Design and Clinical Evaluation of Pharmacologic Stress-Test with Dalargin for SPECT Detection of Viable Myocardium in Patients after Myocardial Infarction

2021 ◽  
Vol 66 (3) ◽  
pp. 48-54
Author(s):  
I. Bukhovets ◽  
O. Vasiltseva ◽  
Yu. Lishmanov ◽  
I. Vorozhtsova ◽  
A. Lavrov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stress Test ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Contractile Reserve ◽  
Pharmacological Stress ◽  
99Mtc Tetrofosmin ◽  
Perfusion Spect ◽  
Stress Agent

Purpose: To develop a functional stress-test with Dalargin used as a pharmacological stress agent and to study its diagnostic capabilities for quantifying the general and segmental systolic function of the left ventricle in patients with IHD using SPECT and echo methods. Material and methods: The study comprised 29 male patients with CHD-angina of 2-3 functional classes, studied on 15–25 days (on average 20 ± 2.8 days) after a large-focal myocardial infarction. A fractional step-wise injection of Dalargin was performed with step doses as 0.1 mg / kg (1 ml up to a total of 8 ml, with intervals of 90 seconds, for a total of 12 minutes), in a supine position. After each dose of Dalargin, blood pressure, heart rate, ECG were recorded, and an echocardiographic assessment of hemodynamic parameters and local contractility was carried out. At the peak of the effect of dalargin, 99mTc-Tetrofosmin was administered intravenously (370 – 540 MBq), followed by chest SPECT. Results: The optimal dose of dalargin for assessing the contractility of the LV was 0.3 mg/kg. From the data of myocardial perfusion SPECT, at dalargin test, the number of segments with normal regional blood supply increased statistically significantly from 56,0 % to 64,7 %, the number of hypoperfused segments decreased from 41.0% to 33.7% as compared to rest, and the number of non-perfused ones – from 3.0 % to 1.6 %. Spearman’s correlation coefficient between segmental contractility and local perfusion at the top dalargin inotropic effect was high and significant (R=0.67, p<0.01). The sensitivity and specificity of the pharmacological test with intravenous administration of dalargin for prediction of postoperative improvement of perfusion and contractility of the viable myocardium were: sensitivity 78.8 %, specificity 76.4 %, diagnostic accuracy 77.6 %. Conclusion. The use of the agonist of the μ - and δ-opioid receptors dalargin as a pharmacological stress-agent at perfusion SPECT and Stress Echocardiography to assess the contractile reserve of a dysfunctional viable myocardium is informative and appropriate. In patients with IHD who have suffered a myocardial infarction and are referred to myocardial revascularization, dalargin can be employed as an effective stress-agent for assessing the reserve of perfusion and contractility of dysfunctional left ventricular myocardium using perfusion SPECT and echocardiography.

scholarly journals Preservation of Contractile Reserve and Diastolic Function by Inhibiting the NLRP3 Inflammasome with OLT1177® (Dapansutrile) in a Mouse Model of Severe Ischemic Cardiomyopathy Due to Non-Reperfused Anterior Wall Myocardial Infarction

Molecules ◽  
2021 ◽  
Vol 26 (12) ◽  
pp. 3534
Author(s):  
Joseph Aliaga ◽  
Aldo Bonaventura ◽  
Eleonora Mezzaroma ◽  
Yogesh Dhakal ◽  
Adolfo Gabriele Mauro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Function ◽  
Nlrp3 Inflammasome ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Control Group ◽  
Contractile Reserve ◽  
Standard Diet ◽  
Group 3 ◽  
Group 1

