Myocardial Injury In Patients Research Articles

Evidence of autoinflammation as a principal mechanism of myocardial injury in SARS-CoV-2 PCR-positive medical examiner cases

BackgroundDisease from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) remains the seventh leading cause of death in the United States. Many patients infected with this virus develop later cardiovascular complications including myocardial infarctions, stroke, arrhythmia, heart failure, and sudden cardiac death (20–28%). The purpose of this study is to understand the primary mechanism of myocardial injury in patients infected with SARS-CoV-2.MethodsWe investigated a consecutive cohort of 48 medical examiner cases who died with PCR-positive SARS-CoV-2 (COVpos) infection in 2020. We compared them to a consecutive cohort of 46 age- and sex-matched controls who were PCR-negative for SARS-CoV-2 (COVneg). Clinical information available at postmortem examination was reviewed on each patient. Formalin-fixed sections were examined using antibodies directed against CD42 (platelets), CD15 (myeloid cells), CD68 (monocytes), C4d, fibrin, CD34 (stem cell antigen), CD56 (natural killer cells), and myeloperoxidase (MPO) (neutrophils and neutrophil extracellular traps(NETs)). We used a Welch 2-sample T-test to determine significance. A cluster analysis of marker distribution was also done.ResultsWe found a significant difference between COVpos and COVneg samples for CD42, CD15, CD68, C4d, fibrin, and MPO, all of which were significant at p < 0.001. The most prominent features were neutrophils (CD15, MPO) and MPO-positive debris suggestive of NETs. A similar distribution of platelets, monocytes, fibrin and C4d was seen in COVpos cases. Clinical features were similar in COVpos and COVneg cases for age, sex, and body mass index (BMI).ConclusionThese findings suggest an autoinflammatory process is likely involved in cardiac damage during SARS-CoV-2 infection. No information about clinical cardiac disease was available.

Possible effect of the early administration of tranexamic acid on myocardial injury in patients with severe trauma

Hemodynamic stabilization plays a crucial role in the treatment of patients suffering from severe trauma. Current guidelines recommend the early administration of tranexamic acid (TXA) for bleeding control. While less blood loss can result in less end-organ damage, including myocardial injury, TXA also exhibits prothrombotic effects with potentially adverse myocardial effects. The aim of this study was to investigate the association between the administration of TXA and myocardial injury in patients with severe trauma. We conducted a monocentric cohort study including severely injured patients ≥ 18 years [defined by Injury severity score (ISS) ≥ 16], who were admitted to a tertiary care hospital between 2016 and 2019. Primary outcome measure was myocardial injury according to the fourth Universal Definition (= high sensitive troponin T ≥ 14 ng/l). Secondary endpoints were in-hospital major adverse cardiovascular events (MACE) and mortality. Main exposure was defined as administration of TXA during prehospital period. We conducted multivariate logistic regression models including predefined covariables. A total of 368 patients were screened. Among the 297 included patients (72% male, age. 55?21 years), 119 (40%) presented myocardial injury at hospital arrival. TXA was administered to 20/297 (7%) patients in the prehospital setting, and in 96/297 (32%) patients during pre-or in-hospital period. MACE incidence was 9% (26/297) and in-hospital mortality was 26% (76/297). The adjusted odds ratios (OR) for prehospital TXA and myocardial injury, MACE and mortality were 0.75 [95% confidence interval (CI): 0.25–2.23], 0.51 [95%CI: 0.06–4.30] and 0.84 [0.21–3.33], respectively. In the present cohort of patients suffering from severe trauma, prehospital TXA did not affect the incidence of myocardial injury.

