Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study

Khan, Akhtar A.; Davies, Allan; Whitehead, N.; McGee, Michael; Al-Omary, M.; Baker, David W.; Bhagwandeen, Rohan; Renner, Ian; Majeed, Tazeen; Hatton, Rachael; Collins, Nicholas; Attia, John; Boyle, Andrew

doi:10.1177/2048872618819657

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Despite the advancements in the management of patients with STEMI, elevated LVEDP has seldom been used as a treatment target. The elevated LVEDP in STEMI patients without cardiogenic shock can be safely reduced pharmacologically in the acute setting after primary PCI with a combination of nitrates and diuretics [ 26 ]. Thus, it is enticing to speculate that the early reduction in LVEDP in STEMI patients, specifically targeting those with the highest LVEDP, will reduce LVR and improve outcomes; however this hypothesis remains to be tested in prospective randomised controlled trials, such as the ongoing Reduction of End Diastolic Pressure in Acute Myocardial Infarction [REDPAMI] trial (registered at ANZCTR.org.au; registration number ACTRN12618000096257).…”

Section: Discussionmentioning

confidence: 99%

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

Al-Omary

Collins

et al. 2021

BMC Cardiovasc Disord

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Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study. Methods A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) (p = 0.01) from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

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

Al-Omary

Collins

et al. 2021

BMC Cardiovasc Disord

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“…3 In individuals with STEMI, the left ventricular end-diastolic pressure (LVEDP) is an important hemodynamics marker that has been demonstrated to be strongly associated with heart failure and death. 4,5 It is feasible and can be easily measured during primary PCI. However, LVEDP is often omitted in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…In acute MI, pre-existing hypertrophy or myocardial fibrosis can also lead to the progression and development of diastolic dysfunction. 5 Several studies have established the prognostic role of LVEDP in acute MI settings, [4][5][6]8 however, only limited studies have explored the relationship of LVEDP with the severity and extent of coronary artery diseases. 8,10 Therefore, the objective of this study was to assess the association of LVEDP with extent and severity of CAD in individuals undergoing primary PCI at a tertiary care cardiac center of Karachi, Pakistan.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular End-Diastolic Pressure and Extent of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention

Ahmed,

Shaikh,

Shah

et al. 2023

Pak Heart J

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Objectives: This study aimed to assess the association of left ventricular end-diastolic pressure (LVEDP) with the extent and severity of coronary artery diseases (CAD) in individuals undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center in Karachi, Pakistan. Methodology: This descriptive cross-sectional study included consecutive patients undergoing primary PCI. LVEDP was assessed with the help of a multipurpose catheter. The Association of LVEDP with the extent and severity of CAD was assessed. Results: LVEDP was stratified as ≤15 mmHg, 15-25 mmHg, and >25 mmHg. Out of 498 patients included in this study, 76.3% (380) were male, and mean age was 53.7±11.7 years. Mean LVEDP was 19.35±6.17 mmHg. Burden of diseases was found to be significantly associated with LVEDP level (p<0.001) with mean LVEDP of 18.5±5.6 mmHg, 19.5±6 mmHg, and 21.4±7.2 mmHg among patients with single, two and three-vessel disease respectively. Proportion of three-vessel diseases was 15.5% (37/239), 22.5% (47/209), and 36% (18/50) at LVEDP ≤15 mmHg, 15-25 mmHg, and >25 mmHg, respectively. Conclusion: There was a strong inverse relationship between LVEDP and initial TIMI flow grade (p=0.013) and a positive relationship between LVEDP and total length of the lesion (p=0.002). In conclusion, increased LVEDP was found to be associated with increased burden and extent of coronary artery disease, poor initial TIMI flow grade, and longer length of lesion.

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Left ventricular end-diastolic pressure predicts in-hospital outcomes in takotsubo syndrome

Buono

Montone

Meucci

et al. 2021

European Heart Journal. Acute Cardiovascular Care

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Aims Takotsubo syndrome (TTS) is associated to serious adverse in-hospital complications. We evaluated the role of invasively assessed left ventricular end-diastolic pressure (LVEDP) for predicting in-hospital complications in TTS patients compared to the most widely used echocardiographic parameters of ventricular function. Methods and Results We prospectively enrolled 130 patients (mean age 71.2 ± 11.3 years, 114 [87.7%] female) with TTS. Invasive measurement of LVEDP was performed at the time of cardiac catheterization. The rate of in-hospital complications (composite of acute heart failure, life-threatening arrhythmias and all-cause death) was examined. In-hospital complications occurred in 37 (28.5%) patients. Patients who experienced in-hospital complications had a higher prevalence of neurological trigger and lower prevalence of emotional trigger, higher LVEDP and mean E/e′ ratio and lower LV ejection fraction (LVEF) values compared to those who did not experience in-hospital complications. At multivariate logistic regression, higher LVEDP [odds ratio (OR) 1.12, 95% confidence interval (CI) [1.05–1.20], P < 0.001] and lower LVEF (OR 0.95, 95% CI [0.91–0.99], P = 0.011) remained independently predictors of in-hospital complications, while emotional trigger was associated to a lower risk (OR 0.24, 95% CI [0.06–0.96], P = 0.044). The area under the curve (AUC) for LEVDP in the prediction of in-hospital events was 0.776 (95% CI [0.69–0.86], P <0.001, with a sensitivity and specificity of 95% and 58% using a LVEDP cut-off value of 22.5 mmHg). The AUC was significantly higher for LVEDP than for E/e′ ratio (P = 0.037). Conclusions LVEDP measured at the time of catheterization may help in identifying TTS patients at higher risk of cardiovascular deterioration with relevant therapeutic implications.

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Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study

Cited by 3 publications

References 17 publications

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

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

Left Ventricular End-Diastolic Pressure and Extent of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention

Left ventricular end-diastolic pressure predicts in-hospital outcomes in takotsubo syndrome

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