ABSTRACT
BACKGROUND AND OBJECTIVES: The TIMI myocardial perfusion (TMP) grade is known as one of the methods to assess the viability of the myocardium in ischemic heart disease. This study was designed to assess the value of TMP grade itself and to evaluate the correlation with coronary flow reserve (CFR) in the prediction of left ventricular remodeling and functional change after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). SUBJECTS AND METHODS: We measured CFR and TMP grade after successful elective PCI (diameter stenosis <0%, and TIMI flow 3) in 83 patients (mean age 55+/-1 years, 18 females) with AMI within 7 days of symptom onset. Left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), ejection fraction (LVEF), and left ventricular regional wall motion score index (LVRWMSI) were assessed by echocardiography just before and at 9 months after angioplasty (mean 9+/-5 months). RESULTS: Although they had achieved (TIMI 0.021) TIMI 3 flow after successful intervention, 27 of 83 patients (32.5%) had impaired myocardial perfusion. After PCI, angiographic TMP grade was well correlated with CFR measured using Doppler wire (TMP 0/1;1.4+/-0.3, TMP 2;1.9+/-0.6, TMP 3;2.2+/-0.4, rs=0.618, p=0.000). Post-PCI TMP grade was significantly related to the change of LVEDVI (r=0.452, p=0.000), LVESVI (r=0.435, p=0.000), LVEF (r=0.281, p=0.010) and LVRWMSI (r=0.328, p=0.036). CONCLUSION: The TMP grade, a simple angiographic method, might be useful as a predictor of LV volume and functional change in AMI. In the cardiac catheterization laboratory, it could simply replace CFR for the assessment of myocardial viability in patients who receive an elective PCI within 7 days of AMI onset.
Subject(s)
Humans , Angioplasty , Cardiac Catheterization , Cardiac Catheters , Constriction, Pathologic , Coronary Circulation , Echocardiography , Myocardial Infarction , Myocardial Ischemia , Myocardium , Percutaneous Coronary Intervention , Perfusion , Stents , Stroke Volume , Thymidine Monophosphate , Ventricular RemodelingABSTRACT
BACKGROUND AND OBJECTIVES: Previous studies advocated the C-reactive protein (CRP) as an objective marker of the inflammatory reaction in cardiovascular disease, and an independent risk factor for predicting the progression of heart failure (HF) of an ischemic origin. However, it is unclear if this can also be applied to non-ischemic HF. We report the measurement of the CRP in non-ischemic dilated cardiomyopathy (DCM), and its relationship to the prognosis. SUBJECTS AND METHODS: Sixty-nine consecutive patients, with non-ischemic DCM, were enrolled based on their history, echocardiography and coronary angiography findings. The variables, including NYHA functional class, were examined. The CRP levels were measured with high sensitive turbidometry; and each patient followed up for 18 months. The endpoints of the study were considered as readmission and death. RESULTS: Out of the 69 patients, there were 47 (68%) were males and 22 (32%) females, with an average age of 60+/-12. The CRP level (mg/d) in the patients with DCM (1.66+/-2.91) was higher than in the controls (0.07+/-0.25;p<0.001), and increased in relation to the NYHA functional class on discharge (I:0.98+/-2.15, II:0.78+/-1.48, III:3.55+/-4.66, IV:2.94+/-2.39;p<0.01). During the follow-up, 19(28%) experienced the aggravation of HF and had higher CRP and NYHA functional classes, and lower Na+, K+ and hemoglobin levels. From a multiple regression analysis, only the K+ and NYHA functional class on discharge revealed significant relationships with the aggravation of HF (p<0.05). Moreover, an increased in the CRP level had a significant negative relation to the Na+ only (p<0.05). CONCLUSION: The patients with non-ischemic DCM exhibited an increase in CRP levels in relation to the severity of the HF. However, the levels of CRP in non-ischemic DCM could not elucidate the prognosis as with ischemic HF.