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Article ; Online: ST-elevation myocardial infarction due to coronary thrombus in a young patient with diabetic ketoacidosis and a new diagnosis of type 2 diabetes.

Doherty, Daniel James / Sykes, Robert / Connelly, Paul / Hood, Stuart

BMJ case reports

2022 Volume 15, Issue 3

Abstract: The association between cardiovascular disease and diabetes is increasingly understood and shared therapeutic targets are emerging. We describe the presentation and successful management of ST-elevation myocardial infarction (STEMI) secondary to coronary ...

Abstract	The association between cardiovascular disease and diabetes is increasingly understood and shared therapeutic targets are emerging. We describe the presentation and successful management of ST-elevation myocardial infarction (STEMI) secondary to coronary thrombus in a young patient with a new diagnosis of type 2 diabetes and diabetic ketoacidosis.
MeSH term(s)	Diabetes Mellitus, Type 2/complications ; Diabetic Ketoacidosis/complications ; Diabetic Ketoacidosis/diagnosis ; Humans ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction/complications ; ST Elevation Myocardial Infarction/etiology ; Thrombosis/complications ; Treatment Outcome
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-247090
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Article ; Online: Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors.

Collison, Damien / Copt, Samuel / Mizukami, Takuya / Collet, Carlos / McLaren, Ruth / Didagelos, Matthaios / Aetesam-Ur-Rahman, Muhammad / McCartney, Peter / Ford, Thomas J / Lindsay, Mitchell / Shaukat, Aadil / Rocchiccioli, Paul / Brogan, Richard / Watkins, Stuart / McEntegart, Margaret / Good, Richard / Robertson, Keith / O'Boyle, Patrick / Davie, Andrew /

Khan, Adnan / Hood, Stuart / Eteiba, Hany / Berry, Colin / Oldroyd, Keith G

Circulation. Cardiovascular interventions

2023 Volume 16, Issue 4, Page(s) e012511

Abstract: Background: Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical function, and reduced quality of life. Understanding patient and ... ...

Abstract	Background: Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical function, and reduced quality of life. Understanding patient and procedural factors associated with post-PCI angina may inform alternative approaches to treatment. Methods: Two hundred thirty patients undergoing PCI completed the Seattle Angina Questionnaire (SAQ-7) and European quality of life-5 dimension-5 level (EQ-5D-5L) questionnaires at baseline and 3 months post-PCI. Patients received blinded intracoronary physiology assessments before and after stenting. A post hoc analysis was performed to compare clinical and procedural characteristics among patients with and without post-PCI angina (defined by follow-up SAQ-angina frequency score <100). Results: Eighty-eight of 230 patients (38.3%) reported angina 3 months post-PCI and had a higher incidence of active smoking, atrial fibrillation, and history of previous myocardial infarction or PCI. Compared with patients with no angina at follow-up, they had lower baseline SAQ summary scores (69.48±24.12 versus 50.20±22.59, Conclusions: Larger improvements in FFR following PCI were associated with less angina and better quality of life at follow-up. In patients with stable symptoms, intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine the appropriateness of PCI. Registration: URL: https://www. Clinicaltrials: gov; Unique identifier: NCT03259815.
MeSH term(s)	Humans ; Angina Pectoris/diagnosis ; Angina Pectoris/therapy ; Angina Pectoris/epidemiology ; Coronary Angiography ; Coronary Artery Disease/therapy ; Fractional Flow Reserve, Myocardial ; Microcirculation ; Percutaneous Coronary Intervention/adverse effects ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2023-03-28
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2450797-0
ISSN	1941-7632 ; 1941-7640
ISSN (online)	1941-7632
ISSN	1941-7640
DOI	10.1161/CIRCINTERVENTIONS.122.012511
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Article ; Online: Redefining Adverse and Reverse Left Ventricular Remodeling by Cardiovascular Magnetic Resonance Following ST-Segment-Elevation Myocardial Infarction and Their Implications on Long-Term Prognosis.

Bulluck, Heerajnarain / Carberry, Jaclyn / Carrick, David / McEntegart, Margaret / Petrie, Mark C / Eteiba, Hany / Hood, Stuart / Watkins, Stuart / Lindsay, Mitchell / Mahrous, Ahmed / Ford, Ian / Oldroyd, Keith G / Berry, Colin

Circulation. Cardiovascular imaging

2020 Volume 13, Issue 7, Page(s) e009937

Abstract: Background: Cut off values for change in left ventricular end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) by cardiovascular magnetic resonance following ST-segment-elevation myocardial infarction have recently been proposed and 4 ... ...

