MI Patients Research Articles

LncRNA HIF1A-AS2: a potential biomarker for early diagnosis of acute myocardial infarction and predictor of left ventricular dysfunction

BackgroundRapid diagnosis of acute myocardial infarction (AMI) is the subject of many clinical studies as it enables an effective therapy, preventing adverse progression of AMI and increasing survival rates. Recent studies have revealed that specific blood-based long non-coding RNAs (lncRNAs) are deregulated in patients with AMI and serve as promising diagnostic and prognostic tools. The current study aimed to determine the potential role of a hypoxia-responsive lncRNA, hypoxia-inducible factor 1A antisense RNA 2 (HIF1A-AS2), as a biomarker for early diagnosis and predictor of left ventricular dysfunction (LVD).MethodsThis study was carried out on 48 patients with AMI and 50 age-and sex-matched controls. The relative quantification of HIF1A-AS2 expression was done using reverse transcription real‐time polymerase chain reaction.ResultsCompared to the control group, HIF1A-AS2 were significantly higher in MI patients (P < 0.001). Interestingly, patients presenting within 3 h of chest pain onset had elevated levels of HIF1A‐AS2 as compared to patients with late presentation. The ROC curve was constructed to assess HIF1A-AS2 as an early marker. It demonstrated higher sensitivity (94%) and specificity (86%). Moreover, the multivariate regression analysis revealed that HIF1A‐AS2 was significantly associated with LVD in the patient group after 6 months follow up (p = 0.018).ConclusionOur study suggests that HIF1A‐AS2 may be a potential early diagnostic biomarker of AMI with high sensitivity. In addition, it might have a promising role as a predictor of left ventricular dysfunction.

Integrated whole-genome gene expression analysis reveals an atlas of dynamic immune landscapes after myocardial infarction.

Myocardial infarction (MI) is a deadly medical condition leading to irreversible damage to the inflicted cardiac tissue. Elevated inflammatory response marks the severity of MI and is associated with the development of heart failure (HF), a long-term adverse outcome of MI. However, the efficacy of anti-inflammatory therapies for MI remains controversial. Deciphering the dynamic transcriptional signatures in peripheral blood mononuclear cells (PBMCs) is a viable and translatable route to better understand post-MI inflammation, which may help guide post-MI anti-inflammatory treatments. In this work, integrated whole-genome gene expression analysis was performed to explore dynamic immune landscapes associated with MI. GSEA and GSVA showed that pathways involved in the inflammatory response and metabolic reprogramming were significantly enriched in PBMCs from MI patients. Based on leukocyte profiles generated by xCell algorithm, the relative abundance of monocytes and neutrophils was significantly increased in PBMCs from MI patients and had positive correlations with typical inflammation-associated transcripts. Mfuzz clustering revealed temporal gene expression profiles of PBMCs during the 6-month post-MI follow-up. Analysis of DEGs and gene sets indicated that PBMCs from HF group were characterized by elevated and lasting expression of genes implicated in inflammation and coagulation. Consensus clustering generated 4 metabolic subtypes of PBMCs with molecular heterogeneity in HF patients. In summary, integrated whole-genome gene expression analysis here outlines a transcriptomic framework that may improve the understanding of dynamic signatures present in PBMCs, as well as the heterogeneity of PBMCs in MI patients with or without long-term clinical outcome of HF. Moreover, the work here uncovers the diversity and heterogeneity of PBMCs from HF patients, providing novel bioinformatic evidence supporting the mechanistic implications of metabolic reprogramming and mitochondrial dysfunction in the post-MI inflammation and HF. Therefore, our work here supports the notion that individualized anti-inflammatory therapies are needed to improve the clinical management of post-MI patients.

