Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A14942-A14942, November 8, 2022. Background, hypothesis:Gyrencephalic large-animal models of acute ischemic stroke (AIS) such as swine gain attention in translating preclinical to clinical stroke research, with brain anatomy similar to humans. Most swine models employ young animals with AIS by permanent occlusion (P-AIS). This does not reflect the, often elderly, stroke patient. Therefore, recanalized AIS (R-AIS) in adult mini-pigs could improve preclinical to clinical translation.Methods:Anesthetized adult (2 yrs) Aachen mini-pigs (n=6) underwent craniotomy to occlude right-side middle cerebral arteries (MCA) with aneurysm clips. Clips were released at 4 hrs to allow recanalization for 2-4 hrs (R-AIS, n=4) or left in place until sacrifice (P-AIS, n=1). 3D angiography confirmed occlusion and recanalization. Infarct size was determined by TTC staining and expressed as % infarct per hemisphere (median, min-max). Qualitative neurovascular histology was performed in HE-stained sections of ischemic and remote (contralateral) tissue.Results:All animals survived until end-of-procedure. In 4 of 5 animals R-AIS successfully induced cortical infarcts (infarct size, 16.2% [9.1%-25.2%]). R-AIS was unsuccessful in 1 animal, with a smallstriatuminfarct (2.7%) without cortical involvement and unclear angiographic occlusion. P-AIS (n=1) resulted in 12.7% infarct. Assessment of ischemic (TTC-neg) tissue revealed characteristic histology of ischemia/reperfusion-derived neurovascular damage, including erythrocyte extravasation, vasostasis, increased perivascular space and intravascular platelet/fibrin aggregates (Figure 1) in all animals. Remote tissue did not show any of these features.Conclusions:Adult Aachen mini-pigs can be used for acute ischemic stroke modelling and display characteristic neurovascular features associated with ischemia and reperfusion. They may serve as a model for translational therapeutic neuro(vascular)-protective research.

Circulation, Volume 146, Issue Suppl_1, Page A12589-A12589, November 8, 2022. Introduction:Left ventricular (LV) unloading by percutaneous ventricular assist device (pVAD) reduces myocardial workload and oxygen consumption and provides a new concept for improving outcome for acute myocardial infarction complicated with cardiogenic shock (AMI-CS). AMI results in reduced LV ejection fraction and left atrium remodeling, and increased the incidence of atrial fibrillation. The aim of this study is to investigate the effectiveness of LV unloading by pVAD in terms of mid-term mortality, LV function, and the incidence of atrial fibrillation.Methods:We retrospectively reviewed AMI-CS patients who were admitted to our hospital between July 2014 and December 2021. We investigated patient demographics and baseline characteristics, mid-term clinical outcome, re-admission rate as well as new-onset atrial fibrillation compared between the patients supported with pVAD and without pVAD group during 180-day follow-up.Results:A total of 82 AMI-CS patients treated with pVAD (n=54) or without pVAD (n=28) were analyzed. Mean age was 70±15 years old and 56 patients were male. Door to balloon time (110±56min vs. 91±53min, p=0.33) and Peak CK-MB (471.8±338mg/dl vs. 486.0±545mg/dl, p=0.43) were similar in both groups. During the 180-days follow-up, 23 patients died and 12 patients were re-hospitalized for heart failure (HF). New-onset atrial fibrillation occurred in 16 patients, which was significantly less frequent in pVAD group (11% vs. 36%. p=0.016). Between baseline and 180-days follow-up period, changes of LV ejection fraction (16% vs. 6%, p=0.02) and NT-proBNP (-28% vs. -5%, p=0.03) were significantly higher in pVAD group. There was no significant difference in 180-day all-cause mortality (28% vs. 29%, p=1.0) between the two groups. Multivariate logistic regression showed new-onset atrial fibrillation was independently associated with an increased risk of HF readmission (hazard ratio 2.63, 95% confidence interval 1.91-3.57; p=0.01).Conclusion:pVAD support preserves LV function following ventricular unloading and reduces new-onset atrial fibrillation, which might be contributed to the improvement of mid-term outcome.

