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Minerva Cardioangiologica Feb 2007Cardiac magnetic resonance imaging (cMRI) is a promising non-invasive technique to assess the presence of coronary artery disease (CAD), which is free of ionizing... (Review)
Review
Cardiac magnetic resonance imaging (cMRI) is a promising non-invasive technique to assess the presence of coronary artery disease (CAD), which is free of ionizing radiation and iodine contrast. cMRI can detect CAD by angiographic methods or indirectly by perfusion stress techniques. While coronary angiography by cMRI remains limited to research protocols, stress perfusion cMRI is currently being applied worldwide in the clinical setting. Studies have shown good correlation between adenosine-induced stress myocardial perfusion cMRI and single-photon-emission computed tomography or positron emission tomography to detect CAD. Quantitative methods to analyze cMRI perfusion data have been developed in an attempt to provide a more objective imaging interpretation. Standardization of such quantitative methods, with minimal operator dependency, would be useful for clinical and research applications. Myocardial perfusion reserve (MPR), calculated using Fermi deconvolution technique, has been compared with well established anatomical and physiological CAD detection techniques. MPR appears to be the most accurate quantitative index to detect anatomical and hemodynamically significant CAD. Beyond physiological assessment of CAD, cMRI provides information regarding regional and global left ventricular function and morphology, myocardial infarction size, transmurality and viability. Such comprehensive information would require the performance of multiple tests if other modalities were used. This article describes current applications of cMRI for evaluation of patients with CAD.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Magnetic Resonance Imaging; Myocardial Reperfusion; Sensitivity and Specificity
PubMed: 17287685
DOI: No ID Found -
Journal of the American Heart... Feb 2024Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are well-established imaging biomarkers of failed myocardial tissue reperfusion in patients with...
BACKGROUND
Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are well-established imaging biomarkers of failed myocardial tissue reperfusion in patients with ST-segment elevation-myocardial infarction treated with percutaneous coronary intervention. MVO and IMH are associated with an increased risk of adverse outcome independent of infarct size, but whether the size of the culprit lesion vessel plays a role in the occurrence and severity of reperfusion injury is currently unknown. This study aimed to evaluate the association between culprit lesion vessel size and the occurrence and severity of reperfusion injury as determined by cardiac magnetic resonance imaging.
METHODS AND RESULTS
Patients (n=516) with first-time ST-segment-elevation myocardial infarction underwent evaluation with cardiac magnetic resonance at 4 (3-5) days after infarction. MVO was assessed with late gadolinium enhancement imaging and IMH with T2* mapping. Vessel dimensions were determined using catheter-based reference. Median culprit lesion vessel size was 3.1 (2.7-3.6) mm. MVO and IMH were found in 299 (58%) and 182 (35%) patients. Culprit lesion vessel size was associated with body surface area, diabetes, total ischemic time, postinterventional thrombolysis in myocardial infarction flow, and infarct size. There was no association between vessel size and MVO or IMH in univariable and multivariable analysis (>0.05). These findings were consistent across patient subgroups with left anterior descending artery and non-left anterior descending artery infarctions and those with thrombolysis in myocardial infarction 3 flow post-percutaneous coronary intervention.
CONCLUSIONS
Comprehensive characterization of myocardial tissue reperfusion injury by cardiac magnetic resonance revealed no association between culprit lesion vessel size and the occurrence of MVO and IMH in patients treated with primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.
Topics: Humans; Contrast Media; Gadolinium; Magnetic Resonance Imaging; ST Elevation Myocardial Infarction; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardial Reperfusion; Hemorrhage; Percutaneous Coronary Intervention; Microcirculation
PubMed: 38293938
DOI: 10.1161/JAHA.123.033102 -
The Israel Medical Association Journal... Nov 2006Rapid restoration of cerebral blood flow is the principle goal of acute ischemic stroke therapy. Intravenous recombinant tissue plasminogen activator is an effective...
