RESUMEN
BACKGROUND: The extent to which infarct artery impacts the extent of myocardial injury and outcomes in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention is uncertain. METHODS AND RESULTS: We performed a pooled analysis using individual patient data from 7 randomized STEMI trials in which myocardial injury within 30 days after primary percutaneous coronary intervention was assessed in 1774 patients by cardiac magnetic resonance (n=1318) or technetium-99m sestamibi single-photon emission computed tomography (n=456). Clinical follow-up was performed at a median duration of 351 days (interquartile range, 184-368 days). Infarct size and outcomes were assessed in anterior (infarct vessel=left anterior descending) versus nonanterior (non-left anterior descending) STEMI. Median infarct size (percentage left ventricular myocardial mass) was larger in patients with anterior compared with nonanterior STEMI (19.7% [interquartile range, 9.4%-31.7%] versus 12.6% [interquartile range, 5.1%-20.5%]; P<0.001). Patients with anterior compared with nonanterior STEMI were at higher risk for 1-year all-cause mortality (6.2% versus 3.6%; adjusted hazard ratio [HR], 1.66 [95% CI, 1.02-2.69]; P=0.04) and heart failure hospitalization (4.4% versus 2.6%; adjusted HR, 1.96 [95% CI, 1.15-3.36]; P=0.01). Infarct size was a predictor of subsequent all-cause mortality or heart failure hospitalization in anterior STEMI (adjusted HR per 1% increase, 1.05 [95% CI, 1.03-1.07]; P<0.001), but not in nonanterior STEMI (adjusted HR, 1.02 [95% CI, 0.99-1.05]; P=0.19). The P value for this interaction was 0.04. CONCLUSIONS: Anterior STEMI was associated with substantially greater myonecrosis after primary percutaneous coronary intervention compared with nonanterior STEMI, contributing in large part to the worse prognosis in patients with anterior infarction.
Asunto(s)
Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Tomografía Computarizada de Emisión de Fotón Único , Humanos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/cirugía , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Miocardio/patología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Factores de Riesgo , Tecnecio Tc 99m Sestamibi , Infarto de la Pared Anterior del Miocardio/terapia , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/cirugíaRESUMEN
The value of cardiovascular magnetic resonance (CMR) in assessing and predicting acute right ventricular (RV) dysfunction in patients with anterior ST-segment elevation myocardial infarction (STEMI) remains ascertained. Eighty eight patients with anterior STEMI were prospectively recruited and underwent CMR examinations within one week following the coronary intervention. Patients with RV ejection fraction (RVEF) less than 2 standard deviations below the average at the center (RVEF ≤ 45.0%) were defined as having RV dysfunction. The size of infarction, segmental wall motion, and T1 and T2 mapping values of global myocardium and the interventricular septum (IVS) were measured. Predictive performance was calculated using receiver-operating characteristic curve analysis and logistic regression test. Twenty two patients presented with RV dysfunction. The RV dysfunction group had a larger IVS infarct extent (54.28 ± 10.35 vs 33.95 ± 15.09%, P < 0.001) and lower left ventricle stroke volume index (33.93 ± 7.96 vs 42.46 ± 8.14 ml/m2, P < 0.001) compared to the non-RV dysfunction group. IVS infarct extent at 48.8% best predicted the presence of RV dysfunction with an area under the curve of 0.864. Left ventricular stroke volume index (LVSVI) and IVS infarct extent were selected by stepwise multivariable logistic regression analysis. Lower LVSVI (odds ratio [OR] 0.90; 95% confidence interval [CI], 0.79 to 0.99; P = 0.044) and higher IVS infarct extent (OR 1.16; 95% CI 1.05 to 1.33; P = 0.01) were found to be independent predictors for RV dysfunction. In patients with anterior STEMI, those with larger IVS infarct extent and worse LV function are more likely to be associated with RV dysfunction.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Imagen por Resonancia Cinemagnética , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST , Volumen Sistólico , Disfunción Ventricular Derecha , Función Ventricular Derecha , Tabique Interventricular , Humanos , Masculino , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Femenino , Persona de Mediana Edad , Disfunción Ventricular Derecha/fisiopatología , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología , Estudios Prospectivos , Anciano , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/fisiopatología , Infarto de la Pared Anterior del Miocardio/fisiopatología , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/terapia , Función Ventricular Izquierda , Factores de Riesgo , Intervención Coronaria PercutáneaRESUMEN
