Acute Anterior ST-segment Elevation Research Articles

Evaluation of Pharmaco-invasive PCI in Terms of in Hospital Clinical Outcome of Acute Anterior ST Segment Elevation Myocardial Infarction Patients Compared to Primary PCI

Background: The strategic reperfusion early after Myocardial Infarction trial and the French Registry of Acute Anterior ST segment elevation MI suggested that pharmaco-invasive strategy compares favorably with primary percutaneous coronary intervention (PPCI). Objectives: To evaluate in hospital clinical outcome of patients with acute anterior ST segment elevation myocardial infarction undergoing Primary PCI and pharmaco-invasive PCI. Methods: This cross sectional study was conducted in United Hospital, Dhaka. A total of 120 patients were studied. These patients were categorized into two groups. Those with acute anterior ST segment elevation MI who underwent primary PCI was denoted as group A (n= 55) and those with acute anterior ST segment elevation thrombolysed by streptokinase followed by PCI confined to pharmaco-invasive PCI was denoted as group B (n=65). Results: Acute LVF was more in pharmaco-invasive group than in primary PCI group and was statistically significant (p= 0.032). 02 patients (3.6%) died in primary PCI group: one of which was due to ventricular fibrillation followed by asystole 3 hours after procedure and the other died due to cardiac arrest 10 hours after the procedure. No major bleeding incidence was found in both groups. Conclusion: Acute anterior ST segment elevation myocardial infarction patients receiving pharmaco-invasive treatment compared with the Primary PCI had higher incidence of acute LVF and no significant discrepancy was observed regarding bleeding events, death, stent thrombosis, arrythymia, heart block and cardiac arrest. J Shaheed Suhrawardy Med Coll 2023; 15(1): 34-38

Association between neutrophil-to-lymphocyte ratio and outcomes in hospitalized patients with left ventricular thrombus.

Left ventricular thrombus (LVT) is a severe cardiovascular complication occurring in approximately 10% of patients with acute anterior ST-segment elevation myocardial infarction. This study aimed to evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with LVT. This multicenter retrospective study was conducted between January 2000 and June 2022 in hospitalized patients with LVT. The outcome included in-hospital MACCE. The association between NLR and in-hospital MACCE was measured by odds ratios (ORs). The restricted cubic spline model was used for dose-response analysis. A total of 197 LVT patients from four centers were included for analysis in this study. MACCE occurred in 13.7% (27/197) of the patients. After adjusting for estimated glomerular filtration rate (eGFR), D-dimer, and age, the OR for MACCE comparing first to the third tertile of NLR was 13.93 [95% confidence interval: 2.37-81.77, P = 0.004, P -trend = 0.008]. When further adjusting for etiology and heart failure with reduced ejection fraction (HFrEF), the association remained statistically significant. Spline regression models showed an increasing trend in the incidence of MACCEs with NLR both in crude and adjusted models. Subgroup analyses showed that a high NLR may be correlated with poorer outcomes for LVT patients older than 65 years, or with hypertension, dyslipidemia, low ejection fraction, liver, and renal dysfunctions. In conclusion, these findings suggested that higher NLR may be associated with an increased risk of in-hospital MACCE in patients with LVT.

Effect of Cardiac Rehabilitation on Left Ventricular Remodeling After Acute Anterior Wall ST Segment Elevation Myocardial Infarction Treated by Late PCI Using 3D Echocardiography: A Randomized Study

Effect of Cardiac Rehabilitation on Left Ventricular Remodeling After Acute Anterior Wall ST Segment Elevation Myocardial Infarction Treated by Late PCI Using 3D Echocardiography: A Randomized Study

Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Association of Left Ventricular Systolic Function with Diagonal Branch Flow in Patients with First Anterior ST-Elevation Myocardial Infarction Treated with Primary Angioplasty