Circulation, Volume 146, Issue Suppl_1, Page A13029-A13029, November 8, 2022. Introduction:Acute Myocardial Infarction (AMI) contributes to a significant cardiovascular related deaths in the general population. AMI is a life-threatening condition that occurs when the blood supply to the myocardium is abruptly cut-off due to blockage in coronary arteries resulting in tissue infarction. AMI is associated with high morbidity and mortality (up to 34-42%). We hypothesized that with recent advancements in reperfusion therapy and techniques for treating arrhythmias and pump failure, the mortality rates might show downward trends.Methods:In this retrospective observational study, death certificate data was retrieved from the Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (WONDER) database from 2001 to 2020. WONDER database identifies the underlying cause of death. Mortality for AMI including anterior, posterior, inferior wall, or unspecified (ICD-10 121.0; 121.1; 121.2; 121.3; 121.4; 121.9) as an underlying cause of death was queried from 2001 to 2020. This study duration was further divided into five-year periods. Crude mortality rate and age-adjusted mortality rate per 100,000 deaths (with a 95% confidence interval) were calculated for four U.S. census regions to explore regional variations (CR-1 Northeast; CR-2 Midwest; CR-3 South; CR-4 West).Results:The overall age-adjusted mortality rate (AAMR) decreased from 58.0 to 27.1 per 100,000 deaths (53.5%) in the years 2001-2005 to 2016-2020 as illustrated in the figure 1. AAMR showed a comparable downward trend in all 4 U.S. census regions (Figure 1).Conclusions:From 2001 to 2020 AAMR showed a downward trend which may indicate an improvement in AMI patient care with evolving guidelines based therapeutic interventions. Limitations of this study include intrinsic weakness of the WONDER dataset (Changes with ICD-9 to ICD 10 codes, and potential miscoding) which may need further discovery.

Circulation, Volume 146, Issue Suppl_1, Page A11880-A11880, November 8, 2022. Introduction:We evaluated differential contribution of the left atrial (LA) function by cardiovascular magnetic resonance (CMR) and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and reperfused acute myocardial infarction (AMI).Hypothesis:The differential role of the LA function and LV fibrosis indices for pulmonary pressure elevation would be different in various myocardial diseases and there would be a predictive value in addition to the conventional echocardiographic parameters.Methods:Data of 370 patients with HCM (n=133), DCM (n=114) and reperfused AMI (n=123) who underwent both echocardiography and CMR were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), LA stiffness index, defined as E/e’/LA-GLS and extracellular volume fraction (ECV) of LV were measured using CMR.Results:E/e’ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The LA stiffness index was related to PASP in HCM (p=0.01) and DCM (p=0.03) independent of LA volume index and E/e’, but not in AMI. In DCM, ECV was significantly related to PASP (p

Circulation, Volume 146, Issue Suppl_1, Page A9970-A9970, November 8, 2022. Introduction:Accountable Care Organizations (ACOs) aim to improve quality and reduce costs of care, but few studies have described variation across ACOs in hospitalization rates for patients with heart failure (HF) or factors associated with hospitalization rates.Methods:We identified a sample of Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program (MSSP) ACO in 2017 and survived at least 30 days into 2018. Using a hierarchical, negative binomial model that accounted for clustering of patients within ACOs, we calculated 2018 risk-standardized, unplanned ACO admission rates (RSAARs) as the ratio of predicted to expected admissions per 100 persons, multiplied by the overall rate of admissions. We then used multiple linear regression to identify ACO characteristics associated with RSAAR variation.Results:Among 1,232,222 beneficiaries with HF, 283,795 were assigned to one of 467 MSSP ACOs (mean age 81 years, 54% female, 86% white, 78% urban). Median RSAAR [IQR] was 87 [82-92] admissions per 100 persons (Figure 1). A 5% increase in the percentage of Black beneficiaries in the ACO corresponded to an increase of 0.65 admissions per 100 HF patients (95% CI 0.31, 0.99, p

