IMPACT OF TOTAL ISCHEMIC TIME ON THE RECOVERY OF REGIONAL WALL MOTION ABNORMALITY AFTER STEMI IN THE MODERN REPERFUSION ERA
Main Article Content
Keywords
STEMI, total ischemic time, reperfusion therapy, regional wall motion abnormality, left ventricular function.
Abstract
Introduction: Total ischemic time (TIT) plays a critical role in determining the recovery of regional wall motion abnormalities (RWMA) in STEMI patients treated with primary percutaneous coronary intervention (PCI).
Objectives: To evaluate the impact of TIT on RWMA recovery using advanced diagnostic modalities in STEMI patients undergoing reperfusion therapy.
Materials and Methods: This prospective study included 200 STEMI patients treated with PCI at multiple centers including Rashid Latif Medical University Lahore, Pakistan and Sindh Institute of Cardiovascular Diseases (SICVD) Hyderabad, Pakistan. Patients were categorized based on TIT: ≤3 hours, 3–6 hours, and >6 hours.Speckle-tracking echocardiography and cardiac magnetic resonance imaging were applied to evaluate RWMA and left ventricular function.
Results: Shorter TIT (≤3 hours) was associated with significant improvement in RWMA and left ventricular ejection fraction (LVEF). Prolonged TIT (>6 hours) led to higher rates of adverse remodeling and complications, including heart failure.
Conclusion: Reducing TIT is critical for optimizing RWMA recovery and improving outcomes in STEMI patients.
References
2. Kassem, H.K., Elsaidy, M.A., Alarag, A.F. and Khraba, A.H., 2022. Impact of Time Factor on Wall Motion Abnormalities in Patients with STEMI and Underwent Primary PCI. Cardiology and Angiology: An International Journal, 11(4), pp.384-391.
3. Luisi, G.A., Pestelli, G., Lorenzoni, G., Trevisan, F., Smarrazzo, V., Fiorencis, A., Flamigni, F., Ferrari, R. and Mele, D., 2022. Severe Impairment of Left Ventricular Regional Strain in STEMI Patients Is Associated with Post-Infarct Remodeling. Journal of Clinical Medicine, 11(18), p.5348.
4. Ahmed, M.M., Abd El Ghaffar, M.A. and Abd El Nasser, H.A., 2024. Early resolution of ST-segment Elevation after Reperfusion Therapy for Acute Myocardial Infarction and It's Relation to Left Ventricular Functions by Echocardiography. Al-Azhar International Medical Journal, 5(9), p.22.
5. Calvieri, C., Riva, A., Sturla, F., Dominici, L., Conia, L., Gaudio, C., Miraldi, F., Secchi, F. and Galea, N., 2023. Left ventricular adverse remodeling in ischemic heart disease: emerging cardiac magnetic resonance imaging biomarkers. Journal of Clinical Medicine, 12(1), p.334.
6. Talha, A.R., Alhefnawy, S.B., Zaki, M., Elamrousy, S.M.S. and Elsayed, M., 2024. Predictors of myocardial functional recovery after successful reperfusion of acute St elevation myocardial infarction using speckle tracking echocardiography. IJCS, 6(2), pp.01-06.
7. Aparicio-Ortiz, A.D., Alonso-Jimenez, M.N., Espejel-Guzman, A., Cabello-Ganem, A., Serrano-Roman, J., Luna-Alcala, S. and Espinola-Zavaleta, N., 2024. Mechanical Complications after Myocardial Infarction: A Comprehensive Review. World Journal of Cardiovascular Diseases, 14(1), pp.43-60.
8. Playford, D., Stewart, S., Harris, S.A., Chan, Y.K. and Strange, G., 2023. Pattern and Prognostic Impact of Regional Wall Motion Abnormalities in 255 697 Men and 236 641 Women Investigated with Echocardiography. Journal of the American Heart Association, 12(22), p.e031243.
9. Radike, M., Sutelman, P., Ben‐Aicha, S., Gutiérrez, M., Mendieta, G., Alcover, S., Casaní, L., Arderiu, G., Borrell‐Pages, M., Padró, T. and Badimon, L., 2023. A comprehensive and longitudinal cardiac magnetic resonance imaging study of the impact of coronary ischemia duration on myocardial damage in a highly translatable animal model. European Journal of Clinical Investigation, 53(1), p.e13860.
10. Pantos, C.I., Grigoriou, K.P., Trikas, A.G., Alexopoulos, N.A. and Mourouzis, I.S., 2024. Translating thyroid hormone into clinical practice: lessons learned from the post-hoc analysis on data available from the ThyRepair study. Frontiers in Endocrinology, 15, p.1405251.
11. Tsega, W., Awoke, W., Sendekie, A.K., Dagnew, E.M. and Bayih, H., 2023. Electrocardiogram and echocardiography findings and the outcomes of patients with myocardial infarction: Retrospective study in tertiary care hospitals in Northwest Ethiopia. Plos one, 18(8), p.e0288698.
12. Pius, C., Niort, B., Radcliffe, E.J. and Trafford, A.W., 2024. A refined, minimally invasive, reproducible ovine ischaemia–reperfusion–infarction model using implantable defibrillators: Methodology and validation. Experimental Physiology.
13. El Dosouky, I.I., Abd El Salam, K.M., Ahmed, A.E. and Mohamed, I.G.A., Percutaneous Coronary Intervention in Acute Myocardial Infarction.
14. Wang, X., Li, B., Hu, Y., Xiao, S., Guo, M., Xu, T., Wu, H., Huan, C., Yin, J., Zhu, H. and Pan, D., 2022. Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Scientific Reports, 12(1), p.19349.
15. Kaluza, G.L., Creech, J.L., Furer, A., Afari, M.E., Milewski, K., Yi, G.H., Cheng, Y., Conditt, G.B., McGregor, J.C., Blum, D. and Rousselle, S.D., 2022. Chronic myocardial and coronary arterial effects of intracoronary supersaturated oxygen therapy in swine with normal and ischemic-reperfused myocardium. Scientific reports, 12(1), p.5785.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Muhammad Tayyab
Assistant Professor, Department of Cardiology, Rashid Latif Medical University Lahore, Pakistan
Muhammad Saleem
Assistant Professor of Cardiology, Department of Cardiology, Sahiwal Teaching Hospital/ Sahiwal Medical College, Sahiwal, Pakistan
Altaf Hussain
Assistant Professor (Adult Cardiology), Sindh Institute of Cardiovascular Diseases (SICVD) Hyderabad, Pakistan
Muhammad Saeed Afridi
Associate Professor Cardiac Surgery, RLKU Medical College Lahore, Pakistan
Atif Ahmed Khan
Assistant Professor, Intervention Cardiology, Sindh Institute of Cardiovascular Diseases Hyderabad, Sindh, Pakistan
Rizwan Ahmed
Senior Registrar Cardiology, Rawal Institute of Health Sciences Islamabad, Pakistan