Microvascular dysfunction following ST-elevation myocardial infarction and its recovery over time

Mariëlla E.C.J. Hassell, Matthijs Bax, Martijn A. Van Lavieren, Robin Nijveldt, Alexander Hirsch, Lourens Robbers, Koen M. Marques, Jan G.P. Tijssen, Felix Zijlstra, Albert C. Van Rossum, Ronak Delewi, Jan J. Piek*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aims: It is unclear whether microvascular dysfunction following ST-elevation myocardial infarction (STEMI) is prognostic for long-term left ventricular function (LVF), and whether recovery of the microvasculature status is associated with LVF improvement. The aim of this study was to assess whether microvascular dysfunction in the infarct-related artery (IRA), as assessed by coronary flow reserve (CFR) within one week after PPCI, was associated with LVF at both four months and two years. Methods and results: In 62 patients, CFR and hyperaemic microvascular resistance index (HMRI) in the IRA were assessed by intracoronary Doppler flow measurements within one week and at four months. CMR was performed at the same time points and also at two years. CFR at baseline was associated with left ventricular ejection fraction (LVEF) at four months (β=4.66, SE=2.10; p=0.03) and at two-year follow-up (β=5.84, SE=2.45; p=0.02). HMRI was not associated with LVF. In large infarcts, absolute improvement of CFR in the first four months was associated with LVEF improvement (β=5.09, SE=1.86, p=0.01). Conclusions: Microvascular dysfunction, assessed by CFR, in the subacute phase of STEMI is prognostic for LVEF at four months and two years. This underlines the pivotal role of microvascular dysfunction following STEMI.

Original languageEnglish
Pages (from-to)e578-e584
JournalEuroIntervention
Volume13
Issue number5
DOIs
Publication statusPublished - 1 Aug 2017

Cite this

Hassell, M. E. C. J., Bax, M., Van Lavieren, M. A., Nijveldt, R., Hirsch, A., Robbers, L., ... Piek, J. J. (2017). Microvascular dysfunction following ST-elevation myocardial infarction and its recovery over time. EuroIntervention, 13(5), e578-e584. https://doi.org/10.4244/EIJ-D-16-00818