Segment Resolution Research Articles

Prediction of Reperfusion and Infarct Related Artery Patency after Thrombolysis in Acute Anterior Myocardial Infarction by Degree of P Wave Dispersion on ECG

Background: Early detection IRA patency following thrombolytic therapy is of great importance in terms of prognosis and identification of candidates for rescue percutaneous coronary intervention (PCI). P wave dispersion (PWD), a new parameter measured before and after thrombolytic therapy is supposed to predict successful reperfusion in patients with anterior acute myocardial infarction (AMI).Methods: 132 patients were selected and divided into two groups on the basis of ST Segment resolution (STR) after 120 minutes of thrombolysis. Group I: patients with STR >70%; Group II: patients with STR < 70%. P wave dispersion was measured in both groups before and after thrombolysis. All patients underwent coronary angiography (CAG). IRA was considered patent if TIMI flow grade was e”2.Results: It was observed that diabetes mellitus and dyslipidemia were significantly higher in group II patients (p=0.04 and p=0.03, respectively). PWD before thrombolysis (PWD0) and 90 minutes after thrombolysis (PWD90) in both groups were statistically insignificant (p=0.45 and p=0.19, respectively). The mean level of PWD120 was statistically significant (p=0.001). After multivariate regression analysis PWD120 was found to be the significant predictor of IRA patency (OR = 1.101; 95% CI = 1.012 – 1.240; p = 0.01).Conclusion: P wave dispersion in patients receiving thrombolytic therapy can be a predictor of successful reperfusion and patent IRA. PWD values, in combination with other reperfusion parameters, can contribute to the identification of rescue PCI candidates.Cardiovasc. j. 2018; 10(2): 158-163

UNUSUAL PRESENTATION OF CONGENITAL LONG QT SYNDROME

A case of congenital long QT syndrome unmasked by acute MI A 29 years old female presented with acute inferior STEMI. Patient received primary PCI. Post PCI EKG showed sinus rhythm, normal axis, resolution of ST segments and QTc of 589 ms. Patient was discharge after uneventful hospital stay.

Object-based land-cover change detection applied to Brazilian seasonal savannahs using geostatistical features

ABSTRACTA new method for remote-sensing land-use/land-cover (LULC) change detection is proposed to eliminate the effects of forest phenology on classification results. This method is insensitive to spectral changes caused by vegetation seasonality and uses an object-based approach to extract geostatistical features from bitemporal Landsat TM (Thematic Mapper) images. We first create image objects by multiresolution segmentation to extract geostatistical features (semivariogram parameters and indices) and spectral information (average values) from NDVI (normalized difference vegetation index), acquired in the wet and dry seasons, as input data to train a Support Vector Machine algorithm. We also used the image difference traditional change-detection method to validate the effectiveness of the proposed method. We used two classes: (1) LULC change class and (2) seasonal change class. Using the most geostatistical features, the change detection results are considerably improved compared with the spectral features and image differencing technique. The highest accuracy was achieved by the sill (σ2 overall variability) semivariogram parameter (95%) and the AFM (area first lag–first maximum) semivariogram index (88.33%), which were not affected by vegetation seasonality. The results indicate that the geostatistical context makes possible the use of bitemporal NDVI images to address the challenge of accurately detecting LULC changes in Brazilian seasonal savannahs, disregarding changes caused by phenological differences, without using a dense time series of remote-sensing images. The challenge of extracting accurate semivariogram curves from objects of long and narrow shapes requires further study, along with the relationship between the scale of segmentation and image spatial resolution, including the type of change and the initial land-cover class.

Optical coherence tomography angiography: a review of current and future clinical applications.

Optical coherence tomography angiography is a non-invasive imaging technique that now allows for simultaneous in vivo imaging of the morphology as well as the vasculature in the eye. In this review, we provide an update on the existing clinical applications of optical coherence tomography angiography technology from the anterior to posterior segment of the eye. We also discuss the limitations of optical coherence tomography angiography technology, as well as the caveats to the interpretation of images. As current optical coherence tomography angiography systems are optimized for the retina, most studies have focused on interpreting images from conditions such as age related macular degeneration and retinal vascular diseases. However, the interpretation of these optical coherence tomography angiography images should be taken in consideration with other multi-modal imaging to overcome the limitations of each technique. In addition, there are a growing variety of clinical applications for optical coherence tomography angiography imaging in optic nerve head evaluation for glaucoma and optic neuropathies. Further developments in anterior optical coherence tomography angiography have now allowed for evaluation of anterior segment pathology such as glaucoma, ocular surface diseases, corneal vascularisation, and abnormal iris vasculature. Future developments in software could allow for improved segmentation and image resolution with automated measurements and analysis.

