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Complementary value of ECG and echocardiographic left ventricular hypertrophy for prediction of adverse outcomes in the general population. J Hypertens 2021; 39:548-555. [PMID: 33543885 DOI: 10.1097/hjh.0000000000002652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether ECG left ventricular hypertrophy (ECG-LVH) has prognostic value independent of echocardiography LVH (Echo-LVH). METHODS Participants (N = 9744, mean age, 53.81 ± 10.49 years and 45.5% male) from the Northeast China Rural Cardiovascular Health Study were included. Associations between Echo-LVH (sex-specific left ventricular mass normalized to BSA) and ECG-LVH (diagnosed using the Cornell-voltage duration product) and adverse outcomes were evaluated using Cox regression. The value of ECG-LVH for predicting adverse events was evaluated by reclassification and discrimination analyses. RESULTS Median follow-up was 4.65 years; 563 participants developed incident stroke or coronary heart disease (CHD) and 402 died. Compared with participants without either condition, those with both Echo-LVH and ECG-LVH had a significantly increased risk of incident stroke or CHD (hazard ratio, 2.42; 95% confidence interval, 1.82-3.22) and mortality (2.58; 1.85-3.60). ECG-LVH remained an independent risk factors for both outcomes when ECG-LVH and Echo-LVH were included in the model as separate variables [incident stroke or CHD (1.43; 1.14-1.79); mortality (1.41; 1.08-1.84)]. Reclassification and discrimination analyses indicated ECG-LVH addition could improve the conventional model for predicting adverse outcomes within 4 years. These relationships persisted after excluding participants with cardiovascular disease history or taking antihypertension drugs or upon applying other ECG-LVH and Echo-LVH diagnostic criteria. CONCLUSION Our study provides strong evidence that ECG-LVH is associated with adverse outcomes, independent of Echo-LVH. Clinically, ECG-LVH could be considered as a consequential factor, especially in those with Echo-LVH. These findings have potential clinical relevance for risk stratification.
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Bakhtiari F, Davarmoin G, Ghaffari S, Aslanabadi N, Separham A. Electrocardiographic left ventricular hypertrophy is not associated with increased in-hospital adverse events in patients with first Non-ST segment elevation myocardial infarction: A single center study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:289-294. [PMID: 31558990 PMCID: PMC6729159 DOI: 10.22088/cjim.10.3.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: There is conflicting data about prognostic implication of electrocardiographic (ECG) left ventricular hypertrophy (LVH) in patients with first non- ST-segment elevation myocardial infarction (NSTEMI). We aimed to examine the association of left ventricular hypertrophy (LVH) on admission electrocardiogram with adverse outcomes in patients with NSTEMI. Methods: In the present study, 460 patients (77.5% males with mean age of 65.44±13.15 years) with first NSTEMI were evaluated. ECG left ventricular hypertrophy (LVH) was diagnosed based on Sokolow-Lyon voltage criteria. Baseline laboratory and clinical results, angiographic data, as well as in- hospital adverse events were compared between the patients with and without LVH. Results: Electrocardiographic LVH was observed in 74 (16.1%) patients. Patients with LVH had higher admission systolic blood pressure (132.91±21.08 vs 125.80±21.78; P=0.01) and higher peak troponin (6.42±1.03 vs 4.41±0.28; P=0.004), but less likely to undergo coronary angiography (54.1% vs 66.8%; P=0.03) .Patients with electrocardiographic LVH had similar in-hospital mortality (5.4% vs 3.6%, P=0.5) and heart failure/ pulmonary edema (2.7% vs 2.07%, P=0.6) compared to patients without LVH. Conclusion: The present study showed that among the patients with first NSTEMI, electrocardiographic LVH was not associated with increased in-hospital adverse events.
