Protective Value of Aspirin Loading Dose on Left Ventricular Remodeling After ST-Elevation Myocardial Infarction

Abstract

AimsLeft ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) is a complex process, defined as changes of LV volumes over time. CMR feature tracking analysis (CMR-FT) offers an accurate quantitative assessment of LV wall deformation and myocardial contractile function. This study aimed to evaluate the role of myocardial strain parameters in predicting LV remodeling and to investigate the effect of Aspirin (ASA) dose before primary coronary angioplasty (pPCI) on myocardial injury and early LV remodeling.Methods and ResultsSeventy-eight patients undergoing CMR, within 9 days from symptom onset and after 6 months, were enrolled in this cohort retrospective study. We divided the study population into three groups based on a revised Bullock's classification and we evaluated the role of baseline CMR features in predicting early LV remodeling. Regarding CMR strain analysis, worse global circumferential and longitudinal strain (GCS and GLS) values were associated with adverse LV remodeling. Patients were also divided based on pre-pPCI ASA dosage. Significant differences were detected in patients receiving ASA 500 mg dose before pPCI, which showed lower infarct size extent and better strain values compared to those treated with ASA 250 mg. The stepwise multivariate logistic regression analysis, adjusted for covariates, indicated that a 500 mg ASA dose remained an inverse independent predictor of early adverse LV remodeling.ConclusionGCS and GLS have high specificity to detect early LV adverse remodeling. We first reported a protective effect of ASA loading dose of 500 mg before pPCI on LV myocardial damage and in reducing early LV adverse remodeling.

Aspirin in combination with gastrodin protects cardiac function and mitigates gastric mucosal injury in response to myocardial ischemia/reperfusion

“…Aspirin is frequently prescribed in the perioperative period of PCI among these drugs. Patients with AMI often receive anti-thrombotic therapy with aspirin at doses of 250–500 mg/kg before PCI ( Calvieri et al, 2022 ). Furthermore, long term use of aspirin is used to prevent secondary myocardial infarction after PCI.…”

“…In this study, drug preconditioning were used to investigate the effect and mechanism of aspirin and gastrodin in myocardial I/R injury. According to equivalent dose conversion between humans and rats, 50 mg/kg aspirin was used for the study ( Huang et al, 2004 ; Calvieri et al, 2022 ). 100 SD rats were randomly divided into two parts.…”

Takotsubo syndrome: left atrial and ventricular myocardial strain impairment in the subacute and convalescent phases assessed by CMR

“…CMR feature-tracking analysis of LV strain was performed using ventricular short- and long-axis views in cineMR images in a semiautomatic way. LV myocardial tracking was visually reviewed, contouring errors were corrected, and the analysis was repeated as previously described [ 24 , 25 ]. We finally reported the average value of three repeated measurements of global radial (GR-), circumferential (GC-), and longitudinal (GL-) strain (-S) and strain rate (-SR).…”

Impact of antiplatelet therapy on microvascular thrombosis during ST-elevation myocardial infarction

“…Data from the ISIS-2 trial showed unequivocally that aspirin reduces mortality in patients with STEMI but these patients were treated with thrombolysis rather than emergency PCI. It is unlikely that any trial will ever re-examine the efficacy of aspirin in this setting although the differences between the two modes of restoration of vessel patency are considerable ( Calvieri et al, 2022 ). Few studies have looked at dose responses of aspirin in STEMI.…”

“…Few studies have looked at dose responses of aspirin in STEMI. One study showed that aspirin loading with 500 mg, compared to 250 mg may further reduce MVO, infarct size and adverse remodelling as assessed by CMR ( Calvieri et al, 2022 ). Furthermore, impaired microcirculatory perfusion after PCI may in part be related to levels of thromboxane B 2 , which is inhibited by aspirin ( Basili et al, 2014 ).…”