Microvascular Injury Phenomena in Myocardial Infarction

Алексеева, Я. В.; Вышлов, Е. В.; Усов, В. Ю.; Марков, В. А.

doi:10.29001/2073-8552-2018-33-4-19-26

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…Феномен невосстановленного КК у пациента С. был диагностирован интраоперационно по отсутствию антеградного поступления контрастного вещества дистальнее места окклюзии по шкале TIMI [11], что является повседневной практикой в работе инвазивных стационаров [12,13]. Еще одним методом диагностики феномена невосстановленного КК интраоперационно является оценка перфузии миокарда (myocardial blush grade, MBG) [14], хотя многие авторы отмечают субъективность диагностики по этой шкале [1,3].…”

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The Clinical Value of no-Reflow Phenomenon in the Routing Operation of The Regional Vascular Center

et al. 2020

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Coronary no-reflow phenomenon (CNR) is a complication of primary percutaneous coronary intervention (PCI). According to different reports, CNR occurs in 10 to 60 % of cases. Despite the long history of studying this phenomenon many issues remain unsolved. This article presents a clinical case of electrocardiographically confirmed ST-segment elevation myocardial infarction. In this case, the CNR phenomenon occurred during PCI and was associated with heart rhythm disorders, left ventricular (LV) cavity dilatation with a decrease in LV contractility, and formation of intracavitary thrombus. The patient asked for medical care late, which could influence the development of CNR. This case demonstrates the clinical significance, diagnostic characteristics, and successful drug correction of the no-reflow phenomenon.

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Section: Discussionunclassified

The Clinical Value of no-Reflow Phenomenon in the Routing Operation of The Regional Vascular Center

et al. 2020

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Quantitative spect measurement of the tissue blood flow in myocardium by the absolute uptake of radiopharmaceutical <sup>99m </sup>TC -Technetril

Ussov

Soukhov

Babikov

et al. 2022

Transl. med. (Print)

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Background. Quantitative calculation of tissue blood flow by means of radionuclide emission tomography is of great importance in studies of myocardial blood supply. Quantifying blood flow with PET requires a medical cyclotron. 99mTc-Technetrile is a unique radiopharmaceutical (rfp) with a high and approximately the same extraction fraction by the myocardium and other tissues — chemical microspheres.Objective. Development of a technique for calculating tissue blood flow for a quantitative assessment of the blood supply to the heart muscle, according to the determination of tissue absorption of 99mTc-Technetrile during CardioSPECT.Design and methods. The distribution of rfp — chemical microspheres 99mTc-Technetrile in the body is proportional to blood flow. Determining the amount of accumulation of rfp in different regions can be performed using SPECT. Weused data of 14 patients with myocardial infarction, who underwent SPECT with 99mTc-Technetrile, with the calculation of tissue blood flow.Results. Evaluation of rMBF at rest in the area of unaffected myocardium revealed rMBF = 65±7 ml/min/100 g, in segments with the presence of viable myocardium according to the ultrasound test with dipyridamole rMBF = 53±7 ml/min/100 g, in postinfarction regions of the transmural damage to the left ventricular wall without viable myocardium rMBF = 27±8 ml/min/100 g.Conclusion. The calculation of tissue blood flow via CardioSPECT is useful for pathophysiological assessment of the blood supply to the heart muscle.

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Peculiarities of the ST-segment elevation myocardial infarction morphogenesis after mechanical restoration of epicardial blood flow without ECG signs of reperfusion

Nefedova,

Gazaryan,

Titova

2024

Medicinskij alfavit

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The aim of the study was to investigate the peculiarities of STEMI morphogenesis after mechanical restoration of epicardial blood flow without ECG signs of reperfusion. The autopsy data of 44 patients with STEMI who died at different times after PCI performed within the first 12 hours (27 cases), or 12–24 hours (17 cases), without ECG signs of reperfusion after the intervention, were analyzed. The comparison group consisted of 85 deceased without reperfusion therapy (RT). Histological examination of the myocardium was performed at following time: within 12 hours, at 13–24 hours, 2–4 days, 5–8 days, 9–15 and 16–22 days. The most common cause of death was acute left ventricular failure (ALVF) both in the group of blood flow restoration without ECG signs of reperfusion, and in the group without RT: 85 % and 79 %, respectively. In each of the two groups the number of deaths occurred in the first 12 hours exceeded one third, half of the patients died in the subsequent 12 hours, two thirds of the deaths occurred within further 2–3 days. The rates of risk factors: older age, anterior and recurrent myocardial infarction, three-vessel lesion of the coronary artery, and a large infarction area were similar in the two groups. From the first hours after PCI, the infarction zone was characterized by hemorrhagic imbibition, numerous injuries of the microcirculatory bed, by the signs of blood flow restoration in damaged vessels appeared from days 2–4, early manifestations of repair from days 5–7. In the MI group without PCI, the hemorrhagic demarcation started on days from 3–4, coagulation necrosis prevailed in the microvascular bed, signs of repair appeared at a later date. Multiple spasms and thromboses in the microvasculature may have been a response to a blood pressure drop that accompanies an acute decrease in the left ventricle contractile function caused by a large infarction area and/or unresolved complications arising during the interventions per se. This mechanism explains the rapid progression of left ventricular failure, the most common cause of death after the interventions with achieving the epicardial blood flow without ECG signs of reperfusion. The revealed microcirculation disorders reflect the absence of myocardial reperfusion, which is more prognostically significant than the restoration of epicardial blood flow.

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Microvascular Injury Phenomena in Myocardial Infarction

Cited by 4 publications

References 30 publications

The Clinical Value of no-Reflow Phenomenon in the Routing Operation of The Regional Vascular Center

The Clinical Value of no-Reflow Phenomenon in the Routing Operation of The Regional Vascular Center

Quantitative spect measurement of the tissue blood flow in myocardium by the absolute uptake of radiopharmaceutical <sup>99m </sup>TC -Technetril

Peculiarities of the ST-segment elevation myocardial infarction morphogenesis after mechanical restoration of epicardial blood flow without ECG signs of reperfusion

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