Imaging the myocardial ischemic cascade

Stillman, Arthur E.; Oudkerk, Matthijs; Bluemke, David A.; Boer, Menko Jan de; Bremerich, Jens; Garcia, Ernest; Gutberlet, Matthias; Harst, Pim van der; Hundley, W. Gregory; Jerosch‐Herold, Michael; Kuijpers, Dirkjan; Kwong, Raymond Y.; Nagel, Eike; Oshinski, John N.; Paul, Jean‐François; Slart, Riemer H. J. A.; Thourani, Vinod H.; Vliegenthart, Rozemarijn; Wintersperger, Bernd J.

doi:10.1007/s10554-018-1330-4

Cited by 38 publications

(29 citation statements)

References 159 publications

(53 reference statements)

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“…At part, impaired RA conduit function may also imply diastolic RV dysfunction. The onset of diastolic dysfunction forestalls systolic dysfunction during the ischemic cascade [39], and a link between total LA strain and LV filling pressures has previously been made [40]. Reports also indicate independence of LA passive conduit function of LV stiffness [41]; thus, RA passive restoring forces (conduit function) themselves may have a distinct role in cardiac pathophysiology and patients with AMI beyond RV function.…”

Section: Discussionmentioning

confidence: 99%

Impact of Right Atrial Physiology on Heart Failure and Adverse Events after Myocardial Infarction

Schuster

Backhaus

Stiermaier

et al. 2020

JCM

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Background: Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion need further evaluation. Methods: In this cardiovascular magnetic resonance (CMR)-substudy of AIDA STEMI and TATORT NSTEMI, 1235 AMI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation myocardial infarction and 440 with non-ST-elevation MI). Right atrial (RA) performance was evaluated using CMR myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa), and associated strain rates (SR) in a blinded core-laboratory. The primary endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post AMI. Results: RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with the clinical onset of heart failure and MACE independently of RV systolic function and atrial fibrillation (AF) (multivariable analysis hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.009), while RV systolic function and AF were not independent prognosticators. Furthermore, RA conduit strain identified low- and high-risk groups within patients with reduced RV systolic function (p = 0.019 on log rank testing). Conclusions: RA impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT-derived quantification of RA strain.

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Section: Discussionmentioning

confidence: 99%

Impact of Right Atrial Physiology on Heart Failure and Adverse Events after Myocardial Infarction

Schuster

Backhaus

Stiermaier

et al. 2020

JCM

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“…The ischemic cascade illustrates the progressive pathological conditions that develop from hemodynamically significant stenosis, evolving from subclinical to clinical stages ( Fig. 1) [2][3][4]. Decreased perfusion leads to metabolic changes, followed by diastolic and then systolic dysfunction, electrocardiographic (ECG) changes, and anginal chest pain [3].…”

Section: Introductionmentioning

confidence: 99%

“…1) [2][3][4]. Decreased perfusion leads to metabolic changes, followed by diastolic and then systolic dysfunction, electrocardiographic (ECG) changes, and anginal chest pain [3]. Blood flow and contractile function in myocardial ischemia can be improved by medical therapy or revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CTfractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.

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“…The role of CMR for imaging ischemic heart disease was reviewed [64,65]. Incomplete coverage of the left ventricle using three short axis slices was not found adversely affect diagnostic accuracy compared with a whole heart assessment but may fail to detect apical ischemia and underestimate the extent and severity of perfusion defects [66].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%