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Xanthis CG, Jablonowski R, Bidhult-Johansson S, Nordlund D, Haidich AB, Lala T, Arheden H, Aletras AH. Unravelling the mechanisms of CE-SSFP in imaging myocardium at risk: The effect of relaxation times on myocardial contrast. Magn Reson Imaging 2024; 111:90-102. [PMID: 38579972 DOI: 10.1016/j.mri.2024.03.043] [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: 11/15/2023] [Revised: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE The aim of this study was to investigate the contrast mechanisms of Contrast-enhanced steady-state free-precession (CE-SSFP) through the utilization of Bloch simulations in an experimental porcine model and in patients with acute myocardial infarction. METHODS Six pigs and ten patients with myocardial infarction underwent CMR and tissue characterization at 1.5 T whereas a Bloch simulation framework was utilized to simulate the CE-SSFP signal formation and compare it against the actual CE-SSFP signal acquired from the experimental porcine model and the patient population. The relaxation times of remote, salvaged, and infarcted myocardium were calculated after the injection of gadolinium, at the time of CE-SSFP acquisition. Simulations were performed using the same CE-SSFP pulse sequence as used on the scanner on a set of spins with the calculated relaxation times from the CMR scans. RESULTS The normalized signal intensities of salvaged and infarcted myocardium obtained with simulations were lower than the corresponding normalized signal intensities obtained in vivo in pigs (p < 0.05, 134% vs 153%) and in patients (p < 0.05, 126% vs 145%). The results from simulations showed a linear relationship to the results obtained in the experimental porcine model (r2 = 0.61) and in patients (r2 = 0.69). CONCLUSION The T1 and T2 values of remote, salvaged, and infarcted myocardium only partly explain the signal intensities in CE-SSFP images. Bloch simulations suggest that there may be more elements that contribute to the CE-SSFP contrast. Integration of other aspects of the MR experiment into the simulation model could further help to fully unravel the mechanisms of CE-SSFP.
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Affiliation(s)
- Christos G Xanthis
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden; Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Jablonowski
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Sebastian Bidhult-Johansson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Nordlund
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Tania Lala
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden; Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden; Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Binek A, Castans C, Jorge I, Bagwan N, Rodríguez JM, Fernández-Jiménez R, Galán-Arriola C, Oliver E, Gómez M, Clemente-Moragón A, Ibanez B, Camafeita E, Vázquez J. Oxidative Post-translational Protein Modifications upon Ischemia/Reperfusion Injury. Antioxidants (Basel) 2024; 13:106. [PMID: 38247530 PMCID: PMC10812827 DOI: 10.3390/antiox13010106] [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: 11/29/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
While reperfusion, or restoration of coronary blood flow in acute myocardial infarction, is a requisite for myocardial salvage, it can paradoxically induce a specific damage known as ischemia/reperfusion (I/R) injury. Our understanding of the precise pathophysiological molecular alterations leading to I/R remains limited. In this study, we conducted a comprehensive and unbiased time-course analysis of post-translational modifications (PTMs) in the post-reperfused myocardium of two different animal models (pig and mouse) and evaluated the effect of two different cardioprotective therapies (ischemic preconditioning and neutrophil depletion). In pigs, a first wave of irreversible oxidative damage was observed at the earliest reperfusion time (20 min), impacting proteins essential for cardiac contraction. A second wave, characterized by irreversible oxidation on different residues and reversible Cys oxidation, occurred at late stages (6-12 h), affecting mitochondrial, sarcomere, and inflammation-related proteins. Ischemic preconditioning mitigated the I/R damage caused by the late oxidative wave. In the mouse model, the two-phase pattern of oxidative damage was replicated, and neutrophil depletion mitigated the late wave of I/R-related damage by preventing both Cys reversible oxidation and irreversible oxidation. Altogether, these data identify protein PTMs occurring late after reperfusion as an actionable therapeutic target to reduce the impact of I/R injury.
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Grants
- PGC2018-097019-B-I00, PID2021-122348NB-I00, PID2022-140176OB-I00 Spanish Ministry of Science, Innovation and Universities
- Fondo de Investigación Sanitaria grant PRB3 PT17/0019/0003- ISCIII-SGEFI / ERDF, ProteoRed Instituto de Salud Carlos III
- IMMUNO-VAR, P2022/BMD-7333, and RENIM-CM, P2022/BMD-7403 Comunidad de Madrid
- HR17-00247, HR22-00533 and HR22-00253 "la Caixa" Banking Foundation
- ERC Consolidator Grant "MATRIX", 819775 European Commission
- grant PI22/01560 ISCIII-Fondo de Investigación Sanitaria and European Union
- FP7-PEOPLE-2013-ITN-Cardionext European Union's Seventh Framework Programme
- Formacion del Profesorado Universitario (FPU14/05292) Spanish Ministry of Education, Culture and Sports
- PID2021-133167OB-100, RYC2020-028884-I, CEX2020-001041-S MCIN/AEI/10.13039/501100011033
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Affiliation(s)
- Aleksandra Binek
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Celia Castans
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Inmaculada Jorge
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Navratan Bagwan
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - José Manuel Rodríguez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Profesor Martín Lagos, s/n, 28040 Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Eduardo Oliver
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Centro de Investigaciones Biológicas Margarita Salas (CIB), CSIC, Ramiro de Maeztu 9, 28040 Madrid, Spain
| | - Mónica Gómez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Agustín Clemente-Moragón
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - Emilio Camafeita
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Jesús Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Halvorsrød MI, Thorstensen A, Kiss G, Støylen A. Segmental myocardial viability by echocardiography at rest. SCAND CARDIOVASC J 2023; 57:2181390. [PMID: 38095169 DOI: 10.1080/14017431.2023.2181390] [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: 10/21/2022] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Myocardial viability assessment adds value to the therapeutic decision-making of patients with ischemic heart disease. In this feasibility study, we investigated whether established echocardiographic measurements of post-systolic shortening (PSS), strain, strain rate and wall motion score (WMS) can discover viable myocardial segments. Our hypothesis is that non-viable myocardial segments are both akinetic and without PSS. METHODS The study population consisted of 26 examinations strictly selected by visible dysfunction. We assessed WMS, strain by speckle tracking and strain rate by tissue Doppler. The segments (16*26 = 416) were categorized into either normokinetic/hypokinetic or akinetic/dyskinetic and whether there was PSS. The reference method was the presence of scar with segmental percentage volume scar fraction >50%, detected by late gadolinium-enhanced cardiovascular magnetic resonance. Agreement with echocardiography was evaluated by Kappa coefficient. RESULTS WMS had Kappa coefficient 0.43 (sensitivity 99%, specificity 35%). Kappa coefficient of strain was 0.28 (sensitivity 98%, specificity 23%). By combining PSS in akinetic segments with WMS and strain, the Kappa coefficient was 0.06 and 0.08 respectively. CONCLUSION Segmental viability was best shown by the presence of systolic function. Post-systolic shortening adds no value to the assessment of segmental myocardial viability.
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Affiliation(s)
- Marlene Iversen Halvorsrød
- Department of Circulation and Medical Imaging (ISB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Anders Thorstensen
- Department of Circulation and Medical Imaging (ISB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Gabriel Kiss
- St. Olavs University Hospital, Trondheim, Norway
- Department of Computer Science (IDI), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging (ISB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
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Xiao Z, Zhong J, Zhong L, Dai S, Lu W, Song L, Zhang H, Yang J, Yao W. The prognostic value of myocardial salvage index by cardiac magnetic resonance in ST-segment elevation myocardial infarction patients: a systematic review and meta-analysis. Eur Radiol 2023; 33:8214-8225. [PMID: 37328640 DOI: 10.1007/s00330-023-09739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess the prognostic value of myocardial salvage index (MSI) by cardiac magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients. METHODS We systematically searched PubMed, Embase, Web of Science, Cochrane Central, China National Knowledge Infrastructure, and Wanfang Data to identify primary studies reporting MSI in STEMI patients with major adverse cardiovascular events (MACE) comprised of death, myocardial reinfarction, and congestive heart failure. The MSI and MACE rates were pooled. The bias of risk was assessed using the Quality In Prognosis Studies tool. The evidence level was rated based on the meta-analysis of hazard ratio (HR) and 95% confidence interval (CI) of MSI for predicting MACE. RESULTS Eighteen studies were included covering twelve unique cohorts. Eleven cohorts measured MSI using T2-weighted imaging and T1-weighted late gadolinium enhancement, while one cohort applied T2-mapping and T1-mapping. The pooled MSI (95% CI) was 44% (39 to 49%; 11 studies, 2946 patients), and the pooled MACE rate (95% CI) was 10% (7 to 14%; 12 studies, 311/3011 events/patients). Seven prognostic studies overall showed low risk of bias. The HR (95% CI) per 1% increase of MSI for MACE was 0.95 (0.92 to 0.98; 5 studies, 150/885 events/patients), and HR (95% CI) of MSI < median versus MSI > median for MACE was 5.62 (3.74 to 8.43; 6 studies, 166/1570 events/patients), both rated as weak evidence. CONCLUSIONS MSI presents potential in predicting MACE in STEMI patients. The prognostic value of MSI using advanced CMR techniques for adverse cardiovascular events needs further investigation. CLINICAL RELEVANCE STATEMENT Seven studies supported the MSI to serve as a predictor for MACE in STEMI patients, indicating its potential as a risk stratification tool to help manage expectations for these patients in clinical practice. KEY POINTS • The pooled infarct size (95% CI) and area at risk (95% CI) were 21% (18 to 23%; 11 studies, 2783 patients) and 38% (34 to 43%; 10 studies, 2022 patients), respectively. • The pooled rates (95% CI) of cardiac mortality, myocardial reinfarction, and congestive heart failure were 2% (1 to 3%; 11 studies, 86/2907 events/patients), 4% (3 to 6%; 12 studies, 127/3011 events/patients), and 3% (1 to 5%; 12 studies, 94/3011 events/patients), respectively. • The HRs (95% CI) per 1% increase of MSI for cardiac mortality and congestive heart failure were 0.93 (0.91 to 0.96; 1 study, 14/202 events/patients) and 0.96 (0.93 to 0.99; 1 study, 11/104 events/patients), respectively, but the prognostic value of MSI for myocardial re-infraction has not been measured.
