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Milasinovic D, Tesic M, Nedeljkovic Arsenovic O, Maksimovic R, Sobic Saranovic D, Jelic D, Zivkovic M, Dedovic V, Juricic S, Mehmedbegovic Z, Petrovic O, Trifunovic Zamaklar D, Djordjevic Dikic A, Giga V, Boskovic N, Klaric M, Zaharijev S, Travica L, Dukic D, Mladenovic D, Asanin M, Stankovic G. Correlation of Non-Invasive Transthoracic Doppler Echocardiography with Invasive Doppler Wire-Derived Coronary Flow Reserve and Their Impact on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. J Clin Med 2024; 13:2484. [PMID: 38731013 PMCID: PMC11084315 DOI: 10.3390/jcm13092484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Coronary microvascular dysfunction is associated with adverse prognosis after ST-segment elevation myocardial infarction (STEMI). We aimed to compare the invasive, Doppler wire-based coronary flow reserve (CFR) with the non-invasive transthoracic Doppler echocardiography (TTDE)-derived CFR, and their ability to predict infarct size. Methods: We included 36 patients with invasive Doppler wire assessment on days 3-7 after STEMI treated with primary percutaneous coronary intervention (PCI), of which TTDE-derived CFR was measured in 47 vessels (29 patients) within 6 h of the invasive Doppler. Infarct size was assessed by cardiac magnetic resonance at a median of 8 months. Results: The correlation between invasive and non-invasive CFR was modest in the overall cohort (rho 0.400, p = 0.005). It improved when only measurements in the LAD artery were considered (rho 0.554, p = 0.002), with no significant correlation in the RCA artery (rho -0.190, p = 0.435). Both invasive (AUC 0.888) and non-invasive (AUC 0.868) CFR, measured in the recanalized culprit artery, showed a good ability to predict infarct sizes ≥18% of the left ventricular mass, with the optimal cut off values of 1.85 and 1.80, respectively. Conclusions: In patients with STEMI, TTDE- and Doppler wire-derived CFR exhibit significant correlation, when measured in the LAD artery, and both have a similarly strong association with the final infarct size.
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Affiliation(s)
- Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Milorad Tesic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragana Sobic Saranovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dario Jelic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Milorad Zivkovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Vladimir Dedovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Stefan Juricic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Zlatko Mehmedbegovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Olga Petrovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Danijela Trifunovic Zamaklar
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Ana Djordjevic Dikic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Vojislav Giga
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Nikola Boskovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Marija Klaric
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Stefan Zaharijev
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Lazar Travica
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Djordje Dukic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Djordje Mladenovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Milika Asanin
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
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Ellis SG, Alencherry B, Ziada K. Prestent Hyperemic, Not Resting, Coronary Flow Indexes Correlate With Improvement in Left Ventricular Systolic Function. JACC Cardiovasc Interv 2024; 17:955-957. [PMID: 38599705 DOI: 10.1016/j.jcin.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/12/2024]
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Zarà M, Baggiano A, Amadio P, Campodonico J, Gili S, Annoni A, De Dona G, Carerj ML, Cilia F, Formenti A, Fusini L, Banfi C, Gripari P, Tedesco CC, Mancini ME, Chiesa M, Maragna R, Marchetti F, Penso M, Tassetti L, Volpe A, Bonomi A, Marenzi G, Pontone G, Barbieri SS. Circulating Small Extracellular Vesicles Reflect the Severity of Myocardial Damage in STEMI Patients. Biomolecules 2023; 13:1470. [PMID: 37892152 PMCID: PMC10605123 DOI: 10.3390/biom13101470] [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: 08/03/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Circulating small extracellular vesicles (sEVs) contribute to inflammation, coagulation and vascular injury, and have great potential as diagnostic markers of disease. The ability of sEVs to reflect myocardial damage assessed by Cardiac Magnetic Resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) is unknown. To fill this gap, plasma sEVs were isolated from 42 STEMI patients treated by primary percutaneous coronary intervention (pPCI) and evaluated by CMR between days 3 and 6. Nanoparticle tracking analysis showed that sEVs were greater in patients with anterior STEMI (p = 0.0001), with the culprit lesion located in LAD (p = 0.045), and in those who underwent late revascularization (p = 0.038). A smaller sEV size was observed in patients with a low myocardial salvage index (MSI, p = 0.014). Patients with microvascular obstruction (MVO) had smaller sEVs (p < 0.002) and lower expression of the platelet marker CD41-CD61 (p = 0.039). sEV size and CD41-CD61 expression were independent predictors of MVO/MSI (OR [95% CI]: 0.93 [0.87-0.98] and 0.04 [0-0.61], respectively). In conclusion, we provide evidence that the CD41-CD61 expression in sEVs reflects the CMR-assessed ischemic damage after STEMI. This finding paves the way for the development of a new strategy for the timely identification of high-risk patients and their treatment optimization.
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Affiliation(s)
- Marta Zarà
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Patrizia Amadio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Sebastiano Gili
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Andrea Annoni
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Gianluca De Dona
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | | | - Francesco Cilia
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Alberto Formenti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20156 Milan, Italy
| | - Cristina Banfi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | | | | | - Mattia Chiesa
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Francesca Marchetti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Marco Penso
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Luigi Tassetti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Alessandra Volpe
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Goh FQ, Sia CH, Chan MY, Yeo LL, Tan BY. What's the optimal duration of anticoagulation in patients with left ventricular thrombus? Expert Rev Cardiovasc Ther 2023; 21:947-961. [PMID: 37830297 DOI: 10.1080/14779072.2023.2270906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Left ventricular thrombus (LVT) occurs in acute myocardial infarction and in ischemic and non-ischemic cardiomyopathies. LVT may result in embolic stroke. Currently, the duration of anticoagulation for LVT is unclear. This is an important clinical question as prolonged anticoagulation is associated with increased bleeding risks, while premature discontinuation may result in embolic complications. AREAS COVERED There are no randomized trial data regarding anticoagulation duration for LVT. Guidelines and expert consensus recommend anticoagulation for 3-6 months with cessation of anticoagulation if interval imaging demonstrates thrombus resolution. Cardiac magnetic resonance imaging (CMR) is more sensitive and specific compared to echocardiography for LVT detection, and may be appropriate for high-risk patients. Prolonged anticoagulation may be considered in unresolved protuberant or mobile LVT, and in patients with resolved LVT but persistent depressed left ventricular ejection fraction and/or myocardial akinesia or dyskinesia. EXPERT OPINION CMR will likely be increasingly used for LVT surveillance to guide anticoagulation duration. Further research is needed to determine which patients with persistent LVT on CMR benefit from prolonged anticoagulation.
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Affiliation(s)
- Fang Qin Goh
- Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
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Milasinovic D, Nedeljkovic O, Maksimovic R, Sobic-Saranovic D, Dukic D, Zobenica V, Jelic D, Zivkovic M, Dedovic V, Stankovic S, Asanin M, Vukcevic V. Coronary Microcirculation: The Next Frontier in the Management of STEMI. J Clin Med 2023; 12:jcm12041602. [PMID: 36836137 PMCID: PMC9962942 DOI: 10.3390/jcm12041602] [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: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Although the widespread adoption of timely invasive reperfusion strategies over the last two decades has significantly improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI), up to half of patients after angiographically successful primary percutaneous coronary intervention (PCI) still have signs of inadequate reperfusion at the level of coronary microcirculation. This phenomenon, termed coronary microvascular dysfunction (CMD), has been associated with impaired prognosis. The aim of the present review is to describe the collected evidence on the occurrence of CMD following primary PCI, means of assessment and its association with the infarct size and clinical outcomes. Therefore, the practical role of invasive assessment of CMD in the catheterization laboratory, at the end of primary PCI, is emphasized, with an overview of available technologies including thermodilution- and Doppler-based methods, as well as recently developing functional coronary angiography. In this regard, we review the conceptual background and the prognostic value of coronary flow reserve (CFR), index of microcirculatory resistance (IMR), hyperemic microvascular resistance (HMR), pressure at zero flow (PzF) and angiography-derived IMR. Finally, the so-far investigated therapeutic strategies targeting coronary microcirculation after STEMI are revisited.
