Signs Of Myocardial Infarction Research Articles

Automated detection of myocardial infarction using binary Harry Hawks feature selection and ensemble KNN classifier

Myocardial infarction (MI), referred to as a heart attack, is a life-threatening condition that happens due to blood clots, typically, blood flow to a portion of the heart muscle is blocked. The cardiac muscle may become permanently damaged if there is insufficient oxygen and blood flow to the affected area. It’s crucial to treat MI as soon as possible because even a small delay might have serious effects. The primary diagnostic tool to track and identify the signs of MI is the electrocardiogram (ECG). The complexity of MI signals combined with noise makes it difficult for clinicians to make a precise and prompt diagnosis. It might be laborious and time-consuming to manually analyse an enormous quantity of ECG data. Therefore, techniques for autonomously diagnosing from the ECG data are required. There have been numerous research on the topic of MI espial, but the majority of the algorithms are cognitively intensive when working with empirical data. The current study suggests a unique method for the efficient and reliable identification of MI. We employed circulant singular spectrum analysis (CSSA) for baseline wander removal, a 4-stage Savitzky–Golay (SG) filter to expunge powerline interference from the ECG signal and segmented in the preprocessing stage. Thus segmented ECG has been decomposed using CSSA, entropy based features are extracted. The best features are selected by using binary Harris hawk optimization (BHHO) and to machine learning (ML) classifiers like Naive Bayes, Decision tree, K-nearest neighbor (KNN), Support vector machine (SVM), and Ensemble subspace KNN. Our suggested method has been examined from both class as well as subject oriented perspectives. While the subject-oriented technique uses data from one patient for testing while using data from the other subjects for training, the class-wise strategy divides data as test data as well as training data regardless of subjects. We succeeded in achieving accuracy ( A c % ) of 99.8, sensitivity ( S e % ) of 99, and 100 specificity (Sp %) under the class-oriented approach. Similarly, for the subject wise strategy we achieved a mean A c % , Se %, and Sp % of 85.2, 83.1, and 84.5, respectively.

Diastolic and systolic blood pressure time in target range as a cardiovascular risk marker in patients with type 2 diabetes: A post hoc analysis of ACCORD BP trial

AimsWe investigated the associations between time in target range (TTR) of blood pressure (BP) and cardiovascular outcomes in patients with diabetes. Methods4651 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial were included in the present study. The diastolic BP target range was defined as 70 to 80 mm Hg, and the systolic as 120 to 140 mm Hg and 110 to 130 mm Hg for the standard and intensive therapy, respectively. ResultsAfter adjusting for covariates, 1-SD increase of diastolic TTR was significantly associated with lower risks of primary outcome (HR 0.82, 95% CI: 0.74–0.91, P < 0.001; HR 0.86, 95% CI: 0.77–0.95, P = 0.0044, as well as nonfatal myocardial infarction (HR 0.79, 95% CI: 0.69–0.91, P < 0.001). Meanwhile, systolic TTR was significantly associated with various cardiovascular outcomes (P ≤ 0.016) in fully-adjusted models. The diastolic TTR sustained significance in myocardial infarction when systolic blood pressure average was higher than 120 mm Hg. ConclusionsIn patients with diabetes, TTR of diastolic and systolic BP was independently associated with lower risks of major outcomes. The diastolic BP within the optimal target range was considerably important for reducing the risk of myocardial infarction, even when systolic BP was under stable control.

The role of triglyceride-glucose index in predicting cardiovascular and metabolic outcomes in patients with type 2 diabetes mellitus

Diabetes mellitus type 2 is a global medical and social problem, which, in terms of population coverage around the world, is becoming a pandemic. The main cause of premature death in patients with type 2 diabetes is diseases of the cardiovascular system. The presence of diabetes is associated with an increase in the risk of developing coronary heart disease by two-four times, and every sixth patient has signs of myocardial infarction in the past. The risk of developing ASCVD in patients with type 2 diabetes is early onset, rapid progression, and asymptomatic course. It is known that patients with type 2 diabetes develop ASCVD 8–10 years earlier than people of the same age group who do not have diabetes. Along with chronic hyperglycemia, an independent risk factor for cardiovascular complications in patients with type 2 diabetes is dyslipidemia, which occurs in 30–40% of patients. Insulin resistance, the state of chronic hyperglycemia, dyslipidemia play a key role in the development of the metabolic syndrome and atherosclerosis. The TyG index and the parameter of non-HDL-C have convincingly established themselves as predictors of the development of CVD, as well as markers reflecting signs of the presence of independent factors of the metabolic syndrome that increase the risk of CVD. Conducted clinical studies have confirmed the predictive value of these parameters in relation to CVD. This review focuses on the pathogenesis, development mechanisms, and methods for correcting lipid disorders that underlie the development of CV complications in patients with type 2 diabetes.