Abstract	Background: Cut off values for change in left ventricular end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) by cardiovascular magnetic resonance following ST-segment-elevation myocardial infarction have recently been proposed and 4 patterns of LV remodeling were described. We aimed to assess their long-term prognostic significance. Methods: A prospective cohort of unselected patients with ST-segment-elevation myocardial infarction with paired acute and 6-month cardiovascular magnetic resonance, with the 5-year composite end point of all-cause death and hospitalization for heart failure was included. The prognosis of the following groups (group 1: reverse LV remodeling [≥12% decrease in LVESV]; group 2: no LV remodeling [changes in LVEDV and LVESV <12%]; group 3: adverse LV remodeling with compensation [≥12% increase in LVEDV only]; and group 4: adverse LV remodeling [≥12% increase in both LVESV and LVEDV]) was compared. Results: Two hundred eighty-five patients were included with a median follow-up was 5.8 years. The composite end point occurred in 9.5% in group 1, 12.3% in group 2, 7.1% in group 3, and 24.2% in group 4. Group 4 had significantly higher cumulative event rates of the composite end point (log-rank test, Conclusions: Patients with ST-segment-elevation myocardial infarction developing adverse LV remodeling at 6 months, defined as ≥12% increase in both LVESV and LVEDV by cardiovascular magnetic resonance, was associated with worse long-term clinical outcomes than those with adverse LV remodeling with compensation, reverse LV remodeling, and no LV remodeling, with the latter 3 groups having similar outcomes in a cohort of stable reperfused patients with ST-segment-elevation myocardial infarction. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.
MeSH term(s)	Aged ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Predictive Value of Tests ; Prospective Studies ; Recovery of Function ; Risk Assessment ; Risk Factors ; ST Elevation Myocardial Infarction/diagnostic imaging ; ST Elevation Myocardial Infarction/physiopathology ; ST Elevation Myocardial Infarction/therapy ; Stroke Volume ; Time Factors ; Treatment Outcome ; Ventricular Function, Left ; Ventricular Remodeling
Language	English
Publishing date	2020-07-21
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2435045-X
ISSN	1942-0080 ; 1941-9651
ISSN (online)	1942-0080
ISSN	1941-9651
DOI	10.1161/CIRCIMAGING.119.009937
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Article: Fractional Flow Reserve-Guided Stent Optimisation in Focal and Diffuse Coronary Artery Disease.

Ohashi, Hirofumi / Collison, Damien / Mizukami, Takuya / Didagelos, Matthaios / Sakai, Koshiro / Aetesam-Ur-Rahman, Muhammad / Munhoz, Daniel / McCartney, Peter / Ford, Thomas J / Lindsay, Mitchell / Shaukat, Aadil / Rocchiccioli, Paul / Brogan, Richard / Watkins, Stuart / McEntegart, Margaret / Good, Richard / Robertson, Keith / O'Boyle, Patrick / Davie, Andrew /

Khan, Adnan / Hood, Stuart / Eteiba, Hany / Amano, Tetsuya / Sonck, Jeroen / Berry, Colin / De Bruyne, Bernard / Oldroyd, Keith G / Collet, Carlos

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 15

Abstract: Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of ... ...

Abstract	Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs. diffuse disease on physiology-guided incremental optimisation strategy (PIOS) is unknown. This is a sub-study of the TARGET-FFR randomized clinical trial (NCT03259815). The study protocol directed that optimisation be attempted for patients in the PIOS arm when post-PCI FFR was <0.90. Overall, 114 patients (
Language	English
Publishing date	2023-08-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13152612
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Article ; Online: Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial.

Hennigan, Barry / Berry, Colin / Collison, Damien / Corcoran, David / Eteiba, Hany / Good, Richard / McEntegart, Margaret / Watkins, Stuart / McClure, John D / Mangion, Kenneth / Ford, Thomas Joseph / Petrie, Mark C / Hood, Stuart / Rocchiccioli, Paul / Shaukat, Aadil / Lindsay, Mitchell / Oldroyd, Keith G

Heart (British Cardiac Society)

2020 Volume 106, Issue 10, Page(s) 758–764

Abstract: Introduction: There is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve (: Methods: We enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. ... ...