FREQUENCY OF ACUTE HEART FAILURE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER REVASCULARIZATION

Aim – to study the frequency of acute heart failure (AHF) in patients with Q-myocardial infarction (MI), to establish the clinical and functional features of the course and risk factors for high-grade heart failure in patients with Q-MI.Materials and methods. The data of 308 middle-aged Q-MI patients (62.9±0.6) years old, including 215 men (69.8%) and 93 women (30.2%), who were treated in a specialized cardiology department, were analyzed. Among the examined patients, an analysis of the combination of Q-MI with AHF of different classes according to Killip was performed. All patients underwent a general clinical examination, ECG, echocardiography and lung ultrasound, coronary ventriculography, additional laboratory examination (quantitative troponin I, D-dimer, CPK-MV, CRP, NT-proBNP). Statistical analysis of the results was performed in the "Statistica 7.0" system. The results. Among all examined, 161 (52.3%) persons had AHF class I according to Killip, 44 (14.3%) – class II, 55 (17.8%) – class III, and 48 (15.6%) patients - class IV. When dividing by age and sex, no significant difference was found between different classes of AHF. Men predominated in all groups - from 61.8% in the group of MI+AHF of class III to 73.3% in the group of MI+AHF of class I. In all groups the majority of those examined were patients who were hospitalized within 2 to 6 hours of the onset of the pain syndrome - 63.4% in group I, 45.4% in group II, 49.1% in group III, and 56.2% in group IV. Hospitalized within 6-12 hours among all MI patients was 19.2%, slightly more in groups of AHF I and II (20.5% and 22.7%) than in groups III and IV (16.4% and 14, 7%), (р=0.34). The smallest part of patients - 7.2% - was hospitalized within more than 12 hours from the onset of the pain syndrome, from 3.7% in the group of MI and AHF I to 12.7% in the group of AHF III (p=0.32). The average BMI was (29.6±0.3) kg/m2, the highest BMI was determined in the group of MI and GOS AHF – (30.5±0.4) kg/m2, the lowest – in the group of MI and AHF I – (29 .1±0.4) kg/m2 (р=0.24). Arterial hypertension (AH) among persons with AHF I occurred in 85.1% of cases, with AHF II - in 100%, in the group of AHF III - in 90.9%, in AHF IV - in 89.6% (р=0,66). When comparing the data of patients with MI and AHF of high degrees - Killip III-IV (group II) it was found that they were significantly older than people with MI without signs of AHF of high gradations (p=0.016). It was found that patients with MI and high-grade heart failure differed from people with class I-II heart failure by higher BMI - (30.4±0.5) versus (29.1±0.2) kg/m2, respectively (p=0.046), as well as a longer history of hypertension - 52.4% of patients in group II had hypertension for more than 10 years, while in group I - 36.1% (p=0.006). There is a significantly higher frequency of all forms of atrial fibrillation (AF) in the anamnesis in patients with high-grade heart failure - 12.6% versus 3.9% in group I (p=0.0004) and a higher frequency of chronic obstructive pulmonary diseases - 10.7 % against 4.4% (p=0.035).Conclusions. Patients with AHF classes III and IV differ from people with HF I and II classes in the frequency of AF cases, while other concomitant diseases are present in all groups without a significant difference. Patients with MI complicated by high-grade AHF differ from the group of MI without high-grade AHF by older age, higher BMI, a longer history of hypertension, and a higher frequency of AF and COPD. Stable angina pectoris in the anamnesis is noted more often in persons without high gradation of AHF.

Identification of patient subtypes based on protein expression for prediction of heart failure after myocardial infarction

This study investigates the ability of high-throughput aptamer-based platform to identify circulating biomarkers able to predict occurrence of heart failure (HF), in blood samples collected during hospitalization of patients suffering from a firstmyocardial infarction (MI). REVE-1 (derivation) and REVE-2 (validation) cohorts included respectively 254 and 238 patients, followed up respectively 9·2± 4 · 8 and 7 · 6± 3 · 0 years. A blood sample collected during hospitalization was used for quantifying 4,668 proteins. Fifty proteins were significantly associated with long-term occurrence of HF with all-cause death as the competing event. k-means, an unsupervised clustering method, identified two groups of patients based on expression levels of the 50 proteins. Group 2 was significantly associated with a higher risk of HF in both cohorts. These results showed that a subset of 50 selected proteins quantified during hospitalization of MI patients is able to stratify and predict the long-term occurrence of HF.

Effect of Smoking Cessation on Left Ventricular Ejection Fraction after Acute ST Elevation Myocardial Infarction.

Acute Myocardial Infarction (AMI) is the leading cause of global mortality. Moreover, Left Ventricular Ejection Fraction (LVEF) is the most important predictor of post-AMI mortality. Thus, the present study aimed to investigate the relationship between smoking cessation and LVEF following one year from the STEMI. The present study was a part of the Kermanshah STEMI Registry and included 825 smokers admitted to Imam Ali Hospital, Kermanshah, Iran, with AMI during a 2-year study period. Data collection was performed using the standardized case report form by the European Observational Registry Program (EORP). Moreover, multiple logistic regression was used to compare LVEF between the patients who had quit smoking post-AMI and those who were still smokers after one year. Also, one-to-one Propensity Score Matching (PSM) was used to reduce the assessment error and selection bias, increase the result accuracy, and minimize the effects of confounders on the LVEF-smoking relationship. Following one year after AMI, 219 (26.55%) patients had quit smoking, while 606 (73.45%) still smoked. Using the PSM, a total of 168 ex-smokers were matched to 168 current smokers. Moreover, it was shown that LVEF was higher in current smokers compared to ex-smokers. However, the difference was not significant. Also, multiple logistic regression showed that the Odds Ratio (OR) of LVEF reduction was insignificantly higher in ex-smokers (OR=1.13; 95% CI: 0.98-1.29) compared to current smokers. Multivariate regression analysis found similar results even after the application of PSM (OR = 1.02; 95% CI: 0.82-1.22). Given the low rate of smoking cessation after MI, physicians are recommended to ask about the smoking status of MI patients at each office visit or re-admission and strongly recommend quitting smoking.

