Post Myocardial Infarction Complications Research Articles

A stratified study of human blood metabolites and coronary artery diseases—A Mendelian randomization study

Background and aimsMetabolic dysregulation is closely associated with coronary artery diseases (CAD). Exploring the relationship between metabolites and CAD is helpful in identifying changes in energy metabolism during disease progression. Methods and resultsWe use Mendelian Randomization (MR) analysis to assess the relationships between 275 serum metabolites and CAD such as angina pectoris, post-myocardial infarction complications, coronary atherosclerosis, myocardial infarction (MI), and unstable angina pectoris (UA). The inverse variance-weighted method (IVW) served as the primary approach for causal analysis, with MR-Egger and weighted median (WM) as supplementary methods. Sensitivity analyses were conducted to assess heterogeneity and multiple effects. We also analyzed potentially related metabolic pathways.We identified causal relationships between 42 known metabolites and CAD. Among them, the genetic susceptibility to elevated levels of amino acid Isobutyrylcarnitine is associated with an increased risk of coronary artery atherosclerosis; but it provides protection against the development of MI. Genetic susceptibility to elevated levels of fatty acids Stearate, Caprylate is associated with higher risk of angina pectoris, while Threonate has a protective effect in the development of angina; Stearate is associated with an increased risk of UA, whereas higher levels of the lipids Choline, 1−arachidonoylglycerophosphoinositol∗, Hexadecanedioate, Tetradecanedioate play a protective role in UA.Metabolic pathway analysis identified 6 pathways that may be associated with CAD. ConclusionWe identified causal relationships between 42 serum metabolites and CAD. Specifically, changes in metabolites such as Isobutyrylcarnitine, Caprylate, and Stearate were associated with risks of CAD. These findings provide new insights into the metabolic mechanisms of CAD.

OR6-6 | In-Hospital Outcomes of Post-Myocardial Infarction Complications In Patients Without Standard Modifiable Risk Factors: A Nationwide Analysis

OR6-6 | In-Hospital Outcomes of Post-Myocardial Infarction Complications In Patients Without Standard Modifiable Risk Factors: A Nationwide Analysis

Acute Coronary Syndrome in Pregnancy and the Post-Partum Period.

Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS.

Epidemiological Variation of Acute Myocardial Infarction Relevant to In-Hospital Outcomes-Tertiary Center Experience-Saudi Arabia.

BackgroundEpidemiological related differences in patients presenting with ST-elevation myocardial infarction (STEMI) have not yet been fully characterized in the Middle East countries. The aim of this study was to assess gender, ethnic and racial variation in clinical profiles, presentation and treatment strategies with relation to the in-hospital outcomes.MethodThis is a retrospective, single center study reviewing the epidemiological details of STEMI patients who were admitted to our center during the period between October 2015 and August 2019.ResultOut of 3079 patients presented with STEMI, 498 (16%) were women, 2170 (70%) were from Middle Eastern Countries and only 1200 (39%) were non- Arabic speakers. Women were older in age compared to men (60.04 ± 11.2 vs 55.35 ± 11.8; P < 0.001). They showed significantly higher rates of cardiovascular risk factors (P < 0.001 for diabetes mellitus (DM), hypertension (HTN) and obesity) and lower prevalence of smoking and old history of previous revascularization (P < 0.001 and 0.007, respectively). Middle Eastern Countries- STEMI patients were elderly, showed higher prevalence of DM, HTN, smoking and obesity compared to South Asian patients (p = 0.001, 0.057, <0.001, <0.001 respectively). Arabic speaking - STEMI patients showed more prevalence of DM, smoking and obesity compared to non-Arabic speaking patients (p < 0.001). Regarding STEMI localization, post myocardial infarction complications and in-hospital length of stay, there were no detected significant gender, ethnic or racial variation. Women showed higher rates of all in-hospital mortality compared to men (5% vs 3%; p = 0.027) however, no ethnic/racial mortality difference was recorded among STEMI patients. Being elderly, presence of multivessel coronary artery disease and left ventricular systolic dysfunction (LVEF < 30%) are the three independent predictors of mortality among our patients (p = 0.013, 0.048 and <0.0001 respectively).ConclusionOur study demonstrates that there are gender, ethnic/racial-related differences in the demographics and clustered cardiovascular risk factors. However, there were no significant detected variation between both genders and different ethnic groups regarding post MI complications, management provided, and hospital outcomes except for increased the mortality rates among women. Old age, presence of multi-vessel disease and severe left ventricular systolic dysfunction have the greatest effect on in-hospital mortality among STEMI patients.

