MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure

Acute heart failure; Acute myocardial infarction; ElderlyInsuficiència cardíaca aguda; Infart agut de miocardi; Gent granInsuficiencia cardíaca aguda; Infarto agudo de miocardio; AncianoBackground Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF). Purpose To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI. Study Type Prospective. Population Multicenter registry of 759 reperfused STEMI patients (23.3% elderly). Field Strength/Sequence 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences. Assessment One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%–49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33–7.54] years. Statistical Tests Univariable (Student's t, Mann–Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant. Results Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91–0.98]) and elderly patients (HR 0.94 [0.91–0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67–22.32]) and elderly patients (HR 7.55 [3.29–17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54–8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients. Data Conclusion MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group. Evidence Level 2. Technical Efficacy Stage 2.Grant sponsor: This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (grant numbers PI20/00637, PI15/00531, and CIBERCV16/11/00486, CIBERCV16/11/00420, CIBERCV16/11/00479, and CM21/00175 to V.M.-G.), Fundació La Marató TV3 (grant 20153030-31-32), La Caixa Banking Foundation (HR17-00527) and by Conselleria de Educación – Generalitat Valenciana (PROMETEO/2021/008). J.G. acknowledges financial support from the “Agencia Estatal de Investigación” (grant FJC2020-043981-I/AEI/10.13039/501100011033)

Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction

[EN] Background: Cardiac magnetic resonance (CMR) performed early after ST-segment elevation myocardial infarction (STEMI) can improve major adverse cardiac event (MACE) risk prediction. We aimed to create a simple clinical-CMR risk score for early MACE risk stratification in STEMI patients. Methods: We performed a multicenter prospective registry of reperfused STEMI patients (n = 1118) in whom early (1-week) CMR-derived left ventricular ejection fraction (LVEF), infarct size and microvascular obstruction (MVO) were quantified. MACE was defined as a combined clinical endpoint of cardiovascular (CV) death, nonfatal myocardial infarction (NF-MI) or re-admission for acute decompensated heart failure (HF). Results: During a median follow-up of 5.52 [2.63-7.44] years, 216 first MACE (58 CV deaths, 71 NF-MI and 87 HF) were registered. Mean age was 59.3 +/- 12.3 years and most patients (82.8%) were male. Based on the four variables independently associated with MACE, we computed an 8-point risk score: time to reperfusion >4.15 h (1 point), GRACE risk score > 155 (3 points), CMR-LVEF 1.5 segments (1 point). This score permitted MACE risk stratification: MACE per 100 person-years was 1.96 in the low-risk category (0-2 points), 5.44 in the intermediate-risk category (3-5 points), and 19.7 in the high-risk category (6-8 points): p 4.15 h and GRACE risk score > 155) and CMR (LVEF 1.5 segments) variables allows for simple and straightforward MACE risk stratification early after STEMI. External validation should confirm the applicability of the risk score.This work was supported by the Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) (grants PI20/00637 and CIBERCV16/11/00486), "Marató TV3" [grant number 20153030-31-32], the Catalonian Society of Cardiology 2015, La Caixa Foundation [HR17-00527], and by Sociedad Española de Cardiología (grant SEC/FECINV-CLI 21/024). D.M. acknowledges financial support from the Conselleria d'Educació, Investigació, Cultura i Esport, Generalitat Valenciana (grants AEST/ 2019/037 and AEST/2020/029). J. G. acknowledges financial support from the Agencia Estatal de Investigación (grant FJC2020-043981-I / AEI/10.13039/501100011033).Marcos-Garcés, V.; Perez, N.; Gavara-Doñate, J.; Lopez-Lereu, MP.; Monmeneu, JV.; Rios-Navarro, C.; De Dios, E.... (2022). Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction. International Journal of Cardiology. 349:150-154. https://doi.org/10.1016/j.ijcard.2021.11.05015015434

Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients

[EN] Background older patients with ST-segment elevation myocardial infarction (STEMI) represent a very high-risk population. Data on the prognostic value of cardiac magnetic resonance (CMR) in this scenario are scarce. Methods the registry comprised 247 STEMI patients over 70 years of age treated with percutaneous intervention and included in a multicenter registry. Baseline characteristics, echocardiographic parameters and CMR-derived left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were prospectively collected. The additional prognostic power of CMR was assessed using adjusted C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI). Results during a 4.8-year mean follow-up, the number of first major adverse cardiac events (MACE) was 66 (26.7%): 27 all-cause deaths and 39 re-admissions for acute heart failure. Predictors of MACE were GRACE score (HR 1.03 [1.02-1.04], P 155, LVEF = 2 segments. A simple score (0, 1, 2, 3) based on the number of altered factors accurately predicted the MACE per 100 person-years: 0.78, 5.53, 11.51 and 78.79, respectively (P < 0.001). Conclusions CMR data contribute valuable prognostic information in older patients submitted to undergo CMR soon after STEMI. The Older-STEMI-CMR score should be externally validated.This work was supported by Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER (grant numbers PI20/00637, PI15/00531, and CIBERCV16/11/00486,CIBERCV16/11/00420, CIBERCV16/11/00479), apostgraduate contract FI18/00320 to C.R.-N., CM21/00175 to V.M.-G. and JR21/00041 to C.B., Fundacio La MaratoTV3 (grant 20153030-31-32), La Caixa Banking Foundation (HR17-00527), by Conselleria de Educacion-Generalitat Valenciana (PROMETEO/2021/008) and by Sociedad Espanola de Cardiologia (grant SEC/FEC-INV-CLI 21/024). J.G. acknowledges financial support from the Agencia Estatal de Investigacion (grant FJC2020-043981-I/AEI/10.13039/501100011033). D.M. acknowledges financial support from the Conselleria d'Educacio,Investigacio, Cultura i Esport, Generalitat Valenciana (grants AEST/2019/037, AEST/2020/029).Gabaldón-Pérez A; Marcos-Garcés, V.; Gavara-Doñate, J.; López-Lereu, MP.; Monmeneu, JV.; Pérez, N.; Ríos-Navarro, C.... (2022). Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients. Age and Ageing. 51(11):1-11. https://doi.org/10.1093/ageing/afac248111511

Cardiac magnetic resonance outperforms echocardiography to predict subsequent implantable cardioverter defibrillator therapies in ST-segment elevation myocardial infarction patients

Altres ajuts: Conselleria de Educación-Generalitat Valenciana (PROMETEO/2021/008); Sociedad Española de Cardiología (Grant SEC/FEC-INVCLI 21/024)Implantable cardioverter defibrillators (ICD) are effective as a primary prevention measure of ventricular tachyarrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) and depressed left ventricular ejection fraction (LVEF). The implications of using cardiac magnetic resonance (CMR) instead of echocardiography (Echo) to assess LVEF prior to the indication of ICD in this setting are unknown. We evaluated 52 STEMI patients (56.6 ± 11 years, 88.5% male) treated with ICD in primary prevention who underwent echocardiography and CMR prior to ICD implantation. ICD implantation was indicated based on the presence of heart failure and depressed LVEF (≤ 35%) by echocardiography, CMR, or both. Prediction of ICD therapies (ICD-T) during follow-up by echocardiography and CMR before ICD implantation was assessed. Compared to echocardiography, LVEF was lower by cardiac CMR (30.2 ± 9% vs. 37.4 ± 7.6%, p < 0.001). LVEF ≤ 35% was detected in 24 patients (46.2%) by Echo and in 42 (80.7%) by CMR. During a mean follow-up of 6.1 ± 4.2 years, 10 patients received appropriate ICD-T (3.16 ICD-T per 100 person-years): 5 direct shocks to treat very fast ventricular tachycardia or ventricular fibrillation, 3 effective antitachycardia pacing (ATP) for treatment of ventricular tachycardia, and 2 ineffective ATP followed by shock to treat ventricular tachycardia. Echo-LVEF ≤ 35% correctly predicted ICD-T in 4/10 (40%) patients and CMR-LVEF ≤ 35% in 10/10 (100%) patients. CMR-LVEF improved on Echo-LVEF for predicting ICD-T (area under the curve: 0.76 vs. 0.48, p = 0.04). In STEMI patients treated with ICD, assessment of LVEF by CMR outperforms Echo-LVEF to predict the subsequent use of appropriate ICD therapies

