Supervisors info:
Κυρίτση Ελένη, Ομότιμη Καθηγήτρια, Τμήμα Νοσηλευτικής, ΠΑΔΑ
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Π. Τούτουζας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Acute Myocardial Infarction with ST-segment elevation (STEMI) is a serious clinical condition associated with high rates of mortality and morbidity. Despite significant advancements in therapeutic management through percutaneous coronary intervention (angioplasty), the disease continues to result in adverse remodeling and increased filling pressures of the left ventricle, further impairing both its systolic and diastolic function. The extent of the infarcted area is a critical determinant in disease progression and prognosis. Cardiac Magnetic Resonance Imaging (CMR) is considered the "gold standard" for accurately assessing infarct size; however, its availability in everyday clinical practice is limited due to its high cost and the feasibility of patients undergoing the procedure. Objective: The aim of this study was to investigate the correlation between Left Atrial Stiffness Index (LASI), measured 72 hours after successful PCI, and the infarct size assessed through alternative, readily available methods, such as the Selvester Score, troponin I levels, and Wall Motion Score Index (WMSI).. Materials and Methods: The study included 50 patients diagnosed with STEMI, who were treated with PCI and hospitalized at the General Hospital of Athens "G. Gennimatas." The extent of the infarct was evaluated using three indicators: the Selvester score, the Wall Motion Score Index (WMSI), and troponin levels measured at 72 hours. Left atrial stiffness was assessed using the LASI. Data were retrospectively collected from medical records, clinical examinations, laboratory tests, and echocardiographic/imaging studies.. Results: The study sample consisted of 50 patients with a mean age of 58.8 years (SD =10.6), 88% men. Statistical analysis revealed a positive correlation between LASI and BNP levels (r=0.298, p=0.036) and a borderline correlation with the Selvester score at 72 hours (r=0.267, p=0.061). The WMSI showed a statistically significant positive correlation with the Selvester score from the admission ECG (r=0.395, p=0.004), the post-PCI ECG (r=0.476, p<0.001), and the 72-hour ECG (r = 0.516, p < 0.001), as well as with troponin levels at 72 hours (r=0.516, p<0.001). In contrast, WMSI demonstrated a strong negative correlation with the left ventricular ejection fraction (r=-0.810, p<0.001). Statistically significant differences were observed between patients with normal and pathological LASI values, both in WMSI (p=0.021) and the Selvester score (p<0.001). Additionally, patients with pathological LASI values showed larger infarct sizes based on WMSI (χ²=4.04, p=0.044), Selvester score (χ²=4.847, p=0.028), and troponin levels at 72 hours (χ²=4.168, p=0.041). Logistic regression analysis found tha tonly the Selvester score from the 72-hour ECG had a statistically significant correlation with the prediction of pathological LASI (p = 0.008). Conclusion: Abnormal LASI values are associated with larger infarct sizes regardless of the index used for assessment. The Selvester score at 72 hours post-PCI showed the highest prognostic value, as each increase in score was linked to a higher likelihood of abnormal LASI. LASI may serve as a valuable tool for assessing infarct severity and predicting outcomes in STEMI patients.
Keywords:
LASI, STEMI, Infarct size, diastolic dysfunction, LA strain, Left atrium,PCI