BACKGROUND: Myocardial strain can analyze early myocardial dysfunction after myocardial infarction (MI). However, the correlation between left ventricular (LV) strain (including regional and global strain) obtained by cardiac magnetic resonance (CMR) imaging and left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: The retrospective clinical observation study included patients with LVT (n = 20) and non-LVT (n = 195) who underwent CMR within two weeks after STEMI. CMR images were analyzed using CVI 42 (Circle Cardiovascular Imaging, Canada) to obtain LV strain values. Logistic regression analysis identified risk factors for LVT among baseline characteristics, CMR ventricular strain, and left ventricular ejection fraction (LVEF). Considering potential correlations between strains, the ability of LV strain to identify LVT was evaluated using 9 distinct models. Receiver operating characteristic curves were generated with GraphPad Prism, and the area under the curve (AUC) of LVEF, apical longitudinal strain (LS), and circumferential strain (CS) was calculated to determine their capacity to distinguish LVT. RESULTS: Among 215 patients, 9.3% developed LVT, with a 14.5% incidence in those with anterior MI. Univariate regression indicated associations of LAD infarct-related artery, lower NT-proBNP, lower LVEF, and reduced global, midventricular, and apical strain with LVT. Further multivariable regression analysis showed that apical LS, LVEF and NT-proBNP were still independently related to LVT (Apical LS: OR = 1.14, 95%CI (1.01, 1.30), P = 0.042; LVEF: OR = 0.91, 95%CI (0.85, 0.97), P = 0.005; NT-proBNP: OR = 2.35, 95%CI (1.04, 5.31) ). CONCLUSION: Reduced apical LS on CMR is independently associated with LVT after STEMI.
Asunto(s)
Imagen por Resonancia Cinemagnética , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST , Volumen Sistólico , Función Ventricular Izquierda , Humanos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Factores de Riesgo , Contracción Miocárdica , Fragmentos de Péptidos/sangre , Análisis Multivariante , Fenómenos Biomecánicos , Péptido Natriurético Encefálico/sangre , Curva ROC , Trombosis/diagnóstico por imagen , Trombosis/fisiopatología , Trombosis/etiología , Factores de Tiempo , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/fisiopatología , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/terapia , Oportunidad Relativa , Distribución de Chi-Cuadrado , Cardiopatías/diagnóstico por imagen , Cardiopatías/fisiopatología , Cardiopatías/etiologíaRESUMEN
BACKGROUND: The aim of this study was to perform a retrospective analysis of patients with acute anterior wall ST-segment elevation myocardial infarction (AAW-STEMI) whose left anterior descending (LAD) artery was completely occluded and reperfused by primary percutaneous coronary intervention (PPCI) and to determine the influencing factors and prognostic value of left ventricular systolic dysfunction (LVSD) in the acute phase of acute myocardial infarction (AMI). METHODS: A total of 304 patients with AAW-STEMI were selected. The selected patients were divided into two groups: the preserved left ventricular ejection fraction (pLVEF) group (LVEF ≥ 50%, n = 185) and the reduced left ventricular ejection fraction (rLVEF) group (LVEF < 50%, n = 119). The influencing factors of LVSD and their predictive value for LVSD were analyzed. Patients were followed up by examining outpatient records and via telephone. The predictive value of LVSD for the cardiovascular mortality of patients with AAW-STEMI was analyzed. RESULTS: Age, heart rate (HR) at admission, number of ST-segment elevation leads (STELs), peak creatine kinase (CK) and symptom to wire-crossing (STW) time were independent risk factors for LVSD (P < 0.05). The receiver operating characteristic (ROC) analysis showed that the peak CK had the strongest predictive value for LVSD, with an area under the curve (AUC) of 0.742 (CI, 0.687 to 0.797) as the outcome. At a median follow-up of 47 months (interquartile range, 27 to 64 months), the KaplanâMeier survival curves