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Sample records for intravenous myocardial contrast

  1. Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Weihui SHENTU; Yuhan WU; Youbin DENG; Runqing HUANG; Peng LI; Xiang WEI; Haoyi YANG; Yun ZHANG; Li XIONG; Fen YU

    2008-01-01

    The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions: homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.

  2. Assessment of myocardial perfusion by myocardial contrast echocardiography combined with intravenous infusion of levovist in patients with post-myocardial infaction%利声显经静脉心肌声学造影评价心肌梗死后患者的心肌灌注

    Institute of Scientific and Technical Information of China (English)

    仲肇舒; 孔繁荣; 张新琳; 朱正明

    2001-01-01

    Objective To evaluate myocardial perfusion by myocardial contrast echocardiography (MCE) with intermittent harmonic power Doppler imaging combined with intravenous infusion levovist in post-myocardial infaction patients.Methods The study was performed with a HP Sonos 5500 during intravenous infusion levovist (300 mg/ml, 2 ml/min) using harmonic power Doppler mode twenty-five post-myocardial infaction patients [mean age (67±7) years, 21 males]. The imaging was acquired during end-systolic triggering at intervals of 1∶4 beats. Using a 16 segments model, myocardial perfusion both in gray and power Doppler was scored as 0(contrast deficit),0.5(partial and non-homogenous contrast), 1(complete and homogenous contrast).Results ①Compared with baseline, heart rate and blood pressure didn′t show significant changes after MCE.There were no signs and symptoms in all patients during MCE.②Myocardial perfusion was detectable in all the patients. ③Intravenous infusion Levovist(300 mg/ml, 2 ml/min) using intermittent harmonic power Doppler model resulted in 4~5 minites of left ventricular opacification and avoided the attenuation.Conclusions Myocardial perfusion was detectable by using intravenous infusion Levovist with intermittent harmonic power Doppler imaging. MCE thus may be a clinically useful technique for the detection and quantification of coronary artery disease at rest.%目的 心肌造影超声心动图(MCE)采用触发谐频能量多普勒显像模式并用静脉持续输注利声显,观察心肌梗死后患者的心肌灌注情况。方法 使用谐频频率 1.8~3.6 MHz的能量多普勒模式,于心电图T波终末处,按1∶4心动周期进行触发。利声显浓度为300 mg/ml,采用微量输液泵将所配心肌造影剂于患者左肘静脉内持续输注4 min(2 ml/min)。观察25例心肌梗死后患者的血压和心率变化并对心肌灌注情况进行半定量分析。结果 ①MCE前后,患者血压和心率

  3. Use of intravenous dipyridamole in thallium 201 myocardial perfusion imaging

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    Zeller, F.P.; Blend, M.J.

    1987-01-01

    Thallium 201 myocardial perfusion imaging is a standard method of evaluating regional myocardial blood flow. Myocardial perfusion is best evaluated at rest and during exercise, however, alternative methods have been sought to increase coronary blood flow in patients incapable of performing adequate exercise. A promising new method is the use of intravenous dipyridamole for pharmacologic stress imaging. It has distinct advantages over traditional treadmill exercise testing. The primary advantage of combining intravenous dipyridamole and thallium 201 is for testing patients in whom exercise is impractical or contraindicated. Examples include patients taking beta blockers and those who have had myocardial infarction or have severe peripheral vascular disease. To date, this agent has been available only to clinical investigators in approved protocols. With continued success, it should be approved for general use in the near future. 33 references.

  4. An Experimental Study of Myocardial Viability with Myocardial Contrast Echocardiography

    Institute of Scientific and Technical Information of China (English)

    张稳柱; 查道刚; 成官迅; 杨绍青; 刘伊丽

    2001-01-01

    Background Myocardial blood flow(MBF) can be quantified with myocardial contrast echocardiography (MCE) during a venous in fusion of microbubble. A minimal MBF is required to maintain cell membrane integrity and myocardial viability in ischemic condition. Thus, we hypothesized that MCE could be used to assess myocardial viability by the determination of MBF. Methods and Results MCE was performed at 4 hours after ligation of proximal left anterior descending coronary artery in 7dogs with constant venous infusions of microbubbles.The video intensity versus pulsing interval plots derived from each myocardial pixel were fitted to an exponential function: y=A(1-e-βt), where y is Ⅵ at pulsing interval t, A reflects rnicrovascular cross- sectional area (or myocardial blood volume), and β reflects mean myocardial microbubble velocity. The product of A · β represents MBF. MBF was also obtained by radiolabeled microsphere method servered as reference.MBF derived by radiolabeled microsphere- method in the regions of normal, ischemia and infarction was 1.5±0.3, 0.7±0.3, 0.3±0.2mL·min-1· g-1respectively. The product of A · β obtained by MCE in those regions was 52. 46 ± 15.09, 24.36 ± 3.89, 3.74± ± 3.80 respectively. There was good correlation between normalized MBF and the normalized A · β (r =0. 81, P = 0. 001 ). Conclusions MCE has an ability to determine myocardial viability in myocardial in farction canine model.

  5. QUANTITATIVE ASSESSMENT OF MYOCARDIAL PERFUSION DEFECTS WITH REAL-TIME THREE-DIMENSIONAL MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

    Institute of Scientific and Technical Information of China (English)

    Lei Zhuang; Ming-xing Xie; Wei-juan Wang; Xiang-xin Yang; Tao Liu

    2006-01-01

    Objective To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3 DE).Methods RT3DE was performed in 21 open-chest mongrel dogs undergoing acute ligation of the left anterior descending artery (LAD,n=14) or distal branch of the left circumflex artery (LCX,n=7).A perfluorocarbon microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with Philips Sonos7500 ultrasound system. Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. In vitro anatomic measurement of myocardial mass after removal of the animal's heart was regarded as the control. Blinded off-line calculation of left ventricular mass and perfusion defect mass from RT3DE images were performed using an interactive aided-manual tracing technique.Results Total left ventricular (LV) myocardial mass ranged from 38. 9 to78.5 (mean±SD: 60.0±10.1)g. The mass of perfusion defect ranged from 0 to 21.4 (mean±SD: 12.0±5.0) g or 0 to 27% of total LV mass (mean±SD: 19%±6%). The RT3DE estimation of total LV mass (mean±SD: 59.8±9.9 g) strongly correlated with the anatomic measurement (r=0.98; y=2.01+0.96x). The CE-RT3DE calculation of the mass of underperfused myocardium (mean±SD: 12.3±5.3 g) also strongly correlated with the anatomic measurement (r=0.96; y=0.10+1.04x) and when expressed as percentage of total LV mass (r=0.95; y=-0.20+1.04x).Conclusions RT3DE with myocardial contrast opacification could accurately estimate underperfused myocardial mass in dogs of acute coronary occlusion and would play an important role in quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.

  6. Real-time myocardial contrast echocardiography and its applications in evaluation for coronary artery disease

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    杨莉

    2004-01-01

    It is important to assess myocardial perfusion in the diagnosis, treatment and risk stratification of patients with coronary artery disease. At present, single-photon emission computed tomography (SPECT) is used to evaluate myocardial perfusion, but it is limited by relatively low spatial resolution, the need to inject radioisotopes, and not being able to be performed at the patient ' s bedside. Using intracoronary injection of ultrasound contrast agent, the potential of myocardial contrast echocardiography (MCE) instead of perfusion assessment has been proved in numerous animal and human studies. Recent improvements in contrast agents have resulted in stable microbubbles that, following intravenous administration, traverse the pulmonary circulation and reach the left heart. Combined with the emergence of contrast-specific imaging modalities along with quantitative analytical method, intravenous MCE is now a feasible and promising noninvasive technique for perfusion assessment.

  7. High dose intravenous immunoglobulin may be complicated by myocardial infarction

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    Kolar Vishwanath Vinod

    2014-01-01

    Full Text Available Intravenous immunoglobulin [IVIg] is useful for treating several clinical conditions and is largely considered safe, without major adverse events. Here we report a case of acute ST elevation myocardial infarction associated with high dose IVIg administration in a previously healthy 69-year-old male patient of Guillain Barre syndrome. The case is being reported to emphasize the need for treating physicians to be aware of thrombotic complications associated with IVIg. The thrombotic complications associated with IVIg are reviewed in brief , and the measures to reduce them are discussed.

  8. Adverse reactions to intravenous iodinated contrast media: a prospective study

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    Dhruv J. Modi

    2012-06-01

    Full Text Available Background: Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be sub classified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. This study was done to determine clinical adverse effects of the iodinated contrast media. Methods: Data of 899 consecutive patients at C.U. Shah Medical College and Hospital, Surendranagar, who received sodium meglumine diatrizoate intravenous iodinated contrast media during the period of May 2011 to April 2012, were collected for any adverse drug reactions. Results: Out of 899, 189 patients developed adverse contrast reactions. The incidences of mild, moderate and severe adverse reactions were 19.47%, 1.33% and 0.28%, respectively. There were no differences in the incidence of adverse reactions according to gender (males 21.1%; females 20.7%; p= >0.05 or age (p= >0.05. The incidence of adverse reactions was significantly higher in patients with a history of previous reactions (50% than in those with no history (21.25%; p= <0.05. Conclusions: The skin was the most commonly affected site of reactions. In reactions, mild forms were more common compared to moderate and severe. [Int J Basic Clin Pharmacol 2012; 1(3.000: 211-215

  9. Regional myocardial lidocaine concentration following continuous intravenous infusion early and later after myocardial infarction

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    Zito, R.A.; Caride, V.J.; Holford, T.; Zaret, B.L.

    1982-09-01

    The regional concentration of lidocaine using a double constant infusion technique (250 micrograms/kg/min x 15 minutes followed by 35 micrograms/kg/mg/min x 120 minutes) was studied immediately (2 hours) in seven dogs and 24 hours (six dogs) after myocardial infarction. Tissue levels were determined by gas chromatography and related to regional myocardial blood flow as determined by the radioactive microsphere technique in multiple samples. At 2 hours after infarction a significantly higher lidocaine concentration (4.1 +/- 0.42 micrograms/g) was found in zones with greatly reduced blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that (2.6 +/- 0.19 micrograms/g) in zones with normal blood flow (regional myocardial blood flow greater than 0.8 ml/min per g) (p less than 0.01). In contrast, in the 24 hour model the opposite situation was observed. Although the concentration of lidocaine in the infarct zone was substantial, a significant decline in lidocaine tissue concentration was found in the zones of lowest blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that in normal zones (1.76 +/- 0.21 versus 3.38 +/- 0.21 micrograms/g, p less than 0.001). In addition, no significant differences in lidocaine concentrations were found between endocardium and epicardium in any of the groups other than those related to regional myocardial blood flow. Thus, with the double constant infusion technique, lidocaine reached normal and ischemic myocardium in concentrations equivalent to therapeutic plasma concentrations, even in lower infarct blood flow zones, with no significant differences between endocardium and epicardium. Of perhaps greater significance, the age of the ischemic insult is an important determinant of lidocaine tissue distribution in infarcted myocardium.

  10. Real-time three-dimensional myocardial contrast echocardiography in assessment of myocardial perfusion defects

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    CHEN Li-xin 陈立新; YANG Ying 杨颖; FEI Hong-wen 费洪文; WANG Liang-yu 王良玉; WANG Xin-fang 王新房; Navin C Nanda; Andrew P Miller; XIE Ming-xing 谢明星; ZHUANG Lei 庄磊; YANG Ya 杨娅; WANG Jing 王静; HUANG Run-qing 黄润青

    2004-01-01

    Background Both real-time three-dimensional echocardiography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects.Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C3F8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and right coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals' hearts were used as controls.Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g [mean, (54.6±9.6) g] before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass [range, 38.9-71.1 g; mean, (55.6±9.3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36.7-68.9 g; mean, (51.3±12.5) g. Or range, 38.9-71.1 g; mean, (53.7±12.3) g, respectively] and under-perfused mass [range, 0-21.4 g; mean, (12.0±6.9) g. Or range, 0-19.8 g; mean, (10.8±6.3) g, respectively] after the LAD ligation (P>0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50.1-65.4 g; mean, (57.5±5.9) g. Or range, 51.5-65.8 g; mean, (57.3±6.4) g, respectively] and under-perfused mass [range, 0-25.6 g; mean, (13.3±9.6) g. Or range, 0-22.7 g; mean, (12.8±8.1) g, respectively] after the LCX ligation (P>0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g [mean, (54.8±10.0) g] and there was

  11. Failure of intravenous metoprolol to limit acute myocardial infarct size in a nonreperfused porcine model.

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    Kern, K B; Hilwig, R W; Warner, A; Basnight, M; Ewy, G A

    1995-04-01

    The usefulness of intravenous beta-adrenergic receptor blockade in limiting infarct size when neither reperfusion nor collateral flow occurs is unknown. The effect of intravenous metoprolol on limiting myocardial infarct size was therefore examined in a nonreperfused porcine model. Closed-chest techniques were used to occlude the left anterior descending coronary artery, after which animals were randomized at 20 minutes to receive intravenous metoprolol, 0.75 mg/kg, or placebo. Infarct size examined at 5 hours with Evans blue and triphenyltetrazolium staining techniques was expressed as a percentage of total ventricular myocardium at ischemic risk. This percentage was not significantly different between the groups (84% +/- 5% with metoprolol vs 90% +/- 4% with placebo; p = 0.4). Myocardial infarct size was not significantly decreased at 5 hours by early administration of intravenous metoprolol when the infarct artery remained occluded and collateral flow was minimal.

  12. EXPERIMENTAL STUDY OF HOMIUM: YAG LASER TRANSMYOCARDIAL REVASCULARIZATION IN ACUTE ISCHEMIC SETFINGS WITH MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

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    王立清; 胡盛涛; 李澎; 谢峰; 吴清玉; 郭加强

    2000-01-01

    Objective. To study the mechanism and effects of blood perfusion to the acute ischemic region of myecardium through Ho-YAG laser channels with myocardial contrast echocardiography Methods. To produce the model of acute myocardial ischemia, we partially ligated the left anterior decending (IAD)coromry artery of canine hearts between 1st. and 2nd. diagonal branches and then performed transmyocardial revasmgafizafion in this region with Ho- YAG laser. Myocardial contrast echecardingmphy was made with a new gen-eration of ultrasound contrast agent and second harmonic imaging of this region before,after ischemia and after laser revascalarizafion. Pictures were taken with “R” wave trigger skill. Results. Acoustic demity derterming in the ischemia region (anterior wall)with MCE(myocardial contrast e-checardiography) was obviously decreased(5.40 ± 1.81) after the LAD was ligated,as compared with before( 11.69± 1.61, P 0.05). There were no dif-ferences in acoustic density in the lateral wall(as control)among these comprehensive three periods (P > 0.05). Con-trast in the laser region developed one cardiac cycle ahead of that in the non-iscbemic normal region. Conclusion. Acute ischemic myecardium can be perfused by oxygenated blood from the left ventricle through Ho-YAG laser channels. Evidenee of blood perfusion through laser channels during systolic phase was detected,and my-ocardial cormast ultrasonngtaphy using intravenous perfluorocarbon-exposed sonicated dextrose albumin may be regard-ed as a reliable method in the study of tranmlyecardial revasculariztion.

  13. Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

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    Rong LIU; Youbin DENG; Xiaojun BI; Yani LIU; Li XIONG; Liuping CHEN

    2009-01-01

    The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echo-cardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months af-ter coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu-dinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs (-10.45±8.31)%, P0.05]. It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of re-gional systolic function. The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

  14. Justification for intravenous magnesium therapy in acute myocardial infarction

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    Rasmussen, H S

    1988-01-01

    Recent studies have shown that patients with acute myocardial infarction (AMI) are magnesium-deficient and develop an additional transient decrease in serum magnesium concentrations (S-Mg c) during the acute phase of the infarct. Animal experiments, as well as studies on humans, have indicated...... of routine practice for patients with acute myocardial infarction....... that the acute decrease in S-Mg c as well as a more chronic magnesium (Mg) deficiency state are harmful to the myocardium in the setting of acute ischaemia. This knowledge has led during the last couple of years to the performance of four double-blind placebo controlled studies in which the effect of i...

  15. Contrast-enhanced MRI of murine myocardial infarction - part II.

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    Coolen, Bram F; Paulis, Leonie E M; Geelen, Tessa; Nicolay, Klaas; Strijkers, Gustav J

    2012-08-01

    Mouse models are increasingly used to study the pathophysiology of myocardial infarction in vivo. In this area, MRI has become the gold standard imaging modality, because it combines high spatial and temporal resolution functional imaging with a large variety of methods to generate soft tissue contrast. In addition, (target-specific) MRI contrast agents can be employed to visualize different processes in the cascade of events following myocardial infarction. Here, the MRI sequence has a decisive role in the detection sensitivity of a contrast agent. However, a straightforward translation of clinically available protocols for human cardiac imaging to mice is not feasible, because of the small size of the mouse heart and its extremely high heart rate. This has stimulated intense research in the development of cardiac MRI protocols specifically tuned to the mouse with regard to timing parameters, acquisition strategies, and ECG- and respiratory-triggering methods to find an optimal trade-off between sensitivity, scan time, and image quality. In this review, a detailed analysis is given of the pros and cons of different mouse cardiac MR imaging methodologies and their application in contrast-enhanced MRI of myocardial infarction. Copyright © 2012 John Wiley & Sons, Ltd.

  16. Renal stones on portal venous phase contrast-enhanced CT: does intravenous contrast interfere with detection?

    Science.gov (United States)

    Dym, R. Joshua; Duncan, Dameon R.; Spektor, Michael; Cohen, Hillel W.; Scheinfeld, Meir H.

    2015-01-01

    Purpose To determine the sensitivity of portal venous phase contrast-enhanced CT for the detection of renal stones. Methods This retrospective study included 97 CT examinations of the abdomen without and with intravenous contrast, including 85 (87.6%) examinations with at least one renal stone on the “gold standard” noncontrast images, as scored by a single radiologist. Three other radiologists each independently reviewed only the contrast-enhanced images from all 97 examinations and recorded all renal stones. Reviewer sensitivity for stones was categorized by stone diameter. Reviewer sensitivity and specificity for stone disease were also calculated on a per-kidney basis. Results The 97 cases included a total of 238 stones ≥1 mm, with a mean (±SD) of 1.2 ± 1.9 stones per kidney and a stone diameter of 3.5 ± 3.0 mm. Pooling data for the three reviewers, sensitivity for all stones was 81%; sensitivity for stones ≥2, ≥3, ≥4, and ≥5 mm was 88%, 95%, 99%, and 98%, respectively. Sensitivity for stone disease on a per-kidney basis was 94% when considering all stones; when considering only stones ≥2, ≥3, and ≥4 mm, sensitivity was 96%, 99%, and 100%, respectively. Specificity for stone disease on a per-kidney basis was 98% overall, 99% when considering only stones ≥2 mm, and 100% when considering only stones ≥3 mm. Conclusion: Contrast-enhanced CT is highly sensitive for the detection of renal stones ≥3 mm in diameter and less sensitive for smaller stones. In cases where the clinical diagnosis is uncertain and performance of a CT examination is being contemplated, intravenous contrast utilization would allow assessment for stone disease while also optimizing evaluation for other conditions. PMID:24504541

  17. Automatic Characterization of Myocardial Perfusion in Contrast Enhanced MRI

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    Positano, Vincenzo; Santarelli, Maria Filomena; Landini, Luigi

    2003-12-01

    The use of contrast medium in cardiac MRI allows joining the high-resolution anatomical information provided by standard magnetic resonance with functional information obtained by means of the perfusion of contrast agent in myocardial tissues. The current approach to perfusion MRI characterization is the qualitative one, based on visual inspection of images. Moving to quantitative analysis requires extraction of numerical indices of myocardium perfusion by analysis of time/intensity curves related to the area of interest. The main problem in quantitative image sequence analysis is the heart movement, mainly due to patient respiration. We propose an automatic procedure based on image registration, segmentation of the myocardium, and extraction and analysis of time/intensity curves. The procedure requires a minimal user interaction, is robust with respect to the user input, and allows effective characterization of myocardial perfusion. The algorithm was tested on cardiac MR images acquired from voluntaries and in clinical routine.

  18. Does intravenous administration of recombinant tissue plasminogen activator for ischemic stroke can cause inferior myocardial infarction?

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    Mostafa Almasi

    2016-06-01

    Full Text Available Recombinant tissue plasminogen activator (rTPA is one of the main portions of acute ischemic stroke management, but unfortunately has some complications. Myocardial infarction (MI is a hazardous complication of administration of intravenous rTPA that has been reported recently. A 78-year-old lady was admitted for elective coronary artery bypass graft surgery. On the second day of admission, she developed acute left hemiparesis and intravenous rTPA was administered within 120 minutes. Three hours later, she has had chest pain. Rescue percutaneous coronary intervention was performed on right coronary artery due to diagnosis of inferior MI, and the symptoms were resolved.

  19. Assessment of Protective Effect of KATP Channel on Ischemi c Myocardium by Peripheral Intravenous Myocardial Contrast Echocardiography%经静脉心肌声学造影技术评价ATP敏感钾通道的开放对心肌缺血的保护作用

    Institute of Scientific and Technical Information of China (English)

    冯力; 刘伊丽; 查道刚; 黄小波; 张稳柱; 罗义

    2001-01-01

    Objective:To verify that the myocardial ris k area and infarct area could be accurately identified with intravenous myocardi al contrast echocardiography(MCE)and to assess the protective effect of KATP channel on ischemic myocardium by the method.Methods:Twenty-one dogs were randomly divided into three groups:IR group(n=7):LAD of the dogs were occluded 90min followed by 120mi n reperfusion.NIC group(n=7):Nicorandil(NIC)100μg/kg was administrated by intravenous injection 10min before occlusion and 10μg/kg/min continuated to the end of reperfusion.GLIB(Glibenclamide)+NIC group(n=7):Before NIC was administ rated,the dogs had been pretreated with GLIB 0.3mg/kg 10min.Hemodynamics data w ere determined in baseline,60min post occlusion,and 120min post reperfusion.By u sing 2,3,5-triphenyltetrazolium chloride(TTC)staining,the area at risk(AAR)and infarct area(IA)were indicated with image analyzer.MCE was performed during peri pheral intravenous injection of Quan Fu Xian.Mid ventricular short axis images w ere obtained.The perfusion defected 60min after occlusion was defined as AAR and perfusion defected after 120min reperfusion defined as the IA.Results:At 60min post occlusion.the cardiac output(CO)of each group was reduced as compared with that of the baseline(P<0.01),but at 1 20min post reperfusion in NIC group,the CO value recovered (P>0.05).With T TC staining,there were no significent differences among three groups in AAR(P >0.05),NIC group produced a marked reduction in infarct size compared with IR and GLIB+NIC group(P<0.01).MCE defined AAR in three groups had good li near relation with TTC staining(r=0.975)at 1h after reperfusion.MCE define d IA in IR and GLIB+NIC groups also had good linear relation with TTC staining( r=0.949).Conclusions:Our study showed that ischemic and infarcted myoca rdium could accurately identified by MCE technique;KATP channel opener nic orandil could make marked reduction in infarct size.%目的:证实经

  20. Effect of streptozotocin-induced diabetes on myocardial blood flow reserve assessed by myocardial contrast echocardiography in rats

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    Weytjens Caroline; Garbar Christian; Degaillier Céline; Hernot Sophie; Droogmans Steven; Cosyns Bernard; Roosens Bram; Schoors Danny; Lahoutte Tony; Franken Philippe R; Van Camp Guy

    2008-01-01

    Abstract The role of structural and functional abnormalities of small vessels in diabetes cardiomyopathy remains unclear. Myocardial contrast echocardiography allows the quantification of myocardial blood flow at rest and during dipyridamole infusion. The aim of the study was to determine the myocardial blood flow reserve in normal rats compared with Streptozotocin-induced diabetic rats using contrast echocardiography. Methods We prospectively studied 40 Wistar rats. Diabetes was induced by ...

  1. Intravenous methylphenidate: an unusual way to provoke ST-elevation myocardial infarction.

    Science.gov (United States)

    Hay, Emile; Shklovski, Vitaly; Blaer, Yossef; Shlakhover, Vladimir; Katz, Amos

    2015-02-01

    Acute ST-T elevation is a sign of myocardial ischemia or infarction usually due to coronary artery atherosclerosis or coronary spasm. Coronary spasm may be spontaneous or can occur as a result of a drug that causes arterial spam. Ritalin, Novartis Pharmaceut. Corporation, USA (methylphenidate hydrochloride), a dopamine reuptake inhibitor,is an oral drug used to treat attention-deficit/hyperactivity disorder and narcolepsy. Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual dose for attention-deficit/hyperactivity disorder [1]. This drug is not supplied as solution for injection [2]. We report here, what we believe to be, the first case report of a 40-year-old male patient who was admitted for acute chest pain and ST-elevation myocardial infarction after intravenous self-injection of Ritalin. His coronary angiogram demonstrated nonobstructive coronary disease.

  2. ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction

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    Clemmensen, P; Grande, P; Pedersen, F

    1990-01-01

    Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage...... was therefore studied in 65 patients with a first AMI, randomized to treatment with streptokinase (n = 33) or placebo (control group, n = 32). Reperfusion was defined as a CK-MB appearance rate constant (k1) greater than 0.185. The final AMI size was first predicted from the admission standard ECG by previously...... developed formulas based on ST segment elevation. The final AMI size was estimated from the QRS score on the predischarge ECG. Myocardial salvage was defined as a greater than or equal to 20% decrease from predicted to final AMI size. The k1 value in the control group was significantly lower than...

  3. Contrast material and gallbladder kinetics: implications for same day sonography after intravenous pyelography or CT scanning.

    Science.gov (United States)

    Khan, O; Naipaul, R; Rampaul, R S; Abhang, V; Archibald, A; Maharaj, P; Mohammed, S; Mohammed, L

    1999-11-01

    Sonographic examination of the gallbladder has allowed us to study the effects of various substances on this organ. A prospective study involving 77 patients was undertaken to evaluate the effects of intravenous or oral contrast agents on gallbladder volume changes in patients without known gallbladder disease. A mean volume after contraction of 24.8% was observed after administration of intravenous contrast agent (P < 0.01) and of 31.9% after oral administration (P < 0.01). This phenomenon of contraction of the gallbladder should therefore be recognized when sonographic or computed tomographic evaluation of the gallbladder is undertaken after imaging procedures that use radiographic contrast agents either intravenously or orally.

  4. Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy

    Directory of Open Access Journals (Sweden)

    Lantam Sonhaye

    2015-01-01

    Full Text Available The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER of the Teaching Hospital of Lomé (Togo during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619, p value = 0.886; only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26, p value = 0.031.

  5. Intravenous contrast-enhanced cone beam computed tomography (IVCBCT of intrahepatic tumors and vessels

    Directory of Open Access Journals (Sweden)

    Cynthia L. Eccles, BSc

    2016-01-01

    Conclusions: Intravenous-CBCT may enhance the visibility of hepatic vessels and tumor in CBCT scans obtained during breath hold. Optimization of IV contrast timing and reduction of artifacts to improve tumor visualization warrant further investigation.

  6. Characterization of macrolesions induced by myocardial contrast enabled therapy (MCET)

    Science.gov (United States)

    Zhu, Yiying I.; Miller, Douglas L.; Dou, Chunyan; Kripfgans, Oliver D.

    2017-03-01

    Intermittent high intensity ultrasound pulses with circulating contrast agent microbubbles can induce scattered cavitation microlesions of potential value for myocardial reduction therapy. In this study, a computer-aided evaluation scheme of the effective treated volume was implemented in order to optimize ultrasound pulse parameters, exposure duration, and contrast agent dose. Rats with Evans blue injections were treated with 1.5 MHz focused ultrasound bursts. Evans blue staining indicates lethal cardiomyocytic injury. After frozen in compound on dry ice, each heart was sectioned to provide samples covering the entire exposed myocardial volume. Both brightfield and fluorescence images of 25 tissue sections were taken. Tissue detection and microlesion detection were first done based on the 2D images to form microlesion masks containing the outline of the heart and the dead cell regions. Image registration was then performed on the microlesion masks to reconstruct a volume-based model according to the morphology of the heart. The therapeutic beam path was estimated from 3D stacked microlesions, and finally the total impacted volume with microlesions, here termed macrolesion, was characterized along the therapeutic beam axis. Radially symmetric fractional macrolesions were characterized via stepping disks of variable radius determined by the local distribution of microlesions. Treated groups show significant macrolesions with approximately 100 µL volume, an average radius of 2.5 mm, 6 mm length, and 13% lesion density compared to zero radius, length and lesion density for the sham group.

  7. 静息心电图、经静脉心肌声学造影与冠脉造影诊断冠心病的对比分析%The comparative analysis of resting electrocardiogram and intravenous myocardial contrast coronary angiography for the diagnosis of heart disease

    Institute of Scientific and Technical Information of China (English)

    王庆元; 索晓霞; 马风妹; 郭山春

    2011-01-01

    Objective To explore the diagnostic value of resting electrocardiogram (ECG) and intravenous myocardial contrast echocardiography (MCE) for the diagnosis of coronary heart disease and vascular lesions associated sites of the sensitivity,specificity and accuracy.Methods May 2009 to November 2010,selected 78 patients,39 ones were male and the others were female,aged f45-75,the average age was (50.8 ± 12.9) years (excluding cardiomyopathy,Hypertensive heart disease and diabetes)from the Department of Cardiology at Binzhou People' s Hospital.22 cases were diagnosed with coronary heart disease conbined with myocardial infarction,13 cases with angina pectoris (including one case of variant angina),23 cases were suspected with coronary artery disease,20 cases with unknown chest pain.The same period (<2 weeks),carried out resting Electrocardiogram and cardiac ultrasound contrast and coronary on them.Results 1.There was statistically significant difference among MCE diagnosis of coronary artery disease susceptibility,resting ECG,and resting ECG + MCE (P<0.05).There was statistically significant difference between resting ECG + MCE specific diagnosis of coronary artery disease and resting ECG,MCE e (P<0.05).2.Using MCE,resting ECG,and resting ECG + MCE to speculate LAD,LCX had higher sensitivity(P<0.05).There was statistically significant difference on the specificity between using resting ECG + MCE to speculate LAD,LCX and using resting ECG,MCE (P<0.05).3.Among resting ECG,MCE,resting ECG + MCE RCA speculating on the sensitivity,specificity,and accuracy,the difference was not significant (P> 0.05).Conclusion 1.Resting ECG for the diagnosis of coronary heart disease and vascular diseases related to the judge has some limitations.2.MCE for the determination of coronary heart disease and coronary artery LAD,LCX has a higher sensitivity.3.Resting ECG + MCE for the exclusion of coronary heart disease and LAD,LCX lesions has some reference value.4.CAG for the

  8. Magnetic resonance imaging of microvascular leakage induced by myocardial contrast echocardiography in rats.

    Science.gov (United States)

    Swanson, Scott D; Dou, Chunyan; Miller, Douglas L

    2006-06-01

    The extent and magnitude of microvascular leakage induced by myocardial contrast echocardiography (MCE) were characterized with contrast-aided magnetic resonance imaging (MRI). Evans blue dye, Definity ultrasound contrast agent and Omniscan magnetic resonance contrast agent were injected intravenously in anesthetized rats suspended in a water bath. Diagnostic ultrasound B mode scans with 1:4 end-systolic triggering were performed at 1.5 MHz using a cardiac phased array scanhead to provide a short axis view of the left ventricle. The in situ peak rarefactional pressure amplitude (PRPA) was 2.0 MPa. Microvascular leakage was characterized by extraction of the dye from tissue samples and by imaging the distribution and concentration of Omniscan within the myocardium. The extracted Evans blue was 2.3 times greater than in shams (Prats (after sacrifice). These results demonstrate a potential for MR mapping of capillary leakage induced by contrast-aided ultrasound, with a possible application to spatial characterization of local drug delivery.

  9. 3D perfusion mapping in the intact mouse heart after myocardial infarction using myocardial contrast echocardiography

    Science.gov (United States)

    Li, Yinbo; Yang, Zequan; French, Brent A.; Hossack, John A.

    2005-04-01

    An intact mouse model of surgically-induced myocardial infarction (MI) caused by permanent occlusion of the Left Anterior Descending (LAD) coronary artery was studied. Normal mice with no occlusion were also studied as controls. For each mouse, contrast enhanced ultrasound images of the heart were acquired in parallel cross-sections perpendicular to the sternum at millimeter increments. For accurate 3D reconstruction, ECG gating and a tri-axial adjustable micromanipulator were used for temporal and spatial registration. Ultrasound images at steady-state of blood refilling were color-coded in each slice to show relative perfusion. Myocardial perfusion defects and necrosis were also examined postmortem by staining with Phthalo blue and TTC red dyes. Good correlation (R>0.93) in perfused area size was observed between in vivo measurements and histological staining. A 3D multi-slice model and a 3D rendering of perfusion distribution were created and showed a promising match with postmortem results, lending further credence to its use as a more comprehensive and more reliable tool for in vivo assessment of myocardial perfusion than 2D tomographic analysis.

  10. Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

    Directory of Open Access Journals (Sweden)

    P.M.M. Dourado

    2006-06-01

    Full Text Available Myocardial contrast echocardiography has been used for assessing myocardial perfusion. Some concerns regarding its safety still remain, mainly regarding the induction of microvascular alterations. We sought to determine the bioeffects of microbubbles and real-time myocardial contrast echocardiography (RTMCE in a closed-chest canine model. Eighteen mongrel dogs were randomly assigned to two groups. Nine were submitted to continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA plus continuous imaging using power pulse inversion RTMCE for 180 min, associated with manually deflagrated high-mechanical index impulses. The control group consisted of 3 dogs submitted to continuous imaging using RTMCE without PESDA, 3 dogs received PESDA alone, and 3 dogs were sham-operated. Hemodynamics and cardiac rhythm were monitored continuously. Histological analysis was performed on cardiac and pulmonary tissues. No hemodynamic changes or cardiac arrhythmias were observed in any group. Normal left ventricular ejection fraction and myocardial perfusion were maintained throughout the protocol. Frequency of mild and focal microhemorrhage areas in myocardial and pulmonary tissue was similar in PESDA plus RTMCE and control groups. The percentages of positive microscopical fields in the myocardium were 0.4 and 0.7% (P = NS in the PESDA plus RTMCE and control groups, respectively, and in the lungs they were 2.1 and 1.1%, respectively (P = NS. In this canine model, myocardial perfusion imaging obtained with PESDA and RTMCE was safe, with no alteration in cardiac rhythm or left ventricular function. Mild and focal myocardial and pulmonary microhemorrhages were observed in both groups, and may be attributed to surgical tissue manipulation.

  11. 糖尿病患者静脉溶栓治疗急性心肌梗塞临床对比研究%A contrast study on clinical effect of intravenous thrombolysis therapy on acute myocardial infarction patients with diabetes and wjthout diabetes

    Institute of Scientific and Technical Information of China (English)

    郑刚; 蒋文超; 刘兆昶; 张丽华; 杨顺来; 刘继会

    2000-01-01

    Objective The aim of this study was to observe the clinical effect of intravenous thrombolysis therapy on diabetic patients with acute myocardial infarction. Methods In the coronary care unit (CCU) at our hospital, 182 of the patients with acute myocardial infarction were divided into two groups with (DM-AMI) and without diabetes (NDM-AMI). All patients were treated with intravenous thrombolysis therapy. Results ①Hospital mortality in DMAMI groups was 15.15%, and 6. 03% in NDM-AMI (χ2= 4. 17, P <0. 05). The reperfusion rate of infarct-related artery (IRA) was 45.45% in DM-AMI groups, and 62. 93% in NDM-AMI groups (χ2=5.23, P <0. 05). ②BS、CR、BUN、TC and TG in DM-AMI groups were significantly higher than in NDM-AMI groups ( P <0. 001、 P <0. 05). ③Complications of AMI were significantly higher in DM-AMI groups than in NDM-AMI, with left ventricular failure significantly higher (36. 36% vs 12. 97%,χ2= 13. 72, P <0. 001)and cardial shock significantly higher (16. 67% vs 6.03%,χ2 = 5. 33, P < 0. 05). Conclusion This study showed that intravenous thrombolysis therapy exerted a beneficial effect on the early-term prognosis of AMI patients without diabetes. But for the patients with diabetes intravenous thrombolysis therapy did not show a beneficial effect.%目的探讨糖尿病患者静脉溶栓治疗急性心肌梗塞临床近期疗效。方法冠心病监护病房(CCU)收治的182例急性心肌梗塞患者,分成糖尿病(DM-AMI)组、非糖尿病(NDM-AMI)组。其中DM-AMI组66例、NDM-AMI组116例。两组同时给予国产尿激酶静脉溶栓治疗。结果①DM-AMI组住院病死率为15.15%,明显高于NDM-AMI组的6.03%(χ2=4.17,P<0.05);DM-AMI组静脉尿激酶溶栓治疗梗塞相关血管(IRA)的再通率为45.45%,明显低于NDM-AMI组的62.93%(χ2=5.23,P<0.05),②DM-AMI组静脉血糖(BS)、肌酐(CR)、尿素氮(BUN)、胆固醇(TC)和甘油三酯(TG)浓度均显著高于NDM-AMI组(P<0

  12. Intravenous contrast injection significantly affects bone mineral density measured on CT

    NARCIS (Netherlands)

    Pompe, Esther; Willemink, Martin J.; Dijkhuis, Gawein R.; Verhaar, Harald J. J.|info:eu-repo/dai/nl/111379628; Mohamed Hoesein, Firdaus A A|info:eu-repo/dai/nl/341235512; de Jong, Pim A.|info:eu-repo/dai/nl/287955672

    2015-01-01

    OBJECTIVE: The objective is to evaluate the effect of intravenous contrast media on bone mineral density (BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography (CT) examinations performed for other indications. METHODS: One hundred and fifty-two patients (99 without and 5

  13. Intravenous contrast injection significantly affects bone mineral density measured on CT

    NARCIS (Netherlands)

    Pompe, Esther; Willemink, Martin J.; Dijkhuis, Gawein R.; Verhaar, Harald J. J.; Mohamed Hoesein, Firdaus A A; de Jong, Pim A.

    2015-01-01

    OBJECTIVE: The objective is to evaluate the effect of intravenous contrast media on bone mineral density (BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography (CT) examinations performed for other indications. METHODS: One hundred and fifty-two patients (99 without and 5

  14. Effect of intravenous infusion of iodinated contrast media on the coronary blood flow in dogs

    OpenAIRE

    Abd, Thura T; Asim I. Shafique; Hayder S. Yasir; Jung-Hee Seo; George, Richard T.; Rajat Mittal; Lardo, Albert C.

    2016-01-01

    Background: Coronary computed tomography angiography (CCTA) is obtained using peripheral intravenous iodinated contrast agents (ICA) injection. There is continuing attempts to derive coronary physiological information like coronary blood flow (CBF) and/or fractional flow reserve from CCTA images. However, no data is available regarding the effect of peripheral intravenous injection of ICA on CBF. Methods: A series of 4 experiments was performed using healthy mongrel dogs. All dogs underwen...

  15. Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

    Energy Technology Data Exchange (ETDEWEB)

    Nyman, Ulf [University of Lund, Department of Diagnostic Radiology, Trelleborg (Sweden); Almen, Torsten [Skaane University Hospital, Department of Clinical Sciences/Medical Radiology, University of Lund, Malmoe (Sweden); Jacobsson, Bo [University of Gothenburg and the Sahlgrenska Academy, Department of Diagnostic Radiology, The Queen Silvia Children' s Hospital, Goeteborg (Sweden); Aspelin, Peter [Karolinska Institute and University Hospital, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

    2012-06-15

    We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since (1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, (2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, (3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, (4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, (5) roughly the same gram-iodine/GFR ratio ({approx}1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and (6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points circle Most intra-arterial injections of contrast media are intravenous relative to the kidneys. circle No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial. circle Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. circle Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies. (orig.)

  16. Diagnostic utility of intravenous contrast for MR imaging in pediatric appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Lyons, Gray R.; Renjen, Pooja; Kovanlikaya, Arzu [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Radiology, New York, NY (United States); Askin, Gulce; Giambrone, Ashley E. [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Biostatistics and Epidemiology, New York, NY (United States); Beneck, Debra [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology, New York, NY (United States)

    2017-04-15

    Magnetic resonance imaging (MRI) is increasingly employed as a diagnostic modality for suspected appendicitis in children. However, there is uncertainty as to which MRI sequences are sufficient for safe, timely and accurate diagnosis. Several recent studies have described different MRI protocols, including exams both with and without the use of intravenous contrast. We hypothesized that intravenous contrast may be useful in some patients but could be safely omitted in others. All MRI examinations (n=112) performed at our institution for evaluating appendicitis in children were retrospectively reevaluated. Exams were reread by pediatric radiologists under three conditions: With postcontrast images, Without postcontrast images, and Without/With - selective use of postcontrast sequences only when needed for diagnostic certainty. Samples were scored as positive, negative or equivocal for appendicitis. Findings were compared to pathological or clinical follow-up in the medical record. Without the use of intravenous contrast yielded more equivocal results (12.4%) compared to With contrast (3.4%). By selectively using postcontrast sequences, the Without/With group yielded fewer equivocal results (1.1%) compared to Without while also reducing contrast use 79.8% compared to the With contrast group. No significant differences in conditional sensitivity or conditional specificity were detected among the three groups. MRI diagnosis of acute appendicitis can be performed without contrast for most patients; injection of contrast can be reserved for only those patients with equivocal non-contrast imaging. (orig.)

  17. Early and Delayed Myocardial Enhancement in Myocardial Infarction Using Two-Phase Contrast-Enhanced Multidetector-Row CT

    Science.gov (United States)

    Kim, Young-Whan; Han, Seong-Wook; Seo, Joon-Beom

    2007-01-01

    Objective The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). Materials and Methods Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. Results After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). Conclusion Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI. PMID:17420626

  18. Early and Delayed Myocardial Enhancement in Myocardial Infarction Using Two-Phase Contrast-Enhanced Multidetector-Row CT

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Sung-Min; Kim, Young-Whan; Han, Seong-Wook [University of Keimyung College of Medicine, Dongsan Medical Center, Daegu (Korea, Republic of); Seo, Joon-Beom [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2007-04-15

    The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast enhanced multidetector-row computed tomography (MDCT). Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.

  19. Measurement of myocardial perfusion and infarction size using computer-aided diagnosis system for myocardial contrast echocardiography.

    Science.gov (United States)

    Du, Guo-Qing; Xue, Jing-Yi; Guo, Yanhui; Chen, Shuang; Du, Pei; Wu, Yan; Wang, Yu-Hang; Zong, Li-Qiu; Tian, Jia-Wei

    2015-09-01

    Proper evaluation of myocardial microvascular perfusion and assessment of infarct size is critical for clinicians. We have developed a novel computer-aided diagnosis (CAD) approach for myocardial contrast echocardiography (MCE) to measure myocardial perfusion and infarct size. Rabbits underwent 15 min of coronary occlusion followed by reperfusion (group I, n = 15) or 60 min of coronary occlusion followed by reperfusion (group II, n = 15). Myocardial contrast echocardiography was performed before and 7 d after ischemia/reperfusion, and images were analyzed with the CAD system on the basis of eliminating particle swarm optimization clustering analysis. The myocardium was quickly and accurately detected using contrast-enhanced images, myocardial perfusion was quantitatively calibrated and a color-coded map calibrated by contrast intensity and automatically produced by the CAD system was used to outline the infarction region. Calibrated contrast intensity was significantly lower in infarct regions than in non-infarct regions, allowing differentiation of abnormal and normal myocardial perfusion. Receiver operating characteristic curve analysis documented that -54-pixel contrast intensity was an optimal cutoff point for the identification of infarcted myocardium with a sensitivity of 95.45% and specificity of 87.50%. Infarct sizes obtained using myocardial perfusion defect analysis of original contrast images and the contrast intensity-based color-coded map in computerized images were compared with infarct sizes measured using triphenyltetrazolium chloride staining. Use of the proposed CAD approach provided observers with more information. The infarct sizes obtained with myocardial perfusion defect analysis, the contrast intensity-based color-coded map and triphenyltetrazolium chloride staining were 23.72 ± 8.41%, 21.77 ± 7.8% and 18.21 ± 4.40% (% left ventricle) respectively (p > 0.05), indicating that computerized myocardial contrast echocardiography can

  20. Acute Severe Thrombocytopenia Following Non-Ionic Low-Osmolarity Intravenous Contrast Medium Injection

    Energy Technology Data Exchange (ETDEWEB)

    Bata Pal; Domonkos, Adam; Tamoki, David Laszio; Horvath, Evelin; Berczi, Viktor; Szalay, Ferenc [Semmelweis University, Budapest (Hungary)

    2012-07-15

    Intravenous contrast medium (ICM) rarely induces anaphylactic reactions, including urticaria, hypotension and respiratory failure. Even the most modern ICM may cause such adverse events. Thrombocytopenia has been reported as an extreme rare consequence of ICM. Here we report on a case of a 72-year-old male patient with a self-limiting severe acute thrombocytopenia following administration of intravenous non-ionic low-osmolarity contrast medium. No such low platelet count has ever been reported. We also present a review of the literature.

  1. Addition of lacal anesthetics to contrast media. Pt. 2. Increase of acute mortality in mice with intravenous contrast administration

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, P.; Almen, T.; Golman, K.; Jonsson, K.; Nyman, U.

    The acute intravenous toxicity (i.v. LD/sub 50/) of solutions of the ratio 1.5 contrast media metrizoate or diatrizoate and the ratio 3.0 contrast medium metrizamide was determined in mice with and without the addition of local anesthetics to the solutions. The two local anesthetics mepivacaine or lidocaine were added to final concentrations up to 2.0 mg/ml of the contrast medium solutions. This corresponds to clinically used concentrations. All additions of local anesthetics to the solutions increased the mortalities caused by the contrast medium solutions. Addition of local anesthetics to a final concentration of 2 mg/ml approximately doubled the acute intravenous toxicity of the contrast media. The ratio 3 contrast media produce less hypertonic solutions than the ratio 1.5 contrast media and should be preferred for angiography because they cause less pain and do not require the addition of local anesthetics which increase the acute toxicity of the solutions.

  2. EXPERIMENTAL STUDY OF HOMIUM: YAG LASER TRANSMYOCARDIAL REVASCULARIZATION IN ACUTE ISCHEMIC SET TINGS WITH MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

    Institute of Scientific and Technical Information of China (English)

    王立清; 胡盛寿; 李澎; 谢峰; 吴清玉; 郭加强

    2000-01-01

    Objective. To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography. Methods. To produce the model of acute myocardial ischemia, we partially ligated the left anterior decending (LAD)coronary artery of canine hearts between lst. and 2nd. diagonal branches and then performed transmyocardial revascularization in this region with Ho- YAG laser. Myocardial contrast echocardiography was made with a new gen eration of ultrasound contrast agent and second harmonic imaging of this region before, after ischemia and after laser revascularization. Pictures were taken with “R” wave trigger skill. Results. Acoustic density derterming in the ischemia region (anterior wall)with MCE (myocardial contrast e chocardiography )was obviously decreased( 5.40 ± 1.81) after the LAD was ligated, as compared with before( 11.69 ± 1.61, P < 0.01 ). It was increased remarkably after transmyocardial laser revascularizatuon (TMLR) ( 11.2 ± 2.01, P < 0. 01 )as compared with that when ischemia and approximated to that before ischemia(P > 0.05). There were no dif ferences in acoustic density in the lateral wall(as control)among these comprehensive three periods(P > 0.05). Con trast in the laser region developed one cardiac cycle ahead of that in the non-ischemic normal region. Conclusion. Acute ischemic myocardium can be peffused by oxygenated blood from the left ventricle through Ho YAG laser channels. Evidence of blood perfusion through laser channels during systolic phase was detected, and my ocardial contrast ultrasonography using intravenous perfluorocarbon-exposed sonicated dextrose albumin may be regard ed as a reliable method in the study of transmyocardial revascularization.

  3. Acute kidney injury: intravenous fluid to prevent contrast-induced AKI.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2009-05-01

    Trials that compared sodium bicarbonate and sodium chloride for the prevention of contrast-induced acute kidney injury have yielded highly conflicting results. The authors of a recent meta-analysis endeavored to provide a definitive assessment of the relative efficacy of these two intravenous fluids.

  4. Acute pulmonary edema after intravenous administration of nonionic contrast media: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun; Im, Jung Gi; Chung, Jin Wook; Park, Jae Hyung; Han, Man Chung [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-02-01

    We describe high-resolution CT findings of pulmonary edema following the administration of intravenous nonionic contrast media in a patient who had no previous history of cardiovascular disease; areas of ground glass opacity and interlobular septal thickenings which partly disappeared on scans obtained 90 minutes after the initial scans. The proposed mechanisms of pulmonary edema are briefly discussed.

  5. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

  6. Non-ST Elevation Myocardial Infraction after High Dose Intravenous Immunoglobulin Infusion

    Directory of Open Access Journals (Sweden)

    Meir Mizrahi

    2009-01-01

    Full Text Available Intravenous immunoglobulins (IVIgs are used for several indications, including autoimmune conditions. IVIg treatment is associated with several possible adverse reactions including induction of a hypercoagulable state. We report a 76-year-old woman treated with IVIg for myasthenia gravis, which developed chest pain and weakness following IVIg infusion. The symptoms were associated with ST segment depression in V4–6 and elevated troponin levels. The patient was diagnosed with non-ST elevation myocardial infarction (NSTEMI. The patient had no significant risk factor besides age and a cardiac perfusion scan was interpreted as normal (the patient refused to undergo cardiac catheterization. This case is compatible with IVIg-induced hypercoagulability resulting in NSTEMI. Cardiac evaluation should therefore be considered prior to initiation of IVIg treatment especially in patients with multiple cardiovascular risks.

  7. Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps

    Energy Technology Data Exchange (ETDEWEB)

    Bhatia, Anmol, E-mail: anmol_bhatia26@yahoo.co.in [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Saxena, Akshay K., E-mail: fatakshay@yahoo.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Kalra, Naveen, E-mail: navkal2004@yahoo.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Sodhi, Kushaljit S., E-mail: sodhiks@gmail.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Thapa, Babu R., E-mail: brthapa1@yahoo.co.in [Division of Pediatric Gastroenterology, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Rao, Katragadda L.N., E-mail: klnrao@hotmail.com [Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Khandelwal, Niranjan, E-mail: khandelwaln@hotmail.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India)

    2013-06-15

    Objective: The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. Methods: This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. Results: By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. Conclusion: CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of

  8. [Coronary thrombolysis in acute myocardial infarction. Initial experience with an intravenous thrombolytic agent].

    Science.gov (United States)

    Martínez Ríos, M A; Cárdenas, M; Gil, M; Iturbe, I; Alarcón, A; Soní, J

    1984-01-01

    Thirteen patients with less than 5 hours of the onset of symptoms of acute myocardial infarction underwent selective coronary angiography. Ten of them had angiographic signs of coronary thrombosis. In these ten patients 15 mgs of an acylated streptokinase-plasminogen complex (BRL 26921 Beecham Farmaceuticals) were administered intravenously. Total angiographic recanalization was observed in 7 patients. The coronary arteries involved were the left anterior descending in 4 cases and the right coronary artery in 3. In 8 out of the 10 patients significant diminution of injury pattern in EKG was registered, however in all of them the necrosis pattern supervened. Prolongation of the thrombin and thromboplastin times, as well as an important fibrinogen disminution were documented in all instances. There were not complications related to the administration of the drug. An increase of muscle enzimes was documented in all cases. The follow-up was uneventfull with excellent results in all the patients. This study proves that with IV trombolitic therapy coronary recanalization can be achieved in the mayority of the patients; however there is no question that myocardial infarction finally ocurred. We speculate about the possibility of avoiding infarction by the administration of the drug within the first hour after the onset of the symptoms.

  9. Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13 labeled ammonia

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, W.F.; Harper, P.V.; Resnekov, L.; Fill, H.

    1976-08-01

    The short half-life positron emitter /sup 13/N, as labeled ammonia (/sup 13/NH/sub 4//sup +/), was evaluated as a myocardial imaging agent. Regional myocardial uptake of /sup 13/NH/sub 4/ correlated with the distribution of labeled microspheres in experimental myocardial infarction. Using intravenous /sup 13/NH/sub 4//sup +/, myocardial scintigraphy was performed in 85 cardiac patients and 27 normal subjects. Ninety-five scintigrams were suitable for analysis. Eighteen of 24 normal subjects had homogeneous myocardial images; six had inhomogeneous images attributable to early technical problems. Perfusion defects were observed in the scintigrams of 82% (57/65) of patients with coronary artery disease, being most common in patients with myocardial infarction (27/28). Six sequential studies showed changes in perfusion consistent with the clinical course of each patient. Scintigraphic abnormalities were also observed in 4/6 patients with valvular heart disease. /sup 13/NH/sub 4//sup +/ myocardial scintigraphy is a valid and sensitive method of assessing regional myocardial perfusion and is especially useful for sequential imaging at short intervals.

  10. Intravenous Erythropoietin in Patients with ST-Segment Elevation Myocardial Infarction

    Science.gov (United States)

    Najjar, Samer S.; Rao, Sunil V.; Melloni, Chiara; Raman, Subha V.; Povsic, Thomas J.; Melton, Laura; Barsness, Gregory W.; Prather, Kristi; Heitner, John F.; Kilaru, Rakhi; Gruberg, Luis; Hasselblad, Vic; Greenbaum, Adam B.; Patel, Manesh; Kim, Raymond J.; Talan, Mark; Ferrucci, Luigi; Longo, Dan L.; Lakatta, Edward G.; Harrington, Robert A.

    2012-01-01

    Context Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. Objective To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. Design, Setting, and Patients Prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single-dose (60,000 units of epoetin alfa) efficacy phase involving 222 patients with STEMI who underwent successful percutaneous coronary intervention (PCI) as a primary or rescue reperfusion strategy. Intervention Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. Main Outcome Measure Infarct size, expressed as a percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging 2–6 days after study medication administration. Results In the efficacy cohort (n=138), infarct size did not differ between groups at either 2–6 days (15.8±10.3 vs. 15.0±10.0, P=.666) or 12±2 weeks (10.6±8.6 vs. 10.4±7.6, P=.886). Left ventricular ejection fraction also did not differ between groups at either the early (48.2±9.1 vs. 48.9±8.7, P=.671) or late (52.5±9.3 vs. 52.0±8.8, P=.760) timepoints. In pre-specified analyses of patients aged ≥70 years (n=21), mean infarct size within the first week was larger in the epoetin alfa arm than in the placebo group (19.9±9.9 vs.11.7±7.2, P=.026). Patients who received epoetin alfa had a higher incidence of the composite endpoint of death, myocardial infarction, stroke, or stent thrombosis (4.0% vs. 0.0%, P=.042), and a higher incidence of serious adverse events (20.0% vs. 10.3%, P=.052). Conclusions In STEMI patients successfully reperfused with primary or rescue PCI, a single intravenous bolus of epoetin alfa did not reduce infarct size and was

  11. Early treatment with intravenous metoprolol for suspected acute myocardial infarction: a phase IV United States trial. Phase IV Metoprolol in Myocardial Infarction Study Group.

    Science.gov (United States)

    Antman, E M; Dupont, W D; Bonalsky, J; Califf, R M; Corwin, S; Fink, L; Hansen, D E; Kawanishi, D T; Kronenberg, M W; McKay, C R

    1989-05-01

    Recent randomized clinical trials have shown that total mortality and cardiovascular mortality are reduced by the early intravenous administration of beta-blockers to patients suspected of suffering from acute myocardial infarction. These trials were conducted on patients meeting strict entry criteria. In order to assess this therapy when applied to a broader range of myocardial infarction patients, we performed a Phase IV study of metoprolol in acute myocardial infarction. The study was designed to test whether early (less than 8 hours from onset of chest pain) intervention by practicing physicians with open label intravenous metoprolol for cases of suspected acute myocardial infarction achieved mortality results similar to those obtained in large randomized clinical trials. We studied 3824 patients treated by 741 physicians representing a broad spectrum of clinical practice in the United States. Seventy-two percent of the patients entered into the study had confirmed myocardial infarction (39% anterior, 39% inferior, 22% other locations) and 85% of all individuals treated tolerated the full intravenous dose of 15 mg of metoprolol. The 15 day total mortality and cardiovascular mortality rates were 4.9% and 4.5%; 90 day mortality rates were 6.9 and 5.9%. Patients with anterior infarctions had a significantly greater cumulative mortality rate than patients with other types of infarctions. Marked bradycardia (heart rate less than 45 beats per minute) in the first 8 hours post treatment occurred in 4.7% cases and hypotension (systolic blood pressure less than 90 mm Hg) occurred in 9.8% of cases. When compared with the results of the Göteborg and MIAMI trials of metoprolol, it appears that there is no appreciable increase in mortality or morbidity when metoprolol is used in the community practice of acute coronary care.

  12. Correlation between myocardial dysfunction and perfusion impairment in diabetic rats with velocity vector imaging and myocardial contrast echocardiography.

    Science.gov (United States)

    Wei, Zhangrui; Zhang, Haibin; Su, Haili; Zhu, Ting; Zhu, Yongsheng; Zhang, Jun

    2012-11-01

    The purpose of this study was to investigate whether myocardial systolic dysfunction and perfusion impairment occur in diabetic rats, and to assess their relationship using velocity vector imaging (VVI) and myocardial contrast echocardiography (MCE). Forty-six rats were randomly divided into either control or the diabetes mellitus (DM) groups. DM was induced by intraperitoneal administration of streptozotocin. Twelve weeks later, 39 survival rats underwent VVI and MCE in short-axis view at the middle level of the left ventricle, both at rest and after dipyridamole stress. VVI-derived contractile parameters included peak systolic velocity (Vs ), circumferential strain (εc ), strain rate (SRc ), and their reserves. MCE-derived perfusion parameters consisted of myocardial blood flow (MBF) and myocardial flow reserve (MFR). At rest, SRc in the DM group was significantly lower than in the control group, Vs , εc , and MBF did not differ significantly between groups. After dipyridamole stress, all VVI parameters and their reserves in the DM group were significantly lower than those in the control group, MBF and MFR were substantially lower than those in the control group, too. Meanwhile, significant correlations between VVI parameter reserves and MFR were observed in the DM group. Both myocardial systolic function and perfusion were impaired in DM rats. Decreased MFR could be an important contributor to the reduction in myocardial contractile reserve.

  13. Contrast-enhanced MRI of murine myocardial infarction - part II

    NARCIS (Netherlands)

    Coolen, B.F.; Paulis, L.E.M.; Geelen, T.; Nicolay, K.; Strijkers, G.J.

    2012-01-01

    Mouse models are increasingly used to study the pathophysiology of myocardial infarction in vivo. In this area, MRI has become the gold standard imaging modality, because it combines high spatial and temporal resolution functional imaging with a large variety of methods to generate soft tissue contr

  14. Contrast-enhanced MRI of murine myocardial infarction - part II

    NARCIS (Netherlands)

    Coolen, B.F.; Paulis, L.E.M.; Geelen, T.; Nicolay, K.; Strijkers, G.J.

    2012-01-01

    Mouse models are increasingly used to study the pathophysiology of myocardial infarction in vivo. In this area, MRI has become the gold standard imaging modality, because it combines high spatial and temporal resolution functional imaging with a large variety of methods to generate soft tissue

  15. Sudden death after intravenous administration of a perflutren contrast agent: a case of pseudocomplication?

    Science.gov (United States)

    Mahjoub, Haïfa; Roméo, Philippe; Leung, Tack-Ki; Burelle, Denis; Cartier, Raymond; Basmadjian, Arsène J

    2009-06-01

    Perflutren cardiac ultrasound agents improve diagnostic accuracy in patients whose imaging is technically difficult. This report describes a case of sudden death approximately 5 minutes after the intravenous administration of 0.5 mL of perflutren contrast agent (Definity) during transthoracic echocardiography with suboptimal baseline images performed 10 days after coronary artery bypass graft surgery because of hypotension and tachycardia in a 73-year-old patient with severe left ventricular systolic dysfunction. Autopsy did not reveal a clear direct relationship between perflutren and death. This is the first reported case of death related temporally to an echocardiographic contrast agent occurring in Canada and could represent a case of pseudocomplication.

  16. Magnetic resonance imaging dynamic contrast enhancement (DCE) characteristics of healed myocardial infarction differ from viable myocardium.

    Science.gov (United States)

    Goldfarb, James W; Zhao, Wenguo

    2014-12-01

    To determine whether healed myocardial infarction alters dynamic contrast-enhancement (DCE) curve shapes as well as late gadolinium-enhancement (LGE). Twenty patients with chronic myocardial infarction underwent MR imaging at 1.5 T with blood and myocardial T1 measurements before and after contrast administration for forty minutes. Viable and infarcted myocardial partition coefficients were calculated using multipoint slope methods for ten different DCE sampling intervals and windows. Partition coefficients and coefficients of determination were compared with paired statistical tests to assess the linearity of DCE curve shapes over the 40 min time period. Calculated partition coefficients did not vary significantly between methods (p=0.325) for viable myocardium but did differ for infarcted myocardium (pinfarcted DCE. There was a significant difference between viable and infarcted myocardial partition coefficients estimates for all methods with the exception of methods that included measurements during the first 10 min after contrast agent administration. Myocardial partition coefficients calculated from a slope calculation vary in healed myocardial infarction based on the selection of samples due to non-linear DCE curve shapes. Partition coefficient calculations are insensitive to data sampling effects in viable myocardium due to linear DCE curve shapes. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial

    OpenAIRE

    Mateos, Alonso; García Lunar, Inés; García Ruiz, José María; Pizarro, Gonzalo; Fernández Jiménez, Rodrigo; Huertas, Pilar; García Álvarez, Ana; Fernández-Friera, Leticia; Bravo, Jesús; Flores Arias, José; Barreiro, María V.; Chayán Zas, Luisa; Corral, Ervigio; Fuster, Valentín; Sánchez Brunete, Vicente

    2015-01-01

    We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)–administered intravenous metoprolol in anterior ST-segment elevation myocardial infarction patients undergoing eventual primary angioplasty. This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprol...

  18. Is intravenous contrast enhancement effective in improving CT diagnosis of hepatic disease?

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Katsuhide; Ono, Chiaki [Hiroshima Univ. (Japan). Hospital; Kohno, Atsushi[Japanese Foundation for Cancer Research, Tokyo (Japan). Hospital; Sumi, Yukiharu [Juntendo Univ., Chiba (Japan). Urayasu Hospital; Honda, Masanori [Saiseikai Utsunomiya Hospital (Japan); Uchimura, Fumiaki [Yamagata Prefectural Nihonkai Hospital, Sakata (Japan); Ogawa, Kenji [Nihon Koukan Hospital, Kawasaki, Kanagawa (Japan); Ohtaki, Megu [Hiroshima Univ. (Japan). Research Inst. for Radiation Biology and Medicine

    2003-03-01

    The purpose of this study was to evaluate the effectiveness of contrast enhancement in the diagnosis of hepatic disease. 2761 cases involving CT of the liver and abdomen were analyzed using logistic analysis. CT was either helical-CT (SDCT) or multi-detector CT (MDCT), with power injector. Contrast enhancement use was 92% in liver disease and 95% in tumor cases. A typical case involved a 66-year-old man given 2-4 ml/sec of contrast material using dual injection. CT imaging was done in the equilibrium stage. The use of contrast material was effective for the diagnosis of liver tumor except in the qualitative diagnosis of hepatocellular carcinoma with SDCT where the odds ratio was 0.084. Intravenous contrast enhancement was effective for the CT diagnosis of hepatic tumor. Dynamic CT was effective using MDCT, and dual injection of contrast material was also valid for SDCT. Multiphasic studies were needed for detecting liver tumors not only on MDCT but also on SDCT. CT imaging during the equilibrium phase alone is inadequate to document diagnosis of metastatic liver tumors. The addition of various phasic contrast materials during CT was effective in evaluating liver tumors that showed angiogenesis. (author)

  19. Quantitative assessment of harmonic power doppler myocardial perfusion imaging with intravenous levovist™ in patients with myocardial infarction: comparison with myocardial viability evaluated by coronary flow reserve and coronary flow pattern of infarct-related artery

    Directory of Open Access Journals (Sweden)

    Nagai Kunihiko

    2005-08-01

    Full Text Available Abstract Background Myocardial contrast echocardiography and coronary flow velocity pattern with a rapid diastolic deceleration time after percutaneous coronary intervention has been reported to be useful in assessing microvascular damage in patients with acute myocardial infarction. Aim To evaluate myocardial contrast echocardiography with harmonic power Doppler imaging, coronary flow velocity reserve and coronary artery flow pattern in predicting functional recovery by using transthoracic echocardiography. Methods Thirty patients with anterior acute myocardial infarction underwent myocardial contrast echocardiography at rest and during hyperemia and were quantitatively analyzed by the peak color pixel intensity ratio of the risk area to the control area (PIR. Coronary flow pattern was measured using transthoracic echocardiography in the distal portion of left anterior descending artery within 24 hours after recanalization and we assessed deceleration time of diastolic flow velocity. Coronary flow velocity reserve was calculated two weeks after acute myocardial infarction. Left ventricular end-diastolic volumes and ejection fraction by angiography were computed. Results Pts were divided into 2 groups according to the deceleration time of coronary artery flow pattern (Group A; 20 pts with deceleration time ≧ 600 msec, Group B; 10 pts with deceleration time Conclusion The preserved microvasculature detecting by myocardial contrast echocardiography and coronary flow velocity reserve is related to functional recovery after acute myocardial infarction.

  20. Dual bolus intravenous contrast injection technique for multiregion paediatric body CT

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Karen E.; Mann, E.H.; Padfield, N.; Greco, L.; BenDavid, G. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Alzahrani, A. [King Abdulaziz Medical City, PO Box 22490, Riyadh (Saudi Arabia)

    2015-04-01

    Optimal vascular and parenchymal enhancement for multi-region paediatric body computed tomography (CT) has many challenges. A variety of approaches are currently employed, associated with varying image quality and radiation dose implications. We present a dual bolus intravenous (DBI) contrast technique for single-acquisition imaging of the chest, abdomen and pelvis, with evaluation of multi-compartmental vascular enhancement. A DBI regime was designed for use with a programmable dual head pump injector. A larger initial bolus (two-thirds volume) is followed by a smaller bolus (one-third volume) before imaging the chest, abdomen and pelvis in a single acquisition, 45-65 seconds from the start of initial injection. Flow rates and second bolus timing were tailored to patient weight and contrast volume, using five weight categories. Multi-compartmental vascular opacification was graded and image quality was assessed in a cohort of 130 patients. The DBI technique resulted in concordant multi-compartmental (thoracic aortic, pulmonary arterial, abdominal aortic and portal venous) vascular enhancement. Early splenic parenchymal enhancement artefacts and alterations to renal enhancement were observed. We present a weight-stratified dual bolus intravenous contrast technique to improve image quality in paediatric multi-region body CT. (orig.)

  1. The developmental history of the gadolinium chelates as intravenous contrast media for magnetic resonance.

    Science.gov (United States)

    Runge, Val M; Ai, Tao; Hao, Dapeng; Hu, Xuemei

    2011-12-01

    The developmental history of the gadolinium chelates, which spans 30 years, is described, focusing, in part, on the seminal work with each of the major agents in use today. By examining this history, insight is gained into important issues of efficacy and safety, with valuable lessons to be learned from the mistakes made during this period. An overview of physicochemical characteristics and chemical structures is also provided. The review concludes with a discussion of current research directions involving this field, which is that of the intravenous contrast media for magnetic resonance, in the past 5 years.

  2. Intravenous contrast injection significantly affects bone mineral density measured on CT

    Energy Technology Data Exchange (ETDEWEB)

    Pompe, Esther; Willemink, Martin J.; Dijkhuis, Gawein R.; Verhaar, Harald J.J.; Hoesein, Firdaus A.A.M.; Jong, Pim A. de [University Medical Center Utrecht, Department of Radiology and Internal Medicine-Geriatrics, Postbus 85500, Postbox: E.03.511, GA, Utrecht (Netherlands)

    2014-09-05

    The objective is to evaluate the effect of intravenous contrast media on bone mineral density (BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography (CT) examinations performed for other indications. One hundred and fifty-two patients (99 without and 53 with malignant neoplasm) who underwent both unenhanced and two contrast-enhanced (arterial and portal venous phase) abdominal CT examinations in a single session between June 2011 and July 2013 were included. BMD was evaluated on the three examinations as CT-attenuation values in Hounsfield Units (HU) in the first lumbar vertebra (L1). CT-attenuation values were significantly higher in both contrast-enhanced phases, compared to the unenhanced phase (p < 0.01). In patients without malignancies, mean ± standard deviation (SD) HU-values increased from 128.8 ± 48.6 HU for the unenhanced phase to 142.3 ± 47.2 HU for the arterial phase and 147.0 ± 47.4 HU for the portal phase (p < 0.01). In patients with malignancies, HU-values increased from 112.1 ± 38.1 HU to 126.2 ± 38.4 HU and 130.1 ± 37.3 HU (p < 0.02), respectively. With different thresholds to define osteoporosis, measurements in the arterial and portal phase resulted in 7-25 % false negatives. Our study showed that intravenous contrast injection substantially affects BMD-assessment on CT and taking this into account may improve routine assessment of low BMD in nonquantitative CT. (orig.)

  3. Intravenous contrast media application using cone-beam computed tomography in a rabbit model

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Sung; Kim, Bok Yeol; Choi, Hwa Young [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul (Korea, Republic of); and others

    2015-03-15

    This study was performed to evaluate the feasibility of visualizing soft tissue lesions and vascular structures using contrast-enhanced cone-beam computed tomography (CE-CBCT) after the intravenous administration of a contrast medium in an animal model. CBCT was performed on six rabbits after a contrast medium was administered using an injection dose of 2 mL/kg body weight and an injection rate of 1 mL/s via the ear vein or femoral vein under general anesthesia. Artificial soft tissue lesions were created through the transplantation of autologous fatty tissue into the salivary gland. Volume rendering reconstruction, maximum intensity projection, and multiplanar reconstruction images were reconstructed and evaluated in order to visualize soft tissue contrast and vascular structures. The contrast enhancement of soft tissue was possible using all contrast medium injection parameters. An adequate contrast medium injection parameter for facilitating effective CE-CBCT was a 5-mL injection before exposure combined with a continuous 5-mL injection during scanning. Artificial soft tissue lesions were successfully created in the animals. The CE-CBCT images demonstrated adequate opacification of the soft tissues and vascular structures. Despite limited soft tissue resolution, the opacification of vascular structures was observed and artificial soft tissue lesions were visualized with sufficient contrast to the surrounding structures. The vascular structures and soft tissue lesions appeared well delineated in the CE-CBCT images, which was probably due to the superior spatial resolution of CE-CBCT compared to other techniques, such as multislice computed tomography.

