Impact of percutaneous coronary intervention on acute echocardiographic parameters in patients with ST-segment elevation myocardial infarction
Authors: Holle S , Frydland M , Andersen M , Hassager C , Linde J , Kunkel J B , Soeholm H 
Published: January 2025

Abstract

Background
Transthoracic echocardiography (TTE) provides a rapid, non-invasive, bedside assessment of the cardiac function and hemodynamic condition. It is a valuable tool for the acute clinical evaluation in patients with ST-elevation myocardial infarction (STEMI) at arrival in the catheterization laboratory (cath lab).

Purpose
To examine the relationship between TTE parameters obtained before and after primary percutaneous coronary intervention (pPCI) in STEMI patients.

Method
From September 2023 STEMI patients at one tertiary heart center underwent acute bedside TTE examination before pPCI in the cath lab. Patients in cardiogenic shock before leaving the cath lab were excluded. The 5-min focused acute TTE protocol included: LV ejection fraction (LVEF), valvulopathy, mechanical complications, LV outflow tract velocity time integral (LVOT VTI), and diastolic dysfunction (mitral inflow (E and E/A), mitral deceleration time, and mitral annular early diastolic velocity é lateral). The LVEF was categorized in groups: LVEF&gt;45%, moderately reduced (LVEF 35-45%), and severely reduced (LVEF&lt;35%). A full protocol TTE examination was performed before discharge.

Results
A total of 133 STEMI patients (mean age 63 years, 21% women) were included. Prior to admission, 49% had hypertension, 40% hyperlipidemia, 16% diabetes, 17% chronic ischemic heart disease, and 71% were active or previous smokers. Anterior STEMI was present in 39%, and the median time from cath lab arrival to first wire crossing the culprit lesion was 28 min (IQR 24;38). Vital parameters upon admission were: heart rate 75 bpm (IQR: 66;85), Killip Class 1 (96%), lactate levels 1.6 mM (IQR: 1.2;2.3), and systolic blood pressure of 134±27 mmHg.
Considering TTE parameters LVEF and E/A ratio changed significantly from before vs after pPCI (LVEFbefore: 45% vs LVEFafter: 50%, p&lt;0.001 and E/Abefore: 1.1 vs E/Aafter: 0.93, p&lt;0.001), Figure 1. Before pPCI severely reduced LVEF was seen in 17% of patients with improvement in 44% to moderately reduced LVEF, and 4% to normal-slightly reduced LVEF. Before PCI, moderately reduced LVEF was seen in 40% of patients with improvement in 38% to normal-slightly reduced LVEF after PCI. Patients who experienced a decline in LVEF had a longer, though not statistically significant, ECG-to-wire crossing time (119 min [IQR 94;213] vs 102 min [IQR 75;142], p=0.10).

Conclusion
This study shows that in STEMI patients, the TTE parameters LVEF and E/A ratio were altered after pPCI. Despite a significant decrease in one of the diastolic dysfunction parameters, the E/A ratio remained within the normal range before and after PCI. The increase in LVEF was small, however it may be clinically significant, indicating improved heart function, potentially leading to less symptoms, adjusted treatment plans, and a more favorable prognosis for the patient. However, the parameters should be cautiously interpreted due to measurement uncertainty and validated with a larger sample size.
Figure 1. ANCOVA plot