Acute Period Of Myocardial Infarction Research Articles

Comparative assessment of the indices of the left ventricle post-infarction remodelling of the left ventricle and its dependence on the strategy of acute myocardial infarction management

Comparative assessment of the indices of post-infarction remodelling of the left ventricle was carried out in the patients with myocardium reperfusion (thrombolytic therapy) and without reperfusion. ECG was performed for all patients on admission to the hospital and then 3 and 6 months later. The results obtained demonstrated that after the acute period of myocardial infarction there was no difference between the parameters under control. At the same time the results of dynamic monitoring confirmed that later on the patients felt some peculiarities during the left ventricle remodelling process. Three months later there was an increase of the left ventricle sphericity index during the systoly in the patients of group II. Six months later the patients of group II showed significant difference in five indices of remodelling versus the patients on thrombolitic therapy.

Change of the main parameters of 24-hour ekg monitoring in patients with myocardial infarction associated with ventricular arrhythmias

Aim. To study the change of the main parameters of 24-hour EKG monitoring over time in patients with myocardial infarction associated with ventricular arrhythmias of different grades. Methods. The change of the echocardiography parameters, heart rhythm variability, corrected QT interval duration and dispersion, late ventricular potentials, heart rhythm turbulence were examined in 70 adult men (mean age 52.6±1.3 years) with primary Q-wave myocardial infarction on 10-14th day of the disease and after 6 months. Patients were assigned into 3 groups depending on ventricular arrhythmias severity (according to Lown classification modified by Ryan): А1 (n=29) - grade 1-2, А2 (n=23) - grade 3-4, А3 (n=18) - patients with paroxysmal ventricular tachycardia. Results. Presence of late ventricular potentials and pathologic heart rhythm turbulence in patients in acute period of myocardial infarction suggested high grade of ventricular arrhythmia. Ventricular arrhythmias were associated with severe sympathicotonia, prolongation of corrected QT interval and QT dispersion. 6 months after Q-wave myocardial infarction an autonomic imbalance increased and no positive changes of myocardial homogenicity parameters, late ventricular potentials and pathologic heart rhythm turbulence were observed with increasing ventricular arrhythmia grading and heart rate frequency. A relationship between left ventricle ejection fraction, myocardium mass and myocardial electric non-stability values was revealed. In patients with Q-wave myocardial infarction ventricular arrhythmias are mediated by several mechanisms: systolic and autonomic disorder, repolarization abnormalities, late ventricular potentials pathologic heart rhythm turbulence. The severity of abnormalities is marked by the ventricular arrhythmias grade. Conclusion. 6 months after myocardial infarction (in healing stage) the significant positive changes are found only in patients with 1-2 grades ventricular arrhythmias. The significant non-homogeneity of myocardial electrophysiological features still persists in patients with life-threatening ventricular arrhythmias.

Metabolomics Study of Protective Effects of Shexiang Baoxin Pill and its Bioactive Constitutes Combination in Treating the Early Period of Acute Myocardial Infarction in Rats

Ginsenoside Re, ginsenoside Rb1, muscone, cinnamic acid, bufalin, cholic acid and borneol are the main active ingredients of Shexiang Baoxin Pill (SBP) for protective effects on acute myocardial infarction (AMI). In this study, the protective effects of SBP, single component treatments and combination treatment of 7 bioactive ingredients of SBP (SFSBP) were investigated by metabolomics technology. Liquid chromatography/quadrupole time-of-flight mass spectrometry (LC-Q-TOF/MS) has been used to analyze the plasma samples of AMI rats. Partial least squares discriminate analysis (PLS-DA) models were built to evaluate the protective effects of different treatments at whole level. Reverse effect on mean levels of 19 identified biomarkers were also carried out to investigate the protective effects of different treatments. The results showed that the protective effect of multi-component medicines (SBP and SFSBP) was superior to 7 single-component treatments, demonstrated the multi-effective advantages of multicomponent treatments (SBP and SFSBP). Meanwhile, the reverse effects of SFSBP were inferior to SBP, indicating that there might be other bioactive components in SBP taking responsibility for the protection effect on AMI rats, and the simplified formula of SBP should be further optimized, while also revealed the rationality of TCM formula, and it cannot be simply substituted by a combination of bioactive ingredients.