Background: There are few studies about the impact of diagonal branch blood flow on echocardiographic findings in patients with first acute anterior myocardial infarction undergoing primary angioplasty. Objectives: We aimed to compare left ventricular systolic function measures in patients with first acute anterior ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty based on diagonal branch blood flow after the procedure. Methods: This study was a single-center study that enrolled patients with their first acute anterior STEMI treated with primary angioplasty in our center between October 2020 and March 2021. Patients were divided into two groups: The patients with final thrombolysis in myocardial infarction (TIMI) flow III in diagonal (sufficient diagonal flow) and patients with final TIMI flow less than III in diagonal (insufficient diagonal flow) after the procedure. The left ventricular Wall-Motion Score Index (WMSI) and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: A total of 107 patients with first anterior STEMI treated with primary PCI were enrolled in the present study, of which 13 patients (12.1%) had insufficient diagonal flow after primary coronary angioplasty. The LVEF was lower in patients with insufficient diagonal flow (32.92 ± 7.29% vs. 39 ± 8.68%, P = 0.018). Also, this group had higher LV WMSI (1.68 ± 0.28 vs. 1.49 ± 0.26, P = 0.029). Conclusions: The present study showed that in patients with first acute anterior STEMI undergoing primary angioplasty, insufficient diagonal branch flow after the procedure was associated with worse left ventricular systolic function and higher LV WMSI.

Shark Fin Electrocardiogram in the Intensive Care Unit.

Shark Fin Electrocardiogram in the Intensive Care Unit.

Takostubo syndrome combined with ventricular septal perforation: a case report

BackgroundThe precise clinical features and etiologic basis of Takotsubo syndrome remain unclear, although an association with emotional or stressful triggers has been recognized. Ventricular septal perforation is a very rare life-threatening complication.Case presentationA 77-year-old female patient presented to the hospital with unrelieved chest tightness and shortness of breath. Three months ago, the patient's electrocardiogram revealed ischemic T wave inversion of the anterior wall, along with an increase in myocardial injury markers. There was no evidence of a ventricular septal defect on echocardiography. The patient was admitted to the respiratory department to treat lung lesions. The electrocardiogram demonstrated dynamic changes following admission, and the myocardial markers returned to normal, but the echocardiography revealed a ventricular septal defect. The initial diagnosis was ventricular septal perforation because of myocardial infarction with acute anterior ST-segment elevation. Coronary angiography revealed no abnormalities, but left ventricular angiography revealed an enlarged apex and VSD, with a right ventricular shunt bundle. Later, cardiac MRI revealed an apical ventricular septal defect. Further inquiry of the patient's medical history revealed that her husband died unexpectedly three months ago, and her daughter was seriously injured in a car accident, causing the patient severe emotional distress. Takotsubo syndrome was then determined in conjunction with the patient's medical history, symptoms, signs, and pertinent examinations. Without using a catheter or a surgical procedure, we managed the patient's medical condition. Two weeks later, the patient was discharged with symptoms improved.ConclusionsTakotsubo syndrome is comparable to an acute myocardial infarction on clinical and electrocardiographic examination in the absence of significant coronary disease. Although ventricular septal perforation is most commonly associated with acute myocardial infarction, it can also happen following Takotsubo syndrome. Takotsubo syndrome complicated by ventricular septal perforation is easily misdiagnosed. The early recognition and management of this condition can avoid or reduce morbidity and mortality.

Inhomogeneous Distribution of Regional Myocardial Work Efficiency Predicts Early Left Ventricular Remodeling After Acute Anterior Myocardial Infarction Treated With Primary Percutaneous Intervention.

BackgroundThis study aimed to investigate the hypothesis that specific pattern of myocardial work (MW) distribution in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) could provide prognostic value for predicting left ventricular (LV) remodeling.MethodsA total of 98 first anterior wall STEMI patients treated with primary percutaneous coronary intervention [85 men (86.7%), mean age: 58 ± 12 years] were enrolled. Transthoracic echocardiography was performed 24–72 h after angioplasty and during 3-month follow-up. MW was estimated from the left ventricular pressure–strain loop derived from speckle tracking echocardiography and simultaneous noninvasive brachial artery cuff pressure. The primary endpoint was early LV remodeling, defined as an increase in LV end-diastolic volume ≥20% compared with baseline at 3 months after STEMI. Major adverse cardiac events and combined clinical outcomes were recorded.ResultsLV remodeling was present in 32 patients (33%), who exhibited lower global and culprit-regional work index (WI), constructive work (CW), work efficiency (WE), and specifically, greater differences of WE (delta-WE) and CW (delta-CW) between the culprit and non-culprit region than those without LV remodeling both at the acute phase and follow-up (all P < 0.0125). During follow-up, all global and regional WI, CW, and WE were improved (P < 0.0125 compared with baseline), with less improvement in patients with LV remodeling. In multivariate analysis, baseline delta-WE (odds ratio: 2.304; 95% CI: 1.093–4.856, P = 0.028) and peak troponin I level (odds ratio: 1.035; 95%CI: 1.008–1.063, P = 0.010) were independently associated with early LV remodeling. Patients with greater delta-WE at baseline were associated with a higher incidence of heart failure and combined clinical outcomes during follow-up.ConclusionAfter reperfused acute anterior STEMI, patients with LV remodeling presented with more inhomogeneous MW distribution. The absolute difference of WE between culprit and non-culprit territory at the acute phase is an independent predictor for early LV remodeling.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT05107102.

