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Wang X, Pu J. Recent Advances in Cardiac Magnetic Resonance for Imaging of Acute Myocardial Infarction. SMALL METHODS 2024; 8:e2301170. [PMID: 37992241 DOI: 10.1002/smtd.202301170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/14/2023] [Indexed: 11/24/2023]
Abstract
Acute myocardial infarction (AMI) is one of the primary causes of death worldwide, with a high incidence and mortality rate. Assessment of the infarcted and surviving myocardium, along with microvascular obstruction, is crucial for risk stratification, treatment, and prognosis in patients with AMI. Nonionizing radiation, excellent soft tissue contrast resolution, a large field of view, and multiplane imaging make cardiac magnetic resonance (CMR) a "one-stop" method for assessing cardiac structure, function, perfusion, and metabolism. Hence, this imaging technology is considered the "gold standard" for evaluating myocardial function and viability in AMI. This review critically compares the advantages and disadvantages of CMR with other cardiac imaging technologies, and relates the imaging findings to the underlying pathophysiological processes in AMI. A more thorough understanding of CMR technology will clarify their advanced clinical diagnosis and prognostic assessment applications, and assess the future approaches and challenges of CMR in the setting of AMI.
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Affiliation(s)
- Xu Wang
- Shanghai Jiao Tong University, School of Medicine Affiliated Renji Hospital, Shanghai, 200127, China
| | - Jun Pu
- Shanghai Jiao Tong University, School of Medicine Affiliated Renji Hospital, Shanghai, 200127, China
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Martínez-Fernández J, Almengló C, Babarro B, Iglesias-Rey R, García-Caballero T, Fernández ÁL, Souto-Bayarri M, González-Juanatey JR, Álvarez E. Edoxaban treatment in a post-infarction experimental model. Eur J Pharmacol 2024; 962:176216. [PMID: 38040081 DOI: 10.1016/j.ejphar.2023.176216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The sequelae of myocardial infarction (MI) require specific pharmacological therapy to minimise the post-MI remodelling, which in many cases evolves into cardiovascular complications. The aim of this study was to analyse the effect of edoxaban, an oral anticoagulant, on cardiac recovery in a rat model of permanent coronary artery ligation. METHODS An experimental method to assess the post-MI remodelling in rats for 4 weeks, based on cardiac magnetic resonance imaging (MRI) and final histological analysis of the hearts was performed. The influence of daily oral treatment with edoxaban (20 mg/kg/day) for 28 days post-MI was analysed in comparison to vehicle. RESULTS In our model, edoxaban was shown to be safe and bleeding was observed in 1 of 10 animals. General physical recovery of the treated animals was shown by higher body weight recovery compared with non-treated animals (38.6 ± 2.9 vs. 29.9 ± 3.1 g, respectively, after 28 days). There was not a pronounced effect of edoxaban in post-MI cardiac remodelling, but mitigated fibrosis was observed by the reduced expression of vascular endothelial growth factor and tumour growth factor β1 in the peri-infarct zone. CONCLUSIONS Our analysis provided the experimental basis to support the feasibility of MRI to study cardiac function and characterise myocardial scarring in a rat model. Overall data suggested the safety of edoxaban in the model, and compared to placebo, it showed a better post-MI recovery, probably by reducing fibrosis of the heart. Further research on mid-term cardiac recovery with edoxaban after MI is justified.
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Affiliation(s)
- Javier Martínez-Fernández
- Servicio de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain
| | - Cristina Almengló
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain
| | - Borja Babarro
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain
| | - Tomás García-Caballero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain; Department of Morphological Sciences, School of Medicine, University of Santiago de Compostela and University Clinical Hospital, 15782, Santiago de Compostela, Spain
| | - Ángel L Fernández
- Heart Surgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; CIBERCV, Madrid, Spain
| | - Miguel Souto-Bayarri
- Servicio de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain
| | - José R González-Juanatey
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain; Departamento de Medicina, Universidad de Santiago de Compostela, 15782, A Coruña, Spain; CIBERCV, Madrid, Spain; Servicio de Cardiología y Unidad de Hemodinámica. Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain
| | - Ezequiel Álvarez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). SERGAS, Travesía da Choupana s/n, A Coruña, Santiago de Compostela, 15706, Spain; CIBERCV, Madrid, Spain; Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, Universidad de Santiago de Compostela, 15782, Santiago de Compostela, A Coruña, Spain.
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Diagnosis of an Acute Anterior Wall Infarction in Dual-Energy CT. Diagnostics (Basel) 2023; 13:diagnostics13040761. [PMID: 36832249 PMCID: PMC9955461 DOI: 10.3390/diagnostics13040761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
Due to its high morbidity and mortality, myocardial infarction is the leading cause of death worldwide. Against this background, rapid diagnosis is of immense importance. Especially in case of an atypical course, the correct diagnosis may be delayed and thus lead to increased mortality rates. In this report, we present a complex case of acute coronary syndrome. A triple-rule-out CT examination was performed in dual-energy CT (DECT) mode. While pulmonary artery embolism and aortic dissection could be ruled out with conventional CT series, the presence of anterior wall infarction was only detectable on DECT reconstructions. Subsequently, adequate and rapid therapy was then initiated leading to survival of the patient.