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

Diseño para el desarrollo sustentable y la habitabilidad segura e incluyente

Este libro se divide en dos partes que permiten permear en el campo de la enseñanza del diseño; la primera se enfoca en temáticas que se desprenden del diseño en la educación para la sustentabilidad; en la segunda, se identifican las tendencias del diseño como un modo de verlo y sentirlo: va desde el diseño emocional hacia uno de conservación, reúso y reparación de objetos para reducir el consumo de recursos materiales

Avances en estratificación pronóstica mediante resonancia magnética cardíaca en pacientes con síndrome coronario crónico

El objetivo del presente trabajo, dividido en tres partes, es estudiar el papel pronóstico y la utilidad a la hora de la toma de decisiones de dos pruebas diagnósticas, a saber, la resonancia magnética cardíaca de estrés (RMC) y la prueba de esfuerzo electrocardiográfica (ExECG), en pacientes con síndrome coronario crónico conocido o sospechado. La RMC juega un papel fundamental en el diagnóstico de pacientes con síndrome coronario crónico. No obstante, su utilidad pronóstica ha sido menos estudiada. En la primera parte del trabajo, confirmamos el valor pronóstico de esta prueba y realizamos un score clínico y de RMC (C-CMR-10) para predecir, de forma sencilla, la muerte por todas las causas a largo plazo. Las variables incluidas en este score fueron la edad (≥65 años = 3 puntos), la diabetes mellitus (= 1 punto), el sexo masculino (= 1 punto), la fracción de eyección del ventrículo izquierdo (FEVI, ≤50% = 3 puntos) y la carga isquémica extensa (>5 segmentos miocárdicos = 1 punto). Teniendo disponible una técnica como la RMC que aporta un valor pronóstico tan relevante, se desconoce si la ExECG puede aportar información pronóstica adicional en pacientes con síndrome coronario crónico. En la segunda parte del estudio analizamos una población de pacientes en los cuales se habían realizado ambas pruebas, y concluimos que la ExECG, mediante la medición de la frecuencia cardíaca máxima, permite añadir valor pronóstico significativo para predecir un objetivo combinado de eventos clínicos adversos. En la última parte del estudio confirmamos la utilidad de la carga isquémica medida mediante RMC para predecir el riesgo de muerte por todas las causas a largo plazo. Concluimos que este parámetro permite predecir y estratificar el riesgo de mortalidad en nuestra cohorte consecutiva de pacientes. Además, evidenciamos que la revascularización sólo confería un beneficio pronóstico a aquellos pacientes con carga isquémica extensa (en más de 5 segmentos miocárdicos), contribuyendo así a mejorar la selección de pacientes con cardiopatía isquémica estable a los que someter a una estrategia de revascularización miocárdica, un tema hoy en día aún pendiente de clarificar de forma definitiva.The present work, divided in three parts, aimed to study the prognostic role and the usefulness in decision-making of two diagnostic tests, namely cardiac magnetic resonance (CMR) and exercise ECG testing (ExECG), in patients with known or suspected chronic coronary syndrome. CMR plays a fundamental role in the diagnosis of patients with chronic coronary syndrome. However, its prognostic value has been seldom analysed. In the first part of the work, we confirmed the prognostic value of this technique and performed a clinical and CMR score (C-CMR-10) to straightforwardly predict long-term all-cause mortality. Variables included in the score were age (≥65 years = 3 points), diabetes mellitus (= 1 point), male sex (= 1 point), left ventricular ejection fraction (≤50% = 3 points), and extensive ischemic burden (>5 myocardial segments = 1 point). In the era of increasingly available CMR, which offers such relevant prognostic value, it is unknown whether traditional techniques such as ExECG can contribute additional prognostic information in patients with chronic coronary syndrome. In the second part of the study, we concluded that ExECG, and specifically maximum heart rate achieved during the test, contributes significantly to prognostic value beyond CMR in this population to predict a combined clinical endpoint. In the last part of our study, we confirmed the prognostic value of the ischemic burden by CMR to predict the long-term risk of all-cause mortality. We concluded that this parameter can predict and stratify the risk of mortality in our cohort. Furthermore, we evidenced that revascularization was only beneficial in terms of improved survival in patients with extensive ischemic burden (in more than 5 myocardial segments). Our results can contribute to improved selection of patients with chronic coronary syndrome who could undergo a myocardial revascularization strategy, a topic that is still under debate nowadays