Atherosclerotic patients with diabetes mellitus may break through the threshold of healthy TMAO levels formed by long-term statins therapy

BackgroundCardiovascular disease (CVD) is the leading course of disease-related death in both developed and developing countries. Atherosclerosis is main pathology of CVD, and its severity is thought to be related to trimethylamine N-oxide (TMAO) level in plasma. Therefore, it is necessary to deeply understand the synergistic patterns between TMAO and other contribution variables to atherosclerosis, allowing for effective and timely monitoring or intervention. MethodsA total of 359 participants were recruited in our study, including 190 atherosclerosis patients, 82 MI or stroke patients, 68 non-atherosclerosis controls and 19 healthy controls. Information on their risk associated with atherosclerosis and plasma TMAO concentration were collected. LASSO regression, multivariate analysis and univariate analysis were then performed to confirm the correlation between TMAO level and risk factors of atherosclerosis. ResultsCompared to patients and non-atherosclerosis controls, healthy participants had a normal BMI range (lower than 24), lower triglyceride concentration, and healthy lifestyle habits (no smoking and low salt diet). However, under backgrounds of statins treatment and balanced dietary preferences, TMAO levels were not significantly different among patients, non-atherosclerosis controls and healthy controls. Using LASSO regression model, four indicators was identified to have contribution to TMAO levels, including diabetes, atherosclerosis, low-density lipoprotein and total cholesterol. Subsequent univariate analysis further confirmed that the presence or absence of diabetes had a decisive effect on patients' plasma TMAO levels, even though they had been taking statin lipid-lowering drugs for a long time. ConclusionDiabetics have abnormally high plasma TMAO levels even under continuous statins treatment, which may contribute to the development and progression of atherosclerosis. Therefore, it is necessary to focus on monitoring TMAO levels in diabetic patients to reduce adverse cardiovascular events in diabetic patients.

Effects of β-blockers on all-cause mortality in patients with diabetes and coronary heart disease: A systematic review and meta-analysis.

Beta-blockers have been considered as an effective treatment in secondary prevention of coronary heart disease (CHD). However, there is still disputed whether β-blockers can increase all-cause mortality in patients with coronary heart disease and diabetes mellitus (DM). Here, our systematic review and meta-analysis is aiming to assess the effects of β-blockers on all-cause mortality in patients with coronary heart disease and diabetes mellitus. Four databases (PubMed, Embase, Cochrane Library and Web of Science) and other sources were searched to collect randomized controlled trials (RCTs) and cohort studies related to the treatment of β-blockers for coronary heart disease and diabetes mellitus patients. We further evaluated quality of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Finally, a total of 16,188 records were identified, and four randomized controlled trials and six cohort studies (206,490 patients) were included. Random effects analysis revealed that β-blockers combined with routine treatment (RT) significantly decreased all-cause mortality in patients with coronary heart disease and diabetes mellitus compared with RT in control group (RR 0.59, 95% CI 0.47 to 0.75; p < 0.000 01; I2 = 72%). Subgroup analysis of all-cause mortality by the subtype of diabetes mellitus and definite MI patients (RR 0.54, 95% CI 0.45 to 0.65, p < 0.000 01, I2 = 29%) and the subtype of randomized controlled trials (RR 0.49, 95% CI 0.32 to 0.76, p = 0.001, I2 = 0%) indicated a relatively small heterogeneity and stable results. β-blockers application significantly reduced cardiovascular death as well (RR 0.56, 95% CI 0.42 to 0.74; p < 0.000 1; I2 = 0%). Our meta-analysis provided critical evidence of β-blockers treatment for patients with coronary heart disease (especially MI type) and diabetes mellitus, and discussed the advantages and potential metabolic risks for the clinical use of β-blockers. This study suggested that β-blockers application may improve all-cause mortality and cardiovascular death in coronary heart disease (especially MI type) and diabetes mellitus patients. However, given a small number of included studies, the aforementioned conclusion should be confirmed in a multi-center, large-scale, and strictly designed trial.

