Post Infarction Research Articles

Factors Associated With Mortality During the First Year Post Infarction: Survival Analysis of Patients With Acute Myocardial Infarction in Colombia.

Cardiovascular diseases account for over 80% of global deaths. Risk factors and social determinants influence mortality in patients post acute myocardial infarction (AMI). To evaluate factors associated with post-AMI mortality during the one-year follow-up. The study is a prospective cohort study of adults aged 18 years and older with type 1 AMI conducted between October 2021 and January 2024. Intrahospital and outpatient information was collected. Statistical analyses included the Kaplan-Meier survival curve and Cox regression analysis. Proportional hazards and model predictive capacity were evaluated. A total of 1873 patients were included, with a 9.4% mortality rate in the first year. At one year, the estimated survival probability was 88.61% (95% CI: 86.82-90.18). Cox analysis identified several factors associated with mortality, highlighting age (HR = 1.04, 95% CI: 1.02-1.06, p = 0.001), diabetes (HR = 1.77, 95% CI: 1.09-2.87, p = 0.020), renal insufficiency (HR = 2.25, 95% CI: 1.32-3.84, p = 0.003), and type of intervention. The model evaluation showed strong predictive capacity. It is essential to emphasize the importance of comprehensive management in AMI patients with risk factors such as diabetes and chronic kidney disease, as they are significant predictors of mortality during the first year post infarction.

Post translational modifications of connexin 43 in ventricular arrhythmias after myocardial infarction.

Ventricular arrhythmias are the leading cause of sudden cardiac death in patients after myocardial infarction (MI). Connexin43 (Cx43) is the most important gap junction channel-forming protein in cardiomyocytes. Dysfunction of Cx43 contributes to impaired myocardial conduction and the development of ventricular arrhythmias. Following an MI, Cx43 undergoes structural remodeling, including expression abnormalities, and redistribution. These alterations detrimentally affect intercellular communication and electrical conduction within the myocardium, thereby increasing the susceptibility to post-infarction ventricular arrhythmias. Emerging evidence suggests that post-translational modifications play essential roles in Cx43 regulation after MI. Therefore, Cx43-targeted management has the potential to be a promising protective strategy for the prevention and treatment of post infarction ventricular arrhythmias. In this article, we primarily reviewed the regulatory mechanisms of Cx43 mediated post-translational modifications on post-infarction ventricular arrhythmias. Furthermore, Cx43-targeted therapy have also been discussed, providing insights into an innovative treatment strategy for ventricular arrhythmias after MI.

The predictive value of microvascular obstruction for adverse left ventricular remodeling after primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a prospective study

Objectives: Microvascular obstruction (MVO) is a specific cardiac magnetic resonance (CMR) imaging feature in patients with acute myocardial infarction. The purpose of this study was to elucidate the predictive value of MVO in left ventricular adverse remodeling after primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 167 patients with STEMI undergoing primary PCI in the Chinese PLA General Hospital from 2016 to 2020 were enrolled in this prospective cohort study, the average age of study patients was 57±10 years old, with 151 males (90.4%) and 16 females (9.6%). The patients were divided into the MVO group (n=81) and non-MVO group (n=86) according to the presence or absence of MVO on CMR imaging, respectively. The primary endpoint of the study was the occurrence of left ventricular adverse remodeling, which was defined as an increase in left ventricular end diastolic volume (LVEDV) by >20% at 6 months after primary PCI compared with the baseline. Patients who completed follow-up were diagnosed as left ventricular adverse remodeling or no left ventricular adverse remodeling according to CMR. The baseline data, perioperative data, and related data of end points were compared between the MVO group and non-MVO group. Finally, the predictive value of MVO in left ventricular adverse remodeling was calculated by receiver operating characteristic curve analysis. Results: In the baseline data, preoperative thrombolysis in myocardial infarction (TIMI) flow (χ2=13.74, P=0.003) and postoperative TIMI flow (χ2=14.87, P=0.001) were both obviously decreased in the MVO group. After 6 months of follow-up, the incidence of left ventricular adverse remodeling in the MVO group was significantly higher than that in the non-MVO group [37.0%(27/73) vs. 18.9%(14/74), χ2=5.96, P=0.015]. The left ventricular end systolic volume at 6 months post infarction in the MVO group was significantly larger than that in the non-MVO group [(94±32) vs. (68±20) ml, t=-5.98, P<0.001], as well as the LVEDV [(169±38) vs. (143±29) ml, t=-4.74, P<0.001]. Receiver operating characteristic curve showed that the area under the curve of MVO size for predicting left ventricular adverse remodeling was 0.637. Conclusion: The risk of left ventricular adverse remodeling is significantly increased in patients with MVO after primary PCI for acute STEMI.

