1
|
Civieri G, Kerkhof PLM, Montisci R, Iliceto S, Tona F. Sex differences in diagnostic modalities of coronary artery disease: Evidence from coronary microcirculation. Atherosclerosis 2023; 384:117276. [PMID: 37775426 DOI: 10.1016/j.atherosclerosis.2023.117276] [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: 03/24/2023] [Revised: 06/16/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
Although atherosclerosis is usually considered a disease of the large arteries, risk factors for atherosclerosis also trigger structural and functional abnormalities at a microvascular level. In cardiac disease, microvascular dysfunction is especially relevant in women, among whom the manifestation of ischemic disease due to impaired coronary microcirculation is more common than in men. This sex-specific clinical phenotype has important clinical implications and, given the higher pre-test probability of coronary microvascular dysfunction in females, different diagnostic modalities should be used in women compared to men. In this review, we summarize invasive and non-invasive diagnostic modalities to assess coronary microvascular function, ranging from catheter-based evaluation of endothelial function to Doppler echocardiography and positron emission tomography. Moreover, we discuss different clinical settings in which microvascular disease plays an important role, underlining the importance of choosing the right diagnostic modality depending on the sex of the patients.
Collapse
Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| |
Collapse
|
2
|
Zhang S, Zhu Z, Luo M, Chen L, He C, You Z, He H, Lin M, Zhang L, Lin K, Guo Y. The optimal definition and prediction nomogram for left ventricular remodelling after acute myocardial infarction. ESC Heart Fail 2023; 10:2955-2965. [PMID: 37489064 PMCID: PMC10567660 DOI: 10.1002/ehf2.14479] [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: 03/13/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS Left ventricular (LV) remodelling after acute myocardial infarction (AMI) is associated with heart failure and increased mortality. There was no consensus on the definition of LV remodelling, and the prognostic value of LV remodelling with different definitions has not been compared. We aimed to find the optimal definition and develop a prediction nomogram as well as online calculator that can identify patients at risk of LV remodelling. METHODS AND RESULTS This prospective, observational study included 829 AMI patients undergoing percutaneous coronary intervention from January 2015 to January 2020. Echocardiography was performed within the 48 h of admission and at 6 months after infarction to evaluate LV remodelling, defined as a 20% increase in LV end-diastolic volume (LVEDV), a 15% increase in LV end-systolic volume (LVESV), or LV ejection fraction (LVEF) < 50% at 6 months. The impact of LV remodelling on long-term outcomes was analysed. Lasso regression was performed to screen potential predictors, and multivariable logistic regression analysis was conducted to establish the prediction nomogram. The area under the curve, calibration curve and decision curve analyses were used to determine the discrimination, calibration and clinical usefulness of the remodelling nomogram. The incidences of LV remodelling defined by LVEDV, LVESV and LVEF were 24.85% (n = 206), 28.71% (n = 238) and 14.60% (n = 121), respectively. Multivariable Cox regression models demonstrated that different definitions of LV remodelling were independently associated with the composite endpoint. However, only remodelling defined by LVEF was significantly connected with long-term mortality (hazard ratio = 2.78, 95% confidence interval 1.41-5.48, P = 0.003). Seven variables were selected to construct the remodelling nomogram, including diastolic blood pressure, heart rate, AMI type, stent length, N-terminal pro brain natriuretic peptide, troponin I, and glucose. The prediction model had an area under the receiver operating characteristics curve of 0.766. The calibration curve and decision curve analysis indicated consistency and better net benefit in the prediction model. CONCLUSIONS LV remodelling defined by LVEDV, LVESV and LVEF were independent predictors for long-term mortality or heart failure hospitalization in AMI patients after percutaneous coronary intervention. However, only remodelling defined by LVEF was suitable for predicting all-cause death. In addition, the nomogram can provide an accurate and effective tool for the prediction of postinfarct remodelling.
Collapse
Affiliation(s)
- Sicheng Zhang
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Zheng Zhu
- Department of Endocrine and Metabolic Diseases, School of MedicineShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Manqing Luo
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Lichuan Chen
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Chen He
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Zhebin You
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
- Department of Geriatric MedicineShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
| | - Haoming He
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Maoqing Lin
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Liwei Zhang
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Kaiyang Lin
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Yansong Guo
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| |
Collapse
|
3
|
Al-Katat A, Bergeron A, Parent L, Lorenzini M, Fiset C, Calderone A. Rapamycin treatment unmasks a sex-specific pattern of scar expansion of the infarcted rat heart: The relationship between mTOR and K ATP channel. IUBMB Life 2023; 75:717-731. [PMID: 36988388 DOI: 10.1002/iub.2722] [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: 01/02/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023]
Abstract
Inhibition of the mammalian target of rapamycin (mTOR) with the macrolide rapamycin or pharmacological suppression of KATP channel opening translated to scar expansion of the myocardial infarcted (MI) adult female rodent heart. The present study tested the hypotheses that rapamycin-mediated scar expansion was sex-specific and that mTOR signaling directly influenced KATP channel subunit expression/activity. Scar size was significantly larger in post-MI male rats as compared to the previous data reported in post-MI female rats. The reported scar expansion of rapamycin-treated post-MI female rats was not observed following the administration of the macrolide to post-MI male rats. Protein levels of the KATP channel subunits Kir6.2 and SUR2A and phosphorylation of the serine2448 residue of mTOR were similar in the normal heart of adult male and female rats. By contrast, greater tuberin inactivation characterized by the increased phosphorylation of the threonine1462 residue and reduced raptor protein levels were identified in the normal heart of adult female rats. Rapamycin pretreatment of phorbol 12,13-dibutyrate (PDBu)-treated neonatal rat ventricular cardiomyocytes (NNVMs) suppressed hypertrophy, inhibited p70S6K phosphorylation, and attenuated SUR2A protein upregulation. In the presence of low ATP levels, KATP channel activity detected in untreated NNVMs was significantly attenuated in PDBu-induced hypertrophied NNVMs via a rapamycin-independent pathway. Thus, rapamycin administration to post-MI rats unmasked a sex-specific pattern of scar expansion and mTOR signaling in PDBu-induced hypertrophied NNVMs significantly increased SUR2A protein levels. However, the biological advantage associated with SUR2A protein upregulation was partially offset by an mTOR-independent pathway that attenuated KATP channel activity in PDBu-induced hypertrophied NNVMs.
Collapse
Affiliation(s)
- Aya Al-Katat
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, Québec, Canada
| | - Alexandre Bergeron
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Lucie Parent
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, Québec, Canada
| | - Maxime Lorenzini
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Celine Fiset
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Angelino Calderone
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
4
|
Mikail N, Rossi A, Bengs S, Haider A, Stähli BE, Portmann A, Imperiale A, Treyer V, Meisel A, Pazhenkottil AP, Messerli M, Regitz-Zagrosek V, Kaufmann PA, Buechel RR, Gebhard C. Imaging of heart disease in women: review and case presentation. Eur J Nucl Med Mol Imaging 2022; 50:130-159. [PMID: 35974185 PMCID: PMC9668806 DOI: 10.1007/s00259-022-05914-6] [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: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
Collapse
Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging - Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, Strasbourg, France.,Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin, Berlin, Berlin, Germany.,University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland. .,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
5
|
Kleinbongard P, Lieder H, Skyschally A, Heusch G. No sex-related differences in infarct size, no-reflow and protection by ischaemic preconditioning in Göttingen minipigs. Cardiovasc Res 2022; 119:561-570. [PMID: 35426434 DOI: 10.1093/cvr/cvac062] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Female sex has been proposed to be cardioprotective per se. Studies with myocardial ischaemia/reperfusion and infarct size as endpoint have demonstrated cardioprotection in female, castrated male and male pigs. These studies are difficult to compare, given the different pig strains, models, durations of ischaemia and methods of infarct size quantification. The few studies using both female and male pigs reported no differences in infarct size and cardioprotection. We therefore prospectively compared infarct size in Göttingen minipigs undergoing ischaemia/reperfusion (I/R) without and with ischaemic preconditioning (IPC) between female, castrated male and male pigs.
