Association of myocardial hemorrhage and persistent microvascular obstruction with circulating inflammatory biomarkers in STEMI patients

Clinical Impact of Persistent Microvascular Obstruction in CMR After Reperfused STEMI

BACKGROUND

Microvascular injury in the course of acute ST-segment-elevation myocardial infarction (STEMI) has been identified a as determinant of adverse outcomes and manifests as microvascular obstruction (MVO). MVO has long been regarded as a transient finding, vanishing within a few weeks after infarction. However, recent studies have shown that it may persist beyond the early phase, resulting in adverse remodeling. However, its clinical implications remain unclear. This study aims to evaluate the association of MVO persistence and major adverse cardiac events after STEMI.

METHODS

In total, 609 patients with revascularized first-time STEMI underwent cardiac magnetic resonance imaging (CMR) at 4 days, 4 months, and 12 months after STEMI to assess MVO, infarct size, and left ventricular function. Major adverse cardiac events were defined as composite of death, reinfarction, and new congestive heart failure within a median interval of 3.2 years.

RESULTS

Baseline MVO was present in 365 (60%) patients and persisted in 35 (10%) patients at 4-month CMR and in 20 (5%) patients at 12-month CMR. Compared with transient MVO not present at follow-up, patients with MVO persistence ≥4 months were more likely to experience major adverse cardiac events during follow-up (29% versus 13%; P=0.016). Within patients with MVO, those with MVO persistence had lower left ventricular ejection fraction (P=0.002), larger infarcts (P=0.00001), and more frequent intramyocardial hemorrhage (P=0.001) at baseline CMR.

CONCLUSIONS

Persistent MVO after STEMI occurs in up to 10% of patients with baseline MVO and is linked to major adverse cardiac events. Patients with MVO persistence had larger infarcts, lower left ventricular function, and more frequent intramyocardial hemorrhage at baseline CMR. All patients with MVO persisting ≥12 months initially showed intramyocardial hemorrhage.

Association of Intramyocardial Hemorrhage With Inflammatory Biomarkers in Patients With ST-Segment Elevation Myocardial Infarction

BACKGROUND

Ischemia-reperfusion (I/R) injury patterns detected by cardiac magnetic resonance imaging after percutaneous coronary intervention (PCI) have important prognostic implications and trigger inflammatory processes that can further enhance myocardial tissue damage.

OBJECTIVES

The authors aimed to investigate the association of circulating inflammatory markers and I/R injury patterns in patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

This observational study included 456 STEMI patients. Peripheral venous blood samples were drawn 48 hours after PCI for analysis of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBCc), and interleukin (IL)-6. The presence of I/R injury was defined by the detection of intramyocardial hemorrhage (IMH) according to cardiac magnetic resonance T2∗. Clinical endpoint was the occurrence of major adverse cardiac events, defined as composite of all-cause death, nonfatal reinfarction, and new congestive heart failure.

RESULTS

IMH was present in 150 (33%) patients. Hs-CRP (OR: 2.89; 95% CI: 1.96-4.26; P < 0.001), WBCc (OR: 1.32; 95% CI: 1.04-1.67; P = 0.021), and IL-6 (OR: 1.86; 95% CI: 1.38-2.51; P < 0.001) were associated with presence of IMH. Only hs-CRP was independently associated with IMH (OR: 1.95; 95% CI: 1.30-2.93; P = 0.001) after adjustment for other clinical parameters. Furthermore, patients with hs-CRP levels above the median (>26.4 mg/L) were more likely to experience major adverse cardiac events (12% vs 4%, P = 0.002) during a median follow-up of 12 (Q1-Q3: 12-13) months.

CONCLUSIONS

In patients with STEMI treated with primary PCI, inflammatory parameters including hs-CRP, WBCc, and IL-6 were significantly associated with I/R injury as defined by IMH. After adjustment for other factors, hs-CRP was the only independent inflammatory biomarker associated with IMH.