Interleukin-1β (IL-1β), a product of the NLRP3 inflammasome, modulates cardiac contractility and diastolic function. We proposed that OLT1177® (dapansutrile), a novel NLRP3 inhibitor, could preserve contractile reserve and diastolic function after myocardial infarction (MI). We used an experimental murine model of severe ischemic cardiomyopathy through the ligation of the left coronary artery without reperfusion, and after 7 days randomly assigned mice showing large anterior MI (>4 akinetic segments), increased left ventricular (LV) dimensions ([LVEDD] > 4.4 mm), and reduced function (LV ejection fraction <40%) to a diet that was enriched with OLT1177® admixed with the chow in the diet at 3.75 g/kg (Group 1 [n = 10]) or 7.5 g/kg (Group 2 [n = 9]), or a standard diet as the no-treatment control group (Group 3 [n = 10]) for 9 weeks. We measured the cardiac function and contractile reserve with an isoproterenol challenge, and the diastolic function with cardiac catheterization at 10 weeks following the MI surgery. When compared with the control (Group 3), the mice treated with OLT1177 (Group 1 and 2) showed significantly greater preservation of their contractile reserve (the percent increase in the left ventricular ejection fraction [LVEF] after the isoproterenol challenge was +33 ± 11% and +40 ± 6% vs. +9 ± 7% in the standard diet; p < 0.05 and p < 0.005 for Group 1 and 2, respectively) and of diastolic function measured as the lower left ventricular end-diastolic pressure (3.2 ± 0.5 mmHg or 4.5 ± 0.5 mmHg vs. 10.0 ± 1.6 mmHg; p < 0.005 and p < 0.009 respectively). No differences were noted between the resting LVEF of the MI groups. These effects were independent of the effects on the ventricular remodeling after MI. NLRP3 inflammasome inhibition with OLT1177® can preserve β-adrenergic responsiveness and prevent left ventricular diastolic dysfunction in a large non-reperfused anterior MI mouse model. OLT1177® could therefore be used to prevent the development of heart failure in patients with ischemic cardiomyopathy.

scholarly journals PILOT RESULTS OF STUDYING CARDIAC MICROPOTENTIALS IN PATIENTS WITH MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK

2019 ◽  
Vol 33 (4) ◽  
pp. 103-110 ◽  
Author(s):  
I. V. Maximov ◽  
D. K. Avdeeva ◽  
M. L. Ivanov ◽  
I. A. Zimin ◽  
M. M. Yuzhakov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pilot Study ◽  
High Resolution ◽  
Cardiogenic Shock ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
National Guidelines ◽  
Software Complex ◽  
Heart Rhythm Disorders ◽  
Life Threatening

Aim. To study cardiac micropotentials registered by the hardware and software complex with nanosensors in patients with myocardial infarction for the early detection of life-threatening conditions.Materials and Methods. The pilot study included 29 patients with acute myocardial infarction who had life-threatening complications such as heart rhythm disorders, the development of acute left ventricular failure, or clinical death prehospitally or at admission to the coronary care unit. The diagnosis of myocardial infarction was established and treatment was carried out according to the national guidelines for the management of patients with myocardial infarction, including the methods of myocardial revascularization.Results. During hospitalization, eight patients developed cardiogenic shock and died. 21 patients survived and were included in the comparison group. At admission, all patients underwent high-resolution electrocardiography using the originally developed hardware and software complex with nanosensors. The micropotentials on the ST segment of the electrocardiogram were recorded for 30 s in three leads on-line. The numbers of micropotentials in the studied groups were analyzed. The analysis of the number of micropotentials within certain ranges of amplitude and duration registered on high-resolution electrocardiogram showed a decrease of the micropotential number in group of patients who died from cardiogenic shock compared with the group of survived patients.Conclusions. The results of this pilot study of cardiac micropotentials are preliminary and require further accumulation of data as well as a search for new criteria for diagnostics, prognosis, and evaluation of the treatment efficacy in patients with myocardial infarction.

Chronic ischaemic heart disease

2018 ◽  
pp. 179-201
Author(s):  
Bernhard L Gerber ◽  
Mouaz H Al-Mallah ◽  
Joao AC Lima ◽  
Mohammad R Ostovaneh
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Magnetic Resonance ◽  
Ischaemic Heart Disease ◽  
Myocardial Ischaemia ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Contractile Reserve ◽  
Additional Information ◽  
Artery Disease

Chronic ischaemic heart disease (IHD) is one of the most common cardiac conditions worldwide and is generally caused by the consequences of coronary atherosclerosis, including myocardial infarction. Clinical challenges in chronic IHD include detection of myocardial ischaemia in symptomatic patients with suspected coronary artery disease (CAD), evaluation of myocardial viability in patients with established IHD and poor left ventricular ejection fraction (LVEF) when revascularization is considered, as well as risk stratification and identification of patients with chronic IHD at high risk of complications. Cardiovascular magnetic resonance (CMR) can provide vital answers to all three of these challenges. Stress CMR is now increasingly used to detect ischaemia by means of vasodilator stress perfusion or dobutamine stress contractile reserve stress imaging. For viability assessment, late gadolinium enhancement is currently the method of choice to detect myocardial infarction, and low-dose dobutamine stress magnetic resonance can provide additional information to determine viability and guide therapy. Cardiovascular risk in patients with chronic IHD is mainly determined by left ventricular function, most commonly utilizing LVEF, as well as infarct size, infarct characteristics, and ischaemic burden, which can all be measured reliably with CMR. This chapter will review the role of CMR for the detection of myocardial ischaemia, viability, and risk.

