Successful visible thrombus aspiration in ST-segment elevation myocardial infarction: associated factors and the clinical impact.

BACKGROUND: Thrombus aspiration (TA) has been considered a procedure for controlling distal emboli and improving microvascular perfusion. However, current guidelines classify routine TA as class III recommendation, and it has been reported that the efficacy of TA is limited because of the relatively high incidence of failure in retrieval of thrombotic material. The aim of this study was to explore patient characteristics and procedural factors associated with successful TA in ST-elevation myocardial infarction (STEMI) and to assess the clinical impact of successful TA. METHODS: This single-center retrospective study enrolled 158 STEMI patients who underwent TA as initial recanalization. Factors associated with successful TA, which was defined as retrieving any visible material by aspiration catheter, were explored, and angiographical and short-term outcomes were assessed. RESULTS: In 146 cases (92.4%), the aspiration catheter reached the culprit lesion. Successful TA was achieved in 72 cases (45.6%). The single angiographical characteristic of successful TA was a higher Thrombolysis in Myocardial Infarction grade before TA. Among the procedural characteristics, the rate of successful TA was higher with a 7-French aspiration catheter compared with the rate with a 6-French catheter (57.1% vs. 29.9%, P = 0.01). Thrombolysis in Myocardial Infarction grade 3 flow was more frequent in patients with successful TA immediately after TA (36.1% vs. 16.3%, P = 0.006) and at final angiography (91.7% vs 79.1%, P = 0.04) compared with the grade in patients without successful TA, respectively. CONCLUSIONS: The use of a larger aspiration catheter may be effective in retrieving visible thrombus material, and successful TA led to better angiographical results.

Neurological Prognostic Value of Adjusted Ca2+ Concentration in Adult Patients with Out-of-Hospital Cardiac Arrest.

Many patients are transferred to hospital due to out-of-hospital cardiac arrest (OHCA), and, unfortunately, most suffer from cerebral damage. Currently, it is difficult to predict the recovery of neurological function after return of spontaneous circulation (ROSC) in the acute phase. Increased intracellular Ca2+ induces cell death in the acute phase. Accordingly, we predicted that serum adjusted Ca2+ will decrease following Ca2+ influx into cells. Consequently, serum adjusted Ca2+ in the acute phase may be able to predict recovery of neurological function in patients with ROSC from OHCA. This is a retrospective and observational study from 2 centers. A total of 190 consecutive patients with ROSC from OHCA were recruited, with 33 patients meeting the inclusion criteria. The relationship between serum adjusted Ca2+ within 48 hours after ROSC and neurological function at discharge (as evaluated by the Glasgow-Pittsburgh cerebral performance category) was examined. Serum adjusted Ca2+ was measured every 4 hours within a 48-hour period after ROSC. There were no significant differences in hemodynamical state and laboratory data between the 2 groups. However, lowest serum adjusted Ca2+ within 48 hours after ROSC was significantly lower in the poor neurological outcome group (0.96 ± 0.06 versus 1.02 ± 0.06 mmol/L, P = 0.011). Thus, lowest serum adjusted Ca2+ within 48 hours after ROSC may be a predictive factor for recovery of neurological function at discharge in patients with ROSC from OHCA.

Impact of delayed hyperenhancement obtained by non-contrast computed tomography following coronary angiography in patients undergoing extracorporeal cardiopulmonary resuscitation.

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve outcomes in patients with refractory cardiac arrest. However, the outcome is difficult to predict on admission. Recent reports have described early evaluation of myocardial damage in patients with acute myocardial infarction by detecting delayed enhancement in non-contrast computed tomography (CT) following coronary angiography (CAG). We investigated the impact of delayed hyperenhancement obtained by non-contrast CT following CAG in patients with ischaemic and non-ischaemic cardiovascular diseases who underwent ECPR for refractory cardiac arrest. METHODS: Forty-two patients who underwent ECPR, CAG, and postprocedural CT for refractory cardiac arrest in our institute were retrospectively enrolled. Two blinded readers independently and semi-quantitatively judged whether hyperenhancement was present or absent in non-contrast axial CT images following CAG. We evaluated the relationship between in-hospital death and delayed hyperenhancement. RESULTS: The identification of delayed hyperenhancement was highly consistent between the two readers (kappa ​= ​0.71). The survival rate was 21.4% in this cohort. The only significant difference between the survival group and in-hospital death group was the presence of delayed hyperenhancement, which was detected only in the in-hospital death group (p ​= ​0.03). The prevalence of cardiac death was higher in patients with than without delayed hyperenhancement. Delayed hyperenhancement was observed even in areas perfused by non-obstructive coronary arteries. CONCLUSIONS: Delayed hyperenhancement of the left ventricular wall on non-contrast CT imaging following CAG might help to predict in-hospital death in patients undergoing ECPR for refractory cardiac arrest.

Myocardial delayed enhancement on dual-energy computed tomography: The prevalence and related factors in patients with suspicion of coronary artery disease.

BACKGROUND: We aimed to assess the prevalence of myocardial delayed enhancement (MDE) in patients with suspected obstructive coronary artery disease (CAD), and to investigate factors related to the presence or absence of MDE. METHODS: We retrospectively evaluated 191 consecutive patients who underwent coronary computed tomography angiography (CCTA) with MDE imaging for clinical suspicion of CAD from December 2014 to December 2016. The presence of MDE on iodine-density images using dual-energy CT was assessed by two independent readers. Multivariable logistic regression analyses were used to determine factors associated with the presence of MDE. RESULTS: MDE was detected in 58 (30%) patients. Male gender, hypertension, prior heart failure (HF) hospitalization, and CCTA-detected CAD were independent factors related to the presence of MDE. When CCTA-detected CAD was excluded to narrow down the analysis to factors obtainable before CCTA, interventricular septum thickness (IVST) ≥12 mm was added as another independent factor. The combination of the following four factors: female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm demonstrated high specificity (98.3%) and positive predictive value (96.2%) for predicting the absence of MDE. CONCLUSIONS: Male gender, hypertension, prior HF hospitalization, and CAD were independently associated with the presence of MDE in patients with suspected CAD. The combination of female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm is likely to be a helpful predictor in discriminating patients without MDE before CCTA.

Assessment of myocardial fibrosis using T1-mapping and extracellular volume measurement on cardiac magnetic resonance imaging for the diagnosis of radiation-induced cardiomyopathy.

Radiation-induced heart disease (RIHD) is a serious side effect of thoracic radiation therapy (RT) and is associated with significant morbidity and mortality. Radiation-induced cardiomyopathy (RICM) is one of the manifestations of RIHD, which represents with left ventricular (LV) systolic and diastolic dysfunction due to myocardial fibrosis. Although the diagnosis of RIHD is challenging and is generally an exclusion diagnosis, multimodality imaging including echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) imaging could help the diagnosis. Herein, we report a case of 70-years-old male, who had been treated with chemo-radiation therapy for early esophageal cancer, was suffered from medically refractory heart failure due to severely reduced LV systolic function and constrictive pericarditis 8 years after chemo-radiation therapy. Although no gadolinium-enhancement (LGE) was detected on CMR, T1 mapping depicted increased extracellular matrix volumes of 45%, which suggested global myocardial fibrosis. Histopathological analysis by endomyocardial biopsy (EBM) revealed marked degeneration of myocytes and interstitial fibrosis, while vacuolation in myocytes which is characteristics of chemotherapy induced cardiomyopathy was not specific by electron microscopy. Therefore, we diagnosed that the present case was likely to the RICM. .