scholarly journals The role of cytokines and cortisol in the non-thyroidal illness syndrome following acute myocardial infarction

2000 ◽  
pp. 236-242 ◽  
Author(s):  
H Karga ◽  
P Papaioannou ◽  
K Venetsanou ◽  
F Papandroulaki ◽  
L Karaloizos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
First Episode ◽  
Necrosis Factor Alpha ◽  
Ventricular Ejection Fraction ◽  
Group I ◽  
Cortisol Levels ◽  
Group Ii

OBJECTIVE: A number of different hormone changes have been described during the acute myocardial infarction (AMI), including those of the non-thyroidal illness syndrome (NTIS). DESIGN AND METHODS: We assessed the alterations of serum thyroid hormones, cytokines and cortisol levels in 30 patients with a first episode of AMI 4, 24, 48h and 10 days (240h) after the onset of the chest pain and we investigated the possible relationship of these alterations with the severity of AMI. RESULTS: Fifteen patients had left ventricular ejection fraction (LVEF) </=50% (group I) and 15 patients had LVEF >50% (group II). A transient decrease of total tri-iodothyronine (T(3)), more prominent in group I (P<0.05, t-test) with a concomitant rise of reverse T(3 )(rT(3)) occurred at 24h. Total thyroxine (T(4)), free T(4) (FT(4)) and free T(4) index did not change significantly, but tended to be higher in group I patients, whereas TSH significantly increased in group II at 48h. Interleukin-6 (IL-6) increased significantly at 24h only in group I and declined thereafter (24 vs 240h, P<0.001) and this temporal change of IL-6 was associated with similar changes of creatine phosphokinase and creatine kinase isoenzyme MB (CK-MB). Tumor necrosis factor-alpha and IL-1beta remained low in both groups. Cortisol was higher at 4h and in 12 patients was above the normal values. Negative correlation was found between LVEF and IL-6 (P<0. 001), whereas T(3), T(4) or cortisol levels were not correlated with the LVEF. CONCLUSIONS: Our data indicate that NTIS, in association with increase of IL-6, occurs in the early post-infarction period. In the NTIS following AMI the high level of IL-6 is the best predictor, among several parameters, of the severity of AMI as assessed by the LVEF and the rise of CK-MB.

Randomized, double blind, placebo-controlled, safety and efficacy study of dutogliptin in combination with filgrastim in early recovery post-MI: rationale, design and first interim analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Von Lewinski ◽  
B Merkely ◽  
I Buysschaert ◽  
R.A Schatz ◽  
G.G Nagy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Stem Cells ◽  
Adverse Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Early Recovery ◽  
Ventricular Ejection Fraction ◽  
Combined Application

Abstract Background Regenerative therapies offer new approaches to improve cardiac function after acute ST-elevation myocardial infarction (STEMI). Mobilization of stem cells and homing within the infarcted area have been identified as the key mechanisms for successful treatment. Application of granulocyte-colony stimulating factor (G-CSF) is the least invasive way to mobilize stem cells while DDP4-inhibitor facilitates homing via stromal cell-derived factor 1 alpha (SDF-1α). Dutogliptin, a novel DPP4 inhibitor, combined with stem cell mobilization using G-CSF significantly improved survival and reduced infarct size in a murine model. Purpose We initiated a phase II, multicenter, randomized, placebo-controlled efficacy and safety study (N=140) analyzing the effect of combined application of G-CSF and dutogliptin, a small molecule DPP-IV-inhibitor for subcutaneous use after acute myocardial infarction. Methods The primary objective of the study is to evaluate the safety and tolerability of dutogliptin (14 days) in combination with filgrastim (5 days) in patients with STEMI (EF &lt;45%) following percutaneous coronary intervention (PCI). Preliminary efficacy will be analyzed using cardiac magnetic resonance imaging (cMRI) to detect &gt;3.8% improvement in left ventricular ejection fraction (LV-EF). 140 subjects will be randomized to filgrastim plus dutogliptin or matching placebos. Results Baseline characteristics of the first 26 patients randomized (24 treated) in this trial reveal a majority of male patients (70.8%) and a medium age of 58.4 years (37 to 84). During the 2-week active treatment period, 35 adverse events occurred in 13 patients, with 4 rated as serious (hospitalization due to pneumonia N=3, hospitalization due to acute myocardial infarction N=1), and 1 adverse event was rated as severe (fatal pneumonia), 9 moderate, and 25 as mild. 6 adverse events were considered possibly related to the study medication, including cases of increased hepatic enzymes (N=3), nausea (N=1), subcutaneous node/suffusion (N=1) and syncope (N=1). Conclusions Our data demonstrate that the combined application of dutogliptin and G-CSF appears to be safe on the short term and feasible after acute myocardial infarction and may represent a new therapeutic option in future. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This research is funded by the sponsor RECARDIO, Inc., 1 Market Street San Francisco, CA 94150, USA. RECARDIO Inc. is funding the complete study. The Scientific Board of RECARDIO designed the study. Data Collection is at the participating sites. Interpretation of the data by the Scientific Board and Manuscript written by the authors and approved by the Sponsor

Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YeeKyoung KO ◽  
Seungjae JOO ◽  
Jong Wook Beom ◽  
Jae-Geun Lee ◽  
Joon-Hyouk CHOI ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

scholarly journals Acute myocardial infarction in young adults: features of pathogenesis, disease course and justification of strategy for prevention of complications

