Turk Kardiyol Dern Ars. 2020; 48(2): 116-126 | DOI: 10.5543/tkda.2019.62121
Relationship between histopathological features of aspirated thrombi and long-term left ventricular function in patients with ST-segment elevation myocardial infarction
Mehmet Onur Omaygenç1
, Cem Doğan2
, Adnan Somay3
, Oğuz Karaca1
, Ruken Bengi Bakal2
, Mehmet Kamil Teber4
, Suzan Hatipoğlu5
, Zübeyde Bayram2
, Cihangir Kaymaz2
, Nihal Özdemir21
Department of Cardiology, İstanbul Medipol University, International Medical Faculty, İstanbul, Turkey2
Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey3
Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey4
Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey5
Department of Radiology (Division of CMR), Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
OBJECTIVE This study was an investigation of the severity of inflammation (SOI) in aspirated material and thrombus age to examine any association with pre-discharge and long-term left ventricular (LV) function after ST-elevation myocardial infarction (STEMI).
METHODS The study group comprised 25 patients with STEMI from whom an occlusive thrombus was aspirated from the infarct-related artery with a 7-F catheter. The SOI in the aspirate was determined according to the mean leukocyte count in 5 high-power magnification fields and graded as mild in the presence of ≤100 leukocytes per field or significant if there were >100 leukocytes per field. The thrombi were categorized as fresh or lytic/organized (L/O) using predefined criteria. Echocardiographic assessment was performed prior to discharge and at 1 year. Adverse left ventricular remodeling (LVR) was defined as a 20% increase in LV end-diastolic volume in comparison with baseline values.
RESULTS LVR was observed in 8 patients. The mean leukocyte count of the aspirate (127.5±86.0 vs 227.2±120.7; p=0.026) and frequency of significant inflammation (35% vs 75%; p=0.046) were significantly higher in the group with LVR. The serum high-sensitivity C-reactive protein (hsCRP) level was significantly correlated with the leukocyte count of the aspirate (r=0.532; p=0.006). An L/O thrombus was related to better pre-discharge and long-term LV volumes and ejection fraction values compared with a fresh thrombus.
CONCLUSION A significant increase in the leukocyte count in the aspirate and a fresh thrombus might predict long-term LV functional deterioration irrespective of the clinical and procedure-related characteristics. In addition, serum markers of inflammation, like hsCRP, might also reflect the intensity of the local inflammatory response at the site of occlusion.
Inflammation mediators, leukocyte count, myocardial infarction; thrombectomy; ventricular remodeling.
How to cite this article
Mehmet Onur Omaygenç, Cem Doğan, Adnan Somay, Oğuz Karaca, Ruken Bengi Bakal, Mehmet Kamil Teber, Suzan Hatipoğlu, Zübeyde Bayram, Cihangir Kaymaz, Nihal Özdemir. Relationship between histopathological features of aspirated thrombi and long-term left ventricular function in patients with ST-segment elevation myocardial infarction. Turk Kardiyol Dern Ars. 2020; 48(2): 116-126
Corresponding Author: Mehmet Onur Omaygenç, Türkiye