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Sample records for reduced regional myocardial

  1. Endoscopic retrograde cholangiopancreatography causes reduced myocardial blood flow

    DEFF Research Database (Denmark)

    Christensen, M; Hendel, H W; Rasmussen, V;

    2002-01-01

    ). PATIENTS AND METHODS: 11 patients scheduled for ERCP were monitored with a Holter tape recorder and underwent myocardial perfusion scintigraphies, to evaluate myocardial perfusion at rest and during ERCP. RESULTS: Ten patients completed the study. Eight patients had no sign of myocardial ischemia...... with either of the two methods, while two patients developed signs of ischemia during ERCP with both the Holter tape recording and on myocardial scintigraphy (P = 0.02). CONCLUSIONS: Patients undergoing ERCP may develop true myocardial ischemia with reduced myocardial blood flow. Although this is a small...

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

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

    1982-09-01

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

  3. Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H; Pless, P; Nielsen, J R

    1992-01-01

    In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy...... less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144...... myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study....

  4. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction.

    Directory of Open Access Journals (Sweden)

    Tor Biering-Sørensen

    Full Text Available Global longitudinal systolic strain (GLS has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI. The aim of this study was to evaluate the prognostic value of regional longitudinal myocardial deformation in comparison to GLS, conventional echocardiography and clinical information.In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI, treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were examined by tissue Doppler imaging (TDI and two-dimensional strain echocardiography (2DSE.During a median-follow-up of 5.3 (IQR 2.5-6.1 years the primary endpoint (death, heart failure or a new MI was reached by 145 (38.9% patients. After adjustment for significant confounders (including conventional echocardiographic parameters and culprit lesion, reduced longitudinal performance in the anterior septal and inferior myocardial regions (but not GLS remained independent predictors of the combined outcome. Furthermore, inferior myocardial longitudinal deformation provided incremental prognostic information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032. In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p<0.05 for all deformation parameters.Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional echocardiographic risk factors. Furthermore, impaired longitudinal deformation outside the culprit lesion perfusion region seems to be a paramount marker of adverse outcome.

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

    Science.gov (United States)

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

    2014-05-01

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

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

    Science.gov (United States)

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

    1978-07-01

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

  7. PET and MRI for the evaluation of regional myocardial perfusion and wall thickening after myocardial infarction

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    Slart, Riemer H.J.A.; Golestani, Reza; Glaudemans, Andor W.J.M. [University Medical Center Groningen, University of Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands); Glauche, Julius; Jansen, Jan W. [University Medical Center Groningen, University of Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands); University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen (Netherlands); Zeebregts, Clark J. [University Medical Center Groningen, University of Groningen, Department of Surgery, Division of Vascular Surgery, Groningen (Netherlands); Dierckx, Rudi A.J.O. [University Medical Center Groningen, University of Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands); Ghent University Hospital, Department of Nuclear Medicine, Ghent (Belgium); Oudkerk, Matthijs; Willems, Tineke P. [University Medical Center Groningen, University of Groningen, Department of Radiology, Groningen (Netherlands); Boersma, Hendrikus H. [University Medical Center Groningen, University of Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands); University Medical Center Groningen, University of Groningen, Clinical and Hospital Pharmacy, Groningen (Netherlands); Tio, Rene A. [University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen (Netherlands)

    2012-06-15

    Deterioration of left ventricular (LV) function after myocardial infarction (MI) is a major cause of heart failure. Myocardial perfusion performance may play an important role in deterioration or improvement in LV function after MI. The aim of this study was to evaluate the myocardial perfusion reserve (MPR) and stress perfusion in deteriorating and non-deteriorating LV segments in patients after MI by PET and MRI, respectively. Regional wall thickening of 352 segments in 22 patients was assessed at 4 and 24 months after MI by cardiac MRI. PET was performed to evaluate MPR and adenosine stress {sup 13}N-ammonia perfusion 24 months after MI. Segments were divided into four groups according to deterioration or improvement in wall thickening. Normal functional segments at 4 months after MI that remained stable had a significantly higher mean MPR and mean stress perfusion PET value than deteriorated segments (p < 0.001). Furthermore, dysfunctional segments that improved had a significantly higher mean stress perfusion PET value than dysfunctional segments that remained dysfunctional (p < 0.001). This study demonstrated the additional value of myocardial perfusion assessment in relation to the functional integrity of the injured myocardium. Segmental functional LV improvement after MI was associated with better regional myocardial perfusion characteristics. Furthermore, the amount of wall thickening reduction was associated with regional myocardial perfusion abnormalities in patients after MI. (orig.)

  8. 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.

  9. Regional time-density measurement of myocardial perfusion

    Science.gov (United States)

    Eusemann, Christian D.; Breen, Jerome F.; Robb, Richard A.

    2003-05-01

    The measurement of time-density relationships of the myocardium in studies of Magnetic Resonance perfusion data sets is a clinical technique used in assessing myocardial perfusion. Traditionally, to measure the time-density relationship a physician draws a region on the same 2-D image of the myocardium in sequential cardiac cycles. Throughout multiple cardiac cycles the density changes in this region are measured. A major limitation of this technique is change in anatomy relative to the selected region on the myocardium during consecutive cardiac cycles. This causes measurement errors, which are amplified if the traced region does not encompass the entire myocardial thickness, or includes a boundary exterior to the epicardial or endocardial surface. The technique described in this paper uses approximately the same myocardial region throughout the entire perfusion study, which insures inclusion of the entire endocardial to epicardial region and exclusion of exterior regions. Moreover, this region can be subdivided into smaller regions of interest. This can be accomplished by careful segmentation and reformatting of the data into polar coordinates. This allows sectioning both axially and transaxially through the myocardium permitting regional assessment of perfusion specific values such as maximum and/or the time to reach maximum density. These values can then be illustrated using density-mapped colors or time-density curves. This measurement and display technique may provide enhanced detection and evaluation of regional deficits in myocardial contractility and perfusion.

  10. Effect of regional myocardial ischemia on sympathetic nervous system as assessed by fluorine-18-metaraminol

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    Schwaiger, M.; Guibourg, H.; Rosenspire, K.; McClanahan, T.; Gallagher, K.; Hutchins, G.; Wieland, D.M. (Univ. of Michigan Medical Center, Ann Arbor (USA))

    1990-08-01

    With the introduction of radiolabeled catecholamine analogues, the noninvasive evaluation of the cardiac sympathetic nervous system has become possible. This study evaluated the effect of regional ischemia on myocardial retention of the new norepinephrine analogue 6-({sup 18}F) fluorometaraminol (FMR) in the open chest dog model. Six dogs were injected intravenously with FMR following 30-min occlusion of the left anterior descending artery. Six sham animals served as control group. Regional myocardial blood flow as determined by microspheres decreased 87% during ischemia (p less than 0.01), but was not significantly different from control myocardium following reperfusion. Regional myocardial 18F activity as determined postmortem was significantly reduced in reperfused myocardium (-34%), which paralleled an 18% reduction of tissue norepinephrine concentration. Thus, short time periods of coronary occlusion affect neuronal function indicating the sensitivity of the sympathetic nerve terminals to ischemia. FMR provides a new tracer approach for the characterization of neuronal integrity in postischemic myocardium.

  11. Does retirement reduce the risk of myocardial infarction?

    DEFF Research Database (Denmark)

    Olesen, Kasper; Rugulies, Reiner; Rod, Naja Hulvej;

    2014-01-01

    adjusting for age, sex, income, occupational position, education, cohabitation and immigrant status. The participants were followed for up to 7 years. RESULTS: Of the study population, 3% were diagnosed with MI during follow-up. Retirement was associated with a modestly higher risk of MI with a hazard ratio......BACKGROUND: Recent studies have suggested that retirement may have beneficial effects on health outcomes. In this study we examined whether the risk of myocardial infarction (MI) was reduced following retirement in a Danish population sample. METHODS: Participants were 617 511 Danish workers, born...

  12. Quantitative analysis and parametric display of regional myocardial mechanics

    Science.gov (United States)

    Eusemann, Christian D.; Bellemann, Matthias E.; Robb, Richard A.

    2000-04-01

    Quantitative assessment of regional heart motion has significant potential for more accurate diagnosis of heart disease and/or cardiac irregularities. Local heart motion may be studied from medical imaging sequences. Using functional parametric mapping, regional myocardial motion during a cardiac cycle can be color mapped onto a deformable heart model to obtain better understanding of the structure- to-function relationships in the myocardium, including regional patterns of akinesis or diskinesis associated with ischemia or infarction. In this study, 3D reconstructions were obtained from the Dynamic Spatial Reconstructor at 15 time points throughout one cardiac cycle of pre-infarct and post-infarct hearts. Deformable models were created from the 3D images for each time point of the cardiac cycles. Form these polygonal models, regional excursions and velocities of each vertex representing a unit of myocardium were calculated for successive time-intervals. The calculated results were visualized through model animations and/or specially formatted static images. The time point of regional maximum velocity and excursion of myocardium through the cardiac cycle was displayed using color mapping. The absolute value of regional maximum velocity and maximum excursion were displayed in a similar manner. Using animations, the local myocardial velocity changes were visualized as color changes on the cardiac surface during the cardiac cycle. Moreover, the magnitude and direction of motion for individual segments of myocardium could be displayed. Comparison of these dynamic parametric displays suggest that the ability to encode quantitative functional information on dynamic cardiac anatomy enhances the diagnostic value of 4D images of the heart. Myocardial mechanics quantified this way adds a new dimension to the analysis of cardiac functional disease, including regional patterns of akinesis and diskinesis associated with ischemia and infarction. Similarly, disturbances in

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

    Science.gov (United States)

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

    2009-01-01

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

  14. Physiologically tolerable insulin reduces myocardial injury and improves cardiac functional recovery in myocardial ischemic/reperfused dogs.

    Science.gov (United States)

    Zhang, Hang-Xiang; Zang, Yi-Min; Huo, Jian-Hua; Liang, Shao-Jun; Zhang, Hai-Feng; Wang, Yue-Min; Fan, Qian; Guo, Wen-Yi; Wang, Hai-Chang; Gao, Feng

    2006-12-01

    This study was designed to examine whether physiologically tolerable insulin, which maintains lower blood glucose, can protect the myocardium against ischemia/reperfusion (I/R) injury in a preclinical large animal model. Adult dogs were subjected to 50 minutes of myocardial ischemia (80% reduction in coronary blood flow) followed by 4 hours of reperfusion and treated with vehicle, glucose-insulin-potassium (GIK; glucose, 250 g/L; insulin, 60 U/L; potassium, 80 mmol/L), GK, or low-dose insulin (30 U/L) 10 minutes before reperfusion. Treatment with GIK exerted significant cardioprotective effects as evidenced by improved cardiac function, improved coronary blood flow, reduced infarct size, and myocardial apoptosis. In contrast, treatment with GK increased blood glucose level and aggravated myocardial I/R injury. It is interesting that treatment with insulin alone at the dose that reduced blood glucose to a clinically tolerable level exerted significant cardioprotective effects that were comparable to that seen in the GIK-treated group. This low-dose insulin had no effect on coronary blood flow after reperfusion but markedly reduced coronary reactive hyperemia and switched myocardial substrate uptake from fat to carbohydrate. Our results suggest that lower glucose supply to the ischemic myocardium at early reperfusion may create a "metabolic postconditioning" and thus reduce myocardial ischemia/reperfusion injury after prolonged reperfusion.

  15. Regional differences of myocardial infarct development and ischemic preconditioning.

    Science.gov (United States)

    Schulz, Rainer; Gres, Petra; Konietzka, Ina; Heusch, Gerd

    2005-01-01

    The spatial and temporal development of myocardial infarction depends on the area at risk (AAR), the severity and duration of blood flow reduction (energy supply) as well as on heart rate and regional wall function (energy demand). Both supply and demand can vary within the AAR of a given heart, potentially resulting in differences in infarct development. We therefore retrospectively analyzed infarct size (IS, %AAR, TTC) in 24 anesthetized pigs in vivo following 90 min hypoperfusion and 120 min reperfusion of the LAD coronary artery, which supplies parts of the LV septum (LVS) and anterior free wall (LVAFW). The total LAD perfusion territory averaged 49.8 +/- 14.2 (SD) g (49.2 +/- 8.4% of LV); 61.4 +/- 8.1% of the AAR was LVAFW. IS within the LVS was 25.3 +/- 15.1%, while IS within the LVAFW was 16.6 +/-10.1% (p<0.05). While ischemic blood flow (radiolabeled microspheres) did not differ between LVS (0.05 +/- 0.02 ml/min/g) and LVAFW (0.05 +/- 0.03 ml/min/g), perivascular connective tissue (56 +/- 9 vs. 38+/-7 microm(2), p < 0.05) and the capillary-to-myocyte distance (1.65 +/- 0.23 vs. 1.18 +/- 0.23 mm, p < 0.05) were larger in LVS than in LVAFW. Interestingly, IS in LVS (9.3 +/- 9.6%, n = 24) and LVAFW (9.2 +/- 9.1%) were reduced to the same absolute extent by ischemic preconditioning with one cycle of 10 min ischemia and 15 min reperfusion, suggesting that a similar regional difference exists also in the protection afforded by ischemic preconditioning. The mechanism(s) for that remain(s) to be established. In pigs, regional differences in infarct development and protection from it exist in the LAD perfusion territory, which are independent of ischemic blood flow but apparently related to pre-existing structural differences.

  16. Desvenlafaxine reduces apoptosis in amygdala after myocardial infarction.

    Science.gov (United States)

    Malick, Mandy; Gilbert, Kim; Barry, Mathieu; Godbout, Roger; Rousseau, Guy

    2014-10-01

    This study was designed to determine if desvenlafaxine (DV), a serotonin-norepinephrine reuptake inhibitor, can attenuate apoptosis observed in the limbic system after myocardial infarction (MI). MI was induced in rats by occlusion of the left descending artery for 40 min followed by reperfusion. Another group of sham (control) rats was similarly manipulated, but without occlusion. Half of the full cohort received DV (3 mg/kg/day intraperitoneal), starting 5 min after the onset of reperfusion; the other half received the vehicle (0.5 ml of 0.9% saline). Rats were sacrificed after 3 days for biochemical analyses and MI size measurements. Infarct size was significantly smaller in DV- compared to vehicle-treated rats. At 3 days post-MI, caspase-3 and -8 activities and terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling-positive cells were decreased in the amygdala of DV-treated rats compared to MI-vehicle controls. No difference was observed between the sham groups. The data indicates that DV given immediately after an acute MI event can reduce MI size and apoptosis in amygdala when measured three days post-MI. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Chronic Metformin Treatment is Associated with Reduced Myocardial Infarct Size in Diabetic Patients with ST-segment Elevation Myocardial Infarction

    NARCIS (Netherlands)

    Lexis, Chris P. H.; Wieringa, Wouter G.; Hiemstra, Bart; van Deursen, Vincent M.; Lipsic, Erik; van der Harst, Pim; van Veldhuisen, Dirk J.; van der Horst, Iwan C. C.

    2014-01-01

    Increased myocardial infarct (MI) size is associated with higher risk of developing left ventricular dysfunction, heart failure and mortality. Experimental studies have suggested that metformin treatment reduces MI size after induced ischaemia but human data is lacking. We aimed to investigate the e

  18. Assessment of Left Ventricular Longitudinal Regional Myocardial Systolic Function by Strain Imaging Echocardiography in Patients with Hypertrophic Cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    LIU Yani; DENG Youbin; LI Xiulan; CHANG Qing; LU Yongping; LI Chunlei

    2005-01-01

    To assess the left ventricular longitudinal regional myocardial systolic function by strain imaging (SI) echocardiography and to study the relationship between regional myocardial systolic function and left ventricular structure in patients with hypertrophic cardiomyopathy (HCM). SI echocardiography were performed in 18 patients with HCM and 17 healthy subjects. For each wall,regional myocardial systolic strain was analyzed at the basal, mid, and apical level respectively.And the peak systolic strain was measured. Our results showed that the patients with HCM had reduced peak systolic strain at almost each segment of different walls when compared with healthy subjects. There was significant correlation between the mid-septum peak systolic strain and the thickness of IVS, so was the correlation between the mid-septum peak systolic strain and the IVS to LVPW thickness ratio. This study demonstrated that the left ventricular longitudinal regional myocardial systolic function was abnormal in HCM, and this kind of abnormalities existed extensively in hypertrophic and non-hypertrophic cardiac segments. The degrees of left ventricle hypertrophy and asymmetry are related to the myocardial regional systolic function in HCM.

  19. Detecting regional changes in myocardial contraction patterns using MRI

    Science.gov (United States)

    Sanchez-Ortiz, Gerardo I.; Chandrashekara, Raghavendra; Rhode, Kawal S.; Razavi, Reza; Hill, Derek L. G.; Rueckert, Daniel

    2004-04-01

    Measuring changes in cardiac motion patterns can assist in diagnosing the onset of arrhythmia and ischaemia and in the follow-up of treatment. This work presents a methodology for measuring such motion changes from MR images. Non-rigid registration is used to track cardiac motion in a sequence of 3D tagged MR images. We use a cylindrical coordinate system to subdivide the myocardium into smaller anatomically meaningful regions and to express motion derived measurements such as displacement and strain for each myocardial region during the cardiac cycle. In the first experiment we have evaluated the proposed methods using synthetic image sequences where the ground truth was available. These images were generated using a cardiac motion simulator for tagged MRI. Normal and abnormal motion fields were produced by modifying parameters in a small region of the myocardium. In the second experiment we have acquired two separate tagged MR image sequences from five healthy volunteers. Both acquisitions have been carried out without moving the volunteer inside the scanner, thus avoiding potential misregistration errors due to subject motion between scans. In addition, one of volunteers was subjected to stress during one of the scans. In the final experiment we acquired tagged MR images from a patient with super-ventricular tachyarrhythmia, before and after radio frequency ablation. The image acquisition and catheter intervention were performed with a combined X-ray and MRI system. Detection results were correct on synthetic data and no region was incorrectly classified as having significant changes in the repetition studies. Significant changes in motion pattern were measured in the stress and ablation studies. Furthermore, results seem to corroborate that the ablation regularised cardiac contraction.

  20. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Jensen, Jan Skov; Pedersen, Sune H;

    2016-01-01

    BACKGROUND: Global longitudinal systolic strain (GLS) has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI). The aim of this study was to evaluate the prognostic value of regional longitudinal...... myocardial deformation in comparison to GLS, conventional echocardiography and clinical information. METHOD: In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All...... patients were examined by tissue Doppler imaging (TDI) and two-dimensional strain echocardiography (2DSE). RESULTS: During a median-follow-up of 5.3 (IQR 2.5-6.1) years the primary endpoint (death, heart failure or a new MI) was reached by 145 (38.9%) patients. After adjustment for significant confounders...

  1. Hepatocyte growth factor gene therapy reduces ventricular arrhythmia in animal models of myocardial ischemia.

    Directory of Open Access Journals (Sweden)

    Yumoto,Akihisa

    2005-06-01

    Full Text Available

    It was recently reported that gene therapy using hepatocyte growth factor (HGF has the potential to preserve cardiac function after myocardial ischemia. We speculated that this HGF gene therapy could also prevent ventricular arrhythmia. To investigate this possibility, we examined the antiarrhythmic effect of HGF gene therapy in rat acute and old myocardial infarction models. Myocardial ischemia was induced by ligation of the left descending coronary artery. Hemagglutinating virus of Japan (HVJ-coated liposome containing HGF genes were injected directly into the myocardium fourteen days before programmed pacing. Ventricular fibrillation (VFwas induced by programmed pacing. The VF duration was reduced and the VF threshold increased after HGF gene therapy ( p< 0.01. Histological analyses revealed that the number of vessels in the ischemic border zone was greatly increased after HGF gene injection. These findings revealed that HGF gene therapy has an anti-arrhythmic effect after myocardial ischemia.

  2. Is reduced myocardial sympathetic innervation associated with clinical symptoms of autonomic impairment in idiopathic Parkinson's disease?

    Science.gov (United States)

    Guidez, Daniel; Behnke, Stefanie; Halmer, Ramona; Dillmann, Ulrich; Faßbender, Klaus; Kirsch, Carl M; Hellwig, Dirk; Spiegel, Jörg

    2014-01-01

    Patients with idiopathic Parkinson's disease (IPD) have a reduced myocardial MIBG uptake in MIBG scintigraphy, indicating myocardial sympathetic denervation. We were interested whether this myocardial sympathetic denervation coincides with clinical symptoms of autonomic impairment in IPD patients. We performed MIBG scintigraphy, the SCOPA-AUT scale, a standardized medical history (developed in our clinic) and autonomic nervous system testing in 47 IPD patients (21 female, 26 male patients). We correlated myocardial MIBG uptake with the results of the SCOPA-AUT scale, the standardized medical history and the autonomic nervous system testing through the use of Spearman's correlation. Myocardial MIBG uptake correlated significantly (p autonomic nervous system testing (all patients: sum score, Ewing orthostasis test). Remarkably, we found more significant correlations in male than in female patients. Reduced myocardial sympathetic innervation-as revealed by MIBG scintigraphy-is associated with clinical symptoms of autonomic impairment. This association is more pronounced in male than in female patients. The cause for this gender-specific phenomenon is unclear.

  3. Heparins with reduced anti-coagulant activity reduce myocardial reperfusion injury.

    Science.gov (United States)

    Barry, William H; Kennedy, Thomas P

    2011-05-01

    Heparin which is desulfated at the 2-O and 3-O positions (ODSH) has reduced anti-coagulant properties, and reduced interaction with heparin antibodies. Because of the reduced anti-coagulant effect, ODSH can be safely administered to animals and humans intravenously at doses up to 20 mg/kg, resulting in a serum concentration of up to 250µg/ml. Administration of ODSH causes a 35% reduction in infarct size in dogs and pigs subjected to coronary artery occlusion and reperfusion when given 5 min before reperfusion. ODSH has anti-inflamatory effects, manifest as a decrease in neutrophil infiltration into ischemic tissue at high doses, but this effect does not entirely account for the reduction in infarct size. ODSH decreases Na(+) and Ca(2+) loading in isolated cardiac myocytes subjected to simulated ischemia. This effect appears due to an ODSH-induced reduction in an enhanced Na(+) influx via the Na channel in the membrane of cardiac myocyes caused by oxygen radicals generated during ischemia and reperfusion. Reduction in Na(+) influx decreases Ca(2+) loading by reducing Ca2(+) influx via Na/Ca exchange, thus reducing Ca(2+) - dependent reperfusion injury. ODSH does not appear to interact with antibodies to the heparin/platelet factor 4 complex, and does not cause heparin-induced thrombocytopenia. Because of these therapeutic and safety considerations, ODSH would appear to be a promising heparin derivative for prevention of reperfusion injury in humans undergoing thrombolytic or catheter-based reperfusion for acute myocardial infarction. The review article discussed the use of heparin and the discussion of some of the important patents, including: US6489311; US7478358; PCTUS2008070836 and PCTUS2009037836.

  4. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Gimelli, Alessia; Masci, Pier Giorgio; Pasanisi, Emilio Maria; Lombardi, Massimo [Fondazione CNR/Regione Toscana, Pisa (Italy); Liga, Riccardo; Grigoratos, Chrysanthos [University Hospital of Pisa, Pisa (Italy); Marzullo, Paolo [Fondazione CNR/Regione Toscana, Pisa (Italy); Institute of Clinical Physiology, CNR, Pisa (Italy)

    2014-09-15

    To assess the relationships between myocardial structure and function on cardiac magnetic resonance (CMR) imaging and sympathetic tone on {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy early after myocardial infarction (MI). Ten patients underwent {sup 123}I-MIBG and {sup 99m}Tc-tetrofosmin rest cadmium zinc telluride scintigraphy 4 ± 1 days after MI. The segmental left ventricular (LV) relative radiotracer uptake of both {sup 99m}Tc-tetrofosmin and early {sup 123}I-MIBG was calculated. The day after scintigraphy, on CMR imaging, the extent of ischaemia-related oedema and of myocardial fibrosis (late gadolinium enhancement, LGE) was assessed. Accordingly, the extent of oedema and LGE was evaluated for each segment and segmental wall thickening determined. Based on LGE distribution, LV segments were categorized as ''infarcted'' (56 segments), ''adjacent'' (66 segments) or ''remote'' (48 segments). Infarcted segments showed a more depressed systolic wall thickening and greater extent of oedema than adjacent segments (p < 0.001) and remote segments (p < 0.001). Interestingly, while uptake of {sup 99m}Tc-tetrofosmin was significantly depressed only in infarcted segments (p < 0.001 vs. both adjacent and remote segments), uptake of {sup 123}I-MIBG was impaired not only in infarcted segments (p < 0.001 vs. remote) but also in adjacent segments (p = 0.024 vs. remote segments). At the regional level, after correction for {sup 99m}Tc-tetrofosmin and LGE distribution, segmental {sup 123}I-MIBG uptake (p < 0.001) remained an independent predictor of ischaemia-related oedema. After acute MI the regional impairment of sympathetic tone extends beyond the area of altered myocardial perfusion and is associated with myocardial oedema. (orig.)

  5. Quantification of regional myocardial oxygenation by magnetic resonance imaging: validation with positron emission tomography.

    Science.gov (United States)

    McCommis, Kyle S; Goldstein, Thomas A; Abendschein, Dana R; Herrero, Pilar; Misselwitz, Bernd; Gropler, Robert J; Zheng, Jie

    2010-01-01

    A comprehensive evaluation of myocardial ischemia requires measures of both oxygen supply and demand. Positron emission tomography (PET) is currently the gold standard for such evaluations, but its use is limited because of its ionizing radiation, limited availability, and high cost. A cardiac MRI method was developed for assessing myocardial oxygenation. The purpose of this study was to evaluate and validate this technique compared with PET during pharmacological stress in a canine model of coronary artery stenosis. Twenty-one beagles and small mongrel dogs without coronary artery stenosis (controls) or with moderate to severe acute coronary artery stenosis underwent MRI and PET imaging at rest and during dipyridamole vasodilation or dobutamine stress to induce a wide range of changes in cardiac perfusion and oxygenation. MRI first-pass perfusion imaging was performed to quantify myocardial blood flow and volume. The MRI blood oxygen level-dependent technique was used to determine the myocardial oxygen extraction fraction during pharmacological hyperemia. Myocardial oxygen consumption was determined by the Fick law. In the same dogs, (15)O-water and (11)C-acetate were used to measure myocardial blood flow and myocardial oxygen consumption, respectively, by PET. Regional assessments were performed for both MR and PET. MRI data correlated nicely with PET values for myocardial blood flow (R(2)=0.79, P<0.001), myocardial oxygen consumption (R(2)=0.74, P<0.001), and oxygen extraction fraction (R(2)=0.66, P<0.01). Cardiac MRI methods may provide an alternative to radionuclide imaging in settings of myocardial ischemia. Our newly developed quantitative MRI oxygenation imaging technique may be a valuable noninvasive tool to directly evaluate myocardial energetics and efficiency.

  6.   Adenosine-diphosphate (ADP) reduces infarct size and improves porcine heart function after myocardial infarction

    DEFF Research Database (Denmark)

    Bune, Laurids Touborg; Larsen, Jens Kjærgaard Rolighed; Thaning, Pia;

    2013-01-01

    (UTP) are both released during myocardial ischemia, influencing hemodynamics. Both mediate the release of tissue plasminogen activator (t-PA), which can reduce infarct size (IS). The objective of this study was to investigate whether exogenous ADP and UTP administration during reperfusion could reduce......Acute myocardial infarction continues to be a major cause of morbidity and mortality. Timely reperfusion can substantially improve outcomes and the administration of cardioprotective substances during reperfusion is therefore highly attractive. Adenosine diphosphate (ADP) and uridine-5-triphoshate...... myocardial IS and whether this correlated to t-PA release or improvements in hemodynamic responses. Hemodynamic variables and t-PA were measured in 22 pigs before, during, and after 45 min of left anterior coronary artery occlusion. During reperfusion, the pigs were randomized to 240 min of intracoronary...

  7. Reduced Admissions for Acute Myocardial Infarction Associated with a Public Smoking Ban: Matched Controlled Study

    Science.gov (United States)

    Seo, Dong-Chul; Torabi, Mohammad R.

    2007-01-01

    There has been no research linking implementation of a public smoking ban and reduced incidence of acute myocardial infarction (AMI) among nonsmoking patients. An ex post facto matched control group study was conducted to determine whether there was a change in hospital admissions for AMI among nonsmoking patients after a public smoking ban was…

  8. Statins reduce new-onset atrial fibrillation in a first-time myocardial infarction population

    DEFF Research Database (Denmark)

    Bang, Casper N; Gislason, Gunnar H; Greve, Anders M

    2014-01-01

    AIM: To evaluate the effect of statins on reducing new-onset atrial fibrillation (AF) in a large real-world post-myocardial infarction (MI) population. Subsequently, to test if different statin doses, various types and compliance affected the incidence of new-onset AF post MI. METHODS: All patien...

  9. Apyrase treatment of myocardial infarction according to a clinically applicable protocol fails to reduce myocardial injury in a porcine model

    Directory of Open Access Journals (Sweden)

    Otto Andreas

    2010-01-01

    Full Text Available Abstract Background Ectonucleotidase dependent adenosine generation has been implicated in preconditioning related cardioprotection against ischemia-reperfusion injury, and treatment with a soluble ectonucleotidase has been shown to reduce myocardial infarct size (IS when applied prior to induction of ischemia. However, ectonucleotidase treatment according to a clinically applicable protocol, with administration only after induction of ischemia, has not previously been evaluated. We therefore investigated if treatment with the ectonucleotidase apyrase, according to a clinically applicable protocol, would reduce IS and microvascular obstruction (MO in a large animal model. Methods A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min, in 16 anesthetized pigs (40-50 kg. The pigs were randomized to 40 min of 1 ml/min intracoronary infusion of apyrase (10 U/ml, n = 8 or saline (0.9 mg/ml, n = 8, twenty minutes after balloon inflation. Area at risk (AAR was evaluated by ex vivo SPECT. IS and MO were evaluated by ex vivo MRI. Results No differences were observed between the apyrase group and saline group with respect to IS/AAR (75.7 ± 4.2% vs 69.4 ± 5.0%, p = NS or MO (10.7 ± 4.8% vs 11.4 ± 4.8%, p = NS, but apyrase prolonged the post-ischemic reactive hyperemia. Conclusion Apyrase treatment according to a clinically applicable protocol, with administration of apyrase after induction of ischemia, does not reduce myocardial infarct size or microvascular obstruction.

  10. Regional Myocardial Substrate Uptake in Hypertensive Rats: A Quantitative Autoradiographic Measurement

    Science.gov (United States)

    Yonekura, Yoshiharu; Bertrand Brill, A.; Som, Prantika; Yamamoto, Kazutaka; Srivastava, Suresh C.; Iwai, Junichi; Elmaleh, David R.; Livni, Eli; Strauss, H. William; Goodman, Mark M.; Knapp, Furn F.

    1985-03-01

    Severe hypertension causes global and regional changes in myocardial perfusion and substrate utilization. Regional perfusion and fatty acid utilization were evaluated by dual-tracer autoradiography in normotensive and hypertensive rats of the Dahl strain. The regional distributions of perfusion and fatty acid utilization were homogeneous in normotensive rats. Severe hypertension was associated with a homogeneous pattern of regional perfusion, but fatty acid utilization was focally decreased in the free wall of the left ventricle. The decrease in fatty acid uptake was associated with a concomitant increase in glucose utilization. These findings suggest that severe hypertension is associated with uniform myocardial perfusion and focal alterations in the substrates used for the performance of myocardial work.

  11. Regional sympathetic denervation after myocardial infarction: a follow-up study using [123I]MIBG.

    Science.gov (United States)

    Podio, V; Spinnler, M T; Spandonari, T; Moretti, C; Castellano, G; Bessone, M; Brusca, A

    1995-12-01

    Previous studies in dogs have shown that experimental infarction produces myocardial sympathetic denervation not only in the infarcted area, but also in a region apical to the infarction. In these dogs MIBG myocardial scintigraphy detected denervation but returned to normal in a few months at which time reinnervation was shown to have occurred. Myocardial sympathetic denervation was studied with MIBG scintigraphy in ten patients after their first acute transmural myocardial infarction; scans were repeated at 4 months, one year and 30 months to follow the time course of possible reinnervation. Except during the first 48 hours following the infarction, no therapy except for antiaggregants was administered to the patients; during this follow-up period no cardiac events were seen. One week after infarction, comparison of MIBG images with perfusion scans revealed that the denervated area was larger than the infarcted area; no difference in MIBG uptake by the infarcted myocardium was found during the 30 months follow-up.

  12. Abnormal Glucose Tolerance Is Associated with a Reduced Myocardial Metabolic Flexibility in Patients with Dilated Cardiomyopathy.

    Science.gov (United States)

    Tricò, Domenico; Baldi, Simona; Frascerra, Silvia; Venturi, Elena; Marraccini, Paolo; Neglia, Danilo; Natali, Andrea

    2016-01-01

    Dilated cardiomyopathy (DCM) is characterized by a metabolic shift from fat to carbohydrates and failure to increase myocardial glucose uptake in response to workload increments. We verified whether this pattern is influenced by an abnormal glucose tolerance (AGT). In 10 patients with DCM, 5 with normal glucose tolerance (DCM-NGT) and 5 with AGT (DCM-AGT), and 5 non-DCM subjects with AGT (N-AGT), we measured coronary blood flow and arteriovenous differences of oxygen and metabolites during Rest, Pacing (at 130 b/min), and Recovery. Myocardial lactate exchange and oleate oxidation were also measured. At Rest, DCM patients showed a reduced nonesterified fatty acids (NEFA) myocardial uptake, while glucose utilization increased only in DCM-AGT. In response to Pacing, glucose uptake promptly rose in N-AGT (from 72 ± 21 to 234 ± 73 nmol/min/g, p equivalents, p metabolism and the reduced myocardial metabolic flexibility in response to an increased workload. This trial is registered with ClinicalTrial.gov NCT02440217.

  13. Treatment with the gap junction modifier rotigaptide (ZP123) reduces infarct size in rats with chronic myocardial infarction

    DEFF Research Database (Denmark)

    Haugan, Ketil; Marcussen, Niels; Kjølbye, Anne Louise;

    2006-01-01

    Treatment with non-selective drugs (eg, long-chain alcohols, halothane) that reduce gap junction intercellular communication (GJIC) is associated with reduced infarct size after myocardial infarction (MI). Therefore, it has been suggested that gap junction intercellular communication stimulating ...

  14. Quantitative assessment of regional myocardial blood flow with thallium-201 and SPECT.

    Science.gov (United States)

    Iida, H; Eberl, S

    1998-01-01

    Thallium-201 has been used extensively as a myocardial perfusion agent and to assess myocardial viability. Unlike other 99mTc-labeled agents such as 99mTc-sestamibi and 99mTc-tetrofosmine, the regional concentration of 201Tl varies with time, and its kinetics make it a potential candidate for estimating absolute physiologic parameters with kinetic model analysis. This article outlines a strategy for quantitative assessment of regional myocardial blood flow in man using 201Tl and dynamic single photon emission computed tomography (SPECT). Quantitatively accurate SPECT images that are proportional to the true radioactivity distribution are prerequisites for model-based kinetic analysis. Our technique for quantitative SPECT includes ordered-subset maximum likelihood-expectation maximization (ML-EM) reconstruction with transmission data-based attenuation correction and transmission-dependent convolution subtraction scatter correction. A three-compartment model was found to reproduce the observed regional time-activity curves well, and dog experiments demonstrated that influx rate constant (K1) values estimated from the dynamic SPECT data correlated well with absolute myocardial blood flow determined by in vitro microspheres for a physiologically wide range of flows. Several possible strategies for simplifying the study procedures, without compromising accuracy, are also presented, which should make absolute quantitation of regional myocardial blood flow feasible using 201Tl and a conventional SPECT camera in a clinical setting.

  15. Myocardial MR tagging. Analysis of regional and global myocardial function; Kardiales MR-Tagging. Analyse regionaler und globaler Myokardfunktion

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, U.; Fenchel, M. [Universitaet Tuebingen, Abt. fuer Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Tuebingen (Germany); Hennemuth, A. [Fraunhofer MEVIS, Bremen (Germany)

    2010-06-15

    Myocardial MR tagging is a powerful method which allows for assessment of myocardial function and may become an important tool for clinical evaluation of cardiac dysfunction, particularly in ischemic heart disease. In addition to visual assessment it allows direct quantification of myocardial deformation and strain to measure contractility. The use of myocardial tagging has provided new insights into the (patho)physiology of regional wall motion, and several parameters have been described as being useful to identify an ischemic response of the myocardium. One challenge encountered with tagging at 1.5 T is the fading of tags at end-diastole, greatly limiting the evaluation of myocardial function during diastole. Due to longer T{sub 1} relaxation times of the myocardium, tagging at 3 T has shown to have a higher CNR{sub Tag} and better tag persistence when compared to current clinical gradient-echo tagging protocols at 1.5 T. As a consequence, tagging at higher field strengths may be well suited for the characterization of the diastolic portion of the cardiac cycle in future applications. (orig.) [German] Das myokardiale Tagging mittels der kardialen Magnetresonanztomographie (MRT) stellt ein spezielles Verfahren dar, das eine quantitative Analyse der regionalen Myokardfunktion erlaubt. Mit der Analyse der regionalen Wandbewegung koennen pathologische Bewegungsablaeufe fruehzeitig erkannt und kardiale Dysfunktionen differenziert werden. Neben der visuellen Analyse ist es in erster Linie die quantitative Bestimmung der aus der Echokardiographie bekannten Funktionsparameter, die den Vorteil des Taggings bei der Charakterisierung der myokardialen Funktion ausmachen. Die quantitative Erfassung des Rotations- und Kontraktionsverhaltens mit dem myokardialen Tagging eroeffnet bei verschiedenen Erkrankungen des Herzens neue Einblicke in die Pathophysiologie. Eine intrinsische Limitation dieses Verfahrens besteht in dem insbesondere in der diastolischen Phase des Herzzyklus

  16. Abnormal Glucose Tolerance Is Associated with a Reduced Myocardial Metabolic Flexibility in Patients with Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Domenico Tricò

    2016-01-01

    Full Text Available Dilated cardiomyopathy (DCM is characterized by a metabolic shift from fat to carbohydrates and failure to increase myocardial glucose uptake in response to workload increments. We verified whether this pattern is influenced by an abnormal glucose tolerance (AGT. In 10 patients with DCM, 5 with normal glucose tolerance (DCM-NGT and 5 with AGT (DCM-AGT, and 5 non-DCM subjects with AGT (N-AGT, we measured coronary blood flow and arteriovenous differences of oxygen and metabolites during Rest, Pacing (at 130 b/min, and Recovery. Myocardial lactate exchange and oleate oxidation were also measured. At Rest, DCM patients showed a reduced nonesterified fatty acids (NEFA myocardial uptake, while glucose utilization increased only in DCM-AGT. In response to Pacing, glucose uptake promptly rose in N-AGT (from 72 ± 21 to 234 ± 73 nmol/min/g, p<0.05, did not change in DCM-AGT, and slowly increased in DCM-NGT. DCM-AGT sustained the extra workload by increasing NEFA oxidation (from 1.3 ± 0.2 to 2.9 ± 0.1 μmol/min/gO2 equivalents, p<0.05, while DCM-NGT showed a delayed increase in glucose uptake. Substrate oxidation rates paralleled the metabolites data. The presence of AGT in patients with DCM exacerbates both the shift from fat to carbohydrates in resting myocardial metabolism and the reduced myocardial metabolic flexibility in response to an increased workload. This trial is registered with ClinicalTrial.gov NCT02440217.

  17. Evaluation of Regional Myocardial Systolic Function in the Early Stage of Acute Myocardial Infarction by Strain Rate Imaging

    Directory of Open Access Journals (Sweden)

    M Esmaeilzadeh

    2009-12-01

    Full Text Available Background: We sought to evaluate the impact of different therapeutic strategies on longitudinal regional myocardial systolic function in the early phase of acute myocardial infarction using strain rate imaging.Methods: A total of 38 patients (34 males, with first acute myocardial infarction (AMI were evaluated. Our patients were divided into 3 groups according to the kind of therapy. The mean age of the patients was 55 ± 9.4 years (range: 39- 75 years. Mean left ventricular ejection fraction (LVEF in the patients was 41 ± 10.7%. Primary percutaneous coronary intervention (PCI was performed in 10 patients. Sixteen patients were treated by thrombolytic therapy using streptokinase (SK and 12 were followed-up conservatively. All patients underwent a comprehensive echocardiography study including SR imaging within 3- 5 days after AMI. The parameters measured included peak systolic strain (peakε and strain rate (SRs, end-systolic strain (εes, post systolic shortening (PSS, time to peak systolic strain rate (tSRs, time to end of shortening (teSRs, post systolic strain (PSε, post-systolic strain index (PSI, PSS ratio (PSS/ εMax and peak postsystolic strain rate (SRPSS. Results: There was not any association either between WMSI and tå (P=0.4, or MI location and PSS ratio (P=0.13. But there was an inverse relationship between WMSI and mean SRS, especially when WMSI was more pronounced. A significant relationship was found between tε and teSRs with the kind of therapy (shorter in PCI group (P= 0.04. Using a simple linear regression model, no association was found between PSS ratio and SRs (â=0.056, P =0.70, PSI and teSRs (β= -0.772, P=0.12. Simple linear regression model showed a weak but significant relationship between PSI and Median tε (β = -0.851, P =0.04; r =0.33.Conclusion: Our study showed that PCI resulted in early recovery of regional systolic function of infarcted myocardium during the early stage of acute myocardial infarction.

  18. Improvement of regional myocardial blood flow and function and reduction of infarct size with ivabradine: protection beyond heart rate reduction.

    Science.gov (United States)

    Heusch, Gerd; Skyschally, Andreas; Gres, Petra; van Caster, Patrick; Schilawa, Dustin; Schulz, Rainer

    2008-09-01

    Effects of the bradycardic agent ivabradine on regional blood flow, contractile function, and infarct size were studied in a pig model of myocardial ischaemia/reperfusion. Heart rate reduction by beta-blockade is associated with negative inotropism and unmasked alpha-adrenergic coronary vasoconstriction. Ivabradine is the only available bradycardic agent for clinical use. Anaesthetized pigs were subjected to 90 min controlled left anterior descending coronary artery hypoperfusion and 120 min reperfusion. Regional blood flow was measured with microspheres, regional function with sonomicrometry, and infarct size with triphenyl tetrazolium chloride staining. Pigs received placebo or ivabradine (0.6 mg/kg i.v.) before or during ischaemia or before reperfusion, respectively. Pre-treatment with ivabradine reduced infarct size from 35 +/- 4 (SEM) to 19 +/- 4% of area at risk (AAR). Ivabradine 15-20 min after the onset of ischaemia increased regional myocardial blood flow from 2.12 +/- 0.31 to 3.55 +/- 0.56 microL/beat/g and systolic wall thickening from 6.7 +/- 1.0 to 16.3 +/- 3.0%; infarct size was reduced from 12 +/- 4 to 2 +/- 1% of AAR. Ivabradine 5 min before reperfusion still reduced infarct size from 36 +/- 4 to 21 +/- 5% of AAR. The benefit of ivabradine on flow and function was eliminated by atrial pacing, but part of the reduction of infarct size by ivabradine was not. Ivabradine's protection goes beyond heart rate reduction.

  19. Evaluation of Global and Regional Strain in Patients with Acute Coronary Syndrome without Previous Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Alireza Moaref

    2016-03-01

    Full Text Available Speckle Tracking Echocardiography (STE is a new non-invasive method, which has been recently used as an alternative technique to assess regional and global myocardial function, especially left ventricular function. It is also considered to be a valid technique to evaluate the patients with Acute Coronary Syndrome (ACS.

  20. Continuous monitoring of regional function by a miniaturized ultrasound transducer allows early quantification of low-grade myocardial ischemia.

    Science.gov (United States)

    Hyler, Stefan; Pischke, Søren E; Halvorsen, Per Steinar; Espinoza, Andreas; Bergsland, Jacob; Tønnessen, Tor Inge; Fosse, Erik; Skulstad, Helge

    2015-04-01

    Sensitive methods for the early detection of myocardial dysfunction are still needed, as ischemia is a leading cause of decreased ventricular function during and after heart surgery. The aim of this study was to test the hypothesis that low-grade ischemia could be detected quantitatively by a miniaturized epicardial ultrasound transducer (Ø = 3 mm), allowing continuous monitoring. In 10 pigs, transducers were positioned in the left anterior descending and circumflex coronary artery areas. Left ventricular pressure was obtained by a micromanometer. The left internal mammary artery was grafted to the left anterior descending coronary artery, which was occluded proximal to the anastomosis. Left internal mammary artery flow was stepwise reduced by 25%, 50%, and 75% for 18 min each. From the transducers, M-mode traces were obtained, allowing continuous tissue velocity traces and displacement measurements. Regional work was assessed as left ventricular pressure-displacement loop area. Tissue lactate measured from intramyocardial microdialysis was used as reference method to detect ischemia. All steps of coronary flow reduction demonstrated reduced peak systolic velocity (P transducer allowed the precise detection of different levels of coronary flow reduction. The results also showed a quantitative and linear relationship among coronary flow, ischemia, and myocardial function. Thus, the ultrasound transducer has the potential to improve the monitoring of myocardial ischemia and to detect graft failure during and after heart surgery. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  1. Regional myocardial perfusion in patients with atherosclerotic coronary artery disease, at rest and during angina pectoris induced by tachycardia

    Energy Technology Data Exchange (ETDEWEB)

    Maseri, A.; L' Abbate, A.; Pesola, A.; Michelassi, C.; Marzilli, M.; De Nes, M.

    1977-03-01

    We studied regional myocardial perfusion by scintigraphic computer-assisted analysis of initial distribution, washout rates, and residual activity of /sup 133/Xe injected into the left coronary artery of four patients with normal arteriograms and 14 patients with coronary stenosis. At rest, residual activity in poststenotic regions was always greater than in control regions, but initial washout rates were not slower. During angina, following xenon injections, the amount of indicator distributed to the poststenotic regions was markedly reduced; the increase of the initial washout rates was smaller than in control regions relative to rest, and residual activity was higher. Initial washout rates did not differ as much as from those of normal myocardium because in severe ischemia too little indicator is deposited initially in these regions to produce a change of any magnitude. Indeed, when angina was induced immediately after the xenon injection, poststenotic washout rates became much slower during angina than at rest, a finding that implicates functional factors in impairing poststenotic myocardial perfusion during angina.

  2. Alteration in the global and regional myocardial strain patterns in patients with inferior ST-elevation myocardial infarction prior to and after percutaneous coronary intervention.

    Science.gov (United States)

    Song, Chen-Fang; Zhou, Qing; Guo, Rui-Qiang

    2014-01-01

    This study was designed to investigate the alteration on regional and global strains of left and right ventricle (LV, RV) in patients with inferior wall ST-elevation myocardial infarction (MI). Patients were examined prior to and 7 days after percutaneous coronary intervention (PCI) using speckle-tracking techniques. Fifty-nine patients (36 males and 23 females) and 60 healthy controls (40 males and 20 females) were enrolled in this study. LV strains were measured from three deformations including radial, longitudinal, and circumferential. RV strains were measured only from the longitudinal. Three types of LV global strains were significantly lower in patients than in controls, and LV global longitudinal and circumferential strains were moderately improved by PCI. The LV regional strains reduced significantly in most of the segments (87%) after inferior wall MI and over half of them (60%) were improved by PCI. The RV global longitudinal strains were significantly lower in patients than in controls, and they were moderately improved by PCI. In conclusion, the regional and global strains of LV and RV were reduced in patients with inferior wall MI, and PCI most markedly improved the global strains and regional strains of the infarct and adjacent myocardium in the apical and middle levels.

  3. Dietary n-3 fatty acids promote arrhythmias during acute regional myocardial ischemia in isolated pig hearts

    NARCIS (Netherlands)

    Coronel, R.; Wilms-Schopman, F.J.G.; Ruijter, den H.M.; Belterman, C.N.; Schumacher, C.A.; Opthof, T.; Hovernier, R.; Lemmens, A.G.; Terpstra, A.H.M.; Katan, M.B.; Zock, P.L.

    2007-01-01

    Objective Dietary supplementation with fish oil-derived n-3 fatty acids reduces mortality in patients with myocardial infarction, but may have adverse effects in angina patients. The underlying electrophysiologic mechanisms are poorly understood. We studied the arrhythmias and the electrophysiologic

  4. Dietary n-3 fatty acids promote arrhythmias during acute regional myocardial ischemia in isolated pig hearts

    NARCIS (Netherlands)

    Coronel, R.; Wilms-Schopman, F.J.G.; Ruijter, den H.M.; Belterman, C.N.; Schumacher, C.A.; Opthof, T.; Hovernier, R.; Lemmens, A.G.; Terpstra, A.H.M.; Katan, M.B.; Zock, P.L.

    2007-01-01

    Objective Dietary supplementation with fish oil-derived n-3 fatty acids reduces mortality in patients with myocardial infarction, but may have adverse effects in angina patients. The underlying electrophysiologic mechanisms are poorly understood. We studied the arrhythmias and the electrophysiologic

  5. Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine

    Energy Technology Data Exchange (ETDEWEB)

    Stanton, M.S.; Tuli, M.M.; Radtke, N.L.; Heger, J.J.; Miles, W.M.; Mock, B.H.; Burt, R.W.; Wellman, H.N.; Zipes, D.P. (Indiana Univ. School of Medicine, IN (USA))

    1989-11-15

    Transmural myocardial infarction in dogs produces denervation of sympathetic nerves in viable myocardium apical to the infarct that may be arrhythmogenic. It is unknown whether sympathetic denervation occurs in humans. The purpose of this study was to use iodine-123-metaiodobenzylguanidine (MIBG), a radiolabeled guanethidine analog that is actively taken up by sympathetic nerve terminals, to image noninvasively the cardiac sympathetic nerves in patients with and without ventricular arrhythmias after myocardial infarction. Results showed that 10 of 12 patients with spontaneous ventricular tachyarrhythmias after myocardial infarction exhibited regions of thallium-201 uptake indicating viable perfused myocardium, with no MIBG uptake. Such a finding is consistent with sympathetic denervation. One patient had frequent episodes of nonsustained ventricular tachycardia induced at exercise testing that was eliminated by beta-adrenoceptor blockade. Eleven of the 12 patients had ventricular tachycardia induced at electrophysiologic study and metoprolol never prevented induction. Sympathetic denervation was also detected in two of seven postinfarction patients without ventricular arrhythmias. Normal control subjects had no regions lacking MIBG uptake. This study provides evidence that regional sympathetic denervation occurs in humans after myocardial infarction and can be detected noninvasively by comparing MIBG and thallium-201 images. Although the presence of sympathetic denervation may be related to the onset of spontaneous ventricular tachyarrhythmias in some patients, it does not appear to be related to sustained ventricular tachycardia induced at electrophysiologic study.

  6. Assessment of Regional Myocardial Function in Patients with Hypertrophic Cardiomyopathy by Tissue Strain Imaging

    Institute of Scientific and Technical Information of China (English)

    XIONG Runqing; XIE Mingxing; WANG Xinfang; L(U) Qing

    2006-01-01

    The value of tissue strain imaging (SI) in regional myocardial systolic anddiastolic function assessment was studied. In 18 patients with nonobstructive hypertrophic cardiomyopathy (HCM) and 20 age-matched healthy subjects, regional myocardial longitudinal peak systolic strain in eject time (represented by εet) was measured at basal, mid and apical segments of septal, lateral and posterior walls of the left ventricle (LV) and compared between groups. εet had no significant difference between segments in control group (P>0.05), which displayed a decreasing trend from basal segments to apical ones. εet in the HCM group was significantly decreased (P<0. 05) as compared with that in the healthy group. In the HCM group, εet in the midseptum was significantly less than at the basal and apical septum, and was also less than at the rest LV walls in the same group (P<0.01). The systolic reversed εet was noticed in 35 % of the hypertrophic segments in HCM group. Significantly negative correlation existed between the absolute value of εet and wall thickness in the midseptum (r=- 0.83). The post-systolic strain(PSS) segment number the and amplitudes in healthy group were significantly less than those in HCM group (P<0.05). Both regional myocardial systolic and diastolic functions were impaired in hypertrophic or non-hypertrophic segments in patients with the HCM, especially in hypertrophic segments. Strain imaging technique is a sensitive and accura tool in myocardial dysfunction assessment.

  7. Regional left ventricular myocardial contraction abnormalities and asynchrony in patients with hypertrophic cardiomyopathy evaluated by magnetic resonance spatial modulation of magnetization myocardial tagging

    Energy Technology Data Exchange (ETDEWEB)

    Mishiro, Yuichiro; Oki, Takashi [Tokushima Univ. (Japan). School of Medicine; Iuchi, Arata [and others

    1999-06-01

    Global left ventricular (LV) pump function is generally preserved in patients with hypertrophic cardiomyopathy (HCM). However, it is unknown whether regional myocardial contractility is impaired, especially in nonhypertrophied regions. The purpose of this study was to evaluate regional LV myocardial contraction in patients with HCM using magnetic resonance (MR) spatial modulation of magnetization (SPAMM) myocardial tagging. The study group comprised 20 patients with asymmetric septal hypertrophy (HCM group) and 16 age-matched normal patients (control group), and data were collected using transthoracic M-mode and 2-dimensional echocardiography, and MR SPAMM myocardial tagging. The systolic strain ratio, maximum systolic strain velocity, and time from end-diastole to maximum systolic strain ({Delta}T) in the anterior, ventricular septal, inferior and lateral regions for 2 LV short-axis sections at the levels of the chordae tendineae and papillary muscles were measured at 50-ms intervals by MR myocardial tagging. The end-diastolic anterior and ventricular septal wall thicknesses and LV mass index were significantly different between the HCM and control groups. The systolic strain ratio for all 4 walls, particularly the anterior and ventricular septal regions, was significantly lower in the HCM group. In the HCM group, the maximum systolic strain velocity was significantly lower and {Delta}T was significantly shorter for all 4 walls, particularly the anterior and ventricular septal regions. The standard deviation for the {Delta}T, calculated from the {Delta}T for the 8 regions of the 2 LV short-axis sections, was significantly greater in the HCM group. In conclusion, regional LV myocardial contraction is impaired in both hypertrophied and nonhypertrophied regions, and systolic LV wall asynchrony occurs in patients with HCM. (author)

  8. Regional Myocardial Blood Volume and Flow: First-Pass MR Imaging with Polylysine-Gd-DTPA

    Science.gov (United States)

    Wilke, Norbert; Kroll, Keith; Merkle, Hellmut; Wang, Ying; Ishibashi, Yukata; Xu, Ya; Zhang, Jiani; Jerosch-Herold, Michael; Mühler, Andreas; Stillman, Arthur E.; Bassingthwaighte, James B.; Bache, Robert; Ugurbil, Kamil

    2010-01-01

    The authors investigated the utility of an intravascular magnetic resonance (MR) contrast agent, poly-L-lysine-gadolinium diethylenetriaminepentaacetic acid (DTPA), for differentiating acutely ischemic from normally perfused myocardium with first-pass MR imaging. Hypoperfused regions, identified with microspheres, on the first-pass images displayed significantly decreased signal intensities compared with normally perfused myocardium (P < .0007). Estimates of regional myocardial blood content, obtained by measuring the ratio of areas under the signal intensity-versus-time curves in tissue regions and the left ventricular chamber, averaged 0.12 mL/g ± 0.04 (n = 35), compared with a value of 0.11 mL/g ± 0.05 measured with radiolabeled albumin in the same tissue regions. To obtain MR estimates of regional myocardial blood flow, in situ calibration curves were used to transform first-pass intensity-time curves into content-time curves for analysis with a multiple-pathway, axially distributed model. Flow estimates, obtained by automated parameter optimization, averaged 1.2 mL/min/g ± 0.5 [n = 29), compared with 1.3 mL/min/g ± 0.3 obtained with tracer microspheres in the same tissue specimens at the same time. The results represent a combination of T1-weighted first-pass imaging, intravascular relaxation agents, and a spatially distributed perfusion model to obtain absolute regional myocardial blood flow and volume. PMID:7766986

  9. Assessment of Regional Myocardial Displacement via Spectral Tissue Doppler Compared with Color Tissue Tracking

    Directory of Open Access Journals (Sweden)

    Zahra Ojaghi-Haghighi

    2008-12-01

    Full Text Available Background: The recent developments in tissue Doppler imaging (TDI now more than ever permit the quantification of the myocardial function. In the current systems, tissue tracking or displacement curves are generated from color tissue Doppler data through the instantaneous temporal integral of velocity-time curves. Methods: The purpose of the present study was to assess regional myocardial displacement via spectral TDI. Maximum myocardial velocities were extracted from spectral pulsed tissue Doppler images using a developed computer program and were integrated throughout the cardiac cycle. Spectral tissue Doppler echocardiography was performed to evaluate longitudinal and radial functions in 20 healthy men, and the calculated end-systolic displacements were subsequently compared with the displacements measured from the same areas via color tissue tracking. Results: According to the Bland-Altman analysis between spectral tissue tracking and color tissue tracking, the significant arithmetic mean was 7.34 mm with SD mean differences of ±2.24 mm in all of the evaluated segments. Despite significant differences (p<0.001, there was a good significant correlation between the two methods (r=0.79, p<0.001. Conclusion: A verification study showed that the proposed approach had the ability to assess regional myocardial displacement using spectral TDI, which can be used in a wider range of equipment than is currently possible.

  10. Regional myocardial oxygen consumption estimated by carbon-11 acetate and positron emission tomography before and after repetitive ischemia

    DEFF Research Database (Denmark)

    Kofoed, K F; Hansen, P R; Holm, S

    2011-01-01

    Preserved myocardial oxygen consumption estimated by carbon 11-acetate and positron emission tomography (PET) in myocardial regions with chronic but reversibly depressed contractile function in patients with ischemic heart disease have been suggested to be caused by repeated short episodes of acu...

  11. Regional myocardial oxygen consumption estimated by carbon-11 acetate and positron emission tomography before and after repetitive ischemia

    DEFF Research Database (Denmark)

    Kofoed, K F; Hansen, P R; Holm, S

    2011-01-01

    Preserved myocardial oxygen consumption estimated by carbon 11-acetate and positron emission tomography (PET) in myocardial regions with chronic but reversibly depressed contractile function in patients with ischemic heart disease have been suggested to be caused by repeated short episodes of acute...

  12. Validity of microsphere depositions for regional myocardial flows

    Energy Technology Data Exchange (ETDEWEB)

    Bassingthwaighte, J.B.; Malone, M.A.; Moffett, T.C.; King, R.B.; Little, S.E.; Link, J.M.; Krohn, K.A.

    1987-07-01

    Due to the particulate nature of microspheres, their deposition in small-tissue regions may not be strictly flow dependent. To evaluate the importance of rheological and geometric factors and random error, their deposition densities in small regions of rabbit hearts were examined in comparison with those of a new molecular microsphere, 2-iododesmethylimipramine (IDMI), whose high lipid solubility allows it to be delivered into tissue in proportion to flow, and whose binding in tissue prevents rapid washout. /sup 141/Ce- and /sup 103/Ru-labeled 16.5-..mu..m spheres in one syringe and (/sup 125/I)- and (/sup 131/I)DMI in another syringe were injected simultaneously into the left atrium of open-chest rabbits, while obtaining reference blood samples from the femoral artery. Hearts were removed 1 min after injection, cut into /approximately/ 100 pieces averaging 54 mg, and the regional deposition densities calculated for each tracer from the isotopic counts. Scatter plots of sphere densities vs. IDMI densities showed that differences between microspheres and IDMI had substantial scatter and were not random. Microsphere depositions tended to be lower that IDMI deposition at low flows and higher at high flows. The authors conclude that microspheres are generally adequate for estimating regional flows but suffer systematic error when the regions of interest are supplied via arteries of diameters only a few times those of microspheres.

  13. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Jons, Christian; Raatikainen, M J Pekka

    2010-01-01

    Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction (C...... (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction.......Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction...

  14. Improvement of pacing induced regional myocardial ischemia by Solcoseryl in conscious dogs with coronary stenosis.

    Science.gov (United States)

    Shimada, T; Sasayama, S; Takahashi, M; Osakada, G; Kawai, C

    1984-02-01

    The effects of Solcoseryl on regional myocardial function were studied in 5 conscious dogs with partial coronary constriction, in which temporary ischemia was induced by rapid cardiac pacing. During the coronary artery constriction, the percent shortening of the ischemic segment decreased by 9%. When the heart rate was increased by pacing, the percent shortening of the ischemic segments was further reduced by 57%. On cessation of cardiac pacing, the early potentiation of dP/dt and of control segment shortening became evident and was followed by exponential decay in the subsequent several beats. In the ischemic segment, the percent shortening was significantly improved in the first post-pacing beat but was more severely depressed at five seconds. Thirty minutes after administration of Solcoseryl, the cardiac pacing was repeated in the same manner but the pacing-induced hypokinesia of the ischemic segment were less marked, the percent shortening being at an average of 9.1% during control pacing and 12.7% during the second pacing after Solcoseryl (p less than 0.05). Postpacing deterioration of the ischemic segment shortening was also significantly improved from 9.8 to 11.8% at 5 seconds (p less than 0.05). These findings indicate that Solcoseryl exerts protective effects on the ischemic myocardium by promoting a rapid recovery from ischemia, probably due to the improvement of oxygen utility through activated cellular respiration.

  15. Methotrexate carried in lipid core nanoparticles reduces myocardial infarction size and improves cardiac function in rats.

    Science.gov (United States)

    Maranhão, Raul C; Guido, Maria C; de Lima, Aline D; Tavares, Elaine R; Marques, Alyne F; Tavares de Melo, Marcelo D; Nicolau, Jose C; Salemi, Vera Mc; Kalil-Filho, Roberto

    2017-01-01

    Acute myocardial infarction (MI) is accompanied by myocardial inflammation, fibrosis, and ventricular remodeling that, when excessive or not properly regulated, may lead to heart failure. Previously, lipid core nanoparticles (LDE) used as carriers of the anti-inflammatory drug methotrexate (MTX) produced an 80-fold increase in the cell uptake of MTX. LDE-MTX treatment reduced vessel inflammation and atheromatous lesions induced in rabbits by cholesterol feeding. The aim of the study was to investigate the effects of LDE-MTX on rats with MI, compared with commercial MTX treatment. Thirty-eight Wistar rats underwent left coronary artery ligation and were treated with LDE-MTX, or with MTX (1 mg/kg intraperitoneally, once/week, starting 24 hours after surgery) or with LDE without drug (MI-controls). A sham-surgery group (n=12) was also included. Echocardiography was performed 24 hours and 6 weeks after surgery. The animals were euthanized and their hearts were analyzed for morphometry, protein expression, and confocal microscopy. LDE-MTX treatment achieved a 40% improvement in left ventricular (LV) systolic function and reduced cardiac dilation and LV mass, as shown by echocardiography. LDE-MTX reduced the infarction size, myocyte hypertrophy and necrosis, number of inflammatory cells, and myocardial fibrosis, as shown by morphometric analysis. LDE-MTX increased antioxidant enzymes; decreased apoptosis, macrophages, reactive oxygen species production; and tissue hypoxia in non-infarcted myocardium. LDE-MTX increased adenosine bioavailability in the LV by increasing adenosine receptors and modulating adenosine catabolic enzymes. LDE-MTX increased the expression of myocardial vascular endothelium growth factor (VEGF) associated with adenosine release; this correlated not only with an increase in angiogenesis, but also with other parameters improved by LDE-MTX, suggesting that VEGF increase played an important role in the beneficial effects of LDE-MTX. Overall effects of

  16. 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.

  17. Nonuniform loss of regional flow reserve during myocardial ischemia in dogs.

    Science.gov (United States)

    Coggins, D L; Flynn, A E; Austin, R E; Aldea, G S; Muehrcke, D; Goto, M; Hoffman, J I

    1990-08-01

    To determine whether coronary vasodilator reserve that persists during myocardial ischemia is present in all left ventricular regions, we measured regional blood flow in 192 left ventricular pieces (mean weight, 201 mg) in each of eight dogs by using radioactive microspheres while perfusing the left main coronary artery at 70, 50, 40, and 30 mm Hg. Flows were measured before and during adenosine infusion to determine flow reserve. Perfusion at 40 and 30 mm Hg produced ischemia in all dogs. At 70 mm Hg, 100% of left ventricular regions had significant flow reserve, compared with 92%, 55%, and 8% during perfusion at 50, 40, and 30 mm Hg, respectively. A greater amount of flow reserve and a greater number of regions responded to adenosine in the subepicardium than in the subendocardium at 50, 40, and 30 mm Hg. We conclude that coronary flow reserve persists in only a subset of left ventricular regions during ischemia and that the number of regions with persistent flow reserve decreases with perfusion pressure. These findings may best be explained by a model in which regional ischemia is a maximal coronary vasodilator and persistent pharmacological vasodilator reserve seen when global markers indicate ischemia simply reflects persistent endogenous flow reserve in myocardial regions not yet ischemic.

  18. Endurance exercise accelerates myocardial tissue oxygenation recovery and reduces ischemia reperfusion injury in mice.

