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Sample records for ventricular myocardial performance

  1. Left Ventricular Myocardial Function in Children With Pulmonary Hypertension: Relation to Right Ventricular Performance and Hemodynamics.

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    Burkett, Dale A; Slorach, Cameron; Patel, Sonali S; Redington, Andrew N; Ivy, D Dunbar; Mertens, Luc; Younoszai, Adel K; Friedberg, Mark K

    2015-08-01

    Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular strain, and functional measures of PH. At 2 institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. Patients with PH had reduced LV global longitudinal strain (LS; -18.8 [-17.3 to -20.4]% versus -20.2 [-19.0 to -20.9]%; P=0.0046) predominantly because of reduced basal (-12.9 [-10.8 to -16.3]% versus -17.9 [-14.5 to -20.7]%; Pright ventricular free-wall LS (r=0.64; Pright ventricular strain, and functional PH measures. © 2015 American Heart Association, Inc.

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

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

    2001-01-01

    a first myocardial infarction (MI). To do so, serial Doppler echocardiography was performed in 77 consecutive patients with a first MI. Right ventricular MPI correlated significantly with LV MPI (r = 0.51, P signs of RV MI, the RV MPI was significantly higher (0...

  3. Myocardial performance is reduced immediately prior to ventricular ectopy

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    Bloch Thomsen, Poul Erik; Hansen, Thomas Fritz; Jons, Christian

    2012-01-01

    patients had no structural heart disease, 5 had dilated cardiomyopathy, 4 had ischemic heart disease, 2 had arrhythmogenic right ventricular dysplasia, and 1 had aortic stenosis. The ectopy originated in the ventricular outflow tracts in 15 patients and in the left ventricle 8. Eleven of the patients...

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

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

    2001-01-01

    To investigate the value of the Doppler-derived myocardial performance index to predict early left-ventricular (LV) dilation and cardiac death after a first acute myocardial infarction (AMI), Doppler echocardiography was performed within 24 h of hospital admission, on day 5, 1 and 3 months after...... AMI in 125 consecutive patients. The index measured on day 1 correlated well with the change in end-diastolic volume index observed from day 1 to 3 months following AMI (r = 0.66, p 0.0001). One-year survival in patients with Doppler index patients with index > or = 0......, we conclude that the Doppler echocardiographic myocardial performance index is a predictor of LV dilation and cardiac death after a first AMI....

  5. Echoventriculography in acute myocardial infarction. II: Monitoring of left ventricular performance.

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    Nieminen, M; Heikkilä, J

    1976-03-01

    In acute myocardial infarction the overall left ventricular pump function and the regional performance of the infarcted and non-infarcted myocardial segments were studied serially by echocardiographic techniques in 24 patients during the first week of their illness. Left ventricular cavity sizes were acutely increased in 62 per cent of the patients (P less than 0-005). The end-systolic diameter in anterior infarcts increased to the greatest extent, +44 per cent, the end-diastolic diameter by +27 per cent, giving a volume of 246+/-25 ml. In the anterior myocardial infarcts all the function parameters deteriorated more than in the posteroinferior ones. Ejection fraction was subnormal (P less than 0-005) in every patient, and mean circumferential fibre shortening (Vcf) was slowed by about 30 per cent (P less than 0-005). Regionally, contraction of the infarcted area of the ventricle was asynergic in every instance, and its function was almost totally lost (P less than 0-001). Systolic paradoxical motion was a constant and stable finding in the anterior infarctions but not so in the posterior ones. While this asynergic systolic contraction may distort echocardiographic measurement of the end-systolic left vlic phase. The serial deviations from normal in the amplitude or velocity of the uninvolved segments were small, but in the case of clearly enlarged end-diastolic volumes these figures in fact indicate supernormal, compensating function. Both overall and regional performance were worst within the first 3 days of infarction, improving thereafter. The patient with a fatal course showed, instead, progressive deterioration. This noninvasive left ventriculogram by ultrasound gives valuable insight into overall pump function and ventricular volumes, little studied so far in acute infarction, and it may serially quantify the segmental function of both the infarcted and uninvolved regions.

