Assessment of iron deposition post myocardial infarction as a marker of myocardial hemorrhage
The invention provides various methods of identifying myocardial infarction (MI) patients who have microvascular obstruction (MO), persistent microvascular obstruction (PMO), reperfusion hemorrhage, iron deposition, chronic iron deposition, and/or fat infiltration/accumulation. The invention provides various methods of identifying myocardial infarction (MI) patients who are at risk of prolonged inflammation burden in heart, adverse cardiac remodeling, electrical abnormality, mechanical abnormality, malignant cardiac arrhythmia, ischemic heart failure, and/or sudden cardiac death. The invention also provides various methods of treating these MI patients with chelation drugs, anti-inflammatory drugs, fat-lowering drugs, cooling therapies, or device therapies, or their combinations.
1. A method of treating a subject having had myocardial infarction (MI) and undergone reperfusion therapy, comprising:
imaging the subject's heart during an acute phase of the myocardial infarction;
identifying persistent microvascular obstructions (PMO) in the subject's heart based on the imaging and administering at least in a chronic phase of the MI a therapeutically effective amount of a therapeutic agent to the subject having been identified with the PMO, based on the knowledge that the identified PMO following the reperfusion therapy leads to iron deposits in the chronic phase, wherein the therapeutic agent is selected from the group consisting of a chelating agent, anti-inflammatory agent, lipid-lowering agent, carbon monoxide therapy, heme-oxygenase regulating drug, an agent capable of promoting heart blood flow, and a combination thereof.
2. The method of claim 1 , further comprising identifying no hemorrhage in the subject's heart.
3. The method of claim 1 , wherein the subject has no hemorrhage in the heart.
4. The method of claim 1 , wherein imaging the subject's heart is performed with cardiac magnetic resonance imaging (CMR), late-gadolinium enhancement CMR (LGE-CMR), cine CMR, T2* CMR, chemical shift-encoded T2* CMR, T2 CMR, T1 CMR, T1ρ CMR, SPECT, PET, CT, or echocardiography (ECG), or a combination thereof.
5. The method of claim 1 , wherein the PMO is identified in the heart's infarcted region, non-infarcted region, myocardial tissue, non-myocardial tissue, myocardium, endocardium, epicardium, pericardium, valvular tissue, non-valvular tissue, pulmonary valve, tricuspid valve, mitral valve, aortic valve, blood vessel, coronary blood vessel, non-coronary blood vessel, coronary artery, cardiac vein, superior vena cava, inferior vena cava, pulmonary trunk, pulmonary artery, pulmonary vein, right pulmonary vein, left pulmonary vein, or aorta, or a combination thereof.
6. The method of claim 1 , wherein the therapeutic agent is a chelating agent.
7. The method of claim 6 , wherein the chelating agent is deferoxamine, deferasirox, or deferiprone, or a combination thereof.
8. The method of claim 1 , wherein the anti-inflammatory agent is a corticosteroid, nonsteroidal anti-inflammatory drug (NSAID), anti-IL-1beta, anti-TNF-a, anti-IL-6, anti-MMP, macrophage modulators, phosphatidylserine-presenting liposomes, NLRP3 inflammasome inhibitor, 16673-34-0 (5-chloro-2-methoxy-N-[2-(4-sulfamoylphenyl)ethyl]benzamide)), inflammasome antagonists, anti-diabetic medication, insulin, metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, or glucagon-like peptide-1 analog.
9. The method of claim 1 , wherein the lipid-lowering agent is a statin, cholesterol absorption inhibitors, bile-acid-binding resins/sequestrants, niacin or vitamin B3.
10. The method of claim 1 , wherein the agent capable of promoting heart blood flow is a coronary vasodilator.
11. The method of claim 1 , further comprising imaging the subject's heart during the chronic phase of the MI,
identifying the iron deposits and/or fat accumulation in the subject's heart.
12. The method of claim 11 , wherein the iron deposits are 5Fe 2 O 3 .9H 2 O with iron in Fe(III) state.
13. The method of claim 11 , wherein the iron deposits are iron oxide nanocrystals in ferric state.
14. The method of claim 1 , wherein administering in the chronic phase comprises administering from 10 days to 15 days, from 15 days to 20 days, from 20 days to 25 days, from 25 days to 30 days, or from 56 days to 6 months following the reperfusion therapy.