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Affiliation(s)
- Fatemeh Bakhtiari
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Ghiti Davarmoin
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Ahmad Separham
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
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Four ECG left ventricular hypertrophy criteria and the risk of cardiovascular events and mortality in patients with vascular disease. J Hypertens 2018; 36:1865-1873. [DOI: 10.1097/hjh.0000000000001785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barrabés JA, Gupta A, Porta-Sánchez A, Strait KM, Acosta-Vélez JG, D'Onofrio G, Lidón RM, Geda M, Dreyer RP, Lorenze NP, Lichtman JH, Spertus JA, Bueno H, Krumholz HM. Comparison of Electrocardiographic Characteristics in Men Versus Women ≤ 55 Years With Acute Myocardial Infarction (a Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients Substudy). Am J Cardiol 2017; 120:1727-1733. [PMID: 28865896 DOI: 10.1016/j.amjcard.2017.07.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/16/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
Young women with acute myocardial infarction (AMI) have a worse prognosis than their male counterparts. We searched for differences in the electrocardiographic presentation of men and women in a large, contemporary registry of young adults with AMI that could help explain gender differences in outcomes. The qualifying electrocardiogram was blindly assessed by a central core lab in 3,354 patients (67% women) aged 18 to 55 years included in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study. Compared with men, women did not have a different frequency of sinus rhythm, and they had shorter PR and QRS intervals and longer QTc intervals. Intraventricular conduction disturbances were not different among genders. Notably, women were more likely than men to have abnormal Q waves in anterior leads and a lower frequency of Q waves in other territories. ST-segment elevation myocardial infarction (STEMI) diagnosis was less frequent in women than in men (44.6% vs 55.1%, p < 0.001). Among patients with STEMI, women had less magnitude and extent of ST-segment elevation than men. In patients with non-STEMI, the frequency, magnitude, and extent of ST-segment depression were not different among genders, but women had anterior ST-segment depression less frequently and anterior negative T waves more frequently compared with men. These differences remained statistically significant after adjusting for baseline characteristics. In conclusion, there are significant gender differences in the electrocardiographic presentation of AMI among young patients. Further studies are warranted to evaluate their impact on gender-related differences in the management and outcomes of AMI.
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Affiliation(s)
- José A Barrabés
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain.
| | - Aakriti Gupta
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Columbia University Medical Center, New York, New York
| | - Andreu Porta-Sánchez
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - J Gabriel Acosta-Vélez
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rosa-Maria Lidón
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Mary Geda
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy P Lorenze
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - John A Spertus
- University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Instituto de Investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Electrocardiographic left ventricular hypertrophy Cornell product is a feasible predictor of cardiac prognosis in patients with chronic heart failure. Clin Res Cardiol 2013; 103:275-84. [DOI: 10.1007/s00392-013-0646-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
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Figueras J, Barrabés JA, Evangelista A, Lidón RM, Gutierrez L, Garcia del Blanco B, Garcia-Dorado D. Admission Wall Motion Score and Quantitative ST-Segment Depression in the Assessment of 30-Day Mortality in Patients with First Non–ST-Segment Elevation Acute Coronary Syndromes. J Am Soc Echocardiogr 2013; 26:885-92. [DOI: 10.1016/j.echo.2013.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 11/17/2022]
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Bouzas-Mosquera A, Peteiro J, Broullón FJ, Méndez E, Barge-Caballero G, López-Pérez M, López-Sainz A, Alvarez-García N, Castro-Beiras A. Impact of electrocardiographic interpretability on outcome in patients referred for stress testing. Eur J Clin Invest 2012; 42:541-7. [PMID: 22050029 DOI: 10.1111/j.1365-2362.2011.02615.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is limited insight into the association of electrocardiographic interpretability with outcome in patients referred for stress testing. METHODS Exercise echocardiography was performed in 8226 patients with known or suspected coronary artery disease. Electrocardiograms were considered uninterpretable in the presence of left bundle-branch block (LBBB), left ventricular hypertrophy (LVH) with strain, repolarization abnormalities because of digitalis therapy, ventricular paced rhythm, preexcitation or ST depression ≥ 0.1 mV because of other causes. End points were all-cause mortality, cardiac death and hard cardiac events (i.e. cardiac death or nonfatal myocardial infarction). RESULTS A total of 2450 patients had uninterpretable electrocardiograms. During a follow-up period of 4.1 ± 3.5 years, there were 1011 deaths (of which 478 were cardiac deaths) and 1069 patients experienced a hard cardiac event. The 5-year rates of death, cardiac death and hard cardiac events were, respectively, 18.7%, 10.9% and 18.8% in patients with uninterpretable ECGs, compared with 9.5%, 4.1% and 10.9% in those with interpretable ECGs (P < 0.001). After covariate adjustment, lack of ECG interpretability remained an independent predictor of all-cause mortality (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.08-1.44, P = 0.002), cardiac death (HR 1.63, 95% CI 1.32-2.01, P < 0.001) and hard cardiac events (HR 1.28, 95% CI 1.11-1.47, P < 0.001). When the specific ECG abnormalities were included as covariates, LBBB, LVH and digitalis therapy remained predictors of cardiac death; LBBB and LVH were predictors of hard cardiac events, and LVH remained predictive of all-cause mortality. CONCLUSION Uninterpretable ECGs portend a worse prognosis in patients referred for stress testing.
