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Heerajnarain Bulluck Mervyn H. H. Chan Valeria Paradies Robert L. Yellon He H. Ho Mark Y. Chan Calvin W. L. Chin Jack W. Tan Derek J. Hausenloy 《Journal of cardiovascular magnetic resonance》2018,20(1):72
Introduction
The incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence and predictors of LV thrombus by cardiovascular magnetic resonance (CMR) in STEMI treated by primary PCI.Methods
We searched MEDLINE and EMBASE databases up to February 2018. We included all studies published as a full-text article, reporting the incidence of LV thrombus by CMR within 1 month following acute STEMI in patients treated by primary PCI. A binary random-effects model was used to estimate the pooled incidence of LV thrombus. The diagnostic performance of transthoracic echocardiography (TTE) as compared with CMR was pooled to obtain the sensitivity and specificity of TTE with CMR as the gold standard. Embolic and bleeding complications of LV thrombus were also evaluated.Results
Ten studies were included in the meta-analysis. The incidence of LV thrombus by CMR in all-comer STEMI patients (n?=?2072) was 6.3% with 96% of LV thrombus occurring in those with anterior STEMI (12.2% incidence). When only anterior STEMI with LVEF<?50% were considered (n?=?447), the incidence of LV thrombus was 19.2%. Compared with CMR, the sensitivity of TTE to detect LV thrombus was 29% with a specificity of 98%. The sensitivity of TTE increased to 70% in those with anterior STEMI and reduced LVEF. LV thrombus resolved in 88% of cases by 3 to 6 months. After 1–2 years follow-up, the embolic complication rate was similar at 1.5% (P?=?0.25) but the bleeding complication rate was significantly higher (8.8% versus 0.5%, P?<?0.001) in the LV thrombus group on triple therapy when compared to the no LV thrombus group on dual antiplatelet therapy.Conclusion
In the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk.2.
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Age and ejection fraction modify the impact of atrial fibrillation on acute heart failure outcomes
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Tushar Kotecha Ana Martinez-Naharro Thomas A. Treibel Rohin Francis Sabrina Nordin Amna Abdel-Gadir Daniel S. Knight Giulia Zumbo Stefania Rosmini Viviana Maestrini Heerajnarain Bulluck Roby D. Rakhit Ashutosh D. Wechalekar Janet Gilbertson Mary N. Sheppard Peter Kellman Julian D. Gillmore James C. Moon Marianna Fontana 《Journal of the American College of Cardiology》2018,71(25):2919-2931
Background
Prognosis in light-chain (AL) and transthyretin (ATTR) amyloidosis is influenced by cardiac involvement. ATTR amyloidosis has better prognosis than AL amyloidosis despite more amyloid infiltration, suggesting additional mechanisms of damage in AL amyloidosis.Objectives
The aim of the study was to assess the presence and prognostic significance of myocardial edema in patients with amyloidosis.Methods
The study recruited 286 patients: 100 with systemic AL amyloidosis, 163 with cardiac ATTR amyloidosis, 12 with suspected cardiac ATTR amyloidosis (grade 1 on 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid), 11 asymptomatic individuals with amyloidogenic TTR gene mutations, and 30 healthy volunteers. All subjects underwent cardiovascular magnetic resonance with T1 and T2 mapping and 16 underwent endomyocardial biopsy.Results
Myocardial T2 was increased in amyloidosis with the degree of elevation being highest in untreated AL patients (untreated AL amyloidosis 56.6 ± 5.1 ms; treated AL amyloidosis 53.6 ± 3.9 ms; ATTR amyloidosis 54.2 ± 4.1 ms; each p < 0.01 compared with control subjects: 48.9 ± 2.0 ms). Left ventricular (LV) mass and extracellular volume fraction were higher in ATTR amyloidosis compared with AL amyloidosis while LV ejection fraction was lower (p < 0.001). Histological evidence of edema was present in 87.5% of biopsy samples ranging from 5% to 40% myocardial involvement. Using Cox regression models, myocardial T2 predicted death in AL amyloidosis (hazard ratio: 1.48; 95% confidence interval: 1.20 to 1.82) and remained significant after adjusting for extracellular volume fraction and N-terminal pro–B-type natriuretic peptide (hazard ratio: 1.32; 95% confidence interval: 1.05 to 1.67).Conclusions
Myocardial edema is present in cardiac amyloidosis by histology and cardiovascular magnetic resonance T2 mapping. T2 is higher in untreated AL amyloidosis compared with treated AL and ATTR amyloidosis, and is a predictor of prognosis in AL amyloidosis. This suggests mechanisms additional to amyloid infiltration contributing to mortality in amyloidosis. 相似文献8.