Repair of Post-Infarction Ventricular Septal Rupture and Ventricular Aneurysm: A Case Report

Ventricular septal rupture is one of the fatal complications of acute myocardial infarction. With the advancement of medical management and availability of emergency cardiac care, the incidence of post infarct ventricular septal rupture has reduced considerably. We report a case, unique in being a late presentation of post infarct ventricular septal rupture with left ventricular aneurysm. The Ventricular septal rupture was repaired using a PTFE patch, followed by reinforced linear closure of aneurysm by a glutaraldehyde treated pericardial felt and revascularization using reversed saphenous vein graft to left anterior descending artery. The patient survived surgery with an uneventful postoperative course. Eastern Med Coll J. July 2023; 8 (2):75-77

Improvement of graphene induced pulmonary edema by graphene exfoliator NaCl with KCl solution

89-year-old man with left basal ganglia internal capsule post limb infarct to our hospital with a history of sputum, fever (37.8oC), dyspnea combined with nasal cannula oxygen therapy, vital signs: blood pressure 120 (systolic) / 60 (diastolic), heart rate 82, respiratory rate 21, O2 saturation 78%, total leukocyte count of 11200/cmm, Lactate Dehydrogenase (LDH) 330 IU/l, alkaline phosphatase 360 u/l, Blood Urea Nitrogen (BUN) 23.7 mg/dl and erythrocyte sedimentation rate (ESR) 50 mm in the first hour using Westergren method, C-reactive protein (CRP) 28.71 mg/dl. The intravenous infusion of a solution consisting of 250 mL normal saline with of potassium chloride (KCl) over 6 h , vitamin C intake with supportive care resulted in recovery of O2 saturation 94%, intramuscular injections of the graphene previously [1-4]. Congestive heart failure (CHF) is the result of insufficient output because of cardiac failure, high resistance in the circulation or fluid overload. Left ventricle (LV) failure is the most common and results in decreased cardiac output and increased pulmonary venous pressure. In the lungs LV failure will lead to dilatation of pulmonary vessels, leakage of fluid into the interstitium and the pleural space and finally into the alveoli resulting in pulmonary edema. Right ventricle (RV) failure is usually the result of long standing LV failure or pulmonary disease and causes increased systemic venous pressure resulting in edema in dependent tissues and abdominal viscera [5]. Abnormal left ventricular structure and function as in, for example, left ventricular hypertrophy or chronic heart failure, is associated with sudden cardiac death and, when the ejection fraction is depressed, with prolongation of the QT interval [6].

Association of aortic stiffness early post myocardial infarction with left ventricular remodelling.

Adverse left ventricular (LV) remodelling after myocardial infarction is associated with heart failure. We investigated whether aortic stiffness during acute ST-segment elevation myocardial infarction is associated with LV remodelling at long-term follow-up. In 109 patients within 48 h of myocardial infarction post-primary percutaneous coronary intervention and after 2 years, we measured: (a) carotid to femoral pulse wave velocity (PWV), (b) LV global longitudinal strain (GLS) and left atrial strain using speckle-tracking echocardiography, (c) PWV/GLS ratio as a surrogate marker of ventricular-arterial interaction, and (d) LV end-diastolic and end-systolic volumes. A > 15% decrease from the baseline in LV end-systolic volume at 2-year follow-up was considered as a criterion of reverse LV remodelling. Compared with baseline, all patients had reduced PWV, LV end-diastolic and end-systolic volumes while PWV/GLS, GLS and reservoir left atrial strain were improved (p < .05) after 2 years. Baseline values of PWV, GLS, PWV/GLS ratio and reservoir left atrial strain were associated with percentage change of LV end-systolic volume at 2 years (p < .05). Multivariable analysis revealed that lower baseline values of PWV and a less impaired GLS and PWV/GLS were independently associated with reverse LV remodelling at 2 years with a C-statistic of .748, .711 and .787, respectively. Aortic stiffness early post-infarction determines LV remodelling after 2 years of the ischemic event despite post successful revascularization. http://www. gov. Unique identifier: NCT03984123, 30/04/2020.

