BACKGROUND: Assessments of compromised myocardium and infarct size early after thrombolytic treatment in acute myocardial infarction (AMI) are important for risk stratification and for treatment management. We have therefore evaluated the clinical usefulness of myocardial perfusion scintigraphy (MIBI-SPECT) for the assessment of myocardial viability early after AMI. METHODS: Seventy-one patients [53 men and 18 women, aged 64 +/- 9 years (range 45-75 years)] with AMI treated by thrombolysis took part in this prospective study at University Hospital, Stockholm, Sweden. Sixty of them underwent adenosine-stress and resting MIBI-SPECT 2-4 days after AMI, and 11 were examined only at rest. Six months after the AMI, a repeat MIBI-SPECT at rest was obtained for comparison. RESULTS: All patients had significant perfusion defects compared with an age- and sex-matched healthy reference population. Seventy-six percent of the patients able to undergo a complete adenosine-stress and rest SPECT showed signs of reversible perfusion defects. Defect size (extent) and severity at rest decreased between the tests at 2-5 days and 6 months after AMI (P
Elevated serum free pregnancy-associated plasma protein-A independently predicts mortality in haemodialysis patients but is not associated with recurrent haemodialysis-induced ischaemic myocardial injury.
Pregnancy-associated plasma protein-A (PAPP-A) is a putative marker of atheroma instability and ischaemic myocardial stress prior to necrosis. Total PAPP-A (tPAPP-A) levels in acute coronary syndromes predict adverse outcomes. However, free PAPP-A (fPAPP-A) predominates in the circulation. Ischaemic haemodialysis (HD)-induced cardiac injury (myocardial stunning) is common and is associated with markers of myocardial necrosis, inflammation, cardiovascular events and mortality. Coronary plaque instability in pathophysiology of HD-induced myocardial stunning has not been studied. We aimed to investigate the relationship of fPAPP-A with stunning and mortality.
130 prevalent patients from two HD centres (Finland and UK) were studied. Pre-HD free, complexed and total PAPP-A were measured by immunoassay. A subset of 62 patients underwent echocardiography to assess HD-induced myocardial stunning. The mean duration of follow-up was 407 ± 98 days.
fPAPP-A was elevated (median: 3.45 mIU/l) and correlated with dialysis vintage (r = 0.391, p
In vivo or in vitro administration of a omega 1 receptor agonist d-SKF 10,047 (1 mg/kg intravenously or 10 mg/l in vitro) promoted an increase in the resistance of isolated perfused rat heart to ischemia/reperfusion injury. Both in vivo and in vitro stimulation of omega receptors prevents development of reperfusion contracture and release of creatine kinase and increases the developed pressure, double product, +dP/dt, and -dP/dt in the left ventricle. Activation of omega receptors has no significant effect on the occurrence of reperfusion arrhythmias ex vivo. Stimulation of cardiac sigma receptors is proposed to prevent myocardial stunning.