First Day Of Myocardial Infarction Research Articles

Serum levels of GM-CSF, CCL11, CCL22 and TRAIL in patients with primary ST-segment elevation myocardial infarction and post-infarction heart remodeling

Aim: To study serum values of GM-GSF, CCL22, CCL11 and TRAIL in patients with primary ST-segment elevation myocardial infarction (STEMI) in early and late post-MI period and their relationship with heart remodeling in 12 months after acute myocardial infarction (MI) diagnosis.Materials and Methods. Eighty four patients with new-onset STEMI were enrolled in the study. Echocardiography was done on day 1 and in 12 months MI. Serum levels of GM-GSF, CCL22, CCL11, TRAIL and C-reactive protein (CRP), NT-pro-NP, troponin I, CK-MV were assessed on days 1 (T1), 7 (T2), in 6 (T3) and 12 months (T4). Patients with adverse left ventricle (LV) remodeling were classified as group 1, and patients with adaptive LV remodeling were classified as group 2 in 12 month of follow-up.Results. 64 patients underwent a 12-month follow-up, of which adverse LV remodeling developed in. Patients from group 1 showed significantly higher levels of markers of myocardial necrosis (CPK MB, troponin I) on the first day of MI and NT-proBNP at all points of the investigation than in patients from 2nd group, p < 0.05. Analysis of the chemokines revealed, that the serum concentration of GM-CSF at the points Т2, Т3, T4 and TRAIL at points T1, T4 were significantly higher, and CCL22 at all of the study and CCL11 at T1, T2, T3 significantly lower than patients from group 2, p < 0,05. According of multiple linear regression predictors of LV dilatation by the 12th month of MI were the serum levels of GM-CSF (p = 0,004), NT-pro-BNP (p = 0,009) on the 7th day of MI and the age of patients (p = 0,005).Conclusions. In patients with adverse LV remodeling have higher levels of circulating GM-GSF, TRAIL and lower levels CCL11, CCL22 in early and late post-MI period. Among the studied inflammatory biomarkers, only the level of GM-CSF on the 7th day of STEMI showed an independent relationship with late adverse LV remodeling.

VISCOSE AND THROMBOCYTIC-AGGREGATION DISORDERS ON PATIENTS WITH MYOCARDIAL INFARCTION WITH STABLE ELEMENTATION OF ST SEGMENT

Relevance. Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro– and microcirculation.
 Objective: the aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease.
 Materials and methods. Patient inclusion criteria for the study: MI with persistent ST-segment elevation; multi-vascular atherosclerotic coronary artery disease; angiographically significant stenosis of the coronary vessels more than 50-70%, at least in 2 projections; functionally significant stenosis of the coronary arteries, according to the fractional blood flow reserve (FBFR) (<0.80). 102 patients were divided into 4 groups of the same type. The groups used 4 different tactical and treatment-diagnostic approaches. Group 1 (n = 25) - occlusion of an infarct-dependent vessel was detected using coronary angiography and its immediate stenting was performed; FBFR was established on days 2-3, and stenosis of infarction-independent arteries was proved; using optical coherence tomography (OCT), the stability, size, length of atheroma was assessed and delayed stenting of these vessels was performed. Group 2 (n = 26) - stenting of the infarct-dependent artery was performed; FBFR was established on days 2-3, but without OCT, followed by stenting of infarct-independent arteries. Group 3 (n = 25) - carried out simultaneous stenting of infarct-dependent and infarct-independent vessels after coronary angiography. Group 4 (n = 26) - only stenting of the infarct-dependent vessel was performed. All patients received standard two-component antiplatelet therapy (acetylsalicylic acid 75-150 mg/day and clopidogrel 75 mg/day) and received 20 mg of atorvastatin and 10 mg of ezetimibe. The results obtained in patients were compared with those results obtained in 30 practically healthy people of the same age and gender. The number of platelets and the concentration of fibrinogen were determined in each subject. Using a viscometer and a laser aggregometer the degree of platelet adhesion, the time of platelet adhesion, the degree of platelet aggregation, and blood viscosity were assessed. All indicators were studied three times - on the first day of myocardial infarction, after 3-4 weeks, and after a year. 
 Results. Hyperviscous and hypercoagulable syndromes were established in patients with MI with persistent ST-segment elevation. They manifested themselves in the first weeks by a compensatory increase in the number of platelets, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Delayed stenting of infarct-independent arteries used in group 1 contributed to a lower amplitude of fluctuations of all laboratory parameters in comparison with other tactical and therapeutic approaches.
 Conclusions. It is possible to optimize the state of viscosity and the processes of adhesion/aggregation of platelets due to the systemic stepwise improvement of arterial blood supply. Traditional tactical and therapeutic-diagnostic principles of management of such category of patients do not fundamentally improve the state of viscous and coagulation-aggregation parameters even when using double antiplatelet therapy.