Abstract P1080: Periostin Is Induced During Cell-based Repair In The Sheep Model Of Myocardial Infarction

Cardiac disease is the leading cause of death worldwide. Stem cell-based therapy may improve patient outcomes following a myocardial infarction. Our laboratory is studying the mechanistic basis by which neonatal Islet-1 positive cardiovascular progenitor cells (CPC) facilitate post infarct repair in the sheep model of myocardial infarction. Here, we addressed the hypothesis that periostin (POSTN) is induced in the cardiovascular repair zone following neonatal Islet-1+ cell-based repair. POSTN promotes cardiomyocyte proliferation, recruitment of M2 macrophages, epithelial-mesenchymal transition (EMT), migration, and angiogenesis. We examined human neonatal Islet-1+ cardiovascular progenitor cell clones isolated from several patients to initially determine whether or not POSTN was expressed in these cells. All clones expressed POSTN as shown by RT-PCR. The size of the amplified transcripts was confirmed by gel electrophoresis and POSTN expression in these clones was further confirmed by RNA sequencing. We then examined POSTN expression in the cardiovascular repair zone following myocardial infarction and cell transplantation in sheep. Sheep neonatal Islet-1+ CPC clones were used in this model of allogeneic cell-based repair. A myocardial infarction was induced in three Western sheep by left anterior descending coronary artery ligation. Ten million neonatal sheep Islet1+ cardiac progenitor cell clones isolated from 9 day old sheep were injected into the area surrounding the infarct site 3-4 weeks post infarction. RNA was isolated from the cardiovascular repair zone two months after cell injection. The non-infarcted region of the left ventricle and the left ventricle of normal, non-infarcted sheep were used as controls. POSTN transcripts were significantly elevated in the cell-treated cardiovascular repair zone of all three sheep, as identified by qRT-PCR relative to controls. Periostin levels were elevated between 6 and 255 fold in the repair zone relative to the non-infarcted region of the heart. Our data shows that POSTN is expressed in human Islet-1+ neonatal cardiovascular progenitor cells and that POSTN levels are induced during cell-based cardiovascular repair in the sheep model of myocardial infarction.

Impact of Covid-19 and pandemic restrictions on post infarction myocardial scar evaluated on cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Italy was one of the first nations in the world to face the threat of COVID-19. Data suggest that mortality from cardiovascular causes increased during the pandemic period, compared with a reduction of the number of hospitalizations for the same cause1–2. Purpose Extension of myocardial damage after a cardiac ischemic event is strongly related to patient's short- and long-term prognosis. Aim of this retrospective study is to evaluate the impact of COVID-19 and pandemic restrictions on the extension of the post-infarct myocardial scar, assessed by cardiac magnetic resonance imaging. Methods Fifty consecutive patients hospitalized for acute myocardial infarction who underwent CMR were retrospectively enrolled: 30 patients in the pre-COVID period (from January 2015 to February 2020) and 20 in the pandemic period (from March 2020 to June 2021). We selected only patients with no previous history of ischemic heart disease. Clinical, anamnestic and imaging data (echocardiography and cardiac magnetic resonance) were collected. Results Patients of the two groups did not differ in clinical characteristics, except for the absence of women in the pandemic group (23% vs 0%, p = 0.02). Drugs and treatments used, severity of coronary artery disease and echocardiographic parameters were similar in both groups. The number of segments with transmural fibrosis was larger in COVID group (5.9 vs 4.2, p = 0.05, considering 17 myocardial segments on a bull eyes map). Furthermore in COVID group end diastolic volume was larger (101.3 vs 86.9 ml/mq, p = 0.08) and left ejection fraction was lower (36.0 vs 41.4%, p = 0.18), although not statistically significative. Right ventricle ejection fraction was significatively lower (59.0 vs 63.2%, p = 0.04). Conclusion Patients admitted during pandemic waves had a larger myocardial scar, bigger left ventricular volume and lower ejection fraction. According to literature, this have mainly been caused by the long presentation time from symptoms to hospital admission3. Considering that the extension of the post-infarct myocardial scar visible on cardiac magnetic resonance imaging strongly correlates with the short- and long-term prognosis4-5, these data suggest that COVID 19 had and will have in the coming years a significant impact on mortality from myocardial infarction.

