Currently, there are practically no works that are devoted to the analysis of different types of damage to ischemic and nonischemic patterns in patients with acute myocardial infarction (AMI), depending on the nature of atherosclerotic lesions of the coronary arteries.In this regard, the aim of this work was to evaluate the frequency of ischemic pattern of heart damage in patients with AMI depending on the presence of obstructive coronary artery disease.Material and Methods. The study retrospectively included patients with a working diagnosis of acute coronary syndrome (ACS) who underwent contrast-enhanced cardiac magnetic resonance (MR) imaging (CMR) during the first week after hospitalization. A 1.5 T CMR was performed using a standard protocol. T2-WI, T1-WI, and IR-images were visually assessed for edema and scar/necrosis, respectively. The pattern of acute ischemic damage to the left ventricular (LV) myocardium was an increase in the signal intensity on T2-WI as a sign of myocardial edema and late gadolinium enhancement (LGE) with a typical ischemic nature of contrast enhancement: subendocardial/subtransmural/transmural. The non-ischemic nature of myocardial injury was defined as intramyocardial/subepicardial LGE.Results. Based on invasive coronary angiography (ICA) data, patients were divided into two groups: group of myocardial infarction (MI) and coronary artery disease (MICAD group) and group of MI and non-obstructive coronary arteries (MINOCA group). It was found that the frequencies of occurrence of subendocardial pattern of cardiac LGE in early CMR did not differ in the groups of AMI patients against the background of obstructive and non-obstructive coronary artery disease (CAD). The most characteristic MR-pattern in MICAD patients was transmural LGE, including that in combination with microvascular obstruction (MVO). The most characteristic MR-pattern in MINOCA patients was mid-wall/insertion point LGE. Subepicardial LGE occurred with equal frequency in MICAD and MINOCA patients.Conclusion. The most pathognomonic MR-pattern of myocardial damage in AMI against the background of obstructive CAD was the transmural type of LGE with or without the phenomenon of MVO. Identification of the subendocardial type of LGE in patients with MINOCA allowed to stratify these patients into a higher risk group with a further change in treatment tactics.
Aim. To compare the concentrations of proinflammatory and anti-inflammatory cytokines in patients with myocardial infarction with non-obstructive (MINOCA) and obstructive coronary arteries (MIOCA) in the early postinfarction period and after 1-year follow-up.Material and methods. The study included 40 patients with myocardial infarction (experimental group, 19 patients; control group, 21 patients). Three (15,7%) patients with diagnosed acute myocarditis were excluded from the final analysis. Blood samples were taken upon admission, on the 2nd, 4th and 7th days from hospitalization, and also after 1-year follow-up. Twenty-three parameters were analyzed using multiplex analysis and the Multiplex Instrument FLEXMAP 3D system (Luminex Corporation), as well as the MILLIPLEX map Human Cytokine/ Chemokine Panel II.Results. According to multiplex analysis of blood serum of the studied groups, a comparable increase in proinflammatory cytokines CCL-15, CCL-26, CCL-27 in the early postinfarction period and after 1-year follow-up, as well as antiinflammatory and regenerative cytokines CXCL-12, TPO in the early postinfarction period and after 1-year follow-up. In patients with MINOCA, higher concentrations of the following proinflammatory cytokines were determined: IL-16 upon admission (p=0,03), IL-20 on days 2 and 4 of the early postinfarction period (p=0,005 and p = 0.03), as well as CCL-15 on days 4 and 7 (p=0,05 and p=0,02). After 1-year follow-up, among the proinflammatory cytokines, a greater increase in CCL-21 (p=0,02) was noted in the patients of experimental group. Also, in patients with MINOCA, a greater increase in TPO was determined upon admission and on the 2nd day (p=0,02 and p=0,02), SCF — on the 7th day and after 1-year follow-up (p=0,04 and p=0,04), and LIF on the 4th day of early postinfarction period (p=0,007). In contrast, MIOCA patients showed a greater increase in CXCL-12 levels upon admission (p=0,04). At the same time, patients with MINOCA showed a higher level of C-reactive protein on the 1st day, as well as a higher relative monocyte count after 1-year follow-up.Conclusion. Despite a comparable increase in the cytokines CCL-8, CCL-13, CCL26, CCL-27 in patients of both groups, in patients with MINOCA there was a greater increase in proinflammatory cytokines IL-16, IL-20, CCL-15, CCL-21, and also CXCL-12, LIF, TPO, SCF, which have anti-inflammatory and regenerative activity. After 1 year follow-up, MINOCA patients showed a significant increase in CCL-21 and SCF, with a comparable increase in other proinflammatory cytokines in patients of both groups. A greater increase in proinflammatory cytokines in patients with MINOCA may indicate a more aggressive atherosclerosis course and lead to plaque destabilization followed by ischemic event.
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