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      Therapeutics and Clinical Risk Management (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of clinical studies, outcomes and safety in all therapeutic areas and surgical intervention areas. Sign up for email alerts here.

      34,006 Monthly downloads/views I 2.755 Impact Factor I 4.5 CiteScore I 1.0 Source Normalized Impact per Paper (SNIP) I 0.598 Scimago Journal & Country Rank (SJR)

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      Comparison of Diagnostic Value Between STE+LDDSE and CMR-FT for Evaluating Coronary Microvascular Obstruction in Post-PCI Patients for STEMI

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          Abstract

          Background

          Coronary microvascular obstruction (CMVO) is closely associated with poor prognosis of ST-segment elevation myocardial infarction (STEMI) patients. However, data showing the comparison between cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) combined with low-dose dobutamine stress echocardiography (LDDSE) in evaluating CMVO was scarcely available. We aimed to explore and compare the predictive value between CMR-FT and STE+LDDSE in detecting CMVO.

          Methods

          Sixty-one STEMI patients were executed cardiac magnetic resonance and echocardiography within the first 5–7 days after primary percutaneous coronary intervention (PCI). The myocardial strain analysis was performed in STE, STE+LDDSE, and CMR-FT, and strain parameters included radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). ROC curves were performed to predict infarcted myocardium segments with CMVO.

          Results

          Finally, 324 infarcted myocardium segments were analyzed, including 100 infarcted segments with CMVO and 224 segments without CMVO by the gold standard assessment of late gadolinium-enhancement cardiac magnetic resonance imaging (LGE-CMR). The results showed that CS was generally superior to RS and LS in identifying CMVO. CS in CMR-FT facilitated the detection of CMVO, with a sensitivity, specificity, and accuracy of 78.00%, 81.25%, and 80.25%, respectively. The sensitivity, specificity, and accuracy of CS in STE combined with LDDSE were better than STE alone (76.00% vs 60.00%, 79.91% vs 64.29%, and 78.70% vs 62.96%, P < 0.05). In addition, CMR-FT is not superior to STE+LDDSE for detection of CMVO ( P > 0.05).

          Conclusion

          Low-dose dobutamine can improve the clinical value of STE for evaluating CMVO in STEMI patients. Compared with CMR-FT, STE+LDDSE might be a better choice for STEMI patients because of its safety, convenience, and low-cost.

          Most cited references37

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          Comparing the Areas under Two or More Correlated Receiver Operating Characteristic Curves: A Nonparametric Approach

          David DeLong, Elizabeth Delong, Daniel L Clarke-Pearson (1988)
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            Fourth Universal Definition of Myocardial Infarction (2018).

            Kristian Thygesen, Joseph Alpert, Allan S. Jaffe … (2018)
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              Myocardial ischaemia–reperfusion injury and cardioprotection in perspective

              Gerd Heusch (2020)
              Despite the increasing use and success of interventional coronary reperfusion strategies, morbidity and mortality from acute myocardial infarction are still substantial. Myocardial infarct size is a major determinant of prognosis in these patients. Therefore, cardioprotective strategies aim to reduce infarct size. However, a perplexing gap exists between the many preclinical studies reporting infarct size reduction with mechanical and pharmacological interventions and the poor translation into better clinical outcomes in patients. This Review revisits the pathophysiology of myocardial ischaemia-reperfusion injury, including the role of autophagy and forms of cell death such as necrosis, apoptosis, necroptosis and pyroptosis. Other cellular compartments in addition to cardiomyocytes are addressed, notably the coronary microcirculation. Preclinical and clinical research developments in mechanical and pharmacological approaches to induce cardioprotection, and their signal transduction pathways, are discussed. Additive cardioprotective interventions are advocated. For clinical translation into treatments for patients with acute myocardial infarction, who typically are of advanced age, have comorbidities and are receiving several medications, not only infarct size reduction but also attenuation of coronary microvascular obstruction, as well as longer-term targets including infarct repair and reverse remodelling, must be considered to improve patient outcomes. Future clinical trials must focus on patients who really need adjunct cardioprotection, that is, those with severe haemodynamic alterations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ther Clin Risk Manag
                Journal ID (iso-abbrev): Ther Clin Risk Manag
                Journal ID (publisher-id): tcrm
                Title: Therapeutics and Clinical Risk Management
                Publisher: Dove
                ISSN (Print): 1176-6336
                ISSN (Electronic): 1178-203X
                Publication date (Electronic): 15 August 2022
                Publication date Collection: 2022
                Volume: 18
                Pages: 813-823
                Affiliations
                [1 ]Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University , Xuzhou, People’s Republic of China
                Author notes
                Correspondence: Tongda Xu; Dongye Li, Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University , Xuzhou, People’s Republic of China, Email xutongda3004@163.com; dongyeli@xzhmu.edu.cn
                [*]

                These authors contributed equally to this work

                Author information
                https://orcid.org/http://orcid.org/0000-0003-1156-2431
                Article
                Publisher ID: 374866
                DOI: 10.2147/TCRM.S374866
                PMC ID: 9391944
                SO-VID: aa7fc4fb-b409-4cfb-a49b-fa473813fa18
                Copyright statement: © 2022 Liu et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 16 May 2022
                Date accepted : 09 August 2022
                Page count
                Figures: 3, Tables: 8, References: 37, Pages: 11
                Funding
                Funded by: Jiangsu Provincial Science and Technology Department Social Development Fund;
                Funded by: Jiangsu Provincial Health Commission Project Fund;
                Funded by: Practice Innovation Plan for Postgraduates in General Colleges and Universities in Jiangsu Province;
                Funded by: Jiangsu Traditional Chinese Medicine Science and Technology Development Plan Project;
                This study was supported by the Jiangsu Provincial Science and Technology Department Social Development Fund (Grant number: BE2019639), Jiangsu Provincial Health Commission Project Fund (Grant number: M2020015), Research and Practice Innovation Plan for Postgraduates in General Colleges and Universities in Jiangsu Province (Grant number: SJCX22_1267) and Jiangsu Traditional Chinese Medicine Science and Technology Development Plan Project (Grant number: YB201988).
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: st-segment elevation myocardial infarction,magnetic resonance feature tracking,speckle tracking echocardiography,low-dose dobutamine,coronary microvascular obstruction
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: st-segment elevation myocardial infarction, magnetic resonance feature tracking, speckle tracking echocardiography, low-dose dobutamine, coronary microvascular obstruction

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