Comparative Results of Emergency Carotid Endarterectomy and Emergency Carotid Angioplasty With Stenting in the Acute Period of Ischemic Stroke. Multicenter Study Results

AIM OF STUDY Study of hospital results of emergency carotid endarterectomy (CEE) and carotid angioplasty with stenting (CAS) in the acute period of acute cerebrovascular accident (ACVA). MATERIAL AND METHODS From January 2008 to August 2020, the study included 615 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA), operated on in the acute period of ischemic stroke (within 3 days from the onset of stroke). Depending on the type of revascularization implemented, all patients were divided into 2 groups: group 1 — CAS (n=312); 2nd group — CEE (n=357). Inclusion criteria were as follows: 1. Mild neurological disorders: NIHSS score 3–8; Modified Rankin Scale score 2 of less; Barthel Scale > 61; 2. Indications for CEE / CAS according to the current national recommendations; 3. Ischemic focus in the brain not more than 2.5 cm in diameter. Exclusion criteria: 1. Presence of con-traindications to CEE / CAS. Carotid angioplasty with stenting was performed according to the standard technique; in all cases, distal embolism protection systems were used. Carot-id endarterectomy was performed according to the classical and eversion techniques. When the retrograde pressure in the ICA was less than 60% of the systemic pressure, a temporary shunt (TS) was installed. In the postoperative period, all patients underwent multispiral computed tomography (MSCT) of the brain. In the absence of negative dynam-ics in the neurological status, MSCT was performed on the 7th day after the operation, if available, it was performed urgently. The checkpoints were the development of such unfa-vorable cardiovascular events as death, myocardial infarction (MI), stroke / transient is-chemic attack (TIA), “mute” stroke, “mute” hemorrhagic transformations, combined end-point (death + all strokes / TIA + MI). Strokes were mute if diagnosed according to MSCT, without symptoms. RESULTS In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months. RESULTS When analyzing hospital complications, significant differences in the frequency of lethal outcome were not obtained (group 1: n=6 (1.92%); group 2: n=8 (2.24%); p=0.98; OR=0.85; 95% CI 0.29–2.49); MI (group 1: n=5 (1.6%); group 2: n=5 (1.4%); p=0.91; OR=1.14; 95% CI 0.32–3.99 ); ACVA (ischemic type) / TIA (group 1: n=5 (1.6%); group 2: n=6 (1.7%); p=0.82; OR=0.95; 95% CI 0.28–3.15), as well as “mute” ACVA (group 1: n=7 (2.2%); group 2: n=15 (4.2%); p=0.23; OR=0.52; 95% CI 0.21–1.3). However, the vast majority of hemorrhagic transformations (group 1: n=2 (0.64%); group 2: n=13 (3.6%); p=0.018; OR=0.17; 95% CI 0.03–0.76) and all “mute” hemorrhagic transformations (group 1: n=0; group 2: n=26 (7.3%); p=0.001; OR=0.02; 95% CI 0.001–0.33) were observed only in the CEE group, which was reflected in the maximum values of the combined end point: group 1: n=22 (7.05%); group 2: n=73 (20.4%); p<0.0001; OR=0.29; 95% CI 0.17–0.48). Thus, in the CEE group, every 5th patient had a complication. CONCLUSION Carotid angioplasty with stenting is the safest method of revascularization for patients in the acute period of ACVA. This is largely due to the reduction in the risk of reperfusion syndrome and the prevention of embolism due to the use of modern protection systems. Carotid endarterectomy can be performed with comparable efficiency only when a tempo-rary shunt is placed in the internal carotid arteries in the absence of unstable atheroscle-rotic plaque.