Fourier analysis of collagen bundle orientation in myocardial infarction scars

[EN] Collagen bundle orientation (CBO) in myocardial infarct scars plays a major role in scar mechanics and complications after infarction. We aim to compare four histopathological methods for CBO measurement in myocardial scarring. Myocardial infarction was induced in 21 pigs by balloon coronary occlusion. Scar samples were obtained at 4 weeks, stained with Masson's trichrome, Picrosirius red, and Hematoxylin-Eosin (H&E), and photographed using light, polarized light microscopy, and confocal microscopy, respectively. Masson's trichrome images were also optimized to remove non-collagenous structures. Two observers measured CBO by means of a semi-automated, Fourier analysis protocol. Interrater reliability and comparability between techniques were studied by the intraclass correlation coefficient (ICC) and Bland-Altman (B&A) plots and limits of agreement. Fourier analysis showed an almost perfect interrater reliability for each technique (ICC >= 0.95, p < 0.001 in all cases). CBO showed more randomly oriented values in Masson's trichrome and worse comparability with other techniques (ICC vs. Picrosirius red: 0.79 [0.47-0.91], p = 0.001; vs. H&E-confocal: 0.70 [0.26-0.88], p = 0.005). However, optimized Masson's trichrome showed almost perfect agreement with Picrosirius red (ICC 0.84 [0.6-0.94], p < 0.001) and H&E-confocal (ICC 0.81 [0.54-0.92], p < 0.001), as well as these latter techniques between each other (ICC 0.84 [0.60-0.93], p < 0.001). In summary, a semi-automated, Fourier-based method can provide highly reproducible CBO measurements in four different histopathological techniques. Masson's trichrome tends to provide more randomly oriented CBO index values, probably due to non-specific visualization of non-collagenous structures. However, optimization of Masson's trichrome microphotographs to remove non-collagenous components provides an almost perfect comparability between this technique, Picrosirius red and H&E-confocal.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was supported by grants from "Instituto de Salud Carlos III" and "Fondos Europeos de Desarrollo Regional FEDER" [Grant numbers PI20/00637, and CIBERCV16/11/00486, a postgraduate contract FI18/00320 to C.R.-N. and CM21/00175 to V. M.-G.], by Conselleria de Educacion-Generalitat Valenciana (PROMETEO/2021/008). J. G. acknowledges financial support from the "Agencia Estatal de Investigacion" (Grant FJC2020-043981-I/AEI/1013039/501100011033).Marcos-Garcés, V.; Rios-Navarro, C.; Gómez-Torres, F.; Gavara-Doñate, J.; De Dios, E.; Diaz, A.; Miñana, G.... (2022). Fourier analysis of collagen bundle orientation in myocardial infarction scars. Histochemistry and Cell Biology. 158(5):471-483. https://doi.org/10.1007/s00418-022-02132-x4714831585Baak JPA (2002) The framework of pathology: good laboratory practice by quantitative and molecular methods. J Pathol 198:277–283. https://doi.org/10.1002/path.1233Bancroft JD, Layton C (2013) Chapter 11: Connective and mesenchymal tissues with their stains. Bancroft’s Theory and Practice of Histological Techniques, 7th edn. Churchill Livingstone. Elsevier, Amsterdam, pp 187–214Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet Lond Engl 1:307–310Bugg D, Bretherton R, Kim P et al (2020) Infarct Collagen topography regulates fibroblast fate via p38-yes-associated protein transcriptional enhanced associate domain signals. Circ Res 127:1306–1322. https://doi.org/10.1161/CIRCRESAHA.119.316162Fomovsky GM, Rouillard AD, Holmes JW (2012) Regional mechanics determine collagen fiber structure in healing myocardial infarcts. J Mol Cell Cardiol 52:1083–1090. https://doi.org/10.1016/j.yjmcc.2012.02.012Frangogiannis NG (2014) The inflammatory response in myocardial injury, repair and remodelling. Nat Rev Cardiol 11:255–265. https://doi.org/10.1038/nrcardio.2014.28Frangogiannis NG (2017) The extracellular matrix in myocardial injury, repair, and