Stage Of Acute Myocardial Infarction Research Articles

Comparative assessment of long-term survival of patients after primary and recurrent myocardial infarction: a data from the RIMIS registry

Aim. To compare the long-term prognosis of life of patients after primary and recurrent acute myocardial infarction (MI).Material and methods. The study was based on the RIMIS registry, which included all patients after transmural MI in 2017 in one of the Moscow vascular centers. The prospective part included 191 patients who survived the acute stage of MI, of which 145 suffered a primary acute MI, 46 — a recurrent acute MI. Long-term follow-up data were collected 71 (53;75) months after discharge from the hospital. The primary endpoint was any-cause death.Results. During the follow-up period, 35 (25,2%) patients with a primary MI and 25 (64,1%) patients with a recurrent MI died (p<0,001). It was not possible to establish the fate of 13 (6,81%) patients, of which 7 (4,83%) were people with primary MI and 6 (13,04%) people with recurrent MI. The death risk was significantly higher in patients who had a recurrent MI compared to patients who had a primary MI: hazard ratio (HR)=3,52 (2,09;5,96), p<0,001). An unfavorable prognosis was determined not by the fact of a recurrent MI, but by the complications that resulted from a previous MI, primarily heart failure, as well as age, sex, smoking status, and hospitalizations for cardiovascular diseases in the year before the reference MI, history of angina and following comorbidities: a prior stroke, major bleeding (life-threatening gastrointestinal bleeding requiring complex surgical intervention). Patients who had a recurrent MI were significantly more adherent to follow-up and prescribed therapy.Conclusion. Despite the modern strategy for treating MI both in the acute stage and in the long-term period, the prognosis after recurrent MI remains unfavorable. Signs negatively affecting the prognosis were sex, age, a history of heart failure and angina pectoris, and hospitalizations for cardiovascular diseases one year prior to reference MI.

THE USE OF SODIUM-DEPENDENT GLUCOSE CO-TRANSPORTER-2 INHIBITORS IN PATIENTS IN THE ACUTE PHASE OF MYOCARDIAL INFARCTION

The purpose of the work– to analyze the data of modern literature concerning expediencyof using sodium- dependent glucose cotransporter type 2 inhibitors in the early stages ofacute myocardial infarction to improve the prognosis and reduce mortality.Conclusions. The analysis of literature data shows the growing evidence of iNZKTG2effectiveness as the newest generation of cardiorenal protectors. The potential effects ofiNZCTH2 may be particularly beneficial for patients with acute myocardial infarction.Proving the effectiveness of iNZCTH2 in acute myocardial infarction may become thebasis for revising the standards of treatment of this common acute cardiovascular disease,which leads to significant complications and mortality.

The Acute Effects Of ATP-Sensitive Potassium Channel Opener (Pinacidil) And Blocker (Glimepride) On the Ischemia or Reperfusion-Induced Arrhythmias

Introduction: Myocardial ischemia due to coronary obstruction and reperfusion due to the opening of the coronary vessel occurring in the acute stage of myocardial infarction leads to lethal arrhythmia and sudden death in humans. That is why pharmacological drug research to decrease these arrhythmias have been researched intensively. In this study, the effect of acute administration of pinacidil and glimepride, on ischemia or reperfusion-induced arrhythmia was aimed to be researched. Methods: Two groups were produced; In the first group, only ischemia was produced by the ligation of the left coronary artery in 20 minutes, and in the second group 6 minutes of ischemia by the ligation of the artery and the subsequent 15 minutes of reperfusion were produced by the opening of the occluded artery. Drugs were administered intravenously at 2 minutes of ischemia in the first group and just following the reperfusion in the second group. The ECG and blood pressure were recorded during ischemia and reperfusion. The type, duration, incidence of arrhythmia, heart rate, blood pressure, and the death rate from the recording were determined. All data were first compared by one-way ANOVA. Then, the drug groups with their control, and control and drug groups with each other were compared by a one-tailed student t-test. The incidence of arrhythmia and the death rate between groups was compared by the Ki square test. Results: Pinacidil significantly decreased the arrhythmia score both in the ischemia and reperfusion period but glimepiride was not effective when they were given intravenously in the acute stage of ischemia or reperfusion. Discussion and Conclusion: This study suggests that pinacidil might be a candidate for drugs that can be used to decrease arrhythmia in the acute stage of myocardial infarction but more study is needed to reveal the antiarrhythmic or proarrhythmic effect of glimepride in the acute stage of myocardial infarction.

