RESUMO
Intimal sarcomas (IS) are rare, malignant, rapidly progressive mesenchymal tumors that typically occur in the tunica intima of larger vessels, and they rarely involve the heart. IS are frequently misdiagnosed during the initial clinical presentation. This case report describes an uncommonly located IS, highlighting specific findings obtained through multimodality imaging.
Assuntos
Mesenquimoma , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Sarcoma , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Imagem Multimodal , Coração , Sarcoma/complicações , Sarcoma/diagnóstico por imagemRESUMO
BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.
Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Sistema de Registros , Cateterismo Cardíaco/efeitos adversosRESUMO
Percutaneous structural interventions are being performed at increased numbers and rare findings or complications occur more frequently. Lipomatous hypertrophy of the interatrial septum (LHIS) is a relatively uncommon finding on transthoracic echocardiogram (TTE). The major challenge is the difficulty in performing transseptal puncture. We aimed to report the difficulties that were experienced during the left atrial appendage (LAA) closure in a case with an extreme form of LHIS.
Assuntos
Apêndice Atrial , Fibrilação Atrial , Septo Interatrial , Humanos , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Ecocardiografia/métodos , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/métodos , Resultado do Tratamento , Ecocardiografia TransesofagianaRESUMO
Paravalvular leak (PVL) is a complication of valve replacement surgery which may lead to serious clinical consequences including hemolytic anemia. This study aimed to retrospectively evaluate the effect of successful intervention on serum lipid parameters in patients with PVL. A total of 106 patients (mean age: 57.2 ± 13.6 years, male: 67) who underwent surgical or transcatheter closure for symptomatic PVL were enrolled in this study. During the follow-up period, hemolysis and lipid parameters were evaluated at each clinical visit. This is the first study describing the effects of PVL on lipid metabolism after surgical or transcatheter closure. In the study, 18 patients (17%) had aortic PVL, 84 patients (79%) had mitral PVL, and 4 patients (3.8%) had both aortic and mitral PVL. A total of 59 patients underwent transcatheter closure and 47 patients were treated surgically. Technical success of the procedures was 83%. After successful PVL closure, hemoglobin and haptoglobin levels increased significantly (9.5 ± 1.3 vs 11.9 ± 2.1 g/dl, p <0.001 and 16.6 ± 7.9 vs 34.1 ± 19.9 mg, p <0.001, respectively). A significant increase in total cholesterol (158.9 ± 42.7 vs 209.3 ± 58.7 mg/dl, p <0.001), low-density lipoprotein cholesterol (99.1 ± 33.8 vs 133.9 ± 45.7 mg/dl, p <0.001), and high-density lipoprotein cholesterol (39.8 ± 12.4 vs 44.8 ± 11.7 mg/dl, p <0.001) levels was observed after successful PVL closure. In conclusion, symptomatic patients with PVL had hypocholesterolemia, reflected by low serum lipoprotein levels. After successful PVL closure, an increase in serum lipoprotein levels was observed. The recovery in levels of lipoproteins could be used as a marker of successful PVL closure, and absence of recovery of lipoprotein levels may indicate incomplete closure.
Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Idoso , Cateterismo Cardíaco/métodos , Colesterol , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Lipídeos , Lipoproteínas , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Pulmonary artery sarcoma is an extremely uncommon malignancy with a poor prognosis. It is often difficult to distinguish it from pulmonary thromboembolic disease because of nonspe cific signs and symptoms as well as similar imaging findings. We present a 46-year-old man who had initially been diagnosed with presumed asthma that later proved to be pulmonary artery sarcoma. The patient was evaluated with multi-modality imaging studies which showed a mass in the pulmonary artery, its extension, mobility and invasion, and attachment to the artery wall. Pulmonary artery mass was excised and pulmonary artery endarterectomy was performed. The histopathological diagnosis was undifferentiated sarcoma with pleomorphic morphology.
Assuntos
Embolia Pulmonar , Sarcoma , Neoplasias Vasculares , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico , Sarcoma/diagnóstico por imagem , Sarcoma/cirurgia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/cirurgiaRESUMO
BACKGROUND: Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. OBJECTIVES: This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. METHODS: A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. RESULTS: The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). CONCLUSIONS: Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT.