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Affiliation(s)
- Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: (D.M.); (V.V.); Tel.: +381-3613653 (V.V.)
| | - Olga Nedeljkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragana Sobic-Saranovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Djordje Dukic
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Vladimir Zobenica
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Dario Jelic
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Milorad Zivkovic
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Vladimir Dedovic
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Milika Asanin
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vladan Vukcevic
- Department of Cardiology, University Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: (D.M.); (V.V.); Tel.: +381-3613653 (V.V.)
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Rehan R, Yong A, Ng M, Weaver J, Puranik R. Coronary microvascular dysfunction: A review of recent progress and clinical implications. Front Cardiovasc Med 2023; 10:1111721. [PMID: 36776251 PMCID: PMC9908997 DOI: 10.3389/fcvm.2023.1111721] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
The coronary microcirculation plays a cardinal role in regulating coronary blood flow to meet the changing metabolic demands of the myocardium. Coronary microvascular dysfunction (CMD) refers to structural and functional remodeling of the coronary microcirculation. CMD plays a role in the pathogenesis of obstructive and non-obstructive coronary syndromes as well as myocardial diseases, including heart failure with preserved ejection fraction (HFpEF). Despite recent diagnostic advancements, CMD is often under-appreciated in clinical practice, and may allow for the development of novel therapeutic targets. This review explores the diagnosis and pathogenic role of CMD across a range of cardiovascular diseases, its prognostic significance, and the current therapeutic landscape.
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Affiliation(s)
- Rajan Rehan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Department of Cardiology, Concord Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Andy Yong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Martin Ng
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - James Weaver
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia,*Correspondence: Rajesh Puranik,
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van Lavieren MA, Stegehuis VE, Bax M, Echavarría-Pinto M, Wijntjens GWM, de Winter RJ, Koch KT, Henriques JP, Escaned J, Meuwissen M, van de Hoef TP, Piek JJ. Time course of coronary flow capacity impairment in ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:516–522. [PMID: 32450714 PMCID: PMC8248849 DOI: 10.1177/2048872620918706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Microvascular dysfunction in the setting of ST-elevated myocardial infarction (STEMI) plays an important role in long-term poor clinical outcome. Coronary flow reserve (CFR) is a well-established physiological parameter to interrogate the coronary microcirculation. Together with hyperaemic average peak flow velocity, CFR constitutes the coronary flow capacity (CFC), a validated risk stratification tool in ischaemic heart disease with significant prognostic value. This mechanistic study aims to elucidate the time course of the microcirculation as reflected by alterations in microcirculatory physiological parameters in the acute phase and during follow-up in STEMI patients. METHODS We assessed CFR and CFC in the culprit and non-culprit vessel in consecutive STEMI patients at baseline (n = 98) and after one-week (n = 64) and six-month follow-up (n = 65). RESULTS A significant trend for culprit CFC in infarct size as determined by peak troponin T (p = 0.004), time to reperfusion (p = 0.038), the incidence of final Thrombolysis In Myocardial Infarction 3 flow (p = 0.019) and systolic retrograde flow (p = 0.043) was observed. Non-culprit CFC linear contrast analysis revealed a significant trend in C-reactive protein (p = 0.027), peak troponin T (p < 0.001) and heart rate (p = 0.049). CFC improved both in the culprit and the non-culprit vessel at one-week (both p < 0.001) and six-month follow-up (p = 0.0013 and p < 0.001) compared with baseline. CONCLUSION This study demonstrates the importance of microcirculatory disturbances in the setting of STEMI, which is relevant for the interpretation of intracoronary diagnostic techniques which are influenced by both culprit and non-culprit vascular territories. Assessment of non-culprit vessel CFC in the setting of STEMI might improve risk stratification of these patients following coronary reperfusion of the culprit vessel.
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Affiliation(s)
- Martijn A van Lavieren
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Valérie E Stegehuis
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Matthijs Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mauro Echavarría-Pinto
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
- Cardiovascular institute, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Autonomous University of Queretaro, Mexico
| | - Gilbert W M Wijntjens
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Robbert J de Winter
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Karel T Koch
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - José P Henriques
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Javier Escaned
- Cardiovascular institute, Hospital Clínico San Carlos, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Spain
| | | | - Tim P van de Hoef
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Jan J Piek
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
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Niccoli G, Morrone D, De Rosa S, Montone RA, Polimeni A, Aimo A, Mancone M, Muscoli S, Pedrinelli R, Indolfi C. The central role of invasive functional coronary assessment for patients with ischemic heart disease. Int J Cardiol 2021; 331:17-25. [PMID: 33529656 DOI: 10.1016/j.ijcard.2021.01.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Giampaolo Niccoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Medicine, University of Parma, Parma, Italy.
| | - Doralisa Morrone
- Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Polimeni
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Alberto Aimo
- Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Saverio Muscoli
- Department of Medicine, 'Tor Vergata' University of Rome, Rome, Italy
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
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D. Clarke JR, Kennedy R, Duarte Lau F, I. Lancaster G, W. Zarich S. Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance. J Clin Med 2019; 9:jcm9010086. [PMID: 31905738 PMCID: PMC7019371 DOI: 10.3390/jcm9010086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 01/10/2023] Open
Abstract
Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel. However, microvascular consequences after reperfusion, such as microvascular obstruction (MVO), are equally reliable predictors of outcome. The attention on the microcirculation has meant that traditional angiographic/anatomic methods are insufficient. We searched PubMed and the Cochrane database for English-language studies published between January 2000 and November 2019 that investigated the use of invasive physiologic tools in AMI. Based on these results, we provide a comprehensive review regarding the role for the invasive evaluation of the microcirculation in AMI, with specific emphasis on coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR).
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Affiliation(s)
- John-Ross D. Clarke
- Department of Internal Medicine, Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT 06610, USA;
- Correspondence: ; Tel.: +1-203-260-4510
| | - Randol Kennedy
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH 44115, USA;
| | - Freddy Duarte Lau
- Department of Internal Medicine, Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT 06610, USA;
| | - Gilead I. Lancaster
- The Heart and Vascular Institute, Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT 06610, USA; (G.I.L.); (S.W.Z.)
| | - Stuart W. Zarich
- The Heart and Vascular Institute, Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT 06610, USA; (G.I.L.); (S.W.Z.)
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10
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Claessen BE, Cao D, Mehran R. Minding the Microcirculation: Is it Worth the Effort? Circ Cardiovasc Interv 2019; 12:e008312. [PMID: 31525079 DOI: 10.1161/circinterventions.119.008312] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (B.E.C., D.C., R.M.)
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (B.E.C., D.C., R.M.).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (D.C.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (B.E.C., D.C., R.M.)