Myocardial injury and related mortality in hospitalized patients with COVID-19 during the Omicron pandemic: new perspectives and insights

Myocardial injury is one of the most common comorbidity in SARS-CoV-2 infected patients, and has poor prognosis. However, the incidence of myocardial injury in patients with SARS-CoV-2 infection has not been sufficiently investigated during the Omicron wave. We conducted a retrospective study of 2690 patients with confirmed SARS-CoV-2 Omicron infection from Tongji Hospital. The results indicated that the myocardial injury accounted for 30.8% of the total patients with SARS-CoV-2 infection and was associated with higher in-hospital mortality than those without injury before and after propensity score matching (PSM) [adjusted hazard ratio (HR), 10.61; 95% confidence interval (CI), 7.76–14.51; P ​< ​0.001; adjusted HR, 2.70; 95% CI, 1.86–3.93; P ​< ​0.001; respectively]. Further, the levels of cytokines (IL-1β, IL-6, IL-10, and TNF-α) in patients with myocardial injury were higher than those without injury, and the higher levels of cytokines in the myocardial injury group were associated with increased mortality. Administration of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) could significantly reduce the mortality in patients with myocardial injury (adjusted HR, 0.52; 95% CI, 0.38–0.71; P ​< ​0.001). Additionally, the level of angiotensin II increased in patients with SARS-CoV-2 infection was even higher in myocardial injury group compared to those without injury. Collectively, the study summarized the clinical characteristic and outcome of SARS-CoV-2 infected patients with myocardial injury during the Omicron wave in China, and validated the protective role of ACEI/ARB in improving the survival of those with myocardial injury.

Perioperative myocardial injury in patients with coronary artery disease during elective lower limb surgery

Aim. To assess the prevalence of ischemic myocardial injury and the cardioprotective effect of nicorandil by assessing high-sensitivity cardiac troponin (hs-cTn) in patients with stable coronary artery disease (CAD) during elective lower limb surgery, as well as to identify predictors of adverse cardiac events.Material and methods. The study included 70 patients with stable coronary artery disease hospitalized for elective autogenous femoropopliteal bypass (FPB) surgery. After randomization, all patients were divided into two following groups: control group — 35 patients; main group — 35 patients, who, in addition to standard therapy, were prescribed nicorandil (Cordinic, PIQ-PHARMA) in a single dose of 20 mg 2 hours before surgery. In the postoperative period, the incidence of myocardial injury was assessed by hs-cTn increase. The obtained primary data were subjected to mathematical processing using the R-Studio software package (R language).Results. At baseline, patients in both groups were comparable in clinical characteristics, therapy, and duration of vascular surgery. In the main group of patients receiving nicorandil, a significant decrease in the incidence of perioperative myocardial injury was noted. In 5 patients of the control group, hs-cTn level 24 hours after surgery exceeded the threshold value, which indicated myocardial injury in the early postoperative period. In the nicorandil group, there was no hs-cTn increase (14% vs 0%, p=0,027). Regression analysis identified a predictor of perioperative myocardial injury — left ventricular ejection fraction (LVEF) &lt;50%. LVEF &lt;50% increases the risk of myocardial injury in the early postoperative period by 7,36 times (p=0,04) and 9,15 times (p=0,048) according to univariate and multivariate regression analysis, respectively.Conclusion. Perioperative myocardial injury is a common complication in patients with CAD undergoing lower extremity revascularization. The use of nicorandil (Cordinic, PIQ-PHARMA) before elective revascularization surgery helps reduce the incidence of ischemic myocardial injury in the early postoperative period and is not accompanied by adverse reactions, which rationales this approach to improve the clinical outcomes of lower extremity revascularization in patients with stable CAD. A predictor of myocardial injury, determined by hs-cTn, is a LVEF &lt;50%.

Comparison of Incidence and Prognosis of Myocardial Injury in Patients with COVID-19-Related Respiratory Failure and Other Pulmonary Infections: A Contemporary Cohort Study.

