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Sample records for left ventricular infarct

  1. Left ventricular muscle and fluid mechanics in acute myocardial infarction.

    Science.gov (United States)

    Nucifora, Gaetano; Delgado, Victoria; Bertini, Matteo; Marsan, Nina Ajmone; Van de Veire, Nico R; Ng, Arnold C T; Siebelink, Hans-Marc J; Schalij, Martin J; Holman, Eduard R; Sengupta, Partho P; Bax, Jeroen J

    2010-11-15

    Left ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 ± 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size. Patients with a large infarct size (≥ 3 LV segments) had a significantly lower VFT (p mechanical sequence of diastolic restoration play key roles in modulating the morphology and dynamics of early diastolic vortex ring formation.

  2. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2013-01-01

    This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%....

  3. Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Møller, Jacob Eifer; Brendorp, Bente; Ottesen, Michael

    2003-01-01

    AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol...... Evaluation in Acute Myocardial Infarction Trial with definite acute myocardial infarction and echocardiographic assessment of left ventricular systolic function were included between 1998 and 1999 in this prospective observational study. Main outcome measures were occurrences of in-hospital complications...... ventricular systolic function, and is associated with increased risk of in-hospital complications and death following acute myocardial infarction....

  4. Metoprolol treatment lowers thrombospondin-4 expression in rats with myocardial infarction and left ventricular hypertrophy.

    Science.gov (United States)

    Mustonen, Erja; Leskinen, Hanna; Aro, Jani; Luodonpää, Marja; Vuolteenaho, Olli; Ruskoaho, Heikki; Rysä, Jaana

    2010-09-01

    Thrombospondins are matrix proteins linked to extracellular matrix remodelling but their precise role in the heart is not known. In this study, we characterised left ventricular thrombospondin-1 and -4 expression in rats treated with a beta-blocker metoprolol during the remodelling process in response to pressure overload and acute myocardial infarction. Left ventricular thrombospondin-1 and thrombospondin-4 mRNA levels increased 8.4-fold (p infarction, respectively. Metoprolol infusion by osmotic minipumps (1.5 mg/kg/hr) for 2 weeks after myocardial infarction decreased thrombospondin-1 and thrombospondin-4 mRNA levels (55% and 50%, respectively), improved left ventricular function, and attenuated left ventricular remodelling with reduction of left ventricular atrial natriuretic peptide and brain natriuretic peptide gene expression. Thrombospondin-1 and -4 mRNA levels correlated positively with echocardiographic parameters of left ventricular remodelling as well as with atrial natriuretic peptide and brain natriuretic peptide gene expression. Moreover, there was a negative correlation between left ventricular ejection fraction and thrombospondin-1 mRNA levels. In 12-month-old spontaneously hypertensive rats with left ventricular hypertrophy, metoprolol decreased left ventricular thrombospondin-4 levels and attenuated remodelling while thrombospondin-1, atrial natriuretic peptide and brain natriuretic peptide mRNA levels as well as left ventricular function remained unchanged. In metoprolol-treated spontaneously hypertensive rats, thrombospondin-4 gene expression correlated with parameters of left ventricular remodelling, while no correlations between thrombospondins and natriuretic peptides were observed. These results indicate that thrombospondin-1 expression is linked exclusively to left ventricular remodelling process post-infarction while thrombospondin-4 associates with myocardial remodelling both after myocardial infarction and in hypertensive heart disease

  5. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis

    DEFF Research Database (Denmark)

    Berning, J; Rokkedal Nielsen, J; Launbjerg, J

    1992-01-01

    Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide...

  6. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD

    2017-04-01

    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  7. Detection of active left ventricular thrombosis during acute myocardial infarction using indium-111 platelet scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Ezekowitz, M.D.; Kellerman, D.J.; Smith, E.O.; Streitz, T.M.

    1984-07-01

    Platelet scintigraphy with radioactive indium-111 may be used both to identify and to reflect the activity of thrombin in vivo in man. Forty-one patients with acute myocardial infarction were studied for active left ventricular thrombosis by platelet scintigraphy and followed until in-hospital death, discharge, or same-admission cardiac surgery for evidence of systemic embolization. Group 1 (n . 29) had transmural myocardial infarctions, of which 21 were anterior and eight were inferior. Group 2 (n . 12) had subendocardial myocardial infarctions. Those with subendocardial and transmural inferior myocardial infarctions had neither left ventricular thrombosis nor emboli. Ten (48 percent) of 21 with anterior transmural myocardial infarctions had left ventricular thrombosis by platelet scintigraphy. Three with and one without such thrombosis by scintigraphy had acute neurologic episodes. In the group with anterior myocardial infarctions, seven of ten patients with and four of 11 without left ventricular thrombosis received heparin subcutaneously. We conclude that platelet scintigraphy may be used to monitor antiplatelet and anticoagulant therapy in patients with anterior transmural myocardial infarctions who are at risk for left ventricular thrombosis and systemic embolization.

  8. Plasma angiotensin-converting enzyme activity and left ventricular dilation after myocardial infarction

    NARCIS (Netherlands)

    Oosterga, M; Voors, AA; deKam, PJ; Schunkert, H; Pinto, YM; Kingma, H; vanGilst, WH

    1997-01-01

    Background Left ventricular dilation after acute myocardial infarction (MI) is mainly determined by infarct size. In addition, this detrimental structural adaptation seems to be augmented in patients with the ACE DD genotype. The ACE DD genotype is associated with increased ACE activity. The aim of

  9. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Solomon, Scott D; Zelenkofske, Steve; McMurray, John J V

    2005-01-01

    BACKGROUND: The risk of sudden death from cardiac causes is increased among survivors of acute myocardial infarction with reduced left ventricular systolic function. We assessed the risk and time course of sudden death in high-risk patients after myocardial infarction. METHODS: We studied 14,609 ...

  10. Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction

    DEFF Research Database (Denmark)

    Stone, Gregg W; Chung, Eugene S; Stancak, Branislav;

    2016-01-01

    AIMS: We sought to determine whether peri-infarct pacing prevents left ventricular (LV) remodelling and improves functional and clinical outcomes in patients with large first myocardial infarction (MI). METHODS AND RESULTS: A total of 126 patients at 27 international sites within 10 days of onset...

  11. Effect of Metformin on Metabolites and Relation With Myocardial Infarct Size and Left Ventricular Ejection Fraction After Myocardial Infarction

    NARCIS (Netherlands)

    Eppinga, Ruben N; Kofink, Daniel; Dullaart, Robin P F; Dalmeijer, Geertje W; Lipsic, Erik; van Veldhuisen, Dirk J; van der Horst, Iwan C C; Asselbergs, Folkert W; van der Harst, Pim

    2017-01-01

    BACKGROUND: Left ventricular ejection fraction (LVEF) and infarct size (ISZ) are key predictors of long-term survival after myocardial infarction (MI). However, little is known about the biochemical pathways driving LV dysfunction after MI. To identify novel biomarkers predicting post-MI LVEF and IS

  12. Left ventricular pseudoaneurysm caused by coronary spasm, myocardial infarction, and myocardial rupture.

    Science.gov (United States)

    Mahilmaran, Asha; Nayar, Pradeep G; Sheshadri, Mukundan; Sudarsana, Gurijala; Abraham, K A

    2002-01-01

    We report a very rare case of a 47-year-old man who had coronary spasm that resulted in a silent myocardial infarction, a ruptured myocardial wall, and a nonruptured left ventricular pseudoaneurysm. The patient presented with a 6-month history of dyspnea on exertion, without evidence of fixed coronary artery stenosis. Coronary angiography showed severe coronary spasm of the left anterior descending and left circumflex arteries; the spasm was relieved promptly by nitroglycerin. Echocardiography and left ventricular angiography revealed the large left ventricular pseudoaneurysm posterolateral to the left ventricle. We performed surgical resection of the pseudoaneurysm and patch repair of the ruptured left ventricular wall, with excellent results. We present this case because of the highly unusual sequence of events. Early surgical intervention resulted in the patient's recovery.

  13. Myocardial infarction and left ventricular remodeling: results of the CEDIM trial. Carnitine Ecocardiografia Digitalizzata Infarto Miocardico.

    Science.gov (United States)

    Colonna, P; Iliceto, S

    2000-02-01

    Left ventricular dilatation after acute myocardial infarction (MI) is a powerful predictor of progressive functional deterioration, culminating in heart failure and death. The most important determinants of post-MI left ventricular remodeling are the size of the infarct, the degree of residual stenosis in the infarct-related artery, and the viability of the infarct zone. In addition to reperfusion therapy and angiotensin-converting enzyme inhibition, metabolic intervention with L-carnitine may represent a therapeutic approach for preventing left ventricular dilatation and preserving cardiac function. Ongoing studies with early metabolic intervention with carnitine in the acute phase of infarction may prove successful in protecting the microcirculation against ischemic damage and enhancing its ability to respond to blood flow resumption. The results of the multicenter, randomized, double-blind Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial suggest that the early and long-term administration of L-carnitine attenuates progressive left ventricular dilatation after acute anterior MI. Results show significant, consistent reductions in end-diastolic volume and end-systolic volume in patients who received L-carnitine compared with placebo. The ongoing CEDIM-2 trial (projected 4000 patients with acute MI) will assess the efficacy of L-carnitine in reducing the combined incidence of death and heart failure at 6 months. In addition to standard reperfusion therapy and angiotensin-converting enzyme inhibition, metabolic intervention with L-carnitine may be a therapeutic approach for preventing left ventricular dilatation and preserving cardiac function by limiting infarct size, decreasing residual stenosis in the infarct-related artery, and increasing viability of the infarct zone.

  14. Beneficial Effects of Delayed Opening the Infarct -related Artery on Late Phase Left Ventricular Function in Acute Anterior Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Ma Likun; Yu Hua; Huang Xiangyang; Chu Jun; Feng Kefu; Ding Xiaomei; Yan Ji; Gu Tongyuan

    2004-01-01

    Objectives To assess the effect of delayed opening the infarct - related artery(IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute anterior myocardial infarction. Methods 64 patients with initial Q -wave anterior myocardial infarction and the infarct- related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Results VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end - diastolic and end-systolic volume indices (LVEDVI and LVDSVI)were similar in 2 groups at early phase and 2 months.There were no differences between early phase and 2months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months (P > 0.05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P <0.01,P < 0. 05 ). The congestive heart failure events were taken place in 19% of patients in control group compared with 2% in successful PCI group ( P > 0.05 ).Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acute anterior myocardial infarction.

  15. Effects of Tribuli Saponins on Left Ventricular Remodeling after Acute Myocardial Infarction in Rats with Hyperlipidemia

    Institute of Scientific and Technical Information of China (English)

    GUO Yan; YIN Hui-jun; SHI Da-zhuo; CHEN Ke-ji

    2005-01-01

    Objective: To observe the effect of Tribuli saponins (TS) on left ventricularremodeling after acute myocardial infarction(AMI) in rats with hyperlipemia. Methods: A composite model of myocardial infarction and hyperlipemia was established and treated with TS to observe its effect on cardiac structure and function by echocardiography. Results: (1) Cardiac function: As compared with the model group, the fractional shortening (FS) and ejection fraction (EF) got increased, and the left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV) got lower in the groups treated with high dose TS and simvastatin ( P<0.05 or P<0.01 ), but difference between the two treated groups was insignificant. (2) Cardiac structure: As compared with the model group, the left ventricular dimension end diastole (LVDd) and systole (LVDs) in the groups treated with high dose TS and simvastatin got lower ( P<0.05 or P<0.01 ). No treatment showed any effect on the thickness of ventricular wall. (3)Ventricular weight index: Both high dose TS and simvastatin could decrease the left ventricular weight index (LVWI) ( P<0.05). Conclusion: TS could attenuate the left ventricular remodeling after acute myocardial infarction to certain extent, and improve cardiac function in the early phase after AMI, thus playing an important role in controlling morbidity and mortality of cardiac events and long-term prognosis.

  16. Left Ventricular Pseudoaneurysm Following Inferior Myocardial Infarction: A Case for Conservative Management

    Science.gov (United States)

    Ludmir, Jonathan; Kapoor, Karan; George, Praveen; Khural, Jasjeet; Barr, Brian

    2016-01-01

    Left ventricular pseudoaneurysm is a rare complication of myocardial infarction that carries a high mortality rate. Although conventional wisdom suggests prompt surgical repair in order to mitigate risk of expansion and rupture, there are some data to support non-operative management in asymptomatic individuals with likely chronic pseudoaneurysms, particularly when surgical candidacy is poor. We present a case of a medically managed left ventricular pseudoaneurysm subsequent to inferior ST-segment elevation myocardial infarction with 6-month follow-up data. PMID:28197266

  17. Ruptured left ventricular pseudoaneurysm in the mediastinum following acute myocardial infarction: a case report

    Directory of Open Access Journals (Sweden)

    Si Daoyuan

    2013-01-01

    Full Text Available Abstract Left ventricular pseudoaneurysm is an uncommon complication after transmural acute myocardial infarction (AMI. Here we describe the case of a 43-year-old man who presented with AMI and chest distress despite the normal appearance of his coronary artery during coronary angiography. Timely thrombolytic therapy was administered. Echocardiography, and cardiac computed tomography showed a ventricular pseudoaneurysm, and direct visualization at the time of surgery showed that it had ruptured in the mediastinum instead of the pericardium. The survival rate of patients with ventricular pseudoaneurysm rupture is low. The rupture of ventricular pseudoaneurysm in the mediastinum is rare; therefore, this case is noteworthy.

  18. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction?

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

    Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.......Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age

  19. Plasma YKL-40 and recovery of left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Hedegaard, A.; Ripa, Maria Sejersten; Johansen, J.S.

    2010-01-01

    Background: Plasma YKL-40 is increased early in patients with ST-elevation myocardial infarction (STEMI). It is not known whether plasma YKL-40 is related to infarct size and recovery of ventricular function after primary percutaneous coronary intervention (PCI) of STEMI and whether granulocyte......-CSF or placebo injections from day 1 to 7 after the STEMI. Plasma YKL-40, high-sensitivity C-reactive protein (hs-CRP) and CK-MB concentrations were measured at baseline and during the first month. Infarct size and left ventricular ejection fraction (LVEF) were measured by magnetic resonance imaging at baseline...... to LVEF recovery (p = 0.04) but not infarct size. G-CSF injections increased YKL-40 compared to placebo (p infarct size or LVEF recovery. Conclusion: Plasma YKL-40 was significantly increased in STEMI patients at admission and G-CSF treatment caused a further increase...

  20. Relationship between left ventricular longitudinal deformation and clinical heart failure during admission for acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2012-01-01

    Heart failure (HF) complicating acute myocardial infarction (MI) is an ominous prognostic sign frequently caused by left ventricular (LV) systolic dysfunction. However, many patients develop HF despite preserved LV ejection fractions. The aim of this study was to test the hypothesis that LV...

  1. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both

    DEFF Research Database (Denmark)

    Pfeffer, Marc A; McMurray, John J V; Velazquez, Eric J;

    2003-01-01

    BACKGROUND: Angiotensin-converting-enzyme (ACE) inhibitors such as captopril reduce mortality and cardiovascular morbidity among patients with myocardial infarction complicated by left ventricular systolic dysfunction, heart failure, or both. In a double-blind trial, we compared the effect of the...

  2. Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Ma Likun; Yu Hua; Huang Xiangyang; Feng Kefu; Han Xiaoping; Ye Qi

    2006-01-01

    Objectives The long-term benefit of late reperfusion of infarct-related artery (IRA) after acute myocardial infarction (AMI) is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography (LDSE) can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time.Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments (57%) were viable during LDSE. 26 patients (38%) with viability and 43(62%) without. In viable group, left ventricular ejection fraction (LVEF) was increased (P<0.05),and left ventricular end systolic volume index (LVESVI) and wall motion score (WMS) were decreased (P<0.05 and P<0.01) significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased (P<0.01), and LVESVI and left ventricular end diastolic volume index (LVEDVI) were increased (P<0.05) significantly after 6 months, and the WMS did not changed (P>0.05). LVEF increased (P<0.05) and WMS decreased (P<0.05) on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling.Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

  3. Effects of Perindopril on Left Ventricular Remodeling and Osteopontin Expression in Rats With Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    To observe the effects of perindopril on left ventricular remodeling and myocardial osteopontin expression in rats with myocardial infarction. Methods In this study male adult SD rats were randomly divided into 3groups: sham-operation group, MI-saline group and MI-perindopril group. Left anterior descending artery was ligated to generate myocardial infarction. Perindopril (2 mg/kg body weight/day) was administered from the next day of MI.Four weeks later, left ventricular diameter (LVEDD and LVESD) and left ventricular ejection fraction was estimated with echocardiography, LVSP, LVEDP and ± dp/dtmax was detected with hemodynamic measurement, cardiomyocyte diameter and interstitial fibrosis infiltration were evaluated with histological methods, and myocardium osteopontin protein expression level was detected with western blot. Results ①Compared with the sham-operation group, all rats with MI developed significant systolic and diastolic dysfunction, as was indicated by decreased LVEF, LVSP and ± dp/dtmax, as well as increased LVEDP. ②Rats with MI showed significantly dilated left ventricles and higher ventricular weight / body weight ratio, significantly increased cardiomyocyte diameter and marked interstitial fibrosis in the non-infarction area. ③Perindopril treatment partly prevented cardiac dysfunction and left ventricular remodeling as indicated by the parameters mentioned above. ④No osteopontin protein was detected in myocardium of sham-operation rats. In rats with MI, high level osteopontin protein expression was significantly inhibited by perindopril treatment. Conclusions In rats with MI, perindopril treatment significantly prevented left ventricular remodeling and myocardium osteopontin protein expression.

  4. A systematic review: effect of angiotensin converting enzyme inhibition on left ventricular volumes and ejection fraction in patients with a myocardial infarction and in patients with left ventricular dysfunction

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; Barlera, Simona; Latini, Roberto;

    2006-01-01

    BACKGROUND AND AIM: To summarize and quantify results of echocardiographic studies examining the effect of angiotensin converting enzyme (ACE) inhibition on left ventricular remodelling in patients with acute myocardial infarction (MI) and in patients with left ventricular systolic dysfunction...

  5. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies.

    Science.gov (United States)

    Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Veshti, Altin; Demiraj, Aurel; Zeka, Merita; Rruci, Edlira; Bejko, Ervin

    2017-04-01

    The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  6. Left ventricular global longitudinal strain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads

    Systolic dysfunction, clinical heart failure and elevated levels of neurohormonal peptides are major predictors of adverse outcome after acute myocardial infarction (MI). In the present thesis we evaluated global longitudinal strain (GLS) in patients with acute MI in relation to neurohormonal...

  7. Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats

    OpenAIRE

    Nozawa E.; Kanashiro R.M.; Murad N.; Carvalho A.C.C.; Cravo S.L.D.; Campos O.; Tucci P.J.F.; Moises V.A.

    2006-01-01

    Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes), i...

  8. Coronary flow reserve in the remote myocardium predicts left ventricular remodeling following acute myocardial infarction.

    Science.gov (United States)

    Cheng, Rongchao; Wei, Guoqian; Yu, Longhao; Su, Zhendong; Wei, Li; Bai, Xiuping; Tian, Jiawei; Li, Xueqi

    2014-07-01

    Coronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI. We enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration. CFR was 1.55±0.11 in the infarcted zone and 2.05±0.31 in the remote zone (p2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty. Microvascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

  9. [Atrial filling fraction predicts left ventricular systolic function after myocardial infarction: pre-discharge echocardiographic evaluation].

    Science.gov (United States)

    Galderisi, M; Fakher, A; Petrocelli, A; Alfieri, A; Garofalo, M; de Divitiis, O

    1995-10-01

    Aim of the study was to examine the relation between Doppler-derived indices of left ventricular diastolic and systolic function early after myocardial infarction. Fifty-three patients (31 males, 22 females) recovering from acute myocardial infarction underwent predischarge Doppler echocardiographic examination. Patients with age > 70 years, previous myocardial infarction, more than mild mitral and aortic regurgitation, mitral and aortic stenosis were excluded. Twenty-two healthy subjects (13 males; 9 females) free of coronary risk factors were selected as the control group. Both end-diastolic and end-systolic volumes and ejection fraction were measured by two-dimensional echocardiography. Pulsed Doppler was used to evaluate mitral inflow and left ventricular outflow velocity patterns. The following indices were measured: peak velocity of early (E) and late (A) flows, ratio of E/A peak velocities, ratio of early to late time velocity integrals, atrial filling fraction (time velocity integral A / time velocity integral of flow during total diastole) and deceleration time of E wave for mitral inflow; peak and time-velocity integral for left ventricular outflow. Stroke volume and cardiac output were obtained by pulsed Doppler using the left ventricular outflow method. The two groups were comparable for age, with blood pressure (p volumes were significantly higher (both p volume and cardiac output (both p volumes, atrial filling fraction was an independent predictor of stroke volume, with a direct relation (beta coefficient = 0.53, p volume indicates the importance of atrial contribution to maintain an adequate systolic performance in patients with myocardial infarction.

  10. TNF-Like Weak Inducer of Apoptosis Aggravates Left Ventricular Dysfunction after Myocardial Infarction in Mice

    Directory of Open Access Journals (Sweden)

    Kai-Uwe Jarr

    2014-01-01

    Full Text Available Background. TNF-like weak inducer of apoptosis (TWEAK has recently been shown to be potentially involved in adverse cardiac remodeling. However, neither the exact role of TWEAK itself nor of its receptor Fn14 in this setting is known. Aim of the Study. To analyze the effects of sTWEAK on myocardial function and gene expression in response to experimental myocardial infarction in mice. Results. TWEAK directly suppressed the expression of PGC-1α and genes of oxidative phosphorylation (OXPHOS in cardiomyocytes. Systemic sTWEAK application after MI resulted in reduced left ventricular function and increased mortality without changes in interstitial fibrosis or infarct size. Molecular analysis revealed decreased phosphorylation of PI3K/Akt and ERK1/2 pathways associated with reduced expression of PGC-1α and PPARα. Likewise, expression of OXPHOS genes such as atp5O, cycs, cox5b, and ndufb5 was also reduced. Fn14 -/- mice showed significantly improved left ventricular function and PGC-1α levels after MI compared to their respective WT littermates (Fn14 +/+. Finally, inhibition of intrinsic TWEAK with anti-TWEAK antibodies resulted in improved left ventricular function and survival. Conclusions. TWEAK exerted maladaptive effects in mice after myocardial infarction most likely via direct effects on cardiomyocytes. Analysis of the potential mechanisms revealed that TWEAK reduced metabolic adaptations to increased cardiac workload by inhibition of PGC-1α.

  11. Anaemia is an independent predictor of mortality in patients with left ventricular systolic dysfunction following acute myocardial infarction

    DEFF Research Database (Denmark)

    Valeur, Nana; Nielsen, Olav Wendelboe; McMurray, John J V;

    2006-01-01

    BACKGROUND: In patients with chronic heart failure (HF), mortality is inversely related to haemoglobin (hgb) concentration. We investigated the prognostic importance of anaemia in patients with acute myocardial infarction (AMI) and left ventricular systolic dysfunction (LVSD) with and without HF...

  12. The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction

    DEFF Research Database (Denmark)

    Shah, Amil M; Uno, Hajime; Køber, Lars

    2010-01-01

    Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown....

  13. Beneficial effects of the Ca2+ sensitizer EMD 57033 in exercising pigs with infarction-induced chronic left ventricular dysfunction.

    NARCIS (Netherlands)

    D.J.G.M. Duncker (Dirk); D.B. Haitsma; D. Liem (Djien); N. Heins; R. Stubenitsky (René); P.D. Verdouw (Pieter)

    2001-01-01

    textabstract1. It is unknown how cardiac stimulation by Ca(2+) sensitization modulates the cardiovascular response to exercise when left ventricular (LV) function is chronically depressed following a myocardial infarction. We therefore investigated the effects of EMD 57033 at rest

  14. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    We sought to investigate the relation between left ventricular (LV) and right ventricular (RV) function assessed with the Doppler-derived myocardial performance index (MPI), to assess serial changes, and to investigate the prognostic value of biventricular assessment of cardiac function after...... a first myocardial infarction (MI). To do so, serial Doppler echocardiography was performed in 77 consecutive patients with a first MI. Right ventricular MPI correlated significantly with LV MPI (r = 0.51, P ....59 +/- 0.18 versus 0.44 +/- 0.19, P =.001), whereas no difference in LV MPI was seen (0.55 +/- 0.19 versus 0.56 +/- 0.13, P = not significant). Right ventricular MPI showed a rapid normalization during follow-up, whereas LV MPI did not decrease. During follow-up, 23 patients died of cardiac causes or were...

  15. Computational Modeling of the Effects of Myocardial Infarction on Left Ventricular Hemodynamics

    Science.gov (United States)

    Vedula, Vijay; Seo, Jung Hee; Mittal, Rajat; Fortini, Stefania; Querzoli, Giorgio

    2012-11-01

    Most in-vivo and modeling studies on myocardial infarction and ischemia have been directed towards understanding the left ventricular wall mechanics including stress-strain behavior, end systolic pressure-volume correlations, ejection fraction and stroke work. Fewer studies have focused on the alterations in the intraventricular blood flow behavior due to local infarctions. Changes in the motion of the endocardium can cause local circulation and stagnation regions; these increase the blood cell residence time in the left ventricle and may eventually be implicated in thrombus formation. In the present study, we investigate the effects of myocardial infarction on the ventricular hemodynamics in simple models of the left ventricle using an immersed-boundary flow solver. Apart from the Eulerian flow features such as vorticity and velocity flow fields, pressure distribution, shear stress, viscous dissipation and pump work, we also examine the Lagrangian dynamics of the flow to gain insights into the effect of flow dynamics on thrombus formation. The study is preceded by a comprehensive validation study which is based on an in-vitro experimental model of the left ventricle and this study is also described. This research is supported by the U.S. National Science Foundation through (NSF) CDI-Type II grant IOS-1124804. Computational resources for some of the simulations were also provided in part through the NSF grant NSF-OCI-108849.

  16. Does left ventricular function improve with L-carnitine after acute myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Iyer R

    1999-04-01

    Full Text Available A double blind randomized placebo controlled clinical trial was carried out to assess the efficacy and safety of L-carnitine in patients suffering from acute anterior wall myocardial infarction with respect to left ventricular function. Sixty patients (34 men, 26 women, mean age 56+11 yr. with acute anterior wall myocardial infarction were randomized to placebo and L-carnitine. All the patients were given intravenous L-carnitine / placebo in the dose of 6gm/day for the first seven days followed by oral L-carnitine / placebo 3 gm/day in three divided doses for a period of three months. Echocardiography was performed for regional wall motion abnormality, left ventricular end systolic volume (ESV, end diastolic volume (EDV and ejection fraction (EF on admission, after seven days and after three months of the infarction. Forty-four patients completed the study. There were three deaths, two in the placebo and one in the L-carnitine group (p>0.05. Thirteen patients were lost to follow up. Echo parameters in both groups were comparable (p>0.05. The duration of chest pain prior to initiation of the I.V. L-carnitine was 7.5 + 5.2 hrs in the L-carnitine group and 7 + 4 hrs in the placebo group (p>0.05. There was no statistical difference in the EF, ESV and EDV on admission, at discharge and after three months in the L-carnitine and the placebo groups (p>0.05. No significant adverse effects were noted. L-carnitine, though a safe drug, does not affect the left ventricular function in patients with myocardial infarction.

  17. Effects of glucose-insulin-potassium on baroreflex sensitivity, left ventricular function and ventricular arrhythmia in the subacute phase of myocardial infarction in rats

    Institute of Scientific and Technical Information of China (English)

    LIU Jian-Guo; SHU He; SHEN Fu-Ming; MIAO Chao-Yu; SU Ding-Feng

    2004-01-01

    Objective:Glucose-insulin-potassium(GIK) is clinically used for reducing mortality in acute myocardial infarction(MI). It is known that ventricular arrhythmia, left ventricular dysfunction and impaired baroreflex sensitivity(BRS) are the three major determinants for predicting the mortality after acute MI. The present work was designed to study the effects of GIK on BRS, ventricular arrhythmia, and left ventricular function in rats with coronary artery ligature. Sprague-Dawley rats were used and the myocardial infarction was produced by ligature of the left anterior descending artery. Five weeks after coronary artery ligation, BRS was measured in conscious state with a computerized blood pressure monitoring system and left ventricular function and electrocardiogram were determined in the anaesthetized state in the subacute phase of myocardial infarction. It was found that GIK did not affect the blood pressure and heart period in both conscious and anaesthetized rats. GIK did not enhance BRS, but reduced ventricular arrhythmia and improved left ventricular function by reducing left ventricular end diastolic pressure in anaesthetized rats with MI. It is proposed that reducing ventricular arrhythmia and improving left ventricular function contribute to the effect of GIK on reducing the mortality after MI.

  18. Effect of metformin on left ventricular function after acute myocardial infarction in patients without diabetes : the GIPS-III randomized clinical trial

    NARCIS (Netherlands)

    Lexis, Chris P. H.; van der Horst, Iwan C. C.; Lipsic, Erik; Wieringa, Wouter G.; de Boer, Rudolf A.; van den Heuvel, Ad F. M.; van der Werf, Hindrik W.; Schurer, Remco A. J.; Pundziute, Gabija; Tan, Eng S.; Nieuwland, Wybe; Willemsen, Hendrik M.; Dorhout, Bernard; Molmans, Barbara H. W.; van der Horst-Schrivers, Anouk N. A.; Wolffenbuttel, Bruce H. R.; ter Horst, Gert J.; van Rossum, Albert C.; Tijssen, Jan G. P.; Hillege, Hans L.; de Smet, Bart J. G. L.; van der Harst, Pim; van Veldhuisen, Dirk J.

    2014-01-01

    IMPORTANCE Metformin treatment is associated with improved outcome after myocardial infarction in patients with diabetes. In animal experimental studies metformin preserves left ventricular function. OBJECTIVE To evaluate the effect of metformin treatment on preservation of left ventricular function

  19. Effect of hepatocyte growth factor on left ventricular remodeling after acute myocardial infarction in canine

    Institute of Scientific and Technical Information of China (English)

    Ping LI; Tingshu YANG; Liling LIANG

    2006-01-01

    Background and objectives To investigate the effect of hepatocyte growth factor (HGF) on left ventricular (LV) remodeling after acute myocardial infarction (AMI). Methods AMI was produced by ligation of proximal left anterior descending coronary artery(LAD) in 12 mongrel canines. These animals were randomized into 2 groups. In HGF group (n=6), canines were injected with pcDNA3-HGF lml (about 300ug) at the margin of infarcted myocardium; in control group (n=6) canines were injected with equal volume of normal saline. Cardiac function and left ventricular remodeling were evaluated with echocardiography at 1, 4, 8 weeks after MI. LV myocardium specimens were obtained at 8 weeks and stained with hematoxylin and eosin for histological examination or with sirius red to assess the collagen content. Results Compared with control group, LVEF in HGF group was significantly higher at 4 weeks (49.61+6.66 vs 39.84+6.39; P<0.05) and at 8 weeks (51.57+8.53 vs 40.61+7.67; P<0.05) after AMI, while LVESV was significantly lower in HGF group than that in control group at 8 weeks after AMI (18.98+3.47 vs 25.66+5.86; P<0.05). Posterior left ventricular wall thickness decreased significantly from 1 wk to 8 wks after AMI in control group, while remained unchanged in HGF group. Compared with control group, histological examination showed more neovascularization and less scar, and sirius red staining indicated higher volume of type Ⅲ collagen (7.10±4.06% vs 3.77±1.09%; P<0.05) and lower collagen Ⅰ/Ⅲ ratio value (1.11±0.52 vs 2.94±2.48; P<0.05)in HGF group. Conclusion HGF gene transfer might improve cardiac function and LV remodeling after acute myocardial infarction by stimulating angiogenesis, reducing fibrosis, and reducing myocardial scarring.

  20. Effects of Intensive Statin Therapy on Left Ventricular Function in Patients with Myocardial Infarction and Abnormal Glucose Tolerance

    DEFF Research Database (Denmark)

    Auscher, Søren; Løgstrup, Brian Bridal; Møller, Jacob Eifer

    2017-01-01

    statin therapy. Patients were assessed with an oral glucose tolerance test and their left ventricular (LV) function was assessed with speckle-tracking echocardiography measuring regional longitudinal systolic strain (RLSS) in the infarct area. RESULTS: Overall RLSS in the infarct area improved by a mean...

  1. Atorvastatin therapy during the peri-infarct period attenuates left ventricular dysfunction and remodeling after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Xian-Liang Tang

    Full Text Available Although statins impart a number of cardiovascular benefits, whether statin therapy during the peri-infarct period improves subsequent myocardial structure and function remains unclear. Thus, we evaluated the effects of atorvastatin on cardiac function, remodeling, fibrosis, and apoptosis after myocardial infarction (MI. Two groups of rats were subjected to permanent coronary occlusion. Group II (n = 14 received oral atorvastatin (10 mg/kg/d daily for 3 wk before and 4 wk after MI, while group I (n = 12 received equivalent doses of vehicle. Infarct size (Masson's trichrome-stained sections was similar in both groups. Compared with group I, echocardiographic left ventricular ejection fraction (LVEF and fractional area change (FAC were higher while LV end-diastolic volume (LVEDV and LV end-systolic and end-diastolic diameters (LVESD and LVEDD were lower in treated rats. Hemodynamically, atorvastatin-treated rats exhibited significantly higher dP/dt(max, end-systolic elastance (Ees, and preload recruitable stroke work (PRSW and lower LV end-diastolic pressure (LVEDP. Morphometrically, infarct wall thickness was greater in treated rats. The improvement of LV function by atorvastatin was associated with a decrease in hydroxyproline content and in the number of apoptotic cardiomyocyte nuclei. We conclude that atorvastatin therapy during the peri-infarct period significantly improves LV function and limits adverse LV remodeling following MI independent of a reduction in infarct size. These salubrious effects may be due in part to a decrease in myocardial fibrosis and apoptosis.

  2. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction

    DEFF Research Database (Denmark)

    Pedersen, O D; Bagger, H; Køber, Lars Valeur;

    1999-01-01

    BACKGROUND: Studies have suggested that ACE inhibitors have an antiarrhythmic effect on ventricular arrhythmias. Whether they have an effect on atrial fibrillation is unknown. METHODS AND RESULTS: We investigated the effect of ACE inhibition with trandolapril on the incidence of atrial fibrillation...... of atrial fibrillation in patients with left ventricular dysfunction after acute myocardial infarction....... in patients with reduced left ventricular function secondary to acute myocardial infarction. The patients in this study were those who qualified for inclusion into the TRAndolapril Cardiac Evaluation (TRACE) study, a randomized double-blind placebo-controlled study and who had sinus rhythm on the ECG obtained...

  3. Myocardial connective tissue growth factor (CCN2/CTGF attenuates left ventricular remodeling after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Jørgen Gravning

    Full Text Available AIMS: Myocardial CCN2/CTGF is induced in heart failure of various etiologies. However, its role in the pathophysiology of left ventricular (LV remodeling after myocardial infarction (MI remains unresolved. The current study explores the role of CTGF in infarct healing and LV remodeling in an animal model and in patients admitted for acute ST-elevation MI. METHODS AND RESULTS: Transgenic mice with cardiac-restricted overexpression of CTGF (Tg-CTGF and non-transgenic littermate controls (NLC were subjected to permanent ligation of the left anterior descending coronary artery. Despite similar infarct size (area of infarction relative to area at risk 24 hours after ligation of the coronary artery in Tg-CTGF and NLC mice, Tg-CTGF mice disclosed smaller area of scar tissue, smaller increase of cardiac hypertrophy, and less LV dilatation and deterioration of LV function 4 weeks after MI. Tg-CTGF mice also revealed substantially reduced mortality after MI. Remote/peri-infarct tissue of Tg-CTGF mice contained reduced numbers of leucocytes, macrophages, and cells undergoing apoptosis as compared with NLC mice. In a cohort of patients with acute ST-elevation MI (n = 42 admitted to hospital for percutaneous coronary intervention (PCI serum-CTGF levels (s-CTGF were monitored and related to infarct size and LV function assessed by cardiac MRI. Increase in s-CTGF levels after MI was associated with reduced infarct size and improved LV ejection fraction one year after MI, as well as attenuated levels of CRP and GDF-15. CONCLUSION: Increased myocardial CTGF activities after MI are associated with attenuation of LV remodeling and improved LV function mediated by attenuation of inflammatory responses and inhibition of apoptosis.

  4. Myocardial infarction complicated by left ventricular thrombus and fatal thromboembolism following abrupt cessation of dabigatran.

    Science.gov (United States)

    Weiler, Bethany; Marciniak, Ellen T; Reed, Robert M; McCurdy, Michael T

    2014-07-04

    Novel anticoagulants are increasingly utilised in lieu of warfarin to treat non-valvular atrial fibrillation. Their clinical use in other non-FDA approved settings is also increasing. We present a case in which a patient abruptly stopped taking dabigatran due to a small bowel obstruction and shortly thereafter suffered a myocardial infarction complicated by left ventricular thrombosis with fatal embolisation to the superior mesenteric artery. In this context, we discuss the possibility of a rebound phenomenon of hypercoagulability with abrupt cessation of novel anticoagulants.

  5. Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats.

    Science.gov (United States)

    Nozawa, E; Kanashiro, R M; Murad, N; Carvalho, A C C; Cravo, S L D; Campos, O; Tucci, P J F; Moises, V A

    2006-05-01

    Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes), infarct size (percentage of the arc with infarct on 3 transverse planes), systolic function by the change in fractional area, and diastolic function by mitral inflow parameters. The histologic measurement of myocardial infarction size was similar to the echocardiographic method. Myocardial infarct size ranged from 4.8 to 66.6% when determined by histology and from 5 to 69.8% when determined by echocardiography, with good correlation (r = 0.88; P echocardiography (r = -0.87; P rats.

  6. Transplanted human umbilical cord blood mononuclear cells improve left ventricular function through angiogenesis in myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    HU Cheng-heng; WU Gui-fu; WANG Xiao-qing; YANG Yan-hua; DU Zhi-min; HE Xiao-hong; XIANG Peng

    2006-01-01

    Background Human umbilical cord blood contains an abundance of immature stem/progenitor cells, which may participate in the repair of hearts that have been damaged by myocardial infarction (MI). This study aimed to evaluate the effects of human umbilical cord blood mononuclear cells (hUCBC) transplantation on cardiac function and left ventricular remodeling in rat model of MI.Methods Forty-five male Wistar rats were randomized into three groups: MI or control group (n=15), MI plus cell transplantation (n=15), and sham group (n=15). Acute myocardial infarction (AMI) was established by ligating the left anterior descending artery, thereafter, hUCBC were implanted into the marginal area of infarcted myocardium. In MI/control group, DMEM was injected instead of hUCBC following the same protocol. Left ventricular function assessment was carried out by echocardiography and invasive hemodynamic measurements one month post MI. All rats were sacrificed for histological and immunochemical examinations.Results The transplanted hUCBC survived and engaged in the process of myocardial repair in the host heart.Echocardiography demonstrated that left ventricular function improved significantly in the rats that underwent cell transplantation. Hemodynamic studies found a significantly decreased left ventricular end-diastolic pressure (LVEDP) [(21.08±8.10) mmHg vs (30.82±9.59) mmHg, P<0.05], increase in +dp/dtmax [(4.29± 1.27)mmHg/ms vs (3.24±0.75) mmHg/ms, P<0.05), and increase in -dp/dtmax [(3.71 ±0.79) mmHg/ms vs (3.00±0.49) mmHg/ms, P<0.05] among MI group with hUCBC transplantation when compared with MI/control group.Masson's trichrome staining revealed that the collagen density in the left ventricle was significantly lower in rats of transplantation group than that in the MI control groups [(6.33±2.69)% vs (11.10±3.75)%, P< 0.01]. Based on immunostaining of α-actin, the numbers of microvessels were significantly (P<0.01) increased at the boundary of

  7. Improvement of exercise capacity and left ventricular diastolic function with metoprolol XL after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Egstrup, K

    2000-01-01

    BACKGROUND: Left ventricular (LV) diastolic function predicts and correlates with exercise capacity. Beta-blockers improve exercise capacity and LV diastolic function in patients with severe LV systolic dysfunction in dilated cardiomyopathy. However, information on the effect of metoprolol XL...... on exercise capacity in relation to LV diastolic function in patients with mild to moderate LV systolic dysfunction after acute myocardial infarction is limited. METHODS: In a randomized, double-blind, placebo-controlled study of 77 patients, a subgroup of 59 patients with mild to moderate LV systolic...... dysfunction after acute myocardial infarction were given metoprolol XL (n = 29) or placebo (n = 30). The effects of metoprolol XL on exercise capacity in relation to effects on LV diastolic filling were studied. Two-dimensional Doppler echocardiography and maximal symptom limited bicycle test were performed...

  8. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function

    DEFF Research Database (Denmark)

    Amigoni, Maria; Meris, Alessandra; Thune, Jens Jakob

    2007-01-01

    AIMS: Mitral regurgitation (MR) confers independent risk in patients with acute myocardial infarction. We utilized data from the VALsartan In Acute myocardial iNfarcTion echo study to relate baseline MR to left ventricular (LV) size, shape, and function, and to assess the relationship between bas...

  9. A mismatch index based on the difference between measured left ventricular ejection fraction and that estimated by infarct size at three months following reperfused acute myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Bang, Lia E; Lønborg, Jacob;

    2014-01-01

    BACKGROUND AND AIM: The reduction of left ventricular ejection fraction (LVEF) following ST-segment elevation myocardial infarction (STEMI) is a result of infarcted myocardium and may involve dysfunctional but viable myocardium. An index that may quantitatively determine whether LVEF is reduced b...

  10. Infuences of Previous Angina Pectoris on Coronary Collateral Circulation and Left Ventricular Function in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    罗初凡; 杜志民; 胡承恒; 梅卫义; 伍贵富; 李怡; 马虹

    2001-01-01

    Objective To investigate the influences of previous angina pectoris on coronary collateral circulation and left ventricular function in patients with acute myocardial infarction. Methods 307 patients with a first episode acute myocardial infarction underwent selective coronary angiography and left ventriculography. The relation of previous angina pectoris to coronary collateral circulation, peak creatine kinase and left ventricular function were analyzed.Results ① In the 307 patients, there were 192(62.5 % ) with previous angina [PA ( + ) group] and 115 (37.5 % ) without [PA ( - ) group]. ②The peak creatine kinase (CK) and CK- MB were significantly higher in PA (-) group than in PA (+) group ( P < 0.05 for both comparisons) . ③ Collateral circulation to infarct- related artery was more likely to be present in PA (+) group than in PA (-) group ( P < 0.05) . ④ The left ventricular ejection fraction was significantly increased, and the left ventricular wall motion Cortina score decreased, in PA ( + ) group than in PA ( - ) group ( P < 0.01 for both comparisons) .Conclusion In patients with acute myocardial infarction, previous angina pectoris may have beneficial effects on coronary collateral circulation and left ventricular unction.

  11. Dihydroxyflavonol reduces post-infarction left ventricular remodeling by preventing myocyte apoptosis in the non-infarcted zone in goats

    Institute of Scientific and Technical Information of China (English)

    WANG Sheng; FEI Ke; XU Ya-wei; WANG Liang-xu; Chen Yan-qin

    2009-01-01

    Background Myocyte apoptosis is considered to be the major causative factor of left ventricular (LV) remodeling following myocardial infarction (MI). We previously reported that 3', 4'-dihydroxyflavonol (DiOHF), was able to suppress oxidative stress and preserve the expression of endothelial nitric oxide synthase during myocardial reperfusion injury, which may benefit the reduction of myocyte apoptosis. We therefore aimed to evaluate the potential actions of DiOHF against myocyte apoptosis and post-infarction LV remodeling in this study. Methods Following experimental MI, surgical instrumented goats were randomly assigned into vehicle and DiOHF (2 mg/kg; i.v., daily) groups to receive 4 weeks of reperfusion with corresponding treatments. LV pressure recordings and echocardiogram were performed at baseline, 2 and 4 weeks of reperfusion. Myocardial tissues were collected in the end to determine infarct size and apoptosis related assays. Results LV end-diastolic volume and diameter were significantly increased 4 weeks after MI in the vehicle group, accompanied by reduced posterior wall thickness, septal thickness and LV mass, whereas those changes were markedly prevented by DiOHF treatment. Similarly, significantly reduced infarct size was found in DiOHF group as compared to vehicle group, and DiOHF dramatically inhibited the increase in LV end-diastolic pressure and the reductions in ejection fraction, fraction shortening and dP/dtmax. Moreover, DiOHF treatment significantly reduced the extent of myocyte apoptosis detected by TUNEL assay, enhanced the protein expression of caspase-3, Fas, Bax and cytochrome c in the non-infarcted myocardium in comparison to vehicle. Conclusions Daily DiOHF treatment during the reperfusion period after MI in the ovine hearts markedly reduced the magnitude of post-infarction LV remodeling through the inhibition of myocyte apoptosis in the remote non-infarcted myocardium.

  12. Early predictors of left ventricular function improvement late after myocardial infarction

    Directory of Open Access Journals (Sweden)

    Mladenović Zorica

    2008-01-01

    Full Text Available Background/Aim. Prognosis after acute myocardial infarction (AIM depends on the extent of irreversibly damaged myocardium and viable tissue due to stunning or hibernation. The aim of the study was to assess the prognostic significance of early echocardiographic parameters of myocardial viability in prediction of late recovery of regional and global ventricular function. Methods. The study prospectively included 40 patients after the first, uncomplicated univessel AIM treated with percutaneous coronary intervention (PCI. Low-dose dobutamine echocardiography (LDDE was preformed 7-10 days after AIM and follow-up resting echocardiography from 7 to 12 months later. Results. The sensitivity and specificity for the prediction of post revascularisation regional, dyssynergy improvement were 61.29% and 94.59% respectively. The positive and negative predicative values were 90.48% and 74.47% respectively. The number of viable segments (p = 0.01 and extent of contractile reserve (p = 0.01 were univariate, independent predictors of improvement in ejection fraction (EF. From the multivariate stepwise regression analysis contractile reserve was selected as most powerful predictor of late recovery of left ventricular contractile function (p = 0.007. Receiving-operator characteristic curve (ROC analysis demonstrated that three or more recovered segments were necessary for an improvement of left ventricular ejection fraction (LVEF ≥ 5% after the revascularisation, with the highest sensitivity, 100% and specificity 56% (p = 0.01. Conclusion. Low-dose dobutamine echocardiography is a powerful predictor of the regional dyssynergy recovery late after AIM treated with PTCA with implantation stent. Late full functional improvement of the left ventricle is related to the extent of contractile reserve and amount of viable tissue. At least three recovered segments are necessary for a significant recovery of the global left ventricular contractility.

  13. Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats

    Directory of Open Access Journals (Sweden)

    Nozawa E.

    2006-01-01

    Full Text Available Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes, infarct size (percentage of the arc with infarct on 3 transverse planes, systolic function by the change in fractional area, and diastolic function by mitral inflow parameters. The histologic measurement of myocardial infarction size was similar to the echocardiographic method. Myocardial infarct size ranged from 4.8 to 66.6% when determined by histology and from 5 to 69.8% when determined by echocardiography, with good correlation (r = 0.88; P < 0.05; Pearson correlation coefficient. Left ventricular diameter and mean diastolic transverse area correlated with myocardial infarct size by histology (r = 0.57 and r = 0.78; P < 0.0005. The fractional area change ranged from 28.5 ± 5.6 (large-size myocardial infarction to 53.1 ± 1.5% (control and correlated with myocardial infarct size by echocardiography (r = -0.87; P < 0.00001 and histology (r = -0.78; P < 00001. The E/A wave ratio of mitral inflow velocity for animals with large-size myocardial infarction (5.6 ± 2.7 was significantly higher than for all others (control: 1.9 ± 0.1; small-size myocardial infarction: 1.9 ± 0.4; moderate-size myocardial infarction: 2.8 ± 2.3. There was good agreement between echocardiographic and histologic estimates of myocardial infarct size in rats.

  14. Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Shah Ashish S

    2009-08-01

    Full Text Available Abstract We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.

  15. Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial

    DEFF Research Database (Denmark)

    Køber, L; Bloch Thomsen, P E; Møller, M;

    2000-01-01

    BACKGROUND: Arrhythmias cause much morbidity and mortality after myocardial infarction, but in previous trials, antiarrhythmic drug therapy has not been convincingly effective. Dofetilide, a new class III agent, was investigated for effects on all-cause mortality and morbidity in patients with left...... vs seven of 56; p=0.002). There were seven cases of torsade de pointes ventricular tachycardia, all in the dofetilide group. INTERPRETATION: In patients with severe left-ventricular dysfunction and recent myocardial infarction, treatment with dofetilide did not affect all-cause mortality, cardiac...

  16. Surgery for left ventricular aneurysm after myocardial infarction:techniques selection and results assessment

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin; QIU Zhi-bing; XU Ming; LIU Le-le; JIANG Ying-shuo; WANG Li-ming

    2012-01-01

    Background The most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined.We compared the efficacy of the linear versus patch repair techniques,and investigated the mid-term changes of LV geometry and cardiac function,for repair of LV aneurysms.Methods We reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010.Short-term and mid-term outcomes,including complications,cardiac function and mortality,were assessed.LV end-diastolic and systolic dimensions (LVEDD and LVESD),LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.Results Overall in-hospital mortality was 4.12%,and major morbidity showed no significant differences between the two groups.Multivariate analysis identified preoperative left ventricular end diastolic pressure >20 mmHg,low cardiac output and aortic clamping time >2 hours as risk factors for early mortality.Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P=0.008),and from 44% pre-operation to 40% 12 months postoperation in the linear group (P=0.032).In contrast,the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation,and increased again at follow-up.However,in the patch group,the LVEDVI and LVESVI were significantly reduced at follow-up.And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.Conclusions Persistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem.The choice of the technique should be tailored on an individual basis and surgeon's preference.The patch remodeling technique results in a better LVEF improvement,further significant reductions in LV dimensions

  17. Comparison of regional versus global assessment of left ventricular function in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction: the valsartan in acute myocardial infarction echocardiographic study

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Køber, Lars; Pfeffer, Marc A

    2006-01-01

    BACKGROUND: Left ventricular (LV) ejection fraction (EF) and wall-motion index (WMI) have both been shown to be independent predictors of outcome after myocardial infarction (MI). OBJECTIVES: We sought to determine whether these two measurements of LV systolic function provide similar or compleme...

  18. Effect of Astragalus Injection on Left Ventricular Remodeling in Aged Patients with Acute Early-stage Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jin-guo (张金国); LIU Ya-jie(刘雅洁); GAO Dong-sheng (高东升); YANG Na (杨娜); LIU Li-xin (刘立新); HE Hua (何华); DONG Hai-xin (董海新); LIU Xue-ling (刘雪玲); CHEN Ting (陈廷); WANG Xue-zhong (王学忠)

    2003-01-01

    Objective: To observe the effect of Astragalus Injection (AI) on left ventricular remodeling in aged patients with acute myocardial infarction (AMI).Methods: Patients with AMI were randomly divided into the AI group (46 cases) treated with AI and the control group (46 cases) treated conventionally. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), anterior endocardial segmental length (ASL) and posterior endocardial segmental length (PSL) were all assessed by echocardiogram after 1 week and 4 weeks treatment. The cardiac systolic and diastolic functions were detected by nuclide gating cardiac blood pool imaging at the 4th week. Results: After four weeks' treatment, no obvious change of LVEDVI, LVESVI and ASL in the AI group was found, but these indexes increased significantly in the control group, with significant difference shown between the two groups (P<0.05). As compared with the control group, the left ventricular ejection fraction (LVEF), left ventricular peak ejecting rate (LVPER) and left ventricular peak filling rate (LVPFR) were heightened, the time for peak filling rate (LVTPFR) in the left ventricle was shortened in the AI group.Conclusion: AI is one of the effective drugs in reversing left ventricular remodeling in aged patients with AMI.

  19. Usefulness of C-reactive protein as a marker of early post-infarct left ventricular systolic dysfunction

    OpenAIRE

    Świątkiewicz, Iwona; Koziński, Marek; Magielski, Przemysław; Gierach, Joanna; Fabiszak, Tomasz; Kubica, Aldona; Sukiennik, Adam; Navarese, Eliano Pio; Odrowąż-Sypniewska, Grażyna; Kubica, Jacek

    2012-01-01

    Objective To assess the usefulness of in-hospital measurement of C-reactive protein (CRP) concentration in comparison to well-established risk factors as a marker of post-infarct left ventricular systolic dysfunction (LVSD) at discharge. Materials and methods Two hundred and four consecutive patients with ST-segment-elevation myocardial infarction (STEMI) were prospectively enrolled into the study. CRP plasma concentrations were measured before reperfusion, 24 h after admission and at dischar...

  20. Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction: A Matched Case-control Study

    Institute of Scientific and Technical Information of China (English)

    Yue-Xin Jiang; Lin-De Jing; You-Hong Jia

    2015-01-01

    Background:Left ventricular thrombus (LVT) is reported to be a common complication in acute myocardial infarction (AMI) patients.And it has the potential to cause systemic embolism.This retrospective study was to present the current situation of LVT in clinical practice,as well as to evaluate the clinical characteristics and the risk factors of LVT after AMI.Methods:LVT cases (n =96) were identified from 13,732 AMI (non-ST elevation myocardial infarction was excluded) patients in Fuwai Hospital's electronic medical records system from January 2003 to January 2013.The controls (n =192) were gender-and age-matched AMI patients without LVT during this period.A conditional logistic regression (fitted by the Cox model) was performed to identify the independent risk factors.Results:The incidence of LVT after AMI was 0.7%.Univariate analysis indicated that the anterior myocardial infarction (especially extensive anterior myocardial infarction),lower left ventricular ejection fraction (LVEF),LVEF ≤40%,severe regional wall motion abnormalities (RWMA),pericardial effusion,and left ventricular aneurysm were all related to LVT after AMI.The independent risk factors obtained from the conditional logistic regression analysis were lower LVEF (odds ratio (OR) =0.891,95% confidence interval (CI):0.828-0.960),extensive anterior myocardial infarction (OR =6.403,95% CI:1.769-23.169),severe RWMA (OR =7.348,95% CI:1.323-40.819),and left ventricular aneurysm (OR =6.955,95% CI:1.673-28.921).Conclusions:This study indicated that lower LVEF,extensive anterior myocardial infarction,severe RWMA,and left ventricular aneurysm were independent risk factors of LVT after AMI.It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

  1. Timing effect of intramyocardial hydrogel injection for positively impacting left ventricular remodeling after myocardial infarction.

    Science.gov (United States)

    Yoshizumi, Tomo; Zhu, Yang; Jiang, Hongbin; D'Amore, Antonio; Sakaguchi, Hirokazu; Tchao, Jason; Tobita, Kimimasa; Wagner, William R

    2016-03-01

    Intramyocardial injection of various injectable hydrogel materials has shown benefit in positively impacting the course of left ventricular (LV) remodeling after myocardial infarction (MI). However, since LV remodeling is a complex, time dependent process, the most efficacious time of hydrogel injection is not clear. In this study, we injected a relatively stiff, thermoresponsive and bioabsorbable hydrogel in rat hearts at 3 different time points - immediately after MI (IM), 3 d post-MI (3D), and 2 w post-MI (2W), corresponding to the beginnings of the necrotic, fibrotic and chronic remodeling phases. The employed left anterior descending coronary artery ligation model showed expected infarction responses including functional loss, inflammation and fibrosis with distinct time dependent patterns. Changes in LV geometry and contractile function were followed by longitudinal echocardiography for 10 w post-MI. While all injection times positively affected LV function and wall thickness, the 3D group gave better functional outcomes than the other injection times and also exhibited more local vascularization and less inflammatory markers than the earlier injection time. The results indicate an important role for injection timing in the increasingly explored concept of post-MI biomaterial injection therapy and suggest that for hydrogels with mechanical support as primary function, injection at the beginning of the fibrotic phase may provide improved outcomes.

  2. Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Ersbøll, Mads; Køber, Lars;

    2016-01-01

    OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF...... delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI....

  3. Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction: A Matched Case-control Study

    Directory of Open Access Journals (Sweden)

    Yue-Xin Jiang

    2015-01-01

    Conclusions: This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

  4. Sudden cardiovascular death following myocardial infarction: the importance of left ventricular systolic dysfunction and congestive heart failure

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Zabell; Ottesen, Michael M; Rask-Madsen, Christian;

    2005-01-01

    BACKGROUND: To study the prognostic information of congestive heart failure (CHF) and left ventricular systolic dysfunction regarding sudden and non-sudden cardiovascular death (SCD and non-SCD) in patients with acute myocardial infarction (MI), as this may indicate the potential benefit...

  5. Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Delewi, Ronak [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Interuniversity Cardiology Institute of the Netherlands (Netherlands); Nijveldt, Robin [Department of Cardiology, VU University Medical Center, Amsterdam (Netherlands); Hirsch, Alexander [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Marcu, Constantin B.; Robbers, Lourens [Department of Cardiology, VU University Medical Center, Amsterdam (Netherlands); Hassell, Marriela E.C.J.; Bruin, Rianne H.A. de; Vleugels, Jim; Laan, Anja M. van der; Bouma, Berto J. [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Tio, René A. [Thorax Center, University Medical Center Groningen, Groningen (Netherlands); Tijssen, Jan G.P. [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Rossum, Albert C. van [Department of Cardiology, VU University Medical Center, Amsterdam (Netherlands); Zijlstra, Felix [Thorax Center, Department of Cardiology, Erasmus University Medical Center, Rotterdam (Netherlands); Piek, Jan J., E-mail: j.j.piek@amc.uva.nl [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2012-12-15

    Introduction: Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI. Methods: 200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events. Results: On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B = 0.02, SE = 0.02, p < 0.001). Routine TTE had a sensitivity of 21–24% and a specificity of 95–98% compared to CMR for the detection of LV thrombi. Intra- and interobserver variation for detection of LV thrombus were lower for CMR (κ = 0.91 and κ = 0.96) compared to TTE (κ = 0.74 and κ = 0.53). Conclusion: LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large.

  6. Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications

    DEFF Research Database (Denmark)

    Møller, Jacob Eifer; Brendorp, Bente; Ottesen, Michael;

    2003-01-01

    AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol...... and all cause mortality. RESULTS: Congestive heart failure was seen during hospitalisation in 1464 patients (46%), 717 patients had preserved left ventricular systolic function (wall motion index > or =1.3 corresponding to ejection fraction > or =0.40), and 732 patients had systolic dysfunction (wall.......3 (95% CI 2.8-4.0), and after adjustment for baseline characteristics and left ventricular systolic function in multivariate Cox proportional hazards analysis the risk was 2.1 (95% CI 1.7-2.6), PCongestive heart failure is frequently present in patients with preserved left...

  7. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study

    DEFF Research Database (Denmark)

    Verma, Anil; Meris, Alessandra; Skali, Hicham

    2008-01-01

    OBJECTIVES: This study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction. BACKGROUND: The LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse ca...

  8. Circulating NOS3 modulates left ventricular remodeling following reperfused myocardial infarction.

    Science.gov (United States)

    Gorressen, Simone; Stern, Manuel; van de Sandt, Annette M; Cortese-Krott, Miriam M; Ohlig, Jan; Rassaf, Tienush; Gödecke, Axel; Fischer, Jens W; Heusch, Gerd; Merx, Marc W; Kelm, Malte

    2015-01-01

    Nitric oxide (NO) is constitutively produced and released from the endothelium and several blood cell types by the isoform 3 of the NO synthase (NOS3). We have shown that NO protects against myocardial ischemia/reperfusion (I/R) injury and that depletion of circulating NOS3 increases within 24 h of ischemia/reperfusion the size of myocardial infarction (MI) in chimeric mice devoid of circulating NOS3. In the current study we hypothesized that circulating NOS3 also affects remodeling of the left ventricle following reperfused MI. To analyze the role of circulating NOS3 we transplanted bone marrow of NOS3-/- and wild type (WT) mice into WT mice, producing chimerae expressing NOS3 only in vascular endothelium (BC-/EC+) or in both, blood cells and vascular endothelium (BC+/EC+). Both groups underwent 60 min of coronary occlusion in a closed-chest model of reperfused MI. During the 3 weeks post MI, structural and functional LV remodeling was serially assessed (24 h, 4 d, 1 w, 2 w and 3 w) by echocardiography. At 72 hours post MI, gene expression of several extracellular matrix (ECM) modifying molecules was determined by quantitative RT-PCR analysis. At 3 weeks post MI, hemodynamics were obtained by pressure catheter, scar size and collagen content were quantified post mortem by Gomori's One-step trichrome staining. Three weeks post MI, LV end-systolic (53.2±5.9 μl; ***p≤0.001; n = 5) and end-diastolic volumes (82.7±5.6 μl; *pNOS3 ameliorates maladaptive left ventricular remodeling following reperfused myocardial infarction.

  9. Left ventricular thrombus in patients with acute myocardial infarction: Case report and Caribbean focused update

    Directory of Open Access Journals (Sweden)

    CR Potu

    2012-03-01

    Full Text Available Despite the well documented benefit of echocardiography in acute coronary syndromes, its wide-scale use in the Caribbean is limited by access, health literacy and affordability. Because of the limited use of echocardiography in the region, routine complications of acute myocardial infarction (AMI are not fully appreciated and may go unrecognized, further contributing to increased cardiovascular morbidity and mortality. It is therefore necessary to bring focus to this common clinical condition and highlight the clinical utility of echocardiography in facilitating timely and accurate diagnosis. We report here a case of large left ventricular (LV thrombus in a patient with AMI. Coronary angiography showed completely occluded left anterior descending artery (LAD with angiographically normal remaining vessels. Immediate anticoagulation was commenced with heparin and overlapped with warfarin. No Primary Angioplasty (PA was done based on the evidence from occluded artery trial. LV thrombus was completely resolved on echocardiography at three months. No evidence of thrombo-embolism was found during the resolution of LV thrombus.