Circulation, Volume 146, Issue Suppl_1, Page A10470-A10470, November 8, 2022. Introduction:In the ODYSSEY OUTCOMES trial, alirocumab improved cardiovascular outcomes and reduced death after acute coronary syndrome (ACS). Median follow-up was 2.8 yrs (range 2-5). The effects of alirocumab on long-term survival are unknown.Objective:To calculate projected life span and potential survival gains with alirocumab vs placebo after ACS using validated nonparametric age-based methods.Methods:In ODYSSEY OUTCOMES (NCT01663402), 18,924 patients with recent ACS and elevated atherogenic lipoproteins despite high-intensity or maximum-tolerated statin therapy were randomized to alirocumab or placebo. All-cause death was a secondary trial outcome. Age-based estimates of projected survival and event-free (all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke) survival were calculated. In each treatment arm at every year of age, lifespan was estimated from area under the survival curve, to a maximum of 85 yrs. Differences in areas under the survival curves provide an estimate of the benefit of alirocumab on survival.Results:Mean (SD) baseline age was 58.5 (9.3) yrs. Mean survival benefits with alirocumab vs placebo ranged from 0.03 to 1.62 yrs, decreasing with age and becoming neutral at age 80-85 yrs. For example, at age 40, estimated survival was another 37.5 yrs with alirocumab and 35.9 yrs with placebo (difference 1.62 yrs [95% CI, 0.30-2.94];P=0.016). At age 60, it was 20.5 vs 19.6 yrs (difference 0.88 [95% CI, 0.16-1.61];P=0.017); at age 75 it was 8.8 vs 8.3 (difference 0.57 [0.09-1.05];P=0.019); and at age 80, it was 4.5 vs 4.5 years (difference 0.03 [-0.28 to 0.35];P=0.83). Mean event-free survival benefit similarly ranged from 1.85 to 0.0 yrs.Conclusions:Modeling suggests that long-term treatment with alirocumab may result in a meaningful increase in survival among patients less than 80 yrs of age. This analysis may facilitate shared decision-making with patients.Funding:Sanofi, Regeneron Pharmaceuticals

Circulation, Volume 146, Issue Suppl_1, Page A14170-A14170, November 8, 2022. Background:The ratio of early transmitral filling velocity to early diastolic strain rate (E/e’sr) has been proposed as a new measurement of left ventricular filling pressure. We aimed to investigate the ability of E/e’sr to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI).Methods:This was a prospective cohort study of patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmittal early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (e’sr) was measured by speckle tracking of the left ventricular. The E was indexed to e’sr to obtain the E/e’sr as well as to the early myocardial relaxation velocity to obtain the E/e’. The endpoint was new-onset AF.Results:During follow-up (median 5.6 years, IQR:5.0-6.1), 23 of the 369 patients developed AF. In unadjusted analyses, both E/e’sr and E/e’ were significantly associated with AF [E/e’sr: HR=1.06; (1.03-1.10); p

Circulation, Volume 146, Issue Suppl_1, Page A15618-A15618, November 8, 2022. Introduction:Several studies have described trends toward increasing complexity and illness-severity of patients admitted to the cardiac intensive care units (CICU). This has necessitated the development of training pathways in critical care cardiology (CCC). Hybrid training in combinations of interventional cardiology (IC), advanced heart failure and transplant cardiology (AHFTC), and CCC have also gained interest. This review sought to outline current and proposed pathways for hybrid training in acute cardiovascular care.Methods:We performed a systematic review of articles describing training pathways for dual certification in CCC, as well as hybrid models for training in a combination of IC, CCC, and AHFTC. PubMed, EMBASE, and CINAHL were searched from 01/01/2000 to 04/28/2022. Pathways through pediatric and adult non-internal medicine specialties were excluded.Results:Of 2,236 citations, 18 studies were included in the final analysis. Most pathways included sequential CCC training, i.e. traditional cardiovascular fellowship and 1-2 additional years of critical care medicine, although integrated 4-year programs were noted to be emerging. Hybrid models for advanced training in two or more complementary subspecialties, including CCM, AHFTC, and IC, have been described, each with their own strengths and limitations. Additional expertise in advanced therapies such as mechanical circulatory support, the longitudinal AHFTC practice, and the combination of procedural and intensivist skills for management of diseases such as acute coronary syndromes were the stated benefits of these combined models. Alternatively, some advocate for incorporating focused CC training into a single year of IC or AHFTC fellowship. However, this may limit the time required to gain expertise in all areas of advanced training and is insufficient for board certification in CCM.Conclusion:Despite the growing need, there are limited dedicated pathways to train the contemporary acute care cardiologists. Further study is needed to consolidate training to encourage the growth and development of this field.