    Directory of Open Access Journals (Sweden)

    Yuanjing Li

    Full Text Available Exercise training offers cardioprotection against ischemia and reperfusion (I/R injury. However, few essential signals have been identified to underscore the protection from injury. In the present study, we hypothesized that exercise-induced acceleration of myocardial tissue oxygenation recovery contributes to this protection. C57BL/6 mice (4 weeks old were trained on treadmills for 45 min/day at a treading rate of 15 m/min for 8 weeks. At the end of 8-week exercise training, mice underwent 30-min left anterior descending coronary artery occlusion followed by 60-min or 24-h reperfusion. Electron paramagnetic resonance oximetry was performed to measure myocardial tissue oxygenation. Western immunoblotting analyses, gene transfection, and myography were examined. The oximetry study demonstrated that exercise markedly shortened myocardial tissue oxygenation recovery time following reperfusion. Exercise training up-regulated Kir6.1 protein expression (a subunit of ATP-sensitive K(+channel on vascular smooth muscle cells, VSMC sarc-K(ATP and protected the heart from I/R injury. In vivo gene transfer of dominant negative Kir6.1AAA prolonged the recovery time and enlarged infarct size. In addition, transfection of Kir6.1AAA increased the stiffness and reduced the relaxation capacity in the vasculature. Together, our study demonstrated that exercise training up-regulated Kir6.1, improved tissue oxygenation recovery, and protected the heart against I/R injury. This exercise-induced cardioprotective mechanism may provide a potential therapeutic intervention targeting VSMC sarc-K(ATP channels and reperfusion recovery.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1976-08-01

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

  20. Prevalence and distribution of regional scar in dysfunctional myocardial segments in Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Crawford Thomas O

    2011-03-01

    Full Text Available Abstract Background The segmental relationship between cardiovascular magnetic resonance (CMR peak circumferential strain (Ecc and myocardial scar has not been well characterized in Duchenne muscular dystrophy (DMD, and it is unknown whether echocardiography accurately measures Ecc in DMD. We assessed segmental Ecc and scar using CMR with myocardial tissue tagging and late gadolinium enhancement (LGE in patients with DMD, then compared CMR with echocardiographic velocity vector imaging (VVI for regional Ecc based on independent observer assessments. Results Participants enrolled (n = 16; age 8-23 had median left ventricular (LV ejection fraction of 0.52 (range 0.28-0.69, and 156 basal and mid-cavity myocardial segments from the 13 patients completing the LGE protocol were analyzed for strain and scar. Segmental CMR Ecc in the most negative quartile (quartile 4 ruled out scar in that segment, but scar was present in 46% of segments in the least negative (most dysfunctional Ecc quartile 1, 33% of Ecc quartile 2 segments, and 15% of Ecc quartile 3 segments. Overall scar prevalence in inferior, inferolateral, and anterolateral segments was eight times higher than in inferoseptal, anteroseptal, and anterior segments (p Conclusions The relationship between scar and Ecc in DMD is complex. Among myocardial segments with depressed Ecc, scar prevalence was much higher in inferior, inferolateral, and anterolateral segments, indicating a regionally dependent association between abnormal Ecc and scar, with free wall segments commonly developing dysfunction with scar and septal segments developing dysfunction without scar. Although normal echocardiographic Ecc predicted absence of scar, regional echocardiographic Ecc by VVI has only a limited association with CMR Ecc in DMD.

  1. Relation between regional distribution of /sup 201/Tl and myocardial blood flow in normal, acutely ischemic, and infarcted myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Chu, A.; Murdock, R.H. Jr.; Cobb, F.R.

    1982-11-01

    Myocardial localization of /sup 201/Tl was compared with direct measurements of myocardial perfusion in normal, acutely ischemic, and recently infarcted myocardium. Studies were performed in 6 chronically instrumented dogs that were subjected to myocardial infarction by occlusion of the proximal left circumflex coronary artery. Four days after myocardial infarction, /sup 201/Tl and 9 +/- 1 micrometer /sup 95/Nb-labelled microspheres were injected simultaneously after acute left anterior descending coronary arterial occlusion; the animals were killed 5 minutes later and the entire left ventricle was sectioned into 1 to 2 g samples. Regression analyses between /sup 201/Tl activity and regional myocardial blood flow using all myocardial samples demonstrated a very close linear relation in each dog; r values were 0.98 or greater, indicating that the initial localization of /sup 201/Tl in acutely ischemic and recently infarcted myocardium as a function of regional blood flow was essentially identical. Consequently, in each dog the regional distribution of /sup 201/Tl closely approximated myocardial perfusion over a wide range of blood flow and potentially different local metabolic conditions that may be encountered in the clinical use of the isotope.

  2. Ethyl pyruvate reduces myocardial ischemia and reperfusion injury by inhibiting high mobility group box 1 protein in rats.

    Science.gov (United States)

    Hu, Xiaorong; Cui, Bo; Zhou, Xiaoya; Xu, Changwu; Lu, Zhibing; Jiang, Hong

    2012-01-01

    High mobility group box 1 protein (HMGB1) plays an important role in myocardial ischemia and reperfusion (I/R) injury. Ethyl pyruvate (EP), a potent reactive oxygen species scavenger, has been reported to inhibit myocardial apoptosis and reduce myocardial I/R injury. The aim of this study was to investigate the mechanism by which EP reduces myocardial I/R injury in rats. Anesthetized male rats were once treated with EP (50 mg/kg, i.p.) before ischemia, and then subjected to ischemia for 30 min followed by reperfusion for 4 h. Lactate dehydrogenase (LDH), creatine kinase (CK), malondialdehyde (MDA), superoxide dismutase (SOD) activity and infarct size were measured. HMGB1 expression was assessed by immunoblotting. The results showed that pretreatment of EP (50 mg/kg) could significantly reduce the infarct size and the levels of LDH and CK after 4 h reperfusion (all PR. The present study suggested that ethyl pyruvate could attenuate myocardial I/R injury by inhibiting HMGB1 expression.

  3. Dietary red palm oil supplementation reduces myocardial infarct size in an isolated perfused rat heart model

    Directory of Open Access Journals (Sweden)

    Esterhuyse Adriaan J

    2010-06-01

    Full Text Available Abstract Background and Aims Recent studies have shown that dietary red palm oil (RPO supplementation improves functional recovery following ischaemia/reperfusion in isolated hearts. The main aim of this study was to investigate the effects of dietary RPO supplementation on myocardial infarct size after ischaemia/reperfusion injury. The effects of dietary RPO supplementation on matrix metalloproteinase-2 (MMP2 activation and PKB/Akt phosphorylation were also investigated. Materials and methods Male Wistar rats were divided into three groups and fed a standard rat chow diet (SRC, a SRC supplemented with RPO, or a SRC supplemented with sunflower oil (SFO, for a five week period, respectively. After the feeding period, hearts were excised and perfused on a Langendorff perfusion apparatus. Hearts were subjected to thirty minutes of normothermic global ischaemia and two hours of reperfusion. Infarct size was determined by triphenyltetrazolium chloride staining. Coronary effluent was collected for the first ten minutes of reperfusion in order to measure MMP2 activity by gelatin zymography. Results Dietary RPO-supplementation decreased myocardial infarct size significantly when compared to the SRC-group and the SFO-supplemented group (9.1 ± 1.0% versus 30.2 ± 3.9% and 27.1 ± 2.4% respectively. Both dietary RPO- and SFO-supplementation were able to decrease MMP2 activity when compared to the SRC fed group. PKB/Akt phosphorylation (Thr 308 was found to be significantly higher in the dietary RPO supplemented group when compared to the SFO supplemented group at 10 minutes into reperfusion. There was, however, no significant changes observed in ERK phosphorylation. Conclusions Dietary RPO-supplementation was found to be more effective than SFO-supplementation in reducing myocardial infarct size after ischaemia/reperfusion injury. Both dietary RPO and SFO were able to reduce MMP2 activity, which suggests that MMP2 activity does not play a major role in

  4. 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.

  5. Detection of myocardial ischemia and infarction by radionuclide studies

    Energy Technology Data Exchange (ETDEWEB)

    Tamaki, Nagara [Hokkaido Univ., Sapporo (Japan). School of Medicine

    1996-12-31

    Myocardial ischemia and myocardial infarction are the common diseases caused by reduced coronary artery blood flow to the myocardium. Although the radionuclide studies cannot identify stenotic lesions on the coronary arteries, they can demonstrate regional myocardial perfusion at rest and during stress as well which is particularly important for the accurate diagnosis of angina pectoris. (J.P.N.)

  6. Current clinical and epidemiological portrait of a patient with acute myocardial infarction (by the data of the regional vascular center

    Directory of Open Access Journals (Sweden)

    E. Yu. Kovalchuk

    2015-01-01

    Full Text Available Epidemiological and clinical presentation of acute myocardial infarction based upon the data collected in Regional Vascular Centre of Saint-Petersburg Scientific Research Institute of Emergency Care n. a. I. I. Dzhanelidze in 2009-2012 years. In the article, 4697 cases have been analyzed. Specific features of epidemiology and clinical presentation of acute myocardial infarction at the present stage have been considered.

  7. Myocardial feature tracking reduces observer-dependence in low-dose dobutamine stress cardiovascular magnetic resonance.

    Directory of Open Access Journals (Sweden)

    Andreas Schuster

    Full Text Available To determine whether quantitative wall motion assessment by CMR myocardial feature tracking (CMR-FT would reduce the impact of observer experience as compared to visual analysis in patients with ischemic cardiomyopathy (ICM.15 consecutive patients with ICM referred for assessment of hibernating myocardium were studied at 3 Tesla using SSFP cine images at rest and during low dose dobutamine stress (5 and 10 μg/kg/min of dobutamine. Conventional visual, qualitative analysis was performed independently and blinded by an experienced and an inexperienced reader, followed by post-processing of the same images by CMR-FT to quantify subendocardial and subepicardial circumferential (Eccendo and Eccepi and radial (Err strain. Receiver operator characteristics (ROC were assessed for each strain parameter and operator to detect the presence of inotropic reserve as visually defined by the experienced observer.141 segments with wall motion abnormalities at rest were eligible for the analysis. Visual scoring of wall motion at rest and during dobutamine was significantly different between the experienced and the inexperienced observer (p0.05. Eccendo was the most accurate (AUC of 0.76, 10 μg/kg/min of dobutamine parameter. Diagnostic accuracy was worse for resting strain with differences between operators for Eccendo and Eccepi (p0.05.Whilst visual analysis remains highly dependent on operator experience, quantitative CMR-FT analysis of myocardial wall mechanics during DS-CMR provides diagnostic accuracy for the detection of inotropic reserve regardless of operator experience and hence may improve diagnostic robustness of low-dose DS-CMR in clinical practice.

  8. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    Science.gov (United States)

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  9. Activated Notch1 reduces myocardial ischemia reperfusion injury in vitro during ischemic postconditioning by crosstalk with the RISK signaling pathway

    Institute of Scientific and Technical Information of China (English)

    ZHOU Xue-liang; WAN Li; LIU Ji-chun

    2013-01-01

    Background Ischemic postconditioning (IPost),able to significantly attenuate myocardial ischemia reperfusion injury,is dependent on RISK signaling.Studies have shown that Notch signaling repairs damaged myocardium,and this study aimed to investigate the effect of Notch signaling in myocardial IPost.Methods We used H9c2 cells to establish the myocardial IPost and Hypoxia/Reoxygenation (H/R) model in vitro,which were randomly divided into control,H/R,IPost,Hepatocyte growth factor (HGF)+IPost and DAPT+IPost,N1ICD+IPost,miRNA+lPost,and Mock treatment groups.The myocardial cell viability was assessed by MTT,the cell apoptosis was detected using Annexin V/PI double staining and flow cytometry analyses.The expression of N1ICD,Hes1,PTEN Phospho-Akt/Akt,Phospho-GSK-3β/GSK-3β were detected by Western blotting.Finally,we assessed the changes in Ψm using the potential-sensitive dye JC-1 and measured using flow cytometry analyses.Results The Notch1 signaling is activated by HGF and ectopic expression of N1ICD during myocardial IPost,which increased myocardial cell viability,prevented cardiomyocyte apoptosis,and reduced loss of the mitochondrial membrane potential.However,myocardial ischemia reperfusion injury was increased in IPost when Notch1 signaling was inhibited using DAPT or with knockdown by Notch1-miRNA.Western blotting found that PTEN was down-regulated by Hes1 when Notch1 was activated,which consequently promoted Akt and GSK-3β phosphorylation.Conclusions Notch1 crosstalk with RISK signaling may be dependent on PTEN,which plays a cardioprotective role during IPost.This mechanism could provide a promising therapeutic target for the treatment of ischemic heart disease.

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  11. 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...

  12. Ginkgolide B Reduces the Degradation of Membrane Phospholipids to Prevent Ischemia/Reperfusion Myocardial Injury in Rats.

    Science.gov (United States)

    Pei, Hong-Xia; Hua, Rong; Guan, Cha-Xiang; Fang, Xiang

    2015-01-01

    Platelet-activating factor (PAF), a bioactive phospholipid, plays an important role in the integrity of the cellular membrane structure, and is involved in the pathogenesis of myocardial ischemia/reperfusion (IR) injuries. In this study, we tested the hypothesis that blockage of PAF receptor by BN 52021 (Ginkgolide B) can prevent IR-induced degradation of the myocardial membrane phospholipid, and deterioration of the cardiac function. Rat hearts in situ were subjected to 5 min ischemia and followed by 10 min reperfusion. Cardiac performances during periods of ischemia and reperfusion were monitored, and the amount of membrane phospholipids was analyzed. Myocardial total phospholipids, phosphatidylcholine, and phosphatidylethanolamine were decreased significantly in ischemia-reperfusion rat hearts compared with those of sham-operated rat hearts. Degradation of the membrane phospholipid was accompanied by the deterioration of cardiac functions and increase in serum lactate dehydrogenase (LDH) activity. BN 52021 (15 mg/kg), given by intravenous infusion 10 min prior to the left anterior descending coronary artery occlusion, reduced IR-related degradation of the myocardial phospholipids, the activity of serum LDH, and was concomitant with improvement of cardiac function. Furthermore, we demonstrated that the production of PAF was increased and BN 52021 decreased cellular damage in cultured anoxic cardiomyocytes. These results indicated that PAF antagonist BN 52021 has a protective effect against IR-induced myocardial dysfunction and degradation of the membrane phospholipids.

  13. Liposome-encapsulated berberine treatment reduces adverse ventricle remodeling after myocardial infarction

    NARCIS (Netherlands)

    Wang, J.W.; Allijn, I.E.; Czarny, B.M.S.; Wang, X.Y.; Chong, S.Y.; Pastorin, G.; De Kleijn, D.P.V.; Storm, G.; Schiffelers, R.M.

    2016-01-01

    Introduction: Adverse left ventricle remodeling can be measured as a reduction in ejection fraction after myocardial infarction. Left ventricle remodeling leads to congestive heart failure and is a main determinant of mortality and morbidity after myocardial infarction. Berberine is an isoquinoline

  14. Fractal regional myocardial blood flows pattern according to metabolism, not vascular anatomy.

    Science.gov (United States)

    Yipintsoi, Tada; Kroll, Keith; Bassingthwaighte, James B

    2016-02-01

    Regional myocardial blood flows are markedly heterogeneous. Fractal analysis shows strong near-neighbor correlation. In experiments to distinguish control by vascular anatomy vs. local vasomotion, coronary flows were increased in open-chest dogs by stimulating myocardial metabolism (catecholamines + atropine) with and without adenosine. During control states mean left ventricular (LV) myocardial blood flows (microspheres) were 0.5-1 ml·g(-1)·min(-1) and increased to 2-3 ml·g(-1)·min(-1) with catecholamine infusion and to ∼4 ml·g(-1)·min(-1) with adenosine (Ado). Flow heterogeneity was similar in all states: relative dispersion (RD = SD/mean) was ∼25%, using LV pieces 0.1-0.2% of total. During catecholamine infusion local flows increased in proportion to the mean flows in 45% of the LV, "tracking" closely (increased proportionately to mean flow), while ∼40% trended toward the mean. Near-neighbor regional flows remained strongly spatially correlated, with fractal dimension D near 1.2 (Hurst coefficient 0.8). The spatial patterns remain similar at varied levels of metabolic stimulation inferring metabolic dominance. In contrast, adenosine vasodilation increased flows eightfold times control while destroying correlation with the control state. The Ado-induced spatial patterns differed from control but were self-consistent, inferring that with full vasodilation the relaxed arterial anatomy dominates the distribution. We conclude that vascular anatomy governs flow distributions during adenosine vasodilation but that metabolic vasoregulation dominates in normal physiological states.

  15. Correlation of CT-based regional cardiac function (SQUEEZ) with myocardial strain calculated from tagged MRI: an experimental study.

    Science.gov (United States)

    Pourmorteza, Amir; Chen, Marcus Y; van der Pals, Jesper; Arai, Andrew E; McVeigh, Elliot R

    2016-05-01

    The objective of this study was to investigate the correlation between local myocardial function estimates from CT and myocardial strain from tagged MRI in the same heart. Accurate detection of regional myocardial dysfunction can be an important finding in the diagnosis of functionally significant coronary artery disease. Tagged MRI is currently a reference standard for noninvasive regional myocardial function analysis; however, it has practical drawbacks. We have developed a CT imaging protocol and automated image analysis algorithm for estimating regional cardiac function from a few heartbeats. This method tracks the motion of the left ventricular (LV) endocardial surface to produce local function maps: we call the method Stretch Quantification of Endocardial Engraved Zones (SQUEEZ). Myocardial infarction was created by ligation of the left anterior descending coronary artery for 2 h followed by reperfusion in canine models. Tagged and cine MRI scans were performed during the reperfusion phase and first-pass contrast enhanced CT scans were acquired. The average delay between the CT and MRI scans was myocardial strain (Ecc) was calculated from the tagged MRI data. The agreement between peak systolic Ecc and SQUEEZ was investigated in 162 segments in the 9 hearts. Linear regression and Bland-Altman analysis was used to assess the correlation between the two metrics of local LV function. The results show good agreement between SQUEEZ and Ecc: (r = 0.71, slope = 0.78, p function. The good agreement between the estimates of local myocardial function obtained from CT SQUEEZ and tagged MRI provides encouragement to investigate the use of SQUEEZ for measuring regional cardiac function at a low clinical dose in humans.

  16. Encircling endocardial ventriculotomy for refractory ischemic ventricular tachycardia. II. Effects on regional myocardial blood flow.

    Science.gov (United States)

    Ungerleider, R M; Holman, W L; Stanley, T E; Lofland, G K; Williams, J M; Smith, P K; Quick, G; Cox, J L

    1982-06-01

    Previous experimental studies of the encircling endocardial ventriculotomy (EEV) have shown a significant alteration of normal local electrical activity within the encompassed region. Although this procedure may result in isolation of ventricular arrhythmias, the data are more suggestive of a less specific effect on regional myocardial blood flow. This study examines the effect of EEV on local myocardial blood flow using the radioactive tracer microsphere technique in 10 dogs. Flows were determined before and after an EEV with the animals on cardiopulmonary bypass at controlled perfusion pressures, temperatures, and heart rates. Blood flow was studied at subepicardial and subendocardial levels inside, outside, and bordering the EEV. Prior to performance of the EEV, subepicardial blood flow in the left ventricular myocardium ranged from 0.81 +/- 0.07 to 0.89 +/- 0.08 ml/gm/min. Subendocardial flows ranged from 0.80 +/- 0.07 to 0.91 +/- 0.09 ml/gm/min. There was no significant difference between any of the flows across each respective layer of myocardium. Following the EEV procedure, blood flow to the subendocardium within the EEV fell to 0.33 +/- 0.07 ml/gm/min, while flow to the subendocardium of the normal regions of the same hearts actually increased to 1.21 +/- 0.23 ml/gm/min. Similar changes occurred at subepicardial levels, with flow at the center of the EEV falling to 0.66 +/- 0.10 ml/gm/min despite a tendency for normal subepicardial flow to increase to 1.78 +/- 0.24 ml/gm/min. Superimposed ischemia to the EEV-encompassed myocardium, created by occlusion of the distal left anterior descending coronary artery (LAD), accentuated this abnormality by demonstrating that the region continues to receive some flow from epicardially based coronary vessels. The data from this study show that the EEV decreased regional blood flow to the encompassed myocardium and suggests that myocardial ischemia may be responsible for ablation of the delicate re-entrant mechanisms

  17. Regional myocardial blood flow, metabolism and function assessed noninvasively by positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Schelbert, H.R.; Phelps, M.E.; Hoffman, E.; Huang, S.; Kuhl, D.E.

    1979-01-01

    Positron emission computed tomography is a new technique for the noninvasive measure of myocardial blood flow, mechanical function and, in particular, metabolism. The capability of this new study means is due to the technological innovations of the imaging device and the availability of radioactive tracers that are specific for blood flow and metabolism. The device permits recording of cross-sectional images of the left ventricular myocardium that reflect quantitatively regional tracer tissue concentrations. By employing tracer kinetic models this new technique permits the measurement of regional glucose and fatty acid metabolism of the heart. While already an important new tool for investigative studies into cardiac physiology and pathophysiology, the clinical utility of positron emission tomography remains to be defined.

  18. Mozart, but not the Beatles, reduces systolic blood pressure in patients with myocardial infarction.

    Science.gov (United States)

    Gruhlke, Luiza Carolina; Patrício, Marcelo Coelho; Moreira, Daniel Medeiros

    2015-12-01

    Music reduces systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in various clinical situations, but it is unclear whether these changes occur in post-infarction patients. The aim is to evaluate the effects of music on patients with acute myocardial infarction (MI). We evaluated patients with MI and we measured SBP, DBP, HR and double product (DP) two times before the intervention and one time every fifteen minutes with an ambulatory blood pressure monitor. We divided the patients into 3 groups: a group listening to music by Mozart; another listening to a Beatles collection and a third one listening to the radio news. Outcomes were the change in mean SBP, DBP, HR and DP with intervention. We enrolled 60 patients (20 in each group). SBP was significantly reduced in the Mozart group (variation of –7.2 ± 8.5 mmHg) compared to the Beatles group (–1.3 ± 6.2 mmHg) (P = 0.021) and the radio news group (0.6 ± 8.7 mmHg) (P = 0.003). DP was significantly reduced in the Mozart group compared with the News group (–668.5 ± 773.2 vs 31.6 ± 722.1 mmHg) (P = 0.006). There were no differences in DBP and HR. Patients with MI who listened Mozart had a reduction in SBP and DP compared to those who listened to the Beatles or the news.

  19. Adding attenuation corrected images in myocardial perfusion imaging reduces the need for a rest study.

    Science.gov (United States)

    Trägårdh, Elin; Valind, Sven; Edenbrandt, Lars

    2013-04-01

    The American Society of Nuclear Cardiology and the Society of Nuclear Medicine conclude that incorporation of attenuation corrected (AC) images in myocardial perfusion scintigraphy (MPS) will improve diagnostic accuracy. The aim was to investigate the value of adding AC stress-only images for the decision whether a rest study is necessary or not. 1,261 patients admitted to (99m)Tc MPS were studied. The stress studies were interpreted by two physicians who judged each study as "no rest study necessary" or "rest study necessary", by evaluating NC stress-only and NC + AC stress-only images. When there was disagreement between the two physicians, a third physician evaluated the studies. Thus, agreement between 2 out of 3 physicians was evaluated. The physicians assessed 214 more NC + AC images than NC images as "no rest study necessary" (17% of the study population). The number of no-rest-study-required was significantly higher for NC + AC studies compared to NC studies (859 vs 645 cases (p rest study necessary" (22 NC + AC cases; 8 NC cases), (no statistically significant difference). In 11 of these, the final report stated "suspected/possible ischemia or infarction in a small area". Adding AC stress-only images to NC stress-only images reduce the number of unnecessary rest studies substantially.

  20. Regionalization of care for ST-segment elevation myocardial infarction: is it too soon?

    Science.gov (United States)

    Pottenger, Brent C; Diercks, Deborah B; Bhatt, Deepak L

    2008-12-01

    Interest in regionalization of the care of acute ST-segment elevation myocardial infarction (STEMI) has gained momentum recently. Optimal treatment of STEMI involves balancing time to treatment and reperfusion options. Primary percutaneous coronary intervention, when performed in a timely fashion, has been shown to be more effective than fibrinolysis. However, numerous practical barriers prevent many STEMI patients from receiving primary percutaneous coronary intervention. In an effort to increase beneficial primary percutaneous coronary intervention administration to STEMI patients, health care leaders have proposed regionalized STEMI care networks with advanced emergency medical services (EMS) involvement. Constructing regionalized STEMI networks presents a policy challenge because this shift in STEMI care would require changes in current EMS and emergency medicine practices. Therefore, we present various perspectives and issues that decisionmakers and system organizers must address properly before deciding whether to adopt this new model of care. Reorganizing STEMI care in a manner analogous to how trauma and stroke care are currently triaged and treated appeals intuitively; however, given the absence of evidence that STEMI regionalization actually improves patient outcomes and is cost-effective, more research is needed to determine whether STEMI regionalization is an efficient model for providing evidence-based care. The concept of STEMI regionalization represents an effort to inform policy according to evidence-based medicine, but real-world quality, geospatial, financial, cost, business, resource, and practice barriers present obstacles to implementing this concept efficiently and effectively.

  1. Analysis of regional left ventricular function by low-dose dobutamine radionuclide ventriculography; Is it useful to assess myocardial viability

    Energy Technology Data Exchange (ETDEWEB)

    Takeyasu, Noriyuki; Watanabe, Shigeyuki; Ajisaka, Ryuichi (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine) (and others)

    1994-01-01

    The purpose of this study was to assess the value of low-dose dobutamine radionuclide ventriculography in the assessment of myocardial viability. The subjects were 40 patients who underwent both dobutamine radionuclide ventriculography and Tl-201 myocardial single photon emission computed tomography (SPECT). Scintigraphic data were acquired before and one minute after iv injection of 5 [mu]g/kg/min of dobutamine using equilibrium method. Left ventricular sector analysis was made to measure various left ventricular function indicators. In addition, sector analysis from SPECT images both at rest and exercise was made for the quantitative assessment of perfusion images, including normal, hypoperfusion and hyperperfusion, Dobutamine caused a significantly increased regional ejection fraction (rEF) equally in both normal and hypoperfusion zones on SPECT. In both zones, regional one to three ejection fraction (r1/3EF) was increased by dobutamine. This was significantly greater than that in normal zones on SPECT. Defect zones, as shown on SPECT, were less significantly subjected to both rEF and r1/3EF than the other zones; however, some zones showed the same degree of increase as hypoperfusion zones, suggesting myocardial viability. There was no consistent tendency for diastolic parameters. Dobutamine radionuclide ventriculography appears to have a potential for the assessment of myocardial viability by determining regional ventricular function, unlike the value of Tl-201 myocardial SPECT. (N.K.).

  2. Regional myocardial oxygen consumption estimated by carbon-11 acetate and positron emission tomography before and after repetitive ischemia

    DEFF Research Database (Denmark)

    Kofoed, K F; Hansen, P R; Holm, S

    2000-01-01

    BACKGROUND: Preserved myocardial oxygen consumption estimated by carbon 11-acetate and positron emission tomography (PET) in myocardial regions with chronic but reversibly depressed contractile function in patients with ischemic heart disease have been suggested to be caused by repeated short...... alternating with 5 minutes of reperfusion. Before and after repetitive coronary occlusions, oxygen 15 water/oxygen 15 carbon monoxide (blood flow), and 11C-acetate (oxygen consumption) PET imaging were performed. Left ventricular regional systolic wall thickening was measured with sonomicrometry. Forty...

  3. Endothelial cells overexpressing IL-8 receptor reduce cardiac remodeling and dysfunction following myocardial infarction.

    Science.gov (United States)

    Zhao, Xiangmin; Zhang, Wei; Xing, Dongqi; Li, Peng; Fu, Jinyan; Gong, Kaizheng; Hage, Fadi G; Oparil, Suzanne; Chen, Yiu-Fai

    2013-08-15

    The endothelium is a dynamic component of the cardiovascular system that plays an important role in health and disease. This study tested the hypothesis that targeted delivery of endothelial cells (ECs) overexpressing neutrophil membrane IL-8 receptors IL8RA and IL8RB reduces acute myocardial infarction (MI)-induced left ventricular (LV) remodeling and dysfunction and increases neovascularization in the area at risk surrounding the infarcted tissue. MI was created by ligating the left anterior descending coronary artery in 12-wk-old male Sprague-Dawley rats. Four groups of rats were studied: group 1: sham-operated rats without MI or EC transfusion; group 2: MI rats with intravenous vehicle; group 3: MI rats with transfused ECs transduced with empty adenoviral vector (Null-EC); and group 4: MI rats with transfused ECs overexpressing IL8RA/RB (1.5 × 10⁶ cells post-MI). Two weeks after MI, LV function was assessed by echocardiography; infarct size was assessed by triphenyltetrazolium chloride (live tissue) and picrosirus red (collagen) staining, and capillary density and neutrophil infiltration in the area at risk were measured by CD31 and MPO immunohistochemical staining, respectively. When compared with the MI + vehicle and MI-Null-EC groups, transfusion of IL8RA/RB-ECs decreased neutrophil infiltration and pro-inflammatory cytokine expression and increased capillary density in the area at risk, decreased infarct size, and reduced MI-induced LV dysfunction. These findings provide proof of principle that targeted delivery of ECs is effective in repairing injured cardiac tissue. Targeted delivery of ECs to infarcted hearts provides a potential novel strategy for the treatment of acute MI in humans.

  4. Increased regional epicardial fat volume associated with reversible myocardial ischemia in patients with suspected coronary artery disease.

    Science.gov (United States)

    Khawaja, Tuba; Greer, Christine; Thadani, Samir R; Kato, Tomoko S; Bhatia, Ketan; Shimbo, Daichi; Kontak, Andrew; Konkak, Andrew; Bokhari, Sabahat; Einstein, Andrew J; Schulze, P Christian

    2015-04-01

    Epicardial adipose tissue is a source of pro-inflammatory cytokines and has been linked to the development of coronary artery disease. No study has systematically assessed the relationship between local epicardial fat volume (EFV) and myocardial perfusion defects. We analyzed EFV in patients undergoing SPECT myocardial perfusion imaging combined with computed tomography (CT) for attenuation correction. Low-dose CT without contrast was performed in 396 consecutive patients undergoing SPECT imaging for evaluation of coronary artery disease. Regional thickness, cross-sectional areas, and total EFV were assessed. 295 patients had normal myocardial perfusion scans and 101 had abnormal perfusion scans. Mean EFVs in normal, ischemic, and infarcted hearts were 99.8 ± 82.3 cm(3), 156.4 ± 121.9 cm(3), and 96.3 ± 102.1 cm(3), respectively (P coronary artery (87.1 ± 76.4 vs 46.7 ± 40.6 cm(3); P = 0.005). Our results demonstrate increased regional epicardial fat in patients with active myocardial ischemia compared to patients with myocardial scar or normal perfusion on nuclear perfusion scans. Our results suggest a potential role for cardiac CT to improve risk stratification in patients with suspected coronary artery disease.

  5. Coffee reduces the risk of death after acute myocardial infarction: a meta-analysis.

    Science.gov (United States)

    Brown, Oliver I; Allgar, Victoria; Wong, Kenneth Y-K

    2016-11-01

    Habitual coffee consumption is protective against coronary heart disease in women; however, it is not clear whether such cardioprotection is conferred on those who have already experienced an acute myocardial infarction (AMI). Our aim was to investigate whether coffee consumption affected mortality after AMI. We carried out a dose-response meta-analysis of prospective studies that examined the relationship between coffee intake and mortality after an AMI. Using a defined-search strategy, electronic databases (MEDLINE and Embase) were searched for papers published between 1946 and 2015. Two eligible studies investigating post-AMI mortality risk against coffee consumption were identified and assessed using set criteria. Combined, these studies recruited a total of 3271 patients and 604 died. The hazard ratios for the following experimental groups were defined: light coffee drinkers (1-2 cups/day) versus noncoffee drinkers, heavy coffee drinkers (>2 cups/day) versus noncoffee drinkers and heavy coffee drinkers versus light coffee drinkers. A statistically significant inverse correlation was observed between coffee drinking and mortality; all three groups showed a significant reduction in risk ratio. Light coffee drinkers versus noncoffee drinkers were associated with a risk ratio of 0.79 [95% confidence interval (CI): 0.66-0.94, P=0.008]; heavy coffee drinkers versus noncoffee drinkers were associated with a risk ratio of 0.54 (95% CI: 0.45-0.65, Pcoffee drinkers versus light coffee drinkers were associated with a risk ratio of 0.69 (95% CI: 0.58-0.83, Pcoffee habitually following AMI was associated with a reduced risk of mortality.

  6. Effect of one-cycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary intervention.

    Science.gov (United States)

    Zografos, Theodoros A; Katritsis, George D; Tsiafoutis, Ioannis; Bourboulis, Nikolaos; Katsivas, Apostolos; Katritsis, Demosthenes G

    2014-06-15

    Up to 1/3 of percutaneous coronary interventions (PCIs) are complicated by troponin release. Remote ischemic preconditioning (IPC) confers effective cardioprotection; however, a 30-minute remote IPC protocol may be difficult to implement during ad hoc PCI. This study was performed to assess the ability of a brief remote IPC protocol to attenuate cardiac troponin I (cTnI) release after ad hoc PCI. Ninety-four patients undergoing ad hoc PCI for stable coronary artery disease, with undetectable preprocedural cTnI, were recruited and randomized to receive remote IPC (induced by one 5-minute inflation of a blood pressure cuff to 200 mm Hg around the upper arm) or control after the decision for PCI was made. The primary outcome was the difference between cTnI levels 24 hours after PCI and cTnI levels before coronary angiography (ΔcTnI). ΔcTnI in the remote IPC group was significantly lower compared with the control group (0.04 ng/ml [interquartile range 0.01 to 0.14] vs 0.19 ng/ml [interquartile range 0.18 to 0.59], p <0.001). The incidence of PCI-related myocardial infarction (MI) was greater in the control group (42.6% vs 19.1%, p = 0.014). In multivariate analysis, remote IPC was independently associated with ΔcTnI and PCI-related MI. In conclusion, our results suggest that even 1 cycle of remote IPC immediately before ad hoc PCI attenuates periprocedural cTnI release and reduces the incidence of type 4a MI.

  7. Treatment with the gap junction modifier rotigaptide (ZP123) reduces infarct size in rats with chronic myocardial infarction.

    Science.gov (United States)

    Haugan, Ketil; Marcussen, Niels; Kjølbye, Anne Louise; Nielsen, Morten Schak; Hennan, James K; Petersen, Jørgen Søberg

    2006-02-01

    Treatment with non-selective drugs (eg, long-chain alcohols, halothane) that reduce gap junction intercellular communication (GJIC) is associated with reduced infarct size after myocardial infarction (MI). Therefore, it has been suggested that gap junction intercellular communication stimulating compounds may increase infarct size. The antiarrhythmic peptide analogue rotigaptide (ZP123) increases cardiac gap junction intercellular communication and the purpose of the present study was to examine the effects of rotigaptide treatment on infarct size. Myocardial infarction was induced in male rats by ligation of the left anterior descending artery (LAD). Rats (n = 156) were treated with rotigaptide at three dose levels or vehicle from the onset of ischemia and for 3 weeks following LAD occlusion. Infarct size was determined using histomorphometry after 3 weeks treatment. Rotigaptide treatment producing steady state plasma levels of 0.8 +/- 0.1, 5.5 +/- 0.5, and 86 +/- 8 nmol/L had no effect on mortality, but reduced infarct size to 90 +/- 10% (P = 0.41), 67 +/- 7% (P = 0.005), and 82 +/- 7% (P = 0.13), respectively relative to vehicle-treated myocardial infarction rats (100 +/- 12%). In contrast to what was predicted, our data demonstrates that rotigaptide treatment was associated with a significant infarct size reduction. We conclude that whereas treatment with non-selective inhibitors of gap junction intercellular communication cause a reduction in infarct size, this information cannot be extrapolated to the effects of compounds that selectively increase gap junction intercellular communication.

  8. Heme oxygenase-1 induction improves cardiac function following myocardial ischemia by reducing oxidative stress.

    Directory of Open Access Journals (Sweden)

    Yossi Issan

    Full Text Available BACKGROUND: Oxidative stress plays a key role in exacerbating diabetes and cardiovascular disease. Heme oxygenase-1 (HO-1, a stress response protein, is cytoprotective, but its role in post myocardial infarction (MI and diabetes is not fully characterized. We aimed to investigate the protection and the mechanisms of HO-1 induction in cardiomyocytes subjected to hypoxia and in diabetic mice subjected to LAD ligation. METHODS: In vitro: cultured cardiomyocytes were treated with cobalt-protoporphyrin (CoPP and tin protoporphyrin (SnPP prior to hypoxic stress. In vivo: CoPP treated streptozotocin-induced diabetic mice were subjected to LAD ligation for 2/24 h. Cardiac function, histology, biochemical damage markers and signaling pathways were measured. RESULTS: HO-1 induction lowered release of lactate dehydrogenase (LDH and creatine phospho kinase (CK, decreased propidium iodide staining, improved cell morphology and preserved mitochondrial membrane potential in cardiomyocytes. In diabetic mice, Fractional Shortening (FS was lower than non-diabetic mice (35±1%vs.41±2, respectively p<0.05. CoPP-treated diabetic animals improved cardiac function (43±2% p<0.01, reduced CK, Troponin T levels and infarct size compared to non-treated diabetic mice (P<0.01, P<0.001, P<0.01 respectively. CoPP-enhanced HO-1 protein levels and reduced oxidative stress in diabetic animals, as indicated by the decrease in superoxide levels in cardiac tissues and plasma TNFα levels (p<0.05. The increased levels of HO-1 by CoPP treatment after LAD ligation led to a shift of the Bcl-2/bax ratio towards the antiapoptotic process (p<0.05. CoPP significantly increased the expression levels of pAKT and pGSK3β (p<0.05 in cardiomyocytes and in diabetic mice with MI. SnPP abolished CoPP's cardioprotective effects. CONCLUSIONS: HO-1 induction plays a role in cardioprotection against hypoxic damage in cardiomyocytes and in reducing post ischemic cardiac damage in the diabetic heart

  9. Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction

    DEFF Research Database (Denmark)

    Wang, Na; Hung, Chung-Lieh; Shin, Sung Hee

    2016-01-01

    -mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50...

  10. Metoprolol in acute myocardial infarction reduces ventricular arrhythmias both in the early stage and after the acute event.

    Science.gov (United States)

    Rehnqvist, N; Olsson, G; Erhardt, L; Ekman, A M

    1987-06-01

    Fifty three of the 5778 patients included in the MIAMI (Metoprolol in Acute Myocardial Infarction) trial were investigated with long-term ECG recordings in order to evaluate the effect of acute beta-blockade on premature ventricular complexes in and after acute myocardial infarction. Twenty five patients were given placebo and 28 metoprolol in a double-blind randomized fashion for 15 days. After this period the patients were put on open beta-blockade without breaking individual study codes. The mean number of premature ventricular complexes during the inclusion day (day 0) was the same in the two groups. The median numbers were also similar in the two groups: 190 and 154 in the placebo and metoprolol groups, respectively. Metoprolol significantly reduced the median number of premature ventricular complexes in the randomized period. The median numbers on days 1, 2 and 15 were 146, 101, 84 in the placebo group and 73, 59 and 10 in the metoprolol group, respectively (P less than 0.05). Also during the further follow-up, when investigated 1, 3 and 6 months after the infarction, the median number of premature ventricular complexes was lower in the metoprolol group (74, 257, 142 in the placebo group and 7, 5 and 11 in the metoprolol group, P less than 0.05). This indicates that metoprolol treatment in the acute phase of myocardial infarction reduces ventricular arrhythmias both in the early stage and also after the acute event.

  11. Psoriasis Patients Treated With Biologics and Methotrexate Have a Reduced Rate of Myocardial Infarction: A Collaborative Analysis Using International Cohorts.

    Science.gov (United States)

    Gulliver, Wayne P; Young, Heather M; Bachelez, Hervé; Randell, Shane; Gulliver, Susanne; Al-Mutairi, Nawaf

    2016-11-01

    Psoriasis is a chronic inflammatory skin condition characterised by the formation of red scaly plaques on the skin. It is an autoimmune disease cause by the dysregulation of cytokines controlling the inflammatory pathways, a mechanism likely contributing to various comorbidities observed in patients with psoriasis. Cardiovascular disease is one comorbidity observed more frequently in the psoriasis patient population. Biologic treatments specifically target the dysregulation of cytokines in the inflammation pathway and have shown to be an effective treatment for moderate to severe psoriasis where other systemic treatments have failed. More recently, biologics have been shown to reduce the incidence of myocardial infarction in patients with psoriasis compared to patients treated with topical agents. In the present study, 4 international psoriasis patient cohorts are combined and analyzed to examine the effect that biologic or methotrexate treatment has on reducing the incidence of myocardial infarction. Both methotrexate and biologic treatments were found to lower the incidence of myocardial infarction in moderate to severe psoriasis patient populations. © The Author(s) 2016.

  12. Achyranthes bidentata Polypeptides Reduces Oxidative Stress and Exerts Protective Effects against Myocardial Ischemic/Reperfusion Injury in Rats

    Directory of Open Access Journals (Sweden)

    Haifeng Zhang

    2013-09-01

    Full Text Available Achyranthes bidentata, a Chinese medicinal herb, is reported to be neuroprotective. However, its role in cardioprotection remains largely unknown. Our present study aimed to investigate the effects of Achyranthes bidentata polypeptides (ABPP preconditioning on myocardial ischemia/reperfusion (MI/R injury and to test the possible mechanisms. Rats were treated with ABPP (10 mg/kg/d, i.p. or saline once daily for one week. Afterward, all the animals were subjected to 30 min of myocardial ischemia followed by 4 h of reperfusion. ABPP preconditioning for one week significantly improved cardiac function following MI/R. Meanwhile, ABPP reduced infarct size, plasma creatine kinase (CK/lactate dehydrogenase (LDH activities and myocardial apoptosis at the end of reperfusion in rat hearts. Moreover, ABPP preconditioning significantly inhibited superoxide generation, gp91phox expression, malonaldialdehyde formation and enhanced superoxide dismutase activity in I/R hearts. Furthermore, ABPP treatment inhibited PTEN expression and increased Akt phosphorylation in I/R rat heart. PI3K inhibitor wortmannin blocked Akt activation, and abolished ABPP-stimulated anti-oxidant effect and cardioprotection. Our study demonstrated for the first time that ABPP reduces oxidative stress and exerts cardioprotection against MI/R injury in rats. Inhibition of PTEN and activation of Akt may contribute to the anti-oxidant capacity and cardioprotection of ABPP.

  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 SEASON PATTERN ON PREVALENCE AND SEVERITY OF ACUTE MYOCARDIAL INFARCTION, FUNCTION OF HEMOSTASIS IN PATIENTS WITH ISCHEMIC HEART DESEASE OF CLIMATE AREA OF MIDDLE VOLGA REGION

    Directory of Open Access Journals (Sweden)

    O.K. Rybak

    2007-09-01

    Full Text Available The aim of this study is to evaluate season pattern, severity and outcome of acute myocardial infarction in dependence of yearly patterns of function of hemostasis in middle Volga Region. Season pattern of prevalence myocardial infarction with winter peak was discovered, be accompanied of increase platelet aggregation, deterioration of blood viscosity, fibrinolysis depression. Most serious clinical course of summer myocardial infarction was observed with prosperity of hemostasis.

  15. Cardiovascular Magnetic Resonance Relaxometry Predicts Regional Functional Outcome After Experimental Myocardial Infarction.

    Science.gov (United States)

    Haberkorn, Sebastian M; Jacoby, Christoph; Ding, Zhaoping; Keul, Petra; Bönner, Florian; Polzin, Amin; Levkau, Bodo; Schrader, Jürgen; Kelm, Malte; Flögel, Ulrich

    2017-08-01

    Cardiovascular magnetic resonance with gadolinium-based contrast agents has established as gold standard for tissue characterization after myocardial infarction (MI). Beyond accurate diagnosis, the value of cardiovascular magnetic resonance to predict the outcome after MI has yet to be substantiated. Recent cardiovascular magnetic resonance approaches were systematically compared for quantification of tissue injury and functional impairment after MI using murine models with permanent left anterior descending coronary artery ligation (n=14) or 50 minutes ischemia/reperfusion (n=13). Cardiovascular magnetic resonance included native/postcontrast T1 maps, T2 maps, and late gadolinium enhancement at days 1 and 21 post-MI. For regional correlation of parametric and functional measures, the left ventricle was analyzed over 200 sectors. For T1 mapping, we used retrospective triggering with variable flip angle analysis. Sectoral analysis of native T1 maps already revealed in the acute phase after MI substantial discrepancies in myocardial tissue texture between the 2 MI models (native T1 day 1: permanent ligation, 1280.0±162.6 ms; ischemia/reperfusion, 1115.0±140.5 ms; Pfunctional outcome (left ventricular ejection fraction day 21: permanent ligation, 24.5±7.0%; ischemia/reperfusion, 33.7±11.6%; Pfunction in corresponding areas at day 21 demonstrated for early native T1 values the best correlation with the later functional impairment (R(2) =0.94). The present T1 mapping approach permits accurate characterization of local tissue injury and holds the potential for sensitive and graduated prognosis of the functional outcome after MI without gadolinium-based contrast agents. © 2017 American Heart Association, Inc.

  16. Reduced occurrence of atrial fibrillation in acute myocardial infarction treated with streptokinase

    DEFF Research Database (Denmark)

    Nielsen, F E; Sørensen, H T; Christensen, J H

    1991-01-01

    In a historical follow-up study of 152 hospital patients with acute myocardial infarction, the frequency of life-threatening arrhythmias (ventricular fibrillation, sustained ventricular tachycardia, 3rd degree AV-block, 2nd degree AV-block (Mobitz type II), and asystole) and atrial fibrillation...

  17. Reduced microvascular density in non-ischemic myocardium of patients with recent non-ST-segment-elevation myocardial infarction.

    Science.gov (United States)

    Campbell, Duncan J; Somaratne, Jithendra B; Jenkins, Alicia J; Prior, David L; Yii, Michael; Kenny, James F; Newcomb, Andrew E; Kelly, Darren J; Black, Mary Jane

    2013-08-10

    Myocardial microvascular dysfunction has been implicated in the pathogenesis of myocardial infarction (MI). We tested the hypothesis that patients with MI have lower microvasculature density in myocardium remote from the site of infarction than patients with similar extent of coronary artery disease (CAD) without MI and examined the relationship between myocardial capillary length density and plasma levels of angiogenesis-related biomarkers. We analyzed biopsies from non-ischemic left ventricular (LV) myocardium and measured plasma levels of angiogenesis-related biomarkers in patients undergoing coronary artery bypass graft surgery, 57 without previous MI (no-MI) and 27 with recent non-ST-segment-elevation MI (NSTEMI). Comparison was made with biopsies from 31 aortic stenosis (AS) patients and 6 patients with "normal" LV without CAD. Myocardial microvascular density of NSTEMI patients was approximately half the density of no-MI patients, and similar to AS patients. Whereas the reduced microvascular density of AS patients was accounted for by their cardiomyocyte hypertrophy, this was not the case for NSTEMI patients, who had higher diffusion radius/cardiomyocyte width ratio than no-MI, "normal" LV, and AS patients. NSTEMI patients had lower plasma levels of carboxymethyl lysine and low molecular weight fluorophores, higher vascular endothelial growth factor (VEGF) receptor-1/VEGF-A ratio, and higher endostatin and hepatocyte growth factor levels than no-MI patients. Recent MI was associated with reduced microvasculature density in myocardium remote from the site of infarction and alteration in plasma levels of angiogenesis-related biomarkers. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

    Science.gov (United States)

    Zarpelon, Camila Stuchi; Netto, Miguel Chomiski; Jorge, José Carlos Moura; Fabris, Cátia Carolina; Desengrini, Dieli; Jardim, Mariana da Silva; da Silva, Diego Guedes

    2016-01-01

    Background The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. Objective To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Methods Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. Results The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007). Conclusion The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr. PMID:27223641

  19. Regional myocardial function after intracoronary bone marrow cell injection in reperfused anterior wall infarction - a cardiovascular magnetic resonance tagging study

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    Arnesen Harald

    2011-03-01

    Full Text Available Abstract Background Trials have brought diverse results of bone marrow stem cell treatment in necrotic myocardium. This substudy from the Autologous Stem Cell Transplantation in Acute Myocardial Infarction trial (ASTAMI explored global and regional myocardial function after intracoronary injection of autologous mononuclear bone marrow cells (mBMC in acute anterior wall myocardial infarction treated with percutaneous coronary intervention. Methods Cardiovascular magnetic resonance (CMR tagging was performed 2-3 weeks and 6 months after revascularization in 15 patients treated with intracoronary stem cell injection (mBMC group and in 13 controls without sham injection. Global and regional left ventricular (LV strain and LV twist were correlated to cine CMR and late gadolinium enhancement (LGE. Results In the control group myocardial function as measured by strain improved for the global LV (6 months: -13.1 ± 2.4 versus 2-3 weeks: -11.9 ± 3.4%, p = 0.014 and for the infarct zone (-11.8 ± 3.0 versus -9.3 ± 4.1%, p = 0.001, and significantly more than in the mBMC group (inter-group p = 0.027 for global strain, respectively p = 0.009 for infarct zone strain. LV infarct mass decreased (35.7 ± 20.4 versus 45.7 ± 29.5 g, p = 0.024, also significantly more pronounced than the mBMC group (inter-group p = 0.034. LV twist was initially low and remained unchanged irrespective of therapy. Conclusions LGE and strain findings quite similarly demonstrate subtle differences between the mBMC and control groups. Intracoronary injection of autologous mBMC did not strengthen regional or global myocardial function in this substudy. Trial registration ClinicalTrials.gov: NCT00199823

  20. Exenatide reduces reperfusion injury in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Vejlstrup, Niels; Kelbæk, Henning

    2011-01-01

    (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods and results A total of 172 patients with STEMI and Thrombolysis in Myocardial Infarction flow 0/1 were randomly assigned to exenatide or placebo (saline) intravenously. Study treatment was commenced 15 min before intervention...... the infarct size and the AAR for both treatment groups and an analysis of covariance showed that datapoints in the exenatide group lay significantly lower than for the placebo group (P= 0.011). There was a trend towards smaller absolute infarct size in the exenatide group (13 ± 9 vs. 17 ± 14 g; P= 0.......11). No difference was observed in left ventricular function or 30-day clinical events. No adverse effects of exenatide were observed. Conclusion In patients with STEMI undergoing pPCI, administration of exenatide at the time of reperfusion increases myocardial salvage....

  1. Treatment with the C5a receptor antagonist ADC-1004 reduces myocardial infarction in a porcine ischemia-reperfusion model

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    Arheden Håkan

    2010-09-01

    Full Text Available Abstract Background Polymorphonuclear neutrophils, stimulated by the activated complement factor C5a, have been implicated in cardiac ischemia/reperfusion injury. ADC-1004 is a competitive C5a receptor antagonist that has been shown to inhibit complement related neutrophil activation. ADC-1004 shields the neutrophils from C5a activation before they enter the reperfused area, which could be a mechanistic advantage compared to previous C5a directed reperfusion therapies. We investigated if treatment with ADC-1004, according to a clinically applicable protocol, would reduce infarct size and microvascular obstruction in a large animal myocardial infarct model. Methods In anesthetized pigs (42-53 kg, a percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 minutes, followed by 4 hours of reperfusion. Twenty minutes after balloon inflation the pigs were randomized to an intravenous bolus administration of ADC-1004 (175 mg, n = 8 or saline (9 mg/ml, n = 8. Area at risk (AAR was evaluated by ex vivo SPECT. Infarct size and microvascular obstruction were evaluated by ex vivo MRI. The observers were blinded to the treatment at randomization and analysis. Results ADC-1004 treatment reduced infarct size by 21% (ADC-1004: 58.3 ± 3.4 vs control: 74.1 ± 2.9%AAR, p = 0.007. Microvascular obstruction was similar between the groups (ADC-1004: 2.2 ± 1.2 vs control: 5.3 ± 2.5%AAR, p = 0.23. The mean plasma concentration of ADC-1004 was 83 ± 8 nM at sacrifice. There were no significant differences between the groups with respect to heart rate, mean arterial pressure, cardiac output and blood-gas data. Conclusions ADC-1004 treatment reduces myocardial ischemia-reperfusion injury and represents a novel treatment strategy of myocardial infarct with potential clinical applicability.

  2. Strophanthus hispidus attenuates the Ischemia-Reperfusion induced myocardial Infarction and reduces mean arterial pressure in renal artery occlusion

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    Rohit Gundamaraju

    2014-01-01

    Full Text Available Background: The myocardium is generally injured in the case of reperfusion injury and arterial damage is caused by hypertension. In reference to these statements, the present study was focused. Cardiac glycosides were said to have protective effects against myocardial infarction and hypertension. Strophanthus hispidus was thus incorporated in the study. Objective: The prime objective of the study was to investigate the protective effects of Strophanthus hispidus against ischemia-reperfusion myocardial Infarction and renal artery occluded hypertension in rats. Materials and Methods: The animal model adopted was surgically-induced myocardial ischemia, performed by means of left anterior descending coronary artery occlusion (LAD for 30 min followed by reperfusion for another 4 h. Infarct size was assessed by using the staining agent TTC (2,3,5-triphenyl tetrazolium chloride. Hypertension was induced by clamping the renal artery with renal bulldog clamp for 4 h. Results: The study was fruitful by the effect of Strophanthus hispidus on infarction size, which got reduced to 27.2 ± 0.5and 20.0 ± 0.2 by 500 mg/Kg and 1000 mg/Kg ethanolic extracts which was remarkably significant when compared with that of the control group 52.8 ± 4.6. The plant extract did reduce heart rate at various time intervals. There was also a protective effect in the case of mean arterial blood pressure were the 500 mg/Kg and 1000 mg/Kg of the plant extract did reduce the hypertension after 60 minutes was 60.0 ± 4.80 and 50.50 ± 6.80. Conclusion: The results suggest that 500 mg/Kg and 100 mg/Kg ethanolic extract of Strophanthus hispidus was found to possess significant cardiac protective and anti-hypertensive activity.

  3. Three-dimensional regional strain analysis in porcine myocardial infarction: a 3T magnetic resonance tagging study

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    Soleimanifard Sahar

    2012-12-01

    Full Text Available Abstract Background Previous studies of mechanical strain anomalies in myocardial infarction (MI have been largely limited to analysis of one-dimensional (1D and two-dimensional (2D strain parameters. Advances in cardiovascular magnetic resonance (CMR methods now permit a complete three-dimensional (3D interrogation of myocardial regional strain. The aim of this study was to investigate the incremental value of CMR-based 3D strain and to test the hypothesis that 3D strain is superior to 1D or 2D strain analysis in the assessment of viability using a porcine model of infarction. Methods Infarction was induced surgically in 20 farm pigs. Cine, late gadolinium enhancement, and CMR tagging images were acquired at 11 days before (baseline, and 11 days (early and 1 month (late after induction of infarct. Harmonic phase analysis was performed to measure circumferential, longitudinal, and radial strains in myocardial segments, which were defined based on the transmurality of delayed enhancement. Univariate, bivariate, and multivariate logistic regression models of strain parameters were created and analyzed to compare the overall diagnostic accuracy of 3D strain analysis with 1D and 2D analyses in identifying the infarct and its adjacent regions from healthy myocardium. Results 3D strain differed significantly in infarct, adjacent, and remote segments (p  Conclusions Cumulative 3D strain information accurately identifies infarcts and their neighboring regions from healthy myocardium. The 3D interrogation of myocardial contractility provides incremental diagnostic accuracy in delineating the dysfunctional and nonviable myocardium in comparison with 1D or 2D quantification of strain. The infarct neighboring regions are the major beneficiaries of the 3D assessment of regional strain.

  4. Novel, selective EPO receptor ligands lacking erythropoietic activity reduce infarct size in acute myocardial infarction in rats.

    Science.gov (United States)

    Kiss, Krisztina; Csonka, Csaba; Pálóczi, János; Pipis, Judit; Görbe, Anikó; Kocsis, Gabriella F; Murlasits, Zsolt; Sárközy, Márta; Szűcs, Gergő; Holmes, Christopher P; Pan, Yijun; Bhandari, Ashok; Csont, Tamás; Shamloo, Mehrdad; Woodburn, Kathryn W; Ferdinandy, Péter; Bencsik, Péter

    2016-11-01

    Erythropoietin (EPO) has been shown to protect the heart against acute myocardial infarction in pre-clinical studies, however, EPO failed to reduce infarct size in clinical trials and showed significant safety problems. Here, we investigated cardioprotective effects of two selective non-erythropoietic EPO receptor ligand dimeric peptides (AF41676 and AF43136) lacking erythropoietic activity, EPO, and the prolonged half-life EPO analogue, darbepoetin in acute myocardial infarction (AMI) in rats. In a pilot study, EPO at 100U/mL significantly decreased cell death compared to vehicle (33.8±2.3% vs. 40.3±1.5%, pEPO reduced infarct size significantly compared to vehicle (45.3±4.8% vs. 59.8±4.5%, pEPO receptor ligand dimeric peptides AF41676 and AF43136 administered before reperfusion are able to reduce infarct size in a rat model of AMI. Therefore, non-erythropoietic EPO receptor peptide ligands may be promising cardioprotective agents.

  5. Evaluation of regional wall motion in myocardial infarction using animation ECG gated cardiac computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Takahiko; Hyodo, Haruo; Hayashi, Terumi; Yamamoto, Hideo; Yagi, Shigeru

    1984-08-01

    Regional wall motion of the left ventricle was evaluated in 21 patients with myocardial infarction using an animation system of gated cardiac computed tomographic (CT) images (animation gated CCT). The results obtained were compared with data by two-dimensional echocardiography (2-DE). 1. Evaluation of the asynergic area by animation gated CCT and 2-DE: Animation gated CCT detected the following specific regions with asynergy established by 2-DE; 10/10 cases (100%) at the anterior wall of the left ventricle, 14/14 cases (100%) at the interventricular septum, and 9/11 cases (81.8%) at the infero-posterior wall. In addition, one false positive case and one negative case were observed at the lateral wall and the apex, respectively. Of 37 instances with asynergic areas established by 2-DE, 21 cases or 89.2% were detected by animation gated CCT; the sensitivity was 91.9%. 2. Evaluation of severity of asynergy by animation gated CCT and 2-DE: The degree of asynergy evaluated by both methods was compared with each other, and the agreement was as follows: 10/10 cases (100%) at the left-ventricular anterior wall, 13/13 cases (100%) at the interventricular septum, and 7/9 cases (77.8%) at the infero-posterior wall. 3. Evaluation of the asynergic area by nonanimation gated CCT and 2-DE: Nonanimation gated CCT detected asynergic areas ascertained by 2-DE at the following areas; 8/10 cases (80%) at the left-ventricular anterior wall, 12/14 cases (85.7%) at the interventricular septum, and 4/11 cases (36.4%) at the infero-posterior wall. The difference between animation and nonanimation gated CCT was statistically significant (p < 0.05). The severity of asynergy could not be evaluated by nonanimation gated CCT. (J.P.N.).

  6. High-intensity training reduces intermittent hypoxia-induced ER stress and myocardial infarct size.

    Science.gov (United States)

    Bourdier, Guillaume; Flore, Patrice; Sanchez, Hervé; Pepin, Jean-Louis; Belaidi, Elise; Arnaud, Claire

    2016-01-15

    Chronic intermittent hypoxia (IH) is described as the major detrimental factor leading to cardiovascular morbimortality in obstructive sleep apnea (OSA) patients. OSA patients exhibit increased infarct size after a myocardial event, and previous animal studies have shown that chronic IH could be the main mechanism. Endoplasmic reticulum (ER) stress plays a major role in the pathophysiology of cardiovascular disease. High-intensity training (HIT) exerts beneficial effects on the cardiovascular system. Thus, we hypothesized that HIT could prevent IH-induced ER stress and the increase in infarct size. Male Wistar rats were exposed to 21 days of IH (21-5% fraction of inspired O2, 60-s cycle, 8 h/day) or normoxia. After 1 wk of IH alone, rats were submitted daily to both IH and HIT (2 × 24 min, 15-30m/min). Rat hearts were either rapidly frozen to evaluate ER stress by Western blot analysis or submitted to an ischemia-reperfusion protocol ex vivo (30 min of global ischemia/120 min of reperfusion). IH induced cardiac proapoptotic ER stress, characterized by increased expression of glucose-regulated protein kinase 78, phosphorylated protein kinase-like ER kinase, activating transcription factor 4, and C/EBP homologous protein. IH-induced myocardial apoptosis was confirmed by increased expression of cleaved caspase-3. These IH-associated proapoptotic alterations were associated with a significant increase in infarct size (35.4 ± 3.2% vs. 22.7 ± 1.7% of ventricles in IH + sedenary and normoxia + sedentary groups, respectively, P < 0.05). HIT prevented both the IH-induced proapoptotic ER stress and increased myocardial infarct size (28.8 ± 3.9% and 21.0 ± 5.1% in IH + HIT and normoxia + HIT groups, respectively, P = 0.28). In conclusion, these findings suggest that HIT could represent a preventive strategy to limit IH-induced myocardial ischemia-reperfusion damages in OSA patients. Copyright © 2016 the American Physiological Society.

  7. Metabolic Syndrome, Strain, and Reduced Myocardial Function: Multi-Ethnic Study of Atherosclerosis

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    Almeida, André Luiz Cerqueira de, E-mail: andrealmeida@cardiol.br [Johns Hopkins University, Baltimore, MD (United States); Universidade Estadual de Feira de Santana, Bahia (Brazil); Teixido-Tura, Gisela; Choi, Eui-Young; Opdahl, Anders; Fernandes, Verônica R. S. [Johns Hopkins University, Baltimore, MD (United States); Wu, Colin O. [National Heart, Lung and Blood Institute, Bethesda, MD (United States); Bluemke, David A. [National Institutes of Health Clinical Center, National Institute for Biomedical Imaging and Bioengineering, Bethesda, MD (United States); Lima, João A. C. [Johns Hopkins University, Baltimore, MD (United States)

    2014-04-15

    Subclinical cardiovascular disease is prevalent in patients with Metabolic Syndrome (MetSyn). Left ventricular (LV) circumferential strain (ε{sub CC}) and longitudinal strain (ε{sub LL}), assessed by Speckle Tracking Echocardiography (STE), are indices of systolic function: shortening is indicated by negative strain, and thus, the more negative the strain, the better the LV systolic function. They have been used to demonstrate subclinical ventricular dysfunction in several clinical disorders. We hypothesized that MetSyn is associated with impaired myocardial function, as assessed by STE. We analyzed Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent STE and were evaluated for all MetSyn components. Among the 133 participants included [women: 63%; age: 65 ± 9 years (mean ± SD)], the prevalence of MetSyn was 31% (41/133). Individuals with MetSyn had lower ε{sub CC} and lower ε{sub LL} than those without MetSyn (-16.3% ± 3.5% vs. -18.4% ± 3.7%, p < 0.01; and -12.1% ± 2.5% vs. -13.9% ± 2.3%, p < 0.01, respectively). The LV ejection fraction (LVEF) was similar in both groups (p = 0.09). In multivariate analysis, MetSyn was associated with less circumferential myocardial shortening as indicated by less negative ε{sub CC} (B = 2.1%, 95%CI:0.6 3.5, p < 0.01) even after adjusting for age, ethnicity, LV mass, and LVEF). Likewise, presence of MetSyn (B = 1.3%, 95%CI:0.3 2.2, p < 0.01) and LV mass (B = 0.02%, 95% CI: 0.01-0.03, p = 0.02) were significantly associated with less longitudinal myocardial shortening as indicated by less negative ε{sub LL} after adjustment for ethnicity, LVEF, and creatinine. Left ventricular ε{sub CC} and ε{sub LL}, markers of subclinical cardiovascular disease, are impaired in asymptomatic individuals with MetSyn and no history of myocardial infarction, heart failure, and/or LVEF < 50%.

  8. No evidence that genetically reduced 25-hydroxyvitamin D is associated with increased risk of ischaemic heart disease or myocardial infarction

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Benn, Marianne; Afzal, Shoaib

    2015-01-01

    that genetically reduced plasma 25(OH)D is associated with increased risk of ischaemic heart disease and myocardial infarction. METHODS: We used a Mendelian randomization design in the Copenhagen City Heart Study, the Copenhagen General Population Study, and the Copenhagen Ischaemic Heart Disease Study. Two 25(OH......)D reducing genetic variants in the DCHR7 gene (rs7944926 and rs11234027) and two in the CYP2R1 gene (rs10741657 and rs12794714) were genotyped in 92 416 participants of Danish descent, of whom 14 455 developed ischaemic heart disease (ICD-8:410-414; ICD-10:I20-I25) and 7061 myocardial infarction (ICD-8...... (CI): 1.42-2.32] for ischaemic heart disease. Each allele increase in a combined allele score was associated with a 1.9-nmol/l decrease in p-25(OH)D (P = 7 × 10(-55); R(2) = 0.9%). The genetic variants were, however, not associated with increased risk of ischaemic heart disease. In instrumental...

  9. N-acetylcysteine and allopurinol synergistically enhance cardiac adiponectin content and reduce myocardial reperfusion injury in diabetic rats.

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    Tingting Wang

    Full Text Available BACKGROUND: Hyperglycemia-induced oxidative stress plays a central role in the development of diabetic myocardial complications. Adiponectin (APN, an adipokine with anti-diabetic and anti-ischemic effects, is decreased in diabetes. It is unknown whether or not antioxidant treatment with N-acetylcysteine (NAC and/or allopurinol (ALP can attenuate APN deficiency and myocardial ischemia reperfusion (MI/R injury in the early stage of diabetes. METHODOLOGY/PRINCIPAL FINDINGS: Control or streptozotocin (STZ-induced diabetic rats were either untreated (C, D or treated with NAC (1.5 g/kg/day or ALP (100 mg/kg/day or their combination for four weeks starting one week after STZ injection. Plasma and cardiac biochemical parameters were measured after the completion of treatment, and the rats were subjected to MI/R by occluding the left anterior descending artery for 30 min followed by 2 h reperfusion. Plasma and cardiac APN levels were decreased in diabetic rats accompanied by decreased cardiac APN receptor 2 (AdipoR2, reduced phosphorylation of Akt, signal transducer and activator of transcription 3 (STAT3 and endothelial nitric oxide synthase (eNOS but increased IL-6 and TNF-α (all P<0.05 vs. C. NAC but not ALP increased cardiac APN concentrations and AdipoR2 expression in diabetic rats. ALP enhanced the effects of NAC in restoring cardiac AdipoR2 and phosphorylation of Akt, STAT3 and eNOS in diabetic rats. Further, NAC and ALP, respectively, decreased postischemic myocardial infarct size and creatinine kinase-MB (CK-MB release in diabetic rats, while their combination conferred synergistic protective effects. In addition, exposure of cultured rat cardiomyocytes to high glucose resulted in significant reduction of cardiomyocyte APN concentration and AdipoR2 protein expression. APN supplementation restored high glucose induced AdipoR2 reduction in cardiomyocytes. CONCLUSIONS/SIGNIFICANCE: NAC and ALP synergistically restore myocardial APN and AdipoR2

  10. Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience.