  10. Left ventricular thrombus in patients with acute myocardial infarction:Case report and Caribbean focused update.

    Science.gov (United States)

    Potu, Cr; Tulloch-Reid, Ee; Baugh, Ds; Madu, Ec

    2012-01-01

    Despite the well documented benefit of echocardiography in acute coronary syndromes, its wide-scale use in the Caribbean is limited by access, health literacy and affordability. Because of the limited use of echocardiography in the region, routine complications of acute myocardial infarction (AMI) are not fully appreciated and may go unrecognized, further contributing to increased cardiovascular morbidity and mortality. It is therefore necessary to bring focus to this common clinical condition and highlight the clinical utility of echocardiography in facilitating timely and accurate diagnosis. We report here a case of large left ventricular (LV) thrombus in a patient with AMI. Coronary angiography showed completely occluded left anterior descending artery (LAD) with angiographically normal remaining vessels. Immediate anticoagulation was commenced with heparin and overlapped with warfarin. No Primary Angioplasty (PA) was done based on the evidence from occluded artery trial. LV thrombus was completely resolved on echocardiography at three months. No evidence of thrombo-embolism was found during the resolution of LV thrombus.

  11. [Left-ventricular function and physical exertion tolerance in patients with myocardial infarction with isolated lesion of the coronary arteries].

    Science.gov (United States)

    Golikov, A P; Levshunov, S P; Belozerov, G E

    1989-01-01

    Myocardial infarction area and left-ventricular myocardial contractility, determined by sectoral scanning, and exercise tolerance were assessed in 47 myocardial infarction patients with isolated coronary arterial lesions. The area under myocardial infarction was shown to be dependent on the site of the atherosclerotic process rather than the degree of stenosis in patients with isolated coronary arterial lesions. A relationship was established between the incidence of complications developing in the acute phase of infarction and the degree of stenosis. The disease was complicated more frequently in patients with coronary arterial occlusion as compared to those with severe coronary-arterial stenosis. High stress tolerance, irrespective of the site of myocardial infarction, is an evidence of great functional potentials in this category of patients.

  12. Global and regional left ventricular strain indices in post-myocardial infarction patients with ventricular arrhythmias and moderately abnormal ejection fraction.

    Science.gov (United States)

    Nguyen, Bich Lien; Capotosto, Lidia; Persi, Alessandro; Placanica, Attilio; Rafique, Asim; Piccirillo, Gianfranco; Gaudio, Carlo; Gang, Eli S; Siegel, Robert J; Vitarelli, Antonio

    2015-02-01

    The aim of the study described here was to compare myocardial strains in ischemic heart patients with and without sustained ventricular tachycardia (VT) and moderately abnormal left ventricular ejection fraction (LVEF) to investigate which index could better predict VT on the basis of the analysis of global and regional left ventricular (LV) dysfunction. We studied 467 patients with previous myocardial infarction and LVEF >35%. Fifty-one patients had documented VT, and 416 patients presented with no VT. LV volumes and score index were obtained by 2-D echocardiography. Longitudinal, radial and circumferential strains were determined. Strains of the infarct, border and remote zones were also obtained. There were no differences in standard LV 2-D parameters between patients with and those without VT. Receiver operating characteristic values were -12.7% for global longitudinal strain (area under the curve [AUC] = 0.72), -4.8% for posterior-inferior wall circumferential strain (AUC = 0.80), 61 ms for LV mechanical dispersion (AUC = 0.84), -10.1% for longitudinal strain of the border zone (AUC = 0.86) and -9.2% for circumferential strain of the border zone (AUC = 0.89). In patients with previous myocardial infarction and moderately abnormal LVEF, peri-infarct circumferential strain was the strongest predictor of documented ventricular arrhythmias among all strain quantitative indices. Additionally, strain values from posterior-inferior wall infarctions had a higher association with arrhythmic events compared with global strain.

  13. Optimal Timing of Surgical Revascularization for Myocardial Infarction and Left Ventricular Dysfunction

    Science.gov (United States)

    Wang, Rong; Cheng, Nan; Xiao, Cang-Song; Wu, Yang; Sai, Xiao-Yong; Gong, Zhi-Yun; Wang, Yao; Gao, Chang-Qing

    2017-01-01

    Background: The optimal timing of surgical revascularization for patients presenting with ST-segment elevation myocardial infarction (STEMI) and impaired left ventricular function is not well established. This study aimed to examine the timing of surgical revascularization after STEMI in patients with ischemic heart disease and left ventricular dysfunction (LVD) by comparing early and late results. Methods: From January 2003 to December 2013, there were 2276 patients undergoing isolated coronary artery bypass grafting (CABG) in our institution. Two hundred and sixty-four (223 male, 41 females) patients with a history of STEMI and LVD were divided into early revascularization (ER, 3 months) groups according to the time interval from STEMI to CABG. Mortality and complication rates were compared among the groups by Fisher's exact test. Cox regression analyses were performed to examine the effect of the time interval of surgery on long-term survival. Results: No significant differences in 30-day mortality, long-term survival, freedom from all-cause death, and rehospitalization for heart failure existed among the groups (P > 0.05). More patients in the ER group (12.90%) had low cardiac output syndrome than those in the MR (2.89%) and LR (3.05%) groups (P = 0.035). The mean follow-up times were 46.72 ± 30.65, 48.70 ± 32.74, and 43.75 ± 32.43 months, respectively (P = 0.716). Cox regression analyses showed a severe preoperative condition (odds ratio = 7.13, 95% confidence interval 2.05–24.74, P = 0.002) rather than the time interval of CABG (P > 0.05) after myocardial infarction was a risk factor of long-term survival. Conclusions: Surgical revascularization for patients with STEMI and LVD can be performed at different times after STEMI with comparable operative mortality and long-term survival. However, ER (cardiac output syndrome. A severe preoperative condition rather than the time interval of CABG after STEMI is a risk factor of long-term survival. PMID:28218210

  14. Evaluation and prognostic significance of left ventricular diastolic function assessed by Doppler echocardiography in the early phase of a first acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Gøtzsche, O

    1997-01-01

    deceleration time development of congestive heart failure during the first week following a first acute myocardial infarction. CONCLUSION: Assessment of left ventricular diastolic function complements measurements of systolic function......AIM: To study the prognostic significance of left ventricular diastolic function evaluated by transmitral and pulmonary venous flow velocities obtained in the early phase of a first acute myocardial infarction in relation to later development of congestive heart failure. METHODS: Pulsed Doppler...... echocardiography of transmitral and pulmonary venous flow was assessed in 65 consecutive patients with a first myocardial infarction within 1 h of arrival in the coronary care unit. RESULTS: A univariate regression analysis identified age, left ventricular ejection fraction

  15. Non-uniform recovery of left ventricular transmural mechanics in ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Wilansky Susan

    2010-08-01

    Full Text Available Abstract Background After a transient ischemic episode, the subendocardial region is more severely injured than outer subepicardial layers and may regain a proportionately greater degree of mechanical function in the longitudinal direction. We sought to explore left ventricular (LV transmural mechanics in patients with ST-segment elevation myocardial infarction (STEMI for determining the mechanism underlying recovery of global LV function after primary percutaneous coronary intervention (PCI. Methods A total of 42 patients (62 ± 11 years old, 71% male with a first STEMI underwent serial assessments of LV longitudinal, circumferential and radial strains (LS, CS and RS by selective tracking of subendocardial and subepicardial regions within 48 hours and a median of 5 months after PCI. LV mechanical parameters were compared with sixteen age and gender matched normal controls. Results In comparison with controls, endocardial and epicardial LS were markedly attenuated at 48 hours following PCI (P 5% following PCI was seen in 24 (57% patients and was associated with improvement in endocardial and epicardial LS (P Conclusions In patients with STEMI treated by PCI, the recovery of LV subendocardial shortening strain seen in the longitudinal direction underlies the improvement in LV global function despite persistent abnormalities in radial mechanics and wall motion score index.

  16. Circulating NOS3 modulates left ventricular remodeling following reperfused myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Simone Gorressen

    .Circulating NOS3 ameliorates maladaptive left ventricular remodeling following reperfused myocardial infarction.

  17. Rats with high left ventricular end-diastolic pressure can be identified by Doppler echocardiography one week after myocardial infarction

    OpenAIRE

    R.M. Saraiva; Kanashiro-Takeuchi,R.M.; E.L. Antonio; Campos, O; P.J.F. Tucci; Moisés,V.A.

    2007-01-01

    The severity of left ventricular (LV) dysfunction in rats with myocardial infarction (MI) varies widely. Because homogeneity in baseline parameters is essential for experimental investigations, a study was conducted to establish whether Doppler echocardiography (DE) could accurately identify animals with high LV end-diastolic pressure as a marker of LV dysfunction soon after MI. Direct measurements of LV end-diastolic pressure were made and DE was performed simultaneously 1 week after surgica...

  18. Rapid MR assessment of left ventricular systolic function after acute myocardial infarction using single breath-hold cine imaging with the temporal parallel acquisition technique (TPAT) and 4D guide-point modelling analysis of left ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Eberle, Holger C.; Jensen, Christoph J.; Sabin, Georg V.; Naber, Christoph K.; Bruder, Oliver [Elisabeth Hospital, Department of Cardiology and Angiology, Essen (Germany); Nassenstein, Kai; Schlosser, Thomas [University of Duisburg-Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen (Germany)

    2010-01-15

    We compared four-dimensional guide-point modelling left ventricular function analysis (4DVF) results of cine images in four short-axis and two long-axis slices acquired in a single breath-hold, obtained with the temporal parallel acquisition technique (TPAT), with standard left ventricular function (LVF) analysis results determined by the summation of discs method, in patients who had recently suffered myocardial infarction. Despite wall motion abnormalities, 4DVF yields results for left ventricular ejection fractions and end-diastolic and end-systolic volumes that are in excellent agreement with standard LVF analysis results in these patients. A shortened cardiac magnetic resonance (CMR) protocol using single breath-hold cine image acquisition could facilitate the assessment of left ventricular function soon after myocardial infarction in critically ill patients who are unable to comply with the multiple breath-holds required for standard LVF analysis. (orig.)

  19. Autologous preconditioned mesenchymal stem cell sheets improve left ventricular function in a rabbit old myocardial infarction model

    Science.gov (United States)

    Tanaka, Yuya; Shirasawa, Bungo; Takeuchi, Yuriko; Kawamura, Daichi; Nakamura, Tamami; Samura, Makoto; Nishimoto, Arata; Ueno, Koji; Morikage, Noriyasu; Hosoyama, Tohru; Hamano, Kimikazu

    2016-01-01

    Mesenchymal stem cells (MSCs) constitute one of the most powerful tools for therapeutic angiogenesis in infarcted hearts. However, conventional MSC transplantation approaches result in insufficient therapeutic effects due to poor retention of graft cells in severe ischemic diseases. Cell sheet technology has been developed as a new method to prolong graft cell retention even in ischemic tissue. Recently, we demonstrated that hypoxic pretreatment enhances the therapeutic efficacy of cell sheet implantation in infarcted mouse hearts. In this study, we investigated whether hypoxic pretreatment activates the therapeutic functions of bone marrow-derived MSC (BM-MSC) sheets and improves cardiac function in rabbit infarcted hearts following autologous transplantation. Production of vascular endothelial growth factor (VEGF) was increased in BM-MSC monolayer sheets and it peaked at 48 h under hypoxic culture conditions (2% O2). To examine in vivo effects, preconditioned autologous BM-MSC sheets were implanted into a rabbit old myocardial infarction model. Implantation of preconditioned BM-MSC sheets accelerated angiogenesis in the peri-infarcted area and decreased the infarcted area, leading to improvement of the left ventricular function of the infarcted heart. Importantly, the therapeutic efficacy of the preconditioned BM-MSC sheets was higher than that of standardly cultured sheets. Thus, implantation of autologous preconditioned BM-MSC sheets is a feasible approach for enhancing therapeutic angiogenesis in chronically infarcted hearts. PMID:27347329

  20. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    Science.gov (United States)

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  1. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jons, Christian; Joergensen, Rikke Moerch; Hassager, Christian;

    2010-01-01

    The aim of this study was to investigate the association between diastolic dysfunction and long-term occurrence of new-onset atrial fibrillation (AF) and cardiac events in patients with acute myocardial infarction (AMI) and left ventricular (LV) systolic dysfunction.......The aim of this study was to investigate the association between diastolic dysfunction and long-term occurrence of new-onset atrial fibrillation (AF) and cardiac events in patients with acute myocardial infarction (AMI) and left ventricular (LV) systolic dysfunction....

  2. Plasma YKL-40 and recovery of left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Hedegaard, A.; Ripa, Maria Sejersten; Johansen, J.S.

    2010-01-01

    to LVEF recovery (p = 0.04) but not infarct size. G-CSF injections increased YKL-40 compared to placebo (p STEMI patients at admission and G-CSF treatment caused a further increase......Background: Plasma YKL-40 is increased early in patients with ST-elevation myocardial infarction (STEMI). It is not known whether plasma YKL-40 is related to infarct size and recovery of ventricular function after primary percutaneous coronary intervention (PCI) of STEMI and whether granulocyte...... colony-stimulating factor (G-CSF) therapy influence plasma YKL-40 concentration. Materials and methods: A total of 72 patients (age: 56 +/- 9 years (mean +/- SD), 56 men and 16 women) with STEMI treated with PCI were included in a double-blind, randomized, placebo-controlled trial with subcutaneous G...

  3. Krill oil attenuates left ventricular dilatation after myocardial infarction in rats

    Directory of Open Access Journals (Sweden)

    Fosshaug Linn E

    2011-12-01

    Full Text Available Abstract Background In the western world, heart failure (HF is one of the most important causes of cardiovascular mortality. Supplement with n-3 polyunsaturated fatty acids (PUFA has been shown to improve cardiac function in HF and to decrease mortality after myocardial infarction (MI. The molecular structure and composition of n-3 PUFA varies between different marine sources and this may be of importance for their biological effects. Krill oil, unlike fish oil supplements, contains the major part of the n-3 PUFA in the form of phospholipids. This study investigated effects of krill oil on cardiac remodeling after experimental MI. Rats were randomised to pre-treatment with krill oil or control feed 14 days before induction of MI. Seven days post-MI, the rats were examined with echocardiography and rats in the control group were further randomised to continued control feed or krill oil feed for 7 weeks before re-examination with echocardiography and euthanization. Results The echocardiographic evaluation showed significant attenuation of LV dilatation in the group pretreated with krill oil compared to controls. Attenuated heart weight, lung weight, and levels of mRNA encoding classical markers of LV stress, matrix remodeling and inflammation reflected these findings. The total composition of fatty acids were examined in the left ventricular (LV tissue and all rats treated with krill oil showed a significantly higher proportion of n-3 PUFA in the LV tissue, although no difference was seen between the two krill oil groups. Conclusions Supplement with krill oil leads to a proportional increase of n-3 PUFA in myocardial tissue and supplement given before induction of MI attenuates LV remodeling.

  4. Effect of oral alcohol on left ventricular ejection fraction, volumes, and segmental wall motion in normals and in patients with recent myocardial infarction.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C; Yang, D; Patel, D; Kim, B S; Patel, C; Becker, W H

    1985-11-01

    A first-pass nuclear angiogram and a multiple-gated acquisition study were obtained in 10 normal physicians and in 10 patients with a 7-to-10 day old transmural myocardial infarction. After the scan the subjects drank 2 oz. of whiskey. After 60 minutes, the multiple-gated acquisition study was repeated. In the normal group the left ventricular ejection fraction was 68% before and 72% after alcohol. The left ventricular end-diastolic volume increased from 89 to 97 ml while the left ventricular end-systolic volume decreased from 29 to 27 ml. The stroke volume rose from 61 to 70 ml/beat (p less than 0.05). The cardiac output increased from 4.0 to 5.0 l/min (p less than 0.05). In the infarction group, the left ventricular ejection fraction was 58% before and 56% after alcohol administration. The left ventricular end-diastolic volume fell from 111 to 96 ml, while the left ventricular end-systolic volume declined from 50 to 44 ml. The stroke volume fell from 61 to 52 ml/beat, while the cardiac output fell from 4.5 to 3.8 l/min. In the left ventricular infarction zones, alcohol produced in 9 of the 10 cardiac patients a decline in the left ventricular regional ejection fraction. In the normal group, alcohol produced no significant changes in the regional ejection fraction. The normal and the postinfarction patients responded differently to alcohol.

  5. Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Høfsten, Dan Eik; Christophersen, Thomas Brøcher

    2012-01-01

    . Assessment of CFR by TTE was performed in a modified apical view using color Doppler guidance. Results: The study population consisted of 183 patients (51 females) with a median age of 63 [54;70] years. Eighty-nine (49%) patients had a non-ST elevation myocardial infarction and 94 (51%) patients had a ST......Objectives: We investigated the correlation between left ventricular global and regional longitudinal systolic strain (GLS and LRS) and coronary flow reserve (CFR) assessed by transthoracic echocardiography (TTE) in patients with a recent acute myocardial infarction (AMI). Furthermore, we...... investigated if LRS and GLS imaging is superior to conventional measures of left ventricle (LV) function. Methods: In a consecutive population of first time AMI patients, who underwent successful revascularization, we performed comprehensive TTE. GLS and LRS were obtained from the three standard apical views...

  6. Diagnosis and surgical treatment of post-infarction left ventricular pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    GAN Hui-li; ZHANG Jian-qun

    2009-01-01

    @@ Left ventficular pseudoaneurysm (LVPA) is a rare clinical entity that could be life-threatening. It could be of congenital and acquired origin.1,2 Among the acquired LVPA, post-infarction LVPA constitutes most of the cases. LVPA always occurs after acute myocardial infarction (MI) and develops chronically. Reliable diagnosis and early surgical intervention are vital for the patients' recovery. Here we present 7 cases of LVPA in Anzhen Hospital between May 1993 to March 2007, focusing on the evaluation of diagnosis methods and treatment efficiency of LVPA.

  7. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Carlsen, J E;

    1995-01-01

    BACKGROUND. Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces mortality among survivors of acute myocardial infarction, but whether to use ACE inhibitors in all patients or only in selected patients is uncertain. METHODS. We screened 6676 consecutive patients with 7001...... myocardial infarctions confirmed by enzyme studies. A total of 2606 patients had echocardiographic evidence of left ventricular systolic dysfunction (ejection fraction,

  8. Chronic treatment with metformin suppresses toll-like receptor 4 signaling and attenuates left ventricular dysfunction following myocardial infarction.

    Science.gov (United States)

    Soraya, Hamid; Clanachan, Alexander S; Rameshrad, Maryam; Maleki-Dizaji, Nasrin; Ghazi-Khansari, Mahmoud; Garjani, Alireza

    2014-08-15

    Acute treatment with metformin has a protective effect in myocardial infarction by suppression of inflammatory responses due to activation of AMP-activated protein kinase (AMPK). In the present study, the effect of chronic pre-treatment with metformin on cardiac dysfunction and toll-like receptor 4 (TLR4) activities following myocardial infarction and their relation with AMPK were assessed. Male Wistar rats were randomly assigned to one of 5 groups (n=6): normal control and groups were injected isoproterenol after chronic pre-treatment with 0, 25, 50, or 100mg/kg of metformin twice daily for 14 days. Isoproterenol (100mg/kg) was injected subcutaneously on the 13th and 14th days to induce acute myocardial infarction. Isoproterenol alone decreased left ventricular systolic pressure and myocardial contractility indexed as LVdp/dtmax and LVdp/dtmin. The left ventricular dysfunction was significantly lower in the groups treated with 25 and 50mg/kg of metformin. Metfromin markedly lowered isoproterenol-induced elevation in the levels of TLR4 mRNA, myeloid differentiation protein 88 (MyD88), tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) in the heart tissues. Similar changes were also seen in the serum levels of TNF-α and IL-6. However, the lower doses of 25 and 50mg/kg were more effective than 100mg/kg. Phosphorylated AMPKα (p-AMPK) in the myocardium was significantly elevated by 25mg/kg of metformin, slightly by 50mg/kg, but not by 100mg/kg. Chronic pre-treatment with metformin reduces post-myocardial infarction cardiac dysfunction and suppresses inflammatory responses, possibly through inhibition of TLR4 activities. This mechanism can be considered as a target to protect infarcted myocardium.

  9. Berberine attenuates adverse left ventricular remodeling and cardiac dysfunction after acute myocardial infarction in rats: role of autophagy.

    Science.gov (United States)

    Zhang, Yao-Jun; Yang, Shao-Hua; Li, Ming-Hui; Iqbal, Javaid; Bourantas, Christos V; Mi, Qiong-Yu; Yu, Yi-Hui; Li, Jing-Jing; Zhao, Shu-Li; Tian, Nai-Liang; Chen, Shao-Liang

    2014-12-01

    The present study aimed to test the hypothesis that berberine, a plant-derived anti-oxidant, attenuates adverse left ventricular remodelling and improves cardiac function in a rat model of myocardial infarction (MI). Furthermore, the potential mechanisms that mediated the cardioprotective actions of berberine, in particular the effect on autophagy, were also investigated. Acute MI was induced by ligating the left anterior descending coronary artery of Sprague-Dawley rats. Cardiac function was assessed by transthoracic echocardiography. The protein activity/levels of autophagy related to signalling pathways (e.g. LC-3B, Beclin-1) were measured in myocardial tissue by immunohistochemical staining and western blot. Four weeks after MI, berberine significantly prevented cardiac dysfunction and adverse cardiac remodelling. MI rats treated with low dose berberine (10 mg/kg per day) showed higher left ventricular ejection fraction and fractional shortening than those treated with high-dose berberine (50 mg/kg per day). Both doses reduced interstitial fibrosis and post-MI adverse cardiac remodelling. The cardioprotective action of berberine was associated with increased LC-3B II and Beclin-1 expressions. Furthermore, cardioprotection with berberine was potentially related to p38 MAPK inhibition and phospho-Akt activation. The present in vivo study showed that berberine is effective in promoting autophagy, and subsequently attenuating left ventricular remodelling and cardiac dysfunction after MI. The potential underlying mechanism is augmentation of autophagy through inhibition of p38 MAPK and activation of phospho-Akt signalling pathways.

  10. The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    To investigate the value of the Doppler-derived myocardial performance index to predict early left-ventricular (LV) dilation and cardiac death after a first acute myocardial infarction (AMI), Doppler echocardiography was performed within 24 h of hospital admission, on day 5, 1 and 3 months after.......63, (p or = 0.63 (relative risk 5.6, p or = II (relative risk 4.0, p = 0.04) to be independent predictors of cardiac death. Therefore......, we conclude that the Doppler echocardiographic myocardial performance index is a predictor of LV dilation and cardiac death after a first AMI....

  11. Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction

    DEFF Research Database (Denmark)

    Huikuri, Heikki V; Raatikainen, M J Pekka; Moerch-Joergensen, Rikke;

    2009-01-01

    . The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors......AIMS: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF

  12. Reduced scar maturation and contractility lead to exaggerated left ventricular dilation after myocardial infarction in mice lacking AMPKα1.

    Science.gov (United States)

    Noppe, Gauthier; Dufeys, Cécile; Buchlin, Patricia; Marquet, Nicolas; Castanares-Zapatero, Diego; Balteau, Magali; Hermida, Nerea; Bouzin, Caroline; Esfahani, Hrag; Viollet, Benoit; Bertrand, Luc; Balligand, Jean-Luc; Vanoverschelde, Jean-Louis; Beauloye, Christophe; Horman, Sandrine

    2014-09-01

    Cardiac fibroblasts (CF) are crucial in left ventricular (LV) healing and remodeling after myocardial infarction (MI). They are typically activated into myofibroblasts that express alpha-smooth muscle actin (α-SMA) microfilaments and contribute to the formation of contractile and mature collagen scars that minimize the adverse dilatation of infarcted areas. CF predominantly express the α1 catalytic subunit of AMP-activated protein kinase (AMPKα1), while AMPKα2 is the major catalytic isoform in cardiomyocytes. AMPKα2 is known to protect the heart by preserving the energy charge of cardiac myocytes during injury, but whether AMPKα1 interferes with maladaptative heart responses remains unexplored. In this study, we investigated the role of AMPKα1 in modulating LV dilatation and CF fibrosis during post-MI remodeling. AMPKα1 knockout (KO) and wild type (WT) mice were subjected to permanent ligation of the left anterior descending coronary artery. The absence of AMPKα1 was associated with increased CF proliferation in infarcted areas, while expression of the myodifferentiation marker α-SMA was decreased. Faulty maturation of myofibroblasts might derive from severe down-regulation of the non-canonical transforming growth factor-beta1/p38 mitogen-activated protein kinase (TGF-β1/p38 MAPK) pathway in KO infarcts. In addition, lysyl oxidase (LOX) protein expression was dramatically reduced in the scar of KO hearts. Although infarct size was similar in AMPK-KO and WT hearts subjected to MI, these changes resulted in compromised scar contractility, defective scar collagen maturation, and exacerbated adverse remodeling, as indicated by increased LV diastolic dimension 30days after MI. Our data genetically demonstrate the centrality of AMPKα1 in post-MI scar formation and highlight the specificity of this catalytic isoform in cardiac fibroblast/myofibroblast biology.

  13. Computer-based assessment of left ventricular regional ejection fraction in patients after myocardial infarction

    Science.gov (United States)

    Teo, S.-K.; Su, Y.; Tan, R. S.; Zhong, L.

    2014-03-01

    After myocardial infarction (MI), the left ventricle (LV) undergoes progressive remodeling which adversely affects heart function and may lead to development of heart failure. There is an escalating need to accurately depict the LV remodeling process for disease surveillance and monitoring of therapeutic efficacy. Current practice of using ejection fraction to quantitate LV function is less than ideal as it obscures regional variation and anomaly. Therefore, we sought to (i) develop a quantitative method to assess LV regional ejection fraction (REF) using a 16-segment method, and (ii) evaluate the effectiveness of REF in discriminating 10 patients 1-3 months after MI and 9 normal control (sex- and agematched) based on cardiac magnetic resonance (CMR) imaging. Late gadolinium enhancement (LGE) CMR scans were also acquired for the MI patients to assess scar extent. We observed that the REF at the basal, mid-cavity and apical regions for the patient group is significantly lower as compared to the control group (P infarction. The results suggest that REF could potentially be used as a discriminator for MI and employed to measure myocardium homogeneity with respect to degree of infarction. The computational performance per data sample took approximately 25 sec, which demonstrates its clinical potential as a real-time cardiac assessment tool.

  14. Influence of Transplantation of Allogenic Bone Marrow Mononuclear Cells on the Left Ventricular Remodeling of Rat after Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    To probe into the influence of transplantation of allogenic bone marrow mononuclear cells (BM-MNCs) on the left ventricular remodeling of rat after acute myocardial infarction (AMD,60 male Wistar rats were evenly divided into three groups at random: control group 1, control group 2and transplantation group. In control group 1, chest was opened without ligation of coronary artery;in control group 2 and transplantation group, the left anterior descending branch of coronary artery was ligated to establish AMI model. Prepared culture medium and allogenic BM-MNCs suspension were respectively implanted the surrounding area of infracted cardiac muscle via epicardium of control group 2 and transplantation group. Four weeks after the operation, the osteopontin gene (OPN mRNA, P<0.01), type Ⅰ collagen (P<0.01) and angiotensin Ⅱ (AngⅡ, P<0.01) content in the left ventricular non-infracted myocardium, and the Ang Ⅱ density in blood plasma (P<0.05) of transplantation group and control group 2 were all significantly higher than that of control group 1. In the transplantation group, the myocardial OPN mRNA, type Ⅰ collagen and Ang Ⅱ content of non-infracted zone in left ventricle, and the Ang Ⅱ concentration in blood plasma were all significantly lower than those of control group 2 (P<0.05 for all). It is concluded that allogenic BM-MNCs transplantation may ease left ventricular remodeling after AMI by inhibiting the synthesis of type Ⅰ collagen in the cardiac muscle and down-regulating the expression of Ang Ⅱ and OPN gene.

  15. Improvement of left ventricular remodeling after myocardial infarction with eight weeks L-thyroxine treatment in rats

    Directory of Open Access Journals (Sweden)

    Chen Yue-Feng

    2013-02-01

    Full Text Available Abstract Background Left ventricular (LV remodeling following large transmural myocardial infarction (MI remains a pivotal clinical issue despite the advance of medical treatment over the past few decades. Identification of new medications to improve the remodeling process and prevent progression to heart failure after MI is critical. Thyroid hormones (THs have been shown to improve LV function and remodeling in animals post-MI and in the human setting. However, changes in underlying cellular remodeling resulting from TH treatment are not clear. Methods MI was produced in adult female Sprague–Dawley rats by ligation of the left descending coronary artery. L-thyroxine (T4 pellet (3.3 mg, 60 days sustained release was used to treat MI rats for 8 weeks. Isolated myocyte shape, arterioles, and collagen deposition in the non-infarcted area were measured at terminal study. Results T4 treatment improved LV ±dp/dt, normalized TAU, and increased myocyte cross-sectional area without further increasing myocyte length in MI rats. T4 treatment increased the total LV tissue area by 34%, increased the non-infarcted tissue area by 41%, and increased the thickness of non-infarcted area by 36% in MI rats. However, myocyte volume accounted for only ~1/3 of the increase in myocyte mass in the non-infarct area, indicating the presence of more myocytes with treatment. T4 treatment tended to increase the total length of smaller arterioles (5 to 15 μm proportional to LV weight increase and also decreased collagen deposition in the LV non-infarcted area. A tendency for increased metalloproteinase-2 (MMP-2 expression and tissue inhibitor of metalloproteinases (TIMPs -1 to −4 expression was also observed in T4 treated MI rats. Conclusions These results suggest that long-term T4 treatment after MI has beneficial effects on myocyte, arteriolar, and collagen matrix remodeling in the non-infarcted area. Most importantly, results suggest improved survival of myocytes in

  16. A novel segmentation method to identify left ventricular infarction in short-axis composite strain-encoded magnetic resonance images

    Science.gov (United States)

    Algohary, Ahmad O.; Metwally, Muhammad K.; El-Bialy, Ahmed M.; Kandil, Ahmed H.; Osman, Nael F.

    2011-03-01

    Composite Strain Encoding (CSENC) is a new Magnetic Resonance Imaging (MRI) technique for simultaneously acquiring cardiac functional and viability images. It combines the use of Delayed Enhancement (DE) and the Strain Encoding (SENC) imaging techniques to identify the infracted (dead) tissue and to image the myocardial deformation inside the heart muscle. In this work, a new unsupervised segmentation method is proposed to identify infarcted left ventricular tissue in the images provided by CSENC MRI. The proposed method is based on the sequential application of Bayesian classifier, Otsu's thresholding, morphological opening, radial sweep boundary tracing and the fuzzy C-means (FCM) clustering algorithm. This method is tested on images of twelve patients with and without myocardial infarction (MI) and on simulated heart images with various levels of superimposed noise. The resulting clustered images are compared with those marked up by an expert cardiologist who assisted in validating results coming from the proposed method. Infarcted myocardium is correctly identified using the proposed method with high levels of accuracy and precision.

  17. Left ventricular remodeling in the first year after acute myocardial infarction and the predictive value of N-terminal pro brain natriuretic peptide

    DEFF Research Database (Denmark)

    Nilsson, Jens C; Groenning, Bjoern A; Nielsen, Gitte;

    2002-01-01

    BACKGROUND: Left ventricular (LV) remodeling after myocardial infarction (MI) has received much attention because of its severe impact on morbidity and mortality rates. However, the incidence and extent of LV remodeling in a modern infarct population who were offered antiremodeling treatment in c......, approximately 30% had significant increments develop in LVEDVI and LVESVI, and LV ejection fraction remained unchanged. Patients in whom LV dilatation developed could be identified early after the MI with elevated plasma levels of NT-proBNP...

  18. Repeated renal infarction in native and transplanted kidneys due to left ventricular thrombus formation caused by antiphospholipid antibody syndrome.

    Science.gov (United States)

    Scully, Paul; Leckstroem, Daniel C; McGrath, Andrew; Chambers, John; Goldsmith, David J

    2013-01-01

    Antiphospholipid syndrome can be a feature of several underlying conditions, such as lupus, but it can also occur idiopathically. Diagnosis usually comes after investigation of recurrent venous or arterial thromboses, emboli, or hypertension/proteinuria where the kidney is involved and is usually confirmed by laboratory testing. We describe a case of a man with a myocardial infarction who developed mural thrombus in an akinetic left ventricular segment but then who recurrently embolized first to one of his native kidneys and then later to a transplanted kidney. Although the clinical behavior was typical of antiphospholipid syndrome, it took numerous laboratory assays over many years until finally the problem was confirmed and life-long warfarin therapy instituted.

  19. [Large left ventricular aneurysm after silent myocardial infarction. Documentation by serial non-invasive imaging].

    Science.gov (United States)

    Ritter, C; Beer, M; Weidemann, F; Strotmann, J; Müllges, W; Mohr, F W; Ertl, G; Hahn, D; Bauersachs, J

    2008-03-01

    A 60-year-old man had a workup for atypical angina. Noninvasive investigations, including computed tomography, showed no evidence for coronary artery disease. A few months later the patient was hospitalized because of severe epileptic seizures. Thyrotoxicosis was diagnosed and emergency thyroidectomy was performed. Two months after discharge the patient was again referred because of exercise-induced angina pectoris. Echocardiography and cardiac magnetic resonance imaging (MRI) showed a large aneurysm of the lateral wall of the left ventricle with a thrombus adhering to the wall. Coronary angiography and levocardiography confirmed the aneurysm and detected an occlusion of the distal part of the circumflex artery. Surgical aneurysm resection with thrombectomy and endoventricular circular plasty (Dor procedure) was performed without postoperative complications. Six months after surgery the patient was in good general condition without any angina. Follow-up echocardiography as well as cardiac MRI gave proof of an excellent postoperative result. Noninvasive preoperative diagnosis and documentation as well as postoperative monitoring with modern imaging modalities, such as echocardiography and MRI are of great value in patients with left ventricular aneurysm.

  20. Factors influencing left ventricular hypertrophy in children and adolescents with or without family history of premature myocardial infarction

    Directory of Open Access Journals (Sweden)

    Seyyed Mohsen Hosseini

    2014-01-01

    Result : The results showed that among the studied variables, gender, age, body mass index, and blood pressure were associated with the left ventricular hypertrophy. Conclusion: Considering the results and previous studies in this field, it was observed that left ventricular hypertrophy exists at early ages, which is very dangerous and can lead to heart diseases at early ages. Factors such as being overweight, having high blood pressure, and being male cause left ventricular hypertrophy and lead to undiagnosable heart diseases.

  1. Autonomic dysfunction and new-onset atrial fibrillation in patients with left ventricular systolic dysfunction after acute myocardial infarction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jøns, Christian; Raatikainen, Pekka; Gang, Uffe J;

    2010-01-01

    Atrial fibrillation (AF) increases morbidity and mortality in patients with previous myocardial infarction and left ventricular systolic dysfunction. The purpose of this study was to identify patients with a high risk for new-onset AF in this population using invasive and noninvasive...

  2. Incidence of atrial fibrillation in patients with either heart failure or acute myocardial infarction and left ventricular dysfunction: a cohort study

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle D; Pedersen, Ole D; Køber, Lars;

    2011-01-01

    We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction. Patients either had a recent myocardial infarction (with or without clinical heart failure) or symptomatic heart failure (without a recent MI). Patients were with and without treatment...

  3. Incidence of atrial fibrillation in patients with either heart failure or acute myocardial infarction and left ventricular dysfunction: a cohort study

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle D; Pedersen, Ole D; Køber, Lars;

    2011-01-01

    We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction. Patients either had a recent myocardial infarction (with or without clinical heart failure) or symptomatic heart failure (without a recent MI). Patients were with and without treatment with t...... with the class III antiarrhythmic drug dofetilide over 36 months....

  4. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: The L-carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial

    NARCIS (Netherlands)

    S. Iliceto (Sabino); D. Scrutinio (Domenico); P. Bruzzi (P.); G. D'Ambrosio (Gaetano); A. Boni (Alejandro); M. Di Biase (Matteo); G. Biasco (Giuseppina); P.G. Hugenholtz (Paul); P. Rizzon (Paolo)

    1995-01-01

    textabstractObjectives. This study was performed to evaluate the effects of l-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction. Background. Carnitine is a physiologic compound that performs an essential role in myocardial energy p

  5. Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Pedersen, O D;

    1996-01-01

    Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously...

  6. Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality

    DEFF Research Database (Denmark)

    Thomas, Kevin L; Al-Khatib, Sana M; Lokhnygina, Yuliya;

    2008-01-01

    BACKGROUND: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post-acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. METHODS: This study used data from VALIAN...

  7. Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction

    DEFF Research Database (Denmark)

    Køber, Lars; Swedberg, Karl; McMurray, John J V

    2006-01-01

    AIMS: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). MET...

  8. Giant and thrombosed left ventricular aneurysm

    Institute of Scientific and Technical Information of China (English)

    Jose; Alberto; de; Agustin; Jose; Juan; Gomez; de; Diego; Pedro; Marcos-Alberca; Jose; Luis; Rodrigo; Carlos; Almeria; Patricia; Mahia; Maria; Luaces; Miguel; Angel; Garcia-Fernandez; Carlos; Macaya; Leopoldo; Perez; de; Isla

    2015-01-01

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur,including heart failure,thromboembolism,or tachyarrhythmias. We report the case of a 78-yearold male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded,and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm,causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  9. Giant and thrombosed left ventricular aneurysm.

    Science.gov (United States)

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  10. Stem cell mechanisms during left ventricular remodeling post-myocardial infarction:Repair and regeneration

    Institute of Scientific and Technical Information of China (English)

    Rogelio; Zamilpa; Mary; M; Navarro; Iris; Flores; Sy; Griffey

    2014-01-01

    Post-myocardial infarction(MI),the left ventricle(LV)undergoes a series of events collectively referred to as remodeling.As a result,damaged myocardium is replaced with fibrotic tissue consequently leading to contractile dysfunction and ultimately heart failure.LV remodeling post-MI includes inflammatory,fibrotic,and neovascularization responses that involve regulated cell recruitment and function.Stem cells(SCs)have been transplanted post-MI for treatment of LV remodeling and shown to improve LV function by reduction in scar tissue formation in humans and animal models of MI.The promising results obtained from the application of SCs post-MI have sparked a massive effort to identify the optimal SC for regeneration of cardiomyocytes and the paradigm for clinical applications.Although SC transplantations are generally associated with new tissue formation,SCs also secrete cytokines,chemokines and growth factors that robustly regulate cell behavior in a paracrine fashion during the remodeling process.In this review,the different types of SCs used for cardiomyogenesis,markers of differentiation,paracrine factor secretion,and strategies for cell recruitment and delivery are addressed.

  11. [Relations of the duration of pre-existing angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction].

    Science.gov (United States)

    Juillière, Y; Danchin, N; Grentzinger, A; Suty-Selton, C; Perrin, O; Guenoun, P; Pernot, C; Cherrier, F

    1990-10-01

    The aim of this retrospective study was to determine the relationship between the duration of preceding angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction. Coronary angiography of 138 consecutive patients showed isolated and complete occlusions of the left anterior descending (58 patients) or right coronary artery (80 patients). One hundred and four patients had myocardial infarction with (Group A, n = 21) or without (Group B, n = 83) preceding angina pectoris and 34 had angina without myocardial infarction (Group C). The left ventricular ejection fraction was measured by ventriculography in the 30 degrees right anterior oblique projection. The collateral circulation was assessed by coronary angiography and evaluated as follows: no flow or flow limited to collateral branches (subgroup 1) and partial or complete filling of the epicardial arterial segment (subgroup 2). In the global population the left ventricular ejection fraction was higher and the duration of preceding angina pectoris was longer in the subgroups with a well developed collateral circulation. There was no difference in ejection fraction between Groups A and B (presence of myocardial infarction), on the other hand, within each of the groups, a good collateral circulation (subgroup 2) was associated with a significantly higher ejection fraction. Group C (without infarction) patients had better ejection fractions than Groups A or B, especially when the collateral circulation was poorly developed. Within Group C, the quality of the collateral circulation did not seem to affect the ejection fraction. The left ventricular ejection fraction is lower in patients with isolated coronary occlusion and myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction, comorbided with arterial hypertension

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2013-12-01

    Full Text Available Recently, much attention was paid to left ventricular diastolic dysfunction and its role in the occurrence of chronic heart failure. In patients after myocardial infarction, diastolic dysfunction often precedes systolic dysfunction and predicts prognosis. In patients after myocardial infarction, diastolic dysfunction is caused by a violation of early diastolic relaxation in the area of increasing stiffness. Diastolic dysfunction is formed by hypertrophy, fibrosis, myocardial ischemia and arterial hypertension. Given the important role of diastolic dysfunction in the formation of heart failure in postinfarction patients with concomitant arterial hypertension, the mechanisms of its impact on clinical features and structural-functional changes of the heart is an actual problem. Objective: To determine the structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction with concomitant arterial hypertension. Materials and methods: In 91 patients with post-infarction cardiosclerosis and preserved left ventricular ejection fraction (EF > 45 % with arterial hypertension were investigated structural and functional changes in the heart and clinical features of heart failure by assessing clinical status and ultrasound of the heart. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 3 groups. The first group included 50 patients with diastolic dysfunction and symptoms of heart failure (mean age 64,1 ± 1,2 years. In the second group were 31 patients with diastolic dysfunction without heart failure symptoms (mean age 59,5 ± 1,6 years. The third group consisted of 10 patients without diastolic dysfunction and manifestations of heart failure (mean age 57 ± 2,8 years. Results and discussion: 10% patients with postinfarction cardiosclerosis and concomitant hypertension with diastolic heart failure had NYHA

  13. Repeated renal infarction in native and transplanted kidneys due to left ventricular thrombus formation caused by antiphospholipid antibody syndrome

    Directory of Open Access Journals (Sweden)

    Scully P

    2013-01-01

    Full Text Available Paul Scully,1 Daniel C Leckstroem,1 Andrew McGrath,2 John Chambers,3 David J Goldsmith11Nephrology Department, 2Radiology Department, 3Cardiology Department, King's Health Partners, Academic Health Sciences Centre, London, United KingdomAbstract: Antiphospholipid syndrome can be a feature of several underlying conditions, such as lupus, but it can also occur idiopathically. Diagnosis usually comes after investigation of recurrent venous or arterial thromboses, emboli, or hypertension/proteinuria where the kidney is involved and is usually confirmed by laboratory testing. We describe a case of a man with a myocardial infarction who developed mural thrombus in an akinetic left ventricular segment but then who recurrently embolized first to one of his native kidneys and then later to a transplanted kidney. Although the clinical behavior was typical of antiphospholipid syndrome, it took numerous laboratory assays over many years until finally the problem was confirmed and life-long warfarin therapy instituted.Keywords: antiphospholipid therapy, emboli, infarction, kidney, kidney transplant

  14. Clinical characteristics, left and right ventricular ejection fraction, and long-term prognosis in patients with non-insulin-dependent diabetes surviving an acute myocardial infarction

    DEFF Research Database (Denmark)

    Melchior, T; Gadsbøll, N; Hildebrandt, P

    1996-01-01

    survivors of acute myocardial infarction, 47 of whom had Type 2 (non-insulin-dependent) diabetes mellitus. None of the patients were treated with insulin. The prevalence of congestive heart failure during hospitalization was similar in patients with and without diabetes, although mean diuretic dose...... mortality in patients with non-insulin-dependent diabetes mellitus is not explained by available risk markers after myocardial infarction. Even though left ventricular ejection fraction and serum creatinine did not differ significantly, the apparent higher dose of Frusemide in patients with than without non-insulin......Patients with diabetes mellitus have a high morbidity and mortality from acute myocardial infarction, the reason for which is not fully understood. The relationship between congestive heart failure symptoms, left ventricular ejection fraction, and long-term mortality was examined in 578 hospital...

  15. The revised role of left ventricular dilatation and ACE-inhibition after myocardial infarction

    NARCIS (Netherlands)

    Kam, Pieter Jan de

    2002-01-01

    It has generally been accepted that a myocardial infarction is complicated by extensive LVdilatation and that the main mechanism by which ACE-inhibitors produce their beneficial effects after myocardial infarction is attenuation of LV dilatation. This thesis tests both theories in an era where the

  16. Autologous cardiomyotissue implantation promotes myocardial regeneration, decreases infarct size, and improves left ventricular function

    NARCIS (Netherlands)

    J.J. Wykrzykowska (Joanna); A. Rosinberg (Audrey); S.U. Lee (Seung); P. Voisine (Pierre); G. Wu (Guanming); E. Appelbaum (Evan); M. Boodhwani (Munir); F.W. Sellke (Frank); R.J. Laham (Roger)

    2011-01-01

    textabstractBackground-: Cell therapy for myocardial infarction (MI) may be limited by poor cell survival and lack of transdifferentiation. We report a novel technique of implanting whole autologous myocardial tissue from preserved myocardial regions into infarcted regions. Methods and results-: Fou

  17. Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars

    2005-01-01

    BACKGROUND: Reports on the prognostic importance of atrial fibrillation following myocardial infarction have provided considerable variation in results. Thus, this study examined the impact of left ventricular systolic function and congestive heart failure on the prognostic importance of atrial...... and congestive heart failure were prospectively collected. Mortality was followed for 5 years. RESULTS: In patients with left ventricular ejection fraction... mortality. In patients with 0.250.35. In patients with congestive heart failure, atrial fibrillation/atrial flutter was associated with an increased in-hospital mortality (OR=1.5 (1.2-1.9); p

  18. Does global longitudinal speckle-tracking strain predict left ventricular remodeling in patients with myocardial infarction? a systematic review

    Directory of Open Access Journals (Sweden)

    Afsoon Fazlinejad

    2016-07-01

    Full Text Available Introduction: Left ventricular remodeling is a relatively prevalent complication of acute myocardial infarction (AMI, and it is associated with higher rates of medical issues and mortality. Left ventricle ejection fraction (LVEF and wall motion score index (WMSI are unable to detect accurately minor lesions following AMI. Global longitudinal strain (GLS, which is obtained through 2D-speckle tracking echocardiography (2D-STE, provides an angle-dependent measurement by which the infarcted area can be assessed as a means of identifying potential dysfunction. The main objective of this study was to evaluate whether GLS could adequately predict LV remodeling in AMI patients. Methods: The MEDLINE database from database inception to May 6th, 2015, was searched for relevant keywords and the reference lists of systematic reviews and eligible studies were also screened. All studies involving patients with their first reported case of AMI were examined for GLS by 2D-STE and were evaluated for LV remodeling at a three-month follow-up point.  Four English-language prospective cohort studies were eligible for inclusion in this study.Result: A total of 291 AMI patients (mean age=57.92 years were investigated across four different studies. The main finding of this study was that the most reliable and consistent measurement for the purposes of predicting LV remodeling in AMI patients is GLS obtained at the time of discharge, especially in STEMI patients.Discussion: In addition to their poor reproducibility, inability to stratify risks, and inter-observer variability, compensatory hyperkinesis of intact myocytes and myocardial stunning after an AMI are among the main reasons why LVEF and WMSI may not be the most effective predictors of LV remodeling in AMI.Conclusion: GLS obtained by 2D-STE at the time of discharge could be used as a reliable predictor of LV remodeling in AMI patients.

  19. Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dt(max) complementary or redundant?

    Science.gov (United States)

    Ishikawa, Kiyotake; Chemaly, Elie R; Tilemann, Lisa; Fish, Kenneth; Ladage, Dennis; Aguero, Jaime; Vahl, Torsten; Santos-Gallego, Carlos; Kawase, Yoshiaki; Hajjar, Roger J

    2012-04-01

    Among the various cardiac contractility parameters, left ventricular (LV) ejection fraction (EF) and maximum dP/dt (dP/dt(max)) are the simplest and most used. However, these parameters are often reported together, and it is not clear if they are complementary or redundant. We sought to compare the discriminative value of EF and dP/dt(max) in assessing systolic dysfunction after myocardial infarction (MI) in swine. A total of 220 measurements were obtained. All measurements included LV volumes and EF analysis by left ventriculography, invasive ventricular pressure tracings, and echocardiography. Baseline measurements were performed in 132 pigs, and 88 measurements were obtained at different time points after MI creation. Receiver operator characteristic (ROC) curves to distinguish the presence or absence of an MI revealed a good predictive value for EF [area under the curve (AUC): 0.998] but not by dP/dt(max) (AUC: 0.69, P EF). Dividing dP/dt(max) by LV end-diastolic pressure and heart rate (HR) significantly increased the AUC to 0.87 (P EF). In naïve pigs, the coefficient of variation of dP/dt(max) was twice than that of EF (22.5% vs. 9.5%, respectively). Furthermore, in n = 19 pigs, dP/dt(max) increased after MI. However, echocardiographic strain analysis of 23 pigs with EF ranging only from 36% to 40% after MI revealed significant correlations between dP/dt(max) and strain parameters in the noninfarcted area (circumferential strain: r = 0.42, P = 0.05; radial strain: r = 0.71, P EF is a more accurate measure of systolic dysfunction than dP/dt(max) in a swine model of MI. Despite the variability of dP/dt(max) both in naïve pigs and after MI, it may sensitively reflect the small changes of myocardial contractility.

  20. Patient-specific assessment of left ventricular thrombogenesis risk after acute myocardial infarction: a pilot clinical study

    Science.gov (United States)

    Rossini, L.; Khan, A.; Del Alamo, J. C.; Martinez-Legazpi, P.; Pérez Del Villar, C.; Benito, Y.; Yotti, R.; Barrio, A.; Delgado-Montero, A.; Gonzalez-Mansilla, A.; Fernandez-Avilés, F.; Bermejo, J.

    2016-11-01

    Left ventricular thrombosis (LVT) is a major complication of acute myocardial infarction (AMI). In these patients, the benefits of chronic anticoagulation therapy need to be balanced with its pro-hemorrhagic effects. Blood stasis in the cardiac chambers, a risk factor for LVT, is not addressed in current clinical practice. We recently developed a method to quantitatively assess the blood residence time (RT) inside the left ventricle (LV) based on 2D color-Doppler velocimetry (echo-CDV). Using time-resolved blood velocity fields acquired non-invasively, we integrate a modified advection equation to map intraventricular stasis regions. Here, we present how this tool can be used to estimate the risk of LVT in patients with AMI. 73 patients with a first anterior-AMI were studied by echo-CDV and RT analysis within 72h from admission and at a 5-month follow-up. Patients who eventually develop LVT showed early abnormalities of intraventricular RT: the apical region with RT>2s was significantly larger, had a higher RT and a longer wall contact length. Thus, quantitative analysis of intraventricular flow based on echocardiography may provide subclinical markers of LV thrombosis risk to guide clinical decision making.

  1. Assessment of left ventricular torsion in patients with anterior wall myocardial infarction before and after revascularization using speckle tracking imaging

    Institute of Scientific and Technical Information of China (English)

    HAN Wei; XIE Ming-xing; WANG Xin-fang; L(U) Qing; WANG Jing; ZHANG li; ZHANG Jing

    2008-01-01

    Background Rotation of the left ventricular(LV)apex to the base,or LV torsion,is related to myocardial contractility and structure and has recently been recognized as a sensitive indicator of cardiac performance,but it has been difficult to measure.The recent development of 2-dimensional(2D)speckle tracking imaging(STI)may provide a powerful means of assessing LV torsion.This study was conducted to evaluate the global and regional LV twist in patients with anterior wall myocardial infarction(AMI)disease before and after revascularization by STI.Methods 2D STI was performed in 35 AMI patients before and one month after revascularization,as well as in 32 normal controls.Left ventricular global and regional rotations were obtained at basal and apical short-axis levels;LV torsion was defined as apical rotation relative to the base.The time sequences were normalized to the percentage of systolic and diastolic duration.Results Before revascularization,LV peak regional and global torsion in patients with Aml were significantly reduced as the result of reduced apical and basal rotation relative to those of normal control group(all P<0.001):most significantly in the anterior and anterior-septal regions(P<0.001);one month after revascularization,there were significant changes in peak rotation at either the base or apex relative to pre-revascularization values(all P<0.001).Similarly,peak regional and global LV torsion were increased significantly(all P<0.001).Global torsion inversely correlated with EDV(r=0.605,P=0.028)and ESV(r=-0.638,P=-0.019):and positively correlated with LVEF(r=0.630,P=0.021).tlght relations were also found between torsion and.LV longitudinal and short axis function.Conclusions Systolic torsion was decreased in AMI patients.Revascularization therapy can improve the LV function of the AMI patients.STI has a potential to quantify left ventricular global and segment torsion in patients with AMI,and may make the assessment more available in clinical and

  2. Three hours continuous injection of adenosine improved left ventricular function and infarct size in patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hang; TIAN Nai-liang; HU Zuo-ying; WANG Feng; CHEN Liang; ZHANG Yao-jun; CHEN Shao-liang

    2012-01-01

    Background The definitive treatment for myocardial ischemia is reperfusion.However,reperfusion injury has the potential to cause additional reversible and irreversible damage to the myocardium.One likely candidate for a cardioprotection is adenosine.The present study aimed at investigating the effect of intravenous adenosine on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1:1:1 ratio to receive either adenosine 50 μg·kg-1·min-1 (low-dose group,n=31),or 70 μgkg-1·min-1 (high-dose group,n=32),or saline 1 ml/min (control group,n=27) for three hours.Drugs were given to the patients immediately after the guide wire crossed the culprit lesion.Recurrence of no-reflow,TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG),and collateral circulation were recorded.The postoperative and preoperative ST segment elevation sum of 18-lead electrocardiogram (ECG) and their ratio (STsum-post/STsum-pre) were recorded,as well as the peak time and peak value of CK-MB enzyme.Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post-stenting.The primary endpoint was left ventricular function,and infarct size.The secondary end-point was the occurrence of cardiac and non-cardiac death,non-fatal myocardial infarction,and heart failure.Results A total of 90 STEMI patients were studied.No-reflow immediately after stent procedure was seen in 11 (35.5%)patients in the control group,significantly different from 6.3% in the low-dose group or 3.7% in the high-dose group (both P=0.001).STsum-post/STsum-pre in the low-dose and high-dose groups was significantly different from the control group (low-dose group vs.control group,P=0.003 and high-dose group vs.control group,P=0.001),without a dose-dependent pattern (P=0.238).The peak value of CK-MB enzyme

  3. Left Ventricular Hypertrophy

    Science.gov (United States)

    ... the chamber itself also increases. The enlarged heart muscle loses elasticity and eventually may fail to pump with as much force as needed. Left ventricular hypertrophy is more common in people who have uncontrolled ...

  4. Catecholaminergic activation in acute myocardial infarction: time course and relation to left ventricular performance

    DEFF Research Database (Denmark)

    Petersen, Claus Leth; Nielsen, Jens Rokkedal; Petersen, Bodil Laub;

    2003-01-01

    AIM: The study was designed to assess (1) the time course of catecholaminergic activation in acute myocardial infarction (AMI) as estimated by adrenaline (ADR) and noradrenaline (NOR) concentrations, and (2) to relate activation of these hormones to predict the outcome of cardiac performance...

  5. Progressive left ventricular hypertrophy after withdrawal of long-term ACE inhibition following experimental myocardial infarction

    NARCIS (Netherlands)

    Westendorp, B; Schoemaker, RG; Buikema, H; Boomsma, F; van Veldhuisen, DJ; van Gilsta, WH

    2006-01-01

    Background: Although discontinuation of chronic ACE inhibitor (ACEi) therapy after myocardial infarction (MI) is common in clinical practice, some clinical studies reported an increased incidence of ischemia-related events after withdrawal. To further address this issue, we assessed hemodynamic, neu

  6. Effects of losartan and captopril on left ventricular systolic and diastolic function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Møller, Jacob E; Dahlström, Ulf; Gøtzsche, Ole

    2004-01-01

    BACKGROUND: Angiotensin-converting enzyme inhibitors have been shown to attenuate adverse remodeling after acute myocardial infarction (AMI), and the same has been suggested for angiotensin II type 1 receptor antagonists in animal models. Therefore the aim of the study was to compare the effects...

  7. Left ventricular filling patterns in patients with previous myocardial infarction measured by conventional cine cardiac magnetic resonance.

    Science.gov (United States)

    Rodríguez-Granillo, Gastón A; Mejía-Campillo, Marlon; Rosales, Miguel A; Bolzán, Gabriel; Ingino, Carlos; López, Federico; Degrossi, Elina; Lylyk, Pedro

    2012-04-01

    To explore left ventricular filling patterns in patients with a history of previous myocardial infarction (MI) using time-volume curves obtained from conventional cine-cardiac magnetic resonance (CMR) examinations. Consecutive patients with a history of previous MI who were referred for CMR evaluation constituted the study population, and a consecutive cohort of sex and age-matched patients with a normal CMR constituted the control group. The following CMR diastolic parameters were evaluated: peak filling rate (PFR), time to PFR (tPFR), normalised PFR adjusted for diastolic volume at PFR (nPFR), and percent RR interval between end systole and PFR. Fifty patients were included, 25 with a history of previous MI and 25 control. The mean age was 59.6 ± 13.9 years and 27 (54%) were male. Within the control group, age was significantly related to PFR (r = -0.53, p = 0.007), whereas among patients with previous MI age was not related to PFR (r = -0.16, p = 0.44). PFR (252.4 ± 96.7 ml/s vs. 316.0 ± 126.4 ml/s, p = 0.05) and nPFR (1.6 ± 1.2 vs. 3.3 ± 1.5, p PFR (18.1 ± 9.7% vs. 20.6 ± 12.2%, p = 0.44). MI size was related to LV ejection fraction (r = -0.76, p PFR (r = -0.40, p = 0.004), nPFR (r = -0.52, p PFR quartile (PFR (p = 0.017). Infarct size has an impact on LV filling profiles, as assessed by conventional cine CMR without additional specific pulse sequences.

  8. Left ventricular function by speckle-tracking echocardiography in patients with low-T3 syndrome and acute myocardial infarction.

    Science.gov (United States)

    Jankauskienė, Edita; Orda, Paulius; Rumbinaitė, Eglė; Žaliaduonytė-Pekšienė, Diana; Steponavičiutė, Rasa; Krasauskienė, Aurelija; Vaškelytė, Jolanta Justina; Bunevičius, Robertas

    2015-01-01

    Low-T3 syndrome is common in patients with acute myocardial infarction (AMI). Recent experimental and clinical data have suggested a potential negative impact of low-T3 syndrome on myocardial function in patients with AMI. The aim of this study was to assess left ventricular (LV) myocardial function in patients with low-T3 syndrome and to investigate the association between hormonal profile and the severity of LV dysfunction using speckle-tracking echocardiography (STE). In 130 patients with first-onset ST-segment elevation acute myocardial infarction (STEMI), conventional 2D and speckle-tracking echocardiography within 48-72h after the hospitalization was performed, and blood samples for TSH, fT4, fT3, and anti-TPO levels were obtained to investigate thyroid hormone production within 24h and on the fourth day after the onset of STEMI symptoms. The patients were divided into two groups according to their serum level of fT3: group 1 with fT3 concentration below 3.2pmol/L (n=34) and group 2 with normal fT3 (>3.2pmol/L) level (n=96). LV ejection fraction (EF) tended to be lower in the low fT3 group. The systolic longitudinal strain did not differ between the groups, but the late diastolic longitudinal strain rate was lower in group 1 (P=0.011). The systolic basal LV rotation positively correlated with the level of fT3 (r=0.4; Pspeckle-tracking echocardiography were impaired in patients with low-T3 syndrome after AMI. Copyright © 2015 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  9. Relationship between site of myocardial infarction, left ventricular function and cytokine levels in patients undergoing coronary artery surgery.

    Science.gov (United States)

    Kiris, Ilker; Kapan, Sahin; Narin, Cuneyt; Ozaydın, Mehmet; Cure, Medine Cumhur; Sutcu, Recep; Okutan, Huseyin

    The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.

  10. High-sensitivity troponin T for prediction of left ventricular function and infarct size one year following ST-elevation myocardial infarction.

