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Staccato reperfusion improves myocardial microcirculatory function and long-term left ventricular remodelling: a randomised contrast echocardiography study
  1. Ignatios Ikonomidis1,
  2. Efstathios K Iliodromitis1,
  3. Stavros Tzortzis1,
  4. Aias Antoniadis1,
  5. Ioannis Paraskevaidis1,
  6. Ioanna Andreadou2,
  7. Katerina Fountoulaki1,
  8. Dimitrios Farmakis1,
  9. Dimitrios T Kremastinos1,
  10. Maria Anastasiou-Nana1
  1. 1Second Department of Cardiology, Athens University Medical School, Attiko, University Hospital, Athens, Greece
  2. 2Department of Pharmaceutical Chemistry, University of Athens School of Pharmacy, Athens, Greece
  1. Correspondence to Dr Ignatios Ikonomidis, University of Athens, Perikleous 19, N. Chalkidona, Athens 14343, Greece; ignoik{at}otenet.gr

Abstract

Objective To investigate the effects of staccato reperfusion (SR) during percutaneous coronary intervention (PCI) on myocardial microcirculatory function as assessed by myocardial contrast echocardiography.

Setting Tertiary centre.

Methods Thirty-nine patients were randomised to SR (n=20) or abrupt reperfusion (AR, n=19) within 48 h of an acute coronary syndrome. Contrast intensity replenishment curves were constructed to assess the blood volume (An), velocity (β) and flow (A×β) of the segments associated with the PCI-treated artery before, 48 h, 1 and 12 months after PCI. Left ventricular (LV) end-diastolic (EDVs) and systolic volumes (ESVs) were evaluated. Plasma malondialdehyde (MDA) was determined immediately before and 18 min after PCI to assess oxidative stress.

Results SR was related to a greater improvement in An, β and A×β at 48 h, 1 and 12 months after intervention compared with AR (mean A×β: 0.91, 5.5, 7.14, 6.9 for SR vs 1.02, 3.34, 4.28, 3.71 for AR, p<0.01). After PCI, the mean MDA change was −27% in SR patients and +55% in the AR patients (p<0.05). The percentage change in MDA correlated with the percentage change in An at all time points (r=0.468, r=0.682, r=0.674, p<0.01). Compared with AR, SR was related to a greater percentage decrease in EDV (−11.61% vs −4.13%) and ESV (−34.68% vs −14.83%) at 12 months after PCI (p<0.05). The percentage change in ESV at 12 months correlated with the corresponding percentage changes in An, β and A×β (r=−0.410, r=−0.509, r=−0.577, respectively, p<0.05).

Conclusions SR improves myocardial microcirculatory function after PCI, leading to a concomitant improvement in LV geometry, probably through reduction of oxidative stress.

  • Staccato reperfusion
  • oxidative stress
  • percutaneous coronary intervention
  • myocardial microcirculatory injury
  • contrast echocardiography
  • echocardiography-contrast
  • acute coronary syndrome
  • microvascular
  • myocardial perfusion
  • oxidative stress

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Attikon University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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