title: Association between time to reperfusion and echocardiography assessed left ventricular filling pressure in patients with first ST-segment elevation myocardial infarction undergoing primary coronary intervention.
abstract: BACKGROUND
  Diastolic dysfunction and elevated left ventricular (LV) filling pressure following acute myocardial infarction are associated with adverse outcomes. Although time to reperfusion is a powerful prognostic marker following acute myocardial infarction, little is known about its impact on diastolic function and LV filling pressure. We hypothesized that delayed time to reperfusion will be associated with worse diastolic function.
  
  
  METHODS
  This study included 180 consecutive patients with first ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). They presented of chest pain within 24 h and underwent echocardiography within 3 days of primary PCI.
  
  
  RESULTS
  Median time to reperfusion, defined as the time from symptom onset to reperfusion at the end of primary PCI, was 185 min (interquartile range 120-660). Patients with reperfusion time > 185 min (n = 92) had a significantly higher E/septal e' (13.3 ± 5.0 vs. 9.7 ± 2.3, p < 0.001) and E/lateral e' (9.8 ± 3.5 vs. 7.8 ± 2.2, p < 0.001) ratios, and more advanced diastolic grade (p < 0.001) compared to those having early reperfusion (n = 88). There were no significant differences in LV ejection fraction and left atrial volume between the two groups. Time to reperfusion was an independent predictor of early E/average e' ratio. The adverse effect of late reperfusion on diastolic dysfunction was more prominent in patients with anterior myocardial infarction.
  
  
  CONCLUSIONS
  Longer time to reperfusion is associated with early elevated LV diastolic pressure in primary PCI-treated patients with STEMI.
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. kobyshacham@gmail.com.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Shacham
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.forename: Eran
authors.initials: E
authors.lastname: Leshem-Rubinow
authors.forename: Eyal
authors.initials: E
authors.lastname: Ben Assa
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.forename: Arie
authors.initials: A
authors.lastname: Roth
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D017725:Ventricular Pressure