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Affiliation(s)
- Zhengguang Xiao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lingna Zhong
- Electrocardiogram Room, Department of Internal Medicine, International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai Jiao Tong University School of Medicine, 20030, Shanghai, China
| | - Shun Dai
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Wenjie Lu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lei Song
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Yang
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Alkhalil M, De Maria GL, Akbar N, Ruparelia N, Choudhury RP. Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair. J Clin Med 2023; 12:4668. [PMID: 37510783 PMCID: PMC10380764 DOI: 10.3390/jcm12144668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The past decade has seen a marked expansion in the understanding of the pathobiology of acute myocardial infarction and the systemic inflammatory response that it elicits. At the same time, a portfolio of tools has emerged to characterise some of these processes in vivo. However, in clinical practice, key decision making still largely relies on assessment built around the timing of the onset of chest pain, features on electrocardiograms and measurements of plasma troponin. Better understanding the heterogeneity of myocardial injury and patient-level responses should provide new opportunities for diagnostic stratification to enable the delivery of more rational therapies. Characterisation of the myocardium using emerging imaging techniques such as the T1, T2 and T2* mapping techniques can provide enhanced assessments of myocardial statuses. Physiological measures, which include microcirculatory resistance and coronary flow reserve, have been shown to predict outcomes in AMI and can be used to inform treatment selection. Functionally informative blood biomarkers, including cellular transcriptomics; microRNAs; extracellular vesicle analyses and soluble markers, all give insights into the nature and timing of the innate immune response and its regulation in acute MI. The integration of these and other emerging tools will be key to developing a fuller understanding of the patient-level processes of myocardial injury and repair and should fuel new possibilities for rational therapeutic intervention.
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Affiliation(s)
- Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | | | - Naveed Akbar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Neil Ruparelia
- Cardiology Department, Hammersmith Hospital, Imperial College London, London W12 0HS, UK
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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6
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Li Y, Wang G, Wang X, Li Y, Zhao Y, Gu X, Xu B, Cui J, Wang X, Sun Y, Liu S, Yu B. Prognostic significance of myocardial salvage assessed by cardiac magnetic resonance in reperfused ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:924428. [PMID: 36110410 PMCID: PMC9468362 DOI: 10.3389/fcvm.2022.924428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Myocardial salvage index (MSI) is attracting increasing attention for predicting prognosis in acute myocardial infarction (AMI); however, the evaluation of MSI is mainly based on contrast agent-dependent cardiac magnetic resonance (CMR) scanning sequences. This study aims to investigate the prognostic value of MSI in reperfused ST-segment elevation myocardial infarction (STEMI) through the contrast agent-free CMR technique. Methods and results Nighty-two patients with acute STEMI, who underwent CMR after primary percutaneous coronary intervention (PPCI), were finally enrolled. Patients were subcategorized into two groups according to median MSI. T1 and T2 mapping were conducted for measuring infarct size (IS) and area at risk (AAR). IS was significantly larger in < median MSI group than ≥ median MSI group (P < 0.001). AAR between the two groups showed no obvious differences (P = 0.108). Left ventricular ejection fraction (LVEF) was lower in < median MSI group than ≥ median MSI group (P = 0.014). There was an obvious inverse correlation between MSI and reperfusion time (R = –0.440, P < 0.001) and a strong inverse correlation between MSI and IS (R = –0.716, P = 0.011). As for the relationship LVEF, MSI showed positive but weak correlation (R = 0.2265, P < 0.001). Over a median follow-up period of 263 (227–238) days, prevalence of MACEs was significantly higher in the < median MSI group [HR: 0.15 (0.04–0.62); Log-rank P = 0.008]. The univariate Cox regression analysis revealed that LVEF, IS, and MSI were significant predictors for major adverse cardiovascular events (MACEs) (all P < 0.05). In the stepwise multivariate Cox regression analysis, LVEF and MSI were identified as independent parameters for predicting MACEs (both P < 0.05). In the receiver-operating characteristic analysis, LVEF, IS, and MSI showed prognostic value in predicting MACEs with AUCs of 0.809, 0.779, and 0.896, respectively, all (P < 0.05). A combination of MSI with LVEF showed the strongest prognostic value of MACEs (AUC: 0.901, sensitivity: 77.78%, specificity: 98.80%, P < 0.001). Delong’s test showed that the combination of LVEF with MSI had an incremental value than LVEF itself in predicting MACEs (P = 0.026). Conclusion Contrast agent-free CMR technique provides a reliable evaluation of MSI, which contributes to assessing the efficacy of reperfusion therapy and predicting the occurrence of MACEs.
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Affiliation(s)
- Yunling Li
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guokun Wang
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueying Wang
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanming Zhao
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Gu
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bing Xu
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinjin Cui
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuedong Wang
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong Sun
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Yong Sun,
| | - Shengliang Liu
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Shengliang Liu,
| | - Bo Yu
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Beijnink CWH, van der Hoeven NW, Konijnenberg LSF, Kim RJ, Bekkers SCAM, Kloner RA, Everaars H, El Messaoudi S, van Rossum AC, van Royen N, Nijveldt R. Cardiac MRI to Visualize Myocardial Damage after ST-Segment Elevation Myocardial Infarction: A Review of Its Histologic Validation. Radiology 2021; 301:4-18. [PMID: 34427461 DOI: 10.1148/radiol.2021204265] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiac MRI is a noninvasive diagnostic tool using nonionizing radiation that is widely used in patients with ST-segment elevation myocardial infarction (STEMI). Cardiac MRI depicts different prognosticating components of myocardial damage such as edema, intramyocardial hemorrhage (IMH), microvascular obstruction (MVO), and fibrosis. But how do cardiac MRI findings correlate to histologic findings? Shortly after STEMI, T2-weighted imaging and T2* mapping cardiac MRI depict, respectively, edema and IMH. The acute infarct size can be determined with late gadolinium enhancement (LGE) cardiac MRI. T2-weighted MRI should not be used for area-at-risk delineation because T2 values change dynamically over the first few days after STEMI and the severity of T2 abnormalities can be modulated with treatment. Furthermore, LGE cardiac MRI is the most accurate method to visualize MVO, which is characterized by hemorrhage, microvascular injury, and necrosis in histologic samples. In the chronic setting post-STEMI, LGE cardiac MRI is best used to detect replacement fibrosis (ie, final infarct size after injury healing). Finally, native T1 mapping has recently emerged as a contrast material-free method to measure infarct size that, however, remains inferior to LGE cardiac MRI. Especially LGE cardiac MRI-defined infarct size and the presence and extent of MVO may be used to monitor the effect of new therapeutic interventions in the treatment of reperfusion injury and infarct size reduction. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Casper W H Beijnink
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Nina W van der Hoeven
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Lara S F Konijnenberg
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Raymond J Kim
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Sebastiaan C A M Bekkers
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Robert A Kloner
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Henk Everaars
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Saloua El Messaoudi
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Albert C van Rossum
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Niels van Royen
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Robin Nijveldt
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
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8
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Association of pre-percutaneous coronary flow grade and clinical outcomes in patients with non-ST-segment elevation myocardial infarction: Data from the Korea Acute Myocardial Infarction Registry. Medicine (Baltimore) 2021; 100:e26947. [PMID: 34397947 PMCID: PMC8360488 DOI: 10.1097/md.0000000000026947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022] Open
Abstract
Because of a paucity of published data, we compared the 2-year major clinical outcomes between pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade 0/1 (pre-TIMI flow grade [pre-TIMI] 0/1) group and pre-PCI TIMI flow grade 2/3 (pre-TIMI 2/3) group in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent successful implantation of newer-generation drug-eluting stent.A total of 7506 NSTEMI patients were divided into 2 groups: pre-TIMI 0/1 group (n = 3157) and pre-TIMI 2/3 group (n = 4349). The primary outcome was major adverse cardiac events defined as all-cause death, recurrent myocardial infarction, or any repeat revascularization. The secondary outcome was stent thrombosis (ST).After propensity score-matched (PSM) analysis, 2 PSM groups (2473 pairs, n = 4946, C-statistic = 0.684) were generated. Major adverse cardiac events (hazard ration [HR], 1.294; 95% confidence interval [CI]: 1.065-1.572; P = .009), all-cause death (HR, 1.559, P = .003), cardiac death (HR: 1.641, P = .005), and all-cause death or MI (HR: 1.531, P = .001) rates were significantly higher in the pre-TIMI 0/1 group than in the pre-TIMI 2/3 group. Moreover, these differences were more prominent during the first 1 month after the index PCI. However, the cumulative incidences of recurrent myocardial infarction, any revascularization, and ST were similar between the 2 groups.Among a contemporary cohort of NSTEMI, these data suggest that the presence of a pre-PCI patency of the infarct-related artery showed better mortality reduction capacity than those with a lack of patency.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Cardiovascular Center, Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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9
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Topal DG, Aleksov Ahtarovski K, Lønborg J, Høfsten D, Nepper-Christensen L, Kyhl K, Schoos M, Ghotbi AA, Göransson C, Bertelsen L, Holmvang L, Helqvist S, Pedersen F, Schnabel R, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T, Clemmensen P. Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction - A cardiac magnetic resonance imaging study. IJC HEART & VASCULATURE 2021; 33:100731. [PMID: 33732867 PMCID: PMC7937772 DOI: 10.1016/j.ijcha.2021.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
Background Coronary collateral circulation and conditioning from
remote ischemic coronary territories may protect culprit myocardium in the
elderly, and younger STEMI patients could suffer from larger infarcts. We
evaluated the impact of age on myocardial salvage and long-term prognosis in a
contemporary STEMI cohort. Methods Of 1603 included STEMI patients 807 underwent cardiac
magnetic resonance. To assess the impact of age on infarct size and left
ventricular ejection fraction (LVEF) as well as the composite endpoint of death
and re-hospitalization for heart failure we stratified the patients by an age
cut-off of 60 years. Results Younger STEMI patients had smaller final infarcts (10%
vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After
adjusting for multiple potential confounders age did not remain significantly
associated with infarct size and LVEF. During 4-year follow-up, the composite
endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a
univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event
estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below
median) showed a gradual increase in the occurrence of the composite endpoint
depending on both age and acute infarct size (log-rank
p < 0.001). Conclusion Having a STEMI after entering the seventh decade of life
more than quadrupled the risk of future death or re-hospitalization for heart
failure. Risk of death and re-hospitalization depended on both advanced age and
infarct size, albeit no substantial difference was found in infarct size, LVEF
and salvage potential between younger and elderly patients with
STEMI.
