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Takeda A, Ikenaga H, Nakano T, Morita Y, Higashihara T, Watanabe N, Sada Y, Nakano Y. Relationship between the Selvester QRS Score and Coronary Microvascular Dysfunction Assessed by the Index of Microcirculatory Resistance. Intern Med 2023; 62:3591-3599. [PMID: 37121753 PMCID: PMC10781549 DOI: 10.2169/internalmedicine.1504-22] [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: 12/22/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Objective The index of microvascular resistance (IMR) is an invasive method for quantifying the coronary microvasculature independent of the presence and degree of epicardial stenosis during cardiac catheterization, whereas the Selvester QRS score, which is related to myocardial damage, is a relatively simple and non-invasive measurement procedure. We investigated the relationship between the QRS score and coronary microvascular dysfunction (CMD) assessed via IMR. Methods Data from 74 patients who underwent invasive coronary physiological measurements were retrospectively reviewed. Using a coronary wire, we measured IMR by the hyperemic mean transit time and distal coronary pressure. We also determined a simplified QRS score following the Selvester QRS score criteria by 12-lead electrocardiography. After determining the best cutoff value for the QRS score to predict IMR ≥25, which was defined as CMD by the Coronary Vasomotion Disorders International Study Group, patients were categorized into the QRS score ≥3 (n=16) and the QRS score 0-2 (n=58) groups. Results IMR in the QRS score ≥3 group was significantly higher in comparison to the QRS score 0-2 group (31; IQR: 19-57 vs. 20; IQR: 14-29, p<0.01). The percentage of patients with IMR ≥25 in the QRS score ≥3 group was significantly higher than that in the QRS score 0-2 group (69% vs. 34%, p=0.01). Conclusion A higher QRS score was associated with CMD, as estimated by IMR. The Selvester QRS score is noninvasive parameter that is potentially useful for predicting CMD.
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Affiliation(s)
- Atsushi Takeda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Takayuki Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yuichi Morita
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Tasuku Higashihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yoshiharu Sada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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2
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Okada K, Hibi K, Kikuchi S, Kirigaya H, Hanajima Y, Sato R, Nakahashi H, Minamimoto Y, Matsuzawa Y, Maejima N, Iwahashi N, Kosuge M, Ebina T, Tamura K, Kimura K. Culprit Lesion Morphology of Rapidly Progressive and Extensive Anterior-Wall ST-Segment Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2022; 15:e014497. [PMID: 36378775 DOI: 10.1161/circimaging.122.014497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapidly progressive, extensive myocardial injury/infarction (RPEMI) beyond the concept of wave-front phenomenon can be observed even when achieving timely reperfusion; however, the pathogenesis of RPEMI remains unknown. This retrospective study investigated clinical and lesion characteristics of RPEMI, focusing on culprit-lesion morphology (CLM). METHODS Among patients with extensive anterior-wall ST-segment elevation myocardial infarction due to proximal left anterior descending artery lesions who had reperfusion within 3 hours of symptom onset, 60 patients undergoing both intravascular ultrasound and cardiac magnetic resonance imaging were enrolled. Myocardial injury/infarction before reperfusion therapy was assessed by QRS scores at hospitalization electrocardiogram, and the extent of myocardial injury/infarction was evaluated by cardiac magnetic resonance imaging, which measured area at risk, infarct size, myocardial salvage index, microvascular obstruction, and left ventricular ejection fraction. RPEMI was defined as lower left ventricular ejection fraction (less median value) with microvascular obstruction. RESULTS Despite comparable onset-to-door and onset-to-reperfusion times and area at risk, patients with RPEMI showed higher QRS scores at hospitalization (5 [4.3-6] versus 3 [2-4], P<0.001) and infarct size (26.5±9.1 versus 20.4±10.5%, P=0.04), and a tendency toward lower myocardial salvage index (0.27±0.14 versus 0.36±0.20, P=0.10) compared with those without. Patients with versus without RPEMI more frequently observed specific CLM on intravascular ultrasound, characterized by the combination of vulnerable plaques, plaque ruptures, and/or large thrombi. When stratified by CLM-score composed of these 3 criteria, higher CLM-scores were or tended to be associated with higher QRS scores and incidence of RPEMI. In multivariate analyses including no-reflow phenomenon and final coronary-flow deterioration, increased CLM-score (≥2) was independently associated with high QRS scores and RPEMI (odd ratio 11.25 [95% CI, 2.43-52.00]; P=0.002). CONCLUSIONS Vulnerable CLM was a consistent determinant of advanced myocardial injury/infarction both before and after reperfusion therapy and may play a pivotal role in the development of RPEMI.