Presepsin: An Emerging Biomarker in the Management of Cardiometabolic Disorders

Background/Objectives: Systemic and tissue inflammation play a crucial role in the pathophysiology of cardiometabolic disorders. Presepsin is a newly discovered marker of acute phase inflammation that is produced by monocytes or macrophages in response to bacterial infection and is a soluble fraction of the lipopolysaccharide (LPS) receptor. LPS is an endotoxin that, through the breakdown of the intestinal barrier, penetrates the systemic circulation and is an important bacterial mediator in the pathogenesis of sepsis and septic shock. Methods: A narrative review of the existing literature. Results: A growing body of evidence demonstrates that intestinal dysbiosis is involved in the pathogenesis of diabetes mellitus (DM) and cardiovascular (CV) disease, leading to increased circulating LPS concentrations in people with cardiometabolic disorders, even in the absence of infection. These data provide the theoretical background for a link between presepsin, DM, and CV pathology. Preliminary studies suggest that presepsin levels are downregulated in patients with well-controlled type 2 DM and correlate with continuous glucose monitoring metrics in infection-free individuals with type 1 DM. However, prospective data on the association between presepsin and the risk of diabetic complications are currently lacking. Presepsin has also been found to be elevated in infection-free individuals with myocardial infarction, heart failure, and myocarditis compared to controls and has been shown to correlate with mortality risk in subjects at high CV risk. Conclusions: The clinical utility of presepsin in the monitoring of patients with cardiometabolic disorders warrants further investigation by future studies.

Early prediction of microvascular obstruction prior to percutaneous coronary intervention

Early prediction of microvascular obstruction (MVO) occurrence in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) can facilitate personalized management and improve prognosis. This study developed a prediction model for MVO occurrence using preoperative clinical data and validated its performance in a prospective cohort. A total of 504 AMI patients were included, with 406 in the exploratory cohort and 98 in the prospective cohort. Feature selection was performed using random forest recursive feature elimination (RF-RFE), identifying five key predictors: High-Sensitivity Troponin T, Neutrophil Count, Creatine Kinase-MB, Fibrinogen, and Left Ventricular Ejection Fraction. Among the models developed, logistic regression demonstrated the highest predictive performance, achieving an AUC score of 0.800 in the exploratory cohort and 0.792 in the prospective cohort. This model has been integrated into a user-friendly online platform, providing a practical tool for guiding personalized perioperative management and improving patient prognosis.

Empagliflozin to prevent worsening of left ventricular volumes and systolic function after myocardial infarction (EMPRESS-MI)

AIMS

Patients with a reduced left ventricular ejection fraction (LVEF) following an acute myocardial infarction (MI) are considered to be at risk of progressive adverse cardiac remodelling which can lead to the development of heart failure and death. The early addition of a sodium-glucose cotransporter 2 (SGLT2) inhibitor to standard treatment may delay or prevent progressive adverse remodelling in these patients.

METHODS AND RESULTS

We performed a randomized, double-blind, placebo-controlled, multicentre trial using cardiovascular magnetic resonance imaging (MRI), in patients with left ventricular systolic dysfunction following MI. Eligible patients were those ≥12 h and ≤14 days following acute MI, with an LVEF <45% by MRI. Patients were randomized to empagliflozin 10 mg once a day or matching placebo. The primary outcome was the change in left ventricular end-systolic volume indexed to body surface area (LVESVI) from baseline to 24 weeks. Secondary outcomes included measures of left ventricular and atrial volumes, left ventricular mass, LVEF, and high-sensitivity troponin I (hs-TnI) and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentrations. From October 2022 to January 2024, 105 eligible patients were randomized. The mean age was 63 ± 11 years and 90 (87%) were male. The mean LVEF was 34.8 ± 6.0%. In the placebo group, LVESVI decreased by 7.8 ± 16.3 ml/m2, left ventricular end-diastolic volume index (LVEDVI) did not change (-0.3 ± 18.7 ml/m2) and LVEF increased by 8.5 ± 7.4% at 24 weeks from baseline. Empagliflozin did not affect the change in LVESVI from baseline to 24 weeks (between-group difference = 0.3 ml/m2, 95% confidence interval -5.2 to 5.8; p = 0.92). Compared with placebo, empagliflozin also had no effect on LVEDVI, LVEF, left atrial volume index, left ventricular mass index, NT-proBNP, or hs-TnI, but did increase haematocrit and reduced uric acid and weight.

