Acute left ventricular dynamic effects of primary percutaneous coronary intervention from occlusion to reperfusion.
OBJECTIVE
We studied the left ventricular (LV) dynamic effects of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) by directly obtaining pressure-volume (PV) loops during the procedure.


BACKGROUND
An acute myocardial infarction causes a decrease in LV compliance. The instantaneous effects of primary PCI on LV compliance are unknown.


METHODS
We studied 15 consecutive patients (10 males, ages 59 +/- 12 years), who presented with their first acute anterior STEMI within 6 h after onset of symptoms, and in whom coronary angiography revealed an occluded left anterior descending coronary artery. Before performing primary PCI, we inserted a pressure-conductance catheter in the LV to continuously obtain PV loops.


RESULTS
Immediately after successful reperfusion, significant improvements were observed in LV diastolic function, as indicated by an increased end-diastolic compliance with a 6.0 +/- 2.8 mm Hg (p < 0.0001) downward shift of the compliance curve. There was a decrease in end-diastolic pressure of 24 +/- 18% (p = 0.0002), in stiffness of 27 +/- 18% (p = 0.0003), and in wall stress of 20 +/- 24% (p = 0.004). Systolic function mainly showed an immediate improvement in apical contractility from 40 +/- 17% to 54 +/- 15% (p = 0.01).


CONCLUSIONS
Primary PCI in anterior STEMI patients causes an immediate improvement in diastolic function, assessed by online PV loop measurements.
Remmelink
Maurice
M
Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands.
Sjauw
Krischan D
KD
Henriques
José P S
JP
Vis
Marije M
MM
van der Schaaf
René J
RJ
Koch
Karel T
KT
Tijssen
Jan G P
JG
de Winter
Robbert J
RJ
Piek
Jan J
JJ
Baan
Jan
J
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D002302:Cardiac Output; D003971:Diastole; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left