  4. Evaluation and simplified measurement of infarct size by myocardial contrast echocardiography in a rat model of myocardial infarction.

    Science.gov (United States)

    Chen, Xianghui; Cui, Kai; Xiu, Jiancheng; Lin, Huanbing; Lao, Yi; Zhou, Biying; Liang, Feixue; Zha, Daogang; Bin, Jianping; Liu, Yili

    2009-10-01

    To test the feasibility and accuracy of myocardial contrast echocardiography (MCE) for predicting infarct size (IS) in a rat model of myocardial infarction (MI) and to compare a simplified single plane-based measurement of IS with the conventional three plane-based approach. Fifty male SD rats underwent left anterior descending artery ligation and were evaluated by MCE 8 h post MI. IS was calculated by the single and three plane-based approaches, compared to that determined by triphenyltetrazolium chloride (TTC) staining method. Simplified single plane-based MCE approach and TTC method showed similar IS values (38.48 +/- 16.80% vs. 35.72 +/- 15.33%, P > 0.05) and presented a favorable positive correlation (r = 0.851, P rats with MI. A single measurement at the mid-papillary muscle level may become a simple, efficient and reliable approach for in vivo IS assessment.

  5. Complications from the use of intravenous gadolinium-based contrast agents for magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Elias Junior, Jorge; Santos, Antonio Carlos dos; Nogueira-Barbosa, Marcello Henrique; Muglia, Valdair Francisco; Koenigkam-Santos, Marcel [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Hospital das Clinicas. Centro de Ciencias das Imagens e Fisica Medica]. E-mail: jejunior@fmrp.usp.br

    2008-07-15

    Gadolinium-based contrast agents are much safer than the iodinated ones; however complications may occur and should be recognized for appropriate orientation and management. The total incidence of adverse reactions to contrast agents in magnetic resonance imaging ranges between 2% and 4%. Cases of severe acute reactions to gadolinium, such as laryngospasm and anaphylactic shock, are rare. Chronic complications secondary to the use of gadolinium also can occur and, recently an association between its use and a rare dermatologic disease occurring in patients with renal failure has been reported. Nephrogenic systemic fibrosis was the subject of an official health notification issued by the American Food and Drug Administration. This progressive disease is characterized by hardened skin with fibrotic nodules and plaques which may involve other parts of the body. Patients who have been affected by this disorder presented chronic renal failure, with metabolic acidosis and had been submitted to magnetic resonance angiography, probably involving exposure to large amounts of intravenous paramagnetic contrast. This review is aimed at presenting a succinct description of the gadolinium-based contrast agent types, possible secondary complications, their preventive measures and management. (author)

  6. Thyroid function in very low birthweight infants after intravenous administration of the iodinated contrast medium iopromide

    Science.gov (United States)

    Dembinski, J; Arpe, V; Kroll, M; Hieronimi, G; Bartmann, P

    2000-01-01

    BACKGROUND—Thyroid function disorders have often been observed in preterm infants after intravenous administration of iodinated contrast medium. The effect on thyroid function depends on the dosage, but the choice of the contrast medium may be equally important, as there are appreciable pharmacological differences between them.
METHOD—Thyroid function was analysed in 20 very low birthweight infants of gestational age less than 30 weeks after injection of iopromide, a monomeric non-ionic iodinated contrast medium. Levels of free thyroxine and thyroid stimulating hormone were compared with those in 26 control infants.
RESULTS—Free thyroxine levels in all study infants ranged from 9.0 to 25.7 pmol/l (days 14-21) and 9.0 to 23.2 pmol/l (days 35-49), and thyroid stimulating hormone levels ranged from 0.13 to 0.26mU/l (days 14-21) and 0.26 to 11.11 mU/l (days 35-49). These levels were not altered after injection of iopromide.
CONCLUSION—The risk of transient hypothyroidism or hyperthyrotropinaemia may be reduced with the use of iopromide compared with other contrast media.

 PMID:10794789

  7. Flat detector computed tomography angiography with intravenous contrast application: feasibility for visualization of cerebral arterial vasculature.

    Science.gov (United States)

    Saake, Marc; Breuer, Lorenz; Goelitz, Philipp; Ott, Sabine; Struffert, Tobias; Doerfler, Arnd

    2013-07-01

    The aim of our study was to evaluate flat detector computed tomography angiography with peripheral intravenous contrast material application (FD-CTA) for visualization of cerebral arteries in comparison with intravenous multidetector computed tomography angiography (CTA) and intraarterial digital subtraction angiography (DSA). The study was approved by the local institutional review board and informed consent was obtained by all participants. Ten patients underwent FD-CTA, CTA, and DSA of the cerebral arterial vasculature for suspected cerebrovascular disease. The image data were evaluated by two readers in consensus for the visualization of cerebral arterial segments on a 5-point scale (0 = vessel cannot be distinguished; 4 = excellent image quality). The Wilcoxon signed-rank test was used for statistical analysis. Note that P < .05 was considered to indicate a significant difference. The depiction of cerebral arterial segments with FD-CTA was significantly superior compared to CTA in most vessel segments (P < .05 in 20 of 23 anatomic regions) and was without significant difference compared with DSA in large and medium intracranial vessels. The results suggest that the cerebral arteries can be visualized by FD-CTA in high resolution, in many vessel segments comparable to DSA. Copyright © 2012 by the American Society of Neuroimaging.

  8. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Kjel [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: kjel_andersen@web.de; Hennersdorf, Marcus [Department of Cardiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: hennersdorf@med.uni-duesseldorf.de; Cohnen, Mathias [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: cohnen@med.uni-duesseldorf.de; Blondin, Dirk [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Moedder, Ulrich [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: moedder@uni-duesseldorf.de; Poll, Ludger W. [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: poll@gmx.de

    2009-07-15

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  9. Intravenous, contrast-enhanced MR colonography using air as endoluminal contrast agent: Impact on colorectal polyp detection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2012-02-01

    PURPOSE: To compare diagnostic accuracy and patient tolerance of MR colonography with intravenous contrast and luminal air (MRC) to conventional colonoscopy (CC). MATERIALS AND METHODS: IRB approval and written informed consent were obtained. Forty-six patients, both screening and symptomatic, underwent MRC followed by CC. The MRC technique employed 3D T1W spoiled gradient echo sequences performed after the administration of gadopenetate dimeglumine, with parallel imaging. The diagnostic accuracy and tolerance of patients for MRC was compared to CC. RESULTS: Twenty-four polyps were detected in eighteen patients with CC (5 polyps >\\/=10mm, 4 polyps 6-9mm, 15 polyps <\\/=5mm). MRC was 66.7% (12\\/18) sensitive and 96.4% (27\\/28) specific for polyp detection on a per-patient basis. When analyzed by polyp size, sensitivity and specificity of MRC was 100% (5\\/5) and 100% (19\\/19), respectively, for lesions greater than 10mm, 100% (4\\/4) and 100% (20\\/20) for lesions 6-9mm, and sensitivity of 20% (3\\/15) lesions less than 5mm. The sensitivity and specificity of MRC for detecting significant lesions (>6mm) was 100% (9\\/9) and 100% (15\\/15), respectively. Regarding tolerance of the exams, there were no significant differences between MRC and CC. Thirty-five percent (n=16) of patients preferred MRC as a future screening test compared to 33% (n=15) for CC. CONCLUSION: MRC using air as an intraluminal contrast agent is a feasible and well-tolerated technique for detecting colonic polyps >\\/=6mm in size. Further studies are warranted.

  10. Intravenous, contrast-enhanced MR colonography using air as endoluminal contrast agent: Impact on colorectal polyp detection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2010-12-03

    PURPOSE: To compare diagnostic accuracy and patient tolerance of MR colonography with intravenous contrast and luminal air (MRC) to conventional colonoscopy (CC). MATERIALS AND METHODS: IRB approval and written informed consent were obtained. Forty-six patients, both screening and symptomatic, underwent MRC followed by CC. The MRC technique employed 3D T1W spoiled gradient echo sequences performed after the administration of gadopenetate dimeglumine, with parallel imaging. The diagnostic accuracy and tolerance of patients for MRC was compared to CC. RESULTS: Twenty-four polyps were detected in eighteen patients with CC (5 polyps ≥10mm, 4 polyps 6-9mm, 15 polyps ≤5mm). MRC was 66.7% (12\\/18) sensitive and 96.4% (27\\/28) specific for polyp detection on a per-patient basis. When analyzed by polyp size, sensitivity and specificity of MRC was 100% (5\\/5) and 100% (19\\/19), respectively, for lesions greater than 10mm, 100% (4\\/4) and 100% (20\\/20) for lesions 6-9mm, and sensitivity of 20% (3\\/15) lesions less than 5mm. The sensitivity and specificity of MRC for detecting significant lesions (>6mm) was 100% (9\\/9) and 100% (15\\/15), respectively. Regarding tolerance of the exams, there were no significant differences between MRC and CC. Thirty-five percent (n=16) of patients preferred MRC as a future screening test compared to 33% (n=15) for CC. CONCLUSION: MRC using air as an intraluminal contrast agent is a feasible and well-tolerated technique for detecting colonic polyps ≥6mm in size. Further studies are warranted.

  11. Renal effects of the non-ionic contrast medium iopentol after intravenous injection in healthy volunteers

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    Jakobsen, J.A.; Berg, K.J.; Waaler, A.; Andrew, E. (Rikshospitalet, Oslo (Norway). Dept. of Radiology Rikshospitalet, Oslo (Norway). Renal Section Nycomed A/S, Oslo (Norway). Dept. of Clinical Research and Development)

    1990-01-01

    Renal effects of the new non-ionic contrast medium iopentol in increasing doses were assessed and compared with the effects of physiologic saline. Twenty-four healthy male volunteers, allocated to three dose groups, were given iopentol intravenously in doses of 0.3, 0.6, and 1.2 g I/kg body weight, respectively. The highest dose group was also given physiologic saline separately as a control. The diuresis increased in all groups, most in the highest dose group, and with a concomitant fall of urine osmolality and increase in osmolar clearance. A slight decrease of serum osmolality, creatinine and urea occurred at 3 hours due to hemodilution. The glomerular filtration rate was unaffected by iopentol. The urinary excretion of albumin and {beta}{sub 2}-microglobulin was unchanged. However, urinary N-acetyl-{beta}-glucosaminidase and alkaline phosphatase increased significantly, most in the highest dose group. All changes were reversible. (orig.).

  12. Quality of abdominal computed tomography angiography: hand versus mechanical intravenous contrast administration in children

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    Ayyala, Rama S.; Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Zurakowski, David [Boston Children' s Hospital and Harvard Medical School, Departments of Anesthesiology and Surgery, Boston, MA (United States)

    2015-11-15

    Abdominal CT angiography has been increasingly used for evaluation of various conditions related to abdominal vasculature in the pediatric population. However, no direct comparison has evaluated the quality of abdominal CT angiography in children using hand versus mechanical administration of intravenous (IV) contrast agent. To compare hand versus mechanical administration of IV contrast agent in the quality of abdominal CT angiography in the pediatric population. We retrospectively reviewed the electronic medical record to identify pediatric patients (≤18 years) who had abdominal CT angiography between August 2012 and August 2013. The information obtained includes: (1) type of administration of IV contrast agent (hand [group 1] versus mechanical [group 2]), (2) size (gauge) of IV catheter, (3) amount of contrast agent administered and (4) rate of contrast agent administration (ml/s). Two reviewers independently performed qualitative and quantitative evaluation of abdominal CT angiography image quality. Qualitative evaluation of abdominal CT angiography image quality was performed by visual assessment of the degree of contrast enhancement in the region of interest (ROI) based on a 4-point scale. Quantitative evaluation of each CT angiography examination was performed by measuring the Hounsfield unit (HU) using an ROI within the abdominal aorta at two levels (celiac axis and the inferior mesenteric artery) for each child. Analysis of variance (ANOVA) using the F-test was applied to compare contrast enhancement within the abdominal aorta at two levels (celiac axis and inferior mesenteric artery) between hand administration and mechanical administration of IV contrast methods with adjustment for age. We identified 46 pediatric patients (24 male, 22 female; mean age 7.3 ± 5.5 years; range 5 weeks to 18 years) with abdominal CT angiography performed during the study period. Of these patients, 16 (35%; 1.7 ± 2.2 years; range 5 weeks to 5 years) had hand

  13. Placement of central venous access via subclavian vein under fluoroscopic guidance with intravenous contrast injection

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Sung Wook; Choo, In Wook; Do, Young Soo; Kim, Seung Hoon; Yoh, Kyu Tong; Ro, Duk Woo; Kim, Bo Kyung [Samsung Medical Center, Seoul (Korea, Republic of)

    1997-01-01

    To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was as the junction of the right atrium and the superior vena cava. One hundred and eighty-six Hickman catheters were successfully placed ; the one failure was due to anatomical tortuosity of the vein (0.53%). Complications included one case of subclavian vein occlusion (0.53%) ; three of line occlusion by thrombus (1.6%) ; one of oozing at the suture site (0.53%) ; six of infection or inflammation (3.2%) ; eight of natural removal (4.2%) ; one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.

  14. Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

    Directory of Open Access Journals (Sweden)

    Getaw Worku Hassen

    2014-05-01

    Full Text Available Introduction: Contrast-induced nephropathy (CIN, defined as an increase in serum creatinine (SCr greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED and were discharged home after computed tomography (CT of the abdomen and pelvis (AP with IV contrast. Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients’ clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD and congestive heart failure (CHF. Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%. Hypertension was present in 141 patients (26.3%, and 82 patients (15.3% were on angiotensin-converting-enzyme inhibitors (ACEI. Five patients (0.9% had documented CHF and all of them were taking furosemide. Seventy patients (13% had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28% followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5% had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5% developed CIN. One hundred ninety patients (35.4% followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2% had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15% developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients. Conclusion: There was a

  15. Are referring clinicians aware of patients at risk from intravenous injection of iodinated contrast media?

    Energy Technology Data Exchange (ETDEWEB)

    Konen, Eli; Konen, Osnat; Katz, Miriam; Levy, Yair; Rozenman, Judith; Hertz, Marjorie

    2002-02-01

    AIM: The purpose of our study was to assess the level of awareness of referring clinicians to populations at risk for complications of intravascular administration of iodinated contrast media. SUBJECTS AND METHODS: Two hundred and three physicians from three university hospitals completed an anonymous questionnaire regarding risk factors and contraindications to the intravenous administration of iodinated contrast media. The questionnaire included medical conditions with increased risk for anaphylactoid reaction (asthma, hay fever and food allergy) as well as chemotoxic (ischaemic heart disease, phaeochromocytoma and myasthenia gravis) adverse reactions, some with dependence on renal function (metformin treatment, diabetes mellitus and multiple myeloma). Two additional multiple-choice questions addressed pre-medication protocols and risk of nephrotoxicity in diabetic patients. RESULTS: Asthma, food allergy and hay fever were recognized as risk factors by 81{center_dot}3%, 77{center_dot}8% and 61{center_dot}6% of respondents respectively, while ischaemic heart disease, phaeochromocytoma and myasthenia gravis were defined as such only by 9{center_dot}8%, 30{center_dot}0% and 28{center_dot}6% respectively. Metformin treatment, diabetes mellitus and multiple myeloma, in the presence of normal renal function, were considered as risk factors by 46{center_dot}3%, 38{center_dot}9% and 58{center_dot}1% of respondents respectively. One of the generally accepted pre-medication protocols was selected by 89{center_dot}8%. The risk of nephrotoxicity in a diabetic patient was correctly assessed by 63{center_dot}5% of respondents. CONCLUSION: We found a relatively high awareness among referring clinicians of a potential anaphylactoid reaction and nephrotoxicity due to iodinated contrast media. However, additional chemotoxic adverse reactions are less well known. Future efforts to improve communication between clinicians and radiologists should be focused in this direction. Konen

  16. Real-time myocardial contrast echocardiography in rat: infusion versus bolus administration.

    Science.gov (United States)

    Su, Hai-Li; Qian, Yun-Qiu; Wei, Zhang-Rui; He, Jian-Guo; Li, Guo-Quan; Zhang, Jun; Zhou, Xiao-Dong; Jing, Wang

    2009-05-01

    To compare the feasibility of real-time myocardial contrast echocardiography (MCE) in rats with infusion and bolus administration of a second-generation ultrasound contrast agent BR1. B-mode real-time MCE was performed in 12 Sprague Dawley rats following the BR1 infusion or bolus injection. The myocardium signal intensity (SI) was plotted against time and was fitted to exponential functions. The plateau SI (A) and rate of SI increase (beta) for the infusion study and peak signal intensity (PSI) for the bolus study were obtained. (99m)Tc-Sestamibi and Evans blue were used to assess myocardial blood perfusion and to calculate the myocardium perfusion defect area ex vivo. High-quality real-time MCE images were successfully obtained using each method. At baseline, all LV segments showed even contrast distribution. Following left anterior descending coronary artery (LAD) ligation, significant perfusion defect was observed in LAD beds with a significantly decreased A* beta and PSI values compared with LCx beds (Infusion: A*beta (LAD): 5.42 +/- 1.57 dB, A*beta (LCx): 46.52 +/- 5.32 dB, p rats and the infusion method was more suitable for quantitative analysis of myocardial blood flow.

  17. Angiographic CT with intravenous contrast agent application for monitoring of intracranial flow diverting stents

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    Saake, Marc; Struffert, Tobias; Goelitz, Philipp; Ott, Sabine; Doerfler, Arnd [University of Erlangen-Nuremberg, Department of Neuroradiology, Erlangen (Germany); Seifert, Frank [University of Erlangen-Nuremberg, Department of Neurology, Erlangen (Germany); Ganslandt, Oliver [University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany)

    2012-07-15

    Intracranial flow diverting devices are increasingly used to treat cerebral aneurysms. A reliable, non-invasive follow-up modality would be desirable. Our aim was to compare intra-arterial digital subtraction angiography (ia DSA) to angiographic computed tomography with intravenous contrast agent application (iv ACT) in the visualisation of flow diverting devices and aneurysm lumina. Follow-up monitoring by iv ACT (n = 36) and ia DSA (n = 25) in 14 patients treated with flow diverting devices for intracranial aneurysms was evaluated retrospectively. Images were evaluated by two neuroradiologists in anonymous consensus reading regarding the device deployment, wall apposition, neck coverage of the aneurysm, opacification of the vessel and device lumen, as well as the degree of aneurysm occlusion. Corresponding ia DSA and iv ACT images were scored identically in all patients regarding the stent deployment, wall apposition and neck coverage, as well as the degree of aneurysm occlusion and patency status of the device and parent artery. Opacification of the parent vessel lumen and perfused parts of the aneurysm was considered slightly inferior for iv ACT in comparison with ia DSA (seven of 36 cases), without impact on diagnosis. We demonstrated the feasibility and diagnostic value of iv ACT in follow-up imaging of intracranial flow diverting devices. Due to its high spatial resolution and non-invasive character, this novel technique might become a valuable imaging modality in these patients. (orig.)

  18. Angiographic CT with intravenous contrast agent application for monitoring of intracranial flow diverting stents.

    Science.gov (United States)

    Saake, Marc; Struffert, Tobias; Goelitz, Philipp; Ott, Sabine; Seifert, Frank; Ganslandt, Oliver; Doerfler, Arnd

    2012-07-01

    Intracranial flow diverting devices are increasingly used to treat cerebral aneurysms. A reliable, non-invasive follow-up modality would be desirable. Our aim was to compare intra-arterial digital subtraction angiography (ia DSA) to angiographic computed tomography with intravenous contrast agent application (iv ACT) in the visualisation of flow diverting devices and aneurysm lumina. Follow-up monitoring by iv ACT (n = 36) and ia DSA (n = 25) in 14 patients treated with flow diverting devices for intracranial aneurysms was evaluated retrospectively. Images were evaluated by two neuroradiologists in anonymous consensus reading regarding the device deployment, wall apposition, neck coverage of the aneurysm, opacification of the vessel and device lumen, as well as the degree of aneurysm occlusion. Corresponding ia DSA and iv ACT images were scored identically in all patients regarding the stent deployment, wall apposition and neck coverage, as well as the degree of aneurysm occlusion and patency status of the device and parent artery. Opacification of the parent vessel lumen and perfused parts of the aneurysm was considered slightly inferior for iv ACT in comparison with ia DSA (seven of 36 cases), without impact on diagnosis. We demonstrated the feasibility and diagnostic value of iv ACT in follow-up imaging of intracranial flow diverting devices. Due to its high spatial resolution and non-invasive character, this novel technique might become a valuable imaging modality in these patients.

  19. Value of adenosine infusion for infarct size determination using real-time myocardial contrast echocardiography

    Directory of Open Access Journals (Sweden)

    da Luz Protásio

    2006-02-01

    Full Text Available Abstract Background Myocardial contrast echocardiography has been used for determination of infarct size (IS in experimental models. However, with intermittent harmonic imaging, IS seems to be underestimated immediately after reperfusion due to areas with preserved, yet dysfunctional, microvasculature. The use of exogenous vasodilators showed to be useful to unmask these infarcted areas with depressed coronary flow reserve. This study was undertaken to assess the value of adenosine for IS determination in an open-chest canine model of coronary occlusion and reperfusion, using real-time myocardial contrast echocardiography (RTMCE. Methods Nine dogs underwent 180 minutes of coronary occlusion followed by reperfusion. PESDA (Perfluorocarbon-Exposed Sonicated Dextrose Albumin was used as contrast agent. IS was determined by RTMCE before and during adenosine infusion at a rate of 140 mcg·Kg-1·min-1. Post-mortem necrotic area was determined by triphenyl-tetrazolium chloride (TTC staining. Results IS determined by RTMCE was 1.98 ± 1.30 cm2 and increased to 2.58 ± 1.53 cm2 during adenosine infusion (p = 0.004, with good correlation between measurements (r = 0.91; p 2 and showed no significant difference with IS determined by RTMCE before or during hyperemia. A slight better correlation between RTMCE and TTC measurements was observed during adenosine (r = 0.99; p Conclusion RTMCE can accurately determine IS in immediate period after acute myocardial infarction. Adenosine infusion results in a slight better detection of actual size of myocardial damage.

  20. Evaluation of the effect of myocardial perfusion after percutaneous coronary intervention in coronary artery disease by using intracoronary myocardial contrast echocardiography and two other angiographic techniques

    Institute of Scientific and Technical Information of China (English)

    WANG Hong; LIU Zheng; YANG Li; HUANG Lan; JIN Jun; SONG Yaoming; GENG Zhaohua; YU Xuejun; QIN Jun; ZHAO Gang; GAO Yunhua

    2007-01-01

    Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease (CAD) after they have undergone percutaneous coronary intervention (PCI).The objective of this study is to evaluate the effect of myocardial perfusion by three different methods-intra-coronary myocardial contrast echocardiography (ICMCE),corrected thrombolysis in myocardial infarction frame count (CTFC),and coronary blood flow velocity (BFV)-and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI.For the study sixty-eight patients were divided into four groups based on selective coronary angiography results:group A (normal coronary artery),group B (75%-95% coronary artery stenosis),group C (coronary artery stenosis > 95%) and group D (acute total coronary occlusion).The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI.IC-MCE was also performed before PCI in group D.The quantitative parameters of MCE involved:contrast peak intensity,time to peak intensity and area under the curve,representing myocardial blood volume,reperfusion velocity and myocardial blood flow,respectively.No difference was found in CTFC between the coronary artery stenosis group and the normal group.BFV was slower in group D than in group A (P < 0.05).The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A (P < 0.05),and there were significant differences in the three MCE parameters between group D and group A (P < 0.05).For those patients with acute or total occlusion,the levels of myocardial perfusion before and after PCI were similar,as determined by IC-MCE and visually analyzed from 61 segments (P < 0.05).Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods.Moreover,with qualitative IC-MCE the level of

  1. Quantitative myocardial perfusion magnetic resonance imaging: the impact of pulsatile flow on contrast agent bolus dispersion

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    Graafen, Dirk; Hamer, Julia; Weber, Stefan; Schreiber, Laura M, E-mail: graafen@uni-mainz.de [Section of Medical Physics, Department of Radiology, Johannes Gutenberg University Medical Center, Mainz (Germany)

    2011-08-21

    Myocardial blood flow (MBF) can be quantified using T{sub 1}-weighted first-pass magnetic resonance imaging (MRI) in combination with a tracer-kinetic model, like MMID4. This procedure requires the knowledge of an arterial input function which is usually estimated from the left ventricle (LV). Dispersion of the contrast agent bolus may occur between the LV and the tissue of interest. The aim of this study was to investigate the dispersion under conditions of physiological pulsatile blood flow, and to simulate its effect on MBF quantification. The dispersion was simulated in coronary arteries using a computational fluid dynamics (CFD) approach. Simulations were accomplished on straight vessels with stenosis of different degrees and shapes. The results show that dispersion is more pronounced under resting conditions than during hyperemia. Stenosis leads to a reduction of dispersion. In consequence, dispersion results in a systematic MBF underestimation between -0.4% and -9.3%. The relative MBF error depends not only on the dispersion but also on the actual MBF itself. Since MBF under rest is more underestimated than under stress, myocardial perfusion reserve is overestimated between 0.1% and 4.5%. Considering other sources of errors in myocardial perfusion MRI, systematic errors of MBF by bolus dispersion are relatively small.

  2. Myocardial physiology measurements using contrast enhanced dynamic computed tomography: simulation of beam hardening effect

    Science.gov (United States)

    Cao, Minsong; Stantz, Keith M.; Liang, Yun

    2006-03-01

    Initial animal study for quantifying myocardial physiology through contrast-enhanced dynamic x-ray CT suggested that beam hardening is one of the limiting factors for accurate regional physiology measurement. In this study, a series of simulations were performed to investigate its deterioration effects and two correction algorithms were adapted to evaluate for their efficiency in improving the measurements. The simulation tool consists of a module simulating data acquisition of a real polyenergetic scanner system and a heart phantom consisting of simple geometric objects representing ventricles and myocardium. Each phantom component was modeled with time-varying attenuation coefficients determined by ideal iodine contrast dynamic curves obtained from experimental data or simulation. A compartment model was used to generate the ideal myocardium contrast curve using physiological parameters consistent with measured values. Projection data of the phantom were simulated and reconstructed to produce a sequence of simulated CT images. Simulated contrast dynamic curves were fitted to the compartmental model and the resultant physiological parameters were compared with ideal values to estimate the errors induced by beam hardening artifacts. The simulations yielded similar deterioration patterns of contrast dynamic curves as observed in the initial study. Significant underestimation of left ventricle curves and corruption of regional myocardium curves result in systematic errors of regional perfusion up to approximately 24% and overestimates of fractional blood volume (f iv) up to 13%. The correction algorithms lead to significant improvement with errors of perfusion reduced to 7% and errors of f iv within 2% which shows promise for more robust myocardial physiology measurement.

  3. The effect of timing of intravenous muscle relaxant on the quality of double-contrast barium enema

    Energy Technology Data Exchange (ETDEWEB)

    Elson, E.M.; Campbell, D.M.; Halligan, S.; Shaikh, I.; Davitt, S.; Bartram, C.I

    2000-05-01

    AIM: To determine whether the timing of buscopan administration during double-contrast barium enema examination (DCBE) affects diagnostic quality. MATERIALS AND METHODS: In a prospective setting, 100 consecutive adult out-patients referred for DCBE received 20 mg buscopan (hyoscine-N-butylbromide) intravenously, either before infusion of barium suspension (Group A) or after barium infusion and gas insufflation (Group B). A subjective assessment of ease of contrast medium infusion was made at the time of examination and the films subsequently analysed by two radiologists unaware of the mode of relaxant administration, who noted the quality of mucosal coating and made subjective and objective measurements of segmental distension. RESULTS: There was no significant difference in screening times, infusion difficulty or colonic contrast medium coating between the two groups. Subjective assessment of distension of the caecum, ascending colon, transverse colon and rectum were not significantly different. Patients receiving intravenous relaxant after barium and gas infusion had less subjective descending (P = 0.05) and sigmoid (P = 0.04) colon distension, but there was no significant difference with respect to maximal bowel diameter in any of the segments measured. CONCLUSION: The timing of intravenous administration during DCBE is likely to have no significant effect on the diagnostic quality of the study. Elson, E.M. (2000)

  4. Myocardial contrast echocardiography to assess perfusion in a mouse model of ischemia/reperfusion injury

    Science.gov (United States)

    Hossack, John A.; Li, Yinbo; Christensen, Jonathan P.; Yang, Zequan; French, Brent A.

    2004-04-01

    Noninvasive approaches for measuring anatomical and physiological changes resulting from myocardial ischemia / reperfusion injury in the mouse heart have significant value since the mouse provides a practical, low-cost model for modeling human heart disease. In this work, perfusion was assessed before, during and after an induced closed- chest, coronary ischemic event. Ultrasound contrast agent, similar to MP1950, in a saline suspension, was injected via cannulated carotid artery as a bolus and imaged using a Siemens Sequoia 512 scanner and a 15L8 intraoperative transducer operating in second harmonic imaging mode. Image sequences were transferred from the scanner to a PC for analysis. Regions of interest were defined in septal and anterior segments of the myocardium. During the ischemic event, when perfusion was diminished in the anterior segment, mean video intensity in the affected segment was reduced by one half. Furthermore, following reperfusion, hyperemia (enhanced blood flow) was observed in the anterior segment. Specifically, the mean video intensity in the affected segment was increased by approximately 50% over the original baseline level prior to ischemia. Following the approach of Kaul et al., [1], gamma variate curves were fitted to the time varying level of mean video intensity. This foundation suggests the possibility of quantifying myocardial blood flow in ischemic regions of a mouse heart using automated analysis of contrast image data sets. An improved approach to perfusion assessment using the destruction-reperfusion approach [2] is also presented.

  5. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: Is intravenous contrast agent necessary in MRI?

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R., E-mail: schmitt.radiologie@herzchirurgie.de [Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Christopoulos, G.; Wagner, M. [Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Krimmer, H. [Department of Hand Surgery, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Fodor, S. [Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Schoonhoven, J. van; Prommersberger, K.J. [Department of Hand Surgery, Cardiovascular Center, Bad Neustadt an der Saale (Germany)

    2011-02-15

    Purpose: The purpose of this prospective study is to assess the diagnostic value of intravenously applied contrast agent for diagnosing osteonecrosis of the proximal fragment in scaphoid nonunion, and to compare the imaging results with intraoperative findings. Materials and methods: In 88 patients (7 women, 81 men) suffering from symptomatic scaphoid nonunion, preoperative MRI was performed (coronal PD-w FSE fs, sagittal-oblique T1-w SE nonenhanced and T1-w SE fs contrast-enhanced, sagittal T2*-w GRE). MRI interpretation was based on the intensity of contrast enhancement: 0 = none, 1 = focal, 2 = diffuse. Intraoperatively, the osseous viability was scored by means of bleeding points on the osteotomy site of the proximal scaphoid fragment: 0 = absent, 1 = moderate, 2 = good. Results: Intraoperatively, 17 necrotic, 29 compromised, and 42 normal proximal fragments were found. In nonenhanced MRI, bone viability was judged necrotic in 1 patient, compromised in 20 patients, and unaffected in 67 patients. Contrast-enhanced MRI revealed 14 necrotic, 21 compromised, and 53 normal proximal fragments. Judging surgical findings as the standard of reference, statistical analysis for nonenhanced MRI was: sensitivity 6.3%, specificity 100%, positive PV 100%, negative PV 82.6%, and accuracy 82.9%; statistics for contrast-enhanced MRI was: sensitivity 76.5%, specificity 98.6%, positive PV 92.9%, negative PV 94.6%, and accuracy 94.3%. Sensitivity for detecting avascular proximal fragments was significantly better (p < 0.001) in contrast-enhanced MRI in comparison to nonenhanced MRI. Conclusion: Viability of the proximal fragment in scaphoid nonunion can be significantly better assessed with the use of contrast-enhanced MRI as compared to nonenhanced MRI. Bone marrow edema is an inferior indicator of osteonecrosis. Application of intravenous gadolinium is recommended for imaging scaphoid nonunion.

  6. Myocardial protection during off pump coronary artery bypass surgery: A comparison of inhalational anesthesia with sevoflurane or desflurane and total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Sharadaprasad Suryaprakash

    2013-01-01

    Full Text Available Aims and Objectives: The objective of the study was to evaluate the myocardial protective effect of volatile agents-sevoflurane and desflurane versus total intravenous anesthesia (TIVA with propofol in offpump coronary artery bypass surgery (OPCAB by measuring cardiac troponin-T (cTnT as a marker of myocardial cell death. Materials and Methods: The study was conducted on 139 patients scheduled to undergo elective OPCAB surgery. The patients were randomly allocated to receive anesthesia with sevoflurane, desflurane or TIVA with propofol. The cTnT levels were measured preoperatively, at arrival in postoperative intensive care unit, at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels at all time intervals were comparable in the three groups. Conclusion: The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.

  7. Intracoronary thallium-201 scintigraphy after thrombolytic therapy for acute myocardial infarction compared with 10 and 100 day intravenous thallium-201 scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Heller, G.V.; Parker, J.A.; Silverman, K.J.; Royal, H.D.; Kolodny, G.M.; Paulin, S.; Braunwald, E.; Markis, J.E.

    1987-02-01

    Thallium-201 imaging has been utilized to estimate myocardial salvage after thrombolytic therapy for acute myocardial infarction. However, results from recent animal studies have suggested that as a result of reactive hyperemia and delayed necrosis, thallium-201 imaging may overestimate myocardial salvage. To determine whether early overestimation of salvage occurs in humans, intracoronary thallium-201 scans 1 hour after thrombolytic therapy were compared with intravenous thallium-201 scans obtained approximately 10 and 100 days after myocardial infarction in 29 patients. In 10 patients with angiographic evidence of coronary reperfusion, immediate improvement in thallium defects and no interim clinical events, there was no change in imaging in the follow-up studies. Of nine patients with coronary reperfusion but no initial improvement of perfusion defects, none showed worsening of defects in the follow-up images. Six of these patients demonstrated subsequent improvement at either 10 or 100 days after infarction. Seven of 10 patients with neither early evidence of reperfusion nor improvement in perfusion defects had improvement of infarct-related perfusion defects, and none showed worsening. In conclusion, serial scanning at 10 and 100 days after infarction in patients with no subsequent clinical events showed no worsening of the perfusion image compared with images obtained in acute studies. Therefore, there is no evidence that thallium-201 imaging performed early in patients with acute myocardial infarction overestimates improvement.

  8. PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients

    DEFF Research Database (Denmark)

    Berthelsen, A K; Holm, S; Loft, A

    2005-01-01

    correction, but this may result in a bias in the attenuation factors. The clinical significance of this bias has not been established. Our aim was to perform a prospective clinical study where each patient had CT performed with and without IV contrast agent to establish whether PET/CT with IV contrast can...

  9. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nielsen, Gitte; Fritz-Hansen, Thomas; Dirks, Christina G

    2004-01-01

    with acute transmural myocardial infarction were studied using a Turbo-fast low angle shot (FLASH) MRI sequence to monitor the first pass of an extravascular contrast agent (CA), gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Quantitation of perfusion, expressed as Ki (mL/100 g/minute), in five...

  10. Gender differences in contrast-enhanced magnetic resonance imaging after acute myocardial infarction.

    Science.gov (United States)

    Langhans, Birgit; Ibrahim, Tareq; Hausleiter, Jörg; Sonne, Carolin; Martinoff, Stefan; Schömig, Albert; Hadamitzky, Martin

    2013-03-01

    Besides different risk profiles for cardiovascular events in men and women, several studies reported gender differences in mortality after acute myocardial infarction (AMI). As infarct size has been shown to correlate with mortality, it is widely accepted as surrogate marker for clinical outcome. Currently, cardiovascular imaging studies covering the issue of gender differences are rare. As magnetic resonance scar characterization parameters are emerging as additional prognostic factors after acute myocardial infarction, we sought to evaluate gender differences in CMR infarct characteristics in patients after acute myocardial infarction. We prospectively analyzed patients (n = 448) with AMI and primary angioplasty, who underwent contrast-enhanced cardiac magnetic resonance (CMR) imaging on a 1.5 T scanner in median 5 [4, 6] days after the acute event. [corrected]. CMR scar size was measured 15 min after gadolinium injection. In addition presence and extent of microvascular obstruction (MVO) was assessed. A matched pair analysis was performed in order to exclude confounding by gender related co-morbidities and gender differences in established clinical risk factors. Matching process according to clinical risk defined by GRACE score resulted in 93 mixed gender couples. Women were significantly older than men (64.4 ± 11.9 vs. 60.5 ± 12.3, p = 0.03) and presented with a significantly better ejection fraction before angioplasty (48.9 ± 8.4 vs. 46.2 ± 8.9, p = 0.04). Infarct size did not differ significantly between women and men (13.5 ± 10.7 vs. 15.1 ± 11.8, p = 0.32). Size of MVO was significantly smaller in women than in men (0.48 ± 1.3 vs. 1.2 ± 3.0, p = 0.03). Comparing scar characterization between women and men with similar risk profiles revealed no gender differences in scar size. Size of MVO, however, was significantly smaller in women and might reflect better cardioprotective mechanisms in women. Whether these changes have prognostic implications has to

  11. Computational Fluid Dynamics Simulations of Contrast Agent Bolus Dispersion in a Coronary Bifurcation: Impact on MRI-Based Quantification of Myocardial Perfusion

    OpenAIRE

    Regine Schmidt; Dirk Graafen; Stefan Weber; Schreiber, Laura M.

    2013-01-01

    Contrast-enhanced first-pass magnetic resonance imaging (MRI) in combination with a tracer kinetic model, for example, MMID4, can be used to determine myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). Typically, the arterial input function (AIF) required for this methodology is estimated from the left ventricle (LV). Dispersion of the contrast agent bolus might occur between the LV and the myocardial tissue. Negligence of bolus dispersion could cause an error in MBF determin...

  12. Regional contrast agent quantification in a mouse model of myocardial infarction using 3D cardiac T1 mapping

    Directory of Open Access Journals (Sweden)

    Nicolay Klaas

    2011-10-01

    Full Text Available Abstract Background Quantitative relaxation time measurements by cardiovascular magnetic resonance (CMR are of paramount importance in contrast-enhanced studies of experimental myocardial infarction. First, compared to qualitative measurements based on signal intensity changes, they are less sensitive to specific parameter choices, thereby allowing for better comparison between different studies or during longitudinal studies. Secondly, T1 measurements may allow for quantification of local contrast agent concentrations. In this study, a recently developed 3D T1 mapping technique was applied in a mouse model of myocardial infarction to measure differences in myocardial T1 before and after injection of a liposomal contrast agent. This was then used to assess the concentration of accumulated contrast agent. Materials and methods Myocardial ischemia/reperfusion injury was induced in 8 mice by transient ligation of the LAD coronary artery. Baseline quantitative T1 maps were made at day 1 after surgery, followed by injection of a Gd-based liposomal contrast agent. Five mice served as control group, which followed the same protocol without initial surgery. Twenty-four hours post-injection, a second T1 measurement was performed. Local ΔR1 values were compared with regional wall thickening determined by functional cine CMR and correlated to ex vivo Gd concentrations determined by ICP-MS. Results Compared to control values, pre-contrast T1 of infarcted myocardium was slightly elevated, whereas T1 of remote myocardium did not significantly differ. Twenty-four hours post-contrast injection, high ΔR1 values were found in regions with low wall thickening values. However, compared to remote tissue (wall thickening > 45%, ΔR1 was only significantly higher in severe infarcted tissue (wall thickening r = 0.81 was found between CMR-based ΔR1 values and Gd concentrations from ex vivo ICP-MS measurements. Furthermore, regression analysis revealed that the

  13. Factor affecting contrast enhancement of the hepatic parenchyma in CT after intravenous injection of iodinated contrast material; Parametres influencant le rehaussement parenchymateux hepatique en tomodensitometrie apres injection intraveineuse de produit de contraste iode

    Energy Technology Data Exchange (ETDEWEB)

    Bonaldi, V.M.; Garcia, P.; Bret, P.M. [McGill Univ., Montreal, PQ (Canada); Bonaldi, V.M. [Nice Univ., 06 (France); Garcia, P. [Clinique Protestante, 69 - Lyon (France)

    1997-04-01

    With the widespread use of spiral CT, a complete reassessment of intravenous injection of contrast material for body computed tomography is necessary. An optimal administration of contrast material with respect to scan timing is indeed more critical with spiral CT. Numerous factors affect hepatic contrast enhancement time-attenuation curves after injection of contrast material into a peripheral vein. Some are patient related, while other result from the modalities of administration of the iodinated agent. The objective of this article is to review the most contributive factors in liver enhancement after iodine injection. Knowledge of these factors can optimize the use of spiral CT, with the expected benefit of saving costs in contrast material. (authors). 39 refs.

  14. Contrast-induced nephropathy in postmenopausal women undergoing percutaneous coronary intervention for acute myocardial infarction.

    Science.gov (United States)

    Ma, Guizhou; Yu, Danqing; Cai, Zhixiong; Ni, Chumin; Xu, Ronghe; Lan, Bin; Chen, Ping; Zhu, Zhidan

    2010-07-01

    Contrast-induced nephropathy (CIN) is a complex syndrome of acute kidney injury induced by exposure to intravascular contrast media. CIN occurs frequently in patients undergoing urgent percutaneous coronary intervention (PCI) and is associated with poor outcomes, making it a major challenge faced by interventional cardiologists. It has been suggested that female sex is a risk factor for development of CIN following PCI. However, no data exist in the literature concerning the risks of postmenopausal women with acute myocardial infarction (AMI) developing CIN after undergoing urgent PCI. To explore the incidence, risk factors and in-hospital outcomes of CIN in this special population, we analyzed 69 postmenopausal women with AMI treated with urgent PCI. CIN was defined as a relative increase of >25% or an absolute increase of >or=0.5 mg/dL in serum creatinine concentration from the baseline value 72 h after exposure to contrast medium. We found 1) the incidence of CIN was 37.68%; 2) patients with CIN had worse in-hospital outcomes, including longer hospital stay and more in-hospital adverse events; and 3) in multivariate logistic analysis, independent risk factors for CIN included a longer menopausal duration and the implantation of an intra-aortic balloon pump (an indirect indicator of hemodynamic instability). These results indicate that CIN is a frequent complication associated with worse in-hospital outcomes in postmenopausal women with AMI who are undergoing urgent PCI, particularly those with longer menopausal duration and hemodynamic instability. It is therefore necessary to pay more attention to preventive strategies for renal protection in this special population.

  15. Time-efficient myocardial contrast partition coefficient measurement from early enhancement with magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Shi-Jun Zhang

    Full Text Available OBJECTIVE: Our purpose was to validate an early enhancement time point for accurately measuring the myocardial contrast partition coefficient (lambda using dynamic-equilibrium magnetic resonance imaging. MATERIALS AND METHODS: The pre- and post-contrast longitudinal relaxation rates (reciprocal of T1 of the interventricular septum (R1(m and blood pool (R1(b were obtained from fifteen healthy volunteers and three diabetic patients with hypertension using two optimized T1 mapping sequences (modified Look-Locker inversion recovery on a 3-Tesla magnetic resonance scanner. Reference lambda values were calculated as the slope of the regression line of R1(m versus R1(b at dynamic equilibrium (multi-point regression method. The simplified pre-/post-enhancement two-acquisition method (two-point method was used to calculate lambda by relating the change in R1(m and R1(b using different protocols according to the acquisition stage of the post-enhancement data point. The agreement with the referential method was tested by calculating Pearson's correlation coefficient and the intra-class correlation coefficient. RESULTS: The lambda values measured by the two-point method increased (from 0.479 ± 0.041 to 0.534 ± 0.043 over time from 6 to 45 minutes after contrast and exhibited good correlation with the reference at each time point (r ≥ 0.875, p<0.05. The intra-class correlation coefficient on absolute agreement with the reference lambda was 0.946, 0.929 and 0.922 at the 6th, 7th and 8th minutes and dropped from 0.878 to 0.403 from the 9th minute on. CONCLUSIONS: The time-efficient two-point method at 6-8 minutes after the Gd-DTPA bolus injection exhibited good agreement with the multi-point regression method and can be applied for accurate lambda measurement in normal myocardium.

  16. Flat-detector computed tomography with intravenous contrast material application in experimental aneurysms: comparison with multislice CT and conventional angiography.

    Science.gov (United States)

    Struffert, Tobias; Doelken, Marc; Adamek, Edyta; Schwarz, Marc; Engelhorn, Tobias; Kloska, Stephan; Ott, Sabine; Doerfler, Arnd

    2010-05-01

    Despite limited soft tissue resolution flat-detector computed tomography (FD-CT) provides substantial superior spatial resolution in comparison with multislice computed tomography (MS-CT). This may add value in the visualization of small vascular structures if intravenous contrast application leads to substantial opacification and visibility of intracranial vessels or aneurysms. To evaluate the feasibility of visualization of vascular structures by FD-CT angiography (FD-CTA) after intravenous contrast injection compared with MS-CTA and intra-arterial digital subtracted angiography (IADSA) in an animal model. Aneurysms were created in the right common carotid artery in six New Zealand White Rabbits using the elastase technique. Imaging was performed using FD-CTA, MS-CTA (injection of 1 ml/kg body weight) and IADSA. Anonymized volume rendering reconstruction (VRT), maximum intensity projection (MIP), and multiplanar reconstruction (MPR) images were reconstructed and evaluated by two experienced reviewers for aneurysm geometry and vascular structure anatomy using standard tools of a dedicated workstation. Aneurysms could be successfully created in all animals. Measurements of aneurysm geometry (aneurysm height, width, neck width) and vascular structures (brachiocephalic trunk, carotid artery diameter and plane) were nearly identical in all three modalities. Intra- and inter-observer correlations of the different parameters showed high r values between 0.83 and 0.99. Our results show the feasibility of FD-CTA in comparison with MS-CTA and IADSA in an animal model. Despite limited soft tissue resolution, opacification of vascular structures with sufficient contrast to the surrounding structures was possible in all animals. Vascular structures appeared better delineated in FD-CTA than in MS-CTA, probably due to the superior spatial resolution.

  17. Usefulness of dobutamine stress myocardial contrast echocardiography for assessing coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    GUO Shi-zun; SHU Xian-hong; PAN Cui-zhen; LI Yan-lin; CE Jun-bo; CHEN Hao-zhu

    2005-01-01

    Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P<0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P<0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P<0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P<0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P<0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P<0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P<0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P<0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and

  18. Patients at high risk of adverse events from intravenous contrast media after computed tomography examination

    Energy Technology Data Exchange (ETDEWEB)

    Reddan, Donal [University College Galway Hospitals, Unit 7, Merlin Park Hospital, Galway (Ireland)]. E-mail: donal.reddan@mailn.hse.ie

    2007-05-15

    Adverse reactions to iodinated contrast media (CM) may occur and require prompt recognition and treatment. Although adverse reactions to radiocontrast agents cannot be eliminated, an important first step toward reducing their incidence is to identify patients at greatest risk. Prior to examinations using CM, patients should be adequately assessed by obtaining thorough medical histories and using simple screening tests. Studies have demonstrated that patients with a history of asthma, allergy, hyperthyroidism, and previous reaction to CM are at risk for severe reactions to iodinated CM. Renal adverse reactions reportedly occur more frequently in patients with pre-existing chronic kidney disease, especially those with diabetic nephropathy. Patients with congestive heart failure, dehydration, older age, and those who use nephrotoxic medications are also at risk for developing contrast-associated nephropathy. The occurrence of adverse events may be further increased in patients with multiple risk factors. As the number of patients undergoing computed tomography procedures continues to increase, it is essential for physicians to be able to identify patients at risk for adverse events of CM. Patient-related risk factors are discussed and simple tools for risk stratification presented.

  19. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: A meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Moos, Shira I., E-mail: s.i.moos@amc.uva.nl; Vemde, David N.H. van; Stoker, Jaap; Bipat, Shandra

    2013-09-15

    Purpose: To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. Methods: This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I{sup 2} index. Results: 42 articles with 18,790 patients (mean age 61.5 years (range: 38–83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR) < 60 mL/min, 55.2% had hypertension; 20.2% had diabetes mellitus (DM) and 6.5% had congestive heart failure (CHF). The overall pooled CIN incidence, defined as a SCr increase of ≥25% or ≥0.5 mg/dL, was 4.96% (95%CI: 3.79–6.47). Data analysis showed associations between CIN and the presence of renal insufficiency, DM, malignancy, age > 65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06–2.82), 1.87 (95%CI: 1.55–2.26), 1.79 (95%CI: 1.03–3.11), 1.95 (95%CI: 1.02–3.70) and 2.32 (95%CI: 1.04–5.19), respectively while hypertension, anaemia and CFH were not associated (p = 0.13, p = 0.38, p = 0.40). Conclusion: The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use.

  20. Sensation of smell and taste during intravenous injection of iodinated contrast media in CT examinations.

    Science.gov (United States)

    Yamaguchi, Naoto; Fukushima, Yasuhiro; Yamaguchi, Aiko; Nagasawa, Naoki; Taketomi-Takahashi, Ayako; Suto, Takayuki; Tsushima, Yoshito

    2017-01-01

    To assess the incidence and types of sensation of smell and taste during i.v. injection of five kinds of contrast media (CM) in CT examinations. 735 patients who underwent contrast-enhanced CT (CE-CT) between 14 March 2016 and 5 April 2016 were enrolled. Medical staff asked patients whether they felt heat sensation and sensation of smell and taste during i.v. injection of CM (one of the following: iopromide, iomeprol, iopamidol, iohexol and ioversol) after their CE-CT. If the patients stated having felt the sensation of smell or taste, they were also asked what kind of smell or taste they sensed. Next, 30 ml of each CM was poured into high-purity pet cups for radiological technologists to smell directly. Radiological technologists were asked whether or not each CM had any smell. The sensations of smell and taste incidence for iopromide were 24.3% and 18.9%, respectively, which were significantly higher than those for other CM (p smell was medicine-ish, and the most frequently noted taste was bitterness. All radiological technologists could directly smell only iopromide, which has an ether group on a side chain and fewer hydroxyl groups. Iopromide showed a higher incidence of sensation of smell and taste than other CM. Advances in knowledge: This was the first investigation of sensation of smell and taste during i.v. injection of CM, and a specific CM showed a higher incidence, which is suspected to be due to its chemical structure.

  1. Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.

    Directory of Open Access Journals (Sweden)

    Swapnil Hiremath

    Full Text Available BACKGROUND: Pre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral to the intravenous route in prevention of contrast-induced acute kidney injury. STUDY DESIGN: A systematic review and meta-analysis of randomised trials with a stratified analysis and metaregression. Databases included MEDLINE (1950 to November 23 2011, EMBASE (1947 to week 47 2011, Cochrane CENTRAL (3(rd quarter 2011. Two reviewers identified relevant trials and abstracted data. SETTINGS AND POPULATION: Trials including patients undergoing a contrast enhanced procedure. SELECTION CRITERIA: Randomised controlled trial; adult (>18 years population; comparison of oral versus intravenous volume expansion. INTERVENTION: Oral route of volume expansion compared to the intravenous route. OUTCOMES: Any measure of acute kidney injury, need for renal replacement therapy, hospitalization and death. RESULTS: Six trials including 513 patients met inclusion criteria. The summary odds ratio was 1.19 (95% CI 0.46, 3.10, p = 0.73 suggesting no difference between the two routes of volume expansion. There was significant heterogeneity (Cochran's Q = 11.65, p = 0.04; I(2 = 57. In the stratified analysis, inclusion of the five studies with a prespecified oral volume expansion protocol resulted in a shift towards oral volume expansion (OR 0.75, 95% CI 0.37, 1.50, p = 0.42 and also resolved the heterogeneity (Q = 3.19, P = 0.53; I(2 = 0. LIMITATIONS: Small number of studies identified; lack of hard clinical outcomes. CONCLUSION: The oral route may be as effective as the intravenous route for volume expansion for contrast-induced acute kidney injury prevention. Adequately powered trials with hard endpoints should be done given the potential advantages of oral (e.g. reduced patient burden and

  2. Effects of hypoxia on coronary flow reserve as determined by myocardial contrast echocardiography in swine

    Institute of Scientific and Technical Information of China (English)

    YANG Yuan 杨源; LI Shu-qing 李树清; Barry Peters; Anthony N DeMaria

    2004-01-01

    Background Time-intensity curves derived from microbubble destruction/refilling sequences and recorded using myocardial contrast echocardiography (MCE) can provide parameters that correlate with coronary blood flow. The response of these parameters to adenosine vasodilatation correlates with coronary flow reserve (CFR) measured by fluorescent microsphere techniques (FMT). Currently, no data exist regarding the effect of physiological variables, such as hypoxia, on the determination of CFR by MCE. The purpose of this study was to define the effects of decreases in blood partial pressure of oxygen (PO2) on CFR as measured by MCE. Methods Studies were performed in 9 closed chest swine. Low-energy, real-time MCE was performed with commercial instruments in short axis view at papillary muscle level while infusing BR1 at 30 ml/h. High-energy ultrasound bursts (referred to as FLASH frames) destroyed the bubbles every 15 cardiac cycles, and resultant time-intensity curves derived from these sequences were fitted to the exponential function y = A (1-e-bt) +c, from which the rate of signal rise (b) was obtained. CFR was calculated as the ratio of b values after adenosine infusion to baseline and was obtained during the control period and after decreasing blood PO2 by giving nitrogen via a respirator to create artificial hypoxic conditions. CFR was independently determined by FMT. Results Nitrogen led to significant decreases in mean PO2, from (120.6±18.9) mmHg to (51.8±15.9) mmHg (P0.05 compared with the baseline). Conclusions CFR values diminish under hypoxic conditions according to both MCE and FMT. The reductions in CFR involve both an increase in resting values and a decrease in post adenosine measurements, as determined by both techniques. The reduction in CFR under hypoxia is slightly greater using MCE than using FMT. Physiological variables, such as hypoxia, must be taken into consideration when assessing CFR by MCE.

  3. Identification of chronic myocardial infarction with extracellular or intravascular contrast agents in magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    Jian WANG; Hong-yu LIU; Hang L(U); Bo XIANG; Marco GRUWEL; Boguslaw TOMANEK; Roxanne DESLAURIERS; Gang-hong TIAN

    2008-01-01

    Aim: To determine whether extracellular or intravascular contrast agents could detect chronic scarred myocardium in magnetic resonance imaging (MRI). Methods: Eighteen pigs underwent a 4 week ligation of 1 or 2 diagonal coronary arteries to induce chronic myocardial infarction. The hearts were then removed and perfused in a Langendorff apparatus. Eighteen hearts were divided into 2 groups. The hearts in groups Ⅰ (n=9) and Ⅱ (n=9) 收稿日期the bolus injection of Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA, 0.05 mmol/kg) and ga-dolinium-based macromolecular agent (P792, 15 μmol/kg), respectively. First pass T2* MRI was acquired using a FLASH sequence. Delayed enhancement T1 MRI was acquired with an inversion recovery prepared TurboFLASH sequence.Results: Wash-in of both agents resulted in a sharp and dramatic T2* signal loss of scarred myocardium similar to that of normal myocardium. The magnitude and velocity of T2* signal recovery caused by wash-out of extracellular agents in normal myocardium was significantly less than that in scarred myocardium. Conversely, the T2* signal of scarred and normal myocardium recovered to plateau rapidly and simultaneously due to wash-out of intravascular agents. At the fol-lowing equilibrium, extracellular agent-enhanced T1 signal intensity was signifi-cantly greater in scarred myocardium than in normal myocardium, whereas there was no significantly statistical difference in intravascular agent-enhanced T1 sig-nal intensity between scarred and normal myocardium. Conclusion: After admin-istration of extracellular agents, wash-out T2* first-pass and delayed enhanced T1 MRI could identify scarred myocardium as a hyperenhanced region. Conversely, scarred myocardium was indistinguishable from normal myocardium during first-pass and the steady state of intravascular agents.

  4. Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction

    Science.gov (United States)

    2012-01-01

    Background Current cardiovascular magnetic resonance (CMR) methods, such as late gadolinium enhancement (LGE) and oedema imaging (T2W) used to depict myocardial ischemia, have limitations. Novel quantitative T1-mapping techniques have the potential to further characterize the components of ischemic injury. In patients with myocardial infarction (MI) we sought to investigate whether state-of the art pre-contrast T1-mapping (1) detects acute myocardial injury, (2) allows for quantification of the severity of damage when compared to standard techniques such as LGE and T2W, and (3) has the ability to predict long term functional recovery. Methods 3T CMR including T2W, T1-mapping and LGE was performed in 41 patients [of these, 78% were ST elevation MI (STEMI)] with acute MI at 12-48 hour after chest pain onset and at 6 months (6M). Patients with STEMI underwent primary PCI prior to CMR. Assessment of acute regional wall motion abnormalities, acute segmental damaged fraction by T2W and LGE and mean segmental T1 values was performed on matching short axis slices. LGE and improvement in regional wall motion at 6M were also obtained. Results We found that the variability of T1 measurements was significantly lower compared to T2W and that, while the diagnostic performance of acute T1-mapping for detecting myocardial injury was at least as good as that of T2W-CMR in STEMI patients, it was superior to T2W imaging in NSTEMI. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental T1 values (P myocardial damage. T1-mapping might become an important complementary technique to LGE and T2W for identification of reversible myocardial injury and prediction of functional recovery in acute MI. PMID:22309452

  5. Comparison of the veracity of real-time perfusion, harmonic angio, and ultraharmonic myocardial contrast imaging modes in evaluation of acute myocardial infarction area

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Innovative advancements in ultrasound instrumentation present a number of imaging modalities for myocardial contrast echocardiography (MCE) in ischemic syndromes. How well they compare to each other in diagnostic accuracy in the detection of acute myocardial infarction is unclear. The purpose of this study was to assess the relative accuracy of 3 different imaging modes of MCE, low mechanical index (MI) real-time perfusion imaging (RTPI), triggered harmonic angio mode (HA), and ultraharmonic imaging mode (UH) in the detection of acute experimental myocardial infarction within the time frame suitable for potential reperfusion. Methods MCE was performed in 10 open-chest dogs using RTPI, triggered HA and triggered UH modes at baseline and one hour after occlusion of left anterior descending coronary artery. Presence or absence of perfusion defects, and the perfusion defect size when present, were analyzed and compared with the infarct size delineated by triphenyltetrazolium chloride(TTC)staining. Results The infarct area was (15.8±2.4)% by TTC staining; Perfusion defect area by MCE was similar to anatomic infarct area in all the three MCE approaches: (16.1±2.7)% by RTPI mode, (15.5±2.9)% by HA mode, and (15.5±3.0)% by UH mode. The sensitivity, specificity and overall diagnostic accuracy in the detection of myocardial infarction were 100%, 88%, and 94% for RTPI mode, 88%, 100%, and 94 % for HA mode, and 100%, 75%, and 88% for UH mode. Conclusion All modes of MCE, RTPI, triggered HA mode and triggered UH mode have excellent diagnostic accuracy in the immediate hour of acute coronary occlusion within the optimal time frame suitable for reperfusion therapy.

  6. Impact of repeated intravenous bone marrow mesenchymal stem cells infusion on myocardial collagen network remodeling in a rat model of doxorubicin-induced dilated cardiomyopathy.

    Science.gov (United States)

    Yu, Qin; Li, Qianxiao; Na, Rongmei; Li, Xiaofei; Liu, Baiting; Meng, Lili; Liutong, Hanyu; Fang, Weiyi; Zhu, Ning; Zheng, Xiaoqun

    2014-02-01

    Bone marrow mesenchymal stem cells (MSCs) transplantation improved cardiac function and reduced myocardial fibrosis in both ischemic and non-ischemic cardiomyopathies. We evaluated the effects of repeated peripheral vein injection of MSCs on collagen network remodeling and myocardial TGF-β1, AT1, CYP11B2 (aldosterone synthase) gene expressions in a rat model of doxorubicin (DOX)-induced dilated cardiomyopathy (DCM). Thirty-eight out of 53 SD rats survived at 10 weeks post-DOX injection (2.5 mg/kg/week for 6 weeks, i.p.) were divided into DCM blank (without treatment, n = 12), DCM placebo (intravenous tail injection of 0.5 mL serum-free culture medium every other day for ten times, n = 13), and DCM plus MSCs group (intravenous tail injection of 5 × 10(6) MSCs dissolved in 0.5 mL serum-free culture medium every other day for 10 times, n = 13). Ten untreated rats served as normal controls. At 20 weeks after DOX injection, echocardiography, myocardial collagen content, myocardial expressions of types I and III collagen, TGF-β1, AT1, and CYP11B2 were compared among groups. At 20 weeks post-DOX injection, 8 rats (67%) survived in DCM blank group, 9 rats (69%) survived in DCM placebo group while 13 rats (100 %) survived in DCM plus MSCs group. Left ventricular end-diastolic diameter was significantly higher and ejection fraction was significantly lower in DCM blank and DCM placebo groups compared to normal control rats, which were significantly improved in DCM plus MSCs group (all p collagen volume fraction, types I and III collagen, myocardial mRNA expressions of TGF-β1, AT1, CYP11B2, and collagen I/III ratio were all significantly lower in DCM plus MSCs group compared to DCM blank and DCM placebo groups (all p collagen network remodeling possibly through downregulating renin-angiotensin-aldosterone system in DOX-induced DCM rats.

  7. No increase in kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin excretion following intravenous contrast enhanced-CT

    Energy Technology Data Exchange (ETDEWEB)

    Kooiman, Judith [Leiden University Medical Center, Department of Thrombosis and Haemostasis, Leiden (Netherlands); Leiden University Medical Center, Department of Nephrology, Leiden (Netherlands); Peppel, Wilke R. van de; Huisman, Menno V. [Leiden University Medical Center, Department of Thrombosis and Haemostasis, Leiden (Netherlands); Sijpkens, Yvo W.J. [Bronovo Hospital, Department of Nephrology, The Hague (Netherlands); Brulez, Harald F.H. [Sint Lucas Andreas Hospital, Department of Nephrology, Amsterdam (Netherlands); Vries, P.M. de [St. Antonius Hospital, Department of Vascular Surgery, Nieuwegein (Netherlands); Nicolaie, Mioara A.; Putter, H. [Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Leiden (Netherlands); Kooij, W. van der; Kooten, Cees van; Rabelink, Ton J. [Leiden University Medical Center, Department of Nephrology, Leiden (Netherlands)

    2015-07-15

    To analyze kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (N-GAL) excretion post-intravenous contrast enhanced-CT (CE-CT) in patients with chronic kidney disease (CKD). Patients were enrolled in a trial on hydration regimes to prevent contrast-induced acute kidney injury (CI-AKI). Blood and urine samples were taken at baseline, 4 - 6, and 48 - 96 h post CE-CT. Urinary KIM-1 and N-GAL values were normalized for urinary creatinine levels, presented as medians with 2.5 - 97.5 percentiles. Of the enrolled 511 patients, 10 (2 %) were lost to follow-up. CI-AKI occurred in 3.9 % of patients (20/501). Median KIM-1 values were 1.2 (0.1 - 7.7) at baseline, 1.3 (0.1 - 8.6) at 4 - 6 h, and 1.3 ng/mg (0.1 - 8.1) at 48 - 96 h post CE-CT (P = 0.39). Median N-GAL values were 41.0 (4.4 - 3,174.4), 48.9 (5.7 - 3,406.1), and 37.8 μg/mg (3.5 - 3,200.4), respectively (P = 0.07). The amount of KIM-1 and N-GAL excretion in follow-up was similar for patients with and without CI-AKI (P-value KIM-1 0.08, P-value N-GAL 0.73). Neither patient characteristics at baseline including severe CKD, medication use, nor contrast dose were associated with increased excretion of KIM-1 or N-GAL during follow-up. KIM-1 and N-GAL excretion were unaffected by CE-CT both in patients with and without CI-AKI, suggesting that CI-AKI was not accompanied by tubular injury. (orig.)

  8. Contrast-induced enphropathy in patients undergoing intravenous contrast-enhanced computed tomography in Korea; A multi-institutional study in 101487 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joong Yub [Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cho, Jeong Yeon [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jeong, Yong Yeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun (Korea, Republic of); and others

    2014-08-15

    To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 ± 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.

  9. Automatic Determination of the Need for Intravenous Contrast in Musculoskeletal MRI Examinations Using IBM Watson's Natural Language Processing Algorithm.

    Science.gov (United States)

    Trivedi, Hari; Mesterhazy, Joseph; Laguna, Benjamin; Vu, Thienkhai; Sohn, Jae Ho

    2017-09-18

    Magnetic resonance imaging (MRI) protocoling can be time- and resource-intensive, and protocols can often be suboptimal dependent upon the expertise or preferences of the protocoling radiologist. Providing a best-practice recommendation for an MRI protocol has the potential to improve efficiency and decrease the likelihood of a suboptimal or erroneous study. The goal of this study was to develop and validate a machine learning-based natural language classifier that can automatically assign the use of intravenous contrast for musculoskeletal MRI protocols based upon the free-text clinical indication of the study, thereby improving efficiency of the protocoling radiologist and potentially decreasing errors. We utilized a deep learning-based natural language classification system from IBM Watson, a question-answering supercomputer that gained fame after challenging the best human players on Jeopardy! in 2011. We compared this solution to a series of traditional machine learning-based natural language processing techniques that utilize a term-document frequency matrix. Each classifier was trained with 1240 MRI protocols plus their respective clinical indications and validated with a test set of 280. Ground truth of contrast assignment was obtained from the clinical record. For evaluation of inter-reader agreement, a blinded second reader radiologist analyzed all cases and determined contrast assignment based on only the free-text clinical indication. In the test set, Watson demonstrated overall accuracy of 83.2% when compared to the original protocol. This was similar to the overall accuracy of 80.2% achieved by an ensemble of eight traditional machine learning algorithms based on a term-document matrix. When compared to the second reader's contrast assignment, Watson achieved 88.6% agreement. When evaluating only the subset of cases where the original protocol and second reader were concordant (n = 251), agreement climbed further to 90.0%. The classifier was

  10. Validation of Contrast Enhanced Cine Steady-State Free Precession and T2-Weigthed CMR for Assessment of Ischemic Myocardial Area- At-Risk

    DEFF Research Database (Denmark)

    Søvsø Szocska Hansen, Esben; Pedersen, Steen Fjord; Pedersen, Steen Bønløkke

    2017-01-01

    Measuring myocardial salvage is important to evaluate the possible cardioprotective effects of adjunctive cardioprotective intervention in patients with myocardial infarction undergoing primary percutaneous intervention. Contrast-enhanced steady-state free precession magnetic resonance imaging (CE-CINE......) has recently been used to quantify AAR and validated against myocardial perfusion SPECT. In this study we sought to determine how well T2-STIR and CE-CINE depicts AAR in an experimental porcine model of myocardial ischemia-reperfusion injury using histopathology as the reference for infarct size...

  11. Myocardial contrast echocardiography (MCE) with triggered ultrasound does not cause premature ventricular complexes: evidence from PB127 MCE studies.

    Science.gov (United States)

    Raisinghani, Ajit; Wei, Kevin S; Crouse, Linda; Villanueva, Floredeliza; Feigenbaum, Harvey; Schiller, Nelson B; Weiss, James; Naqvi, Tasneem Z; Siegel, Robert; Monaghan, Mark; Goldman, Jonathan H; Demaria, Anthony

    2003-10-01

    Previous studies suggest that myocardial contrast echocardiography using high mechanical index triggered ultrasound can be associated with increased frequency of the premature ventricular complex (PVC). However, this association has not been systematically examined. PB127 (Point Biomedical Corp, San Carlos, Calif) is a novel microsphere designed for evaluation of myocardial perfusion with ultrasound. PB127 myocardial contrast echocardiography was performed with triggered harmonic power Doppler in early/mid diastole (mechanical index premature ventricular complex frequency at baseline, during, and after infusion of PB127 (dose premature ventricular complex were determined. PVC frequency did not increase with PB127 infusion in either cohort (P =.572, P =.263). Proportion of triggered intervals after QRS associated with PVC was similar to proportion of untriggered intervals in cohort A (P >.999) and was lower than untriggered intervals (P =.001) in B, suggesting that triggers do not cause PVC. PB127 does not cause increase PVC frequency during or after imaging with triggered ultrasound at mechanical index of 1.

  12. Comparison of Myocardial Perfusion Estimates From Dynamic Contrast-Enhanced Magnetic Resonance Imaging With Four Quantitative Analysis Methods

    Science.gov (United States)

    Pack, Nathan A.; DiBella, Edward V. R.

    2012-01-01

    Dynamic contrast-enhanced MRI has been used to quantify myocardial perfusion in recent years. Published results have varied widely, possibly depending on the method used to analyze the dynamic perfusion data. Here, four quantitative analysis methods (two-compartment modeling, Fermi function modeling, model-independent analysis, and Patlak plot analysis) were implemented and compared for quantifying myocardial perfusion. Dynamic contrast-enhanced MRI data were acquired in 20 human subjects at rest with low-dose (0.019 ± 0.005 mmol/kg) bolus injections of gadolinium. Fourteen of these subjects were also imaged at adenosine stress (0.021 ± 0.005 mmol/kg). Aggregate rest perfusion estimates were not significantly different between all four analysis methods. At stress, perfusion estimates were not significantly different between two-compartment modeling, model-independent analysis, and Patlak plot analysis. Stress estimates from the Fermi model were significantly higher (~20%) than the other three methods. Myocardial perfusion reserve values were not significantly different between all four methods. Model-independent analysis resulted in the lowest model curve-fit errors. When more than just the first pass of data was analyzed, perfusion estimates from two-compartment modeling and model-independent analysis did not change significantly, unlike results from Fermi function modeling. PMID:20577976

  13. Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study

    Directory of Open Access Journals (Sweden)

    Slordahl Stig

    2005-06-01

    Full Text Available Abstract Background Real-time myocardial contrast echocardiography (MCE is a novel method for assessing myocardial perfusion. The aim of this study was to evaluate the feasibility of a very low-power real-time MCE for quantification of regional resting myocardial blood flow (MBF velocity in normal human myocardium. Methods Twenty study subjects with normal left ventricular (LV wall motion and normal coronary arteries, underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during constant IV. infusion of SonoVue®. Following transient microbubble destruction, the contrast replenishment rate (β, reflecting MBF velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function; y (t =A (1-e-β(t-t0 + C. Results Quantification was feasible in 82%, 49% and 63% of four-chamber, two-chamber and apical long-axis view segments, respectively. The LAD (left anterior descending artery and RCA (right coronary artery territories could potentially be evaluated in most, but contrast detection in the LCx (left circumflex artery bed was poor. Depending on localisation and which frames to be analysed, mean values of were 0.21–0.69 s-1, with higher values in medial than lateral, and in basal compared to apical regions of scan plane (p = 0.03 and p Conclusion Low-power real-time MCE did have the potential to give contrast enhancement for quantification of resting regional MBF velocity. However, the technique is difficult and subjected to several limitations. Significant variability in β suggests that this parameter is best suited for with-in patient changes, comparing values of stress studies to baseline.

