First classification of four stages of heart attack based on heart muscle damage is released
Canadian Cardiovascular Society consensus statement published in the Canadian Journal of Cardiology paves the way for refining treatment and providing individualized care
IMAGE:
SCHEMATIC REPRESENTATION OF THE FOUR STAGES OF THE CANADIAN
CARDIOVASCULAR SOCIETY CLASSIFICATION OF ACUTE ATHEROTHROMBOTIC MYOCARDIAL
INFARCTION ON A MACROSCOPIC HEART.
CREDIT: CANADIAN JOURNAL OF CARDIOLOGY
Philadelphia, October 31, 2023 – Heart attacks, or acute myocardial infarction (MI), are one of the leading causes of death worldwide. The newly released Canadian Cardiovascular Society Classification of Acute Myocardial Infarction (CCS-AMI) appearing in the Canadian Journal of Cardiology, published by Elsevier, presents a four-stage classification of heart attack based on heart muscle damage. This work by a group of noted experts has the potential to stratify risk more accurately in heart attack patients and lays the groundwork for development of new, injury-stage-specific and tissue pathology-based therapies.
Lead author Andreas Kumar, MD, MSc, Northern Ontario School of Medicine University, and Department of Cardiovascular Sciences, Health Sciences North, Sudbury, ON, Canada, explains: “MI remains a leading cause of morbidity and mortality. Existing tools classify MIs using a patient’s clinical presentation and/or the cause of the heart attack, as well as ECG findings. Although these tools are very helpful to guide treatment, they do not consider details of the underlying tissue damage caused by the heart attack. This expert consensus, based on decades of data, is the first classification system of its kind ever released in Canada and internationally. It offers a more differentiated definition of heart attacks and improves our understanding of acute atherothrombotic MI. On a tissue level, not all heart attacks are the same; the new CCS-AMI classification paves the way for development of more refined therapies for MI, which could ultimately result in better patient clinical care and improved survival rates.”
The CCS-AMI classification describes damage to the heart muscle following an MI in four sequential and progressively severe stages. Each stage reflects progression of tissue pathology of myocardial ischemia and reperfusion injury from the previous stage. It is based on a strong body of evidence about the effect an MI has on the heart muscle.
As damage to the heart increases through each progressive CCS-AMI stage, patients have dramatically increased risk of complications such as arrhythmia, heart failure, and death. Appropriate therapy can potentially stop injury from progressing and halt the damage at an earlier stage.
- Stage 1: Aborted MI (no/minimal myocardial necrosis). No or minimal damage to the heart muscle. In the best case the entire area of myocardium at risk may be salvaged.
- Stage 2: MI with significant cardiomyocyte necrosis, but without microvascular injury. Damage to the heart muscle and no injury to small blood vessels in the heart. Revascularization therapy will result in restoration of normal coronary flow.
- Stage 3: MI with cardiomyocyte necrosis and microvascular dysfunction leading to microvascular obstruction (i.e., “no-reflow”). Damage to the heart muscle and blockage of small blood vessels in the heart. The major adverse cardiac event rate is increased 2- to 4-fold at long-term follow-up.
- Stage 4: MI with cardiomyocyte and microvascular necrosis leading to reperfusion hemorrhage. Damage to the heart muscle, blockage and rupture of small blood vessels resulting in bleeding into the heart muscle. This is a more severe form of microvascular injury, and the most severe form of ischemia-reperfusion injury. It is associated with a further increase in adverse cardiac event rate of 2- to 6-fold at long-term follow-up.
Dr. Kumar concludes: The new classification will help differentiate heart attacks according to the stage of tissue damage and allow healthcare providers to estimate a patient’s risk more precisely for arrhythmia, heart failure, and death. The CCS-AMI is ultimately expected to lead to better care, better recovery, and better survival rates for heart attack patients.”
In an accompanying editorial, Prakriti Gaba, MD, Brigham and Women’s Hospital, Harvard Medical School, and Deepak L. Bhatt, MD, MPH, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, comment: “Kumar et al. present a novel and intriguing four-tiered classification scheme of patients with acute MI. This allows unique utilization of prognostic pathologic features to help distinguish between high and low risk acute MI patients. Greater access to cardiovascular magnetic resonance would be needed to implement this new clinical approach broadly, however, for research on emerging diagnostic and therapeutic strategies, it could be implemented immediately.”
JOURNAL
Canadian Journal of Cardiology
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
The Canadian Cardiovascular Society Classification of Acute Atherothrombotic Myocardial Infarction Based on Stages of Tissue Injury: An Expert Consensus Statement
ARTICLE PUBLICATION DATE
28-Oct-2023
Wearable heart monitor ticks all the boxes for better healthcare: Study
IMAGE:
AN ARTIST'S IMPRESSION OF THE RMIT ECG DEVICE, SHOWING THE VARIOUS LAYERS INCLUDING A DRESSING, BLUETOOTH MODULE AND DRY ELECTRODES.
view moreCREDIT: PETER ELANGO, RMIT UNIVERSITY
A new compact, lightweight, gel-free and waterproof electrocardiogram (ECG) sensor offers more comfort and less skin irritation, compared to similar heart monitoring devices on the market.
