The American Heart Hospital Journal Discussion


The aim of acute MI treatment is to restore coronary circulation as soon as possible by opening the occluded vessel. Success of reperfusion treatment depends on time and rate of TIMI flow 3. However, recent studies reported that improvement in epicardial coronary artery circulation is not sufficient to show myocardial perfusion. The investigation of the efficacy of reperfusion treatment (thrombolytic or primary PCI), effects on left ventricle function (systolic and diastolic), and mortality requires different examinations and tools.10


These tools include


regression of ST segment elevation in ECG and echocardiography monitoring of myocardial perfusion, coronary flow reserve (CFR) measurement after PCI, angiographic myocardial blush grade (MBG) analysis, corrected TIMI frame count (CTFC), and coronary flow rate by Doppler.7–9


The effects of primary PCI on left


ventricle function in patients with acute MI may be determined by left ventricle pressure measured during PCI. In patients with acute STEMI, left ventricle compliance increases, left ventricle filling pressure/EDP decreases, and diastolic function improves after PCI. In the early period (in minutes), left ventricle systolic functions also increase partially.


Diastolic Function


In all STEMI studies, diastolic dysfunction was determined. Reperfusion improves passive diastolic features of the myocardium. Most previous findings were from experimental studies11,12 thrombolytic treatment.14


and they were evaluated after Primary PCI is the best


reperfusion treatment and most previous PCI studies have echocardiography findings from the late period.13


In these


In our study we determined the improvement in both patient groups with anterior and inferior STEMI.


Only one study showed early (in one hour) improvement of left ventricle diastolic function and decrease of LVEDP after PCI in patients with acute anterior MI.17


During elective PCI, the left ventricle pressure/volume curve has a positive change. Increased left ventricle filling pressure and diastolic function disturbances in stable angina pectoris improved rapidly post elective PCI and reperfusion.18,19


Left ventricle systolic function has no or


minimal change in the early period of primary PCI. Studies that investigated thrombotic reperfusion treatment effects on left ventricle systolic function in STEMI patients demonstrated that minimal improvement was determined on left ventricle wall movement after one week.20


Winter 2010


studies there are no early changes in left ventricle function. Experimental and clinical studies have demonstrated that left ventricle compliance improves one week after reperfusion.14–16


Original Contribution


Figure 6: Complete Occlusion in the Right Coronary Artery in a Patient with Acute Inferior Myocardial Infarction (Thrombolysis In Myocardial Infarction Flow 0)


Figure 7: The Vessel is Open after Primary Percutaneous Coronary Intervention and Stent Implantation (Thrombolysis In Myocardial Infarction Flow 3) in the Same Patient


In our study, we determined that complete opening of the vessels that are responsible from MI resulted in a decrease of LVEDP in 10 minutes (see Figures 4–7). Post-PCI decrease of left ventricle diastolic filling pressure indicates the rapid improvement of left ventricle compliance and diastolic function. In these patients clinical symptoms improved rapidly after PCI. Without complication all patients were discharged in stable condition. After one-month follow-up, patients had no complaints or clinical symptoms.


Acute Change in Left Ventricle End-diastolic Pressure after Primary Percutaneous Coronary Intervention 89


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