Methods and Results
In a prospective, randomised approach, 28 Göttingen open-chest, anaesthetised minipigs underwent 60 min ischaemia by distal left anterior descending artery (LAD) occlusion and 180 min reperfusion without and with IPC by 3 cycles of 5 min LAD occlusion/10 min reperfusion. Infarct size with I/R was not different between female, castrated male and male pigs (45±8 vs. 45±13 vs. 41±9% area at risk), as was the reduction in infarct size with IPC (25±11 vs. 30±8 vs. 19±10% area at risk). Also, the area of no-reflow was not different between female, castrated male and male pigs with I/R (57±13 vs. 35±7 vs. 47±26% infarct size) or IPC (4±10 vs.12±20 vs. 0±0% infarct size). Phosphorylation of signal transducer and activator of transcription 3 was increased at 10 min reperfusion by IPC but not by I/R to the same extent in female, castrated male and male pigs (198±30 vs. 230±165 vs. 179±107% of baseline).
Conclusion
Our data do not support the notion of sex- or castration-related differences in infarct size, coronary microvascular injury and cardioprotection by ischaemic preconditioning.
Translational perspective
The translation of successful preclinical studies on cardioprotection to the benefit of patients with reperfused myocardial infarction has been difficult. The difficulties have been attributed to confounders such as co-morbidities and co-medications which patients typically have but animals don´t, but also to age and sex. Notably, female sex has been considered as protective per se. We have now, using our established and clinically relevant pig model of reperfused acute myocardial infarction and ischaemic preconditioning as the most robust cardioprotective intervention looked for sex-related differences of infarct size, no-reflow and cardioprotection by ischaemic preconditioning in a prospectively powered approach but found none such difference.
Collapse
Affiliation(s)
- Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| | - Helmut Lieder
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| | - Andreas Skyschally
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
6
|
Calvieri C, Galea N, Cilia F, Pambianchi G, Mancuso G, Filomena D, Cimino S, Carbone I, Francone M, Agati L, Catalano C. Protective Value of Aspirin Loading Dose on Left Ventricular Remodeling After ST-Elevation Myocardial Infarction. Front Cardiovasc Med 2022; 9:786509. [PMID: 35369291 PMCID: PMC8965885 DOI: 10.3389/fcvm.2022.786509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
AimsLeft ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) is a complex process, defined as changes of LV volumes over time. CMR feature tracking analysis (CMR-FT) offers an accurate quantitative assessment of LV wall deformation and myocardial contractile function. This study aimed to evaluate the role of myocardial strain parameters in predicting LV remodeling and to investigate the effect of Aspirin (ASA) dose before primary coronary angioplasty (pPCI) on myocardial injury and early LV remodeling.Methods and ResultsSeventy-eight patients undergoing CMR, within 9 days from symptom onset and after 6 months, were enrolled in this cohort retrospective study. We divided the study population into three groups based on a revised Bullock's classification and we evaluated the role of baseline CMR features in predicting early LV remodeling. Regarding CMR strain analysis, worse global circumferential and longitudinal strain (GCS and GLS) values were associated with adverse LV remodeling. Patients were also divided based on pre-pPCI ASA dosage. Significant differences were detected in patients receiving ASA 500 mg dose before pPCI, which showed lower infarct size extent and better strain values compared to those treated with ASA 250 mg. The stepwise multivariate logistic regression analysis, adjusted for covariates, indicated that a 500 mg ASA dose remained an inverse independent predictor of early adverse LV remodeling.ConclusionGCS and GLS have high specificity to detect early LV adverse remodeling. We first reported a protective effect of ASA loading dose of 500 mg before pPCI on LV myocardial damage and in reducing early LV adverse remodeling.
Collapse
Affiliation(s)
- Camilla Calvieri
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Policlinico Umberto I” Hospital, Sapienza University of Rome, Rome, Italy
| | - Nicola Galea
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Nicola Galea
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Mancuso
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Policlinico Umberto I” Hospital, Sapienza University of Rome, Rome, Italy
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Policlinico Umberto I” Hospital, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Policlinico Umberto I” Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
7
|
Liu T, Wang C, Wang L, Shi X, Li X, Chen J, Xuan H, Li D, Xu T. Development and Validation of a Clinical and Laboratory-Based Nomogram for Predicting Coronary Microvascular Obstruction in NSTEMI Patients After Primary PCI. Ther Clin Risk Manag 2022; 18:155-169. [PMID: 35250271 PMCID: PMC8893270 DOI: 10.2147/tcrm.s353199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Cardiac microvascular obstruction (CMVO) remains a severe complication in non-ST elevation myocardial infarction (NSTEMI) patients with reperfusion therapy. We aimed at developing and validating the nomogram to predict the possibility of CMVO after primary percutaneous coronary intervention (PCI) by integrating clinical and laboratory-based information. Methods A total of 325 patients undergoing primary PCI for NSTEMI were recruited and divided into the training cohort (n=226) and the validating cohort (n = 99). The development of the nomogram was based on independent predictors of CMVO, and these variables were selected by multivariable logistic regression analysis. Results Independent predictors contained in nomogram were identified by multivariable logistic regression analysis, and these independent predictors included neutrophils (OR 1.166, 95% CI 1.044–1.303, P<0.01), hemoglobin (OR 1.037, 95% CI 1.013–1.062, P<0.01), triglyceride (OR 1.343, 95% CI 1.059; 1.704, P=0.015), Killip grade (OR 2.190, 95% CI 1.065–4.503, P=0.033), high thrombus load (OR 3.146, 95% CI 1.424–6.952, P<0.01), no-reflow (OR 3.142, 95% CI 1.419–6.955, P<0.01) and ischemic postconditioning (OR 0.445, 95% CI 0.209–0.944, P=0.035). The nomogram accurately predicted the presentation of CMVO in both the training set and validating set (AUC, 0.835 and 0.881, respectively). The results predicted by nomogram were confirmed to be highly consistent with the results of DE-CMR, both the training and validating cohorts, by Calibration plot and Hosmer-Lemeshow test. Decision curve analysis (DCA) also suggested that the nomogram was applicable in the clinic. Conclusion The nomogram showed good performance in predicting CMVO, and it could help clinicians optimize the clinical treatments to improve the prognosis of NSTEMI patients.
Collapse
Affiliation(s)
- Tao Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xiangxiang Shi
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xiaoqun Li
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Hoachen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
- Correspondence: Tongda Xu; Dongye Li, Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China, Email ;
| |
Collapse
|
8
|
Aimo A, Panichella G, Barison A, Maffei S, Cameli M, Coiro S, D'Ascenzi F, Di Mario C, Liga R, Marcucci R, Morrone D, Olivotto I, Tritto I, Emdin M. Sex-related differences in ventricular remodeling after myocardial infarction. Int J Cardiol 2021; 339:62-69. [PMID: 34314766 DOI: 10.1016/j.ijcard.2021.07.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
The epidemiology, clinical features and outcome of myocardial infarction (MI) display significant differences between men and women. Prominent sex differences have also been suggested in left ventricular (LV) remodeling after MI. Ventricular remodeling refers to a deterioration of LV geometry and function often leading to heart failure (HF) development and an increased risk of adverse cardiovascular events. Women have a lower propensity to the acquisition of a spherical geometry and LV dysfunction. These differences can be attributed at least partially to a lower frequency of transmural infarction and smaller areas of microvascular obstruction in women, as well as to a less prominent activation of neuroendocrine systems and apoptotic, inflammatory and profibrotic pathways in women. Estrogens might play a role in this difference, which could partially persist even after the menopause because of a persisting intramyocardial synthesis of estrogens in women. Conversely, androgens may exert a detrimental influence. Future studies should better clarify sex differences in the predictors, clinical correlates, prognostic impact and disease mechanisms of remodeling, as well as the existence of sex-specific therapeutic targets. This research effort should hopefully allow to optimize the treatment of MI during the acute and post-acute phase, possibly through different therapeutic strategies in men and women, with the goal of reducing the risk of HF development and improving patient outcome.
