Coronary interventions

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

EuroIntervention 2021;17:220-228. DOI: 10.4244/EIJ-D-19-00904

Annette Maznyczka
Annette M. Maznyczka1,2,3, PhD; David Carrick2, PhD; Keith G. Oldroyd1,2, MD(Hons); Greg James-Rae4, MRes; Peter McCartney1,2, MBChB; John P. Greenwood5, PhD; Richard Good2, MD; Margaret McEntegart2, PhD; Hany Eteiba2, MD; Mitchell M. Lindsay2, MD; James M. Cotton6, MD; Mark C. Petrie1,2, MBChB; Colin Berry1,2, PhD
1. BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; 2. West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom; 3. Portsmouth University Hospitals NHS Trust, Portsmouth, United Kingdom; 4. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom; 5. Leeds University and Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom; 6. Wolverhampton University Hospital NHS Trust, Wolverhampton, United Kingdom

Background: Novel parameters that detect failed microvascular reperfusion might identify better the patients likely to benefit from adjunctive treatments during primary percutaneous coronary intervention (PCI).

Aims: The aim of this study was to test the hypothesis that a novel invasive parameter, the thermodilution-derived temperature recovery time (TRT), would be associated with microvascular obstruction (MVO) and prognosis.

Methods: 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.

Results: In the retrospective derivation cohort (n=271, mean age 60±12 years, 72% male), higher TRT was associated with more MVO (coefficient: 4.09 [95% CI: 2.70-5.48], p<0.001), independently of IMR >32, CFR ≤2, hyperaemic Tmn >median, thermodilution waveform, age and ischaemic time. At five 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 59±11 years, 80% male), the findings were confirmed prospectively.

Conclusions: TRT represents a novel diagnostic advance for predicting MVO and prognosis. Identifiers: NCT02072850 & NCT02257294

Visual summary. Thermodilution-derived temperature recovery time (TRT): a novel predictor of microvascular reperfusion & prognosis after STEMI. CMR: cardiovascular magnetic resonance; MACE: major adverse cardiac events; MVO: microvascular obstruction; PCI: percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction

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