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PM146 The value of fractional flow reserve in predicting myocardial recovery in patients with ST elevation myocardial infarction
Electrocardiographic characteristics of patients presenting with left main coronary artery ST-elevation myocardial infarction or its equivalent kelvin chua*1, choong hou koh1, jonathan yap1, jenn rong chiam1, ling ling sim1, jack tan1, aaron wong1, soo teik lim1, tian hai koh1, khung keong yeo1 1 Cardiology, National Heart Centre Singapore, Singapore, Singapore Introduction: Left main coronary artery (LMCA) ST-elevation myocardial infarction (STEMI) is associated with high mortality. Electrocardiographic (ECG) characteristics have not been well described for these patients. Objectives: To describe the ECG characteristics of patients presenting with LMCA STEMI or its equivalent to a single tertiary cardiology centre. Methods: Patients who presented with LMCA STEMI or its equivalent to a single tertiary referral centre from January 2007 to December 2011 were included. LMCA STEMI was defined as STEMI secondary to a culprit LMCA stenosis of more than 80% or acute thrombosis based on angiography. LMCA STEMI equivalent was defined as cardiogenic shock, ventricular tachycardia/fibrillation (VT/VF) or sudden cardiac arrest due to a culprit lesion in the LMCA defined above. Patients with a non-culprit LMCA stenosis or prior coronary artery bypass grafting (CABG) were excluded. ECG characteristics and in-hospital mortality are described. Results: Of the 47 patients identified, 7 (14.9%) patients presented with VT/VF or sudden cardiac arrest and 32 (68.1%) patients presented with ST-segment elevation in aVR with ST-segment elevation in aVR more than V1 and ST-depressions of at least 0.5mm in 6 or more leads. VT/VF events were documented in 18 (38.3%) patients and 22 (46.8%) patients had a cardiac arrest while in hospital. Angiographically, 15 (31.9%) patients had a completely occluded LMCA. In-hospital mortality was seen in 16 (34.0%) patients. Univariate analysis showed that an ST-elevation in aVR more than V1 was associated with a complete LMCA occlusion (p¼0.0223). Other than the presence of VT/VF (p¼0.0125), there was no unique ECG characteristic that was associated with in-hospital mortality. Conclusion: In patients presenting with LMCA STEMI or its equivalent, the majority had an ECG showing ST-segment elevation in aVR with ST-segment elevation in aVR more than V1 and ST-depressions of at least 0.5mm in 6 or more leads. An ST-elevation in aVR more than V1 was associated with a complete LMCA occlusion. Disclosure of Interest: None Declared
Introduction: It has been widely demonstrated the relationship between fractional flow reserve (FFR) and myocardial viability in patients with prior myocardial infarction and significant residual coronary stenosis. However, no studies have evaluated this issue in ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Objectives: The aim of the study was to evaluate the relationship between FFR with left ventricular (LV) contractile function recovery at 6 month in patients with STEMI undergoing primary PCI. Methods: Study population consisted of 79 consecutive patients (mean age 56 +/- 10 years, 77.8% male, 16.3% diabetics, 40.2% hypertension, 42.4% smokers, 42.4% dyslipidemia) with STEMI and significant coronary stenosis undergoing primary PCI of infarct-related coronary artery. We evaluated basal and post-adenosine FFR pre- and post- primary PCI. FFR Index was defined according the following formula*: Echocardiographic evaluation of contractility and global ejection fraction (biplane Simpson method) was done in the first 24 hours and 6 months after the acute ischemic event. Contractile echocardiographic index was calculated adding the contractile score of each LV segments (total contractile score) and divided by the number of segments studied. Results: Total ischemic time was 286,8 minutes . The infarct location was Anterior in 47.1%, Inferior in 43.5% and lateral in 7.1% of the patiens. Baseline and 6 months echocardiographic index averages were 1.54 0.32 and 1.37 0.29, respectively. Spearman’s rho correlation coefficient between echocardiographic index and Index FFR was r ¼ -0.38: p ¼ 0.034 (see figure)
PM145 Effects of ischemia on distribution of Speckle Tracking derived deformation parameters according to long term progression of regional kinetics in acute and chronic myocardial infarction Krasimira Hristova*1 National Heart Hospital, Sofia, Bulgaria
1
