TY - JOUR
T1 - Coronary thermodilution waveforms after acute reperfused stsegment-elevation myocardial infarction
T2 - Relation to microvascular obstruction and prognosis
AU - Yew, Shu Ning
AU - Carrick, David
AU - Corcoran, David
AU - Ahmed, Nadeem
AU - Carberry, Jaclyn
AU - May, Vannesa Teng Yue
AU - McEntegart, Margaret
AU - Petrie, Mark C.
AU - Eteiba, Hany
AU - Lindsay, Mitchell
AU - Hood, Stuart
AU - Watkins, Stuart
AU - Davie, Andrew
AU - Mahrous, Ahmed
AU - Mordi, Ify
AU - Ford, Ian
AU - Oldroyd, Keith G.
AU - Berry, Colin
PY - 2018/8/4
Y1 - 2018/8/4
N2 - Background-Invasive measures of microvascular resistance in the culprit coronary artery have potential for risk stratification in acute ST-segment-elevation myocardial infarction. We aimed to investigate the pathological and prognostic significance of coronary thermodilution waveforms using a diagnostic guidewire. Methods and Results-Coronary thermodilution was measured at the end of percutaneous coronary intervention, (PCI) and contrastenhanced cardiacmagnetic resonance imaging (MRI)was intended on day 2 and 6 months later to assess left ventricular (LV) function and pathology. All-cause death or first heart failure hospitalization was a pre-specified outcome (median follow-up duration 1469 days). Thermodilution recordings underwent core laboratory assessment. A total of 278 patients with acute ST-segment elevation myocardial infarction EMI (72% male, 59±11 years) had coronary thermodilution measurements classified as narrow unimodal (n=143 [51%]), wide unimodal (n=100 [36%]), or bimodal (n=35 [13%]). Microvascular obstruction and myocardial hemorrhage were associated with the thermodilution waveformpattern (P=0.007 and 0.011, respectively), and both pathologies were more prevalent in patients with a bimodal morphology. On multivariate analysis with baseline characteristics, thermodilution waveform status was a multivariable associate of microvascular obstruction (odds ratio [95% confidence interval]=5.29 [1.73, 16.22];, P=0.004) and myocardial hemorrhage (3.45 [1.16, 10.26]; P=0.026), but the relationship was not significant when index of microvascular resistance (IMR) <40 or change in index of microvascular resistance (5 per unit) was included. However, a bimodal thermodilution waveform was independently associated with allcause death and hospitalization for heart failure (odds ratio [95% confidence interval]=2.70 [1.10, 6.63]; P=0.031), independent of index of microvascular resistance<40, ST-segment resolution, and TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade. Conclusions-The thermodilution waveform in the culprit coronary artery is a biomarker of prognosis and may be useful for risk stratification immediately after reperfusion therapy.
AB - Background-Invasive measures of microvascular resistance in the culprit coronary artery have potential for risk stratification in acute ST-segment-elevation myocardial infarction. We aimed to investigate the pathological and prognostic significance of coronary thermodilution waveforms using a diagnostic guidewire. Methods and Results-Coronary thermodilution was measured at the end of percutaneous coronary intervention, (PCI) and contrastenhanced cardiacmagnetic resonance imaging (MRI)was intended on day 2 and 6 months later to assess left ventricular (LV) function and pathology. All-cause death or first heart failure hospitalization was a pre-specified outcome (median follow-up duration 1469 days). Thermodilution recordings underwent core laboratory assessment. A total of 278 patients with acute ST-segment elevation myocardial infarction EMI (72% male, 59±11 years) had coronary thermodilution measurements classified as narrow unimodal (n=143 [51%]), wide unimodal (n=100 [36%]), or bimodal (n=35 [13%]). Microvascular obstruction and myocardial hemorrhage were associated with the thermodilution waveformpattern (P=0.007 and 0.011, respectively), and both pathologies were more prevalent in patients with a bimodal morphology. On multivariate analysis with baseline characteristics, thermodilution waveform status was a multivariable associate of microvascular obstruction (odds ratio [95% confidence interval]=5.29 [1.73, 16.22];, P=0.004) and myocardial hemorrhage (3.45 [1.16, 10.26]; P=0.026), but the relationship was not significant when index of microvascular resistance (IMR) <40 or change in index of microvascular resistance (5 per unit) was included. However, a bimodal thermodilution waveform was independently associated with allcause death and hospitalization for heart failure (odds ratio [95% confidence interval]=2.70 [1.10, 6.63]; P=0.031), independent of index of microvascular resistance<40, ST-segment resolution, and TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade. Conclusions-The thermodilution waveform in the culprit coronary artery is a biomarker of prognosis and may be useful for risk stratification immediately after reperfusion therapy.
KW - Magnetic resonance imaging
KW - Myocardial infarction
KW - Pathophysiology
UR - http://www.scopus.com/inward/record.url?scp=85051436579&partnerID=8YFLogxK
U2 - 10.1161/JAHA.118.008957
DO - 10.1161/JAHA.118.008957
M3 - Article
C2 - 30371237
AN - SCOPUS:85051436579
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease (JAHA)
JF - Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease (JAHA)
IS - 15
M1 - e008957
ER -