up to 6-year follow-up revealed a total of 8 patients succumbed to cardiovascular disease, with 7 (6.54%) in the rLVEF group and 1 (0.56%) in the pLVEF group, respectively (hazard ratio: 12.11, [P = 0.02]). Univariate and multivariate Cox proportional hazards regression analysis demonstrated that rLVEF was an independent risk predictor of cardiovascular death in patients with AAW-STEMI discharged after PPCI (P < 0.01). CONCLUSIONS: Age, HR at admission, number of STELs, peak CK, and STW time may be used to identify patients with a high risk of heart failure (HF) in a timely manner and initiate early standard therapy for incident LVSD in the acute phase of AAW-STEMI reperfused by PPCI. A trend toward increased cardiovascular mortality at follow-up was significantly linked to LVSD.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Infarto del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Disfunción Ventricular Izquierda , Humanos , Función Ventricular Izquierda , Volumen Sistólico , Pronóstico , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/terapia , Vasos Coronarios , Intervención Coronaria Percutánea/efectos adversos , Pacientes Ambulatorios , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/terapia , Creatina Quinasa , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/terapiaRESUMEN
BACKGROUND: The incidence of left ventricular thrombus (LVT) after anterior acute myocardial infarction (AMI) has not been well established in the era of primary percutaneous coronary intervention (pPCI) and potent dual antiplatelet therapy. The objective of this study is to establish the contemporary incidence of LVT in this population, to identify their risk factors, and to examine their association with clinical outcomes. METHODS: A multicenter retrospective cohort study including AMI patients with new-onset antero-apical wall motion abnormalities treated with pPCI between 2009 and 2017 was conducted. The primary outcome was LVT during the index hospitalization. Predictors of LVT were identified using multivariate logistic regression. Net adverse clinical events (NACE), a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or BARC type 3 or 5 bleeding at 6 months were compared between the LVT and no LVT groups. RESULTS: Among the 2136 patients included, 83 (3.9%) patients developed a LVT during index hospitalization. A lower left ventricular ejection fraction (LVEF) [adjusted odds ratio (aOR) 0.97; 95% confidence intervals (CI) 0.94-0.99] and the degree of worse anterior WMA (aOR 4.34; 95% CI 2.24-8.40) were independent predictors of LVT. A NACE occurred in 5 (5.72 per 100 patient-year) patients in the LVT group and in 127 (6.71 per 100 patient-year) patients in the no LVT group at 6 months [adjusted hazard ratio (aHR): 0.87; 95% CI 0.35-2.14]. CONCLUSIONS: The risk of LVT after anterior AMI with new-onset wall motion abnormalities is low, but this complication remains present in the contemporary era of timely pPCI and potent dual antiplatelet therapy .
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Cardiopatías , Infarto del Miocardio , Intervención Coronaria Percutánea , Trombosis , Humanos , Estudios Retrospectivos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Cardiopatías/etiología , Volumen Sistólico , Incidencia , Función Ventricular Izquierda , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Trombosis/diagnóstico , Trombosis/epidemiología , Trombosis/tratamiento farmacológico , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto de la Pared Anterior del Miocardio/terapia , Intervención Coronaria Percutánea/efectos adversosRESUMEN
Since the emergence of revascularisation for the treatment of myocardial infarction (MI), the incidence of left ventricular thrombus (LVT) has been declining. However, despite this, it is independently associated with increased morbidity and mortality rates. The mainstay of treatment is vitamin K antagonists, although non-vitamin K antagonists have been shown to be effective. Imaging plays an important role in the surveillance of LVT subsequent to MI. Herein, we emphasise the utility of multimodality imaging of a case of anterior MI complicated by a large LVT, and detail its management.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Infarto del Miocardio , Trombosis , Humanos , Ventrículos Cardíacos/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Trombosis/etiología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/terapia , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/terapia , Anticoagulantes/uso terapéuticoRESUMEN
