Rationale: Despite advances in treatment of acute myocardial infarction (AMI), many patients suffer significant myocardial damage with cardiac dysfunction. Sympathetic renal denervation (RD) may reduce adrenergic activation following AMI.
Objective: To investigate the potential role of RD limiting myocardial damage and remodeling when performed immediately after AMI.
Methods And Results: Sixteen farm pigs underwent 90 min left anterior descending artery balloon occlusion. Eight pigs underwent RD immediately after reperfusion. LV function, extent of myocardium at risk, and myocardial necrosis were quantified by cardiac magnetic resonance 5 and 30 days after AMI. I-MIBG scintigraphy was performed 31 days after AMI to image myocardial sympathetic innervation. Heart norepinephrine was quantified (from necrotic, border and remote zone). RD and control did not differ in myocardium at risk extent (59 ± 9 vs 55 ± 11% of LV mass) at 5 days. At 30 days CMR, RD pigs had smaller necrotic areas than control as assessed by gadolinium delay enhancement (18 ± 7 vs 30 ± 12% of LV mass, p = 0.021) resulting in improved myocardial salvage index (60 ± 11 vs 44 ± 27%, p < 0.001). RD pigs had higher cardiac output (3.7 ± 0.8 vs 2.66 ± 0.7 L/min, p < 0.001) and lower LV end diastolic volume (98 ± 16 vs 113 ± 31 ml, p = 0.041). I-MIBG defect extension was smaller in RD than control (60 ± 28 vs 78 ± 17%, p < 0.05) with significant reduction in the difference between innervation and perfusion defects (25 ± 12 vs 36 ± 30%, p = 0.013). NE content from necrotic area (238; IQR 464 vs 2546; IQR 1727 ng/g in RD and control, respectively, p < 0.001) and from border zone (295; IQR 264 vs 837; IQR 207 in RD and control, respectively, p = 0.031) was significantly lower in RD than control.
Conclusions: RD results in increased myocardial salvage and better cardiac function, when performed immediately after AMI. Reduction of sympathetic activation with preservation of cardiac sympathetic functionality warranted by RD may sustain these effects.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00392-020-01685-y | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Endoscopic Vein Harvest Is Associated with Worse but Improving Outcomes in Infrainguinal Bypass.
J Vasc Surg
December 2024
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, USA. Electronic address:
Objective: The impact of great saphenous vein harvest technique on infrainguinal bypass outcomes remains a matter of debate, with no robust evidence favoring a specific technique over the other. This study aims to compare the outcomes of open vein harvest with endoscopic vein harvest in patients undergoing infrainguinal bypass surgery.
Methods: Patients who underwent an infrainguinal bypass from a femoral origin using a single-segment great saphenous vein between 2011 and 2023 were identified in the Vascular Quality Initiative infrainguinal bypass module.
Transcoronary cooling and dilution for cardioprotection during revascularisation for ST-segment elevation myocardial infarction: design and rationale of the STEMI-Cool study.
Am Heart J
December 2024
Department of cardiology, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, London, UK; King's College London, London, UK.
Background: ST-segment elevation myocardial infarction (STEMI) is treated with immediate primary percutaneous coronary intervention (pPCI) to restore coronary blood flow in the acutely ischaemic territory, but is associated with reperfusion injury limiting the benefit of the therapy. No treatment has proven effective in reducing reperfusion injury. Transcoronary hypothermia has been tested in clinical studies and is well tolerated, but is generally established after crossing the occlusion with a guidewire therefore after initial reperfusion, which might have contributed to the neutral outcomes.
View Article and Find Full Text PDFMorphine and P2Y12 Inhibitors in ST-Elevation Myocardial Infarction: An Updated Meta-Analysis.
Am J Cardiovasc Drugs
December 2024
Cardiovascular Institute, Detroit Medical Center, Heart Hospital, Wayne State University, 311 Mack Ave, Detroit, MI, 48201, USA.
Background: Morphine is used to control pain in ST-elevation myocardial infarction but reduces P2Y12 inhibition. It is not known if this modulation of platelet inhibition appreciably affects clinical outcomes.
Methods: We screened 979 articles and identified seven studies that met the eligibility criteria for meta-analysis.
Xuebijing Injection Alleviates the Inflammatory Response in Patients with Venous-Arterial Extracorporeal Membrane Oxygenation: A Prospective Randomized Controlled Study.
Rev Cardiovasc Med
November 2024
Medical Research Center of the Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China.
Background: Both acute myocardial infarction (AMI) and its salvage treatment, venoarterial-extracorporeal membrane oxygenation (VA-ECMO), may lead to the production of proinflammatory cytokines and further aggravate tissue damage. Xuebijing (XBJ) may modulate cytokine production involved in the inflammatory response. We aimed to determine the efficacy of XBJ in cardiogenic shock patients on VA-ECMO.
View Article and Find Full Text PDFInterleukin-6 receptor antibodies (tocilizumab) in acute myocardial infarction with intermediate to high risk of cardiogenic shock development (DOBERMANN-T): study protocol for a double-blinded, placebo-controlled, single-center, randomized clinical trial.
Trials
November 2024
Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2142, DK-2100, Copenhagen, Denmark.
Background: Inflammation and neurohormonal activation play a significant role in the adverse outcome seen in acute myocardial infarction (AMI) and the development of cardiogenic shock (CS), which is associated with a mortality rate up to 50%. Treatment with anti-inflammatory drugs such as tocilizumab, an interleukin-6 receptor antagonist, has been shown to reduce troponin release and reduce the myocardial infarct size in AMI patients and it may therefore have cardioprotective properties.
Methods: This is a double-blind, placebo-controlled, single-center randomized clinical trial, including adult AMI patients without CS at hospital arrival, undergoing percutaneous coronary intervention (PCI) within 24 h from symptom onset, and at intermediate to high risk of developing CS (ORBI risk score ≥ 10).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!