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1.
Gac. méd. Méx ; 158(2): 86-92, mar.-abr. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375533

ABSTRACT

Resumen Introducción: El índice triglicéridos-glucemia (ITG/G) es considerado un nuevo marcador de resistencia a la insulina y está relacionado con el desarrollo de enfermedades cardiovasculares. Objetivo: Evaluar la capacidad del ITG/G para predecir mortalidad intrahospitalaria en los pacientes con infarto agudo del miocardio con elevación del segmento ST. Métodos: Estudio multicéntrico de cohorte que incluyó a 1123 pacientes del Registro Cubano de Infarto del Miocardio Agudo entre enero de 2018 y junio de 2021. Resultados: El punto de corte óptimo del ITG/G para predecir mortalidad fue 8.96 (sensibilidad de 65.2 %, especificidad de 62.0 % y área bajo la curva de 0.636; p < 0.001). La mortalidad intrahospitalaria se incrementó significativamente en el grupo con ITG/G ≥ 8.96. El análisis de regresión logística reveló que el ITG/G fue un marcador predictor independiente de mortalidad (RM = 2.959, IC 95 % = 1.457-6.010, p = 0.003). El modelo multivariado que incluyó el ITG/G elevó su capacidad predictiva (área bajo la curva de 0.917, p < 0.001). Las curvas de Kaplan-Meier mostraron diferencias significativas entre los grupos de pacientes (p < 0.001). Conclusiones: El ITG/G constituye un factor de riesgo independiente de mortalidad intrahospitalaria por infarto agudo del miocardio con elevación del segmento ST.


Abstract Introduction: The triglycerides-glucose (TyG) index is considered a new marker of insulin resistance, and is associated with the development of cardiovascular diseases. Objective: To evaluate the capability of TyG index to predict in-hospital mortality in patients with acute ST-elevation myocardial infarction. Methods: Multicenter cohort study that enrolled 1123 patients included in the Cuban Registry of Acute Myocardial Infarction between January 2018 and June 2021. Results: TyG index optimal cutoff point to predict mortality was 8.96 (sensitivity, 65.2%; specificity, 62.0%; area under the curve; 0.636; p < 0.001). In-hospital mortality was significantly higher in the group with TyG index ≥ 8.96. The logistic regression analysis revealed that the TyG index was an independent mortality predictor (OR = 2.959; 95% CI = 1.457-6.010; p = 0.003). When the TyG index was included in the multivariate model, it increased its predictive capacity (area under the curve, 0.917, p < 0.001). Kaplan-Meier curves showed significant differences between patient groups (p < 0.001). Conclusions: The TyG index constitutes an independent risk factor of in-hospital mortality in patients with acute ST-elevation myocardial infarction.

2.
Rev. colomb. cardiol ; 29(2): 139-144, ene.-abr. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1376870

ABSTRACT

Abstract Introduction: Hyperglycemia has a negative impact on morbidity and mortality among patients with acute myocardial infarction (AMI). Objective: The objective of the study was to evaluate the impact of chronic hyperglycemia on in-hospital and short-term outcome in patients with acute anterior MI treated with streptokinase as thrombolytic therapy. Materials and methods: A total of 100 patients with acute anterior myocardial infarction received streptokinase as thrombolytic therapy were enrolled. They were classified according to the admission glycated hemoglobin (HbA1c) level into two groups: Chronic hyperglycemic group (HbA1c ≥ 6.5%) (36 patients) and non-chronic hyperglycemic group (HbA1c <6.5%) (64 patients). Laboratory investigation, conventional echocardiography, and speckle tracking were performed. Results: Global longitudinal strain (GLS) was significantly lower in patients with chronic hyperglycemia group compared to non-chronic hyperglycemia group (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). In-hospital outcome: Heart failure and reinfarction were significantly increased in patients with chronic hyperglycemia (45.5 vs. 16.7% and 18.2 vs. 3.3%, respectively, p < 0.05). Six months outcome: Heart failure, left ventricular (LV) remodeling, arrhythmias, and bleeding rates were significantly increased in patients with chronic hyperglycemia (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7%, and 6.5 vs. 1.7%, respectively, p < 0.05). GLS cutoff value ≥ −13.5 has the best diagnostic accuracy in predicting LV remodeling (sensitivity: 100%, specificity: 93%, positive predictive value: 94%, negative predictive value: 100%, accuracy: 97%, and area under curve: 0.99). Conclusion: Chronic hyperglycemia had higher incidence of heart failure and LV remodeling following acute MI. GLS can be used as a predictor of LV remodeling.