Benefit of correction of hyponatremia in the acute phase of myocardial infarction

The significant prognostic impact of hyponatremia in patients with heart failure is widely known. However, little data is available regarding its significance in myocardial infarction (MI). Furthermore, it is not known whether correction of hyponatraemia has an impact on outcomes in these patients. The aim of this study was to assess the prognostic value of hyponatremia in patients with myocardial infarction and the effect of its correction on all-cause mortality. Prospective study over 6 months. Inclusion of patients with myocardial infarction and whose serum sodium levels were measured within 24 hours of admission. Multivariate analysis was used to determine predictors of all-cause mortality. In total, 124 patients (61 ± 12 years, men 57%) were included in the study. There were 15 deaths (18.6%) in patients with corrected hyponatremia and 32 deaths (39.6%) in patients with persistent hyponatremia. Multivariate analysis indicated that corrected hyponatremia and persistent hyponatremia were independent predictors of all-cause mortality (P < 0.0001). When analysing short-term (30 days) and long-term mortality, the corrected hyponatraemia group had no associated long-term mortality or rehospitalisation. Persistent, corrected hyponatraemia in patients with MI was predictive of all-cause mortality, major adverse cardiac events, and rehospitalisation due to heart failure. In some cases, correction of hyponatremia may actually improve patient survival.

Кардіопротективні властивості торакальної паравертебральної блокади в гострому періоді закритої торакальної травми різного ступеня тяжкості

Вступ. Адекватність аналгезії при тяжкій закритій торакальній травмі (ЗТТ) забезпечується регіонарними методами знеболювання, одним із яких є торакальна паравертебральна блокада (ТПБ), яка вже довела свою ефективність. Проте не наведені дослідження впливу ТПБ на перебіг саме ушкодження серця після ЗТТ. Мета. Виявлення впливу ТПБ, проведеної в гострому періоді ЗТТ, на перебіг первинних і вторинних травматичних ушкоджень серця. Матеріали та методи. Контрольоване проспективне нерандомізоване дослідження засновано на аналізі лікування 82 постраждалих із ЗТТ: 70 (85,4 %) чоловіків, 12 (14,6 %) жінок, віком 53 (45, 65) роки. Групи сформовані за тяжкістю ЗТТ, де у підгрупах («a», «b») порівнювалася ефективність системної аналгезії (нестероїдні протизапальні засоби (НПЗЗ) та опіоїд) і ТПБ, проведеної у гострому періоді й надалі упродовж 4–5 діб. 1-ша групa — Injury Severity Score (ISS) — 16,0 ± 4,4 бала, APACHE II — 11,7 ± 3,6; 2-га група — ISS — 17,1 ± 3,9 бала, APACHE II — 13,8 ± 4,1; 3-тя група — ISS — 18,5 ± 4,9 бала, APACHE II — 14,5 ± 2,3. Результати. ЗТТ (ISS — 18 (14, 20) балів) із контузійним ушкодженням легенів І і ІІ ступеня у 62 (76 %) постраждалих (у 22 % виявлено на 1-шу добу, у 79 % — на 2-гу — 3-тю добу) ускладнювалася струсом чи забоєм серця до 70 % спостережень, післятравматичною міокардіо­дистрофією у ранньому та відновлювальному періодах — майже в усіх постраждалих. На електрокардіограмі (ЕКГ) — субендокардіальні та субепікардіальні зміни, пробіжки тахікардії, екстрасистоли, неспецифічні зміни кінцевої частки шлуночкового комплексу, ознаки інфаркту міокарда травматичного походження, а також і ІІ типу через крововтрату (у 2 пацієнтів). Не виявлено різниці ЕКГ-ознак між гемодинамічно стабільними і нестабільними пацієнтами. Застосування НПЗЗ та опіоїду (n = 43, підгрупи «а») достатньою мірою не усувало біль і гіпоксемію, зберігався периферичний вазоспазм (загальний периферичний судинний опір (ЗПСО) — 1987 ± 159 дин/с · см2), тахікардія (86 ± 13 уд · хв–1), зменшення роботи серця (серцевий індекс (СІ) — 2,71 ± 0,27 л/м2 · хв). Застосування ТПБ (n = 39, підгрупи «b») одразу знижувало біль на 68 ± 7 %, забезпечувало ліпше SрО2 95,6 ± 1,7 % проти 94,1 ± 1,5 % та РаО2/FіО2 340 ± 25 проти 312 ± 50 у підгрупах «а», що поєднувалось зі зменшенням тахікардії (80 ± 7 уд · хв–1) та периферичного судинного опору (ЗПСО — 1692 ± 157 дин/с · см2; p = 0,01) при одночасному сприятливому збільшенні продуктивності серцевої діяльності (СІ — 3,1 ± 0,17 л/м2 · хв). На 5-ту добу на фоні ТПБ РаО2/FiО2 був вищий, ніж у підгрупах «а» — 380 ± 28 % проти 362 ± 27 %; SрО2 — 96,8 ± 0,7 % проти 95,1 ± 1,1 % (p = 0,02). Висновки. ТПБ, проведена одразу в гострому періоді ЗТТ через усунення болю і гіпоксемії, має кардіопротекторну дію, що виявляється в антиаритмічному та протиішемічному ефектах, запобігаючи ускладненому перебігу струсу чи забою серця, зменшуючи прояви первинної і вторинної посттравматичної міокардіодистрофії.