Introduction: Ischemic tissue is characterized not only by reduced peak deformation, but also by an altered deformation pattern. Objectives: The aim of the study was to examine the effects of ischemia on distribution of myocardial deformation imaging parapameters - longitudinal, circumferential and radial strain for assessment of myocardial function in patients with STEMI by 2 dimensional speckle tracking and compare these parameters with 4 months follow up after a PCI. Methods: 20 normal volunteers (31y5) and 30 patients (63y13) with AMI in the first 24 hours after PCI, were enrolled. Standard echocardiography was performed in first hours and 4 months follow up -(4mFU) and B- mode gray scale (657 frames/s) were acquired and strain (ε) was analyzing, using a commercial speckle tracking tool in infarct, perinfarct and remote regions. The i.c. ECG was performed during PCI procedure, placing the coronary guidewire tip in all branches >1.5mm, making a “map” of residual ischemic region expressed in same 18 segment model. ST-segment resolution less than 70% was accepted as a marker of necrosis in a given segment. Results: After infarct, adverse remodeling (progressive increase in LV size, mass and reduced EF) was found. The radial and circumferential strain decreased in the infarct, perinfarct and remote regions acutely comparable with normals.The reduction was numerically lower for all types of strain (radial, circumferential and longitudinal).The longitudinal strain was only significantly decreased in infarct regions at baseline and 4mFU. Circumferential and radial strain after 4mFU were reduced in the infarcted segments too, but in periinfarcted were bellow normals, in remote - close to the normals . There was a significant correlation between the infarct size (31,1 3,4 %) and longitudinal strain (r¼ -0.49, p< 0.01), radial strain (r ¼-0.37, p<0,01) and circumferential strain ( r¼-0.39, p< 0.05). Conclusion: All indices of myocardial function demonstrate reduced systolic deformation in infarcted myocardium. The deformation gradually reduces with increasing infarct size and transmural distribution. The longitudinal strain measured early after mechanical reperfusion may predict infarct size and LV remodeling, radial and circumferential strain in perinfarct and remote regions demonstrate early after AMI may cause to adverse left ventricular remodeling and progression to ischemic cardiomyopathy. Disclosure of Interest: None Declared PM146 The value of fractional flow reserve in predicting myocardial recovery in patients with ST elevation myocardial infarction Manuel J. Vargas-Torres*1, Francisco Bosa-Ojeda2, Martín J. García-Gonzalez1, Geoffrey Yanes-Bowden1, Alejandro Sanchez-Grande Flecha1, Juan Lacalzada-Almeida1 1 Cardiology, Hospital Universitario de Canarias, Tenerife, 2Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Conclusion: FFR Index provide significant complementary data on the improvement in myocardial function in patients with STEMI undergoing primary PCI. The evaluation of FFR before and after angioplasty identifies viable myocardium that may recover following revascularization and may be used as an alternative to non-invasive testing. Disclosure of Interest: None Declared
PM147 Newer generation drug eluting stent (DES) use in STEMI PCI Matthew J. Brooks1, Jeffrey Lefkovits1, Andrew E. Ajani1, Nick Andrianopoulos2, David Clark3, Matias Yudi1, Angela Brennan2, Martin Sebastian4, David Tsang5, Ronen Gurvitch*1 1 Cardiology Department, The Royal Melbourne Hospital, 2Monash University, 3Cardiology Department, Austin Hospital, Melbourne, 4Cardiology Department, Geelong Hospital, Geelong, 5 The Royal Melbourne Hospital, Melbourne, Australia Introduction: The use of DES in STEMI PCI remains controversial. While newer generation DES have been shown to have improved efficacy and safety performance little is known about their use in STEMI PCI. Objectives: To determine the pattern of DES use in STEMI PCI in a large Australian PCI population, and to evaluate safety and efficacy outcomes of newer generation DES compared to BMS and first generation DES in STEMI PCI. Methods: We prospectively collected data on 2,534 patients undergoing PCI for acute STEMI at 7 Australian public hospitals from 1st January 2005 to 31st December 2011. Patients ineligible for DES (stent size <2.25 or >4.0mm) and those presenting with cardiogenic shock and/or out of hospital cardiac arrest were excluded. 12-month safety and efficacy outcomes of newer generation DES were evaluated and compared to BMS and first generation DES (Taxus and Cypher). Results: A bimodal trend in DES use in STEMI was observed with an initial peak of 43.2% in 2005, a trough of 21.5% in 2007 (corresponding stent thrombosis [ST] concerns with first generation DES) and a subsequent gradual increase in use in the era of newer generation DES to 29.2% in 2011 (p trend 2007 to 2011 <0.001).
