Coexistence of transmural and lateral wavefront progression of myocardial infarction in the human heart

Translated title of the contribution: Coexistence of transmural and lateral wavefront progression of myocardial infarction in the human heart

Rebeca Lorca, Marta Jiménez-Blanco, José Manuel García-Ruiz, Gonzalo Pizarro, Rodrigo Fernández-Jiménez, Ana García-Álvarez, Leticia Fernández-Friera, Manuel Lobo-González, Valentín Fuster, Xavier Rossello, Borja Ibáñez

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Introduction and objectives: According to the wavefront phenomenon described in the late 1970s, myocardial infarction triggered by acute coronary occlusion progresses with increasing duration of ischemia as a transmural wavefront from the subendocardium toward the subepicardium. However, whether wavefront progression of necrosis also occurs laterally has been disputed. We aimed to assess the transmural and lateral spread of myocardial damage after acute myocardial infarction in humans and to evaluate the impact of metoprolol on these. Methods: We assessed myocardial infarction in the transmural and lateral dimensions in a cohort of 220 acute ST-segment elevation myocardial infarction (STEMI) patients from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction). The patients underwent cardiac magnetic resonance imaging at 5 to 7 days and 6 months post-STEMI. Results: On day 5 to 7 post-STEMI cardiac magnetic resonance, there was a strong linear correlation between the transmural and lateral extent of infarction (delayed gadolinium enhancement) (r = -0.88; P <.001). Six months after STEMI, myocardial scarring (delayed gadolinium enhancement) was significantly less extensive in the transmural and lateral dimensions, suggesting that infarct resorption occurs in both. Furthermore, progression in both directions occurred both in patients receiving metoprolol and control patients, implying that myocardial salvage occurs both in the transmural and the lateral direction. Conclusions: Our findings challenge the assumption that irreversible injury does not spread laterally. A “circumferential” or multidirectional wavefront would imply that cardioprotective therapies might produce meaningful salvage at lateral borders of the infarct. This trial was registered at ClinicalTrial.gov (Identifier: NCT01311700).

Translated title of the contributionCoexistence of transmural and lateral wavefront progression of myocardial infarction in the human heart
Original languageEnglish
Pages (from-to)870-877
Number of pages8
JournalRevista Espanola de Cardiologia
Volume74
Issue number10
DOIs
StatePublished - Oct 2021
Externally publishedYes

Keywords

  • Cardioprotection
  • Ischemia/reperfusion injury
  • Metoprolol
  • Myocardial infarction
  • Wavefront phenomenon

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