Significance of the N-terminal Fragment of Brain Natriuretic Peptides in Predicting Ventricular Arrhythmias in Young and Middle-Aged Patients with Diabetes and Myocardial Infarction

ABSTRACT. Fatal ventricular arrhythmias in patients with diabetes mellitus (DM) in the acute stage of myocardial infarction (MI) and postinfarction period often cause adverse outcomes. Therefore, the search for new reliable biomarkers in predicting ventricular arrhythmias in the long term is necessary.
 AIM: This study aimed to evaluate the value of N-terminal-pro hormone BNP (NT-proBNP) in predicting ventricular arrhythmias in young and middle-aged patients with MI and DM-associated ST-segment elevation.
 MATERIALS AND METHODS: Seventy-six patients (59 men and 17 women) with DM and MI with ST-segment elevation (aged 3659 years; mean 53 5 years) were examined. Anterior MI was diagnosed in 35 patients, and non-anterior MI was detected in 41 patients. The DM duration was up to 1 year in 16 patients, 15 years in 24, and 512 years in 36. Patients were examined on day 1 after percutaneous coronary intervention (PCI) with implantation of 13 stents in the coronary arteries (CA) and again after 12 months. Holter monitoring, echocardiography, and blood tests for NT-proBNP were performed.
 RESULTS: After PCI, ventricular extrasystole (VES) of grades IIIV according to Lown and Wolf was detected in 21 of 37 (56.7%) patients with DM. The left ventricular ejection fraction (LVEF) was 42% (27%45%), and the NT-proBNP level was 1127 (7902530) at a rate of up to 125 pg/mL. After 12 months, VES was noted in 9 of 37 (24.3%) patients. The LVEF was 33% (28%35%), and the NT-proBNP level was 938 (4971294) pg/mL. A positive correlation was found between the blood serum level of NT-proBNP on day 1 after PCI and the number of grade IIIV VES 12 months later. At an NT-proBNP level of 898 pg/mL on day 1 after PCI, the sensitivity of this biomarker in predicting high-grade VES 12 months after MI in patients with DM was 100%.
 CONCLUSIONS: The NT-proBNP level after PCI in patients with DM and MI is a reliable predictor of ventricular arrhythmias over the next 12 months.

Early Changes in Acute Myocardial Infarction in Pigs: Achieving Early Detection with Wearable Devices

We examined the changes in variables that could be recorded on wearable devices during the early stages of acute myocardial infarction (AMI) in an animal model. Early diagnosis of AMI is important for prognosis; however, delayed diagnosis is common because of patient hesitation and lack of timely evaluations. Wearable devices are becoming increasingly sophisticated in the ability to track indicators. In this study, we retrospectively reviewed the changes in four variables during AMI in a pig model to assess their ability to help predict AMI onset. AMI was created in 33 pigs by 90-min balloon occlusion of the left anterior descending artery. Blood pressure, EKG, and lactate and cardiac troponin I levels were recorded during the occlusion period. Blood pressure declined significantly within 15 min after balloon inflation (mean arterial pressure, from 61 ± 8 to 50 ± 8 mmHg) and remained at this low level. Within 5 min of balloon inflation, the EKG showed ST-elevation in precordial leads V1-V3. Blood lactate levels increased gradually after occlusion and peaked at 60 min (from 1.48 to 2.53 mmol/L). The continuous transdermal troponin sensor demonstrated a gradual increase in troponin levels over time. Our data suggest that significant changes in key indicators (blood pressure, EKG leads V1-V3, and lactate and troponin levels) occurred at the onset of AMI. Monitoring of these variables could be used to develop an algorithm and alert patients early at the onset of AMI with the help of a wearable device.

Copeptin Reflect Left Ventricular Systolic Function at Early Stage of Acute Myocardial Infarction in a Pig Model.

Measurement of biomarkers early after acute myocardial infarction (AMI) might provide a cost-effective and widely available tool to assess infarct severity, myocardial dysfunction, and clinical outcomes. We aimed to induce AMI in miniature pigs, measure the levels of serum biomarkers and global LV function dynamically and explore the release kinetics and optimal sampling time points of copeptin and its correlation with global LV function. We induced AMI in the experimental group using a closed-chest model. Left ventricular (LV) function was detected by dual-source computed tomography (DSCT) and serum copeptin was determined by ELISA. The serum copeptin levels were increased at 1 hour, peaked at 3 hours, gradually decreased after 6 hours, and returned to baseline 3 days after AMI. At 3 to 6 hours, the copeptin cutoff of 16.97 to 17.44 pmol/l had 100% sensitivity and 100% specificity (P ⩽ .001) for AMI. Serum copeptin levels at 3 hours and 3 days were negatively correlated with the 3-hours LVEF (P ⩽ .001), respectively. Serum copeptin levels change in time, and measurements at 3 to 6 hours after AMI had the highest predictive value.