Preventative effects of dapagliflozin on early ventricular dysfunction and remodeling in patients with acute anterior STEMI - The PREDOMINACE trial

BackgroundSodium glucose cotransporter 2 inhibitors (SGLT-2i) are oral hypoglycemic drugs that can reduce the risk of deteriorating heart failure (HF) or cardiovascular death in patients with HF. Although some animal models have shown that SGLT-2i can effectively inhibit reperfusion injury after acute myocardial infarction (AMI), there is no clinical evidence to prove that SGLT-2i can also play a significant role in improving reperfusion injury in patients with AMI. Therefore, PREDOMINACE study enrolled patients with acute anterior large ST-segment elevation myocardial infarction, who are at high risk of developing HF in the future. The aim of this trial is to study the prevention effects of dapagliflozin on early ventricular dysfunction and remodeling in patients with acute anterior ST-segment elevation myocardial infarction (STEMI), and to explore the efficacy and safety of dapagliflozin in the treatment of patients with diabetes and without diabetes after acute anterior STEMI. MethodsWithin a multi-center, randomized, single-blind, controlled trial we will recruit patients with acute anterior STEMI from the Second Hospital of Tianjin Medical University and Tianjin Chest Hospital, who are randomly divided into intervention group or control group in a 1:1 ratio. The intervention group was given dapagliflozin (10 mg once daily) before primary percutaneous coronary intervention (PPCI) and 30 days after PPCI, while the control group is not given SGLT-2i. The primary endpoint is the impact of dapagliflozin on changes of NT-proBNP levels in 30 days of acute anterior STEMI. Secondary endpoints include changes in echocardiographic left ventricular remodeling parameters (LVESV, LVEDV, EF), and the changes of ECG (Q wave leads 30 days after PPCI/ST-segment elevation leads at baseline,ST-segment decline degree 24 h and 7 days after PPCI). Hospitalization rate due to HF or other causes, incidence of malignant arrhythmias, and all-cause mortality will be assessed as exploratory secondary endpoints. DiscussionThe PREDOMINACE trial will test dapagliflozin in patients with acute anterior STEMI, regardless of the presence or absence of diabetes. Therefore, the PREDOMINACE trial may support that the effects of SGLT-2i on improving cardiac remodeling, reducing cardiac pre and after load and improving cardiac metabolism are independent of its antidiabetic effects. Results will provide the clinical rationale for SGLT-2i to improve prognosis in patients with AMI.Trial registration: Chinese Clinical Trial Registry. Identifier: ChiCTR2100048157. Registered 23 September 2021.

Undiagnosed Hidradenitis Suppurativa Associated with Acute Myocardial Infarction: A Case Report

Hidradenitis suppurativa (HS) is a chronic inflammatory disease believed to be a risk factor for cardiovascular events. Traditional cardiovascular risk factors, such as metabolic syndrome, often coexist with HS. Chronic inflammatory conditions may underlie cardiovascular events in young patients or those with few traditional risk factors. A 34-year-old female was admitted to the authors’ tertiary care hospital with acute anterior ST-segment elevation myocardial infarction, and underwent a successful primary percutaneous coronary intervention to their left anterior descending artery. They were a smoker, had a high BMI, and had a positive family history of premature coronary artery disease. During their admission, the patient disclosed that they had discharging lesions under their left breast. The patient had a long-standing history of multiple discharging lesions alternating with disfiguring scars that had started in their late childhood; however, despite this leading to self-dissatisfaction, they did not seek medical advice. Examination revealed plaques and scarring in both axillae and a chronic abscess under the left breast, the swabs from which were sterile, as is consistent with HS. The laboratory results showed a raised troponin and white cell count with mildly elevated levels of C-reactive protein. The patient was managed with standard acute coronary syndrome treatment and a course of oral doxycycline, and awaits further treatment by dermatology and plastic surgery. The morbidity of HS is grossly underestimated. This case study highlights that HS has significant cardiovascular implications, in addition to psychological impacts, and that underlying systemic inflammation may promote rapid atherosclerosis. Further research into pathogenesis and strategies to prevent adverse cardiovascular events are needed.