P158 REMOTE FOLLOW–UP OF ISCHEMIC HEART DISEASE AFTER MYOCARDIAL INFARCTION: PRELIMINARY RESULTS OF A TELEVISIT PROJECT IN THE CARDIOLOGY OF G.B. GRASSI HOSPITAL IN ROME

Abstract Introduction In literature there are few studies reported on follow–up of post infarction using telemedicine. Objective and Methods Considering recent pandemic and thanks to the development of digital also in its regulations, it was decided to organize a televisit service with a dedicated team (cardiologist, nurse, cardiology technician) for patients (pt) discharged after a myocardial infarction. The platform of Regione Lazio SISMED has been used to carry out all the necessary procedures (dematerialised recipe, booking, videoconference, digital signature reporting and sending to FSE). We selected pt with: ST elevation myocardial infarction (STEMI), myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) or Takotsubo syndrome, non ST elevation myocardial infarction (NSTEMI) with high–risk, providing a follow–up to 1 and 4 months to monitor cardiovascular events, adherence to therapy, achievement of therapeutic targets and level of satisfaction. An Access file was designed for reporting and data collection. Results From 23–11–21 to 2–11–22, we followed 58 pt (average age 64±10 years, 73% males). Figure 1 represents the cardiovascular risk factors and Figure 2 the type and location of the myocardial infarction; at discharge (average stay 7±2 days), the ejection fraction of the left ventricle was 53±9%. At the televisit control at 1 month, 5 pt reported symptoms (4 dyspnea, 1 cardiopalm), all continued the antiaggregant therapy; Figure 3 shows those who have reached the target for LDL cholesterol (average 56±34 mg/dl), blood pressure (average 124±10 mmhg) and blood sugar level (average 107±19 mg/dl); 6 pt had no target LDL cholesterol (three stopped hypolipidaemic therapy). One pt showed intense pallor, asthenia and reduced hemoglobin (6 g/dl): after hospitalization, we found colon diverticulosis with bleeding (he took oral anticoagulant due to prior atrial fibrillation, suspended, with benefit). The 4–month follow–up was performed for 42 pt, with overlapping results, without reospedalizations. No pt died. Conclusions The televisit showed itself safe as an option in the follow–up of these pt, with a high approval rating. This was possible through the structuring of a health coordination center with a dedicated team, which also supported pt in the new path.

P198 PRELIMINARY 30–60 DAY EVALUATION OF INCLISIRAN EFFICACY

Abstract Background Inclisiran is a small–interfering RNA that selectively silences the hepatic synthesis of PCSK–9 protein with a two doses per year administration, increasing the availability of LDL receptors. Consequent reduction in circulating LDL levels observed in clinical trials, when associated with statin and ezetimibe therapy, is about 50%, with effect onset 14 days after the first administration. Methods This initial experience refers to three male patients with post–infarction ischemic heart disease who underwent revascularization (two with PCI, one with BPAC) one to three years previously, treated with ezetimibe 10 mg OD and high–dose atorvastatin (two with 80 mg OD, one with 40 mg OD). LDL levels were higher than recommended in patients at very high cardiovascular risk by European Society of Cardiology guidelines (mean 90 mg/dL, range 87–95). Patients were informed of the available data on Inclisiran and consented to the terms of use. Subcutaneous administration was performed by a physician in a hospital outpatient setting. Lipid values were checked on the 30th day. Results Two patients continued oral therapy and got a 58% reduction in values (mean 39 mg/dL, range 22–55). One patient, despite informed of the need to continue oral treatment, spontaneously stopped statin and ezetimibe treatment, obtaining a 30–day increase in LDL of 50% (131 vs 87 mg/dL). At the next control, 30 days after the resumption of oral therapy, the value was 44 mg/dL, with a reduction of 49% compared to baseline. No adverse events were recorded. Conclusions Data at 30–60 days on three patients treated with Inclisiran show that its addition to statin and ezetimibe treatment resulted in an average reduction in LDL cholesterol of 56% allowing the achievement of the target in 100% of cases. The favorable interaction between Inclisiran, statin and ezetimibe represents an effective strategy in patients at very high cardiovascular risk. The case of suspension of oral treatment seems to suggest a marked interaction of Inclisiran effect with statin therapy. Administration by a healthcare professional represents an opportunity for better follow–up management, allowing monitoring of therapeutic adherence and re–evaluation of concomitant therapies.