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Tanzilli G, Truscelli G, Arrivi A, Carnevale R, Placanica A, Viceconte N, Raparelli V, Mele R, Cammisotto V, Nocella C, Barillà F, Lucisano L, Pennacchi M, Granatelli A, Dominici M, Basili S, Gaudio C, Mangieri E. Glutathione infusion before primary percutaneous coronary intervention: a randomised controlled pilot study. BMJ Open 2019; 9:e025884. [PMID: 31399448 PMCID: PMC6701599 DOI: 10.1136/bmjopen-2018-025884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE In the setting of reperfused ST-elevation myocardial infarction (STEMI), increased production of reactive oxygen species (ROS) contributes to reperfusion injury. Among ROS, hydrogen peroxide (H2O2) showed toxic effects on human cardiomyocytes and may induce microcirculatory impairment. Glutathione (GSH) is a water-soluble tripeptide with a potent oxidant scavenging activity. We hypothesised that the infusion of GSH before acute reoxygenation might counteract the deleterious effects of increased H2O2 generation on myocardium. METHODS Fifty consecutive patients with STEMI, scheduled to undergo primary angioplasty, were randomly assigned, before intervention, to receive an infusion of GSH (2500 mg/25 mL over 10 min), followed by drug administration at the same doses at 24, 48 and 72 hours elapsing time or placebo. Peripheral blood samples were obtained before and at the end of the procedure, as well as after 5 days. H2O2 production, 8-iso-prostaglandin F2α (PGF2α) formation, H2O2 breakdown activity (HBA) and nitric oxide (NO) bioavailability were determined. Serum cardiactroponin T (cTpT) was measured at admission and up to 5 days. RESULTS Following acute reperfusion, a significant reduction of H2O2 production (p=0.0015) and 8-iso-PGF2α levels (p=0.0003), as well as a significant increase in HBA (p<0.0001)and NO bioavailability (p=0.035), was found in the GSH group as compared with placebo. In treated patients, attenuated production of H2O2 persisted up to 5 days from the index procedure (p=0.009) and these changes was linked to those of the cTpT levels (r=0.41, p=0.023). CONCLUSION The prophylactic and prolonged infusion of GSH seems to determine a rapid onset and persistent blunting of H2O2 generation improving myocardial cell survival. Nevertheless, a larger trial, adequately powered for evaluation of clinical endpoints, is ongoing to confirm the current finding. TRIAL REGISTRATION NUMBER EUDRACT 2014-00448625; Pre-results.
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Affiliation(s)
- Gaetano Tanzilli
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Giovanni Truscelli
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Alessio Arrivi
- Department of Cardiology, "Santa Maria" Hospital, Terni, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Attilio Placanica
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | - Nicola Viceconte
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rita Mele
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammisotto
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Cristina Nocella
- Internal Medicine and Medical Specialties, Sapienza University of Rome
| | - Francesco Barillà
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Luigi Lucisano
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | - Mauro Pennacchi
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | - Antonino Granatelli
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | | | - Stefania Basili
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Gaudio
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Enrico Mangieri
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
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12
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Montisci R, Ruscazio M, Tona F, Corbetti F, Sarais C, Marchetti MF, Cacciavillani L, Iliceto S, Perazzolo Marra M, Meloni L. Coronary flow reserve is related to the extension and transmurality of myocardial necrosis and predicts functional recovery after acute myocardial infarction. Echocardiography 2019; 36:844-853. [PMID: 31002185 DOI: 10.1111/echo.14337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Few studies have examined the effect of transmurality of myocardial necrosis on coronary microcirculation. The aim of this study was to examine the influence of cardiac magnetic resonance-derived (GE-MRI) structural determinants of coronary flow reserve (CFR) after anterior myocardial infarction (STEMI), and their predictive value on regional functional recovery. METHODS Noninvasive CFR and GE-MRI were studied in 37 anterior STEMI patients after primary coronary angioplasty. The wall motion score index in the left descending anterior coronary artery territory (A-WMSI) was calculated at admission and follow-up (FU). Recovery of regional left ventricular (LV) function was defined as the difference in A-WMSI at admission and FU. The necrosis score index (NSI) and transmurality score index (TSI) by GE-MRI were calculated in the risk area. Baseline (BMR) and hyperemic (HMR) microvascular resistance, arteriolar resistance index (ARI), and coronary resistance reserve (CRR) were calculated at the Doppler echocardiography. RESULTS Bivariate analysis indicated that the CPK and troponin I peak, heart rate, NSI, TSI, BMR, the ARI, and CRR were related to CFR. Multivariable analysis revealed that TSI was the only independent determinant of CFR. The CFR value of >2.27, identified as optimal by ROC analysis, was 77% specific and 73% sensitive with accuracy of 76% in identifying patients with functional recovery. CONCLUSIONS Preservation of microvascular function after AMI is related to the extent of transmurality of myocardial necrosis, is an important factor influencing regional LV recovery, and can be monitored by noninvasive CFR.
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Affiliation(s)
- Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Massimo Ruscazio
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesco Tona
- Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Cristiano Sarais
- Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Maria Francesca Marchetti
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Luisa Cacciavillani
- Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Martina Perazzolo Marra
- Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Luigi Meloni
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
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13
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Effect of Erythropoietin Administration on Myocardial Viability and Coronary Microvascular Dysfunction in Anterior Acute Myocardial Infarction: Randomized Controlled Trial in the Japanese Population. Cardiol Ther 2018; 7:151-162. [PMID: 30353280 PMCID: PMC6251819 DOI: 10.1007/s40119-018-0122-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction Cardioprotective effects of erythropoietin (EPO) on infarcted myocardium in acute myocardial infarction (AMI) patients have been inconclusive. This study aimed to assess the effect of EPO administration on coronary microvascular dysfunction (CMD) and myocardial viability in anterior AMI. We also evaluated the serial changes in CMD and cardiac remodeling in these patients. Methods Patients with a successful percutaneous coronary intervention (PCI) for the first anterior AMI were randomly assigned to two groups (EPO and control groups), and given single-dose intravenous administration of recombinant human EPO (12,000 IU) or saline after PCI. Delayed-enhanced cardiac magnetic resonance imaging was performed at 1 week after AMI to assess the average of transmural extent of infarction and infarct size. Coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery was measured by Doppler echocardiography at 1 week, 1 month, and 8 months after AMI. All patients underwent clinical follow-up for the assessment of cardiac remodeling. Results Sixty-one patients (EPO 32, control 29) were eligible for analysis. EPO group (2.4 ± 1.2) had a tendency of smaller transmural extent of infarction than that of control group (2.9 ± 1.1; p = 0.063). CFVR-8 months improved significantly in EPO group (2.9 ± 0.6) compared to control group (2.6 ± 0.5; p = 0.04). Left atrial (LA) volume − 8 months was significantly lower in EPO group (47 ± 11) than those of control group (65 ± 20; p = 0.004). Conclusions A single medium dose of EPO could have a favorable effect on CMD and LA remodeling in the chronic phase of anterior AMI. Trial Registration The institutional ethics committee of Wakayama Medical University, identifier, 1125. Electronic supplementary material The online version of this article (10.1007/s40119-018-0122-1) contains supplementary material, which is available to authorized users.
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14
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de Waard GA, van Royen N. Coronary Physiology in the Nonculprit Vessel After Acute Myocardial Infarction: To Go With the Flow or Unexpected Resistance? JACC Cardiovasc Interv 2018; 11:1859-1861. [PMID: 30236359 DOI: 10.1016/j.jcin.2018.07.034] [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: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Guus A de Waard
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands.
| | - Niels van Royen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Hinton J, Mahmoudi M, Myat A, Curzen N. The role of mineralocorticoid receptor antagonists in patients with acute myocardial infarction: Is the evidence reflective of modern clinical practice? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:452-456. [PMID: 29730238 DOI: 10.1016/j.carrev.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/14/2018] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Jonathan Hinton
- Coronary Research Group, Department of Cardiology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Michael Mahmoudi
- Coronary Research Group, Department of Cardiology, University Hospital Southampton, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, UK
| | - Aung Myat
- University of Brighton and Brighton and Sussex Medical School, UK
| | - Nick Curzen
- Coronary Research Group, Department of Cardiology, University Hospital Southampton, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, UK.
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Baeza Garzón F, Pan Álvarez-Ossorio M, Romero Moreno MÁ, Martín Palanco V, Herrera Arroyo C, Suárez de Lezo Cruz Conde J. Reserva coronaria y función ventricular izquierda tras la terapia regenerativa en pacientes con infarto anterior agudo revascularizado. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, Banfi C. Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With STEMI: A Cardiac Magnetic Resonance Study. JACC Cardiovasc Imaging 2018; 12:1007-1017. [PMID: 29680345 DOI: 10.1016/j.jcmg.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to evaluate the correlation between different haptoglobin (Hp) phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR) in consecutive patients after ST-segment elevation myocardial infarction (STEMI). BACKGROUND Hp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE) technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH) in patients with STEMI treated by primary percutaneous coronary intervention (pPCI). METHODS A total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men) were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI. RESULTS CMR showed an area at risk (AAR) involving 26.6 ± 19.1% of left ventricular (LV) mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%) and 12 (8%) patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR) (OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008]) and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]). CONCLUSIONS Hp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.
