Impact of Early ST-Segment Changes on Cardiac Magnetic Resonance-Verified Intramyocardial Haemorrhage and Microvascular Obstruction in ST-Elevation Myocardial Infarction Patients

Ding, Song; Li, Zheng; Ge, Heng; Qiao, Zhiqing; Chen, Yilin; Andong, Ao-lei; Yang, Fan; Kong, Lingcong; Jiang, Meng; He, Ben; Pu, Jun

doi:10.1097/md.0000000000001438

Cited by 10 publications

(6 citation statements)

References 32 publications

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“…19 The Kaplan–Meier method was used for plotting time to event, and the log rank test was used to compare event-free survival curves. 20 Simple logistic regression analysis was used to assess univariate associations between patient characteristics, biochemical measurements, grayscale IVUS parameters, VH-IVUS parameters, and tertiles of PAPP-A levels.…”

Section: Methodsmentioning

confidence: 99%

“…Variables were compared between groups using t -test and analysis of variance or the Mann–Whitney nonparametric test (displayed as median and interquartile ranges [IQRs]) when the frequency distribution was skewed and not normally distributed. 19 The Kaplan–Meier method was used for plotting time to event, and the log rank test was used to compare event-free survival curves. 20 Simple logistic regression analysis was used to assess univariate associations between patient characteristics, biochemical measurements, grayscale IVUS parameters, VH-IVUS parameters, and tertiles of PAPP-A levels.…”

Section: Methodsmentioning

confidence: 99%

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Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease

Yang

et al. 2016

Medicine

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Pregnancy-associated plasma protein-A (PAPP-A) level is an independent predictor of acute cardiovascular event occurrence. To test the hypothesis that increased PAPP-A levels would be associated with a higher burden of coronary thin-cap fibroatheroma (TCFA) thereby underlying the heightened risk for cardiovascular events in patients with coronary artery disease; 154 patients (462 vessels and 975 plaques) with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) referred for percutaneous coronary intervention were assessed using 3-vessel virtual histology (VH)-intravascular ultrasound (IVUS). Thin-cap fibroatheroma virtual histology was defined as focal, necrotic core (NC)-rich (≥10% of cross-sectional area) plaques in contact with the lumen, and plaque burden ≥40%. Pregnancy-associated plasma protein-A levels were determined by sandwich enzyme-linked immunosorbent assay, and patients were divided into 3 groups based on PAPP-A level tertiles. Although the highest PAPP-A level tertile was not associated with 3-vessel plaque number, it was associated with 3-vessel VH-TCFA number and necrotic core volume. Patients with ≥3 VH-TCFAs had a higher PAPP-A level than patients with 1 to 3 VH-TCFAs or without any VH-TCFA (13.3 ± 11.8 versus 7.8 ± 4.7 versus 7.4 ± 4.7 mIU/L, P < 0.001, respectively). Moreover, PAPP-A level was an independent predictor of higher total number of VH-TCFAs (OR 1.18; 95% CI 1.07–1.29, P = 0.001). This VH-IVUS study demonstrated, for the first time to our knowledge, that higher PAPP-A levels are associated with higher 3-vessel TCFA burden in patients with coronary artery disease. Pregnancy-associated plasma protein-A, therefore, might be a useful serum biomarker to predict increased coronary TCFA burden and plaque instability.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease

Yang

et al. 2016

Medicine

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“…However, it revealed the importance of performing at least three slices of T2 mapping in the different myocardial segments, to increase MRI accuracy in depicting IMH in routine cardiac MR. Thirteen cases (35%) had MVO with IMH. The detected IMH in those cases was significant enough to reduce T2 mapping signals along the culprit artery's territory [15,20,21]. All cases that fulfilled the criteria of IMH by TRIM also showed reduced signals in the T2 mapping sequence denoting the T2 mapping's high sensitivity.…”