Factors influencing no-reflow phenomenon in patients with ST-segment myocardial infarction treated with primary percutaneous coronary intervention

Background/Aim. It is not know which factors influence no-reflow phenomenon after successful primary percutaneous intervention (pPCI) in patients with myocardial infarction with ST elevation (STEMI). The aim of this study was to estimate predictive value of some admission characteristics of patients with STEMI, who underwent pPCI, for the development of no-reflow phenomenon. Worse clinical outcome in patients with no-reflow points to importance of selection and aggressive treatment in a group at high risk. Methods. This was retrospective and partly prospective study which included 491 consecutive patients with STEMI, admitted to a single centre, during the period from 2000 to September 2015, who underwent pPCI. Descriptive characteristics of the patients, presence of classical risk factors for cardiovascular disease, total ischemic time and clinical features at admission were all estimated as predictors for the development of no-reflow phenomenon. No-reflow phenomenon is defined as the presence of thrombolysis in myocardial infarction (TIMI) < 3 coronary flow at the end of the pPCI procedure, or ST-segment resolution by less than 50% in the first hours after the procedure. The significance of the predictive value of some parameters was evaluated by univariate and multivariate regression analysis. In univariate analysis, we used the ?2 test and Mann Whitney and Student's t-tests. Results. No-reflow phenomenon was detected in 84 (17.1%) patients (criteria used: TIMI < 3 coronary flow) and in 144 (29.3%) patients (criteria used: STsement resolution < 50%). Patients older than 75 years [odds ratio (OR) = 2.53; 95% confidence interval (CI) 1.48? 4.33; p = 0.001] and those who had Killip class at admission higher than 1 had increased risk to achieve TIMI-3 flow after pPCI. Killip class higher than 1 (OR 1.59; 95% CI 1.23? 2.04; p < 0.001), left anterior descendent artery (LAD) as infarct related artery (IRA) and total ischemic time higher than 4 hour were associated with increased risk to failure of rapid ST segment resolution after pPCI. Conclusion. Older age and Killip class were main predictors of TIMI < 3 flow, and Killip class, LAD as IRA and longer total ischemic time were predictors for the failure of rapid ST segment resolution after pPCI.

Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention.

Objective:T-peak–T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI.Methods:In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population.Results:Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR.Conclusion:To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.

Acute myocardial infarction and coronary embolism: Mechanisms and management

Coronary artery embolism (CE) is recognized as an important non-atherosclerotic cause of acute myocardial infarction. Its prevalence, clinical features, and prognosis remain unclear. We studied 1232 consecutive patients who presented with de novo acute myocardial infarction between 2006 and 2015. CE was diagnosed based on criteria encompassing clinical, angiographic, and other imaging findings including intravascular imaging. The prevalence of CE was 4.3% ( n = 53), including 12 patients (22.6% of cases) with multivessel CE. In comparison with the non-CE group, age and coronary risks factors except smoking ( P = 0.03) were not significantly different in the CE group. PCI procedures was characterized by a distal coronary occlusion in 33 patients (62.2%), a more frequent GP2b3a inhibitors use (62.2% vs. 37.7%, P < 0.001) but lower angioplasty requiring balloon and/or stent rate in CE group (54.7% vs. 45.2%, P < 0.001). CE group was characterized by a lower ST segment resolution post-MI and worse postprocedural TIMI flow grade but no significant difference in left ventricular ejection fraction were seen between the two groups. The most frequent underlying disease was atrial fibrillation ( n = 15, 28.3% of cases) followed by intracardiac tumor ( n = 3) and endocarditis ( n = 4) whereas malignancy and antiphospholipid syndrome represented two major cause of hypercoagulable state ( n = 15) leading also to CE. However, 14 patients (26% of cases) had no identified cause of CE. During a median follow-up of 54 months, no CE and thromboembolism was noted. Kaplan-Meier curves of event free survival (all-cause death and recurrent myocardial infarction) showed that CE group had a poorer prognosis (Log-rank test P < 0.004) mainly influenced by neoplasia and endocarditis ( Fig. 1 ). Patients with CE represent a high-risk subgroup of patients and their prognosis is mainly influenced by underlying cause.