Resumen Introducción: La hiperglucemia tiene un impacto negativo sobre la morbimortalidad en pacientes con infarto agudo de miocardio. Objetivo: Evaluar el impacto de la hiperglucemia crónica sobre el desenlace hospitalario y a corto plazo en pacientes con infarto agudo de miocardio (IAM) anterior, tratados con estreptoquinasa como terapia trombolítica. Materiales y métodos: Se incluyeron un total de 100 pacientes con IAM anterior, quienes recibieron estreptoquinasa como terapia trombolítica. Se clasificaron en dos grupos de acuerdo con el nivel de hemoglobina glicosilada (HbA1c) al ingreso: el grupo con hiperglucemia crónica (HbA1c ≥ 6.5%) (36 pacientes) y el grupo sin hiperglucemia crónica (HbA1c <6.5%) (64 pacientes). Se practicaron estudios de laboratorio, y ecocardiografía convencional y con rastreo de marcas. Resultados: El strain longitudinal global (SLG) fue significativamente menor en pacientes del grupo con hiperglucemia crónica comparados con los del grupo sin hiperglucemia crónica (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). Desenlace hospitalario: La falla cardíaca y el reinfarto aumentaron significativamente en los pacientes con hiperglucemia crónica (45.5 vs. 16.7% y 18.2 vs. 3.3%, respectivamente, p < 0.05). Desenlace a los seis meses: Las tasas de falla cardíaca, remodelación del ventrículo izquierdo (VI), arritmia, y sangrado aumentaron significativamente en pacientes con hiperglucemia crónica (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7% y 6.5 vs. 1.7%, respectivamente, p < 0.05). El punto de corte de SLG ≥ −13.5 tiene la mejor precisión diagnóstica para predecir la remodelación del VI (sensibilidad: 100%, especificidad: 93%, VPP: 94%, VPN: 100%, precisión: 97% y área bajo la curva -AUC-: 0.99). Conclusión: La hiperglucemia crónica tuvo una mayor frecuencia de falla cardíaca y remodelación del VI luego de un infarto agudo de miocardio. El SLG se puede utilizar como predictor de la remodelación del VI.

3.
Int. j. cardiovasc. sci. (Impr.) ; 35(1): 113-122, Jan.-Feb. 2022. graf
Article in English | LILACS | ID: biblio-1356305

ABSTRACT

Abstract ST elevation myocardial infarction (STEMI) is a highly prevalent condition worldwide. Reperfusion therapy is strongly associated with the prognosis of STEMI and must be performed with a high standard of quality and without delay. A systematic review of different reperfusion strategies for STEMI was conducted, including randomized controlled trials that included major cardiovascular events (MACE), and systematic reviews in the last 5 years through the PRISMA ( Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology. The research was done in the PubMed and Cochrane Central Register of Controlled Trials databases, in addition to a few manual searches. After the exclusion criteria were applied, 90 articles were selected for this review. Despite the reestablishment of IRA patency in PCI for STEMI, microvascular lesions occur in a significant proportion of these patients, which can compromise ventricular function and clinical course. Several therapeutic strategies - intracoronary administration of nicorandil, nitrates, melatonin, antioxidant drugs (quercetin, glutathione), anti-inflammatory substances (tocilizumab [an inhibitor of interleukin 6], inclacumab, P-selectin inhibitor), immunosuppressants (cyclosporine), erythropoietin and ischemic pre- and post-conditioning and stem cell therapy - have been tested to reduce reperfusion injury, ventricular remodeling and serious cardiovascular events, with heterogeneous results: These therapies need confirmation in larger studies to be implemented in clinical practice


Subject(s)
Prognosis , Myocardial Reperfusion/methods , Reperfusion Injury , ST Elevation Myocardial Infarction/therapy , Stents , Thrombolytic Therapy , Health Strategies , Thrombectomy , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Electrocardiography/methods , Purinergic P2Y Receptor Antagonists , Ischemic Postconditioning , Fibrinolytic Agents/therapeutic use , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/rehabilitation , Dual Anti-Platelet Therapy , Myocardial Revascularization
4.
South African Family Practice ; 64(3): 1-8, 19 May 2022. Figures, Tables
Article in English | AIM | ID: biblio-1380567

ABSTRACT

Acute myocardial infarction (AMI) following ischaemic heart disease (IHD) is associated with increased morbidity and mortality. The condition remains a management challenge in resource-constrained environments. This study analysed the management and outcomes of patients presenting with AMI at a district hospital in KwaZulu-Natal. Methods: A descriptive study that assessed hospital records of all patients diagnosed with AMI over a 2-year period (01 August 2016 to 31 July 2018). Data extracted recorded patient demographics, risk factors, timing of care, therapeutic interventions, follow up with cardiology and mortality of patients. Results: Of the 140 patients who were admitted with AMI, 96 hospital records were analysed. The mean (standard deviation [s.d.]) age of patients was 55.8 (±12.7) years. Smoking (73.5%) and hypertension (63.3%) were the most prevalent risk factors for patients with ST elevation myocardial infarction (STEMI) in contrast to dyslipidaemia (70.2%) and hypertension (68.1%) in patients with non-ST elevation myocardial infarction (NSTEMI). Almost 49.5% of patients arrived at hospital more than 6 h after symptom onset. Three (12.5%) patients received thrombolytic therapy within the recommended 30-min time frame. The mean triage-to-needle time was 183 min ­ range (3; 550). Median time to cardiology appointment was 93 days. The in-hospital mortality of 12 deaths considering 140 admissions was 8.6%. Conclusion: In a resource-constrained environment with multiple systemic challenges, in-hospital mortality is comparable to that in private sector conditions in South Africa. This entrenches the role of the family physician. There is need for more coordinated systems of care for AMI between district hospitals and tertiary referral centres.


Subject(s)
Ischemic Stroke , Heart Diseases , Hospitals, District , Inferior Wall Myocardial Infarction , Non-ST Elevated Myocardial Infarction , ST Elevation Myocardial Infarction , Patient Reported Outcome Measures
5.
Article in Japanese | WPRIM | ID: wpr-924529

ABSTRACT

We report a case of arbitrary delayed surgical repair for left ventricular free wall rupture (LVFWR) after acute myocardial infarction with suspected posterior papillary muscle necrosis. The case was a 67-year-old woman who had chest and back pain in the morning, and relapsed in the evening, and was urgently transported. She had an acute lateral wall myocardial infarction on an electrocardiogram and pericardial effusion on transthoracic echocardiography (TTE). She was found to have an obstruction at the origin of the left circumflex branch on coronary angiography. TTE showed low-intensity findings on the head of the posterior papillary muscle, suggesting necrosis of the papillary muscle. For LVFWR, conservative treatment was prioritized and IABP (intra-aortic balloon pumping) management was performed for the purpose of reducing after load because there was concern about papillary muscle rupture (PMR) due to cardiac manipulation and because it was an oozing type and did not disrupt respiratory of circulatory dynamics. On the 7th day after the onset, TTE showed improvement in echo-luminance of the posterior papillary muscle head and gradual increase in pericardial fluid, and a non-suture procedure was performed. She withdrew from the IABP on the third day after surgery and was discharged home on the 12th day.