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Affiliation(s)
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea I Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico" of Bari, Bari, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Fabio Fazzari
- Department of Cardiology, University Hospital P. Giaccone, Palermo, Italy
| | - Claudio Berzovini
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Annalisa Pasquini
- Department of Cardiology, "La Sapienza" University of Rome, Rome, Italy
| | | | | | | | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois; Edward Hines Jr. VA Hospital, Hines, Illinois
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Pavlović M, Djordjević D, Apostolović S, Šalinger S, Perišić Z, Damjanović M, Ćirić - Zdravković S, Živković M, Kostić T, Božinović N. ANGIOGRAPHIC CORRECTED TIMI FRAME COUNT CAN PREDICT LEFT VENTRICULAR REMODEL NG AFTER ACUTE ANTERIOR MYOCARDIAL INFARCTION IN PATIENTS WITH TIMI 3 FLOW IMMEDIATELY AFTER PRIMARY PCI ON PROXIMAL LEFT ANTERIOR DESCENDING CORONARY ARTERY. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gewirtz H. PET measurements of myocardial blood flow post myocardial infarction: Relationship to invasive and cardiac magnetic resonance studies and potential clinical applications. J Nucl Cardiol 2017; 24:1883-1892. [PMID: 28577226 DOI: 10.1007/s12350-017-0930-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023]
Abstract
This review focuses on clinical studies concerning assessment of coronary microvascular and conduit vessel function primarily in the context of acute and sub acute myocardial infarction (MI). The ability of quantitative PET measurements of myocardial blood flow (MBF) to delineate underlying pathophysiology and assist in clinical decision making in this setting is discussed. Likewise, considered are physiological metrics fractional flow reserve, coronary flow reserve, index of microvascular resistance (FFR, CFR, IMR) obtained from invasive studies performed in the cardiac catheterization laboratory, typically at the time of PCI for MI. The role both of invasive studies and cardiac magnetic resonance (CMR) imaging in assessing microvascular function, a key determinant of prognosis, is reviewed. The interface between quantitative PET MBF measurements and underlying pathophysiology, as demonstrated both by invasive and CMR methodology, is discussed in the context of optimal interpretation of the quantitative PET MBF exam and its potential clinical applications.
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Affiliation(s)
- Henry Gewirtz
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Yawkey 5E, 55 Fruit St, Boston, MA, 02114, USA.
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Bulluck H, Foin N, Tan JW, Low AF, Sezer M, Hausenloy DJ. Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand? Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004373. [PMID: 28242607 DOI: 10.1161/circinterventions.116.004373] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
For patients presenting with an acute ST-segment-elevation myocardial infarction, the most effective therapy for reducing myocardial infarct size and preserving left ventricular systolic function is primary percutaneous coronary intervention (PPCI). However, mortality and morbidity remain significant. This is partly attributed to the development of microvascular obstruction, which occurs in around 50% of ST-segment-elevation myocardial infarction patients post-PPCI, and it is associated with adverse left ventricular remodeling and worse clinical outcomes. Although microvascular obstruction can be detected by cardiac imaging techniques several hours post-PPCI, it may be too late to intervene at that time. Therefore, being able to predict the development of microvascular obstruction at the time of PPCI may identify high-risk patients who might benefit from further adjuvant intracoronary therapies, such as thrombolysis, vasodilators, glycoprotein IIb/IIIa inhibitors, and anti-inflammatory agents that may reduce microvascular obstruction. Recent studies have shown that invasive coronary physiology measurements performed during PPCI can be used to assess the coronary microcirculation. In this article, we provide an overview of the various invasive methods currently available to assess the coronary microcirculation in the setting of ST-segment-elevation myocardial infarction, and how they could potentially be used in the future for tailoring therapies to those most at risk.
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Affiliation(s)
- Heerajnarain Bulluck
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Nicolas Foin
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Jack W Tan
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Adrian F Low
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Murat Sezer
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
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Baeza Garzón F, Pan Álvarez-Ossorio M, Romero Moreno MÁ, Martín Palanco V, Herrera Arroyo C, Suárez de Lezo Cruz Conde J. One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion. A Multicenter Registry. ACTA ACUST UNITED AC 2017; 71:344-350. [PMID: 29097079 DOI: 10.1016/j.rec.2017.07.018] [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: 01/08/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. METHODS Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. RESULTS Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. CONCLUSIONS Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.
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Bravo Baptista S, Faustino M, Brizida L, Loureiro J, Augusto J, Abecasis J, Monteiro C, Leal P, Nédio M, Farto E Abreu P, Gil V, Morais C. Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction. Rev Port Cardiol 2017; 36:731-742. [PMID: 29033166 DOI: 10.1016/j.repc.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. METHODS ED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI <1.67. Infarct extension was assessed by troponin I (TnI) release and contrast-enhanced cardiac magnetic resonance (ceCMR). MVO was assessed by ceCMR and by indirect angiographic and ECG indicators. An echocardiogram was also performed in the first 12 h. RESULTS We included 38 patients (mean age 60.0±13.7 years, 29 male). Mean RHI was 1.87±0.60 and 16 patients (42.1%) had ED. Peak TnI (median 118 mg/dl, IQR 186 vs. 67/81, p=0.024) and AUC of TnI (median 2305, IQR 2486 vs. 1076/1042, p=0.012) were significantly higher in patients with ED, who also showed a trend for more transmural infarcts (63.6% vs. 22.2%, p=0.06) and larger infarct mass on ceCMR (median 17.5%, IQR 15.4 vs. 10.1/10.3, p=0.08). Left ventricular ejection fraction (LVEF) was lower and wall motion score index (WMSI) was higher on both echocardiogram and ceCMR in patients with ED. On ceCMR, MVO was more frequent in patients with RHI <1.67 (54.5% vs. 11.1%, p=0.03). ECG and angiographic indicators of MVO all showed a trend toward worse results in these patients. CONCLUSIONS The presence of ED assessed by PAT 24 h after P-PCI in patients with STEMI is associated with larger infarcts, lower LVEF, higher WMSI and higher prevalence of MVO.
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Affiliation(s)
| | | | - Luís Brizida
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - José Loureiro
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - João Augusto
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | | | - Célia Monteiro
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paulo Leal
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - Maura Nédio
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | | | - Victor Gil
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal; Hospital dos Lusíadas, Lisboa, Portugal
| | - Carlos Morais
- Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
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Bravo Baptista S, Faustino M, Brizida L, Loureiro J, Augusto J, Abecasis J, Monteiro C, Leal P, Nédio M, Farto e Abreu P, Gil V, Morais C. Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cuenin L, Lamoureux S, Schaaf M, Bochaton T, Monassier JP, Claeys MJ, Rioufol G, Finet G, Garcia-Dorado D, Angoulvant D, Elbaz M, Delarche N, Coste P, Metge M, Perret T, Motreff P, Bonnefoy-Cudraz E, Vanzetto G, Morel O, Boussaha I, Ovize M, Mewton N. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction - Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year. Circ J 2017; 82:1379-1386. [PMID: 28943533 DOI: 10.1253/circj.cj-17-0671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. CONCLUSIONS Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.