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Ali S, Goodman SG, Yan RT, Budaj A, Fox KA, Gore JM, Brieger D, López-Sendón J, Langer A, van de Werf F, Steg PG, Yan AT. Prognostic significance of electrocardiographic-determined left ventricular hypertrophy and associated ST-segment depression in patients with non-ST-elevation acute coronary syndromes. Am Heart J 2011; 161:878-85. [PMID: 21570517 DOI: 10.1016/j.ahj.2011.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/05/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is frequently associated with ST depression (STD) on the electrocardiogram (ECG), a so-called strain pattern. Although STD is a well-established adverse prognosticator in non-ST-elevation acute coronary syndrome (NSTE-ACS), the relative prognostic importance of LVH and associated STD has not been elucidated. METHODS A total of 7,761 patients with NSTE-ACS in the Global Registry of Acute Coronary Events (GRACE) and ACS-I registries had admission ECGs analyzed at a core laboratory. Left ventricular hypertrophy (determined by Sokolow-Lyon and/or Casale criteria) was observed in 296 (3.8%) patients. We examined the independent association between LVH (determined by the admission ECG) and outcomes in relation to STD. RESULTS Patients with LVH were older, had more comorbidities and STD, and presented with a higher Killip class. They were less likely to undergo cardiac catheterization (43.1% vs 51.2%, P = .006) and percutaneous coronary intervention (18.3% vs 24.6%, P = .014). Patients with LVH had higher unadjusted mortality at 6 months (10.5% vs 7.1%, P = .038), but similar rates of in-hospital mortality (4.1% vs 3.4%, P = .54) and reinfarction (7.1% vs 7.6%, P = .75). Patients with LVH were more likely to have heart failure in-hospital (21.8% vs 11.8%, P < .001). Among LVH patients, degree of quantitative STD did not predict higher short- or long-term mortality, but was associated with in-hospital heart failure. Multivariable analysis adjusting for other clinical prognosticators of the GRACE risk models revealed that LVH was not a significant independent predictor of in-hospital mortality (adjusted odds ratio = 0.75, 95% CI 0.40-1.41, P = .37) or 6-month mortality (adjusted odds ratio = 0.83, 95% CI 0.52-1.35, P = .44). In contrast, STD remained a strong independent predictor of adverse outcomes. There was no significant interaction between STD and LVH. CONCLUSIONS Across the broad spectrum of NSTE-ACS, LVH is associated with adverse prognostic factors including STD. Electrocardiographic-determined LVH provides no significant additional prognostic utility beyond comprehensive risk assessment using the GRACE risk score. The adverse prognosis associated with LVH in NSTE-ACS may be attributable to other prognosticators such as STD.
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Núñez-Gil IJ, García-Rubira JC, Luaces M, Vivas D, De Agustín JA, González-Ferrer JJ, Bordes S, Macaya C, Fernández-Ortiz A. Mild heart failure is a mortality marker after a non-ST-segment acute myocardial infarction. Eur J Intern Med 2010; 21:439-43. [PMID: 20816601 DOI: 10.1016/j.ejim.2010.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 06/02/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Killip classification categorizes heart failure (HF) in acute myocardial infarction, and has a prognostic value. Although non-ST-elevation myocardial infarction (NSTEMI) is increasing steadily, little information is available about the prognostic value of low Killip class in this scenario. Our aim was to assess the prognostic value of mild HF in NSTEMI. METHODS 835 patients with NSTEMI between 2005 and 2007 were prospectively recruited. Patients in Killip-1 (K1=684) or Killip-2 class (K2=113) were selected (38, with K>2, excluded). Clinical, angiographic, treatment strategies, and 30-day all-cause mortality, together with other cardiovascular outcomes were recorded. RESULTS K2 patients were mostly women (K1 27.9% vs K2 48.0%, p<0.001) and older (K1 66.6years vs K2 73.8years, p<0.001) with a higher frequency of diabetes mellitus (p<0.001) and hypertension (p<0.001). Smoking was less frequent in the K2-group (p=0.003). A previous infarction/revascularization history was similar in both groups. The infarction size, assessed by Troponin I/Creatin kinase, did not differ between groups (p=0.378 and p=0.855). Multivessel coronary disease and revascularization procedures were less common in group K2 (p=0.015 and p=0.005 vs group K1, respectively). Patients in K2 had a worse prognosis in terms of maximum Killip class, death and major adverse cardiovascular events (p<0.001). After multivariate analysis, mild HF at presentation was an independent risk factor for mortality (OR=6.50; IC 95%: 2.48-16.95; p<0.001). CONCLUSION Mild HF at presentation in NSTEMI is linked to a poor prognosis, with increased short-term mortality. Thus, a more aggressive approach including early cardiac catheterization and revascularization should be considered.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Plaza Cristo Rey, Madrid, Spain.