Collapse
Affiliation(s)
- Alberto Aimo
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Andrea Barison
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Italy
| | - Stefano Coiro
- Division of Cardiology, University of Perugia, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Rossella Marcucci
- Experimental and Clinical Medicine, University of Florence, Atherothrombotic Center, AOU Careggi, Florence, Italy
| | - Doralisa Morrone
- Cardio-Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Iacopo Olivotto
- Cardiomiopathy Unit, AOU Careggi, Florence, Italy. Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra
| | | | - Michele Emdin
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
9
|
Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The effect of sex on door-to-balloon time in patients presenting with ST-elevation myocardial infarction and referred for primary percutaneous coronary intervention: A systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:120-127. [PMID: 34334335 DOI: 10.1016/j.carrev.2021.07.011] [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: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Timely reperfusion using primary percutaneous coronary intervention (pPCI) is the cornerstone of acute ST-elevation myocardial infarction (STEMI) management. We conducted a systematic review to examine the effect of sex on door-to-balloon (D2B) time and symptom-to-balloon (S2B) time. We observed longer D2B times and S2B times in female patients presenting with STEMI and referred for pPCI when compared to male patients. Future work is required to try and elucidate and mitigate sex-based front-line treatment delays for female STEMI patients.
Collapse
Affiliation(s)
- Corinne S Babiolakis
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Shubham Sharma
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Nawid Sayed
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Joseph G Abunassar
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia.
| | - Wael Abuzeid
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| |
Collapse
|
10
|
Pontone G, Di Cesare E, Castelletti S, De Cobelli F, De Lazzari M, Esposito A, Focardi M, Di Renzi P, Indolfi C, Lanzillo C, Lovato L, Maestrini V, Mercuro G, Natale L, Mantini C, Polizzi A, Rabbat M, Secchi F, Secinaro A, Aquaro GD, Barison A, Francone M. Appropriate use criteria for cardiovascular magnetic resonance imaging (CMR): SIC-SIRM position paper part 1 (ischemic and congenital heart diseases, cardio-oncology, cardiac masses and heart transplant). LA RADIOLOGIA MEDICA 2021; 126:365-379. [PMID: 33629237 PMCID: PMC7937599 DOI: 10.1007/s11547-020-01332-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as new mainstream technique for the evaluation of patients with cardiac diseases, providing unique information to support clinical decision-making. This document has been developed by a joined group of experts of the Italian Society of Cardiology and Italian society of Radiology and aims to produce an updated consensus statement about the current state of technology and clinical applications of CMR. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac radiology. Part 1 of the document will cover ischemic heart disease, congenital heart disease, cardio-oncology, cardiac masses and heart transplant.
Collapse
Affiliation(s)
| | - Ernesto Di Cesare
- Department of Life, Healt and Enviromental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvia Castelletti
- Center for the Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Manuel De Lazzari
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonio Esposito
- Center for the Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Marta Focardi
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Di Renzi
- U.O.C. Radiologia, Ospedale "San Giovanni Calibita" Fatebenefratelli - Isola Tiberina, Rome, Italy
| | - Ciro Indolfi
- Division of Cardiology, University Magna Graecia, Italy and Mediterranea Cardiocentro, Naples, Italy
| | | | - Luigi Lovato
- Cardiovascular Radiology Unit, Department of Imaging S.Orsola, Malpighi University Hospital, Bologna, Italy
| | - Viviana Maestrini
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Natale
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology - Diagnostic Imaging Area, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Universita ` Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Aldo Polizzi
- Unit of Radiodiagnostics II, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Mark Rabbat
- Loyola University of Chicago, Chicago, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy.
| |
Collapse
|
11
|
Kleinbongard P, Bøtker HE, Ovize M, Hausenloy DJ, Heusch G. Co-morbidities and co-medications as confounders of cardioprotection-Does it matter in the clinical setting? Br J Pharmacol 2020; 177:5252-5269. [PMID: 31430831 PMCID: PMC7680006 DOI: 10.1111/bph.14839] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023] Open
Abstract
The translation of cardioprotection from robust experimental evidence to beneficial clinical outcome for patients suffering acute myocardial infarction or undergoing cardiovascular surgery has been largely disappointing. The present review attempts to critically analyse the evidence for confounders of cardioprotection in patients with acute myocardial infarction and in patients undergoing cardiovascular surgery. One reason that has been proposed to be responsible for such lack of translation is the confounding of cardioprotection by co-morbidities and co-medications. Whereas there is solid experimental evidence for such confounding of cardioprotection by single co-morbidities and co-medications, the clinical evidence from retrospective analyses of the limited number of clinical data is less robust. The best evidence for interference of co-medications is that for platelet inhibitors to recruit cardioprotection per se and thus limit the potential for further protection from myocardial infarction and for propofol anaesthesia to negate the protection from remote ischaemic conditioning in cardiovascular surgery. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.23/issuetoc.
Collapse
Affiliation(s)
- Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular CenterUniversity of Essen Medical SchoolEssenGermany
| | - Hans Erik Bøtker
- Department of CardiologyAarhus University Hospital SkejbyAarhusDenmark
| | - Michel Ovize
- INSERM U1060, CarMeN Laboratory, Université de Lyon and Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de LyonLyonFrance
| | - Derek J. Hausenloy
- Cardiovascular and Metabolic Disorders ProgramDuke‐National University of Singapore Medical SchoolSingapore
- National Heart Research Institute SingaporeNational Heart CentreSingapore
- Yong Loo Lin School of MedicineNational University SingaporeSingapore
- The Hatter Cardiovascular InstituteUniversity College LondonLondonUK
- Research and DevelopmentThe National Institute of Health Research University College London Hospitals Biomedical Research CentreLondonUK
- Tecnologico de MonterreyCentro de Biotecnologia‐FEMSAMonterreyNuevo LeonMexico
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular CenterUniversity of Essen Medical SchoolEssenGermany
| |
Collapse
|
12
|
Bucciarelli-Ducci C, Ostenfeld E, Baldassarre LA, Ferreira VM, Frank L, Kallianos K, Raman SV, Srichai MB, McAlindon E, Mavrogeni S, Ntusi NAB, Schulz-Menger J, Valente AM, Ordovas KG. Cardiovascular disease in women: insights from magnetic resonance imaging. J Cardiovasc Magn Reson 2020; 22:71. [PMID: 32981527 PMCID: PMC7520984 DOI: 10.1186/s12968-020-00666-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement.This article reviews the sex differences in cardiovascular disease, explores the diagnostic and prognostic role of cardiovascular magnetic resonance (CMR) in the spectrum of cardiovascular disorders in women, and proposes the added value of CMR compared to other imaging modalities. In addition, this article specifically reviews the role of CMR in cardiovascular diseases occurring more frequently or exclusively in female patients, including Takotsubo cardiomyopathy, connective tissue disorders, primary pulmonary arterial hypertension and peripartum cardiomyopathy. Gaps in knowledge and opportunities for further investigation of sex-specific cardiovascular differences by CMR are also highlighted.
Collapse
Affiliation(s)
- Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Getingevägen 5, SE-22185 Lund, Sweden
| | | | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- University of Texas Medical Branch, Galveston, TX USA
| | | | | | | | - Elisa McAlindon
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | | | | | | | | | | |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
van der Bijl P, Abou R, Goedemans L, Gersh BJ, Holmes DR, Ajmone Marsan N, Delgado V, Bax JJ. Left ventricular remodelling after ST-segment elevation myocardial infarction: sex differences and prognosis. ESC Heart Fail 2020; 7:474-481. [PMID: 32059084 PMCID: PMC7160476 DOI: 10.1002/ehf2.12618] [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: 10/23/2019] [Revised: 12/13/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Aims Left ventricular (LV) remodelling after ST‐segment elevation myocardial infarction (STEMI) worsens outcome. The effect of sex on LV post‐infarct remodelling is unknown. We therefore investigated the sex distribution and long‐term prognosis of LV post‐infarct remodelling after STEMI in the contemporary era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy. Methods and results Data were obtained from an ongoing primary PCI STEMI registry. LV remodelling was defined as ≥20% increase in LV end‐diastolic volume at either 3, 6, or 12 months post‐infarct, and LV remodelling impact on outcome was evaluated with a log‐rank test. A total population of 1995 STEMI patients were analysed (mean age 60 ± 12 years): 1527 (77%) men and 468 (23%) women. The mean age of male patients was 60±11 versus 63±13 years for women (P < 0.001). A total of 953 (48%) patients experienced LV remodelling in the first 12 months of follow‐up, and it was equally frequent amongst men (n = 729, 48%) and women (n = 224, 48%). After a median follow‐up of 94 (interquartile range 69–119) months, 225 patients died: 171 (11%) men and 54 (12%) women. No survival difference was seen between remodellers and non‐remodellers in the male (P = 0.113) and female (P = 0.920) groups. Conclusion LV post‐infarct remodelling incidence, as well as long‐term survival of LV remodellers and non‐remodellers, was similar in men and women who were treated with primary PCI and optimal pharmacotherapy post‐STEMI.