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Affiliation(s)
- Divan Gabriel Topal
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Renate Schnabel
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.,Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Peter Clemmensen
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of Medicine, Nykøbing F Hospital, Nykøbing F, Institute for Regional Research, University of Southern Denmark, Odense, Denmark
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10
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Broncano J, Bhalla S, Caro P, Hidalgo A, Vargas D, Williamson E, Gutiérrez F, Luna A. Cardiac MRI in Patients with Acute Chest Pain. Radiographics 2020; 41:8-31. [PMID: 33337967 DOI: 10.1148/rg.2021200084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute chest pain is a common reason for visits to the emergency department. It is important to distinguish among the various causes of acute chest pain, because treatment and prognosis are substantially different among the various conditions. It is critical to exclude acute coronary syndrome (ACS), which is a major cause of hospitalization, death, and health care costs worldwide. Myocardial ischemia is defined as potential myocyte death secondary to an imbalance between oxygen supply and demand due to obstruction of an epicardial coronary artery. Unobstructed coronary artery disease can have cardiac causes (eg, myocarditis, myocardial infarction with nonobstructed coronary arteries, and Takotsubo cardiomyopathy), and noncardiac diseases can manifest with acute chest pain and increased serum cardiac biomarker levels. In the emergency department, cardiac MRI may aid in the identification of patients with non-ST-segment elevation myocardial infarction or unstable angina or ACS with unobstructed coronary artery disease, if the patient's clinical history is known to be atypical. Also, cardiac MRI is excellent for risk stratification of patients for adverse left ventricular remodeling or major adverse cardiac events. Cardiac MRI should be performed early in the course of the disease (<2 weeks after onset of symptoms). Steady-state free-precession T2-weighted MRI with late gadolinium enhancement is the mainstay of the cardiac MRI protocol. Further sequences can be used to analyze the different pathophysiologic subjacent mechanisms of the disease, such as microvascular obstruction or intramyocardial hemorrhage. Finally, cardiac MRI may provide several prognostic biomarkers that help in follow-up of these patients. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Pilar Caro
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Alberto Hidalgo
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Eric Williamson
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Fernando Gutiérrez
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
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11
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Abstract
Cardiac magnetic resonance (CMR) imaging is a unique imaging modality, which provides accurate noninvasive tissue characterization. Various CMR sequences can be utilized to identify and quantify patterns of myocardial edema, fibrosis, and infiltrates, which are important determinants for diagnosis and prognostication of heart failure. This article describes available methods of tissue characterization imaging applied in CMR. The presence and patterns of abnormal tissue characterization are related to common etiologies of heart failure and the techniques employed to demonstrate this. CMR provides the opportunity to identify the etiology of heart failure based on the recognition of different patterns of myocardial abnormalities.
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12
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Abstract
Ischemic heart disease is the most common cause of cardiovascular morbidity and mortality. Cardiac magnetic resonance (CMR) improves on other noninvasive modalities in detection, assessment, and prognostication of ischemic heart disease. The incorporation of CMR in clinical trials allows for smaller patient samples without the sacrifice of power needed to demonstrate clinical efficacy. CMR can accurately quantify infarct acuity, size, and complications; guide therapy; and prognosticate recovery. Timing of revascularization remains the holy grail of ischemic heart disease, and viability assessment using CMR may be the missing link needed to help reduce morbidity and mortality associated with the disease.
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Affiliation(s)
- Aneesh S Dhore-Patil
- Tulane University Heart and Vascular Center, Tulane University, 1415 Tulane Avenue, New Orleans, LA 70112, USA
| | - Ashish Aneja
- Department of Cardiovascular Diseases, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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13
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Topal DG, Engstrøm T, Nepper-Christensen L, Holmvang L, Køber L, Kelbæk H, Lønborg J. Degree of ST-segment elevation in patients with STEMI reflects the acute ischemic burden and the salvage potential. J Electrocardiol 2020; 63:28-34. [PMID: 33070031 DOI: 10.1016/j.jelectrocard.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/20/2020] [Accepted: 09/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is clinically diagnosed by significant ST-segment elevation (STE) in the electrocardiogram (ECG). The importance of the sum of significant ST-segment elevation (∑STE) before primary percutaneous coronary intervention (PPCI) - considered an indicator of the degree of ischemia - is sparse. We evaluated the association of ∑STE before PPCI with respect to area at risk, infarct size and myocardial salvage. METHODS A total of 503 patients with STEMI and available cardiac magnetic resonance (CMR) were included. CMR was performed at day 1 (interquartile range [IQR], 1-1) and at follow-up at day 92 (IQR, 88-96). The ECG before PPCI with the most prominent STE was used for analysis. RESULTS ∑STE divided into quartiles were progressive linearly associated with area at risk (p < 0.001), final infarct size (p < 0.001) and extent of microvascular obstruction (p < 0.001) and inverse linearly associated with final myocardial salvage (p < 0.001). Similar results were found for linear regression analyses. However, ∑STE was not associated with final myocardial salvage in patients with pre-PCI TIMI (thrombolysis in myocardial infarction) flow 0/1 (p = 0.24) in contrast to patients with pre-PCI TIMI flow 2/3 (p ≤ 0.001). CONCLUSION In patients with STEMI presenting within 12 h of symptom onset, the degree of STE in the ECG before PPCI is a marker of the extent of myocardium at risk that in turn affects the infarct size in patients with pre-PCI TIMI flow 0/1, whereas the degree of STE in patients with pre-PCI TIMI flow 2/3 is a marker of the extent of the myocardium at risk as well as myocardial salvage - both affecting the myocardial damage.
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Affiliation(s)
- Divan Gabriel Topal
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Cardiology, Lund University Hospital, Lund, Sweden
| | | | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
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14
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Kendziora B, Stier H, Schlattmann P, Dewey M. MRI for measuring therapy efficiency after revascularisation in ST-segment elevation myocardial infarction: a systematic review and meta-regression analysis. BMJ Open 2020; 10:e034359. [PMID: 32988935 PMCID: PMC7523216 DOI: 10.1136/bmjopen-2019-034359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To summarise existing data on the relation between the time from symptom onset until revascularisation (time to reperfusion) and the myocardial salvage index (MSI) calculated as proportion of non-necrotic myocardium inside oedematous myocardium on T2-weighted and T1-weighted late gadolinium enhancement MRI after ST-segment elevation myocardial infarction (STEMI). METHODS Studies including patients with revascularised STEMI and stating both the time to reperfusion and the MSI measured by T2-weighted and T1-weighted late gadolinium enhancement MRI were searched in MEDLINE, EMBASE and ISI Web of Science until 16 May 2020. A mixed effects model was used to evaluate the relation between the time to reperfusion and the MSI. The gender distribution and mean age in included patient groups, the timing of MRI, used MRI sequences and image interpretation methodology were included in the mixed effects model to explore between-study heterogeneity. RESULTS We included 38 studies with 5106 patients. The pooled MSI was 42.6% (95% CI: 38.1 to 47.1). The pooled time to reperfusion was 3.8 hours (95% CI: 3.5 to 4.0). Every hour of delay in reperfusion was associated with an absolute decrease of 13.1% (95% CI: 11.5 to 14.6; p<0.001) in the MSI. Between-study heterogeneity was considerable (σ2=167.8). Differences in the gender distribution, timing of MRI and image interpretation among studies explained 45.2% of the between-study heterogeneity. CONCLUSIONS The MSI on T2-weighted and T1-weighted late gadolinium enhancement MRI correlates inversely with the time to reperfusion, which indicates that cardioprotection achieved by minimising the time to reperfusion leads to a higher MSI. The analysis revealed considerable heterogeneity between studies. The heterogeneity could partly be explained by differences in the gender distribution, timing and interpretation of MRI suggesting that the MRI-assessed MSI is not only influenced by cardioprotective therapy but also by patient characteristics and MRI parameters.
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Affiliation(s)
- Benjamin Kendziora
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany
| | - Heli Stier
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Germany
| | - Marc Dewey
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany
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15
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Mokhtari A, Akbarzadeh M, Sparv D, Bhiladvala P, Arheden H, Erlinge D, Khoshnood A. Oxygen therapy in patients with ST elevation myocardial infarction based on the culprit vessel: results from the randomized controlled SOCCER trial. BMC Emerg Med 2020; 20:12. [PMID: 32070283 PMCID: PMC7027294 DOI: 10.1186/s12873-020-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oxygen (O2) treatment has been a cornerstone in the treatment of patients with myocardial infarction. Recent studies, however, state that supplemental O2 therapy may have no effect or harmful effects in these patients. The aim of this study was thus to evaluate the effect of O2 therapy in patients with ST Elevation Myocardial Infarction (STEMI) based on the culprit vessel; Left Anterior Descending Artery (LAD) or Non-LAD. METHODS This was a two-center, investigator-initiated, single-blind, parallel-group, randomized controlled trial at the Skåne university hospital, Sweden. A simple computer-generated randomization was used. Patients were either randomized to standard care with O2 therapy (10 l/min) or air until the end of the primary percutaneous coronary intervention. The patients underwent a Cardiac Magnetic Resonance Imaging (CMRI) days 2-6. The main outcome measures were Myocardium at Risk (MaR), Infarct Size (IS) and Myocardial Salvage Index (MSI) as measured by CMRI, and median high-sensitive troponin T (hs-cTnT). RESULTS A total of 229 patients were assessed for eligibility, and 160 of them were randomized to the oxygen or air arm. Because of primarily technical problems with the CMRI, 95 patients were included in the final analyses; 46 in the oxygen arm and 49 in the air arm. There were no significant differences between patients with LAD and Non-LAD as culprit vessel with regard to their allocation (oxygen or air) with regards to MSI, MaR, IS and hs-cTnT. CONCLUSION The results indicate that the location of the culprit vessel has probably no effect on the role of supplemental oxygen therapy in STEMI patients. TRIAL REGISTRATION Swedish Medical Products Agency (EudraCT No. 2011-001452-11) and ClinicalTrials.gov Identifier (NCT01423929).
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Affiliation(s)
- Arash Mokhtari
- Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mahin Akbarzadeh
- Department of Clinical Sciences Lund, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Akutmottagningen, EA10, SUS Lund, 221 85, Lund, Sweden
| | - David Sparv
- Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences Lund, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Akutmottagningen, EA10, SUS Lund, 221 85, Lund, Sweden.
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16
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Fox H, Hetzenecker A, Stadler S, Oldenburg O, Hamer OW, Zeman F, Bruch L, Seidel M, Buchner S, Arzt M. Rationale and design of the randomised Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation trial (TEAM-ASV I). Trials 2020; 21:129. [PMID: 32005277 PMCID: PMC6995094 DOI: 10.1186/s13063-020-4091-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/18/2020] [Indexed: 12/25/2022] Open
Abstract
Aims In acute myocardial infarction (AMI), impaired myocardial salvage and large infarct size result in residual heart failure, which is one of the most important predictors of morbidity and mortality after AMI. Sleep-disordered breathing (SDB) is associated with reduced myocardial salvage index (MSI) within the first 3 months after AMI. Adaptive servo-ventilation (ASV) can effectively treat both types of SDB (central and obstructive sleep apnoea). The Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation trial (TEAM-ASV I) will investigate the effects of ASV therapy, added to percutaneous coronary intervention (PCI) and optimal medical management of AMI, on myocardial salvage after AMI. Methods/design TEAM ASV-I is a multicentre, randomised, parallel-group, open-label trial with blinded assessment of PCI outcomes. Patients with first AMI and successful PCI within 24 h after symptom onset and SDB (apnoea–hypopnoea index ≥ 15/h) will be randomised (1:1 ratio) to PCI and optimal medical therapy alone (control) or plus ASV (with stratification of randomisation by infarct location; left anterior descending (LAD) or no LAD lesion). The primary outcome is the MSI, assessed by cardiac magnetic resonance imaging. Key secondary outcomes are change of infarct size, left ventricular ejection fraction and B-type natriuretic peptide levels and disease-specific symptom burden at 12 weeks. Conclusion TEAM ASV-I will help to determine whether treatment of SDB with ASV in the acute phase after myocardial infarction contributes to more myocardial salvage and healing. Trial registration ClinicalTrials.gov, NCT02093377. Registered on March 21, 2014.