CONCLUSIONS

In patients with left ventricular systolic dysfunction after an acute MI receiving contemporary standard of care, treatment with empagliflozin had no effect on cardiac volumes or LVEF compared with placebo. Progressive adverse cardiac remodelling did not occur in the majority of patients.

Intra-myocardial hemorrhage and cardiac microvascular injury in ischemia/reperfusion. A systematic review of current evidences

The in-hospital mortality rate in acute myocardial infarction (AMI) remains high despite the undoubted achievements in treatment of this disease achieved in the last 40 years. The dangerous complications of AMI remain cardiac microvascular injury (CMI) and intramyocardial hemorrhage (IMH). IMH is a widespread pathology that occurs in 42 - 57% of patients with ST-segment elevation myocardial infarction and percutaneous coronary intervention. IMH is associated with larger infarct size and contractile dysfunction. IMH is accompanied by inflammation. The appearance of IMH is depending on the duration of ischemia and requires reperfusion of the heart. IMH is accompanied by contractile dysfunction and adverse remodeling of the heart. The most likely cause of IMH is CMI. Pretreatment with ATL-146e, melatonin, tanshinone IIA, relaxin, empagliflozin, dapagliflozin, and astragaloside IV can mitigate I/R-induced CMI. CMI is accompanied by an increase in the myocardial and plasma proinflammatory cytokine levels and also the downregulation of tight junction proteins in cardiac vascular endothelial cells. However, there is no convincing evidence that proinflammatory cytokines trigger CMI. An increase in the proinflammatory cytokine levels and CMI could be two independent processes.

Soluble suppression of tumorigenicity 2 associated with microvascular obstruction in patients with ST-segment elevation myocardial infarction

BACKGROUND

Microvascular obstruction (MVO) develops in approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) after undergoing percutaneous coronary intervention (PCI). MVO is strongly linked to inflammation, myocardial fibrosis, and adverse clinical outcomes. Soluble suppression of tumorigenicity 2 (sST2) serves as a biomarker for inflammation and myocardial fibrosis. Yet, the correlation between sST2 and MVO in STEMI patients has not been fully elucidated. This study attempts to evaluate the association between sST2 levels and MVO in STEMI patients following pPCI.

METHODS

In this retrospective study, 315 STEMI patients who underwent pPCI at the Affiliated Hospital of Xuzhou Medical University between June 2018 and August 2023 were included. Cardiac magnetic resonance imaging (CMR) was used to assess the characteristics of myocardial infarction and microvascular obstruction (MVO), while sST2 levels were measured upon admission.

RESULTS

The median time for completion of CMR after hospitalization was 5 (4, 6) days. Multivariate regression analysis showed that sST2 (OR 1.01, 95% CI 1.01-1.02, p < 0.001), peak high-sensitivity troponin T (OR 2.40, 95% CI 1.66-3.47, p < 0.001), peak high-C-reactive protein (OR 1.01, 95% CI 1.01-1.02, p < 0.001), left ventricular ejection fraction (OR 0.93, 95% CI 0.89- 0.98, p = 0.009) and age (OR 1.03, 95% CI 1.01- 1.05, p = 0.042)were independently associated with MVO.

CONCLUSION

sST2 is associated with MVO after pPCI in STEMI patients. Incorporating soluble ST2 (sST2) into the risk model for MVO leads to significant improvement.