Collapse
Affiliation(s)
- Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rachid Abou
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Laurien Goedemans
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
15
|
Wang M, Smith K, Yu Q, Miller C, Singh K, Sen CK. Mitochondrial connexin 43 in sex-dependent myocardial responses and estrogen-mediated cardiac protection following acute ischemia/reperfusion injury. Basic Res Cardiol 2019; 115:1. [PMID: 31741053 DOI: 10.1007/s00395-019-0759-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/05/2019] [Indexed: 01/23/2023]
Abstract
Preserving mitochondrial activity is crucial in rescuing cardiac function following acute myocardial ischemia/reperfusion (I/R). The sex difference in myocardial functional recovery has been observed after I/R. Given the key role of mitochondrial connexin43 (Cx43) in cardiac protection initiated by ischemic preconditioning, we aimed to determine the implication of mitochondrial Cx43 in sex-related myocardial responses and to examine the effect of estrogen (17β-estradiol, E2) on Cx43, particularly mitochondrial Cx43-involved cardiac protection following I/R. Mouse primary cardiomyocytes and isolated mouse hearts (from males, females, ovariectomized females, and doxycycline-inducible Tnnt2-controlled Cx43 knockout without or with acute post-ischemic E2 treatment) were subjected to simulated I/R in culture or Langendorff I/R (25-min warm ischemia/40-min reperfusion), respectively. Mitochondrial membrane potential and mitochondrial superoxide production were measured in cardiomyocytes. Myocardial function and infarct size were determined. Cx43 and its isoform, Gja1-20k, were assessed in mitochondria. Immunoelectron microscopy and co-immunoprecipitation were also used to examine mitochondrial Cx43 and its interaction with estrogen receptor-α by E2 in mitochondria, respectively. There were sex disparities in stress-induced cardiomyocyte mitochondrial function. E2 partially restored mitochondrial activity in cardiomyocytes following acute injury. Post-ischemia infusion of E2 improved functional recovery and reduced infarct size with increased Cx43 content and phosphorylation in mitochondria. Ablation of cardiac Cx43 aggravated mitochondrial damage and abolished E2-mediated cardiac protection during I/R. Female mice were more resistant to myocardial I/R than age-matched males with greater protective role of mitochondrial Cx43 in female hearts. Post-ischemic E2 usage augmented mitochondrial Cx43 content and phosphorylation, increased mitochondrial Gja1-20k, and showed cardiac protection.
Collapse
Affiliation(s)
- Meijing Wang
- Department of Surgery, Indiana University School of Medicine, 950 W. Walnut Street, R2 E319, Indianapolis, IN, 46202, USA.
| | - Kwynlyn Smith
- Department of Surgery, Indiana University School of Medicine, 950 W. Walnut Street, R2 E319, Indianapolis, IN, 46202, USA
| | - Qing Yu
- Department of Surgery, Indiana University School of Medicine, 950 W. Walnut Street, R2 E319, Indianapolis, IN, 46202, USA
| | - Caroline Miller
- Electron Microscopy Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kanhaiya Singh
- Department of Surgery, Indiana University School of Medicine, 950 W. Walnut Street, R2 E319, Indianapolis, IN, 46202, USA.,Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandan K Sen
- Department of Surgery, Indiana University School of Medicine, 950 W. Walnut Street, R2 E319, Indianapolis, IN, 46202, USA.,Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
16
|
Lalem T, Devaux Y. Circulating microRNAs to predict heart failure after acute myocardial infarction in women. Clin Biochem 2019; 70:1-7. [DOI: 10.1016/j.clinbiochem.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022]
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
Maznyczka AM, Carrick D, Carberry J, Mangion K, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Ford I, Welsh P, Sattar N, Oldroyd KG, Berry C. Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction. Open Heart 2019; 6:e000979. [PMID: 31168381 PMCID: PMC6519583 DOI: 10.1136/openhrt-2018-000979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/29/2019] [Accepted: 03/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI). Methods Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up. Results In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation. Conclusion There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women. Trial registration number NCT02072850.
Collapse
Affiliation(s)
- Annette Marie Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Hood
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Davie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Ahmed Mahrous
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
19
|
Galea N, Dacquino GM, Ammendola RM, Coco S, Agati L, De Luca L, Carbone I, Fedele F, Catalano C, Francone M. Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction. Eur Radiol 2018; 29:2369-2377. [PMID: 30552479 DOI: 10.1007/s00330-018-5895-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/23/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF). METHODS Seventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF > 50% at CMR were included. The median time between STEMI and CMR was 5 days (IQR 2-8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up. RESULTS During median follow-up of 4 years (range 3 to 5 years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p = 0.044) and its extent (2.30 ± 1.64 g vs. 0.18 ± 0.12 g, respectively; p = 0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75-1.0; p = 0.000), late MVO extent > 0.385 g was a strong independent predictor of MACE at long-term follow-up (sensitivity = 87%, specificity = 90%; hazard ratio = 2.24; 95% confidence interval, 1.51-3.33; p = 0.000). CONCLUSIONS Late MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF > 50%. Noticeably, late MVO extent > 0.385 g provided relevant prognostic insights leading to improved long-term risk stratification. KEY POINTS • Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction • The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up. • The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.
Collapse
Affiliation(s)
- Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy.,Department of Experimental Medicine, University of Rome "Sapienza", Rome, Italy
| | - Gian Marco Dacquino
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy
| | - Rosa Maria Ammendola
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy
| | - Simona Coco
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy
| | - Luciano Agati
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University of Rome "Sapienza", Rome, Italy
| | - Laura De Luca
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University of Rome "Sapienza", Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University of Rome "Sapienza", Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy.
| |
Collapse
|
20
|
Prognosis-based definition of left ventricular remodeling after ST-elevation myocardial infarction. Eur Radiol 2018; 29:2330-2339. [PMID: 30547201 PMCID: PMC6443916 DOI: 10.1007/s00330-018-5875-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/17/2018] [Accepted: 11/07/2018] [Indexed: 01/03/2023]
Abstract
Objectives Cardiac magnetic resonance (CMR) is the gold-standard modality for the assessment of left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI) patients. However, the commonly used remodeling criteria have never been validated for hard clinical events. We therefore aimed to define clear CMR criteria of LV remodeling following STEMI with proven prognostic impact. Methods This observational study included 224 patients suffering from acute STEMI. CMR was performed within 1 week and 4 months after infarction to evaluate different remodeling criteria including relative changes in LV end-diastolic volume (%∆LVEDV), end-systolic volume (%∆LVESV), ejection fraction (%∆LVEF), and myocardial mass (%∆LVMM). Primary endpoint was the occurrence of major adverse cardiovascular events (MACE) including all-cause death, re-infarction, stroke, and new congestive heart failure 24 months following STEMI. Secondary endpoint was defined as composite of primary endpoint and cardiovascular hospitalization. The Mann–Whitney U test was applied to assess differences in LV remodeling measures between patients with and without MACE. Values for the prediction of primary and secondary endpoints were assessed by c-statistics and Cox regression analysis. Results The incidence of MACE (n = 13, 6%) was associated with higher %∆LVEDV (p = 0.002) and %∆LVMM (p = 0.02), whereas %∆LVESV and %∆LVEF were not significantly related to MACE (p > 0.05). The area under the curve (AUC) for the prediction of MACE was 0.76 (95% confidence interval [CI], 0.65–0.87) for %∆LVEDV (optimal cut-off 10%) and 0.69 (95%CI, 0.52–0.85) for %∆LVMM (optimal cut-off 5%). From all remodeling criteria, %∆LVEDV ≥ 10% showed highest hazard ratio (8.68 [95%CI, 2.39–31.56]; p = 0.001) for MACE. Regarding secondary endpoint (n = 35, 16%), also %∆LVEDV with an optimal threshold of 10% emerged as strongest prognosticator (AUC 0.66; 95%CI, 0.56–0.75; p = 0.004). Conclusions Following revascularized STEMI, %∆LVEDV ≥ 10% showed strongest association with clinical outcome, suggesting this criterion as preferred CMR-based definition of post-STEMI LV remodeling. Key Points • CMR-determined %∆LVEDV and %∆LVMM were significantly associated with MACE following STEMI. • Neither %∆LVESV nor %∆LVEF showed a significant relation to MACE. • %∆LVEDV ≥ 10 was revealed as LV remodeling definition with highest prognostic validity.