Antihyperglycemic therapy in patients with type 2 diabetes mellitus and ischaemic heart disease: management during acute period of myocardial infarction and interventional procedures

Current paper presents data from international multicenter studies performed with participation of patients with type 2 diabetes mellitus(T2DM) and ischaemic heart disease. We analyze results regarding advisability of different glycemic targets, prescription safetyof various classes of antihyperglycemic agents in patients with inschaemic heart disease, acute coronary syndrome and chronic heartfailure, as well as therapeutic approach to glycemic control in acute myocardial infarction and cardiologic interventional procedures.

Deficiency of Capn4 Gene Inhibits Nuclear Factor-κB (NF-κB) Protein Signaling/Inflammation and Reduces Remodeling after Myocardial Infarction

Calpain has been implicated in acute myocardial injury after myocardial infarction (MI). However, the causal relationship between calpain and post-MI myocardial remodeling has not been fully understood. This study examined whether deletion of Capn4, essential for calpain-1 and calpain-2 activities, reduces myocardial remodeling and dysfunction following MI, and if yes, whether these effects of Capn4 deletion are associated with NF-κB signaling and inflammatory responses in the MI heart. A novel mouse model with cardiomyocyte-specific deletion of Capn4 (Capn4-ko) was employed. MI was induced by left coronary artery ligation. Deficiency of Capn4 dramatically reduced the protein levels and activities of calpain-1 and calpain-2 in the Capn4-ko heart. In vivo cardiac function was relatively improved in Capn4-ko mice at 7 and 30 days after MI when compared with their wild-type littermates. Deletion of Capn4 reduced apoptosis, limited infarct expansion, prevented left ventricle dilation, and reduced mortality in Capn4-ko mice. Furthermore, cardiomyocyte cross-sectional areas and myocardial collagen deposition were significantly attenuated in Capn4-ko mice, which were accompanied by down-regulation of hypertrophic genes and profibrotic genes. These effects of Capn4 knock-out correlated with restoration of IκB protein and inhibition of NF-κB activation, leading to suppression of proinflammatory cytokine expression and inflammatory cell infiltration in the Capn4-ko heart after MI. In conclusion, deficiency of Capn4 reduces adverse myocardial remodeling and myocardial dysfunction after MI. These effects of Capn4 deletion may be mediated through prevention of IκB degradation and NF-κB activation, resulting in inhibition of inflammatory responses.

Biomarkers in the early period of acute myocardial infarction in rat serum and protective effects of Shexiang Baoxin Pill using a metabolomic method

Ethnopharmacological relevanceTo identify the biomarkers in early period of acute myocardial infarction (AMI) in rat serum and reveal the effective mechanism of a Traditional Chinese Medicine (TCM) named Shexiang Baoxin Pill (SBP). Material and methodA metabolomic approach using reversed-phase liquid chromatography/quadrupole time-of-flight mass spectrometry (LC-Q-TOF-MS) was developed. ResultsFourteen biomarkers in the early period of acute myocardial infarction (AMI) in rat serum were identified. These biomarkers include 5-methylcytosine, cystathionine ketimine, 2-oxoadipic acid, thymidine, epinephrine, homocystine, uric acid, 12(S)-hydroperoxyeicosatetraenoic acid (12s-HPETE), 11-dehydrocorticosterone, 12(S)-hydroxyeicosatetraenoic acid (12s-HETE), deoxycorticosterone, corticosterone, aldosterone and cortisol. Through pathway analysis of these biomarkers, inflammation, hypertrophy and oxidative injury were considered the most relevant pathological changes in early period of AMI. ConclusionIdentification of AMI biomarkers not only supplied a systematic view of the progression of AMI in the early period but also provided the theoretical basis for the prevention or treatment of AMI. The results demonstrated that SBP pretreatment could offer protective effects for AMI through regulating the pathway of steroid hormone biosynthesis.

