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Abstract Background The aim of the present study was to compare circulating levels of selected prothrombotic markers in patients suffering acute myocardial infarction (AMI) with and without left ventricular (LV) thrombus. Methods One hundred patients with AMI treated with PCI on the LAD and dual antiplatelet therapy were included. LV thrombus formation was detected by echocardiography and/or MRI in 15 patients. Fasting blood samples were drawn 4–5 days (baseline), 6–7 days, 8–9 days, 2–3 weeks and 3 months after the AMI for determination of haemostatic markers. Results We found higher levels of soluble tissue factor (TF) and D-dimer in the LV thrombus group 4–5 days, 8–9 days and 3 months (only TF) after the AMI compared to the patients without thrombus formation (p The levels of prothrombin fragment 1+2 (F1+2) and endogenous thrombin potential (ETP) were significantly lower in the thrombus group after 8–9 days (only ETP), 2–3 weeks and 3 months. The levels of plasminogen activator inhibitor 1 activity and tissue plasminogen activator antigen did not differ between the groups. Conclusion In the acute phase of AMI, we found higher levels of TF and D-dimer in the LV thrombus group, indicating hypercoagulability of possible importance for the generation of mural thrombus. Lower levels of F1+2, ETP and D-dimer in the thrombus group late during follow-up are probably induced by the initiated anticoagulation therapy.

Abstract Background Trials have brought diverse results of bone marrow stem cell treatment in necrotic myocardium. This substudy from the Autologous Stem Cell Transplantation in Acute Myocardial Infarction trial (ASTAMI) explored global and regional myocardial function after intracoronary injection of autologous mononuclear bone marrow cells (mBMC) in acute anterior wall myocardial infarction treated with percutaneous coronary intervention. Methods Cardiovascular magnetic resonance (CMR) tagging was performed 2-3 weeks and 6 months after revascularization in 15 patients treated with intracoronary stem cell injection (mBMC group) and in 13 controls without sham injection. Global and regional left ventricular (LV) strain and LV twist were correlated to cine CMR and late gadolinium enhancement (LGE). Results In the control group myocardial function as measured by strain improved for the global LV (6 months: -13.1 ± 2.4 versus 2-3 weeks: -11.9 ± 3.4%, p = 0.014) and for the infarct zone (-11.8 ± 3.0 versus -9.3 ± 4.1%, p = 0.001), and significantly more than in the mBMC group (inter-group p = 0.027 for global strain, respectively p = 0.009 for infarct zone strain). LV infarct mass decreased (35.7 ± 20.4 versus 45.7 ± 29.5 g, p = 0.024), also significantly more pronounced than the mBMC group (inter-group p = 0.034). LV twist was initially low and remained unchanged irrespective of therapy. Conclusions LGE and strain findings quite similarly demonstrate subtle differences between the mBMC and control groups. Intracoronary injection of autologous mBMC did not strengthen regional or global myocardial function in this substudy. Trial registration ClinicalTrials.gov: NCT00199823

Background: Trials have brought diverse results of bone marrow stem cell treatment in necrotic myocardium. This substudy from the Autologous Stem Cell Transplantation in Acute Myocardial Infarction trial (ASTAMI) explored global and regional myocardial function after intracoronary injection of autologous mononuclear bone marrow cells (mBMC) in acute anterior wall myocardial infarction treated with percutaneous coronary intervention. Methods: Cardiovascular magnetic resonance (CMR) tagging was performed 2-3 weeks and 6 months after revascularization in 15 patients treated with intracoronary stem cell injection (mBMC group) and in 13 controls without sham injection. Global and regional left ventricular (LV) strain and LV twist were correlated to cine CMR and late gadolinium enhancement (LGE). Results: In the control group myocardial function as measured by strain improved for the global LV (6 months: -13.1 ± 2.4 versus 2-3 weeks: -11.9 ± 3.4%, p = 0.014) and for the infarct zone (-11.8 ± 3.0 versus -9.3 ± 4.1%, p = 0.001), and significantly more than in the mBMC group (inter-group p = 0.027 for global strain, respectively p = 0.009 for infarct zone strain). LV infarct mass decreased (35.7 ± 20.4 versus 45.7 ± 29.5 g, p = 0.024), also significantly more pronounced than the mBMC group (inter-group p = 0.034). LV twist was initially low and remained unchanged irrespective of therapy. Conclusions: LGE and strain findings quite similarly demonstrate subtle differences between the mBMC and control groups. Intracoronary injection of autologous mBMC did not strengthen regional or global myocardial function in this substudy. [ABSTRACT FROM AUTHOR]