6.
Article in English | WPRIM | ID: wpr-923823

ABSTRACT

@#BACKGROUND: Previous studies have reported inconsistent findings regarding the association between catestatin and outcomes of acute myocardial infarction (AMI). This study aims to investigate the prognostic value of catestatin for long-term outcomes in patients with AMI. METHODS: One hundred and sixty-five patients with AMI were enrolled in this series. The plasma catestatin levels at baseline and clinical data were collected. All patients were followed up for four years to investigate whether there were major adverse cardiovascular events (MACEs), including cardiovascular death, recurrent AMI, rehospitalization for heart failure, and revascularization. RESULTS: There were 24 patients who had MACEs during the follow-up period. The MACEs group had significantly lower plasma catestatin levels (0.74±0.49 ng/mL vs. 1.10±0.79 ng/mL, P=0.033) and were older (59.0±11.4 years old vs. 53.2±12.8 years old, P=0.036). The rate of MACEs was significantly higher in the elderly group (≥60 years old) than in the young group (<60 years old) (23.8% [15/63] vs. 8.8% [9/102], P=0.008). The catestatin level was significantly lower in the MACEs group than that in the non-MACEs group (0.76±0.50 ng/mL vs. 1.31±0.77 ng/mL, P=0.012), and catestatin was significantly associated with MACEs (Kaplan Meier, P=0.007) among the elderly group, but not in the young group (Kaplan Meier, P=0.893). In the Cox proportional hazards regression, high catestatin was one of the independent factors for predicting MACEs after adjustment for other risk factors (hazard ratio 0.19, 95% confidence interval 0.06-0.62, P=0.006) among elderly patients. CONCLUSIONS: Elderly AMI patients with lower plasma catestatin levels are more likely to develop MACEs. Catestatin may be a novel marker for the long-term prognosis of AMI, especially in elderly patients.

7.
Article in English | WPRIM | ID: wpr-923822

ABSTRACT

@#BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) remains challenging, especially for institutions without the high-sensitive cardiac troponin (hs-cTn) assay. Herein, we aim to assess the value of creatine kinase-myocardial band isoenzyme (CK-MB) combined with different cardiac troponin (cTn) assays in AMI diagnosis. METHODS: This multicenter, observational study included 3,706 patients with acute chest pain from September 1, 2015, to September 30, 2017. We classified the participants into three groups according to the cTn assays: the point-of-care cTn (POC-cTn) group, the contemporary cTn (c-cTn) group, and hs-cTn group. The diagnostic value was quantified using sensitivity and the area under the curve (AUC). RESULTS: Compared to the single POC-cTn/c-cTn assays, combining CK-MB and POC-cTn/c-cTn increased the diagnostic sensitivity of AMI (56.1% vs. 63.9%, P<0.001; 82.7% vs. 84.3%, P=0.025). In contrast, combining CK-MB and hs-cTn did not change the sensitivity compared with hs-cTn alone (95.0% vs. 95.0%, P>0.999). In the subgroup analysis, the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset <6 h compared with c-cTn alone (72.8% vs. 75.0%, P=0.046), while the sensitivity did not increase with time from symptom onset >6 h (97.5% vs. 98.3%, P=0.317). The AUC of the combination of CK-MB and POC-cTn significantly increased compared to the single POC-cTn assay (0.776 vs. 0.750, P=0.002). The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h. CONCLUSIONS: The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI, especially when hs-cTn is not available.

8.
Clinics ; 77: 100038, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394296

ABSTRACT

Abstract Background: The strain parameters of Real-Time Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) are GLS, GAS, GRS, and GCS, while each index can significantly diagnose Acute Myocardial Infarction (AMI) patients, but none of them can distinguish between NSTEMI and STEMI. MicroRNAs (miRNAs) play essential roles in Acute Myocardial Infarction (AMI), but little is known about the value of exosome miRNA combined with RealTime Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) between ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Aim: To estimate the exosomal miRNAs related to strain parameters of RT3D-STE as biomarkers for early detection of STEMI and NSTEMI. Methods: The present study collected plasma samples from thirty-four (34) patients with AMI (including STEMI and NSTEMI) and employed high-throughput sequence technology and real-time quantitative polymerase chain reaction (RT-qPCR) to identify the differentially expressed miRNAs. The Pearson correlation coefficient is used to measure the strength of a linear association between differentially expressed miRNAs and strain parameters of RT3D-STE. Results: Twenty-eight (28) differentially expressed exosomal miRNAs were universally identified between STEMI, NSTEM, and normal groups. Among them, there are 10 miRNAs (miR-152-5p, miR-3681-5p, miR-193a-5p, miR-193b-5p miR-345-5p, miR-125a-5p, miR-365a-3p, miR-4520-2-3p, hsa-miR-193b-3p and hsa-miR-5579-5p) with a Pearson correlation greater than 0.6 with RT3D-STE strain parameters. Especially, miR-152-5p and miR-3681-5p showed the most significant correlation with RT3D-STE strain parameters. Target genes of these 10 miRNAs are analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment, and they were found to be mainly involved in the cellular metabolism processes and HIF-1 signaling pathway. RT-qPCR verified the significant differential expression of miR-152-5p and miR-3681-5p between STEMI and NSTEM groups. Conclusion: RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. If the RT3D-STE is abnormal, the exosome miRNAs can be detected again to obtain more detailed and accurate diagnostic results between STEMI and NSTEM groups. Exosomal miR-152-5p and miR-3681-5p may serve as potential biomarkers for ST-segment elevation myocardial infarction. HIGHLIGHTS RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction.

