Stage Of Acute Myocardial Infarction Research Articles

Abstract 028: Effects of N-acetyl-seryl-aspartyl-lysyl-proline on Inflammatory Cells During the Acute Stage of Myocardial Infarction

Background: The natural peptide N-Acetyl-Seryl-Aspartyl-Lysyl-Proline (Ac-SDKP) decreases inflammation in chronic diseases such as hypertension and heart failure. The effects of Ac-SDKP on acute inflammatory responses during myocardial infarction (MI) are unknown. During the first 72 hours post-MI, neutrophils, M1 macrophages (pro-inflammatory), and M2 macrophages (pro-resolution) and the release of myeloperoxidase (MPO) and matrix metalloproteinases (MMP) play a role in the development of cardiac rupture which is an uncommon, but fatal complication. We hypothesize that in the acute stage of MI, Ac-SDKP decreases the incidence of cardiac rupture and mortality by preventing the infiltration of immune cells and by decreasing the activation of MPO and MMP. Methods: MI was induced by the ligation of the left descending coronary artery in C57 mice. Vehicle or Ac-SDKP (1.6 mg/kg/d) was infused via osmotic minipump. Cardiac immune cell infiltration was assessed by flow cytometry, cardiac MPO and MMP activities were measured at 24-48 hrs post-MI. The incidence of cardiac rupture and mortality was determined at 7 days post-MI. Neutrophil migration was studied in vitro by chemotaxis transwell assay. Results: In infarcted mice, Ac-SDKP decreased the incidence of cardiac rupture from 51.0% (26 of 51 animals) to 27.3% (12/44; p=0.015) and mortality from 56.9% (29/51) to 31.8% (14/44; p=0.019). Ac-SDKP also reduced the cardiac infiltration by the M1 macrophages (veh: 1,495±236 vs Ac-SKDP: 765±69 cells/heart, p=0.027), without affecting M2 macrophages. Ac-SDKP did not affect neutrophil and MPO activity in vivo and neither affected neutrophil chemotaxis in vitro . However, Ac-SDKP prevented the activation of MMP-9 (veh: 3,686±508 vs Ac-SDKP: 1,696±512 optical density units, p=0.029) in infarcted hearts. Conclusion: Ac-SDKP prevents cardiac rupture and mortality in acute MI. These protective effects of Ac-SDKP are associated with a decrease in pro-inflammatory M1 macrophage infiltration and MMP-9 activation. Perspective: Cardiac rupture is an uncommon, but fatal complication of MI that could be prevented by the administration of Ac-SDKP or a peptidase resistant analog.

EFFECTS OF MYOCARDIAL INFARCTION IN PAST HISTORY AND PREINFARCTION SYNDROME ON DURATION OF PREHOSPITAL STAGE OF ACUTE MYOCARDIAL INFARCTION

Purpose. To compare duration of the prehospital stage of acute myocardial infarction (AMI) in patients with and without myocardial infarction in past medical history and with and without preinfarction syndrome over six years. Materials and methods. The study was based on 2008 and 2013 data form the information analysis database of the populationbased epidemiology program of the World Health Organization “Register of Acute Myocardial Infarction”. A total of 627 and 840 cases of AMI were analyzed in Tomsk in 2008 and 2013, respectively. The rates of individuals with AMI in past medical history were 170 (27.1 %) in 2008 and 223 (27.7 %) in 2013; the rates of patients with preinfarction syndrome were 382 (60.9 %) in 2008 and 448 (53.3 %) in 2013. Results. Among patients with and without AMI in past medical history, no significant differences were found in duration of prehospital stages between 2008 and 2015 both for the entire periods and for the temporal components of prehospital stage. Total duration of prehospital stage was longer in patients with preinfarction syndrome compared with those without it. It was true both for the entire prehospital stage duration and for the particular periods except the period of medical delay (physical examination and hospital admission) when the differences were insignificant. Conclusion. This study showed that AMI in past medical history significantly affected neither prehospital stage duration of index AMI nor promptness of seeking medical help by patients. Our results confirmed literature data suggesting that the presence of preinfarction syndrome contributes to the longer duration of the prehospital stage of AMI because patients get used to their pain and spend more time on making decision to seek medical assistance.