Prognostic value of myocardial contrast echocardiography in acute anterior wall ST-segment elevation myocardial infarction with successful epicardial recanalization.

Although myocardial contrast echocardiography (MCE) can evaluate microvascular perfusion abnormalities, its prognostic value is uncertain in acute anterior wall ST-Segment elevation myocardial infarction (STEMI) with successful epicardial recanalization. Therefore, the study aims to investigate the prognostic role of qualitative and quantitative MCE in acute anterior wall STEMI with successful epicardial recanalization. 153 STEMI patients were assessed by MCE within 7days after successful epicardial recanalization. Qualitative perfusion parameters (microvascular perfusion score index, MPSI) and quantitative perfusion parameters (A, β, and Aβ) were acquired using a 17-segment model. And corrected A and Aβ were calculated. Patients were all followed for major adverse cardiovascular events (MACEs). During median follow-up of 27 (4) months, 39 (25.49%) patients experienced MACEs, while 114 (74.51%) were free from MACEs. Patients with MACEs had higher MPSI (1.65 ± 0.13 vs. No-MACEs 1.35 ± 0.20, P < 0.001), lower β (1.09 ± 0.19s-1 vs. No-MACEs 1.34 ± 0.30s-1, P < 0.001), corrected A (0.17 ± 0.03dB vs. No-MACEs 0.19 ± 0.04dB, P = 0.039) and lower corrected Aβ (0.19 ± 0.06dB/s vs. No-MACEs 0.25 ± 0.08dB/s, P < 0.001). MPSI of 1.44 provided an area under the curve (AUC) of 0.872, while β of 1.18s-1 and corrected Aβ of 0.22dB/s provided AUCs of 0.759 and 0.724, respectively. The combination of MPSI, β and corrected Aβ provided an increased AUC of 0.964 (all P < 0.05). Time-dependent ROC analysis showed that the AUCs of the MPSI, β, corrected Aβ and the combination at 1, 1.5 and 2years indicated a strong predictive power for MACEs (AUC = 0.900/0.894/0.881 for MPSI, 0.648/0.704/0.732 for β, 0.674/0.686/0.722 for corrected Aβ, and 0.947/0.962/0.967 for the combination, respectively). Patients with MPSI < 1.44, β > 1.18s-1, or corrected Aβ > 0.22dB/s had lower event rate (all Log Rank P ≤ 0.001). MPSI, β, corrected Aβ, GLS and WBC were independent predictors of MACEs with adjusted hazard ratio of 34.41 (8.18-144.87), P < 0.001 for MPSI; 39.29 (27.46-65.44), P < 0.001 for β; 8.93 (1.46-54.55), P = 0.018 for corrected Aβ; 10.88 (2.83-41.86), P = 0.001 for GLS; and 1.43 (1.16-1.75), P = 0.001 for WBC. Qualitative and quantitative MCE can accurately predict MACEs in acute anterior wall STEMI with successful epicardial recanalization, and their combined predictive value is higher.

Effects of Home-Based Baduanjin Exercise on Left Ventricular Remodeling in Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: Study Protocol for a Randomized Controlled Trial.

BackgroundLeft ventricular (LV) remodeling after ST-segment elevation myocardial infarction (STEMI) is a major pathological basis associated with heart failure and increased mortality. Exercise-based cardiac rehabilitation has been verified to significantly improve prognosis and quality of life. As a traditional Chinese Qigong, Baduanjin exercise has effectively alleviated adverse LV remodeling in STEMI patients. Despite this, participation in exercise rehabilitation remains low, and home-based exercise rehabilitation may be an alternative approach. Besides, anterior STEMI is reported to have higher risk of adverse LV remodeling. However, the efficiency regarding home-based Baduanjin exercise on LV remodeling in anterior STEMI patients remains uncertain currently.Methods/DesignA single-blind, randomized controlled clinical trial was conducted to explore the efficacy and safety of home-based Baduanjin exercise in anterior STEMI patients compared with moderate intensity aerobic walking. A total of 114 participants were assigned randomly to the Baduanjin group or walking control group at a 1:1 ratio. Eligible participants practiced Baduanjin or walking exercise (5 times a week) for 12 weeks, and then followed up for another 12 weeks. The primary outcome is a relative change in the LV end-diastolic volume. The secondary outcomes include the plasma levels of hypersensitive C-reactive protein and interleukin 6, health-related quality of life measured by EQ-5D-5L, LV ejection fraction, patient health questionnaire-9, generalized anxiety disorder screener-7, short physical performance battery score, and clinical endpoint events. The proportion of circulating regulatory T-cells were also assessed. Adverse events were recorded throughout the trial for safety evaluation. Data were be analyzed by researchers blinded to the treatment allocation.DiscussionThis study provided powerful evidence for the use of home-based Baduanjin exercise in anterior STEMI patients in alleviating LV remodeling and improving clinical outcomes.Trial RegistrationThe Research Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine has approved this study (ZYYECK[2020]045). Written informed consent of patients were required. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2100047298).DisseminationOur results will be published in peer-reviewed journals and disseminated through academic conferences and the Internet.

