Absence Of Myocardial Infarction Research Articles

Abstract 4137448: Systemic Heparin Administration Does Not Inhibit microRNA Amplification in Patients with Myocardial Infarction

Purpose: MicroRNAs (miRs) have been proposed as biomarkers of myocardial infarction (MI), but prior evidence has demonstrated that heparin, commonly administered to patients presenting with MI, inhibits amplification during quantitative PCR (qPCR). The purpose of this study was to determine whether qPCR amplification of miRs is reduced in plasma of patients receiving heparin and if heparinase reverses this effect. Methods: Blood samples were collected and plasma recovered from patients with normal coronary arteries who had undergone CT coronary angiography ( N=5 ) or who had received intravenous heparin at the time of invasive coronary angiography( N=8 ). Blood was also collected at the time of invasive coronary angiography from patients presenting with ST elevation MI ( N=9 ). RT-qPCR was performed to quantify levels of 84 cardiac miRs, and Cel-miR-39-3p was utilized as a spike-in control. MiR qPCR was also performed following the addition of heparinase to plasma from 2 patients without MI treated with heparin and 2 patients presenting with MI who had received heparin. Results: Mean age of patients was 57 years, and 55% of patients were male. As compared with control patients, the cycle number for cel-miR-39-3p was significantly increased for patients receiving heparin (Figure 1a). No difference was seen in levels of cel-39-3p in heparin-treated patients with respect to the presence or absence of MI. Cel-miR-39-3p cycle times decreased when heparinase was added to samples from heparin-treated patients (Figure 1b). In contrast, heparin did not increase cycle times in any of the cardiac miRs tested, and cycle times decreased even further for miRs 499a-5p and 208b-3p in patients with MI (Figure 2). Conclusions: Systemic heparin treatment inhibits qPCR amplification of cel-mir-39-3p but does not inhibit endogenous miR amplification under these conditions. MiRs 499a-5p and 208b-3p are potentially important candidates for MI detection and quantification.

Sirt1/Nrf2/TNFα; TLR4/Myd88/NF-κB signaling pathways are involved in mediating hepatoprotective effect of bupropion in rat model of myocardial infarction

Background The aim of the current study is to identify the possible protective effect of bupropion (BUP) on liver injury in rat model of myocardial infarction (MI). BUP was administered in the presence and absence of MI. Materials and methods Thirty-two Wistar adult male rats were randomly arranged into four groups: control, BUP (30 mg/kg/day, intraperitoneal) for 28 days, isoproterenol (ISO) was injected subcutaneous (85 mg/kg) in the 26th and 27th days and BUP/ISO groups. Cardiac and hepatic enzymes were measured, also Hepatic oxidative stress indicators, as well as inflammatory and apoptotic biomarkers, were evaluated. Cardiac and hepatic histopathological examination and hepatic nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) immunohistochemical study were also detected. Results ISO significantly increased cardiac and hepatic enzymes, hepatic oxidative stress, inflammatory, apoptotic, with a histopathological picture of cardiac and hepatic damage and high hepatic NF-κB immunoexpression were detected. BUP significantly normalized the upraised oxidative, inflammatory, and apoptotic parameters, with an impressive improvement in the histopathological picture and a reduction in hepatic NF-κB immunoexpression. Conclusion BUP protects against liver injury on top of MI in rat model via modulation of Sirtuin type 1 (Sirt1)/Nuclear factor (erythroid-derived 2)-like 2 (Nrf2)/tumor necrosis factor α (TNFα); Toll-like receptor 4 (TLR4)/Hepatic myeloid differentiation primary response 88(Myd88)/NF-κB signaling pathways.

Metabolomics of repetitive myocardial stunning in chronic multivessel coronary artery stenosis: Effect of non-selective and selective β1-receptor blockers.