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A Robustness Evaluation of Machine Learning Algorithms for ECG Myocardial Infarction Detection. J Clin Med 2022; 11:jcm11174935. [PMID: 36078865 PMCID: PMC9456488 DOI: 10.3390/jcm11174935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
An automatic electrocardiogram (ECG) myocardial infarction detection system needs to satisfy several requirements to be efficient in real-world practice. These requirements, such as reliability, less complexity, and high performance in decision-making, remain very important in a realistic clinical environment. In this study, we investigated an automatic ECG myocardial infarction detection system and presented a new approach to evaluate its robustness and durability performance in classifying the myocardial infarction (with no feature extraction) under different noise types. We employed three well-known supervised machine learning models: support vector machine (SVM), k-nearest neighbors (KNN), and random forest (RF), and tested the performance and robustness of these techniques in classifying normal (NOR) and myocardial infarction (MI) using real ECG records from the PTB database after normalization and segmentation of the data, with a suggested inter-patient paradigm separation as well as noise from the MIT-BIH noise stress test database (NSTDB). Finally, we measured four metrics: accuracy, precision, recall, and F1-score. The simulation revealed that all of the models performed well, with values of over 0.50 at lower SNR levels, in terms of all the metrics investigated against different types of noise, indicating that they are encouraging and acceptable under extreme noise situations are are thus considered sustainable and robust models for specific forms of noise. All of the methods tested could be used as ECG myocardial infarction detection tools in real-world practice under challenging circumstances.
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Zhang S, Ma Q, Jiao Y, Wu J, Yu T, Hou Y, Sun Z, Zheng L, Sun Z. Prognostic value of myocardial salvage index assessed by cardiovascular magnetic resonance in reperfused ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:933733. [PMID: 36051284 PMCID: PMC9425200 DOI: 10.3389/fcvm.2022.933733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/20/2022] [Indexed: 12/19/2022] Open
Abstract
AimsCardiovascular magnetic resonance (CMR) is a powerful tool to quantify the myocardial area at risk (AAR) and infarct size (IS), and evaluate the extent of myocardial salvage in acute ST-segment elevation myocardial infarction (STEMI). This study aimed to assess the prognostic value of myocardial salvage index (MSI) assessed by CMR in reperfused STEMI and investigate whether MSI could improve the predictive efficacy of the Global Registry of Acute Coronary Events (GRACE) risk score.Methods and results:About 104 consecutive patients who were hospitalized with first-time STEMI and received reperfusion therapy were prospectively enrolled. The primary endpoint was the incident of major adverse cardiovascular event (MACE) including all-cause mortality, non-fatal myocardial reinfarction and congestive heart failure within 36 months after the index event. Cox regression analysis was used to evaluate the prognostic association of MSI with MACE risk. About 21 (20.2%) patients developed MACE during the 3-year follow-up period, and patients with MSI < median had a higher incidence of MACE than those with MSI ≥ median [16 (30.8%) vs. 5 (9.6%), P = 0.007]. After adjusting all the parameters associated with MACE in univariate Cox analysis, MSI assessed by CMR remained independently significant as a predictor of MACE in multivariate Cox analysis (hazard ratio 0.963, 95% CI: 0.943–0.983; P < 0.001). Adding MSI to the GRACE risk score significantly increased the prognostic accuracy of the GRACE risk score (area under the curve: 0.833 vs. 0.773; P = 0.044), with a net reclassification improvement of 0.635 (P = 0.009) and an integrated discrimination improvement of 0.101 (P = 0.002).ConclusionThis study confirmed that MSI assessed by CMR had a good long-term prognostic value in reperfused STEMI and improve the prognostic performance of the GRACE risk score.
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Affiliation(s)
- Shiru Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Radiology, Ganzhou Municipal Hospital, Ganzhou, China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Liqiang Zheng,
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
- Zhaoqing Sun,
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Huang Y, Lei D, Chen Z, Xu B. Factors associated with microvascular occlusion in patients with ST elevation myocardial infarction after primary percutaneous coronary intervention. J Int Med Res 2021; 49:3000605211024490. [PMID: 34154432 PMCID: PMC8236804 DOI: 10.1177/03000605211024490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to determine predictors of microvascular occlusion (MVO) in patients with ST elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (pPCI). Methods This retrospective, observational study consecutively included 113 patients with STEMI undergoing pPCI. Cardiac magnetic resonance imaging was used to determine the presence of MVO in these patients. Biomarkers in serum were routinely tested 1 day after pPCI. Multivariable logistic regression analysis was used to evaluate significant predictors of occurrence of MVO. Results There were 62 patients in the MVO group and 51 patients in the non-MVO group. C-reactive protein (CRP), thrombomodulin, lymphatic vessel endothelial hyaluronan receptor-1, syndecan-1, and troponin T (TnT) levels after the procedure were significantly higher in the MVO group than in the non-MVO group. CRP (hazard ratio [HR]=1.036), TnT (HR=1.316), and syndecan-1 (HR=1.986) levels were independently associated with MVO in patients with acute myocardial infarction after pPCI. Conclusions Levels of CRP, TnT, and syndecan-1 can be used as serum biomarkers for MVO in patients with STEMI receiving pPCI.
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Affiliation(s)
- Yinhao Huang
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Dazhou Lei
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Ziwei Chen
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Biao Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
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Sun ZQ, Yu TT, Ma Y, Ma QM, Jiao YD, He DX, Jia-KeWu, Wen ZY, Wang XN, Hou Y, Sun ZJ. Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study. World J Clin Cases 2020; 8:1232-1240. [PMID: 32337197 PMCID: PMC7176617 DOI: 10.12998/wjcc.v8.i7.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes. However, the association between depression and myocardial injury on cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) has still not been assessed.
AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.
METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention (P-PCI) were analyzed in this prospectivecohort study. Each subject completed the Patient Health Questionnaire-9 (PHQ-9) to assess the presence and severity of depressive symptoms. CMR was performed at a median of 3 d after P-PCI for quantifying post-MI myocardial injury. Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.
RESULTS In this study, 19 patients (17.8%) were diagnosed with major depression identified by the PHQ-9 ≥ 10. PHQ-9 was analyzed both as a continuous variable and dichotomous variable. After multivariable adjustment, the proportion of patients with large infarction size was significantly higher in the major depression group (PHQ-9 ≥ 10) (OR: 4.840, 95%CI: 1.122–20.868, P =0.034). When the PHQ-9 was evaluated as a continuous variable, after multivariable adjustment, an increased PHQ-9 score was associated with an increased risk of large infarction size (OR: 1.226, 95%CI: 1.073–1.401, P =0.003).
CONCLUSION In patients with STEMI undergoing PCI, depression was independently associated with a large infarction size.
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Affiliation(s)
- Zhao-Qing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tong-Tong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yue Ma
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Quan-Mei Ma
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Yun-Di Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Dong-Xu He
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jia-KeWu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zong-Yu Wen
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiao-Nan Wang
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Yang Hou
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Kendziora B, Dewey M. Prognostic value of the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction: A systematic review and meta-regression analysis. PLoS One 2020; 15:e0228736. [PMID: 32053651 PMCID: PMC7018083 DOI: 10.1371/journal.pone.0228736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/21/2020] [Indexed: 12/16/2022] Open
Abstract
In all patients with ST-segment elevation myocardial infarction, risk stratification should be performed before discharge. The measurement of therapy efficiency with magnetic resonance imaging has been proposed as part of the risk assessment, but it has not been adopted widely. This meta-analysis was conducted to summarize published data on the prognostic value of the proportion of salvaged myocardium inside previously ischemic myocardium (myocardial salvage index) measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction. Random and mixed effects models were used for analyzing the data of 10 studies with 2,697 patients. The pooled myocardial salvage index, calculated as the proportion of non-necrotic myocardium inside edematous myocardium measured by T2-weighted and T1-weighted late gadolinium enhancement MRI, was 43.0% (95% confidence interval: 37.4, 48.6). The pooled length of follow-up was 12.3 months (95% confidence interval: 7.0, 17.6). The pooled incidence of major cardiac events during follow-up, defined as cardiac death, nonfatal myocardial infarction, or admission for heart failure, was 10.6% (95% confidence interval: 5.7, 15.5). The applied mixed effects model showed an absolute decrease of 1.7% in the incidence of major cardiac events during follow-up (95% confidence interval: 1.6, 1.9) with every 1% of increase in the myocardial salvage index. The heterogeneity between studies was considerable (τ = 21.3). Analysis of aggregated follow-up data after ST-segment elevation myocardial infarction suggests that the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging provides prognostic information on the risk of major cardiac events, but considerable heterogeneity exists between studies.
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Affiliation(s)
- Benjamin Kendziora
- Department of Radiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- * E-mail:
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Lin B, Feng D, Xu J. Cardioprotective effects of microRNA-18a on acute myocardial infarction by promoting cardiomyocyte autophagy and suppressing cellular senescence via brain derived neurotrophic factor. Cell Biosci 2019; 9:38. [PMID: 31168354 PMCID: PMC6509849 DOI: 10.1186/s13578-019-0297-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/20/2019] [Indexed: 12/18/2022] Open
Abstract
Background The prevention of cardiovascular diseases is a matter of great concern, of which acute myocardial infarction (AMI) remains one of the leading causes of death resulting in high morbidity worldwide. Emerging evidence highlights the importance of microRNAs (miRNAs) as functional regulators in cardiovascular disease. In this study, an AMI rat model was established in order to investigate the effect of miR-18a on cardiomyocyte autophagy and senescence in AMI and the underlying mechanism. Methods In the present study, an AMI model was induced by ligating the anterior descending branch of left coronary artery in Wistar rats. Dual-luciferase reporter gene assay was introduced for exploration on the relationship between miR-18a and brain derived neurotrophic factor (BDNF). The gain- and loss-of-function experiments were performed to elucidate miR-18a and BDNF effects on cell autophagy and senescence in AMI by transfecting hypoxia-exposed H9c2 cells with miR-18a inhibitor or mimic, siRNA against BDNF, or hypoxia-exposed H9c2 cell treatment with an agonist of the Akt/mTOR axis (LM22B-10). Results Upregulation of miR-18a was found in AMI, while downregulation was present in BDNF to activate the Akt/mTOR axis. Compared with the miR-18a inhibitor group, the expression of p-Akt and p-mTOR increased and the number of senescent cells increased in the miR-18a inhibitor + LM22B-10 group, and the expression of Beclin1, LC3-II, p62 decreased and autophagy decreased (all p < 0.05). Furthermore, this could be rescued by knocking down BDNF or Akt/mTOR axis activation by LM22B-10. Conclusion All in all, downregulation of miR-18a could promote BDNF expression, which offers protection against AMI by inactivating the Akt/mTOR axis, highlighting a promising therapeutic strategy for AMI treatment.