P290 EXTRACORPOREAL MEMBRANE OXYGENATION SYSTEM AS A BRIDGE TO REPARATIVE SURGERY IN VENTRICULAR SEPTAL DEFECT COMPLICATING ACUTE MYOCARDIAL INFARCTION

Abstract Introduction Post–infarct ventricular septal defect (VSD) is a life tethering complication of acute myocardial infarction which is associated to high in–hospital mortality (90–95%). The optimal peri–operative management including timing of surgical correction is still debated. There is a large body of evidence demonstrating that surgical repair is also associated to poor post–operative outcomes due to cardiogenic shock and multiorgan failure (MOF). The use of extracorporeal membrane oxygenation (ECMO) system in adult cardiac surgery is not routine, occurring in a minority of critically ill patients, typically postoperatively. Here we present our single centre experience of patients with post–infarct VSD managed preoperatively with ECMO support as a bridge to definitive surgical closure. Materials and methods Between February 2020 to July 2021, 5 patients presented to our unit with diagnosis of post–infarct VSD and were managed with preoperative veno–arterial (V–A) ECMO implantation and enrolled in our study. Clinical parameters (such as mean arterial pressure, central venous pressure, ECG, pulmonary artery pressure), blood tests, trans–thoracic and trans–esophageal echocardiography, chest X–rays have been evaluated both before and after surgery. Primary end–point was all causes in–hospital mortality. Results Three (60%) patients were male and mean age was 70,4 (60–78) years. All patients underwent surgical repair. ECMO was positioned between 1 and 9 days prior to surgical correction, giving the chance to reduce the pharmacological inotropic support while still reverting the MOF as demonstrated by the reduction of AST, ALT, bilirubin level, decreased CVP and systemic lactate levels. Two (40%) patients were successfully weaned off from the mechanical support and discharged home in good clinical conditions. Two (40%) patients developed MOF after surgery leading to the exitus. Conclusions We postulate that the use of V–A use preoperatively in patients with cardiogenic shock secondary to post–infarct VSD is appropriate and where feasible should be considered. It allows restoration of haemodynamic stability and resolution of MOF. This provides for a delayed surgical repair with a likely higher chance of operative success and reduced mortality.

A clinical case of postinfaction aneurysm development, in a patient after COVID-19

There is no data in the literature on the course of myocardial infarction in patients after COVID-19. Purpose to use a clinical example to present a case of postinfarction left ventricular aneurysm in a patient after undergoing COVID-19. Materials and methods: Patient T., 49 years old, was admitted to the federal state budgetary institution Federal Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation (Astrakhan) with complaints of pain in the heart with irradiation in the left shoulder and lower jaw. Considers himself ill for 7 days. It is known from anamnesis of life that the patient suffered COVID-19 two weeks ago. He has been suffering from arterial hypertension for a year. Results: A clinical example demonstrates that COVID-19 affects course of myocardial infarction: it is a risk factor for the development of post infarction aneurysm of the left ventricle in the early stages after a myocardial infarction. Myocardial infarction was accompanied by the formation of pathological Q waves, impaired conduction of the right leg of the Gis bundle a decrease in the ejection fraction of the left ventricle, acute occlusion of the right coronary artery. Postinfarction aneurysm of the left ventricle had an anterior-septal apical localization. In addition, the study of highly sensitive troponin T and N-terminal fragment of the pro-brain natriuretic peptide type B in patients with myocardial infarction complicated by postinfarction aneurysm of the left ventricle after COVID-19 is also important for determining the stages of development of pathological processes in this pathology, evaluating the effectiveness of therapy and the outcome of this pathology.