BACKGROUND
Rapid restoration of cerebral blood flow is the principle goal of acute ischemic stroke therapy. Intravenous recombinant tissue plasminogen activator is an effective therapy for acute ischemic stroke. It has been available in the United States for over a decade and was approved for use in Israel at the end of 2004.
OBJECTIVES
To assess the implementation of intravenous rt-PA in routine clinical care at our center after its formal approval in Israel, and the therapeutic and logistic implications for reperfusion therapy for acute ischemic stroke in Israel.
METHODS
Patients with acute ischemic stroke admitted between January 2005 and June 2006 who were treated with intravenous rt-PA or endovascular-based reperfusion were reviewed. Implementation, timing, safety and clinical outcomes were assessed.
RESULTS
Forty-six patients received reperfusion therapy (37 with intravenous rt-PA and 9 with endovascular-based therapy), corresponding to 4.0% of ischemic stroke patients in 2005 and a projection of 6.2% in 2006. The mean age of intravenously treated patients was 67 years (range 22-85 years), median baseline NIHSS score was 14 (25-75%, 10-18) and the median 'onset to drug time' was 150 minutes (25-75%, 120-178). Symptomatic intracerebral hemorrhage and orolingual angioedema each occurred in one patient (2.7%). Significant clinical improvement occurred in 54% of treated patients, and 38% of patients were independent at hospital discharge.
CONCLUSIONS
The use of reperfusion therapy for acute ischemic stroke has increased in our center after the formal approval of rt-PA therapy to over 5%, with 'onset to drug time', safety and outcome after intravenous rt-PA treatment comparing favorably with worldwide experience. A prerequisite for the implementation of effective reperfusion therapy and expansion of the proportion of patients treated nationwide is the establishment of a comprehensive infrastructure.
Topics: Adult; Aged; Female; Humans; Israel; Male; Medical Records; Middle Aged; Myocardial Reperfusion; Severity of Illness Index; Stroke; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 17180831
DOI: No ID Found -
Age and Ageing Jan 2024The use of myocardial reperfusion-mainly via angioplasty-has increased in our region to over 95%. We wondered whether old and very old patients have benefited from this...
BACKGROUND
The use of myocardial reperfusion-mainly via angioplasty-has increased in our region to over 95%. We wondered whether old and very old patients have benefited from this development.
METHODS
Setting: Greater Paris Area (Ile-de-France).
DATA
Regional registry, prospective, including since 2003, data from 39 mobile intensive care units performing prehospital treatment of patients with ST segment elevation myocardial infarction (STEMI) (<24 h).
PARAMETERS
Demographic, decision to perform reperfusion and outcome (in-hospital mortality).
PRIMARY ENDPOINT
Reperfusion decision rate by decade over age 70.
SECONDARY ENDPOINT
Outcome.
RESULTS
We analysed the prehospital management of 27,294 patients. There were 21,311 (78%) men and 5,919 (22%) women with a median age of 61 (52-73 years). Among these patients, 8,138 (30%) were > 70 years, 3,784 (14%) > 80 years and 672 (2%) > 90 years.The reperfusion decision rate was 94%. It decreased significantly with age: 93, 90 and 76% in patients in their seventh, eighth and ninth decade, respectively. The reperfusion decision rate increased significantly over time. It increased in all age groups, especially the higher ones. Mortality was 6%. It increased significantly with age: 8, 16 and 25% in patients in their seventh, eighth and ninth decade, respectively. It significantly decreased over time in all age groups. The odds ratio of the impact of reperfusion decision on mortality reached 0.42 (0.26-0.68) in patients over 90 years.
CONCLUSION
the increase in the reperfusion decision rate was the greatest in the oldest patients. It reduced mortality even in patients over 90 years of age.
