Relation of admission white blood cell count to left ventricular remodeling after anterior wall acute myocardial infarction

We investigated whether a high white blood cell (WBC) count on admission for acute myocardial infarction (AMI) may be associated with a higher risk of subsequent left ventricular (LV) remodeling. We included 107 patients with anterior AMI. Echocardiographic studies were performed at hospital discharge, at 3 months, and at 1 year after AMI. LV remodeling (>20% increase in end-diastolic volume) was observed in 27% of patients. WBC counts during hospitalization were higher in patients who subsequently underwent LV remodeling (p = 0.003 for WBC count on admission). The increase in end-diastolic volume from baseline to 1 year was greater for patients in the higher tertile of WBC count on admission (p = 0.04). When adjusting for baseline clinical and echocardiographic characteristics by multivariate analysis, WBC count on admission was independently associated with LV remodeling (odds ratio 1.23, 95% confidence interval 1.04 to 1.45, p = 0.018). In conclusion, a high WBC count on admission for AMI is an independent predictor of LV remodeling, even when predischarge echocardiographic variables are taken into account.     

延迟经皮冠状动脉腔内成形术对急性心肌梗死患者左室心功能的影响

目的　本研究评价延迟的经皮冠状动脉腔内成形术 (PTCA)所产生的梗死区再灌注血流对急性心肌梗死 (AMI)患者左心室功能恢复的影响。方法　 33例初次Q波型AMI患者 ,于发病 2～3周内分别进行PTCA治疗。全部病例梗塞相关血管均为完全或次全闭塞病变。经过左心室造影应用面积长轴法计算每例患者的左室射血分数 (LVEF) ,梗塞区室壁运动百分率 ,左心室舒张末容积指数 (EDVI)及Cortina室壁运动不良积分。PTCA 6个月后所有患者重复进行左心室造影及重复以上指标的测量。结果　在PTCA 6个月后 ,本组病例表现出左室局部及整体收缩功能明显改善 [LVEF(5 5 2± 10 1) %vs (4 9 2± 9 9) % ,P <0 0 1]。梗塞区收缩百分率 [(12 8± 5 2 ) %vs (11 5± 6 0 ) % ,P <0 0 5 ]。Cortina室壁运动不良积分下降 [(7 6± 3 2 )vs (9 2± 2 8) ,P <0 0 1]。而EDVI则无明显变化 ,说明左心室的扩张受到了限制。结论　提示Q波型急性心肌梗死接受延迟的PTCA再血管化治疗有益于患者左心功能的恢复。     

Oxidative stress correlates with left ventricular volume after acute myocardial infarction

It has been suggested that oxidative stress may play a role in the pathophysiology of heart failure. However, little is known about the clinical relationship between oxidative stress and left ventricular dilatation after acute myocardial infarction (AMI). We prospectively studied 28 consecutive patients, successfully treated with primary coronary angioplasty, after their first AMI. To evaluate oxidative stress, plasma oxidized low-density LDL levels (U/mL) were measured serially 1 day, 7 days, 14 days, 30 days, and 90 days after the onset of AMI using a specific sandwich enzyme-linked immunosorbent assay. Left ventriculography and coronary angiography were obtained in all patients 3 months after the AMI and infarct-related arteries were all patent. Peak plasma oxidized LDL levels were seen 7 days after AMI (after 1 day: 14.7+/-1.5, 7 days: 21.0+/-2.8, 14 days: 20.2+/-2.8, 30 days: 18.3+/-2.5, 90 days: 16.5+/-2.3 U/mL). Plasma oxidized LDL levels 7 days after AMI were significantly correlated with left ventricular end-diastolic volume (115+/-7 mL; r=0.54, P=0.0025) and end-systolic volume (58+/-5 mL; r=0.49, P=0.008) 3 months after the AMI. Moreover, they were also correlated with end-diastolic volume index (68+/-4 mL/m2, r=0.40, P<0.05). However, no correlation was seen between peak plasma oxidized LDL levels and ejection fraction. These findings suggest that oxidative stress may play an important role in the development and progression of left ventricular remodeling after AMI.     