Assuntos
Doenças das Valvas Cardíacas , Próteses Valvulares Cardíacas , Trombose , Adulto , Feminino , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Doenças das Valvas Cardíacas/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Trombose/complicações , Trombose/etiologia , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: This prospective study aimed to investigate the myocardial energy metabolism in severe mitral regurgitation (MR) and explore its effect on postoperative differentiation of ejection fraction (EF). METHODS: A total of 85 patients with severe MR were prospectively enrolled from October 2018 to June 2019. During the study period, a total of 50 patients underwent mitral valve surgery and 49 patients were finally enrolled due to 1 missing data. Left ventricular function, circumferential end-systolic stress (cESS), and myocardial energy expenditure (MEE) were measured by transthoracic echocardiography preoperatively and 3 months after surgery. Patients were divided into 2 groups according to absolute difference of postoperative differentiation of EF. RESULTS: Nine patients underwent mitral valve repair and 40 underwent prosthetic valve replacement. Patients with reduced EF had higher MEE demonstrated with cESS and MEE. Negative correlation between preoperative EF and N-terminal pro-brain natriuretic peptide (NT-proBNP), cESS, MEEs, and MEEm and positive correlation between preoperative EF and effective regurgitant orifice area were found. Complications occurred in 12 patients during hospitalization. Basal NT-proBNP, left atrium (LA), and cESS were significantly higher in postoperatively decreased EF group. Taking into consideration the covariates of multiple logistic regression analysis, LA and cESS were found to be independent predictors of EF reduction postoperatively. CONCLUSION: Higher LA and cESS are independent predictors of postoperative EF reduction. Preoperative high end-systolic stress could predict postoperative EF reduction and hence could be helpful for determining the timing of mitral valve surgery. Although MEE was higher in postoperatively decreased EF group, it did not reach statistical significance.
Assuntos
Insuficiência da Valva Mitral/cirurgia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Metabolismo Energético , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Volume SistólicoRESUMO
Coronary embolism (CE) is the underlying cause of 3% of acute coronary syndromes but is frequently overlooked in the differential diagnoses of acute coronary syndromes. The CE may be direct (left sided from the native or prosthetic heart valve, the left atrium, left atrial appendage or pulmonary venous bed), paradoxical (from the venous circulation through a patent foramen ovale, atrial septal defect, ventricular septal defects, cyanotic congenital heart defects or pulmonary arteriovenous malformations), or iatrogenic (following cardiac interventions. In patients with atrial fibrillation (AF), left atrial appendage (LAA) ligation during mitral valve surgery has long been recommended to decrease the future risk of embolic events such as myocardial infarction or ischemic stroke. Recently, Aryana et al reported that in patients with AF who underwent surgical ligation of LAA, the presence of incomplete ligation was associated with a significantly higher risk of stroke/systemic embolization than complete ligation (24% vs 2%).
Assuntos
Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia/métodos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Tromboembolia/complicações , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Ligadura , Fatores de Risco , Falha de TratamentoRESUMO
BACKGROUND: The use of the CHA2DS2-VASc scoring system and red cell distribution width (RDW) as post-op Atrial Fibrillation (POAF) predictors may be promising for the identification of patients that are at a higher risk of POAF. METHODS: A total of 358 patients (57 patients with POAF, and 301 patients with non-POAF ) with sinus rhythm undergoing a coronary artery bypass graft (CABG) operation were included in the study retrospectively. Preoperative RDW levels and electrocardiograms with sinus rhythm were recorded. Patients with at least one 12-lead electrocardiogram with atrial fibrillation in the postoperative period, with or without medical or electrical cardioversion, were considered to have postoperative atrial fibrillation. A CHADS2 and CHA2DS2-VASc score was calculated for all of the patients. RESULTS: RDW levels were significantly higher in POAF group. RDW levels were significantly correlated with CHADS2 ( r = 0.15, P = .007) and CHA2DS2-VASc (r = 0.19 P = .0001) scores. CHA2DS2-VASc scores were significantly higher in patients with POAF, whereas CHADS2 scores did not differ between groups. In multivariate analysis, left atrial diameter (LAD) (OR:2.44 [95% CI 1.16 - 5.1], P = .018), age (OR:1.04 [95% CI 1.01 - 1.08], P = .01), and RDW (OR:1.16 [95% CI 1.0 - 1.36], P = .05) were found to be predictive for POAF. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.57 - 0.72, P = .0001) with 68.4% sensitivity and 51.2 % specificity to predict POAF. CONCLUSION: Our study showed that age, LAD, and the reduced probability of RDW are predictors of POAF, and that RDW is strongly associated with the thromboembolic risk as determined by CHADS2 and CHA2DS2-VASc scores.