Circulation, Volume 146, Issue Suppl_1, Page A11958-A11958, November 8, 2022. Introduction:Although there is robust evidence for the superiority of contemporary femoropopliteal (FP)-specific devices to traditional therapy using non-coated balloon or bare metal stent, cohesive reports on the incidence of acute thrombotic occlusion (ATO) after endovascular therapy (EVT) with contemporary FP devices are scarce. This study investigated the incidence of ATO and its predictors after contemporary FP-EVT for peripheral artery disease.Methods:We retrospectively examined 763 limbs (chronic limb-threatening ischemia [CLTI]: 44%, involving popliteal arterial lesion: 44%) in 644 patients (mean age: 75±9 years, male: 71%, hemodialysis: 34%) who successfully underwent EVT with contemporary FP devices (drug-coated balloon [DCB]: n=235, scaffold: n=528 [drug-coated stent: n=220, stent graft: n=158, drug-eluting stent: n=150]) from June 2012 to July 2020. The outcome measure was ATO defined as acute onset of claudication and/or signs of CLTI in combination with angiographic evidence of occlusive thrombus formation within the treated segment. Cox proportional hazards regression models were used to identify baseline characteristics associated with the incidence of ATO after contemporary FP-EVT.Results:The 24-month incidence of ATO in the overall population was 4.3±0.8% (DCB: 1.0±0.7% versus scaffold: 5.8±1.1%, P

Circulation, Volume 146, Issue Suppl_1, Page A15591-A15591, November 8, 2022. Introduction:Ryanodine receptor 2 (RyR2) hyperactivity is commonly observed in structural heart diseases that are a result of ischemia or heart failure. It results in abnormal calcium handling and calcium leak that can trigger arrhythmias. Dantrolene, a RyR inhibitor, is used to prevent calcium leak from RyR1 in skeletal muscles.Hypothesis:Suppressing RyR2 hyperactivity with acute dantrolene treatment can reduce arrhythmia burden in human hearts.Methods:Human donor hearts that were not used in transplantation were obtained and 1 cm3cubes were isolated from the left ventricle. Slices at 400 μm thickness were generated from these cubes, pinned and perfused with Tyrode’s solution in a recording tissue chamber. Pseudo-ECGs were recorded with ECG electrodes and the slices were optically mapped to measure conduction velocity (CV), action potential duration (APD) and calcium transient duration (CaTD). After an initial 30 min equilibration period, baseline optical recordings were obtained. Slices were then treated with 1) Isoproterenol (Iso, 250 nM) to stimulate β-adrenergic receptors, 2) Caffeine (200 μM) for RyR2 receptor activation and 3) Dantrolene (10 μM), sequentially. Dual optical recordings, Vm and Ca, were obtained after each treatment.Results:Substrate: Iso reduced APD (425±36 vs 394±43, p=0.03), as expected, and addition of Caffeine restored APD to baseline. More importantly, addition of Dantrolene prolonged APD even further (460±90, p=0.04). CaTD was also similarly reduced by Iso (445±48 vs 387±25, p=0.04) and restored to baseline by Caffeine+Iso. No significant changes in CV were measured under any condition. Trigger: In slices where PVCs were inducible, Caffeine+Iso increased occurrence of PVCs (20 vs 53 PVCs/min) while addition of Dantrolene reduced PVC incidence (18 PVCs/min).Conclusions:Dantrolene treatment, acutely reversed proarrhythmogenic substrate and reduced triggers and could therefore be a suitable approach for anti-arrhythmic therapy in patients with structural heart disease. Additionally, human LV slice preparation is useful in antiarrhythmic drug studies.