10.
Article in English | WPRIM | ID: wpr-928946

ABSTRACT

OBJECTIVE@#To investigate whether Lingbao Huxin Pill (LBHX) protects against acute myocardial infarction (AMI) at the infarct border zone (IBZ) of myocardial tissue by regulating apoptosis and inflammation through the sirtuin 1 (SIRT1)-mediated forkhead box protein O1 (FOXO1) and nuclear factor-κ B (NF-κ B) signaling pathways.@*METHODS@#Six-week-old Wistar rats with normal diet were randomized into the sham, the model, Betaloc (0.9 mg/kg daily), LBHX-L (0.45 mg/kg daily), LBHX-M (0.9 mg/kg daily), LBHX-H (1.8 mg/kg daily), and LBHX+EX527 (0.9 mg/kg daily) groups according to the method of random number table, 13 in each group. In this study, left anterior descending coronary artery (LADCA) ligation was performed to induce an AMI model in rats. The myocardial infarction area was examined using a 2,3,5-triphenyltetrazolium chloride solution staining assay. A TdT-mediated dUTP nick-end labeling (TUNEL) assay was conducted to assess cardiomyocyte apoptosis in the IBZ. The histopathology of myocardial tissue at the IBZ was assessed with Heidenhain, Masson and hematoxylineosin (HE) staining assays. The expression levels of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-1 β, and intercellular adhesion molecule-1 were measured using enzyme-linked immunosorbent assays (ELISAs). The mRNA expressions of SIRT1 and FOXO1 were detected by real-time qPCR (RT-qPCR). The protein expressions of SIRT1, FOXO1, SOD2, BAX and NF- κ B p65 were detected by Western blot analysis.@*RESULTS@#The ligation of the LADCA successfully induced an AMI model. The LBHX pretreatment reduced the infarct size in the AMI rats (P<0.01). The TUNEL assay revealed that LBHX inhibited cardiomyocyte apoptosis at the IBZ. Further, the histological examination showed that the LBHX pretreatment decreased the ischemic area of myocardial tissue (P<0.05), myocardial interstitial collagen deposition (P<0.05) and inflammation at the IBZ. The ELISA results indicated that LBHX decreased the serum levels of inflammatory cytokines in the AMI rats (P<0.05 or P<0.01). Furthermore, Western blot analysis revealed that the LBHX pretreatment upregulated the protein levels of SIRT1, FOXO1 and SOD2 (P<0.05) and downregulated NF- κ B p65 and BAX expressions (P<0.05). The RT-qPCR results showed that LBHX increased the SIRT1 mRNA and FOXO1 mRNA levels (P<0.05). These protective effects, including inhibiting apoptosis and alleviating inflammation in the IBZ, were partially abolished by EX527, an inhibitor of SIRT1.@*CONCLUSION@#LBHX could protect against AMI by suppressing apoptosis and inflammation in AMI rats and the SIRT1-mediated FOXO1 and NF- κ B signaling pathways were involved in the cardioprotection effect of LBHX.


Subject(s)
Animals , Apoptosis , Drugs, Chinese Herbal , Inflammation/metabolism , Myocardial Infarction/pathology , NF-kappa B/metabolism , Nerve Tissue Proteins , Rats , Rats, Wistar , Sirtuin 1/genetics
11.
Article in Chinese | WPRIM | ID: wpr-932382

ABSTRACT

Objective:To evaluate left ventricular systolic function and myocardial perfusion in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by left ventricular pressure-strain loop (PSL).Methods:From August 2020 to December 2020, 47 patients with AMI admitted to the Intensive Care Unit of Cardiovascular Department of the First People′s Hospital of Foshan and treated with PCI were selected. Myocardial contrast echocardiography (MCE) and conventional echocardiography were performed within 72 hours after operation (T1 phase) and conventional echocardiography was repeated 3 months later (T2 phase). Myocardial perfusion scores (MPS) of left ventricular segments were obtained by MCE and the overall myocardial perfusion score index (PSI) was calculated. According to PSI, the patients were divided into good perfusion group and poor perfusion group. Conventional ultrasonic parameters and two-dimensional global longitudinal strain (2D-GLS) were collected. Left ventricular PSL analyzed in off-line EchoPAC software was used to evaluate the left ventricular myocardial work index, including global work index (GWI), global constructive work (GCW), global waste work (GWW), global work efficiency (GWE). The differences of parameters between patients with different perfusion levels and the change of parameters with time at the same perfusion level were compared. ROC curves were used to analyze the diagnostic values of strain parameters and myocardial work parameters in patients with hypoperfusion.Results:There were no significant differences in conventional ultrasound parameters between groups in T1 and T2 phases (all P>0.05), while there were significant differences in 2D-GLS and myocardial work parameters (except GWI in T2 phase) (all P<0.05). The absolute values of 2D-GLS and myocardial work parameters (except GWW ) were higher than those in T1 phase (all P<0.05). There was no significant difference in GWW ( P>0.05), but it decreased in good perfusion group while increased in poor perfusion group over time. ROC curve analysis showed that 2D-GLS, GWI, GCW and GWE had high area under the curve. Conclusions:Left ventricular PSL provides a new sensitive method for the evaluation of cardiac function in patients with AMI after PCI, and is expected to become a new index for the preliminary evaluation of microcirculation.

