Related Experiment Video
Updated: Jun 14, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
The unexpected silent manifestation of myocardial infarctions in ischemic heart failure patients: Insights from a
Gabriel Cordeiro Polo Mendes1, Paulo Cury Rezende1, Arthur Cicupira Rodrigues de Assis1
1Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
Silent Myocardial Infarction (SMI) is frequent, but its factors in severe coronary artery disease (CAD) patients with left ventricular dysfunction (LVD) are unclear. Peripheral diabetic neuropathy and inferior wall MI are associated with SMI in these patients.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Silent Myocardial Infarction (SMI) is increasingly recognized but poorly understood in severe Coronary Artery Disease (CAD) patients with Left Ventricular Dysfunction (LVD).
- Associated factors for SMI in this specific high-risk population remain unclear in existing literature.
Purpose of the Study:
- To compare clinical, laboratorial, ventricular, and angiographic factors between silent and classical presentations of Myocardial Infarction (MI) in patients with CAD and LVD.
- To identify factors associated with SMI in a cohort of severe CAD and LVD patients.
Main Methods:
- Patients with multivessel CAD (>70% obstructive lesions) and LVD (EF <35%) were evaluated.
- Ventricular function assessed by echocardiography; coronary disease severity by SYNTAX score.
- Population stratified into SMI and Clinically Manifested Myocardial Infarction (CMMI) groups for comparison.
Main Results:
- Of 132 patients, 47 (35.6%) had SMI and 85 (64.4%) had CMMI.
- No significant differences in age, sex, diabetes, SYNTAX score, or collateral circulation between groups.
- SMI group showed higher NYHA II, inferior wall MI, and lower creatinine clearance. Peripheral diabetic neuropathy (OR=4.6) and inferior wall MI (OR=4.1) were significantly associated with SMI.
Conclusions:
- Peripheral diabetic neuropathy and inferior wall MI are significantly associated with SMI presentation in severe CAD and LVD patients.
- While many factors are similar between SMI and CMMI, diabetic patients with chronic neuropathy require special attention.
Background:
Recent studies show Silent Myocardial Infarction (SMI) as a quite frequent event. However, regarding severe tertiary care patients that frequently present consequences of Coronary Artery Disease (CAD) and Left Ventricular Dysfunction (LVD), the occurrence of this manifestation is unexpected and its associated factors aren't clear in the literature.
Aim:
To compare clinical, laboratorial, ventricular and angiographic factors between silent and classical presentation of MI in patients with CAD and LVD.
Methods:
Patients with multivessel CAD with over 70 % obstructive lesions and LVD with EF less than 35 % were evaluated for MASS VI trial and later included in the present study. The ventricular function and coronary assessment were measured by echocardiography and SYNTAX score, respectively. The population was stratified in a SMI group and Clinically Manifested Myocardial Infarction (CMMI) group based on MI presentation for a comparison of medical parameters.
Results:
From 132 patients, 47 (35.6 %) were classified as SMI and 85 (64.4 %) as CMMI. No differences were observed between groups regarding age, sex, diabetes mellitus, SYNTAX score, or collateral circulation. Higher proportion of NYHA II classification, inferior wall MI and lower creatinine clearance were found in SMI group. After multivariate analysis, peripheral diabetic neuropathy (OR = 4.6 [1.1‒12.7] p = 0.032) and inferior wall MI (OR = 4.1 [1.5‒11.4] p = 0.007) were significantly associated with SMI.
Conclusion:
Peripheral diabetic neuropathy and inferior wall MI were associated with SMI presentation. Overall, associated factors tend to be similar comparing SMI and CMMI, but in the specific population of diabetic patients with chronic neuropathy a special care should be taken.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
04:29A Modified Simple Method for Induction of Myocardial Infarction in Mice
Published on: December 3, 2021
