Abstract 3379: Feasibility Of Adrenomedullin Infusion In Patients With Acute Myocardial Infarction -a Possible Cardioprotective Therapy Against Ischemic Injury-

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Satoshi Yasuda ◽  
Shunichi Miyazaki ◽  
Noritoshi Nagaya ◽  
Yu Kataoka ◽  
Teruo Noguchi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Intravenous Administration ◽  
Ischemia Reperfusion ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Stress Generation

Background : Adrenomedullin (ADM) is a 52-amino-acid vasodilator peptide that was originally isolated from human pheochromocytoma. In the previous experimental study with rat ischemia/reperfusion model, ADM reduced infarct size and inhibited myocyte apoptosis. ADM also suppressed the production of oxygen-free-radicals. The present study was designed to evaluate the feasibility of intravenous administration of ADM in patients with acute myocardial infarction (AMI). Methods : We studied 10 patients with first AMI (M/F;9/1, mean age;65 years, peak CPK level; 4090 U/L[median]), who were hospitalized within 12 hours of symptom onset. ADM infusion preceded percutaneous coronary intervention (PCI) and was continued at concentration of 0.0125 − 0.025μg/kg/minute for 12 hours. We also studied 10 control AMI patients matched for age, sex and infarct size, who did not receive ADM. Results : During ADM infusion, hemodynamics kept stable except one patient with right ventricular infarction. Urinary levels of 8-iso-prostaglandine F2α, which was measured after the reperfusion therapy with ADM infusion as a marker of oxidative stress, was significantly lower in patients who received ADM than those who did not (76 ± 40 vs 174±21 pmol/mol of creatinine, P<0.01). Infarct area (IA) evaluated by magnetic resonance imaging and brain natriuretic peptide (BNP) levels were also different between the two groups (Table ). Conclusions : Intravenous administration of ADM, which possesses a variety of cardiovascular protective actions, is feasible and can be adjunctive to PCI. Suppression of oxidative stress generation may be beneficial for attenuation of left ventricular dysfunction and remodeling following AMI.

Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stanley Chia ◽  
O. Christopher Raffel ◽  
Faisal Merchant ◽  
Frans J Wackers ◽  
Fred Senatore ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Troponin I ◽  
Troponin T ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Primary Pci ◽  
Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

Abstract 836: Impact of Hypoadiponectinemia on Left Ventricular Remodeling after Primary Coronary Intervention for Acute Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yukio Arita
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Ischemia Reperfusion ◽  
Photon Emission ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Volume Index ◽  
Emission Computed Tomography ◽  
Lv Remodeling

Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is a precursor of the development of overt heart failure and is an important predictor of mortality. Adiponectin (AN) is an adipose-derived plasma protein that has the cardio-protective role against ischemia-reperfusion injury. Altered activity of matrix metalloproteinase (MMP) family has been implicated in the development of LV remodeling after myocardial infarction. Serum AN levels affect MMPs and tissue inhibitor of MMP (TIMP) levels, and attenuate adverse LV remodeling after AMI. In 88 consecutive patients with AMI successfully treated with primary percutaneous coronary intervention (PCI), serum levels of AN, MMP-2, MMP-9, and TIMP-1 were measured on admission, at day 7, and at 6 months after the onset. LV end-diastolic volume index (EDVI) and ejection fraction (EF) were assessed with 99m− Tc-tetrofosmin quantitative gated single-photon emission computed tomography within 10 days (early) and six months (chronic) after the onset. Serum AN and MMP-2 levels were decreased and serum MMP-9 and TIMP-1 levels were increased at day 7 compared to those at the onset and 6 months. Chronic/early EDVI ratio was negatively correlated with log AN at day 7 (r= −0.265, p=0.013), log AN at 6 months (r= −0.335, p=0.008), log MMP-2 at day 7 (r= −0.229, p=0.042), and positively correlated with log MMP-9 at day 7 (r= 0.237, p=0.037), log TIMP-1 on admission (r=0.277, p=0.0408). Chronic EF was positively correlated with log AN at day 7 (r=0.225, p=0.0374) and negatively correlated with log TIMP-1 at day 7 (r= −0.281, p=0.0133). Multiple logistic regression analyses revealed that chronic/early EDVI ratio independently correlated with log AN (r= −0.249, p=0.034) at day 7, although Log AN correlated positively log MMP-2, and negatively with log MMP-9 both at day 7 and 6 months. Measurement of AN at subacute phase can predict adverse cardiac remodeling in patients with AMI successfully treated with PCI.

Abstract 16525: Left Ventricular Unloading Before, Not After, Reperfusion Limits Infarct Size and Improves Survival in Acute Myocardial Infarction: A Bench to Bedside Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Navin K Kapur ◽  
Vikram Paruchuri ◽  
Xiaoying Qiao ◽  
Kevin Morine ◽  
Lyanne Buiten ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Clinical Utility ◽  
Ischemia Reperfusion ◽  
Left Ventricular ◽  
Coronary Reperfusion ◽  
Infarct Zone ◽  
Mitochondrial Integrity ◽  
Phosphorylated Akt