Coronary Artery Disease in Patients Presenting With Acute Ischemic Stroke or Transient Ischemic Attack and Elevated Troponin Levels.

Background: There is little information concerning the invasive coronary angiography (ICA) findings of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) with elevated troponin levels and suspected myocardial infarction (MI). This study analyzed patient characteristics associated with ICA outcomes.Methods: A total of 8,322 patients with AIS or TIA, treated between March 2010 and May 2020, were retrospectively screened for elevated serum troponin I at hospital admission. Patients in whom ICA was performed, due to suspected type 1 MI based on symptoms, echocardiography, and ECG, were categorized according to ICA results (non-obstructive coronary artery disease (CAD): ≥1 stenosis ≥50% but no stenosis ≥80%; obstructive CAD: any stenosis ≥80% or hemodynamically relevant stenosis assessed by FFR/iwFR).Results: Elevated troponin levels were detected in 2,205 (22.5%) patients, of whom 123 (5.6%) underwent ICA (mean age 71 ± 12 years; 67% male). CAD was present in 98 (80%) patients, of whom 51 (41%) were diagnosed with obstructive CAD. Thus, ICA findings of obstructive CAD accounted for 2.3% of patients with troponin elevation and 0.6% of all stroke patients. The clinical hallmarks of myocardial ischemia, including angina pectoris (31 vs. 15%, p < 0.05) and regional wall motion abnormalities (49 vs. 32%, p = 0.07), and increased cardiovascular risk indicated obstructive CAD. While there was no association between lesion site or stroke severity and ICA findings, causal large-artery atherosclerosis was significantly more common in patients with obstructive coronary disease (p < 0.05).Conclusion: The rate of obstructive CAD in patients with stroke or TIA and elevated troponin levels with suspected concomitant type I MI is low. The cumulation of several cardiovascular risk factors and clinical signs of MI were predictive. AIS patients with large-artery atherosclerosis and elevated troponin may represent an especially vulnerable subgroup of stroke patients with risk for obstructive CAD.

Development features of coronavirus disease complications in patients with coronary heart disease

Background and Aims: To study the incidence and clinical features of myocardial infarction development in patients with coronary heart disease (CHD) after suffering coronavirus disease. Methods: We studied clinical condition of 64 patients admitted with chest pain complaints to the emergency room of the multidisciplinary clinic of the Tashkent Medical Academy. The average age was 52,5±2,4 years. Results: Only 41 patients (64%) had acute myocardial infarction (MI) with various localization. The group included 10 women and 31 men. The pain verbal scale showed a low level of pain syndrome, as well as an atypical location of pain in the heart. In 13 patients, was detected a high level of IgG of coronavirus infection, whereas IgM level was high in 28 patients. The level of fibrinogen in the blood plasma averaged 355 g/l, the blood sugar level was around 7.3 mmol/l on an empty stomach, hematocrit level increased to approximately 0.49 l/l. In men, was noted the decrease of blood hemoglobin to 101.6 g/l. The rest of the indicators were practically not deviated from the norm. The ECG shows typical elevations of the ST segment from the isoline. Conclusions: Atypical clinical development signs of MI in patients with CHD is associated with a previous coronavirus infection, a large amount of lung tissue damage, a low awareness of patients about possible complications of CHD and low adherence to maintenance drug therapy after suffering Covid-19.

