Influence of Cardiovascular Risk Factors, Comorbidities, Medication Use and Procedural Variables on Remote Ischemic Conditioning Efficacy in Patients with ST-Segment Elevation Myocardial Infarction

Pryds, Kasper; Hjortbak, Marie Vognstoft; Schmidt, Michael

doi:10.3390/ijms20133246

Cited by 12 publications

(15 citation statements)

References 95 publications

(137 reference statements)

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“…The concept of ischemic conditioning can be applied locally on the heart as ischemic preconditioning (IPC) or as remote ischemic conditioning (RIC), which is a more clinically applicable approach [ 10 ]. IPC and RIC have shown substantial cardioprotective effect in preclinical studies, but translating the favourable effect to significant clinical benefits remains challenging [ 11 , 12 ]. Most preclinical studies have been performed in healthy young animals that do not represent the complex nature of a clinical population suffering from acute myocardial infarction [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in intrinsic aerobic capacity alters sensitivity to ischemia-reperfusion injury but not cardioprotective capacity by ischemic preconditioning in rats

et al. 2020

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Introduction Aerobic capacity is a strong predictor of cardiovascular mortality. Whether aerobic capacity influences myocardial ischemia and reperfusion (IR) injury is unknown. Purpose To investigate the impact of intrinsic differences in aerobic capacity and the cardioprotective potential on IR injury. Methods We studied hearts from rats developed by selective breeding for high (HCR) or low (LCR) capacity for treadmill running. The rats were randomized to: (1) control, (2) local ischemic preconditioning (IPC) or (3) remote ischemic preconditioning (RIC) followed by 30 minutes of ischemia and 120 minutes of reperfusion in an isolated perfused heart model. The primary endpoint was infarct size. Secondary endpoints included uptake of labelled glucose, content of selected mitochondrial proteins in skeletal and cardiac muscle, and activation of AMP-activated kinase (AMPK). Results At baseline, running distance was 203±7 m in LCR vs 1905±51 m in HCR rats (p<0.01). Infarct size was significantly lower in LCR than in HCR controls (49±5% vs 68±5%, p = 0.04). IPC reduced infarct size by 47% in LCR (p<0.01) and by 31% in HCR rats (p = 0.01). RIC did not modulate infarct size (LCR: 52±5, p>0.99; HCR: 69±6%, p>0.99, respectively). Phosphorylaion of AMPK did not differ between LCR and HCR controls. IPC did not modulate cardiac phosphorylation of AMPK. Glucose uptake during reperfusion was similar in LCR and HCR rats. IPC increased glucose uptake during reperfusion in LCR animals (p = 0.02). Mitochondrial protein content in skeletal muscle was lower in LCR than in HCR (0.77±0.10 arbitrary units (AU) vs 1.09±0.07 AU, p = 0.02), but not in cardiac muscle. Conclusion Aerobic capacity is associated with altered myocardial sensitivity to IR injury, but the cardioprotective effect of IPC is not. Glucose uptake, AMPK activation immediately prior to ischemia and basal mitochondrial protein content in the heart seem to be of minor importance as underlying mechanisms for the cardioprotective effects.

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Section: Introductionmentioning

confidence: 99%

Differences in intrinsic aerobic capacity alters sensitivity to ischemia-reperfusion injury but not cardioprotective capacity by ischemic preconditioning in rats

et al. 2020

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“…The prognosis of patients with acute myocardial infarction is affected by a variety of factors [21] . In this study, there were no signi cant differences in age, gender, cardiovascular risk factors between the two groups of patients with myocardial infarction, except S-TO-B, which were signi cant differences.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Ventricular Systolic Function After Revascularization in Patients with ST Segment Elevation Myocardial Infarction by Stratified Strain Technique

