Technetium pyrophosphate scanning in the detection of acute myocardial infarction: clinical experience.

Technetium-99m-stannous pyrophosphate (99mTc-PYP) accumulates in acutely infarcted myocardium and can be detected by scintiscanning. The clinical value of 99mTc-PYP scintiscanning was studied in 83 patients 6 hours to 21 days after the onset of acute chest pain. In 12 patients with normal electrocardiograms and serum enzyme values no uptake of 99mTc-PYP was detected on the scintigrams. Of 44 patients with electrocardiographic or enzyme evidence, or both, of acute myocardial infarction the scintigrams were positive in 31, "questionable" in 2 and negative in 11; no positive scan was obtained within 12 hours of the onset of pain, and the scans generally remained positive for up to 5 days. In 24 patients with evidence of prolonged myocardial ischemia the scans were positive in 2, questionable in 4 and negative in 18. The scans were negative in each of three patients with acute or constrictive pericarditis. Localization by electrocardiography and scintiscanning correlated nearly perfectly for transmural infarcts but subendocardial infarcts could not always be localized precisely by scintiscanning. The infarct area (total area of 99mTc-PYP uptake) correlated well with the peak serum value of creatine phosphokinase.     

Lactic dehydrogenase isozyme patterns and alpha-hydroxybutyrate dehydrogenase activities in serum from newborns, patients with ovarian cancer or myocardial infarction

Lactic dehydrogenase (LDH) and alpha-hydroxybutyrate dehydrogenase (HBD) and LDH isozyme patterns were studied in serum from newborns and patients with ovarian cancer or myocardial infarction. LDH and HBD activities from newborns and patients with ovarian cancer or myocardial infarction were significantly increased, compared with those from patients with benign ovarian tumor. These increases were accompanied with a decrease of LDH-H and an increase of LDH-M in serum from newborns and patients with ovarian cancer, while an increase of LDH-H in serum from patients with myocardial infarction was dominant. However, the raised HBD activities in serum from patients with benign ovarian tumor did not affect the LDH isozyme patterns. From analysis of linear regression, a negative correlation between LDH-1 or -2 and HBD activity in serum from patients with ovarian cancer was observed while there was a positive correlation between LDH-4 and HBD activity. Similar patterns in serum from newborns were observed. On the other hand, a positive correlation between LDH-1 and HBD activity and a negative correlation between LDH-4 and HBD activity were found in serum from patients with myocardial infarction.     

心肌酶和红细胞形态学参数与心肌梗死的相关性研究

目的:研究红细胞形态学参数对心肌梗死患者诊断作用及其与心肌酶谱的相关性。方法:选取40例心肌梗死患者,40例稳定型心绞痛组患者,40例健康对照组人群。对比分析稳定性心绞痛、急性心肌梗死(入院1h内)和对照组红细胞形态学参数(MCV、MCH、MCHC、RDW)、及心肌酶谱(CK-MB、c Tn I)。分析心肌梗死不同时间MCV、MCH、MCHC、RDW变化趋势。结果:稳定性心绞痛、心肌梗死组1 h内MCV、RDW明显高于正常对照组,差异有统计学意义(P0.05);稳定性心绞痛、心肌梗死组1 h内MCHC、MCH低于对照组,差异有统计学意义(P0.05)。心肌梗死组MCV、RDW在发病后1 h、24 h、48 h、7 d水平逐渐升高,各时间点间差异有统计学意义(P0.05)。心肌梗死组发病后1 h、24 h、48 h、7 d、14 d MCHC、MCH水平逐渐降低,各时间点间差异有统计学意义(P0.05)。RDW和CK-MB、c Tn I呈正相关性(P0.05)。RDW对心肌梗死诊断的灵敏度最高达到93.4%,特异度为69.7%,RDW对急性心肌梗塞的诊断临界值为14.04%。结论:RDW对心肌梗死的诊断具有较高的敏感性,可用于临床早期诊断心肌梗死,为临床诊断提供一新的诊断标准。     

