scholarly journals Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000979 ◽  
Author(s):  
Annette Marie Maznyczka ◽  
David Carrick ◽  
Jaclyn Carberry ◽  
Kenneth Mangion ◽  
Margaret McEntegart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Sex Differences ◽  
Microvascular Obstruction ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Flow Reserve ◽  
St Segment ◽  
Heart Failure Hospitalisation

ObjectivesWe aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).MethodsPatients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up.ResultsIn 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation.ConclusionThere were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women.Trial registration numberNCT02072850.

scholarly journals Microvascular Obstruction in Acute Myocardial Infarction

2017 ◽  
Vol 3 (4) ◽  
pp. 197-202
Author(s):  
Ioana Dregoesc ◽  
Adrian Iancu ◽  
Simona Manole ◽  
Şerban Bălănescu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pressure Wave ◽  
Microvascular Obstruction ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Left Anterior Descending Artery ◽  
St Segment ◽  
Wedge Pressure

Abstract Introduction: The no-reflow phenomenon has been described in 20–40% of patients with acute ST-segment elevation myocardial infarction, despite restoration of TIMI 3 myocardial flow. It is associated with adverse left ventricular remodeling and an unfavorable long-term prognosis. Case presentation: A 45-year-old gentleman was admitted one hour after the onset of an acute anterior ST-segment elevation myocardial infarction. Emergency coronary angiography was performed, and a severe stenosis of the left anterior descending artery was identified. The lesion was crossed with a pressure-wire, and a drug-eluting stent was directly implanted, with restoration of TIMI 3 epicardial flow. Predilatation was not performed. Coronary wedge pressure was measured during stent deployment. The mean pressure value was 27 mmHg. However, a tall systolic wave was identified in the morphology of the pressure curve. Myocardial blush grade and ST-segment resolution were concordant with early micro-vascular obstruction. Similarly, at transthoracic Doppler echocardiography, the flow in the left anterior descending artery revealed the same pattern. An apical left ventricular aneurysm was echocardiographically detected. The MRI described extensive interstitial edema that affected the anterior, septal, and apical regions of the left ventricle. Areas of intramyocardial hemorrhage and microvascular obstruction were also detected. According to recent literature data, the morphology of the coronary wedge pressure wave suggested at least the presence of pre-procedural distal embolization. Conclusions: In the setting of acute myocardial infarction, the integrity of coronary microvasculature is an important issue. The distal coronary pressure wave pattern before primary percutaneous revascularization can be a deciding factor for an early therapeutic approach.

scholarly journals B-type natriuretic peptide levels and its correlation with left ventricular functions and heart failure in patients of acute coronary syndromes

2021 ◽  
Vol 9 (4) ◽  
pp. 1112
Author(s):  
Rajinder Kumar ◽  
Muzaffar Majeed Khujwal ◽  
Isha Sharma ◽  
Amit Varma
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Entire Spectrum ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Clinical Heart Failure

Background: This study was designed to measure levels of B-type natriuretic peptide (BNP) across entire spectrum of acute coronary syndrome (ACS) and to find its correlation with left ventricular functions and heart failure.Methods: We measured BNP levels at baseline in 100 consecutive patients between 24-96 hours after the onset of ischemic symptoms in patients of ACS. Echocardiography was performed in all patients between day 2-5 after the index diagnosis and stabilizing the patients.Results: The BNP levels were raised across the entire spectrum of ACS, with levels (>80 pg/ml) in 32.2% of patients with ST segment-elevation myocardial infarction (STEMI), in 24% with non-ST segment-elevation myocardial infarction (NSTEMI), and in 16.6% with unstable angina (UA) respectively. High BNP levels were associated with greater increase in LV end-systolic volumes (r=+0.545, p<0.001) (LVESV) and end-diastolic volumes (LVEDV) (r=+0.336, p<0.001). There was a negative correlation between BNP levels and left ventricular ejection fraction (LVEF) (r=-0.394, p<0.002). BNP levels were significantly raised (156.0±45.1 vs 57.7±18.3 pg/ml, p<0.02) in patients developing symptomatic clinical heart failure, irrespective of LVEF ≤40%.Conclusions: Integrated use of echocardiography and BNP levels provide powerful incremental assessment of cardiac functions, clinical status, and outcome across the entire spectrum of acute coronary syndromes (ACS). Increased BNP levels are associated with progressive ventricular dilatation, LV-dysfunction, development of clinical heart failure and is associated with poor prognosis in patients of ACS.

scholarly journals Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arshad A. Khan ◽  
Mohammed S. Al-Omary ◽  
Nicholas J. Collins ◽  
John Attia ◽  
Andrew J. Boyle
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Natural History ◽  
Hospital Discharge ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study. Methods A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) (p = 0.01) from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. Graphic abstract

scholarly journals Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy

2021 ◽  
Vol 116 (1) ◽  
Author(s):  
Rohin Francis ◽  
Jun Chong ◽  
Manish Ramlall ◽  
Chiara Bucciarelli-Ducci ◽  
Tim Clayton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Microvascular Obstruction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Lv Mass ◽  
Remote Ischaemic Conditioning ◽  
Ischaemic Conditioning

AbstractThe effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1–17.1)% of LV mass; control: 11.1 (7.0–17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.

scholarly journals Natural History and Prognostic Implications of Left Ventricular End-Diastolic Pressure in Reperfused ST-Segment Elevation Myocardial Infarction – An Analysis of the Thrombolysis in Myocardial Infarction (TIMI) II Randomized Controlled Trial.

2021 ◽  
Author(s):  
Arshad A Khan ◽  
Mohammed S Al-Omary ◽  
Nicholas J Collins ◽  
John Attia ◽  
Andrew Boyle
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Natural History ◽  
Hospital Discharge ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction II study. Methods A total of 3,339 patients were randomized to either an invasive (n = 1,681) or a conservative (n = 1,658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) [p = 0.01] from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis.

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