Περίληψη:
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.
Συγγραφείς:
Ikonomidis, I.
Iliodromitis, E.K.
Tzortzis, S.
Antoniadis, A.
Paraskevaidis, I.
Andreadou, I.
Fountoulaki, K.
Farmakis, D.
Kremastinos, D.T.
Anastasiou-Nana, M.
Λέξεις-κλειδιά:
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