Coronary artery thrombosis and elevated urine immunoreactive thromboxane B2

Immunoreactive thromboxane B2 (i-TXB2) was measured by radio-immunoassay (RIA) in urines collected over eight hours on the day of admission in 25 patients who were admitted with the diagnosis of myocardial infarction. In 16 of the patients myocardial infarction was confirmed by ECG and plasma enzymes. Another patient presented with pulmonary embolism and the remaining eight patients had angina pectoris. A further eight hour urine collection was obtained 24 hours later from eleven of the sixteen patients with myocardial infarction. In these eleven patients myocardial infarction was associated with five fold higher urine i-TXB2 (2.72 +/- 0.48 ng/ml) at the day of admission when compared to patients admitted under the same diagnosis but found to have angina only (0.51 +/- 0.08 ng/ml, p less than 0.001). In patients with myocardial infarction the urine i-TXB2 values were reduced 24 hours later (1.58 +/- 0.27 ng/ml, p less than 0.01). One patient was followed with urine i-TXB2 from three days prior to diagnosis of myocardial infarction and to one day prior to a second infarction. In this patient i-TXB2 was highest three days prior to infarction. We conclude that this early elevation of urine i-TXB2 three days prior to diagnosis of infarction and the increased i-TXB2 in patients with myocardial infarction when compared to patients with angina suggest thromboxane is probably released from activated platelets prior to infarction. We suggest that urine i-TXB2 may be of value in the differential diagnosis between myocardial infarction and angina.     

Internal synchronization of the main 0.1-Hz rhythms in the autonomic control of the cardiovascular system

Synchronization parameters of 0.1-Hz rhythms isolated from the heart rate and the oscillations of the blood volume in microcirculatory vessels were studied in 12 healthy subjects and 32 patients with acute myocardial infarction. Recordings of the electrocardiogram and the pulsogram from the distal phalanx of the index finger, as well as mechanical recording of respiration with the body in a horizontal position, were performed. In patients with myocardial infarction, the recordings were performed during the first three to five days and the third week after the infarction. Synchronization was tested by plotting phase differences and calculating the total percentage of phase synchronization. Synchronization parameters of 0.1-Hz rhythms were high in healthy subjects. In patients with acute myocardial infarction, synchronization of 0.1-Hz rhythms was considerably poorer. The data obtained suggest that the studied 0.1-Hz rhythms are two independent oscillatory processes that are synchronized in healthy subjects. However, this interaction may be disturbed in cardiovascular pathologies, e.g., myocardial infarction.     

Attitude to work of patients after myocardial infarction, not accepting medical recommendations

The study aimed at determining the influence of non-acceptation of diagnosis and physicians recommendations on job attitude in survivors after myocardial infarction. Sixty men after the acute myocardial infarction have been examined with Attitude to Illness Questionnaire by Wrze?niewski and with the questionnaire on the information on job attitude. The obtained results have lead to a conclusion, that patients after myocardial infarction--who dies not accept the diagnosis and physicians recommendations--have less adequate information on the illness and rarely expect help. Moreover, the patients show greater occupational satisfaction, high motivation and more positive relation to the personnel and job circumstances.     