  14. Determinants of microvascular damage recovery after acute myocardial infarction: results from the acute myocardial infarction contrast imaging (AMICI) multi-centre study.

    Science.gov (United States)

    Funaro, Stefania; Galiuto, Leonarda; Boccalini, Francesca; Cimino, Sara; Canali, Emanuele; Evangelio, Francesca; DeLuca, Laura; Paraggio, Lazzaro; Mattatelli, Antonella; Gnessi, Lucio; Agati, Luciano

    2011-04-01

    Microvascular damage (MD) occurring soon after primary percutaneous coronary intervention (PPCI) may reverse or remain sustained within the first week after ST-elevation myocardial infarction (STEMI). We investigated the incidence, determinants, and long-term clinical relevance of MD reversal after PPCI. Serial two-dimensional echocardiograms (2DE) and a myocardial contrast study were obtained within 24 h of PPCI (T1) and at pre-discharge (T2) in 110 successfully re-perfused STEMI patients. Six months 2DE and 2-year clinical follow-up were obtained. After PPCI myocardial re-perfusion was normal at T1 only in 40 patients (36%, 'normal reflow'), recovered at T2 in 33 (30%, 'reversible MD'), and remained abnormal in 37 (34%, 'sustained MD'). At follow-up, normal reflow and reversible MD were coupled with a significant reduction in the infarct area, decrease in cardiac volumes, and a slight non-significant improvement in systolic function. Conversely, in the sustained MD group, the infarct area did not change and cardiac volumes significantly increased with a parallel worsening in systolic function. By multivariate analysis, independent predictors of reversible MD were: absence of family history of coronary artery disease (CAD), younger age, shorter time to re-perfusion, and absence of diabetes. The 2-year combined events rate was significantly lower in reversible MD (log-rank test P= 0.03) compared with sustained MD patients. In STEMI patients treated according to the current guidelines, MD frequently occurs soon after re-perfusion but it is reversible in ~50% of cases and it is associated with a favourable functional and clinical outcome. Family history of CAD, aging, time to re-perfusion, and diabetes are independent predictors of MD reversibility.

  15. Intracoronary versus intravenous bolus abciximab administration in patients undergoing primary percutaneous coronary intervention with acute ST-elevation myocardial infarction : a pooled analysis of individual patient data from five randomised controlled trials

    NARCIS (Netherlands)

    Piccolo, Raffaele; Eitel, Ingo; Iversen, Allan Zeeberg; Gu, Youlan L.; Dominguez-Rodriguez, Alberto; de Smet, Bart J. G. L.; Mahmoud, Karim D.; Abreu-Gonzalez, Pedro; Thiele, Holger; Piscione, Federico

    2014-01-01

    Aims: In recent years, intracoronary bolus abciximab has emerged as an alternative to the standard intravenous route in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The aim of the current study was to perform an individual pati

  16. Acute ST elevation myocardial infarction after intravenous immunoglobulin infusion in a young patient: a rare but probable adverse effect of immunoglobulin

    Directory of Open Access Journals (Sweden)

    Manish Ruhela

    2014-06-01

    Full Text Available Intravenous immunoglobulin (IVIG is used in the treatment of a variety of disorders, including autoimmune conditions. IVIG has been considered a safe medication, with minor and transient adverse effects. With the wider use of IVIG, the reported rate of adverse effects has been increased, some of them are potentially fatal cardiovascular reactions due to induction of hypercoagulable state. We report a 40-year-old female treated with IVIG for Guillain-Barre syndrome, who developed chest pain 1 hr following IVIG infusion. The symptoms were associated with ST elevation in anterior leads on electrocardiogram. This anterior wall myocardial infarction (MI is compatible with IVIG-induced hypercoagulability and considered as a probable adverse effect of this medication. To the best of our knowledge, this is probably the first case report where a young patient developed acute MI without any cardiac risk factors after IVIG infusion. [Int J Basic Clin Pharmacol 2014; 3(3.000: 569-571

  17. Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Roolvink, Vincent; Ibanez, Borja; Ottervanger, Jan Paul; Pizarro, Gonzalo; van Royen, Niels; Mateos, Alonso; Dambrink, Jan-Henk E.; Escalera, Noemi; Lipsic, Erik; Albarran, Agustin; Fernandez-Ortiz, Antonio; Fernandez-Aviles, Francisco; Goicolea, Javier; Botas, Javier; Remkes, Wouter; Hernandez-Jaras, Victoria; Kedhi, Elvin; Zamorano, Jose L.; Navarro, Felipe; Alfonso, Fernando; Garcia-Lledo, Alberto; Alonso, Joaquin; van Leeuwen, Maarten; Nijveldt, Robin; Postma, Sonja; Kolkman, Evelien; Gosselink, Marcel; de Smet, Bart; Rasoul, Saman; Piek, Jan J.; Fuster, Valentin; Van 't Hof, Arnoud W. J.

    2016-01-01

    BACKGROUND The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing

  18. Theoretical considerations in measurement of time discrepancies between input and myocardial time-signal intensity curves in estimates of regional myocardial perfusion with first-pass contrast-enhanced MRI.

    Science.gov (United States)

    Natsume, Takahiro; Ishida, Masaki; Kitagawa, Kakuya; Nagata, Motonori; Sakuma, Hajime; Ichihara, Takashi

    2015-11-01

    The purpose of this study was to develop a method to determine time discrepancies between input and myocardial time-signal intensity (TSI) curves for accurate estimation of myocardial perfusion with first-pass contrast-enhanced MRI. Estimation of myocardial perfusion with contrast-enhanced MRI using kinetic models requires faithful recording of contrast content in the blood and myocardium. Typically, the arterial input function (AIF) is obtained by setting a region of interest in the left ventricular cavity. However, there is a small delay between the AIF and the myocardial curves, and such time discrepancies can lead to errors in flow estimation using Patlak plot analysis. In this study, the time discrepancies between the arterial TSI curve and the myocardial tissue TSI curve were estimated based on the compartment model. In the early phase after the arrival of the contrast agent in the myocardium, the relationship between rate constant K1 and the concentrations of Gd-DTPA contrast agent in the myocardium and arterial blood (LV blood) can be described by the equation K1={dCmyo(tpeak)/dt}/Ca(tpeak), where Cmyo(t) and Ca(t) are the relative concentrations of Gd-DTPA contrast agent in the myocardium and in the LV blood, respectively, and tpeak is the time corresponding to the peak of Ca(t). In the ideal case, the time corresponding to the maximum upslope of Cmyo(t), tmax, is equal to tpeak. In practice, however, there is a small difference in the arrival times of the contrast agent into the LV and into the myocardium. This difference was estimated to correspond to the difference between tpeak and tmax. The magnitudes of such time discrepancies and the effectiveness of the correction for these time discrepancies were measured in 18 subjects who underwent myocardial perfusion MRI under rest and stress conditions. The effects of the time discrepancies could be corrected effectively in the myocardial perfusion estimates.

  19. Comparison of intravenous urokinase plus heparin versus heparin alone in acute myocardial infarction. Urochinasi per via Sistemica nell'Infarto Miocardico (USIM) Collaborative Group.

    Science.gov (United States)

    Rossi, P; Bolognese, L

    1991-09-01

    In a randomized trial of the effects on in-hospital mortality of intravenous urokinase plus heparin versus heparin alone, 2,531 patients with acute myocardial infarction in 89 coronary care units were enrolled for greater than 30 months. Patients admitted within 4 hours of the onset of pain were randomized to receive either intravenous urokinase (a bolus dose of 1 million U repeated after 60 minutes) plus heparin (a bolus dose of 10,000 U followed by 1,000 IU/hour for 48 hours) or heparin alone (infused at the same rate). Complete data were obtained in 2,201 patients (1,128 taking urokinase and 1,073 taking heparin). At 16 days, overall hospital mortality was 8% in the urokinase and 8.3% in the heparin group (p = not significant). Among patients with anterior infarction, mortality was 10.3% in the urokinase and 13.9% in the heparin group (p = 0.09; relative risk = 0.73). The incidence of major bleeding (urokinase 0.44%, heparin 0.37%) as well as the overall incidence of stroke (urokinase 0.35%, heparin 0.20%) was similar in the 2 groups. The rates of major in-hospital cardiac complications (reinfarction, postinfarction angina) were also similar.

  20. Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Atar, Dan; Arheden, Håkan; Berdeaux, Alain

    2015-01-01

    AIM: The MITOCARE study evaluated the efficacy and safety of TRO40303 for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). METHODS: Patients presenting with STEMI within 6 h of the onset of pain randomly received TRO40303...... days, was not significantly different between treatment groups. There were no significant differences in the CMR-assessed myocardial salvage index (1-infarct size/myocardium at risk) (mean 52 vs. 58% with placebo, P = 0.1000), mean CMR-assessed infarct size (21.9 g vs. 20.0 g, or 17 vs. 15% of LV......-mass) or left ventricular ejection fraction (LVEF) (46 vs. 48%), or in the mean 30-day echocardiographic LVEF (51.5 vs. 52.2%) between TRO40303 and placebo. A greater number of adjudicated safety events occurred in the TRO40303 group for unexplained reasons. CONCLUSION: This study in STEMI patients treated...

  1. Detection of myocardial fibrosis in systemic sclerosis by contrast-enhanced magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nassenstein, K.; Ladd, S.C.; Schlosser, T. [Abt. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitaetsklinikum Essen (Germany); Breuckmann, F. [Westdeutsches Herzzentrum, Klinik fuer Kardiologie, Universitaetsklinikum Essen (Germany); Huger, M.; Kreuter, A. [Klinik fuer Dermatologie und Allergologie, St.-Josef-Hospital Bochum, Klinikum der Ruhr-Univ. Bochum (Germany); Barkhausen, J. [Klinik fuer Radiologie und Nuklearmedizin, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck (Germany)

    2008-12-15

    Purpose: our study aimed to assess the prevalence and pattern of late gadolinium enhancement (LGE) as an in vivo correlate of myocardial fibrosis in cardiac asymptomatic patients with systemic sclerosis (SSc). Materials and methods: cardiac magnetic resonance imaging was successfully performed in 34 patients (30 female, 4 male, mean age of 54 {+-} 14 years) with proven SSc and in controls with matching age, sex and cardiovascular risk factors. All examinations were performed on a 1.5 T MR system (Avanto, Siemens, Germany). 2D inversion recovery spoiled gradient echo images (TR 8.0 msec, TE4.0 msec, TI180-240 msec, FA20 , slice thickness 8 mm, in-plane resolution 1.2 x 1.2 mm{sup 2}) were acquired 10 to 15 min after injection of 0.2 mmol Gd-DTPA per kg body weight to detect myocardial LGE. Results: poorly defined, patchy as well as well-defined focal areas of LGE were detected predominantly in the mid-myocardial layer of the basal left ventricular segments in 5 of 34 (15%) SSc patients. A focal area of LGE was observed within the apical septum in one control (3%, p > 0.05). LGE was observed in a total of 15 segments of the SSc patients and in 1 segment of the controls (p < 0.005). (orig.)

  2. Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Roolvink, Vincent; Ibáñez, Borja; Ottervanger, Jan Paul; Pizarro, Gonzalo; van Royen, Niels; Mateos, Alonso; Dambrink, Jan-Henk E; Escalera, Noemi; Lipsic, Erik; Albarran, Agustín; Fernández-Ortiz, Antonio; Fernández-Avilés, Francisco; Goicolea, Javier; Botas, Javier; Remkes, Wouter; Hernandez-Jaras, Victoria; Kedhi, Elvin; Zamorano, José L; Navarro, Felipe; Alfonso, Fernando; García-Lledó, Alberto; Alonso, Joaquin; van Leeuwen, Maarten; Nijveldt, Robin; Postma, Sonja; Kolkman, Evelien; Gosselink, Marcel; de Smet, Bart; Rasoul, Saman; Piek, Jan J; Fuster, Valentin; van 't Hof, Arnoud W J

    2016-06-14

    The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. A total of 683 patients (mean age 62 ± 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 ± 11.0%) and placebo groups (14.9 ± 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 ± 10.9% in the metoprolol group and 51.6 ± 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. (Early-Beta blocker Administration before reperfusion primary PCI in patients with ST-elevation Myocardial Infarction [EARLY

  3. Does the application of X-ray contrast agents impair the clinical effect of intravenous recombinant tissue-type plasminogen activator in acute ischemic stroke patients?

    Science.gov (United States)

    Dzialowski, Imanuel; Puetz, Volker; Buchan, Alastair M; Demchuk, Andrew M; Hill, Michael D

    2012-06-01

    Experimental data suggest a negative interaction between x-ray contrast agents and fibrinolytic efficacy of recombinant tissue-type plasminogen activator (rtPA). We hypothesized that the application of a contrast agent before intravenous thrombolysis with rtPA reduces its clinical efficacy in acute ischemic stroke. We retrospectively studied consecutive ischemic stroke patients receiving contrast agents for computed tomography angiography before intravenous treatment with rtPA. We compared functional outcomes with an historical control group from the Canadian Alteplase for Stroke Effectiveness Study who did not receive contrast agents before thrombolysis with rtPA. Primary end point was favorable functional outcome at 90 days defined as modified Rankin Scale scores 0 to 2. We performed logistic regression analysis and a propensity score matching analysis to estimate the effect size of contrast agent use as a negative predictor of outcome. We identified 111 patients for the computed tomography angiography and 1119 patients for the control group. Proportions of favorable functional outcome were 47.7% (53/111 patients) for the computed tomography angiography group and 49.5% (542/1094 patients) for the control group (P=0.77). Adjusted probabilities for favorable outcome were 0.48 (95% CI, 0.37-0.58) and 0.51 (95% CI, 0.47-0.54), respectively. Contrast use was associated with reduced odds of favorable outcome (OR, 0.62(;) 95% CI, 0.38-0.99). Propensity score matching suggested a larger effect size (OR, 10.0%; 95% CI, 0.5%-19.3%). Our study did not show a significant negative clinical effect of x-ray contrast agents applied before intravenous thrombolysis with rtPA. However, to confirm a possible small negative interaction between contrast agents and rtPA, additional experimental and prospective clinical studies are needed.

  4. Multiphase CT scanning and different intravenous contrast media concentrations in combined F-18-FDG PET/CT: Effect on quantitative and clinical assessment

    Energy Technology Data Exchange (ETDEWEB)

    Rebiere, Marilou, E-mail: Marilou.Rebiere@rwth-aachen.de [Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Verburg, Frederik A., E-mail: fverburg@ukaachen.de [Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Department of Nuclear Medicine, Maastricht University Medical Center, P. Debeylaan 25, 6202 AZ Maastricht (Netherlands); Palmowski, Moritz, E-mail: mpalmowski@ukaachen.de [Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Department of Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Department of Experimental Molecular Imaging, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Krohn, Thomas, E-mail: tkrohn@ukaachen.de [Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Pietsch, Hubertus, E-mail: hubertus.pietsch@bayer.com [Contrast Media Research, Bayer Pharma AG, Muellerstr. 178, 13353 Berlin (Germany); Kuhl, Christiane K., E-mail: ckuhl@ukaachen.de [Department of Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Mottaghy, Felix M., E-mail: fmottaghy@ukaachen.de [Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Department of Nuclear Medicine, Maastricht University Medical Center, P. Debeylaan 25, 6202 AZ Maastricht (Netherlands); Behrendt, Florian F., E-mail: fbehrendt@ukaachen.de [Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany)

    2012-08-15

    Purpose: To evaluate the influence of multiphase CT scanning and different intravenous contrast media on contrast enhancement, attenuation correction and image quality in combined PET/CT. Material and methods: 140 patients were prospectively enrolled for F-18-FDG-PET/CT including a low-dose unenhanced, arterial and venous contrast enhanced CT. The first (second) 70 patients, received contrast medium with 370 (300) mg iodine/ml. The iodine delivery rate (1.3 mg/s) and total iodine load (44.4 g) were identical for both groups. Contrast enhancement and maximum and mean standardized FDG uptake values (SUVmax and SUVmean) were determined for the un-enhanced, arterial and venous PET/CT at multiple anatomic sites and PET reconstructions were visually evaluated. Results: Arterial contrast enhancement was significantly higher for the 300 mg/ml contrast medium compared to 370 mg I/ml at all anatomic sites. Venous enhancement was not different between the two contrast media. SUVmean and SUVmax were significantly higher for the contrast enhanced compared to the non-enhanced PET/CT at all anatomic sites (all P < 0.001). Tracer uptake was significantly higher in the arterial than in the venous PET/CT in the arteries using both contrast media (all P < 0.001). No differences in tracer uptake were found between the contrast media (all P > 0.05). Visual assessment revealed no relevant differences between the different PET reconstructions. Conclusions: There is no relevant qualitative influence on the PET scan from the use of different intravenous contrast media in its various phases in combined multiphase PET/CT. For quantitative analysis of tracer uptake it is required to use an identical PET/CT protocol.

  5. Immediate adverse reactions to intravenous iodinated contrast media in computed tomography Reacciones adversas inmediatas al contraste yodado intravenoso en tomografía computarizada Reações adversas imediatas ao contraste iodado intravenoso em tomografia computadorizada

    Directory of Open Access Journals (Sweden)

    Beatriz Cavalcanti Juchem

    2007-02-01

    Full Text Available This exploratory-descriptive, non-experimental quantitative research aimed to learn about immediate adverse reactions to intravenous iodinated contrast media in hospitalized patients submitted to computed tomography at a teaching hospital in the South of Brazil. During the study period, all adverse reactions showed mild intensity, at a frequency of 12.5% with ionic iodinated contrast media, and 1% with non-ionic contrast agent. The extravasation of contrast occurred in 2.2% of the injections in a peripheral vein without complications in any of the cases. The results are within the limits cited in international literature and suggest that tomography service professionals should know their own rates of adverse reactions to iodinated contrast agent, as well as the conditions in which they occur, in order to obtain evidence to evaluate the respective care delivery processes.Investigación cuantitativa del tipo exploratorio-descriptivo, de carácter no experimental. El objetivo consistía en conocer las reacciones adversas inmediatas al contraste yodado intravenoso en pacientes internados, sometidos a tomografía computarizada en un hospital escuela del sur de Brasil. Durante el período del estudio, todas las reacciones adversas tuvieron intensidad leve y una frecuencia del 12,5% con la utilización del contraste yodado iónico, y 1% con contraste no iónico. La extravasación del contraste ocurrió en un 2,2% de las inyecciones en vena periférica, no ocasionando complicaciones en ninguno de los casos. Los índices evidenciados en el presente estudio se mantuvieron dentro de los límites que constan en la revisión de literatura y, entre las recomendaciones, se sugiere que los servicios de tomografía conozcan los propios índices de reacciones adversas al contraste yodado y las condiciones en que ocurren, con la finalidad de obtener evidencias para evaluación de los respectivos procesos asistenciales.Pesquisa quantitativa, explorat

  6. Fusion of intravenous contrast-enhanced C-arm CT and pretreatment imaging for ablation margin assessment of liver tumors: A preliminary study

    Directory of Open Access Journals (Sweden)

    Jin Iwazawa

    2012-01-01

    Full Text Available The aim of this preliminary study was to evaluate the feasibility of assessing ablation margins after radiofrequency ablation (RFA of liver tumors from fusion images of post-treatment C-arm computed tomography (CT images fused to pretreatment images. Five patients with liver tumors underwent RFA. Intravenous contrast-enhanced C-arm CT images were obtained for all patients immediately after RFA, and multi-detector CT (MDCT images were obtained 3-7 days later. The C-arm CT and MDCT images were fused to pretreatment images using a multimodality image fusion software. The minimum ablation margins were assessed in the C-arm CT and MDCT fusion images. Ablation margins after RFA of liver tumors can be measured using intravenous contrast-enhanced C-arm CT images fused with pretreatment images. This technique has the potential for use in the intra-procedural assessment of liver tumor ablation.

  7. Integration of myocardial scar identified by preoperative delayed contrast-enhanced MRI into a high-resolution mapping system for planning and guidance of VT ablation procedures

    Science.gov (United States)

    Rettmann, M. E.; Suzuki, A.; Wang, S.; Pottinger, N.; Arter, J.; Netzer, A.; Parker, K.; Viker, K.; Packer, D. L.

    2017-03-01

    Myocardial scarring creates a substrate for reentrant circuits which can lead to ventricular tachycardia. In ventricular catheter ablation therapy, regions of myocardial scarring are targeted to interrupt arrhythmic electrical pathways. Low voltage regions are a surrogate for myocardial scar and are identified by generating an electro anatomic map at the start of the procedure. Recent efforts have focussed on integration of preoperative scar information generated from delayed contrast-enhanced MR imaging to augment intraprocedural information. In this work, we describe an initial feasibility study of integration of a preoperative MRI derived scar maps into a high-resolution mapping system to improve planning and guidance of VT ablation procedures.

  8. Prediction of presence of kidney disease in patients undergoing intravenous iodinated contrast enhanced computed tomography: a validation study

    Energy Technology Data Exchange (ETDEWEB)

    Schreuder, Sanne M.; Stoker, Jaap; Bipat, Shandra [University of Amsterdam, Department of Radiology, Academic Medical Centre, G1-212, Amsterdam (Netherlands)

    2017-04-15

    To validate two previously presented models containing risk factors to identify patients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m{sup 2} or eGFR <45 ml/min/1.73 m{sup 2}. In random patients undergoing intravenous contrast-enhanced computed tomography (CECT) the following risk factors were assessed: history of urological/nephrological disease, hypertension, diabetes mellitus, anaemia, congestive heart failure, other cardiovascular disease or multiple myeloma or Waldenstroem disease. Data on kidney function, age, gender and type and indication of CECT were also registered. We studied two models: model A - diabetes mellitus, history of urological/nephrological disease, cardiovascular disease, hypertension; model B - diabetes mellitus, history of urological/nephrological disease, age >75 years and congestive heart failure. For each model, associations with eGFR <60 ml/min/1.73 m{sup 2} or eGFR <45 ml/min/1.73 m{sup 2} was studied. A total of 1,001 patients, mean age 60.36 years were included. In total, 92 (9.2 %) patients had an eGFR <60 ml/min/1.73 m{sup 2} and 11 (1.1 %) patients an eGFR <45 ml/min/1.73 m{sup 2}. Model A detected 543 patients: 81 with eGFR <60 ml/min/1.73 m{sup 2} (missing 11) and all 11 with eGFR <45 ml/min/1.73 m{sup 2}. Model B detected 420 patients: 70 (missing 22) with eGFR <60 ml/min/1.73 m{sup 2} and all 11 with eGFR <45 ml/min/1.73 m{sup 2}. Associations were significant (p < 0.05). Model B resulted in the lowest superfluous eGFR measurements while detecting all patients with eGFR <45 ml/min/1.73 m{sup 2} and nearly all with eGFR <60 ml/min/1.73 m{sup 2}. (orig.)

  9. Prevalence of NSF following intravenous gadolinium-contrast media administration in dialysis patients with endstage renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Heinz-Peer, Gertraud, E-mail: gertraud.heinz@meduniwien.ac.a [Department of Radiology, Medical University of Vienna (Austria); Neruda, Anita [Department of Radiology, Medical University of Vienna (Austria); Watschinger, Bruno; Vychytil, Andreas [Department of Nephrology, Medical University of Vienna (Austria); Geusau, Alexandra [Department of Dermatology, Medical University of Vienna (Austria); Haumer, Markus [Department of Internal Medicine II, Medical University of Vienna (Austria); Weber, Michael [Department of Radiology, Medical University of Vienna (Austria)

    2010-10-15

    Purpose: To evaluate the prevalence of nephrogenic systemic fibrosis (NSF) in a patient population being at highest risk for developing this disease and to evaluate possible risk factors. Materials and methods: The radiological records of 552 patients with ESRD being on hemodialysis (HD) or peritoneal dialysis (PD) were retrospectively reviewed to identify whether the patients underwent MR-examinations with or without intravenous administration of GBCA. In case of exposure to GBCA, the number of contrast injections, the benchmark and the cumulative doses of GBCA, and possible cofactors regarding pathogenesis of NSF were recorded. Diagnosis of NSF was confirmed either by deep skin biopsy or by review of medical and histopathological records. Data of NSF patients were compared with data of dialysis patients who did not develop NSF after MR-examinations. Results: 146 dialysis patients underwent MRI without i.v.-administration of GBCA. No case of NSF was observed in this patient population. 195/552 patients proved to have a total number of 325 well-documented exposures to GBCA. Seven different types of GBCA were used during these MR-examinations. NSF prevalence rate was 1.6%. One patient died of NSF. Three different types of GBCA were involved in 6 NSF cases. 4/6 proved to be confounded cases. The cumulative dose of GBCA, history of thrombosis, recent surgery, and the combination of HD and PD proved to be significant cofactors for the development of NSF (p < .05). No significant difference regarding residual renal clearance (p = .898) and residual urine volume (p = .083) was found between NSF and non-NSF patients. Conclusion: The prevalence of NSF proved to be much lower in this high risk patient group being exposed to GBCA compared to the literature. NSF was not observed in ESRD patients undergoing MRI without administration of GBCA. Our data support a positive association between cumulative dose of GBCA and development of NSF. No positive association was found

  10. Prediction of presence of kidney disease in a general patient population undergoing intravenous iodinated contrast enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Moos, Shira I.; Stoker, Jaap; Nagan, Gajenthiran; Weijert, Roderick S. de; Vemde, David N.H. van; Bipat, Shandra [Academic Medical Center, University of Amsterdam, Department of Radiology, G1-215, Amsterdam (Netherlands)

    2014-06-15

    To assess which risk factors can be used to reduce superfluous estimated glomerular filtration rate (eGFR) measurements before intravenous contrast medium administration. In consecutive patients, all decreased eGFR risk factors were assessed: diabetes mellitus (DM), history of urologic/nephrologic disease (HUND), nephrotoxic medication, cardiovascular disease, hypertension, age > 60 years, anaemia, malignancy and multiple myeloma/M. Waldenstroem. We studied four models: (1) all risk factors, (2) DM, HUND, hypertension, age > 60 years; (3) DM, HUND, cardiovascular disease, hypertension; (4) DM, HUND, age > 75 years and congestive heart failure. For each model, association with eGFR < 60 ml/min/1.73 m{sup 2} or eGFR < 45 ml/min/1.73 m{sup 2} was studied. A total of 998 patients, mean age 59.94 years were included; 112 with eGFR < 60 ml/min/1.73 m{sup 2} and 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 1 detected 816 patients: 108 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 2 detected 745 patients: 108 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 3 detected 622 patients: 100 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 4 detected 440 patients: 86 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Associations were significant (p < 0.001). Model 4 is most effective, resulting in the lowest proportion of superfluous eGFR measurements while detecting all patients with eGFR < 45 ml/min/1.73 m{sup 2} and most with eGFR < 60 ml/min/1.73 m{sup 2}. (orig.)

  11. Biochemical aspects on adverse reactions to contrast media. Changes of kininogen levels in dog plasma after intravenous injections of iohexol, iopamidol, and iothalamate.

    Science.gov (United States)

    Tanaka, T; Katayama, H; Shirakata, A; Takahasi, H

    1988-09-01

    The adverse reactions to contrast media have been investigated by several authors but the exact mechanisms have not yet been established. To study whether kinin-releasing systems are involved in these adverse reactions, we determined total plasma kininogen levels at intervals up to 30 minutes after the intravenous injections of contrast media in dogs. Injections of iohexol, iopamidol, and iothalamate decreased total plasma kininogen levels. This effect increased with increasing dose of the media and suggests that they activated the kinin-releasing systems in the plasma.

  12. Intracoronary Compared to Intravenous Bolus Abciximab during Primary Percutaneous Coronary Intervention in ST-segment Elevation Myocardial Infarction (STEMI) Patients Reduces 30-day Mortality and Target Vessel Revascularization: A Randomized Trial

    DEFF Research Database (Denmark)

    Iversen, Allan; Abildgaard, Ulrik; Galloe, Anders;

    2011-01-01

    Background: Abciximab is beneficial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, the optimal administration route of the initial bolus of abciximab, that is, intravenous (IV) versus intracoronary (IC), has...... patients who underwent pPCI and had indication for abciximab to either IV or IC bolus followed by a 12-hour IV infusion. Primary end-points at 30 days were target vessel revascularization (TVR), recurrent myocardial infarction (MI) or death, and the composite of the three. Secondary end-points were...

  13. In vivo nuclear magnetic resonance imaging of myocardial perfusion using the paramagnetic contrast agent manganese gluconate.

    Science.gov (United States)

    Schaefer, S; Lange, R A; Kulkarni, P V; Katz, J; Parkey, R W; Willerson, J T; Peshock, R M

    1989-08-01

    Previous nuclear magnetic resonance (NMR) imaging studies have indicated that coronary occlusion does not produce sufficient changes in standard tissue relaxation times to allow the detection of acute ischemia. To identify acute myocardial perfusion abnormalities, the use of the paramagnetic agent manganese gluconate combined with calcium gluconate (MnGlu/CaGlu) was investigated in canine models of acute coronary artery occlusion. In vitro studies showed that MnGlu/CaGlu was a more efficient relaxing agent than gadolinium-DTPA (relaxivity of 7.8 versus 5.1 s-1 mM-1) and demonstrated affinity for normal myocardium. The distribution of MnGlu/CaGlu as measured by manganese-54 tracer studies was proportional to myocardial blood flow in both normal and ischemic tissue. Hearts excised from dogs after coronary artery occlusion and administration of 0.035 mM/kg MnGlu/CaGlu were imaged ex vivo using a relatively spin-lattice relaxation time (T1)-weighted gradient reversal technique (repetition time [TR] 50 ms and echo time [TE] 9 ms). These images showed increased signal intensity in the normally perfused myocardium with a mean signal intensity ratio of hypoperfused to normal myocardium of 0.55 +/- 0.12 (mean +/- SD). In vivo images obtained in nine dogs after coronary artery occlusion and administration of the same dose of MnGlu/CaGlu demonstrated the region of hypoperfused myocardium in six dogs with a signal intensity ratio of hypoperfused to normal myocardium of 0.64 +/- 0.23 (p less than 0.05 versus control). When a higher dose of 0.1 mM/kg MnGlu/CaGlu was utilized and in vivo imaging was performed using a relatively spin-spin relaxation time (T2)-weighted (TR gated, TE 60 ms) spin-echo sequence in six dogs, the signal intensity of normal myocardium was decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Hansen, Thomas Fritz; Dirks, Christina G; Jensen, Gorm B;

    2004-01-01

    PURPOSE: To investigate the diagnostic ability of quantitative magnetic resonance imaging (MRI) heart perfusion in acute heart patients, a fast, multislice dynamic contrast-enhanced MRI sequence was applied to patients with acute myocardial infarction. MATERIALS AND METHODS: Seven patients...... slices, each having 60 sectors, provided an estimation of the severity and extent of the perfusion deficiency. Reperfusion was assessed both by noninvasive criteria and by coronary angiography (CAG). RESULTS: The Ki maps clearly delineated the infarction in all patients. Thrombolytic treatment...... was clearly beneficial in one case, but had no effect in the two other cases. Over the time-course of the study, normal perfusion values were not reestablished following thrombolytic treatment in all cases investigated. CONCLUSION: This study shows that quantitative MRI perfusion values can be obtained from...

  15. Comparison of gadolinium polylysine and gadopentetate in contrast enhanced MR imaging of myocardial ischemia-reperfusion in cats

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Tae Hwan [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lee, Jung Hee; Lee, Tae Keun; Mun, Chi Woong [Asan Institute for Life Sciences, Seoul (Korea, Republic of)

    1995-07-15

    To assess the signal enhancement by gadolinium-DTPA-polylysine (Gd-polylysine) as compared to gadopentetate (Gd-DTPA) in MR imaging of heart that have undergone ischemia-reperfusion, and to estimate the extent of myocardial damage covered by the MR signal enhancement. A series of contrast enhanced cardiac MR images were obtained from 17 cats subjected to a 90 minutes of occlusion of the left anterior descending coronary artery (LAD) followed by a 90 minutes of reperfusion. Time courses of changes in the signal intensity (SI) of the ischemic area were measured in Gd-polylysine group (8 cats) and Gd-DTPA group (9 cats). The size of MR signal enhanced area was then compared to the sizes of infarction and the area at risk revealed by TTC histochemical staining. Maximum SIs were obtained at 60 minutes and 30 minutes after injection of the contrast material, respectively for Gd-polylysine group and Gd-DTPA group. Signal enhancement was stronger and persistent for a longer period in Gd-polylysine group than in GD-DTPA group. Sizes of the enhanced are, the infarction, and the area at risk were about 30%, 15%, and 50% of the total left ventricle (LV) area; the difference between the groups was statistically insignificant. Gd-polylysine can be used better for a blood pool marker than Gd-DTPA in MR imaging of myocardial ischemia, due to its strong and persistent signal enhancement. The MR signal enhanced area includes both the infarcted area and a portion of the area at risk.

  16. Imaging of the Achilles tendon in spondyloarthritis: a comparison of ultrasound and conventional, short and ultrashort echo time MRI with and without intravenous contrast

    Energy Technology Data Exchange (ETDEWEB)

    Hodgson, R.J.; Emery, P. [University of Leeds, Chapel Allerton Hospital, Leeds Musculoskeletal Biomedical Research Centre, Leeds (United Kingdom); Grainger, A.J.; O' Connor, P.J.; Evans, R. [Chapel Allerton Hospital, Leeds Musculoskeletal Biomedical Research Centre, Leeds (United Kingdom); Coates, L.; Marzo-Ortega, H.; Helliwell, P.; McGonagle, D. [University of Leeds, Leeds Institute for Molecular Medicine, Leeds (United Kingdom); Robson, M.D. [University of Oxford, Oxford Centre for Clinical Magnetic Resonance Research, Oxford (United Kingdom)

    2011-06-15

    To compare conventional MRI, ultrashort echo time MRI and ultrasound for assessing the extent of tendon abnormalities in spondyloarthritis. 25 patients with spondyloarthritis and Achilles symptoms were studied with MRI and ultrasound. MR images of the Achilles tendon were acquired using T1-weighted spin echo, gradient echo and ultrashort echo time (UTE) sequences with echo times (TE) between 0.07 and 16 ms, before and after intravenous contrast medium. Greyscale and power Doppler ultrasound were also performed. The craniocaudal extent of imaging abnormalities measured by a consultant musculoskeletal radiologist was compared between the different techniques. Abnormalities were most extensive on spoiled gradient echo images with TE=2 ms. Contrast enhancement after intravenous gadolinium was greatest on the UTE images (TE=0.07 ms). Fewer abnormalities were demonstrated using unenhanced UTE. Abnormalities were more extensive on MRI than ultrasound. Contrast enhancement was more extensive than power Doppler signal. 3D spoiled gradient echo images with an echo time of 2 ms demonstrate more extensive tendon abnormalities than the other techniques in spondyloarthritis. Abnormalities of vascularity are best demonstrated on enhanced ultrashort echo time images. (orig.)

  17. Estimation of coronary artery stenosis by low-dose adenosine stress real-time myocardial contrast echocardiography: a quantitative study

    Institute of Scientific and Technical Information of China (English)

    ZHOU Xiao; ZHI Guang; XU Yong; WANG Jing; YAN Guo-hui

    2012-01-01

    Background Coronary microcirculation reserve is an important field in the research of coronary artery disease,but it is difficult to identify clinically.Currently it is widely accepted that myocardial contrast echocardiography (MCE) is a safe,inexpensive method and has comparatively high image resolution.The present study used quantitative low-dose adenosine stress real-time (RT)-MCE to estimate myocardial perfusion and the coronary stenosis.Methods Forty-nine left ventricular (LV) segments from 14 unselected patients were divided into three groups according to the coronary angiography or CT angiography results:group 1 (n=20,41%) without significant stenosis (<70%),group 2 (n=12,24%)with successful percutaneous coronary intervention (PCI),and group 3 (n=17,35%)with significant stenosis (>70%).RT-MCE was performed in these patients with low-dose adenosine stress and continuous infusion of Sonovue.The replenishing curves were drawn according to the contrast density measured at the end-diastolic frame of every cardiac circle by ACQ software.Results Forty-nine LV segments with satisfactory image quality were picked for quantitative contrast echo analysis.The replenishing curves were analyzed at baseline and after stress.Perfusion of group 3 did not decrease significantly at baseline,and showed no improvement during adenosine stress and was significantly different from groups 1 and 2 (P <0.05).The A·β and β increased more significantly in group 1 than in groups 2 and 3 (P <0.05).In a receiver operating characteristic (ROC) curve analysis,A·β under adenosine stress <1.74 dB/s had a sensitivity and specificity of 71% for diagnosis of coronary artery stenosis,reduced adenosine-induced rise (percentage of A·β <81%) had a sensitivity and specificity of 83% and 79% for the diagnosis of low-reserve,and β <54% had a sensitivity of 86% and specificity of 79%.Conclusions Rest perfusion of severely stenosed arteries may be normal

  18. Association between diffuse myocardial fibrosis by cardiac magnetic resonance contrast-enhanced T(1) mapping and subclinical myocardial dysfunction in diabetic patients: a pilot study.

    NARCIS (Netherlands)

    Ng, A.C.; Auger, D.; Delgado, V.; Elderen, S.G. van; Bertini, M.; Siebelink, H.M.; Geest, R.J. van der; Bonetti, C.; Velde, E.T. van der; Roos, A. de; Smit, J.W.A.; Leung, D.Y.; Bax, J.J.; Lamb, H.J.

    2012-01-01

    BACKGROUND: Diabetic patients have increased interstitial myocardial fibrosis on histological examination. Magnetic resonance imaging (MRI) T(1) mapping is a previously validated imaging technique that can quantify the burden of global and regional interstitial fibrosis. However, the association bet

  19. Evans blue staining of cardiomyocytes induced by myocardial contrast echocardiography in rats: evidence for necrosis instead of apoptosis.

    Science.gov (United States)

    Miller, Douglas L; Li, Peng; Dou, Chunyan; Armstrong, William F; Gordon, David

    2007-12-01

    High mechanical index (MI) echocardiography with contrast agent has been shown to induce Evans blue staining of cardiomyocytes, seen 1 d after exposure, in addition to contraction band necrosis, seen immediately after exposure. This research examined the roles of necrosis vs. apoptosis in these bioeffects. Myocardial contrast echocardiography at high MI with 1:4 electrocardiogram triggering was performed in anesthetized rats at 1.5 MHz. Histologically observable cell injury was accumulated by infusing a high dose of 50 microL/kg ultrasound contrast media via tail vein for 5 min at the start of 10 min of scanning. Evans blue dye or propidium iodide was injected as an indicator of cardiomyocyte plasma membrane integrity. Histologic sections were stained using the terminal dUTP nick-end labeling (TUNEL) method for labeling nuclei with DNA degradation (e.g., apoptosis). Evans blue fluorescent cells were counted on frozen sections or on hematoxylin-stained and TUNEL-labeled paraffin sections. In addition, transmission electron microscopy was used to assess potential apoptotic nuclei. Hypercontraction and propidium iodide staining were observed immediately after imaging exposure. Although TUNEL-positive cells were evident after 4 h, these also had indications of contraction band necrosis, and features of apoptosis were not confirmed by electron microscopy. Inflammatory cell infiltration was evident after 24 h. A second, more subtle injury was recognized by Evans blue staining, with minimal inflammatory cell infiltration at the morphologically intact stained cells after 24 h. Apoptosis was not detected by the TUNEL method in the cardiomyocytes stained with Evans blue at 24 h. However, Evans blue-stained cell numbers declined after 48 h, with continued inflammatory cell infiltration. The initial insult for Evans blue-stained cardiomyocytes apparently induced partial permeability of the plasma membrane, which led to gradual degeneration (but not apoptosis) and necrosis

  20. CONTRAST

    DEFF Research Database (Denmark)

    Kristensen, Thomas Krogsgaard

    2007-01-01

    Dette er en afrapportering fra den årlige CONTRAST workshop, der i 2007 blev afholdt i Yaoundé, Cameroon.......Dette er en afrapportering fra den årlige CONTRAST workshop, der i 2007 blev afholdt i Yaoundé, Cameroon....

  1. Informed consent for the administration of an intravenous contrast agent: importance and determinants of patient refusal; Consentimiento informado para la administracion de contraste intravenoso. Importancia y factores determinantes del rechazo por los pacientes

    Energy Technology Data Exchange (ETDEWEB)

    Martel, J. [Fundacion Hospital Alcorcon. Madrid (Spain); Garcia-Diaz, J. D. [Hospital Universitario Principe de Asturias. Alcala de Henares. Madrid (Spain)

    1999-07-01

    We proposed to determine the proportion of patients who refuse to undergo intravenous contrast administration and the factors that influence their refusal. Our series consisted of 442 patients who were supposed to undergo imaging studies involving the intravenous injection of an iodine contrast. In a personal interview, the patients were issued a questionnaire specifically designed for this study. The following parameters were recorded: sex, age, inpatient or outpatient status, medical history available, person who informed them about the procedure, person signing the informed consent (patient or other) , highest academic degree, attitude toward receiving the information and degree of concern after reading and signing the consent form. In our series 8.6% of the patients (95% confidence interval: 6-11.2) refused to sign the informed consent form. In addition, there were a number of patients who delayed the procedure or hindered the daily work schedule by some other means. When the relationship between each of the variables studied and refusal to sign the consent form was assessed, significant associations were observed between the latter and the academic level of the patient, his or her degree of concern and having received the information from a trained person. There was also a nearly significant trend toward the association between refusal and the patient's background. Relatively few patients refuse to sign the informed consent to receive intravenous contrast administration but this negative decision interferes with the health care practice. It is possible to identify certain correctable factors that influence the patient in this respect. (Author) 13 refs.

  2. Grey scale enhancement of rabbit liver and kidney by intravenous injection of a new lipid-coated ultrasound contrast agent

    Institute of Scientific and Technical Information of China (English)

    Ping Liu; Yun-Hua Gao; Kai-Bin Tan; Zheng Liu; Song Zuo

    2004-01-01

    AIM: To assess the grey scale enhancement of a new lipidcoated ultrasound contrast agent in solid abdominal organs as liver and kidney.METHODS: Size distribution and concentration of the lipidcoated contrast microbubbles were analyzed by a Coulter counter. Two-dimensional (2D) second harmonic imaging of the hepatic parenchyma, the inferior vena cava and the right kidney of the rabbits were acquired before and after contrast agent injection. Images were further quantified by histogram in Adobe Photoshop 6.0. Time-intensity curves of hepatic parenchyma, inferior vena cava and renal cortex were generated from the original grey scale.RESULTS: The 2D images of hepatic parenchyma and cortex of the kidney were greatly enhanced after injection and the peak time could last more than 50 min.CONCLUSION: This new lipid ultrasound contrast agent could significantly enhance the grey scale imaging of the hepatic parenchyma and the renal cortex for more than 50 min.

  3. Real-time myocardial contrast echocardiography can predict functional recovery and left ventricular remodeling after revascularization in patients with ischemic heart disease

    Institute of Scientific and Technical Information of China (English)

    ZENG Xin; SHU Xian-hong; PAN Cui-zhen; LI Qing; GUO Shi-zun; LIU Shi-zhen; CHEN Hao-zhu

    2007-01-01

    Background Previous studies showed that preservation of microvascular integrity after myocardial ischemia was associated with myocardial viability. Real-time myocardial contrast echocardiography (RT-MCE) is a promising modality for non-invasive evaluation of microcirculation perfusion. Thus, it provides a unique tool to detect myocardial viability. We sought in this study to investigate the role of RT-MCE in predicting left ventricular (LV) functional recovery and remodeling after revascularization in patients with ischemic heart disease.Methods Thirty-one patients with ischemic heart disease and resting regional LV dysfunction were included. LV volume,global and regional function were evaluated by echocardiography before and 6-9 months after revascularization.RT-MCE was performed before revascularization using low mechanical index power modulation imaging. Myocardial contrast opacification of dysfunctional segments was scored on a 3-point scale and mean contrast score in dysfunctional segments was calculated. Patients were divided into 2 groups according to mean contrast score in dysfunctional segments: group A, patients with mean contrast score ≥0.5 (n=19); group B, patients with mean contrast score < 0.5(n=12).Results Wall motion improvement was found to be 94.5%, 45.5% and 16.1% respectively (P<0.01) in homogenous,patchy and absent contrast opacification segments. At baseline, there was no significant difference in LV volume and global function between the two groups. After revascularization, group B had significantly larger LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV), lower LV ejection fraction (LVEF) and higher wall motion score index(WMSI) than those of group A (all P<0.05). Revascularization was followed by significant improvement of LV volume and recovery of global LV function in group A (all P<0.01); however, in group B, after revascularization, deterioration of LVEDV (P<0.05) was observed, moreover LVESV, WMSI and LVEF

  4. Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography

    Directory of Open Access Journals (Sweden)

    Ugo Fabrizio

    2010-05-01

    Full Text Available Abstract Background We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE. Wall motion (WM assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD, particularly in patients with isolated intermediate (50%-70% coronary stenosis. Methods We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography. Results and discussion When CAD was defined as the presence of a ≥50% stenosis, the addition of MPI increased sensitivity (+30% and decreased specificity (-14%, with a final increase in total diagnostic accuracy (+16%, p Conclusions The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (≥50% or > 70% stenosis, but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis. The total diagnostic accuracy increased only when defining CAD as ≥50% stenosis, since in patients with severe stenosis (> 70% the decrease in specificity is not counterbalanced by the minor sensitivity increase.

  5. Effect of intravenous contrast agent volume on colorectal cancer vascular parameters as measured by perfusion computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Goh, V. [Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, London (United Kingdom); Bartram, C. [Intestinal Imaging Centre, St Mark' s Hospital, Harrow, London (United Kingdom); Halligan, S. [Department of Academic Radiology, University College Hospital, London (United Kingdom)], E-mail: s.halligan@ucl.ac.uk

    2009-04-15

    Aim: To determine the effect of two different contrast agent volumes on quantitative and semi-quantitative vascular parameters as measured by perfusion computed tomography (CT) in colorectal cancer. Materials and methods: Following ethical approval and informed consent, eight prospectively recruited patients with proven colorectal adenocarcinoma underwent two separate perfusion CT studies on the same day after (a) 100 ml and (b) 50 ml of a 340 mg/ml iodinated contrast medium, respectively. Quantitative (blood volume, blood flow, permeability surface area product) and semi-quantitative (peak enhancement, time to peak enhancement) tumour vascular parameters were determined using commercial software based on distributed parameter analysis and compared using t-testing. Results: Tumour blood volume, blood flow, and permeability surface area product were not substantially different following the injection of 100 ml and 50 ml contrast medium: 6.12 versus 6.23 ml/100 g tissue; 73.4 versus 71.3 ml/min/100 g tissue; 15.6 versus 15.3 ml/min/100 g tissue for 100 and 50 ml, respectively; p > 0.05. Tumour peak enhancement and time to peak were significantly greater following the injection of 100 ml versus 50 ml contrast medium: 41.2 versus 28.5 HU; 16.1 versus 11.8 s for 100 ml and 50 ml, respectively; p = 0.002; p = 0.0003. Conclusion: Quantitative parameters do not appear to change substantially with a higher contrast agent volume suggesting a combined diagnostic staging-perfusion CT study following a single injection is feasible for colorectal cancer.

  6. Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Schepis, Tiziano; Achenbach, Stephan; Marwan, Mohamed; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G.; Pflederer, Tobias [University of Erlangen, Department of Internal Medicine 2 (Cardiology), Erlangen (Germany)

    2010-07-15

    To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS). Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings. PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%. In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels. (orig.)

  7. Computational Fluid Dynamics Simulations of Contrast Agent Bolus Dispersion in a Coronary Bifurcation: Impact on MRI-Based Quantification of Myocardial Perfusion

    Directory of Open Access Journals (Sweden)

    Regine Schmidt

    2013-01-01

    Full Text Available Contrast-enhanced first-pass magnetic resonance imaging (MRI in combination with a tracer kinetic model, for example, MMID4, can be used to determine myocardial blood flow (MBF and myocardial perfusion reserve (MPR. Typically, the arterial input function (AIF required for this methodology is estimated from the left ventricle (LV. Dispersion of the contrast agent bolus might occur between the LV and the myocardial tissue. Negligence of bolus dispersion could cause an error in MBF determination. The aim of this study was to investigate the influence of bolus dispersion in a simplified coronary bifurcation geometry including one healthy and one stenotic branch on the quantification of MBF and MPR. Computational fluid dynamics (CFD simulations were combined with MMID4. Different inlet boundary conditions describing pulsatile and constant flows for rest and hyperemia and differing outflow conditions have been investigated. In the bifurcation region, the increase of the dispersion was smaller than inside the straight vessels. A systematic underestimation of MBF values up to −16.1% for pulsatile flow and an overestimation of MPR up to 7.5% were found. It was shown that, under the conditions considered in this study, bolus dispersion can significantly influence the results of quantitative myocardial MR-perfusion measurements.

  8. Effect of intravenous FX06 as an adjunct to primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction results of the F.I.R.E. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury) trial

    DEFF Research Database (Denmark)

    Atar, Dan; Petzelbauer, Peter; Schwitter, Jürg

    2009-01-01

    by mitigating reperfusion injury. METHODS: In all, 234 patients presenting with acute ST-segment elevation myocardial infarction were randomized in 26 centers. FX06 or matching placebo was given as intravenous bolus at reperfusion. Infarct size was assessed 5 days after myocardial infarction by late gadolinium...... enhanced cardiac magnetic resonance imaging. Secondary outcomes included size of necrotic core zone and microvascular obstruction at 5 days, infarct size at 4 months, left ventricular function, troponin I levels, and safety. RESULTS: There were no baseline differences between groups. On day 5......: In this proof-of-concept trial, FX06 reduced the necrotic core zone as one measure of infarct size on magnetic resonance imaging, while total late enhancement was not significantly different between groups. The drug appears safe and well tolerated. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion...

  9. Quantitative comparison of tumor vascularity of HCC after intravenous contrast Agent: Conventional versus harmonic power Doppler US

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seong Ho; Kim, Tae Kyoung; Lee, Kyoung Ho; Kim, Ah Young; Han, Joon Koo; Choi, Byung Ihn [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1999-09-15

    For the quantitative comparison of the degree of enhancement in nodular hepatocellular carcinoma (HCC) at conventional and harmonic Power Doppler (PD) ultrasound (US). The average of %PDA of ten nodules gradually increased until 60 seconds after contrast injection and then gradually decreased. The average %PDA on conventional and harmonic PD US at 60 seconds were 34.9% and 19.5%, respectively. The average %PDA were significantly higher on conventional PD US than those on harmonic PD US at all times except at 20 seconds. The ratio of average %pda on conventional PD US to those on harmonic PD US became gradually larger after 120 seconds. Although contrast-enhanced harmonic PD US can be an effective method in evaluating the tumor vascularity of HCC because of less PD artifacts, the duration of effective enhancement was shorter and degree of enhancement is less than that of conventional PD US.

  10. Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year

    DEFF Research Database (Denmark)

    Iversen, Allan Zeeberg; Galatius, Soeren; Abildgaard, Ulrik;

    2011-01-01

    Objectives: Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior...... to the standard intravenous (IV) administration. We have previously reported reduced short-term mortality and need for target vessel revascularization (TVR) with the IC route. We now present long-term data from our randomized trial on IC versus IV abciximab in pPCI-treated STEMI patients. Methods: A total of 355...

  11. Pulmonary edema following intravenous injection of nonionic low-osmolar contrast medium - appearance on HRCT. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Bristedt, P.; Tylen, U. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Diagnostic Radiology

    1998-01-01

    Pulmonary edema following i.v. contrast medium injection is a rare adverse reaction. We report on a 71-year-old woman who developed pulmonary edema following i.v. injection of iohexol during spiral CT of the thorax. She developed shortness of breath during the injection, and the first radiographic signs of pulmonary edema were visible on CT images 25 s after the onset of injection. On HRCT images 15 min later, marked edema was demonstrated in both lungs in a mosaic pattern of distribution. After appropriate therapy, the patient recovered without sequelae. A repeat CT 6 days later showed complete normalization. (orig.).

  12. Myocardial contrast defect associated with thrombotic coronary occlusion: Pre-autopsy diagnosis of a cardiac death with post-mortem CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon; Cha, Jang Gyu [Dept. of Radiology, Soonchunhyang University Hospital, Bucheon (Korea, Republic of); Park, Hye Jin; Lee, Soo Kyoung; Yang, Kyung Moo [Dept. of Forensic Medicine, National Forensic Service, Wonju (Korea, Republic of)

    2015-10-15

    We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

  13. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate.

    Science.gov (United States)

    McDonald, Jennifer S; McDonald, Robert J; Carter, Rickey E; Katzberg, Richard W; Kallmes, David F; Williamson, Eric E

    2014-04-01

    To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT). This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m(2). Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of ≥0.5 mg/dL [≥44.2 μmol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test. A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95% confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95% CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95% CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m(2) (n = 1486), OR was 0.97 (95% CI: 0.72, 1.30), P = .89. Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in

  14. Spiral CT and optimization of the modalities of the iodinated intravenous contrast material: Experimental studies in human pathology; Tomodensitometrie spiralee et optimisation des protocoles d'injection du contraste iode intra-veineux: etudes experimentales en pathologie humaine

    Energy Technology Data Exchange (ETDEWEB)

    Bonaldi, V

    1998-06-19

    Spiral (or helical) CT represents the most recent improvement in the field of computed assisted tomography (CAT scan). The capabilities of this new imaging modality are much superior to these of conventional CT scanning; then result from the rapid acquisition and from the volumetric nature of the derived data set. The short time of data acquisition had made mandatory the revision of protocols for intravenous administration of iodinated contrast material. By the means of several studies, carried out on pathologic and healthy patients, we have attempted to improve knowledge in factors influencing CT attenuation values after injection of contrast material, in the aim of improving contrast administration performed during spiral CT scanning. Anatomical landmarks that we have studied till now have been liver, the pancreas, the kidney and the cervical spine. In addition, a paired based methodology has been used. The volumetric set of data derived from spiral CT scanning leads to optimal post-processing tasks, the most interesting being related to cine-display and multiplanar reformatting; both modalities have been evaluated, about the pancreas and the musculo-skeletal system respectively. Conversely, this new modality, as for other imaging modalities, is responsible for additional costs derived from restless increase in the number of images to be dealt with and from the occurrence of new tasks (in post-processing particularly). The place of spiral CT in diagnostic strategies among other modern imaging modalities should be assessed, especially with respect to Magnetic Resonance Imaging (MRI). (author)

  15. Determination of optimal intravenous contrast agent iodine dose for the detection of liver metastasis at 80-kVp CT

    Energy Technology Data Exchange (ETDEWEB)

    Goshima, Satoshi; Kanematsu, Masayuki; Noda, Yoshifumi; Kondo, Hiroshi; Watanabe, Haruo; Kawada, Hiroshi; Kawai, Nobuyuki; Tanahashi, Yukichi [Gifu University Hospital, Department of Radiology, Gifu (Japan); Bae, Kyongtae T. [University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States)

    2014-08-15

    To determine the optimal iodine mass (IM) to achieve a 50-HU increase in hepatic attenuation for the detection of liver metastasis based on total body weight (TBW) or body surface area (BSA) at 80-kVp computed tomography (CT) imaging of the liver. One-hundred and fifty patients who underwent contrast-enhanced CT at 80-kVp were randomised into three groups: 0.5 gI/kg, 0.4 gI/kg and 0.3 gI/kg. Portal venous phase images were evaluated for hepatic parenchymal enhancement (∇HU) and visualisation of liver metastasis. Iodine mass per BSA (gI/m{sup 2}) calculated in individual patients were evaluated. Mean ∇HU for the 0.5 gI/kg group (84.2 HU) was higher than in the 0.4 gI/kg (66.1 HU) and 0.3 gI/kg (53.7 HU) groups (P < 0.001). Linear correlation equations between ∇HU and IM per TBW or BSA are ∇HU = 7.0 + 153.0 x IM/TBW (r = 0.73, P < 0.001) and ∇HU = 11.4 + 4.0 x IM/BSA (r = 0.75, P < 0.001), respectively. The three groups were comparable for the visualisation of hepatic metastases. The iodine mass to achieve a 50-HU increase in hepatic attenuation at 80-kVp CT was estimated to be 0.28 gI/kg of body weight or 9.6 gI/m{sup 2} of body surface area. (orig.)

  16. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Ferreira Vanessa M

    2012-06-01

    Full Text Available Abstract Background T2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR. Methods We investigated 21 controls (55 ± 13 years and 21 patients (61 ± 10 years with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI ratio relative to both skeletal muscle and remote myocardium. Results All patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p  Conclusions Non-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis.

  17. Dual-phase contrast-enhancement multislice computed tomography imaging for the assessment of elderly patients with acute myocardial infarction after primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Shaofeng Guan; Weiyi Fang; Xinkai Qu; Jianding Ye; Yan Shen; Jing Jiao

    2009-01-01

    Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography (MSCT) was implicated in porcine model. There have been few attempts to use this diagnostic modality for the early assessment of coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI), especially after primary percutaneous coronary intervention (PCI). In elderly patients with STEMI, the safety issues remain unknown. Methods Dual phase contrast-enhancement MSCT examinations were performed in 11 elderly patients (≥60 years old) with STEMI within one week after primary PCI. The presence, location and enhancement pattern on MSCT were evaluated. MSCT findings were compared with the catheter angiographic results and area under the curve of creatine kinase (CK) release. Serum creatinine level was recorded before and after MSCT scan. Results MSCT scans were successfully performed in all the patients. Early myocardial perfusion defect (early defect, ED) was detected in all of the 11 patients (100%) in the early phase of the contrast bolus (subendocardial ED in 10 patients and transmural in 1 patient). Mean CT attenuation value of ED was significantly different from CT attenuation value of remote myocardium (46±17 HU vs 104 ± 17 HU; P < 0.01). Location of ED area correlated well with infarction related artery territory on catheter angiography in all of the 11 patients (100%). On delayed phase of MSCT scan, different enhancement patterns were observed: isolated subendocardial late enhancement (LE) in 6 patients, subendocardial residual perfusion defect (RD) and subepicardial LE in 1 patient, subendocardial RD in 4 patients. Infarct volume assessed by MSCT correlated well with area under the curve CK release (R=0.72, P < 0.01). Serum creatinine level after MSCT scan showed no difference with that before MSCT scan. Conclusion Dual phase MSCT could be safely implicated in elderly patients with STEMI. Variable

  18. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation

    Directory of Open Access Journals (Sweden)

    G. J. Pelgrim

    2016-01-01

    Full Text Available Technological advances in magnetic resonance imaging (MRI and computed tomography (CT, including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET. This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD, as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.

  19. Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain.

    Science.gov (United States)

    Ham, Hyungjoo; McInnes, Matthew D F; Woo, Michael; Lemonde, Sylvie

    2012-01-01

    The purpose of this study is to calculate the negative predictive value (NPV) CT of the abdomen in patients presenting to the emergency department (ED) with undifferentiated upper abdominal pain. Approved by the hospital research ethics board, this retrospective study examined consecutive patients presenting to the ED with undifferentiated upper abdominal pain whose intravenous contrast-enhanced CT of the abdomen was reported as "normal" from June 2006-August 2010. Exclusion criteria included active malignancy, trauma, and known inflammatory bowel disease. True-negative (TN) vs. false-negative (FN) cases were categorized by consensus opinion of radiologist and emergency physician using a composite reference standard including clinical, laboratory, imaging, surgery, pathology, and patient self-reporting via phone questionnaire. The NPV was calculated with confidence intervals of 95%. The TN and FN groups were compared based on gender, age, site of pain, oral contrast use, and laboratory values. One hundred twenty-seven patients were included for analysis. The NPV was 64% (95% CI 55-72). The FN group had a higher proportion of patients with epigastric pain (p = 0.02) and a lower proportion of patients with left upper quadrant pain (p = 0.02). The WBC, lipase, and ALT were all higher in the FN group compared with the TN group. The most commonly missed pathologies were inflammatory conditions of the biliary tract and upper gastrointestinal systems. The NPV of CT for evaluation of undifferentiated upper abdominal pain in the ED was low at 64%. Physicians should consider this limitation and the commonly missed pathology when discharging patients with a "normal" CT report.

  20. Morphine Does Not Affect Myocardial Salvage in ST-Segment Elevation Myocardial Infarction

    Science.gov (United States)

    Song, Young Bin; Kim, Eun Kyoung; Jang, Woo Jin; Yang, Jeong Hoon; Hahn, Joo-Yong; Choi, Seung-Hyuk; Choi, Jin-Ho; Lee, Sang Hoon; Choe, Yeon Hyeon; Ahn, Joonghyun; Carriere, Keumhee Chough; Gwon, Hyeon-Cheol

    2017-01-01

    Recent studies have proposed intravenous (IV) morphine is associated with delayed action of antiplatelet agents in acute myocardial infarction. However, it is unknown whether morphine results in increased myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated myocardial salvage index (MSI) to determine whether IV morphine affects myocardial injury adversely in STEMI patients undergoing primary PCI. 299 STEMI patients underwent contrast-enhanced magnetic resonance imaging a median of 3 days after PCI. Infarct size was measured on delayed-enhancement imaging, and area at risk was quantified on T2-weighted imaging. MSI was calculated as ‘[area at risk–infarct size] X 100 / area at risk’. IV morphine was administrated in 32.1% of patients. Patients treated with morphine had shorter symptom to balloon time and higher prevalence of Thrombolysis in Myocardial Infarction flow grade 0 or 1. The morphine group showed a trend toward larger MSI and infarct size and significantly greater area at risk than the non-morphine group. After propensity score matching (90 pairs), MSI was similar between the morphine and non-morphine group (46.1% versus 43.5%, P = .11), and infarct size and area at risk showed no difference. In propensity score-matched analysis, IV morphine prior to primary PCI in STEMI patients did not cause adverse impacts on myocardial salvage. PMID:28081269

  1. 静脉使用美托洛尔治疗急性前壁心肌梗死的近期疗效%The short-term clinical efficacy of intravenous metopmlol on patients with acute anterior myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    张丽媛; 贾志; 郭牧; 张云强; 王群; 宋昱

    2012-01-01

      Objective To observe the short-term clinical efficacy and safety of intravenous metoprolol on patients with acute anterior myocardial infarction. Methods 362 patients suffered from acute anterior myocardial infarction were randomly divided into two groups: intravenous group(n=179) and oral group(n=183). All patients were given conventional treatment, patients in intravenous group were injected metoprolol intravenously at doses of 5-15mg and then treated with oral metoprolol, patients in oral group were treated with oral metoprolol. The clinical effectiveness including the incidence of adverse cardiac events during 7 days and 3 months follow-up and cardiac ultrasound data at one month were compared between the two groups. Results Compared with oral group, the malignant arrhythmia(14.0% Vs. 25.7%, P<0.01) and major adverse cardiac events(MACE) (10.1% Vs 18.0%, P<0.05) in intravenous group were decreased markedly. During 1 month follow-up period, left ventricular ejection fraction(LVEF)in both group all increase gradually, and the LVEF improvement in intravenous group was more remarkable at 7 days and three months [(55.70±5.92)% Vs (53.18±8.06)%, P<0.01, (58.74±6.32)% Vs (56.38± 8.24]%, P<0.01]. Conclusion The injection of metoprolol can effectively improve the short-term clinical effect without increasing heart failure in haemodynamically stable patients with acute anterior myocardial infarction.%  目的观察静脉使用美托洛尔治疗急性前壁心肌梗死患者的近期临床疗效和安全性.方法入选362例急性前壁心肌梗死患者,随机分为静脉组(179例)和口服组(183例),静脉组静脉注射酒石酸美托洛尔,继之口服;口服组直接给予口服制剂.比较两组患者住院7d及3个月心脏不良事件和1个月心脏超声资料.结果与口服组比较,静脉组住院7d严重心律失常(14.0%Vs 25.7%,P<0.01)及主要心脏不良事件(MACE)(10.1%Vs 18.0%,P<0.05)减少.1个月随访,两组左室

  2. Assessment of the ability of myocardial contrast echocardiography with harmonic power Doppler imaging to identify perfusion abnormalities in patients with Kawasaki disease at rest and during dipyridamole stress.

    Science.gov (United States)

    Ishii, M; Himeno, W; Sawa, M; Iemura, M; Furui, J; Muta, H; Sugahara, Y; Egami, K; Akagi, T; Ishibashi, M; Kato, H

    2002-01-01

    The aim of our study was to assess the ability of myocardial contrast echocardiography (MCE) with harmonic power Doppler imaging (HPDI) to identify perfusion abnormalities in patients with Kawasaki disease at rest and during pharmacological stress imaging with dipyridamole. Results were compared with those of 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) imaging as the clinical reference standard. MCE with HPDI was performed on 20 patients with a history of Kawasaki disease. Images were obtained at baseline and during dipyridamole infusion (0.56 mg x kg(-1)) in the apical two- and four-chamber views. Myocardial opacification suitable for the analysis was obtained in all patients. Nine patients with stenotic lesions had a reversible defect after dipyridamole infusion detected by both MCE with HPDI and SPECT, and 3 patients with a history of myocardial infarction had a partially or completely irreversible defect detected by both methods. Three patients with coronary aneurysm without stenotic lesion, 4 patients with regressed coronary aneurysm, and 2 patients with normal coronary artery in acute phase also had normal perfusion at rest and after pharmacological stress by both methods. A 96% concordance (kappa = 0.87) was obtained when comparing the respective segmental perfusion scores using the two methods at baseline, and an 86% concordance (kappa = 0.81) was obtained at postdipyridamole infusion. After combining baseline and postdipyridamole images, each segment was labeled as having normal perfusion, irreversible defects, or reversible defects. Using these classifications, concordance for the two methods was 92% (kappa = 0.87). MCE with HPDI is a safe and feasible method by which to detect asymptomatic ischemia due to severe stenotic lesion, and it may be an important addition to the modalities used to identify patients at risk for myocardial infarction as a complication of Kawasaki disease.

  3. 胺碘酮对急性心肌梗死并发室性心动过速的治疗分析%Clinical analysis on intravenous Amiodarone for continuous ventricular tachycardia in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    阎晋华; 齐守罡

    2012-01-01

      目的观察静脉注射胺碘酮治疗急性心肌梗死并发室性心动过速的疗效。方法将30例急性心肌梗死患者分为2组,每组15例,分别给予静脉注射利多卡因、胺碘酮治疗,观察2组临床疗效。结果胺碘酮组15例患者中,13例患者室性心动过速得到控制,对照组有8例患者室性心动过速得到控制,胺碘酮组有效率高于对照组。结论静脉注射胺碘酮治疗急性心肌梗死并发室性心动过速安全有效,可提高急性心肌梗死的抢救成功率。%  Objective To investigate the effect of amiodarone to continuous ventricular tachycardia in patients with acute myocardial infarction.Methods 30 cases of acute myocardial infarction patients were divided into 2 groups, 15 cases in each group, were given intravenous lidocaine, amiodarone treatment, observation of clinical curative effect of 2 sets.Results Among 15 cases in the observation group, 13 patients with ventricular tachycardia were under control, in the control group, 8 patients with ventricular tachycardia got controlled heartbeat, amiodarone group was higher than that of control group.Conclusion Intravenous amiodarone is more effective and safer than lidocaine in treating continuous ventricular tachycardia in patients with AMI.

  4. Hemodynamic Changes on Color Doppler Flow Imaging and Intravenous Contrast-enhanced Ultrasound for Assessing Transplanted Liver and Early Diagnosis of Complications

    Institute of Scientific and Technical Information of China (English)

    Daozhong HUANG; Yanchao CHEN; Kaiyan LI; Qingping ZHANG

    2008-01-01

    The value of color Doppler flow imaging (CDFI) and intravenous contrast-enhanced ultrasound (CEUS) for assessing the transplanted liver and early diagnosing complications by examining hemodynamic changes was discussed. Seventy-five patients with orthotopic liver transplantation (OLT) underwent CDFI. The following parameters were measured: peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV) and velocity of hepatic vein (HV) in different stages post-operation. And 11 patients of them received CEUS. Thirty healthy subjects were enrolled as controls. The results showed that: (1) In 23 patients without obvious complications, TAV of PV within 15 days post-operation was significantly higher than in controls (P<0.05), PS and DPI of HA within 7 days postoperation were lower, but RI was higher than in controls (P<0.05); (2) When the hepatic artery thrombosis (HAT) occurred, PS and DPI of HA were obviously decreased, but TAV of PV significantly increased like a high saw-tooth wave; (3) While rejection occurred, both TAV of PV and PS of HA were decreased with the increase in RI of HA, and the triphasic wave of HV disappeared and displayed as saw-tooth wave; (4) The incidence of biliary complications in liver transplantation was in-creased when DPI was reduced; (5) Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on CEUS; (6) In 2 cases of HA thrombus, there was no visualized enhancement in arterial phase of CEUS, but enhancement during the portal vein and parenchymal phase. It was concluded that the hemodynamic changes of PV, HA and HV in the transplanted liver are valuable for assessing the transplanted liver and early diagnosing complications on CDFI and CEUS.

