scholarly journals Left ventricular mechanical dispersion in ischaemic cardiomyopathy: association with myocardial scar burden and prognostic implications

2020 ◽  
Vol 21 (11) ◽  
pp. 1227-1234 ◽  
Author(s):  
Rachid Abou ◽  
Edgard A Prihadi ◽  
Laurien Goedemans ◽  
Rob van der Geest ◽  
Mohammed El Mahdiui ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Border Zone ◽  
Infarct Core ◽  
Scar Burden ◽  
St Segment Elevation ◽  
Mechanical Dispersion ◽  
Prognostic Implications ◽  
Event Rates

Abstract Aims Left ventricular (LV) mechanical dispersion (MD) may result from heterogeneous electrical conduction and is associated with adverse events. The present study investigated (i) the association between LV MD and the extent of LV scar as assessed with contrast-enhanced cardiac magnetic resonance (CMR) and (ii) the prognostic implications of LV MD in patients after ST-segment elevation myocardial infarction. Methods and results LV MD was calculated by echocardiography and myocardial scar was analysed on CMR data retrospectively. Infarct core and border zone were defined as ≥50% and 35–50% of maximal signal intensity, respectively. Patients were followed for the occurrence of the combined endpoint (all-cause mortality and appropriate implantable cardioverter-defibrillator therapy). In total, 96 patients (87% male, 57 ± 10 years) were included. Median LV MD was 53.5 ms [interquartile range (IQR) 43.4–62.8]. On CMR, total scar burden was 11.4% (IQR 3.8–17.1%), infarct core tissue 6.2% (IQR 2.0–12.7%), and border zone was 3.5% (IQR 1.5–5.7%). Correlations were observed between LV MD and infarct core (r = 0.517, P < 0.001), total scar burden (r = 0.497, P < 0.001), and border zone (r = 0.298, P = 0.003). In total, 14 patients (15%) reached the combined endpoint. Patients with LV MD >53.5 ms showed higher event rates as compared to their counterparts. Finally, LV MD showed the highest area under the curve for the prediction of the combined endpoint. Conclusion LV MD is correlated with LV scar burden. In addition, patients with prolonged LV MD showed higher event rates. Finally, LV MD provided the highest predictive value for the combined endpoint when compared with other parameters.

scholarly journals ST-Segment Resolution as a Marker for Myocardial Scar in ST-Segment Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Qian Dong ◽  
Xuesong Wen ◽  
Guanglei Chang ◽  
Rui Xia ◽  
Sihang Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Area Under The Curve ◽  
Emergency Admission ◽  
Coronary Intervention ◽  
Myocardial Scar ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Myocardial Scars

Abstract Objective: To investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).Methods: Forty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (>75%) or non-transmural (<75%) myocardial scars.Results: The sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.92. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR<40.15% had a 112.95-fold higher probability of developing transmural scars compared with patients with STR≥40.15%. STR percentage was negatively correlated with myocardial scar thickness (β=-0.838, P<0.001) and size (β=-0.714, P<0.001).Conclusion: STR<40.15% at 24 h after PCI may provide meaningful diagnostic nformation regarding the extent of myocardial scarification in STEMI patients.

scholarly journals Value of C-Reactive Protein in Predicting Left Ventricular Remodelling in Patients with a First ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Iwona Swiatkiewicz ◽  
Marek Kozinski ◽  
Przemyslaw Magielski ◽  
Tomasz Fabiszak ◽  
Adam Sukiennik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
C Reactive Protein ◽  
Left Ventricular Remodelling ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Objective. To assess the value of C-reactive protein (CRP) in predicting postinfarct left ventricular remodelling (LVR).Methods.We measured in-hospital plasma CRP concentrations in patients with a first ST-segment elevation myocardial infarction (STEMI).Results. LVR was present at 6 months in 27.8% of 198 patients. CRP concentration rose during the first 24 h, mainly in LVR group. The prevalence of LVR was higher in patients from the highest quartile of CRP concentrations at 24 h as compared to those from any other quartile (odds ratio (OR) 3.48, 95% confidence interval (95% CI) 1.76–6.88). Multivariate analysis identified CRP concentration at 24 h (OR for a 10 mg/L increase 1.29, 95% CI 1.04–1.60), B-type natriuretic peptide at discharge (OR for a 100 pg/mL increase 1.21, 95% CI 1.05–1.39), body mass index (OR for a 1 kg/m2increase 1.10, 95% CI 1.01–1.21), and left ventricular end-diastolic volume (OR for a 1 mL increase 0.98, 95% CI 0.96-0.99) as independent predictors of LVR. The ROC analysis revealed a limited discriminative value of CRP (area under the curve 0.61; 95% CI 0.54–0.68) in terms of LVR prediction.Conclusions. Measurement of CRP concentration at 24 h after admission possesses a significant but modest value in predicting LVR after a first STEMI.

scholarly journals ST-segment resolution as a marker for severe myocardial fibrosis in ST-segment elevation myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qian Dong ◽  
Xuesong Wen ◽  
Guanglei Chang ◽  
Rui Xia ◽  
Sihang Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Pearson Correlation ◽  
Area Under The Curve ◽  
Emergency Admission ◽  
Myocardial Scar ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Myocardial Scars

Abstract Objective To investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods Forty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (> 75%) or non-transmural (< 75%) myocardial scars, according to previous study. Results The sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.925. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR < 40.15% had a 170.90-fold higher probability of developing transmural scars compared with patients with STR ≥ 40.15%. Pearson correlation and linear regression analyses showed STR percentage was significantly associated with myocardial scar thickness and size. Conclusion STR < 40.15% at 24 h after PCI may provide meaningful diagnostic information regarding the extent of myocardial scarification in STEMI patients.