Assuntos
Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Complicações Pós-Operatórias , Medição de Risco , Idoso , Fibrilação Atrial/sangue , Fibrilação Atrial/epidemiologia , Doença da Artéria Coronariana/sangue , Contagem de Eritrócitos , Índices de Eritrócitos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologiaRESUMO
Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction (AMI) with an associated mortality that ranges from 41% to 80%. The treatment consists of supplemental oxygenation, afterload reduction, intraaortic balloon pump, and surgical repair. In selected patients, extracorporeal membrane oxygenation (ECMO) and/or percutaneous closure of the defect can be considered if anatomically appropriate. Echocardiography evaluates the morphology and location of the defect, anatomical concerns for percutaneous closure, and accompanying pathologies. We present a 48-year-old man with inferior myocardial infarction and basal VSR who was not a candidate for percutaneous closure. Surgery was planned, but he died from extensive subarachnoid and intracranial hemorrhage.
Assuntos
Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Ruptura do Septo Ventricular/complicações , Ruptura do Septo Ventricular/diagnóstico por imagem , Doença Aguda , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
A 71-year-old male with a medical history of hypertension was admitted to emergency department with hypertensive pulmonary edema. The patient appeared anxious and diaphoretic, and physical examination revealed tachypnea, crepitant rales in the both lungs and a systolic ejection murmur at the right sternal border, radiating to the both carotid arteries. The electrocardiography showed sinus tachycardia with indications of left ventricle hypertrophy Before the aortic valve surgery, transesophageal echocardiography (TEE) was performed for detailed evaluation of the aortic valve. Two-dimensional TEE showed mild tricuspid valve regurgitation and only two of three leaflets of the tricuspid valve at a time.
Assuntos
Ecocardiografia Transesofagiana/métodos , Hipertensão Pulmonar/complicações , Edema Pulmonar/complicações , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/anormalidades , Idoso , Eletrocardiografia , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Edema Pulmonar/fisiopatologia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
INTRODUCTION: The arteriovenous (AV) loop is recommended when further support is needed during paravalvular leak (PVL) closure. AIM: We report the feasibility and safety of mitral PVL closure without constructing an AV loop, based on a single-centre experience. MATERIAL AND METHODS: Fourteen patients with mitral valve replacement (MVR) who had New York Heart Association (NYHA) class III-IV dyspnoea or NYHA class II symptoms with significant haemolytic anaemia caused by severe or moderate-to-severe paravalvular regurgitation and who underwent transcatheter PVL closure (TPVLC) between May 2014 and February 2017 were enrolled. RESULTS: In total, 15 PVL procedures and 19 device deployments were performed. The patients had one (n = 10), three (n = 1) or four (n = 1) devices for closure at the time of the procedure; one patient had two devices from two procedures at different times with different access ways. Nineteen devices (10 (66.6%) via transseptal access; 4 (26.6%), transapical access; and 1 (6.6%), retrograde access) were deployed successfully without making an AV loop. CONCLUSIONS: The TPVLC is a less invasive and effective alternative to surgery in symptomatic patients with significant PVLs and high operational risks. The success rates are satisfactory, with improving techniques and devices. Procedural success without using an AV loop can be achieved with reduced costs, fluoroscopic times and complications.
RESUMO
BACKGROUND: The goal of this study was to determine changes in left atrial (LA) function with two-dimensional speckle tracking echocardiography (2DSTE) and real-time full-volume three-dimensional echocardiography (RT3DE) after percutaneous mitral valve repair with the MitraClip system. Furthermore, we investigated whether baseline and/or changes in LA function after MitraClip repair had any impact on prognosis. METHODS: A total of 25 consecutive patients (age: 57±12 years, 76% male) with moderate-to-severe or severe mitral regurgitation (MR) were included. Patients underwent 2DSTE and RT3DE before the clip implantation and after the 12-month follow-up. Prognostic data were also recorded via the use of telephone calls and follow-up visits for 12 months after the procedure. RESULTS: Compared with the baseline, the LA reservoir strain (LA-Res) (7.66±4.3% vs 11.15±7.5%, P<.001) and LA contraction strain (LA-Pump) (4.64±4.3% vs 7.63±5.8%, P=.001) improved significantly after MitraClip repair; significant improvements were also seen in three-dimensional (3D) minimum LA volume index (LAV min) and maximum LA volume index (LAV max). On the other hand, conventional LA indices did not change. In total, eleven major adverse cardiac events (MACE) were observed at the 1-year follow-up. In univariate analyses, the preprocedural echocardiographic parameters that were associated with the MACE within 1 year after MitraClip repair were 3D-LAV min and LA-Res. Furthermore, these indices significantly correlated with improved functional parameters and MR reduction. CONCLUSION: In conclusion, a successful MitraClip procedure can reverse the process of LA remodeling within 12 months, and this can be detected by 2DSTE and RT3DE. Also, patients with preprocedural lower LA-Res and higher 3D-LAV min had the worst prognoses at the 1-year follow-up.