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | | | - Hidekuni Kirigaya
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Ryosuke Sato
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | | | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kouichi Tamura
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan
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Yang N, Han X, Zhang J, Zhang S, Sun J. What can we find in QRS in patients with ST-segment-elevation myocardial infarction? J Electrocardiol 2022. [DOI: 10.1016/j.jelectrocard.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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4
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Predictive value of Selvester QRS score for severity of coronary artery disease in ST-segment elevation myocardial infarction. COR ET VASA 2021. [DOI: 10.33678/cor.2021.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Iwahashi N, Gohbara M, Kirigaya J, Abe T, Horii M, Takahashi H, Kosuge M, Hanajima Y, Akiyama E, Okada K, Matsuzawa Y, Maejima N, Hibi K, Ebina T, Tamura K, Kimura K. Prognostic Significance of a Combination of QRS Score and E/e' Obtained 2 Weeks After the Onset of ST-Elevation Myocardial Infarction. Circ J 2020; 84:1965-1973. [PMID: 33041290 DOI: 10.1253/circj.cj-20-0486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The early mitral inflow velocity to mitral early diastolic velocity ratio (E/e') and electrocardiogram (ECG) determination of QRS score are useful for risk stratification in patients with ST-elevation myocardial infarction (STEMI).Methods and Results:In this study, 420 consecutive patients (357 male; mean [±SD] age 63.6±12.2 years) with first-time STEMI who successfully underwent primary percutaneous coronary intervention within 12 h of symptom onset were followed-up for 5 years (median follow-up 67 months). Echocardiography, ECG, and blood samples were obtained 2 weeks after onset. Infarct size was estimated by the QRS score after 2 weeks (QRS-2wks) and creatine phosphokinase-MB concentrations (peak and area under the curve). The primary endpoint was death from cardiac causes or rehospitalization for heart failure (HF). During follow-up, 21 patients died of cardiac causes and 62 had HF. Multivariate Cox proportional hazard analysis showed that mean E/e' (hazard ratio [HR] 1.152; 95% confidence interval [CI] 1.088-1.215; P<0.0001), QRS-2wks (HR 1.153; 95% CI 1.057-1.254; P<0.0001), and hypertension (HR 1.702; 95% CI 1.040-2.888; P=0.03) were independent predictors of the primary endpoint. Kaplan-Meier curve analysis showed that patients with QRS-2wks >4 and mean E/e' >14 were at an extremely high risk of cardiac death or HF (log rank, χ2=116.3, P<0.0001). CONCLUSIONS In patients with STEMI, a combination of QRS-2wks and mean E/e' was a simple but useful predictor of cardiac death and HF.
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Affiliation(s)
| | - Masaomi Gohbara
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | - Jin Kirigaya
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeru Abe
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center
| | - Mutsuo Horii
- Division of Cardiology, Yokohama City University Medical Center
| | | | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center
| | | | | | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | - Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
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Both baseline Selvester QRS score and change in QRS score predict prognosis in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention. Coron Artery Dis 2020; 31:403-410. [PMID: 32168048 PMCID: PMC7331825 DOI: 10.1097/mca.0000000000000869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to demonstrate the prognostic value of Selvester QRS scores in patients with acute ST-segment elevation myocardial infarction (STEMI).