Evaluation of an Association of Thyroid Disorder and Dyslipidemia in Patients with Cardiovascular Disease: A Cross-sectional Study

Background: Subclinical Hypothyroidism (SCH) is defined as normal serum free thyroid hormone levels coexisting with elevated serum Thyroid-Stimulating Hormone (TSH) levels. SCH is a common condition observed in clinical practice with several unique features. The present study was conducted to find prevalence of subclinical hypothyroidism in patients with myocardial infarction and demographic differences between patients with and without SCH. Materials and Methods: A total of 100 patients with Myocardial Infarction of Adult (age &gt; 18 years) males and females were selected from the patients attending Medicine OPD, IPD or Intensive Care Unit (ICU) in GMC, Azamgarh. Clinical examination, laboratory investigations for myocardial infarction, thyroid status and lipid profile was done in all patients in our study. All Patients with TSH values &gt; 10mU/L or &lt; 0.04mU/L or Known cases of Thyroid abnormalities were excluded from the study. Statistical analysis was done using excel and SPSS software. Results: Out of 100 patients 44 patients of MI had subclinical hypothyroid were as rest 56 patients were euthyroid. In both the groups no statistical difference was seen in the type of Myocardial infarction. There was significant difference in lipid profile (p&lt;0.05) in SCH group as compared to euthyroid group. Conclusion: Patients with Subclinical hypothyroid and MI had more lipid abnormalities as compared to Euthyroid group although the type of myocardial infarction was similar in both the groups. Males had more myocardial infarction as compared to females in both the subclinical hypothyroid and euthyroid groups.

Predicting complications of myocardial infarction within several hours of hospitalization using data mining techniques

Myocardial Infarction, commonly known as heart attack, is an extremely dangerous condition caused by inadequate blood flow to the heart. It is a major cause of death worldwide and swift appropriate actions need to be taken after hospitalization to save a patient's life. Clinicians need to be extremely cautious in handling such situations. A decision-support system predicting the risk in MI patients can be quite beneficial to clinicians. In this study, we develop such a system to predict the complications in MI patients immediately after hospitalization. In that regard, we utilized a dataset containing the records of 1700 MI patients. Class imbalance is a major concern in most medical datasets as it biases the predictions of the ML algorithms towards the majority (negative) class. Appropriate measures need to be taken to address the imbalance scenario and develop a reliable prediction system. In that regard, we propose a new approach that combines sampling techniques with cost-sensitive learning. The advantage of this hybrid approach is that it reduces the number of minority class samples required to be generated or the number of majority class samples needed to be eliminated to obtain balance. Additionally, it reduces the weight to be assigned as the penalty for the cost-sensitive classifier. The complications associated with using sampling or cost-sensitive learning separately are reduced by using this kind of hybridization. We hypothesize that a suitable balance between the two approaches can optimize the prediction performance. The proposed approach performed significantly better than both traditional sampling techniques and cost-sensitive learning. The highest ROC-AUC score of 80.88% and MCC score of 66.53% were achieved using this approach. External validation was also performed on 36 imbalanced datasets and the proposed methodology outperformed other popular techniques used in imbalanced learning. Thus, the prediction framework presented in this study can ensure reliable risk prediction of MI patients at an early stage of hospitalization which can be quite beneficial to clinicians in the decision-making process.

IMPACT OF EARLY EXERCISE-BASED CARDIAC REHABILITATION ON HOSTILITY, ITS BEHAVIORAL COMPONENTS AND DISEASE PERCEPTION IN PATIENTS AFTER MYOCARDIAL INFARCTION.

Aim: Hostility and its behavioral components, anger and aggression are psychosocial risk factors for coronary heart disease. The purpose of the study was to evaluate the effectiveness of physical training on the level of negative emotions, the cognitive aspect of adaptation to disease and physical capacity in patients after MI who participated in cardiac rehabilitation. Materials and Methods: We enrolled 60 post-MI men and women in the study. They underwent an 8-week training program. Before and after completion of trainings patients underwent exercise test and a psychological examination.The Buss-Perry Aggression Questionnaire and the Brief Illness Perception Questionnaire were performed with results analysis in the entire group and in subgroups of men, women, patients under 60 years of age (younger) and over 60 years of age (older). Results: After rehabilitation a significant reduction in the general level of negative emotions was found in younger: 67.8±4.6 vs 63.9±3.7 points (p< 0.01). Similarly, a significant reduction in the sense of the impact of the disease on life was found only in younger 6.96±0.5 vs 5.48±0.5 points (p<0.01). There was a significant improvement in overall adaptation to the disease in women from 40.6±2.2 to 35.7±1.9 points (p < 0.05).Moreover,patients with higher levels of negative emotions had more difficulty adapting to the disease r=0.361, p<0.01. Physical capacity increased significantly in all groups. Conclusions: Participating in cardiac rehabilitation improved physical capacity, beneficially contributed to a decrease in negative emotions and had a positive effect on disease adaptation but only in younger post -MI patients.

