ABSTRACT
Objective • To investigate the influence of smoking on acute myocardial injury and long-term prognosis in the patients with ST-segment elevation myocardial infraction (STEMI) by cardiac magnetic resonance (CMR). Methods • Three hundred and forty-nine STEMI patients were retrospectively selected from a prospective cohort from May 2012 to August 2017, and were followed up for at least 2 years. The primary endpoint was a composite of all-cause death, reinfarction and stroke. The secondary endpoint was heart failure rehospitalization. The patients were divided into smoker group and non-smoker group according to the baseline status of smoking which was recorded at admission. The difference in the incidence of endpoint events was further analyzed in combination with the presence or absence of intramyocardial hemorrhage (IMH) between the two groups. Results • There were 221 patients in the smoker group, accounting for 63.3% of the total sample. The average age of onset in smokers were 4.66 years earlier than nonsmokers. However, smokers showed a lower incidence of left ventricular thrombosis and lower levels of brain natriuretic peptide than non-smokers (P=0.023, P=0.000). There was no difference in the left ventricular ejection fraction between the two groups (P>0.05), but the smokers had a better endsystolic and end-diastolic volume index (P=0.019, P=0.007). Smokers and non-smokers had similar clinical outcomes of all-cause death, reinfarction and stroke (P>0.05). The incidence of heart failure rehospitalization in smokers was quite lower than that of the non-smokers, but this kind of protective effect disappeared after differences in baseline being adjusted (P=0.167). In the patients with IMH, smoking had a protective effect on primary endpoints (HR=0.266, P=0.008), but in the patients without IMH, smokers had a worse outcome of all-cause death and reinfarction than non-smokers (P=0.024). Conclusion • In patients with STEMI, smoking has no protective effect on long-term prognosis. When IMH appears in STEMI patients, smoking has a protective effect on all-cause death, reinfarction and stoke. However, in patients without IMH, smokers have a worse prognosis than non-smokers.
ABSTRACT
El uso de la Resonancia Magnética Cardiaca (RMC), se ha convertido en los últimos años en una herramienta fundamental para el diagnóstico de diversas miocardiopatías, entre las cuales sobresale la miocarditis, entidad que cursa con manifestaciones y signos clínicos muy variables y poco específicos en la mayor parte de los casos, lo que la convierte en una patología difícil de reconocer sobre todo en sus episodios de presentación inicial, lo que probablemente conlleve a que sea subdiagnosticada. El desarrollo de nuevas modalidades de imagen ha permitido que ante la sospecha de esta entidad el uso de la RMC se convierta en la técnica ideal para el diagnóstico temprano. A continuación se presenta el caso clínico de un paciente masculino que acude con cuadro de dolor torácico agudo, enzimas cardiacas elevadas, electrocardiograma no concluyente y coronarias normales, mostrando el curso insidioso de esta patología así como de manera resumida el rol de la RMC en su diagnóstico y pronóstico.
The use of cardiac magnetic resonance (CMR) has become in recent years an essential tool for diagnosing various cardiomyopathies, among which stands myocarditis, an entity that presents with demonstrations and highly variable clinical signs and unspecific in most cases, which makes it a difficult disease to recognize especially in its initial filing episodes, which probably lead to be underdiagnosed. The development of new imaging modalities has allowed suspicion of this entity using the RMC becomes the ideal technique for early diagnosis. Next, the case of a male patient presenting with symptoms of acute chest pain, elevated cardiac enzymes inconclusive electrocardiogram and normal coronary showing insidious course of this disease and in summary the role of the RMC in its presented diagnosis and prognosis.
Subject(s)
Humans , Male , Aged , Magnetic Resonance Spectroscopy , Computed Tomography Angiography , Myocarditis , Diagnosis , ElectrocardiographyABSTRACT
Objective • To evaluate the strain parameters measured by two-dimensional speckle tracking echocardiography (2D-STE) in predicting myocardial segment functional recovery and left ventricular (LV) remodeling. Methods • Eighty-one patients with first acute ST-elevation myocardial infarction were enrolled. All patients underwent cardiac magnetic resonance (CMR) within 8 days after reperfusion therapy to detect the percentage of necrotic myocardium and the presence of microvascular obstruction or intra myocardial hemorrhage. Echocardiography examination for the first time was performed on the same day as CMR. Segmental and global circumferential strain (CS), radial strain, and longitudinal strain were measured by 2D-STE. Echocardiography was performed again after an average follow-up of 14 months. Results • The segments with functional recovery were associated with higher absolute values of strain parameters at baseline compared to those without functional recovery. The receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of CS≤-7.77% to predict the functional recovery of myocardial segment were 77.17% and 61.40%, respectively (AUC=0.74, P=0.000). Multiple Logistic regression showed that the percentage of necrotic myocardium and global CS (GCS) were the powerful predictors of LV remodeling (P<0.05). According to ROC curve analysis, GCS≥-17.48% had sensitivity of 88.33% and specificity of 69.23%(AUC=0.80, P=0.000) in predicting LV remodeling. Conclusion • Among the strain parameters of 2D-STE, CS may be an ideal predictor of segment functional recovery and LV remodeling after myocardial infarction.