  6. Ventricular performance and Na+-K+ ATPase activity are reduced early and late after myocardial infarction in rats

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    I. Stefanon

    2009-10-01

    Full Text Available Myocardial infarction leads to compensatory ventricular remodeling. Disturbances in myocardial contractility depend on the active transport of Ca2+ and Na+, which are regulated by Na+-K+ ATPase. Inappropriate regulation of Na+-K+ ATPase activity leads to excessive loss of K+ and gain of Na+ by the cell. We determined the participation of Na+-K+ ATPase in ventricular performance early and late after myocardial infarction. Wistar rats (8-10 per group underwent left coronary artery ligation (infarcted, Inf or sham-operation (Sham. Ventricular performance was measured at 3 and 30 days after surgery using the Langendorff technique. Left ventricular systolic pressure was obtained under different ventricular diastolic pressures and increased extracellular Ca2+ concentrations (Ca2+e and after low and high ouabain concentrations. The baseline coronary perfusion pressure increased 3 days after myocardial infarction and normalized by 30 days (Sham 3 = 88 ± 6; Inf 3 = 130 ± 9; Inf 30 = 92 ± 7 mmHg; P < 0.05. The inotropic response to Ca2+e and ouabain was reduced at 3 and 30 days after myocardial infarction (Ca2+ = 1.25 mM; Sham 3 = 70 ± 3; Inf 3 = 45 ± 2; Inf 30 = 29 ± 3 mmHg; P < 0.05, while the Frank-Starling mechanism was preserved. At 3 and 30 days after myocardial infarction, ventricular Na+-K+ ATPase activity and contractility were reduced. This Na+-K+ ATPase hypoactivity may modify the Na+, K+ and Ca2+ transport across the sarcolemma resulting in ventricular dysfunction.

  7. Relation of plasma lipoprotein(a) with myocardial viability and left ventricular performance in survivors of myocardial infarction

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    Aksoy, M.; Goktekin, O.; Gursurer, M.; Emre, A.; Bilge, M.; Yesilcimen, K.; Ersek, B. [Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Istanbul (Turkey); Kepekci, Y.; Akdemir, I.

    1999-11-01

    Previous studies have reported that high serum lipoprotein(a) levels may be responsible for total occlusion of the infarct-related artery via inhibition of intrinsic fibrinolysis during acute myocardial infarction. We evaluated whether this would result in a greater extent of myocardial necrosis and impaired left ventricular function in patients with high lipoprotein(a) levels. Sixty-eight patients with prior myocardial infarction, who were not receiving thrombolytic therapy underwent coronary angiography and stress-redistribution-reinjection Tl-201 scintigraphy. Antegrade TIMI flow in the infarct-related artery was lower (1.54{+-}1.14 vs 2.15{+-}1.05; p=0.03) and the collateral index was higher (1.3{+-}1.0 vs 0.8{+-}0.9; p=0.07) in patients with high lipoprotein(a) levels (>30 mg/dl) compared to those with low lipoprotein(a) levels ({<=}30 mg/dl). Regional wall motion score index was lower (0.8{+-}0.8 vs 1.4{+-}0.5; p=0.008) and global ejection fraction was higher (46{+-}10% vs 40{+-}11%; p=0.03) in patients with low lipoprotein(a) levels. On SPECT images, the number of nonviable defects was higher in patients with high lipoprotein(a) levels (4.0{+-}2.5 vs 1.9{+-}1.3; p=0.0002), whereas the number of viable defects was higher in those with low lipoprotein(a) levels (2.5{+-}1.8 vs 1.5{+-}1.3; p=0.02). We conclude, that high lipoprotein(a) levels may prolong the occlusion of infarct-related artery during acute myocardial infarction and lead to a greater extent of myocardial necrosis and impaired left ventricular function. (author)

  8. Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia.

