Correlation of Ischemic Time with Diastolic Dysfunction and Correlation of Diastolic Dysfunction with 6 Minute Walk Test Distance in STEMI Patients Receiving Percutaneus Coronary Intervention

Authors

DOI:

https://doi.org/10.21776/ub.hsj.2022.003.02.5

Keywords:

PCi, Ischemic time, STEMI, Diastolic dysfunction

Abstract

Background: Minimizing the time between ischemia and reperfusion in STEMI patients is critical for salvaging ischemic myocardium and limiting residual injury. One of the methods for determining the impact of ischemic time on the myocardium and correlating the findings to the outcomes is by using echocardiography.

Objectives: To evaluate the correlation of ischemic time to diastolic dysfunction and also the correlation of diastolic dysfunction to functional capacity by 6-minute walk distance in STEMI patients. 

Methods: The study was a retrospective cohort, with all STEMI patients who underwent PCI at RSUD Dr. Saiful Anwar Malang between January 2018 and November 2021 being eligible. All patients underwent PCI, echocardiography, and a 6-minute walk test before being discharged. We defined significant diastolic dysfunction as grade 2 or 3 diastolic dysfunction, according to the 2016 American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines. The distance of 6-minute walk test was divided into three categories: less than 300m, 300-400m, and more than 400m.

Results: From total 258 patients, 92 patients (35.7%) had significant diastolic dysfunction. The significant diastolic dysfunction was correlated with ischemic time > 12 hours (r = 0.51, p = 0.000), Killip class (r= 0.46, p = 0.000), culprit artery (r= 0.203, p=0,001), and peak toponin I levels (r=0.35, p=0.000). We identified that the ischemic time (odds ratio / OR 6.78; 95% Confidence Interval / CI 3.27 – 14.09; p  = 0.000), Killip class (odds ratio 4.62, 95% CI 2.53 to 8.48, p = 0.000), and infarct size by peak troponin I levels (OR 1.12, 95% CI 1.06 to 1.18, p  = 0.000) as independent predictors of significant diastolic dysfunction. There was inversely correlation of diastolic dysfunction with 6-minute walk test distance. (r = -0,422 dan p=0,000), with E/e’ as independent predictors of level of 6 minute walk distance (OR -1.126, 95% CI -1.78 to -0.48, p = 0.001).

Conclusion: Ischemic time is one of the independent predictors of significant diastolic dysfunction. LV diastolic dysfunction was inversely correlated with 6-minute walk test distance in STEMI patient.

Author Biography

  • Imelda Krisnasari, Brawijaya University
    Cardiology

References

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2018;39(2):119-177. doi:10.1093/eurheartj/ehx393.

Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation, 2021; 143(8), e254-e743.

Dharma S, Andriantoro H, Purnawan I, Dakota I, Basalamah F, Hartono B, et al. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry. BMJ Open. 2016;6(8):e012193. doi:10.1136/bmjopen-2016-012193.

Fox KAA. Management Principles in Myocardial Infarction. In Myocardial Infarction: A Companion to Braunwald's Heart Disease E-Book. Elsevier 2016; p.139-152.

Damluji AA, van Diepen S, Katz JN, Menon V, Tamis-Holland JE, Bakitas M, et al. Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation, 2021; 144: e16–e35.

Wang YC, Wu HP, Lo PH, Liang HY, and Chang KC. Impact of prolonged door-to-balloon times on the diastolic function in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Acta Cardiologica Sinica, 2015; 31(4), 281.

Yilmaz A. Angina pectoris in patients with normal coronary angiograms: Current pathophysiological concepts and therapeutic options. Heart 2012; 98: 1020-1029.

Ross RM, Murthy JN, Wollak ID, Jackson AS. The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulmonary Medicine, 2010: 10:31.

Ekblom O, Ek A, Cider Å, Hambraeus K, and Börjesso M. Increased physical activity post–myocardial infarction is related to reduced mortality: results From the SWEDEHEART Registry. Journal of the American Heart Association, 2018; 7(24), e010108.

Tern PJW, Ho AKH, Sultana R, Ahn Y, Almahmeed W, Brieger D, et al. Comparative overview of ST-elevation myocardial infarction epidemiology, demographics, management, and outcomes in five Asia-Pacific countries: a meta-analysis. European Heart Journal-Quality of Care and Clinical Outcomes, 2021; 7(1), 6-17.

Badimon L. Pathogenesis of ST-Elevation Myocardial Infarction. In Coronary Microvascular Obstruction in Acute Myocardial Infarction. Elsevier, 2018; pp. 1-13.

Prasad SB, See V, Brown P, McKay T, Narayan A, Kovoor P, and Thomas L. Impact of Duration of Ischemia on Left Ventricular Diastolic Properties Following Reperfusion for Acute Myocardial Infarction. American Journal of Cardiology 2011;108:348–354.

Prasad SB, Lin A, Kwan C, Sippel J, Younger JF, Hammett C, and Thomas L. Determinants of Diastolic Dysfunction Following Myocardial Infarction: Evidence for Causation Beyond Infarct Size. Heart, Lung and Circulation, 2020; https://doi.org/10.1016/j.hlc.2020.04.016.

Giannitsis E, Steen H, Kurz K, Ivandic B, Simon AC, Futtere S, et al. Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial Versus Single Time-Point Measurements of Cardiac Troponin T. J Am Coll Cardiol 2008; 51:307–14.

Arruda-Olson AM, Roger VL, Jaffe AS, Hodge DO, Gibbons RJ, and Miller TD. Troponin T levels and infarct size by SPECT myocardial perfusion imaging. JACC: Cardiovascular Imaging, 2011; 4(5), 523-533.

Ersbøll M, Andersen MJ, Valeur N, Mogensen UM, Fahkri Y, Thune JJ, et al. Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study. European heart journal, 35(10), 648-656.

Fontes-Carvalho R, Sampaio F, Teixeira M, Rocha-Goncalves, Gama V, Azevedo A, Leite-Moreira A. Left Ventricular Diastolic Dysfunction and E/E’ Ratio as the Strongest Echocardiographic Predictors of Reduced Exercise Capacity After Acute Myocardial Infarction. Clinical Cardiology 2015; 38, 4 : 222–229. DOI:10.1002/clc.22378.

Nagueh SF. Left ventricular diastolic function: understanding pathophysiology, diagnosis, and prognosis with echocardiography. JACC: Cardiovascular Imaging, 2020; 13(1 Part 2), 228-244.

Grewal J, McCully RB, Kane GC, Lam C, and Pellikka PA. Left Ventricular Function and Exercise Capacity. JAMA. 2009;301(3):286-294.

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Published

2022-04-30