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. 2015 Dec 30;10(12):e0145495.
doi: 10.1371/journal.pone.0145495. eCollection 2015.

Impact of Heart Rate on Myocardial Salvage in Timely Reperfused Patients with ST-Segment Elevation Myocardial Infarction: New Insights from Cardiovascular Magnetic Resonance

Luca Arcari  1 , Sara Cimino  1 , Laura De Luca  1 , Marco Francone  2 , Nicola Galea  2 , Manuela Reali  1 , Iacopo Carbone  2 , Carlo Iacoboni  1 , Luciano Agati  1
Affiliations

Impact of Heart Rate on Myocardial Salvage in Timely Reperfused Patients with ST-Segment Elevation Myocardial Infarction: New Insights from Cardiovascular Magnetic Resonance

Luca Arcari et al. PLoS One. .

Abstract

Background: Previous studies evaluating the progression of the necrotic wave in relation to heart rate were carried out only in animal models of ST-elevated myocardial infarction (STEMI). Aim of the study was to investigate changes of myocardial salvage in relation to different heart rates at hospital admission in timely reperfused patients with STEMI by using cardiovascular magnetic resonance (CMR).

Methods: One hundred-eighty-seven patients with STEMI successfully and timely treated with primary coronary angioplasty underwent CMR five days after hospital admission. According to the heart rate at presentation, patients were subcategorized into 5 quintiles: <55 bpm (group I, n = 44), 55-64 bpm (group II, n = 35), 65-74 bpm (group III, n = 35), 75-84 bpm (group IV, n = 37), ≥85 bpm (group V, n = 36). Area at risk, infarct size, microvascular obstruction (MVO) and myocardium salvaged index (MSI) were assessed by CMR using standard sequences.

Results: Lower heart rates at presentation were associated with a bigger amount of myocardial salvage after reperfusion. MSI progressively decreased as the heart rates increased (0.54 group I, 0.46 group II, 0.38 group III, 0.34 group IV, 0.32 group V, p<0.001). Stepwise multivariable analysis showed heart rate, peak troponin and the presence of MVO were independent predictor of myocardial salvage. No changes related to heart rate were observed in relation to area at risk and infarct size.

Conclusions: High heart rates registered before performing coronary angioplasty in timely reperfused patients with STEMI are associated with a reduction in salvaged myocardium. In particular, salvaged myocardium significantly reduced when heart rate at presentation is ≥85 bpm.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Bar graphs showing the influence of heart rate on myocardial salvage (A), area at risk (B) and infarct size (C) in patients categorized in quintiles according to heart rate at hospital admission (details in the text).
See this image and copyright information in PMC

References

    1. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs. duration of coronary occlusion in dogs. Circulation 1977;56:786–94. - PubMed
    1. Masci PG, Ganame J, Strata E, Desmet W, Aquaro GD, Dymarkowski S, et al. Myocardial salvage by CMR correlates with LV remodeling and early ST-segment resolution in acute myocardial infarction. J Am Coll Card Cardiovasc Imaging 2010;3:45–51. - PubMed
    1. Eitel I, Desch S, de Waha S, Fuernau G, Gutberlet M, Schuler G, et al. Long-term prognostic value of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction. Heart 2011;97:2038–45. 10.1136/heartjnl-2011-300098 - DOI - PubMed
    1. Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross J Jr, et al. Factors Influencing Infarct Size Following Experimental Coronary Artery Occlusions. Circulation 1971;43:67–82. - PubMed
    1. Przyklenk K, Vivaldi MT, Schoen FJ, Malcolm J, Arnold O, Kloner RA. Salvage of Ischaemic myocardium by reperfusion: importance of collateral blood flow and myocardial oxygen demand during occlusion. Cardiovascular Research 1986;20:403–414. - PubMed