scholarly journals Features of the structural state of the myocardium in patients with myocardial infarction without ST segment elevation depending on the nature of the anatomical lesion of the coronary arteries

2021 ◽  
Vol 25 (4) ◽  
pp. 589-592
Author(s):  
V. Yu. Maslovsky
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Angiography ◽  
Functional State ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
St Segment Elevation ◽  
St Segment

Annotation. In Ukraine, one of the most pressing medical and social problems is coronary heart disease, in particular, such a form as myocardial infarction. Also, as in most countries, coronary heart disease plays a leading role in morbidity and mortality. In Ukraine, coronary heart disease accounts for 65% of the mortality from diseases of the circulatory system of the working population and is the main cause of disability. The aim of the work is to determine the features of the structural and functional state of the myocardium in patients with myocardial infarction without ST segment elevation depending on the nature of the anatomical lesion of the coronary arteries. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation (NSTEMI) aged 38 to 80 years. According to coronary angiography, the degree of damage to the coronary arteries was determined, and according to echocardiography – the structural and functional state of the myocardium. Comparison of percentages between groups was performed by the criterion χ2, absolute values – by Mann-Whitney U test. The structural condition of the left ventricular myocardium in NSTEMI patients deteriorated significantly. The total severity of coronary artery disease, calculated from coronary angiography, was> 3, indicating a more severe anatomical lesion of the coronary arteries in these patients. This pathology was associated primarily with an increase in the incidence of eccentric left ventricular hypertrophy. A similar association has been established with regard to the development of left ventricular diastolic dysfunction.

scholarly journals The ratio of structural and functional status of myocardium to plasma level of stimulating growth factor expressed by gene 2 in patients with myocardial infarction without ST segment elevation

2019 ◽  
pp. 38-42
Author(s):  
I.А. Mezhiievska
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Growth Factor ◽  
Functional Status ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
St Segment

Coronary heart disease remains one of the leading causes of temporary and persistent disability, invalidization and mortality in economically developed countries and is one of the most pressing problems in cardiology. Myocardial infarction is the most common manifestation of coronary heart disease and one of the main causes of the disability and mortality of the working population. The aim is to evaluate the structural and functional status of the myocardium in patients with acute myocardial infarction without ST segment elevation, depending on the plasma level of growth factor-stimulating factor expressed by gene 2 (ST2). 90 patients with acute myocardial infarction without ST segment elevation from 38 to 79 years old were examined. Among them, 60 (66.7%) male patients. Echocardiography assessed the structural and functional status of the myocardium. By enzyme-linked immunosorbent assay determined ST2 levels in blood plasma. It has been determined that myocardial infarction without ST segment elevation is associated with more severe structural left ventricular remodeling, left atrial overload, and decreased left ventricular contractility. In patients, myocardial infarction without ST segment elevation is associated with an increase in cases of left ventricular concentric hypertrophy. Analysis of the nature of diastolic transmitral blood flow showed a significant increase in cases of blood flow by type of pseudonormalization (43.5% versus 8.7%). Therefore, the data obtained showed that in patients with myocardial infarction without ST segment elevation, ST2 elevation was associated with a more frequent manifestation of diastolic transmitral blood flow by type of pseudonormalization. Patients with myocardial infarction without ST segment elevation showed a predominance of systolic dysfunction in the group with relatively high levels of ST2 in the blood plasma, and no significant differences in remodeling types were found in all study groups.

scholarly journals Electroangiographic Correlation of Simultaneous ST-Segment Elevations of Anterior and Inferior Segment: Who Is the Culprit?