Left ventricular (LV) apical thrombus formation is a well described and clinically important complication of acute myocardial infarction (MI) with a substantial risk of thromboembolism. Alterations in the inflammatory status may contribute to this complication. The aim of this study was to evaluate the predictive role of the systemic immune-inflammation index (SII) in identifying high risk patients who will develop an apical thrombus formation during the acute phase of anterior transmural infarction. Consecutive 1753 patients (mean age: 61.5â ±â 9.6 years; male: 63.8 %) with first acute anterior MI who underwent primary percutaneous coronary intervention were assessed. Patients were divided into 2 groups according to the presence of apical thrombus. SII was calculated using the following equation: neutrophil (N)â ×â platelet (P)â ÷â lymphocyte (L). LV apical thrombus was detected on transthoracic echocardiogram in 99 patients (5.6%). Patients with an apical thrombus had lower LV ejection fraction, prolonged time from symptoms to treatment, higher rate of post-percutaneous coronary intervention thrombolysis in myocardial infarction flowâ ≤1 and significantly higher mean high-sensitivity C-reactive protein, and SII values and lower lymphocyte than those without an apical thrombus. Admission SII level was found to be a significant predictor for early LV apical thrombus formation complicating a first-ever anterior MI. This simple calculated tool may be used to identify high-risk patients for LV thrombus and individualization of targeted therapy.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Infarto del Miocardio , Trombosis , Humanos , Masculino , Persona de Mediana Edad , Anciano , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/terapia , Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto del Miocardio/complicaciones , Trombosis/diagnóstico , Ecocardiografía , Inflamación/complicaciones , Proteína C-ReactivaRESUMEN
Left ventricular thrombus (LVT) after acute ST-segment elevation myocardial infarction (STEMI) are generally associated with poorer outcomes for patients at long-term follow-up. We hypothesis that tissue characteristics and strain parameters by cardiac magnetic resonance (CMR) imaging may indicate the interactions of LVT with ventricular myocardium remodeling at both acute stage and chronic stages in STEMI patients. This retrospective study included 111 consecutive STEMI patients (38 with LVT and 73 without LVT). All patients underwent CMR during acute stage (within 7 days) and chronic stage (after at least 2 months) periods after percutaneous coronary intervention (PCI). Left ventricular native T1, extracellular volume (ECV), radial, circumferential, and longitudinal strain were analyzed in both phases. Major adverse cardiac events (MACE, including cardiovascular death, myocardial reinfarction, and hospitalization for heart failure), thromboembolic and bleeding events, were the clinical endpoints of the study. During the acute stage, left ventricular ejection fraction (LVEF) (OR 0.77, P value = 0.01) and longitudinal strain (OR 1.90, P value < 0.001) were correlated with LVT formation. Strain parameters were reduced, while the native T1 and ECV values of both the infarcted area and remote myocardium were elevated in LVT patients. During the chronic stage, LVT resolved in 29 of 38 patients (76%). LVT remaining patients had lower LVEF, a larger LV, and higher ECV in the acute stage than those of the LVT-resolved patients. In the long-term follow up of 678 days, LVT (HR 2.45, P value = 0.02), aneurysm (HR 1.81, P value = 0.04), and native T1 (HR 2.44, P value = 0.01) were identified as three independent predictors of MACE, the incidence of thromboembolic events and bleeding events by a multivariable stepwise Cox proportional hazards regression. STEMI patients developing LVT had worse LV function, myocardial infarction extent, strain, and higher T1 and ECV values than STEMI patients without LVT. The LVT-remaining patients in the chronic stage had poorer functional and mapping parameters beginning in the first week. During the acute stage, LVEF and global longitudinal strain were independent correlated with LVT formation. During the long-term follow up, LVT, aneurysm and elevated myocardial T1 were associated with adverse outcomes in acute STEMI patients.