Abstract Number ‐ 154: Outcomes of Rescue Intracranial Stenting vs Failed Recanalization during Mechanical Thrombectomy

Introduction Rescue stenting may be considered during mechanical thrombectomy (MT) if a newly recanalized intracranial vessel keeps re‐occluding, or recanalization is not achieved with conventional thrombectomy methods. There are multiple published case series with mixed results on safety and efficacy of this approach, and there are no available randomized trials. We aimed to compare the outcomes of rescue intracranial stenting with unsuccessful/poor reperfusion after MT. Methods Retrospective review of ischemic stroke patients who underwent MT from 2016–2021. Emergent intracranial stent patients were selected and compared with those who had poor/unsuccessful post‐procedural reperfusion (TICI 0–2a). Initial ASPECT score, NIHSS, number of passes, and MT method (aspiration vs stentriever) were recorded. Complications (intracranial hemorrhage, vessel perforation, groin or retroperitoneal hematoma, or distal embolization), final infarct size, 90‐day mRS, and mortality were analyzed. Results Sixteen patients underwent emergent intracranial stenting. Of the 89patients with failed MT, 34 had TICI 2a, 11 had TICI 1, and 44 had TICI 0 reperfusion. All 16 stenting patients achieved TICI 2B‐3 grade recanalization. Pre‐procedure ASPECT score was similar between both groups. Six patients had either intracranial vertebral or basilar artery stenting, and 10 had either intracranial ICA or MCA stenting. Patients with posterior compared to anterior circulation involvement were more likely to receive stenting (50% vs 11%, p = 0.003). There were no differences in the stenting versus non‐stenting group in 24‐hour post intervention NIHSS, post‐procedural complications, intracranial hemorrhage, infarct size, and mortality (75% vs 67%). The stenting group had better functional independence (mRS 0–2) at 90 days (33% vs 11%, p = 0.04). There were no outcome differences in anterior compared to posterior circulation stenting. Conclusions Rescue stenting was more often seen with posterior circulation strokes. In patients with failed or unsuccessful reperfusion after conventional MT, emergent stenting achieved better 90‐day functional independence without increasing rates of complications, intracranial hemorrhage, or mortality.

Does extracorporeal life support influence outcome after surgical management of post infarct ventricular septal rupture? A monocenter retrospective study.

Ventricular septal rupture (VSR) is an uncommon but life-threatening complication of acute myocardial infarction. Extra corporeal life support (ECLS) use in the preoperative setting allows hemodynamic stabilization for a delayed surgery. We aimed to assess the role of ECLS in the preoperative period of post infarction VSR surgery. We retrospectively analyzed all consecutive patients operated for VSR between January 2007 and August 2019. We assessed baseline characteristics, pre and post-operative clinical status and the use of ECLS in the peri-operative period. A total of 39 patients were included. Mean age was 69.8 years. In-hospital mortality was 48.7%. Survivors and non-survivor patients had similar characteristics except for lower postoperative ejection fraction (32% vs. 42%, P=0.02) and more acute renal failure (71.4% vs. 10%, P=0.0005) in the non-survivor group. Patients who received ECLS preoperatively were younger (72 vs. 65, P=0.02) and had more preoperative invasive ventilation (16% vs. 50%, P=0.04). Cardiopulmonary bypass (CPB, 140 min vs. 75 min, P=0.0008) and cross clamping times (94 min vs. 52 min, P=0.0026) were significantly higher in the ECLS group. There were more bleeding complications in the ECMO group (45.4% vs. 0%, P=0.0019) and more need for reintervention (63.3% vs. 13%, P=0.015). There was no difference in mortality between the two groups. There was no difference in postoperative characteristics between urgent and delayed surgery. In our study, post-operative ECLS use was associated with more bleeding complications and need for reintervention. Although mortality was similar, bleeding complications remain a major limitation for the systematic use of ECLS in the post-operative period.

Late myocardial reperfusion in ST-elevation myocardial infarction: protocol for a systematic review and meta-analysis

IntroductionST-segment elevation myocardial infarction (STEMI) is the most severe clinical form of acute myocardial infarction, for which the current treatment consists of effective and timely myocardial reperfusion (within 12 hours...