Hematological parameters and early-onset coronary artery disease: a retrospective case-control study based on 3366 participants.

Thrombosis and inflammation are crucial elements in the pathogenesis of cardiovascular disease. Hematological parameters elucidate information involving the inflammatory and blood coagulation processes. The current study explored the association of hematological parameters with EOCAD to identify specific risk factors. A single-center retrospective case-control study was conducted with 1693 coronary artery disease patients and 1693 controls. Hematological parameters were examined through an automated analyzer. The basophil percentage was significantly reduced in EOCAD (0.43 ± 0.26, p < 0.001) and MI (0.33 ± 0.24, p < 0.001) groups compared with controls (0.54 ± 0.28). The eosinophil percentage was also significantly lower in EOCAD (2.21 ± 1.71, p < 0.001) and MI (1.71 ± 2.44, p < 0.001) groups compared with controls (2.41 ± 1.75). The lymphocyte percentage in patients of EOCAD and MI and controls was 31.65 ± 7.93, 25.48 ± 9.43, and 34.82 ± 7.28, respectively. A significant difference was observed among the groups (p < 0.001). Except for the mean corpuscular hemoglobin (MCH), other red blood cell (RBC) parameters significantly differed between EOCAD patients and controls. The red blood cell distribution width (RDW), hematocrit (HCT), RBC count, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), and hemoglobin level were associated with EOCAD prevalence after adjusting for baseline differences. Platelet volume distribution width (PDW) also correlated with EOCAD prevalence (ORadjust = 1.087, 95% CI: 1.044-1.131). Hematological parameters are closely associated with EOCAD. Moreover, leukocyte parameters correlated with the presence and severity of the disease. In addition, erythrocyte parameters were associated with the disease presence but not with the disease severity. Among the platelet parameters, only PDW was related to the disease presence.

Identification of the metabolic state of surviving cardiomyocytes in the human infarcted heart by spatial single-cell transcriptomics.

A spatial scRNA-seq dataset was used to compare the genetic profiles of CM from patients with MI and control patients; we analyzed the metabolic adaptations of surviving CM within the ischemic niche. A standard pipeline in Seurat was used for data analysis, including normalization, feature selection, and identification of highly variable genes using principal component analysis (PCA). Harmony was used to remove batch effects and integrate the CM samples based on annotations. Uniform manifold approximation and projection (UMAP) was used for dimensional reduction. The Seurat "FindMarkers" function was used to identify differentially expressed genes (DEGs), which were analyzed by the Gene Ontology (GO) enrichment pathway. Finally, the scMetabolism R tool pipeline with parameters method = VISION (Vision is a flexible system that utilizes a high-throughput pipeline and an interactive web-based report to annotate and explore scRNA-seq datasets in a dynamic manner) and metabolism.type = Kyoto Encyclopedia of Genes and Genomes (KEGG) was used to quantify the metabolic activity of each CM. Analysis of spatial scRNA-seq data showed fewer surviving CM in infarcted hearts than in control hearts. GO analysis revealed repressed pathways in oxidative phosphorylation, cardiac cell development, and activated pathways in response to stimuli and macromolecular metabolic processes. Metabolic analysis showed downregulated energy and amino acid pathways and increased purine, pyrimidine, and one-carbon pool by folate pathways in surviving CM. Surviving CM within the infarcted myocardium exhibited metabolic adaptations, as evidenced by the downregulation of most pathways linked to oxidative phosphorylation, glucose, fatty acid, and amino acid metabolism. In contrast, pathways linked to purine and pyrimidine metabolism, fatty acid biosynthesis, and one-carbon metabolism were upregulated in surviving CM. These novel findings have implications for the development of effective strategies to improve the survival of hibernating CM within the infarcted heart.