ECGs help manage cardiovascular disease – which affects around 4 million Australians and kills more than 100 people every day – by alerting users to seek medical care.
The team led by RMIT University in Australia has made the wearable ECG device that could be used to prevent heart attacks for people with cardiovascular disease, including in remote healthcare and ambulatory care settings. While most wearable ECG monitors typically weigh a few hundred grams, the RMIT device weighs only 10 grams.
The latest research is published in AIP Applied Physics Reviews.
Lead author PhD scholar Peter Elango from RMIT said heart attacks often occurred with little or no warning, as signals were difficult to spot without continuous monitoring.
“Nearly half of the people who have heart attacks do not realise what’s happening until it’s too late,” Elango said.
“My dream is a world with zero preventable heart attacks.”
Elango was one of the top 10 competitors at the recent Falling Walls Lab Australia 2023 Final at the Australian Shine Dome in Canberra, where he gave a pitch about the ECG device.
RMIT has filed an international patent (PCT) application to protect the ECG device that the team developed.
“RMIT is exploring ways to translate the work into a commercial product, and we are in discussions with partners regarding potential licensing opportunities,” Elango said.
Optimising design and comfort
Professor Madhu Bhaskaran, Deputy Director (Research) of the ARC Hub for Connected Sensors for Health at RMIT said the team’s focus was on improving the electrode design and materials for increased performance as well as comfort.
“Commercially available wearable ECG devices are usually bulky, heavy and have 12 ‘wet’ electrodes connecting the patient to the device, whereas the RMIT invention can fit in the palm of your hand,” Bhaskaran said.
“The device has just three ‘dry’ electrodes that are almost invisibly thin, can sense even the slightest signals of a heart in distress, and can also be recycled.”
Wet electrodes contain a conductive gel to increase cardiac signals, while dry electrodes do not need this gel to operate effectively.
“Wet electrodes are uncomfortable, dry out over time and have been known to cause skin irritation,” Bhaskaran said.
The team’s experiments tested the RMIT miniaturised three-electrode ECG device’s sensing performance against a 12-electrode wearable monitor on the market, demonstrating a comparable level of precision in capturing the heart’s electrical activity.
“The RMIT device efficiently captures the heart’s activity, whether the user is at rest or experiencing stress,” Bhaskaran said.
Enabling continuous monitoring
ECG data recorded over time helps obtain important diagnostic information concerning the activity of the patient's heart.
To conduct continuous monitoring, Elango said dry electrodes offered some significant advantages.
“Dry electrodes prioritise user comfort, remain durable over time and reduce the likelihood of skin irritation,” Elango said.
“The electrodes are also hydrophobic, meaning they don’t get wet, and so a user can wear the device while they do activities in the water such as swimming and showering – unlike other ECG monitors.
“These attributes make them ideal for continuous monitoring – a crucial feature for wearable ECG devices.”
After extensive experimentation, the team discovered that a hexagonal design was the “winning formula”, as it suits the curvy nature of skin and active lifestyles and more accurately captures ECG signals, compared with other wearable devices on the market.
“The device can capture ECG signals even when it is fitted behind a person’s neck – ideal for patients in the aged care sector, including for someone with dementia who may remove it from their chest.”
But it wasn't all about design aesthetics, Elango said.
“We also dived into the nitty gritty of how different body areas influence ECG measurements. This yielded valuable insights to enhance sensor performance,” he said.
“The dry electrodes, which are less than one tenth the width of a human hair, are highly sensitive to the cardiac signals of the user.”
Support for the research
This work was performed in part at the Micro Nano Research Facility at RMIT in the Victorian Node of the Australian National Fabrication Facility (ANFF). The team acknowledges the support and funding from the Cooperative Research Centres Projects and ARC Research Hub for Connected Sensors for Health.
RMIT led this research in collaboration with Dr Sherly Elango from Annamalai University in India.
The paper ‘Dry electrode geometry optimization for wearable ECG devices’ is published in AIP Applied Physics Reviews (DOI: 10.1063/5.0152554).
You can link directly to the research paper via: Dry electrode geometry optimization for wearable ECG devices | Applied Physics Reviews | AIP Publishing
MULTIMEDIA AVAILABLE
You can watch a short RMIT video about the ECG innovation here: Wearable heart monitor ticks all the boxes for better healthcare | RMIT University - YouTube
The video will be unlisted until tomorrow morning, when it will be made public.
Illustrations/images, a short video and b-roll video footage of the lead researchers and their work are available via this link: https://cloudstor.aarnet.edu.au/plus/s/vJKG0EVCwUBFrGh
JOURNAL
Applied Physics Reviews
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Dry electrode geometry optimization for wearable ECG devices
ARTICLE PUBLICATION DATE
31-Oct-2023
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