Comparing the efficacy of angiotensin receptor-neprilysin inhibitor and enalapril in acute anterior STEMI patients after primary percutaneous coronary intervention: a prospective randomized trial.

For patients with heart failure (HF), the effect of angiotensin receptor-neprilysin inhibitors (ARNIs, sacubitril/valsartan) on cardiac remodeling has been found to be superior to angiotensin-converting enzyme inhibitors (ACEI). However, little data have described the impact of early-initiation ARNI in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). In this prospective, randomized, double-blind, parallel-group trial, we enrolled 131 anterior STEMI patients who were treated with primary percutaneous coronary intervention (PCI) between February 2019 and December 2019. All patients received standard STEMI management and were divided into 2 groups (ARNI/enalapril). Primary efficacy outcomes were the between-group difference in change (from baseline to 4-, 12-, and 24-week) in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration, left ventricular ejection fraction (LVEF), and left ventricular end-systolic volumes and end-diastolic volumes (LVESV and LVEDV). Secondary outcomes were determined by a composite of death, reinfarction, outpatient HF or HF hospitalization, malignant arrhythmia, and stroke. Safety outcomes included worsening renal function, hypotension, hyperkalemia, angioedema and cough. We found that NT-proBNP concentration decreased more in the ARNI group than in the enalapril group [4 weeks: ratio of ARNI vs. enalapril 0.36, 95% confidence interval (CI): 0.24 to 0.52, P<0.001; 12 weeks: 0.54, 95% CI: 0.35 to 0.79, P<0.001; 24 weeks: 0.53, 95% CI: 0.32 to 0.83, P<0.001). When compared to the enalapril group, the ARNI group patients had a significant reduction in LVEDV (P<0.001) and LVESV (P<0.001), and an improvement in LVEF (P=0.011) at 24 weeks. Secondary outcomes occurred in 13 participants (20.3%) in the ARNI group and 22 participants (34.4%) in the enalapril group [hazard ratio (HR), 0.56; 95% CI: 0.28 to 1.12; P=0.102]. The incidence of outpatient HF or HF hospitalization in the ARNI group was significantly lower than that in the enalapril group (HR, 0.36; 95% CI: 0.14 to 0.94; P=0.037). There were no significant differences in the safety between the 2 groups. For patients with acute anterior STEMI undergoing primary PCI, early initiation of ARNI provided significant clinical benefits. Chinese Clinical Trial Registry (ChiCTR2100042944) registered on February 1, 2021.

Arrhythmogenic anterior myocardial infarction with QRS-complex fragmentations and Passing phenomenon or Yasser’s phenomenon; the risk and serious implications

Rationale: The arrhythmias associated with myocardial infarction may be serious. Increasing morbidity and mortality in myocardial infarction-induced arrhythmias will be expected. The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated Passing phenomenon or “Yasser’s phenomenon” may have an apparent hemodynamic impact. Patient concerns: A 68-year-old married, housewife, Egyptian female patient presented to the physician outpatient clinic with acute chest pain and anterior myocardial infarction with QRS-complex fragmentations and Passing phenomenon or “Yasser’s phenomenon”. Diagnosis: Arrhythmogenic acute extensive anterior infarction with QRS-complex fragmentations and Passing phenomenon or Yasser’s phenomenon. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute arrhythmogenic anterior ST-segment elevation myocardial infarction with QRS-complex fragmentations to streptokinase and percutaneous transluminal coronary angioplasty. Lessons: The presence of runs of ventricular tachycardia, multiform frequent premature ventricular contractions, and QRS-complex fragmentations, elderly, female sex are prognostic factors for the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase, fibrinolytic, and percutaneous transluminal coronary angioplasty. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications. Passing phenomenon or “Yasser’s phenomenon” should be directed at the disease progression.