Impact of acute hyperglycemia after primary angioplasty for acute myocardial infarction

Hyperglycemia (HG) has been shown to be a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI). Investigate the relationship between acute HG and angiographic and clinical outcome after primary or rescue angioplasty for STEMI. We retrospectively included 489 patients who underwent revascularization for STEMI. We compared hospital outcomes of patients with HG (HG+) with those without HG (HG−) and outcomes of diabetic with non-diabetic patients in the HG+ group. Plasma glucose was measured at hospital admission. HG was defined as plasma glucose > 11 mmol/L (198 mg/dL). Among the overall population, 184 (37.6%) patients had HG. Procedural success was significantly lower in the HG+ group (86% vs. 92%, P = 0.05) with lower rates of ST segment resolution at 24 hours (47.3% vs. 61.4%, P = 0.006). Hospital outcomes were worse in the HG+ group with a higher mortality (20% vs. 10.4%, P = 0.008). Predictive factors for intrahospital mortality in the overall cohort were: procedural failure (OR: 4.76; 95% CI [1.65–13.7]; P = 0.004), heart failure at admission (OR: 9.75; 95% CI [4.14–22.87]; P < 0.001), anemia (OR: 4.22; 95% CI [2.06–8.63]; P < 0.001), high serum creatinine level (OR: 1.09; 95% CI [1.03–1.14]; P = 0.001), high glycemia (OR: 2.66; 95% CI [1.2–5.9]; P = 0.016). Diabetes did not predict hospital mortality ( P = 0.64) even in the group of patients with hyperglycemia. In non-diabetic patients ( n = 260), HG was associated with larger infarct size ( P = 0.001) and more adverse outcome ( P = 0.009). In the same group, HbA 1c was associated with one year mortality ( P = 0.02). In patients with STEMI, HG is an important predictor of worse outcomes with an increased mortality risk even beyond 11 mmol/L. In non-diabetic patients, both elevated glucose and HbA1c levels were associated with adverse outcomes.

A randomized study of prourokinase during primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction.

To evaluate the efficacy and safety of intracoronary administration of prourokinase via balloon catheter during primary percutaneous coronary interventions (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Acute STEMI patients underwent primary PCI were randomly divided into two groups: intracoronary prourokinase (IP) group (n = 118) and control group (n = 112). During primary PCI, prourokinase or saline were injected to the distal end of the culprit lesion via balloon catheter after balloon catheter dilatation. Demographic and clinical characteristics, infarct size, myocardial reperfusion, and cardiac functions were evaluated and compared between two groups. Hemorrhagic complications and MACE occurred in the 6-months follow up were recorded. No significant differences were observed between two groups with respect to baseline demographic, clinical, and angiographic characteristics (P > 0.05). In IP group, more patients had complete ST segment resolution (>70%) compared with control group (P < 0.05). Patients in IP group showed lower levels of serum CK, CK-MB and TnI, and a much higher myocardial blood flow (MBF) than those in control group (P < 0.05). No significant differences of TIMI major or minor bleeding complications were observed between the two groups (P > 0.05). At 6-months follow-up, there was a trend that patients in the IP group had a less chance to have MACE, though it was not statistically different (8.5% vs 12.5%, P > 0.05). Intracoronary administration of prourokinase via balloon catheter during primary PCI effectively improved myocardial perfusion in STEMI patients.

Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial infarction: predictors and clinical consequences

ObjectiveECG ST segment resolution (STR) has been used to assess myocardial perfusion in STEMI patients undergoing PPCI. However, in most of the studies ECGs recorded at different time points after the actual procedure have been used, limiting the options of therapeutic interventions while the patient is still in the catheterisation laboratory. The aim of this study was to investigate the presence and clinical consequences of intra-procedural STR during PPCI. MethodsWe analysed 12 lead ECGs recorded at the onset and the end of the PPCI procedure, measuring STR in the lead with maximum ST elevation on the initial recording. STR was defined as good when > 50% compared to baseline. ResultsPre and immediately post PPCI ECGs were recorded in 467 STEMI cases whilst the patient was on the catheter lab table. Mean patient age was 63 (+/- 12) years old and 75% were men. Mean duration of symptoms to admission was 3.8 (+/- 3.4) hours and 51% of infarcts were anterior. Good ST resolution at the end of the procedure was seen in 46.5% of patients and was observed more commonly in inferior compared to anterior infarcts (60.1% vs. 32.6%, p<0.001), and in current smokers (53.2% vs. 42.4%, p=0.031). In patients presenting with symptoms for < 4 hours, good STR was more common (74% vs. 66%, p=0.019). Thrombus aspiration was used more frequently in patients who had good STR (88.5% vs 79.8% p=0.011). Patients with good ST resolution had a shorter mean hospital length of stay (3.8 vs. 4.5 days, p=0.009) and a higher left ventricular ejection fraction (49.9% vs. 44.2%, p<0.001) measured by transthoracic echocardiography prior to discharge. ConclusionGood peri-procedural ST resolution was seen in less than half of STEMI patients undergoing PPCI. There were important clinical consequences of good ST resolution. Identification of suboptimal peri-procedural ST resolution could help identify patients who may benefit from new treatments aimed at protecting the microcirculation, whilst the patients are still in the angiography laboratory.