    Science.gov (United States)

    Khot, Umesh N; Johnson-Wood, Michele L; Geddes, Jason B; Ramsey, Curtis; Khot, Monica B; Taillon, Heather; Todd, Randall; Shaikh, Saeed R; Berg, William J

    2009-07-26

    The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown. We prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004-August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005-June 26, 2006 after protocol implementation. Per hospital admission, insurance payments (hospital revenue) decreased ($35,043 +/- $36,670 vs. $25,329 +/- $16,185, P = 0.039) along with total hospital costs ($28,082 +/- $31,453 vs. $18,195 +/- $9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs. $7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped $1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 +/- $74,033 vs. $53,514 +/- $23,378, P = 0.059), diagnosis related group relative weight (3.7479 +/- 2.6731 vs. 2.9729 +/- 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 +/- $53,741 vs. $35,937 +/- $23,125, P = 0.044; Total hospital costs: $39,974 +/- $37,434 vs. $26,778 +/- $15,561, P = 0.007; Net Income: $9984 vs. $9159, P = 0.855. All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial

  11. Attenuation of myocardial apoptosis by alpha-lipoic acid through suppression of mitochondrial oxidative stress to reduce diabetic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    LI Chun-jun; ZHANG Qiu-mei; LI Ming-zhen; ZHANG Jing-yun; YU Pei; YU De-min

    2009-01-01

    Background Cardiac failure is a leading cause of the mortality of diabetic patients.In part this is due to a specific cardiomyopathy,referred to as diabetic cardiomyopathy.Oxidative stress is widely considered to be one of the major factors underlying the pathogenesis of the disease.This study aimed to test whether the antioxidant α-lipoic acid(α-LA)could attenuate mitochondrion-dependent myocardial apoptosis through suppression of mitochondrial oxidative stress to reduce diabetic cardiomyopathy.Methods A rat model of diabetes was induced by a single tail intravenous injection of streptozotocin(STZ)45 mg/kg.Experimental animals were randomly assigned to 3 groups:normal control(NC),diabetes(DM)and DM treated with α-LA (α-LA).The latter group was administered with α-LA(100 mg/kg ip per day),the remainder received the same volume vehicle.At weeks 4,8,and 12 after the onset of diabetes,cardiac apoptosis was examined by TUNEL assay.Cardiomyopathy was evaluated by assessment of cardiac structure and function.Oxidative damage was evaluated by the content of malondialdehyde(MDA),reduced glutathione(GSH)and the activity of manganese superoxide diamutase (Mn-SOD)in the myocardial mitochondria.Expression of caspase-9 and caspase-3 proteins was determined by immunohistochemistry and mitochondrial cytochrome c release was detected by Western blottingResults At 4,8,and 12 weeks after the onset of diabetes,significant reductions in TUNEL-positive cells,caspase-9,-3 expression,and mitochondrial cytochrome c release were observed in the α-LA group compared to the DM group.In the DM group,the content of MDA in the myocardial mitochondria was significantly increased,and there was a decrease in both the mitochondrial GSH content and the activities of Mn-SOD.They were significantly improved by α-LA treatment.HE staining displayed structural abnormalities in diabetic hearts,while α-LA reversed this structural derangement.The index of cardiac function(±dp/dtmax)in the diabetes

  12. Is the time between onset of pain and restoration of patency of infarct-related artery shortened in patients with myocardial infarction? The effects of the Kielce Region System for Optimal Management of Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Marcin Sadowski

    2014-09-01

    Full Text Available Introduction : The importance of delay in the restoration of infarct-related artery patency in patients with myocardial infarction was discussed, and actions were undertaken in the Kielce Region aimed at shortening this time within the System for Optimal Management of Acute Myocardial Infarction. Aim of the research: To evaluate the effectiveness of shortening time delays during transport of patients and diagnostics of myocardial infarction in the Kielce Region. Material and methods: Time delays were analysed in 5,934 patients with ST-segment elevation myocardial infarction (STEMI, hospitalised in cardiology wards with interventional cardiology on 24-hour duty, during the period 2008–2012. Time delays were analysed between the onset of myocardial infarction pain and undertaking treatment – T1 and T2 time – within which a patient with myocardial infarction, after admission to hospital, has intervention performed on infarct-related coronary artery. Results : During the period 2008–2012, the median T1 time was successfully shortened from 355 to 203 min, and the T2 time from 101 to 48 min. Conclusions: The effectiveness of the system was confirmed, and the necessity for further improvement of the system indicated.

  13. Myocardial hydroxyproline reduced by early administration of methylprednisolone or ibuprofen to rabbits with radiation-induced heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Reeves, W.C.; Cunningham, D.; Schwiter, E.J.; Abt, A.; Skarlatos, S.; Wood, M.A.; Whitesell, L.

    1982-05-01

    The ability of methylprednisolone (MP) and ibuprofen (IB) to reduce the severity of the late state of radiation-induced heart disease was assessed in 57 New Zealand white rabbits. Before and shortly after cardiac irradiation, 15 rabbits received i.v. MP, 30 mg/kg twice daily for 3 days, and 15 others received IB, 12.5 mg/kg twice daily for 2 days. No drug administered to 14 irradiated rabbits, and neither irradiation nor drugs were administered to 13 rabbits that served as controls. All 15 rabbits treated with MP and 13 of the 15 treated with IB lived for 100 days. Only seven of the untreated, irradiated rabbits lived that long. Longevity of each treated group of rabbits was better (p < 0.01 and 0.05) than that of the untreated, irradiated rabbits. Surviving rabbits were killed 100 days after irradiation. Pericarditis (p < 0.05) and pericardial effusion (p < 0.01) were less frequent in the treated, irradiated groups than in the untreated, irradiated rabbits. At least some rabbits in each irradiated group had microscopic evidence of myocardial fibrosis. The fibrosis was quantitated by determination of myocardial hydroxyproline concentrations (MHP). MHP concentration in the untreated, irradiated rabbits was greater than in those treated with MP (p < 0.05) or IB (p < 0.01) and in the untreated, unirradiated rabbits (p < 0.01). Early administrative of MP or IB retarded the development of myocardial fibrosis, pericarditis and pericardial effusin, and improved survival in this experimental model of radiation-induced heart disease.

  14. Myocardial hydroxyproline reduced by early administration of methylprednisolone or ibuprofen to rabbits with radiation-induced heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Reeves, W.C.; Cunningham, D.; Schwiter, E.J.; Abt, A.; Skarlatos, S.; Wood, M.A.; Whitesell, L.

    1982-05-01

    The ability of methylprednisolone (MP) and ibuprofen (IB) to reduce the severity of the late state of radiation-induced heart disease was assessed in 57 New Zealand white rabbits. Before and shortly after cardiac irradiation, 15 rabbits received i.v. MP, 30 mg/kg twice daily for 3 days, and 15 others received IB, 12.5 mg/kg twice daily for 2 days. No drug was administered to 14 irradiated rabbits, and neither irradiation nor drugs were administered to 13 rabbits that served as controls, All 15 rabbits treated with MP and 13 of the 15 treated with IB lived for 100 days. Only seven of the untreated, irradiated rabbits lived that long. Longevity of each treated group of rabbits was better (p less than 0.01 and 0.05) than that of the untreated, irradiated rabbits. Surviving rabbits were killed 100 days after irradiation. Pericarditis (p less than 0.05) and pericardial effusion (p less than 0.01) were less frequent in the treated, irradiated groups than in the untreated, irradiated rabbits. At least some rabbits in each irradiated group had microscopic evidence of myocardial fibrosis. The fibrosis was quantitated by determination of myocardial hydroxyproline concentrations (MHP). MHP concentration in the untreated, irradiated rabbits was greater than in those treated with MP (p less than 0.05) or IB (p less than 0.01) and in the untreated, unirradiated rabbits (p less than 0.01). Early administration of MP or IB retarded the development of myocardial fibrosis, pericarditis and pericardial effusion, and improved survival in this experimental model of radiation-induced heart disease.

  15. Melatonin reduces cardiac morbidity and markers of myocardial ischemia after elective abdominal aortic aneurism repair

    DEFF Research Database (Denmark)

    Gögenür, Ismail; Kücükakin, Bülent; Panduro Jensen, Leif

    2014-01-01

    The aim was to examine the effect of perioperative melatonin treatment on clinical cardiac morbidity and markers of myocardial ischemia in patients undergoing elective surgery for abdominal aortic aneurism. Reperfusion injury results in increased cardiac morbidity in patients undergoing surgery...... for abdominal aortic aneurisms (AAA). A randomized, placebo-controlled, clinical trial including patients undergoing surgery for AAA was performed. The patients received by infusion over a 2-hr period either, 50 mg melatonin or placebo intra-operatively, and 10 mg melatonin or placebo orally, the first three...... by Holter monitoring. A total of 26 patients received melatonin, while 24 received placebo. A significant reduction in cardiac morbidity was seen in the melatonin-treated patients compared with those given placebo [4% versus 29% (P = 0.02)]. Five patients (19%) who received melatonin had increased Tp...

  16. 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...

  17. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Moises Teixeira Sobrinho

    2014-04-01

    Full Text Available Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy.

  18. Extra-cellular expansion in the normal, non-infarcted myocardium is associated with worsening of regional myocardial function after acute myocardial infarction.

    Science.gov (United States)

    Garg, Pankaj; Broadbent, David A; Swoboda, Peter P; Foley, James R J; Fent, Graham J; Musa, Tarique A; Ripley, David P; Erhayiem, Bara; Dobson, Laura E; McDiarmid, Adam K; Haaf, Philip; Kidambi, Ananth; Crandon, Saul; Chew, Pei G; van der Geest, R J; Greenwood, John P; Plein, Sven

    2017-09-25

    Expansion of the myocardial extracellular volume (ECV) is a surrogate measure of focal/diffuse fibrosis and is an independent marker of prognosis in chronic heart disease. Changes in ECV may also occur after myocardial infarction, acutely because of oedema and in convalescence as part of ventricular remodelling. The objective of this study was to investigate changes in the pattern of distribution of regional (normal, infarcted and oedematous segments) and global left ventricular (LV) ECV using semi-automated methods early and late after reperfused ST-elevation myocardial infarction (STEMI). Fifty patients underwent cardiovascular magnetic resonance (CMR) imaging acutely (24 h-72 h) and at convalescence (3 months). The CMR protocol included: cines, T2-weighted (T2 W) imaging, pre-/post-contrast T1-maps and LGE-imaging. Using T2 W and LGE imaging on acute scans, 16-segments of the LV were categorised as normal, oedema and infarct. 800 segments (16 per-patient) were analysed for changes in ECV and wall thickening (WT). From the acute studies, 325 (40.6%) segments were classified as normal, 246 (30.8%) segments as oedema and 229 (28.6%) segments as infarct. Segmental change in ECV between acute and follow-up studies (Δ ECV) was significantly different for normal, oedema and infarct segments (0.8 ± 6.5%, -1.78 ± 9%, -2.9 ± 10.9%, respectively; P < 0.001). Normal segments which demonstrated deterioration in wall thickening at follow-up showed significantly increased Δ ECV compared with normal segments with preserved wall thickening at follow up (1.82 ± 6.05% versus -0.10 ± 6.88%, P < 0.05). Following reperfused STEMI, normal myocardium demonstrates subtle expansion of the extracellular volume at 3-month follow up. Segmental ECV expansion of normal myocardium is associated with worsening of contractile function.

  19. Fusion of morphological data obtained by coronary computed tomography angiography with quantitative echocardiographic data on regional myocardial function.

    Science.gov (United States)

    Lipiec, Piotr; Wejner-Mik, Paulina; Wdowiak-Okrojek, Katarzyna; Szymczyk, Ewa; Skurski, Adam; Napieralski, Andrzej; Kamiński, Marek; Szymczyk, Konrad; Kasprzak, Jarosław D

    2016-01-01

    Three-dimensional (3D) fusion of morphological data obtained by coronary computed tomography angiography (CCTA) with functional data from resting and stress echocardiography could potentially provide additional information compared to examination results analyzed separately and increase the diagnostic and prognostic value of non-invasive imaging in patients with suspected coronary artery disease (CAD). Using vendor-independent software developed in our institution, we aimed to assess the feasibility and reproducibility of 3D fusion of morphological CCTA data with echocardiographic data regarding regional myocardial function. Thirty patients with suspected CAD underwent CCTA and resting transthoracic echocardiography. From CCTA we obtained 3D reconstructions of coronary arteries and left ventricle (LV). Offline speckle-tracking analysis of the echocardiographic images provided parametric maps depicting myocardial longitudinal strain in 17 segments of the LV. Using our software, 3 independent investigators fused echocardiographic maps with CCTA reconstruc-tions in all patients. Based on the obtained fused models, each segment of the LV was assigned to one of the major coronary artery branches. Mean time necessary for data fusion was 65 ± 7 s. Complete agreement between independent investigators in assignment of LV segments to coronary branches was obtained in 94% of the segments. The average coefficient of agreement (kappa) between the investigators was 0.950 and the intra-class correlation coefficient was 0.9329 (95% CI 0.9227-0.9420). Three-dimensional fusion of morphological CCTA data with quantitative echocardiographic data on regional myocardial function is feasible and allows highly repro-ducible assignment of myocardial segments to coronary artery branches.

  20. Role of speckle tracking imaging in the assessment of myocardial regional ventricular function in experimental blunt cardiac injury

    Institute of Scientific and Technical Information of China (English)

    Wen-Hua Du; Xiang Wang; Xiu-Qin Xiong; Tao Li; Hua-Ping Liang

    2015-01-01

    Purpose:To evaluate the usefulness and information collecting ability of speckle tracking imaging techniques in the assessment of myocardial regional ventricular contractility in a rabbit model with blunt cardiac injury.Methods:Fifteen healthy New Zealand rabbits weighing (2.70 ± 0.28) kg were anesthetized (3% pentobarbital sodium/i.v) and impacted using the BIM-Ⅱ biological impact machine to induce myocardial contusion (MC).Hemodynamic parameters,such as heart rate,systolic pressure,mean arterial pressure,diastolic pressure and central venous pressure,were determined before and after MC.Further,parameters reflecting left ventricular functions,such as left ventricular end systolic pressure,left ventricular end diastolic pressure,isovolumic pressure (IP) and the maximal increasing/decreasing rate of left intraventricular pressure (±dp/dtmax),were also determined before and after MC.Left ventricular functions were determined either by two dimensional transthoracic echocardiography or by speckle tracking imaging for segmental abnormal ventricular wall motions.Results:Heart rate,systolic pressure,diastolic pressure and mean arterial pressure decreased significantly but transiently,while central venous pressure markedly increased after MC.In contrast to significant changes in diastolic functions,there was no significant change in cardiac systolic functions after MC.The speckle tracking imaging demonstrated that strain values of different myocardial segment significantly decreased post impact,and that of the ventricular segment decreased from segment to segment.Conclusion:Speckle tracking imaging is useful and informative to assess myocardial regional dysfunctions post MC.

  1. Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Shane P. Smith

    2016-01-01

    Full Text Available Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects. Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded. Results. Peak longitudinal and circumferential strain was globally reduced in patients (p<0.001, when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p<0.001. LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p<0.001. Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains.

  2. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology Milan, Genoa (Italy); Giusti, Massimo; Vera, Lara; Minuto, Francesco [University of Genoa, Department of Endocrinological and Metabolic Sciences, Genoa (Italy); Armonino, Riccardo; Ghigliotti, Giorgio; Bezante, Gian Paolo; Morbelli, Silvia; Pomposelli, Elena; Massollo, Michela; Gandolfo, Patrizia; Sambuceti, Gianmario [University of Genoa, Department of Internal Medicine, Genoa (Italy)

    2010-12-15

    The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using {sup 99m}Tc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 {+-} 0.64 vs. 3.36 {+-} 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 {+-} 0.18 vs. 2.25 {+-} 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p < 0.02). pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels. (orig.)

  3. Characteristics of regional sympathetic innervation in diabetic patients with silent myocardial ischemia assessed by {sup 123}I-metaiodobenzylguanidine imaging

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, Shinro; Takahashi, Masayuki; Yoshida, Shintaro; Inoue, Tohru; Nakamura, Yasuyuki; Mitsunami, Kenichi; Kinoshita, Masahiro [Shiga Univ. of Medical Science, Otsu (Japan)

    1996-05-01

    The purpose of this study was to clarify any association between clinically detectable silent myocardial ischemia (SMI) and myocardial {sup 123}I-metaiodobenzylguanidine (MIBG) uptake. Subjects of this study were patients with SMI with diabetes (n=15), patients with angina pectoris with diabetes (n=15), patients with SMI without diabetes (n=8) and normal subjects (n=23). Subjects underwent planar and single photon-emission-computed tomography (SPECT) imaging 15 min and 3 hours after injection of {sup 123}I-MIBG. H/M ratio was significantly lower in diabetic SMI (2.1{+-}0.3) and non-diabetic SMI (2.3{+-}0.3) than control subjects (2.6{+-}0.3). The inferior-to-anterior wall count ratio (I/A) in diabetic SMI group was the lowest among all groups (p<0.05). A significant difference was observed in relative regional uptake in the inferior segment of the distal left ventricle between SMI and angina group in patients with diabetes mellittus (p<0.05). The decreased MIBG uptake in the inferior wall may be an important sign of cardiac sympathetic dysfunction, suggesting the abnormalities in cardiac nervous system play an important role in the mechanism of diabetic silent myocardial ischemia. (author)

  4. Reduced consumption of analgesics in patients with diabetes mellitus admitted to hospital for acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Gram-Hansen, P; Christensen, J H;

    1991-01-01

    .05). There was no statistically significant trend for the duration of pain to be shorter in the diabetes group. There was no difference between the two groups with respect to number of patients with Q-wave infarct, initial heart rate-blood pressure product or body weight, all of which are possible confounders. We conclude......In a case-control study, the consumption of analgesics was analysed in 39 patients with diabetes, admitted with acute myocardial infarction (MI). The control group comprised of non-diabetics with MI was computer-matched to the diabetic group with respect to age and sex as well as enzyme......-estimated size of the infarction. The median number of injections of opioid analgesics in the diabetes and non-diabetes groups was 2 and 5, respectively (0.01 less than P less than 0.05), and the median consumption of morphine was 20 mg and 35 mg, respectively (0.01 less than P less than 0...

  5. Identification of temporal and region-specific myocardial gene expression patterns in response to infarction in swine.

    Directory of Open Access Journals (Sweden)

    Cristina Prat-Vidal

    Full Text Available Molecular mechanisms associated with pathophysiological changes in ventricular remodelling due to myocardial infarction (MI remain poorly understood. We analyzed changes in gene expression by microarray technology in porcine myocardial tissue at 1, 4, and 6 weeks post-MI.MI was induced by coronary artery ligation in 9 female pigs (30-40 kg. Animals were randomly sacrificed at 1, 4, or 6 weeks post-MI (n = 3 per group and 3 healthy animals were also included as control group. Total RNA from myocardial samples was hybridized to GeneChip® Porcine Genome Arrays. Functional analysis was obtained with the Ingenuity Pathway Analysis (IPA online tool. Validation of microarray data was performed by quantitative real-time PCR (qRT-PCR.More than 8,000 different probe sets showed altered expression in the remodelling myocardium at 1, 4, or 6 weeks post-MI. Ninety-seven percent of altered transcripts were detected in the infarct core and 255 probe sets were differentially expressed in the remote myocardium. Functional analysis revealed 28 genes de-regulated in the remote myocardial region in at least one of the three temporal analyzed stages, including genes associated with heart failure (HF, systemic sclerosis and coronary artery disease. In the infarct core tissue, eight major time-dependent gene expression patterns were recognized among 4,221 probe sets commonly altered over time. Altered gene expression of ACVR2B, BID, BMP2, BMPR1A, LMNA, NFKBIA, SMAD1, TGFB3, TNFRSF1A, and TP53 were further validated.The clustering of similar expression patterns for gene products with related function revealed molecular footprints, some of them described for the first time, which elucidate changes in biological processes at different stages after MI.

  6. [Myocardial regional thickness in patients with and without cardiomyopathy assessed by cardiac magnetic resonance].

    Science.gov (United States)

    de Zan, Macarena; Carrascosa, Patricia; Deviggiano, Alejandro; Capuñay, Carlos; Rodríguez-Granillo, Gastón A

    To explore regional differences in myocardial wall thickness (WT) among the most prevalent cardiomyopathies and in individuals without structural heart disease using cardiac magnetic resonance. Patients older than 18 years referred to cardiac magnetic resonance during the period between January 2014 and September 2014, with a diagnosis of hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and myocarditis were retrospectively selected from our database. One hundred twenty patients patients were included. The control group had an average WT of 5.9±1.1mm, with a WT index of 2.9±0.8. Significantly lower mean WT in the apical segments were identified in both the control group (basal 6.7±1.3 vs. mid 6.0±1.3 vs. apical 4.6±1.0mm, P<.0001) and in all evaluated cardiomyopathies (hypertrophic cardiomyopathy: basal 10.5±2.4 vs. mid 10.8±2.7 vs. apical 7.3±3.3mm, P<.0001; idiopathic dilated cardiomyopathy: basal 7.7±1.7 vs. mid 7.6±1.3 vs. apical 5.4±1.3mm, P<.0001; ischemic cardiomyopathy: basal 7.4±1.7 vs. mid 7.5±1.9 vs. apical 5.5±1.8mm, P<.0001; myocarditis: basal 7.1±1.5 vs. mid 6.4±1.1 vs. apical 5.1±0.8, P<.0001). Significant gender differences were also evident regarding the mean WT both in the control group (male 6.5±2.1 vs. female 5.2±1.7mm, P<.0001), as in hypertrophic cardiomyopathy (10.5±5.3 vs. 8.5±5.7mm, P<.0001) and myocarditis (6.6±2.0 vs. 5.2±1.6mm, P<.0001). We found a relatively high prevalence of segments commonly deemed thinned among patients without structural heart disease. We also observed a marked asymmetry and longitudinal gradient in wall thickness both in controls and in the various cardiomyopathies evaluated. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Nicolay Klaas

    2011-10-01

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

  8. Normal values of regional left ventricular myocardial thickness, mass and distribution-assessed by 320-detector computed tomography angiography in the Copenhagen General Population Study

    DEFF Research Database (Denmark)

    Hindsø, Louise; Fuchs, Andreas; Kühl, Jørgen Tobias

    2017-01-01

    Left ventricular (LV) hypertrophy is associated with cardiovascular complications and the geometry is important for prognosis. In some cardiovascular diseases, myocardial hypertrophy or dilation occurs regionally without modifying the global size of the heart. It is therefore relevant to determine...... myocardial distribution (LVMD) as a measure of regional variation of the LVMT. Moreover, we wanted to determine whether these parameters varied between men and women. We studied 568 (181 men; 32%) adults, free of cardiovascular disease and risk factors, who underwent 320-detector CCTA. Mean age was 55 (range...... but different regional distribution for men and women. This study introduces LVMD and provides gender specific reference values for regional LVMT, LVMM, and LVMD....

  9. Berberine Attenuates Myocardial Ischemia/Reperfusion Injury by Reducing Oxidative Stress and Inflammation Response: Role of Silent Information Regulator 1

    Directory of Open Access Journals (Sweden)

    Liming Yu

    2016-01-01

    Full Text Available Berberine (BBR exerts potential protective effect against myocardial ischemia/reperfusion (MI/R injury. Activation of silent information regulator 1 (SIRT1 signaling attenuates MI/R injury by reducing oxidative damage and inflammation response. This study investigated the antioxidative and anti-inflammatory effects of BBR treatment in MI/R condition and elucidated its potential mechanisms. Sprague-Dawley rats were treated with BBR in the absence or presence of the SIRT1 inhibitor sirtinol (Stnl and then subjected to MI/R injury. BBR conferred cardioprotective effects by improving postischemic cardiac function, decreasing infarct size, reducing apoptotic index, diminishing serum creatine kinase and lactate dehydrogenase levels, upregulating SIRT1, Bcl-2 expressions, and downregulating Bax and caspase-3 expressions. Stnl attenuated these effects by inhibiting SIRT1 signaling. BBR treatment also reduced myocardium superoxide generation, gp91phox expression, malondialdehyde (MDA level, and cardiac inflammatory markers and increased myocardium superoxide dismutase (SOD level. However, these effects were also inhibited by Stnl. Consistently, BBR conferred similar antioxidative and anti-inflammatory effects against simulated ischemia reperfusion injury in cultured H9C2 cardiomyocytes. SIRT1 siRNA administration also abolished these effects. In summary, our results demonstrate that BBR significantly improves post-MI/R cardiac function recovery and reduces infarct size against MI/R injury possibly due to its strong antioxidative and anti-inflammatory activity. Additionally, SIRT1 signaling plays a key role in this process.

  10. Basal and hyperaemic myocardial blood flow in regionally denervated canine hearts: an in vivo study with positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Rimoldi, Ornella E.; Camici, Paolo G. [Hammersmith Hospital, MRC Clinical Sciences Centre, London (United Kingdom); Imperial College, National Heart and Lung Institute, London (United Kingdom); Drake-Holland, Angela J. [Robert Gordon University, School of Pharmacy, Aberdeen (United Kingdom); Noble, Mark I.M. [University of Aberdeen, Department of Cardiology, Aberdeen (United Kingdom)

    2007-02-15

    Positron emission tomography (PET) studies in patients with diabetic autonomic neuropathy (DAN) have demonstrated the impact of this disease on cardiac sympathetic innervation and myocardial blood flow (MBF). To investigate the effects of selective partial sympathetic denervation of the left ventricle (LV) on baseline and hyperaemic MBF, we measured myocardial presynaptic catecholamine re-uptake (uptake-1), {beta}-adrenoceptor ({beta}-AR) density and MBF non-invasively by means of PET in a canine model of regional sympathetic denervation. In 11 anaesthetised dogs, the sympathetic nerves of the free wall and septum of the LV were removed by means of dissection and phenol painting. Three weeks later, the animals were studied with PET. MBF was measured at baseline and following i.v. adenosine (140 {mu}g kg{sup -1} min{sup -1}) and dobutamine (20 {mu}g kg{sup -1} min{sup -1}) using{sup 15}O-labelled water. Sympathetic denervation was confirmed by an 80{+-}12% decrease in the volume of distribution (V{sub d}) of [{sup 11}C]hydroxyephedrine (HED) compared with innervated regions. Myocardial {beta}-AR density was measured using [{sup 11}C]CGP12177. Innervated and denervated regions showed no differences in MBF at baseline and during adenosine or dobutamine. [{sup 11}C]HED V{sub d}was inversely correlated with MBF in both regions at baseline, and the correlation was lost during hyperaemia in denervated regions. However, for any given value of MBF, [{sup 11}C]HED V{sub d}was significantly lower in the denervated regions. {beta}-AR density was comparable in denervated and innervated regions (17.9{+-}4.2 vs 18.4{+-}3.3 pmol g{sup -1};p=NS). In this experimental model, selective, regional sympathetic denervation of the LV, which results in a profound reduction in [{sup 11}C]HED V{sub d}, did not affect baseline or hyperaemic MBF. In addition, we demonstrated that, under baseline conditions, there was a significant inverse correlation between [{sup 11}C]HED V{sub d}and MBF in

  11. c-Src Kinase Inhibition Reduces Arrhythmia Inducibility and Connexin43 Dysregulation after Myocardial Infarction

    Science.gov (United States)

    Rutledge, Cody A.; Ng, Fu Siong; Sulkin, Matthew S.; Greener, Ian D.; Sergeyenko, Artem M.; Liu, Hong; Gemel, Joanna; Beyer, Eric C.; Sovari, Ali A.; Efimov, Igor R.; Dudley, Samuel C.

    2014-01-01

    Objectives The aim of this study was to evaluate the role of c-Src inhibition on connexin43 (Cx43) regulation in a mouse model of myocardial infarction (MI). Background MI is associated with decreased expression of Cx43, the principal gap junction protein responsible for propagating current in ventricles. Activated c-Src has been linked to Cx43 dysregulation. Methods MI was induced in 12-week-old mice by coronary artery occlusion. MI mice were treated with c-Src inhibitors (PP1 or AZD0530), PP3 (an inactive analogue of PP1), or saline. Treated hearts were compared to sham mice by echocardiography, optical mapping, telemetry ECG monitoring, and inducibility studies. Tissues were collected for immunoblotting, quantitative PCR, and immunohistochemistry. Results Active c-Src was elevated in PP3-treated MI mice compared to sham at the scar border (280%, p=0.003) and distal ventricle (346%, p=0.013). PP1 treatment restored active c-Src to sham levels at the scar border (86%, p=0.95) and distal ventricle (94%, p=1.0). PP1 raised Cx43 expression by 69% in the scar border (p=0.048) and by 73% in distal ventricle (p=0.043) compared to PP3 mice. PP1-treated mice had restored conduction velocity at the scar border (PP3: 32 cm/s, PP1: 41 cm/s, p < 0.05) and lower arrhythmic inducibility (PP3: 71%, PP1: 35%, p < 0.05) than PP3 mice. PP1 did not change infarct size, ECG pattern, or cardiac function. AZD0530 treatment demonstrated restoration of Cx43 comparable to PP1. Conclusions c-Src inhibition improved Cx43 levels and conduction velocity and lowered arrhythmia inducibility after MI, suggesting a new approach for arrhythmia reduction following MI. PMID:24361364

  12. EVALUATION OF LIPOPROTEIN ( a LEVELS IN YOUNG PATIENTS WITH MYOCARDIAL INFARCTION IN NORTH COASTAL ANDHRA REGION

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    Rajini

    2015-01-01

    Full Text Available CONTEXT: Coronary artery disease (CAD is one of the leading causes of mortality in the developing countries. Various risk factors i.e,. Conventional, modifiable and novel risk factors along with certain medical conditions may contribute to CAD. In India, due to rapid changes in life style towards sedentary and dietary habits, contribute to myocardial infarction (MI in young individuals. Lp (a – lipoprotein (a is now recognized as an independent risk factor for CAD. It is also a genetic r isk factor. AIM : to evaluate Lp (a levels in young patients, of both sexes, with myocardial infarction. STUDY DESIGN : Fifty young patients with myocardial infarction, of both sexes, with cut off age 45 years. Values are compared with age and sex matched 2 5 controls. METHODOLOGY: Fasting samples are collected for sugar, creatinine, uric acid and particularly lipid profile and Lp (a levels, using a fully automated analyzer and a turbid metric biochemistry analyzer. Statistical analysis is carried out by using student’s t - test. RESULTS : The Lp (a levels in patient cases were significantly higher, in comparison to controls (p valu e <0.001. The uric acid levels are increased at a mild rate in proportion to raised Lp (a levels. The LDL cholesterol and triglycerides show a linear rise, being significant, with raised Lp (a levels, w here as HDL - c showed an inverse relation. CONCLUSION S: The study demonstrated that in young patients with myocardial infarction, there is a male predominance with more raised Lp (a values, being lesser in females - may be due to estrogens’ effect in them, Lp (a level had been an important and independent r isk factor for CAD.

  13. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement.

    Science.gov (United States)

    Ellahham Md, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience.

  14. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement

    Science.gov (United States)

    Ellahham, MD, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J. Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience. PMID:26734321

  15. Reduced chronotropic reserve to the metabolic requirement during exercise in advanced heart failure with old myocardial infarction.

    Science.gov (United States)

    Yamabe, H; Kobayashi, K; Takata, T; Fukuzaki, H

    1987-03-01

    We studied the metabolic and cardiac responses to exercise by expiratory gas analysis in 40 patients with old myocardial infarction and 33 normal sedentary males. On the basis of exercise energy metabolism, the elevation of the respiratory quotient (RQ; RQ = VCO2/VO2) during exercise is caused by the increase of blood lactate due to the augmented anaerobic metabolism. Functional aerobic impairment (FAI) in our study was significantly advanced in the control group and the NYHA functional class I, class II and class III groups, that is, -2.3 +/- 11.2%, +14.8 +/- 10.4%, +27.8 +/- 13.8% and +49.4 +/- 2.8%, respectively. The delta RQ values were similar among all groups; 0.29 respectively. The delta RQ values were similar among all groups; 0.29 +/- 0.06, 0.28 +/- 0.07, 0.27 +/- 0.07 and 0.29 +/- 0.09, respectively. Functional chronotropic impairment (FCI) for the same groups was -0.9 +/- 7.0%, +1.4 6.1%, +3.8 +/- 4.8% and +8.7 +/- 6.0%, and that of the class III group was significantly larger than that of the control group. Thus, in the class III congestive heart failure group, the chronotropic response to the metabolic requirement was impaired in comparison to the control group. It was concluded that the reduced chronotropic reserve was present in NYHA class III patients with old myocardial infarction, and that this mechanism might contribute to a decrease in the pump reserve of the heart, resulting in further impairment of physical capacity in these patients.

  16. Aerobic exercise reduces neuronal responses in food reward brain regions.

    Science.gov (United States)

    Evero, Nero; Hackett, Laura C; Clark, Robert D; Phelan, Suzanne; Hagobian, Todd A

    2012-05-01

    Acute exercise suppresses ad libitum energy intake, but little is known about the effects of exercise on food reward brain regions. After an overnight fast, 30 (17 men, 13 women), healthy, habitually active (age = 22.2 ± 0.7 yr, body mass index = 23.6 ± 0.4 kg/m(2), Vo(2peak) = 44.2 ± 1.5 ml·kg(-1)·min(-1)) individuals completed 60 min of exercise on a cycle ergometer or 60 min of rest (no-exercise) in a counterbalanced, crossover fashion. After each condition, blood oxygen level-dependent responses to high-energy food, low-energy food, and control visual cues, were measured by functional magnetic resonance imaging. Exercise, compared with no-exercise, significantly (P Exercise alone significantly (P exercise alone significantly (P Exercise reduced neuronal responses in brain regions consistent with reduced pleasure of food, reduced incentive motivation to eat, and reduced anticipation and consumption of food. Reduced neuronal response in these food reward brain regions after exercise is in line with the paradigm that acute exercise suppresses subsequent energy intake.

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

    Science.gov (United States)

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

    2015-11-01

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

  18. 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

  19. B beta(15-42) (FX06) reduces pulmonary, myocardial, liver, and small intestine damage in a pig model of hemorrhagic shock and reperfusion

    NARCIS (Netherlands)

    Roesner, Jan P.; Petzelbauer, Peter; Koch, Alexander; Tran, Nguyen; Iber, Thomas; Vagts, Dierk A.; Scheeren, Thomas W. L.; Vollmar, Brigitte; Noeldge-Schomburg, Gabriele E. F.; Zacharowski, Kai

    2009-01-01

    Objective:  The fibrin-derived peptide B beta(15-42) (also called FX06) has been shown to reduce myocardial infarct size following ischemia/reperfusion. Hemorrhagic shock (HS) followed by volume resuscitation represents a similar scenario, whereby a whole organism is vulnerable to reperfusion injury

  20. Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a KATP-dependent mechanism: first demonstration of remote ischemic perconditioning

    DEFF Research Database (Denmark)

    Schmidt, Michael Rahbek; Smerup, M; Konstantinov, I E

    2006-01-01

    . Intermittent limb ischemia during myocardial ischemia reduces MI, preserves global systolic and diastolic function, and protects against arrhythmia during the reperfusion phase through a K(ATP) channel-dependent mechanism. Understanding this process may have important therapeutic implications for a range...

  1. Insulin-Like Growth Factor-1 (IGF-1 Reduces ischemic changes and increases circulating angiogenic factors in experimentally - induced myocardial infarction in rats

    Directory of Open Access Journals (Sweden)

    Lisa Mathews

    2011-06-01

    Full Text Available Abstract Background Coronary artery disease is a global health concern in the present day with limited therapies. Extensive efforts have been devoted to find molecular therapies to enhance perfusion and function of the ischemic myocardium. Aim of the present study was to look into the effects of insulin like growth factor -1 (IGF-1 on circulating angiogenic factors after myocardial ischemia in rats. Methods Adult male Sprague-Dawley rats were randomly divided into 10-days control, myocardial infarction, IGF-1 alone (2 μg/rat/day and ISO+IGF-1 groups. Isoproterenol (ISO, a synthetic catecholamine was used to induce myocardial infarction. Serum transforming growth factor-β (TGF-β and vascular endothelial growth factor (VEGF levels were checked after 10-days of IGF-1 administration. Results There was a significant increase in heart weight after IGF-1 treatment. A significant increase in cardiac enzyme level (CK-MB and LDH was seen in isoproterenol treated rats when compared to control group. IGF-1treatment induced a significant increase in serum angiogenic factors, IGF-1, VEGF and TGF beta levels. IGF-1 also reduced the ischemic changes in the myocardium when compared to the isoproterenol alone treated group. Conclusions In conclusion, treatment with insulin-like growth factor-1 (IGF-1 in myocardial infarction significantly increased circulating angiogenic growth factors like IGF-1, VEGF and TGF beta thus, protecting against myocardial ischemia.

  2. Reduced 123I-BMIPP uptake implies decreased myocardial flow reserve in patients with chronic stable angina.

    Science.gov (United States)

    Kageyama, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Tsukamoto, Takahiro; Noriyasu, Kazuyuki; Mabuchi, Megumi; Naya, Masanao; Kawai, Yuko; Tamaki, Nagara

    2006-01-01

    Long-chain fatty acid (LCFA) is the main energy source for normal myocardium at rest, but in ischemic myocardium, the main energy substrate shifts from LCFA to glucose. 123I-BMIPP is a radiolabeled LCFA analog. In chronic stable angina without previous infarction, we suppose that reduced 123I-BMIPP uptake is related to the substrate shift in myocardium with decreased myocardial flow reserve (MFR). The purpose of this study was to relate 123I-BMIPP uptake to rest myocardial blood flow (MBF), hyperemic MBF, and MFR assessed with 15O-water positron emission tomography (PET). We enrolled 21 patients with chronic stable angina without previous infarction, all of whom underwent 123I-BMIPP single-photon emission computed tomography (SPECT) and 15O-water PET. The left ventricle was divided into 13 segments. In each segment, rest MBF and hyperemic MBF were measured by PET. 123I-BMIPP uptake was evaluated as follows: score 0=normal, 1=slightly decreased uptake, 2=moderately decreased uptake, 3=severely decreased uptake, and 4=complete defect. 123I-BMIPP uptake was compared with rest MBF, hyperemic MBF, and MFR. The numbers of segments with 123I-BMIPP scores 0, 1, 2, 3, and 4 were 178, 40, 25, 24, and 0, respectively. The rest MBFs for scores 0, 1, 2, and 3 were 0.93+/-0.25, 0.86+/-0.21, 0.97+/-0.30, and 0.99+/-0.37 ml/min/g, respectively. The hyperemic MBFs for scores 0, 1, 2, and 3 were 2.76+/-1.29, 1.84+/-0.74, 1.37+/-0.39, and 1.08+/-0.40 ml/min/g, respectively. The MFRs for scores 0, 1, 2, and 3 were 3.01+/-1.38, 2.20+/-0.95, 1.44+/-0.22, and 1.10+/-0.26, respectively. As 123I-BMIPP uptake declined, hyperemic MBF and MFR decreased. In chronic stable angina without previous infarction, reduced 123I-BMIPP uptake implies decreased MFR.

  3. Reduced {sup 123}I-BMIPP uptake implies decreased myocardial flow reserve in patients with chronic stable angina

    Energy Technology Data Exchange (ETDEWEB)

    Kageyama, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Mabuchi, Megumi; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Tsukamoto, Takahiro; Noriyasu, Kazuyuki; Naya, Masanao [Hokkaido University, Department of Cardiovascular Medicine, Sapporo (Japan); Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Kawai, Yuko [Hokko Memorial Hospital, Department of Cardiovascular Medicine, Sapporo (Japan)

    2006-01-01

    Long-chain fatty acid (LCFA) is the main energy source for normal myocardium at rest, but in ischemic myocardium, the main energy substrate shifts from LCFA to glucose. {sup 123}I-BMIPP is a radiolabeled LCFA analog. In chronic stable angina without previous infarction, we suppose that reduced {sup 123}I-BMIPP uptake is related to the substrate shift in myocardium with decreased myocardial flow reserve (MFR). The purpose of this study was to relate {sup 123}I-BMIPP uptake to rest myocardial blood flow (MBF), hyperemic MBF, and MFR assessed with {sup 15}O-water positron emission tomography (PET). We enrolled 21 patients with chronic stable angina without previous infarction, all of whom underwent {sup 123}I-BMIPP single-photon emission computed tomography (SPECT) and {sup 15}O-water PET. The left ventricle was divided into 13 segments. In each segment, rest MBF and hyperemic MBF were measured by PET. {sup 123}I-BMIPP uptake was evaluated as follows: score 0=normal, 1=slightly decreased uptake, 2=moderately decreased uptake, 3=severely decreased uptake, and 4=complete defect. {sup 123}I-BMIPP uptake was compared with rest MBF, hyperemic MBF, and MFR. The numbers of segments with {sup 123}I-BMIPP scores 0, 1, 2, 3, and 4 were 178, 40, 25, 24, and 0, respectively. The rest MBFs for scores 0, 1, 2, and 3 were 0.93{+-}0.25, 0.86{+-}0.21, 0.97{+-}0.30, and 0.99{+-}0.37 ml/min/g, respectively. The hyperemic MBFs for scores 0, 1, 2, and 3 were 2.76{+-}1.29, 1.84{+-}0.74, 1.37{+-}0.39, and 1.08{+-}0.40 ml/min/g, respectively. The MFRs for scores 0, 1, 2, and 3 were 3.01{+-}1.38, 2.20{+-}0.95, 1.44{+-}0.22, and 1.10{+-}0.26, respectively. As {sup 123}I-BMIPP uptake declined, hyperemic MBF and MFR decreased. In chronic stable angina without previous infarction, reduced {sup 123}I-BMIPP uptake implies decreased MFR. (orig.)

  4. Natriuretic peptide infusion reduces myocardial injury during acute ischemia/reperfusion

    DEFF Research Database (Denmark)

    Kousholt, Birgitte S.; Larsen, Jens Kjærgaard Rolighed; Bisgaard, Line Stattau

    2012-01-01

    in apoptotic changes in the BNP-stimulated cells. Pigs tolerated the BNP and CD-NP (a CNP analogue) infusion well, with a decrease in systemic blood pressure (~15 mmHg) and increased diuresis compared with the controls. Left ventricular pressure decreased in the pigs that received BNP infusion compared...... in the ischemic left ventricular region (Pdiuresis and vasodilation). The results suggest a role for natriuretic peptide therapy...

  5. Natriuretic peptide infusion reduces myocardial injury during acute ischemia/reperfusion

    DEFF Research Database (Denmark)

    Kousholt, Birgitte S.; Larsen, Jens Kjærgaard Rolighed; Bisgaard, Line Stattau

    2012-01-01

    in apoptotic changes in the BNP-stimulated cells. Pigs tolerated the BNP and CD-NP (a CNP analogue) infusion well, with a decrease in systemic blood pressure (∼15 mmHg) and increased diuresis compared with the controls. Left ventricular pressure decreased in the pigs that received BNP infusion compared...... in the ischemic left ventricular region (Pdiuresis and vasodilation). The results suggest a role for natriuretic peptide therapy...

  6. PHARMACOEPIDEMIOLOGIC ANALYSIS OF ST-ELEVATION MYOCARDIAL INFARCTION REPERFUSION THERAPY AT SARATOV REGION HOSPITALS OF DIFFERENT TYPES

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2016-01-01

    Full Text Available Aim. To evaluate the real practice of thrombolytic therapy of patients with ST-elevation myocardial infarction (STEMI at cardiological departments of Saratov and Saratov region hospitals.Material and methods. Retrospective pharmacoepidemiologic study was carried out. Case histories of STEMI patients discharged from cardiologic departments of several central district hospitals (CDH of Saratov region, cardiologic department of one of Saratov general municipal hospitals (MH and urgent cardiology department of Saratov clinical hospital (CH in 2006 were analyzed.Results. In CH all patients received thrombolytic therapy given they did not have contraindications and were admitted to the hospital timely. Few patients received thrombolytic therapy in MH and CDH in 2006.Conclusion. Correlation between hospital type and quality of STEMI management has been revealed.

  7. Ivabradine reduces myocardial stunning in patients with exercise-inducible ischaemia.

    Science.gov (United States)

    Maranta, F; Tondi, L; Agricola, E; Margonato, A; Rimoldi, O; Camici, Paolo G

    2015-11-01

    Ivabradine is an effective treatment for angina in patients with stable coronary artery disease (CAD) and for heart failure. Experiments in a canine model have shown that ivabradine reduces both acute left ventricular (LV) dysfunction and post-ischaemic stunning. Aim of this study was to investigate the effect of ivabradine on LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. Fifteen patients with ejection fraction >40 % and heart rate >70 bpm were enrolled. After pharmacologic washout, echocardiography was performed at rest, at peak treadmill exercise and during recovery until return to baseline. After 2 weeks of ivabradine (7.5 mg bid) stress echocardiography was repeated at the same workload achieved during washout. Peak global and segmental (ischaemic vs. remote normal segments) LV longitudinal strain (LS) was assessed by 2D speckle tracking analysis. At washout, LS was significantly impaired in ischaemic compared to remote segments at peak stress and for several minutes during recovery. After ivabradine a smaller, albeit still significant, impairment of LS in ischaemic segments was observed at peak whilst no difference with remote segments was present during recovery. Furthermore, the average global LS value improved significantly after treatment. In conclusion, ivabradine reduces both acute LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. We hypothesise that this mechanism might contribute to reduce chronic LV dysfunction in patients with CAD. In this setting the drug might limit the development of hibernating myocardium which is believed to result from repeated episodes of ischaemia and stunning.

  8. LXRα improves myocardial glucose tolerance and reduces cardiac hypertrophy in a mouse model of obesity-induced type 2 diabetes

    NARCIS (Netherlands)

    Cannon, Megan V; Silljé, Herman H W; Sijbesma, Jürgen W A; Khan, Mohsin A F; Steffensen, Knut R; van Gilst, Wiek H; de Boer, Rudolf A

    Aims/hypothesis Diabetic cardiomyopathy is a myocardial disease triggered by impaired insulin signalling, increased fatty acid uptake and diminished glucose utilisation. Liver X receptors (LXRs) are key transcriptional regulators of metabolic homeostasis. However, their effect in the diabetic heart

  9. Studying in the region of proximal learning reduces mind wandering.

    Science.gov (United States)

    Xu, Judy; Metcalfe, Janet

    2016-07-01

    Insofar as mind wandering has been linked to poor learning, finding ways to reduce the propensity to mind wander should have implications for improving learning. We investigated the possibility that studying materials at an appropriate level of difficulty with respect to the individual's capabilities-that is, studying in the region of proximal learning (RPL)-might reduce mind wandering. In Experiments 1 and 2, participants were probed for their attentional state while they studied blocks of English-Spanish word pairs that were (a) easy, (b) in the RPL, or (c) difficult. We found that studying materials in the RPL was associated with reduced mind wandering. Test performance on items studied while mind wandering was also poorer. In Experiment 3, we investigated the relation between differences in participants' mastery and mind wandering. We found that high performers mind wandered more when studying the easier word pairs, whereas low performers mind wandered more when studying the difficult items. These results indicate that the RPL is specific to the individual's level of mastery and that mind wandering occurs when people are outside that region.

  10. Did clinical trials in which erythropoietin failed to reduce acute myocardial infarct size miss a narrow therapeutic window?

    Directory of Open Access Journals (Sweden)

    Mark I Talan

    Full Text Available BACKGROUND: To test a hypothesis that in negative clinical trials of erythropoietin in patients with acute myocardial infarction (MI the erythropoietin (rhEPO could be administered outside narrow therapeutic window. Despite overwhelming evidence of cardioprotective properties of rhEPO in animal studies, the outcomes of recently concluded phase II clinical trials have failed to demonstrate the efficacy of rhEPO in patients with acute MI. However, the time between symptoms onset and rhEPO administration in negative clinical trials was much longer that in successful animal experiments. METHODOLOGY/PRINCIPAL FINDINGS: MI was induced in rats either by a permanent ligation of a descending coronary artery or by a 2-hr occlusion followed by a reperfusion. rhEPO, 3000 IU/kg, was administered intraperitoneally at the time of reperfusion, 4 hrs after beginning of reperfusion, or 6 hrs after permanent occlusion. MI size was measured histologically 24 hrs after coronary occlusion. The area of myocardium at risk was similar among groups. The MI size in untreated rats averaged ~42% of area at risk, or ~24% of left ventricle, and was reduced by more than 50% (p<0.001 in rats treated with rhEPO at the time of reperfusion. The MI size was not affected by treatment administered 4 hrs after reperfusion or 6 hrs after permanent coronary occlusion. Therefore, our study in a rat experimental model of MI demonstrates that rhEPO administered within 2 hrs of a coronary occlusion effectively reduces MI size, but when rhEPO was administered following a delay similar to that encountered in clinical trials, it had no effect on MI size. CONCLUSIONS/SIGNIFICANCE: The clinical trials that failed to demonstrate rhEPO efficacy in patients with MI may have missed a narrow therapeutic window defined in animal experiments.

  11. Rural Development - Necessity for Reducing Regional GAPS in Romania

    Directory of Open Access Journals (Sweden)

    Adrian Turek Rahoveanu

    2016-06-01

    Full Text Available An important role in rural development is to revitalize agriculture as a key sector for reducing regional disparities at national level. Creating a functioning market in Romania which is able to cope with market forces within the EU, implies reducing existing disparities in Romania's agriculture, and including those relating to physical production and value are in the foreground. Performance of production structures in agriculture is determined by a number of factors, among which the most important are: the natural potential of farm financial resources required purchase of inputs, ensuring balance in the allocation of production factors, potential technical and technological , the existing workforce and readiness of the farm manager. The agricultural potential of the area is high, but the fragmentation of agricultural land, plus inadequate technical equipment, poor infrastructure and an aging workforce and / or unqualified to practice agriculture, make this potentially be exploited weak.

  12. Improving long-term survival of patients with acute myocardial infarction from 1977-1988 in a region of Denmark

    DEFF Research Database (Denmark)

    Torp-Pedersen, C; Hildebrandt, P; Køber, L;

    1995-01-01

    The aim of this investigation was to study secular trends in long-term survival following myocardial infarction (MI). Five thousand one hundred and fifty-seven consecutive cases of MI in 3942 patients were recorded in a well-defined region in the study period 1977-1988. The study period ended...... significant (P infarction was an independent predictor of survival. Patients were subdivided into a high risk group suffering from either congestive heart failure or cardiac arrest during hospitalization, and a low risk group without these complications....... Year of infarction was without importance in the high risk group but highly significant in the low risk group. Long-term survival following MI gradually improved prior to the introduction of thrombolytic therapy. The improvement was confined to low risk patients without cardiac arrest or congestive...

  13. Reduced silent information regulator 1 signaling exacerbates myocardial ischemia-reperfusion injury in type 2 diabetic rats and the protective effect of melatonin.

    Science.gov (United States)

    Yu, Liming; Liang, Hongliang; Dong, Xiaochao; Zhao, Guolong; Jin, Zhenxiao; Zhai, Mengen; Yang, Yang; Chen, Wensheng; Liu, Jincheng; Yi, Wei; Yang, Jian; Yi, Dinghua; Duan, Weixun; Yu, Shiqiang

    2015-10-01

    Diabetes mellitus (DM) increases myocardial oxidative stress and endoplasmic reticulum (ER) stress. Melatonin confers cardioprotective effect by suppressing oxidative damage. However, the effect and mechanism of melatonin on myocardial ischemia-reperfusion (MI/R) injury in type 2 diabetic state are still unknown. In this study, we developed high-fat diet-fed streptozotocin (HFD-STZ) rat, a well-known type 2 diabetic model, to evaluate the effect of melatonin on MI/R injury with a focus on silent information regulator 1 (SIRT1) signaling, oxidative stress, and PERK/eIF2α/ATF4-mediated ER stress. HFD-STZ treated rats were exposed to melatonin treatment in the presence or the absence of sirtinol (a SIRT1 inhibitor) and subjected to MI/R surgery. Compared with nondiabetic animals, type 2 diabetic rats exhibited significantly decreased myocardial SIRT1 signaling, increased apoptosis, enhanced oxidative stress, and ER stress. Additionally, further reduced SIRT1 signaling, aggravated oxidative damage, and ER stress were found in diabetic animals subjected to MI/R surgery. Melatonin markedly reduced MI/R injury by improving cardiac functional recovery and decreasing myocardial apoptosis in type 2 diabetic animals. Melatonin treatment up-regulated SIRT1 expression, reduced oxidative damage, and suppressed PERK/eIF2α/ATF4 signaling. However, these effects were all attenuated by SIRT1 inhibition. Melatonin also protected high glucose/high fat cultured H9C2 cardiomyocytes against simulated ischemia-reperfusion injury-induced ER stress by activating SIRT1 signaling while SIRT1 siRNA blunted this action. Taken together, our study demonstrates that reduced cardiac SIRT1 signaling in type 2 diabetic state aggravates MI/R injury. Melatonin ameliorates reperfusion-induced oxidative stress and ER stress via activation of SIRT1 signaling, thus reducing MI/R damage and improving cardiac function.

  14. Effects of rapid digitalization on total and regional myocardial performance in patients with coronary artery disease.

    Science.gov (United States)

    Ferlinz, J; DelVicario, M; Aronow, W S

    1978-09-01

    In order to evaluate the effects of rapid digitalization on LV volumes, ejection fraction, and asynergy, 21 patients without heart failure were studied with a combination of hemodynamic and angiographic techniques before and after administration of intravenous ouabain (0.007 mg./Kg.). Seven patients had no CAD and served as normal (control) subjects (Group I), while 14 patients had extensive coronary disease (Group II). All pre-ouabain parameters were within the normal limits in Group I. After ouabain infusion, all indices of LV contractility: dP/dt, VCF, and ejection fraction rose significantly in the normal group, while LV filling pressure and end-diastolic volume remained unchanged. The baseline hemodynamic and volumetric values for Group II patients corresponded closely to their normal (Group I) counterparts, and exhibited similar changes after ouabain administration. Eight patients in Group II also had regional disorders of LV contractility, delineated by 23 abnormal hemiaxes of shortening. After ouabain, 15 out of 23 asynergic segments (65 per cent) improved, seven remained unchanged, and one worsened. It is therefore concluded that rapid digitalization not only enhances LV performance in normal subjects and in patients with CAD, but can also markedly reduce the extent of LV asynergy.

  15. Field triage reduces treatment delay and improves long-term clinical outcome in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Pedersen, Sune H; Galatius, Soren; Hansen, Peter R

    2009-01-01

    OBJECTIVES: We evaluated the independent impact of field triage on treatment delay and long-term clinical outcome in a large contemporary, consecutive population of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). BACKGROUND......: Reduction of treatment delay is crucial for patients with STEMI. METHODS: From January 2005 to July 2008, 1,437 STEMI patients were treated with pPCI at a single high-volume invasive center. We present the 1-year outcome in this observational registry study. RESULTS: A total of 616 patients were admitted...... triage had a reduced risk of reaching the combined end point of all-cause mortality or nonfatal myocardial infarction (hazard ratio: 0.67; 95% confidence interval: 0.46 to 0.97; p=0.035). CONCLUSIONS: This study shows that field triage of STEMI patients to pPCI significantly reduces treatment delay...

  16. Using Multiple Implant Regions To Reduce Development Wafer Usage

    Science.gov (United States)

    Walther, S. R.; Falk, S.; Mehta, S.; Erokhin, Y.; Nunan, P.

    2006-11-01

    The cost of new process development has risen significantly with larger wafer sizes and the increased number of fabrication steps needed to create advanced devices. The high value of each 300 mm development wafer has spurred efforts to find a way to explore more than a single process setting with each wafer. Traditional methods of defining multiple spatially distinct implant regions on a single wafer achieve poor utilization of device die. The need for efficient utilization of the die and wide process latitude for defining multiple implant regions per wafer has led to the development of an implant proximity mask (vMask™), which permits sharply defined borders between implant regions that may have different species, energy, angle, or dose. The capability of this system to achieve multiple spatially resolved implant conditions per wafer with high die utilization and using the same process parameters as production implants will be described. Specifically, results for measurement of the uniform process area, process repeatability, and cleanliness will illustrate the potential of this technique to dramatically reduce implant process development costs.

  17. Detection of Left Ventricular Regional Dysfunction and Myocardial Abnormalities Using Complementary Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis without Cardiac Symptoms: A Pilot Study.

    Science.gov (United States)

    Kobayashi, Yasuyuki; Kobayashi, Hitomi; T Giles, Jon; Yokoe, Isamu; Hirano, Masaharu; Nakajima, Yasuo; Takei, Masami

    2016-01-01

    Objective We sought to detect the presence of left ventricular regional dysfunction and myocardial abnormalities in systemic sclerosis (SSc) patients without cardiac symptoms using a complementary cardiac magnetic resonance (CMR) imaging approach. Methods Consecutive patients with SSc without cardiac symptoms and healthy controls underwent CMR on a 1.5 T scanner. The peak systolic regional function in the circumferential and radial strain (Ecc, % and Err, %) were calculated using a feature tracking analysis on the mid-left ventricular slices obtained with cine MRI. In addition, we investigated the myocardial characteristics by contrast MRI. Pharmacological stress and rest perfusion scans were performed to assess perfusion defect (PD) due to micro- or macrovascular impairment, and late gadolinium enhancement (LGE) images were obtained for the assessment of myocarditis and/or fibrosis. Results We compared 15 SSc patients with 10 healthy controls. No statistically significant differences were observed in the baseline characteristics between the patients and healthy controls. The mean peak Err and Ecc of all segments was significantly lower in the patients than the controls (p=0.011 and p=0.003, respectively). Four patients with LGE (28.6%) and seven patients with PD (50.0%) were observed. PD was significantly associated with digital ulcers (p=0.005). Utilizing a linear regression model, the presence of myocardial LGE was significantly associated with the peak Ecc (p=0.024). After adjusting for age, the association between myocardial LGE and the peak Ecc was strengthened. Conclusion A subclinical myocardial involvement, as detected by CMR, was prevalent in the SSc patients without cardiac symptoms. Regional dysfunction might predict the myocardial abnormalities observed in SSc patients without cardiac symptoms.

  18. 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.

  19. Selective activation of E-type prostanoid(3)-receptors reduces myocardial infarct size. A novel insight into the cardioprotective effects of prostaglandins.

    Science.gov (United States)

    Thiemermann, C; Zacharowski, K

    2000-07-01

    Prostaglandins (PGs) and other eicosanoids are members of a large family of lipid mediators (autacoids). In 1978, Lefer and colleagues (Science 200, 52-55 [1978]) reported that prostacyclin reduces the myocardial tissue injury caused by coronary artery occlusion and reperfusion in the cat. Since this discovery, more than 50 papers have reported on the cardioprotective effects of vasodilator PGs, including prostacyclin. The cardioprotective effects of PGs are due in part to (1) a reduction in afterload, (2) an increase in coronary blood flow, (3) the inhibition of platelet function, and (4) the inhibition of the activation and extravasation of polymorphonuclear granulocytes. All of these effects are secondary to the activation of EP (E-type prostanoid)(2)-receptors, which activate G(s)-protein and, hence, adenylate cyclase. In addition, the protection of organs such as the heart by PGs has been attributed to a cytoprotective effect of these agents, the mechanism of which is largely unknown. We recently have discovered that certain E-type PGs, which do not activate EP(2)-receptors, also reduce myocardial infarct size, without causing a fall in blood pressure (EP(2)-receptor-mediated effects). Having provided a brief introduction into the role of eicosanoids in ischaemia-reperfusion injury of the heart, this review focuses on the recent discovery that selective agonists of EP(3)-receptors reduce myocardial infarct size, without causing haemodynamic side effects. The mechanisms of the cardioprotective effects of these agents are discussed, as are the therapeutic implications.

  20. Atorvastatin reduces myocardial fibrosis in a rat model with post-myocardial infarction heart failure by increasing the matrix metaHoproteinase-2/tissue matrix metalloproteinase inhibitor-2 ratio

    Institute of Scientific and Technical Information of China (English)

    AN Zhe; YANG Guang; HE Yu-quan; DONG Ning; GE Li-li; LI Shu-mei; ZHANG Wen-qi

    2013-01-01

    Background The cholesterol-lowering statin drugs have some non-lipid-lowering effects,such as inhibiting myocardial remodeling.However,the underlying mechanism is still unclear.Methods The left anterior descending coronary artery was ligated to establish a rat model of heart failure,and the rats were divided into a sham operation (SO) group,myocardial infarction model (MI) group,and MI-atorvastatin group.Changes in hemodynamic parameters were recorded after the final drug administration.Histological diagnosis was made by reviewing hematoxylin and eosin (HE) stained tissue.Real-time quantitative polymerase chain reaction (PCR)was performed to determine the expressions of type Ⅰ and type Ⅲ collagen,matrix metalloproteinase-2 (MMP-2),and tissue matrix metalloproteinase inhibitor-2 (TIMP-2).Further,primary rat cardiac fibroblasts were cultured and the MTT assay was performed to determine the effect of atorvastatin on cardiac fibroblast proliferation.Results The model of heart failure was established and the results of HE staining and Masson's trichrome staining revealed that the rats in the heart failure group showed obvious hyperplasia of fibrotic tissue,which was significantly reduced in the atorvastatin group.Real-time quantitative PCR showed that the MI group showed a significantly increased expression of type Ⅰ and type Ⅲ collagen,MMP-2,and TIMP-2,but a significantly reduced MMP-2/TIMP-2 ratio.Compared with the MI group,the atorvastatin group showed significantly reduced expression of type Ⅰ and Ⅲcollagen,unchanged expression of MMP-2,significantly reduced expression of TIMP-2,and an increased MMP-2/TIMP-2 ratio.We further found that atorvastatin significantly inhibited the Ang Ⅱ-induced flbroblast proliferation and the expression of type Ⅰ and type Ⅲ collagen in cardiac flbroblasts while increasing the MMP-2/TIMP-2 ratio.Conclusions These data suggest that atorvastatin can inhibit cardiac fibroblast proliferation and enhance collagen degradation

  1. The association of depressed angiogenic factors with reduced capillary density in the Rhesus monkey model of myocardial ischemia.

    Science.gov (United States)

    Zhang, Wenjing; Zhao, Xinmei; Xiao, Ying; Chen, Jianmin; Han, Pengfei; Zhang, Jingyao; Fu, Haiying; James Kang, Y

    2016-07-13

    Depressed capillary density is associated with myocardial ischemic infarction, in which hypoxia-inducible factor 1α (HIF-1α) is increased. The present study was undertaken to examine changes in the angiogenic factors whose expression is regulated by HIF-1 and their relation to the depressed capillary density in the Rhesus monkey model of myocardial ischemic infarction. Male Rhesus monkeys 2-3 years old were subjected to myocardial ischemia by permanent ligation of left anterior descending (LAD) artery leading to the development of myocardial infarction. Eight weeks after LAD ligation, copper concentrations, myocardial histological changes and capillary density were examined, along with Western blot and immunohistochemical analysis of angiogenic factors and detection of HIF-1 activity. Capillary density was significantly decreased but the concentrations of HIF-1α and HIF-1β were significantly increased in the infarct area. However, the levels of mRNA and protein for VEGF and VEGFR1 were significantly decreased. Other HIF-1 regulated angiogenic factors, including Tie-2, Ang-1 and FGF-1, were also significantly depressed, but vascular destabilizing factor Ang-2 was significantly increased. Copper concentrations were depressed in the infarct area. Copper-independent HIF-1 activity was increased shown by the elevated mRNA level of IGF-2, a HIF-1 target gene. Removal of copper by a copper chelator, tetraethylenepentamine, from primary cultures of neonatal rat cardiomyocytes also suppressed the expression of HIF-1 regulated VEGF and BNIP3, but not IGF-2. The data suggest that under ischemic conditions, copper loss suppressed the expression of critical angiogenic genes regulated by HIF-1, but did not affect copper-independent HIF-1 activation of gene expression. This copper-dependent dysregulation of angiogenic gene expression would contribute to the pathogenesis of myocardial ischemic infarction.

  2. Acute regional improvement of myocardial function after interventional transfemoral aortic valve replacement in aortic stenosis: A speckle tracking echocardiography study

    Directory of Open Access Journals (Sweden)

    Schattke Sebastian

    2012-03-01

    Full Text Available Abstract Background Transcatheter aortic valve implantation (TAVI is a promising therapy for patients with severe aortic stenosis (AS and high perioperative risk. New echocardiographic methods, including 2D Strain analysis, allow the more accurate measurement of left ventricular (LV systolic function. The goal of this study was to describe the course of LV reverse remodelling immediately after TAVI in a broad spectrum of patients with symptomatic severe aortic valve stenosis. Methods Thirty consecutive patients with symptomatic aortic valve stenosis and preserved LVEF underwent transfemoral aortic valve implantation. We performed echocardiography at baseline and one week after TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as 2D Strain measurements of longitudinal, radial and circumferential LV motion and Tissue Doppler echocardiography. Results The baseline biplane LVEF was 57 ± 8.2%, the mean pressure gradient was 46.8 ± 17.2 mmHg and the mean valve area was 0.73 ± 0.27 cm2. The average global longitudinal 2D strain of the left ventricle improved significantly from -15.1 (± 3.0 to -17.5 (± 2.4 % (p Conclusion There is an acute improvement of myocardial longitudinal systolic function of the basal and medial segments measured by 2D Strain analysis immediately after TAVI. The radial, circumferential strain and LVEF does not change significantly in all patients acutely after TAVI. These data suggest that sensitive new echo methods can reliably detect early regional changes of myocardial function after TAVI before benefits in LVEF are detectable.

  3. Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Kelbæk, Henning Skov; Vejlstrup, Niels Grove

    2012-01-01

    Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defin...

  4. The Novel Extracellular Cyclophilin A (CyPA - Inhibitor MM284 Reduces Myocardial Inflammation and Remodeling in a Mouse Model of Troponin I -Induced Myocarditis.

    Directory of Open Access Journals (Sweden)

    David Heinzmann

    Full Text Available Cyclophilins are a group of highly conserved cytosolic enzymes that have a peptidylprolyl cis/trans isomerase activity. Cyclophilin A (CyPA can be secreted in the extracellular space by inflammatory cells and upon cell death. The presence of CyPA in patients with non-ischemic cardiomyopathy is associated with poor clinical prognosis. Here, we investigated the inhibition of extracellular CyPA in a mouse model of troponin I-induced autoimmune myocarditis using the strictly extracellular CyPA-inhibitor MM284. Since A/J mice develop severe inflammation and fibrosis after immunization with murine cardiac troponin I (mcTn I, we used this model to analyze the effects of an extracellular CyPA inhibition. As extracellular CyPA-inhibitor we used the recently described CsA-derivate MM284. In vitro studies confirmed that MM284 inhibits CyPA-induced monocytic migration and adhesion. A/J mice immunized with mcTnI were treated with MM284 or vehicle every second day. After 28 days, we found a considerable reduction of myocardial injury and fibrosis. Further analysis revealed a reduced myocardial presence of T-cells and macrophages compared to control treated animals. Whereas MMP-9 expression was reduced significantly by MM284, we observed no significant reduction of inflammatory cytokines such as IL-6 or TNFα. Extracellular CyPA plays an important role in autoimmune myocarditis for myocardial damage and fibrosis. Our data suggest a new pharmacological approach for the treatment of myocardial inflammation and reduction of cardiac fibrosis by inhibition of extracellular CyPA.