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Affiliation(s)
- Henrik Fox
- Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Andrea Hetzenecker
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Zentrum für Pneumologie, Klinik Donaustauf, Donaustauf, Germany
| | - Stefan Stadler
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Olaf Oldenburg
- Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Florian Zeman
- Zentrum für klinische Studien, Biostatistics, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Leonhard Bruch
- Klinik für Innere Medizin / Kardiologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Mirko Seidel
- Klinik für Innere Medizin / Kardiologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Innere Medizin II - Kardiologie, Sana Kliniken des Landkreises Cham, Cham, Germany
| | - Michael Arzt
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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17
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Lindow T, Pahlm O, Khoshnood A, Nyman I, Manna D, Engblom H, Lassen AT, Ekelund U. Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation. SCAND CARDIOVASC J 2019; 54:100-107. [PMID: 31885293 DOI: 10.1080/14017431.2019.1705383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Identification of true STEMI among patients with different ST-elevation etiology may be improved by considering reciprocal ST depression, ST depression in aVR and chest-lead PR depression.
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Affiliation(s)
- Thomas Lindow
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.,Department of Research and Development, Region Kronoberg, Sweden.,Clinical Physiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Olle Pahlm
- Department of Research and Development, Region Kronoberg, Sweden
| | - Ardavan Khoshnood
- Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Ingvar Nyman
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
| | - Daniel Manna
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
| | - Henrik Engblom
- Department of Research and Development, Region Kronoberg, Sweden
| | | | - Ulf Ekelund
- Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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18
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Ibanez B, Aletras AH, Arai AE, Arheden H, Bax J, Berry C, Bucciarelli-Ducci C, Croisille P, Dall'Armellina E, Dharmakumar R, Eitel I, Fernández-Jiménez R, Friedrich MG, García-Dorado D, Hausenloy DJ, Kim RJ, Kozerke S, Kramer CM, Salerno M, Sánchez-González J, Sanz J, Fuster V. Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 74:238-256. [PMID: 31296297 PMCID: PMC7363031 DOI: 10.1016/j.jacc.2019.05.024] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
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Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, IIS Fundación Jiménez Díaz Hospital, Madrid, Spain.
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hakan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, and Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Pierre Croisille
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, United Kingdom
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Division of Cardiology, Department of Medicine, University of California, Los Angeles, California
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthias G Friedrich
- Departments of Medicine & Diagnostic Radiology, McGill University, Montreal, Quebec, Canada; Department of Medicine, Heidelberg University, Heidelberg, Germany
| | - David García-Dorado
- CIBERCV, Madrid, Spain; Vall d'Hebron University Hospital and Research Institute, Universtat Autònoma de Barcelona, Barcelona, Spain
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, National Heart Research Institute Singapore, National Heart Centre, Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, and The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London, United Kingdom; Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, and Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Christopher M Kramer
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | | | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
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Nordlund D, Engblom H, Bonnet JL, Hansen HS, Atar D, Erlinge D, Ekelund U, Heiberg E, Carlsson M, Arheden H. Gender but not diabetes, hypertension or smoking affects infarct evolution in ST-elevation myocardial infarction patients - data from the CHILL-MI, MITOCARE and SOCCER trials. BMC Cardiovasc Disord 2019; 19:161. [PMID: 31269907 PMCID: PMC6610840 DOI: 10.1186/s12872-019-1139-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infarct evolution rate and response to acute reperfusion therapy may differ between patients, which is important to consider for accurate management and treatment of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was therefore to investigate the association of infarct size and myocardial salvage with gender, smoking status, presence of diabetes or history of hypertension in a cohort of STEMI-patients. METHODS Patients (n = 301) with first-time STEMI from the three recent multi-center trials (CHILL-MI, MITOCARE and SOCCER) underwent cardiac magnetic resonance (CMR) imaging to determine myocardium at risk (MaR) and infarct size (IS). Myocardial salvage index (MSI) was calculated as MSI = 1-IS/MaR. Pain to balloon time, culprit vessel, trial treatments, age, TIMI grade flow and collateral flow by Rentrop grading were included as explanatory variables in the statistical model. RESULTS Women (n = 66) had significantly smaller MaR (mean difference: 5.0 ± 1.5% of left ventricle (LV), p < 0.01), smaller IS (mean difference: 5.1 ± 1.4% of LV, p = 0.03), and larger MSI (mean difference: 9.6 ± 2.8% of LV, p < 0.01) compared to men (n = 238). These differences remained significant when adjusting for other explanatory variables. There were no significant effects on MaR, IS or MSI for diabetes, hypertension or smoking. CONCLUSIONS Female gender is associated with higher myocardial salvage and smaller infarct size suggesting a pathophysiological difference in infarct evolution between men and women.
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Affiliation(s)
- David Nordlund
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Jean-Louis Bonnet
- Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ulf Ekelund
- Department of Emergency Medicine, Clinical Sciences, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.
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20
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Bulluck H, Dharmakumar R, Arai AE, Berry C, Hausenloy DJ. Cardiovascular Magnetic Resonance in Acute ST-Segment-Elevation Myocardial Infarction: Recent Advances, Controversies, and Future Directions. Circulation 2019; 137:1949-1964. [PMID: 29712696 DOI: 10.1161/circulationaha.117.030693] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although mortality after ST-segment elevation myocardial infarction (MI) is on the decline, the number of patients developing heart failure as a result of MI is on the rise. Apart from timely reperfusion by primary percutaneous coronary intervention, there is currently no established therapy for reducing MI size. Thus, new cardioprotective therapies are required to improve clinical outcomes after ST-segment-elevation MI. Cardiovascular magnetic resonance has emerged as an important imaging modality for assessing the efficacy of novel therapies for reducing MI size and preventing subsequent adverse left ventricular remodeling. The recent availability of multiparametric mapping cardiovascular magnetic resonance imaging has provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and changes in the remote myocardial interstitial space after ST-segment-elevation MI. In this article, we provide an overview of the recent advances in cardiovascular magnetic resonance imaging in reperfused patients with ST-segment-elevation MI, discuss the controversies surrounding its use, and explore future applications of cardiovascular magnetic resonance in this setting.
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Affiliation(s)
- Heerajnarain Bulluck
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.).,Royal Papworth Hospital, Cambridge, United Kingdom (H.B.)
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute and Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.D.).,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (R.D.)
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (A.E.A.)
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.B.)
| | - Derek J Hausenloy
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.). .,National Institute of Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (D.J.H.).,Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom (D.J.H.).,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.).,Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.)
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21
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Kyhl K, Ahtarovski KA, Nepper-Christensen L, Ekström K, Ghotbi AA, Schoos M, Göransson C, Bertelsen L, Helqvist S, Holmvang L, Jørgensen E, Pedersen F, Saunamäki K, Clemmensen P, De Backer O, Høfsten DE, Køber L, Kelbæk H, Vejlstrup N, Lønborg J, Engstrøm T. Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A DANAMI-3-PRIMULTI Cardiac Magnetic Resonance Substudy. JACC Cardiovasc Interv 2019; 12:721-730. [PMID: 31000010 DOI: 10.1016/j.jcin.2019.01.248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of fractional flow reserve (FFR)-guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions. BACKGROUND Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown. METHODS In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)-PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up. RESULTS A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12). CONCLUSIONS Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.
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Affiliation(s)
- Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Medicine, Nykoebing F Hospital, Nykoebing F and University of Southern Denmark, Odense, Denmark; University Clinic of Hamburg-Eppendorf, The Heart Centre, Hamburg, Germany
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University, Roskilde, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Zealand University, Roskilde, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Zealand University, Roskilde, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, University of Lund, Lund, Sweden
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22
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A. Fagiry M, A. Hassan I, Abukonna A, Yousef M, Alonazi B, N. Alnasse M, Z. Mahmoud M. Cardiac Magnetic Resonance Imaging in the Diagnosis of Ischemic Heart Disease. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2019.1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van der Weg K, Kuijt WJ, Bekkers SC, Tijssen JG, Green CL, Smulders MW, Lemmert ME, Krucoff MW, Gorgels AP. Bursts of reperfusion arrhythmias occur independently of area at risk size and are the first marker of reperfusion injury. Int J Cardiol 2018; 271:240-246. [DOI: 10.1016/j.ijcard.2018.05.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/22/2018] [Accepted: 05/22/2018] [Indexed: 12/22/2022]
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Effect of oxygen therapy on myocardial salvage in ST elevation myocardial infarction: the randomized SOCCER trial. Eur J Emerg Med 2018; 25:78-84. [PMID: 27893526 DOI: 10.1097/mej.0000000000000431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI). MATERIALS AND METHODS This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI. CMR was performed 2-6 days after the inclusion. The primary endpoint was the myocardial salvage index assessed by CMR. The secondary endpoints included infarct size and myocardium at risk. RESULTS At inclusion, the O2 (n=46) and air (n=49) patient groups had similar patient characteristics. There were no significant differences in myocardial salvage index [53.9±25.1 vs. 49.3±24.0%; 95% confidence interval (CI): -5.4 to 14.6], myocardium at risk (31.9±10.0% of the left ventricle in the O2 group vs. 30.0±11.8% in the air group; 95% CI: -2.6 to 6.3), or infarct size (15.6±10.4% of the left ventricle vs. 16.0±11.0%; 95% CI: -4.7 to 4.1). CONCLUSION In STEMI patients undergoing acute PCI, we found no effect of high-flow oxygen compared with room air on the size of ischemia before PCI, myocardial salvage, or the resulting infarct size. These results support the safety of withholding supplemental oxygen in normoxic STEMI patients.
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Andrikopoulou E, Lloyd SG. Could 82Rb-PET be the next best thing in evaluation of myocardial salvage? J Nucl Cardiol 2018; 25:982-985. [PMID: 27878515 DOI: 10.1007/s12350-016-0733-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Efstathia Andrikopoulou
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 201, Birmingham, AL, USA
| | - Steven G Lloyd
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 201, Birmingham, AL, USA.
- Birmingham VA Medical Center, Birmingham, AL, USA.