Plasma miR-1, miR-208, miR-499 as potential predictive biomarkers for acute myocardial infarction: An independent study of Han population

BackgroundIt has been demonstrated that circulating muscle-enriched miR-1 and the cardiac-specific miR-208 and miR-499 might leak out of the necrotic myocardium and release into the circulation during the early stages of acute myocardial infarction (AMI). This study aims to investigate potential predictive value of the three miRNAs in AMI. MethodsPlasma samples were taken from 70 AMI patients and 72 healthy controls. The expression levels of target miRNAs were measured by qRT-PCR. Student's t test and χ2 test were applied to test the significance of the differences between AMI patients and controls. Additionally, a meta-analysis about the prediction accuracy of the three miRNAs in AMI was performed to summarize all the results from available studies. ResultsThe expression of plasma miR-1, miR-208 and miR-499 were all significantly elevated in AMI patients compared with controls. By receiver operating characteristic (ROC) curve analysis, plasma miR-1, miR-208 and miR-499 were demonstrated to be potential biomarkers for the prediction of AMI with AUC values of 0.81, 0.72, and 0.88, respectively. The meta-analysis consisted of nine studies for miR-1, eight studies for miR-208 and eight studies for miR-499. The summary estimates of miR-1, miR-208 and miR-499 were 0.73, 0.80 and 0.83 for sensitivity, 0.82, 0.95 and 0.90 for specificity, 0.84, 0.89 and 0.91 for AUC, respectively. ConclusionIn summary, we confirmed the predictive values of plasma miR-1, miR-208 and miR-499 in AMI. In contrast to miR-1, the cardiac-specific miR-208 and miR-499 were supposed to be more reliable as biomarkers in AMI screening and prediction.

Gender-dependent profile of heart rate turbulence parameters in patients after acute myocardial infarction treated invasively.

The aim of this study was to determine whether gender is related to differences in heart rate turbulence (HRT) parameters and the authors' own predefined HRT categories comprising turbulence timing (TT) in patients at the early stage of acute myocardial infarction (AMI) treated invasively. We analysed 489 consecutive patients (147 females and 342 males, aged 63.9 ± 11.7 years) with AMI admitted to our department and treated invasively on admission to the hospital. On the fifth day after MI 24-h digital Holter recordings were performed to assess HRT, and the following HRT parameters were calculated in all patients using the HRTView pro-gram: turbulence onset (TO, %), slope (TS, ms/RR interval), and TT. The following values of HRT parameters were considered abnormal: TO ≥ 0, TS ≤ 2.5, and TT ≥ 10. Based on the abovementioned parameters, the authors defined their own HRT categories (A, B, C): A - comprising three normal parameters, B - one abnormal parameter, C - three abnormal parameters. TT was significantly later in women than in men: 7.5 ± 3.1 vs. 6.8 ± 3.1 (p < 0.05), respectively. When analysing the authors' own predefined HRT categories, significant differences between women and men were present in the occurrence of the category C, including all three abnormal HRT parameters: TO, TS, and TT. In women worse TT was present and all three abnormal HRT parameters occurred more frequently. HRT in women after AMI is profoundly altered compared to in men. This indicates greater autonomic dysfunction and higher risk for sudden cardiac death in women after AMI.

Comprehensive medical rehabilitation program after percutaneous coronary intervention for acute myocardial infarction in patients with coronary heart disease and arterial hypertension: efficacy, safety, and the results of remote monitoring

