Infarct evolution in man studied in patients with first-time coronary occlusion in comparison to different species - implications for assessment of myocardial salvageReportar como inadecuado




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Journal of Cardiovascular Magnetic Resonance

, 11:38

First Online: 23 September 2009Received: 13 May 2009Accepted: 23 September 2009

Abstract

BackgroundThe time course of infarct evolution, i.e. how fast myocardial infarction MI develops during coronary artery occlusion, is well known for several species, whereas no direct evidence exists on the evolution of MI size normalized to myocardium at risk MaR in man. Despite the lack of direct evidence, current literature often refers to the -golden hour- as the time during which myocardial salvage can be accomplished by reperfusion therapy. Therefore, the aim of the present study was to investigate how duration of myocardial ischemia affects infarct evolution in man in relation to previous animal data. Consecutive patients with clinical signs of acute myocardial ischemia were screened and considered for enrollment. Particular care was taken to assure uniformity of the patients enrolled with regard to old MI, success of revascularization, collateral flow, release of biochemical markers prior to intervention etc. Sixteen patients were ultimately included in the study. Myocardium at risk was assessed acutely by acute Myocardial Perfusion Single photon emission computed tomography MPS and by T2 imaging T2-STIR cardiovascular magnetic resonance CMR after one week in 10 of the 16 patients. Infarct size was measured by late gadolinium enhancement LGE at one week.

ResultsThe time to reach 50% MI of the MaR T50 was significantly shorter in pigs 37 min, rats 41 min and dogs 181 min compared to humans 288 min. There was no significant difference in T50 when using MPS compared to T2-STIR p = 0.53 for assessment of MaR 288 ± 23 min vs 310 ± 22 min, T50 ± standard error. The transmural extent of MI increased progressively as the duration of ischemia increased R = 0.56, p < 0.001.

ConclusionThis is the first study to provide direct evidence of the time course of acute myocardial infarct evolution in relation to MaR in man with first-time MI. Infarct evolution in man is significantly slower than in pigs, rats and dogs. Furthermore, infarct evolution assessments in man are similar when using MPS acutely and T2-STIR one week later for determination of MaR, which significantly facilitates future clinical trials of cardioprotective therapies in acute coronary syndrome by the use of CMR.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-11-38 contains supplementary material, which is available to authorized users.

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Autor: Erik Hedström - Henrik Engblom - Fredrik Frogner - Karin Åström-Olsson - Hans Öhlin - Stefan Jovinge - Håkan Arheden

Fuente: https://link.springer.com/







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