Plasma MMP-2, MMP-9 and N-BNP in Long-Term Survivors Following Complicated Myocardial Infarction: Relation to Cardiac Magnetic Resonance Imaging Measures of Left Ventricular Structure and Function

AbstractTo study the long-term prognosis of early pre-discharge and late left ventricular (LV) dilatation in patients with first ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) and contemporary medical therapy. Long-term follow-up > 15 years was available in 53 consecutive patients (55 ± 13 years) with first STEMI. Late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (CMR) was obtained at baseline 5 ± 3 days and follow-up 8 ± 3 months after STEMI to measure LV function, volumes and infarct size. Early pre-discharge dilatation was defined as increased left ventricular end-diastolic volume index (LVEDVi) at baseline CMR with > 97 ml/m2 for males and > 90 ml/m2 for females. Late dilatation was defined as initially normal LVEDVi, which increased ≥ 20% at follow-up. Early dilatation was present in 7 patients (13%), whereas late dilatation occurred in 11 patients (21%). Patients with early LV dilatation had highest mortality (57%), whereas patients with late dilatation had similar mortality (27%) compared to patients without dilatation (26%). Multivariate Cox analysis showed that age (P < 0.001), ejection fraction at baseline (P < 0.01) and early dilatation (P < 0.01) were independent predictors of death. Early dilatation qualified as an exclusive independent predictor of long-term mortality after adjustment for age and ejection fraction (P < 0.05, hazard ratio: 2.2, 95% confidence interval: 1.2 to 7.9). Early pre-discharge LV dilatation by CMR enabled strong long-term risk stratification after STEMI. The high mortality of early LV dilatation underscores the clinical importance of this post-infarction complication, which occurred despite PCI and contemporary medical therapy.

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The association of isosorbide-5-monitrate to an ACE inhibitor started early after myocardial infarction improves left ventricular structure and function over three months: the Delapril and Remodelling in Acute Myocardial Infarction (DRAMI) study

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)81287-6 ◽

2002 ◽

Vol 39 ◽

pp. 287

Author(s):

Roberto Latini ◽

Aldo P. Maggioni ◽

Lidia Staszewsky ◽

Violeta Labarta ◽

Paolo Marino ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ace Inhibitor ◽

Left Ventricular ◽

Structure And Function ◽

Left Ventricular Structure ◽

Ventricular Structure ◽

And Function

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Left ventricular global function index assessed by cardiac magnetic resonance imaging for the prediction of cardiovascular events in ST-elevation myocardial infarction

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-17-s1-o34 ◽

2015 ◽

Vol 17 (S1) ◽

Cited By ~ 1

Author(s):

Ingo Eitel ◽

Janine Pöss ◽

Alexander Jobs ◽

Charlotte Eitel ◽

Suzanne de Waha ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Cardiovascular Events ◽

Left Ventricular ◽

Resonance Imaging ◽

Global Function ◽

St Elevation

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Abstract 9634: As Compared With Cardiac Magnetic Resonance Imaging, Transthoracic Echocardiography Has an Excellent Accuracy in Diagnosing a Left Ventricular Thrombus After an Anterior Myocardial Infarction Complicated With Left Ventricular Dysfunction: Results of a Prospective Multicentric Study

Circulation ◽

10.1161/circ.130.suppl_2.9634 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Philippe Meurin ◽

Virginie Brandao Carreira ◽

Raphaelle D Dumaine ◽

Alain Shqueir ◽

Olivier Milleron ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Antiplatelet Therapy ◽

Transthoracic Echocardiography ◽

Dual Antiplatelet Therapy ◽

Left Ventricular ◽

Resonance Imaging

Introduction: The generalization of reperfusion techniques to treat acute myocardial infarction (MI) has allowed for markedly reduced incidence in left ventricular (LV) thrombi because of the reduced myocardial damage. LV thrombi are estimated to complicate 5% to 10% of unselected anterior-wall MI (Ant-MI). However, the incidence and evolution of LV thrombi in high-risk patients with Ant-MI complicated by LV systolic dysfunction is not well known. Cardiac magnetic resonance imaging with contrast delayed enhancement (CMR-DE) is the gold standard in assessing LV thrombus, but comparisons of transthoracic echocardiography (TTE) and CMR-DE are scarce. Hypothesis: We assessed whether LV thrombi are still frequent after major Ant-MI, despite systematic dual antiplatelet therapy, and whether focused TTE has a good accuracy for detection as compared with CMR-DE. Methods: From 2011 to 2013, from 7 centers, we prospectively included patients with LV ejection fraction (LVEF) < 45% at a first TTE performed < 7 days after Ant-MI. A second evaluation including TTE and CMR-DE (analyzed by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status and adverse events were performed between months 6 and 12. Results: We included 100 consecutive patients (71% males; mean age 59.1 ± 12.1 years; LVEF 33.5 ± 6.0%) at a mean of 4.8 ± 1.9 days after Ant-MI; 88% had undergone primary coronary angioplasty. In total, 26 patients had LV thrombi detected at a mean of 23.2 ± 34.8 days after MI (6 during the first week after the MI, 16 from days 8 to 30, 4 after day 30). As compared with CMR-DE, TTE sensitivity and specificity were 94.7% and 98.5%, respectively. For 24 patients (92.3%), the LV thrombi disappeared with triple antithrombotic therapy including dual antiplatelet therapy and a vitamin K antagonist. One patient died from a recurrent subdural haematoma and another had a peripheral embolism. Conclusions: In this prospective multicenter study, LV thrombus occurred in 26% of patients after Ant-MI complicated by LV dysfunction. Focused TTE has a high accuracy for detection. CMR-DE should be performed only when the apex is not clearly seen.

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Cardiac arrest in a healthy child due to paradoxical embolus across a previously unrecognised sinus venosus defect

BMJ Case Reports ◽

10.1136/bcr-2019-230135 ◽

2019 ◽

Vol 12 (12) ◽

pp. e230135

Author(s):

Margaret M Samyn ◽

Todd M Gudausky ◽

Joshua R Kovach ◽

Ronald K Woods

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Cardiac Arrest ◽

Cardiac Magnetic Resonance ◽

Coronary Artery Occlusion ◽

Artery Occlusion ◽

Left Ventricular ◽

Resonance Imaging ◽

Sinus Venosus Defect ◽

Paradoxical Embolus

A previously healthy, preadolescent female suffered an unwitnessed cardiac arrest with prompt return of circulation following bystander initiated resuscitation. Workup demonstrated the cause of her cardiac arrest to be distal left anterior descending coronary artery occlusion with small apical left ventricular transmural myocardial infarction, from a paradoxical embolus traversing a previously undiagnosed large sinus venous defect. This case demonstrates the value of cardiac magnetic resonance imaging may bring to the diagnosis of the pathophysiology leading to cardiac arrest.

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