Improved regional left ventricular function after successful satellite cell grafting in rabbits with myocardial infarction

OBJECTIVE: To evaluate whether satellite cells injected into infarct areas in rabbits remain viable during 6 weeks follow-up and can improve cardiac function as assessed by echocardiography. METHODS: Myocardial infarction was induced in 16 New Zealand white rabbits, by ligation of the marginalis sinistra artery. Tissue from gluteus muscle biopsies was dissected into small pieces and cultured. Within 2-3 weeks the cells were expanded by 2-3 orders of magnitude and were fluorescent labeled. Single cell pellets for resuspension at >10(6)/1 ml were directly injected into the infarct areas in 8 rabbits. In 8 additional rabbits, 1 ml saline was injected (control). Regional left ventricular function was assessed weekly by 2-D echocardiography until animals were sacrificed. Analysis was performed blind and independently by two experienced echocardiographers, based on the American Society of Echocardiography scheme. RESULTS AND DISCUSSION: Six treated and five control rabbits completed the study. One week after the artery occlusion, left ventricular function scoring did not differ between groups, mean 8.7+/-1.6 vs 8.3+/-1.9 (P=0.74). At 6 weeks post-injection, echocardiographic score was significantly better in the treated group, mean 2.6+/-0.9 vs 6.9+/-2.1 (P=0.002). The treated group showed significant gradual segmental improvement between the first week up to week 6. After sacrifice, macro and microscopic transmural areas showed typical changes of myocardial infarction. Histochemical staining identified viable grafted cells in high density 6 weeks post-transplantation in all grafted hearts. CONCLUSION: Autologous satellite cells (skeletal myofiber), can be successfully grafted into rabbit hearts following myocardial infarction and may induce improved regional left ventricular function.     

急性心肌梗塞静脉溶栓治疗改善左心室功能的作用

为评价急性心肌梗塞（ＡＭＩ）静脉溶栓再灌注对左心室功能及重塑的影响，应用二维超声心动图（２ＤＥ）对６１例ＡＭＩ接受静脉溶栓治疗的患者，分别在急性期及６个月后随访时测量并计算左心室容积（ＥＳＶ和ＥＤＶ），射血分数（ＥＦ），左心室内膜弧长（ＡＳＬ和ＰＳＬ）以及室壁运动指数（ＧＷ－ＭＩ和ＲＷＭＩ）。结果显示，以上各项指标急性期时两组比较差异均无显著性，在６个月后的随访中，再通组ＥＦ值明显高于未通组，再通组左室容量减小、变形减轻。急性期两组的心功能无差异，随访时再通组心功能较未通组显著改善。提示溶栓再灌注能明显减轻左心室的扩张及抑制左心室重塑，改善患者的心功能和预后。     

Influence of reperfusion therapy on left ventricular remodeling after acute myocardial infarction

To determine the relation between reperfusion therapy and left ventricular function and remodeling after acute myocardial infarction (AMI), 75 consecutive patients with anterior AMI were studied. The patients were divided into four groups according to the reperfusion outcome and time to reperfusion from onset of MI: 12 patients with spontaneous reperfusion, 18 patients with early (less than 4th) successful reperfusion, 16 patients with late (greater than or equal to 4th) successful reperfusion and 29 patients with unsuccessful reperfusion. The right oblique left ventriculograms (LVG), which was performed early (n = 19) and late after infarction (n = 75) were analyzed to assess left ventricular (LV) volume and global and regional LV function. At the late examination, spontaneous early and late reperfused patients showed smaller LV volume (endo diastolic and endo-systolic volume index) than unsuccessfully reperfused patients LV volume was similar in both early and late reperfused patients. Spontaneous and early reperfused patients showed higher LV ejection fraction (EF) and better regional wall motion (RWM) than unsuccessfully reperfused patients. Both EF and RWM was similar in late and unsuccessfully reperfused patients at the late examination. Endo-diastolic and endo-systolic volume index increased significantly with time in patients with unsuccessful reperfusion (n = 10), as compared with the index found in the early examination. In patients with late reperfusion (n = 5), end-diastolic volume index increased with time, but end-systolic volume index was unchanged. RMW improved in patients with early reperfusion (n = 4), but was unchanged in patients with late and unsuccessful reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion

Ventricular remodeling is a major determinant of the long-term prognosis of patients with acute myocardial infarction (AMI). No previous study examined the relation of ST-segment re-elevation to left ventricular (LV) volume and function in patients with successful reperfusion. We examined the relation of ST-segment re-elevation to LV function and volume indices in 51 patients with anterior wall AMI who underwent successful reperfusion by direct coronary angioplasty. A 12-lead electrocardiogram was recorded once a day until 7 days after the onset of AMI. ST-segment shift was measured and Sigma ST was defined as the sum of ST-segment elevation obtained from leads V2, V3, and V4. ST-segment re-elevation was defined as present when the difference between maximal and minimal Sigma ST (Delta ST) was >0.3mV. LV indices were obtained from left ventriculography performed approximately 1 month after the onset of AMI. ST-segment re-elevation was observed in 15 patients (29%). No significant differences were observed between the ST- re-elevation group and non-ST-re-elevation group in LV ejection fraction (49.4+/-14.0 vs. 51.2+/-11.5%), LV end-systolic volume index (35.8+/-13.1 vs. 33.8+/-12.5 mL/m(2)) or LV end-diastolic volume index (69.7+/-12.8 vs. 68.3+/-14.4 mL/m(2)). The difference between maximal and minimal Sigma ST (Delta ST) was not significantly correlated with any LV index examined. In conclusion, the present study revealed that ST-segment re-elevation after successful reperfusion in anterior wall AMI patients was not related to LV volume or function, indicating that ST-re-elevation is not a clinically meaningful indicator of LV remodeling.     

Fragmented QRS complexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling

Background

Recovery of left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) is not universal and is difficult to predict. Fragmented QRS (fQRS) complexes are thought to be markers of myocardial scar. We hypothesized that fQRS complexes on 12?lead surface ECGs during the initial post-MI period would be associated with adverse LV remodeling over the following year.

Usefulness of combined white blood cell count and plasma glucose for predicting in-hospital outcomes after acute myocardial infarction

Admission white blood cell (WBC) count and plasma glucose (PG) have been associated with adverse outcomes after acute myocardial infarction (AMI). This study investigated the joint effect of WBC count and PG on predicting in-hospital outcomes in patients with AMI. WBC count and PG were measured at the time of hospital admission in 3,665 patients with AMI. Patients were stratified into tertiles (low, medium, and high) based on WBC count and PG. Patients with a high WBC count had a 2.0-fold increase in in-hospital mortality compared with those with a low WBC count. Patients with a high PG level had a 2.7-fold increase in mortality compared with those with a low PG level. When a combination of different strata for each variable was analyzed, a stepwise increase in mortality was seen. There was a considerable number of patients with a high WBC count and low PG level or with a low WBC count and high PG level. These patients had an intermediate risk, whereas those with a high WBC count and high PG level had the highest risk, i.e., 4.8-fold increase in mortality, compared with those with a low WBC count and low PG level. Multivariate analysis was performed to assess the predictor for in-hospital mortality using WBC count and PG level as continuous variables and showed that WBC count and PG level were independently associated with in-hospital mortality. These findings suggested that a simple combination of WBC count and PG level might provide further information for predicting outcomes in patients with AMI.     