Collapse
|
21
|
Kosmidou I, Redfors B, Selker HP, Thiele H, Patel MR, Udelson JE, Magnus Ohman E, Eitel I, Granger CB, Maehara A, Kirtane A, Généreux P, Jenkins PL, Ben-Yehuda O, Mintz GS, Stone GW. Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials. Eur Heart J 2018; 38:1656-1663. [PMID: 28407050 DOI: 10.1093/eurheartj/ehx159] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/13/2017] [Indexed: 11/14/2022] Open
Abstract
Aim Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. Methods and results We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1 month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P < 0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. Conclusions In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.
Collapse
Affiliation(s)
- Ioanna Kosmidou
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Björn Redfors
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Harry P Selker
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Holger Thiele
- University Heart Center and the German Center for Cardiovascular Research, Lübeck, Germany
| | | | - James E Udelson
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Ingo Eitel
- University Heart Center and the German Center for Cardiovascular Research, Lübeck, Germany
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Ajay Kirtane
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA.,Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Morristown Medical Center, Morristown, NJ, USA
| | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
22
|
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]
|
23
|
Ciocci Pardo A, Scuri S, González Arbeláez LF, Caldiz C, Fantinelli J, Mosca SM. Survival kinase-dependent pathways contribute to gender difference in the response to myocardial ischemia-reperfusion and ischemic post-conditioning. Cardiovasc Pathol 2017; 33:19-26. [PMID: 29414428 DOI: 10.1016/j.carpath.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 01/02/2023] Open
Abstract
The response to ischemia/reperfusion and the effects of ischemic post-conditioning (IPC) are sex-dependent, but the mechanisms have not been clarified. Male (M) and female (F) rat hearts isolated and perfused using the Langendorff technique were subject to 30 min of global ischemia (GI) and 60 min reperfusion (R). In IPC hearts, three cycles of 30-sec GI/30-sec R were applied at the beginning of R. Infarct size and myocardial function were assessed. Superoxide production, antioxidant systems, and expressions of phosphorylated forms of serine/threonine kinase (Akt), glycogen synthase kinase 3β (GSK-3β), protein kinase C ε (PKCε), endothelial nitric oxide synthase (eNOS), and apoptosis were measured. In the basal state, superoxide production and apoptosis were lower, and antioxidant systems and phospho-kinase expressions were higher in F rather than in M hearts. After ischemia-reperfusion, infarct size was less in F hearts, and post-ischemic recovery of myocardial function was higher in F rather than in M hearts. Superoxide production, phospho-kinase activity, phospho-eNOS, and apoptosis increased in both sexes while antioxidants decreased in both sexes. After IPC, infarct size, superoxide production, and apoptosis decreased and phospho-eNOS increased in F and M hearts but phospho-kinase expressions and post-ischemic recovery of myocardial function improved only in M hearts. These results show that Akt/GSK-3β/PKCε/eNOS-dependent pathways-mediated superoxide production and apoptosis appear as important factors involved in the observed gender differences.
Collapse
Affiliation(s)
- Alejandro Ciocci Pardo
- Centro de Investigaciones Cardiovasculares ¨Dr Horacio E. Cingolani¨, CCT-CONICET, Universidad Nacional de La Plata, La Plata, Argentina
| | - Sergio Scuri
- Centro de Investigaciones Cardiovasculares ¨Dr Horacio E. Cingolani¨, CCT-CONICET, Universidad Nacional de La Plata, La Plata, Argentina
| | - Luisa F González Arbeláez
- Centro de Investigaciones Cardiovasculares ¨Dr Horacio E. Cingolani¨, CCT-CONICET, Universidad Nacional de La Plata, La Plata, Argentina
| | - Claudia Caldiz
- Centro de Investigaciones Cardiovasculares ¨Dr Horacio E. Cingolani¨, CCT-CONICET, Universidad Nacional de La Plata, La Plata, Argentina
| | - Juliana Fantinelli
- Centro de Investigaciones Cardiovasculares ¨Dr Horacio E. Cingolani¨, CCT-CONICET, Universidad Nacional de La Plata, La Plata, Argentina
| | - Susana M Mosca
- Centro de Investigaciones Cardiovasculares ¨Dr Horacio E. Cingolani¨, CCT-CONICET, Universidad Nacional de La Plata, La Plata, Argentina.
| |
Collapse
|
24
|
Traverse JH, Henry TD, Pepine CJ, Willerson JT, Chugh A, Yang PC, Zhao DXM, Ellis SG, Forder JR, Perin EC, Penn MS, Hatzopoulos AK, Chambers JC, Baran KW, Raveendran G, Gee AP, Taylor DA, Moyé L, Ebert RF, Simari RD. TIME Trial: Effect of Timing of Stem Cell Delivery Following ST-Elevation Myocardial Infarction on the Recovery of Global and Regional Left Ventricular Function: Final 2-Year Analysis. Circ Res 2017; 122:479-488. [PMID: 29208679 DOI: 10.1161/circresaha.117.311466] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE The TIME trial (Timing in Myocardial Infarction Evaluation) was the first cell therapy trial sufficiently powered to determine if timing of cell delivery after ST-segment-elevation myocardial infarction affects recovery of left ventricular (LV) function. OBJECTIVE To report the 2-year clinical and cardiac magnetic resonance imaging results and their modification by microvascular obstruction. METHODS AND RESULTS TIME was a randomized, double-blind, placebo-controlled trial comparing 150 million bone marrow mononuclear cells versus placebo in 120 patients with anterior ST-segment-elevation myocardial infarctions resulting in LV dysfunction. Primary end points included changes in global (LV ejection fraction) and regional (infarct and border zone) function. Secondary end points included changes in LV volumes, infarct size, and major adverse cardiac events. Here, we analyzed the continued trajectory of these measures out to 2 years and the influence of microvascular obstruction present at baseline on these long-term outcomes. At 2 years (n=85), LV ejection fraction was similar in the bone marrow mononuclear cells (48.7%) and placebo groups (51.6%) with no difference in regional LV function. Infarct size and LV mass decreased ≥30% in each group at 6 months and declined gradually to 2 years. LV volumes increased ≈10% at 6 months and remained stable to 2 years. Microvascular obstruction was present in 48 patients at baseline and was associated with significantly larger infarct size (56.5 versus 36.2 g), greater adverse LV remodeling, and marked reduction in LV ejection fraction recovery (0.2% versus 6.2%). CONCLUSIONS In one of the longest serial cardiac magnetic resonance imaging analyses of patients with large anterior ST-segment-elevation myocardial infarctions, bone marrow mononuclear cells administration did not improve recovery of LV function over 2 years. Microvascular obstruction was associated with reduced recovery of LV function, greater adverse LV remodeling, and more device implantations. The use of cardiac magnetic resonance imaging leads to greater dropout of patients over time because of device implantation in patients with more severe LV dysfunction resulting in overestimation of clinical stability of the cohort. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00684021.