12.
Chinese Critical Care Medicine ; (12): 178-182, 2022.
Article in Chinese | WPRIM | ID: wpr-931845

ABSTRACT

Objective:To explore the diagnostic performance of cardiac magnetic resonance imaging (CMR) with T1 mapping and T2 mapping for detection of acute phase of ischemic cardiomyopathy.Methods:Twenty-four patients with acute myocardial infarction (AMI) detected by coronary angiography from May 2020 to April 2021 in Tianjin First Center Hospital were selected. All patients underwent CMR (Philips Ingenia 3.0-T) at (9±4) days after definite diagnosis, which was defined as the first diagnosis. After 3 months and 6 months of chronic myocardial infarction (CMI) phase, one CMR was performed. On the same period with age and sex matching, a total of 26 cases of healthy volunteers and outpatient with non-specific chest pain and CMR examination without abnormality as control group. Plain scan included Cine, T2-weighted (STIR), and native T1/T2 mapping. The enhanced scan included perfusion, late gadolinium enhancement, post-T1 mapping. The changes of myocardial quantitative parameters before and after myocardial infarction were compared. Receiver operator characteristic curves (ROC curve) were developed to evaluate, compare, and distinguish the changes in the AMI group and the CMI group after 6 months.Results:Pre-enhanced T1 value, T2 value and extracellular volume (ECV) of AMI group were significantly higher than those of control group [pre-enhanced T1 value (ms): 1 438.7±173.4 vs. 1 269.2±42.3, pre-enhanced T2 value (ms): 49.8±9.3 vs. 21.7±4.0 , ECV (%): 33.2±10.2 vs. 27.2±2.1, all P < 0.05]. ECV was significantly higher in AMI (%: 33.2±10.2 vs. 27.2±2.1), but stabilized after 3 months (%: 33.2±10.2 vs. 32.4±5.1), and after 6 months later (%: 27.7±4.9 vs. 32.4±5.1), there were no significant difference (all P > 0.05). Pre-enhanced T1 and T2 values were significantly higher in AMI, lower after 3 months, but significantly decreased after 6 months [pre-enhanced T1 values (ms): 1 438.7±173.4 vs. 1 272.1±25.2, pre-enhanced T2 values (ms): 49.8±9.3 vs. 29.0±4.0, all P < 0.05]. The ROC curve showed that the specificity of pre-enhanced T1 and T2 values between AMI and CMI were 100%, and the sensitivity were 72.7%, 100%, respectively, pre-enhanced T1 and T2 value could be better distinguish between AMI and CMI diagnosis method. Conclusion:T1 mapping and T2 mapping with ECV can clearly diagnosis ischemic cardiomyopathy, especially pre-enhanced myocardial T1 and T2 values which is non-invasive diagnosis method of AMI, and can distinguish AMI or CMI, has a great significance to the patient's clinical treatment and follow-up.

13.
Article in Chinese | WPRIM | ID: wpr-930759

ABSTRACT

Objective:To search, evaluate and integrate the best evidence of exercise rehabilitation intervention after PCI in patients with acute myocardial infarction, so as to provide evidence-based basis for clinical doctors and nurses to intervene in exercise rehabilitation of patients.Methods:We searched PubMed, China National Knowledge Infrastructure, Wanfang Data and other domestic and foreign databases, guide websites and professional association websites about the evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI. The search period is from January 2010 to June 2021. The quality of the included literature was evaluated by two researchers, and the literature evidence in accordance with the quality standard was extracted.Results:A total of 20 articles were included, and 39 pieces of evidence were summarized from 11 aspects, such as the establishment of multidisciplinary team, evaluation, exercise prescription, exercise monitoring and so on.Conclusions:This study summarized the best evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI, and provided theoretical support for clinical practice. It is suggested to combine the clinical situation and patients' wishes to promote the transformation of the best evidence to clinical practice.

14.
Article in Chinese | WPRIM | ID: wpr-930703

ABSTRACT

Objective:To explore the risk factors of unplanned readmission in patients with acute myocardial infarction, and to construct a risk prediction model.Methods:This study used cross-sectional survey method. A total of 270 acute myocardial infarction patients admitted from Tianjin Union Medical Cencer from March 2020 to March 2021 were evaluated in a cardiology department. We used the electronic medical record system to collect the patients′ data. Patients were divided into two groups according to the occurrence of readmission within 1 year or not. Logistic regression analysis was performed to identify risk factors and formulated prediction model.Results:Totally 81 patients (30%) were readmitted. Binary Logistic regression model showed that the independent influencing factors of unplanned readmission in acute myocardial infarction patients included smoking ( X1), hypertension ( X2), marital status ( X3), hospitalization days ( X4), percutaneous coronary intervention ( X5), and heart failure ( X6). Area under ROC curve was 0.840, the maximum value of the Youden index was 0.560, and the sensitivity was 85.2%, the specificity was 70.8%, and the cutoff value was 0.377. Prediction model expression of unplanned readmission risk in patients with acute myocardial infarction was Logit(p/1-p)=-4.012+1.172 X1+1.104 X2+0.992 X3+0.118 X4+1.191 X5+1.093 X6. Conclusions:The risk prediction model of unplanned readmission in patients with acute myocardial infarction established in this article was with a good predictive effect, and it could be used in early identification of those patients with high-risk in unplanned readmission. At the same time, combined with the risk factors of depression, targeted intervention measures can be formulated.