Topics: Male; Humans; Female; Aged, 80 and over; Aged; ST Elevation Myocardial Infarction; Prospective Studies; Myocardial Reperfusion; Hospital Mortality; France; Treatment Outcome; Registries
PubMed: 38167925
DOI: 10.1093/ageing/afad215 -
JACC. Cardiovascular Imaging Jun 2019
Topics: Haptoglobins; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Myocardial Reperfusion; Phenotype; Precision Medicine; Reperfusion Injury; ST Elevation Myocardial Infarction
PubMed: 29680354
DOI: 10.1016/j.jcmg.2018.03.010 -
PloS One 2016Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore,... (Observational Study)
Observational Study
The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry.
BACKGROUND
Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population.
METHODS
Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups.
RESULTS
Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not.
CONCLUSIONS
Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.
Topics: Aged; Aged, 80 and over; Anticoagulants; China; Female; Fibrinolysis; Fibrinolytic Agents; Heart Arrest; Heart Failure; Hemorrhage; Humans; Male; Myocardial Reperfusion; Percutaneous Coronary Intervention; Registries; ST Elevation Myocardial Infarction; Thrombolytic Therapy; Treatment Outcome
PubMed: 27812152
DOI: 10.1371/journal.pone.0165672 -
EuroIntervention : Journal of EuroPCR... Aug 2014The role of nurses and technicians in the treatment of ST-elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI) is vital for the... (Review)
Review
The role of nurses and technicians in the treatment of ST-elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI) is vital for the success of the multidisciplinary Heart Team. Several editorials have emphasised the importance of a holistic treatment which links each step of care to the next, a chain that is essential for quality and efficacy in the management of STEMI patients. In pre-hospital acute coronary care, the first medical contact is most commonly a nurse and/or a paramedic. The time from symptom onset to reperfusion is crucial for the long-term outcome. On arrival at the hospital, it is important for the nurse or paramedic to share an overview of what has been done to the patient so far, in a structured and evidence-based way, with the receiving nurse and physician. During PPCI, the role of nurses and technicians includes puncture site assessment, administration of pharmaceuticals and the ability to anticipate and prevent complications. In patients with cardiogenic shock and cardiac arrest, advanced knowledge of haemodynamic support systems is required. In the future, this knowledge must be extended from a limited number of individuals in a small number of centres to a standard of care which is available for all citizens throughout Europe. This review demonstrates the necessity for a multidisciplinary team approach where every person plays an equal, important role in every element of PPCI. The future role of nurses and technicians is intriguing and demands education and experience from an advanced medical and nursing point of view, where the multidisciplinary Heart Team and the knowledge of the different key players are vital.
Topics: Health Personnel; Humans; Myocardial Infarction; Myocardial Reperfusion; Percutaneous Coronary Intervention; Time Factors; Treatment Outcome
PubMed: 25256539
DOI: 10.4244/EIJV10STA13 -
Journal of Cardiology Aug 2014If 'no reflow' is observed within 45min of reperfusion using balloon angioplasty or stent, it is probably related to microthromboemboli, which may also contribute to the... (Review)
Review
If 'no reflow' is observed within 45min of reperfusion using balloon angioplasty or stent, it is probably related to microthromboemboli, which may also contribute to the extension of the 'no reflow' zone by converting 'low reflow' areas into necrotic ones even when reperfusion is achieved more than 45min after the onset of coronary occlusion. Since 'no reflow' is noted when 45min of coronary occlusion has elapsed even in the absence of a thrombus, 'no reflow' late after reperfusion is predominantly due to tissue necrosis and unlikely to be resolved unless methods to reduce infarct size are used. Attempts at reducing the intracoronary thrombus burden during a coronary procedure for acute myocardial infarction (AMI) have been shown to reduce 'no reflow' and improve clinical outcome, as has the use of potent antithrombotic agents. Drugs that can reduce infarct size, when given intracoronary or intravenous in conjunction with a coronary intervention during AMI can also reduce 'no reflow' and improve outcomes in patients with AMI. The prognostic importance of 'no reflow' post-AMI is related to its close correspondence with infarct size. Although several imaging and non-imaging methods have been used to assess 'no reflow' or 'low reflow' myocardial contrast echocardiography remains the ideal method for its assessment both in and outside the cardiac catheterization laboratory.
