Función ventricular y viabilidad miocárdica en infartos de miocardio evolucionados con buena circulación colateral precoz

Abstract

IntroductionThe role of collateral circulation (CC) in ischemic heart diseases remains controversial. There is a lack of evidence about the effect of CC on late presentation myocardial infarction (MI0) (>24h). We hypothesized that coronary CC may be related to myocardial viability and left ventricular ejection fraction (LVEF) in late presenter MI patients and its connection with ECG and analytical parameters. MethodsA total of 138 consecutive patients with a late presentation MI and a thrombotic occlusion (TIMI 0) in a major coronary artery were enrolled in this multicenter ambispective and blinded study. CC was classified according to Rentrop and Werner classifications in a blinded manner by 2expert interventional cardiologists. Twelve patients were prospectively followed up and the wall motion score (WMS) was calculated using the 16 ventricular segments standard model in a blinded manner by 2expert cardiologists at baseline and at 2-4 follow-up. ECG and analysis were requested before catheterization and during follow-up. ResultsOf all patients included, 67 patients (49%) was Rentrop 0-1 and 71 patients (51%) was Rentrop 2-3. The interobserver concordance for WMS calculation (r=0.99, p=0.001) was excellent.The culprit vessel was successfully revascularized in 84/113 patients (74%) but it was not related neither to LVEF nor with WMS (p>0.05). Myocardial viability was confirmed in 65/116 patients (56%) and it was related to good CC (78 vs. 33.9%, p<0.001). Rentrop and Werner classifications were related to LVEF (r=0.29, p=0.004 and r=0.24, p=0.01) and with WMS (r=−0.73, p=0.01 and r=−0.72, p=0.01) at baseline and at follow-up (r=0.67, p=0.01 and r=−0.53, p=0.01) but also with some electrocardiographic parameters: number of leads showing: persistent ST elevation (r=−0.78, p=0.001 and r=−0.71, p=0.001), and Q and T waves (r=−0.79, p=0.001 and r=−0.7, p=0.01). Analytically, more eosinophils, lymphocytes and platelets and fever neutrophils are observed. ConclusionsGood CC development in late presentation MI was related to myocardial viability and with LVEF.