@article{3130086,
    title = "Staccato reperfusion improves myocardial microcirculatory function and long-term left ventricular remodelling: A randomised contrast echocardiography study",
    author = "Ikonomidis, I. and Iliodromitis, E.K. and Tzortzis, S. and Antoniadis, A. and Paraskevaidis, I. and Andreadou, I. and Fountoulaki, K. and Farmakis, D. and Kremastinos, D.T. and Anastasiou-Nana, M.",
    journal = "British Heart Journal",
    year = "2010",
    volume = "96",
    number = "23",
    pages = "1898-1903",
    doi = "10.1136/hrt.2010.201681",
    keywords = "acetylsalicylic acid;  beta adrenergic receptor blocking agent;  clopidogrel;  enoxaparin;  fibrinogen receptor antagonist;  fondaparinux;  heparin;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  malonaldehyde;  nitrate;  sonovue, adult;  article;  blood flow velocity;  clinical article;  clinical trial;  continuous infusion;  contrast echocardiography;  controlled clinical trial;  controlled study;  female;  heart left ventricle enddiastolic volume;  heart left ventricle endsystolic volume;  heart muscle blood flow;  heart ventricle remodeling;  human;  male;  microcirculation;  non ST segment elevation myocardial infarction;  oxidative stress;  percutaneous coronary intervention;  priority journal;  randomized controlled trial;  reperfusion;  single blind procedure;  ST segment elevation myocardial infarction;  staccato reperfusion;  unstable angina pectoris, Acute Coronary Syndrome;  Anticoagulants;  Echocardiography;  Female;  Humans;  Male;  Microcirculation;  Middle Aged;  Myocardial Infarction;  Myocardial Reperfusion;  Myocardial Reperfusion Injury;  Ventricular Dysfunction, Left;  Ventricular Remodeling",
    abstract = "Objective: To investigate the effects of staccato reperfusion (SR) during percutaneous coronary intervention (PCI) on myocardial microcirculatory function as assessed by myocardial contrast echocardiography. Setting: Tertiary centre. Methods: Thirty-nine patients were randomised to SR (n=20) or abrupt reperfusion (AR, n=19) within 48 h of an acute coronary syndrome. Contrast intensity replenishment curves were constructed to assess the blood volume (An), velocity (β) and flow (AXβ) of the segments associated with the PCI-treated artery before, 48 h, 1 and 12 months after PCI. Left ventricular (LV) end-diastolic (EDVs) and systolic volumes (ESVs) were evaluated. Plasma malondialdehyde (MDA) was determined immediately before and 18 min after PCI to assess oxidative stress. Results: SR was related to a greater improvement in An, β and AXβ at 48 h, 1 and 12 months after intervention compared with AR (mean AXβ: 0.91, 5.5, 7.14, 6.9 for SR vs 1.02, 3.34, 4.28, 3.71 for AR, p<0.01). After PCI, the mean MDA change was -27% in SR patients and +55% in the AR patients (p<0.05). The percentage change in MDA correlated with the percentage change in An at all time points (r=0.468, r=0.682, r=0.674, p<0.01). Compared with AR, SR was related to a greater percentage decrease in EDV (-11.61% vs -4.13%) and ESV (-34.68% vs -14.83%) at 12 months after PCI (p<0.05). The percentage change in ESV at 12 months correlated with the corresponding percentage changes in An, β and AXβ (r=-0.410, r=-0.509, r=-0.577, respectively, p<0.05). Conclusions: SR improves myocardial microcirculatory function after PCI, leading to a concomitant improvement in LV geometry, probably through reduction of oxidative stress."
}