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Affiliation(s)
- Bin Lin
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, 1, Jianshe East Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Deguang Feng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, 1, Jianshe East Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Jing Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, 1, Jianshe East Road, Zhengzhou, 450052 Henan People's Republic of China
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Evaluation of myocardial viability in myocardial infarction patients by magnetic resonance perfusion and delayed enhancement imaging. Herz 2018; 44:735-742. [DOI: 10.1007/s00059-018-4741-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
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Qin J, Zhou S, Li Z, Chen Y, Qin Q, Ai T. Combination of magnetic resonance imaging and targeted contrast agent for the diagnosis of myocardial infarction. Exp Ther Med 2018; 16:3303-3308. [PMID: 30233676 PMCID: PMC6143907 DOI: 10.3892/etm.2018.6600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/05/2018] [Indexed: 12/05/2022] Open
Abstract
Myocardial infarction is one of the most common human cerebrovascular conditions and frequently leads to ischemic stroke. Evidence has indicated that magnetic resonance imaging (MRI) is a potential method for the diagnosis of patients with cardiovascular injury. However, the efficacy of MRI in diagnosing patients with myocardial infarction requires to be improved. In the present study, a novel nano-size contrast agent, a chitosan/Fe3O4-enclosed albumin (CFEA), was introduced that was used to quantify blood volume and permeability in the infarcted myocardium. A total of 68 patients with suspected myocardial infarction were recruited to analyze the efficacy of MRI combined with CFEA (MRI-CFEA). All patients received diagnosis by MRI and MRI-CFEA. It was revealed that MRI-CFEA provided a higher signal intensity than MRI in the same patients. It was demonstrated that the diagnostic efficacy of MRI-CFEA for patients with myocardial infarction was higher than that of MRI (P<0.05). By MRI-CFEA, 50/68 of cases with myocardial infarction were diagnosed, providing a significantly higher diagnostic rate compared with the 38/68 of cases diagnosed by contrast-enhanced MRI (P<0.01). MRI-CFEA successfully discriminated the infarcted regions based on a decreased fractional blood volume and increased permeability-surface (PS) area product in the infarcted myocardium. A pharmacodynamics analysis indicated that CFEA was eliminated within 24 h in all individuals. In conclusion, the present study provided a novel method to diagnose infarcted myocardium for patients with myocardial infarction, providing an imaging biomarker for the assessment of endothelial dysfunction in the clinic.
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Affiliation(s)
- Jiangjun Qin
- Department of Radiology, The Third People's Hospital of Hainan, Sanya, Hainan 571100, P.R. China
| | - Shuchang Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhiwei Li
- Department of Radiology, The Third People's Hospital of Hainan, Sanya, Hainan 571100, P.R. China
| | - Yinan Chen
- Department of Ultrasound, Sanya Maternity and Child Health Care Hospital, Sanya, Hainan 572000, P.R. China
| | - Qun Qin
- Department of Radiology, The Third People's Hospital of Hainan, Sanya, Hainan 571100, P.R. China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Zhao Y, Qin F, He B, Liu Q. Is microvascular obstruction independent predictor of the major adverse cardiovascular events in latecomers after ST-elevation myocardial infarction? Int J Cardiol 2017; 243:108. [PMID: 28747019 DOI: 10.1016/j.ijcard.2017.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/09/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Yuwei Zhao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Fen Qin
- Department of Cardiology/Cardiac Catheterisation Lab, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Qiming Liu
- Department of Cardiology/Cardiac Catheterisation Lab, Second Xiangya Hospital, Central South University, Changsha 410011, China
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Rodean I, Beganu E, Hodas R, Himcinschi E, Bordi L, Benedek T. Cardiac Magnetic Resonance and Myocardial Viability: Why Is It so Important? JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
For a better assessment of ischemic heart diseases, myocardial viability should be quantified. Current studies underline the importance and the evolution of several techniques and methods used in the evaluation of myocardial viability. Taking into account these considerations, the aim of this manuscript was to present the recent points of view regarding myocardial viability and its clinical significance in patients with ischemic cardiomyopathies and left ventricular dysfunction. On the other hand, the manuscript points out the role of magnetic resonance imaging (MRI), one of the most useful noninvasive imaging techniques, in the assessment of myocardial viability. By comparing the advantages and disadvantages of cardiac MRI, its usefulness can be better appreciated by the clinician. In the following years, it is considered that MRI will be an indispensable imaging tool in the assessment of ischemic heart disease, guiding interventions for revascularization and long-term risk stratification in patients with stable angina or myocardial infarction.
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Affiliation(s)
- Ioana Rodean
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Elena Beganu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Roxana Hodas
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Elisabeta Himcinschi
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Lehel Bordi
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
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Saeed M, Liu H, Liang CH, Wilson MW. Magnetic resonance imaging for characterizing myocardial diseases. Int J Cardiovasc Imaging 2017; 33:1395-1414. [PMID: 28364177 DOI: 10.1007/s10554-017-1127-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/23/2017] [Indexed: 12/21/2022]
Abstract
The National Institute of Health defined cardiomyopathy as diseases of the heart muscle. These myocardial diseases have different etiology, structure and treatment. This review highlights the key imaging features of different myocardial diseases. It provides information on myocardial structure/orientation, perfusion, function and viability in diseases related to cardiomyopathy. The standard cardiac magnetic resonance imaging (MRI) sequences can reveal insight on left ventricular (LV) mass, volumes and regional contractile function in all types of cardiomyopathy diseases. Contrast enhanced MRI sequences allow visualization of different infarct patterns and sizes. Enhancement of myocardial inflammation and infarct (location, transmurality and pattern) on contrast enhanced MRI have been used to highlight the key differences in myocardial diseases, predict recovery of function and healing. The common feature in many forms of cardiomyopathy is the presence of diffuse-fibrosis. Currently, imaging sequences generating the most interest in cardiomyopathy include myocardial strain analysis, tissue mapping (T1, T2, T2*) and extracellular volume (ECV) estimation techniques. MRI sequences have the potential to decode the etiology by showing various patterns of infarct and diffuse fibrosis in myocarditis, amyloidosis, sarcoidosis, hypertrophic cardiomyopathy due to aortic stenosis, restrictive cardiomyopathy, arrythmogenic right ventricular dysplasia and hypertension. Integrated PET/MRI system may add in the future more information for the diagnosis and progression of cardiomyopathy diseases. With the promise of high spatial/temporal resolution and 3D coverage, MRI will be an indispensible tool in diagnosis and monitoring the benefits of new therapies designed to treat myocardial diseases.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA, 94107-5705, USA.