remodeling. J Clin Invest 127:1600–1612. https://doi.org/10.1172/JCI87491Gabriel-Costa D (2018) The pathophysiology of myocardial infarction-induced heart failure. Pathophysiology 25:277–284. https://doi.org/10.1016/j.pathophys.2018.04.003Hervas A, Ruiz-Sauri A, de Dios E et al (2016) Inhomogeneity of collagen organization within the fibrotic scar after myocardial infarction: results in a swine model and in human samples. J Anat 228:47–58. https://doi.org/10.1111/joa.12395Heusch G (2020) Myocardial ischaemia–reperfusion injury and cardioprotection in perspective. Nat Rev Cardiol 17:773–789. https://doi.org/10.1038/s41569-020-0403-yHeusch G, Gersh BJ (2016) The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge. Eur Heart J. https://doi.org/10.1093/eurheartj/ehw224Iles LM, Ellims AH, Llewellyn H et al (2015) Histological validation of cardiac magnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis. Eur Heart J - Cardiovasc Imaging 16:14–22. https://doi.org/10.1093/ehjci/jeu182Junqueira LC, Bignolas G, Brentani RR (1979) Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections. Histochem J 11:447–455. https://doi.org/10.1007/BF01002772Kanitakis J (2002) Anatomy, histology and immunohistochemistry of normal human skin. Eur J Dermatol EJD 12:390–399 (quiz 400–401)Kischer CW, Shetlar MR (1979) Electron microscopic studies of connective tissue repair after myocardial injury. Tex Rep Biol Med 39:357–369Korenczuk CE, Barocas VH, Richardson WJ (2019) Effects of collagen heterogeneity on myocardial infarct mechanics in a multiscale fiber network model. J Biomech Eng 141:091015. https://doi.org/10.1115/1.4043865Laurinavicius A, Laurinaviciene A, Dasevicius D et al (2012) Digital image analysis in pathology: benefits and obligation. Anal Cell Pathol Amst 35:75–78. https://doi.org/10.3233/ACP-2011-0033Li W (2020) Biomechanics of infarcted left ventricle: a review of modelling. Biomed Eng Lett 10:387–417. https://doi.org/10.1007/s13534-020-00159-4Lin J, Shi Y, Men Y et al (2020) Mechanical roles in formation of oriented collagen fibers. Tissue Eng Part B Rev 26:116–128. https://doi.org/10.1089/ten.teb.2019.0243Lindsey ML, Brunt KR, Kirk JA et al (2021) Guidelines for in vivo mouse models of myocardial infarction. Am J Physiol-Heart Circ Physiol 321:H1056–H1073. https://doi.org/10.1152/ajpheart.00459.2021Ma Y, de Castro Brás LE, Toba H et al (2014) Myofibroblasts and the extracellular matrix network in post-myocardial infarction cardiac remodeling. Pflüg Arch - Eur J Physiol. https://doi.org/10.1007/s00424-014-1463-9Marcos-Garcés V, Harvat M, Molina Aguilar P et al (2017) Comparative measurement of collagen bundle orientation by Fourier analysis and semiquantitative evaluation: reliability and agreement in Masson’s trichrome, Picrosirius red and confocal microscopy techniques. J Microsc. https://doi.org/10.1111/jmi.12553Moreo A, Ambrosio G, De Chiara B et al (2009) Influence of myocardial fibrosis on left ventricular diastolic function: noninvasive assessment by cardiac magnetic resonance and echo. Circ Cardiovasc Imaging 2:437–443. https://doi.org/10.1161/CIRCIMAGING.108.838367Mostaço-Guidolin L, Rosin N, Hackett T-L (2017) Imaging collagen in scar tissue: developments in second harmonic generation microscopy for biomedical applications. Int J Mol Sci 18:1772. https://doi.org/10.3390/ijms18081772Nong Z, O’Neil C, Lei M et al (2011) Type I collagen cleavage is essential for effective fibrotic repair after myocardial infarction. Am J Pathol 179:2189–2198. https://doi.org/10.1016/j.ajpath.2011.07.017Osman OS, Selway JL, Harikumar PE et al (2013) A novel method to assess collagen architecture in skin. BMC Bioinformatics 14:260. https://doi.org/10.1186/1471-2105-14-260Perez-Terol I, Rios-Navarro C, de Dios E et al (2019) Magnetic resonance microscopy and correlative histopathology of the infarcted heart. Sci Rep 9:20017. https://doi.org/10.1038/s41598-019-56436-5Prabhu SD, Frangogiannis NG (2016) The biological basis for cardiac