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Panoulas VF, Toms TE, Metsios GS, Stavropoulos-Kalinoglou A, Kosovitsas A, Milionis HJ, Douglas KMJ, John H, Kitas GD. Target organ damage in patients with rheumatoid arthritis: the role of blood pressure and heart rate. Atherosclerosis 2009; 209:255-60. [PMID: 19781703 DOI: 10.1016/j.atherosclerosis.2009.08.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 08/17/2009] [Accepted: 08/24/2009] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is characterised by increased cardiovascular morbidity and mortality. Even though hypertension (HT) is highly prevalent in RA, the extent of target organ damage (TOD) caused by it remains unknown. Inflammation and sympathetic overdrive may also associate with TOD. We investigated the prevalence and associations of TOD in RA. METHODS In this cross-sectional, observational study, 251 RA patients with no overt cardiovascular or renal disease had extensive clinical and laboratory evaluations, including a 12-lead electrocardiogram and urine albumin:creatinine ratio. Pulse pressure (PP) was used as a proxy of arterial stiffness and heart rate (HR) of autonomic activity. TOD was defined as described in the European guidelines for the management of arterial hypertension. Binary logistic regression analysis was used to evaluate the independence of the variables that associated with the presence of TOD. RESULTS TOD prevalence was 23.5% (59/251). Of the 59 patients with TOD, 45.8% had suboptimally controlled HT, whereas 32.3% had undiagnosed HT. In univariable analysis, TOD was significantly associated with higher age (64.2+/-11.7 years vs. 58.0+/-12.4 years, p=0.001), HT prevalence (89.8% vs. 60.4%, p<0.001), systolic blood pressure (SBP) (150.3+/-18.8mmHg vs. 139.7+/-20.7mmHg, p=0.001), PP (70.6+/-16.6mmHg vs. 60.3+/-17.3mmHg, p<0.001), HR (77.1+/-15.4bpm vs. 72.2+/-12.2bpm, p<0.001), serum uric acid (320.6+/-88.8mumol/l vs. 285.0+/-74.9mumol/l, p=0.03) and type 2 diabetes mellitus prevalence (13.6% vs. 4.7%, p=0.019). Binary logistic regression analysis revealed that only hypertension indices and HR associated independently with TOD. CONCLUSIONS TOD is highly prevalent in patients with RA and associates independently with hypertension, arterial stiffness and heart rate. Further prospective studies are needed to confirm these findings and examine the role of beta-blockers in this particular population.
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Affiliation(s)
- Vasileios F Panoulas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, West Midlands, UK.
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Gnyawali SC, Roy S, McCoy M, Biswas S, Sen CK. Remodeling of the ischemia-reperfused murine heart: 11.7-T cardiac magnetic resonance imaging of contrast-enhanced infarct patches and transmurality. Antioxid Redox Signal 2009; 11:1829-39. [PMID: 19450139 PMCID: PMC2872241 DOI: 10.1089/ars.2009.2635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Our laboratory has published the first evidence obtained from fast low-angle-shot cine magnetic resonance imaging (11.7 T) studies demonstrating secondary myocyte death after ischemia/reperfusion (IR) of the murine heart. This work provides the first evidence from 11.7-T magnet-assisted pixel-level analysis of the post-IR murine myocardial infarct patches. Changes in function of the remodeling heart were examined in tandem. IR compromised cardiac function and induced LV hypertrophy. During recovery, the IR-induced increase in LV mass was partly offset. IR-induced wall thinning was noted in the anterior aspect of LV and at the diametrically opposite end. Infarct size was observed to be largest on post-IR days 3 and 7. With time (day 28), however, the infarct size was significantly reduced. IR-induced absolute signal-intensity enhancement was highest on post-IR days 3 and 7. As a function of post-IR time, signal-intensity enhancement was attenuated. The threshold of hyperenhanced tissue resulted in delineation of contours that identified necrotic (bona fide infarct) and reversibly injured infarct patches. The study of infarct transmurality indicated that whereas the permanently injured tissue volume remained unchanged, part of the reversibly injured infarct patch recovered in 4 weeks after IR. The approach validated in the current study is powerful in noninvasively monitoring remodeling of the post-IR beating murine myocardium.
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Affiliation(s)
- Surya C Gnyawali
- Davis Heart & Lung Research Institute, Department of Surgery The Ohio State University Medical Center, Columbus, Ohio 43210, USA
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