Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

Kern, Karl B.; Hanna, John; Young, Hayley N.; Ellingson, Carl J.; White, Joshua J.; Heller, Brian; Illindala, Uday; Hsu, Chiu Hsieh; Zuercher, Mathias

doi:10.1016/j.jcin.2016.08.040

Cited by 14 publications

(7 citation statements)

References 35 publications

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“…In addition, it could have been shown that TTM alone without reperfusion reveals adverse effects because the extent of myocardial infarction was comparable independently of treatment with TTM. TTM plus reperfusion resulted in the best recovery of cardiac function with the lowest myocardial infarction size [39]. This experimental evidence confirms the disadvantage of delayed coronary revascularization and limits the benefit of sole TTM after cardiac arrest.…”

Section: Targeted Temperature Managementsupporting

confidence: 55%

Interventional Therapies for Post-Cardiac Arrest Patients Suffering from Coronary Artery Disease

Behnes¹,

Kuche²,

Akın³

et al. 2019

Myocardial Infarction

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Acute myocardial infarction and coronary artery disease (CAD) are the most common causes for the development of malignant arrhythmia often leading to cardiogenic shock and cardiac arrest. Structural heart disease represents the main pathology in older patients, whereas young adults mostly suffer from cardiomyopathies and channelopathies. This book chapter delineates modern interventional therapies for patients with cardiogenic shock or aborted cardiac arrest. Epidemiological data on the incidence of malignant arrhythmia depending causing cardiac arrest depending on the presence or absence of CAD and myocardial infarction are presented. Realistic difficulties within clinical decision-making are counterbalanced for and against an early, aggressive and invasive therapeutic approach including early coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management and mechanical cardiac assist devices, depending on the individual clinical presentation and underlying cardiac arrhythmia.

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Section: Targeted Temperature Managementsupporting

confidence: 55%

Interventional Therapies for Post-Cardiac Arrest Patients Suffering from Coronary Artery Disease

Behnes¹,

Kuche²,

Akın³

et al. 2019

Myocardial Infarction

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“…Translational models of AMI have a major importance to develop interventions for the clinical practice [18, 51, 52]. For this purpose, pigs are excellent model animals, since their cardiac anatomy and cardiovascular physiology exhibit similarities to the human heart [53].…”

Section: Discussionmentioning

confidence: 99%

In vivo MRI and ex vivo histological assessment of the cardioprotection induced by ischemic preconditioning, postconditioning and remote conditioning in a closed-chest porcine model of reperfused acute myocardial infarction: importance of microvasculature

et al. 2017

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BackgroundCardioprotective value of ischemic post- (IPostC), remote (RIC) conditioning in acute myocardial infarction (AMI) is unclear in clinical trials. To evaluate cardioprotection, most translational animal studies and clinical trials utilize necrotic tissue referred to the area at risk (AAR) by magnetic resonance imaging (MRI). However, determination of AAR by MRI‚ may not be accurate, since MRI-indices of microvascular damage, i.e., myocardial edema and microvascular obstruction (MVO), may be affected by cardioprotection independently from myocardial necrosis. Therefore, we assessed the effect of IPostC, RIC conditioning and ischemic preconditioning (IPreC; positive control) on myocardial necrosis, edema and MVO in a clinically relevant, closed-chest pig model of AMI.Methods and resultsAcute myocardial infarction was induced by a 90-min balloon occlusion of the left anterior descending coronary artery (LAD) in domestic juvenile female pigs. IPostC (6 × 30 s ischemia/reperfusion after 90-min occlusion) and RIC (4 × 5 min hind limb ischemia/reperfusion during 90-min LAD occlusion) did not reduce myocardial necrosis as assessed by late gadolinium enhancement 3 days after reperfusion and by ex vivo triphenyltetrazolium chloride staining 3 h after reperfusion, however, the positive control, IPreC (3 × 5 min ischemia/reperfusion before 90-min LAD occlusion) did. IPostC and RIC attenuated myocardial edema as measured by cardiac T2-weighted MRI 3 days after reperfusion, however, AAR measured by Evans blue staining was not different among groups, which confirms that myocardial edema is not a measure of AAR, IPostC and IPreC but not RIC decreased MVO.ConclusionWe conclude that IPostC and RIC interventions may protect the coronary microvasculature even without reducing myocardial necrosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-017-1166-z) contains supplementary material, which is available to authorized users.

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“…The decrease in biomarkers of STEMI, especially specific Hs‐troponin T, indicates a down‐regulation of the injury related to ischemia/reperfusion . The effective reduction of Troponin T levels following treatment with TH was in accordance with a 75% reduction in IS in STEMI models. In the present study, intracoronary hypothermia caused a significant reduction in Hs‐troponin T concentrations post‐PPCI procedure, which was in agreement with Gotberg et al who reported that total body hypothermia caused a significant decrease in troponin T. However, Erlinge et al could not find the same decrease in troponin T with augmentation of sample size.…”

Section: Discussionmentioning

confidence: 60%

A pilot clinical study of adjunctive therapy with selective intracoronary hypothermia in patients with ST‐segment elevation myocardial infarction

Wang

Zhang

et al. 2018

Cathet Cardio Intervent

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Objectives: We aimed to assess the effect of selective intracoronary hypothermia on outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Background: Intracoronary hypothermia, the feasibility and safety of which has been validated in humans, induced by selective trans-coronary infusion of saline at different temperatures can reduce infarct size (IS) prior to reperfusion in animal models of STEMI.Methods: Sixty STEMI patients presenting with thrombolysis in myocardial infarction (TIMI) flow grade 0/1 were randomized after coronary artery angiography. Intracoronary hypothermia was induced by selective trans-coronary infusion of saline at 4 C to the endangered myocardium in the 30 patients. The primary endpoint, absolute IS expressed as IS/myocardium at risk (MaR), was assessed by cardiac magnetic resonance imaging at day 7 post-PPCI in 50 patients.Clinical follow-up was undertaken at day 30 after procedure.Results: Intracoronary hypothermia was successfully performed in hypothermia group, without increase in arrhythmia or hemodynamic instability. The mean temperature reduction of 5.8 AE 1.1 C in distal coronary artery was achieved before reperfusion. Mean IS/MaR was predominantly reduced in the hypothermia group (44.85 AE 5.89% vs. 50.69 AE 10.75%, P = 0.022), especially in the anterior STEMI subgroup (46.12 AE 7.54% vs. 55.27 AE 11.175%, P = 0.023). The clinical events appeared no statistical difference between the two groups at the 30-day follow-up.Conclusion: The statistical difference in IS/MaR by intracoronary hypothermia as adjunctive therapy to PPCI is an important observation and warrants a larger pivotal trial fully powered for efficacy. K E Y W O R D S intracoronary hypothermia, primary percutaneous coronary intervention, ST-segment elevation myocardial infarction

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Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

Abstract: Abstract:Background: Cohort studies have shown that one in four post cardiac arrest

Cited by 14 publications

References 35 publications

Interventional Therapies for Post-Cardiac Arrest Patients Suffering from Coronary Artery Disease

Interventional Therapies for Post-Cardiac Arrest Patients Suffering from Coronary Artery Disease

In vivo MRI and ex vivo histological assessment of the cardioprotection induced by ischemic preconditioning, postconditioning and remote conditioning in a closed-chest porcine model of reperfused acute myocardial infarction: importance of microvasculature

A pilot clinical study of adjunctive therapy with selective intracoronary hypothermia in patients with ST‐segment elevation myocardial infarction

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