Predictors of Contractile Recovery After Successful Primary Percutaneous Coronary Intervention

Abstract

Background: Accurate diagnosis, characterization, and quantification of myocardial infarction (MI) are essential to assess the impact of therapy and to aid in predicting prognosis of patients with ischaemic heart disease.Objective: This study aimed to define different parameters regarding prediction of myocardial functional recovery following successful reperfusion of acute ST segment elevation myocardial infarction (STEMI). Patients and methods: This prospective study was carried out in Zagazig University and National Heart Institute (NHI) of Egypt during the period from June 2020 to June 2021. The study included 48 patients admitted with first acute STEMI. All patients were subjected to demographic data taking, electrocardiography and echocardiography examination (two examinations were done, the first was immediately after reperfusion and the second was 3 months from primary percutaneous coronary intervention (PCI). Results: There was no statistically significant difference between demographic data and risk factors except smoking habit. Regarding laboratory findings there were significant lower troponin value, peak CKMB value compared to patients had remolding (p=0.0001, p=0.027 respectively). Regarding ECG parameters, there was no statistical significant difference between the study groups regarding sum ST elevation and MI territory (p value > 0.05), but there was highly statistically significant difference between the study groups regarding 90 min ST resolution among contractile recovery (group I) p=0.0001. Conclusions: In this study patients affected by AMI with ST segment elevation and treated by primary PCI showed contractile recovery in 60.4% of the patients, while the remodeling of the LV has been observed in 39.6%.

Myocardial recovery after percutaneous coronary intervention in coronary artery disease patients with impaired systolic function- predictive utility of global longitudinal strain

“…This was consistent with other studies. 14 , 17 , 18 Also, there was a statistically significant difference between the study groups regarding baseline LV- EDV as the group improving LVEF post PCI had smaller values and this is similar to other studies. 14 , 19 This all could be explained by the severity/extension of myocardial injury (reflected by an elevated level of serum troponin) and the degree of LV remodeling (dilatation) during the acute ischemic phase both hindering LV improvement and further recovery even after successful revascularization.…”

“…They mostly suggested a GLS lower than about 12%–15% to be a significant independent predictor of adverse outcomes. 14 , 26 , 27 Our results showed that a GLS- cut-off value of greater than 9%; predicts further LV recovery and this relatively differs from other reported values among similar studies. Many factors might be attributed to this finding; the mean age of our patients is slightly older compared to other studies, variable types of ACS presentation, lower mean LVEF at the acute insult, and a larger sample of the population with a variable background.…”

“…This finding is consistent with many other studies. 14 , 15 , 16 The overview of most of the literature investigating the LV recovery post PCI concerns STEMI, however, the unique value of our study is to evaluate myocardial recovery among all patients who presented with different types of ACS and had impaired LV systolic function. This also explains the relatively higher prevalence of LV improvement at the follow-up stage in the current study.…”