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Circadian variation in acute myocardial infarct size assessed by cardiovascular magnetic resonance in reperfused STEMI patients

Bulluck, H; Nicholas, J; Crimi, G; White, SK; Ludman, AJ; Pica, S; Raineri, C; ... Hausenloy, DJ; + view all (2017) Circadian variation in acute myocardial infarct size assessed by cardiovascular magnetic resonance in reperfused STEMI patients. International Journal of Cardiology , 230 pp. 149-154. 10.1016/j.ijcard.2016.12.030. Green open access

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Abstract

Objective: Clinical studies using serum cardiac biomarkers to investigate a circadian variation in acute myocardial infarct (MI) size in ST-segment elevation myocardial infarction (STEMI) patients reperfused by primary percutaneous coronary intervention (PPCI) have produced mixed results. We aimed to investigate this phenomenon using acute MI size measured by cardiovascular magnetic resonance (CMR). Methods: Patient-level data was obtained from 4 randomized controlled trials investigating the MI-limiting effects of cardioprotective therapies in this pooled analysis. The primary analysis was performed in those patients with no pre-infarct angina; duration of ischemia > 60 min and < 360 min; Thrombolysis In Myocardial Infarction (TIMI) flow pre-PPCI ≤ 1; TIMI flow post-PPCI 3; and no collateral flow. Results: 169 out of 376 patients with CMR data met the inclusion criteria for the primary analysis. A 24-hour circadian variation in acute MI size as a % of the area-at-risk (%AAR), after adjusting for confounders, was observed with a peak and nadir MI size in patients with symptom onset between 00:00 and 01:00 and between 12:00 and 13:00 respectively (difference from the average MI size 5.2%, 95%CI 1.1–9.4%; p = 0.013). This was associated with a non-significant circadian variation in left ventricular ejection fraction (LVEF) (difference from the average LVEF 5.9%, 95%CI − 0.6–2.2%, p = 0.073). There was no circadian variation in MI size or LVEF in the whole cohort.

Type: Article
Title: Circadian variation in acute myocardial infarct size assessed by cardiovascular magnetic resonance in reperfused STEMI patients
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijcard.2016.12.030
Publisher version: http://dx.doi.org/10.1016/j.ijcard.2016.12.030
Additional information: © 2016 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, ST-segment elevation myocardial infarction, Circadian rhythm, Myocardial infarct size, Cardiovascular magnetic resonance, PERCUTANEOUS CORONARY INTERVENTION, CONTROLLED CLINICAL-TRIAL, LEFT-VENTRICULAR FUNCTION, QUANTITATIVE-ANALYSIS, BLOOD-PRESSURE, HEART-RATE, CLOCK, ECHOCARDIOGRAPHY, REPRODUCIBILITY, HYPERTROPHY
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: https://discovery.ucl.ac.uk/id/eprint/1535884
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