Circadian variation in acute myocardial infarct size assessed by cardiovascular magnetic resonance in reperfused STEMI patients.

Autor: Bulluck H; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore., Nicholas J; London School Hygiene and Tropical Medicine, London, UK., Crimi G; Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy., White SK; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK., Ludman AJ; Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK., Pica S; Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy; Struttura Complessa Cardiologia, Azienda Ospedaliera SS: Antonio e Biagio, Alessandria, Italy., Raineri C; Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy., Cabrera-Fuentes HA; Institute of Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore., Yellon D; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK., Rodriguez-Palomares J; Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain., Garcia-Dorado D; Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain., Hausenloy DJ; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore. Electronic address: derek.hausenloy@duke-nus.edu.sg.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2017 Mar 01; Vol. 230, pp. 149-154. Date of Electronic Publication: 2016 Dec 19.
DOI: 10.1016/j.ijcard.2016.12.030
Abstrakt: Objective: Clinical studies using serum cardiac biomarkers to investigate a circadian variation in acute myocardial infarct (MI) size in ST-segment elevation myocardial infarction (STEMI) patients reperfused by primary percutaneous coronary intervention (PPCI) have produced mixed results. We aimed to investigate this phenomenon using acute MI size measured by cardiovascular magnetic resonance (CMR).
Methods: Patient-level data was obtained from 4 randomized controlled trials investigating the MI-limiting effects of cardioprotective therapies in this pooled analysis. The primary analysis was performed in those patients with no pre-infarct angina; duration of ischemia >60min and <360min; Thrombolysis In Myocardial Infarction (TIMI) flow pre-PPCI ≤1; TIMI flow post-PPCI 3; and no collateral flow.
Results: 169 out of 376 patients with CMR data met the inclusion criteria for the primary analysis. A 24-hour circadian variation in acute MI size as a % of the area-at-risk (%AAR), after adjusting for confounders, was observed with a peak and nadir MI size in patients with symptom onset between 00:00 and 01:00 and between 12:00 and 13:00 respectively (difference from the average MI size 5.2%, 95%CI 1.1-9.4%; p=0.013). This was associated with a non-significant circadian variation in left ventricular ejection fraction (LVEF) (difference from the average LVEF 5.9%, 95%CI -0.6-2.2%, p=0.073). There was no circadian variation in MI size or LVEF in the whole cohort.
Conclusions: We report a circadian variation in acute MI size assessed by CMR in a subset of STEMI patients treated by PPCI, with the largest and smallest MI size occurring in patients with symptom onset between 00:00 and 01:00 and between 12:00 and 13:00 respectively.
(Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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