Reperfusion ventricular arrhythmia bursts identify larger infarct size in spite of optimal epicardial and microvascular reperfusion using cardiac magnetic resonance imaging

Abstract

In the presence of suboptimal reperfusion with MVO by CMR, VA burst does not further define MI size. However, with optimal TIMI 3 reperfusion and optimal microvascular perfusion (i.e. no MVO), VA burst is associated with larger IS, indicating that VA burst is a marker of additional cell death.

Role of miRNA-1 and miRNA-21 in Acute Myocardial Ischemia-Reperfusion Injury and Their Potential as Therapeutic Strategy

“…The same pathophysiology that exists in IR injury, e.g., apoptosis and mitochondrial dysfunction, drives many forms of arrhythmias, including the main type, accelerated idioventricular rhythms [47]. Thus, the two conditions complement each other and, together, contribute to larger infarct size, meaning more myocyte death and decreased ventricular functioning [47][48][49][50][51][52][53]. Notably, studies support that reperfusion without arrhythmia has a smaller infarct size regardless of the same initial areas at risk [47][48][49][50][51][52].…”

Editor’s Choice- Reperfusion cardiac arrhythmias and their relation to reperfusion-induced cell death

“…This connection is supported by previous findings by our group. [3][4][5][6][7][8][9] We found, in several independent cohorts, the presence of a 'burst' of ventricular reperfusion arrhythmias (VA burst) to be related to clinically significant larger infarct size. This increase remained while correcting for other known factors of increased infarct size.…”

“…reopening of the infarct vessel, more recent studies have shown that reperfusion without arrhythmias resulted in smaller infarcts in spite of equal initial areas at risk. [3][4][5][6][7][8]…”

“…With the advent of PCI of the culprit coronary vessel it was found that ventricular reperfusion arrhythmias were associated with increased infarct size and decreased ventricular functioning despite optimal epicardial and microvascular flow and equal area at risk. 3–9…”

The 12 lead ECG rules the waves in acute cardiovascular care

“…However, in a study of STEMI patients in whom infarct size and microvascular obstruction was assessed by cardiac magnetic resonance imaging a burst of reperfusion ventricular arrhythmias was associated with a much greater infarct size. 13 The increased infarct size was only observed in the group of patients with an optimal TIMI 3 epicardial blood flow and no microvascular obstruction. It appears therefore that a burst of reperfusion ventricular arrhythmias is an independent marker of additional myocardial reperfusion injury.…”