Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment–Elevation Myocardial Infarction

Carrick, David; Haig, Caroline; Ahmed, Nadeem; Carberry, Jaclyn; May, Vannesa Teng Yue; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Lindsay, Mitchell; Hood, Stuart; Watkins, Stuart; Davie, Andrew; Mahrous, Ahmed; Mordi, Ify; Ford, Ian; Radjenovic, Aleksandra; Oldroyd, Keith G.; Berry, Colin

doi:10.1161/circulationaha.116.022603

Cited by 153 publications

(126 citation statements)

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“…Variables with a P <0.05 in univariable analysis and possible confounders of PWV were entered in a multivariable model together with PWV. As previously discussed, due to the limited number of MACCE events, a maximum of 2 variables were entered in each model 17. Together with presence of multivessel disease, PWV, age, mean blood pressure, NT‐proBNP concentrations, and LV stroke volume were used as dichotomized variables for outcome analysis to allow for an adequate comparison of hazard ratios.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction

Feistritzer

Klug

Reinstadler

et al. 2017

JAHA

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BackgroundHigh aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far.Methods and ResultsThis prospective observational study included 160 consecutive patients with first acute ST‐elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2‐4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow‐up of 1.2 years (interquartile range 1.0‐3.1 years), 19 (12%) MACCE events occurred. Kaplan‐Meier analysis showed a significantly lower MACCE‐free survival in patients with high PWV (PWV >7.3 m/s, log‐rank P=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N‐terminal pro–brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4‐13.3; all P≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06‐0.17; P<0.001).ConclusionsIncreased aortic stiffness is an independent predictor of MACCE after acute ST‐elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification.

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Section: Methodsmentioning

confidence: 99%

Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction

Feistritzer

Klug

Reinstadler

et al. 2017

JAHA

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Section: Discussionmentioning

confidence: 78%

“…We previously found that an IMR value of >27 was most closely associated with microvascular obstruction and myocardial hemorrhage, whereas an IMR >40 was most closely associated with all‐cause death or heart failure 13. We also observed that IMR was associated with the systemic concentration of IL‐6 on the first day post‐STEMI, reflecting systemic inflammation and vascular injury 13. The current study extends these findings because a bimodal thermodilution waveform was associated with heart failure post–myocardial infarction, systemic inflammation (monocyte count), and circulating concentrations of NT‐proBNP early post–myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

“…The thermodilution curve (time [seconds] on x‐axis, temperature on y‐axis) was recorded in real time (RADIAnalyzer, Abbott Vascular, Santa Clara, CA) and available for analysis (Radiview 2.2, St Jude Medical, St. Paul, MN). IMR was calculated as the product of simultaneously measured distal coronary pressure (mm Hg) and mean hyperemic transit time (seconds), as previously described 12, 13…”

Section: Methodsmentioning

confidence: 99%

“…IMR is inversely associated with left ventricular (LV) function post‐MI12 and positively associated with infarct size12 and pathology 2. An IMR >40 is a multivariable associate of mortality post‐STEMI 12, 13…”

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confidence: 99%

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Coronary Thermodilution Waveforms After Acute Reperfused ST‐Segment–Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognosis

Yew

Carrick

Corcoran

et al. 2018

JAHA

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BackgroundInvasive measures of microvascular resistance in the culprit coronary artery have potential for risk stratification in acute ST‐segment–elevation myocardial infarction. We aimed to investigate the pathological and prognostic significance of coronary thermodilution waveforms using a diagnostic guidewire.Methods and ResultsCoronary thermodilution was measured at the end of percutaneous coronary intervention, (PCI) and contrast‐enhanced cardiac magnetic resonance imaging (MRI) was intended on day 2 and 6 months later to assess left ventricular (LV) function and pathology. All‐cause death or first heart failure hospitalization was a pre‐specified outcome (median follow‐up duration 1469 days). Thermodilution recordings underwent core laboratory assessment. A total of 278 patients with acute ST‐segment elevation myocardial infarction EMI (72% male, 59±11 years) had coronary thermodilution measurements classified as narrow unimodal (n=143 [51%]), wide unimodal (n=100 [36%]), or bimodal (n=35 [13%]). Microvascular obstruction and myocardial hemorrhage were associated with the thermodilution waveform pattern (P=0.007 and 0.011, respectively), and both pathologies were more prevalent in patients with a bimodal morphology. On multivariate analysis with baseline characteristics, thermodilution waveform status was a multivariable associate of microvascular obstruction (odds ratio [95% confidence interval]=5.29 [1.73, 16.22];, P=0.004) and myocardial hemorrhage (3.45 [1.16, 10.26]; P=0.026), but the relationship was not significant when index of microvascular resistance (IMR) >40 or change in index of microvascular resistance (5 per unit) was included. However, a bimodal thermodilution waveform was independently associated with all‐cause death and hospitalization for heart failure (odds ratio [95% confidence interval]=2.70 [1.10, 6.63]; P=0.031), independent of index of microvascular resistance>40, ST‐segment resolution, and TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade.ConclusionsThe thermodilution waveform in the culprit coronary artery is a biomarker of prognosis and may be useful for risk stratification immediately after reperfusion therapy.

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Deep Learning‐Based Optical‐Resolution Photoacoustic Microscopy for In Vivo 3D Microvasculature Imaging and Segmentation

Zhao

Huang

Zhou

et al. 2022

Advanced Intelligent Systems

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Optical‐resolution photoacoustic microscopy (OR‐PAM) technique is a noninvasive imaging technique that can be used to obtain high‐resolution images. This technique does not require the use of exogenous contrast agents. The technique can be effectively used to realize endogenous and exogenous imaging of microvasculature. However, the depth of focus (DOF) realized using OR‐PAM is low and inadequate to cover the entire 3D data for microvasculature imaging. A varying extent of signal‐to‐noise ratio (SNR) is recorded when varying depths of the 3D sample are studied. This significantly hindered the processes of image recognition, segmentation, and analysis. Herein, a deep learning‐based OR‐PAM technique to image and analyze 3D datasets is proposed. Endogenous and exogenous multi‐organ imaging data are sequentially imaged and segmented, and excellent generalization ability is observed. Wide‐field and ultradense exogenous 3D imaging of mouse brain vasculature located at different depths is obtained and segmented by OR‐PAM for the first time. The results reveal that the proposed method can be used for effectively imaging the entire microvasculature. The method can be potentially used for imaging the microcirculation system in clinics.

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Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment–Elevation Myocardial Infarction

Abstract: Supplemental Digital Content is available in the text.

Cited by 153 publications

References 61 publications

Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction

Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction

Coronary Thermodilution Waveforms After Acute Reperfused ST‐Segment–Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognosis

Deep Learning‐Based Optical‐Resolution Photoacoustic Microscopy for In Vivo 3D Microvasculature Imaging and Segmentation

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