Chronic coronary artery stenosis can lead to regional myocardial dysfunction in the absence of myocardial infarction by repetitive stunning, hibernation or both. The molecular mechanisms underlying repetitive stunning-associated myocardial dysfunction are not clear. We used non-targeted metabolomics to elucidate responses to chronically stunned myocardium in a canine model with and without β-adrenergic blockade treatment. After development of left ventricular systolic dysfunction induced by ameroid constrictors on the coronary arteries, animals were randomized to 3months of placebo, metoprolol or carvedilol. We compared these two β-blockers with their different β-adrenergic selectivities on myocardial function, perfusion and metabolic pathways involved in tissue undergoing chronic stunning. Control animals underwent sham surgery. Dysfunction in stunned myocardium was associated with reduced fatty acid oxidation and enhanced ketogenic amino acid metabolism, together with alterations in mitochondrial membrane phospholipid composition. These changes were consistent with impaired mitochondrial function and were linked to reduced nitric oxide and peroxisome proliferator-activated receptor signalling, resulting in a decline in adenosine monophosphate-activated protein kinase. Mitochondrial changes were ameliorated by carvedilol more than metoprolol, and improvement was linked to nitric oxide and possibly hydrogen sulphide signalling. In summary, repetitive myocardial stunning commonly seen in chronic multivessel coronary artery disease is associated with adverse metabolic remodelling linked to mitochondrial dysfunction and specific signalling pathways. These changes are reversed by β-blockers, with the non-selective inhibitor having a more favourable impact. This is the first investigation to demonstrate that β-blockade-associated improvement of ventricular function in chronic myocardial stunning is associated with restoration of mitochondrial function. KEY POINTS: The mechanisms responsible for the metabolic changes associated with repetitive myocardial stunning seen in chronic multivessel coronary artery disease have not been fully investigated. In a canine model of repetitive myocardial stunning, we showed that carvedilol, a non-selective β-receptor blocker, ameliorated adverse metabolic remodelling compared to metoprolol, a selective β1-receptor blocker, by improving nitric oxide synthase and adenosine monophosphate protein kinase function, enhancing calcium/calmodulin-dependent protein kinase, probably increasing hydrogen sulphide, and suppressing cyclic-adenosine monophosphate signalling. Mitochondrial fatty acid oxidation alterations were ameliorated by carvedilol to a larger extent than metoprolol; this improvement was linked to nitric oxide and possibly hydrogen sulphide signalling. Both β-blockers improved the cardiac energy imbalance by reducing metabolites in ketogenic amino acid and nucleotide metabolism. These results elucidated why metabolic remodelling with carvedilol is preferable to metoprolol when treating chronic ischaemic left ventricular systolic dysfunction caused by repetitive myocardial stunning.

Left anterior descending coronary T-wave inversion pattern (Wellens’ syndrome) associated with myopericarditis and a normal left coronary artery

Background: Wellens’ syndrome is characterised by a history of chest pain with an abnormal electrocardiogram (EKG), demonstrating biphasic or deeply inverted T waves in leads V2–3 (may extend to involve all precordial and lateral limb leads – the type B Wellens’ pattern). A Wellens’ EKG pattern is considered highly specific for critical stenosis involving the ostial/proximal left anterior descending artery (LAD). However, there are no reported cases of an association of a Wellens’ EKG pattern with myopericarditis. Here, we present such a rare case. Case description: A thirty-one-year-old female with known essential hypertension and psoriatic arthritis presented with a constant, central chest pain radiating to the shoulders and back. The patient’s physical examination was unremarkable at presentation other than elevated blood pressure at 170/68 mmHg. An EKG at presentation demonstrated deep symmetric T-wave inversions in anterolateral leads with elevated high-sensitivity troponin, and an elevated erythrocyte sedimentation rate. The patient was referred to the cardiac catheterisation laboratory for concerns of a Wellens’ EKG pattern; however, invasive angiography demonstrated only obtuse marginal branch disease – no LAD disease was noted. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis of myopericarditis and absence of myocardial infarction. The patient was medically managed and discharged home in a stable condition. Conclusion: In literature and established clinical practice, the Wellens’ EKG pattern is considered highly concerning for critical ostial/proximal LAD stenosis. However, we now propose that myopericarditis may be considered in a differential diagnosis for this EKG pattern.