Participation of the C-terminal propeptide procollagen type I in the formation of cardiofibrosis in patients with myocardial infarction with preserved left ventricular ejection fraction

Aim. To study the dynamics of procollagen type I carboxy-terminal propeptide (PICP) with an assessment of potential associations with cardiac fibrosis (CF) and diastolic dysfunction (DD) of the left ventricle (LV) during the hospitalization and one year after ST segment elevation myocardial infarction (STEMI).Material and methods. The study included 120 patients with STEMI. There were following inclusion criteria: diagnosis of STEMI (2015 European Society of Cardiology guidelines); Killip £III acute heart failure (AHF); signed informed consent; patient age >18 years old. There were following exclusion criteria: STEMI due to percutaneous coronary intervention or coronary artery bypass grafting; Killip IV AHF; patient age >80 years; clinically significant comorbidities; death of the patient during the first day of hospitalization. On the 1st, 12th day of the disease and after a year all patients underwent echocardiography and the PICP concentration was determined. One year after myocardial infarction, contrast-enhanced cardiac magnetic resonance imaging was performed to assess CF. In the analyzed group of patients, on day 1 of STEMI, mean values of LV ejection fraction (EF) in the range of 40-49% were observed in 3 (2,5%) patients, LVEF <40% — in 31 (26%), LVEF ≥50% — in 86 (71,7%). The final analysis was performed on a sample of patients with preserved LVEF (n=86) (71,7%).Results. On the first day of myocardial infarction, signs of DD were noted in 25 (29,1%) patients, while after 1 year, their number increased by 9 (10%) and amounted to 34 (39,5%) patients. In 15 (17,6%) people, worsening of myocardial systolic dysfunction was noted. Patients with a CF ³16% had the highest PICP expression on the first day of the disease. CF ≥16% one year after STEMI with preserved EF is associated with PICP concentration on day 1 of the disease. In addition, multidirectional correlations were revealed between the CF ≥16% and parameters of LV diastolic function (e’, mean pulmonary artery pressure, E/e’).Conclusion. Determination of the PICP concentration on the 1st day of myocardial infarction will allow early identification of patients at risk of CF one year after STEMI with preserved EF.

Predictive Value of N-Terminal Prohormone of Brain Natriuretic Peptide in Long-Term Remodeling of the Left Ventricle in Diabetic Patients of Young and Middle Age With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Abstract. Recently, quantitative analysis of the level of the N-terminal prohormone of the brain naturetic peptide (NT-proBNP) has been widely used to diagnose heart failure (HF). A statistically significant correlation was found between the serum NT-proBNP concentration and HF stage. It was found that in patients with high cardiovascular risk, NT-proBNP has the highest predictive value in relation to mortality. In young and middle-aged patients with diabetes mellitus (DM) with myocardial infarction (MI) and stents of an infarct-associated artery, the frequency of unfavorable remodeling (UR) of the left ventricle (LV) in the long-term prognosis was studied. The frequency of atherosclerotic lesions of the coronary arteries (CA) in patients with diabetes in acute coronary syndrome (ACS) was determined, the results of echocardiographic parameters were presented in the follow-up dynamics, the value of serum NT-proBNP in predicting LV UR 12 months after myocardial infarction (MI) was determined.Aim of study. To assess the diagnostic capabilities of NT-proBNP in the long-term prediction of the development of LV infarction in patients with MI with diabetes in young and middle age after percutaneous coronary intervention (PCI).Design. Prospective controlled non-randomized trial. The patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months after AMI. The study included 191 patients with ACS with / without ST-segment elevation, who were divided into two groups. The main group included 76 patients with ACS with diabetes mellitus, the comparison group included 115 patients with ACS without diabetes mellitus. Patients in both groups were comparable in age, gender, comorbidity, and complications of AMI. The duration of diabetes was, on average, 6 years (from one to 12 years).Material and methods. All patients underwent electrocardiography, echocardiography, tests for the content of troponin I, NT-proBNP, glycosylated hemoglobin, lipids, determined the level of creatinine in the blood and the glomerular filtration rate according to the Modification of diet in renal disease (MDRD). All patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months later.Results. In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months.Conclusion. The NT-proBNP level of more than 776 pg/ml on the first day after PCI is an indicator of an unfavorable long-term prognosis in patients with young and middle-aged diabetes in terms of the development of LV systolic dysfunction.

