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

Abstract

Introduction

The 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) (>24 h). 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.

Methods

A 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 2 expert 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 2 expert cardiologists at baseline and at 2-4 follow-up. ECG and analysis were requested before catheterization and during follow-up.

Results

Of 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.

Conclusions

Good CC development in late presentation MI was related to myocardial viability and with LVEF.