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Chang-Hong Liang
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA, 94107-5705, USA
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15
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Mavrogeni S, Markousis-Mavrogenis G, Koutsogeorgopoulou L, Dimitroulas T, Bratis K, Kitas GD, Sfikakis P, Tektonidou M, Karabela G, Stavropoulos E, Katsifis G, Boki KA, Kitsiou A, Filaditaki V, Gialafos E, Plastiras S, Vartela V, Kolovou G. Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases. Int J Cardiol 2017; 236:151-156. [PMID: 28185705 DOI: 10.1016/j.ijcard.2017.01.104] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND-AIM Cardiac involvement at diagnosis of connective tissue disease (CTD) has been described by echocardiography. We hypothesized that cardio-vascular magnetic resonance (CMR) detects occult lesions at CTD diagnosis. PATIENTS-METHODS CMR was performed early after diagnosis in 78 treatment-naïve CTDs (aged 43±11, 59F/19M) without cardiac involvement [5 Takayasu arteritis (TA), 4 Churg Strauss syndrome (CSS), 5 Wegener granulomatosis (WG), 16 systemic lupus erythematosus (SLE), 12 rheumatoid arthritis (RA), 8 mixed connective tissue diseases (MCTD), 12 ankylosing spondylitis (AS), 3 polymyalgia rheumatica (PMR), 8 systemic sclerosis (SSc) and 5 dermatomyositis (DM)]. Acute and chronic lesions were assessed by T2>2 with positive LGE and T2<2 with positive LGE, respectively. RESULTS In 3/5 TA, 3/4 CSS, 4/5 WG, 10/16 SLE, 9/12 RA, 6/8 MCTD, 4/12 AS, 1/3 PMR, 2/8 SSc and 2/5 DM, the T2 ratio was higher compared to normal (2.78±0.25 vs 1.5±0.2, p<0.01). Myocarditis was identified in 1 TA, 1 SLE, 1 RA, 1 SSc and 2 DM patients; diffuse, subendocardial fibrosis in 1 CSS and 1 RA patient, while subendocardial myocardial infarction in 3 SLE, 1 MCTD, 1 PMR and 2 RA patients. CMR re-evaluation after 6 and 12months of rheumatic and cardiac treatment, available in 28/52 CTDs with increased T2 ratio, showed significant improvement in T2 ratio (p<0.001), non-significant change in LGE extent and normalisation of those with impaired LV function. CONCLUSIONS Occult CMR lesions, including oedema, myocarditis, diffuse subendocardial fibrosis and myocardial infarction are not unusual in treatment naïve CTDs and may be reversed with appropriate treatment.
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Affiliation(s)
| | | | | | - Theodoros Dimitroulas
- Department of Rheumatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George D Kitas
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
| | - Petros Sfikakis
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | - Maria Tektonidou
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | | | | | | | | | | | | | - Elias Gialafos
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | - Sotiris Plastiras
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
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16
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Diware MS, Cho HM, Chegal W, Cho YJ, Kim DS, O SW, Kim KS, Paek SH. Ultrasensitive, label-free detection of cardiac biomarkers with optical SIS sensor. Biosens Bioelectron 2017; 87:242-248. [DOI: 10.1016/j.bios.2016.08.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/04/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022]
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17
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Jin J, Chen M, Li Y, Wang Y, Zhang S, Wang Z, Wang L, Ju S. Detecting Acute Myocardial Infarction by Diffusion-Weighted versus T2-Weighted Imaging and Myocardial Necrosis Markers. Tex Heart Inst J 2016; 43:383-391. [PMID: 27777517 DOI: 10.14503/thij-15-5462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We used a porcine model of acute myocardial infarction to study the signal evolution of ischemic myocardium on diffusion-weighted magnetic resonance images (DWI). Eight Chinese miniature pigs underwent percutaneous left anterior descending or left circumflex coronary artery occlusion for 90 minutes followed by reperfusion, which induced acute myocardial infarction. We used DWI preprocedurally and hourly for 4 hours postprocedurally. We acquired turbo inversion recovery magnitude T2-weighted images (TIRM T2WI) and late gadolinium enhancement images from the DWI slices. We measured the serum myocardial necrosis markers myoglobin, creatine kinase-MB isoenzyme, and cardiac troponin I at the same time points as the magnetic resonance scanning. We used histochemical staining to confirm injury. All images were analyzed qualitatively. Contrast-to-noise ratio (the contrast between infarcted and healthy myocardium) and relative signal index were used in quantitative image analysis. We found that DWI identified myocardial signal abnormity early (<4 hr) after acute myocardial infarction and identified the infarct-related high signal more often than did TIRM T2WI: 7 of 8 pigs (87.5%) versus 3 of 8 (37.5%) (P=0.046). Quantitative image analysis yielded a significant difference in contrast-to-noise ratio and relative signal index between infarcted and normal myocardium on DWI. However, within 4 hours after infarction, the serologic myocardial injury markers were not significantly positive. We conclude that DWI can be used to detect myocardial signal abnormalities early after acute myocardial infarction-identifying the infarction earlier than TIRM T2WI and widely used clinical serologic biomarkers.
