Iranian Heart Journal

Iranian Heart Journal

Colchicine for Preserving Left Ventricular Systolic Function in Patients With STEMI Following Successful Primary PCI: A Speckle-Tracking Echocardiography Study

Document Type : Original Article

Authors
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract
Background: Colchicine is a safe and well-tolerated medication in patients with cardiovascular disease. Speckle-tracking echocardiography (STE) with global longitudinal strain average is a validated method for evaluating left ventricular (LV) function. Utilizing 2D STE, this study aimed to investigate the safety and efficacy of colchicine administration on LV systolic function in anterior ST-segment elevation myocardial infarction (STEMI) patients following a successful primary percutaneous coronary intervention (PPCI).
 
Methods: This randomized clinical trial involved 200 anterior STEMI patients who underwent successful PPCI, allocated to 2 groups: Group I (control group), receiving guideline-directed medical therapy (GDMT), and Group II (colchicine group), receiving both GDMT and colchicine (loading and maintenance dose) for 6 months. Assessment of LV systolic function was performed using Simpson’s method, along with 2D STE and global longitudinal strain GLS averages. This evaluation was conducted for all patients during their hospital stay and followed up 6 months later.
 
Results: Assessment of LV systolic function, measured as ejection fraction (EF [%]), calculated using Simpson’s method, indicated a significant improvement in the colchicine group compared to the control group at the 6-month follow-up (EF = 41.38% ± 3.98 in the colchicine group vs 39.38% ± 7.74 in the control group; P = 0.011). Additionally, there was a highly statistically significant improvement in LV GLS average (−13.28 ± 2.13 in the colchicine group vs −11.64 ± 2.73 in the control group; P = 0.001). No significant difference was observed in the rate of acute and chronic complications during the follow-up between the control and colchicine groups.
 
Conclusions: Colchicine administration in anterior STEMI patients following a successful PPCI was found to significantly improve LV systolic function without an increase in the incidence of complications. (Iranian Heart Journal 2024; 25(4): 84-95)
Keywords

  1. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. EurHeart J 2014; 35: 2950–59.
  2. Saeed B, Aziz M, Omran A, Daoud Y, Al-Mallah M, Balghith M. Left ventricular function and remodelling following primary PCI for STEMI patients and relation to time delay. J. Saudi Hear. Assoc., 2012; 24(4): 274–275.
  3. Frangogiannis NG. The inflammatory response in myocardial injury, repair, and remodeling. Nat Rev Cardiol. 2014; 11:255–65.
  4. Potter E, Marwick TH. Assessment of Left Ventricular Function by Echocardiography: The Case for Routinely Adding Global Longitudinal Strain to Ejection Fraction. Vol. 11, JACC: Cardiovascular Imaging. Elsevier Inc.; 2018. 260–74.
  5. Giugliano GR, Giugliano RP, Gibson CM, Kuntz RE. Meta- analysis of corticosteroid treatment in acute myocardial infarction. Am J Cardiol 2003; 91: 1055 – 1059.
  6. Ravelli RB, Gigant B, Curmi PA, Jourdain I, Lachkar S, Sobel A, et al. Insight into tubulin regulation from a complex with colchicine and a stathmin- like domain. Nature 2004; 428:198-202.
  7. Pope RM, Tschopp J. The role of inter- leukin-1 and the inflammasome in gout: implications for therapy. Arthritis Rheum 2007; 56:3183-8.
  8. Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP,  et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019; 381:2497–2505.
  9. D'hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F, et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. European Journal of Echocardiography. 2000 Sep 1; 1(3):154-70.
  10. Jia C, Olafsson R, Huang SW, Kolias TJ, Kim K, Rubin JM, et al. Comparison of 2-D speckle tracking and tissue Doppler imaging in an isolated rabbit heart model. IEEE transactions on ultrasonics, ferroelectrics, and frequency control. 2010; 57(11):2491-502.
  11. Appleby MA, Angeja BG, Dauterman K, Gibson CM. Angiographic assessment of myocardial perfusion: TIMI myocardial perfusion (TMP) grading system. Heart. 2001; 86(5):485–486.
  12. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). Glob Heart. 2018; 13(4):305-338.
  13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L,  et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 [cited 2021]; 28(1):1-39.e14.
  14. Broderick TM, Bourdillon PD, Ryan T, Feigenbaum H, Dillon JC, Armstrong WF. Comparison of regional and global left ventricular function by serial echocardiograms after reperfusion in acute myocardial infarction. J Am SocEchocardiogr. 1988; 2:315–323.
  15. Choi ER, Park SJ, Choe YH, Ryu DR, Chang SA, Choi JO, et al. Early detection of cardiac involvement in Miyoshi myopathy: 2D strain echocardiography and late gadolinium enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010; 12:31.
  16. Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: A meta-analysis. J Am Soc Echocardiogr. 2013; 26(2):185–91.
  17. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2):119-177.
  18. Heyndrickx GR, Baig HA, Nellens PA, Leusen IS, Fishbein MC, Vatner SF et al. Depression of regional blood flow and wall thickening after brief coronary occlusions. Am J Physiol. 1978; 234(6): H653-9.
  19. Doughty RN, Whalley GA, Walsh HA, Gamble GD, López-Sendón J, Sharpe N. et al. Effects of carvedilol on left ventricular remodeling after acute myocardial infarction: the CAPRICORN Echo Substudy. Circulation 2004; 109:201–206.
  20. Mastrocola R, Penna C, Tullio F, Femminò S, Nigro D, Chiazza F, et al. Pharmacological inhibition of NLRP3 inflammasome attenuates myocardial ischemia/reperfusion injury by activation of RISK and mitochondrial pathways. Oxid Med Cell Longev. 2016; 2016:5271251.
  21. Deftereos S, Giannopoulos G, Angelidis C, Alexopoulos N, Filippatos G, Papoutsidakis N, et al. Anti-inflammatory treatment with colchicine in acute myocardial infarction: a pilot study. Circulation. 2015; 132:1395–1403.
  22. Pope RM, Tschopp J. The role of inter- leukin-1 and the inflammasome in gout: implications for therapy. Arthritis Rheum 2007; 56:3183-8.
  23. Imazio M, Belli R, Brucato A, Cemin R, Ferrua S, Beqaraj F, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicenter, double-blind, placebo-controlled, randomized trial. Lancet. 2014; 383(9936):2232–2237.
  24. Samuel M, Tardif JC, Bouabdallaoui N, Khairy P, Dubé MP, Blondeau L, et al. Colchicine for secondary prevention of cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials. Can J Cardiol. 2021; 37:776–785.
  25. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014 Nov; 100(21):1673-80.