Electro-immunosensor for ultra-sensitive determination of cardiac troponin I based on reduced graphene oxide and polytyramine.

This work reports the construction of a novel nanostructured immunosensor for detection of the troponin I biomarker (cTnI). Anti-troponin I antibody was anchored on the modified graphite electrode with reduced graphene oxide and polytyramine for detection of troponin I in serum samples. The performance of the electro-immunosensor was evaluated by differential pulse voltammetry. The immunosensor presented a wide work range, from 4ng mL-1 to 4pg mL-1 , whose detection limit (4pg mL-1 ) is significantly lower than the basal level in human serum, and maintained 100% of response after 30 days of storage. Moreover, the immunosensor showed good selectivity for detection of cTnI in real sample containing interfering substances and specificity of response to cTnI in the serum of healthy and sick patients, and demonstrated the possibility of reuse for two consecutive analyses, in addition to using a simplified and inexpensive platform when compared to other devices, demonstrating them excellent potential for application in diagnosis in the early stages of acute myocardial infarction.

Rescuing Cardiac Cells and Improving Cardiac Function by Targeted Delivery of Oxygen-Releasing Nanoparticles after or Even before Acute Myocardial Infarction.

Myocardial infarction (MI) causes massive cell death due to restricted blood flow and oxygen deficiency. Rapid and sustained oxygen delivery following MI rescues cardiac cells and restores cardiac function. However, current oxygen-generating materials cannot be administered during acute MI stage without direct injection or suturing methods, both of which risk rupturing weakened heart tissue. Here, we present infarcted heart-targeting, oxygen-releasing nanoparticles capable of being delivered by intravenous injection at acute MI stage, and specifically accumulating in the infarcted heart. The nanoparticles can also be delivered before MI, then gather at the injured area after MI. We demonstrate that the nanoparticles, delivered either pre-MI or post-MI, enhance cardiac cell survival, stimulate angiogenesis, and suppress fibrosis without inducing substantial inflammation and reactive oxygen species overproduction. Our findings demonstrate that oxygen-delivering nanoparticles can provide a nonpharmacological solution to rescue the infarcted heart during acute MI and preserve heart function.

Diagnostic value of myocardial stress detection based on feature tracking MRI in patients with acute myocardial infarction.

BackgroundEvaluate the predictive value of myocardial stress measured by magnetic resonance imaging (MRI) on the severity of coronary artery stenosis and acute myocardial infarction (AMI). In the early stage of acute myocardial infarction, many imaging findings are negative, and MRI myocardial stress detection is controversial in the diagnosis of this aspect. Therefore, it is necessary to determine whether MRI myocardial stress can diagnose acute myocardial infarction.MethodsA total of 120 patients were divided into an AMI group and non-AMI group. The AMI group was further divided into a mild group, moderate group, and severe group. The myocardial stress was measured by MRI, compared in each group, the correlation between myocardial stress and coronary artery stenosis rate was analyzed, and coronary artery disease (CAD) compared between patients with AMI, and the relationship between myocardial stress and AMI was observed.ResultsAmong the 120 patients, there were 77 cases in the AMI group, including 21 cases in the mild group, 40 cases in the moderate group, and 16 cases in the severe group. There were a total of 43 cases in the non-AMI group. Myocardial stress in the AMI group was significantly higher than that in the non-AMI group (P<0.05). The myocardial stress increased gradually in the mild, moderate, and severe AMI groups (P<0.001). Myocardial stress was positively correlated with coronary artery stenosis rate (P<0.001) and CAD (P<0.05). Logistic regression analysis showed that myocardial stress was an independent risk factor for AMI (P<0.05). The sensitivity and specificity of myocardial stress >5.15 mm in the diagnosis of AMI were 83.5%, 68.6% (AUC =0.834), respectively. Acute myocardial infarction is often caused by risk factors such as hyperlipidemia, hypertension and hyperglycemia, as well as vascular stenosis caused by arterial wall malformation, vascular wall inflammation or vasospasm.ConclusionsThe MRI measurement of myocardial stress is simple, reliable, and practical to evaluate the degree of coronary artery lesions. Myocardial stress is closely related to AMI and can assist in the diagnosis of AMI.