Objective. To evaluate the clinical effects and safety of an integrated rehabilitation program, appointed in the early stages of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in patients with arterial hypertension (AH), the analysis of the results at 1 year and 5 years.Material and methods. The study included men (n=62), acute myocardial infarction and undergone PCI in the period from 1 to 8 weeks after surgery. After initial clinical and instrumental examination, patients were randomized in 2 groups:basic “O” group (n=31), where patients were engaged in the educational program “School for patients after acute myocardial infarction” (hereinafter - School) with the involvement of controlled physical training (PT) and uncontrolled (at home) FT (FTdom);control “K” group (n=31), where patients were only trained in the School of Education with a recommendation to participate inuncontrolled FTdom. The patients were examined at the time of inclusion, 1.5, 4, 6 and 12 months. After 5 years, a telephone survey of patients in order to assess their clinical status.The Results. According to the results of exercise test (FN) at 6 and 12 months in the “O” significantly increased physical performance indicators: the duration of FN, its threshold power and total work performed. In the group of “K” after PCI, these figures also significantly increased, but to a lesser extent than in trained patients. By the 12th month in the “About” FN duration greater than that seen in the group “K” by 1.7 times (p

Differences in immune responses between CMV-seronegative and -seropositive patients with myocardial ischemia and reperfusion.

CMV infection is responsible for acceleration of immune senescence and linked to systemic pathologies, including cardiovascular diseases. In this study, we investigated differences in the immune response between CMV-seropositive and seronegative patients undergoing primary percutaneous coronary intervention (PPCI) for acute myocardial infarction (MI). Peripheral blood samples were taken at six different time points: pre-, 15, 30, 90 min, 24 h after PPCI and at 3 months after MI. Absolute counts of lymphocyte subpopulations, immune response to specific and nonspecific stimulation, serum cytokines and levels of CMV-IgG, cardiolipin-IgG, and anti-endothelial cell antibodies were assessed. CMV-seropositive patients with MI showed a twofold higher IFN-γ production to PHA-stimulation, up to 2.5-fold higher levels of IP-10 in serum and up to 30% lower serum levels of IL-16 compared to CMV-seronegative individuals. CMV-seropositive patients could be divided into two subgroups with high (IL-10Hi) and low (IL-10Lo) IL-10 serum levels during the acute stage of MI. The IL-10Hi CMV-seropositive subgroup showed an increased exit of late-differentiated T lymphocytes, NK and NKT-like cells from the circulation, which may potentially enhance cytotoxic damage in the ischemic myocardium. Finally, we did not observe an acceleration of autoimmunity by MI in CMV-seropositive individuals. The immune response during acute MI showed characteristic differences between CMV seronegative and seropositive patients, with a stronger pro-inflammatory response in seropositive patients. The effects of IP-10, IL-16, and IL-10 on characteristics of acute immune responses and formation of different immune profiles in CMV-seropositive individuals require further investigation.

Тип тромболитического препарата и частота острого повреждения почек у больных инфарктом миокарда

Aim of this study was to assess incidence and severity of acute kidney injury (AKI) in patients with ST-elevation (STE) myocardial infarction (MI) after thrombolytic therapy with alteplase or streptokinase. Among 292 included patients (227 men, 65 women, mean age 58 ± 11 years) 170 received streptokinase, 122 - alteplase. Coronary angiography in acute stage of MI was an exclusion criterion. Thrombolysis was effective in 213 (73%) patients. There was no statistically significant difference in effectiveness of thrombolysis among streptokinase or alteplase treated patients. Incidence of AKI in patients with STEMI was 25%. Both incidence and severity of AKI were higher in streptokinase treated patients. Only stage II-III AKI was significantly associated with higher in-hospital mortality.

Early eicosapentaenoic acid treatment after percutaneous coronary intervention reduces acute inflammatory responses and ventricular arrhythmias in patients with acute myocardial infarction: A randomized, controlled study