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Infarto de la Pared Anterior del Miocardio , Infarto del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Trombosis , Humanos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/complicaciones , Intervención Coronaria Percutánea/efectos adversos , Volumen Sistólico , Estudios Retrospectivos , Función Ventricular Izquierda , Valor Predictivo de las Pruebas , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/terapia , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/terapia , Infarto del Miocardio/complicaciones , Arritmias Cardíacas/complicaciones , Imagen por Resonancia Magnética/efectos adversosRESUMEN
AIMS: To explore treatment with Direct Oral Anticoagulants (DOACs) in left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI). BACKGROUND: Contemporary data regarding using DOACs for LVT after STEMI patients who underwent PCI is limited. OBJECTIVES: To investigate the efficacy and safety of DOACs on the treatment of LVT post STEMI and PCI. METHODS: This retrospective study enrolled patients with LVT post STEMI and PCI within 1month from onset who received warfarin or DOACs at discharge. The primary endpoint was LVT resolution. Secondary endpoints were major adverse cardiovascular events (MACEs), including death, stroke, systemic embolism (SE), myocardial infarction (MI) and major or minor bleeding. RESULTS: A total of 128 consecutive patients were recruited, of which 72 received warfarin and 56 DOACs [48 on rivaroxaban and 8 on dabigatran]. The rate of LVT resolution was higher within 1 month in the DOACs group than warfarin (26.8% vs. 11.1%; p = 0.022) (Kaplan-Meier estimates, p = 0.002). No significant differences were found at 3 months (p = 0.246), 6 months (p = 0.201), 9 months (p = 0.171) and 12 months (p = 0.442). No patients treated with DOACs had major bleeding, while two patients with warfarin had upper gastrointestinal bleeding (0 vs. 2 (2.8%); p = 0.209). No death or SE occurred. No significant differences on secondary endpoints were found in both the groups, including stroke, MI, minor bleeding and all bleeding events. CONCLUSION: DOACs appear to be a suitable alternative to warfarin for the management of LVT post STEMI, especially in patients who are intolerant to warfarin.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Infarto del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Accidente Cerebrovascular , Trombosis , Humanos , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/terapia , Warfarina/efectos adversos , Estudios Retrospectivos , Infarto de la Pared Anterior del Miocardio/terapia , Trombosis/diagnóstico por imagen , Trombosis/etiología , Hemorragia/inducido químicamente , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Anticoagulantes/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: Left ventricular thrombosis (LVT) is a common complication of acute ST-segment elevation myocardial infarction (STEMI). This study attempted to synthesize the available evidence to understand the incidence and risk factors of LVT in acute STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science for studies published from January 2001 to January 2022. The random-effects and fixed-effects model meta-analysis estimated pooled incidence, mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The Review Manager 5.4 software was used for meta-analysis performance. RESULTS: The results of meta-analysis showed that the incidence of LVT in acute STEMI treated by primary PCI was 4% (95% CI [0.03, 0.05]), and the overall pooled incidence in patients with anterior STEMI was 10.0% (95% CI [0.07, 0.12]). Anterior STEMI (OR = 11.93, 95% CI [6.25, 22.78], p = 0.0003), left anterior descending-related infarct (OR = 6.85, 95% CI [3.70, 12.66], p < 0.00001), left ventricular wall motion abnormalities (OR = 7.53, 95% CI [3.18, 17.82], p < 0.00001), and lower post-PCI LVEF (MD = 13.78, 95% CI [12.15, 15.41], p < 0.00001) were risk factors for post-PCI LVT. CONCLUSION: The incidence of LVT after acute STEMI in the PCI era remains high. This study provides a preliminary overview of STEMI patients at risk for post-PCI LVT and will help the design of prospective randomized controlled trials for the management and prevention of LVT.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Cardiopatías , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Trombosis , Humanos , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/cirugía , Intervención Coronaria Percutánea/efectos adversos , Incidencia , Estudios Prospectivos , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/terapia , Trombosis/epidemiología , Factores de Riesgo , Cardiopatías/epidemiología , Arritmias Cardíacas , Resultado del TratamientoRESUMEN
Acute myocardial infarction is an uncommon complication of infective endocarditis, burdened by high mortality and often underdiagnosed. Due to its reduced frequency, current guidelines do not always highlight this condition or provide clear indications regarding treatment. We present a case of acute coronary syndrome induced by the occlusion of the anterior descending artery, due to a septic embolus and treated by aspiration of the embolic material. The clinical-instrumental aspects necessary to raise the suspicion of endocarditis and make the diagnosis are then examined. Subsequently, all the possible therapeutic strategies and any complications of the traditional treatment of acute coronary syndromes during infectious valve disease are analyzed. Since clinical presentation may be extremely variable, the establishment of a multidisciplinary team would allow, in these cases, a more appropriate and complete diagnostic and therapeutic management.