Urgent Myocardial Revascularization in Non ST-Segment Elevation Acute Myocardial Infarction Guided by Speckle Tracking Echocardiography: A Challenging Interventional Decision-Making

Cardiology ◽  
2018 ◽  
Vol 140 (4) ◽  
pp. 222-226 ◽  
Author(s):  
Fabio Capasso ◽  
Marco Pepe ◽  
Salvatore Severino ◽  
Giuseppe Valva ◽  
Pietro Landino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Myocardial Revascularization ◽  
Invasive Procedure ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Final Infarct Size

A 68-year-old man with a non-ST elevation myocardial infarction (NSTEMI) presented with a low risk profile indicating invasive revascularization within 72 h. However, left ventricular (LV) global longitudinal strain (GLS) calculated by two-dimensional speckle tracking echocardiography (2D-STE) in the Emergency Room showed substantial myocardial infarction. Therefore, urgent reperfusion therapy was decided and delivered within 30 min from hospital admission. LV GLS fully recovered after the invasive procedure and the final infarct size was 7%. This case shows that very early revascularization in NSTEMI patients can be guided by 2D-STE and might be considered for those patients with substantial LV myocardial infarction.

scholarly journals The Influence of the Duration of Acute Coronary Syndrome on the Outcomes of Endovascular Treatment

2021 ◽  
pp. 43-48
Author(s):  
Sergii V. Salo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Efficiency ◽  
Clinical Course ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Systolic Pulmonary Artery Pressure ◽  
Infarct Zone ◽  
Coronary Syndrome

Multicenter studies have proven the high effectiveness of percutaneous coronary intervention (PCI) in terms of restoring patency of the infarct-related artery (IRA) and improving the prognosis in acute myocardial infarction (AMI). The mechanism of improvement of clinical result after PCI procedure appears to be multifactorial. The aim. To investigate the effect of IRA stenting on the clinical course, prognosis and contractility of the heart in patients with different duration of acute myocardial infarction and its influence on the short-term and long-term effects after intervention. The main determinant for the favorable clinical course and improvement of the prognosis is early (within the first hours of the disease) restoration of antegrade blood flow by IRA stenting. Thus, it is possible to signifi-cantly improve the blood supply to the peri-infarct zone and limit the area of necrosis and maintain heart rate. Materials and methods. The analyzed group included 684 patients with AMI who were endovascularly treated at the Department of Emergency Endovascular Heart Surgery of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 1, 2017 to January 1, 2021. Coronary artery stenting was performed in all the patients. STEMI occurred in 495 (72.4%) patients, and non-STEMI in 189 (27.6%) patients. The mean age of the subjects was 61.8 ± 12.1 years. There were 289 women (42.3%) and 395 men (57.7%). Distribu-tion of the patients depending on the initial Killip class was as follows: 13 (1.9%) had class I, 199 (29.1%) had class II, and 472 (69.0%) had class III myocardial infarction. Atrial fibrillation occurred in 72 (10.5%) patients. Echocardiographic parameters were as follows: left ventricular (LV) end-systolic index 54.1 ± 12.8 ml/m2, LV ejection fraction 0.53 ± 0.05, left atrial diameter 39.5 ± 3.8 mm, systolic pulmonary artery pressure 44.8 ± 7.8 mmHg. In this study, clinical condition and functional capacity of the heart muscle in patients with AMI depending on the condition of the stent segment and the timing of endovascular procedures after the onset of the disease were first inves-tigated in the long term. Conclusions. High efficiency and safety of PCI have been proven, which makes it possible to recommend this pro-cedure for wide application. It has been proven that PCI using matrix and modular stents, as well as statins can reduce the frequency of in-stent stenosis and improve the clinical course of the disease in the long term. It has been proven that stenting in patients with AMI is most effective in the earliest stages of the disease with preservation of LV contractility with possibly complete myocardial revascularization, which contributes to the preservation of viable myocardium in the peri-infarct zone, improvement of myocardial contractility and prevention of myocardium remodeling.