Stronger positive correlation of the left ventricular mass index and extracellular volume fraction with diastolic function in diabetic patients without myocardial infarction

BackgroundThe structural and functional characteristics of the heart in patients with diabetes mellitus (DM) and without myocardial infarction (MI) are not fully understood. MethodsWe retrospectively analysed the data of patients with left ventricular ejection fraction (LVEF) ≥ 40% who underwent contrast-enhanced cardiac magnetic resonance imaging (CMR), which was also used to exclude MI, at two hospitals. Volumetric data and extracellular volume fraction (ECVf) of the myocardium evaluated using CMR were compared between patients with and without DM, and their association with diastolic function was evaluated. ResultsAmong 322 analysed patients, 53 had DM. CMR revealed that the left ventricular mass index (LVMi) and ECVf were increased while LVEF was decreased in patients with DM after adjusting for patient characteristics (all P < 0.05). A stronger positive correlation was observed between LVMi and the early diastolic transmitral flow velocity to early diastolic mitral annular velocity ratio (E/e′) in patients with DM than in those without DM (correlation coefficient [R] = 0.46, p = 0.001; R = 0.15, p = 0.021, respectively; p for interaction = 0.011). ECVf correlated with E/e′ only in patients with DM (R = 0.61, p = 0.004). ConclusionsPatients with DM have increased LVMi and ECVf. Importantly, there was a difference between patients with and without DM in the relationship between these structural changes and E/e′, with a stronger relationship in patients with DM. Furthermore, DM is associated with mildly reduced LVEF even in the absence of MI.

Abstract 18862: Optimal High Sensitivity Troponin “Delta” for Prediction of 30-Day Mace

Introduction: High-sensitivity troponin (hsTnT) values are used extensively in clinical practice to determine acute myocardial infarction (MI). Most hsTnT algorithms use an accelerated diagnostic protocol based on ranges of hsTnT and time-based changes within those ranges. Little is known about the performance of a protocol based on absolute change with time regardless of absolute values. Research question: Is there a level of hsTnT change (dTnT) that can be used as a single decision factor in the triage of chest pain? Goals/Aims: To assess the diagnostic value of dTnT in ruling out 30-day MI or 30-day death and to identify optimal cut-off values. Methods: Retrospective review of patients with chest pain (CP) who presented to the ED of a single tertiary medical center between September 2017 to September 2019. Patients were included if they had at least 2 hsTnT measurements. dTnT was calculated using the difference between the first and second readings. Presence or absence of MI or death at 30 days from this ED presentation was also recorded from chart review. ROC analysis was performed to determine cut-off values for predicting each event. Statistical analysis was performed using SPSS. Results: dTnT was available in 488 patients and predicted 30-day MI (4/488) with a high AUC of 0.864 (p=0.01). The Cut-off value range of 12.5 to 20.5% had a similar sensitivity of 75% but the specificity increased as the cut-off increased to 20.5%, highest specificity being 87%.dTnT was not sensitive in predicting 30-day death, the AUC was 0.524 (p=0.9). Conclusion: Without compromising on sensitivity, the specificity of this test may increase as the cut-off value is increased. The use of troponin change as a risk marker for MACE in pts with CP has optimal sensitivity and good specificity in predicting 30-day MI and its diagnostic utility should be evaluated further.

Exploring how enrolment in the TARGET-CTCA clinical trial may modify patient perception of heart health

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Background The TARGET-CTCA trial aims to determine whether the use of high-sensitivity cardiac troponin to target computed tomography coronary angiography (CTCA) improves outcomes in patients presenting to hospital with suspected acute coronary syndrome in whom myocardial infarction has been ruled out. What patients understand of their subsequent risk of cardiovascular disease in this setting, and how intervention with CTCA may influence this is unknown. Purpose To explore how trial participants perceive their heart health and whether this has been modified by trial participation. Methods The TARGET-CTCA trial randomises patients with intermediate high sensitivity cardiac troponin levels to standard care, or CTCA plus standard care. Patients receive CTCA scan results informing them if they have a normal heart or they have mild, moderate or obstructive coronary artery disease. Forty semi-structured interviews were conducted with trial participants across standard care and intervention arms ensuring representation across disease category, age, sex and socioeconomic status groups. Data were coded and organized into themes. Results Emergent themes from the data included insights into attitudes to future health, perception of heart health, and health education needs. While some participants displayed a proactive approach to maintaining health, the consideration of future health goals was often a reactive process in response to the initial chest pain episode or the CTCA findings. While some patients discussed personal responsibility for health maintenance others described a passive approached requiring direct management from a health professional. For some standard care participants, the absence of myocardial infarction was a sign of a healthy heart. Others were left with unanswered questions after the hospital assessment. Confirmation of the absence of coronary artery disease with CTCA gave patients great confidence and a positive change to health seeking behaviour patterns was reported. Patients differed in their interpretation of the terms mild, moderate and obstructive coronary artery disease. This affected their subsequent action with some using the presence of disease as an opportunity to appraise their risk of future cardiac events and begin a preventative approach. Others reported fear and reducing activity to avoid precipitating a possible event. Many patients reported a desire to implement lifestyle changes but did not have the knowledge to do so. Conclusion Exploring how the information contained in participant result letters may contribute to the understanding of risk of future cardiac events has provided valuable information for application of the trial intervention outside of the main trial setting.