  5. 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)

  6. Scintigraphic evaluation of regional myocardial sympathetic activity in patients with hypertrophic cardiomyopathy. Comparison between asymmetrical hypertrophic cardiomyopathy and apical hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Eno, Shin; Takeo, Eiichiro; Sasaki, Satoshi; Matsuda, Keiji; Fujii, Hideaki; Kanazawa, Ikuo [Chugoku Rosai General Hospital, Kure, Hiroshima (Japan)

    1998-02-01

    Using {sup 123}I-MIBG (metaiodobenzylguanidine) and {sup 201}Tl imagings, an examination concerning the relation between the hypertrophic region and its sympathetic nervous function was done. Subjects were 12 normal adults (4 males and 8 females, mean age 61.3 yr), 13 patients with asymmetrical hypertrophic cardiomyopathy (10 males and 3 females, 63.9 yr) and 13 patients with apical hypertrophy (9 males and 4 females, 67.2 yr). The SPECT apparatus was Toshiba two-gated gamma camera GCA 7200A. At 20 min and 3 hr after intravenous injection of 111 MBq of {sup 123}I-MIBG, myocardial SPECT and planar images were obtained with collimator LEHR under following conditions: photoelectric peak 159 KeV, window width 20%, matrix size 64 x 64 (256 x 256 for the planar image), step angle 6deg, 40 sec/step and 180deg for 1 camera. In another day, {sup 201}Tl SPECT and planar imagings were performed 10 min after intravenous injection of 111 MBq of {sup 201}Tl for the photoelectric peak 72 KeV under similar conditions to above. SPECT images were reconstructed using Butterworth filter and Shepp and Logan filter. Images were examined for the defect score, myocardium/mediastinum ratio, whole heart washout rate and regional washout rate. In the asymmetrical hypertrophic myopathy, abnormal sympathetic nerve function was recognized on the regions regardless of their disease severity while in the apical hypertrophy, abnormality was restricted on the apical region. Therefore, the two diseases were found different from each other from the aspect of sympathetic nerve functions. (K.H.)

  7. Regional quantification of myocardial mechanics in rat using 3D cine DENSE cardiovascular magnetic resonance.

    Science.gov (United States)

    Zhang, Xiaoyan; Liu, Zhan-Qiu; Singh, Dara; Wehner, Gregory J; Powell, David K; Campbell, Kenneth S; Fornwalt, Brandon K; Wenk, Jonathan F

    2017-08-01

    Rat models have assumed an increasingly important role in cardiac research. However, a detailed profile of regional cardiac mechanics, such as strains and torsion, is lacking for rats. We hypothesized that healthy rat left ventricles (LVs) exhibit regional differences in cardiac mechanics, which are part of normal function. In this study, images of the LV were obtained with 3D cine displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance in 10 healthy rats. To evaluate regional cardiac mechanics, the LV was divided into basal, mid-ventricular, and apical regions. The myocardium at the mid-LV was further partitioned into four wall segments (i.e. septal, inferior, lateral, and anterior) and three transmural layers (i.e. sub-endocardium, mid-myocardium, and sub-epicardium). The six Lagrangian strain components (i.e. Err , Ecc , Ell , Ecl , Erl , and Ecr ) were computed from the 3D displacement field and averaged within each region of interest. Torsion was quantified using the circumferential-longitudinal shear angle. While peak systolic Ecl differed between the mid-ventricle and apex, the other five components of peak systolic strain were similar across the base, mid-ventricle, and apex. In the mid-LV myocardium, Ecc decreased gradually from the sub-endocardial to the sub-epicardial layer. Ell demonstrated significant differences between the four wall segments, with the largest magnitude in the inferior segment. Err was uniform among the four wall segments. Ecl varied along the transmural direction and among wall segments, whereas Erl differed only among the wall segments. Erc was not associated with significant variations. Torsion also varied along the transmural direction and among wall segments. These results provide fundamental insights into the regional contractile function of healthy rat hearts, and form the foundation for future studies on regional changes induced by disease or treatments. Copyright © 2017 John Wiley & Sons, Ltd.

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  9. Early Detection of Regional and Global Left Ventricular Myocardial Function Using Strain and Strain-rate Imaging in Patients with Metabolic Syndrome

    Institute of Scientific and Technical Information of China (English)

    Qin Wang; Qi-Wei Sun; Dan Wu; Ming-Wu Yang; Rong-Juan Li; Bo Jiang; Jiao Yang

    2015-01-01

    Background:Strain and strain-rate imaging (SRI) have been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies,and identifying early subclinical changes in various pathologies.The aim of this study was to evaluate the regional and global left ventricular (LV) myocardial function in metabolic syndrome (MS) with SRI so that we can provide more myocardial small lesions in patients with MS,which is robust and reliable basis for early detection of LV function.Methods:Thirty-nine adults with MS were enrolled in the study.There was a control group of 39 healthy adults.In addition to classic echocardiographic assessment of LV global functional changes,SRI was used to evaluate regional and global LV function.Including:Peak systolic strain (S),peak systolic strain-rate (SR-s),peak diastolic strain-rate (SR-e).Results:There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function.On the other hand,significant differences were observed between MS and the control group in most of the parameters of S,SR-s,SR-e in regional LV function.Multiple stepwise regression analyses revealed that S and SR significantly were negatively correlated with blood pressure,waist circumference,fasting plasma glucose,uric acid,suggesting that risk factories were relevant to regional systolic dysfunction.Conclusion:In MS with normal LV ejection fraction,there was regional myocardial dysfunction,risk factors contributed to the impairment of systolic and diastolic function of the regional myocardium.Assessment of myocardial function using SRI could be more accurate in MS patient evaluation than conventional echocardiography alone.

  10. Early Detection of Regional and Global Left Ventricular Myocardial Function Using Strain and Strain-rate Imaging in Patients with Metabolic Syndrome

    Directory of Open Access Journals (Sweden)

    Qin Wang

    2015-01-01

    Full Text Available Background: Strain and strain-rate imaging (SRI have been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. The aim of this study was to evaluate the regional and global left ventricular (LV myocardial function in metabolic syndrome (MS with SRI so that we can provide more myocardial small lesions in patients with MS, which is robust and reliable basis for early detection of LV function. Methods: Thirty-nine adults with MS were enrolled in the study. There was a control group of 39 healthy adults. In addition to classic echocardiographic assessment of LV global functional changes, SRI was used to evaluate regional and global LV function. Including: Peak systolic strain (S, peak systolic strain-rate (SR-s, peak diastolic strain-rate (SR-e. Results: There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of S, SR-s, SR-e in regional LV function. Multiple stepwise regression analyses revealed that S and SR significantly were negatively correlated with blood pressure, waist circumference, fasting plasma glucose, uric acid, suggesting that risk factories were relevant to regional systolic dysfunction. Conclusion: In MS with normal LV ejection fraction, there was regional myocardial dysfunction, risk factors contributed to the impairment of systolic and diastolic function of the regional myocardium. Assessment of myocardial function using SRI could be more accurate in MS patient evaluation than conventional echocardiography alone.

  11. Estimation of regional myocardial mass at risk based on distal arterial lumen volume and length using 3D micro-CT images.

    Science.gov (United States)

    Le, Huy; Wong, Jerry T; Molloi, Sabee

    2008-09-01

    The determination of regional myocardial mass at risk distal to a coronary occlusion provides valuable prognostic information for a patient with coronary artery disease. The coronary arterial system follows a design rule which allows for the use of arterial branch length and lumen volume to estimate regional myocardial mass at risk. Image processing techniques, such as segmentation, skeletonization and arterial network tracking, are presented for extracting anatomical details of the coronary arterial system using micro-computed tomography (micro-CT). Moreover, a method of assigning tissue voxels to their corresponding arterial branches is presented to determine the dependent myocardial region. The proposed micro-CT technique was utilized to investigate the relationship between the sum of the distal coronary arterial branch lengths and volumes to the dependent regional myocardial mass using a polymer cast of a porcine heart. The correlations of the logarithm of the total distal arterial lengths (L) to the logarithm of the regional myocardial mass (M) for the left anterior descending (LAD), left circumflex (LCX) and right coronary (RCA) arteries were log(L)=0.73log(M)+0.09 (R=0.78), log(L)=0.82log(M)+0.05 (R=0.77) and log(L)=0.85log(M)+0.05 (R=0.87), respectively. The correlation of the logarithm of the total distal arterial lumen volumes (V) to the logarithm of the regional myocardial mass for the LAD, LCX and RCA were log(V)=0.93log(M)-1.65 (R=0.81), log(V)=1.02log(M)-1.79 (R=0.78) and log(V)=1.17log(M)-2.10 (R=0.82), respectively. These morphological relations did not change appreciably for diameter truncations of 600-1400microm. The results indicate that the image processing procedures successfully extracted information from a large 3D dataset of the coronary arterial tree to provide prognostic indications in the form of arterial tree parameters and anatomical area at risk.

  12. Cyclosporin variably and inconsistently reduces infarct size in experimental models of reperfused myocardial infarction: a systematic review and meta-analysis.

    Science.gov (United States)

    Lim, W Y; Messow, C M; Berry, C

    2012-04-01

    Cyclosporin is an immunosuppressant that has recently been proposed as a treatment to prevent reperfusion injury in acute myocardial infarction (MI). We aimed to determine the overall efficacy of cyclosporin in experimental studies of acute reperfused MI. We conducted a systematic review and stratified meta-analysis of published studies describing the efficacy of cyclosporin in experimental models of acute reperfused MI. We included all in vivo publications of cyclosporin where infarct size was measured. A literature search identified 29 potential studies of which 20 fulfilled the eligibility criteria. In these studies (involving four species of animals), cyclosporin reduced myocardial infarct size by a standardized mean (95% confidence interval) difference of -1.60 (-2.17, -1.03) compared with controls. Cyclosporin failed to demonstrate a convincing benefit in studies involving pigs. Despite this observation, the overall efficacy of cyclosporin did not differ across species (P= 0.358). The dose of cyclosporin given did not affect final infarct size (P= 0.203). Funnel plots of these data suggested heterogeneity among the studies. Cyclosporin had variable effects on infarct size compared with placebo. Cyclosporin had no effect on myocardial infarct size in swine, raising a question over the potential cardioprotective effects of cyclosporin in man. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  13. Regional myocardial shortening in relation to graft-reactive hyperemia and flow after coronary bypass surgery

    NARCIS (Netherlands)

    R.W. Brower (Ronald); P.W.J.C. Serruys (Patrick); E. Bos (Egbert); J. Nauta (Jan)

    1979-01-01

    textabstractExtent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was mani

  14. Artifact-reduced two-dimensional cine steady state free precession for myocardial blood- oxygen-level-dependent imaging.

    Science.gov (United States)

    Zhou, Xiangzhi; Tsaftaris, Sotirios A; Liu, Ying; Tang, Richard; Klein, Rachel; Zuehlsdorff, Sven; Li, Debiao; Dharmakumar, Rohan

    2010-04-01

    To minimize image artifacts in long TR cardiac phase-resolved steady state free precession (SSFP) based blood-oxygen-level-dependent (BOLD) imaging. Nine healthy dogs (four male, five female, 20-25 kg) were studied in a clinical 1.5 Tesla MRI scanner to investigate the effect of temporal resolution, readout bandwidth, and motion compensation on long repetition time (TR) SSFP images. Breath-held 2D SSFP cine sequences with various temporal resolutions (10-204 ms), bandwidths (239-930 Hz/pixel), with and without first-order motion compensation were prescribed in the basal, mid-ventricular, and apical along the short axis. Preliminary myocardial BOLD studies in dogs with controllable coronary stenosis were performed to assess the benefits of artifact-reduction strategies. Shortening the readout time by means of increasing readout bandwidth had no observable reduction in image artifacts. However, increasing the temporal resolution in the presence of first-order motion compensation led to significant reduction in image artifacts. Preliminary studies demonstrated that BOLD signal changes can be reliably detected throughout the cardiac cycle. Artifact-reduction methods used in this study provide significant improvement in image quality compared with conventional long TR SSFP BOLD MRI. It is envisioned that the methods proposed here may enable reliable detection of myocardial oxygenation changes throughout the cardiac cycle with long TR SSFP-based myocardial BOLD MRI. (c) 2010 Wiley-Liss, Inc.

  15. Phosphomimetic modulation of eNOS improves myocardial reperfusion and mimics cardiac postconditioning in mice.

    Directory of Open Access Journals (Sweden)

    Terrence Pong

    Full Text Available OBJECTIVE: Myocardial infarction resulting from ischemia-reperfusion injury can be reduced by cardiac postconditioning, in which blood flow is restored intermittently prior to full reperfusion. Although key molecular mechanisms and prosurvival pathways involved in postconditioning have been identified, a direct role for eNOS-derived NO in improving regional myocardial perfusion has not been shown. The objective of this study is to measure, with high temporal and spatial resolution, regional myocardial perfusion during ischemia-reperfusion and postconditioning, in order to determine the contribution of regional blood flow effects of NO to infarct size and protection. METHODS AND RESULTS: We used myocardial contrast echocardiography to measure regional myocardial blood flow in mice over time. Reperfusion after myocardial ischemia-reperfusion injury is improved by postconditioning, as well as by phosphomimetic eNOS modulation. Knock-in mice expressing a phosphomimetic S1176D form of eNOS showed improved myocardial reperfusion and significantly reduced infarct size. eNOS knock-out mice failed to show cardioprotection from postconditioning. The size of the no-reflow zone following ischemia-reperfusion is substantially reduced by postconditioning and by the phosphomimetic eNOS mutation. CONCLUSIONS AND SIGNIFICANCE: Using myocardial contrast echocardiography, we show that temporal dynamics of regional myocardial perfusion restoration contribute to reduced infarct size after postconditioning. eNOS has direct effects on myocardial blood flow following ischemia-reperfusion, with reduction in the size of the no-reflow zone. These results have important implications for ongoing clinical trials on cardioprotection, because the degree of protective benefit may be significantly influenced by the regional hemodynamic effects of eNOS-derived NO.

  16. NOGA-guided analysis of regional myocardial perfusion abnormalities treated with intramyocardial injections of plasmid encoding vascular endothelial growth factor A-165 in patients with chronic myocardial ischemia: subanalysis of the EUROINJECT-ONE multicenter double-blind randomized study

    DEFF Research Database (Denmark)

    Gyongyosi, Mariann; Khorsand, Aliasghar; Zamini, Sholeh;

    2005-01-01

    . The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI....... CONCLUSIONS: Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A165 plasmid improve, but do not normalize, the stress...

  17. Beneficial effects of atorvastatin on myocardial regions with initially low vasodilatory capacity at various stages of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Wielepp, Peter [Ruhr-University Bochum, Institute of Molecular Biophysics, Radiopharmacy and Nuclear Medicinea, Bad Oeynhausen (Germany); Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen (Germany); Baller, Detlev [Ruhr-University Bochum, Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen (Germany); Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen (Germany); Gleichmann, Ulrich; Pulawski, Ewa; Horstkotte, Dieter [Ruhr-University Bochum, Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen (Germany); Burchert, Wolfgang [Ruhr-University Bochum, Institute of Molecular Biophysics, Radiopharmacy and Nuclear Medicinea, Bad Oeynhausen (Germany)

    2005-12-01

    The aim of this study was to analyse non-invasively the regional effect of therapy with an HMG-CoA reductase inhibitor on myocardial blood flow in patients with coronary artery disease (CAD) with special reference to segments with initially substantially impaired vasodilation. The study included 26 patients with untreated hypercholesterolaemia. Coronary angiography revealed CAD in nine patients with stenosis >50% and wall irregularities or minimal stenosis <30% in 17 patients. Before and 4.6{+-}1.8 months after atorvastatin therapy,{sup 13}N-ammonia positron emission tomography (PET) studies were performed at rest and under pharmacological stress. Minimum coronary vascular resistance (MCR) and coronary flow reserve (CFR) were determined. Segments were divided into those with normal or near-normal (MBF during adenosine {>=}2.0 ml/min/g) and those with abnormal (MBF<2.0 ml/min/g) vasodilator flow response. In CAD patients, 156 segments were analysed, 85 of which had abnormal MBF; in the non-obstructive group, 59 of 297 segments had abnormal MBF. LDL cholesterol decreased after atorvastatin therapy from 186{+-}43 mg/dl to 101{+-}26 mg/dl (p<0.001). In normal segments no significant changes in MBF, CFR and MCR were found. However, initially abnormal segments showed significant improvements in MCR (15%, p<0.0001) and MBF during adenosine (30%, p<0.0001) after therapy. The improvement in regional coronary vasodilator function after atorvastatin in patients with coronary atherosclerosis may be caused, at least in part, by increased flow-mediated (endothelium-dependent) dilation of the total arteriolar and arterial vascular system. These data further support the concept of non-invasive management of stable CAD by statin therapy and life-style modification guided by PET. (orig.)

  18. Normal values of regional left ventricular myocardial thickness, mass and distribution-assessed by 320-detector computed tomography angiography in the Copenhagen General Population Study.

    Science.gov (United States)

    Hindsø, Louise; Fuchs, Andreas; Kühl, Jørgen Tobias; Nilsson, Emma Julia P; Sigvardsen, Per Ejlstrup; Køber, Lars; Nordestgaard, Børge G; Kofoed, Klaus Fuglsang

    2017-03-01

    Left ventricular (LV) hypertrophy is associated with cardiovascular complications and the geometry is important for prognosis. In some cardiovascular diseases, myocardial hypertrophy or dilation occurs regionally without modifying the global size of the heart. It is therefore relevant to determine regional normal reference values of the left ventricle. The aim of this study was to derive reference values of regional LV myocardial thickness (LVMT) and mass (LVMM) from a healthy study group of the general population using cardiac computed tomography angiography (CCTA). We wanted to introduce LV myocardial distribution (LVMD) as a measure of regional variation of the LVMT. Moreover, we wanted to determine whether these parameters varied between men and women. We studied 568 (181 men; 32%) adults, free of cardiovascular disease and risk factors, who underwent 320-detector CCTA. Mean age was 55 (range 40-84) years. Regional LVMT and LVMM were measured, according to the American Heart Association's 17 segment model, using semi-automatic software. Mean LVMT were 6.6 mm for men and 5.4 mm for women (p normal LV was thickest in the basal septum (segment 3; men = 8.3 mm; women = 7.2 mm) and thinnest in the mid-ventricular anterior wall (segment 7; men = 5.6 mm; women = 4.5 mm) for both men and women. However, the regional LVMD differed between men and women, with the LV being most heterogenic in women. The normal human LV is morphologically heterogenic, and showed same overall pattern but different regional distribution for men and women. This study introduces LVMD and provides gender specific reference values for regional LVMT, LVMM, and LVMD.

  19. Assessment of segmental myocardial viability using regional 2-dimensional strain echocardiography.

    Science.gov (United States)

    Migrino, Raymond Q; Zhu, Xiaoguang; Pajewski, Nicholas; Brahmbhatt, Tejas; Hoffmann, Raymond; Zhao, Ming

    2007-04-01

    We determined whether 2-dimensional strain echocardiography can identify viable from infarcted myocardium in a rat ischemia-reperfusion model. A total of 16 male Sprague-Dawley rats underwent left anterior descending coronary artery occlusion for 12 or 30 minutes followed by 60-minute reperfusion. Short-axis 2-dimensional strain echocardiography was performed at the mid-ventricle 60 minutes post-reperfusion. Post-sacrifice, triphenyl tetrazolium chloride was infused to the coronary circulation. Regional end-systolic radial and circumferential strain, and time to peak strain, were measured using software in all 96 segments and correlated with areas of infarct in corresponding histologic slices. Segments with greater than 50% area of infarct had lower end-systolic radial and circumferential strain and longer time to peak strain versus areas with 50% or less strain or no infarct. Extent of infarct correlates with radial and circumferential strain. End-systolic radial strain less than 2% has 88% sensitivity and 95% specificity for detecting infarcted area greater than 50%. Two-dimensional strain echocardiography-derived strain is useful in distinguishing infarcted from viable myocardium.

  20. Mass media interventions to reduce help-seeking delay in people with symptoms of acute myocardial infarction: time for a new approach?

    Science.gov (United States)

    Caldwell, Mary A; Miaskowski, Christine

    2002-01-01

    Minimizing patient delay in seeking care for acute myocardial infarction (AMI) is important in the reduction of morbidity and mortality. However, mass media interventions to reduce these delays have had limited success. This paper critiques delay reducing intervention studies and draws on other public health campaigns to identify new directions. A Medline search for the years 1985 through 2000 yielded eight intervention studies meeting inclusion criteria. Three of eight studies reported successful interventions although two of three were only marginally successful. Most studies used similar messages. Campaign lengths, type of media, and sample sizes varied. High risk populations and those with confirmed MI responded more quickly. To reduce patient delay, media messages need to do more than create awareness. Future interventions should target high risk audiences, promote dialogue between previous AMI patients and high risk patients, address problems of denial, provide gender specific education, and emphasize symptom evaluation, problem solving, and decision-making skills.

  1. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ho, Chi-Kung; Chen, Fu-Cheng; Chen, Yung-Lung; Wang, Hui-Ting; Lee, Chien-Ho; Chung, Wen-Jung; Lin, Cheng-Jui; Hsueh, Shu-Kai; Hung, Shin-Chiang; Wu, Kuan-Han; Liu, Chu-Feng; Kung, Chia-Te; Cheng, Cheng-I

    2017-01-01

    This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p cloud computing system in our present protocol did not reduce DTB time.

  2. Mismatched regional myocardial uptake between [sup 123]I-BMIPP and [sup 201]Tl SPECT; Comparison between hypertrophic myocardium and dilated myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Otsuka, Makoto; Ichiya, Yuichi; Kuwabara, Yasuo; Sasaki, Masayuki; Fukumura, Toshimitsu; Masuda, Kouji; Ejima, Junichi; Tsuda, Yasuo (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine)

    1992-07-01

    The distribution of a new myocardial fatty acid metabolic agent [sup 123]I-BMIPP was compared in 6 each patients with hypertrophic myocardium (4 cases of hypertensive heart disease and 2 of hypertrophic cardiomyopathy) and dilated myocardium (4 of dilated type of valvular heart disease and 2 of dilated cardiomyopathy) with that of [sup 201]Tl. Mismatched regional myocardial uptake between [sup 123]I-BMIPP and [sup 201]Tl SPECT was observed in all of the hypertrophic myocardium, however no but one in the dilated myocardium. Relative increase or decrease in regional BMIPP from the images of 20 min and to those of 4 h was observed in 3 cases of the hypertrophic myocardium. FDG-PET was performed in 2 cases of the hypertrophic myocardium. The distribution of FDG was different from neither those of BMIPP nor Tl in a hypertrophic cardiomyopathy case with the reserved distribution of BMIPP and Tl. Although more investigations are necessary, we concluded that [sup 123]I-BMIPP is a promising radiopharmaceutical for evaluating myocardial fatty acid metabolism in hypertrophic myocardium. (author).

  3. MG132 Inhibits Myocardial Ischemia-reperfusion Injury by Regulating Apoptotic Pathway

    Institute of Scientific and Technical Information of China (English)

    Dai Cuilian; Luo Kailiang; Chen Zhangrong

    2007-01-01

    Objectives To administrated proteasome inhibitor-MG-132 prior to reperfusion in rat myocardial ischemia-reperfusion model to determine whether MG-132 could reduce myocytic apoptosis. Methods and results MG-132 (0.75 mg/kg in 2 ml DMSO) injection 5 min prior to reperfusion resulted significant reduction of myocardial reperfusion injury. This effect was accompanied by reduced polymorphonuclear neutrophils(PMN) infiltration in myocardial region surrounding the myocardial infarct, reduced apoptosis in cardiac myocytes, reduced NF-κB activation, as determined by electron microscopy, histology, immunohistochemistry, the terminal deoxynucleotidyl transferase-mediated nick endlabeling (TUNEL) method, reverse transcription-polymerase chain reaction. Functional effects of MG-132 on PMN accumulation, activation of nuclear factor kappa B(p65 mRNA and protein levels ), and apoptosis were characterized in rat myocardial tissue. MG132 time-dependently inhibited myocardial p65 mRNA expression and reduced myocardial apoptotic index (AI) after reperfusion for 2 h, 6 h and 24 h ( P<0.01 ). Moreover, MG-132 time-dependently decreased Bax protein levels, while increased Bcl-2 protein levels in ischemic and reperfused myocardium ( P<0.05 ), its effect peaked after reperfusion for 24 h. Conclusions Our results demonstrate that MG-132 reduced myocardial reperfusion injury by inhibiting myosytic apoptotic cell death and blocking activation of NF-κB, down-regulating Bax expression and up-regulating Bcl-2 expression as well as elevating Bcl-2/Bax ratio.

  4. Reducing maternal mortality in the eastern Mediterranean region.

    Science.gov (United States)

    Mahaini, R; Mahmoud, H

    2005-07-01

    Current efforts in some countries of the Eastern Mediterranean Region are still insufficient to achieve the fifth Millennium Development Goal on improving maternal health. Strong commitment, intensive efforts and effective national policies and strategies are now urgently required in order to translate vision into action. Such efforts and plans should target the strengthening of health systems, the expansion in the coverage of effective integrated interventions, and the recognition of the essential role of individuals, families and communities in making pregnancy safer. This article provides a background on the current situation of maternal health in the Eastern Mediterranean Region, including underlying causes and contributing factors, and describes strategic directions aimed at accelerating the reduction of maternal mortality in the Region and moving closer to the achievement of the Millennium Development Goals.

  5. Reduced myocardial {sup 18}F-FDG uptake after calcium channel blocker administration. Initial observation for a potential new method to improve plaque detection

    Energy Technology Data Exchange (ETDEWEB)

    Gaeta, Chiara; Flotats, Albert; Artigas, Carles; Deportos, Jordi; Geraldo, Llanos; Carrio, Ignasi [Sant Pau Hospital, PET Unit, Department of Nuclear Medicine, Barcelona (Spain); Fernandez, Yolanda [Center for Experimental Molecular Imaging (CIME), CETIR-ERESA, Barcelona (Spain); Pavia, Javier [Center for Experimental Molecular Imaging (CIME), CETIR-ERESA, Barcelona (Spain); Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona (Spain)

    2011-11-15

    Physiological glucose uptake by the myocardium may hamper visualization of coronary atherosclerotic plaques in {sup 18}F-FDG PET studies. Intracellular myocardial calcium relates to glucose influx. We assessed whether administration of a calcium channel blocker such as verapamil could decrease myocardial {sup 18}F-FDG uptake in mice. Experiments were conducted on ten male C57BL/6JOlaHsd mice. The mice were studied by {sup 18}F-FDG PET/CT under basal conditions and after a single administration of verapamil injected 1 h prior to {sup 18}F-FDG administration at doses of 1 mg/kg (group A, n = 5) and 20 mg/kg (group B, n = 5). PET scanning was started 60 min after injection of {sup 18}F-FDG employing a dedicated small-animal PET/CT system (ARGUS-CT). In each mouse, post-verapamil PET images were coregistered with the basal PET images. Volumetric regions of interest (VOI) were drawn on the basal study containing the myocardium of the whole left ventricle and quantitatively compared with the same VOI applied to the post-verapamil scan. The SUV{sub mean} was used to express the mean myocardial {sup 18}F-FDG uptake. The relative coefficient of variation (RV) between the basal and post-verapamil conditions was calculated. Verapamil administration decreased myocardial {sup 18}F-FDG uptake in all animals. The median (range) SUV{sub mean} values in group A were 2.6 (1.6-4.1) under basal conditions and 1.7 (1.1-2.9) after verapamil administration (p = 0.043), and in group B were 1.6 (1.3-2.0) under basal conditions and 1.0 (0.9-1.4) after verapamil administration (p = 0.043). The median (range) RV values were -31% (-5%, -50%) in group A, and -37% (-10%, -51%) in group B (p = 0.6). In this animal model there was a significant reduction in {sup 18}F-FDG uptake in the myocardium following verapamil administration. This type of intervention could facilitate the definition of coronary atherosclerotic plaque inflammation on {sup 18}F-FDG PET scans. (orig.)

  6. High prevalence of angina pectoris in Mexican-American men. A population with reduced risk of myocardial infarction.

    Science.gov (United States)

    Mitchell, B D; Hazuda, H P; Haffner, S M; Patterson, J K; Stern, M P

    1991-08-01

    Mexican-American men experience lower rates of cardiovascular mortality and have a lower prevalence of nonfatal myocardial infarction than do non-Hispanic white men. To see if this ethnic difference exists for other cardiovascular end points, we compared the prevalence of angina pectoris, as assessed by the Rose Angina Questionnaire, between Mexican Americans (n = 3272) and non-Hispanic whites (n = 1848) examined in the San Antonio Heart Study, a population-based survey of cardiovascular disease and diabetes conducted in San Antonio, Texas, between 1979 and 1988. Contrary to our expectations, angina prevalence was approximately twice as high in Mexican Americans as in non-Hispanic whites, with age-adjusted odds ratios of 2.01 (95% confidence interval (CI), 1.13 to 3.58; P = .02) in men and 1.84 (95% CI, 1.26 to 2.70; P = .001) in women. After controlling for age, body mass index, diabetes status, cigarette smoking, and educational level by logistic regression analysis, angina prevalence remained statistically associated with Mexican American ethnicity in men, but not women. There was little ethnic difference in the proportion of Mexican-American and non-Hispanic white subjects who reported nonspecific chest pain (chest pain not meeting the Rose criteria), suggesting that the ethnic difference in angina prevalence was not an artifact of reporting bias. This was further supported by the fact that the conventional cardiovascular risk factors were more strongly associated with angina prevalence in Mexican Americans than in non-Hispanic whites. These data suggest that Mexican-American men experience high rates of angina despite low rates of myocardial infarction. Future studies should investigate ethnic factors that may have differential effects on the various manifestations of coronary heart disease.

  7. Cardiac-Restricted IGF-1Ea Overexpression Reduces the Early Accumulation of Inflammatory Myeloid Cells and Mediates Expression of Extracellular Matrix Remodelling Genes after Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Enrique Gallego-Colon

    2015-01-01

    Full Text Available Strategies to limit damage and improve repair after myocardial infarct remain a major therapeutic goal in cardiology. Our previous studies have shown that constitutive expression of a locally acting insulin-like growth factor-1 Ea (IGF-1Ea propeptide promotes functional restoration after cardiac injury associated with decreased scar formation. In the current study, we investigated the underlying molecular and cellular mechanisms behind the enhanced functional recovery. We observed improved cardiac function in mice overexpressing cardiac-specific IGF-1Ea as early as day 7 after myocardial infarction. Analysis of gene transcription revealed that supplemental IGF-1Ea regulated expression of key metalloproteinases (MMP-2 and MMP-9, their inhibitors (TIMP-1 and TIMP-2, and collagen types (Col 1α1 and Col 1α3 in the first week after injury. Infiltration of inflammatory cells, which direct the remodelling process, was also altered; in particular there was a notable reduction in inflammatory Ly6C+ monocytes at day 3 and an increase in anti-inflammatory CD206+ macrophages at day 7. Taken together, these results indicate that the IGF-1Ea transgene shifts the balance of innate immune cell populations early after infarction, favouring a reduction in inflammatory myeloid cells. This correlates with reduced extracellular matrix remodelling and changes in collagen composition that may confer enhanced scar elasticity and improved cardiac function.

  8. Selection of reference genes in different myocardial regions of an in vivo ischemia/reperfusion rat model for normalization of antioxidant gene expression.

    Science.gov (United States)

    Vesentini, Nicoletta; Barsanti, Cristina; Martino, Alessandro; Kusmic, Claudia; Ripoli, Andrea; Rossi, AnnaMaria; L'Abbate, Antonio

    2012-02-29

    Changes in cardiac gene expression due to myocardial injury are usually assessed in whole heart tissue. However, as the heart is a heterogeneous system, spatial and temporal heterogeneity is expected in gene expression. In an ischemia/reperfusion (I/R) rat model we evaluated gene expression of mitochondrial and cytoplasmatic superoxide dismutase (MnSod, Cu-ZnSod) and thioredoxin reductase (trxr1) upon short (4 h) and long (72 h) reperfusion times in the right ventricle (RV), and in the ischemic/reperfused (IRR) and the remote region (RR) of the left ventricle. Gene expression was assessed by Real-time reverse-transcription quantitative PCR (RT-qPCR). In order to select most stable reference genes suitable for normalization purposes, in each myocardial region we tested nine putative reference genes by geNorm analysis. The genes investigated were: Actin beta (actb), Glyceraldehyde-3-P-dehydrogenase (gapdh), Ribosomal protein L13A (rpl13a), Tyrosine 3-monooxygenase (ywhaz), Beta-glucuronidase (gusb), Hypoxanthine guanine Phosphoribosyltransferase 1 (hprt), TATA binding box protein (tbp), Hydroxymethylbilane synthase (hmbs), Polyadenylate-binding protein 1 (papbn1). According to our findings, most stable reference genes in the RV and RR were hmbs/hprt and hmbs/tbp/hprt respectively. In the IRR, six reference genes were recommended for normalization purposes; however, in view of experimental feasibility limitations, target gene expression could be normalized against the three most stable reference genes (ywhaz/pabp/hmbs) without loss of sensitivity. In all cases MnSod and Cu-ZnSod expression decreased upon long reperfusion, the former in all myocardial regions and the latter in IRR alone. trxr1 expression did not vary. This study provides a validation of reference genes in the RV and in the anterior and posterior wall of the LV of cardiac ischemia/reperfusion model and shows that gene expression should be assessed separately in each region.

  9. Selection of reference genes in different myocardial regions of an in vivo ischemia/reperfusion rat model for normalization of antioxidant gene expression

    Directory of Open Access Journals (Sweden)

    Vesentini Nicoletta

    2012-02-01

    Full Text Available Abstract Background Changes in cardiac gene expression due to myocardial injury are usually assessed in whole heart tissue. However, as the heart is a heterogeneous system, spatial and temporal heterogeneity is expected in gene expression. Results In an ischemia/reperfusion (I/R rat model we evaluated gene expression of mitochondrial and cytoplasmatic superoxide dismutase (MnSod, Cu-ZnSod and thioredoxin reductase (trxr1 upon short (4 h and long (72 h reperfusion times in the right ventricle (RV, and in the ischemic/reperfused (IRR and the remote region (RR of the left ventricle. Gene expression was assessed by Real-time reverse-transcription quantitative PCR (RT-qPCR. In order to select most stable reference genes suitable for normalization purposes, in each myocardial region we tested nine putative reference genes by geNorm analysis. The genes investigated were: Actin beta (actb, Glyceraldehyde-3-P-dehydrogenase (gapdh, Ribosomal protein L13A (rpl13a, Tyrosine 3-monooxygenase (ywhaz, Beta-glucuronidase (gusb, Hypoxanthine guanine Phosphoribosyltransferase 1 (hprt, TATA binding box protein (tbp, Hydroxymethylbilane synthase (hmbs, Polyadenylate-binding protein 1 (papbn1. According to our findings, most stable reference genes in the RV and RR were hmbs/hprt and hmbs/tbp/hprt respectively. In the IRR, six reference genes were recommended for normalization purposes; however, in view of experimental feasibility limitations, target gene expression could be normalized against the three most stable reference genes (ywhaz/pabp/hmbs without loss of sensitivity. In all cases MnSod and Cu-ZnSod expression decreased upon long reperfusion, the former in all myocardial regions and the latter in IRR alone. trxr1 expression did not vary. Conclusions This study provides a validation of reference genes in the RV and in the anterior and posterior wall of the LV of cardiac ischemia/reperfusion model and shows that gene expression should be assessed separately in

  10. 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.

  11. 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.

  12. 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...

  13. Myocardial Bridging

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2016-02-01

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

  14. Myocardial capillary permeability after regional ischemia and reperfusion in the in vivo canine heart. Effect of superoxide dismutase

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Bjerrum, P J; Haunsø, S

    1991-01-01

    This study assesses the effect of the superoxide anion scavenger superoxide dismutase on myocardial capillary permeability-surface area (PS) products for small hydrophilic molecules after ischemia and reperfusion. Open-chest dogs underwent a 20-minute occlusion of the left anterior descending...... the start of reperfusion. In 13 dogs, no scavenger treatment was given (nonprotected control group), whereas eight dogs were treated systemically with 15,000 units/kg superoxide dismutase during 1 hour, starting 20 minutes before ischemia. In the control group, three dogs developed reperfusion ventricular...... fibrillation in contrast to none in the superoxide dismutase group. Before ischemia, plasma flow rate, myocardial capillary extraction fraction, and PS values were similar in the two groups. Five minutes after the start of reperfusion, plasma flow rate increased significantly (p less than 0.01) in both groups...

  15. Quantitative proteomic changes during post myocardial infarction remodeling reveals altered cardiac metabolism and Desmin aggregation in the infarct region.

    Science.gov (United States)

    Datta, Kaberi; Basak, Trayambak; Varshney, Swati; Sengupta, Shantanu; Sarkar, Sagartirtha

    2017-01-30

    Myocardial infarction is one of the leading causes of cardiac dysfunction, failure and sudden death. Post infarction cardiac remodeling presents a poor prognosis, with 30%-45% of patients developing heart failure, in a period of 5-25years. Oxidative stress has been labelled as the primary causative factor for cardiac damage during infarction, however, the impact it may have during the process of post infarction remodeling has not been well probed. In this study, we have implemented iTRAQ proteomics to catalogue proteins and functional processes, participating both temporally (early and late phases) and spatially (infarct and remote zones), during post myocardial infarction remodeling of the heart as functions of the differential oxidative stress manifest during the remodeling process. Cardiac metabolism was the dominant network to be affected during infarction and the remodeling time points considered in this study. A distinctive expression pattern of cytoskeletal proteins was also observed with increased remodeling time points. Further, it was found that the cytoskeletal protein Desmin, aggregated in the infarct zone during the remodeling process, mediated by the protease Calpain1. Taken together, all of these data in conjunction may lay the foundation to understand the effects of oxidative stress on the remodeling process and elaborate the mechanism behind the compromised cardiac function observed during post myocardial infarction remodeling.

  16. Myocardial disease

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

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

  17. Interleukin-17 (IL-17 Expression Is Reduced during Acute Myocardial Infarction: Role on Chemokine Receptor Expression in Monocytes and Their in Vitro Chemotaxis towards Chemokines

    Directory of Open Access Journals (Sweden)

    Guro Valen

    2012-11-01

    Full Text Available The roles of immune cells and their soluble products during myocardial infarction (MI are not completely understood. Here, we observed that the percentages of IL-17, but not IL-22, producing cells are reduced in mice splenocytes after developing MI. To correlate this finding with the functional activity of IL-17, we sought to determine its effect on monocytes. In particular, we presumed that this cytokine might affect the chemotaxis of monocytes important for cardiac inflammation and remodeling. We observed that IL-17 tends to reduce the expression of two major chemokine receptors involved in monocyte chemotaxis, namely CCR2 and CXCR4. Further analysis showed that monocytes pretreated with IL-17 have reduced in vitro chemotaxis towards the ligand for CCR2, i.e., MCP-1/CCL2, and the ligand for CXCR4, i.e., SDF-1α/CXCL12. Our results support the possibility that IL-17 may be beneficial in MI, and this could be due to its ability to inhibit the migration of monocytes.

  18. Blockades of angiotensin and aldosterone reduce osteopontin expression and interstitial fibrosis infiltration in rats with myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yu-ling; ZHOU Shu-xian; LEI Juan; YUAN Gui-yi; WANG Jing-feng

    2008-01-01

    Background It has been reported that osteopontin has an important role in cardiac fibrosis and remodeling.However,its direct mechanisms remain unclear.The purpose of this study was to investigate the role of angiotensin and aldosterone blockades in cardiac osteopontin expression associated with cardiac remodeling in myocardial infarcted (MI) rats.Methods Fifty SD rats that survived 24 hours after ligating left anterior descending coronary artery were randomly divided into three groups:Ml-saline group (n=15,5 ml/d),MI-perindopril group (n=18,perindopril 2 mg·kg-1·d-1) and MI-spironolacton (n=17,spironolacton 20 mg·kg-1.d-1).A sham operation group (n=15) was selected as non-infarcted control.At 6 weeks after treatment,hemodynamic pararmeters and left ventricular function were measured with catheterization,interstitial fibrosis infiltration and cardiomyocyte diameters were evaluated histologically.Myocardium osteopontin protein expression level in the non-infarcted myocardium was detected by Western blotting.Results No osteopontin protein was detected in the myocardium of sham-operation rats.High levels of osteopontin protein expression were detected in the MI-saline rats,but the levels were suppressed in the MI-perindopril and MI-spironolacton rats at 6 weeks following MI (P<0.01,respectively).Compared with the sham operation group,all rats in the MI group showed marked interstitial fibrosis infiltration in the non-infarction area,higher ventricular weight]body weight ratio,significantly increased cardiomyocyte diameter (P<0.01,respectively),and developed significant systolic and diastolic dysfunction as indicated by decreased left ventricular systolic pressure (LVSP) and ±dp/dt,as well as increased left ventricular end-diastolic pressure (LVEDP) (P<0.01,respectively).Angiotensin and aldosterone blockades partly prevented cardiac fibrosis and systolic and diastolic dysfunction (P<0.01,respectively).Conclusion Treatment with angiotensin and aldosterone blockades

  19. 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....

  20. Role of omega-3 ethyl ester concentrate in reducing sudden cardiac death following myocardial infarction and in management of hypertriglyceridemia: An Indian consensus statement

    Science.gov (United States)

    Dalal, J.J.; Kasliwal, R.R.; Dutta, A.L.; Sawhney, J.P.S.; Iyengar, S.S.; Dani, S.; Desai, N.; Sathyamurthy, I.; Rao, D.; Menon, A.; Dasbiswas, A.; Wander, G.S.; Chadha, M.; Hiremath, M.S.; Roy, D.G.; Gupta, V.; Shivakadaksham, N.

    2012-01-01

    Introduction Sudden cardiac death (SCD) is the most lethal manifestation of heart disease. In an Indian study the SCDs contribute about 10% of the total mortality and SCD post ST elevation myocardial infarction (MI) constitutes for about half of total deaths. Objective Given the limitations of existing therapy there is a need for an effective, easy to use, broadly applicable and affordable intervention to prevent SCD post MI. Leading cardiologists from all over India came together to discuss the potential role of n-3 acid ethyl esters (90%) of eicosapentaenoic acid (EPA) 460 mg & docosahexaenoic acid (DHA) 380 mg in the management of post MI patients and those with hypertriglyceridemia. Recommendations Highly purified & concentrated omega-3 ethyl esters (90%) of EPA (460 mg) & DHA (380 mg) has clinically proven benefits in improving post MI outcomes (significant 15% risk reduction for all-cause mortality, 20% risk reduction for CVD and 45% risk reduction in SCD in GISSI-Prevenzione trial) and in reducing hypertriglyceridemia, and hence, represent an interesting option adding to the treatment armamentarium in the secondary prevention after MI based on its anti-arrhythmogenic effects and also in reducing hypertriglyceridemia. PMID:23102390

  1. Two-dimensional speckle-tracking-derived segmental peak systolic longitudinal strain identifies regional myocardial involvement in patients with myocarditis and normal global left ventricular systolic function.

    Science.gov (United States)

    Uppu, Santosh C; Shah, Amee; Weigand, Justin; Nielsen, James C; Ko, H Helen; Parness, Ira A; Srivastava, Shubhika

    2015-06-01

    The presence of myocardial late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in concert with electrocardiography and elevated biomarkers helps support the diagnosis of acute myocarditis. Two-dimensional echocardiography is limited to global and qualitative regional function assessment and may not contribute to the diagnosis, especially in the presence of normal LV systolic function. Two-dimensional speckle-tracking (2D-STE)-derived segmental peak systolic (pkS) longitudinal strain (LS) may identify segmental myocardial involvement in myocarditis. We sought to identify an association between segmental pkS, LGE, and troponin levels in patients with myocarditis. Retrospective analysis of myocardial segmental function by 2D-STE segmental strain was compared to the presence of LGE and admission peak troponin levels in patients with acute myocarditis and preserved global LV systolic function. American Heart Association 17-segment model was used for comparison between imaging modalities. Global function was assessed by m-mode-derived shortening fraction (SF). Descriptive statistics and regression analysis were utilized. Forty-four CMRs performed to evaluate for myocarditis were identified. Of the 44, 10 patients, median age 17.5 years (14-18.5 years) and median SF 35 % (28-44 %), had paired CMR and 2D-STE data for analysis, and 161/170 segments could be analyzed by both methods for comparison. PkS LS was decreased in 51 % of segments that were positive for LGE with average pkS of -14.7 %. Segmental pkS LS abnormalities were present in all but one patient who had abnormal pkS circumferential strain. Global pkS LS was decreased in patients with myocarditis. There is a moderate correlation between decreased pkS LS and the presence of LGE by CMR, 2D-STE for myocardial involvement in acute myocarditis can serve as an useful noninvasive adjunct to the existing tests used for the diagnosis of acute myocarditis and might have a role in prognostication.

  2. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L

    2012-02-01

    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  3. Effects of dipyridamole and aminophylline on hemodynamics, regional myocardial blood flow and thallium-201 washout in the setting of a critical coronary stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Granato, J.E.; Watson, D.D.; Belardinelli, L.; Cannon, J.M.; Beller, G.A. (Univ. of Virginia Health Sciences Center, Charlottesville (USA))

    1990-12-01

    Experiments were performed to characterize the interaction of intravenous dipyridamole and aminophylline on thallium-201 transport kinetics, regional myocardial blood flow and systemic hemodynamics in the presence of a critical coronary artery stenosis. In 12 dogs with a critical left anterior descending coronary artery stenosis, arterial pressure decreased from a mean value (+/- SEM) of 107 +/- 6 to 94 +/- 3 mm Hg and distal left anterior descending artery pressure decreased from 70 +/- 7 to 55 +/- 4 mm Hg after intravenous administration of dipyridamole. In the left anterior descending perfusion zone, the endocardial/epicardial flow ratio decreased from 0.70 to 0.36 and the intrinsic thallium washout rate was significantly prolonged. Intravenous aminophylline reversed the dipyridamole-induced systemic hypotension and transmural coronary steal and restored the thallium washout rate to baseline values. In six other dogs, aminophylline alone resulted in no alterations in systemic and coronary hemodynamics or regional myocardial blood flow. As expected, dipyridamole-induced vasodilation and coronary steal were prevented by aminophylline pretreatment. These data show that in a canine model of partial coronary stenosis, systemic hypotension, adverse regional flow effects and prolonged thallium-201 washout consequent to intravenously administered dipyridamole are promptly reversed by intravenous aminophylline administration. Aminophylline alone had no significant hemodynamic and coronary flow effects. This study provides further insight into the altered thallium kinetics occurring as a consequence of dipyridamole-induced vasodilation and suggests that the prompt reversal of symptoms and signs of ischemia with aminophylline in patients receiving intravenous dipyridamole for clinical imaging studies probably reflects the reversal of transmural coronary steal.

  4. Comparison of outcomes after hospitalization for worsening heart failure, myocardial infarction, and stroke in patients with heart failure and reduced and preserved ejection fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Jhund, Pardeep S; Køber, Lars

    2015-01-01

    AIMS: To investigate the prognostic significance of hospitalization for worsening heart failure (WHF), myocardial infarction (MI), and stroke in patients with chronic heart failure (HF). METHODS AND RESULTS: We studied 5011 patients with HF and reduced EF (HF-REF) in the CORONA trial and 4128...... patients with HF and preserved EF (HF-PEF) in the I-Preserve trial. Adjusted hazard ratios (HRs) for death were estimated for 0-30 days and ≥31 days after first post-randomization WHF, MI, or stroke used as a time-dependent variable, compared with patients with none of these events. In CORONA, 1616.......21-700.17), and stroke 223.30 (95% CI 51.42-969.78); for >30 days it was WHF 3.36 (95% CI 2.79-4.05), MI 3.29 (95% CI 2.14-5.06), and stroke 5.13 (95% CI 3.61-7.29). CONCLUSIONS: In patients with both HF-REF and HF-PEF, hospitalization for WHF was associated with high early and late mortality. The early relative risk...

  5. Reducing time delay in the thrombolysis of myocardial infarction: an internal quality improvement project. ARIAM Project Group. Analisis del Retraso en Infarto Agudo de Miocardio.

    Science.gov (United States)

    Saturno, P J; Felices, F; Segura, J; Vera, A; Rodriguez, J J

    2000-01-01

    The objectives of this study were to improve thrombolytic therapy in acute myocardial infarction by reducing the "door-to-needle" time in a 285-bed university hospital in Spain. A quality management approach was used involving all the relevant staff. Target standard was set at 35 minutes. Baseline data, intervention effect, and continuous monitoring were analyzed using x control charts. Analysis of baseline data showed a wide out-of-control variation and 72 minutes' average delay. Cause analysis revealed organizational and clinical problems that were subjected to intervention. Postintervention data showed a stable process, with an average of 30 minutes. Continuous monitoring showed further improvement in average time and predictable variation. The template of the current control chart has an average of 26 minutes. Quality management methods, particularly staff involvement in problem analysis and intervention design, and the use of control charts were useful to understand, solve, and continuously monitor an important clinical problem whose existence was evident only after it was measured.

  6. Potential diagnostic value of regional myocardial adrenergic imaging using {sup 123}I-MIBG SPECT to identify patients with Lewy body diseases

    Energy Technology Data Exchange (ETDEWEB)

    Lebasnier, Adrien; Peyronnet, Damien; Bouvard, Gerard [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Lamotte, Guillaume; Defer, Gilles [University Hospital Center of Caen, Department of Neurology, Caen (France); Manrique, Alain [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Cyceron PET Centre, Caen (France); Normandie Universite, Caen (France); Agostini, Denis [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Normandie Universite, Caen (France)

    2015-01-28

    The aim of this study was to determine the potential diagnostic value of regional myocardial adrenergic {sup 123}I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) imaging to identify patients with Lewy body diseases (LBD+). Sixty-four consecutive patients who underwent cardiac {sup 123}I-MIBG SPECT to differentiate LBD+, including Parkinson's disease (PD) and dementia with Lewy bodies (DLB), from patients without LBD (LBD-) were retrospectively reviewed. A neurologist expert in memory disorders determined the final clinical diagnosis by using international clinical diagnostic criteria. Planar [heart to mediastinum ratio (HMR)] and {sup 123}I-MIBG SPECT[innervation defect score (IDS)] using the 17-segment left ventricular model (five-point scale) were obtained 4 h after the injection of {sup 123}I-MIBG on a low-energy high-resolution (LEHR) collimator. Receiver-operating characteristic (ROC) analysis was performed to determine the optimal HMR and IDS cut-off values to discriminate LBD+ from LBD-. Of the 64 patients, 45 (70 %) were diagnosed LBD+ (DLB, n = 27; PD, n = 18) and 19 were diagnosed LBD- (5 other dementias, 14 other parkinsonisms). The HMR and IDS of LBD+ were significantly different from those of LBD- (1.30 ± 0.21 vs 1.65 ± 0.26, p < 0.001; 39 ± 28 vs 8 ± 16, p = 0.001). The optimal HMR and IDS cut-off values to discriminate LBD+ (n = 45) from LBD- (n = 19) were 1.47 and 6/68, providing a sensitivity and specificity of 82.2 and 84.2 % and 86.7 and 73.7 %, respectively. Regional myocardial adrenergic {sup 123}I-MIBG imaging SPECT has a potential diagnostic value to identify LBD+. (orig.)

  7. Attenuation of mitochondrial, but not cytosolic, Ca2+ overload reduces myocardial injury induced by ischemia and reperfusion

    Institute of Scientific and Technical Information of China (English)

    Chun-mei CAO; Wing-yee YAN; Jing LIU; Kenneth WL KAM; Shi-zhong ZHAN; James SK SHAM; Tak-ming WONG

    2006-01-01

    Aim: Attenuation of mitochondrial Ca2+ ([Ca2+]m, but not cytosolic Ca2+ ([Ca2+]c), overload improves contractile recovery. We hypothesized that attenuation of [Ca2+]m, but not [Ca2+]c, overload confers cardioprotection against ischemia/ reperfusion-induced injury. Methods: Infarct size from isolated perfused rat heart, cell viability, and electrically-induced Ca2+ transient in isolated rat ventricular myocytes were measured. We determined the effects of BAPTA-AM, a Ca2+ chelator, at concentrations that abolish the overload of both [Ca2+]c and [Ca2+]m, and ruthenium red, an inhibitor of mitochondrial uniporter of Ca2+ transport, at concentrations that abolish the overload of [Ca2+]m, but not [Ca2+]c, on cardiac injury induced by ischemia/reperfusion. Results: Attenuation of both [Ca2+]m and [Ca2+]c by BAPTA-AM, and attenuation of [Ca2+]m, but not [Ca2+]c, overload by ruthenium red, reduced the cardiac injury observations, indicating the importance of [Ca2+]m in cardioprotection and contractile recovery in response to ischemia/reperfusion. Conclusion: The study has provided unequivocal evidence using a cause-effect approach that attenuation of [Ca2+]m, but not [Ca2+]c, overload is responsible for cardioprotection against ischemia/reperfusion-induced injury. We also confirmed the previous observation that attenuation of [Ca2+]m, but not [Ca2+]c, by ruthenium red improves contractile recovery following ischemia/ reperfusion.

  8. Gene deletion of P2Y4 receptor lowers exercise capacity and reduces myocardial hypertrophy with swimming exercise.

    Science.gov (United States)

    Horckmans, Michael; Léon-Gómez, Elvira; Robaye, Bernard; Balligand, Jean-Luc; Boeynaems, Jean-Marie; Dessy, Chantal; Communi, Didier

    2012-10-01

    Nucleotides released within the heart under pathological conditions can be involved in cardioprotection or cardiac fibrosis through the activation purinergic P2Y(2) and P2Y(6) receptors, respectively. We previously demonstrated that adult P2Y(4)-null mice display a microcardia phenotype related to a cardiac angiogenic defect. To evaluate the functional consequences of this defect, we performed here a combination of cardiac monitoring and exercise tests. We investigated the exercise capacity of P2Y(4) wild-type and P2Y(4)-null mice in forced swimming and running tests. Analysis of their stress, locomotion, and resignation was realized in open field, black and white box, and tail suspension experiments. Exercise-induced cardiac hypertrophy was evaluated after repeated and prolonged exercise in P2Y(4) wild-type and P2Y(4)-null hearts. We showed that P2Y(4)-null mice have a lower exercise capacity in both swimming and treadmill tests. This was not related to decreased motivation or increased stress, since open field, white and black box, and mouse tail suspension tests gave comparable results in P2Y(4) wild-type and P2Y(4)-null mice. Heart rate and blood pressure rose normally in P2Y(4)-null swimming mice equipped with a telemetric implant. On the contrary, we observed a delayed recovery of postexercise blood pressure after exercise in P2Y(4)-null mice. The heart rate increment in response to catecholamines was also similar in P2Y(4) wild-type and P2Y(4)-null implanted mice, which is consistent with a similar level of cardiac β-receptor expression. Interestingly, the heart of P2Y(4)-null mice displayed a reduced sympathetic innervation associated with a decreased norepinephrine level. We also demonstrated that exercise-induced cardiac hypertrophy was lower in P2Y(4)-null mice after repeated and prolonged exercise. This was associated with a lower increase in cardiomyocyte size and microvessel density. In conclusion, besides its role in cardiac development, P2Y(4

  9. AcvR1-mediated BMP signaling in second heart field is required for arterial pole development: implications for myocardial differentiation and regional identity.

    Science.gov (United States)

    Thomas, Penny S; Rajderkar, Sudha; Lane, Jamie; Mishina, Yuji; Kaartinen, Vesa

    2014-06-15

    BMP signaling plays an essential role in second heart field-derived heart and arterial trunk development, including myocardial differentiation, right ventricular growth, and interventricular, outflow tract and aortico-pulmonary septation. It is mediated by a number of different BMP ligands, and receptors, many of which are present simultaneously. The mechanisms by which they regulate morphogenetic events and degree of redundancy amongst them have still to be elucidated. We therefore assessed the role of BMP Type I receptor AcvR1 in anterior second heart field-derived cell development, and compared it with that of BmpR1a. By removing Acvr1 using the driver Mef2c[AHF]-Cre, we show that AcvR1 plays an essential role in arterial pole morphogenesis, identifying defects in outflow tract wall and cushion morphology that preceded a spectrum of septation defects from double outlet right ventricle to common arterial trunk in mutants. Its absence caused dysregulation in gene expression important for myocardial differentiation (Isl1, Fgf8) and regional identity (Tbx2, Tbx3, Tbx20, Tgfb2). Although these defects resemble to some degree those in the equivalent Bmpr1a mutant, a novel gene knock-in model in which Bmpr1a was expressed in the Acvr1 locus only partially restored septation in Acvr1 mutants. These data show that both BmpR1a and AcvR1 are needed for normal heart development, in which they play some non-redundant roles, and refine our understanding of the genetic and morphogenetic processes underlying Bmp-mediated heart development important in human congenital heart disease.

  10. Depression after myocardial infarction.

    Science.gov (United States)

    Ziegelstein, R C

    2001-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张稳柱; 查道刚; 成官迅; 杨绍青; 刘伊丽

    2001-01-01

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

  12. In older men, higher plasma testosterone or dihydrotestosterone is an independent predictor for reduced incidence of stroke but not myocardial infarction.

    Science.gov (United States)

    Yeap, Bu B; Alfonso, Helman; Chubb, S A Paul; Hankey, Graeme J; Handelsman, David J; Golledge, Jonathan; Almeida, Osvaldo P; Flicker, Leon; Norman, Paul E

    2014-12-01

    Older men have lower T levels, but whether differences in circulating T or its metabolites dihydrotestosterone (DHT) or estradiol (E2) contribute to cardiovascular disease remains controversial. We tested the hypothesis that plasma T, DHT, and E2 are differentially associated with the incidence of myocardial infarction (MI) and stroke in older men. Plasma total T, DHT, and E2 were assayed using liquid chromatography-mass spectrometry in early-morning samples from 3690 community-dwelling men aged 70-89 years. Outcomes of the first hospital admission or death due to MI or stroke were ascertained by data linkage. Mean follow-up was 6.6 years. Incident MI occurred in 344, stroke in 300, and neither in 3046 men. In a multivariate analysis adjusting for age and other risk factors, T, DHT, and E2 were not associated with incident MI [fully adjusted hazard ratio (HR) for T in quartile (Q) 4 vs Q1: 0.92, 95% confidence interval (CI) 0.66-1.28; DHT: 0.83, 95% CI 0.59-1.15; E2: 0.84, 95% CI 0.62-1.15]. Higher T or DHT was associated with a lower incidence of stroke (T: Q4: Q1 fully adjusted HR 0.56, 95% CI 0.39-0.81, P = .002; DHT: 0.57, 95% CI 0.40-0.81, P = .002). E2 was not associated with stroke (HR 0.76, 95% CI 0.54-1.08, P = .123). Higher plasma T or DHT is a biomarker for reduced risk of stroke but not MI. Androgen exposure may influence outcomes after rather than the incidence of MI, whereas androgens but not E2 are independent predictors of stroke risk. Randomized clinical trials are needed to clarify the impact of modifying T or DHT on the risk of stroke in aging men.

  13. Higher education is associated with reduced risk of heart failure among patients with acute myocardial infarction: A nationwide analysis using data from the CVDNOR project.

    Science.gov (United States)

    Sulo, Gerhard; Nygård, Ottar; Vollset, Stein Emil; Igland, Jannicke; Ebbing, Marta; Sulo, Enxhela; Egeland, Grace M; Tell, Grethe S

    2016-11-01

    Coronary heart disease (CHD) outcomes are characterised by socioeconomic gradients. Although heart failure (HF) is a severe complication of CHD, sparse evidence exists on the association between socioeconomic status and HF among coronary patients. This study aimed to explore potential educational differences in the risk of HF among acute myocardial infarction (AMI) patients in Norway during 2001-2009. A total of 70,506 patients hospitalised for an incident (first) AMI and without history of HF were included in the analyses. Information on education was obtained from the Norwegian Education Database and categorised into primary, secondary or tertiary. In 12,487 (17.7%) patients, HF was present at admission or developed during the AMI hospitalisation (early-onset HF). Compared to patients with primary education, patients with secondary or tertiary education had 9% [incidence rate ratio (IRR) = 0.91; 95% confidence interval (CI): 0.87-0.94] and 20% (IRR = 0.80; 95% CI: 0.75-0.86) lower risks of early-onset HF, respectively. Of the 54,095 AMI patients discharged alive without concurrent HF, 6375 (11.8%) were subsequently hospitalised with or died from late-onset HF during a median follow-up period of 3.4 years. Compared to patients with primary education, those with secondary or tertiary education had 14% [hazard ratio (HR = 0.86; 95% CI: 0.82-0.91] and 27% (HR = 0.73; 95% CI: 0.66-0.80) lower risks of HF, respectively. Educational differences in the risk of HF were not influenced by gender. We observed an inverse association between educational level and risk of HF. More efforts in preventing this severe complication of AMI among less educated patients may help to reduce the socioeconomic gap in survival following coronary events. © The European Society of Cardiology 2016.

  14. Measures to reduce infarct size in treatment of acute myocardial infarction%急性心肌梗死治疗中缩小梗死范围的措施

    Institute of Scientific and Technical Information of China (English)

    蒋运发

    2015-01-01

    Objective:To analyze and summarize the measures to reduce infarct size in treatment of acute myocardial infarction. Methods:120 patients with acute myocardial infarction were selected from 2011 to 2014.They were randomly divided into the control group and the observation group with 60 cases in each group.The control group was treated with routine method,and the observation group was treated by metoprolol on the basis of the control group,before discharge,QRS scoring system was used to calculate the last 1 ECG score.We compared infarct size and hospital mortality of two groups of patients,and summarized the measures to reduce the infarct size in acute myocardial infarction treatment.Results:After 4 weeks of treatment,in the observation group,the infarct size was significantly lower than that of control group.In the control group,the mortality rate was 23.33%,the observation group was 3.33%,the mortality rate of the observation group was significantly lower than the control group.Conclusion:On the basis of conventional therapy,plus beta blockers for the treatment of acute myocardial infarction can reduce infarct area, reduce the mortality rate;after acute myocardial infarction.We should strengthen the nursing,increase myocardial oxygen supply and myocardial energy supply,reduce myocardial oxygen consumption,protect ischemic myocardium,and we also can use external counterpulsation surgery or thrombolytic therapy for the treatment,in order to reduce infarct range.%目的:分析并总结急性心肌梗死治疗中缩小梗死范围的措施。方法:2011-2014年收治急性心肌梗死患者120例,随机分为对照组和观察组,各60例。对照组采用常规方法治疗,观察组在此基础上加用美托洛尔治疗,于出院前使用QRS计分系统计算最后1次心电图记分,比较两组患者的梗死范围及住院期间病死率,并总结急性心肌梗死治疗中缩小梗死范围的措施。结果:经4周治疗后,观察组的梗

  15. Myocardial disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

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

  16. Growth factor-induced mobilization of cardiac progenitor cells reduces the risk of arrhythmias, in a rat model of chronic myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Leonardo Bocchi

    Full Text Available Heart repair by stem cell treatment may involve life-threatening arrhythmias. Cardiac progenitor cells (CPCs appear best suited for reconstituting lost myocardium without posing arrhythmic risks, being commissioned towards cardiac phenotype. In this study we tested the hypothesis that mobilization of CPCs through locally delivered Hepatocyte Growth Factor and Insulin-Like Growth Factor-1 to heal chronic myocardial infarction (MI, lowers the proneness to arrhythmias. We used 133 adult male Wistar rats either with one-month old MI and treated with growth factors (GFs, n = 60 or vehicle (V, n = 55, or sham operated (n = 18. In selected groups of animals, prior to and two weeks after GF/V delivery, we evaluated stress-induced ventricular arrhythmias by telemetry-ECG, cardiac mechanics by echocardiography, and ventricular excitability, conduction velocity and refractoriness by epicardial multiple-lead recording. Invasive hemodynamic measurements were performed before sacrifice and eventually the hearts were subjected to anatomical, morphometric, immunohistochemical, and molecular biology analyses. When compared with untreated MI, GFs decreased stress-induced arrhythmias and concurrently prolonged the effective refractory period (ERP without affecting neither the duration of ventricular repolarization, as suggested by measurements of QTc interval and mRNA levels for K-channel α-subunits Kv4.2 and Kv4.3, nor the dispersion of refractoriness. Further, markers of cardiomyocyte reactive hypertrophy, including mRNA levels for K-channel α-subunit Kv1.4 and β-subunit KChIP2, interstitial fibrosis and negative structural remodeling were significantly reduced in peri-infarcted/remote ventricular myocardium. Finally, analyses of BrdU incorporation and distribution of connexin43 and N-cadherin indicated that cytokines generated new vessels and electromechanically-connected myocytes and abolished the correlation of infarct size with deterioration

  17. Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause? A population-based case-control study.

    Science.gov (United States)

    Carrasquilla, Germán D; Berglund, Anita; Gigante, Bruna; Landgren, Britt-Marie; de Faire, Ulf; Hallqvist, Johan; Leander, Karin

    2015-06-01

    This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk. This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression. Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48). Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

  18. Mechanisms and therapeutic modulation of myocardial infarct healing

    NARCIS (Netherlands)

    Timmers, L.

    2008-01-01

    This thesis aimed to increase the basic mechanistic understanding of myocardial infarct healing and to develop novel approaches to prevent heart failure following myocardial infarction (MI). Different approaches have been tested to reduce myocardial injury in the acute phase of MI, leading to reduce

  19. 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...

