[PP.18.01] VENTRICULAR-ARTERIAL COUPLING MAY BE AN EARLY MARKER OF CARDIAC REMODELING AFTER MYOCARDIAL INFARCTION TREATED WITH PERCUTANEOUS CORONARY INTERVENTION

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Abstract

Objective:

Ventricular remodeling may occur following myocardial infarction (MI) of the left ventricle (LV) and such remodeling has been shown to be correlated with increased patient morbidity and mortality. It is important to estimate the likelihood of remodeling from the state of the infarcted LV. The aim of the study was to assess the ventricular-arterial coupling (VAC) in patients with ST segment elevation (STEMI) and non ST segment elevation MI (NSTEMI) treated with percutaneous coronary intervention (PCI).

Design and method:

In 93 patients with acute coronary syndrome and PCI (70% male, age 61,5 ± 10,1 years (M ± SD), 57 (61,3%) with STEMI, smokers 25%, arterial hypertension 20.4%, blood pressure (BP) 129 ± 6/82 ± 7 mmHg, LVEF 47,4 ± 4,3%) 2-dimentional echocardiography was performed to assess arterial elastance (Ea) and end-systolic LV elastance (Ees) on admission and in 4 weeks. VAC was assessed as the ratio Ea/Ees.

Results:

Baseline LF EF was 47.4 ± 4.3, E/A 0.95 ± 0,18, Ea 1.9 ± 0.3 mmHg/ml/m2, Ees 2.1 ± 0.4 mmHg/ml/m2, VAC 0.89 ± 0.1. At baseline all patients had LVEF >40% and VAC in optimal range. In 4 weeks after PCI VAC >1.2 (upper optimal level) was revealed in 19% of patients with STEMI and 44% with NSTEMI. In patients with achieved VAC >1.2 Ees (2.1 ± 0.4 vs 1.6 ± 0.2 mmHg/ml/m2, p < 0.001), stroke work (SW) (6254 ± 1516 vs 6112 ± 1059 mmHg*ml/m2, p>0.05), potential energy (PE) (62.8 ± 4.3 vs 56.3 ± 5.4 mmHg*ml/m2, p < 0.001), pressure-volume area (PVA) (6317 ± 2136 vs 6179 ± 1060 mmHg*ml/m2, p < 0.001), LV work efficiency (SW/PVA) significantly decreased (p < 0.001) while Ea (1.9 ± 0.3 to 2.1 ± 0.4 mmHg/ml/m2, p > 0.05) did not change. In patients with VAC in optimal range in 4 weeks Ees decreased from 2.3 ± 0.3 to 2.1 ± 0.4 mmHg/ml/m2 (p < 0.001), Ea (p < 0.001) and VAC (p < 0.001) did not change.

Conclusions:

Impairment of functioning of cardio-vascular system assessed by increased value of VAC > 1.2 was revealed in 27% of patients with acute coronary syndrome. Increase of VAC is associated predominantly with decrease of Ees and LV work efficiency (SW/PVA). Increased in the VAC index > 1.2 indicating LV-arterial uncoupling may be an early marker of cardiovascular remodeling in MI or systolic dysfunction.

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