Liang

Chen

et al. 2020

Preprint

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Objective: Stratified strain was used to evaluate the local stratified strain and the overall longitudinal strain of the left ventricle of the affected myocardium after revascularization in patients with ST-segment elevation myocardial infarction (STEMI).Methods: 120 patients diagnosed as STEMI in the Affiliated Hospital of Jiangsu University from July 2017 to August 2018 were selected. According to the time from symptom onset to balloon dilation (S-TO-B), 120 patients were divided into group A (S-TO-B≤6h) and group B (6h<S-TO-B <12h) .The changes of left ventricular global longitudinal strain (GLS), local partial layer strain (TLSendo, TLS-mid, TLSepi) and LVEF were compared between the two groups immediately after operation, 3 hours ,24 hours and 1 week after operation. The incidence of major adverse cardiovascular events (MACE) and LVEF were followed up during hospitalization and one month after operation.Results: In group A, TLSendo, TLSmid, TLSepi and GLS increased gradually at each time after vascular opening; in group B, TLSendo, TLSmid, TLSepi and GLS decreased immediately after vascular opening 3 hours after surgery, with obvious TLSendo and gradually increased, but the increase was smaller than that in group A. TLSendo,TLSmid, TLSepi and GLS increased in all patients one week after operation, but TLSendo and TLSepi increased more significantly than TLSmid, and GLS changed less. TlSendo increase of 4.50% is the most accurate parameter to predict the significant improvement of left ventricular systolic function in patients with STEMI one month after operation, with an AUC area of 0.87, sensitivity and specificity of 80.0% and 86.0%, respectively.Conclusions: Layered strain technique can be used to evaluate the myocardial strain in patients with STEMI, and recognize the effect of S-TO-B on the prognosis of STEMI, which has important clinical application value.

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“…Regarding the STEMI population in Saudi Arabia, the current study indicated a high prevalence of coronary artery disease risk factors in a younger age group, compared to other registries. It also highlighted a high prevalence of DM, HTN, and smoking, and controlling these risks is crucial for the prevention of acute coronary syndromes [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The Primary Management Strategies for ST-Elevation Myocardial Infarction Patients in Saudi Arabia: A Sub-Study of the Saudi Acute Myocardial Infarction Registry

Kinsara

Al-Saleh

Taher

et al. 2020

Cureus

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Background and objective Not all patients with ST-elevation myocardial infarction (STEMI) in Saudi Arabia are managed with a primary percutaneous coronary intervention (PPCI). We analyzed the management strategies for STEMI patients in the Saudi Acute Myocardial Infarction Registry (STARS). The strategies include PPCI, revascularization with thrombolytic therapy, and conservative management. This study involved a substudy of the STARS. Methods STEMI patients were categorized into three groups. Group 1 was managed with PPCI, group 2 with revascularization with thrombolytic therapy, and group 3 with conservative approaches. The data were collected at presentation, at one month, and at one year after discharge. Results The sample consisted of 1,471 patients. The mean age of the participants was 54 ±12 years; 51% were Saudi citizens, and the majority (89%) were male. Their background revealed a high coronary risk profile, with 48% diagnosed with diabetes mellitus (DM) and 44% with hypertension (HTN); 54% were active or ex-smokers, 30% had a high lipid profile, and 74% were overweight. PPCI was performed in 42%, and 29% were managed with revascularization using thrombolytic therapy. A conservative approach was followed in 29% of the patients. Patients who had a stroke were treated conservatively due to the risk of bleeding. The patients in group 1 were mostly hypertensive with recurrent angina and a history of prior revascularization, with PPCI or coronary artery bypass grafting (CABG). The crude all-cause mortality at one year was 11%; it was 7% at one month for group 1, 8% for group 2, and 9% for group 3, which was not statistically significant. Conclusions Controlling the risk factors and improving access to PPCI in hospitals are fundamental in the management of STEMI patients. PPCI is still underused. Guideline-directed medical therapy (GDMT) is a reasonable approach if PPCI is not available.

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Influence of Cardiovascular Risk Factors, Comorbidities, Medication Use and Procedural Variables on Remote Ischemic Conditioning Efficacy in Patients with ST-Segment Elevation Myocardial Infarction

Cited by 12 publications

References 95 publications

Differences in intrinsic aerobic capacity alters sensitivity to ischemia-reperfusion injury but not cardioprotective capacity by ischemic preconditioning in rats

Differences in intrinsic aerobic capacity alters sensitivity to ischemia-reperfusion injury but not cardioprotective capacity by ischemic preconditioning in rats

Assessment of Left Ventricular Systolic Function After Revascularization in Patients with ST Segment Elevation Myocardial Infarction by Stratified Strain Technique

The Primary Management Strategies for ST-Elevation Myocardial Infarction Patients in Saudi Arabia: A Sub-Study of the Saudi Acute Myocardial Infarction Registry

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