ObjectiveWe examined whether early loading of eicosapentaenoic acid (EPA) reduces clinical adverse events by 1month, accompanied by a decrease in C-reactive protein (CRP) values in patients with acute myocardial infarction (MI). BackgroundAcute MI triggers an inflammatory reaction, which plays an important role in myocardial injury. EPA could attenuate the inflammatory response. MethodsThis prospective, open-label, blinded endpoint, randomized trial consisted of 115 patients with acute MI. They were randomly assigned to the EPA group (57 patients) and the control group (58 patients). After percutaneous coronary intervention (PCI), 1800mg/day of EPA was initiated within 24h. The primary endpoint was composite events, including cardiac death, stroke, re-infarction, ventricular arrhythmias, and paroxysmal atrial fibrillation within 1month. ResultsAdministration of EPA significantly reduced the primary endpoint within 1month (10.5 vs 29.3%, p=0.01), especially the incidence of ventricular arrhythmias (7.0 vs 20.6%, p=0.03). Peak CRP values after PCI in the EPA group were significantly lower than those in the control group (median [interquartile range], 8.2 [5.6–10.2] mg/dl vs 9.7 [7.6–13.9] mg/dl, p<0.01). Logistic regression analysis showed that EPA use was an independent factor related to ventricular arrhythmia until 1month, with an odds ratio of 0.29 (95% confidence interval, 0.09 to 0.96, p=0.04). ConclusionsEarly EPA treatment after PCI in the acute stage of MI reduces the incidence of ventricular arrhythmias, and lowers CRP values.

Clinical aspects of vaso-and cardioprotection in patients with primary and recurrent myocardial infarction

The paper is devoted to characteristics of vascular and cardiac remodeling in patients with primary and recurrent myocardial infarction (MI). Data on multifocal atheroslerotic involvement of vessels in these patients associated with development of multivascular involvement of coronary arteries are presented. Emphasis is made on remodeling of vessels and the heart, parameters of vasodilation. We have elucidated frequency of vascular vasoconstrictory reactions in acute stage of MI and relationship between vascular and myocardial remodeling. Special consideration is given to possibility of correction of vascular vasoconstrictory reaction with indapamide. We have corroborated its administration starting from first days of treatment and demonstrated its effect during use for 3 months. We have established possibility of normalization of endothelium dependent vasodilation in most patients with primary MI. Expedience of the use of indapamide for prevention of development of chronic heart failure is stressed.

Effects of spironolactone and losartan on the early neovascularization of acute myocardial infarction.

The aim of the present study was to investigate the effects of spironolactone and losartan on the early healing stage of acute myocardial infarction (AMI) in rats. An AMI rat model was established and the rats were randomly divided into four groups: AMI (n=12), AMI + spironolactone (AMI + S; n=12), AMI + losartan (AMI + L; n=12) and AMI + spironolactone combined with losartan (AMI + S + L; n=12). Sham-operated rats served as a control group (n=12). The expression levels of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the non-infarcted myocardium surrounding the AMI area were determined using immunohistochemistry. In addition, the capillary density in the non-infarcted myocardium surrounding the AMI area was detected. The capillary densities around the infarcted area in the AMI and treatment groups at day 7 and 14 following AMI surgery were significantly higher compared with the sham-operated rats. Compared with the AMI group, the capillary densities around the infarcted area and the ratio of MMPs/TIMP-1 were increased in the treatment groups following AMI surgery; however, the increased ratio of MMPs/TIMP-1 was reduced at day 14 following AMI surgery. Therefore, these results indicated that spironolactone and losartan may promote the formation of collateral circulation in the non-infarcted tissue surrounding the infarcted area by regulating the production of MMPs.

SVCAM-1 vascular cell adhesion molecules and heart structural and functional changes in patients with acute left ventricular aneurism following myocardial infarction

