Objective: The echocardiographic Doppler flow surro-gate parameters of microvascular obstruction (MVO) were evaluated in relation with coronary wedge pre-ssure (CWP), as markers of severe microcirculatory dysfunction and predictors of adverse left ventricular remodeling, in a group of patients with anterior ST-segment elevation myocardial infarction (STEMI).
Methods: Twenty-four patients who underwent thro-mbus aspiration, downstream intracoronary eptifibati-de administration and left anterior descending artery stenting in the setting of anterior STEMI were divided into two groups based on the 38mmHg CWP cut-off for adverse left ventricular remodeling. Diastolic de-celeration time (DDT), coronary flow reserve (CFR), systolic retrograde flow, peak systolic and peak diasto-lic velocities in the infarct related artery were evaluated by transthoracic echocardiography following revascu-larization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling.
Results: There were no significant differences between groups with regard to the echocardiographic parame-ters of MVO. No significant correlation was identified between CWP and DDT (p=0.30), or between CWP and CFR (p=0.39), irrespective of total ischemic time and extracted thrombus burden. No difference in five years follow-up left ventricular remodeling was detec-ted in patients with DDT <900 msec as compared to those with DDT ≥900msec. The increase in left ventri-cular end-systolic volume in patients with low CWP was 24.78%, while it reached 127.27% (p=0.03) in pati-ents with CWP >38 mmHg.
Conclusions: CWP did not correlate with the non-invasive surrogate parameters of MVO, but it was a predictor of negative left ventricular remodeling. The echocardiographic MVO parameters were not associ-ated with adverse remodeling at five years follow-up.