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    Christoph Czernik

    Full Text Available OBJECTIVES: Elevated pulmonary vascular resistance occurs during the first days after birth in all newborn infants and persists in infants at risk for bronchopulmonary dysplasia (BPD. It is difficult to measure in a non-invasive fashion. We assessed the usefulness of the right ventricular index of myocardial performance (RIMP to estimate pulmonary vascular resistance in very low birth weight infants. STUDY DESIGN: Prospective echocardiography on day of life (DOL 2, 7, 14, and 28 in 121 preterm infants (median [quartiles] gestational age 28 [26]-[29] weeks, birth weight 998 [743-1225] g of whom 36 developed BPD (oxygen supplementation at 36 postmenstrual weeks. RESULTS: RIMP derived by conventional pulsed Doppler technique was unrelated to heart rate or mean blood pressure. RIMP on DOL 2 was similar in infants who subsequently did (0.39 [0.33-0.55] and did not develop BPD (0.39 [0.28-0.51], p = 0.467. RIMP declined steadily in non-BPD infants but not in BPD infants (DOL 7: 0.31[0.22-0.39] vs. 0.35[0.29-0.48], p = 0.014; DOL 14: 0.23[0.17-0.30] vs. 0.35[0.25-0.43], p<0.001; DOL 28: 0.21[0.15-0.28] vs. 0.31 [0.21-0.35], p = 0.015. CONCLUSIONS: In preterm infants, a decline in RIMP after birth was not observed in those with incipient BPD. The pattern of RIMP measured in preterm infants is commensurate with that of pulmonary vascular resistance.

  9. CT imaging features and frequency of left ventricular myocardial fat in patients with CT findings of chronic left ventricular myocardial infarction

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    Zafar, H.M.; Litt, H.I. [Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Torigian, D.A. [Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)], E-mail: drew.torigian@uphs.upenn.edu

    2008-03-15

    Aim: To determine the frequency of left ventricular myocardial fat in patients with computed tomography (CT) findings of chronic left ventricular myocardial infarction, and to review the typical CT imaging features. Materials and methods: A retrospective search of the CT and nuclear scintigraphy reports from 1998-2005 for chronic left ventricular myocardial infarction was performed. The study group comprised those cases with available CT examinations revealing findings of chronic left ventricular myocardial infarction. Assessment for the presence of various imaging characteristics of left ventricular myocardial fat was performed in all cases. Results: The frequency of left ventricular myocardial fat in 47 patients with CT evidence of chronic left ventricular myocardial infarction was 51%. Typical CT imaging features include thin linear or curvilinear fat attenuation within left ventricular myocardium, most commonly subendocardial, often associated with left ventricular wall thinning and/or calcification, predominantly in elderly men. Conclusions: Fat in the left ventricular myocardium is a common additional finding in patients with CT findings of chronic left ventricular myocardial infarction. The potential, but as yet unproven, use of this CT imaging finding is that the radiologist may be able to suggest a potential diagnosis of chronic left ventricular myocardial infarction on unenhanced, thick-section, non-gated or non-triggered chest CT imaging where identification of myocardial wall thinning may be difficult.

  10. Left ventricular myocardial performance assessed by 2-dimensional speckle tracking echocardiography in patients with sickle cell crisis.

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    Sengupta, Shantanu P; Jaju, Rahul; Nugurwar, Abhijeet; Caracciolo, Giuseppe; Sengupta, Partho P

    2012-01-01

    The status of left ventricle in sickle cell anemia presenting in sickle crisis and follow up has been minimally studied in past. To determine the left ventricular (LV) myocardial performance in these patients, we performed the study to assess two dimensional strains imaging which allowed a rapid and an accurate analysis of global and regional LV myocardial performance in longitudinal, radial, and circumferential directions. In this prospective study, 2-dimensional echocardiography (2DE) images of the LV were obtained in 52 subjects which included 32 patients (23 ± 8yrs, 16 male) with homozygous sickle cell anemia (SCA) in sickle cell crisis and 20 healthy controls (23 ± 5 yrs, 11 male) using apical 4-chamber and parasternal short-axis at the basal, mid, and apical levels. Of these 32 patients, 2DE was performed again in 18 patients in follow up (8 months ± 5 days). Longitudinal, circumferential and radial strains (LS, CS and RS respectively) were quantified and compared in an 18-segment model using a novel speckle tracking system (2D Cardiac Performance Analysis, TomTec Imaging System, Munich, Germany). There was no significant difference in LV ejection fraction between both the groups (59.32 ± 12.6 vs. 52.3 ± 7.9; p-value > 0.05). In comparison with normal controls and follow up of sickle cell patients, peak LS was significantly attenuated in the subendocardial and subepicardial regions during sickle cell crisis (p crisis showed significantly higher radial strain parameters than controls (p crisis have reduced longitudinal shortening. LV myocardial performance remains unaltered due to relatively preserved circumferential shortening and increased radial thickening. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  11. [Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].