Effect of Paroxetine-Mediated G-Protein Receptor Kinase 2 Inhibition vs Placebo in Patients With Anterior Myocardial Infarction

Left ventricular remodeling following acute myocardial infarction results in progressive myocardial dysfunction and adversely affects prognosis. To investigate the efficacy of paroxetine-mediated G-protein-coupled receptor kinase 2 inhibition to mitigate adverse left ventricular remodeling in patients presenting with acute myocardial infarction. This double-blind, placebo-controlled randomized clinical trial was conducted at Bern University Hospital, Bern, Switzerland. Patients with acute anterior ST-segment elevation myocardial infarction with left ventricular ejection fraction (LVEF) of 45% or less were randomly allocated to 2 study arms between October 26, 2017, and September 21, 2020. Patients in the experimental arm received 20 mg of paroxetine daily; patients in the control group received a placebo daily. Both treatments were provided for 12 weeks. The primary end point was the difference in patient-level improvement of LVEF between baseline and 12 weeks as assessed by cardiac magnetic resonance tomography. Secondary end points were changes in left ventricular dimensions and late gadolinium enhancement between baseline and follow-up. Fifty patients (mean [SD] age, 62 [13] years; 41 men [82%]) with acute anterior myocardial infarction were randomly allocated to paroxetine or placebo, of whom 38 patients underwent cardiac magnetic resonance imaging both at baseline and 12 weeks. There was no difference in recovery of LVEF between the experimental group (mean [SD] change, 4.0% [7.0%]) and the control group (mean [SD] change, 6.3% [6.3%]; mean difference, -2.4% [95% CI, -6.8% to 2.1%]; P = .29) or changes in left ventricular end-diastolic volume (mean difference, 13.4 [95% CI, -12.3 to 39.0] mL; P = .30) and end-systolic volume (mean difference, 11.4 [95% CI, -3.6 to 26.4] mL; P = .13). Late gadolinium enhancement as a percentage of the total left ventricular mass decreased to a larger extent in the experimental group (mean [SD], -13.6% [12.9%]) compared with the control group (mean [SD], -4.5% [9.5%]; mean difference, -9.1% [95% CI, -16.6% to -1.6%]; P = .02). In this trial, treatment with paroxetine did not improve LVEF after myocardial infarction compared with placebo. ClinicalTrials.gov Identifier: NCT03274752.

Combined protocol for remote ischemic conditioning as the method of cardioprotection in patients with acute ST-segment elevation myocardial infarction

Background. There is currently no commonly accepted strategy for limiting the reperfusion injury that occurs after revascularization in patients with myocardial infarction. This study aimed to investigate the efficacy of a promising cardioprotective method.Material and Methods. Patients with acute anterior ST-segment elevation myocardial infarction (STEMI) (n = 87) were included in an open-label prospective randomized controlled trial. Control group comprised patients with STEMI who underwent only primary percutaneous coronary intervention (PPCI) (n = 44). Patients of intervention group (n = 43) underwent PPCI and remote ischemic perconditioning combined with postconditioning (RIC). The efficacy of RIC was assessed based on cardiac magnetic resonance (CMR) imaging data.Results. The medians of left ventricular (LV) infarct size were significantly higher in patients of control group: 44.8 (33.6; 55.5) versus 52.7 (35.5; 73.9) mL (p = 0.039) at day 10 after STEMI and 34.0 (25.8; 39.8) mL versus 46.0 (32.8; 55.0) mL six months after STEMI in control and intervention groups, respectively (p = 0.004). The groups of patients did not differ in the sizes of area at risk relative to the total LV myocardial volume: 40 (35; 45) and 43 (34; 49)% in control and intervention groups, respectively (р = 0.232). The groups significantly differed in the ratios of infarct size to area at risk: 70.3 (65.1; 86.6)% in control group versus 63.5 (52.7; 72.0)% in intervention group (р = 0.014) as well as in the myocardial salvage indexes: 29.7 (13.5; 34.9)% in control group versus 36.5 (28.0; 47.3)% in intervention group (р = 0.014). The study showed the tendency to greater LV myocardial salvage in intervention group versus control group at six-months follow-up (р = 0.073). The groups significantly differed in the medians of microvascular obstruction volume: 1.9 (1.4; 2.9) mL in intervention group versus 2.5 (1.8; 8.1) mL in control group (p = 0.049) as well as in the proportions of microvascular obstruction in the LV myocardium: 0.94 (0.79; 1.37)% in intervention group versus 1.50 (0.89; 3.66)% in control group (р = 0.046).Conclusion. The RIC method combined with PPCI contributed to the limitation of infarct and microvascular obstruction sizes and was associated with an increase in the myocardial salvage index in STEMI patients.