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Zhao H, Lee APW, Li Z, Qiao Z, Fan Y, An D, Xu J, Pu J, Shen X, Ge H, He B. Impact of Intramyocardial Hemorrhage and Microvascular Obstruction on Cardiac Mechanics in Reperfusion Injury: A Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr 2016; 29:973-982. [PMID: 27523265 DOI: 10.1016/j.echo.2016.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intramyocardial hemorrhage (IMH) and microvascular obstruction (MVO) are two major mechanisms of reperfusion injury of the left ventricle after acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess the impact of IMH and MVO on left ventricular (LV) cardiac mechanics using two-dimensional speckle-tracking echocardiography during the acute phase of STEMI and on LV functional recovery. METHODS Eighty-one patients with STEMI who received primary reperfusion therapy were prospectively studied. Infarct segments were classified by cardiac magnetic resonance according to infarct transmurality and the presence or absence of IMH and/or MVO. Segmental systolic longitudinal strain, circumferential strain (CS), and radial strain were measured by two-dimensional speckle-tracking echocardiography. Adverse LV remodeling and major adverse cardiovascular events were assessed at 1 year. RESULTS MVO without IMH was much less frequent in nontransmural infarct segments than in transmural infarct segments (6.0% vs 19.1%, P = .000), while IMH was present only in transmural infarct segments. In nontransmural infarct segments, MVO was not associated with any significant changes in strain (P > .5). In transmural infarct segments, there were no differences in all types of strain between segments without reperfusion injury and those with MVO alone (P > .20). IMH was evident in the midmyocardial layer within the infarct zone in 196 segments (46.1%). The presence of IMH in addition to MVO decreased CS significantly (P = .004), but not longitudinal and radial strain (P > .5). A receiver operating characteristic curve analysis with cross-validation by k-folding showed that the sensitivity and specificity of CS using a cutoff of >-11.66% to diagnose IMH were 78.00% and 79.45%, respectively (area under the curve = 0.86; P = .0001). At 1 year, patients with major adverse cardiovascular events and LV remodeling had significantly lower baseline measurements of all types of global strain (P < .05). CONCLUSIONS In the acute phase of STEMI, reperfusion MVO and IMH injury have differential effects on cardiac mechanics. IMH preferentially affects CS, presumably related to its location in the midmyocardial layer.
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Affiliation(s)
- Hang Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Qiao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiting Fan
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongaolei An
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Xu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuedong Shen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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19
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Carrick D, Haig C, Carberry J, May VTY, McCartney P, Welsh P, Ahmed N, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Mahrous A, Rauhalammi SM, Mordi I, Ford I, Radjenovic A, Sattar N, Oldroyd KG, Berry C. Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction. JCI Insight 2016; 1:e85768. [PMID: 27699259 PMCID: PMC5033815 DOI: 10.1172/jci.insight.85768] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND. Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors. METHODS. IMR (n = 288) and CFR (n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire–based thermodilution. Cardiac MRI disclosed left ventricular pathology, function, and volumes at 2 days (n = 281) and 6 months after STEMI (n = 264). All-cause death or first heart failure hospitalization was independently adjudicated (median follow-up 845 days). RESULTS. Myocardial hemorrhage and microvascular obstruction occurred in 89 (42%) and 114 (54%) patients with evaluable T2*-MRI maps. IMR and CFR were associated with microvascular pathology (none vs. microvascular obstruction only vs. microvascular obstruction and myocardial hemorrhage) (median [interquartile range], IMR: 17 [12.0–33.0] vs. 17 [13.0–39.0] vs. 37 [21.0–63.0], P < 0.001; CFR: 1.7 [1.4–2.5] vs. 1.5 [1.1–1.8] vs. 1.4 [1.0–1.8], P < 0.001), whereas thrombolysis in myocardial infarction blush grade was not. IMR was a multivariable associate of changes in left ventricular end-diastolic volume (regression coefficient [95% CI] 0.13 [0.01, 0.24]; P = 0.036), whereas CFR was not (P = 0.160). IMR (5 units) was a multivariable associate of all-cause death or heart failure hospitalization (n = 30 events; hazard ratio [95% CI], 1.09 [1.04, 1.14]; P < 0.001), whereas CFR (P = 0.124) and thrombolysis in myocardial infarction blush grade (P = 0.613) were not. IMR had similar prognostic value for these outcomes as <50% ST-segment resolution on the ECG. CONCLUSIONS. IMR is more closely associated with microvascular pathology, left ventricular remodeling, and health outcomes than the angiogram or CFR. TRIAL REGISTRATION. NCT02072850. FUNDING. A British Heart Foundation Project Grant (PG/11/2/28474), the National Health Service, the Chief Scientist Office, a Scottish Funding Council Senior Fellowship, a British Heart Foundation Intermediate Fellowship (FS/12/62/29889), and a nonfinancial research agreement with Siemens Healthcare. The index of microvascular resistance correlates with microvascular pathology and is a diagnostic test of myocardial reperfusion in patients with acute ST-elevation myocardial infarction.