Topics: Angioplasty, Balloon, Coronary; Coronary Occlusion; Coronary Thrombosis; Fibrinolytic Agents; Humans; Myocardial Infarction; Myocardial Reperfusion; No-Reflow Phenomenon; Stents; Time Factors; Treatment Outcome; Ultrasonography
PubMed: 24799155
DOI: 10.1016/j.jjcc.2014.03.008 -
Acta Medica Okayama Feb 2017Redox regulation has recently been recognized as an important factor in acute illnesses as well as in chronic diseases. It has also become a target for neuroprotection... (Review)
Review
Redox regulation has recently been recognized as an important factor in acute illnesses as well as in chronic diseases. It has also become a target for neuroprotection in acute intensive care. Despite its well-known therapeutic effects, therapeutic hypothermia has recently been re-evaluated for its potential use in emergency and critical care medicine. Hypothermia is an undesirable physiological condition that can increase oxidative stress and decrease anti-oxidative potency. However, many studies have shown that under ischemia/reperfusion conditions, therapeutic hypothermia actually suppresses enhanced oxidative stress and maintains or increases anti-oxidative potency. This review provides an overview and outlook for the future of therapeutic hypothermia for neuroprotection from the perspective of redox regulation in patients with post-cardiac arrest syndrome and traumatic brain injury.
Topics: Animals; Brain Injuries, Traumatic; Brain Ischemia; Critical Care; Extracorporeal Membrane Oxygenation; Heart Arrest; Humans; Hypothermia, Induced; Lipid Peroxidation; Myocardial Reperfusion; Neuroprotection; Oxidation-Reduction; Oxidative Stress
PubMed: 28238004
DOI: 10.18926/AMO/54819 -
Cardiology 2014Postconditioning has been reported to reduce infarct size in ST-segment myocardial infarction (STEMI). However, recently, few other studies did not show any effect of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Postconditioning has been reported to reduce infarct size in ST-segment myocardial infarction (STEMI). However, recently, few other studies did not show any effect of postconditioning and suggested that it may be even harmful. We sought to assess whether postconditioning could reduce infarct size and improve myocardial reperfusion in early presenters with STEMI.
METHODS
72 STEMI patients treated with primary percutaneous coronary intervention (PCI) were randomly assigned to either the postconditioning (n = 35) or the standard PCI group (control group; n = 37). Blood samples were obtained for creatine kinase (CK) and its MB isoform (CK-MB) within 36 h. The angiographic (myocardial blush grade, MBG) and electrocardiographic (ST-segment resolution, STR) data were evaluated and compared between groups.
RESULTS
The areas under the curve of CK and CK-MB release were significantly reduced in the postconditioning group compared with the control group (38,612.91 ± 25,028.42 vs. 60,547.30 ± 25,264.63 for CK and 5,498.23 ± 3,787.91 vs. 7,443.12 ± 3,561.13 for CK-MB, p < 0.0001). MBG was significantly better in the postconditioning group than in the control group (MBG 3: 82.3 vs. 47.1%, p = 0.0023). In the postconditioning group, STR >70% was more often observed (97.1 vs. 64.1%, p = 0.0007).
CONCLUSIONS
In patients with STEMI, postconditioning could significantly reduce enzymatic infarct size and improve myocardial reperfusion.
Topics: Area Under Curve; Biomarkers; Creatine Kinase; Creatine Kinase, MB Form; Female; Humans; Ischemic Postconditioning; Male; Microcirculation; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Myocardial Reperfusion Injury; Percutaneous Coronary Intervention; Prospective Studies; Treatment Outcome
PubMed: 25402666
DOI: 10.1159/000367965