Time ST-elevation Myocardial Infarction Research Articles

Left Atrial Volume Index (LAVI) as a Predictor of Outcome for First Time ST Elevation Myocardial Infarction (STEMI), Compared to Other Conventional Echocardiographic Parameters of Left Ventricular (LV) Function

AbstractBackground: Acute Heart Failure (AHF) complicates acute Myocardial Infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of Left Atrial Volume Index (LAVI) compared to other con-ventional parameters of systolic and diastolic Left Ventricular function (LV) in patients with first time ST Segment Elevation Myocardial Infarction (STEMI), in predicting in-Hospital Heart failure (HF), in-hospital mortality and development of heart failure and subsequent rehospitalisation over a follow-up period of 6 months.Material and Methods: The present study is a prospective observational study conducted in the Cardiology Department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to Coronary Care Unit (CCU). Left Ventricular Ejection Fraction (LVEF), LV End-Systolic and End-Diatolic Dimensions (LVESD and LVEDD), LAVI, diastolic and systo-lic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with the development of heart failure according to Killip classifi-cation on admission and 6 months later by NYHA classifica-tion.Results: There was a statistically significant difference regarding development of in-hospital HF (Killip classification >II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function except Isovolumetric Relaxation Time (IVRT) and E/A ratio, whereas in-hospital mortality was related signifi-cantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. (p-value <0.001).After 6 months of follow-up, there was a statistically significant relation between mortality development and the following variables; LAVI, EF, Deceleration Time (DT), IVRT, TDI (tissue Doppler imaging) septal e` and E/e` by univariate analysis. (p-value <0.001).A statistically significant correlation between development of HF symptoms according to NYHA classification and subsequent rehospitalization was observed with the previously mentioned variables except DT and IVRT by univariate analysis. (p-value <0.001).LAVI, EF, TDI septal e and E/e ratio had a statistically significant correlation with development of in-hospital HF (p-value <0.001), but only E/e ratio and TDI septal e` were significantly related to in-hospital mortality (p-value <0.05). All the previously mentioned four variables were significant predictors of mortality or symptoms of HF and rehospitalization over six months follow-up. (p-value <0.05).Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital HF with E/e` ratio being the most powerful predictor. (p-value=0.001) and LAVI ml/m2 was the most powerful predictor of mortality during the follow up period. (p-value=0.03).Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of HF and mortality both in the in-hospital setting and after a follow-up period of 6 months.LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor, LAVI and EF were the most powerful predictors of mortality and HF during a follow-up period of 6 months respectively.

Correlation of Reciprocal Changes and QRS Amplitude in ECG to Left Ventricular Dysfunction, Wall Motion Score and Clinical Outcome in First Time ST Elevation Myocardial Infarction.

Electrocardiogram (ECG) is the simplest tool for diagnosing ST Elevation Myocardial Infarction (STEMI). We can use a12 lead ECG for prognostication purposes also. The aim of the study was to find out the role of ECG as a prognostic marker in terms of clinical outcome and wall motion abnormality. It was a prospective study done in PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, from January 2014 to September 2014. Patients aged above 18 years admitted with first episode of ST EMI as per the inclusion and exclusion criteria were recruited for the study. Presence of reciprocal changes and QRS amplitude was measured from ECG. Presence of Left Ventricular Dysfunction (LVD) and wall motion score were calculated from ECG along with clinical outcome during first follow up visit. Statistical analysis was done using SPSS software. Probability was calculated using chi-square test, independent t-test and ANOVA analysis. A total of 120 patients were recruited for the study of which six were excluded based on the exclusion criteria. Among 114 patients analysed, 55 had reciprocal changes; 38 of them developed LVD which was statistically significant (p=0.002). Of the 78 patients with Anterior Wall Myocardial Infarction (AWMI), 35 had reciprocal changes; 15 (42.9%) of them had NYHA Class 1 symptoms, 14 (40%) had Class II and 4 (11%) had class III symptoms at follow up. The association was statistically significant (p=0.001). Similar statistically significant association was found in patients with Inferior Wall Myocardial Infarction (IWMI) who had reciprocal changes and NYHA symptoms at follow up (p=0.004). The mean wall motion score in patients with AWMI and reciprocal changes was 24.83 ± 4.1; whereas, without reciprocal changes was 23.98 ± 3.6; the association was not statistically significant. The mean QRS amplitude of all patients with LVD was 33.25 ±16.34. The association between QRS amplitude and LVD was not statistically significant. The overall mean wall motion score was 24.86 ± 3.91. The association between QRS amplitude and wall motion score was statistically significant (r value = 0.210). The association between QRS amplitude and wall motion score was statistically significant when we analysed AWMI (r= -0.147, p=0.199) and IWMI (r= -0.359, p=0.031) separately. ECG can be used as a tool for prognostication in acute STEMI. The presence of reciprocal changes in the ECG can signify poorer outcome on follow up. Lower QRS amplitude can be used as a predictor of larger infarct.