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Síndrome Coronario Agudo , Infarto de la Pared Anterior del Miocardio , Embolia , Endocarditis Bacteriana , Endocarditis , Infarto del Miocardio , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto de la Pared Anterior del Miocardio/terapia , Embolia/complicaciones , Embolia/terapia , Endocarditis/complicaciones , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnósticoRESUMEN
Objective: This study aimed to observe the effect of dapagliflozin on left ventricular ejection function (LVEF) and left ventricular end-diastolic volume (LVEDV) in patients with acute anesthesia ST segment elevation myocardial infarction (ASTEMI) and explore the effect of prophylactic treatment on ventricular remodeling (VR). Methods. A retrospective cohort design was employed to collect 188 patients with anterior wall STEMI who received emergency percutaneous coronary intervention (PCI). The patients were divided into dapagliflozin group and control group. The baseline data, the results of echocardiography at 6 months and on admission, and the proportion of VR were compared between the two groups. Echocardiography followed up for the two groups for 6 months after PCI and VR (LVEDV increased ≥20%) were considered the main clinical outcomes. Single-factor and multifactor logistic regression was conducted to explore the preventive effect of dapagliflozin on VR in patients with anterior wall STEMI. Results. There were significant differences in gender, history of diabetes, glycosylated hemoglobin (Hb1AC), admission LVEF, Killip grade of heart failure, and brain natriuretic peptide (BNP) between the dapagliflozin group and the control group regarding the baseline data. Compared with the results of echocardiography at admission and 6 months, the decrease in LVEDV and the increase of LVEF at 6 months in the dapagliflozin group were significantly higher than those in the control group. During the follow-up of 6 months, the VR rate in the dapagliflozin group was significantly lower than that in the control group. Multifactor logistic regression analysis suggested that the risk of VR was reduced by taking dapagliflozin after the adjustment of the confounding factors. Additionally, the combined use of dapagliflozin, ACEI/ARB, and ß-block can further reduce the risk. Conclusion. Regular taking of dapagliflozin has a positive effect on the improvement of middle and LVEF and left ventricular volume enlargement in patients with anterior wall STEMI, as well as the prevention of the occurrence of VR.
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Infarto de la Pared Anterior del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina , Infarto de la Pared Anterior del Miocardio/terapia , Arritmias Cardíacas , Compuestos de Bencidrilo , Glucósidos , Humanos , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Remodelación VentricularRESUMEN
BACKGROUND: The clinical efficacy of the Impella for high-risk percutaneous coronary intervention (PCI) and cardiogenic shock remains under debate. We thus sought to investigate the protective effects on the heart with the Impella's early use pre-PCI using cardiac magnetic resonance imaging (CMRI). METHODS: We retrospectively evaluated the difference in the subacute phase CMR imaging results (19 ± 9 days after admission) between patients undergoing an Impella (n = 7) or not (non-Impella group: n = 18 [12 intra-aortic balloon pumps (1 plus veno-arterial extracorporeal membrane oxygenation) and 6 no mechanical circulation systems]) in broad anterior ST-elevation myocardial infarction (STEMI) cases. A mechanical circulation system was implanted pre-PCI. RESULTS: No differences were found in the door-to-balloon time, peak creatine kinase, and hospital admission days between the Impella and non-Impella groups; however, the CMRI-derived left ventricular ejection fraction was significantly greater (45 ± 13% vs. 34 ± 7.6%, P = 0.034) and end-diastolic and systolic volumes smaller in the Impella group (149 ± 29 vs. 187 ± 41 mL, P = 0.006: 80 ± 29 vs. 121 ± 40 mL, P = 0.012). Although the global longitudinal peak strain did not differ, the global radial (GRS) and circumferential peak strain (GCS) were significantly higher in the IMPELLA than non-IMPELLA group. Greater systolic and diastolic strain rates (SRs) in the Impella than non-Impella group were observed in non-infarcted rather than infarcted areas. CONCLUSIONS: Early implantation of an Impella before PCIs for STEMIs sub-acutely prevented cardiac dysfunction through preserving the GRS, GCS, and systolic and diastolic SRs in the remote myocardium. This study provided mechanistic insight into understanding the usefulness of the Impella to prevent future heart failure.