repair after myocardial infarction: from inflammation to fibrosis. Circ Res 119:91–112. https://doi.org/10.1161/CIRCRESAHA.116.303577Quinn KP, Sullivan KE, Liu Z et al (2016) Optical metrics of the extracellular matrix predict compositional and mechanical changes after myocardial infarction. Sci Rep. https://doi.org/10.1038/srep35823Richardson W, Clarke S, Quinn T, Holmes J (2015) Physiological implications of myocardial scar structure. Compr Physiol 5:1877–1909. https://doi.org/10.1002/cphy.c140067Richardson WJ, Holmes JW (2016) Emergence of collagen orientation heterogeneity in healing infarcts and an agent-based model. Biophys J 110:2266–2277. https://doi.org/10.1016/j.bpj.2016.04.014Rog-Zielinska EA, Norris RA, Kohl P, Markwald R (2016) The living scar-cardiac fibroblasts and the injured heart. Trends Mol Med 22:99–114. https://doi.org/10.1016/j.molmed.2015.12.006Ross Stewart KM, Walker SL, Baker AH et al (2021) Hooked on heart regeneration: the zebrafish guide to recovery. Cardiovasc Res. https://doi.org/10.1093/cvr/cvab214Rouillard AD, Holmes JW (2012) Mechanical regulation of fibroblast migration and collagen remodelling in healing myocardial infarcts: Mechanics determine infarct collagen alignment. J Physiol 590:4585–4602. https://doi.org/10.1113/jphysiol.2012.229484Rusu M, Hilse K, Schuh A et al (2019) Biomechanical assessment of remote and postinfarction scar remodeling following myocardial infarction. Sci Rep 9:16744. https://doi.org/10.1038/s41598-019-53351-7Ryan R, Moyse BR, Richardson RJ (2020) Zebrafish cardiac regeneration—looking beyond cardiomyocytes to a complex microenvironment. Histochem Cell Biol 154:533–548. https://doi.org/10.1007/s00418-020-01913-6Saeed M, Weber O, Lee R et al (2006) Discrimination of myocardial acute and chronic (Scar) infarctions on delayed contrast enhanced magnetic resonance imaging with intravascular magnetic resonance contrast media. J Am Coll Cardiol 48:1961–1968. https://doi.org/10.1016/j.jacc.2006.03.071Seo BR, Chen X, Ling L et al (2020) Collagen microarchitecture mechanically controls myofibroblast differentiation. Proc Natl Acad Sci 117:11387–11398. https://doi.org/10.1073/pnas.1919394117Shechtman O (2013) The Coefficient of Variation as an Index of Measurement Reliability. In: Doi SAR, Williams GM (eds) Methods of Clinical Epidemiology. Springer, Berlin Heidelberg, Berlin, Heidelberg, pp 39–49van Zuijlen PPM, de Vries HJC, Lamme EN et al (2002) Morphometry of dermal collagen orientation by Fourier analysis is superior to multi-observer assessment. J Pathol 198:284–291. https://doi.org/10.1002/path.1219Verhaegen PD, Schouten HJ, Tigchelaar-Gutter W et al (2012a) Adaptation of the dermal collagen structure of human skin and scar tissue in response to stretch: an experimental study: collagen adaptation in response to stretch. Wound Repair Regen 20:658–666. https://doi.org/10.1111/j.1524-475X.2012.00827.xVerhaegen PDHM, Marle JV, Kuehne A et al (2012b) Collagen bundle morphometry in skin and scar tissue: a novel distance mapping method provides superior measurements compared to Fourier analysis. J Microsc 245:82–89. https://doi.org/10.1111/j.1365-2818.2011.03547.xVoorhees AP, Han H-C (2014) A model to determine the effect of collagen fiber alignment on heart function post myocardial infarction. Theor Biol Med Model 11:6. https://doi.org/10.1186/1742-4682-11-6Wang L, Singh H, Mulyala RR et al (2020) The association between left ventricular diastolic dysfunction and myocardial scar and their collective impact on all-cause mortality. J Am Soc Echocardiogr 33:161–170. https://doi.org/10.1016/j.echo.2019.09.022Whittaker P, Boughner DR, Kloner RA (1989) Analysis of healing after myocardial infarction using polarized light microscopy. Am J Pathol 134:879–893Zimmerman SD, Karlon WJ, Holmes JW et al (2000) Structural and mechanical factors influencing infarct scar collagen organization. Am J Physiol Heart Circ Physiol 278:H194-200. https://doi.org/10.1152/ajpheart.2000.278.1.H19

