Effect of Myocardial Reperfusion on Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction

Abstract

Background. During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11–19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood.Objective. To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion.Materials and methods. We included in this study 68 patients with AMI and IMR aged 36–79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV).Results. Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 – patients who had a decrease in IMR (n=23, 33.8 %), group 2 – patients with increase of IMR (n=28, 41.1 %), group 3 – patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24).Conclusion. Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.

Atorvastatin combined with routine therapy on HIF-1, VEGF concentration and cardiac function in rats with acute myocardial infarction

“…Atorvastatin is a statin lipid-regulating drug (26), mainly acting on the liver, which can reduce the synthesis of cholesterol and has the effect of lowering blood lipid (27,28). Statins lipid-lowering drugs can improve the cardiac function of patients with acute myocardial infarction (29), and can be used for the treatment of the disorder of lipid metabolism in patients caused by acute myocardial infarction, which is beneficial to the treatment of acute myocardial infarction. Ielasi et al (30) found that atorvastatin combined with aspirin has a synergistic effect in the treatment of ischemic stroke, which can be a testament to our experimental results.…”

Oxygen therapy versus conservative therapy in suspected uncomplicated myocardial infarction without hypoxemia: A meta‐analysis of randomized controlled studies

“…Trial sequential analysis was performed using TSA software (version 0.9.5.9 Beta; Copenhagen Trial Unit, Copenhagen, Denmark), The Lan–DeMets approach was used for construction of the O'Brien‐Fleming monitoring boundaries and the optimal information size, which was set to an alpha of 0.05 with a two‐sided beta of 0.80 and relative risk reduction of 10%. The mortality incidence in the control group was set according to previously published studies 11–17 …”

“…Mortality data were available from all seven included studies with various follow‐up durations 11–17 . In the study by Hofmann and colleagues, the duration of patient follow‐up was 1 year, which was the longest.…”

“…In the studies by Stub et al 15 and Khoshnood et al, 12 the duration of patient follow‐up was 6 months. In the studies by Heidari et al, 14 the follow‐up duration was 24 h. In the studies by Ukholkina et al 17 and Ranchord et al, 16 the follow‐up duration were 10 days and 30 days, respectively. When these data were pooled together, there was no heterogeneity among studies (χ 2 = 0.36, p = 0.36, I 2 = 9%, Figure 2) and the oxygen therapy group did not show a significant mortality reduction compared with that of the conservative group (RR = 0.97; 95% CI = 0.68 to 1.40; z = 0.15; p = 0.88; Figure 2).…”

“…2,3 Many randomized controlled trials (RCT) found no benefits in patients with uncomplicated MI and without hypoxemia at baseline. [11][12][13][14][15][16][17] Two recently published meta-analyses evaluated the effect of oxygen therapy in MI patients. 18,19 However, one study 20 including MI patients with great proportion of hypoxemia at baseline was involved in both meta-analyses.…”