  20. The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy patients with or without left ventricular outflow tract obstruction: Assessment with first-pass perfusion imaging using 3.0-T cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Hua-yan [Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 (China); Yang, Zhi-gang, E-mail: yangzg666@163.com [Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 (China); Sun, Jia-yu; Wen, Ling-yi; Zhang, Ge; Zhang, Shuai [Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 (China); Guo, Ying-kun [Department of Radiology, West China Second University Hospital, Sichuan University (China)

    2014-04-15

    Purpose: To assess regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction using 3.0-T cardiac magnetic resonance (CMR) first-pass perfusion imaging. Materials and methods: Forty-two HCM patients, including 25 HCM patients with left ventricular outflow tract obstruction (HOCM), 17 HCM patients without left ventricular outflow tract obstruction (NOHCM), and 14 healthy subjects underwent CMR. The left ventricular (LV) function, left ventricular end-diastolic wall thickness (EDTH), and diameter of left ventricular outflow tract (LVOT) were measured and calculated. Based on the signal–time curve of the first-pass myocardium perfusion imaging, perfusion parameters including upslope, time to peak, and peak intensity, were assessed and compared by using one-way analysis of variance and independent t tests. Results: On the first-pass perfusion imaging, lower upslope and peak intensity and longer time to peak were found in HCM patients compared with normal subjects (all p < 0.05). In contrast to the NOHCM group, the average time to peak of the HOCM group was increased (13.30 ± 4.82 s vs 16.28 ± 4.90 s, p < 0.05), but first-pass perfusion upslope was reduced (4.96 ± 2.55 vs 2.58 ± 0.77, p < 0.05). According to the bull's-eye model, the HOCM group's average thickness of basal segments was thicker than the NOHCM group, especially the anteroseptal, inferolateral, and anterior wall values, with a corresponding lower first-pass perfusion upslope than the NOHCM group (all p < 0.05). A significant correlation was observed between first-pass perfusion upslope and LV EDTH (r = −0.551, p < 0.001) and LVOT diameter (r = 0.472, p < 0.001). Conclusions: The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction can be detected with first-pass perfusion CMR

  1. A reduced-order method for estimating the stability region of power systems with saturated controls

    Institute of Scientific and Technical Information of China (English)

    GAN; DeQiang; XIN; HuanHai; QIU; JiaJu; HAN; ZhenXiang

    2007-01-01

    In a modern power system, there is often large difference in the decay speeds of transients. This could lead to numerical problems such as heavy simulation burden and singularity when the traditional methods are used to estimate the stability region of such a dynamic system with saturation nonlinearities. To overcome these problems, a reduced-order method, based on the singular perturbation theory, is suggested to estimate the stability region of a singular system with saturation nonlinearities. In the reduced-order method, a low-order linear dynamic system with saturation nonlinearities is constructed to estimate the stability region of the primary high-order system so that the singularity is eliminated and the estimation process is simplified. In addition, the analytical foundation of the reduction method is proven and the method is validated using a test power system with 3 buses and 5 machines.

  2. Novel adjunctive treatments of myocardial infarction

    DEFF Research Database (Denmark)

    Schmidt, Michael Rahbek; Pryds, Kasper; Bøtker, Hans Erik

    2014-01-01

    Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve...... by endovascular infusion of cold saline all reduce infarct size and may confer clinical benefit for patients admitted with acute myocardial infarcts. Equally promising, three follow-up studies of the effect of remote ischemic conditioning (RIC) show clinical prognostic benefit in patients undergoing coronary...... clinical outcome, but reperfusion may induce further myocardial damage itself. Development of adjunctive therapies to limit myocardial reperfusion injury beyond opening of the coronary artery gains increasing attention. A vast number of experimental studies have shown cardioprotective effects of ischemic...

  3. 实时三维斑点追踪成像技术评价冠状动脉狭窄患者左心室整体及局部心肌收缩功能%Evaluation of globle and regional left ventricular myocardial systolic function in patients with coronary stenosis by real-time three-dimensional speckle tracking imaging

    Institute of Scientific and Technical Information of China (English)

    陈莹; 刘昕; 郭淑芹

    2014-01-01

    Objective To explore the value of real‐time three‐dimensional speckle tracking imaging (RT‐3D‐STI) in the early detection of globle and regional left ventricular myocardial systolic function in patients of coronary stenosis without regional wall motion abnormality. Methods 64 coronary stenosis patients without regional wall motion abnormality were divided into 2 groups according to angiography (CAG):without coronary stenosis group( n = 20) and coronary stenosis group ( n = 44), and all the myocardial segments of the patients were divided into 5 groups:without coronary stenosis group normal myocardial segments ( n = 340 ), coronary stenosis group normal myocardial segments ( n = 235 ), mild coronary stenosis myocardial segments( n = 126), moderate coronary stenosis myocardial segments( n =213) and severe coronary stenosis myocardial segments( n =174). Real‐time three‐dimensional full volume of left ventricle was obtained, left ventricular global area strain (GAS)and regional area strain(AS) of 17 myocardial segments, etc, were measured by RT‐3D‐STI respectively. The parameters between the two groups and among the five sub groups were compared, the correlation between GAS and coronary artery Gensini score was also analyzed. Results GAS in coronary stenosis group significantly reduced compared with without coronary stenosis group( P 0 0.5) S.egmental AS in moderate and severe coronary stenosis myocardial segments significantly reduced ( P < 0.05 ), and that in severe coronary stenosis myocardial segments was lower than that in moderate coronary stenosis myocardial segments, the differences were statistically significant ( P < 0.05 ). In addition, GAS was significantly correlated with coronary artery Gensini score( r =0.828, P <0.01). Conclusions RT‐3D‐STI can quantitatively assess the early changes of left ventricular globle and regional myocardial systolic function in patients with coronary stenosis.%目的:探讨实时三

  4. Chlorhexidine Gluconate Dressings Reduce Bacterial Colonization Rates in Epidural and Peripheral Regional Catheters

    Directory of Open Access Journals (Sweden)

    Klaus Kerwat

    2015-01-01

    Full Text Available Introduction. Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. Methods. In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. Results. A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. Conclusion. CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.

  5. Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

    Directory of Open Access Journals (Sweden)

    M Kit Delgado

    2013-09-01

    Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.

  6. Growth Poles - an Alternative to Reducing Regional Disparities. Case Study-Iaşi Growth Pole

    Directory of Open Access Journals (Sweden)

    NICOLETA MONICA MUSTĂȚEA

    2013-01-01

    Full Text Available The current development of the European Union is based on the cohesion policy which focuses on the attenuation of regional disparities. For this purpose, the idea of growth poles emerged in Romania, and its role became more than familiar: the determination of an internal socio-economic cohesion. Polycentrism becomes a concept of territorial planning increasingly promoted. Development of growth poles aims to reduce the attraction force of large centres and to balance the location of activities generating functions across a territory. This was the idea that led to the formation of Iaşi Metropolitan Area, territorial unit that is intended to be the main regional centre of the North-East Region, thus polarizing the surrounding areas. Iaşi Growth Pole objectives are represented by economic competitiveness, the development of regional connectivity and the promotion of regional cooperation. One of the major assets of the growth pole in achieving these goals is the cross-border position near the eastern border of the European Union. This paper examines to what extent Iași Growth Pole can rise to the required standards, while the peripheral position seems to be rather a disadvantage and the uncertain functionality of the metropolitan area shows that the main problem remains the reduced economic competitiveness.

  7. Comparison of homogenous strain-analysis with wall thickening for the assessment of regional myocardial function; Homogene Strain-Analyse im Vergleich zur Wanddickenzunahme fuer die MR-tomographische Beurteilung der regionalen Myokardfunktion

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, D.; Pickup, S.; Zhou, R.; Glickson, J. [Dept. of Radiology, Univ. of Pennsylvania, Philadelphia, PA (United States); Ferrari, V.A. [Dept. of Radiology, Univ. of Pennsylvania, Philadelphia, PA (United States); Dept. of Medicine, Div. of Cardiology, Univ. of Pennsylvania (United States)

    2005-07-01

    Purpose: to compare strain analysis and wall thickening (WT) analysis in differentiating the infarcted, adjacent, and remote zones in a rat model of myocardial infarction (MI). Material and methods: three normal (NL) and ten rats subjected to myocardial infarction were imaged on a 4.7T scanner. Gradient-echo and SPAMM-tagged cine images were acquired at three short axis levels of the left ventricle (LV). A homogenous strain analysis (principal strains {lambda}1 and {lambda}2, displacement D, angle {beta}) and a WT-analysis (mm- and %-thickening) were performed in all slices demonstrating MI. Regional function was compared between infarcted rats (infarcted, adjacent and remote zone) and corresponding regions in the NL rats. Additional segmental analysis was performed in the NL rats for the anterior, lateral, inferior and septal wall. Results: in the NL rats, {lambda}{sub 1} (greatest radial thickening) was greatest in the lateral and anterior wall. WT-analysis showed a pattern of function similar to {lambda}1, however, regional differences using WT-analysis were not significant. {lambda}{sub 2} (greatest circumferential shortening) was most negative in the anterior wall. D was greatest in the lateral and inferior wall. The angle {beta} was radially directed in all segments. In the infarcted rats, both strain and WT-analyses revealed significant impairment in function in the infarcted and adjacent zones as compared to NL (p < 0.001). However, only the strain analysis ({lambda}1, {lambda}2, p < 0.001) detected significant remote myocardial dysfunction. Myocardial function differed significantly between the infarcted and adjacent and between the infarcted and remote regions. Strain analysis ({lambda}2, D, {beta}, p < 0.001) also identified significant functional differences between the adjacent and remote zones, however, no statistically significant differences were found using WT-analysis. (orig.)

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

    Science.gov (United States)

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

    2016-02-05

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

  9. Reducing Agricultural Water Footprints at the Farm Scale: A Case Study in the Beijing Region

    Directory of Open Access Journals (Sweden)

    Jing Huang

    2015-12-01

    Full Text Available Beijing is one of the most water-stressed regions in the world. Reducing agricultural water use has long been the basis of local policy for sustainable water use. In this article, the potential to reduce the life cycle (cradle to gate water footprints of wheat and maize that contribute to 94% of the local cereal production was assessed. Following ISO 14046, consumptive and degradative water use for the wheat-maize rotation system was modeled under different irrigation and nitrogen (N application options. Reducing irrigation water volume by 33.3% compared to current practice did not cause a significant yield decline, but the water scarcity footprint and water eutrophication footprint were decreased by 27.5% and 23.9%, respectively. Similarly, reducing the N application rate by 33.3% from current practice did not cause a significant yield decline, but led to a 52.3% reduction in water eutrophication footprint while maintaining a similar water scarcity footprint. These results demonstrate that improving water and fertilizer management has great potential for reducing the crop water footprints at the farm scale. This situation in Beijing is likely to be representative of the challenge facing many of the water-stressed regions in China, where a sustainable means of agricultural production must be found.

  10. Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT: optimization of the CT protocol to reduce the radiation dose.

    Science.gov (United States)

    Kim, Sung Mok; Kim, Yoo Na; Choe, Yeon Hyeon

    2013-04-01

    The aim of this study was to compare the radiation dose and image quality of different adenosine-stress dynamic myocardial perfusion CT protocols using a 128-slice dual-source computed tomography (DSCT) scanner. We included 330 consecutive patients with suspected coronary artery disease. Protocols employed the following dynamic scan parameters: protocol I, a 30-s scan with a fixed tube current (FTC, n = 172); protocol II, a 30-s scan using an automatic tube current modulation (ATCM) technique (n = 108); protocol III, a 14-s scan using an ATCM (n = 50). To determine the scan interval for protocol III, we analyzed time-attenuation curves of 26 patients with myocardial perfusion who had been scanned using protocol I or II. The maximum attenuation difference between normal and abnormal myocardium occurred at 18.0 s to 30.3 s after initiation of contrast injection. Myocardial perfusion images of FTC and ATCM were of diagnostic image quality based on visual analysis. The mean radiation dose associated with protocols I, II, and III was 12.1 ± 1.6 mSv, 7.7 ± 2.5 mSv, and 3.8 ± 1.3 mSv, respectively (p < 0.01). Use of a dose-modulation technique and a 14-s scan duration for adenosine-stress CT enables significant dose reduction while maintaining diagnostic image quality.

  11. Silent myocardial ischemia.

    Science.gov (United States)

    Gutterman, David D

    2009-05-01

    Although much progress has been made in reducing mortality from ischemic cardiovascular disease, this condition remains the leading cause of death throughout the world. This might in part be due to the fact that over half of patients have a catastrophic event (heart attack or sudden death) as their initial manifestation of coronary disease. Contributing to this statistic is the observation that the majority of myocardial ischemic episodes are silent, indicating an inability or failure to sense ischemic damage or stress on the heart. This review examines the clinical characteristics of silent myocardial ischemia, and explores mechanisms involved in the generation of angina pectoris. Possible mechanisms for the more common manifestation of injurious reductions in coronary flow; namely, silent ischemia, are also explored. A new theory for the mechanism of silent ischemia is proposed. Finally, the prognostic importance of silent ischemia and potential future directions for research are discussed.

  12. Myocardial Infarction Type 2 and Myocardial Injury

    DEFF Research Database (Denmark)

    Sandoval, Yader; Thygesen, Kristian

    2017-01-01

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

  13. Reducing biases in regional climate downscaling by applying Bayesian model averaging on large-scale forcing

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Hongwei [APEC Climate Center, Busan (Korea, Republic of); Wang, Bin [University of Hawaii at Manoa, Department of Meteorology, Honolulu, HI (United States); University of Hawaii at Manoa, International Pacific Research Center, Honolulu, HI (United States); Wang, Bin [Chinese Academy of Sciences, LASG, Institute of Atmospheric Physics, Beijing (China)

    2012-11-15

    Reduction of uncertainty in large-scale lateral-boundary forcing in regional climate modeling is a critical issue for improving the performance of regional climate downscaling. Numerical simulations of 1998 East Asian summer monsoon were conducted using the Weather Research and Forecast model forced by four different reanalysis datasets, their equal-weight ensemble, and Bayesian model averaging (BMA) ensemble means. Large discrepancies were found among experiments forced by the four individual reanalysis datasets mainly due to the uncertainties in the moisture field of large-scale forcing over ocean. We used satellite water-vapor-path data as observed truth-and-training data to determine the posterior probability (weight) for each forcing dataset using the BMA method. The experiment forced by the equal-weight ensemble reduced the circulation biases significantly but reduced the precipitation biases only moderately. However, the experiment forced by the BMA ensemble outperformed not only the experiments forced by individual reanalysis datasets but also the equal-weight ensemble experiment in simulating the seasonal mean circulation and precipitation. These results suggest that the BMA ensemble method is an effective method for reducing the uncertainties in lateral-boundary forcing and improving model performance in regional climate downscaling. (orig.)

  14. Reducing uncertainty in the american community survey through data-driven regionalization.

    Directory of Open Access Journals (Sweden)

    Seth E Spielman

    Full Text Available The American Community Survey (ACS is the largest survey of US households and is the principal source for neighborhood scale information about the US population and economy. The ACS is used to allocate billions in federal spending and is a critical input to social scientific research in the US. However, estimates from the ACS can be highly unreliable. For example, in over 72% of census tracts, the estimated number of children under 5 in poverty has a margin of error greater than the estimate. Uncertainty of this magnitude complicates the use of social data in policy making, research, and governance. This article presents a heuristic spatial optimization algorithm that is capable of reducing the margins of error in survey data via the creation of new composite geographies, a process called regionalization. Regionalization is a complex combinatorial problem. Here rather than focusing on the technical aspects of regionalization we demonstrate how to use a purpose built open source regionalization algorithm to process survey data in order to reduce the margins of error to a user-specified threshold.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  16. Reduced sensitivity to contrast signals from the eye region in developmental prosopagnosia.

    Science.gov (United States)

    Fisher, Katie; Towler, John; Eimer, Martin

    2016-08-01

    Contrast-related signals from the eye region are known to be important for the processing of facial identity. Individuals with developmental prosopagnosia (DP) have severe face recognition problems, which may be linked to deficits in the perceptual processing of identity-related information from the eyes. We tested this hypothesis by measuring N170 components in DP participants and age-matched controls in response to face images where the contrast polarity of the eyes and of other face parts was independently manipulated. In different trials, participants fixated either the eye region or the lower part of a face. In the Control group, contrast-reversal of the eyes resulted in enhanced and delayed N170 components, irrespective of the contrast of other face parts and of gaze location. In the DP group, these effects of eye contrast on N170 amplitudes were strongly and significantly reduced, demonstrating that perceptual face processing in DP is less well tuned to contrast information from the eye region. Inverting the contrast of other parts of the face affected N170 amplitudes only when fixation was outside the eye region. This effect did not differ between the two groups, indicating that DPs are not generally insensitive to the contrast polarity of face images. These results provide new evidence that a selective deficit in detecting and analysing identity-related information provided by contrast signals from the eye region may contribute to the face recognition impairment in DP.

  17. Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities.

    Science.gov (United States)

    Wells, Kristen J; Lima, Diana S; Meade, Cathy D; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K; Pledger, W Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E; Fouad, Mona; Moreno, Carlos S; Lacey, Michelle; Christie, Debra W; Price-Haywood, Eboni G; Quinn, Gwendolyn P; Coppola, Domenico; Sodeke, Stephen O; Green, B Lee; Lichtveld, Maureen Y

    2014-06-01

    Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals.

  18. Hydrogen Sulfide Donor GYY4137 Protects against Myocardial Fibrosis

    Directory of Open Access Journals (Sweden)

    Guoliang Meng

    2015-01-01

    Full Text Available Hydrogen sulfide (H2S is a gasotransmitter which regulates multiple cardiovascular functions. However, the precise roles of H2S in modulating myocardial fibrosis in vivo and cardiac fibroblast proliferation in vitro remain unclear. We investigated the effect of GYY4137, a slow-releasing H2S donor, on myocardial fibrosis. Spontaneously hypertensive rats (SHR were administrated with GYY4137 by intraperitoneal injection daily for 4 weeks. GYY4137 decreased systolic blood pressure and inhibited myocardial fibrosis in SHR as evidenced by improved cardiac collagen volume fraction (CVF in the left ventricle (LV, ratio of perivascular collagen area (PVCA to lumen area (LA in perivascular regions, reduced hydroxyproline concentration, collagen I and III mRNA expression, and cross-linked collagen. GYY4137 also inhibited angiotensin II- (Ang II- induced neonatal rat cardiac fibroblast proliferation, reduced the number of fibroblasts in S phase, decreased collagen I and III mRNA expression and protein synthesis, attenuated oxidative stress, and suppressed α-smooth muscle actin (α-SMA, transforming growth factor-β1 (TGF-β1 expression as well as Smad2 phosphorylation. These results indicate that GYY4137 improves myocardial fibrosis perhaps by a mechanism involving inhibition of oxidative stress, blockade of the TGF-β1/Smad2 signaling pathway, and decrease in α-SMA expression in cardiac fibroblasts.

  19. Differences in global and regional left ventricular myocardial mechanics in various morphologic subtypes of patients with obstructive hypertrophic cardiomyopathy referred for ventricular septal myotomy/myectomy.

    Science.gov (United States)

    Kobayashi, Taisei; Dhillon, Ashwat; Popovic, Zoran; Bhonsale, Aditya; Smedira, Nicholas G; Thamilarasan, Maran; Lytle, Bruce W; Lever, Harry M; Desai, Milind Y

    2014-06-01

    Patients with obstructive hypertrophic cardiomyopathy (HC) have various left ventricular (LV) shapes: reverse septal curvature (RSC, commonly familial), sigmoid septum (SS, common in hypertensives), and concentric hypertrophy (CH). Longitudinal (systolic and early diastolic) strain rate (SR) is sensitive in detecting regional myocardial dysfunction. We sought to determine differences in longitudinal SR of patients with obstructive HC, based on LV shapes. We studied 199 consecutive patients with HC (50% men) referred for surgical myectomy. Clinical and echocardiographic parameters were recorded. LV shapes were classified on echocardiography, using basal septal 1/3 to posterior wall ratio: RSC = ratio >1.3 (extending to mid and distal septum), SS = ratio >1.3 (extending only to basal 1/3), and concentric = ratio ≤1.3. Longitudinal systolic and early diastolic SRs were measured from apical 4- and 2-chamber views (VVI 2.0; Siemens, Erlangen). Distribution of RSC, SS, and CH was 50%, 28%, and 22%, respectively. Patients with RSC were significantly younger (47 ± 12 vs 64 ± 10 and 57 ± 11, respectively) with lower hypertension (40% vs 71% and 67%, respectively) than patients with SS or CH (both p RSC had lower global systolic (-0.99 ± 0.3 vs -1.05 ± 0.3 and -1.17 ± 0.3) and early diastolic SR (0.95 ± 0.4 vs 0.98 ± 0.3 and 1.16 ± 0.4) versus patients with SS and CH (in 1/s, both p RSC was associated with abnormal global LV systolic (beta 0.16) and early diastolic (beta -0.17) SR (both p <0.01). In conclusion, patients with HC with RCS have significantly abnormal LV mechanics, despite being younger and less hypertensive. A combination of LV mechanics and shapes could help differentiate between genetically mediated and other causes of obstructive HC.

  20. A common polymorphism in the promoter region of the TNFSF4 gene is associated with lower allele-specific expression and risk of myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Massimiliano Ria

    Full Text Available BACKGROUND: The TNFSF4/TNFRSF4 system, along with several other receptor-ligand pairs, is involved in the recruitment and activation of T-cells and is therefore tentatively implicated in atherosclerosis and acute coronary syndromes. We have previously shown that genetic variants in TNFSF4 are associated with myocardial infarction (MI in women. This prompted functional studies of TNFSF4 expression. METHODS AND RESULTS: Based on a screening of the TNFSF4 genomic region, a promoter polymorphism (rs45454293 and a haplotype were identified, conceivably involved in gene regulation. The rs45454293T-allele, in agreement with the linked rs3850641G-allele, proved to be associated with increased risk of MI in women. Haplotype-specific chromatin immunoprecipitation of activated polymerase II, as a measure of transcriptional activity in vivo, suggested that the haplotype including the rs45454293 and rs3850641 polymorphisms is functionally important, the rs45454293T- and rs3850641G-alleles being associated with lower transcriptional activity in cells heterozygous for both polymorphisms. The functional role of rs45454293 on transcriptional levels of TNFSF4 was clarified by luciferase reporter assays, where the rs45454293T-allele decreased gene expression when compared with the rs45454293C-allele, while the rs3850641 SNP did not have any effect on TNFSF4 promoter activity. Electromobility shift assay showed that the rs45454293 polymorphism, but not rs3850641, affects the binding of nuclear factors, thus suggesting that the lower transcriptional activity is attributed to binding of one or more transcriptional repressor(s to the T-allele. CONCLUSIONS: Our data indicate that the TNFSF4 rs45454293T-allele is associated with lower TNFSF4 expression and increased risk of MI.

  1. α-Lipoic acid reduces infarct size and preserves cardiac function in rat myocardial ischemia/reperfusion injury through activation of PI3K/Akt/Nrf2 pathway.

    Directory of Open Access Journals (Sweden)

    Chao Deng

    Full Text Available BACKGROUND: The present study investigates the effects and mechanisms of α-Lipoic acid (LA on myocardial infarct size, cardiac function and cardiomyocyte apoptosis in rat hearts subjected to in vivo myocardial ischemia/reperfusion (MI/R injury. METHODOLOGY/PRINCIPAL FINDINGS: Male adult rats underwent 30 minutes of ischemia followed by 3, 24, or 72 h of reperfusion. Animals were pretreated with LA or vehicle before coronary artery ligation. The level of MI/R- induced LDH and CK release, infarct size, cardiomyocyte apoptosis and cardiac functional impairment were examined and compared. Western blot analysis was performed to elucidate the mechanism of LA pretreatment. The level of inflammatory cytokine TNF-α released to serum and accumulated in injured myocardium as well as neutrophil accumulation in injured myocardium were also examined after MI/R injury. Our results reveal that LA administration significantly reduced LDH and CK release, attenuated myocardial infarct size, decreased cardiomyocytes apoptosis, and partially preserved heart function. Western blot analysis showed that LA pretreatment up-regulated Akt phosphorylation and Nrf2 nuclear translocation while producing no impact on p38MAPK activation or nitric oxide (NO production. LA pretreatment also increased expression of HO-1, a major target of Nrf2. LA treatment inhibited neutrophil accumulation and release of TNF-α. Moreover, PI3K inhibition abolished the beneficial effects of LA. CONCLUSIONS/SIGNIFICANCE: This study indicates that LA attenuates cardiac dysfunction by reducing cardiomyoctyes necrosis, apoptosis and inflammation after MI/R. LA exerts its action by activating the PI3K/Akt pathway as well as subsequent Nrf2 nuclear translocation and induction of cytoprotective genes such as HO-1.

  2. A Translational Study of a New Therapeutic Approach for Acute Myocardial Infarction: Nanoparticle-Mediated Delivery of Pitavastatin into Reperfused Myocardium Reduces Ischemia-Reperfusion Injury in a Preclinical Porcine Model

    Science.gov (United States)

    Ichimura, Kenzo; Matoba, Tetsuya; Nakano, Kaku; Tokutome, Masaki; Honda, Katsuya; Koga, Jun-ichiro; Egashira, Kensuke

    2016-01-01

    Background There is an unmet need to develop an innovative cardioprotective modality for acute myocardial infarction, for which interventional reperfusion therapy is hampered by ischemia-reperfusion (IR) injury. We recently reported that bioabsorbable poly(lactic acid/glycolic acid) (PLGA) nanoparticle-mediated treatment with pitavastatin (pitavastatin-NP) exerts a cardioprotective effect in a rat IR injury model by activating the PI3K-Akt pathway and inhibiting inflammation. To obtain preclinical proof-of-concept evidence, in this study, we examined the effect of pitavastatin-NP on myocardial IR injury in conscious and anesthetized pig models. Methods and Results Eighty-four Bama mini-pigs were surgically implanted with a pneumatic cuff occluder at the left circumflex coronary artery (LCx) and telemetry transmitters to continuously monitor electrocardiogram as well as to monitor arterial blood pressure and heart rate. The LCx was occluded for 60 minutes, followed by 24 hours of reperfusion under conscious conditions. Intravenous administration of pitavastatin-NP containing ≥ 8 mg/body of pitavastatin 5 minutes before reperfusion significantly reduced infarct size; by contrast, pitavastatin alone (8 mg/body) showed no therapeutic effects. Pitavastatin-NP produced anti-apoptotic effects on cultured cardiomyocytes in vitro. Cardiac magnetic resonance imaging performed 4 weeks after IR injury revealed that pitavastatin-NP reduced the extent of left ventricle remodeling. Importantly, pitavastatin-NP exerted no significant effects on blood pressure, heart rate, or serum biochemistry. Exploratory examinations in anesthetized pigs showed pharmacokinetic analysis and the effects of pitavastatin-NP on no-reflow phenomenon. Conclusions NP-mediated delivery of pitavastatin to IR-injured myocardium exerts cardioprotective effects on IR injury without apparent adverse side effects in a preclinical conscious pig model. Thus, pitavastatin-NP represents a novel therapeutic

  3. Intramyocardial analysis of regional systolic and diastolic function in ischemic heart disease with Doppler tissue imaging: role of the different myocardial layers.

    Science.gov (United States)

    Marcos-Alberca, Pedro; García-Fernández, Miguel A; Ledesma, María J; Malpica, Norberto; Santos, Andrés; Moreno, Mar; Bermejo, Javier; Antoranz, José C; Desco, Manuel

    2002-02-01

    Preliminary experimental data have shown a nonuniform distribution of myocardial velocities (MVs) across the myocardial wall in normal conditions. However, after ischemic damage to the myocardium, a different pattern of reduction in the myocardial layers has been reported. The aim of this study is to analyze the spatial distribution of MVs and the resultant myocardial velocity gradients (MVGs) during the systolic and diastolic time periods. Doppler tissue imaging (DTI) in color M-mode was used to evaluate 3 different myocardial layers (endocardium, mesocardium, and epicardium) and their changes as a result of ischemia. Thirty-two consecutive patients were studied with DTI color M-mode: 18 patients with a history of previous or ongoing myocardial infarction and 14 healthy subjects. Postprocessing of images was accomplished with proprietary software. MV and MVG values of all layers along both systolic and diastolic time were calculated. For temporal analysis, systole was subdivided in 3 equal periods. Early- and late-diastolic times were also identified. In ischemic patients, the mean MV and maximum MV throughout systole decreased significantly in the endocardium and mesocardium, whereas only slightly in the epicardium. The mean MVG was less in ischemic patients (0.66 +/- 0.11 vs 0.23 +/- 0.15, P <.03). Temporal analysis showed a decrease in the maximal MV and MVG in all layers over the 3 systolic periods. This decrease was the more consistent in mesocardium. In diastole, there was a decrease in maximal MV in all layers, being more pronounced in endocardium and mesocardium. Diastolic mean MVG was shown to be different between control and ischemic groups (-0.2 +/- 0.05 vs -0.10 +/- 0.04, P <.06). A significant decrease of the maximal MV in endocardium and mesocardium was reported in the temporal analysis during early diastole. No change was reported in the epicardium. The MVG value also showed a significant decrease (-2.69 +/- 0.29 vs -1.59 +/- 0.89, P <.02). In

  4. Applications of monsoon research: Opportunities to inform decisionmaking and reduce regional vulnerability

    Science.gov (United States)

    Ray, A. J.; Garfin, G. M.; Wilder, M.; Lenart, M.; Vásquez-León, M.; Comrie, A. C.

    2007-05-01

    This presentation will describe ongoing efforts to understand interactions between the North American Monsoon and society, in order to develop applications for monsoon research in a highly complex, multicultural and binational region. The North American Monsoon is an annual precipitation regime that begins in early June in Mexico and progresses northward to the southwestern United States. The region includes stakeholders in large urban complexes, productive agricultural areas, and sparsely populated arid and semi-arid ecosystems. The political, cultural, and socioeconomic divisions between the U.S. and Mexico create a broad range of sensitivities to climate variability as well as capacities to use forecasts and other information to cope with climate. We will highlight methodologies to link climate science with society and analyze opportunities for monsoon science to benefit society in four sectors: natural hazards management, agriculture, public health, and water management. We present a synthesized list of stakeholder needs and a calendar of decisions to help scientists link user needs to potential forecasts and products. To ensure usability of forecasts and other research products, we recommend iterative scientist-stakeholder interactions, through integrated assessments. These knowledge- exchange interactions can improve the capacity for stakeholders to use forecasts thoughtfully and inform the development of research, and for the research community to obtain feedback on climate-related products and receive insights to guide research direction. We expect that integrated assessments can capitalize on the opportunities for monsoon science to inform decisionmaking, in the best instances, reduce regional climate vulnerabilities and enhance regional sustainability

  5. Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Dennis T.L.; Weightman, Michael J.; Baumert, Mathias; Tayeb, Hussam; Richardson, James D.; Puri, Rishi; Bertaso, Angela G.; Roberts-Thomson, Kurt C.; Sanders, Prashanthan; Worthley, Matthew I. [University of Adelaide, Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, SA (Australia); Worthley, Stephen G. [University of Adelaide, Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, SA (Australia); Royal Adelaide Hospital, Cardiovascular Investigational Unit, SA (Australia)

    2012-08-15

    To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 {+-} 4.6 vs -5.9 {+-} 7.4, P < 0.001) and CSR (-86.4 {+-} 33.3 vs -73.5 {+-} 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

  6. Reduced serotonin synthesis and regional cerebral blood flow after anxiolytic treatment of social anxiety disorder.

    Science.gov (United States)

    Frick, Andreas; Åhs, Fredrik; Appel, Lieuwe; Jonasson, My; Wahlstedt, Kurt; Bani, Massimo; Merlo Pich, Emilio; Bettica, Paolo; Långström, Bengt; Lubberink, Mark; Fredrikson, Mats; Furmark, Tomas

    2016-11-01

    Social anxiety disorder (SAD) is associated with increased fear-related neural activity in the amygdala and we recently found enhanced serotonin synthesis rate in the same region. Anxiolytic agents like selective serotonin re-uptake inhibitors (SSRIs) and neurokinin-1 receptor (NK1R) antagonists reduce amygdala activity and may attenuate serotonin formation according to animal studies. Here, we examined the effects of SSRI pharmacotherapy, NK1R antagonism, and placebo on serotonin synthesis rate in relation to neural activity, measured as regional cerebral blood flow (rCBF), and symptom improvement in SAD. Eighteen SAD patients were randomized to receive daily double-blind treatment for six weeks either with the SSRI citalopram (n=6; 40mg), the NK1R antagonist GR205171 (n=6; 5mg; 4 weeks following 2 weeks of placebo), or placebo (n=6). Serotonin synthesis rate at rest and rCBF during stressful public speaking were assessed, before and after treatment, using positron emission tomography with the tracers [(11)C]5-hydroxytryptophan and [(15)O]water respectively. The Liebowitz Social Anxiety Scale (LSAS-SR) indexed symptom severity. All groups exhibited attenuated amygdala serotonin synthesis rate after treatment, which was associated with reduced amygdala rCBF during public speaking and accompanied by symptom improvement. These results are consistent with the notion that serotonin in the amygdala exerts an anxiogenic influence and, conversely, that anxiolysis is achieved through decreased serotonin formation in the amygdala.

  7. Neurons in Vulnerable Regions of the Alzheimer's Disease Brain Display Reduced ATM Signaling.

    Science.gov (United States)

    Shen, Xuting; Chen, Jianmin; Li, Jiali; Kofler, Julia; Herrup, Karl

    2016-01-01

    Ataxia telangiectasia (A-T) is a multisystemic disease caused by mutations in the ATM (A-T mutated) gene. It strikes before 5 years of age and leads to dysfunctions in many tissues, including the CNS, where it leads to neurodegeneration, primarily in cerebellum. Alzheimer's disease (AD), by contrast, is a largely sporadic neurodegenerative disorder that rarely strikes before the 7th decade of life with primary neuronal losses in hippocampus, frontal cortex, and certain subcortical nuclei. Despite these differences, we present data supporting the hypothesis that a failure of ATM signaling is involved in the neuronal death in individuals with AD. In both, partially ATM-deficient mice and AD mouse models, neurons show evidence for a loss of ATM. In human AD, three independent indices of reduced ATM function-nuclear translocation of histone deacetylase 4, trimethylation of histone H3, and the presence of cell cycle activity-appear coordinately in neurons in regions where degeneration is prevalent. These same neurons also show reduced ATM protein levels. And though they represent only a fraction of the total neurons in each affected region, their numbers significantly correlate with disease stage. This previously unknown role for the ATM kinase in AD pathogenesis suggests that the failure of ATM function may be an important contributor to the death of neurons in AD individuals.

  8. Scintigraphic Assessment of Myocardial Viability

    Energy Technology Data Exchange (ETDEWEB)

    Bom, Hee Seung [Chonnam University Hospital, Kwangju (Korea, Republic of)

    1993-07-15

    The identification of viable myocardium in patients with coronary artery disease and left ventricular dysfunction is an issue of increasing clinical relevance in the current era of myocardial revascularization. There are at least two forms of reversible myocardial dysfunction. Early reperfusion does not always lead to immediate functional improvement; rather, the return of contractility in tissue salvaged by reperfusion is delayed for hours, days or even weeks, a phenomenon that has been termed {sup s}tunned myocardium{sup .} Some patients with coronary artery disease show myocardial dysfunction ar rest which are associated with reduced perfusion, and which disappear after revascularization; this phenomenon has been termed {sup h}ibernating myocardium{sup .} Recently, cardiac imaging techniques that evaluate myocardial viability on the basis of perfusion contraction mismatch and inotropic reserve have gained substantial popularity and clinical success. This review focus on the application of {sup 201}T1 and {sup 99m}Tc-MIBI to address myocardial viability in patients with hibernating and stunned myocardium. It is clear that 4-hour redistribution images of {sup 201}T1 underestimate ischemia and overestimate scar. Delayed imaging and reinjection imaging have been developed for the assessment of viability. Among many protocols suggested, stress-redistribution-reinjection imaging gained most popularity. Although {sup 99m}Tc- MIBI could identify myocardial viability, {sup 201}T1 reinjection technique was regarded as superior to it. In conclusion, {sup 201}T1 stress, 4-hr rest redistribution, and reinjection imaging technique may be the most preferable method for evaluation of myocardial viability.

  9. Nitrogen-13-labeled ammonia for myocardial imaging

    Energy Technology Data Exchange (ETDEWEB)

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

    1977-01-01

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

  10. Reduced adipose tissue lipoprotein lipase responses, postprandial lipemia, and low high-density lipoprotein-2 subspecies levels in older athletes with silent myocardial ischemia.

    Science.gov (United States)

    Katzel, L I; Busby-Whitehead, M J; Rogus, E M; Krauss, R M; Goldberg, A P

    1994-02-01

    Healthy older (64 +/- 1 years, mean +/- SEM) athletic (maximal oxygen consumption [VO2max] > 40 mL/kg/min) normocholesterolemic men with no prior history of coronary artery disease (CAD) were recruited for cardiovascular and metabolic studies. Thirty-three percent had asymptomatic exercise-induced ST segment depression on their exercise electrocardiogram (ECG), consistent with silent myocardial ischemia (SI). We hypothesized that abnormalities in high-density lipoprotein (HDL) and postprandial triglyceride (TG) metabolism may increase their risk for CAD. Compared with 12 nonischemic controls of comparable age, percent body fat, and VO2max, the 13 men with SI had decreased fasting HDL cholesterol ([HDL-C] 41 +/- 2 v 50 +/- 2 mg/dL, P postprandial plasma TG, chylomicron-TG, and very-low-density lipoprotein (VLDL)-TG levels and postprandial areas were higher in men with SI (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

  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. Reduced left precentral regional responses in patients with major depressive disorder and history of suicide attempts.

    Science.gov (United States)

    Tsujii, Noa; Mikawa, Wakako; Tsujimoto, Emi; Adachi, Toru; Niwa, Atsushi; Ono, Hisae; Shirakawa, Osamu

    2017-01-01

    Previous neuroimaging studies have revealed frontal and temporal functional abnormalities in patients with major depressive disorder (MDD) and a history of suicidal behavior. However, it is unknown whether multi-channel near-infrared spectroscopy (NIRS) signal changes among individuals with MDD are associated with a history of suicide attempts and a diathesis for suicidal behavior (impulsivity, hopelessness, and aggression). Therefore, we aimed to explore frontotemporal hemodynamic responses in depressed patients with a history of suicide attempts using 52-channel NIRS. We recruited 30 patients with MDD and a history of suicidal behavior (suicide attempters; SAs), 38 patient controls without suicidal behavior (non-attempters; NAs), and 40 healthy controls (HCs) matched by age, gender ratio, and estimated IQ. Regional hemodynamic responses during a verbal fluency task (VFT) were monitored using NIRS. Our results showed that severities of depression, impulsivity, aggression, and hopelessness were similar between SAs and NAs. Both patient groups had significantly reduced activation compared with HCs in the bilateral frontotemporal regions. Post hoc analyses revealed that SAs exhibited a smaller hemodynamic response in the left precentral gyrus than NAs and HCs. Furthermore, the reduced response in the left inferior frontal gyrus was negatively correlated with impulsivity level and hemodynamic responses in the right middle frontal gyrus were negatively associated with hopelessness and aggression in SAs but not in NAs and HCs. Our findings suggest that MDD patients with a history of suicide attempts demonstrate patterns of VFT-induced NIRS signal changes different from those demonstrated by individuals without a history of suicidal behaviors, even in cases where clinical symptoms are similar. NIRS has a relatively high time resolution, which may help visually differentiate SAs from NAs.

  13. Obesity and insulin resistance are associated with reduced activity in core memory regions of the brain.

    Science.gov (United States)

    Cheke, Lucy G; Bonnici, Heidi M; Clayton, Nicola S; Simons, Jon S

    2017-02-01

    Increasing research in animals and humans suggests that obesity may be associated with learning and memory deficits, and in particular with reductions in episodic memory. Rodent models have implicated the hippocampus in obesity-related memory impairments, but the neural mechanisms underlying episodic memory deficits in obese humans remain undetermined. In the present study, lean and obese human participants were scanned using fMRI while completing a What-Where-When episodic memory test (the "Treasure-Hunt Task") that assessed the ability to remember integrated item, spatial, and temporal details of previously encoded complex events. In lean participants, the Treasure-Hunt task elicited significant activity in regions of the brain known to be important for recollecting episodic memories, such as the hippocampus, angular gyrus, and dorsolateral prefrontal cortex. Both obesity and insulin resistance were associated with significantly reduced functional activity throughout the core recollection network. These findings indicate that obesity is associated with reduced functional activity in core brain areas supporting episodic memory and that insulin resistance may be a key player in this association. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Cardiomyocyte-specific overexpression of an active form of Rac predisposes the heart to increased myocardial stunning and ischemia-reperfusion injury

    Science.gov (United States)

    Talukder, M. A. Hassan; Elnakish, Mohammad T.; Yang, Fuchun; Nishijima, Yoshinori; Alhaj, Mazin A.; Velayutham, Murugesan; Hassanain, Hamdy H.

    2013-01-01

    The GTP-binding protein Rac regulates diverse cellular functions including activation of NADPH oxidase, a major source of superoxide production (O2·−). Rac1-mediated NADPH oxidase activation is increased after myocardial infarction (MI) and heart failure both in animals and humans; however, the impact of increased myocardial Rac on impending ischemia-reperfusion (I/R) is unknown. A novel transgenic mouse model with cardiac-specific overexpression of constitutively active mutant form of Zea maize Rac D (ZmRacD) gene has been reported with increased myocardial Rac-GTPase activity and O2·− generation. The goal of the present study was to determine signaling pathways related to increased myocardial ZmRacD and to what extent hearts with increased ZmRacD proteins are susceptible to I/R injury. The effect of myocardial I/R was examined in young adult wild-type (WT) and ZmRacD transgenic (TG) mice. In vitro reversible myocardial I/R for postischemic cardiac function and in vivo regional myocardial I/R for MI were performed. Following 20-min global ischemia and 45-min reperfusion, postischemic cardiac contractile function and heart rate were significantly reduced in TG hearts compared with WT hearts. Importantly, acute regional myocardial I/R (30-min ischemia and 24-h reperfusion) caused significantly larger MI in TG mice compared with WT mice. Western blot analysis of cardiac homogenates revealed that increased myocardial ZmRacD gene expression is associated with concomitant increased levels of NADPH oxidase subunit gp91phox, O2·−, and P21-activated kinase. Thus these findings provide direct evidence that increased levels of active myocardial Rac renders the heart susceptible to increased postischemic contractile dysfunction and MI following acute I/R. PMID:23161879

  15. 利用定量组织速度成像技术评价心肌梗死患者局部心肌不同时相的纵向运动%Assessing longitudinal wall motion characteristics at different phases in regional myocardial in patients with myocardial infarction by quantitative tissue velocity imaging

    Institute of Scientific and Technical Information of China (English)

    张涓; 杨新春; 曾定尹; 吴雅峰

    2005-01-01

    BACKGROUND: At present, Doppler tissue imaging can be used extensively to make a quantitative assessment of left ventricular regional myocardial function. Postsystolic shortening is a delayed relaxation in regional myocardium following acute ischemia.OBJECTIVE: To observe longitudinal wall motion characteristics in left ventricular regional myocardiun and evaluate the clinical significance of postsystolic shortening in isovolumic relaxation period.DESIGN: Case-control observation.SETTING: Heart Center of Beijing Chaoyang Hospital.PARTICIPANTS: We selected 30 myocardial infarction inpatients hospitalized in the Heart Center of Beijing Chaoyang Hospital between April 2003 and September 2003 as myocardial infarction group; another 30 patients with non-cardiac diseases were set as control group. Subjects of the two groups volunteered in the experiment.METHODS: Dynamic images were collected and information was analyzed off-line. Left ventricular myocardial velocity and time velocity integral profiles were acquired along long axis asynchronously in basal and mid- segments of different walls. Peak velocity of isovolumic contraction period (VIC), ejection period (Ye), isovolumie relaxation period (VIR), rapid filling period (VRF) and atrial systole (VAS) and maximum time velocity integral (TVIMAX) in regional myocardium were measured.Doppler in different segments at longitudinal wall of myocardium in the the two groups.RESULTS: Thirty patients were recruited in myocardial infarction group and control group separately and all of them entered the result analysis ocardium was lower in myocardial infarction group than in control group,especially in infarcted segments, suggesting that the function of cardiac contraction and relaxation in patients with myocardial infarction was demyocardial isovolumic relaxation in myocardial infarction group, indicating period and isovolumic relaxation period in TVIMAX in myocardial infarction group.mal movement at isovolumic relaxation phase

  16. Acute myocardial infarction does not affect functional characteristics of adipose-derived stem cells in rats, but reduces the number of stem cells in adipose tissue.

    Science.gov (United States)

    Naaijkens, B A; Krijnen, P A J; Meinster, E; ter Horst, E N; Vo, K; Musters, R J P; Kamp, O; Niessen, H W M; Juffermans, L J M; van Dijk, A

    2015-12-01

    In most pre-clinical animal studies investigating stem cell therapy in acute myocardial infarction (AMI), the administered stem cells are isolated from healthy donors. In clinical practice, however, patients who suffer from AMI will receive autologous cells, for example using adipose-derived stem cells (ASC). During AMI, inflammation is induced and we hypothesized that this might affect characteristics of ASC. To investigate this, ASC were isolated from rat adipose tissue 1 day (1D group, n = 5) or 7 days (7D group, n = 6) post-AMI, and were compared with ASC from healthy control rats (Control group, n = 6) and sham-operated rats (Sham 1D group, n = 5). We found that significantly fewer ASC were present 1 day post-AMI in the stromal vascular fraction (SVF), determined by a colony-forming-unit assay (p cells in SVF of the 1D group. When cultured, no differences were found in proliferation rate and cell size between the groups in the first three passages. Also, no difference in the differentiation capacity of ASC was found. In conclusion, it was shown that significantly fewer stem cells were present in the SVF 1 day post-AMI; however, the stem cells that were present showed no functional differences.

  17. Reduced carriership of 4G allele of plasminogen activator inhibitor-1 4G/5G polymorphism in very young survivors of myocardial infarction.

    Science.gov (United States)

    Rallidis, Loukianos S; Gialeraki, Argyri; Merkouri, Efrosyni; Liakos, George; Dagres, Nikolaos; Sionis, Dimitrios; Travlou, Anthi; Lekakis, John; Kremastinos, Dimitrios T

    2010-05-01

    There are limited and controversial data regarding the impact of 4G/5G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene in the pathogenesis of premature myocardial infarction (MI). We explored whether 4G/5G polymorphism of the PAI-1 gene is associated with the development of MI 4G/5G polymorphism of PAI-1 was tested with polymerase chain reaction and reverse hybridization. 4G allele carriers (4G/4G and 4G/5G genotypes) of PAI-1 were less frequent in patients than in controls (69.6 vs. 83.6%, P = 0.007). 4G carriership of the polymorphism of PAI-1 was associated with lower risk for acute MI (odds ratio 0.45, 95% confidence interval 0.23-0.88, P = 0.02) after adjusting for major cardiovascular risk factors. Patients possessing the 4G allele had higher PAI-1 plasma levels (32.2 +/- 25 vs. 22.2 +/- 11.3 ng/ml, P = 0.006) but lower lipoprotein(a) levels (10.1 [2.1-29.9] vs. 15.3 [8.2-57.1] mg/dl, P = 0.03) compared to 5G/5G homozygotes. Our data indicate that the 4G allele of the PAI-1 4G/5G polymorphism is less frequent among survivors of MI at very young age compared with matched controls.

  18. Acarbose improves glycemic control and reduces body weight: Subanalysis data of South Asia region

    Directory of Open Access Journals (Sweden)

    S Kalra

    2013-01-01

    Full Text Available Alpha-glucosidase inhibitors (AGIs are widely used especially in Asian countries as a treatment option for type 2 diabetes patients with high postprandial glycaemia. However, data from South Asia region is very limited. In order to examine the effect of AGI in real-life setting, 10 PMS/NIS from all over the world from the launch of acarbose to date were pooled in one database and exploratory analysis was performed for glycemic parameters and weight. In total 62,905 patients were pooled from 21 countries and regions. Mean follow up (± SD was 12.2 ± 4.8 weeks (range 0.1-108.9. From South Asia region (India and Pakistan, 8,738 Asian patients were enrolled. Mean PPG decreased from 240.0 and 261.1 mg/dl at baseline by 70.26 ± 65.10 and 82.96 ± 56.59 mg/dl at the last visit in total and South Asian populations, respectively (n = 53,883; n = 7,991, P < 0.0001 for both. Mean FPG decreased from 171.6 and 176.5 mg/dl at baseline by 38.48 ± 47.83 and 49.59 ± 41.41 mg/dl at the last visit in total and South Asian populations, respectively (n = 56,672; n = 7,837, P < 0.0001 for both. Mean HbA1c decreased from 8.4 and 8.4% at baseline by 1.11 ± 1.31% and 0.91 ± 0.93% at the last visit in total and South Asian populations, respectively (n = 38,843; n = 2,343, P < 0.0001 for both. Mean relative reduction of body weight (BW was 1.40 ± 3.28% and 1.10 ± 3.39% at the last visit for mean baseline BW 73.6 and 74.2 kg in total and South Asian populations, respectively (n = 54,760; n = 7,718, P < 0.0001 for both. Consistent with RCT meta-analyses, post-hoc analysis of real-life data showed acarbose treatment improved glycaemic control and reduced the BW. Acarbose treatment in real life setting showed significant reductions in all glycemic parameters and BW in Asian patients from South Asia region.

  19. Classification of myocardial infarction

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  20. Roles of myocardial blood volume and flow in coronary artery disease: an experimental MRI study at rest and during hyperemia

    Energy Technology Data Exchange (ETDEWEB)

    McCommis, Kyle S.; Goldstein, Thomas A.; Pilgram, Thomas [Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Abendschein, Dana R. [Washington University School of Medicine, Center for Cardiovascular Research, St. Louis, MO (United States); Misselwitz, Bernd [Bayer Schering Pharma AG, Berlin (Germany); Gropler, Robert J. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Washington University School of Medicine, Center for Cardiovascular Research, St. Louis, MO (United States); Zheng, Jie [Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Cardiovascular Imaging Lab, St. Louis, MO (United States)

    2010-08-15

    To validate fast perfusion mapping techniques in a setting of coronary artery stenosis, and to further assess the relationship of absolute myocardial blood volume (MBV) and blood flow (MBF) to global myocardial oxygen demand. A group of 27 mongrel dogs were divided into 10 controls and 17 with acute coronary stenosis. On 1.5-T MRI, first-pass perfusion imaging with a bolus injection of a blood-pool contrast agent was performed to determine myocardial perfusion both at rest and during either dipyridamole-induced vasodilation or dobutamine-induced stress. Regional values of MBF and MBV were quantified by using a fast mapping technique. Color microspheres and {sup 99m}Tc-labeled red blood cells were injected to obtain respective gold standards. Microsphere-measured MBF and {sup 99m}Tc-measured MBV reference values correlated well with the MR results. Given the same changes in MBF, changes in MBV are twofold greater with dobutamine than with dipyridamole. Under dobutamine stress, MBV shows better association with total myocardial oxygen demand than MBF. Coronary stenosis progressively reduced this association in the presence of increased stenosis severity. MR first-pass perfusion can rapidly estimate regional MBF and MBV. Absolute quantification of MBV may add additional information on stenosis severity and myocardial viability compared with standard qualitative clinical evaluations of myocardial perfusion. (orig.)

  1. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

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

  2. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

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

  3. Criteria for implementing interventions to reduce health inequalities in primary care settings in European regions.

    Science.gov (United States)

    Daponte, Antonio; Bernal, Mariola; Bolívar, Julia; Mateo, Inmaculada; Salmi, Louis-Rachid; Barsanti, Sara; Berghmans, Luc; Piznal, Ewelina; Bourgueil, Yann; Marquez, Soledad; González, Ingrid; Carriazo, Ana; Maros-Szabo, Zsuzsanna; Ménival, Solange

    2014-12-01

    The current social and political context is generating socio-economic inequalities between and within countries, causing and widening health inequalities. The development and implementation of interventions in primary health care (PHC) settings seem unavoidable. Attempts have been made to draw up adequate criteria to guide and evaluate interventions but none for the specific case of PHC. This methodological article aims to contribute to this field by developing and testing a set of criteria for guiding and evaluating real-life interventions to reduce health inequalities in PHC settings in European regions. A literature review, nominal group technique, survey and evaluation template were used to design and test a set of criteria. The questionnaire was answered by professionals in charge of 46 interventions carried out in 12 European countries, and collected detailed information about each intervention. Third-party experts scored the interventions using the set of evaluation criteria proposed. Nine criteria to guide and evaluate interventions were proposed: relevance, appropriateness, applicability, innovation, quality assurance, adequacy of resources, effectiveness in the process, effectiveness in results and mainstreaming. A working definition was drawn up for each one. These criteria were then used to evaluate the interventions identified. The set of criteria drawn up to guide the design, implementation and evaluation of interventions to reduce health inequalities in PHC will be a useful instrument to be applied to interventions under development for culturally, politically and socio-economically diverse PHC contexts throughout Europe. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  4. Impaired β-cell function attenuates training effects by reducing the increase in heart rate reserve in patients with myocardial infarction.

    Science.gov (United States)

    Omiya, Kazuto; Minami, Keisuke; Sato, Yukio; Takai, Manabu; Takahashi, Eiji; Hayashi, Akio; Yamauchi, Masahiro; Suzuki, Kengo; Akashi, Yoshihiro J; Osada, Naohiko; Izawa, Kazuhiro P; Watanabe, Satoshi

    2015-02-01

    Insulin resistance (IR) is characterized as a metabolic disorder syndrome that is upstream of hypertension, dyslipidemia, and diabetes mellitus (DM). This study investigated exercise training effects on the exercise tolerance and heart rate dynamics in patients with IR or pancreatic β-cell dysfunction. Seventy patients (mean age, 60.1 years) with myocardial infarction (MI) participating in a phase II cardiac rehabilitation program were studied. Patients diagnosed with DM were excluded. Homeostasis model-assessment indices were used to divide patients into three groups - A: IR; B: normal; and C: β-cell dysfunction. A cardiopulmonary exercise test (CPX) was performed and peak oxygen uptake (V˙O2) was measured. After baseline testing, subjects participated in a supervised, combined aerobic and resistance exercise program. Peak V˙O2 at baseline was comparable among the three groups, and it improved after training in all groups (pincrease and percentage increase in peak V˙O2 were smaller in Group C than in Group A (pHeart rate (HR) reserve (peak HR-rest HR), and HR recovery immediately 1min after exercise during CPX were calculated in 45 patients who were not taking negative chronotropic agents. Group C alone did not show any significant increase in HR reserve. HR reserve at both baseline and after training had significant positive correlations with peak V˙O2. HR recovery was 1.9 beats/min lower in group C than group A, but this was not significant. HR recovery in group C did not increase after cardiac rehabilitation. Impaired HR reserve increase after training in patients with pancreatic β-cell dysfunction attenuates exercise training effects on functional capacity. Comprehensive treatment including vigorous exercise training will be needed in such prediabetic patients. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  5. High N-terminal pro-B-type natriuretic peptide levels are associated with reduced heart rate variability in acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Luc Lorgis

    Full Text Available AIM: We investigated the relationships between the autonomic nervous system, as assessed by heart rate variability (HRV and levels of N-terminal Pro-B-type Natriuretic Peptide (Nt-proBNP in patients with acute myocardial infarction (MI. METHODS AND RESULTS: The mean of standard deviation of RR intervals (SDNN, the percentage of RR intervals with >50 ms variation (pNN50, square root of mean squared differences of successive RR intervals (rMSSD, and frequency domain parameters (total power (TP, high frequency and low frequency power ratio (LF/HF were assessed by 24 h Holter ECG monitoring. 1018 consecutive patients admitted <24 h for an acute MI were included. Plasma Nt-proBNP (Elecsys, Roche was measured from blood samples taken on admission. The median (IQR Nt-proBNP level was 681(159-2432 pmol/L. Patients with the highest quartile of Nt-proBNP were older, with higher rate of risk factors and lower ejection fraction. The highest Nt-proBNP quartile group had the lowest SDNN, LF/HF and total power but similar pNN50 and rMSSD levels. Nt-proBNP levels correlated negatively with SDNN (r = -0.19, p<0.001, LF/HF (r = -0.37, p<0.001, and LF (r = -0.29, p<0.001 but not HF (r = -0.043, p = 0.172. Multiple regression analysis showed that plasma propeptide levels remained predictive of LF/HF (B(SE = -0.065(0.015, p<0.001, even after adjustment for confounders. CONCLUSIONS: In conclusion, our population-based study highlights the importance of Nt-proBNP levels to predict decreased HRV after acute MI.

  6. Optimal portfolio design to reduce climate-related conservation uncertainty in the Prairie Pothole Region.

    Science.gov (United States)

    Ando, Amy W; Mallory, Mindy L

    2012-04-24

    Climate change is likely to alter the spatial distributions of species and habitat types but the nature of such change is uncertain. Thus, climate change makes it difficult to implement standard conservation planning paradigms. Previous work has suggested some approaches to cope with such uncertainty but has not harnessed all of the benefits of risk diversification. We adapt Modern Portfolio Theory (MPT) to optimal spatial targeting of conservation activity, using wetland habitat conservation in the Prairie Pothole Region (PPR) as an example. This approach finds the allocations of conservation activity among subregions of the planning area that maximize the expected conservation returns for a given level of uncertainty or minimize uncertainty for a given expected level of returns. We find that using MPT instead of simple diversification in the PPR can achieve a value of the conservation objective per dollar spent that is 15% higher for the same level of risk. MPT-based portfolios can also have 21% less uncertainty over benefits or 6% greater expected benefits than the current portfolio of PPR conservation. Total benefits from conservation investment are higher if returns are defined in terms of benefit-cost ratios rather than benefits alone. MPT-guided diversification can work to reduce the climate-change-induced uncertainty of future ecosystem-service benefits from many land policy and investment initiatives, especially when outcomes are negatively correlated between subregions of a planning area.

  7. Optimal portfolio design to reduce climate-related conservation uncertainty in the Prairie Pothole Region

    Science.gov (United States)

    Ando, Amy W.; Mallory, Mindy L.

    2012-01-01

    Climate change is likely to alter the spatial distributions of species and habitat types but the nature of such change is uncertain. Thus, climate change makes it difficult to implement standard conservation planning paradigms. Previous work has suggested some approaches to cope with such uncertainty but has not harnessed all of the benefits of risk diversification. We adapt Modern Portfolio Theory (MPT) to optimal spatial targeting of conservation activity, using wetland habitat conservation in the Prairie Pothole Region (PPR) as an example. This approach finds the allocations of conservation activity among subregions of the planning area that maximize the expected conservation returns for a given level of uncertainty or minimize uncertainty for a given expected level of returns. We find that using MPT instead of simple diversification in the PPR can achieve a value of the conservation objective per dollar spent that is 15% higher for the same level of risk. MPT-based portfolios can also have 21% less uncertainty over benefits or 6% greater expected benefits than the current portfolio of PPR conservation. Total benefits from conservation investment are higher if returns are defined in terms of benefit–cost ratios rather than benefits alone. MPT-guided diversification can work to reduce the climate-change–induced uncertainty of future ecosystem-service benefits from many land policy and investment initiatives, especially when outcomes are negatively correlated between subregions of a planning area. PMID:22451914

  8. 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

  9. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions.

    LENUS (Irish Health Repository)

    Rodríguez-Granillo, Gastón A

    2012-01-05

    Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.

  10. Increased titin compliance reduced length-dependent contractionand slowed cross-bridge kinetics in skinned myocardial strips from Rbm20ΔRRM mice

    Directory of Open Access Journals (Sweden)

    Hannah C. Pulcastro

    2016-07-01

    Full Text Available Titin is a giant protein spanning from the Z-disk to the M-band of the cardiac sarcomere. In the I-band titin acts as a molecular spring, contributing to passive mechanical characteristics of the myocardium throughout a heartbeat. RNA Binding Motif Protein 20 (RBM20 is required for normal titin splicing, and its absence or altered function leads to greater expression of a very large, more compliant N2BA titin isoform in Rbm20 homozygous mice (Rbm20ΔRRM compared to wild-type mice (WT that almost exclusively express the stiffer N2B titin isoform. Prior studies using Rbm20ΔRRM animals have shown that increased titin compliance compromises muscle ultrastructure and attenuates the Frank-Starling relationship. Although previous computational simulations of muscle contraction suggested that increasing compliance of the sarcomere slows the rate of tension development and prolongs cross-bridge attachment, none of the reported effects of Rbm20ΔRRM on myocardial function have been attributed to changes in cross-bridge cycling kinetics. To test the relationship between increased sarcomere compliance and cross-bridge kinetics, we used stochastic length-perturbation analysis in Ca2+-activated, skinned papillary muscle strips from Rbm20ΔRRM and WT mice. We found increasing titin compliance depressed maximal tension, decreased Ca2+-sensitivity of the tension-pCa relationship, and slowed myosin detachment rate in myocardium from Rbm20ΔRRM vs. WT mice. As sarcomere length increased from 1.9 to 2.2 µm, length-dependent activation of contraction was eliminated in the Rbm20ΔRRM myocardium, even though myosin MgADP release rate decreased ~20% to prolong strong cross-bridge binding at longer sarcomere length. These data suggest that increasing N2BA expression may alter cardiac performance in a length-dependent manner, showing greater deficits in tension production and slower cross-bridge kinetics at longer sarcomere length. This study also supports the idea

  11. 斑点追踪技术评价缺血心肌短轴缩短率和圆周应变%Evaluation of Regional Shortening Fraction and Circumferential Strain in Patients with Myocardial Ischemia by Speckle Tracking Imaging

    Institute of Scientific and Technical Information of China (English)

    何艳; 王东平; 陈金国; 张娜; 杨体霞; 张军; 周利民

    2012-01-01

    目的 运用斑点追踪技术(STI)测量缺血心肌的短轴缩短率和圆周应变值,探讨其在诊断心肌缺血,评价心肌功能中的应用价值.方法 对29例心肌缺血患者(冠状动脉狭窄≥75%)和28例正常对照组(冠状动脉没有狭窄)分别行超声心动图检查,采集并记录左室短轴观(二尖瓣水平)的高帧频动态二维灰阶图像,应用二维应变分析软件进行脱机分析,系统自动将左室短轴分为前间隔、前壁、侧壁、后壁、下壁、后间隔6个节段,并给出应变曲线,分别测量各节段心肌的短轴缩短率和圆周应变值.结果 正常对照组的圆周应变曲线是负向峰值曲线,短轴缩短率曲线是正向峰值曲线,整组曲线排列较整齐;而心肌缺血组的应变曲线形态不规则.心肌缺血组圆周应变和短轴缩短率均低于正常对照组,差异有统计学意义(P<0.05).结论 斑点追踪技术能对心肌的二维应变进行定量分析,为临床诊断心肌缺血,评价心肌功能提供了无创性新方法.%Objective To evaluate the clinical value of speckle tracking imaging in the measurement of regional shortening fraction and circumferential strain in patients with myocardial ischemia. Methods Twenty-nine patients with myocardial ischemia and twenty-eight healthy subjects underwent echocardiography,high frame rate two-dimensional images were recorded from the left ventricular short-axis views at the levels of mitral annulus, regional shortening fraction and circumferential strain were measured in the left ventricular short-axis views using two-dimensional strain software. Results Circumferential strain curve, regional shortening fraction curve in healthy group changed regularly, while in myocardial ischemia patients, the curve changed irregularly. Regional shortening fraction and circumferential strain in myocardial ischemia patients showed significant reduction compared with normal myocardium(P<0.05). Conclusion Speckle

  12. Regional distribution of brain and myocardial perfusion in swine while awake and during 1.0 and 1.5 MAC isoflurane anaesthesia produced without or with 50% nitrous oxide.