Coronary artery thrombosis and evaluated urine immunoreactive thromboxane B2

Immunoreactive thromboxane B₂ (i-TXB₂) was measured by radio-immunoassay (RIA) in urine collective over eight hours on the day of admission in 25 patients who were admitted with the diagnosis of myocardial infarction. In 16 of the patients myocardial infarction was confirmed by ECG and plasma enzymes. Another patient presented with pulmonary embolism and the remaining eight patients had angina pectoris. A further eight hour urine collection was obtained 24 hours later from eleven of the sixteen patients with myocardial infarction. In these eleven patients myocardial infarction was associated with five fold higher urine i-TXB₂ (2.72 ± 0.48 ng/ml) at the day of admission when compared to patients admitted under the same diagnosis but found to have angina only (0.51 ± 0.08 ng/ml, p < 0.001). In patients with myocardial infarction the urine i-TXB₂ values were reduced 24 hours later (1.58 ± 0.27 ng/ml, p < 0.01). One patient was followed with urine i-TXB₂ from three days prior to diagnosis of myocardial infarction and to one day prior to a second infarction. In this patient i-TXB₂ was highest three days prior to infarction. We conclude that this early elevation of urine i-TXB₂ three days prior to diagnosis of infarction and the increased i-TXB₂ in patients with myocardial infarction when compared to patients with angina suggest thromboxane is probably released from activated platelets prior to infarction. We suggest that urine i-TXB₂ may be of value in the differential diagnosis between myocardial infarction and angina.     

Long-term spectral analysis of heart rate variability — An algorithm based on segmental frequency distributions of beat-to-beat intervals

Reduced heart rate variability has been reported as a predictor of long-term mortality in recent myocardial infarction patients. However, it has not been systematically investigated whether the reduction in heart rate variability in those post myocardial infarction patients who later suffer death or severe arrhythmias is caused by a reduction of short-term variability of heart rate (such as respiratory arrhythmia) or whether the differences in long term variability (such as diurnal rhythm) are involved. In order to perform such an evaluation, a new algorithm has been developed which permits different wavelength components (including the long-term components due to diurnal rhythm) of heart rate variability to be approximated. In general, the method uses segmental frequency distributions of durations of intervals between successive normal cardiac beats. To assess the spectral components of heart rate variability, a scale of wavelength limits is used and for each limit of this scale, the algorithm excludes the rate changes of wavelength longer than the given bound. The method was applied to the analysis of electrocardiograms recorded in 14 post myocardial infarction patients who later suffered death or ventricular tachycardia, and in 14 other randomly selected patients with an uncomplicated course following acute myocardial infarction. The rate variability spectra obtained for both groups of patients were compared statistically and the results showed that the groups of positive and negative cases were most significantly distinguished when including both short- and long-term components of heart rate variability. Separate evaluation of different wavelength components showed that the very long-term components of heart rate variability were more powerful in distinguishing between positive and negative cases than the short term components.     

Thrombolytic therapy with ultra-high doses of streptokinase

Two pilot studies were carried out in patients suffering from acute myocardial infarction. They received high doses of streptokinase and acylated streptokinase-plasminogen activator complex intravenously as a bolus injection. Furthermore, the possibility of using streptokinase bolus therapy was examined in patients with acute vascular occlusion. Due to the limited number and the heterogenicity of cases the results obtained in patients with acute myocardial infarction are to evaluate with some reservation. In patients with acute vascular occlusion streptokinase bolus therapy at high doses proved to be a promising alternative to the conventional therapy.     

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort study

ObjectiveTo assess the clinical efficacy and accuracy of an emergency department based six hour rule-out protocol for myocardial damage.DesignDiagnostic cohort study.SettingEmergency department of an inner city university hospital.Participants383 consecutive patients aged over 25 years with chest pain of less than 12 hours'' duration who were at low to moderate risk of acute myocardial infarction.InterventionSerial measurements of creatine kinase MB mass and continuous ST segment monitoring for six hours with 12 leads.ResultsOutcome of the gold standard test was available for 292 patients. On the diagnostic test for the protocol, 53 patients had positive results and 239 patients had negative results. There were 18 false positive results and one false negative result. Sensitivity was 97.2% (95% confidence interval 95.0% to 99.0%), specificity 93.0% (90.0% to 96.0%), the negative predictive value 99.6%, and the positive predictive value 66.0%. The positive likelihood ratio was 13.9 and the negative likelihood ratio 0.03.ConclusionsThe six hour rule-out protocol for myocardial infarction is accurate and efficacious. It can be used in patients presenting to emergency departments with chest pain indicating a low to moderate risk of myocardial infarction.

