Increasing myocardial edema is associated with greater microvascular obstruction in ST-segment elevation myocardial infarction

Bonfig, Nicole L; Soukup, Chase R; Shah, Ananya A; Olet, Susan; Davidson, Sarah J; Schmidt, Christian; Peterson, Rose; Henry, Timothy D.; Traverse, Jay H.

doi:10.1152/ajpheart.00347.2022

Cited by 13 publications

(8 citation statements)

References 36 publications

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“…However, the L/S of NAFLD differed signi cantly. Regarding AMI, MIS correlated with coronary microvascular dysfunction and prompt reperfusion [30,31]. Furthermore, NAFLD is an independent predictor of coronary microvascular dysfunction [26].…”

Section: Discussionmentioning

confidence: 99%

Association between Nonalcoholic Fatty Liver Disease on CT and Myocardial Infarct Size using SPECT-MPI in patients with ST-elevation Myocardial Infarction

Cui,

Li,

Gao

et al. 2024

Preprint

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Background: We aim to explore the association between nonalcoholic fatty liver disease (NAFLD), intrathoracic fat (IF), pericardial fat (PF) and myocardial infarct size (MIS) in patients with ST-elevation myocardial infarction (STEMI). Methods: SPECT-MPI was used to detect MIS, while CT scans were used to measure IF, PF, and NAFLD in patients with STEMI. Firstly, we categorised the patients into two groups (those with measurable and nonmeasurable MIS). The difference in fat between the two groups was compared using a two-sample t-test to determine which type of fat might be correlated with MIS. Secondly, the association between the related fats obtained in the aforementioned steps and MIS was evaluated using linear regression analysis. Third, to further verify this association at the molecular level, we explored the potential shared genes associated with related fat obtained in the above steps and acute myocardial infarction via bioinformatics analysis using the Gene Expression Omnibus (GEO) database. Finally, the association between the expression of shared genes in the serum of patients with STEMI and related fat was confirmed using Pearson’s correlation analysis. Results: The volume and fat attenuation index of IF and PF showed no difference between patients with MIS and those without. However, the L/S of NAFLD on CT reduced significantly in patients with MIS (P =0.001). The L/S of NAFLD on CT was an independent predictor of MIS on SPECT-MPI in patients with STEMI (P =0.042). We identified ST2, THBD, LEPR, and CEBP-α in NAFLD and acute myocardial infarction cases from the GEO database (P <0.05). Compared to patients with STEMI without NAFLD, those with NAFLD exhibited a reduction in sST2 levels (P=0.042); however, no differences were observed in THBD, LEPR, and CEBP-α levels. Correlation analysis showed a positive correlation between L/S and sST2 levels (r=0.459, P =0.032). Conclusions:Among patients with STEMI, the L/S of NAFLD, but not IF or PF, was associated with MIS on SPECT-MPI. Additionally, the L/S of NAFLD on CT emerged as an independent predictor of MIS. The expression of sST2, a biomarker associated with NAFLD and STEMI, positively correlated with the L/S on CT imaging.

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Section: Discussionmentioning

confidence: 99%

Association between Nonalcoholic Fatty Liver Disease on CT and Myocardial Infarct Size using SPECT-MPI in patients with ST-elevation Myocardial Infarction

Cui,

Li,

Gao

et al. 2024

Preprint

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“…We discovered that the MVO area within one week post-primary PCI was notably smaller in the bivalirudin group compared to the UFH group. This could be attributed to less severe myocardial edema in the bivalirudin group, a known causal factor of MVO [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Bivalirudin on Ischemia/Reperfusion Injury in Patients with Reperfused STEMI Assessed by Cardiac Magnetic Resonance

Zhang,

Zou,

et al. 2024

Pharmaceuticals

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Thrombin is an important ischemia/reperfusion injury (IRI) mediator in patients with ST-elevation myocardial infarction (STEMI). This study examines the use of bivalirudin, a direct thrombin inhibitor, in reducing IRI in STEMI patients. STEMI patients (n = 21) were treated with bivalirudin and compared to 21 patients treated with unfractionated heparin (UFH) from the EARLY Assessment of Myocardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453). Infarct size (IS) and left ventricular ejection fraction (LVEF) were comparable between the two groups at follow up. During the first cardiac magnetic resonance (CMR) scan within the first week after percutaneous coronary intervention (PCI), all patients in both the bivalirudin and UFH groups exhibited myocardial edema. However, the myocardium edema volume was significantly less in the bivalirudin group (p < 0.05). At the one-month follow-up, a smaller proportion of patients in the bivalirudin group than in the UFH group exhibited myocardial edema (4.7% vs. 33.3%, p < 0.05). At the three-month follow-up, myocardial edema had completely resolved in the bivalirudin group, while it persisted in two patients in the UFH group. The incidence and volume of microvascular obstruction (MVO) were significantly lower in the bivalirudin group during the acute phase. Additionally, the incidence of intramyocardial hemorrhage (IMH) was significantly lower in the bivalirudin group during both the acute and follow up (p < 0.05). These findings were corroborated by T2 and T1 mapping results. The study concluded that the use of bivalirudin for anticoagulation is associated with attenuated IRI in STEMI patients who receive primary PCI.

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“…Coronary capillaries are easily compressed by interstitial edema and become hypoperfused. Cardiovascular magnetic resonance imaging studies using T2 weighted imaging for the quantification of edema have provided clear correlation of the extent of edema and hemorrhage with infarct size and clinical outcome [32,33]. The extent of myocardial edema is therefore an important prognostic criterion for STEMI outcome.…”

Section: Myocardial Irimentioning

confidence: 99%

Microvascular Leakage as Therapeutic Target for Ischemia and Reperfusion Injury

Kloka

Friedrichson

Wülfroth

et al. 2023

Cells

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Reperfusion injury is a very common complication of various indicated therapies such as the re-opening of vessels in the myocardium or brain as well as reflow in hemodynamic shutdown (cardiac arrest, severe trauma, aortic cross-clamping). The treatment and prevention of reperfusion injury has therefore been a topic of immense interest in terms of mechanistic understanding, the exploration of interventions in animal models and in the clinical setting in major prospective studies. While a wealth of encouraging results has been obtained in the lab, the translation into clinical success has met with mixed outcomes at best. Considering the still very high medical need, progress continues to be urgently needed. Multi-target approaches rationally linking interference with pathophysiological pathways as well as a renewed focus on aspects of microvascular dysfunction, especially on the role of microvascular leakage, are likely to provide new insights.

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Increasing myocardial edema is associated with greater microvascular obstruction in ST-segment elevation myocardial infarction

Cited by 13 publications

References 36 publications

Association between Nonalcoholic Fatty Liver Disease on CT and Myocardial Infarct Size using SPECT-MPI in patients with ST-elevation Myocardial Infarction

Association between Nonalcoholic Fatty Liver Disease on CT and Myocardial Infarct Size using SPECT-MPI in patients with ST-elevation Myocardial Infarction

Impact of Bivalirudin on Ischemia/Reperfusion Injury in Patients with Reperfused STEMI Assessed by Cardiac Magnetic Resonance

Microvascular Leakage as Therapeutic Target for Ischemia and Reperfusion Injury

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