Aim. To study the expression of sVCAM-1 soluble vascular cell adhesion molecules in patients with acute left ventricular aneurysm following myocardial infarction and assess the relationship with the processes of heart remodeling. Methods. 170 patients diagnosed with acute myocardial infarction in the presence of Q-wave were examined. The expression of sVCAM-1 soluble vascular cell adhesion molecule, electrocardiogram and Doppler echocardiography changes were studied depending on comorbidities and the development of acute left ventricular aneurysm following myocardial infarction. Results. ST-segment elevation was still detectable in patients with left ventricular aneurysm compared to patients with no aneurism on the 3rd and 5th day after the disease onset, its amplitude was significantly higher, no dynamic changes of the T-wave in the anterior chest leads were registered. The prevalence of left ventricular dilatation, mitral regurgitation, reduced systolic function of left ventricle and type II diastolic dysfunction was higher in patients with left ventricular aneurysm. The relationship between sVCAM-1 vascular adhesion molecules expression with early remodeling after the myocardial infarction and left ventricular aneurysm development in acute stage of myocardial infarction in the presence of Q-wave was revealed. Conclusion. In the presence of such comorbidities as hypertension and diabetes, a higher level of sVCAM-1 vascular adhesion molecules expression was revealed in patients with left ventricular aneurysm following myocardial infarction. ST-segment elevation and no dynamic changes of the T-wave were still registered by electrocardiography till the 5th day after the disease onset. Amplitudes of ST-segment and T-wave were significantly higher in patients with left ventricular aneurysm following myocardial infarction compared to patients with no complications of myocardial infarction.

VALIDITY OF AUTOMATED GLOBAL LONGITUDINAL STRAIN MEASUREMENTS WITH LOW-DOSE DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR THE ASSESSMENT OF MYOCARDIAL VIABILITY AFTER ACUTE MYOCARDIAL INFARCTION: COMPARISON WITH DELAYED ENHANCEMENT AND MICROVASCULAR OBSTRUCTION BY CARDIAC MAGNETIC RESONANCE IMAGING

Low-dose dobutamine stress echocardiography (DSE) assesses myocardial viability at the early stage of acute myocardial infarction (AMI), but its assessment is subjective and variable. Recently, automated function imaging (AFI) was shown to determine global longitudinal peak strain (GLPS) based on

The relationship between serum C-reactive protein and pre-albumin and the acute heart failure during the early stage of acute myocardial infarction patients

Objective To investigate the relationship between the serum high sensitive c-reactive protein (hs-CRP) and prealbumin (PAB) and the acute heart failure during the early stage of acute myocardial infarction (MI) patients.Methods A total of 181 MI patients (male:n =154,85.1％ vs.female:n =27,14.9％),admitted between Seppember 2010 and September 2012,were enrolled.They were divided into heart failure group (n =114,63.0％) with Killip classification recorded and control group (n =67,37.0％) without heart failure.The levels of serum hs-CRP and PAB were determined from the venous blood in the followed morning after admission.The clinical data were analyzed by logistic regression,Spearman correlation,and ROC curve.Results The serum level of hs-CRP (mg/L) in the heart failure group was significantly higher than that in the control group (P =0.000),while the serum level of PAB (mg/L) in the heart failure group was significantly lower than that in the control group (P =0.000).High level of hs-CRP and low level of PAB were significantly correlated with Killip classification (rhs-CRP =0.234,Phs-CRP =0.003 ; rPAB =-0.321,PPAB =0.000).Serum hs-CRP (P =0.023,OR 1.086,95％ Cl 1.012-1.167) and PAB (P =0.038,OR O.991,95％ CI O.983-0.999) were the independent risk biomarkers of acute heart failure subsequent to myocardial infarction determined by multivariate logistic regression analysis.The area under the ROC curve:AUChs-CRP =0.722,95％ CI 0.651-0.786; AUCPAB =0.723,95％ CI 0.652-0.787.Conclusions With high level of serum hs-CRP or low level of serum PAB during the early stage of acute myocardial infarction,patients were predisposed to the development of acute heart failure consequently.Both of them are the independent risk biomarkers of acute heart failure subsequent to myocardial infarction.Furthermore,they were significantly correlated with severity of the heart failure in terms of Killip classification. Key words: Myocardial infarction; Acute heart failure; High sensitive C-reactive protein; Prealbumin; Killip classification; ROC curve; Logistic regression analysis ; Risk factor

Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction: a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) Registry

IntroductionThere are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage.MethodsWe analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions.ResultsOf 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30 days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, more frequent concomitant in-hospital complications, and were less often managed invasively than those without CS.Five-year survival was 59% in patients with, versus 76% in those without shock (adjusted hazard ratio (HR) = 1.72 [1.24-2.38], P = 0.001). The excess of death associated with CS, however, was observed only during the first year (one-year survival: 77% vs 93%, adjusted HR: 2.87 [1.85 to 4.46] P <0.001), while survival from one to 5 years was similar (76% vs 82%, adjusted HR: 1.06 [0.64 to 1.74]). Propensity score-matched analyses yielded similar results.ConclusionsIn patients surviving the early phase of AMI, CS at the initial stage carries an increased risk of death up to one year after the acute event. Beyond one year, however, mortality is similar to that of patients without shock.Trial registrationClinicalTrials.gov number, NCT00673036, Registered May 5, 2008.