Longitudinal evaluation of diastolic dyssynchrony by SPECT gated myocardial perfusion imaging early after acute myocardial infarction and the relationship with left ventricular remodeling progression in a swine model

BackgroundLeft ventricular diastolic dyssynchrony (LVDD), a dyssynchronous relaxation pattern, has been known to develop after myocardial damage. We aimed to evaluate the dynamic changes in LVDD in the early stage of acute myocardial infarction (AMI) by phase analysis of 99mtechnetium methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) and explore its relationship with the progression of left ventricular remodeling (LVR). MethodsThe left anterior descending coronary arteries of 16 Bama miniature swine were occluded with a balloon to build AMI models. Animals were imaged by SPECT GMPI before AMI and at 1 day, 1 week and 4 weeks after AMI, and quantitative analysis was performed to determine the extent of left ventricle (LV) perfusion defects, left ventricular systolic dyssynchrony (LVSD) and the LVDD parameters: phase histogram bandwidth (PBW) and phase standard deviation (PSD). Echocardiography was simultaneously applied to evaluate left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the LVDD parameters: Te-12-diff and Te-12-SD. Myocardial injury markers were measured, and 12-lead ECGs were performed. The degree of LVR progression was defined as ΔLVESV (%) = (LVESVAMI4weeks − LVESVAMI1day)/LVESVAMI1day. ResultsThirteen swine completed the study. LVDD parameters changed dynamically at different time points after AMI. LVDD occurred as early as 1 day after AMI, peaked at 1 week, and trended toward a partial recovery at 4 weeks. Phase analysis on SPECT GMPI showed a significant correlation with tissue Doppler imaging for the assessment of LVDD during the longitudinal evaluation (r = 0.569 to 0.787, both P <0.05). During the univariate and multivariate regression analyses, the LVDD parameters PBW and PSD as of 1 day after AMI were significantly associated with the progression of LVR, respectively (PBW, β = 0.004, 95% CI 0.001 to 0.007, P = 0.024; PSD, β = 0.008, 95% CI 0.000 to 0.017, P = 0.049). Adjusted smooth curve fitting and threshold effect analysis indicated PBW and PSD break-point values of 142° and 60.4°, respectively, to predict the progression of LVR after AMI. ConclusionsPhase analysis of SPECT GMPI can accurately and reliably characterize LVDD. LVDD occurred on the first day after AMI, reached its peak at 1 week, and partially recovered at 4 weeks after AMI. LVDD as evaluated by phase analysis of SPECT GMPI early after AMI was significantly associated with the progression of LVR. The early assessment of LVDD after AMI may provide helpful information for predicting the progression of LVR in the future.

SIX-MINUTE WALK TEST IN ACUTE MYOCARDIAL INFARCTION PATIENTS

The most common cause of morbidity and mortality in both developed and developing nations worldwide is myocardial infarction (MI). Functional capacity can be assessed using the 6MWTapproach, which is inexpensive, practical, and nearly accurate. Early exercise testing after an AMI may be benecial in determining functional capacity and the ability to conduct everyday tasks at home and at work. It may also be used to assess medical therapy's success and estimate the likelihood of experiencing a future cardiac event. The 6MWT represents the level of daily living activities, and it may be a safe and practical choice for determining functional capability in the early stages of acute myocardial infarction. The increased efciency of AMI therapy is shown by reduced hospitalisation periods, with patients who do not have difculties often being discharged from the hospital in fewer than ve days. The safe execution of this test, particularly in hospitalised patients who have had an AMI, has been inadequately documented. In this article, we will address the literature available for the safe execution of 6MWTafter acute MI to better understand the patient's selection and participation in rehabilitation as quickly as feasible.

Analysis of correlation between heart failure in the early stage of acute myocardial infarction and serum pregnancy associated plasma protein-A, prealbumin, C-reactive protein, and brain natriuretic peptide levels.

The study sought to analyze the predictive value of the early measurement of pregnancy associated plasma protein-A (PAPP-A), prealbumin (PAB), C-reactive protein (CRP), brain natriuretic peptide (BNP), and other indicators of heart failure (HF) after acute myocardial infarction (AMI). A total of 200 AMI patients admitted to Wuyi People's Hospital from November 1, 2019 to October 31, 2020 were continuously enrolled as the research objects and divided into a HF group (Killip class II or above, n=94) and HF-free group (Killip class I or below, n=106) according to the Killip Classification for Heart Function. The age, creatine kinase-myocardial band (CK-MB), PAPP-A, CRP, suppression of tumorigenicity 2 (ST2), BNP, aldosterone (ALD), and left ventricular end-diastolic diameter (LVEDD) of the HF group were all significantly higher than those of the HF-free group, while the PAB and left ventricular ejection fraction (LVEF) were significantly lower (P<0.05). The PAPP-A, CRP, and BNP of HF patients increased as the Killip class increased, while the PAB decreased progressively (P<0.05). After including the statistically significant single factors in a multivariate logistic regression analysis, it was found that PAPP-A, PAB, CRP, and BNP were the independent influencing factors causing HF in the early stage of AMI; and the diagnostic efficacy of HF in the early stage of AMI (from high to low) was combined test, PAPP-A, PAB, BNP and CRP. Serum PAPP-A, PAB, CRP and BNP levels are the independent influencing factors of HF after AMI, but comprehensive tests of clinical indicators, including PAPP-A, PAB, CRP, and BNP, are more accurate at predicting and evaluating HF and can be used to guide clinical decisions.

