Post-myocardial Infarction Period Research Articles

Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: The VERY-STEMI study

BackgroundVentricular arrhythmias (VAs) mainly occur in the early post-myocardial infarction (MI) period. However, studies examining the association between total myocardial ischemia time interval and the risk of new-onset VAs during a long-term follow-up are scarce. MethodsThis study (symptom-to-balloon time and VEntricular aRrhYthmias in patients with STEMI, VERY-STEMI study) was a multicenter, observational cohort and real-world study, which included patients with ST-segment elevation MI (STEMI) undergoing percutaneous coronary intervention (PCI). The primary endpoint was cumulative new-onset VAs during follow-up. The secondary endpoints were the major adverse cardiovascular events (MACE) and changes in left ventricular ejection fraction (ΔLVEF, %). ResultsA total of 517 patients with STEMI were included and 236 primary endpoint events occurred. After multivariable adjustments, compared to patients with S2BT of 24 h-7d, those with S2BT ≤ 24 h and S2BT > 7d had a lower risk of primary endpoint. RCS showed an inverted U-shaped relationship between S2BT and the primary endpoint, with an S2BT of 68.4 h at the inflection point. Patients with S2BT ≤ 24 h were associated with a lower risk of MACE and a 4.44 increase in LVEF, while there was no significant difference in MACE and LVEF change between the S2BT > 7d group and S2BT of 24 h-7d group. ConclusionsS2BT of 24 h-7d in STEMI patients was associated with a higher risk of VAs during follow-up. There was an inverted U-shaped relationship between S2BT and VAs, with the highest risk at an S2BT of 68.4 h.

Risk Factors for Arrhythmic Death, Overall Mortality, and Ventricular Tachyarrhythmias Requiring Shock After Myocardial Infarction

The VEST (Vest Prevention of Early Sudden Death Trial) showed a trend toward decreased sudden death and lower overall mortality with a wearable cardioverter-defibrillator (WCD) in the postmyocardial infarction (post-MI) period. However, it is unclear which patients should receive WCD therapy. We aimed to identify the risk factors for arrhythmic death, all-cause mortality, and ventricular tachyarrhythmias requiring appropriate shock to identify patients most likely to benefit from a WCD. The VEST trial included patients with acute MI with ejection fraction ≤35%. Using logistic regression, 7 risk factors were evaluated for association with arrhythmic death, all-cause mortality, and appropriate shock. Among 2,302 participants, 44 had arrhythmic death (1.9%) and 86 died of any cause (3.7%). Among 1,524 participants randomized to WCD, 20 experienced appropriate shock (1.3%) over 90days. In the multivariable analyses, lower systolic blood pressure (SBP; odds ratio [OR] 1.64 per 10mm Hg) and higher heart rate at discharge (OR 1.19 per 10beats/min) were associated with arrhythmic death. Lower SBP (OR 1.37) and higher heart rate (OR 1.10) were associated with all-cause mortality. Higher heart rate (OR 1.20) was associated with appropriate shock. Patients with both SBP ≤100 and heart rate ≥100 were at increased odds of arrhythmic death (OR 4.82), all-cause mortality (OR 3.10), and appropriate shock (OR 6.13). In patients with acute MI and reduced ejection fraction, lower SBP and higher heart rate at discharge were strongly associated with arrhythmic death and all-cause mortality. In conclusion, these risk factors identify a select group at high risk of adverse events in a setting where WCD therapy is reasonable.

THE MONOTHERAPEUTIC ROLE OF GEOMIN FORTE IN THE POST-INFARCTION PERIOD

The aim of our work was to study the mono therapeutic role of the mineral Geomin - Forte in the post-myocardial infarction period. In the Office of Preventive Cardiology of the International Society of the Commonwealth of Foreign Countries of Georgia, in 2018-2022, we conducted outpatient observation of the monotherapeutic capabilities of Geomin Forte on 68 (10 women, 58 men) patients. As a result of the conducted investigations, it was determined: 1. Geomin Forte is harmless and its use does not cause both side effects and individual incompatibilities in patients with heart attack. 2. Geomin Forte significantly increases the body's energy resources, which is so necessary for patients with heart attacks. 3. Geomin Forte creates prospects for its wide use in the future in both treatment and prevention of ischemic heart disease.