2019 ◽  
Vol 26 (4) ◽  
pp. 32-43
Author(s):  
O. M. Parkhomenko ◽  
Ya. M. Lutay ◽  
O. I. Irkin ◽  
D. O. Bilyi ◽  
A. O. Stepura ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Young Patients ◽  
Coronary Vessels ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Premature Coronary Artery Disease ◽  
Ventricular Ejection Fraction ◽  
Arrhythmogenic Substrate

We retrospectively and prospectively studied 835 patients with acute myocardial infarction (AMI) under the age of 45 and older. Depending on age, patients were divided into two groups: < 45 years and ≥ 45 years. In 189 patients under 45 years of age, the main risk factors leading to the development of ST-elevation myocardial infarction were male sex (OR 6.58; 95 % CI (2.64–16.41), smoking (OR 2.02; 95 % CI (1.44–2.82) and family history of premature coronary artery disease (OR 1.75; 95 % CI (1.21–2.54). According to coronary angiography, AMI patients under 45 years of age in most cases showed no hemodynamically significant coronary vessels damage and had a different course of AMI caused by other reasons – aneurysms of the coronary arteries, muscle bridges, coronary spasm, spontaneous dissections. It was found that 10 % of young patients who did not have obstructive lesions of coronary vessels, according to magnetic resonance imaging (MRI) had focal myocarditis. However, it is noted that in patients under 45 years of age, the presence of familial hypercholesterolemia (FH) may affect the development of AMI. Thus, according to the DLCNS criteria, FH was more frequently reported in young patients than in patients older than 45 years (7.34 % vs 1.32 % (p<0.05)). Hospital course of AMI in young adults was more favorable, with fewer complications. Data from studies of flow-dependent vasodilation have shown that young patients have worse endothelial function on the 1st day of AMI (p=0.043), but better recovery of it in the dynamics of observation. However, in young patients, early (day 7, p=0.029) and late (day 90, p=0.041) left ventricular dilatation was more commonly reported compared with older patients. According to the MRI data on day 1 and in the dynamics (90 days), it was found that, despite the higher prevalence of AMI, young patients have better recovery of contractile myocardial function. The arrhythmogenic substrate (according to late ventricular potential) for life-threatening arrhythmias was more commonly recorded in the older age group at the beginning of the development of AMI, but it was detected with the same frequency in both groups during prolonged observation (6–12 months). Despite better survival and fewer complications during long-term follow-up (4.9 years on average), the greatest impact on the development of the combined endpoint (cardiovascular death / recurrent myocardial infarction / stroke) and death from any cause was made by the patients’ age up to 35 years (best prognosis), concomitant hypertension (worsens prognosis) and low left ventricular ejection fraction (increases complications). The study indicates the possibility of implementing a secondary prevention system in AMI patients of young age through careful (active) observation and control of adherence to treatment and the adequacy of its implementation.

Abstract 19826: Utility of Stroke Volume Index for Stratification of Patients With Low Gradient Severe Aortic Stenosis and Normal Left Ventricular Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hong Shen ◽  
Brandon Stacey ◽  
Bob Applegate ◽  
David Zhao ◽  
Sujethra Vasu ◽  
...  
Keyword(s):  
Stroke Volume Index ◽  
Left Ventricular ◽  
Group Iv ◽  
Low Flow ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cumulative Survival ◽  
Group I ◽  
Group Ii

Background: Decision of intervention for low gradient severe aortic stenosis (AS) with normal left ventricular ejection fraction (LVEF) is clinically challenging. The study was to determine the impact of stroke volume index (SVi) on prognosis in patients (pts) with AS. Methods: We examined 410 pts with moderate or severe AS and normal EF (≥50%). Pts were divided into four groups based on aortic valve area (AVA), mean pressure gradient (MPG) and SVi: Group I: low flow low gradient severe AS (AVA≤1.0cm 2 , MPG<40mmHg and SVi<35mL/m 2 , n=75); Group II: normal flow low gradient severe AS (AVA≤1.0cm 2 , MPG<40mmHg and SVi≥35mL/m 2 , n=97); Group III: severe AS with matched gradient-AVA (AVA≤1.0cm 2 and MPG≥40mmHg, n=88); Group IV: moderate AS (AVA>1.0cm 2 and MPG>20mmHg, <40 mmHg, n=150). Aortic valve gradients, AVA and SVi were assessed by echocardiography. Clinical charts were reviewed. Mean follow-up duration was 3.2±1.6 years. Results: Group I had higher prevalence of atrial fibrillation, more pronounced LV hypertrophy, lower SVi, smaller AVA, higher valvuloarterial impedance (Zva) (Table) and lower 3-year cumulative survival compared to Group II and Group IV (61% vs. 75% and 80%, p=0.004). Group II had a 3-year cumulative survival similar to moderate AS (75% vs. 80%, p>0.05). In pts with medical management, Group I and Group III had lower 3-year cumulative survival in comparison with Group II and Group IV (48% and 56% vs. 73% and 76%, p=0.001). Multivariate analysis showed SVi was a strong predictor of mortality in low gradient severe AS (HR 0.95, CI: 0.91-0.99, P=0.02). However, in gradient-AVA matched severe AS and moderate AS, SVi was not associated with mortality (p>0.05). Conclusions: Without AS intervention, low flow low gradient severe AS with normal EF carries poor prognosis similar to high gradient AS, but normal flow low gradient AS does not, suggesting that SVi may be used to identify the pts benefiting most from AS intervention in pts with low gradient AS.

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