Collapse
Affiliation(s)
- Jay H Traverse
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Timothy D Henry
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Carl J Pepine
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - James T Willerson
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Atul Chugh
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Phillip C Yang
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - David X M Zhao
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Stephen G Ellis
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - John R Forder
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Emerson C Perin
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Marc S Penn
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Antonis K Hatzopoulos
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Jeffrey C Chambers
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Kenneth W Baran
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Ganesh Raveendran
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Adrian P Gee
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Doris A Taylor
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Lem Moyé
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.).
| | - Ray F Ebert
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Robert D Simari
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| |
Collapse
|
25
|
Zwetsloot PP, Kouwenberg LHJA, Sena ES, Eding JE, den Ruijter HM, Sluijter JPG, Pasterkamp G, Doevendans PA, Hoefer IE, Chamuleau SAJ, van Hout GPJ, Jansen Of Lorkeers SJ. Optimization of large animal MI models; a systematic analysis of control groups from preclinical studies. Sci Rep 2017; 7:14218. [PMID: 29079786 PMCID: PMC5660150 DOI: 10.1038/s41598-017-14294-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022] Open
Abstract
Large animal models are essential for the development of novel therapeutics for myocardial infarction. To optimize translation, we need to assess the effect of experimental design on disease outcome and model experimental design to resemble the clinical course of MI. The aim of this study is therefore to systematically investigate how experimental decisions affect outcome measurements in large animal MI models. We used control animal-data from two independent meta-analyses of large animal MI models. All variables of interest were pre-defined. We performed univariable and multivariable meta-regression to analyze whether these variables influenced infarct size and ejection fraction. Our analyses incorporated 246 relevant studies. Multivariable meta-regression revealed that infarct size and cardiac function were influenced independently by choice of species, sex, co-medication, occlusion type, occluded vessel, quantification method, ischemia duration and follow-up duration. We provide strong systematic evidence that commonly used endpoints significantly depend on study design and biological variation. This makes direct comparison of different study-results difficult and calls for standardized models. Researchers should take this into account when designing large animal studies to most closely mimic the clinical course of MI and enable translational success.
Collapse
Affiliation(s)
- P P Zwetsloot
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - L H J A Kouwenberg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E S Sena
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - J E Eding
- Hubrecht Institute, Koninklijke Nederlandse Academie van Wetenschappen (KNAW), University Medical Center Utrecht, Utrecht, The Netherlands
| | - H M den Ruijter
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P G Sluijter
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.,UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Pasterkamp
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.,UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - I E Hoefer
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.,UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G P J van Hout
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
26
|
Schüpke S, Mehilli J. Less myocardial scar but greater propensity for heart failure: another gender paradox in myocardial infarction. Eur Heart J 2017; 38:1664-1665. [PMID: 28475753 DOI: 10.1093/eurheartj/ehx230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stefanie Schüpke
- Deutsches Herzzentrum München, ISAResearch Center, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Julinda Mehilli
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany.,Cardiology Department, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
27
|
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: 22] [Impact Index Per Article: 3.1] [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.
Collapse
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
| |
Collapse
|
28
|
Kim EK, Choi JH, Song YB, Hahn JY, Chang SA, Park SJ, Lee SC, Choi SH, Choe YH, Park SW, Gwon HC. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction. Am Heart J 2016; 171:56-63. [PMID: 26699601 DOI: 10.1016/j.ahj.2015.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/17/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. METHODS In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. RESULTS Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). CONCLUSIONS In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity.
Collapse
Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Young Bin Song
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hyeon Choe
- Division of Radiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
29
|
Arcari L, Cimino S, De Luca L, Francone M, Galea N, Reali M, Carbone I, Iacoboni C, Agati L. Impact of Heart Rate on Myocardial Salvage in Timely Reperfused Patients with ST-Segment Elevation Myocardial Infarction: New Insights from Cardiovascular Magnetic Resonance. PLoS One 2015; 10:e0145495. [PMID: 26716452 PMCID: PMC4696663 DOI: 10.1371/journal.pone.0145495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous studies evaluating the progression of the necrotic wave in relation to heart rate were carried out only in animal models of ST-elevated myocardial infarction (STEMI). Aim of the study was to investigate changes of myocardial salvage in relation to different heart rates at hospital admission in timely reperfused patients with STEMI by using cardiovascular magnetic resonance (CMR). METHODS One hundred-eighty-seven patients with STEMI successfully and timely treated with primary coronary angioplasty underwent CMR five days after hospital admission. According to the heart rate at presentation, patients were subcategorized into 5 quintiles: <55 bpm (group I, n = 44), 55-64 bpm (group II, n = 35), 65-74 bpm (group III, n = 35), 75-84 bpm (group IV, n = 37), ≥85 bpm (group V, n = 36). Area at risk, infarct size, microvascular obstruction (MVO) and myocardium salvaged index (MSI) were assessed by CMR using standard sequences. RESULTS Lower heart rates at presentation were associated with a bigger amount of myocardial salvage after reperfusion. MSI progressively decreased as the heart rates increased (0.54 group I, 0.46 group II, 0.38 group III, 0.34 group IV, 0.32 group V, p<0.001). Stepwise multivariable analysis showed heart rate, peak troponin and the presence of MVO were independent predictor of myocardial salvage. No changes related to heart rate were observed in relation to area at risk and infarct size. CONCLUSIONS High heart rates registered before performing coronary angioplasty in timely reperfused patients with STEMI are associated with a reduction in salvaged myocardium. In particular, salvaged myocardium significantly reduced when heart rate at presentation is ≥85 bpm.
Collapse
Affiliation(s)
- Luca Arcari
- Department of Cardiology, Sapienza University of Rome, Rome, Italy
| | - Sara Cimino
- Department of Cardiology, Sapienza University of Rome, Rome, Italy
| | - Laura De Luca
- Department of Cardiology, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiology, Sapienza University of Rome, Rome Italy
| | - Nicola Galea
- Department of Radiology, Sapienza University of Rome, Rome Italy
| | - Manuela Reali
- Department of Cardiology, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiology, Sapienza University of Rome, Rome Italy
| | - Carlo Iacoboni
- Department of Cardiology, Sapienza University of Rome, Rome, Italy
| | - Luciano Agati
- Department of Cardiology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
30
|
Ferdinandy P, Hausenloy DJ, Heusch G, Baxter GF, Schulz R. Interaction of risk factors, comorbidities, and comedications with ischemia/reperfusion injury and cardioprotection by preconditioning, postconditioning, and remote conditioning. Pharmacol Rev 2015; 66:1142-74. [PMID: 25261534 DOI: 10.1124/pr.113.008300] [Citation(s) in RCA: 461] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pre-, post-, and remote conditioning of the myocardium are well described adaptive responses that markedly enhance the ability of the heart to withstand a prolonged ischemia/reperfusion insult and provide therapeutic paradigms for cardioprotection. Nevertheless, more than 25 years after the discovery of ischemic preconditioning, we still do not have established cardioprotective drugs on the market. Most experimental studies on cardioprotection are still undertaken in animal models, in which ischemia/reperfusion is imposed in the absence of cardiovascular risk factors. However, ischemic heart disease in humans is a complex disorder caused by, or associated with, cardiovascular risk factors and comorbidities, including hypertension, hyperlipidemia, diabetes, insulin resistance, heart failure, altered coronary circulation, and aging. These risk factors induce fundamental alterations in cellular signaling cascades that affect the development of ischemia/reperfusion injury per se and responses to cardioprotective interventions. Moreover, some of the medications used to treat these risk factors, including statins, nitrates, and antidiabetic drugs, may impact cardioprotection by modifying cellular signaling. The aim of this article is to review the recent evidence that cardiovascular risk factors and their medication may modify the response to cardioprotective interventions. We emphasize the critical need to take into account the presence of cardiovascular risk factors and concomitant medications when designing preclinical studies for the identification and validation of cardioprotective drug targets and clinical studies. This will hopefully maximize the success rate of developing rational approaches to effective cardioprotective therapies for the majority of patients with multiple risk factors.