THE EFFECT OF BETA BLOCKAGE IN PATIENTS FOLLOWING ACUTE CORONARY SYNDROME - STRATIFIED ACCORDING TO LEFT VENTRICULAR EJECTION FRACTION.

THE EFFECT OF BETA BLOCKAGE IN PATIENTS FOLLOWING ACUTE CORONARY SYNDROME - STRATIFIED ACCORDING TO LEFT VENTRICULAR EJECTION FRACTION.

Outcomes of post-mi vsr surgical repair in-patients operated in different time periods upon acute myocardial infarction evolvement

Aim: The article highlights problematic issues of surgical treatment of mechanical complications of acute myocardial infarction (AMI), specifically, post-myocardial infarction ventricular septum rupture (post-MI VSR). Based on the study of the results of surgical treatment of post-MI VSR in patients with different terms of surgical intervention upon AMI evolvement, the most rational approach to ventricular septum defect (VSD) repair in such patients has been determined. Specifically, subject to hemodynamic stability in patients with post-MI VSR within the first two weeks after AMI evolvement, given the risk of mortality (42.1%), the wait-and-see tactics of surgical treatment is deemed a wise measure. Since the third week after AMI the stabilization of operative mortality rate (up to 10.5-15.8%) has been observed this lays the grounds for active surgical treatment tactics. Notably, analysis of the dynamics of echocardiographic characteristics and changes in the degree of tolerance to physical activity (PA) in patients with post-MI VSR who underwent surgery in different periods after AMI evolvement have been particularly addressed. It has been found that the probability of achievement the most favourable clinical condition corresponding to class I by New York Heart Association (NYHA) classification (χ2 (2, n=65) = 20,791; p<0,001) increases when patients performed are operated on in later periods after AMI. Thus, given the risk of mortality in the early post myocardial infarction period, the most appropriate measure in the tactics of managing patients with post-MI VSR is surgical intervention aimed at VSD repairing 2 weeks after AMI. Nonetheless, the decision on the necessity of emergency surgery patients with post-MI VSR must be also based on the potential stabilization of systemic hemodynamic system characteristics using drug therapy and endovascular practices. Material and Methods: In the study we have presented the retrospectively analysis of data of 90 ischemic heart disease (IHD) patients with post-MI VSR complications. The age of post-MI VSR in-patients ranged from 29 to 81 (60.0 ± 9.6). Among such patients men prevailed (72.3%). Duration of hospitalization of those post-MI VSR from AMI onset varied from 1 to 462 days (n=90). Depending on the time of surgery to be performed after AMI suffered, all patients were divided into groups: group 1 – up to 28 days (n=28); group 2 – from 29 to 56 days n=26); group 3 – from 57 days (n=36). Among the 90 patients who participated in the study, the surgical treatment of post-MI VSR was used in 93.3% (n=84) of patients. LV aneurysm repair according to W. M. Dagget’s technique (14) was performed in 54.8% of patients (n=46), according to T. E. David’s technique (7) – in 36.9% of patients (n=31). Results: Overall surgical mortality among 84 patients has been observed in 22.6% (n=19). In patients of group 1 there occurred 10 lethal cases, in group 2 there were 5, and in group 3 – there were 4 deaths ( n=84)observed. Starting from the 3rd week after AMI onset, significant decrease in operative mortality from 42.1% to 10.5-15.8% has been observed. Study of the dynamics of echocardiography characteristics show less marked changes in LVESV and LVEDV in group 1 compared to groups 2 and 3 testify, in the latter, in favor of completed post-infarction "heart remodeling" with LV aneurysm formed. Conclusion: 1. When planning the scope of surgical intervention at a later date from AMI evolvement, account must be taken of individual dynamics of post-myocardial infarction "cardiac remodeling". 2. Postoperative decrease in ECHO values of LVESV, LVEDV and LVSV in patients with post-MI VSR speaks for the effectiveness of surgical intervention aimed at repairing VSD and restoring LV geometry. 3. The probability of achieving the most favorable NYHA class I clinical state increases when surgery is performed in patients at the later time after AMI suffered.