Abstract	Introduction: There is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve ( Methods: We enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. The artery was interrogated with a Doppler flow/pressure wire. Patients underwent Magnetic Resonance Imaging (MRI) with follow-up at 3 and 12 months. The primary outcome was angina status at 3 months using the Seattle Angina Questionnaire (SAQ). Results: 104 patients (age 60±9 years), 79 (76%) males and 79 (76%) Left Anterior Descending (LAD) stenoses were randomised. Coronary physiology and SAQ were similar. Of 98 patients with stress perfusion MRI data, 17 (17%) had abnormal perfusion (≥2 segments with ≥25% ischaemia or ≥1 segment with ≥50% ischaemia) in the target Conclusions: Non-invasive evidence of major ischaemia is uncommon in patients with Trial registration number: NCT02425969.
MeSH term(s)	Angina, Stable/diagnosis ; Angina, Stable/physiopathology ; Angina, Stable/therapy ; Cardiovascular Agents/therapeutic use ; Coronary Angiography/methods ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/physiopathology ; Echocardiography, Doppler, Color/methods ; Female ; Fractional Flow Reserve, Myocardial/physiology ; Humans ; Magnetic Resonance Imaging, Cine/methods ; Male ; Middle Aged ; Myocardial Perfusion Imaging/methods ; Outcome Assessment, Health Care ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/methods ; Symptom Assessment/methods
Chemical Substances	Cardiovascular Agents
Language	English
Publishing date	2020-02-29
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2019-316075
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Article ; Online: Displacement Encoding With Stimulated Echoes Enables the Identification of Infarct Transmurality Early Postmyocardial Infarction.

Mangion, Kenneth / Loughrey, Christopher M / Auger, Daniel A / McComb, Christie / Lee, Matthew M / Corcoran, David / McEntegart, Margaret / Davie, Andrew / Good, Richard / Lindsay, Mitchell / Eteiba, Hany / Rocchiccioli, Paul / Watkins, Stuart / Hood, Stuart / Shaukat, Aadil / Haig, Caroline / Epstein, Frederick H / Berry, Colin

Journal of magnetic resonance imaging : JMRI

2020 Volume 52, Issue 6, Page(s) 1722–1731

Abstract: Background: Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post-ST-segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery.: Hypothesis: We ... ...

Abstract	Background: Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post-ST-segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery. Hypothesis: We hypothesized that segmental circumferential strain with displacement encoding with stimulated echoes (DENSE) would be a stronger predictor of infarct transmurality than feature-tracking strain, and noninferior to extracellular volume fraction (ECV). Study type: Prospective. Population: Fifty participants (mean ± SD, 59 ± 9 years, 40 [80%] male) underwent cardiac MRI on day 1 post-STEMI. Field-strength/sequences: 1.5T/cine, DENSE, T Assessment: Two observers assessed segmental percentage LGE extent, presence of microvascular obstruction (MVO), circumferential and radial strain with DENSE and feature-tracking, T Statistical tests: Normality was tested using the Shapiro-Wilk test. Skewed distributions were analyzed utilizing Mann-Whitney or Kruskal-Wallis tests and normal distributed data using independent t-tests. Diagnostic cutoff values were identified using the Youden index. The difference in area under the curve was compared using the z-statistic. Results: Segmental circumferential strain with DENSE was associated with the extent of infarction ≥50% (AUC [95% CI], cutoff value = 0.9 [0.8, 0.9], -10%) similar to ECV (AUC = 0.8 [0.8, 0.9], 37%) (P = 0.117) and superior to feature-tracking circumferential strain (AUC = 0.7[0.7, 0.8], -19%) (P < 0.05). For the detection of segmental infarction ≥75%, circumferential strain with DENSE (AUC = 0.9 [0.8, 0.9], -10%) was noninferior to ECV (AUC = 0.8 [0.7, 0.9], 42%) (P = 0.132) and superior to feature-tracking (AUC = 0.7 [0.7, 0.8], -13%) (P < 0.05). For MVO detection, circumferential strain with DENSE (AUC = 0.8 [0.8, 0.9], -12%) was superior to ECV (AUC = 0.8 [0.7, 0.8] 34%) (P < 0.05) and feature-tracking (AUC = 0.7 [0.6, 0.7] -21%) (P < 0.05). Data conclusion: Circumferential strain with DENSE is a functional measure of infarct severity and may remove the need for gadolinium contrast agents in some circumstances. Level of evidence: 2 TECHNICAL EFFICACY STAGE: 5 J. MAGN. RESON. IMAGING 2020;52:1722-1731.
MeSH term(s)	Contrast Media ; Gadolinium ; Humans ; Magnetic Resonance Imaging, Cine ; Male ; Myocardial Infarction/diagnostic imaging ; Myocardium ; Predictive Value of Tests ; Prospective Studies ; Ventricular Function, Left
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2020-07-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.27295
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Article ; Online: Risk Stratification Guided by the Index of Microcirculatory Resistance and Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction.