Plasma Metabolites Alert Patients With Chest Pain to Occurrence of Myocardial Infarction.

Myocardial infarction (MI) is one of the leading causes of death worldwide, and knowing the early warning signs of MI is lifesaving. To expand our knowledge of MI, we analyzed plasma metabolites in MI and non-MI chest pain cases to identify markers for alerting about MI occurrence based on metabolomics. A total of 230 volunteers were recruited, consisting of 146 chest pain patients admitted with suspected MI (85 MIs and 61 non-MI chest pain cases) and 84 control individuals. Non-MI cardiac chest pain cases include unstable angina (UA), myocarditis, valvular heart diseases, etc. The blood samples of all suspected MI cases were collected not longer than 6 h since the onset of chest pain. Gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry were applied to identify and quantify the plasma metabolites. Multivariate statistical analysis was utilized to analyze the data, and principal component analysis showed MI could be clearly distinguished from non-MI chest pain cases (including UA and other cases) in the scores plot of metabolomic data, better than that based on the data constructed with medical history and clinical biochemical parameters. Pathway analysis highlighted an upregulated methionine metabolism and downregulated arginine biosynthesis in MI cases. Receiver operating characteristic curve (ROC) and adjusted odds ratio (OR) were calculated to evaluate potential markers for the diagnosis and prediction ability of MI (MI vs. non-MI cases). Finally, gene expression profiles from the Gene Expression Omnibus (GEO) database were briefly discussed to study differential metabolites' connection with plasma transcriptomics. Deoxyuridine (dU), homoserine, and methionine scored highly in ROC analysis (AUC > 0.91), sensitivity (>80%), and specificity (>94%), and they were correlated to LDH and AST (p < 0.05). OR values suggested, after adjusting for gender, age, lipid levels, smoking, type II diabetes, and hypertension history, that high levels of dU of positive logOR = 3.01, methionine of logOR = 3.48, and homoserine of logOR = 1.61 and low levels of isopentenyl diphosphate (IDP) of negative logOR = −5.15, uracil of logOR = −2.38, and arginine of logOR = −0.82 were independent risk factors of MI. Our study highlighted that metabolites belonging to pyrimidine, methionine, and arginine metabolism are deeply influenced in MI plasma samples. dU, homoserine, and methionine are potential markers to recognize MI cases from other cardiac chest pain cases after the onset of chest pains. Individuals with high plasma abundance of dU, homoserine, or methionine have increased risk of MI, too.

Patients' reflections on prehospital symptom recognition and timely treatment of myocardial infarction.

Early treatment is crucial to successful therapy in patients with acute myocardial infarction (MI). Prehospital delay is associated with increased morbidity and mortality. There is little empirical evidence of patients' reflections on prehospital symptoms of MI and timely treatment at the time of discharge from hospital. To explore patients' reflections on prehospital symptoms of MI and their experiences of interaction with local hospitals, general practitioners, and laypersons. An inductive explorative design with a qualitative method approach was used to conduct in-depth interviews of patients after confirmed MI. Twenty patients were purposefully selected based on age and gender. Face-to-face, semi-structured interviews were conducted prior to hospital discharge. The interviews were organized around a set of predetermined, open-ended questions, transcribed verbatim and analysed using qualitative content analysis. There were patients who acted upon severe symptoms of MI by seeking medical assistance. Patients commonly experienced that the time from the onset of symptoms to treatment posed a transitional challenge. They did not take subtle signs of MI seriously; they underestimated symptoms of MI and delayed seeking medical assistance. Patients frequently experienced that healthcare professionals did not take them seriously, as they struggled to gain access to healthcare services. This study highlights patients' unique experiences of the pathway from symptom onset to confirmed MI. Severe chest pain is associated with MI and triggers an immediate need for care. However, patients often underestimated moderate chest pain or subtle signs and symptoms of MI. Existing knowledge gaps concerning the misinterpretation of symptoms in primary care need to be addressed in order to reduce this clinical challenge.