What is already known on this topic

Many patients with chest pain in emergency departments indicating a low to moderate risk of myocardial infarction are admitted to rule out myocardial damageSome 6% of those discharged have undiagnosed myocardial damage

What this study adds

An emergency department based chest pain assessment unit protocol to rule out myocardial damage is sensitive enough to allow safe discharge of patients at low to moderate risk of myocardial infarction within six hoursSuch units can also reduce the number of patients admitted unnecessarily     

CK-MBmass, hs-cTnT及CK-MB与急性心肌梗死的相关性及其联合诊断价值

摘要 目的：研究肌酸激酶同工酶质量（CK-MBmass)、肌酸激酶同工酶（CK-MB）和高敏心肌肌钙蛋白T（hs-cTnT）在急性心肌梗死患者（AMI）血清中的含量,并探讨三者联合对AMIDE诊断价值。方法：选择2018年1月到2021年10月我院收治的AMI患者90例作为研究组,并选择同期在我院体检健康志愿者40例作为对照组,比较两组AMI患者血清CK-MBmass,hs-cTnT和CK-MB。根据Killp分级法将不同心力衰竭将AMI患者分为II、III和IV级,并根据心肌梗死范围将AMI患者分为轻度、中度和重度心肌梗死组。比较不同AMI患者血清CK-MBmass,hs-cTnT和CK-MB。通过受试者工作曲线计算血清CK-MBmass,hs-cTnT和CK-MB联合诊断AMI的阳性预测值、阴性预测值、敏感度和特异度。结果：（1）AMI患者血清CK-MBmass,hs-cTnT和CK-MB均显著高于健康志愿者（P<0.05）;（2）AMI患者血清CK-MBmass,hs-cTnT和CK-MB随Killp分级或心肌梗死范围升高而升高（P<0.05）;（3）AMI患者血清CK-MBmass,hs-cTnT,CK-MB与急性心肌梗死患者左室射血分数（LVEF）呈负相关（P<0.05）,与左室舒张末期容积（LVEDd）和梗死范围呈正相关（P<0.05）;（4）血清CK-MBmass,hs-cTnT和CK-MB联合检测急性心肌梗死的阳性预测值、阴性预测值、敏感度和特异度均高于单独诊断。结论：血清CK-MBmass,hs-cTnT和CK-MB在AMI患者含量升高,并且与患者心功能和心肌梗死范围有关,适用于AMI的联合诊断。     

The effect of insulin on the heart

Insulin infusion has been advocated in the treatment of myocardial ischaemia and myocardial infarction. There is evidence from experimental animal studies for a protective effect of high-dose insulin administration in myocardial ischaemia and myocardial infarction. In some relatively small study populations a reduction in mortality was reported in those patients who received glucose-insulin-potassium (GIK) during myocardial infarction, which was confirmed in two meta-analyses. However, it has not been possible to reproduce these positive results in large randomised clinical trials. (Neth Heart J 2010;18:255-9.)     

Post mortem detection of early myocardial infarction by determination of the tissue K+/Na+ ratio

The K+/Na+ ratio was determined in myocardial specimens obtained post mortem from a total of 90 patients. The ratio was 1.0 or higher 25 cases in which there was firm evidence against myocardial infarction, and 0.7, or less in 30 cases with grossly visible signs of myocardial narcosis. The remaining 35 cases were suspect of myocardial infarction on the grounds of either clinical observation or sudden death, without gross change. Out of these the K+/Na+ ratio was above 0.7 histological evidence of myocardial infarction was absent, but other changes accounting for death were present in 17 cases. In another 16 cases a K+/Na+ ratio of 0.7 or less was the sole indication of myocardial infarction, and any other change likely to be responsible for death was absent. In two further cases a false negative result was obtained for the K+/Na+ ratio, owing in all probability to some technical error. The findings suggest that determination of the myocardial K+/Na+ ratio is a great aid in detecting early myocardial infarction. The technique is not affected by post mortem autolysis, and is simple enough for routine use.     

