[The thermodilution method for the understanding of heart function].
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Purpose: We aimed to investigate if baseline NTproBNP and clinical variables, predict incident atrial fibrillation (AF) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Methods: From a prospective registry, we assessed 984 PPCI patients. In univariate and multivariate regression analysis, we investigated the association of NTproBNP level determined just prior to PPCI, peri-procedural systolic and diastolic blood pressure, infarct size (maximum CK), gender and age, with the incidence of AF. A Kaplan-Meier curve with quartiles of NTproBNP was computed with a log-rank test to assess for significance of differences. Results: NTproBNP was higher (1297 pg/ml versus 570 pg/ml) in patients with versus without incident AF. In univariate analysis, NTproBNP was significantly associated with incident AF (OR 1,11, 95% CI 1,03-1,21, P=0,009). In multivariate analysis, age was the strongest predictor of incident AF (highest quartiles versus lowest quartile OR 7,04, 95% CI 2,77 -17,87, P<0,001). NTproBNP (OR 1,09, 95% CI 1,00 -1,20, P=0,049), systolic blood pressure (OR 0,98, 95% CI 0,97 -1,00, P=0,021) and infarct size (OR 1,18, 95% CI 1,04 -1,33, P=0,01) were also independently associated with incident AF. Gender, target lesion vessel and diastolic blood pressure were not associated with incident AF. Kaplan-Meier curves (Figure 1) depict that higher NTproBNP quartile is significantly (P=0,001) associated with incident AF. Figure 1. Kaplan-Meier curves Conclusion: Age is strongly predictive for incident AF in STEMI patients undergoing PPCI. NTproBNP and infarct size are also independent predictors of incident AF, whereas peri-procedural systolic blood pressure is inversely related to incident AF.
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Left ventricular remodeling (LVR), an increase in left ventricular end-diastolic volume index > or = 20%, is an adverse consequence of myocardial infarction. The aim of this study was to assess the association between LVR and adiponectin, which has been shown to protect against myocardial ischemia-reperfusion injury.In 75 patients echocardiographic examination was performed one year after ST-segment elevation myocardial infarction, successfully treated with primary percutaneous coronary intervention (pPCI). Two groups of patients were analyzed: those with LVR (n = 15) and those without LVR (n = 60).The predictors of LVR were: anterior myocardial infarction, glucose at admission, baseline C-reactive protein, adiponectin, and echocardiographic parameters: left ventricular end-diastolic and end-systolic volume indices, ejection fraction < 40% and left ventricular wall motion score index (WMSI) at discharge. On multivariable regression analysis, lower adiponectin level (OR = 0.67, 95% CI 0.49-0.91, p < 0.05) and higher WMSI (OR = 20.14, 95% CI 2.62-154.82, p < 0.01) were the only independent negative predictors of LVR. The optimal cut-off for adiponectin for predicting LVR was < or = 4.7 mg/mL (sensitivity: 73%, specificity: 85%) and this level increased the risk of LVR 15-fold (95% CI 4.05-59.87, p = 0.0001).Baseline low blood adiponectin concentration, along with WMSI, can be considered as a predictor of the LVR in male patients one year after myocardial infarction and pPCI.
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primary diabetic cardiomyopathy. Echocardiography allows the monitoring of systolic
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Methods : The aim of the study was to assess the effect of type 2 DM on postinfarct left
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