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Kalinauskiene E, Gerviene D, Bacharova L, Krivosikova Z, Naudziunas A. Differences in the Selvester QRS score after primary PCI strategy and conservative treatment for STEMI patients with negative T waves. Ann Noninvasive Electrocardiol 2019; 24:e12684. [PMID: 31368226 DOI: 10.1111/anec.12684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/22/2019] [Accepted: 06/11/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND According to current guidelines, the main indications for PCI in patients with STEMI are ST-segment deviations and defined time from the onset of symptoms. Negative T wave at admission can be a sign of prolonged ischemia or spontaneous reperfusion. In both situations, the urgent intervention is questionable. We evaluated the infarct size and in-hospital mortality in STEMI patients with negative T wave in cases of primary PCI strategy compared with conservative treatment. METHODS A retrospective analysis of 116 STEMI patients with negative T wave at the presenting ECG was performed. Sixty-eight patients (59%) underwent primary PCI strategy (PCI group), and 48 (41%) were treated conservatively (non-PCI group). The infarct size estimated by using the Selvester score, and in-hospital mortality were evaluated. RESULTS The difference between Selvester score values at admission and at discharge in the non-PCI group was statistically significant (1.48; 95% CI 0.694-2.27), while no significant difference was observed in the PCI group (-0.07; 95% CI -0.546-0.686). The in-hospital mortality was higher in the non-PCI group; however, the numbers were relatively small: PCI 2 (2.9%) and non-PCI 5 (10.4%). CONCLUSION In this study, we showed a reduction in the infarct size estimated by Selvester score in STEMI patients with negative T wave who were treated conservatively, while there was no significant change in the infarct size after primary PCI strategy. The higher mortality in patients treated conservatively could be attributed to higher age and comorbidities in the non-PCI group. It seems that conservative treatment strategy might be an option in STEMI patients with negative T wave.
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Affiliation(s)
- Egle Kalinauskiene
- Department of Internal Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Gerviene
- Department of Internal Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ljuba Bacharova
- International Laser Center, Bratislava, Slovakia.,Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovakia
| | | | - Albinas Naudziunas
- Department of Internal Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Yuan J, Mo H, Luo J, Zhao S, Liang S, Jiang Y, Zhang M. PPARα activation alleviates damage to the cytoskeleton during acute myocardial ischemia/reperfusion in rats. Mol Med Rep 2018; 17:7218-7226. [PMID: 29568903 PMCID: PMC5928683 DOI: 10.3892/mmr.2018.8771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
The cytoskeleton serves an important role in maintaining cellular morphology and function, and it is a substrate of calpain during myocardial ischemia/reperfusion (I/R) injury (MIRI). Calpain may be activated by endoplasmic reticulum (ER) stress during MIRI. The activation of peroxisome proliferator-activated receptor α (PPARα) may inhibit ischemia/reperfusion damage by regulating stress reactions. The present study aimed to determine whether the activation of PPARα protects against MIRI-induced cytoskeletal degradation, and investigated the underlying mechanism involved. Wistar rats were pretreated with or without fenofibrate and subjected to left anterior descending coronary artery ligation for 45 min, followed by 120 min of reperfusion. Calpain activity and the expression of PPARα, desmin and ER stress parameters were evaluated. Electrocardiography was performed and cardiac function was evaluated. The ultrastructure was observed under transmission electron microscopy. I/R significantly induced damage to the cytoskeleton in cardiomyocytes and cardiac dysfunction, all of which were improved by PPARα activation. In addition, I/R increased ER stress and calpain activity, which were significantly decreased in fenofibrate-pretreated rat heart tissue. The results suggested that PPARα activation may exert a protective effect against I/R in the myocardium, at least in part via ER stress inhibition. Suppression of ER stress may be an effective therapeutic target for protecting the I/R myocardium.
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Affiliation(s)
- Jie Yuan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Hongdan Mo
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Jing Luo
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Suhong Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Shuang Liang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yu Jiang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Maomao Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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9
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Affiliation(s)
- Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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