scholarly journals The importance of chronic kidney disease for the assessment of risk of adverse outcomes after myocardial infarction

2017 ◽  
Vol 95 (6) ◽  
pp. 563-570 ◽  
Author(s):  
V. N. Karetnikova ◽  
V. V. Kalaeva ◽  
Maria V. Evseeva ◽  
O. V. Gruzdeva ◽  
M. V. Zykov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Dysfunction ◽  
Acute Phase ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Group I ◽  
Time Of Admission

Renal dysfunction (RD) in the acute phase of myocardial infarction (MI) is pivotal for the risk stratification of adverse long-term outcomes after myocardial infarction and, therefore, requires further study. Purpose. To determine the role of CKD and renal dysfunction (in the acute phase of MI) in the adverse long-term post-MI prognosis. Material and methods. 954 patients with ST-segment elevation myocardial infarction (STEMI) were enrolled in a registry study, performed in the period from 2008 to 2010 at the Kemerovo Cardiology Dispensary. All patients were assigned to two groups according to the presence of concomitant CKD. Serum creatinine levels were measured at the time of admission and on 10-12th days, with further calculation of glomerular filtration rate (GFR) using the CKD-EPI equation. Patients without CKD were assigned to Group I (n = 616 (64.5%), and STEMI patients with CKD to Group II (n=338 (35.4%). Observations during the three-year follow-up period were evaluated from the end-points. Results. The factors associated with mortality among patients with CKD were as follows: left ventricular ejection fraction (LVEF) < 40% at the time of admission (OR 2.1; 95% CI 1.0-4.4), signs of RD at the time of discharge (OR 2.5, 95% CI 1.0-5.9), non-performance of myocardial revascularization (OR 3.1, 95% CI 1.4-6.8). The long-term prognosis in the group of patients without CKD depended on the following factors: non-performance of PCI (OR 2.1, 95% CI 1.0-4.3), severe AHF (Killip class) (OR 3.5, 95% CI 1.9-6.7), LVEF < 40% (OR 2.0, 95% CI 1.0-3.8), and older age (OR 2.0, 95% CI 1.0-3.9). Conclusion. Renal dysfunction (regardless of the presence of CKD) diagnosed in the acute phase of MI as well as left ventricular dysfunction (EF < 40%) were found to affect long-term mortality risk in the post-MI period.

scholarly journals Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

2019 ◽  
Vol 76 (2) ◽  
pp. 152-160
Author(s):  
Milovan Petrovic ◽  
Milana Jarakovic ◽  
Milenko Cankovic ◽  
Ilija Srdanovic ◽  
Mila Kovacevic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Vessel Disease ◽  
Early Revascularization ◽  
Infarct Related Artery

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The study group consisted of 235 patients treated in the period from August 2007 until October 2016 for STEMI complicated by cardiogenic shock. Three groups were formed. The first group consisted of patients with one vessel disease who underwent revascularization of infarct related artery; the second group of patients had multi-vessel disease and only culprit lesions were revascularized and the third one consisted of patients with multi-vessel disease and the complete myocardial revascularization performed. Additional subgroups were formed in reference to the intra-aortic balloon pump (IABP) implantation. Intra-hospital mortality was analyzed in all groups and subgroups. Results. Revascularization of the culprit lesion alone among patients with multivessel disease was performed in 142 (60.4%) patients while the complete revascularization (revascularization of ?culprit? and other significant lesions) was performed in 28 (11.9%) patients with multi-vessel disease. There were 65 (27.7%) patients with single-vessel disease who underwent revascularization of infarct related artery. The lowest mortality was found in the group of patients with multi-vessel coronary disease who underwent complete myocardial revascularization and had IABP implanted (mortality was 35.7%). The difference in the mean value of the left ventricular ejection fraction (EF) between the surviving and deceased patients was statistically significant (p < 0.005). The average EF of survivors was 44% (35%?50%) while 30% (25%?39.5%) deceased of patients. Based on the obtained data, the mathematically predictive model was tested. The receiver operating characteristic (ROC) curve showed that our model is a good predictor of fatal outcome (p < 0.0005; AUROC = 0.766) with the sensitivity of 80.3%, and the specificity of 67%. Conclusion. STEMI complicated by cardiogenic shock is still associated with a high mortality rate. Complete myocardial revascularization independently as well as in combination with an IABP, significantly reduces mortality in patients with acute STEMI complicated by cardiogenic shock.

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