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Infarto de la Pared Anterior del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/terapia , Humanos , Imagen por Resonancia Magnética , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/terapia , Choque Cardiogénico/diagnóstico por imagen , Choque Cardiogénico/etiología , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
Objective To quantitatively evaluate the associations of infarct size, regional myocardial function examined by cardiac magnetic resonance feature tracking (CMR-FT) strain analysis with infarct location in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion. The patients were divided into the anterior wall myocardial infarction (AWMI) and nonanterior wall myocardial infarction (NAWMI) groups. Infarct characteristics were assessed by late gadolinium enhancement. Global and regional strains and associated strain rates in the radial, circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images. The associations of infarct size, regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod. Results There were 44 patients in the AWMI group and 51 in the NAWMI group. The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group (24.47±11.89, 21.06±12.08 %LV; t=3.928, P = 0.008). In infarct zone analysis, strains in the radial, circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group (z=-20.873, -20.918, -10.357, all P < 0.001). The volume (end-systolic volume index), total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group (all P < 0.001). Conclusion In STEMI patients treated by percutaneous coronary intervention, myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Infarto del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Infarto de la Pared Anterior del Miocardio/etiología , Infarto de la Pared Anterior del Miocardio/terapia , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/patología , Medios de Contraste , Estudios Retrospectivos , Función Ventricular Izquierda , Imagen por Resonancia Cinemagnética/métodos , Gadolinio , Imagen por Resonancia Magnética , Infarto del Miocardio/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Volumen SistólicoRESUMEN
Objective To quantitatively evaluate the associations of infarct size, regional myocardial function examined by cardiac magnetic resonance feature tracking (CMR-FT) strain analysis with infarct location in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion. The patients were divided into the anterior wall myocardial infarction (AWMI) and nonanterior wall myocardial infarction (NAWMI) groups. Infarct characteristics were assessed by late gadolinium enhancement. Global and regional strains and associated strain rates in the radial, circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images. The associations of infarct size, regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod. Results There were 44 patients in the AWMI group and 51 in the NAWMI group. The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group (24.47±11.89, 21.06±12.08 %LV; t=3.928, P = 0.008). In infarct zone analysis, strains in the radial, circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group (z=-20.873, -20.918, -10.357, all P < 0.001). The volume (end-systolic volume index), total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group (all P < 0.001). Conclusion In STEMI patients treated by percutaneous coronary intervention, myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.
Asunto(s)
Humanos , Infarto de la Pared Anterior del Miocardio/terapia , Infarto del Miocardio con Elevación del ST/patología , Medios de Contraste , Estudios Retrospectivos , Función Ventricular Izquierda , Imagen por Resonancia Cinemagnética/métodos , Gadolinio , Imagen por Resonancia Magnética , Infarto del Miocardio/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Intervención Coronaria Percutánea , Volumen SistólicoAsunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Infarto de la Pared Anterior del Miocardio/terapia , COVID-19/complicaciones , Vasos Coronarios/lesiones , Embolización Terapéutica , Lesiones Cardíacas/terapia , Infarto del Miocardio con Elevación del ST/terapia , Anciano , Angioplastia Coronaria con Balón/instrumentación , Infarto de la Pared Anterior del Miocardio/complicaciones , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , COVID-19/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Stents Liberadores de Fármacos , Resultado Fatal , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Humanos , Masculino , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/diagnóstico , Resultado del TratamientoRESUMEN
Type 2 myocardial infarction (T2MI) is an ischemic injury that occurs due to a mismatch between myocardial oxygen supply and demand. T2MI can occur with hypertensive crisis. Nevertheless, the impact of T2MI on hypertensive crisis outcome is poorly understood due to limited data. This study was a retrospective analysis of the National Readmission Database year 2018. Patients were included if the primary diagnosis was hypertensive crisis, hypertensive urgency, or hypertensive emergency. Patients were excluded if they had type 1 myocardial infarction (T1MI), severe sepsis, septic shock, gastrointestinal bleeding, or hemorrhagic anemia at index admission. The primary outcome was 90-day readmission with T1MI. Secondary outcomes were in-hospital mortality, length of stay, resource utilization, and all-cause 90-day readmission. Subgroup analysis was done according to urgency and emergency presentation. A total of 101,211 index hospitalizations were included in our cohort, of whom 3,644 (3.6%) received a diagnosis of T2MI. A total of 912 patients were readmitted within 90 days with T1MI. T2MI was an independent predictor of 90-day readmission with T1MI (adjusted odds ratio [aOR] 2.64, 95% confidence interval [CI] 1.90 to 3.66, p <0.01). Subgroup analysis including only hypertensive urgency and hypertensive emergency yielded similar results (aOR 2.80, 95% CI 1.56 to 5.01, p <0.01 and aOR 2.28, 95% CI 1.59 to 3.27, p <0.01, respectively). In conclusion, T2MI was an independent predictor of poor outcome in patients presenting with hypertensive crisis. Further studies are needed to guide the management of T2MI in this population.