Myocardial injury (MI) is frequent in critically ill patients with COVID-19, but its pathogenesis remains unclear. We hypothesized that MI is not solely due to viral infection by SARS-CoV-2 but rather due to the common pathophysiological mechanisms associated with severe pulmonary infections and respiratory failure. This contemporary cohort study was designed to compare the incidence of MI in patients with acute respiratory failure caused by COVID-19 to patients with other pulmonary infections. In addition, we aimed to investigate whether MI was a distinct risk factor for in-hospital mortality in patients with COVID-19 compared to those with non-COVID-19 infections. This study included 1444 patients with COVID-19 (55.5% men; age 58 (46;68) years) and 182 patients with other pulmonary infections (46.9% men; age 62 (44;73) years). The incidence of MI at ICU admission was lower in COVID-19 patients (36.4%) compared to non-COVID-19 patients (56%), and this difference persisted after adjusting for age, sex, coronary artery disease, heart failure, SOFA score, lactate, and C-reactive protein (RR 0.84 (95% CI, 0.71-0.99)). MI at ICU admission was associated with a 59% increase in mortality (RR 1.59 (1.36-1.86); p < 0.001), and there was no significant difference in the mortality between patients with COVID-19 and those with other pulmonary infections (p = 0.271). We concluded that MI is less frequent in patients with critical COVID-19 pneumonia and respiratory failure compared to those with other types of pneumonia. The occurrence of MI is a significant risk factor for in-hospital mortality, regardless of the etiology of the pulmonary infection.

Risk Factors and Patterns of Myocardial Injury in Patients with COVID-19: A Single-Centre Cohort Study

Objective: The primary objective was to compare the risk factors and trends of patients with COVID-19 with and without biochemical evidence of myocardial injury. Secondary objectives were the duration of hospitalisation, admission to an intensive care unit, mode of resuscitation, and use of supplemental O2. Design, and place and duration of study: This retrospective cohort study was conducted at Shifa International Hospitals, Islamabad, Pakistan. The study was conducted from May 2021–May 2022. Methodology: 113 patients admitted with a confirmed diagnosis of COVID-19 and troponin-I investigation were included in the study. Patients were divided into two groups: with and without myocardial injury on admission. Demographics, symptoms, diagnostics, vitals, comorbidities, and outcomes were noted. The χ2 exact test for categorical variables and independent t-test for continuous variables were used. All statistical analyses were performed with SPSS Statistics®, version 26.0 (IBM®, Armonk, New York, USA), with 0.05 as a level of significance. Results: Out of 113 patients, 47 patients (42%) had no myocardial injury on admission. The mean age of the patients was 63 years. Patients with myocardial injury were older, male, and unvaccinated against COVID-19 (p&lt;0.01). No vital signs or presenting symptoms were statistically significant for myocardial injury. A comorbidity of hypertension on admission was suggestive of myocardial damage. Patients with myocardial injury had a higher risk of requiring resuscitation by cardiopulmonary resuscitation or pharmacologic means. Conclusion: Patients with myocardial injury did not have any impact on the composite of secondary outcomes, such as the duration of hospitalisation, admission to an intensive care unit, and use of supplemental O2.

Impact of Serum Free Triiodothyronine level in Predicting the Degree of Myocardial Injury In Patients With Acute ST Segment Elevation Myocardial Infarction

Impact of Serum Free Triiodothyronine level in Predicting the Degree of Myocardial Injury In Patients With Acute ST Segment Elevation Myocardial Infarction

TCT-177 Impact of Pericoronary Adipose Tissue Attenuation on Periprocedural Myocardial Injury in Patients With Chronic Coronary Syndrome

TCT-177 Impact of Pericoronary Adipose Tissue Attenuation on Periprocedural Myocardial Injury in Patients With Chronic Coronary Syndrome

