Value of Fast MVO Identification From Contrast-Enhanced Cine (CE-SSFP) Combined With Myocardial Strain in Predicting Adverse Events in Patients After ST-Elevation Myocardial Infarction

Association between cardiac magnetic resonance ventricular strain and left ventricular thrombus in patients with ST-segment elevation myocardial infarction

BACKGROUND

Myocardial strain can analyze early myocardial dysfunction after myocardial infarction (MI). However, the correlation between left ventricular (LV) strain (including regional and global strain) obtained by cardiac magnetic resonance (CMR) imaging and left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) is unclear.

METHODS

The retrospective clinical observation study included patients with LVT (n = 20) and non-LVT (n = 195) who underwent CMR within two weeks after STEMI. CMR images were analyzed using CVI 42 (Circle Cardiovascular Imaging, Canada) to obtain LV strain values. Logistic regression analysis identified risk factors for LVT among baseline characteristics, CMR ventricular strain, and left ventricular ejection fraction (LVEF). Considering potential correlations between strains, the ability of LV strain to identify LVT was evaluated using 9 distinct models. Receiver operating characteristic curves were generated with GraphPad Prism, and the area under the curve (AUC) of LVEF, apical longitudinal strain (LS), and circumferential strain (CS) was calculated to determine their capacity to distinguish LVT.

RESULTS

Among 215 patients, 9.3% developed LVT, with a 14.5% incidence in those with anterior MI. Univariate regression indicated associations of LAD infarct-related artery, lower NT-proBNP, lower LVEF, and reduced global, midventricular, and apical strain with LVT. Further multivariable regression analysis showed that apical LS, LVEF and NT-proBNP were still independently related to LVT (Apical LS: OR = 1.14, 95%CI (1.01, 1.30), P = 0.042; LVEF: OR = 0.91, 95%CI (0.85, 0.97), P = 0.005; NT-proBNP: OR = 2.35, 95%CI (1.04, 5.31) ).

CONCLUSION

Reduced apical LS on CMR is independently associated with LVT after STEMI.

The Role of Microvascular Obstruction and Intra-Myocardial Hemorrhage in Reperfusion Cardiac Injury. Analysis of Clinical Data

Microvascular obstruction (MVO) of coronary arteries promotes an increase in mortality and major adverse cardiac events in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). Intramyocardial hemorrhage (IMH) is observed in 41-50% of patients with ST-segment elevation myocardial infarction and PCI. The occurrence of IMH is accompanied by inflammation. There is evidence that microthrombi are not involved in the development of MVO. The appearance of MVO is associated with infarct size, the duration of ischemia of the heart, and myocardial edema. However, there is no conclusive evidence that myocardial edema plays an important role in the development of MVO. There is evidence that platelets, inflammation, Ca 2 + overload, neuropeptide Y, and endothelin-1 could be involved in the pathogenesis of MVO. The role of endothelial cell damage in MVO formation remains unclear in patients with AMI and PCI. It is unclear whether nitric oxide production is reduced in patients with MVO. Only indirect evidence on the involvement of inflammation in the development of MVO has been obtained. The role of reactive oxygen species (ROS) in the pathogenesis of MVO is not studied. The role of necroptosis and pyroptosis in the pathogenesis of MVO in patients with AMI and PCI is also not studied. The significance of the balance of thromboxane A2, vasopressin, angiotensin II, and prostacyclin in the formation of MVO is currently unknown. Conclusive evidence regarding the role of coronary artery spasm in the development of MVhasn't been established. Correlation analysis of the neuropeptide Y, endothelin-1 levels and the MVO size in patients with AMI and PCI has not previously been performed. It is unclear whether epinephrine aggravates reperfusion necrosis of cardiomyocytes. Dual antiplatelet therapy improves the efficacy of PCI in prevention of MVO. It is unknown whether epinephrine or L-type Ca 2 + channel blockers result in the long-term improvement of coronary blood flow in patients with MVO.

Preoperative sST2 levels relate to myocardial remodeling and cardiac function improvement after cardiac valve surgery

AIMS

We aim to investigate the correlation between preoperative soluble suppression of tumourigenicity 2 (sST2) and postoperative myocardial remodelling and cardiac function in patients with valvular heart disease.

METHODS AND RESULTS

This retrospective study included patients who underwent heart valve surgery at the General Hospital of Northern Theatre Command from July 2019 to June 2020. Preoperative, early postoperative, and 1-month postoperative cardiac ultrasound data were collected. Multivariable linear regression was used to analyse the factors associated with preoperative sST2 and postoperative cardiac function parameters. A receiver operator characteristic curve analysis was used to analyse the predictive value of sST2 for left ventricular ejection fraction (LVEF) reduction at 1 month after surgery. This study included 156 patients. Left ventricular end-systolic volume (b = 0.125, P = 0.004), atrial fibrillation (b = 7.933, P = 0.003), and coronary artery disease (b = 5.826, P = 0.043) were correlated with the preoperative sST2 levels. Preoperative sST2 was independently associated with early postoperative left ventricular end-systolic volume (b = -0.136, P = 0.035), left ventricular end-diastolic volume (b = -0.225, P = 0.036), and LVEF (b = 0.056, P = 0.008). At 1 month after surgery, LVEF (r = -0.234, P = 0.023) and reduction in LVEF (r = -0.316, P = 0.002) were negatively correlated with preoperative sST2. The area under the receiver operator characteristic curve of preoperative sST2 in predicting LVEF reduction at 1 month was 0.646, with a sensitivity of 0.357 and a specificity of 0.918.

CONCLUSIONS

Preoperative sST2 levels are related to early postoperative myocardial remodelling and have a predictive value for the improvement of cardiac function 1 month after surgery.

Prediction of microvascular obstruction by coronary artery angiography score after acute ST-segment elevation myocardial infarction: a single-center retrospective observational study

Background

Some coronary artery angiography (CAG) scores are associated with the no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). However, quality evidence regarding the association between the CAG scores and microvascular injury is still needed. Our study aimed to validate the ability of the CAG scores in predicting microvascular obstruction (MVO) detected by cardiac magnetic resonance (CMR) imaging.

Methods

From October 2020 to October 2021, 141 consecutive patients with acute STEMI who underwent primary PCI and CMR were retrospectively reviewed. CMR imaging was performed between 3 and 7 days after PCI. The patients were divided into MVO and non-MVO group based on the CMR results. Three CAG scores (SYNTAX score, SYNTAX II score and Gensini score) were used to assess the severity of coronary artery atherosclerotic burden.

Results

A total of 122 patients were included (mean age 60.6 ± 12.8 years). MVO occurred in 51 patients (41.8%). Patients with MVO had higher SYNTAX scores, SYNTAX II scores and Gensini scores than those without MVO (all p < 0.001). The Gensini score (r = 0.567, p < 0.001) showed the strongest correlation with infarction size than SYNTAX score (r = 0.521, p < 0.001) and SYNTAX II score (r = 0.509, p < 0.001). The areas under the receiver operator characteristic curves of SYNTAX score, SYNTAX II score and Gensini score for predicting MVO patients were 0.726, 0.774 and 0.807. In multivariable regression analysis, peak troponin I (odd ratio [OR] = 1.236, p = 0.001) and SYNTAX II score (OR = 11.636, p = 0.010) were identified as independent predictors of MVO.

Conclusions

In patients with acute STEMI undergoing primary PCI treatment, the peak troponin I and SYNTAX II score may be an independent predictor of MVO.