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26
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Ghotbi AA, Kjaer A, Nepper-Christensen L, Ahtarovski KA, Lønborg JT, Vejlstrup N, Kyhl K, Christensen TE, Engstrøm T, Kelbæk H, Holmvang L, Bang LE, Ripa RS, Hasbak P. Subacute cardiac rubidium-82 positron emission tomography ( 82Rb-PET) to assess myocardial area at risk, final infarct size, and myocardial salvage after STEMI. J Nucl Cardiol 2018; 25:970-981. [PMID: 27743299 PMCID: PMC5966489 DOI: 10.1007/s12350-016-0694-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 09/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Determining infarct size and myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) is important when assessing the efficacy of new reperfusion strategies. We investigated whether rest 82Rb-PET myocardial perfusion imaging can estimate area at risk, final infarct size, and myocardial salvage index when compared to cardiac SPECT and magnetic resonance (CMR). METHODS Twelve STEMI patients were injected with 99mTc-Sestamibi intravenously immediate prior to reperfusion. SPECT, 82Rb-PET, and CMR imaging were performed post-reperfusion and at a 3-month follow-up. An automated algorithm determined area at risk, final infarct size, and hence myocardial salvage index. RESULTS SPECT, CMR, and PET were performed 2.2 ± 0.5, 34 ± 8.5, and 32 ± 24.4 h after reperfusion, respectively. Mean (± SD) area at risk were 35.2 ± 16.6%, 34.7 ± 11.3%, and 28.1 ± 16.1% of the left ventricle (LV) in SPECT, CMR, and PET, respectively, P = 0.04 for difference. Mean final infarct size estimates were 12.3 ± 15.4%, 13.7 ± 10.4%, and 11.9 ± 14.6% of the LV in SPECT, CMR, and PET imaging, respectively, P = .72. Myocardial salvage indices were 0.64 ± 0.33 (SPECT), 0.65 ± 0.20 (CMR), and 0.63 ± 0.28 (PET), (P = .78). CONCLUSIONS 82Rb-PET underestimates area at risk in patients with STEMI when compared to SPECT and CMR. However, our findings suggest that PET imaging seems feasible when assessing the clinical important parameters of final infarct size and myocardial salvage index, although with great variability, in a selected STEMI population with large infarcts. These findings should be confirmed in a larger population.
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Affiliation(s)
- Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kiril Aleksov Ahtarovski
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Emil Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Lindow T, Pahlm O, Olson CW, Khoshnood A, Ekelund U, Carlsson M, Swenne CA, Man S, Engblom H. Diagnostic Accuracy Of The Electrocardiographic Decision Support – Myocardial Ischaemia (EDS-MI) Algorithm In Detection Of Acute Coronary Occlusion. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:13-25. [DOI: 10.1177/2048872618768081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Electrocardiographic Decision Support – Myocardial Ischaemia (EDS-MI) is a graphical decision support for detection and localization of acute transmural ischaemia. A recent study indicated that EDS-MI performs well for detection of acute transmural ischaemia. However, its performance has not been tested in patients with non-ischaemic ST-deviation. We aimed to optimize the diagnostic accuracy of EDS-MI in patients with verified acute coronary occlusion as well as patients with non-ischaemic ST deviation and compare its performance with STEMI criteria. We studied 135 patients with non-ischaemic ST deviation (perimyocarditis, left ventricular hypertrophy, takotsubo cardiomyopathy and early repolarization) and 117 patients with acute coronary occlusion. In 63 ischaemic patients, the extent and location of the ischaemic area (myocardium at risk) was assessed by both cardiovascular magnetic resonance imaging and EDS-MI. Sensitivity and specificity of ST elevation myocardial infarction criteria were 85% (95% confidence interval (CI) 77, 90) and 44% (95% CI 36, 53) respectively. Using EDS-MI, sensitivity and specificity increased to 92% (95% CI 85, 95) and 81% (95% CI 74, 87) respectively (p=0.035 and p<0.001). Agreement was strong (83%) between cardiovascular magnetic resonance imaging and EDS-MI in localization of ischaemia. Mean myocardium at risk was 32% (± 10) by cardiovascular magnetic resonance imaging and 33% (± 11) by EDS-MI when the estimated infarcted area according to Selvester QRS scoring was included in myocardium at risk estimation. In conclusion, EDS-MI increases diagnostic accuracy and may serve as an automatic decision support in the early management of patients with suspected acute coronary syndrome. The added clinical benefit in a non-selected clinical chest pain population needs to be assessed.
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Affiliation(s)
- Thomas Lindow
- Department of Clinical Physiology, Växjö Central Hospital, Sweden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Sweden
| | - Olle Pahlm
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Sweden
| | | | - Ardavan Khoshnood
- Lund University, Department of Clinical Sciences Lund, Emergency Medicine, Skane University Hospital, Sweden
| | - Ulf Ekelund
- Lund University, Department of Clinical Sciences Lund, Emergency Medicine, Skane University Hospital, Sweden
| | - Marcus Carlsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Sweden
| | - Cees A Swenne
- Cardiology Department, Leiden University Medical Center, The Netherlands
| | - Sumche Man
- Cardiology Department, Leiden University Medical Center, The Netherlands
| | - Henrik Engblom
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Sweden
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Travin MI. Potential for adrenergic imaging to serve as a unique tool for guidance of patient management during and after an acute ischemic event. J Nucl Cardiol 2018; 25:581-585. [PMID: 27650444 DOI: 10.1007/s12350-016-0675-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY, 10467-2490, USA.
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Vauchot F, Ben Bouallègue F, Hedon C, Piot C, Roubille F, Mariano-Goulart D. Assessment of the area at risk after acute myocardial infarction using 123I-MIBG SPECT: Comparison with the angiographic APPROACH-score. J Nucl Cardiol 2018; 25:572-580. [PMID: 27549427 DOI: 10.1007/s12350-016-0644-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessment of the area at risk (AAR) associated with an acute myocardial infarction is crucial for evaluating prevention and revascularization strategies. The aim of this study was to evaluate whether 123I-metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) provides a more widely available assessment of anatomical AAR than the established anatomical angiographic methods. METHODS Seventy patients with ST-segment elevation acute myocardial infarction (STEMI) underwent coronary angiography with percutaneous coronary intervention and subsequent 123I-MIBG myocardial scintigraphy with left myocardial relative radiotracer uptake evaluation 12 ± 10 days after STEMI. Patients were divided into two groups depending on whether the culprit artery was occluded (50 patients) or sub-occluded (20 patients). Two scores were calculated as a percentage of the left ventricular myocardium surface, the first using a standard 17-segment summed rest score derived from the relative quantitative evaluation of 123I-MIBG myocardial uptake (MAR) and the second using the modified APPROACH-score (ApAR). RESULTS For the patients with occluded artery, this study showed a high correlation between MAR and the angiographic score (Pearson r = .762 and P < .0001). For the patients with sub-occluded artery, for which the ApAR is not reliable, this study showed no correlation between MAR and the angiographic score (Pearson r = .18 and P = 0.45). CONCLUSIONS 123I-MIBG myocardial scintigraphy provides ARR assessment similar to that of ApAR in patients with a single occluded coronary artery. However, MAR differs from ApAR when angiographic scores are known to be inaccurate (sub-occluded culprit artery) or impossible to use. Further studies are needed to evaluate the potential clinical interest of 123I-MIBG SPECT as an alternative for area at risk assessment after STEMI even when the culprit artery is sub-occluded or when the angiographic scores cannot be used.
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Affiliation(s)
- Fabien Vauchot
- Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
| | - Fayçal Ben Bouallègue
- Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
| | - Christophe Hedon
- Department of Cardiology, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
| | - Christophe Piot
- Department of Cardiology, Clinique du Millénaire, 34960, Montpellier Cedex 2, France
- IGF - UMR5203 - U1191 - UM, Montpellier, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France
| | - Denis Mariano-Goulart
- Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France.
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France.
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Jia X, Heiberg E, Ripa MS, Engblom H, Halvorsen S, Arheden H, Atar D, Clemmensen P, Birnbaum Y. Correlation of ST changes in leads V4-V6 to area of ischemia by CMR in inferior STEMI. SCAND CARDIOVASC J 2018; 52:189-195. [PMID: 29595340 DOI: 10.1080/14017431.2018.1458145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aim to determine the correlation between ST-segment changes in leads V4-V6 and the extent of myocardial injury by cardiac magnetic resonance (CMR) in patients with inferior ST elevation (STE) myocardial infarction (iSTEMI). DESIGN Admission electrocardiogram and CMR data from the MITOCARE trial were used. Differences in mean myocardium at risk, infarct size, ejection fraction and myocardial segment involvement by CMR were compared in patients with first iSTEMI with STE, ST depression (STD) or no ST changes (NST) in V4-V6. Myocardial segment involvement was further evaluated by comparing proportion of patients in each group with ≥25% and ≥50% segment involvement. RESULTS Fifty-four patients were included. Patients with STE (n = 22) and STD (n = 16) in V4-V6 had significantly lower ejection fraction compared to NST (n = 16) (48% vs 48% vs 54%, p = .02). STE showed more apical, apical lateral and mid-inferolateral involvement but less basal inferior involvement than NST. STD exhibited greater basal inferoseptal involvement compared to STE. There were more patients with STE that had ≥25% and ≥50% apical lateral involvement compared with STD and NST groups. Patients with STD were more likely to have ≥25% and ≥50% basal inferoseptal involvement compared with STE and NST groups. CONCLUSION Our study suggests that in iSTEMI, ST changes in the precordial leads V4-V6 correlates with greater myocardial injury and distribution of myocardium at risk.
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Affiliation(s)
- Xiaoming Jia
- a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA
| | - Einar Heiberg
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Maria Sejersten Ripa
- c Department of Cardiology, The Heart Centre , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Henrik Engblom
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Sigrun Halvorsen
- d Department of Cardiology, Division of Medicine , Oslo University Hospital and Institute of Clinical Sciences, University of Oslo , Oslo , Norway
| | - Håkan Arheden
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Dan Atar
- d Department of Cardiology, Division of Medicine , Oslo University Hospital and Institute of Clinical Sciences, University of Oslo , Oslo , Norway
| | - Peter Clemmensen
- e Department of Medicine, Division of Cardiology , Nykøbing Falster Hospital , Nykøbing Falster , Denmark.,f Institute of Regional Health Research , University of Southern Denmark , Odense , Denmark.,g Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Yochai Birnbaum
- a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA
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Myocardial Salvage Imaging: Where Are We and Where Are We Heading? A Cardiac Magnetic Resonance Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9448-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Khoshnood A, Akbarzadeh M, Carlsson M, Sparv D, Bhiladvala P, Mokhtari A, Erlinge D, Ekelund U. Effect of oxygen therapy on chest pain in patients with ST elevation myocardial infarction: results from the randomized SOCCER trial. SCAND CARDIOVASC J 2018; 52:69-73. [PMID: 29436868 DOI: 10.1080/14017431.2018.1439183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Oxygen (O2) have been a cornerstone in the treatment of acute myocardial infarction. Studies have been inconclusive regarding the cardiovascular and analgesic effects of oxygen in these patients. In the SOCCER trial, we compared the effects of oxygen treatment versus room air in patients with ST-elevation myocardial infarction (STEMI). There was no difference in myocardial salvage index or infarct size assessed with cardiac magnetic resonance imaging. In the present subanalysis, we wanted to evaluate the effect of O2 on chest pain in patients with STEMI. DESIGN Normoxic patients with first time STEMI were randomized in the ambulance to standard care with 10 l/min O2 or room air until the end of the percutaneous coronary intervention (PCI). The ambulance personnel noted the patients´ chest pain on a visual analog scale (VAS; 1-10) before randomization and after the transport but before the start of the PCI, and also registered the amount of morphine given. RESULTS 160 patients were randomized to O2 (n = 85) or room air (n = 75). The O2 group had a higher median VAS at randomization than the air group (7.0 ± 2.3 vs 6.0 ± 2.9; p = .02) and also received a higher median total dose of morphine (5.0 mg ± 4.4 vs 4.0 mg ± 3.7; p = .02). There was no difference between the O2 and air groups in VAS at the start of the PCI (4.0 ± 2.4 vs 3.0 ± 2.5; p = .05) or in the median VAS decrease from randomization to the start of the PCI (-2.0 ± 2.2 vs -1.0 ± 2.9; p = .18). CONCLUSION Taken together with previously published data, these results do not support a significant analgesic effect of oxygen in patients with STEMI. European Clinical Trials Database (EudraCT): 2011-001452-11. ClinicalTrials.gov Identifier: NCT01423929.