Cardiac magnetic resonance imaging in patients with history of COVID-19

BACKGROUND: Myocarditis is among the most common complications arising from coronavirus infection (COVID-19).&#x0D; AIM: This study aims to find the differences in the patterns of myocardial injury between patients who had COVID-19 and those from the pre-pandemic period, as determined by contrast-enhanced cardiac magnetic resonance imaging.&#x0D; MATERIALS AND METHODS: The study encompassed a retrospective analysis of 47 patients who underwent contrast-enhanced cardiac magnetic resonance imaging to rule out acute myocarditis. Group 1 comprised 34 patients with a confirmed history of COVID-19 through PCR testing (nasal and/or throat swabs), while Group 2 comprised 13 individuals who underwent contrast-enhanced cardiac magnetic resonance imaging in 2017 prior to the onset of the COVID-19 pandemic. All patients enrolled in the study had clinical manifestation of cardiac injury without signs of coronary artery disease as an underlying cause of condition.&#x0D; RESULTS: The mean time from the onset of heart symptoms to the administration of contrast-enhanced cardiac magnetic resonance imaging was 166 days. In group 1, a decrease in exercise tolerance was observed in 77% of patients, and 14 (42%), 30 (88%), and 28 (85%) of patients complained of chest pain, shortness of breath, and heart palpitations, respectively. In group 2, four patients (30%) had dyspnea, nine patients (69%) complained of chest pain, and six patients (46%) had heart palpitations and/or feeling of arrhythmia. Myocardial injury in group 1 was more generalized. The third of them had displayed preserved increased pulmonary vascularity and pleural effusion. Within group 1, men had significantly lower left ventricular ejection fraction, lower values of global longitudinal deformation, and higher values of left atrial function compared with the corresponding parameters in women. Differences in women were found only in the number of the affected segments in the left ventricular myocardium.&#x0D; CONCLUSION: SARS-CoV-2 virus caused extended myocardial injury, affecting a significant number of myocardial segments. Men had more frequent postinflammatory complications, characterized by abnormal function of the left ventricle and left atrium. Obtained results require continuous efforts for further assessment of long-term consequences of previous COVID-19 to the cardiovascular system. In this regard, contrast-enhanced cardiac magnetic resonance imaging may represent a sensitive imaging tool for the assessment of cardiac injury severity.

Assessment of Extent of Myocardial Injury in Patients Undergoing Transvenous Implantation of Pacemaker Using Cardiac Troponin I (cTnI) as a Marker of Structural Heart Damage and It’s Relation to Different Sites of RV Implantation

Abstract Aim and objectives The aim of the study is to assess the extent of myocardial injury in patients undergoing trans-venous implantation of pacemaker using cardiac troponin I (cTnI) as a marker of myocardial injury and it’s relation to different sites of RV pacing and number of screwing. Patients and Methods This study included 50 patients undergoing Trans-venous Implantation of single or dual chamber permanent pacemakers at Ain Shams University Hospitals during the period from February 2020 to August 2020, divided into 2 equal groups according to the site of RV lead implantation, 25 patients RV lead implanted in the Apex and 25 patients RV lead implanted in the Septum. Results All patients had rise in Troponin I after implantation of pacemaker indicating that there is significant relationship between trans-venous implantation of permanent pacemaker and incidence of myocardial injury. Comparing the RV septal pacing group to the RV apical pacing group, results showed that septal RV pacing caused more rise in cardiac troponin I after implantation than in apical pacing group indicating that there is a significant relationship between site of RV pacing and extent of myocardial injury being more in septal RV pacing than apical RV pacing. Furthermore, our study showed that regarding active fixation of RV lead into the myocardium, increasing number of trials of screwing the lead in different sites to achieve the best pacing threshold causes more rise in cardiac troponin I. So, there is a significant relationship between number of screwing and extent of myocardial injury. Conclusion We conclude that trans-venous implantation of permanent pacemakers is associated with an increased incidence of myocardial injury and septal RV pacing is associated with more extent of myocardial injury than apical RV pacing. Also, increasing number of trials of active fixation by screwing the RV leads into the myocardium is associated with more extent of myocardial injury.

High-Sensitivity Cardiac Troponin for Risk Assessment in Patients With Chronic Coronary Artery Disease