Decreased nuclear translocation of FoxP3 transcription factor in patients with ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Ministry of Science and Higher Education of Russian Federation T regulatory lymphocytes (Treg) participate in resolution of inflammation and are essential in post-infarct myocardial healing. The crucial mediator of Treg activity is transcription factor FoxP3. Nuclear localization of FoxP3 is an obligatory requirement for anti-inflammatory properties of the cells. FoxP3 is also expressed in conventional T-lymphocytes at the stage of their activation. Data on functional state of FoxP3 in chronic and acute coronary syndromes are absent. Purpose Our aim was to comparatively evaluate the level of FoxP3 nuclear translocation in subpopulations of FoxP3+ T-lymphocytes in patients with chronic and acute coronary syndromes. Methods We have recruited 14 patients with chronic coronary syndrome (CCS) (8 males; 6 females; 63.2 ± 9.0 y.o.) and 5 patients with acute anterior ST-segment elevation myocardial infarction (STEMI) (4 males; 1 female; 61.4 ± 11.2 y.o.). Reperfusion of the infarct-related artery (IRA) has been achieved in all STEMI patients (the mean time of recanalization constituted 5 hours), and coronary angioplasty and IRA stenting were performed. Health status was evaluated and functional class of chronic heart failure was assessed according to the 6-minute walk test. Peripheral blood mononuclear cells were isolated from heparinized blood of CCS patients and STEMI patients during the first day after the event. Frequency of T regulatory and T conventional lymphocytes and degree of FoxP3 nuclear translocation in them were evaluated by imaging flow cytometry. Results Numbers of T regulatory lymphocytes in STEMI patients were lower than in patients with CCS, while numbers of T conventional lymphocytes were higher. However these differences did not reach the level of statistical significance: 7.2 (6.2; 8.4)% vs. 6.7 (3.8; 7.0)% of T regulatory lymphocytes (p = 0.298) and 1.6 (1.3; 1.8)% vs. 2.1 (1.0; 2.8)% of T conventional cells (p = 0.754), in CCS and in STEMI patients, respectively. Meanwhile, STEMI patients displayed significantly lower nuclear translocation of FoxP3 in lymphocytes compared to CCS patients: 74.8 (64.9; 92.9)% vs. 98.2 (96.8; 98.7)% in T regulatory cells (p = 0.026) and 58.7 (33.9; 67.7)% vs. 88.3 (73.1; 96.9)% in T conventional lymphocytes (p = 0.034). Conclusions Our study is the first one to comparatively describe the FoxP3 nuclear translocation in patients with chronic coronary syndrome and STEMI. We showed that STEMI is primarily associated with the decrease of nuclear localization of FoxP3 rather than with changes in numbers of FoxP3+ T-lymphocytes in peripheral blood. The revealed phenomenon demonstrates that alterations of the balance between the suppressive and inflammatory activities of T-lymphocytes are observed already in the early inflammatory phase of STEMI, long before their expected clonal expansion.

Risk Prediction Model Based on Biomarkers of Remodeling in Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction.