    Science.gov (United States)

    Manohar, M; Parks, C

    1984-06-01

    Isoflurane has been hailed as the anaesthetic of the eighties. We examined the effects of isoflurane anaesthesia on regional distribution of brain and myocardial blood flow in 11 healthy isocapnic pigs using 15 micron diameter radionuclide labelled microspheres that were injected into the left atrium. Each animal was studied during five of the following six conditions: (i) unanaesthetised (control; n = 8); (ii) 1.45% end-tidal (ET; 1.0 MAC) isoflurane anaesthesia (n = 10); (iii) 2.18% ET (1.5 MAC) isoflurane anaesthesia (n = 9); (iv) 0.95% ET isoflurane + 50% N2O anaesthesia (equivalent to 1 MAC; n = 8); (v) 1.68% ET isoflurane + 50% N2O anaesthesia (equivalent to 1.5 MAC; n = 8); and (vi) 50% N2O alone (n = 8). The order of anaesthetised steps was randomised for each pig. At every step 50 to 55 min were allowed for equilibration with isoflurane, and for N2O 35 to 40 min were allowed for equilibration. Recovery periods of 60 min each were interposed between anaesthetised steps to allow pigs to recover towards control values. Control values of blood flow in the cerebrum, cerebellum, and brain-stem were 81 +/- 5, 87 +/- 8, and 64 +/- 6 ml X min-1 X 100 g-1, respectively. During 1.45% isoflurane anaesthesia, cerebral, cerebellar and brainstem blood flows were 120%, 152%, and 145% of respective control values. With 2.18% isoflurane, perfusion in these regions of the brain was 140%, 200%, and 226% of respective control values. Substitution of 50% N2O to maintain equipotent anaesthesia markedly exaggerated the increment in cerebral blood flow, while changes in cerebellar and brain-stem blood flow were similar. Cerebral blood flow during 0.95% isoflurane + 50% N2O and 1.68% isoflurane + 50% N2O anaesthesia was 137% and 210% of the control value, respectively. Regional brain blood flow was only insignificantly altered by 50% N2O alone. It is concluded that isoflurane caused dose-dependent vasodilatation in all regions of the brain, the magnitude being greater in the

  13. Assessment of left ventricular regional myocardial systolic function after bone marrow mesenchymal stem cells injection in rabbits with acute myocardial infarction by speckle tracking imaging%斑点追踪成像评价实验兔心肌梗死后骨髓干细胞移植区域心肌收缩功能

    Institute of Scientific and Technical Information of China (English)

    穆玉明; 曾倩倩; 李艳红; 曹桂秋; 徐娟

    2011-01-01

    目的 应用超声斑点追踪(STI)技术探讨兔左室心肌梗死区域骨髓干细胞移植后的心肌收缩功能.方法 24只健康新西兰兔,随机分为3组:正常对照组(假开胸组)、急性心肌梗死(AMI)组(结扎左冠状动脉前降支,造成左室前壁心肌梗死)和骨髓干细胞移植组(AMI后2周,对梗死区域进行干细胞移植),于骨髓干细胞移植后4周分别采集三组动物左室短轴基底段、中间段及心尖段的动态二维灰阶图像;应用STI技术分析左室不同水平各节段心内膜下心肌径向应变率(SrR)、周向应变率(SrC)、旋转率(RotR)及扭转角度(Rot),常规超声心动图测定左室舒张末期内径(LVEDd)、左室射血分数(LVEF)及左室短轴缩短率(LVFS),心导管测量左室收缩压(LVSP)、左室舒张末期压(LVEDP)、左室压力最大上升及下降速率(LVdp/dtmax).结果 与正常对照组比较,AMI组LVEDd显著增大,LVEF、LVFS显著减低,LVSP、LVdp/dtmax明显降低,LVEDP明显升高,左室前壁局部及左室短轴三水平整体SrR、SrC、RotR和左室Rot均降低;骨髓干细胞移植组LVEDd较AMI组显著减小,LVEF、LVFS明显升高,LVSP、LVdp/dtmax明显升高,LVEDP降低明显,左室前壁局部及左室短轴三水平整体SrR、SrC、RotR和左室Rot均升高,但与正常对照组比较差异无统计学意义.结论 STI可准确评价骨髓干细胞移植区域的心肌功能.%Objective To assess the left ventricular(LV) regional myocardial systolic function after bone marrow mesenchymal stem cells (BMSCs) injection in rabbits with acute myocardial infarction(AMI) by 2-dimensional ultrasound speckle-tracking imaging.Methods Twenty-four healthy rabbits were randomly divided into three groups:group of sham-operated,group of masculine control (AMI was induced by ligation of left anterior descending coronary artery),and group of cell infusion(after two weeks of AMI,bone marrow mesenchymal stem cells were injected to the region of AMI

  14. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

    Institute of Scientific and Technical Information of China (English)

    QIU Jian-ping; ZHANG Qi; LU Ji-de; WANG Hai-rong; LIN Jie; GE Zhi-ru; ZHANG Rui-yan; SHEN Wei-feng

    2011-01-01

    Background Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.Methods The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group).Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time,and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.Results Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001)and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P<0.0001).The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis

  15. Evaluation of myocardial viability with cardiac PET before and after CABG and the study of hibernating myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Masahiro; Sakamoto, Shigeru [Kanazawa Medical Univ., Uchinada, Ishikawa (Japan); Seki, Hiroyasu

    1997-09-01

    This study included 28 patients in whom graft patency after coronary artery bypass graft (CABG) was confirmed by coronary angiography. Diagnosis included angina pectoris following myocardial infarction and severe angina pectoris accompanied by stenosis at the left main trunk region or lesion involving multiple branches. As a rule, cardiac PET ({sup 13}NH{sub 3}, {sup 18}FDG) was performed in fasted patients before and 1 to 2 months after surgery. Myocardial blood flow and glucose metabolism in the bypass site were mainly investigated. Furthermore, {sup 201}Tl-SPECT was concurrently performed. The effect of CABG was examined by the two procedures, and redistribution was compared between PET and {sup 201}Tl-SPECT. Preoperative PET with {sup 13}NH{sub 3} revealed reduced blood flow in the ischemic site in all patients. However, preoperative {sup 201}Tl-SPECT showed redistribution in 16 (57.1%) of 28 patients, while there was no redistribution in 12 patients (42.9%). In 10 (83.3%) of 12 patients evaluated as having no myocardial viability on {sup 201}Tl-SPECT, PET showed accumulation of {sup 18}FDG. However, in 21 (75%) of 28 patients, accumulation of {sup 18}FDG was reduced postoperatively, suggesting improvement of aerobic metabolism in cardiac muscle. These patients also showed improvement in regional wall motion. The energy source of cardiac muscle consists mainly of free fatty acid and glucose. Fasting healthy cardiac muscle depends on fatty acid for approximately 60% of its energy source. However, ischemic cardiac muscle depends on the glycolytic system, utilizing glucose. Progression of ischemia causes myocardial necrosis without metabolism. Therefore, ischemic cardiac muscle can be differentiated from infarcted cardiac muscle by cardiac PET. We evaluated myocardial viability before and after CABG for ischemic heart disease, and confirmed that cardiac PET is more useful than standard myocardial scan with {sup 201}Tl for evaluating myocardial viability. (K.H.)

  16. Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the "risk region" during acute anterior or inferior myocardial infarction.

    Science.gov (United States)

    Vervaat, F E; Bouwmeester, S; van Hellemond, I E G; Wagner, G S; Gorgels, A P M

    2014-01-01

    The myocardial area at risk (MaR) is an important aspect in acute ST-elevation myocardial infarction (STEMI). It represents the myocardium at the onset of the STEMI that is ischemic and could become infarcted if no reperfusion occurs. The MaR, therefore, has clinical value because it gives an indication of the amount of myocardium that could potentially be salvaged by rapid reperfusion therapy. The most validated method for measuring the MaR is (99m)Tc-sestamibi SPECT, but this technique is not easily applied in the clinical setting. Another method that can be used for measuring the MaR is the standard ECG-based scoring system, Aldrich ST score, which is more easily applied. This ECG-based scoring system can be used to estimate the extent of acute ischemia for anterior or inferior left ventricular locations, by considering quantitative changes in the ST-segment. Deviations in the ST-segment baseline that occur following an acute coronary occlusion represent the ischemic changes in the transmurally ischemic myocardium. In most instances however, the ECG is not available at the very first moments of STEMI and as times passes the ischemic myocardium becomes necrotic with regression of the ST-segment deviation along with progressive changes of the QRS complex. Thus over the time course of the acute event, the Aldrich ST score would be expected to progressively underestimate the MaR, as was seen in studies with SPECT as gold standard; anterior STEMI (r=0.21, p=0.32) and inferior STEMI (r=0.17, p=0.36). Another standard ECG-based scoring system is the Selvester QRS score, which can be used to estimate the final infarct size by considering the quantitative changes in the QRS complex. Therefore, additional consideration of the Selvester QRS score in the acute phase could potentially provide the "component" of infarcted myocardium that is missing when the Aldrich ST score alone is used to determine the MaR in the acute phase, as was seen in studies with SPECT as gold

  17. Extracorporeal Cardiac Shock Wave Therapy Ameliorates Clinical Symptoms and Improves Regional Myocardial Blood Flow in a Patient with Severe Coronary Artery Disease and Refractory Angina

    Directory of Open Access Journals (Sweden)

    Christian Prinz

    2009-01-01

    Full Text Available Different therapeutic options are being used for chronic coronary artery disease (CAD. We report about a 51-year-old female with CAD and refractory angina pectoris despite maximally tolerated medical therapy and after both percutaneous coronary intervention (PCI and coronary artery bypass grafting (CABG. The patient received cardiac shock wave therapy (CSWT over a period of 6 month. There was no arrhythmia during or after treatment; enzyme levels were normal at all times. PET imaging showed a substantial improvement of myocardial stress perfusion. Since the patient reported that she now was fully capable to deal with her everyday life, further treatment options were postponed. Our case report suggests that ultrasound-guided CSWT is able to improve symptoms and perfusion in ischemic myocardium.

  18. An Audit of Cardiac Mortality Due to Acute Myocardial Infarction at a Tertiary Institution in the Southwestern Region of Trinidad and Tobago

    Directory of Open Access Journals (Sweden)

    M Bahall

    2015-07-01

    Full Text Available Objective: This study aims to identify the profile of patients who died from acute myocardial infarction (AMI during hospital admission in southwest Trinidad. Methods: This retrospective descriptive study was done using the death register of the San Fernando General Hospital (SFGH during the period 2011 and 2012. Confirmed cases of AMI were selected based on the American College of Cardiology (ACC/American Heart Association (AHA guidelines 2011 or 2013. Relevant information on patient’s profile, risks for ischaemic heart disease (IHD, clinical presentation and treatment were analysed using SPSS version 19 software. Results: Males accounted for 56.3% and females 43.8% of AMI deaths. East Indians were predominantly affected with an East Indian:African:Mixed ratio of 5:1:2. The mean age was 68.6 years and 72.8 years for males and females, respectively. The combination of diabetes mellitus and hypertension was responsible for most (52.5% AMI deaths. Patients who were not diabetic, hypertensive, smoking nor hypercholesterolaemic accounted for six (7.5% of the total deaths (4 = East Indians, 2 = Mixed. One death occurred in the emergency department while the rest occurred in the ward; 44% of deaths occurred within 48 hours. Non-ST segment elevation myocardial infarction (NSTEMI accounted for 70.0% and STEMI for 30.0% of AMI deaths. Five (20.8% of the 24 STEMI patients received thrombolytic treatment on arrival to casualty department. Conclusion: Deaths occurred predominantly among males of East Indian descent at a mean age of 70 years. The East Indian:African mortality ratio was 5:1. Patients suffered mainly from diabetes mellitus, hypertension or a combination of both.

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

    Institute of Scientific and Technical Information of China (English)

    王婷; 邓又斌; 朱英; 王纯; 杨好意; 毕小军; 刘红云

    2011-01-01

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

  20. The etiology and implications of dense cavitary "photopenia" on myocardial perfusion scintigraphy.

    Science.gov (United States)

    Dae, M; Canhasi, B; Botvinick, E; Olvera, S; Schechtmann, N; Engelstad, B; Hattner, R; Schiller, N; O'Connell, W; Faulkner, D

    1985-07-01

    Dense cavitary "photopenia" was observed on 21 of 200 consecutive stress perfusion scintigrams. A prominent finding in many cases, it sometimes occupied only a portion of the region overlying the ventricular cavity, was often seen in some projections and not others, and was frequently adjacent to myocardial perfusion defects. To distinguish an etiology among reduced cavitary radioactivity, relatively increased background radioactivity, or reduced radioactivity in overlying myocardium, quantitative analysis of cavitary, lung and myocardial radioactivity was performed in patients with dense cavitary "photopenia," with and without lung uptake, and compared with results from studies showing increased lung uptake without cavitary photopenia and with normal studies. The results showed that dense cavitary photopenia was related to reduced radioactivity in overlying myocardium. Correlative imaging studies performed with echocardiography and contrast ventriculography confirmed this relationship to myocardial scar in 15 of 21 patients in whom associated akinesis or dyskinesis was seen. Hence, dense cavitary photopenia on stress perfusion scintigraphy is due to a dense myocardial perfusion abnormality, and is often indicative of related scar and an associated severe contraction abnormality.

  1. Etiology and implications of dense cavitary ''photopenia'' on myocardial perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Dae, M.; Canhasi, B.; Botvinick, E.; Olvera, S.; Schechtmann, N.; Engelstad, B.; Hattner, R.; Schiller, N.; O' Connell, W.; Faulkner, D.

    1985-07-01

    Dense cavitary ''photopenia'' was observed on 21 of 200 consecutive stress perfusion scintigrams. A prominent finding in many cases, it sometimes occupied only a portion of the region overlying the ventricular cavity, was often seen in some projections and not others, and was frequently adjacent to myocardial perfusion defects. To distinguish an etiology among reduced cavitary radioactivity, relatively increased background radioactivity, or reduced radioactivity in overlying myocardium, quantitative analysis of cavitary, lung and myocardial radioactivity was performed in patients with dense cavitary ''photopenia,'' with and without lung uptake, and compared with results from studies showing increased lung uptake without cavitary photopenia and with normal studies. The results showed that dense cavitary photopenia was related to reduced radioactivity in overlying myocardium. Correlative imaging studies performed with echocardiography and contrast ventriculography confirmed this relationship to myocardial scar in 15 of 21 patients in whom associated akinesis or dyskinesis was seen. Hence, dense cavitary photopenia on stress perfusion scintigraphy is due to a dense myocardial perfusion abnormality, and is often indicative of related scar and an associated severe contraction abnormality.

  2. Insecticide Treated Camouflage Sceening Reduces Sand Fly Numbers in Leishmania-Endemic Regions in Kenya

    Science.gov (United States)

    Current U.S. military operations in deserts face persistent threats from sand flies that transmit human Leishmania. In this study we investigated the efficacy of artificial barriers treated with residual insecticide to potentially reduce the risk of human infection from leishmaniasis by reducing the...

  3. EPA Regional Administrator Highlights the Benefits of Reducing Food Waste in South Bend

    Science.gov (United States)

    (SOUTH BEND, IND. - November 5, 2015) U.S. Environmental Protection Agency Regional Administrator Susan Hedman joined South Bend Mayor Pete Buttigieg today at Ivy Tech Community College's culinary school to highlight the benefits of diverting food waste fr

  4. STUDY OF THE EFFECTS OF REDUCING SYSTEMATIC ERRORS ON MONTHLY REGIONAL CLIMATE DYNAMICAL FORECAST

    Institute of Scientific and Technical Information of China (English)

    ZENG Xin-min; XI Chao-li

    2009-01-01

    A nested-model system is constructed by embedding the regional climate model RegCM3 into a general circulation model tbr monthly-scale regional climate forecast over East China. The systematic errors are formulated for the region on the basis of 10-yr (1991-2000) results of the nested-model system,and of the datasets of the Climate Prediction Center (CPC) Merged Analysis of Precipitation (CMAP) and the temperature analysis of the National Meteorological Center (NMC),U.S.A.,which are then used for correcting the original forecast by the system for the period 2001-2005. After the assessment of the original and corrected forecasts for monthly precipitation and surthce air temperature,it is found that the corrected forecast is apparently better than the original,suggesting that the approach can be applied for improving monthly-scale regional climate dynamical lbrecast.

  5. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...... turbo-FLASH (fast low-angle shot) sequence and Gd-DTPA has been presented. Here, an extension of the model is presented taking into account fast and slow water exchange between the compartments, enabling the calculation of the unidirectional influx constant (Ki) for Gd-DTPA, the distribution volume...... of Gd-DTPA (lambda), the vascular blood volume (Vb), and the time delay through the coronary arteries (delta T). The model was evaluated by computer simulation and used on experimental results from seven healthy subjects. The results in the healthy volunteers for a region of interest placed...

  6. Left Ventricular Regional Myocardial Longitudinal Systolic Dysfunctions in HFNEF%射血分数正常时心力衰竭左室节段心肌长轴收缩运动的研究

    Institute of Scientific and Technical Information of China (English)

    胡敏; 江成璠; 王素霞; 孙晓霞; 张晓轩; 张胜; 冯芳芳

    2013-01-01

    目的 研究射血分数正常的心力衰竭(HFNEF)左室节段心肌长轴收缩运动.方法 使用基于组织多普勒(TDI)的应变技术对比分析44例HFNEF患者(A组)和33例条件匹配的健康对照者(B组)左室节段心肌长轴方向应变指标的差异.结果 A组较B组应变峰值绝对值降低,达峰时间延长,发生收缩后收缩及收缩期反常伸展的节段增多(均P<0.01);达峰时间标准差增大(P=0.02).结论 HFNEF左室节段心肌存在长轴收缩运动异常.%Objective To investigate left ventricular (LV) regional myocardial longitudinal contractile function in HFNEF by TDI derived strain. Methods There were 44 HFNEF patients (group A) and 33 matched health controls (group B) , the TDI derived strain was used to analyze the longitudinal contractile function of LV segments which were obtained from four chamber, two chamber and long axis apical view. Results The group A's peak strain was lower, the timing to peak strain was longer, the postsystolic shortening's segments and the paradoxic systolic expansion's segments increased, all P<0. 01; the timing to peak strain's standard deviation of LV 18 segments was larger (P = 0. 02), compared to the group B. Conclusions HFNEF existed LV regional myocardial longitudinal systolic dysfunctions.

  7. Sustainable Development Focused on Reducing Regional Inequalities. Romania Progression as Emergent Economy

    Directory of Open Access Journals (Sweden)

    Sorin Grigoras

    2014-11-01

    Full Text Available Decrease of regional disparities is one of the main goal for every single or mixed economy, such as national regions within Europe or European Union as a whole. Disparities occurrence are differently set up from one territory to another, however emergent economies are characterized by a higher degree of regional inequality, being revealed as vulnerable once the European integration process begun, bearing in mind that living standard conditions seems not to be always as expected. Thus, the spatial analysis and territorial planning are major interest fields, in dealing with the problem of disparities, due to heterogeneous nature of the regions, based on the specific community-related problems. The present article aims to bring an updated statement of Romania’s regional disparities, using different methods and techniques, being able to perform rankings based on economic competitiveness, to analyze the main causes that significantly impact territorial unbalanced development and to release some useful advices that should avoid economic growth around few clusters, which may lead to a higher exposure to economic cycles.

  8. Quantitative Evaluation of Left Ventricular Regional Systolic Function in Patients with Different Location of Myocardial Infraction by 3D Speckle Tracking Echocardiography%超声三维斑点追踪技术定量评价不同部位心肌梗死患者心功能的研究

    Institute of Scientific and Technical Information of China (English)

    王丁; 邓又斌; 黄润青; 汤乔颖; 孙杰; 刘琨

    2013-01-01

    目的 应用超声三维斑点追踪技术定量评价不同部位心肌梗死(myocardial infarction,MI)患者左室心肌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例心梗患者及20例正常人进行心肌运动分析,自动计算左室射血分数(left ventricular ejection fraction,LVEF)和左室整体及各节段纵向、圆周、径向与面积收缩期峰值应变.结果 与正常对照组对比,前壁心肌梗死组左室12/17节段的面积峰值应变减低;集中于前、侧壁、室间隔及心尖部;下壁心肌梗死组左室11/17节段面积峰值应变减低,集中于下、后壁.与非梗死节段比较,梗死节段的纵向、圆周、径向及面积峰值应变均显著降低(P<0.01).前壁心肌梗死组整体纵向、圆周、径向及面积峰值应变均与LVEF显著相关(r=-0.752,r=-0.892,r=0.828,r=-0.876,P<0.01),下壁心肌梗死组各整体峰值应变与LVEF无显著相关(r=-0.08,r=0.113,r=0.044,r=-0.019,P>0.05).结论 超声三维斑点追踪技术是准确、定量评价心脏局部室壁运动异常及整体收缩功能新的无创方法.面积应变峰值可能是全面、准确、定量评价心功能的新指标.%Objective This study was performed to evaluate the value and characteristics of left ventricular systolic strain and its relation to the left ventricular global systolic function in patients with myocardial infarction(MI) which were in different location by using 3D speckle tracking echocardiography (3D-STI).Methods In 24 patient with MI and 20 control subjects,the myocardial motion was recorded and analyzed with 3D-STI.Left ventricular cjection fraction (LVEF),longitudinal strain(LS),circumferential strain(CS),radial strain(RS) and area strain(AS) in regional myocardial segments were measured automatically.Results Compared with control subjects,AS reduced in 12/17 myocardial segments of the anterior wall MI group,and its reduced segments were mainly in

  9. Reducing Test Anxiety among 12th Grade Students: Iraqi Kurdistan Region/Soran City as an Example

    Science.gov (United States)

    Faqe, Chiayee Khorshid; Moheddin, Kurdistan Rafiq; Kakamad, Karwan Kakabra

    2016-01-01

    This study aims at reducing test anxiety among twelfth grade students at Soran city high schools. Throughout the study both quantitative and qualitative methods used to collect data. The participants were 450 twelfth grade students in five schools at Soran City-Kurdistan region of Iraq. Non-random purposive sampling because the students needed…

  10. Regional atmospheric budgets of reduced nitrogen over the British isles assessed using a multi-layer atmospheric transport model

    NARCIS (Netherlands)

    Fournier, N.; Tang, Y.S.; Dragosits, U.; Kluizenaar, Y.de; Sutton, M.A.

    2005-01-01

    Atmospheric budgets of reduced nitrogen for the major political regions of the British Isles are investigated with a multi-layer atmospheric transport model. The model is validated against measurements of NH3 concentration and is developed to provide atmospheric budgets for defined subdomains of the

  11. [Percutaneous myocardial laser revascularization (PMR)].

    Science.gov (United States)

    Lauer, B; Stahl, F; Bratanow, S; Schuler, G

    2000-09-01

    In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. Between January 1997 and November 1999, this "percutaneous myocardial laser revascularization" (PMR) has been performed in 101 patients at the Herzzentrum Leipzig. In 63 patients, only 1 region of the heart (anterior, lateral, inferior or septal) was treated with PMR, in 38 patients 2 or 3 regions were treated in 1 session. There were 12.3 +/- 4.5 (range 4 to 22) channels/region created into the myocardium. After 3 months, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4, after 6 months: 1.6 +/- 0.8) (p PMR, the CCS class after 2 years was 1.3 +/- 0.7, exercise capacity was 500 +/- 193 s. However, thallium scintigraphy failed to show increased perfusion in the PMR treated regions. The pathophysiologic mechanisms of myocardial laser revascularization is not yet understood. Most of the laser channels are found occluded after various time intervals after intervention. Other possible mechanisms include myocardial denervation or angioneogenesis after laser revascularization, however, unequivocal evidence for these theories is not yet available. In conclusion, PMR seems to be a safe and feasible new therapeutic option for patients with refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity, whereas evidence of increased perfusion after laser

  12. The prognostic importance of creatinine clearance after acute myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, C R; Brendorp, B; Rask-Madsen, C

    2002-01-01

    AIMS: The purpose of this study was to assess renal dysfunction as an independent predictor of mortality after acute myocardial infarction. METHODS: The study population was 6252 patients with a myocardial infarction admitted alive from 1990 to 1992. The mortality status was obtained after at least.......9-1.3) respectively. CONCLUSION: Renal dysfunction is an important risk factor after acute myocardial infarction. When the risk is adjusted for available competing risk factors only severely reduced renal function is associated with an important and independent risk of mortality after acute myocardial infarction...

  13. Prognostic usefulness of insulin-like growth factor-binding protein 7 in heart failure with reduced ejection fraction: a novel biomarker of myocardial diastolic function?

    Science.gov (United States)

    Gandhi, Parul U; Gaggin, Hanna K; Sheftel, Alex D; Belcher, Arianna M; Weiner, Rory B; Baggish, Aaron L; Motiwala, Shweta R; Liu, Peter P; Januzzi, James L

    2014-11-15

    Insulin-like growth factor-binding protein 7 (IGFBP7) is a biomarker that has recently been associated with heart failure and cardiac hypertrophy. The aim of this study was to examine IGFBP7 relative to echocardiographic abnormalities reflecting diastolic dysfunction. One hundred twenty-four patients with ambulatory heart failure with reduced ejection fraction and baseline detailed 2-dimensional echocardiograms were followed for a mean of 10 months. IGFBP7 was measured serially at each office visit; 108 patients underwent follow-up echocardiography. Echocardiographic parameters of diastolic function were compared at baseline and over time. IGFBP7 concentrations were not linked to left ventricular size or systolic function. In contrast, those with elevated baseline IGFBP7 concentrations were more likely to have abnormalities of parameters describing diastolic function, such as higher left atrial volume index, transmitral E/A ratio, E/E' ratio, and right ventricular systolic pressure. IGFBP7 was correlated with left atrial volume index (ρ = 0.237, p = 0.008), transmitral E/A ratio (ρ = 0.304, p = 0.001), E/E' ratio (ρ = 0.257, p = 0.005), and right ventricular systolic pressure (ρ = 0.316, p = 0.001). Furthermore, each was found to be independently predictive of IGFBP7 in adjusted analysis. In subjects with baseline and final echocardiograms, more time spent with elevated IGFBP7 concentrations in serial measurement was associated with worsening diastolic function and increasing left atrial volume index or right ventricular systolic pressure. IGFBP7 concentrations were predictive of an increased risk for cardiovascular events independent of echocardiographic measures of diastolic function (p = 0.006). In conclusion, IGFBP7 is a novel prognostic biomarker for heart failure with reduced ejection fraction and shows significant links to the presence and severity of echocardiographic parameters of abnormal diastolic function.

  14. Characterizing and reducing equifinality by constraining a distributed catchment model with regional signatures, local observations, and process understanding

    Science.gov (United States)

    Kelleher, Christa; McGlynn, Brian; Wagener, Thorsten

    2017-07-01

    Distributed catchment models are widely used tools for predicting hydrologic behavior. While distributed models require many parameters to describe a system, they are expected to simulate behavior that is more consistent with observed processes. However, obtaining a single set of acceptable parameters can be problematic, as parameter equifinality often results in several behavioral sets that fit observations (typically streamflow). In this study, we investigate the extent to which equifinality impacts a typical distributed modeling application. We outline a hierarchical approach to reduce the number of behavioral sets based on regional, observation-driven, and expert-knowledge-based constraints. For our application, we explore how each of these constraint classes reduced the number of behavioral parameter sets and altered distributions of spatiotemporal simulations, simulating a well-studied headwater catchment, Stringer Creek, Montana, using the distributed hydrology-soil-vegetation model (DHSVM). As a demonstrative exercise, we investigated model performance across 10 000 parameter sets. Constraints on regional signatures, the hydrograph, and two internal measurements of snow water equivalent time series reduced the number of behavioral parameter sets but still left a small number with similar goodness of fit. This subset was ultimately further reduced by incorporating pattern expectations of groundwater table depth across the catchment. Our results suggest that utilizing a hierarchical approach based on regional datasets, observations, and expert knowledge to identify behavioral parameter sets can reduce equifinality and bolster more careful application and simulation of spatiotemporal processes via distributed modeling at the catchment scale.

  15. Demographics, Management Strategies, and Problems in ST-Elevation Myocardial Infarction from the Standpoint of Emergency Medicine Specialists: A Survey-Based Study from Seven Geographical Regions of Turkey

    Science.gov (United States)

    Kayipmaz, Afsin Emre; Karacaglar, Emir; Muderrisoglu, Haldun

    2016-01-01

    Background This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. Methods We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions. Results The regions were not significantly different with respect to primary percutaneous coronary intervention (PCI) resources (p = 0.286). Sixty six point two percent (66.2%) of emergency specialists stated that patients presented to emergency within 2 hours of symptom onset. Forty three point six percent (43.6%) of them contacted cardiology department within 10 minutes and 47.1% within 30 minutes. In addition, 68.3% of the participants improved themselves through various educational activities. The Southeastern Anatolian region had the longest time from symptom onset to emergency department admission and the least favorable hospital admission properties, not originating from physicians or 112 emergency healthcare services. Conclusion Seventy point seven percent (70.7%) of the emergency specialists working in all geographical regions of Turkey comply with the latest guidelines and current knowledge about STEMI care; they also try to improve themselves, and receive adequate support from 112 emergency healthcare services and cardiologists. While inter-regional gaps between the number of primary PCI capable centers and quality of STEMI care progressively narrow, there are still issues to address, such as delayed patient presentation after symptoms onset and difficulties in patient admission. PMID:27760229

  16. Implementation of transformed lenses in bed of nails reducing refractive index maximum value and sub-unity regions.

    Science.gov (United States)

    Prado, Daniel R; Osipov, Andrey V; Quevedo-Teruel, Oscar

    2015-03-15

    Transformation optics with quasi-conformal mapping is applied to design a Generalized Maxwell Fish-eye Lens (GMFEL) which can be used as a power splitter. The flattened focal line obtained as a result of the transformation allows the lens to adapt to planar antenna feeding systems. Moreover, sub-unity refraction index regions are reduced because of the space compression effect of the transformation, reducing the negative impact of removing those regions when implementing the lens. A technique to reduce the maximum value of the refractive index is presented to compensate for its increase because of the transformation. Finally, the lens is implemented with the bed of nails technology, employing a commercial dielectric slab to improve the range of the effective refractive index. The lens was simulated with a 3D full-wave simulator to validate the design, obtaining an original and feasible power splitter based on a dielectric lens.

  17. PERIOPERATIVE MYOCARDIAL INFRACTION

    Directory of Open Access Journals (Sweden)

    Ravindra S

    2015-10-01

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

  18. Matrix attachment regions (MARs) enhance transformation frequencies and reduce variance of transgene expression in barley

    DEFF Research Database (Denmark)

    Petersen, K.; Leah, R.; Knudsen, S.

    2002-01-01

    Nuclear matrix attachment regions (MARs) are defined as genomic DNA sequences, located at the physical boundaries of chromatin loops. They are suggested to play a role in the cis unfolding and folding of the chromatin fibre associated with the regulation of gene transcription. Inclusion of MARs i...

  19. Computational modeling of acute myocardial infarction.

    Science.gov (United States)

    Sáez, P; Kuhl, E

    2016-01-01

    Myocardial infarction, commonly known as heart attack, is caused by reduced blood supply and damages the heart muscle because of a lack of oxygen. Myocardial infarction initiates a cascade of biochemical and mechanical events. In the early stages, cardiomyocytes death, wall thinning, collagen degradation, and ventricular dilation are the immediate consequences of myocardial infarction. In the later stages, collagenous scar formation in the infarcted zone and hypertrophy of the non-infarcted zone are auto-regulatory mechanisms to partly correct for these events. Here we propose a computational model for the short-term adaptation after myocardial infarction using the continuum theory of multiplicative growth. Our model captures the effects of cell death initiating wall thinning, and collagen degradation initiating ventricular dilation. Our simulations agree well with clinical observations in early myocardial infarction. They represent a first step toward simulating the progression of myocardial infarction with the ultimate goal to predict the propensity toward heart failure as a function of infarct intensity, location, and size.

  20. Effect of recombinant human brain natriuretic peptide-assisted interventional treatment on prognosis of acute myocardial infarction patients complicated with cardiogenic shock

    Institute of Scientific and Technical Information of China (English)

    Xi-Zhou Chen

    2016-01-01

    Objective:To analyze the effect of recombinant human brain natriuretic peptide-assisted interventional treatment on prognosis of acute myocardial infarction patients complicated with cardiogenic shock.Methods: A total of 112 cases of inpatients treated in Cardiology Department of our hospital from March 2013 to March 2015 were selected, all of whom had acute myocardial infarction within 12 hours of onset and received direct PCI treatment. They were divided into observation group and control group according to random number table, each group with 56 cases, control group received conventional interventional treatment and observation group received recombinant human brain natriuretic peptide-assisted interventional treatment. Then differences of regional myocardial deformability, myocardial enzyme spectrum indicators, brain natriuretic peptide and inflammatory factors, blood sugar and stress hormones as well as myocardial infarction prognosis-associated indexes, etc, between two groups after treatment were compared.Results:After treatment, LVEF, SRs, SRe and Sra levels of observation group were higher than those of control group, WMSI level was lower than that of control group; serum myocardial enzyme spectrum indicators CK, CK-MB, AST and LDH values were lower than those of control group; serum BNP, CRP, TNF-α and IL-6 levels were lower than those of control group; serum cortisol, growth hormone and glucagon levels were lower than those of control group, insulin level was higher than that of control group; FT3 and IGF-1 levels were higher than those of control group, sPLA2 and Hcy levels were lower than those of control group.Conclusion: Recombinant human brain natriuretic peptide-assisted interventional treatment for acute myocardial infarction patients complicated with cardiogenic shock can reduce myocardial function injury, protect normal myocardial function and optimize patients' long-term prognosis; it has active clinical significance.

  1. Change of regional choroid thickness after reduced-fluence photodynamic therapy for chronic central serous chorioretinopathy.

    Science.gov (United States)

    Manabe, Saki; Shiragami, Chieko; Hirooka, Kazuyuki; Izumibata, Saeko; Tsujikawa, Akitaka; Shiraga, Fumio

    2015-04-01

    To evaluate macular choroidal thickness after reduced-fluence photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Prospective, consecutive, interventional case series. Twenty-two eyes with chronic CSC were treated with reduced-fluence PDT. Macular choroidal thickness was examined using spectral-domain optical coherence tomography with a 3-dimensinonal radial scan protocol in the choroidal mode before and 1, 3, and 6 months after the treatment. The mean choroidal thickness in the Early Treatment Diabetic Retinopathy Study grid (center, inner circle, and outer circle) was compared between before and after therapy, as well as between treated eyes and 54 volunteer normal eyes. Chronic CSC eyes showed significantly thicker choroids in the macular area compared with normal controls (P Choroidal thickness within the center area and inner circle showed a significant reduction at all time points after treatment (P choroidal thickness in the outer circle showed a statistically significant reduction at 1 and 3 months but not at 6 months. After treatment, the choroidal thickness reduced to the normal values at the center and inner circle, but was still significantly thicker in the outer circle (P choroids in the macular area. After reduced-fluence PDT, macular choroidal thickness became thinner within 6 months of treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Myocardial factor revisited: The importance of myocardial fibrosis in adults with congenital heart disease.

    Science.gov (United States)

    Broberg, Craig S; Burchill, Luke J

    2015-06-15

    Pioneers in congenital heart surgery observed that exercise capacity did not return to normal levels despite successful surgical repair, leading some to cite a "myocardial factor" playing a role. They conjectured that residual alterations in myocardial function would be significant for patients' long-term outlook. In fulfillment of their early observations, today's adult congenital heart disease (ACHD) population shows well-recognized features of heart failure, even among patients without clear residual anatomic or hemodynamic abnormalities, demonstrating the vital role of the myocardium in their morbidity and mortality. Whereas the 'myocardial factor' was an elusive concept in the early history of congenital heart care, we now have imaging techniques to detect and quantify one such factor--myocardial fibrosis. Understanding the importance of myocardial fibrosis as a final common pathway in a variety of congenital lesions provides a framework for both the study and treatment of clinical heart failure in this context. While typical heart failure pharmacology should reduce or attenuate fibrogenesis, efforts to show meaningful improvements with standard pharmacotherapy in ACHD repeatedly fall short. This paper considers the importance of myocardial fibrosis and function, the current body of evidence for myocardial fibrosis in ACHD, and its implications for research and treatment.

  3. Echocardiographic assessment of myocardial strain.

    Science.gov (United States)

    Gorcsan, John; Tanaka, Hidekazu

    2011-09-27

    Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional myocardial function. First introduced as post-processing of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the myocardium, and the effects of valvular disease on myocardial function, and to advance our understanding of diastolic function. Strain imaging has also been used to quantify abnormalities in the timing of mechanical activation for heart failure patients undergoing cardiac resynchronization pacing therapy. Further advances, such as 3-dimensional speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging has become established as a robust research tool and has great potential to play many roles in routine clinical practice to advance the care of the cardiovascular patient. This perspective reviews the physiology of myocardial strain, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, their strengths and weaknesses, and the state-of-the-art present and potential future clinical applications.

  4. Oxytocin receptors in brain cortical regions are reduced in haploinsufficient (+/-) reeler mice.

    Science.gov (United States)

    Liu, Wensheng; Pappas, George D; Carter, C Sue

    2005-06-01

    Both oxytocin (OT) and reelin are particularly significant during development and the absence of either may interfere with normal brain development. In addition, reelin is critical to the development of the GABAergic system and GABA modulates the release of OT. Availability of the reelin haploinsufficient (+/-) reeler mouse (HRM) provides a model for examining the role of reelin in the development of the OT system and especially in the expression of the OT receptor (OTR). In this study we used immunocytochemistry and in situ hybridization in HRM versus wild-type (+/-) mice (WTM) to quantify OTR abundance in regions of the brain cortex. Our findings reveal that the oxytocin receptor (OTR), measured either by immunohistochemistry or in situ hybridization, is significantly lower in HRM. Areas showing significant deficits included the piriform cortex, neocortex, retrosplenial cortex and certain regions of the hippocampus. Both reelin and OT play a role in regulating affect and mood. Down-regulation of reelin has been strongly correlated with schizophrenia and it is proposed that HRM may serve as a model for neural deficits seen in both schizophrenia and autism. We report that HRM show regionally specific reductions in OTRs, especially in cortical areas, which previously have been implicated in social memory and cognitive functions. These findings offer support for the more general hypothesis that down-regulation of reelin, of either genetic or epigenetic origin, through associated reductions in the OTRs, contributes to the deficiencies in social behavior that are characteristic of both schizophrenia and autism.

  5. 二维应变超声心动图评价干细胞移植对心肌梗死大鼠左心室局部收缩功能的影响%Assessment of Regional Myocardial Function Following Mesenchymal Stem Cells Transportation in A Rat Model of Myocardial Infarction by 2 -dimensional Strain Echocardiography

    Institute of Scientific and Technical Information of China (English)

    廖书生; 阮琴韵; 林美燕; 鄢磊; 苏津自; 林茂海

    2012-01-01

    Objective To investigate the value of 2 -dimensional strain echocardiography (2DSE) in a research of mesenchymal stem cells ( MSCs) transplantation therapy in a ral model of myocardial infarction. Methods Forty Sprague - Dawley rats were divided into myocardial infarct (Ml) group (n = 14) , MSCs treatment group ( n = 16) , and control group(ra = 10). Rat model of myocardial infarction was established following ligation of the proximal left anterior descending coronary artery for MI - group and MSCs group, and control group with sham - operation. The MSCs labeled by DAP1 was implanted into the acute infarct site for the MSCs group. Myocardial strain and strain rate of left ventricular mid - anterior segment were detected by 2DSE pre - procedurally at baseline, 1 - week and 4 -week after procedures. Fluorescence microscope was used to identify the DAPI - labeled cells, and immunohistochemistry staining of Tro-ponin I was used to evaluate the differentiation and expression of engrafted MSCs. Results In the end of 4 weeks, when compared with MI group, increased strain parameters were found in MSCs group (P<0.01). The labeled cells were viable in the host myocardium and immunochemical staining revealed that the engrafted stem cells expressed Troponin I. Conclusion 2DSE may detect the improved regional systolic function after transplantation of MSCs on a post - MI of rat model noninvasively.%目的 应用二维应变超声心动图(2 -dimensional strain echocardiography,2DSE)观察心肌梗死大鼠在骨髓间充质干细胞(mesenchymal stem ceils,MSCs)移植后局部心肌功能改善情况,探讨2DSE在心肌梗死大鼠干细胞移植研究中心功能评价的价值.方法40只SD大鼠随机分为心肌梗死组(n=14)、MSCs治疗组(n=16)和对照组(n=10),心肌梗死组与MSCs组建立心肌梗死模型,对照组只进行假手术.MSCs组在梗死区心肌局部注射DAPI标记的MSCs,心肌梗死组和对照组只注射DMEM培养基.分别于术前1天和术后1

  6. 52 Genetic Loci Influencing Myocardial Mass

    Science.gov (United States)

    van der Harst, Pim; van Setten, Jessica; Verweij, Niek; Vogler, Georg; Franke, Lude; Maurano, Matthew T.; Wang, Xinchen; Leach, Irene Mateo; Eijgelsheim, Mark; Sotoodehnia, Nona; Hayward, Caroline; Sorice, Rossella; Meirelles, Osorio; Lyytikäinen, Leo-Pekka; Polašek, Ozren; Tanaka, Toshiko; Arking, Dan E.; Ulivi, Sheila; Trompet, Stella; Müller-Nurasyid, Martina; Smith, Albert V.; Dörr, Marcus; Kerr, Kathleen F.; Magnani, Jared W.; Fabiola Del Greco, M.; Zhang, Weihua; Nolte, Ilja M.; Silva, Claudia T.; Padmanabhan, Sandosh; Tragante, Vinicius; Esko, Tõnu; Abecasis, Gonçalo R.; Adriaens, Michiel E.; Andersen, Karl; Barnett, Phil; Bis, Joshua C.; Bodmer, Rolf; Buckley, Brendan M.; Campbell, Harry; Cannon, Megan V.; Chakravarti, Aravinda; Chen, Lin Y.; Delitala, Alessandro; Devereux, Richard B.; Doevendans, Pieter A.; Dominiczak, Anna F.; Ferrucci, Luigi; Ford, Ian; Gieger, Christian; Harris, Tamara B.; Haugen, Eric; Heinig, Matthias; Hernandez, Dena G.; Hillege, Hans L.; Hirschhorn, Joel N.; Hofman, Albert; Hubner, Norbert; Hwang, Shih-Jen; Iorio, Annamaria; Kähönen, Mika; Kellis, Manolis; Kolcic, Ivana; Kooner, Ishminder K.; Kooner, Jaspal S.; Kors, Jan A.; Lakatta, Edward G.; Lage, Kasper; Launer, Lenore J.; Levy, Daniel; Lundby, Alicia; Macfarlane, Peter W.; May, Dalit; Meitinger, Thomas; Metspalu, Andres; Nappo, Stefania; Naitza, Silvia; Neph, Shane; Nord, Alex S.; Nutile, Teresa; Okin, Peter M.; Olsen, Jesper V.; Oostra, Ben A.; Penninger, Josef M.; Pennacchio, Len A.; Pers, Tune H.; Perz, Siegfried; Peters, Annette; Pinto, Yigal M.; Pfeufer, Arne; Pilia, Maria Grazia; Pramstaller, Peter P.; Prins, Bram P.; Raitakari, Olli T.; Raychaudhuri, Soumya; Rice, Ken M.; Rossin, Elizabeth J.; Rotter, Jerome I.; Schafer, Sebastian; Schlessinger, David; Schmidt, Carsten O.; Sehmi, Jobanpreet; Silljé, Herman H.W.; Sinagra, Gianfranco; Sinner, Moritz F.; Slowikowski, Kamil; Soliman, Elsayed Z.; Spector, Timothy D.; Spiering, Wilko; Stamatoyannopoulos, John A.; Stolk, Ronald P.; Strauch, Konstantin; Tan, Sian-Tsung; Tarasov, Kirill V.; Trinh, Bosco; Uitterlinden, Andre G.; van den Boogaard, Malou; van Duijn, Cornelia M.; van Gilst, Wiek H.; Viikari, Jorma S.; Visscher, Peter M.; Vitart, Veronique; Völker, Uwe; Waldenberger, Melanie; Weichenberger, Christian X.; Westra, Harm-Jan; Wijmenga, Cisca; Wolffenbuttel, Bruce H.; Yang, Jian; Bezzina, Connie R.; Munroe, Patricia B.; Snieder, Harold; Wright, Alan F.; Rudan, Igor; Boyer, Laurie A.; Asselbergs, Folkert W.; van Veldhuisen, Dirk J.; Stricker, Bruno H.; Psaty, Bruce M.; Ciullo, Marina; Sanna, Serena; Lehtimäki, Terho; Wilson, James F.; Bandinelli, Stefania; Alonso, Alvaro; Gasparini, Paolo; Jukema, J. Wouter; Kääb, Stefan; Gudnason, Vilmundur; Felix, Stephan B.; Heckbert, Susan R.; de Boer, Rudolf A.; Newton-Cheh, Christopher; Hicks, Andrew A.; Chambers, John C.; Jamshidi, Yalda; Visel, Axel; Christoffels, Vincent M.; Isaacs, Aaron; Samani, Nilesh J.; de Bakker, Paul I.W.

    2017-01-01

    BACKGROUND Myocardial mass is a key determinant of cardiac muscle function and hypertrophy. Myocardial depolarization leading to cardiac muscle contraction is reflected by the amplitude and duration of the QRS complex on the electrocardiogram (ECG). Abnormal QRS amplitude or duration reflect changes in myocardial mass and conduction, and are associated with increased risk of heart failure and death. OBJECTIVES This meta-analysis sought to gain insights into the genetic determinants of myocardial mass. METHODS We carried out a genome-wide association meta-analysis of 4 QRS traits in up to 73,518 individuals of European ancestry, followed by extensive biological and functional assessment. RESULTS We identified 52 genomic loci, of which 32 are novel, that are reliably associated with 1 or more QRS phenotypes at p < 1 × 10−8. These loci are enriched in regions of open chromatin, histone modifications, and transcription factor binding, suggesting that they represent regions of the genome that are actively transcribed in the human heart. Pathway analyses provided evidence that these loci play a role in cardiac hypertrophy. We further highlighted 67 candidate genes at the identified loci that are preferentially expressed in cardiac tissue and associated with cardiac abnormalities in Drosophila melanogaster and Mus musculus. We validated the regulatory function of a novel variant in the SCN5A/SCN10A locus in vitro and in vivo. CONCLUSIONS Taken together, our findings provide new insights into genes and biological pathways controlling myocardial mass and may help identify novel therapeutic targets. PMID:27659466

  7. Reduced pulmonary blood flow in regions of injury 2 hours after acid aspiration in rats.

    Science.gov (United States)

    Richter, Torsten; Bergmann, Ralf; Musch, Guido; Pietzsch, Jens; Koch, Thea

    2015-01-01

    Aspiration-induced lung injury can decrease gas exchange and increase mortality. Acute lung injury following acid aspiration is characterized by elevated pulmonary blood flow (PBF) in damaged lung areas in the early inflammation stage. Knowledge of PBF patterns after acid aspiration is important for targeting intravenous treatments. We examined PBF in an experimental model at a later stage (2 hours after injury). Anesthetized Wistar-Unilever rats (n = 5) underwent unilateral endobronchial instillation of hydrochloric acid. The PBF distribution was compared between injured and uninjured sides and with that of untreated control animals (n = 6). Changes in lung density after injury were measured using computed tomography (CT). Regional PBF distribution was determined quantitatively in vivo 2 hours after acid instillation by measuring the concentration of [(68)Ga]-radiolabeled microspheres using positron emission tomography. CT scans revealed increased lung density in areas of acid aspiration. Lung injury was accompanied by impaired gas exchange. Acid aspiration decreased the arterial pressure of oxygen from 157 mmHg [139;165] to 74 mmHg [67;86] at 20 minutes and tended toward restoration to 109 mmHg [69;114] at 110 minutes (P < 0.001). The PBF ratio of the middle region of the injured versus uninjured lungs of the aspiration group (0.86 [0.7;0.9], median [25%;75%]) was significantly lower than the PBF ratio in the left versus right lung of the control group (1.02 [1.0;1.05]; P = 0.016). The PBF pattern 2 hours after aspiration-induced lung injury showed a redistribution of PBF away from injured regions that was likely responsible for the partial recovery from hypoxemia over time. Treatments given intravenously 2 hours after acid-induced lung injury may not preferentially reach the injured lung regions, contrary to what occurs during the first hour of inflammation. Please see related article: http://dx.doi.org/10.1186/s12871-015-0014-z.

  8. Periodontitis and myocardial hypertrophy.

    Science.gov (United States)

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

    2017-04-01

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

  9. Combretastatin A4 disodium phosphate-induced myocardial injury

    Science.gov (United States)

    Tochinai, Ryota; Nagata, Yuriko; Ando, Minoru; Hata, Chie; Suzuki, Tomo; Asakawa, Naoyuki; Yoshizawa, Kazuhiko; Uchida, Kazumi; Kado, Shoichi; Kobayashi, Toshihide; Kaneko, Kimiyuki; Kuwahara, Masayoshi

    2016-01-01

    Histopathological and electrocardiographic features of myocardial lesions induced by combretastatin A4 disodium phosphate (CA4DP) were evaluated, and the relation between myocardial lesions and vascular changes and the direct toxic effect of CA4DP on cardiomyocytes were discussed. We induced myocardial lesions by administration of CA4DP to rats and evaluated myocardial damage by histopathologic examination and electrocardiography. We evaluated blood pressure (BP) of CA4DP-treated rats and effects of CA4DP on cellular impedance-based contractility of human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs). The results revealed multifocal myocardial necrosis with a predilection for the interventricular septum and subendocardial regions of the apex of the left ventricular wall, injury of capillaries, morphological change of the ST junction, and QT interval prolongation. The histopathological profile of myocardial lesions suggested that CA4DP induced a lack of myocardial blood flow. CA4DP increased the diastolic BP and showed direct effects on hiPS-CMs. These results suggest that CA4DP induces dysfunction of small arteries and capillaries and has direct toxicity in cardiomyocytes. Therefore, it is thought that CA4DP induced capillary and myocardial injury due to collapse of the microcirculation in the myocardium. Moreover, the direct toxic effect of CA4DP on cardiomyocytes induced myocardial lesions in a coordinated manner. PMID:27559241

  10. No tillage and liming reduce greenhouse gas emissions from poorly drained agricultural soils in Mediterranean regions

    Energy Technology Data Exchange (ETDEWEB)

    García-Marco, Sonia, E-mail: sonia.garcia@upm.es [Departamento de Química y Tecnología de los Alimentos, E.T.S.I. Agronómica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid, Ciudad Universitaria, 28040 Madrid (Spain); Abalos, Diego, E-mail: diego.abalosrodriguez@wur.nl [Departamento de Química y Tecnología de los Alimentos, E.T.S.I. Agronómica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid, Ciudad Universitaria, 28040 Madrid (Spain); Espejo, Rafael, E-mail: rafael.espejo@upm.es [Departamento de Producción Agraria, E.T.S.I. Agronómica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid, Ciudad Universitaria, 28040 Madrid (Spain); Vallejo, Antonio, E-mail: antonio.vallejo@upm.es [Departamento de Química y Tecnología de los Alimentos, E.T.S.I. Agronómica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid, Ciudad Universitaria, 28040 Madrid (Spain); Mariscal-Sancho, Ignacio, E-mail: i.mariscal@upm.es [Departamento de Producción Agraria, E.T.S.I. Agronómica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid, Ciudad Universitaria, 28040 Madrid (Spain)

    2016-10-01

    No tillage (NT) has been associated to increased N{sub 2}O emission from poorly drained agricultural soils. This is the case for soils with a low permeable Bt horizon, which generates a perched water layer after water addition (via rainfall or irrigation) over a long period of time. Moreover, these soils often have problems of acidity and require liming application to sustain crop productivity; changes in soil pH have large implications for the production and consumption of soil greenhouse gas (GHG) emissions. Here, we assessed in a split-plot design the individual and interactive effects of tillage practices (conventional tillage (CT) vs. NT) and liming (Ca-amendment vs. not-amendment) on N{sub 2}O and CH{sub 4} emissions from poorly drained acidic soils, over a field experiment with a rainfed triticale crop. Soil mineral N concentrations, pH, temperature, moisture, water soluble organic carbon, GHG fluxes and denitrification capacity were measured during the experiment. Tillage increased N{sub 2}O emissions by 68% compared to NT and generally led to higher CH{sub 4} emissions; both effects were due to the higher soil moisture content under CT plots. Under CT, liming reduced N{sub 2}O emissions by 61% whereas no effect was observed under NT. Under both CT and NT, CH{sub 4} oxidation was enhanced after liming application due to decreased Al{sup 3+} toxicity. Based on our results, NT should be promoted as a means to improve soil physical properties and concurrently reduce N{sub 2}O and CH{sub 4} emissions. Raising the soil pH via liming has positive effects on crop yield; here we show that it may also serve to mitigate CH{sub 4} emissions and, under CT, abate N{sub 2}O emissions. - Highlights: • The effect of tillage and liming on GHG was studied in poorly drained acidic soils. • NT reduced N{sub 2}O emissions, global warming potential and greenhouse gases intensity. • Liming reduced N{sub 2}O and CH{sub 4} emissions under CT; no effect was observed under NT

  11. 速度向量成像技术评价犬心肌缺血与梗死状态下左心室节段性旋转特征%Assessment of regional rotation by velocity vector imaging in canine with myocardial ischemia and acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    张晓娟; 智光

    2011-01-01

    Objective To assess the regional rotation in canine with myocardial ischemia and acute myocardial infarction by velocity vector imaging( VVI ).Methods Myocardial ischemia and infarction model were successfully made by partly and fully ligating the left anterior descending coronary artery ( LAD ) in twelve mongrel dogs. The ventricle rotation and strain were measured by VVI. Results The results revealed: The LAD part ligation: rotation decreased in ventricular septal before LAD ligation status in LAD part ligation status( P <0. 05 ). The strain and strain rate has no significant difference. The LAD ful ligation: the rotation rate, rotation, circumferential strain and strain rate of the anterior septal, anterior wall and ventricular septal were significantly decreased in myocardial infarction status compared with those in the normal status, and were also significantly decreased compared with those in the myocardial ischemia status( P <0. 05 ). The strain and strain rate in the anterior septal,anterior wall and ventricular septal were significantly decreased in myocardial infarction status compared with those in the normal status( P <0. 05 ), but not significantly decreased compared with those in partly ligation status. Conclusion VVI can non-invasively and sensitively assess the left ventricular rotation and the results indicated the ventricular rotation is more sensitive than the strain and strain rate in evaluation of the ventricular systolic function.%目的 应用速度向量成像(VVI)技术评价心肌缺血及心肌梗死状态下犬心肌旋转运动特征.方法 选用杂种犬12只,在超声实时引导下结扎前降支定量制备前降支轻度狭窄(狭窄率:50%~75%)与完全闭塞模型,应用VVI技术分析前降支结扎前、轻度狭窄与完全闭塞状态下左心室旋转特征的改变.结果 12只杂种犬成功制备前降支轻度狭窄与完全闭塞模型,应用VVI技术对缺血与梗死状态下心肌旋

  12. NMDA receptor binding is reduced within mesocorticolimbic regions following chronic inhalation of toluene in adolescent rats.

    Science.gov (United States)

    Dick, Alec Lindsay Ward; Pooters, Tine; Gibbs, Sarah; Giles, Emma; Qama, Ashleigh; Lawrence, Andrew John; Duncan, Jhodie Rubina

    2015-10-22

    The purposeful inhalation of volatile solvents, such as toluene, to induce self-intoxication is prevalent, particularly within adolescent populations. Chronic misuse results in cognitive and neurobiological impairments, as well as an increased risk for addictive behaviours in adulthood. Toluene-induced neuroadaptations within mesocorticolimbic circuitry are thought, in part, to mediate some of the adverse outcomes of toluene misuse, however our understanding of the neuroadaptive processes remains equivocal. An understanding of these processes is particularly important relative to exposure that occurs during adolescence and at concentrations that reflect various patterns of use. Therefore, we exposed male adolescent Wistar rats (postnatal day [PN] 27) to either air or low or high concentrations of inhaled toluene in a chronic and intermittent fashion (CIT, 3,000 or 10,000ppm) for 1 h/day, 3-5 times per week for 4 weeks to model different patterns of human inhalant abuse. Brains were subsequently analysed using autoradiography, qPCR and immunohistochemistry 3 days following the exposure period to investigate toluene-induced neuroadaptations within mesocorticolimbic circuitry. In CIT-exposed rats binding to N-methyl-D-aspartate (NMDA) receptors containing the GluN2B subunit, as determined using [(3)H]-ifenprodil, was decreased in a concentration-related manner in the caudal cingulate cortex, dorsal striatum and accumbens; however, this was not associated with changes in GluN2B protein expression. There were no differences in [(3)H]-epibatidine binding to heteromeric neuronal nicotinic acetylcholine (nACh) receptors. Relative expression of mRNA transcripts encoding NMDA, nACh, γ-aminobutyric acid type-A (GABAA) and dopamine receptor subunits was unchanged in all regions assessed following CIT. Our data suggest that adolescent CIT exposure impacts NMDA receptors within regions of corticostriatal circuitry, possibly via post-translational mechanisms. Dysfunctional

  13. Nitrogen footprints: Regional realities and options to reduce nitrogen loss to the environment.

    Science.gov (United States)

    Shibata, Hideaki; Galloway, James N; Leach, Allison M; Cattaneo, Lia R; Cattell Noll, Laura; Erisman, Jan Willem; Gu, Baojing; Liang, Xia; Hayashi, Kentaro; Ma, Lin; Dalgaard, Tommy; Graversgaard, Morten; Chen, Deli; Nansai, Keisuke; Shindo, Junko; Matsubae, Kazuyo; Oita, Azusa; Su, Ming-Chien; Mishima, Shin-Ichiro; Bleeker, Albert

    2017-03-01

    Nitrogen (N) management presents a sustainability dilemma: N is strongly linked to energy and food production, but excess reactive N causes environmental pollution. The N footprint is an indicator that quantifies reactive N losses to the environment from consumption and production of food and the use of energy. The average per capita N footprint (calculated using the N-Calculator methodology) of ten countries varies from 15 to 47 kg N capita(-1) year(-1). The major cause of the difference is the protein consumption rates and food production N losses. The food sector dominates all countries' N footprints. Global connections via trade significantly affect the N footprint in countries that rely on imported foods and feeds. The authors present N footprint reduction strategies (e.g., improve N use efficiency, increase N recycling, reduce food waste, shift dietary choices) and identify knowledge gaps (e.g., the N footprint from nonfood goods and soil N process).

  14. No tillage and liming reduce greenhouse gas emissions from poorly drained agricultural soils in Mediterranean regions.

    Science.gov (United States)

    García-Marco, Sonia; Abalos, Diego; Espejo, Rafael; Vallejo, Antonio; Mariscal-Sancho, Ignacio

    2016-10-01

    No tillage (NT) has been associated to increased N2O emission from poorly drained agricultural soils. This is the case for soils with a low permeable Bt horizon, which generates a perched water layer after water addition (via rainfall or irrigation) over a long period of time. Moreover, these soils often have problems of acidity and require liming application to sustain crop productivity; changes in soil pH have large implications for the production and consumption of soil greenhouse gas (GHG) emissions. Here, we assessed in a split-plot design the individual and interactive effects of tillage practices (conventional tillage (CT) vs. NT) and liming (Ca-amendment vs. not-amendment) on N2O and CH4 emissions from poorly drained acidic soils, over a field experiment with a rainfed triticale crop. Soil mineral N concentrations, pH, temperature, moisture, water soluble organic carbon, GHG fluxes and denitrification capacity were measured during the experiment. Tillage increased N2O emissions by 68% compared to NT and generally led to higher CH4 emissions; both effects were due to the higher soil moisture content under CT plots. Under CT, liming reduced N2O emissions by 61% whereas no effect was observed under NT. Under both CT and NT, CH4 oxidation was enhanced after liming application due to decreased Al(3+) toxicity. Based on our results, NT should be promoted as a means to improve soil physical properties and concurrently reduce N2O and CH4 emissions. Raising the soil pH via liming has positive effects on crop yield; here we show that it may also serve to mitigate CH4 emissions and, under CT, abate N2O emissions.

  15. Dissonance-Based Eating Disorder Prevention Program Reduces Reward Region Response to Thin Models; How Actions Shape Valuation.

    Directory of Open Access Journals (Sweden)

    Eric Stice

    Full Text Available Research supports the effectiveness of a dissonance-based eating disorder prevention program wherein high-risk young women with body dissatisfaction critique the thin ideal, which reduces pursuit of this ideal, and the theory that dissonance induction contributes to these effects. Based on evidence that dissonance produces attitudinal change by altering neural representation of valuation, we tested whether completing the Body Project would reduce response of brain regions implicated in reward valuation to thin models. Young women with body dissatisfaction were randomized to this intervention or an educational control condition, completing assessments and fMRI scans while viewing images of thin versus average-weight female models at pre and post. Whole brain analyses indicated that, compared to controls, Body Project participants showed greater reductions in caudate response to images of thin versus average-weight models, though participants in the two conditions showed pretest differences in responsivity of other brain regions that might have contributed to this effect. Greater pre-post reductions in caudate and putamen response to thin models correlated with greater reductions in body dissatisfaction. The finding that the Body Project reduces caudate response to thin models provides novel preliminary evidence that this intervention reduces valuation of media images thought to contribute to body dissatisfaction and eating disorders, providing support for the intervention theory by documenting that this intervention alters an objective biological outcome.

  16. Grouping of amino acids and recognition of protein structurally conserved regions by reduced alphabets of amino acids

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Sequence alignment is a common method for finding protein structurally conserved/similar regions. However, sequence alignment is often not accurate if sequence identities between to-be-aligned se- quences are less than 30%. This is because that for these sequences, different residues may play similar structural roles and they are incorrectly aligned during the sequence alignment using substitu- tion matrix consisting of 20 types of residues. Based on the similarity of physicochemical features, residues can be clustered into a few groups. Using such simplified alphabets, the complexity of protein sequences is reduced and at the same time the key information encoded in the sequences remains. As a result, the accuracy of sequence alignment might be improved if the residues are properly clustered. Here, by using a database of aligned protein structures (DAPS), a new clustering method based on the substitution scores is proposed for the grouping of residues, and substitution matrices of residues at different levels of simplification are constructed. The validity of the reduced alphabets is confirmed by relative entropy analysis. The reduced alphabets are applied to recognition of protein structurally conserved/similar regions by sequence alignment. The results indicate that the accuracy or efficiency of sequence alignment can be improved with the optimal reduced alphabet with N around 9.

  17. Grouping of amino acids and recognition of protein structurally conserved regions by reduced alphabets of amino acids

    Institute of Scientific and Technical Information of China (English)

    LI Jing; WANG Wei

    2007-01-01

    Sequence alignment is a common method for finding protein structurally conserved/similar regions.However, sequence alignment is often not accurate if sequence identities between to-be-aligned sequences are less than 30%. This is because that for these sequences, different residues may play similar structural roles and they are incorrectly aligned during the sequence alignment using substitution matrix consisting of 20 types of residues. Based on the similarity of physicochemical features,residues can be clustered into a few groups. Using such simplified alphabets, the complexity of protein sequences is reduced and at the same time the key information encoded in the sequences remains. As a result, the accuracy of sequence alignment might be improved if the residues are properly clustered.Here, by using a database of aligned protein structures (DAPS), a new clustering method based on the substitution scores is proposed for the grouping of residues, and substitution matrices of residues at different levels of simplification are constructed. The validity of the reduced alphabets is confirmed by relative entropy analysis. The reduced alphabets are applied to recognition of protein structurally conserved/similar regions by sequence alignment. The results indicate that the accuracy or efficiency of sequence alignment can be improved with the optimal reduced alphabet with N around 9.

  18. Dissonance-Based Eating Disorder Prevention Program Reduces Reward Region Response to Thin Models; How Actions Shape Valuation.

    Science.gov (United States)

    Stice, Eric; Yokum, Sonja; Waters, Allison

    2015-01-01

    Research supports the effectiveness of a dissonance-based eating disorder prevention program wherein high-risk young women with body dissatisfaction critique the thin ideal, which reduces pursuit of this ideal, and the theory that dissonance induction contributes to these effects. Based on evidence that dissonance produces attitudinal change by altering neural representation of valuation, we tested whether completing the Body Project would reduce response of brain regions implicated in reward valuation to thin models. Young women with body dissatisfaction were randomized to this intervention or an educational control condition, completing assessments and fMRI scans while viewing images of thin versus average-weight female models at pre and post. Whole brain analyses indicated that, compared to controls, Body Project participants showed greater reductions in caudate response to images of thin versus average-weight models, though participants in the two conditions showed pretest differences in responsivity of other brain regions that might have contributed to this effect. Greater pre-post reductions in caudate and putamen response to thin models correlated with greater reductions in body dissatisfaction. The finding that the Body Project reduces caudate response to thin models provides novel preliminary evidence that this intervention reduces valuation of media images thought to contribute to body dissatisfaction and eating disorders, providing support for the intervention theory by documenting that this intervention alters an objective biological outcome.

  19. Regional cooling for reducing brain temperature and intracranial pressure Resfriamento cerebral regional para redução da temperatura e pressão intracraniana

    Directory of Open Access Journals (Sweden)

    Luis Vicente Forte

    2009-06-01

    Full Text Available OBJECTIVE: To evaluate the effectiveness of regional cooling for reducing brain temperature (BrTe and intracranial pressure (ICP in patients where conventional clinical treatment has failed. METHOD: Regional cooling was carried out using ice bags covering the area of the craniectomy (regional method in 23 patients. The BrTe and ICP were determined using a fiber optic sensor. Thirteen patients (56.52% were female. The ages ranged from 16 to 83 years (mean of 48.9. The mean APACHE II score was 25 points (11-35. The patients were submitted, on mean, to 61.7 hours (20-96 of regional cooling. RESULTS: There was a significant reduction in mean BrTe (pOBJETIVO: Avaliar a eficácia do resfriamento regional na redução da temperatura cerebral (TeCe e pressão intracraniana (PIC após falha das medidas clínicas convencionais de tratamento. MÉTODO: O resfriamento cerebral foi realizado com bolsas com gelo, colocadas sobre a área de craniectomia (método regional em 23 doentes. A TeCe e PIC foram verificadas com sensor de fibra óptica. Treze (56,52% eram do sexo feminino. A idade variou de 16 a 83 anos (média 48,96. A pontuação média no índice APACHE II foi 25 pontos (11-35. Os doentes foram submetidos, em média, a 61,7 horas (20-96 de resfriamento regional. RESULTADOS: Houve uma redução significativa da TeCe média (p<0,0001-de 37,1ºC para 35,2ºC e da PIC média (p=0,0001-de 28 mmHg para 13 mmHg. CONCLUSÃO: Nossos resultados sugerem que o resfriamento regional foi eficaz no controle da PIC nos doentes submetidos, previamente, a craniectomia descompressiva.

  20. [Depression and myocardial infaction].

    Science.gov (United States)

    Testuz, A

    2009-03-04

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

  1. Appraising options to reduce shallow groundwater tables and enhance flow conditions over regional scales in an irrigated alluvial aquifer system

    Science.gov (United States)

    Morway, Eric D.; Gates, Timothy K.; Niswonger, Richard G.

    2013-01-01

    Some of the world’s key agricultural production systems face big challenges to both water quantity and quality due to shallow groundwater that results from long-term intensive irrigation, namely waterlogging and salinity, water losses, and environmental problems. This paper focuses on water quantity issues, presenting finite-difference groundwater models developed to describe shallow water table levels, non-beneficial groundwater consumptive use, and return flows to streams across two regions within an irrigated alluvial river valley in southeastern Colorado, USA. The models are calibrated and applied to simulate current baseline conditions in the alluvial aquifer system and to examine actions for potentially improving these conditions. The models provide a detailed description of regional-scale subsurface unsaturated and saturated flow processes, thereby enabling detailed spatiotemporal description of groundwater levels, recharge to infiltration ratios, partitioning of ET originating from the unsaturated and saturated zones, and groundwater flows, among other variables. Hybrid automated and manual calibration of the models is achieved using extensive observations of groundwater hydraulic head, groundwater return flow to streams, aquifer stratigraphy, canal seepage, total evapotranspiration, the portion of evapotranspiration supplied by upflux from the shallow water table, and irrigation flows. Baseline results from the two regional-scale models are compared to model predictions under variations of four alternative management schemes: (1) reduced seepage from earthen canals, (2) reduced irrigation applications, (3) rotational lease fallowing (irrigation water leased to municipalities, resulting in temporary dry-up of fields), and (4) combinations of these. The potential for increasing the average water table depth by up to 1.1 and 0.7 m in the two respective modeled regions, thereby reducing the threat of waterlogging and lowering non-beneficial consumptive use

  2. [Indications of primary cesarean deliveries in a regional teaching hospital and reasonable strategies for reducing them].

    Science.gov (United States)

    Zelli, P; Boussat, B; Wetzel, A; Ronin, C; Pons, J-C; Sergent, F

    2016-10-01

    To characterize the indications of primary cesarean sections and discuss the various possibilities to reduce them. Retrospective study, carried out over a period of 1 year in a university hospital having a level 3 perinatal activity, including the 499 primary cesarean sections of 2013. Two groups were defined by parity: nulliparous patients (group 1) and multiparous patients who had never previously been delivered by cesarean section (group 2). We have assessed the indication of every primary cesarean section and health status of newborns in each group. Groups 1 and 2 respectively included 369 and 130 patients. The cesarean section rate in 2013 was 24.7% with a primary cesarean section rate of 17%. Seventy-four percent of the primary caesarean deliveries were performed on nulliparous women and 26% on multiparous (Pcesarean delivery were non-reassuring fetal heart rate tracing (47.1%), failure to progress (24.8%) for which nulliparous women were more involved (29% vs. 13%, Pcesarean section rate. Copyright © 2016. Published by Elsevier Masson SAS.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  4. FHL1 reduces dystrophy in transgenic mice overexpressing FSHD muscular dystrophy region gene 1 (FRG1.