Clinical Predictors and Prognosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) without ST-Segment Elevation in Older Adults

A non-neglectable percentage of patients with non-ST elevation myocardial infarction (NSTEMI) show non-obstructive coronary arteries (MINOCA). Specific data in older patients are scarce. We aimed to identify the clinical predictors of MINOCA in older patients admitted for NSTEMI and to explore the long-term prognosis of MINOCA. This was a single-center, observational, consecutive cohort study of older (&ge;70 years) patients admitted for NSTEMI between 2010 and 2014 who underwent coronary angiography. Univariate and multivariate Cox regression were performed to analyze the association of variables with MINOCA and all-cause mortality and with major adverse cardiac events (MACE), defined as a combined endpoint of all-cause mortality and nonfatal myocardial infarction and a combined endpoint of cardiovascular mortality, nonfatal myocardial infarction, and unplanned revascularization. The registry included 324 patients (mean age 78.8 &plusmn; 5.4 years), of which 71 (21.9%) were diagnosed with MINOCA. Predictors of MINOCA were female sex, left bundle branch block, pacemaker rhythm, chest pain at rest, peak troponin level, previous MI, Killip &ge;2, and ST segment depression. Regarding prognosis, patients with obstructive coronary arteries (stenosis &ge;50%) and the subgroup of MINOCA patients with plaques &lt;50% had a similar prognosis; while MINOCA patients with angiographically smooth coronary arteries had a reduced risk of MACE. We conclude that the following: (1) in elderly patients admitted for NSTEMI, certain universally available clinical, electrocardiographic, and analytical variables are associated with the diagnosis of MINOCA; (2) elderly patients with MINOCA have a better prognosis than those with obstructive coronary arteries; however, only those with angiographically smooth coronary arteries have a reduced risk of all-cause mortality and MACE