Prognostic value of growth differentiation factor-15 in patients with acute myocardial infarction

Abstract Introduction Growth differentiation factor-15 (GDF-15) is a member of the transforming growth factor-β superfamily. Its expression was found in various tissues under the circumstances of hypoxia, inflammation, acute injury. GDF-15 is considered as a biomarker of the risk of cardiovascular events, however, most of the studies on GDF-15 have been carried out in patients with chronic heart failure and comorbid pathology. Our study assessed the clinical value of GDF-15 in the acute stage of myocardial infarction (MI) in patients without concomitant inflammatory diseases, cardiac arrhythmias and with an ejection fraction above 40% according to echocardiography. Purpose To evaluate the prognostic value of GDF-15 in patients with acute MI. Materials and methods Our study included 118 patients under the age of 70 years with MI with and without elevation of the ST-segment on the electrocardiogram. We determined the levels of GDF-15 by enzyme-linked immunosorbent assay in the first 48 hours from the clinical onset of MI. The clinical dynamics was assessed by questioning patients at 1, 3, 6 and 12 months after discharge from the hospital. The statistical significance of differences in quantitative indicators was assessed by the Student's t-test for a normal distribution and by the Mann-Whitney U test for a non-normal distribution; in qualitative indicators – according to the Pearson's χ2 criterion. Pearson's and Spearman's correlation coefficients were used to assess the tightness of the relationship between quantitative indicators. Results The average GDF-15 level in patients with acute MI was 2.25±1.0 ng/ml. 29 cardiovascular events occurred during 12 months of observation, including 2 deaths and 8 recurrent MI. According to autopsy data both deaths occurred due to large-focal transmural MI. 22.8% of patients were re-admitted to hospitals for unstable angina pectoris or recurrent MI. Moreover, in 89.6% of that cases GDF-15 was in the third or fourth quartiles and was ≥2.07 ng/ml. Absolutely all patients with recurrent MI and in the case of death had GDF-15 level in the upper quartile (&amp;gt;2.73 ng/ml). Patients with GDF-15 in the upper quartile had a significantly higher risk of recurrent cardiovascular events including cardiovascular mortality and hospitalizations for unstable angina and MI (RR 4.3 [95% CI 2.4–7.9], p&amp;lt;0.05) in comparison with patients with GDF-15 in the three lower quartiles. We assessed the possibility of combined use of GDF-15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and it was revealed that patients who simultaneously had GDF-15 and NT-pro-BNP in the upper quartiles (GDF-15 &amp;gt;2.73 ng/ml, NT-proBNP &amp;gt;1418 pg/ml) had a 5.4 times higher risk of recurrent cardiovascular events (RR 5.4 [95% CI 3.4–8.5] p&amp;lt;0.05). Conclusion The increased level of GDF-15 in the acute stage of MI has predictive value and may serve as an additional cardiovascular risk marker. Funding Acknowledgement Type of funding sources: None.

RECIPROCAL ST SEGMENT CHANGES IN MYOCARDIAL INFARCTION: ISCHEMIA AT DISTANCE VS. MIRROR REFLECTION OF ST-ELEVATION

Background: ST-elevation myocardial infarction (STEMI) is considered one of the commonest causes of morbidity and mortality all over the world. Nevertheless, survival following acute STEMI showed a considerable improvement as a result of increased symptom recognition, precise diagnosis in addition to effective timely reperfusion. Objective: To detect the significance of the reciprocal ST segment alterations in the early stage of acute myocardial infarction (AMI) and whether it is truly reciprocal or represents a distant ischemia that might be revealed by coronary angiography. Patients and methods: This study was conducted on 133 patients admitted to Al-Mokattam Health Insurance Hospital, with the diagnosis of acute STEMI treated with primary percutaneous coronary intervention (PPCI) during the period between November 2018 and December 2019. Results: Distant ischemia in patients with STEMI undergoing PPCI level was significantly higher in reciprocal ST segment depression (RSTD) group (p-value < 0.001). Besides, multivessel disease (MVD) was more prevalent in RSTD group (36.8% vs. 17.5%) in comparison with NRSTD group. The degree of mitral regurge (MR) was more severe among patients with RSTD (P value = 0.029). Mortality rate was more in patients with RSTD, six patients has passed away all of them had RSTD. Conclusion: The reciprocal changes (RC) caused by interaction of distant ischemia of non-infarcted coronaries and benign mirror electrical alterations, and it has a mortality effect. So, RSTD that was a simple ECG finding used as an indicator of patients at high risk who require a more aggressive approach.