  5. Usage of the T{sub 1} effect of an iron oxide contrast agent in an animal model to quantify myocardial blood flow by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Luedemann, Lutz [Department of Radiology and Nuclear Medicine Charite-Universitaetmedizin Berlin, Campus Virchow-Klinikum (Germany)]. E-mail: lutz.luedemann@charite.de; Schmitt, Boris [Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin (Germany); Podrabsky, Petr [Department of Radiology and Nuclear Medicine Charite-Universitaetmedizin Berlin, Campus Virchow-Klinikum (Germany); Schnackenburg, Bernhard [Philips Medical Systems, Hamburg (Germany); Boeck, Johannes [Department of Radiology and Nuclear Medicine Charite-Universitaetmedizin Berlin, Campus Virchow-Klinikum (Germany); Gutberlet, Matthias [Department of Radiology and Nuclear Medicine Charite-Universitaetmedizin Berlin, Campus Virchow-Klinikum (Germany)

    2007-05-15

    Background: To present a new method for fully quantitative analysis of myocardial blood flow (MBF) using magnetic resonance imaging. The first pass of an intravascular iron oxide contrast medium can be used to quantify myocardial perfusion. The technique was validated in an animal model using colored microspheres. Materials and methods: In six pigs, a tracking catheter was positioned in the left anterior descending artery (LAD). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed on a 1.5-T scanner using a hybrid gradient-echo/echoplanar imaging (GRE-EPI) sequence. Regional myocardial blood flow (rMBF) was altered by either inducing vasodilatation with adenosine or creating coronary artery obstruction. The T{sub 1} effect of a superparamagnetic iron oxide-based contrast medium (Resovist[reg]) administered at a dose of 8 {mu}mol/kg was used. Upslope, time-to-peak and peak intensity were calculated from the signal intensity-time curves and absolute rMBF using the Kety-Schmidt equation; results were compared to those obtained using colored microspheres. Results: The mean rMBF calculated by MRI was 1.49 ({+-}6.91, quartile width) ml/min/g versus 3.21 ({+-}1.61) ml/min/g measured by means of microspheres under resting conditions. rMBF increased to a mean of 6.21 ({+-}2.83) ml/min/g versus 4.22 ({+-}1.70) ml/min/g under adenosine and was reduced to zero flow in total occlusion. Linear regression showed the best correlation for upslope (R = 0.714), time-to-peak (R = 0.626) and the Kety-Schmidt equation (R = 0.584). Conclusions: The T{sub 1} effect of an iron oxide-based contrast medium allows determination of rMBF when using the Kety-Schmidt equation. The results are similar to those obtained with the standard of reference, colored micropheres, but not better than the results of the semiquantitative approach.

  6. Clinical study of emergency ICU intravenous thrombolysis in patients with acute myocardial infarction%急性心肌梗死急诊ICU静脉溶栓的临床研究

    Institute of Scientific and Technical Information of China (English)

    阿布力孜•阿布都吉力力

    2016-01-01

    Objective:To investigate the timing, methods and effects of emergency ICU intravenous thrombolysis in acute myocardial infarction.Methods:50 patients with acute myocardial infarction were selected.They were divided into two groups,25 cases in each.Emergency intensive care treatment as the observation group,department of cardiology ward treatment for the control group.Two groups were treated with thrombolytic therapy,but the treatment time was different.Therapeutic effect was observed.Results:The observation group visits to the thrombolytic treatment time,recanalization rate and mortality within four weeks were better than the control group(P<0.05).Conclusion:Emergency care for patients with acute myocardial infarction in patients with thrombolytic therapy can improve the treatment effect,ensure the safety of patients.%目的:探讨急性心肌梗死急诊ICU静脉溶栓的治疗时机、方法及其效果。方法:收治急性心肌梗死患者50例,分两组,各25例,急诊重症监护室内治疗为观察组,心内科病房内治疗为对照组,两组均接受溶栓治疗,但治疗时机不同。观察治疗效果。结果:观察组就诊到溶栓治疗的时间、血栓再通率及4周内死亡率均优于对照组(P<0.05)。结论:急诊监护室内对急性心肌梗死患者行溶栓治疗能够提高治疗效果,保障患者的生命安全。

  7. Short- and Long-term Therapeutic Efficacies of Intravenous Transplantation of Bone Marrow Stem Cells on Cardiac Function in Rats with Acute Myocardial Infarction:A Meta-analysis of Randomized Controlled Trials

    Institute of Scientific and Technical Information of China (English)

    Can Jiang; Dong Zheng; Yun-lu Feng; Jun Guo; Hai-rui Li; Ai-dong Zhang

    2016-01-01

    Objective To investigate the short- and long-term therapeutic efficacies of intravenous trans- plantation of bone marrow stem cells (MSCs) in rats with experimental myocardial infarction by meta- analysis. Methods Randomized controlled trials were systematically searched from PubMed, Science Citation Index (SCI), Chinese journal full-text database (CJFD) up to December 2014. While the experimental groups (MSCs groups) were injected MSCs intravenously, the control groups were injected Delubecco’s minimum essential medium (DMEM) or phosphate buffered saline (PBS).Subgroup analysis for each outcome measure was performed for the observing time point after the transplantation of MSCs. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated for outcome parameters including ejection fraction (EF) and fractional shortening (FS), which were measured by echocardiogram after intravenous injection and analyzed by RevMan 5.2 and STATA 12.0. Results Data from 9 studies (190 rats)were included in the meta-analysis. As compared to the control groups, the cardiac function of the experimental groups were not improved at day 7 (EF: WMD=0.08, 95%CI−1.32 to 1.16,P>0.01; FS: WMD=−0.12, 95%CI−0.90 to 0.65,P>0.01) until at day 14 after MSCs’ transplantation (EF: WMD=10.79, 95%CI 9.16 to 12.42,P<0.01; FS: WMD=11.34, 95%CI 10.44 to 12.23, P<0.01), and it lasted 4 weeks or more after transplantation of MSCs (EF: WMD=13.94, 95%CI 12.24 to 15.64,P<0.01; FS: WMD=9.64, 95%CI 7.98 to 11.31,P<0.01). Conclusion The therapeutic efficacies of MSCs in rats with myocardid infarction become increasing apparent as time advances since 2 weeks after injection.

  8. Classification of myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Hosbond, Susanne Elisabeth

    2013-01-01

    The classification of myocardial infarction into 5 types was introduced in 2007 as an important component of the universal definition. In contrast to the plaque rupture-related type 1 myocardial infarction, type 2 myocardial infarction is considered to be caused by an imbalance between demand...... and supply of oxygen in the myocardium. However, no specific criteria for type 2 myocardial infarction have been established....

  9. Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging.

    Science.gov (United States)

    Lee, Hye-Jeong; Im, Dong Jin; Youn, Jong-Chan; Chang, Suyon; Suh, Young Joo; Hong, Yoo Jin; Kim, Young Jin; Hur, Jin; Choi, Byoung Wook

    2016-07-01

    Purpose To evaluate the feasibility of equilibrium contrast material-enhanced dual-energy cardiac computed tomography (CT) to determine extracellular volume fraction (ECV) in nonischemic cardiomyopathy (CMP) compared with magnetic resonance (MR) imaging. Materials and Methods This study was approved by the institutional review board; informed consent was obtained. Seven healthy subjects and 23 patients (six with hypertrophic CMP, nine with dilated CMP, four with amyloidosis, and four with sarcoidosis) (mean age ± standard deviation, 57.33 years ± 14.82; 19 male participants [63.3%]) were prospectively enrolled. Twelve minutes after contrast material injection (1.8 mL/kg at 3 mL/sec), dual-energy cardiac CT was performed. ECV was measured by two observers independently. Hematocrit levels were compared between healthy subjects and patients with the Mann-Whitney U test. In per-subject analysis, interobserver agreement for CT was assessed with the intraclass correlation coefficient (ICC), and intertest agreement between MR imaging and CT was assessed with Bland-Altman analysis. In per-segment analysis, Student t tests in the linear mixed model were used to compare ECV on CT images between healthy subjects and patients. Results Hematocrit level was 43.44% ± 1.80 for healthy subjects and 41.23% ± 5.61 for patients with MR imaging (P = .16) and 43.50% ± 1.92 for healthy subjects and 41.35% ± 5.92 for patients with CT (P = .15). For observer 1 in per-subject analysis, ECV was 34.18% ± 8.98 for MR imaging and 34.48% ± 8.97 for CT. For observer 2, myocardial ECV was 34.42% ± 9.03 for MR imaging and 33.98% ± 9.05 for CT. Interobserver agreement for ECV at CT was excellent (ICC = 0.987). Bland-Altman analysis between MR imaging and CT showed a small bias (-0.06%), with 95% limits of agreement of -1.19 and 1.79. Compared with healthy subjects, patients with hypertrophic CMP, dilated CMP, amyloidosis, and sarcoidosis had significantly higher myocardial ECV at dual

  10. Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection -- Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS?

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Ostergaard, Mikkel; Conaghan, Philip G;

    2009-01-01

    OBJECTIVE: Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) provides highly sensitive assessment of inflammatory and destructive changes in rheumatoid arthritis (RA) joints, but intravenous (IV) Gd injection prolongs examination time and increases cost, invasiveness, and patient discomfo......: Omitting IV contrast injection did not change scores of bone erosions and bone edema, but decreased the reliability of synovitis scores. However, this disadvantage may for some purposes be outweighed by the possibility to assess more joints and/or greater feasibility....

  11. Low-dose dynamic myocardial perfusion CT image reconstruction using pre-contrast normal-dose CT scan induced structure tensor total variation regularization

    Science.gov (United States)

    Gong, Changfei; Han, Ce; Gan, Guanghui; Deng, Zhenxiang; Zhou, Yongqiang; Yi, Jinling; Zheng, Xiaomin; Xie, Congying; Jin, Xiance

    2017-04-01

    Dynamic myocardial perfusion CT (DMP-CT) imaging provides quantitative functional information for diagnosis and risk stratification of coronary artery disease by calculating myocardial perfusion hemodynamic parameter (MPHP) maps. However, the level of radiation delivered by dynamic sequential scan protocol can be potentially high. The purpose of this work is to develop a pre-contrast normal-dose scan induced structure tensor total variation regularization based on the penalized weighted least-squares (PWLS) criteria to improve the image quality of DMP-CT with a low-mAs CT acquisition. For simplicity, the present approach was termed as ‘PWLS-ndiSTV’. Specifically, the ndiSTV regularization takes into account the spatial-temporal structure information of DMP-CT data and further exploits the higher order derivatives of the objective images to enhance denoising performance. Subsequently, an effective optimization algorithm based on the split-Bregman approach was adopted to minimize the associative objective function. Evaluations with modified dynamic XCAT phantom and preclinical porcine datasets have demonstrated that the proposed PWLS-ndiSTV approach can achieve promising gains over other existing approaches in terms of noise-induced artifacts mitigation, edge details preservation, and accurate MPHP maps calculation.

  12. Optimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms?

    Science.gov (United States)

    Gölitz, Philipp; Struffert, Tobias; Ganslandt, Oliver; Saake, Marc; Lücking, Hannes; Rösch, Julie; Knossalla, Frauke; Doerfler, Arnd

    2012-07-01

    The purpose of this study was to evaluate the diagnostic accuracy of an optimized angiographic CT (ACT) program with intravenous contrast agent injection (ivACT) in the assessment of potential aneurysm remnants after neurosurgical clipping compared with conventional digital subtraction angiography (DSA). The authors report on 14 patients with 19 surgically clipped cerebral aneurysms who were scheduled to undergo angiographic follow-up. For each patient, the authors performed ivACT with dual rotational acquisition and conventional angiography including a 3D rotational run. The ivACT and 3D DSA data were reconstructed with different imaging modes, including a newly implemented subtraction mode with motion correction. Thereafter, the data sets were merged by the dual-volume technique, and freely rotatable 3D images were obtained for further analysis. Observed aneurysm remnants were electronically measured and classified for each modality by 2 experienced neuroradiologists. Digital subtraction angiography and ivACT both provided high-quality images without motion artifacts. Artifact disturbances from the aneurysm clips led to a compromised, but still sufficient, image quality in 1 case. The ivACT assessed all aneurysm remnants as true-positive up to a minimal size of 2.6×2.4 mm in accordance with the DSA findings. There was a tendency for ivACT to overestimate the size of the aneurysm remnants. All cases without aneurysm remnants on DSA were scored correctly as true-negative by ivACT. By using an optimized image acquisition protocol as well as enhanced postprocessing algorithms, the noninvasive ivACT seems to achieve results comparable to those of conventional angiography in the follow-up of clipped cerebral aneurysms. The authors have shown that ivACT can provide reliable diagnostic information about potential aneurysm remnants after neurosurgical clipping with high sensitivity and specificity, sufficient for clinical decision making, at least for aneurysms in the

  13. The myocardial ischemia evaluated by real-time contrast echocardiography may predict the response to cardiac resynchronization therapy: a large animal study.

    Directory of Open Access Journals (Sweden)

    Yongle Chen

    Full Text Available Evidence-based criteria for applying cardiac resynchronization therapy (CRT in patients with ischemic cardiomyopathy are still scarce. The aim of the present study was to evaluate the predictive value of real-time myocardial contrast echocardiography (RT-MCE in a preclinical canine model of ischemic cardiomyopathy who received CRT. Ischemic cardiomyopathy was produced by ligating the first diagonal branch in 20 beagles. Dogs were subsequently divided into two groups that were either treated with bi-ventricular pacing (CRT group or left untreated (control group. RT-MCE was performed at baseline, before CRT, and 4 weeks after CRT. Two-dimensional speckle tracking imaging was used to evaluate the standard deviation of circumferential (Cir12SD, radial (R12SD, and longitudinal (L12SD strains of left ventricular segments at basal as well as middle levels. Four weeks later, the Cir12SD, R12SD, and myocardial blood flow (MBF of the treated group were significantly improved compared to their non-CRT counterparts. Furthermore, MBF values measured before CRT were significantly higher in responders than in non-responders to bi-ventricular pacing. Meanwhile, no significant differences were observed between the responder and non-responder groups in terms of Cir12SD, R12SD, and L12SD. A high degree of correlation was found between MBF values before CRT and LVEF after CRT. When MBF value>24.9 dB/s was defined as a cut-off point before CRT, the sensitivity and specificity of RT-MCE in predicting the response to CRT were 83.3% and 100%, respectively. Besides, MBF values increased significantly in the CRT group compared with the control group after 4 weeks of pacing (49.8±15.5 dB/s vs. 28.5±4.6 dB/s, p<0.05. Therefore, we considered that myocardial perfusion may be superior to standard metrics of LV synchrony in selecting appropriate candidates for CRT. In addition, CRT can improve myocardial perfusion in addition to cardiac synchrony, especially in the setting

  14. Intracoronary Versus Intravenous Administration of Abciximab in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention With Thrombus Aspiration The Comparison of Intracoronary Versus Intravenous Abciximab Administration During Emergency Reperfusion of ST-Segment Elevation Myocardial Infarction (CICERO) Trial

    NARCIS (Netherlands)

    Gu, Youlan L.; Kampinga, Marthe A.; Wieringa, Wouter G.; Fokkema, Marieke L.; Nijsten, Maarten W.; Hillege, Hans L.; van den Heuvel, Ad F. M.; Tan, Eng-Shiong; Pundziute, Gabija; van der Werf, Rik; Guyomi, Siyrous Hoseyni; van der Horst, Iwan C. C.; Zijlstra, Felix; de Smet, Bart J. G. L.

    2010-01-01

    Background-Administration of the glycoprotein IIb/IIIa inhibitor abciximab is an effective adjunctive treatment strategy during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Although small-scale studies have suggested beneficial effects of intracoronary

  15. Comparison of infarct size changes with delayed contrast-enhanced magnetic resonance imaging and electrocardiogram QRS scoring during the 6 months after acutely reperfused myocardial infarction

    DEFF Research Database (Denmark)

    Bang, L.E.; Ripa, R.S.; Grande, P.

    2008-01-01

    that has infarcted. There are no comparison of serial changes on ECG and DE-MRI measuring infarct size. AIM: The general aim of this study was to describe the acute, healing, and chronic phases of the changes in infarct size estimated by the ECG and DE-MRI. The specific aim was to compare estimates......INTRODUCTION: Magnetic resonance imaging using the delayed contrast-enhanced (DE-MRI) method can be used for characterizing and quantifying myocardial infarction (MI). Electrocardiogram (ECG) score after the acute phase of MI can be used to estimate the portion of left ventricular myocardium...... of the Selvester QRS scoring system and DE-MRI to identify the difference between the extent of left ventricle occupied by infarction in the acute and chronic phases. METHODS: In 31 patients (26 men, age 56 +/- 9) with reperfused ST-elevation MI (11 anterior, 20 inferior), standard 12-lead ECG and DE-MRI were...

  16. Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction

    Science.gov (United States)

    Ahmed, Nadeem; Layland, Jamie; Carrick, David; Petrie, Mark C.; McEntegart, Margaret; Eteiba, Hany; Hood, Stuart; Lindsay, Mitchell; Watkins, Stuart; Davie, Andrew; Mahrous, Ahmed; Carberry, Jaclyn; Teng, Vannesa; McConnachie, Alex; Curzen, Nick; Oldroyd, Keith G.; Berry, Colin

    2016-01-01

    Aims Coronary guidewire-based diagnostic assessments with hyperemia may cause iatrogenic complications. We assessed the safety of guidewire-based measurement of coronary physiology, using intravenous adenosine, in patients with an acute coronary syndrome. Methods We prospectively enrolled invasively managed STEMI and NSTEMI patients in two simultaneously conducted studies in 6 centers (NCT01764334; NCT02072850). All of the participants underwent a diagnostic coronary guidewire study using intravenous adenosine (140 μg/kg/min) infusion for 1–2 min. The patients were prospectively assessed for the occurrence of serious adverse events (SAEs) and symptoms and invasively measured hemodynamics were also recorded. Results 648 patients (n = 298 STEMI patients in 1 hospital; mean time to reperfusion 253 min; n = 350 NSTEMI in 6 hospitals; median time to angiography from index chest pain episode 3 (2, 5) days) were included between March 2011 and May 2013. Two NSTEMI patients (0.3% overall) experienced a coronary dissection related to the guidewire. No guidewire dissections occurred in the STEMI patients. Chest symptoms were reported in the majority (86%) of patient's symptoms during the adenosine infusion. No serious adverse events occurred during infusion of adenosine and all of the symptoms resolved after the infusion ceased. Conclusions In this multicenter analysis, guidewire-based measurement of FFR and IMR using intravenous adenosine was safe in patients following STEMI or NSTEMI. Self-limiting symptoms were common but not associated with serious adverse events. Finally, coronary dissection in STEMI and NSTEMI patients was noted to be a rare phenomenon. PMID:26418191

  17. Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction.

    Science.gov (United States)

    Ahmed, Nadeem; Layland, Jamie; Carrick, David; Petrie, Mark C; McEntegart, Margaret; Eteiba, Hany; Hood, Stuart; Lindsay, Mitchell; Watkins, Stuart; Davie, Andrew; Mahrous, Ahmed; Carberry, Jaclyn; Teng, Vannesa; McConnachie, Alex; Curzen, Nick; Oldroyd, Keith G; Berry, Colin

    2016-01-01

    Coronary guidewire-based diagnostic assessments with hyperemia may cause iatrogenic complications. We assessed the safety of guidewire-based measurement of coronary physiology, using intravenous adenosine, in patients with an acute coronary syndrome. We prospectively enrolled invasively managed STEMI and NSTEMI patients in two simultaneously conducted studies in 6 centers (NCT01764334; NCT02072850). All of the participants underwent a diagnostic coronary guidewire study using intravenous adenosine (140 μg/kg/min) infusion for 1-2 min. The patients were prospectively assessed for the occurrence of serious adverse events (SAEs) and symptoms and invasively measured hemodynamics were also recorded. 648 patients (n=298 STEMI patients in 1 hospital; mean time to reperfusion 253 min; n=350 NSTEMI in 6 hospitals; median time to angiography from index chest pain episode 3 (2, 5) days) were included between March 2011 and May 2013. Two NSTEMI patients (0.3% overall) experienced a coronary dissection related to the guidewire. No guidewire dissections occurred in the STEMI patients. Chest symptoms were reported in the majority (86%) of patient's symptoms during the adenosine infusion. No serious adverse events occurred during infusion of adenosine and all of the symptoms resolved after the infusion ceased. In this multicenter analysis, guidewire-based measurement of FFR and IMR using intravenous adenosine was safe in patients following STEMI or NSTEMI. Self-limiting symptoms were common but not associated with serious adverse events. Finally, coronary dissection in STEMI and NSTEMI patients was noted to be a rare phenomenon. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. Relationship between myocardial extracellular space expansion estimated with post-contrast T1 mapping MRI and left ventricular remodeling and neurohormonal activation in patients with dilated cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Ji Hyun; Son, Jung Woo; Chung, Hye Moon [Cardiology Division, Dept. of Internal Medicine, Yonsei University College of Medicine, Seoul (Korea, Republic of); and others

    2015-10-15

    Post-contrast T1 values are closely related to the degree of myocardial extracellular space expansion. We determined the relationship between post-contrast T1 values and left ventricular (LV) diastolic function, LV remodeling, and neurohormonal activation in patients with dilated cardiomyopathy (DCM). Fifty-nine patients with DCM (mean age, 55 ± 15 years; 41 males and 18 females) who underwent both 1.5T magnetic resonance imaging and echocardiography were enrolled. The post-contrast 10-minute T1 value was generated from inversion time scout images obtained using the Look-Locker inversion recovery sequence and a curve-fitting algorithm. The T1 sample volume was obtained from three interventricular septal points, and the mean T1 value was used for analysis. The N-Terminal pro-B-type natriuretic peptide (NT-proBNP) level was measured in 40 patients. The mean LV ejection fraction was 24 ± 9% and the post-T1 value was 254.5 ± 46.4 ms. The post-contrast T1 value was significantly correlated with systolic longitudinal septal velocity (s'), peak late diastolic velocity of the mitral annulus (a'), the diastolic elastance index (Ed, [E/e']/stroke volume), LV mass/volume ratio, LV end-diastolic wall stress, and LV end-systolic wall stress. In a multivariate analysis without NT-proBNP, T1 values were independently correlated with Ed (β = -0.351, p = 0.016) and the LV mass/volume ratio (β = 0.495, p = 0.001). When NT-proBNP was used in the analysis, NT-proBNP was independently correlated with the T1 values (β = -0.339, p = 0.017). Post-contrast T1 is closely related to LV remodeling, diastolic function, and neurohormonal activation in patients with DCM.

  19. 替罗非班治疗急性心肌梗死的疗效和安全性观察%Efficiency and safety for intravenously administration of urokinase and tirofiban in treating acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    干志红; 苟华良; 孙向阳

    2012-01-01

    目的 观察替罗非班治疗急性心肌梗死(AMI)与尿激酶静脉溶栓合用的安全性及疗效.方法 对122例AMI患者随机分为治疗组60例,对照组62例.两组患者均给予静脉溶栓、硝酸甘油、培哚普利/或氯沙坦、美托洛尔、拜阿司匹林、氯吡格雷、阿托伐他汀钙、依诺肝素等作为基础治疗.治疗组在溶栓后静脉泵入替罗非班,先0.4μg/(kg·min)× 30min,后0.15μg/(kg·min).观察梗死血管再通、出血并发症、主要心脏不良事件(MACE).结果 梗死血管再通率治疗组比对照组显著提高,P<0.05,差异有统计学意义.出血并发症两组无统计学意义,P>0.05.MACE治疗组比对照组显著降低,差异有统计学意义(P<0.05).结论 替罗非班在治疗AMI与尿激酶静脉溶栓合用是安全有效的.%To assess the efficiency and safety for intravenously administration of urokinase and tirofiban for the treatment of acute myocardial infarction. Methods 122 patients with acute myocardial infarction were randomly divided into two groups. 60 were in tirofiban group and 62 in basic therapy group. Patients in both groups took intravenous thrombolysis together with nitroglycerine, perindopril or losartan, metoprolol, aspirin, clopidogrel, atorvastatin calcium, enoxaparin etc. as basic medication. For patients in tirofiban group, tirofiban was additionally administrated by intravenous micro-pump with 0.4μg/(kg·min) for 30 minutes and 0.15μg/(kg·min) for maintenance after thrombolysis. Development of infarction related artery refu-sion, hemorrhage and major adverse cardiac events were observed and recorded. Results The infarction related artery refusion rate in tirofiban group was significantly higher than basic therapy group (P>0.05). There was no major difference in the incidence of hemorrhage between two groups (P<0.05). The development of major adverse cardiac events was significantly lower in tirofiban group than basic therapy group (P <0

  20. Pooled Analysis Comparing the Efficacy of Intracoronary Versus Intravenous Abciximab in Smokers Versus Nonsmokers Undergoing Primary Percutaneous Coronary Revascularization for Acute ST-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Galasso, Gennaro; Eitel, Ingo

    2016-01-01

    Cigarette smokers with ST-segment elevation myocardial infarction (STEMI) may present different response to potent antithrombotic therapy compared to nonsmokers. We assessed the impact of smoking status and intracoronary abciximab in patients with STEMI undergoing primary percutaneous coronary.......001), with no difference in nonsmokers (HR 1.20, 95% CI 0.71 to 2.01, p = 0.50). Stent thrombosis was lowered by intracoronary abciximab in smokers (HR 0.28, 95% CI 0.06 to 0.66, p = 0.009), but was ineffective in nonsmokers (HR 1.04, 95% CI 0.54 to 2.00, p = 0.903). Interaction testing showed heterogeneity in treatment...... effect for reinfarction (p = 0.002) and stent thrombosis (p = 0.018) according to smoking status. In conclusion, among patients with STEMI undergoing primary PCI, smoking status did not affect the adjusted risk of clinical events. Intracoronary abciximab bolus improved clinical outcomes by reducing...

  1. Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99m sestamibi myocardial tomographic imaging in predicting coronary events.

    Science.gov (United States)

    McClellan, J R; Travin, M I; Herman, S D; Baron, J I; Golub, R J; Gallagher, J J; Waters, D; Heller, G V

    1997-03-01

    Left ventricular (LV) cavity dilation during stress myocardial perfusion imaging has been associated with multivessel disease, and may be an independent prognostic marker in addition to perfusion defects. The present study examines the predictive value for future cardiac events of transient or fixed LV dilation during dipyridamole technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) imaging. The study included 512 consecutive patients who underwent SPECT imaging with Tc-99m sestamibi after dipyridamole infusion. Transient LV dilation was seen in 70 patients (14%) and 74 had fixed cavity dilation (14%); cavity size was normal in 368 patients (72%). Each perfusion scan was classified as normal or abnormal, and if abnormal, defects were categorized as transient or fixed, and as small, medium, or large (depending upon the number of abnormal vascular territories). Events during a mean follow-up of 12.8 +/- 6.8 months were tabulated by direct review of hospital charts and death certificates. The cardiac event rate (cardiac death or nonfatal infarction) was 1.9% in patients with normal cavity size, 11.4% with transient LV dilation, and 13.5% with fixed LV dilation (p < 0.01). Compared with patients with normal cavity size, those with transient LV dilation were more likely to sustain a myocardial infarction (p < 0.01) and those with fixed dilation more frequently suffered cardiac death (p < 0.01) and hospitalization for heart failure (p < 0.01). The group with the highest risk had both a large perfusion defect and cavity dilation. By Cox proportional hazard regression analysis, both transient and fixed LV dilation were strong independent predictors of cardiac events. Transient or fixed LV dilation are commonly seen during dipyridamole Tc-99m sestamibi SPECT imaging (14% incidence for each) and are useful predictors of cardiac events.

  2. Intravenous glial growth factor 2 (GGF2 isoform of neuregulin-1β improves left ventricular function, gene and protein expression in rats after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Michael F Hill

    Full Text Available AIMS: Recombinant Neuregulin (NRG-1β has multiple beneficial effects on cardiac myocytes in culture, and has potential as a clinical therapy for heart failure (HF. A number of factors may influence the effect of NRG-1β on cardiac function via ErbB receptor coupling and expression. We examined the effect of the NRG-1β isoform, glial growth factor 2 (GGF2, in rats with myocardial infarction (MI and determined the impact of high-fat diet as well as chronicity of disease on GGF2 induced improvement in left ventricular systolic function. Potential mechanisms for GGF2 effects on the remote myocardium were explored using microarray and proteomic analysis. METHODS AND RESULTS: Rats with MI were randomized to receive vehicle, 0.625 mg/kg, or 3.25 mg/kg GGF2 in the presence and absence of high-fat feeding beginning at day 7 post-MI and continuing for 4 weeks. Residual left ventricular (LV function was improved in both of the GGF2 treatment groups compared with the vehicle treated MI group at 4 weeks of treatment as assessed by echocardiography. High-fat diet did not prevent the effects of high dose GGF2. In experiments where treatment was delayed until 8 weeks after MI, high but not low dose GGF2 treatment was associated with improved systolic function. mRNA and protein expression analysis of remote left ventricular tissue revealed a number of changes in myocardial gene and protein expression altered by MI that were normalized by GGF2 treatment, many of which are involved in energy production. CONCLUSIONS: This study demonstrates that in rats with MI induced systolic dysfunction, GGF2 treatment improves cardiac function. There are differences in sensitivity of the myocardium to GGF2 effects when administered early vs. late post-MI that may be important to consider in the development of GGF2 in humans.

  3. Intravenous Glial Growth Factor 2 (GGF2) Isoform of Neuregulin-1β Improves Left Ventricular Function, Gene and Protein Expression in Rats after Myocardial Infarction

    Science.gov (United States)

    Murphy, Abigail; Smith, Holly M.; Galindo, Cristi L.; Pentassuglia, Laura; Peng, Xuyang; Lenneman, Carrie G.; Odiete, Oghenerukevwe; Friedman, David B.; Kronenberg, Marvin W.; Zheng, Siyuen; Zhao, Zhongming; Song, Yanna; Harrell, Frank E.; Srinivas, Maya; Ganguly, Anindita; Iaci, Jennifer; Parry, Tom J.; Caggiano, Anthony O.; Sawyer, Douglas B.

    2013-01-01

    Aims Recombinant Neuregulin (NRG)-1β has multiple beneficial effects on cardiac myocytes in culture, and has potential as a clinical therapy for heart failure (HF). A number of factors may influence the effect of NRG-1β on cardiac function via ErbB receptor coupling and expression. We examined the effect of the NRG-1β isoform, glial growth factor 2 (GGF2), in rats with myocardial infarction (MI) and determined the impact of high-fat diet as well as chronicity of disease on GGF2 induced improvement in left ventricular systolic function. Potential mechanisms for GGF2 effects on the remote myocardium were explored using microarray and proteomic analysis. Methods and Results Rats with MI were randomized to receive vehicle, 0.625 mg/kg, or 3.25 mg/kg GGF2 in the presence and absence of high-fat feeding beginning at day 7 post-MI and continuing for 4 weeks. Residual left ventricular (LV) function was improved in both of the GGF2 treatment groups compared with the vehicle treated MI group at 4 weeks of treatment as assessed by echocardiography. High-fat diet did not prevent the effects of high dose GGF2. In experiments where treatment was delayed until 8 weeks after MI, high but not low dose GGF2 treatment was associated with improved systolic function. mRNA and protein expression analysis of remote left ventricular tissue revealed a number of changes in myocardial gene and protein expression altered by MI that were normalized by GGF2 treatment, many of which are involved in energy production. Conclusions This study demonstrates that in rats with MI induced systolic dysfunction, GGF2 treatment improves cardiac function. There are differences in sensitivity of the myocardium to GGF2 effects when administered early vs. late post-MI that may be important to consider in the development of GGF2 in humans. PMID:23437060

  4. Telmisartan in the diabetic murine model of acute myocardial infarction: dual contrast manganese-enhanced and delayed enhancement MRI evaluation of the peri-infarct region.

    Science.gov (United States)

    Toma, Ildiko; Kim, Paul J; Dash, Rajesh; McConnell, Michael V; Nishimura, Dwight; Harnish, Phillip; Yang, Phillip C

    2016-02-05

    A novel MRI technique, employing dual contrast manganese-enhanced MRI (MEMRI) and delayed enhancement MRI (DEMRI), can evaluate the physiologically unstable peri-infarct region. Dual contrast MEMRI-DEMRI enables comprehensive evaluation of telmisartan to salvage the peri-infarct injury to elucidate the underlying mechanism of restoring the ischemic cardiomyopathy in the diabetic mouse model. Dual contrast MEMRI-DEMRI was performed on weeks 1, 2, and 4 following initiation of telmisartan treatment in 24 left anterior descendent artery ligated diabetic mice. The MRI images were analyzed for core infarct, peri-infarct, left ventricular end-diastolic, end-systolic volumes, and the left ventricular ejection fraction (LVEF). Transmission electron microscopy (TEM) and real-time PCR were used for ex vivo analysis of the myocardium. Telmisartan vs. control groups demonstrated significantly improved LVEF at weeks 1, 2, and 4, respectively (33 ± 7 %*** vs. 19 ± 5 %, 29 ± 3 %*** vs. 22 ± 4 %, and 31 ± 2 %*** vs 18 ± 6 %, ***p Telmisartan group significantly salvaged the peri-infarct injury. The myocardial effects were validated by TEM, which confirmed the presence of the injured but viable cardiomyocyte morphology in the peri-infarct region and by flow cytometry of venous blood, which demonstrated significantly increased circulating endothelial progenitor cells (EPCs). The improved cardiac function in ischemic cardiomyopathy of diabetic mice by telmisartan is attributed to the attenuation of the peri-infarct injury by the angiogenic effects of EPCs to salvage the injured cardiomyocytes. Dual-contrast MEMRI-DEMRI technique tracked the therapeutic effects of telmisartan on the injured myocardium longitudinally.

  5. One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care] Trial).

    Science.gov (United States)

    Selker, Harry P; Udelson, James E; Massaro, Joseph M; Ruthazer, Robin; D'Agostino, Ralph B; Griffith, John L; Sheehan, Patricia R; Desvigne-Nickens, Patrice; Rosenberg, Yves; Tian, Xin; Vickery, Ellen M; Atkins, James M; Aufderheide, Tom P; Sayah, Assaad J; Pirrallo, Ronald G; Levy, Michael K; Richards, Michael E; Braude, Darren A; Doyle, Delanor D; Frascone, Ralph J; Kosiak, Donald J; Leaming, James M; Van Gelder, Carin M; Walter, Gert-Paul; Wayne, Marvin A; Woolard, Robert H; Beshansky, Joni R

    2014-05-15

    The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

  6. Safety of intravenous ivabradine in acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a randomized, placebo-controlled, double-blind, pilot study

    Science.gov (United States)

    Lopez-de-Sà, E; Schiele, F; Hamon, M; Meinertz, T; Goicolea, J; Werdan, K; Lopez-Sendon, JL

    2013-01-01

    Aims: Rapid heart rate lowering may be attractive in acute ST-segment elevation myocardial infarction (STEMI). Accordingly we studied the effect of intravenous ivabradine on heart rate in this setting. Methods and results: This was a multicenter randomized double-blind placebo-controlled trial: patients aged 40–80 years were randomized after successful primary percutaneous coronary intervention (PCI) performed within 6 h of STEMI symptom onset. Patients were in sinus rhythm and with heart rate >80 bpm and systolic blood pressure >90 mm Hg. They were randomly assigned (2:1 ratio) to intravenous ivabradine (n=82) (5 mg bolus over 30 s, followed by 5 mg infusion over 8 h) or matching placebo (n=42). The primary outcome measure was heart rate and blood pressure. In both groups, heart rate was reduced over 8 h, with a faster and more marked decrease on ivabradine than placebo (22.2±1.3 vs 8.9±1.8 bpm, p<0.0001). After treatment discontinuation, heart rate was similar in both groups. Throughout the study, there was no difference in blood pressure between groups. There was no difference in cardiac biomarkers (creatine kinase (CK-MB), troponin T and troponin I). On echocardiography performed at baseline and post treatment (median 1.16 days), final left ventricular volumes were lower in the ivabradine group both for left ventricular end-diastolic volume (LVEDV) (87.1±28.2 vs 117.8±21.4 ml, p=0.01) and left ventricular end-systolic volume (LVESV) (42.5±19.0 versus 59.1±11.3 ml, p=0.03) without differences in volume change or left ventricular ejection fraction. Conclusion: This pilot study shows that intravenous ivabradine may be used safely to slow the heart rate in STEMI. Further studies are needed to characterize its effect on infarct size, left ventricular function and clinical outcomes in this population. PMID:24222839

  7. 静脉使用美托洛尔治疗急性前壁心肌梗死的近期疗效%Short-term clinical efficacy of intravenous metopmlol on patients with acute anterior myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    张丽媛; 贾志; 郭牧; 张云强; 王群; 宋昱

    2013-01-01

    目的 观察静脉使用美托洛尔(倍他乐克)治疗急性前壁心肌梗死患者的近期临床疗效和安全性.方法 入选急性前壁心肌梗死患者362例,随机分为静脉组179例和口服组183例,静脉组静脉注射酒石酸美托洛尔5~15 mg,继之口服25 mg,每日2次;口服组直接给予口服制剂,25 mg,每日2次.比较两组患者疗效,以及住院7天及3个月心脏不良事件和1个月心脏超声资料.结果 与治疗前比较,口服组和静脉组的心率、收缩压和舒张压在治疗后1、6、12、24、48和72小时均呈逐渐下降趋势,但静脉组下降的更多,除了舒张压在两组间差异无统计学意义外,其他指标在组间、不同时点及组间和不同时点的交互作用差异均有统计学意义(P <0.05或<0.01);1个月随访,两组左心室射血分数(LVEF)均逐渐增加,但静脉组增加的幅度更大,口服组和静脉组在治疗前、治疗7天和治疗1个月分别为:LVEF(51.08±8.40)%、(53.18±8.06)%和(56.38±8.24)% vs (51.39±6.82)%、(55.70±5.92)%和(58.74±6.32)%,组间、不同时点、组间和不同时点交互作用差异均有统计学意义(P<0.05或<0.01);两组左心室舒张末期内径(LVDD)均逐渐缩小,LVDD(50.61±5.00)mm,(50.32±4.98) mm和(49.86±4.58) mm vs (50.56±4.15)mm、(49.72±3.97) mm和(49.63±4.03) mm,两组不同时点差异有统计学意义(P<0.01);治疗后7天两组心律失常和主要心脏不良事件差异有统计学意义,分别为25.7%(47/183) vs 14.0%(25/179),18.0%(33/183) vs 10.1%(18/179)(P<0.05或<0.01).结论 早期静脉应用美托洛尔可更有效改善血流动力学稳定的急性前壁心肌梗死患者的近期预后,而且不增加早期心力衰竭的风险.%Objective To observe the short-term clinical efficacy and safety of intravenous metoprolol on patients with acute anterior myocardial infarction.Methods 362 patients who suffered from acute anterior myocardial infarction were

  8. 经静脉声学造影诊断肾动脉狭窄的初步探讨%The preliminary study of diagnosis in renal artery stenosis with intravenous contrast ultrasound

    Institute of Scientific and Technical Information of China (English)

    吴凤林; 龚渭冰; 王晓青; 梁珠波; 侯连兵

    2000-01-01

    目的 探讨经静脉声学造影诊断肾动脉狭窄的可行性.方法 对9例临床疑诊肾动脉狭窄患者进行了经静脉声学造影检查,并与DSA结果对比.结果 声学造影显示2例肾动脉无彩色血流信号,ECT扫描肾脏不显影;5例肾动脉中段或起始段彩色血流束局限性细窄,其宽度0.30~0.38 cm之间,而非狭窄处的宽度在0.83-1.04 cm之间;DSA显示彩色血流束细窄处有肾动脉狭窄存在.另2例无肾动脉狭窄者,其血流束宽0.70~0.85 cm.结论 经静脉声学造影剂能显著增强肾动脉彩色血流信号;通过观察造影增强后肾动脉彩色血流表现,能较准确地诊断肾动脉狭窄、闭塞等病变.%Objective To investigate the feasibility of diagnosis in renal artery stenosis (RAS) with intravenous contrast ultrasound.Methods Nine Cases were examined with intravenous contrast ultrasound,who were suspected clinically to suffer from RAS.The results were compared with those of DSA.Results With the enhancenlent of intravenous ultrasound contrast agent,in 2 Cases,cobr flow was not seen in renal arteries;their kidneys were also not visualized by ECT examination.In five cases the narrow of color Doppler flows in middle or beginning parts of renal arteries was scanned with the width of 0.30~0.38 cm,where renal artery stenosis was confirmatively found bv DSA.But in another 2 cases with normal renal arteries,the blood flows were 0.70~0.85 cm wide.Conclusions The color Doppler flow signals could be significantly enhanced by intravenous contrast ultrasound,and it may be helpful to diagnose confirmatively the RAS through observing the blood flows in renal arteries by enhanced color Doppler ultrasonography.

  9. Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment-Myocardial Infarction

    DEFF Research Database (Denmark)

    Thayssen, Per; Lassen, Jens Flensted; Jensen, Svend Eggert

    2014-01-01

    alone. Patients in cardiogenic shock were excluded. Acute CIN was defined as an increase in serum creatinine concentration >25% from the baseline value within a 3-day period. Overall, CIN occurred in 141 (21.9%) patients. The prevention treatment with NAC, NaHCO3, or the combined NAC and NaHCO3 did...... and NaHCO3 (18.7% versus 19.1% versus 9.2% versus 21.3%; P=0.033). CONCLUSIONS: Treatment with NAC or NaHCO3 did not reduce the rate of acute CIN significantly. Combined treatment with NAC and NaHCO3 may reduce the risk of renal dysfunction after 30 days. CLINICAL TRIAL REGISTRATION URL: http......BACKGROUND: Contrast-induced nephropathy (CIN) is a serious condition in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. We compared the risk of acute CIN and the influence of preventive strategies in patients with ST...

  10. 心肌造影超声心动图对糖尿病大鼠心肌微循环的评价%Assessment of myocardial microcirculation in diabetic rats using myocardial contrast echocardiography

    Institute of Scientific and Technical Information of China (English)

    卫张蕊; 张军; 苏海砾; 张海滨; 施红; 朱霆

    2009-01-01

    目的 研究心肌造影超声心动图(MCE)技术结合潘生丁负荷试验是否能够早期检测糖尿病(DM)大鼠左室心肌微循环的功能障碍.方法 雄性SD大鼠18只,腹腔注射链脲菌素复制DM模型,另12只体质量匹配的雄性SD大鼠腹腔注射生理盐水作为对照.分别在静息状态和潘生丁负荷后,对两组大鼠(12周)乳头肌水平左室短轴行MCE检查,测定各室壁感兴趣区域峰值声学强度(PI)、造影剂灌注速率(β)及声学强度达峰时间(TTP)等指标,计算心肌血流量(MBF)和心肌血流储备(MFR).MCE检查完毕后,对心肌组织分别行~(99m)Tc-MIBI核素摄取量及毛细血管密度测定.结果 无论静息状态还是负荷后,同组大鼠后壁的MBF较前壁、侧壁和室间隔的MBF显著减低(P<0.05);取前壁心肌进行组间比较,静息状态和负荷后,DM组的PI、MBF和MFR均较对照组显著减低(P<0.05).潘生丁负荷后,DM组β也较对照组显著减低,TTP显著延长(P<0.05).DM组各室壁的核素摄取量和毛细血管密度均显著减低(P<0.05).结论 MCE检测的PI、β、TTP、MBF及MFR等指标可以敏感地检测出DM早期的心肌微循环功能障碍.%Objective To investigate whether myocardial contrast echocardiography(MCE)combined with stress echocardiography could detect myocardial microcirculation disturbance of left ventricular(LV)in diabetic rats.Methods MCE were performed at rest and after dipyridamole infusion from parasternal shortaxis views at the papillary muscle level in DM rats(n=18,12 weeks later after STZ administration)and control rats(n=12).Regions of interest(ROI)were positioned with the anterior, lateral, posterior and septum walls.Plateau intensity(PI), initial slope of the curve(β)and time to PI(TTP)were obtained from the curve and myocardial blood flow(MBF)and myocardial flow reserve(MFR)was estimated.After the performance of MCE, myocardium was prepared for γ Well counting with ~(99m)Tc-MIBI and CD31

  11. Delayed-enhancement magnetic resonance imaging at 3.0 T using 0.15 mmol/kg of contrast agent for the assessment of chronic myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jun, E-mail: yangjunyhd@163.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Ma, Heng, E-mail: mahengyhd@163.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Liu, Jing, E-mail: liujingyhd@163.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Wang, Chunxiao, E-mail: chunxiaoyhd@163.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Shi, Yinghong, E-mail: yinghongyhd@163.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Xie, Haizhu, E-mail: haizhuyhd@163.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Huo, Futao, E-mail: kailinusa@126.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Liu, Fengli, E-mail: fengliyhd@126.com [Yuhuangding Hospital, Yantai, Shandong Province (China); Lin, Kai, E-mail: kai-lin@northwestern.edu [Department of Radiology, Northwestern University, Chicago, IL (United States)

    2014-05-15

    Objective: A recent international, multicenter, double-blinded, randomized trial shows delayed-enhanced magnetic resonance imaging (DE-MRI) using contrast doses of ≥0.2 mmol/kg is effective in the detection and assessment of myocardial infarction (MI), and 0.1 mmol/kg is not enough; intermediate doses between 0.1 and 0.2 mmol/kg have not been tested. The aim of this study was to prospectively test the performance of DE-MRI using 0.15 mmol/kg of contrast agent for the detection of MI. Materials and methods: A total of 31 consecutive patients with chronic MI underwent DE-MRI at 3.0 T using both 0.15 mmol/kg and 0.2 mmol/kg of contrast agent in random order and on separate days. Infarction segment and infarction size were compared on DE-MRI images using a 17-segment model. Bland–Altman analysis was used to analyze correlation and agreement between global infarct sizes. Results: DE-MRI showed enhanced myocardium in all the 31 patients with chronic MI. There was no significant difference between the 0.15 mmol/kg and 0.2 mmol/kg images in all 31 patients based on the infarction segment (7.87 ± 2.72 vs. 7.81 ± 2.64, respectively; p = 0.33). There was no significant difference between the infarction size obtained from 0.15 mmol/kg acquisition and that from 0.2 mmol/kg acquisition (16.3 ± 7.8% vs. 16.4 ± 7.9%, respectively; p = 0.87). A strong correlation between the infarction size obtained from 0.15 mmol/kg acquisition and that from 0.2 mmol/kg acquisition was indicated through Bland–Altman analysis. Conclusion: DE-MRI at 3.0 T using 0.15 mmol/kg of contrast agent is effective for the assessment of MI.

  12. 兔骨髓间充质干细胞穴位移植与静脉移植对梗死区类心肌细胞新生影响的比较%Comparison of the Effects in Rabbit bone Marrow Mesenchymal Stem Cells Transplantation and Intravenous Transplantation of Myocardial Cells Freshman

    Institute of Scientific and Technical Information of China (English)

    张哲; 杨永菊; 陈强; 杨关林

    2012-01-01

    Objective; To discuss the situation of myocardial cells freshman differentiation in the infarcted after myocardial infarction by points and the vein graft in 0 days and 7 days. Methods: With anterior descending coronary artery ligaled way model of acute myocardial infarction,models of myocardial infarction in Japan white rabbits were randomly divided into 5 groups, Japan s big ears white rabbit from healthy bone marrow,separate training of bone marrow stromal stem cells and ChuanDai. In acute myocardial infarction after forming 0 days and 7 days acupuncture points and intravenous stem cells. Brdu immunohistochemical staining, take a slice of brdu positive cells to immunohislochemical stains,a microscope myocardial specificity ctni dyeing. Results: Model control group myocardial infarction area did not see the brdu markers of bone marrow stromal stem cells; Point injection stem cells 0 days brdu group of positive cells average light density values more intravenous stem cells 0 days increase trend of obviousP 0. 05. Conclusion: In 0 days meridians and intravenous bone marrow stromal stem cell migration to infarction area,in the infarction area live and differentiation is kind of myocardial appearance cell; In 7 days meridians and intravenous bone marrow stromal stem cell migration to infarction area, in the infarction area for the kind of myocardial appearance cell differentiation, point injection and intravenous there were no significant differences.%目的:探讨急性心肌梗死后0天与7天穴位与静脉分别注射骨髓间充质于细胞(MSCs)在梗死区分化为类心肌细胞的情况.方法:用开胸结扎冠状动脉前降支的方法建立急性心肌梗死模型,将已建立急性心肌梗死模型的日本大耳白兔随机分为5组,抽取健康日本大耳白兔骨髓,分离培养MSCs并传代,于急性心肌梗死形成后0天与7天穴位及静脉注射于细胞.免疫组化brdu染色,取有brdu阳性细胞的切片进行免疫组化染色,显

  13. 应用实时心肌超声造影定量评价心功能对急性心肌梗死犬心肌血流量的影响%Real-time myocardial contrast echocardiography evaluates the effection of cardiac function on myocardial blood flow of acute myocardial infarction in mongrel

    Institute of Scientific and Technical Information of China (English)

    吕静; 丁尚伟; 王静; 张艳容; 李秀兰; 王淑彬; 吕清

    2012-01-01

    Objective:To investigate the effect of cardiac function on myocardial perfusion of the mongrel's acute myocardial infarction model. Method:Eighteen dogs were performed the acute myocardial infarction models by ligating the left anterior descending (LAD) 3 hours, then the contrast agent (C3F8) was injected into femoral vein to perform myocardial contrast echocardiography (MCE) examination, and quantitative calculate the myocardial blood flow (MBF) both of left ventricle middle-anterior wall and middle-posterior wall. Result:Seventeen dogs are successfully performed acute myocardial infraction models. Three hours after ligating LAD, in the A group (n = 7) the eject fraction of left ventricle≥50%, the MBF of middle-anterior wall is obviously lower than the one before ligating LAD (P0. 05) ; in the B group (n=10) the eject fraction of left ventricle 0. 05); Between A group and B group after 3-hour ligating LAD, the MBF of both middle-anterior wall and middle-posterior wall in B group are only slightly lower than those in A group. Conclusion:The cardiac function can influence MBF sometines and maybe induce to undervalue the coronary reserve of flow and overmeasure the narrow degree of coronary, it's helpful to consider the cardiac function's effection using MCE to diagnosis coronary disease.%目的:探讨心功能对心肌梗死犬心肌血流灌注的影响.方法:18只健康杂种犬于前降支分出的第1对角支远端约1 cm处结扎3h,应用心肌超声造影(MCE)定量分析左室前壁中间段和下壁中间段心肌血流量(MBF).结果:17只犬成功建立急性心肌梗死模型.根据结扎3h后左室整体射血分数(EF)分为2组:A组(EF≥50%)7只,B组(EF<50%)10只.B组左室前壁中间段和下壁中间段MBF均低于A组,但2组之间差异无统计学意义;与结扎前相比,2组左室前壁中间段MBF均明显降低,差异有统计学意义(P<0.05),A组左室下壁中间段MBF略升高,B组则降低,但均差异无统计学意义.

  14. Intravenous contrast-enhanced CT can be used for CT-based attenuation correction in clinical 111In-octreotide SPECT/CT

    DEFF Research Database (Denmark)

    Klausen, Thomas Levin; Mortensen, Jann; de Nijs, Robin

    2015-01-01

    in a central volume. Ten patients referred for (111)In-octreotide scintigraphy were scanned according to our clinical (111)In-SPECT/CT protocol including a topogram, a LD (140 kVp), and a FD (120 kVp). The FD/contrast-enhanced CT was acquired in both arterial (FDAP) and venous phase (FDVP) following a mono......BACKGROUND: CT-based attenuation correction (CT-AC) using contrast-enhancement CT impacts (111)In-SPECT image quality and quantification. In this study we assessed and evaluated the effect. METHODS: A phantom (5.15 L) was filled with an aqueous solution of In-111. Three SPECT/CT scans were...... performed: (A) no IV contrast, (B) with 100-mL IV contrast, and (C) with 200-mL IV contrast added. Scan protocol included a localization CT, a low-dose CT (LD), and a full-dose CT (FD). Phantom, LD and FD scan series were performed at 90, 120, and 140 kVp. Phantom data were evaluated looking at mean counts...

  15. Resting myocardial blood flow quantification using contrast-enhanced magnetic resonance imaging in the presence of stenosis: A computational fluid dynamics study

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, Karsten, E-mail: sommerk@uni-mainz.de, E-mail: Schreiber-L@ukw.de [Section of Medical Physics, Department of Radiology, Johannes Gutenberg University Medical Center, Mainz 55131, Germany and Max Planck Graduate Center with the Johannes Gutenberg University Mainz, Mainz 55128 (Germany); Bernat, Dominik; Schmidt, Regine; Breit, Hanns-Christian [Section of Medical Physics, Department of Radiology, Johannes Gutenberg University Medical Center, Mainz 55131 (Germany); Schreiber, Laura M., E-mail: sommerk@uni-mainz.de, E-mail: Schreiber-L@ukw.de [Comprehensive Heart Failure Center, Department of Cardiovascular Imaging, Würzburg University Hospital, Würzburg 97078 (Germany)

    2015-07-15

    Purpose: The extent to which atherosclerotic plaques affect contrast agent (CA) transport in the coronary arteries and, hence, quantification of myocardial blood flow (MBF) using magnetic resonance imaging (MRI) is unclear. The purpose of this work was to evaluate the influence of plaque induced stenosis both on CA transport and on the accuracy of MBF quantification. Methods: Computational fluid dynamics simulations in a high-detailed realistic vascular model were employed to investigate CA bolus transport in the coronary arteries. The impact of atherosclerosis was analyzed by inserting various medium- to high-grade stenoses in the vascular model. The influence of stenosis morphology was examined by varying the stenosis shapes but keeping the area reduction constant. Errors due to CA bolus transport were analyzed using the tracer-kinetic model MMID4. Results: Dispersion of the CA bolus was found in all models and for all outlets, but with a varying magnitude. The impact of stenosis was complex: while high-grade stenoses amplified dispersion, mild stenoses reduced the effect. Morphology was found to have a marked influence on dispersion for a small number of outlets in the post-stenotic region. Despite this marked influence on the concentration–time curves, MBF errors were less affected by stenosis. In total, MBF was underestimated by −7.9% to −44.9%. Conclusions: The presented results reveal that local hemodynamics in the coronary vasculature appears to have a direct impact on CA bolus dispersion. Inclusion of atherosclerotic plaques resulted in a complex alteration of this effect, with both degree of area reduction and stenosis morphology affecting the amount of dispersion. This strong influence of vascular transport effects impairs the accuracy of MRI-based MBF quantification techniques and, potentially, other bolus-based perfusion measurement techniques like computed tomography perfusion imaging.

  16. Determination of location, size, and transmurality of chronic myocardial infarction without exogenous contrast media by using cardiac magnetic resonance imaging at 3 T.

    Science.gov (United States)

    Kali, Avinash; Cokic, Ivan; Tang, Richard L Q; Yang, Hsin-Jung; Sharif, Behzad; Marbán, Eduardo; Li, Debiao; Berman, Daniel S; Dharmakumar, Rohan

    2014-05-01

    Late-gadolinium-enhanced (LGE) cardiac MRI (CMR) is a powerful method for characterizing myocardial infarction (MI), but the requisite gadolinium infusion is estimated to be contraindicated in ≈20% of patients with MI because of end-stage chronic kidney disease. The purpose of this study is to investigate whether T1 CMR obtained without contrast agents at 3 T could be an alternative to LGE CMR for characterizing chronic MIs using a canine model of MI. Canines (n=29) underwent CMR at 7 days (acute MI [AMI]) and 4 months (chronic MI [CMI]) after MI. Infarct location, size, and transmurality measured by using native T1 maps and LGE images at 1.5 T and 3 T were compared. Resolution of edema between AMI and CMI was examined with T2 maps. T1 maps overestimated infarct size and transmurality relative to LGE images in AMI (P=0.016 and P=0.007, respectively), which was not observed in CMI (P=0.49 and P=0.81, respectively) at 3 T. T1 maps underestimated infarct size and transmurality relative to LGE images in AMI and CMI (P0.20) at both field strengths. Histology showed extensive replacement fibrosis within the CMI territories. CMI detection sensitivity and specificity of T1 CMR at 3 T were 95% and 97%, respectively. Native T1 maps at 3 T can determine the location, size, and transmurality of CMI with high diagnostic accuracy. Patient studies are necessary for clinical translation. © 2014 American Heart Association, Inc.

  17. Indirect MR arthrography of anterior shoulder instability in the ABER and the apprehension test positions: a prospective comparative study of two different shoulder positions during MRI using intravenous gadodiamide contrast for enhancement of the joint fluid

    Energy Technology Data Exchange (ETDEWEB)

    Wintzell, G.; Larsson, S. [Uppsala University Hospital (Sweden). Dept. of Orthopaedics; Larsson, H. [Nacka-Soeder Hospital, Stockholm (Sweden). Dept. of Radiology

    1998-09-01

    The value of MRI for the evaluation of anterior shoulder instability can be enhanced by shoulder positions that stress the stabilising structures. The ABER position is one that has been described in combination with intra-articular gadopentetate dimeglumine arthrography. We believe that MRI in the Apprehension test position with 90 abduction and maximal tolerable external rotation provides maximum tension on the anterior stabilising structures and with this technique it is sufficient to use indirect gadodiamide arthrography following intravenous injection of the contrast medium. The purpose of this study was to make a prospective comparative evaluation of the ABER and Apprehension test positions when using indirect arthrography with intravenous gadodiamide administration in shoulders with anterior instability. Results. Both the ABER and the Apprehension test position were useful techniques in detecting capsulolabral pathology and Hill-Sachs lesions. The Apprehension test position produced significantly better gadodiamide-enhanced joint fluid in the region of pathology in both the capsulolabral lesion and the Hill-Sachs lesion. It also visualised the size of the Hill-Sachs lesion significantly better than did the ABER position. (orig.)

  18. 静脉硫酸镁治疗急性心肌梗死的疗效和安全性评价的研究方案%Intravenous magnesium for acute myocardial infarction [protocol

    Institute of Scientific and Technical Information of China (English)

    李静; 张庆

    2002-01-01

    Background Mortality and morbidity of acute myocardial infarction remains high. Intravenous magnesium started early after the onset of myocardial infarction is a promising adjunctive treatment that may limit infarct size, prevent serious arrhythmias, and reduce mortality. Several earlier trials and meta-analyses demonstrated a mortality rate reduction with magnesium treatment, but one mega trial found no benefit. Objective To examine the effect of intravenous magnesium versus control on early mortality and morbidity, stratified by time since onset of symptoms (< 6 hours, 6+ hours), use of thrombolysis (used, not used), dose of magnesium used (<75mmol, 75+ mmol). Search strategy We search the Cochrane controlled trial register (CCTR) of Cochrane Library, Medline and Embase. We also search Chinese Biomedical Disk (CBM disk) to identify the Chinese trials. Each database will be searched from its starting date to the first-half year of 2002. Selection criteria All randomized controlled trials that compared intravenous magnesium with placebo in the presence or absence of fibrolytic therapy in addition to routine treatment are eligible if they reported mortality and clinical events within 35 days of onset, regardless of language. Methods of review A data abstraction form will be specifically developed to extract information from the eligible articles. The quality assessment of RCT will be focused on method of treatment assignment, blinding of participants and investigators, control of selection bias after treatment assignment. The selection of studies, data extraction and assessment of methodological quality will be performed independently by two reviewers. Disagreements will be resolved through discussion, when necessary, in consultation with a third reviewer. Publication bias, heterogeneity and sensitivity analysis will be performed. The odds ratio (OR) will be used to pooling the effect if appropriate.%背景急性心肌梗死的死亡率和并发症发生率仍

  19. Intravenous Contrast Material Administration at High-pitch Dual-source CT Coronary Angiography: Bolus-tracking Technique with Shortened Time of Respiratory Instruction Versus Test Bolus Technique

    Institute of Scientific and Technical Information of China (English)

    Kai Sun; Guo-rong Liu; Yue-chun Li; Rui-juan Han; Li-fang Cui; Li-jun Ma; Li-gang Li; Chang-yong Li

    2012-01-01

    Objective To investigate the feasibility of acquiring the similar homogeneous enhancement using bolus-tracking techniques with shortened respiratory time in prospectively electrocardiogram-gated high-pitch spiral acquisition mode (Flash mode) coronary computed tomography angiography (CCTA) compared with test bolus technique.Methods One hundred and eighty-four consecutive patients with mean heart rate ≤65 beats per minute undergoing CCTA were prospectively included in this study.The patients were randomly divided into two groups.Patients in the group A (n=92) instructed to shorten respiratory time received CCTA using bolus-tracking technique with high-pitch spiral acquisition mode (Flash mode),while those in the group B (n=92) underwent CCTA with test bolus technique.The attenuation in the ascending aorta,image noise,contrast-to-noise ratio and radiation doses of the two groups were assessed.Results There were no significant differences in the mean attenuation values in the ascending aorta (483.18±59.07 HU vs.498.7±83.51 HU,P=0.183),image noise (21.4±4.5 HU vs.20.9±4.3 HU,P=0.414),contrast-to-noise ratio (12.1±4.2 vs.13.8±5.1,P=0.31) between the groups A and B.There were no significant differences in the radiation dose of dynamic monitoring scans (0.056±0.026 mSv vs.0.062±0.018 mSv,P=0.068) and radiation dose of angiography (0.94±0.07 mSv vs.0.96±0.15 mSv,P=0.926) between the two groups,while 15 mL less contrast material volume was administered in the group A than the group B.Conclusion Bolus-tracking technique with shortened time of respiratory in Flash mode of dual-source CT yields the similar homogeneous enhancement with less contrast material in comparison to the test bolus technique.

  20. 新型心肌超声造影软件定量评价心肌梗死治疗前后微循环灌注%Experimental study of myocardial perfusion by myocardial contrast echocardiography using a novel software before and after myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    杜国庆; 陈双; 杜佩; 薛竞宜; 王超; 张蕾; 李海茹; 田家玮

    2013-01-01

    目的 探讨自制新型心肌超声造影软件在定量评价心肌梗死模型治疗前后左室心肌微循环灌注方面的应用价值.方法 将34只SD大鼠分为心肌梗死组(MI组)和促红细胞生成素治疗组(EPO组),分别于术前、术后1周及3周行心肌超声造影检查;应用计算机软件对心肌造影图像进行分割、分区灌注强度标注及彩色编码等自动处理,并获得心肌灌注强度指标—造影剂密度值(CI).CI值与免疫组化微血管密度行相关分析.结果 ①术后1周和3周,与EPO组比较,MI组梗死节段心肌的CI值较低,差异有统计学意义(P<0.001).EPO组危险节段的CI值在术后1周和3周呈上升趋势,且差异有统计学意义(P<0.01).②术后3周时,前壁危险节段CI值与免疫组化微血管密度呈正相关(r=0.852,P<0.01).③彩色编码:术后3周MI组梗死节段心肌明显变薄,呈大片红色渲染,EPO组于前壁、侧壁有小片状红色区域,其他节段显示为绿色和蓝色混杂,与微球染色及TTC染色明显相似.结论 计算机辅助心肌超声造影可以实现对左室心肌微循环灌注的定量评估,在评价梗死心肌治疗效果方面具有较好的应用前景.%Objective To evaluate the feasibility and value of quantitatively assessing left ventricular myocardial perfusion by myocardial contrast echocardiography (MCE) with computer-aided technique in myocardial infarction model.Methods 34 rats were randomly divided into myocardial infarction (MI) group and erythropoietin (EPO) treatment group.Echocardiography and MCE were performed before MI and at 1,3 weeks after MI.Automatic segmentation of the myocardium,a reasonable partition of myocardium,quantitative calculation of myocardial perfusion intensity and color-coded map of the myocardial perfusion were accomplished by computer software.Contrast intensity (CI),a parameter of myocardial perfusion,was acquired.The correlation between CI and immunohistochemical microvascular

  1. Combination of contrast with stress echocardiography: A practical guide to methods and interpretation

    Directory of Open Access Journals (Sweden)

    Marwick Thomas H

    2004-08-01

    Full Text Available Abstract Contrast echocardiography has an established role for enhancement of the right heart Doppler signals, the detection of intra-cardiac shunts, and most recently for left ventricular cavity opacification (LVO. The use of intravenously administered micro-bubbles to traverse the myocardial microcirculation in order to outline myocardial viability and perfusion has been the source of research studies for a number of years. Despite the enthusiasm of investigators, myocardial contrast echocardiography (MCE has not attained routine clinical use and LV opacification during stress has been less widely adopted than the data would support. The purpose of this review is to facilitate an understanding of the involved imaging technologies that have made this technique more feasible for clinical practice, and to guide its introduction into the practice of the non-expert user.

  2. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E;

    1992-01-01

    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic......, where 83%-92% of the myocardium showed ischemia as defined by a 99mTc-hexamibi uptake below an arbitrary limit on half maximum uptake. Myocardial hypoperfusion might thus aggravate the functional impairment at myocardial infarction and lead to cardiogenic shock....

  3. Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores.

    Science.gov (United States)

    De Palma, Rodney; Sörensson, Peder; Verouhis, Dinos; Pernow, John; Saleh, Nawzad

    2017-07-27

    Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed. Retrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction. MaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p myocardial salvage in this patient population. Clinical trial registration information for the parent clinical trial: Karolinska Clinical Trial Registration (2008) Unique identifier: CT20080014. Registered 04(th) January 2008.

  4. Assessment of myocardial perfusion before and after intervention therapy of coronary heart disease by real-time myocardial contrast echocardiography combined with adenosine stress echocardiography%实时心肌声学造影结合腺苷负荷试验对冠心病介入治疗前后心肌灌注的评价

    Institute of Scientific and Technical Information of China (English)

    吴向军; 王庆元; 马风妹

    2013-01-01

    目的 评价冠心病(CHD)经皮冠状动脉介入治疗(PCI)术前后心肌灌注情况.方法 选择经冠状动脉造影(CAG)证实有冠状动脉狭窄的冠心病患者共42例,对入选的冠状动脉狭窄的患者在行PCI术前后进行经静脉心肌声学造影(MCE)结合腺苷负荷检查,通过心肌显影程度定量判断冠状动脉微循环灌注并记录图像,将治疗前后心肌声学造影结果进行对比分析,评价手术疗效,估计患者预后.结果 23例患者经PCI术治疗后,相关心肌节段的局部所有毛细血管横截面积之和(A)、血流速度(β)、心肌的血流量(A×β)均较冠状动脉介入前显著增加(P <0.05);PCI术后相关心肌节段组与冠状动脉正常者心肌节段组比较,局部所有毛细血管横截面积之和、血流速度、心肌的血流量A、β、A×β仍减低(P<0.05);相关分析显示,随访期EF值和室壁运动记分指数较术前明显增加,并与PCI术治疗后A、β、A×β相关性好(P<0.01).结论 经静脉心肌声学造影结合腺苷负荷检查为冠心病诊断治疗领域提供一种准确、无创评价心肌微循环的临床检测手段;进一步评价经皮冠状动脉介入治疗对改善心肌梗死患者心肌组织灌注的效果.未经再灌注治疗的心肌梗死或心绞痛患者应尽早行择期PCI术,挽救梗死区的缺血心肌,改善左心室功能.%Objective To evaluate the situation of myocardial perfusion before and after percutaneous coronary intervention (PCI).Methods Forty-two patients with coronary artery stenosis confirmed by coronary angiography were selected.Transvenous myocardial contrast echocardiography and adenosine stress echocardiography were administered for the patients.Coronary microcirculation perfusion was quantitatively judged through the extent of myocardial visualization and the images were recorded,the results of myocardial contrast echocardiography were compared,the surgical efficacy was evaluated,and the

  5. Assessment of myocardial perfusion and systolic function in patients with coronary artery disease after percutaneous coronary intervention by real-time myocardial contrast echocardiography and two-dimensional strain echocardiography%实时心肌超声造影结合二维应变评价经皮冠状动脉重建术后心肌灌注与收缩功能改变

    Institute of Scientific and Technical Information of China (English)

    钱建芬; 汤裕华; 林银康

    2012-01-01

    目的 应用实时心肌超声造影(RT-MCE)结合二维应变(2DS)、左心室射血分数(LVEF)评价急性心肌梗死经皮冠状动脉介入术(PCI)后心肌灌注情况与收缩功能的变化.方法对45例急性心肌梗死患者PCI术后1周内行RT-MCE,按照目测定性和半定量法将所有患者分成再灌注良好组、无灌注组和再灌注减弱组,采用Qlab软件计算出各组心肌的充盈速度和心肌的血容量.3组术后3个月复查常规超声心动图测量LVEF及应用2DS软件测量各个节段的收缩期纵向峰值应变(SRs),并将3组LVEF和SRs进行比较.结果 心肌再灌注良好组术后3个月LVEF为(0.60±0.06)%,较术后1周LVEF(0.54±0.05)%增大,差异有统计学意义( t=3.402,P<0.01).术后3个月时,心肌灌注良好组LVEF、左心室心肌SRs分别为(0.60±0.06)%、(-0.96±0.35)s-1,无灌注组分别为(0.41±0.08)%、(-0.43±0.14)s-1,两组比较差异有统计学意义(t= 2.819、3.214,P均<0.01);心肌灌注减弱组LVEF、左心室心肌SRs分别为(0.53±0.05 )%、(-0.59±0.31)s-1,与无灌注组比较差异有统计学意义(t= 2.209、2.418,P<0.05).结论 PCI术后心肌灌注改善与否可以反映心肌功能恢复的趋势,而2DS可较好地定量评价局部心肌收缩功能.%Objective To assess the changes of myocardial perfusion and systolic function in patients with acute myocardial infarction after revascularization by real -time intravenous myocardial contrast echocardiography ( RT-MCE) combined with 2D-3train(2DS). Methods Forty-five patients were examined by RT-MCE within one week after percutaneous coronary intervention (PCI). These patients were divided into groups according to qualitation and demi-quantitation method. The myocardial filling speed and blood volume were calculated by Qlab software. Three months later, the echocardiography was rechecked again to measure the left ventricular ejection fraction (LVEF) and 2DS was used to measure the SRs of every segment of left

  6. Value of Quantitative Tissue Velocity Imaging in the Detection of Regional Myocardial Function in Dogs with Acute Subendocardial Ischemia

    Institute of Scientific and Technical Information of China (English)

    Qinyyang ZHANG; Youbin DENG; Yani LIU; Haoyi YANG; Bingbing LIU; Weihui SHENTU; Peng LI

    2008-01-01

    This study evaluated the application of quantitative tissue velocity imaging (QTVI) in assessing regional myocardial systolic and diastolic functions in dogs with acute subendocardial ischemia. Animal models of subendocardial ischemia were established by injecting microspheres (about 300 μm in diameter) into the proximal end of left circumflex coronary artery in 11 hybrid dogs through cannulation. Before and after embolization, two-dimensional echocardiography, QTVI and real-time myocardial contrast echocardiography (RT-MCE) via intravenous infusion of self-made microbubbles, were performed, respectively. The systolic segmental wall thickening and subendocardial myocardial longitudinal velocities of risk segments before and after embolization were compared by using paired t analysis. The regional myocardial video intensity versus contrast time could be fitted to an exponential function: y=A-(1-exp-β-t), in which the product of A and β provides a measure of myocardial blood flow. RT-MCE showed that subendocardial normalized A.β was decreased markedly from 0.99±0.19 to 0.35±0.11 (P0.05), the longitudinal peak systolic velocities (Vs) and early-diastolic peak velocities (Ve) recorded by QTVI were declined significantly (P<0.05). Moreover, the subendocardial velocity curves during isovolumic relaxation predominantly showed positive waves, whereas they mainly showed negative waves before the embolization. This study demonstrates that QTVI can more sensitively and accurately detect abnormal regional myocardial function and post-systolic systole causedby acute subendocardial ischemia.

  7. [The relation of electric myocardial instability to the intensity of coronary disease--correlation of the data of programmed electrostimulation of the ventricles, selective coronarography and contrast ventriculography].