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Affiliation(s)
- Léo Cuenin
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | - Mathieu Schaaf
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Thomas Bochaton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Gilles Rioufol
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Gérard Finet
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Meyer Elbaz
- Centre Hospitalier Universitaire de Rangueil
| | | | | | | | | | | | | | | | | | - Inesse Boussaha
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Michel Ovize
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
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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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Hassell M, Bax M, van Lavieren M, Nijveldt R, Hirsch A, Robbers L, Marques K, Tijssen J, Zijlstra F, van Rossum A, Delewi R, Piek J. Microvascular dysfunction following ST-elevation myocardial infarction and its recovery over time. EUROINTERVENTION 2017; 13:e578-e584. [DOI: 10.4244/eij-d-16-00818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Montone RA, Niccoli G, Minelli S, Fracassi F, Vetrugno V, Aurigemma C, Burzotta F, Porto I, Trani C, Crea F. Clinical outcome and correlates of coronary microvascular obstruction in latecomers after acute myocardial infarction. Int J Cardiol 2017; 236:30-35. [DOI: 10.1016/j.ijcard.2017.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/03/2017] [Indexed: 12/20/2022]
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Comprehensive assessment of microcirculation after primary percutaneous intervention in ST-segment elevation myocardial infarction: insight from thermodilution-derived index of microcirculatory resistance and coronary flow reserve. Coron Artery Dis 2016; 27:34-9. [PMID: 26492628 PMCID: PMC4885592 DOI: 10.1097/mca.0000000000000310] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives A pathophysiological mechanism of microvascular dysfunction in ST-segment elevation myocardial infarction (STEMI) is multifactorial; thus, multiple modalities were needed to precisely evaluate a microcirculation. Methods We complementarily assessed microcirculation in STEMI by the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) immediately after a primary percutaneous intervention in 89 STEMI patients. Cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, target vessel failure, heart failure, and stroke were assessed during a mean follow-up period of 3.0 years. Results The microcirculation of enrolled patients was classified into four groups using cutoff CFR and IMR values (CFR>2 and mean IMR): group-1 (n=23, CFR>2 and IMR≤27); group-2 (n=31, CFR≤2 and IMR≤27); group-3 (n=9, CFR>2 and IMR>27); and group-4 (n=26, CFR<2 and IMR>27). On echocardiography 3 months later, improvement in the wall motion score index was shown in group-1 (P<0.01), group-2 (P<0.01), and group-3 (P=0.04), whereas group-4 did not show improvement in wall motion score index (P=0.06). During clinical follow-up, there were no MACCE in group-1 and the patients in group-2 and group-3 showed significantly lower MACCE compared with group-4 (group-1=0%, group-2, and group-3=10%, group-4=23.1%, P=0.04). Conclusion Complimentary assessment of microcirculation by the IMR and CFR may be useful to evaluate myocardial viability and the long-term prognosis of STEMI patients.
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Faustino M, Baptista SB, Freitas A, Monteiro C, Leal P, Nédio M, Antunes C, Farto e Abreu P, Gil V, Morais C. The Index of Microcirculatory Resistance as a Predictor of Echocardiographic Left Ventricular Performance Recovery in Patients With ST-Elevation Acute Myocardial Infarction Undergoing Successful Primary Angioplasty. J Interv Cardiol 2016; 29:137-45. [PMID: 26927606 DOI: 10.1111/joic.12278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aims to evaluate the relationship between IMR (Index of Microcirculatory Resistance) and the echocardiographic evolution of left ventricular (LV) systolic and diastolic performance after ST-elevation acute myocardial infarction (STEMI), undergoing primary angioplasty (P-PCI). METHODS IMR was evaluated immediately after P-PCI. Echocardiograms were performed within the first 24 hours (Echo1) and at 3 months (Echo2): LV volumes, ejection fraction (LVEF), wall motion score index (WMSI), E/é ratio, global longitudinal strain (GLS), and left atrial volume were measured. RESULTS Forty STEMI patients were divided in 2 groups according to median IMR: Group 1 (IMR < 26), with less microvascular dysfunction, and Group 2 (IMR > = 26), with more microvascular dysfunction. In Echo1 GLS was significantly better in Group 1 (-14.9 vs. -12.9 in Group 2, P = 0.005). However, there were no significant differences between the two groups in LV systolic volume, LVEF and WMS. Between Echo1 and Echo2, there were significant improvements in LVEF (0.48 ± 0.06 vs. 0.55 ± 0.06, P < 0.0001), GLS (-14.9 ± 1.3 vs. -17.3 ± 7.6, P = 0.001), and E/é ratio (9.3 ± 3.4 vs. 8.2 ± 2.0, P = 0.037) in Group 1, but not in Group 2: LVEF (0.49 ± 0.06 vs. 0.50 ± 0.05, P = 0.47), GLS (-12.9 ± 2.4 vs. -14.4 ± 3.2, P = 0.052), and E/é ratio (8.8 ± 2.4 vs. 10.0 ± 4.7, P = 0.18). WMSI improved significantly more in Group 1 (reduction of -17.1% vs. -6.8% in Group 2, P = 0.015). CONCLUSION Lower IMR was associated with better myocardial GLS acutely after STEMI, and with a significantly higher recovery of the LVEF, WMSI, E/E' ratio and GLS, suggesting that IMR is an early marker of cardiac recovery, after acute myocardial infarction.
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Affiliation(s)
- Mariana Faustino
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Sérgio Bravo Baptista
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - António Freitas
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Célia Monteiro
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paulo Leal
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Maura Nédio
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Claudia Antunes
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Pedro Farto e Abreu
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Victor Gil
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Carlos Morais
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
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Teunissen PFA, de Waard GA, Hollander MR, Robbers LFHJ, Danad I, Biesbroek PS, Amier RP, Echavarría-Pinto M, Quirós A, Broyd C, Heymans MW, Nijveldt R, Lammertsma AA, Raijmakers PG, Allaart CP, Lemkes JS, Appelman YE, Marques KM, Bronzwaer JGF, Horrevoets AJG, van Rossum AC, Escaned J, Beek AM, Knaapen P, van Royen N. Doppler-derived intracoronary physiology indices predict the occurrence of microvascular injury and microvascular perfusion deficits after angiographically successful primary percutaneous coronary intervention. Circ Cardiovasc Interv 2015; 8:e001786. [PMID: 25717044 DOI: 10.1161/circinterventions.114.001786] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A total of 40% to 50% of patients with ST-segment-elevation myocardial infarction develop microvascular injury (MVI) despite angiographically successful primary percutaneous coronary intervention (PCI). We investigated whether hyperemic microvascular resistance (HMR) immediately after angiographically successful PCI predicts MVI at cardiovascular magnetic resonance and reduced myocardial blood flow at positron emission tomography (PET). METHODS AND RESULTS Sixty patients with ST-segment-elevation myocardial infarction were included in this prospective study. Immediately after successful PCI, intracoronary pressure-flow measurements were performed and analyzed off-line to calculate HMR and indices derived from the pressure-velocity loops, including pressure at zero flow. Cardiovascular magnetic resonance and H2 (15)O PET imaging were performed 4 to 6 days after PCI. Using cardiovascular magnetic resonance, MVI was defined as a subendocardial recess of myocardium with low signal intensity within a gadolinium-enhanced area. Myocardial perfusion was quantified using H2 (15)O PET. Reference HMR values were obtained in 16 stable patients undergoing coronary angiography. Complete data sets were available in 48 patients of which 24 developed MVI. Adequate pressure-velocity loops were obtained in 29 patients. HMR in the culprit artery in patients with MVI was significantly higher than in patients without MVI (MVI, 3.33±1.50 mm Hg/cm per second versus no MVI, 2.41±1.26 mm Hg/cm per second; P=0.03). MVI was associated with higher pressure at zero flow (45.68±13.16 versus 32.01±14.98 mm Hg; P=0.015). Multivariable analysis showed HMR to independently predict MVI (P=0.04). The optimal cutoff value for HMR was 2.5 mm Hg/cm per second. High HMR was associated with decreased myocardial blood flow on PET (myocardial perfusion reserve <2.0, 3.18±1.42 mm Hg/cm per second versus myocardial perfusion reserve ≥2.0, 2.24±1.19 mm Hg/cm per second; P=0.04). CONCLUSIONS Doppler-flow-derived physiological indices of coronary resistance (HMR) and extravascular compression (pressure at zero flow) obtained immediately after successful primary PCI predict MVI and decreased PET myocardial blood flow. CLINICAL TRIAL REGISTRATION URL http://www.trialregister.nl. Unique identifier: NTR3164.