Increased post myocardial infarction complications in COVID-19 outbreak: Is it dilemma?

Increased post myocardial infarction complications in COVID-19 outbreak: Is it dilemma?

May cystatin-c be associated with post-myocardial infarction complications?

May cystatin-c be associated with post-myocardial infarction complications?

ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction.

Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction. Prospective cohort study. Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared. ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39]. Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.

Cardiac Computed Tomographic Angiography: Clinical Applications

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiac imaging plays an important role in diagnosis and risk stratification of various cardiac diseases. Cardiac computed tomography added a major diagnostic value and led to reducing the need for invasive cardiac measures in many cardiac conditions. Cardiac computed tomography has emerged as an accurate anatomic method for detection of coronary artery disease. The negative predictive value to exclude significant coronary artery stenosis approaches 100%. Advances in multidetector computed tomography technology improved coronary arteries imaging during a single breath hold in a wide range of coronary pathologies. Appropriate patient preparation, image acquisition, and post processing techniques to detect coronary artery stenosis and plaque are prerequisites to achieving diagnostic image quality. Cardiac computed tomography applications also include assessment of cardiac structure and function, post myocardial infarction complications, electro anatomical mapping, and delineation of the pericardium.

Adipose stromal cells primed with hypoxia and inflammation enhance cardiomyocyte proliferation rate in vitro through STAT3 and Erk1/2

BackgroundExperimental clinical stem cell therapy has been used for more than a decade to alleviate the adverse aftermath of acute myocardial infarction (aMI). The post-infarcted myocardial microenvironment is characterized by cardiomyocyte death, caused by ischemia and inflammation. These conditions may negatively affect administered stem cells. As postnatal cardiomyocytes have a poor proliferation rate, while induction of proliferation seems even more rare. Thus stimulation of their proliferation rate is essential after aMI. In metaplastic disease, the pro-inflammatory cytokine interleukin-6 (IL-6) has been identified as potent mediators of the proliferation rate. We hypothesized that IL-6 could augment the proliferation rate of (slow-)dividing cardiomyocytes.MethodsTo mimic the behavior of therapeutic cells in the post-infarct cardiac microenvironment, human Adipose Derived Stromal Cells (ADSC) were cultured under hypoxic (2% O2) and pro-inflammatory conditions (IL-1β) for 24h. Serum-free conditioned medium from ADSC primed with hypoxia and/or IL-1β was added to rat neonatal cardiomyocytes and adult cardiomyocytes (HL-1) to assess paracrine-driven changes in cardiomyocyte proliferation rate and induction of myogenic signaling pathways.ResultsWe demonstrate that ADSC enhance the proliferation rate of rat neonatal cardiomyocytes and adult HL-1 cardiomyocytes in a paracrine fashion. ADSC under hypoxia and inflammation in vitro had increased the interleukin-6 (IL-6) gene and protein expression. Similar to conditioned medium of ADSC, treatment of rat neonatal cardiomyocytes and HL-1 with recombinant IL-6 alone also stimulated their proliferation rate. This was corroborated by a strong decrease of cardiomyocyte proliferation after addition of IL-6 neutralizing antibody to conditioned medium of ADSC. The stimulatory effect of ADSC conditioned media or IL-6 was accomplished through activation of both Janus Kinase-Signal Transducer and Activator of Transcription (JAK/STAT) and Mitogen-Activated Protein (MAP) kinases (MAPK) mitogenic signaling pathways.ConclusionADSC are promising therapeutic cells for cardiac stem cell therapy. The inflammatory and hypoxic host post-MI microenvironment enhances the regenerative potential of ADSC to promote the proliferation rate of cardiomyocytes. This was achieved in paracrine manner, which warrants the development of ADSC conditioned medium as an “of-the-shelf” product for treatment of post-myocardial infarction complications.