Diagnostic value of T1- and T2-weighted 3-Tesla MRI for postmortem detection and age stage classification of myocardial infarction

The aims of this study are to retrospectively evaluate the diagnostic value of T1- and T2-weighted 3-T magnetic resonance imaging (MRI) for postmortem detection of myocardial infarction (MI) in terms of sensitivity and specificity and to compare the MRI appearance of the infarct area with age stages. Postmortem MRI examinations (n = 88) were retrospectively reviewed for the presence or absence of MI by two raters blinded to the autopsy results. The sensitivity and specificity were calculated using the autopsy results as the gold standard. A third rater, who was not blinded to the autopsy findings, reviewed all cases in which MI was detected at autopsy for MRI appearance (hypointensity, isointensity, hyperintensity) of the infarct area and the surrounding zone. Age stages (peracute, acute, subacute, chronic) were assigned based on the literature and compared with the age stages reported in the autopsy reports. The interrater reliability between the two raters was substantial (κ = 0.78). Sensitivity was 52.94% (both raters). Specificity was 85.19% and 92.59%. In 34 decedents, autopsy identified an MI (peracute: n = 7, acute: n = 25, chronic: n = 2). Of 25 MI classified as acute at autopsy, MRI classified peracute in four cases and subacute in nine cases. In two cases, MRI suggested peracute MI, which was not detected at autopsy. MRI could help to classify the age stage and may indicate the area for sampling for further microscopic examination. However, the low sensitivity requires further additional MRI techniques to increase the diagnostic value.

Correlation between Microalbuminuria and Coronary Angiographic Severity in Non-diabetic Myocardial Infarction patients

Background: Microalbuminuria may have an association with myocardial infarction in absence of traditional risk factors like diabetes. The present study was intended to find the association between microalbuminuria and angiographic severity of coronary artery disease in non-diabetic myocardial infarction patients. Methods: This cross sectional analytical study included 105 non-diabetic patients with myocardial infarction who underwent coronary angiography (CAG). The microalbuminuria was defined as urine albumin to creatinine ratio (ACR) of 30 -300 mg/g, while angiographic severity was measured by Gensini score with score e” 36 was taken as moderate to severe coronary artery disease (Group I) and score below 36 was termed as absent or mild coronary artery disease (Group II). Association of microalbuminuria with severity of coronary artery disease was determined. Results: Presence of microalbuminuria was found significantly higher (45%) in patients with moderate to severe coronary artery disease than that in patients with absent or mild CAD (4.6%). The Odds of having moderate to severe coronary artery disease in patients with microalbuminuria was observed to be 17 times (95% CI = 4.5 - 63) higher than that in patients without having this condition. Correlation between ACR and Gensini score was also found a significant positive relationship (r=0.702, p&lt;0.001) with 70% of variation in Gensini score being explained by ACR. Conclusion: Microalbuminuria can be considered as a predictor of the severity of coronary artery disease in non-diabetic myocardial infarction patients. Cardiovasc j 2022; 15(1): 56-62

Differentiated search for disease in a patient with hyperthyroisis with a prevailing syndrome of cardiovascular disorders. Clinical case