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Affiliation(s)
- Paul F A Teunissen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Guus A de Waard
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Maurits R Hollander
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Lourens F H J Robbers
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Ibrahim Danad
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - P Stefan Biesbroek
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Raquel P Amier
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Mauro Echavarría-Pinto
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Alicia Quirós
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Christopher Broyd
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Martijn W Heymans
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Robin Nijveldt
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Adriaan A Lammertsma
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Pieter G Raijmakers
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Cornelis P Allaart
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Jorrit S Lemkes
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Yolande E Appelman
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Koen M Marques
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Jean G F Bronzwaer
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Anton J G Horrevoets
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Albert C van Rossum
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Javier Escaned
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Aernout M Beek
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Paul Knaapen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Niels van Royen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.).
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Echavarría-Pinto M, Serruys PW, Garcia-Garcia HM, Broyd C, Cerrato E, Macaya C, Escaned J. Use of intracoronary physiology indices in acute coronary syndromes. Interv Cardiol 2015. [DOI: 10.2217/ica.15.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Niccoli G, Scalone G, Lerman A, Crea F. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J 2015; 37:1024-33. [PMID: 26364289 DOI: 10.1093/eurheartj/ehv484] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022] Open
Abstract
The success of a primary percutaneous intervention (PCI) in the setting of ST elevation myocardial infarction depends on the functional and structural integrity of coronary microcirculation. Coronary microvascular dysfunction and obstruction (CMVO) occurs in up to half of patients submitted to apparently successful primary PCI and is associated to a much worse outcome. The current review summarizes the complex mechanisms responsible for CMVO, including pre-existing coronary microvascular dysfunction, and highlights the current limitations in the assessment of microvascular function. More importantly, at the light of the substantial failure of trials hitherto published on the treatment of CMVO, this review proposes a novel integrated therapeutic approach, which should overcome the limitations of previous studies.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Giancarla Scalone
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Amir Lerman
- Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
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Torabi A, Cleland JG, Rigby AS, Sherwi N. Development and course of heart failure after a myocardial infarction in younger and older people. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:1-12. [PMID: 24748875 PMCID: PMC3981977 DOI: 10.3969/j.issn.1671-5411.2014.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/11/2014] [Accepted: 03/18/2014] [Indexed: 12/02/2022]
Abstract
Background Acute myocardial infarction (AMI) is a common cause of heart failure (HF), which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age. Methods Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were categorised into those aged < 65 years, 65–75 years, and > 75 years. Results Of 896 patients, 311, 297 and 288 were aged < 65, 65–75 and >75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 (8%), 68 (23%) and 107 (37%) occurred during the index admission, many associated with acute HF. A further 37 (12%), 63 (21%) and 82 (29%) developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 (24%), 55 (40%) and 37 (47%) patients developed HF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 (70%), 93 (91%) and 107 (85%) in aged < 65 years, 65–75 years and >75 years, respectively. Conclusions The risk of developing HF and of dying after an MI increases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.
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Affiliation(s)
- Azam Torabi
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
| | - John Gf Cleland
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Alan S Rigby
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Nasser Sherwi
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
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Sasi V, Kalapos A, Gavallér H, Domsik P, Ungi T, Zimmermann Z, Nagy FT, Horváth T, Forster T, Nemes A. Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction. Orv Hetil 2014; 155:187-93. [DOI: 10.1556/oh.2014.29799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: It is known that there is a relationship between myocardial perfusion and left ventricular function. Aim: The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function. Method: The study included 25 patients with ST elevation myocardial infarction. A quantitative parameter of myocardial (re)perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) following invasive treatment. Magnetic resonance imaging was performed 387±262 days after ST elevation myocardial infarction for the evaluation of left ventricular function in all cases. Results: Significant correlations were demonstrated between left ventricular ejection fraction and Gmax(r = 0.40, p = 0.05) and Gmax/Tmax(r = 0.41, p = 0.04) following vessel masking. Conclusions: The results demonstrate significant relationship between densitometric Gmax/Tmaxand late left ventricular function following ST elevation myocardial infarction. Orv. Hetil., 2014. 155(5), 187–193.
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Affiliation(s)
- Viktor Sasi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Anita Kalapos
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Henriette Gavallér
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
- Euromedic Diagnostics Szeged Kft. Szeged
| | - Péter Domsik
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Tamás Ungi
- Queen’s University School of Computing Kingston ON Kanada
| | - Zsolt Zimmermann
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Ferenc Tamás Nagy
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Tamás Horváth
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Tamás Forster
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
| | - Attila Nemes
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Invazív Kardiológiai Részleg Szeged Korányi fasor 6. 6720
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Activation of hypoxia response in endothelial cells contributes to ischemic cardioprotection. Mol Cell Biol 2013; 33:3321-9. [PMID: 23775121 DOI: 10.1128/mcb.00432-13] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Small-molecule inhibition of hypoxia-inducible factor prolyl 4-hydroxylases (HIF-P4Hs) is being explored for the treatment of anemia. Previous studies have suggested that HIF-P4H-2 inhibition may also protect the heart from an ischemic insult. Hif-p4h-2(gt/gt) mice, which have 76 to 93% knockdown of Hif-p4h-2 mRNA in endothelial cells, fibroblasts, and cardiomyocytes and normoxic stabilization of Hif-α, were subjected to ligation of the left anterior descending coronary artery (LAD). Hif-p4h-2 deficiency resulted in increased survival, better-preserved left ventricle (LV) systolic function, and a smaller infarct size. Surprisingly, a significantly larger area of the LV remained perfused during LAD ligation in Hif-p4h-2(gt/gt) hearts than in wild-type hearts. However, no difference was observed in collateral vessels, while the size of capillaries, but not their number, was significantly greater in Hif-p4h-2(gt/gt) hearts than in wild-type hearts. Hif-p4h-2(gt/gt) mice showed increased cardiac expression of endothelial Hif target genes for Tie-2, apelin, APJ, and endothelial nitric oxide (NO) synthase (eNOS) and increased serum NO concentrations. Remarkably, blockage of Tie-2 signaling was sufficient to normalize cardiac apelin and APJ expression and resulted in reversal of the enlarged-capillary phenotype and ischemic cardioprotection in Hif-p4h-2(gt/gt) hearts. Activation of the hypoxia response by HIF-P4H-2 inhibition in endothelial cells appears to be a major determinant of ischemic cardioprotection and justifies the exploration of systemic small-molecule HIF-P4H-2 inhibitors for ischemic heart disease.