Section: Discussionmentioning

confidence: 89%

Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema

Kharabish

Hosny

Hassan

et al. 2021

Egypt J Radiol Nucl Med

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Background There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema. Results Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping < 60 ms). No statistical significance was found between the TIRM and the T2 mapping neither in the total amount of edema (p = 0.79), nor in the LV basal, mid, and apical segments’ edema (p = 0.69, 0.5, and 0.8 respectively). The upper and lower limits of agreements were tested between the TIRM and the T2 mapping of total edema mass, basal segments, mid, and apical ventricular segments were = 18 and − 7.7 g, 11.3 and − 5.1 g, 12.3 and − 5.2 g, and 15.5 and − 7.8 g respectively. Conclusion This study supports the proof of the principle that there is no statistical significant difference per myocardial segments between the T2 mapping and routine edema’s sequences. Larger studies are recommended to assess the impact in clinical outcome.

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“…Despite improvement in reperfusion strategies, patients who experience MVD following STEMI are known to exhibit a higher prevalence of early post-infarction complications, adverse left ventricular remodeling, recurrent hospitalizations, heart failure and mortality [3][4][5]20]. In the present study, restoration of myocardial perfusion was assessed angiographically by TMPFC, which measures the filling and clearance of contrast in the myocardium using cine-angiographic frame-counting to quantify myocardial tissue-level perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Microvascular dysfunction (MVD) is a common complication after reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI), which has been confirmed to be associated with increased post-procedural myocardial infarction occurrence, in-hospital mortality, adverse left ventricular (LV) remodeling and diminished recovery of LV function [1][2][3][4][5]. Traditional angiographic methods for assessment of myocardial tissuelevel perfusion were thrombolysis in myocardial infarction (TIMI) myocardial perfusion grading (TMPG) and myocardial blush grading (MBG), which were limited by their subjective and categorical nature [6,7].…”

Section: Introductionmentioning

confidence: 99%

Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion

Ding

Qiao

et al. 2016

Int J Cardiovasc Imaging

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To investigate the impact of microvascular dysfunction assessed by angiography on myocardial deformation assessed by two-dimensional speckle-tracking echocardiography in ST-segment elevation myocardial infarction (STEMI). A total of 121 STEMI patients who received primary percutaneous coronary intervention were included. Thrombolysis in myocardial infarction, Myocardial Perfusion Frame Count (TMPFC), a novel angiographic method to assess myocardial perfusion, was used to evaluate microvascular dysfunction. Two-dimensional speckle-tracking echocardiography was performed at 3-7 days after reperfusion. The infarction related regional longitudinal (RLS) strains as well as circumferential (RCS) and radial (RRS) ones, along with global longitudinal, circumferential (GCS), and radial (GRS) strains were measured. Patients with microvascular dysfunction had decreased peak amplitude of RLS (p = 0.012), RCS (p < 0.001), RRS (p = 0.012) at the regional level and decreased peak amplitude of GCS (p = 0.005), GRS (p = 0.012) at the global level. The RCS to RLS and RCS to RRS ratios were significantly different between patients without than with microvascular dysfunction (1.28 ± 0.31 vs. 1.07 ± 0.47, p = 0.027 and 0.69 ± 0.33 vs. 0.56 ± 0.28, p = 0.047). Receiver operator characteristics curves identified a cutoff value of 94 frames for TMPFC to differentiate between normal and abnormal wall motion score index in the sub-acute phase of STEMI (AUC = 0.72; p < 0.001). In the sub-acute phase of STEMI, the presence of microvascular dysfunction in infarcted tissue relates to reduced global and regional myocardial deformation. RCS alterations were more significant than RLS and RRS between patients with than without microvascular dysfunction. TMPFC was useful to predict left ventricular systolic dysfunction in the sub-acute phase of STEMI.

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Impact of Early ST-Segment Changes on Cardiac Magnetic Resonance-Verified Intramyocardial Haemorrhage and Microvascular Obstruction in ST-Elevation Myocardial Infarction Patients

Cited by 10 publications

References 32 publications

Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease

Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease

Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema

Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion

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