Focal ST-segment elevation without coronary occlusion: myocardial infarction with no obstructive coronary atherosclerosis associated with COVID-19-a case report.

BackgroundWhile it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge.Case summaryAn 86-year-old man presented to our institution with acute hypoxic respiratory failure and an ECG showing anteroseptal ST-segment elevation concerning for myocardial infarction. Mechanic ventilation was initiated prior to presentation, and emergent transthoracic echocardiography reported an ejection fraction of 50–55%, with no significant regional wall motion abnormalities. Next, emergent coronary angiography was performed, and no significant coronary artery disease was detected. The patient tested positive for COVID-19. Despite supportive management in the intensive care unit, the patient passed away.DiscussionWe present a case of COVID-19 that is likely associated with MINOCA. It is crucial to understand that in COVID-19 patients with signs of myocardial infarction, not all myocardial injury is due to obstructive coronary artery disease. In the case of COVID-19 pathophysiology, it is important to consider the cardiovascular effects of hypoxic respiratory failure, potential myocarditis, and significant systemic inflammation. Continued surveillance and research on the cardiovascular complications of COVID-19 is essential to further elucidate management and prognosis.

Prevalence and clinical significance of electrocardiogram abnormalities in older civil aviation pilots

Abstract. Prevalence and clinical significance of electrocardiography findings was studied in 1189 older pilots in aged 55 years and older, who were consistently admitted to the Central Civil Aviation Hospital (Moscow) and examined on the regular bases. Resting 12-lead electrocardiogram was recorded in all subjects according to generally accepted methods. Normal electrocardiogram was found in 78,5% of older pilots. None of the examined showed signs of myocardial infarction. Minor electrocardiogram abnormalities was registered in 21,5% of pilots. Cardiac conduction disorders were predominated 16,1% of cases, most of them were intraventricular conduction disorders 13,7% of cases. Another electrocardiogram abnormalities were less common 4% of cases. Mixed electrocardiogram abnormalities were noted in a small number of observations in 1,4% of individuals. Thus, older civil aviation pilots are characterized a lower frequency of majority electrocardiogram deviations compared to a population of the same age. The evaluation of fitness to flight in some electrocardiogram deviations is depend of the presence or absence of cardiovascular disease, functional condition of the cardiovascular system and the data of additional examination methods. On the whole, the electrocardiogram use as a screening in asymptomatic individuals has some significant limitations - a number of detected abnormalities may be normal variants, as well as a normal electrocardiogram may be in significant narrowing of the coronary artery. Nevertheless, the need for electrocardiogram recording is recognized by aeromedical specialists of different countries, since this method is exclude a number of pathological changes, which are significant for flight safety.

Association of Recognized and Unrecognized Myocardial Infarction With Depressive and Anxiety Disorders in 125,988 Individuals: A Report of the Lifelines Cohort Study.

No previous study has focused on recognition of myocardial infarction (MI) and the presence of both depressive and anxiety disorders in a large population-based sample. The aim of this study was to investigate the association of recognized MI (RMI) and unrecognized MI (UMI) with depressive and anxiety disorders. Analyses included 125,988 individuals enrolled in the Lifelines study. Current mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) were assessed with the Mini-International Neuropsychiatric Interview. UMI was detected using electrocardiogram in participants who did not report a history of MI. The classification of RMI was based on self-reported MI history together with the use of either antithrombotic medications or electrocardiogram signs of MI. Analyses were adjusted for age, sex, smoking, somatic comorbidities, and physical health-related quality of life as measured by the RAND 36-Item Health Survey in different models. Participants with RMI had significantly higher odds of having any depressive and any anxiety disorder as compared with participants without MI (depressive disorder: odds ratio [OR] = 1.86, 95% confidence interval [CI] = 1.38-2.52; anxiety disorder: OR = 1.60, 95% CI = 1.32-1.94) after adjustment for age and sex. Participants with UMI did not differ from participants without MI (depressive disorder: OR = 1.60, 95% CI = 0.96-2.64; anxiety disorder: OR = 0.73, 95% CI = 0.48-1.11). After additional adjustment for somatic comorbidities and low physical health-related quality of life, the association between RMI with any depressive disorder was no longer statistically significant (OR = 1.18; 95% CI =0.84-1.65), but the association with any anxiety disorder remained (OR = 1.27, 95% CI = 1.03-1.57). Recognition of MI seems to play a major role in the occurrence of anxiety, but not depressive, disorders.

