The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Thermodilution-Derived Temperature Recovery Time, a Novel Predictor of Microvascular Reperfusion and Prognosis After Myocardial Infarction

DOI: 10.4244/EIJ-D-19-00904

1. Golden Jubilee National Hospital, Cardiology, Glasgow, United Kingdom
2. West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, U.K.
3. BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, U.K.; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, U.K.
4. Robertson Centre for Biostatistics, University of Glasgow, U.K.
5. Leeds University and Leeds Teaching Hospital NHS Trust, U.K.
6. Wolverhampton University Hospital NHS Trust, U.K.
7. BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, U.K.; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, U.K
8. BHF Glasglow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK, United Kingdom
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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.

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