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POSTER ABSTRACTS
PM144
Introduction: It has been widely demonstrated the relationship between fractional flow reserve (FFR) and myocardial viability in patients with prior myocardial infarction and significant residual coronary stenosis. However, no studies have evaluated this issue in ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Objectives: The aim of the study was to evaluate the relationship between FFR with left ventricular (LV) contractile function recovery at 6 month in patients with STEMI undergoing primary PCI. Methods: Study population consisted of 79 consecutive patients (mean age 56 +/- 10 years, 77.8% male, 16.3% diabetics, 40.2% hypertension, 42.4% smokers, 42.4% dyslipidemia) with STEMI and significant coronary stenosis undergoing primary PCI of infarct-related coronary artery. We evaluated basal and post-adenosine FFR pre- and post- primary PCI. FFR Index was defined according the following formula*: Echocardiographic evaluation of contractility and global ejection fraction (biplane Simpson method) was done in the first 24 hours and 6 months after the acute ischemic event. Contractile echocardiographic index was calculated adding the contractile score of each LV segments (total contractile score) and divided by the number of segments studied. Results: Total ischemic time was 286,8 minutes . The infarct location was Anterior in 47.1%, Inferior in 43.5% and lateral in 7.1% of the patiens. Baseline and 6 months echocardiographic index averages were 1.54 0.32 and 1.37 0.29, respectively. Spearman’s rho correlation coefficient between echocardiographic index and Index FFR was r ¼ -0.38: p ¼ 0.034 (see figure)
PM145 Effects of ischemia on distribution of Speckle Tracking derived deformation parameters according to long term progression of regional kinetics in acute and chronic myocardial infarction Krasimira Hristova*1 National Heart Hospital, Sofia, Bulgaria
1
Introduction: Ischemic tissue is characterized not only by reduced peak deformation, but also by an altered deformation pattern. Objectives: The aim of the study was to examine the effects of ischemia on distribution of myocardial deformation imaging parapameters - longitudinal, circumferential and radial strain for assessment of myocardial function in patients with STEMI by 2 dimensional speckle tracking and compare these parameters with 4 months follow up after a PCI. Methods: 20 normal volunteers (31y5) and 30 patients (63y13) with AMI in the first 24 hours after PCI, were enrolled. Standard echocardiography was performed in first hours and 4 months follow up -(4mFU) and B- mode gray scale (657 frames/s) were acquired and strain (ε) was analyzing, using a commercial speckle tracking tool in infarct, perinfarct and remote regions. The i.c. ECG was performed during PCI procedure, placing the coronary guidewire tip in all branches >1.5mm, making a “map” of residual ischemic region expressed in same 18 segment model. ST-segment resolution less than 70% was accepted as a marker of necrosis in a given segment. Results: After infarct, adverse remodeling (progressive increase in LV size, mass and reduced EF) was found. The radial and circumferential strain decreased in the infarct, perinfarct and remote regions acutely comparable with normals.The reduction was numerically lower for all types of strain (radial, circumferential and longitudinal).The longitudinal strain was only significantly decreased in infarct regions at baseline and 4mFU. Circumferential and radial strain after 4mFU were reduced in the infarcted segments too, but in periinfarcted were bellow normals, in remote - close to the normals . There was a significant correlation between the infarct size (31,1 3,4 %) and longitudinal strain (r¼ -0.49, p< 0.01), radial strain (r ¼-0.37, p<0,01) and circumferential strain ( r¼-0.39, p< 0.05). Conclusion: All indices of myocardial function demonstrate reduced systolic deformation in infarcted myocardium. The deformation gradually reduces with increasing infarct size and transmural distribution. The longitudinal strain measured early after mechanical reperfusion may predict infarct size and LV remodeling, radial and circumferential strain in perinfarct and remote regions demonstrate early after AMI may cause to adverse left ventricular remodeling and progression to ischemic cardiomyopathy. Disclosure of Interest: None Declared PM146 The value of fractional flow reserve in predicting myocardial recovery in patients with ST elevation myocardial infarction Manuel J. Vargas-Torres*1, Francisco Bosa-Ojeda2, Martín J. García-Gonzalez1, Geoffrey Yanes-Bowden1, Alejandro Sanchez-Grande Flecha1, Juan Lacalzada-Almeida1 1 Cardiology, Hospital Universitario de Canarias, Tenerife, 2Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Conclusion: FFR Index provide significant complementary data on the improvement in myocardial function in patients with STEMI undergoing primary PCI. The evaluation of FFR before and after angioplasty identifies viable myocardium that may recover following revascularization and may be used as an alternative to non-invasive testing. Disclosure of Interest: None Declared
PM147 Newer generation drug eluting stent (DES) use in STEMI PCI Matthew J. Brooks1, Jeffrey Lefkovits1, Andrew E. Ajani1, Nick Andrianopoulos2, David Clark3, Matias Yudi1, Angela Brennan2, Martin Sebastian4, David Tsang5, Ronen Gurvitch*1 1 Cardiology Department, The Royal Melbourne Hospital, 2Monash University, 3Cardiology Department, Austin Hospital, Melbourne, 4Cardiology Department, Geelong Hospital, Geelong, 5 The Royal Melbourne Hospital, Melbourne, Australia Introduction: The use of DES in STEMI PCI remains controversial. While newer generation DES have been shown to have improved efficacy and safety performance little is known about their use in STEMI PCI. Objectives: To determine the pattern of DES use in STEMI PCI in a large Australian PCI population, and to evaluate safety and efficacy outcomes of newer generation DES compared to BMS and first generation DES in STEMI PCI. Methods: We prospectively collected data on 2,534 patients undergoing PCI for acute STEMI at 7 Australian public hospitals from 1st January 2005 to 31st December 2011. Patients ineligible for DES (stent size <2.25 or >4.0mm) and those presenting with cardiogenic shock and/or out of hospital cardiac arrest were excluded. 12-month safety and efficacy outcomes of newer generation DES were evaluated and compared to BMS and first generation DES (Taxus and Cypher). Results: A bimodal trend in DES use in STEMI was observed with an initial peak of 43.2% in 2005, a trough of 21.5% in 2007 (corresponding stent thrombosis [ST] concerns with first generation DES) and a subsequent gradual increase in use in the era of newer generation DES to 29.2% in 2011 (p trend 2007 to 2011 <0.001).
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POSTER ABSTRACTS
PM144