RESUMEN
Introduction: No-reflow phenomenon in coronary vessels, manifested in some patients with reperfused acute myocardial infarction [MI], is associated with poor clinical and functional outcomes. Therefore, evaluation of predisposing risk factors can be helpful in risk assessment and identification of patients at higher risk. Herein, we aimed to study the predictive factors for the development of no-reflow phenomenon in patients with ST-elevation acute MI [STEMI], following primary percutaneous coronary intervention [PCI]
Materials and Methods: Overall, 141 patients with STEMI, treated with primary PCI, were enrolled in a cross sectional study. Angiographic data associated with no-reflow phenomenon including thrombolysis in MI [TIMI] were evaluated. Patients were divided into study and control [TIMI grade 3] groups. Demographic, clinical and laboratory [lab] data including cardiovascular risk factors [e.g., diabetes, hypertension, hyperlipidemia, smoking], door-to-balloon time, serum creatinine and glucose levels, white and red blood cell counts [WBC and RBC counts, respectively], mean platelet volume [MPV], and red cell distribution width [RDW] were evaluated in both groups
Results: The mean age of the patients was 60.3 +/- 11.9 years. No-reflow was observed in 35 [24.8%] cases. WBC count, MPV, serum creatinine, BS, and high-density lipoprotein [HDL] levels were significantly correlated with TIMI flow <3
Conclusion: Certain lab indices including MPV, WBC count, creatinine and HDL levels played significant independent roles in the no-reflow phenomenon. Thus, measuring such parameters might be helpful in predicting the risk of this condition in patients; however, further studies are required
RESUMEN
We aimed to investigate of effect of left bundle branch block [LBBB] on perfusion and functional parameters in dipyridamole Tc99m-MIBI gated myocardial perfusion SPECT which may be helpful in interpretation of myocardial perfusion imaging. We studied 70 patients with low pre-test probability of coronary artery disease in two groups: 35 patients with LBBB and 35 subjects with normal ECG. Both groups underwent two-day dipyridamole stress-rest Tc99m-MIBI GSPECT. From 35 patients with LBBB, 6, 12, and 3 patients had reversible, fixed and partially reversible defects respectively. In 35 patients with LBBB, 8 [22.9%], 6[17.1%] 15[42.9%] and 10 [28.6%] patients had perfusion defects in the apicoseptal, mid-anterior segments, mid-anteroseptal and mid-inferoseptal segments respectively. There was significant difference in TID ratio between two groups: LBBB group: 1.07 +/- 0.21 and control group: 0.96 +/- 0.14 [P=0.01]. There was a significant difference in end systolic volume and ejection fraction between LBBB patients group and control group, while no significant difference was noticed in end-diastolic volume. Nineteen, 14 and 2 from 35 patients with LBBB had normal LV wall motion, paradoxical septal wall motion, and septal hypokinesia, respectively. False positive septal, anterior and apicoseptal perfusion abnormalities are frequently seen on Tc99m-MIBI GSPECT, in patients with LBBB without CAD. Moreover reversible defects are frequently seen with Tc99m-MIBI. Even Tc99-MIBI and vasodilator stress do not increase diagnostic accuracy to clinically useful levels. Lower systolic performance and higher TID ratio could be seen in these patients