2021 ◽  
pp. 263246362110155
Author(s):  
Pankaj Jariwala ◽  
Shanehyder Zaidi ◽  
Kartik Jadhav
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Index Case ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Inferior Segment ◽  
The Right ◽  
Proximal Occlusion

Simultaneous ST-segment elevation (SST-SE) in anterior and inferior leads in the setting of ST-segment elevation myocardial infarction is often confounding for a cardiologist and further more challenging is the angiographic localization of the culprit vessel. SST-SE can be fatal as it jeopardizes simultaneously a larger area of myocardium. This phenomenon could be due to “one lesion, one artery,” “two lesions, one artery,” “two lesions, two arteries,” or combinations in two different coronary arteries. We have discussed an index case where we encountered a phenomenon of SST-SE and coronary angiography demonstrated “two lesions, one artery” (proximal occlusion and distal critical diffuse stenoses of the wrap-around left anterior descending [LAD] artery) and “two lesions, two (different coronary) arteries” (previously mentioned stenoses of the LAD artery and critical stenosis of the posterolateral branch of the right coronary arteries). We have also described in brief the possible causes of this phenomena and their electroangiographic correlation of the culprit vessels.

scholarly journals 588 Prognostic impact of early vs. deferred angiography in MINOCA patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Armillotta ◽  
Angelo Sansonetti ◽  
Sara Amicone ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Optimal Timing ◽  
Prognostic Impact ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Aims Although an early invasive strategy (coronary angiography performed <24 h) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non-obstructive coronary arteries and non-ST-segment elevation presentation (NSTE-MINOCA) has not been explored. This study tested the hypothesis that, compared to early (<24 h) invasive strategy, deferred (≥24 h) coronary angiography has equivalent prognostic impact in patients with NSTE-MINOCA. Methods and results From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut-off of < 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non-ST-segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high-risk NSTEMI patients have been excluded from the study. The prognostic value of an early (<24 h) vs. deferred (≥24 h) coronary angiography was assessed. All-cause mortality and a composite endpoint of all-cause mortality, stroke, re-hospitalization for heart failure, and myocardial re-infarction were evaluated. 198 NSTE-MINOCA patients were enrolled. MINOCA patients were more frequently females (64%) and the mean age was 68.6 ± 13.2 years. The median follow-up time was 26 (14–40) months. The total number of events was 54 (27.3%). Kaplan–Meier curves showed that there was no statistically significant difference (P = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, the rates of death (15% vs. 11.3%) and MACEs (28.3% vs. 25%) were similar in MINOCA patients undergoing early vs. deferred angiography. Conclusions We demonstrate for the first time that in the MINOCA population the prognosis was not influenced by an early vs. deferred coronary angiography, unlike in AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non-invasive imaging strategy (e.g. Coronary-CT), mostly in patients with NSTEMI and high clinical suspicion of non-obstructive coronary arteries.

scholarly journals Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

2020 ◽  
Vol 17 (2) ◽  
pp. 39-42
Author(s):  
Ram Chandra Kafle ◽  
Girija Shankar Jha ◽  
Dibya Sharma ◽  
Vijay Madhav Alurkar
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Prior Use

Background and Aims: It is well known that ST segment elevation myocardial infarction results from complete occlusion of a coronary artery supplying that area. However, in up to 15% of patients with clinical diagnosis of myocardial infarction, early angiography reveal either non-obstructive or normal coronary artery. This subgroup of disease, myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), represent a diagnostic and therapeutic challenge to clinicians. We aimed to determine prevalence and clinical profile of patients with MINOCA in current study. Methods: This is a retrospective, observational study conducted in cardiology department of Manipal Teaching Hospital, Pokhara, Nepal from 6th April 2014 to 5th April 2019. Patients with age ≥18 years and clinically diagnosed acute myocardial infarction who underwent coronary angiography without prior use of thrombolytic agents were selected. Data were analyzed using the software SPSS for windows version 18. Results: A total of 177 patients’ underwent early coronary angiography without prior use of thrombolytic agent. The prevalence of MINOCA was 13.5% (n=24) in our study population. MINOCA patients were younger (p<0.001) compared to non-MINOCA. Smoking, systemic hypertension, access through femoral route and depressed left ventricular ejection fraction were significantly lower in MINOCA patients (p<0.05, for all). Conclusion: The prevalence of MINOCA was high (13.5%) in our study. Prospective studies are needed to conclude its high prevalence and to look for other associated factors and etiology.

scholarly journals DIASTOLIC FUNCTION OF LEFT VENTRICLE IN PATIENTS WITH CORONARY ARTERY DISEASE DURING THE DEVELOPMENT OF ACUTE MYOCARDIAL INFARCTION