Myocardial T1 mapping using an instantaneous signal loss simulation modeling and a Bayesian estimation method: A robust T1 extraction method free of tuning parameters

The Instantaneous Signal Loss Simulation (InSiL) model is a promising alternative to the classical mono-exponential fitting of the Modified Look-Locker Inversion-recovery (MOLLI) sequence in cardiac T1 mapping applications, which achieves better accuracy and is less sensitive to heart rate (HR) variations. Classical non-linear least squares (NLLS) estimation methods require some parameters of the model to be fixed a priori in order to give reliable T1 estimations and avoid outliers. This introduces further bias in the estimation, reducing the advantages provided by the InSiL model. In this paper, a novel Bayesian estimation method using a hierarchical model is proposed to fit the parameters of the InSiL model. The hierarchical Bayesian modeling has a shrinkage effect that works as a regularizer for the estimated values, by pulling spurious estimated values toward the group-mean, hence reducing greatly the number of outliers. Simulations, physical phantoms, and in-vivo human cardiac data have been used to show that this approach estimates accurately all the InSiL parameters, and achieve high precision estimation of the T1 compared to the classical MOLLI model and NLLS InSiL estimation.

Studying the efficacy of low-dose colchicine on clinical outcomes of patients with STEMI: a randomized controlled trial

BACKGROUND

Numerous studies have underscored the essential role of inflammation across all stages of atherosclerosis. While various anti-inflammatory interventions have been implemented to mitigate inflammation-induced injuries, outcomes have been conflicting. Given the essential role of inflammation in these patients and limited data regarding the efficacy of low-dose Colchicine as an anti-inflammatory drug, we aimed to study the efficacy of low-dose Colchicine on clinical outcomes of patients with STEMI in Iran.

RESULTS

Participants presented with STEMI and qualified revascularization at Shahid Beheshti Hospital in Qom during 2022 and 2023 were included into the study. This study included 172 STEMI patients (114 males and 58 females) within the mean age of 58.93 ± 7.79. Results indicate that colchicine (2 mg for loading dose and 0.5 mg daily for 30 days) and placebo group were not significant differences in identical profiles regarding age and gender. Analyses revealed no significant differences in clinical outcome after the 40-day follow-up period.

CONCLUSIONS

This study revealed that the addition of colchicine did not yield a significant benefit in enhancing the outcomes of patients with STEMI.

CLINICAL TRIAL REGISTRATION

This study was prospectively registered on Iranian registry of clinical trials, with registration number (IRCT20231001059578N1).

Deciphering the Enigma of Intramyocardial Hemorrhage Following Reperfusion Therapy in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Exploration from Mechanisms to Therapeutic Strategies

Acute ST-segment elevation myocardial infarction (STEMI) is a formidable challenge in cardiovascular medicine, demanding advanced reperfusion strategies such as emergency percutaneous coronary intervention. While successful revascularization is pivotal, the persistent "no-reflow" phenomenon remains a clinical hurdle, often intertwined with microvascular dysfunction. Within this intricate scenario, the emergence of intramyocardial hemorrhage (IMH) has garnered attention as a significant contributor. This review offers a detailed exploration of the multifaceted relationship between IMH and the "no-reflow" phenomenon, delving into the mechanisms governing IMH occurrence, state-of-the-art diagnostic modalities, predictive factors, clinical implications, and the evolving landscape of preventive and therapeutic strategies. The nuanced examination aims to deepen our comprehension of IMH, providing a foundation for the identification of innovative therapeutic avenues and enhanced clinical outcomes for STEMI patients.

The Role of Microvascular Obstruction and Intra-Myocardial Hemorrhage in Reperfusion Cardiac Injury. Analysis of Clinical Data

