Circulating Erythrocyte Microparticles and the Biochemical Extent of Myocardial Injury in ST Elevation Myocardial Infarction

Cardiology ◽  
2016 ◽  
Vol 136 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Georgios Giannopoulos ◽  
Dimitrios A. Vrachatis ◽  
Georgios Oudatzis ◽  
Georgios Paterakis ◽  
Christos Angelidis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Myocardial Damage ◽  
Primary Angioplasty ◽  
St Elevation Myocardial Infarction ◽  
Vascular Effects ◽  
St Elevation

Objectives: Red blood cell microparticles (RBCm) have potential adverse vascular effects and they have been shown to be elevated in ST elevation myocardial infarction (STEMI). The purpose of this study is to investigate their relationship with biochemical infarct size. Methods: RBCm were quantified with flow cytometry in blood drawn from 60 STEMI patients after a primary angioplasty. The creatine kinase-myocardial brain fraction (CK-MB) was measured at predefined time points and the area under the curve (AUC) was calculated. Results: RBCm count was correlated with CK-MB AUC (Spearman's ρ = 0.83, p < 0.001). The CK-MB AUC values per RBCm quartile (lower to upper) were: 3,351 (2,452-3,608), 5,005 (4,450-5,424), 5,903 (4,862-10,594), and 8,406 (6,848-12,782) ng × h/ml, respectively. From lower to upper quartiles, the maximal troponin I values were: 42.2 (23.3-49.3), 49.6 (28.8-54.1), 59.2 (41.4-77.3), and 69.1 (48.0-77.5) ng/ml (p = 0.005). In multivariable analysis, RBCm remained a significant predictor of CK-MB AUC (standardized β = 0.63, adjusted p = 0.001). Conclusions: Erythrocyte microparticles appear to be related to the total myocardial damage biomarker output. The exact pathophysiologic routes, if any, for this interaction remain to be identified. However, these results suggest that erythrocytes may be a - thus far virtually ignored - player in the pathogenesis of ischemic injury.

scholarly journals P669 Functional remodeling of the left atrium after first acute ST-elevation myocardial infarction: a 3D echocardiography study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Jarjour ◽  
S Civera ◽  
A Vijiiac ◽  
B Elnagar ◽  
C Palermo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Atrium ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Troponin I ◽  
Myocardial Damage ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Functional Remodeling ◽  
St Elevation

Abstract Background Left atrium (LA) is a dynamic structure which is functionally coupled with the left ventricle and modulates its function in many cardiac conditions. The geometric and functional remodeling of the LA occurring early after myocardial infarction are poorly understood. Purpose We sought to evaluate the early changes in LA geometry and function occurring in survivors of a first acute ST-elevation myocardial infarction (STEMI), using three-dimensional echocardiography (3DE). Methods LA phasic volumes and strain (both longitudinal and circumferential) were measured using a dedicated automated software package in 54 patients at pre-discharge after STEMI, and in 54 age- and sex-matched healthy volunteers (controls), (figure 1). Results In STEMI patients, both maximal (LAV max) and minimal (LAV min) LA volumes were significantly larger than in controls 63 ± 15 vs. 53 ±11 ml; p = 0,002 and 38 ± 15 ml vs. 25 ± 6; p &lt;0.0001 (respectively). Moreover, when compared to controls (Table 1). Both longitudinal (LASr) and circumferential strain reservoirs showed a significant negative correlation with peak cardiac troponin I values (r=-0.344; p = 0.007 and r=-0.357; p = 0.005, respectively) as an estimate of the extent of myocardial damage. Conclusion STEMI was associated to significant geometrical and functional remodeling of the LA which was correlated with the extent of myocardial damage. Table 1 Controls STEMI patients P-value Longitudinal% LASr 21.8 ± 8.4 13.72 ± 8.27 &lt;0.0001 LAScd -12.8 ± 8.48 -6.43 ± 4.74 &lt;0.0001 LASct -9.73 ± 6.04 -7.26 ± 5.87 0.05 Circumferential % LASr-c 27.31 ± 8.07 18.92 ± 9.16 &lt;0.0001 LAScd-c -11.2 ± 5.93 -6.46 ± 5.68 0.0002 LASct-c -16.22 ± 6.33 -12.41 ± 5.94 0.004 LASr longitudinal strain reservoir, LAScd: longitudinal strain conduit, LAScd: longitudinal strain contraction, LASr-c: circumferential strain reservoir, LAScd-c: circumferential strain conduit , LASct-c:circumferential strain contraction Abstract P669 Figure 1