    Science.gov (United States)

    Kaĭk, Iu L; Vaĭnu, M K; Makhotina, V N; Mezikepp, A Kh

    1989-01-01

    Altogether 104 persons with coronary disease were examined in order to determine the correlation between the presence of electric myocardial instability (EMI) identified with the aid of programmed electrostimulation of the ventricles (PESV) and the gravity of injuries to the coronary vessels and to the contractile myocardium of the left ventricle (LV). In accordance with the number of the stimulation-induced recurrent contractions (RC), the patients were distributed into 4 groups. The patients of the second group (4 to 9 RC), of the third group (with unstable tachycardia) and of the fourth group (with stable tachycardia) were considered as having EMI. A marked relationship was discovered between EMI identified with the aid of stimulation and the condition of the contractile myocardium of the LV according to the ventriculography readings (the frequency of recording akinetic and dyskinetic myocardial segments, the magnitude of the end-diastolic pressure). Coronary circulation failure (the degree of stenotic injury to the coronary arteries, the number of impaired vessels) did not determine EMI according to the PESV data.

  8. Contrast induced nephropathy

    DEFF Research Database (Denmark)

    Stacul, Fulvio; van der Molen, Aart J; Reimer, Peter

    2011-01-01

    measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points • Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed. • CIN risk is lower with intravenous than intra-arterial iodinated contrast medium. • eGFR of 45 ml....../min/1.73 m (2) is CIN risk threshold for intravenous contrast medium. • Hydration with either saline or sodium bicarbonate reduces CIN incidence. • Patients with eGFR ≥ 60 ml/min/1.73 m (2) receiving contrast medium can continue metformin normally....

  9. Contrast induced nephropathy

    DEFF Research Database (Denmark)

    Stacul, Fulvio; van der Molen, Aart J; Reimer, Peter

    2011-01-01

    measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points • Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed. • CIN risk is lower with intravenous than intra-arterial iodinated contrast medium. • eGFR of 45 ml....../min/1.73 m (2) is CIN risk threshold for intravenous contrast medium. • Hydration with either saline or sodium bicarbonate reduces CIN incidence. • Patients with eGFR = 60 ml/min/1.73 m (2) receiving contrast medium can continue metformin normally....

  10. Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.

    LENUS (Irish Health Repository)

    Quirke, M

    2011-03-01

    Introduction Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP). Methods A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result. Results Patients having NHCT who attended between 00:00-08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate\\/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths. Conclusion NHCT allows for the detection of incidental\\/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.

  11. Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.

    LENUS (Irish Health Repository)

    Quirke, M

    2012-02-01

    INTRODUCTION: Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP). METHODS: A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result. RESULTS: Patients having NHCT who attended between 00:00-08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate\\/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths. CONCLUSION: NHCT allows for the detection of incidental\\/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.

  12. Evaluation on myocardial perfusion of coronary heart disease percutaneous coronary intervention pre and post by the transvenous myocardial contrast echocardiography%实时心肌声学造影评价冠心病介入治疗前后心肌灌注

    Institute of Scientific and Technical Information of China (English)

    吴向军

    2011-01-01

    Objective To evaluate myocardial perfusion of coronary heart disease percutaneous coronary intervention ( PCI ) pre and post. Methods 42 cases were selected by doctors in department of cardiology who are confirmed coronary artery normal subjects and have coronary artery stenosis subjects by the coronary angiography, transvenous myocardial contrast echocardiography were conducted pre and post PCI in patients with coronary artery stenosis and coronary artery normal, quantitative diagnosis of coronary microcir-culation perfusion through the extent of myocardial development and record images, will be comparative analysis pre and post treatment and coronary artery normal subjects, evaluate surgical efficacy, estimate prognosis of patients. Results After PCI treatment to 23 cases, the correlation-myocardial segments to the partial cross sectional area of all the capillaries( A ), blood flow velocity( β ), myocardial blood flow volume correlation-myocardial segments group compared to the coronary artery normal subjects of the correlationmyocardial segments group, the partial cross sectional area of all the capillaries( A ), blood flow velocity ( β ), myocatrlial blood flow volume( A·β )still all decreased, correlation analysis showed, follow-up period EF values and wall motion score index incwased significantly compared with those of preoperative and after treatment with PCI in A, β, A · β good correlation. Conclusion Transvenous myocardial contrast echocardiography examination for the diagnosis and treatment of coronary heart disease areas provide an accurate, noninvasive evaluation of myocardial microcirculation and clinical test; further evaluate the treatment of percutaneous coronary intervention in patients with myocardial infarction to improve myocardial perfusion effectively. Those patients without reperfusion therapy and angina pectofis or myocardial infarction should be treated with delayed PCI as early as possible, to save the ischemic myocardial

  13. 静脉注射艾司洛尔治疗急性心肌梗死合并交感风暴的临床观察%Clinical observation of intravenous esmolol in the treatment of acute myocardial infarction patients with sympathetic storm

    Institute of Scientific and Technical Information of China (English)

    董小燕; 于东明; 郭伟; 袁靖

    2015-01-01

    Objective To observe the clinical efficacy of intravenous injection of esmolol to treat acute myocardial infarction patients with sympathetic storm. Methods A total of 44 acute myocardial infarction patients with sympathetic storms were randomly divided into three groups:an amiodarone group receiving intravenous amiodarone in addition to conventional cardiopulmonary resuscitation and electrical cardioversion (n=15), a metoprolol tartrate group which was treated with intravenous metoprolol tartrate in addition to the above amiodarone therapy (n=15), and an esmolol group which was intravenously injected with esmolol in addition to the above amiodarone therapy (n=14). Results The esmolol group and metoprolol tartrate group produced markedly higher inhibitory rates of recurrent ventricular tachycardia and ventricular fibrillation than the amiodarone group. The esmolol group and metoprolol tartate groups required substantially less times of electric cardioversion to terminate ventricular tachycardia and ventricular fibrillation than the amiodarone group. There was no statistical difference as to the incidences of hypotension and bradycardia among these three groups. Conclusion Based on the conventional therapy, intravenous injection of esmolol can significantly improve the successful rate of rescue for acute myocardial infarction patients with sympathetic storm.%目的:观察静脉注射艾司洛尔治疗急性心肌梗死合并交感风暴的临床疗效。方法急性心肌梗死合并交感风暴患者44例,随机分为3组。其中胺碘酮组(n=15),应用常规心肺复苏及电复律加静脉应用胺碘酮治疗;酒石酸美托洛尔组(n=15),在胺碘酮组治疗基础上静脉联合酒石酸美托洛尔治疗;艾司洛尔组(n=14),在胺碘酮组治疗基础上联合静脉应用艾司洛尔治疗。结果艾司洛尔组及酒石酸美托洛尔组终止反复室性心动过速、心室颤动成功率明显高于胺碘酮组;艾司洛

  14. Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year

    DEFF Research Database (Denmark)

    Iversen, Allan Zeeberg; Galatius, Soeren; Abildgaard, Ulrik

    2011-01-01

    pPCI-treated STEMI patients were randomized to either IC or IV bolus abciximab followed by a 12-hour IV infusion. Patients were followed for 1 year to observe mortality, TVR or myocardial infarction (MI) and the combination of these. Results: The two treatment arms (IV, n = 170; IC, n = 185) were...... a relative risk reduction of 55% for the combined endpoint after 1 year (p = 0.002) compared to the IV treatment arm. Conclusions: In pPCI-treated STEMI patients treated with abciximab, IC bolus administration resulted in a significant reduction in mortality, TVR and MI compared to IV bolus administration.......Objectives: Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior...

  15. Cardiac MRI. Estimation of changes in normalized myocardial gadolinium accumulation over time after contrast injection in patients with acute myocarditis and healthy volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Breuckmann, F.; Buhr, C. [Mainz Univ. (Germany). Dept. of Internal Medicine II; Maderwald, S. [Duisburg-Essen Univ. (Germany). Erwin L. Hahn Inst. for Magnetic Resonance Imaging; Bruder, O. [Elisabeth Hospital Essen (Germany). Dept. of Cardiology and Angiology; Schlosser, T.; Nassenstein, K. [University Hospital Essen (Germany). Dept. of Diagnostic and Interventional Radiology and Neuroradiology; Erbel, R. [University Hospital Essen (Germany). West German Heart Center Essen; Barkhausen, J. [University Medical Center Schleswig-Holstein (Germany). Dept. of Radiology and Nuclear Medicine

    2011-10-15

    An increased normalized gadolinium accumulation (NGA) in the myocardium during early washout has been used for the diagnosis of acute myocarditis (AM). Due to the fact that the pharmacokinetics of contrast agents are complex, time-related changes in NGA after contrast injection are likely. Because knowledge about time-related changes of NGA may improve the diagnostic accuracy of MR, our study aimed to estimate the time course of NGA after contrast injection in patients as well as in healthy volunteers. An ECG-triggered inversion recovery SSFP sequence with incrementally increasing inversion times was repetitively acquired over the 15 minutes after injection of 0.2 Gd-DTPA per kg body weight in a 4-chamber view in 15 patients with AM and 20 volunteers. The T 1relaxation times and the longitudinal relaxation rates (R1) of the myocardium and skeletal musculature were calculated for each point in time after contrast injection. The time course of NGA was estimated based on the linear relationship between R 1 and tissue Gd concentration. NGA decreased over time in the form of a negative power function in patients with AM and in healthy controls. NGA in AM tended to be higher than in controls (p > 0.05). NGA rapidly changes after contrast injection, which must be considered when measuring NGA. Although we observed a trend towards higher NGA values in patients with AM with a maximum difference one minute after contrast injection, NGA did not allow us to differentiate patients with AM from healthy volunteers, because the observed differences did not reach a level of significance. (orig.)

  16. 应用心肌造影超声心动图结合速度向量成像对糖尿病大鼠心肌微循环与收缩功能障碍的相关性研究%Relationship between myocardial perfusion impairment and dysfunction in diabetic rats using myocardial contrast echocardiography and velocity vector imaging

    Institute of Scientific and Technical Information of China (English)

    卫张蕊; 张军; 张海滨; 苏海砾; 施红; 朱霆; 朱永胜

    2012-01-01

    目的 应用心肌造影超声心动图(MCE)结合速度向量成像(VVI)技术研究糖尿病(DM)大鼠左室心肌微循环障碍与心肌收缩功能损伤之间的相关关系.方法 雄性SD大鼠23只,腹腔注射链脲菌素复制DM模型,另23只体质量匹配的雄性SD大鼠腹腔注射等量生理盐水作为对照.分别在静息状态和潘生丁负荷后,对两组大鼠(12周)乳头肌水平左室短轴行MCE和VVI检查,分别测定心肌血流量(MBF)、心肌血流储备(MFR)、收缩期最大圆周应变率(SRc)及其储备,分析MBF/MFR与SRc/SRc储备之间是否存在相关关系.结果 DM组大鼠的SRc、SRc储备、MBF及MFR均较对照组显著减低.DM组大鼠SRc与MBF之间没有明显相关性,而SR.储备与MFR之间呈现显著的负相关.结论 静息状态下,心肌血流量的降低并不是圆周应变率降低的主要决定因素,而潘生丁负荷后,心肌血流储备的降低可能是心肌圆周应变率储备降低的主要决定因素.%Objective To investigate whether myocardial dysfunction and perfusion impairment had happened in diabetes mellitus(DM)rats,and to assess the relationship between them by using myocardial contrast echocardiography(MCE)and velocity vector imaging(VVI).Methods MCE and VVI were performed from the short-axis views of the mid-left ventricular level both at rest and after dipyridamole stress in control rats and DM rafs(12 weeks after induction with streptozotocin).MCE-derived myocardial blood flow(MBF)and myocardial flow reserve(MFR)and VVI-derived circumferential strain rate(SRc)and SRc reserve were obtained.Results SRc(absolute value)and MBF in the DM group were significantly lower than those in the control group at rest(P =0.03 for SRc and P =0.005 for MBF).SRc reserve and MFR in the DM group were significantly lower than those in the control group after dipyridamole stress (P =0.000 for SRc reserve and P =0.014 for MFR).There was no significant correlation between SRc and MBF at rest in the

  17. Complicações do uso intravenoso de agentes de contraste à base de gadolínio para ressonância magnética Complications from the use of intravenous gadolinium-based contrast agents for magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Jorge Elias Junior

    2008-08-01

    . Nephrogenic systemic fibrosis was the subject of an official health notification issued by the American Food and Drug Administration. This progressive disease is characterized by hardened skin with fibrotic nodules and plaques which may involve other parts of the body. Patients who have been affected by this disorder presented chronic renal failure, with metabolic acidosis and had been submitted to magnetic resonance angiography, probably involving exposure to large amounts of intravenous paramagnetic contrast. This review is aimed at presenting a succinct description of the gadolinium-based contrast agent types, possible secondary complications, their preventive measures and management.

  18. Myocardial Bridging

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  19. Peripheral intravenous line (image)

    Science.gov (United States)

    A peripheral intravenous line is a small, short plastic catheter that is placed through the skin into a vein, ... or foot, but occasionally in the head. A peripheral intravenous line is used to give fluids and ...

  20. Myocardial disease

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970309 Myocardial injury of Keshan disease andapoptosis. ZHONG Xuekuan(钟学宽), et al. KeshanDis Instit, Harbin Med Univ, Harbin, 150086. Chin JEndemiol 1997, 16(2): 81-82. Objective: To discuss the relationship between my-ocardial injury Of Keshan disease and apoptosis. Meth-

  1. Development of early myocardial perfusion in diabetic rats:the stress myocardial contrast echocardiography s tudy%负荷心肌超声造影评价糖尿病大鼠早期心肌灌注演变规律

    Institute of Scientific and Technical Information of China (English)

    段云燕; 张军; 卫张蕊; 苏海砾; 刘丽文; 郑敏娟; 朱霆; 李红玲

    2015-01-01

    Objective To investigate the development of early myocardial perfusion with myocardial contrast echocardiography (MCE) combined with dipyridamole stress echocardiography in diabetic rats . Methods The diabetes mellitus (DM) group comprised 40 male diabetic rats ,induced with streptozotocin . The control group comprised 40 normal male rats ,comparable body weights with the DM group .The DM group was divided into four subgroups (0 week ,2 weeks ,4 weeks and 8 weeks after diabetic model established) and the control group was also divided into four subgroups matched with the DM group .Each rat was performed with conventional echocardiography ,MCE at baseline and after dipyridamole stress .The reserve parameters were compared between the control group and the DM group .In addition ,the differences among four subgroups in the control group and the DM group were compared ,respectively .Results MCE demonstrated that the 4 weeks and 8 weeks DM subgroup had lower myocardial blood velocity reserve and myocardial blood flow reserve than the control subgroup .The myocardial blood volume reserve was reduced in the 8 weeks DM subgroup ,too .Conclusions The impairment of myocardial perfusion in the DM rats are detected earlier with the MCE combined with dipyridamole stress .%目的:应用实时心肌超声造影(MCE)结合潘生丁负荷研究早期糖尿病(DM )大鼠心肌灌注障碍的发生、发展过程和演变规律。方法对照组和DM组各40只大鼠,分为0周、2周、4周和8周四个亚组,于DM成模后不同时间点进行常规超声、MCE并结合潘生丁负荷检查,对各个时间点对照组和DM组两组间各项参数进行比较,同时对组内各个时间点参数进行比较。结果静息MCE指标显示最早从8周亚组可以检出DM组的心肌血容量和心肌血流量的指标较对照组明显减低。潘生丁负荷后DM 组从4周亚组开始血流速度储备和心肌血流量储备较对照组减低,8周亚组的三

  2. COMPARATIVE EXPERIMENTAL STUDY OF HO-YAG LASER AND TRUE-CUT BIOPSY NEEDLE IN MYOCARDIAL REVASCULARIZATION

    Institute of Scientific and Technical Information of China (English)

    王立清; 胡盛寿; 常欣; 吴清玉; 李澎; 谢峰; 郭加强

    2001-01-01

    Objective. To study the mechanism and effects of blood perfusion on acute ischemic region of myocardiumthrough channel created by Ho-Yag laser and True-cut biopsy needles with myocardial contrast echocardiography. Methods. We partially ligated the left anterior descending coronary artery of canine hearts between the 1st and 2nd diagonal branches to produce two groups of acute myocardial ischemia models and then performed transmyocardial revascularization (TMR) on this region with Ho-Yag laser and True-cut biopsy needles. Myocardial contrast echocardiography was performed with a new generation of ultrasound contrast agent and second harmonicimaging of this region before, during ischemia and after revascularization. Pictures were taken with “R” wave trigger skill. Results. Acoustic density (dB) in the iscbemic region (anterior wall) with myocardial contrast echocardiogra-phy decreased obviously after the left anterior descending artery was ligated (Laser group: 5.40 ± 1.81, Needlegroup: 7.11 ± 2. 51 ) compared with that before (Laser group: 11.69 ± 1.61, Needle group: 12. 96 ± 2. 88,P 0. 05). We found that the acoustic density of the contrast developed one picture (one cardiac cycle) ahead in the transmyocardial revascularization region than that in the lateral and other region of the left ventricle wall in the scan of both groups. Conclusions. Acute ischemic myocardium can be perfused immediately by oxygenated blood from the left ventricle through channels created with both Ho-Yag laser and True-cut biopsy needles. Evidence of blood perfusion through these channels mainly during systolic phase was detected, and myocardial contrast ultrasound using intravenous peffluorocarbon-exposed sonicated dextrose albumin was regarded as a reliable method in the study of transmyocardial revaseularization.

  3. Benign transient eosinophilia following intravenous urography

    Energy Technology Data Exchange (ETDEWEB)

    Vincent, M.E.; Gerzof, S.G.; Robbins, A.H.

    1977-06-13

    Eosinophilia, a component of the allergic response, may occur after the use of iodinated radiographic contrast media for intravenous urography. A benign transient elevation in differential eosinophil count was seen in 21 of 101 patients following the injection of iodinated contrast agents for that purpose.

  4. 心肌超声造影评价肥厚型心肌病患者局部心肌收缩功能与灌注的关系%Evaluation of correlation between regional myocardial function and perfusion in patients with hypertrophic cardiomyopathy by myocardial contrast echocardiography

    Institute of Scientific and Technical Information of China (English)

    王婷; 邓又斌; 朱英; 王纯; 杨好意; 毕小军; 刘红云

    2011-01-01

    目的 应用斑点追踪技术评价肥厚型心肌病患者局部心肌收缩功能,同时应用心肌超声造影观察肥厚型心肌病患者局部心肌灌注改变,并探讨局部心肌收缩功能与灌注之间的关系.方法 对肥厚型心肌病患者(35例)和健康对照组(17名)行常规超声心动图检查,应用斑点追踪技术测量各节段二维应变值.按照患者就诊顺序随机进行心肌超声造影检查后对35例肥厚型心肌病患者中的20例愿意行造影检查者行心肌超声造影检查,测量系统自动给出心肌造影强度定量分析拟合指数函数Y=A(1-e-Kt)中的A值、K值并进行分析.结果 肥厚型心肌病患者心肌的总体纵向应变值、总体圆周应变值和总体径向应变值(23.48±1.86,24.22±3.95,41.05±10.28)均较健康对照组(15.76±3.63,20.03±4.24,30.83±11.28)明显减低,差异有统计学意义(t=-7.775、-3.167、-2.913,P均<0.01);总体圆周应变绝对值和A值正相关,有统计学意义(R=0.610,t=3.079,P<0.01);总体纵向应变绝对值与K值负相关,有统计学意义(R=0.469,t=-2.252,P<0.05);总体圆周应变绝对值与K值负相关,有统计学意义(R=0.550,t=-2.632,P<0.05).结论 肥厚型心肌病患者局部心肌收缩功能减低与灌注损伤有关,心肌超声造影检查是研究和诊断肥厚型心肌病可靠、有效的方法.%Objective To evaluate the regional myocardial function in patients with hypertrophic cardiomyopathy by speckle tracking imaging, then to observe the perfusion by myocardial contrast echocardiography and to explore the correlation between abnormal regional myocardial function and perfusion in patients with hypertrophic cardiomyopathy. Methods Fifty-two persons were investigated ( 35 patients with hypertrophic cardiomyopathy, 17 controls were included)to analyze the two-dimensional strain by speckle tracking imaging in the 3 left ventricle short-axis views( including mitral annulus level view, papillary muscle level view

  5. Study on Effect and Safety about Intravenous Thrombolytic Therapy and Direct PCI in Acute ST Elevation Myocardial In-farction Onset in 3 Hours%发病3h 内急性 STEMI 静脉溶栓及直接 PCI治疗的效果及安全性研究

    Institute of Scientific and Technical Information of China (English)

    牛锋

    2016-01-01

    目的:探讨发病3h内急性ST段抬高型心肌梗死(STEMI)的静脉溶栓及直接经皮冠状动脉介入治疗术(PCI)治疗的效果及安全性。方法:将我院发病3h内急性STEMI患者95例分为PCI组和静脉溶栓组,静脉溶栓组给予尿激酶治疗,PCI组给予直接PCI术,观察两组临床效果及并发症发生率。结果:PCI组梗死相关动脉再通率明显高于静脉溶栓组(P<0.05)。PCI组再次血运重建或补救性 PCI、心绞痛再发作率明显低于静脉溶栓组(P<0.05)。PCI组再发非致死性心肌梗死率及死亡率与静脉溶栓组比较,差异无统计学意义(P>0.05)。治疗7d后PCI组LVESD、LVEDD及LVEDD与静脉溶栓组比较,差异无统计学意义(P>0.05)。治疗14d后 PCI组 LVESD、LVEDD 及LVEDD明显优于静脉溶栓组(P<0.05)。PCI组患者出血率明显低于静脉溶栓组(P<0.05)。结论:PCI治疗发病3h内急性STEMI其梗死相关动脉的开通率更高,更有利于保护左室功能。%Objective :To investigate the effect and safety about intravenous thrombolytic therapy and direct PCI in the acute ST elevation myocardial infarction (STEMI) onset within 3 hours . Methods:In our hospital ,the STEMI cases on‐set within 3 hours were divided into the PCI group and the intravenous thrombolytic therapy group .The intravenous thrombolytic therapy group was given the urokinase treatment ,and the direct PCI group was given the direct PCI ,and the effect and incidence of complications were evaluated .Results:The recanalization of infarction related artery in the di‐rect PCI group was significantly higher than that of intravenous thrombolysis group (P0 .05) .The LVESD ,LVEDD and LVEDD after 7d treatment of the direct PCI group were same to those of the thrombolytic therapy group (P>0 .05) .The LVESD , LVEDD and LVEDD after 14d treatment of the direct PCI group was superior to those of the intravenous thrombolysis

  6. 心肌声学造影定量急性心肌梗塞后心肌血流量的实验研究%Experimental study on quantitative measurement of myocardial blood flow after acute myocardial infarction by contrast echocardiography

    Institute of Scientific and Technical Information of China (English)

    李清; 沈学东; 黄钢; 陈灏珠; 朱伟; 钱菊英; 姚瑞明

    1999-01-01

    Objective To evaluate the capability of myocardial contrast echocardiography (MCE) in quantitative measurement of myocardial perfusion.Methods Six open-chest dogs were studied 3 hours after acute left circumflex coronary occlusion by means of non-selective coronary contrast echocardiography.The sonicated 5% human albumin was used for MCE.Myocardial blood flow(MBF)was measured by radiolabeled microspheres.Background-subtracted time-intensity curves from MCE images in each segmental myocardium of the left ventricular short-axis view were derived and quantified using an off-line videodensitometric analysis system.Measurements of the curves included peak intensity(PI),area under the curve(AUC),half-time of descent(T1/2d)or ascent(T1/2a)and time to peak intensity(Tp).The results were compared with concomitant MBF.Results An excellent correlation was obtained between the index of relative perfusion(the ratio of MBF in the hypoperfused area to the perfused area)and the ratios of AUC or PI in the hypoperfused area to the perfused area(r=0.92 and 0.84 respectively,P<0.01).AUC and PI demonsrated a fair correlation with the absolute MBF(r=0.77 and 0.71 respectively,P<0.01),and could directly reflect changes in MBF.However,the remaining time parameters failed to correlate.Concl usions Regional myocardial perfusion can be accurately quantified by background-subtracted time-intensity curves derived from MCE images.Thus,it may be possible in the future to quantitatively assess collateral perfusion with MCE during coronary occlusion.%目的 评价心肌声学造影定量心肌梗塞心肌血流灌注的价值.方法 、对6条犬急性心肌梗塞模型进行心肌声学造影,采用自身对照的方法分析缺血区和非缺血区心肌显影时间.强度曲线各参数之比与心肌血流量的关系.结果 梗塞区时间-强度曲线各参数中,曲线下面积(AUC)和峰值强度(PI)与心肌相对血流量高度相关(r=0.92和0.84,P<0.01),与心肌绝

  7. Methods for blood flow measurements using ultrasound contrast agents

    Science.gov (United States)

    Fowlkes, J. Brian

    2003-10-01

    Blood flow measurements using ultrasound contrast agents are being investigated for myocardial perfusion and more recently in other organ systems. The methods are based largely on the relative increase in echogenicity due to the concentration of bubbles present in the ultrasound beam. In the simplest form, regional differences in blood volume can be inferred but the possibility exists to extract perfusion from the transit of contrast agent through tissue. Perfusion measurements rely on determining the flux of blood through a tissue volume and as such require knowledge of the fractional blood volume (FBV), i.e., ml blood/g tissue and the rate of exchange, commonly measured as the mean transit time (MTT). This presentation will discuss methods of determining each of these values and their combination to estimate tissue perfusion. Underlying principles of indicator-dilution theory will be provided in the context of ultrasound contrast agents. Current methods for determining MTT will include imaging of the intravenous bolus, in-plane contrast disruption with interval and real-time contrast recovery imaging, and control of contrast agent flow using arterial disruption (contrast interruption). The advantages and limitations of the methods will be examined along with current applications. [Work supported in part by NIH.

  8. 急性心肌梗死早期静脉及口服应用美托洛尔对心率变异性的相关研究%Related Research of Heart Rate Variability Patients with Acute Myocardial Infarction Treated by Metoprolol Early Intravenous then Oral

    Institute of Scientific and Technical Information of China (English)

    李朝晖; 廖通; 刘彩娟

    2014-01-01

    目的:探讨急性心肌梗死(AMI)早期静脉及口服应用美托洛尔对心率变异性(HRV)的影响。方法:将我院2012年1月-2012年12月收治的AMI患者100例随机分为对照组和观察组各50例,对照组予常规药物治疗,观察组在对照组治疗的基础上,予静脉及口服应用美托洛尔治疗4周,比较治疗前、后两组 HRV 的变化。结果:与治疗前比较,治疗后两组HRV指标均明显改善,但观察组的改善更明显,P均<0.05。结论:早期静脉及口服应用美托洛尔可改善AMI患者的HRV ,使失衡自主神经改善。%Objective: To investigate the effect of early intravenous then oral using of metoprolol on heart rate variability(HRV) for patient with acute myocardial infarction(AMI). Methods: 100 patients with AMI from Jan 2012 to Dec 2012 were randomly divided into observation group and control group , each group was 50 cases. The patients in observation group were treated by early intravenous then oral using of metoprolol based on control group treated by conventional drug therapy for 4 weeks. The HRV were compared between the two groups. Results: Compared with the before treatment,the HRV were significantly improved after the treatment 4 weeks in the both groups, but HRV in observation group was significantly better than that in ontrol group after the treatment , both P < 0.05. Conclusion:Early intravenous then oral using of metoprolol can effectively improve HRV of patients with AMI and improve the imbalance autonomic nervous.

  9. [Effects of intravenous transplantation of human umbilical cord blood mononuclear cells combined compound Danshen dripping pills on the microenvironment and apoptosis in the myocardium of the rabbits with acute myocardial infarction].

    Science.gov (United States)

    Yuan, Chunjun; Ai, Qi; Deng, Liuxia; Yu, Guolong

    2013-08-01

    To explore the effects of compound Danshen dripping pills (CDDP) and CDDP combined with transplantation of human umbilical cord blood cells (HUMNCs) on the inflammatory response, oxidative stress, myocardial cell apoptosis and cardiac function, and also to investigate the possible mechanisms of the combined therapy in the acute myocardial infarction (AMI). Rabbit model of AMI successfully established by ligation of the left anterior coronary artery (LAD). Forty rabbits were randomly divided into 4 groups (n=10 per group): a control group, injected with 0.5 mL of saline in 24 h after AMI and then gavaged with 5 mL of saline daily; a CDDP group, injected with saline 0.5 mL after AMI and then gavaged with CDDP (270 mg/d) daily; a transplantation group, injected with 0.5 mL of saline contained 3 × 10(7) HUCBMCs [labeled with green fluorescent protein (GFP)] and then gavaged with 5 mL of saline daily; a combined group, injected with 0.5 mL of saline contained 3 × 10(7) HUCBMCs (labeled with GFP) and then gavaged with CDDP (270 mg/d) daily. Cardiac function index such as left ventricular fractional shorting (LVFS) and ejection fraction(LVEF) were measured by echocardiography; the pathological changes were observed by HE staining and the white blood cells in the myocardium were determined by light microscopy. The superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in myocardium were detected by nitrotetrazolium blue chloride (NBT) and thiobarbituric acid colorimetric measurement respectively. The number of transplanted cells in the myocardium was examined by GFP positive cells counted with fluorescence microscopy. 1) Compared with the control group (at 1 or 4 week), LVEF and LVFS were significant improved in the CDDP group, the transplantation group and the combined groups (all Pmyocardial cell apoptosis ratio were decreased significantly in the CDDP group, the transplantation group and the combined groups (all Pmyocardial infarction area in the

  10. 多巴胺速尿持续静注在治疗老年急性心肌梗死合并泵功能不全中的临床应用%Clinical application of continuous intravenous treatment of Dopamine and Furosemide in elderly patients with acute myocardial infarction complicating pump function insufficiency

    Institute of Scientific and Technical Information of China (English)

    李健武; 潘淘涛; 周阳; 老成暖

    2013-01-01

    目的 观察多巴胺、速尿应用微泵持续静注在治疗老年急性心肌梗死(AMI)合并泵功能不全的临床效果.方法 将42例老年AMI合并泵功能不全患者分为观察组(22例)和对照组(20例),对照组应用西地兰及速尿间断静注治疗,观察组应用多巴胺、速尿微泵持续静注治疗.比较两组治疗前及治疗后48 h的心率、平均动脉压(MBP)、尿量及中心静脉压(CVP)的情况.结果 观察组在总有效率为90.9%,明显优于对照组(75.0%)(P < 0.05),并且观察组在用药后对MBP影响及利尿的效果明显优于对照组(P < 0.05或P < 0.01).结论 多巴胺速尿持续静注治疗老年AMI合并泵功能不全,合理有效,泵功能级别明显改善,应用过程中血压平稳,也无其他明显不良反应,有较好的近期疗效,是一种有较高临床价值的治疗方法.%Objective To observe the clinical effects of applying continuous intravenous treatment of Dopamine and Furosemide in elderly patients with acute myocardial infarction (AMI) complicating pump function insufficiency. Methods 42 cases of AMI complicating pump function insufficiency were divided into observation group (22 cases) and control group (20 cases). The control group was applied with intermittent intravenous therapy of Cedilanid and Furosemide, and the observation group was applied with continuous intravenous treatment of Dopamine and Furosemide. Heart rate, mean arterial blood pressure (MBP), urine output and central venous pressure (CVP) were compared between the two groups before treatment and after 48-hour treatment. Results In the observation group, the efficiency was significantly higher when compared with the control guoup (90.9% vs 75.0%,P < 0.05). And the effect on MBP and diuresis after administration in observation group was significantly better than that in the control group (P < 0.05 or P < 0.01). Conclusion The continuous intravenous treatment of Dopamine and Furosemide in AMI suffering with

  11. Evaluation of 99m Tc-MIBI myocardial perfusion imaging with intravenous infusion of adenosine triphosphate in diagnosis of coronary artery disease%静脉注射三磷酸腺苷99mTc-MIBI心肌灌注显像诊断冠心病的评价

    Institute of Scientific and Technical Information of China (English)

    何青; 姚稚明; 于雪; 屈婉莹; 孙福成; 季福绥; 许锋; 钱贻简

    2002-01-01

    目的评价三磷酸腺苷(ATP)药物负荷99mTc-MIBI 心肌灌注断层显像在诊断冠心病中的可行性、安全性和特异性.方法共263例临床诊断为冠心病的病人.所有病人都行ATP负荷的99mTc-MIBI心肌灌注显像(0.16 mg/kg/min, 5 min)检查. 在静脉注射ATP 3分钟时静脉注射20 mCi的99mTc-MIBI, 60分钟后行心肌断层显像.再于48小时后静脉注射99mTc-MIBI 20 mCi, 行静息心肌灌注断层显像.51例病人在2周内行冠状动脉造影以评价ATP介入心肌灌注断层显像诊断冠心病的准确性.在静脉注射ATP的过程中仔细地观察心脏的和非心脏的反应.结果所有病人都完成整个ATP负荷试验.尽管有58.9% 的病人有不同类型的副作用发生,但其程度都不严重.无任何病人需要氨茶碱.最为严重的副作用是II度II型房室传导阻滞(4/263 ),但其持续时间均短暂.ATP介入心肌灌注断层显像诊断冠心病的敏感性和特异性分别为97.1%和82.4%.结论对于不能完成运动试验的病人,ATP负荷心肌灌注断层显像是安全、可行的诊断冠心病的影像学技术.%Objective To evaluate the feasibility, safety and diagnostic accuracy of pharmacologic stress of 99m Technetium-MIBI single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) in patients with suspected coronary artery disease.Methods The study group included 263 patients who were suspected of having coronary artery disease. All patients underwent 99m Tc-MIBI myocardial perfusion imaging with ATP infusion (0.16 mg/kg body weight per min for 5 min). 20 mCi of 99m Tc-MIBI were injected 3 minutes after the start of ATP infusion. Myocardial SPECT images were obtained 60 minutes later. Then, two days later, 20 mCi of 99m Tc-MIBI were administered at rest and myocardial SPECT was repeated. 51 patients also underwent coronary angiography within two weeks for evaluation of sensitivity and specificity of ATP-myocardial perfusion

  12. A contrast study of clinical effects of intravenous thrombolysis therapy for men and women with acute myocardial infarction%男、女性急性心肌梗死患者溶栓疗效临床的对比

    Institute of Scientific and Technical Information of China (English)

    郑刚; 王静; 刘兆昶; 张德明; 张善春

    2001-01-01

    目的:探讨男、女性急性心肌梗死(AMI)患者静脉溶栓治疗临床近期疗效的差别.方法:冠心病监护病房(CCU)收治的且符合静脉溶栓治疗适应证、并除外禁忌证的266例AMI患者,根据性别分成女性组(A组)71例,男性组(B组)195例.两组同时给予国产尿激酶静脉溶栓治疗.结果:①男性接受静脉溶栓治疗的AMI患者,年龄较女性提前(P<0.01);②两组住院病死率差异无显著性意义(P>0.05);③男性梗死相关血管再通率高于女性(P<0.05),④两组既往史中,高血压史均较高,但两组差异无显著性意义(P>0.05),女性组糖尿病、高血脂症史显著高于男性(P<0.01),余既往史差异无显著性意义(P>0.05);⑤女性组静脉血糖、甘油三酯浓度均显著高于男性组(P<0.01、<0.05);⑥女性组心力衰竭或心源性休克,房室传导阻滞并发症明显高于男性组(P<0.05).结论:静脉溶栓治疗AMI近期疗效女性不如男性.

  13. Clinical research of intravenous and intracoronary transplantation of autologous artery bone marrow stem cells in acute myocardial infarction%经静脉和冠状动脉自体骨髓干细胞移植治疗急性心肌梗死的临床研究

    Institute of Scientific and Technical Information of China (English)

    张清队; 祁春梅; 武维恒; 许琳

    2012-01-01

    Objective To evaluate the effect of autologous bone marrow stem cell ( MSCs) transplantation in acute myocardial infarction (AMI) with different transplantation methods. Methods Thirty patients with AMI included in the cardiology department of our hospital were divided into 3 groups,with 10 cases in each group. Patients in Group 1 underwent percutaneous coronary intervention (PCI) ,Group 2 intravenous transplantation of autologous artery bone MSCs after PCI ,and Group 3 intracoronary transplantation of autologous artery bone MSCs after PCI. Echocardiogram,single photon emission computed tomography and Six -Minute Walk Test were carried out between transplantation and discharge . Results The heart function of patients was improved significantly in both Group 2 and 3(P 0.05). Difference between Group 2 and 3 was not significant (P > 0.05). The single photon emission computed tomography (SPECT) demonstrated significant improvement in myocardial metabolism imaging after transplantation of MSCs in Group 2 and 3. Six-Minute Walk Test results elevated significantly six months after MSCs transplantation compared with pre -transplantation (P 0.05 ). Conclusions Autologous bone MSCs transplantation for AMI is safe and effective . Intravenous and intracoronary transplantation show no statistically signifi -cant difference in curative effect.%目的 比较不同输入途径对骨髓干细胞(Bone Marrow Stem Cells,MSCs)移植治疗急性心肌梗死(Acute Myocardial Infarction,AMI )效果的影响.方法 入选我院心内科 AMI 住院患者 30 例分成 3 组,每组 10 例.1 组单纯经皮冠状动脉 介入术(Percutaneous Coronary Intervention,PCI),2 组 PCI 后经静脉行 MSCs 移植,3 组 PCI 后经冠脉行 MSCs 移植.出院前及 移植后定期复查心脏彩超、心肌单光子发射计算机断层扫描(Sigle-photon Emission Computed Tomography,SPECT)及 6 分钟步 行试验.结果 ①心脏彩超显示三组术后心功能均好转,术后 6 月与移植前比

  14. Intracoronary adenosine improves myocardial perfusion in late reperfused myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background Myocardial perfusion associates with clinical syndromes and prognosis.Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours,but few data are available on late perfusion of myocardial infarction (MI).This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography(MCE).Methods Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups:adenosine group(n=12) and normal saline group(n=14).Their history of myocardial infarction was about 3-12 weeks.Adenosine or normalsaline was given when the guiding wire crossed the lesion through percutaneous coronary intervention(PCI),then the balloon was dilated and stent(Cypher/Cypher select)was implanted at the lesion.Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI.Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software.Heart function and cardiac events were followed up within 30 days.Results Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group(5.71±0.29 vs 4.95±1.22,P<0.05).Ischemic myocardial segment was deminished significantly afterPCI,but the meliorated area was bigger in the adenosine group than in the saline group((1.56±0.60)cm2 vs(1.02±0.56) cm2,P<0.05).The video densitometry in critical segments was also improved significantly in the adenosine group (5.53±0.36 vs 5.26±0.35,P<0.05).Left ventricular ejection fraction(LVEF)was improved in all patients after PCI,but EF was not significant between the two groups((67±6)% vs(62±7)%,P>0.05).There was no in-hospital or 30-day major adverse cardiac event(MACE)in the adenosine group but 3 MACE in the saline group in 30 days after PCI.Conclusions Adenosine could improve myocardial microvascular

  15. Effects of intravenous transplantation of human umbilical cord blood mononuclear cells combined with perindopril on inflammatory response of acute myocardial infarction%人脐血单个核细胞静脉移植联合培哚普利对急性心肌梗死炎症反应的影响★

    Institute of Scientific and Technical Information of China (English)

    邓柳霞; 余国龙; 艾旗; 袁春菊

    2013-01-01

    促炎因子白细胞介素6水平表达作用增强有关。%BACKGROUND:A recent study has indicated that angiotensin-converting enzyme inhibitor, perindopril, combined with transplantation of bone marrow-derived mesenchymal stem cel s can reduce inflammatory response in the injured myocardium associated with enhanced improvement of cardiac function in an animal model of acute myocardial infarction. OBJECTIVE:To observe the effects of intravenous transplantation of human umbilical cord blood mononuclear cel s combined with perindopril on the inflammatory responses and pro-inflammatory cytokine interleukin-6 expression as wel as the cardiac function in rabbits with acute myocardial infarction, and to investigate the possible protective mechanism of the combination treatment for acute myocardial infarction. METHODS:The human umbilical cord blood mononuclear cel s were obtained from healthy ful-term delivery maternal cord blood. Sixty healthy rabbits were selected to establish the models of acute myocardial infarction, and the models were divided into four groups randomly:control group, perindopril group, simple transplantation group and combination group. Five rabbits were selected from each group to detect the cardiac function index of left ventricular ejection fraction and left ventricular fractional shortening with echocardiography at 1, 2 and 4 weeks after treatment. Hematoxylin-eosin staining was performed to observe the myocardial pathological changes and white blood cel count under light microscope. The protein expression of interleukin-6 in myocardial tissue was detected with immunohistochemistry. The number of green fluorescent protein-positive cel s was observed under fluorescence microscope. RESULTS AND CONCLUSION:Compared with the control group, left ventricular ejection fraction and left ventricular fractional shortening were significantly improved in the perindopril group, simple transplantation group and combination group at 1, 2 and 4 weeks respectively after the treatment (P<0

  16. Intravenous paracetamol (acetaminophen).

    Science.gov (United States)

    Duggan, Sean T; Scott, Lesley J

    2009-01-01

    Intravenous paracetamol (rINN)/intravenous acetaminophen (USAN) is an analgesic and antipyretic agent, recommended worldwide as a first-line agent for the treatment of pain and fever in adults and children. In double-blind clinical trials, single or multiple doses of intravenous paracetamol 1 g generally provided significantly better analgesic efficacy than placebo treatment (as determined by primary efficacy endpoints) in adult patients who had undergone dental, orthopaedic or gynaecological surgery. Furthermore, where evaluated, intravenous paracetamol 1 g generally showed similar analgesic efficacy to a bioequivalent dose of propacetamol, and a reduced need for opioid rescue medication. In paediatric surgical patients, recommended doses of intravenous paracetamol 15 mg/kg were not significantly different from propacetamol 30 mg/kg for the treatment of pain, and showed equivocal analgesic efficacy compared with intramuscular pethidine 1 mg/kg in several randomized, active comparator-controlled studies. In a randomized, noninferiority study in paediatric patients with an infection-induced fever, intravenous paracetamol 15 mg/kg treatment was shown to be no less effective than propacetamol 30 mg/kg in terms of antipyretic efficacy. Intravenous paracetamol was well tolerated in clinical trials, having a tolerability profile similar to placebo. Additionally, adverse reactions emerging from the use of the intravenous formulation of paracetamol are extremely rare (<1/10 000). [table: see text].

  17. Pharmacokinetics and pharmacodynamics of intravenous inotropic agents.

    Science.gov (United States)

    Lehtonen, Lasse A; Antila, Saila; Pentikäinen, Pertti J

    2004-01-01

    Positive inotropic drugs have various mechanisms of action. Long-term use of cyclic adenosine monophosphate (cAMP)-dependent drugs has adverse effects on the prognosis of heart failure patients, whereas digoxin has neutral effect on mortality. There are, however, little data on the effects of intravenous inotropic drugs on the outcome of patients. Intravenous inotropic agents are used to treat cardiac emergencies and refractory heart failure. beta-Adrenergic agonists are rapid acting and easy to titrate, with short elimination half-life. However, they increase myocardial oxygen consumption and are thus hazardous during myocardial ischaemia. Furthermore they may promote myocyte apoptosis. Phosphodiesterase (PDE) III inhibiting drugs (amrinone, milrinone and enoximone) increase contractility by reducing the degradation of cAMP. In addition, they reduce both preload and afterload via vasodilation. Short-term use of intravenous milrinone is not associated with increased mortality, and some symptomatic benefit may be obtained when it is used in refractory heart failure. Furthermore, PDE III inhibitors facilitate weaning from the cardiopulmonary bypass machine after cardiac surgery. Levosimendan belongs to a new group of positive inotropic drugs, the calcium sensitisers. It has complex pharmacokinetics and long-lasting haemodynamic effects as a result of its active metabolites. In comparative trials, it has been better tolerated than the most widely used beta-agonist inotropic drug, dobutamine. The pharmacokinetics of the intravenous inotropic drugs might sometimes greatly modify and prolong the response to the therapy, for example because of long-acting active metabolites. These drugs display considerable differences in their pharmacokinetics and pharmacodynamics, and the selection of the most appropriate inotropic drug for each patient should be based on careful consideration of the clinical status of the patient and on the pharmacology of the drug.

  18. Repetitive Myocardial Infarctions Secondary to Delirium Tremens

    Directory of Open Access Journals (Sweden)

    David Schwartzberg

    2014-01-01

    Full Text Available Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.

  19. Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel intervention-meta-analysis of randomized trials and risk prediction modeling study using observational data.

    Science.gov (United States)

    Chatterjee, Saurav; Kundu, Amartya; Mukherjee, Debabrata; Sardar, Partha; Mehran, Roxana; Bashir, Riyaz; Giri, Jay; Abbott, Jinnette D

    2017-08-01

    Ascertaining risk of contrast induced acute kidney injury (CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing multi-vessel percutaneous coronary intervention (MV-PCI). Complete revascularization may improve outcomes in STEMI patients with multi-vessel disease. However, a practice of MV-PCI may be associated with a higher risk of CI-AKI. We aimed to evaluate the risk of CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a validated risk score. We searched PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI and infarct-related artery (IRA) only PCI during index hospitalization. A random effects model was used to estimate the risk ratio (RR) and respective 95% confidence intervals (CI). We queried the Nationwide Inpatient Sample (NIS) to assess the ability of the Mehran risk score to accurately predict the incidence of CI-AKI in patients undergoing MV-PCI. Four randomized studies (N = 1,602) were included in the final analysis. The risk of CI-AKI was low and no difference was observed with MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57; P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI for STEMI patients in the NIS. The Mehran risk score accurately discriminated 78% of the patients who developed CI-AKI in this cohort (c-statistic of 0.78, P = 0.002). MV-PCI in STEMI is not associated with a higher risk of CI-AKI and the Mehran risk score can identify patients at higher risk for this complication. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Intravenous nitroglycerin-induced heparin resistance: a qualitative antithrombin III abnormality.

    Science.gov (United States)

    Becker, R C; Corrao, J M; Bovill, E G; Gore, J M; Baker, S P; Miller, M L; Lucas, F V; Alpert, J A

    1990-06-01

    An ability of intravenous nitroglycerin to interfere with the anticoagulant properties of intravenous heparin would have profound clinical implications. To investigation nitroglycerin-heparin interactions, the following pilot study was performed. Patients (N = 18) admitted to the coronary care unit with a diagnosis of either acute myocardial infarction or unstable angina were divided into four treatment groups: (1) intravenous nitroglycerin and intravenous heparin; (2) intravenous nitroglycerin alone; (3) intravenous heparin alone; or (4) neither intravenous nitroglycerin nor intravenous heparin. Serial determinations of activated partial thromboplastin time (APTT), serum heparin concentration, antithrombin III (ATIII) antigen (ATA), and ATIII activity (ATC) were obtained over a 72-hour period. Overall, patients receiving intravenous nitroglycerin did not differ significantly from other patients in APTT, heparin dose, heparin concentration, ATA, ATC, or ATA/ATC ratio (ATR). However, patients receiving intravenous nitroglycerin at a rate exceeding 350 micrograms per minute had a lower APTT (p less than 0.05), lower ATC (p = 0.02), higher ATR (p = 0.004), and a larger heparin dose requirement than patients receiving lower infusion rates. ATR correlated directly (r = 0.91; p less than 0.05) and ATC inversely (r = -0.78; p less than 0.05) with the intravenous nitroglycerin dose. Serum heparin concentration did not correlate with the intravenous nitroglycerin dose. Intravenous nitroglycerin-induced heparin resistance occurs at a critical nitroglycerin dose. A nitroglycerin-induced qualitative ATIII abnormality may be the underlying mechanism.

  1. Myocardial disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920666 Immunocytochemical study ofCuZn superoxide dismutase in the myocardi-um of normal subjects and patients ofrheumatic heart disease.ZHENG Yi(郑毅),et al. Dept Intern Med, Navy General Hosp,PLA, Beijing. 100037. Natl Med J China 1992;72(4): 225-227. By using the methods of immunocytochemistry

  2. Protective effect of continuous intravenous infusion of Isoproterenol on myocardial mitochondria of early septic rats and the corresponding mechanism%持续输注异丙肾上腺素对早期脓毒症大鼠心肌线粒体的保护作用及其机制

    Institute of Scientific and Technical Information of China (English)

    谢美燕; 项丹; 吕娟娟; 郑贵浪; 黄锦达; 刘翠; 曾其毅

    2015-01-01

    Objective To investigate the protective effect of continuous intravenous infusion of Isoproterenol (ISO)on myocardial mitochondria of early septic rats and the corresponding mechanism.Methods Thirty Sprague Dawley (SD)rats were randomly divided into 5 groups (6 cases per group):control group,endotoxin group,ISO small-dose group,ISO medium-dose group and ISO large-dose group.Endotoxin group and ISO intervene group received same management apart from drug intervention:receiving intravenous injection of lipopolysaccharide (LPS)10 mg/kg followed by an continuous intravenous infusion of 9 g/L saline 1 mL/h or ISO 0.06 μg/(kg · min),0.30 μg/(kg · min)and 0.60 μg/(kg · min).Control group received intraperitoneal injection and continuous intravenous infusion with the same amount of 9 g/L saline.The primary endpoint of the study was 24 hours after injection of 9 g/L saline or LPS.Serum creatine kinase (CK) and creatine kinase isoenzyme (CK-MB),oxidative and nitrosative stress levels and swelling of isolated heart mitochondrion were detected.The pathological changes of the myocardium and morphologic changes of the heart mitochondria were observed through light microscope and scanning electron microscope,respectively.Results The levels of CK,CK-MB,nitric oxide (NO) content,inducible nitric oxide synthase (iNOS) activity and malondialdehyde (MDA)content in endotoxin group were increased compared with control group (all P < 0.05),while the superoxide dismutase (SOD) activity decreased [(11.543 ± 1.080) U/mg prot vs (9.892 ±0.815) U/mg prot,P <0.05].The morphology of the heart mitochondria significantly changed (such as swelling,disordered arrangement,crest fracture,fusion and cavitations,and so on).ISO intervention significantly decreased the levels of CK,CK-MB and mitochondrial swelling (all P < 0.05) and increased the SOD activity (all P < 0.05).The levels of NO content,iNOS activity and MDA content were significantly decreased in small-dose group [(10.823

  3. Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion.

    Science.gov (United States)

    Caliskan, A; Yavuz, C; Karahan, O; Yazici, S; Guclu, O; Demirtas, S; Mavitas, B

    2014-05-01

    Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia. Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis. Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade II myocardial tissue specimens and one grade I myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022). Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.

  4. Effect of strain rate imaging on the assessment of left ventricular regional systolic myocardial function before and after intravenous thrombolytic therapy in patients with acute myocardial infarction%应变率成像评价急性心肌梗死患者溶栓前后左室局部收缩功能48例分析

    Institute of Scientific and Technical Information of China (English)

    魏天辉

    2010-01-01

    @@ 治疗急性心肌梗死(acute myocardial infarction,AMI)的治疗关键是及早开通梗死相关血管,而紧急溶栓是目前治疗AMI的重要方法,但部分患者于血管再通后心肌再灌注障碍,影响心脏功能及临床预后.应变率显像技术(strain rate imaging,SRI)是新近发展起来的一种无创、可定量评价局部室壁运动的超声心动图新方法[1].我们采用SRI技术观察心肌梗死溶栓治疗前后左室局部收缩功能的变化,探讨其临床价值.

  5. The effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction:a Meta analy-sis%早期静脉应用β受体阻滞剂对急性心肌梗死患者预后影响的 Meta 分析

    Institute of Scientific and Technical Information of China (English)

    王丹宁; 陈鹏飞; 黄颖; 陈侃; 王磊; 廖德宁

    2015-01-01

    目的:系统评价再灌注时心肌梗死后早期静脉应用β受体阻滞剂对患者预后的影响。方法检索Pubmed、Embase、Cochrane 图书馆、中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库,收集比较再灌注背景下心肌梗死后早期静脉使用β受体阻滞剂(试验组)不使用或者使用安慰剂(对照组)对患者预后影响的研究。主要观察指标为短期及长期的全因病死率及恶性心律失常、心肌再梗死、心源性休克等发生率。采用Revman5.2软件对提取的数据进行荟萃分析。结果纳入8项临床研究,共48367例患者。 Meta分析显示,试验组与对照组相比,心肌梗死患者恶性室性心律失常发生率下降(OR=0.83,95%CI 0.75~0.93, P =0.0009);心源性休克、心力衰竭发生率增加(OR=1.29,95%CI 1.18~1.41, P <0.01),2组心肌梗死患者全因病死率、再梗死、缺血等不良事件发生率差异无统计学意义(OR=0.98 ,95%CI 0.92~1.05, P =0.63;OR=0.95 ,95%CI 0.88~1.03, P =0.21)。结论在心肌梗死早期静脉给予β受体阻滞剂可以降低梗死后恶性室性心律失常发生率,但同时也有增加心源性休克、心力衰竭发生的风险,在改善病死率方面没有明显获益。%Objective To evaluate the effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction( AMI) .Methods Searched on PubMed, Embase, Cochrane library, CNKI, Wanfang Data,VIP journal resources integration service platform, the Chinese biomedical literature database, collected and compared AMI reperfusion pa-tients received early intravenous beta blockers ( test group) and does not use beta blockers or placebo ( control group) to study the impact on prognosis.Main outcome measurements included short-term and long-term all

  6. Enhanced homing of bone-marrow derived mesenchymal stem cells on rabbit myocardial ischemia by intravenous injection of mesenchymal stem cells under the mediation of diagnostic ultrasound and microbubbles%诊断超声联合微泡增强骨髓间充质干细胞归巢兔缺血心肌的研究

    Institute of Scientific and Technical Information of China (English)

    徐亚丽; 高云华; 方针强; 谭开彬; 刘政; 杨希

    2008-01-01

    Objective To explore the targeting homing capacity of bone-marrow derived mesenchymal stem eells(MSCs) on rabbit myocardial ischemia by intravenous injection of MSCs under the mediation of diagnostic ultrasound and microbubble. Methods Density gradient centrifugation and adherent culture method were used in the isolation and cultivation of MSCs. MSCs were labeled with DAPI. Rabbit myocardial infarction(MI) models were builded by totally ligation of left anterior descending branch of coronary artery. DAPI labeled MSCs were implanted by intravenous injection with or without the mediation of diagnostic ultrasound and microbubbles. Forty-eight hours after cell transplantation, the hearts of MI rabbits were made of frozen section and observed under fluorescent microscope. The DAPI positive cells were counted in the MI and border area of rabbit heart and compared between two groups. Pathological changes of MI area were observed with HE staining under light microscope and transmission electronic microscope. Results The number of DAPI positive cells in MI and border area of rabbit in both groups were counted under fluorescent microscope. There were more DAPI positive cells in the MI area in ultrasound + microbubble + MSCs group (213.2±26.5) than that in the intravenous injection group (146.8±18.78, P<0.01). There were erythrocytes leaking out of the vessels in MI area in HE staining section under light microscope in ultrasound + microbubble + MSCs group while there were nearly none in the intravenous injection MSCs group. The intercellular space of endothelial cells of the vessels wall was increased and serum component leaked out of the vessel wall in ultrasound + microbubble + MSCs under transmission electronic microscope. Conclusions The targeted homing capacity of BM-MSCs in the MI area of rabbit heart can be enhanced under the mediation of diagnostic ultrasound and microbubbles.%目的 探讨诊断超声联合微泡对经静脉移植兔骨髓间充质干细胞(BM

  7. Assessment of myocardial fibrosis and coronary arteries in hypertrophic cardiomyopathy using combined arterial and delayed enhanced CT: comparison with MR and coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Lei; Ma, Xiaohai; Zhang, Chen; Liu, Yi; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); DeLano, Mark C. [Michigan State University, Division of Radiology and Biomedical Imaging, College of Human Medicine, Lancing, MI (United States); Jiang, Tengyong [Capital Medical University, Department of Cardiology, Beijing Anzhen Hospital, Beijing (China)

    2013-04-15

    We sought to determine the feasibility and accuracy of dual-source computed tomography (DSCT) in assessing coronary artery disease and myocardial fibrosis of hypertrophic cardiomyopathy (HCM) compared with cardiac magnetic resonance (CMR) imaging and coronary angiography (CA). Forty-seven consecutive patients with HCM were prospectively enrolled. DSCT images were acquired in the arterial and late phases following intravenous contrast medium. The CMR and CA were performed within 7 days. Independent blinded readers read each study. Patients were classified according to myocardial delayed enhanced (MDE) CMR, coronary artery stenosis by CA, and arterial and MDE-DSCT. The diagnostic accuracy of DSCT in detecting coronary stenosis and MDE was analysed. Wall thickness determined by DSCT was strongly correlated with MR results (r = 0.91). DSCT and CMR MDE showed substantial agreement for the detection of myocardial fibrosis on per-patient and per-segment levels. The CT classification of patients by arterial stenosis and delayed enhancement had excellent agreement with MR and CA methods. The comprehensive cardiac CT examination provides reliable coronary artery and myocardial assessments. MDE-DSCT is a robust alternative method to MDE-CMR in assessing myocardial fibrosis in HCM particularly in patients with pacemakers or other contraindications to CMR. (orig.)

  8. Measuring myocardial perfusion

    DEFF Research Database (Denmark)

    Qayyum, A A; Kastrup, J

    2015-01-01

    -pass of non-ionic and ionic contrast agents, respectively. Absolute quantification with CMR has yet to be established in routine clinical practice, while CT has yet to prove its diagnostic and prognostic value. The upcoming years may change the way we diagnose and treat patients suspected of having CAD......Recently, focus has changed from anatomical assessment of coronary arteries towards functional testing to evaluate the effect of stenosis on the myocardium before intervention. Besides positron-emission tomography (PET), cardiac MRI (CMR), and cardiac CT are able to measure myocardial perfusion...

  9. 白细胞靶向心肌超声造影技术评价心脏移植后急性排斥反应的研究%Evaluation of acute cardiac transplant rejection with targeted myocardial contrast echocardiography

    Institute of Scientific and Technical Information of China (English)

    董静; 张平洋; 方玲玲; 黄福华; 汪黎明; 赵有财; 王劲松

    2010-01-01

    Objective To discuss the value of leukocyte-targeted myocardial contrast echocardiography (MCE) as a tool in observing the degree of acute rejection after heart transplantation. Methods Abdominal heterotopic cardiac transplantation was performed on 32 rats successfully, among which 8 isografts served as group A, and groups B, C and D involved 8 allografts respectively. The rats in groups B and C were treated with cyclosporine A (CsA) at a high dose (10mg· kg-1 · day-1 ), a low dose (3 mg · kg-1 · day-1 ) from 3rd day before transplantation respectively.The rats in groups A and D were untreated with CsA. MCE was performed during continuous intravenous SonoVue injection postoperatively on the third day after operation. We performed 2 types of MCE: perfusion imaging and leukocyte-targeted imaging. The images were obtained at 20 s and 5 min after injection of contrast agent. The value of the contrast image grayscale (GS) was measured by image analyzer (GS20s, GS5 min). GStarget was calculated as the GS5min minus the GS20s in the same rat.Postmortem histology was performed after observation. The degree of myocardial rejection was determined by HE-stained graft myocardium. Immunohistochemistry was performed to quantify the CD3-positive cells, and correlation analysis was performed between CD3-positive cell count and GS20s,GS5min, GStarget. Results Perfusion imaging showed no significant difference in myocardial GS20s of each group. Leukocyte-Targeted imaging exhibited a clear gradient in these groups (P<0. 05). There was significant difference in GStarget of each group (P<0. 001). Postmortem histology showed 0- Ⅰ grade rejection in group A, Ⅰ -Ⅱ grade rejection in group B, Ⅱ-Ⅲ grade rejection in group C, Ⅲ-Ⅳ grade rejection in group D. Immunohistochemistry revealed the CD3-positive cell infiltration was increased in turn from the group A to the group D. There was a significantly positive correlation between the CD3-positive cell count and GStarget

  10. Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry.

    Directory of Open Access Journals (Sweden)

    Sang-Don Park

    Full Text Available Besides contrast-induced acute kidney injury(CI-AKI, adscititious vital organ damage such as hypoxic liver injury(HLI may affect the survival in patients with ST-elevation myocardial infarction (STEMI. We sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI.A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years from the INTERSTELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as an increase of ≥0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after the index procedure. HLI was defined as ≥2-fold increase in serum aspartate transaminase above the upper normal limit on admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE defined as a composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded.Over a mean follow-up period of 2.2±1.6 years, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in the no organ damage group; 21.3% and 21.3% in CI-AKI group; 18.5% and 14.6% in HLI group; and 57.7% and 50.0% in combined CI-AKI and HLI group. Survival probability plots of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI group was associated with the worst prognosis (p<0.0001 for both.Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR ClinicalTrials.gov number, NCT02800421..

  11. Nitrogen-13-labeled ammonia for myocardial imaging

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, W.F.; Fill, H.R.; Harper, P.V.

    1977-01-01

    Cyclotron-produced nitrogen-13 (half-life 10 min), as labeled ammonia (/sup 13/NH/sub 4//sup +/), has been evaluated as a myocardial perfusion imaging agent. The regional myocardial uptake of /sup 13/NH/sub 4//sup +/ has been shown to be proportional to regional tissue perfusion in animal studies. Intravenously administered /sup 13/NH/sub 4//sup +/ is rapidly cleared from the circulation, being extracted by the liver (15 percent), lungs, myocardium (2 percent--4 percent), brain, kidney, and bladder. Myocardial ammonia is metabolized mainly to glutamine via the glutamine synthetase pathway. Pulmonary uptake is substantial, but usually transient, except in smokers where clearance may be delayed. The positron annihilation irradiation (511 keV) of /sup 13/N may be imaged with a scintillation camera, using either a specially designed tungsten collimator or a pinhole collimator. After early technical problems with collimation and the production method of /sup 13/NH/sub 4//sup +/ were overcome, reproducible high quality myocardial images were consistently obtained. The normal myocardial image was established to be of a homogeneous ''doughnut'' configuration. Imaging studies performed in patients with varying manifestations of ischemic and valvular heart disease showed a high incidence of localized perfusion defects, especially in patients with acute myocardial infarction. Sequential studies at short intervals in patients with acute infarction showed correlation between alterations in regional perfusion and the clinical course of the patient. It is concluded that myocardial imaging with /sup 13/NH/sub 4//sup +/ and a scintillation camera provides a valid and noninvasive means of assessing regional myocardial perfusion. This method is especially suitable for sequential studies of acute cardiac patients at short intervals. Coincidence imaging of the 511 keV annihilation irradiation provides a tomographic and potentially quantitative assessment of the

  12. Contrast Materials

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Contrast Materials What are contrast materials and how do they ... material? Pregnancy and contrast materials What are contrast materials and how do they work? Contrast materials, also ...

  13. Influence of delayed ST-segment re-elevation on prognosis after successful intravenous thrombolysis in female patients with acute myocardial infarction%女性急性心肌梗死静脉溶栓后ST段再抬高对预后的影响

    Institute of Scientific and Technical Information of China (English)

    张宏伟; 许虹; 李元红; 及心

    2012-01-01

    Objective To investigate the influence of delayed ST-segment re-elevation on prognosis after successful intravenous thrombolysis in female patients with acute myocardial infarction ( AMI ). Methods The female AMI patients ( n = 106 ) with successful intravenous thrombolysis within 6 hours after disease onset were selected and divided into group of ST-segment re-elevation ( re-elevation group,n = 38 ) and group without ST-segment re-elevation ( control group, re = 68 ) according to whether there was ST-segment elevation 12 hours after successful intravenous thrombolysis. The peak value and peak time of creatine kinase-MB ( CK-MB ) were monitored in two groups. In one week,two weeks,one month,three months and six months after intravenous thrombolysis,the changes of ECG,dynamic ECG and echocardiography were re-examined. Within six months,6-minute walk test was reviewed every month. All the above indexes were compared between two groups. Results In re-elevation group, age, proportion of complicated hypertension , diabetes, hyperlipidemia and obesity, and peak value of CK-MB were all significantly higher than those in control group ( all P <0. 05 ). The degree of shift forward in peak time of CK-MB was lower in re-elevation group than that in control group ( P < 0. 05 ). The incidence and mortality of malignant arrhythmia, heart failure and ventricular an-eurysm were significantly higher in re-elevation group than those in control group ( P < 0.05 ). The values of left ventricular ejection fraction ( LVEF ) and 6-minute walk test were lower in re-elevation group than those in control group ( P <0. 05 ). Conclusion The incidence and mortality of malignant arrhythmia, heart failure and ventricular aneurysm are higher in female AMI patients with delayed ST-segment re-elevation after successful intravenous thrombolysis and the prognosis is poor.%目的 探讨女性急性心肌梗死(AMI)静脉溶栓成功后ST段延迟性再抬高对预后的影响.方法 入选发病6 h

  14. Myocardial Infarction Type 2 and Myocardial Injury

    DEFF Research Database (Denmark)

    Sandoval, Yader; Thygesen, Kristian

    2017-01-01

    BACKGROUND: The development and implementation of sensitive and high-sensitivity cardiac troponin assays has not only expedited the early ruling in and ruling out of acute myocardial infarction, but has also contributed to the identification of patients at risk for myocardial injury with necrosis......, as confirmed by the presence of cardiac troponin concentrations above the 99th percentile. Myocardial injury with necrosis may occur either in the presence of overt ischemia from myocardial infarction, or in the absence of overt ischemia from myocardial injury accompanying other conditions. Myocardial...... infarction type 2 (T2MI) has been a focus of attention; conceptually T2MI occurs in a clinical setting with overt myocardial ischemia where a condition other than an acute atherothrombotic event is the major contributor to a significant imbalance between myocardial oxygen supply and/or demand. Much debate...

  15. Pain management in emergency department: intravenous morphine vs. intravenous acetaminophen

    Directory of Open Access Journals (Sweden)

    Morteza Talebi Doluee

    2015-01-01

    Full Text Available Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting.In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine.It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphine.

  16. Application of Contrast Echocardiography in Invasive Cardiology

    Directory of Open Access Journals (Sweden)

    Mustafa Bulut

    2010-12-01

    Full Text Available Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in demonstrating myocardial viability after reperfusion treatment in patients who had myocardial infarction. It is expected to be used more widely in invasive cardiology for decision making, guiding and determining the success of the procedures. Advances in imaging techniques , development of contrast materials for evaluation of left system, contrast echocardiography may become a routine clinical practice.

  17. Cardiac MRI for myocardial ischemia.

    LENUS (Irish Health Repository)

    Daly, Caroline

    2013-01-01

    Proper assessment of the physiologic impact of coronary artery stenosis on the LV myocardium can affect patient prognosis and treatment decisions. Cardiac magnetic resonance imaging (CMR) assesses myocardial perfusion by imaging the myocardium during a first-pass transit of an intravenous gadolinium bolus, with spatial and temporal resolution substantially higher than nuclear myocardial perfusion imaging. Coupled with late gadolinium enhancement (LGE) imaging for infarction during the same imaging session, CMR with vasodilating stress perfusion imaging can qualitatively and quantitatively assess the myocardial extent of hypoperfusion from coronary stenosis independent of infarcted myocardium. This approach has been validated experimentally, and multiple clinical trials have established its diagnostic robustness when compared to stress single-photon emission computed tomography. In specialized centers, dobutamine stress CMR has been shown to have incremental diagnostic value above stress echocardiography due to its high imaging quality and ability to image the heart with no restriction of imaging window. This paper reviews the technical aspects, diagnostic utility, prognostic values, challenges to clinical adaptation, and future developments of stress CMR imaging.

  18. Application of Contrast Echocardiography in Invasive Cardiology

    OpenAIRE

    2010-01-01

    Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature) and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in de...

  19. 心肌声学造影评价大鼠心脏移植急性排斥反应模型心肌血流灌注的动态变化%Dynamic myocardial perfusion in acute rejection models of rats following heart transplantation with myocardial contrast echocardiography

    Institute of Scientific and Technical Information of China (English)

    华兴; 吴蔚; 卓丽莎; 丁俊; 何芸; 陈朝辉

    2012-01-01

    Objective To assess the value of myocardial contrast echocardiography ( MCE ) for the myocardial perfusion of acute rejection in rats following heart transplantation. Methods Twenty-three male Brown Norway rats aged 12 - 15 weeks with a BMI of 143 ±23 g were used as allograft donors, and 53 male Lewis rats aged 12-15 weeks with a BMI of 158 ±19 g were used as allograft recipients (n - 23 ) , isograft donors (re = 15) and recipients (re = 15) in this study. Rat heart transplantation models were established by transplanting allograft in 23 rats and by transplanting isograft in 15 rats. Thirty established transplanted rats were divided into 3 groups on days 2, 4 and 6 with 6 allografts and 4 isografts in each, and then underwent MCE. Automatic fitting curve was plotted. A, β and A × β values were compared among 3 groups and between allograft and isograft transplantation groups. Results The rat heart transplantation models were successfully established in 18 allograft rats and in 12 isograft rats. The A, β and A X β values were significantly lower in allograft transplantation group on day 6 after transplantation ( 15. 87 ± 4. 20, 0. 320 ± 0. 019, 4. 974 ± 1. 355 , P<0.05,P<0.01) and in isograft transplantation group on day 2 than on days 4 and 6 after transplantation (21.71 ±0.017, 0.365 ±0.013, 7.908 ±0.374, P<0.05). A significant difference was found in the A and p values between allograft and isograft transplantation groups on day 6 after transplantation (P <0. 05) and the A × β value was significantly different on day 4, especially on day 6, after transplantation (P <0. 05, P < 0. 01) . Conclusion MCE can show the gradually decreasing myocardial perfusion characteristics of ischemia/ reperfusion and acute rejection in rats following heart transplantation, and can thus be used in the diagnosis and  monitoring of acute rejection, in which the A ×β value is a rather sensitive index.%目的 评价心肌声学造影在检测大鼠心脏移植急性

  20. Measurement of myocardial perfusion using magnetic resonance

    DEFF Research Database (Denmark)

    Fritz-Hansen, T.; Jensen, L.T.; Larsson, H.B.

    2008-01-01

    Cardiac magnetic resonance imaging (MRI) has evolved rapidly. Recent developments have made non-invasive quantitative myocardial perfusion measurements possible. MRI is particularly attractive due to its high spatial resolution and because it does not involve ionising radiation. This paper reviews...... myocardial perfusion imaging with MR contrast agents: methods, validation and experiences from clinical studies. Unresolved issues still restrict the use of these techniques to research although clinical applications are within reach Udgivelsesdato: 2008/12/8...