15.
Article in Chinese | WPRIM | ID: wpr-930232

ABSTRACT

Objective:To explore the regulatory effect of cellular FLICE-like inhibitory protein (cFLIP) on myocardial ischemia-reperfusion injury based on the RIPK1/RIPK3/MLKL-mediated necroptosis pathway.Methods:The cardiomyocyte hypoxia/reoxygenation (H/R) model was constructed by hypoxia for 4 h/reoxygenation for 12 h, and the rat ischemia reperfusion (I/R) model was constructed by ligating the left anterior descending artery for 30 min and reperfusion for 3 h. CCK-8 method was used to detect the viability of cardiomyocytes in each group. DAPI/PI double staining was used to observe changes in necrosis rate of myocardial cell. STRING database was used to predict the protein interaction network of cFLIP. TTC staining was used to detect the area of myocardial infarction in each group of rats, and the protein expression of cFLIPL, cFLIPS, p-RIPK1, p-RIPK3 and p-MLKL were detected by Western blot.Results:In cardiomyocyte H/R injury and myocardial tissue I/R injury, the protein expressions of cFLIPL and cFLIPS were significantly down-regulated, while the levels of p-RIPK1, p-RIPK3 and p-MLKL were increased significantly. Up-regulating the protein expression of cFLIPL and cFLIPS could significantly reduce the damage of cardiomyocytes and the rate of cell necrosis induced by H/R, and decrease the area of myocardial infarction caused by I/R. STRING database results showed that cFLIP had direct protein interactions with RIPK1 and RIPK3. Overexpression of cFLIP in cardiomyocyte and myocardial tissue significantly inhibited H/R or I/R induced the phosphorylation levels of RIPK1, RIPK3 and MLKL.Conclusions:Overexpression of cFLIP can significantly inhibit the RIPK1/RIPK3/MLKL-mediated necroptosis, thereby reducing myocardial cell damage and decreasing the area of myocardial infarction.

16.
Article in English | WPRIM | ID: wpr-920349

ABSTRACT

@#BACKGROUND: We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury (MIRI) in patients with acute ST-elevation myocardial infarction (STEMI) using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism. METHODS: The mononuclear cells were separated by ficoll centrifugation, and plasma total antioxidant capacity (T-AOC) was determined by the ferric reducing ability of plasma (FRAP) assay. The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction (qRT-PCR). Additionally, gene ontology (GO) enrichment analysis was performed on DAVID website to analyze the potential mechanism further. RESULTS: The total numbers of white blood cells (WBC) and neutrophils (N) in the peripheral blood of STEMI patients (the AMI group) were significantly higher than those in the control group (WBC: 11.67±4.85 ×109/L vs. 6.41±0.72 ×109/L, P<0.05; N: 9.27±4.75 ×109/L vs. 3.89±0.81 ×109/ L, P<0.05), and WBCs were significantly associated with creatine kinase-myocardial band (CK-MB) on the first day (Y=8.945+0.018X, P<0.05). In addition, the T-AOC was significantly lower in the AMI group comparing to the control group (12.80±1.79 U/mL vs. 20.48±2.55 U/mL, P<0.05). According to the gene analysis, eight up-regulated differentially expressed genes (DEGs) included GADD45A, PRDX2, HSPD1, DNAJB1, DNAJB2, RAD50, TNFSF6, and TRADD. Four down-regulated DEGs contained CCNG1, CAT, CYP1A1, and ATM. TNFSF6 and CYP1A1 were detected by polymerase chain reaction (PCR) to verify the expression at different time points, and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression. GO and kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response (UPR) and apoptosis. CONCLUSIONS: WBCs, especially neutrophils, were the critical cells that mediating reperfusion injury. MIRI was regulated by various genes, including oxidative metabolic stress, heat shock, DNA damage and repair, and apoptosis-related genes. The underlying pathway may be associated with UPR and apoptosis, which may be the novel therapeutic target.

17.
Medisan ; 25(6)2021. tab, graf, ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1356467

ABSTRACT

Introducción: En numerosos estudios realizados en las últimas 3 décadas, se ha tratado de atribuir una relación causal a la enfermedad periodontal en la fisiopatología de la cardiopatía isquémica. Objetivo: Caracterizar el estado periodontal de pacientes con cardiopatía isquémica y algunos factores de riesgo cardiovascular. Métodos: Se realizó un estudio transversal de 50 pacientes, atendidos en la sala de cuidados coronarios del Hospital Provincial Vladimir Ilich Lenin de Holguín, desde septiembre de 2019 hasta enero de 2020. Se evaluó el estado periodontal mediante el Índice Periodontal de Russell simplificado. Se exploraron algunos factores de riesgo de la cardiopatía isquémica y se emplearon métodos teóricos, empíricos, así como la estadística descriptiva. Resultados: En la serie predominó el grupo de 60-69 años de edad (23 para 46,0 %); 56,0 % de los pacientes presentó infarto agudo de miocardio y 62,0 % periodontitis avanzada. Entre los factores de riesgo cardiovascular más frecuentes figuraron: hipertensión arterial (74,0 %) y tabaquismo (70,0 %). Conclusiones: En este estudio se halló, en gran medida, la periodontitis crónica en pacientes con cardiopatía isquémica, lo cual sirve de pauta para la toma de decisiones de médicos y estomatólogos.