Microvascular obstruction (MVO) of coronary arteries promotes an increase in mortality and major adverse cardiac events in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). Intramyocardial hemorrhage (IMH) is observed in 41-50% of patients with ST-segment elevation myocardial infarction and PCI. The occurrence of IMH is accompanied by inflammation. There is evidence that microthrombi are not involved in the development of MVO. The appearance of MVO is associated with infarct size, the duration of ischemia of the heart, and myocardial edema. However, there is no conclusive evidence that myocardial edema plays an important role in the development of MVO. There is evidence that platelets, inflammation, Ca 2 + overload, neuropeptide Y, and endothelin-1 could be involved in the pathogenesis of MVO. The role of endothelial cell damage in MVO formation remains unclear in patients with AMI and PCI. It is unclear whether nitric oxide production is reduced in patients with MVO. Only indirect evidence on the involvement of inflammation in the development of MVO has been obtained. The role of reactive oxygen species (ROS) in the pathogenesis of MVO is not studied. The role of necroptosis and pyroptosis in the pathogenesis of MVO in patients with AMI and PCI is also not studied. The significance of the balance of thromboxane A2, vasopressin, angiotensin II, and prostacyclin in the formation of MVO is currently unknown. Conclusive evidence regarding the role of coronary artery spasm in the development of MVhasn't been established. Correlation analysis of the neuropeptide Y, endothelin-1 levels and the MVO size in patients with AMI and PCI has not previously been performed. It is unclear whether epinephrine aggravates reperfusion necrosis of cardiomyocytes. Dual antiplatelet therapy improves the efficacy of PCI in prevention of MVO. It is unknown whether epinephrine or L-type Ca 2 + channel blockers result in the long-term improvement of coronary blood flow in patients with MVO.

Differential gene expression patterns in ST-elevation Myocardial Infarction and Non-ST-elevation Myocardial Infarction

The ST-elevation Myocardial Infarction (STEMI) and Non-ST-elevation Myocardial Infarction (NSTEMI) might occur because of coronary artery stenosis. The gene biomarkers apply to the clinical diagnosis and therapeutic decisions in Myocardial Infarction. The aim of this study was to introduce, enrich and estimate timely the blood gene profiles based on the high-throughput data for the molecular distinction of STEMI and NSTEMI. The text mining data (50 genes) annotated with DisGeNET data (144 genes) were merged with the GEO gene expression data (5 datasets) using R software. Then, the STEMI and NSTEMI networks were primarily created using the STRING server, and improved using the Cytoscape software. The high-score genes were enriched using the KEGG signaling pathways and Gene Ontology (GO). Furthermore, the genes were categorized to determine the NSTEMI and STEMI gene profiles. The time cut-off points were identified statistically by monitoring the gene profiles up to 30 days after Myocardial Infarction (MI). The gene heatmaps were clearly created for the STEMI (high-fold genes 69, low-fold genes 45) and NSTEMI (high-fold genes 68, low-fold genes 36). The STEMI and NSTEMI networks suggested the high-score gene profiles. Furthermore, the gene enrichment suggested the different biological conditions for STEMI and NSTEMI. The time cut-off points for the NSTEMI (4 genes) and STEMI (13 genes) gene profiles were established up to three days after Myocardial Infarction. The study showed the different pathophysiologic conditions for STEMI and NSTEMI. Furthermore, the high-score gene profiles are suggested to measure up to 3 days after MI to distinguish the STEMI and NSTEMI.

Colchicine in acute myocardial infarction: cardiovascular events at 1-year follow up

OBJECTIVE

In the COVERT-MI randomised placebo-controlled trial, oral administration of high-dose colchicine at the time of reperfusion and for 5 days in acute ST-elevated myocardial infarction did not reduce infarct size but was associated with a significant increase in left ventricular thrombus (LVT) in comparison to placebo. We aimed to assess the 1-year clinical outcomes of the study population.

METHODS

This study is a follow-up analysis of the COVERT-MI study on prespecified secondary clinical endpoints at 1 year. The primary endpoint of this study was a composite of major adverse cardiovascular events (MACEs), including all-cause death, acute coronary syndromes, heart failure events, ischaemic strokes, sustained ventricular arrhythmias and acute kidney injury at 1-year follow-up. The quality of life (QOL) and the drug therapy prescription were also assessed.