SERUM ALDOSTERONE LEVEL DYNAMICS AND CARDIAC REMODELING IN MYOCARDIAL INFARCTION PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA TREATED WITH SELECTIVE ALDOSTERONE RECEPTOR BLOCKER

Aim. To study serum aldosterone level dynamics and cardiac remodeling characteristics in myocardial infarction (MI) patients with undifferentiated connective tissue dysplasia (UCTD) treated with selective aldosterone receptors antagonist eplerenone.Study population and methods. A total of 110 MI patients with and without UCTD and 32 healthy controls without cardiovascular pathology and without signs of UCTD were enrolled in the study. Clinical examination, phenotyping, echocardiography and serum aldosterone levels evaluation were performed. MI patients were divided into 3 groups: I (n=20) - patients with UCTD who was treated by eplerenone additionally to basic therapy of MI; II (n=60) - patients without UCTD treated by basic therapy of MI; III (n=30) -patients with UCTD treated by basic therapy of MI only.Results. All MI patients regardless of UCTD presence had increased serum aldosterone in the first day of MI. In 28 days the significant increase of serum aldosterone level in group I in comparison with groups II, III and control group was observed. Analysis of structural and functional characteristics of the heart in MI patients in a 6 month after MI had shown more significant left ventricle enlargement and decrease of cardiac pump function in group III compared to group I.Conclusion. Presence of UCTD in MI patients does not affect serum aldosterone levels dynamics. Inclusion of eplerenone in the treatment of MI patients with UCTD during 6 months inhibits left ventricular dilatation and attenuates reduction of its ejection fraction.

The influence of the treatment recommendations completeness on the first day of myocardial infarction with the Q wave of the left ventricle with expansion to the right ventricle on the clinical course of the disease

The aim — to determine the correlation between the implementation completeness of the recommendations for treatment on the first day of the Q­IM of the left ventricle (LV) posterior wall (PW) with expansion to the right ventricle (RV) on the clinical course of the disease.Materials and methods.155 patients with Q­MI of the PWLV with expansion to the RV aged 64.11 ± 2.42 years, 103 (66.5 %) men and 52 (33.5 %) women were examined. Patients were divided into two groups: the 1st group — 29 (18.7 %) patients, who demonstrated severe hemodynamic complications (cardiogenic shock (CS) and Killip III); the 2nd group — 126 (81.3 %) patients with a stable hemodynamics. The quality of therapy was evaluated in the first 24 hours of MI treatment.Results and discussion. Severe hemodynamic complications were more common in women (p = 0.0016) and were associated with later hospitalization (p < 0.05), and with a low frequency of the ECG RV3—RV4 (p = 0.00001) recording at the prehospital stage. The development of CS and Killip III in patients with Q­IM of the PWLV with expansion to the RV was associated with low frequency of adequate doses of antiplatelet drugs prescription (p = 0.001), anticoagulants (p = 0.00002) and statins (p = 0.037) in the prehospital stage. The correlation between the development of severe hemodynamic disorders and the insufficient use of infusion solutions for the purpose of preload restoration on the RV (p = 0.011) and the high frequency of drugs with vasodilator properties application, in particular, ACE/ARA (p = 0.0004), nitrates (89 7 %, p = 0.0005), diuretics (62.1 %, p = 0.0012) and MgSO4 (51.7 %, p = 0.002) was established.Conclusions. In patients with Q­IM PWLV with expansion to the RV, the development of life­threatening hemodynamic complications, in particular, CS and Killip III, is significantly associated with a low level of diagnosis of the RV MI and non­compliance with the requirements of treatment recommendations on the first day of MI.