Myocardial Infarction in Heart Failure With Preserved Ejection Fraction: Pooled Analysis of 3 Clinical Trials

ObjectivesThe authors investigated the relationship between past or incident myocardial infarction (MI) and cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF). BackgroundMI and HFpEF share some common risk factors. The prognostic significance of MI in patients with HFpEF is uncertain. MethodsThe authors pooled data from 3 trials—CHARM Preserved (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity), I-Preserve (Irbesartan in Heart Failure With Preserved Systolic Function), and the Americas region of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) (N = 8,916)—and examined whether MI before or following enrollment independently predicted CV death and heart failure (HF) hospitalization. ResultsAt baseline, 2,668 patients (30%) had history of MI. Prior MI was independently associated with greater risk of CV death (4.7 vs. 3.5 events/100 patient-years [py], adjusted hazard ratio [HR]: 1.42 [95% confidence interval (CI): 1.23 to 1.64]; p < 0.001). Excess sudden death drove this difference (1.9 vs. 1.2 events/100 py, adjusted HR: 1.55 [95% CI: 1.23 to 1.97]; p < 0.001). There was no difference in HF hospitalization (5.9 vs. 5.5 events/100 py, adjusted HR: 1.05, 95% CI: 0.92 to 1.19) or HF death by prior MI. During follow-up, MI occurred in 336 patients (3.8%). Risk of CV death increased 31-fold in the first 30 days after first post-enrollment MI, and remained 58% higher beyond 1 year after MI. Risk of first or recurrent HF hospitalization increased 2.4-fold after MI. ConclusionsPrior MI in HFpEF is associated with greater CV and sudden death but similar risk of HF outcomes. Patients with HFpEF who experience MI are at high risk of subsequent CV death and HF hospitalization. These data highlight the importance of primary and secondary prevention of MI in patients with HFpEF. (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712; Irbesartan in Heart Failure With Preserved Systolic Function [I-Preserve]; NCT00095238; and Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT]; NCT00094302)

Attention PCP&amp;apos;s: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic

Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.

P804 Heart complication of chikungunya fever: ecocardiographic evaluation of late effects

Abstract Introduction Chicungunya fever, epidemic caused by Alphavirus (CHIKV) transmitted by mosquitoes of the genus Aedes, is characterized by highly debilitating joint pain and can cause atypical cardiac complications in 10% of patients. CHIKV produces direct damage to myofibrils (inflammation and infiltration) and secondary damage due to hypersensitivity and necrosis. Objective To evaluate, by echocardiography, the chronic cardiac alterations of the CHIKV infection. Methods Thirty-two patients were studied (mean age was 56 ± 14 years, 17 females) with CHIKV-confirmed infection and signs of cardiac involvement between 5 and 25 months of evolution. The dimensions and function of the ventricles were measured by two-dimensional and Doppler echocardiography. The global longitudinal strain (GLS) of the left ventricle (LV) and left atrial longitudinal strain (LALS) were evaluated. Patients were divided into Group A, with duration of CHIKV infection shorter than 12 months (12 patients) and Group B, with disease duration equal to or greater than 12 months (20 patients). Comparative statistical data were considered significant when p &amp;lt;0.05. Results The diameters and volumes of LV, Left atrium (LA), right ventricular (RV) diameter and RV wall thickness were increased in Group B. LV ejection fraction (EF) was lower in Group B patients. The GLS was decreased in both Groups and the regression equation with EF were significant (r = 0.74, r ² = 0.55, p &amp;lt;0.00001). LALS was decreased in Group B. Diastolic dysfunction was predominantly grade 1 in Group A and restrictive in Group B. Segmental alteration (akinesia, dyskinesia) occurred in 7 patients. No patient had a history of precordial pain or coronary disease, nor clear signs of myocardial infarction on the ECG. Seven patients were hypertensive and four were diabetic. Eccentric LV hypertrophy and concentric remodeling of the walls were observed in 14 patients. Two patients had atrial fibrillation. Nine patients presented other types of arrhythmia, mainly ventricular extrasystoles. Conclusion Decreased EF of LV and SLG was observed in most patients with chronic CHIKV infection. In the first 12 months of evolution, the dimensions of the LV were normal, but after one year, most of the patients had dilatation of the cavity. LV concentric remodeling was more frequent in the first year and eccentric hypertrophy after one year of evolution. Segmental changes were observed in almost a quarter of the cases, as well as a high incidence of arrhythmias. All these findings suggest the progressive nature of the disease. Echocardiography plays an important role in the detection of cardiovascular alterations caused by Chicungunya fever and should be used after confirmation of infection, to initiate appropriate treatment already in the acute phase, which will probably minimize the deleterious effects of disease.