Asunto(s)
Infarto de la Pared Anterior del Miocardio/complicaciones , Hipertensión/complicaciones , Readmisión del Paciente/tendencias , Sistema de Registros , Infarto de la Pared Anterior del Miocardio/mortalidad , Infarto de la Pared Anterior del Miocardio/terapia , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Humanos , Hipertensión/mortalidad , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiologíaAsunto(s)
Infarto de la Pared Anterior del Miocardio , Dolor en el Pecho/diagnóstico , Electrocardiografía/métodos , Revascularización Miocárdica/métodos , Miocardio/citología , Infarto del Miocardio con Elevación del ST , Supervivencia Tisular/fisiología , Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto de la Pared Anterior del Miocardio/fisiopatología , Infarto de la Pared Anterior del Miocardio/terapia , Dolor en el Pecho/etiología , Angiografía Coronaria/métodos , Ecocardiografía/métodos , Servicios Médicos de Urgencia/métodos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/terapia , Resultado del TratamientoAsunto(s)
Infarto de la Pared Anterior del Miocardio , Aneurisma Coronario , Vasos Coronarios , Displasia Fibromuscular , Infarto del Miocardio con Elevación del ST , Arteria Vertebral , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Infarto de la Pared Anterior del Miocardio/terapia , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/terapia , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Displasia Fibromuscular/diagnóstico por imagen , Displasia Fibromuscular/terapia , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/instrumentación , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/terapia , Stents , Resultado del Tratamiento , Arteria Vertebral/diagnóstico por imagenRESUMEN
BACKGROUND: Patients with type 2 myocardial infarction (T2MI) and other mechanisms of nonthrombotic myocardial injury have an unmet therapeutic need. Eligibility for novel medical therapy is generally uncertain. METHODS: We predefined colchicine, eplerenone and ticagrelor as candidates for repurposing towards novel therapy for T2MI or myocardial injury. Considering eligibility for randomisation in a clinical trial, each drug was classified according to indications and contraindications for therapy and survival for at least 24 hours following admission. Eligibility criteria for prescription were evaluated against the Summary of Medical Product Characteristics. Consecutive hospital admissions were screened to identify patients with ≥1 high-sensitivity troponin-I value >99th percentile. Endotypes of myocardial injury were adjudicated according to the Fourth Universal Definition of MI. Patients' characteristics and medication were prospectively evaluated. RESULTS: During 1 March to 15 April 2020, 390 patients had a troponin I>URL. Reasons for exclusion: type 1 MI n=115, indeterminate diagnosis n=42, lack of capacity n=14, death <24 hours n=7, duplicates n=2. Therefore, 210 patients with T2MI/myocardial injury and 174 (82.8%) who survived to discharge were adjudicated for treatment eligibility. Patients who fulfilled eligibility criteria initially on admission and then at discharge were colchicine 25/210 (11.9%) and 23/174 (13.2%); eplerenone 57/210 (27.1%) and 45/174 (25.9%); ticagrelor 122/210 (58.1%) and 98/174 (56.3%). Forty-six (21.9%) and 38 (21.8%) patients were potentially eligible for all three drugs on admission and discharge, respectively. CONCLUSION: A reasonably high proportion of patients may be considered eligible for repurposing novel medical therapy in secondary prevention trials of type 2 MI/myocardial injury.