MethotrexaTE THerapy in ST-Segment Elevation MYocardial InfarctionS

2017 ◽  
Vol 22 (6) ◽  
pp. 538-545 ◽  
Author(s):  
Daniel Medeiros Moreira ◽  
Maria Emilia Lueneberg ◽  
Roberto Leo da Silva ◽  
Tammuz Fattah ◽  
Carlos Antonio Mascia Gottschall
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Troponin I ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Timi Frame Count ◽  
St Segment

Purpose: Methotrexate is an anti-inflammatory drug that has been shown to have anti-ischemic effects. Our aim was to evaluate if methotrexate could reduce infarct size in patients with ST-segment elevation myocardial infarction (STEMI). Methods: We randomly assigned patients with STEMI to receive either methotrexate or placebo. Primary outcome was infarct size determined by calculating the area under the curve (AUC) for creatine kinase (CK) release. Secondary outcomes were AUC of CK MB (CK-MB) and AUC of troponin I; peak CK, peak CK-MB, and troponin I; B-type natriuretic peptide (BNP) level, high-sensitivity C-reactive protein (hsCRP) result, and erythrocyte sedimentation rate (ESR); left ventricular ejection fraction (LVEF); thrombolysis in myocardial infarction (TIMI) frame count; Killip score; mortality and reinfarction incidence; and incidence of adverse reactions. Results: We included 84 patients. Median AUC of CK was 78 861.0 in the methotrexate group and 68 088.0 in the placebo group ( P = .10). Patients given methotrexate and placebo exhibited, respectively, median AUC for CK-MB of 9803.4 and 8037.0 ( P = .42); median AUC for troponin of 3691.1 and 2132.6 ( P = .09); peak CK of 2806.0 and 2147.0 ( P = .05); peak CK-MB of 516.0 and 462.3 ( P = .25); and peak troponin of 121.0 and 85.1 ( P = .06). At 3 months, LVEF was lower in patients who received methotrexate (49.0% ± 14.1%) than in patients given placebo (56.4% ± 10.0%; P = .01). There were no differences in hsCRP, ESR, BNP, Killip scores, TIMI frame count, reinfarction, and mortality rates. There was a higher median serum glutamic–pyruvic transaminase levels in the methotrexate group. Conclusion: Methotrexate did not reduce infarction size and worsened LVEF at 3 months ( Clinicaltrials.gov identifier NCT01741558).

scholarly journals Reproducibility of non-invasive VT substrate characterization: finding the same paths

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Silva Garcia ◽  
D Villanueva ◽  
W Delgado ◽  
A Berruezo ◽  
D Soto-Iglesias ◽  
...  
Keyword(s):  
Scar Tissue ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Observer Agreement ◽  
Border Zone ◽  
Tissue Mass ◽  
Non Invasive ◽  
Funding Sources ◽  
Inter Observer Variability ◽  
The Mean

Abstract Background Delayed enhancement gadolinium MRI is a useful technique to identify myocardial scar. The objective of this study is compare the reproducibility of the scar quantification and characterization based on cardiac MRI. Methods 10 patients with ischemic ethology underwent to 1,5T DE-MRI acquisition for myocardial scar analysis. Images were processed using a commercial software (ADAS3D-Galgo Medical) and different parameters from scar tissue (mass of the scar, core of scar and border zone expressed in grams) were analysed. Conducting channels evaluation was obtained by the number of corridors and the mass of the border zone of those corridors. To perform this analysis, 2 experienced and 1 non experienced users segmented DE-MRI acquisition in order to evaluate the inter observer variability. Bland-Altman analysis was employed to evaluate the comparison between the measurements. Results Inter observer agreement between experienced users was high (table). The mean and the standard deviation of the differences between two measurements for the scar mass was −3,9±14,66 gr. Analysing the scar tissue divided in core and border zone, the mass of these volume tissues were very similar (−3,51±4,56gr and −0,4±12,87gr respectively. Regarding conducting channels characteristics, the mean of the differences was 0±2 for the number of channels and 1,71±7,76 gr for the mass on the border zone of the corridors. Comparing the measurements between one of the experienced users and the beginner user, results were similar but significant differences were found on the mass of the core and the number of channels, with a variability of ±2 channels (table). Conclusions Left ventricular scar size and characteristics derived from late gadolinium enhanced post-processed images are highly reproducible between experienced observers. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Scar analysis performed by 3 users

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