Influence of Supraphysiologic Biomaterial Stiffness on Ventricular Mechanics and Myocardial Infarct Reinforcement

Injectable intramyocardial biomaterials have promise to limit adverse ventricular remodeling through mechanical and biologic mechanisms. While some success has been observed by injecting materials to regenerate new tissue, optimal biomaterial stiffness to thicken and stiffen infarcted myocardium to limit adverse remodeling has not been determined. In this work, we present an in-vivo study of the impact of biomaterial stiffness over a wide range of stiffness moduli on ventricular mechanics. We utilized injectable methacrylated polyethylene glycol (PEG) hydrogels fabricated at 3 different mechanical moduli: 5 kPa (low), 25 kPa (medium/myocardium), and 250 kPa (high/supraphysiologic). We demonstrate that the supraphysiological high stiffness favorably alters post-infarct ventricular mechanics and prevents negative tissue remodeling. Lower stiffness materials do not alter mechanics and thus to be effective, must instead target biological reparative mechanisms. These results may influence rationale design criteria for biomaterials developed for infarct reinforcement therapy. Statement of significanceAcellular biomaterials for cardiac application can provide benefit via mechanical and biological mechanisms post myocardial infarction. We study the role of biomaterial mechanical characteristics on ventricular mechanics in myocardial infarcts. Previous studies have not measured the influence of injected biomaterials on ventricular mechanics, and consequently rational design criteria is unknown. By utilizing an in-vivo assessment of ventricular mechanics, we demonstrate that low stiffness biomaterial do not alter pathologic ventricular mechanics. Thus, to be effective, low stiffness biomaterials must target biological reparative mechanisms. Physiologic and supra-physiologic biomaterials favorably alter post-infarct mechanics and prevents adverse ventricular remodeling.

One-year survival among patients with ST-elevation myocardial infarction in Peru

To determine one-year survival and factors associated with mortality in patients with ST-segment elevation myocardial infarction in Peru. An analysis was made of the cohort of patients included in the PERSTEMI-II registry during the year 2020, in whom survival at one year after the event and its risk factors were evaluated using Kaplan-Meier survival analysis and Cox regression. Of 374 patients in the PERSTEMI-II study, 366 (97.9%) completed follow-up up to one year after the event with a survival rate of 85%. Successful reperfusion was related to better survival at 1 year (hazard ratio [HR]=0.30, 95% CI: 0.14-0.62, p=0.001). Age (HR=1.04, 95% CI: 1.01-1.07, p=0.003), chronic kidney disease (HR=2.15, 95% CI: 1.04-4.39, p=0.037) and cardiogenic shock (HR=6.67, 95% CI: 3.72-11.97, p<0.001) were factors of higher mortality at 1-year follow-up. The PERSTEMI-II registry is the first Peruvian registry that provides data on survival after ST-segment elevation myocardial infarction, which is 85% at one year. Successful reperfusion improves survival at one-year post infarction.

P130 A RARE CASE OF LARGE POST INFARCTION LEFT VENTRICULAR PSEUDOANEURYSM UNDERGOING CONSERVATIVE MANAGEMENT

Abstract Introduction Left ventricular pseudoaneurysm is a rare complication of myocardial infarction and its natural history is still unclear. Non invasive imaging improves detection ability and differential diagnosis with aneurysm. We present the case of large post infarction left ventricular pseudoaneurysm undergoing conservative management. Case Report A 81–years–old woman presented to emergency room complaining dyspnea and epigastric and right hemithoracic pain. Her past medical history included: chronic coronary syndrome, already undergoing CABG; recent inferior STEMI complicated with complete AVB, with ineffective RCA reperfusion attempt and bicameral pacemaker implantation; Paroxysmal AF in antithrombotic prophylaxis with DOAC. The ECG showed sinus tachycardia, HR 114 bpm, electro–induced ventricular complexes. Objectively, fine bilateral basal crackles were detected. Chest x–ray showed pulmonary congestion. The echocardiographic examination revealed: left ventricle with eccentric remodeling and severe depression of the contractile function (EF 35%), coarse neochamber in communication with the basal segment of the lower wall (D: 6.4 cm x 4.9 cm). The narrow neck, with a ratio &amp;lt;0.5 between inlet orifice diameter / neochamber diameter, suggested pseudoaneurysm. Working diagnosis of NSTEMI–ACS was made (usTnT peak: 344 pg / mL, NV: 0–15 pg / mL) complicated by heart failure. Progressive improvement in compensation was achieved through diuretic therapy. To improve diagnostic definition, cardio–synchronized chest CT with contrast medium was performed. The examination confirmed the voluminous neochamber, consistent with pseudoaneurysm, in correspondence with the mid–basal segments of the lower and inferior septal wall, with thinned walls and mass effect on the great cardiac vein, and highlighted the patency of the bypasses. The venous graft to OM was 5 mm distant from the posterior sternal surface. The case was discussed collectively in Heart Team, due to the high operative risk, the surgical option was rejected and a decision was made for conservative therapy. It was titled beta–blocker, ranolazine was introduced, heart failure therapy was implemented, introducing ARNI. The patient was discharged at home and is in follow–up at the outpatient clinic for heart failure. One month after discharge, she is in NYHA functional class II and she is asymptomatic for angor. The pseudoaneurysmatic dimensions are unchanged on echocardiographic control.

