Dataset Information

Fractal analysis of left ventricular trabeculae in post-STEMI: from acute to chronic phase.

ABSTRACT:

Purpose

The temporal evolution of ventricular trabecular complexity and its correlation with major adverse cardiovascular events (MACE) remain indeterminate in patients presenting with acute ST elevation myocardial infarction (STEMI).

Methods

This retrospective analysis enrolled patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI, possessing cardiac magnetic resonance (CMR) data in the acute (within 7 days), subacute (1 month after pPCI), and chronic phases (6 months after pPCI) from January 2015 to January 2020 at the three participating sites. Fractal dimensions (FD) were measured for the global, infarct, and remote regions of left ventricular trabeculae during each phase. The potential association of FD with MACE was analyzed using multivariate Cox regression.

Results

Among the 200 analyzed patients (182 men; median age, 61 years; age range, 50-66 years), 37 (18.5%) encountered MACE during a median follow-up of 31.2 months. FD exhibited a gradual decrement (global FD at acute, subacute, and chronic phases: 1.253 ± 0.049, 1.239 ± 0.046, 1.230 ± 0.045, p < 0.0001), with a more pronounced decrease observed in patients subsequently experiencing MACE (p < 0.001). The global FD at the subacute phase correlated with MACE (hazard ratio 0.89 (0.82, 0.97), p = 0.01), and a global FD value below 1.26 was associated with a heightened risk.

Conclusion

In patients post-STEMI, the global FD, serving as an indicator of left ventricular trabeculae complexity, independently demonstrated an association with subsequent major adverse cardiovascular events, beyond factors encompassing left ventricular ejection fraction, indexed left ventricular end-diastolic volume, infarct size, heart rate, NYHA class, and post-pPCI TIMI flow.

Critical relevance statement

In patients who have had an ST-segment elevation myocardial infarction, global fractal dimension, as a measure of left ventricular trabeculae complexity, provided independent association with subsequent major adverse cardiovascular event.

Key points

• Global and regional FD decreased after STEMI, and more so in patients with subsequent MACE. • Lower global FD at the subacute phase and Δglobal FD from acute to subacute phase were associated with subsequent MACE besides clinical and CMR factors. • Global FD at the subacute phase independently correlated with MACE and global FD value below 1.26 was associated with higher risk.

SUBMITTER: Shi RY

PROVIDER: S-EPMC10948656 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Publications

Fractal analysis of left ventricular trabeculae in post-STEMI: from acute to chronic phase.

Shi Ruo-Yang RY Wu Rui R Ran Jinjun J Tang Lang-Lang LL Wesemann Luke L Hu Jiani J Du Liang L Zhang Wei-Jun WJ Xu Jian-Rong JR Zhou Yan Y Zhao Lei L Pu Jun J Wu Lian-Ming LM

Insights into imaging 20240318 1

<h4>Purpose</h4>The temporal evolution of ventricular trabecular complexity and its correlation with major adverse cardiovascular events (MACE) remain indeterminate in patients presenting with acute ST elevation myocardial infarction (STEMI).<h4>Methods</h4>This retrospective analysis enrolled patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI, possessing cardiac magnetic resonance (CMR) data in the acute (within 7 days), subacute (1 month after pPCI), and chro ...[more]

PMID: 38499900

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Project description:BackgroundST-elevation myocardial infarction (STEMI) demands near-time reperfusion to reduce the risk of long-term heart failure. This study evaluates the proportion of impaired left ventricular ejection fraction (LVEF) following STEMI in the context of current healthcare settings at a tertiary care center equipped with the most advanced and up-to-date standards of care.MethodsPatients experiencing STEMI as their first manifestation of coronary artery disease were analyzed, as these individuals had no prior experience with heart-related chest pain. LVEF was assessed by levocardiography at admission and semiautomatically using TOMTEC in patients with eligible full-cycle echocardiography of 2- and 4-chamber view available at discharge and 1-year follow-up (FU). Pain-to-balloon time was divided into quartiles (Q) [0-111, 112-159, 160-246 and 247-784 min]. Multiple logistic regression analysis identified independent predictors of reduced LVEF < 50% at 1-year FU.ResultsA total of 1,379 consecutive STEMI patients were reviewed from 2010 to 2017, with 130 meeting the inclusion criteria. Mean age was 63 ± 12 years, 75% were male, 14% had diabetes, 72% had arterial hypertension, and 56% had history of smoking. LVEF was reduced in 94% of patients at admission, 69% at discharge, and remained reduced in 45% at the 1-year follow-up. Anterior wall myocardial infarction (OR 3.2 [95%-CI 1.2-6.9], p = 0.018) and increasing pain-to-balloon time across quartiles (Q2: OR 15.7 [95%-CI 1.8-140.4], p = 0.014; Q4: OR 33.7 [3.4-278.7] p = 0.002) were independently associated with reduced LVEF at 1 year.ConclusionDespite optimal medical management and advanced healthcare structures, nearly half of patients with STEMI as their first presentation of coronary artery disease continue to exhibit reduced LVEF at 12-months. Anterior wall myocardial infarction and pain-to-balloon time exceeding 2 h remain independent predictors of left ventricular dysfunction. Further improvements in healthcare systems and public education are essential to reduce treatment delays and improve long-term outcomes.

Project description:To assess drug-induced pro-arrhythmic risk, especially Torsades de Pointe (TdP), new models have been proposed, such as in-silico modeling of ventricular action potential (AP) and stem cell-derived cardiomyocytes (SC-CMs). Previously we evaluated the electrophysiological profile of 15 reference drugs in hESC-CMs and hiPSC-CMs for their effects on intracellular AP and extracellular field potential, respectively. Our findings indicated that SC-CMs exhibited immature phenotype and had the propensity to generate false positives in predicting TdP risk. To expand our knowledge with mature human cardiac tissues for drug-induced pro-arrhythmic risk assessment, human ventricular trabeculae (hVT) from ethically consented organ donors were used to evaluate the effects of the same 15 drugs (8 torsadogenic, 5 non-torsadogenic, and 2 discovery molecules) on AP parameters at 1 and 2 Hz. Each drug was tested blindly with 4 concentrations in duplicate trabeculae from 2 hearts. To identify the pro-arrhythmic risk of each drug, a pro-arrhythmic score was calculated as the weighted sum of percent drug-induced changes compared to baseline in various AP parameters, including AP duration and recognized pro-arrhythmia predictors such as triangulation, beat-to-beat variability and incidence of early-afterdepolarizations, at each concentration. In addition, to understand the translation of this preclinical hVT AP-based model to clinical studies, a ratio that relates each testing concentration to the human therapeutic unbound Cmax (Cmax) was calculated. At a ratio of 10, for the 8 torsadogenic drugs, 7 were correctly identified by the pro-arrhythmic score; 1 was mislabeled. For the 5 non-torsadogenic drugs, 4 were correctly identified as safe; 1 was mislabeled. Calculation of sensitivity, specificity, positive predictive value, and negative predictive value indicated excellent performance. For example, at a ratio of 10, scores for sensitivity, specificity, positive predictive value and negative predictive values were 0.88, 0.8, 0.88 and 0.8, respectively. Thus, the hVT AP-based model combined with the integrated analysis of pro-arrhythmic score can differentiate between torsadogenic and non-torsadogenic drugs, and has a greater predictive performance when compared to human SC-CM models.

Dataset Information

Fractal analysis of left ventricular trabeculae in post-STEMI: from acute to chronic phase.

Purpose

Methods

Results

Conclusion

Critical relevance statement

Key points

Publications

Fractal analysis of left ventricular trabeculae in post-STEMI: from acute to chronic phase.

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