Key result
Left ventricular blood stasis imaging strongly predicted the incidence of brain microemboli during acute myocardial infarction (C-index 0.89; 95% CI 0.75-1.00).
Why the study?
Quantitative characterization of intracardiac blood stasis was hypothesized to determine cardioembolic risk, prompting assessment of the link between LV blood stasis metrics and brain microembolism during acute myocardial infarction.
Does intraventricular blood stasis mapping predict cerebral microembolism in an animal model of acute myocardial infarction?
Does intraventricular blood stasis mapping predict cerebral microembolism in an animal model of acute myocardial infarction?
Intraventricular blood stasis imaging using color Doppler echocardiography accurately predicts the incidence of cerebral microembolism in an acute myocardial infarction animal model.
Answers are grounded in this paper and cite their sources.
LV stasis metrics predicted microemboli in this AMI model; hypothesis-generating for patient-specific cardioembolic risk assessment.
BACKGROUND: Cardioembolic stroke is a major source of mortality and disability worldwide. The authors hypothesized that quantitative characterization of intracardiac blood stasis may be useful to determine cardioembolic risk in order to personalize anticoagulation therapy. The aim of this study was to assess the relationship between image-based metrics of blood stasis in the left ventricle and brain microembolism, a surrogate marker of cardiac embolism, in a controlled animal experimental model of acute myocardial infarction (AMI). METHODS: Intraventricular blood stasis maps were derived from conventional color Doppler echocardiography in 10 pigs during anterior AMI induced by sequential ligation of the mid and proximal left anterior descending coronary artery (AMI-1 and AMI-2 phases). From these maps, indices of global and local blood stasis were calculated, such as the average residence time and the size and ratio of contact with the endocardium of blood regions with long residence times. The incidence of brain microemboli (high-intensity transient signals [HITS]) was monitored using carotid Doppler ultrasound. RESULTS: HITS were detected in 0%, 50%, and 90% of the animals at baseline and during AMI-1 and AMI-2 phases, respectively. The average residence time of blood in the left ventricle increased in parallel. The residence time performed well to predict microemboli (C-index = 0.89, 95% CI, 0.75-1.00) and closely correlated with the number of HITS (R = 0.87, P < .001). Multivariate and mediation analyses demonstrated that the number of HITS during AMI phases was best explained by stasis. Among conventional echocardiographic variables, only apical wall motion score weakly correlated with the number of HITS (R = 0.3, P = .04). Mural thrombosis in the left ventricle was ruled out in all animals. CONCLUSIONS: The degree of stasis of blood in the left ventricle caused by AMI is closely related to the incidence of brain microembolism. Therefore, stasis imaging is a promising tool for a patient-specific assessment of cardioembolic risk.
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Delgado-Montero et al. (2019) studied Acute myocardial infarction (n=10). Blood stasis imaging (average residence time) was evaluated on Brain microemboli (high-intensity transient signals [HITS]) (C-index 0.89, 95% CI 0.75-1.00, p=<.001). Left ventricular blood stasis imaging strongly predicted the incidence of brain microemboli during acute myocardial infarction (C-index 0.89; 95% CI 0.75-1.00).
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