Background. Elderly patients in the presence of iodine deficiency most often develop functional autonomy of the thyroid gland, accompanied by dysfunction— hyperthyroidism. Due to an excess of thyroid hormones, thyrotoxic cardiomyopathy is formed, in which in most cases there is a syndrome of heart rhythm disturbances— atrial fibrillation. The aim of the study: to find out the algorithm for the differential search for a disease in the presence of hyperthyroidism with severe cardiovascular disorders using the example of a specific elderly patient from real clinical practice. Clinical case. A 61-year-old patient was hospitalized in the intensive care unit for arrhythmogenic shock against the background of an attack of atrial fibrillation. The absence of myocardial infarction, pulmonary embolism, acute adrenal insufficiency was stated. The examination revealed a significant decrease in the level of TSH along with an increase in the levels of thyroid hormones without the phenomena of autoaggression, hyperglycemia, hypocholesterolemia, a tendency to hypoproteinemia, leukopenia. An increase in the thyroid gland, heterogeneity of the structure with hypovascularization, the presence of small multiple nodular formations that require clarification were determined. The patient has atrial fibrillation with variability in blood pressure, impaired repolarization processes, hyperkinetic type of hemodynamics, reflecting cardiomyopathy. In this case, there are all prerequisites for the development of functional autonomy of the thyroid gland: age, endemic region, absence of autoimmune changes, dermopathy, ophthalmopathy. Attention is drawn to the severity of manifestations of thyrotoxic heart with dyshormonal and catabolic syndromes, superimposed on comorbid coronary heart disease, hypertension. Conclusions. Hyperthyroidism in the elderly is manifested primarily by cardiovascular disorders, most often with the presence of an arrhythmia syndrome in the form of atrial fibrillation, which can provoke arrhythmogenic shock. Functional autonomy of the thyroid gland with the formation of thyrotoxic cardiomyopathy has specific clinical course, especially in comorbid conditions, which significantly impairs the quality of life.

Coronary Atherosclerosis, Cardiac Troponin, and Interleukin-6 in Patients With Chest Pain: The PROMISE Trial Results

BackgroundIncreased inflammation and myocardial injury can be observed in the absence of myocardial infarction or obstructive coronary artery disease (CAD). ObjectivesThe authors determined whether biomarkers of inflammation and myocardial injury—interleukin (IL)-6 and high-sensitivity cardiac troponin (hs-cTn)—were associated with the presence and extent of CAD and were independent predictors of major adverse cardiovascular events (MACEs) in stable chest pain. MethodsUsing participants from the PROMISE trial, the authors measured hs-cTn I and IL-6 concentrations and analyzed computed tomography angiography (CTA) images in the core laboratory for CAD characteristics: significant stenosis (≥70%), high-risk plaque (HRP), Coronary Artery Disease Reporting and Data System (CAD-RADS) categories, segment involvement score (SIS), and coronary artery calcium (CAC) score. The primary endpoint was a composite MACE (death, myocardial infarction, or unstable angina). ResultsThe authors included 1,796 participants (age 60.2 ± 8.0 years; 47.5% men, median follow-up 25 months). In multivariable linear regression adjusted for atherosclerotic cardiovascular disease (ASCVD) risk, hs-cTn was associated with HRP, stenosis, CAD-RADS, and SIS. IL-6 was only associated with stenosis and CAD-RADS. hs-cTn above median (1.5 ng/L) was associated with MACEs in univariable analysis (HR: 2.1 [95% CI: 1.3-3.6]; P = 0.006), but not in multivariable analysis adjusted for ASCVD and CAD. IL-6 above median (1.8 ng/L) was associated with MACEs in multivariable analysis adjusted for ASCVD and HRP (HR: 1.9 [95% CI: 1.1-3.3]; P = 0.03), CAC (HR: 1.9 [95% CI: 1.0-3.4]; P = 0.04), and SIS (HR: 1.8 [95% CI: 1.0-3.2]; P = 0.04), but not for stenosis or CAD-RADS. In participants with nonobstructive CAD (stenosis 1%-69%), the presence of both hs-cTn and IL-6 above median was strongly associated with MACEs (HR: 2.5-2.7 after adjustment for CAD characteristics). ConclusionsConcentrations of hs-cTn and IL-6 were associated with CAD characteristics and MACEs, indicating that myocardial injury and inflammation may each contribute to pathways in CAD pathophysiology. This association was most pronounced among participants with nonobstructive CAD representing an opportunity to tailor treatment in this at-risk group. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550)

Incident and recurrent myocardial infarction (MI) in relation to comorbidities: Prediction of outcomes using machine-learning algorithms.