链激酶溶栓治疗急性心肌梗死对左心室功能的改善作用

为评价链激酶溶栓治疗急性心肌梗死（ＡＭＩ）对左心室功能的影响，应用二维超声心动图对２６例接受链激酶溶栓治疗的ＡＭＩ患者和２７例未溶栓的ＡＭＩ患者，分别在急性期及６个月后随访时测量并计算左心室容积（ＥＤＶ和ＥＳＶ），射血分数（ＥＦ）以及室壁运动指数（ＧＷＭＩ和ＲＷＭＩ）。以上各项指标在急性期时比较各组无显著性差异；在随访期再通组ＥＦ值明显高于未通组和未溶栓组，再通组左室容量减小。急性期各组心功能无差异，随访时再通组心功能较未通组显著改善。提示:链激酶溶栓能明显减轻ＡＭＩ患者的左心室扩张，改善左心室功能和长期预后     

Recovery of left ventricular wall motion in early periods by successful reperfusion following myocardial infarction]

To study the time course and recovery of left ventricular (LV) function after reperfusion therapy (PTCR or PTCA), we recorded 2 D E in 1, 3, 5, 7, 14, 28 days following myocardial infarction in 41 cases with complete occlusion of left anterior descending artery. LV volumes and regional wall motion were analyzed by the centerline method (100 chords) between a reperfused (R) and a non-R group. LV end-diastolic volumes of R increased from 3 to 7 days were smaller than those in non-R. LV end-systolic volume of R decreased during the same periods were also smaller than those of non-R. Besides global ejection fractions of R were larger significantly (p less than 0.05) than those of non-R. Moreover mean percent fractional shortening of infarct-related chords from anteroseptum (-15) to lateral wall (61-80) in R improved more than those in non-R. In conclusion, LV function following myocardial infarction can be assessed by quantitative 2D echo and improved early, and become constant 7 days after successful reperfusion therapy.     

Treatment of recurrent ischemia after thrombolysis and successful reperfusion for acute myocardial infarction: effect on in-hospital mortality and left ventricular function

To determine the effect of treatment of recurrent ischemia after reperfusion for acute myocardial infarction on in-hospital mortality and left ventricular function recovery and to identify patients at highest risk of serious consequences in the event of recurrent ischemia in this setting, 405 consecutively treated patients were studied retrospectively. All patients received intravenous thrombolytic therapy within 6 h of ST segment elevation-documented infarction and had angiographic confirmation of their reperfusion status performed within 120 min of treatment. Three hundred three patients had successful reperfusion with or without rescue angioplasty and had no recurrent ischemia (group 1), 74 patients had initially successful reperfusion but subsequent recurrent ischemia (group 2) and 28 patients had failed reperfusion (group 3). The in-hospital mortality in groups 1 to 3 was 2.0%, 14.9% and 32.1%, respectively (p less than 0.001) and the change from baseline to prehospital discharge left ventricular ejection fraction was 1.2 +/- 9.3%, -0.8 +/- 8.7% and -4.3 +/- 5.3%, respectively (p = NS). Within the recurrent ischemia group (group 2), multiple regression analysis found absence of cardiogenic shock at presentation (p = 0.002) and successful treatment initiated within 90 min of recurrent ischemia (p = 0.045) to be the only variables independently correlated with in-hospital survival. Later successful reperfusion was not associated with improved hospital survival. The timing and success of treatment did not affect recovery of global or regional left ventricular function in the patients with paired angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)     

急性心肌梗死患者心室血栓与血小板体积和数量的相关性

目的分析急性心肌梗死(AMI)患者并发左心室血栓与平均血小板体积(MPV)和血小板计数(PLT)的相关性。方法回顾性分析2007年1月至2011年4月在阜外心血管病医院住院治疗的69例AMI并心室血栓形成患者,及138例与之年龄匹配(1∶2)的无心室血栓形成的AMI患者。比较两组患者入院时和入院后第6～8天两个时间点的MPV和PLT变化特点,以及分析MPV和PLT的相关性。结果两组患者入院时MPV差异无统计学意义[(10.3±1.0)fl比(10.3±0.8)fl,P=0.854],入院后第6～8天心室血栓组患者的MPV明显高于无心室血栓组[(11.1±1.7)fl比(10.7±0.7)fl,P=0.029]。入院时和入院后第6～8天PLT在两组间差异均无统计学意义(P=0.587、0.807)。入院后第6～8天患者MPV与PLT的关联表现为线性关系。结论 AMI患者MPV增大可能与心室血栓形成相关。     