    Science.gov (United States)

    Reinstadler, Sebastian Johannes; Feistritzer, Hans-Josef; Klug, Gert; Mair, Johannes; Tu, Alexander Minh-Duc; Kofler, Markus; Henninger, Benjamin; Franz, Wolfgang-Michael; Metzler, Bernhard

    2016-01-01

    Data relating high-sensitivity cardiac troponin T (hs-cTnT) to long-term myocardial function and infarct size in patients after ST-elevation myocardial infarction (STEMI) are lacking. We aimed to evaluate the use of early hs-cTnT concentrations for prediction of myocardial function and infarct size assessed by cardiac magnetic resonance imaging (CMR) one year following STEMI. Sixty-six patients, revascularized by primary percutaneous coronary intervention (PCI) for first-time STEMI, were enrolled in this observational study. Serial hs-cTnT, creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP) and lactate dehydrogenase (LDH) levels were measured on admission, 6 h, 12 h, and 24 h post-PCI. Patients underwent CMR within the first week and 12months thereafter. Except for admission hs-cTnT, all single time point and peak hs-cTnT concentrations showed significant correlations with left ventricular ejection fraction (LVEF: r=-0.404 to -0.517, all ps8%) at 12months. The combination of all four biomarkers resulted in an AUC of 0.82 and 0.92 for the prediction of reduced LVEF and large IS at 12months, respectively (both ps>0.05). In stable STEMI patients successfully revascularized by primary PCI, serial and peak concentrations of hs-cTnT are closely correlated to long-term LVEF and IS. Combination of hs-cTnT with CK, hs-CRP, or LDH did not add any significant prognostic value as compared with hs-cTnT alone. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. EFFECT OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION ON CEREBRAL HEMODYNAMICS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (THE RESULTS OF OBSERVATIONAL STUDIES

    Directory of Open Access Journals (Sweden)

    V. E. Kulikov

    2015-12-01

    Full Text Available Aim. To study the effect of left ventricular (LV systolic dysfunction on cerebral hemodynamic in patients with ST segment elevation myocardial infarction (STEMI during acute period. Material and methods. Cerebral hemodynamics ultrasound assessment was performed in the extra-and intracranial vessels in 118 patients with STEMI. Results. Significant changes in cerebral hemodynamics were found in LV systolic dysfunction with ejection fraction (LVEF ≤40% due to hemispheric blood flow asymmetry in the middle cerebral artery (MCA as large as 45.1±6.7% with correlation coefficient r=-0.87. Compensation of cerebral blood flow was manifested in vasoconstriction or vasodilation (resistive index 0.63-0.76 and 0.49-0.43 c.u., respectively. Conclusion. A strong relationship between LV systolic dysfunction and cerebral hemodynamic was found in patients with STEMI. It was manifested in significant contralateral hemispheric blood flow asymmetry in MCA in patients with LVEF ≤40%. Reduction in cerebral blood flow velocity activated autoregulation mechanism in the form of vasoconstriction or vasodilation.

  12. Effect of the angiotensin-converting enzyme inhibitor trandolapril on mortality and morbidity in diabetic patients with left ventricular dysfunction after acute myocardial infarction. Trace Study Group

    DEFF Research Database (Denmark)

    Gustafsson, I; Torp-Pedersen, C; Køber, L;

    1999-01-01

    OBJECTIVES: This study evaluated the efficacy of long-term treatment with the angiotensin-converting enzyme (ACE) inhibitor trandolapril in diabetic patients with left ventricular dysfunction after acute myocardial infarction (AMI). BACKGROUND: Patients with diabetes mellitus have a high mortality...... following AMI, probably due to a high risk of congestive heart failure and reinfarction. Because ACE inhibition effectively reduces progression of heart failure, it could be particularly beneficial in diabetic patients after AMI. METHODS: The study is a retrospective analysis using data from.......21 to 0.67]), and no significant reduction of this end point was found in the nondiabetic group. CONCLUSIONS: The ACE inhibition after myocardial infarction complicated by left ventricular dysfunction appears to be of considerable importance in patients with diabetes mellitus by saving lives...

  13. Increased infarct wall thickness by a bio-inert material is insufficient to prevent negative left ventricular remodeling after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Aboli A Rane

    Full Text Available BACKGROUND: Several injectable materials have been shown to preserve or improve cardiac function as well as prevent or slow left ventricular (LV remodeling post-myocardial infarction (MI. However, it is unclear as to whether it is the structural support or the bioactivity of these polymers that lead to beneficial effects. Herein, we examine how passive structural enhancement of the LV wall by an increase in wall thickness affects cardiac function post-MI using a bio-inert, non-degradable synthetic polymer in an effort to better understand the mechanisms by which injectable materials affect LV remodeling. METHODS AND RESULTS: Poly(ethylene glycol (PEG gels of storage modulus G' = 0.5±0.1 kPa were injected and polymerized in situ one week after total occlusion of the left coronary artery in female Sprague Dawley rats. The animals were imaged using magnetic resonance imaging (MRI at 7±1 day(s post-MI as a baseline and again post-injection 49±4 days after MI. Infarct wall thickness was statistically increased in PEG gel injected vs. control animals (p<0.01. However, animals in the polymer and control groups showed decreases in cardiac function in terms of end diastolic volume, end systolic volume and ejection fraction compared to baseline (p<0.01. The cellular response to injection was also similar in both groups. CONCLUSION: The results of this study demonstrate that passive structural reinforcement alone was insufficient to prevent post-MI remodeling, suggesting that bioactivity and/or cell infiltration due to degradation of injectable materials are likely playing a key role in the preservation of cardiac function, thus providing a deeper understanding of the influencing properties of biomaterials necessary to prevent post-MI negative remodeling.

  14. Heart rate index: an indicator of left ventricular ejection fraction. Comparison of left ventricular ejection fraction and variables assessed by exercise test in patients studied early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Haedersdal, C; Pedersen, F H; Svendsen, Jesper Hastrup

    1992-01-01

    The present study compares the variables assessed by standard exercise test with the left ventricular ejection fraction (LVEF) measured by multigated radionuclide angiocardiography (MUGA) in 77 patients early after myocardial infarction. The exercise test and MUGA were performed within two weeks...... after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate...... at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...

  15. Heart rate index: an indicator of left ventricular ejection fraction. Comparison of left ventricular ejection fraction and variables assessed by exercise test in patients studied early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Haedersdal, C; Pedersen, F H; Svendsen, Jesper Hastrup

    1992-01-01

    at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...... after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate......The present study compares the variables assessed by standard exercise test with the left ventricular ejection fraction (LVEF) measured by multigated radionuclide angiocardiography (MUGA) in 77 patients early after myocardial infarction. The exercise test and MUGA were performed within two weeks...

  16. Relation of early changes of QT dispersion to changes in left ventricular systolic and diastolic function after a first acute myocardial infarction

    DEFF Research Database (Denmark)

    Møller, Jacob E; Husic, Mirza; Søndergaard, Eva

    2002-01-01

    OBJECTIVE: To describe the relation between changes of left ventricular systolic and diastolic function and changes of QT dispersion (difference in duration between longest and shortest QT interval) following acute myocardial infarction. DESIGN: QT dispersion was determined at admission, hospital...... normalized QT dispersion was associated with a significant decrease of ventricular volumes. After 1 year end-systolic (70 +/- 32 ml vs 49 +/- 16 ml, p = 0.006) and end-diastolic volumes (138 +/- 41 ml vs 105 +/- 22 ml, p = 0.001) were higher in Group B. In a multivariate model Group B was significantly...

  17. Impact of Left Ventricular Hypertrophy on Troponin Release During Acute Myocardial Infarction: New Insights From a Comprehensive Translational Study

    Science.gov (United States)

    Fernández‐Jiménez, Rodrigo; Silva, Jacobo; Martínez‐Martínez, Sara; López‐Maderuelo, Mª Dolores; Nuno‐Ayala, Mario; García‐Ruiz, José Manuel; García‐Álvarez, Ana; Fernández‐Friera, Leticia; Pizarro, Tech Gonzalo; García‐Prieto, Jaime; Sanz‐Rosa, David; López‐Martin, Gonzalo; Fernández‐Ortiz, Antonio; Macaya, Carlos; Fuster, Valentin; Redondo, Juan Miguel; Ibanez, Borja

    2015-01-01

    Background Biomarkers are frequently used to estimate infarct size (IS) as an endpoint in experimental and clinical studies. Here, we prospectively studied the impact of left ventricular (LV) hypertrophy (LVH) on biomarker release in clinical and experimental myocardial infarction (MI). Methods and Results ST‐segment elevation myocardial infarction (STEMI) patients (n=140) were monitored for total creatine kinase (CK) and cardiac troponin I (cTnI) over 72 hours postinfarction and were examined by cardiac magnetic resonance (CMR) at 1 week and 6 months postinfarction. MI was generated in pigs with induced LVH (n=10) and in sham‐operated pigs (n=8), and serial total CK and cTnI measurements were performed and CMR scans conducted at 7 days postinfarction. Regression analysis was used to study the influence of LVH on total CK and cTnI release and IS estimated by CMR (gold standard). Receiver operating characteristic (ROC) curve analysis was performed to study the discriminatory capacity of the area under the curve (AUC) of cTnI and total CK in predicting LV dysfunction. Cardiomyocyte cTnI expression was quantified in myocardial sections from LVH and sham‐operated pigs. In both the clinical and experimental studies, LVH was associated with significantly higher peak and AUC of cTnI, but not with differences in total CK. ROC curves showed that the discriminatory capacity of AUC of cTnI to predict LV dysfunction was significantly worse for patients with LVH. LVH did not affect the capacity of total CK to estimate IS or LV dysfunction. Immunofluorescence analysis revealed significantly higher cTnI content in hypertrophic cardiomyocytes. Conclusions Peak and AUC of cTnI both significantly overestimate IS in the presence of LVH, owing to the higher troponin content per cardiomyocyte. In the setting of LVH, cTnI release during STEMI poorly predicts postinfarction LV dysfunction. LV mass should be taken into consideration when IS or LV function are estimated by troponin

  18. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Garber, Adam M; Mentz, Robert J; Al-Khalidi, Hussein R; Shaw, Linda K; Fiuzat, Mona; O'Connor, Christopher M; Velazquez, Eric J

    2016-04-01

    We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.

  19. Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm: long-term results

    Institute of Scientific and Technical Information of China (English)

    HUANG Xin-sheng; ZHOU Qi-wen; GU Cheng-xiong; YANG Jun-feng; WEI Hua; LI Jing-xing; YU Yang; FANG Ying; LIU Rui; LI Hai-tao

    2012-01-01

    Background The temporal response to off-pump anteroapical aneurysm plication has not been well defined.We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.Methods From March 2005 to May 2010,163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA),54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B).All patients had simultaneous coronary revascularization,other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six.Follow-up ranged from 1 to 5 years,short-term and mid-term outcomes,including complications,cardiac function,and mortality,were assessed.Results Early mortality was 1.8% for all patients (group A 1 death vs.group B 2 deaths,not significant (NS)).Peri-operative support included intraaortic balloon pumping in 16 (9.8%),(group A 6 patients vs.group B 10 patients,NS)and inotropic drugs in 84 (51.5%),(group A 34 vs.group B 50,NS).During a mean follow-up of (3.7±0.8) years,eight patients died,with four due to cardiac-related causes.No patient required transplantation,and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia.Survival at 1 and 5 years was 95% and 86%,respectively.It did not differ significantly between group A and group B.Functional class improved from 2.90±0.59 to 1.65±0.54 among the mid-term survivors (P <0.001),with no significant difference between the two groups.Pre-operative risk factors for mortality or poor function were ejection fraction (EF) <0.35 (OR=7.9,95% CI 1.6-40.0); congestive heart failure (CHF) (OR=4.4,95% CI 1.0-19.0); end-systolic volume index (ESVI) >80 ml/m2 (OR=3.7,95% C/ 1.0-14.0); and advanced age >70 years (OR=2.4,95% C/ 1.0-12.0).Conclusions The technique of off-pump anteroapical aneurysm

  20. Depletion of circulating blood NOS3 increases severity of myocardial infarction and left ventricular dysfunction.

    Science.gov (United States)

    Merx, Marc W; Gorressen, Simone; van de Sandt, Annette M; Cortese-Krott, Miriam M; Ohlig, Jan; Stern, Manuel; Rassaf, Tienush; Gödecke, Axel; Gladwin, Mark T; Kelm, Malte

    2014-01-01

    Nitric oxide (NO) derived from endothelial NO synthase (NOS3) plays a central role in myocardial ischemia/reperfusion (I/R)-injury. Subsets of circulating blood cells, including red blood cells (RBCs), carry a NOS3 and contribute to blood pressure regulation and RBC nitrite/nitrate formation. We hypothesized that the circulating blood born NOS3 also modulates the severity of myocardial infarction in disease models. We cross-transplanted bone marrow in wild-type and NOS3(-/-) mice with wild-type mice, producing chimeras expressing NOS3 only in vascular endothelium (BC-/EC+) or in both blood cells and vascular endothelium (BC+/EC+). After 60-min closed-chest coronary occlusion followed by 24 h reperfusion, cardiac function, infarct size (IS), NOx levels, RBCs NO formation, RBC deformability, and vascular reactivity were assessed. At baseline, BC-/EC+ chimera had lower nitrite levels in blood plasma (BC-/EC+: 2.13 ± 0.27 μM vs. BC+/EC+ 3.17 ± 0.29 μM; *p NOS3 in an acute model of myocardial I/R in chimeric mice.

  1. Predictors of ventricular remodelling in patients with reperfused acute myocardial infarction and left ventricular dysfunction candidates for bone marrow cell therapy: insights from the BONAMI trial

    Energy Technology Data Exchange (ETDEWEB)

    Manrique, Alain [Nuclear Medicine, CHU de Caen, Caen (France); Universite de Caen Normandie, EA 4650, Caen (France); CHU de Caen et GIP Cyceron, Caen cedex 6 (France); Lemarchand, Patricia; Delasalle, Beatrice; Lamirault, Guillaume; Trochu, Jean-Noel; Le Tourneau, Thierry [L' Institut du thorax, INSERM, UMR1087, Nantes (France); CNRS, UMR 6291, Nantes (France); Universite de Nantes, Nantes (France); CHU de Nantes, Nantes (France); Lairez, Olivier; Roncalli, Jerome [Institut CARDIOMET-Toulouse, Cardiac Imaging Center, CIC Biotherapies, CHU de Toulouse, Toulouse (France); Sportouch-Duckan, Catherine; Piot, Christophe [Universite Montpellier, Institut de Genomique Fonctionnelle, INSERM U661, CNRS UMR 5203, Montpellier (France); Clinique du Millenaire, Montpellier (France); Le Corvoisier, Philippe [Hopital Henri Mondor, INSERM, Centre d' Investigation Clinique 1430 et U955 equipe 3, Creteil (France); Neuder, Yannick [CHU de Grenoble, Pole Thorax et Vaisseaux, Grenoble (France); Richardson, Marjorie [CHRU Lille, Service d' Explorations Fonctionnelles Cardiovasculaires, Hopital Cardiologique, Lille (France); Lebon, Alain [CHU de Caen, Service de Cardiologie, Caen (France); Teiger, Emmanuel [Hopital Henri Mondor, AP-HP, Unite de Cardiologie Interventionnelle et Federation de Cardiologie, Creteil (France); Hossein-Foucher, Claude [Hopital Salengro CHRU de Lille, Service de Medecine Nucleaire, Lille (France); Universite de Lille 2, UFR de Medecine, Lille (France)

    2016-04-15

    Few data are available regarding the relation of left ventricular (LV) mechanical dyssynchrony to remodelling after acute myocardial infarction (MI) and stem cell therapy. We evaluated the 1-year time course of both LV mechanical dyssynchrony and remodelling in patients enrolled in the BONAMI trial, a randomized, multicenter controlled trial assessing cell therapy in patients with reperfused MI. Patients with acute MI and ejection fraction (EF) ≤ 45 % were randomized to cell therapy or to control and underwent thallium single-photon emission computed tomography (SPECT), radionuclide angiography, and echocardiography at baseline, 3 months, and 1 year. Eighty-three patients with a comprehensive 1-year follow-up were included. LV dyssynchrony was assessed by the standard deviation (SD) of the LV phase histogram using radionuclide angiography. Remodelling was defined as a 20 % increase in LV end-systolic volume index (LVESVI) at 1 year. At baseline, LVEF, wall motion score index, and perfusion defect size were significantly impaired in the 43 patients (52 %) with LV remodelling (all p < 0.001), without significant increase in LV mechanical dyssynchrony. During follow-up, there was a progressive increase in LV SD (p = 0.01). Baseline independent predictors of LV remodelling were perfusion SPECT defect size (p = 0.001), LVEF (p = 0.01) and a history of hypertension (p = 0.043). Bone marrow cell therapy did not affect the time-course of LV remodelling and dyssynchrony. LV remodelling 1 year after reperfused MI is associated with progressive LV dyssynchrony and is related to baseline infarct size and ejection fraction, without impact of cell therapy on this process. (orig.)

  2. Acute Myocardial Infarction with Left Ventricular Failure as an Initial Presentation of Takayasu’s Arteritis

    Science.gov (United States)

    Sontakke, Tushar R; Mishra, Deepankar; Saxena, Shilpa; Banode, Pankaj

    2016-01-01

    Takayasu’s Arteritis (TA) is an uncommon chronic inflammatory and stenotic disease of medium and large-sized arteries characterized by a strong predilection for the aortic arch and its major branches. We report a rare manifestation of TA in a 16-year-old female with no previous history of heart disease who presented with heart failure. She was found to have hypertension and discrepancies of pulses in upper and lower limbs. She developed ST elevated anterior wall myocardial infarction (MI) during hospitalization. Her aortography revealed narrowing of descending thoracic, upper abdominal and infrarenal aorta with significant stenosis of both renal arteries. She was diagnosed as a case of TA on the basis of her clinical profile and arteriography. Her coronary angiography did not reveal any stenosis or occlusion or aneurysm in coronary arteries or at coronary ostia which is in contrast to patients of TA with MI reported in the literature who had focal or diffuse stenosis or aneurysm in the coronaries. PMID:27437287

  3. Abnormal glucose metabolism in acute myocardial infarction: influence on left ventricular function and prognosis

    DEFF Research Database (Denmark)

    Høfsten, Dan E; Løgstrup, Brian B; Møller, Jacob E

    2009-01-01

    tolerance test before discharge. LV function was assessed using echocardiographic measurements (LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, restrictive diastolic filling pattern, early transmitral flow velocity to early diastolic mitral annular velocity ratio [E/e'], and left...... atrial volume index) and by measuring plasma N-terminal pro-B-type natriuretic peptide levels. RESULTS: After adjustment for age and gender, a linear relationship between the degree of abnormal glucose metabolism was observed for each marker of LV dysfunction (p(trend)

  4. Value of three-dimensional strain parameters for predicting left ventricular remodeling after ST-elevation myocardial infarction.

    Science.gov (United States)

    Xu, Lin; Huang, Xiaomin; Ma, Jun; Huang, Jiangming; Fan, Yongwang; Li, Huidi; Qiu, Jian; Zhang, Heye; Huang, Wenhua

    2017-02-01

    This study was to evaluate the value of multi-directional strain parameters derived from three-dimensional (3D) speckle tracking echocardiography (STE) for predicting left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) compared with that of two-dimensional (2D) global longitudinal strain (GLS). A total of 110 patients (mean age, 54 ± 9 years) after STEMI treated with primary PCI were enrolled in our study. At baseline (within 24 h after PCI), standard 2D echocardiography, 2D STE and 3D STE were performed to acquire the conventional echocardiographic parameters and strain parameters. At 3-month follow-up, standard 2D echocardiography was repeated to all the patients to determine LV remodeling, which was defined as a 20% increase in LV end-diastolic volume. At 3-month follow-up, LV remodeling occurred in 26 patients (24%). Compared with patients without LV remodeling, patients with remodeling had significantly reduced 2D GLS (-12.5 ± 3.2% vs -15.0 ± 3.1%, p remodeling. However, receiver-operating characteristic curve analysis showed that the area under the curve of 3D GLS (0.82) for predicting LV remodeling was significantly higher than that of 2D GLS (0.72, p = 0.034), 3D GAS (0.68, p remodeling and 3D GLS is the most powerful predictor among them.

  5. Rats with high left ventricular end-diastolic pressure can be identified by Doppler echocardiography one week after myocardial infarction.

    Science.gov (United States)

    Saraiva, R M; Kanashiro-Takeuchi, R M; Antonio, E L; Campos, O; P J F, Tucci; Moisés, V A

    2007-11-01

    The severity of left ventricular (LV) dysfunction in rats with myocardial infarction (MI) varies widely. Because homogeneity in baseline parameters is essential for experimental investigations, a study was conducted to establish whether Doppler echocardiography (DE) could accurately identify animals with high LV end-diastolic pressure as a marker of LV dysfunction soon after MI. Direct measurements of LV end-diastolic pressure were made and DE was performed simultaneously 1 week after surgically induced MI (N = 16) or sham-operation (N = 17) in female Wistar rats (200 to 250 g). The ratio of peak early (E) to late (A) diastolic LV filling velocities and the ratio of E velocity to peak early (Em) diastolic myocardial velocity were the best predictors of high LV end-diastolic pressure (>12 mmHg) soon after MI. Cut-off values of 1.77 for the E/A ratio (P = 0.001) identified rats with elevated LV end-diastolic pressure with 90% sensitivity and 80% specificity. Cut-off values of 20.4 for the E/Em ratio (P = 0.0001) identified rats with elevated LV end-diastolic pressure with 81.8% sensitivity and 80% specificity. Moreover, E/A and E/Em ratios were the only echocardiographic parameters independently associated with LV end-diastolic pressure in multiple linear regression analysis. Therefore, DE identifies rats with high LV end-diastolic pressure soon after MI. These findings have implications for using serial DE in animal selection and in the assessment of their response to experimental therapies.

  6. Assessment of the Effect of Cardiomyocyte Transplantation on Left Ventricular Remodeling and Function in Post-Infarction Wister Rats by Using High-frequency Ultrasound

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing; XIE Mingxing; WANG Xinfang; L(U) Qing; LANG Mingjian; DENG Binhua

    2007-01-01

    The effects of cardiomyocyte grafting on left ventricular (LV) remodeling and function in rats with chronic myocardial infarction were evaluated using high-frequency ultrasound. Chronic myocardial infarction was induced in 50 Wister rats by ligating the left anterior descending artery. They were randomized into two groups: a trial group that received neonatal rat cardiomyocyte trans- plantation (n=25) and a control group which were given intramyocardial injection of culture medium (n=25). The left ventricular (LV) geometry and function were evaluated by high-frequency ultrasound before and 4 weeks after the cell transplantation. After the final evaluation, all rats were sacrificed for histological study. The results showed that 4 weeks after the cell transplantation, as compared with the control group, the LV end-systolic dimension, end-diastolic dimension, end-systolic volume and end-diastolic volume were significantly decreased and the LV anterior wall end-diastolic thickness, LV ejection fraction and fractional shortening were significantly increased in the trial group (P<0.01). Histological study showed that transplanted neonatal rat cardiomyocytes were found in all host hearts and identified by Brdu staining. It was suggested that transplantation of neonatal rat cardiomyocytes can reverse cardiac remodeling and improve heart function in chronic myocardial infarction rats. High-frequency ultrasound can be used as a reliable technique for the non-invasive evaluation of the effect of cardiomyocyte transplantation.

  7. Surgical Treatment of Left Ventricular Pseudoaneurysm

    Science.gov (United States)

    Mujanovic, Emir; Bergsland, Jacob; Avdic, Sevleta; Stanimirovic-Mujanovic, Sanja; Kovacevic-Preradovic, Tamara; Kabil, Emir

    2014-01-01

    Introduction: Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a cata­strophic complication of myocardial infarction, occurring in approximately 4% of pa­tients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. Case report: In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients. PMID:25568538

  8. Differential prognostic importance of QRS duration in heart failure and acute myocardial infarction associated with left ventricular dysfunction

    DEFF Research Database (Denmark)

    Fosbøl, Emil Loldrup; Seibaek, Marie; Brendorp, Bente;

    2007-01-01

    randomised 3028 patients to dofetilide (class III antiarrhythmic) or placebo. The study consisted of two almost identical trials conducted simultaneously. One trial included 1518 patients with chronic HF and the other trial 1510 patients with a recent MI. All patients had left ventricular dysfunction...

  9. Long-term prognostic importance of resting heart rate in patients with left ventricular dysfunction in connection with either heart failure or myocardial infarction: the DIAMOND study

    DEFF Research Database (Denmark)

    Fosbøl, Emil Loldrup; Seibaek, Marie; Brendorp, Bente

    2010-01-01

    dysfunction in connection with either heart failure (HF) or myocardial infarction (MI). METHODS: In the Danish Investigations and Arrhythmia ON Dofetilide (DIAMOND) study; patients with left ventricular dysfunction were randomized to Dofetilide (class III antiarrhythmic drug) or placebo. One part of the study......BACKGROUND: Elevated resting heart rate is associated with increased mortality in a variety of cardiac diseases, but comparisons between different clinical settings are lacking. We investigated the long-term prognostic importance of resting heart rate in patients hospitalized with left ventricular...... increment in baseline heart rate of 10 bpm was associated with an increase in mortality in both MI-patients (hazard ratio, 1.14; 95%-confidence interval (CI): 1.09-1.19; Pheart rate on short-term prognosis...

  10. Left atrial remodelling in patients with myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALIANT Echo study

    DEFF Research Database (Denmark)

    Meris, Alessandra; Amigoni, Maria; Uno, Hajime

    2009-01-01

    AIMS: To assess the relationship between left atrial (LA) size and outcome after high-risk myocardial infarction (MI) and to study dynamic changes in LA size during long-term follow-up. METHODS AND RESULTS: The VALIANT Echocardiography study prospectively enrolled 610 patients with left ventricul...

  11. Is there still a role for treatment with beta-adrenoceptor antagonists in post-myocardial infarction patients with well-preserved left ventricular systolic function?

    Science.gov (United States)

    Horowitz, John D; Arstall, Margaret A; Zeitz, Christopher J; Beltrame, John F

    2008-01-01

    The utility of beta-adrenoceptor antagonists post myocardial infarction was established in the pre-thrombolytic era. Evidence for improvement in long-term prognosis with metoprolol, timolol and propranolol in particular derives from reduction in event rates in patients who have had substantial left ventricular damage at the time of infarction and probably correlates largely with the more recently demonstrated salutary effects of this group of drugs in patients with chronic heart failure. In all other respects, evidence for beneficial effects of beta-adrenoceptor antagonists in peri-infarct and post-infarct therapeutics is equivocal. They appear to exert no major influence on outcomes in patients with unstable angina, nor do they markedly alter early clinical course in uncomplicated acute myocardial infarction, irrespective of other interventions. Furthermore, the limited available analyses suggest no discernible beneficial effect on long-term outcomes post-uncomplicated infarction. It is possible that in such patients, current recommendations for 'routine' long-term beta-adrenoceptor blockade can no longer be justified.

  12. Left ventricular apical diseases.

    Science.gov (United States)

    Cisneros, Silvia; Duarte, Ricardo; Fernandez-Perez, Gabriel C; Castellon, Daniel; Calatayud, Julia; Lecumberri, Iñigo; Larrazabal, Eneritz; Ruiz, Berta Irene

    2011-08-01

    There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users.

  13. Long-Term Left Ventricular Remodelling in Rat Model of Nonreperfused Myocardial Infarction: Sequential MR Imaging Using a 3T Clinical Scanner

    Directory of Open Access Journals (Sweden)

    Muhammad G. Saleh

    2012-01-01

    Full Text Available Purpose. To evaluate whether 3T clinical MRI with a small-animal coil and gradient-echo (GE sequence could be used to characterize long-term left ventricular remodelling (LVR following nonreperfused myocardial infarction (MI using semi-automatic segmentation software (SASS in a rat model. Materials and Methods. 5 healthy rats were used to validate left ventricular mass (LVM measured by MRI with postmortem values. 5 sham and 7 infarcted rats were scanned at 2 and 4 weeks after surgery to allow for functional and structural analysis of the heart. Measurements included ejection fraction (EF, end-diastolic volume (EDV, end-systolic volume (ESV, and LVM. Changes in different regions of the heart were quantified using wall thickness analyses. Results. LVM validation in healthy rats demonstrated high correlation between MR and postmortem values. Functional assessment at 4 weeks after MI revealed considerable reduction in EF, increases in ESV, EDV, and LVM, and contractile dysfunction in infarcted and noninfarcted regions. Conclusion. Clinical 3T MRI with a small animal coil and GE sequence generated images in a rat heart with adequate signal-to-noise ratio (SNR for successful semiautomatic segmentation to accurately and rapidly evaluate long-term LVR after MI.

  14. [Effects of long-term exercise training on left ventricular function and remodeling in patients with anterior wall myocardial infarction].

    Science.gov (United States)

    Rivas-Estany, Eduardo; Sixto-Fernández, Sherien; Barrera-Sarduy, José; Hernández-García, Susana; González-Guerra, Roberto; Stusser-Beltranena, Rodolfo

    2013-01-01

    To assess the effects of long-term exercise training on the function and remodeling of the left ventricle after myocardial infarction. We studied 90 patients with a first acute anterior-wall myocardial infarction, all received conventional medical treatment. Symptom-limited maximal exercise stress tests, echocardiograms and effort-rest isotopic ventriculographies at 2, 6 and 12 months after myocardial infarction were performed; the follow-up time averaged 36.3±17 months. All patients joined a cardiac rehabilitation program with moderate or intense exercise training lasting at least a year. Of all patients, 41.1% suffered severe left ventricle dysfunction. Ergometric parameters that expressed functional capacity increased significantly (P<.0005) at the sixth month evaluation and remained unchanged after a year. There was significant decrease (P<.01) of exercise myocardial ischemia at 6 months. The variables that measured size and function of left ventricle did not change during evolution. Morbidity amounted to 16.7% and total mortality of the series was 13.3%, with 8.9% of cardiovascular cause. Long-term exercise training showed no deleterious effects on left ventricle function or remodeling and beneficial functional and clinical effects were obtained in these rehabilitated postinfarction patients. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  15. Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; Jøns, Christian; Jørgensen, Rikke Mørch;

    2011-01-01

    High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this st...... of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function....

  16. A panel of 4 microRNAs facilitates the prediction of left ventricular contractility after acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Yvan Devaux

    Full Text Available BACKGROUND: Prediction of clinical outcome after acute myocardial infarction (AMI is challenging and would benefit from new biomarkers. We investigated the prognostic value of 4 circulating microRNAs (miRNAs after AMI. METHODS: We enrolled 150 patients after AMI. Blood samples were obtained at discharge for determination of N-terminal pro-brain natriuretic peptide (Nt-proBNP and levels of miR-16, miR-27a, miR-101 and miR-150. Patients were assessed by echocardiography at 6 months follow-up and the wall motion index score (WMIS was used as an indicator of left ventricular (LV contractility. We assessed the added predictive value of miRNAs against a multi-parameter clinical model including Nt-proBNP. RESULTS: Patients with anterior AMI and elevated Nt-proBNP levels at discharge from the hospital were at high risk of subsequent impaired LV contractility (follow-up WMIS>1.2, n = 71. A combination of the 4 miRNAs (miR-16/27a/101/150 improved the prediction of LV contractility based on clinical variables (P = 0.005. Patients with low levels of miR-150 (odds ratio [95% confidence interval] 0.08 [0.01-0.48] or miR-101 (0.19 [0.04-0.97] and elevated levels of miR-16 (15.9 [2.63-95.91] or miR-27a (4.18 [1.36-12.83] were at high risk of impaired LV contractility. The 4 miRNA panel reclassified a significant proportion of patients with a net reclassification improvement of 66% (P = 0.00005 and an integrated discrimination improvement of 0.08 (P = 0.001. CONCLUSION: Our results indicate that panels of miRNAs may aid in prognostication of outcome after AMI.

  17. Value of C-Reactive Protein in Predicting Left Ventricular Remodelling in Patients with a First ST-Segment Elevation Myocardial Infarction

    OpenAIRE

    Iwona Swiatkiewicz; Marek Kozinski; Przemyslaw Magielski; Tomasz Fabiszak; Adam Sukiennik; Eliano Pio Navarese; Grazyna Odrowaz-Sypniewska; Jacek Kubica

    2012-01-01

    Objective. To assess the value of C-reactive protein (CRP) in predicting postinfarct left ventricular remodelling (LVR). Methods. We measured in-hospital plasma CRP concentrations in patients with a first ST-segment elevation myocardial infarction (STEMI). Results. LVR was present at 6 months in 27.8% of 198 patients. CRP concentration rose during the first 24 h, mainly in LVR group. The prevalence of LVR was higher in patients from the highest quartile of CRP concentrations at 24 h as compar...

  18. A Meta-analysis of the effects of Exercise Training on Left Ventricular Remodeling Following Myocardial Infarction: Start early and go longer for greatest exercise benefits on remodeling

    Directory of Open Access Journals (Sweden)

    Warburton Darren

    2011-04-01

    Full Text Available Abstract Background The effects of variations in exercise training on Left ventricular (LV remodeling in patients shortly after Myocardial Infarction (MI are important but poorly understood. Methods Systematic review incorporating meta-analysis using meta-regression. Studies were identified via systematic searches of: OVID MEDLINE (1950 to 2009, Cochrane Central Register of Controlled Trials (1991 to 2009, AMED (1985 to 2009, EMBASE (1988 to 2009, PUBMED (1966 to 2009, SPORT DISCUS (1975 to 2009, SCOPUS (1950 to 2009 and WEB OF SCIENCE (1950 to 2009 using the medical subject headings: myocardial infarction, post myocardial infarction, post infarction, heart attack, ventricular remodeling, ventricular volumes, ejection fraction, left ventricular function, exercise, exercise therapy, kinesiotherapy, exercise training. Reference lists of all identified studies were also manually searched for further relevant studies. Studies selected were randomized controlled trials of exercise training interventions reporting ejection fraction (EF and/or ventricular volumes in patients following recent MI (≤ 3 months post-MI patients involving control groups. Studies were excluded if they were not randomized, did not have a 'usual-care' control (involving no exercise, evaluated a non-exercise intervention, or did not involve human subjects. Non-English studies were also excluded. Results After screening of 1029 trials, trials were identified that reported EF (12 trials, n = 647, End Systolic Volumes (ESV (9 trials, n = 475 and End Diastolic Volumes (EDV (10 trials, n = 512. Meta-regression identified that changes in EF effect size difference decreased as the time between MI and initiation of the exercise program lengthened, and increased as the duration of the program increased (Q = 25.48, df = 2, p 2 = 0.76. Greater reductions in ESV and EDV (as indicated by effect size decreases occurred with earlier initiation of exercise training and with longer training

  19. Effects of rosuvastatin and atorvastatin on inflammatory factors and left ventricular remodeling in patients with non-ST segment elevation acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Yun Zhou; Le Qu; Xiao-Li Zhu

    2016-01-01

    Objective:To explore the effects of rosuvastatin and atorvastatin on inflammatory factors and left ventricular remodeling in patients with non-ST segment elevation acute myocardial. Methods:A total of 100 cases patients of NSTEMI were selected that they were admitted during January 2013 to December 2014 and randomly divided into observer group and control group, each of 50 cases. Patients were given a comprehensive treatment of myocardial infarction, the control group was given the treatment of rosuvastatin and the observer group was given the treatment of atorvastatin over the same period, compared the related indicators of serum inflammatory factors and left ventricular remodeling after treatment in two groups. Results:The observer group serum TNF- , IL-6, hs-CRP levels were significantly lower than the control group in the treatment of 1 month, 3 months. The observer group was treated for 1 month, 3 months LVEF was significantly higher than the control group, and LVEDD, LVESD, PWT was significantly lower than the control group. The observer group was treated for 1 month, 3 months AngⅡ, PⅢNP, NT-proBNP level was significantly lower than the control group.Conclusions:The rosuvastatin is better than the atorvastatin in improving the level of NSTEMI inflammatory factors, prevention of left ventricular remodeling.

  20. Effect of loading-dose ticagrelor on coronary blood flow, left ventricular remodeling and myocardial enzyme spectrum in patients with acute myocardial infarction after interventional therapy

    Institute of Scientific and Technical Information of China (English)

    Xiao-Rui Xie; Pu Yang

    2016-01-01

    Objective:To study the effect of loading-dose ticagrelor on coronary blood flow, left ventricular remodeling and myocardial enzyme spectrum in patients with acute myocardial infarction after interventional therapy.Methods: A total of 86 patients with acute myocardial infarction who received emergency PCI in our hospital between May 2013 and May 2016 were selected and randomly divided into two groups, ticagrelor group received perioperative ticagrelor therapy and clopidogrel group received perioperative clopidogrel therapy. After PCI, coronary blood flow reperfusion was evaluated, serum myocardial remodeling indexes and myocardial enzymes were determined, and cardiac color Doppler ultrasonography was conducted to determine the cardiac function indexes.Results:TIMI grading and TMPG grading of ticagrelor group after PCI were significantly higher than those of clopidogrel group; serum MMP9, BNP, CITP, PICP, PIIINP, CK, CK-MB, cTnI and cTnT content of ticagrelor group 24h after operation were significantly lower than those of clopidogrel group; LVEDD, LVSED and LVMI of ticagrelor group 2 weeks after operation were significantly lower than those of clopidogrel group while LVEF was significantly higher than that of clopidogrel group.Conclusion:Peri-PCI loading-dose ticagrelor can improve coronary blood perfusion and reduce ventricular remodeling and myocardial injury in patients with acute myocardial infarction.

  1. Tamponade by an expanding left ventricular pseudoaneurysm: A unique presentation.

    Science.gov (United States)

    Mahesh, Balakrishnan; Ong, Ping; Kutty, Ramesh; Abu-Omar, Yasir

    2015-10-01

    Left ventricular free wall rupture secondary to myocardial infarction is an uncommon but catastrophic event requiring emergency surgery. We describe a unique presentation of left ventricular free wall rupture as delayed tamponade caused by a gradually expanding pseudoaneurysm compressing the left atrium, leading to pulmonary congestion that required increasing respiratory support to maintain oxygenation, and necessitated emergency surgery. We discuss the options available to treat pseudoaneurysms due to left ventricular free wall rupture.

  2. Relation between Tc-99m-PYP and Tl-201 scintigraphic findings and left ventricular function in acute myocardial infarction with early reperfusion

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Takao; Fukuzaki, Hisashi; Igarashi, Yuuichirou; Minamiji, Katsumi; Takarada, Akira; Imai, Naoaki; Fujino, Motohiro; Kurogane, Hiroyuki; Yoshida, Yutaka.

    1988-07-01

    The purpose of this study was to examine the significance of Tc-99m PYP uptake in the evaluation of myocardial salvage and reperfusion injury during early reperfusion in acute myocardial infarction. The subjects were 54 patients with initial myocardial infarction attributable to left anterior descending branch lesion in whom early reperfusion was attained by spontaneous recanalization (SR), intracoronary thrombolysis (ICT), and percutaneous transluminal angioplasty (PTCA). The radionuclide imaging appearances of the myocardium fell into four categories : I) small Tl-201 defect and faint Tc-99m PYP uptake ; II) small Tl-201 defect and intense Tc-99m PYP uptake ; III) large Tl-201 defect and faint Tc-99m PYP uptake ; and IV) large Tl-201 defect and intense Tc-99m PYP uptake. The incidences of I and II were higher in the group of SR patients than the group of ICT and PTCA patients. Features of left ventricular ejection fraction (LVEF) from the acute through the chronic stages were as follows : Category I - favorable LVEF through the stages ; Category II - improvement at chronic stage ; Category III - no consistent tendency for LVEF ; and Category IV - aggravation at chronic stage. In cases of early recanalization of acute myocardial infarction, Tc-99m PYP images combined with Tl-201 images may provide useful information on changes of cardiac function and salvage of the ischemic myocardium. (Namekawa, K.).

  3. Additive effects of endothelial progenitor cells combined with ACE inhibition and beta-blockade on left ventricular function following acute myocardial infarction.

    Science.gov (United States)

    Boyle, Andrew J; Schuster, Michael; Witkowski, Piotr; Xiang, Guosheng; Seki, Tetsunori; Way, Kerrie; Itescu, Silviu

    2005-03-01

    Animal studies have demonstrated the efficacy of endothelial progenitor cells (EPCs) in preventing left ventricular (LV) remodelling following myocardial infarction (MI). Preliminary human studies are underway, yet no studies have demonstrated efficacy in combination with standard medical therapy, i.e. angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. Nude rats underwent left anterior descending coronary artery ligation to induce MI. Animals were randomised to receive no treatment (MI, n = 5), quinapril 200 mg/L + metoprolol 2 g/L (ACE/BB, n = 5), two million EPCs intravenously (EPC, n = 5)or both (ACE/BB + EPC [n = 5]), then sacrificed after two weeks treatment. ACE/BB resulted in a 75% reduction in fibrosis in the region remote from the MI (p infarct rim, thereby preventing peri-infarct apoptosis by 81% (p < 0.05). Acting via different but complementary mechanisms, the combination of ACE/BB + EPCs resulted in a greater overall improvement in LV function on echocardiography than either therapy alone. Clinical trials using stem cell therapy in conjunction with standard medical treatment are warranted.

  4. Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment–Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling

    Science.gov (United States)

    Bulluck, Heerajnarain; Rosmini, Stefania; Abdel-Gadir, Amna; White, Steven K.; Bhuva, Anish N.; Treibel, Thomas A.; Fontana, Marianna; Ramlall, Manish; Hamarneh, Ashraf; Sirker, Alex; Herrey, Anna S.; Manisty, Charlotte; Yellon, Derek M.; Kellman, Peter; Moon, James C.

    2016-01-01

    Background— The presence of intramyocardial hemorrhage (IMH) in ST-segment–elevation myocardial infarction patients reperfused by primary percutaneous coronary intervention has been associated with residual myocardial iron at follow-up, and its impact on adverse left ventricular (LV) remodeling is incompletely understood and is investigated here. Methods and Results— Forty-eight ST-segment–elevation myocardial infarction patients underwent cardiovascular magnetic resonance at 4±2 days post primary percutaneous coronary intervention, of whom 40 had a follow-up scan at 5±2 months. Native T1, T2, and T2* maps were acquired. Eight out of 40 (20%) patients developed adverse LV remodeling. A subset of 28 patients had matching T2* maps, of which 15/28 patients (54%) had IMH. Eighteen of 28 (64%) patients had microvascular obstruction on the acute scan, of whom 15/18 (83%) patients had microvascular obstruction with IMH. On the follow-up scan, 13/15 patients (87%) had evidence of residual iron within the infarct zone. Patients with residual iron had higher T2 in the infarct zone surrounding the residual iron when compared with those without. In patients with adverse LV remodeling, T2 in the infarct zone surrounding the residual iron was also higher than in those without (60 [54–64] ms versus 53 [51–56] ms; P=0.025). Acute myocardial infarct size, extent of microvascular obstruction, and IMH correlated with the change in LV end-diastolic volume (Pearson’s rho of 0.64, 0.59, and 0.66, respectively; P=0.18 and 0.62, respectively, for correlation coefficient comparison) and performed equally well on receiver operating characteristic curve for predicting adverse LV remodeling (area under the curve: 0.99, 0.94, and 0.95, respectively; P=0.19 for receiver operating characteristic curve comparison). Conclusions— The majority of ST-segment–elevation myocardial infarction patients with IMH had residual myocardial iron at follow-up. This was associated with

  5. Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials.

    Science.gov (United States)

    Kosmidou, Ioanna; Redfors, Björn; Selker, Harry P; Thiele, Holger; Patel, Manesh R; Udelson, James E; Magnus Ohman, E; Eitel, Ingo; Granger, Christopher B; Maehara, Akiko; Kirtane, Ajay; Généreux, Philippe; Jenkins, Paul L; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

    2017-06-01

    Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1 month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P size or LVEF on the risk of death or HF hospitalization. In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.

  6. Change in left ventricular systolic function in patients with ST elevation myocardial infarction: Evidence for smoker's paradox or pseudo-paradox?

    Science.gov (United States)

    Acar, Burak; Ozeke, Ozcan; Unal, Sefa; Karakurt, Mustafa; Kara, Meryem; Kirbas, Ozgur; Sen, Fatih; Korkmaz, Ahmet; Aras, Dursun; Aydogdu, Sinan

    The 'smoker's paradox' refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI). Aim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI. Our population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined. Basal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95±7.93% vs. 40.32±7.28%; p=0.011); it worsened in smokers at follow-up (mean decrease in LVEF: -2.70±5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97±8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF. True or persistent 'smoker's paradox' does not appear to be relevant among STEMI patients undergoing p-PCI. The 'smoker's paradox' is in fact a pseudo-paradox. Further studies with larger numbers may be warranted. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  7. Impact of intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction on left ventricular perfusion and function: a 6-month follow-up gated {sup 99m}Tc-MIBI single-photon emission computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Lipiec, Piotr [Medical University of Lodz, 2nd Department of Cardiology, Lodz (Poland); Medical University of Lodz, 2nd Department of Cardiology, Bieganski Hospital, Lodz (Poland); Krzeminska-Pakula, Maria; Plewka, Michal; Kasprzak, Jaroslaw D. [Medical University of Lodz, 2nd Department of Cardiology, Lodz (Poland); Kusmierek, Jacek; Plachcinska, Anna; Szuminski, Remigiusz [Medical University of Lodz, Department of Nuclear Medicine, Lodz (Poland); Robak, Tadeusz; Korycka, Anna [Medical University of Lodz, Department of Hematology, Lodz (Poland)

    2009-04-15

    We investigated the impact of intracoronary injection of autologous mononuclear bone marrow cells (BMC) in patients with acute ST elevation myocardial infarction (STEMI) on left ventricular volumes, global and regional systolic function and myocardial perfusion. The study included 39 patients with first anterior STEMI treated successfully with primary percutaneous coronary intervention. They were randomly assigned to the treatment group or the control group in a 2:1 ratio. The patients underwent baseline gated single-photon emission computed tomography (G-SPECT) 3-10 days after STEMI with quantitative and qualitative analysis of left ventricular perfusion and systolic function. On the following day, patients from the BMC treatment group were subjected to bone marrow aspiration, mononuclear BMC isolation and intracoronary injection. No placebo procedure was performed in the control group. G-SPECT was repeated 6 months after STEMI. Baseline and follow-up G-SPECT studies were available for 36 patients. At 6 months in the BMC group we observed a significantly enhanced improvement in the mean extent of the perfusion defect, the left ventricular perfusion score index, the infarct area perfusion score and the infarct area wall motion score index compared to the control group (p=0.01-0.04). However, the changes in left ventricular volume, ejection fraction and the left ventricular wall motion score index as well as the relative changes in the infarct area wall motion score index did not differ significantly between the groups. Intracoronary injection of autologous mononuclear BMC in patients with STEMI improves myocardial perfusion at 6 months. The benefit in infarct area systolic function is less pronounced and there is no apparent improvement of global left ventricular systolic function. (orig.)

  8. Native T1 value in the remote myocardium is independently associated with left ventricular dysfunction in patients with prior myocardial infarction.

    Science.gov (United States)

    Nakamori, Shiro; Alakbarli, Javid; Bellm, Steven; Motiwala, Shweta R; Addae, Gifty; Manning, Warren J; Nezafat, Reza

    2017-10-01

    To compare remote myocardium native T1 in patients with chronic myocardial infarction (MI) and controls without MI and to elucidate the relationship of infarct size and native T1 in the remote myocardium for the prediction of left ventricular (LV) systolic dysfunction after MI. A total of 41 chronic MI (18 anterior MI) patients and 15 age-matched volunteers with normal LV systolic function and no history of MI underwent cardiac magnetic resonance imaging (MRI) at 1.5T. Native T1 map was performed using a slice interleaved T1 mapping and late gadolinium enhancement (LGE) imaging. Cine MR was acquired to assess LV function and mass. The remote myocardium native T1 time was significantly elevated in patients with prior MI, compared to controls, for both anterior MI and nonanterior MI (anterior MI: 1099 ± 30, nonanterior MI: 1097 ± 39, controls: 1068 ± 25 msec, P infarct size had a moderate correlation with reduced LV ejection fraction (r = -0.33, P infarct size. Native T1 time in the remote myocardium was independently associated with reduced LV ejection fraction, after adjusting for age, gender, infarct size, and comorbidity (β = -0.34, P = 0.03). In chronic MI, the severity of LV systolic dysfunction after MI is independently associated with native T1 in the remote myocardium. Diffuse myocardial fibrosis in the remote myocardium may play an important pathophysiological role of post-MI LV dysfunction. 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1073-1081. © 2017 International Society for Magnetic Resonance in Medicine.

  9. Comprehensive cardiac assessment with multislice computed tomography: evaluation of left ventricular function and perfusion in addition to coronary anatomy in patients with previous myocardial infarction

    Science.gov (United States)

    Henneman, M M; Schuijf, J D; Jukema, J W; Lamb, H J; de Roos, A; Dibbets, P; Stokkel, M P; van der Wall, E E; Bax, J J

    2006-01-01

    Objective To evaluate a comprehensive multislice computed tomography (MSCT) protocol in patients with previous infarction, including assessment of coronary artery stenoses, left ventricular (LV) function and perfusion. Patients and methods 16‐slice MSCT was performed in 21 patients with previous infarction; from the MSCT data, coronary artery stenoses, (regional and global) LV function and perfusion were assessed. Invasive coronary angiography and gated single‐photon emission computed tomography (SPECT) served as the reference standards for coronary artery stenoses and LV function/perfusion, respectively. Results 236 of 241 (98%) coronary artery segments were interpretable on MSCT. The sensitivity and specificity for detection of stenoses were 91% and 97%. Pearson's correlation showed excellent agreement for assessment of LV ejection fraction between MSCT and SPECT (49 (13)% v 53 (12)%, respectively, r  =  0.85). Agreement for assessment of regional wall motion was excellent (92%, κ  =  0.77). In 68 of 73 (93%) segments, MSCT correctly identified a perfusion defect as compared with SPECT, whereas the absence of perfusion defects was correctly detected in 277 of 284 (98%) segments. Conclusions MSCT permits accurate, non‐invasive assessment of coronary artery stenoses, LV function and perfusion in patients with previous infarction. All parameters can be assessed from a single dataset. PMID:16740917

  10. Effects of resting ischemia assessed by thallium scintigraphy on QRS scoring system for estimating left ventricular function quantified by radionuclide angiography in acute myocardial infarction patients

    Energy Technology Data Exchange (ETDEWEB)

    DePace, N.L.; Hakki, A.H.; Iskandrian, A.S.

    1984-06-01

    The purpose of this study was to determine whether resting ischemia limits the usefulness of the QRS scoring system in predicting left ventricular (LV) ejection fraction (EF) in patients with acute infarction. We studied 48 patients after acute infarction by means of 12-lead ECG, thallium-201 scintigraphy, and radionuclide angiography. The thallium-201 scintigrams showed fixed defects in 25 patients, perfusion defects with partial or complete redistribution in the delayed images in 19 patients, and normal images in the remaining four patients. In the 48 patients there was a significant correlation between the QRS score and LVEF (r . -0.67; p less than 0.001). Patients with fixed defects showed a better correlation than patients with resting ischemia (r . -0.77 vs r . -0.60). A QRS score of 3 or less was used to separate patients with LVEF of 40% or greater from those with lower LVEF in patients with fixed defects (p . 0.0005), but this cutoff did not categorize patients with resting ischemia as to LVEF. Thus the presence of rest ischemia in patients with acute infarction may affect the correlation between QRS score and LVEF.

  11. Effects of resting ischemia assessed by thallium scintigraphy on QRS scoring system for estimating left ventricular function quantified by radionuclide angiography in acute myocardial infarction patients.

    Science.gov (United States)

    DePace, N L; Hakki, A H; Iskandrian, A S

    1984-06-01

    The purpose of this study was to determine whether resting ischemia limits the usefulness of the QRS scoring system in predicting left ventricular (LV) ejection fraction (EF) in patients with acute infarction. We studied 48 patients after acute infarction by means of 12-lead ECG, thallium-201 scintigraphy, and radionuclide angiography. The thallium-201 scintigrams showed fixed defects in 25 patients, perfusion defects with partial or complete redistribution in the delayed images in 19 patients, and normal images in the remaining four patients. In the 48 patients there was a significant correlation between the QRS score and LVEF (r = -0.67; p less than 0.001). Patients with fixed defects showed a better correlation than patients with resting ischemia (r = -0.77 vs r = -0.60). A QRS score of 3 or less was used to separate patients with LVEF of 40% or greater from those with lower LVEF in patients with fixed defects (p = 0.0005), but this cutoff did not categorize patients with resting ischemia as to LVEF. Thus the presence of rest ischemia in patients with acute infarction may affect the correlation between QRS score and LVEF.

  12. Optimising the dichotomy limit for left ventricular ejection fraction in selecting patients for defibrillator therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, J Martin;

    2007-01-01

    of MI. METHODS AND RESULTS: Data from the placebo arms of four randomised trials were pooled to create a cohort of 2828 patients (2206 men, mean (SD) age 65 (11) years) with reduced left ventricular function after MI. The median LVEF was 33% (range 6-40%). LVEF significantly predicted mortality. Each 10......% to death in 2 years. At an LVEF of 16-20%, more patients are likely to die from arrhythmic than non-arrhythmic cardiac deaths, whereas in those...... with LVEF deaths were non-arrhythmic. However, the total number of deaths substantially decreased with lower LVEF. CONCLUSION: A trade-off exists between the sensitivity and positive predictive accuracy across a range of LVEF, and no single dichotomy limit is completely satisfactory...

  13. 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.

  14. 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

  15. Utility of peak creatine kinase-MB measurements in predicting myocardial infarct size, left ventricular dysfunction, and outcome after first anterior wall acute myocardial infarction (from the INFUSE-AMI trial).

    Science.gov (United States)

    Dohi, Tomotaka; Maehara, Akiko; Brener, Sorin J; Généreux, Philippe; Gershlick, Anthony H; Mehran, Roxana; Gibson, C Michael; Mintz, Gary S; Stone, Gregg W

    2015-03-01

    Infarct size after ST-segment elevation myocardial infarction (STEMI) is associated with long-term clinical outcomes. However, there is insufficient information correlating creatine kinase-MB (CK-MB) or troponin levels to infarct size and infarct location in first-time occurrence of STEMI. We, therefore, assessed the utility of CK-MB measurements after primary percutaneous coronary intervention of a first anterior STEMI using bivalirudin anticoagulation in patients who were randomized to intralesion abciximab versus no abciximab and to manual thrombus aspiration versus no aspiration. Infarct size (as a percentage of total left ventricular [LV] mass) and LV ejection fraction (LVEF) were evaluated by cardiac magnetic resonance imaging at 30 days and correlated to peak CK-MB. Peak CK-MB (median 240 IU/L; interquartile range 126 to 414) was significantly associated with infarct size and with LVEF (r = 0.67, p MB tertile group than in the other tertiles (87.6% vs 49.5% vs 9.1%, p MB of at least 300 IU/L predicted with moderate accuracy both a large infarct size (area under the curve 0.88) and an LVEF ≤40% (area under the curve 0.78). Furthermore, CK-MB was an independent predictor of 1-year major adverse cardiac events (hazard ratio 1.42 per each additional 100 IU/L [1.20 to 1.67], p MB measurement is useful in estimating infarct size and LVEF and in predicting 1-year clinical outcomes after primary percutaneous coronary intervention for first anterior STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Effect of ACE inhibitor trandolapril on life expectancy of patients with reduced left-ventricular function after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Torp-Pedersen, C; Køber, L

    1999-01-01

    be in terms of an increase in life expectancy, but this approach has not previously been possible because of limited data on long-term outcome. We aimed to calculate the effect of trandolapril on life expectancy with follow-up data from the Trandolapril Cardiac Evaluation (TRACE) Study. METHODS: The TRACE...... they had been followed up for a minimum of 6 years. We estimated life expectancy as median lifetime, which was the time for 50% of the patients to have died. Change in life expectancy is expressed as change in median lifetime. Analysis was by intention to treat. FINDINGS: The life expectancy of patients......-blind treatment; continued use of trandolapril was recommended at study closure. INTERPRETATION: In patients with severely reduced left-ventricular function, long-term treatment with an ACE inhibitor during the critical period after myocardial infarction is associated with a substantial increase in life...

  17. Assessment of left ventricular segmental function after autologous bone marrow stem cells transplantation in patients with acute myocardial infarction by tissue tracking and strain imaging

    Institute of Scientific and Technical Information of China (English)

    RUAN Wen; PAN Cui-zhen; HUANG Guo-qian; LI Yan-lin; GE Jun-bo; SHU Xian-hong

    2005-01-01

    Background Emerging evidence suggests that stem cells can be used to improve cardiac function in patients after acute myocardial infarction. In this randomized trial, we aimed to use Doppler tissue tracking and strain imaging to assess left ventricular segmental function after intracoronary transfer of autologous bone-marrow stem cells (BMCs) for 6 months' follow up. Methods Twenty patients with acute myocardial infarction and anterior descending coronary artery occlusion proven by angiography were double-blindedly randomized into intracoronary injection of bone-marrow cell (treated, n=9) or diluted serum (control, n=11) groups. GE vivid 7 and Q-analyze software were used to perform echocardiogram in both groups 1 week, 3 months and 6 months after treatment. Three apical views of tissue Doppler imaging were acquired to measure peak systolic displacement (Ds) and peak systolic strain (εpeak) from 12 segments of LV walls. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were obtained by Simposon's biplane method. Results (1) 3 months later, Ds and εpeak over the infract-related region clearly increased in the BMCs group [Ds: (4.49±2.71) mm vs (7.56±2.95) mm, P0.05; εpeak : (-13.84±6.05)% vs (-15.04±6.75)%, P>0.05]. At the same time, Ds over the normal region also increased, but the Ds enhancement was markedly higher in the BMCs group than that in the control group [(3.21±3.17) mm vs (0.76±1.94) mm, P0.05). (2) LVEF in treated and control groups were almost the same at baseline (1st week after PCI) [(53.37±8.92)% vs (53.51±5.84)%, P>0.05]. But 6 months later, LVEF in the BMCs group were clearly higher than that in the control group [(59.33±12.91)% vs (50.30±8.30)%, P0.05; ESV: (57.12±18.66) ml vs (62.09±17.68) ml, P>0.05]. Three months later, EDV and ESV in the control group were markedly greater than those in the BMCs group [EDV: (154.89±46.34) ml vs (104.85±33.21) ml, P0.05). Conclusions Emergency

  18. The effect of treatment with carvedilol in patients with left ventricular dysfunction after acute myocardial infarction%卡维地洛治疗急性心肌梗死患者左室功能的疗效观察

    Institute of Scientific and Technical Information of China (English)

    贺礼荣

    2013-01-01

    Object To explore the effect of treatment with carvedilol in patients with left ventricular dysfunction after acute myocardial infarction . Method From 2005.1 to 2009.7, 100 cases with acute myocardial infarction were randomly divided into two groups.carvedilol group (50 cases) and metoprolol group (50 cases) . The left ventricular systolic function and diastolic function of both group were recorded by echocardiography at the time both within 24 hours when the patient was hospitalized and one month after the end of treatment .Result The left ventricular systolic function of the carvedilol group improved more than the metoprolol group (P0.05)。结论在治疗1个月后,卡维地洛和美托洛尔均显著改善左心室功能,但卡维地洛疗效更好。

  19. Impact of early, late, and no ST-segment resolution measured by continuous ST Holter monitoring on left ventricular ejection fraction and infarct size as determined by cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    J.D.E. Haeck; N.J.W. Verouden; W.J. Kuijt; K.T. Koch; M. Majidi; A. Hirsch; J.G.P. Tijssen; M.W. Krucoff; R.J. de Winter

    2011-01-01

    Background: The goal of this study is to determine the predictive value of ST-segment resolution (STR) early after percutaneous coronary intervention (PCI), late STR, and no STR for left ventricular ejection fraction (LVEF) and infarct size (IS) by cardiovascular magnetic resonance (CMR) at follow-u

  20. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Andersen, Mads J; Valeur, Nana;

    2013-01-01

    Peak atrial longitudinal strain (PALS) during the reservoir phase has been proposed as a measure of left atrium function in a range of cardiac conditions, with the potential for added pathophysiological insight and prognostic value. However, no studies have assessed the interrelation of PALS and ...

  1. Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; Jøns, Christian; Jørgensen, Rikke Mørch;

    2011-01-01

    High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this st......High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim...... of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function....

  2. Association of the beta-1 adrenergic receptor carboxyl terminal variants with left ventricular hypertrophy among diabetic and non-diabetic survivors of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hakalahti Anna E

    2010-08-01

    Full Text Available Abstract Background The beta-1 adrenergic receptor (β1AR plays a fundamental role in the regulation of cardiovascular functions. It carries a nonsynonymous single nucleotide polymorphism in its carboxyl terminal tail (Arg389Gly, which has been shown to associate with various echocardiographic parameters linked to left ventricular hypertrophy (LVH. Diabetes mellitus (DM, on the other hand, represents a risk factor for LVH. We investigated the possible association between the Arg389Gly polymorphism and LVH among non-diabetic and diabetic acute myocardial infarction (AMI survivors. Methods The study population consisted of 452 AMI survivors, 20.6% of whom had diagnosed DM. Left ventricular parameters were measured with two-dimensional guided M-mode echocardiography 2-7 days after AMI, and the Arg389Gly polymorphism was determined using a polymerase chain reaction-restriction fragment length polymorphism assay. Results The Arg389 homozygotes in the whole study population had a significantly increased left ventricular mass index (LVMI when compared to the Gly389 carriers (either Gly389 homozygotes or Arg389/Gly389 heterozygotes [62.7 vs. 58.4, respectively (p = 0.023]. In particular, the Arg389 homozygotes displayed thicker diastolic interventricular septal (IVSd measures when compared to the Gly389 carriers [13.2 vs. 12.3 mm, respectively (p = 0.004]. When the euglycemic and diabetic patients were analyzed separately, the latter had significantly increased LVMI and diastolic left ventricular posterior wall (LVPWd values compared to the euglycemic patients [LVMI = 69.1 vs. 58.8 (p = 0.001 and LVPWd = 14.2 vs. 12.3 mm (p Conclusions The data suggest an association between the β1AR Arg389Gly polymorphism and LVH, particularly the septal hypertrophy. The Arg389 variant appears to confer a higher risk of developing LVH than the corresponding Gly389 variant among patients who have suffered AMI. This association cannot be considered to be universal

  3. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size

    DEFF Research Database (Denmark)

    Ersboll, M; Andersen, Mads Jønsson; Valeur, N.