Assuntos
Remodelamento Atrial , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Cateteres Cardíacos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anuloplastia da Valva Mitral/métodos , Desenho de Prótese , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoAssuntos
Aorta Torácica/anormalidades , Bronquiectasia/etiologia , Circulação Colateral , Artéria Pulmonar/anormalidades , Malformações Vasculares/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aortografia , Bronquiectasia/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações , Malformações Vasculares/fisiopatologiaRESUMO
OBJECTIVE: Slow coronary flow (SCF) phenomenon is described as the delayed opacification of the distal vasculature and angiographically normal coronary arteries. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tpe) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. In this study, we intended to evaluate ventricular repolarization in patients with SCF by using the Tpe interval and Tpe/QT ratio. METHODS: The study population included 33 patients with angiographically proven SCF and 33 control patients with angiographically proven normal coronary arteries without associated SCF. Coronary flow rates of patients and the control group were documented by TIMI (Thrombolysis in Myocardial Infarction) frame count. From the electrocardiograms, Tpe interval and Tpe/QT ratio were calculated and compared between groups. RESULTS: No statistically significant difference was found between the two groups in terms of basic characteristics. Mean Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were prolonged in the study group compared to the control group (p<0.001). CONCLUSION: Tpe interval and Tpe/QT ratio were increased in SCF patients.
Assuntos
Arritmias Cardíacas/fisiopatologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Arritmias Cardíacas/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia Coronária , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo RegionalAssuntos
Cordas Tendinosas/diagnóstico por imagem , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Mixoma/complicações , Mixoma/diagnóstico por imagem , Cordas Tendinosas/cirurgia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Mixoma/cirurgia , Ruptura , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVES: Osteoprotegerin (OPG) upregulates endothelial cell adhesion molecule response to TNF-α by upregulating angiopoietin-2 (Ang-2). The aim of this study was to investigate the association between admission plasma levels of OPG, Ang-2 and TNF-α in patients with acute ST-segment elevation myocardial infarction (STEMI) and no-reflow after primary angioplasty and subsequent left ventricular remodeling (LVR). METHODS: Ninety-two patients with first STEMIs, reperfused within 12 h of symptom onset, were included. LVR was defined as a >20% increase in LV end-diastolic volume at 6-month follow-up assessed using echocardiography. RESULTS: The incidences of angiographic no-reflow and electrocardiographic no-reflow were 40.2% and 55.4%, respectively. Thirty-six percent of patients subsequently developed LVR. OPG levels were significantly higher in patients who developed angiographic no-reflow (173 pg/ml, interquartile range [IQR] 83-416 vs 104 pg/ml, IQR 57-235; p=0.04), electrocardiographic no-reflow (160 pg/ml, IQR 81-315 vs 102 pg/ml, IQR 47-230; p=0.025) and LVR (174 pg/ml, IQR 120-342 vs 97 pg/ml, IQR 51-219; p=0.004). In multivariable logistic regression, OPG level was an independent predictor of angiographic (OR 1.05: 95% CI 1.01-1.08 [per 10 pg/ml increase]; p=0.005) and electrocardiographic (OR 1.04: 95% CI 1.00-1.07 [per 10 pg/ml increase]; p=0.04) no-reflow. ROC analysis showed an area under the curve of 0.69 for OPG and LVR. Plasma OPG≥132 pg/ml showed a sensitivity of 72% and a specificity of 61% for predicting LVR (OR 4.05: 95% CI 1.06-15.38; p=0.04). CONCLUSION: High OPG level on admission is significantly associated with no-reflow after primary angioplasty and subsequent LVR at follow-up in patients with STEMI.