The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC‐GTN Study
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Ashraf Hamarneh MBChB MRCP Vivek Sivaraman MBChB MRCP Heerajnarain Bulluck MBChB MRCP Hilary Shanahan MB BCh BAO NUI FCARCSI Bonnie Kyle BSc MBChB FRCA Manish Ramlall MBChB MRCP Robin Chung MBChB MRCP Claire Jarvis BSc Maria Xenou BSc MSc Cono Ariti MSc Roger Cordery MB BS FRCA Derek M. Yellon PhD DSc FRCP Derek J. Hausenloy MBChB PhD 《Clinical cardiology》2015,38(11):641-646
Remote ischemic conditioning (RIC) using transient limb ischemia/reperfusion has been reported to reduce perioperative myocardial injury in patients undergoing coronary artery bypass grafting and/or valve surgery. The role of intravenous glyceryl trinitrate (GTN) therapy administered during cardiac surgery as a cardioprotective agent and whether it interferes with RIC cardioprotection is not clear and is investigated in the ERIC‐GTN trial ( http://www.clinicaltrials.gov : NCT01864252). The ERIC‐GTN trial is a single‐site, double‐blind, randomized, placebo‐controlled study. Consenting adult patients (age > 18 years) undergoing elective coronary artery bypass grafting ± valve surgery with blood cardioplegia will be eligible for inclusion. Two hundred sixty patients will be randomized to 1 of 4 treatment groups following anesthetic induction: (1) RIC alone, a RIC protocol comprising three 5‐minute cycles of simultaneous upper‐arm and thigh cuff inflation/deflation followed by an intravenous (IV) placebo infusion; (2) GTN alone, a simulated sham RIC protocol followed by an IV GTN infusion; (3) RIC + GTN, a RIC protocol followed by an IV GTN infusion; and (4) neither RIC nor GTN, a sham RIC protocol followed by IV placebo infusion. The primary endpoint will be perioperative myocardial injury as quantified by the 72‐hour area‐under‐the‐curve serum high‐sensitivity troponin T. The ERIC‐GTN trial will determine whether intraoperative GTN therapy is cardioprotective during cardiac surgery and whether it affects RIC cardioprotection. 相似文献
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Heerajnarain Bulluck Nazia Chowdhury Mei Xing Lim John C. Allen Jennifer A. Bryant Mark Y. Chan Mervyn H.H. Chan Calvin W.L. Chin Hee Hwa Ho Soo T. Lim Ru‐San Tan Jack W. Tan Philip E. Wong Khung K. Yeo Stuart A. Cook Derek J. Hausenloy 《Journal of magnetic resonance imaging : JMRI》2020,51(2):644-645
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Heerajnarain Bulluck Mervyn H. H. Chan Jennifer A. Bryant Ping Chai Ashish Chawla Terrance S. Chua Yiu‐Cho Chung Gao Fei Hee H. Ho Andrew F. W. Ho Andrew J. Hoe Syed S. Imran Chi‐Hang Lee Swee H. Lim Boon W. Liew Patrick L. Z. Yun Marcus O. E. Hock Valeria Paradies Matthew T. Roe Lynette Teo Aaron S. Wong Evelyn Wong Philip E. Wong Timothy Watson Mark Y. Chan Jack W. Tan Derek J. Hausenloy 《Clinical cardiology》2019,42(1):5-12