Resolving vision and language ambiguities together: Joint segmentation & prepositional attachment resolution in captioned scenes

We present an approach to simultaneously perform semantic segmentation and prepositional phrase attachment resolution for captioned images. Some ambiguities in language cannot be resolved without simultaneously reasoning about an associated image. If we consider the sentence “I shot an elephant in my pajamas”, looking at language alone (and not using common sense), it is unclear if it is the person or the elephant wearing the pajamas or both. Our approach produces a diverse set of plausible hypotheses for both semantic segmentation and prepositional phrase attachment resolution that are then jointly re-ranked to select the most consistent pair. We show that our semantic segmentation and prepositional phrase attachment resolution modules have complementary strengths, and that joint reasoning produces more accurate results than any module operating in isolation. Multiple hypotheses are also shown to be crucial to improved multiple-module reasoning. Our vision and language approach significantly outperforms the Stanford Parser (De Marneffe et al., 2006) by 17.91% (28.69% relative) and 12.83% (25.28% relative) in two different experiments. We also make small improvements over DeepLab-CRF (Chen et al., 2015).

Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial.

In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02-0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19-0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44-0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

Association of admission testosterone level with ST-segment resolution in male patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundLow level of testosterone may be associated with cardiovascular diseases in men, as some evidence suggests a protective role for testosterone in cardiovascular system. Little is known about the possible role of serum testosterone in response to reperfusion therapy in ST-elevation myocardial infarction (STEMI) and its relationship with ST-segment recovery. The present study was conducted to evaluate the association of serum testosterone levels with ST-segment resolution following primary percutaneous coronary intervention (PPCI) in male patients with acute STEMI.MethodsForty-eight men (mean age 54.55 ± 12.20) with STEMI undergoing PPCI were enrolled prospectively. Single-lead ST segment resolution in the lead with maximum baseline ST-elevation was measured and patients were divided into two groups according to the degree of ST-segment resolution: complete (> or =50%) or incomplete (<50%). The basic and demographic data of all patients, their left ventricular ejection fraction (LVEF) and laboratory findings including serum levels of free testosterone and cardiac enzymes were recorded along with angiographic finding and baseline TIMI (Thrombolysis in Myocardial Infarction) flow and also in-hospital complications and then these variables were compared between two groups.ResultsA complete ST-resolution (≥50%) was observed in 72.9% of the patients. The serum levels of free testosterone (P = 0.04), peak cardiac troponin (P = 0.03) were significantly higher and hs-CRP (P = 0.02) were lower in patients with complete ST-resolution compared to those with incomplete ST-resolution. In-hospital complications were observed in 31.2% of patients. The patients with a lower baseline TIMI flow (P = 0.03) and those who developed complications (P = 0.04) had lower levels of free testosterone. A significant positive correlation was observed between the left ventricular function and serum levels of free testosterone (P = 0.01 and r = +0.362).ConclusionThis study suggests that in men with STEMI undergoing PPCI, higher serum levels of testosterone are associated with a better reperfusion response, fewer complications and a better left ventricular function.

Unmet goals in the treatment of Acute Myocardial Infarction: Review.