Microcapillary-based multicolor assay for quantitative and sensitive point-of-care testing of proteins

A microcapillary-based multicolor assay was developed for proteins quantification in serum sample with the assistance of manual centrifugal platform. The proposed assay only required the operation of “one suction and one extrusion” to realize the target detection. Myoglobin (Myo), a biomarker in the early stage of acute myocardial infarction (AMI), was chosen as the model target. The microcapillary was first modified with polydopamine (PDA), then Myo aptamer was immobilized on the PDA modified microcapillary and hybridized with glucose oxidase (Gox) functionalized DNA probe (DNA-Gox). The step “one suction” referred to the inhalation of the sample into the functionalized microcapillary. Then the target Myo in the sample could bind to the Myo aptamer on the microcapillary so that DNA-Gox complexes were released from the microcapillary into solution. Through the step “one extrusion”, the DNA-Gox complexes in the solution could catalyze glucose to generate hydrogen peroxide, and then the etching of gold nanorods (AuNRs) was initiated, causing a color change from brown to yellow. According to the color change based on the etching of AuNRs, as low as 0.1 nM Myo was detected with naked eyes. Combined with the manual centrifugal platform, even the Myo in the serum samples could be detected without power supply. It was expected to build a universal and adaptable sensing platform for different targets more quickly and efficiently.

Markers of myocodial fibrosis in acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. One of the leading mechanisms in the healing process of acute myocardial infarction (AMI) is damage and loss of extracellular matrix, which plays a leading role in the pathogenesis of LV myocardial remodeling. Tissue inhibitor of matrix metalloprotease-1 is a protein that is a natural inhibitor of metalloproteases, forms complexes with MMP-1 and other metalloproteases (they destroy components of the extracellular matrix of the heart), irreversibly inhibiting their activity. Bayes-Genis A. et al presented histological data on the expression in ruptured and eroded plaques of plasma protein A (PAPP-A), metalloproteinase and insulin-like growth factor-1 detected during pregnancy. Myocardial formation of aldosterone and angiotensin II (as a result of activation of the renin-angiotensin-aldosterone system, including the tissue component) after acute myocardial infarction stimulates the formation of collagen and fibrous tissue in the myocardium with further changes in the structure and geometric characteristics of the left ventricle. Purpose of the study. To study the markers of interstitial myocardial fibrosis in the acute stage of myocardial infarction and assess the dynamics of these indicators in patients after 2.5-3 weeks of inpatient treatment. Methods. The study included 31 patients with myocardial infarction with ST segment elevation. The control groups consisted of 20 apparently healthy individuals. During the study, serum parameters of tissue inhibitor of matrix metalloproteinase-1 (TIMMP-1 and aldosterone were measured on days 1-3 after AMI and after 2.5-3 weeks of inpatient treatment. Results. The level of TIMMP-1 in patients with acute MI was 418.19 ± 103.77 ng / ml and was statistically significantly higher than in practically healthy individuals - 103.44 ± 7.06 ng / ml (p &amp;lt;0.0001) , The level of TIMMP-1 in patients with AMI after 3 weeks, against the background of ongoing therapy, was 366.70 ± 93.34 ng / ml, and the decrease in TIMMP-1, compared with the initial value in the acute stage, had a statistical significance (p = 0.046). The level of aldosterone in acute myocardial infarction was 165.12 ± 32.67 pg / ml and was statistically significantly higher (p &amp;lt;0.0001) than in the control group. In patients with myocardial infarction who are hospitalized, for 2.5-3 weeks, there is a statistically significant (p = 0.003) decrease in the concentration of aldosterone in blood plasma by 15.1% from 165.12 ± 32.67 pg / ml to 140.24 ± 22.78 pg / ml. Conclusions. In the acute stage of myocardial infarction (1-3 days), there is a significant increase in the concentrations of markers of interstitial myocardial fibrosis, such as tissue inhibitor of matrix metalloproteinase-1 and aldosterone, which reflects the initiation of fibroblast activation processes and, accordingly, stimulation of collagen synthesis. Subsequently, there is a decrease in the concentration of tissue inhibitor of matrix metalloproteinase-1 and aldosterone.

