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eISSN: 1643-3750

Ischemic Versus Non-Ischemic (Neurogenic) Myocardial Contractility Impairment in Acute Coronary Syndromes: Prevalence and Impact on Left Ventricular Systolic Function Recovery

Paweł Iwaszczuk, Bartosz Kołodziejczyk, Tomasz Kruczek, Leszek Drabik, Wojciech Płazak, Monika Komar, Piotr Podolec, Piotr Musiałek

Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, Cracow, Poland

Med Sci Monit 2018; 24: CLR3693-3701

DOI: 10.12659/MSM.907466

Available online: 2018-06-02

Published: 2018-06-02


#907466

BACKGROUND: Neurogenic mechanism is believed to contribute to left ventricular (LV) systolic dysfunction in acute coronary syndromes (ACS); its extreme form is known as takotsubo cardiomyopathy. However, the magnitude of neurogenic contribution to LV dysfunction in all-comer first-time ACS remains unknown.
MATERIAL AND METHODS: In 120 consecutive patients with first-time ACS (age 66.3±12.3years, 40 women) coronary angiograms were individually matched to the echocardiographic left ventricular (LV) segments (17-segment model). Baseline contractility impairment was classified as ischemic (I): confined to the stenotic artery(ies) supply area(s), neurogenic (N): in absence of attributable coronary stenosis, or partially ischemic/partially neurogenic (I&N). Echocardiography was repeated at 6 months to determine LV systolic function recovery.
RESULTS: Neurogenic component (NC) contribution to myocardial contractility impairment was present in 24.2% of ACS patients, with pure N in 6.7% and I&amp;N in 17.5%. Diabetes/pre-diabetes was present in 38.5% vs. 33.5% vs. 0% (I vs. I&amp;N vs. N; p=0.02). Major stressor preceding symptom onset was reported in 3.3% in I, 9.5% in I&amp;N, and 25.0% in N (p=0.03). The number of LV segments with contractility impairment was 2±4 in I, 17±11 in I&amp;N, and 3±16 in N (p<0.05). NC presence was independently associated with better recovery of global LV systolic function (OR 2.99, 95% CI: 1.16–7.76; p=0.024).
CONCLUSIONS: Novel findings from this study are: (1) NC may contribute to myocardial contractility impairment in 1 in every 4 first-time ACS patients, (2) NC contribution to contractility impairment in ACS is blunted in diabetes or pre-diabetes, and (3) LV systolic function recovery is better in patients with NC.

Keywords: acute coronary syndrome, Myocardial Contraction, Myocardial Stunning, Sympathetic Nervous System, takotsubo cardiomyopathy, Ventricular Dysfunction, Left



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