BackgroundCardiac troponin is used for risk stratification of patients with acute coronary syndromes; however, the role of testing in other settings remains unclear. ObjectivesThe aim of this study was to evaluate whether cardiac troponin testing could enhance risk stratification in patients with chronic coronary artery disease independent of disease severity and conventional risk measures. MethodsIn a prospective cohort of consecutive patients with symptoms suggestive of stable angina attending for outpatient coronary angiography, high-sensitivity cardiac troponin I was measured before angiography, and clinicians were blinded to the results. The primary outcome was myocardial infarction or cardiovascular death during follow-up. ResultsIn 4,240 patients (age 66 years [IQR: 59-73 years], 33% female), coronary artery disease was identified in 3,888 (92%) who had 255 (6%) primary outcome events during a median follow-up of 2.4 years (IQR: 1.3-3.6 years). In patients with coronary artery disease, troponin concentrations were 2-fold higher in those with an event compared with those without (6.7 ng/L [IQR: 3.2-14.2 ng/L] vs 3.3 ng/L [IQR: 1.7-6.6 ng/L]; P < 0.001). Troponin concentrations were associated with the primary outcome after adjusting for cardiovascular risk factors and coronary artery disease severity (adjusted HR: 2.3; 95% CI: 1.7-3.0, log10 troponin; P < 0.001). A troponin concentration >10 ng/L identified patients with a 50% increase in the risk of myocardial infarction or cardiovascular death. ConclusionsIn patients with chronic coronary artery disease, cardiac troponin predicts risk of myocardial infarction or cardiovascular death independent of cardiovascular risk factors and disease severity. Further studies are required to evaluate whether routine testing could inform the selection of high-risk patients for treatment intensification. (Myocardial Injury in Patients Referred for Coronary Angiography [MICA]; ISRCTN15620297)

Alirocumab effect on preventing periprocedural ischaemic events in coronary heart disease patients undergoing coronary stenting (APPEASE trial): study protocol of a multicentre, open-label, randomised controlled trial

IntroductionPercutaneous coronary intervention (PCI)-related myocardial infarction (type 4a MI) and major periprocedural myocardial injury have been demonstrated leading to poor prognosis of patients with coronary heart disease (CHD) undergoing elective...

Cardiovascular Magnetic Resonance Assessment of Myocardial Injury in Patients Treated With Immune Checkpoint Inhibitors

Cardiovascular Magnetic Resonance Assessment of Myocardial Injury in Patients Treated With Immune Checkpoint Inhibitors

Myocard Injury in COVID-19 Patients After Application Of Umbilical Cord Mesenchymal Stem Cell (UC-MSC) as Adjuvant Therapy in Persahabatan Hospital

Background: Myocardial injury was a frequent cardiovascular manifestation of COVID-19 and associated with high mortality. Cell-based approaches, primarily using mesenchymal stem cell (MSC) has demonstrated safety and possible efficacy as adjuvant therapy in COVID-19 patients. This study aims to evaluate myocardial injury in patients with moderate-severe and critically ill COVID-19 after the application of umbilical cord mesenchymal stem cell (UC-MSC) as adjuvant therapy in Persahabatan hospital. Method: This is a retrospective and prospective cohort study. A total of 28 subjects were allocated to 13 subjects in the control and 15 subjects in the experimental group. Subjects were given the standard treatment and UC-MSC or placebo. Myocardial injury is defined by an increase of troponin I &gt;26 pg/ml. The biomarkers of troponin I, NT-proBNP and CRP was examined periodically. Cardiac pump evaluated by EF and TAPSE from echocardiography examination before and after UC-MSC application. The evaluation of myocardial injury, biomarkers, cardiac pump and 15-day mortality were observed between the two groups. Results: The incidence of myocardial injury was 28,6% of total subjects. Subjects with worsening myocardial injury were higher in the control group (6 subjects) than the experimental group (4 subjects) although not statistically significant. The difference in biomarkers (troponin I, NT- pro-BNP and CRP), cardiac pump function (EF and TAPSE) and 15-day mortality between two groups were not statistically significant. There was a trend of decreasing troponin I, NT-proBNP and CRP in the experimental group. Conclusion: UC-MSC application can be an option as adjuvant therapy in improving myocardial injury of moderate-severe and critically ill COVID-19 patients.