  1. COMPARATIVE EXPERIMENTAL STUDY OF HO-YAG LASER AND TRUE-CUT BIOPSY NEEDLE IN MYOCARDIAL REVASCULARIZATION

    Institute of Scientific and Technical Information of China (English)

    王立清; 胡盛寿; 常欣; 吴清玉; 李澎; 謝峰; 郭加强

    2001-01-01

    Objective. To study the mechanism and effects of blood perfusion on acute ischemic region of myocardium through channel created by Ho-Yag laser and True-cut biopsy needles with myocardial contrast echocardiography.``Methods. We partially ligated the left anterior descending coronary artery of canine hearts between the 1st and 2nd diagonal branches to produce two groups of acute myocardial ischemia models and then performed transmvocardial revascularization (TMR) on this region with Ho-Yag laser and True-cut biopsy needles. Myocardial contrast echocardiography was performed with a new generation of ultrasound contrast agent and second harmonic imaging of this region before, during ischemia and after revascularization. Pictures were taken with "R" wave trig ger skill.``Results. Acoustic density (dB) in the ischemic region (anterior wall) with myocardial contrast echocardiography decreased obviously after the left anterior descending artery was ligated (Laser group: 5.40 ± 1.81, Needle group: 7.11 ±2.51) compared with that before (Laser group: 11.69 ± 1.61, Needle group: 12. 96 ±2.88,P < 0. 01 ) . dB inreased remarkably after TMR by either laser or True-cut biopsy needle (Laser group:11.02 ± 2.01, Needle group: 10. 01 ± 4.45. P < 0. 01 ) compared to that during ischemia and approximated to that before ischemia ( P > 0. 05). We found that the acoustic density of the contrast developed one picture (one cardiac cycle) ahead in the transmyocardial revascularization region than that in the lateral and other region of the left ventricle wall in the scan of both groups.``Conclusions. Acute ischemic myocardium can be perfused immediately by oxygenated blood from the left ventricle through channels created with both Ho-Yag laser and True-cut biopsy needles. Evidence of blood perfusion through these channels mainly during systolic phase was detected, and myocardial contrast ultrasound using intravenous perfluorocarbon-exposed sonicated dextrose albumin was regarded

  2. Mechanism of reduced myocardial glucose utilization during acute hypertriglyceridemia in rats.

    Science.gov (United States)

    Ménard, Sébastien L; Ci, Xiuli; Frisch, Frédérique; Normand-Lauzière, François; Cadorette, Jules; Ouellet, René; Van Lier, Johannes E; Bénard, François; Bentourkia, M'hamed; Lecomte, Roger; Carpentier, André C

    2009-01-01

    The purpose of the research is to study the effect of acute inhibition of intravascular lipolysis on myocardial substrate selection during hypertriglyceridemia using in vivo radiotracer analysis and positron emission tomography. We induced acute hypertriglyceridemia in vivo using an intravenous infusion of Intralipid 20% (IL) without and with acute inhibition of fatty acid delivery from circulating triglycerides with injection of Triton WR-1339 (TRI) during a euglycemic-hyperinsulinemic clamp in Wistar rats. We determined the effect of TRI on myocardial uptake of circulating triglycerides and free fatty acids using intravenous injection of [(3)H]-triolein and [(14)C]-bromopalmitate, respectively. Myocardial blood flow, oxidative metabolism, and metabolic rate of glucose (MMRG) were determined using micro-positron emission tomography (microPET) with [(13)N]-ammonia, [(11)C]-acetate, and 2-deoxy-2-[F-18]fluoro-D: -glucose (FDG). TRI reduced myocardial incorporation of [(3)H]-triolein but not [(14)C]-bromopalmitate showing that it selectively reduces myocardial fatty acid delivery from circulating triglycerides but not from free fatty acids. IL reduced myocardial blood flow and MMRG by 37% and 56%, respectively, but did not affect myocardial oxidative metabolism. TRI did not abolish the effect of IL on myocardial blood flow and MMRG. Hypertriglyceridemia acutely reduces myocardial blood flow and MMRG in rats, but this effect is not explained by increased myocardial fatty acid delivery through intravascular triglyceride lipolysis.

  3. 应用定量 CT骨测量技术评价骨密度与静脉注射造影剂间的关系%Relationship between bone mineral density and intravenous contrast media:a radiographic study via quantitative CT de-tection

    Institute of Scientific and Technical Information of China (English)

    周巍; 杨本强

    2015-01-01

    目的:通过定量CT骨检测( QTC),评估受试者注射增强造影剂前后骨密度( BMD)的变化。方法自2014年5月至2015年3月,共166例患者(其中106例无肾癌者,60例肾癌患者),同时接受腹部CT扫描,通过测量腰1椎体的CT值,记录三期(平扫、动脉期及静脉期)的骨密度( BMD)变化。结果注射增强剂的两组(动脉期及静脉期) CT衰减值比无注射组(平扫期)显著增高(P <0.01)。无肾癌组:增强组动脉期 CT 值由(127.6±46.3) HU增长至(141.2±46.2) HU,静脉期增长至(146.3±47.1) HU(P<0.01)。肾癌组:增强组动脉期 CT 值由(113.2±37.8) HU增长至(125.2±38.2) HU,静脉期增长至(131.2±36.1) HU(P<0.05)。结论 QCT对有肾癌组及无肾癌组患者进行三期(平扫、动脉期及静脉期)骨密度检测,注射增强造影剂均大幅度增加骨衰减,因此,造影剂对CT检测骨质疏松程度存在干扰,提示临床诊断骨质疏松症时须将造影剂的影响考虑在内。%Objective To evaluate the effect of intravenous contrast media on bone mineral density( BMD) assessment by comparing unenhanced and contrast-enhanced computed tomography( CT) examinations performed for other indications. Methods One hun-dred and sixty-six patients ( 106 without and 60 with malignant neoplasm ) who underwent both unenhanced and two contrast-en-hanced( arterial and portal venous phase) abdominal CT examinations in a single session between May 2014 and March 2015 were included. BMD was evaluated on the three examinations as CT-attenuation values in Hounsfield Units( HU) in the first lumbar verte-bra(L1). Results CT-attenuation values were significantly higher in both contrast-enhanced phases,compared to the unenhanced phase(P<0. 01). In patients without malignancies,HU-values increased from(127. 6 ± 46. 3) HU for the unenhanced phase to (141.2±46.2)HUforthearterialphaseand(146.3±47.1)HUfortheportalphase(P<0.01).Inpatientswithmalignancies, HU-valuesincreasedfrom(113.2±37

  4. [Diltiazem versus intravenous nitroglycerin in the treatment of unstable angina pectoris. A randomized study].

    Science.gov (United States)

    Castro, P; Corbalán, R; Vergara, I; Kunstmann, S

    1995-07-01

    Prognosis of unstable angina pectoris is related to admission EKG changes and prompt symptom control. The aim of this study was to compare the clinical effects of intravenous diltiazem (DTZ) or nitroglycerin (NTG) in patients with unstable angina pectoris. We studied 43 patients admitted to the hospital with a history of rest angina within the last 48 hours, associated with EKG evidence of ischemia. All subjects received intravenous heparin and oral aspirin, 23 were randomly assigned to receive intravenous DTZ and 20 to receive intravenous NTG. Both groups had similar baseline features and the endpoints of treatment were recurrence of angina, myocardial infarction, death during hospitalization and secondary side effects. Treatment with DTZ, when compared to NTG, resulted in a significant reduction of recurrent angina (8.7 and 59% respectively; p bradicardia with DTZ (28% of patients). In each group, one patient had a myocardial infarction and one patient died. It is concluded that intravenous DTZ reduces myocardial ischemia to a greater extent than NTG and can be safely used in patients with unstable angina pectoris.

  5. ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析%Clinical efficacy of intracoronary versus intravenous administration of platelet glycoprotein Ⅱb/Ⅲa receptor antagonists in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction: a systematic review

    Institute of Scientific and Technical Information of China (English)

    尹建; 徐强; 司良毅

    2012-01-01

    目的 系统评价ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者,冠脉较静脉使用血小板糖蛋白(platelet glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂的有效性及安全性.方法 2011年9月至10月,计算机检索美国国立生物医学信息中心PubMed数据库、Cochrane图书馆临床对照试验数据库、荷兰医学文摘embase数据库、中国生物医学文献数据库(CBM)和中国期刊全文数据库(CJFD).同时检索相关网站,尽量获取会议摘要及灰色文献.使用RevMan 5.1软件对纳入研究进行Meta分析.结果 共纳入11篇文献,总计1569例患者.Meta分析结果示:冠脉较静脉使用GPⅡb/Ⅲa受体拮抗剂能显著改善STEMI患者术后心肌梗死溶栓试验(TIMI)3级血流(RR= 1.08,95% CI为1.04~1.13,P<0.01),TIMI心肌组织灌注分级(TMPG)3级血流(RR= 1.37,95%CI为1.16 ~1.63,P<0.01),左室射血分数(MD =0.04,95% CI为0.02 ~0.06,P<0.01),降低主要不良心脏事件(MACE)发生率(RR=0.48,95% CI为0.34 ~ 0.69,P<0.01),同时不增加主要出血并发症(RR =1.04,95% CI为0.55~1.95,P=0.90).阿昔单抗在此基础上能进一步降低1个月时死亡率(RR =0.45,95% CI为0.21~0.99,P=0.05).结论 冠脉较静脉途径使用GPⅡb/Ⅲa受体拮抗剂能改善STEMI行PCI治疗患者术后罪犯血管再通、心肌灌注及左心室功能恢复,降低主要不良心脏事件发生率,同时不增加主要出血并发症.%Objective To evaluate the efficiency and safety of intracoronary versus intravenous administration of platelet glycoprotein IIb/IIIa (GP Ilb/IIIa) receptor antagonists in patients with ST-segment elevation myocardial infarction (STEMI) received percutaneous coronary intervention (PCI). Methods Randomized controlled trials were searched in the following databases including PubMed, Excerpta Medica Database (Embase), Cochrane library

  6. Reduced myocardial blood flow in acute and chronic digitalization.

    Science.gov (United States)

    Steiness, E; Bille-Brahe, N E; Hansen, J F; Lomholt, N; Ring-Larsen, H

    1978-07-01

    The myocardial blood flow was measured by the 133Xenon disappearance curve from the left ventricular wall following an injection of 133Xenon in the left coronary artery in 8 dogs without digoxin pretreatment and in 8 chronically digitalized dogs. The myocardial blood flow was significantly less (30%) in the digitalized dogs than in the dogs without pretreatment. In the digitalized dogs as well as in those without pretreatment an intravenous injection of digoxin resulted in a further significant decrease of the myocardial blood flow of about 20% and a significant increase of the coronary vascular resistance. The reduced myocardial blood flow both during acute and chronic digitalization is beleived to be of clinical importance.

  7. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction...... the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia...... exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring...

  8. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction...... the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia...... exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring...

  9. The Effects of Electroacupuncture at the Heart Meridian on Myocardial Contractile Function in Rabbits with Myocardial Ischemia

    Institute of Scientific and Technical Information of China (English)

    方志斌; 周逸平; 王月兰

    2002-01-01

    @@ Acute myocardial ischemia was induced by intravenous injection of pituitrin, and electroacupuncture (EA) was applied at the Heart and Lung Meridians (HM and LM), 3 points on each meridian. The changes in the left intraventricular pressure (LVP), the maximum rise rate of intraventricular pressure (LVP dp/dtmax), the area of cardiac force loop (ACFL), and the maximum shortening velocity of myocardial contractile element (Vmax) were observed. As a result, there were significant differences in the improvement of LVP, LVP dp/dtmax, ACFL and Vmax between EA at HM and LM. The regulatory action of EA at HM on the myocardial contractile function was significantly better than that of EA at LM, indicating that HM has a close relationship with the myocardial contractile function.

  10. 不同部位注射造影剂对多层螺旋CT冠状动脉成像检查图像效果的影响%Influence of different injection site of intravenous contrast media on MSCT coronary angiography imaging

    Institute of Scientific and Technical Information of China (English)

    孔艳红; 王克扬; 贺文; 钟朝晖

    2014-01-01

    Objective To discuss the influence of different site of intravenous injection of contrast media on imaging effect of multi-slice computed tomography( MSCT)coronary angiography. Methods One hundred and fifteen patients were randomly divided into four groups( left median cubital vein group with 20 patients,right median cubital vein group with 49 patients,right basilic vein group with 23 patients,and right cephalic vein group with 23 patients)according to different site of intravenous bolus injection before undergoing MSCT coronary angiography. Then the acquired images were observed and analyzed for quality by radiologists. Results There was significant difference between the left and right median cubital vein groups( P <0. 01). The image quality was higher in the right median cubital vein group. There was significant difference a-mong the three groups of different injection sites in right arm( P <0. 01). The image quality was higher in the right median cubital vein group and the right basilic vein group than in the right radial cephalic vein group. Conclusion The right median cubital intravenous injection is suggested to be the first choice to obtain higher image quality of MSCT. The second choice is right basilic vein,while the right radial cephalic vein will be the last one.%目的:观察不同部位注射造影剂对多层螺旋CT冠状动脉成像检查图像效果的影响。方法选取115例拟行冠脉造影的患者,依造影剂注射部位,随机分为:左肘正中静脉组(20例)、右肘正中静脉组(49例)、右前臂贵要静脉组(23例)和右前臂头静脉桡侧组(23例)。观察各组冠状动脉成像质量。结果经右侧肘正中静脉团注成功后冠状动脉显影效果高于左侧,差异有统计学意义( P <0.01)。右侧肘正中静脉和右侧前臂贵要静脉团注成功后冠状动脉显影效果好,其次是右侧前臂头静脉桡侧。三组注射部位之间图像质量差

  11. Value of real-time myocardial contrast echocardiography in the detection of the myocardial perfusion abnormalities in early diabetic rats model%实时心肌超声造影评价糖尿病早期心肌血流灌注改变的实验研究

    Institute of Scientific and Technical Information of China (English)

    郑磊; 张明; 梁天琳; 茹翱; 刘敏; 赵应征; 田新桥

    2014-01-01

    Objective: To explore the value of real-time myocardial controast echocardiography to detect myocardial perfusion abnormalities in early diabetic rats.Methods: Among twenty-four male SD rats, twelve rats were randomly selected as DM group which were induced with streptozotocin, the remain twelve rats as normal control group which were induced with buffer solution. Eight weeks after diabetic model established, all rats underwent MCE examination at the resting state. The plateau intensity (A), initial slope of the curve (β) and myocardial blood lfow (A×β) of left ventricular anterior wall at the papillary muscle level were measured in left ventricular short-axis view by MCE. At last, myocardial tissue of the rats were stained with CD31 immuno-histochemistry to detect myocardial microvascular density (MVD). The correlation between A and MVD at DM group was analyzed.Results: Compared with the control group, A and A×β in DM group were obviously lower (P<0.01), β in DM group was also lower, but without statistical difference. The MVD in the DM group was sig-niifcantly decreased compared with the control group (P<0.01). There were signiifcant positive correlations be-tween A and MVD at DM group (r=0.903,P<0.01).Conclusion: MCE can be used to detect the left ventricular myocardial perfusion abnormalities in early diabetic rats and has important application value in diagnosis of the diabetic cardiomyopathy.%目的:探讨实时心肌超声造影(RT-MCE)技术检测糖尿病(DM)早期大鼠心肌血流灌注异常的价值。方法:24只雄性SD大鼠中随机选取12只通过腹腔注射链脲佐菌素建立DM模型(DM组),剩余12只大鼠作为对照,腹腔注射等量枸橼酸缓冲液。模型建成8周后,在静息状态下,对两组大鼠行RT-MCE检查,检测两组大鼠乳头肌水平左室壁感兴趣区的峰值声学强度(A)以及造影剂的灌注速度(β),并计算出心肌血流量(A×β)。RT-MCE检查结束后

  12. Contrast induced nephropathy in urology

    Directory of Open Access Journals (Sweden)

    Viji Samuel Thomson

    2009-01-01

    Full Text Available Intravenous contrast agents have a distinct role in urological imaging: to study precise anatomical delineation, vascularity, and to assess the function of the renal unit. Contrast induced nephropathy (CIN is a known adverse effect of intravenous contrast administration. The literature on incidence, pathophysiology, clinical features, and current preventive strategies available for CIN relevant to urologists was reviewed. A search of the PubMed database was done using the keywords nephropathy and media, prevention and control or prevention Contrast media (explode, all adverse effects, and kidney diseases (explode. An online search of the EMBASE database for the time ranging from 1977 to February 2009 was performed using the keywords ionic contrast medium, adverse drug reaction, major or controlled clinical study, human, nephrotoxicity, and kidney disease. Current publications and data most relevant to urologists were examined. CIN was the third most common cause of hospital-acquired renal failure. The incidence is less common with intravenous contrast administration as compared with intra-arterial administration. The pathogenesis of contrast mediated nephropathy is due to a combination of toxic injury to renal tubules and medullary ischemic injury mediated by reactive oxygen species. CIN most commonly manifests as a nonoliguric and asymptomatic transient decline in renal function. Patients who developed CIN were found to have increased mortality, longer hospital stay, and complicated clinical course. An overview of risk factors and risk prediction score for prognostication of CIN are elaborated. Preventive strategies including choice of contrast agents, maximum tolerated dose, role of hydration, hydration regime, etc. are discussed. The role of N- acetyl cysteine, Theophylline, Fenoldapam, Endothelin receptor antagonists, iloprost, atrial natriuretic peptide, and newer therapies such as targeted renal therapy (TRT are discussed. A working

  13. 多普勒组织成像结合心肌声学造影评估无复流时心脏收缩和舒张功能的变化%Evaluation of cardiac contractility and relaxation during no-reflow phenomenon by the combination of Doppler tissue imaging with myocardial contrast echocardiography

    Institute of Scientific and Technical Information of China (English)

    焦阳; 陈立新; 陶红; 朱向明

    2008-01-01

    AIM: To evaluate the cardiac contractility and relaxation by Doppler tissue imaging (DTI) combined with myocardial contrast echocardiography (MCE) via injection of contrast media, Albunex. METHODS: Nineteen healthy mongrel dogs were conducted 60 min ligation of left anterior descending coronary artery (LAD), followed by reperfusion of 60, 120 and 180 min to establish an acute myocardial ischemic-reperfused canine model. (1) MCE was performed by bolus injection of Albunex at pre-reperfusion and at post-reperfusion. The perfused defect area defined by MCE at pre-reperfusion was regarded as risk area (RAMCE), while perfused defect area at post-reperfusion was regarded as no-reflow area (NRAMCE). When the ratio of NRAMCE to RAMCE exceeded 25%, myocardial reperfusion was considered incomplete, I.e., no-reflow group; If the ratio was <25%, myocardial reperfusion was considered adequate, I.e., reflow group. (2) Left ventricular ejection fraction (LVEF) and wall thickness ratio (△T%) of LV anterior wall were determined. (3)S-wave, e-wave and a-wave velocities at the LV anterior wall were determined by DTI. The e/a ratio was measured. RESULTS: The results of MCE showed 7 dogs in reflow group and 10 dogs in no-reflow group. (1) LVEF in reflow group gradually increased with time course after myocardial reperfusion, and in no-reflow group, however, LVEF increasingly declined with ongoing myocardial reperfusion. At the same reperfusion time point, LVEF of no-reflow group was significantly lower than that of reflow group. (2) △T% in reflow group improved gradually, and however, it can not come back to that of baseline at 180-min reperfusion. △T% in no-reflow group had no signal of recovery with progressive reperfusion. (3) S-wave, e-wave velocities measured by DTI significantly declined after ligation of LAD, and a-wave velocity increased, leading to decline of e/a. After myocardial reperfusion, s-wave, e-wave velocities and e/a in reflow group gradually increased at

  14. Diverse Effects of L-arginine on Cardiac Function of Rats Subjected to Myocardial Ischemia and Reperfusion in vivo

    Institute of Scientific and Technical Information of China (English)

    Xiaoliang WANG; Feng LIANG; Xiangying JIAO; Lei LIU; Xiaojie BAI; Meixia LI; Jianmin ZHI; Huirong LIU

    2007-01-01

    In vivo administration of L-arginine at different time points during the course of myocardial ischemia and reperfusion (MI/R) has been shown to differentially regulate postischemic apoptosis.Cardiac function is one of the most important indexes used to judge the degree of myocardial injury.The present study attempted to determine whether in vivo administration of L-arginine at different stages of MI/R has a diverse influence on cardiac function of ischemic reperfused hearts and,if So,to investigate the mechanisms involved.Male adult rats were subjected to 30 min myocardial ischemia followed by 5 h reperfusion.An intravenous L-arginine bolus was given either 10 min before and 50 min after reperfusion (early treatment) or 3 h and 4 h after reperfusion (late treatment).Early treatment with L-arginine markedly increased the left ventricular systolic pressure (LVSP) and dP/dtmax,and decreased myocardial nitrotyrosine content.In strict contrast,late treatment with L-arginine resulted in a significant decrease in LVSP and dP/dtmx from 4 h to 5h after reperfusion,and increase in toxic peroxynitrite formation as measured by nitrotyrosine.These results suggest that the administration of L-arginine at different time points during the course of MI/R leads to diverse effects on cardiac dysfunction.Early supplementation decreased the nitrative stress and improved left ventricular function.However,late treatment with L-arginine increased the formation of peroxynitrite and aggravated cardiac functional injury.

  15. Contrastive Lexicology.

    Science.gov (United States)

    Hartmann, R. R. K.

    This paper deals with the relation between etymologically related words in different languages. A survey is made of seven stages in the development of contrastive lexicology. These are: prelinguistic word studies, semantics, lexicography, translation, foreign language learning, bilingualism, and finally contrastive analysis. Concerning contrastive…

  16. Impact of different graded coronary stenosis on myocardial perfnsion and function by two-dimensional strain echocardiography combined with myocardial contrast echocardiography%二维应变超声心动图结合实时心肌超声造影评价冠状动脉不同狭窄程度对心肌灌注和心功能的影响

    Institute of Scientific and Technical Information of China (English)

    李燕; 吕清; 王静; 张艳容; 陈明; 张静; 方凌云

    2009-01-01

    目的 应用二维应变超声心动图(2D-Strain)结合实时心肌超声造影(MCE)评价静息状态下冠状动脉(冠脉)不同程度狭窄患者局部心肌血流灌注和应变的变化及两者之间的关系.方法 对25例冠心病患者及15例健康志愿者行MCE和2D-Strain检查.血供异常的心肌节段按供血冠狭窄程度分为轻度狭窄组(50%~75%)、中度狭窄组(76%~89%)和重度狭窄组(≥90%).从MCE再灌注允盈曲线获得A值和β值分析心肌灌注;应用2D-Strain测量心肌纵向收缩期峰值应变(SL)分析心功能.结果 在异常冠脉供血区,随着冠脉狭窄程度的加重;各组的A值与对照组相比呈递减趋势,但差异无统计意义(P>0.05);而中度狭窄组和重度狭窄组的β值和SL值均显著低于对照组(β值:0.75±0.67和0.67±0.53对0.97±0.65;SL值:11.60±5.89和9.58±6.51对19.46±6.17,均P75%的冠脉狭窄引起的心肌缺血,且两者具有较好的相关性.%Objective To estimate the impact of various extent of coronary stenosis at rest on myocardial perfusion and functional indices from myocardial contrast echocardiography(MCE) and two-dimensional strain echocardiography(2D-Strain) and characterize the relationship between them. Methods Three levels of coronary stenosis:mild (50%~75%),moderate (76%~89%),severe (≥90%) in 25 patients with coronary artery stenosis and 15 healthy subjects in the control group were examined. Plateau videointensity (value A) and time to plateau (value β) of the replenishment curve from MCE were calculated for perfusion analysis,and longitudinal peak systolic strain(SL) from 2D-Strain were measured for functional analysis. Results Value A tended to decrease with increasing severity of stenosis,ahhough these differences did not reach the level of statistical significance, β and SL were significantly increased in the context of moderate and severe coronary stenosis when compared with control group (β, moderate 0.75±0.67 and severe 0.67±0

  17. Acute suprachoroidal haemorrhage post-tenecteplase thrombolysis for myocardial infarction: management considerations.

    Science.gov (United States)

    Trikha, Sameer; Lockwood, Alastair; Puvanachandra, Narman; Kirwan, James

    2010-05-13

    We report a case of a 63-year-old man who received intravenous tenecteplase as thrombolytic therapy for an inferior ST elevation myocardial infarction. Three hours later he complained of blurred vision in the right eye and on examination had sustained a suprachoroidal haemorrhage. With conservative treatment the haemorrhage resolved, leading to a normalisation of visual acuity. To the authors' knowledge, no case reports exist of this rare complication following intravenous tenecteplase. We discuss implications for further thrombolysis and anticoagulation.

  18. Acute suprachoroidal haemorrhage post-tenecteplase thrombolysis for myocardial infarction: management considerations

    OpenAIRE

    2010-01-01

    We report a case of a 63-year-old man who received intravenous tenecteplase as thrombolytic therapy for an inferior ST elevation myocardial infarction. Three hours later he complained of blurred vision in the right eye and on examination had sustained a suprachoroidal haemorrhage. With conservative treatment the haemorrhage resolved, leading to a normalisation of visual acuity. To the authors’ knowledge, no case reports exist of this rare complication following intravenous tenecteplase. We di...

  19. Assessment of myocardial viability using multidetector computed tomography in patients with reperfused acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, T. [Department of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of); Choi, B.J. [Department of Cardiology, Ajou University School of Medicine, Suwon (Korea, Republic of); Kang, D.K., E-mail: kdklsm@ajou.ac.kr [Department of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of); Sun, J.S. [Department of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2012-08-15

    Aim: To assess the prognostic value of 64-section multidetector computed tomography (MDCT) to predict follow-up myocardial dysfunction and functional recovery after reperfusion therapy in patients with acute myocardial infarction (MI) as defined by echocardiography. Materials and methods: After reperfusion therapy for acute MI, 71 patients underwent two-phase contrast-enhanced MDCT and follow-up echocardiography. MDCT findings were compared with echocardiographic findings using kappa statistics. The areas under the receiver operating characteristic curves (AUCs) and the odds ratios (ORs) of early perfusion defects (EPD), delayed enhancement (DE), and residual perfusion defects (RPD) for predicting follow-up myocardial dysfunction and functional recovery were calculated on a segmental basis. Results: The presence of transmural EPD (EPD{sub TM}) or RPD showed good agreement (k = 0.611 and 0.658, respectively) with follow-up myocardial dysfunction, while subendocardial EPD (EPD{sub sub}) or subendocardial DE (DE{sub sub}) showed fair agreement with follow-up myocardial dysfunction (k = 0.235 and 0.234, respectively). The AUC of RPD (0.796) was superior (p < 0.001 and 0.031, respectively) to those of EPD{sub TM} (0.761) and DE{sub TM} (0.771). The presence of EPD{sub TM}, DE{sub TM}, and RPD were significant, independent positive predictors of follow-up myocardial dysfunction (OR = 6.4, 1.9, and 9.8, respectively). EPD{sub TM} was a significant, independent negative predictor of myocardial functional recovery (OR = 0.13). Conclusion: Abnormal myocardial attenuation on two-phase MDCT after reperfusion therapy may provide promising information regarding myocardial viability in patients with acute MI.

  20. Ultrasound enhanced prehospital thrombolysis using microbubbles infusion in patients with acute ST elevation myocardial infarction: Rationale and design of the Sonolysis study

    Directory of Open Access Journals (Sweden)

    van Dijk Arie PJ

    2008-12-01

    Full Text Available Abstract Background - Experimental studies have shown that ultrasound contrast agents enhance the effectiveness of thrombolytic agents in the presence of ultrasound in vitro and in vivo. Recently, we have launched a clinical pilot study, called "Sonolysis", to study this effect in patients with ST-elevation myocardial infarction based on proximal lesions of the infarct-related artery. Methods/design - In our multicenter, randomized, placebo controlled clinical trial we will include patients between 18 and 80 years of age with their first ST-elevation myocardial infarction based on a proximal lesion of the infarct-related artery. After receiving a single bolus alteplase 50 mg IV (Actilyse® Boehringer Ingelheim GmbH, a loading dose of aspirin 500 mg, and heparin 5000 IU in the ambulance according to the prehospital thrombolysis protocol, patients, following oral informed consent, are randomized to undergo 15 minutes of pulsatile ultrasound with intravenous administration of ultrasound contrast agent or placebo without ultrasound. Afterwards coronary angiography and, if indicated, percutaneous coronary intervention will take place. A total of 60 patients will be enrolled in approximately 1 year. The primary endpoints are based on the coronary angiogram and consist of TIMI flow, corrected TIMI frame count, and myocardial blush grade. Follow-up includes 12-lead ECG, 2D-echocardiography, cardiac MRI, and enzyme markers to obtain our secondary endpoints, including the infarct size, wall motion abnormalities, and the global left ventricular function. Discussion - The Sonolysis study is the first multicenter, randomized, placebo controlled clinical trial investigating the therapeutic application of ultrasound and microbubbles in acute ST-elevation myocardial infarction patients. A positive finding may stimulate further research and technical innovations to implement the treatment in the ambulance and maybe obtain even more patency at an earlier stage

  1. Measurement of myocardial perfusion using magnetic resonance

    DEFF Research Database (Denmark)

    Fritz-Hansen, T.; Jensen, L.T.; Larsson, H.B.;

    2008-01-01

    Cardiac magnetic resonance imaging (MRI) has evolved rapidly. Recent developments have made non-invasive quantitative myocardial perfusion measurements possible. MRI is particularly attractive due to its high spatial resolution and because it does not involve ionising radiation. This paper review...... myocardial perfusion imaging with MR contrast agents: methods, validation and experiences from clinical studies. Unresolved issues still restrict the use of these techniques to research although clinical applications are within reach Udgivelsesdato: 2008/12/8......Cardiac magnetic resonance imaging (MRI) has evolved rapidly. Recent developments have made non-invasive quantitative myocardial perfusion measurements possible. MRI is particularly attractive due to its high spatial resolution and because it does not involve ionising radiation. This paper reviews...

  2. PERIOPERATIVE MYOCARDIAL INFRACTION

    Directory of Open Access Journals (Sweden)

    Ravindra S

    2015-10-01

    Full Text Available Perioperative myocardial ischaemia and infarction (PMI is a major cause of short and long term morbidity and mortality in the surgical population. It is estimated that more than one half of postoperative deaths are caused by cardiac events, most of which are ischaemic in origin. Over 50,000 patients each year sustain a perioperative MI . Thus prevention of a PMI is important to improve overall postoperative outcome. Myocardial ischaemia is a dual state composed of inadequate myocardial oxygenation and accu mulation of anaerobic metabolites and occurs when myocardial oxygen demand exceeds the supply. Myocardial infarction is defined as the death of myocardial myocytes due to prolonged ischaemia. In patients with, or at risk of coronary artery disease (CAD, t he reported incidence of perioperative myocardial ischaemia is 20 - 63%. Various studies have shown that postoperative myocardial ischaemia was consistently found to occur considerably more often than preoperative and intraoperative ischaemia ( R atio approxim ately 3:1 and 5:1 respectively. As more and more patients coming for non - cardiac surgeries who have already undergone coronary intervention such as balloon angioplasty, stenting or CABG, we as anaesthesiologists should have thorough knowledge of the perio perative implications of the same in a day to day practice. Secondly, as the geriatric population is increasing there are more chances of encountering patients with known or unknown ischaemic heart disease both on an emergency and elective basis.

  3. Prophylactic lidocaine for myocardial infarction.

    Science.gov (United States)

    Martí-Carvajal, Arturo J; Simancas-Racines, Daniel; Anand, Vidhu; Bangdiwala, Shrikant

    2015-08-21

    /37) were conducted without an a priori sample size estimation. Ten trials were sponsored by the pharmaceutical industry. Trials were conducted in 17 countries, and intravenous intervention was the most frequent route of administration.In trials involving participants with proven or non-proven acute myocardial infarction, lidocaine versus placebo or no intervention showed no significant differences regarding all-cause mortality (213/5879 (3.62%) vs 199/5848 (3.40%); RR 1.02, 95% CI 0.82 to 1.27; participants = 11727; studies = 18; I(2) = 15%); low-quality evidence), cardiac mortality (69/4184 (1.65%) vs 62/4093 (1.51%); RR 1.03, 95% CI 0.70 to 1.50; participants = 8277; studies = 12; I(2) = 12%; low-quality evidence) and prophylaxis of ventricular fibrillation (76/5128 (1.48%) vs 103/4987 (2.01%); RR 0.78, 95% CI 0.55 to 1.12; participants = 10115; studies = 16; I(2) = 18%; low-quality evidence). In terms of sinus bradycardia, lidocaine effect is imprecise compared with effects of placebo or no intervention (55/1346 (4.08%) vs 49/1203 (4.07%); RR 1.09, 95% CI 0.66 to 1.80; participants = 2549; studies = 8; I(2) = 21%; very low-quality evidence). In trials involving only participants with proven acute myocardial infarction, lidocaine versus placebo or no intervention showed no significant differences in all-cause mortality (148/2747 (5.39%) vs 135/2506 (5.39%); RR 1.01, 95% CI 0.79 to 1.30; participants = 5253; studies = 16; I(2) = 9%; low-quality evidence). No significant differences were noted between lidocaine and any other antiarrhythmic drug in terms of all-cause mortality and ventricular fibrillation. Data on overall survival 30 days after myocardial infarction were not reported. Lidocaine compared with placebo or no intervention increased risk of asystole (35/3393 (1.03%) vs 14/3443 (0.41%); RR 2.32, 95% CI 1.26 to 4.26; participants = 6826; studies = 4; I(2) = 0%; very low-quality evidence) and dizziness/drowsiness (74/1259 (5.88%) vs 16/1274 (1.26%); RR 3.85, 95% CI

  4. Clinically relevant strategies for lowering cardiomyocyte glucose uptake for {sup 18}F-FDG imaging of myocardial inflammation in mice

    Energy Technology Data Exchange (ETDEWEB)

    Thackeray, James T.; Bankstahl, Jens P.; Bengel, Frank M. [Hanover Medical School, Department of Nuclear Medicine, Hanover (Germany); Wang, Yong; Wollert, Kai C. [Hanover Medical School, Department of Cardiology and Angiology, Hanover (Germany)

    2015-04-01

    Myocardial inflammation is an emerging target for novel therapies and thus for molecular imaging. Positron emission tomography (PET) with {sup 18}F-fluorodeoxyglucose (FDG) has been employed, but requires an approach for suppression of cardiomyocyte uptake. We tested clinically viable strategies for their suitability in mouse models in order to optimize preclinical imaging protocols. C57BL/6 mice (n = 56) underwent FDG PET under various conditions. In healthy animals, the effect of low-dose (5 units/kg) or high-dose (500 units/kg, 15 min prior) intravenous heparin, extended fasting (18 h) and the impact of conscious injection with limited, late application of isoflurane anaesthesia after 40 min of conscious uptake were examined in comparison to ketamine/xylazine anaesthesia. Conscious injection/uptake strategies were further evaluated at 3 days after permanent coronary artery occlusion. Under continuous isoflurane anaesthesia, neither heparin administration nor extended fasting significantly impacted myocardial {sup 18}F-FDG accumulation. Injection with 40 min uptake in awake mice resulted in a marked reduction of global myocardial {sup 18}F-FDG uptake compared to standard isoflurane anaesthesia (5.7 ± 1.1 %ID/g vs 30.2 ± 7.9 %ID/g, p < 0.01). Addition of heparin and fasting further reduced uptake compared to conscious injection alone (3.8 ± 1.5 %ID/g, p < 0.01) similar to ketamine/xylazine (2.4 ± 2.2 %ID/g, p < 0.001). In the inflammatory phase, 3 days after myocardial infarction, conscious injection/uptake with and without heparin/fasting identified a marked increase in myocardial {sup 18}F-FDG accumulation that was similar to that observed under ketamine/xylazine. Continuous isoflurane anaesthesia obscures any suppressive effect of heparin or fasting on cardiomyocyte glucose utilization. Conscious injection of FDG in rodents significantly reduces cardiomyocyte uptake and enables further suppression by heparin and fasting, similar to clinical observations. In

  5. [Physiopathology of nephropathy studied with contrast media].

    Science.gov (United States)

    Morales Buenrostro, L E; Tellez Zenteno, J F; Torre Delgadillo, A

    2000-01-01

    For the technological advances in diagnostic and therapeutic procedures, the use of intravenous contrast media in the hospital is more and more frequent. It can produce acute renal failure secondary to its nephrotoxicity known as contrast media nephropathy. This review describes the pathophysiologic mechanisms of contrast media injury, including cytotoxicity caused by hyperosmoloarity of contrast media, the hemodynamic factors and the role of the renin-angiotensin system, prostaglandins, oxygen free radicals, endothelin-1, adenosine, nitric oxide and others. The understanding of this information is of vital importance for the development of prophylactic strategies for contrast media nephropathy.

  6. Periodontitis and myocardial hypertrophy.

    Science.gov (United States)

    Suzuki, Jun-Ichi; Sato, Hiroki; Kaneko, Makoto; Yoshida, Asuka; Aoyama, Norio; Akimoto, Shouta; Wakayama, Kouji; Kumagai, Hidetoshi; Ikeda, Yuichi; Akazawa, Hiroshi; Izumi, Yuichi; Isobe, Mitsuaki; Komuro, Issei

    2017-04-01

    There is a deep relationship between cardiovascular disease and periodontitis. It has been reported that myocardial hypertrophy may be affected by periodontitis in clinical settings. Although these clinical observations had some study limitations, they strongly suggest a direct association between severity of periodontitis and left ventricular hypertrophy. However, the detailed mechanisms between myocardial hypertrophy and periodontitis have not yet been elucidated. Recently, we demonstrated that periodontal bacteria infection is closely related to myocardial hypertrophy. In murine transverse aortic constriction models, a periodontal pathogen, Aggregatibacter actinomycetemcomitans markedly enhanced cardiac hypertrophy with matrix metalloproteinase-2 activation, while another pathogen Porphyromonas gingivalis (P.g.) did not accelerate these pathological changes. In the isoproterenol-induced myocardial hypertrophy model, P.g. induced myocardial hypertrophy through Toll-like receptor-2 signaling. From our results and other reports, regulation of chronic inflammation induced by periodontitis may have a key role in the treatment of myocardial hypertrophy. In this article, we review the pathophysiological mechanism between myocardial hypertrophy and periodontitis.

  7. Detecting Acute Myocardial Infarction by Diffusion-Weighted versus T2-Weighted Imaging and Myocardial Necrosis Markers

    Science.gov (United States)

    Chen, Min; Li, Yongjun; Wang, YaLing; Zhang, Shijun; Wang, Zhen; Wang, Lin; Ju, Shenghong

    2016-01-01

    We used a porcine model of acute myocardial infarction to study the signal evolution of ischemic myocardium on diffusion-weighted magnetic resonance images (DWI). Eight Chinese miniature pigs underwent percutaneous left anterior descending or left circumflex coronary artery occlusion for 90 minutes followed by reperfusion, which induced acute myocardial infarction. We used DWI preprocedurally and hourly for 4 hours postprocedurally. We acquired turbo inversion recovery magnitude T2-weighted images (TIRM T2WI) and late gadolinium enhancement images from the DWI slices. We measured the serum myocardial necrosis markers myoglobin, creatine kinase-MB isoenzyme, and cardiac troponin I at the same time points as the magnetic resonance scanning. We used histochemical staining to confirm injury. All images were analyzed qualitatively. Contrast-to-noise ratio (the contrast between infarcted and healthy myocardium) and relative signal index were used in quantitative image analysis. We found that DWI identified myocardial signal abnormity early (clinical serologic biomarkers.

  8. [Therapeutic effect of p-tyrosol on myocardial electric instability induced by coronary occlusion].

    Science.gov (United States)

    Chernyshov, G A; Plotnikov, M B; Smol'iakova, V I; Krasnov, E A

    2007-01-01

    In experiments on rats with left coronary artery occlusion, p-tyrosol (20 mg/kg, intravenously) showed the ability to decrease myocardial electric instability in phase 1b of ventricular arrhythmias: a fraction of rats without arrhythmia was increased by 36%, and the mean value of ventricular arrhythmia index exhibited a 3-fold decrease.

  9. [Antioxidant and cardioprotective effects of N-tyrosol in myocardial ischemia with reperfusion in rats].

    Science.gov (United States)

    Smol'iakova, V I; Chernyshova, G A; Plotnikov, M B; Aliev, O I; Krasnov, E A

    2010-01-01

    We demonstrated in experiments on rats with left coronary artery occlusion that intravenous administration of 20 mg/kg n-tyrosol during ischemia limited manifestations of oxidative stress in myocardial tissue during early post reperfusion period: content of diene and triene conjugates lowered 16 and 20%, respectively. This was associated with higher preservation of cardiomyocytes and reduction of the infarction zone.

  10. Semi-automated myocardial segmentation of bright blood multi-gradient echo images improves reproducibility of myocardial contours and T2* determination

    NARCIS (Netherlands)

    Triadyaksa, Pandji; Prakken, Niek H J; Overbosch, Jelle; Peters, Robin B; van Swieten, J Martijn; Oudkerk, Matthijs; Sijens, Paul E

    OBJECTIVES: Early detection of iron loading is affected by the reproducibility of myocardial contour assessment. A novel semi-automatic myocardial segmentation method is presented on contrast-optimized composite images and compared to the results of manual drawing. MATERIALS AND METHODS: Fifty-one

  11. [Depression and myocardial infaction].

    Science.gov (United States)

    Testuz, A

    2009-03-04

    Several works show an association between depression and the occurence of a first myocardial infarction. Depression after myocardial infarction seems to be a marker of poorer outcome, regardless of other risk factors or severity of the myocardial infarction. Dysautonomia and alteration of platelet activation are a few physiopathological changes shared by both affections, through which they might be related. Treatment of depression is not associated with better cardiovascular outcome, but selective serotonin reuptake inhibitors have been shown safe and efficient among patients with coronary heart disease. Cognitivo-comportemental approach and cardiovascular rehabilitation program after myocardial infarction also play a role in improving quality of life of the depressed patient with coronary heart disease.

  12. Contrast-induced nephropathy after computed tomography

    Directory of Open Access Journals (Sweden)

    Luciano da Silva Selistre

    2015-03-01

    Full Text Available Introduction: Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. Objective: We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. Methods: We studied 400 patients prospectively. Results: The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively. Conclusions: We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure.

  13. Acoustic properties of ultrasound contrast agents

    NARCIS (Netherlands)

    N. de Jong (Nico)

    1993-01-01

    textabstractSafety of contrast agents is reported in the years after. Both the intracoronary use of sonicated Renografin as well as intravenous use of commercial product as Albunex and Lechovist has been investigated. Thereafter more pathophysiologic studies were performed. Ten Cate described the po

  14. The effect of streptokinase on chest pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Christensen, J H; Sørensen, H T; Rasmussen, S E;

    1991-01-01

    Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76...... patients not treated with streptokinase. All patients had acute myocardial infarction and less than 6 h of cardiac symptoms. Patients treated with streptokinase had a significantly lower need for nicomorphine (median 20 mg) than patients not treated with streptokinase (median 41 mg). Correspondingly......, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain....

  15. Myocardial indium-111-antimyosin uptake in essential hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Uenlue, M.; Temiz, N.H. [Dept. of Nuclear Medicine, Dept. of Nuclear Medicine, Ankara (Turkey); Cengel, A. [Dept. of Cardiology, Gazi Univ. School of Medicine, Dept. of Nuclear Medicine, Ankara (Turkey)

    2003-06-01

    Aim: Evaluation of myocardial uptake of {sup 111}In-antimyosin antibodies in patients with essential hypertension for the verification of our hypothesis that it may increase in stage 1 in the left ventricle as a result of myocardial damage. Patients, methods: Twelve men (mean age: 59 {+-} 2.4 years) suffering from angina like symptoms and essential hypertension in clinical stage 1 according to the JNC-VI criteria were included into the study. These patients showed normal perfusion as revealed by thallium-201 myocardial study and coronary angiography. Left ventricular mass index was determined in echocardiography. Planar antimyosin images were obtained 48 h after the intravenous injection of the tracer. Heart to lung ratios were calculated as a parameter of myocardial tracer uptake using appropriate region of interests; values >1.52 were considered as abnormal. Results: We observed increased antimyosin uptake (mean: 1.71 {+-} 0.12) consistent with myocardial damage in 11 of 12 patients. Nine of 12 patients had a left ventricular hypertrophy with left ventricular mass index values (mean: 131 g/m{sup 2} {+-} 9.48) above 115 g/m{sup 2}. Heart to lung ratio was correlated significantly to left ventricular mass index (r = 0.902, p <0.001) and duration of hypertension (r = 0.948, p <0.001). Conclusion: Our results suggest that {sup 111}In-antimyosin imaging may indicate myocyte damage in early phases of hypertensive heart disease. (orig.)

  16. Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: Results from the Metocard-CNIC trial (Effect of Metoprolol in Cardioprotection during an Acute Myocardial Infarction)

    OpenAIRE

    Pizarro, Gonzalo; García Lunar, Inés; Martínez de Vega, Vicente; Cabrera Rodríguez, José Ángel

    2014-01-01

    The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events. Early IV metoprolol during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI). The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 pat...

  17. Brief communication: radiographic contrast infusion and catecholamine release in patients with pheochromocytoma.

    NARCIS (Netherlands)

    Baid, S.K.; Lai, E.W.; Wesley, R.A.; Ling, A.; Timmers, H.J.L.M.; Adams, K.T.; Kozupa, A.; Pacak, K.

    2009-01-01

    BACKGROUND: Contrast-enhanced computed tomography (CT) is useful for localizing pheochromocytoma. However, in patients with suspected pheochromocytoma, CT is often canceled or not performed because of the strong belief that intravenous contrast may induce hypertensive crisis. OBJECTIVE: To examine

  18. Detecting Acute Myocardial Infarction by Diffusion-Weighted versus T2-Weighted Imaging and Myocardial Necrosis Markers.

    Science.gov (United States)

    Jin, Jiyang; Chen, Min; Li, Yongjun; Wang, YaLing; Zhang, Shijun; Wang, Zhen; Wang, Lin; Ju, Shenghong

    2016-10-01

    We used a porcine model of acute myocardial infarction to study the signal evolution of ischemic myocardium on diffusion-weighted magnetic resonance images (DWI). Eight Chinese miniature pigs underwent percutaneous left anterior descending or left circumflex coronary artery occlusion for 90 minutes followed by reperfusion, which induced acute myocardial infarction. We used DWI preprocedurally and hourly for 4 hours postprocedurally. We acquired turbo inversion recovery magnitude T2-weighted images (TIRM T2WI) and late gadolinium enhancement images from the DWI slices. We measured the serum myocardial necrosis markers myoglobin, creatine kinase-MB isoenzyme, and cardiac troponin I at the same time points as the magnetic resonance scanning. We used histochemical staining to confirm injury. All images were analyzed qualitatively. Contrast-to-noise ratio (the contrast between infarcted and healthy myocardium) and relative signal index were used in quantitative image analysis. We found that DWI identified myocardial signal abnormity early (acute myocardial infarction and identified the infarct-related high signal more often than did TIRM T2WI: 7 of 8 pigs (87.5%) versus 3 of 8 (37.5%) (P=0.046). Quantitative image analysis yielded a significant difference in contrast-to-noise ratio and relative signal index between infarcted and normal myocardium on DWI. However, within 4 hours after infarction, the serologic myocardial injury markers were not significantly positive. We conclude that DWI can be used to detect myocardial signal abnormalities early after acute myocardial infarction-identifying the infarction earlier than TIRM T2WI and widely used clinical serologic biomarkers.

  19. Intravenous nitroglycerin for rest angina. Potential pathophysiologic mechanisms of action.

    Science.gov (United States)

    DePace, N L; Herling, I M; Kotler, M N; Hakki, A H; Spielman, S R; Segal, B L

    1982-10-01

    Twenty patients with refractory rest angina pectoris were treated with intravenously (IV) administered nitroglycerin (mean dosage, 72.4 micrograms/min; range, 15 to 226 micrograms/min). There was a considerable reduction or abolition in the number of ischemic episodes in 85% of patients without overall substantial changes in heart rate, mean arterial BP, pulmonary capillary wedge pressure (PCWP), and pulmonary arterial mean pressure. However, those patients with an initial PCWP of more than 12 mm Hg or a systolic pressure of more than 130 mm Hg had a substantial reduction in PCWP and systolic BP following IV nitroglycerin. We conclude that IV nitroglycerin may relieve rest angina by different pathophysiologic mechanisms. In some patients, IV nitroglycerin favorably altered the hemodynamic determinants of myocardial oxygen consumption. In others, however, no change in these determinants occurred, suggesting a direct effect on the coronary circulation.

  20. [Intravenous remifentanyl for labor analgesia].

    Science.gov (United States)

    Arnal, D; Serrano, M L; Corral, E M; García del Valle, S

    2009-04-01

    Intravenous remifentanil may be the preferred analgesic when regional techniques are contraindicated. To perform a systematic review on the use of remifentanil for analgesia in labor. We searched MEDLINE (January 1995-August 2007) for studies on obstetric analgesia with remifentanil. We found 32 references representing the use of remifentanil in 257 women in labor. In most cases, patients reported relief of pain and a high level of satisfaction, with no severe side effects in mothers or neonates. When compared with meperidine and nitrous oxide in clinical trials, remifentanil provided better analgesia with fewer adverse effects. Analgesia with intravenous remifentanil is more effective and safer than other alternatives to regional analgesic techniques in obstetrics. Nevertheless, the optimum system for infusing the drug must b e established and further studies of maternal and fetal safety should be carried out.

  1. Intravenous Antiepileptic Drugs in Russia

    Directory of Open Access Journals (Sweden)

    P. N. Vlasov

    2014-01-01

    Full Text Available Launching four intravenous antiepileptic drugs: valproate (Depakene and Convulex, lacosamide (Vimpat, and levetiracetam (Keppra – into the Russian market has significantly broadened the possibilities of rendering care to patients in seizure emergency situations. The chemi- cal structure, mechanisms of action, indications/contraindications, clinical effectiveness and tolerability, advantages/disadvantages, and adverse events of using these drugs in urgent and elective neurology are discussed. 

  2. Anaphylactic reaction to intravenous diclofenac

    Directory of Open Access Journals (Sweden)

    Ranju Singh

    2011-01-01

    Full Text Available Diclofenac sodium is a non-steroidal anti-inflammatory drug widely used as an opioid sparing agent for postoperative analgesia. Anaphylaxis due to intravenous diclofenac sodium is very rare. We report a case of anaphylactic reaction to IV diclofenac sodium, occurring postoperatively in a 25-year-old primigravida, the clinical features of which mimicked pulmonary embolism. The rarity, clinical importance and the diagnostic dilemma associated prompted us to report this case.

  3. 阿托伐他汀对急性心肌梗死择期冠状动脉介入治疗患者造影剂肾病的防治作用%Prevention of contrast-induced nephropathy with atorvastatin in patients with acute myocardial infarction undergoing elective percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    华先平; 吴瑞霞; 杨勇; 曹政; 陈彬; 陈平英

    2011-01-01

    167例急性心肌梗死患者行冠状动脉介入治疗术前随机分为试验组(84例,阿托伐他汀80mg/d)和对照组(83例,阿托伐他汀20mg/d).给药7 d后行冠状动脉介入术.与术前24 h比较,术后两组患者血清高敏C反应蛋白(ha-CRP)和血清肌酐均升高,肾小球滤过率降低(均P<0.05);与对照组比较,试验组术前24 h、术后血清hs-CRP和血肌酐较低,肾小球滤过率较高(均P<0.05);试验组造影剂肾病发生率为7%(6/84),低于对照组18%(15/83)(P<0.05).提示急性心肌梗死择期冠状动脉介入治疗患者术前口服大剂量阿托伐他汀可能通过抑制炎症发挥预防造影剂肾病作用.%The study intended to evaluate the effect of high-dese atorvastafin on serum high sensitive C-reactive protein (hs-CRP) and renal function in patients with acute myocardial infarction undergoing elective pereutancous coronary intervention ( PCI ). One hundred and sixty seven patients were randomly divided into two groups: in test group (n =84) patients received oral atorvastatin 80 mg/d and in control group (n = 83) patients received atorvastatin 20 mg/d, the medication in both groups was lasted for 7 days before PCL Compared to levels at 24 h before PCI, serum hs-CRP and creatinine levels at 48 h after PCI were increased in both groups ( both P < 0. 05), and glomerular filtration rate was decreased ( P < 0. 05 ). Compared to control group, serum hs-CRP and creatinine levels 24 h before PCI and 48 h after PCI in test group were significantly lower, and glomerular filtration rate was significantly higher (P <0. 05, respectively). The incidence of contrast-induced nephropathy was lower in test group than that in control group[7% (6/84) vs.18% (15/83), P <0.05]. The results indicate that high-dose atorvastatin might be effective in protecting patients with acute myocardial infarction undergoing elective PCI from contrast-induced nephropathy via inflammatory response inhibition.

  4. Decreased myocardial perfusion reserve in diabetic autonomic neuropathy

    DEFF Research Database (Denmark)

    Taskiran, Mustafa; Fritz-Hansen, Thomas; Rasmussen, Verner

    2002-01-01

    The pathophysiological mechanisms responsible for increased cardiovascular mortality in diabetic autonomic neuropathy are unknown. To investigate the effect of autonomic neuropathy on myocardial function, we performed dynamic contrast-enhanced magnetic resonance perfusion imaging during baseline...... conditions and after Dipyridamole-induced vasodilatation in nine type 1 diabetic patients with autonomic neuropathy (AN+), defined by cardiovascular tests, as well as in 10 type 1 diabetic patients without autonomic neuropathy (AN-) and 10 healthy control subjects. Baseline myocardial perfusion index (K...... blood pressure response to Dipyridamole and myocardial perfusion reserve index. We conclude that type 1 diabetic patients with autonomic neuropathy have a decreased myocardial perfusion reserve capacity when challenged with a vasodilatator, a finding that may in part be the pathophysiological substrate...

  5. Intravenous injection of ioxilan, iohexol and diatrizoate

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, H.S.; Dorph, S.; Mygind, T.; Sovak, M.; Nielsen, H.; Rygaard, H.; Larsen, S.; Skaarup, P.; Hemmingsen, L.; Holm, J.

    Effects of intravenous ioxilan, a new third generation non-ionic contrast medium, diatrizoate, iohexol and saline on urine profiles were compared. Albumin, glucose, sodium, phosphate, and the enzymes NAG, LDH and GGT were followed in 24 normal rats over 7 days. Diatrizoate significantly affected all profile components during the first two hours. Albuminuria was significantly greater after diatrizoate than after iohexol or ioxilan, and excretion of glucose, LDH and GGT was significantly higher than after ioxilan. Both iohexol and ioxilan increased the excretion of albumin, LDH and GGT, while iohexol also significantly increased excretion of glucose and sodium. There was a greater excretion of glucose and GGT after iohexol than after ioxilan. Saline did not induce any changes. At day 7, serum sodium, urea, creatinine, and albumin were normal for all test substances, and kidney histology revealed no difference between the groups of animals. It is thus concluded that both high osmolar ionic and low osmolar non-ionic contrast media may cause temporary glomerular and tubular dysfunction in rats. In this model, the kidney is affected most by diatrizoate, less by iohexol, and least by ioxilan.

  6. Experimental reversal of acute coronary thrombotic occlusion and myocardial injury in animals utilizing streptokinase.

    Science.gov (United States)

    Lee, G; Giddens, J; Krieg, P; Dajee, A; Suzuki, M; Kozina, J A; Ikeda, R M; DeMaria, A N; Mason, D T

    1981-12-01

    Fresh autologous thrombus, 1.0 to 1.5 ml, was injected into the left anterior descending and/or left diagonal coronary arteries of 19 open-chest dogs to produce evolving acute myocardial infarction (AMI). Thrombotic obstruction was documented by coronary angiography. Multilead epicardial ECGs showed ST segment elevations of affected left ventricular (LV) areas within 2 minutes after thrombus injection, and LV segmental wall cyanosis with hypocontraction was observed within 10 minutes in the myocardial areas supplied by the thrombosed artery. Ten animals then received an initial dose of streptokinase (STK), 250,000 U (intravenous), followed by STK, 1000 to 3000 U/min (intracoronary), while nine control dogs untreated with STK received normal saline infusion. All but one STK-treated animal (all nine animals receiving intracoronary STK) had reestablishment of blood flow in the previously occluded vessels within 1 1/2 hours, disappearance of ventricular cyanosis, return of normal LV contractile function, and normalization of elevated ST segments within 1 hour after intracoronary STK therapy. In contrast, in the non-STK-treated control group, all animals had continued coronary obstruction, progressive ST elevations, and worsening LV cyanosis and hypocontraction until death or for more than 3 hours post thrombus; three control animals died of ventricular fibrillation (VF) within 1 hour of thrombus occlusion, three more died of VF within 2 hours post thrombus, and only three survived beyond 2 hours post thrombus. Postmortem examination of non-STK-treated animals revealed extensive residual coronary thrombus. All intracoronary STK-treated animals evidenced absence of residual coronary thrombus at postmortem examination. These data provide clinically relevant evidence that early intracoronary STK effects thrombolysis in AMI by reopening coronary vessels occluded by fresh thrombus, thereby protecting myocardium from further ischemia and necrosis, preserving LV function, and

  7. New perspectives on the role of cardiac magnetic resonance imaging to evaluate myocardial salvage and myocardial hemorrhage after acute reperfused ST-elevation myocardial infarction.

    Science.gov (United States)

    Mangion, Kenneth; Corcoran, David; Carrick, David; Berry, Colin

    2016-07-01

    Cardiac magnetic resonance (CMR) imaging enables the assessment of left ventricular function and pathology. In addition to established contrast-enhanced methods for the assessment of infarct size and microvascular obstruction, other infarct pathologies, such as myocardial edema and myocardial hemorrhage, can be identified using innovative CMR techniques. The initial extent of myocardial edema revealed by T2-weighted CMR has to be stable for edema to be taken as a retrospective marker of the area-at-risk, which is used to calculate myocardial salvage. The timing of edema assessment is important and should be focused within 2 - 7 days post-reperfusion. Some recent investigations have called into question the diagnostic validity of edema imaging after acute STEMI. Considering the results of these studies, as well as results from our own laboratory, we conclude that the time-course of edema post-STEMI is unimodal, not bimodal. Myocardial hemorrhage is the final consequence of severe vascular injury and a progressive and prognostically important complication early post-MI. Myocardial hemorrhage is a therapeutic target to limit reperfusion injury and infarct size post-STEMI.

  8. Prevention of contrast-induced nephropathy with volume expansion.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2008-01-01

    Contrast-induced nephropathy is one of the few preventable forms of acute kidney injury. Several pharmacologic agents have been evaluated for the prevention of contrast-induced nephropathy, yet disappointingly, few have been shown conclusively to reduce the risk for this condition. A series of studies have demonstrated that volume expansion, particularly with intravenous fluids, is an effective intervention to reduce the risk for contrast-induced nephropathy. This article reviews the clinical trials that have assessed the role of volume expansion for the prevention of contrast-induced nephropathy. The administration of isotonic sodium chloride before and after radiocontrast injection seems to be more protective than equivalent volumes of hypotonic saline and, when feasible, should be administered over a sustained period of time. Recent clinical trials suggested that an abbreviated regimen of intravenous sodium bicarbonate may be superior to a comparable protocol of sodium chloride. Although a small number of studies have found that volume supplementation by mouth may be effective in preventing contrast-induced nephropathy, the routine use of enteral fluids or solute in lieu of intravenous fluids in high-risk patients cannot be recommended at this time. Rather, liberal oral fluid and solute intake should complement intravenous fluid administration to minimize risk. Future studies will be required to define clearly the optimal prophylactic intravenous fluid regimen for contrast-induced nephropathy and further delineate the independent role of oral volume expansion for the prevention of this condition.

  9. Influence of Intravenous Injection of Hydroxyapatite on Mouse Movement Ability

    Institute of Scientific and Technical Information of China (English)

    HU Sheng; HU Yazhe; ZHANG Haibin

    2014-01-01

    Lactic acid is usually formed during strenuous exercise, and a large amount of lactic acid and slow anaerobic glycolysis in muscle lead to limitations of movement ability. Hydroxyapatite (HAp) is an alkaline inorganic material with a good biocompatibility. It slowly degrades in vivo and releases trace amounts of calcium ions, reducing cell damage by reacting with polylactic acid and neutralizing local acid environment. Whether HAp can reduce the concentration of lactic acid in vivo and improve movement ability is not yet clear. Here, after eight days of training, 40 mice were randomly divided into four groups: control, distilled water, sodium bicarbonate and HAp group. After one day of rest, the mice were intravenously injected via the lateral tail veins with 1 ml distilled water, sodium bicarbonate and HAp suspension (2.2 mg/ml), respectively, and subjected to a swimming exhaustive experiment (load 10%). The swimming time of mice in the water, under water and total time were recorded. The exhaustive exercise mice were immediately subject to abdominal cavity anaesthesia. The concentrations of blood, gastrocnemius and myocardial lactic acid as well as serum LDH activity were detected. We demonstrate that HAp can significantly prolong swimming time and improve serum LDH activity, but does not affect lactic acid concentration. In conclusion, intravenous injection of HAp nanoparticles can significantly improve the exhaustive swimming ability of mice mainly because of the elevated blood LDH activity induced by HAp.

  10. Contrast-enhanced peripheral MRA. Technique and contrast agents

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Yousef W. [Dept. of Radiology, Copenhagen Univ. Hospital Bispebjerg, Bispebjerg (Denmark)], e-mail: ywnielsen@gmail.com; Thomsen, Henrik S. [Dept. of Diagnostic Radiology, Copenhagen Univ. Hospital Herlev, Herlev (Denmark)

    2012-09-15

    In the last decade contrast-enhanced magnetic resonance angiography (CE-MRA) has gained wide acceptance as a valuable tool in the diagnostic work-up of patients with peripheral arterial disease. This review presents current concepts in peripheral CE-MRA with emphasis on MRI technique and contrast agents. Peripheral CE-MRA is defined as an MR angiogram of the arteries from the aortic bifurcation to the feet. Advantages of CE-MRA include minimal invasiveness and lack of ionizing radiation. The basic technique employed for peripheral CE-MRA is the bolus-chase method. With this method a paramagnetic MRI contrast agent is injected intravenously and T1-weighted images are acquired in the subsequent arterial first-pass phase. In order to achieve high quality MR angiograms without interfering venous contamination or artifacts, a number of factors need to be taken into account. This includes magnetic field strength of the MRI system, receiver coil configuration, use of parallel imaging, contrast bolus timing technique, and k-space filling strategies. Furthermore, it is possible to optimize peripheral CE-MRA using venous compression techniques, hybrid scan protocols, time-resolved imaging, and steady-state MRA. Gadolinium(Gd)-based contrast agents are used for CE-MRA of the peripheral arteries. Extracellular Gd agents have a pharmacokinetic profile similar to iodinated contrast media. Accordingly, these agents are employed for first-pass MRA. Blood-pool Gd-based agents are characterized by prolonged intravascular stay, due to macromolecular structure or protein binding. These agents can be used for first-pass, as well as steady-state MRA. Some Gd-based contrast agents with low thermodynamic stability have been linked to development of nephrogenic systemic fibrosis in patients with severe renal insufficiency. Using optimized technique and a stable MRI contrast agent, peripheral CE-MRA is a safe procedure with diagnostic accuracy close to that of conventional catheter X

  11. Contrast-enhanced harmonic endoscopic ultrasound

    DEFF Research Database (Denmark)

    Săftoiu, A; Dietrich, C F; Vilmann, P

    2012-01-01

    Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, and improving staging and guidance of therapeutic procedures. Although...... contrast-enhanced harmonic EUS based on a very low mechanical index (0.08 - 0.12). Quantification techniques based on dynamic contrast-enhanced ultrasound have been recommended for perfusion imaging and monitoring of anti-angiogenic treatment, mainly based on time-intensity curve analysis. Most...

  12. How to misuse echo contrast

    Directory of Open Access Journals (Sweden)

    Missios Anna

    2009-01-01

    Full Text Available Abstract Background Primary intracardiac tumours are rare, there are however several entities that can mimic tumours. Contrast echocardiography has been suggested to aid the differentiation of various suspected masses. We present a case where transthoracic echocardiography completely misdiagnosed a left atrial mass, partly due to use of echo contrast. Case presentation An 80 year-old woman was referred for transthoracic echocardiography because of one-month duration of worsening of dyspnoea. Transthoracic echocardiography displayed a large echodense mass in the left atrium. Intravenous injection of contrast (SonoVue, Bracco Inc., It indicated contrast-enhancement of the structure, suggesting tumour. Transesophageal echocardiography revealed, however, a completely normal finding in the left atrium. Subsequent gastroscopy examination showed a hiatal hernia. Conclusion It is noteworthy that the transthoracic echocardiographic exam completely misdiagnosed what seemed like a left atrial mass, which in part was an effect of the use of echo contrast. This example highlights that liberal use of transoesophageal echocardiography is often warranted if optimal display of cardiac structures is desired.

  13. Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN [atorvastatin for reduction of myocardial damage during angioplasty--contrast-induced nephropathy] trial.

    Science.gov (United States)

    Patti, Giuseppe; Ricottini, Elisabetta; Nusca, Annunziata; Colonna, Giuseppe; Pasceri, Vincenzo; D'Ambrosio, Andrea; Montinaro, Antonio; Di Sciascio, Germano

    2011-07-01

    Contrast-induced nephropathy (CIN) impairs clinical outcome in patients undergoing angiographic procedures. The aim of this study was to investigate whether short-term high-dose atorvastatin load decreases the incidence of CIN after percutaneous coronary intervention (PCI). Statin-naive patients with acute coronary syndrome undergoing PCI (n = 241) randomly received atorvastatin (80 mg 12 hours before intervention with another 40-mg preprocedure dose, n = 120) or placebo (n = 121). All patients had long-term atorvastatin treatment thereafter (40 mg/day). Primary end point was incidence of CIN defined as postintervention increase in serum creatinine ≥0.5 mg/dl or >25% from baseline. Five percent of patients in the atorvastatin arm developed CIN versus 13.2% of those in the placebo arm (p = 0.046). In the atorvastatin group, postprocedure serum creatinine was significantly lower (1.06 ± 0.35 vs 1.12 ± 0.27 mg/dl in placebo, p = 0.01), creatinine clearance was decreased (80.1 ± 32.2 vs 72.0 ± 26.6 ml/min, p = 0.034), and C-reactive protein peak levels after intervention were decreased (8.4 ± 10.5 vs 13.1 ± 20.8 mg/l, p = 0.01). Multivariable analysis showed that atorvastatin pretreatment was independently associated with a decreased risk of CIN (odds ratios 0.34, 95% confidence interval 0.12 to 0.97, p = 0.043). Prevention of CIN with atorvastatin was paralleled by a shorter hospital stay (p = 0.007). In conclusion, short-term pretreatment with high-dose atorvastatin load prevents CIN and shortens hospital stay in patients with acute coronary syndrome undergoing PCI; anti-inflammatory effects may be involved in this renal protection. These results lend further support to early use of high-dose statins as adjuvant pharmacologic therapy before percutaneous coronary revascularization. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Depression after myocardial infarction.

    Science.gov (United States)

    Ziegelstein, R C

    2001-01-01

    Depression is an independent risk factor for increased postmyocardial infarction morbidity and mortality, even after controlling for the extent of coronary artery disease, infarct size, and the severity of left ventricular dysfunction. This risk factor takes on added significance when one considers that almost half of patients recovering from a myocardial infarction have major or minor depression and that major depression alone occurs in about one in five of these individuals. Despite the well-documented risk of depression, questions remain about the mechanism of the relationship between mood disturbance and adverse outcome. The link may be explained by an association with lower levels of social support, poor adherence to recommended medical therapy and lifestyle changes intended to reduce the risk of subsequent cardiac events, disturbances in autonomic tone, enhanced platelet activation and aggregation, and systemic immune activation. Unfortunately, questions about the pathophysiologic mechanism of depression in this setting are paralleled by uncertainties about the optimal treatment of depression for patients recovering from a myocardial infarction and by a lack of knowledge about whether treating depression lowers the associated increased mortality risk. Ongoing research studies will help to determine the benefits of psychosocial interventions and of antidepressant therapy for patients soon after myocardial infarction. Although the identification of depression as a risk factor may by itself be a reason to incorporate a comprehensive psychological evaluation into the routine care of patients with myocardial infarction, this practice should certainly become standard if studies show that treating depression reduces the increased mortality risk of these patients.

  15. IMMUNOREGULATORY EFFECTS OF INTRAVENOUS IMMUNOGLOBULINS

    Directory of Open Access Journals (Sweden)

    S. A. Sel'kov

    2013-01-01

    Full Text Available Treatment with intravenous immunoglobulins (IVIG is widely used in modern clinical practice inorder to cure different clinical disorders, including obstetric conditions. Currently, IVIGs have become drugs of  choice  for  treatment of  anti-phospholipid  syndrome  in pregnant women,  like  as  in  cases of  intrauterine cytomegalovirus infection.

  16. Pulmonary edema following high intravenous doses of diatrizoate in the rat

    Energy Technology Data Exchange (ETDEWEB)

    Maare, K.; Violante, M.; Zack, A.

    Serious adverse reactions to intravenous contrast media are rare but of major concern. Corticosteroids are the most commonly used drugs for prophylaxis but there is little documentation of their effectiveness. Controversy also exists about the optimum regime for these drugs. A rat model was used to evaluate the effect of methylprednisolone pretreatment for contrast media-induced pulmonary edema. Rats were given 40 mg methylprednisolone/kg intravenously at various time intervals before the intravenous injection of a high dose of diatrizoate (6 g I/kg). The combination of one dose of methylprednisolone at 24 hours plus another dose at 0.5 hours was the only regimen that caused a significant reduction in the degree of pulmonary edema induced by contrast media. This result provides support for the clinical regimen utilizing iterated doses of corticosteroids over a prolonged period of time. (orig.).

  17. Effect of metoprolol on chest pain in acute myocardial infarction.

    OpenAIRE

    Herlitz, J; Hjalmarson, A.; Holmberg, S.; Pennert, K; Swedberg, K; Vedin, A; Waagstein, F; Waldenström, A; Wedel, H.; Wilhelmsen, L

    1984-01-01

    A total of 1395 patients aged 40 to 74 years were included in a double blind trial with the beta 1 selective blocker metoprolol in suspected acute myocardial infarction. Metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital followed by 200 mg daily for three months. A placebo was given in the same manner. The severity of chest pain in the acute phase was calculated by recording the number of injections of analgesics given and the time from the start of bli...

