Predictor Of Microvascular Obstruction Research Articles

TCTAP A-032 Prevalence and Predictors of Microvascular Obstruction Following Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction

Findings from recent studies show that patients with microvascular obstruction have poorer prognoses following primary PCI. Knowledge of predictors for the occurrence of MVO after STEMI is lacking. The current study aimed to investigate the prevalence of MVO inpatients with STEMI and its relation

Predictors of Microvascular Obstruction Assessed by the Index of Microcirculatory Resistance Following Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction

OP-010 PURPOSE: We aimed to investigate the predictors of microvascular obstruction (MVO) among clinical, electrocardiographic, laboratory and angiographic parameters available on admission in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary

A novel index of infarct morphology predicts the presence of microvascular obstruction in patients with acute myocardial infarction

Background Microvascular obstruction (MO) has been associated with poor LV remodeling and adverse prognosis. Infarct morphology is related to the presence of MO in that patients with MO generally have larger infarct size (IS) and greater mean infarct transmurality. However, neither index is highly predictive on an individual patient basis. In the current study, we investigated the utility of a novel index of infarct morphology, which reflects the circumferential extent of fully transmural infarction extending to the epicardial surfacethe epicar- dial surface area (EpiSA) of infarctionto predict MO. Methods We studied 302 consecutive patients from 2 centers (Duke and Maastricht University) with first AMI. On contrast-enhanced-CMR, early (2-min post-contrast) and late MO (10-min post-contrast) were defined as hypoenhanced regions within hyperenhanced infarction. Infarct size, mean transmurality, and EpiSA were quanti- fied by manual planimetry of the stack of short-axis views. Results Patients were 58±11 years old (71% male). Prevalence of early and late MO was 64% and 55%, respectively. For the population, IS, mean transmurality, and EpiSA were 14% of LV mass (IQR 7-25%), 74% of infarct sector (IQR 57-86%) and 6% of total LV epicardial-surface-area (IQR 1-13%), respectively. All 3 infarct characteristics were significantly larger in patients with MO (all p 42% of LV (4% of population). However, only a small portion of the population (5%+4%=9%) had infarct size reaching these thresholds, showing that IS had limited discrimi- natory value on an individual patient basis. Similarly, infarct transmurality had limited discriminatory value. In contrast, EpiSA thresholds allowed ruling-in or rul- ing-out MO in a significantly larger percentage of the population (44% for both early and late; p<0.0001 com- pared with IS and transmurality). No patient had MO unless EpiSA was greater than zero. Multivariable analy- sis incorporating clinical, ECG, and CMR data demon- strated that EpiSA was the strongest, independent predictor of early and late MO (p<0.0001 for both). Conclusions The epicardial surface area of infarction, a novel index of infarct morphology, is a stronger predictor of MO than infarct size or mean transmurality. MO does not occur unless infarction extends to the epicardial surface.

Clinical predictors of microvascular obstruction by delayed enhanced CMR in STEMI patients

Clinical predictors of microvascular obstruction by delayed enhanced CMR in STEMI patients

Clinical predictors of microvascular obstruction by delayed enhanced CMR in STEMI patients

Background The presence of microvascular obstruction (MO) on delayed enhanced cardiac magnetic resonance (DECMR) imaging is associated with adverse remodeling and poor prognosis after STEMI. Identifying which patients that may develop MO prior to undergoing acute mechanical reperfusion maybe important in managing patients for more direct interventions. We sought to evaluate clinical predictors of MO as depicted by DECMR. Methods We included 255 patients with their first STEMI reperfused with primary percutaneous intervention. A standard DE-CMR was performed acutely at a mean of 3.9±2.0 days after admission. Clinical risk factors, time to reperfusion as well as angiographic variables were prospectively collected. The angiographic area at risk and the infarct size as a % of the left ventricle (LV) were computed. The number of segments with MO, defined as an area of hypoenhancement surrounded by delayed enhancement on DE-CMR, were summed to calculate MO extent.

The Sum of ST-Segment Elevation Is the Best Predictor of Microvascular Obstruction in Patients Treated Successfully by Primary Percutaneous Coronary Intervention. Cardiovascular Magnetic Resonance Study

The usefulness of ST-segment elevation resolution (STR) for predicting epicardial reperfusion is well established. However, it is still not clear how ST-segment changes are related to microvascular obstruction (MVO) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). The study involved 85 consecutive patients admitted for a first STEMI and treated by pPCI who had a patent infarct-related artery. An ECG was recorded on admission and 90 min and 6, 24, 48 and 96 h after pPCI. Thereafter, STR and the sum of ST-segment elevation (sumSTE) in all leads were determined. Overall, CMR revealed MVO in 37 patients. In infarcts with MVO, sumSTE was greater both before and after revascularization than in infarcts without MVO (P≤.001 at all times). In contrast, there was no significant difference in the magnitude of STR between infarcts with and without MVO 90 min after revascularization (P=.1), though there was after 6 h (P< .05 at all times). The area under the receiver operating characteristic curve for detecting MVO was greater for sumSTE than STR (P< .05 for all measurements). On multivariate analysis, after adjusting for clinical, angiographic and ECG characteristics, a sumSTE >3 mm 90 min after pPCI was an independent predictor of MVO on CMR, while an STR ≥70% was not (odds ratio=3.1; 95% confidence interval, 1.2-8.4; P=.02). MVO was associated with a significantly increased sumSTE at all times after revascularization. The difference in the magnitude of STR between infarcts with and without MVO was significant only >6 h after revascularization. The best predictor of MVO was a sumSTE >3 mm 90 min after pPCI.

Analyzing cell mechanics in hematologic diseases with microfluidic biophysical flow cytometry.

Pathological processes in hematologic diseases originate at the single-cell level, often making measurements on individual cells more clinically relevant than population averages from bulk analysis. For this reason, flow cytometry has been an effective tool for single-cell analysis of properties using light scattering and fluorescence labeling. However, conventional flow cytometry cannot measure cell mechanical properties, alterations of which contribute to the pathophysiology of hematologic diseases such as sepsis, diabetic retinopathy, and sickle cell anemia. Here we present a high-throughput microfluidics-based 'biophysical' flow cytometry technique that measures single-cell transit times of blood cell populations passing through in vitro capillary networks. To demonstrate clinical relevance, we use this technique to characterize biophysical changes in two model disease states in which mechanical properties of cells are thought to lead to microvascular obstruction: (i) sepsis, a process in which inflammatory mediators in the bloodstream activate neutrophils and (ii) leukostasis, an often fatal and poorly understood complication of acute leukemia. Using patient samples, we show that cell transit time through and occlusion of microfluidic channels is increased for both disease states compared to control samples, and we find that mechanical heterogeneity of blood cell populations is a better predictor of microvascular obstruction than average properties. Inflammatory mediators involved in sepsis were observed to significantly affect the shape and magnitude of the neutrophil transit time population distribution. Altered properties of leukemia cell subpopulations, rather than of the population as a whole, were found to correlate with symptoms of leukostasis in patients-a new result that may be useful for guiding leukemia therapy. By treating cells with drugs that affect the cytoskeleton, we also demonstrate that their transit times could be significantly reduced. Biophysical flow cytometry offers a low-cost and high-throughput diagnostic and drug discovery platform for hematologic diseases that affect microcirculatory flow.