Altered Gene Expression Pattern in Peripheral Blood Mononuclear Cells in Patients with Acute Myocardial Infarction

BackgroundDespite a substantial progress in diagnosis and therapy, acute myocardial infarction (MI) is a major cause of mortality in the general population. A novel insight into the pathophysiology of myocardial infarction obtained by studying gene expression should help to discover novel biomarkers of MI and to suggest novel strategies of therapy. The aim of our study was to establish gene expression patterns in leukocytes from acute myocardial infarction patients.Methods and ResultsTwenty-eight patients with ST-segment elevation myocardial infarction (STEMI) were included. The blood was collected on the 1st day of myocardial infarction, after 4–6 days, and after 6 months. Control group comprised 14 patients with stable coronary artery disease, without history of myocardial infarction. Gene expression analysis was performed with Affymetrix Human Gene 1.0 ST microarrays and GCS3000 TG system. Lists of genes showing altered expression levels (fold change >1.5, p<0.05) were submitted to Ingenuity Pathway Analysis. Gene lists from each group were examined for canonical pathways and molecular and cellular functions. Comparing acute phase of MI with the same patients after 6 months (stable phase) and with control group we found 24 genes with changed expression. In canonical analysis three pathways were highlighted: signaling of PPAR (peroxisome proliferator-activated receptor), IL-10 and IL-6 (interleukin 10 and 6).ConclusionsIn the acute phase of STEMI, dozens of genes from several pathways linked with lipid/glucose metabolism, platelet function and atherosclerotic plaque stability show altered expression. Up-regulation of SOCS3 and FAM20 genes in the first days of myocardial infarction is observed in the vast majority of patients.

CARDIAC RUPTURE IN MYOCARDIAL INFARCTION: INCIDENCE AND PREDISPOSING FACTORS (15 YEAR FOLLOW-UP)

Aim. To evaluate the incidence of cardiac rupture (CR) in patients with acute myocardial infarction (MI) as well as predisposing factors during 15-year follow-up. Material and methods. 1453 patients with acute MI who were admitted to Krasnoyarsk cardiological center during 1989, 1993 and 2003 years were studied. All patients were divided into three groups: group I - 447 patients, who were on treatment in 1989, group II - 475 patients of 1993, and group III – 531 patients of 2003. There were no differences in groups on patient sex, location and depth of MI, previous MI, arrhythmias, heart failure and diabetes mellitus. Results. CR was found in 18 of 447 patients (4%) of group I (1989), in 16 of 475 patients (3,4%) of group II (1993) and in 10 of 531 patients (1,9%) of group 3 (2003), (p1,3 <0,05). Incidence of CR significantly decreased from 1989 to 2003 in female patients (7,2%; 5,7% and 1,6% in 1989, 1993 and 2003, respectively; p1,3 < 0,01, p2,3 < 0,05). Incidence of CR in male patients didn’t changed (2,5%, 1,8% and 2,1%, respectively). The average blood pressure (BP) during the first day of MI in female patients was higher than this in male ones in 1989 and 1993. There were no significant differences in BP between women and men in 2003. Heart rate (HR) during the first day of MI in female patients was higher than this in male patients in 1989. However in 1993 and 2003 there were no differences in HR between women and men. MI therapy more often included betablockers, angiotensin converting enzyme inhibitors, intravenous nitrates, statins, thrombolythics and anticoagulants in 2003 than in 1989 and 1993. Conclusion. Effective BP and HR control is the most effective way to prevent CR in patients with MI.

Gender differences in cardiac function during early remodeling after acute myocardial infarction in mice

