Echocardiographic Predictors of Remote Outcome in Patients With Angiographically Successful Reflow After Acute Myocardial Infarction

Prognostic Significance of Percutaneous Coronary Intervention for First Acute Myocardial Infarction with Heart Failure: Five-Year Follow-Up Results

Objective

The study aimed to investigate the incidence and influencing factors of heart failure after 5 years of percutaneous coronary intervention (PCI) for first acute myocardial infarction.

Methods

A total of 1235 patients, diagnosed as acute myocardial infarction and treated with PCI in Beijing Anzhen Hospital, Capital Medical University, from January 1, 2014, to December 31, 2014, were enrolled. Based on the exclusion criteria, 671 patients were followed up to obtain echocardiographic results 5 years after the onset of myocardial infarction (from January 1, 2019, to December 31, 2019). Of 671 patients, 62 were lost to follow-up. Finally, 609 patients were recruited in this study. According to the results of the echocardiographic examination, patients were divided into a heart failure group (n = 97) (LVEF < 50%) and a nonheart failure group (n = 512) (LVEF ≥ 50%). The clinical characteristics were compared between the two groups, and the influencing factors of heart failure after 5 years of PCI in patients with acute myocardial infarction were analyzed using logistic regression and receiver-operating characteristic (ROC) analyses.

Results

Of 609 patients, 97 had heart failure within 5 years after PCI for first myocardial infarction, with an incidence of 15.9%. Multivariate regression analysis finally examined the predictors related to the occurrence of heart failure, including age (aOR, 1.008; 95% confidence interval (CI), 1.054–1.123; P ≤ 0.001), peak troponin I level (aOR, 1.020; 95% CI, 1.006–1.034; P = 0.004), left ventricular ejection fraction (LVEF) (during admission) (aOR, 0.908; 95% CI, 0.862–0.956; P ≤ 0.001), and left ventricular end-diastolic dimension (LVEDD) (at admission) (aOR, 1.136; 95% CI, 1.016–1.271; P = 0.025).

Conclusion

In this study, the incidence of heart failure (LVEF < 50%) in patients with acute myocardial infarction who underwent PCI was 15.9% at a five-year follow up. Age, peak troponin I level, and LVEDD (at admission) were risk factors for heart failure, while LVEF (at admission) of patients during hospitalization was a protective factor for heart failure.

Toll-like receptor 4 ablation rescues against paraquat-triggered myocardial dysfunction: Role of ER stress and apoptosis

Paraquat is a nitrogen herbicide imposing severe organ toxicity in human leading to acute lung injury and heart failure. The present study was designed to examine the impact of ablation of the innate proinflammatory mediator toll-like receptor 4 (TLR4) in paraquat-induced cardiac contractile dysfunction and the underlying mechanisms involved with a focus on endoplasmic reticulum (ER) stress and apoptosis. Adult male wild-type (WT) and TLR4 knockout (TLR4^-/- ) mice were challenged with paraquat (45 mg/kg, i.p.) for 48 h prior to the assessment of myocardial and cardiomyocyte sarcomere function, ER stress, apoptosis and inflammation. Acute paraquat challenge exerted myocardial functional and geometric alterations including enlarged left ventricular end systolic diameter (LVESD), reduced fractional shortening, decreased sarcomere shortening, maximal velocities of sarcomere shortening and relengthening associated with unchanged LV posterior wall thickness, septal thickness, LV end diastolic diameter (LVEDD), heart rate, sarcomere length, time-to-peak shortening and time-to-90% relengthening. Although TLR4 ablation did not affect mechanical properties in the heart, it significantly attenuated or ablated paraquat-induced cardiac contractile anomalies. Moreover, paraquat imposed overt ER stress, apoptosis and inflammation as evidenced by upregulation of Bip, CHOP, Caspase-3, -9, Bax, Bad, and IL-1β, phosphorylation of PERK, eIF2α and IΚB, as well as activation of the stress molecules ERK and p38, with unchanged Caspase-8, Bcl2, TNF-α, p53, HMGB1, MyD88 and phosphorylation of Akt, GSK3β and JNK, the effects of which were attenuated or negated by TLR4 knockout. Taken together, our results suggested that TLR4 ablation alleviated paraquat-induced myocardial contractile dysfunction possibly through attenuation of ER stress, apoptosis and inflammation. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 656-668, 2017.

Longitudinal Study of Acute Myocardial Infarction in the Southeast Osaka District From 1988 to 2002

BACKGROUND

Data on clinical characteristics, long-term mortality rates, and factors influencing outcome of acute myocardial infarction (AMI) based on an unselected cohort in the percutaneous coronary intervention (PCI) era are still limited in Japan.

METHODS AND RESULTS

In the present study 415 consecutive patients with AMI who were admitted to hospital within 24 h of symptom onset between January 1988 and December 2002 were studied. There was a marked seasonal variation of AMI with a minimum in summer and a maximum in winter, as well as a marked circadian variation with a significant morning peak. Overall, 45.8% of patients were treated with primary PCI. Increased age and female sex were negatively associated with the probability of undergoing PCI. During the follow-up period (mean duration, 4.01+/-3.41 years), the unadjusted long-term all-cause mortality rate was 21.4%. Multivariate Cox regression analysis showed that age, prior cerebrovascular disease, renal failure, Killip > or =2, and ventricular tachycardia/fibrillation were independent predictors of worse long-term mortality after AMI. Furthermore, the use of PCI was independently associated with favorable long-term survival after AMI.

CONCLUSIONS

Although PCI was associated with a favorable long-term mortality, it remains underused in subsets of patients and increased use may further reduce the long-term mortality rate in Japanese AMI patients.

Can Transthoracic Doppler Echocardiography Predict the Discrepancy Between Left Ventricular End-Diastolic Pressure and Mean Pulmonary Capillary Wedge Pressure in Patients With Heart Failure?

BACKGROUND

Left ventricular end-diastolic pressure (LVEDP) is difficult to measure continuously; therefore, pulmonary capillary wedge pressure (PCWP) is frequently used instead for hemodynamic monitoring in patients with heart failure. However, a discrepancy between LVEDP and mean PCWP is sometimes observed.

METHODS AND RESULTS

To assess the feasibility of evaluating this discrepancy using echo-Doppler indexes, 140 consecutive patients with heart disease were studied. Transthoracic Doppler echocardiography (TTDE) was performed immediately before bilateral-sided cardiac catheterization. We measured peak velocities of early (E: cm/s) and late (A: cm/s) diastolic transmitral flow, and duration of A wave (MAd: ms). We also measured the duration of atrial reversal of pulmonary venous flow (PAd: ms). The difference between PAd and MAd (Deltad = PAd-MAd: ms) was calculated. The ratio of E to tissue Doppler-derived peak early diastolic velocity of mitral annulus (Ea: cm/s) was also calculated (E/Ea). There was a good positive correlation between LVEDP and Deltad (r = 0.77, p < 0.001). There was a modest correlation between mean PCWP and E/Ea (r = 0.56, p < 0.001). When patients were classified by Deltad > or = 10 ms and E/Ea < or = 14, elevated LVEDP (> or = 17 mmHg) and normal mean PCWP (< or = 12 mmHg) were predicted with 100% sensitivity and 85% specificity.

CONCLUSIONS

Evaluation of the discrepancy between LVEDP and mean PCWP in patients with heart failure was feasible by separately estimating LVEDP by Deltad and mean PCWP by E/Ea using noninvasive TTDE. Early detection of patients with elevated LVEDP and normal mean PCWP may be useful for preventing acute exacerbation of chronic heart failure.