Reperfusion therapy decreases myocardium damage during an acute coronary event and consequently mortality. However, there are unmet needs in the treatment of acute myocardial infarction, consequently mortality and heart failure continue to occur in about 10% and 20% of cases, respectively. Different strategies could improve reperfusion. These strategies, like generation of warning sign recognition and being initially assisted and transferred by an emergency service, could reduce the time to reperfusion. If the first electrocardiogram is performed en route, it can be transmitted and interpreted in a timely manner by a specialist at the receiving center, bypassing community hospitals without percutaneous coronary intervention capabilities. To administer thrombolytic therapy during transport to the catheterization laboratory could reduce time to reperfusion in cases with expected prolonged transport time to a percutaneous coronary intervention center or to a center without primary percutaneous coronary intervention capabilities with additional expected delay, known as pharmaco-invasive strategy. Myocardial reperfusion is known to produce damage and cell death, which defines the reperfusion injury. Lack of resolution of ST segment is used as a marker of reperfusion failure. In patients without ST segment resolution, mortality triples. It is important to note that, until recently, reperfusion injury and no-reflow were interpreted as a single entity and we should differentiate them as different entities; whereas no-reflow is the failure to obtain tissue flow, reperfusion injury is actually the damage produced by achieving flow. Therefore, treatment of no-reflow is obtained by tissue flow, whereas in reperfusion injury the treatment objective is protection of susceptible myocardium from reperfusion injury. Numerous trials for the treatment of reperfusion injury have been unsuccessful. Newer hypotheses such as “ controlled reperfusion”, in which the interventional cardiologist assumes not only the treatment of the culprit vessel but also the way to reperfuse the myocardium at risk, could reduce reperfusion injury.

Digital coal: Generation of fractured cores with microscale features

Coal is highly heterogeneous at multiple scales, such that the characterisation of coal lags behind that of conventional reservoir rocks. This paper demonstrates the capability of a digital coal model that can be used to characterise the multiscale structure of coal as well as its petrophysical properties at the core scale (cm). X-ray micro-computed tomography (micro-CT) is applied to obtain the internal cleat structure of a heterogeneous fractured coal sample, based on which statistics of coal lithotype distributions and cleat geometrical properties are extracted. Digital coal models are constructed stochastically according to the measured statistics. Resulting models preserve the core scale (cm) heterogeneity and pore scale (µm to mm) cleat properties of the imaged coal sample. Furthermore, petrophysical evaluation is performed based on the stochastic digital coal models. We find that the generated digital coal models can provide permeability estimation with errors of 26.7% in comparison to that of the original micro-CT data. Since the presented model is able to preserve the multiscale heterogeneities as well as petrophysical properties of coal, our work provides an alternative to segmented micro-CT images. Therefore, we can avoid the challenges that are inherent to micro-CT images, such as segmentation errors, size and resolution limitations. The digital coal model can also be a tool of linking the rock microstructure to petrophysical properties at the core scale, such that we can predict the permeability of coal based on its geometrical measures rather than expensive laboratory experiments.

P wave peak time; a novel electrocardiographic parameter in the assessment of coronary no-reflow

ObjectivesCoronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PWDIS, respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PWDIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients. MethodFifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PWDIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI. ResultsPatients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPTD2) and V1 (PWPTV1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPTD2 was found to be an independent predictor of NR development. ConclusionIn our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development.

Effect of Pentoxifylline in Ameliorating Myocardial Injury in Patients With Myocardial Infarction Undergoing Thrombolytic Therapy: A Pilot Randomized Clinical Trial.

Cell death following acute myocardial infarction (MI) is the hallmark pathology of cardiovascular disease, leading to considerable mortality and morbidity. Platelet and neutrophil activation and inflammatory cytokines, prominently TNF-α, play an important role in the development of cell death. Because pentoxifylline inhibits platelet and neutrophil activation and reduces TNF-α, this study was performed to assess the potential benefit of pentoxifylline in the reduction of myocardial injury following acute MI. In this randomized clinical trial, 98 patients with acute MI were randomly divided into 2 groups. The intervention group received an oral dose of 1200mg of pentoxifylline immediately before thrombolytic therapy (TLT). All patients received the same standard protocol for treatment of MI. Cardiac enzymes were checked over 48 hours. ST resolution was measured over 90 minutes. Then all patients were followed up for a 1-month period to assess major adverse cardiac effects (MACEs). There were no significant differences in peak levels of CPK (P = .18) and CK-MB (P = .33) between the 2 groups, whereas peak level of troponin I was significantly lower in the pentoxifylline group (16.8±10.4 vs 21.3±11.6; P=.048). No significant change between the groups was observed in biomarkers levels, ST segment resolution, cardiac ejection fraction, and MACEs. The results showed that pentoxifylline significantly reduced the peak value of troponin I in patients with acute MI receiving TLT. No significant change was observed in the other studied parameters. Further outcome-based studies are needed to show the clinical relevance of differences between the groups in troponin peak.

