Can copeptin and troponin T ratio predict final infarct size and myocardial salvage index in patients with ST-elevation myocardial infarction: A sub-study of the DANAMI-3 trial

2018 ◽  
Vol 59 ◽  
pp. 37-42 ◽  
Author(s):  
Ásthildur Árnadóttir ◽  
Mikkel Schoos ◽  
Jacob Lønborg ◽  
Kiril Ahtarovski ◽  
Henning Kelbæk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Troponin T ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Salvage ◽  
Final Infarct Size ◽  
St Elevation

P4436Impaired myocardial healing in patients with diabetes after ST-Elevation Myocardial Infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Wamil ◽  
A Borlotti ◽  
A Banerjee ◽  
L Gaughran ◽  
G L De Maria ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Underlying Mechanism ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Salvage ◽  
Monocyte Count ◽  
Area At Risk ◽  
Ischaemic Injury ◽  
Final Infarct Size ◽  
St Elevation

Abstract Background Diabetes mellitus (DM) significantly increases mortality following myocardial infarction (MI). The underlying mechanism explaining this adverse prognosis is not completely understood. Purpose This study sought to investigate the characteristics of myocardial healing after MI in DM patients. Methods 62 recruited ST-elevation myocardial infarction (STEMI) patients (21 with DM and 41 controls) underwent acute (1–3 days post-STEMI) and 6 months (6M) follow-up cardiac magnetic resonance scans (CMR). Control cases were matched for the peak troponin levels and area at risk on the acute CMR scans. Blood samples were obtained 6, 24, 48 hours and 6 months after STEMI. Results Despite similar severity of the initial ischaemic injury, DM patients had lower myocardial salvage index (MSI) and as a result larger final infarct size at 6 months. Further segment-based analysis of the acute CMR scans showed significantly prolonged T1-mapping values in all segments including non-ischaemic myocardium in DM patients and poorer recovery of the late gadolinium enhancement (LGE) of the infarcted segments in that group. Additionally, DM patients had higher monocyte counts 24 hours post-MI (1.2±0.4x109/μl DM vs 0.88±0.3 x109/μl control, p=0.001). We found that HbA1C correlated with monocyte count measured 24 hours after STEMI (r=0.577, p=0.006, n=21). HbA1C also predicted myocardial salvage index (MSI) at 6M post STEMI in the DM patients (r=0.891, p=0.017, n=13). Conclusions DM patients presenting with STEMI have increased peripheral blood monocytosis and larger final infarct size compared with STEMI patients without DM. Poorly controlled DM predisposes to adverse cardiac remodelling after STEMI. Acknowledgement/Funding OHSRC Research Grant, National Institute for Health Research (NIHR), British Heart Foundation Centre of Excellence Oxford

Elevated serum osteoprotegerin levels measured early after acute ST-elevation myocardial infarction predict final infarct size

Heart ◽  
2011 ◽  
Vol 97 (6) ◽  
pp. 460-465 ◽  
Author(s):  
G. O. Andersen ◽  
E. C. Knudsen ◽  
P. Aukrust ◽  
A. Yndestad ◽  
E. Oie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Elevated Serum ◽  
St Elevation Myocardial Infarction ◽  
Final Infarct Size ◽  
St Elevation

Abstract 16142: Grad 3-Ischemia (QRS Complex Distortion) as a Predictor of Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging and Clinical Prognosis in Patients With ST-Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Karl-Philipp Rommel ◽  
Hadil Badarnih ◽  
Steffen Desch ◽  
Matthias Gutberlet ◽  
Gerhard Schuler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Cox Regression ◽  
Myocardial Damage ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Salvage ◽  
Qrs Complex ◽  
Clinical Prognosis ◽  
Cox Regression Analysis ◽  
St Elevation

