Subacute Infarct

Subacute Infarct: Insights from Recent Research

Frequency and Demographics of Subacute Infarcts

Incidence in Population-Based Studies

Subacute cerebral infarcts are relatively rare but significant findings in population-based studies. Research involving 2,095 participants aged 50 to 98 years revealed that subacute infarcts were identified in approximately 0.43% of individuals, with a higher prevalence in those aged 70 years or older. Notably, most of these infarcts were asymptomatic and predominantly found in men with an average age of 76.9 years.

Subacute Myocardial Infarction Complications

Subacute infarcts can also occur in the context of myocardial infarction. In a study of 2,608 patients with acute myocardial infarction, 0.92% developed subacute free wall rupture, a serious complication that often presents with varied clinical manifestations such as shock and severe arrhythmias. Another study highlighted that subacute ventricular wall rupture, a frequent complication post-myocardial infarction, can be accurately diagnosed and successfully treated, with a significant number of patients surviving surgical intervention.

Therapeutic Interventions and Functional Recovery

Hematopoietic Cytokines in Subacute Phase

The administration of hematopoietic cytokines such as granulocyte colony-stimulating factor (G-CSF) and stem cell factor (SCF) during the subacute phase post-cerebral infarction has shown promising results. These cytokines facilitate the proliferation of intrinsic neural stem/progenitor cells and the transition of bone marrow-derived neuronal cells, significantly improving motor performance and higher brain functions compared to acute-phase treatment.

Coronary Angiography Timing in NST-ACS

For patients with non-ST-elevation acute coronary syndrome (NST-ACS), the timing of coronary angiography (CAG) is crucial. A study comparing acute versus subacute CAG found no significant difference in outcomes such as all-cause death, reinfarction, and readmission with congestive heart failure between the two approaches. This suggests that both acute and subacute CAG are viable options, with early identification and triage being essential for effective management.

Diagnostic Challenges and Biomarkers

Echocardiographic and Clinical Criteria

Diagnosing subacute ventricular wall rupture requires a combination of clinical, hemodynamic, and echocardiographic criteria. High diagnostic sensitivity and specificity can be achieved by identifying signs such as cardiac tamponade, pericardial effusion, and right atrial or ventricular wall compression. These combined criteria provide critical information for making therapeutic decisions.

Biomarkers for Venous Infarction

In cases of cerebral venous thrombosis (CVT), biomarkers such as serum claudin-5 and high-sensitivity C-reactive protein (hs-CRP) have been associated with venous infarction. Elevated levels of these biomarkers indicate blood-brain barrier disruption and inflammation, correlating with the severity of clinical symptoms in acute/subacute CVT patients.

Special Considerations

Pseudonormalisation Effect

A phenomenon known as pseudonormalisation can complicate the diagnosis of subacute infarcts. This effect occurs when a previously hypodense infarct appears isodense on repeat imaging due to recent intravenous contrast administration, potentially leading to misinterpretation of the infarct's age and extent.

COVID-19 and Subacute Infarcts

The COVID-19 pandemic has introduced additional complexities in the diagnosis and management of subacute infarcts. Severe systemic ischemia and stroke, including subacute infarcts, have been reported in patients with SARS-CoV-2 infection, underscoring the need for heightened awareness and careful evaluation in these cases.

Conclusion

Subacute infarcts, whether cerebral or myocardial, present unique diagnostic and therapeutic challenges. Population-based studies highlight their prevalence in older adults, particularly men, while advancements in cytokine therapy and timely coronary interventions offer promising avenues for recovery. Accurate diagnosis through combined clinical and imaging criteria, along with the identification of specific biomarkers, is essential for effective management. The ongoing COVID-19 pandemic further emphasizes the need for vigilance in recognizing and treating subacute infarcts in affected patients.

Summary

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