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van de Hoef TP, Bax M, Meuwissen M, Damman P, Delewi R, de Winter RJ, Koch KT, Schotborgh C, Henriques JP, Tijssen JG, Piek JJ. Impact of Coronary Microvascular Function on Long-term Cardiac Mortality in Patients With Acute ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2013; 6:207-15. [DOI: 10.1161/circinterventions.112.000168] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tim P. van de Hoef
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Matthijs Bax
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Martijn Meuwissen
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Peter Damman
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Ronak Delewi
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Robbert J. de Winter
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Karel T. Koch
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Carl Schotborgh
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - José P.S. Henriques
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan G.P. Tijssen
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan J. Piek
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., P.D., R.D., R.J.d.W., K.T.K., J.P.S.H., J.G.P.T., J.J.P.); Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B., C.S.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
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Yong AS, Fearon WF. Coronary Microvascular Dysfunction After ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2013; 6:201-3. [DOI: 10.1161/circinterventions.113.000462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andy S.C. Yong
- From the Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - William F. Fearon
- From the Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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Amier RP, Teunissen PFA, Marques KM, Knaapen P, van Royen N. Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI. Heart 2013; 100:13-20. [DOI: 10.1136/heartjnl-2013-303832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Knaapen P, van Royen N. Microcirculatory function and left ventricular recovery after STEMI, exploring the hidden territories. Neth Heart J 2013; 21:236-7. [PMID: 23539331 PMCID: PMC3636341 DOI: 10.1007/s12471-013-0402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- P. Knaapen
- Department of Cardiology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands
| | - N. van Royen
- Department of Cardiology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands
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Remmelink M, Sjauw KD, Yong ZY, Haeck JDE, Vis MM, Koch KT, Tijssen JGP, de Winter RJ, Henriques JPS, Piek JJ, Baan J. Coronary microcirculatory dysfunction is associated with left ventricular dysfunction during follow-up after STEMI. Neth Heart J 2013; 21:238-44. [PMID: 23423600 PMCID: PMC3636343 DOI: 10.1007/s12471-013-0382-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronary microvascular resistance is increased after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), which may be related in part to changed left ventricular (LV) dynamics. Therefore we studied the coronary microcirculation in relation to systolic and diastolic LV function after STEMI. METHODS The study cohort consisted of 12 consecutive patients, all treated with primary PCI for a first anterior wall STEMI. At 4 months, we assessed pressure-volume loops. Subsequently, we measured intracoronary pressure and flow velocity and calculated coronary microvascular resistance. Infarct size and LV mass were assessed using magnetic resonance imaging. RESULTS Patients with an impaired systolic LV function due to a larger myocardial infarction showed a higher baseline average peak flow velocity (APV) than the other patients (26 ± 7 versus 17 ± 5 cm/s, p = 0.003, respectively), and showed an impaired variable microvascular resistance index (2.1 ± 1.0 versus 4.1 ± 1.3 mmHg cm(-1)∙s(-1), p = 0.003, respectively). Impaired diastolic relaxation time was inversely correlated with hyperaemic APV (r = -0.56, p = 0.003) and positively correlated with hyperaemic microvascular resistance (r = 0.48, p = 0.01). LV dilatation was associated with a reduced variable microvascular resistance index (r = 0.78, p = 0.006). CONCLUSION A larger anterior myocardial infarction results in impaired LV performance associated with reduced coronary microvascular resistance variability, in particular due to higher coronary blood flow at baseline in these compromised left ventricles.
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Affiliation(s)
- M Remmelink
- Department of Cardiology, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands,
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Juárez-Orozco LE, Glauche J, Alexanderson E, Zeebregts CJ, Boersma HH, Glaudemans AWJM, Dierckx RA, van Veldhuisen DJ, Tio RA, Slart RHJA. Myocardial perfusion reserve in spared myocardium: correlation with infarct size and left ventricular ejection fraction. Eur J Nucl Med Mol Imaging 2013; 40:1148-54. [PMID: 23553081 DOI: 10.1007/s00259-013-2394-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Left ventricular ejection fraction (LVEF) after myocardial infarction is considered to be determined by the size of the infarction and residual function of the spared myocardium. Myocardial perfusion reserve (MPR) has been shown to be a strong prognostic factor in patients with ischaemic heart failure, even stronger than LVEF. In the present study, the interrelationship between MPR, LVEF and infarct size was investigated. METHODS In total, 102 patients with a prior history of myocardial infarction were included. All underwent rest and stress (13)N-ammonia and gated (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) for evaluation of myocardial ischaemia and viability. FDG polar maps were used to determine the size of the infarction. The LVEF was obtained by gated (18)F-FDG PET or another available method within 3 months of the PET scan. MPR was obtained per segment in the spared myocardium. RESULTS The mean age of the subjects was 68 ± 12 years. Global MPR was 1.63 ± 0.51. The mean LVEF was 36 ± 10 % and mean infarct size 23.72 ± 14.8 %. A linear regression model was applied for the analysis considering the LVEF as a dependent variable. All risk factors, mean stress flow, infarct size and MPR were entered as variables. The infarct size (p < 0.001) and MPR (p = 0.04) reached statistical significance. In a multivariate model MPR had a stronger correlation with LVEF than infarct size. CONCLUSION In patients with a prior history of myocardial infarction, LVEF is not just related to infarct size but also to MPR in the spared myocardium.
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Affiliation(s)
- Luis Eduardo Juárez-Orozco
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands
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De Silva K, Foster P, Guilcher A, Bandara A, Jogiya R, Lockie T, Chowiencyzk P, Nagel E, Marber M, Redwood S, Plein S, Perera D. Coronary Wave Energy. Circ Cardiovasc Interv 2013; 6:166-75. [DOI: 10.1161/circinterventions.112.973081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kalpa De Silva
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Paul Foster
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Antoine Guilcher
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Asela Bandara
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Roy Jogiya
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Tim Lockie
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Phil Chowiencyzk
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Eike Nagel
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Michael Marber
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Simon Redwood
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Sven Plein
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
| | - Divaka Perera
- From the King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust, Cardiovascular Division (K.D., P.F., A.B., T.L., M.M., S.R., D.P.), and King’s College London British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Welcome Trust and Engineering and Physical Sciences Research Council Medical
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Giga V, Dobric M, Beleslin B, Sobic-Saranovic D, Tesic M, Djordjevic-Dikic A, Stepanovic J, Nedeljkovic I, Artiko V, Obradovic V, Seferovic PM, Ostojic M. Estimation of infarct size using transthoracic Doppler echocardiographic measurement of coronary flow reserve in infarct related and reference coronary artery. Int J Cardiol 2012; 168:169-75. [PMID: 23058345 DOI: 10.1016/j.ijcard.2012.09.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/17/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients in chronic phase of myocardial infarction (MI) have decreased coronary flow reserve (CFR) in infarct related artery (IRA) that is proportional to the extent of microvascular/myocardial damage. We proposed a novel model for the assessment of microvascular damage and infarct size using Doppler echocardiography evaluation of CFRs of the IRA (LAD) and reference artery (RCA). METHODS Our study included 34 consecutive patients (28 men, mean age 50 ± 11 years) with first anterior STEMI and single vessel disease successfully treated with primary PCI. All patients underwent SPECT MPI for the assessment of infarct size (expressed as a percentage of myocardium with fixed perfusion abnormalities) and CFR evaluation of LAD and RCA. CFR derived percentage of microvascular damage (CFR PMD) was calculated as: CFR PMD=(CFR RCA-CFR LAD)/(CFR RCA-1)×100 (%). RESULTS CFR PMD correlated significantly with all parameters evaluating the severity of myocardial damage including: peak CK activity (r=0.632, p<0.001), WMSI (r=0.857, p<0.001), ejection fraction (r=-0.820, p<0.001), left ventricular end diastolic (r=0.757, p<0.001) and end systolic volume (r=0.794, p<0.001). Most importantly, CFR PMD (22 ± 17%) correlated significantly with infarct size by SPECT MPI (21 ± 17%) (r=0.874, p<0.001). CONCLUSIONS CFR PMD derived from the proposed model was significantly related to echocardiographic and enzymatic parameters of infarct size, as well as to myocardial damage assessed by SPECT MPI in patients with successfully reperfused first anterior STEMI.
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Affiliation(s)
- Vojislav Giga
- Clinic for Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.
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Koshy SK, Govindarajan G. Rationale and Pitfalls of Noninvasive Coronary Flow Reserve Estimation in Assessment of Microvascular Disease. Echocardiography 2012; 29:631-3. [DOI: 10.1111/j.1540-8175.2012.01669.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Van Herck PL, Paelinck BP, Haine SE, Claeys MJ, Miljoen H, Bosmans JM, Parizel PM, Vrints CJ. Impaired coronary flow reserve after a recent myocardial infarction: correlation with infarct size and extent of microvascular obstruction. Int J Cardiol 2012; 167:351-6. [PMID: 22244483 DOI: 10.1016/j.ijcard.2011.12.099] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/30/2011] [Accepted: 12/24/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The exact relationship between the coronary flow reserve (CFR) and infarct size remains unknown. In this prospective study the relationship between the CFR both in the infarcted and remote myocardium and infarct size was investigated. Furthermore, the diagnostic value of the CFR to predict the extent of microvascular obstruction (MO) was evaluated. METHODS In thirty patients the CFR was measured with a Doppler guide wire 6 ± 3 days after a first myocardial infarction (MI) in the infarct related and in a reference coronary artery. MO and infarct size were determined with magnetic resonance imaging. RESULTS The CFR was inversely related to infarct size in the infarcted and remote myocardium (respectively, r=-0.60, p<0.01 and r=-0.62, p<0.01). In the infarcted myocardium the extent of MO was strongly related to the infarct size and was in a multivariate analysis the single significant determinant of the CFR and the hyperaemic flow. In the remote myocardium no relationship was present between infarct size and hyperaemic flow, but the baseline flow increased as the infarct size became larger (r=0.58, p<0.01). In a receiver operator characteristic (ROC) analysis, a CFR value ≤ 2 in the infarct related coronary artery offered the best sensitivity (65%) and specificity (71%) to detect the presence of MO (p<0.05). CONCLUSIONS After MI, the CFR both in the infarcted and remote myocardium is inversely related to infarct size. In the infarcted myocardium, a CFR value ≤ 2 predicts the presence of MO with moderate sensitivity and specificity.