Incidence of sudden cardiac death after ventricular fibrillation complicating acute myocardial infarction: a 5-year cause-of-death analysis of the FAST-MI 2005 registry

Limited data are available on long-term prognosis or causes-of-death analysis among survivors of acute myocardial infarction (MI) according to whether or not they developed ventricular fibrillation (VF) during the acute stage of MI. Among 3670 MI patients hospitalized in France in 2005 and enrolled in this prospective follow-up cohort study, we assessed in-hospital mortality and 5-year cause of death among those who survived to hospital discharge, according to whether they developed VF (116 cases) or not, during the acute stage. 94.5% of patients had complete follow-up at 5 years. In-hospital mortality was significantly higher among VF patients (adjusted OR 7.38, 95% CI 4.27-12.75, P < 0.001). Among 3463 survivors at hospital discharge, 1024 died during a mean follow-up of 52 ± 2 months. The overall survival rate at 5 years was 74.4% (95% CI 72.8-76.0). In Cox multivariate analysis, occurrence of VF during the acute phase of MI was not associated with an increased mortality at 5 years (HR 0.78, 95% CI 0.38-1.58, P = 0.21). The distribution of causes of death at 5 years did not statistically differ according to the presence or absence of VF, especially for sudden cardiac death (13.1% in VF group vs.12.9% in non-VF group), despite a very low rate of implantation of cardioverter defibrillator in both groups (Overall rate 1.2%). Patients developing VF in the setting of acute MI are at higher risk of in-hospital mortality. However, VF is not associated with a higher long-term all-cause or sudden cardiac death mortality.

Influence of Microvascular Obstruction on Cellular Inflammation During Early Stages of Acute Myocardial Infarction: Evaluation Using Hybrid Pet-MRI Imaging

Microvascular obstruction (MO) has been associated with adverse left ventricular remodelling and worse outcomes following acute myocardial infarction (AMI). Marked reductions in microvascular blood flow is hypothesized to mitigate delivery of inflammatory cell species required for appropriate infarct healing and collagen deposition, a theory supported by investigations showing that non-selective suppression of inflammation soon following infarction is associated with infarct expansion and a higher incidence of ventricular arrhythmias. Given its potential as a therapeutic target the influence of MO on cellular inflammatory activity following AMI is of particular interest. In this study we exploit a new hybrid PET-MRI platform to serially examine MO and inflammatory cell activity in a non-reperfused canine infarct model using simultaneous, spatially registered volumetric imaging.

Myocardial Salvage is Reduced in Primary PCI-Treated STEMI Patients with Microvascular Obstruction, Demonstrated by Early and Late CMR

ObjectivesThis study evaluates the association between microvascular obstruction and myocardial salvage, determined by cardiac magnetic resonance performed both in the acute stage of myocardial infarction and after 4 months.MethodsIn patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, myocardial salvage, infarct size, left ventricular volumes, and ejection fraction were assessed by early (1–4 days) and follow-up (4 months) cardiac magnetic resonance. These variables were related to the presence or absence of microvascular obstruction at early investigation. Myocardial salvage was determined by: (1) myocardium at risk and infarct size measured in the acute stage and (2) myocardium at risk, measured acutely, and infarct size measured after 4 months. Multivariate analyses were performed, adjusting for clinical confounders at baseline.ResultsMicrovascular obstruction was present in 49 of 94 included patients, (52%). Myocardial salvage was significantly reduced in patients with microvascular obstruction, compared to those without: 23% vs. 38%, measured acutely, and 39.8% vs. 65.4%, after 4 months (p<0.001). The presence of microvascular obstruction was significantly and independently associated with large infarct size, lower left ventricular ejection fraction, and larger left ventricular end-systolic volume.ConclusionThe presence of microvascular obstruction demonstrated by cardiac magnetic resonance early after infarction was associated with impaired myocardial salvage. This association was more marked when based on measurement of infarct size after 4 months compared to assessment in the acute stage.