BackgroundThe aim of the present study was to develop a risk prediction model in patients with acute anterior ST-segment elevation myocardial infarction (STEMI).Material/MethodsClinical data from 333 patients with acute anterior STEMI were retrospectively analyzed. Clinical echocardiographic and angiographic data from patients with left ventricular remodeling (LVR) and those without LVR were compared. Factors that influenced risk were identified using multivariate logistic regression analysis. The area under the curve (AUC) of the receiver operating characteristic curve was used to assess the diagnostic performance of the model.ResultsAfter 6-month follow-up, 135 of the patients experienced LVR (LVR group), whereas 198 did not (non-LVR group). Results of multivariate analysis showed that the number of stenosed coronary vessels, left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), transforming growth factor-beta (TGF-β) at admission, and cardiac troponin I 3 days after admission (3-d cTnI) were all factors predictive of LVR in patients with acute anterior STEMI (all P<0.05). The established prediction model was Y=−20.639+0.711×number of stenosed coronary vessels + 0.137×LVEDV-0.129×LVEF+0.026×TGF-β at admission + 0.162×3-d cTnI. The estimated AUC of this model was 0.978 (95% confidence interval [CI] 0.955–0.991), significantly superior to the single-factor numbers for stenosed coronary vessel of 0.650 (95% CI 0.597–0.702), LVEDV of 0.876 (95% CI 0.836–0.910), LVEF of 0.684 (95% CI 0.631–0.734), TGF-β at admission of 0.696 (95% CI 0.644–0.745), cTnI at admission of 0.913 (95% CI 0.877–0.941), and 3-d cTnI of 0.945 (95% CI 0.914–0.967).ConclusionsThe established model had excellent diagnostic accuracy for predicting LVR in patients with acute anterior STEMI.

Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

BackgroundTo evaluate the predictive value of the index of microcirculatory resistance (IMR) for long-term cardiac systolic function after primary percutaneous coronary intervention (pPCI) in patients with acute anterior wall ST-segment elevation myocardial infarction (STEMI).MethodsA total of 53 acute anterior wall STEMI patients were included and followed up within 1-year. IMR was measured to evaluate the immediate intraoperative reperfusion. IMR > 40 U was defined as the high IMR group and ≤ 40 U was defined as the low IMR group. Left ventricular ejection fraction (LVEF) was measured by echocardiography at 24 h, 1 month, 3 months, and 1 year after PCI to analyze the correlation between IMR and cardiac systolic function. Heart failure was estimated according to classification within one year.ResultsThe ratio of TMPG (TIMI myocardial perfusion grade) 3 (85.7% vs. 52%, p = 0.015) and STR (ST-segment resolution) > 70% (82.1% vs. 48%, p = 0.019) were significantly higher in the low IMR group. The LVEF in the low IMR group was significantly higher than that in the high IMR group at 3 months (43.06 ± 2.63% vs. 40.20 ± 2.67%, p < 0.001) and 1 year (44.16 ± 2.40% vs. 40.13 ± 3.48%, p < 0.001). IMR was negatively correlated with LVEF at 3 months (r = − 0.1014, p = 0.0040) and 1 year (r = − 0.1754, p < 0.0001).ConclusionsThe IMR showed significant negative correlation with the LVEF value after primary PCI. The high IMR is a strong predictor of heart failure within 1 year after anterior myocardial infarction.

Role of Speckle Tracking in the Evaluation of Left Ventricular Remodeling After Streptokinase Infusion in Patients with Acute Anterior Myocardial Infarction

Background. Left ventricular (LV) remodeling is an adverse consequence after acute myocardial infarction.Aim. To assess the role of speckle tracking in the evaluation of LV remodeling after streptokinase infusion in patients with acute anterior ST-segment elevation myocardial infarction (STEMI).Material and methods. A total of 200 patients with first acute anterior STEMI received streptokinase as a reperfusion therapy were included. Conventional echocardiography and speckle tracking were performed within 3 days of admission and 3 months later. According to the development of LV remodeling, patients were classified into two groups. Group (I) patients with LV remodeling (60 patients) and group (II) patients without remodeling (140 patients).Results. Patients with LV remodeling had lower global longitudinal (GLS) and circumferential (GCS) strain values (-13.19±4.57 vs. -18.90±4.23 % and -13.16±4.27 vs. -17.16±3.3 %, respectively, p&lt;0.001). GLS cutoff value of &gt;-13.5 was shown to have the best diagnostic accuracy (sensitivity =60.0% &amp; specificity =87.1%) in predicting LV remodeling (AUC 0.816, 95% confidence interval [CI] 0.754-0.877, p&lt;0.001). GCS cutoff value of &gt;-16.21 was shown to have the best diagnostic accuracy (sensitivity =75.0% &amp; specificity =71.4%) in predicting LV remodeling (AUC 0.785, 95%CI 0.719-0.85, p&lt;0.001).Conclusion. Speckle tracking echocardiography either longitudinal or circumferential strain has good sensitivity and specificity in predicting LV remodeling after acute myocardial infarction.