Circulation, Volume 146, Issue Suppl_1, Page A11248-A11248, November 8, 2022. Introduction:Patients with acute coronary syndromes (ACS) are known to have a higher risk of target vessel revascularization after percutaneous coronary intervention (PCI) and worse long-term prognosis than patients with stable angina. Neoatherosclerosis is one of the significant factors at very late stent thrombosis. And the presence of in-stent neoatherosclerosis is independently associated with major adverse cardiac event. Although many studies have been reported on neoatherosclerosis, few have been reported on short-term in-stent neoatherosclerosis. Moreover, none have evaluated the impact of ACS. We investigated the impact of ACS on in-stent neoatheroscrelosis using Optical Coherence Tomography (OCT) in the present study.Methods:From March 2017 to November 2020, we investigated 102 patients (122 lesions) who had undergone PCI using drug eluting stent during that period and were followed up for OCT within one year. Subjects were categorized as ACS or non-ACS according to clinical findings at the time of target lesion intervention. We used OCT to investigate the presence of early in-stent neoatherosclerosis.Result:ACS group consisted of 21 (20.6%). In patients with ACS, women tended to be more common (38% vs 19%,P=0.0777). There were no differences in age or presence of diabetes or dyslipidemia during treatment. There were also no significant differences in LDL-C levels at the time of PCI (88 (73-114) mg/dL vs 100 (85-124) mg/dL,P=0.319) and when observed by OCT (67 (55-81) mg/dL vs 68 (57-89) mg/dL,P=0.622). The ACS group was significantly more likely to have a previous history of ACS (38% vs 12%,P=0.0104). Stent length was significantly shorter in ACS patients (24 (18-28) mm vs 32 (23-38) mm,P=0.0365). The mean dulation from PCI was 292 days. In-stent neoatherosclerosis was more frequent in the ACS group (31.8 % vs 9.9 %,P=0.014).Conclusion:This observational study using OCT indicates that stenting for ACS lesion is associated with early in-stent neoatherosclerosis.

Circulation, Volume 146, Issue Suppl_1, Page A11269-A11269, November 8, 2022. Introduction:There have been efforts to accurately measure adherence to ticagrelor to identify suboptimal medication therapy in the first year post-ACS as nonadherence during this crucial period is a major obstacle to optimizing clinical outcomes. Our study aims to examine ticagrelor adherence and persistence using different methods to better understand adherence patterns.Methods:We conducted a retrospective cohort study of patients aged ≥65 years who had filled a ticagrelor prescription within 7 days post-ACS discharge in Ontario, Canada between 4/2014-3/2018. We estimated mean proportion of days covered [PDC], the proportion of patients with “good” adherence of PDC≥80%, both at 1 year and the proportion of patients who were persistently taking ticagrelor at 1-year, using permissible gaps between prescriptions of 3, 7, 14 and 30 days.Results:There were 9,763 ticagrelor users (mean age 73.6; 65.4% men). The mean 1-year PDC (±SD) was 80.8±29.2, while only 73.0% of the cohort showed good adherence (PDC≥80%). Using a permissible gap definition of 14 days, only 55.7% of patients were persistent with ticagrelor in the year post-ACS. The 1-year persistence rates were as high as 62.6% with an allowable gap of 30 days and as low as 49.7% for a 7-day gap and 39.3% for a 3-day gap.Conclusions:Adherence and persistence estimates varied widely based on the definition used. While the PDC estimates implied reasonable 1-year ticagrelor adherence, PDC methods overestimated continuous use of ticagrelor, yet persistence methods with small gaps were likely too stringent. Readers of adherence and persistence studies should pay close attention to the methods and definitions used.

Circulation, Volume 146, Issue Suppl_1, Page A10851-A10851, November 8, 2022. Introduction:Patients are at high risk for a recurrent cardiovascular (CV) event in the first year following acute coronary syndrome (ACS). Low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for recurrent CV events. Despite the availability of lipid-lowering therapies (LLT), many patients fail to achieve guideline recommended LDL-C

Circulation, Volume 146, Issue Suppl_1, Page A9747-A9747, November 8, 2022. Introduction:While gastrointestinal (GI) bleeding is a possible surgical complication, there is a paucity of information on the incidence and risk among Acute Myocardial Infarction (AMI) patients undergoing Coronary artery bypass graft surgery (CABG).Methods:We queried the 2019 National Inpatient Sample to identify cases of GI bleeding among AMI patients undergoing CABG. Patient characteristics and risk factors were estimated using multiple logistic regression.Results:Our analysis found that 48590 patients with AMI underwent CABG, and 865 (1.8%) gastrointestinal bleeding events were recorded. It was more prevalent among Whites (aOR 1.462, p=0.012) and Hispanics (aOR 2.436, p60 (aOR 1.591, p