The value of non-contrast chest CT in the prediction of myocardial injury in patients with the COVID-19 Omicron variant

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Omicron variant associated myocardial injury seriously affected the patient's health. Chest computed tomography (CT) is an essential imaging diagnostic tool for evaluating lung diseases in these patients, but its value in the diagnosis of myocardial injury remains unknown. The purpose of this study was to evaluate the lung lesions in patients with Omicron infection with or without myocardial injury, and to evaluate the predictive value of non-contrast chest CT in such patients with myocardial injury. We enrolled 122 consecutive hospitalized patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) for non-contrast chest CT examination. These patients were divided into two groups according to whether myocardial injury occurred. Myocardial injury was defined as a Troponin I level above the 99th-percentile upper reference limit (0.04 ng/mL). The imaging manifestations of the patients’ lungs were evaluated. Myocardial CT value, left atrium (LA) size, long diameter of left ventricular (LV), and cardiothoracic ratio (CTR) were recorded. Multivariate logistic analysis was performed to identify the predictive factors associated with myocardial injury. Of 122 patients, 61 patients (50%) had myocardial injury. Compared with patients without myocardial injury, there was worse NYHA class, more critical patients, higher incidence of bronchial meteorology, larger area and percentage of lung lesions, diameters of LA, and lower myocardial CT value in the myocardial injury group (P < 0.05). Troponin I concentration in patients with myocardial injury group showed negative correlation with myocardial CT value (r = − 0.319, P = 0.012). The multivariable logistic regression analysis showed that disease severity status (OR 2.279; 95% CI 1.247–4.165, P = 0.007), myocardial CT value (OR 0.849; 95% CI 0.752–0.958, P = 0.008), neutrophil count (OR 1.330; 95% CI 1.114–1.587, P = 0.002) were independent predictors of myocardial injury. The discrimination of the model was good (C-statistic = 0.845, 95% CI 0.775–0.914) and well calibrated with a Hosmer–Lemeshow test for goodness of fit (P = 0.476). Patients infected with Omicron with myocardial injury had more severe lung disease than those without myocardial injury. Non-contrast chest CT can be a useful method of detection of myocardial injury in Omicron infection patients.

Correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Purpose The extent of myocardial injury is a prognostic factor in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI). The purpose of this study was the assessment of possible correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF). Methods Patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, were enrolled in this study. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. The biomarkers were maximum high sensitive troponin I (hsTNI) during hospitalization, creatine phosphokinase (CPK) and its myocardial isoenzyme (CK-MB). Correlation between the variables was examined with Spearman method, and a p value &amp;lt;0.05 was considered statistically significant. Results In this study 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) participated. Median |GLS| was 17.9%, GWI 1957.7mmHg%, GCW 2231.0mmHg%, GWW 141.7mmHg% and GWE 92.2% (Table 1). As for the biomarkers, median maximum hsTNI value was 1718.0ng/l, CPK 172.0U/l and CK-MB 31.0U/l. A negative correlation was shown between hsTNI and GWE (Spearman’s rs =−0.515, p = 0.002), and a positive between hsTNI and GWW (Spearman’s rs =−0.426, p = 0.013). Also, CK-MB values had a negative correlation with |GLS| (Spearman’s rs =−0.411, p = 0.017) and GWE (Spearman’s rs =−0.425, p = 0.014). No correlation was found between CPK and the echocardiographic indices. Conclusion Novel echocardiographic indices were correlated with biomarkers of myocardial injury in patients presenting with NSTEMI and normal LVEF.

The role of novel echocardiographic indices in the identification of myocardial injury in patients with NSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Purpose Early detection of myocardial injury in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI) is crucial for prognosis estimation. The purpose of this study is the assessment of novel echocardiographic indices in the detection of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF). Methods In this case-control study, patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, and controls were enrolled. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. Τ - test was used to compare the means of the variables, since the distributions were normal, and a p value &amp;lt;0.05 was considered statistically significant. Results The participants of the study were 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) and 25 healthy volunteers (19 males), of mean age 52.5 years (SD 7.5 years). For the patients, mean |GLS| was 17.9% (SD 2.2), GWI 1957.7mmHg% (SD 368.2), GCW 2231.0mmHg% (SD 380.5), GWW 141.7mmHg% (SD 79.4) and GWE 92.2% (SD 3.8) (Table 1). As for the volunteers mean |GLS| was 20,6% (SD 2.2), GWI 2179.4mmHg% (SD 407.4), GCW 2409.9mmHg% (SD 406.1), GWW 93.2mmHg% (SD 64.4) and GWE 95.5% (SD 2.7). Patients with NSTEMI showed significantly lower values of GLS (p&amp;lt;0.01), GWI (p = 0.033) and GWE (p = 0.01) compared to healthy volunteers (Diagrams). Also, their GWW values were higher (p = 0.015) compared to volunteers. No statistically significant difference was found in the GCW values. Conclusion Novel echocardiographic indices were able to identify myocardial injury, even in patients presenting with NSTEMI and normal LVEF.