Impact of the Location of ST-T Abnormalities Accompanying Minor Q-Waves on the Definition of Prior Myocardial Infarction

According to the Fourth Universal Definition of myocardial infarction (MI), the likelihood of a previous MI is increased when ST-T abnormalities exist with minor Q-waves in the same leads. Therefore, we examined whether differences in location of ST-T abnormalities in relation to minor Q-waves as part of the old MI definition impact the prevalence and prognostic significance of MI. This analysis included 7,878 participants with available baseline electrocardiogram (ECG) and follow-up data from the third National Health and Nutrition Examination Survey. Two ECG MI definitions were utilized; both were based on the standards of the Minnesota Code (MC) ECG Classification, and both incorporated major Q-waves but differed in whether major ST-T abnormalities and minor Q waves, as part of the definition, were in the same lead group (Standard MC-MI) or not (Fourth Universal MI). All-cause mortality and cardiovascular disease mortality were ascertained during 14 years (median). We found no difference between baseline prevalence of Standard MC-MI (3.48%; n = 274) and Fourth Universal MI (3.27%; n = 258), p = 0.46. Also, Standard MC-MI and Fourth Universal MI were similarly associated with increased risk of all-cause mortality (hazard ratio [95% confidence interval] 1.64 [1.42 to 1.90] and 1.61 [1.38 to 1.87], respectively; p value for differences in associations = 0.86), and cardiovascular disease mortality (hazard ratio [95% confidence interval] 1.99 [1.61 to 2.48] and 1.94 [1.56 to 2.42], respectively; p value for differences in associations = 0.84). In conclusion, the location of ST-T abnormalities accompanying minor Q-waves does not impact the prevalence or prognostic significance of a prior MI which raise doubts about the clinical impact of considering the location of ST-T in relation to minor Q-waves when defining an old MI.

T2 and T2∗ mapping in ex situ porcine myocardium: myocardial intravariability, temporal stability and the effects of complete coronary occlusion.

Diagnosis of ischaemia-related sudden cardiac death in the absence of microscopic and macroscopic ischaemic lesions remains a challenge for medical examiners. Medical imaging techniques increasingly provide support in post-mortem examinations by detecting and documenting internal findings prior to autopsy. Previous studies have characterised MR relaxation times to investigate post-mortem signs of myocardial infarction in forensic cohorts. In this prospective study based on an ex situ porcine heart model, we report fundamental findings related to intramyocardial variability and temporal stability of T2 as well as the effects of permanent coronary occlusion on T2 and T2∗ relaxation in post-mortem myocardium. The ex situ porcine hearts included in this study (n= 19) were examined in two groups (Ss, n= 11 and Si, n= 8). All magnetic resonance imaging (MRI) examinations were performed ex situ, at room temperature and at 3 T. In the Ss group, T2 mapping was performed on slaughterhouse porcine hearts at different post-mortem intervals (PMI) between 7 and 26 h. Regarding the intramyocardial variability, no statistically significant differences in T2 were observed between myocardial segments (p= 0.167). Assessment of temporal stability indicated a weak negative correlation (r=- 0.21) between myocardial T2 and PMI. In the Si group, animals underwent ethanol-induced complete occlusion of the left anterior descending artery. T2 and T2∗ mapping were performed within 3 h of death. Differences between the expected ischaemic and remote regions were statistically significant for T2 (p= 0.007), however not for T2∗ (p= 0.062). Our results provide important information for future assessment of the diagnostic potential of quantitative MRI in the post-mortem detection of early acute myocardial infarction.