Circulation, Volume 146, Issue Suppl_1, Page A13575-A13575, November 8, 2022. Introduction:Patients who present to the hospital with acute coronary syndromes (ACS) often have poor control of cardiac risk factors. Multiple studies have demonstrated that lipid lowering therapy is not appropriately initiated or intensified in these patients.Hypothesis:We hypothesized that an interruptive alert delivered via the electronic medical record would increase the initiation and intensification of lipid lowering therapies.MethodsUsing Epic EHR (Epic Systems, Verona, WI), an interruptive alert was designed to trigger upon opening the patient’s chart when the patients were admitted with an ICD code that indicated an ACS (i.e., STEMI, NSTEMI, or Unstable Angina). The alert included an order set to obtain a cholesterol panel or if a cholesterol panel had already been collected it would be displayed and suggest modifications to the patient’s current medication regimen. These alterations included statin intensification or the addition of ezetimibe.ResultsBetween September 1, 2021 and May 30, 2022 172 unique patients were identified. The mean age was 64.8 ±13.8 years, 64.5% were male, 74% were white, and 12% were black. The identified patients had multiple comorbidities including cerebrovascular disease (23%), heart failure (47%), peripheral vascular disease (30%), and being a current or former smoker (53%). The triggered order set had a direct effect on 42 (24%) patients, with 10 initiating ezetimibe and 32 having their statins intensified. The most common indicated reason for overriding the alert (n=99) was not meeting criteria. Of these 99 patients, 4 were ultimately started on ezetimibe, 57 had their statin intensified, and 23 were appropriately excluded (including patients with type II myocardial infarctions who were not the target of this intervention). Of note, 15 patients should have received intensified therapy but had their alert over ridden.ConclusionsThis targeted alert led to direct intensification of lipid lowering therapy in 24% of ACS patients with an additional 35% of patients identified by the alert also having therapeutic intensification. This alert will remain in place to allow for further assessment of its effects and can be easily translated to other clinical systems.

Circulation, Volume 146, Issue Suppl_1, Page A11914-A11914, November 8, 2022. Introduction.Resident tissue macrophages (RTM) are essential cellular hubs regulating tissue homeostasis beyond their classical immune surveillance functions. Of note, after acute myocardial infarction (AMI), cardiac RTM have been shown to inhibit fibrosis, promote angiogenesis, and foster the anti-inflammatory response to injury by interacting with other immune cell types, such as monocytes and T lymphocytes, to drive them towards pro-healing phenotypes.Hypothesis.Using Single Cell RNA Sequencing, we identified a new subpopulation of cardiac RTM characterized by the expression of VSIG4 (B7 family-related protein V-set and Ig domain-containing 4). In this work, we hypothesized that VSIG4+ RTM display protective function in the infarcted heart.Method and results.Visg4deficient mice showed adverse cardiac remodeling and worsened cardiac function at day 14 and 28 after the onset of ischemia when compared to their wild-type littermates. Echocardiography-based transthoracic injection of FACS-sorted cardiac VISG4+ macrophages into infarcted hearts 2 weeks post-AMI, improved cardiac function in both WT andVsig4-/- mice, underlying the protective role of VSIG4+ RTM in this pathological setting. Conversely, injection ofVsig4-/- macrophages impaired cardiac function in WT andVsig4-/- animals. VSIG4 deficiency is associated with a higher number of neutrophils, inflammatory monocytes and macrophages but also with a reduction in the amount of CCR5+ regulatory T lymphocytes in the cardiac tissue without any changes in blood, bone marrow and spleen. In cultured peritoneal macrophages, a prototypical example of RTM, IL4 and IL13 stimulation improved VSIG4 mRNA and protein levels through IL4 receptor alpha and IL13 receptor alpha1 activation. IL4 and IL13 treatment also increased secretion of CCL3 and CCL4, two chemokine ligands of CCR5, these effects were blunted in VSIG4 deficient macrophages.Conclusion.VSIG4+ RTM are key regulators of cardiac remodeling after AMI likely through their ability to hamper inflammation and recruit protective regulatory T cells in infarcted heart.