    2013-01-01

    BACKGROUND: Peak atrial longitudinal strain (PALS) during the reservoir phase has been proposed as a measure of left atrium function in a range of cardiac conditions, with the potential for added pathophysiological insight and prognostic value. However, no studies have assessed the interrelation...... atrium volumes, and PALS within 48 hours of admission. PALS was related to a composite outcome of death and heart failure hospitalization. Reduced PALS was associated with hypertension, diabetes mellitus, and Killip class >1 (P...

  4. COMPARISON OF THE EFFECTS OF LOSARTAN, ENALAPRIL AND THEIR COMBINATION IN THE PREVENTION OF LEFT VENTRICULAR REMODELING AFTER ACUTE MYOCARDIAL INFARCTION IN THE RAT

    Institute of Scientific and Technical Information of China (English)

    杨跃进; 张沛; 阮英茆; 宋来凤; 徐新林; 李永利; 周燕文; 田毅; 徐义枢; 陈在嘉

    2002-01-01

    Objectives. To compare the effects of losartan, enalapril and their combination in the prevention ofleft ventricular remodeling (LVRM) after acute myocardial infarction (AMI) in the rat. Methods. AMI model was induced in female SD rats by ligating left coronary artery. Forty-eight hours after the procedure, 83 surviving rats were randomized into one of the following 4 groups: 1 ) AMI control group (n =19), 2) losartan group (n= 22, 3 mg @ kg - 1 @ d - 1 ), 3 ) enalapril group (n = 20, 1 mg @ kg - 1 @ d - 1 ), 4) losartan - enalapril combinative group (n = 22, 3 and 1 mg @ kg- 1 @ d - 1 respectively). 5 ) sham-operated group ( n =10) and 6) normal rats group (n = 10) were selected randomly to serve as non-infarction controls. Losartan and enalapril were delivered by direct gastric gavage. After 4 weeks of medical therapy, hemodynamic studies were performed in each group, then the rat hearts were fixed with 10% formalin and pathologic analysis on them was performed. Complete experimental data was obtained in 56 rats, comprising 1 ) AMI controls (n = 11 ), 2) losartan group (n = 10), 3 ) enalapril group (n = 10), 4) the combination of losartan and enalapril group (n = 11 ),5) sham - operated group (n = 6) and 6) normal controls (n=8). Results. There were no significant differences among the 4 AMI groups in MI size (41.7% ~ 43.4%, all P> 0.05). Compared with sham group, the left ventricular (LV) end diastolic pressure (LVEDP), volume (LVV), long and short axis length (L and D), as well as LV absolute and relative weight (LVAW and LVRW)in AMI group were all significantly increased ( P <0.05 ~ 0. 001 ); whereas the maximum left ventricular pressure rising and droping rates ( + dp/dt) and their corrected values by LV systolic pressure ( + dp/dt/LVSP)were significantly reduced (all P <0.001 ), indicating LVRM occurred and LV systolic and diastolic function impaired after AMI. Compared with AMI group , LVEDP, LVV, LVAW and LVRW were all significantly decreased (P

  5. Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure on long-term survival after acute myocardial infarction. TRACE Study Group

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Ottesen, M;

    1996-01-01

    The aim of this study was to assess the importance of congestive heart failure and left ventricular (LV) systolic dysfunction after an acute myocardial infarction (AIM) on long-term mortality in different age groups. A total of 7,001 consecutive enzyme-confirmed AMIs (6,676 patients) were screened...... for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Medical history, echocardiographic estimation of LV systolic function determined as wall motion index, infarct complications, and survival were documented for all patients. To study the importance of congestive heart failure and wall motion......%, and 55%, respectively. The risk ratios (and 95% confidence limits) associated with congestive heart failure in the same 4 age strata were 1.9 (1.3 to 2.9), 2.8 (2.1 to 3.7), 1.8 (1.5 to 2.2) and 1.8 (1.5 to 2.2), respectively. The risk ratios associated with decreasing wall motion index were 6.5 (3...

  6. Mitochondria and left ventricular hypertrophy

    Institute of Scientific and Technical Information of China (English)

    Haiyan Zhu; Shiwen Wang

    2008-01-01

    @@ Introduction Left ventricular hypertrophy (LVH) is one of the vicious organ damages of essential hypertension.It contributes a lot to high mortality of essential hypertension due to sudden cardiac death,ventricular arrhythmia and heart failure.Many factors involve in the pathogenesis of hypertension-induced LVH including inherited variants as well as environmental factors.

  7. Regulation of PTEN/Akt pathway enhances cardiomyogenesis and attenuates adverse left ventricular remodeling following thymosin β4 Overexpressing embryonic stem cell transplantation in the infarcted heart.

    Directory of Open Access Journals (Sweden)

    Binbin Yan

    Full Text Available Thymosin β4 (Tβ4, a small G-actin sequestering peptide, mediates cell proliferation, migration, and angiogenesis. Whether embryonic stem (ES cells, overexpressing Tβ4, readily differentiate into cardiac myocytes in vitro and in vivo and enhance cardioprotection following transplantation post myocardial infarction (MI remains unknown. Accordingly, we established stable mouse ES cell lines, RFP-ESCs and Tβ4-ESCs, expressing RFP and an RFP-Tβ4 fusion protein, respectively. In vitro, the number of spontaneously beating embryoid bodies (EBs was significantly increased in Tβ4-ESCs at day 9, 12 and 15, compared with RFP-ESCs. Enhanced expression of cardiac transcriptional factors GATA-4, Mef2c and Txb6 in Tβ4-EBs, as confirmed with real time-PCR analysis, was accompanied by the increased number of EB areas stained positive for sarcomeric α-actin in Tβ4-EBs, compared with the RFP control, suggesting a significant increase in functional cardiac myocytes. Furthermore, we transplanted Tβ4-ESCs into the infarcted mouse heart and performed morphological and functional analysis 2 weeks after MI. There was a significant increase in newly formed cardiac myocytes associated with the Notch pathway, a decrease in apoptotic nuclei mediated by an increase in Akt and a decrease in levels of PTEN. Cardiac fibrosis was significantly reduced, and left ventricular function was significantly augmented in the Tβ4-ESC transplanted group, compared with controls. It is concluded that genetically modified Tβ4-ESCs, potentiates their ability to turn into cardiac myocytes in vitro as well as in vivo. Moreover, we also demonstrate that there was a significant decrease in both cardiac apoptosis and fibrosis, thus improving cardiac function in the infarcted heart.

  8. Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang-Geon; Park, Ki Seong; Kim, Jahae; Kim, Jong Sang; Song, Ho-Chun [Chonnam National University Hospital, Department of Nuclear Medicine, Gwang-ju (Korea, Republic of); Jabin, Zeenat; Kang, Sae-Ryung; Kwon, Seong Young; Jeong, Geum-Cheol; Song, Minchul; Min, Jung-Joon; Bom, Hee-Seung [Chonnam National University Hwasun Hospital, Department of Nuclear Medicine, Hwasun-gun, Jeonnam (Korea, Republic of); Cho, Jae Yeong; Kim, Hyun Kuk [Chonnam National University Hospital, Department of Cardiology, Gwang-ju (Korea, Republic of)

    2017-02-15

    The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease. One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated. MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3 vs. 35.3 ± 18.9 ; p <0.001), stress PBW (147.6 ± 54.6 vs. 96.8 ± 59.2 ; p = 0.001) and resting PBW (126.8 ± 37.5 vs. 96.6 ± 48.9 ; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5 and stress PBW ≥126.0 were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication. LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging

  9. Preemptive heme oxygenase-1 gene delivery reveals reduced mortality and preservation of left ventricular function 1 yr after acute myocardial infarction.

    Science.gov (United States)

    Liu, Xiaoli; Simpson, Jeremy A; Brunt, Keith R; Ward, Christopher A; Hall, Sean R R; Kinobe, Robert T; Barrette, Valerie; Tse, M Yat; Pang, Stephen C; Pachori, Alok S; Dzau, Victor J; Ogunyankin, Kofo O; Melo, Luis G

    2007-07-01

    We reported previously that predelivery of heme oxygenase-1 (HO-1) gene to the heart by adeno-associated virus-2 (AAV-2) markedly reduces ischemia and reperfusion (I/R)-induced myocardial injury. However, the effect of preemptive HO-1 gene delivery on long-term survival and prevention of postinfarction heart failure has not been determined. We assessed the effect of HO-1 gene delivery on long-term survival, myocardial function, and left ventricular (LV) remodeling 1 yr after myocardial infarction (MI) using echocardiographic imaging, pressure-volume (PV) analysis, and histomorphometric approaches. Two groups of Lewis rats were injected with 2 x 10(11) particles of AAV-LacZ (control) or AAV-human HO-1 (hHO-1) in the anterior-posterior apical region of the LV wall. Six weeks after gene transfer, animals were subjected to 30 min of ischemia by ligation of the left anterior descending artery followed by reperfusion. Echocardiographic measurements and PV analysis of LV function were obtained at 2 wk and 12 mo after I/R. One year after acute MI, mortality was markedly reduced in the HO-1-treated animals compared with the LacZ-treated animals. PV analysis demonstrated significantly enhanced LV developed pressure, elevated maximal dP/dt, and lower end-diastolic volume in the HO-1 animals compared with the LacZ animals. Echocardiography showed a larger apical anterior-to-posterior wall ratio in HO-1 animals compared with LacZ animals. Morphometric analysis revealed extensive myocardial scarring and fibrosis in the infarcted LV area of LacZ animals, which was reduced by 62% in HO-1 animals. These results suggest that preemptive HO-1 gene delivery may be useful as a therapeutic strategy to reduce post-MI LV remodeling and heart failure.

  10. Value of C-Reactive Protein in Predicting Left Ventricular Remodelling in Patients with a First ST-Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Iwona Swiatkiewicz

    2012-01-01

    Full Text Available Objective. To assess the value of C-reactive protein (CRP in predicting postinfarct left ventricular remodelling (LVR. Methods. We measured in-hospital plasma CRP concentrations in patients with a first ST-segment elevation myocardial infarction (STEMI. Results. LVR was present at 6 months in 27.8% of 198 patients. CRP concentration rose during the first 24 h, mainly in LVR group. The prevalence of LVR was higher in patients from the highest quartile of CRP concentrations at 24 h as compared to those from any other quartile (odds ratio (OR 3.48, 95% confidence interval (95% CI 1.76–6.88. Multivariate analysis identified CRP concentration at 24 h (OR for a 10 mg/L increase 1.29, 95% CI 1.04–1.60, B-type natriuretic peptide at discharge (OR for a 100 pg/mL increase 1.21, 95% CI 1.05–1.39, body mass index (OR for a 1 kg/m2 increase 1.10, 95% CI 1.01–1.21, and left ventricular end-diastolic volume (OR for a 1 mL increase 0.98, 95% CI 0.96-0.99 as independent predictors of LVR. The ROC analysis revealed a limited discriminative value of CRP (area under the curve 0.61; 95% CI 0.54–0.68 in terms of LVR prediction. Conclusions. Measurement of CRP concentration at 24 h after admission possesses a significant but modest value in predicting LVR after a first STEMI.

  11. Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

    DEFF Research Database (Denmark)

    Bang, Casper; Gerdts, Eva; Aurigemma, Gerard P;

    2013-01-01

    Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatatio...

  12. Early exercise training normalizes myofilament function and attenuates left ventricular pump dysfunction in mice with a large myocardial infarction

    NARCIS (Netherlands)

    M.C. de Waard (Monique); J. van der Velden (Jolanda); V. Bito (Virginie); S. Ozdemir (Semir); L. Biesmans (Liesbeth); N.M. Boontje (Nicky); D.H. Dekkers (Dick); K. Schoonderwoerd (Kees); J.C.H. Schuurbiers (Johan); R. de Crom (Rini); G.J.M. Stienen (Ger); K.R. Sipido (Karin); J.M.J. Lamers (Jos); D.J.G.M. Duncker (Dirk)

    2007-01-01

    textabstractThe extent and mechanism of the cardiac benefit of early exercise training following myocardial infarction (MI) is incompletely understood, but may involve blunting of abnormalities in Ca-handling and myofilament function. Consequently, we investigated the effects of 8-weeks of voluntary

  13. Relationships Between Biomarkers and Left Ventricular Filling Pressures at Rest and During Exercise in Patients After Myocardial Infarction

    DEFF Research Database (Denmark)

    Andersen, Mads J; Ersbøll, Mads; Bro-Jeppesen, John

    2014-01-01

    BACKGROUND: Increased pulmonary capillary wedge pressure (PCWP) is an independent prognostic predictor after myocardial infarction (MI), but PCWP is difficult to assess noninvasively in subjects with preserved ejection fraction (EF). We hypothesized that biomarkers would provide information regar...... levels of natriuretic peptides, particularly MR-proANP, are associated with filling pressures at rest and during exercise....

  14. Influence of manual thrombus aspiration on left ventricular diastolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Ilić Ivan

    2016-01-01

    Full Text Available Introduction. Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI population are scarce. Objective. We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI center. Methods. A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients’ status was assessed by an office visit or telephone interview. Results. Patients treated with thrombus aspiration (TA+, n=216 had similar baseline characteristics as those without thrombus aspiration (TA-, n=217. Groups had similar total ischemic time (319 ± 276 vs. 333±372 min; p=0.665, but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p15, as a marker of severe diastolic dysfunction (TA+ 23.1% vs. TA- 15.2%; p=0.050. During average follow-up of 14Ѓ}5 months, major adverse cardiac/ cerebral events occurred at the similar rate (log rank p=0.867. Conclusion. Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn’t influence the incidence of major adverse cardiovascular events. [Projekat Ministarstva nauke Republike Srbije, br. 175099

  15. Endothelial progenitor cells, microvascular obstruction, and left ventricular remodeling in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Porto, Italo; De Maria, Giovanni Luigi; Leone, Antonio Maria; Dato, Ilaria; D'Amario, Domenico; Burzotta, Francesco; Niccoli, Giampaolo; Trani, Carlo; Biasucci, Luigi Marzio; Bolognese, Leonardo; Crea, Filippo

    2013-09-15

    Endothelial progenitor cells (EPCs) are released from the bone marrow during cardiac ischemic events, potentially influencing vascular and myocardial repair. We assessed the clinical and angiographic correlates of EPC mobilization at the time of primary percutaneous coronary intervention in 78 patients with ST elevation myocardial infarction and the impact of both baseline and follow-up EPC levels on left ventricular (LV) remodeling. Blood samples were drawn from the aorta and the culprit coronary artery for cytofluorimetric EPC detection (CD34+CD45dimKDR+ cells, in percentage of cytofluorimetric counts). Area at risk was assessed by Bypass Angioplasty Revascularization Investigation myocardial jeopardy index, thrombotic burden as thrombus score and microvascular obstruction (MVO) as a combination of ST segment resolution and myocardial blush grade. Echocardiographic evaluation of LV remodeling was performed at 1-year follow-up in 54 patients, whereas peripheral EPC levels were reassessed in 40 patients. EPC levels during primary percutaneous coronary intervention were significantly higher in intracoronary than in aortic blood (0.043% vs 0.0006%, p <0.001). Both intracoronary and aortic EPC were related to area at risk extent, to intracoronary thrombus score (p <0.001), and inversely to MVO (p = 0.001). Peripheral EPC levels at 1-year follow-up were lower in patients with LV remodeling than in those without (0.001% [0.001 to 0.002] vs 0.003% [0.002 to 0.010]; p = 0.01) and independently predicted absence of remodeling at multivariate analysis. In conclusion, a rapid intracoronary EPC recruitment takes place in the early phases of ST elevation myocardial infarction, possibly reflecting an attempted reparative response. The extent of this mobilization seems to be correlated to the area at risk and to the amount of MVO. Persistently low levels of EPC are associated to LV remodeling.

  16. Relation between plasma brain natriuretic peptide, serum indexes of collagen type I turnover, and left ventricular remodeling after reperfused acute myocardial infarction.

    Science.gov (United States)

    Cerisano, Giampaolo; Pucci, Paolo Domenico; Sulla, Antonio; Tommasi, Mariasilvia; Raspanti, Silvia; Santoro, Giovanni Maria; Antoniucci, David

    2007-03-01

    The aim of the study is to investigate the relation between plasma brain natriuretic peptide (BNP), collagen type I turnover, and left ventricular (LV) remodeling after primary angioplasty. Echo-Doppler, BNP, carboxy-terminal telopeptide of procollagen type I (ICTP), C-terminal propeptide of procollagen type I (PICP), and their ratio PICP/ICTP (as an index of coupling between the synthesis and degradation of collagen type I) were evaluated at days 1 and 3 and months 1 and 6 after primary angioplasty in 56 consecutive patients with a first large acute myocardial infarction (AMI). During the 6 months after AMI, a direct relation was shown between BNP and ICTP (day 1, r = 0.54, p = 0.000; day 3, r = 0.64, p = 0.000; month 1, r = 0.64, p = 0.000; month 6, r = 0.41, p = 0.005) and BNP and PICP/ICTP (day 1, r = -0.54, p = 0.003; day 3, r = -0.58, p = 0.000; month 1, r = -0.50, p = 0.000; month 6, r = -0.30, p = 0.043), but not between BNP and PICP. Using analysis of covariance, relations between BNP and ICTP and PICP/ICTP were independent from infarct size. Patients with LV remodeling had significantly higher plasma ICTP and BNP levels and lower PICP/ICTP than patients without LV remodeling. Day-1 ICTP independently predicted 6-month remodeling (exp beta = 2.14, 95% confidence interval 1,120 to 3,550, p = 0.01). In conclusion, a relation exists between plasma BNP collagen type I turnover and LV remodeling after reperfused AMI.

  17. Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature.

    Science.gov (United States)

    Varbella, F; Bongioanni, S; Sibona Masi, A; Iazzolino, E; Alunni, G; Conte, M R; Brusca, A

    1999-02-01

    Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. Heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature.

  18. Influence of the Angiotensin Converting Enzyme I/D Gene Polymorphisms on Left Ventricular Diastolic Filling Parameteres in Patients with a First Anterior Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Önder Öztürk

    2006-01-01

    Full Text Available An insertion / deletion (I/D polymorphism exerts effects on left ventricular (LV diastolic performance. The purpose of this study is to determine the effects of polymorphism of the ACE on LV diastolic filling parameters after a first anterior acute myocardial infarction (AMI. The subjects were 142 patients (115 men, 27 women, 59±12 years with a first anterior AMI. Echocardiograms were used to LV diastolic function parameters (Mitral E/A, DT, IVRT, E VTI / A VTI and M-mode measurements of LV within 24 hours after the on set of AMI. Based on the polymorphism of the ACE, they were classified into three groups: Group 1 (DD genotype of 59 patients, group 2 (ID genotype of 63 and Group 3 (II genotype 20 patients. There were no significant differences between the groups in the baseline characteristics and echocardiographic parameters of patients. (p>0.05.In patients with an anterior AMI, ACE gene polymorphism may have not influence on LV diastolic filling parameters.

  19. Occurrence and predictors of left ventricular systolic dysfunction at hospital discharge and in long−term follow−up after acute myocardial infarction treated with primary percutaneous coronary intervention

    OpenAIRE

    Świątkiewicz, Iwona; Magielski, Przemysław; Woźnicki, Marek; Gierach, Joanna; Jabłoński, Mirosław; Fabiszak, Tomasz; Koziński, Marek; Sukiennik, Adam; Bronisz, Agata; Kubica, Jacek

    2011-01-01

    Background: Post-ST-segment elevation myocardial infarction (STEMI) left ventricular systolic dysfunction (LVSD) has been identified as an important marker of poor prognosis. Aim: To assess the prevalence and course of LVSD at hospital discharge and in long-term follow-up in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Methods: We enrolled 205 patients (157 male, 48 female) with a first STEMI. Echocardiography was performed before hospital disc...

  20. Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

    Directory of Open Access Journals (Sweden)

    Machado Cristiano V

    2011-06-01

    Full Text Available Abstract Background Left ventricular ejection fraction (LVEF has been considered a major determinant of early outcome in acute myocardial infarction (AMI. Myocardial performance index (MPI has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF specifically in patients with a first isolated ST-elevation AMI. Methods Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. Results Early in-hospital CHF occurred in 29 (31% of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p Conclusion For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.

  1. 缬沙坦或卡托普利或二者联合治疗心肌梗塞伴心力衰竭和(或)左心室功能障碍的评价%Evaluation of Valsartan, Captopril or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both

    Institute of Scientific and Technical Information of China (English)

    钱卫民

    2005-01-01

    Pfeffer MA, McMurray JV, Velazquez E J, et al. Valsartan, Captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both [J]. N Engl J Med, 2003, 349 (20) : 1893-1905.

  2. Metaloproteinases 2 e 9 são preditoras de remodelação ventricular esquerda após o infarto do miocárdio Metalloproteinases-2 and -9 predict left ventricular remodeling after myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ana Lucia Cogni

    2013-04-01

    included 29 patients; 62% exhibited ventricular remodeling. The patients who exhibited remodeling had higher infarct size based on creatine phosphokinase (CPK peak values (p = 0.037, higher prevalence of in-hospital congestive heart failure (p = 0.004, and decreased ejection fraction (EF (p = 0.007. The patients with ventricular remodeling had significantly lower serum levels of inactive MMP-9 (p = 0.007 and significantly higher levels of the active form of MMP-2 (p = 0.011. In a multivariate logistic regression model, adjusted by age, CPK peak, EF and prevalence of heart failure, MMP-2 and -9 serum levels remained associated with remodeling (p = 0.033 and 0.044, respectively. CONCLUSIONS: Higher serum levels of inactive MMP-9 were associated with the preservation of left ventricular volumes, and higher serum levels of the active form of MMP-2 were a predictor of remodeling 6 months after MI.

  3. Comparison of regional and global left ventricular function by serial echocardiograms after reperfusion in acute myocardial infarction.

    Science.gov (United States)

    Broderick, T M; Bourdillon, P D; Ryan, T; Feigenbaum, H; Dillon, J C; Armstrong, W F

    1989-01-01

    Fifty patients undergoing successful reperfusion therapy (percutaneous transluminal coronary angioplasty 20, thrombolysis 10, combined 20) for acute myocardial infarction were evaluated with serial two-dimensional echocardiograms performed early (less than 24 hours, mean 8 hours) and late (greater than 3 days, mean 6 days) after presentation. Treatment occurred within 12 hours of the onset of symptoms with most patients achieving reperfusion in less than 6 hours (mean 4.7 hours) from the onset of pain. Reperfusion was demonstrated short-term by angiography in 42 of 50 patients (84%). Four patients had clinical signs of reperfusion and subsequent angiographic confirmation. An additional four patients with "stuttering" infarct courses were treated late by percutaneous transluminal coronary angioplasty. Echocardiograms were analyzed for global performance by calculation of fractional area change at the papillary muscle level and ejection fraction (biplane Simpson's rule) in 18 patients in whom this analysis could be performed. Measurements of regional function included fractional shortening at the base (n = 37), regional wall motion index (n = 50) and percent of normal functioning myocardium (n = 50). Overall there was a significant improvement in regional wall scores and percent of functioning myocardium (regional wall motion index 1.73 to 1.43, p less than 0.001 and percent of functioning myocardium 0.61 to 0.70, p less than 0.001) but only a trend toward improvement when global function was assessed by ejection fraction (0.42 to 0.48, p less than 0.14).(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Schoos, Mikkel Malby; Kelbæk, Henning Skov;

    2012-01-01

    The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is le...... prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI)....

  5. Relationship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure

    Directory of Open Access Journals (Sweden)

    Gruzdeva O

    2013-02-01

    Full Text Available Olga Gruzdeva, Evgenya Uchasova, Yulia Dyleva, Ekaterina Belik, Vasily Kashtalap, Olga BarbarashFederal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, RussiaBackground: The most common cause of myocardial infarction (MI is stenotic atherosclerotic lesions in subepicardial coronary arteries. Artery disease progression induces clinical signs and symptoms, among which MI is the leader in mortality and morbidity. Recent studies have been trying to find new biochemical markers that could predict the evolution of clinical complications; among those markers, free fatty acids (FFA and oxidative modification of low-density lipoproteins (oxidized LDL have a special place.Materials and methods: Seventy-nine ST-elevation MI patients were enrolled. The first group included MI patients without the signs of acute heart failure (Killip class I while MI patients with Killip classes II–IV made up the second group. Thirty-three individuals with no cardiovascular disease were the controls. The lipid profile, serum oxidized LDL, and their antibodies, C-peptide and insulin were measured at days 1 and 12. The level of insulin resistance was assessed with the quantitative insulin sensitivity check index (QUICKI.Results: MI patients had atherogenic dyslipidemia; however, the Killip II–IV group had the most pronounced and prolonged increase in FFA, oxidized LDL, and their antibodies. Additionally, positive correlations between FFA levels and creatine kinase activity (12 days, R = 0.301; P = 0.001 and negative correlations between the QUICKI index and FFA levels (R = –0.46; P = 0.0013 and R = –0.5; P = 0.01 were observed in the both groups.Conclusion: The development of MI complications is accompanied by a significant increase in FFA levels, which not only demonstrate myocardial injury, but also take part in development of insulin resistance. Measuring FFA levels can have a great prognostic potential for

  6. Predictors and prognostic impact of recurrent myocardial infarction in patients with left ventricular dysfunction, heart failure, or both following a first myocardial infarction

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Signorovitch, James E; Kober, Lars;

    2011-01-01

    IMS: Recurrent myocardial infarction (MI) is common after a first MI and is associated with increased morbidity and mortality. Predictors and prognosis of a recurrent MI with contemporary management are not well known. METHODS AND RESULTS: We assessed the predictors and prognostic impact of a fir...

  7. Antiarrhythmic effect of carvedilol after acute myocardial infarction: results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial

    DEFF Research Database (Denmark)

    McMurray, John; Køber, Lars; Robertson, Michele;

    2005-01-01

    ratio (HR) of 0.41 (95% confidence interval [CI] 0.25 to 0.68; p = 0.0003). The corresponding rates of ventricular tachycardia/flutter/fibrillation were 38 to 984 (3.9%) and 9 to 975 (0.9%) (HR 0.24, 95% CI 0.11 to 0.49; p

  8. Assessment of Left Ventricular Myocardial Viability by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Myocardial Infarction.

    Science.gov (United States)

    Ran, Hong; Zhang, Ping-Yang; Zhang, You-Xiang; Zhang, Jian-Xin; Wu, Wen-Fang; Dong, Jing; Ma, Xiao-Wu

    2016-08-01

    To determine whether 3-dimensional (3D) speckle-tracking echocardiography could provide a new way to assess myocardial viability in patients with myocardial infarction (MI). Forty-five patients with MI underwent routine echocardiography, 2-dimensional (2D) speckle-tracking echocardiography, and 3D speckle-tracking echocardiography. Radionuclide myocardial perfusion/metabolic imaging was used as a reference standard to define viable and nonviable myocardia. Among 720 myocardial segments in 45 patients, 368 showed abnormal motion on routine echocardiography; 204 of 368 were categorized as viable on single-photon emission computed tomography/positron emission tomography (SPECT/PET), whereas 164 were defined as nonviable; 300 normal segments on SPECT/PET among 352 segments without abnormal motion on routine echocardiography were categorized as a control group. The radial, longitudinal, 3D, and area strain on 3D speckle-tracking echocardiography had significant differences between control and nonviable groups (P speckle-tracking echocardiography between viable and nonviable groups. Although there was no significant difference in circumferential strain between the groups, radial and longitudinal strain from 3D speckle-tracking echocardiography decreased significantly in the nonviable group. Moreover, 3D and area strain values were lower in the nonviable segments than the viable segments. By receiver operating characteristic analysis, radial strain from 3D speckle-tracking echocardiography with a cutoff of 11.1% had sensitivity of 95.1% and specificity of 53.4% for viable segments; longitudinal strain with a cutoff of 14.3% had sensitivity of 65.2% and specificity of 65.7%; 3D strain with a cutoff of 17.4% had sensitivity of 70.6% and specificity of 77.2%; and area strain with a cutoff of 23.2% had sensitivity of 91.5% and specificity of 82.8%. Three-dimensional speckle-tracking echocardiography might have potential for detection of myocardial viability in patients with

  9. Impact of thermodilution-derived coronary blood flow patterns after percutaneous coronary intervention on mid-term left ventricular remodeling in patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Sumiyoshi, Akinori; Fujii, Kenichi; Fukunaga, Masashi; Shibuya, Masahiko; Imanaka, Takahiro; Kawai, Kenji; Miki, Kojiro; Tamaru, Hiroto; Horimatsu, Tetsuo; Saita, Ten; Nishimura, Machiko; Masuyama, Tohru; Ishihara, Masaharu

    2017-01-01

    We recently reported the coronary thermodilution curve can be evaluated by analyzing the thermodilution curve obtained from a pressure sensor/thermistor-tipped guidewire, and presence of a bimodal-shaped thermodilution curve following primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients was associated with worse outcomes. This study evaluated whether the bimodal-shaped thermodilution curve predicts left ventricular (LV) remodeling after STEMI. The coronary thermodilution curve patterns were evaluated for 75 patients treated by pPCI for their first STEMI using a pressure sensor/thermistor-tipped guidewire, and classified into the three groups according to the thermodilution curve shape: narrow unimodal (n = 39), wide unimodal (n = 26), and bimodal pattern (n = 10). Echocardiography was performed at baseline and 6 months after STEMI. LV remodeling was defined as a >20 % increase in LV end-diastolic volumes (LVEDV). LVEDV at 6-month follow-up was greater in the bimodal group than in the other groups (p remodeling was highest in the bimodal group than in the narrow and wide unimodal groups (60, 12, and 15 %, respectively; p = 0.003). Multivariate analysis revealed a bimodal-shaped thermodilution curve as an independent predictor of the prevalence of LV remodeling. A bimodal-shaped thermodilution curve is associated with LV remodeling after STEMI. This easily assessable coronary thermodilution curve pattern is useful to predict mid-term LV remodeling for STEMI patients at the catheterization laboratory.

  10. Circulating Endothelial Cells and Endothelial Function predict Major Adverse Cardiac Events and Early Adverse Left Ventricular Remodeling in Patients with ST-Segment Elevation Myocardial Infarction

    Science.gov (United States)

    Magdy, Abdel Hamid; Bakhoum, Sameh; Sharaf, Yasser; Sabry, Dina; El-Gengehe, Ahmed T; Abdel-Latif, Ahmed

    2016-01-01

    Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) are mobilized from the bone marrow and increase in the early phase after ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the prognostic significance of CECs and indices of endothelial dysfunction in patients with STEMI. In 78 patients with acute STEMI, characterization of CD34+/VEGFR2+ CECs, and indices of endothelial damage/dysfunction such as brachial artery flow mediated dilatation (FMD) were determined. Blood samples for CECs assessment and quantification were obtained within 24 hours of admission and FMD was assessed during the index hospitalization. At 30 days follow up, the primary composite end point of major cardiac adverse events (MACE) consisting of all-cause mortality, recurrent non-fatal MI, or heart failure and the secondary endpoint of early adverse left ventricular (LV) remodeling were analyzed. The 17 patients (22%) who developed MACE had significantly higher CEC level (P = 0.004), vWF level (P =0.028), and significantly lower FMD (P = 0.006) compared to the remaining patients. Logistic regression analysis showed that CECs level and LV ejection fraction were independent predictors of MACE. The areas under the receiver operating characteristic curves (ROC) for CEC level, FMD, and the logistic model with both markers were 0.73, 0.75, and 0.82 respectively for prediction of the MACE. The 16 patients who developed the secondary endpoint had significantly higher CEC level compared to remaining patients (p =0.038). In conclusion, increased circulating endothelial cells and endothelial dysfunction predicted the occurrence of major adverse cardiac events and adverse cardiac remodeling in patients with STEMI. PMID:26864952

  11. Serum profiles of circulating granulocyte-macrophage colony-stimulating factor in acute myocardial infarction and relation with post-infarction left ventricular function

    Institute of Scientific and Technical Information of China (English)

    MA Yi-tong; FU Zhen-yan

    2005-01-01

    @@ Accumulating evidence indicates that inflammation plays an important role in cardiac repairing and remodeling after acute myocardial infarction (AMI), process of which is mediated by a cytokine reaction cascade.1 Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine, which belongs to the family of haemopoietic cell colony-stimulating factor and regulates the proliferation and differentiation of myeloid progenitor cells.

  12. [EFFICACY OF STANDARD TWO-YEAR COMPREHENSIVE THERAPY TO ACHIEVE TARGET BLOOD PRESSURE AND REGRESSION DEGREES OF REMODELING OF THE LEFT VENTRICULAR HYPERTROPHY IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION WITH COMORBID HYPERTENSION].

    Science.gov (United States)

    Denesiuk, E V

    2015-01-01

    The study involved 23 men after acute myocardial infarction (AMI) with comorbid arterial hypertension (AH). Mean age of patients was 56.7 years. Recurrent myocardial infarction was determined in 38.4%, cardiac failure I-III functional classes--100% of the cases. All patients underwent clinical examination, electrocardiography and echocardiography, blood lipid profile. Standard comprehensive treatment for two years included an perindopril 5-10 mg/day, beta-blocker bisoprolol--5-10 mg/day, antisclerotic drug atorvastatin--20 mg/day and aspirin--75 mg/day. The patients after treatment was determined by a gradual increase towards the target of AT at 3, 6 and 12 to 24 months. Concentric left ventricular hypertrophy (LVH) before treatment was determined in 47.8%, eccentric--in 52.2% of patients. In the study of degrees of LVH I (initial) the extent to treatment was determined by 4.3%, II (moderate)--26.1%, III (large)--at 69.6%, indicating the development of cardiac remodeling. After the treatment was determined by marked reduction III (large) degree and transfer it in the II (moderate) and I (small) degree of left ventricular hypertrophy due to more or less pronounced changes remodeling left ventricular. The obtained data allow a more detailed and adequately assess the structural and functional outcome variables and determine the regression of myocardial hypertrophy in the background to achieve target blood pressure, which is important in practical cardiology.

  13. ASSOCIATION BETWEEN REDUCED HEART-RATE-VARIABILITY AND LEFT-VENTRICULAR DILATATION IN PATIENTS WITH A FIRST ANTERIOR MYOCARDIAL-INFARCTION

    NARCIS (Netherlands)

    DAMBRINK, JHE; TUININGA, YS; VANGILST, WH; PEELS, KH; LIE, KI; KINGMA, JH

    1994-01-01

    Background-Reduced heart rate variability has been identified as an important prognostic factor after myocardial infarction. This factor is thought to reflect an imbalance between sympathetic and parasympathetic activity, which may lead to unfavourable loading conditions and thus promote left ventri

  14. Heart rate variability density analysis (Dyx) for identification of appropriate implantable cardioverter defibrillator recipients among elderly patients with acute myocardial infarction and left ventricular systolic dysfunction

    DEFF Research Database (Denmark)

    Jørgensen, Rikke Mørch; Levitan, Jacob; Halevi, Zohar

    2015-01-01

    AIMS: Dyx is a new heart rate variability (HRV) density analysis specifically designed to identify patients at high risk for malignant ventricular arrhythmias. The aim of this study was to test if Dyx can improve risk stratification for malignant ventricular tachyarrhythmias and to test if the pr......AIMS: Dyx is a new heart rate variability (HRV) density analysis specifically designed to identify patients at high risk for malignant ventricular arrhythmias. The aim of this study was to test if Dyx can improve risk stratification for malignant ventricular tachyarrhythmias and to test...... if the previously identified cut-off can be reproduced. METHODS AND RESULTS: This study included 248 patients from the CARISMA study with ejection fraction ≤40% after an acute myocardial infarction and an analysable 24 h Holter recording. All patients received an implantable cardiac monitor, which was used...... to diagnose the primary endpoint of near-fatal or fatal ventricular tachyarrhythmias likely preventable by an implantable cardioverter defibrillator (ICD), during a period of 2 years. A Dyx ≤ 1.96 was considered abnormal. The secondary endpoint was cardiovascular death. At enrolment 59 patients (24%) had...

  15. Long-term changes in collagen formation expressed by serum carboxyterminal propeptide of type-I procollagen and relation to left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Høst, N B; Egstrup, K

    2001-01-01

    The purpose of this study was to investigate the long-term sequential changes in serum levels of the carboxyterminal propeptide of type-I procollagen (s-PICP), which is a marker of type-I collagen synthesis, and to assess its clinical value in relation to left ventricular (LV) function...

  16. Relationship between serum amino-terminal propeptide of type III procollagen and changes of left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Høst, N B; Jensen, S E

    2000-01-01

    : The relationship between PIIINP and changes of left ventricular (LV) function was studied in 47 consecutive patients with first acute MI and 16 control subjects. Serum PIIINP analysis was measured daily during hospitalization and on days 90, 180, and 360. LV function was assessed by echocardiography on days 1, 5...

  17. Decrease in Plasma Cyclophilin A Concentration at 1 Month after Myocardial Infarction Predicts Better Left Ventricular Performance and Synchronicity at 6 Months: A Pilot Study in Patients with ST Elevation Myocardial Infarction

    Science.gov (United States)

    Huang, Ching-Hui; Chang, Chia-Chu; Kuo, Chen-Ling; Huang, Ching-Shan; Lin, Chih-Sheng; Liu, Chin-San

    2015-01-01

    Background: Cyclophilin A (CyPA) concentration increases in acute coronary syndrome. In an animal model of acute myocardial infarction, administration of angiotensin-converting-enzyme inhibitor was associated with lower left ventricular (LV) CyPA concentration and improved LV performance. This study investigated the relationships between changes in plasma CyPA concentrations and LV remodeling in patients with ST-elevation myocardial infarction (STEMI). Methods and Results: We enrolled 55 patients who underwent percutaneous coronary intervention for acute STEMI. Plasma CyPA, matrix metalloproteinase (MMP), interleukin-6 and high-sensitivity C-reactive protein concentrations were measured at baseline and at one-month follow-up. Echocardiography was performed at baseline and at one-, three-, and six-month follow-up. Patients with a decrease in baseline CyPA concentration at one-month follow-up (n = 28) had a significant increase in LV ejection fraction (LVEF) (from 60.2 ± 11.5% to 64.6 ± 9.9%, p decrease in CyPA concentration at one month (n = 27) did not show improvement in LVEF and had a significantly increased systolic dyssynchrony index (SDI) (from 1.170 ± 0.510% to 1.637 ± 1.299%, p = 0.042) at six months. Multiple linear regression analysis showed a significant association between one-month CyPA concentration and six-month LVEF. The one-month MMP-2 concentration was positively correlated with one-month CyPA concentration and LV SDI. Conclusions: Decreased CyPA concentration at one-month follow-up after STEMI was associated with better LVEF and SDI at six months. Changes in CyPA, therefore, may be a prognosticator of patient outcome. PMID:25552928

  18. Left ventricular wall stress compendium.

    Science.gov (United States)

    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  19. Speckle-tracking echocardiography elucidates the effect of pacing site on left ventricular synchronization in the normal and infarcted rat myocardium.

    Directory of Open Access Journals (Sweden)

    Michal Mor

    Full Text Available BACKGROUND: Right ventricular (RV pacing generates regional disparities in electrical activation and mechanical function (ventricular dyssynchrony. In contrast, left ventricular (LV or biventricular (BIV pacing can improve cardiac efficiency in the setting of ventricular dyssynchrony, constituting the rationale for cardiac resynchronization therapy (CRT. Animal models of ventricular dyssynchrony and CRT currently relay on large mammals which are expensive and not readily available to most researchers. We developed a methodology for double-site epicardial pacing in conscious rats. Here, following post-operative recovery, we compared the effects of various pacing modes on LV dyssynchrony in normal rats and in rats with ischemic cardiomyopathy. METHODS: Two bipolar electrodes were implanted in rats as follows: Group A (n = 6 right atrial (RA and RV sites; Group B (n = 7 RV and LV sites; Group C (n = 8 as in group B in combination with left coronary artery ligation. Electrodes were exteriorized through the back. Following post-operative recovery, two-dimensional transthoracic echocardiography was performed during pacing through the different electrodes. Segmental systolic circumferential strain (Ecc was used to evaluate LV dyssynchrony. RESULTS: In normal rats, RV pacing induced marked LV dyssynchrony compared to RA pacing or sinus rhythm, as measured by the standard deviation (SD of segmental time to peak Ecc, SD of peak Ecc, and the average delay between opposing ventricular segments. LV pacing and, to a greater extend BIV pacing diminished the LV dyssynchrony compared to RV pacing. In rats with extensive MI, the effects of LV and BIV pacing were markedly attenuated, and the response of individual animals was variable. CONCLUSIONS: Rodent cardiac pacing mimics important features seen in humans. This model may be developed as a simple new tool to study the pathophysiology of ventricular dyssynchrony and CRT.

  20. Echocardiographic evaluation of left ventricular function in ischemic heart disease

    NARCIS (Netherlands)

    Mollema, Sjoerd Adriaan

    2010-01-01

    The presence of a decreased left ventricular (LV) function after myocardial infarction has demonstrated to be of considerable clinical importance. In this thesis, the role of 2D echocardiography to evaluate LV function in ischemic heart disease was investigated. In the first part of the thesis, rece

  1. Echocardiographic evaluation of left ventricular function in ischemic heart disease

    NARCIS (Netherlands)

    Mollema, Sjoerd Adriaan

    2010-01-01

    The presence of a decreased left ventricular (LV) function after myocardial infarction has demonstrated to be of considerable clinical importance. In this thesis, the role of 2D echocardiography to evaluate LV function in ischemic heart disease was investigated. In the first part of the thesis,

  2. Right ventricular dysfunction affects survival after surgical left ventricular restoration.

    Science.gov (United States)

    Couperus, Lotte E; Delgado, Victoria; Palmen, Meindert; van Vessem, Marieke E; Braun, Jerry; Fiocco, Marta; Tops, Laurens F; Verwey, Harriëtte F; Klautz, Robert J M; Schalij, Martin J; Beeres, Saskia L M A

    2017-04-01

    Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function. A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed. Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was -24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left

  3. Arrhythmia in Acute Right Ventricular Infarction

    Directory of Open Access Journals (Sweden)

    Azin Alizadeh Asl

    2007-09-01

    Full Text Available Acute inferior myocardial infarction (MI frequently involves the right ventricle (RV.1-3 We assessed the prognostic impact of RV myocardial involvement in patients with inferior MI. One hundred seventy patients were admitted to the cardiac care unit of Madani Heart Hospital (Tabriz-Iran with the diagnosis of inferior MI with (group1 or without (group2 the simultaneous involvement of RV during the study period (from 2005 to 2006. Patients presenting within 12h of symptom onset were eligible for inclusion. Patients with simultaneous anterior wall MI or renal impairment (creatinine > 2 mg/dl, as well as those undergoing primary percutaneous translational coronary angioplasty, were excluded. Eighty eight percent of the patients with RVMI and 75% of those with isolated inferior MI had some type of arrhythmia. Atrioventricular (AV block occurred in 42% of the infarctions with RV involvement and only in 29% of the control group. Intra-ventricular conduction disturbance (IVCD was also more frequent in RVMI (29.4% vs. 13.1%, p=0.021, especially right bundle branch block (RBBB (20% vs. 7.4%, P=0.003. There was, however, no meaningful difference in the incidence of left bundle branch block (LBBB between the two groups (3.5% vs. 2.35%, P=0.95. Ventricular fibrillation (VF was observed in 5.2% and 1.2% and ventricular tachycardia in 26% and 12.2% of the patients in groups 1 and 2, respectively. In 27% of patients with RVMI, it was necessary to implant a pacemaker as compared to 10% of those in the control group. Mortality was higher in the patients with inferior infarction extended to the RV (15.3% vs. 3.5%, P= 0.0001. Thus, the differences between the findings in the two groups in terms of the occurrence of post-MI arrhythmias and conduction disorders were quite significant, but there was no meaningful difference with respect to the incidence of LBBB between the two groups. Additionally, patients with inferior MI who also had RV myocardial involvement were

  4. 斑点追踪成像技术在心肌梗死左室心肌应变能力中的应用%Application of Speckle Tracking Imaging in Left Ventricular Strain Capacity of Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    喻丽华; 赵季红; 蔡伟; 李学文

    2012-01-01

    目的:探讨超声斑点追踪成像(speckle tracking imaging,STI)技术评价心肌梗死患者左室心肌整体和局部应变的价值.方法:收集医院60例确诊为前壁心肌梗死患者,将同期体检健康志愿者60例作为正常对照.分别收集2组心尖位左室长轴3个切面高帧频二维动态图像,以自动功能成像软件(automated functional imaging,AFI)测量左室18节段峰值收缩期应变(S)、切面峰值收缩应变(GLS)及左室长轴平均总应变(GLS-Avg),分析GLS-Avg与左室射血分数(left ventricular ejection fraction,LVEF)的相关性;比较2组患者GLS-Avg.结果:前壁心肌梗死患者左室18节段S值自基底段向心尖段逐渐增加,各壁间差异无统计学意义(P>0.05);前壁心肌梗死患者各节段壁应变绝对值低于正常对照组(P<0.05).GLS-Avg与LVEF具有良好相关性(r=0.93,P<0.05).结论:斑点追踪成像技术能定量测定心肌梗死患者左室和整体心肌的变化.%Objective To study the application of speckle tracking imaging(STI) technology in myocardial infarction patients with left ventricular global and local strain. Methods Sixty cases of myocardial infarction patients were selected, and another sixty healthy patients were in control group. Left ventricular apical long-axis positions were recorded in three two-dimensional slices of high frame rate dynamic images. Left ventricular peak systolic strain in paragraph 18(S), the section peak systolic strain(GLS) and left ventricular long axis of the average total strain(GLS-Avg) of all cases were measured by automated functional imaging(AFI). The relationship of GLS-Avg and left ventricular ejection fraction(LVEF) was analyzed. Results Paragraph 18(S) values of left ventricle from the basal to apical segments gradually increased in control group. The intramural difference was not statistically significant(P>0.05), and strain of the wall segment in myocardial infarction group was lower than that of the control

  5. Impact of the combined presence of left ventricular systolic and renal dysfunction on the 5-year outcome after ST-elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Savić Lidija

    2015-01-01

    Full Text Available Background/Aim. The coincidence of left ventricular systolic dysfunction (LVSD and renal dysfunction (RD is a strong independent predictor of adverse events in the short-term and mid-term follow-ups of patients with ST-elevation myocardial infarction (STEMI treated with primary percutaneous coronary intervention (pPCI. The aim of this study was primarily to assess the prognostic impact of the LVSD-RD combination on the 5-year all-cause mortality in patients with STEMI treated with pPCI, as well as to assess the prognostic impact of the LVSD-RD combination on the occurrence of major adverse cardiovascular events (MACEs: cardiovascular death, reinfarction, stroke and target vessel revascularization in these patients. Methods. We analyzed 951 patients divided into 4 groups according to the presence of LVSD (ejection fraction < 40% and/or baseline RD (creatinine clearance < 60 mL/min: group I (no LVSD, no RD; group II (LVSD, no RD; group III (RD, no LVSD; group IV (LVSD+RD. Results. The 5-year mortality rates were 2.3%, 17.6%, 11.7% and 38.3%, while the 5-year MACE rates were 8.8%, 28.4%, 18.3% and 44.4% in the groups I, II, III and IV, respectively (p < 0.001. The highest percentage of lethal outcomes and MACE was registered in the first year of follow-up in all the groups. The 1-year landmark analysis confirmed that the patients with LVSD-RD combination had the highest percentage of lethal outcomes in the period of 1 to 5 years (p = 0.028. There was a strong trend toward the significance in the occurrence of MACE among the analyzed groups in the period of 1 to 5 years (p = 0.085. In the Cox regression model the LVSD-RD combination was a strong independent predictor of 5-year mortality and the occurrence of MACE: mortality hazard ratio (HR 4.5 (95%CI 1.9-10.8; MACE HR 2.5 (95%CI 1.4-4.5. Conclusion. The strong negative independent prognostic impact of the LVSD-RD combination persisted in the long-term follow-up of the patients with STEMI treated

  6. Influence of rosuvastatin in left ventricular remodeling and cardiac function after myocardial infarction in rabbits%瑞舒伐他汀对老年兔心肌梗死左室重构和心功能的影响

    Institute of Scientific and Technical Information of China (English)

    陈丹丹; 李加平

    2013-01-01

    Objective To observe and study correlation influence of rosuvastatin in left ventricular remodeling and cardiac function after myocardial infarction in rabbits. Methods Olderly male New Zealand white rabbits were random divided into control group, myocardial infarction group and rosuvastatin group. Myocardial infarction combination rosuvastatin group were established the left anterior descending coronary artery ligation after infarction model, infarction after the establishment of the model to red easy cutting statin calcium from the gastrointestinal tract infusion 4 weeks group for Rosuvastatin group. Before and after molding respectively, left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVDS), left ventricular short axis shorten rate (LVFS) and left ventricular ejection fraction (LVEF) were measured, postoperation muscle cell scar index and muscle cell apoptosis index (AI) was measured. Results The scores and sham operation group comparison, after the success of the infarction myocardial infarction group and red easy cutting statin group of LVFS, LVEF was decreased, but in a way LVDD, LVDS significantly increased (P <0. 01); In myocardial infarction manufacturing model after the success of 14 and 28 d red easy cutting statin group LVDS below myocardial infarction group (P<0. 05 and 0. 01), however LVFS and LVEF were significantly higher than that of myocardial infarction group (P<0. 01) ; In the infarction model after the establishment of the 28 d Rosuvastatin group myocardial scarring index less than myocardial infarction group (P<0. 05); sham operation group AI significantly lower than easy cutting statin group and myocardial infarction group (P<0. 01), but the myocardial infarction group is obviously higher than that of the red easy cutting statin group (P<0. 05). Conclusion Rosuvastatin for elderly rabbit after myocardial infarction myocardial remodeling and cardiac function in a benign influence, its

  7. Sustained myocardial production of stromal cell-derived factor-1α was associated with left ventricular adverse remodeling in patients with myocardial infarction.

    Science.gov (United States)

    Uematsu, Manabu; Yoshizaki, Toru; Shimizu, Takuya; Obata, Jun-ei; Nakamura, Takamitsu; Fujioka, Daisuke; Watanabe, Kazuhiro; Watanabe, Yosuke; Kugiyama, Kiyotaka

    2015-11-15

    The role of stromal cell-derived factor-1α (SDF-1α) expressed in infarcted myocardium is unknown in humans. We examined whether SDF-1α produced in an infarcted myocardial lesion may play a role in left ventricle (LV) remodeling and dysfunction in patients with acute myocardial infarction (AMI). We measured SDF-1α levels in plasma obtained from aortic root (AO) and anterior interventricular vein (AIV) in the early phase (2 wk after MI) and the chronic phase (6 mo after MI) in 80 patients with anterior MI. An increment in SDF-1α level from AO to AIV, reflecting SDF-1α release from infarcted myocardium, was more frequent in patients with MI in the early phase of MI [n = 52 (65%), P = 0.03] but not in the chronic phase of MI [n = 46 (58%), P = 0.11] compared with that in control patients [n = 6/17 (35%)]. On linear regression analysis, the transmyocardial gradient in SDF-1α level in the chronic phase of MI was correlated with percentage changes in LV end-diastolic volume index (r = 0.39, P infarcted myocardium in the chronic phase of MI was associated with LV adverse remodeling and progressive dysfunction in AMI survivors.

  8. Assessment of Left Ventricular 2D Flow Pathlines during Early Diastole Using Spatial Modulation of Magnetization with Polarity Alternating Velocity Encoding (SPAMM-PAV): a study in normal volunteers and canine animals with myocardial infarction

    Science.gov (United States)

    Zhang, Ziheng; Friedman, Daniel; Dione, Donald P.; Lin, Ben A.; Duncan, James S.; Sinusas, Albert J.; Sampath, Smita

    2013-01-01

    A high temporal resolution 2D flow pathline analysis method that describes the spatio-temporal distribution of blood entering the left ventricle during early diastolic filling is presented. Filling patterns in normal volunteers (n=8) and canine animals (baseline (n=1) and infarcted (n=6)) are studied using this approach. Data is acquired using our recently reported MR technique, SPAMM-PAV, which permits simultaneous quantification of blood velocities and myocardial strain at high temporal resolution of 14 ms. Virtual emitter particles, released from the mitral valve plane every time frame during rapid filling, are tracked to depict the propagation of 2D pathlines on the imaged plane. The pathline regional distribution patterns are compared with regional myocardial longitudinal strains and regional chamber longitudinal pressure gradients. Our results demonstrate strong spatial inter-dependence between left ventricular (LV) filling patterns and LV mechanical function. Significant differences in pathline-described filling patterns are observed in the infarcted animals. Quantitative analysis of net kinetic energy for each set of pathlines is performed. Peak net kinetic energy of 0.06±0.01 mJ in normal volunteers, 0.043 mJ in baseline dog, 0.143±0.03 mJ in three infarcted dogs with nominal flow dysfunction, and 0.016±0.007 mJ in three infarcted dogs with severe flow dysfunction is observed. PMID:23044637

  9. Continuous administration of insulin-like growth factor-I and basic fibroblast growth factor does not affect left ventricular geometry after acute myocardial infarction in rats.

    Science.gov (United States)

    Scheinowitz, M; Abramov, D; Kotlyar, A; Savion, N; Eldar, M

    1998-02-28

    We examined the long-term effect of exogenous administration of bFGF and IGF-I on myocardial geometry in 72 Sprague-Dawley male rats subjected to AMI. A preloaded miniature osmotic pump subsequently implanted in the peritoneum for continuous infusion (1 week) of IGF-I, bFGF, IGF-I+bFGF or rat albumin. Six weeks following AMI the rats were killed and cross-section slices were analyzed for left ventricular geometry. No differences were observed between IGF-I-treated, bFGF-treated, IGF-I+bFGF-treated and control groups in all parameters of the left ventricle.

  10. Automated left ventricular capture management.

    Science.gov (United States)

    Crossley, George H; Mead, Hardwin; Kleckner, Karen; Sheldon, Todd; Davenport, Lynn; Harsch, Manya R; Parikh, Purvee; Ramza, Brian; Fishel, Robert; Bailey, J Russell

    2007-10-01

    The stimulation thresholds of left ventricular (LV) leads tend to be less reliable than conventional leads. Cardiac resynchronization therapy (CRT) requires continuous capture of both ventricles. The purpose of this study is to evaluate a novel algorithm for the automatic measurement of the stimulation threshold of LV leads in cardiac resynchronization systems. We enrolled 134 patients from 18 centers who had existing CRT-D systems. Software capable of automatically executing LV threshold measurements was downloaded into the random access memory (RAM) of the device. The threshold was measured by pacing in the left ventricle and analyzing the interventricular conduction sensed in the right ventricle. Automatic LV threshold measurements were collected and compared with manual LV threshold tests at each follow-up visit and using a Holter monitor system that recorded both the surface electrocardiograph (ECG) and continuous telemetry from the device. The proportion of Left Ventricular Capture Management (LVCM) in-office threshold tests within one programming step of the manual threshold test was 99.7% (306/307) with a two-sided 95% confidence interval of (98.2%, 100.0%). The algorithm measured the threshold successfully in 96% and 97% of patients after 1 and 3 months respectively. Holter monitor analysis in a subset of patients revealed accurate performance of the algorithm. This study demonstrated that the LVCM algorithm is safe, accurate, and highly reliable. LVCM worked with different types of leads and different lead locations. LVCM was demonstrated to be clinically equivalent to the manual LV threshold test. LVCM offers automatic measurement, output adaptation, and trends of the LV threshold and should result in improved ability to maintain LV capture without sacrificing device longevity.

  11. Left ventricular aneurysm repair with use of a bovine pericardial patch.

    Science.gov (United States)

    Henry, Matthew J; Preventza, Ourania; Cooley, Denton A; de la Cruz, Kim I; Coselli, Joseph S

    2014-08-01

    Left ventricular aneurysm, which can impair systolic function, has a reported incidence of 10% to 35% in patients after myocardial infarction. In a 58-year-old woman who had a history of myocardial infarction, we excised a large left ventricular aneurysm and restored left ventricular geometry with use of a bovine pericardial patch. The aneurysm's characteristics and the patient's preoperative left ventricular ejection fraction of 0.25 had indicated surgical intervention. The patient had an uneventful postoperative course, and her left ventricular ejection fraction was 0.50 to 0.55 on the 4th postoperative day. This case illustrates the value of surgical treatment for patients who have a debilitating left ventricular aneurysm.

  12. Establishment of a chronic left ventricular aneurysm model in rabbit

    Institute of Scientific and Technical Information of China (English)

    Cang-Song XIAO; Chang-Qing GAO; Li-Bing LI; Yao WANG; Tao ZHAO; Wei-Hua YE; Chong-Lei REN; Zhi-Yong LIU; Yang WU

    2014-01-01

    Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm (LVA) in rabbits. Methods Acute myocardial infarction (AMI) was induced in 35 rabbits via concomitant ligation of the left anterior descending (LAD) coronary artery and the circumflex (Cx) branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure (LVESP) and diastolic pressure (LVEDP) were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV), and ejection fraction (EF) were recorded by echo-cardiography. Results Thirty one (88.6%) rabbits survived myocardial infarction and 26 of them developed aneurysm (83.9%). The mean area of aneurysm was 33.4% ± 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle (LV) that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%±2.4%which involves the apex, anterior wall and lateral wall of the LV.

  13. Risk factors and predictors of Torsade de pointes ventricular tachycardia in patients with left ventricular systolic dysfunction receiving Dofetilide

    DEFF Research Database (Denmark)

    Pedersen, Henriette Sloth; Elming, Hanne; Seibaek, Marie

    2007-01-01

    The purpose of this study was to identify risk factors of Torsade de pointes (TdP) ventricular tachycardia in patients medicated with a class III antiarrhythmic drug (dofetilide) and left ventricular systolic dysfunction with heart failure (HF) or recent myocardial infarction (MI). The 2 Danish...

  14. The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction.

    Science.gov (United States)

    Cho, Jung Sun; Youn, Ho-Joong; Her, Sung-Ho; Park, Maen Won; Kim, Chan Joon; Park, Gyung-Min; Jeong, Myung Ho; Cho, Jae Yeong; Ahn, Youngkeun; Kim, Kye Hun; Park, Jong Chun; Seung, Ki Bae; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo; Han, Kyoo Rok; Kim, Hyo Soo

    2015-07-01

    The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

  15. Serial changes and prognostic implications of a Doppler-derived index of combined left ventricular systolic and diastolic myocardial performance in acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, Steen H; Jensen, Svend E; Nielsen, Jens C

    2000-01-01

    consecutive patients with AMI and in 30 patients admitted to hospital with suspected but disproved AMI who served as controls. The patients were studied at days 1, 5, 90, and 360 after arrival in the coronary care unit. The index was defined as the sum of isovolumetric contraction time, and isovolumetric...... relaxation time divided by ejection time was measured from mitral inflow and left ventricular outflow Doppler velocity profiles. The index was significantly higher in patients with AMI than in control subjects at days 1 and 360 (day 1, 0.58 +/- 0.09 vs 0.41 +/- 0.08, p ....39 +/- 0.07, p 1, 0.63 +/- 0.10 vs 0...

  16. Nanosecond pulse electric field activation of platelet-rich plasma reduces myocardial infarct size and improves left ventricular mechanical function in the rabbit heart.

    Science.gov (United States)

    Hargrave, Barbara; Li, Francis

    2012-12-01

    In the current study, we used the novel, nonchemical method of nanosecond pulsed electric fields (nsPEF) to investigate the efficiency of a protocol involving the in vivo treatment of the ischemic and reperfused heart and heart cells in culture with platelet-rich plasma (PRP). Associated with the restoration of blood flow to the ischemic tissue is a phenomenon referred to as "ischemic reperfusion injury." Clinically a type of reperfusion injury occurs during coronary bypass surgery once blood perfusion to the heart is restarted. Although the restoration of oxygen to ischemic myocardial cells is critical for tissue survival, reperfusion causes myocardial oxidative stress, attributable in part to the increased production of reactive oxygen species (ROS). Enhanced ROS production is associated with mitochondrial damage. Adult female New Zealand white rabbits were anesthetized and a left thoracotomy performed to expose the heart. The distal segment of the left anterior descending coronary artery was occluded for 15 minutes and then released so reperfusion of the tissue could occur. PRP (.21 mg/heart) or saline was injected into the ischemic area of the myocardium. Mechanical function of the left ventricle was analyzed using a Millar catheter attached to a Micro-Med Analysis System. H9c2 cells in culture were treated with 1 mL of nsPEF activated PRP (1.05 mg/flask) for 24 hours before analysis for ROS production or mitochondrial depolarization damage). The left ventricle contracted and relaxed faster and infarct size was reduced in hearts treated with PRP compared with saline. ROS production and mitochondrial depolarization were reduced in H9c2 cells treated with PRP and stimulated with hydrogen peroxide. These results provide evidence that nsPEFs can successfully be used to prepare PRP and that the PRP is functional in heart protection possibly by reducing ROS generation and stabilizing the mitochondria of the ischemic/reperfused heart.