Association of Increased Oncostatin M with Adverse Left Ventricular Remodeling in Patients with Myocardial Infarction

Background: Myocardial infarction is the leading cause of death worldwide. Patients suffering from myocardial infarction with a ST-elevated segment termed as STEMI experience high risk of death and these patients report recurrent attacks even more as compared to other MI patients. Objective: The goal of this study was to check that either oncostatin M (OSM) can be used as a biomarker for the evaluation of myocardial infarction Study design: This control-experimental study was conducted in Biochemistry department of the Islam Medical College, Sialkot. Materials and methods: The study included 35 STEMI patients admitted in hospital, their oncostatin M level after 24 h of the onset of disease was calculated. The oncostatin M level after 6 months was later on analyzed. Electrocardiography was performed for all patients. The serum level was studied properly to look for level of biomarkers. The review board and ethical committee of the hospital approved the study. Results: OSM level was increased after 24h of the onset of the disease. There was reduction in the level of OSM when measured after 6 months but still the levels suggested that OSM was detectable in the serum and can be used as a biomarker for myocardial infarction. Conclusion: High levels of OSM in the serum after 24h can be attributed to its link with development of adverse LV remodeling among patients suffering from myocardial infarction. The OSM levels were decreased eventually but it was still high even after 6 months of the onset. Keywords: CAD, oncostatin M, myocardial infarction, STEMI

The Effect of Protease-Activated Receptor-1 (PAR-1) Inhibition on Endothelial-Related Biomarkers in Patients with Coronary Artery Disease.

Vorapaxar has been shown to reduce cardiovascular mortality in post-myocardial infarction (MI) patients. Pharmacodynamic biomarker research related to protease-activated receptor-1 (PAR-1) inhibition with vorapaxar in humans has short follow-up (FU) duration and is mainly focused on platelets rather than endothelial cells. This article assesses systemic changes in endothelial-related biomarkers during vorapaxar treatment compared with placebo at 30 days' FU and beyond, in patients with coronary heart disease. Local substudy patients in Norway were included consecutively from two randomized controlled trials; post-MI subjects from TRA2P-TIMI 50 and non-ST-segment elevation MI (NSTEMI) patients from TRACER. Aliquots of citrated blood were stored at -80°C. Angiopoietin-2, angiopoietin-like 4, vascular endothelial growth factor, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, von Willebrand factor, thrombomodulin, and plasminogen activator inhibitor-1 and -2 were measured at 1-month FU and at study completion (median 2.3 years for pooled patients). A total of 265 consecutive patients (age median 62.0, males 83%) were included. Biomarkers were available at both FUs in 221 subjects. In the total population, angiopoietin-2 increased in patients on vorapaxar as compared with placebo at 1-month FU (p = 0.034). Angiopoietin-like 4 increased (p = 0.028) and plasminogen activator inhibitor-2 decreased (p = 0.025) in favor of vorapaxar at final FU. In post-MI subjects, a short-term increase in E-selectin favoring vorapaxar was observed, p = 0.029. Also, a short-term increase in von Willebrand factor (p = 0.032) favoring vorapaxar was noted in NSTEMI patients. Significant endothelial biomarker changes during PAR-1 inhibition were observed in post-MI and NSTEMI patients.

Hypothetical interventions on emergency ambulance and prehospital acetylsalicylic acid administration in myocardial infarction patients presenting without chest pain

BackgroundMyocardial infarction (MI) patients presenting without chest pain are a diagnostic challenge. They receive suboptimal prehospital management and have high mortality. To elucidate potential benefits of improved management, we analysed expected outcome among non-chest pain MI patients if hypothetically they (1) received emergency ambulances/acetylsalicylic acid (ASA) as often as observed for chest pain patients, and (2) all received emergency ambulance/ASA.MethodsWe sampled calls to emergency and non-emergency medical services for patients hospitalized with MI within 24 h and categorized calls as chest pain/non-chest pain. Outcomes were 30-day mortality and a 1-year combined outcome of re-infarction, heart failure admission, and mortality. Targeted minimum loss-based estimation was used for all statistical analyses.ResultsAmong 5418 calls regarding MI patients, 24% (1309) were recorded with non-chest pain. In total, 90% (3689/4109) of chest pain and 40% (525/1309) of non-chest pain patients received an emergency ambulance, and 73% (2668/3632) and 37% (192/518) of chest pain and non-chest pain patients received prehospital ASA. Providing ambulances to all non-chest pain patients was not associated with improved survival. Prehospital administration of ASA to all emergency ambulance transports of non-chest pain MI patients was expected to reduce 30-day mortality by 5.3% (CI 95%: [1.7%;9%]) from 12.8% to 7.4%. No significant reduction was found for the 1-year combined outcome (2.6% CI 95% [− 2.9%;8.1%]). In comparison, the observed 30-day mortality was 3% among ambulance-transported chest pain MI patients.ConclusionsOur study found large differences in the prehospital management of MI patients with and without chest pain. Improved prehospital ASA administration to non-chest pain MI patients could possibly reduce 30-day mortality, but long-term effects appear limited. Non-chest pain MI patients are difficult to identify prehospital and possible unintended effects of ASA might outweigh the potential benefits of improving the prehospital management. Future research should investigate ways to improve the prehospital recognition of MI in the absence of chest pain.

