Presence of myocardial hypoenhancement on multidetector computed tomography after primary percutaneous coronary intervention in acute myocardial infarction predicts poor prognosis

Ogasawara, Shinyu; Mukawa, Hiroaki; Sone, Toshio; Tsuboi, Hideyuki; Morishima, Itsuro; Uesugi, Masayuki; Matsushita, Etsushi; Morita, Yasuhiro; Okumura, Kenji; Murohara, Toyoaki

doi:10.1016/j.ijcard.2015.01.085

Cited by 9 publications

(3 citation statements)

References 33 publications

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“…It has been shown that 65% of patients with acute STEMI still had microvascular obstruction following advanced percutaneous coronary procedures (18). The results of the cardiovascular magnetic resonance survey showed that microvascular obstruction was associated with a larger infarct size (19) and a poorer prognosis (20), confirming the close link between infarct size and microvascular obstruction.…”

Section: Enhancing the Microcirculation By Using Better Techniquesmentioning

confidence: 92%

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

Qiu¹,

Zhong²,

Feng³

et al. 2022

Quant Imaging Med Surg

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Background: This study aimed to evaluate the multiple interactions between therapeutic ultrasound (TUS), microbubbles (MB), and recombinant tissue plasminogen activator (r-tPA) by using three-dimensional (3D) ultrasound to examine the impact of thrombolysis with r-tPA on epicardial recanalization and microcirculation in patients with acute ST-segment-elevation myocardial infarction (STEMI).Methods: Acute thrombotic occlusion of the left anterior descending (LAD) artery was induced in 32 Bama pigs, who were fed a high-cholesterol diet and randomized into four groups: (I) a 3D-sono-assisted-thrombolysis (3D/TUS + MB + r-tPA) group; (II) a 3D/TUS + MB group; (III) a full-dose r-tPA group; and (IV) a 3D/TUS alone group. Epicardial angiographic recanalization rate, microcirculation in the at-risk myocardium, STsegment elevation on electrocardiogram, and changes in the at-risk myocardium and the myocardial infarct area were compared between the groups.Results: After treatment, distal LAD recanalization was observed in 87.5% (7/8) of pigs in the 3D/TUS + MB + r-tPA group, which was significantly higher than the rates observed in the 3D/TUS + MB (37.5%) and the full-dose r-tPA (50.0%) groups (all P<0.05). The average acoustic intensity in the 3D/TUS + MB + r-tPA group (193.78±10.15 dB) was also significantly higher than that in the 3D/TUS + MB (154.29±31.94 dB) and the r-tPA (141.42±28.31 dB) groups (all P<0.05). The decrease in ST-segment elevation in the 3D/TUS + MB + r-tPA group (1.31±1.22 mm) was significantly higher than that in the 3D/TUS + MB (5.38±1.77 mm) and the r-tPA (4.30±2.08 mm) groups (all P<0.05). Furthermore, the ratio of the infarcted myocardial area divided by the at-risk myocardial area was markedly lower in the 3D/TUS + MB + r-tPA group (0.51±0.14) than in the 3D/TUS + MB (0.69±0.28) and r-tPA (0.75±0.23) groups (all P<0.05).Conclusions: Three-dimensional sono-assisted-thrombolysis directly improves infarct-related recanalization rates, enhances microcirculation, reduces r-tPA dosage, and ameliorates the thrombolytic effect of r-tPA in acute STEMI.