Plasma Brain Natriuretic Peptide (BNP) as an Indicator of Left Ventricular Function, Early Outcome and Mechanical Complications after Acute Myocardial Infarction

Aims:This study investigated the prognostic value of B type natriuretic peptide (BNP) in acute myocardial infarction (AMI) patients and its relation with left ventricular function and post-myocardial infarction complications.Methods:In this cross-sectional study, plasma BNP level was measured for 42 consecutive patients (mean ± SD: 61.6 ± 10.85 years old) with acute ST elevation myocardial infarction (MI) and 42 healthy, age and gender matched subjects.Result:BNP level in AMI patients were significantly higher than control group (P < 0.001). Regarding to infarct location, the highest BNP level measured in inferoposterior MI (BNP = 4436.63 ± 6188.159 pg/ml) and the lowest one indicated in standalone inferior MI (BNP = 598.83 ± 309.867 pg/ml (P = 0.071). There was significant reverse relation between BNP and EF (P = 0.006, OR = −0.47) and a significant relationship between BNP and killip classification (P = 0.036). There was no significant relation between diastolic and right-ventricular function and BNP level (P = 0.61, P = 0.21). The highest BNP level was detected in LV septal rupture and false aneurysm (P = 0.02) and in ventricular tachycardia, but without significant relationship (P = 0.25).Conclusion:After the onset of AMI, BNP blood level can be used as an important predictor for left ventricular dysfunction, killip classification, early mechanical complications and cardiac death.

Cardiovascular MRI in acute myocardial infarction

At present, cardiovascular MRI is the only noninvasive diagnostic tool that can combine the assessment of regional and global function, morphology and tissue-specific information in a single investigation. With good spatial and temporal resolution and high contrast-to-noise ratio, cardiovascular MRI is an accurate and feasible tool for the evaluation of ischemic heart disease. It is not only considered to be the gold standard for assessment of myocardial function, but also for the detection of myocardial necrosis and fibrosis. In addition, cardiovascular MRI provides clinically relevant information on stunning, microvascular obstruction, transmural extent of the infarction, hemorrhage and postmyocardial infarction complications such as thrombus, Dressler syndrome and aneuryms.