Collapse
Affiliation(s)
- Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged and Pharmahungary Group, Szeged, Hungary (P.F.); The Hatter Cardiovascular Institute, University College London, London, United Kingdom (D.J.H.); Institute for Pathophysiology, University of Essen Medical School, Essen, Germany (G.H.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom (G.F.B.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Derek J Hausenloy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged and Pharmahungary Group, Szeged, Hungary (P.F.); The Hatter Cardiovascular Institute, University College London, London, United Kingdom (D.J.H.); Institute for Pathophysiology, University of Essen Medical School, Essen, Germany (G.H.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom (G.F.B.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Gerd Heusch
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged and Pharmahungary Group, Szeged, Hungary (P.F.); The Hatter Cardiovascular Institute, University College London, London, United Kingdom (D.J.H.); Institute for Pathophysiology, University of Essen Medical School, Essen, Germany (G.H.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom (G.F.B.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Gary F Baxter
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged and Pharmahungary Group, Szeged, Hungary (P.F.); The Hatter Cardiovascular Institute, University College London, London, United Kingdom (D.J.H.); Institute for Pathophysiology, University of Essen Medical School, Essen, Germany (G.H.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom (G.F.B.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Rainer Schulz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged and Pharmahungary Group, Szeged, Hungary (P.F.); The Hatter Cardiovascular Institute, University College London, London, United Kingdom (D.J.H.); Institute for Pathophysiology, University of Essen Medical School, Essen, Germany (G.H.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom (G.F.B.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| |
Collapse
|
31
|
Dow JS, Bhandari A, Hale SL, Kloner RA. Does sex influence the incidence or severity of reperfusion-induced cardiac arrhythmias? SPRINGERPLUS 2015; 4:96. [PMID: 25763306 PMCID: PMC4352162 DOI: 10.1186/s40064-015-0878-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/06/2015] [Indexed: 04/19/2023]
Abstract
Whether sex affects the acute phase of myocardial ischemia in experimental animal models is currently being debated. Our purpose was to determine if sex influences either the incidence or severity of reperfusion-induced arrhythmias resulting from a brief coronary occlusion. Male and female Sprague–Dawley rats were assigned to the study. Anesthetized animals were subjected to a 5-minute coronary artery occlusion followed by 5 minutes of reperfusion. Mortality differed by sex: 10/27 (37%) of males died due to VT/VF while only 1/16 females (6%) died due to VT/VF (p = 0.033). Quantitative analysis of the electrocardiogram was performed on data acquired from 17 male and 15 female survivors. Analysis showed no other significant differences in ventricular arrhythmias between the two groups. Conclusion: Lethal reperfusion-induced arrhythmias led to a higher mortality in male rats versus female rats. Among survivors there was no difference in any other arrhythmic parameters measured.
Collapse
Affiliation(s)
- Joan S Dow
- The Heart Institute, Good Samaritan Hospital, Los Angeles, CA USA
| | - Anil Bhandari
- The Heart Institute, Good Samaritan Hospital, Los Angeles, CA USA
| | - Sharon L Hale
- The Heart Institute, Good Samaritan Hospital, Los Angeles, CA USA ; Huntington Medical Research Institutes, Pasadena, CA USA
| | - Robert A Kloner
- The Heart Institute, Good Samaritan Hospital, Los Angeles, CA USA ; Huntington Medical Research Institutes, Pasadena, CA USA ; Keck School of Medicine, Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
32
|
Lecour S, Bøtker HE, Condorelli G, Davidson SM, Garcia-Dorado D, Engel FB, Ferdinandy P, Heusch G, Madonna R, Ovize M, Ruiz-Meana M, Schulz R, Sluijter JPG, Van Laake LW, Yellon DM, Hausenloy DJ. ESC working group cellular biology of the heart: position paper: improving the preclinical assessment of novel cardioprotective therapies. Cardiovasc Res 2014; 104:399-411. [PMID: 25344369 PMCID: PMC4242141 DOI: 10.1093/cvr/cvu225] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Ischaemic heart disease (IHD) remains the leading cause of death and disability worldwide. As a result, novel therapies are still needed to protect the heart from the detrimental effects of acute ischaemia–reperfusion injury, in order to improve clinical outcomes in IHD patients. In this regard, although a large number of novel cardioprotective therapies discovered in the research laboratory have been investigated in the clinical setting, only a few of these have been demonstrated to improve clinical outcomes. One potential reason for this lack of success may have been the failure to thoroughly assess the cardioprotective efficacy of these novel therapies in suitably designed preclinical experimental animal models. Therefore, the aim of this Position Paper by the European Society of Cardiology Working Group Cellular Biology of the Heart is to provide recommendations for improving the preclinical assessment of novel cardioprotective therapies discovered in the research laboratory, with the aim of increasing the likelihood of success in translating these new treatments into improved clinical outcomes.
Collapse
Affiliation(s)
- Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa and MRC Inter-University Cape Heart Group, University of Cape Town, Cape Town, South Africa
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus N, Denmark
| | - Gianluigi Condorelli
- Humanitas Clinical and Research Institute, National Research Council of Italy, Rozzano, Italy
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews
| | - David Garcia-Dorado
- Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Felix B Engel
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary Pharmahungary Group, Szeged, Hungary
| | - Gerd Heusch
- Institut für Pathophysiologie, West German Heart and Vascular Centre, Universitätsklinikum Essen, Essen, Germany
| | - Rosalinda Madonna
- Institute of Cardiology and Center of Excellence on Aging, 'G. d'Annunzio' University of Chieti, Chieti, Italy Texas Heart Institute, Houston, TX, USA Department of Internal Medicine, University of Texas Medical School, Center of Cardiovascular and Atherosclerosis Research, Houston, TX, USA
| | - Michel Ovize
- Inserm U 1060 (CarMeN_Cardioprotection Team) & CIC de Lyon, Service d'Exploration Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Lyon, France
| | - Marisol Ruiz-Meana
- Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Linda W Van Laake
- University Medical Center Utrecht and Hubrecht Institute, Utrecht, the Netherlands
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews
| |
Collapse
|
33
|
Bjerre M, Munk K, Sloth AD, Nielsen SS, Flyvbjerg A, Bøtker HE. High osteoprotegerin levels predict MACCE in STEMI patients, but are not associated with myocardial salvage. SCAND CARDIOVASC J 2014; 48:209-15. [PMID: 24758546 DOI: 10.3109/14017431.2014.917767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES High circulating levels of osteoprotegerin (OPG) carry prognostic impact in cohorts with various cardiovascular diagnoses. With the present study, we aim to investigate the role of OPG within the scale of myocardial damage. DESIGN This study includes 219 consecutive patients with acute ST-elevation myocardial infarction randomized to primary percutaneous coronary intervention (pPCI) or pPCI and remote ischemic per-conditioning. Salvage index via myocardial single-photon emission CT assessment (data available in 61% of the patients) was performed, and derived from Day 1 (myocardial area at risk) and Day 30 (final infarct size). Plasma OPG levels were measured using an in-house immunoassay. A combined end-point of all-mortality, myocardial infarction, stroke, readmission for heart failure and ischemic stroke/transient ischemic attack (Major Adverse Cardiac and Cerebrovascular Events [MACCE]) was used for follow-up; 45 (38-48 months). RESULTS High OPG levels were associated with the severity of cardiovascular disease. During follow-up, OPG was a predictor of MACCE (unadjusted, HR: 2.1, 95% CI: 1.14-3.85, P = 0.017). Adjustments for age, gender, and body mass index preserved the independent predictive power of OPG. However, OPG levels were neither associated with salvage index nor with the final infarct size. Remote ischemic per-conditioning had no effect on OPG levels. CONCLUSION Despite absent association between OPG levels and the scale of myocardial damage, high OPG levels predict a significantly increased risk of MACCE.
