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Updated: Jun 13, 2025
In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Hypothermia as an adjunctive therapy to percutaneous intervention after ST-elevation myocardial infarction-Effects on
Lucas de Mello Queiroz1, Rafael Almeida Fonseca2, Luis Augusto Palma Dallan3
1University of Sao Paulo Medical School, Sao Paulo, SP, Brazil; Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, SP, Brazil.
Insights
Endovascular therapeutic hypothermia (ETH) improved regional contractility in ST-elevation myocardial infarction (STEMI) patients. This therapy enhanced infarcted areas but not remote regions, suggesting potential clinical benefits for left ventricular remodeling.
Area of Science:
- Cardiology
- Medical Imaging
- Therapeutic Hypothermia
Background:
- The impact of endovascular therapeutic hypothermia (ETH) on regional contractility in ST-elevation myocardial infarction (STEMI) remains unclear.
- Segmental contractility changes following ETH as an adjunct to percutaneous coronary intervention (PCI) in STEMI have not been previously evaluated.
Purpose of the Study:
- To assess segmental myocardial strain in patients with STEMI who received ETH as an adjunct to PCI.
- To evaluate the effects of ETH on left ventricular (LV) strain in infarcted, adjacent, and remote myocardial segments.
Main Methods:
- A cohort of 40 STEMI patients from a previous randomized trial were analyzed.
- Cardiovascular magnetic resonance (CMR) imaging was performed 5 and 30 days post-STEMI.
- Left ventricle (LV) strain, including circumferential (CS) and radial strains (RS), was measured using feature-tracking imaging.
Main Results:
- ETH treatment led to significant recovery of RS and CS in infarcted areas compared to controls (p=0.001).
- Transmural infarcted segments in the ETH group showed improved RS and CS at 30 days compared to controls (p=0.001).
- No significant improvement in strain was observed in remote myocardial areas for the ETH group compared to controls.
Conclusions:
- ETH as an adjunct to PCI in STEMI patients is associated with improved contractility in infarcted and transmural segments.
- ETH does not appear to significantly affect strain in remote myocardial areas.
- These findings may enhance understanding of early LV remodeling and suggest potential clinical utility for ETH in STEMI management.
Background:
The effects of endovascular therapeutic hypothermia (ETH) in ST-elevation myocardial infarction (STEMI) regional contractility are unknown, and its impact on segmental contractility has still not been evaluated. We sought to evaluate segmental myocardial strain after ETH adjuvant to percutaneous coronary intervention (PCI) in STEMI.
Methods:
We included patients who underwent 1.5T cardiovascular magnetic resonance exams 5 and 30 days after acute anterior or inferior STEMI in a previous randomized trial. Left ventricle (LV) strain was evaluated on infarcted, adjacent, and remote myocardium. Segmental circumferential (CS) and radial strains (RS) were measured using feature-tracking imaging. Repeated measures of analysis of variance were used for comparisons within time and treatment.
Results:
Forty patients were divided into hypothermia (ETH, n = 29) and control (n = 11) groups, with 5210 LV segments. In ETH infarcted areas, RS (11.2 ± 16 vs 14.8 ± 15.2, p = 0.001) and CS (-5.4 ± 11.1 vs -8 ± 11.1, p = 0.001) showed recovery from 5-30 days compared to controls (11.4 ± 14 vs 13.1 ± 1 6.8, p = 0.09; -6.5 ± 10.6 vs -6.4 ± 12.5, p = 0.94). In control remote areas, RS (28 ± 18 vs 31.7 ± 18.5, p = 0.001) and CS (-15.5 ± 10.7 vs -17.1 ± 9, p = 0.001) improved from 5-30 days compared to ETH (28.6 ± 18.6 vs 29 ± 20, p = 0.44; -15.2 ± 10.4 vs -15.3 ± 10.6, p = 0.82). Transmural infarcted areas in ETH improved RS (11.8 ± 13.2 vs 8.17 ± 14.7, p = 0.001) and CS (-6.1 ± 10.9 vs.-3.1 ± 11.3, p = 0.001) compared to controls, with better contractility at 30 days.
Conclusion:
In anterior or inferior STEMI patients, ETH adjuvant to PCI is associated with significant improvement in RS and CS of infarcted areas, including transmural segments, but not in remote area. This might further increase our pathophysiological knowledge on early LV remodeling and ultimately suggest potential clinical value.
Availability Of Data And Materials:
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