Altered Gene Expression Pattern in Peripheral Blood Mononuclear Cells in Patients with Acute Myocardial Infarction

Background

Despite a substantial progress in diagnosis and therapy, acute myocardial infarction (MI) is a major cause of mortality in the general population. A novel insight into the pathophysiology of myocardial infarction obtained by studying gene expression should help to discover novel biomarkers of MI and to suggest novel strategies of therapy. The aim of our study was to establish gene expression patterns in leukocytes from acute myocardial infarction patients.

Methods and Results

Twenty-eight patients with ST-segment elevation myocardial infarction (STEMI) were included. The blood was collected on the 1^st day of myocardial infarction, after 4–6 days, and after 6 months. Control group comprised 14 patients with stable coronary artery disease, without history of myocardial infarction. Gene expression analysis was performed with Affymetrix Human Gene 1.0 ST microarrays and GCS3000 TG system. Lists of genes showing altered expression levels (fold change >1.5, p<0.05) were submitted to Ingenuity Pathway Analysis. Gene lists from each group were examined for canonical pathways and molecular and cellular functions. Comparing acute phase of MI with the same patients after 6 months (stable phase) and with control group we found 24 genes with changed expression. In canonical analysis three pathways were highlighted: signaling of PPAR (peroxisome proliferator-activated receptor), IL-10 and IL-6 (interleukin 10 and 6).

Conclusions

In the acute phase of STEMI, dozens of genes from several pathways linked with lipid/glucose metabolism, platelet function and atherosclerotic plaque stability show altered expression. Up-regulation of SOCS3 and FAM20 genes in the first days of myocardial infarction is observed in the vast majority of patients.     

H-FABP、cTnI及copeptin在老年急性非ST段抬高型心肌梗死患者早期诊断中的应用价值

目的:研究心肌型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)及和肽素(copeptin)在老年急性非ST段抬高型心肌梗死患者早期诊断中的应用价值。方法:选取2016年2月-2018年2月我院收治的老年急性非ST段抬高型心肌梗死患者60例为研究对象,记为观察组。另取同期于我院接受治疗的心绞痛患者50例记为对照组。分别比较患者H-FABP与cTnI阳性、阴性分布情况以及copeptin表达水平。绘制受试者工作特征曲线(ROC),分析H-FABP、cTnI、copeptin以及三项联合检测老年急性非ST段抬高型心肌梗死的早期诊断价值。结果:观察组患者H-FABP与cTnI阳性人数占比均高于对照组(P0.05)。观察组患者copeptin表达水平高于对照组(P0.05)。H-FABP、cTnI及copeptin等3个指标均具有一定的早期诊断价值,H-FABP+cTnI+copeptin联合检测的敏感度和特异度更高,分别为86.46%和87.15%。结论:老年急性非ST段抬高型心肌梗死患者H-FABP、cTnI、copeptin表达较高,联合检查上述三项指标水平可提高临床诊断价值。     

Erectile dysfunction after myocardial infarction--myth or a real problem?

Erectile dysfunction is a common problem whose relation to cardiovascular diseases has scientifically been proved, but it has not been studied sufficiently in patients recovering from myocardial infarction. The objective of this study was to establish the frequency of erectile dysfunction in patients recovering from myocardial infarction. We examined 89 patients (aged 30 to 75 years) included in the program of cardiac rehabilitation after myocardial infarction. The results were compared with 91 healthy examinees of the same age. Even 82% of the patients who recovered from myocardial infarction have problems with erectile dysfunction, compared to 42.9% of healthy examinees. The prevalence of erectile dysfunction increases with the age in both groups. In the group of patients recovering from myocardial infarction aged 30 do 39 years, the erectile dysfunction decreased after 6 months, while in other age subgroups and between controls, there were no significant changes in erectile dysfunction prevalence during the analysed time period. We concluded that erectile dysfunction is a significant problem in patients recovering from myocardial infarction. It should be recognized on time in order to provide a better life quality for the patient with a multidisciplinary approach.     