220 MANAGING CARDIAC ARREST SECONDARY TO SPONTANEOUS CORONARY ARTERY DISSECTION: SHOULD WE ROUTINELY CONSIDER ICD IMPLANTATION?

Abstract Introduction Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represents a challenging scenario. It deserves specific considerations due to the dramatic presentation and the need for secondary sudden cardiac death prevention. Methods We collected clinical data of four women admitted during the last two years in the Coronary Care Unit of Parma University Hospital, whose presentation of SCAD were cardiac arrest due to ventricular fibrillation. Results Three patients survived the acute phases. One patient, being considered at high risk of SCAD recurrence, received a subcutaneous implantable cardioverter-defibrillator (S-ICD). Acute management of cardiac arrest related to SCAD deserves specific considerations. Our case series illustrates the importance of prompt resuscitation manoeuvres and early defibrillation. We propose a flow chart of management of cardiac arrest in patient with suspect of SCAD. Evaluating risk of SCAD recurrence and sudden cardiac death The management of SCAD patients complicated by malignant ventricular arrhythmias and cardiac arrest is challenging. Looking at published registries, it appears that SCAD patients are more likely to suffer from ventricular arrythmia or sudden cardiac death than non-SCAD MI patients. The risk-benefit ratio of ICD implantation in these patients remain uncertain . Evaluation of scar burden with CMR can help stratify the global arrhythmic risk, especially as extensive myocardial scar with a residual impaired LVEF increases the risk of future arrhythmic events. In our series, only one patient underwent S-ICD implantation, and the decision was mainly driven by the finding of underlying arteriopathy affecting other vascular territories, suggesting a potentially higher rate of SCAD recurrence. For this particular subset of patients, we propose an algorithm that combines predisposing factors and myocardia injury quantification data that could be useful for the estimate of the risk of malignant arrythmias, as well as the risk of recurrence of SCAD, but needs to be validated in larger case studies. Conclusions The acute management of cardiac arrest related to SCAD deserves specific consideration. The residual myocardial damage, predisposing and precipitants factors should be evaluated in order to estimate the SCAD recurrence and sudden cardiac death risks.

Need for home care or nursing home admission after myocardial infarction complicated by cardiogenic shock and/or out-of-hospital cardiac arrest.

Myocardial infarction (MI) with cardiogenic shock (CS) and/or out-of-hospital cardiac arrest (OHCA) are conditions with potential loss of autonomy. In patients with MI, the association between CS and OHCA and need for home care or nursing home admission was examined. Danish nationwide registries identified patients with MI (2008-19), who prior to the event lived at home without home care and discharged alive. One-year cumulative incidences and hazard ratios (HRs) were reported for home care need or nursing home admission, a composite proxy for disability in activities of daily living (ADL), along with all-cause mortality. The study population consisted of 67109 patients with MI (by groups: -OHCA/-CS: 63644; -OHCA/+CS: 1776; +OHCA/-CS: 968; and +OHCA/+CS: 721). The 1-year cumulative incidences of home care/nursing home were 7.1% for patients who survived to discharge with -OHCA/-CS, 20.9% for -OHCA/+CS, 5.4% for +OHCA/-CS, and 8.2% for those with +OHCA/+CS. The composite outcome was driven by home care. With the -OHCA/-CS as reference, the adjusted HRs for home care/nursing home were 2.86 (95% CI: 2.57-3.19) for patients with -OHCA/+CS; 1.31 (95% CI: 1.00-1.73) for+OHCA/-CS; and 2.18 (95% CI: 1.68-2.82) for those with +OHCA/+CS. The 1-year cumulative mortality were 5.1% for patients with -OHCA/-CS, 9.8% for -OHCA/+CS, 3.0% for +OHCA/-CS, and 3.4% for those with +OHCA/+CS. In patients discharged alive after a MI, CS, and to a lesser degree OHCA were associated with impaired ADL with a two-fold higher 1-year incidence of home care or nursing home admission compared with MI patients without CS or OHCA.

Beta-blockers after myocardial infarction with preserved systolic function: useful or redundant?