Indirect autonomic nervous system activity assessment in patients with myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Abnormalities in the cardiac sympathetic nervous system have been documented in myocardial infarction (MI) and have been directly implicated in pathogenesis and progression of MI. Assessment of the autonomic nervous system activity in acute stage of MI allowed us to identify groups of high-risk patients. Purpose To investigate the sympathetic nervous system activity in patients with MI by assessing the condition of beta-adrenergic reactivity of erythrocytes. To analyze ADRB1 Arg389Gly associations with the state of beta-adrenergic reactivity of erythrocytes in patients with MI. Methods During the study period, 62 patients were enrolled. The patients were divided into 2 groups. The first group consisted of 11 patients (nine women and two men, median age of 54.0 [49.0;61.0] years) with normal beta-adrenergic reactivity of erythrocytes, the second group consisted of 51 patients (40 women and 11 man, median age of 61.0 [48.0;72.0] years) with abnormal beta-adrenergic reactivity of erythrocytes. The research of beta-adrenergic reactivity of erythrocytes was conducted by analysis of changing erythrocyte osmoresistance under the influence of beta blocker in the first 6 hours from the onset of the heart attack. The genetic research was conducted by PСR method in real time. Results Groups of patients were comparable in main clinical indicators (anamnesis of ischemic heart disease and chronic heart failure, frequency of beta blockers administration before and during of MI, electrocardiography features: elevation of ST-segment, Q-wave and etc.). The second group presented with a higher occurrence of acute left ventricular failure (33.3% vs 0%, p = 0.026) and arterial hypertension (90.2% vs 63.6%, p = 0.044). Parameters of myocardial damage were significantly higher in the second group than the first group. Primarily, this manifested in the presence of a greater number of hypokinesis zones on echocardiography (p = 0.015). In addition, patients of the second group had a lower ejection fraction according to echocardiography (51.0 [46.5;59.0]% vs 58.0 [52.0;63.0]%, p = 0.042). Levels of blood necrosis biomarkers were significantly higher in the second group, e.g. Troponin I (24.1 [9.9;68.0] ng/ml vs 1.3 [0.2;1.8] ng/ml, p = 0.001). At the same time statistically significant distinctions of the severity of coronary atherosclerosis in groups were not revealed. The analysis of ADRB1 Arg389Gly demonstrated association of CC-genotype with abnormal beta-adrenergic reactivity of erythrocytes [OR 5.9, 95% СI 1.16-30.25, p = 0.043]. Conclusion Patients with an abnormal beta-adrenergic reactivity were characterized by a greater volume of damage to the heart muscle. Moreover, association of CC-genotype of gene ADRB1 Arg389Gly with abnormal beta-adrenergic reactivity of erythrocytes was identified.

Doppler examination of aorta after therapeutic hypothermia and administering MSCs in experimental myocardial infarction

Background. At present, there are attempts aimed at repairing the myocardium affected by acute myocardial infarction (MI) via biologically sourced drugs, which are able to stimulate reparative regeneration, including the use of mesenchymal stromal cells (MSCs). On the other hand, therapeutic hypothermia initially after the occurrence of impaired blood flow in the coronary arteries aids in reducing the level of metabolism in cardiomyocytes and, accordingly, suppressing the formation of free radicals and inhibiting apoptosis.&#x0D; Purpose – рerforming and analysing Doppler sonography of the ascending aorta in rats with experimental MI in order to assess the systolic function of the left ventricular myocardium influenced by the combined use of therapeutic hypothermia and administering allogeneic MSCs.&#x0D; Materials and methods. The study involved 90 outbred white rats weighing 240–270 g. Myocardial infarction was reproduced by ligating the left coronary artery. Therapeutic hypothermia was performed in a cold chamber, 60 minutes long. The local skin temperature of the neck area was maintained at +4 оС. A suspension of allogeneic cryopreserved MSCs of the placenta was administered once intravenously. Sonography of the ascending aorta on day 7 and day 30 after ligating the coronary artery was carried out by means of «Сономед 500» ultrasound scanner in B-mode with the Doppler (PW-mode).&#x0D; Results. Studying the aortic blood flow showed that on day 7 after ligating the coronary artery, rats had a decrease in max systolic velocity and a tendency to increase diastolic blood flow velocity. Those changes influenced the pulsatility index and systolic-diastolic ratio. A 19 % decrease in the Stewart index confirmed the development of systolic dysfunction in the control group, the severity of which did not decrease until day 30 of the experiment. The impact of allogeneic MSCs on the process of remodeling the heart of rats after ligating the left coronary artery was evident on day 7 (acute stage of myocardial infarction) via abnormally low (below control) blood flow in the aorta with complete hemodynamics restoring on day 30 of the experiment. The combination of therapeutic hypothermia and administering allogeneic MSCs aided in the minimal deviation of hemodynamic parameters from the normal range. On day 7, there was only an increase in the average aortic blood flow rate by 29%, and a decrease in systolic-diastolic ratio by 12% compared to the corresponding normal range, suggesting compensation of the pumping function of the myocardium.&#x0D; Conclusions. Doppler assessment of systolic and diastolic blood flow velocities in the ascending aorta of rats makes it possible to indirectly record the presence and severity of systolic dysfunction of the left ventricle and follow up myocardial contractile function affected by MI. The combination of therapeutic hypothermia and administering allogeneic MSCs after ligating the left coronary artery helps to maintain hemodynamic parameters in the aorta at a level close to normal range during the acute phase of myocardial infarction as well as at the stage of scarring.