Postoperative outcomes in patients with post infarction ventricular septal defect – Institutional experience

Context: Postinfarction ventricular septal defect (VSD) is a rare but serious complication of myocardial infarction with a reported incidence of 1% to 3% in the pre thrombolytic era and &lt;0.5% post thrombolytic therapy. Risk of death is greatest immediately after myocardial defect and then gradually declines. Early surgical treatment is recommended; however, surgical repair is associated with a high rate of mortality. Aim: To investigate the immediate survival outcome and prognostic factors associated with surgical repair of postinfarction ventricular septal rupture at our institute over a 3-year period. Materials and Methods: From April 2012 to April 2015, 32 patients underwent surgical repair of post-infarction ventricular septal rupture at our institute. Patients were identified from the electronic medical records database and preoperative, intraoperative, and postoperative variables were retrieved. Multiple perioperative variables such as anthropometric data, demography, and clinical history and preoperative details such as echocardiographic indices, coronary angiography, and intraoperative variables were analyzed. The outcomes were compared between the survivors and nonsurvivors. Results: Overall, younger patients tolerated the disease and the surgery better than the older population (59.96 ± 10.67 vs. 69.11 ± 8.11; P = 0.02). Female sex, cardiogenic shock (n = 20, 86.95% vs. n = 2, 22.22%; P = 0.001), and emergency surgery were independently associated with higher risk of postoperative mortality. History of systemic hypertension was found to be significantly associated with poor postoperative outcomes (survivors n = 9, 39.1% vs. nonsurvivors n = 8, 88.9%; P = 0.017). In our series, the overall mortality was 28.1% (n = 9). Higher NYHA class at presentation, intra-aortic balloon pump requirement and low ejection fraction are all independently associated with poor outcomes. Longer interval between the myocardial infarct and surgical repair is associated with a lower risk of operative mortality. Preoperative renal dysfunction (61.77 ± 19.04 vs. 41.36 ± 21.15; P = 0.025) and postoperative renal dysfunction (65.26 ± 28.81 vs. 27.27 ± 9.04; P = 0.001) is one of the most important predictors of postoperative outcome. The duration of aortic cross-clamp and cardiopulmonary bypass was not associated with early mortality in this study (89.17 ± 42.70 vs. 97.11 ± 76.38; P = 0.775). Conclusion: Postinfarction VSD still remains one of the most challenging conditions to treat surgically with considerable early mortality. Although percutaneous device closure and left ventricular assist devices may be used as a method to stabilize the patient preoperatively and improve the chances of survival after surgery, it is currently not advocated as a definitive treatment option. All efforts should be made to predict and prevent postoperative renal dysfunction as it is the single-most important factor affecting both short- and long-term survival outcomes.

Pathways of prevention and treatment of ischemic‐reperfusion injury as consequence of myocardial infarction

Myocardial infarction and the phenomenon of ischemic‐reperfusion injury (IRI) which happens as adverse unwanted effect of the restoration of blood flow in the affected area in the post infarction period is one of the main causes of patient’s death all over the world, what makes the prevention and treatment of this condition a frequent issue for clinicians. For treatment patient undergoes mechanical reperfusion of the affected area of the heart and often uses potent antithrombotic agents. Ischemic‐reperfusion injury can happen consequently because of cellular mechanisms (like calcium overload in cardiomyocytes, excessive generation of reactive oxygen species, mitochondrial damage and others). It was discovered that cardiomyocytes can resist ischemic‐reperfusion injury because of specific mechanisms inherent to these cells; ability was named ‘cardio protection’. For future use for prevention and treatment of this health issue, research has been carried out on experimental heart conditioning and pre‐conditioning (it has low possibility of application in clinical practice), new pharmacological preparations are being searched for and their effectiveness is being verified in terms of their ability to induce a cardio protective effect.