    Directory of Open Access Journals (Sweden)

    Sandra J Feeney

    Full Text Available Facioscapulohumeral muscular dystrophy (FSHD is an autosomal-dominant disease with no effective treatment. The genetic cause of FSHD is complex and the primary pathogenic insult underlying the muscle disease is unknown. Several disease candidate genes have been proposed including DUX4 and FRG1. Expression analysis studies of FSHD report the deregulation of genes which mediate myoblast differentiation and fusion. Transgenic mice overexpressing FRG1 recapitulate the FSHD muscular dystrophy phenotype. Our current study selectively examines how increased expression of FRG1 may contribute to myoblast differentiation defects. We generated stable C2C12 cell lines overexpressing FRG1, which exhibited a myoblast fusion defect upon differentiation. To determine if myoblast fusion defects contribute to the FRG1 mouse dystrophic phenotype, this strain was crossed with skeletal muscle specific FHL1-transgenic mice. We previously reported that FHL1 promotes myoblast fusion in vitro and FHL1-transgenic mice develop skeletal muscle hypertrophy. In the current study, FRG1 mice overexpressing FHL1 showed an improvement in the dystrophic phenotype, including a reduced spinal kyphosis, increased muscle mass and myofiber size, and decreased muscle fibrosis. FHL1 expression in FRG1 mice, did not alter satellite cell number or activation, but enhanced myoblast fusion. Primary myoblasts isolated from FRG1 mice showed a myoblast fusion defect that was rescued by FHL1 expression. Therefore, increased FRG1 expression may contribute to a muscular dystrophy phenotype resembling FSHD by impairing myoblast fusion, a defect that can be rescued by enhanced myoblast fusion via expression of FHL1.

  5. Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study

    Directory of Open Access Journals (Sweden)

    Brooks Samantha J

    2011-11-01

    Full Text Available Abstract Background Previous Magnetic Resonance Imaging (MRI studies of people with anorexia nervosa (AN have shown differences in brain structure. This study aimed to provide preliminary extensions of this data by examining how different levels of appetitive restraint impact on brain volume. Methods Voxel based morphometry (VBM, corrected for total intracranial volume, age, BMI, years of education in 14 women with AN (8 RAN and 6 BPAN and 21 women (HC was performed. Correlations between brain volume and dietary restraint were done using Statistical Package for the Social Sciences (SPSS. Results Increased right dorsolateral prefrontal cortex (DLPFC and reduced right anterior insular cortex, bilateral parahippocampal gyrus, left fusiform gyrus, left cerebellum and right posterior cingulate volumes in AN compared to HC. RAN compared to BPAN had reduced left orbitofrontal cortex, right anterior insular cortex, bilateral parahippocampal gyrus and left cerebellum. Age negatively correlated with right DLPFC volume in HC but not in AN; dietary restraint and BMI predicted 57% of variance in right DLPFC volume in AN. Conclusions In AN, brain volume differences were found in appetitive, somatosensory and top-down control brain regions. Differences in regional GMV may be linked to levels of appetitive restraint, but whether they are state or trait is unclear. Nevertheless, these discrete brain volume differences provide candidate brain regions for further structural and functional study in people with eating disorders.

  6. Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study.

    Science.gov (United States)

    Brooks, Samantha J; Barker, Gareth J; O'Daly, Owen G; Brammer, Michael; Williams, Steven C R; Benedict, Christian; Schiöth, Helgi B; Treasure, Janet; Campbell, Iain C

    2011-11-17

    Previous Magnetic Resonance Imaging (MRI) studies of people with anorexia nervosa (AN) have shown differences in brain structure. This study aimed to provide preliminary extensions of this data by examining how different levels of appetitive restraint impact on brain volume. Voxel based morphometry (VBM), corrected for total intracranial volume, age, BMI, years of education in 14 women with AN (8 RAN and 6 BPAN) and 21 women (HC) was performed. Correlations between brain volume and dietary restraint were done using Statistical Package for the Social Sciences (SPSS). Increased right dorsolateral prefrontal cortex (DLPFC) and reduced right anterior insular cortex, bilateral parahippocampal gyrus, left fusiform gyrus, left cerebellum and right posterior cingulate volumes in AN compared to HC. RAN compared to BPAN had reduced left orbitofrontal cortex, right anterior insular cortex, bilateral parahippocampal gyrus and left cerebellum. Age negatively correlated with right DLPFC volume in HC but not in AN; dietary restraint and BMI predicted 57% of variance in right DLPFC volume in AN. In AN, brain volume differences were found in appetitive, somatosensory and top-down control brain regions. Differences in regional GMV may be linked to levels of appetitive restraint, but whether they are state or trait is unclear. Nevertheless, these discrete brain volume differences provide candidate brain regions for further structural and functional study in people with eating disorders.

  7. 超声斑点追踪技术对系统性红斑狼疮患者局部心肌收缩功能的评价%The implementation of speckle tracking imaging technology on functional assessment of regional myocardial contraction in patients with systemic lupus erythematosus

    Institute of Scientific and Technical Information of China (English)

    乔英艳; 雷成功; 段银玲; 芦芳; 王泽; 王彩虹; 张玖; 马洪山

    2011-01-01

    were measured by automated functional imaging (AFI) software of 2-DSE.All parameters were compared between the two groups.② Twenty cases were randomly taken from the normal group.The same observer at different times and two observers measure the strain of left ventricular respectively.The results of the measurement between the two groups were compared with unpaired t test and its relevance was analyzed using Pearson's correlation analysis.ResultsLeft ventricular two-dimensional longitudinal strain gradually increased from the base to apex in the normal group.There were statistically differences between the apical segments and the basal,middle segments of every left ventricular wall (P<0.05).The same wall segment time to peak myocardial systolic peak strain was consistent.Left ventricular two-dimensional longitudinal strain gradually increased from the base to apex in the SLE group,except for the anterio-septal and anterior wall [ (-18.7±4.2)%,(-16.3±9.4)%,(-18.1±10.5)% vs (-19.0±9.0)%,(-18.6±7.9)%,(-17.7±1.4)% ].There was no statistically significant difference between the apical segments and the basal,middle segments of every left ventricular wall(P>0.05).All parameters of S were significantly higher in the normal group than those of the SLE group.The difference was statistically signoficant (P<0.05).The time to peak systolic peak strain of every segments was not consistent.The results from the same observer at different times and peak systolic myocardial strain measurements by the two observers were correlated well(P<0.01).Conclusion The myocardial function assessment by STI technology in the SLE patients is significantly different from that of the normal control:SLE patients with left ventricular myocardial damage can be manifested as reduced regional myocardial systolic peak strain.

  8. [The features of myocardial deformation of left ventricle in patients with ischemic heart disease defined by the two dimensional strain method].

    Science.gov (United States)

    Galimskaia, V A; Donchenko, I A; Romanovskaia, E M; Oleĭnikov, V É

    2014-01-01

    Aim of this study was to assess qualitative and quantitative features of deformation parameters of left ventricular myocardium in patients with ischemic heart disease (IHD) with and without history of myocardial infarction (MI) using two-dimensional strain imaging. We examined 30 patients with clinical IHD with (group 1, n = 15) and without (group 2, n = 15) history of MI and 20 healthy volunteers. Compared with healthy subjects IHD patients of both groups had reduced longitudinal and circular myocardial deformation. There were no significant differences between patients with IHD and controls in parameters of radial, global, and regional deformation.

  9. Glycemic Control for Patients With Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Hai-peng XIAO; Juan CHEN

    2009-01-01

    @@ The risk of myocardial infarction increases in patients with diabetes mellitus. The incidence of myocardial in-farction is similar in patients with type 2 diabetes without history of myocardial infarction and in non-diabetic pa-tients with history of myocardial infarction. Diabetes mellitus was considered as a coronary disease equivalent by the National Cholesterol Education Program. Strict glycemic control can improve the long-term outcome of both type 1 and type 2 diabetes mellitus. Whatever with diabetic or non-diabetic, strict glycemic control with in-tensive insulin therapy can reduce the mortality of criti-cally ill patients in hospital. After myocardial infarction, there would be a worse outcome for patients with poor glycemic control, whatever in diabetic or non-diabetic patients with stress hyperglycemia.

  10. Cardioprotective effect of amlodipine in oxidative stress induced by experimental myocardial infarction in rats

    Directory of Open Access Journals (Sweden)

    Sudhira Begum

    2007-12-01

    Full Text Available The present study investigated whether the administration of amlodipine ameliorates oxidative stress induced by experimental myocardial infarction in rats. Adrenaline was administered and myocardial damage was evaluated biochemically [significantly increased serum aspertate aminotransferase (AST, lactate dehydrogenase (LDH and malondialdehyde (MDA levels of myocardial tissue] and histologically (morphological changes of myocardium. Amlodipine was administered as pretreatment for 14 days in adrenaline treated rats. Statistically significant amelioration in all the biochemical parameters supported by significantly improved myocardial morphology was observed in amlodipine pretreatment. It was concluded that amlodipine afforded cardioprotection by reducing oxidative stress induced in experimental myocardial infarction of catecholamine assault.

  11. Effects of reperfusion arrhythmias and myocardial connexin 43 by Compound Astragalus Mixture Nourishing Heart in a rat model of acute myocardial ischemic reperfusion injury%复方黄芪养心合剂对大鼠缺血再灌注心肌缝隙连接蛋白43的影响

    Institute of Scientific and Technical Information of China (English)

    陈启兰; 龚一萍; 祝光礼; 齐国安; 赫小龙; 任兴昌; 王骋

    2013-01-01

    目的:观察复方黄芪养心合剂对SD大鼠缺血再灌注心肌细胞缝隙连接蛋白43(Cx43)分布的改变和表达的影响.方法:应用复方黄芪养心合剂按每天14g/kg剂量、琥珀酸美托洛尔缓释片按每天(MSSRT) 9.5mg/kg剂量灌胃2周后,对SD大鼠行冠状动脉左前降支结扎30min后再灌注60min造成心肌缺血再灌注(I/R)损伤模型,记录Ⅱ导联心电图,采用免疫组织化学法(IHC)观察心肌细胞Cx43分布的改变;运用Image Pro Plus 6.0图像分析软件对Cx43的表达进行半定量分析.结果:Cx43平均光密度(AOD)I/R组心肌内膜下缺血区Cx43的AOD显著低于假手术组(P<0.01),且MSSRT组、复方组较1/R组升高(P<0.05).结论:对冠状动脉左前降支结扎术后再灌注SD大鼠,复方黄芪养心合剂对心肌细胞Cx43分布的改变有改善作用,有促进心肌内膜下缺血区域Cx43表达的作用,其作用与MSSRT相近.%Objective: To evaluate the effects of Compound Astragalus Mixture Nourishing Heart (CAMNH) antiarrhythmia and myocardial connexin 43 (Cx43) in a rat model of acute myocardial ischemic reperfusion injury. Methods: Myocardial infarction (MI) was induced by ligating left anterior descending coronary artery (LAD) for 30 minutes, followed by reperfusion of 60 minutes in rats. Rats were treated with CAMNH (14g·kg-1·d-1) or metoprolol succinate sustained-release tablets (MSSRT, 9.5mg·kg-1d-1) for 14 days before MI. The distribution of myocardial Cx43 was observed by Immunohistochemistry (IHC), and the expression of myocardial Cx43, which were represented by average optical density (AOD), was measured by Image Pro Plus 6.0. Results: The expression of myocardial Cx43 in infarction region was significantly reduced, disordered and even all disappearing, the expression of myocardial Cx43 from infarction region into ischemic region and normal region had a gradual recovery of transitional variability. Ischemia/reperfusion(I/R) group vs sham-operated (SO

  12. Rock outcrops reduce temperature-induced stress for tropical conifer by decoupling regional climate in the semiarid environment.

    Science.gov (United States)

    Locosselli, Giuliano Maselli; Cardim, Ricardo Henrique; Ceccantini, Gregório

    2016-05-01

    We aimed to understand the effect of rock outcrops on the growth of Podocarpus lambertii within a microrefuge. Our hypothesis holds that the growth and survival of this species depend on the regional climate decoupling provided by rock outcrops. To test this hypothesis, we characterized the microclimate of (1) surrounding vegetation, (2) rock outcrop corridors, and (3) adjacencies. We assessed population structure by collecting data of specimen stem diameter and height. We also assessed differences between vegetation associated or not with outcrops using satellite imaging. For dendrochronological analyses, we sampled 42 individuals. Tree rings of 31 individuals were dated, and climate-growth relationships were tested. Rock outcrops produce a favorable microclimate by reducing average temperature by 4.9 °C and increasing average air humidity by 12 %. They also reduce the variability of atmospheric temperature by 42 % and air humidity by 20 % supporting a vegetation with higher leaf area index. Within this vegetation, specimen height was strongly constrained by the outcrop height. Although temperature and precipitation modulate this species growth, temperature-induced stress is the key limiting growth factor for this population of P. lambertii. We conclude that this species growth and survival depend on the presence of rock outcrops. These topography elements decouple regional climate in a favorable way for this species growth. However, these benefits are restricted to the areas sheltered by rock outcrops. Although this microrefuge supported P. lambertii growth so far, it is unclear whether this protection would be sufficient to withstand the stress of future climate changes.

  13. Maintaining yields and reducing nitrogen loss in rice-wheat rotation system in Taihu Lake region with proper fertilizer management

    Science.gov (United States)

    Xue, Lihong; Yu, Yingliang; Yang, Linzhang

    2014-11-01

    In the Tailake region of China, heavy nitrogen (N) loss of rice-wheat rotation systems, due to high fertilizer-N input with low N use efficiency (NUE), was widely reported. To alleviate the detrimental impacts caused by N loss, it is necessary to improve the fertilizer management practices. Therefore, a 3 yr field experiments with different N managements including organic combined chemical N treatment (OCN, 390 kg N ha-1 yr-1, 20% organic fertilizer), control-released urea treatment (CRU, 390 kg N ha-1 yr-1, 70% resin-coated urea), reduced chemical N treatment (RCN, 390 kg N ha-1 yr-1, all common chemical fertilizer), and site-specific N management (SSNM, 333 kg N ha-1 yr-1, all common chemical fertilizer) were conducted in the Taihu Lake region with the ‘farmer’s N’ treatment (FN, 510 kg N ha-1 yr-1, all common chemical fertilizer) as a control. Grain yield, plant N uptake (PNU), NUE, and N losses via runoff, leaching, and ammonia volatilization were assessed. In the rice season, the FN treatment had the highest N loss and lowest NUE, which can be attributed to an excessive rate of N application. Treatments of OCN and RCN with a 22% reduced N rate from FN had no significant effect on PNU nor the yield of rice in the 3 yr; however, the NUE was improved and N loss was reduced 20-32%. OCN treatment achieved the highest yield, while SSNM has the lowest N loss and highest NUE due to the lowest N rate. In wheat season, N loss decreased about 28-48% with the continuous reduction of N input, but the yield also declined, with the exception of OCN treatment. N loss through runoff, leaching and ammonia volatilization was positively correlated with the N input rate. When compared with the pure chemical fertilizer treatment of RCN under the same N input, OCN treatment has better NUE, better yield, and lower N loss. 70% of the urea replaced with resin-coated urea had no significant effect on yield and NUE improvement, but decreased the ammonia volatilization loss. Soil

  14. Tissue Velocities and Myocardial Deformation in Asymptomatic and Symptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian

    2015-01-01

    BACKGROUND: Assessment of myocardial longitudinal function has proved to be a sensitive marker of deteriorating myocardial function in aortic stenosis, demonstrated by both color Doppler tissue imaging and recently by two-dimensional speckle-tracking echocardiography. The aim of this study...... was to compare velocity (color Doppler tissue imaging) and deformation (two-dimensional speckle-tracking echocardiography) in relation to global and regional longitudinal function in asymptomatic and severe symptomatic aortic stenosis. METHODS: In a cross-sectional design, 231 patients with aortic stenosis were...... divided into four groups: asymptomatic moderate aortic stenosis (aortic valve area, 1.0-1.5 cm(2); n = 38), asymptomatic severe aortic stenosis (aortic valve area aortic stenosis with preserved (n = 68) and reduced (

  15. Developing the "Compendium of Strategies to Reduce Teacher Turnover in the Northeast and Islands Region." A Companion to the Database. Issues & Answers. REL 2008-No. 052

    Science.gov (United States)

    Ellis, Pamela; Grogan, Marian; Levy, Abigail Jurist; Tucker-Seeley, Kevon

    2008-01-01

    This report provides state-, regional-, and district-level decisionmakers in the Northeast and Islands Region with a description of the "Compendium of Strategies to Reduce Teacher Turnover in the Northeast and Islands Region," a searchable database of selected profiles of retention strategies implemented in Connecticut, Maine,…

  16. INFLAMMATORY REACTIONS IN EXPERIMENTAL MYOCARDIAL DAMAGE

    Directory of Open Access Journals (Sweden)

    L. D. Khidirova

    2015-12-01

    Full Text Available Aim. To study the role of hormonal and metabolic changes specific to myocardial infarction in the development of inflammatory reactions in the experimental non-coronarogenic myocardial damage. Material and methods. Wistar male rats weighing 180–220 g (n=80 were used in the study. Metabolic myocardial infarction in intact rats and rats with alloxan diabetes was induced by epinephrine injected subcutaneously as single dose or daily (7 days. Myocardial infarction was verified by ECG analysis, and by histological control. Nitroblue tetrazolium test (NBT-test both spontaneous and zymosan induced NBT-test was used to determine the oxygen-dependent functional activity of neutrophils and their biocidal reserve. Determination of cationic proteins in neutrophils of peripheral blood was performed using lysosomal-cationic test. Results. Increase in oxygen-dependent neutrophil biocidal activity was found as well as reduction in biocidal reserves. Indicators of zymosan induced NBT-test raised according to aggravation of hormonal changes much slower: alloxan increased them by 10% only , epinephrine single dose — by 35%, long-term epinephrine administration simultaneously with alloxan — by 54%. At the same time oxygen-independent neutrophil activity determined by intra-neutrophil cationic proteins level was significantly reduced. Blood levels of pro-inflammatory cytokines raised according to progression of the changes in myocardium: tumor necrosis factor-α (from 5.5±0.03 to 12.6±1.23 pg/ml and interleukin-1β (from 6.0±0.18 to 11.1±0.78 pg/ml. Conclusion. Experimental model of hormonal changes specific to myocardial infarction detected a relationship between inflammatory reactions accompanying myocardial damage and increased catecholamine production.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  18. Vegetation-climate feedback causes reduced precipitation in CMIP5 regional Earth system model simulation over Africa

    Science.gov (United States)

    Wu, Minchao; Smith, Benjamin; Schurgers, Guy; Lindström, Joe; Rummukainen, Markku; Samuelsson, Patrick

    2013-04-01

    Terrestrial ecosystems have been demonstrated to play a significant role within the climate system, amplifying or dampening climate change via biogeophysical and biogeochemical exchange with the atmosphere and vice versa (Cox et al. 2000; Betts et al. 2004). Africa is particularly vulnerable to climate change and studies of vegetation-climate feedback mechanisms on Africa are still limited. Our study is the first application of A coupled Earth system model at regional scale and resolution over Africa. We applied a coupled regional climate-vegetation model, RCA-GUESS (Smith et al. 2011), over the CORDEX Africa domain, forced by boundary conditions from a CanESM2 CMIP5 simulation under the RCP8.5 future climate scenario. The simulations were from 1961 to 2100 and covered the African continent at a horizontal grid spacing of 0.44°. RCA-GUESS simulates changes in the phenology, productivity, relative cover and population structure of up to eight plant function types (PFTs) in response to forcing from the climate part of the model. These vegetation changes feedback to simulated climate through dynamic adjustments in surface energy fluxes and surface properties. Changes in the net ecosystem-atmosphere carbon flux and its components net primary production (NPP), heterotrophic respiration and emissions from biomass burning were also simulated but do not feedback to climate in our model. Constant land cover was assumed. We compared simulations with and without vegetation feedback switched "on" to assess the influence of vegetation-climate feedback on simulated climate, vegetation and ecosystem carbon cycling. Both positive and negative warming feedbacks were identified in different parts of Africa. In the Sahel savannah zone near 15°N, reduced vegetation cover and productivity, and mortality caused by a deterioration of soil water conditions led to a positive warming feedback mediated by decreased evapotranspiration and increased sensible heat flux between vegetation and

  19. 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,

  20. Novel cardiac nuclear magnetic resonance method for noninvasive assessment of myocardial fibrosis in hemodialysis patients.

    Science.gov (United States)

    Graham-Brown, Matthew P M; March, Daniel S; Churchward, Darren R; Stensel, David J; Singh, Anvesha; Arnold, Ranjit; Burton, James O; McCann, Gerry P

    2016-10-01

    Left ventricular hypertrophy and myocardial fibrosis frequently occur in patients with end-stage renal disease receiving hemodialysis therapy and are associated with poor prognosis. Native T1 mapping is a novel cardiac magnetic resonance imaging technique that measures native myocardial T1 relaxation, a surrogate of myocardial fibrosis. Here we compared global and segmental native myocardial T1 time and global longitudinal, circumferential and segmental strain, and cardiac function of 35 hemodialysis patients and 22 control individuals. The median native global T1 time was significantly higher in the hemodialysis than the control group (1270 vs. 1085 ms), with the septal regions of hemodialysis patients having significantly higher median T1 times than nonseptal regions (1293 vs. 1252 ms). The mean peak global circumferential strain and global longitudinal strain were both significantly reduced in hemodialysis patients compared with controls (-18.3 vs. -21.7 and -16.1 vs. -20.4, respectively). Systolic strain was also significantly reduced in the septum compared with the nonseptal myocardium in hemodialysis patients (-16.2 vs. -21.9) but not in control subjects. Global circumferential strain and longitudinal strain significantly correlated with global native T1 values (r = 0.41 and 0.55, respectively), and the septal native T1 significantly correlated with the septal systolic strain (r = 0.46). Thus, myocardial fibrosis may be assessed noninvasively with native T1 mapping; the interventricular septum appears to be particularly prone to the development of fibrosis in hemodialysis patients.

  1. Deletions within the mouse beta-globin locus control region preferentially reduce beta(min) globin gene expression.

    Science.gov (United States)

    Alami, R; Bender, M A; Feng, Y Q; Fiering, S N; Hug, B A; Ley, T J; Groudine, M; Bouhassira, E E

    2000-02-01

    The mouse beta-globin gene cluster is regulated, at least in part, by a locus control region (LCR) composed of several developmentally stable DNase I hypersensitive sites located upstream of the genes. In this report, we examine the level of expression of the beta(min) and beta(maj) genes in adult mice in which HS2, HS3, or HS5,6 has been either deleted or replaced by a selectable marker via homologous recombination in ES cells. Primer extension analysis of RNA extracted from circulating reticulocytes and HPLC analysis of globin chains from peripheral red blood cells revealed that all mutations that reduce the overall output of the locus preferentially decrease beta(min) expression over beta(maj). The implications of these findings for the mechanism by which the LCR controls expression of the beta(maj) and beta(min) promoters are discussed.

  2. Safety and Efficacy of a Pharmacoinvasive Strategy in ST-Segment Elevation Myocardial Infarction: A Patient Population Study Comparing a Pharmacoinvasive Strategy With a Primary Percutaneous Coronary Intervention Strategy Within a Regional System.

    Science.gov (United States)

    Rashid, Mohammed K; Guron, Nita; Bernick, Jordan; Wells, George A; Blondeau, Melissa; Chong, Aun-Yeong; Dick, Alexander; Froeschl, Michael P V; Glover, Chris A; Hibbert, Benjamin; Labinaz, Marino; Marquis, Jean-François; Osborne, Christina; So, Derek Y; Le May, Michel R

    2016-10-10

    This study investigated the safety and efficacy of a pharmacoinvasive strategy compared with a primary percutaneous coronary intervention (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) in the context of a real-world system. Primary PCI continues to be the optimal reperfusion therapy; however, in areas where PCI centers are not readily available, a pharmacoinvasive strategy has been proposed. The University of Ottawa Heart Institute regional STEMI system provides a primary PCI strategy for patients presenting within a 90-km radius from the PCI center, and a pharmacoinvasive strategy for patients outside this limit. We included all confirmed STEMI patients between April 2009 and May 2011. The primary efficacy outcome was a composite of mortality, reinfarction, or stroke and the primary safety outcome was major bleeding. We identified 236 and 980 consecutive patients enrolled in pharmacoinvasive and primary PCI strategies, respectively. The median door-to-needle time was 31 min in the pharmacoinvasive group and the median door-to-balloon time was 95 min in the primary PCI group. In a multivariable model, there was no significant difference in the primary efficacy outcome (odds ratio: 1.54; p = 0.21); however, the propensity for more bleeding with a pharmacoinvasive strategy approached statistical significance (odds ratio: 2.02; p = 0.08). Within the context of a STEMI system, a pharmacoinvasive strategy was associated with similar rates of the composite of mortality, reinfarction, or stroke as compared with a primary PCI strategy; however, there was a propensity for more bleeding with a pharmacoinvasive strategy. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. MYOCARDIAL DEFORMATION AND COMPLETE LEFT BUNDLE BRANCH BLOCK

    Directory of Open Access Journals (Sweden)

    E. N. Pavlyukova

    2015-12-01

    Full Text Available Tissue Doppler imaging is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular systolic and diastolic function. Over the last 10 years, myocardial deformation imaging has become possible initially with tissue Doppler , and more recently with myocardial speckle-tracking using 2D echocardiography. Unlike simple tissue velocity measurements, deformation measurements are specific for the region of interest. Strain rate or strain measurements have been used as sensitive indicators for subclinical diseases, and it is the most widely used tool to assess mechanical dyssynchrony. Left bundle branch block is a frequent, etiologically heterogeneous, clinically hostile and diagnostically challenging entity. About 2% of patients underwent cardiac stress testing show stable or intermittent left bundle branch block. Presence of left bundle branch block is associated with a lower and slower diastolic coronary flow velocity especially during hyperemia. Stress echocardiography is the best option for the diagnosis of ischemic heart disease, albeit specificity and sensitivity reduce in patients with left bundle branch block in the territory of left anterior descending artery in presence of initial septum dyskinesia.

  4. Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Markis, J.E.; Malagold, M.; Parker, J.A.; Silverman, K.J.; Barry, W.H.; Als, A.V.; Paulin, S.; Grossman, W.; Braunwald, E.

    1981-10-01

    Nine patients with acute myocardial infarction had cardiac catheterization and intracoronary infusions of streptokinase 2.3 to 4.3 hours (mean, 3.5) after the onset of symptoms. Occluded coronary arteries were opened within approximately 20 minutes in all patients, but reocclusion occurred in one patient. The immediate effect of thrombolysis on myocardial salvage was assessed with the intracoronary injection of thallium-201. Improved regional perfusion, indicating myocardial salvage after recanalization, was observed in seven of the nine patients. One patient, who had also sustained a nontransmural infarction one week before, had no change after thrombolysis. In the ninth patient, recanalization of a coronary artery was followed by reocclusion and worsening of the myocardial-perfusion defect. Intracoronary thallium-201 studies two weeks and three months after streptokinase infusion in two patients were unchanged in comparison with scintiscans performed 1.5 hours after thrombolysis. These short-term observations suggest that recanalization of obstructed coronary arteries after intracoronary thrombolysis can salvage jeopardized myocardium, However, evaluation of the long-term effects of this procedure on survival and myocardial function will require controlled clinical trials.

  5. Detection and localization of myocardial infarction using K-nearest neighbor classifier.

    Science.gov (United States)

    Arif, Muhammad; Malagore, Ijaz A; Afsar, Fayyaz A

    2012-02-01

    This paper presents automatic detection and localization of myocardial infarction (MI) using K-nearest neighbor (KNN) classifier. Time domain features of each beat in the ECG signal such as T wave amplitude, Q wave and ST level deviation, which are indicative of MI, are extracted from 12 leads ECG. Detection of MI aims to classify normal subjects without myocardial infarction and subjects suffering from Myocardial Infarction. For further investigation, Localization of MI is done to specify the region of infarction of the heart. Total 20,160 ECG beats from PTB database available on Physio-bank is used to investigate the performance of extracted features with KNN classifier. In the case of MI detection, sensitivity and specificity of KNN is found to be 99.9% using half of the randomly selected beats as training set and rest of the beats for testing. Moreover, Arif-Fayyaz pruning algorithm is used to prune the data which will reduce the storage requirement and computational cost of search. After pruning, sensitivity and specificity are dropped to 97% and 99.6% respectively but training is reduced by 93%. Myocardial Infarction beats are divided into ten classes based on the location of the infarction along with one class of normal subjects. Sensitivity and Specificity of above 90% is achieved for all eleven classes with overall classification accuracy of 98.8%. Some of the ECG beats are misclassified but interestingly these are misclassified to those classes whose location of infarction is near to the true classes of the ECG beats. Pruning is done on the training set for eleven classes and training set is reduced by 70% and overall classification accuracy of 98.3% is achieved. The proposed method due to its simplicity and high accuracy over the PTB database can be very helpful in correct diagnosis of MI in a practical scenario.

  6. Effect of oxidation state on Bi mineral speciation in oxidized and reduced granitoids from the Uetsu region, NE Japan

    Science.gov (United States)

    Izumino, Yuya; Maruoka, Teruyuki; Nakashima, Kazuo

    2016-06-01

    The relationship between bismuth (Bi) mineral speciation and redox state in three types of granitoids from the Uetsu region, northeast Japan is investigated. Electron microprobe analysis of Bi minerals, sphalerite, Mg-Fe-bearing carbonate minerals, and muscovite, as well as sulfur isotope analysis of sulfide minerals and microthermometric study of fluid inclusions reveal that Bi mineral speciation varies according to the redox state of the granitoids. For example, native bismuth and bismuthinite are abundant and Bi sulfosalts are rare in the lowest fS2 and fO2 mineralized zones of the reduced Iwafune granite (S-type, ilmenite-series) while Bi sulfosalts (Bi3+) are abundant and trace amounts of native bismuth (Bi0) and bismuthinite are found in the highest fS2 and fO2 mineralized zones of the oxidized Wasada granodiorite (I-type, magnetite-series). Bismuthinite is a major Bi mineral, and native bismuth and Bi sulfosalts occur in only minor amounts in the mineralized zones of the Nishitagawa granodiorite (I-type, ilmenite-series), which has intermediate fS2 and fO2 to that of the Iwafune and Wasada samples. Our study indicates that Bi mineral speciation related to granitic intrusive activity is controlled by the redox state of the magmatism, such that native bismuth is typical of reducing conditions, whereas Bi sulfosalts are typical of oxidizing conditions.

  7. Using FOSM-Based Data Worth Analyses to Design Geophysical Surveys to Reduce Uncertainty in a Regional Groundwater Model Update

    Science.gov (United States)

    Smith, B. D.; White, J.; Kress, W. H.; Clark, B. R.; Barlow, J.

    2016-12-01

    Hydrogeophysical surveys have become an integral part of understanding hydrogeological frameworks used in groundwater models. Regional models cover a large area where water well data is, at best, scattered and irregular. Since budgets are finite, priorities must be assigned to select optimal areas for geophysical surveys. For airborne electromagnetic (AEM) geophysical surveys, optimization of mapping depth and line spacing needs to take in account the objectives of the groundwater models. The approach discussed here uses a first-order, second-moment (FOSM) uncertainty analyses which assumes an approximate linear relation between model parameters and observations. This assumption allows FOSM analyses to be applied to estimate the value of increased parameter knowledge to reduce forecast uncertainty. FOSM is used to facilitate optimization of yet-to-be-completed geophysical surveying to reduce model forecast uncertainty. The main objective of geophysical surveying is assumed to estimate values and spatial variation in hydrologic parameters (i.e. hydraulic conductivity) as well as map lower permeability layers that influence the spatial distribution of recharge flux. The proposed data worth analysis was applied to Mississippi Embayment Regional Aquifer Study (MERAS) which is being updated. The objective of MERAS is to assess the ground-water availability (status and trends) of the Mississippi embayment aquifer system. The study area covers portions of eight states including Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. The active model grid covers approximately 70,000 square miles, and incorporates some 6,000 miles of major rivers and over 100,000 water wells. In the FOSM analysis, a dense network of pilot points was used to capture uncertainty in hydraulic conductivity and recharge. To simulate the effect of AEM flight lines, the prior uncertainty for hydraulic conductivity and recharge pilots along potential flight lines was

  8. Effect of Wenxin Granule on Ventricular Remodeling and Myocardial Apoptosis in Rats with Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Aiming Wu

    2013-01-01

    Full Text Available Aim. To determine the effect of a Chinese herbal compound named Wenxin Granule on ventricular remodeling and myocardial apoptosis in rats with myocardial infarction (MI. Methods. Male Sprague-Dawley (SD rats were randomly divided into four groups: the control group, the model group, the metoprolol group, and the Wenxin Granule group (WXKL group with sample size (n of 7 rats in each group. An MI model was established in all rats by occlusion of the left anterior descending coronary artery (the control group was without occlusion. Wenxin Granule (1.35 g/kg/day, metoprolol (12 mg/kg/day, and distilled water (5 mL/kg/day for the control and model groups were administered orally for 4 weeks. Ultrasonic echocardiography was used to examine cardiac structural and functional parameters. Myocardial histopathological changes were observed using haematoxylin and eosin (H&E dyeing. Myocardial apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL staining. Serum angiotensin II (Ang II concentration was measured using the enzyme-linked immunosorbent assay (ELISA. Results. It was found that Wenxin Granule could partially reverse ventricular remodeling, improve heart function, alleviate the histopathological damage, inhibit myocardial apoptosis, and reduce Ang II concentration in rats with MI. Conclusions. The results of the current study suggest that Wenxin Granule may be a potential alternative and complementary medicine for the treatment of MI.

  9. Practical guidelines for treatment with beta-blockers and nitrates in patients with acute myocardial infarction

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); P.W.J.C. Serruys (Patrick); P.M. Fioretti (Paolo); M.J.B.M. van den Brand (Marcel); P.G. Hugenholtz (Paul)

    1983-01-01

    textabstractTreatment of a patient with myocardial infarction might include opiates and sedatives to reduce pain and anxiety, heparin, antiarrhythmic drugs, diuretics which aim at improvement of myocardial function and drugs which might reduce the ischemic area at risk and thus mortality such as bet

  10. Late reperfusion of a totally occluded infarct-related artery increases granulocyte-colony stimulation factor and reduces stroma-derived factor-1alpha blood levels in patients with ongoing ischemia after acute myocardial infarction.

    Science.gov (United States)

    Kuo, Li-Tang; Chen, Shih-Jen; Cherng, Wen-Jin; Yang, Ning-I; Lee, Chen-Chin; Cheng, Chi-Wen; Verma, Subodh; Wang, Chao-Hung

    2009-07-01

    After acute myocardial infarction (AMI), reopening of a totally occluded infarct-related artery (IRA) at a subacute stage is still controversial in symptom-free patients. However, in patients with persistent ischemic symptoms and inadequate collaterals to the infarct area, recanalization is thought to provide beneficial effects. In addition to augmenting myocardial perfusion, we hypothesized that the benefit of recanalization involves the manipulation of circulating stem cell-mobilizing cytokines. This study included 30 patients with a totally occluded IRA and ongoing ischemic symptoms (the study group) and 30 patients with a partially occluded IRA (the control group). All patients underwent successful angioplasty and/or stenting. Before and immediately after the coronary intervention, blood granulocyte-colony-stimulating factor (G-CSF), stem-cell factor (SCF), vascular endothelial growth factor (VEGF), and stroma-derived factor-1 (SDF-1alpha) were measured. After recanalization, G-CSF levels significantly increased in the study group compared to the control group (P=0.03). SDF-1alpha levels in the study group decreased relative to the controls (P=0.02). However, no significant changes in VEGF or SCF levels between the two groups were found. In the multivariate analysis, reopening of a totally occluded IRA was independently and significantly associated with changes in G-CSF and SDF-1alpha levels after recanalization. In conclusion, our data suggest that the benefits of late reperfusion of a totally occluded IRA in patients with ongoing myocardial ischemia may involve mechanisms associated with stem cell-mobilizing and plaque-stabilizing cytokines. This study provides the rationale to investigate serial changes in cytokines and the numbers of circulating progenitors after reperfusion in the future.

  11. THE SPEKL-TREKING PREDICTIVE VALUE OF THE ECHOCARDIOGRAPHY AT THE ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    N. A. Kosheleva

    2016-01-01

    Full Text Available Speckle-tracking echocardiography is a non-invasive method  for assessment of myocardial deformation, which is closely associated with its regional and global function. Although it is not yet introduced into clinical practice, deformation parameters are actively studied in different clinical conditions, particularly in acute myocardial infarction. Numerous studies show deformation  impairment may have important prognostic value at patients with a acute myocardial infarction.

  12. Effect of NO synthase inhibition on myocardial metabolism during moderate ischemia.

    Science.gov (United States)

    Martin, Claus; Schulz, Rainer; Post, Heiner; Gres, Petra; Heusch, Gerd

    2003-06-01

    Nitric oxide (NO) is involved in the control of myocardial metabolism. In normoperfused myocardium, NO synthase inhibition shifts myocardial metabolism from free fatty acid (FFA) toward carbohydrate utilization. Ischemic myocardium is characterized by a similar shift toward preferential carbohydrate utilization, although NO synthesis is increased. The importance of NO for myocardial metabolism during ischemia has not been analyzed in detail. We therefore assessed the influence of NO synthase inhibition with N(G)-nitro-l-arginine (l-NNA) on myocardial metabolism during moderate ischemia in anesthetized pigs. In control animals, the increase in left ventricular pressure with l-NNA was mimicked by aortic constriction. Before ischemia, l-NNA decreased myocardial FFA consumption (MV(FFA); P < 0.05), while consumption of carbohydrate and O(2) (MVo(2)) remained constant. ATP equivalents [calculated with the assumption of complete oxidative substrate decomposition (ATP(eq))] decreased with l-NNA (P < 0.05), associated with a decrease of regional myocardial function (P < 0.05). In contrast, aortic constriction had no effect on MV(FFA), while MVo(2) increased (P < 0.05) and ATP(eq) and regional myocardial function remained constant. During ischemia, alterations in myocardial metabolism were similar in control and l-NNA-treated animals: MV(FFA) decreased (P < 0.05) and net lactate consumption was reversed to net lactate production (P < 0.05). Regional myocardial function was decreased (P < 0.05), although more markedly in animals receiving l-NNA (P < 0.05). We conclude that the efficiency of oxidative metabolism was impaired by l-NNA per se, paralleled by impaired regional myocardial function. During ischemia, l-NNA had no effect on myocardial substrate consumption, indicating that NO synthases were no longer effectively involved in the control of myocardial metabolism.

  13. Reducing the predictive uncertainty associated with groundwater management decision-making in the Perth regional aquifer system of Western Australia

    Science.gov (United States)

    Siade, A. J.

    2015-12-01

    The Perth Regional Aquifer Model (PRAMS) framework has been used for about a decade now to evaluate the potential anthropogenic impacts associated with management decisions that affect Perth's groundwater resources. A great wealth of data, expertise and numerical analysis have gone into the development of PRAMS over the years. However, there has been little quantitative work conducted on systemically addressing the uncertainty in the model's structure and predictions. PRAMS is designed to make a variety of regional and local-scale predictions and, both the nature and magnitude of the uncertainty associated with these predictions can vary significantly. A primary prediction to be addressed using the PRAMS framework, will be the effects of various deep-aquifer groundwater management scenarios on both the environmental and social concerns surrounding the superficial aquifer, which supports sensitive wetlands, and the negative impacts of seawater intrusion into the deep aquifers. A particular model-structure component that greatly affects the predictions associated with deep-aquifer groundwater extraction is the characterization of the local fault structure, i.e., whether or not faults are acting as barriers to groundwater flow. Therefore, uncertainty in fault characterization can subsequently lead to significant predictive uncertainty. However, new observation data can be obtained to reduce this uncertainty. In this study, an experimental design methodology is employed to optimally acquire new observations of state in such a way as to maximize the information obtained about the hydraulic properties of faults. Various information criteria are employed to develop optimal locations of new observation wells. The A-optimality criterion was found to be the most effective for comparing sampling strategies given the design assumptions, which include the parameter sets employed, hydraulic forcing, temporal considerations, and the use of the existing observation network. A

  14. Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities.

    Science.gov (United States)

    Dewey, Kathryn G

    2016-05-01

    Meeting the high nutrient needs of pregnant and lactating women and their young children in regions such as South Asia is challenging because diets are dominated by staple foods with low nutrient density and poor mineral bioavailability. Gaps in nutritional adequacy in such populations probably date back to the agricultural revolution ~10 000 years ago. Options for improving diets during the first 1000 days include dietary diversification and increased intake of nutrient-rich foods, improved complementary feeding practices, micronutrient supplements and fortified foods or products specifically designed for these target groups. Evidence from intervention trials indicates that several of these strategies, both prenatal and post-natal, can have a positive impact on child growth, but results are mixed and a growth response is not always observed. Nutrition interventions, by themselves, may not result in the desired impact if the target population suffers from frequent infection, both clinical and subclinical. Further research is needed to understand the mechanisms underlying both prenatal and post-natal growth restriction. In the meantime, implementation and rigorous evaluation of integrated interventions that address the multiple causes of stunting is a high priority. These intervention packages should ideally include improved nutrition during both pregnancy and the post-natal period, prevention and control of prenatal and post-natal infection and subclinical conditions that restrict growth, care for women and children and stimulation of early child development. In regions such as South Asia, such strategies hold great promise for reducing stunting and enhancing human capital formation.

  15. Exercise and rest Tl-201 myocardial SPECT, and low dose dobutamine echocardiography to assess myocardial viability in patients with myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Toyama, Takuji; Ishida, Yoshio; Shimonagata, Tsuyoshi; Kawano, Shigeo; Beppu, Shintaro (National Cardiovascular Center, Suita, Osaka (Japan)); Nishimura, Tsunehiko

    1994-01-01

    To evaluate viability of infarcted myocardium, findings of Tl-201 myocardial SPECT were compared with those of low-dose dobutamine (DOB) echocardiography. The subjects were 19 patients with myocardial infarction (23 infarcted zones), consisting of 16 men and 3 women. Findings on myocardial SPECT were classified as evidence of myocardial viability (14 zones, Group A) and no evidence of myocardial viability (9 zones, Group B). For both groups, wall motion and regional % uptake (%UP) were obtained. DOB echocardiography revealed an improvement in 5 of 8 akinesis zones in Group A. In addition, one other zone was found improved by follow-up examination. Six hypokinesis zones were all found improved on DOB echocardiography. Out of a total of 14 akinesis or hypokinesis zones, 11 (79%) showed improvement on DOB echocardiography in Group A. In Group B, all akinesis zones remained unchanged on DOB echocardiography, although one zone was improved by follow-up examination. In 11 zones in which wall motion was improved on DOB echocardiography, %UT was increased by an average of 58% on 4 hr-delayed images and 70% on resting images. The corresponding figures for 12 zones which did not improve on DOB echocardiography were 49% and 50% on the average, respectively. In conclusion, low-dose DOB echocardiography appeared to reflect viability of severely infarcted myocardium, although it had a slightly lower sensitivity than convensional Tl-201 myocardial SPECT in its ability to detect. (N.K.).

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-01-01

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

  17. Non-photic solar associations of heart rate variability and myocardial infarction

    Science.gov (United States)

    Cornélissen, Germaine; Halberg, Franz; Breus, Tamara; Syutkina, Elena V.; Baevsky, Roman; Weydahl, Andi; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila; Fiser, Bohumil; Bakken, Earl E.

    2002-03-01

    Alignment of serial epidemiological, physiological, including electrocardiographic data with variations in galactic cosmic rays, geomagnetic activity, and atmospheric pressure suggests the possibility of links among these physical environmental variations and health risks, such as myocardial infarctions and ischemic strokes, among others. An increase in the incidence of myocardial infarction in association with magnetic storms, reported by several investigators from Russia, Israel, Italy and Mexico, accounts in Minnesota for a 5% (220cases/year) increase in mortality during years of maximal solar activity by comparison with years of minimal solar activity. Magnetic storms are also found to decrease heart rate variability (HRV), indicating a possible mechanism since a reduced HRV is a prognostic factor for coronary artery disease and myocardial infarction. Longitudinal electrocardiographic monitoring for a week or much longer spans in different geographic locations, notably in the auroral oval, further suggests that the decrease in HRV affects spectral regions other than that around 3.6s (0.15-0.40Hz), reportedly associated with the parasympathetic nervous system. Differences in some associations are observed from solar cycle to solar cycle, and as a function of solar cycle stage, a finding resolving controversies. Coordinated physiological and physical monitoring, the scope of an international project on the Biosphere and the Cosmos, seeks reference values for a better understanding of environmental effects on human health and for testing the merit of space weather reports that could prompt countermeasures in space and on earth. Physiological data being collected systematically worldwide and morbidity/mortality statistics from causes such as myocardial infarction and stroke constitute invaluable data bases for assessing changes within the physiological range, for detecting environmental effects and for recognizing endogenous as well as exogenous disease

  18. The usefulness of {sup 123}I-BMIPP myocardial SPECT in diagnosis for silent myocardial ischemia induced by vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Kawasaki, Tatsuya; Ito, Kazuki; Okano, Akira; Nagata, Kazuhiro; Yoneyama, Satoshi; Katoh, Shuji [Asahi Univ., Gifu (Japan). Murakami Memorial Hospital; Sugihara, Hiroki

    1999-01-01

    This study was designed to evaluate the clinical usefulness of {sup 123}I-BMIPP myocardial SPECT in patients with silent myocardial ischemia induced by vasospasm. Ultrasonic echocardiography (UCG), Holter electrocardiogram recording (Holter ECG), exercise {sup 201}Tl myocardial SPECT (EX-Tl) and rest {sup 123}I-BMIPP myocardial SPECT (BMIPP) were performed in 8 patients with asymptomatic vasospasm without history of myocardial infarction. The sensitivity of each modality in detecting coronary artery spasm was 37.5% (3 of 8 cases) for UCG, 37.5% (3 of 8 cases) in Holter ECG, 25.0% (2 of 8 cases) in Ex-Tl, 62.5% (5 of 8 cases) on initial BMIPP images and 75.0% (6 of 8 cases) on delayed BMIPP images. Severity of regional left ventricular wall motion abnormality in UCG correlated with the severity of regionally decreased tracer uptake in BMIPP. The washout rate of BMIPP was 18.7{+-}2.4 in normal controls, 32.4{+-}5.9 in asymptomatic vasospasm, and 38.2{+-}4.0 in asymptomatic vasospasm with abnormal left ventricular wall motion. It was suggested that {sup 123}I-BMIPP myocardial SPECT might be useful for assessing asymptomatic vasospasm. (author)

  19. Defibrillator implantation early after myocardial infarction.

    Science.gov (United States)

    Steinbeck, Gerhard; Andresen, Dietrich; Seidl, Karlheinz; Brachmann, Johannes; Hoffmann, Ellen; Wojciechowski, Dariusz; Kornacewicz-Jach, Zdzisława; Sredniawa, Beata; Lupkovics, Géza; Hofgärtner, Franz; Lubinski, Andrzej; Rosenqvist, Mårten; Habets, Alphonsus; Wegscheider, Karl; Senges, Jochen

    2009-10-08

    The rate of death, including sudden cardiac death, is highest early after a myocardial infarction. Yet current guidelines do not recommend the use of an implantable cardioverter-defibrillator (ICD) within 40 days after a myocardial infarction for the prevention of sudden cardiac death. We tested the hypothesis that patients at increased risk who are treated early with an ICD will live longer than those who receive optimal medical therapy alone. This randomized, prospective, open-label, investigator-initiated, multicenter trial registered 62,944 unselected patients with myocardial infarction. Of this total, 898 patients were enrolled 5 to 31 days after the event if they met certain clinical criteria: a reduced left ventricular ejection fraction ( or = 150 beats per minute) during Holter monitoring (criterion 2: 208 patients), or both criteria (88 patients). Of the 898 patients, 445 were randomly assigned to treatment with an ICD and 453 to medical therapy alone. During a mean follow-up of 37 months, 233 patients died: 116 patients in the ICD group and 117 patients in the control group. Overall mortality was not reduced in the ICD group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.35; P=0.78). There were fewer sudden cardiac deaths in the ICD group than in the control group (27 vs. 60; hazard ratio, 0.55; 95% CI, 0.31 to 1.00; P=0.049), but the number of nonsudden cardiac deaths was higher (68 vs. 39; hazard ratio, 1.92; 95% CI, 1.29 to 2.84; P=0.001). Hazard ratios were similar among the three groups of patients categorized according to the enrollment criteria they met (criterion 1, criterion 2, or both). Prophylactic ICD therapy did not reduce overall mortality among patients with acute myocardial infarction and clinical features that placed them at increased risk. (ClinicalTrials.gov number, NCT00157768.) 2009 Massachusetts Medical Society

  20. Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs.

    Science.gov (United States)

    Zhu, Gang-jie; Sun, Li-na; Li, Xing-hai; Wang, Ning-fu; Wu, Hong-hai; Yuan, Chen-xing; Li, Qiao-qiao; Xu, Peng; Ren, Ya-qi; Mao, Bao-gen

    2015-09-01

    The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups-control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P myocardial infarct size of ECMO group did not reduce significantly, but myocardial enzyme and troponin-I decreased significantly. Compared with drug therapy, ECMO improves left ventricular diastolic function, and may improve systolic function. ECMO cannot reduce myocardial infarct size without revascularization, but may have positive effects on ischemic areas by avoiding further injuring.

  1. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis.

    Science.gov (United States)

    Barbosa, Fabiano Timbó; da Cunha, Rafael Martins; da Silva Ramos, Fernando Wagner; de Lima, Fernando José Camello; Rodrigues, Amanda Karine Barros; do Nascimento Galvão, Ailton Mota; de Sousa-Rodrigues, Célio Fernando; Lima, Paula Monique Barbosa

    2016-01-01

    Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32-1.95), MI (RR=0.96, 95% CI=0.52-1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50-0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA has been used in association with general anesthesia (GA for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA, myocardial infarction (MI, length of hospital stay (LHS, length of ICU stay (ICUS, reoperations, blood transfusion (BT, quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD was estimated for continuous variables, and relative risk (RR and risk difference (RD for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01, CVA (RR = 0.79, 95% CI = 0.32-1.95, MI (RR = 0.96, 95% CI = 0.52-1.79 and LHS (MD = -1.94, 95% CI = -3.99 to 0.12 were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93. ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26. CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

  3. Reliability of myocardial perfusion quantification in angiography using a digital flat panel cardiac system

    Science.gov (United States)

    Perrin, Muriel; Vaillant, Regis; Gavit-Houdant, Laurence; Lienard, Jean; Benali, Karim

    2002-04-01

    Discordance between lesion severity from angiocardiography and physiological effects has been reported elsewhere. Quantification of myocardial perfusion during the angiography procedure may supply additional information about short- and long-term outcomes and may be helpful for clinical decision making. In previous works, myocardial perfusion has been assessed using time density curves (TDC), which represent the contrast medium dilution over time in the myocardium. The mean transit time (MTT), derived from the TDC, has been reported as a good indicator of the regional myocardial perfusion. Our objective is to estimate the accuracy and reproducibility of MTT estimation on digital flat panel (DFP) images. We have simulated typical myocardium TDC obtained with a DFP cardiac system (Innova 2000, GE), taking into account scatter and noise. Logarithmic or linear subtractions have been applied to derive a contrast medium concentration proportional quantity from image intensity. A non-linear minimisation realises the model curve fitting. MTT estimates are more stable with linear subtraction in presence of scatter. However logarithmic subtraction presents smaller bias when scatter level is small. Both approaches are equally sensible to image noise. Linear subtraction should be preferred. Image noise has a high influence on MTT accuracy and we may reduce.

  4. Discordant iodine-123 metaiodobenzylguanidine uptake area reflects recovery time dispersion in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Masai, Miho; Naruse, Hitoshi; Morita, Masato; Arii, Tohru; Takahashi, Keiko; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru [Hyogo Coll. of Medicine, Nishinomiya (Japan)

    2001-08-01

    Iodine-123 metaiodobenzylguanidine (MIBG) uptake was reported to be reduced compared to Tl-201 (Tl) in acute myocardial infarction (AMI). Within such an area, degrees of both sympathetic neural function and ischemic myocardial cell damage are considered to be greatly dispersed. These kinds of damage were reported to effect reporalization time in myocardial cells, and we evaluated our hypothesis that extension of the discordant MIBG uptake area correlates with recovery time (RT) dispersion and relate ventricular arrhythmias in AMI. MIBG and Tl images were obtained in AMI patients. Regional Tl or MIBG uptake was estimated in 9 segments of SPECT by using four-point scoring. The total score was the sum of scores in 9 SPECT segments. {delta}Tl-MIBG was calculated by subtracting the total MIBG score from the total Tl score. Corrected RT (RTc) was measured as a signal-averaged ECG. RTc dispersion was defined as the difference between maximal and minimal RTc. The patients were assigned to two groups (group A; {<=}Lown 4a, group B; {>=}Lown 4b) according to the results of 24-hour Holter monitoring. A positive correlation between RTc dispersion and {delta}Tl-MIBG was found. {delta}Tl-MIBG and RTc dispersion in group B were greater than those in group A. These results suggested that {delta}Tl-MIBG could be used to predict the development of malignant ventricular arrhythmias. (author)

  5. 二维斑点追踪成像技术在生理性和病理性心肌肥厚鉴别中的作用%Evaluation the global and regional myocardial function of patients with hypertrophic cardiomyopathy by two-dimensional speckle tracking imaging

    Institute of Scientific and Technical Information of China (English)

    尹家保; 郭瑞强; 陈金玲

    2011-01-01

    运用二维斑点追踪成像(2D-STI)技术分析肥厚型心肌病患者16例、运动员18例、健康对照组20例三组左心室心肌应变,心尖四腔观切面获取整体长轴应变(GLS)和局部心肌峰值收缩应变(PSS).结果显示,与运动员组和对照组比较,肥厚型心肌病组GLS减低[-(8.0±3.6)%,P<0.01];运动员组与正常对照组GLS比较差异无统计学意义(P>0.05).但正常对照组间隔基底段、中间段、侧壁中间段长轴应变,间隔基底段、中间段、心尖段、侧壁基底段、中间段局部心肌节段PSS显著高于运动员组.以左心室GLS小于-10%为截断值诊断病理性左心室肥厚的敏感性、特异性分别为84.0%、94.0%.提示STI技术能定量评价左室整体与局部收缩功能,有助于区分左心室生理性肥厚与病理性肥厚.%Two-dimensional speckle tracking imaging(2D-STI)can accurately evaluate myocardial strain with non-angle dependent and good reproducibility. In this study, 16 patients with hypertrophic cardiomyopathy (HCM), 18 athletes and 20 normal subjects underwent 2D-STI examination. The global longitudinal strain (GLS) and regional peak systolic strain (PSS) were assessed by 2D-STI in the apical four-chamber-view. Compared to athletes and normal subjects, GLS in patients with HCM was significantly reduced [GLS: -(8. 0±3.6)% , P < 0. 01]. There was no significant difference in GLS between athletes and the controls, but GLS in basal or middle segments of interventricular septum and middle segments of lateral wall; PSS in basal, middle or apical segments of interventricular septum and basal or middle segments of lateral wall of the normal controls were significantly higher than those of the athletes. A cut-off value of less than -10% in GLS for diagnosis of pathologic hypertrophy resulted in a sensitivity of 84. 0% and a specificity of 94. 0%. The results suggest that 2D-STI can quantify global and regional myocardial function and may be used for the

  6. New techniques for the assessment of regional left ventricular wall motion.

    Science.gov (United States)

    Garcia-Fernandez, Miguel Angel; Bermejo, Javier; Perez-David, Esther; Lopez-Fernandez, Teresa; Ledesma, Maria Jesus; Caso, Pio; Malpica, Norberto; Santos, Andres; Moreno, Mar; Desco, Manuel

    2003-10-01

    The assessment of regional left ventricular (LV) function has been an important yet unresolved problem since the introduction of echocardiography as a diagnostic tool. Abnormal regional LV wall motion is an early finding in multiple cardiac pathologies and its diagnosis is of critical importance. In the last few years diagnostic procedures based on combined use of existing echocardiographic technologies were geared toward improving the accuracy of detection of baseline and/or induced regional wall motion abnormalities. One of the assumptions is that the combination of reduced LV wall thickening and reduced myocardial velocities can be used to accurately diagnose regional myocardial dysfunction. In this article we will discuss several new techniques for the quantification of regional LV function using Doppler echocardiography.

  7. Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain.

    Science.gov (United States)

    Falla, Deborah; Gizzi, Leonardo; Tschapek, Marika; Erlenwein, Joachim; Petzke, Frank

    2014-05-01

    This study investigated change in the distribution of lumbar erector spinae muscle activity and pressure pain sensitivity across the low back in individuals with low back pain (LBP) and healthy controls. Surface electromyographic (EMG) signals were recorded from multiple locations over the lumbar erector spinae muscle with a 13×5 grid of electrodes from 19 people with chronic nonspecific LBP and 17 control subjects as they performed a repetitive lifting task. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution. Pressure pain thresholds (PPT) were recorded before and after the lifting task over a similar area of the back. For the control subjects, the EMG RMS progressively increased more in the caudal region of the lumbar erector spinae during the repetitive task, resulting in a shift in the distribution of muscle activity. In contrast, the distribution of muscle activity remained unaltered in the LBP group despite an overall increase in EMG amplitude. PPT was lower in the LBP group after completion of the repetitive task compared to baseline (average across all locations: pre: 268.0±165.9 kPa; post: 242.0±166.7 kPa), whereas no change in PPT over time was observed for the control group (320.1±162.1 kPa; post: 322.0±179.5 kPa). The results demonstrate that LBP alters the normal adaptation of lumbar erector spinae muscle activity to exercise, which occurs in the presence of exercise-induced hyperalgesia. Reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  8. A new method to quantify and reduce projection error in whole-solar-active-region parameters measured from vector magnetograms

    Science.gov (United States)

    Falconer, David; Tiwari, Sanjiv K.; Moore, Ronald L.; Khazanov, Igor

    2017-08-01

    Projection error limits the use of vector magnetograms of active regions (ARs) far from disk center. For ARs observed up to 60o from disk center, we demonstrate a method of measuring and reducing the projection error in the magnitude of any whole-AR parameter derived from a vector magnetogram that has been deprojected to disk center. The method assumes that the center-to-limb curve of the average of the parameter’s absolute values measured from the disk passage of a large number of ARs and normalized to each AR’s absolute value of the parameter at central meridian, gives the average fractional projection error at each radial distance from disk center. To demonstrate the method, we use a large set of large-flux ARs and apply the method to a whole-AR parameter that is among the simplest to measure: whole-AR magnetic flux. We measure 30,845 SDO/HMI vector magnetograms covering the disk passage of 272 large-flux ARs, each having whole-AR flux >1022 Mx. We obtain the center-to-limb radial-distance run of the average projection error in measured whole-AR flux from a Chebyshev fit to the radial-distance plot of the 30,845 normalized measured values. The average projection error in the measured whole-AR flux of an AR at a given radial distance is removed by multiplying the measured flux by the correction factor given by the fit. The correction is important for both the study of evolution of ARs and for improving the accuracy of forecasting an AR’s major flare/CME productivity. We will also show corrections for other whole-AR parameters, especially AR free-energy proxies.

  9. Histochemical and immunohistochemical analyses of the myocardial scar fallowing acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Tatić Vujadin

    2012-01-01

    Full Text Available Background/Aim. The heart has traditionally been considered as a static organ without capacity of regeneration after trauma. Currently, the more and more often asked question is whether the heart has any intrinsic capacities to regenerate myocytes after myocardial infarction. The aim of this study was to present the existence of the preserved muscle fibers in the myocardial scar following myocardial infarction as well as the presence of numerous cells of various size and form that differently reacted to the used immunohistochemical antibodies. Methods. Histological, histochemical and immunohistochemical analyses of myocardial sections taken from 177 patients who had died of acute myocardial infarction and had the myocardial scar following myocardial infarction, were carried out. More sections taken both from the site of acute infarction and scar were examined by the following methods: hematoxylin-eosin (HE, periodic acid schiff (PAS, PAS-diastasis, Masson trichrom, Malory, van Gieson, vimentin, desmin, myosin, myoglobin, alpha actin, smoth muscle actin (SMA, p53, leukocyte common antigen (LCA, proliferating cell nuclear antigen (PCNA, Ki-67, actin HHF35, CD34, CD31, CD45, CD45Ro, CD8, CD20. Results. In all sections taken from the scar region, larger or smaller islets of the preserved muscle fibers with the signs of hypertrophy were found. In the scar, a large number of cells of various size and form: spindle, oval, elongated with abundant cytoplasm, small with one nucleus and cells with scanty cytoplasm, were found. The present cells differently reacted to histochemical and immunohistochemical methods. Large oval cells showed negative reaction to lymphocytic and leukocytic markers, and positive to alpha actin, actin HHF35, Ki-67, myosin, myoglobin and desmin. Elongated cells were also positive to those markers. Small mononuclear cells showed positive reaction to lymphocytic markers. Endothelial and smooth muscle cells in the blood vessel walls

  10. Usefulness of BMIPP SPECT to evaluate myocardial viability, contractile reserve and coronary stenotic progression after reperfusion in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Katsunuma, Eita; Kurokawa, Shingo; Takahashi, Motoi; Fukuda, Naoto; Kurosawa, Toshiro; Izumi, Tohru [Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine

    2001-07-01

    Using combined {sup 123}I-BMIPP (BMIPP), {sup 201}Tl (Tl) and {sup 99m}Tc-PYP (PYP) myocardial SPECT imaging, risk areas of acute myocardial infarction were documented in the acute stage, and then these images were evaluated for how well they reflected muscle viability, contractile reserve and coronary stenotic progression subsequent to reperfusion therapy. Patients who only experienced a first attack of myocardial infarction were enrolled. In total, 36 cases who had had the occluded artery successfully reperfused were examined during the past year. They had no significant vessel disease except for the culprit single artery. The patients were comprised of 32 men and 4 women. The mean age was 59.5 years. All patients underwent coronary angiography and left ventricular (LV) angiography in the emergency room. BMIPP/Tl and PYP myocardial SPECT were conducted in the acute stage and chronic stage. In the chronic stage LV angiography was repeated to assess the improvement of LV wall motion. The response to postextrasystolic potentiation (PESP) testing was performed to estimate myocardial contractile reserve. The risk area of acute myocardial infarction (AMI) was documented by reduced BMIPP accumulation. The size of reduced BMIPP accumulation was larger than that of PYP accumulation. A BMIPP/Tl discrepancy and PYP accumulation were documented to assess myocardial viability. Both improvement in LV wall motion and augmentation of PESP response were more closely related to a BMIPP/Tl discrepancy in the presence or absence of PYP accumulation. Therefore, it would be possible to evaluate myocardial viability and contractile reserve by the BMIPP/Tl discrepancy. In patients with good viability, it is important to predict whether there is coronary stenotic progression or not. In this study, we demonstrated that most patients with improved BMIPP images had no significant progression at the site of intervention. Serial observation of BMIPP images from the acute stage to the chronic

  11. Effects of permanent dual chamber pacing on myocardial perfusion in symptomatic hypertrophic cardiomyopathy

    NARCIS (Netherlands)

    Posma, JL; Blanksma, PK; VanderWall, EE; Vaalburg, W; Crijns, HJGM; Lie, KI

    1996-01-01

    Objective-Angina and the presence of myocardial ischaemia are common in hypertrophic cardiomyopathy. Dual chamber pacing results in clinical improvement in these patients. This study evaluates the effects of permanent dual chamber pacing on absolute regional myocardial perfusion and perfusion

  12. Effects of permanent dual chamber pacing on myocardial perfusion in symptomatic hypertrophic cardiomyopathy

    NARCIS (Netherlands)

    Posma, JL; Blanksma, PK; VanderWall, EE; Vaalburg, W; Crijns, HJGM; Lie, KI

    1996-01-01

    Objective-Angina and the presence of myocardial ischaemia are common in hypertrophic cardiomyopathy. Dual chamber pacing results in clinical improvement in these patients. This study evaluates the effects of permanent dual chamber pacing on absolute regional myocardial perfusion and perfusion reserv

  13. 区域协同救治模式对急性 ST 段抬高型心肌梗死治疗的影响%Impact of new regional cooperative rescue model on first medical contact to balloon time and outcome in patients with ST-elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    杨宁; 司定然; 王恒亮; 任付先; 商惠萍

    2015-01-01

    Objective:To explore the impact of new regional cooperative rescue model on first medical contact to balloon time and outcome in patients with ST‐elevation myocardial infarction (STEMI) . Methods:A total of 360 patients with STEMI ,who underwent emergency percutaneous coronary intervention (PCI) within 24 h from the onset of attack between August 2011 and October 2014 in our hospital were divided into the observation group (n= 200) adopting regional cooperative mode therapy and the control group (n=160)adopting non‐regional cooperative mode therapy .First medical contact to balloon dilatation (FMC‐to‐B) time ,the door to balloon dilatation (D‐to‐B) time ,heart function ,average length of stay ,hospitalization cost and major adverse cardiac events (MACE)during a follow‐up period of 6 months were compared between the two groups . Results:Left ventricular ejection fraction(LVEF) in observation group (54 .8% ± 8 .5% )was higher than that in control group (48 .5% ± 7 .9% ) (P<0 .05);left ventricular end‐diastolic diameter (LVEDd)in the observation group was lower than that in control group [(47 .5 ± 4 .8) mm vs .(51 .4 ± 5 .6) mm ,P<0 .05] .Compared with control group ,FMC‐to‐B time [(118 .3 ± 45 .6) min vs .(145 .6 ± 61 .5) min] ,D‐to‐B time[(74 .5 ± 33 .4) min vs .(110 .8 ± 40 .9) min ] ,hospitalization time[(7 .0 ± 2 .5) d vs .(11 .6 ± 4 .5) d]and costs[(53 562 ± 1 455) yuan vs .(53 562 ± 1 455) yuan]in observation group were all lower(all P< 0 .05) .During six months of follow‐up ,4 cases of sudden cardiac death ,8 cases of myocardial infarction recurrence were observed in observation group;while 10 cases of sudden cardiac death ,21 cases of myocardial infarction recurrence were observed in control group(all P<0 .05) . Conclusion:New regional cooperative mode therapy can significantly shorten FMC‐to‐B and D‐to‐B time , improve cardiac function and reduce hospitalization time ,costs and M ACE .%目的:探讨区域

  14. Reducing regional vulnerabilities and multi-city robustness conflicts using many-objective optimization under deep uncertainty

    Science.gov (United States)

    Reed, Patrick; Trindade, Bernardo; Jonathan, Herman; Harrison, Zeff; Gregory, Characklis

    2016-04-01

    Emerging water scarcity concerns in southeastern US are associated with several deeply uncertain factors, including rapid population growth, limited coordination across adjacent municipalities and the increasing risks for sustained regional droughts. Managing these uncertainties will require that regional water utilities identify regionally coordinated, scarcity-mitigating strategies that trigger the appropriate actions needed to avoid water shortages and financial instabilities. This research focuses on the Research Triangle area of North Carolina, seeking to engage the water utilities within Raleigh, Durham, Cary and Chapel Hill in cooperative and robust regional water portfolio planning. Prior analysis of this region through the year 2025 has identified significant regional vulnerabilities to volumetric shortfalls and financial losses. Moreover, efforts to maximize the individual robustness of any of the mentioned utilities also have the potential to strongly degrade the robustness of the others. This research advances a multi-stakeholder Many-Objective Robust Decision Making (MORDM) framework to better account for deeply uncertain factors when identifying cooperative management strategies. Results show that the sampling of deeply uncertain factors in the computational search phase of MORDM can aid in the discovery of management actions that substantially improve the robustness of individual utilities as well as the overall region to water scarcity. Cooperative water transfers, financial risk mitigation tools, and coordinated regional demand management must be explored jointly to decrease robustness conflicts between the utilities. The insights from this work have general merit for regions where adjacent municipalities can benefit from cooperative regional water portfolio planning.

