title: Early change in invasive measures of microvascular function can predict myocardial recovery following PCI for ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Predicting the likely success of primary PCI to salvage potential infarcted myocardium is desirable. We compared early invasive parameters of coronary microcirculation function with the levels of circulating endothelin (ET-1) and 6-month ejection fraction after STEMI.
  
  
  RESULTS
  Forty-four STEMI patients underwent assessment of coronary flow reserve (CFR) and index of myocardial resistance (IMR) on completion of PPCI and one day later. Cardiac magnetic resonance (CMR) at 24 h and 6 months assessed ejection fraction, oedema, late gadolinium enhancement, and salvage. In patients with depressed EF, there was no difference in IMR or CFR measured immediately after PPCI compared with those with preserved EF. However, by Day 1, CFR was significantly lower in those with depressed EF [2.0(1.5-2.3) vs. 2.6(2.1-3.3), P = 0.008]. In multivariable models, higher CFR post-PPCI [EST: +8.9 (SE 3.7) per 1 CFR unit, P = 0.03] and greater increase in CFR between post-PPCI and Day 1 [EST: +8.5 (SE 3.4) per 1 CFR unit, P = 0.01] were associated with higher salvage index. Circulating endothelin levels were significantly elevated in the low EF group at both 6 and 24 h, and 24 h levels correlated with CFR.
  
  
  CONCLUSIONS
  Changes of the coronary microcirculation in the first day after PPCI are associated with 6-month ejection fraction and myocardial salvage. Depressed CFR at 24 h is associated with CMR imaging indices of MVO and haemorrhage and elevated endothelin levels.
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
authors.forename: Florim
authors.initials: F
authors.lastname: Cuculi
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, Oxford University Hospitals, Oxford, UK.
authors.forename: Erica
authors.initials: E
authors.lastname: Dall'Armellina
authors.affiliation: Department of Clinical Biochemistry, University of Oxford, Oxford University Hospitals, Oxford, UK.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
authors.forename: Alberto R
authors.initials: AR
authors.lastname: De Caterina
authors.affiliation: The Hospital for Sick Children, Toronto, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Colyer
authors.affiliation: Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, Calgary, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ferreira
authors.affiliation: The Hospital for Sick Children, Toronto, Canada.
authors.forename: Alireza
authors.initials: A
authors.lastname: Morovat
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
authors.forename: Bernard D
authors.initials: BD
authors.lastname: Prendergast
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
authors.forename: J Colin
authors.initials: JC
authors.lastname: Forfar
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Alp
authors.affiliation: Oxford Acute Vascular Imaging Centre, Radcliffe Department of Medicine, Oxford, UK.
authors.forename: Robin P
authors.initials: RP
authors.lastname: Choudhury
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, Oxford University Hospitals, Oxford, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, Oxford University Hospitals, Oxford, UK.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Channon
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK.
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
authors.affiliation: Oxford Heart Centre, The John Radcliffe Hospital, University of Oxford, Oxford University Hospitals, OX3 9DU, Oxford, UK rajesh.kharbanda@ouh.nhs.uk.
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Kharbanda
mesh_terms: D003326:Coronary Circulation / Q000502:physiology*; D054059:Coronary Occlusion / Q000503:physiopathology; D003331:Coronary Vessels / Q000502:physiology; D019332:Endothelin-1 / Q000378:metabolism; D005260:Female; D006470:Hemorrhage / Q000503:physiopathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008833:Microcirculation / Q000502:physiology; D055806:Microvessels / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D019332:Endothelin-1
keywords: Angioplasty; Blood flow; Magnetic resonance imaging; Microcirculation; Myocardial infarction