Collapse
Affiliation(s)
- Mette Bjerre
- The Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University , Aarhus C , Denmark
| | | | | | | | | | | |
Collapse
|
34
|
Meller SM, Lansky AJ, Costa RA, Soffler M, Costantini CO, Brodie BR, Cox DA, Stuckey TD, Fahy M, Grines CL, Stone GW. Implications of myocardial reperfusion on survival in women versus men with acute myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2013; 112:1087-92. [PMID: 23827398 DOI: 10.1016/j.amjcard.2013.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 01/14/2023]
Abstract
We evaluated the effects of myocardial perfusion after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) on gender-based mortality rates. Research has demonstrated a gender-specific response of cardiomyocytes to ischemia and a potential increase in myocardial salvage in women compared with men. Myocardial blush grade (MBG), an angiographic surrogate of myocardial perfusion, is an independent predictor of early and late survival after AMI. Whether the incidence and prognosis of myocardial perfusion differs according to gender among patients with AMI undergoing PCI is unknown. MBG and short- and long-term mortality were evaluated in 1,301 patients (male = 935; female = 366) with AMI randomized to primary angioplasty ± abciximab versus stent ± abciximab. Following PCI, >96% of patients achieved final Thrombolysis In Myocardial Infarction 3 flow, of which MBG 2/3 was present in 58.3% of women versus 51.1% of men (p = 0.02). Worse MBG was an independent predictor of mortality in women at 30 days (7.4% for MBG 0/1 vs 2.4% for MBG 2/3, p = 0.04) and at 1-year (11.0% for MBG 0/1 vs 3.4% for MBG 2/3, p = 0.01); however, MBG was not associated with differences in mortality for men. In conclusion, impaired myocardial perfusion following PCI for AMI, indicated by worse MBG, is an independent predictor of early and late mortality in women but not in men. These findings imply an enhanced survival benefit from restoring myocardial perfusion for women compared with men during primary angioplasty and may have clinical implications for interventional strategies in women.
Collapse
Affiliation(s)
- Stephanie M Meller
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Dreyer RP, Beltrame JF, Neil C, Air T, Tavella R, Hoffmann B, Pati PK, Di Fiore D, Arstall M, Zeitz C. Cardiac hemodynamics in men versus women during acute ST-segment elevation myocardial infarction. Am J Cardiol 2013; 112:143-9. [PMID: 23628307 DOI: 10.1016/j.amjcard.2013.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 10/26/2022]
Abstract
Several biologic and clinical factors contribute to the increased 30-day mortality and re-infarction rate in women with ST-segment elevation myocardial infarction (STEMI). Sex differences in cardiac hemodynamic parameters such as pulmonary capillary wedge pressure (PCWP) have not been examined and might play an important role. The objectives of the present study were to examine whether female sex is an independent determinant of PCWP during acute STEMI and whether an elevated PCWP contributes to all-cause 30-day mortality and re-infarction in women. The clinical, angiographic, and hemodynamic features of 470 consecutive patients with STEMI (n = 135 women) undergoing emergency coronary angiography with right-side heart catheterization were evaluated with respect to sex. Women had an elevated PCWP (20 ± 8 vs 16 ± 7 mm Hg, p <0.001) and reduced mixed venous oxygen saturation (67 ± 11% vs 71 ± 9%, p = 0.004). On multivariate analysis, female sex (β = 4.04, 95% confidence interval [CI] 2.04 to 6.04, p <0.001), hypertension (β = 2.07, 95% CI 0.31 to 3.83, p = 0.021), and creatine kinase-estimated infarct size (β = 0.001, 95% CI 0.001 to 0.002, p ≤0.001) were independent predictors of an elevated PCWP. Female sex exerted a minor independent effect on 30-day mortality and re-infarction (odds ratio 2.36, 95% CI 1.25 to 4.46, p = 0.008). However, once PCWP was entered into the mediation model, sex was no longer significant, suggesting that the effect of sex on the post-STEMI outcomes is potentially mediated through PCWP (odds ratio 1.07, 95% CI 1.02 to 1.12, p = 0.011). In conclusion, during acute STEMI, women have greater left ventricular filling pressures compared with men, independent of age, hypertension, and infarct size. The biologic explanation for this difference requires additional investigation, although it does not appear to contribute to the increased 30-day mortality and re-infarction rate observed in women.
Collapse
|
36
|
Edvardsen T, Plein S, Saraste A, Knuuti J, Maurer G, Lancellotti P. The year 2012 in the European Heart Journal-Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2013; 14:509-14. [PMID: 23671232 DOI: 10.1093/ehjci/jet069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The new multi-modality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was started in 2012. During its first year, the new Journal has published an impressive collection of cardiovascular studies utilizing all cardiovascular imaging modalities. We will summarize the most important studies from its first year in two articles. The present 'Part I' of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
Collapse
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | | | | | | | | | | |
Collapse
|
37
|
De Luca G, Parodi G, Sciagrà R, Bellandi B, Verdoia M, Vergara R, Migliorini A, Valenti R, Antoniucci D. Relation of gender to infarct size in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty. Am J Cardiol 2013; 111:936-40. [PMID: 23332594 DOI: 10.1016/j.amjcard.2012.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 11/29/2022]
Abstract
Previous reports have shown that female gender is associated with impaired outcomes among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, mainly owing to a worst risk profile (more diabetes, more advanced age, and higher Killip class at presentation) compared to men. Still contrasting are data on the effect of gender on the outcome in patients with STEMI undergoing primary angioplasty. In particular, it is still unclear whether a larger infarct size might contribute to the explanation of the worse outcome in women. Therefore, the aim of the present study was to investigate gender-related differences in infarct size as evaluated by myocardial scintigraphy in a large cohort of patients with STEMI undergoing primary percutaneous coronary intervention. We included 830 patients with STEMI undergoing primary percutaneous coronary intervention. The infarct size was evaluated at 30 days using technetium-99m-sestamibi. A logistic regression analysis was performed to determine the relation between gender and infarct size (as percentage of patients above the median) after correction for baseline confounding factors. We also evaluated the presence of a potential age-gender interaction. A total of 183 patients (20.8%) were women. Female gender was associated with more advanced age and a greater prevalence of hypertension; previous infarction and smoking were more frequently observed in men. Female gender was associated with a smaller infarct size (p <0.001) that was confirmed after correction for baseline confounding factors (adjusted odds ratio 0.48, 95% confidence interval 0.33-0.7, p <0.001). No age-gender interaction was observed (p = 0.13). In conclusion, the results of the present study have shown that despite the presence of high-risk features at presentation, female gender was associated with a smaller infarct size than that in men, without any interaction between age and gender.
Collapse
Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Gender differences in contrast-enhanced magnetic resonance imaging after acute myocardial infarction. Int J Cardiovasc Imaging 2012; 29:643-50. [PMID: 23053858 DOI: 10.1007/s10554-012-0132-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/21/2012] [Indexed: 12/31/2022]
Abstract
Besides different risk profiles for cardiovascular events in men and women, several studies reported gender differences in mortality after acute myocardial infarction (AMI). As infarct size has been shown to correlate with mortality, it is widely accepted as surrogate marker for clinical outcome. Currently, cardiovascular imaging studies covering the issue of gender differences are rare. As magnetic resonance scar characterization parameters are emerging as additional prognostic factors after acute myocardial infarction, we sought to evaluate gender differences in CMR infarct characteristics in patients after acute myocardial infarction. We prospectively analyzed patients (n = 448) with AMI and primary angioplasty, who underwent contrast-enhanced cardiac magnetic resonance (CMR) imaging on a 1.5 T scanner in median 5 [4, 6] days after the acute event. [corrected]. CMR scar size was measured 15 min after gadolinium injection. In addition presence and extent of microvascular obstruction (MVO) was assessed. A matched pair analysis was performed in order to exclude confounding by gender related co-morbidities and gender differences in established clinical risk factors. Matching process according to clinical risk defined by GRACE score resulted in 93 mixed gender couples. Women were significantly older than men (64.4 ± 11.9 vs. 60.5 ± 12.3, p = 0.03) and presented with a significantly better ejection fraction before angioplasty (48.9 ± 8.4 vs. 46.2 ± 8.9, p = 0.04). Infarct size did not differ significantly between women and men (13.5 ± 10.7 vs. 15.1 ± 11.8, p = 0.32). Size of MVO was significantly smaller in women than in men (0.48 ± 1.3 vs. 1.2 ± 3.0, p = 0.03). Comparing scar characterization between women and men with similar risk profiles revealed no gender differences in scar size. Size of MVO, however, was significantly smaller in women and might reflect better cardioprotective mechanisms in women. Whether these changes have prognostic implications has to be tested on a larger patient population.
Collapse
|