1,721,632 research outputs found
Redefining the Success of Mechanical Reperfusion: Cardiac MRI
No full textAfter ST-segment elevation myocardial infarction (STEMI), the immediate therapeutic goal is to establish patency of the infarct-related artery. Nevertheless, the successful restoration of epicardial coronary artery patency by thrombolysis, primary angioplasty, or bypass, does not necessarily translate into improved myocardial reperfusion. Patient's prognosis after STEMI relates directly to the extent of myocardial injury produced during coronary occlusion. Postinfarction electrocardiography, echocardiography, and contrast ventriculography are often used to indirectly assess the degree of myocardial damage, whereas radionuclide studies with 99mTc sestamibi and gadolinium-enhanced magnetic resonance imaging (cMR) can measure infarct size directly. In addition to the extent of infarcted myocardium, the magnitude of structural obstruction or disruption of the microvasculature, called “no-reflow” or “low-reflow” phenomenon, sustained before or during primary percutaneous coronary intervention (PCI) has been related to worse clinical outcome, despite successful epicardial revascularization. Therefore, attention has shifted away from merely achieving epicardial artery patency toward the obtainment of an adequate myocardial and microvascular reperfusion
E' ragionevole un trattamento farmacologico antianginoso dopo il successo dell'angioplastica o del bypass?
No full text
MRI in acute myocardial infarction.
No full textAlthough acute myocardial infarction (AMI) is still one of the main causes of high morbidity in Western countries, the rate of mortality has decreased significantly. The main cause of this drop appears to be the decline of the incidence of ST-segment elevation myocardial infarction (STEMI) along with an absolute reduction in case fatality rate once STEMI has occurred. Myocardial ischaemia progresses with the duration of coronary occlusion and the delay in time to reperfusion determines the extent of irreversibile necrosis from subendocarial layers towards the epicardium in accordance with the so-called 'wave-front phenomenon'. Coronary artery recanalization, either by thrombolitic therapy or primary percutaneous intervention, may prevent myocardial cell necrosis increasing salvage of damaged, but still viable, myocardium within the area at risk. Magnetic resonance imaging (MRI) can provide a wide range of clinically useful information in AMI by detecting not only location of transmural necrosis, infarct size and myocardial oedema, but also showing in vivo important microvascular pathophysiological processes associated with AMI in the reperfusion era, such as intramyocardial haemorrhage and no-reflow. The focus of this review will be on the impact of cardiac MRI in the characterization of AMI pathophysiology in vivo in the current reperfusion era, concentrating also on clinical applications and future perspectives for specific therapeutic strategies
The diagnosis of the antiphospholipid syndrome
No full textI.F. 0.981
The concurrence of antiphospholipid (aPL) antibodies and thrombosis or pregnancy loss defines the 'antiphospholipid syndrome' (APS). The Sydney update of the classification criteria for definite APS diagnosis introduced numerous ameliorations to the previous preliminary consensus statement. Clinical criteria are now better defined as vascular thrombosis must be diagnosed on the basis of objective criteria. Moreover,additional risk factors for thrombosis or pregnancy loss must be taken into account before the diagnosis is made and should be described in detail in scientific reports. As far as laboratory criteria are concerned,the lack of standardization and the misinterpretation of results remain major problems often leading to overdiagnosis. A single positive test result out of the possible assays determining aPL antibodies (Lupus Anticoagulant, LAC, anticardiolipin, aCL and anti. beta2-Glycoprotein I, beta2-GPI, antibodies) is still sufficient,according to the Sydney criteria, to justify a diagnosis of APS. Nevertheless single test positivity may result in overdiagnosis or identification of low risk patients and use of all three tests seems more reasonable. Multiple positivity or (better) triple positivity in our experience allows for the identification of high risk patients for possible recurrence. In the near future, coagulation tests discriminating between a beta2-GPI and anti-prothrombin LAC may be useful in identifying high risk patients
Interaction Among Risk-Time and Benefit of Primary Angioplasty
No full textInterazione tra tempo, estensione dell'infarto, utilità della rivascolarizzazion
Aborted myocardial infarction: a clinical-magnetic resonance correlation
No full textThis report illustrates a magnetic resonance image of aborted
myocardial infarction after primary angioplasty. Myocardial
oedema in the absence of late enhancement seems to be the
magnetic resonance marker of the myocardium at risk of
infarction that has been reperfused within 30 minutes and
aborted in the clinic
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