There are conflicting data about gender differences in cardiac function after myocardial infarction (MI), including cardiac rupture and mortality. Using a mouse model of MI, we recently found that the cardiac rupture rate during the first week after MI was significantly lower in females than in males, suggesting that females have attenuated structural remodeling. Thus in this study, we attempted to determine whether: a) females have attenuated remodeling and faster healing during the early phase post-MI, and b) females have better cardiac function and outcome during the chronic phase compared to males. MI was induced in 12-week-old male and female C57BL/6J mice. Signs of early remodeling, including cardiac rupture, infarct expansion, inflammatory response, and collagen deposition, were studied during the first 2 weeks post-MI. Left ventricular remodeling and function were followed for 12 weeks post-MI. We found that males had a higher rate of cardiac rupture, occurring mainly at 3 to 5 days of MI and associated with a higher infarct expansion index. Neutrophil infiltration at the infarct border was more pronounced in males than females during the first days of MI, which were also characterized by increased MMP activity. However, the number of infiltrating macrophages was significantly higher in females at day 4. During the chronic phase post-MI, males had significantly poorer LV function, more prominent dilatation and significant myocyte hypertrophy compared to females. In conclusion, males have delayed myocardial healing, resulting in cardiac rupture, and the survivors have poorer cardiac function and pronounced maladaptive remodeling, whereas females show a better outcome during the development of HF.

Detection of acute myocardial infarction with digital image processing of two-dimensional echocardiograms

We have previously described the ability of a computer-based image digitizing system to assess early textural changes in acute canine myocardial infarction. To determine whether this technique could be applied to human beings, we studied 12 patients with a first acute transmural myocardial infarction and five normal subjects. Two-dimensional echocardiograms were performed on days 1 and 8 in normal subjects and on days 1 (day of admission), 2, 3, 5, and 14 in the patient population. All recording parameters on the echocardiography machine were kept identical for serial studies. The mean period between hospitalization and first echocardiogram was 11.1 hours (range 4 to 20 hours). End-diastolic frames from the two-dimensional echocardiographic images were digitized and displayed on a monitor. The mean pixel intensity (MPI) (±SD) in the region of asynergy (area of myocardial infarction) and a normal area were determined. In normal volunteers, no significant change in MPI was noted between anteroseptal and lateral areas on two separate two-dimensional echocardiographic studies, which were performed 7 days apart (anteroseptal: MPI, 21.6 ± 1.1 vs 21.8 ± 0.4, p = not significant) and (lateral: MPI, 21.5 ± 1.2 vs 21.4 ± 1.4, p = not significant). In patients with myocardial infarction, a significant increase in MPI was noted on the first day of myocardial infarction between normal and infarcted myocardium (20.4 ± 2.0 vs 24.3 ± 2.3, p < 0.05) and progressively increased thereafter until day 14 (20.5 ± 1.7 vs 31.9 ± 3.7, p < 0.05). In conclusion, two-dimensional echocardiograms, which were obtained when the transducer was placed on the chest wall and digital image processing was performed, enabled the differentiation of normal myocardium from infarcted myocardium in its early stages. This technique may be clinically useful, especially when conventional electrocardiography does not provide a diagnosis.

Early Indium-111 antimyosin scintigraphy for assessment of regional wall motion asynergy on discharge after myocardial infarction

To assess the relation between early Indium-111 monoclonal antimyosin antibody scintigraphy and degree of regional asynergy on discharge, 38 patients with a first acute myocardial infarct were studied (18 anterior, 20 inferoposterior infarctions). In 21 patients thrombolytic therapy was administered. On the first day of myocardial infarction, 80 MBq Indium-111 Antimyosin was injected. Planar images, anterior, lateral and left anterior oblique, were made 24 hours later. Localized myocardial uptake was present in 37/38 patients, and was evaluated for Count Density Index (count density of infarct zone/left lung count density) in the left anterior oblique images, which displayed the infarct zone well. Regional asynergy on discharge was evaluated by cross-sectional echocardiography and defined mild (hypokinesia) or severe (akinesia or dyskinesia). Count density index was significantly lower in 15 patients with mild asynergy, compared with 22 patients with severe asynergy (1.61 +/- 0.25 vs. 2.42 +/- 0.40, p less than 0.001). This difference was present in both patient groups treated with or without thrombolysis. We conclude that early count density index, reflecting the amount of local necrosis, is highly correlated to the ultimate degree of wall motion impairment.

