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

Hedström, Erik LU ; Engblom, Henrik LU ; Frogner, Fredrik; Astrom-Olsson, Karin; Ohlin, Hans; Jovinge, Stefan and Arheden, Håkan LU (2009) In Journal of Cardiovascular Magnetic Resonance 11.
Abstract
Background: The 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... (More)
Background: The 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. Results: The time to reach 50% MI of the MaR (T-50) 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 T-50 when using MPS compared to T2-STIR (p = 0.53) for assessment of MaR (288 +/- 23 min vs 310 +/- 22 min, T-50 +/- standard error). The transmural extent of MI increased progressively as the duration of ischemia increased (R-2 = 0.56, p < 0.001). Conclusion: This 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. (Less)
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author
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publishing date
type
Contribution to journal
publication status
published
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in
Journal of Cardiovascular Magnetic Resonance
volume
11
publisher
BioMed Central
external identifiers
  • wos:000270929600001
  • scopus:76749113471
ISSN
1097-6647
DOI
10.1186/1532-429X-11-38
language
English
LU publication?
yes
id
a1c5db38-c328-4fe9-97c4-381ad899329e (old id 1506306)
date added to LUP
2009-11-23 16:10:39
date last changed
2017-08-06 03:48:56
@article{a1c5db38-c328-4fe9-97c4-381ad899329e,
  abstract     = {Background: The 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. Results: The time to reach 50% MI of the MaR (T-50) 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 T-50 when using MPS compared to T2-STIR (p = 0.53) for assessment of MaR (288 +/- 23 min vs 310 +/- 22 min, T-50 +/- standard error). The transmural extent of MI increased progressively as the duration of ischemia increased (R-2 = 0.56, p &lt; 0.001). Conclusion: This 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.},
  author       = {Hedström, Erik and Engblom, Henrik and Frogner, Fredrik and Astrom-Olsson, Karin and Ohlin, Hans and Jovinge, Stefan and Arheden, Håkan},
  issn         = {1097-6647},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {Journal of Cardiovascular Magnetic Resonance},
  title        = {Infarct evolution in man studied in patients with first-time coronary occlusion in comparison to different species - implications for assessment of myocardial salvage},
  url          = {http://dx.doi.org/10.1186/1532-429X-11-38},
  volume       = {11},
  year         = {2009},
}