Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

Khan, Akhtar A.; Al-Omary, M.; Collins, Nicholas; Attia, John; Boyle, Andrew

doi:10.1186/s12872-021-02046-x

Cited by 3 publications

(2 citation statements)

References 28 publications

(28 reference statements)

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“…Similar to our result, Tesak et al [20] showed statistically significant higher LVEDP in non-survivors group (median= 30 mmHg, range 22-39 mmHg) when compared to survivors group (24 mmHg, range 12-38 mmHg) with p-value= 0.001 & with LVEDP was independent predictor for 30-day mortality [AUC 0.715, 95% CI (0.626; 0.803), p-value <0.001, cut-off value ≥20.5 mmHg]. Also, Khan et al [21] in examination of the TIMI II randomised controlled trial examining the prognostic significance of LVEDP in re-perfused STEMI, as well as its natural history. That study subdivided patients into 4 quartiles according to their LVEDP (quartile 1: median LVEDP= 10 mmHg vs 16 mmHg in quartile 2, 20 mmHg in quartile 3 and 27 mmHg in quartile 4) and found significant increase of all-cause mortality [15 patients (5%), 17 patients (5%), 15 patients (6%) and 39 patients (14%); respectively] and heart failure [41 patients (12%) vs. 51 patients (15%), 54 patients (21%) and 86 patients (32%); respectively] with p-value < 0.001.…”

Section: Discussionmentioning

confidence: 92%

Role of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure Ratio in Prediction of Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

2023

The Egyptian Journal of Hospital Medicine

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Background: Among all cardiovascular illnesses, myocardial infraction is regarded as one of the major causes of morbidity and death. Though, mortality rates have been reduced all over the past few years, there is still a relative risk for occurrence of the different major adverse cardiac events (MACEs). Objective: To evaluate the role of ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention (PPCI) to predict MACEs both in-hospital and during 3-months follow up in patients with STEMI. Patients and Methods: This was a multicenter prospective study, conducted in Nasr City Health Insurance Hospital and Benha University Hospital in the period from March 2022 to March 2023. Included 100 patients who were presented by acute STEMI and managed by successful PPCI for a single vessel disease. Results: In our results, there was no statistically significant difference between the 2 groups as regarding demographic data and risk factors. Patients with MACEs had higher incidence of door to balloon time > 90 minutes, higher incidence of Killip class II and III, and of anterior STEMI in comparison with those without MACEs. Also, patients with MACEs had lower SBP and DBP, higher HR, lower LVEF, higher LVESV, higher incidence of DD grade II and lower both mean septal and lateral e' wave velocities, higher mean E wave velocity, both septal and lateral e/e' ratios. Patients with MACEs also had higher TIMI and GRACE RS, LVEDP, higher incidence of LAD as a culprit vessel. While, they had lower invasive SBP, DBP and SBP/LVEDP ratio. Regarding ROC curve analysis, SBP/LVEDP ratio cutoff value of ≤ 4.7 was shown to have the best diagnostic accuracy. TIMI risk score cut-off value > 3 was shown to have the second diagnostic accuracy in prediction of MACEs. AUC of SBP/LVEDP ratio was higher than that of TIMI RS, so SBP/LVEDP ratio was more accurate in predicting MACEs in STEMI patients who underwent primary PCI to a single vessel disease. Conclusion: SBP/LVEDP ratio is an easily rapidly determined ratio at the time of PPCI that can provide important prognostic information regarding risk stratification of STEMI patients.

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Section: Discussionmentioning

confidence: 92%

Role of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure Ratio in Prediction of Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

2023

The Egyptian Journal of Hospital Medicine

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“…When using only the systolic support, a further increase in the support pressure would theoretically lead to the desired EF. However, the EDP would remain elevated, which has been identified as a potential predictor of heart failure ( 44 – 46 ). Whether solely the reduction in EDP would eventually lower the risk needs to be investigated further.…”

Section: Discussionmentioning

confidence: 99%

Support Pressure Acting on the Epicardial Surface of a Rat Left Ventricle—A Computational Study

Martonová

Holz

Brackenhammer

et al. 2022

Front. Cardiovasc. Med.

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The present computational study investigates the effects of an epicardial support pressure mimicking a heart support system without direct blood contact. We chose restrictive cardiomyopathy as a model for a diseased heart. By changing one parameter representing the amount of fibrosis, this model allows us to investigate the impairment in a diseased left ventricle, both during diastole and systole. The aim of the study is to determine the temporal course and value of the support pressure that leads to a normalization of the cardiac parameters in diseased hearts. These are quantified via the end-diastolic pressure, end-diastolic volume, end-systolic volume, and ejection fraction. First, the amount of fibrosis is increased to model diseased hearts at different stages. Second, we determine the difference in the left ventricular pressure between a healthy and diseased heart during a cardiac cycle and apply for the epicardial support as the respective pressure difference. Third, an epicardial support pressure is applied in form of a piecewise constant step function. The support is provided only during diastole, only during systole, or during both phases. Finally, the support pressure is adjusted to reach the corresponding parameters in a healthy rat. Parameter normalization is not possible to achieve with solely diastolic or solely systolic support; for the modeled case with 50% fibrosis, the ejection fraction can be increased by 5% with purely diastolic support and 14% with purely systolic support. However, the ejection fraction reaches the value of the modeled healthy left ventricle (65.6%) using a combination of diastolic and systolic support. The end-diastolic pressure of 13.5 mmHg cannot be decreased with purely systolic support. However, the end-diastolic pressure reaches the value of the modeled healthy left ventricle (7.5 mmHg) with diastolic support as well as with the combination of the diastolic and systolic support. The resulting negative diastolic support pressure is −4.5 mmHg, and the positive systolic support pressure is 90 mmHg. We, thereby, conclude that ventricular support during both diastole and systole is beneficial for normalizing the left ventricular ejection fraction and the end-diastolic pressure, and thus it is a potentially interesting therapy for cardiac insufficiency.

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TRAF3 promoted ROS-induced oxidative stress in model of cardiac infarction through the regulation of ULK1 ubiquitination

Zhu¹,

Chen²,

Liang³

2022

Clinical and Experimental Hypertension

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Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

Cited by 3 publications

References 28 publications

Role of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure Ratio in Prediction of Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Role of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure Ratio in Prediction of Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Support Pressure Acting on the Epicardial Surface of a Rat Left Ventricle—A Computational Study

TRAF3 promoted ROS-induced oxidative stress in model of cardiac infarction through the regulation of ULK1 ubiquitination

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