scholarly journals Complete versus simplified Selvester QRS score for infarct severity assessment in ST-elevation myocardial infarction

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Christina Tiller ◽  
Martin Reindl ◽  
Sebastian Johannes Reinstadler ◽  
Magdalena Holzknecht ◽  
Michael Schreinlechner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin T ◽  
Area Under The Curve ◽  
Reference Method ◽  
Myocardial Damage ◽  
Scoring Systems ◽  
St Elevation Myocardial Infarction ◽  
Clinical Tool ◽  
Microvascular Damage ◽  
St Elevation

Abstract Background Complete and simplified Selvester QRS score have been proposed as valuable clinical tool for estimating myocardial damage in patients with ST-elevation myocardial infarction (STEMI). We sought to comprehensively compare both scoring systems for the prediction of myocardial and microvascular injury assessed by cardiac magnetic resonance (CMR) imaging in patients with acute STEMI. Methods In this prospective observational study, 201 revascularized STEMI patients were included. Electrocardiography was conducted at a median of 2 (interquartile range 1–4) days after the index event to evaluate the complete and simplified QRS scores. CMR was performed within 1 week and 4 months thereafter to determine acute and chronic infarct size (IS) as well as microvascular obstruction (MVO). Results Complete and simplified QRS score showed comparable predictive value for acute (area under the curve (AUC) = 0.64 vs. 0.67) and chronic IS (AUC = 0.63 vs. 0.68) as well as for MVO (AUC = 0.64 vs. 0.66). Peak high sensitivity cardiac troponin T (hs-cTnT) showed an AUC of 0.88 for acute IS and 0.91 for chronic IS, respectively. For the prediction of MVO, peak hs-cTnT represented an AUC of 0.81. Conclusions In reperfused STEMI, complete and simplified QRS score displayed comparable value for the prediction of acute and chronic myocardial as well as microvascular damage. However, both QRS scoring systems provided inferior predictive validity, compared to peak hs-cTnT, the clinical reference method for IS estimation.

scholarly journals Influence of myocardial damage on serum procalcitonin in ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Reindl ◽  
C Tiller ◽  
M Holzknecht ◽  
I Lechner ◽  
B Henninger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Release Kinetics ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
St Elevation Myocardial Infarction ◽  
Funding Source ◽  
St Elevation ◽  
Hs Crp ◽  
Cmr Imaging