Therapeutic Influence of Exosomes Derived from Non-heat versus Heat Shocked Stem Cells on Experimentally Induced Myocardial Infarction in Adult Male Albino Rats

Background: Worldwide, myocardial infarction (MI) is considered as a principal cause of mortality. It results in death of the cardiac myocytes and declining of the cardiac functions. Exosomes of the bone marrow mesenchymal stem cells (BMMSCs) are cell-free, nano-sized extracellular vesicles that have the same reparative potentiality of the stem cells. Heat shock is one of the stresses that increase the production of heat shock proteins in the stem cells augmenting their survival capabilities. Aim of the Work: The current study aimed at assessing and comparing the therapeutic potentiality of exosomes derived from the non-heat and the heat shocked BMMSCs (non-HSBMMSCs-EXOs and HSBMMSCs-EXOs) on experimentally induced MI (acute & chronic stages) with underlining the probable explanation for that difference.Materials and Methods: 56 adult male albino rats were divided into the donor group (for non-HSBMMSCs-EXOs & HSBMMSCs-EXOs preparation) and the experimental groups (control, MI, MI-non-HSBMMSCs-EXOs & MI-HSBMMSCs-EXOs). Four control rats with two rats from each MI-non-HSBMMSCs-EXOs & MI-HSBMMSCs-EXOs groups were sacrificed 1 day following MI to confirm BMMSCs homing while other rats were sacrificed after 3 &28 days. Serological, biochemical, histological and morphometric studies were done.Results: The acute stage of MI revealed degenerative and inflammatory features whereas the chronic stage demonstrated marked fibrotic changes. Such changes were regressed in MI-non-HSBMMSCs-EXOs & MI-HSBMMSCs-EXOs groups except that of MI-non-HSBMMSCs-EXOs sacrificed after 28 days.Conclusion: Both non-HSBMMSCs-EXOs and HSBMMSCs-EXOs had therapeutic capabilities in the acute stage of MI which was more evident with HSBMMSCs-EXOs. In the chronic stage, non-HSBMMSCs-EXOs exhibited non-curative effect despite the perfect effect of HSBMMSCs-EXOs.

The non-invasive evaluation of heart function in patients with an acute myocardial infarction: The role of impedance cardiography.

The purpose of this study was to analyze hemodynamic changes in patients treated with percutaneous coronary intervention (PCI) at an early stage of acute myocardial infarction (AMI) and at 1-month follow-up. Patients with AMI (n = 27) who underwent PCI were analyzed using impedance cardiography (ICG). ICG data were collected continuously (beat by beat) during the whole PCI procedure and thereafter at every 60 s for the next 24 h. Blood pressure was taken every 10 min and stored for analysis. Additionally the following parameters were measured: cardiac index (CI), stroke volume index (SVi), left cardiac work index (LCWi), contractility index (CTi), ventricular ejection time (VET), systemic vascular resistance index (SVRi), thoracic fluid content index (TFCi) and heart rate (HR). In the first 24 h after PCI all the contractility parameters including CI, SVi, LCWi, CTi and VET significantly decreased, whereas HR, SVRi and TFCi increased compared to baseline. All of the parameters examined got normalized at 1 month. The CI, SVi, LCWi, CTi, SVRi did not significantly differ from baseline, however the HR and VET were significantly lower compared to first day after PCI CONCLUSIONS: Cardiac performance deteriorates early after PCI and normalizes after 1 month in patients with an AMI. ICG is useful for hemodynamic monitoring of AMI patients during and after invasive therapy.