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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Acute Left Ventricular Dynamic Effects of Primary Percutaneous Coronary Intervention

From Occlusion to Reperfusion

Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Manuscript received October 15, 2008; revised manuscript received December 9, 2008, accepted December 15, 2008.

^_* Reprint requests and correspondence: Dr. Jan Baan, Jr., Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands (Email: j.baan{at}amc.uva.nl).

Objectives: We studied the left ventricular (LV) dynamic effects of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) by directly obtaining pressure–volume (PV) loops during the procedure.

Background: An acute myocardial infarction causes a decrease in LV compliance. The instantaneous effects of primary PCI on LV compliance are unknown.

Methods: We studied 15 consecutive patients (10 males, ages 59 ± 12 years), who presented with their first acute anterior STEMI within 6 h after onset of symptoms, and in whom coronary angiography revealed an occluded left anterior descending coronary artery. Before performing primary PCI, we inserted a pressure-conductance catheter in the LV to continuously obtain PV loops.

Results: Immediately after successful reperfusion, significant improvements were observed in LV diastolic function, as indicated by an increased end-diastolic compliance with a 6.0 ± 2.8 mm Hg (p < 0.0001) downward shift of the compliance curve. There was a decrease in end-diastolic pressure of 24 ± 18% (p = 0.0002), in stiffness of 27 ± 18% (p = 0.0003), and in wall stress of 20 ± 24% (p = 0.004). Systolic function mainly showed an immediate improvement in apical contractility from 40 ± 17% to 54 ± 15% (p = 0.01).

Conclusions: Primary PCI in anterior STEMI patients causes an immediate improvement in diastolic function, assessed by online PV loop measurements.

Key Words: acute myocardial infarction • hemodynamics • left ventricular function • pressure–volume relations • primary angioplasty

Abbreviations and Acronyms   CO = cardiac output   EDP = end-diastolic pressure   EDV = end-diastolic volume   EES = end-systolic elastance   EF = ejection fraction   ESP = end-systolic pressure   ESV = end-systolic volume   LV = left ventricular   PCI = percutaneous coronary intervention   PV = pressure–volume   STEMI = ST-segment elevation myocardial infarction   SV = stroke volume   SW = stroke work   TIMI = Thrombolysis In Myocardial Infarction

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