Intramyocardial Hemorrhage and the 'Wave Front' of Reperfusion Injury Compromising Myocardial Salvage
| Autor: | Ting Liu, Andrew G. Howarth, Yinyin Chen, Anand R. Nair, Hsin-Jung Yang, Daoyuan Ren, Richard Tang, Jane Sykes, Michael S. Kovacs, Damini Dey, Piotr Slomka, John C. Wood, Robert Finney, Mengsu Zeng, Frank S. Prato, Joseph Francis, Daniel S. Berman, Prediman K. Shah, Andreas Kumar, Rohan Dharmakumar |
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| Rok vydání: | 2021 |
| Předmět: |
Salvage Therapy
Myocardium Magnetic Resonance Imaging Cine Hemorrhage Myocardial Reperfusion Injury Troponin Time-to-Treatment Disease Models Animal Necrosis Dogs Percutaneous Coronary Intervention Positron-Emission Tomography Animals Humans ST Elevation Myocardial Infarction Prospective Studies Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 79(1) |
| ISSN: | 1558-3597 |
| Popis: | Reperfusion therapy for acute myocardial infarction (MI) is lifesaving. However, the benefit of reperfusion therapy can be paradoxically diminished by reperfusion injury, which can increase MI size.Hemorrhage is known to occur in reperfused MIs, but whether hemorrhage plays a role in reperfusion-mediated MI expansion is not known.We studied cardiac troponin kinetics (cTn) of ST-segment elevation MI patients (n = 70) classified by cardiovascular magnetic resonance to be hemorrhagic (70%) or nonhemorrhagic following primary percutaneous coronary intervention. To isolate the effects of hemorrhage from ischemic burden, we performed controlled canine studies (n = 25), and serially followed both cTn and MI size with time-lapse imaging.CTn was not different before reperfusion; however, an increase in cTn following primary percutaneous coronary intervention peaked earlier (12 hours vs 24 hours; P 0.05) and was significantly higher in patients with hemorrhage (P 0.01). In hemorrhagic animals, reperfusion led to rapid expansion of myocardial necrosis culminating in epicardial involvement, which was not present in nonhemorrhagic cases (P 0.001). MI size and salvage were not different at 1 hour postreperfusion in animals with and without hemorrhage (P = 0.65). However, within 72 hours of reperfusion, a 4-fold greater loss in salvageable myocardium was evident in hemorrhagic MIs (P 0.001). This paralleled observations in patients with larger MIs occurring in hemorrhagic cases (P 0.01).Myocardial hemorrhage is a determinant of MI size. It drives MI expansion after reperfusion and compromises myocardial salvage. This introduces a clinical role of hemorrhage in acute care management, risk assessment, and future therapeutics. |
| Databáze: | OpenAIRE |
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