Abstract 16356: Higher Mortality Up to 36 Months in ST-Segment Elevation Myocardial Infarction Patients Without Standard Modifiable Risk Factors: Results From the SWEDEHEART Registry

Introduction: While prevention strategies that target S tandard M odifiable cardiovasc u lar R isk F actors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) are critical to reduce coronary heart disease risk, myocardial infarction (MI) in the absence of SMuRFs is not infrequent. Methods: We examined the presenting features, treatment, short- and long-term outcomes of patients with ST-segment-elevation MI (STEMI) without SMuRFs compared to STEMI patients with >0 SMuRFs in the national Swedish MI registry SWEDEHEART between 2006-2018. Adjusted logistic regression models were used to determine outcome predictors of all cause 30-day mortality. Kaplan Meir survival analysis was performed. Results: 8,400 (14%) of 60,692 patients without a history of coronary artery disease had no SMuRFs. Patients with and without SMuRFs had the same rate of primary PCI but lower rate of multivessel disease (37% vs. 44%). SMuRF-less patients had higher rates of unadjusted all-cause mortality at 30 days (12% vs. 8%, P <0.0001) and at 36 months (20% vs. 17%, P <0.0001). In adjusted models, having SMuRFs vs. being SMuRF-less (OR 0.63 [95% CI 0.54-0.73]), female sex, LVEF <40%, pre-hospital cardiac arrest, higher heart rate and creatinine, and lower systolic blood pressure were predictors of 30-day mortality (P <0.0001 for all). All-cause mortality rate at 30 days was highest among SMuRF-less females and those with LVEF <40% (Figure 1). The proportion on preventive pharmacotherapy at discharge was lower in SMuRF-less patients. Conclusions: 14% of STEMI presentations occurred in the absence of SMuRFs. Higher rates of 30-day mortality in SMuRF-less STEMI patients, especially among women, highlight the need for improved risk stratification and evidence-based pharmacotherapy during the post MI period, irrespective of baseline risk factors and sex. Figure 1. Kaplan Meier survival curves for patients with and without SMuRFs. A) Women. B) Men. C) LVEF < 40%. D) LVEF > 40%.

Physical Activity in Adults With Wearable Cardioverter Defibrillators in the Post-Myocardial Infarction Period.

Wearable cardioverter defibrillators (WCDs) provide lifesaving defibrillation and are equipped with accelerometers, capable of providing information on patient wear time and physical activity (PA). The purpose of this study was to report on patient PA while wearing a WCD. This study derived data from the WCD vendor in patients prescribed WCD post-myocardial infarction (MI) with left ventricular ejection fraction ≤35% in 2016. Using the device accelerometer, the relationship between wear time and PA was examined in a sample of consistent wearers of the WCD. Demographic variables, including sex and age, were examined for impact on wear time and PA. Changes in PA over time were also examined. A total of 1952 patients (71% male) with a median age of 63 yr were included. Descriptive analyses indicated that overall median wear time was 23.8 hr/d; PA was 5568 steps/d. Significant differences in PA over time were identified, with median steps increasing by 67% from the first week of wear to the last week of wear. Patient age and wear time significantly predicted PA; patient age also significantly predicted patient wear time. There were significant differences in median hours of wear time, as well as median steps, based on sex. PA in adults early after hospital discharge is modest and improves over the course of the 90-d WCD prescription in regular wearers. Improved health status may account for this change. The WCD accelerometer may have value in future clinical care and research by providing a window into daily patient PA levels via remote monitoring.

Heart failure as a substrate and trigger for ventricular tachycardia.