Objectives. To examine the influence of intracoronary autologous bone marrow cell transplantation after acute myocardial infarction on circulating growth factors and their relationship to left ventricular function. Methods. Circulating insulin-like growth factor-1 (IGF-1), hepatocyte growth factor (HGF), stromal derived factor-1-alpha (SDF-1α), and transforming growth factor beta (TGF-β) were measured in patients randomized to cell treatment or control, in the ASTAMI study. Autologous cells were injected intracoronary on day 6; blood was sampled on days 5, 9, and at three months. Left ventricular ejection fraction was recorded by electrocardiogram-gated single photon emission computed tomography at six months. Results. Only change in IGF-1 from baseline to three months differed between groups (p=0.024). A weak but significant correlation was found between left ventricular ejection fraction and the averaged IGF-1 concentrations of all patients (r=0.24, p=0.02). Patients with IGF-1 above or below median (102 ng/ml) had a left ventricular ejection fraction of 52.3% (±11.4) versus 46.4% (±12.2) respectively (p=0.017). Conclusions. Intracoronary bone marrow cell treatment after myocardial infarction attenuates a reduction in circulating IGF-1. IGF-1 levels over time were weakly, but significantly correlated to left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

Intracoronary transplantation of different cell populations has been used in acute myocardial infarction (AMI) with promising results. The primary objective of the Autologous Stem cell Transplantation in Acute Myocardial Infarction (ASTAMI) study is to test whether intracoronary transplantation of autologous mononuclear bone marrow cells (mBMC) improves left ventricular ejection fraction (LVEF) after anterior wall AMI. The ASTAMI study is a randomized, controlled, prospective study. One hundred patients with acute anterior wall ST-elevation myocardial infarction (STEMI) treated with acute percutaneous coronary intervention (PCI) are randomized in a 1:1 way to either intracoronary transplantation of autologous mBMC 5–8 d after PCI or to control. Left ventricular function, exercise capacity, biochemical status, functional class, quality of life and complications are validated at baseline and during a 12-month follow-up. By August 2004, out of 1004 patients with STEMI, 49 patients have been included in the study. Twenty-four patients have been randomized to intracoronary mBMC transplantation. Twenty patients had chest pain and 16 patients had ischemic ECG changes during the mBMC transplantation procedure. One patient had ventricular fibrillation 24?h after transplantation. Intracoronary transplantation of autologous mBMC in the acute phase after AMI is feasible and seems safe in the short term. [ABSTRACT FROM AUTHOR]

Univariate and multivariate statistical analyses were applied to 1200 consecutive patients undergoing first-time myocardial revascularization. Forty-three patients (3.6%) developed evidence of myocardial infarction as judged by serial electrocardiograms and release of enzymes. Out of 23 preoperative and intraoperative potential risk factors for perioperative myocardial infarction, multivariate regression analysis revealed that duration of aortic cross-clamping was a powerful continuous variable risk factor. The relative risk increased twofold at 44 minutes compared to 17 minutes, approached three times the risk at 53 minutes, and reached more than six times the risk after 84 minutes of aortic cross-clamping. Two other independent predictors for perioperative myocardial infarction were identified: the presence of preoperative arterial hypertension and significant (> 75%) left main coronary artery stenosis. Left ventricular impairment, gender, age, severity of angina, and the number of distal anastomoses were not identified as risk factors for perioperative myocardial infarction. Our data indicate that the incidence of perioperative myocardial infarction may be reduced by consistent efforts to minimize aortic cross-clamp time without compromising the adequacy of myocardial revascularization. [ABSTRACT FROM PUBLISHER]

A 15-year-old girl had had syncope induced by swallowing since infancy. An ECG recorded during food intake revealed SA block with very slow junctional and ventricular escape rhythms. No symptoms or signs of other cardiac disorders or gastrointestinal diseases were present. Activation of a strong vagal reflex, able to inhibit impulse formation and propagation in an otherwise normal heart, is the most likely explanation of the disorder in this patient. Furthermore, ECGs of her close relatives which were recorded during food intake as compared with the findings in a reference group (n = 20), indicated that a genetic factor could be involved. [ABSTRACT FROM AUTHOR]

Our study included eight patients with physiological pacemakers programmed to the VDD mode. The blood velocity in the aortic root was determined by Doppler echocardiography. Changes in the integral of maximum velocity reflect stroke volume changes. The Doppler probe was placed and held in the suprasternal position while programming the pacemakers from the VVI to all available AV delays in the VDD mode; the heart rates were nearly constant. Stroke volumes were highly dependent on changes of the AV delay; the optimum AV delay varied considerably from patient to patient. These changes were more pronounced in the patients with left ventricular strain due to aortic valve disease than in the patients with isolated conduction defects. [ABSTRACT FROM AUTHOR]

