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Confirmation of Myocardial Ischemia and Reperfusion Injury in Mice Using Surface Pad Electrocardiography
Published on: November 24, 2016
Prospective evaluation of where reperfusion ventricular arrhythmia "bursts" fit into optimal reperfusion in STEMI
Kirian van der Weg1, Wichert J Kuijt2, Jan G P Tijssen2
1Maastricht University Medical Center, Maastricht, The Netherlands; Duke University Medical Center, Durham, United States.
Insights
Ventricular arrhythmia bursts after reperfusion therapy for myocardial infarction indicate larger infarct size. This finding, confirmed with DE-CMR, suggests VA bursts are an early electrobiomarker of infarct size.
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Background:
- Optimal salvage of ischemic myocytes in acute myocardial infarction (AMI) requires early reperfusion.
- Ventricular arrhythmia (VA) bursts post-recanalization correlate with larger infarct size (IS) in SPECT studies.
Purpose of the Study:
- To validate the association between VA bursts and IS in an independent cohort.
- To confirm findings using delayed-enhancement cardiovascular magnetic resonance imaging (DE-CMR) for more accurate IS assessment.
Main Methods:
- 196 patients from PREPARE and MAST studies with successful reperfusion (TIMI 3 flow, ST-recovery) were analyzed.
- Continuous 12-lead Holter monitoring identified VA bursts using a statistical outlier method.
- Infarct size (IS) was quantified by DE-CMR, with all assessments performed blinded.
Main Results:
- VA bursts were observed in 79% of patients (154/196).
- VA bursts were significantly associated with larger IS (median 11.3% vs 5.3%, p=0.001).
- This association persisted in non-anterior MI (median 9.9% vs 4.9%, p=0.003), but not significantly in anterior MI due to small sample size.
Conclusions:
- Ventricular arrhythmia bursts during reperfusion are an early electrobiomarker of larger infarct size.
- This finding complements traditional markers of reperfusion like TIMI 3 flow and ST-segment recovery.
Background:
Early reperfusion of ischemic myocytes is essential for optimal salvage in acute myocardial infarction. VA (ventricular arrhythmia) bursts after recanalization of the culprit vessel have been found to be related to larger infarct size (IS), using SPECT.
Objective:
The hypothesis was tested that this finding could be confirmed in an independent cohort using a more accurate technique, i.e. delayed-enhancement cardiovascular magnetic resonance imaging (DE-CMR).
Methods:
All 196 patients from the PREPARE and MAST studies who had 24-hour, continuous, 12-lead Holter, started before primary percutaneous coronary intervention resulting in brisk TIMI (thrombolysis in myocardial infarction) 3 flow and stable ST-recovery were included. VA bursts were identified against subject-specific background VA rates using a previously published statistical outlier method. IS was assessed using DE-CMR. Angiography, Holter and DE-CMR results were assessed in core laboratories, blinded to all other data.
Results:
VA bursts were present in 154/196 (79%) of patients. Baseline characteristics between the groups with and without bursts were similar. VA burst was associated with significantly larger infarct size in the population as a whole (median 11.3% vs 5.3%; p=0.001) and also when divided in non-anterior (median 9.9% vs 4.9%; p=0.003) and anterior myocardial infarction (median 21.4% vs 12.0%; p=0.48), the latter not reaching statistical significance due to the small subset of patients.
Conclusion:
Beyond the classical markers of "optimal" reperfusion such as TIMI 3 flow and stable ST-segment recovery, VA bursts occurring during the reperfusion phase are an early electrobiomarker of larger IS.
Clinical Trial Registration:
PREPARE: ISRCTN71104460 http://www.controlled-trials.com/ISRCTN71104460.
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