RESULTS

At 1 year, 192 patients (101 patients in the colchicine group, 91 in the placebo group) were followed up. Seventy-six (39.6%) MACEs were reported in the study population. There was no significant difference regarding the number of MACEs between groups: 36 (35.6%) in the colchicine group and 40 (44.1%) in the placebo group (p=0.3). There were no differences in the occurrence of ischaemic strokes between the colchicine group and the control group (3 (3%) vs 2 (2.2%), respectively, p=0.99). There was a trend towards fewer heart failure events in the colchicine group compared with the placebo group (12 (11.9%) vs 18 (19.8%), p=0.20). There was no significant difference in QOL scores at 1 year (75.8±15.7 vs 72.7±16.2 respectively, p=0.18).

CONCLUSIONS

There was no significant difference between the colchicine and placebo groups at 1 year regarding MACEs, especially concerning deaths or ischaemic strokes. No excess of ischaemic adverse events was observed despite the initial increase in LVT in the colchicine group.

TRIAL REGISTRATION NUMBER

NCT0315681.

Inflammation in Cardiovascular Disease: A Comprehensive Review of Biomarkers and Therapeutic Targets

Cardiovascular disorders (CVDs) represent a global challenge and are regarded as one of the leading causes of mortality. The role of inflammation as a risk factor in these disorders has been studied, with the accelerated atherosclerotic process being a crucial factor in the pathogenesis. Several inflammatory biomarkers such as C-reactive protein (CRP), Interleukins (ILs), Tumor Necrosis Factor-alpha (TNF-α), and others have been identified that play a role in the atherosclerotic process, thus linking systemic inflammatory conditions with CVDs, including acute myocardial infarction (AMI), chronic heart failure (CHF), venous thromboembolism (VTE) and others. These markers could be used to predict the risk of CVDs. Understanding the precise mechanisms can lead to therapeutic strategies targeted at pro-inflammatory processes. We aim to provide an overview of the existing literature on the role of inflammation in various cardiovascular disorders and identify different inflammatory biomarkers and therapeutic targets in this comprehensive literature review. We reviewed 190 references published between 2013 and August 3, 2023, in well-reputed journals and analyzed eight selected papers in-depth. We describe the pathophysiologic pathways that lead to atherosclerosis and other cardiovascular pathologies. Several inflammatory cytokines encompassing various groups were identified to be causing endothelial dysfunction, leading to an increased risk for CVDs. Polymorphisms in the genes for different cytokines also led to different levels of susceptibility to CVDs. Nevertheless, future research detailing the inflammatory pathways and their link with CVDs would lead to better outcomes for patients with preexisting and new onset of CVDs as well as chronic inflammatory disorders.

Nomograms referenced by cardiac magnetic resonance in the prediction of cardiac injuries in patients with ST-elevation myocardial infarction

BACKGROUND

Evaluation of cardiac injuries is essential in patients with ST-elevation myocardial infarction (STEMI). Cardiac magnetic resonance (CMR) has become the gold standard for quantifying cardiac injuries; however, its routine application is limited. A nomogram is a useful tool for prognostic prediction based on the comprehensive utilization of clinical data. We presumed that the nomogram models established using CMR as a reference could precisely predict cardiac injuries.

METHODS

This analysis included 584 patients with acute STEMI from a CMR registry study for STEMI (NCT03768453). The patients were divided into training (n = 408) and testing (n = 176) datasets. The least absolute shrinkage and selection operator method and multivariate logistic regression were used to construct nomograms for predicting left ventricular ejection fraction (LVEF) ≤40%, infarction size (IS) ≥ 20% on the LV mass, and microvascular dysfunction.

RESULTS

The nomogram for predicting LVEF≤40%, IS≥20%, and microvascular dysfunction comprised 14, 10, and 15 predictors, respectively. With the nomograms, the individual risk probability of developing specific outcomes could be calculated, and the weight of each risk factor was demonstrated. The C-index of the nomograms in the training dataset were 0.901, 0.831, and 0.814, respectively, and were comparable in the testing set, showing good nomogram discrimination and calibration. The decision curve analysis demonstrated good clinical effectiveness. Online calculators were also constructed.

CONCLUSIONS

With the CMR results as the reference standard, the established nomograms demonstrated good effectiveness in predicting cardiac injuries after STEMI and could provide physicians with a new option for individual risk stratification.