Homogeneous and inhomogeneous material effect in gamma index evaluation of IMRT technique based on fan beam and Cone Beam CT patient images

Patient-specific Quality Assurance (QA) technique in lung case Intensity-Modulated Radiation Therapy (IMRT) is traditionally limited to homogeneous material, although the fact that the planning is carried out with inhomogeneous material present. Moreover, the chest area has many of inhomogeneous material, such as lung, soft tissue, and bone, which inhomogeneous material requires special attention to avoid inaccuracies in dose calculation in the Treatment Planning System (TPS). Recent preliminary studies shown that the role of Cone Beam CT (CBCT) can be used not only to position the patient at the time prior to irradiation but also to serve as planning modality. Our study presented the influence of a homogeneous and inhomogeneous materials using Fan Beam CT and Cone Beam CT modalities in IMRT technique on the Gamma Index (GI) value. We used a variation of the segment and Calculation Grid Resolution (CGR). The results showed the deviation of averaged GI value to be between CGR 0.2 cm and 0.4 cm with homogeneous material ranging from −0.44% to 1.46%. For inhomogeneous material, the value was range from −1.74% to 0.98%. In performing patient-specific IMRT QA techniques for lung cancer, homogeneous material can be implemented in evaluating the gamma index.

High-dose bolus tirofiban versus low-dose bolus in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Aim of the present study was to determine effects of high-dose versus low-dose intravenous (IV) bolus tirofiban on angiographic measures, ST resolution, enzymatic infarct size, and clinical outcomes in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI) and received current pharmacoinvasive therapy. Acute coronary syndrome patients (n=271, 85.6% male; mean age: 57.9±12.6 years) from between 2009 and 2015 who received IV tirofiban therapy following PCI were retrospectively analyzed. All patients had received maintenance tirofiban infusion (0.15 µg/kg/min) after bolus dose and 600 mg clopidogrel. Percentage of patients undergoing drug eluting stent implantation procedure was 33.5%. Tirofiban was administered to all patients in bailout situation or for thrombotic complication after PCI. High-dose IV bolus group (25 µg/kg; n=140) was associated with greater ST segment resolution (66% vs. 50%, p=0.013) and reduced peak troponin release [12.4 ng/dL (range: 6.5-21.5 ng/dL) vs. 16.4 ng/dL (range: 10.1-27.4 ng/dL), p=0.001] compared with low-dose bolus group (10 µg/kg, n=131). Cardiovascular event rates were similar between groups at in-hospital, 1-month, and 6-month follow-up (p=1.000, 1.000, and 0.287, respectively). Percentage of patients with post-procedural Thrombolysis in Myocardial Infarction (TIMI) grade III flow, major, and minor bleeding were similar (p=0.085, 1.000, and 0.965, respectively). Use of high-dose IV bolus tirofiban in addition to aspirin and high-dose clopidogrel improves ST segment resolution, reduces infarct size, and does not increase bleeding events in patients with ACS undergoing PCI compared with low-dose bolus. Angiographic measures and clinical endpoints were similar between groups.

Combined analysis of the safety of intra-coronary drug delivery during primary percutaneous coronary intervention for acute myocardial infarction: A study of three clinical trials.

BackgroundThe local injection of novel cardioprotective study drugs prior to percutaneous coronary intervention could cause embolisation of thrombus, resulting in increased reperfusion injury and subsequent infarct size. The aim of this study was to assess the safety of the delivery of an intracoronary therapy delivered during primary percutaneous coronary intervention for acute myocardial infarction prior to the re-establishment of thrombolysis in myocardial infarction III flow.MethodsOne hundred sixty-seven patients with acute myocardial infarction successfully reperfused through primary percutaneous coronary intervention and undergoing Cardiac MRI within the first week after reperfusion were studied. Patients either underwent the delivery of an intracoronary agent (IMP or placebo) prior to balloon dilatation (n = 80) or standard primary percutaneous coronary intervention procedure (n = 117).ResultsBaseline characteristics were similar between the two groups. There were a similar number of successful procedures (IC IMP 75 (93.8%) vs. No IMP 114, (97.4%), p = 0.374), rates of no-reflow (IC IMP 1 (1.3%) vs. No IMP 2 (1.7%), p = 0.99) and levels of ST segment resolution (88.5% IC IMP vs. No IC IMP 87.0%, p = 0.669) between the two groups. Similar levels of microvascular obstruction were seen between the two groups with a trend to reduced infarct size, and improved ejection fractions in the IMP group. Lower MACE rates were seen in the IMP group.ConclusionThe local intracoronary infusion of potential cardioprotective agents prior to the restoration of TIMI flow in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction appears to be safe and does not increase microvascular damage. This route should be considered when testing novel cardioprotective agents.