重组人脑钠肽对急性心肌梗死冠脉未通患者左室重塑和心功能的影响

目的研究重组人脑钠肽（rhBNP）对急性心肌梗死（AMI）冠脉未通患者左室重塑和心功能的影响。方法将103例AMI冠脉未通患者随机分为常规治疗组23例、地高辛组40例、rhBNP治疗组40例,并于AMI后1周、12周、24周分别进行超声心动图分析,测定左室心肌重量,左室收缩功能、舒张功能,了解rhBNP对AMI后左室重塑的阻抑作用。结果①AMI后24周时rhBNP组与常规治疗组和地高辛组比较,室间隔厚度、左室后壁厚度、左室舒张末内径和左室心肌重量指数均明显降低。地高辛组与常规治疗组各项指标比较差异无统计学意义。②AMI后1周时,地高辛组和rhBNP组左室收缩末期容积较常规治疗组降低（P〈0．01）,左室射血分数较常规治疗组升高（P〈0．05）,两组间差异无统计学意义（P〉0．05）。治疗后12周、24周时,rhBNP组左室舒张末期容积和收缩末期容积较同时间点常规治疗组和地高辛组均显著降低（P〈0．05）,而左室射血分数、E／A则显著升高（P〈0．05）。结论rhBNP能明显减轻心肌梗死后心肌肥厚和左室重塑,阻抑左室重塑过程,改善左室功能。     

急性心肌梗死后左室重构的临床危险因素探讨

目的对急性心肌梗死后左室重构的临床危险因素进行评估。方法将进入本观察的５１例病人,按溶栓治疗后,有无Ｑ波形成,分为Ｑ波组和非Ｑ波组,全部病人入住ＣＣＵ,并在入院即刻及入院后８、１６、２４、４８和７２小时分别进行血清心肌酶学检查。对其中３４例病人在心梗后１周和６周行超声心动图检查,并测定左室质量指数。结果Ｑ波组血清ＣＰＫ峰值（１３４７５８±２２０３３）ＩＵ,左室质量指数在心梗后１周和６周分别为（２３４２８±９２３６）ｇ·ｍ－２、（２７１５２±９３１２）ｇ·ｍ－２,均明显高于非Ｑ波组,随访半年表明新近出现心衰亦明显高于非Ｑ波组。结论溶栓后的有Ｑ波出现,血清ＣＰＫ峰值高于５００ＩＵ,左室质量指数＞２２０ｇ·ｍ－２,是急性心肌梗死后左室重构的危险因素。     

Cardiac troponin I level correlates with chronic-phase left ventricular function after successful direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction

OBJECTIVES: The relationships between cardiac troponin I, various biochemical markers, and chronic-phase left ventricular ejection fraction (LVEF) after successful direct percutaneous transluminal coronary angioplasty (PTCA) were examined in 36 patients with acute myocardial infarction. METHODS: Biochemical markers were measured on admission, immediately after, and from 6 hours to 9 days after PTCA. RESULTS: The time to peak values were: creatine kinase-MB 9.7 hours, cardiac troponin I 9.8 hours, myoglobin 10.7 hours, creatine kinase 10.6 hours, cardiac troponin T 18.6 hours, and myosin light chain 68.9 hours. Cardiac troponin T, cardiac troponin I and myosin light chain levels were elevated over 9 days after successful direct PTCA. Chronic-phase LVEF inversely correlated with peak values of creatine kinase-MB (r = -0.519, p < 0.01), cardiac troponin T (r = -0.500, p < 0.01), cardiac troponin I (r = -0.441, p < 0.05) and creatine kinase (r = -0.411, p < 0.05). The values of cardiac troponin I, cardiac troponin T, creatine kinase and creatine kinase-MB at each sampling point were significantly inversely related to chronic-phase LVEF. The value of cardiac troponin I at each time point for 7 days correlated well with chronic-phase LVEF. CONCLUSIONS: Cardiac troponin I has high specificity for predicting long-term cardiac function after successful direct PTCA when early values are unavailable.