PMID- 19775428
OWN - NLM
STAT- MEDLINE
DCOM- 20091202
LR  - 20240117
IS  - 1532-429X (Electronic)
IS  - 1097-6647 (Print)
IS  - 1097-6647 (Linking)
VI  - 11
IP  - 1
DP  - 2009 Sep 23
TI  - Infarct evolution in man studied in patients with first-time coronary occlusion 
      in comparison to different species - implications for assessment of myocardial 
      salvage.
PG  - 38
LID - 10.1186/1532-429X-11-38 [doi]
AB  - BACKGROUND: The time course of infarct evolution, i.e. how fast myocardial 
      infarction (MI) develops during coronary artery occlusion, is well known for 
      several species, whereas no direct evidence exists on the evolution of MI size 
      normalized to myocardium at risk (MaR) in man. Despite the lack of direct 
      evidence, current literature often refers to the "golden hour" as the time during 
      which myocardial salvage can be accomplished by reperfusion therapy. Therefore, 
      the aim of the present study was to investigate how duration of myocardial 
      ischemia affects infarct evolution in man in relation to previous animal data. 
      Consecutive patients with clinical signs of acute myocardial ischemia were 
      screened and considered for enrollment. Particular care was taken to assure 
      uniformity of the patients enrolled with regard to old MI, success of 
      revascularization, collateral flow, release of biochemical markers prior to 
      intervention etc. Sixteen patients were ultimately included in the study. 
      Myocardium at risk was assessed acutely by acute myocardial perfusion single 
      photon emission computed tomography (MPS) and by T2 imaging (T2-STIR) 
      cardiovascular magnetic resonance (CMR) after one week in 10 of the 16 patients. 
      Infarct size was measured by late gadolinium enhancement (LGE) at one week. 
      RESULTS: The time to reach 50% MI of the MaR (T50) was significantly shorter in 
      pigs (37 min), rats (41 min) and dogs (181 min) compared to humans (288 min). 
      There was no significant difference in T50 when using MPS compared to T2-STIR (p 
      = 0.53) for assessment of MaR (288 +/- 23 min vs 310 +/- 22 min, T50 +/- standard 
      error). The transmural extent of MI increased progressively as the duration of 
      ischemia increased (R2 = 0.56, p < 0.001). CONCLUSION: This is the first study to 
      provide direct evidence of the time course of acute myocardial infarct evolution 
      in relation to MaR in man with first-time MI. Infarct evolution in man is 
      significantly slower than in pigs, rats and dogs. Furthermore, infarct evolution 
      assessments in man are similar when using MPS acutely and T2-STIR one week later 
      for determination of MaR, which significantly facilitates future clinical trials 
      of cardioprotective therapies in acute coronary syndrome by the use of CMR.
FAU - Hedstrom, Erik
AU  - Hedstrom E
AD  - Department of Clinical Physiology, Lund University Hospital, SE-221 85 Lund, 
      Sweden. erik.hedstrom@med.lu.se
FAU - Engblom, Henrik
AU  - Engblom H
FAU - Frogner, Fredrik
AU  - Frogner F
FAU - Astrom-Olsson, Karin
AU  - Astrom-Olsson K
FAU - Ohlin, Hans
AU  - Ohlin H
FAU - Jovinge, Stefan
AU  - Jovinge S
FAU - Arheden, Hakan
AU  - Arheden H
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20090923
PL  - England
TA  - J Cardiovasc Magn Reson
JT  - Journal of cardiovascular magnetic resonance : official journal of the Society 
      for Cardiovascular Magnetic Resonance
JID - 9815616
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Animals
MH  - Coronary Occlusion/*complications/diagnosis/therapy
MH  - Disease Models, Animal
MH  - Disease Progression
MH  - Dogs
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*etiology/therapy
MH  - Myocardial Perfusion Imaging/methods
MH  - Myocardial Reperfusion
MH  - Myocardial Revascularization
MH  - Myocardium/*pathology
MH  - Rats
MH  - Species Specificity
MH  - Swine
MH  - Time Factors
MH  - Tomography, Emission-Computed, Single-Photon
PMC - PMC2758877
EDAT- 2009/09/25 06:00
MHDA- 2009/12/16 06:00
PMCR- 2009/09/23
CRDT- 2009/09/25 06:00
PHST- 2009/05/13 00:00 [received]
PHST- 2009/09/23 00:00 [accepted]
PHST- 2009/09/25 06:00 [entrez]
PHST- 2009/09/25 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
PHST- 2009/09/23 00:00 [pmc-release]
AID - S1097-6647(23)00519-7 [pii]
AID - 1532-429X-11-38 [pii]
AID - 10.1186/1532-429X-11-38 [doi]
PST - epublish
SO  - J Cardiovasc Magn Reson. 2009 Sep 23;11(1):38. doi: 10.1186/1532-429X-11-38.