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  16. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  17. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  18. SURGERY OF SYMPTOMATIC MYOCARDIAL BRIDGING

    Directory of Open Access Journals (Sweden)

    N. Maghamipour N. Safaei

    2007-06-01

    Full Text Available Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD may be associated with myocardial ischemia. In symptomatic myocardial bridging unresponsive to medical treatment, surgical unroofing of the left LAD can be performed. Little information is available about the long-term prognosis of patients with this coronary anomaly after the surgical unroofing, so we decided to evaluate the result of this operation. A total of 26 patients underwent surgical unroofing of myocardial bridging. Patients had a myocardial bridge of at least 3 cm in length in the middle of LAD and with more than 70% compression during systole. Unroofing was performed with cardiopulmonary bypass in 16 and with off pump technique in 10 patients. In 6 patients repeat angiographies for control of myotomy were done. In one of them a nonsignificant 20% narrowing was seen. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary flow and myocardial perfusion without residual myocardial bridges under beta-stimulation in 24 patients. Two patients had residual narrowing. With off pump technique, 1 patient had perforation of the right ventricle and 1 patient underwent reoperation because of incomplete unroofing during the first operation. None of the patients with cardiopulmonary bypass technique had residual chest pain or other complications. Surgical unroofing of myocardial bridging with the aid of cardiopulmonary bypass is a safe and easy procedure with low operative risk and with excellent functional results.

  19. [Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis].

    Science.gov (United States)

    Barbosa, Fabiano Timbó; Cunha, Rafael Martins da; Ramos, Fernando Wagner da Silva; Lima, Fernando José Camello de; Rodrigues, Amanda Karine Barros; Galvão, Ailton Mota do Nascimento; de Sousa-Rodrigues, Célio Fernando; Lima, Paula Monique Barbosa

    2016-01-01

    Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32 to 1.95), MI (RR=0.96, 95% CI=0.52 to 1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50 to 0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  20. Measuring myocardial perfusion

    DEFF Research Database (Denmark)

    Qayyum, A A; Kastrup, J

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-09-01

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

  2. Efficacy of coronary artery reconstruction in maintaining myocardial viability. Quntitative determination of local myocardial circulation with {sup 13}NH{sub 3} myocardial positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Satoshi; Takaba, Toshihiro [Showa Univ., Tokyo (Japan). School of Medicine; Kume, Masato; Kashima, Toshitaka; Michihata, Tetsuro

    1996-04-01

    Thirty patients (280 areas) whose bypass grafts remained patent after surgical reconstruction of the coronary artery were examined. Before and after reconstruction, local myocardial blood circulation in infarcted regions and post-stenotic regions was measured by {sup 13}NH{sub 3} myocardial positron emission computed tomography (PET) at rest or during physical exercise in order to evaluate the efficacy of coronary artery reconstruction. Before operation, mean blood flow in post-stenotic regions (n=198) was 65{+-}15 ml/min/100 g at rest and 85{+-}23 ml/min/100 g during exercise. After coronary artery bypass grafting (CABG), mean blood flow was increased to 78{+-}21 ml/min/100 g at rest (p, 0.01) and 105{+-}32 ml/min/100 g during exercise (p<0.01). In infarcted regions (n=82), mean blood flow before operation was 51{+-}23 ml/min/100 g at rest and 69{+-}23 ml/min/100 g during exercise. After CABG, it increased to 62{+-}19 ml/min/100 g at rest (p<0.01) and 81{+-}29 ml/min/100 g during exercise (p<0.01). Thus, significant increases in blood flow were observed in both post-stenotic and infarcted regions at rest and physical exercise after operation. The regions of infarction were divided into three groups based on local myocardial blood flow at rest before operation: Group I: greater than 45 ml/min/100 g (n=35); Group II: less than 45 ml/min/100 g (n=30) but greater than 30 ml/min/100 g; and Group III: less than 30 ml/min/100 g (n=30). The efficacy of reconstruction was compared among these groups. The group with preoperative myocardial blood flow greater than 30 ml/min/100 g had increased blood flow after operation, indicating myocardial viability. (author).

  3. Prognostic impact of physical activity prior to myocardial infarction

    DEFF Research Database (Denmark)

    Ejlersen, Hanne; Andersen, Zorana Jovanovic; von Euler-Chelpin, My Catarina

    2017-01-01

    Background: Animal studies indicate that exercise reduces myocardial damage during myocardial infarction by ischaemic preconditioning. Aim: To determine from a prospective cohort study whether the level of leisure time physical activity (LTPA) in humans prior to myocardial infarction could modify......: adjusted ORs (95% confidence interval), with reference to sedentary LTPA were 0.68 (0.51-0.89) for light LTPA and 0.53 (0.38-0.74) for moderate/high LTPA. A total of 360 (29.1%) of the 1,239 myocardial infarction survivors developed heart failure and 1,033 (83.4%) died during follow......-up. There was no association between LTPA levels prior to myocardial infarction and the risk of heart failure or all-cause mortality after non-fatal myocardial infarction: adjusted HRs for moderate/high versus sedentary LTPA were 1.06 (0.78-1.45) and 0.90 (0.74-1.08), respectively. Conclusion Individuals who were physically...

  4. Reducing regional drought vulnerabilities and multi-city robustness conflicts using many-objective optimization under deep uncertainty

    Science.gov (United States)

    Trindade, B. C.; Reed, P. M.; Herman, J. D.; Zeff, H. B.; Characklis, G. W.

    2017-06-01

    Emerging water scarcity concerns in many urban regions are associated with several deeply uncertain factors, including rapid population growth, limited coordination across adjacent municipalities and the increasing risks for sustained regional droughts. Managing these uncertainties will require that regional water utilities identify coordinated, scarcity-mitigating strategies that trigger the appropriate actions needed to avoid water shortages and financial instabilities. This research focuses on the Research Triangle area of North Carolina, seeking to engage the water utilities within Raleigh, Durham, Cary and Chapel Hill in cooperative and robust regional water portfolio planning. Prior analysis of this region through the year 2025 has identified significant regional vulnerabilities to volumetric shortfalls and financial losses. Moreover, efforts to maximize the individual robustness of any of the mentioned utilities also have the potential to strongly degrade the robustness of the others. This research advances a multi-stakeholder Many-Objective Robust Decision Making (MORDM) framework to better account for deeply uncertain factors when identifying cooperative drought management strategies. Our results show that appropriately designing adaptive risk-of-failure action triggers required stressing them with a comprehensive sample of deeply uncertain factors in the computational search phase of MORDM. Search under the new ensemble of states-of-the-world is shown to fundamentally change perceived performance tradeoffs and substantially improve the robustness of individual utilities as well as the overall region to water scarcity. Search under deep uncertainty enhanced the discovery of how cooperative water transfers, financial risk mitigation tools, and coordinated regional demand management must be employed jointly to improve regional robustness and decrease robustness conflicts between the utilities. Insights from this work have general merit for regions where

  5. Clinical usefulness of {sup 123}I-BMIPP myocardial SPECT in collagen disease

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kazuki; Zen, Kan [Asahi Univ., Gifu (Japan). Murakami Memorial Hospital; Sugihara, Hiroki (and others)

    2000-07-01

    This study was designed to evaluate the clinical usefulness of {sup 123}I-BMIPP myocardial SPECT for detecting cardiac involvement in patients with collagen disease. We studied 12 patients with systemic lupus erythematosus (SLE), 8 with progressive systemic sclerosis (PSS), 6 with polymyositis/dermatomyositis (PM/DM) and 3 with allergic granulomatosis and angiitis (AGA). A 111 MBq of {sup 123}I-BMIPP was intravenously injected at rest, and SPECT images were obtained at 15 min after the injection. Seven of 12 SLE, 6 of 8 PSS, 3 of 6 PM/DM and all 3 AGA patients showed an abnormal tracer uptake. The left ventricular ejection fraction was inversely correlated with a BMIPP abnormality. The regional wall motion abnormality was reduced in regions with reduced tracer uptake. These findings suggest that {sup 123}I-BMIPP imaging could be useful for assessment of cardiac involvement in patients with collagen disease. (author)

  6. High frequency asymptotic solutions of the reduced wave equation on infinite regions with non-convex boundaries

    Directory of Open Access Journals (Sweden)

    Bloom Clifford O.

    1996-01-01

    Full Text Available The asymptotic behavior as λ → ∞ of the function U ( x , λ that satisfies the reduced wave equation L λ [ U ] = ∇ ⋅ ( E ( x ∇ U + λ 2 N 2 ( x U = 0 on an infinite 3-dimensional region, a Dirichlet condition on ∂ V , and an outgoing radiation condition is investigated. A function U N ( x , λ is constructed that is a global approximate solution as λ → ∞ of the problem satisfied by U ( x , λ . An estimate for W N ( x , λ = U ( x , λ − U N ( x , λ on V is obtained, which implies that U N ( x , λ is a uniform asymptotic approximation of U ( x , λ as λ → ∞ , with an error that tends to zero as rapidly as λ − N ( N = 1 , 2 , 3 , ... . This is done by applying a priori estimates of the function W N ( x , λ in terms of its boundary values, and the L 2 norm of r L λ [ W N ( x , λ ] on V . It is assumed that E ( x , N ( x , ∂ V and the boundary data are smooth, that E ( x − I and N ( x − 1 tend to zero algebraically fast as r → ∞ , and finally that E ( x and N ( x are slowly varying; ∂ V may be finite or infinite. The solution U ( x , λ can be interpreted as a scalar potential of a high frequency acoustic or electromagnetic field radiating from the boundary of an impenetrable object of general shape. The energy of the field propagates through an inhomogeneous, anisotropic medium; the rays along which it propagates may form caustics. The approximate solution (potential derived in this paper is defined on and in a neighborhood of any such caustic, and can be used to connect local “geometrical optics” type approximate solutions that hold on caustic free subsets of V .The result of this paper generalizes previous work of Bloom and Kazarinoff [C. O. BLOOM and N. D. KAZARINOFF, Short Wave Radiation Problems in Inhomogeneous Media: Asymptotic Solutions, SPRINGER VERLAG, NEW YORK, NY, 1976].

  7. A regional initiative to reduce skin infections amongst aboriginal children living in remote communities of the Northern Territory, Australia.

    Directory of Open Access Journals (Sweden)

    Ross M Andrews

    Full Text Available BACKGROUND: Linked to extreme rates of chronic heart and kidney disease, pyoderma is endemic amongst Aboriginal children in Australia's Northern Territory (NT. Many of those with pyoderma will also have scabies. We report the results of a community-based collaboration within the East Arnhem Region, which aimed to reduce the prevalence of both skin infections in Aboriginal children. METHODOLOGY/PRINCIPAL FINDINGS: Commencing September 2004, we conducted an ecological study that included active surveillance for skin infections amongst children aged <15 years in five remote East Arnhem communities over a three year period. Screening was undertaken by trained local community workers, usually accompanied by another project team member, using a standard data collection form. Skin infections were diagnosed clinically with the aid of a pictorial flip chart developed for the purpose. Topical 5% permethrin was provided for age-eligible children and all household contacts whenever scabies was diagnosed, whilst those with pyoderma were referred to the clinic for treatment in accordance with current guidelines. In addition, annual mass scabies treatment (5% permethrin cream was offered to all community residents in accordance with current guidelines but was not directly observed. Pyoderma and scabies prevalence per month was determined from 6038 skin assessments conducted on 2329 children. Pyoderma prevalence dropped from 46.7% at baseline to a median of 32.4% (IQR 28.9%-41.0% during the follow-up period - an absolute reduction of 14.7% (IQR 4.7%-16.8%. Compared to the first 18 months of observation, there was an absolute reduction in pyoderma prevalence of 18 cases per 100 children (95%CI -21.0, -16.1, p

  8. 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 ...

  9. A GENE FROM HUMAN-CHROMOSOME REGION-3P21 WITH REDUCED EXPRESSION IN SMALL-CELL LUNG-CANCER

    NARCIS (Netherlands)

    CARRITT, B; KOK, K; van den Berg, Anke; OSINGA, J; PILZ, A; HOFSTRA, RMW; DAVIS, MB; VANDERVEEN, AY; RABBITTS, PH; GULATI, K; BUYS, CHCM

    1992-01-01

    A combination of cytogenetic and molecular studies has implicated the p21 region of human chromosome 3 as the probable site of a gene the loss of which contributes to the development of small cell lung cancer. We report here the isolation of a gene from this region which is expressed in normal lung

  10. Protective effects of betaglucin on myocardial tissue during myocardial infarction in rats and dogs

    Institute of Scientific and Technical Information of China (English)

    Jiao QIAN; Ai-jun LIU; Wei ZHANG; Zhi-peng WEN; Lili LIN; Jing-hang WANG; Ding-feng SU; Jian-guo LIU

    2009-01-01

    Aim: To test the protective effects of betaglucin, a novel beta-glucan, on models of myocardial infarction (MI) in rats and dogs.Methods: The left anterior descending (LAD) coronary artery occlusion model was used to induce an MI in rats and dogs. Three doses of betaglucin (10, 30 and 100 mg/kg), propranolol (positive control, 1 mg/kg) and vehicle alone (5% glucose solution) were adminis-tered before LAD occlusion, and characteristics of the resulting MI were subsequently assessed. In anesthetized dogs, blood pressure,heart rate, ventricular function, coronary artery blood flow and myocardial oxygen consumption were determined before and after the drug administration.Results: The MI mass in both rats and dogs was significantly reduced by betaglucin (30 and 100 mg/kg, P0.05). High-dose betaglucin (100 mg/kg) increased myocar-dial oxygen consumption, but not to a statistically significant level (P>0.05). The hemodynamic indexes were significantly changed by propranolol.Conclusion: Betaglucin has protective effects on myocardial tissue during MI in rats and dogs and has no influence on hemodynamic parameters at a therapeutic dose. The increase in coronary artery blood flow induced by betaglucin might be beneficial in the treat-ment of patients with MI.

  11. Reducing uncertainty in flood frequency analyses: A comparison of local and regional approaches involving information on extreme historical floods

    Science.gov (United States)

    Halbert, K.; Nguyen, C. C.; Payrastre, O.; Gaume, E.

    2016-10-01

    This paper proposes a detailed comparison of local and regional approaches for flood frequency analyses, with a special emphasis on the effects of (a) the information on extreme floods used in the analysis (historical data or recent extreme floods observed at ungauged sites), and (b) the assumptions associated with regional approaches (statistical homogeneity of considered series, independence of observations). The results presented are based on two case studies: the Ard e ̀ che and Argens rivers regions in south-east of France. Four approaches are compared: 1 - local analysis based on continuous measured series, 2 - local analysis with historical information, 3 - regional index-flood analysis based on continuous series, 4 - regional analysis involving information on extremes (including both historical floods and recent floods observed at ungauged sites). The inference approach used is based on a GEV distribution and a Bayesian Monte Carlo Markov Chain approach for parameters estimation. The comparison relies both on (1) available observed datasets and (2) Monte Carlo simulations in order to evaluate the effects of sampling variability and to analyze the possible influence of regional heterogeneities. The results indicate that a relatively limited level of regional heterogeneity, which may not be detected through homogeneity tests, may significantly affect the performances of regional approaches. These results also illustrate the added value of information on extreme floods, historical floods or recent floods observed at ungauged sites, in both local and regional approaches. As far as possible, gathering such information and incorporating it into flood frequency studies should be promoted. Finally, the presented Monte Carlo simulations appear as an interesting analysis tool for adapting the estimation strategy to the available data for each specific case study.

  12. Myocardial overexpression of TIMP3 after myocardial infarction exerts beneficial effects by promoting angiogenesis and suppressing early proteolysis.

    Science.gov (United States)

    Takawale, Abhijit; Zhang, Pu; Azad, Abul; Wang, Wang; Wang, Xiuhua; Murray, Allan G; Kassiri, Zamaneh

    2017-08-01

    Myocardial infarction (MI) results in loss of cardiomyocytes, adverse extracellular matrix (ECM) and structural remodeling, and left ventricular (LV) dilation and dysfunction. Tissue inhibitors of metalloproteinase (TIMPs) inhibit matrix metalloproteinases (MMPs), the main regulators of ECM turnover. TIMPs also have MMP-independent functions. TIMP3 levels are reduced in the heart within 24 h of MI in mice. We investigated if overexpression of TIMP3 post-MI limits adverse remodeling and LV dilation and dysfunction. MI was induced by left anterior descending coronary artery ligation in 10- to 12-wk-old male C57BL/6J mice, and adenoviral constructs expressing human (h)TIMP3 (Ad-hTIMP3) or no TIMP (Ad-Null) were injected in the peri-infarct zone (5.4 × 10(7) plaque-forming units/heart, 5 injections/heart). Cardiac function assessed by echocardiography showed improved LV physiology and reduced LV dilation after TIMP3 overexpression compared with the Ad-Null-MI group. Post-MI adverse remodeling was attenuated in the Ad-hTIMP3-MI group, as assessed by greater cardiomyocyte density, less infarct expansion, and ECM disruption. TIMP3 overexpression blunted the early rise in proteolytic activities post-MI. A higher density of coronary arteries and a greater number of proliferating endothelial cells were detected in the infarct and peri-infarct regions in the Ad-hTIMP3-MI group compared with the Ad-Null-MI group. In vitro three-dimensional angiogenesis assay confirmed that recombinant TIMP3 promotes angiogenesis in human endothelial cells, although biphasically and in a dose-dependent manner. Intriguingly, overexpression of Ad-hTIMP3 at 10-fold higher concentration had no beneficial effects, consistent with antiangiogenic effects of TIMP3 at higher doses. In conclusion, optimal overexpression of TIMP3 can be a promising therapeutic approach to limit adverse post-MI remodeling by dually inhibiting early proteolysis and promoting angiogenesis.NEW & NOTEWORTHY Here, we report

  13. Assessment of left ventricular regional myocardial function after acute occlusion of the left anterior descending artery in rats model by two-dimensional strain echocardiography%二维应变超声心动图评价大鼠急性心肌梗死模型局部心肌功能改变的应用价值

    Institute of Scientific and Technical Information of China (English)

    付倩; 谢明星; 王静; 王新房; 吕清; 卢晓芳; 方凌云; 程龙

    2009-01-01

    目的 探讨二维应变超声心动图定量评价大鼠急性心肌梗死模型左室局部心肌功能改变的应用价值.方法 60只Wistar大鼠随机分为两组:实验组50只,制备急性冠状动脉心肌梗死模型;假手术组10只.两组分别于术前及术后1周、4周、8周行超声心动图检查.解剖M型超声心动图测量左室舒张末期及收缩末期内径(LVIDd、LVIDs)、短轴缩短率(FS)、射血分数(EF)和左室质量(LVM).记录左室乳头肌短轴高帧频图像,应用二维应变分析软件测量各节段的收缩期峰值径向应变(PRS)、环向应变(PCS).实验组大鼠检查结束后处死,取出心脏行TTC染色并计算梗死面积;VG染色观察心肌组织中的胶原纤维.结果 根据TTC染色结果将实验组大鼠左窀分为梗死心肌、梗死周围和远处心肌.术后1周VG染色显示实验组大鼠左室各节段均出现不同程度的胶原纤维沉着.与术前及同时期假手术组相比,实验组大鼠于术后1周时梗死心肌、梗死周围及远处心肌的PRS、PCS均明显降低(P0. 01). Compared with baseline and sham-operated group,LVIDd,LVIDs and LVM of study group all increased significantly ( P <0. 05) in 4 weeks and 8 weeks after operation,and FS and EF reduced significantly ( P <0. 05). Two-dimensional strain obtained in interobserver and intraobserver both showed high agreement. Conclusions Two-dimensional strain echocardiography can assess regional function of myocardium with different perfusion in rats following acute myocardial infarction, and provides a sensitive and reliable method to follow up the process of left ventricular remodeling after myocardial infarction.

  14. 3D cardiac wall thickening assessment for acute myocardial infarction

    Science.gov (United States)

    Khalid, A.; Chan, B. T.; Lim, E.; Liew, Y. M.

    2017-06-01

    Acute myocardial infarction (AMI) is the most severe form of coronary artery disease leading to localized myocardial injury and therefore irregularities in the cardiac wall contractility. Studies have found very limited differences in global indices (such as ejection fraction, myocardial mass and volume) between healthy subjects and AMI patients, and therefore suggested regional assessment. Regional index, specifically cardiac wall thickness (WT) and thickening is closely related to cardiac function and could reveal regional abnormality due to AMI. In this study, we developed a 3D wall thickening assessment method to identify regional wall contractility dysfunction due to localized myocardial injury from infarction. Wall thickness and thickening were assessed from 3D personalized cardiac models reconstructed from cine MRI images by fitting inscribed sphere between endocardial and epicardial wall. The thickening analysis was performed in 5 patients and 3 healthy subjects and the results were compared against the gold standard 2D late-gadolinium-enhanced (LGE) images for infarct localization. The notable finding of this study is the highly accurate estimation and visual representation of the infarct size and location in 3D. This study provides clinicians with an intuitive way to visually and qualitatively assess regional cardiac wall dysfunction due to infarction in AMI patients.

  15. MYOCARDIAL INFARCTION TYPE 2. MYTH OR REALITY?

    OpenAIRE

    V. V. Zhelnov; N. V. Dyatlov; L. I. Dvoretsky

    2016-01-01

    According to The Third Definition of Myocardial Infarction there are five types of myocardial infarction depending on pathogenesis. This review provides actual data about myocardial infarction type 2 mechanism including diagnosis management, epidemiological characteristic and patient prognosis. Previously published data shows discordant information about myocardial infarction type 2 frequency, treatment and diagnostic options. Our clinical observation illustrates these severities in diagnosis...

  16. Reducing occurrence of Giardia duodenalis in children living in semiarid regions: impact of a large scale rainwater harvesting initiative

    National Research Council Canada - National Science Library

    Fonseca, Jacqueline Evangelista; Carneiro, Mariângela; Pena, João Luiz; Colosimo, Enrico A; da Silva, Nívea Bispo; da Costa, André Gabriel F C; Moreira, Luciano E; Cairncross, Sandy; Heller, Léo

    2014-01-01

    In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program "One Million Cisterns" (P1MC...

  17. Reducing maternal mortality in Senegal: using GIS to identify priority regions for the expansion of human resources for health.

    Science.gov (United States)

    Massey, Philip

    2011-01-01

    In 2005, Senegal had an estimated maternal mortality ratio of 980 deaths per 100,000 live births, well above the global average of 400. The concentration of health workers has been shown to be associated with improved health outcomes, including maternal mortality. To explore this relationship, this paper uses geographic information systems (GIS) to examine the regional distribution of human resources for health and related maternal health indicators in Senegal. Results show that a regional imbalance in the distribution of health personnel and health indicators exists in Senegal. This disparity may contribute to the disproportionate burden of disease experienced in the eastern part of the country. Based on a spatial analysis, a priority index is used to identify regions to target for the recruitment and training of midwives. GIS is an appropriate and practical tool for governments and other agencies to use in identifying regional disparities and for priority setting.

  18. Anorexia nervosa is linked to reduced brain structure in reward and somatosensory regions: a meta-analysis of VBM studies.

    Science.gov (United States)

    Titova, Olga E; Hjorth, Olof C; Schiöth, Helgi B; Brooks, Samantha J

    2013-04-09

    Structural imaging studies demonstrate brain tissue abnormalities in eating disorders, yet a quantitative analysis has not been done. In global and regional meta-analyses of 9 voxel-based morphometry (VBM) studies, with a total of 228 eating disorder participants (currently ill with anorexia nervosa), and 240 age-matched healthy controls, we compare brain volumes using global and regional analyses. Anorexia nervosa (AN) patients have global reductions in gray (effect size = -0.66) and white matter (effect size = -0.74) and increased cerebrospinal fluid (effect size = 0.98) and have regional decreases in left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate, and no significant increases. No significant difference in hemispheric lateralization was found. Global and regional meta-analyses suggest that excessive restrained eating as found in those with anorexia nervosa coincides with structural brain changes analogous to clinical symptoms.

  19. SBAR Panel: Phase I Federal Implementation Plans (FIPs) To Reduce the Regional Transport of Ozone in the Eastern United States

    Science.gov (United States)

    SBAR panel on regional reductions of nitrogen oxides, with focus on the windborne transport of ozone smog and nitrogen oxides from NOx-producing sources in 22 eastern states and the District of Columbia

  20. Myocardial contractile function and intradialytic hypotension.

    Science.gov (United States)

    Owen, Paul J; Priestman, William S; Sigrist, Mhairi K; Lambie, Stewart H; John, Stephen G; Chesterton, Lindsay J; McIntyre, Christopher W

    2009-07-01

    Dialysis-induced hypotension remains a significant problem in hemodialysis (HD) patients. Numerous factors result in dysregulation of blood pressure control and impaired myocardial reserve in response to HD-induced cardiovascular stress. Episodic intradialytic hypotension may be involved in the pathogenesis of evolving myocardial injury. We performed an initial pilot investigation of cardiovascular functional response to pharmacological cardiovascular stress in hypotension-resistant (HR) and hypotension-prone (HP) HD patients. We studied 10 matched chronic HD patients (5 HP, 5 HR). Dobutamine-atropine stress (DAS) was performed on a nondialysis short interval day, with noninvasive pulse-wave analysis using the Finometer to continuously measure hemodynamic variables. Baroreflex sensitivity was assessed at rest and during DAS. Baseline hemodynamic variables were not significantly different. The groups had differing hemodynamic responses to DAS. The Mean arterial pressure was unchanged in the HR group but decreased in HP patients (-13.6 +/- 3.5 mmHg; P<0.001). This was associated with failure to significantly increase cardiac output in the HP group (cf. increase in cardiac output in the HR group of +33.4 +/- 6%; P<0.05), and a reduced response in total peripheral resistance (HP -10.3 +/- 6.8%, HR -22.7 +/- 2.9%, P=NS). Baroreflex sensitivity was not significantly different between groups at baseline or within groups with increasing levels of DAS; however, the mean baroreflex sensitivity was higher in HR cf. HP subjects throughout pharmacological stress (P<0.05). Hypotension-prone patients appear to have an impaired cardiovascular response to DAS. The most significant abnormality is an impaired myocardial contractile reserve. Early identification of these patients would allow utilization of therapeutic strategies to improve intradialytic tolerability, potentially abrogating aggravation of myocardial injury.

  1. The incomplete bucindolol evaluation in acute myocardial infarction Trial (BEAT)

    DEFF Research Database (Denmark)

    Torp-Pedersen, Christian; Køber, Lars; Ball, Stephen

    2002-01-01

    The aim of this study was to evaluate the efficacy of adding the beta-blocker bucindolol to standard therapy shortly after a myocardial infarction in a high-risk population with reduced left ventricular function. METHODS: The study was planned to include 2000 patients with an enzyme confirmed...... myocardial infarction and severely reduced left ventricular function determined by echocardiography (corresponding to ejection fraction ... of bucindolol 0.88 (95% confidence limits 0.5-1.5; P=0.6). There were 9/4 (bucindolol/placebo, P=0.16) heart failure events and 5/17 (P=0.01) reinfarctions in the bucindolol/placebo groups. CONCLUSION: Due to early closure it is unknown whether bucindolol changes mortality in high-risk post myocardial infarct...

  2. The tole of ischemic preconditioning in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ristić Anđelka

    2005-01-01

    Full Text Available Introduction Ischemic preconditioning is a phenomenon in which brief episodes of ischemia and reperfusion increase myocardial tolerance and substantially reduce the infarction size. Case report Two patients with acute left anterior descending artery occlusion received fibrinolytic therapy within 6 hours of symptom onset, but nevertheless developed myocardial infarctions of different size. The first patient, without a history of preinfarction angina, developed a large anterior infarction, because there was no time for ischemic preconditioning or development of coronary collateral vessels. The second patient, with a 4-day history of preinfarction angina, had a more favorable outcome-he developed apical necrosis, with greater myocardial viability in the infarct-related area. Conclusion The beneficial effects of angina occurring 24-48h before infarction are resulting from ischemic preconditioning, which reduces cardiac mortality, infarct size and occurrence of life-threatening ventricular arrhythmias. .

  3. Fast 3-Breath-Hold 3-Dimensional Tagging Cardiac Magnetic Resonance in Patients with Hypertrophic Myocardial Diseases: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Yasuo Amano

    2016-01-01

    Full Text Available Tagging CMR has been established as the standard reference for measurement of myocardial strain. The current 2D tagging technique requires multiple breath-holds to cover the whole heart and cannot show the 3D motions of the left ventricle. We performed fast 3-breath-hold 3D tagging with localized tagging preparation and complementary spatial modulation of magnetization in 10 patients with hypertrophic myocardial diseases and 6 normal volunteers. The left wall motion was observed at any view angle, which allowed for the identification of regional and global hypokinesis using the fast 3D tagging. Although a decrease in the circumferential strain and LGE were observed at the basal septum in hypertrophic cardiomyopathy, they were not located together in each patient. In hypertensive heart disease, the decrease in circumferential strain was observed more widely than LGE, and the summed strain of all segments was significantly decreased. The decrease in strain and LGE were observed diffusely in cardiac amyloidosis. In conclusion, fast 3-breath-hold 3D tagging is feasible for the regional and global strain analysis. The location of reduced circumferential strain is not necessarily the same as that of LGE and is related to the global cardiac function in patients with hypertrophic myocardial diseases.

  4. Carbon now and carbon futures -- a systems and performance based approach to reducing GHG emissions in the Auckland region

    Energy Technology Data Exchange (ETDEWEB)

    Perry, R., E-mail: robert.perry@arc.govt.nz; Chambers, P. [Auckland Regional Council (New Zealand)

    2010-07-01

    The Auckland Regional Council (ARC) has led a consortium of all Auckland councils and key stakeholders to develop an integrated regional policy response to address the critical climate change-related issues affecting the Auckland region's resilience and sustainable development. The development of climate mitigation policy has been underpinned by two separate but complementary initiatives known as Carbon Now, and Carbon Futures. Carbon Now is a performance and systems based management framework for measuring, monitoring and reporting greenhouse gas (GHG) emissions reductions against prescribed targets. Carbon Futures refers to a backcasting and visioning study which sought to (i) develop long-term (year 2040) emissions projections, and (ii) to evaluate a suite of mitigations to achieve a range of reduction targets. These initiatives were developed in five broad stages. Stage one focused on the development of the Carbon Now framework and guidelines to provide a consistent methodology for the development of a detailed regional emissions inventory. An initial estimation of Auckland regional GHG emissions was undertaken in stage two based on a 2006 base year. In stage three a suite of potential GHG mitigation options were identified and evaluated to deliver GHG reductions and broader co-benefits for Auckland region. Stage four was the development of the Auckland regional GHG emission inventory using the Carbon Now Framework. In stage five a series of modified projections have been evaluated based on a series of scenarios and underpinning assumptions. It was estimated using a 'top down' approach (stage one) that Auckland's regional emissions have risen by 17.7% between 2001 and 2008, compared to a 26% increase rise in national emissions since 1990. It was predicted that by 2040, regional emissions will increase by 87.3% relative to 2001 levels. The Auckland regional footprint equated to 10,040,084 tonnes carbon-dioxide equivalent (CO{sub 2}e) or 7

  5. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

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

    1992-01-01

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

  6. Combined VEGF gene transfer and erythropoietin in ovine reperfused myocardial infarction.

    Science.gov (United States)

    Olea, Fernanda D; De Lorenzi, Andrea; Cortés, Claudia; Cuniberti, Luis; Fazzi, Lucía; Flamenco, María del Pilar; Locatelli, Paola; Cabeza Meckert, Patricia; Bercovich, Andrés; Laguens, Rubén; Crottogini, Alberto

    2013-05-10

    In reperfused acute myocardial infarction (RAMI), cardioprotective treatments may enhance myocardial salvage and hence reduce the area of necrosis. Based on studies showing that plasmid-mediated vascular endothelial growth factor (pVEGF) gene transfer reduces infarct size by combining angio-arteriogenic and cardiomyogenic effects and that erythropoietin (EPO) exerts anti-apoptotic actions in animal models of AMI, we aimed to assess if their association would reduce infarct size to a larger extent than any of them individually in a large mammalian model of RAMI. Adult sheep subjected to 90-minute coronary artery occlusion received upon reperfusion intramyocardial pVEGF 3.8 mg plus intravenous EPO 1000 IU/kg (n=8), pVEGF (n=8), EPO (n=8) or placebo (n=8). Fifteen days after treatment, infarct size was smaller in the 3 treatment groups (pVEGF+EPO: 8 ± 1 %; pVEGF: 16 ± 5 %; EPO: 13 ± 4 %) compared to placebo (25 ± 7 %, p<0.001). However, in the EPO+VEGF group infarct size was significantly smaller than in the groups receiving EPO or VEGF individually (p<0.05). DNA fragmentation, a hallmark of late apoptosis, was significantly lower in sheep receiving EPO. The combined treatment, while not affecting global left ventricular performance, improved regional peri-infarct function and prevented over-time expansion of the post-infarct perfusion defect. Combined pVEGF and EPO treatment might be clinically useful to enhance the benefits of early revascularization in patients with acute myocardial infarction. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Protection effect of survivin protein overexpression on acute myocardial infarction in rats.

    Science.gov (United States)

    Yang, Meng; Li, Bo; Liu, Jingwei; Sun, Haiyan

    2015-01-01

    To investigate the protective effect of adenovirus mediated Survivin protein overexpression on acute myocardial infarction in rats. 45 acute myocardial infarction rat models were constructed by suture method and were randomly divided into sham group, model group and treatment group. The treatment group was injected with Survivin gene packed virus via ventricle. The model group was injected with equal titer of adenovirus packed empty vector. The sham group was not ligated. These rats were killed in 96 h after treatment. The levels of Survivin, Caspase-3, caspase-7 mRNA and protein in myocardial tissues were detected by real-time fluorescence quantitative PCR and Western blot. Myocardium tissue cell apoptosis were analyzed by TUNEL staining, the immunology of myocardial infarction tissue was analyzed by TTC staining. Compared with model group and sham group, the level of survivin protein in myocardium tissue of rats in treatment group was significantly increased (Pmyocardial tissue of rats in model group and treatment group were significantly increased, but the treatment group were significantly lower than those of model group (Pmyocardial infarction areas of rats in model group and treatment group were significantly higher than those of sham group, but the treatment group were significantly lower than those of model group (Pmyocardial tissue can significantly inhibit the expression of apoptosis promoting factor in myocardial tissue of acute myocardial infarction rats, reduce the apoptosis index of myocardial cells and the myocardial infarct size, which has great significance for protecting myocardial function.

  8. Engaging the Dan River Region to reduce obesity: application of the Comprehensive Participatory Planning and Evaluation process.

    Science.gov (United States)

    Zoellner, Jamie; Motley, Monica; Wilkinson, Margie E; Jackman, Barbara; Barlow, Morgan L; Hill, Jennie L

    2012-01-01

    Despite ongoing recommendations to engage health-disparate populations in the initiation and execution of community-based research, few studies report on the process of community engagement. The action-oriented Comprehensive Participatory Planning and Evaluation (CPPE) process is designed to guide community health planning and evaluation. This article describes how the CPPE process was utilized within a community-based participatory research initiative aimed at addressing obesity in the health-disparate Dan River Region. Encouraging community engagement in formulating research agendas and promoting ownership of health solutions will be key to improving obesity risk factors among Dan River Region residents and similar vulnerable communities.

  9. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...... whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... thorough understanding of the mechanisms that influence the prognosis as well as knowledge of the present care provided. The purpose of this PhD thesis is accordingly subdivided into four specific aims: 1. To estimate the prevalence of depression in people with MI after three months, and to estimate...

  10. Elevated risk of myocardial infarction in very young immigrants from former Yugoslavia.

    Science.gov (United States)

    Wiesbauer, Franz; Blessberger, Hermann; Goliasch, Georg; Holy, Erik Walter; Pfaffenberger, Stephan; Tentzeris, Ioannis; Maurer, Gerald; Huber, Kurt; Abdolvahab, Farshid; Sodeck, Gottfried; Exner, Markus; Wojta, Johann; Schillinger, Martin

    2009-01-01

    We performed a hospital based case-control study to assess if the risk of myocardial infarction at a very young age (Yugoslavia. Patients were classified as "exposed" if they or both their parents were born in former Yugoslavia. Consecutive myocardial infarction patients were recruited in the immediate post-infarction period from two Viennese hospitals over a 3.5-year period. Control patients free of myocardial infarction were frequency matched on age, gender, centre, and time in an approximate 1:2 ratio. Logistic regression was used for the assessment of an association between Yugoslavian descent and myocardial infarction. Overall, we recruited 102 myocardial infarction patients and 200 controls. The median age of infarction patients was 37.3 years. Yugoslavian descent was strongly associated with myocardial infarction (crude OR 7.3, 95% CI 3-18). This association was attenuated after multivariate adjustment (OR 3.9, 95% CI 1.2-13) but remained statistically significant. Using Miettinen's formula for population attributable risk, we calculated that between 15.3% (adjusted) and 17.8% (unadjusted) of myocardial infarction cases in very young patients could be attributable to immigrants from the studied region. In conclusion, we found that the risk of developing myocardial infarction at a young age is elevated in immigrants from the region of former Yugoslavia and their offspring. Even though residual confounding cannot be ruled out definitively, this risk seems to be independent of established cardiovascular risk factors.

  11. Native Myocardial T1 as a Biomarker of Cardiac Structure in Non-Ischemic Cardiomyopathy.

    Science.gov (United States)

    Shah, Ravi V; Kato, Shingo; Roujol, Sebastien; Murthy, Venkatesh; Bellm, Steven; Kashem, Abyaad; Basha, Tamer; Jang, Jihye; Eisman, Aaron S; Manning, Warren J; Nezafat, Reza

    2016-01-15

    Diffuse myocardial fibrosis is involved in the pathology of nonischemic cardiomyopathy (NIC). Recently, the application of native (noncontrast) myocardial T1 measurement has been proposed as a method for characterizing diffuse interstitial fibrosis. To determine the association of native T1 with myocardial structure and function, we prospectively studied 39 patients with NIC (defined as left ventricular ejection fraction (LVEF) ≤ 50% without cardiac magnetic resonance (CMR) evidence of previous infarction) and 27 subjects with normal LVEF without known overt cardiovascular disease. T1, T2, and extracellular volume fraction (ECV) were determined over 16 segments across the base, mid, and apical left ventricular (LV). NIC participants (57 ± 15 years) were predominantly men (74%), with a mean LVEF 34 ± 10%. Subjects with NIC had a greater native T1 (1,131 ± 51 vs 1,069 ± 29 ms; p NIC was associated with a greater LVEF (β = -0.59, p = 0.0003), greater right ventricular ejection fraction (β = -0.47, p = 0.006), and smaller left atrial volume index (β = 0.51, p = 0.001). The regional distribution of native myocardial T1 was similar in patients with and without NIC. In NIC, native myocardial T1 is elevated in all myocardial segments, suggesting a global (not regional) abnormality of myocardial tissue composition. In conclusion, native T1 may represent a rapid, noncontrast alternative to ECV for delineating myocardial tissue remodeling in NIC.

  12. The benefits of prone SPECT myocardial perfusion imaging in reducing both artifact defects and patient radiation exposure; Beneficio da aquisicao de imagem na posicao Prona em perfusao miocardica com SPECT para reducao de artefatos e exposicao do paciente a radiacao

    Energy Technology Data Exchange (ETDEWEB)

    Stathaki, Maria; Koukouraki, Sophia; Papadaki, Emmanouela; Tsaroucha, Angeliki; Karkavitsas, Nikolaos, E-mail: mariast_cha@yahoo.gr [Department of Nuclear Medicine, University Hospital of Heraklion, Crete (Greece)

    2015-10-15

    Background: Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation. Objectives: To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure. Methods: We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the 'gold standard' for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings. Results: Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects. Conclusion: Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed. (author)

  13. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging

    National Research Council Canada - National Science Library

    Amundsen, Brage H; Helle-Valle, Thomas; Edvardsen, Thor; Torp, Hans; Crosby, Jonas; Lyseggen, Erik; Støylen, Asbjørn; Ihlen, Halfdan; Lima, João A C; Smiseth, Otto A; Slørdahl, Stig A

    2006-01-01

    The aim of this study was to validate speckle tracking echocardiography (STE) as a method for angle-independent measurement of regional myocardial strain, using sonomicrometry and magnetic resonance imaging (MRI...

  14. Improvement of myocardial perfusion reserve detected by cardiovascular magnetic resonance after direct endomyocardial implantation of autologous bone marrow cells in patients with severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Lau Chu-Pak

    2010-01-01

    Full Text Available Abstract Background Recent studies suggested that bone marrow (BM cell implantation in patients with severe chronic coronary artery disease (CAD resulted in modest improvement in symptoms and cardiac function. This study sought to investigate the functional changes that occur within the chronic human ischaemic myocardium after direct endomyocardial BM cells implantation by cardiovascular magnetic resonance (CMR. Methods and Results We compared the interval changes of left ventricular ejection fraction (LVEF, myocardial perfusion reserve and the extent of myocardial scar by using late gadolinium enhancement CMR in 12 patients with severe CAD. CMR was performed at baseline and at 6 months after catheter-based direct endomyocardial autologous BM cell (n = 12 injection to viable ischaemic myocardium as guided by electromechanical mapping. In patients randomized to receive BM cell injection, there was significant decrease in percentage area of peri-infarct regions (-23.6%, P = 0.04 and increase in global LVEF (+9.0%, P = 0.02, the percentage of regional wall thickening (+13.1%, P= 0.04 and MPR (+0.25%, P = 0.03 over the target area at 6-months compared with baseline. Conclusions Direct endomyocardial implantation of autologous BM cells significantly improved global LVEF, regional wall thickening and myocardial perfusion reserve, and reduced percentage area of peri-infarct regions in patients with severe CAD.

  15. Oxytocin ameliorates the immediate myocardial injury in heart transplant through down regulation of the neutrophil dependent myocardial apoptosis

    Directory of Open Access Journals (Sweden)

    F Fadhil Al-Amran

    2014-01-01

    Conclusion: Oxytocin ameliorates myocardial injury in heart transplant through down-regulation the myocardial inflammatory response, reactive oxygen species, and neutrophil-dependant myocardial apoptosis.

  16. Direct myocardial perfusion imaging in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Soto, R.C.; Durante, M.L.; Villacorta, E.V.; Torres, J.F.; Monzon, O.P.

    1981-02-01

    Twenty two patients with rheumatic valvular heart disease - 21 having a history of heart failure - were studied using direct coronary injection of /sup 99m/Tc labelled MAA particles during the course of hemodynamic and arteriographic studies. Myocardial perfusion deficit patterns have been shown to be consistent or indicative of either patchy, regional or gross ischemia. In patients with history of documented heart failure 90% (18 cases) had ischemic perfusion deficit in the involved ventricle. We conclude that diminished myocardial blood flow is an important mechanism contributing to the development of heart failure.

  17. A case of serpentine coronaries and acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Shivashankara TH

    2015-06-01

    Full Text Available Microvascular disease is a prominent feature of systemic sclerosis (SSc and leads to Raynaud's phenomenon, pulmonary arterial hypertension, and scleroderma renal crisis. The presence of macrovascular disease is less well established, and, in particular, it is not known whether the prevalence of coronary heart disease in SSc is increased. We report a case of SSc who presented with evolved myocardial infarction whose angiogram revealed tortuous coronaries and peripheral arteries. Regional wall motion abnormality was not demonstrated on echocardiography. The microvascular dysfunction and vasospasm of coronaries were responsible for the myocardial infarction. [Int J Res Med Sci 2015; 3(6.000: 1511-1513

  18. 52 Genetic Loci Influencing Myocardial Mass

    DEFF Research Database (Denmark)

    van der Harst, Pim; van Setten, Jessica; Verweij, Niek

    2016-01-01

    BACKGROUND: Myocardial mass is a key determinant of cardiac muscle function and hypertrophy. Myocardial depolarization leading to cardiac muscle contraction is reflected by the amplitude and duration of the QRS complex on the electrocardiogram (ECG). Abnormal QRS amplitude or duration reflect......, and transcription factor binding, suggesting that they represent regions of the genome that are actively transcribed in the human heart. Pathway analyses provided evidence that these loci play a role in cardiac hypertrophy. We further highlighted 67 candidate genes at the identified loci that are preferentially...

  19. GAMMAGRAFÍA DE PERFUSIÓN MIOCÁRDICA EN MUJERES POSMENOPÁUSICAS CON ANGINA Y CORONARIAS EPICÁRDICAS ANGIOGRÁFICAMENTE NORMALES / Myocardial perfusion scintigraphy in postmenopausal women with angina and angiographically normal epicardial coronary

    Directory of Open Access Journals (Sweden)

    Sherien Sixto Fernández

    2011-03-01

    Full Text Available Introduction and Objectives: Microvascular angina is common in postmenopausal women. Myocardial ischemia was induced by stress testing, and reports have been published about the relationship between endothelial dysfunction and myocardial perfusion. The objective of this research was to determine whether myocardial ischemia can be evidenced by abnormalities in perfusion and function, as detected by myocardial scintigraphy in women with typical angina, normal coronary angiography and endothelial dysfunction. Methods: 59 women underwent lipid and endothelial function measurements by brachial artery ultrasound, in addition, a 24-hour ECG study (Holter. During the scintigraphy a stress-rest protocol was applied. Patients were divided into two groups according to presence (group I or absence (group II of myocardial perfusion defects. Results: 21 patients showed perfusion defects. 57 % of group I exhibited greater endothelial dysfunction. Only twelve patients showed reversible perfusion defects, and 75 % of the cases was associated with a reduction of post-stress left ventricular ejection fraction, greater than 5 %, and regional abnormalities of wall motion. Three patients in group I showed evidence of ischemia compared with four in Group II. Conclusions: The stress-induced ischemia was associated with a reduced post-stress ejection fraction and endothelial dysfunction in the studied women, and no ischemic changes in the Holter were found.

  20. 10.11.Myocardial disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920088 Effect and significance of neuro-peptide Y on synthesis of myocardial pro-tein.WANG Tao (王涛),et al.Cardiovasc Lab,3rd Hosp,Beijing Med Univ.Chin Cir J 1991; 6 (5):354-356.The rate of myocardial protein synthesis andthe cardiac content of neuropeptide Y (NPY) inrats were measured by ~3H-leucine incorporation

  1. Glycine receptors contribute to cytoprotection of glycine in myocardial cells

    Institute of Scientific and Technical Information of China (English)

    QI Ren-bin; ZHANG Jun-yan; LU Da-xiang; WANG Hua-dong; WANG Hai-hua; LI Chu-jie

    2007-01-01

    Background The classic glycine receptor (GlyR) in the central nervous system is a ligand-gated membrane-spanning ion channel. Recent studies have provided evidence for the existence of GlyR in endothelial cells, renal proximal tubular cells and most leukocytes. In contrast, no evidence for GlyR in myocardial cells has been found so far. Our recent researches have showed that glycine could protect myocardial cells from the damage induced by lipopolysaccharide (LPS). Further studies suggest that myocardial cells could contain GlyR or binding site of glycine.Methods In isolated rat heart damaged by LPS, the myocardial monophasic action potential (MAP), the heart rate (HR),the myocardial tension and the activities of lactate dehydrogenase (LDH) from the coronary effluent were determined.The concentration of intracellular free calcium ([Ca2+]i) was measured in cardiomyocytes injured by LPS and by hypoxia/reoxygenation (H/R), which excludes the possibility that reduced calcium influx because of LPS neutralized by glycine. Immunohistochemistry was used to detect the GlyR in myocardial tissue. GlyR and its subunit in the purified cultured cardiomyocytes were identified by Western blotting.Results Although significant improvement in the MAP/MAPD20, HR, and reduction in LDH release were observed in glycine + LPS hearts, myocardial tension did not recover. Further studies demonstrated that glycine could prevent rat mycordial cells from LPS and hypoxia/reoxygenation injury (no endotoxin) by attenuating calcium influx.Immunohistochemistry exhibited a positive green-fluorescence signaling along the cardiac muscle fibers. Western blotting shows that the purified cultured cardiomyocytes express GlyR β subunit, but GlyR α1 subunit could not be detected.Conclusions The results suggest that glycine receptor is expressed in cardiomyocytes and participates in cytoprotection from LPS and hypoxia/reoxygenation injury. Glycine could directly activate GlyR on the cardiomyocytes and

  2. Myocardial regeneration potential of adipose tissue-derived stem cells

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xiaowen, E-mail: baixw01@yahoo.com [Department of Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 (United States); Alt, Eckhard, E-mail: ealt@mdanderson.org [Department of Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 (United States)

    2010-10-22

    Research highlights: {yields} Various tissue resident stem cells are receiving tremendous attention from basic scientists and clinicians and hold great promise for myocardial regeneration. {yields} For practical reasons, human adipose tissue-derived stem cells are attractive stem cells for future clinical application in repairing damaged myocardium. {yields} This review summarizes the characteristics of cultured and freshly isolated stem cells obtained from adipose tissue, their myocardial regeneration potential and the, underlying mechanisms, and safety issues. -- Abstract: Various tissue resident stem cells are receiving attention from basic scientists and clinicians as they hold promise for myocardial regeneration. For practical reasons, adipose tissue-derived stem cells (ASCs) are attractive cells for clinical application in repairing damaged myocardium based on the following advantages: abundant adipose tissue in most patients and easy accessibility with minimally invasive lipoaspiration procedure. Several recent studies have demonstrated that both cultured and freshly isolated ASCs could improve cardiac function in animal model of myocardial infarction. The mechanisms underlying the beneficial effect of ASCs on myocardial regeneration are not fully understood. Growing evidence indicates that transplantation of ASCs improve cardiac function via the differentiation into cardiomyocytes and vascular cells, and through paracrine pathways. Paracrine factors secreted by injected ASCs enhance angiogenesis, reduce cell apoptosis rates, and promote neuron sprouts in damaged myocardium. In addition, Injection of ASCs increases electrical stability of the injured heart. Furthermore, there are no reported cases of arrhythmia or tumorigenesis in any studies regarding myocardial regeneration with ASCs. This review summarizes the characteristics of both cultured and freshly isolated stem cells obtained from adipose tissue, their myocardial regeneration potential, and the

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

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

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

  4. Green Tourism in Mountain Regions - Reducing Vulnerability and Promoting People and Place Centric Development in the Himalayas

    Institute of Scientific and Technical Information of China (English)

    R. B. Singh; D. K. Mishra

    2004-01-01

    In recent years, mountain regions are attracting great attention to Indian tourists in general and foreign tourists in particular. The potential mountain resources for promoting green tourism are enormous in the form of natural and cultural heritage such as biosphere reserves, flora and fauna, lakes and rivers and traditional rural resources. In order to utilise tourism industry market, uncontrolled numbers of tourists and related haphazard infrastructural facilities in the vulnerable mountain regions pose serious environmental implications. The ecological pressures are threatening land, water and wild life resources through direct and indirect environmental impacts together with generation of solid and liquid wastes, so green tourism is emerging as an important task in order to develop new relationship between communities, government agencies and private sectors. The strategy focuses on ecological understanding, environmental protection and ecodevelopment. The major attributes of the green tourism include environmental conservation and education and distribution of income to local people based on strong partnership. Various knowledge systems go a long way for achieving the goals of the green tourism, which creates awareness about the value of environmental resources.Mountains have ecological, recreational, educational and scientific values, which need to be utilised in sustainable way. Various tourist activities and facilities need to be diversified in order to achieve multiple benefits including scientific field excursion,recreation in natural and cultural areas, community festivals and sport tourisms. Green tourism considers tourism development as an integral part of a national and regional development. The paper discusses the social, economic and environmental dimensions of the green tourism with particular reference to village tourism development programme taking empirical evidences from the Himalaya. Such programme also minimises biophysical and human

  5. Localizing F(ST) outliers on a QTL map reveals evidence for large genomic regions of reduced gene exchange during speciation-with-gene-flow.

    Science.gov (United States)

    Via, Sara; Conte, Gina; Mason-Foley, Casey; Mills, Kelly

    2012-11-01

    Populations that maintain phenotypic divergence in sympatry typically show a mosaic pattern of genomic divergence, requiring a corresponding mosaic of genomic isolation (reduced gene flow). However, mechanisms that could produce the genomic isolation required for divergence-with-gene-flow have barely been explored, apart from the traditional localized effects of selection and reduced recombination near centromeres or inversions. By localizing F(ST) outliers from a genome scan of wild pea aphid host races on a Quantitative Trait Locus (QTL) map of key traits, we test the hypothesis that between-population recombination and gene exchange are reduced over large 'divergence hitchhiking' (DH) regions. As expected under divergence hitchhiking, our map confirms that QTL and divergent markers cluster together in multiple large genomic regions. Under divergence hitchhiking, the nonoutlier markers within these regions should show signs of reduced gene exchange relative to nonoutlier markers in genomic regions where ongoing gene flow is expected. We use this predicted difference among nonoutliers to perform a critical test of divergence hitchhiking. Results show that nonoutlier markers within clusters of F(ST) outliers and QTL resolve the genetic population structure of the two host races nearly as well as the outliers themselves, while nonoutliers outside DH regions reveal no population structure, as expected if they experience more gene flow. These results provide clear evidence for divergence hitchhiking, a mechanism that may dramatically facilitate the process of speciation-with-gene-flow. They also show the power of integrating genome scans with genetic analyses of the phenotypic traits involved in local adaptation and population divergence. © 2012 Blackwell Publishing Ltd.

  6. Beta-Blocker Therapy Early After Myocardial Infarction

    DEFF Research Database (Denmark)

    Pedersen, Susanne Bendesgaard; Nielsen, Jens Cosedis; Bøtker, Hans Erik

    2016-01-01

    BACKGROUND: Beta-blocker (BB) therapy after myocardial infarction (MI) reduces all-cause mortality. OBJECTIVE: The aim of this study was to investigate BB dosing patterns and compliance following MI. METHODS: Using medical patient files and nationwide databases, we identified 100 patients who were...

  7. Oxygen free radicals in myocardial ischemia and reperfusion

    NARCIS (Netherlands)

    A.M.M. van der Kraaij

    1989-01-01

    textabstractIn patients with acute myocardial infarction, death normally results from rhythmic disturbances or pump failure. Over the past 3 decades, the mortality rate from this disease has been substantially reduced predominantly by vigorous treatment of dysrhythmias using modern monitoring techni

  8. New insights in management and prognosis in acute myocardial infarction

    NARCIS (Netherlands)

    Kampinga, Marthe Anna

    2015-01-01

    The evaluation of new treatments during primary percutaneous coronary intervention (PCI) to reduce morbidity and mortality remains important in patients with ST-segment elevation myocardial infarction (STEMI). Studies evaluating the adjunctive treatments for STEMI patients ‘thrombus aspiration’ and

  9. Plasma HDL cholesterol and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Voight, Benjamin F; Peloso, Gina M; Orho-Melander, Marju

    2012-01-01

    High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes...

  10. Integrated regional network construction for ST-segment elevation myocardial infarction care%区域协同ST段抬高型心肌梗死救治网络建设探讨

    Institute of Scientific and Technical Information of China (English)

    王斌; 王焱; 叶涛; 肖国胜; 常贺; 温红梅; 陈媛; 林吉怡; 杨鹭琳

    2014-01-01

    目的 探讨在我国建立区域协同急性ST段抬高型心肌梗死(STEMI)救治网络系统(IRN-STEMI)的可行性及实施效果.方法 以实时心电图传输技术为纽带,通过管理模式创新,以厦门市心脏中心为核心,协调120急救系统、其他具备直接经皮冠状动脉介入(PCI)能力的医院及部分基层医院等多家医疗单位创建厦门区域协同STEMI救治网络.总结IRN-STEMI运行1年来网络内所有医疗单位STEMI患者的救治情况,对厦门市心脏中心IRN-STEMI建立前(2012年3月16日至2013年3月15日,n=165)和建立后(2013年3月16日至2014年3月15日,n=256)两组患者基线特征,年平均首次医疗接触至球囊(FMC-to-B)时间、平均门至球囊时间(D-to-B)、平均住院天数、住院费用及住院期间病死率进行比较.结果 IRN-STEMI成立前网络内所有医疗单位收治STEMI患者245例,有221例(90.2%)接受再灌注治疗,其中直接PCI 185例(75.5%).IRN-STEMI成立后纳入STEMI患者343例,共321例(93.6%)接受再灌注治疗,其中直接PCI有290例(84.5%).与IRN-STEMI成立前比较,成立厦门市心脏中心后接受直接PCI的STEMI患者年平均FMC-to-B时间[(110.3±34.0)min比(137.9 ±58.5)min,P<0.01]及年平均D-to-B时间[(76.5±33.0)min比(107.3±38.0)min,P<0.01]较短,平均住院天数[(9.0±4.3)d比(9.7±4.8)d,P>0.05]及住院期间病死率[3.1%(8/256)比3.0%(5/165),P>0.05]差异无统计学意义,但平均住院费用明显减少[(51 398 ±22 100)元比(56 970 ±24593)元,P<0.05].结论 在国内由具有数家PCI能力的医院、120急救系统及基层网络医院共同建立区域性STEMI救治网络是可行的.通过IRN-STEMI可显著增加本地区接受直接PCI患者比例,明显缩短FMC-to-B及D-to-B时间,减少住院费用,是提升区域内STEMI救治水平的有效方法.%Objective To investigate the feasibility of establishing an integrated regional network for ST-segment elevation myocardial infarction

  11. PET/CT Imaging in Mouse Models of Myocardial Ischemia

    Directory of Open Access Journals (Sweden)

    Sara Gargiulo

    2012-01-01

    Full Text Available Different species have been used to reproduce myocardial infarction models but in the last years mice became the animals of choice for the analysis of several diseases, due to their short life cycle and the possibility of genetic manipulation. Many techniques are currently used for cardiovascular imaging in mice, including X-ray computed tomography (CT, high-resolution ultrasound, magnetic resonance imaging, and nuclear medicine procedures. Cardiac positron emission tomography (PET allows to examine noninvasively, on a molecular level and with high sensitivity, regional changes in myocardial perfusion, metabolism, apoptosis, inflammation, and gene expression or to measure changes in anatomical and functional parameters in heart diseases. Currently hybrid PET/CT scanners for small laboratory animals are available, where CT adds high-resolution anatomical information. This paper reviews mouse models of myocardial infarction and discusses the applications of dedicated PET/CT systems technology, including animal preparation, anesthesia, radiotracers, and images postprocessing.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

    魏天辉

    2010-01-01

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

  14. Clinical Study of Ultrasonic Tissue Characterization with Integrated Backscatter and Echo Intensity in the Diagnosis of Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    王志刚; 冉海涛; 黄晶; 陈庆伟; 邹建中; 苏海兵; 蒲世玉; 凌智瑜; 陈永新; 何明菊

    2001-01-01

    Objectives The purpose of this study was to determine if the ultrasonic integrated backscatter and echo intensity could be used in clinical diagnosis of acute myocardial infarction. Methods and Results Within 2 weeks after acute myocardial infarction, 35 patients underwent ultrasonic tissue characterization from the papillary short- axis view.The cyclic variation of integrated backscatter and echo intensity of three different myocardial regions perfused by left anterior descending coronary artery, left cir cumflex coronary and right coronary were measured .The value of cyclic variation of integrated backscatter and integrated backscatter and echo intensity ≤ half of the highest value of three different myocardial regions on a same view were define as the criteria for diag nosing acute myocardial infarction , and the results were compared with coronary angiography. The sensitivity of diagnosing acute myocardial infarction by both Ultrasonic tissue characterization with integrated backscatter and echo intensity were 91.43 % . The location of myocardial infarction detected by this technique corresponded with the damaged myocardial region determined by coronary angiography. Conclusions Ultrasonic tissue characterization with integrated backscatter and echo intensity could clinically be used as a noninvasive approach in the diagnosis of acute myocardial infarction.

  15. Inactivation of neuronal function in the amygdaloid region reduces tail artery blood flow alerting responses in conscious rats.

    Science.gov (United States)

    Mohammed, M; Kulasekara, K; De Menezes, R C; Ootsuka, Y; Blessing, W W

    2013-01-03

    Few studies have investigated whether neuronal function in the amygdaloid complex is necessary for the occurrence of the cardiovascular response to natural (unconditioned) environmental threats. In the present investigation in conscious unrestrained Sprague-Dawley rats we inactivated neuronal function in the amygdaloid complex acutely (bilateral muscimol injections) or chronically (unilateral or bilateral ibotenic acid injections) and measured the effect on sudden falls in tail artery blood flow elicited by non-noxious salient stimuli (sympathetic cutaneous vasomotor alerting responses, SCVARs). After acute bilateral injection of vehicle (200nl Ringer's solution) the SCVAR index was 81 ± 2%, indicating that tail blood flow was reduced by 81% in response to the salient stimuli. After acute bilateral injection of muscimol (1 nmol in 200 nl of Ringer's solution) into the amygdaloid complex the SCVAR index was 49 ± 5%, indicating that tail blood flow was reduced by 49% in response to the salient stimuli (pbody with more immediate metabolic requirements.

  16. Reducing inappropriate emergency department attendances--a review of ambulance service attendances at a regional teaching hospital in Scotland.

    Science.gov (United States)

    Patton, Gareth Gordon; Thakore, Shobhan

    2013-06-01

    Emergency Departments (ED) in the UK have seen increasing attendance rates in recent years. Departments are now seeking strategies to reduce their attendances. A review of all ambulance attendances to the ED at Ninewells Hospital was conducted to identify if patients presenting by ambulance could be seen and treated more appropriately in other parts of the health service. A retrospective review of ambulance attendances to the ED at Ninewells Hospital over 7 non-consecutive days. The ambulance patient report form and the ED notes were reviewed by the duty consultant to deem whether it was appropriate for the patient to be presented to the ED. If inappropriate, an alternative destination was suggested. Additional data was collected on the source of the ambulance call. There were 910 attendances in the 7 days. 295 (32%) presented by ambulance. 32 had incomplete data and were excluded. 185 (70%) and 179 (68%) of the 263 were deemed appropriate from review of the patient report form and notes respectively. Of the inappropriate, 74.4% and 79.7% had primary care suggested as an alternative. Patients who call for their own ambulance and NHS24 had higher rates of inappropriate attendances. The ambulance services present one-third of the patients to the ED at Ninewells Hospital. 30%-32% were found to be attending inappropriately and 74%-80% of these could have been managed in primary care. Reducing inappropriate ambulance attendances could reduce the departmental patient load by 11%.

  17. The Post-Myocardial Infarction Pacing Remodeling Prevention Therapy (PRomPT) Trial

    DEFF Research Database (Denmark)

    Chung, Eugene S; Fischer, Trent M; Kueffer, Fred

    2015-01-01

    BACKGROUND: Despite considerable improvements in the medical management of patients with myocardial infarction (MI), patients with large MI still have substantial risk of developing heart failure. In the early post-MI setting, implantable cardioverter defibrillators have reduced arrhythmic deaths...

  18. A study of partial volume effect on SPECT imaging using myocardial phantom. With HCM (ASH) model myocardial phantom

    Energy Technology Data Exchange (ETDEWEB)

    Onoguchi, Masahisa [Kanazawa Univ. (Japan). School of Medicine

    1997-05-01

    In order to evaluate simultaneously both myocardial perfusion and regional wall motion using ECG-gated myocardial SPECT imaging, correction for the partial volume effect (PVE) should be performed. For the quantitative analysis of myocardial SPECT imaging in patients with hypertrophic cardiomyopathy (HCM), we formed a new phantom simulating HCM with various septal wall thicknesses and estimated PVE using the recovery coefficient (RC). The value of RC in all phantoms increased with increasing thickness of the septal wall reaching a plateau at 25 mm for the cylindrical phantom and 25 mm for the Ep-phantom. Compared with the RC value, the PMMA-phantom had little influence on PVE. Therefore, our results suggested that the count in the septal wall could be underestimated if PVE was corrected by the value obtained for the cylindrical phantom. In conclusion, our new phantom simulating HCM was useful in assessing PVE in the hypertrophic septal wall. (author)

  19. Fragmentation reduces regional-scale spatial genetic structure in a wind-pollinated tree because genetic barriers are removed

    Science.gov (United States)

    Wang, Rong; Compton, Stephen G; Shi, Yi-Su; Chen, Xiao-Yong

    2012-01-01

    Gene flow strongly influences the regional genetic structuring of plant populations. Seed and pollen dispersal patterns can respond differently to the increased isolation resulting from habitat fragmentation, with unpredictable consequences for gene flow and population structuring. In a recently fragmented landscape we compared the pre- and post-fragmentation genetic structure of populations of a tree species where pollen and seed dispersal respond differentially to forest fragmentation generated by flooding. Castanopsis sclerophylla is wind-pollinated, with seeds that are dispersed by gravity and rodents. Using microsatellites, we found no s