New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID-19.

Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated. All patients were selected prospectively from a multicenter registry of adults hospitalized with confirmed COVID-19. Cases had hypertension and myocardial injury, defined by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantified and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury. The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fluorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38-cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR-CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated significantly with myocardial injury. Our findings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.

Myocardial injury in patients with acute ischemic stroke detected by cardiovascular magnetic resonance imaging

BackgroundPatients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population. MethodsPatients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers. ResultsCMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable. ConclusionsMore than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.

Effect of immunotherapy combined with chemotherapy with or without thoracic radiotherapy on markers of myocardial injury in patients with thoracic tumors.

e14624 Background: Thoracic radiotherapy (TRT) is widely used in the treatment of thoracic tumors (TTs) including esophageal and lung cancers. Previous studies suggest that it may increase the risk of myocardial injury. The use of immune checkpoint inhibitors combined with chemotherapy (ICC) in TTs is becoming prevalent, and immune myocarditis is of interest to clinicians. Markers of myocardial injury (MMIs) (e.g., cTnT, CK-MB) have been used with high sensitivity and specificity for the diagnosis of immune myocarditis. Previous studies have focused on severe immune myocarditis due to its high lethality, and less attention has been paid to myocarditis with mildly elevated MMIs. However, ICC are increasingly being used in the treatment of earlier-stage TTs (e.g., neoadjuvant treatment of NSCLC), so the safety of treatment is particularly crucial. The main objective of this study was to analyze the effect of ICC with or without TRT on the MMIs in patients with TTs. Methods: This is a single-center retrospective study with the following main inclusion criteria: 1, pathologically confirmed esophageal and lung cancers only; 2, treated with ICC; 3, presence of comparable serial MMIs results from 1 week prior to the start of treatment to 12 weeks after the end of treatment; 4, TRT allowed in the same period. Primary exclusion criteria: 1，Elevation of MMIs occurs before ICC. 2，For patients who have received TRT, MMIs elevated before radiotherapy. As Chinese Society of Clinical Oncology PD-1 treatment-related myocarditis diagnostic criteria, cTnT was defined as elevated when it was significantly higher than baseline (20 μg/mL) and CK-MB was defined as elevated when it was 2.5 times higher than the upper limit of normal (≥62.5 U/L); Elevation of cTnT and CK-MB after treatment was used as the primary observation and a chi-square test was performed using the SPSS version 25. Results: This study investigated patient data from Jan 1st,2019 to Sep 20th,2022 for a total of 196 patients with esophageal squamous cancer and 298 patients with lung cancer (SCLC vs NSCLC = 13:285) who met the enrollment criteria. The median age was 64 years (29-89 years), male vs female = 406:88. 256 patients received ICC plus radiotherapy (Group A) and 238 patients without radiotherapy (Group B). The median dose of TRT was 50.4 Gy (12 - 60 Gy). The median cycles of use of Immune checkpoint inhibitors (including PD-1 and PD-L1 inhibitors) was 5 (1- 43). The proportion of all patients with post-treatment elevations of cTnT was 12.2% (29/238), including 11.9% (13/109) and 12.4% (16/129) in group A and B, p &gt; 0.05. The whole proportion of patients with elevated CK-MB was 2.7% (13/473), including 3.2% (8/251) and 2.3% (5/222) in group A and B, p &gt; 0.05. Conclusions: Elevated MMIs were common after the use of ICC in patients with TTs with or without radiotherapy, and TRT did not increase the risk of elevation of MMIs.