Enhancement of Myocardial Function and Reduction of Injury with Levosimendan after Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Pilot Study

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Abstract

Objectives: To determine the short-term clinical effects of levosimendan in acute myocardial infarction (AMI) patients with myocardial stunning after emergency percutaneous coronary intervention (PCI). Methods: The study population consisted of 30 patients with AMI who received emergency PCI and satisfied the inclusion criteria. Levosimendan was given as a continuous infusion of 0.1 μg/kg/min for 24 h, and the remaining 10 patients received placebo treatment. The patients were observed with invasive haemodynamic monitoring and were evaluated biochemically and echocardiographically before and after the drug infusion. Results: Following treatment, biochemical indices (not including creatine kinase and its MB fraction) were significantly lower in the levosimendan group than in the placebo group. Meanwhile, left-ventricular (LV) end-systolic volume, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and systemic vascular resistance were significantly reduced in the levosimendan group, whereas the early-to-late diastolic velocities ratio, LV ejection fraction, cardiac index and cardiac power index were increased. Troponin I levels were reduced and fewer stunned and infarction segments were observed in the patients treated with levosimendan. Conclusions: Levosimendan can significantly improve the myocardium function of patients with myocardial stunning after PCI.

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Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry

Ph. Steg, Nicola Greenlaw, Jean-Claude Tardif … (2012)

Aims Men and women differ in terms of presentation and management in coronary artery disease (CAD). Whether these differences translate into different clinical outcomes in stable CAD is unclear. We analysed data from the international prospective CLARIFY registry to compare cardiovascular clinical outcomes in men and women with stable CAD. Methods and results We analysed 1-year outcomes in 30 977 outpatients with stable CAD [23 975 (77.4%) men; 7002 (22.6%) women]. Women were older than men, more likely to have hypertension and diabetes, and less likely to exercise or smoke. They had more frequent angina, but were less likely to have undergone diagnostic non-invasive testing or coronary angiography. Women received less optimized treatment for stable CAD. One-year outcomes were similar for men and women for the composite of cardiovascular death, non-fatal myocardial infarction, or stroke [adjusted rates 1.7 vs. 1.8%, respectively, odds ratio (OR) 0.93, 95% confidence interval (CI) 0.75–1.15]; all-cause death (adjusted 1.5 vs. 1.6%, OR: 0.91, 95% CI: 0.72–1.13); fatal or non-fatal myocardial infarction (adjusted 1.0 vs. 0.9%, OR: 0.81, 95 CI: 0.60–1.08); and cardiovascular death or non-fatal myocardial infarction (adjusted 1.4 vs. 1.4%, OR: 0.89, 95% CI: 0.70–1.12). Fewer women underwent revascularization (2.6 vs. 2.2%, OR: 0.77, 95% CI: 0.64–0.93), although appropriateness was not analysed. Conclusion The risk profiles of women and men with stable CAD differ substantially. However, 1-year outcomes were similar. Fewer women underwent revascularization. Further research is needed to better understand gender determinants of outcome and devise strategies to minimize bias in the management and treatment of women.

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Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction.

Javier Ganame, Walter Desmet, Frank E Rademakers … (2009)