Circulation. Cardiovascular interventions

2021 Volume 14, Issue 2, Page(s) e009529

Abstract: Background: The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical ...

Abstract	Background: The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown. Methods: IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year. Results: IMR and LVEDP were both measured in 131 patients (mean age 59±10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17-55), the median LVEDP was 17 mm Hg (interquartile range, 12-21), and the correlation between them was not statistically significant ( Conclusions: IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
MeSH term(s)	Aged ; Blood Pressure ; Female ; Humans ; Male ; Microcirculation ; Middle Aged ; Myocardial Infarction/therapy ; Percutaneous Coronary Intervention/adverse effects ; Prospective Studies ; Risk Assessment ; Treatment Outcome ; Ventricular Function, Left
Language	English
Publishing date	2021-02-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2450797-0
ISSN	1941-7632 ; 1941-7640
ISSN (online)	1941-7632
ISSN	1941-7640
DOI	10.1161/CIRCINTERVENTIONS.120.009529
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Article ; Online: Post-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR).

European heart journal

2021 Volume 42, Issue 45, Page(s) 4656–4668

Abstract: Aims: A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to ... ...

Abstract	Aims: A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. Methods and results: After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval -1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (-11.2%, 95% confidence interval -21.87 to -0.35], P = 0.045). Conclusion: Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80.
MeSH term(s)	Coronary Angiography ; Coronary Artery Disease ; Fractional Flow Reserve, Myocardial ; Humans ; Percutaneous Coronary Intervention ; Stents ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2021-08-04
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehab449
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Article: Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction.

Maznyczka, Annette Marie / Carrick, David / Carberry, Jaclyn / Mangion, Kenneth / McEntegart, Margaret / Petrie, Mark C / Eteiba, Hany / Lindsay, Mitchell / Hood, Stuart / Watkins, Stuart / Davie, Andrew / Mahrous, Ahmed / Ford, Ian / Welsh, Paul / Sattar, Naveed / Oldroyd, Keith G / Berry, Colin

Open heart

2019 Volume 6, Issue 1, Page(s) e000979

Abstract: Objectives: We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).: Methods: Patients with STEMI ... ...

Abstract	Objectives: We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI). Methods: Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up. Results: In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation. Conclusion: There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women. Trial registration number: NCT02072850.
Language	English
Publishing date	2019-04-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2053-3624
ISSN	2053-3624
DOI	10.1136/openhrt-2018-000979
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Article ; Online: Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction.

Mangion, Kenneth / Carrick, David / Clerfond, Guillaume / Rush, Christopher / McComb, Christie / Oldroyd, Keith G / Petrie, Mark C / Eteiba, Hany / Lindsay, Mitchell / McEntegart, Margaret / Hood, Stuart / Watkins, Stuart / Davie, Andrew / Auger, Daniel A / Zhong, Xiaodong / Epstein, Frederick H / Haig, Caroline E / Berry, Colin

European journal of radiology

2019 Volume 112, Page(s) 121–129

Abstract: Objective: We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial ... ...

Abstract	Objective: We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods: Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization RESULTS: At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p < 0.001) and feature-tracking (p < 0.001), extent of oedema (p < 0.001), infarct size (p < 0.001), and microvascular obstruction (p < 0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per -1% peak strain, 1.05-1.12, p < 0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per -1% peak strain, 1.03-1.07, p < 0.001) and segmental normalization (DENSE: 1.08 per -1% peak strain, 1.04-1.12, p < 0.001, feature-tracking: 1.06 per -1% peak strain, 1.04-1.08, p < 0.001). Conclusions: Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.
MeSH term(s)	Female ; Humans ; Magnetic Resonance Angiography/methods ; Magnetic Resonance Imaging, Cine/methods ; Male ; Middle Aged ; Movement/physiology ; Myocardium/pathology ; Recovery of Function ; ST Elevation Myocardial Infarction/pathology ; ST Elevation Myocardial Infarction/physiopathology ; Stress, Physiological/physiology
Language	English
Publishing date	2019-01-14
Publishing country	Ireland
Document type	Clinical Trial ; Journal Article
ZDB-ID	138815-0
ISSN	1872-7727 ; 0720-048X
ISSN (online)	1872-7727
ISSN	0720-048X
DOI	10.1016/j.ejrad.2019.01.010
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