Acute myocardial infarction in an elderly patient treated for lung cancer

There is a growing number of elderly patients, so it is necessary to create new standards of oncologic care for such individuals in order to provide them with the best possible treatment. An elderly woman was treated for locally advanced small-cell lung cancer. Due to the suspicion of coronary disease, arterial hypertension and age, anti-cancer treatment with carboplatin and etoposide was recommended. When carboplatin infusion came to a stop, signs of myocardial infarction in ECG as well as elevated levels of troponin I were reported. Originally, non-invasive treatment was introduced, but several days later three DES stents were placed in coronary arteries. An attempt was made to treat the patient with cisplatin and etoposide, after which respiratory failure, tumor lysis syndrome and pancytopenia occurred. That is why chemotherapy was discontinued at the time. The patient’s tumor area and brain was irradiated. 16 months later, she is still alive without signs of disease progression. New oncologic standards should be elaborated in order to ensure appropriate treatment for elderly patients.

Abstract P375: Secular Trends in Validity of Troponin I Assays for Myocardial Infarction Classification Among Four US Communities: Findings From the ARIC Study

Introduction: The Atherosclerosis Risk In Communities (ARIC) study conducted community surveillance of hospitalized myocardial infarction (MI) from 1987 to 2014 among four US communities (Jackson MS, Forsyth County NC, Washington County MD, and Minneapolis MN). Surveillance of MI during the troponin era (1996 - ) has been complicated by increasing sensitivity of troponin I assays. It is unclear to what extent increased assay sensitivity has affected the validity of event classification. We hypothesized that among events that would have been classified as a definite/probable MI or a suspect/no MI regardless of cardiac biomarkers, the sensitivity and specificity of troponin I assays to identify abnormal enzyme levels (ARIC community surveillance criterion: 2x upper limit of normal) has changed over time in hospitals participating in ARIC community surveillance. Methods and results: From 33,995 community hospitalizations with suspicion of MI or coronary heart disease with a troponin I measurement that occurred between 1996 and 2014, 2,143 met ARIC criteria as MI cases (ARIC computer algorithm classification of definite or probable MI regardless of cardiac biomarker levels) and 9,909 we considered noncases (ARIC computer algorithm classification of no or suspect MI regardless of cardiac biomarker levels). In order to be an MI case, the event had to include an evolving diagnostic ECG. To be an noncase, the event had to include no chest pain and an equivocal or absent/uncodable ECG. We used survey-weighted logistic regression models to predict sensitivity and specificity from 1996 - 2014. The sensitivity of troponin I assay being abnormal was approximately 50% for most of the time period, with a potential increase to 70% after 2010. The specificity was approximately 90% in the late 1990s and early 2000s, but fell to 68% (95% confidence interval: 63% - 73%) by 2014. The median upper limit normal (ULN) for troponin I among all 33,995 hospitalizations dropped from 1.4 ng/mL in 1996 to 0.045 ng/mL in 2014. Conclusions: For most of the troponin era among the four ARIC communities, hospitalizations that were classified as an MI regardless of cardiac biomarker levels were equally likely to have or not have abnormal troponin I. In recent years, the likelihood that hospitalizations that were classified as no MI regardless of cardiac biomarker levels had normal troponin I decreased, potentially affecting the usefulness of troponin I measurements to separate hospitalized MIs from non-MIs in the context of community surveillance, particularly among hospitalizations with few other signs of MI. These shifts in assay validity were likely due in part to a decrease in ULN for troponin I in the four ARIC communities.

The comparison of clinical signs presentation in middle age men and women with myocardial infarction

Introduction: Acute myocardial infarction (MI) indicates irreversible myocardial injury resulting in necrosis of a significant portion of myocardium. MI is associated with high mortality. The difference between the signs of MI in each gender is unclear. The aim of this study was to describe gender-associated differences in symptom presentation after acute MI. Methods: This analytic-descriptive research was carried out on 102 patients (44 women and 58 men) with MI experience who referring in Shahid Mohamadi hospital and Abolfazl hospital, Hormozgan, Iran. Patients participating in the study were randomly selected. Individual information; the pain characteristics records, electrocardiogram and laboratory results, pain numerical rating scale, were collected. Results: The results showed that chest pain was the most common initial symptom in both men and women (92) This is while sweating in men (74) and dyspnea in women (61.4) as the second reported sign. No gender-related differences in other symptoms such as vomiting, nausea, dizziness, palpitations, pallor, epigastric pain, chills and weakness were observed. Conclusion: In this study in patients with MI, women had a worse-risk profile in comparison to men. No significant gender-related differences in symptoms were observed.