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Affiliation(s)
- Ardavan Khoshnood
- a Department of Clinical Sciences, Emergency and Internal Medicine , Lund University, Skåne University Hospital , Lund , Sweden
| | - Mahin Akbarzadeh
- a Department of Clinical Sciences, Emergency and Internal Medicine , Lund University, Skåne University Hospital , Lund , Sweden
| | - Marcus Carlsson
- b Department of Clinical Sciences, Clinical Physiology , Lund University, Skåne University Hospital , Lund , Sweden
| | - David Sparv
- c Department of Clinical Sciences, Cardiology , Lund University, Skåne University Hospital , Lund , Sweden
| | | | - Arash Mokhtari
- a Department of Clinical Sciences, Emergency and Internal Medicine , Lund University, Skåne University Hospital , Lund , Sweden
| | - David Erlinge
- c Department of Clinical Sciences, Cardiology , Lund University, Skåne University Hospital , Lund , Sweden
| | - Ulf Ekelund
- a Department of Clinical Sciences, Emergency and Internal Medicine , Lund University, Skåne University Hospital , Lund , Sweden
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Myocardium at risk assessed by electrocardiographic scores and cardiovascular magnetic resonance - a MITOCARE substudy. J Electrocardiol 2017; 50:725-731. [DOI: 10.1016/j.jelectrocard.2017.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 11/19/2022]
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Tahir E, Sinn M, Bohnen S, Avanesov M, Säring D, Stehning C, Schnackenburg B, Eulenburg C, Wien J, Radunski UK, Blankenberg S, Adam G, Higgins CB, Saeed M, Muellerleile K, Lund GK. Acute versus Chronic Myocardial Infarction: Diagnostic Accuracy of Quantitative Native T1 and T2 Mapping versus Assessment of Edema on Standard T2-weighted Cardiovascular MR Images for Differentiation. Radiology 2017; 285:83-91. [DOI: 10.1148/radiol.2017162338] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Enver Tahir
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Martin Sinn
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Sebastian Bohnen
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Maxim Avanesov
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Dennis Säring
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Christian Stehning
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Bernhard Schnackenburg
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Christine Eulenburg
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Joshua Wien
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Ulf K. Radunski
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Stefan Blankenberg
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Gerhard Adam
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Charles B. Higgins
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Maythem Saeed
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Kai Muellerleile
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Gunnar K. Lund
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
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Aquaro GD, Di Bella G, Castelletti S, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Pontone G. Clinical recommendations of cardiac magnetic resonance, Part I: ischemic and valvular heart disease: a position paper of the working group 'Applicazioni della Risonanza Magnetica' of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2017; 18:197-208. [PMID: 28072628 DOI: 10.2459/jcm.0000000000000498] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as a reliable and accurate diagnostic tool for the evaluation of patients with cardiac disease in several clinical settings and with proven additional diagnostic and prognostic value compared with other imaging modalities. This document has been developed by the working group on the 'application of CMR' of the Italian Society of Cardiology to provide a perspective on the current state of technical advances and clinical applications of CMR and to inform cardiologists on how to implement their clinical and diagnostic pathways with the inclusion of this technique in clinical practice. The writing committee consisted of members of the working group of the Italian Society of Cardiology and two external peer reviewers with acknowledged experience in the field of CMR.
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Affiliation(s)
- Giovanni Donato Aquaro
- aU.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa bUO Cardiologia, Università di Messina, Messina cIstituto Auxologico Italiano, Milano dDepartment of Cardiovascular, Respiratory, Geriatric, Anesthesiologic and Nephrologic Sciences, Sapienza University of Rome, Rome, Italy eCentre for Cardiac MR, Cardiology Unit, University Hospital Lausanne, Lausanne, Switzerland fU.O. Radiologia Diagnostica, Humanitas Hospital, Milan gDivision of Cardiology, Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piemont University, Novara hU.O. Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università di Padova, Padua iUnità Operativa di Cardiologia Universitaria Dipartimento di Emergenze e Trapianti di Organi (D.E.T.O.) Azienda Ospedaliera Policlinico Consorziale di Bari, Bari jLaboratorio di RM Cardiovascolare Divisione di Cardiologia Clinica Villa dei Fiori, Acerra kU.O. Cardiologia, Centro Cardiologico Monzino, Milano, Italy
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Fernández-Jiménez R, Barreiro-Pérez M, Martin-García A, Sánchez-González J, Agüero J, Galán-Arriola C, García-Prieto J, Díaz-Pelaez E, Vara P, Martinez I, Zamarro I, Garde B, Sanz J, Fuster V, Sánchez PL, Ibanez B. Dynamic Edematous Response of the Human Heart to Myocardial Infarction: Implications for Assessing Myocardial Area at Risk and Salvage. Circulation 2017; 136:1288-1300. [PMID: 28687712 PMCID: PMC5625960 DOI: 10.1161/circulationaha.116.025582] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/26/2017] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Clinical protocols aimed to characterize the post–myocardial infarction (MI) heart by cardiac magnetic resonance (CMR) need to be standardized to take account of dynamic biological phenomena evolving early after the index ischemic event. Here, we evaluated the time course of edema reaction in patients with ST-segment–elevation MI by CMR and assessed its implications for myocardium-at-risk (MaR) quantification both in patients and in a large-animal model. Methods: A total of 16 patients with anterior ST-segment–elevation MI successfully treated by primary angioplasty and 16 matched controls were prospectively recruited. In total, 94 clinical CMR examinations were performed: patients with ST-segment–elevation MI were serially scanned (within the first 3 hours after reperfusion and at 1, 4, 7, and 40 days), and controls were scanned only once. T2 relaxation time in the myocardium (T2 mapping) and the extent of edema on T2-weighted short-tau triple inversion-recovery (ie, CMR-MaR) were evaluated at all time points. In the experimental study, 20 pigs underwent 40-minute ischemia/reperfusion followed by serial CMR examinations at 120 minutes and 1, 4, and 7 days after reperfusion. Reference MaR was assessed by contrast-multidetector computed tomography during the index coronary occlusion. Generalized linear mixed models were used to take account of repeated measurements. Results: In humans, T2 relaxation time in the ischemic myocardium declines significantly from early after reperfusion to 24 hours, and then increases up to day 4, reaching a plateau from which it decreases from day 7. Consequently, edema extent measured by T2-weighted short-tau triple inversion-recovery (CMR-MaR) varied with the timing of the CMR examination. These findings were confirmed in the experimental model by showing that only CMR-MaR values for day 4 and day 7 postreperfusion, coinciding with the deferred edema wave, were similar to values measured by reference contrast-multidetector computed tomography. Conclusions: Post-MI edema in patients follows a bimodal pattern that affects CMR estimates of MaR. Dynamic changes in post–ST-segment–elevation MI edema highlight the need for standardization of CMR timing to retrospectively delineate MaR and quantify myocardial salvage. According to the present clinical and experimental data, a time window between days 4 and 7 post-MI seems a good compromise solution for standardization. Further studies are needed to study the effect of other factors on these variables.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Manuel Barreiro-Pérez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Ana Martin-García
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Javier Sánchez-González
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Jaume Agüero
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Carlos Galán-Arriola
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Jaime García-Prieto
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Elena Díaz-Pelaez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Pedro Vara
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Irene Martinez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Ivan Zamarro
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Beatriz Garde
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Javier Sanz
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Valentin Fuster
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Pedro L Sánchez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.).
| | - Borja Ibanez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.).
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Khoshnood A, Akbarzadeh M, Roijer A, Meurling C, Carlsson M, Bhiladvala P, Höglund P, Sparv D, Todorova L, Mokhtari A, Erlinge D, Ekelund U. Effects of oxygen therapy on wall-motion score index in patients with ST elevation myocardial infarction-the randomized SOCCER trial. Echocardiography 2017; 34:1130-1137. [DOI: 10.1111/echo.13599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Ardavan Khoshnood
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| | - Mahin Akbarzadeh
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| | - Anders Roijer
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | - Carl Meurling
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | | | - Peter Höglund
- Region Skåne Research and Development Center; Lund Sweden
| | - David Sparv
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | | | - Arash Mokhtari
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | - Ulf Ekelund
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
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Fernández-Jiménez R, Galán-Arriola C, Sánchez-González J, Agüero J, López-Martín GJ, Gomez-Talavera S, Garcia-Prieto J, Benn A, Molina-Iracheta A, Barreiro-Pérez M, Martin-García A, García-Lunar I, Pizarro G, Sanz J, Sánchez PL, Fuster V, Ibanez B. Effect of Ischemia Duration and Protective Interventions on the Temporal Dynamics of Tissue Composition After Myocardial Infarction. Circ Res 2017; 121:439-450. [PMID: 28596216 PMCID: PMC5542781 DOI: 10.1161/circresaha.117.310901] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 01/18/2023]
Abstract
Supplemental Digital Content is available in the text. Rationale: The impact of cardioprotective strategies and ischemia duration on postischemia/reperfusion (I/R) myocardial tissue composition (edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction) is not well understood. Objective: To study the effect of ischemia duration and protective interventions on the temporal dynamics of myocardial tissue composition in a translational animal model of I/R by the use of state-of-the-art imaging technology. Methods and Results: Four 5-pig groups underwent different I/R protocols: 40-minute I/R (prolonged ischemia, controls), 20-minute I/R (short-duration ischemia), prolonged ischemia preceded by preconditioning, or prolonged ischemia followed by postconditioning. Serial cardiac magnetic resonance (CMR)-based tissue characterization was done in all pigs at baseline and at 120 minutes, day 1, day 4, and day 7 after I/R. Reference myocardium at risk was assessed by multidetector computed tomography during the index coronary occlusion. After the final CMR, hearts were excised and processed for water content quantification and histology. Five additional healthy pigs were euthanized after baseline CMR as reference. Edema formation followed a bimodal pattern in all 40-minute I/R pigs, regardless of cardioprotective strategy and the degree of intramyocardial hemorrhage or microvascular obstruction. The hyperacute edematous wave was ameliorated only in pigs showing cardioprotection (ie, those undergoing short-duration ischemia or preconditioning). In all groups, CMR-measured edema was barely detectable at 24 hours postreperfusion. The deferred healing-related edematous wave was blunted or absent in pigs undergoing preconditioning or short-duration ischemia, respectively. CMR-measured infarct size declined progressively after reperfusion in all groups. CMR-measured myocardial salvage, and the extent of intramyocardial hemorrhage and microvascular obstruction varied dramatically according to CMR timing, ischemia duration, and cardioprotective strategy. Conclusions: Cardioprotective therapies, duration of index ischemia, and the interplay between these greatly influence temporal dynamics and extent of tissue composition changes after I/R. Consequently, imaging techniques and protocols for assessing edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction should be standardized accordingly.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Carlos Galán-Arriola
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Javier Sánchez-González
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Jaume Agüero
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Gonzalo J López-Martín
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Sandra Gomez-Talavera
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Jaime Garcia-Prieto
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Austin Benn
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Antonio Molina-Iracheta
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Manuel Barreiro-Pérez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Ana Martin-García
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Inés García-Lunar
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Gonzalo Pizarro
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Javier Sanz
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Pedro L Sánchez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Valentin Fuster
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Borja Ibanez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.).