Heart failure (HF) is a major cause of morbidity and mortality with more than 5.1 million individuals affected in the USA. Ventricular tachyarrhythmias (VAs) including ventricular tachycardia and ventricular fibrillation are common in patients with heart failure. The pathophysiology of these mechanisms as well as the contribution of heart failure to the genesis of these arrhythmias is complex and multifaceted. Myocardial hypertrophy and stretch with increased preload and afterload lead to shortening of the action potential at early repolarization and lengthening of the action potential at final repolarization which can result in re-entrant ventricular tachycardia. Myocardial fibrosis and scar can create the substrate for re-entrant ventricular tachycardia. Altered calcium handling in the failing heart can lead to the development of proarrhythmic early and delayed after depolarizations. Various medications used in the treatment of HF such as loop diuretics and angiotensin converting enzyme inhibitors have not demonstrated a reduction in sudden cardiac death (SCD); however, beta-blockers (BB) are effective in reducing mortality and SCD. Amongst patients who have HF with reduced ejection fraction, the angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) has been shown to reduce cardiovascular mortality, specifically by reducing SCD, as well as death due to worsening HF. Implantable cardioverter-defibrillator (ICD) implantation in HF patients reduces the risk of SCD; however, subsequent mortality is increased in those who receive ICD shocks. Prophylactic ICD implantation reduces death from arrhythmia but does not reduce overall mortality during the acute post-myocardial infarction (MI) period (less than 40days), for those with reduced ejection fraction and impaired autonomic dysfunction. Furthermore, although death from arrhythmias is reduced, this is offset by an increase in the mortality from non-arrhythmic causes. This article provides a review of the aforementioned mechanisms of arrhythmogenesis in heart failure; the role and impact of HF therapy such as cardiac resynchronization therapy (CRT), including the role, if any, of CRT-P and CRT-D in preventing VAs; the utility of both non-invasive parameters as well as multiple implant-based parameters for telemonitoring in HF; and the effect of left ventricular assist device implantation on VAs.

The impact of thyroid hormone dysfunction on ischemic heart disease.

Thyroid hormones have a central role in cardiovascular homeostasis. In myocardium, these hormones stimulate both diastolic myocardial relaxation and systolic myocardial contraction, have a pro-angiogenic effect and an important role in extracellular matrix maintenance. Thyroid hormones modulate cardiac mitochondrial function. Dysfunction of thyroid axis impairs myocardial bioenergetic status. Both overt and subclinical hypothyroidism are associated with a higher incidence of coronary events and an increased risk of heart failure progression. Endothelial function is also impaired in hypothyroid state, with decreased nitric oxide-mediated vascular relaxation. In heart disease, particularly in ischemic heart disease, abnormalities in thyroid hormone levels are common and are an important factor to be considered. In fact, low thyroid hormone levels should be interpreted as a cardiovascular risk factor. Regarding ischemic heart disease, during the late post-myocardial infarction period, thyroid hormones modulate left ventricular structure, function and geometry. Dysfunction of thyroid axis might even be more prevalent in the referred condition since there is an upregulation of type 3 deiodinase in myocardium, producing a state of local cardiac hypothyroidism. In this focused review, we summarize the central pathophysiological and clinical links between altered thyroid function and ischemic heart disease. Finally, we highlight the potential benefits of thyroid hormone supplementation as a therapeutic target in ischemic heart disease.

Differential Response to Injury in Fetal and Adolescent Sheep Hearts in the Immediate Post-myocardial Infarction Period

Aim: Characterizing the response to myocardial infarction (MI) in the regenerative sheep fetus heart compared to the post-natal non-regenerative adolescent heart may reveal key morphological and molecular differences that equate to the response to MI in humans. We hypothesized that the immediate response to injury in (a) infarct compared with sham, and (b) infarct, border, and remote tissue, in the fetal sheep heart would be fundamentally different to the adolescent, allowing for repair after damage.Methods: We used a sheep model of MI induced by ligating the left anterior descending coronary artery. Surgery was performed on fetuses (105 days) and adolescent sheep (6 months). Sheep were randomly separated into MI (n = 5) or Sham (n = 5) surgery groups at both ages. We used magnetic resonance imaging (MRI), histological/immunohistochemical staining, and qRT-PCR to assess the morphological and molecular differences between the different age groups in response to infarction.Results: Magnetic resonance imaging showed no difference in fetuses for key functional parameters; however there was a significant decrease in left ventricular ejection fraction and cardiac output in the adolescent sheep heart at 3 days post-infarction. There was no significant difference in functional parameters between MRI sessions at Day 0 and Day 3 after surgery. Expression of genes involved in glucose transport and fatty acid metabolism, inflammatory cytokines as well as growth factors and cell cycle regulators remained largely unchanged in the infarcted compared to sham ventricular tissue in the fetus, but were significantly dysregulated in the adolescent sheep. Different cardiac tissue region-specific gene expression profiles were observed between the fetal and adolescent sheep.Conclusion: Fetuses demonstrated a resistance to cardiac damage not observed in the adolescent animals. The manipulation of specific gene expression profiles to a fetal-like state may provide a therapeutic strategy to treat patients following an infarction.

Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease: Sudden Cardiac Death.

