Staccato reperfusion improves myocardial microcirculatory function and long-term left ventricular remodelling: a randomised contrast echocardiography study.
OBJECTIVE
To investigate the effects of staccato reperfusion (SR) during percutaneous coronary intervention (PCI) on myocardial microcirculatory function as assessed by myocardial contrast echocardiography.


METHODS
Tertiary centre.


METHODS
Thirty-nine patients were randomised to SR (n=20) or abrupt reperfusion (AR, n=19) within 48 h of an acute coronary syndrome. Contrast intensity replenishment curves were constructed to assess the blood volume (An), velocity (β) and flow (A×β) of the segments associated with the PCI-treated artery before, 48 h, 1 and 12 months after PCI. Left ventricular (LV) end-diastolic (EDVs) and systolic volumes (ESVs) were evaluated. Plasma malondialdehyde (MDA) was determined immediately before and 18 min after PCI to assess oxidative stress.


RESULTS
SR was related to a greater improvement in A(n), β and A×β at 48 h, 1 and 12 months after intervention compared with AR (mean A×β: 0.91, 5.5, 7.14, 6.9 for SR vs 1.02, 3.34, 4.28, 3.71 for AR, p<0.01). After PCI, the mean MDA change was -27% in SR patients and +55% in the AR patients (p<0.05). The percentage change in MDA correlated with the percentage change in A(n) at all time points (r=0.468, r=0.682, r=0.674, p<0.01). Compared with AR, SR was related to a greater percentage decrease in EDV (-11.61% vs -4.13%) and ESV (-34.68% vs -14.83%) at 12 months after PCI (p<0.05). The percentage change in ESV at 12 months correlated with the corresponding percentage changes in A(n), β and A×β (r=-0.410, r=-0.509, r=-0.577, respectively, p<0.05).


CONCLUSIONS
SR improves myocardial microcirculatory function after PCI, leading to a concomitant improvement in LV geometry, probably through reduction of oxidative stress.
University of Athens, Perikleous 19, N. Chalkidona, Athens, Greece. ignoik@otenet.gr
Ignatios
I
Ikonomidis
Efstathios K
EK
Iliodromitis
Stavros
S
Tzortzis
Aias
A
Antoniadis
Ioannis
I
Paraskevaidis
Ioanna
I
Andreadou
Katerina
K
Fountoulaki
Dimitrios
D
Farmakis
Dimitrios T
DT
Kremastinos
Maria
M
Anastasiou-Nana
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology; D020257:Ventricular Remodeling / Q000502:physiology*
D000925:Anticoagulants