Page 39 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Table 3. Recovery of Global and Regional Left Ventricular Function
Prediction of recovery of LV function
Before PCI
Recovery† at one day Recovery† at one week Recovery† at six months
Global WMI
1.86 (0.23) 0.03 (0.22) 0.20 (0.28) 0.32 (0.34)
p Value*
0.0001
Regional WMI
2.39 (0.30) 0.09 (0.25) 0.33 (0.37) 0.52 (0.48)
p Value*
0.0001
2
*p value obtained in analysis of variance for repeated measurements; †Recovery defined as WMI before PCI minus WMI at specific time points. Values are given as means ± SD. PCI = percutaneous coronary intervention; WMI = Wall Motion Index.
Recovery of global and regional LV function
A progressive improvement of short-term and long-term global and regional LV function was documented (Table 3). All baseline variables were used to identify univariate predictors for short-term and long-term global (data not shown) and regional (Tables 1 and 2) LV function recovery. The relation between CFR and LV function recovery is plotted in Figure 1. All patients with a CFR ≥2.0 immediately after primary PCI showed improvement of LV function (Fig. 1A). No relation existed between angiographic parameters and recovery of LV function (Fig. 1B,1C, and 1D). Coronary flow velocity reserve of the LAD coronary artery directly after primary PCI was the only independent predictor in multivariate analysis of global (Table 4) and regional (Table 5) LV function recovery at six months. Global and regional LV function recovery at one week were predicted by clinical, echocardiographic, angiographic, and Doppler-derived variables (Tables 4 and 5). Independent predictors of short- term LV function improvement were not similar to those predicting long-term improvement (Tables 4 and 5).
LV ejection fraction
Mean ejection fraction at five weeks’ follow-up was 47 ± 13%. Multivariate regression analysis revealed CFR in the LAD coronary artery and early systolic retrograde flow velocity as independent predictors of ejection fraction at five weeks (coefficient of constant, 14.6; coefficient of CFR, 15.7; 95% confidence interval, 5.8 to 25.5; p = 0.003; coefficient of systolic retrograde flow, -10.0; 95% confidence interval, -18.0 to -2.1; p = 0.01).
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