Monophasic action potentials were recorded in the outflow tract of the right ventricle in patients with coronary artery disease during ventricular pacing at different basic cycle lengths and programmed stimulation. During continuous pacing (basic cycle length 600 ms) the time for 90% repolarisation (MAP90) and the QTa interval decreased exponentially during the first 1.5-2 min of pacing to 90% of control values. The reproducibility of the monophasic action potential signals and the ventricular effective refractory period were assessed as good when studied after repetitive trains of 8 beats for more than 1.5 min. The reproducibility of conduction, however, was less good. Electrical restitution of MAP90 duration of the premature beats determined at three different basic cycle lengths was different from that in single muscle preparations. The curves showed two phases with unchanged MAP90 durations despite longer coupling intervals. The first phase was close to the ventricular effective refractory period, probably because subnormal conduction left the diastolic interval constant for the earliest premature beats. This indicates that subnormal conduction may influence the premature dispersion of repolarisation. [ABSTRACT FROM PUBLISHER]

Presents the results of a case study on operation for coarctation of the aorta among patients in Norway from 1948 through 1973. Complications derived from the operation, including paresis of the lower limbs; Causes of late death in patients operated on for coarctation of the aorta; Associated cardiovascular diseases at postoperative operation.

From 1948 to 1973, 356 patients with coarctation of the aorta were operated on. The dominating symptoms were dyspnea and increased fatigue. The mean systolic blood pressures in the arm in patients aged 12 years or less and in patients more than 12 years were 150 mm Hg and 185 mm Hg respectively. The femoral pulse could not be palpated in 43%, and it was decreased in the remainder. The foot pulse was absent in 86%. The usual surgical technique was resection of the stenotic segment and end-to-end anastomosis of the aorta. Eleven patients died within 30 days after surgery (3.1%); 10 of them were infants less than 5 months old who had associated cardiovascular anomalies. Four patients have been reoperated on for coarctation 4 to 17 years after the initial resection. The follow-up study, which will be published later, has revealed residual coarctation or recoarctation in some further patients. In a few, reoperation will be recommended. [ABSTRACT FROM AUTHOR]

In Norway, highly specialized medicine has been under governmental steering since 1991. The Social and Health Department decides at which hospitals certain medical functions should be offered. In the field of cardiovascular medicine this has been experienced as mainly positive. The quality of the work has improved, and cooperation between hospitals has been stimulated. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown improvement in left ventricular function after intracoronary injection of autologous cells derived from bone marrow (BMC) in the acute phase of myocardial infarction. We designed a randomized, controlled trial to further investigate the effects of this treatment. Methods: Patients with acute ST-elevation myocardial infarction of the anterior wall treated with percutaneous coronary intervention were randomly assigned to the group that underwent intracoronary injection of autologous mononuclear BMC or to the control group, in which neither aspiration nor sham injection was performed. Left ventricular function was assessed with the use of electrocardiogram-gated single-photon-emission computed tomography (SPECT) and echocardiography at baseline and magnetic resonance imaging (MRI) 2 to 3 weeks after the infarction. These procedures were repeated 6 months after the infarction. End points were changes in the left ventricular ejection fraction (LVEF), end-diastolic volume, and infarct size. Results: Of the 50 patients assigned to treatment with mononuclear BMC, 47 underwent intracoronary injection of the cells at a median of 6 days after myocardial infarction. There were 50 patients in the control group. The mean (±SD) change in LVEF, measured with the use of SPECT, between baseline and 6 months after infarction for all patients was 7.6±10.4 percentage points. The effect of BMC treatment on the change in LVEF was an increase of 0.6 percentage point (95% confidence interval [CI], −3.4 to 4.6; P=0.77) on SPECT, an increase of 0.6 percentage point (95% CI, −2.6 to 3.8; P=0.70) on echocardiography, and a decrease of 3.0 percentage points (95% CI, 0.1 to −6.1; P=0.054) on MRI. The two groups did not differ significantly in changes in left ventricular end-diastolic volume or infarct size and had similar rates of adverse events. Conclusions: With the methods used, we found no effects of intracoronary injection of autologous mononuclear BMC on global left ventricular function. (ClinicalTrials.gov number, NCT00199823.) N Engl J Med 2006;355:1199-209. [ABSTRACT FROM AUTHOR]