55 research outputs found
Late phase of repolarization (TpeakTend) as a prognostic marker of left ventricle remodeling in patients with anterior myocardial infarction treated with primary coronary intervention
Background: Left ventricle remodeling (LVR) is regarded as a marker of unfavorable outcome
in patients following acute myocardial infarction (AMI). Repolarization, especially its
late part (TpeakTend), is strongly related to local myocardial attributes. We assessed prospectively
in this study if repolarization duration (measured from one hour of nighttime) might
predict LVR occurrence in patients with anterior AMI treated with primary percutaneous
coronary intervention (PCI).
Methods: The study population consisted of 111 patients with first anterior AMI (82 males, age
58 ± 11 years, LVEF 41 ± 7%) treated with the primary PCI of left anterior descending coronary
artery. LVR, defined as left ventricle end-diastolic volume increase by > 20% during six
months follow-up, occurred in 35 patients (31 males, age 56 ± 10 years, LVEF 37 ± 7%, LVR+),
while the other 76 subjects were free of LVR (51 males, age 58 ± 10 years, LVEF 43 ± 7%, LVR–).
Holter recordings were performed in the fifth day of AMI. Repolarization parameters: QT, QTpeak
and TpeakTend were assessed from one hour of nighttime Holter recording (between 1-4 a.m.).
Results: LVR occurred more frequently in males (p = 0.02). LVEF was lower in LVR+
patients (p = 0.001). QTc was similar: 441 ± 29 ms vs 434 ± 25 ms, p = 0.37 for LVR+ vs
LVR–. Patients with LVR had shorter QTpeakc (333 ± 34 ms vs 345 ± 25 ms, p = 0.03) and
remarkably longer TpeakTendc (108 ± 15 ms vs 89 ± 17 ms, p = 0.0001). Receiver operating
characteristics analysis revealed that the best cut-off value for LVR prediction was 103 ms -
sensitivity: 65.7%, specificity: 81.6%, positive predictive value: 62%, negative predictive value: 83.8%.
Conclusions: The greater transmural heterogeneity of the repolarization processes described
by TpeakTend interval measured at discharge after AMI seems to be a prognostic marker of
left ventricle remodeling occurrence during six months follow-up in patients with acute anterior
infarction. (Cardiol J 2010; 17, 3: 244-248
Managed care for acute myocardial infarction survivors in the Silesian agglomeration during the COVID-19 pandemic
Aggressive lipid-lowering treatment in Managed Care after Acute Myocardial Infarction (MC-AMI) patients — results better but still not sufficient: A single center prospective analysis
Repolarization parameters in patients with acute ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention with respect to predischarge ST-T pattern: A preliminary study
Background: Negative T wave and lack of ST segment elevation in predischarge ECG in
ST-segment elevation myocardial infraction (STEMI) patients are given as markers of good
prognosis. Repolarization duration, especially its late part (TpeakTend - TpTe), likewise
ST-T patterns, is related to local post-myocardial infarction myocardial attributes. We analyzed
the differences in QT parameters in STEMI patients with negative or not-negative T wave
pattern in predischarge ECG.
Methods: The data from 83 STEMI patients (LVEF > 45%, first MI, one-vessel disease)
who underwent successful percutaneous coronary intervention of infarct-related coronary artery
(TIMI 3 flow) were collected. According to ST-T patterns in predischarge ECG, the cohort
was divided into two groups: 38 patients with persistent ST elevation and/or non-negative
T wave pattern (STT+), and 45 patients with negative T wave, without ST elevation (STT-).
QT, QTpeak, and TpTe intervals were obtained from 5 consecutive beats of sinus rhythm
60–70 bpm between 6 a.m. and 8 a.m. from Holter recording, corrected to the heart rate (HR)
with Bazett’s formula.
Results: The study groups did not differ in gender, age, or treatment. No true antiarrhythmics
were given. Both QTc and TpTec were longer in STT+ patients: 459 ± 26 ms vs. 440 ± 25 ms,
p = 0.01 and 108 ± 10 ms vs. 96 ± 11 ms, p = 0.000015, respectively. Prolongation of late
repolarization was found both in anterior and inferior infarction.