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Affiliation(s)
- David Carrick
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Vannesa Teng Yue May
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Peter McCartney
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nadeem Ahmed
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Samuli Mo Rauhalammi
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ify Mordi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Aleksandra Radjenovic
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
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20
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Saeed M, Van TA, Krug R, Hetts SW, Wilson MW. Cardiac MR imaging: current status and future direction. Cardiovasc Diagn Ther 2015; 5:290-310. [PMID: 26331113 DOI: 10.3978/j.issn.2223-3652.2015.06.07] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022]
Abstract
Coronary artery disease is currently a worldwide epidemic with increasing impact on healthcare systems. Magnetic resonance imaging (MRI) sequences give complementary information on LV function, regional perfusion, angiogenesis, myocardial viability and orientations of myocytes. T2-weighted short-tau inversion recovery (T2-STIR), fat suppression and black blood sequences have been frequently used for detecting edematous area at risk (AAR) of infarction. T2 mapping, however, indicated that the edematous reaction in acute myocardial infarct (AMI) is not stable and warranted the use of edematous area in evaluating therapies. On the other hand, cine MRI demonstrated reproducible data on LV function in healthy volunteers and LV remodeling in patients. Noninvasive first pass perfusion, using exogenous tracer (gadolinium-based contrast media) and arterial spin labeling MRI, using endogenous tracer (water), are sensitive and useful techniques for evaluating myocardial perfusion and angiogenesis. Recently, new strategies have been developed to quantify myocardial viability using T1-mapping and equilibrium contrast enhanced MR techniques because existing delayed contrast enhancement MRI (DE-MRI) sequences are limited in detecting patchy microinfarct and diffuse fibrosis. These new techniques were successfully used for characterizing diffuse myocardial fibrosis associated with myocarditis, amyloidosis, sarcoidosis heart failure, aortic hypertrophic cardiomyopathy, congenital heart disease, restrictive cardiomyopathy, arrhythmogenic right ventricular dysplasia and hypertension). Diffusion MRI provides information regarding microscopic tissue structure, while diffusion tensor imaging (DTI) helps to characterize the myocardium and monitor the process of LV remodeling after AMI. Novel trends in hybrid imaging, such as cardiac positron emission tomography (PET)/MRI and optical imaging/MRI, are recently under intensive investigation. With the promise of higher spatial-temporal resolution and 3D coverage in the near future, cardiac MRI will be an indispensible tool in the diagnosis of cardiac diseases, coronary intervention and myocardial therapeutic delivery.
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Affiliation(s)
- Maythem Saeed
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Tu Anh Van
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Roland Krug
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Steven W Hetts
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Mark W Wilson
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
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21
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Hidalgo A, Pons-Lladó G. Usefulness of cardiac MRI in the prognosis and follow-up of ischemic heart disease. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Hidalgo A, Pons-Lladó G. Usefulness of cardiac MRI in the prognosis and follow-up of ischemic heart disease. RADIOLOGIA 2015; 57:201-12. [PMID: 25648795 DOI: 10.1016/j.rx.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 01/29/2023]
Abstract
Cardiac magnetic resonance imaging (MRI) is an important tool that makes it possible to evaluate patients with cardiovascular disease; in addition to infarction and alterations in myocardial perfusion, cardiac MRI is useful for evaluating other phenomena such as microvascular obstruction and ischemia. The main prognostic factors in cardiac MRI are ventricular dysfunction, necrosis in late enhancement sequences, and ischemia in stress sequences. In acute myocardial infarction, cardiac MRI can evaluate the peri-infarct zone and quantify the size of the infarct. Furthermore, cardiac MRI's ability to detect and evaluate microvascular obstruction makes it a fundamental tool for establishing the prognosis of ischemic heart disease. In patients with chronic ischemic heart disease, cardiac MRI can detect ischemia induced by pharmacological stress and can diagnose infarcts that can be missed on other techniques.
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Affiliation(s)
- A Hidalgo
- Sección de Radiología Cardiotorácica. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
| | - G Pons-Lladó
- Unidad de Imagen Cardíaca, Departamento de Cardiología, Universitat Autònoma de Barcelona, Barcelona, España
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24
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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25
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Lu X, Xia R, Zhang B, Gao F. MRI tracking stem cells transplantation for coronary heart disease. Pak J Med Sci 2014; 30:899-903. [PMID: 25097541 PMCID: PMC4121722 DOI: 10.12669/pjms.304.4936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/14/2014] [Accepted: 04/02/2014] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular disease is the leading cause of mortality worldwide. Stem cell transplantation has become a new treatment option for cardiovascular disease because the stem cells are able to migrate to damaged cardiac tissue, repair the myocardial infarction area and ultimately reduce the role of the infarct-related mortality. Cardiac magnetic resonance imaging (MRI) is a new robust non-invasive imaging technique that can detect anatomical information and myocardial dysfunction, study the mechanism of stem cells therapy with superb spatial/temporal resolution, relatively safe contrast material and lack of radiation. This review describes the advantages and disadvantages of cardiac MRI applied in stem cells transplantation and discusses how to translate this technique into clinical therapy. Sources of Data/Study Selection: Data from cross-sectional and prospective studies published between the years 2001-2013 on the topic were included. Data searches included both human and animal studies. Data Extraction: The data was extracted from online resources of statistic reports, Pub med, THE MEDLINE, Google Scholar, Medical and Radiological journals. Conclusion: MRI is an appealing technique for cell trafficking depicting engraftment, differentiation and survival.