Abstract Background Myocardial tissue injury due to acute ST-elevation myocardial infarction (STEMI) initiates an inflammatory response with a release of systemic inflammatory biomarkers including C-reactive protein (CRP) and white blood cell count (WBCc), which, however, hampers the usefulness of these routine biomarkers to identify concomitant infections. The clinical role of Procalcitonin (PCT), a promising marker of bacterial infections, to detect concomitant infections in acute STEMI is unknown, mainly because it is unclear whether myocardial injury per se induces a systemic PCT release. Purpose To investigate release kinetics of serum PCT in the acute setting of STEMI and possible associations with myocardial injury markers as comprehensively assessed by cardiac magnetic resonance (CMR) imaging. Methods In this prospective observational study, we included 141 STEMI patients treated with primary percutaneous coronary intervention (PCI). Concentrations of PCT, high-sensitivity CRP (hs-CRP), WBCc and high-sensitivity cardiac troponin T (hs-cTnT) were measured serially at day 1 and day 2 after infarction. CMR imaging to assess infarct size (IS), extent of microvascular injury (MVI) and occurrence of intramyocardial haemorrhage (IMH) was performed within the first week following STEMI. Results Median concentrations of PCT were 0.07μg/l at both time points. In 140 patients (99%), both PCT values were within the normal range (≤0.5μg/l). Whereas hs-CRP, WBCc, and hs-TnT were significantly correlated with CMR markers of myocardial damage, PCT did not show significant correlations (all p&gt;0.10) with IS (PCT24h: r=0.07; PCT48h: r=0.13) or MVI (PCT24h: r=−0.03; PCT48h: r=0.09). Furthermore, PCT failed to discriminate between large and small IS or MVI or between presence and absence of IMH (AUC values:0.46–0.55). Conclusions In the acute phase after PCI for STEMI, circulating PCT remained unaffected by the extent of myocardial and microvascular tissue damage as visualized by CMR imaging. These data highlight the clinical potential of PCT to identify concomitant infections and to guide antibiotic treatments in STEMI patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund, Tiroler Wissenschaftsförderung

The effects of Allopurinol on levels of cardiac troponin Following Non-ST Elevation Myocardial Infarction: A Pilot Randomized Clinical Trial

2021 ◽  
Author(s):  
Sajad Khiali ◽  
Parvin Sarbakhsh ◽  
Sina Mashayekhi ◽  
Elham Mohamadrezapour ◽  
Samaneh Dousti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Standard Treatment ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
St Elevation Myocardial Infarction ◽  
St Elevation

Purpose: Given the potential anti-ischemic effects of allopurinol, we aimed to assess whether allopurinol administration may reduce myocardial injury following non-ST elevation myocardial infarction (NSTEMI). Methods: A randomized clinical trial (RCT) was conducted on 100 individuals with NSTEMI. The intervention group (n=50) received 600 mg oral allopurinol at the time of diagnosis of NSTEMI, followed by 300 mg every day for two next days and the standard treatment of NSTEMI, while the control group (n=50) received only the standard treatment. Serum concentrations of cardiac troponin I (cTnI) were measured at baseline, and 8, 16, 24, and 32 hours after the treatment. Results: The baseline demographic and clinical data of the patients were not statistically different between the intervention and control groups (all P > 0.05). The comparing estimated marginal mean ± standard error for cardiac troponin I (cTnI) levels revealed no significant difference between the study groups (2.93 ± .27, 2.25 ± .27; P=0.082). The linear mixed model results showed that the interaction of time and group was not statistically different (P=0.751). Moreover, there was a decreasing trend over time for cTnI in both groups (P=0.039). Conclusion: The present pilot RCT did not support the potential cardio-protective benefits of allopurinol administration on decreasing myocardial injury following NSTEMI.

Time-dependent effects of unfractionated heparin in patients with ST-elevation myocardial infarction transferred for primary angioplasty

2015 ◽  
Vol 198 ◽  
pp. 70-74 ◽  
Author(s):  
Teresa Giralt ◽  
Xavier Carrillo ◽  
Oriol Rodriguez-Leor ◽  
Eduard Fernandez-Nofrerias ◽  
Ferran Rueda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unfractionated Heparin ◽  
Primary Angioplasty ◽  
Time Dependent ◽  
St Elevation Myocardial Infarction ◽  
St Elevation

scholarly journals Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199299
Author(s):  
Wenlan Hu ◽  
Kaiping Zhao ◽  
Youzhou Chen ◽  
Jihong Wang ◽  
Mei Zheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Orthopaedic Surgery ◽  
Troponin I ◽  
Cox Regression ◽  
St Elevation Myocardial Infarction ◽  
Entire Cohort ◽  
St Elevation ◽  
Universal Definition ◽  
Long Term Mortality

Objective To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. Methods This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.

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