In 2014, approximately 30,000 patients on dialysis in the United States, died due to sudden cardiac death (SCD) ([1][1]). The risk of SCD after starting dialysis (10%) is comparable with the risk in the postmyocardial infarction period (8%) and among patients with heart failure with reduced ejection

P4026Short-term blockade of the S100A8/A9 alarmin in the immediate post-myocardial infarction period inhibits acute myocardial inflammation and preserves myocardial repair

P4026Short-term blockade of the S100A8/A9 alarmin in the immediate post-myocardial infarction period inhibits acute myocardial inflammation and preserves myocardial repair

CLINICAL AND ELECTROPHYSIOLOGICAL PREDICTORS OF RECURRENT POSTINFARCTION VENTRICULAR TACHICARDIAS AFTER CATHETER ABLATION

Aim. To find out the clinical and electrophysiological predictors of recurrent ventricular tachyarrhythmias (VTA) after catheter homogenization of post-infarction scar areas. Material and methods . Patients included, with myocardial infarction (MI) in anamnesis and documented sustained VTA, regardless effective treatment by implantable cardioverter-defibrillator. Totally, 72 patients included (mean age 64±13 y.o.), of those 63 males with postinfarction VTA. In 12 cases there were“electrical storms” demanded urgent catheter management. In such patients, the extended catheter homogenization of the scar was performed, that is ablation of all conduction channels, anomalous potentials and surrounding ablation of infarction zone. Patients were selected to 2 groups according to recurrent VT in post-surgery period. First group included 27 (37%) VTA recurrent patients, mean age 62±10 y.o. Second group included 45 patients (63%) with non tachyarrhythmias recurrence, mean age 63±12 y.o. The evaluation was done, of the selected parameters with the aim to define predictors of rhythm disorders recurrence. Results. Main clinical predictors of VTA recurrence after catheter ablation were the duration of post MI period and its anterior localization. Full area of the scar surface (bipolar voltage lower 1,5 mV) was comparable in patients with recurrent VT and with none (66±51 cm 2 vs 82±49 cm 2 ). However the area of the dense scar (bipolar amplitude ≤0,5 mV) and percent of the dense scar in relation to entire scar was significantly smaller in the recurrence group (group 1 — 23±22 cm 2 and 24±18%, in group 2 — 41±22 cm 2 and 45±21%; p<0,05). The differences were found in the cycle length of clinical VTA assessment in groups 1 and 2 (290±62 and 330±93 ms, respectively, p<0,05). Conclusion. The analysis that was done, made it to define the following variables and VT predictors: localization of the MI (anterior vs inferior), duration of ischemic anamnesis, cycle of clinical VT, non-homogeneity of the scar, area of the fractionized potentials and delayed potentials of electrograms, area of the dense scar.

Effect and safety of escitalopram in the treatment of depressive disorder in patients with myocardial infarction: A prospective study

Background: The top two contributors to the worldwide burden of disease are predicted to be ischemic heart disease (IHD) and major depression. Patients with established IHD are at risk to develop depression. Major depression is common among patients recovering from myocardial infarction (MI). As depression can worsen the prognosis of cardiac patients, it might be possible to improve the prognosis by treating the depression with antidepressants. Aim: The index study aimed to find the prevalence of depressive disorder in adult patients with MI admitted to the cardiology unit and to examine the outcome as regards to the effect and safety of escitalopram as per the treatment regime routinely followed for the treatment of depression in such patients. Methods: One hundred consecutive patients with an established diagnosis of MI admitted to the Department of Cardiology constituted the study sample. Patients who qualified for the major depressive disorder were then treated with escitalopram. Results: The overall prevalence of depression in patients with MI is 22%. The study highlights that depression in the post-MI period is common and responds well to antidepressant treatment. Escitalopram could be an effective and safe antidepressant for the treatment of depression in patients with MI. Conclusion: The study highlights that depression in post MI period is common and escitalopram seems to be an effective and safe antidepressant for the treatment of depression in MI patients.