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Affiliation(s)
- Xi Lu
- Xi Lu, Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, No.1, Ke Yuan Road 4, Gao Xin District, Chengdu, 610041, Sichuan, China
| | - Rui Xia
- Rui Xia, Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, No.1, Ke Yuan Road 4, Gao Xin District, Chengdu, 610041, Sichuan, China
| | - Bing Zhang
- Bing Zhang, Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, No.1, Ke Yuan Road 4, Gao Xin District, Chengdu, 610041, Sichuan, China
| | - Fabao Gao
- Fabao Gao, Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, No.1, Ke Yuan Road 4, Gao Xin District, Chengdu, 610041, Sichuan, China
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Kandler D, Lücke C, Grothoff M, Andres C, Lehmkuhl L, Nitzsche S, Riese F, Mende M, de Waha S, Desch S, Lurz P, Eitel I, Gutberlet M. The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging. Eur Radiol 2014; 24:3277-88. [PMID: 25097126 PMCID: PMC4231283 DOI: 10.1007/s00330-014-3318-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 06/19/2014] [Accepted: 07/04/2014] [Indexed: 01/08/2023]
Abstract
Background Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development. Methods and results A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2*-weighted sequences to detect IMH. IMH+/IMH− patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH+, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often. Conclusions IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2* imaging might be the preferred CMR imaging method for comprehensive IMH assessment. Key Points • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction. • T2*imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage. • Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.
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Affiliation(s)
- Diana Kandler
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Strümpellstraße 39, 04289, Leipzig, Germany
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Ekeløf S, Rosenberg J, Jensen JS, Gögenur I. Pharmacological attenuation of myocardial reperfusion injury in a closed-chest porcine model: a systematic review. J Cardiovasc Transl Res 2014; 7:570-80. [PMID: 25004991 DOI: 10.1007/s12265-014-9574-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022]
Abstract
Myocardial ischemia-reperfusion injury is a clinical challenge in interventional cardiology, and at the moment, no pharmacological agent is universally accepted in the prevention. In order to prevent inappropriate clinical trials, a potential pharmacological agent should be proved reproducibly effective in clinically relevant experimental studies before initiation of human studies. The closed-chest porcine model is a promising experimental model of ischemia-reperfusion injury. The purpose of this systematic review was to describe the pharmacological treatments evaluated in the closed-chest porcine model and discuss different aspects of the model for future use. The systematic review was performed according to the PRISMA guidelines.
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Affiliation(s)
- Sarah Ekeløf
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark,
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28
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome. World J Cardiol 2014; 6:405-414. [PMID: 24976912 PMCID: PMC4072830 DOI: 10.4330/wjc.v6.i6.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/10/2014] [Accepted: 04/19/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
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29
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Edema and fibrosis imaging by cardiovascular magnetic resonance: how can the experience of Cardiology be best utilized in rheumatological practice? Semin Arthritis Rheum 2014; 44:76-85. [PMID: 24582213 DOI: 10.1016/j.semarthrit.2014.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/19/2013] [Accepted: 01/17/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES CMR, a non-invasive, non-radiating technique can detect myocardial oedema and fibrosis. METHOD CMR imaging, using T2-weighted and T1-weighted gadolinium enhanced images, has been successfully used in Cardiology to detect myocarditis, myocardial infarction and various cardiomyopathies. RESULTS Transmitting this experience from Cardiology into Rheumatology may be of important value because: (a) heart involvement with atypical clinical presentation is common in autoimmune connective tissue diseases (CTDs). (b) CMR can reliably and reproducibly detect early myocardial tissue changes. (c) CMR can identify disease acuity and detect various patterns of heart involvement in CTDs, including myocarditis, myocardial infarction and diffuse vasculitis. (d) CMR can assess heart lesion severity and aid therapeutic decisions in CTDs. CONCLUSION The CMR experience, transferred from Cardiology into Rheumatology, may facilitate early and accurate diagnosis of heart involvement in these diseases and potentially targeted heart treatment.
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Corocoran DS, Lee MMY, Berry C. Cardiac magnetic resonance imaging: the new reference method for infarct characterization and prognostication after myocardial infarction? Eur Heart J Cardiovasc Imaging 2013; 15:130-2. [DOI: 10.1093/ehjci/jet201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Imazio M, Brucato A, Barbieri A, Ferroni F, Maestroni S, Ligabue G, Chinaglia A, Cumetti D, Della Casa G, Bonomi F, Mantovani F, Di Corato P, Lugli R, Faletti R, Leuzzi S, Bonamini R, Modena MG, Belli R. Good prognosis for pericarditis with and without myocardial involvement: results from a multicenter, prospective cohort study. Circulation 2013; 128:42-9. [PMID: 23709669 DOI: 10.1161/circulationaha.113.001531] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The natural history of myopericarditis/perimyocarditis is poorly known, and recently published studies have presented contrasting data on their outcomes. The aim of the present article is to assess the prognosis of myopericarditis/perimyocarditis in a multicenter, prospective cohort study. METHODS AND RESULTS A total of 486 patients (median age, 39 years; range, 18-83 years; 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis; 85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of 2 of 4 clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atypical ECG changes for pericarditis, arrhythmias, and cardiac troponin elevation or new or worsening ventricular dysfunction on echocardiography and confirmed by cardiac magnetic resonance. After a median follow-up of 36 months, normalization of left ventricular function was achieved in >90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, as well as evolution to heart failure or symptomatic left ventricular dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up and were recorded more frequently in patients with acute pericarditis (32%) than in those with myopericarditis (11%) or perimyocarditis (12%; P<0.001). Troponin elevation was not associated with an increase in complications. CONCLUSIONS The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation is not a negative prognostic marker in this setting.
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Affiliation(s)
- Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, Via Luigi Cibrario 72, 10141 Torino, Italy.
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