The impact of gender difference on the effects of preinfarction angina on microvascular damage with reperfused myocardial infarction.

BACKGROUND: Few studies have addressed gender differences in evoking preconditioning. In an experimental study, it was reported that the preconditioning effect disappeared after gonadectomy. OBJECTIVES: We sought to determine the effects of preinfarction angina (PA) on myocardial damage using intravenous contrast echocardiography. METHODS: We studied 334 consecutive patients with anterior myocardial infarction (AMI) who underwent successful angioplasty. All patients underwent myocardial contrast echocardiography (MCE) 14 days after percutaneous coronary intervention (PCI). Contrast defect was calculated as contrast defect area/myocardial area. Typical angina occurring in the 24-hour period preceding myocardial infarction was present in 133 patients (29 women) (group PA) and absent in 201 patients (43 women) (group non-PA). All women were postmenopausal. RESULTS: The contrast defect size and peak creatinine phosphokinase (max CPK) level in women were both significantly higher than that of men in group PA (18.3% +/- 6.3% vs 11.9% +/- 9.0%; P < 0.01 and 5000 +/- 599 IU/L vs 2672 +/- 221 IU/L; P < 0.005). The functional status of the myocardium among group PA, as expressed by risk area wall motion score index, was better in men than in women at 14 days (1.1 +/- 0.8 vs 1.7 +/- 0.8; P < 0.01) and at 6 months (0.7 +/- 0.4 vs 1.6 +/- 0.6; P < 0.01). However there were no significant gender differences in group non-PA. Multivariate regression analysis showed that the female gender (P < 0.05) was a significant independent predictor for microvascular damage. CONCLUSIONS: These findings suggest that preconditioning effects were attenuated in women with reperfused AMI.

Waist circumference reduction is more strongly correlated with the improvement in endothelial function after acute coronary syndrome than body mass index reduction.

BACKGROUND: Endothelial function predicts recurrence of adverse cardiac events in patients with acute coronary syndromes (ACS). Moreover, the recovery of endothelial function correlates with cardiac event-free survival. OBJECTIVES: The aim of this study was to determine which clinical factors correlate with the improvement in endothelial function after ACS. METHODS: Vascular endothelial function was assessed in 98 patients with ACS by flow-mediated dilation (FMD) of the brachial artery using high-resolution ultrasound at 2 weeks and 6 months after ACS. We measured several risk parameters including plasma markers of glucose homeostasis, lipids, and blood pressure at baseline and at 6 months after ACS. Body mass index (BMI) and waist circumference (WC) were also measured as anthropometric assessments. RESULTS: At baseline, FMD was significantly correlated with BMI, WC, high-density lipoprotein cholesterol, the homeostasis model assessment of insulin resistance, and brachial artery diameter (r=-0.32, p=0.001; r=-0.44, p<0.0001; r=0.34, p=0.0006; r=-0.21, p=0.04; r=-0.47, p<0.0001, respectively). In a stepwise multivariate regression analysis at baseline, larger WC and brachial artery diameter were independently correlated with lower brachial artery FMD (R(2)=0.319, p<0.0001). At 6 months, the change in FMD was significantly correlated with the change in WC and BMI (r=-0.59, p<0.0001; r=-0.33, p=0.001, respectively). In a stepwise multivariate regression analysis, WC reduction was independently correlated with improved FMD (R(2)=0.349, p<0.0001). CONCLUSIONS: WC reduction is more strongly correlated with the improvement of endothelial function after ACS than BMI reduction.

Relationship of admission neutrophil count to microvascular injury, left ventricular dilation, and long-term outcome in patients treated with primary angioplasty for acute myocardial infarction.

BACKGROUND: The relationship of admission neutrophil count to the degree of microvascular injury, left ventricular (LV) volume, and long-term outcome after acute myocardial infarction (AMI) was examined in the present study. METHODS AND RESULTS: The study group comprised 228 consecutive patients with a first anterior wall AMI who underwent primary angioplasty within 12 h of onset. The degree of microvascular injury was evaluated by Doppler guidewire. Adverse cardiac events were recorded during an average follow-up of 52+/-28 months. Using a receiver-operating characteristic analysis, a neutrophil count >or=7,260 cells/mm(3) was the best predictor of future cardiac events. By regression analysis, the neutrophil count significantly correlated with diastolic deceleration time (r=-0.40, p<0.0001), coronary flow reserve (r=-0.43, p<0.0001), and LV end-diastolic volume at 4 weeks (r=0.32, p<0.0001). Kaplan-Meier survival analysis showed a higher incidence of adverse cardiac events in patients with a high neutrophil count (p=0.002). By multivariate analysis, a neutrophil count >or=7,260 cells/mm(3) was an independent predictor of long-term adverse cardiac events (odds ratio 3.8, p=0.002). CONCLUSION: Neutrophilia on admission is associated with impaired microvascular perfusion, LV dilation, and long-term adverse cardiac events in patients treated with primary angioplasty for AMI.

Usefulness of coronary flow reserve immediately after primary coronary angioplasty for acute myocardial infarction in predicting long-term adverse cardiac events.

Coronary flow reserve (CFR) evaluated immediately after reperfusion is thought to reflect the degree of microvascular injury and predict left ventricular (LV) functional recovery after acute myocardial infarction. It was hypothesized that CFR immediately after reperfusion would be predictive of the occurrence of long-term adverse cardiac events. Using a Doppler guidewire, CFR was evaluated immediately after primary coronary angioplasty in 118 consecutive patients with first anterior acute myocardial infarctions. Adverse cardiac events combining cardiac death, recurrent myocardial infarction, and congestive heart failure were recorded during an average follow-up period of 62 +/- 32 months. Using receiver-operating characteristic analysis, CFR 1.3 (n = 68). Patients with CFR 1.3. CFR was significantly correlated with the LV ejection fraction at 4 weeks (r = 0.50, p <0.0001) and LV end-diastolic volume at 4 weeks (r = -0.43, p <0.0001). Kaplan-Meier survival analysis showed a higher incidence of adverse cardiac events in patients with CFR

Relation between neutrophil counts on admission, microvascular injury, and left ventricular functional recovery in patients with an anterior wall first acute myocardial infarction treated with primary coronary angioplasty.

Increased neutrophil counts have been associated with an increased risk of adverse clinical events after acute myocardial infarction (AMI). We examined the association of neutrophil counts on admission with degree of microvascular injury and left ventricular functional recovery after primary coronary angioplasty in AMI. We studied 116 patients with a first anterior wall AMI who underwent primary coronary angioplasty within 12 hours of onset. Patients were categorized into 3 groups based on initial neutrophil count: low (<5,000/mm(3)), intermediate (5,000 to 10,000/mm(3)), and high (>10,000/mm(3)). Coronary flow velocity parameters were assessed immediately after reperfusion using a Doppler guidewire. We defined severe microvascular injury as the presence of systolic flow reversal and a diastolic deceleration time <600 ms. Echocardiographic wall motion was analyzed before revascularization and 4 weeks after revascularization. In patients with a high neutrophil count, systolic flow reversal was more frequently observed, diastolic deceleration time was shorter, and coronary flow reserve was lower. By regression analysis, neutrophil count significantly correlated with diastolic deceleration time (r = -0.38, p <0.0001), coronary flow reserve (r = -0.33, p = 0.0004), and score for change in wall motion (r = -0.36, p = 0.0004). Multivariate analysis showed that neutrophil count on admission was an independent predictor of severe microvascular injury (odds ratio 2.94, p = 0.02). In conclusion, neutrophilia on admission is associated with impaired microvascular reperfusion and poor functional recovery after primary coronary angioplasty.