Cardiology update 2017

In the latter half of 2016, the Danish study evaluated the need of automatic implantable cardioverter-defibrillator in nonischemic cardiomyopathies group of heart failure population. HOPE-3 in 2016 expanded the dimension of statin use. Novel age, biomarker, and clinical history stroke risk score for atrial fibrillation was validated. Success of Phase 2b clinical trial for CSL112 was one more step to reduce the ischemic events in the postmyocardial infarction period. On the one hand, NORSTENT study compared the bare-metal stents with drug-eluting stent, and on the other hand, 3-year follow-up data of ABSORB II trail discussed the performance of bioresorbable scaffolds. NOBLE and EXCEL trials evaluated the coronary intervention with coronary artery bypass graft in the left main coronary artery disease. Reduction of major adverse cardiac event with low-density lipoprotein cholesterol <50 mg/dl was analyzed with alirocumab. Fractional flow reserve was tested as a tool to decide treatment modality in patients with stable coronary artery disease. Natural history of rheumatic heart disease in the current era was described in REMEDY study. A few technological advancements in cardiac resynchronization therapy defibrillator technology were also approved by the Food and Drug Administration. Birth prevalence and pattern of congenital heart disease in North India were presented.

English

BACKGROUND: Arrythmias have been frequently associated with Myocardial Infarction (MI) since long. There are many studies about monitoring or recording of arrythmias in the post MI period ranging from weeks to years. But there is a scarcity of studies in our region (Visakhapatnam) regarding the association of arrythmias with acute myocardial infarction observed within 48 hours of the acute episode. Hence the present study was conducted with an objective of studying the association of arrythmias in the PERI-infarction period. MATERIALS AND METHODS: One hundred consecutive patients were studied who were admitted to the Intensive Cardiac Care Unit (ICCU) after being diagnosed with Acute Myocardial Infarction (AMI). Recruitment lasted for one year. Inclusion criteria: Patients ≥18 years of age admitted to ICCU with AMI with the occurrence of acute episode within 48 hours. Exclusion criteria: Patients 48 hours Patients' ECGs were continuously monitored. Risk factor for heart disease were investigated. RESULTS: Anterior wall MI accounted for a larger group (58%). Overall incidence of ventricular arrythmias was 33%. Sinus arrythmia was predominantly associated with antero-lateral and inferior wall MI. Bundle branch blocks were more accounted for with anterior wall MI. Reperfusion arrythmias were observed in 33 % of subjects. CONCLUSIONS: Acute Myocardial Infarction (AMI) is commonly seen in anterior wall with high incidence of tachyarrythmias and higher mortality whereas inferior wall MI is less common and generally associated with bradyarrythmias and lesser mortality.Sinus bradycardia, if transient, has a protective role in AMI whereas persistent sinus tachycardia is associated with high mortality. Early streptokinase therapy has a favourable impact on mortality in MI and hence should be tried in all the Acute MI patients wh donot have

Эффекты мельдония в раннем постинфарктном периоде

Эффекты мельдония в раннем постинфарктном периоде

Chronic Losartan Treatment Up-Regulates AT1R and Increases the Heart Vulnerability to Acute Onset of Ischemia and Reperfusion Injury in Male Rats.

Inhibition of angiotensin II type 1 receptor (AT1R) is an important therapy in the management of hypertension, particularly in the immediate post-myocardial infarction period. Yet, the role of AT1R in the acute onset of myocardial ischemia and reperfusion injury still remains controversial. Thus, the present study determined the effects of chronic losartan treatment on heart ischemia and reperfusion injury in rats. Losartan (10 mg/kg/day) was administered to six-month-old male rats via an osmotic pump for 14 days and hearts were then isolated and were subjected to ischemia and reperfusion injury in a Langendorff preparation. Losartan significantly decreased mean arterial blood pressure. However, heart weight, left ventricle to body weight ratio and baseline cardiac function were not significantly altered by the losartan treatment. Of interest, chronic in vivo losartan treatment significantly increased ischemia-induced myocardial injury and decreased post-ischemic recovery of left ventricular function. This was associated with significant increases in AT1R and PKCδ expression in the left ventricle. In contrast, AT2R and PKCε were not altered. Furthermore, losartan treatment significantly increased microRNA (miR)-1, -15b, -92a, -133a, -133b, -210, and -499 expression but decreased miR-21 in the left ventricle. Of importance, addition of losartan to isolated heart preparations blocked the effect of increased ischemic-injury induced by in vivo chronic losartan treatment. The results demonstrate that chronic losartan treatment up-regulates AT1R/PKCδ and alters miR expression patterns in the heart, leading to increased cardiac vulnerability to ischemia and reperfusion injury.

