TY - JOUR 
A1 - Fernández Jiménez, Rodrigo
AU - Galán Arriola, Carlos
AU - Sánchez González, Javier
AU - Agüero, Jaume
AU - López Martín, Gonzalo J.
AU - Gómez Talavera, Sandra
AU - García Prieto, Jaime
AU - Benn, Austin
AU - Molina Iracheta, Antonio
AU - Barreiro-Pérez, Manuel
AU - Martín García, Ana
AU - García Lunar, Inés
AU - Pizarro, Gonzalo
AU - Sanz, Javier
AU - Sánchez, Pedro L.
AU - Fuster, Valentín
AU - Ibáñez Cabeza, Borja
T1 - Effect of Ischemia Duration and Protective Interventions on the Temporal Dynamics of Tissue Composition After Myocardial Infarction
Y1 - 2017
SN - 0009-7330

UR - http://hdl.handle.net/11268/7175
AB - The impact of cardioprotective strategies and ischemia duration on postischemia/reperfusion (I/R) myocardial tissue composition (edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction) is not well understood.

OBJECTIVE:
To study the effect of ischemia duration and protective interventions on the temporal dynamics of myocardial tissue composition in a translational animal model of I/R by the use of state-of-the-art imaging technology.

METHODS AND RESULTS:
Four 5-pig groups underwent different I/R protocols: 40-minute I/R (prolonged ischemia, controls), 20-minute I/R (short-duration ischemia), prolonged ischemia preceded by preconditioning, or prolonged ischemia followed by postconditioning. Serial cardiac magnetic resonance (CMR)-based tissue characterization was done in all pigs at baseline and at 120 minutes, day 1, day 4, and day 7 after I/R. Reference myocardium at risk was assessed by multidetector computed tomography during the index coronary occlusion. After the final CMR, hearts were excised and processed for water content quantification and histology. Five additional healthy pigs were euthanized after baseline CMR as reference. Edema formation followed a bimodal pattern in all 40-minute I/R pigs, regardless of cardioprotective strategy and the degree of intramyocardial hemorrhage or microvascular obstruction. The hyperacute edematous wave was ameliorated only in pigs showing cardioprotection (ie, those undergoing short-duration ischemia or preconditioning). In all groups, CMR-measured edema was barely detectable at 24 hours postreperfusion. The deferred healing-related edematous wave was blunted or absent in pigs undergoing preconditioning or short-duration ischemia, respectively. CMR-measured infarct size declined progressively after reperfusion in all groups. CMR-measured myocardial salvage, and the extent of intramyocardial hemorrhage and microvascular obstruction varied dramatically according to CMR timing, ischemia duration, and cardioprotective strategy.

CONCLUSIONS:
Cardioprotective therapies, duration of index ischemia, and the interplay between these greatly influence temporal dynamics and extent of tissue composition changes after I/R. Consequently, imaging techniques and protocols for assessing edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction should be standardized accordingly.
KW - Edema
KW - Cardiopatía isquémica
KW - Enfermedad cardiovascular
LA - eng
ER -