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Clinical Trial
. 2024 Dec;119(6):911-921.
doi: 10.1007/s00395-024-01091-9. Epub 2024 Nov 23.

Effect of ventricular fibrillation on infarct size after myocardial infarction: a translational study

Affiliations
Clinical Trial

Effect of ventricular fibrillation on infarct size after myocardial infarction: a translational study

Neven Stevic et al. Basic Res Cardiol. 2024 Dec.

Abstract

Ventricular fibrillation (VF)-induced cardiac arrest frequently complicates ST-segment elevation myocardial infarction (STEMI). Although larger infarct sizes (IS) correlate with a higher risk of VF, the influence of VF itself on IS has remained poorly investigated. To address this knowledge gap, we analyzed the effect of VF on IS in patients and two experimental models. From a prospective cohort, 30 STEMI patients with VF were matched 1:2 with STEMI patients without VF on the common determinants of IS. The primary endpoint was IS, assessed using the 48-h area under the curve (AUC) for troponin. We also compared IS in pigs with/without spontaneous VF during STEMI (n = 15/group), and in an isolated rat heart model of myocardial infarction with/without electrically induced VF (n = 7/group). After matching, the patient characteristics, including the area at risk (AR), were similar. IS was 33% lower in the VF group compared to the control group (troponin AUC 1.6 [0.5-3.3] 106 arbitrary units vs. 2.4 [0.9-4.1] 106 arbitrary units; p < 0.05), but infarct scar size (assessed using MRI and ECG) did not differ between the groups at 1 and 6 months. In both experimental models, IS, expressed as a percentage of AR, was lower (p < 0.05) in the VF group than in the control group. When common determinants of IS are comparable, VF occurring prior to myocardial infarction reperfusion appears to be associated with smaller IS. Nevertheless, this finding, observed under specific experimental conditions and in a highly selected group of patients, was not associated with reduced infarct scar size.Registration (HIBISCUS-STEMI cohort): ClinicalTrials.gov NCT05794022.

Keywords: Cardiac arrest; Infarct size; Ischemia–reperfusion injury; Myocardial infarction; Ventricular fibrillation.

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Conflict of interest statement

Declarations. Conflict of interests: The authors reports that they have no relationships relevant to the contents of this paper to disclose.

Figures

Fig. 1
Fig. 1
Effect of ventricular fibrillation on infarct size in patients with STEMI The area at risk (AR), expressed as a percentage of the left ventricle (LV), did not differ significantly between patients with STEMI and ventricular fibrillation (VF) and matched controls (CTRL) (left panel). The area under the curve (AUC) of 48-h troponin I was significantly lower in the VF group than in the CTRL group (right panel). Data are expressed as median (first-to-third quartiles). The circles represent individual data
Fig. 2
Fig. 2
Effect of ventricular fibrillation on troponin kinetics in patients with STEMI Geometrical means and 95% confidence intervals of troponin levels are presented just before (0), and at 4, 24, and 48 h after primary percutaneous coronary intervention (PPCI) in the ventricular fibrillation (VF) group (blue dots) and the control (CTRL) group (orange squares). * p < 0.05 versus CTRL
Fig. 3
Fig. 3
Effect of ventricular fibrillation on infarct size in animal models The area at risk (AR), expressed as a percentage of the left ventricle (LV), and the infarct size, expressed as a percentage of AR are presented for both the in vivo (A) and ex vivo (B) models of acute myocardial infarction with ventricular fibrillation (VF) or without VF (CTRL). Data are expressed as median (first-to-third quartiles). The circles represent individual data

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