The influence of insulin resistance and disturbances of carbohydrate metabolism in the acute period of myocardial infarction

This work was designed to study parameters of carbohydrate metabolism and insulin resistance (IR) in patients presenting with myocardial infarction (MI) and elucidate their relation to MI complications. Special attention was given to the relationship between disturbances of carbohydrate metabolism (DCM), the clinical course of myocardial infarction in the acute and cicatrization phases, characteristics of coronary arteries in the patients with and without diabetes mellitus (groups 2 and 1 respectively). Insulin resistance was documented in 83.2% of the patients. Multiple lesions in the coronary arteries were shown to be directly related to the immunoreactive insulin (IRI) level (r=0.277; p=0.0008) and HOMA index (r=0.304; p=0.0001). They were more common in patients with IR (86%; p<0.001). The clinical course of MI was more frequently complicated by early post-infarction angina, MI relapses, and heart failure (Killip functional class II) in the patients presenting with a combination of IR and DCM than in those showing normal sensitivity to insulin regardless of the characteristics of carbohydrate metabolism. It is concluded that the detection and correction of insulin resistance and disturbances of carbohydrate metabolism are the indispensable prerequisites for the successful prevention of myocardial infarction.

PRESENT-DAY ROLE OF HYPERBARIC OXYGENATION IN THE THERAPY OF CARDIOVASCULAR DISEASES

He application of the HBO in the acute period of myocardial infarction and unstable angina allowed to decrease in-patients mortality and decrease mortality from 9,6 % (90 patients) in reference group to 2,9 % (8 patients), in test group (р = 0,001), but there are not result in stable angina patients in the 2-year random research, р > 0,05.

Abciximab and left ventricular thrombus formation in early period of acute myocardial infarction treated with successful primary stenting

Left ventricular (LV) thrombus related to acute myocardial infarction (AMI) has been rarely diagnosed since primary stenting has become the routine treatment. The salvage of myocardium at risk is considered as a reason for low frequency of this complication. The impact of glycoprotein IIb/IIIa inhibitors on LV thrombus formation remains unknown. This study investigated the relationship between abciximab treatment and presence of LV thrombus in the first few days after primary stenting. A total of 3,078 patients with AMI, who underwent successful primary stenting, were retrospectively analyzed. There were 1,614 patients, who received abciximab and 1,414 treated without it. All patients received aspirin and clopidogrel. LV thrombus was diagnosed by two-dimensional echocardiography within 3-5 days after invasive treatment. This complication appeared equally frequently in both the abciximab and no-abciximab group (2.9% vs. 2.1%, respectively). According to results of multiple log-regression analysis, both groups did not differ in predictors of thrombus formation, such as infarct size and degree of LV dysfunction. Treatment with abciximab was not proved to be an independent predictor of LV thrombus absence. Abciximab does not have a direct influence on LV thrombus formation in the early period of AMI.

Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study

We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI). We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non-fatal cardiovascular events or deaths within 45 days of randomization) without a prior history of HF enrolled in the VALIANT trial. Multivariable models were developed to identify independent predictors of HF and HF or cardiovascular death. Of 11 040 stable post-MI patients, 1139 (10.3%) developed HF during the median 25-month follow-up at a rate of approximately 3.4% per year. Most patients, 824 (72.3%), did not have a symptomatic recurrent MI between randomization and the onset of HF. The most important predictors of HF were older age, antecedent diabetes, prior MI before index MI, and reduced renal function. HF markedly increased the risk of death [HR(hazard ratio) 8.22; 95% CI(confidence interval), 7.49-9.01]. HF post high risk-MI occurs in a time-dependent fashion and is usually not directly related to re-infarction. Patients who experience HF beyond the acute phase have increased mortality. Long-term survivors of high-risk MI should be followed closely and treated aggressively beyond the acute MI period.

747 The extent of myocardium damage and the left ventricle thrombus in early period of acute myocardial infarction treated with successful primary PCI

747 The extent of myocardium damage and the left ventricle thrombus in early period of acute myocardial infarction treated with successful primary PCI

Effects of basic fibroblast growth factor microspheres on angiogenesis in ischemic myocardium and cardiac function: analysis with dobutamine cardiovascular magnetic resonance tagging

Therapeutic angiogenesis with angiogenic growth factors has described as one of the promising methods for collateral formation in the treatment of ischemic heart diseases. The purpose of this study is to assess the value of intramyocardial injection of slow-released basic fibroblast growth factor microspheres on angiogenesis and cardiac function in the early period of acute infarcted myocardium with dobutamine cardiovascular magnetic resonance tagging. Acute myocardial infarction was made by ligation of the left anterior descending coronary artery distal to its first diagonal branch. Immediately after coronary artery occlusion, 1 ml of saline containing 100 microg of basic fibroblast growth factor microspheres was injected into peri-infarct myocardial area in the basic fibroblast growth factor group, whereas only gelatin hydrogel microspheres with 1 ml of saline was given in control dogs. Cardiac function was evaluated by cine magnetic resonance imaging. Dobutamine cardiovascular magnetic resonance was performed at rest and during low doses of dobutamine to assess regional wall motion. Immunohistochemical study with von Willebrand factor was performed to observe angiogenesis. Left ventricular ejection fraction improved markedly 10 and 17 days after treatment in the basic fibroblast growth factor group. The basic fibroblast growth factor group had more viable myocardium. Microvessel density was higher in the basic fibroblast growth factor group than in the control group except the first day after treatment. Intramyocardial administration of basic fibroblast growth factor microspheres can promote the growth of microvessels and improve left ventricular function and myocardial viability in the early period of acute myocardial infarction.

