Thermodilution-derived temperature recovery time, a novel predictor of microvascular reperfusion and prognosis after myocardial infarction

Maznyczka, A. M. et al. (2020) Thermodilution-derived temperature recovery time, a novel predictor of microvascular reperfusion and prognosis after myocardial infarction. EuroIntervention, (PMID:32122822) (Early Online Publication)

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Abstract

Aims: Novel parameters that detect failed microvascular reperfusion might better identify the patients likely to benefit from adjunctive treatments during primary percutaneous coronary intervention (PCI). We hypothesised that a novel invasive parameter, the thermodilution-derived temperature recovery time (TRT), would be associated with microvascular obstruction (MVO) and prognosis. Methods and results: TRT was derived and validated in two independent ST-elevation myocardial infarction populations and was measured immediately post-PCI. TRT was defined as the duration (seconds) from the nadir of the hyperaemic thermodilution curve to 20% from baseline body temperature. MVO extent (% left ventricular mass) was assessed by cardiovascular magnetic resonance imaging at 2-7 days. In the retrospective derivation cohort (n=271, mean age 60±12 years, 72% male), higher TRT was associated with more MVO (coefficient: 4.24 [95% CI: 2.26-6.22) p<0.001), independently of IMR>32, CFR≤2, hyperaemic Tmn>median, thermodilution waveform, age and ischaemic time. At 5-years, higher TRT was multivariably associated with all-cause death/ heart failure hospitalisation (OR: 4.14 [95% CI: 2.08-8.25] p<0.001) and major adverse cardiac events (OR: 4.05 [95% CI: 2.00-8.21] p<0.001). In the validation population (n=144, mean age 60±11 years, 80% male), the findings were confirmed prospectively. Conclusions: TRT represents a novel diagnostic advance for predicting MVO and prognosis.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and McEntegart, Dr Margaret and Carrick, Dr David and Maznyczka, Dr Annette Marie and Petrie, Professor Mark and McCartney, Dr Peter and Eteiba, Dr Hany and Oldroyd, Dr Keith and James-Rae, Mr Greg
Authors: Maznyczka, A. M., Carrick, D., Oldroyd, K. G., James-Rae, G., McCartney, P., Greenwood, J. P., Good, R., McEntegart, M., Eteiba, H., Lindsay, M., Cotton, J. M., Petrie, M. C., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:EuroIntervention
Publisher:Europa Digital & Publishing
ISSN:1774-024X
ISSN (Online):1969-6213
Published Online:03 March 2020
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174049T-TIME Coronary Physiology StudyColin BerryBritish Heart Foundation (BHF)FS/16/74/32573Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
190350Validation and significance of myocardial haemorrhage revealed by "bright blood" T2-weighted MRI in heart attack survivors: a prospective cohort study.Colin BerryBritish Heart Foundation (BHF)PG/11/2/28474Institute of Cardiovascular & Medical Sciences
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences
190864A randomised parallel group double blind placebo-controlled trial of low dose adjunctive alteplase during primary PCI (T-TIME)Colin BerryNational Institute for Health Research (NIHR)12/170/45Institute of Cardiovascular & Medical Sciences