Abstract
The prognosis of patients with acute myocardial infarction depends on multiple features that can demonstrate myocardial injury degree (such as serum markers of cardiac necrosis), and also on adaptive mechanisms relative to the acute event. The aim of the study was to assess the relation between biochemical and echocardiographic findings from three-dimensional echocardiographic (3D Echo) analysis and echocardiographic two-dimensional (2D Echo) left ventricular ejection fraction in patients with ST-segment elevation acute myocardial infarction, submitted to primary percutaneous treatment. A prospective study with 2D Echo and 3D Echo of 23 patients (17 males, mean age of 57 ± 13 years) with ST-segment elevation acute myocardial infarction, primarily percutaneously treated (stent). Serum cardiac markers (creatine kinase MB, Troponin I and Myoglobin) and serum brain natriuretic peptide were compared to echocardiographic parameters (volumes, left ventricular ejection fraction and ventricular dyssynchrony index). The statistical analysis was performed using Pearson's correlation coefficient, 95% CI, p < 0.05, linear regression equation and Bland & Altman test. Pearson's correlation coefficient (r)relative to 3D left ventricular ejection fraction: 1- brain natriuretic peptide: r: - 0.7427, p < 0.0001; 2- creatine kinase MB: r: - 0.660, p = 0.001. Left ventricular ejection fraction 2D (r) : 1- brain natriuretic peptide: r: - 0.5478, p = 0.001; 2- creatine kinase MB: r: - 0.4800, p < 0.0277. Other associations were not significant. In this series, it was observed better correlation in regard to serum creatine kinase MB, brain natriuretic peptide and 3D Echo left ventricular ejection fraction, when compared to 2D Echo left ventricular ejection fraction.
Highlights
The prognosis of patients with ST-segment elevation acute myocardial infarction is based on multiple features reflecting myocardial injury degree, as well as adaptive mechanisms of the acute event
From March 2007 to March 2008, a total of 23 patients were prospectively studied, 17 (73%) men, mean age 57 ± 13 [41-89] years, who suffered ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention with a balloon time up to 90 minutes
None of the patients presented a previous history of myocardial infarction
Summary
The prognosis of patients with ST-segment elevation acute myocardial infarction is based on multiple features reflecting myocardial injury degree (enzyme markers of myocardial necrosis), as well as adaptive mechanisms of the acute event. The study LEVEREM, involving 834 post myocardial infarction patients, published in 2004, showed that the initial measurements of proBNP were related to a poor prognosis three months after the acute event[1]. In this same study, the left ventricular volumes, measured by twodimensional echocardiography, were not indicative of poor prognosis for the analysis three months after the myocardial infarction. The level of dilation (ventricular remodeling) mirrored by the measurement of ventricular volumes, as well as ventricular geometry and left ventricular ejection fraction (LVEF) are parameters used to analyze the prognosis in these patients[2,3,4,5].
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