Cardiac Structural and Functional Changes in Acute Myocardial Infarction

Twelve patients with acute myocardial infarction and 41 patients with postinfarct cardiosclerosis complicated by NYHA Functional Classes I—IV chronic heart failure (CHF) were examined. The structural and functional status of the left and right cardiac cavities was evaluated by echocardiography. Remodeling processes separately occurred in the left ventricle (LV) in the acute period of myocardial infarction. The structural and functional rearrangement of the right cardiac chambers in patients with CHD and CHF proceeds simultaneously with LV remodeling processes, starting from the earliest stages. In patients with CHF and rigid diastolic dysfunction with normal LV filling pressure and mean pulmonary and right atrial pressures, the observing dilatation of the right ventricle is one of the signs of its remodeling.

The effects of trimetazidine on heart rate variability and signal-averaged electrocardiography in early period of acute myocardial infarction

Background: Acute myocardial infarction (AMI) is accompanied by electrophysiological changes in cardiovascular system as well as those in autonomic cardiac control. Heart rate variability (HRV) is depressed due to increased sympathetic activity and/or decreased parasympathetic activity following AMI. Moreover, the frequency of ventricular late potentials (VLP) is increased due to the electrophysiological changes. Based on the hypothesis that the treatments increasing HRV and decreasing the frequency of VLP can improve the prognosis of AMI, we investigated the short-term effects of trimetazidine (TMZ) on HRV and VLP in patients with AMI. Methods: The study group consisted of 64 patients (men 49, mean age 55±12 years, range 26–70) suffering from first Q-wave AMI. Thirty-one of them were treated with conventional therapy (thrombolytic therapy, aspirin, beta-blocker, heparin and intravenous nitroglycerin) plus TMZ 20 mg tid. The remaining 33 patients served as controls. Holter monitorization between 24 and 48 h, echocardiography at average day 6 (range 4–7 days) and SAECG and sub-maximal exercise at average day 7 (range 6–9 days) were performed to all patients. Results: While HRV parameters reflecting parasympathetic activity (SDSD: 43±16 ms–35±13 ms, RMSSD: 34±14 ms–27±8 ms, HF: 7.8±5 ms 2 –4.3±4 ms 2, P<0.05) were of significantly higher levels in TMZ group, the low frequency component mainly reflecting sympathetic activity (LF: 10±6 ms 2–10±5 ms 2, P>0.05) was similar in both groups. In addition, LF/HF ratio showing sympatho–vagal balance was significantly decreased in TMZ group (1.5–3.0, P=0.005). About VLP, the mean FQRS (105±8 ms–107±10 ms), LAS (28±10 ms–30±11 ms) and RMS-40 (34±15 μV–41±12 μV) were not different in both two groups ( P>0.05). Conclusion: Our results suggest that TMZ treatment causes changes in sympatho–vagal balance in favor of vagal activity by increasing parasympathetic activity in AMI at early period; however, no effect on VLP was observed.

Efficiency of antioxidant therapy in patients with acute myocardial infarction and unstable stenocardia

The efficiency of preductal (trimetazidin), essentiale, li postabil and vitamin E in acute myocardial infarction and unstable stenocardia is estimated. It is shown that in unstable stenocardia and in the acute period of myocardial infarction the high level of lipid peroxide oxidation and the decrease of erythrocyte stability are observed. The clinical efficiency of antioxidants in the treatment of the acute forms of ischemic heart disease is proved: the antianginal effect is achieved, readaptation possibilities of patients to physical loads are increased, effect of anti rhythmical drugs is intensified, myocardial infarction size is limited (especially in using preductal). The presence of pronounced antioxidant and membranoprotective properties in preductal, lipostabil, essentiale comparing well with -tokopherol is proved. It is shown that preductal manifests the antianginal effect by the microcirculation system and metabolism correction. Antioxidants promote the decrease of blood elements sledge and increase of the number of perfused capillars.