  17. Review of Current Research on Aldosterone and Left Ventricular Remodeling after Acute Myocardial Infarction%醛固酮对急性心肌梗死后左心室重构影响的研究进展

    Institute of Scientific and Technical Information of China (English)

    吴春涛

    2011-01-01

    心力衰竭已经成为影响人们生命和生活质量的主要疾病,心肌梗死后心室重构是其重要原因之一,急性心肌梗死后神经内分泌系统的过度激活对心室重构的影响已成为共识.作为肾素-血管紧张素-醛固酮系统的重要组成部分,醛固酮对于心血管系统的病理生理作用以及醛固酮逃逸现象确定了醛固酮受体拮抗剂在心力衰竭治疗中的决定性地位.现就醛固酮对于急性心肌梗死后左心室重构影响的研究进展作一综述.%Heart failure is a disease that affects people's quality of life, and ventricular remodeling after myocardial infarction is one of the major reasons. There is a consensus on the effect of over-activation of the neuroendocrine system after acute myocardial infarction ( AMI) on ventricular remodeling. Aldosterone acts as an important part of the renin-angiotensin-aldosterone system, and the aldosterone receptor antagonist plays a crucial role in the modern therapeutic regimen for heart failure attributed to aldosterone's pathophysiological effects on the cardiovascular system and aldosterone escape phenomenon. This article reviews the effects of aldosterone on left ventricular remodeling of AMI.

  18. Changes in absolute and relative importance in the prognostic value of left ventricular systolic function and congestive heart failure after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Jørgensen, S;

    1998-01-01

    ) by echocardiography, was assessed in 6,676 consecutive patients with an enzyme-confirmed AMI. So that changes in the prognostic value of WMI or CHF could be studied, separate analyses were performed at selected time periods. Average monthly mortality (deaths per 100 patients per month) was determined from life......Changes in the importance of left ventricular (LV) systolic dysfunction and congestive heart failure (CHF) with time after an acute myocardial infarction (AMI) after the introduction of thrombolytic therapy have not been studied. LV systolic function, measured as wall motion index (WMI...... dysfunction or CHF, monthly mortality was high during the first month (18.3 +/- 1.6% and 20.2 +/- 1.6%, respectively), decreased during the first year, and was stable thereafter (0.8 +/- 0.1% and 1.0 +/- 0.1%, respectively, average monthly mortality after year 3). The relative risk of LV dysfunction decreased...

  19. Case series: Congenital left ventricular diverticulum

    Directory of Open Access Journals (Sweden)

    Shah Dharita

    2010-01-01

    Full Text Available Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac chamber. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture can be the initial presentation. Diagnosis can be established by USG, echocardiography, CT angiography, and MRI. We report here two neonates with congenital left ventricular apical diverticulum associated with epigastric hernia.

  20. Implantable cardiac monitors in high-risk post-infarction patients with cardiac autonomic dysfunction and moderately reduced left ventricular ejection fraction: Design and rationale of the SMART-MI trial.

    Science.gov (United States)

    Hamm, Wolfgang; Rizas, Konstantinos D; Stülpnagel, Lukas von; Vdovin, Nikolay; Massberg, Steffen; Kääb, Stefan; Bauer, Axel

    2017-08-01

    Most deaths after myocardial infarction (MI) occur in patients with left ventricular ejection fraction (LVEF) >35%, for whom no specific prophylactic strategies exist. Deceleration capacity (DC) of heart rate and periodic repolarization dynamics (PRD) are noninvasive electrophysiological markers depending on the vagal and sympathetic tone. The combination of abnormal DC and/or PRD identifies a new high-risk group among postinfarction patients with LVEF 36%-50%. This new high-risk group has similar characteristics with respect to prognosis and patient numbers to those of the established high-risk group identified by LVEF ≤ 35%. The SMART-MI trial is an investigator-initiated randomized prospective multicenter trial that tests the efficacy of implantable cardiac monitors (ICM) in this new high-risk group. The study will enroll approximately 1,600 survivors of acute MI with sinus rhythm and an LVEF of 35%-50% in 17 centers in Germany who will be tested for presence of cardiac autonomic dysfunction. Four hundred patients with either abnormal DC (≤2.5 ms) and/or PRD (≥5.75deg(2)) will be randomized in a 1:1 fashion to intensive follow-up via telemonitoring using an ICM device (experimental arm) or conventional follow-up (control arm). For the ICM arm, specific treatment paths have been developed according to current guidelines. The primary end point is time to detection of predefined serious arrhythmic events during follow-up, including atrial fibrillation ≥6minutes, nonsustained ventricular tachycardia (cycle length≤320 ms; ≥40 beats), atrioventricular block ≥IIb, and sustained ventricular tachycardia/ventricular fibrillation. The median follow-up period is 18months with a minimum follow-up of 6months. The effect of remote monitoring on clinical outcomes will be tested as secondary outcome measure (ClinicalTrials.gov NCT02594488). Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A CMR study of the effects of tissue edema and necrosis on left ventricular dyssynchrony in acute myocardial infarction: implications for cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Manka Robert

    2012-07-01

    Full Text Available Abstract Background In acute myocardial infarction (AMI, both tissue necrosis and edema are present and both might be implicated in the development of intraventricular dyssynchrony. However, their relative contribution to transient dyssynchrony is not known. Cardiovascular magnetic resonance (CMR can detect necrosis and edema with high spatial resolution and it can quantify dyssynchrony by tagging techniques. Methods Patients with a first AMI underwent percutaneous coronary interventions (PCI of the infarct-related artery within 24 h of onset of chest pain. Within 5–7 days after the event and at 4 months, CMR was performed. The CMR protocol included the evaluation of intraventricular dyssynchrony by applying a novel 3D-tagging sequence to the left ventricle (LV yielding the CURE index (circumferential uniformity ratio estimate; 1 = complete synchrony. On T2-weighted images, edema was measured as high-signal (>2 SD above remote tissue along the LV mid-myocardial circumference on 3 short-axis images (% of circumference corresponding to the area-at-risk. In analogy, on late-gadolinium enhancement (LGE images, necrosis was quantified manually as percentage of LV mid-myocardial circumference on 3 short-axis images. Necrosis was also quantified on LGE images covering the entire LV (expressed as %LV mass. Finally, salvaged myocardium was calculated as the area-at-risk minus necrosis (expressed as % of LV circumference. Results After successful PCI (n = 22, 2 female, mean age: 57 ± 12y, peak troponin T was 20 ± 36ug/l and the LV ejection fraction on CMR was 41 ± 8%. Necrosis mass was 30 ± 10% and CURE was 0.91 ± 0.05. Edema was measured as 58 ± 14% of the LV circumference. In the acute phase, the extent of edema correlated with dyssynchrony (r2 = −0.63, p 2 = −0.19, p = 0.05. PCI resulted in salvaged myocardium of 27 ± 14%. LV dyssynchrony (=CURE decreased at 4 months from 0.91

  2. Regional ejection fraction and regional area strain for left ventricular function assessment in male patients after first-time myocardial infarction.

    Science.gov (United States)

    Teo, Soo-Kng; Vos, F J A; Tan, Ru-San; Zhong, Liang; Su, Yi

    2015-04-01

    In this work, we present a method to assess left ventricle (LV) regional function from cardiac magnetic resonance (CMR) imaging based on the regional ejection fraction (REF) and regional area strain (RAS). CMR scans were performed for 30 patients after first-time myocardial infarction (MI) and nine age- and sex-matched healthy volunteers. The CMR images were processed to reconstruct three-dimensional LV geometry, and the REF and RAS in a 16-segment model were computed using our proposed methodology. The method of computing the REF was tested and shown to be robust against variation in user input. Furthermore, analysis of data was feasible in all patients and healthy volunteers without any exclusions. The REF correlated well with the RAS in a nonlinear manner (quadratic fit-R(2) = 0.88). In patients after first-time MI, the REF and RAS were significantly reduced across all 16 segments (REF: p function in the patients with preserved global ejection fraction with reasonable accuracy (more than 78%). These preliminary results confirmed the validity of our approach for accurate analysis of LV regional function. Our approach potentially offers physicians new insights into the local characteristics of the myocardial mechanics after a MI.

  3. Applications of magnetic resonance imaging in the assessment of left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Beacock, David John

    2002-07-01

    This thesis has described the use of Magnetic Resonance Imaging (MRI) in the investigation of left ventricular dimensions and systolic function. This has been performed in conditions of left ventricular dysfunction, in congestive cardiac failure and following anterior myocardial infarction. The reproducibility of measurements of left ventricular dimensions using MRI has been presented. Such measurements were shown to be reproducible between different MRI studies of normal volunteers and patients with congestive heart failure. Furthermore, measurements from different MRI studies obtained from two commercially different systems were reproducible for the same subject groups. Ventricular dimensions and systolic function was evaluated in adult normal volunteers of different ages. Although left ventricular volumes and mass remained unchanged, detailed studies of the systolic images revealed significant differences between the two age groups. Differences in left ventricular cavity volumes and mass between patients with congestive heart failure and age-matched normal volunteers were also investigated. Left ventricular volumes and myocardial mass were assessed in a group of patients following anterior myocardial infarction. End-systolic volume was significantly increased compared to age-matched volunteers, but no changes in end-diastolic volume or myocardial mass was observed. Serial re-evaluation of these patients revealed no other changes over the subsequent six months. All these patients were treated with optimal medical therapy (thrombolysis, aspirin, beta-blockade and angiotensin converting enzyme inhibition). Thus, the use of this therapy may attenuate the process of left ventricular remodelling. Regional wall thickness was measured in the post-infarct patients. Wall thickening was significantly reduced both in the infarcted regions and in myocardium remote to the infarction. In contrast to previous echocardiographic studies, no 'hypercontractility' was

  4. Thrombo-embolic renal infarction in a case of mid-ventricular takotsubo syndrome.

    Science.gov (United States)

    Y-Hassan, Shams; Shahgaldi, Kambiz

    2011-01-01

    Thrombo-embolism is one of the serious complications of takotsubo syndrome (TS). It typically occurs in the classical mid-apical left ventricular ballooning form of TS. This complication has not been reported in cases of left mid-ventricular ballooning type of TS. We describe a 67-year-old woman who presented with 2-3 days of increasing signs and symptoms of heart failure. Echocardiography showed marked hypokinesia/akinesia in the mid-anterior, mid-anterolateral, and mid-inferior wall of the left ventricle and mild hypokinesia in the apical region. There was also hypokinesia of the mid and apical parts of the right ventricle. One day after admission, she developed acute left-sided renal infarction. Left ventriculography and coronary angiography 3 days after admission showed typical left mid-ventricular ballooning with no identifiable coronary lesion. Follow-up echocardiography showed complete resolution of left and right ventricular dysfunction. Takotsubo syndrome with right ventricular involvement complicated with heart failure and left renal embolic infarction was diagnosed. The mechanism of left renal embolic infarction is discussed.

  5. Recombinant human growth hormone secreted from tissue-engineered bioartificial muscle improves left ventricular function in rat with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    RONG Shu-ling; WANG Yong-jin; WANG Xiao-lin; LU Yong-xin; CHANG Chao; WANG Feng-zhi; LIU Qi-yun; LIU Xiang-yang; GAO Yan-zhang; MI Shao-hua

    2009-01-01

    Background Experimental studies and preliminary clinical studies have suggested that growth hormone (GH) treatment may improve cardiovascular parameters in chronic heart failure (CHF). Recombinant human GH (rhGH) has been delivered by a recombinant protein, by plasmid DNA, and by genetically engineered cells with different pharmacokinetic and physiological properties. The present study aimed to examine a new method for delivery of rhGH using genetically modified bioartificial muscles (BAMs), and investigate whether the rhGH delivered by this technique improves left ventricular (LV) function in rats with CHF.Methods Primary skeletal myoblasts were isolated from several Sprague-Dawley (SD) rats, cultured, purified, and retrovirally transduced to synthesize and secrete human rhGH, and tissue-engineered into implantable BAMs. Ligation of the left coronary artery or sham operation was performed. The rats that underwent ligation were randomly assigned to 2 groups: CHF control group (n=6) and CHF treatment group (n=6). The CHF control group received non-rhGH-secreting BAM (GFP-BAMs) transplantation, and the CHF treatment group received rhGH-secreting BAM (GH-BAMs) transplantation. Another group of rats served as the sham operation group, which was also randomly assigned to 2 subgroups: sham control group (n=6) and sham treatment group (n=6). The sham control group underwent GFP-BAM transplantation, and the sham treatment group underwent GH-BAM transplantation. GH-BAMs and GFP-BAMs were implanted subcutaneously into syngeneic rats with ligaUon of the left coronary artery or sham operation was performed. Eight weeks after the treatment,echocardiography was performed, hGH, insulin-like growth factor-1 (IGF-1) and TNF-a levels in rat serum were measured by radioimmunoassay and ELISA, and then the rats were killed and ventricular samples were subjected to immunohistochemistry. Results Primary rat myoblasts were retrovirally transduced to secrete rhGH and tissue-engineered into

  6. 心肌梗死对左心室同步性影响的实验研究%The effect of myocardial infarction induced by distal left ascending artery occlusion on left ventricular synchronism: an experimental study

    Institute of Scientific and Technical Information of China (English)

    孙寅光; 张奇; 蒲里津; 阮雯; 沈卫峰

    2008-01-01

    目的 探讨左前降支远端堵闭后心肌梗死对左心室同步性的影响.方法 在选择性堵闭左前降支远端制备猪心肌梗死模型前2 h内(心肌梗死前)和心肌梗死后7~14 d内各进行一次常规超声心动图和速度向量成像检查,测量心肌梗死前后左心室舒张末期内径、舒张末期容积、收缩末期内径、收缩末期容积和球形指数0等重构指标.比较心肌梗死前后左心室6个节段心肌运动收缩期速度、应变、应变率及其达峰时间.结果 前壁心肌梗死后早期左心室舒张末期长径和收缩末期长径增大,收缩末期容积增大,射血分数降低.左心室6节段收缩速度、应变和应变率均显著减低,只有平均应变率达峰时间心肌梗死后显著延长.结论 心肌梗死后左心室同步性异常加重左心室的收缩功能异常.%Objective To study the effect of myocardial infarction induced by distal left ascending artery occlusion on left ventrieular(LV) synchronism. Methods Routine echocardiography and vector velocity imaging were performed within 2 hours before and 7-14 days after myocardial infarction by occluding distal left ascending coronary arteries in experimental pigs. Routine eehocardiographie parameters of LV, including end diastolic and systolic diameters, volumes, and spherical indexes were measured or calculated. Six segmental peak systolic velocity, strain and strain rate were compared between pre- and post-myocardial infarction. Results After myocardial infarction, LV end diastolic, end systolic long diameter and end systolic volume increased with decreased ejection fraction. With the 6 segmental systolic velocity, strain and strain rate significantly reduced,the mean 6-segmental time to peak strain rate delayed significantly. Conclusions Abnormal synchronism after myocardial infarction may aggravate LV systolic dysfunction.

  7. The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jons, Christian; Jacobsen, Uffe G; Joergensen, Rikke Moerch;

    2011-01-01

    The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown.......The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown....

  8. Postoperative normalization of left ventricular noncompaction and new echocardiographic signs in aorta to left ventricular tunnel.

    Science.gov (United States)

    Malakan Rad, Elaheh; Zeinaloo, Ali Akbar

    2013-04-01

    We report postoperative normalization of left ventricular noncompaction in a neonate undergoing successful neonatal surgery for type II aorta to left ventricular tunnel (ALVT) associated with a large patent ductus arteriosus, floppy and extremely redundant anterior mitral leaflet, right coronary artery arising directly from the tunnel, and severe left ventricular noncompaction. We also described 2 novel echocardiographic findings in ALVT including "triple wavy line sign" on M-mode echocardiography which disappeared 1 month after operation and "abnormally increased left ventricular posterior wall motion" on M-mode of standard parasternal long-axis view on color tissue Doppler imaging (TDI) that also normalized postoperatively. We showed that proper definition of endocardial border is extremely important in strain and strain rate imaging in the context of left ventricular noncompaction. Preoperative longitudinal strain and strain rate were significantly decreased in comparison to radial strain and strain rate. Circumferential strain and strain rate were normal. © 2013, Wiley Periodicals, Inc.

  9. Acute inferior myocardial infarction with right ventricular infarction is more prone to develop cardiogenic shock.

    Science.gov (United States)

    Bari, M A; Roy, A K; Islam, M Z; Aditya, G; Bhuiyan, A S

    2015-01-01

    Cardiogenic shock is rare in isolated acute inferior myocardial infarction but there is relationship of cardiogenic shock with inferior myocardial infarction if associated with right ventricular infarction. A prospective study was carried out to see the association of cardiogenic shock with inferior myocardial infarction if associated with right ventricular infarction. This study was conducted from January 2011 to November 2011. A total of 100 cases were selected as study population which was taken from the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Among them 50 were in Group A and 50 were in Group B. Group A was the patients of acute myocardial infarction with right ventricular infarction. Group B was the patients of acute myocardial infarction without right ventricular infarction. It revealed that 9(18%) in Group A and 3(6%) in Group B developed cardiogenic shock which is statistically significant (pcardiogenic shock.

  10. Effects of a timely therapy with doxycycline on the left ventricular remodeling according to the pre-procedural TIMI flow grade in patients with ST-elevation acute myocardial infarction.

    Science.gov (United States)

    Cerisano, Giampaolo; Buonamici, Piergiovanni; Valenti, Renato; Moschi, Guia; Taddeucci, Enrico; Giurlani, Letizia; Migliorini, Angela; Vergara, Ruben; Parodi, Guido; Sciagrà, Roberto; Romito, Roberta; Colonna, Paolo; Antoniucci, David

    2014-07-01

    Doxycycline has been demonstrated to reduced left ventricular (LV) remodeling, but its effect in patients with ST-elevation myocardial infarction (STEMI) and a baseline occluded [thrombolysis in myocardial infarction (TIMI) flow grade ≤1] infarct-related artery (IRA) is unknown. According to the baseline TIMI flow grade, 110 patients with a first STEMI were divided into 2 groups. Group 1: 77 patients with TIMI flow ≤1 (40 patients treated with doxycycline and 37 with standard therapy, respectively), and a Group 2: 33 patients with TIMI flow 2-3 (15 patients treated with doxycycline and 18 with standard therapy, respectively). The two randomized groups were well matched in baseline characteristics. A 2D-Echo was performed at baseline and at 6 months, together with a coronary angiography, for the remodeling and IRA patency assessment, respectively. The LV end-diastolic volume index (LVEDVi) decreased in Group 2 [-3 mL/m(2) (IQR: -12 to 4 mL/m(2))], and increased in Group 1 [6 mL/m(2) (IQR: -2 to 14 mL/m(2))], (p = 0.001). In Group 2, LVEDVi reduction was similar regardless of drug therapy, while in Group 1 the LVEDVi was smaller in patients treated with doxycycline as compared to control [3 mL/m(2) (IQR: -3 to 8 mL/m(2)) vs. 10 mL/m(2) (IQR: 1-27 mL/m(2)), p = 0.006]. A similar pattern was observed also for LV end-systolic volume and ejection fraction. In STEMI patients at higher risk, as those with a baseline TIMI flow grade ≤1, doxycycline reduces LV remodeling.

  11. Right Ventricular Involvement in either Anterior or Inferior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Firoozeh Abtahi

    2016-06-01

    Full Text Available Background: Unlike left ventricular function, less attention has been paid to Right Ventricular (RV function after Myocardial Infarction (MI. Objectives: The current study aimed to compare RV function in patients with inferior and anterior MI. Patients and Methods: During the study period, 60 patients consecutively presented to the Emergency Department with chest pain were divided into two groups based on their electrocardiographic findings. Accordingly, 25 patients had inferior MI (IMI group and 35 ones had anterior MI (AMI group. Echocardiography was performed 48 hours after starting the standard therapy. Conventional echocardiographic parameters and Tissue Doppler Imaging (TDI measurements were acquired from the standard views. Student t-test and the chi-square test were respectively used for comparisons of the normally distributed continuous and categorical variables in the two groups. Besides, P < 0.05 was considered to be statistically significant.

  12. Surgical treatment of a giant left ventricular aneurysm- A case report

    Directory of Open Access Journals (Sweden)

    Gustavo Alves Schaitza

    2014-12-01

    Full Text Available An aneurysm of the left ventricle is a complication of acute myocardial infarction. We report a case of a giant aneurysm of the left ventricle after myocardial infarction in a 59 year-old male patient. The surgery to correct the aneurysm was performed with the use of cardiopulmonary bypass under normothermia. A bovine pericardial patch was used for the geometric reconstruction of the ventricular wall affected by the aneurysm. After the procedure, echocardiography and magnetic resonance imaging revealed improvement in left ventricular ejection fraction and volume reduction.

  13. Surgical treatment of a giant left ventricular aneurysm- a case report.

    Science.gov (United States)

    Schaitza, Gustavo Alves; Faria Neto, José Rocha; Francisco, Julio Cesar; Baena, Cristiana Pellegrino; Giffhorn, Helcio; Olandoski, Bruna; Meira, Leanderson Franco de; Guarita-Souza, Luiz César

    2014-01-01

    An aneurysm of the left ventricle is a complication of acute myocardial infarction. We report a case of a giant aneurysm of the left ventricle after myocardial infarction in a 59 year-old male patient. The surgery to correct the aneurysm was performed with the use of cardiopulmonary bypass under normothermia. A bovine pericardial patch was used for the geometric reconstruction of the ventricular wall affected by the aneurysm. After the procedure, echocardiography and magnetic resonance imaging revealed improvement in left ventricular ejection fraction and volume reduction.

  14. Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Pouleur, Anne-Catherine; Barkoudah, Ebrahim; Uno, Hajime;

    2010-01-01

    The frequency of sudden unexpected death is highest in the early post-myocardial infarction (MI) period; nevertheless, 2 recent trials showed no improvement in mortality with early placement of an implantable cardioverter-defibrillator after MI....

  15. Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Pouleur, Anne-Catherine; Barkoudah, Ebrahim; Uno, Hajime

    2010-01-01

    The frequency of sudden unexpected death is highest in the early post-myocardial infarction (MI) period; nevertheless, 2 recent trials showed no improvement in mortality with early placement of an implantable cardioverter-defibrillator after MI....

  16. Timing of granulocyte-colony stimulating factor treatment after acute myocardial infarction and recovery of left ventricular function: results from the STEMMI trial

    DEFF Research Database (Denmark)

    Overgaard, Mikkel; Ripa, Rasmus Sejersten; Wang, Yongzhong

    2010-01-01

    Granulocyte-colony stimulating factor (G-CSF) therapy after ST-elevation myocardial infarction (STEMI) have not demonstrated impact on systolic recovery compared to placebo. However, recent studies suggest that timing of G-CSF therapy is crucial.......Granulocyte-colony stimulating factor (G-CSF) therapy after ST-elevation myocardial infarction (STEMI) have not demonstrated impact on systolic recovery compared to placebo. However, recent studies suggest that timing of G-CSF therapy is crucial....

  17. Tei index in evaluation on left ventricular dysfunction in early phase acute myocardial infarction in rats%Tei指数评价大鼠超急性期心肌梗死左心功能

    Institute of Scientific and Technical Information of China (English)

    林蔚; 白旭东; 刘美佳

    2012-01-01

    目的 探讨Tei指数对评价大鼠超急性期心肌梗死后左心功能的作用.方法 将健康雄性Wistar大鼠23只随机分为两组:13只予垂体后叶素腹腔注射(实验组),10只予等量生理盐水腹腔注射(对照组).建模后分别记录两组大鼠心电图,用超声心动图检测获取左心室射血分数(EF)、等容收缩时间(ICT)、射血时间(ET)及等容舒张时间(IRT),然后取心肌组织行病理检查.结果 实验组ICT、Tei指数较对照组显著增加(P<0.01).Pearson相关分析显示,ICT及Tei指数与心电图ST段抬高程度、EF相关性良好(P<0.01).结论 Tei指数及其相关参数能客观评价大鼠超急性期心肌梗死的左心功能,可作为基础研究中判断该期心功能异常的良好指标.%Objective To observe the value of Tei index in evaluation on left ventricular dysfunction in early stage of acute myocardial infarction (AMI) in rat. Methods A total of 23 healthy male Wistar rats were randomly classified into experimental group (n=13) and control group (n=10) , and intraperitoneal injecting of Pituitrin or saline was performed, respectively. Parameters were measured with electrocardiography, and left ventricular ejection fraction (EF) , isovolumetric contraction time (ICT) , ejection time (ET) and isovolumic relaxation time (IRT) were obtained with echocardiography after modeling. Then pathological examination was performed in myocardium tissue sections. Results Compared with control group, ICT and Tei index of experimental group significantly increased (P<0. 01). Pearson correlation analysis showed ICT and Tei index were well correlated with ST segment elevation and EF (P<0. 01). Conclusion Tei index and the related parameters are efficient enough to evaluate left ventricular function after rat AMI in super early period, which can be used for basic research in evaluation of cardiac function.

  18. Comparison of cardiovascular magnetic resonance feature tracking and tagging for the assessment of left ventricular systolic strain in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Jamal N., E-mail: jk211@le.ac.uk; Singh, Anvesha, E-mail: as707@le.ac.uk; Nazir, Sheraz A., E-mail: sn191@le.ac.uk; Kanagala, Prathap, E-mail: pk214@le.ac.uk; Gershlick, Anthony H., E-mail: agershlick@aol.com; McCann, Gerry P., E-mail: gerry.mccann@uhl-tr.nhs.uk

    2015-05-15

    Highlights: • We compared feature tracking (FT) and tagging quantification of myocardial strain in acute MI. • This is the first study assessing FT strain assessment in acute MI. • FT was more robust and had better myocardial tracking than tagging. • FT had better interobserver agreement and FT analysis was quicker. • FT has stronger correlation with global and segmental infarct size, area at risk (oedema), myocardial salvage and infarct transmurality. • FT is feasible in acute MI and is likely to become the preferred quantification method. - Abstract: Aims: To assess the feasibility of feature tracking (FT)-measured systolic strain post acute ST-segment elevation myocardial infarction (STEMI) and compare strain values to those obtained with tagging. Methods: Cardiovascular MRI at 1.5 T was performed in 24 patients, 2.2 days post STEMI. Global and segmental circumferential (Ecc) and longitudinal (Ell) strain were assessed using FT and tagging, and correlated with total and segmental infarct size, area at risk and myocardial salvage. Results: All segments tracked satisfactorily with FT (p < 0.001 vs. tagging). Total analysis time per patient was shorter with FT (38.2 ± 3.8 min vs. 63.7 ± 10.3 min, p < 0.001 vs. tagging). Global Ecc and Ell were higher with FT than with tagging, apart from FT Ecc using the average of endocardial and epicardial contours (−13.45 ± 4.1 [FT] vs. −13.85 ± 3.9 [tagging], p = 0.66). Intraobserver and interobserver agreement for global strain were excellent for FT (ICC 0.906–0.990) but interobserver agreement for tagging was lower (ICC < 0.765). Interobserver and intraobserver agreement for segmental strain was good for both techniques (ICC > 0.7) apart from tagging Ell, which was poor (ICC = 0.15). FT-derived Ecc significantly correlated with total infarct size (r = 0.44, p = 0.03) and segmental infarct extent (r = 0.44, p < 0.01), and best distinguished transmurally infarcted segments (AUC 0.77) and infarcted from

  19. Changes in ECG features and clinical prognosis of ventricular electrical storm in patients with left ventricular hypertrophy and acute myocardial infarction%左心室肥厚并急性心肌梗死室性电风暴心电图对预后的影响

    Institute of Scientific and Technical Information of China (English)

    于文江; 王为民

    2009-01-01

    目的 探讨沿海居民高血压性左室肥厚(left ventricular hypertrophy,LNH)并急性心肌梗死(acute myocardial infarction,AMI)后心电图特征性改变,评估室性电风暴与临床预后危险分层.方法 选择急诊住院有高皿压性LVH并AMI室性电风暴(室速或室颤)317例(Ⅱ组),另选无高血压性LVH室性电风暴AMI 109例(Ⅰ组)进行心电图检查和持续心电监护,分析心电图特征与临床高危特点.结果 室性电风暴组以高血压LVH并AMI患者心电图指标心房终末电势异常、∑ST段抬高振幅、ST段抬高导联数、QTc间期延长、对应导联ST段振幅下移等特征,梗死部位以前壁或复合前壁,并以左前降支合并回旋支或/和右冠脉完全闭塞多支病变为主,与Ⅰ组比较差异有统计学意义(P<0.05或P<0.01),临床并发泵衰竭、AMI扩展、住院病死率、室性电风暴AMI发病后6 h内发生率明显增多(P<0.01).结论 高血压性LVH并AMI室性电风暴患者,心电图多项指标异常对临床预后有预测作用.%Objective To investigate changes in ECG feature and clinical prognosis of ventricular electrical storm (VES) in patients with left ventricular hypertrophy (LVH) and acute myocardial infarction (AMI). Methods Three hundred and seventeen cases of left ventricular hypertrophy induced by hypertension and combined with AMI (Group Ⅱ) from emergency inpatients, and another 109 patients without LVH induced by hypertension and accompanied with AMI (Group Ⅰ) were chosen to have sustained ECG monitoring, analyze ECG features and clinical high risks. Results Clinical features, such as abnormality in PTFvl,ΣST segment elevation amplitude, ST segment elevation leads, ST segment reduction amplitude leads, QTc interval prolongation could be noted in the VES group. Infarction could be seen at sites of anterior and complex anterior walls, and dominant clinical signs were mainly at left descending branches accompanied by circumflex arteries and

  20. Isolated right ventricular infarct presenting as ventricular fibrillation arrest and confirmed by delayed-enhancement cardiac MRI.

    Science.gov (United States)

    Cavalcante, João L; Al-Mallah, Mouaz; Hudson, Michael

    2010-10-01

    Malignant ventricular arrhythmias resulting from isolated right ventricular myocardial infarction (RVMI) without left ventricular myocardial ischaemia or infarction occur rarely. We present a case of a 61 year-old male with acute onset of chest pain and ventricular fibrillation cardiac arrest requiring prompt defibrillation. Subsequent 15-lead EKG, showed ST-segment elevation in the anterior and right precordial leads without ST-segment elevation in the inferior leads. Angiography documented occlusion of a large RV marginal branch. Delayed enhancement cardiac magnetic resonance imaging (DE-CMR) with gadolinium performed two days post-infarct showed isolated RVMI. Patient remained symptom free and haemodynamically stable throughout his hospital stay. The clinical presentation of isolated RV infarct can be misleading and diagnosis difficult. EKG findings can resemble acute anterior wall myocardial infarction, while its course can be accompanied by life-threatening ventricular arrhythmias. This case uniquely combines this rare clinical sequence with DE-CMR images using gadolinium to confirm isolated RVMI. A brief review of RVMI presentation and associated EKG patterns is also discussed.

  1. Left ventricular thrombus formation after repair of anomalous left coronary artery from the pulmonary artery.

    Science.gov (United States)

    Freud, Lindsay R; Koenig, Peter R; Russell, Hyde M; Patel, Angira

    2014-04-01

    Although thrombus formation following myocardial infarction in adults is well known, intracardiac thrombosis in children is uncommon. We report the case of a large left ventricular thrombus in an infant with ischemic cardiomyopathy secondary to anomalous origin of the left coronary artery from the pulmonary artery. Given its mobility and protrusion across the aortic valve, the patient underwent urgent thrombus removal through a transaortic approach. There were no embolic or neurologic complications. This case highlights that thrombectomy may be performed safely and successfully in critically ill pediatric patients.

  2. Left Ventricular Thrombus Formation After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery

    Science.gov (United States)

    Freud, Lindsay R.; Koenig, Peter R.; Russell, Hyde M.; Patel, Angira

    2014-01-01

    Although thrombus formation following myocardial infarction in adults is well known, intracardiac thrombosis in children is uncommon. We report the case of a large left ventricular thrombus in an infant with ischemic cardiomyopathy secondary to anomalous origin of the left coronary artery from the pulmonary artery. Given its mobility and protrusion across the aortic valve, the patient underwent urgent thrombus removal through a transaortic approach. There were no embolic or neurologic complications. This case highlights that thrombectomy may be performed safely and successfully in critically ill pediatric patients. PMID:24668990

  3. Subacute gastric perforation caused by a left ventricular assist device

    Institute of Scientific and Technical Information of China (English)

    Demetris Yannopoulos

    2007-01-01

    This case report describes a rare complication of a left ventricular assist device (LVAD). A patient with ischemic cardiomyopathy had an LVAD placed due to intractable congestive heart failure following a large anterior myocardial infarction. The patient developed chronic bacteremia and multiple septic episodes. A gastric endoscopy revealed perforation of the anterior wall of the stomach by the LVAD. Gastric acid related erosions were present on the metallic surface suggesting prolonged exposure. This is the second case report of this rare complication and the first case report of a subacute course.

  4. 美托洛尔对大鼠急性心肌梗死后左心室重构的影响%Effects of Metoprolol on Left Ventricular Remodeling after Acute Myocardial Infarction in Rats

    Institute of Scientific and Technical Information of China (English)

    王薇娜; 赵良平; 李冰

    2011-01-01

    目的 观察美托洛尔对大鼠急性心肌梗死(AMI)后左心室重构(VR)的影响,并初步探讨其作用机制.方法 将大鼠随机分为美托洛尔治疗组、模型组及假手术组.结扎美托洛尔治疗组和模型组大鼠左冠状动脉前降支,假手术组给予假手术.美托洛尔治疗组于术后24 h灌胃给予美托洛尔10 mg·kg-1·d-1,其他两组灌胃给予等量0.9%氯化钠溶液.手术4周后,采用高频彩色多普勒超声观察各组大鼠左室舒张末期内径(LVDD)、左室舒张末期容积(LEDV)、左室质量指数(LVMI)、射血分数(EF)、短轴缩短率(FS)变化,病理切片观察大鼠心肌细胞和细胞间质变化.结果 与假手术组比较,模型组大鼠LVDD、LEDV、LVMI均显著增加,EF、FS等显著降低,光镜下心肌细胞肥大,间质增生明显;与模型组比较,美托洛尔治疗组LVDD、LEDV、LVMI降低,EF、FS升高,均差异有统计学意义(均P<0.05).结论 美托洛尔对AMI大鼠左心室重构具有治疗作用,其作用机制可能与纠正血流动力学异常和神经内分泌异常、降低交感神经过度再生有关.%Objective To investigate the effects and mechanism of metoprolol on left ventricular remodeling (LVR) after acute myocardial infarction( AMI) in rats. Methods The Wistar rats were randomly assigned to three groups: AMI control (n - 9), metoprolol treatment (n = 9) and sham-operated group ( n = 9). The rats of AMI control and metoprolol treatment were ligated in the left anterior descending coronary artery; the sham-operated rats were not ligated. The metoprolol group was given with metoprolol 10 mg · kg-1 · d-1, and the other two groups with the same dose of 0.9% natrium chloride. Four weeks later, the left ventricular end-diastolic dimension (LVDD) , left ventricular end-diastolic volume (LEDV) , left ventricular mass index ( LVMI), ejection fraction ( EF) and fractional shortening ( FS) of each rat was detected by echocardiogram. Myocardial cell and

  5. Diastolic Left Ventricular Dysfunction : A Clinical Appraisal

    NARCIS (Netherlands)

    Bronzwaer, J.G.F.

    2003-01-01

    Diastolic left ventricular (LV) distensibility is determined by the material properties of the LV wall and by LV geometry (i.e., LV shape, LV volume and LV wall thickness). These material properties are influenced both by the physical structure of the LV myocardium and by the dynamic process of myoc

  6. Left ventricular hypertrophy : virtuous intentions, malign consequences

    NARCIS (Netherlands)

    Pokharel, S; Sharma, UC; Pinto, YM

    2003-01-01

    Left ventricular hypertrophy (LVH) is currently the focus of intense cardiovascular research, with the resultant rapid evolution of novel concepts relating to its exceedingly complex pathophysiology. In addition to the alterations in signal transduction and disturbances in Ca2+ homeostasis, there ar

  7. Congestive cardiomyopathy and left ventricular thrombus.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C; Chandy, F; Kim, B S

    1983-07-01

    A left ventricular thrombus was detected by echocardiography in a 54-year-old man with congestive cardiomyopathy. With the use of anticoagulants, the thrombus completely disappeared. Patients with congestive cardiomyopathy who are at high risk for thrombus formation should be screened with two-dimensional echocardiography. If a thrombus is recognized, anticoagulation therapy can then be instituted.

  8. Diastolic Left Ventricular Dysfunction : A Clinical Appraisal

    NARCIS (Netherlands)

    Bronzwaer, J.G.F.

    2003-01-01

    Diastolic left ventricular (LV) distensibility is determined by the material properties of the LV wall and by LV geometry (i.e., LV shape, LV volume and LV wall thickness). These material properties are influenced both by the physical structure of the LV myocardium and by the dynamic process of

  9. Magnetic Resonance Imaging of Transient Left Ventricular Apical Ballooning Related to Emotional Stress: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Mu Sook; Choi, Byoung Wook; Choe, Kyu Ok; Chung, Namsik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2007-02-15

    Transient left ventricular apical ballooning is characterized by transient wall motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of coronary arterial occlusion. A 66-year-old woman presented to the emergency department with chest pain that mimicked acute myocardial infarction. An aortogram showed akinesis from the mid to apical left ventricle with sparing of the basal segments. Four days later, she underwent MRI, which demonstrated characteristic apical contractile dysfunction, the same as the aortogram, without evidence of myocardial infarction on the MRI. Two weeks later, her symptoms were resolved and follow-up echocardiography showed normal ventricular function. We suggest that MRI might be an integrated imaging diagnostic tool for the diagnosis of this syndrome, which demonstrated characteristic apical contractile dysfunction with performing cine MRI, the absence of significant coronary artery stenosis with performing coronary MR angiography and the absence of myocardial infarction with performing contrast enhanced delayed MRI.

  10. Global left ventricular longitudinal strain is closely associated with increased neurohormonal activation after acute myocardial infarction in patients with both reduced and preserved ejection fraction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig;

    2012-01-01

    N-terminal pro brain natriuretic peptide (NT-proBNP) is released in response to increased myocardial wall stress and is associated with adverse outcome in acute myocardial infarction. However, little is known about the relationship between longitudinal deformation indices and NT-proBNP....

  11. Dietary sodium restriction specifically potentiates left ventricular ACE inhibition by zofenopril, and is associated with attenuated hypertrophic response in rats with myocardial infarction

    NARCIS (Netherlands)

    Westendorp, B; Schoemaker, RG; Buikema, H; de Zeeuw, D; Van Veldhuisen, DJ; Van Gilst, WH

    2004-01-01

    Introduction In patients with myocardial infarction (MI)-induced heart failure, angiotensin-converting enzyme (ACE) inhibitors are proven effective therapy in inhibiting the progression towards overt heart failure. However, the prognosis in these patients is still very poor, and optimisation of ther

  12. Dietary sodium restriction specifically potentiates left ventricular ACE inhibition by zofenopril, and is associated with attenuated hypertrophic response in rats with myocardial infarction

    NARCIS (Netherlands)

    Westendorp, B; Schoemaker, RG; Buikema, H; de Zeeuw, D; Van Veldhuisen, DJ; Van Gilst, WH

    2004-01-01

    Introduction In patients with myocardial infarction (MI)-induced heart failure, angiotensin-converting enzyme (ACE) inhibitors are proven effective therapy in inhibiting the progression towards overt heart failure. However, the prognosis in these patients is still very poor, and optimisation of ther

  13. Dietary sodium restriction specifically potentiates left ventricular ACE inhibition by zofenopril, and is associated with attenuated hypertrophic response in rats with myocardial infarction

    NARCIS (Netherlands)

    Westendorp, B; Schoemaker, RG; Buikema, H; de Zeeuw, D; Van Veldhuisen, DJ; Van Gilst, WH

    Introduction In patients with myocardial infarction (MI)-induced heart failure, angiotensin-converting enzyme (ACE) inhibitors are proven effective therapy in inhibiting the progression towards overt heart failure. However, the prognosis in these patients is still very poor, and optimisation of

  14. Cardiac structure and function, remodeling, and clinical outcomes among patients with diabetes after myocardial infarction complicated by left ventricular systolic dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Shah, Amil M; Hung, Chung-Lieh; Shin, Sung Hee

    2011-01-01

    The mechanisms responsible for the increased risk of heart failure (HF) post-myocardial infarction (MI) may differ between patients with versus without diabetes. We hypothesized that after high-risk MI, patients with diabetes would demonstrate patterns of remodeling that are suggestive of reduced...

  15. Impact of Glycemic Excursions on Left Ventricular Function of Patients with Acute Myocardial Infarction%血糖波动对急性心肌梗死患者左心室功能的影响研究

    Institute of Scientific and Technical Information of China (English)

    隋利军

    2016-01-01

    目的:探讨血糖波动对急性心肌梗死患者左心室功能的影响。方法选取2013—2015年无锡市第九人民医院收治的急性心肌梗死患者200例,根据平均血糖波动幅度(MAGE)分为 MAGE ﹤3.9 mmol/ L 组122例(A 组)与 MAGE≥3.9 mmol/ L 组78例(B 组)。比较两组患者一般资料、实验室检查结果、心功能指标,并分析 MAGE 对急性心肌梗死患者左心室功能的影响。结果两组患者性别、年龄、体质指数(BMI)、高血压病史阳性率、慢性阻塞性肺疾病病史阳性率、脑卒中病史阳性率、收缩压(SBP)、舒张压(DBP)、心率比较,差异无统计学意义(P ﹥0.05);A 组患者糖尿病病史阳性率低于 B 组(P ﹤0.05)。两组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、舒张期末容积指数比较,差异无统计学意义(P ﹥0.05);A 组患者空腹血糖、糖化血红蛋白(HbA1c )低于 B 组,收缩期末容积指数小于 B 组,左心室射血分数(LVEF)、每搏输出量高于 B组,Killip 分级优于 B 组,室壁运动积分指数大于 B 组(P ﹤0.05)。多因素 logistic 回归分析结果显示,MAGE〔OR =1.567,95% CI(1.021,2.178)〕是急性心肌梗死患者左心室功能的影响因素(P ﹤0.05)。结论血糖波动会影响急性心肌梗死患者左心室功能,MAGE 是急性心肌梗死患者左心室功能的影响因素之一。%Objective To explore the impact of glycemic excursions on left ventricular function of patients with acute myocardial infarction. Methods A total of 200 patients with acute myocardial infarction were selected in the Ninth People's Hospital of Wuxi from 2013 to 2015,and they were divided into A group(with mean amplitude of glycemic excursions less than 3. 9 mmol/ L,n = 122)and B group(with mean amplitude of glycemic excursions equal or over 3. 9

  16. Left ventricular hypertrophy: an initial response to myocardial injury.

    Science.gov (United States)

    Francis, G S; McDonald, K M

    1992-06-04

    The prevailing wisdom generally has been that the failing heart hypertrophies in response to increased wall stress. The increase in myocardial mass observed in heart failure is therefore a relatively late compensatory event geared to normalize wall stress. Although this is undoubtedly true, especially for heart failure resulting from a large anterior myocardial infarction accompanied by rapid left ventricular expansion, it is possible that an important form of hypertrophy occurs much earlier as an initial response to myocardial injury. One can hypothesize that the initial response to injury is a nonspecific phenotypic alteration of the cardiac myocyte to one of growth and development. Such changes may be driven by both trophic and mechanical forces and may be important in altering the architecture of the myocardial cell and surrounding cardiac interstitium. Preliminary data from a variety of models support the concept that neuroendocrine activity is an important component in the ventricular remodeling process, and that pharmacologic interventions designed to block systemic and tissue neuroendocrine activity may prevent excessive cardiac enlargement and its ultimate consequences. Because this concept has important implications for preventive cardiology, the results of several prevention trials, including the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS), Studies of Left Ventricular Dysfunction (SOLVD), and Survival and Ventricular Enlargement (SAVE) are awaited eagerly.

  17. Endoventriculoplasty using autologous endocardium for anterior left ventricular aneurysms

    NARCIS (Netherlands)

    Grandjean, JG; Mariani, MA; D'Alfonso, A; Musazzi, A; Boonstra, PW

    Background: There is currently consensus that endoventriculoplasty is the treatment of choice for an anterior left ventricular aneurysm. We describe here a new technique of endoventriculoplasty using autologous endocardium for left ventricular anterior aneurysm. Method: From 1990 until 2003, 49

  18. Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; GAO Ming-xin; LI Hai-tao; ZHANG Fan; GU Cheng-xiong

    2012-01-01

    Background Left ventricular aneurysm (LVA) is one of the serious complications after acute myocardial infarction.We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting (OPCAB).Methods From June 2009 to April 2011,31 patients with LVA had angina symptoms and ventricular arrhythmia.In all patients,circular and cross-shaped radiofrequency epicardial ablations were performed using unipolar ablation pen along the border between the aneurysm wall and normal cardiac tissue and in the central zone of the aneurysms,followed by a linear placation of ventricular aneurysms on beating heart.Results All the patients showed complete recovery.The average number of grafted vessels was 2.7±1.3.Intraoperative examinations revealed that the ventricular arrhythmia was effectively controlled by radiofrequency ablation.All cases had been followed up for one year.Holter monitoring revealed a significant reduction in ventricular arrhythmias (P <0.05).Echocardiography showed significant increase in left ventricular ejection fraction (P <0.05) and decrease in left ventricular end-diastolic diameter (P <0.05).Conclusions For patients with ventricular aneurysm and preoperative malignant arrhythmia,aneurysm repair plus epicardial radiofrequency ablation in OPCAB was found to be an effective and feasible therapeutic technique.However,medium-to long-term therapeutic efficacy of this method remains to be determined by future studies and observations.

  19. Risk markers of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; Jøns, Christian; Jørgensen, Rikke Mørch;

    2011-01-01

    was documented in 28 (10%) patients during a median follow-up of 2.0 (0.4-2.0) years. Heart rate variability (HRV) measures and non-sustained ventricular tachycardia occurring at the week 6 Holter monitoring were highly predictive of HAVB. Power law slope .... An ILR was implanted for continuous arrhythmia surveillance. Risk stratification testing was performed at inclusion and 6 weeks after AMI. The tests included echocardiography, electrocardiogram (ECG), 24 h Holter monitoring, and an invasive electrophysiological study. High-degree atrioventricular block...

  20. Myocardial infarction with ventricular septal rupture complicating elective aortic valve replacement.

    Science.gov (United States)

    Milhous, J Gerrit-Jan; Heijmen, Robin H; Ball, Egbert T; Plokker, H W Thijs

    2006-07-01

    Herein is described the case of a 79-year-old woman who underwent elective aortic valve replacement. The procedure was complicated by a particulate embolism into the left anterior descending artery leading to a myocardial infarction, complicated by ventricular septal rupture. Subsequently, the patient was reoperated on and the septal defect closed successfully, with an uneventful recovery.

  1. Diastolic Left Ventricular Dysfunction : A Clinical Appraisal

    OpenAIRE

    Bronzwaer, J.G.F.

    2003-01-01

    Diastolic left ventricular (LV) distensibility is determined by the material properties of the LV wall and by LV geometry (i.e., LV shape, LV volume and LV wall thickness). These material properties are influenced both by the physical structure of the LV myocardium and by the dynamic process of myocardial relaxation. The material properties of the myocardium dictate the strain that follows a given stress, and determine position and shape of the myocardial stress-strain relationship. The mater...

  2. Brief left ventricular pressure overload reduces myocardial apoptosis.

    Science.gov (United States)

    Huang, Hsien-Hao; Lai, Chang-Chi; Chiang, Shu-Chiung; Chang, Shi-Chuan; Chang, Chung-Ho; Lin, Jin-Ching; Huang, Cheng-Hsiung

    2015-03-01

    Both apoptosis and necrosis contribute to cell death after myocardial ischemia and reperfusion. We previously reported that brief left ventricular pressure overload (LVPO) decreased myocardial infarct (MI) size. In this study, we investigated whether brief pressure overload reduces apoptosis and the mechanisms involved. MI was induced by a 40-min occlusion of the left anterior descending coronary artery and 3-h reperfusion in male anesthetized Sprague-Dawley rats. Brief LVPO was achieved by two 10-min partial snarings of the ascending aorta, raising the systolic left ventricular pressure 50% above the baseline value. Ischemic preconditioning was elicited by two 10-min coronary artery occlusions and 10-min reperfusions. Brief LVPO and ischemic preconditioning significantly decreased MI size (P Brief pressure overload significantly reduced myocardial apoptosis, as evidenced by the decrease in the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive nuclei (P brief pressure overload significantly increased Bcl-2 (P brief pressure overload (P Brief left LVPO significantly reduces myocardial apoptosis. The underlying mechanisms might be related to modulation of Bcl-2 and Bax, inhibition of p53, increased Akt phosphorylation, and suppressed c-Jun N-terminal kinase phosphorylation. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Seward, J B;

    2000-01-01

    OBJECTIVES: To determine the ability of the ratio of peak E-wave velocity to flow propagation velocity (E/Vp) measured with color M-mode Doppler echocardiography to predict in-hospital heart failure and cardiac mortality in an unselected consecutive population with first myocardial infarction (MI......). BACKGROUND: Several experimental studies indicate color M-mode echocardiography to be a valuable tool in the evaluation of diastolic function, but data regarding the clinical value are lacking. METHODS: Echocardiography was performed within 24 h of arrival at the coronary care unit in 110 consecutive...... or =1.5 measured with color M-mode echocardiography is a strong predictor of in-hospital heart failure. Furthermore, E/Vp is superior to systolic measurements in predicting 35 day survival although Dt

  4. 丹红注射液对心肌梗死大鼠心功能和左室重构的改善作用%The improvement effect of Danhong injection on the cardiac function and left ventricular remodeling in myocardial infarction rats

    Institute of Scientific and Technical Information of China (English)

    李骏峰; 王虹; 贾玲; 邢永红; 王育新

    2013-01-01

    目的:探讨丹红注射液(DHI)对心肌梗死大鼠的心功能和左室重构的改善作用.方法:采用冠状动脉结扎法(CAL)制备心肌梗死(MI)模型,观察DHI对大鼠心肌梗死后12周的心脏及肺的解剖学指标、心室的疤痕面积、左心室血流动力学指标、心肌病理指标及凋亡基因水平的影响.结果:心肌梗死后连续12周的DHI治疗可降低心脏和湿肺与体质量的比值、左室舒张末期压力、心肌细胞直径和胶原容积分数(P<0.05),升高左心室内压最大上升速率(P<0.05),但对凋亡基因的异常表达和心室前壁出现梗死疤痕无明显作用(P>0.05).结论:丹红注射液可有效逆转CAL诱导的心肌梗死大鼠的心功能恶化并改善除凋亡外的心室重构.%OBJECTIVE To explore the improving effect of Danhong injection(DHI)on the cardiac function and left ventricular remodeling in myocardial infarction rats. METHODS Coronary artery ligation (CAD was used to induce an in vivo model of myocardial infarction (MI). The experiment observed the influences of DHI on the anatomy indicators of heart and lung, ventricular scar area, left ventricular hemodynamics, myocardial pathological indicators and the levels of apoptotic genes. RESULTS 12 consecutive weeks' treatment of DHI after myocardial infarction could reduce the ratio of HW/BW and WLW/ BW,left ventricular end-diastolic pressure, the diameter of cardiomyocyte and collagen volume fraction (P<0. 05) ,and increase the maximum rate of change of left ventricular pressure(P<0. 05), while caused no changes on the ventricular scar area and the apoptosis. CONCLUSION Danhong injection can attenuate the deterioration of cardiac function and ventricular remodeling (except the apoptosis) in the myocardial infarction rats.

  5. Left ventricular remodeling after experimental myocardial cryoinjury in rats.

    Science.gov (United States)

    Ciulla, Michele M; Paliotti, Roberta; Ferrero, Stefano; Braidotti, Paola; Esposito, Arturo; Gianelli, Umberto; Busca, Giuseppe; Cioffi, Ugo; Bulfamante, Gaetano; Magrini, Fabio

    2004-01-01

    The standard coronary ligation, the most studied model of experimental myocardial infarction in rats, is limited by high mortality and produces unpredictable areas of necrosis. To standardize the location and size of the infarct and to elucidate the mechanisms of myocardial remodeling and its progression to heart failure, we studied the functional, structural, and ultrastructural changes of myocardial infarction produced by experimental myocardial cryoinjury. The cryoinjury was successful in 24 (80%) of 30 male adult CD rats. A subepicardial infarct was documented on echocardiograms, with an average size of about 21%. Macroscopic examination reflected closely the stamp of the instrument used, without transition zones to viable myocardium. Histological examination, during the acute setting, revealed an extensive area of coagulation necrosis and hemorrhage in the subepicardium. An inflammatory infiltrate was evident since the 7th hour, whereas the reparative phase started within the first week, with proliferation of fibroblasts, endothelial cells, and myocytes. From the 7th day, deposition of collagen fibers was reported with a reparative scar completed at the 30th day. Ultrastructural study revealed vascular capillary damage and irreversible alterations of the myocytes in the acute setting and confirmed the histological findings of the later phases. The damage was associated with a progressive left ventricular (LV) remodeling, including thinning of the infarcted area, hypertrophy of the noninfarcted myocardium, and significant LV dilation. This process started from the 60th day and progressed over the subsequent 120 days period; at 180 days, a significant increase in LV filling pressure, indicative of heart failure, was found. In conclusion, myocardial cryodamage, although different in respect to ischemic damage, causes a standardized injury reproducing the cellular patterns of coagulation necrosis, early microvascular reperfusion, hemorrhage, inflammation

  6. Left ventricular heart failure and pulmonary hypertension†

    Science.gov (United States)

    Rosenkranz, Stephan; Gibbs, J. Simon R.; Wachter, Rolf; De Marco, Teresa; Vonk-Noordegraaf, Anton; Vachiéry, Jean-Luc

    2016-01-01

    In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context. PMID:26508169

  7. Changes of Left Ventricular Geometry Shape and Left Ventricular Regional Function in Patients With Dilated Cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    Liang-yu WANG; Ming-xing XIE; Qing-bo LI; Ping CHEN; Zhi-xiong CAI; Zhi-dan ZHU

    2009-01-01

    Objectives To assess the left ventricle regional systolic and diastolic function, left ventricle geometry and left venti-tie sphericity indexes in patients with dilated cardiomyopathy (DCM) by quantitative tissue velocity imaging (QTVI). Methods Thirty normal subjects and 52 DCM patients underwent QTVI and colour Doppler flow imaging study in or-der to measure the left ventricular regional function along left ventricle apical long-axis view and the left ventricle geom-etry. Peak tissue velocities of left venticle regional muscular tissue during systole (Vs), systolic acceleration (a), ear-ly diastole(Ve) and left atrium contraction(Va) along left venticle apical long axis view were measured. The indexes of left ventdcular regional systolic and diastolic function were mearsured at the same time. The left ventricle geometry shape was reflected from the systolic and diastolic sphericity index (Sis and Sid), the left ventricular ejection fraction (LVEF) and D wave/A wave (PVd/Pva) of pulmonary veins flowing spectrum reflected the global left ventricular systolic and diastolic function. The Vs, Ve, Va, a, PVd/Pva ratio, LVEF, Sis, Sid and their correlations between normal subjects and patients with DCM were compared and analyzed. Results Vs, Ve, Va, a, PVd/Pva, Sis and Sid in patients with DCM were lower than those in normal persons. There were significant relations between Sis and a (r=0.6142, P<0.05), Ve/Va and Sid (r=0.6271, P<0.05). Conclusions QTVI offer a newer method which has a higher sensitivity and accuracy in evaluating the left venticle regional systolic and diastolic function in DCM patients. There was significant relation between regional cardiac function and left venticle sphericity.

  8. Spontaneous closure of a large left ventricular pseudoaneurysm after mitral valve replacement.

    Science.gov (United States)

    Inoue, Takahiro; Hashimoto, Kazuhiro; Sakamoto, Yoshimasa; Nagahori, Ryuichi; Yoshitake, Michio; Matsumura, Yoko; Takagi, Tomomitsu; Kinami, Hiroo

    2016-06-01

    Left ventricular pseudoaneurysm is a rare, but potentially fatal, condition that generally occurs as a complication of myocardial infarction, infective endocarditis, or cardiac surgery. Surgical repair is the treatment of first choice because of the marked risk of rupture, but deteriorated hemodynamics and complicated procedures to treat the pseudoaneurysm may lead to a high mortality rate. We report a 62-year-old woman with a large left ventricular pseudoaneurysm after mitral valve replacement for rheumatic mitral valve stenosis. Surgical repair was not performed due to the patient's refusal, but her pseudoaneurysm resolved spontaneously by 2 years after mitral valve replacement. Spontaneous obliteration of a large left ventricular pseudoaneurysm is very rare in a patient on warfarin therapy. This case suggests that a left ventricular pseudoaneurysm with a narrow neck may resolve spontaneously in rare settings.

  9. EVALUATION ON THE EFFECT OF PRE-HOSPITALIZED VENOUS THROMBOLYTIC THERAPY FOR LARGE AREA MYOCARDIAL INFARCTION EARLY LEFT VENTRICULAR REMODELING WITH ECHOCARDIOGRAPHY%超声评价院前静脉溶栓对大面积心肌梗死早期左室重构的影响

    Institute of Scientific and Technical Information of China (English)

    刘佳; 汪克非; 贾黎丹; 王翠丽; 赵晓兰

    2001-01-01

    目的:评价患者入院前静脉溶栓治疗对大面积心肌梗死(心梗)早期左室重构的影响,探讨超声新技术评价左室重构的价值。方法:对院前静脉溶栓治疗有效(32例)及未溶栓治疗(30例)两组大面积急性心梗病例应用超声多项技术进行同期(心梗后1周、6周)左室结构及功能的观察、分析及对比研究。结果:未溶栓治疗组左室重构在1周时已发生,左室趋向球形变化、容积增大、整体及局部收缩功能下降、舒张功能减低。溶栓治疗有效组左室结构及功能无明显变化。结论:有效的院前静脉溶栓治疗可阻止大面积心梗早期左室重构的发生及心功能的恶化,应用超声心动图声学定量技术、彩色室壁动力技术评价急性心梗后左室重构方法简便、省时,结果客观、准确。%Objective:Evaluate the effect of pre-hospitalized venousthrombolytic therapy for large area myocardial infarction early left ventricular remodeling,and discuss the value of evaluation of left ventricular remodeling with new ultrasonic technology.Methods:Observe,analysis and research by contrast the left ventricular structure and its function of the same stage (one week and 6 weeks after myocardial infarction) of two groups of large area myocardial infarction cases in which one is efficient(32 cases) for pre-hospitalized venous thrombolytic therapy and the other hasn't undergoing venous thrombolytic therapy (30 cases) with several method of echocardiography.Results:In the group which no thrombolytic therapy has been taken,the left ventricular remodeling can be seen after the one week myocardial infarction,with left ventricular leading to ball-shape and bigger cubage and whole and local contraction and diastolic function decreased.And in efficinent group,there are no distinct changes.Conclusion:The efficient pre-hospitalization venous thrombolygtic therapy can prevent the happening of large area myocardial

  10. The contemporary value of peak creatine kinase-MB after ST-segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality.

    Science.gov (United States)

    Hartman, Minke H T; Eppinga, Ruben N; Vlaar, Pieter J J; Lexis, Chris P H; Lipsic, Erik; Haeck, Joost D E; van Veldhuisen, Dirk J; van der Horst, Iwan C C; van der Harst, Pim

    2017-05-01

    Complex multimarker approaches to predict outcome after ST-elevation myocardial infarction (STEMI) have only considered a single baseline sample, while neglecting easily obtainable peak creatine kinase and creatine kinase-MB (CK-MB) values during hospitalization. We studied 476 patients undergoing primary percutaneous coronary intervention for STEMI and cardiac magnetic resonance imaging (CMRI) at 4-6 months after STEMI. We determined the association with cardiac biomarkers (peak CK-MB, peak troponin T, N-terminal pro-brain natriuretic peptide), clinical and angiographic characteristics with infarct size, and LVEF, followed by association with mortality in 1120 STEMI patients. Peak CK-MB was the strongest predictor for infarct size (PMB cutpoints, for differentiation among small (MB measured during hospitalization for STEMI was superior to other clinical and angiographic characteristics in predicting CMRI-defined infarct size and LVEF, and should be included and validated in future multimarker studies. Peak CK-MB cutpoints differentiated among infarct size categories and were associated with increased 90-day mortality risk. © 2016 Wiley Periodicals, Inc.