Myocardial Infarction: A Five-Year Follow-up of Patients

Patients with acute myocardial infarction (2,020) admitted to coronary care units (CCU) in Utah were studied for five years. Of these, 1,641 (81.4 percent) survived to leave the hospital. The male to female ratio was 3.5:1. At four months, one year and yearly thereafter from the date of admission to CCU, patients were mailed follow-up questionnaires. Cause of death was obtained from autopsy reports and death certificates. Patients were grouped yearly by the number of cardiac symptoms reported. Of patients discharged whose cases were followed, 925 (61.9 percent) were alive after five years. Reinfarction was the major cause of death in the hospital; however, during follow-up only 36.8 percent of deaths were attributable to myocardial infarction. At follow-up after a year, fewer cardiac symptoms were reported by patients who survived to the fifth year of follow-up than by patients who did not. Women were older and showed a higher death rate during follow-up. Increasing age was found to be a determining factor in long-term mortality after acute myocardial infarction.     

Psychological rehabilitation after myocardial infarction.

The value of psychological counselling in rehabilitating patients after myocardial infarction was assessed. A total of 143 men who had recently had a myocardial infarction were randomly allocated to either a group receiving intensive rehabilitation or a control group, their outcome being examined after six months. Patients with neurotic, introverted personalities had a poor outcome in the control group but a satisfactory outcome when rehabilitated. Neurotic personalities responded to help, and rehabilitative measures did not increase neurosis. In addition all patients with a negative attitude towards their illness and future had a poor outcome but those with a positive attitude did well. Selection by simple methods of patients who would benefit from psychological rehabilitation seems desirable.     

Trial of early nifedipine in acute myocardial infarction: the Trent study.

Over 30 months 9292 consecutive patients admitted to nine coronary care units with suspected myocardial infarction were considered for admission to a randomised double blind study comparing the effect on mortality of nifedipine 10 mg four times a day with that of placebo. Among the 4801 patients excluded from the study the overall one month fatality rate was 18.2% and the one month fatality rate in those with definite myocardial infarction 26.8%. A total of 4491 patients fulfilled the entry criteria and were randomly allocated to nifedipine or placebo immediately after assessment in the coronary care unit. Roughly 64% of patients in both treatment groups sustained an acute myocardial infarction. The overall one month fatality rates were 6.3% in the placebo treated group and 6.7% in the nifedipine treated group. Most of the deaths occurred in patients with an in hospital diagnosis of myocardial infarction, and their one month fatality rates were 9.3% for the placebo group and 10.2% for the nifedipine group. These differences were not statistically significant. Subgroup analysis also did not suggest any particular group of patients with suspected acute myocardial infarction who might benefit from early nifedipine treatment in the dose studied.     

急性心肌梗死患者肠道优势菌群分析

目的探讨急性心肌梗死患者肠道优势菌群的改变及其与疾病严重程度的关系。方法共筛选急性心肌梗死患者71名及正常健康体检者33名,急性心肌梗死患者根据是否心衰分为急性心肌梗死组36名和急性心肌梗死伴泵衰竭组35名,所有入选者收集大便及血清标本,分别采用qPCR及化学发光仪测定肠道优势菌群改变和血清脑钠肽前体及肌钙蛋白水平。结果急性心肌梗死患者肠道优势菌群显著改变,肠道肠杆菌以及肠球菌细菌数量较对照组显著增加,均与脑钠肽前体、肌钙蛋白、Killip分级显著正相关,而双歧杆菌、乳酸杆菌等细菌数量显著降低,与脑钠肽前体、肌钙蛋白、Killip分级显著负相关。结论急性心肌梗死患者呈现典型的肠道菌群紊乱,且与患者疾病严重程度相关。