Response to: Relation of circumferential and longitudinal strain to other independent prognostic imaging markers in first time ST-elevation myocardial infarction

Response to: Relation of circumferential and longitudinal strain to other independent prognostic imaging markers in first time ST-elevation myocardial infarction

Relation of circumferential and longitudinal strain to other independent prognostic imaging markers in first time ST-elevation myocardial infarction

Relation of circumferential and longitudinal strain to other independent prognostic imaging markers in first time ST-elevation myocardial infarction

Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement

Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement

Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement

PurposeTo investigate whether myocardial deformation imaging, assessed by feature tracking cardiac magnetic resonance (FTI-CMR), would allow objective quantification of myocardial strain and estimation of functional recovery in patients with first time ST-elevation myocardial infarction (STEMI). MethodsCardiac magnetic resonance (CMR) imaging was performed in 74 consecutive patients 2–4days after successfully reperfused STEMI, using a 1.5T CMR scanner (Philips Achieva). Peak systolic circumferential and longitudinal strains were measured using the FTI applied to SSFP cine sequences and were compared to infarct size, determined by late gadolinium enhancement (LGE). Follow-up CMR at 6months was performed in order to assess residual ejection fraction, which deemed as the reference standard for the estimation of functional recovery. ResultsDuring the follow-up period 53 of 74 (72%) patients exhibited preserved residual ejection fraction ≥50%. A cut-off value of −19.3% for global circumferential strain identified patients with preserved ejection fraction ≥50% at follow-up with sensitivity of 76% and specificity of 85% (AUC=0.86, 95% CI=0.75–0.93, p<0.001), which was superior to that provided by longitudinal strain (ΔAUC=0.13, SE=0.05, z-statistic=2.5, p=0.01), and non-inferior to that provided by LGE (ΔAUC=0.07, p=NS). Multivariate analysis showed that global circumferential strain and LGE exhibited independent value for the prediction of preserved LV-function, surpassing that provided by age, diabetes and baseline ejection fraction (HR=1.4, 95% CI=1.0–1.9 and HR=1.4, 95% CI=1.1–1.7, respectively, p<0.05 for both). ConclusionsEstimation of circumferential strain by FTI provides objective assessment of infarct size without the need for contrast agent administration and estimation of functional recovery with non-inferior accuracy compared to that provided by LGE.

Circulating endothelial and platelet derived microparticles reflect the size of myocardium at risk in patients with ST-elevation myocardial infarction

ObjectivesMicroparticles (MP) are small membrane vesicles, released from activated, damaged and apoptotic endothelial cells (EMP) or platelets (PMP) that may actively modulate inflammation, coagulation and vascular function. We tested the hypothesis that the number of circulating EMP or PMP in acute myocardial infarction correlates with the myocardium at risk (MaR) and infarct size (IS). MethodsEMP were quantified in plasma samples of 36 patients (age: 63±10 years) with first time ST-elevation myocardial infarction (STEMI) using flow cytometry. EMP were defined as CD31+/CD42− MP and CD144+ MP and PMP as CD31+/CD42+ MP. MaR and IS was determined by cardiovascular magnetic resonance imaging one week after the index event. ResultsPlasma levels of CD31+/CD42− EMP were 251.0±178.8/μl and CD144+ 106.3±33.7/μl. PMP levels were 579.2±631.8/μl. MaR was 31.0±11.2% of the left ventricle and IS was 11.4±7.1% of the left ventricle. Patients with STEMI in the left anterior descending artery had higher levels of CD31+/CD42− EMP and PMP than those with other infarct-related arteries (p<0.05). The numbers of CD31+/CD42− EMP and PMP correlated to MaR, but not to IS. ConclusionsCirculating EMP and PMP correlate to the size of MaR in patients with STEMI suggesting that they reflect the severity of the endothelial injury and platelet activation during myocardial ischemia.

C-reactive protein, infarct size, microvascular obstruction, and left-ventricular remodelling following acute myocardial infarction

This study assessed the relationship between inflammatory mediators and indices of infarct size and left-ventricular (LV) remodelling following successful primary percutaneous coronary intervention (PCI) in patients with first time ST elevation myocardial infarction (MI). Forty-two patients admitted with an occluded single vessel were recruited consecutively. Cardiac magnetic resonance was used for serial assessment (2 days, 1 week, 2 months) of infarct size, microvascular obstruction (MO), and LV remodelling. Inflammatory mediators were analysed before and after PCI. Our major findings were: (1) Following PCI, there was a marked increase in plasma levels of C-reactive protein, closely correlated with an increase in interleukin-6 and terminal complement complex, reaching maximum 2 days after PCI; (2) C-reactive protein 2 days after PCI was significantly correlated with infarct size and parameters of LV remodelling 2 months after PCI; (3) Patients with persistent MO had significantly higher C-reactive protein levels 2 days following PCI. We suggest that the rapid increase in C-reactive protein levels in this model of successful revascularization of a single, totally occluded vessel reflects the degree of inflammation within the infarcted area. Our findings support a role for C-reactive protein-mediated complement activation as both a marker and mediator of myocardial damage following MI. Clinical study no.: NCT 00465868.