  11. Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Chinali, M.; Simone, G. de; Wachtell, K.;

    2008-01-01

    systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n......In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... with larger left ventricular diameter and higher left ventricular mass index (both P ventricular hypertrophy was greater (84 vs. 64%; P

  12. Intracoronary artery transplantation of cardiomyoblast-like cells from human adipose tissue-derived multi-lineage progenitor cells improve left ventricular dysfunction and survival in a swine model of chronic myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Okura, Hanayuki [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Saga, Ayami; Soeda, Mayumi [Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Miyagawa, Shigeru; Sawa, Yoshiki [Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Daimon, Takashi [Division of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 (Japan); Ichinose, Akihiro [Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); Matsuyama, Akifumi, E-mail: akifumi-matsuyama@umin.ac.jp [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); RIKEN Program for Drug Discovery and Medical Technology Platforms, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045 (Japan)

    2012-09-07

    Highlights: Black-Right-Pointing-Pointer We administered human CLCs in a swine model of MI via intracoronary artery. Black-Right-Pointing-Pointer Histological studies demonstrated engraftment of hCLCs into the scarred myocardium. Black-Right-Pointing-Pointer Echocardiography showed rescue of cardiac function in the hCLCs transplanted swine. Black-Right-Pointing-Pointer Transplantation of hCLCs is an effective therapeutics for cardiac regeneration. -- Abstract: Transplantation of human cardiomyoblast-like cells (hCLCs) from human adipose tissue-derived multi-lineage progenitor cells improved left ventricular function and survival of rats with myocardial infarction. Here we examined the effect of intracoronary artery transplantation of human CLCs in a swine model of chronic heart failure. Twenty-four pigs underwent balloon-occlusion of the first diagonal branch followed by reperfusion, with a second balloon-occlusion of the left ascending coronary artery 1 week later followed by reperfusion. Four weeks after the second occlusion/reperfusion, 17 of the 18 surviving animals with severe chronic MI (ejection fraction <35% by echocardiography) were immunosuppressed then randomly assigned to receive either intracoronary artery transplantation of hCLCs hADMPCs or placebo lactic Ringer's solution with heparin. Intracoronary artery transplantation was followed by the distribution of DiI-stained hCLCs into the scarred myocardial milieu. Echocardiography at post-transplant days 4 and 8 weeks showed rescue and maintenance of cardiac function in the hCLCs transplanted group, but not in the control animals, indicating myocardial functional recovery by hCLCs intracoronary transplantation. At 8 week post-transplantation, 7 of 8 hCLCs transplanted animals were still alive compared with only 1 of the 5 control (p = 0.0147). Histological studies at week 12 post-transplantation demonstrated engraftment of the pre DiI-stained hCLCs into the scarred myocardium and their expression of

  13. Congenital left ventricular aneurysm coexisting with left ventricular non-compaction in a newborn.

    Science.gov (United States)

    Ootani, Katsuki; Shimada, Jun; Kitagawa, Yosuke; Konno, Yuki; Miura, Fumitake; Takahashi, Toru; Ito, Etsuro; Ichinose, Kouta; Yonesaka, Susumu

    2014-10-01

    Described herein is the case of a rare combination of congenital left ventricular (LV) aneurysm and left ventricular non-compaction (LVNC) in a newborn. The patient developed refractory heart failure soon after birth and died at 5 months of age. The etiology of both congenital LV aneurysm and LVNC seems to be maldevelopment of the ventricular myocardium during early fetal life. Treatment should be individually tailored depending on clinical severity, and treatment options are limited. Given that this combination of congenital LV aneurysm and LVNC is significantly associated with poor prognosis, it appears that patients with congenital LV aneurysm and LVNC are candidates for early, aggressive intervention, including surgical aneurysmectomy and evaluation for transplantation. It is important to be aware of this combination of congenital LV aneurysm and LVNC, and to make earlier decisions on therapeutic strategy.

  14. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study)

    DEFF Research Database (Denmark)

    Anavekar, Nagesh S; Skali, Hicham; Bourgoun, Mikhail

    2008-01-01

    Severe right ventricular dysfunction independent of left ventricular ejection fraction increased the risk of heart failure (HF) and death after myocardial infarction (MI). The association between right ventricular function and other clinical outcomes after MI was less clear. Two-dimensional echoc...

  15. Primary angioplasty for infarction due to isolated right ventricular artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Anwar; A; Chahal; Min-Young; Kim; Alexander; N; Borg; Yahya; Al-Najjar

    2014-01-01

    We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.

  16. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation

    Science.gov (United States)

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin

    2016-01-01

    Abstract Background: Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. Methods: We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Results: Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Conclusion: Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture. PMID:27661047

  17. A case of chronic left ventricular thrombus with ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Vikram Bhausaheb Vikhe

    2013-01-01

    Full Text Available Left ventricular (LV thrombus is a serious complication of anterior wall myocardial infarction (MI, especially in patients with severe LV dysfunction. LV thrombus carries a high risk of causing stroke and other thromboembolic complications despite adequate anticoagulation therapy. There is a benefit of anticoagulation in patients with ischemic cardiomyopathy to reduce thromboembolic events or in resolution of LV thrombus. Two-dimensional (2D echocardiography is the most commonly used technique for the diagnosis and follow-up of such cases. Our patient developed a chronic LV thrombus with ischemic cardiomyopathy post anterior wall MI and was managed well on anticoagulants to prevent the thromboembolic events under strict vigilance and follow-up.

  18. Increased myocardial vulnerability to ischemia-reperfusion injury in the presence of left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Mølgaard, Søren; Faricelli, Barbara; Salomonsson, Max

    2016-01-01

    Objective: Despite its high prevalence among patients suffering myocardial infarction, the significance of left ventricle hypertrophy for infarct size is not known. We asked whether infarct size might be increased by this condition, and whether any such increase might be associated with an increa......Objective: Despite its high prevalence among patients suffering myocardial infarction, the significance of left ventricle hypertrophy for infarct size is not known. We asked whether infarct size might be increased by this condition, and whether any such increase might be associated...... with an increased mitochondrial damage following coronary occlusion.  Methods: Occlusion of the left descending artery in isolated, perfused hearts of SHR-SP (spontaneously hypertensive rat stroke-prone) (left ventricular hypertrophy) or Wistar-Kyoto (WKY) (control) rats was used, followed by reperfusion.......  Conclusion: Hearts from hypertensive (SHR-SP) rats with left ventricle hypertrophy appeared more vulnerable to ischemia-reperfusion injury, as supported by a more profound infarct development and an earlier loss of postconditioning by Exe-4. Mitochondrial complexes III and IV were identified among possible...

  19. Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives.

    Science.gov (United States)

    Suzuki, Natsuko; Suzuki, Keisuke; Mizuno, Tomofumi; Kato, Yukari; Suga, Norihiro; Yoshino, Masabumi; Miura, Naoto; Banno, Shogo; Imai, Hirokazu

    2016-01-01

    A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being well-controlled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.

  20. Recurrent Postmyocardial Infarction Ventricular Tachycardia: An Unusual Culprit

    Directory of Open Access Journals (Sweden)

    Akhil Kumar Sharma

    2015-01-01

    Full Text Available Although temporary transvenous pacing is life-saving in patients with myocardial infarction who develop bradyarrhythmias, the electrical complications resulting from it can be fatal and are rarely reported. We report here a patient with acute inferior wall myocardial infarction who required temporary transvenous pacing due to second-degree atrioventricular block accompanied with hypotension. Following coronary angiography and successful revascularisation, the patient developed multiple episodes of monomorphic and polymorphic ventricular tachycardia as well as ventricular fibrillation which on careful inspection were found to be initiated by fusion of the intrinsic and paced complexes. The problem of malignant ventricular tachycardia was solved by simple removal of the pacing lead. To the best of our knowledge, malignant ventricular tachycardia of both monomorphic and polymorphic types initiated by fusion complexes in a paced patient has not been reported in literature.

  1. ECG manifestations of left ventricular electrical remodeling.

    Science.gov (United States)

    Estes, E Harvey

    2012-01-01

    Research and thinking about the electrocardiographic manifestations of left ventricular hypertrophy has been constrained by a limited conceptual model of the process: heart disease produces chamber enlargement (increased mass), which in turn produces an altered electrocardiogram. The process is much more complex than can be represented in this simple model. A more robust and intricate model is proposed, in which heart (and vascular) disease causes structural changes, electrical changes, biochemical changes, and others, all of which interact to produce electrical remodeling of ventricular myocardium. This electrical remodeling results in a variety of ECG changes. All of these changes interact, leading to an altered clinical course, and to premature death. It is suggested that research, based on this model, can provide new clues to the processes involved, and improve the prediction of clinical outcomes. New directions in research, in recording equipment, and in organizational activities are suggested to test this new model, and to improve the usefulness of the electrocardiogram as a research and diagnostic tool.

  2. Left ventricular noncompaction: Clinical-echocardiographic study

    Directory of Open Access Journals (Sweden)

    Nikolić Aleksandra

    2012-01-01

    Full Text Available Background/Aim. Left ventricular noncompaction (LVNC is a disorder in endomyocardial morphogenesis, seen either isolated (in the absence of other cardiac anomalies or in association with congenital heart disease and some neuromuscular diseases. Intrauterine arrest of the compaction of myocardial fibers is postulated to be the reason of LVNC. Recognition of this condition is extremely important due to its high mortality and morbidity that lead to progressive heart failure, ventricular arrhythmias and thromboembolic events. The aim of this study was to determine the prevalence and clinical presentation of LVNC among consecutive outpatients according to clinical and echocardiographyic findings. Methode. A total of 3,854 consecutive patients examined at the Institute for Cardiovascular Diseases within a period January 2006 - January 2007 were included in the study. All the patients underwent echocardiographic examination using the same equipment (Vivid 7, GE Medical System. Echocardiographic parameters and clinical presentation in patients with echocardiographic criteria for LVNC were analyzed. Results. Analyzing 3,854 consecutive outpatients, using two-dimensional Color Doppler echocardiography from January 2006 to January 2007, 12 patients met the criteria for LVNC. Seven of them were male. The mean age at diagnosis was 45 ± 15 years. Analyzing clinical manifestation of LVNC it was found that seven patients had signs of heart failure, six had arrhythmias with no embolic events. Conclusion. Our results suggest that the real prevalence of LVNC may be higher than expected. New studies have to be done to solve this problem.

  3. Beta blockers & left ventricular hypertrophy regression.

    Science.gov (United States)

    George, Thomas; Ajit, Mullasari S; Abraham, Georgi

    2010-01-01

    Left ventricular hypertrophy (LVH) particularly in hypertensive patients is a strong predictor of adverse cardiovascular events. Identifying LVH not only helps in the prognostication but also in the choice of therapeutic drugs. The prevalence of LVH is age linked and has a direct correlation to the severity of hypertension. Adequate control of blood pressure, most importantly central aortic pressure and blocking the effects of cardiomyocyte stimulatory growth factors like Angiotensin II helps in regression of LVH. Among the various antihypertensives ACE-inhibitors and angiotensin receptor blockers are more potent than other drugs in regressing LVH. Beta blockers especially the newer cardio selective ones do still have a role in regressing LVH albeit a minor one. A meta-analysis of various studies on LVH regression shows many lacunae. There have been no consistent criteria for defining LVH and documenting LVH regression. This article reviews current evidence on the role of Beta Blockers in LVH regression.

  4. 体外心脏震波对急性心肌梗死模型猪左心室重塑的影响%Effect of extracorporeal cardiac shock wave therapy on left ventricular remodeling in a porcine model of acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陶四明; 郭涛; 王钰; 李建美; 蔡红雁; 羊超

    2012-01-01

    BACKGROUND: Initial studies have confirmed that extracorporeal cardiac shock wave therapy can ameliorate metabolism of ischemia myocardium from the level of gene and cells. However, will the therapy improve the development of post-infarction ventricular remodeling in a morphology level?OBJECTIVE: To explore the effects of extracorporeal cardiac shockwave therapy on the function and morphology of the left ventricle after acute myocardial infarction.METHODS: A total of 25 pigs were randomly divided into three groups: shock wave group, sham shock wave group and sham operation group. Pigs in the shock wave group were treated with extracorporeal cardiac shock wave therapy on 3, 5 and 7 days after the model construction of myocardial infarction. Pigs in the sham shock wave group received the same therapy to the shock wave group except for the shock waves and energy. Sham operation group received the same treatment to the sham shock wave group without constructing the myocardial infarction model.RESULTS AND CONCLUSION: Compared with the sham shockwave group, shockwave therapy significantly reduced the left ventricular end-systolic volume, increased the end-diastolic volume and improved the global left ventricular function (P< 0.001); it significantly improved the ventricular wall motor function in the myocardium of the myocardial infarction border zone and the motion compatibleness of the left ventricular. These findings demonstrate that the early application of effective extracorporeal cardiac shock wave therapy can delay the development to some extent from reversible stage to irreversible stage in the left ventricular remodeling after myocardial infarction.%背景:初期实验已经证实体外心脏震波治疗可从基因和细胞水平改善缺血心肌代谢,但是否在形态学水平也可缓解梗死后心室重塑的发展?目的:观察体外心脏震波对急性心肌梗死后左心室心功能及形态学指标的影响.方法:将25只猪随机分为3组:震

  5. 运动幅度曲线直观评价心肌梗死患者左心室局域舒张功能%Evaluation of regional left ventricular diastolic function in patients with myocardial infarction by the curve of ventricular wall motion

    Institute of Scientific and Technical Information of China (English)

    王世宏

    2008-01-01

    Objective To detect the curve of ventricular wall motion features of regional wall abnor-malities in patients with coronary artery disease during each diastolic period, and its possibility to evaluate re-gional left ventricular diastolic function. Methods Fifty-four patients with anterior myocardial infarction (MI group) and 78 normal subjects (NOR group) underwent Doppler tissue imaging, which were performed in 2-chamber-view by the tracing technology of ventrieular wall motion synchronously. Isovolumic relax-ation period, rapid flow period, slow filling phase, atrial systole period were measured. Results In NOR group, distant value of 76 patients (97.44%) showed a gradually decreasing positive value from the apex to middle and from middle to base of left ventricle. While in MI group, such rules disappeared, 52 patients (96.30%) were negative in infarction area. In isevolumic relaxation period in NOR group, 76 patients (97.44%) showed palliative downward wave, but in MI group, 27 patients (50.00%) showed palliative downward wave(P<0.05). In rapid flow period, both NOR and MI group showed downward and steep waves,but in MI group, the gradient rule disappeared and distance of ventricular wall motion was negative in infarc-tion area. In slow filling phase, compared with NOR group, which had horizontal wave, MI group had no obvi-ously horizontal waves. Conclusion Regional myocardial ischemia and infarction can cause significant ab-normalities of regional ventricular wall motion in active diastolic phase, and it can be evaluated quantitatively and synchronously with high sensitivity by the curve of ventricular wall motion which has the potential value in regional left ventricular diastolic function.%目的 探讨冠心病患者左心室舒张各期局部心肌运动幅度曲线特点及其评价左心室局域舒张功能的可能性.方法 对54例前壁心肌梗死患者(MI组)和78例健康对照者(NOR组)左心室心肌进行组织多普勒成像检查.记录心

  6. Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients: Effect of Left Ventricular Mass Index Criteria

    Directory of Open Access Journals (Sweden)

    Eduardo Cantoni Rosa

    2002-04-01

    Full Text Available PURPOSE: To evaluate left ventricular mass (LVM index in hypertensive and normotensive obese individuals. METHODS: Using M mode echocardiography, 544 essential hypertensive and 106 normotensive patients were evaluated, and LVM was indexed for body surface area (LVM/BSA and for height² (LVM/h². The 2 indexes were then compared in both populations, in subgroups stratified according to body mass index (BMI: or = 30kg/m². RESULTS: The BSA index does not allow identification of significant differences between BMI subgroups. Indexing by height² provides significantly increased values for high BMI subgroups in normotensive and hypertensive populations. CONCLUSION: Left ventricular hypertrophy (LVH has been underestimated in the obese with the use of LVM/BSA because this index considers obesity as a physiological variable. Indexing by height² allows differences between BMI subgroups to become apparent and seems to be more appropriate for detecting LVH in obese populations.

  7. Psychotic Symptoms Associated with Left Caudate Infarction

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    Ying-Chih Cheng

    2015-09-01

    Full Text Available Psychotic symptoms following acquired brain lesion are relatively rare, and thus, the specific association linking such symptoms to the distinct brain structure remains unclear. The frontal–subcortical circuits are thought to modulate motor activity and human behavior, and have been reported to be associated with many neuropsychiatric symptoms. We herein report the case of a 77-year-old man without previous psychiatric disorder who developed a new onset of psychotic symptoms following left caudate infarction. The presented case supports the fact that psychosis might arise from alteration of the distinct brain structure. The functional impairment of the frontal–subcortical circuits may be a critical factor linking the pathogenesis of psychosis associated with acquired brain lesion.

  8. Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; GU Cheng-xiong; WEI Hua; LIU Rui; CHEN Chang-cheng; FANG Ying

    2005-01-01

    Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery.Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student's t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P<0.001). The mean left ventricular, end diastolic diameter decreased significantly (P<0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.

  9. Evaluation of left ventricular volumes measured by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Møgelvang, J; Thomsen, C; Mehlsen, J

    1986-01-01

    Left ventricular end-diastolic and end-systolic volumes were determined in 17 patients with different levels of left ventricular function by magnetic resonance imaging (MRI). A 1.5 Tesla Magnet was used obtaining ECG triggered single and multiple slices. Calculated cardiac outputs were compared...

  10. Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty.

    Science.gov (United States)

    Arakawa, Mamoru; Yamaguchi, Atsushi; Nishimura, Takashi; Itoh, Satoshi; Yuri, Koichi; Kyo, Shunei; Adachi, Hideo

    2015-12-01

    Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case.

  11. Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture

    Directory of Open Access Journals (Sweden)

    Bryan G Maxwell

    2013-01-01

    Full Text Available A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

  12. Left and right ventricular diastolic function in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rudhani Ibrahim

    2010-01-01

    Full Text Available The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD and the correlation of this func-tion with the duration of HD. The study included 42 patients (22 females and 20 males with chro-nic renal failure (CRF, treated with HD, and 40 healthy subjects (24 females and 16 males with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under-went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E, acceleration time of E wave (AT-E, tricuspid E and A waves (E tr and A tr and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  13. The effect of the localization of Q wave myocardial infarction on ventricular electromechanics.

    Science.gov (United States)

    O'Sullivan, Christine A; Ramzy, Ihab S; Li, Wei; Sutton, Richard; Coats, Andrew; Gibson, Derek G; Henein, Michael Y

    2002-08-01

    The exact location of a Q wave myocardial infarction has an important effect on overall left ventricular function. To assess the effect of localization of Q wave infarction on left ventricular minor and long axis function, with particular reference to electromechanical disturbances. We studied 72 patients with Q wave myocardial infarction; 35 anterior, age 61+/-15 years and 37 inferior, age 62+/-12 years. ECG intervals were automatically measured by Hewlett-Packard Pagewriter and LV dimension and filling velocities studied by transthoracic echocardiography and simultaneous phonocardiogram. Findings were compared with 21 controls of similar age. Heart rate and all ECG intervals were similar in the two patient groups and controls. QRS axis was more to the left in patients with inferior MI. Normal septal q wave was absent in lead V5 and V6 in 33/35 (94%) patients with anterior MI and in only 3/37 (8%) with inferior MI, pchange in early diastole. This disturbance in electromechanical behaviour might play an important role in the differing outcomes between the two different sites of myocardial infarction.

  14. Utilization of 3 amplatzer occluders for closure of post-myocardial infarction ventricular septal defect.

    Science.gov (United States)

    Kar, Saibal; Ibebuogu, Uzoma N; Conte, Antonio Hernandez

    2012-05-01

    This case report describes a patient who sustained a post-myocardial infarction ventricular septal defect (VSD) with an associated left ventricular aneurysm who developed cardiogenic shock and required an intra-aortic balloon pump for hemodynamic stabilization. After deployment of a single Amplatzer occluder (AGA Medical), a residual VSD measuring 0.5 cm was noted. Therefore, a second Amplatzer occluder was deployed and a minimal residual VSD remained. The patient remained hemodynamically stable throughout the procedure and was subsequently extubated with removal of intra-aortic balloon pump. Post-discharge, the patient was readmitted with congestive heart failure. A third Amplatzer device was deployed to ameliorate the recurrent VSD shunt. At 9-week follow-up, transthoracic echocardiogram was performed and findings included: 1) left ventricular ejection fraction of 62%; 2) appearance of 3 Amplatzer devices along the interventrcular septum seated well with no motion and residual shunt; 3) moderate diastolic dysfunction with pseudonormal left ventricular filling pattern; and 4) no valvular abnormalities. The patient had increased exercise tolerance with no shortness of breath at rest or with exertion. This case demonstrates the utility and viability of multiple Amplatzer device deployment as a means of repairing a large post-myocardial infarction VSD and recurrent VSDs.

  15. Infarto del ventrículo derecho Right ventricular infarction

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    Alberto Barón C

    importante recanalizar rápidamente la arteria obstruida mediante trombólisis o angioplastia. Si persisten signos de bajo gasto se debe usar inotrópico parenteral. Se puede usar un balón de contrapulsación aórtica o dispositivo de asistencia mecánica. Recientemente, se ha descrito el uso de óxido nítrico para reducir la resistencia vascular pulmonar y mejorar el gasto cardiaco.In general, right ventricular infarction is associated with left ventricular inferior wall infarction. Obstructive chronic pulmonary disease and right ventricular hypertrophy are predisposing factors. It usually occurs as a consequence of proximal obstruction of the right coronary artery, which leads to right systolic and diastolic ventricle dysfunction. Stroke volume is diminished and diastolic volume and right ventricular filling pressure increase, causing hypotension and peripheral congestion. Pulmonary blood flow and left ventricular venous return are diminished, which may lead to shock. Besides, complications such as atrioventricular block, sinus dysfunction and ventricular aneurysm may occur. The electrocardiogram shows ST elevation in leads III, V1 to V3 and in V4R. The echocardiogram shows right ventricular free wall hypokinesis or akinesis and there is right cavities dilation and tricuspid regurgitation. The Doppler shows an increment in the duration of isovolumetric contraction and relaxation intervals; the ejection period is shortened and the myocardial performance index increase to abnormal values. The tissue Doppler is abnormal because of the decrease of systolic velocity in the tricuspid annulus. The optimization of rhythm and heart rate is an important part of treatment, and by this reason, beta-blockers may be avoided; depending on the severity of bradycardia, atropine, aminophylline or transient pace-maker can be used in order to ensure an adequate heart rate. In case of atrial fibrillation, anti-arrhythmic drugs or electric cardioversion may be used. An adequate filling volume

  16. Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

    Science.gov (United States)

    Kudaiberdiev, Taalaibek; Akhmedova, Irina; Imanalieva, Gulzada; Abdildaev, Ildar; Jooshev, Kilichbek; Ashimov, Jamalbek; Mirzabekov, Azamat; Gaybildaev, Janibek

    2017-01-01

    Objective: We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium. Methods: The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago. Results: Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function. Conclusion: Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture. PMID:28228965

  17. Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Taalaibek Kudaiberdiev

    2017-01-01

    Full Text Available Objective: We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium. Methods: The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago. Results: Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function. Conclusion: Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

  18. Direct cardiac injection of G-CSF mobilized bone-marrow stem-cells improves ventricular function in old myocardial infarction.

    Science.gov (United States)

    Archundia, Abel; Aceves, José Luis; López-Hernández, Manuel; Alvarado, Martha; Rodriguez, Emma; Díaz Quiroz, Guillermo; Páez, Araceli; Rojas, Felipe Masso; Montaño, Luis Felipe

    2005-12-01

    Autologous transplant of bone marrow stem cells (BMSC), although extremely useful after acute myocardial events, has not been evaluated in patients with old (>one-year-old) myocardial infarction. Our aim was to determine if CD34(+)-enriched peripheral-blood cells, obtained by apheresis, injected directly into the severely damaged myocardium of five patients with old myocardial infarction could restore depressed myocardial function. We found that 28 weeks after revascularization and peri-infarction injection of the enriched CD34(+) peripheral mononuclear cells, ventricular hemodynamic parameters that included left ventricular ejection fraction, left ventricular diastolic volume, ventricular systolic volume and left ventricular diastolic diameter approximated normal values and there was no restenosis; two patients have been followed for >52 weeks and their parameters are within normal values. In conclusion, intramyocardial injection of easily obtained CD34(+) enriched peripheral blood cells represent an encouraging procedure for patients with severely scarred and dysfunctional myocardium.

  19. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard;

    2016-01-01

    PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...... conduction, tLVp, and BiV pacing and compared as paired data. Echocardiographic analysis was done blinded with respect to pacing mode. RESULTS: LVEF was significantly higher during BiV pacing (47 ± 11 %) compared with intrinsic conduction (43 ± 13 %, P = 0.001) and tLVp (44 ± 13 %, P = 0.001), while......V pacing. CONCLUSIONS: The acute effect of tLVp on LV systolic function and contraction pattern is significantly lower than the effect of BiV pacing and not different from intrinsic conduction in patients with LBBB and CRT....

  20. Impact of reperfusion therapy and infarct localization on frequency of premature ventricular beats in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Davor Horvat

    2015-08-01

    Full Text Available Aim To determine the impact of infarct localization and types of reperfusion therapy on the frequency of ventricular premature beats (VPBs in patients with acute myocardial infarction (AMI and reduced left ventricular ejection fraction (LVEF. Methods A total of 705 patients with acute ST elevation myocardial infarction (STEMI were divided according to the infarct localization (anteroseptal, anterolateral, inferior and posterior and reperfusion therapy (fibrinolysis or percutaneous coronary intervention with stenting into two groups: LVEF45% was a control group. The occurrence of VPBs10 per hour defined as a significant. Results In patients with fibrinolysis therapy and LVEF<45% significant number of VPBs were in anteroseptal (p=0.017, anterolateral (p<0.001 and posterior AMI (p<0.001, but in patients with percutaneous coronary intervention (PCI and LVEF<45% significant number of VPBs were only in anteroseptal AMI (p=0.001 localization. Conclusion In patients with reduced ejection fraction in AMI, treatment with PCI method has a better antiarrhythmic effect compared to fibrinolysis treatment.

  1. Design and rationale of the Reduction of Infarct Expansion and Ventricular Remodeling with Erythropoietin After Large Myocardial Infarction (REVEAL) trial

    Science.gov (United States)

    Melloni, Chiara; Rao, Sunil V.; Povsic, Thomas J.; Melton, Laura; Kim, Raymond J.; Kilaru, Rakhi; Patel, Manesh; Talan, Mark; Ferrucci, Luigi; Longo, Dan L.; Lakatta, Edward G.; Najjar, Samer S.; Harrington, Robert A.

    2010-01-01

    Background Acute myocardial infarction (MI) remains a leading cause of death despite advances in pharmacologic and percutaneous therapies. Animal models of ischemia/reperfusion have demonstrated that single-dose erythropoietin (EPO) may reduce infarct size, decrease apoptosis, and increase neovascularization, possibly through mobilization of endothelial progenitor cells (EPCs). Study Design REVEAL is a randomized, double-blind, placebo-controlled, multicenter trial evaluating the effects of epoetin alfa on infarct size and left ventricular (LV) remodeling in patients with large MIs. The trial comprises a dose-escalation safety phase and a single-dose efficacy phase using the highest acceptable epoetin alfa dose up to 60,000 units. Up to 250 STEMI patients undergoing primary or rescue percutaneous coronary intervention (PCI) will be randomized to intravenous epoetin alfa or placebo within 4 hours of successful reperfusion. The primary study endpoint is infarct size expressed as a percentage of LV mass, as measured by cardiac magnetic resonance imaging 2–6 days post study medication administration. Secondary endpoints will assess changes in EPC numbers and changes in indices of ventricular remodeling. Conclusion The REVEAL trial will evaluate the safety and efficacy of the highest tolerated single dose of epoetin alfa in patients who have undergone successful rescue or primary PCI for acute STEMI. PMID:21095264

  2. Left ventricular diastolic function in patients with advanced cystic fibrosis.

    Science.gov (United States)

    Koelling, Todd M; Dec, G William; Ginns, Leo C; Semigran, Marc J

    2003-05-01

    To assess left ventricular systolic and diastolic function in adult patients with cystic fibrosis using radionuclide ventriculography. Although myocardial fibrosis has been described in autopsy specimens of patients with cystic fibrosis, the possibility that myocardial dysfunction may occur during life in adult patients with cystic fibrosis has not been explored. To assess the possibility of cardiac dysfunction occurring in cystic fibrosis, we studied 40 patients with advanced cystic fibrosis with first-pass radionuclide ventriculography and compared them to 9 patients with advanced bronchiectasis and 18 normal control subjects. Indexes of right ventricular systolic function were similarly impaired in patients with cystic fibrosis and patients with bronchiectasis. Left ventricular ejection fraction of patients with cystic fibrosis, patients with bronchiectasis, and normal control subjects did not differ. Fractional left ventricular filling at 50% of diastole, an index of diastolic function, was significantly lower in patients with cystic fibrosis (54 +/- 13%, mean +/- SD) in comparison to patients with bronchiectasis (66 +/- 4%, p = 0.009) or normal control subjects (69 +/- 14, p = 0.0002). The contribution of atrial systole to total diastolic left ventricular filling was greater in patients with cystic fibrosis (38 +/- 18%) than in patients with bronchiectasis (21 +/- 4%, p = 0.01) or normal control subjects (25 +/- 12%, p = 0.01). Patients with advanced cystic fibrosis demonstrate impaired left ventricular distensibility when compared to normal control subjects and patients with bronchiectasis. Patients with cystic fibrosis may be at risk of heart failure due to right ventricular dysfunction or left ventricular diastolic dysfunction.

  3. Left and right ventricular diastolic function in hemodialysis patients.

    Science.gov (United States)

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  4. Endocarditis in left ventricular assist device

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

    2016-01-01

    Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

  5. Arterial baroreflex function and left ventricular hypertrophy

    Institute of Scientific and Technical Information of China (English)

    MIAO Chao-Yu; SU Ding-Feng

    2004-01-01

    It is well known that the arterial baroreflex(ABR)plays a key role in the regulation of heart rate and stabilization of blood pressure.Currently,it appears that ABR dysfunction is involved in the pathophysiology of cardiovascular disease states.Since the mid-1990s,a number of studies have been carried out in our laboratory to explore the pathological significance of ABR function in cardiovascular damage.This minireview summarizes our research work on the topic of ABR and left ventricular hypertrophy(LVH).On the basis of discussion concerning the importance of ABR dysfunction in hypertensive LVH and sinoaortic denervation-induced LVH,we advance a new strategy for reversal of LVH,that is,restoration of impaired ABR function.We tested this hypothesis in animal models with ABR deficiency.It was found that improvement of impaird ABR function with long-term treatment of ketanserin or candesartan was accompanied by reversal of LVH.The preliminary results indicate that it is feasible to target ABR for treatment of LVH.

  6. Salt and left ventricular hypertrophy: what are the links?

    Science.gov (United States)

    Langenfeld, M R; Schmieder, R E

    1995-11-01

    Left ventricular hypertrophy is a frequent and prognostically unfavourable finding in patients with essential hypertension and has been found to be a predictor for the development of essential hypertension in normotensive subjects. Among various genetic, haemodynamic and humoral determinants, dietary salt intake has been demonstrated to influence left ventricular mass in hypertensive disease. Several cross-sectional studies have shown a close relation between dietary salt intake and parameters of left ventricular hypertrophy. Moreover, reduction of dietary sodium intake was associated with a decrease of left ventricular mass in a prospective study. The underlying mechanism of how salt intake modulates myocardial structure has not been explained yet. Three possible explanations are discussed: (1) sodium influences left ventricular mass via raised preload, (2) the sympathetic nervous system acts as a mediator, and (3) the renin-angiotensin-aldosterone system is the responsible link. Recent animal experiments and clinical studies suggest that the renin-angiotensin-aldosterone system may mediate both the cardiotrophic and the blood pressure raising effects of salt. However, not all individuals have a similar high susceptibility to blood pressure elevation develop left ventricular hypertrophy when exposed to high salt intake. We suggest that the underlying mechanism is a dysregulation of the renin-angiotensin-aldosterone system. Some individuals may have an impaired downregulation of angiotensin II synthesis when challenged with high salt intake. Accordingly, we found that relatively too high levels of angiotensin II in relation to urinary sodium excretion were associated with left ventricular hypertrophy in these individuals on high salt intake.

  7. Cardiac Arrest due to Recurrent Ventricular Fibrillation Triggered by Unifocal Ventricular Premature Complexes in a Silent Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Dong Hyun Lee

    2014-11-01

    Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.

  8. Unusual case of left ventricular ballooning involving the inferior wall: a case report

    OpenAIRE

    Rognoni, Andrea; Bertolazzi, Marzia; Maccio', Sergio; Reale, Danilo; PROIETTI, RICCARDO; Rognoni, Giorgio

    2009-01-01

    Background Tako – tsubo like syndrome (also named left ventricular apical ballooning) is an unusual cardiomyopathy with an high incidence in Japanese population of female sex, following an emotional stress. The clinical features (typical chest pain), and the electrocardiographic changes (negative T wave and persistent ST elevation in anterior leads), are suggestive of an acute myocardial infarction; nevertheless the coronary angiography show coronary arteries without lesions and the ventricul...

  9. A two phase harmonic model for left ventricular function

    CERN Document Server

    Dubi, S; Dubi, Y

    2006-01-01

    A minimal model for mechanical motion of the left ventricle is proposed. The model assumes the left ventricle to be a harmonic oscillator with two distinct phases, simulating the systolic and diastolic phases, at which both the amplitude and the elastic constant of the oscillator are different. Taking into account the pressure within the left ventricle, the model shows qualitative agreement with functional parameters of the left ventricle. The model allows for a natural explanation of heart failure with preserved systolic left ventricular function, also termed diastolic heart failure. Specifically, the rise in left ventricular filling pressures following increased left-ventricular wall stiffness is attributed to a mechanism aimed at preserving heart rate and cardiac output.

  10. Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs - invasive versus echocardiographic evaluation

    Directory of Open Access Journals (Sweden)

    Bartunek Jozef

    2010-06-01

    Full Text Available Abstract Background Heart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction. The aim of this study was to investigate the physiopathology of heart failure with preserved ejection fraction in a model of healed myocardial infarction in dogs. Methods Echocardiography, levels of neurohormones and conductance catheter measurements of left ventricular pressure-volume relationships were obtained in 17 beagle dogs 2 months after a coronary artery ligation, and in 6 controls. Results Healed myocardial infarction was associated with preserved echocardiographic left ventricular ejection fraction (0.57 ± 0.01, mean ± SEM and altered Doppler mitral indices of diastolic function. NT-proBNP was increased, aldosterone was decreased, and norepinephrine was unchanged. Invasive measurements showed a markedly decreased end-systolic elastance (2.1 ± 0.2 vs 6.1 ± 0.8, mmHg/ml, p Conclusions In the canine model of healed myocardial infarction induced by coronary ligation, heart failure is essentially characterized by an altered contractility with left ventricular-arterial uncoupling despite vascular compensation rather than by abnormal diastolic function

  11. Evaluation of regional left ventricular function in patients with myocardial infarction by speckle tracking imaging%斑点追踪显像技术定量评价心肌梗死局部室壁运动异常

    Institute of Scientific and Technical Information of China (English)

    李胜; 汪太平; 徐岩; 史学功; 王其海; 金朝龙

    2009-01-01

    Objective To evaluate the clinical value of speckle tracking imaging in the measurement of two-dimensional strain in patients with myocardial infarction. Methods High frame rate two-dimensional echocardiography were performed in 30 healthy subjects,21patients with anterior myocardial infarction and 15 patients with inferior myocardial infarction. Longitudinal strain (LS), radial velocity (Vs), regional shortening fraction (RFS),radial strain (RS) were measured in the apical two-chamber view and short-axis view(the level of papillary muscle) using two-dimensional strain software. Results Compared with healthy subjects, LS, Vs, RFS, RS decreased in the segments with infarction(P<0.05). LS, Vs, RFS, RS of the two myocardial infarction groups had partly differences(P<0.05). Conclusions Regional wall motion of left ventricle in patients with myocardial infarction can be evaluated accurately with speckle tracking imaging.%目的 应用超声斑点追踪显像技术测量心肌梗死患者各节段室壁的二维应变,探讨其诊断局部室壁运动异常的临床应用价值.方法 30例正常人、21例前壁心肌梗死患者和15例下壁心肌梗死患者分别记录心尖位两腔观及左室乳头肌水平短轴观的高帧频图像,应用二维应变软件测量各节段的纵向应变(LS)、径向收缩期峰值速度(Vs)、局部短轴缩短分数(RFS)、径向应变(RS).结果 与正常组相比,心肌梗死各组心尖位节段LS、Vs、RFS、RS明显减低(P<0.05).心肌梗死组间比较,部分节段的LS、Vs、RFS、RS存在明显差异(P<0.05).结论 超声斑点追踪显像技术可准确评价节段性室壁运动异常,为临床评价心肌梗死患者左室收缩功能提供了无创性新方法.

  12. Effects of losartan on ventricular remodeling in experimental infarction in rats

    Directory of Open Access Journals (Sweden)

    Zornoff Leonardo A. M.

    2000-01-01

    Full Text Available OBJECTIVE: To evaluate the effects of losartan on ventricular remodeling and on survival after myocardial infarction in rats. METHODS: After surgical occlusion of left coronary artery, 84 surviving male Wistar rats were divided into two groups: LO treated with losartan (20mg/kg/day, n=33 and NT (n=51, without medication. After 3 months, we analyzed mortality; ventricular to body mass ratio (VM /BM; myocardial hydroxyproline concentration (HOP; isovolumetric pressure, +dp/dt, -dp/dt, and diastolic volume/left ventricle mass ratio (VO/LV. RESULTS: Mortality was: LO = 22%, and NT = 47% (p0.05. The V0/LV values (median were 0.24 mL/g in group LO and 0.31 mL/g in group NT (p<0.05 compared to NT group. There were no differences between the groups for +dp/dt and -dp/dt parameters. CONCLUSION: 1- The use of losartan myocardial infarction causes an attenuation of ventricular remodeling, bringing about an increased survival, an attenuation of ventricular hypertrophy and dilation, and an improvement of the isovolumetric pressure; 2- the treatment does not modify the myocardial collagen concentration.

  13. Evaluation of left ventricular scar identification from contrast enhanced magnetic resonance imaging for guidance of ventricular catheter ablation therapy

    Science.gov (United States)

    Rettmann, M. E.; Lehmann, H. I.; Johnson, S. B.; Packer, D. L.

    2016-03-01

    Patients with ventricular arrhythmias typically exhibit myocardial scarring, which is believed to be an important anatomic substrate for reentrant circuits, thereby making these regions a key target in catheter ablation therapy. In ablation therapy, a catheter is guided into the left ventricle and radiofrequency energy is delivered into the tissue to interrupt arrhythmic electrical pathways. Low bipolar voltage regions are typically localized during the procedure through point-by-point construction of an electroanatomic map by sampling the endocardial surface with the ablation catheter and are used as a surrogate for myocardial scar. This process is time consuming, requires significant skill, and has the potential to miss low voltage sites. This has led to efforts to quantify myocardial scar preoperatively using delayed, contrast-enhanced MRI. In this paper, we evaluate the utility of left ventricular scar identification from delayed contrast enhanced magnetic resonance imaging for guidance of catheter ablation of ventricular arrhythmias. Myocardial infarcts were created in three canines followed by a delayed, contrast enhanced MRI scan and electroanatomic mapping. The left ventricle and myocardial scar is segmented from preoperative MRI images and sampled points from the procedural electroanatomical map are registered to the segmented endocardial surface. Sampled points with low bipolar voltage points visually align with the segmented scar regions. This work demonstrates the potential utility of using preoperative delayed, enhanced MRI to identify myocardial scarring for guidance of ventricular catheter ablation therapy.

  14. Left ventricular biomechanics in professional football players.

    Science.gov (United States)

    von Lueder, T G; Hodt, A; Gjerdalen, G F; Steine, K

    2017-04-04

    Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Color M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, Pplayers (-124.5±4.2 vs -106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both Pplayers. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Post myocardial infarction of the left ventricle: the course ahead seen by cardiac MRI

    Science.gov (United States)

    Masci, Pier Giorgio

    2012-01-01

    In the last decades, cardiac magnetic resonance imaging (MRI) has gained acceptance in cardiology community as an accurate and reproducible diagnostic imaging modality in patients with ischemic heart disease (IHD). In particular, in patients with acute myocardial infarction (MI) cardiac MRI study allows a comprehensive assessment of the pattern of ischemic injury in term of reversible and irreversible damage, myocardial hemorrhage and microvascular obstruction (MVO). Myocardial salvage index, derived by quantification of myocardium (area) at risk and infarction, has become a promising surrogate end-point increasingly used in clinical trials testing novel or adjunctive reperfusion strategies. Early post-infarction, the accurate and reproducible quantification of myocardial necrosis, along with the characterization of ischemic myocardial damage in its diverse components, provides important information to predict post-infarction left ventricular (LV) remodeling, being useful for patients stratification and management. Considering its non-invasive nature, cardiac MRI suits well for investigating the time course of infarct healing and the changes occurring in peri-infarcted (adjacent) and remote myocardium, which ultimately promote the geometrical, morphological and functional abnormalities of the entire left ventricle (global LV remodeling). The current review will focus on the cardiac MRI utility for a comprehensive evaluation of patients with acute and chronic IHD with particular regard to post-infarction remodeling. PMID:24282705

  16. Imaging diagnosis of right ventricular infarction and tricuspid regurgitation by radionuclide first pass method

    Energy Technology Data Exchange (ETDEWEB)

    Koito, Hitoshi; Iwasaka, Toshiji; Yoshioka, Hiroshi (Kansai Medical School, Moriguchi, Osaka (Japan))

    1983-07-01

    Radionuclide first pass findings of right ventricular infarction and tricuspid regurgitation are reported. Findings of right ventricular infarction are reduced wall motion and regional ejection fraction in the right ventricular inferior wall. Tricuspid regurgitation is suggested when the dilatation of right atrium and right ventricle are seen with regurgitant RI images through tricuspid valve. We can get regurgitant fraction from time-activity curve. Dynamic images are also useful for assessing quality of right ventricular infarction and tricuspid regurgitation. We conclude that radionuclide first pass method is useful to diagnose right ventricular infarction and to quantify tricuspid regurgitation.

  17. Surgical repair of subacute left ventricular free wall rupture

    NARCIS (Netherlands)

    Zeebregts, CJ; Noyez, L; Hensens, AG; Skotnicki, SH; Lacquet, LK

    1997-01-01

    Background: The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis, hemod

  18. Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults

    DEFF Research Database (Denmark)

    Shah, Amil M; Claggett, Brian; Kitzman, Dalane

    2017-01-01

    BACKGROUND: Although age-associated changes in left ventricular diastolic function are well recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values for in...

  19. left ventricular hypertrophy in renal failure a review

    African Journals Online (AJOL)

    Key words: Left Ventricular hypertrophy (LVH), Renal failure; cardiovascular. INTRODUCTION. Chronic ... of anaemia; age, disturbed elasticity of the central arteries with elevated ..... Arodiwe E. B. Prevalence of and factors associated with LVH ...

  20. Autosomal dominant inheritance of left ventricular outflow tract obstruction

    NARCIS (Netherlands)

    Wessels, Marjolein; Berger, Rudolphus; Frohn-Mulder, Ingrid M E; Roos-Hesselink, Jolien W; Hoogeboom, Jeanette J M; Mancini, Grazia S; Bartelings, Margot M; Krijger, Ronald de; Wladimiroff, Jury W; Niermeijer, Martinus F; Grossfeld, Paul; Willems, Patrick J

    2005-01-01

    Most nonsyndromic congenital heart malformations (CHMs) in humans are multifactorial in origin, although an increasing number of monogenic cases have been reported recently. We describe here four new families with presumed autosomal dominant inheritance of left ventricular outflow tract obstruction

  1. Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes

    DEFF Research Database (Denmark)

    Flethøj, M.; Schwarzwald, C. C.; Haugaard, M. M.;

    2016-01-01

    Background: Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown. Objectives :To investigate the effects of prolonged exercise on LV systolic...

  2. Ventricular septal rupture and right ventricular intramyocardial dissection secondary to acute inferior myocardial infarction.

    Science.gov (United States)

    Bittencourt, Márcio Sommer; Seltmann, Martin; Muschiol, Gerd; Achenbach, Stephan

    2010-01-01

    A 61-year-old female patient presented with sub acute myocardial infarction with an occluded right coronary artery on invasive evaluation and a ventricular septal rupture on echocardiogram. Cardiac computed tomography (CT) was performed to better define the septal anatomy. As the anatomy on cardiac CT was considered unfavorable for percutaneous intervention, the patient underwent successful surgical repair.

  3. Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD.

    Science.gov (United States)

    Schneider, Markus P; Raff, Ulrike; Kopp, Christoph; Scheppach, Johannes B; Toncar, Sebastian; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Floege, Jürgen; Schmid, Matthias; Birukov, Anna; Dahlmann, Anke; Linz, Peter; Janka, Rolf; Uder, Michael; Schmieder, Roland E; Titze, Jens M; Eckardt, Kai-Uwe

    2017-06-01

    The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using (23)sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, Pskin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients. Copyright © 2017 by the American Society of Nephrology.

  4. Relationship between right and left ventricular function in candidates for implantable cardioverter defibrillator with low left ventricular ejection fraction.

    Science.gov (United States)

    Jimenez-Juan, Laura; Karur, Gauri R; Connelly, Kim A; Deva, Djeven; Yan, Raymond T; Wald, Rachel M; Singh, Sheldon; Leung, General; Oikonomou, Anastasia; Dorian, Paul; Angaran, Paul; Yan, Andrew T

    2017-04-01

    Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD. In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured. In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m(2) and 81±27 mL/m(2), respectively. Eighty-six (84%) patients had a LVEF right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF (r=0.40, pright ventricular systolic dysfunction (Kappa=0.041). Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa.

  5. Assessment of left ventricular contraction asynchrony in patients with acute myocardial infarction using velocity vector imaging%速度向量成像技术评价急性心肌梗死患者左心室不同步运动的临床研究

    Institute of Scientific and Technical Information of China (English)

    谢芳; 黄宇玲; 李海朋

    2011-01-01

    Objective To assess the left ventricular contraction asynchrony in patients with acute myocardial infarction(AMI) by velocity vector imaging(VVI).Methods Sixty AMI patients and 40 healthy volunteers were included.Using VVI,the time to peak longitudinal systolic velocity (TL-V) was measured in the left ventricular long axis views,the time to peak radial systolic velocity (TR-V) was measured in parasternal short axis views.The deviation of the earliest and the latest TL-V and TR-V (Ts max-min) was measured,and the standard deviation of TL-V and TR-V (TS-SD) was also measured.Results ①TL-V ,TR-V of the infarcted and non-infarcted segments in patients with acute myocardial infarction were longer than those of the normal segments (P <0.05).②The longitudinal Tsmax-min,Ts-SD and the radial Tsmax-min,Ts-SD in infarcted patients were increased compared with the healthy volunteers (P <0.001).③Ts of the infarcted segments was increased in turn from the class Ⅰ to class Ⅳ of the cardiac function (P <0.001).Conclusions VVI could be used to assess the left ventricular contraction asynchrony in patients with AMI.VVI is a new useful method to determine the infarcted segments.%目的 应用速度向量成像(VVI)技术评价急性心肌梗死(AMI)患者心脏不同步运动.方法 选择AMI患者60例和健康志愿者40例,采用VVI技术测量并比较两组间左室局部心肌纵向收缩速度达峰时间(TL-V)、左室局部心肌径向收缩速度达峰时间(T R-V)、左室最早与最迟速度达峰时间的差值(Ts max-min)、左室16节段速度达峰时间标准差(Ts-SD)的差异.结果 ①AMI组梗死节段与非梗死节段心肌TL-V、TR-V分别大于对照组正常节段(P<0.05);②AMI组纵向及径向Ts max-min、Ts-SD均大于对照组(P<0.001);③AMI组梗死节段心肌Ts从心功能Ⅰ级至Ⅳ级依次延长(P<0.001).结论 VVI技术为评价AMI患者心肌不同步运动及判断梗死节段提供了一种新的方法.

  6. Relation between QT dispersion, left ventricle systolic function and frequency of ventricular arrhythmias in coronary patients

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    Stoičkov Viktor

    2007-01-01

    Full Text Available Introduction QT dispersion (QTd is a measure of non-homogeneous repolarisation of the myocardium and is used as an indicator of arrhythmogenicity. Objective The aim of this study was to assess the relation between QT dispersion, left ventricle systolic function and frequency of ventricular arrhythmias in coronary patients. Method We studied 290 coronary patients, 72 with angina pectoris and 218 after myocardial infarction. Eighty-one coronary patients had frequent and complex ventricular arrhythmias (out of them 19 had ventricular tachycardia and 209 were without arrhythmias or with infrequent ventricular premature contractions (VPC≤10/h. In all patients, QT dispersion, exercise test, 24-hour Holter monitoring and echocardiographic examination were performed. Results Patients with frequent and complex ventricular arrhythmias had significantly higher values of QTd (71.8±25.5 vs 55.6±21.7 ms; p<0.001, corrected QT dispersion (QTdc: 81.3±31.5 vs. 60.3±26.1 ms; p<0.001, left ventricular end-diastolic diameter (LVEDd: 56.2±6.9 vs. 53.4±6.2 mm; p<0.001 and left ventricular end-systolic diameter (LVESd: 39.5±6.2 vs. 36.0±6.3 mm; p<0.001, and significantly lower values of left ventricular ejection fraction (LVEF: 47.7±13.9 vs. 55.9±11.6%; p<0.001 in comparison to those without arrhythmias or with infrequent VPC. Patients with VT had significantly higher values of QTd and QTdc in comparison to other patients with frequent and complex ventricular arrhythmias (83.8±17.1 vs. 69.4±26.2 ms; p<0.02 for QTd; 101.1±23.9:77.6±31.4 ms; p<0.005 for QTdc. There is a significant negative correlation of QTd and QTdc with LVEF, and a significant positive correlation of QTd and QTdc with inside dimensions of the left ventricle, in patients with frequent and complex ventricular arrhythmias. Conclusion The study demonstrated that patients with frequent and complex ventricular arrhythmias had significantly higher values of QTd and QTdc, as well as a higher

  7. Soluble TNF receptors are associated with infarct size and ventricular dysfunction in ST-elevation myocardial infarction.

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    Lennart Nilsson

    Full Text Available OBJECTIVES: The aim of the study was to investigate circulating markers of apoptosis in relation to infarct size, left ventricular dysfunction and remodeling in an ST-elevation myocardial infarction (STEMI population undergoing primary percutaneous coronary intervention (PCI. BACKGROUND: Immediate re-opening of the acutely occluded infarct-related artery via primary PCI is the treatment of choice in STEMI to limit ischemia injury. However, the sudden re-initiation of blood flow can lead to a local acute inflammatory response with further endothelial and myocardial damage, so-called reperfusion injury. Apoptosis is suggested to be a key event in ischemia-reperfusion injury, resulting in LV-dysfunction, remodeling and heart failure. METHODS: The present study is a prespecified substudy of the F.I.R.E. trial. We included 48 patients with STEMI undergoing primary PCI. Blood samples were collected prior to PCI and after 24 hours. Plasma was separated for later analysis of soluble tumor necrosis factor receptor (sTNFR 1, sTNFR2, sFas and sFas ligand (sFasL by ELISA. Infarct size, left ventricular (LV dysfunction and remodeling were assessed by cardiac magnetic resonance imaging at five days and four months after STEMI. RESULTS: The levels of sTNFR1 at 24 h as well as the relative increases in sTNFR1 and sTNFR2 over 24 h showed consistent and significant correlations with infarct size and LV-dysfunction at four months. Moreover, both sTNFRs correlated strongly with Troponin I and matrix metalloproteinase (MMP-2 measurements. Soluble Fas and sFasL did not overall correlate with measures of infarct size or LV-dysfunction. None of the apoptosis markers correlated significantly with measures of remodeling. CONCLUSIONS: In STEMI patients, circulating levels of sTNFR1 and sTNFR2 are associated with infarct size and LV dysfunction. This provides further evidence for the role of apoptosis in ischemia-reperfusion injury.

  8. [An unusual case of transient ST-segment elevation during hypertensive crisis in a patient with left ventricular hypertrophy].

    Science.gov (United States)

    Cappelletti, Alberto; Maggio, Silvia; Maranta, Francesco; Mazzavillani, Monica; Margonato, Alberto; Camici, Paolo G

    2012-10-01

    We report the case of a 73-year-old patient with severe left ventricular hypertrophy presenting with acute ST-segment elevation mimicking acute myocardial infarction on ECG during a hypertensive crisis. Unexpectedly, emergency coronary angiography showed no evidence of coronary thrombosis or spasm. Electrocardiographic alterations gradually resolved after lowering blood pressure.

  9. Association of arterial stiffness and electrocardiography-determined left ventricular hypertrophy with left ventricular diastolic dysfunction.

    Directory of Open Access Journals (Sweden)

    Po-Chao Hsu

    Full Text Available OBJECTIVES: Increased arterial stiffness is associated with left ventricular diastolic dysfunction (LVDD, but this association may be influenced by left ventricular (LV performance. Left ventricular hypertrophy (LVH is not only a significant determinant of LV performance, but is also correlated with LVDD. This study is designed to compare LV diastolic function among patients divided by brachial-ankle pulse wave velocity (baPWV and electrocardiography (ECG-determined LVH and to assess whether increased baPWV and ECG-determined LVH are independently associated with LVDD. METHODS: This cross-sectional study enrolled 270 patients and classified them into four groups according to the median value of baPWV and with/without ECG-determined LVH. The baPWV was measured using an ABI-form device. ECG-determined LVH was defined by Sokolow-Lyon criterion. LVDD was defined as impaired relaxation, pseudonormal, and restrictive mitral inflow patterns. Groups 1, 2, 3, and 4 were patients with lower baPWV and without ECG-determined LVH, lower baPWV but with ECG-determined LVH, higher baPWV but without ECG-determined LVH, and higher baPWV and with ECG-determined LVH respectively. RESULTS: Early diastolic mitral velocity (Ea was gradually decreased from group 1 to group 4 (p≦0.027. Patients in group 4 had the highest prevalence of LVDD (all p<0.001. After multivariate analysis, both baPWV and ECG-determined LVH were independent determinants of Ea (β = -0.02, P<0.001; β = -1.77, P<0.001 respectively and LVDD (odds ratio = 1.02, P = 0.011 and odds ratio = 3.53, P = 0.013 respectively. CONCLUSION: Our study showed the group with higher baPWV and ECG-determined LVH had the lowest Ea and highest prevalence of LVDD. In addition, both baPWV and ECG-determined LVH were independently associated with Ea and LVDD. Hence, assessment of arterial stiffness by baPWV and LVH by ECG may be useful in identifying the high risk group of LVDD.

  10. Increased angiotensin-converting enzyme activity in the left ventricle after infarction

    Directory of Open Access Journals (Sweden)

    V.C.W. Busatto

    1997-05-01

    Full Text Available An increase in angiotensin-converting enzyme (ACE activity has been observed in the heart after myocardial infarction (MI. Since most studies have been conducted in chronically infarcted individuals exhibiting variable degrees of heart failure, the present study was designed to determine ACE activity in an earlier phase of MI, before heart failure development. MI was produced in 3-month old male Wistar rats by ligation of the anterior branches of the left coronary artery, control rats underwent sham surgery and the animals were studied 7 or 15 days later. Hemodynamic data obtained for the anesthetized animals showed normal values of arterial blood pressure and of end-diastolic pressure in the right and left ventricular cavities of MI rats. Right and left ventricular (RV, LV muscle and scar tissue homogenates were prepared to determine ACE activity in vitro by measuring the velocity of His-Leu release from the synthetic substrate Hyp-His-Leu. ACE activity was corrected to the tissue wet weight and is reported as nmol His-Leu g-1 min-1. No significant change in ACE activity in the RV homogenates was demonstrable. A small nonsignificant increase of ACE activity (11 ± 9%; P0.05 was observed 7 days after MI in the surviving left ventricular muscle. Two weeks after surgery, however, ACE activity was 46 ± 11% (P<0.05 higher in infarcted rats compared to sham-operated rats. The highest ACE activity was demonstrable in the scar tissue homogenate. In rats studied two weeks after surgery, ACE activity in the LV muscle increased from 105 ± 7 nmol His-Leu g-1 min-1 in control hearts to 153 ± 11 nmol His-Leu g-1 min-1 (P<0.05 in the remaining LV muscle of MI rats and to 1051 ± 208 nmol His-Leu g-1 min-1 (P<0.001 in the fibrous scar. These data indicate that ACE activity increased in the heart after infarction before heart failure was demonstrable by hemodynamic measurements. Since the blood vessels of the scar drain to the remaining LV myocardium, the

  11. Prognostic Value of N-terminal pro-B-type Natriuretic Peptide and MMP-9 in Early Left Ventricular Re-modeling After Acute Myocardial Infarction%NT-proBNP和MMP-9与急性心肌梗死患者早期左室重构的相关性研究

    Institute of Scientific and Technical Information of China (English)

    吴鹏翠; 阳军; 陈然; 程春; 刘赵云

    2015-01-01

    【目的】探讨氨基末端B型脑钠肽前体(N T‐proBN P )、基质金属蛋白酶‐9(M M P‐9)对急性心肌梗死(AMI)患者经皮冠脉介入治疗(PCI)术后早期心室重构的影响及其相关性。【方法】根据PCI术后4周时92例AMI患者左心室容积增加率的不同,将其分为左室重构组,非左室重构组,并设稳定性冠心病对照组。比较患者NT‐proBNP、MMP‐9水平及其与PCI术后患者的左室收缩末期容积( LVESV)和舒张末期容积(LVEDV)、左室射血分数(LVEF)、左室收缩末容积指数( LVESVI)、左室舒张末容积指数(LVEDVI)等的关系。【结果】AMI患者PCI治疗前后血浆NT‐proBNP和MMP‐9水平较稳定型冠心病对照组明显升高;左室重构组血浆 NT‐proB‐NP、MMP‐9水平持续增高,与非左室重构组在PCI术后7 d比较差异有统计学意义( P<0.01)。血浆NT‐proB‐NP、MMP‐9水平与LVEDV均呈明显正相关( P <0.01),与LVEF均呈明显负相关( P <0.05)。【结论】AMI患者血浆NT‐proBNP、MMP‐9水平与左室重构指标有相关性,可作为AMI早期左室重构的预测因子。%[Objective] To explore the relationship between N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and matrix metalloproteinase‐9 (MMP‐9) in early left ventricular remodeling after acute myocardial infarction (AMI) .[Methods] A total of 92 AMI patients were divided into two groups based on left ventricular end‐diastolic volume index . The plasma levels of NT‐proBNP and MMP‐9 were determined by radioimmunoassay .Left ventricular end systolic volume (LVESV) ,left ventricular end diastolic volume (LVEDV) ,ejection fraction (EF) and left ventricle mass (LVM ) were measured by echocardiography .[Results] The plasma levels of NT‐proBNP and MMP‐9 were higher in AMI group than those in control group ( P<0 .01) .And their levels kept rising in left ventricular

  12. Concentric left ventricular morphology in aerobically trained kayak canoeists.

    Science.gov (United States)

    Gates, Phillip E; Campbell, Ian G; George, Keith P

    2004-09-01

    The aim of the present study was to test the hypothesis that upper body aerobically trained athletes (kayak canoeists) would have greater left ventricular wall thickness, but similar left ventricular diastolic chamber dimensions, compared with recreationally active and sedentary men. Ultrasound echocardiography was used to determine cardiac structure and function in highly trained kayak canoeists (n = 10), moderately active (n = 10) and sedentary men (n = 10). The septal and posterior left ventricular walls were approximately 0.2 cm thicker in kayak canoeists (P kayak canoeists had a concentric pattern of left ventricular adaptation to aerobic upper body training. Scaling the data to body composition indices had no effect on the outcome of the statistical analysis. There were no differences in resting Doppler left ventricular diastolic or systolic function among the groups. Ejection fraction was lower in the kayak canoeists, but the magnitude of the difference was within the normal variability for this measurement. Thus aerobically upper body trained athletes demonstrated a concentric pattern of cardiac enlargement, but resting left ventricle function was not different between athletes, moderately active and sedentary individuals.

  13. [A case of rupture of the left ventricle free wall with papillary muscle dysfunction following acute myocardial infarction, operated on successfully].

    Science.gov (United States)

    de Lima, R; Perdigão, C; Neves, L; Cravino, J; Dantas, M; Bordalo, A; Pais, F; Diogo, A N; Ferreira, R; Ribeiro, C

    1990-09-01

    The authors present a case of left ventricular free wall rupture post acute myocardial infarction, associated with mitral papillary posterior muscle necrosis, operated by infartectomy and mitral valvular protesis replacement. They refer the various complications occurred during the hospital staying, and discuss its medical and surgical approach. The patient was discharged alive and six months after the infarction keeps a moderate activity.

  14. Device closure of post-myocardial infarction ventricular septal defect three weeks after coronary angioplasty

    Science.gov (United States)

    Patnaik, A. N.; Barik, Ramachandra; Kumari, N. Rama; Gulati, A. S.

    2012-01-01

    Percutaneus device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as after two to three weeks of index myocardial infarction. The index case presented with a ventricular septal defect on second of acute myocardial infarction thrombolysed with streptokinase. The general condition of the patient was fairly stable. Cardiac catheterization and coronary angiography showed significant left to right shunt and there was 90 % proximal stenosis of left anterior descending coronary artery. Other coronary arteries were normal. Angioplasty and stenting to the coronary artery lesion was done using drug eluting stent (DES) with very good angiographic result. Patient was discharged after four days in stable condtion. After 3 weeks his ventricular septal defect was closed percutaneusly using cardio -O-fix device with tiny residual shunt. The procedure was uneventful and of brief duration. He was discharged after 5 days of the post procedure in very stable condition with minimal residual shunt. A staged procedure is a better option if the condition of the patient allows strengthening ventricular septal defect border. PMID:22629038

  15. Radionuclide assessment of left ventricular function following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Howe, W.R.; Jones, R.H.; Sabiston, D.C. Jr.

    1976-01-01

    Use of a high count-rate gamma scintillation camera permits the noninvasive assessment of left ventricular function by nuclear angiocardiography. Counts recorded from the region of the left ventricle at 50- or 100-msec intervals during the first transit of an intravenously administered bolus of radioisotope produce a high-fidelity indicator-dilution curve. Count fluctuations reflect left ventricular volume changes during the cardiac cycle and permit measurement of dv/dt, ejection fraction, mean transit time, and wall motion of this chamber. The present study evaluates (1) the accuracy of this technique compared to standard biplane cineangiography and (2) its usefulness in evaluating patients after cardiac surgery.

  16. Assessment of left ventricular regional wall motion by color kinesis technique: comparison with angiographic findings.

