title: Endothelial dysfunction evaluated by peripheral arterial tonometry is related with peak TnI values in patients with ST elevation myocardial infarction treated with primary angioplasty.
abstract: OBJECTIVE
  The role of endothelial-dependent function in patients with acute ST elevation myocardial infarction (STEMI) is not clear. Endothelial dysfunction may contribute to the pathophysiological processes occurring after STEMI and influence the extension of myocardial necrosis. Endothelial-dependent dysfunction evaluated by peripheral arterial tonometry (PAT) has already showed to be correlated with microvascular coronary endothelial dysfunction. Our purpose was to evaluate the impact of endothelial dysfunction on peak Troponin I (TnI) values, as a surrogate for the extension of myocardial infarction, in patients with STEMI treated with primary angioplasty (P-PCI).
  
  
  METHODS
  58 patients with STEMI treated with P-PCI (mean age 59.0 ± 14.0 years, 46 males) were included. Endothelial function was assessed by reactive hyperaemia index (RHI) determined by PAT. Patients were divided in two groups according to the previously reported RHI threshold for high risk (1.67). The extension of myocardial necrosis was evaluated by peak TnI levels.
  
  
  RESULTS
  RHI median value was 1.78 (IQR0.74);25 patients had endothelial dysfunction (RHI b 1.67). The two groups had no significant differences in age, gender, main risk factors and pain-to-balloon time. Patients with an RHI b 1.67 had significant larger infarcts: TnI 73.5 ng/mL (IQR 114.42 ng/mL) versus TnI 33.2 ng/mL (IQR 65.2 ng/mL); p = 0.028. On multivariate analysis, the presence of an RHI b 1.67 kept significant impact on TnI peak values (p=0.02).
  
  
  CONCLUSIONS
  The presence of endothelial-dependent dysfunction, assessed by PAT, is related with higher peak TnI values in STEMI patients treated with P-PCI. These results strength the possibility that endothelial-dependent dysfunction may be a marker of poor prognosis and eventually a therapeutic target in patients with STEMI.
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal. Electronic address: sergio.b.baptista@gmail.com.
authors.forename: Sérgio Bravo
authors.initials: SB
authors.lastname: Baptista
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal. Electronic address: marianafaustino85@gmail.com.
authors.forename: Mariana
authors.initials: M
authors.lastname: Faustino
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Simões
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Maura
authors.initials: M
authors.lastname: Nédio
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Célia
authors.initials: C
authors.lastname: Monteiro
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Elsa
authors.initials: E
authors.lastname: Lourenço
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Leal
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Farto eAbreu
authors.affiliation: Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Gil
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008365:Manometry / Q000379:methods*; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Acute ST elevation myocardial infarction; Endothelial dysfunction; Primary angioplasty; Reactive hyperaemia index; Troponin I