The Control Attitudes Scale-Revised

Perceived control is an individual’s belief that he or she has the resources required to cope with negative events in a way that positively influences their adversive nature (Moser & Dracup, 1995; Thompson, Sobolew-Shubin, Galbraith, Schwankovsky, & Cruzen, 1993). Higher levels of perceived control are associated with lower levels of psychological distress. A number of investigators have demonstrated that anxiety and depression levels are substantially higher and quality of life lower in individuals with low levels of perceived control (Ballash, Pemble, Usui, Buckley, & Woodruff-Borden, 2006; Donovan, Hartenbach, & Method, 2005; Evangelista, Moser, Dracup, Doering, & Kobashigawa, 2004; Thuen & Rise, 2006). Although thought to be a personality characteristic, perceived control is not immutable and can be increased by intervention, the most common of which is education and counseling (Moser & Dracup, 2000; Olajos-Clow, Costello, & Lougheed, 2005). Thus, perceived control is an appropriate topic for nursing and other healthcare researchers, particularly in patient groups with a chronic illness who require a high degree of self-management. As the number of individuals with chronic illnesses increase dramatically worldwide (Strong, Mathers, Leeder, & Beaglehole, 2005), it is particularly important for nurses to understand how to improve their adaptation. The phenomenon of perceived control is important to clinicians caring for patients with chronic illnesses for a number of reasons. First, perceived control is a construct fundamental to nursing and behavioral science and clinical practice. Many interventions, such as education and the provision of information, have at their foundation the goal of increasing perceptions of control in order to improve patients’ emotional adjustment and clinical outcomes (Johnston, Gilbert, Partridge, & Collins, 1992; Moser & Dracup, 2000; Skinner, 1996; Thompson et al., 1993). Second, perceived control moderates the negative impact of emotional distress on clinical outcomes such as post-myocardial infarction complications including recurrent ischemia, reinfarction and malignant dysrhythmias (Moser et al., 2007). Third, despite the importance of perceived control, this mechanism has not been elucidated clearly in many interventions, possibly due to lack of an instrument capable of capturing the construct. The construct of perceived control is particularly relevant to patients with cardiovascular disease. Besides being the number one killer of Americans, coronary heart disease (CHD) is highly prevalent; more than 13 million people have CHD in the United States alone (Rosamond et al., 2007). Of these, more than 7 million are survivors of an acute myocardial infarction (AMI) and it is estimated that 1.2 million will suffer a new or recurrent AMI each year (Rosamond et al., 2007). Other cardiac conditions are equally prevalent. For example, more than 5 million Americans have heart failure (Rosamond et al., 2007). Quality of life, adaptation to the chronicity of cardiac disease and psychosocial recovery from acute cardiac events depends more on psychological than on physical factors (Heo, Moser, Riegel, Hall, & Christman, 2005; Moser & Dracup, 1995). A fundamental construct predicting how successfully patients adapt to cardiovascular conditions is perceived control (Johnson & Morse, 1990). Practical application of the construct in research and clinical practice awaits development of an easily administered, instrument that has evidence of reliability and validity. Accordingly, the purpose of this study was to obtain psychometric support for the Control Attitudes Scale-Revised (CAS-R). The research hypotheses were that the instrument would show evidence of (a) quality of item distributions and their contribution to the scale; (b) internal consistency reliability; and (c) construct validity.

Doble complicación postinfarto agudo de miocardio: rotura del septo interventricular e insuficiencia mitral aguda

We present a case of double post acute myocardial infarction complication: ventricular septal defect and acute and severe mitral insufficiency. As a consequence of the delay in the diagnosis, the patient developed pulmonary hypertension with values at the systemic level. The patient underwent surgery in order to close the ventricular septal defect and aneurysmectomy, resulting in posterior regression of mitral insufficiency and pulmonary circuit values became normal. The ethology, diagnosis, evolution and treatment of this exceptional association of acute post myocardial infarction complications are discussed.

Safety and utility of transesophageal echocardiography in the critically ill patient

We studied the safety and utility of transesophageal echocardiography in the evaluation of critically ill patients in the intensive care unit setting. Sixty-two studies were performed in four different intensive care units on 61 patients with a mean age of 58 +/- 14 years (range 25 to 78 years). Indications for the study included suspected aortic pathologic conditions (18 patients), cardiac source of embolus (16 patients), postmyocardial infarction complications (6 patients), and suspected infective endocarditis (5 patients). Studies were performed at bedside with the use of small amounts of intravenous sedatives. The probe was passed successfully in 61 of 62 attempts. Diagnoses that were missed by surface echocardiography, including aortic dissection, left atrial thrombus, ruptured papillary muscle, and prosthetic valve vegetation were clearly identified by transesophageal echocardiography, which facilitated appropriate management in these cases. In cases in which no pathologic condition was identified, transesophageal echocardiography was useful in ruling out intracardiac shunt, in assessing left ventricular function, and in excluding significant valvular pathologic conditions. No serious complications were recorded, and the procedure was, in general, very well tolerated.

Postmyocardial infarction complications requiring surgery

Postmyocardial infarction complications requiring surgery