161 The influence of plasmapheresis on dynamics of DIC-syndrome and hospital mortality in patients during acute period of myocardial infarction

161 The influence of plasmapheresis on dynamics of DIC-syndrome and hospital mortality in patients during acute period of myocardial infarction

Depression following myocardial infarction: a one year longitudinal study.

The purpose of this study was to examine the course and clinical correlates of depression during the first year after myocardial infarction. A group of seventy patients hospitalized for the treatment of myocardial infarction (MI) were assessed for the presence of mood disorders during their hospital admission and at three, six, nine, and twelve months follow-up. Patients were evaluated and diagnosed using the Present State Examination and DSM-III criteria. Impairment in activities of daily living was measured by the Johns Hopkins Functioning Inventory and impairment in social functioning was measured by the Social Functioning Examination. A total of twenty-four patients met DSM-III criteria for major depression at some time during the study (18 in the acute stage, 6 during follow-up). There were two patients with minor depression (dysthymia) at intake and six developed minor depression during the follow-up period. The median duration of major depression was 4.5 months. Patients with depression at intake had greater impairment in activities of daily living than non-depressed patients. Depressions lasting more than six months were more likely to be anxious depressions than those lasting less than six months. After the acute MI period, there was a consistent relationship between the existence of depression and impaired social functioning. This is a pilot study and needs further replication due to the low rate of follow-up participation. However, these data suggest that there may be two types of depression following MI: an acute depression associated with greater functional impairment, and a prolonged depression that may be associated with inadequate social support.

Scientific session of the Cardiological Scientific Center of the Russian Academy of Medical Sciences "Emergencies in Cardiology" (Moscow, January 20-21, 1994)

Various aspects of the problem were discussed at the plenary and breakout sessions, as well as at the round table. Prof. M. Ya. Ruda (Moscow) in his report Modern approaches to the treatment of acute myocardial infarction noted that restoration of coronary blood flow is the key to successful treatment of the disease. Pointing out that myocardial necrosis begins 30 minutes after the occlusion of the coronary artery, after 2 hours 50% of the affected area "dies", and after 4 hours - all 100%, he stressed that from these positions, after 4 hours from the onset of the disease, thrombolytic therapy already ineffective. Therefore, it should be started at the prehospital stage. The most widely used tissue plasminogen activator and, especially, streptase (ST), with the use of which less often develop retrombosis and cerebral strokes. In addition, the CT is cheaper. In the prevention of retrombosis, aspirin, heparin can be useful (5000 units intravenously, then infusion of 1000 units per hour for 2 days under the control of blood clotting time). Prof. M. Ya. Ruda also said that at present, the administration of magnesium salts is widely used abroad in the acute period of myocardial infarction, which significantly reduces mortality. Perhaps, he added, "they will soon start with magnesium salts."

Changes of plasma lipids and glucose levels during the early period of acute myocardial infarction

Changes of plasma lipids and glucose levels during the early period of acute myocardial infarction

Influence of gender in acute and long-term cardiac mortality after a first myocardial infarction

The effect of gender and other clinical variables on short-term and long-term cardiac mortality after a first transmural myocardial infarction (MI) was assessed in a population-based hospital register. A cohort of 1216 consecutive patients (1023 men and 193 women), 25–74 years old admitted to the only reference hospital with a coronary care unit at Girona, Northeastern Spain, were recruited for 1978 to 1988 and followed-up for a mean period of almost 5 years (3–12 years). Compared with men, women had a relative risk (RR) of 1.56 (95% confidence interval (CI) of 0.99–2.48) of dying in the acute phase of MI after adjusting for age, MI location, presence of severe arrhythmias, diabetes and hypertension. However, when additionally adjusting for severity (Killip class), women presented a RR of 1.11. Age and hypertension were independent risk factors for acute mortality. Women surviving the acute period of MI showed a RR of 1.37 (CI 0.97–1.92) for long-term mortality, that was only slightly modified by Killip class during hospital stay (RR = 1.27). Age and diabetes were independent risk factors for long term mortality. It is concluded that women have a 56% excess risk for early mortality after a first transmural MI than men mainly explained by a higher severity.