Introduction: In numerous studies carried out in the last 3 decades, it has been tried to attribute a causal relationship to the periodontal disease in the pathophysiology of the ischemic heart disease. Objective: To characterize the periodontal state of patients with ischemic heart disease and some cardiovascular risk factors. Methods: A cross-sectional study of 50 patients, assisted in the Coronary Cares Service of Vladimir Ilich Lenin Provincial Hospital in Holguín, was carried out from September, 2019 to January, 2020. The periodontal state was evaluated by means of the Russell Periodontal Index simplified. Some risk factors of the ischemic heart disease were explored and theoretical, empiric methods were used, as well as the descriptive statistic. Results: In the series there was a prevalence of the 60-69 age group (23 for 46 %); 56.0 % of the patients presented acute myocardial infarction and 62.0 % presented advanced periodontitis. Among the most frequent cardiovascular risk factors we can mention: hypertension (74.0 %) and nicotine addiction (70.0 %). Conclusions: In this study it was found, in great measure, the chronic periodontitis in patients with ischemic heart disease, which serves as rule for the decisions making of doctors and dentists.


Subject(s)
Periodontal Diseases , Myocardial Ischemia , Periodontitis , Risk Factors , Angina, Unstable , Myocardial Infarction
18.
Rev. colomb. cardiol ; 28(6): 556-563, nov.-dic. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1357230

ABSTRACT

Abstract Introduction Until now, only few studies have reported the correlation between vesicle-associated membrane protein-8 (VAMP-8) A/G gene polymorphism and acute myocardial infarction. Whereas, theoretically, VAMP-8 plays a pivotal role in the pathogenesis of acute myocardial infarction through platelet activation, secretion, and aggregation. Objective To investigate the association between VAMP-8 A/G gene polymorphism and the risk of acute myocardial infarction. Methods A cross-sectional study was carried out at Saiful Anwar General Hospital during June 2013 - May 2014. A Mae II enzyme with restriction fragment length polymorphism method was used to genotype VAMP-8 A/G gene polymorphisms in acute myocardial infarction and control groups. A multiple logistic regression test was used to analyze the association between VAMP-8 A/G gene polymorphism and the risk of acute myocardial infarction. Results A total of 35 controls and 97 acute myocardial infarction patients from our Hospital during the period were enrolled for our study. Our results found that VAMP-8 A/G gene polymorphism was not associated with the risk of acute myocardial infarction. Moreover, we also failed to confer the association between VAMP-8 A/G gene polymorphism and both smoking and hypertension among patients with acute myocardial infarction. Furthermore, in the setting of premature acute myocardial infarction, the correlation also failed to confirm. Conclusion In our population, there is no association between VAMP-8 A/G gene polymorphism and the risk of acute myocardial infarction.


Resumen Introducción Hasta la fecha, solo unos pocos estudios han reportado la correlación entre el polimorfismo A/G del gen de la proteína de membrana asociada a vesículas-8 (VAMP-8, por sus siglas en inglés) y el infarto agudo de miocardio. Si bien, en teoría, VAMP-8 juega un papel fundamental en la patogénesis del infarto agudo de miocardio a través de la activación, secreción y agregación plaquetaria. Objetivo Investigar la relación entre el polimorfismo A/G del gen VAMP-8 y el riesgo de infarto agudo de miocardio. Métodos: Se llevó a cabo un estudio transversal en Siful Anwar General Hospital entre junio del 2013 y mayo del 2014. Se utilizó la técnica de polimorfismos de longitud de fragmentos de restricción con la enzima Mae II para genotipificar los polimorfismos A/G del gen VAMP-8 en grupos de infarto agudo de miocardio y de control. Se aplicó una prueba de regresión logística múltiple para analizar la relación entre el polimorfismo A/G del gen VAMP-8 y el riesgo de infarto agudo de miocardio. Resultados Se incluyeron un total de 35 controles y 97 pacientes con infarto agudo de miocardio de nuestro Hospital durante el periodo del estudio. Nuestros resultados encontraron que el polimorfismo A/G del gen VAMP-8 no estaba relacionado con el riesgo de infarto agudo de miocardio. Por otra parte, tampoco pudimos establecer una relación entre el polimorfismo A/G del gen VAMP-8 y tanto tabaquismo como hipertensión en pacientes con infarto agudo de miocardio. Asimismo, en el contexto de infarto agudo de miocardio prematuro, tampoco se confirmó la correlación. Conclusión: En nuestra población, no existe una relación entre el polimorfismo A/G del gen VAMP-8 y el riesgo de infarto agudo de miocardio.

