Abstract
Abstract Background Identification of patients with risk of myocardial injury during PCI would allow targeted novel therapies capable of limiting the extent of this injury or reducing its patients number.CK-MB, Troponin-T and I have enabled the quantification of previously undetectable myocardial injury that can also be CMRI visualized.Elevated LV filling pressures are associated with adverse remodeling, HF, and worse survival.E" velocity (unlike others) appears to be relatively independent of preload, especially if myocardial relaxation decreased.In addition, early transmitral flow velocity /early diastolic mitral annulus velocity(E/E") ratio has recently been shown as the most accurate noninvasive predictor of high LV filling pressure.Purpose: evaluate the reliability and adverse outcome of high E/E" in predicting periprocedural myocardial injury. Methods 60 adult diabetic patients with troponin negative CAD admitted for PCI were studied,then analyzed on the basis of post PCI troponin level:(positive and negative group).E/E" ratio was measured and compared with both groups. Results 24 patients developed high troponin after PCI specially if PCI complicated or number of DES increased (p. value <0.001&0.027 respectively).Septal E" velocity was improved after PCI(p. value 0.031).E/E" ratio was high in troponin positive group as. Average e/e" ratio can differentiate between patient"s with troponin negative and positive values (predict periprocedural myocardial injury) with high p. value <0.0001,with cuttof value >10.7, with sensitivity and specificity(79.17% and 87.11%) respectively. Positive and negative predictive value for average e/e" ratio was (79.2 and 86.1) respectively. Conclusions E/E" ratio can provide useful information on LV filling pressure and can be used as a reliable biomarker for early prediction of periprocedural myocardial injury. But, further studies on a larger number of patients are needed for reliability. Limitations small sample size and pre-defined set of study parameters. E/E" ratio and troponin Negative troponin Positive troponin p. value Mean± SD Median(iqr) Mean± SD Median(iqr) EF Biplane 55.8 ± 6.6 56(50:61.5) 53.8 ± 6.5 51(50:59.5) 0.289 LAV index 30.7 ± 4.6 29.5(28:35.5) 31.6 ± 3.6 33(28:35) 0.675 Average E/E" Post 9.1 ± 7.1 7.3(6.5:9.3) 15.9 ± 8.5 14.2(11.1:18.7) <0.001 Lateral E/E" Post 9 ± 6 7(6:9) 15 ± 7 13(11- 18) <0.001 Septal E/E" Post 10 ± 9 8(7:10) 17 ± 11 15(11:20) <0.001 comparison between focused echocardiographic variables & troponin post PCI
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