GW24-e2110 Analysis of Holter changes at acute and convalescence stage of myocardial infarction

ObjectivesAcute myocardial infarction can cause various arrhythmias. It is postulated that activation of autonomic nervous system induced arrhythmias. The developments of dynamic electrocardiogram provide some methods to evaluate the alternations...

English

BACKGROUND AND OBJECTIVE: At very early stages of acute myocardial infarction (AMI), highly sensitive biomarkers are still lacking. Human heart-type fatty acid- binding protein (H-FABP) has a high potential as an early marker for acute myocardial infarction (AMI) being more sensitive than current routine cardiac markers. The objective of this study is to determine the efficacy of a newly developed qualitative test to measure H eart- type fatty acid-binding protein (H-FABP) levels in the blood for the early diagnosis of acute myocardial infarction (AMI) in patients with chest pain and compared with cardiac Troponin T. DESIGN: Prospective study. METHODS: Fifty patients with acute ischemic-type chest pain were prospectively enrolled and classified according to the American Heart Association/American College of Cardiology guidelines. An initial blood sample was obtained for H-FABP, cTnT, and CK-MB (first 4 hours of symptoms). After 4 hours (4 - 12 hours), repeat samples of H-FABP, cTnT, and CK-MB were obtained. RESULTS: Fifty patients presenting to hospital with a median symptom onset of 3.3 hrs (IQR 2-6 h) were enrolled in this study and 38 (76%) had AMI. At presentation, H-FABP gave the highest sensitivity of 77% (95% CI: 60.7-88.9) and specificity of 91% (95% CI: 58.7-99.8) and troponin T (cTnT) gave the highest specificity of 100% (95% CI: 69.2-100). This study demonstrated that H-FABP immunotest gave a better diagnostic classification at the early stage. Also, AMI was identified significantly earlier by H-FABP than cTnT (29 vs. 8 patients, p<0.05). CONCLUSIONS: Assessment of Heart-type fatty acid-binding protein (H-FABP) within the first 4 h of symptoms is superior to cTnT for detection of AMI, and is a useful additional biomarker for patients with acute ischemic chest pain.

Blockade of spinal nerves inhibits expression of neural growth factor in the myocardium at an early stage of acute myocardial infarction in rats

Neural growth factor (NGF) is required for healing and sprouting of cardiac sympathetic and sensory nerves and plays important roles in cardiac protection, sustaining cardiac function and regeneration in ischaemic heart disease. The overexpression or lack of the NGF could be harmful to the heart. In this study, we examined the role of spinal nerves in the modulation of expression of the NGF in the myocardium at risk of ischaemia soon after acute myocardial infarction in rats. Coronary artery occlusion (CAO) was carried out in anaesthetized rats with and without preconditioning of blockade of the spinal nerves. The expression of the NGF protein and mRNA in the myocardium at risk of ischaemia was examined using immunohistochemical assay, enzyme-linked immunosorbent assay, and real-time quantitative reverse transcription polymerase chain reaction assay. In the left ventricle, immunoreactive cells and fibre-like structures were mainly located in the myocardium and in the epicardium. The NGF protein expression was increased by two-fold in the myocardium at risk of ischaemia during the 60 min of CAO, while the NGF mRNA was up-regulated three-fold, at 360 min after acute myocardial infarction. The blockade of the spinal nerves completely abolished the up-regulation of the NGF in the myocardium (P<0.05). The spinal nerves innervating the heart may play an important role in sustaining the up-regulation of the NGF in the myocardium early after acute myocardial infarction, an effect which can be inhibited by the blockade of these nerves.