolic pressure and volume, resulting in reduced LV diastolic wall stress. This can alleviate compression of capillaries during coronary flow in diastole, which is likely exaggerated in infarct tissue due to increased wall stress (Kattel et al, 2021;Sutton & Sharpe, 2000) and myocardial oedema (Fernández-Jiménez et al, 2015, 2017.…”

Section: Left Ventricular Support Increased Coronary Flowmentioning

confidence: 99%

Reduction of left ventricular diastolic pressure as a key regulator of infarct coronary flow under mechanical left ventricular support

Sakata,

Mavropoulos,

Mazurek

et al. 2024

The Journal of Physiology

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Restoring ischaemic myocardial tissue perfusion is crucial for minimizing infarct size. Acute mechanical left ventricular (LV) support has been suggested to improve infarct tissue perfusion. However, its regulatory mechanism remains unclear. We investigated the physiological mechanisms in six Yorkshire pigs, which were subjected to 90‐min balloon occlusion of the left anterior descending artery. During the acute reperfusion phase, LV support using an Impella heart pump was initiated. LV pressure, coronary flow and pressure of the infarct artery were simultaneously recorded to evaluate the impact of LV support on coronary physiology. Coronary wave intensity was calculated to understand the forces regulating coronary flow. Significant increases in coronary flow velocity and its area under the curve were found after mechanical LV support. Among the coronary flow‐regulating factors, coronary pressure was increased mainly during the late diastolic phase with less pulsatility. Meanwhile, LV pressure was reduced throughout diastole resulting in significant and consistent elevation of coronary driving pressure. Interestingly, the duration of diastole was prolonged with LV support. In the wave intensity analysis, the duration between backward suction and pushing waves was extended, indicating that earlier myocardial relaxation and delayed contraction contributed to the extension of diastole. In conclusion, mechanical LV support increases infarct coronary flow by extending diastole and augmenting coronary driving pressure. These changes were mainly driven by reduced LV diastolic pressure, indicating that the key regulator of coronary flow under mechanical LV support is downstream of the coronary artery, rather than upstream. Our study highlights the importance of LV diastolic pressure in infarct coronary flow regulation. imageKey points Restoring ischaemic myocardial tissue perfusion is crucial for minimizing infarct size. Although mechanical left ventricular (LV) support has been suggested to improve infarct coronary flow, its specific mechanism remains to be clarified. LV support reduced LV pressure, and elevated coronary pressure during the late diastolic phase, resulting in high coronary driving pressure. This study demonstrated for the first time that mechanical LV support extends diastolic phase, leading to increased infarct coronary flow. Future studies should evaluate the correlation between improved infarct coronary flow and resulting infarct size.

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Central stress pathways in the development of cardiovascular disease

Braun,

Patel,

Kameneva

et al. 2023

Clin Auton Res

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Elevated myocardial wall stress after percutaneous coronary intervention in acute ST elevation myocardial infraction is associated with increased mortality

Cited by 4 publications

References 32 publications

Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Reduction of left ventricular diastolic pressure as a key regulator of infarct coronary flow under mechanical left ventricular support

Central stress pathways in the development of cardiovascular disease

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