2020 ◽  
Vol 20 (2) ◽  
pp. 85-90
Author(s):  
E.V. Sid ◽  
O.V. Soloviov
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Relative Risk ◽  
Left Ventricle ◽  
Diastolic Function ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Acute myocardial infarction is still remaining as one of the most challenging in modern cardiology. Impaired diastolic function of the left ventricle is one of the manifestations of myocardial dysfunction in coronary heart disease and one of the early prognostic criteria. Therefore, the investigation of this group of patients is especially relevant to assess the risk of possible complications and their timely correction. The present study was aimed at evaluating diastolic function of the left ventricle in patients with ischemic heart disease in the development of acute myocardial infarction. Materials and methods. The results of the study are based on a comprehensive survey of 477 patients with coronary heart disease: 280 patients with ST-segment elevation myocardial infarction, 91 individuals with non-ST-segment elevation myocardial infarction and the control group included 76 patients with angina pectoris (II and III functional class, each subgroup of 38 people). All 477 were comparable with regard to age, sex, and social status. Results. The level of DT was significantly higher in the ST-segment elevation myocardial infarction group and when compared to non ST-segment elevation myocardial infarction, 186.50 [173.00-242.00] ms versus 224.00 [182.00-244.00] ms, respectively, (p <0.05). There were similar differences in IVRT values ​​between the groups of patients. The highest relative risk among the patients with ST-segment elevation myocardial infarction was significantly found out in the pseudonormal type, and during the development of Q-Myocardial infarction it was RR = 1.52, 95% CI RR 1,02-2,25. The increase in the relative risk was for the stimulation of the mitral flow during the development of Q-Myocardial infarction and made up RR = 1,31, 95% CI RR 1,11-1,55. Conclusions. 1. The patients with acute myocardial infarction demonstrated impaired diastolic function of the left ventricle, with a predominance of pseudonormal type among the patients with ST-segment elevation myocardial infarction and impaired relaxation in patients with non-ST-segment elevation myocardial infarction. 2. The increase in relative risk among patients with ST-segment elevation myocardial infarction has been well established for the pseudonormal type.

scholarly journals Myocardial bridge and coronary artery fistulas in a patient with angina

2019 ◽  
Vol 10 (2) ◽  
pp. 137-141
Author(s):  
Aleksandra A. Kholkina ◽  
Yuriy R. Kovalev ◽  
Vladimir A. Isakov ◽  
Natal’ya O. Gonchar
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Angina Pectoris ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Myocardial Bridge

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

scholarly journals Typical ST-segment elevation myocardial infarction with normal coronary arteries: a case report

2019 ◽  
Vol 47 (11) ◽  
pp. 5903-5909
Author(s):  
Ying Rao ◽  
Yu Wang ◽  
Huang Sun ◽  
Wei Chen ◽  
Wenjuan Song ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Troponin I ◽  
Contrast Echocardiography ◽  
Coronary Spasm ◽  
Imaging Method ◽  
St Segment Elevation ◽  
Plaque Disruption ◽  
St Segment

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a potentially multipathogenic syndrome that affects a subgroup of patients who present with acute myocardial infarction yet have no significant coronary artery disease on angiography. We herein describe a 71-year-old man with typical angina who showed inferior ST-segment elevation on electrocardiography and an increased troponin-I level. Emergency coronary angiography showed no angiographic stenosis. Cardiac magnetic resonance imaging (CMR) and myocardial contrast echocardiography (MCE) with two-dimensional speckle tracking imaging (2D-STI) were performed after coronary angiography. Good consistency was observed between the CMR findings and MCE with 2D-STI findings in identifying the potential causes of MINOCA. We explored an imaging method that is potentially more effective and accurate than CMR, namely MCE combined with 2D-STI, to identify myocardial abnormalities when angiography reveals no obstruction. This application of MCE with 2D-STI may optimize timely treatment. MINOCA has various causes, and the patient in this case was discharged with aspirin, verapamil, and atorvastatin on the presumption that the infarct had arisen from either plaque disruption or coronary spasm. In this study, we analyzed the etiology, clinical diagnosis, and treatment of MINOCA with reference to the relevant literature.

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