Ischemia-reperfusion injury (IRI) is a major determinant of myocardial damage in acute myocardial infarction (AMI). We explored the hypothesis that reducing left ventricular wall stress (LV unloading) with an axial flow catheter (Impella) before, not after, coronary reperfusion reduces infarct size and improves survival. Methods: We first employed a model of AMI. After 90 minutes of LAD occlusion, adult, male swine (n=4/group) were randomized to: 1) 120 minutes of reperfusion alone (IRI), 2) 30 minutes of LV unloading before 120 minutes of reperfusion (Impella to Balloon Group; ITB) or 3) 30 minutes of reperfusion followed by LV unloading and an additional 120 minutes of reperfusion (Balloon to Impella Group; BTI). Infarct size, myocardial kinase activity, and mitochondrial integrity were quantified. To explore the clinical utility of LV unloading before reperfusion we retrospectively studied all patients in the USPella registry presenting with ST-segmentc elevation AMI and cardiogenic shock who received an Impella within 120 minutes before (n=41; STEMI-ITB) or within 120 minutes after (n=76; STEMI-BTI) percutaneous reperfusion between 2009 and 2014. Results: Compared to IRI alone, infarct size was reduced in the ITB group, not the BTI group (62±2% vs 33±6% vs 58±15%, IRI vs ITB vs BTI, p<0.01 for IRI vs ITB; p<0.05 for ITB vs BTI). Levels of phosphorylated Akt, Erk-1/2, and GSK3b were increased within the infarct zone in the ITB, not BTI group. Mitochondrial numbers and markers of integrity were higher within the infarct zone in the ITB, compared to IRI or BTI. In the registry, in-hospital (51% vs 28%, p=0.02) and 30-day survival (42% vs 20%, p=0.03) were higher in the STEMI-ITB than the STEMI-BTI group. A STEMI-ITB time of less than 60 minutes (n=38) was associated with higher in-hospital survival than a STEMI-BTI time of less than 60 minutes (n=40) (50% vs 25%, p=0.02). Conclusion: Primary LV unloading before, not after, coronary reperfusion reduces infarct size, increases cardioprotective signaling, and improves mitochondrial integrity. These findings are supported by improved survival among patients treated with an Impella before, not after reperfusion in AMI. Future studies are required to explore the clinical utility of primary LV unloading in AMI.

Abstract 1878: Improved Detection of Viable Myocardium by a Novel Strain Doppler Measure in Patients with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Trond Vartdal ◽  
Eirik Pettersen ◽  
Thomas Helle-Valle ◽  
Erik Lyseggen ◽  
Hans-Jørgen Smith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Myocardial Function ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Systolic Strain ◽  
Resonance Imaging ◽  
Percutaneous Coronary

BACKGROUND: Detection of viable myocardium is vital for treatment strategy during acute myocardial infarction (AMI). The aim was to study if strain Doppler echocardiography (SDE) prior to reperfusion therapy could predict viable myocardium in AMI as determined by cardiac magnetic resonance imaging (CMR). METHODS: Twenty-five patients (58 ± 12 years, 7 women) with AMI who underwent percutaneous coronary intervention (PCI) were examined by SDE immediately prior to PCI. End-systolic longitudinal strain and duration of systolic lengthening was analyzed in 16 left ventricular segments. CMR was performed 11 ± 4 months after reperfusion therapy. Scars exceeding 50% of the segment was considered non-viable. RESULTS: Duration of systolic lengthening in non-viable myocardial segments was 249 ± 135 ms compared to 39 ± 86 ms in viable segments (p<0.0001), with a direct relationship to scar transmurality (r=0.89, p<0.0001). A duration of systolic lengthening longer than 67.3% (~2/3) of systole (Figure ) detected non-viable myocardium by a sensitivity of 90% and a specificity of 93%. Strain demonstrated end-systolic shortening (−15 ± 6%) in viable segments in contrast to lengthening in non-viable segments (3 ± 4%, p<0.0001). End-systolic strain correlated also with the scar transmurality (r=0.71, p<0.0001). CONCLUSION: SDE performed before reperfusion therapy in AMI can identify viable myocardium. Duration of systolic lengthening which is a novel parameter might prove to be a superior measure for predicting recovery of myocardial function.

scholarly journals A study to find out the effect of remote ischemic post conditioning of lower limb in patients of acute myocardial infarction undergoing primary percutaneous coronary intervention

2017 ◽  
Vol 4 (5) ◽  
pp. 1313
Author(s):  
Sreedhara R. ◽  
Vishwa Deepak Tripathi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Lower Limb ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Control Group ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Infarct Size Reduction

Background: Reperfusion therapy of affected myocardium is among the most successful method for infarct size reduction and achieving the better outcome in patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (pPCI) is among best procedures for successful reperfusion therapy which has effect in reduction of size of infarct, maintaining ventricular function for better outcome. In this study, authors were aimed to assess whether remote ischemic post-conditioning (RIPC) of lower limb could reduce enzymatic infarct size in patients with acute STEMI undergoing pPCI.Methods: A case control, cross sectional, hospital based randomized study was carried out in Institute of Cardiovascular Sciences, IPGMER, Kolkata, from February 2014 to October 2015. Total 40 patients (20 cases and 20 controls) who were undergoing primary PCI for acute myocardial infarction were taken for study. In the active treatment group, the protocol was started with thrombectomy. The lower limb was exposed to 3 cycles of ischemia/reperfusion, each obtained by 5 min cuff inflation at 200mmHg, followed by 5 min complete deflation. End point of the study will be enzymatic infarct size assessed by the area under the curve of creatine kinase-myocardial band (CK-MB) release.Results: The AUC of serum CK release during the first 72 hours of reperfusion was significantly reduced (p=0.0341) in the post-conditioned group compared with the control group, averaging 9632 units in postconditioned compared with 13493 units in control group which represented 26% of reduction of infarct size.Conclusions: Remote ischemic post conditioning of lower limb significantly improves blush grading and enzymatic infarct size reduction with a trend towards significant reduction of mean ST segment deviation.

Sign in / Sign up

Export Citation Format

Share Document