  18. Intravenous injections in neonatal mice.

    Science.gov (United States)

    Gombash Lampe, Sara E; Kaspar, Brian K; Foust, Kevin D

    2014-11-11

    Intravenous injection is a clinically applicable manner to deliver therapeutics. For adult rodents and larger animals, intravenous injections are technically feasible and routine. However, some mouse models can have early onset of disease with a rapid progression that makes administration of potential therapies difficult. The temporal (or facial) vein is just anterior to the ear bud in mice and is clearly visible for the first two days after birth on either side of the head using a dissecting microscope. During this window, the temporal vein can be injected with volumes up to 50 μl. The injection is safe and well tolerated by both the pups and the dams. A typical injection procedure is completed within 1-2 min, after which the pup is returned to the home cage. By the third postnatal day the vein is difficult to visualize and the injection procedure becomes technically unreliable. This technique has been used for delivery of adeno-associated virus (AAV) vectors, which in turn can provide almost body-wide, stable transgene expression for the life of the animal depending on the viral serotype chosen.

  19. Endogenous assessment of myocardial fibrosis with quantitative MRI

    NARCIS (Netherlands)

    Oorschot, J.W.M. van

    2016-01-01

    In this thesis, we have studied the use of quantitative MR contrast mechanisms, that could potentially be used for endogenous detection of myocardial fibrosis in the clinic. we have mainly focused on T2*, T1ρ MRI and Magnetization Transfer Imaging, and found that T1ρ -mapping, and Magnetization Tran

  20. Stochastic modeling for magnetic resonance quantification of myocardial blood flow

    Science.gov (United States)

    Seethamraju, Ravi T.; Muehling, Olaf; Panse, Prasad M.; Wilke, Norbert M.; Jerosch-Herold, Michael

    2000-10-01

    Quantification of myocardial blood flow is useful for determining the functional severity of coronary artery lesions. With advances in MR imaging it has become possible to assess myocardial perfusion and blood flow in a non-invasive manner by rapid serial imaging following injection of contrast agent. To date most approaches reported in the literature relied mostly on deriving relative indices of myocardial perfusion directly from the measured signal intensity curves. The central volume principle on the other hand states that it is possible to derive absolute myocardial blood flow from the tissue impulse response. Because of the sensitivity involved in deconvolution due to noise in measured data, conventional methods are sub-optimal, hence, we propose to use stochastic time series modeling techniques like ARMA to obtain a robust impulse response estimate. It is shown that these methods when applied for the optical estimation of the transfer function give accurate estimates of myocardial blood flow. The most significant advantage of this approach, compared with compartmental tracer kinetic models, is the use of a minimum set of prior assumptions on data. The bottleneck in assessing myocardial blood flow, does not lie in the MRI acquisition, but rather in the effort or time for post processing. It is anticipated that the very limited requirements for user input and interaction will be of significant advantage for the clinical application of these methods. The proposed methods are validated by comparison with mean blood flow measurements obtained from radio-isotope labeled microspheres.

  1. Measuring myocardial perfusion: the role of PET, MRI and CT.

    Science.gov (United States)

    Qayyum, A A; Kastrup, J

    2015-06-01

    Recently, focus has changed from anatomical assessment of coronary arteries towards functional testing to evaluate the effect of stenosis on the myocardium before intervention. Besides positron-emission tomography (PET), cardiac MRI (CMR), and cardiac CT are able to measure myocardial perfusion. Myocardial perfusion abnormalities are the first sign of the ischaemic cascade in the development of coronary artery disease (CAD). PET is considered the non-invasive clinical reference standard for absolute quantification of myocardial perfusion. The diagnostic and prognostic value of PET is well-known and is used in routine clinical practice. However, PET uses radioactive tracers and has a lower spatial resolution compared to CMR and CT. CMR and CT are emerging techniques in the field of myocardial perfusion imaging. CMR uses magnetic resonance to obtain images, whereas CT uses x-rays during first-pass of non-ionic and ionic contrast agents, respectively. Absolute quantification with CMR has yet to be established in routine clinical practice, while CT has yet to prove its diagnostic and prognostic value. The upcoming years may change the way we diagnose and treat patients suspected of having CAD with more precise methods for measuring myocardial perfusion. The aim of this comprehensive review is to discuss current and emerging imaging techniques used for myocardial perfusion imaging.

  2. [Digitalization for acute myocardial infarction: haemodynamic changes in patients with heart failure at rest (author's transl)].

    Science.gov (United States)

    Bachour, G; Hochrein, H

    1975-11-21

    Haemodynamic changes after intravenous administration of 0.4 mg beta-methyldigoxin or 0.4 mg digoxin daily were measured on the first to fourth day in 42 patients in heart failure after onset of transmural myocardial infarction. Regular reduction in filling pressure and increased stroke volume while arterial blood pressure remained unaltered pointed to improved contractility. Digitalization in the first few days after infarction achieved sustained tendency towards improved haemodynamics. It is concluded that early digitalization is indicated in patients with acute myocardial infarction if there are signs of heart failure.

  3. Intravenous nutrition during a twin pregnancy.

    Science.gov (United States)

    Karamatsu, J T; Boyd, A T; Cooke, J; Vinall, P S; McMahon, M J

    1987-01-01

    A case is reported of a woman in the third trimester of a twin pregnancy who required intravenous nutrition because of inadequate absorption of nutrients due to a jejunoileal bypass. Weight gain was poor, and there was evidence of intrauterine growth retardation before commencement of intravenous feeding. She received overnight intravenous nutrition for 6 weeks and gained weight with ultrasound evidence of fetal growth. During the 33rd week of gestation, she was delivered of healthy twin males who were at appropriate birth weights and development for their age of gestation. The considerations in intravenous nutrition for a twin pregnancy after jejunoileal bypass are discussed.

  4. Pancreatic enzyme secretion during intravenous fat infusion.

    Science.gov (United States)

    Burns, G P; Stein, T A

    1987-01-01

    The nutritional support of patients with pancreatic and high gastrointestinal fistulas and severe pancreatitis frequently involves intravenous fat infusion. There are conflicting reports on the effect of intravenous fat on pancreatic exocrine secretion. In 10 dogs with chronic pancreatic fistulas, pancreatic juice was collected during secretin (n = 10) or secretin + cholecystokinin (n = 4) stimulation, with and without intravenous fat infusion (5 g/hr). The hormonal-stimulated secretion of lipase, amylase, trypsin, total protein, bicarbonate, and water was unchanged during fat infusion. This study supports the use of intravenous fat as a nutritional source when it is desirable to avoid stimulation of the pancreas.

  5. Retrospective Analysis of Thrombolysis Therapy for 64 Cases of Acute Myocardial Infarction with Elevated ST Segment

    Institute of Scientific and Technical Information of China (English)

    傅晓霞; 肖文剑; 吕健; 吴乐文; 杨帆

    2009-01-01

    Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XS...

  6. Intravenous Iron Carboxymaltose as a Potential Therapeutic in Anemia of Inflammation.

    Directory of Open Access Journals (Sweden)

    Niklas Lofruthe

    Full Text Available Intravenous iron supplementation is an effective therapy in iron deficiency anemia (IDA, but controversial in anemia of inflammation (AI. Unbound iron can be used by bacteria and viruses for their replication and enhance the inflammatory response. Nowadays available high molecular weight iron complexes for intravenous iron substitution, such as ferric carboxymaltose, might be useful in AI, as these pharmaceuticals deliver low doses of free iron over a prolonged period of time. We tested the effects of intravenous iron carboxymaltose in murine AI: Wild-type mice were exposed to the heat-killed Brucella abortus (BA model and treated with or without high molecular weight intravenous iron. 4h after BA injection followed by 2h after intravenous iron treatment, inflammatory cytokines were upregulated by BA, but not enhanced by iron treatment. In long term experiments, mice were fed a regular or an iron deficient diet and then treated with intravenous iron or saline 14 days after BA injection. Iron treatment in mice with BA-induced AI was effective 24h after iron administration. In contrast, mice with IDA (on iron deficiency diet prior to BA-IA required 7d to recover from AI. In these experiments, inflammatory markers were not further induced in iron-treated compared to vehicle-treated BA-injected mice. These results demonstrate that intravenous iron supplementation effectively treated the murine BA-induced AI without further enhancement of the inflammatory response. Studies in humans have to reveal treatment options for AI in patients.

  7. Intravenous Iron Carboxymaltose as a Potential Therapeutic in Anemia of Inflammation

    Science.gov (United States)

    Traeger, Lisa; Bäumer, Nicole; Schulze, Isabell; Kuhlmann, Tanja; Müller-Tidow, Carsten

    2016-01-01

    Intravenous iron supplementation is an effective therapy in iron deficiency anemia (IDA), but controversial in anemia of inflammation (AI). Unbound iron can be used by bacteria and viruses for their replication and enhance the inflammatory response. Nowadays available high molecular weight iron complexes for intravenous iron substitution, such as ferric carboxymaltose, might be useful in AI, as these pharmaceuticals deliver low doses of free iron over a prolonged period of time. We tested the effects of intravenous iron carboxymaltose in murine AI: Wild-type mice were exposed to the heat-killed Brucella abortus (BA) model and treated with or without high molecular weight intravenous iron. 4h after BA injection followed by 2h after intravenous iron treatment, inflammatory cytokines were upregulated by BA, but not enhanced by iron treatment. In long term experiments, mice were fed a regular or an iron deficient diet and then treated with intravenous iron or saline 14 days after BA injection. Iron treatment in mice with BA-induced AI was effective 24h after iron administration. In contrast, mice with IDA (on iron deficiency diet) prior to BA-IA required 7d to recover from AI. In these experiments, inflammatory markers were not further induced in iron-treated compared to vehicle-treated BA-injected mice. These results demonstrate that intravenous iron supplementation effectively treated the murine BA-induced AI without further enhancement of the inflammatory response. Studies in humans have to reveal treatment options for AI in patients. PMID:27404499

  8. Silent myocardial ischemia.

    Science.gov (United States)

    Gutterman, David D

    2009-05-01

    Although much progress has been made in reducing mortality from ischemic cardiovascular disease, this condition remains the leading cause of death throughout the world. This might in part be due to the fact that over half of patients have a catastrophic event (heart attack or sudden death) as their initial manifestation of coronary disease. Contributing to this statistic is the observation that the majority of myocardial ischemic episodes are silent, indicating an inability or failure to sense ischemic damage or stress on the heart. This review examines the clinical characteristics of silent myocardial ischemia, and explores mechanisms involved in the generation of angina pectoris. Possible mechanisms for the more common manifestation of injurious reductions in coronary flow; namely, silent ischemia, are also explored. A new theory for the mechanism of silent ischemia is proposed. Finally, the prognostic importance of silent ischemia and potential future directions for research are discussed.

  9. Improved myocardial strain measured by strain-encoded magnetic resonance imaging in a patient with cardiac sarcoidosis.

    Science.gov (United States)

    Nakano, Shintaro; Kimura, Fumiko; Osman, Nael; Sugi, Keiki; Tanno, Jun; Uchida, Yoshitaka; Shiono, Ayako; Senbonmatsu, Takaaki; Nishimura, Shigeyuki

    2013-11-01

    A woman aged 64 years with cardiac sarcoidosis responded favourably to corticosteroid therapy in terms of recovered longitudinal myocardial strain, as evaluated by strain-encoded magnetic resonance imaging (SENC-MRI). In contrast, circumferential myocardial strain and late gadolinium enhancement demonstrated minimal improvement, suggesting relatively advanced pathology of the myocardial middle layer. We propose SENC-MRI as a marker of disease at an early stage of cardiac sarcoidosis.

  10. 布地奈德吸入与甲泼尼龙静脉应用治疗慢性阻塞性肺疾病急性加重期的对比研究%Contrast study between budesonide inhalation with methylperdnisolone intravenous in the treatment of acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    王维; 徐秋芬

    2013-01-01

    目的 比较布地奈德吸入与甲泼尼龙静脉应用治疗慢性阻塞性肺疾病(COPD)急性加重期的疗效及安全性.方法 将80例COPD急性加重期患者随机分为对照组和观察组,每组40例.在给予常规治疗的基础上,对照组采用甲泼尼龙静脉应用,观察组则采用布地奈德吸入治疗.观察并比较两组患者的短期与长期的疗效及症状评分、两组患者治疗前后第一秒用力呼气/用力肺活量(FEV1/FVC)以及最大呼气中期流量(MMEF)等肺功能及动脉血氧分压(PaO2)以及二氧化碳分压(PaCO2)等动脉血气分析指标.结果 与对照组比较,观察组近、远期疗效及症状评分等差异均无统计学意义(均P>0.05);治疗后,两组患者肺功能、血气分析指标及气道反应性均改善显著(均P<0.05),但两组间差异均无统计学意义(均P>0.05);观察组不良反应发生率显著低于对照组(P<0.05).结论 糖皮质激素治疗COPD急性加重期疗效肯定,无论给药方式如何,均具有较好的近期及远期疗效,但在不良反应方面布地奈德吸入显著优于甲泼尼龙静脉应用.%Objective To compare the effect and safety between budesonide inhalation with methylperdnisolone intravenous in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods 80 patients with AECOPD were divided into the control group and observation group randomly,each group 40 cases.Based on regular treatment,the patients in the control group received intravenous treatment of methylprednisolone,while patients in the observation group receive inhaled treatment of budesonide.The near-term and long-term effect,symptom score,and the indicators such as FEV1/FVC,MMEF,PaO2,PaCO2 and AHR were observed and compared beween the two groups before and after treatment.Results Compared with control group,there were no significant differences of short-term and long term treatment effects and symptom score in observation group

  11. Intracoronary levosimendan during ischemia prevents myocardial apoptosis.

    Directory of Open Access Journals (Sweden)

    Markus eMalmberg

    2012-02-01

    Full Text Available Background. Levosimendan is a calcium-sensitizing inotropic agent that prevents myocardial contractile depression following cardiac surgery. Levosimendan has also anti-apoptotic properties, but the role of this mechanism is not clear. We studied whether levosimendan prevents cardiomyocyte apoptosis and post-operative stunning after either intracoronary administration or intravenous infusion in an experimental model. Methods. Pigs (n=24 were subjected to 40 minutes of global, cardioplegic ischemia under cardiopulmonary bypass and 240 minutes of reperfusion. L-IV group received intravenous infusion of levosimendan (65 μg/kg 40 minutes before ischemia and L-IC group received levosimendan (65 μg/kg during ischemia administered intracoronary. Control group was operated without levosimendan. Echocardiography was performed to all animals. Apoptosis was determined from transmyocardial biopsies taken from left ventricle using TUNEL assay and immunohistochemistry of active caspace-3. Results. Apoptosis was induced after ischemia-reperfusion in all groups (pre L-IV 0.002±0.004 % vs. post L-IV 0.020±0.017 % p=0.02, pre L-IC 0.001±0.004 % vs. post L-IC 0.020±0.017 % p<0.001, pre control 0.007±0.013 % vs. post control 0.062±0.044 % p=0.01. The amount of apoptosis was higher in the controls, compared with the L-IV (p=0.03 and the L-IC (p=0.03 groups. Longitudinal left ventricular contraction was significantly reduced in the L-IC and the control groups when compared to the L-IV group (L-IV 0.75±0.12 mm vs. L-IC 0.53±0.11 mm p=0.003, L-IV vs. control 0.54±0.11 p=0.01. Conclusions. Both intracoronary administration and pre-ischemic intravenous infusion of levosimendan equally prevented apoptosis, but intravenous administration was required for optimal preservation of the post-operative systolic left ventricle function.

  12. 磁共振延迟成像时间对急性心肌梗死测定的影响%Effect of imaging time on infarct size estimation after acute myocardial infarction using delayed contrast-enhancement magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    马剑英; 张峰; 王克强; 曾蒙苏; 邹云增; 钱菊英; 葛均波; 杨姗; 葛雷; 刘学波; 金航; 林瑾仪; 胡昕婴

    2009-01-01

    Objective To investigate whether timing of image acquisition influenced infarct size estimation using delayed CeMRI,and the association of left ventricular ejection fraction between magnetic resol3anee imaging and left ventrieulography Was also studied.Method From Junary 2005 to April 2006,27 first,onset AMI patients [23 male,mean age(54.3±10.5)years]were enrolledinthistudr.Allpatients receivedleft ventrictdographyas well as coronary angiography.The average checking time was(13.2±5.2)clays after the onset of AMI.MR imaging was performed with a 1.5-T magnet(SIMENS).After breath-hold eine images were acquired,patients re.ceived afI intravenous bolus of 0.05 mmol/kg Gd-DTPA at a rate of 5 ml/8.A first-pass perfusion scan was ac.qllired.Then a second bolus of 0.15 mmoVkg Gd-DTPA was give.at a rate of 2 mE/Is.After the hyperenhancement localized,the typical short axis slice with hyperenhancement WaS chosen to repeat imaging for IlleasuriIin.farct size every5minutesfrom5minutes after secondinjection ofcontrast until 20minutes.Results Twexty-seren patients showed hyperenhancement at the delayed CeMRI and hypoenhancement at the first pass enhancement(FPE).The average infarct size estimated by CeMRI WaS(17.9士9.8)%of LV nlass.Myocardial enhancement at a repesentative short-axis slice WIllS(7.2±6.2)%of LV Imss at 5 minutes,(8.5±7.4)%at 10 minutes,(7.3±6.3)%at 15 minutes and(6.9-t-6.4)%at 20 minutes respectively.There WltlS significant difference be-tween lmfninmes and 20-minutes enhancement size(P<0.05).Correlations of EF obtained by cineventriculo-grapIIy and MR irr,lg were significant(r=0.867,P<0.01).There were also correlations between infarction size and pe.k CK(r:O.819,P

  13. Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration

    Energy Technology Data Exchange (ETDEWEB)

    Chou, Shinn-Huey; Wang, Zhen J.; Kuo, Jonathan; Cabarrus, Miguel; Fu Yanjun; Aslam, Rizwan; Yee, Judy; Zimmet, Jeffrey M.; Shunk, Kendrick; Elicker, Brett [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Yeh, Benjamin M., E-mail: Benjamin.Yeh@ucsf.edu [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States)

    2011-11-15

    Purpose: To examine the clinical significance of persistent renal enhancement after iodixanol administration. Methods: We retrospectively studied 166 consecutive patients who underwent non-enhanced abdominopelvic CT within 7 days after receiving intra-arterial (n = 99) or intravenous (n = 67) iodixanol. Renal attenuation was measured for each non-enhanced CT scan. Persistent renal enhancement was defined as CT attenuation >55 Hounsfield units (HU). Contrast-induced nephropathy (CIN) was defined as a rise in serum creatinine >0.5 mg/dL within 5 days after contrast administration. Results: While the intensity and frequency of persistent renal enhancement was higher after intra-arterial (mean CT attenuation of 73.7 HU, seen in 54 of 99 patients, or 55%) than intravenous contrast material administration (51.8 HU, seen in 21 of 67, or 31%, p < 0.005), a multivariate regression model showed that the independent predictors of persistent renal enhancement were a shorter time interval until the subsequent non-enhanced CT (p < 0.001); higher contrast dose (p < 0.001); higher baseline serum creatinine (p < 0.01); and older age (p < 0.05). The route of contrast administration was not a predictor of persistent renal enhancement in this model. Contrast-induced nephropathy was noted in 9 patients who received intra-arterial (9%) versus 3 who received intravenous iodixanol (4%), and was more common in patients with persistent renal enhancement (p < 0.01). Conclusion: Persistent renal enhancement at follow-up non-contrast CT suggests a greater risk for contrast-induced nephropathy, but the increased frequency of striking renal enhancement in patients who received intra-arterial rather than intravenous contrast material also reflects the larger doses of contrast and shorter time to subsequent follow-up CT scanning for such patients.

  14. 他汀类药物对急性心肌梗死患者直接冠状动脉介入治疗后对比剂肾病的预防作用%Statins for prevention of contrast-induced nephropathy in patients with acute myocardial infarction performed primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    徐验; 衣为民; 龙娟; 罗颖; 张怡清; 胡伟; 郭文玉

    2012-01-01

    Objectives To investigate the efficacy of pretreatment with statins for prevention of contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods Clinical data of 186 patients with acute ST-segment elevation AMI who underwent primary PCI were retrospectively analyzed. Forty two patients had chronically received statins before admission (statins group) and 144 had not (no-statins group). Serum concentration of creatinine (Scr) was measured before and in 48- 72hrs after PCI. Creatinine clearance (Ccr) was calculated. Results Of all 186 patients, 34 patients (18.3%) developed CIN. There was a significantly lower incidence of CIN in statins group compared with no-statins group (7.1% vs. 21.5%, P<0.05). Also, post-procedural Scr was lower and Ccr was higher in statins group than those in no-statins group, which was of statistical significance [ (90.3±26.0)μmol/L vs. (101.5±28.4)jxmol/L, P<0.05; (72.5±21.1) mL/min vs. (63.9±18.2)mL/min, P<0.05]. Multivariate analysis revealed that statin pretreatment before PCI (OR 0.48, 95%CI 0.11 ~0.89,P<0.05) was an independent predictor of CIN along with pre-existing renal insufficiency (baseline Ccr <60 mL/min), implantation of intra-aortic balloon bump and cardiogenic shock. Conclusions Pretreatment with statins can reduce the incidence of CIN by protecting renal function of patients with AMI performed primary PCI, which indicates that preprocedural statin therapy may prevent CIN.%目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者行直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗前,应用他汀类药物对于对比剂肾病(contrast-induced nephropathy,CIN)的预防作用.方法 回顾性分析186例行直接PCI治疗的急性ST段抬高AMI患者的临床资料,根据入院前是否接受他汀类药物治疗,分为他汀组(42例)和非他汀组(144例),

  15. Partial intravenous anesthesia in cats and dogs.

    Science.gov (United States)

    Duke, Tanya

    2013-03-01

    The partial intravenous anesthesia technique (PIVA) is used to lower the inspired concentration of an inhalational anesthetic by concurrent use of injectable drugs. This technique reduces the incidence of undesirable side-effects and provides superior quality of anesthesia and analgesia. Drugs commonly used for PIVA include opioids, alpha-2 adrenergic agonists, injectable anesthetic agents, and lidocaine. Most are administered by intravenous infusion.

  16. Myocardial Perfusion and Function Are Distinctly Altered by Sevoflurane Anesthesia in Diet-Induced Prediabetic Rats

    Directory of Open Access Journals (Sweden)

    Charissa E. van den Brom

    2016-01-01

    Full Text Available Preservation of myocardial perfusion during surgery is particularly important in patients with increased risk for perioperative complications, such as diabetes. Volatile anesthetics, like sevoflurane, have cardiodepressive effects and may aggravate cardiovascular complications. We investigated the effect of sevoflurane on myocardial perfusion and function in prediabetic rats. Rats were fed a western diet (WD; n=18 or control diet (CD; n=18 for 8 weeks and underwent (contrast echocardiography to determine perfusion and function during baseline and sevoflurane exposure. Myocardial perfusion was estimated based on the product of microvascular filling velocity and blood volume. WD-feeding resulted in a prediabetic phenotype characterized by obesity, hyperinsulinemia, hyperlipidemia, glucose intolerance, and hyperglycemia. At baseline, WD-feeding impaired myocardial perfusion and systolic function compared to CD-feeding. Exposure of healthy rats to sevoflurane increased the microvascular filling velocity without altering myocardial perfusion but impaired systolic function. In prediabetic rats, sevoflurane did also not affect myocardial perfusion; however, it further impaired systolic function. Diet-induced prediabetes is associated with impaired myocardial perfusion and function in rats. While sevoflurane further impaired systolic function, it did not affect myocardial perfusion in prediabetic rats. Our findings suggest that sevoflurane anesthesia leads to uncoupling of myocardial perfusion and function, irrespective of the metabolic state.

  17. Myocardial Perfusion and Function Are Distinctly Altered by Sevoflurane Anesthesia in Diet-Induced Prediabetic Rats.

    Science.gov (United States)

    van den Brom, Charissa E; Boly, Chantal A; Bulte, Carolien S E; van den Akker, Rob F P; Kwekkeboom, Rick F J; Loer, Stephan A; Boer, Christa; Bouwman, R Arthur

    2016-01-01

    Preservation of myocardial perfusion during surgery is particularly important in patients with increased risk for perioperative complications, such as diabetes. Volatile anesthetics, like sevoflurane, have cardiodepressive effects and may aggravate cardiovascular complications. We investigated the effect of sevoflurane on myocardial perfusion and function in prediabetic rats. Rats were fed a western diet (WD; n = 18) or control diet (CD; n = 18) for 8 weeks and underwent (contrast) echocardiography to determine perfusion and function during baseline and sevoflurane exposure. Myocardial perfusion was estimated based on the product of microvascular filling velocity and blood volume. WD-feeding resulted in a prediabetic phenotype characterized by obesity, hyperinsulinemia, hyperlipidemia, glucose intolerance, and hyperglycemia. At baseline, WD-feeding impaired myocardial perfusion and systolic function compared to CD-feeding. Exposure of healthy rats to sevoflurane increased the microvascular filling velocity without altering myocardial perfusion but impaired systolic function. In prediabetic rats, sevoflurane did also not affect myocardial perfusion; however, it further impaired systolic function. Diet-induced prediabetes is associated with impaired myocardial perfusion and function in rats. While sevoflurane further impaired systolic function, it did not affect myocardial perfusion in prediabetic rats. Our findings suggest that sevoflurane anesthesia leads to uncoupling of myocardial perfusion and function, irrespective of the metabolic state.

  18. Liver CT with portal-venous contrast

    Energy Technology Data Exchange (ETDEWEB)

    Schild, H.; Mildenberger, P.; Schweden, F.; Eckmann, A.; Nagel, K.; Knuth, A.; Boerner, N.; Thelen, M.; Junginger, T.

    1987-12-01

    Contrast administration through the superior mesenteric or splenic arteries provided additional information in 22 out of 31 patients, when compared with intravenous contrast bolus for CT of the liver. In 11 patients, the demonstration of a tumour lead to a change in treatment. False positive findings occurred in four of the 31 patients. In 2 patients intrahepatic lesions were overlooked, but were found during angiography carried out at the same examination. The diagnosis of intrahepatic space-occupying lesions is discussed as well as the CT appearances of portal-venous liver perfusion.

  19. Persistent staphylococcal bacteremia in an intravenous drug abuser.

    Science.gov (United States)

    Barg, N L; Supena, R B; Fekety, R

    1986-02-01

    A patient with methicillin-resistant Staphylococcus aureus bacteremia received vancomycin (MIC = 0.8 microgram/ml, MBC = 15 micrograms/ml) and heparin simultaneously through the same intravenous line to treat a septic deep venous thrombosis. Bacteremia persisted for 7 days. Bacteremia terminated when the simultaneous infusion of heparin and vancomycin through the same line was stopped. This suggested that an interaction between vancomycin and heparin may have occurred, which resulted in a reduction in vancomycin activity. To test for such an interaction, mixtures of heparin and vancomycin in various concentrations were made and tested for antimicrobial activity against the organisms in the patient. A precipitate formed at the concentrations achieved in the intravenous lines, and when the vancomycin concentrations were measured by bioassay, a 50 to 60% reduction in activity was noted. In contrast, when these solutions were prepared and mixed at microgram concentrations, a precipitate was no longer observed, and antimicrobial activity was not reduced. Heparin appeared to interact unfavorably with vancomycin at the concentrations in the intravenous lines when these drugs were administered simultaneously to patients. This may be the cause of poor therapeutic responses to vancomycin in some patients, especially those infected with tolerant organisms.

  20. Effect of NO synthase inhibition on myocardial metabolism during moderate ischemia.

    Science.gov (United States)

    Martin, Claus; Schulz, Rainer; Post, Heiner; Gres, Petra; Heusch, Gerd

    2003-06-01

    Nitric oxide (NO) is involved in the control of myocardial metabolism. In normoperfused myocardium, NO synthase inhibition shifts myocardial metabolism from free fatty acid (FFA) toward carbohydrate utilization. Ischemic myocardium is characterized by a similar shift toward preferential carbohydrate utilization, although NO synthesis is increased. The importance of NO for myocardial metabolism during ischemia has not been analyzed in detail. We therefore assessed the influence of NO synthase inhibition with N(G)-nitro-l-arginine (l-NNA) on myocardial metabolism during moderate ischemia in anesthetized pigs. In control animals, the increase in left ventricular pressure with l-NNA was mimicked by aortic constriction. Before ischemia, l-NNA decreased myocardial FFA consumption (MV(FFA); P < 0.05), while consumption of carbohydrate and O(2) (MVo(2)) remained constant. ATP equivalents [calculated with the assumption of complete oxidative substrate decomposition (ATP(eq))] decreased with l-NNA (P < 0.05), associated with a decrease of regional myocardial function (P < 0.05). In contrast, aortic constriction had no effect on MV(FFA), while MVo(2) increased (P < 0.05) and ATP(eq) and regional myocardial function remained constant. During ischemia, alterations in myocardial metabolism were similar in control and l-NNA-treated animals: MV(FFA) decreased (P < 0.05) and net lactate consumption was reversed to net lactate production (P < 0.05). Regional myocardial function was decreased (P < 0.05), although more markedly in animals receiving l-NNA (P < 0.05). We conclude that the efficiency of oxidative metabolism was impaired by l-NNA per se, paralleled by impaired regional myocardial function. During ischemia, l-NNA had no effect on myocardial substrate consumption, indicating that NO synthases were no longer effectively involved in the control of myocardial metabolism.

  1. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

    OpenAIRE

    2013-01-01

    The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA) are well known. Compared to other tPAs, tenecteplase use leads to lower rates of b...

  2. Myocardial ischaemia following cocaine and adrenaline exposure in a child during an ophthalmological procedure.

    LENUS (Irish Health Repository)

    McGovern, E

    2015-03-01

    We report a 23-month old girl who presented with bilateral epiphora who underwent bilateral lacrimal probing and syringing, during which a cocaine adrenaline solution was used. Two hours after the procedure she developed acute pulmonary oedema secondary to myocardial ischaemia. The patient was treated with intravenous glyceryltrinitrate and milrinone infusions; cardiac enzymes and left ventricular function normalised over the subsequent 72 hours. Topical administration of cocaine and adrenaline solution may have dangerous systemic cardiac effects and should always be used judiciously.

  3. Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI.

    Science.gov (United States)

    Sağ, Saim; Yıldız, Abdülmecit; Aydin Kaderli, Aysel; Gül, Bülent Cuma; Bedir, Ömer; Ceğilli, Ercan; Özdemir, Bülent; Can, Fatma Ezgi; Aydınlar, Ali

    2017-01-01

    Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN-) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration. A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (+) patients, monocytes were higher [1.02 (0.83-1.39) vs. 0.69 (0.53-0.90) 109/L, pMHR was significantly higher in the CIN (+) group [1.16 (0.89-2.16) vs. 0.72 (0.53-0.95) 109/mmol, pMHR, Mehran score, AGEF score and CV/eGFR were independently correlated with CIN. Higher MHR levels may predict CIN development after primary PCI in STEMI patients.

  4. Intravenous flat detector CT angiography for non-invasive visualisation of intracranial flow diverter: technical feasibility.

    Science.gov (United States)

    Struffert, Tobias; Saake, Marc; Ott, Sabine; Engelhorn, Tobias; Gölitz, Philipp; Kloska, Stephan; Doelken, Marc; Doerfler, Arnd

    2011-08-01

    To demonstrate the feasibility of intravenous Flat Detector CT Angiography (FD-CTA) for visualisation of intracranial Flow Diverting Devices. Flow Diverting Devices are used increasingly for treatment of intracranial aneurysms. A close follow up is necessary because it becomes obvious that a significant proportion of aneurysms treated with these devices remain patent. A minimally invasive method is highly desirable. In two patients treated with flow diverters a Flat Detector CT (FD-CT) with intravenous contrast medium application was performed. Post-processing was performed using commercially available software. In both patients the lumen of the device and the lumen of the aneurysm could be clearly evaluated. Some beam hardening artefacts due to the marker wires of the device were obvious. Flat Detector CT with intravenous contrast material application to evaluate flow-diverting devices seems to be feasible. Further studies are necessary to perform comparative evaluation of FD-CTA with angiography and other techniques like MRA or conventional CT angiography.

  5. Patients without myocardial accumulation of {sup 123}I-metaiodobenzylguanidine. Does it always reflect cardiac adrenergic dysfunction?

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Honda, Minoru; Hohjoh, Osamu [Sumitomo Hospital, Osaka (Japan)

    1994-12-01

    Since December 1992 to March 1994, we have performed myocardial imaging with {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) in 110 patients to examine myocardial sympathetic integrity. Among them 11 patients (10%) showed no accumulation of {sup 123}I-MIBG in the heart. So we have examined the mechanisms of no myocardial {sup 123}I-MIBG accumulation. {sup 123}I-MIBG imaging was obtained at 20 min and 3 h after intravenous injection of {sup 123}I-MIBG (148 MBq) at rest. In addition to routine tomography, anterior planar imaging of the heart and the whole body imaging were performed. Eleven patients without myocardial {sup 123}I-MIBG accumulation consisted of 5 patients with orthostatic hypotension (including 3 patients with diabetic neuropathy). four patients with hypertrophic cardiomyopathy (HCM), one patient with hypertension and one normal subject. In patients with orthostatic hypotension, standing test showed cardiac sympathetic dysfunction. In addition to no myocardial {sup 123}I-MIBG accumulation, accumulation of {sup 123}I-MIBG in the salivary glands was not found in all them. These indicated that in patients with orthostatic hypotension, generalized sympathetic dysfunction caused no myocardial {sup 123}I-MIBG accumulation. But in other 6 patients there was no evidence which suggested the cardiac sympathetic nerve dysfunction. Age, sex, serum norepinephrine level, myocardial perfusion and the medication were not different between the patients with and without myocardial {sup 123}I-MIBG accumulation. So the mechanism of no myocardial {sup 123}I-MIBG accumulation was not clear in these patients. But it was noteworthy that in patients with HCM, no myocardial {sup 123}I-MIBG accumulation appeared in 17% (4/24), and the frequency of no myocardial {sup 123}I-MIBG accumulation in HCM was significantly (p<0.05) higher than in other disease entities when patients with orthostatic hypotension were excluded. (author).

  6. Contrast-enhanced digital mammography

    Energy Technology Data Exchange (ETDEWEB)

    Dromain, Clarisse [Department of Radiology, Institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805 Villejuif Cedex (France)], E-mail: dromain@igr.fr; Balleyguier, Corinne; Adler, Ghazal [Department of Radiology, Institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805 Villejuif Cedex (France); Garbay, Jean Remi [Department of Surgery, Institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805 Villejuif Cedex (France); Delaloge, Suzette [Department of Medicine, Institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805 Villejuif Cedex (France)

    2009-01-15

    CEDM is a recent development of digital mammography using the intra-venous injection of an iodinated contrast agent in conjunction with a mammography examination. Two techniques have been developed to perform CEDM examinations: the temporal subtraction technique with acquisition of high-energy images before and after contrast medium injection and the dual energy technique with acquisition of a pair of low and high-energy images only after contrast medium injection. The temporal subtraction technique offered the possibility to analyze the kinetic curve of enhancement of breast lesions, similarly to breast MRI. The dual energy technique do not provide information about the kinetic of tumor enhancement but allows the acquisition of multiples views of the same breast or bilateral examination and is less sensitive to patient motion than temporal CEDM. Initial clinical experience has shown the ability of CEDM to map the distribution of neovasculature induced by cancer using mammography. Moreover, previous studies have shown a superiority of MX + CEDM, either for the assessment of the probability of malignancy than for BIRADS assessment comparing to MX alone. The potential clinical applications are the clarification of mammographically equivocal lesions, the detection of occult lesions on standard mammography, particularly in dense breast, the determination of the extent of disease, the assessment of recurrent disease and the monitoring of the response to chemotherapy. CEDM should result in a simple way to enhance the detection and the characterization of breast lesions.

  7. CMR of microvascular obstruction and hemorrhage in myocardial infarction

    Directory of Open Access Journals (Sweden)

    Wu Katherine C

    2012-09-01

    Full Text Available Abstract Microvascular obstruction (MO or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.

  8. Myocardial defect detection using PET-CT: phantom studies.

    Directory of Open Access Journals (Sweden)

    Eugene S Mananga

    Full Text Available It is expected that both noise and activity distribution can have impact on the detectability of a myocardial defect in a cardiac PET study. In this work, we performed phantom studies to investigate the detectability of a defect in the myocardium for different noise levels and activity distributions. We evaluated the performance of three reconstruction schemes: Filtered Back-Projection (FBP, Ordinary Poisson Ordered Subset Expectation Maximization (OP-OSEM, and Point Spread Function corrected OSEM (PSF-OSEM. We used the Channelized Hotelling Observer (CHO for the task of myocardial defect detection. We found that the detectability of a myocardial defect is almost entirely dependent on the noise level and the contrast between the defect and its surroundings.

  9. Myocardial defect detection using PET-CT: phantom studies.

    Science.gov (United States)

    Mananga, Eugene S; El Fakhri, Georges; Schaefferkoetter, Joshua; Bonab, Ali A; Ouyang, Jinsong

    2014-01-01

    It is expected that both noise and activity distribution can have impact on the detectability of a myocardial defect in a cardiac PET study. In this work, we performed phantom studies to investigate the detectability of a defect in the myocardium for different noise levels and activity distributions. We evaluated the performance of three reconstruction schemes: Filtered Back-Projection (FBP), Ordinary Poisson Ordered Subset Expectation Maximization (OP-OSEM), and Point Spread Function corrected OSEM (PSF-OSEM). We used the Channelized Hotelling Observer (CHO) for the task of myocardial defect detection. We found that the detectability of a myocardial defect is almost entirely dependent on the noise level and the contrast between the defect and its surroundings.

  10. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  11. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  12. SURGERY OF SYMPTOMATIC MYOCARDIAL BRIDGING

    Directory of Open Access Journals (Sweden)

    N. Maghamipour N. Safaei

    2007-06-01

    Full Text Available Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD may be associated with myocardial ischemia. In symptomatic myocardial bridging unresponsive to medical treatment, surgical unroofing of the left LAD can be performed. Little information is available about the long-term prognosis of patients with this coronary anomaly after the surgical unroofing, so we decided to evaluate the result of this operation. A total of 26 patients underwent surgical unroofing of myocardial bridging. Patients had a myocardial bridge of at least 3 cm in length in the middle of LAD and with more than 70% compression during systole. Unroofing was performed with cardiopulmonary bypass in 16 and with off pump technique in 10 patients. In 6 patients repeat angiographies for control of myotomy were done. In one of them a nonsignificant 20% narrowing was seen. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary flow and myocardial perfusion without residual myocardial bridges under beta-stimulation in 24 patients. Two patients had residual narrowing. With off pump technique, 1 patient had perforation of the right ventricle and 1 patient underwent reoperation because of incomplete unroofing during the first operation. None of the patients with cardiopulmonary bypass technique had residual chest pain or other complications. Surgical unroofing of myocardial bridging with the aid of cardiopulmonary bypass is a safe and easy procedure with low operative risk and with excellent functional results.

  13. Glycine receptors contribute to cytoprotection of glycine in myocardial cells

    Institute of Scientific and Technical Information of China (English)

    QI Ren-bin; ZHANG Jun-yan; LU Da-xiang; WANG Hua-dong; WANG Hai-hua; LI Chu-jie

    2007-01-01

    Background The classic glycine receptor (GlyR) in the central nervous system is a ligand-gated membrane-spanning ion channel. Recent studies have provided evidence for the existence of GlyR in endothelial cells, renal proximal tubular cells and most leukocytes. In contrast, no evidence for GlyR in myocardial cells has been found so far. Our recent researches have showed that glycine could protect myocardial cells from the damage induced by lipopolysaccharide (LPS). Further studies suggest that myocardial cells could contain GlyR or binding site of glycine.Methods In isolated rat heart damaged by LPS, the myocardial monophasic action potential (MAP), the heart rate (HR),the myocardial tension and the activities of lactate dehydrogenase (LDH) from the coronary effluent were determined.The concentration of intracellular free calcium ([Ca2+]i) was measured in cardiomyocytes injured by LPS and by hypoxia/reoxygenation (H/R), which excludes the possibility that reduced calcium influx because of LPS neutralized by glycine. Immunohistochemistry was used to detect the GlyR in myocardial tissue. GlyR and its subunit in the purified cultured cardiomyocytes were identified by Western blotting.Results Although significant improvement in the MAP/MAPD20, HR, and reduction in LDH release were observed in glycine + LPS hearts, myocardial tension did not recover. Further studies demonstrated that glycine could prevent rat mycordial cells from LPS and hypoxia/reoxygenation injury (no endotoxin) by attenuating calcium influx.Immunohistochemistry exhibited a positive green-fluorescence signaling along the cardiac muscle fibers. Western blotting shows that the purified cultured cardiomyocytes express GlyR β subunit, but GlyR α1 subunit could not be detected.Conclusions The results suggest that glycine receptor is expressed in cardiomyocytes and participates in cytoprotection from LPS and hypoxia/reoxygenation injury. Glycine could directly activate GlyR on the cardiomyocytes and

  14. Experimental cell transplantation therapy in rat myocardial infarction model including nude rat preparation.

    Science.gov (United States)

    Dai, Wangde; Kloner, Robert A

    2010-01-01

    As a novel potential therapeutic strategy for cardiac disease, cell transplantation therapy has been extensively investigated in experimental studies and clinical trials. Although encouraging results have been demonstrated, a number of critical questions still remain to be answered. For example, what kind of stem cell and how many cells should be used; what is the best time for cell transplantation after acute myocardial infarction; which delivery approach is better, intravenous injection or direct intramyocardial injection? Transplantation of cells derived from human tissues into experimental animals may elicit an immune rejection. Immunodeficient nude rats provide a useful myocardial infarction model for cell transplantation therapy studies. We introduce our detailed methods of direct intramyocardial injection of immature heart cells and stem cells into the myocardial infarction region of rats and nude rats. Careful maintenance under aseptic conditions and proper surgical technique are essential to improve the survival of immunodeficient rats after surgery.

  15. Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction

    DEFF Research Database (Denmark)

    Svendsen, J H; Madsen, J K; Saunamäki, K I

    1992-01-01

    Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis...... following acute myocardial infarction. The present study was performed to compare exercise test variables in acute myocardial infarction patients following either intravenous thrombolysis or placebo. Symptom-limited bicycle ergometer tests, carried out 1-2 weeks from the infarction, were performed in 85...... heart rate than controls (136 vs. 126 b.min-1, P less than 0.01) but only a trend towards higher systolic blood pressure was seen (175 vs. 163 mmHg, P = 0.09). Rate-pressure product at maximal exercise was 23,620 vs. 20,100 mmHg.b.min-1 respectively, (P less than 0.01). Total exercise time, ST...

  16. Myocardial infarction following recombinant tissue plasminogen activator treatment for acute ischemic stroke: a dangerous complication

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhi-gang; WANG Rui-lan; YU Kang-long

    2012-01-01

    Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis.

  17. Effect of regional myocardial ischemia on sympathetic nervous system as assessed by fluorine-18-metaraminol

    Energy Technology Data Exchange (ETDEWEB)

    Schwaiger, M.; Guibourg, H.; Rosenspire, K.; McClanahan, T.; Gallagher, K.; Hutchins, G.; Wieland, D.M. (Univ. of Michigan Medical Center, Ann Arbor (USA))

    1990-08-01

    With the introduction of radiolabeled catecholamine analogues, the noninvasive evaluation of the cardiac sympathetic nervous system has become possible. This study evaluated the effect of regional ischemia on myocardial retention of the new norepinephrine analogue 6-({sup 18}F) fluorometaraminol (FMR) in the open chest dog model. Six dogs were injected intravenously with FMR following 30-min occlusion of the left anterior descending artery. Six sham animals served as control group. Regional myocardial blood flow as determined by microspheres decreased 87% during ischemia (p less than 0.01), but was not significantly different from control myocardium following reperfusion. Regional myocardial 18F activity as determined postmortem was significantly reduced in reperfused myocardium (-34%), which paralleled an 18% reduction of tissue norepinephrine concentration. Thus, short time periods of coronary occlusion affect neuronal function indicating the sensitivity of the sympathetic nerve terminals to ischemia. FMR provides a new tracer approach for the characterization of neuronal integrity in postischemic myocardium.

  18. Effects of minoxidil and nitroprusside on reflex increases in myocardial contractility.

    Science.gov (United States)

    Robie, N W

    1978-01-01

    1 The effects of nitroprusside and minoxidil on increases in myocardial contractility resulting from carotid artery occlusion were investigated in anaesthetized dogs. The results were compared with those produced by intravenous influsion of noradrenaline. 2 Nitroprusside and minoxidil attenuated the pressor responses produced by carotid artery occlusion. 3 Nitroprusside, but not minoxidil, attenuated the maximal myocardial contractility resulting from carotid occlusion. 4 The pressor and contractility responses to noradrenaline infusion were unaffected by either agent. 5 Nitroprusside failed to alter the myocardial responses produced by dimethylphenylpiperazinium. 6 These results, in conjunction with those of other investigators who have demonstrated that nitroprusside does not affect the release of noradrenaline from adrenergic neurons, suggest that nitroprusside may inhibit sympathetic nervous system reflex activity via an afferent and/or central component. PMID:620094

  19. Effects of intracoronary melatonin on ischemia-reperfusion injury in ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Ekeløf, Sarah V; Halladin, Natalie L; Jensen, Svend E

    2016-01-01

    Acute coronary occlusion is effectively treated by primary percutaneous coronary intervention. However, myocardial ischemia-reperfusion injury is at the moment an unavoidable consequence of the procedure. Oxidative stress is central in the development of ischemia-reperfusion injury. Melatonin......, an endogenous hormone, acts through antioxidant mechanisms and could potentially minimize the myocardial injury. The aim of the experimental study was to examine the cardioprotective effects of melatonin in a porcine closed-chest reperfused infarction model. A total of 20 landrace pigs were randomized...... to a dosage of 200 mg (0.4 mg/mL) melatonin or placebo (saline). The intervention was administered intracoronary and intravenous. Infarct size, area at risk and microvascular obstruction were determined ex vivo by cardiovascular magnetic resonance imaging. Myocardial salvage index was calculated. The plasma...

  20. Neural mechanisms and delayed gastric emptying of liquid induced through acute myocardial infarction in rats.

    Science.gov (United States)

    Nunez, Wilson Ranu Ramirez; Ozaki, Michiko Regina; Vinagre, Adriana Mendes; Collares, Edgard Ferro; Almeida, Eros Antonio de

    2015-02-01

    In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABAB receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABAB receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1 mA/10 s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABAB receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN.

  1. Phosphomimetic modulation of eNOS improves myocardial reperfusion and mimics cardiac postconditioning in mice.

    Directory of Open Access Journals (Sweden)

    Terrence Pong

    Full Text Available OBJECTIVE: Myocardial infarction resulting from ischemia-reperfusion injury can be reduced by cardiac postconditioning, in which blood flow is restored intermittently prior to full reperfusion. Although key molecular mechanisms and prosurvival pathways involved in postconditioning have been identified, a direct role for eNOS-derived NO in improving regional myocardial perfusion has not been shown. The objective of this study is to measure, with high temporal and spatial resolution, regional myocardial perfusion during ischemia-reperfusion and postconditioning, in order to determine the contribution of regional blood flow effects of NO to infarct size and protection. METHODS AND RESULTS: We used myocardial contrast echocardiography to measure regional myocardial blood flow in mice over time. Reperfusion after myocardial ischemia-reperfusion injury is improved by postconditioning, as well as by phosphomimetic eNOS modulation. Knock-in mice expressing a phosphomimetic S1176D form of eNOS showed improved myocardial reperfusion and significantly reduced infarct size. eNOS knock-out mice failed to show cardioprotection from postconditioning. The size of the no-reflow zone following ischemia-reperfusion is substantially reduced by postconditioning and by the phosphomimetic eNOS mutation. CONCLUSIONS AND SIGNIFICANCE: Using myocardial contrast echocardiography, we show that temporal dynamics of regional myocardial perfusion restoration contribute to reduced infarct size after postconditioning. eNOS has direct effects on myocardial blood flow following ischemia-reperfusion, with reduction in the size of the no-reflow zone. These results have important implications for ongoing clinical trials on cardioprotection, because the degree of protective benefit may be significantly influenced by the regional hemodynamic effects of eNOS-derived NO.

  2. Identification of viable myocardium early after acute myocardial infarction under beta-blockade by enoximone echocardiography.

    Science.gov (United States)

    Natale, E; Minardi, G; Wang, F; Tubaro, M; Giovannini, E; Vajola, S F; Milazzotto, F

    1997-04-01

    The influence of the beta-blocker metoprolol on the capacity either of low-dose dobutamine echocardiography or the recently introduced enoximone echocardiography to detect viable dysfunctioning myocardium after myocardial infarction was investigated. Initial clinical experience would suggest that the phosphodiesterase III inhibitor enoximona could be an alternative pharmacological stimulation, inducing an increase in contractility in the presence or absence of beta-receptor stimulation. Ten patients with a baseline low-dose dobutamine-echocardiographic test (up to 10 micrograms/kg/min) positive for myocardial viability in > or = 1 segment(s), performed 4-5 days after a first acute myocardial infarction treated with rtPA, were randomized after the administration of intravenous metoprolol (15 mg in three 5-mg boluses) either to dobutamine (up to 15 micrograms/kg/min) or to an enoximone intravenous bolus (1 mg/kg over 5 min) under echocardiographic monitoring, in a crossover sequence, with a 24-h interval. The infarct related artery was patent (TIMI grade 2 o 3) in all the patients. Follow-up echocardiograms were performed 5-7 weeks later. Resting asynergy was found in 40 segments; of these, 17 were viable. All the viable segments remained unresponsive during the post-metoprolol dobutamine infusion, while improved their contractility during enoximone echocardiography. Two patients suffering from early post-infarction angina underwent coronary angioplasty successfully. Eight out of ten patients (2 revascularized and 6 not) showed contractile recovery in a total of 14 segments at the follow-up echocardiogram. Sensitivity, specificity and overall accuracy in predicting reversible dysfunction after acute myocardial infarction for enoximone echocardiography were 93, 85, and 88%, respectively. Our results support the value of enoximone echocardiography in the identification of myocardial viability after myocardial infarction, in patients treated with beta-blockers, which

  3. Physiologically tolerable insulin reduces myocardial injury and improves cardiac functional recovery in myocardial ischemic/reperfused dogs.

    Science.gov (United States)

    Zhang, Hang-Xiang; Zang, Yi-Min; Huo, Jian-Hua; Liang, Shao-Jun; Zhang, Hai-Feng; Wang, Yue-Min; Fan, Qian; Guo, Wen-Yi; Wang, Hai-Chang; Gao, Feng

    2006-12-01

    This study was designed to examine whether physiologically tolerable insulin, which maintains lower blood glucose, can protect the myocardium against ischemia/reperfusion (I/R) injury in a preclinical large animal model. Adult dogs were subjected to 50 minutes of myocardial ischemia (80% reduction in coronary blood flow) followed by 4 hours of reperfusion and treated with vehicle, glucose-insulin-potassium (GIK; glucose, 250 g/L; insulin, 60 U/L; potassium, 80 mmol/L), GK, or low-dose insulin (30 U/L) 10 minutes before reperfusion. Treatment with GIK exerted significant cardioprotective effects as evidenced by improved cardiac function, improved coronary blood flow, reduced infarct size, and myocardial apoptosis. In contrast, treatment with GK increased blood glucose level and aggravated myocardial I/R injury. It is interesting that treatment with insulin alone at the dose that reduced blood glucose to a clinically tolerable level exerted significant cardioprotective effects that were comparable to that seen in the GIK-treated group. This low-dose insulin had no effect on coronary blood flow after reperfusion but markedly reduced coronary reactive hyperemia and switched myocardial substrate uptake from fat to carbohydrate. Our results suggest that lower glucose supply to the ischemic myocardium at early reperfusion may create a "metabolic postconditioning" and thus reduce myocardial ischemia/reperfusion injury after prolonged reperfusion.

  4. Intravenous drug delivery in neonates: lessons learnt.

    Science.gov (United States)

    Sherwin, Catherine M T; Medlicott, Natalie J; Reith, David M; Broadbent, Roland S

    2014-06-01

    Intravenous drug administration presents a series of challenges that relate to the pathophysiology of the neonate and intravenous infusion systems in neonates. These challenges arise from slow intravenous flow rates, small drug volume, dead space volume and limitations on the flush volume in neonates. While there is a reasonable understanding of newborn pharmacokinetics, an appreciation of the substantial delay and variability in the rate of drug delivery from the intravenous line is often lacking. This can lead to difficulties in accurately determining the pharmacokinetic and pharmacodynamic relationship of drugs in the smallest patients. The physical variables that affect the passage of drugs through neonatal lines need to be further explored in order to improve our understanding of their impact on the delivery of drugs by this route in neonates. Through careful investigation, the underlying causes of delayed drug delivery may be identified and administration protocols can then be modified to ensure predictable, appropriate drug input kinetics.

  5. INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUGS ABUSED PATIENT

    Directory of Open Access Journals (Sweden)

    E. Y. Ponomareva

    2011-01-01

    Full Text Available Three-year observation of acute tricuspid infective endocarditis in intravenous drug abused patient: diagnosis, clinical features, visceral lesions, the possibility of cardiac surgery and conservative treatment, outcome.

  6. MYOCARDIAL INFARCTION TYPE 2. MYTH OR REALITY?

    OpenAIRE

    V. V. Zhelnov; N. V. Dyatlov; L. I. Dvoretsky

    2016-01-01

    According to The Third Definition of Myocardial Infarction there are five types of myocardial infarction depending on pathogenesis. This review provides actual data about myocardial infarction type 2 mechanism including diagnosis management, epidemiological characteristic and patient prognosis. Previously published data shows discordant information about myocardial infarction type 2 frequency, treatment and diagnostic options. Our clinical observation illustrates these severities in diagnosis...

  7. Hypotensive Effect and Accumulation of Dinitrosyl Iron Complexes in Blood and Tissues after Intravenous and Subcutaneous Injection.

    Science.gov (United States)

    Timoshin, A A; Lakomkin, V L; Abramov, A A; Ruuge, E K; Vanin, A F

    2016-12-01

    Subcutaneous injection of Oxacom with glutathione-bound dinitrosyl iron complex as the active principle produced a slower drop of mean BP and longer accumulation of protein-bound dinitrosyl iron complexes in whole blood and tissues than intravenous injection of this drug, while durations of hypotensive effect in both cases were practically identical. In contrast to intravenous injection of the drug, its subcutaneous administration was not characterized by a high concentration of protein-bound dinitrosyl iron complexes in the blood at the onset of experiment; in addition, accumulation of these NO forms in the lungs was more pronounced after subcutaneous injection than after intravenous one.

  8. What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients?

    DEFF Research Database (Denmark)

    Bager, Palle; Dahlerup, Jens Frederik

    for a total of iron-dose was to 233€ to reduce the numbers of infusion from 7 till 2.    Conclusion: The cost of choosing iron carboxymaltose rather than iron sucrose in treatment of iron deficiency in IBD differs depending of the economic perspective chosen. Only the Budget Impact Analysis showed iron......  What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients? It dependent on the economic evaluation perspective!   Aim: To evaluate the health care cost for intravenous iron sucrose (Venofer®, Vifor) and intravenous iron carboxymaltose (Ferinject......®, Vifor) treatment to IBD patients in an outpatient setting.   Background: Intravenous iron sucrose can be given as a maximum of 200 mg Fe++ per infusion vs. intravenous iron carboxymaltose that can be given as a maximum of 1000 mg Fe++ in a single infusion leading to fewer infusions and visits. The drug...

  9. Effect of color coding and subtraction on the accuracy of contrast echocardiography

    Science.gov (United States)

    Pasquet, A.; Greenberg, N.; Brunken, R.; Thomas, J. D.; Marwick, T. H.

    1999-01-01

    BACKGROUND: Contrast echocardiography may be used to assess myocardial perfusion. However, gray scale assessment of myocardial contrast echocardiography (MCE) is difficult because of variations in regional backscatter intensity, difficulties in distinguishing varying shades of gray, and artifacts or attenuation. We sought to determine whether the assessment of rest myocardial perfusion by MCE could be improved with subtraction and color coding. METHODS AND RESULTS: MCE was performed in 31 patients with previous myocardial infarction with a 2nd generation agent (NC100100, Nycomed AS), using harmonic triggered or continuous imaging and gain settings were kept constant throughout the study. Digitized images were post processed by subtraction of baseline from contrast data and colorized to reflect the intensity of myocardial contrast. Gray scale MCE alone, MCE images combined with baseline and subtracted colorized images were scored independently using a 16 segment model. The presence and severity of myocardial contrast abnormalities were compared with perfusion defined by rest MIBI-SPECT. Segments that were not visualized by continuous (17%) or triggered imaging (14%) after color processing were excluded from further analysis. The specificity of gray scale MCE alone (56%) or MCE combined with baseline 2D (47%) was significantly enhanced by subtraction and color coding (76%, pcolorized images (59%) was also significantly greater than gray scale MCE (43% and 29%, pcolor coding significantly improves the accuracy and specificity of MCE for detection of perfusion defects.

  10. Intravenous iron supplementation practices and short-term risk of cardiovascular events in hemodialysis patients.

    Directory of Open Access Journals (Sweden)

    Abhijit V Kshirsagar

    Full Text Available BACKGROUND & OBJECTIVES: Intravenous iron supplementation is widespread in the hemodialysis population, but there is uncertainty about the safest dosing strategy. We compared the safety of different intravenous iron dosing practices on the risk of adverse cardiovascular outcomes in a large population of hemodialysis patients. DESIGN SETTINGS PARTICIPANTS & MEASUREMENTS: A retrospective cohort was created from the clinical database of a large dialysis provider (years 2004-2008 merged with administrative data from the United States Renal Data System. Dosing comparisons were (1 bolus (consecutive doses ≥ 100 mg exceeding 600 mg during one month versus maintenance (all other iron doses during the month; and (2 high (> 200 mg over 1 month versus low dose (≤ 200 mg over 1 month. We established a 6-month baseline period (to identify potential confounders and effect modifiers, a one-month iron exposure period, and a three-month follow-up period. Outcomes were myocardial infarction, stroke, and death from cardiovascular disease. RESULTS: 117,050 patients contributed 776,203 unique iron exposure/follow-up periods. After adjustment, we found no significant associations of bolus dose versus maintenance, hazards ratio for composite outcome, 1.03 (95% C.I. 0.99, 1.07, or high dose versus low dose intravenous iron, hazards ratio for composite outcome, 0.99 (95% C.I. 0.96, 1.03. There were no consistent associations of either high or bolus dose versus low or maintenance respectively among pre-specified subgroups. CONCLUSIONS: Strategies favoring large doses of intravenous iron were not associated with increased short-term cardiovascular morbidity and mortality. Investigation of the long-term safety of the various intravenous iron supplementation strategies may still be warranted.

  11. Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease - Comparison With Targeted Left Ventricular Myocardial Biopsy.

    Science.gov (United States)

    Kockova, Radka; Kacer, Petr; Pirk, Jan; Maly, Jiri; Sukupova, Lucie; Sikula, Viktor; Kotrc, Martin; Barciakova, Lucia; Honsova, Eva; Maly, Marek; Kautzner, Josef; Sedmera, David; Penicka, Martin

    2016-04-25

    The aim of our study was to investigate the relationship between the cardiac magnetic resonance (CMR)-derived native T1 relaxation time and myocardial extracellular volume (ECV) fraction and the extent of diffuse myocardial fibrosis (DMF) on targeted myocardial left ventricular (LV) biopsy. The study population consisted of 40 patients (age 63±8 years, 65% male) undergoing valve and/or ascending aorta surgery for severe aortic stenosis (77.5%), root dilatation (7.5%) or valve regurgitation (15%). The T1 relaxation time was assessed in the basal interventricular septum pre- and 10-min post-contrast administration using the modified Look-Locker Inversion recovery sequence prior to surgery. LV myocardial biopsy specimen was obtained during surgery from the basal interventricular septal segment matched with the T1 mapping assessment. The percentage of myocardial collagen was quantified using picrosirius red staining. The average percentage of myocardial collagen was 22.0±14.8%. Both native T1 relaxation time with cutoff value ≥1,010 ms (sensitivity=90%, specificity=73%, area under the curve=0.82) and ECV with cutoff value ≥0.32 (sensitivity=80%, specificity=90%, area under the curve=0.85) showed high accuracy to identify severe (>30%) DMF. The native T1 relaxation time showed significant correlation with LV mass (P<0.01). Native T1 relaxation time and ECV at 10 min after contrast administration are accurate markers of DMF. (Circ J 2016; 80: 1202-1209).

  12. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...... whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... thorough understanding of the mechanisms that influence the prognosis as well as knowledge of the present care provided. The purpose of this PhD thesis is accordingly subdivided into four specific aims: 1. To estimate the prevalence of depression in people with MI after three months, and to estimate...

  13. A New Therapeutic Modality for Acute Myocardial Infarction: Nanoparticle-Mediated Delivery of Pitavastatin Induces Cardioprotection from Ischemia-Reperfusion Injury via Activation of PI3K/Akt Pathway and Anti-Inflammation in a Rat Model.

    Directory of Open Access Journals (Sweden)

    Kazuhiro Nagaoka

    Full Text Available There is an unmet need to develop an innovative cardioprotective modality for acute myocardial infarction (AMI, for which the effectiveness of interventional reperfusion therapy is hampered by myocardial ischemia-reperfusion (IR injury. Pretreatment with statins before ischemia is shown to reduce MI size in animals. However, no benefit was found in animals and patients with AMI when administered at the time of reperfusion, suggesting insufficient drug targeting into the IR myocardium. Here we tested the hypothesis that nanoparticle-mediated targeting of pitavastatin protects the heart from IR injury.In a rat IR model, poly(lactic acid/glycolic acid (PLGA nanoparticle incorporating FITC accumulated in the IR myocardium through enhanced vascular permeability, and in CD11b-positive leukocytes in the IR myocardium and peripheral blood after intravenous treatment. Intravenous treatment with PLGA nanoparticle containing pitavastatin (Pitavastatin-NP, 1 mg/kg at reperfusion reduced MI size after 24 hours and ameliorated left ventricular dysfunction 4-week after reperfusion; by contrast, pitavastatin alone (as high as 10 mg/kg showed no therapeutic effects. The therapeutic effects of Pitavastatin-NP were blunted by a PI3K inhibitor wortmannin, but not by a mitochondrial permeability transition pore inhibitor cyclosporine A. Pitavastatin-NP induced phosphorylation of Akt and GSK3β, and inhibited inflammation and cardiomyocyte apoptosis in the IR myocardium.Nanoparticle-mediated targeting of pitavastatin induced cardioprotection from IR injury by activation of PI3K/Akt pathway and inhibition of inflammation and cardiomyocyte death in this model. This strategy can be developed as an innovative cardioprotective modality that may advance currently unsatisfactory reperfusion therapy for AMI.

  14. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

    2015-07-15

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  15. A Case of Malignant Melanoma with In-Transit Metastasis That Responded to Intravenous Infusion of Interferon-β

    Directory of Open Access Journals (Sweden)

    Masaru Arima

    2014-03-01

    Full Text Available A 77-year-old man with a history of surgical resection of malignant melanoma involving the fifth toe of his left foot 14 years ago presented at the Kariya Toyota General Hospital with a 3-month history of skin ulcer at the same site and red nodules on the lower left leg. Malignant melanoma was suspected, and the patient was referred to our department. On examination, a skin ulcer measuring 25 × 20 mm was observed at the amputation site on the left foot. In addition, multiple red nodules were observed on the lower left leg. Skin biopsies of the ulcer and nodules revealed recurrent malignant melanoma with in-transit metastasis. Two weeks later, he developed acute myocardial infarction and was hospitalized at the Kariya Toyota General Hospital. One month later, the myocardial infarction ameliorated, and he was transferred to our department. As the myocardial infarction had decreased the patient's tolerance to surgery, interferon-β was administered by intravenous infusion. The skin ulcer and red nodules on the lower left leg disappeared 26 weeks after infusion had been initiated. The patient's progress has been satisfactory, with no evidence of recurrence or metastasis at 1 year and 9 months after the initiation of intravenous infusion.

  16. Oxytocin ameliorates the immediate myocardial injury in heart transplant through down regulation of the neutrophil dependent myocardial apoptosis

    Directory of Open Access Journals (Sweden)

    F Fadhil Al-Amran

    2014-01-01

    Conclusion: Oxytocin ameliorates myocardial injury in heart transplant through down-regulation the myocardial inflammatory response, reactive oxygen species, and neutrophil-dependant myocardial apoptosis.

  17. Algorithms for intravenous insulin delivery.

    Science.gov (United States)

    Braithwaite, Susan S; Clement, Stephen

    2008-08-01

    This review aims to classify algorithms for intravenous insulin infusion according to design. Essential input data include the current blood glucose (BG(current)), the previous blood glucose (BG(previous)), the test time of BG(current) (test time(current)), the test time of BG(previous) (test time(previous)), and the previous insulin infusion rate (IR(previous)). Output data consist of the next insulin infusion rate (IR(next)) and next test time. The classification differentiates between "IR" and "MR" algorithm types, both defined as a rule for assigning an insulin infusion rate (IR), having a glycemic target. Both types are capable of assigning the IR for the next iteration of the algorithm (IR(next)) as an increasing function of BG(current), IR(previous), and rate-of-change of BG with respect to time, each treated as an independent variable. Algorithms of the IR type directly seek to define IR(next) as an incremental adjustment to IR(previous). At test time(current), under an IR algorithm the differences in values of IR(next) that might be assigned depending upon the value of BG(current) are not necessarily continuously dependent upon, proportionate to, or commensurate with either the IR(previous) or the rate-of-change of BG. Algorithms of the MR type create a family of IR functions of BG differing according to maintenance rate (MR), each being an iso-MR curve. The change of IR(next) with respect to BG(current) is a strictly increasing function of MR. At test time(current), algorithms of the MR type use IR(previous) and the rate-of-change of BG to define the MR, multiplier, or column assignment, which will be used for patient assignment to the right iso-MR curve and as precedent for IR(next). Bolus insulin therapy is especially effective when used in proportion to carbohydrate load to cover anticipated incremental transitory enteral or parenteral carbohydrate exposure. Specific distinguishing algorithm design features and choice of parameters may be important to

  18. Impact of acute propranolol administration on dobutamine-induced myocardial ischemia as evaluated by myocardial perfusion imaging and echocardiography.

    Science.gov (United States)

    Shehata, A R; Gillam, L D; Mascitelli, V A; Herman, S D; Ahlberg, A W; White, M P; Chen, C; Waters, D D; Heller, G V

    1997-08-01

    Beta-blocker therapy may delay or completely prevent myocardial ischemia during exercise testing, as assessed by ST-segment shifts, myocardial perfusion defects, or echocardiographic wall motion abnormalities. However, the impact of beta-blocker therapy on these end points during dobutamine stress testing has not been well established. The purpose of this study was to determine the impact of propranolol on dobutamine stress testing with ST-segment monitoring, technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) imaging, and echocardiography. In 17 patients with known reversible perfusion defects, dobutamine stress tests with and without propranolol were performed in randomized order and on separate days, following discontinuation of oral beta blockers and calcium antagonists. Propronolol was administered intravenously to a cumulative dose of 8 mg or to a maximum heart rate reduction of 25% and dobutamine was infused in graded doses in 3 minute stages until a standard clinical end point or the maximum dose of 40 microg/kg/min was achieved. The dobutamine stress test after propranolol was associated with a lower maximum heart rate (83 +/- 18 vs 125 +/- 17, p <0.001) and rate pressure product (14,169 +/- 4,248 vs 19,894 +/- 3,985, p <0.001) despite a higher infusion dose. The SPECT myocardial ischemia score was also lower (6.9 +/- 5.8 vs 10.1 +/- 7.1, p = 0.047) and fewer echocardiographic segments were abnormal (3.4 +/- 3.0 vs 4.6 +/- 3.4, p = 0.042). In 4 of 17 patients, reversible perfusion defects and echocardiographic wall motion abnormalities were detected during the control but not during the propranolol test. Thus, during dobutamine stress testing, beta-blocker therapy attenuates, and in some cases eliminates, evidence of myocardial ischemia.

  19. 10.11.Myocardial disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920088 Effect and significance of neuro-peptide Y on synthesis of myocardial pro-tein.WANG Tao (王涛),et al.Cardiovasc Lab,3rd Hosp,Beijing Med Univ.Chin Cir J 1991; 6 (5):354-356.The rate of myocardial protein synthesis andthe cardiac content of neuropeptide Y (NPY) inrats were measured by ~3H-leucine incorporation

  20. Functional imaging with MR T1 contrast: a feasibility study with blood-pool contrast agent

    Energy Technology Data Exchange (ETDEWEB)

    Majos, Agata; Stefanczyk, Ludomir [Medical University of Lodz, Radiology Department, Lodz (Poland); Bogorodzki, Piotr; Piatkowska-Janko, Ewa; Kurjata, Robert [Warsaw University of Technology, Institute of Radioelectronics, Warsaw (Poland); Wolak, Tomasz [Institute of Physiology and Pathology of Hearing, Warsaw (Poland)

    2009-04-15

    The aim of this study was to prove the concept of using a long intravenous half-life blood-pool T1 contrast agent as a new functional imaging method. For each of ten healthy subjects, two dynamic magnetic resonance (MR) protocols were carried out: (1) a reference run with a typical T2* echo-planar imaging (EPI) sequence based on the blood oxygenation level-dependent (BOLD) effect and (2) a run with a T1-sensitive three-dimensional (3D) gradient-echo (GRE) sequence using cerebral blood volume (CBV) contrast after intravenous administration of a contrast agent containing a chelate of gadolinium diethylene-triamine-pentaacetate with a phosphono-oxymethyl substituent. All sequences were performed during the execution of a block-type finger-tapping paradigm. SPM5 software was used for statistical analysis. For both runs maximum activations (peak Z-score = 5.5, cluster size 3,449 voxels) were localized in the left postcentral gyrus. Visual inspection of respective signal amplitudes suggests the T1 contrast to be substantially smaller than EPI (0.5% vs 1%). A new functional imaging method with potentially smaller image artefacts due to the nature of CBV contrast and characteristics of the T1 sequence was proposed and verified. (orig.)

