Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair
The past decade has seen a marked expansion in the understanding of the pathobiology of acute myocardial infarction and the systemic inflammatory response that it elicits. At the same time, a portfolio of tools has emerged to characterise some of these processes in vivo. However, in clinical practic...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/14/4668 |
| _version_ | 1797588877727236096 |
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| author | Mohammad Alkhalil Giovanni Luigi De Maria Naveed Akbar Neil Ruparelia Robin P. Choudhury |
| author_facet | Mohammad Alkhalil Giovanni Luigi De Maria Naveed Akbar Neil Ruparelia Robin P. Choudhury |
| author_sort | Mohammad Alkhalil |
| collection | DOAJ |
| description | The past decade has seen a marked expansion in the understanding of the pathobiology of acute myocardial infarction and the systemic inflammatory response that it elicits. At the same time, a portfolio of tools has emerged to characterise some of these processes in vivo. However, in clinical practice, key decision making still largely relies on assessment built around the timing of the onset of chest pain, features on electrocardiograms and measurements of plasma troponin. Better understanding the heterogeneity of myocardial injury and patient-level responses should provide new opportunities for diagnostic stratification to enable the delivery of more rational therapies. Characterisation of the myocardium using emerging imaging techniques such as the T1, T2 and T2* mapping techniques can provide enhanced assessments of myocardial statuses. Physiological measures, which include microcirculatory resistance and coronary flow reserve, have been shown to predict outcomes in AMI and can be used to inform treatment selection. Functionally informative blood biomarkers, including cellular transcriptomics; microRNAs; extracellular vesicle analyses and soluble markers, all give insights into the nature and timing of the innate immune response and its regulation in acute MI. The integration of these and other emerging tools will be key to developing a fuller understanding of the patient-level processes of myocardial injury and repair and should fuel new possibilities for rational therapeutic intervention. |
| first_indexed | 2024-03-11T00:58:15Z |
| format | Article |
| id | doaj.art-f7ce667f79a1483089963dfe98817412 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T00:58:15Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f7ce667f79a1483089963dfe988174122023-11-18T19:52:12ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011214466810.3390/jcm12144668Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and RepairMohammad Alkhalil0Giovanni Luigi De Maria1Naveed Akbar2Neil Ruparelia3Robin P. Choudhury4Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UKCardiology Department, John Radcliffe Hospital, Oxford OX3 9DU, UKDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UKCardiology Department, Hammersmith Hospital, Imperial College London, London W12 0HS, UKDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UKThe past decade has seen a marked expansion in the understanding of the pathobiology of acute myocardial infarction and the systemic inflammatory response that it elicits. At the same time, a portfolio of tools has emerged to characterise some of these processes in vivo. However, in clinical practice, key decision making still largely relies on assessment built around the timing of the onset of chest pain, features on electrocardiograms and measurements of plasma troponin. Better understanding the heterogeneity of myocardial injury and patient-level responses should provide new opportunities for diagnostic stratification to enable the delivery of more rational therapies. Characterisation of the myocardium using emerging imaging techniques such as the T1, T2 and T2* mapping techniques can provide enhanced assessments of myocardial statuses. Physiological measures, which include microcirculatory resistance and coronary flow reserve, have been shown to predict outcomes in AMI and can be used to inform treatment selection. Functionally informative blood biomarkers, including cellular transcriptomics; microRNAs; extracellular vesicle analyses and soluble markers, all give insights into the nature and timing of the innate immune response and its regulation in acute MI. The integration of these and other emerging tools will be key to developing a fuller understanding of the patient-level processes of myocardial injury and repair and should fuel new possibilities for rational therapeutic intervention.https://www.mdpi.com/2077-0383/12/14/4668myocardial infarctionMRIcoronary physiologyinflammation |
| spellingShingle | Mohammad Alkhalil Giovanni Luigi De Maria Naveed Akbar Neil Ruparelia Robin P. Choudhury Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair Journal of Clinical Medicine myocardial infarction MRI coronary physiology inflammation |
| title | Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair |
| title_full | Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair |
| title_fullStr | Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair |
| title_full_unstemmed | Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair |
| title_short | Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair |
| title_sort | prospects for precision medicine in acute myocardial infarction patient level insights into myocardial injury and repair |
| topic | myocardial infarction MRI coronary physiology inflammation |
| url | https://www.mdpi.com/2077-0383/12/14/4668 |
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