Myocardial haemorrhage is a common complication following reperfusion of ST-segment-elevation acute myocardial infarction (MI). Although its presence is clearly related to infarct size, at present it is unknown whether post-reperfusion haemorrhage affects left ventricular (LV) remodelling. Magnetic resonance imaging (MRI) can be used to identify MI, myocardial haemorrhage, and microvascular obstruction (MVO), as well as measure LV volumes, function, and mass. Ninety-eight patients (14 females, 84 males, mean age: 57.7 years) with MI reperfused with percutaneous coronary intervention (PCI) were studied within the first week (1W) and at 4 months (4M) after the event. T2-weighted MRI was used to differentiate between haemorrhagic (i.e. hypointense core) and non-haemorrhagic infarcts (i.e. hyperintense core). Microvascular obstruction and infarct size were determined on contrast-enhanced MRI, whereas cine MRI was used to quantify LV volumes, mass, and function. Twenty-four patients (25%) presented with a haemorrhagic MI. In the acute phase, the presence of myocardial haemorrhage was related to larger infarct size and infarct transmurality, lower LV ejection fraction, and lower systolic wall thickening in the infarcted myocardium (all P-values <0.001). At 4M, a significant improvement in LV ejection fraction in patients with non-haemorrhagic MI was seen (baseline: 49.3 +/- 7.9% vs. 4M: 52.9 +/- 8.1%; P < 0.01). Left ventricular ejection fraction did, however, not improve in patients with haemorrhagic MI (baseline: 42.8 +/- 6.5% vs. 4M: 41.9 +/- 8.5%; P = 0.68). Multivariate analysis showed myocardial haemorrhage to be an independent predictor of adverse LV remodelling at 4M (defined as an increase in LV end-systolic volume). This pattern was independent of the initial infarct size. Myocardial haemorrhage, the presence of which can easily be detected with T2-weighted MRI, is a frequent complication after successful myocardial reperfusion and an independent predictor of adverse LV remodelling regardless of the initial infarct size.

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C-reactive protein, infarct size, microvascular obstruction, and left-ventricular remodelling following acute myocardial infarction.

J Damas, Tom Eirik Mollnes, Stein Ørn … (2009)

This study assessed the relationship between inflammatory mediators and indices of infarct size and left-ventricular (LV) remodelling following successful primary percutaneous coronary intervention (PCI) in patients with first time ST elevation myocardial infarction (MI). Forty-two patients admitted with an occluded single vessel were recruited consecutively. Cardiac magnetic resonance was used for serial assessment (2 days, 1 week, 2 months) of infarct size, microvascular obstruction (MO), and LV remodelling. Inflammatory mediators were analysed before and after PCI. Our major findings were: (1) Following PCI, there was a marked increase in plasma levels of C-reactive protein, closely correlated with an increase in interleukin-6 and terminal complement complex, reaching maximum 2 days after PCI; (2) C-reactive protein 2 days after PCI was significantly correlated with infarct size and parameters of LV remodelling 2 months after PCI; (3) Patients with persistent MO had significantly higher C-reactive protein levels 2 days following PCI. We suggest that the rapid increase in C-reactive protein levels in this model of successful revascularization of a single, totally occluded vessel reflects the degree of inflammation within the infarcted area. Our findings support a role for C-reactive protein-mediated complement activation as both a marker and mediator of myocardial damage following MI. Clinical study no.: NCT 00465868.

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Author and article information

Journal

Journal ID (publisher-id): CRD

Journal ID (nlm-ta): Cardiology

Journal ID (doi): 10.1159/issn.0008-6312

Title: Cardiology

Publisher: S. Karger AG

ISSN (Print): 0008-6312

ISSN (Electronic): 1421-9751

Publication date Subscription-year: 2014

Publication date (Print): May 2014

Publication date (Electronic): 16 April 2014

Volume: 128

Issue: 2

Pages: 202-208

Affiliations

Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China

Author notes

*Yanzhou Zhang, PhD, Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Road, Erqi District, Zhengzhou 450000 (PR China), E-Mail wusdxlglx@hotmail.com

Article

Publisher ID: 360933 Other ID: Cardiology 2014;128:202-208

DOI: 10.1159/000360933

PubMed ID: 24751502

SO-VID: 974a1d22-ede9-4bbe-a041-fd5f89c5a10d

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 10 August 2013

Date accepted : 26 February 2014

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Enhancement of Myocardial Function and Reduction of Injury with Levosimendan after Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Pilot Study

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Karger: Cardiovascular System

Most cited references 21

Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry

Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction.

C-reactive protein, infarct size, microvascular obstruction, and left-ventricular remodelling following acute myocardial infarction.

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Cited by 6

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