Given the lack of adequately sized randomized clinical trials (RCTs) testing the value of maintenance beta-blockers for post-myocardial infarction (MI) patients without reduced left ventricular ejection fraction and treated according to current standards, several observational studies have tried to address this highly relevant issue. However, results from observational studies have yielded opposite conclusions, with some suggesting that beta-blockers are associated with clinical benefit and others suggesting that they have no benefit. Due to the observational nature of these studies, the risk of bias is very high. In particular the existence of a confounding by indication factor is present when the prescription of the therapy is not random and is instead based on patients' clinical characteristics. Some randomness is needed to ensure that individuals with identical characteristics can be observed in both states (with or without beta-blockers). The only chance, therefore, to solve the question of benefits of beta-blockers is the execution of adequately sized RCTs. Currently, four large RCTs are ongoing in Europe, and, among them, the REBOOT-CNIC trial is already beyond three quarters of the expected cohort to be enrolled (6000/8648 revascularized MI patients without left ventricular dysfunction). An Italian cohort (1800 patients) will be included, enrolled by the Italian REBOOT Network. Enrollment is expected to be complete by the end of 2022, and the first results will become available by the end of 2025.

Assessment of asprosin level and some of physiological variables in patients with cardiovascular diseases in Kirkuk city, Iraq

Introduction and Aim: Asprosin is a novel fasting-induced glucogenic adipokine, which stimulates the liver to release glucose into the blood stream. The aim of this study was to examine the role of asprosin as well as various physiological and oxidative stress factors in atherosclerosis and myocardial infarction patients in comparison to healthy controls in Kirkuk city, in order to clarify whether asprosin helps in protecting heart and preventing heart disease. Materials and Methods: This study included blood samples collected from patients (n=70) and normal healthy controls (n=20), aged between 45-65 years from the Kirkuk General Hospital and external specialized clinical between December 2021 to February 2022. The samples were divided into three groups which included healthy controls (n=20), patients suffering from atherosclerosis (n=40) and myocardial infarction (n=30) respectively. Individuals in all groups were tested for their blood ASP, CPK-BM Tnt and lipid profile levels. Blood serum was also tested for concentration of FBS, INS, HbA1c, MDA and GSH. Results: The asprosin, CPK-BM, Cardiac troponin (TNt) and INS levels was observed to be significantly elevated in atherosclerosis patients in comparison to healthy controls. However, in myocardial infarction patients significant increase levels was seen only for CPK-BM and INS levels. Lipid profiling showed that except for HDL levels, significant increased levels for TC, TG, LDL and VLDL in both atherosclerosis and MI patients as compared to healthy individuals. The concentration of FBS was seen elevated in blood serum of atherosclerosis and MI patients in comparison to controls. No significant increase was observed for HbA1c and oxidative stress hormones MDA and GSH). Conclusion: Changes in asprosin levels in patients with cardiovascular disease could be considered as a biochemical marker to estimate the severity of injury in heart and heart muscles.

DenseNet-based transfer learning for LV shape Classification: Introducing a novel information fusion and data augmentation using statistical Shape/Color modeling

PurposeMyocardial infarction (MI) causes the left ventricle (LV) remodeling. Statistical shape modeling (SSM) can provide valuable and reliable information about the changes in the shape and functional patterns of the LV after MI. On the other hand, classification and detection tasks using transfer learning by popular pre-trained convolutional neural networks (CNNs) using a large dataset recently presented considerable results. The current study introduces an innovative hybrid approach for MI detection that combines the benefits of 3D and 3D + t shape information using SSM with the power of utilizing transfer learning by previously trained CNNs. MethodsIn this study, we employed a dataset provided for the MI classification challenge using SSM in the form of 3D surface points. We proposed to convert these 3D points as different projections per view (PPV) on the x-y, x-z, and y-z planes. Besides, additional 3D and 3D + t dedicated information, i.e., thickness and displacement were added in color on 2D PPVs. We also proposed two augmentation strategies for shape and color based on the SSM concept. Given the optimal combination of the PPVs and colors, our prepared 2D images were fed into the DenseNet-121, DenseNet-169, and DenseNet-201, independently. Four different fine-tuning scenarios (i.e., scenario-I to scenario-IV) were investigated, compared, and optimized to distinguish MI patients from healthy subjects. ResultsThe experimental results evaluated the performance of the different transfer learning scenarios in MI detection. The results demonstrated that the optimized DenseNet-201-Scenario-II achieved the best performance with the accuracy, sensitivity, specificity, precision, F1-score of 0.942 ± 0.039, 0.899 ± 0.060, 1.000 ± 0.000, 1.000 ± 0.000, and 0.946 ± 0.034, respectively in the MI detection task. ConclusionThe promising results prove that combining the use of images with information fusion, the power of the SSM concept in the augmentation process, and the benefits of transfer learning using CNNs, leads to developing a complementary and automatic MI diagnosis tool that can be extended to other diagnostic applications in the future.