Can the inflammatory response be evaluated using 18F-FDG within zones of microvascular obstruction after myocardial infarction?

Inflammation that occurs after acute myocardial infarction plays a pivotal role in healing by facilitating the creation of a supportive scar. (18)F-FDG, which is taken up avidly by macrophages, has been proposed as a marker of cell-based inflammation. However, its reliability as an accurate indicator of inflammation has not been established, particularly in the early postinfarction period when regional myocardial perfusion is often severely compromised. Nine adult dogs underwent left anterior descending coronary occlusion with or without reperfusion. Animals were imaged between 7 and 21 d after infarction with PET/MR imaging after bolus injection of gadolinium-diethylenetriaminepentaacetic acid (DTPA), bolus injection of (18)F-FDG, bolus injection of (99)Tc-DTPA to simulate the distribution of gadolinium-DTPA (which represents its partition coefficient in well-perfused tissue), and injection of (111)In-labeled white blood cells 24 h earlier. After sacrifice, myocardial tissue concentrations of (18)F, (111)In, and (99)Tc were determined in a well counter. Linear regression analysis evaluated the relationships between the concentrations of (111)In and (18)F and the dependence of the ratio of (111)In/(18)F to the apparent distribution volume of (99m)Tc-DTPA. In 7 of 9 animals, (111)In increased as (18)F increased with the other 2 animals, showing weak negative slopes. With respect to the dependence of (111)In/(18)F with partition coefficient, 4 animals showed no dependence and 4 showed a weak positive slope, with 1 animal showing a negative slope. Further, in regions of extensive microvascular obstruction, (18)F significantly underestimated the extent of the presence of (111)In. In the early post-myocardial infarction period, (18)F-FDG PET imaging after a single bolus administration may underestimate the extent and degree of inflammation within regions of microvascular obstruction.

Influence of the body mass index on the remote outcomes after the first myocardial infarction

Cardiologia CROATICA Objectives: To estimate the influence of an index of weight of a body (BMI) on a lethality and survival after the first myocardial infarction in the remote period. Patients and Methods: Patients after the first myocardial infarction, which happened in 1996-1998, all men (n =232), mean age 48.6±5.52. Supervision median 116.4 months (9.7 years), the maximal 170 months (14.2 years). During the supervision, 108 people died of a cardiovascular disease, and 124 persons remained alive. Patients were arranged in 4 groups on the size of initial BMI: I. BMI <22; II. BMI from 22 to 24,9; III. from 25,0 to 29,9; IV. BMI 30. Group selection with BMI less than 22, instead of less than 18,5 (as index of an underweight of a body by criteria of VOZ, 1997 of g) is caused by that the least BMI on all group of supervision made 20. BMI was calculated by means of an index of Ketle (kg/m), establishment of the fact of existence of level of interrelation — by means of criterion a chi-square, for a connection assessment between BMI and a lethality the index of the relative risk (RR) was used, reliability of results was estimated on Student’s criterion (t), statistically reliable distinctions were considered at p <0.01. Results: In the group of the dead average BMI made 26.65 ±3.56, in the group of the survived BMI was 25.84±4.27 — groups authentically did not differ in size BMI (to t=3.4; p<0.05). The fact of existence of reliable interrelation between criterion of IMT and the remote lethal outcome of a postmyocardial infarction cardiosclerosis was not established (c=1.186, number of degree of freedoms of df=2, p=1.0), however, depending on size BMI changed RR. The risk of death made 1.4, 1.01, 1.01 and 0.77 among persons with BMI less than 22, 22-24.9, 25-29.9 and 30 and more respectively. The relative risk of death was lower in patients with BMI ≥30 in comparison with patients with BMI from 22 to 24.9 (RR=0.75, c <0.01) and with BMI less than 22 (RR=0.55, p <0.05). The relation of risk to die to the survived made 0.77 in the group with BMI ≥30, chances in groups with BMI=22-24.9 and with BMI=25-29.9 did not change, chances (RR to 1.4) — in the group with BMI <22 increased. Conclusions: BMI is not a reliable predictor of the remote prognosis after the primary myocardial infarction. With a known share of probability the risk of death in the remote postmyocardial infarction period increases in persons with BMI less than 22 and decreases with BMI 30 and more.