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Quantifying the area-at-risk of myocardial infarction in-vivo using arterial spin labeling cardiac magnetic resonance. Sci Rep 2017; 7:2271. [PMID: 28536472 PMCID: PMC5442118 DOI: 10.1038/s41598-017-02544-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/12/2017] [Indexed: 01/05/2023] Open
Abstract
T2-weighted cardiovascular magnetic resonance (T2-CMR) of myocardial edema can quantify the area-at-risk (AAR) following acute myocardial infarction (AMI), and has been used to assess myocardial salvage by new cardioprotective therapies. However, some of these therapies may reduce edema, leading to an underestimation of the AAR by T2-CMR. Here, we investigated arterial spin labeling (ASL) perfusion CMR as a novel approach to quantify the AAR following AMI. Adult B6sv129-mice were subjected to in vivo left coronary artery ligation for 30 minutes followed by 72 hours reperfusion. T2-mapping was used to quantify the edema-based AAR (% of left ventricle) following ischemic preconditioning (IPC) or cyclosporin-A (CsA) treatment. In control animals, the AAR by T2-mapping corresponded to that delineated by histology. As expected, both IPC and CsA reduced MI size. However, IPC, but not CsA, also reduced myocardial edema leading to an underestimation of the AAR by T2-mapping. In contrast, regions of reduced myocardial perfusion delineated by cardiac ASL were able to delineate the AAR when compared to both T2-mapping and histology in control animals, and were not affected by either IPC or CsA. Therefore, ASL perfusion CMR may be an alternative method for quantifying the AAR following AMI, which unlike T2-mapping, is not affected by IPC.
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Bulluck H, Rosmini S, Abdel-Gadir A, White SK, Bhuva AN, Treibel TA, Fontana M, Ramlall M, Hamarneh A, Sirker A, Herrey AS, Manisty C, Yellon DM, Kellman P, Moon JC, Hausenloy DJ. Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment-Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004940. [PMID: 27894068 PMCID: PMC5068185 DOI: 10.1161/circimaging.116.004940] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/11/2016] [Indexed: 12/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background— The presence of intramyocardial hemorrhage (IMH) in ST-segment–elevation myocardial infarction patients reperfused by primary percutaneous coronary intervention has been associated with residual myocardial iron at follow-up, and its impact on adverse left ventricular (LV) remodeling is incompletely understood and is investigated here. Methods and Results— Forty-eight ST-segment–elevation myocardial infarction patients underwent cardiovascular magnetic resonance at 4±2 days post primary percutaneous coronary intervention, of whom 40 had a follow-up scan at 5±2 months. Native T1, T2, and T2* maps were acquired. Eight out of 40 (20%) patients developed adverse LV remodeling. A subset of 28 patients had matching T2* maps, of which 15/28 patients (54%) had IMH. Eighteen of 28 (64%) patients had microvascular obstruction on the acute scan, of whom 15/18 (83%) patients had microvascular obstruction with IMH. On the follow-up scan, 13/15 patients (87%) had evidence of residual iron within the infarct zone. Patients with residual iron had higher T2 in the infarct zone surrounding the residual iron when compared with those without. In patients with adverse LV remodeling, T2 in the infarct zone surrounding the residual iron was also higher than in those without (60 [54–64] ms versus 53 [51–56] ms; P=0.025). Acute myocardial infarct size, extent of microvascular obstruction, and IMH correlated with the change in LV end-diastolic volume (Pearson’s rho of 0.64, 0.59, and 0.66, respectively; P=0.18 and 0.62, respectively, for correlation coefficient comparison) and performed equally well on receiver operating characteristic curve for predicting adverse LV remodeling (area under the curve: 0.99, 0.94, and 0.95, respectively; P=0.19 for receiver operating characteristic curve comparison). Conclusions— The majority of ST-segment–elevation myocardial infarction patients with IMH had residual myocardial iron at follow-up. This was associated with persistently elevated T2 values in the surrounding infarct tissue and adverse LV remodeling. IMH and residual myocardial iron may be potential therapeutic targets for preventing adverse LV remodeling in reperfused ST-segment–elevation myocardial infarction patients.
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Affiliation(s)
- Heerajnarain Bulluck
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Stefania Rosmini
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Amna Abdel-Gadir
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Steven K White
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Anish N Bhuva
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Thomas A Treibel
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Marianna Fontana
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Manish Ramlall
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Ashraf Hamarneh
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Alex Sirker
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Anna S Herrey
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Charlotte Manisty
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Derek M Yellon
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Peter Kellman
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - James C Moon
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., S.K.W., M.R., A.H., D.M.Y., D.J.H.); National Institute of Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (H.B., S.K.W., M.R., A.H., A.S., D.M.Y., J.C.M., D.J.H.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (H.B., S.R., A.A.-G., S.K.W., A.N.B., T.A.T., M.F., M.R., A.H., A.S., A.S.H., C.M., J.C.M., D.J.H.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore (D.J.H.).
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Chen WR, Chen YD, Tian F, Yang N, Cheng LQ, Hu SY, Wang J, Yang JJ, Wang SF, Gu XF. Effects of Liraglutide on Reperfusion Injury in Patients With ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005146. [PMID: 27940956 DOI: 10.1161/circimaging.116.005146] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Liraglutide, a glucagon-like peptide-1 analog, was reported to reduce reperfusion injury in mice. We planned to evaluate the effects of liraglutide on reperfusion injury in patients with acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. METHODS AND RESULTS A total of 96 patients with ST-segment-elevation myocardial infarction undergoing emergency primary percutaneous coronary intervention were randomized to receive either subcutaneous liraglutide or placebo. Study treatment was commenced 30 minutes before intervention (1.8 mg) and maintained for 7 days after the procedure (0.6 mg for 2 days, 1.2 mg for 2 days, followed by 1.8 mg for 3 days). The salvage index was calculated from myocardial area at risk, measured during the index admission (35±12 hours), and final infarct size measured at 91±5 days after primary percutaneous coronary intervention by cardiac magnetic resonance. At 3 months, the primary end point, a higher salvage index was found in the liraglutide group than in the placebo group in 77 patients evaluated with cardiac magnetic resonance (0.66±0.14 versus 0.55±0.15; P=0.001). The final infarct size was lower in the liraglutide group than that in the placebo group (15±12 versus 21±15 g; P=0.05). Serum high-sensitivity C-reactive protein level was lower in the liraglutide group (P<0.001). During a 6-month follow-up period, no difference was observed in the incidence of major adverse cardiovascular event. Safety and tolerability were similar among the 2 groups. CONCLUSIONS Our study provides evidence that liraglutide improves myocardial salvage and infarct size after ST-segment-elevation myocardial infarction, possibly by reducing reperfusion injury, making it a promising treatment for evaluation in larger trials. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02001363.
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Affiliation(s)
- Wei Ren Chen
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Yun Dai Chen
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China.
| | - Feng Tian
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Na Yang
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Liu Quan Cheng
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Shun Ying Hu
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Jing Wang
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Jun Jie Yang
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Shi Feng Wang
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
| | - Xiao Fang Gu
- From the Department of Cardiology (W.R.C., Y.D.C., F.T., S.Y.H., J.W., J.J.Y., S.F.W., X.F.G.) and Division of MRI, Department of Radiology (N.Y., L.Q.C.), PLA General Hospital at Beijing, China
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42
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Fernández-Friera L, García-Ruiz JM, García-Álvarez A, Fernández-Jiménez R, Sánchez-González J, Rossello X, Gómez-Talavera S, López-Martín GJ, Pizarro G, Fuster V, Ibáñez B. Impacto del territorio miocárdico infartado en la cuantificación del área en riesgo mediante cardiorresonancia magnética. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Topal DG, Lønborg J, Ahtarovski KA, Nepper-Christensen L, Helqvist S, Holmvang L, Pedersen F, Clemmensen P, Saünamaki K, Jørgensen E, Kyhl K, Ghotbi A, Schoos MM, Göransson C, Bertelsen L, Høfsten D, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T. Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004467. [DOI: 10.1161/circinterventions.116.004467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/10/2017] [Indexed: 11/16/2022]
Abstract
Background—
Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment–elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI.
Methods and Results—
The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1–1) and again at day 92 (IQR, 89–96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39–0.69] versus 0.65 [IQR, 0.46–0.84];
P
<0.001) and larger MVO (1.4 [IQR, 0.0–5.4] versus 0.0 [IQR, 0.0–2.4];
P
<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=−0.12;
P
=0.03) and MVO (β=0.18;
P
=0.001) after adjusting for potential confounders.
Conclusions—
Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01435408.
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Affiliation(s)
- Divan Gabriel Topal
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Jacob Lønborg
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Kiril Aleksov Ahtarovski
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Lars Nepper-Christensen
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Steffen Helqvist
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Lene Holmvang
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Frants Pedersen
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Peter Clemmensen
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Kari Saünamaki
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Erik Jørgensen
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Kasper Kyhl
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Ali Ghotbi
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Mikkel Malby Schoos
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Christoffer Göransson
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Litten Bertelsen
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Dan Høfsten
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Lars Køber
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Henning Kelbæk
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Niels Vejlstrup
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
| | - Thomas Engstrøm
- From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.)