19.
Rev. colomb. cardiol ; 28(6): 564-572, nov.-dic. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1357231

ABSTRACT

Resumen Objetivo Determinar si los niveles plasmáticos de factor de crecimiento de hepatocitos podrían ayudar a realizar el diagnóstico diferencial en pacientes con dolor torácico prolongado y elevación de la troponina cardiaca, y evaluar su valor pronóstico de mortalidad al año en estos pacientes. Método: Estudio prospectivo observacional. Se incluyeron pacientes mayores de 18 años que acudieron a urgencias con dolor torácico agudo de más de 20 minutos y elevación de la troponina cardiaca, con seguimiento al año. Resultados Se incluyeron 303 pacientes, 103 (34%) con infarto de miocardio y 200 (66%) con otras enfermedades. Los niveles plasmáticos del factor de crecimiento de hepatocitos fueron superiores en el grupo sin infarto de miocardio: 329 pg/ml (rango intercuartílico [IQR]: 66-558) vs. 476 pg/ml (IQR: 264-908; p < 0.001). La mortalidad al año fue del 30.7%, superior en el grupo sin infarto de miocardio (36.5% vs. 19.4%; p = 0.002). Se encontró una fuerte asociación entre la mortalidad y los niveles elevados de factor de crecimiento de hepatocitos (650 pg/ml [344-1159] vs. 339 pg/ml [205-607]; p < 0.001). En el análisis multivariado se halló que los niveles de factor de crecimiento de hepatocitos, la edad y la escala GRACE son factores independientes de mortalidad al año en estos pacientes. Conclusiones En los pacientes con dolor torácico agudo prolongado y elevación de la troponina cardiaca, la determinación de los niveles del factor de crecimiento de hepatocitos no permite confirmar ni descartar la presencia de infarto agudo de miocardio. No obstante, podría ser un marcador pronóstico de mortalidad en estos pacientes, junto con la edad y la escala GRACE.


Abstract Objective To determine if plasma levels of hepatocyte growth factor could help in the differential diagnosis of patients with prolonged chest pain and elevated cardiac troponin; and to evaluate its prognostic value for one-year mortality in these patients. Method A prospective observational study. Patients over the age of 18 who were seen in the emergency room for acute chest pain lasting longer than 20 minutes and elevated cardiac troponin were included, with follow up after one year. Results We included 303 patients, 103 (34%) with myocardial infarction and 200 (66%) with other diseases. Plasma levels of hepatocyte growth factor were higher in the group without myocardial infarction: 329 pg/ml (IQR: 166-558) vs. 476 pg/ml (IQR: 264-908; p < 0.001). One-year mortality was 30.7%, higher in the group without myocardial infarction (36.5% vs. 19.4%; p = 0.002). We found a strong association between mortality and elevated levels of hepatocyte growth factor (650 pg/ml [344-1,159] vs. 339 pg/ml [205-607]; p < 0.001). Multivariate analysis showed that levels of hepatocyte growth factor, age and the GRACE scale are independent factors for one-year mortality in these patients. Conclusions In patients with prolonged acute chest pain and elevated cardiac troponin, hepatocyte growth factor levels do not confirm or rule out acute myocardial infarction, although they may be a prognostic marker for mortality in these patients, along with age and the GRACE scale.

20.
Notas enferm. (Córdoba) ; 21(38): 54-62, nov. 2021.
Article in Spanish | LILACS, BDENF, BINACIS, UNISALUD | ID: biblio-1348588

ABSTRACT

El Síndrome coronario agudo (SCA) se define como la obstrucción brusca de una arteria que puede dar lugar a una isquemia miocárdica aguda que se acompaña de un síndrome clínico característico que puede ir desde una isquemia con elevación o sin elevación en el segmento ST, angina estable o inestable y muerte súbita. Dado que el SCA es considerado un problema mundial por su alta incidencia y una de las principales causas de muerte es que resulta indispensable la creación y aplicación de un protocolo de recepción del paciente con SCA donde el enfermero que recepciona al paciente con dolor torácico en un servicio de urgencia pueda realizar la valoración de forma oportuna y rápida teniendo en cuenta una secuencia de intervenciones y cuidados que se encuentren plasmados en una planilla el cual garantice la implementación de las medidas terapéuticas a tiempo, aumentando la eficacia de las mismas, reduciendo la morbimortalidad y disminuyendo los costos hospitalarios. El objetivo del protocolo es estandarizar las intervenciones y cuidados de enfermería en la atención inicial del paciente con SCA[AU]


Acute coronary syndrome (ACS) is defined as a sudden obstruction of an artery that can lead to acute myocardial ischemia that is accompanied by a characteristic clinical syndrome that can range from elevation or without elevation ischemia in the ST segment, angina stable or unstable and sudden death. Ince ACS is considered a worldwide problem due to its high incidence and one of the main causes of death, it is essential to create and apply a protocol for receiving the patient with ACS, where the nurse who receives the patient with chest pain in a The emergency service can carry out the assessment in a timely and fast way, taking into account a sequence of interventions and care that are reflected in a schedule that guarantees the implementation of therapeutic measures in time, increasing their effectiveness, reducing morbidity and mortality. and lowering hospital costs. The objective of the protocol is to standardize nursing interventions and care in the initial care of the patient with ACS[AU]


A síndrome coronariana aguda (SCA) é definida como uma obstrução repentina de uma artéria que pode levar a isquemia miocárdica aguda, acompanhada por uma síndrome clínica característica que pode variar de elevação ou sem isquemia de elevação no segmento ST, angina morte estável ou instável e repentina.Como a SCA é considerada um problema mundial devido à sua alta incidência e uma das principais causas de morte, é essencial criar e aplicar um protocolo para receber o paciente com SCA, onde a enfermeira que recebe o paciente com dor no peito O serviço de emergência pode realizar a avaliação de maneira oportuna e rápida, levando em consideração uma sequência de intervenções e cuidados que se refletem em um cronograma que garante a implementação de medidas terapêuticas no tempo, aumentando sua efetividade, reduzindo a morbimortalidade. e redução de custos hospitalares. O objetivo do protocolo é padronizar intervenções e cuidados de enfermagem nos cuidados iniciais do paciente com SCA[AU]


Subject(s)
Humans , Chest Pain , Myocardial Ischemia , Guidelines as Topic , Acute Coronary Syndrome , Myocardial Infarction , Nursing Care , Emergencies
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