Conclusions: STEMI patients who underwent successful percutaneous coronary intervention
of infarct-related coronary arteries and demonstrated persistent ST elevation, without
negative T wave at hospital discharge, had a longer repolarization duration, especially the late
phase of it. Further studies are necessary to assess the prognostic value of this finding
NT-proBNP level in the diagnosis of isolated left ventricular diastolic dysfunction in patients with documented coronary artery disease
Background: The diagnostic value of NT-proBNP for left ventricular (LV) systolic dysfunction
is well established. However, its role for diastolic dysfunction (DD) diagnosis in patients
with preserved systolic function has not been clearly defined.
Methods: A total of 83 patients with documented coronary arterial disease following anterior
myocardial infarction and with a left ventricular ejection fraction (LVEF) > 45% were
enrolled. According to echocardiographic mitral inflow and right upper pulmonary vein flow,
DD was excluded in 32 patients (group A). The patients with DD were divided into three
subgroups: B1 - 38 patients with impaired relaxation, B2 - 8 patients with
pseudonormalisation and B3 - 7 patients with restrictive inflow. In all patients E-wave
propagation (Vp) and NT-proBNP were determined.
Results: Mean LVEF was 56.2 ± 9% and did not differ between the subgroups. NT-proBNP
levels were 107 ± 101 pg/ml in group A, 299 ± 281 pg/ml in B1, 734 ± 586 pg/ml in B2
(p < 0.05 vs. A) and 2322 ± 886 pg/ml in B3 (p < 0.01 vs. A and p < 0.01 vs. B2).
Propagation Vp was 69 ± 21 cm/s, 56 ± 20 cm/s, 53 ± 17 cm/s (p < 0.05 vs. A) and 44 ± 11 cm/s
(p < 0.01 vs. A) respectively. A positive correlation was found for DD degree with NT-proBNP
level (r = 0.66; p < 0.001) and negative with Vp (r = –0.41; p < 0.001). ROC curves were
constructed to determine the NT-proBNP level cut-off point for DD (> 131 pg/ml, area under
the curve: 0.63) and advanced restrictive DD (> 1670 pg/ml, area under the curve: 0.83)
diagnosis. Sensitivity, specificity, accuracy and positive and negative predictive values were
71%, 50%, 63%, 69%, 52% and 57%, 99%, 95%, 80%, 96% respectively.
Conclusions: In patients with coronary artery disease and preserved LV systolic function
a single NT-proBNP measurement helps to identify those with isolated DD, especially those with
advanced restriction
Long-term effects of the Managed Care After Acute Myocardial Infarction program: an update on a complete 1-year follow-up
Mechanical thrombectomy in acute ischemic stroke: Upper-Silesian Medical Center in Katowice experiences based on the treatment of the first 500 patients
Managed care after acute myocardial infarction (MC-AMI) reduces total mortality in 12-month follow-up : results from a Polands national health fund program of comprehensive post-MI care - a population-wide analysis
Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up. Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression. Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42–0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction. Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed
The prognostic value of contrast echocardiography, electrocardiographic and angiographic perfusion indices for prediction of left ventricular function recovery in patients with acute myocardial infarction treated by percutaneous coronary intervention
Background: Fast and effective culprit artery patency restoration is important in acute
myocardial infarction (MI) but does not ensure that tissue perfusion related to a better prognosis
in the long-term follow-up is achieved. In this study we compared the prognostic value of
myocardial perfusion contrast echocardiography with other well-known electrocardiographic
and angiographic indices of preserved tissue perfusion.
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged
57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial
infarction. These were treated with primary PCI, after which PCI myocardial blush grading
was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction
of > 50% in the sum of ST-segment elevation (ΣST 50%) was assessed as an indicator of
perfusion restoration. During the first 24 hours continuous ECG monitoring recorded
reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50%
in the single lead with the highest ST elevation (Δt ST 50%). On the next day of MI, after
LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed
to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional
segment perfusion score was determined. Regional and global LV function was assessed
again one month after MI. An LVEF increase of over 5% divided the patients into two groups:
group A with LVEF improvement (72 pts) and group B without LVEF improvement (42 pts).
Results: In group A baseline LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS).
The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more
often in group A (64%) than in group B (34%) p < 0.001. Σ ST50% and Δt ST 50%, after
determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in group A and 17 and 16 patients in group B respectively. The accuracy of the tests under
discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG,
SST50% and Δt ST 50% respectively.
Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction
of LV global function improvement. It turned out to be the best predictor among the other angiographic,
echocardiographic and electrocardiographic markers
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