Akut Miyokard İnfarktüsünde Serum Aktik Dehidrogeneaz, Progesteron Ve Testeteron Düzeyleri

SUMMARY SERUM LACTIC DEHYDROGENAZE, PROGESTERONE AND TESTESTERON LEVELS IN ACUTE MYOCARDIAL INFARCTION In order to study the predisposing effects of sex hormones in acute myocardial infarction, plasma lactic dehydrogenaze (LDH), progesteron and testesteron levels were studied in 26 male patients who had acute myocardial infarction and 15 age-matched controls. Mean serum LDH level was significantly elevated in patient group (p 0.05). There was no significant difference in testesteron levels between two groups (p >0.05). Serum LDH Levels were significantly and positively correlated with serum progesteron levels in the first day of myocardial infarction (r=0.43, p 0.05). Serum testesteron duzeyleri bakimindan hasta ve kontrol grubu arasinda onemli farklilik bulunamadi (p>0.05). Akut miyokard infarktusunde serum LDH duzeyi ile progesteron arasinda onemli pozitif bir korelasyon varken (r=0.43). Serum LDH ile serum testesteron duzeyleri arasinda onemli bir korelas¬yon yoktu (r=0.35).

Formation of prostacyclin-sensitive platelet aggregates in human whole blood in vitro. Part II. The occurrence of the phenomenon in males suffering from acute myocardial infarction.

The de-aggregatory effect of prostacyclin (PGI2) and the rate of spontaneous platelet aggregation (SPA) were studied in vitro in whole blood of 24 males with acute myocardial infarction (MI) and 18 males, patient controls (PC). The de-aggregatory effect of PGI2 and the rate of SPA (measured as a percentage of changes in free platelet number in whole blood) were higher (p less than 0.01) in MI than PC. The de-aggregatory effect of PGI2 in whole blood was higher (p less than 0.05) on the first day of MI than on day 14 following MI. The highest de-aggregatory effect of PGI2 was found in whole blood of patients with MI complicated by ventricular fibrillation. In neither of the groups did the de-aggregatory effect of PGI2 correlate with patients' age, haematocrit, erythrocyte and leucocyte counts, triglycerides, HDL, LDL or total cholesterol levels. In the MI group, de-aggregatory effect of PGI2 was correlated with free platelet concentration (r = -0.59, p less than 0.05), elevation of glutamic oxalacetic transaminase (r = 0.53, p less than 0.05) and creatinine phosphokinase (r = 0.69, p less than 0.001). The de-aggregatory effect of PGI2 in blood of patients with evolving MI did not differ from that in PC. It is concluded that the increased rate of SPA and formation of PGI2-sensitive platelet aggregates in vitro in whole blood of MI patients are secondary to myocardial necrosis.

About ruptures of the heart muscle in myocardial infarction

The medical histories of those who died from heart rupture (PC) were analyzed. Of the 1499 patients with myocardial infarction (MI) who were admitted to the specialized department for patients with myocardial infarction from 1972 to 1978, 221 died; PC was the direct cause of death in 56 of them (25.3%). MS was mainly observed in the elderly, more often in women than in men. In the 51-60 age group, PC occurred in 5 out of 284 men (1.8%) and in 3 out of 70 women (4.3%), in the 61-70 age group - in 8 out of 270, respectively (2.9 %) and 18 out of 191 (9.4%); in the group of MI patients over 70 years old - in 5 out of 107 (4.7%) and in 17 out of 155 (10.9%). In all patients, MS occurred against the background of transmural MI in the anterior wall region. More often MS was observed in primary MI (76.7%), in 2 cases with repeated MI (3.3%), in 12 with recurrent MI (20.0%). On the first day of myocardial infarction, cardiac rupture occurred in 30 patients, on days 2-3 - in 10, on 4-7 - in 2, on 19-23 - in 8. All cases of late ruptures (after 7 day) were associated with recurrent myocardial infarction.

M-complex: the electrocardiographic sign of impending cardiac rupture following myocardial infarction.

Out of 284 patients admitted to the Coronary-Care Unit, 60 patients showed an acute monophasic injury pattern (M-Complex) on their initial electrocardiogram (ECG). There were 13 fatalities on the first day of myocardial infarction; 6 from the M-complex group. Three of these 6 patients died with cardiac rupture. The ECG features of these 3 patients were compared with the 3 non-rupture patients. A progressive increase in the elevated R-ST segment of the M-complex with an upward ‘pull’ of the R-ST junction, proved to be an ominous ECG sign of impending cardiac rupture in patients with protracted chest pain and persistent hypertenison. The 3 non-rupture patients remained in a hypotensive state from admission to the time of death. Atrioventricular block and A-V junctional tachycardia were the commonest rhythm disturbances in patients dying with cardiac rupture.