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Affiliation(s)
- P L Van Herck
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
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Sadauskiene E, Zakarkaite D, Ryliskyte L, Celutkiene J, Rudys A, Aidietiene S, Laucevicius A. Non-invasive evaluation of myocardial reperfusion by transthoracic Doppler echocardiography and single-photon emission computed tomography in patients with anterior acute myocardial infarction. Cardiovasc Ultrasound 2011; 9:16. [PMID: 21619676 PMCID: PMC3123269 DOI: 10.1186/1476-7120-9-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/28/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The study was designed to evaluate whether the preserved coronary flow reserve (CFR) 72 hours after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction and is predictive of left ventricular (LV) functional recovery and the final infarct size at follow-up. METHODS In our study, CFR was assessed by transthoracic Doppler echocardiography (TDE) in 44 patients after the successful percutaneous coronary intervention during the acute AMI phase. CFR was correlated with contractile reserve assessed by low-dose dobutamine echocardiography and with the total perfusion defect measured by single-photon emission computed tomography 72 hours after reperfusion and at 5 months follow-up. The ROC analysis was performed to determine test sensitivity and specificity based on CFR. Categorical data were compared by an χ² analysis, continuous variables were analysed with the independent Student's t test. In order to analyse correlation between CFR and the parameters of LV function and perfusion, the Pearson correlation analysis was conducted. The linear regression analysis was used to assess the relationship between CFR and myocardial contractility as well as the final infarct size. RESULTS We estimated the CFR cut-off value of 1.75 as providing the maximal accuracy to distinguish between patients with preserved and impaired CFR during the acute AMI phase (sensitivity 91.7%, specificity 75%). Wall motion score index was better in the subgroup with preserved CFR as compared to the subgroup with reduced CFR: 1.74 (0.29) vs. 1.89 (0.17) (p < 0.001) during the acute phase and 1.47 (0.30) vs. 1.81 (0.20) (p < 0.001) at follow-up, respectively. LV ejection fraction was 47.78% (8.99) in preserved CFR group vs. 40.79% (7.25) in impaired CFR group (p = 0.007) 72 hours after reperfusion and 49.78% (8.70) vs. 40.36% (7.90) (p = 0.001) after 5 months at follow-up, respectively. The final infarct size was smaller in patients with preserved as compared to patients with reduced CFR: 5.26% (6.14) vs. 23.28% (12.19) (p < 0.001) at follow-up. CONCLUSION The early measurement of CFR by TDE can be of high value for the assessment of successful reperfusion in AMI and can be used to predict LV functional recovery, myocardial viability and the final infarct size.
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Affiliation(s)
- Egle Sadauskiene
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Diana Zakarkaite
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Ligita Ryliskyte
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Jelena Celutkiene
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Alfredas Rudys
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Sigita Aidietiene
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
| | - Aleksandras Laucevicius
- Department of Cardiovascular Medicine, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, LT-08661, Lithuania
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, M.K. Ciurlionio 21, Vilnius, LT-03101, Lithuania
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Prediction of Myocardial Functional Recovery by Noninvasive Evaluation of Basal and Hyperemic Coronary Flow in Patients with Previous Myocardial Infarction. J Am Soc Echocardiogr 2011; 24:573-81. [DOI: 10.1016/j.echo.2011.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Indexed: 11/19/2022]
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Amabile N, Jacquier A, Gaudart J, Sarran A, Shuaib A, Panuel M, Moulin G, Bartoli JM, Paganelli F. Value of a new multiparametric score for prediction of microvascular obstruction lesions in ST-segment elevation myocardial infarction revascularized by percutaneous coronary intervention. Arch Cardiovasc Dis 2010; 103:512-21. [PMID: 21130964 DOI: 10.1016/j.acvd.2010.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 09/21/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite improvement in revascularization strategies, microvascular obstruction (MO) lesions remain associated with poor outcome after ST-segment elevation myocardial infarction (STEMI). AIMS To establish a bedside-available score for predicting MO lesions in STEMI, with cardiac magnetic resonance imaging (CMR) as the reference standard, and to test its prognostic value for clinical outcome. METHODS Patients with STEMI of<12 hours' evolution treated by percutaneous coronary intervention (PCI) were included. CMR was performed 4-8 days later, to measure myocardial infarction (MI) extent, left ventricular ejection fraction (LVEF) and volumes, and to identify MO lesions. An MO score was built from multivariable logistic regression results and included clinical, angiographic and electrocardiographic criteria. Adverse cardiovascular events were recorded prospectively after STEMI. RESULTS We analysed data from 112 patients. MO lesions were found in 63 (56%) patients and were associated with larger MI as assessed by higher peak creatine phosphokinase (3755 ± 351 vs 1467 ± 220 IU, p<0.001), lower LVEF (46.7 ± 1.5 vs 53.4 ± 1.6%, p<0.01) and larger MI extent (18.7 ± 1.2 vs 9.0 ± 1.3% LV, p<0.001) on CMR. MO score>4 accurately identified microcirculatory injuries (sensitivity 84%; specificity 82%) and independently predicted the presence of MO lesions on CMR. MO score>4 predicted adverse cardiovascular events during the first year after STEMI (relative risk 2.60 [1.10-6.60], p=0.03). CONCLUSIONS MO lesions are frequent in PCI-treated STEMI and are associated with larger MIs. MO score accurately predicted MO lesions and identified patients with poor outcome post-STEMI.
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Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, CHU Nord, Aix-Marseille University School of Medicine, Marseille, France.
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Innocenti F, Caldi F, Meini C, Agresti C, Baldereschi GJ, Marchionni N, Masotti G, Pini R. Left ventricular remodeling in the elderly with acute anterior myocardial infarction treated with primary coronary intervention. Intern Emerg Med 2010; 5:311-9. [PMID: 20640535 DOI: 10.1007/s11739-010-0425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 06/16/2010] [Indexed: 11/30/2022]
Abstract
We compared left ventricular (LV) remodeling following a first time acute anterior ST-elevation myocardial infarction (aSTEMI) treated with primary coronary intervention (pPCI) in different age groups. A total of 116 patients, 61 aged <65 and 55 aged >or=65 years, who survived after a recent aSTEMI treated with pPCI, underwent dobutamine stress-echocardiography (DSE) and non-invasive measurement of left anterior descending coronary artery flow reserve (CFR) during intravenous adenosine infusion. Baseline LV dimensions and systolic function were similar between the two groups; wall motion score indices during all DSE stages and CFR were also similar. In both groups, the LV ejection fraction was positively affected by the presence of viability in the necrosis area and by a higher CFR, but negatively influenced by viability in a remote area, an indirect sign of an extensive infarction size. This study demonstrates that PCI in the geriatric population with aSTEMI is as equally effective as in younger subjects, in terms of LV remodeling and function.
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Affiliation(s)
- Francesca Innocenti
- Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 1, 50141, Florence, Italy.
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Meuwissen M, Siebes M, Chamuleau SAJ, Verhoeff BJ, Henriques JPS, Spaan JAE, Piek JJ. Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions. Interv Cardiol 2009. [DOI: 10.2217/ica.09.33] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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