Imaging Predictors of Left Ventricular Functional Recovery after Reperfusion Therapy of ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance

BACKGROUND

Left ventricular global longitudinal strain (LV GLS) is a superior predictor of adverse cardiac events in patients with myocardial infarction and heart failure. We investigated the ability of morphological features of infarcted myocardium to detect acute left ventricular (LV) dysfunction and predict LV functional recovery after three months in patients with acute ST-segment elevation myocardial infarction (STEMI).

METHODS

Sixty-six STEMI patients were included in the C-reactive protein (CRP) apheresis in Acute Myocardial Infarction Study (CAMI-1). LV ejection fraction (LVEF), LV GLS, LV global circumferential strain (LV GCS), infarct size (IS), area-at-risk (AAR), and myocardial salvage index (MSI) were assessed by CMR 5 ± 3 days (baseline) and 12 ± 2 weeks after (follow-up) the diagnosis of first acute STEMI.

RESULTS

Significant changes in myocardial injury parameters were identified after 12 weeks of STEMI diagnosis. IS decreased from 23.59 ± 11.69% at baseline to 18.29 ± 8.32% at follow-up (p < 0.001). AAR and MVO also significantly reduced after 12 weeks. At baseline, there were reasonably moderate correlations between IS and LVEF (r = -0.479, p < 0.001), LV GLS (r = 0.441, p < 0.001) and LV GCS (r = 0.396, p = 0.001) as well as between AAR and LVEF (r = -0.430, p = 0.003), LV GLS (r = 0.501, p < 0.001) and weak with LV GCS (r = 0.342, p = 0.020). At follow-up, only MSI and change in LV GCS over time showed a weak but significant correlation (r = -0.347, p = 0.021). Patients with larger AAR at baseline improved more in LVEF (p = 0.019) and LV GLS (p = 0.020) but not in LV GCS.

CONCLUSION

The CMR tissue characteristics of myocardial injury correlate with the magnitude of LV dysfunction during the acute stage of STEMI. AAR predicts improvement in LVEF and LV GLS, while MSI is a sensitive marker of LV GCS recovery at three months follow-up after STEMI.

Regulatory T Cell as Predictor of Intramyocardial Hemorrhage in STEMI Patients after Primary PCI

Background

Intramyocardial hemorrhage (IMH) is a result of ischemia-reperfusion injury in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Despite patients with IMH show poorer prognoses, studies investigating predictors of IMH occurrence are scarce. This study firstly investigated the effectiveness of regulatory T cell (Treg), peak value of Creatine Kinase MB (pCKMB), high-sensitivity C-reactive protein (hsCRP), and left ventricular end-systolic diameter (LVESD) as predictors for IMH.

Methods

In 182 STEMI patients received PPCI, predictors of IMH were analyzed by logistic regression analysis. The predictive ability of risk factors for IMH were determined by receiver operating characteristic curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI) and C-index.

Results

Overall, 80 patients (44.0%) developed IMH. All 4 biomarkers were independent predictors of IMH [odds ratio [OR] (95% confidence interval [CI]): 0.350 (0.202-0.606) for Treg, 1.004 (1.001-1.006) for pCKMB, 1.060 (1.022-1.100) for hsCRP, and 3.329 (1.346-8.236) for LVESD]. After propensity score matching (PSM), the biomarkers significantly predicted IMH with areas under the curve of 0.750 for Treg, 0.721 for pCKMB, 0.656 for hsCRP, 0.633 for LVESD, and 0.821 for the integrated 4-marker panel. The addition of integrated 4-marker panel to a baseline risk model had an incremental effect on the predictive value for IMH [NRI: 0.197 (0.039 to 0.356); IDI: 0.200 (0.142 to 0.259); C-index: 0.806 (0.744 to 0.869), all p < 0.05].

Conclusions

Treg individually or in combination with pCKMB, hsCRP, and LVESD can effectively predict the existence of IMH in STEMI patients received PPCI.

Clinical Trial Registration

NCT03939338.