    Science.gov (United States)

    Vermes, E; Guyon, P; Weingrod, M; Otmani, A; Soussana, C; Halphen, C; Leroy, G; Haïat, R

    2000-08-01

    The analysis of segmental wall motion using two-dimensional (2-D) echocardiography is subjective with high interobserver variability. Color kinesis is a new technique providing a color-encoded map of endocardial motion. We evaluated the accuracy of color kinesis and 2-D for assessment of regional asynergy compared with left ventricular angiography as a reference method. Fifteen patients admitted for myocardial infarction were studied by echocardiography the day before left ventricular angiography. The left ventricle was divided into seven segments. Each segment was classified by two independent observers as normal or abnormal in 2-D and color kinesis. Accuracy of color kinesis and 2-D was evaluated and compared to left ventricular angiography. Color kinesis is significantly superior to 2-D for all seven segments (mean 0.80/0.68, P = 0.05), except for the septum (0.67/0.60, P = NS). Interobserver variability studied by chi-square statistic is lower with color kinesis (0.70) than with 2-D (0.57). We conclude that these data suggest that color kinesis is a useful method for assessing systolic wall motion in all segments, except the septum and for improving the accuracy of segmental ventricular function and interobserver variability.

  17. Availability of /sup 111/In-labeled platelet scintigraphy in patients with postinfarction left ventricular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Tsuda, Takatoshi; Kubota, Masahiro; Iwakubo, Akifumi and others

    1989-03-01

    Eighteen patients with postinfarction left ventricular aneurysm (LVA) were examined with indium-111-labeled autologous platelet scintigraphy to identify intracardiac thrombi and to investigate the effect of antithrombotic agents on thrombogenesitiy within the LVA. Indium-111-platelet scintigraphy had a sensitivity of 60% and a specificity of 100% in detecting LVA mural thrombi. Among 6 patients showing false-negative scintigraphic studies, 4 was managed on antiplatelet therapy. Of 9 patients showing active platelet deposition on initial study, including 8 not receiving antiplatelet therapy, 5 were treated with tichlopidine (300 mg/day) for 29.8+-5.0 days. For the 5 patients, 2 had resolution and the 3 others had interruption of intraaneurysmal deposition in the second platelet study. For one patient receiving the third platelet study after warfarin therapy, it took two weeks to completely interrupt platelet deposition within the LVA. ECG gated radionuclide ventriculography and thallium-201 myocardial SPECT were also performed to assess left ventricular wall motion of left ventricular ejection fraction (LVEF) and myocardial blood perfusion. Thallium-201 SPECT showed apical or anteroapical perfusion defects. Radionuclide ventriculography pinpointed all 18 apical and anteroseptal aneurysms. A comparison between the thrombus positive group and the thrombus negative group revealed no statistical differences in LVEF and the period from the last myocardial infarction to the initial platelet scanning. These results suggest that indium-111 labeled platelet scintigraphy may be useful for identifying active left ventricular mural thrombi and for judging antiplatelet and anticoagulant therapy. (Namekawa, K).

  18. Radiofrequency ablation therapy of intractable ventricular tachycardia present with a left ventricular assist device

    DEFF Research Database (Denmark)

    Nielsen, Jan Møller; Kristiansen, Steen Buus; Gerdes, Christian;

    2015-01-01

    Ventricular tachycardia (VT) occurs in up to 59% of patients with left ventricular assist devices (LVAD). In some of these patients, the VT cannot be managed medically or by implantable cardioverter-defibrillator. In this case, a 66-year-old male was successfully treated with radiofrequency...

  19. Right ventricular failure after implantation of a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Cordtz, Johan Joakim; Nilsson, Jens C; Hansen, Peter B;

    2014-01-01

    Right ventricular failure (RVF) is a significant complication after implantation of a left ventricular assist device. We aimed to identify haemodynamic changes in the early postoperative phase that predicted subsequent development of RVF in a cohort of HeartMate II (HMII) implanted patients....

  20. Giant left ventricular fibroma presenting as ventricular tachycardia in a child.

    Science.gov (United States)

    Khan, Muhammad Arif; Saeedi, Abdul Raoof Al; Tayeab, Hyfeah Al; Momenah, Tarek

    2014-06-01

    We present a rare case of giant left ventricular apical fibroma presenting as recurrent ventricular tachycardia in a 14-month-old girl. The diagnosis was made by echocardiography and chest computed tomography, and confirmed by histopathology. The fibroma was resected surgically, and the patient followed up for 4 years.

  1. Ablation of biglycan attenuates cardiac hypertrophy and fibrosis after left ventricular pressure overload.

    Science.gov (United States)

    Beetz, Nadine; Rommel, Carolin; Schnick, Tilman; Neumann, Elena; Lother, Achim; Monroy-Ordonez, Elsa Beatriz; Zeeb, Martin; Preissl, Sebastian; Gilsbach, Ralf; Melchior-Becker, Ariane; Rylski, Bartosz; Stoll, Monika; Schaefer, Liliana; Beyersdorf, Friedhelm; Stiller, Brigitte; Hein, Lutz

    2016-12-01

    Biglycan, a small leucine-rich proteoglycan, has been shown to play an important role in stabilizing fibrotic scars after experimental myocardial infarction. However, the role of biglycan in the development and regression of cardiomyocyte hypertrophy and fibrosis during cardiac pressure overload and unloading remains elusive. Thus, the aim of the present study was to assess the effect of biglycan on cardiac remodeling in a mouse model of left ventricular pressure overload and unloading. Left ventricular pressure overload induced by transverse aortic constriction (TAC) in mice resulted in left ventricular dysfunction, fibrosis and increased biglycan expression. Fluorescence- and magnetic-assisted sorting of cardiac cell types revealed upregulation of biglycan in the fibroblast population, but not in cardiomyocytes, endothelial cells or leukocytes after TAC. Removal of the aortic constriction (rTAC) after short-term pressure overload (3weeks) improved cardiac contractility and reversed ventricular hypertrophy but not fibrosis in wild-type (WT) mice. Biglycan ablation (KO) enhanced functional recovery but did not resolve cardiac fibrosis. After long-term TAC for 9weeks, ablation of biglycan attenuated the development of cardiac hypertrophy and fibrosis. In vitro, biglycan induced hypertrophy of neonatal rat cardiomyocytes and led to activation of a hypertrophic gene program. Putative downstream mediators of biglycan signaling include Rcan1, Abra and Tnfrsf12a. These genes were concordantly induced by TAC in WT but not in biglycan KO mice. Left ventricular pressure overload induces biglycan expression in cardiac fibroblasts. Ablation of biglycan improves cardiac function and attenuates left ventricular hypertrophy and fibrosis after long-term pressure overload. In vitro biglycan induces hypertrophy of cardiomyocytes, suggesting that biglycan may act as a signaling molecule between cell types to modulate cardiac remodeling. Copyright © 2016 Elsevier Ltd. All rights

  2. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation: A case report.

    Science.gov (United States)

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin

    2016-09-01

    Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture.

  3. Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

    Directory of Open Access Journals (Sweden)

    Gribaa Rim

    2011-10-01

    Full Text Available Abstract Introduction Right ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern. Case presentation We report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction. Conclusion Right ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.

  4. VENTRICULAR FIBRILLATION IN ACUTE MYOCARDIAL INFARCTION - CASE REPORT

    Directory of Open Access Journals (Sweden)

    Tomislav Kostić

    2009-10-01

    Full Text Available Sudden cardiac death poses an immense problem in the middle and highly developed countries because its first expression is at the same time the last one. Ventricle tachycardia, the monomorphous and the polymorphous ones, and ventricular fibrillation are rhythm disorders that are most frequently associated with the phenomenon of sudden cardiac death. Ventricular fibrillation is the most common cause of sudden cardiac death within the first hours of the acute myocardial infarction. A 60-year-old man was admitted to our Clinic from a local hospital due to acute onset of chest pain and ECG signs of anterior ST segment elevation myocardial infarction. He had severe rhythm disturbances, about 70 epizodes of ventricular fibrilation (VF. Due to rhytmical instability of the patient, we decided that along with PCI it was necessary to implant ICD twenty-two days after the first acute coronary event.The ICD implantation ensures the best prevention against sudden cardiac death (secondary and primary in selected high-risk patients and has no alternative for any medicine known so far. It is significant that, lately, the field of application has extended to indication areas of primary prevention of sudden cardiac death, and especially to development of resynchronization implantable cardioverter defibrillator in the heart failure therapy.

  5. PREDICTORS OF MORTALITY IN PATIENTS WITH SUSTAINED VENTRICULAR TACHYCARDIAS OR VENTRICULAR-FIBRILLATION AND DEPRESSED LEFT-VENTRICULAR FUNCTION - IMPORTANCE OF BETA-BLOCKADE

    NARCIS (Netherlands)

    SZABO, BM; CRIJNS, HJGM; WIESFELD, ACP; VANVELDHUISEN, DJ; HILLEGE, HL; LIE, KI

    1995-01-01

    To study prognostic factors in patients with sustained ventricular tachycardias (VT) or ventricular fibrillation (VF) complicated by left ventricular dysfunction, we evaluated the predictive value of demographic, clinical, and hemodynamic parameters for cardiac mortality and sudden cardiac death in

  6. MRI evaluation of injectable hyaluronic acid-based hydrogel therapy to limit ventricular remodeling after myocardial infarction.

    Science.gov (United States)

    Dorsey, Shauna M; McGarvey, Jeremy R; Wang, Hua; Nikou, Amir; Arama, Leron; Koomalsingh, Kevin J; Kondo, Norihiro; Gorman, Joseph H; Pilla, James J; Gorman, Robert C; Wenk, Jonathan F; Burdick, Jason A

    2015-11-01

    Injectable biomaterials are an attractive therapy to attenuate left ventricular (LV) remodeling after myocardial infarction (MI). Although studies have shown that injectable hydrogels improve cardiac structure and function in vivo, temporal changes in infarct material properties after treatment have not been assessed. Emerging imaging and modeling techniques now allow for serial, non-invasive estimation of infarct material properties. Specifically, cine magnetic resonance imaging (MRI) assesses global LV structure and function, late-gadolinium enhancement (LGE) MRI enables visualization of infarcted tissue to quantify infarct expansion, and spatial modulation of magnetization (SPAMM) tagging provides passive wall motion assessment as a measure of tissue strain, which can all be used to evaluate infarct properties when combined with finite element (FE) models. In this work, we investigated the temporal effects of degradable hyaluronic acid (HA) hydrogels on global LV remodeling, infarct thinning and expansion, and infarct stiffness in a porcine infarct model for 12 weeks post-MI using MRI and FE modeling. Hydrogel treatment led to decreased LV volumes, improved ejection fraction, and increased wall thickness when compared to controls. FE model simulations demonstrated that hydrogel therapy increased infarct stiffness for 12 weeks post-MI. Thus, evaluation of myocardial tissue properties through MRI and FE modeling provides insight into the influence of injectable hydrogel therapies on myocardial structure and function post-MI.

  7. RELATIONSHIP OF LEFT VENTRICULAR SIZE TO LEFT ATRIAL AND LEFT ATRIAL APPENDAGE SIZE IN SINUS RHYTHM PATIENTS WITH DILATED CARDIOMYOPATHY

    Science.gov (United States)

    Bakalli, Aurora; Georgievska-Ismail, Ljubica; Musliu, Nebi; Koçinaj, Dardan; Gashi, Zaim; Zeqiri, Nexhmi

    2012-01-01

    Introduction: Thromboembolic events are a frequent cause of mortality in patients with congestive heart failure. The aim of or study was to evaluate the relationship of left ventricular end diastolic diameter (LVEDD) to left atrial (LA) size and left atrial appendage (LAA) size in patients with dilated cardiomyopathy in sinus rhythm, as well as to determine the prevalence of thrombi in LV and LA /LAA. Methods: This was a prospective cross-sectional study, conducted from December 2009 until December 2011. The study included 95 patients with dilated cardiomyopathy in sinus rhythm. Patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flatter, severe systolic dysfunction, and/or patients who were taking oral anticoagulation therapy were excluded. Results: Mean patient age was 58.6 ± 12.2 years and 68.4% were men. Mean LVEDD of our population was 66.5 ± 6.5 mm, while mean LA atrium, LA volume and LAA maximal area were 46 ± 5.1 mm, 87.2 ± 38.7 cm3 and 4.7 ± 1.2 cm2, respectively. LA diameter (p<0.001) and LAA maximal area (p=0.01) showed to be independent predictors of LV size. LV thrombus was detected in 13 (13.7%) patients, while LAA thrombus in 46 (48.4%) patients of our study population. Conclusions: In conclusion, dilated LV size is associated with enlarged LA and LAA size. On the other hand, dilation of LV, LA and LAA is related to high prevalence of left chamber cardiac thrombi. PMID:23322961

  8. 实时三维斑点追踪成像评价心肌梗死左心室整体收缩功能的可行性和重复性研究%Evaluation of Global Left Ventricular systolic Function in Patients with Myocardia Infarction Using three-Dimensional Strain Imaging

    Institute of Scientific and Technical Information of China (English)

    何慧; 张全斌; 张园园; 高瑞锋; 蔚俊丽; 崔艳华

    2013-01-01

    目的:应用实时三维斑点追踪成像(RT-3DSTI)测量心肌梗死收缩期左心室心肌整体峰值纵向应变(GPSL)、整体纵向应变(GLS)、整体圆周应变(GCS)、整体面积应变(GAS)及整体径向应变(GRS),探讨其评价左心室整体收缩功能的可行性和重复性。方法83例研究对象,包括心肌梗死患者38例,健康对照者45例;采用RT-3DSTI测量收缩期左心室GPSL、GLS、GCS、GAS、GRS;分析心肌梗死组RT-3DSTI特征,并探讨其与实时三维超声(RT-3DE)测量射血分数的相关性;随机选取20例心肌梗死患者,用Bland-Altman法研究RT-3DSTI在观察组内和观察组间的重复性。结果⑴心肌梗死组收缩期左心室GPSL、GLS、GCS、GAS、GRS显著低于对照组,差异有统计学意义(P<0.01);⑵ROC曲线显示GPSL、GLS和GAS能反映心肌梗死组整体应变的变化;⑶GPSL、GLS、GCS、GAS及GRS与RT-3DE射血分数有良好的相关性;⑷Bland-Altman法显示心肌梗死患者RT-3DSTI测量在观察组内和观察组间均有良好的一致性。结论 RT-3DSTI可简便快速评价心肌梗死左心室整体收缩功能,其测量左心室整体功能不依赖左心室负荷变化的影响,可能是一种评价左心室整体收缩功能有前景的技术。%Objective The paper is aimed at exploring and evaluating left ventricle systolic function’s practical meaning by using RT-3DSTI to measure speckle tracking’s GPSL, GLS, GCS, GAS and GRS. Methods With 83 patients cases including 38 patients diagnosed with myocardial infarction and 45 patients of healthy control group, the paper takes way of RT-3DSTI to measure the systolic left ventricular GPSL, GLS, GCS, GAS, GRS, analyses the characteristics of myocardial infarction group RT-3DSTI, explores its relationship with the real-time three-dimensional echocardiography(RT-3DE) measurement of ejection fraction. Besides, the Bland-Altman method is used to research myocardial infarction group RT-3

  9. 组织多普勒应变成像评价无心肌梗死的冠心病患者左心室收缩功能变化%Evaluation of Left Ventricular Function in Patients with Coronary Artery Diseases and without Myocardial Infarction by Strain Imaging Based on Tissue Doppler Imaging

    Institute of Scientific and Technical Information of China (English)

    李伟霞; 周宇

    2012-01-01

    Objective: To assess left ventricular function in patients with coronary artery diseases who had no myocardial infarc-tion history by strain imaging based on tissue Doppler imaging (TDD. Methods: Color-coded tissue Doppler echocardiography was performed in 25 healthy subjects and 26 patients with coronary artery diseases and without myocardial infarction. The short-axis views at basal,middle and apical levels were recorded. The mean peak values of strain were measured using Philips Q-Lab 7. 1 workshop. Results; The mean peak value in the group of coronary artery disease was significantly lower than that in the control group[(-42. 3 ± 9. 3) % vs. (-28. 8 ± 10. 3) %,P<0. 01],while other conventional echocardiographic parameters showed no significant difference. Conclusions: Strain imaging based on TDI can be used to assess myocardial function even when there is no obvious change in left ventricular ejection fraction in patients with coronary artery diseases.%目的:应用组织多普勒(tissue Doppler imaging,TDI)应变成像技术评价无心肌梗死史的冠心病患者左心室收缩功能的变化.方法:对既往均无心肌梗死史的25例健康志愿者(对照组)和26例经冠状动脉造影证实冠心痛的患者(冠心病组)进行TDI应变分析.分别得出每例研究对象的平均左心室应变峰值.结果:冠心病组和对照组的年龄、心率以及经常规超声心动图Simpson法测量的左室射血分数(left ventricular ejection fraction,LVEF)的差异均无统计意义(P>0.05),但冠心病组的平均左心室应变峰值显著低于对照组[(-42.3±9.3)%比(-28.8±10.3)%,P<0.01].结论:TDI应变峰值能敏感地反映左室功能不全的亚临床信息,有助于心血管疾病的早期诊断.

  10. Evaluation of radial systolic function of left ventricular with myocardial infarction by velocity vector imaging%速度向量成像技术评价心肌梗死节段室壁径向收缩能力的价值

    Institute of Scientific and Technical Information of China (English)

    杨娅; 谢谨捷; 李治安; 孟圆峰; 郝晓晔; 张京岚

    2010-01-01

    目的 探讨速度向量成像(VVI)技术评价心肌梗死节段径向收缩能力的价值.方法 将雄性Wister大鼠分为两组,一组结扎冠状动脉制成心肌梗死模型组(10只),另一组同样进行手术但不结扎冠状动脉作为对照组(14只).应用VVI技术对左室短轴乳头肌水平室壁径向应变及应变率进行分析.结果 心肌梗死组梗死节段(左室前壁及前间隔)径向应变及应变率较对照组相应节段明显减低,两组间差异具有统计学意义(P0.05).结论 VVI技术能够定量评价心肌梗死节段室壁的径向收缩能力.%Objective To explore the value of velocity vector imaging(VVI)in evaluating radial systolic function of left ventricular with myocardial infarction(MI).Methods Twenty-four male Wister rats were divided into MI group(n=10)and control group(n=14).Left main coronary artery of MI group were ligated,and the similar operation were performed in control group without coronary artery ligation.VVI was used to analyse the radial strain and strain rate of regional left ventricule in rata.Results Compared with control group,the radial strain and strain rate of infarcted segments(anterior wall and anterior septal)were decreased significantly(P0.05)was found when compared radial strain and strain rate in different left ventricle segments in control group.Conclusions VVI can be used as a quantitive tool in evaluating the radial systolic function of left ventricular with MI.

  11. [Left ventricular kinetics studied by the color kinesis method. Comparison of bidimensional echographic and angiographic data].

    Science.gov (United States)

    Vermes, E; Guyon, P; Weingrod, M; Otmani, A; Soussana, C; Halphen, C; Leroy, G; Haïat, R

    1998-10-01

    The object of this study was to assess the value of CK in the evaluation of left ventricular wall motion. Fifteen coronary patients aged 56 +/- 12 years were included: 8 patients were examined after acute myocardial infarction and 7 after unstable angina with a history of myocardial information. The left ventricle was divided into 7 segments after a modified Heger model, excluding the basal septal and basal lateral segments not seen on angiography. The left ventricular wall motion was assessed in two-dimensional echocardiography (2DE) and colour kinesis (CK) by two observers and compared with the results of left ventriculography, considered the reference method. Over all the 105 segments studied (7 segments for each of the 15 patients), CK was significantly better than 2DE (80% of segments correctly evaluated by CK vs 68% by 2DE, p kinesis significantly improved the study of all segments except the interventricular septum (67% vs 60%, p = NS). The inter-observer variability in 2DE and CK evaluated over 135 segments (9 per patient) by the kappa was improved by colour kinesis (0.57 in 2DE, 0.7 in CK). The authors conclude that CK enables evaluation of left ventricular wall motion with greater precision and less inter-observer variability.

  12. [Effectiveness of anticoagulant oral treatment in patients with thrombus in left ventricle after acute myocardial infarction].

    Science.gov (United States)

    Carrillo, A M; Valdespino, A; Solorio, S; Badui, E; Enciso, R; Lepe, L; Lara, A; Ocampo, S; Alonso, R; Romero, M A

    1997-01-01

    Left ventricular mural thrombi (LVMT) is a complication of acute myocardial infarction (AMI), that may produce peripheral embolism which could be fatal. In order to establish an adequate time of oral anticoagulant (OA) therapy, we undertook a prospective study that included 45 patients with AMI and left ventricular thrombi detected by echocardiographic study, in the first 5 to 10 days postinfarction, the study was repeated, in 3 and 6 months. Treatment with oral anticoagulant was initiated at the point of the detection of thrombi maintaining an INR of 1.5 to 2. Thirty nine patients (79%) were males and 6 (11%) were females, with an age of 29 to 85 years and a range of 62 +/- 11 years. Forty four patients (98%) presented anterior wall infarction and 1 (2%) posteroinferior infarction. In patients with anterior infarction, in 38 (85%) the thrombi was located at the apical wall (p < 0.05), 5 (11%) in the septal wall and other (2%) in anterior and apical walls. The patient with the posteroinferior infarction presented extension to the right ventricle, where the thrombus was located (2%). The contractility alterations related with thrombi were diskinesia, followed by hipokinesia and finally akinesia. The ejection fraction had not relationship with thrombi formation. LVMT dissolved in 32 patients (71%) at 3 months (p < 0.05), in 8 (18%) in 6 months and in 5 (11%) it was maintained for more than 6 months. None of the patients presented complications of OA. We conclude that the LVMT are more frequent in anterior infarctions, essentially in those that present diskinesia. The majority of LVMT are resolved in 6 months with OA therapy.

  13. Obsessive-Compulsive Behavior Disappearing after Left Capsular Genu Infarction

    Directory of Open Access Journals (Sweden)

    Ji-Hyang Oh

    2011-01-01

    Full Text Available This case report describes a 74-year-old woman with obsessive-compulsive behaviors that disappeared following a left capsular genu infarction. The patient’s capsular genu infarction likely resulted in thalamocortical disconnection in the cortico-basal ganglia-thalamocortical loop, which may have caused the disappearance of her obsessive-compulsive symptoms. The fact that anterior capsulotomy has been demonstrated to be effective for treating refractory obsessive-compulsive disorder further supports this hypothesis.

  14. [Left ventricular function in hypertension without left ventricular hypertrophy: echographic study with modelisation of left ventricular-aortic coupling].

    Science.gov (United States)

    Bonnet, B; Jourdan, F; du Cailar, G; Mimran, A; Fesler, P

    2014-06-01

    Because the functional interaction between the LV and arterial systems, termed ventricular-arterial coupling, is recognized as a key determinant of LV performance, the objective of the present study was to assess the impact of uncomplicated HT without LVH on LV performance using simultaneously echocardiography and carotid tonometry. LV maximal power (PmaxVG), cardiac power output (CPO), LV efficiency (CPO/PmaxVG), input aortic and output LV elastance (Ea and Ees) were assessed in 20 normotensive control subjects (NT) and 10 patients with untreated HT. PmaxVG was calculated according to the integral of the product of LV wall stress with strain rate (as an index of gradient velocity). Cyclic variation of wall thickness and SR were measured by speckel-tracking. Ea and Ees were derived and modelized from the pressure-volume curve. No difference in age, BMI and sex ratio was observed between NT and HT. Systolic BP (160±18 vs. 119±10mmHg), LV mass (99±15 vs. 76±12g/m(2)), PWV (9.7±2 vs. 6.9±1m/s) were significantly higher (P<0.01) in HT when compared to NT. In HT increased of CPO and Ea was compensated by an increase of LV (15±4 vs. 12±3%, P<0.02) and Ees (5.5±2 vs. 4.5±1.5mmHg/mL), which are significantly elevated in HT (P<0.05). No difference was observed in Ea/Ees between NT and HT. In conclusion at the early phase of HT, in patients without LVH, LV performance and ventricular-arterial coupling were adapted to post-load elevation. This adaptation may be the result of an increased of LV contractility.

  15. Evaluation of global and regional left ventricular function obtained by quantitative gated SPECT using {sup 99m}Tc-tetrofosmin for left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Ban, Kazunobu; Nakajima, Tohru; Iseki, Harukazu; Abe, Sumihisa; Handa, Shunnosuke; Suzuki, Yutaka [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine

    2000-08-01

    The quantitative gated SPECT (QGS) software is able to calculate LV volumes and visualize LV wall motion and perfusion throughout the cardiac cycle using an automatic edge detection algorithm of the left ventricle. We evaluated the reliability of global and regional LV function assessment derived from QGS by comparing it with the results from left ventriculo-cineangiography (LVG). In 20 patients with left ventricular dysfunction who underwent ECG gated {sup 99m}Tc-tetrofosmin SPECT, the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) were calculated. The QGS-assessed regional wall motion was determined using the cinematic display. QGS-derived EDV, ESV and LVEF correlated well with those by LVG (p<0.001 for each). There was a good correlation between wall motion score (WMS) derived from the QGS and the LVG (r=0.40, p<0.05). In some patients with extensive myocardial infarction, there was a discrepancy in the regional wall motion results between QGS and LVG. The ECG-gated SPECT using QGS is useful to evaluate global and regional LV functions in left ventricular dysfunction. (author)

  16. Ventricular fibrillation via torsade des pointes of cardiac sarcoidosis with preserved left ventricular ejection fraction.

    Science.gov (United States)

    Sekihara, Takayuki; Nakane, Eisaku; Nakasone, Kazutaka; Inoko, Moriaki

    2016-10-25

    Generally, low left ventricular ejection fraction (LVEF) is a risk for ventricular arrhythmia in patients with cardiac sarcoidosis. We present a case of cardiac sarcoidosis with preserved LVEF that evoked ventricular fibrillation (VF). A 73-year-old woman with VF presented to our emergency department. She had a history of ocular sarcoidosis, with gradual thinning of the basal intraventricular septum. LVEF was 62% on the most recent echocardiography. The electrocardiogram after defibrillation showed complete atrioventricular block (CAVB) with QT segment prolongation and frequent ventricular premature beats. VF via torsade des pointes (TdP) was suspected, and temporary intravenous ventricular pacing and magnesium sulfate infusion suppressed her VF. Cardiac sarcoidosis was diagnosed, and an implantable cardioverter defibrillator was implanted. Patients with cardiac sarcoidosis with CAVB are at risk of evoking VF via TdP regardless of LVEF. If cardiac sarcoidosis is suspected, early diagnosis and risk stratification of ventricular arrhythmia are important. 2016 BMJ Publishing Group Ltd.

  17. Determination of left ventricular mass through SPECT imaging

    Science.gov (United States)

    Zárate-Morales, A.; Rodríguez-Villafuerte, M.; Martínez-Rodríguez, F.; Arévila-Ceballos, N.

    1998-08-01

    An edge detection algorithm has been applied to estimate left ventricular (LV) mass from single photon emission computed tomography (SPECT) thallium-201 images. The algorithm was validated using SPECT images of a phantom. The algorithm was applied to 20 patient studies from the Hospital de Cardiologia, Centro Médico Nacional Siglo XXI. Left ventricular masses derived from the stress and redistribution studies were highly correlated (r=0.96). The average LV masses obtained were 162±37 g and 169±34 g in the redistribution and stress studies, respectively.

  18. Ebstein's Anomaly, Left Ventricular Noncompaction, and Sudden Cardiac Death

    Science.gov (United States)

    McGee, Michael; Warner, Luke; Collins, Nicholas

    2015-01-01

    Ebstein's anomaly is a congenital disorder characterized by apical displacement of the septal leaflet of the tricuspid valve. Ebstein's anomaly may be seen in association with other cardiac conditions, including patent foramen ovale, atrial septal defect, and left ventricular noncompaction (LVNC). LVNC is characterized by increased trabeculation within the left ventricular apex. Echocardiography is often used to diagnose LVNC; however, magnetic resonance (MR) imaging offers superior characterization of the myocardium. We report a case of sudden cardiac death in a patient with Ebstein's anomaly with unrecognized LVNC noted on post mortem examination with screening documenting the presence of LVNC in one of the patient's twin sons. PMID:26240764

  19. Repeated heart rate measurement and cardiovascular outcomes in left ventricular systolic dysfunction.

    Science.gov (United States)

    Hamill, Victoria; Ford, Ian; Fox, Kim; Böhm, Michael; Borer, Jeffrey S; Ferrari, Roberto; Komajda, Michel; Steg, Philippe Gabriel; Tavazzi, Luigi; Tendera, Michal; Swedberg, Karl

    2015-10-01

    Elevated resting heart rate is associated with increased cardiovascular risk, particularly in patients with left ventricular systolic dysfunction. Heart rate is not monitored routinely in these patients. We hypothesized that routine monitoring of heart rate would increase its prognostic value in patients with left ventricular systolic dysfunction. We analyzed the relationship between heart rate measurements and a range of adverse cardiovascular outcomes, including hospitalization for worsening heart failure, in the pooled placebo-treated patients from the morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction (BEAUTIFUL) trial and Systolic Heart failure treatment with the If inhibitor ivabradine (SHIFT) Trial, using standard and time-varying covariate Cox proportional hazards models. By adjusting for other prognostic factors, models were fitted for baseline heart rate alone or for time-updated heart rate (latest heart rate) alone or corrected for baseline heart rate or for immediate previous time-updated heart rate. Baseline heart rate was strongly associated with all outcomes apart from hospitalization for myocardial infarction. Time-updated heart rate increased the strengths of associations for all outcomes. Adjustment for baseline heart rate or immediate previous time-updated heart rate modestly reduced the prognostic importance of time-updated heart rate. For hospitalization for worsening heart failure, each 5 beats/min increase in baseline heart rate and time-updated heart rate was associated with a 15% (95% confidence interval, 12-18) and 22% (confidence interval, 19-40) increase in risk, respectively. Even after correction, the prognostic value of time-updated heart rate remained greater. In patients with left ventricular systolic dysfunction, time-updated heart rate is more strongly related with adverse cardiovascular outcomes than baseline heart rate. Heart rate should be measured to

  20. Effect of age on left ventricular function during exercise in patients with coronary artery disease.

    Science.gov (United States)

    Hakki, A H; DePace, N L; Iskandrian, A S

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p = not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p = 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p = not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  1. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  2. Multimodality cardiac imaging of a ventricular septal rupture post myocardial infarction: a case report

    Directory of Open Access Journals (Sweden)

    Dhaliwal Surinder

    2012-10-01

    Full Text Available Abstract Background Ventricular septal rupture (VSR, a mechanical complication following an acute myocardial infarction (MI, is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional transthoracic echocardiography (TTE with color flow Doppler and cardiac MRI (CMR are reliable tests for the non-invasive diagnosis of VSR. Case presentation A 62-year-old Caucasian female presented with a late case of a VSR post inferior MI diagnosed by multimodality cardiac imaging including TTE, CMR and ventriculography. Conclusion We review the presentation, diagnosis and management of VSR post MI.

  3. Right ventricular involvement in patients with inferior myocardial infarction, correlation of electrocardiographic findings with echocardiography data.

    Science.gov (United States)

    Javed, Sumbul; Rajani, Ali Raza; Govindaswamy, Pushparani; Radaideh, Ghazi Ahmed; Abubaraka, Harb Ahmed; Qureshi, Tariq Ilyas; Arshad, Hassaan Bin

    2017-03-01

    To determine the right ventricular involvement in patients with inferior myocardial infarction by echocardiography in relation to electrocardiographic findings. This observational, prospective study was conducted at Rashid Hospital, Dubai, the United Arab Emirates, from January to September 2013, and comprised patients with inferior myocardial infarction. All patients aged above 18 years were included. Right ventricular myocardial infarction was defined by the electrocardiographic criteria of > 1mV ST elevation in V4R-V5R leads. RV infarction was assessed on echocardiography by fractional area change, tricuspid annular plane systolic excursion and tricuspid annular systolic velocity by tissue Doppler imaging. SPSS 21 was used for data analysis. Of the 73 patients, there were 68(93%) men and 5(7%) women. The three modalities used to assess the right ventricular infarction showed right ventricular involvement in 36(49.3%) cases by fractional area change, 28(38.4%) cases by tricuspid annular plane systolic excursion and 31(42.5%) cases by tissue Doppler imaging in patients with inferior myocardial infarction. Tissue Doppler imaging and right ventricular function showed low degree of negative correlation (p=0.16) while the correlation between tricuspid annular plane systolic excursion and right ventricular function showed significant positive correlation (pright ventricular infarction by echocardiography helped to diagnose right ventricular infarction in greater number of cases compared to surface electrocardiogram.

  4. Left ventricular ejection fraction and left ventricular end-diastolic volume in patients with diastolic dysfunction.

    Science.gov (United States)

    Jovin, Ion S; Ebisu, Keita; Liu, Yi-Hwa; Finta, Laurie A; Oprea, Adriana D; Brandt, Cynthia A; Dziura, James; Wackers, Frans J

    2013-01-01

    Diastolic dysfunction can be diagnosed on equilibrium radionuclide angiocardiography (ERNA) by a low peak filling rate (PFR) in the setting of a normal left ventricular ejection fraction (LVEF). The authors evaluated the relationship between diastolic dysfunction, LVEF, and end-diastolic volume (EDV). A total of 408 predominantly asymptomatic patients with an LVEF ≥50% by ERNA were studied. LVEF of patients with a low PFR was compared with the LVEF of patients with a normal PFR. Correlation analyses to evaluate the association between PFR and EDV were also performed. The LVEF of patients with a low PFR was lower than the LVEF of patients with normal PFR (59±7 vs 63%±7%; PPFR (r=-0.04; P=.32). The results did not change when the EDV indices were used. In patients who had repeat scans, there was no correlation between the change in EDV and the change in PFR (r=0.16; P=.2). In asymptomatic patients undergoing ERNA who have normal systolic function, a low PFR can be associated with a lower LVEF, but it is not associated with changes in EDV. This suggests that diastolic dysfunction is associated with mild systolic dysfunction.

  5. New strict left bundle branch block criteria reflect left ventricular activation differences

    DEFF Research Database (Denmark)

    Emerek, Kasper Janus Grønn; Risum, Niels; Hjortshøj, Søren Pihlkjær;

    2015-01-01

    applying new strict ECG criteria subsequent rates of response in DCM were 18/19 (95%) and in IHD of 18/23 (78%) respectively, p... ventricular electrical delay (RV-LV-IED) was measured. Response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume. RESULTS: Eighteen of 20 (90%) patients with non-ischemic dilated cardiomyopathy (DCM) and 18 of 29 (62%) with ischemic heart disease (IHD) responded to CRT, p.... CONCLUSION: Interventricular electrical delay predicts left ventricular remodeling after CRT and new, strict ECG criteria of LBBB are superior in predicting remodeling....

  6. Relationship of left ventricular systolic function to persistence or development of electrocardiographic left ventricular hypertrophy in hypertensive patients

    DEFF Research Database (Denmark)

    Okin, Peter M; Wachtell, Kristian; Gerdts, Eva;

    2014-01-01

    left ventricular systolic function in patients with new or persistent ECG LVH. METHODS: Baseline and year-3 ECG LVH and left ventricular midwall shortening (MWS) were examined in 725 hypertensive patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic...... or regression of ECG LVH in 427 patients and persistence or development of new LVH in 298 patients. At baseline, although there were no significant differences in the mean values of MWS and scMWS, patients with persistence or development of ECG LVH at year 3 had significantly higher baseline prevalences...

  7. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J;

    2011-01-01

    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements...

  8. Revascularization in severe left ventricular dysfunction.

    Science.gov (United States)

    Velazquez, Eric J; Bonow, Robert O

    2015-02-17

    The highest-risk patients with heart failure with reduced ejection fraction are those with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (ejection fraction≤35%). The cornerstone of treatment is guideline-driven medical therapy for all patients and implantable device therapy for appropriately selected patients. Surgical revascularization offers the potential for improved survival and quality of life, particularly in patients with more extensive multivessel disease and the greatest degree of left ventricular systolic dysfunction and remodeling. These are also the patients at greatest short-term risk of mortality with coronary artery bypass graft surgery. The short-term risks of surgery need to be balanced against the potential for long-term benefit. This review discusses the evolving data on the role of surgical revascularization, surgical ventricular reconstruction, and mitral valve surgery in this high-risk patient population.

  9. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group

    DEFF Research Database (Denmark)

    Flather, M D; Yusuf, S; Køber, L

    2000-01-01

    enrolled patients within a week after acute myocardial infarction. Data were combined by use of the Peto-Yusuf method. FINDINGS: Overall 12,763 patients were randomly assigned treatment or placebo and followed up for an average of 35 months. In the three post-infarction trials (n=5,966), mortality...

  10. Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: the VALIANT experience

    DEFF Research Database (Denmark)

    Stephenson, Kent; Skali, Hicham; McMurray, John J V;

    2006-01-01

    BACKGROUND: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). OBJECTIVES: The aim of this study wa...

  11. Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report

    Directory of Open Access Journals (Sweden)

    Celermajer David S

    2007-02-01

    Full Text Available Abstract Background Apical ballooning syndrome (or Takotsubo cardiomyopathy is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. Case Presentation We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg. Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. Conclusion This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The

  12. Laparoscopic repair of diaphragmatic hernia after left ventricular assist device.

    Science.gov (United States)

    Farma, Jeffrey; Leeser, David; Furukawa, Satoshi; Dempsey, Daniel T

    2003-06-01

    This case report describes a patient with a symptomatic diaphragmatic hernia that developed after orthotopic heart transplantation and explantation of a left ventricular assist device. The hernia was repaired laparoscopically, and at 6-month follow-up, she is without evidence of recurrence.

  13. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the endo

  14. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, M.I.|info:eu-repo/dai/nl/412015625; Vink, Aryan; Bergmann, W.|info:eu-repo/dai/nl/36275585X; Szatmári, V.|info:eu-repo/dai/nl/272734497

    2016-01-01

    Background: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation: A previously healthy 12-year-old male West Highland white terrier was found dead

  15. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

    2016-01-01

    BACKGROUND: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. CASE PRESENTATION: A previously healthy 12-year-old male West Highland white terrier was found dead

  16. Roseomonas infection associated with a left ventricular assist device.

    Science.gov (United States)

    Singal, Amit; Malani, Preeti N; Day, Larry J; Pagani, Francis D; Clark, Nina M

    2003-12-01

    Roseomonas species have been increasingly noted as causes of human infection. We present what we believe is the first case of left ventricular assist device (LVAD) infection secondary to Roseomonas. The clinical characteristics of Roseomonas infection and the pertinent features of LVAD infection are reviewed.

  17. Electrocardiographic criteria for left ventricular hypertrophy in children.

    NARCIS (Netherlands)

    Rijnbeek, P.R.; Herpen, G van; Kapusta, L.; Harkel, AD Ten; Witsenburg, M.; Kors, J.A.

    2008-01-01

    Previous studies to determine the sensitivity of the electrocardiogram (ECG) for left ventricular hypertrophy (LVH) in children had their imperfections: they were not done on an unselected hospital population, several criteria used in adults were not applied to children, and obsolete limits of norma

  18. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the endo

  19. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

    2016-01-01

    BACKGROUND: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. CASE PRESENTATION: A previously healthy 12-year-old male West Highland white terrier was found dead

  20. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, M.I.; Vink, Aryan; Bergmann, W.; Szatmári, V.

    2016-01-01

    Background: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation: A previously healthy 12-year-old male West Highland white terrier was found dead

  1. Absence of left ventricular hypertrophy in elite college basketball players.

    Science.gov (United States)

    Wolfe, L A; Martin, R P; Seip, R L

    1985-09-01

    Left ventricular dimensions of 11 successful male college basketball players engaged in pre-season conditioning (mean age, 20.3 years) and 13 tall healthy male controls (mean age, 21.6 years) were studied by echocardiography. Left ventricular internal dimension (LVIDd, mm), posterior wall thickness (PWT, mm), septal thickness (ST, mm), and calculated left ventricular mass (LV mass, g) in the athletes were within or only slightly in excess of echocardiographic normal limits and mean values were not significantly different from the control group. LVIDd (mm/m2 body surface area) was significantly lower in the athletes. However, five guard-type players displayed significantly greater mean values for PWT and LV mass compared to six taller forwards/centers with linear body builds. It was concluded that left ventricular hypertrophy is not a common characteristic of college basketball players. It was hypothesized that cardiac dimensions of young men may vary independently of gross body size in relation to somatotype or other anthropometric variables.

  2. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the

  3. The diagnosis of left ventricular assist device thrombosis

    NARCIS (Netherlands)

    Gerds, H. Z. R.; Brugemann, J.; Rienstra, M.; Erasmus, M. E.

    2015-01-01

    The clinical course of a patient with a left ventricular assist device is described. A total of 6 weeks after device insertion, the lactate dehydrogenase (LDH) level increased to 2801 U/l despite adding low-molecular-weight heparin to acenocoumarol and aspirin. Pump thrombosis was suspected but unco

  4. Patient-reported outcomes in left ventricular assist device therapy

    DEFF Research Database (Denmark)

    Brouwers, Corline; Denollet, Johan; de Jonge, Nicolaas;

    2011-01-01

    Technological advancements of left ventricular assist devices (LVAD) have created today's potential for extending the lives of patients with end-stage heart failure. Few studies have examined the effect of LVAD therapy on patient-reported outcomes (PROs), such as health status, quality of life...

  5. Angiographic left ventricular wall motion score to predict arrhythmia recurrence in patients with sustained ventricular tachycardia or fibrillation

    NARCIS (Netherlands)

    Wiesfeld, ACP; Crijns, HJGM; VandenBroek, SAJ; Landsman, MLJ; Hillege, HL; vanGilst, WH; Lie, KI

    1996-01-01

    Methods Sixty-nine patients with sustained ventricular tachyarrhythmias were followed up to evaluate the predictive value of functional capacity (i.e. New York Heart Association class and peak oxygen consumption) and resting left ventricular function (i.e. radionuclide left ventricular ejection frac

  6. Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

    Science.gov (United States)

    Pierson, Richard N; Howser, Renee; Donaldson, Terri; Merrill, Walter H; Dignan, Rebecca J; Drinkwater, Davis C; Christian, Karla G; Butler, Javed; Chomsky, Don; Wilson, John R; Clark, Rick; Davis, Stacy F

    2002-03-01

    Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.

  7. Left ventricular cardiac fibroma in a child presenting with ventricular tachycardia.

    Science.gov (United States)

    Stratemann, Stacy; Dzurik, Yvette; Fish, Frank; Parra, David

    2008-01-01

    Cardiac tumors in children are rare. Although most are histologically benign, they can be associated with life-threatening arrhythmias and sudden death. We report a 7-year-old boy, with a first episode of symptomatic tachycardia, who was found to have a left ventricular (LV) fibroma. He had a normal echocardiogram prior to an electrophysiology study, which revealed a sustained monomorphic ventricular tachycardia and a radio-opacity near the LV apex. These findings prompted a cardiac MRI, which demonstrated a discrete mass on his LV apex and free wall. Our case emphasizes that structural heart disease should be aggressively pursued in children presenting with ventricular tachycardia.

  8. Role of left ventricular twist mechanics in cardiomyopathies, dance of the helices

    Institute of Scientific and Technical Information of China (English)

    Floris; Kauer; Marcel; Leonard; Geleijnse; Bastiaan; Martijn; van; Dalen

    2015-01-01

    Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in "the cardiology community" as it comes to twist mechanics. Fortunately the development of speckle tracking echocardiography, allowing accurate, reproducible and rapid bedside assessment of left ventricular twist, has boosted the interest in this important mechanical aspect of left ventricular deformation. Although the fundamental physiological role of left ventricular twist is undisputable, the clinical relevance of assessment of left ventricular twist in cardiomyopathies still needs to be established. The fact remains; analysis of left ventricular twist mechanics has already provided substantial pathophysiological understanding on a comprehensive variety of cardiomyopathies. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial(microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the "diagnostic toolbox" for cardiomyopathies.

  9. Quantification of Regional Left Ventricular Systolic Dysfunction in Patients With Coronary Artery Disease by Strain Rate Imaging

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardiu mby strain rate imaging ( SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris ( 11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall.SRI parameters were: Systolic SR ( Srsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, Srsys, εsys and εmax decreased significantly in the infarct and ischemic segments ( P < 0.01 ). Compared with ischemic segments, Srsys, εsys and εmax decreased significantly in the infarct segments ( P <0.05 ). Conclusions Srsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.

  10. Implantation of left ventricular assist device complicated by undiagnosed thrombophilia.

    Science.gov (United States)

    Szarszoi, Ondrej; Maly, Jiri; Turek, Daniel; Urban, Marian; Skalsky, Ivo; Riha, Hynek; Maluskova, Jana; Pirk, Jan; Netuka, Ivan

    2012-01-01

    A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.

  11. Study on serum concentration of pro-collagen Ⅲ and left ventricular function in acute myocardial infarction with or without thrombolytic therapy in elderly patients%早期溶栓治疗对老年急性心肌梗死患者血清Ⅲ型前胶原末端肽及左心功能的影响

    Institute of Scientific and Technical Information of China (English)

    党彦平; 耿秀双

    2009-01-01

    目的 观察早期静脉溶栓与非溶栓治疗对老年急性心肌梗死(AMI)患者血清Ⅲ型前胶原水平及左心功能的影响.方法 将56例AMI患者分为静脉溶栓组(29例)和非溶栓组(27例),应用放射免疫法测定血清Ⅲ型前胶原末端肽(PⅢP)含量,采用彩色Doppler超声心动图仪测量左室结构及舒缩功能参数.结果 溶栓组患者在溶栓开始后1、2、4、6周血清PⅢP含量分别为(92±14)、(90±11)、(86±8)和(82±7)μg/L,较同期非溶栓组患者PⅢP(118±11)、(112±11)、(104±11)和(95±9)μg/L明显降低(P<0.05或P<0.01);溶栓未再通组血清PⅢP含量显著高于再通组(P<0.05或P<0.01).血清PⅢP含量与左室重塑(LVRM)程度有良好的相关性(r=0.4314,P<0.05),与左室舒缩功能呈负相关(r=-0.4233,P<0.05;r=-0.4542,P<0.05).结论 早期实施静脉溶栓治疗能降低AMI患者血清PⅢP水平,减少LVRM发生,改善患者左心功能.%Objective To study the serum concentration of pro-collagen Ⅲ(PⅢP)and left ventricular function in acute myocardial infarction(AMI)patients with or without thrombolytic treatment.Methods The 56 patients with AMI were randomly divided into thrombolysis group(n=29)and non-thrombolysis group(n=27).The serum concentration of PⅢP were measured by specific radioimmunoassay.Two-dimensional,M-mode and Doppler ultrasound recordings were obtained from all patients to determine several parameters relating to the left ventricular anatomy and function.Results In comparison with non-thromblysis group at 1st,2nd,4th,6th week after treatment,serum concentrations of PⅢP was significantly decreased in patients of thrombolysis group[(92±14),(90±11),(86±8)and(82±7)μg/L vs(118±11),(112±11),(104±11)and(95±9)μg/L,P<0.05 or P<0.01].PⅢP was significantly increased in non-reperfusion group than that of the reperfusion group.PⅢP was correlated positively with left ventricular remodeling(LVRM)(r=0.4314,P<0.05),and negatively with

  12. Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study). Losartan Intervention For Endpoint

    DEFF Research Database (Denmark)

    Wachtell, K; Smith, G; Gerdts, E;

    2000-01-01

    Abnormal left ventricular (LV) filling may exist in early stages of hypertension. Whether this finding is related to LV hypertrophy is currently controversial. This study was undertaken to assess relations between abnormal diastolic LV filling and LV geometry in a large series of hypertensive pat...

  13. Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Assessed by Echocardiography Predicts Adverse Clinical Outcome

    NARCIS (Netherlands)

    Mast, Thomas P.; Teske, Arco J.; van der Heijden, Jeroen F.; Groeneweg, Judith A.; Te Riele, Anneline S J M; Velthuis, Birgitta K.; Hauer, RNW; Doevendans, Pieter A.; Cramer, Maarten J.

    2015-01-01

    Background Among studies describing the phenotype of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), significant discrepancy exists regarding the extent and impact of left ventricular (LV) involvement. The capability of conventional and new quantitative echocardiographic techniqu

  14. 比较早期和晚期骨髓单个核细胞移植对猪急性心肌梗死后左室重构的影响%Comparison of effects of early and late bone marrow mononuclear cells transplantation on left ventricular remodeling after acute myocardial infarction in swines

    Institute of Scientific and Technical Information of China (English)

    曾建平; 刘颖; 易文艳; 黄河; 孙智山; 康松涛; 彭湘洪; 吴名星; 吴澧源; 孙建平; 彭枝柳

    2011-01-01

    目的 对比观察猪急性心肌梗死后早期(1周)和延期(3个月)进行的骨髓单个核细胞移植对心肌梗死后左室重构的影响.方法 前降支球囊封堵法成功建立15头猪急性心肌梗死模型,随机均分为对照组、早期移植组和延期移植组.造模1周后急性移植组行自体骨髓单个核细胞移植,对照组注射1640培养基10 ml作为对照;造模3个月后延期移植组行自体骨髓单个核细胞移植,造模后1周、造模后3个月、造模后6个月各组分别行心脏超声和SPECT检测,超声检查分析左室舒张末期内径,SPECT分析左室舒张末期容积、射血分数.结果 造模6个月后延期移植组的LVd值[(54.20±3.70) mm]低于对照组[(63.20±5.63) mm],但高于早期移植组[(47.40±1.14)mm];EDV值[(163.00 ±6.96) ml]低于对照组[(209.40±18.69)ml],但高于早期移植组[135.40±4.93)ml];EF值(0.25±0.02)高于对照组(0.19±0.02),但低于早期移植组(0.37±:0.02).结论 猪急性心梗3月后骨髓干细胞移植能有效抑制左室重构的进一步恶化,但其疗效不如早期移植组.%Objective To compare the effects on left ventricular remodeling of bone marrow mononuclear cells transplantation one week and three months after acute myocardial infarction.Methods Acute myocardial infarction models were successfully established in 15 swine,which were randomly divided into three groups:placebo group,early transplantation group and late trasplantation group.One week after model had been established,early transplantation group underwent bone marrow mononuclear cells transplantation,and then so did the late trasplantation group three months after acute myocardial infarction.B-ultrasound and single photon emission computed tomography (SPECT) examinations were performed to assess the left ventricular end diastolic dimension( LVd),left ventricular end diastolic volume(EDV) and left ventricular ejection fraction(EF) before and one week,three months,six months

  15. [Echocardiographic study of left ventricular geometry in spontaneously hypertensive rats].

    Science.gov (United States)

    Escudero, Eduardo M; Pinilla, Oscar A; Carranza, Verónica B

    2009-01-01

    The purpose of this study was to analyze by echocardiogram left ventricular (LV) geometry in spontaneously hypertensive rats (SHR). Echocardiographic study, systolic blood pressure and heart rate were obtained in 114 male, 4-month old rats, 73 SHR and 41 Wistar (W). Left ventricular mass index (LVMI), relative wall thickness (RWT), stroke volume, and mid ventricular shortening were calculated with echocardiographic parameters. Normal LV was defined considering the mean plus 2 SD of LVMI and RWT in W. Patterns of abnormal LV geometry were: LV concentric remodeling, LVMI 0.71; eccentric, left ventricular hypertrophy (LVH), LVMI > 2.06 mg/g - RWT 2.06 mg/g - RWT > 0.71. Systolic blood pressure (SBP) and cardiac output (CO) were used to obtain total peripheral resistance (TPR). twelve % of SHR had normal LV geometry; 18% LV concentric remodeling; 33% concentric LVH and 37% eccentric LVH. LV concentric remodeling showed the smallest CO and highest TPR of any group. Eccentric LVH presented similar SBP as the other SHR groups and high CO with lower TPR. Our findings in SHR exhibit different patterns of LV geometry like in humans. These results strengthen the similarities between SHR and human essential hypertension.

  16. Genetic heterogeneity of left-ventricular noncompaction cardiomyopathy.

    Science.gov (United States)

    Moric-Janiszewska, Ewa; Markiewicz-Łoskot, Grazyna

    2008-05-01

    Isolated noncompaction of the ventricular myocardium (INVM) sometimes referred to as spongy myocardium is a rare, congenital and also acquired cardiomyopathy. It appears to divide the presentation into neonatal, childhood and adult forms of which spongy myocardium and systolic dysfunction is the commonality. The disorder is characterized by a left ventricular hypertrophy with deep trabeculations, and with diminished systolic function, with or without associated left ventricular dilation. In half or more of the cases, the right ventricle is also affected. The sporadic type, however, in some patients, may be due to chromosomal abnormalities and the occurrence of familial incidence. Isolated noncompaction of the left ventricular myocardium in the majority of adult patients is an autosomal dominant disorder. The familial and X-linked disorders have been described by various authors. We here describe the genetic background of this disorder: some of the most mutated genes that are responsible for the disease are (G4.5 (tafazzin gene): alpha-dystrobrevin gene (DTNA); FKBP-12 gene; lamin A/C gene; Cypher/ZASP (LIM, LDB3) gene); and some genotype-phenotype correlations (Becker muscular dystrophy, Emery-Dreifuss muscular dystrophy or Barth syndrome) based on the literature review.

  17. 急诊冠状动脉介入疗法对急性 ST 段抬高型心肌梗死患者左心室功能的影响%Study on the Effect of Emergency Coronary Artery Interventional on Left Ventricular Function of Patients with Acute ST Segment Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    杜英; 兰军; 陈杰民; 蔡振明; 董家龙

    2015-01-01

    Objective:To investigate the effect of emergency coronary artery interventional on left ventricular function in patients with acute ST segment elevation myocardial infarction .Methods:70 cases of acute ST segment elevation my‐ocardial infarction in our hospital ,35 cases with emergency coronary artery interventional therapy were divided into ex‐perience group ,while the other 35 cases with selective PCI were divided into control group .The left ventricular systol‐ic and diastolic function was evaluated by ultrasonic Beckoning graph ,while the overall cardiac function was evaluated by 6min walk test of two groups .Results:The results of this study show that the left ventricular systolic and diastolic function by ultrasonic Beckoning graph of the experience group were significantly better than the control group (P<0.05);while the 6min walk test results showed that the heart function of patients in the experimental group was signif‐icantly better than the control group (P<0 .05) .Conclusion:Emergency coronary artery interventional can improve car‐diac function in patients with acute ST segment elevation myocardial infarction ,and improve the patients quality of life , it is worthy of further clinical promotion .%目的:探讨急诊冠状动脉介入疗法对急性ST段抬高型心肌梗死患者左心室功能的影响。方法:选取我院收治的急性S T段抬高患者70例,将接受急性冠状动脉介入治疗的35例患者纳入实验组,同时将接受择期冠状动脉介入治疗的35例患者纳入对照组。采用超声心动图检查以评价两组患者的左心室收缩与舒张功能,同时采用6min步行实验以评价患者总体心功能。结果:通过超声心动图结果显示,实验组患者左室收缩与舒张功能均显著优于对照组(P<0.05);同时通过6min步行实验结果发现实验组患者的心功能也显著优于对照组(P<0.05)。结论:急诊冠状动脉介入治疗能有效改

  18. Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Gerdts, Eva; Okin, Peter M; Boman, Kurt

    2012-01-01

    The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.......The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain....

  19. Insulin resistance syndrome and left ventricular mass in an elderly population (The Rotterdam Study)

    NARCIS (Netherlands)

    Rheeder, P; Stolk, RP; Mosterd, A; Pols, HAP; Hofman, A; Grobbee, DE

    1999-01-01

    In a study of elderly men and women, age, body mass index, and systolic blood pressure (and in men, also glucose) were significant predictors of left ventricular mass. Postload insulin was not independently associated with left ventricular mass.

  20. Fourier coefficient description of left ventricular shape.

    Science.gov (United States)

    Round, W H; Bates, R H; Ikram, H

    1991-12-01

    A method of quantifying the shape of the left ventricle of the heart as seen in 2D echocardiograms was developed. It is based on describing the shape in terms of the coefficients a fifth-order trigonometric Fourier series. Such a series has eleven Fourier coefficients which is too large a number for clinical application so pairs of coefficients are combined to give six coefficients (alpha 0, alpha 1, ... , alpha 5). A trial was conducted to test the ability of the coefficient description to classify subjects as having normal right ventricles or ventricles with an apical abnormality. The tests showed that one of the coefficients (alpha 2) was higher for the subjects with an apical abnormality and that this difference increased with exercise. This is as was expected. However, it was found to be difficult to get a reliable estimate of alpha 2 from a single scan of a patient and that it is therefore probably necessary to average data from several scans to obtain a reliable alpha 2 value for a single patient.

  1. Selective left ventricular sensing lead implantation to overcome undersensing of ventricular fibrillation during implantable cardioverter defibrillator implantation.

    Science.gov (United States)

    Steinberg, Christian; Philippon, François; O'Hara, Gilles; Molin, Franck

    2013-06-01

    Accurate sensing of malignant arrhythmia is critical for the appropriate delivery of therapy from implantable cardioverter defibrillators, and undersensing of ventricular tachyarrhythmias can have catastrophic consequences. Here, we present an unusual case of ventricular fibrillation undersensing from the right ventricular lead at multiple different implantation sites because of very low amplitude voltage signals during induced ventricular fibrillation. A left ventricular sensing electrode was implanted to allow correct sensing and therapy delivery.

  2. Ruptura subaguda da parede livre do ventrículo esquerdo pós-infarto agudo do miocárdio: relato de caso e revisão de literatura Post-infarct sub-acute left ventricular free wall rupture: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Alexandre Siciliano Colafranceschi

    2006-03-01

    Full Text Available A ruptura da parede livre do ventrículo esquerdo é uma complicação potencialmente fatal e de tratamento essencialmente cirúrgico. A correção cirúrgica é o tratamento de escolha, mas o manejo pré-operatório e as técnicas de correção ainda não estão claramente definidos, sendo determinados conforme as condições clínicas do paciente. Há carência na literatura de grandes séries envolvendo este tipo de afecção e os relatos são baseados nas experiências individuais, com pequeno número de pacientes. São apresentados dois casos de ruptura subaguda da parede livre do ventrículo esquerdo como complicação da evolução do infarto agudo do miocárdio. Discute-se a abordagem cirúrgica completa, com revascularização miocárdica concomitante e a utilização de circulação extracorpórea. A opção de correção do defeito por meio da sutura epicárdica com retalho de pericárdio bovino e a revascularização completa do miocárdio, sobretudo sem circulação extracorpórea, parece ser a melhor estratégia para um grupo de pacientes que apresentam ruptura subaguda da parede livre do ventrículo esquerdo pós-infarto agudo do miocárdio.Post-infarction left ventricular free wall rupture is life threatening and not uncommon. Surgical experience is largely anecdotal with different techniques being used since the first successful surgical treatment was described. Here we present two patients with subacute left ventricular rupture that were managed using different perioperative strategies. Although the aim of surgical intervention is first and foremost to remove the threat to life by relieving of tamponade and closure of the ventricular defect, longer-term goals were those of conventional coronary operations, i.e., to prevent or limit the development of angina postoperatively and to improve the prognosis. These latter goals are controversial, and are discussed. The small number of patients involved prevent us to determine which

  3. The Effect and Mechanism of Forsinopril on Ventricular Hypertrophy of SHR and Left Ventricular Pressure overloading Rat

    Institute of Scientific and Technical Information of China (English)

    黄恺; 戴闺柱

    2002-01-01

    The effects and mechanism of long-term angiotensin converting enzyme inhibitor (ACEI)Forsinopril on left ventricular hypertrophy of spontaneous hypertension rat (SHR) and left ventricular pressure overloading rat were studied. The left ventricular index (left ventricle weight/body weight) was used to evaluate left ventricular hypertrophy and the in situ hybridization to investigate the TGF-β1 gene expression in left ventricle. The results showed that Forsinopril significantly decreased the left ventricular index of both SHR and left ventricle pressure overloading rat. Forsinopril reduced the integral photic density of TGF-β1 gene statement from 2. 836± 0. 314 to 1.91 ± 0. 217(P<0.01, n=8 ) of SHR rat and from 3. 071±0. 456 to 2. 37640. 379 (P<0.01, n=8) of left ventricular pressure overloading rat respectively. It was concluded that Forsinopril could prevent the occurrence of left ventricular hypertrophy and reduce the TGF-β1 gene expression in left ventricle of both SHR and left ventricular pressure overloading rat significantly.