Introduction: Predicting the extent of myocardial damage on early electrocardiographic (ECG) findings could be helpful for improved risk stratification in patients with acute reperfused ST-elevation myocardial infarction (STEMI). Distortion in the terminal portion of the QRS complex (so called grade 3 ischemia, G3I) has been associated with adverse outcomes in STEMI patients. The correlation of G3I with infarct size and microvascular injury is not well defined. Objective: To studied the relation of G3I with myocardial damage as assessed by CMR and the association of G3I with adverse clinical outcomes in a STEMI population treated by primary percutaneous coronary intervention (PCI). Methods: We analyzed the ECGs of 572 consecutive STEMI patients regarding the presence or absence of G3I. G3I was defined as: 1) complete loss of S waves in 2 adjacent leads with typical Rs configuration (i.e. V1-V3), or 2) ST-J point to R wave amplitude ratio >0.5 in other leads with qR configuration. CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical end-point was major adverse cardiac events (MACE) defined as death, reinfaction and readmission for congestive heart failure within 12 months after the index event. Results: G3I was present in 186 (32%) patients. The presence of G3I was associated with larger infarct size (18.3%LV [10.4 to 27.6] versus 16.5%LV (8.2 to 23.5), p=0.01), late microvascular obstruction (0.4%LV [0 to 2.7] versus 0%LV [0 to 1.5], p= 0.05, presence of intramyocardial hemorrhage (41 versus 32%, p=0.04) and less myocardial salvage (47 [28 to 64] versus 53 (35 to 68), p=0.01). G3I was associated with a significant higher incidence of MACE (p=0.01) and was identified as an independent predictor of MACE in Cox regression analysis (Hazard ratio 2.19 [1.10 to 4.38], p=0.03). Conclusions: This largest study to date correlating G3I on the admission ECG with CMR markers of myocardial damage demonstrates that G3I is significantly associated with infarct size, myocardial salvage and reperfusion injury in a STEMI population reperfused by primary PCI. Moreover, G3I was independently associated with MACE.

scholarly journals Myocardial Perfusion Grade by Coronary Angiography can Predict Final Infarct Size and Left Ventricular Function in Patients with ST-elevation Myocardial Infarction Treated with a Pharmaco-invasive Strategy

2021 ◽  
Vol 9 (B) ◽  
pp. 184-190
Author(s):  
Amal Hafez Ahmed ◽  
Amr ELHadidy ◽  
Mohamed Helmy ◽  
Ashraf Hussein ◽  
Abdalla Elagha
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Thrombolytic Therapy ◽  
Infarct Size ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Invasive Strategy ◽  
Final Infarct Size ◽  
St Elevation

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the reperfusion strategy of choice in ST-elevation myocardial infarction (STEMI). Transfer for early angioplasty after thrombolytic therapy should be done without delay and has been directly related to improved patients’ outcome compared with thrombolysis alone. TIMI myocardial perfusion (TMP) grade provides important prognostic information for epicardial flow. AIM: We studied the relationship between TMP grade (at the end of the PCI procedure) and left ventricular ejection fraction (LVEF) and infarct size within 1 month in such patients. METHODS: A total of forty patients with diagnosis of STEMI (mean age 57.32 ± 10.44, 33 men) were studied, all patients underwent primary PCI. Grading of myocardial perfusion was done immediately post-PCI. Infarction size, end-diastolic volume (EDV), end-systolic volume (ESV), and LVEF were all measured by myocardial perfusion imaging (Gated single-photon emission computed tomography) within 1 month of STEMI. RESULTS: Final infarct size ranged from 0 to 59 cm (mean =19.18 ± 15.8 cm). EDV ranged from 52 to 228 ml (mean = 128.60 ± 51.01 ml). ESV ranged from 16 to 169 ml (mean =72.05 ± 42.09 ml) and EF ranged from 21% to 72% (mean = 46.0 ± 12.80%). Viable but ischemic myocardial area ranged from 0 to 18 cm (mean =3.38 ± 4.45 cm). There was a significant “negative” correlation between the myocardial perfusion grade and the final infarct size. Furthermore, myocardial perfusion grade was significantly inversely related to EDV and ESV, but directly related to EF. Patients who received thrombolytic therapy had significant lesser perfusion grade than who underwent PCI directly. CONCLUSION: Assessment of the myocardial perfusion grade during PCI is a good prognostic marker about the final infarct size, ESV, EDV, and EF in patients with STEMI treated with a pharmaco-invasive strategy (thrombolytic followed by PCI).

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