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Mineralocorticoid Receptor Antagonist Pretreatment to MINIMISE Reperfusion Injury After ST‐Elevation Myocardial Infarction (The MINIMISE STEMI Trial): Rationale and Study Design 下载免费PDF全文
Heerajnarain Bulluck MBBS Georg M. Fröhlich MD Shah Mohdnazri MBBS Reto A. Gamma FRCP John R. Davies PhD Gerald J. Clesham MD Jeremy W. Sayer MD Rajesh K. Aggarwal MD Kare H. Tang FRCP Paul A. Kelly MD Rohan Jagathesan MD Alamgir Kabir PhD Nicholas M. Robinson MD Alex Sirker PhD Anthony Mathur PhD Daniel J. Blackman MD Cono Ariti MSc Arvindra Krishnamurthy MBBS Steven K. White MBBS Pascal Meier MD James C. Moon MD John P. Greenwood PhD Derek J. Hausenloy MDPhD 《Clinical cardiology》2015,38(5):259-266
Novel therapies capable of reducing myocardial infarct (MI) size when administered prior to reperfusion are required to prevent the onset of heart failure in ST‐segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Experimental animal studies have demonstrated that mineralocorticoid receptor antagonist (MRA) therapy administered prior to reperfusion can reduce MI size, and MRA therapy prevents adverse left ventricular (LV) remodeling in post‐MI patients with LV impairment. With these 2 benefits in mind, we hypothesize that initiating MRA therapy prior to PPCI, followed by 3 months of oral MRA therapy, will reduce MI size and prevent adverse LV remodeling in STEMI patients. The MINIMISE‐STEMI trial is a prospective, randomized, double‐blind, placebo‐controlled trial that will recruit 150 STEMI patients from four centers in the United Kingdom. Patients will be randomized to receive either an intravenous bolus of MRA therapy (potassium canrenoate 200 mg) or matching placebo prior to PPCI, followed by oral spironolactone 50 mg once daily or matching placebo for 3 months. A cardiac magnetic resonance imaging scan will be performed within 1 week of PPCI and repeated at 3 months to assess MI size and LV remodeling. Enzymatic MI size will be estimated by the 48‐hour area‐under‐the‐curve serum cardiac enzymes. The primary endpoint of the study will be MI size on the 3‐month cardiac magnetic resonance imaging scan. The MINIMISE STEMI trial will investigate whether early MRA therapy, initiated prior to reperfusion, can reduce MI size and prevent adverse post‐MI LV remodeling. 相似文献
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Heerajnarain Bulluck Steven K. White Stefania Rosmini Anish Bhuva Thomas A. Treibel Marianna Fontana Amna Abdel-Gadir Anna Herrey Charlotte Manisty Simon M. Y. Wan Ashley Groves Leon Menezes James C. Moon Derek J. Hausenloy 《Journal of cardiovascular magnetic resonance》2015,17(1)
Background
Whether T1-mapping cardiovascular magnetic resonance (CMR) can accurately quantify the area-at-risk (AAR) as delineated by T2 mapping and assess myocardial salvage at 3T in reperfused ST-segment elevation myocardial infarction (STEMI) patients is not known and was investigated in this study.Methods
18 STEMI patients underwent CMR at 3T (Siemens Bio-graph mMR) at a median of 5 (4–6) days post primary percutaneous coronary intervention using native T1 (MOLLI) and T2 mapping (WIP #699; Siemens Healthcare, UK). Matching short-axis T1 and T2 maps covering the entire left ventricle (LV) were assessed by two independent observers using manual, Otsu and 2 standard deviation thresholds. Inter- and intra-observer variability, correlation and agreement between the T1 and T2 mapping techniques on a per-slice and per patient basis were assessed.Results
A total of 125 matching T1 and T2 mapping short-axis slices were available for analysis from 18 patients. The acquisition times were identical for the T1 maps and T2 maps. 18 slices were excluded due to suboptimal image quality. Both mapping sequences were equally prone to susceptibility artifacts in the lateral wall and were equally likely to be affected by microvascular obstruction requiring manual correction. The Otsu thresholding technique performed best in terms of inter- and intra-observer variability for both T1 and T2 mapping CMR. The mean myocardial infarct size was 18.8 ± 9.4 % of the LV. There was no difference in either the mean AAR (32.3 ± 11.5 % of the LV versus 31.6 ± 11.2 % of the LV, P = 0.25) or myocardial salvage index (0.40 ± 0.26 versus 0.39 ± 0.27, P = 0.20) between the T1 and T2 mapping techniques. On a per-slice analysis, there was an excellent correlation between T1 mapping and T2 mapping in the quantification of the AAR with an R2 of 0.95 (P < 0.001), with no bias (mean ± 2SD: bias 0.0 ± 9.6 %). On a per-patient analysis, the correlation and agreement remained excellent with no bias (R2 0.95, P < 0.0001, bias 0.7 ± 5.1 %).Conclusions
T1 mapping CMR at 3T performed as well as T2 mapping in quantifying the AAR and assessing myocardial salvage in reperfused STEMI patients, thereby providing an alternative CMR measure of the the AAR. 相似文献14.
Hector A. Cabrera-Fuentes Julian Aragones Jürgen Bernhagen Andreas Boening William A. Boisvert Hans E. Bøtker Heerajnarain Bulluck Stuart Cook Fabio Di Lisa Felix B. Engel Bernd Engelmann Fulvia Ferrazzi Péter Ferdinandy Alan Fong Ingrid Fleming Erich Gnaiger Sauri Hernández-Reséndiz Siavash Beikoghli Kalkhoran Moo Hyun Kim Sandrine Lecour Elisa A. Liehn Michael S. Marber Manuel Mayr Tetsuji Miura Sang-Bing Ong Karlheinz Peter Daniel Sedding Manvendra K. Singh M. Saadeh Suleiman Hans J. Schnittler Rainer Schulz Winston Shim Daniel Tello Carl-Wilhelm Vogel Malcolm Walker Qilong Oscar Yang Li Derek M. Yellon Derek J. Hausenloy Klaus T. Preissner 《Basic research in cardiology》2016,111(6):69
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