  4. Predictors of left ventricular remodelling and failure in right ventricular pacing in the young

    Science.gov (United States)

    Gebauer, Roman A.; Tomek, Viktor; Salameh, Aida; Marek, Jan; Chaloupecký, Václav; Gebauer, Roman; Matějka, Tomáš; Vojtovič, Pavel; Janoušek, Jan

    2009-01-01

    Aims To identify risk factors for left ventricular (LV) dysfunction in right ventricular (RV) pacing in the young. Methods and results Left ventricular function was evaluated in 82 paediatric patients with either non-surgical (n = 41) or surgical (n= 41) complete atrioventricular block who have been 100% RV paced for a mean period of 7.4 years. Left ventricular shortening fraction (SF) decreased from a median (range) of 39 (24–62)% prior to implantation to 32 (8–49)% at last follow-up (P +2z-values) and dysfunction (SF < 0.26) was found to increase from 1.3% prior to pacemaker implantation to 13.4% (11/82 patients) at last follow-up (P = 0.01). Ten of these 11 patients had progressive LV remodelling and 8 of 11 were symptomatic. The only significant risk factor for the development of LV dilatation and dysfunction was the presence of epicardial RV free wall pacing (OR = 14.3, P < 0.001). Other pre-implantation demographic, diagnostic, and haemodynamic factors including block aetiology, pacing variables, and pacing duration did not show independent significance. Conclusion Right ventricular pacing leads to pathologic LV remodelling in a significant proportion of paediatric patients. The major independent risk factor is the presence of epicardial RV free wall pacing, which should be avoided whenever possible. PMID:19286675

  5. Analysis of the Influence of the Electrical Asynchrony on Regional Mechanics of the Infarcted Left Ventricle Using Electromechanical Heart Models

    Science.gov (United States)

    Liu, Feng; Xia, Ling; Zhang, Xin

    Asynchronous electrical activation, as induced by myocardial infarction, causes various abnormalities in left ventricle function. The influence of the electrical asynchrony on regional mechanics of the left ventricle is simulated using a mechanical heart model and an electrical heart model. The mechanical model accounts for the ventricular geometry, the fiber nature of the myocardial tissue, and the dependency of the activation sequence of the ventricular wall. The electrical model is based on a heart-torso model with realistic geometry, and different action potential waveforms with variables in duration are used to simulate the abnormal electrical activation after myocardial infarction. Regional deformation, strain and stress are calculated during systole phase. The preliminary results show that asynchronous electrical activation, as an important factor, significantly affects regional mechanical performance of the infarcted left ventricle, it indicates heterogeneous contraction pattern and elevated systolic stresses near the injured region. The simulated results are compared with solutions obtained in the literature. This simulation suggests that such coupled heart models can be used to assess the mechanical function of the left ventricle with diseases such as myocardial infarction, and more realistic models of cardiac function are essential for clinical evaluation of heart disease.

  6. Permanent ligation of the left anterior descending coronary artery in mice: a model of post-myocardial infarction remodelling and heart failure.

    Science.gov (United States)

    Muthuramu, Ilayaraja; Lox, Marleen; Jacobs, Frank; De Geest, Bart

    2014-12-02

    Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure. Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling. Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail.

  7. Image quality influences the assessment of left ventricular function

    DEFF Research Database (Denmark)

    Grossgasteiger, Manuel; Hien, Maximilian D; Graser, Bastian;

    2014-01-01

    divided by the total endocardial border. These ratings were used to generate groups of poor (0%-40%), fair (41%-70%), and good (71%-100%) image quality. The ejection fraction (EF), end-diastolic volume, and end-systolic volume were analyzed by the Simpson method of disks (biplane and monoplane), eyeball......Objectives: Transesophageal echocardiography has become a standard tool for eval uating left ventricular function during cardiac surgery. However, the image quality varies widely between patients and examinations. The aim of this study was to investigate the influence of the image quality on 5...... commonly used 2-dimensional methods. Methods: Transesophageal real-time 3-dimensional echocardiography (3DE) served as a reference. Left ventricular function was evaluated in 63 patients with sufficient real-time 3DE image quality. The image quality was rated using the ratio of the visualized border...

  8. [The design of bionic left ventricular auxiliary pump].

    Science.gov (United States)

    Jin, Henglin; Hu, Xiaobing; Du, Lei

    2015-01-01

    This paper reports a novel design of bionic left ventricular auxiliary pump, and the characteristic is that elastic diaphragm of pump driven by hydraulic, having smooth, reliable blood supply, can prevent blood clots, can use the flow sensor, pressure sensor detection showing the blood pressure and blood volume at the inlet and outlet of the pump. The pump can go with heart rate synchronization or asynchronous auxiliary by the R wave of human body's ECG. The design goal is realization of bionic throb. Through the animal experiment, the blood pressure waveforms are close to expectations, stable flow can stroke according to the set value, which prove that the pump can meet the requirement for heart disease patients for bionic left ventricular assistant.

  9. Right Ventricular Function After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (from the Glycometabolic Intervention as Adjunct toPrimary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction III Trial)

    NARCIS (Netherlands)

    Gorter, Thomas M; Lexis, Chris P H; Hummel, Yoran M; Lipsic, Erik; Nijveldt, Robin; Willems, Tineke P; van der Horst, Iwan C C; van der Harst, Pim; van Melle, Joost P; van Veldhuisen, Dirk J

    2016-01-01

    Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are scarce

  10. Infarct size and recurrence of ventricular arrhythmias after defibrillator implantation

    Energy Technology Data Exchange (ETDEWEB)

    Sutter, J. de; Tavernier, R.; Kazmierckzak, J.; Buyzere, M. de; Clement, D.L. [Department of Cardiology, University Hospital Gent, Gent (Belgium); Wiele, C. van de; Dierckx, R.A. [Department of Nuclear Medicine, University Hospital Gent (Belgium); Jordaens, L. [Thoraxcenter, University Hospital Rotterdam-Dijkzigt (Netherlands)

    2000-07-01

    Infarct size as determined by perfusion imaging is an independent predictor of mortality after implantable cardioverter defibrillator (ICD) implantation in patients with coronary artery disease (CAD) and life-threatening ventricular arrhythmias (VA). However, its value as a predictor of VA recurrence and hospitalisation after ICD implantation is unknown. Therefore, the objective of this study was to evaluate whether infarct size as determined by perfusion imaging can help to identify patients who are at high risk for recurrence of VA and hospitalisation after ICD implantation. We studied 56 patients with CAD and life-threatening VA. Before ICD implantation, all patients underwent a uniform study protocol including a thallium-201 stress-redistribution perfusion study. A defect score as a measurement of infarct size was calculated using a 17-segment 5-point scoring system. Study endpoints during follow-up were documented episodes of appropriate anti-tachycardia pacing and/or shocks for VA and cardiac hospitalisation for electrical storm (defined as three or more appropriate ICD interventions within 24 h), heart failure or angina. After a mean follow-up of 470{+-}308 days, 22 patients (39%) had recurrences of VA. In univariate analysis, predictors for recurrence were: (a) ventricular tachycardia (VT) as the initial presenting arrhythmia (86% vs 59% for patients without ICD therapy, P=0.04), (b) treatment with {beta}-blockers (36% vs 68%, P=0.03) and (c) a defect score (DS) {>=}20 (64% vs 32%, P=0.03). In multivariate analysis, VT as the presenting arrhythmia ({chi}2=5.51, P=0.02) and a DS {>=}20 ({chi}2=4.22, P=0.04) remained independent predictors. Cardiac hospitalisation was more frequent in patients with a DS {>=}20 (44% vs 13% for patients with DS <20, P=0.015) and this was particularly due to more frequent hospitalisations for electrical storm (24% vs 3% for patients with DS<20, P=0.037). The extent of scarring determined by perfusion imaging can separate

  11. Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study

    DEFF Research Database (Denmark)

    Lewis, Eldrin F; Velazquez, Eric J; Solomon, Scott D

    2008-01-01

    AIMS: We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI). METHODS AND RESULTS: We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non-fatal c...

  12. Evaluation of regional left ventricular systolic dysfunction in patients with infarct and ischemia myocardial by speckle tracking imaging%斑点追踪成像技术评价梗死心肌和缺血心肌对左心室局部收缩功能的影响

    Institute of Scientific and Technical Information of China (English)

    覃琴; 周青; 邓倾; 朱丽敏; 郭瑞强

    2011-01-01

    Objective To assess the longitudinal, radial and circumferential systolic strain ( LS , RS , CS ) and strain rate ( LSR, RSR, CSR ) from regional myocardial in patients with myocardial infarction and ischemia by speckle tracking imaging STI ) and to evaluate regional left ventricular systolic dysfunction. Methods The high frame rate two-dimensional echocardiography were performed in the 30 patients of the myocardial infarction and 25 patients of the ischemia myocardial group and 25healthy subjects. The longitudinal and radial and circumferential systolic strain ( LS,RS , CS ) and strain rate ( LSR , RSR , CSR ) from 18 regional myocardial were measured in the apical 2-chamber view.apical 4-chamber view and three level of short-axis views mitral valve, papillary muscle and cardial apex ) by STI. Results Compared with normal segments , the LS , RS, CS and LSR, RSR, CSR of ischemia segments were decreased. LS and LSR were significantly decreased from control group ( P<0.05 ),while there were no significant differences in CS, CSR and RS, RSR ( P> 0.05 ).Compared with normal segments , LS , RS, CS and LSR, RSR, CSR of infarct segments were significantly decreased ( P<0.01 ). Conclusions Regional left ventricular systolic dysfunction could be accurately analyzed by LS, RS, CS and LSR , RSR, CSR from regional myocardial in patients with infarction and ischemia myocardial by STI. LS and LSR are more sensitive than other indices in myocardial ischemia.%目的 应用超声斑点追踪成像(STI)技术分析梗死心肌及缺血心肌节段心肌纵向、径向及周向的收缩期峰值应变及应变率,评价其对左心室局部心肌收缩功能的影响.方法 35例心肌梗死患者(梗死组)、25例心肌缺血患者(缺血组)和25例正常体检者(正常组),接受超声检查,采集左心室长轴观、心尖四腔观,心尖二腔观及左心室短轴观(二尖瓣环水平、乳头肌水平和心尖水平)二维灰阶图像,按左心室18节段划分法,

  13. Weight lifting training and left ventricular function in adolescent subjects.

    Science.gov (United States)

    Sagiv, M; Sagiv, M; Ben-Sira, D

    2007-09-01

    Training during adolescence may influence the myocardium's adaptation. Effects of exercise training on left ventricular function differ depending whether they result from pressure or volume overload. Accordingly, the present study was designed to examine, by echocardiography studies, the effects of endurance versus weight lifting training modes on left ventricular contractility in healthy adolescent boys. Sixty healthy adolescent boys were randomly and evenly divided into 3 groups: weightlifting training, run-training, and control. Exercising groups underwent 28-week training programs, 3-4 times a week, 35 min each session. The weight lifting program for consisted of training on 6 dynamic resistive machines at resistance corresponding to 6-repetition maximum. The running program was composed of aerobic exercise training at 65% of their VO(2max). At rest, only in the runners end diastolic volume and end systolic pressure-volume ratio differed significantly (Pweightlifters demonstrated improvement respectively in: wall stress (245+/-42 and 290+/-35 103 dyn.cm(2)), end systolic pressure-volume ratio (7.2+/-.7 and 6.4+/-.5 ratio) and ejection fraction (82+/-5% and 76+/-5%). Maximal oxygen uptake (48.2+/-3.2 and 43.8+/-3.5 mL.kg(-1).min(-1)), also improved significantly (Padolescent boys the mode of exercise training leads to significant differences in left ventricular function and contractility, related to differences in volume-after-load relationship and not to fundamental differences in the properties of the myocardium.

  14. Left ventricular dysfunction and blood glycohemoglobin levels in young diabetics

    Energy Technology Data Exchange (ETDEWEB)

    Aydiner, A.; Oto, A.; Oram, E.; Oram, A.; Ugurlu, S.; Karamehmetoglu, A. (Hacettepe Univ., Ankara (Turkey). Dept. of Cardiology); Aras, T.; Bekdik, C.F. (Hacettepe Univ., Ankara (Turkey). Dept. of Nuclear Medicine); Gedik, O. (Hacettepe Univ., Ankara (Turkey). Dept. of Endocrinology)

    1991-10-01

    Left ventricular function including regional wall motion (RWM) was evaluated by {sup 99m}Tc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart diesease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection/cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels. (orig.).

  15. Frank-starling control of a left ventricular assist device.

    Science.gov (United States)

    Stevens, Michael Charles; Gaddum, Nicholas Richard; Pearcy, Mark; Salamonsen, Robert F; Timms, Daniel Lee; Mason, David Glen; Fraser, John F

    2011-01-01

    A physiological control system was developed for a rotary left ventricular assist device (LVAD) in which the target pump flow rate (LVADQ) was set as a function of left atrial pressure (LAP), mimicking the Frank-Starling mechanism. The control strategy was implemented using linear PID control and was evaluated in a pulsatile mock circulation loop using a prototyped centrifugal pump by varying pulmonary vascular resistance to alter venous return. The control strategy automatically varied pump speed (2460 to 1740 to 2700 RPM) in response to a decrease and subsequent increase in venous return. In contrast, a fixed-speed pump caused a simulated ventricular suction event during low venous return and higher ventricular volumes during high venous return. The preload sensitivity was increased from 0.011 L/min/mmHg in fixed speed mode to 0.47L/min/mmHg, a value similar to that of the native healthy heart. The sensitivity varied automatically to maintain the LAP and LVADQ within a predefined zone. This control strategy requires the implantation of a pressure sensor in the left atrium and a flow sensor around the outflow cannula of the LVAD. However, appropriate pressure sensor technology is not yet commercially available and so an alternative measure of preload such as pulsatility of pump signals should be investigated.

  16. [Heart failure with preserved left ventricular ejection fraction].

    Science.gov (United States)

    Maeder, Micha T; Rickli, Hans

    2013-10-16

    Heart failure with preserved left ventricular ejection fraction (LVEF; HFpEF) is a common type of heart failure in the elderly, and it typically represents advanced hypertensive heart disease. The left ventricle in patients with HFpEF is characterized by concentric remodeling, normal LVEF, but reduced left longitudinal shortening, and importantly diastolic dysfunction. Dyspnoe and fatigue in patients with HFpEF are due to impaired left ventricular filling with a rapid increase in filling pressures and the lack of an increase in stroke volume during exercise. The diagnosis of HFpEF requires the careful exclusion of non-cardiac causes of dyspnoe as well as cardiac causes of dyspnoe associated with preserved LVEF other than HFpEF, primarily coronary artery disease and valve disease. Then, the following findings are required to make a diagnosis of HFpEF: a non-dilated left ventricle with an LVEF >50% and the presence of a significant diastolic impairment, which can be assessed using invasive haemodynamics, echocardiography, natriuretic peptides, or a combination of these tools. In contrast to patients with heart failure and reduced LVEF there is still no established treatment for patients with HFpEF, which prolongs survival or reduces the rate of hospitalizations for heart failure. There is currently however intense research going on in this field, and results from large trials evaluating the effects of various interventions on clinical endpoints are expected within the next years.

  17. [Surface recording of abnormal post-QRS micropotentials. Description and frequency in ventricular tachycardias after myocardial infarction].

    Science.gov (United States)

    Varenne, A; Blanc, P; Camous, J P; Grangier, L; Morand, P

    1986-10-01

    In order to study abnormal post-QRS micropotentials, so called late potentials, and to determine their frequency in post myocardial infarction ventricular tachycardia (VT), high amplification electrocardiogrammes were recorded in 180 patients classified in 3 different groups: Group A comprising 36 patients who developed sustained VT after myocardial infarction; Group B comprising 124 patients with myocardial infarction uncomplicated by VT. This group was subdivided into subgroup B1 (retrospective study of 35 patients with chronic myocardial infarction, dating on average 10 months--range 7 days to 8 years) and subgroup B2 (prospective study of 89 patients investigated on the 7th and 60th days after infarction); Group C comprising 20 young, normal control subjects. Using computer assisted high amplification electrocardiography, all patients underwent at least 3 successive recordings of the following parameters: averaging 100 cycles; sampling: 1 kHz; band pass 20-300 Hz and 80-300 Hz; gain setting 10,000 and 25,000. Late potentials usually appears, after the end of the S wave, as high frequency oscillations with an amplitude (10 to 20 microV) significantly greater than that of the background noise. Our recordings also showed: the frequent presence, especially in intraventricular blocks, of fragmentation of the end of the R wave and of the S wave or terminal potentials; the presence of an abnormal giant low frequency high amplitude wave (40 to 80 microV) in 5 patients with a large left ventricular aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    Science.gov (United States)

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  19. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Konstantinos A Gatzoulis; Dimitris Tsiachris; Petros Arsenos; Dimitris Tousoulis

    2016-01-01

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  20. Effect of different treatment methods on left ventricular remodeling after acute myocardial infarction%卡托普利联合美托洛尔治疗对改善急性心肌梗死后左心室重构的作用

    Institute of Scientific and Technical Information of China (English)

    彭晓玲

    2009-01-01

    Objective To study the effect of captopril combined with metoprolol and captopril alone on improving left ventricular remodeling(LVR)in acute myocardial infarction(AMI).Methods 100 AMI patients were randomly divided into treatment group of 50 cases(captopril combined metoprolol treatment)and 50 cases in the control group(captopril treatment).Using color Doppler ultrasound to deteimine left ventricular shape,configuration and indicators to compare two groups left ventricular remodeling after early(<2gh);3;6 month end.Results The indices of RaPD;ASL in control group after 6 months end[(63.01±4.10)%and(10.69 ±1.8)cm]were higher than the treatment group[(60.91±3.21)and(10.69±1.8)cm](t=2.121;2.210,all P<0.05);The LVEF in treatment group after 6 months(51.10±4.60)%were higher than the treatment group(49.10±5,10)%(t=2.231,P<0.05).Conclusion The captopril combined metoprolol on left ventricular remodeling inhibition significantly better than captopril alone in AMI.%目的 探讨应用卡托普利联合美托洛尔治疗对改善急性心肌梗死(AMI)后左心室重构的作用.方法 100例AMI患者随机分成治疗组50例(卡托普利联合美托洛尔治疗)和对照组50例(卡托普利治疗),采用彩色多普勒心动超声仪分别于发病后早期(<24 h)、3、6个月末观察左心室形态、构型等多项指标,比较两组发生左心室重构情况.结果 对照组6个月末RaPD、ASL分别为[(63.0l±4.10)%、(10.69±1.8)cm]高于治疗组[(60.91±3.21)、(10.69±1.8)cm](t=2.121、2.210,均P<0.05);治疗组6个月末LVEF(51.10±4.60)%高于对照组(49.10±5.10)%(t=2.231,P<0.05).结论 AMI后应用卡托普利联合美托洛尔对晚期并发左心室重构的抑制作用明显.

  1. Quantitative evaluation of left ventricular global systolic function in patients with myocardial infarction by three-dimensional speckle tracking echocardiography%超声三维斑点追踪成像评价心肌梗死患者左心室整体收缩功能的研究

    Institute of Scientific and Technical Information of China (English)

    王丁; 邓又斌; 黄润青

    2012-01-01

    Objective To evaluate the value and characteristics of left ventricular global systolic strain and its relation to the left ventricular global systolic function in patients with myocardial infarction(MI) by three-dimensional speckle tracking echocardiography (3D-STI).Methods In 24 patient subjects and 20 control subjects,the myocardial motion was tracking by 3D-STI,left ventricular ejection fraction(LVEF),and global longitudinal peak systolic strain(LVGLS),global circular peak systolic strain(LVGCS),global radial peak systolic strain(LVGRS),global area peak systolic strain(LVGAS) were measured.The values were compared between the two groups,the correlations between LVEF and LVGLS,LVGCS,LVGRS,LVGAS were analyzed respectively.Results (1)There was significant difference of each index about LVEF and global strain between normal group and MI group (all P <0.05).(2)The correlations among LVEF and LVGLS,LVGCS,LVGRS,LVGAS were found (r =-0.626,-0.770,0.772,-0.748 respectively,P <0.01 for all).(3) Bland-Altman analysis showed there were good agreements in both patients with MI and control subjects.Conclusions 3D-STI could be applied non-invisibly and objective to assess alteration of myocardial global systolic function by accurately measuring strain.Therefore,3D-STI appears to be a reliable and useful tool to estimate the left ventricular systolic function of MI.%目的 应用超声三维斑点追踪技术评价心肌梗死患者的左室整体应变特征及与左室整体收缩功能的相关性.方法 使用三维斑点追踪技术对24例心肌梗死患者及20例正常人进行心肌运动分析,测量左室射血分数(LVEF),左室整体纵向、圆周、径向及面积收缩期峰值应变,并比较心肌梗死组与正常组之间的各应变指标变化情况及与LVEF的相关性.结果 三维斑点追踪技术测得心肌梗死患者的LVEF及各整体心肌应变参数均较正常组减低(P<0.05).心肌梗死组左室整体纵向、圆周、径向及面

  2. Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    胡小莹

    2013-01-01

    Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture(VSR)following acute myocardial infarction(AMI).Methods A total of 70 consecutive VSR patients following AMI hospitalized in

  3. Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    胡小莹

    2013-01-01

    Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture(VSR)following acute myocardial infarction(AMI).Methods A total of 70 consecutive VSR patients following AMI

  4. Ivabradine protects against ventricular arrhythmias in acute myocardial infarction in the rat.

    Science.gov (United States)

    Mackiewicz, Urszula; Gerges, Joseph Y; Chu, Sandy; Duda, Monika; Dobrzynski, Halina; Lewartowski, Bohdan; Mączewski, Michał

    2014-06-01

    Ventricular arrhythmias are an important cause of mortality in the acute myocardial infarction (MI). To elucidate effect of ivabradine, pure heart rate (HR) reducing drug, on ventricular arrhythmias within 24 h after non-reperfused MI in the rat. ECG was recorded for 24 h after MI in untreated and ivabradine treated rats and episodes of ventricular tachycardia/fibrillation (VT/VF) were identified. Forty-five minutes and twenty-four hours after MI epicardial monophasic action potentials (MAPs) were recorded, cardiomyocyte Ca(2+) handling was assessed and expression and function of ion channels were studied. Ivabradine reduced average HR by 17%. Combined VT/VF incidence and arrhythmic mortality were higher in MI versus MI + Ivabradine rats. MI resulted in (1) increase of Ca(2+) sensitivity of ryanodine receptors 24 h after MI; (2) increase of HCN4 expression in the left ventricle (LV) and funny current (IF) in LV cardiomyocytes 24 h after MI, and (3) dispersion of MAP duration both 45 min and 24 h after MI. Ivabradine partially prevented all these three potential proarrhythmic effects of MI. Ivabradine is antiarrhythmic in the acute MI in the rat. Potential mechanisms include prevention of: diastolic Ca(2+)-leak from sarcoplasmic reticulum, upregulation of IF current in LV and dispersion of cardiac repolarization. Ivabradine could be an attractive antiarrhythmic agent in the setting of acute MI.

  5. Epicardial and endocardial mapping determine most successful site of ablation for ventricular tachyarrhythmias originating from left ventricular summit.

    Science.gov (United States)

    Iijima, Kenichi; Chinushi, Masaomi; Furushima, Hiroshi; Aizawa, Yoshifusa

    2012-06-01

    A 34-year-old woman presented with idiopathic premature ventricular complex (PVC) and ventricular tachycardia (VT) originating from the area called the left ventricular summit. Radiofrequency (RF) application both through the coronary sinus and to the epicardial surface transiently suppressed the VT/PVC. Radiofrequency with sufficient energy was only applicable from the endocardial site, and the VT/PVC was successfully eliminated.

  6. Left Ventricular Non-compaction Cardiomyopathy - A Case Report

    Directory of Open Access Journals (Sweden)

    Timea Szakacs Xantus

    2015-06-01

    Full Text Available Background: Left non-compaction cardiomyopathy (LVNC or “spongy myocardium” is a relatively rare primary genetic cardiomyopathy, characterized by prominent wall trabeculations and intertrabecular recesses which communicate with the ventricular cavity. It appears in isolated form or coexists with other congenital heart diseases and/or systemic abnormalities. Material and method: A 28-year-old woman was admitted with exertional dyspnoea, palpitations, non-specific chest pain and progressive fatigue on exertion. In her family history sudden cardiac-related deaths at young age are present. Cardiovascular system examination revealed tachycardia, intermittent extrabeats. The rest EKG showed sinusal tachycardia (105 bpm, negative T-waves in DII, DIII, aVF, V4-V6. Consecutive 24 hours Holter EKG monitoring revealed nonsustained ventricular tachycardia, paroxysmal atrial fibrillation, isolated ventricular extrasystoles. Echocardiography showed left ventricular systolic dysfunction (LVEF:30-35%, slight LV enlargement, normal right ventricle and small left ventricle (LV trabeculae in the apical area. Cardiac MRI demonstrated dilated LV and the presence of the trabeculations of LV walls suggestive for non-compaction cardiomyopathy. A combined treatment for heart failure and cardiac arrhythmias was initiated with good clinical results. Patient was scheduled for an implantable cardioverter defibrillator “life-saving”. Conclusions: The symptoms of heart failure and cardiac arrhythmias should be considered important in apparently healthy young patients. Besides intensive medical treatment is indicated the implantation of an ICD “life-saving” and in advanced cases heart transplantation. Even if the electrocardiographic findings are non specific for noncompaction, a complete diagnostic evaluation is important, including sophisticated imaging techniques, a screening of first-degree relatives, and an extensive clinical, and genetic appreciation by a

  7. [Acute cerebral ischemia: an unusual clinical presentation of isolated left ventricular noncompaction in an adult patient].

    Science.gov (United States)

    Fiorencis, Andrea; Quadretti, Laura; Bacich, Daniela; Chiodi, Elisabetta; Mele, Donato; Fiorencis, Roberto

    2013-01-01

    Isolated left ventricular noncompaction in adults is uncommon. The most frequent clinical manifestations are heart failure due to left ventricular systolic dysfunction and supraventricular and ventricular arrhythmias, which may be sustained and associated with sudden death. Thromboembolic complications are also possible. We report the case of an adult patient with isolated left ventricular noncompaction who came to our observation because of acute cerebral ischemia, an initial presentation of the disease only rarely described.

  8. Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non-compaction.

    Science.gov (United States)

    Jacquier, Alexis; Thuny, Franck; Jop, Bertrand; Giorgi, Roch; Cohen, Frederic; Gaubert, Jean-Yves; Vidal, Vincent; Bartoli, Jean Michel; Habib, Gilbert; Moulin, Guy

    2010-05-01

    To describe a method for measuring trabeculated left ventricular (LV) mass using cardiac magnetic resonance imaging and to assess its value in the diagnosis of left ventricular non-compaction (LVNC). Between January 2003 and 2008, we prospectively included 16 patients with LVNC. During the mean period, we included 16 patients with dilated cardiomyopathy (DCM), 16 patients with hypertrophic cardiomyopathy (HCM), and 16 control subjects. Left ventricular volumes, LV ejection fraction, and trabeculated LV mass were measured in the four different populations. The percentage of trabeculated LV mass was almost three times higher in the patients with LVNC (32 +/- 10%), compared with those with DCM (11 +/- 4%, P < 0.0001), HCM (12 +/- 4%, P < 0.0001), and controls (12 +/- 5%, P < 0.0001). A value of trabeculated LV mass above 20% of the global mass of the LV predicted the diagnosis of LVNC with a sensitivity of 93.7% [95% confidence interval (CI), 71.6-98.8%] and a specificity of 93.7% (95% CI, 83.1-97.8%; kappa = 0.84). The method described is reproducible and provides an assessment of the global amount of LV trabeculation. A trabeculated LV mass above 20% of the global LV mass is highly sensitive and specific for the diagnosis of LVNC.

  9. Abrogation of CC chemokine receptor 9 ameliorates ventricular remodeling in mice after myocardial infarction.

    Science.gov (United States)

    Huang, Yan; Wang, Dandan; Wang, Xin; Zhang, Yijie; Liu, Tao; Chen, Yuting; Tang, Yanhong; Wang, Teng; Hu, Dan; Huang, Congxin

    2016-01-01

    CC chemokine receptor 9 (CCR9), which is a unique receptor for CC chemokine ligand (CCL25), is mainly expressed on lymphocytes, dendritic cells (DCs) and monocytes/macrophages. CCR9 mediates the chemotaxis of inflammatory cells and participates in the pathological progression of inflammatory diseases. However, the role of CCR9 in the pathological process of myocardial infarction (MI) remains unexplored; inflammation plays a key role in this process. Here, we used CCR9 knockout mice to determine the functional significance of CCR9 in regulating post-MI cardiac remodeling and its underlying mechanism. MI was induced by surgical ligation of the left anterior descending coronary artery in CCR9 knockout mice and their CCR9+/+ littermates. Our results showed that the CCR9 expression levels were up-regulated in the hearts of the MI mice. Abrogation of CCR9 improved the post-MI survival rate and left ventricular (LV) dysfunction and decreased the infarct size. In addition, the CCR9 knockout mice exhibited attenuated inflammation, apoptosis, structural and electrical remodeling compared with the CCR9+/+ MI mice. Mechanistically, CCR9 mainly regulated the pathological response by interfering with the NF-κB and MAPK signaling pathways. In conclusion, the data reveal that CCR9 serves as a novel modulator of pathological progression following MI through NF-κB and MAPK signaling.

  10. Assessment of Left Ventricular Radial Deformation by Speckle Tracking Imaging

    Institute of Scientific and Technical Information of China (English)

    Min PAN; Hao LUO; Ashraf Muhammad; Schultheis Judy; Xiaokui LI; David J. Sahn

    2009-01-01

    The left ventricular radial strain in the inner and outer layers was evaluated by using two-dimensional speckle tracking imaging (2DS). Twenty-five piglets were studied. The short axis views were acquired. Peak systolic radial strain was measured from 6 circumferential points related to 6 standard segments in the inner and outer layers respectively using 2DS methods. The peak positive first derivative (dp/dt) of left ventricular pressure was compared to the radial strain from 2DS. The inner band showed higher peak radial strain values as compared to the outer band at all of the segments (P<0.0001), but the differences had significance just in anteroseptal, posterior, inferior and septal seg-ments (P<0.05). Good correlation could be found between radial strain of inner and outer layers and peak dp/dt (P<0.001). These preliminary results showed that the degree of local deformation or wall thickening of the ventricular wall in its inner layer was more obvious than its outer layer. It is suggested that the 2DS technique is useful and sensitive for better understanding the regional and global myocar-dial motion and its relationship to the complex architecture of myocardium.

  11. Robust left ventricular myocardium segmentation for multi-protocol MR

    Science.gov (United States)

    Groth, A.; Weese, J.; Lehmann, H.

    2012-02-01

    For a number of cardiac procedures like the treatments of ventricular tachycardia (VT), coronary artery disease (CAD) and heart failure (HF) both anatomical as well as vitality information about the left ventricular myocardium are required. To this end, two images for the anatomical and functional information, respectively, must be acquired and analyzed, e.g. using two different 3D MR protocols. To enable automatic analysis, a workflow has been proposed1 which allows to integrate the vitality information extracted from the functional image data into a patient-specific anatomical model generated from the anatomical image. However, in the proposed workflow the extraction of accurate vitality information from the functional image depends to a large extend on the accuracy of both the anatomical model and the mapping of the model to the functional image. In this paper we propose and evaluate methods for improving these two aspects. More specifically, on one hand we aim to improve the segmentation of the often low-contrast left ventricular epicardium in the anatomical 3D MR images by introducing a patient-specific shape-bias. On the other hand, we introduce a registration approach that facilitates the mapping of the anatomical model to images acquired by different protocols and modalities, such as functional 3D MR. The new methods are evaluated on clinical MR data, for which considerable improvements can be achieved.

  12. Using mathematical morphology to determine left ventricular contours

    Energy Technology Data Exchange (ETDEWEB)

    Pladellorens, J. (Universitat Politecnica de Catalunya (Spain). Dept. d' Optica i Optometria); Serrat, J. (Universitat Autonoma de Barcelona (Spain). Dept. d' Informatica); Castell, A. (Hospital de la Vall d' Hebro, Barcelona (Spain). Dept. de Medicina Nuclear); Yzuel, M.J. (Universitat Autonoma de Barcelona (Spain). Dept. de Fisica)

    1993-12-01

    Mathematical morphology is used for the determination of left ventricular contours in scintigraphic images using multigated radionuclide angiography. The authors developed a completely automatic method that first restores the image with a Wiener filter, then finds the region where the left ventricle is contained, and finally segments the left ventricle contour and a background zone. The contours depend on the values of the parameters that appear in the mathematical morphology method, which are related to the height and the slope of the count distribution. Results obtained with this method are compared with the contours and the background zones outlined by experts on the basis of the number of counts, and the authors study the values of the parameters with which optimum correlation is obtained. (author).

  13. Dutch survey of congenital coronary artery fistulas in adults: coronary artery-left ventricular multiple micro-fistulas multi-center observational survey in the Netherlands.

    NARCIS (Netherlands)

    Said, S.A.M.; Werf, T. van der

    2006-01-01

    BACKGROUND: Congenital coronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) in adults are rare anomalies. They may cause angina pectoris and myocardial infarction in association with normal coronary arteries. METHODS AND RESULTS: From the medical databases of a Dutch Survey of corona

  14. Left Ventricular Assist Devices: The Adolescence of a Disruptive Technology.

    Science.gov (United States)

    Pinney, Sean P

    2015-10-01

    Clinical outcomes for patients with advanced heart failure receiving left ventricular assist devices are driven by appropriate patient selection, refined surgical technique, and coordinated medical care. Perhaps even more important is innovative pump design. The introduction and widespread adoption of continuous-flow ventricular assist devices has led to a paradigm shift within the field of mechanical circulatory support, making the promise of lifetime device therapy closer to reality. The disruption caused by this new technology, on the one hand, produced meaningful improvements in patient survival and quality of life, but also introduced new clinical challenges, such as bleeding, pump thrombosis, and acquired valvular heart disease. Further evolution within this field will require financial investment to sustain innovation leading to a fully implantable, durable, and cost-effective pump for a larger segment of patients with advanced heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Ultrasonic evaluation of the relationship between left ventricular hypertrophy or left ventricular geometry and endothelial function in patients with essential hypertension

    Institute of Scientific and Technical Information of China (English)

    Jing Dong; Pingyang Zhang; Xuehong Feng; Chong Wang; Pei Wang

    2009-01-01

    Objective: To assess the relationship between left ventricular hypertrophy (LVH) or left ventricular geometry (LVG) and endothelial function in patients with essential hypertension (EH). Methods: Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia (DIRH) or nitroglycerin (DING) was detected using high-resolution ultrasonography. Results: DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH (4.36±2.54% vs 8.56+1.87 %; P 0.05). While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index (LVMI) correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure (r=-0.61, P < 0.0001; r=0.27, P < 0.05; r=0.31, P < 0.05, respectively), a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia. Conclusion: Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.

  16. LEFT VENTRICULAR ROTATION, TWIST AND UNTWIST: PHYSIOLOGICAL ROLE AND CLINICAL RELEVANCE

    Directory of Open Access Journals (Sweden)

    E. N. Pavlyukova

    2015-01-01

    Full Text Available The helical ventricular myocardial band of Torrent-Guasp is a new concept, which provides strong grounds for reconciliation of some important aspects in cardiovascular medicine. Oblique fiber orientation provides left ventricular rotation, which in addition to radial thickening and longitudinal shortening, is predicted as an essential component of the effective left ventricular pumping. Left ventricular rotation can be measured in clinical practice noninvasively using echocardiography and this provides new opportunities for the assessment of different aspects of left ventricular mechanical function.

  17. 三维斑点追踪成像技术评价急性前壁心肌梗死患者左心室收缩功能%Evaluation of Left Ventricular Systolic Function in Acute Anterior Myocardial Infarction with Three-dimensional Speckle Tracking Imaging

    Institute of Scientific and Technical Information of China (English)

    于蓝; 王银荣; 田永梅; 李玉宏

    2014-01-01

    Purpose To discuss the feasibility of evaluating left ventricular systolic function in patients with acute anterior myocardial infarction (AAMI) with three-dimensional speckle tracking imaging (3D-STI). Materials and Methods Thirty AAMI patients were examined with 3D-STI technique in terms of left ventricular longitudinal strain (LS), radial strain (RS), circumferential strain (CS), area strain (AS), global longitudinal strain (GLS), global riadial strain (GRS), global circumferential strain (GCS) and global area strain (GAS). The results were compared with those of 30 healthy persons and the strain values in normal segments of those AAMI patients. The threshold, sensibility and specificity of those parameters in diagnosing myocardial infarction were analyzed. Results Compared with healthy group, LS reduced in 12 out of 17 segments (12/17), RS reduced in 10/17, CS in 9/17 and AS in 11/17;they mainly focused in the base segment, middle and apex of anterior wall, the base segment and the middle of anterior septal, the apex of aboral septal, and the middle segment, apex of the lateral wall. The GLS, GRS, GCS and GAS were all lower than those in healthy group (differences with statistic signiifcance:P<0.05). In AAMI patient, LS, RS, CS and AS in the infarcted segments were lower compared with those in the normal segments (differences with statistic signiifcance:P<0.05). ROC curve analysis showed that the sensitivity of LS, RS, CS and AS were 89.2%, 79.0%, 77.9%, 85.3%, respectively in the diagnosis of myocardial infarction, and the speciifcity were 65.8%, 71.0%, 66.9%and 92.3%, respectively. The sensitivity of the GLS, GRS, GCS and GAS were 91.2%, 74.0%, 68.9%, 85.3%, respectively in the diagnosis of myocardial infarction, and the speciifcity were 69.8%, 71.0%, 76.9%and 93.3%, respectively. Conclusion 3D-STI can detect the strain values of LV segments efficiently and accurately so as to discriminate normal and infracted segments, which provides a reliable measurement

  18. Anatomic considerations for abdominally placed permanent left ventricular assist devices.

    Science.gov (United States)

    Parnis, S M; McGee, M G; Igo, S R; Dasse, K; Frazier, O H

    1989-01-01

    To determine anatomic parameters for a permanent, electrically actuated left ventricular assist device (LVAD), the effects of abdominal placement of pneumatic LVADs used as temporary support for patients awaiting heart transplantation was studied. Understanding the anatomic constraints imposed by the abdominal viscera in LVAD placement is crucial, because improper placement can result in compression or obstruction of adjacent structures. Anatomic compatibility was assessed in four men (age 22-48 years) who were supported by the LVAD for over 1 month (range 35-132 days). The pump was intraperitoneally placed in the left upper quadrant. Radiographic techniques were employed, including CT scanning (with patients supine) and contrast imaging (patients in anatomical position), and the pump and conduits appeared to be properly positioned, with minimal compression of the body of the stomach, and no obstruction of adjacent organs. Three patients returned to a solid food diet and exercised daily by stationary cycling and walking. No signs of migration or erosion of the pump were present at the time of LVAD removal and cardiac transplantation. Successful clinical experience with short-term use of the LVAD suggests that the electrically actuated device can be well tolerated in patients requiring permanent left ventricular assistance.

  19. Resection of left ventricular fibroma with subacute papillary muscle rupture.

    Science.gov (United States)

    Leja, Monika J; Perryman, Lynda; Reardon, Michael J

    2011-01-01

    Cardiac fibroma is a rare, benign tumor that occurs chiefly in children and rarely in adults. Most fibromas occur in the ventricles and may reach a very large size that complicates surgical removal. Herein, we report the case of a 38-year-old woman who presented with shortness of breath, fatigue, and lightheadedness and was found to have a 6 × 8-cm fibroma of the left ventricle. Surgical resection was successful, but 7 days later she developed sudden-onset severe mitral regurgitation due to partial disruption of the posterolateral papillary muscle. Mitral valve replacement with a 27-mm mechanical valve was performed. Five years later, the patient remained well, without evident tumor recurrence or cardiac dysfunction.Mitral valve dysfunction with regurgitation has been reported to occur before, immediately after, and late after the resection of left ventricular fibromas. To our knowledge, this is the 1st report of subacute papillary muscle rupture after the resection of a left ventricular fibroma. This case highlights the need to evaluate mitral valve function by carefully inspecting the resection margins after surgery and interpreting the echocardiographic results during the acute, subacute, and late time frames.

  20. A large left atrial myxoma causing multiple cerebral infarcts.

    Science.gov (United States)

    Kebede, Saba; Edmunds, Eiry; Raybould, Adrian

    2013-11-27

    A 52-year-old man presented with a history of sudden onset diplopia. On neurological examination, the only abnormality was a right-sided oculomotor (third nerve) palsy. A brain CT was performed and reported as showing no abnormality. He was discharged to be investigated as an outpatient. He presented 1 month later with a new expressive dysphasia and confusional state. MRI was performed which revealed multiple cerebral infarcts. He was discharged on secondary stroke prevention medication. Six months elapsed, before a transthoracic echocardiogram was performed. This showed a large left atrial myxoma. The patient underwent an emergency resection and made a good postoperative recovery. This case report showed the importance of considering a cardiogenic source of emboli in patients who present with cerebral infarcts. Performing echocardiography early will help to detect treatable conditions such as atrial myxoma, and prevent further complications.

  1. Prognostic significance of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy and systemic hypertension (the LIFE Study)

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Palmieri, Vittorio; Gerdts, Eva;

    2010-01-01

    Patients with hypertension and left ventricular (LV) hypertrophy commonly have impaired diastolic filling. However, it remains unknown whether changes in LV diastolic filling variables are associated with cardiovascular morbidity and mortality. In this study, 778 patients with hypertension...... valve flow pattern, this was not associated with reduced cardiovascular morbidity and mortality when adjusting for blood pressure, left atrial diameter, LV mass index, and treatment in time-varying Cox analyses. In contrast, lower in-treatment E/A ratios and shorter mitral valve deceleration times were...... associated with less risk for heart failure. Similarly, normal in-treatment transmitral flow pattern was strongly associated with less risk for heart failure (hazard ratio 0.22, 95% confidence interval 0.05 to 0.98, p = 0.048), even when taking in-treatment left atrial diameter and blood pressure...

  2. Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction

    Science.gov (United States)

    Bonow, Robert O.; Maurer, Gerald; Lee, Kerry L.; Holly, Thomas A.; Binkley, Philip F.; Desvigne-Nickens, Patrice; Drozdz, Jaroslaw; Farsky, Pedro S.; Feldman, Arthur M.; Doenst, Torsten; Michler, Robert E.; Berman, Daniel S.; Nicolau, Jose C.; Pellikka, Patricia A.; Wrobel, Krzysztof; Alotti, Nasri; Asch, Federico M.; Favaloro, Liliana E.; She, Lilin; Velazquez, Eric J.; Jones, Robert H.; Panza, Julio A.

    2012-01-01

    BACKGROUND The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. METHODS In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of pre-specified thresholds. RESULTS Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P = 0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). CONCLUSIONS The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone. (Funded by the National Heart, Lung, and Blood Institute; STICH ClinicalTrials.gov number, NCT00023595.) PMID:21463153

  3. Survival after blunt left ventricular rupture with cardiac tamponade

    Institute of Scientific and Technical Information of China (English)

    Yu-Jang Su; Chang-Chih Chen

    2013-01-01

    A34-year-old man was drunk and drove to hit a traffic island.Cold sweating and unconscious status were found on arrival.Vital signs revealedBP42/25, and heart rate121/min.There was massive pericardial effusion with cardiac tamponade found byCT.Immediate surgical intervention and rupture of left ventricular(LV) free wall was found.He was discharged after2 d intensive care unit(ICU) observation and5-day regular ward care.There is high mortality rate in traumatic heart rupture although timely repair, over all mortality is around20%-36% in recent3 years.

  4. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

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    Fahad Almehmadi

    2016-01-01

    Full Text Available Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  5. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression.

    Science.gov (United States)

    Almehmadi, Fahad; Chandy, Mark; Connelly, Kim A; Edwards, Jeremy

    2016-01-01

    Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  6. Survival after blunt left ventricular rupture with cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2013-01-01

    Full Text Available A 34-year-old man was drunk and drove to hit a traffic island. Cold sweating and unconscious status were found on arrival. Vital signs revealed BP 42/25, and heart rate 121/min. There was massive pericardial effusion with cardiac tamponade found by CT. Immediate surgical intervention and rupture of left ventricular (LV free wall was found. He was discharged after 2 d intensive care unit (ICU observation and 5-day regular ward care. There is high mortality rate in traumatic heart rupture although timely repair, over all mortality is around 20%-36% in recent 3 years.

  7. Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats.

    Science.gov (United States)

    Ward, Jessica L; Schober, Karsten E; Fuentes, Virginia Luis; Bonagura, John D

    2012-10-01

    Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats.

  8. Effects of hypokalemia on transmural dispersion of ventricular repolarization in left ventricular myocardium

    Institute of Scientific and Technical Information of China (English)

    Jiang-Hua Zhong; Shi-Juan Lu; Mo-Shui Chen; Zi-Bin Chen; Liu Wang; Ping-Sheng Wu

    2013-01-01

    Objective: To observe effects of hypokalemia on transmural heterogeneity of ventricular repolarization in left ventricular myocardium of rabbit, and explore the role of hypokalemia in malignant ventricular arrhythmia (MVA). Methods: A total of 20 rabbits were randomly divided into control group and hypokalemic group. Isolated hearts in the control group were simply perfused with modified Tyrode's solution, and were perfused with hypokalemic Tyrode's solution in hypokalemic group. Ventricular fibrillation threshold (VFT), 90% monophasic action potential repolarization duration (APD90) of subepicardial, midmyocardial and subendocardial myocardium, transmural dispersion of repolarization (TDR) and Cx43 protein expression in three layers of myocardium were measured in both groups. Results: VFT in the control group and the hypokalemic group were (13.40±2.95) V, and (7.00±1.49) V, respectively. There was a significant difference between two groups (P<0.01). APD90 of three myocardial layers in the hypokalemic group were significantly prolonged than those in the control group (P<0.01). APD90 in the hypokalemic group and the control group were (38.10±10.29) ms and (23.70±5.68) ms, and TDR were (52.90±14.55) ms and (36.10±12.44) ms, respectively. APD90 and TDR in the hypokalemic group were significantly higher than those in the control group (P<0.05), and the increase in APD90 of midmyocardium was more significant in the hypokalemic group. Cx43 protein expression of all three myocardial layers were decreased significantly in the hypokalemic group (P<0.01), and Cx43 was significantly increased (P<0.05). Reduction of Cx43 protein expression was more significant in the midmyocardium. Conclusions: Hypokalemic can increase transmural heterogeneity of Cx43 expression and repolarization in left ventricular myocardium of rabbit, and decrease VFT and can induce MVA more easily.

  9. [Left Ventricular Rupture during Both Mitral and Aortic Valve Replacements].

    Science.gov (United States)

    Kurumisawa, Soki; Aizawa, Kei; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Ohki, Shinnichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-05-01

    A 73-year-old woman on hemodialysis was transferred to our hospital for surgical treatment of heart valve disease. She required both mitral and aortic valve replacement with mechanical valves, associated with tricuspid annuloplasty. After aortic de-clamping, a massive hemorrhage from the posterior atrioventricular groove was observed. Under repeated cardiac arrest, the left atrium was reopened, the implanted mitral prosthetic valve was removed and a type I left ventricular rupture (Treasure classification) was diagnosed. The lesion was directly repaired with mattress stitches and running sutures, using reinforcement materials such as a glutaraldehyde-treated bovine pericardium. To avoid mechanical stress by the prosthetic valve on the repaired site, a mechanical valve was implanted using a translocation method. The patient suffered from aspiration pneumonia and disuse atrophy for 3 months. However, she was doing well at 1 year post-operation.

  10. Circulating levels of persistent organic pollutants (POPs) are associated with left ventricular systolic and diastolic dysfunction in the elderly.

    Science.gov (United States)

    Sjöberg Lind, Ylva; Lind, P Monica; Salihovic, Samira; van Bavel, Bert; Lind, Lars

    2013-05-01

    Major risk factors for congestive heart failure (CHF) are myocardial infarction, hypertension, diabetes, atrial fibrillation, smoking, left ventricular hypertrophy (LVH) and obesity. However, since these risk factors only explain part of the risk of CHF, we investigated whether persistent organic pollutants (POPs) might also play a role. In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, left ventricular ejection fraction, (EF), E/A-ratio and isovolumic relaxation time (IVRT), were determined by echocardiography and serum samples of 21 POPs were analyzed in serum measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 998 subjects all aged 70 years. In this cross-sectional analysis, high levels of several of the polychlorinated biphenyls (PCB congeners 99, 118, 105, 138, 153, and 180) and octachlorodibenzo-p-dioxin (OCDD) were significantly related to a decreased EF. Some POPs were also related to a decreased E/A-ratio (PCBs 206 and 209). All the results were adjusted for gender, hypertension, diabetes, smoking, LVH and BMI, and subjects with myocardial infarction or atrial fibrillation were excluded from the analysis. Circulating levels of POPs were related to impairments in both left ventricular systolic and diastolic function independently of major congestive heart failure risk factors, suggesting a possible role of POPs in heart failure. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. 应变率成像对急性前壁心肌梗死患者右室功能的评价%Evaluation of right ventricular function in patients with acute left ventricular anterior myocardial infarction by strain rate imaging

    Institute of Scientific and Technical Information of China (English)

    苏军芳; 张军; 张海滨; 王晶明; 郑烨; 田新桥; 贺建国

    2011-01-01

    Objective To evaluate the clinical value of strain rate imaging ( SRI) in quantitative assessment of right ventricular( RV) regional myocardial function. Methods Twenty patients with acute myocardial infarction( AMI) and thirty control subjects were enrolled in the study. Longitudinal peak strain rate of posterior interventricular septum ( PS) and RV walls during systole, early diastole and atrium contraction ( SRS, SRE and SRA) were measured at different levels ( basal middle and apical) . SRI data were compared with coronary angiography results. Results SRS in all levels of PS ( basal. middle and apical)and base RV wall was significantly decreased in AMI group (P <0. 05 ) , SRE in all levels of PS and base and middle level of RV in AMI group was significantly lower than that of control group (P < 0. 05) , SRA in middle and apex level of PS in AMI group was significantly decreased compared with control group ( P < 0. 05 ) . Conclusion SRI is sensitive and feasible in evaluating RV function of acute LV anterior wall myocardial infarction.%目的 探讨应变率成像(SRI)定量评价急性前壁心肌梗死(AMI)患者右室局部心肌功能的临床价值.方法 AMI组20例,健康者30例为对照组,SRI测量其后间隔及右室侧壁不同水平的纵向收缩期、舒张早期及心房收缩期的峰值应变率(SRS、SRE、SRA),并以冠状动脉造影结果为参照进行对比分析.结果 AMI组后间隔基底段、中段、心尖段及右室侧壁基底段的SRS较对照组减低(P<0.05);AMI组后间隔基底段、中段、心尖段及右室侧壁基底段、中段的SRE较对照组减低(P<0.05);AMI组后间隔中段、心尖段的SRA较对照组减低(P<0.05).结论 SRI技术是临床无创、定量评价AMI患者右室局部心肌功能的有效方法.

  12. Left ventricular hypertrophy in obese hypertensives: is it really eccentric? (An echocardiographic study).

    Science.gov (United States)

    Smalcelj, A; Puljević, D; Buljević, B; Brida, V

    2000-06-01

    In order to study left ventricular hypertrophy patterns in obese hypertensives, we examined 132 patients with essential hypertension by 2D, M-mode and Doppler echocardiography. The patients were classified in four comparable groups, corresponding to the values of Quetelet's body mass index (BMI) and grades of obesity. More obese hypertensives had on average larger left ventricles with thicker walls and larger left atria than less obese, or lean ones. Left ventricular mass increased significantly and progressively with advancing grades of obesity, but relative wall thickness (wall thickness/cavity size ratio) did not diminish. Doppler echocardiography revealed significantly higher prevalence of left ventricular diastolic dysfunction among obese than among lean hypertensives. In the second part of our study, we analyzed the subgroups defined by the severity of hypertension and the age of the patients. The correlation of the indices of left ventricular and left atrial hypertrophy with the BMI values was considerably better in the group of moderate than in the group of mild hypertension. The r values were 0.62 vs. 0.22 for left ventricular mass and 0.64 vs. 0.26 for left atrial dimension. The group of patients with severe hypertension was characterized by left ventricular cavity enlargement in correlation with increasing BMI values, but without corresponding left ventricular wall thickening. So called left ventricular "eccentricity index", as the reverse value of relative wall thickness, correlated well (r = 0.76) with the BMI values. The indices of left ventricular hypertrophy correlated with the BMI values slightly better in middle age groups than in the groups of the youngest ( or = 61 years) hypertensives. In conclusion, eccentric left ventricular hypertrophy does not seem to be a distinctive feature of hypertensive heart disease in obesity. There is only some tendency toward the "eccentricity" of left ventricular geometry which becomes more apparent in more severe

  13. Ventricular fibrillation induced by a radiofrequency energy delivery for idiopathic premature ventricular contractions arising from the left ventricular anterior papillary muscle.

    Science.gov (United States)

    Yamada, Takumi; McElderry, H Thomas; Allred, James D; Doppalapudi, Harish; Kay, G Neal

    2009-08-01

    A 73-year-old man with idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Left ventricular activation mapping revealed a focal mechanism of the PVCs with the earliest activation on the anterior papillary muscle (APM). Irrigated radiofrequency (RF) current delivered at that site induced a cluster of non-sustained ventricular tachycardia episodes with the same QRS morphology as the PVCs, followed by ventricular fibrillation (VF). The APM might have served as an abnormal automatic trigger and driver for the VF occurrence. Ventricular fibrillation may occur as a complication during RF catheter ablation of papillary muscle ventricular arrhythmias even if the clinical arrhythmia is limited to PVCs.

  14. Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency

    Science.gov (United States)

    Nishiyama, Motohiro; Shirakawa, Motoaki

    2017-01-01

    Protein C deficiency is a risk of venous thrombosis because of poor fibrinolytic activity. It remains controversial whether protein C deficiency causes arterial thrombosis. A 21-year-old woman was referred with a chief complaint of right leg pain and numbness. Contrast-enhanced computed tomography revealed a low-density mass in the left ventricle (LV), splenic infarction, and peripheral arterial obstructions in her right leg. Thrombosis extending from the renal vein to the inferior vena cava was also detected. Electrocardiography revealed ST depression in leads II, III, and aVF. Transthoracic echocardiography revealed hypokinesis of the apex and interventricular septum and a hypoechoic mass in the LV (26 × 20 mm). She was diagnosed with acute arterial obstruction caused by the LV thrombus, which might have resulted from previous myocardial infarction. Protein C activation turned out to be low (41%) 5 days after admission. The anticoagulant therapy was switched from heparin to rivaroxaban 16 days after admission. The LV thrombus disappeared 24 days after initial treatment, and she has had no thrombotic episodes for 2.8 years under rivaroxaban therapy. Thrombophilia should be investigated for cases of simultaneous left ventricular and deep venous thrombi. Rivaroxaban can be effective in prevention of further thrombotic events. PMID:28194181

  15. Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Abderrahmane Bakkali

    2016-12-01

    Full Text Available Objective: The aim of this study was to evaluate the effect of aortic valve replacement on left ventricular function and remodeling among patients with severe aortic stenosis and severe left ventricular dysfunction. Methods: In this retrospective bicentric study extended over a 15-year period, 61 consecutive patients underwent isolated AVR for severe AS associated to reduced LV function. The mean age was 58.21 ± 12.50 years and 83.60 % were men. 70.50% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF was 32.9 ± 5.6.The mean LVEDD and LVESD were respectively 63.6 ± 9.2 and 50.2 ± 8.8 mm. The mean calculated logistic EuroScore was 12.2 ±4.5. Results: The hospital mortality was 11.5%. Morbidity was marked mainly by low output syndrome in 40.8% of cases. After a median follow-up of 38 months we have recorded 3 deaths. Almost all survivors were in class I and II of NYHA. The mean LV end-diastolic and end-systolic diameters decreased significantly at late postoperative stage. The mean LV ejection fraction increased significantly from 32.9 ± 5.6 to 38.2 ± 9.3 and to 50.3 ± 9.6 in early and late postoperative stages, respectively. Multivariate linear regression analysis found that increased early postoperative LVEF (β= 0.44, 95% CI [0.14; 0.75], p=0.006 and low mean transprosthesis gradient (β=-0.72, 95% CI [-1.42; -0.02], p= 0.04 were the independent predictors of left ventricular systolic function recovery. Conclusion: Patients with aortic valve stenosis and impaired LV systolic function benefited from AVR as regard improvement of LV function parameters and regression of the LV diameters .This improvement depends mainly on early postoperative LVEF and mean transprosthesis gradient.

  16. Hydraulic forces contribute to left ventricular diastolic filling

    Science.gov (United States)

    Maksuti, Elira; Carlsson, Marcus; Arheden, Håkan; Kovács, Sándor J.; Broomé, Michael; Ugander, Martin

    2017-03-01

    Myocardial active relaxation and restoring forces are known determinants of left ventricular (LV) diastolic function. We hypothesize the existence of an additional mechanism involved in LV filling, namely, a hydraulic force contributing to the longitudinal motion of the atrioventricular (AV) plane. A prerequisite for the presence of a net hydraulic force during diastole is that the atrial short-axis area (ASA) is smaller than the ventricular short-axis area (VSA). We aimed (a) to illustrate this mechanism in an analogous physical model, (b) to measure the ASA and VSA throughout the cardiac cycle in healthy volunteers using cardiovascular magnetic resonance imaging, and (c) to calculate the magnitude of the hydraulic force. The physical model illustrated that the anatomical difference between ASA and VSA provides the basis for generating a hydraulic force during diastole. In volunteers, VSA was greater than ASA during 75-100% of diastole. The hydraulic force was estimated to be 10-60% of the peak driving force of LV filling (1-3 N vs 5-10 N). Hydraulic forces are a consequence of left heart anatomy and aid LV diastolic filling. These findings suggest that the relationship between ASA and VSA, and the associated hydraulic force, should be considered when characterizing diastolic function and dysfunction.

  17. Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Bernd Hewing

    2016-10-01

    Full Text Available Background/Aims: Cardiac changes observed in chronic kidney disease patients are of multifactorial origin including chronic uremia, hemodynamics or inflammation. Restoration of renal function by kidney transplantation (KTX may reverse cardiac changes. Novel echocardiographic methods such as speckle tracking echocardiography (STE allow early and sensitive detection of subtle changes of cardiac parameters. We evaluated changes of cardiac structure and function after KTX by advanced echocardiographic modalities. Methods: Thirty-one KTX recipients (female n=11 were evaluated by medical examination, laboratory testing and echocardiography before and after KTX (median follow-up 19 months. Left ventricular (LV and right ventricular (RV diameters and function were assessed by echocardiographic standard parameters. Longitudinal 2D strain of the LV (GLPS and left atrium (LA was determined by 2D STE. Results: After KTX, median serum creatinine level was 1.3 mg/dl (IQR, 1.2-1.5. Systolic blood pressure decreased significantly after KTX. Echocardiography showed a significant reduction in LV end-diastolic septal and posterior wall thickness and LV mass index after KTX, which was accompanied by an improvement of GLPS. There were no relevant changes in parameters of LA (reservoir, conduit or contractile function, LV diastolic or RV function after KTX. Conclusion: LV hypertrophy reversed after successful KTX and was accompanied by an improvement in longitudinal LV function as assessed by STE. Diastolic function and STE-derived LA function parameters did not change significantly after KTX.

  18. Dietary phosphorus is associated with greater left ventricular mass.

    Science.gov (United States)

    Yamamoto, Kalani T; Robinson-Cohen, Cassianne; de Oliveira, Marcia C; Kostina, Alina; Nettleton, Jennifer A; Ix, Joachim H; Nguyen, Ha; Eng, John; Lima, Joao A C; Siscovick, David S; Weiss, Noel S; Kestenbaum, Bryan

    2013-04-01

    Dietary phosphorus consumption has risen steadily in the United States. Oral phosphorus loading alters key regulatory hormones and impairs vascular endothelial function, which may lead to an increase in left ventricular mass (LVM). We investigated the association of dietary phosphorus with LVM in 4494 participants from the Multi-Ethnic Study of Atherosclerosis, a community-based study of individuals who were free of known cardiovascular disease. The intake of dietary phosphorus was estimated using a 120-item food frequency questionnaire and the LVM was measured using magnetic resonance imaging. Regression models were used to determine associations of estimated dietary phosphorus with LVM and left ventricular hypertrophy (LVH). Mean estimated dietary phosphorus intake was 1167 mg/day in men and 1017 mg/day in women. After adjustment for demographics, dietary sodium, total calories, lifestyle factors, comorbidities, and established LVH risk factors, each quintile increase in the estimated dietary phosphate intake was associated with an estimated 1.1 g greater LVM. The highest gender-specific dietary phosphorus quintile was associated with an estimated 6.1 g greater LVM compared with the lowest quintile. Higher dietary phosphorus intake was associated with greater odds of LVH among women, but not men. These associations require confirmation in other studies.

  19. Does in-hospital ventricular fibrillation affect prognosis after myocardial infarction?

    DEFF Research Database (Denmark)

    Jensen, G V; Torp-Pedersen, C; Hildebrandt, P;

    1997-01-01

    AIM: The aim of this study was to estimate the prognostic information to be gained from ventricular fibrillation in patients with myocardial infarction. METHODS AND RESULTS: We studied 4259 consecutive patients with myocardial infarction admitted to one centre in 1977-1988. Five hundred and twenty......-eight (12.4%) of the patients had ventricular fibrillation in hospital. The following risk factors were included in multivariate models to estimate their importance for 30-day and long-term (median 7 year) prognosis: age, gender, ventricular fibrillation, congestive heart failure, pulmonary oedema......, cardiogenic shock, other cardiac arrest and atrial fibrillation. We found that the odds ratio for death on days 6.30 was 6.34 (3.55-11.30, 95% confidence limits, P ventricular fibrillation (without heart failure) and 4.06 (2.68-6.14, P ventricular...

  20. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic.

    Science.gov (United States)

    Cramariuc, Dana; Gerdts, Eva

    2016-08-01

    Left ventricular hypertrophy (LVH) is a common complication to hypertension, indicating the presence of hypertensive heart disease, which puts the patient at a very high risk for subsequent clinical cardiovascular events like sudden cardiac death, stroke, myocardial infarction and heart failure. The epidemiology of LVH has changed in recent years as a consequence of the development of new diagnostic tools and demographic changes in hypertensive populations. Expert commentary: In individual hypertensive patients, the presence and type of LVH and associated systolic and diastolic myocardial dysfunction is modified by the co-presence of other cardiovascular risk factors and comorbidities and as well as activation of the reninangiotensin-aldosterone system and other molecular mechanisms involved in LVH pathophysiology. The purpose of this review is to give a clinical update on LVH in hypertension.