To date, incident and recurrent MI remains a major health issue worldwide, and efforts to improve risk prediction in population health studies are needed. This may help the scalability of prevention strategies and management in terms of healthcare cost savings and improved quality of care. We studied a large-scale population of 4.3million US patients from different socio-economic and geographical areas from three health plans (Commercial, Medicare, Medicaid). Individuals had medical/pharmacy benefits for at least 30months (2years for comorbid history and followed up for 6months or more for clinical outcomes). Machine-learning (ML) algorithms included supervised (logistic regression, neural network) and unsupervised (decision tree, gradient boosting) methodologies. Model discriminant validity, calibration and clinical utility were performed separately on allocated test sample (1/3 of original data). In the absence of MI in comorbid history, the overall incidence rates were 0.442 cases/100 person-years and in the presence of MI history, 0.652. ML algorithms showed that supervised formulations had incrementally higher discriminant validity than unsupervised techniques (e.g., for incident MI outcome in the absence of MI in comorbid history: logistic regression "LR" - c index 0.921, 95%CI 0.920-0.922; neural network "NN" - c index 0.914, 95%CI 0.913-0.915; gradient boosting "GB" - c index 0.902, 95%CI 0.900-0.904; decision tree "DT" - c index 0.500, 95%CI 0.495-0.505). Calibration and clinical utility showed good to excellent results. ML algorithms can substantially improve the prediction of incident and recurrent MI particularly in terms of the non-linear formulation. This approach may help with improved risk prediction, allowing implementation of cardiovascular prevention strategies across diversified sub-populations with different clusters of complexity.

Association of Metabolic Syndrome With Long-Term Cardiovascular Risks and All-Cause Mortality in Elderly Patients With Obstructive Sleep Apnea.

BackgroundEvidence suggests that an increased risk of major adverse cardiac events (MACE) and all-cause mortality is associated with obstructive sleep apnea (OSA), particularly in the elderly. Metabolic syndrome (MetS) increases cardiovascular risk in the general population; however, less is known about its influence in patients with OSA. We aimed to assess whether MetS affected the risk of MACE and all-cause mortality in elderly patients with OSA.MethodsFrom January 2015 to October 2017, 1,157 patients with OSA, aged ≥60 years, no myocardial infarction (MI), and hospitalization for unstable angina or heart failure were enrolled at baseline and were followed up prospectively. OSA is defined as an apnea-hypopnea index of ≥5 events per hour, as recorded by polysomnography. Patients were classified on the basis of the presence of MetS, according to the definition of the National Cholesterol Education Program (NCEP). Incidence rates were expressed as cumulative incidence. Cox proportional hazards analysis was used to estimate the risk of all events. The primary outcomes were MACE, which included cardiovascular death, MI, and hospitalization for unstable angina or heart failure. Secondary outcomes were all-cause mortality, components of MACE, and a composite of all events.ResultsMetS was present in 703 out of 1,157 (60.8%) elderly patients with OSA. During the median follow-up of 42 months, 119 (10.3%) patients experienced MACE. MetS conferred a cumulative incidence of MACE in elderly patients with OSA (log-rank, P < 0.001). In addition, there was a trend for MACE incidence risk to gradually increase in individuals with ≥3 MetS components (P = 0.045). Multivariate analysis showed that MetS was associated with an incidence risk for MACE [adjusted hazard ratio (aHR), 1.86; 95% confidence interval (CI), 1.17–2.96; P = 0.009], a composite of all events (aHR, 1.54; 95% CI, 1.03–2.32; P = 0.036), and hospitalization for unstable angina (aHR, 2.01; 95% CI, 1.04–3.90; P = 0.039). No significant differences in the risk of all-cause mortality and other components of MACE between patients with and without MetS (P > 0.05). Subgroup analysis demonstrated that males (aHR, 2.23; 95% CI, 1.28–3.91, P = 0.05), individuals aged <70 years (aHR, 2.36; 95% CI, 1.27–4.39, P = 0.006), overweight and obese individuals (aHR, 2.32; 95% CI, 1.34–4.01, P = 0.003), and those with moderate-severe OSA (aHR, 1.81;95% CI: 1.05–3.12, P = 0.032) and concomitant MetS were at a higher risk for MACE.ConclusionMetS is common in elderly patients with OSA in the absence of MI, hospitalization for unstable angina or heart failure. Further, it confers an independent, increased risk of MACE, a composite of all events, and hospitalization for unstable angina. Overweight and obese males, aged <70 years with moderate-severe OSA combined with MetS presented a significantly higher MACE risk.