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Khan JN, McCann GP. Cardiovascular magnetic resonance imaging assessment of outcomes in acute myocardial infarction. World J Cardiol 2017; 9:109-133. [PMID: 28289525 PMCID: PMC5329738 DOI: 10.4330/wjc.v9.i2.109] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/02/2016] [Accepted: 01/02/2017] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging uniquely characterizes myocardial and microvascular injury in acute myocardial infarction (AMI), providing powerful surrogate markers of outcomes. The last 10 years have seen an exponential increase in AMI studies utilizing CMR based endpoints. This article provides a contemporary, comprehensive review of the powerful role of CMR imaging in the assessment of outcomes in AMI. The theory, assessment techniques, chronology, importance in predicting left ventricular function and remodelling, and prognostic value of each CMR surrogate marker is described in detail. Major studies illustrating the importance of the markers are summarized, providing an up to date review of the literature base in CMR imaging in AMI.
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Affiliation(s)
- Jamal N Khan
- Jamal N Khan, Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| | - Gerry P McCann
- Jamal N Khan, Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
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Hammer-Hansen S, Leung SW, Hsu LY, Wilson JR, Taylor J, Greve AM, Thune JJ, Køber L, Kellman P, Arai AE. Early Gadolinium Enhancement for Determination of Area at Risk: A Preclinical Validation Study. JACC Cardiovasc Imaging 2017; 10:130-139. [PMID: 27665165 PMCID: PMC5384795 DOI: 10.1016/j.jcmg.2016.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/14/2016] [Accepted: 04/14/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether early gadolinium enhancement (EGE) by cardiac magnetic resonance (CMR) in a canine model of reperfused myocardial infarction depicts the area at risk (AAR) as determined by microsphere blood flow analysis. BACKGROUND It remains controversial whether only the irreversibly injured myocardium enhances when CMR is performed in the setting of acute myocardial infarction. Recently, EGE has been proposed as a measure of the AAR in acute myocardial infarction because it correlates well with T2-weighted imaging of the AAR, but this still requires pathological validation. METHODS Eleven dogs underwent 2 h of coronary artery occlusion and 48 h of reperfusion before imaging at 1.5-T. EGE imaging was performed 3 min after contrast administration with coverage of the entire left ventricle. Late gadolinium enhancement imaging was performed between 10 and 15 min after contrast injection. AAR was defined as myocardium with blood flow <2 SD from remote myocardium determined by microspheres during occlusion. The size of infarction was determined with triphenyltetrazolium chloride. RESULTS There was no significant difference in the size of enhancement by EGE compared with the size of AAR by microspheres (44.1 ± 15.8% vs. 42.7 ± 9.2%; p = 0.61), with good correlation (r = 0.88; p < 0.001) and good agreement by Bland-Altman analysis (mean bias 1.4 ± 17.4%). There was no difference in the size of enhancement by EGE compared with enhancement on native T1 and T2 maps. The size of EGE was significantly greater than the infarct by triphenyltetrazolium chloride (44.1 ± 15.8% vs. 20.7 ± 14.4%; p < 0.001) and late gadolinium enhancement (44.1 ± 15.8% vs. 23.5 ± 12.7%; p < 0.001). CONCLUSIONS At 3 min post-contrast, EGE correlated well with the AAR by microspheres and CMR and was greater than infarct size. Thus, EGE enhances both reversibly and irreversibly injured myocardium.
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Affiliation(s)
- Sophia Hammer-Hansen
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Steve W Leung
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Medicine and Radiology, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Li-Yueh Hsu
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Joel R Wilson
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Medicine and Radiology, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California
| | - Joni Taylor
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Anders M Greve
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Jens Jakob Thune
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Peter Kellman
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
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Myocardium at Risk by Early Gadolinium Enhancement MR Imaging. JACC Cardiovasc Imaging 2017; 10:140-142. [DOI: 10.1016/j.jcmg.2016.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/31/2016] [Indexed: 11/22/2022]
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Nordlund D, Kanski M, Jablonowski R, Koul S, Erlinge D, Carlsson M, Engblom H, Aletras AH, Arheden H. Experimental validation of contrast-enhanced SSFP cine CMR for quantification of myocardium at risk in acute myocardial infarction. J Cardiovasc Magn Reson 2017; 19:12. [PMID: 28132648 PMCID: PMC5278574 DOI: 10.1186/s12968-017-0325-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/12/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Accurate assessment of myocardium at risk (MaR) after acute myocardial infarction (AMI) is necessary when assessing myocardial salvage. Contrast-enhanced steady-state free precession (CE-SSFP) is a recently developed cardiovascular magnetic resonance (CMR) method for assessment of MaR up to 1 week after AMI. Our aim was to validate CE-SSFP for determination of MaR in an experimental porcine model using myocardial perfusion single-photon emission computed tomography (MPS) as a reference standard and to test the stability of MaR-quantification over time after injecting gadolinium-based contrast. METHODS Eleven pigs were subjected to either 35 or 40 min occlusion of the left anterior descending artery followed by six hours of reperfusion. A technetium-based perfusion tracer was administered intravenously ten minutes before reperfusion. In-vivo and ex-vivo CE-SSFP CMR was performed followed by ex-vivo MPS imaging. MaR was expressed as % of left ventricular mass (LVM). RESULTS There was good agreement between MaR by ex-vivo CMR and MaR by MPS (bias: 1 ± 3% LVM, r 2 = 0.92, p < 0.001), between ex-vivo and in-vivo CMR (bias 0 ± 2% LVM, r 2 = 0.94, p < 0.001) and between in-vivo CMR and MPS (bias -2 ± 3% LVM, r 2 = 0.87, p < 0.001. No change in MaR was seen over the first 30 min after contrast injection (p = 0.95). CONCLUSIONS Contrast-enhanced SSFP cine CMR can be used to measure MaR, both in vivo and ex vivo, in a porcine model with good accuracy and precision over the first 30 min after contrast injection. This offers the option to use the less complex ex-vivo imaging when determining myocardial salvage in experimental studies.
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Affiliation(s)
- David Nordlund
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Robert Jablonowski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Anthony H. Aletras
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
- Laboratory of Computing and Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
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Nepper-Christensen L, Lønborg J, Ahtarovski KA, Høfsten DE, Kyhl K, Ghotbi AA, Schoos MM, Göransson C, Bertelsen L, Køber L, Helqvist S, Pedersen F, Saünamaki K, Jørgensen E, Kelbæk H, Holmvang L, Vejlstrup N, Engstrøm T. Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2017; 6:e004823. [PMID: 28069574 PMCID: PMC5523642 DOI: 10.1161/jaha.116.004823] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/02/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all-cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention. METHODS AND RESULTS In this substudy of the DANAMI-3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy-eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10-21] vs 9% [IQR, 3-17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5-0.7] vs 0.7 [IQR, 0.5-0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47-60] vs 61% [IQR, 55-65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all-cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38-4.90], P=0.003). The results remained statistically significant in multivariable models. CONCLUSIONS LVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all-cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.
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Affiliation(s)
- Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Christoffer Göransson
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kari Saünamaki
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Katsumata Y, Sano F, Abe T, Tamura T, Fujisawa T, Shiraishi Y, Kohsaka S, Ueda I, Homma K, Suzuki M, Okuda S, Maekawa Y, Kobayashi E, Hori S, Sasaki J, Fukuda K, Sano M. The Effects of Hydrogen Gas Inhalation on Adverse Left Ventricular Remodeling After Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction ― First Pilot Study in Humans ―. Circ J 2017; 81:940-947. [DOI: 10.1253/circj.cj-17-0105] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine
- Center for Molecular Hydrogen Medicine, Keio University School of Medicine
| | - Fumiya Sano
- Clinical and Translational Research Center, Keio University Hospital
| | - Takayuki Abe
- Clinical and Translational Research Center, Keio University Hospital
| | - Tomoyoshi Tamura
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine
- Center for Molecular Hydrogen Medicine, Keio University School of Medicine
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine
| | | | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine
- Center for Molecular Hydrogen Medicine, Keio University School of Medicine
| | - Masaru Suzuki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine
- Center for Molecular Hydrogen Medicine, Keio University School of Medicine
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine
| | | | - Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine
- Center for Molecular Hydrogen Medicine, Keio University School of Medicine
| | - Shingo Hori
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine
- Center for Molecular Hydrogen Medicine, Keio University School of Medicine
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Jablonowski R, Engblom H, Kanski M, Nordlund D, Koul S, van der Pals J, Englund E, Heiberg E, Erlinge D, Carlsson M, Arheden H. Contrast-Enhanced CMR Overestimates Early Myocardial Infarct Size: Mechanistic Insights Using ECV Measurements on Day 1 and Day 7. JACC Cardiovasc Imaging 2016; 8:1379-1389. [PMID: 26699107 DOI: 10.1016/j.jcmg.2015.08.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to investigate whether an overestimation of infarct size on cardiac magnetic resonance (CMR) versus triphenyltetrazolium chloride (TTC) exists acutely and whether it remains after 7 days in an experimental pig model and to elucidate possible mechanisms. BACKGROUND Overestimation of infarct size (IS) on late gadolinium enhancement CMR early after acute myocardial infarction has been debated. METHODS Pigs were subjected to 40 min of left anterior descending artery occlusion and 6 h (n = 9) or 7 days (n = 9) reperfusion. IS by in vivo and ex vivo CMR was compared with TTC staining. Extracellular volume (ECV) was obtained from biopsies using technetium 99m diethylenetriamine pentaacetic acid (99mTc-DTPA) and light microscopy. TTC slices were rescanned on CMR enabling slice-by-slice comparison. RESULTS IS did not differ between in vivo and ex vivo CMR (p = 0.77). IS was overestimated by 27.3% with ex vivo CMR compared with TTC (p = 0.008) acutely with no significant difference at 7 days (p = 0.39). Slice-by-slice comparison showed similar results. A significant decrease in ECV was seen in biopsies of myocardium at risk (MaR) close to the infarct (sometimes referred to as the peri-infarction zone) over 7 days (48.3 ± 4.4% vs. 29.2 ± 2.4%; p = 0.0025). The ECV differed between biopsies of MaR close to the infarct and the rest of the salvaged MaR acutely (48.3 ± 4.4% vs. 32.4 ± 3.2%; p = 0.013) but not at 7 days (29.2 ± 2.4% vs 25.7 ± 1.4%; p = 0.23). CONCLUSIONS CMR overestimates IS compared with TTC acutely but not at 7 days. This difference may be explained by higher ECV in MaR closest to the infarct acutely that decreases during 7 days to the same level as the rest of the salvaged MaR. The increased ECV in the MaR closest to the infarct day 1 could be due to severe edema or an admixture of infarcted and salvaged myocardium (partial volume) or both. Nonetheless, this could not be reproduced at 7 days. These results have implications for timing of magnetic resonance infarct imaging early after acute myocardial infarction.
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Affiliation(s)
- Robert Jablonowski
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden
| | - David Nordlund
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Elisabet Englund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden; Centre for Mathematical Sciences, Lund University, Lund, Sweden; Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund, Sweden.
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