Left ventricular preejection period and ejection time in patients with acute myocardial infarction.

The phases of systole were measured in 51 patients with acute myocardial infarction and three control groups: (1) a group of 40 patients without heart disease, (2) a group of 23 patients admitted to a coronary care unit for chest pain, who did not have an acute myocardial infarction, and (3) a group of 16 patients with stable angina pectoris and arteriographically proven coronary atherosclerosis. In addition, serial measurements were made in the acute myocardial infarction group. Total electricalmechanical systole (QS 2 ), the preejection period (PEP), and left ventricular ejection time (LVET) were measured in each patient from simultaneous recordings of the ECG, phonocardiogram, and carotid pulse tracing. The systolic and diastolic blood pressures and QRS duration were also measured. Corrections were made for heart rate where appropriate. The average PEP was elevated on the first day of myocardial infarction but was within normal limits thereafter. The LVET and QS 2 were significantly shortened until the fourth week of hospitalization. There was considerable overlap in the PEP values among the four groups. Eight patients died of acute myocardial infarction; the PEP was abnormally short in three (two of whom had cardiogenic shock), normal in two, and abnormally long in three. The PEP/LVET ratio separated the acute MI group from the normal group but not from the other two patient groups. Clinical class, digitalis, and infarct location did not produce characteristic changes in the systolic time intervals. A reduction in stroke volume is the most likely explanation for the reduction in LVET and QS 2 . The wide range in PEP values observed is best explained by alterations in the multiple determinants of PEP. The systolic time intervals do not appear to be useful as a diagnostic or prognostic tool in acute myocardial infarction.

Blood plasma catecholamines and their urinary excretion in patients with acute myocardial infarction

In 43 patients with acute myocardial infarction the plasma content of norepinephrine and epinephrine was determined with the aid of the trioxyindole fluorometric method. Simultaneously, in 26 cases the daily urinary excretion of catecholamines was determined. During the first days of myocardial infarction the increase of the plasma content of norepinephrine was statistically significant. A rise in the plasma concentration of epinephrine was more moderate and short termed. A pronounced increase of the content of catecholamines in the blood plasma was most marked in patients with pulmonary congestion, cardiac rhythm disorders, and severe cardiac pain. In the majority of patients with acute myocardial infarction, the plasma content of catecholamines and the urinary excretion of them changed in the same way. However, in some patients with marked congestive heart failure and hypotension there was a significant discrepancy which was most pronounced in oliguria.

Urinary excretion of dopamine and homovanillic acid in acute myocardial infarction

The urinary excretion of dopamine and homovanillic acid was investigated in 20 patients with acute myocardial infarction. The mean excretion of dopamine was increased during the first five days of the disease. The mean excretion of the metabolite of dopamine—homovanillic acid was also higher during the first days of myocardial infarction than in the subsequent period, although it did not exceed the upper limit of normal. No significant correlation between urinary dopamine and noradrenaline excretion was found. The results of the study are discussed in the light of the augmented sympathetic activity accompanying acute myocardial infarction.

CIRCULATORY DYNAMICS IN MYOCARDIAL INFARCTION

The clinical evidences of circulatory failure in the first days of myocardial infarction often differ conspicuously from the manifestations of decompensation in other diseases of the heart. In many instances the absence of orthopnea is striking; the patient evinces no distress when lying flat in bed despite the fact that grayish cyanosis and cold extremities testify to the impairment of the peripheral circulation. Moreover, inspection of the cervical and other superficial veins reveals that they are largely collapsed. These observations are in sharp contrast to those which one is accustomed to encounter when equally severe retardation of the peripheral circulation occurs in such conditions as, for example, mitral stenosis. In that case the patient is orthopneic, and the superficial veins are engorged. The picture in myocardial infarction is obviously the one which is familiar to every physician under the name of shock and which results from disturbances in the periphery