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Section: Enhancing the Microcirculation By Using Better Techniquesmentioning

confidence: 92%

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

Qiu¹,

Zhong²,

Feng³

et al. 2022

Quant Imaging Med Surg

View full text Add to dashboard Cite

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“…MDCT performed immediately after PPCI could detect hypo-enhanced areas that were significantly associated with coronary angiographic no-reflow. 78 MDCT performed without contrast reinjection immediately after PPCI for the identification of heterogeneous enhancement could also predict the occurrence of MVO and adverse LV remodeling by CMR. 79 This approach is logistically difficult to implement in most centers.…”

Section: Msctmentioning

confidence: 99%

Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment–Elevation Myocardial Infarction Patients

Bulluck

Foin

Tan

et al. 2017

Circ: Cardiovascular Interventions

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For patients presenting with an acute ST-segment-elevation myocardial infarction, the most effective therapy for reducing myocardial infarct size and preserving left ventricular systolic function is primary percutaneous coronary intervention (PPCI). However, mortality and morbidity remain significant. This is partly attributed to the development of microvascular obstruction, which occurs in around 50% of ST-segment-elevation myocardial infarction patients post-PPCI, and it is associated with adverse left ventricular remodeling and worse clinical outcomes. Although microvascular obstruction can be detected by cardiac imaging techniques several hours post-PPCI, it may be too late to intervene at that time. Therefore, being able to predict the development of microvascular obstruction at the time of PPCI may identify high-risk patients who might benefit from further adjuvant intracoronary therapies, such as thrombolysis, vasodilators, glycoprotein IIb/IIIa inhibitors, and anti-inflammatory agents that may reduce microvascular obstruction. Recent studies have shown that invasive coronary physiology measurements performed during PPCI can be used to assess the coronary microcirculation. In this article, we provide an overview of the various invasive methods currently available to assess the coronary microcirculation in the setting of ST-segment-elevation myocardial infarction, and how they could potentially be used in the future for tailoring therapies to those most at risk.

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“…By injecting CM into the thoracic aorta, we emulate percutaneous cardiac interventions. The CM dose used is in the lower range of the doses patients undergoing such interventions usually receive [49][50][51][52], as compared on a per body surface area basis as required for dose-dependent adverse effects between species by regulatory bodies [50]. However, during cardiac interventions the CM is usually given by consecutive smaller injections.…”

Section: Issn: 2380-0585mentioning

confidence: 99%

Comparison of the Effects of Iodixanol and Iopamidol on Urine Flow, Urine Viscosity, and Glomerular Filtration in Rats

2015

J Urol Nephrol

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Dehydration is a major risk for contrast media (CM) induced acute kidney injury, yet prospective studies in human patients without ample hydration are not feasible. The freely drinking rat can serve as a model for hydropenic humans.We compared the effects of two CM, iso-osmolar iodixanol and lowosmolar iopamidol, on urine flow, urine viscosity and glomerular filtration rate (GFR) in non-hydrated rats, and studied the impact of hydration by saline. In four groups of rats, either iodixanol 320 mg iodine/mL or iopamidol 370 mg iodine/mL was injected as 1.5 mL bolus into the thoracic aorta. Two groups had access to drinking water only and two groups received additional saline infusion (4 mL/hour per kg) starting 60 min before CM injection. Urine was collected (10 min sampling periods), urine viscosity measured, and GFR determined by creatinine clearance. In nonprehydrated rats, iodixanol led to a massive increase in urine viscosity and a transient 50% drop in GFR. Iopamidol had a much stronger diuretic effect than iodixanol, urine viscosity increased much less and GFR was unaffected. Saline infusion blunted the viscosity rise and transient decline in GFR caused by iodixanol. It is concluded that the choice of CM and ample hydration are important elements in the prevention of CM induced kidney injury. Low-osmolar iopamidol has a better renal safety profile than iso-osmolar iodixanol, at least in non-hydrated subjects. Hydration by saline counteracts the renal tubular concentration of CM thereby alleviating the increase in urine viscosity and the decline in GFR.

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Presence of myocardial hypoenhancement on multidetector computed tomography after primary percutaneous coronary intervention in acute myocardial infarction predicts poor prognosis

Cited by 9 publications

References 33 publications

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment–Elevation Myocardial Infarction Patients

Comparison of the Effects of Iodixanol and Iopamidol on Urine Flow, Urine Viscosity, and Glomerular Filtration in Rats

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