Prognosis value of serum soluble ST2 level in acute ischemic stroke and STEMI patients in the era of mechanical reperfusion therapy

BACKGROUND

Soluble form suppression of tumorigenicity 2 (sST2) is known to have prognostic value in ST-elevation myocardial infarction (STEMI) and could impact mortality after acute ischemic stroke (AIS). However, before considering sST2 as a therapeutic target, the kinetics of release and its association with adverse clinical events in both STEMI and AIS patients have to be determined.

METHODS

We prospectively enrolled 251 STEMI patients, treated with primary percutaneous coronary intervention, and 152 AIS patients treated with mechanical thrombectomy. We evaluated the level of sST2 in patient sera at five time point (admission, 4, 24, 48 h and 1 month from admission for STEMI patients and admission, 6, 24, 48 h and 3 months from admission for AIS patients). Major adverse clinical events (MACE) (all-cause death, acute myocardial infarction, stroke or hospitalization for heart failure) in STEMI patients and all-cause death in AIS patients were recorded during a 12-month follow-up.

RESULTS

Mean age of the study population was 59 ± 12 and 69 ± 15 years in STEMI and AIS patients, respectively. In STEMI patients, sST2 peaked 24 h after admission (25.5 ng/mL interquartile range (IQR) [14.9-29.1]) whereas an earlier and lower peak was observed in AIS patients (16.8 ng/mL IQR [15.2-18.3] at 6 h). Twenty-five (10.0%) STEMI patients experienced a MACE and 12 (7.9%) AIS patients had all-cause death within the first 12 months. A high level of sST2 at 24 h was associated with MACE in STEMI patients (hazard ratio (HR) = 2.5; 95% confidence interval (CI) [1.1-5.6], p = 0.03) and all-cause death in AIS patients (HR = 11.7; 95% CI [3.8-36.2], p < 0.01) within the first 12 months.

CONCLUSIONS

The study highlights that sST2 levels at 24 h are associated with an increased risk to adverse clinical events in both diseases.

Effect of Colchicine on Myocardial Injury in Acute Myocardial Infarction

Supplemental Digital Content is available in the text.

Background:

Inflammation is a key factor of myocardial damage in reperfused ST-segment–elevation myocardial infarction. We hypothesized that colchicine, a potent anti-inflammatory agent, may reduce infarct size (IS) and left ventricular (LV) remodeling at the acute phase of ST-segment–elevation myocardial infarction.

Methods:

In this double-blind multicenter trial, we randomly assigned patients admitted for a first episode of ST-segment–elevation myocardial infarction referred for primary percutaneous coronary intervention to receive oral colchicine (2-mg loading dose followed by 0.5 mg twice a day) or matching placebo from admission to day 5. The primary efficacy outcome was IS determined by cardiac magnetic resonance imaging at 5 days. The relative LV end-diastolic volume change at 3 months and IS at 3 months assessed by cardiac magnetic resonance imaging were among the secondary outcomes.

Results:

We enrolled 192 patients, 101 in the colchicine group and 91 in the control group. At 5 days, the gadolinium enhancement–defined IS did not differ between the colchicine and placebo groups with a mean of 26 interquartile range (IQR) [16–44] versus 28.4 IQR [14–40] g of LV mass, respectively (P=0.87). At 3 months follow-up, there was no significant difference in LV remodeling between the colchicine and placebo groups with a +2.4% (IQR, –8.3% to 11.1%) versus –1.1% (IQR, –8.0% to 9.9%) change in LV end-diastolic volume (P=0.49). Infarct size at 3 months was also not significantly different between the colchicine and placebo groups (17 IQR [10–28] versus 18 IQR [10–27] g of LV mass, respectively; P=0.92). The incidence of gastrointestinal adverse events during the treatment period was greater with colchicine than with placebo (34% versus 11%, respectively; P=0.0002).

Conclusions:

In this randomized, placebo-controlled trial, oral administration of high-dose colchicine at the time of reperfusion and for 5 days did not reduce IS assessed by cardiac magnetic resonance imaging.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03156816.