  1. Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Eitel, Ingo; Galasso, Gennaro;

    2015-01-01

    BACKGROUND: Although intracoronary abciximab failed to improve prognosis compared with intravenous route in unselected ST-segment elevation myocardial infarction (STEMI) patients, little is known about the role of intracoronary abciximab in diabetic patients. OBJECTIVES: To evaluate the efficacy...... compared to intravenous abciximab (4.7% vs. 8.8%; rate ratio [RR], 0.50; 95% confidence intervals [CI], 0.26-0.99; p=0.04), driven by numerically lower deaths (3.7% vs. 6.4%; RR, 0.56; 95% CI, 0.26-1.20; p=0.13). Moreover, a significant reduction in definite or probable stent thrombosis was observed...

  2. Dynamics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease

    Science.gov (United States)

    Malinova, Lidia I.; Simonenko, Georgy V.; Denisova, Tatyana P.; Tuchin, Valery V.

    2007-02-01

    Dynamics of glucose concentration in human organism is an important diagnostic characteristic for it's parameters correlate significantly with the severity of metabolic, vessel and perfusion disorders. 36 patients with stable angina pectoris of II and III functional classes were involved in this study. All of them were men in age range of 45-59 years old. 7 patients hospitalized with acute myocardial infarction (aged from 49 to 59 years old) form the group of compare. Control group (n = 5) was of practically healthy men in comparable age. To all patients intravenous glucose solution (40%) in standard loading dose was injected. Capillary and vein blood samples were withdrawn before, and 5, 60, 120, 180 and 240 minutes after glucose load. At these time points blood pressure and glucose concentration were measured. In prepared blood smears shape, deformability and sizes of erythrocytes, quantity and degree of shear stress resistant erythrocyte aggregates were studied. Received data were approximated by polynomial of high degree to receive concentration function of studied parameters, which first derivative elucidate velocity characteristics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease and practically healthy persons. Received data show principle differences in dynamics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease as a possible mechanism of coronary blood flow destabilization.

  3. Use of intravenous immunoglobulin in pediatric practice

    Science.gov (United States)

    Zülfikar, Bülent; Koç, Başak

    2014-01-01

    In recent years, human-driven intravenous immunoglobulins (IVIG) administered intravenously have been widely used in treatment of many diseases. Intravenous immunoglobulin is obtained from human-driven plasma pools as in other plasma-driven products and IVIG preperations contain structurally and functionally intact immunoglobulin. Intravenous immunoglobulin was approved by FDA (Food and Drug Administration) in USA in 1981 for the first time and was started to be primarily used in patients with immune deficiency with hypogammaglobulinemia. The effects of intravenous immunoglobulin include complex mechanisms, but it exerts its essential action by eliminating the non-specific Fc receptors found in the mononuclear phagocytic system or by inhibiting binding of immune complexes to Fc receptors in the cells. Their areas of usage include conditions where their anti-inflammatory and immunomudulator effects are utilized in addition to replacement of deficient immunoglobulin. Although the definite indications are limited, it has been shown that it is useful in many diseases in clinical practice. Its side effects include fever, sweating, nausea, tachycardia, eczematous reactions, aseptic meningitis, renal failure and hematological-thromboembolic events. In this article, use of IVIG, its mechanisms of action, indications and side effects were discussed. PMID:26078679

  4. Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache

    Directory of Open Access Journals (Sweden)

    Alireza Baratloo

    2016-06-01

    Full Text Available The aim of this study was to determine if intravenous caffeine is as effective as intravenous ketorolac for the treatment of moderate to severe migraine headaches. Eligible patients randomly received 60 mg caffeine citrate or 60 mg ketorolac infused intravenously. Their pain score were measured at baseline, one hour and two hours after infusion. Therapeutic success was defined as decreasing of at least 3 points on the pain score. In total 110 patients were enrolled (75.5% women. Therapeutic success after 60 min was achieved by 63.6% of patients in the caffeine and 70.1% of patients in the ketorolac group (p = 0.23. After 120 min, 87.3% of the caffeine group and 83.6% of the ketorolac group achieved therapeutic success (p = 0.49. In this multi-center, randomized double blind study, intravenous caffeine was as effective as intravenous ketorolac for first line abortive management of acute migraine.

  5. Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction.

    Science.gov (United States)

    Tanswell, Paul; Modi, Nishit; Combs, Dan; Danays, Thierry

    2002-01-01

    Tenecteplase is a novel fibrinolytic protein bioengineered from human tissue plasminogen activator (alteplase) for the therapy of acute ST-segment elevation myocardial infarction. Specific mutations at three sites in the alteplase molecule result in 15-fold higher fibrin specificity, 80-fold reduced binding affinity to the physiological plasminogen activator inhibitor PAI-1 and 6-fold prolonged plasma half-life (22 vs 3.5 minutes). Consequently, tenecteplase can be administered as a single intravenous bolus of 30-50mg (0.53 mg/kg bodyweight) over 5-10 seconds, in contrast to the 90-minute accelerated infusion regimen of alteplase. Tenecteplase plasma concentration-time profiles have been obtained from a total of 179 patients with acute myocardial infarction. Tenecteplase exhibited biphasic disposition; the initial disposition phase was predominant with a mean half-life of 17-24 minutes, and the mean terminal half-life was 65-132 min. Over the clinically relevant dose range of 30-50mg, mean clearance (CL) was 105 ml/min. The mean initial volume of distribution V(1) was 4.2-6.3L, approximating plasma volume, and volume of distribution at steady state was 6.1-9.9L, suggesting limited extravascular distribution or binding. Bodyweight and age were found to influence significantly both CL and V(1). Total bodyweight explained 19% of the variability in CL and 11% of the variability in V(1), and a 10kg increase in total bodyweight resulted in a 9.6 ml/min increase in CL. This relationship aided the development of a rationale for the weight-adjusted dose regimen for tenecteplase. Age explained only a further 11% of the variability in CL. The percentage of patients who achieved normal coronary blood flow was clearly related to AUC. More than 75% of patients achieved normal flow at 90 minutes after administration when their partial AUC(2-90) exceeded 320 microg.min/ml, corresponding to an average plasma concentration of 3.6 microg/ml. Systemic exposure to tenecteplase at all

  6. Altered maternal thyroid function: Effect of L-carnitine supplementation on fetal and neonatal myocardial free fatty acid oxidation,in vitro

    OpenAIRE

    Kumar, Ratan

    1998-01-01

    Effect of L-carnitine supplementation on myocardial free fatty acid oxidation,in vitro, in offsprings born of hypothyroid and hyperthyroid mothers was studied in rats. L-carnitine supplementation stimulated myocardial fatty acid oxidation during gestational period in offspring born of control and hyperthyroid mothers. In contrast L-carnitine supplementation induced stimulation in myocardial fatty acid oxidation was very less in fetuses born of hypothyroid mothers. However, in neonates born of...

  7. Cranial CT revisited: do we really need contrast enhancement?

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Buelens, C.; Wilms, G.; Baert, A.L. [Department of Radiology, University Hospitals, Leuven (Belgium)

    1998-10-01

    The aim of this study was to define guidelines for intravenous contrast administration in cranial CT, as currently there are no recent guidelines based on a large series of patients. In 1900 consecutive patients (1480 adults and 420 children) pre- and post-contrast scan was analysed in order to assess the contribution of contrast enhancement to the diagnosis. The findings were grouped according to whether abnormalities were seen on the pre- and/or post-contrast scan, or whether no abnormalities were seen at all. Sensitivity, specificity, positive predictive value, negative predictive value and accurracy of a pre-contrast scan were used to determine validity. Intravenous contrast enhancement only contributes to the diagnosis if a suspicious abnormality is seen on the unenhanced scan or in the appropriate clinical setting (33.6 %). In the remaining patients (65.6 %) there is no diagnostic contribution, except for a small number of abnormalities (0.8 %). These are often anatomical variants and have no therapeutic impact. The number of contrast-enhanced cranial CT examinations can significantly be reduced by using four general guidelines for contrast administration resulting in considerable cost savings without affecting the quality of service to the patient. These guidelines are defined by the clinical findings/presentation or by the findings on the unenhanced scan. The number of contrast-related complications will be reduced, which may have medicolegal implications. These guidelines can be applied in any radiology department. (orig.) (orig.) With 2 tabs., 13 refs.

  8. Myocardial T1 mapping: where are we now and where are we going?

    Directory of Open Access Journals (Sweden)

    Abdel-Gadir A

    2014-11-01

    Full Text Available Amna Abdel-Gadir,1,2 Thomas A Treibel,1,2 James C Moon1,2 1The Heart Hospital Imaging Centre, University College London Hospitals, London, UK; 2Institute of Cardiovascular Science, University College London, London, UK Abstract: Cardiovascular magnetic resonance offers noninvasive myocardial tissue characterization as a key unique strength over other imaging techniques. In particular T1, a tissue property that alters with disease, has gained prominence as a diagnostic tool. Prior to the administration of contrast, the native T1 changes with a number of processes such as fibrosis, edema, and infiltration. If a post-contrast scan is also acquired, the post-contrast T1 and extracellular volume fraction can be measured. Detecting and quantifying early and established myocardial pathological processes permits better diagnosis, prognostication, and tracking of therapy. Keywords: extracellular volume fraction, diffuse fibrosis, interstitium, cardiac remodeling, myocardial intracellular volume

  9. Mercury excretion and intravenous ascorbic acid.

    Science.gov (United States)

    Dirks, M J; Davis, D R; Cheraskin, E; Jackson, J A

    1994-01-01

    We tested the hypothesis that intravenous ascorbic acid increases urinary excretion of mercury in subjects with low mercury levels from dental amalgam, food, and other sources. From 89 adult volunteers we selected 28 subjects with the highest mercury excretions (2 to 14 micrograms/24 h). We administered intravenous infusions of 500 ml lactated Ringer's solution with and without addition of 750 mg of ascorbic acid/kg body weight, up to 60 g ascorbic acid. Average mercury excretion during the 24 h after infusion of ascorbic acid was 4.0 +/- 0.5 micrograms (mean +/- SEM), which was not significantly more than after infusion of Ringer's solution alone (3.7 +/- 0.5 micrograms). Lead excretion was similarly unaffected. If ascorbic acid administered intravenously benefits some persons with suspected adverse reactions to mercury, the benefit in subjects similar to ours appears unrelated to short-term enhanced excretion of mercury or lead.

  10. The PI3K/Akt pathway mediates the protection of SO2 preconditioning against myocardial ischemia/reperfusion injury in rats

    Institute of Scientific and Technical Information of China (English)

    Man-man ZHAO; Jin-yan YANG; Xin-bao WANG; Chao-shu TANG; Jun-bao DU; Hong-fang JIN

    2013-01-01

    Aim:To explore the mechanisms underlying the protection by SO2 preconditioning against rat myocardial ischemia/reperfusion (I/R)injury.Methods:Male Wistar rats underwent 30-min left coronary artery ligation followed by 120-min reperfusion.An S02 donor (1 μmol/kg)was intravenously injected 10 min before the ischemia,while LY294002 (0.3 mg/kg) was intravenously injected 30 min before the ischemia.Plasma activities of LDH and CK were measured with an automatic enzyme analyzer.Myocardial infarct size was detected using Evans-TTC method.The activities of caspase-3 and-9 in myocardium were assayed using a commercial kit,and the levels of p-Akt,Akt,P13K and p-P13K were examined with Western blotting.Results:Pretreatment with SO2 significantly reduced the myocardial infarct size and plasma LDH and CK activities,as well as myocardial caspase-3 and-9 activities in the rats.Furthermore,the pretreatment significantly increased the expression levels of myocardial p-Akt and p-PI3K p85.Administration of the PI3K inhibitor LY294002 blocked all the effects induced by SO2 pretreatment.Conclusion:The results suggest that the PI3K/Akt pathway mediates the protective effects of SO2 preconditioning against myocardial I/R injury in rats.

  11. A Translational Study of a New Therapeutic Approach for Acute Myocardial Infarction: Nanoparticle-Mediated Delivery of Pitavastatin into Reperfused Myocardium Reduces Ischemia-Reperfusion Injury in a Preclinical Porcine Model

    Science.gov (United States)

    Ichimura, Kenzo; Matoba, Tetsuya; Nakano, Kaku; Tokutome, Masaki; Honda, Katsuya; Koga, Jun-ichiro; Egashira, Kensuke

    2016-01-01

    Background There is an unmet need to develop an innovative cardioprotective modality for acute myocardial infarction, for which interventional reperfusion therapy is hampered by ischemia-reperfusion (IR) injury. We recently reported that bioabsorbable poly(lactic acid/glycolic acid) (PLGA) nanoparticle-mediated treatment with pitavastatin (pitavastatin-NP) exerts a cardioprotective effect in a rat IR injury model by activating the PI3K-Akt pathway and inhibiting inflammation. To obtain preclinical proof-of-concept evidence, in this study, we examined the effect of pitavastatin-NP on myocardial IR injury in conscious and anesthetized pig models. Methods and Results Eighty-four Bama mini-pigs were surgically implanted with a pneumatic cuff occluder at the left circumflex coronary artery (LCx) and telemetry transmitters to continuously monitor electrocardiogram as well as to monitor arterial blood pressure and heart rate. The LCx was occluded for 60 minutes, followed by 24 hours of reperfusion under conscious conditions. Intravenous administration of pitavastatin-NP containing ≥ 8 mg/body of pitavastatin 5 minutes before reperfusion significantly reduced infarct size; by contrast, pitavastatin alone (8 mg/body) showed no therapeutic effects. Pitavastatin-NP produced anti-apoptotic effects on cultured cardiomyocytes in vitro. Cardiac magnetic resonance imaging performed 4 weeks after IR injury revealed that pitavastatin-NP reduced the extent of left ventricle remodeling. Importantly, pitavastatin-NP exerted no significant effects on blood pressure, heart rate, or serum biochemistry. Exploratory examinations in anesthetized pigs showed pharmacokinetic analysis and the effects of pitavastatin-NP on no-reflow phenomenon. Conclusions NP-mediated delivery of pitavastatin to IR-injured myocardium exerts cardioprotective effects on IR injury without apparent adverse side effects in a preclinical conscious pig model. Thus, pitavastatin-NP represents a novel therapeutic

  12. A ‘brain tumor’ in an intravenous drug abuser

    Directory of Open Access Journals (Sweden)

    Kathir Yoganathan

    2009-04-01

    Full Text Available Kathir YoganathanABM University Trust, Singleton Hospital, Swansea, UKAbstract: A male intravenous drug abuser who was infected with hepatitis B and C, presented with a slowly progressive hemiplegia. Contrast enhanced computerized tomography of the head showed a solitary ring-enhanced mass with surrounding edema. Clinically brain tumor was suspected but a brain biopsy confirmed cerebral toxoplasmosis. An HIV test was not considered until the result of brain biopsy. He also had lymphopenia and positive serum toxoplasma antibody. His subsequent HIV test was positive. He deteriorated after a brain biopsy. Empirical antitoxoplasma treatment is recommended in HIV-positive patients with ring-enhanced lesions with surrounding edema and with positive toxoplasma serology. Cerebral toxoplasmosis is still the commonest cerebral opportunistic infection in HIV-infected patients even though the incidence has declined with the use of antiretroviral therapy. It is often diagnosed in those patients as an initial presentation of HIV infection or in those who failed to attend for disease monitoring. Clinical features and differential diagnosis of cerebral toxoplasmosis in immunocompromised patients are discussed.Keywords: brain tumor, cerebral toxoplasmosis, intravenous drug abuser, primary brain lymphoma, HIV/AIDS

  13. MR-angiography with intravenous administration of Gd-DTPA

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Yoko; Yodono, Hiraku; Tarusawa, Koji; Sasaki, Taisuke; Akimura, Rumiko; Kanehira, Jiro; Takahashi, Satoshi; Takekawa, S.D.

    1989-05-01

    We carried out phase contrast MR-angiography of the lower extremities with intravenous administration of Gd-DTPA. Five healthy male volunteers, 25 to 40 years of age, were examined with a 0.5T MRI unit. We used fast scan (gradient echo) technique and it took about 8 minutes for whole procedure. Images were obtained before and after intravenous injection of Gd-DTPA. Injection dose was 0.1 mmol/kg. In two cases, we got images with variable flip angles. However angles of 30 or 40 degrees were thought to be best on the scan with Gd-DTPA. In three cases, we repeated short time procedures for about 4 minutes each time and continued to check the signal intensities of vessels for as long as one hour. The signal intensities greatly increased soon after administration of Gd-DTPA, and then they gradually decreased, but for as long as 60 minutes after administration they remained much higher than those before administration of Gd-DTPA. MR-angiography with Gd-DTPA was found very useful to demonstrate the peripheral femoral vessels clearly. No significant side effect was noticed in any case. Therefore, this method was thought to be very useful clinically. (author).

  14. Iatrogenic intravascular pneumocephalus secondary to intravenous catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Yildiz, Altan; Oezer, Caner; Egilmez, Hulusi; Duce, Meltem Nass; Apaydin, Demir F.; Yalcinoglu, Orhan [Department of Radiology, Faculty of Medicine, Mersin University (Turkey)

    2002-03-01

    The presence of pneumocephalus without a history of intracranial or intrathecal procedures is a significant radiographic finding. Although pneumocephalus means a violation of the dural barrier or the presence of infection, intravascular pneumocephalus is different from intraparenchymal pneumocephalus and its benign nature must be known in the presence of intravenous catheterization. Herein, we present a case of iatrogenic intravascular pneumocephalus with CT findings. To our knowledge, there are only a few reported cases of iatrogenic intravascular pneumocephalus in the literature. Careful intravenous catheterization and diagnosis of the condition on imaging helps to prevent unnecessary treatment procedures. (orig.)

  15. A phase I trial of intravenous catumaxomab

    DEFF Research Database (Denmark)

    Mau-Sørensen, Morten; Dittrich, Christian; Dienstmann, Rodrigo;

    2015-01-01

    design in epithelial cancers with known EpCAM expression. The dose-limiting toxicity (DLT) period consisted of 4 weeks, with weekly intravenous administration of catumaxomab. Key DLTs were ≥grade 3 optimally treated non-hematological toxicity; ≥grade 3 infusion-related reactions refractory to supportive....... A reversible decrease in liver function test (prothrombin time) at the 7-µg dose level was considered a DLT. The first patient at 10 µg experienced a fatal hepatic failure related to catumaxomab that led to the termination of the study. CONCLUSIONS: The MTD of weekly intravenous catumaxomab was 7 µg. Major...

  16. 3D excretory MR urography: improved image quality with intravenous saline and diuretic administration.

    Science.gov (United States)

    Ergen, F Bilge; Hussain, Hero K; Carlos, Ruth C; Johnson, Timothy D; Adusumilli, Saroja; Weadock, William J; Korobkin, Melvyn; Francis, Isaac R

    2007-04-01

    To assess the effect of diuretic administration on the image quality of excretory magnetic resonance urography (MRU) obtained following intravenous hydration, and to determine whether intravenous hydration alone is sufficient to produce diagnostic quality studies of nondilated upper tracts. A total of 22 patients with nondilated upper tracts were evaluated with contrast-enhanced MRU. All patients received 250 mL of saline intravenously immediately prior to the examination. A total of 11 patients received 10-20 mg furosemide in addition to saline. Imaging was performed with a three-dimensional (3D) and two-dimensional (2D) breathhold spoiled gradient-echo sequences. Excretory MRU images were acquired five minutes after the administration of 0.1 mmol/kg gadolinium and were independently reviewed by two radiologists, who were blinded to the MRU technique. Readers evaluated the calyces, renal pelvis, and ureters qualitatively for degree of opacification, distention, and artifacts on a four-point scale. Statistical analysis was performed using a permutation test. There was no significant disagreement between the two readers (P=0.14). Furosemide resulted in significant improvement in calyceal and renal pelvis distention (PMRU studies obtained following intravenous hydration. Intravenous saline alone is insufficient to produce diagnostic quality studies of the non-dilated upper tracts. Copyright (c) 2007 Wiley-Liss, Inc.

  17. Rat myocardial protein degradation.

    Science.gov (United States)

    Steer, J H; Hopkins, B E

    1981-07-01

    1. Myocardial protein degradation rates were determined by following tyrosine release from rat isolated left hemi-atria in vitro. 2. After two 20 min preincubations the rate of tyrosine release from hemi-atria was constant for 4 h. 3. Skeletal muscle protein degradation was determined by following tyrosine release from rat isolated hemi-diaphragm (Fulks, Li & Goldberg, 1975). 4. Insulin (10(-7) M) inhibited tyrosine release from hemi-atria and hemi-diaphragm to a similar extent. A 48 h fast increased tyrosine release rate from hemi-diaphragm and decreased tyrosine release rate from hemi-atria. Hemi-diaphragm tyrosine release was inhibited by 15 mmol/l D-glucose but a variety of concentrations of D-glucose (0, 5, 15 mmol/l) had no effect on tyrosine release from hemi-atria. Five times the normal plasma levels of the branched-chain amino acids leucine, isoleucine and valine had no effect on tyrosine release from either hemi-atria or hemi-diaphragm.

  18. Scintigraphic Assessment of Myocardial Viability

    Energy Technology Data Exchange (ETDEWEB)

    Bom, Hee Seung [Chonnam University Hospital, Kwangju (Korea, Republic of)

    1993-07-15

    The identification of viable myocardium in patients with coronary artery disease and left ventricular dysfunction is an issue of increasing clinical relevance in the current era of myocardial revascularization. There are at least two forms of reversible myocardial dysfunction. Early reperfusion does not always lead to immediate functional improvement; rather, the return of contractility in tissue salvaged by reperfusion is delayed for hours, days or even weeks, a phenomenon that has been termed {sup s}tunned myocardium{sup .} Some patients with coronary artery disease show myocardial dysfunction ar rest which are associated with reduced perfusion, and which disappear after revascularization; this phenomenon has been termed {sup h}ibernating myocardium{sup .} Recently, cardiac imaging techniques that evaluate myocardial viability on the basis of perfusion contraction mismatch and inotropic reserve have gained substantial popularity and clinical success. This review focus on the application of {sup 201}T1 and {sup 99m}Tc-MIBI to address myocardial viability in patients with hibernating and stunned myocardium. It is clear that 4-hour redistribution images of {sup 201}T1 underestimate ischemia and overestimate scar. Delayed imaging and reinjection imaging have been developed for the assessment of viability. Among many protocols suggested, stress-redistribution-reinjection imaging gained most popularity. Although {sup 99m}Tc- MIBI could identify myocardial viability, {sup 201}T1 reinjection technique was regarded as superior to it. In conclusion, {sup 201}T1 stress, 4-hr rest redistribution, and reinjection imaging technique may be the most preferable method for evaluation of myocardial viability.

  19. Effects of activation of endocannabinoid system on myocardial metabolism

    Directory of Open Access Journals (Sweden)

    Agnieszka Polak

    2016-05-01

    Full Text Available Endocannabinoids exert their effect on the regulation of energy homeostasis via activation of specific receptors. They control food intake, secretion of insulin, lipids and glucose metabolism, lipid storage. Long chain fatty acids are the main myocardial energy substrate. However, the heart exerts enormous metabolic flexibility emphasized by its ability to utilzation not only fatty acids, but also glucose, lactate and ketone bodies. Endocannabinoids can directly act on the cardiomyocytes through the CB1 and CB2 receptors present in cardiomyocytes. It appears that direct activation of CB1 receptors promotes increased lipogenesis, pericardial steatosis and bioelectrical dysfunction of the heart. In contrast, stimulation of CB2 receptors exhibits cardioprotective properties, helping to maintain appropriate amount of ATP in cardiomyocytes. Furthermore, the effects of endocannabinoids at both the central nervous system and peripheral tissues, such as liver, pancreas, or adipose tissue, resulting indirectly in plasma availability of energy substrates and affects myocardial metabolism. To date, there is little evidence that describes effects of activation of the endocannabinoid system in the cardiovascular system under physiological conditions. In the present paper the impact of metabolic diseases, i. e. obesity and diabetes, as well as the cardiovascular diseases - hypertension, myocardial ischemia and myocardial infarction on the deregulation of the endocannabinoid system and its effect on the metabolism are described.

  20. Early myocardial damage assessment in dystrophinopathies using 99Tcm-MIBI gated myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Zhang L

    2015-12-01

    Full Text Available Li Zhang,1,* Zhe Liu,2,* Ke-You Hu,3 Qing-Bao Tian,3 Ling-Ge Wei,4 Zhe Zhao,5 Hong-Rui Shen,5 Jing Hu5 1Department of Cardiovascular Disorders, 2Department of Geriatrics, The Third Hospital of Hebei Medical University, 3The Public Health Department, Hebei Medical University, 4Department of Nuclear Medicine, 5Department of Neuromuscular Disorders, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China *Li Zhang and Zhe Liu are first coauthors of this paper Background: Early detection of muscular dystrophy (MD-associated cardiomyopathy is important because early medical treatment may slow cardiac remodeling and attenuate symptoms of cardiac dysfunction; however, no sensitive and standard diagnostic method for MD at an earlier stage has been well-recognized. Thus, the aim of this study was to test the early diagnostic value of technetium 99m-methoxyisobutylisonitrile (99Tcm-MIBI gated myocardial perfusion imaging (G-MPI for MD.Methods and results: Ninety-one patients underwent 99Tcm-MIBI G-MPI examinations when they were diagnosed with Duchenne muscular dystrophy (DMD (n=77 or Becker muscular dystrophy (BMD; n=14. 99Tcm-MIBI G-MPI examinations were repeated in 43 DMD patients who received steroid treatments for 2 years as a follow-up examination. Myocardial defects were observed in nearly every segment of the left ventricular wall in both DMD and BMD patients compared with controls, especially in the inferior walls and the apices by using 99Tcm-MIBI G-MPI. Cardiac wall movement impairment significantly correlated with age in the DMD and BMD groups (rs=0.534 [P<0.05] and rs=0.784 [P<0.05], respectively. Intermittent intravenous doses of glucocorticoids and continuation with oral steroid treatments significantly improved myocardial function in DMD patients (P<0.05, but not in BMD patients.Conclusion: 99Tcm-MIBI G-MPI is a sensitive and safe approach for early evaluation of cardiomyopathy in patients with DMD or BMD

  1. Safety and efficacy of tenecteplase in acute myocardial infarction.

    Science.gov (United States)

    Guerra, Daniel R; Karha, Juhana; Gibson, C Michael

    2003-05-01

    The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improved mortality achieved with these drugs is tempered by the risk of serious bleeding complications, especially intracranial haemorrhage (ICH). Tenecteplase (TNKase, Genetech Inc.) is an engineered variant of alteplase (Activase, Genentech Inc.) designed to have increased fibrin specificity, greater efficacy and a longer half-life. The longer half-life of tenecteplase compared to alteplase allows for convenient single bolus administration of the drug. In addition, tenecteplase dosing is based on actual or estimated patient weight, which enhances both the safety and efficacy outcomes. Large clinical trials have demonstrated equivalence in mortality and ICH between tenecteplase and alteplase. Compared to alteplase, tenecteplase use leads to lower rates of bleeding complications and a decreased risk of ICH among low weight, elderly women.

  2. Evaluation of transplantation of mesenchymal cells in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Aliya Dzholdasbekova

    2012-12-01

    Full Text Available It has been studied in the pilot clinical research the effect of systemic (intravenous transplantation of mesenchymal stem cells (MSC of a bone marrow to 20 patients with an acute myocardial infarction with lifting segment of ST (STEMI carried out in the first 2 hours by percutaneous coronary intervention (PCI with stenting infarct related artery and the common course of drug therapy. It has been shown that the transplantation of MSCs had not caused any complications (allergic reactions, hazardous to health arrhythmias, embolism and heavy frustration of hemodynamic and had not lead to condition deterioration afterwards. In the first 3-6 months after systemic transplantation of MSCs to the patients’ heart contractive activity has been advanced which was clinically proved in the reduction of the heart failure level degree of expressiveness of warm insufficiency.

  3. Post myocardial infarction cardiogenic shock: a review of current therapies.

    Science.gov (United States)

    Ng, Ramford; Yeghiazarians, Yerem

    2013-01-01

    Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock. Rapid diagnosis of cardiogenic shock and its underlying cause is pivotal to delivering definitive therapy. Intravenous vasoactive agents and mechanical support devices may temporize the patient's hemodynamic status until definitive therapy by percutaneous or surgical intervention can be performed. Despite prompt management, post-MI cardiogenic shock mortality remains high.

  4. 维吾尔族急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗与溶栓保守治疗对预后影响研究%Study on direct percutaneous coronary intervention contrast thrombolytic or conservative theapy in ST-segment elevation acute myocardial infarction of Uyghur

    Institute of Scientific and Technical Information of China (English)

    买买提艾力; 阿里木江; 阿布来提; 阿力木江; 阿布力米提; 阿不力米提; 阿地力; 阿吉木; 木拉提; 郑衡; 古丽娅

    2014-01-01

    Objective To evaluate the clinical efifcacy of direct percutaneous coronary intervention (PCI) in ST-segment elevation acute myocardial infarction (aMi). Methods in 2006 July to 2008 december in hospital 222 cases of patients withnon st segment elevation aMi, were randomly divided into a group (Pci treatment) and 89 cases of noninvasive group 133 cases, major cardiovascular events in the two groups of patients the incidence, mortality, reinfarction andsecond weeks before and after June, echocardiography and left ventricularcheck the diastolic diameter (edd) and left ventricular ejection fraction (lVef)were compared, and according to angiography results in patients, divided intosingle, double and three lesion group, analysis of different effect of lesion on left ventricular function.Results the invasive group, contrast examination results suggest a single vessel disease in 24 cases (26.97%), double vessel disease in 21 cases (23.60%),three lesions in 29 cases (32.58%), 80%of patients achieved success inoperation, 77 stents,74 patients (83.15%) obtained tiMi gradeⅢperfusion of the ira. compared the invasive with the non-invasive group,the in-hospital 30-day mortality rate was 3.3%vs 5.2%(P<0.01), major cardiac events rate was 10.1%vs 26.3%(P<0.005),and reinfarction rate was 2.2%vs 8.3%(P<0.005)respertively .The LVEF in the invasive group was signiifcantly higher(59.87%±8.32%,54.62%±10.32%) than that in the non-invasive group(54.43%±10.21%,51.13%±9.12%) after 2 weeks or 6 months(P<0.001),but the edd was lower in the invasive group than in the controls[(53.02±5.51)mmvs(56.82±7.66)mm,P<0.001].here is a single vessel lesion group the level of lVef group is higher than the other two lesions group (P<0.01), and edd was lower than that of the other twolesions group (P<0.01). Conclusion direct Pci can quickly get through ira, and improve left ventricular function,effectively reduce recurrent angina, re hospitalization, and mortality of coronary artery bypass grafting

  5. Intravenous polyclonal human immunoglobulins in multiple sclerosis

    DEFF Research Database (Denmark)

    Sørensen, Per Soelberg

    2008-01-01

    Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta...

  6. Homicide by intravenous injection of naphtha.

    Science.gov (United States)

    Case, M E; Poklis, A; Mackell, M A

    1985-01-01

    A case of homicide by the intravenous injection of Energine, a petroleum distillate spot remover, is presented. This case is the only known homicide committed with naphtha. This elderly man had severe natural disease in addition to chest trauma sustained in the assault leading to death; however, the rapid injection of approximately 25 mL of Energine was the overwhelming cause of death.

  7. Intravenous magnetic resonance arthrography of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hyeon; Lee, Young Uk; Suh, Jong Dae; Lee, Seung Hee; Kim, Dong Joo [Kangbuk Samsung Hospital, Seoul (Korea, Republic of)

    1995-10-15

    Knee MR images were repeatedly obtained after intravenous administration of gadopentetate dimeglumine to evaluate the arthrographic effect and to determine the optimal scan timing and technique. Sagittal T1-weighted (650/15) sequences were repeated before and after intravenous gadolinium enhancement in 26 patients who were divided into exercise (14/26) and nonexercise (12/26) groups. Fourteen patients in exercise group were allowed to move the affected knee joint actively for 10 minutes immediately after the first post-enhancement scan and before repeating scans. The signal intensities in central and peripheral portions of the joint were measured and compared between these two groups. In all cases, enhancement of joint fluid began at peripheral portion and progressed toward central portion. The diffusion rate in exercise group was far faster than that in nonexercise group and homogeneous arthrographic image was revealed within 10 minutes after completion of joint movement. The arthrographic effect continued and the rate of signal decrease was quite slow. MR arthrographic image of knee joint can be obtained within 10 minutes after completion of a few minute exercise following intravenous injection of gadopentetate dimeglumine. Intravenous MR arthrography is expected to become an useful method as a convenient alternative to direct MR arthrography.

  8. Pharmacokinetics of intravenous buprenorphine in children.

    OpenAIRE

    1989-01-01

    Buprenorphine (3 micrograms kg-1) was given intravenously as premedication to small children (age 4-7 years) undergoing minor surgery. Because of the rapid decline of the plasma buprenorphine concentrations, the terminal elimination half-life could not be estimated reliably. Given this constraint, values of clearance appeared to be higher than those in adults but values of Vss were similar.

  9. Pharmacokinetics of intravenous buprenorphine in children.

    Science.gov (United States)

    Olkkola, K T; Maunuksela, E L; Korpela, R

    1989-08-01

    Buprenorphine (3 micrograms kg-1) was given intravenously as premedication to small children (age 4-7 years) undergoing minor surgery. Because of the rapid decline of the plasma buprenorphine concentrations, the terminal elimination half-life could not be estimated reliably. Given this constraint, values of clearance appeared to be higher than those in adults but values of Vss were similar.

  10. Epileptic fits under intravenous midazolam sedation.

    Science.gov (United States)

    Robb, N D

    1996-09-07

    A case is presented of a patient who suffered from recurrent epileptic fits while being treated under intravenous sedation with midazolam. Those using sedation are advised to beware of the patient who gives a history of fits being provoked in the dental environment.

  11. Intravenous iron supplementation in children on hemodialysis.

    NARCIS (Netherlands)

    Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

    2004-01-01

    BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in child

  12. Intravenous and intramuscular magnesium sulphate regimens in ...

    African Journals Online (AJOL)

    1993-09-03

    Sep 3, 1993 ... Pritchard' and a continuous intravenous (IV) infusion described by Zuspan! ... in the treatment of severe pre-eclampsia with the IM regimen of ..... people under the age of 50 years and more men died than women. In 40% of ...

  13. Intravenous iron supplementation in children on hemodialysis.

    NARCIS (Netherlands)

    Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

    2004-01-01

    BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in

  14. Administration and monitoring of intravenous anesthetics

    NARCIS (Netherlands)

    Sahinovic, Marko M.; Absalom, Anthony R.; Struys, Michel M. R. F.

    2010-01-01

    Purpose of review The importance of accuracy in controlling the dose-response relation for intravenous anesthetics is directly related to the importance of optimizing the efficacy and quality of anesthesia while minimizing adverse drug effects. Therefore, it is important to measure and control all

  15. 3D Myocardial Contraction Imaging Based on Dynamic Grid Interpolation: Theory and Simulation Analysis

    Science.gov (United States)

    Bu, Shuhui; Shiina, Tsuyoshi; Yamakawa, Makoto; Takizawa, Hotaka

    Accurate assessment of local myocardial contraction is important for diagnosis of ischemic heart disease, because decreases of myocardial motion often appear in the early stages of the disease. Three-dimensional (3-D) assessment of the stiffness distribution is required for accurate diagnosis of ischemic heart disease. Since myocardium motion occurs radially within the left ventricle wall and the ultrasound beam propagates axially, conventional approaches, such as tissue Doppler imaging and strain-rate imaging techniques, cannot provide us with enough quantitative information about local myocardial contraction. In order to resolve this problem, we propose a novel myocardial contraction imaging system which utilizes the weighted phase gradient method, the extended combined autocorrelation method, and the dynamic grid interpolation (DGI) method. From the simulation results, we conclude that the strain image's accuracy and contrast have been improved by the proposed method.

  16. Contrast-induced nephropathy

    Directory of Open Access Journals (Sweden)

    Ricardo A. García Hernández

    2016-06-01

    Full Text Available Contrast-induced nephropathy is an important complication associated with the use of contrast media. Favoring factors for the development of contrast-induced nephronpathy have been widely described, being diabetes mellitus and previous renal disease the greatest risk. The pathophysiology is a complex process where the medullary hypoxia represents the trigger element. Previous hydration and the use of low osmolality contrast are the most recommended measures to prevent its development.

  17. Myocardial protection during heart surgery in China

    Institute of Scientific and Technical Information of China (English)

    Bingyang Ji; Jinping Liu

    2007-01-01

    @@ Myocardial protection (MP) is the key for cardiopulmonary bypass (CPB) heart surgery. MP during cardiac surgery (CS) aims to preserve myocardial function while providing a bloodless and motionless operating field. Strategies on how to attenuate or prevent post-ischemic myocardial dysfunction that occurs intra-operatively during CS have been discussed for more than half a century. In 1950, Bigelow et al1 first reported to decrease myocardial oxygen demand by means of hypothermia.

  18. Intravenous immunoglobulin treatment of children with autism.

    Science.gov (United States)

    Plioplys, A V

    1998-02-01

    Since autism has been associated with immunologic abnormalities suggesting an autoimmune cause of autistic symptoms in a subset of patients, this study was undertaken to investigate whether intravenous immunoglobulin (i.v.Ig) would improve autistic symptoms. Ten autistic children with immunologic abnormalities, demonstrated on blood tests, were enrolled in this study. Their ages ranged from 4 to 17 years, with two girls and eight boys. Eight children (1 female and 7 male) historically had undergone autistic regression. Intravenous immunoglobulin, 200 to 400 mg/kg, was administered every 6 weeks for an intended treatment program of four infusions. In five children, there was no detectable change in behavior during the treatment program. In four children, there was a mild improvement noted in attention span and hyperactivity. In none of these children did the parents feel that the improvement was sufficient to warrant further continuation of the infusions beyond the termination of the program. Only in one child was there a very significant improvement, with almost total amelioration of autistic symptoms over the time period of the four infusions. Once the treatment program was completed, this child gradually deteriorated over a 5-month time period and fully reverted to his previous autistic state. In this treatment program, five children had no response to intravenous immunoglobulin. In the four children who showed mild improvements, those improvements may simply have been due to nonspecific effects of physician intervention and parental expectation (ie, placebo effect). However, in one child there was a very significant amelioration of autistic symptoms. There were no distinguishing historic or laboratory features in this child who improved. Given a positive response rate of only 10% in this study, along with the high economic costs of the immunologic evaluations and the intravenous immunoglobulin treatments, the use of intravenous immunoglobulin to treat autistic

  19. Contrast MR imaging of acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kogame, Saeko; Syakudo, Miyuki; Inoue, Yuichi (Osaka City Univ. (Japan). Faculty of Medicine) (and others)

    1992-04-01

    Thirty patients with acute and subacute cerebral infarction (13 and 17 deep cerebral infarction) were studied with 0.5 T MR unit before and after intravenous injection of Gd-DTPA. Thirteen patients were studied within 7 days after neurological ictus, 17 patients were studied between 7 and 14 days. Two types of abnormal enhancement, cortical arterial and parenchymal enhancement, were noted. The former was seen in 3 of 4 cases of very acute cortical infarction within 4 days after clinical ictus. The latter was detected in all 7 cases of cortical infarction after the 6th day of the ictus, and one patient with deep cerebral infarction at the 12th day of the ictus. Gd-DTPA enhanced MR imaging seems to detect gyral enhancement earlier compared with contrast CT, and depict intra-arterial sluggish flow which was not expected to see on contrast CT scans. (author).

  20. Experimental Approaches to Acute Myocardial Infarction

    NARCIS (Netherlands)

    D.B. Uitterdijk (André)

    2015-01-01

    markdownabstractAbstract This thesis is dedicated to i) novel methods and optimization studies to improve the diagnosis of myocardial ischemia and myocardial infarction as well as fundamental studies that precede novel therapies for myocardial infarction. In part ii) 2 novel, adjunctive therapies f

  1. Experimental Approaches to Acute Myocardial Infarction

    NARCIS (Netherlands)

    D.B. Uitterdijk (André)

    2015-01-01

    markdownabstractAbstract This thesis is dedicated to i) novel methods and optimization studies to improve the diagnosis of myocardial ischemia and myocardial infarction as well as fundamental studies that precede novel therapies for myocardial infarction. In part ii) 2 novel, adjunctive therapies

  2. Morphological aspects of myocardial bridges.

    Science.gov (United States)

    Lujinović, Almira; Kulenović, Amela; Kapur, Eldan; Gojak, Refet

    2013-11-01

    Although some myocardial bridges can be asymptomatic, their presence often causes coronary disease either through direct compression of the "tunnel" segment or through stimulation and accelerated development of atherosclerosis in the segment proximally to the myocardial bridge. The studied material contained 30 human hearts received from the Department of Anatomy. The hearts were preserved 3 to 5 days in 10% formalin solution. Thereafter, the fatty tissue was removed and arterial blood vessels prepared by careful dissection with special reference to the presence of the myocardial bridges. Length and thickness of the bridges were measured by the precise electronic caliper. The angle between the myocardial bridge fibre axis and other axis of the crossed blood vessel was measured by a goniometer. The presence of the bridges was confirmed in 53.33% of the researched material, most frequently (43.33%) above the anterior interventricular branch. The mean length of the bridges was 14.64 ± 9.03 mm and the mean thickness was 1.23 ± 1.32 mm. Myocardial bridge fibres pass over the descending blood vessel at the angle of 10-90 degrees. The results obtained on a limited sample suggest that the muscular index of myocardial bridge is the highest for bridges located on RIA, but that the difference is not significant in relation to bridges located on other branches. The results obtained suggest that bridges located on other branches, not only those on RIA, could have a great contractive power and, consequently, a great compressive force, which would be exerted on the wall of a crossed blood vessel.

  3. Dynamic CT myocardial perfusion imaging.

    Science.gov (United States)

    Caruso, Damiano; Eid, Marwen; Schoepf, U Joseph; Jin, Kwang Nam; Varga-Szemes, Akos; Tesche, Christian; Mangold, Stefanie; Spandorfer, Adam; Laghi, Andrea; De Cecco, Carlo N

    2016-10-01

    Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

  4. Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction: a placebo controlled study

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Madsen, J K; Saunamäki, K I

    1992-01-01

    Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis...... following acute myocardial infarction. The present study was performed to compare exercise test variables in acute myocardial infarction patients following either intravenous thrombolysis or placebo. Symptom-limited bicycle ergometer tests, carried out 1-2 weeks from the infarction, were performed in 85...... heart rate than controls (136 vs. 126 b.min-1, P less than 0.01) but only a trend towards higher systolic blood pressure was seen (175 vs. 163 mmHg, P = 0.09). Rate-pressure product at maximal exercise was 23,620 vs. 20,100 mmHg.b.min-1 respectively, (P less than 0.01). Total exercise time, ST...

  5. Efficacy of recombinant tissue-type plasminogen activator thrombolysis and primary coronary stenting after acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈步星; 王伟民; 赵红; 胡大一; 徐成斌; 赵明中; 卢明瑜; 刘健; 吴淳

    2003-01-01

    Objective To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.Methods Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.Results The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P0.05).Conclusion Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.

  6. Current Stem Cell Delivery Methods for Myocardial Repair

    Directory of Open Access Journals (Sweden)

    Calvin C. Sheng

    2013-01-01

    Full Text Available Heart failure commonly results from an irreparable damage due to cardiovascular diseases (CVDs, the leading cause of morbidity and mortality in the United States. In recent years, the rapid advancements in stem cell research have garnered much praise for paving the way to novel therapies in reversing myocardial injuries. Cell types currently investigated for cellular delivery include embryonic stem cells (ESCs, induced pluripotent stem cells (iPSCs, and adult stem cell lineages such as skeletal myoblasts, bone-marrow-derived stem cells (BMSCs, mesenchymal stem cells (MSCs, and cardiac stem cells (CSCs. To engraft these cells into patients’ damaged myocardium, a variety of approaches (intramyocardial, transendocardial, transcoronary, venous, intravenous, intracoronary artery and retrograde venous administrations and bioengineered tissue transplantation have been developed and explored. In this paper, we will discuss the pros and cons of these delivery modalities, the current state of their therapeutic potentials, and a multifaceted evaluation of their reported clinical feasibility, safety, and efficacy. While the issues of optimal delivery approach, the best progenitor stem cell type, the most effective dose, and timing of administration remain to be addressed, we are highly optimistic that stem cell therapy will provide a clinically viable option for myocardial regeneration.

  7. Clinical significance of {sup 123}I-BMIPP myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Junichi [Toho Univ., Tokyo (Japan). School of Medicine

    1998-07-01

    {sup 123}I-BMIPP is a radioiodinated branched chain fatty acid analog, showing high accumulation as well as prolonged retention in the myocardium. Therefore, it is used as a metabolic imaging agent suitable for myocardial SPECT. After {sup 123}I-BMIPP is taken in the myocardium, it remains there mainly as a storage type fatty acid of triglyceride, and it shows different behavior by the stage of cardiac disease. Usually, we evaluate metabolic findings by early imaging (20 minutes) after intravenous injection of {sup 123}I-BMIPP, however, sometimes washout or fill in are seen in the case of myocardial infarction or hypertrophic cardiomyopathy by delayed imaging (after 4 hours). The mismatch of {sup 201}TlCl and {sup 123}I-BMIPP are useful for the diagnosis of stunned myocardium or evaluation of prognosis. However, behavior of {sup 123}I-BMIPP in myocardium is known still not completely. Therefore clinical significance of this examination is thought to be clarified by the stock of cases of various heart diseases. (author)

  8. Current stem cell delivery methods for myocardial repair.

    Science.gov (United States)

    Sheng, Calvin C; Zhou, Li; Hao, Jijun

    2013-01-01

    Heart failure commonly results from an irreparable damage due to cardiovascular diseases (CVDs), the leading cause of morbidity and mortality in the United States. In recent years, the rapid advancements in stem cell research have garnered much praise for paving the way to novel therapies in reversing myocardial injuries. Cell types currently investigated for cellular delivery include embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and adult stem cell lineages such as skeletal myoblasts, bone-marrow-derived stem cells (BMSCs), mesenchymal stem cells (MSCs), and cardiac stem cells (CSCs). To engraft these cells into patients' damaged myocardium, a variety of approaches (intramyocardial, transendocardial, transcoronary, venous, intravenous, intracoronary artery and retrograde venous administrations and bioengineered tissue transplantation) have been developed and explored. In this paper, we will discuss the pros and cons of these delivery modalities, the current state of their therapeutic potentials, and a multifaceted evaluation of their reported clinical feasibility, safety, and efficacy. While the issues of optimal delivery approach, the best progenitor stem cell type, the most effective dose, and timing of administration remain to be addressed, we are highly optimistic that stem cell therapy will provide a clinically viable option for myocardial regeneration.

  9. Brief communication: radiographic contrast infusion and catecholamine release in patients with pheochromocytoma.

    NARCIS (Netherlands)

    Baid, S.K.; Lai, E.W.; Wesley, R.A.; Ling, A.; Timmers, H.J.L.M.; Adams, K.T.; Kozupa, A.; Pacak, K.

    2009-01-01

    BACKGROUND: Contrast-enhanced computed tomography (CT) is useful for localizing pheochromocytoma. However, in patients with suspected pheochromocytoma, CT is often canceled or not performed because of the strong belief that intravenous contrast may induce hypertensive crisis. OBJECTIVE: To examine w

  10. Brief communication: radiographic contrast infusion and catecholamine release in patients with pheochromocytoma.

    NARCIS (Netherlands)

    Baid, S.K.; Lai, E.W.; Wesley, R.A.; Ling, A.; Timmers, H.J.L.M.; Adams, K.T.; Kozupa, A.; Pacak, K.

    2009-01-01

    BACKGROUND: Contrast-enhanced computed tomography (CT) is useful for localizing pheochromocytoma. However, in patients with suspected pheochromocytoma, CT is often canceled or not performed because of the strong belief that intravenous contrast may induce hypertensive crisis. OBJECTIVE: To examine w

  11. Contrast-enhanced dual-energy mammography : a promising new imaging tool in breast cancer detection

    NARCIS (Netherlands)

    Lalji, Ulrich; Lobbes, Marc

    2014-01-01

    Contrast-enhanced dual-energy mammography (CEDM) is a promising new breast imaging tool for breast cancer detection. In CEDM, an iodine-based contrast agent is intravenously administered and subsequently, dual-energy mammography is performed. This results in a set of images containing both a regular

  12. Epidemiology of contrast material-induced nephropathy in the era of hydration.

    NARCIS (Netherlands)

    Balemans, C.E.A.; Reichert, L.J.M.; Schelven, B.I. van; Brand, Jan van den; Wetzels, J.F.M.

    2012-01-01

    PURPOSE: To evaluate the incidence of contrast material-induced nephropathy (CIN) in patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m(2) who received intravenous contrast media and underwent treatment in accordance with current guidelines and to determine ri

  13. A fast and effective method to assess myocardial hyperemia in acute myocarditis by magnetic resonance.

    Science.gov (United States)

    Perfetti, Matteo; Malatesta, Gelsomina; Alvarez, Irene; Liga, Riccardo; Barison, Andrea; Todiere, Giancarlo; Eletto, Nicoletta; De Caterina, Raffaele; Lombardi, Massimo; Aquaro, Giovanni Donato

    2014-03-01

    Current cardiac magnetic resonance (CMR) quantitative signs for the diagnosis of myocarditis include myocardial edema, fibrosis and myocardial hyperemia (Hyp). Methods for the assessment of Hyp are actually complex and time-consuming. To test a simple and fast method to assess Hyp, using contrast enhancement steady state free precession (ceSSFP) technique. CMR imaging at 1.5T was performed on 39 patients with diagnosis of acute myocarditis and in 20 healthy controls. Hyp was evaluated in systolic and diastolic frames (Hyp-SYS and Hyp-DIA) as areas of myocardial hyperintensity in ceSSFP images early after gadolinium injection. Myocardial edema was evaluated using T2-STIR images. Myocardial fibrosis was assessed in conventional late gadolinium enhancement (LGE) images. A value of ≤12.1 g of Hyp-DIA was obtained as cut-off of normality in healthy controls. Using this threshold, Hyp was detected in 30 patients (77 %) with myocarditis. LGE was detected in 36 patients (92 %), and myocardial edema in 38 (97 %) patients with myocarditis A linear relation was found between Hyp-DIA and the extent of myocardial edema (R(2) 0.48, 95 % CI 0.47-0.85, p < 0.001) and the extent of LGE (R(2) 0.41, 95 % CI 0.31-0.61, p < 0.001). Patients with hyperemia had higher levels of C-reactive protein (p < 0.001), a higher extent of LGE (p < 0.05) and a larger left atrial area (p < 0.05). ceSSFP sequence at CMR is a novel and fast method to assess myocardial hyperemia in patient with acute myocarditis. Compared with non-Hyp subjects, patients with Hyp had more signs of inflammation and myocardial damage.

  14. Myocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy Induced by Thoracic Epidural Anesthesia.

    Science.gov (United States)

    Bulte, Carolien S E; Boer, Christa; Hartemink, Koen J; Kamp, Otto; Heymans, Martijn W; Loer, Stephen A; de Marchi, Stefano F; Vogel, Rolf; Bouwman, R Arthur

    2017-02-01

    To evaluate the effect of acute cardiac sympathectomy by thoracic epidural anesthesia on myocardial blood flow and microvascular function. A prospective observational study. The study was conducted in a tertiary teaching hospital. Ten patients with a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery. Myocardial contrast echocardiography was used to study myocardial blood flow and microvascular responsiveness at rest, during adenosine-induced hyperemia, and after sympathetic stimulation by the cold pressor test. Repeated measurements were performed without and with thoracic epidural anesthesia. An increased myocardial blood volume was observed with thoracic epidural anesthesia compared to baseline (from 0.08±0.02 to 0.10±0.03 mL/mL; p = 0.02). No difference existed in resting myocardial blood flow between baseline conditions and epidural anesthesia (0.85±0.24 v 1.03±0.27 mL/min/g, respectively). Hyperemia during thoracic epidural anesthesia increased myocardial blood flow to 4.31±1.07 mL/min/g (p = 0.0008 v baseline) and blood volume to 0.17±0.04 mL/mL (p = 0.005 baseline). After sympathetic stimulation, no difference in myocardial blood flow parameters was observed CONCLUSIONS: Acute cardiac sympathectomy by thoracic epidural anesthesia increased the blood volume in the myocardial capillary system. Also, thoracic epidural anesthesia increased hyperemic myocardial blood flow, indicating augmented endothelial-independent vasodilator capacity of the myocardium. Copyright © 2017. Published by Elsevier Inc.

  15. Evaluation of the causes and cost impact of returned intravenous ...

    African Journals Online (AJOL)

    intravenous medications at a tertiary care hospital in. Riyadh ... cost impact in an in-patient setting in a Saudi tertiary care hospital. ..... Lean Techniques to Reduce Intravenous Waste. Through Premixed Solutions and Increasing Production.

  16. MORPHO - HISTOLOGICAL STUDY OF MYOCARDIAL BRIDGES OF CADAVERIC HEARTS

    Directory of Open Access Journals (Sweden)

    Nalinakumari

    2015-02-01

    Full Text Available INTRODUCTION: A band overlying the in tramural segment of coronary artery - a place where the artery goes through myocardium instead of epicardium is called myocardial bridging (MB. A wide variation of 0.5% - 90.4% occurs in the incidence of MB by the cadaveric and angiographic study. More over the occurrence of atherosclerosis in coronary artery segments under myocardial bridges still remains controversial. And so, the incidence of myocardial brid g es and their association to atherosclerosis formation in cadaveric hearts was done morphologically and histological in this study. METHODS: 30 cadaveric hearts from department of Anatomy were examined. After cleaning the fat from epicardium, course of all three coronary arteries were delineated and observed for presence of MB. In the hearts that exhibited MB, the location, length of MB, its distance from the coronary ostium was measured. Sections were made proximal to MB, under MB and distal to MB in the vessels. The perimeter of the vessels were measured. The section was processed for histological study of intimal – media thickness ratio. RESULT: 24 hearts showed MB in the left anterior interventricular artery. One showed MB in right coronary artery. Multiple MB in single artery was seen rarely. The length of the MB segment was around 4 cm on an average. Mostly the MB is seen in the mid to distal part of the artery. The intima was found to be thinned out in the section of the vessel underneath the MB. CONCLUSION: This study concludes that Left coronary artery is the commonest to have myocardial bridges. But the occurrence of this MB in the distal part of the vessel in contrast to previous studies is an important finding to be noted. The presence of intimal thinning underlying the myocardial bridges questions the previous studies that claimed MB‟s protection of vessels from atherosclerosis

  17. Sphingosine 1-Phosphate Receptor Modulator Fingolimod (FTY720) Attenuates Myocardial Fibrosis in Post-heterotopic Heart Transplantation.

    Science.gov (United States)

    Ahmed, Naseer; Linardi, Daniele; Muhammad, Nazeer; Chiamulera, Cristiano; Fumagalli, Guido; Biagio, Livio San; Gebrie, Mebratu A; Aslam, Muhammad; Luciani, Giovanni Battista; Faggian, Giuseppe; Rungatscher, Alessio

    2017-01-01

    Background and Objective: Sphingosine 1-phosphate (S1P), and S1P receptor modulator fingolimod have been suggested to play important cardioprotective role in animal models of myocardial ischemia/reperfusion injuries. To understand the cardioprotective function of S1P and its mechanism in vivo, we analyzed apoptotic, inflammatory biomarkers, and myocardial fibrosis in an in vivo heterotopic rat heart transplantation model. Methods: Heterotopic heart transplantation is performed in 60 Sprague-Dawley (SD) rats (350-400 g). The heart transplant recipients (n = 60) are categorized into Group A (control) and Group B (fingolimod treated 1 mg/kg intravenous). At baseline with 24 h after heart transplantation, blood and myocardial tissue are collected for analysis of myocardial biomarkers, apoptosis, inflammatory markers, oxidative stress, and phosphorylation of Akt/Erk/STAT-3 signaling pathways. Myocardial fibrosis was investigated using Masson's trichrome staining and L-hydroxyline. Results: Fingolimod treatment activates both Reperfusion Injury Salvage Kinase (RISK) and Survivor Activating Factor Enhancement (SAFE) pathways as evident from activation of anti-apoptotic and anti-inflammatory pathways. Fingolimod treatment caused a reduction in myocardial oxidative stress and hence cardiomyocyte apoptosis resulting in a decrease in myocardial reperfusion injury. Moreover, a significant (p < 0.001) reduction in collagen staining and hydroxyproline content was observed in fingolimod treated animals 30 days after transplantation demonstrating a reduction in cardiac fibrosis. Conclusion: S1P receptor activation with fingolimod activates anti-apoptotic and anti-inflammatory pathways, leading to improved myocardial salvage causing a reduction in cardiac fibrosis.

  18. Postreperfusion myocardial technetium-99m-sestamibi defect corresponds to area at risk

    Energy Technology Data Exchange (ETDEWEB)

    Poulsen, Runa Hyldgaard, E-mail: runa.poulsen@ki.au.dk [Clinical Institute, Aarhus University, DK-8000 Aarhus C (Denmark); Botker, Hans Erik [Department of Cardiology, Aarhus University Hospital, Skejby (Denmark); Rehling, Michael [Department of Nuclear Medicine, Aarhus University Hospital, Skejby (Denmark)

    2011-08-15

    Introduction: Technetium-99m-sestamibi (MIBI) is the most frequently used myocardial perfusion tracer in patients with ischemic heart disease. In patients with acute ST-elevation myocardial infarction, we previously found that the defect in myocardial MIBI uptake was the same in patients injected with MIBI before primary angioplasty and in patients injected immediately after successful treatment. Thus, reperfusion may not be followed by increased uptake of MIBI. Instead, the MIBI defect after reperfusion may reflect the area at risk (AAR) defined by MIBI injected before treatment. We intended to investigate whether myocardial imaging with MIBI administered after reperfusion reflects myocardial perfusion or rather the ischemic AAR. Methods: In 12 pigs, left anterior descending coronary artery was totally occluded for 45 min with an angioplasty balloon. After a 2-h reperfusion, MIBI was injected intravenously, and {sup 153}Gd-microspheres were injected in left atrium. AAR and infarct size (IS) were determined by histochemical staining. MIBI and microsphere distribution were evaluated by counting the sliced left ventricle on a gamma camera. Defects were defined as uptake less than 45% of maximum uptake. Results: The mean{+-}S.D. defect size as a fraction of left ventricle was for MIBI 21%{+-}5.5%, AAR 25%{+-}6.3%, IS 13%{+-}3.9% and microspheres defect size 7.3%{+-}5.5%. MIBI defect size overestimated IS (P=.0005) and microspheres defect size (P=.0001), but it was not significantly different from AAR (P=.30). Conclusion: In a porcine model of myocardial infarction after 45 min of ischemia, MIBI administered 120 min after reperfusion delineates AAR.

  19. Dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C. [Universidade Federal de Minas Gerais (DEN/UFMG), Belo Horizonte (Brazil). Dept. de Engenharia Nuclear. Programa de Pos-Graduacao em Ciencias e Tecnicas Nucleares

    2011-07-01

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  20. Neonatal Myocardial Infarction or Myocarditis?

    NARCIS (Netherlands)

    de Vetten, Leanne; Bergman, Klasien A.; Elzenga, Nynke J.; van Melle, Joost P.; Timmer, Albertus; Bartelds, Beatrijs

    2011-01-01

    We report a 29 week-gestation preterm infant who presented during his second week of life with cardiogenic shock. Clinical presentation and first diagnostics suggested myocardial infarction, but echocardiographic features during follow-up pointed to a diagnosis of enteroviral myocarditis. The child

  1. Spousal Adjustment to Myocardial Infarction.

    Science.gov (United States)

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  2. Pregnancy-related myocardial infarction

    NARCIS (Netherlands)

    Lameijer, H.; Lont, M. C.; Buter, H.; van Boven, A. J.; Boonstra, P. W.; Pieper, P. G.

    Introduction The risk of acute myocardial infarction in young women is low, but increases during pregnancy due to the physiological changes in pregnancy, including hypercoagulability. Ischaemic heart disease during pregnancy is not only associated with increased maternal morbidity and mortality, but

  3. The Orchestra of Myocardial Regeneration

    NARCIS (Netherlands)

    Siddiqi, S.

    2014-01-01

    A glimpse on previous and current literature ignites the recognition of the luxurious era that cardiac science has reached. In particular, the past fifteen years have provided tremendous advancements in the field of myocardial biology with the characterization of cardiac stem cells, reprogramming of

  4. Phosphorylation of endothelial NOS contributes to simvastatin protection against myocardial no-reflow and infarction in reperfused swine hearts: partially via the PKA signaling pathway

    Institute of Scientific and Technical Information of China (English)

    Xiang-dong LI; Yue-jin YANG; Yong-jian GENG; Jing-lin ZHAO; Hai-tao ZHANG; Yu-tong CHENG; Yi-ling WU

    2012-01-01

    Aim:The cholesterol-lowering drugs statins could enhance the activities of endothelial nitric oxide synthase (eNOS) and protect myocardium during ischemia and reperfusion.The aim of this study was to examine whether protein kinase A (PKA) was involved in statinmediated eNOS phosphorylation and cardioprotection.Methods:6-Month-old Chinese minipigs (20-30 kg) underwent a 1.5-h occlusion and 3-h reperfusion of the left anterior descending coronary artery (LAD).In the sham group,the LAD was encircled by a suture but not occluded.Hemodynamic and cardiac function was monitored using a polygraph.Plasma activity of creatine kinase and the tissue activities of PKA and NOS were measured spectrophotometrically.p-CREB,eNOS and p-eNOS levels were detected using Western blotting.Sizes of the area at risk,the area of no-reflow and the area of necrosis were measured morphologically.Results:Pretreatment of the animals with simvastatin (SIM,2 mg/kg,po) before reperfusion significantly decreased the plasma activity of creatine kinase,an index of myocardial necrosis,and reduced the no-reflow size (from 50.4%±2.4% to 36.1%+2.1%,P<0.01) and the infarct size (from 79.0%±2.7% to 64.1%±4.5%,P<0.01).SIM significantly increased the activities of PKA and constitutive NOS,and increased Ser133 p-CREB protein,Ser1179 p-eNOS,and Ser635 p-eNOS in ischemic myocardium.Intravenous infusion of the PKA inhibitor H-89 (1 μg·kg1·min-1) partially abrogated the SIM-induced cardioprotection and eNOS phosphorylation.In contrast,intravenous infusion of the eNOS inhibitor L-NNA (10 mg·kg1) completely abrogated the SIM-induced cardioprotection and eNOS phosphorylation during ischemia and reperfusion,but did not affect the activity of PKA.Conclusion:Pretreatment with a single dose of SIM 2.5 h before reperfusion attenuates myocardial no-reflow and infarction through increasing eNOS phosphorylation at Ser1179 and Ser635 that was partially mediated via the PKA signaling pathway.

  5. Protective effect and mechanism of lithium chloride pretreatment on myocardial ischemia-reperfusion injury in rats

    Institute of Scientific and Technical Information of China (English)

    Fang-Jiang Li; Tao Hsu; Hui-Xian Li; Jin-Zheng Shi; Mei-Ling Du; Xiao-Yuan Wang; Wen-Ting Zhang

    2014-01-01

    Objective:To investigate the protective effect and mechanism of lithium chloride pretreatment on myocardial ischemia-reperfusion injury(I-RI) in rats.Methods:A total of60SD rats were randomly divided into control group, model group, lithium chloride intervention group and L-arginine methyl ester+ lithium chloride intervention group with15 in each.TheI-RI model was established in model group, the lithium chloride intervention group andL-arginine methyl ester+ lithium chloride intervention group by method of seaming along left anterior descending coronary artery myocardial, control group was only opened the chest without seaming,ST-elevation within2 min was regarded as modeling success.Model group did not adopted any intervention, lithium chloride intervention group was treated with lithium chloride injection 15 mg/kg by jugular venipuncture preoperatively,L-arginine methyl ester+ lithium chloride intervention group was treated with intraperitoneal injection of30 mg•kg-1•d-1L-arginine methyl ester7 d before the test, and intravenous catheter of15 mg/kg lithium chloride preoperatively. The hydroxybutyric acid dehydrogenase(HBDH), creatine kinase isoenzyme(CK-MB), superoxide dismutase(SOD), malondialdehyde(MDA) level and nitric oxide synthase(NOS) activites were tested.Each large area of myocardial ischemia tissue was extracted for determination of the MDA content,SOD activity in tissue and serum, and morphological changes of myocardial tissue.Results:SOD activity was highest in lithium chloride intervention group, followed by L-arginine methyl ester+ lithium chloride intervention group, control group and model group (P0.05);HBDH andCK-MB of plasma were highest in model group, followed byL-arginine methyl ester+ lithium chloride intervention group, lithium chloride intervention group and control group(P<0.05).A significantly lighter myocardial damage was observed microscopically in lithium chloride intervention group than that inL-arginine methyl ester+ lithium

  6. Bacillus cereus panophthalmitis after intravenous heroin.

    Science.gov (United States)

    Hatem, G; Merritt, J C; Cowan, C L

    1979-03-01

    Two healthy young black men developed panophthalmitis after intravenous heroin injections. Bacillus cereus, considered to be a relatively noncommon pathogen for man, was found to be the causative agent as it was recovered from the anterior chamber and viterous cavity of both cases. The ocular findings were unilateral in each case, and neither patient had any sistemic involvement from the bacteremia. The onset of visual symptoms varied from 24 to 36 hours after the last intravenous injection with the eye becoming rapidly blind. Photographs of the early fundus lesions included preretinal hypopyon-like lesions and peculiar changes in the blood vasculature. Intracameral gentamicin and steroids did not alter the cause, and treatment was enucleation.

  7. Intravenous pyridoxine in acute ethanol intoxication.

    Science.gov (United States)

    Mardel, S; Phair, I; O'Dwyer, F; Henry, J A

    1994-05-01

    Intravenous pyridoxine was evaluated as an agent for the reversal of ethanol-induced central nervous depression in a randomised double blind controlled study of 108 patients presenting with a clinical diagnosis of acute ethanol intoxication to two accident and emergency departments. Level of consciousness, measured by a modified Glasgow coma scale, showed no significant change after a single 1 g dose of intravenous pyridoxine when compared to controls given saline. The mean fall in blood alcohol concentration after one hour was 33 mg dl-1 (7.2 mmol l-1) in both groups suggesting that pyridoxine has no antidotal action and no short term effect on the rate of metabolism of ethanol.

  8. Uterine intravenous leiomyomatosis with right ventricular extension.

    Science.gov (United States)

    Sogabe, Masaya; Kawahito, Koji; Aizawa, Kei; Sato, Hirotaka; Misawa, Yoshio

    2014-01-01

    Intravenous leiomyomatosis is a rare neoplastic condition characterized by the benign intravascular proliferation of smooth muscle cells originating from either the uterine venous wall or a uterine leiomyoma. In the present report, we describe the case of a 45-year-old woman without a history of gynaecological surgeries, who was referred to our institution due to repeated syncopal attacks. Computed tomography indicated the presence of an intravenous leiomyoma originating from the uterus and extending to the inferior vena cava, right atrium, and right ventricle. The patient was successfully treated by cardiotomy, which was performed under hypothermic circulatory arrest, and laparotomy in a single-stage operation. She continued to recover and did not exhibit any recurrence at the 10-month follow-up.

  9. Protective effects of emulsified isoflurane after myocardial ischemia-reperfusion injury and its mechanism in rabbits

    Institute of Scientific and Technical Information of China (English)

    RAO Yan; WANG Yan-lin; CHEN Yong-quan; ZHANG Wen-sheng; LIU Jin

    2009-01-01

    Objective: To evaluate the protective effects of 8% emulsified isoflurane after myocardial ischemia-reperfusion injury and its mechanism in rabbits.Methods: Twenty-four male adult New Zealand white rabbits were anesthetized with intravenous injection of 30 mg/kg pentobarbital followed by 5 mg·kg-1·h-1 infusion. All rabbits were subjected to 30 minutes of left anterior de-scending coronary artery (LAD) occlusion and 3 hours of subsequent reperfusion. Before LAD occlusion, the rabbits were randomly allocated into three groups for precondi-tioning treatment (eight for each group). The control group (C group) received intravenously 0.9% NaCl for 30 minutes. The emulsified isoflurane group (EI group) received 8% emulsified isoflurane intravenously till 0.64% end-tidal con-centration for 30 minutes that was followed by a 15-minute washout period. The Intralipid group (IN group) received 30% Intralipid for 30 minutes. The infarcted area, plasma malondialdehyde (MDA) content, superoxide dismutase activity (SOD) and nitrite concentration after 3-hour myo-cardial perfusion were recorded simultaneously.Results: For the myocardial ischemia-reperfusion in-jury animals, the infarcted size in the EI group was signifi-cantly reduced (91.9%±8%) as compared with control group (39%±6%,t=5.19, P<0.01). The plasma SOD activity and nitrite concentration in EI group were significantly higher than those in control group (t=2.82, t=8.46, P<0.05), but MDA content was lower in EI group than that in control group (t=2.56, P<0.05).Conclusions: The results indicate that emulsified isoflurane has a cardioprotection effect against ischemia-reperfusion injury. This beneficial effect of emulsified isoflurane is probably through NO release and consequently by increase in autioxidation of myocardium.

  10. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction.

    Science.gov (United States)

    Bal, Muhlis; Atar, Yavuz; Salturk, Ziya; Ateş, Ahmet Hakan; Yağcı, Serkan; Coşkun Bal, Gökçen

    2013-01-01

    The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA) are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient's airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  11. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Muhlis Bal

    2013-01-01

    Full Text Available The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  12. Exenatide reduces reperfusion injury in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Vejlstrup, Niels; Kelbæk, Henning

    2011-01-01

    (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods and results A total of 172 patients with STEMI and Thrombolysis in Myocardial Infarction flow 0/1 were randomly assigned to exenatide or placebo (saline) intravenously. Study treatment was commenced 15 min before intervention...... the infarct size and the AAR for both treatment groups and an analysis of covariance showed that datapoints in the exenatide group lay significantly lower than for the placebo group (P= 0.011). There was a trend towards smaller absolute infarct size in the exenatide group (13 ± 9 vs. 17 ± 14 g; P= 0.......11). No difference was observed in left ventricular function or 30-day clinical events. No adverse effects of exenatide were observed. Conclusion In patients with STEMI undergoing pPCI, administration of exenatide at the time of reperfusion increases myocardial salvage....

  13. Experience with nalbuphine, a new opioid analgesic, in acute myocardial infarction.

    Science.gov (United States)

    Greenbaum, R A; Kaye, G; Mason, P D

    1987-07-01

    A total of 141 patients admitted to hospital with a diagnosis of suspected myocardial infarction were randomized to treatment with intravenous diamorphine (71) or nalbuphine (70). Myocardial infarction was subsequently confirmed in 109 patients. Both drugs provided good analgesia. Heart rate, blood pressur