Прогностическая значимость векторкардиографического исследования у больных с острым инфарктом миокарда

Актуальность. Актуальной является оценка достоверности векторкардиографического (ВКГ) исследования сердца у больных с острым периодом инфаркта миокарда (ИМ) по сравнению с электрокардиографическим (ЭКГ) методом. Цель исследования: определить предсказательную ценность векторкардиографического исследования у больных с острым периодом инфаркта миокарда. Материалы и методы. Обследованы 396 больных с острым ИМ левого желудочка (180 больных с ИМ и 216 больных с сочетанным течением ИМ и стеатоза печени). Возраст больных составил в среднем 61,2 ± 5,1 года. Преобладали лица мужского пола — 54,55 %. Для получения более обширной и глубокой информации о состоянии электрической активности сердца дополнительно к ЭКГ использовалась ВКГ-методика на усовершенствованном кардиодиагностическом многофункциональном комплексе МТМ-СКМ. Для вычисления соотношений между результатами ВКГ-теста и стандартом диагностики (ЭКГ) строилась так называемая четырехпольная таблица. Результаты. Соотношение правильно диагностированных пациентов с помощью ВКГ-исследования позволяет определять его чувствительность и специфичность. Так, чувствительность ВКГ, определяемая отношением a/(a + c) – 395/(395 + 1), составила 99,7 %, т.е. с вероятностью 99,7 % ВКГ покажет положительный результат у больных с ИМ. Специфичность ВКГ, вычисляемая отношением d/(d + b) – 30/(30 + 2), составила 93,8 %, т.е. с вероятностью 93,8 % ВКГ даст отрицательный результат у больного, не имеющего ИМ. Прогностическая ценность метода зависит от его чувствительности и специфичности. Прогностическая ценность положительного результата, т.е. вероятность наличия ИМ при его ВКГ-признаках, составила 99,6 % (a/(a + b) – 395/(395 + 2)). Прогностическая ценность отрицательного результата, т.е. вероятность отсутствия ИМ без его ВКГ-признаков, составила 96,8 % (d/(c + d) – 30/(1 + 30)). Выводы. Чувствительность ВКГ-метода — 99,7 %, специфичность — 93,8 %. Положительная прогностическая значимость ВКГ составила 99,6 %, отрицательная прогностическая значимость ВКГ — 96,8 %.

Coronary artery bypass grafting in myocardial infarction and unstable angina pectoris: in-hospital outcomes. Part 2

To assess in-hospital outcomes of coronary artery bypass grafting in patients with acute coronary syndrome, depending on the presence or absence of myocardial infarction. Over the period from 2017 to 2018 within the framework of a single-centre register, the study enrolled a total of 166 consecutive patients admitted with non-ST segment elevation acute coronary syndrome and subjected to coronary artery bypass grafting. Depending on the outcome of acute coronary syndrome, the patients were divided into 2 groups: Group One included 98 (59%) patients with unstable angina pectoris and Group Two comprised 68 (41%) patients with myocardial infarction, who underwent surgery at an average of 16 (11; 20) days after manifestation of the clinical signs of myocardial infarction. The endpoints of the study were major adverse cardiovascular events during the in-hospital period: death, myocardial infarction, acute cerebral circulation impairment/transitory ischaemic attack, repeat revascularization, septic complications, multiple organ failure syndrome, wound infectious complications, requirement for repeated surgical debridement, remediastinotomy due to haemorrhage, the frequency of extracorporeal membrane oxygenation and renal replacement therapy. The mortality rate in the compared groups was similar: 3% (n=3) and 3% (n=2), respectively. Perioperative myocardial infarction occurred in 1 (1%) patient of the first group, with no cases of this complication observed in the second group. The frequency of reoperations due to haemorrhage in the early postoperative period in the group of unstable angina pectoris amounted to 3% (n=3) and was associated with administration of dual antithrombotic therapy, with no cases of this complication in the group of myocardial infarction. Wound complication in the second group were observed in 7.6% (n=5) and in the first group in 4% (n=4) (p=0.33). The differences turned out to be statistically insignificant for such postoperative complications as multiple organ failure syndrome, requirement for repeated surgical debridement, renal replacement therapy, and extracorporeal membrane oxygenation. The residual SYNTAX Score in the group of myocardial infarction amounted to 2.3±2.8, whereas in the group of unstable angina pectoris to 2.3±3, thus suggesting complete revascularization in the total sample of patients with acute coronary syndrome. The average length of hospital stay (including the postoperative period) in the first group amounted to 26.3±6.6 days and in the second group to 27.4±7.2 days (p=0.53). The postoperative bed-day in the group with unstable angina pectoris was 12.6±3.2 and in the myocardial infarction group - 14.9±5.3 (p=0.06). The obtained in-hospital outcomes suggest that coronary artery bypass grafting may be an efficient and safe method of complete revascularization for patients with non-ST-elevation acute coronary syndrome, including that resulting in myocardial infarction, performed averagely on day 16 (11; 20) after the onset of clinical manifestations of myocardial infarction.

Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction.

BackgroundThe best available imaging technique for the detection of prior myocardial infarction (MI) is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Although the electrocardiogram (ECG) still plays a major role in the diagnosis of prior MI, the diagnostic value of the ECG remains uncertain. This study evaluates the diagnostic value of the ECG in the assessment of prior MI.MethodsIn this retrospective study, data from electronic patient files were collected of 1033 patients who had undergone CMR with LGE between January 2014 and December 2017. After the exclusion of 59 patients, the data of 974 patients were analysed. Twelve-lead ECGs were blinded and evaluated for signs of prior MI by two cardiologists separately. Disagreement in interpretation was resolved by the judgement of a third cardiologist. Outcomes of CMR with LGE were used as the gold standard.ResultsThe sensitivity of the ECG in the detection of MI was 38.0% with a 95% confidence interval (CI) of 31.6–44.8%. The specificity was 86.9% (95% CI 84.4–89.1%). The positive and negative predictive value were 43.6% (95% CI 36.4–50.9%) and 84.0% (95% CI 81.4–86.5%) respectively. In 170 ECGs (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (κ 0.51, 95% CI 0.45–0.58, p < 0.001).ConclusionThe ECG has a low diagnostic value in the detection of prior MI. However, if the ECG shows no signs of prior MI, the absence of MI is likely. This study confirms that a history of MI should not be based solely on an ECG.

Chest Pain and Trponin Levels; Alarming Factors among Patients with Myocardial Infarction

- It is of ace importance to assess a person with myocardial infarction in emergency to impose definitive treatment. The measurement of troponin levels is necessary to identify the presence or absence of myocardial infarction. The aim of this article is to elucidate the importance the importance of troponin level measurement among patients with chest pain as a marker of myocardial infarction. Troponin levels are at a negligible level in a normal person but elevate to a large extent within 3 to 4 hours of initiation of chest pain and remain high upto many days. Measurement of serum troponin levels is a good diagnostic mesure to plan definitive treatment of patients with myocardial infarction and differentiate the chest pain originated from myocardial infarction and chest pain from other factors.

Relationship Of Myocardial Necrosis, Inflammation And Coronary Atherosclerosis To Cardiovascular Outcomes In Patients With Stable Chest Pain: Results From The Promise Trial

Introduction: Myocardial cell death and inflammation can be observed in the absence of myocardial infarction or obstructive coronary artery disease (CAD). Our goal was to determine whether high-sensitivity troponin (hsTn) and interleukin 6 (IL6) are independent predictors of major adverse cardiovascular events (MACE) in stable chest pain and how they are associated with the presence and extent of CAD.

Prognosis of unrecognised myocardial infarction determined by electrocardiography or cardiac magnetic resonance imaging: systematic review and meta-analysis.

ObjectiveTo evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR).DesignSystematic review and meta-analysis of prospective studies.Data sourcesElectronic databases, including PubMed, Embase, and Google Scholar.Study selectionProspective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction.Data extraction and synthesisThe primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction.ResultsThe meta-analysis included 30 studies with 253 425 participants and 1 621 920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively.ConclusionsUMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.

Повышение концентрации кардиоспецифичных тропонинов при отсутствии инфаркта миокарда. Часть 2

Повышение концентрации кардиоспецифичных тропонинов при отсутствии инфаркта миокарда. Часть 2