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    Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J

    2015-01-01

    A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  12. Left ventricular mass, geometric patterns, and diastolic myocardial performance in children with chronic kidney disease

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    Igoche David Peter

    2018-01-01

    Full Text Available Background: Excessive left ventricular mass (LVM and diastolic dysfunction are associated with higher morbidity and mortality among patients with chronic kidney disease (CKD. Objective: The objective of the following study is to determine the prevalence of increased LVM index (LVMI, pattern of abnormal LV geometry, and diastolic dysfunction in Nigerian CKD children and to establish a relationship of these with estimated glomerular filtration rate (eGFR. Subjects and Methods: Cross-sectional comparative study of LV structure and diastolic function of 21 children with CKD age- and sex-matched and controls asymptomatic for cardiac disease. Results: The median LVMI was 62.19 (34.7 g/m2 in CKD patients compared with 52.89 (30.2 g/m2 in controls (P = 0.04. Excessive LVMI was present in 3 (14.3% individuals compared with none (0% of the controls P < 0.001. The prediction equation for LVMI using eGFR is: LVMI = 123.11+ (−0.48 × eGFR ml/m2/min. Abnormal LV geometry was present in 19.05% of the CKD patients and none of the controls (P = 0.04. CKD stages differed significantly with respect to the presence of abnormality with LV geometry (P = 0.04. LV diastolic dysfunction was present in 4 (19.1% individuals (2 each had impaired relaxation and restrictive patterns compared with 1 (4.8% control (restrictive pattern-P <; 0.001. Children with CKD who had abnormal LV geometry had 48 times increase in the odds of having LV diastolic dysfunction when compared with those having normal LV geometry (confidence interval = 2.31–997.18, P = 0.012. Conclusion: Excessive LVM, LV hypertrophy and diastolic dysfunction are significantly more common in children with CKD compared with controls.

  13. Ventricular myocardial architecture in marine fishes.

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    Sanchez-Quintana, D; Hurle, J M

    1987-03-01

    The fiber architecture of the ventricular myocardium has been studied in elasmobranch (Isurus oxyrhinchus, Galeorhinus galeus, Prionace glauca) and teleost (Xiphias gladius, Thunnus thynnus, Thunnus alalunga) fish species with hearts displaying mixed types of ventricular musculature (compact and trabecular). In all cases, the compact myocardium is organized in layers of fiber bundles with an orderly arrangement within the ventricular walls. The number of these layers appears to be dependent on the relative thickness of the compact myocardium. Differences in the pattern of myocardial fiber arrangement were observed among the different fish species. In elasmobranchs the compact myocardium at the level of the atrioventricular orifice is continuous with the trabeculated myocardium. Furthermore, in elasmobranchs the trabeculated myocardium displays a precise arrangement in arcuate trabeculae running from the auriculoventricular to the conoventricular orifices. In teleosts, the compact myocardium is independent of the trabeculated myocardium and a large number of fibers insert into the bulboventricular fibrous ring. The trabeculated myocardium in these species displays an anarchic arrangement except at the level of the bulboventricular orifice, where the fibers tend to be aligned longitudinally, also being inserted into the fibrous ring. Minor differences, consisting mainly of the presence of extra bundles of fibers, were also observed among different individuals of the same species. The possible relationship between myocardial fiber architecture and ventricular shape is discussed.

  14. High dose aspirin and left ventricular remodeling after myocardial infarction: aspirin and myocardial infarction.

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    Adamek, Anna; Hu, Kai; Bayer, Barbara; Wagner, Helga; Ertl, Georg; Bauersachs, Johann; Frantz, Stefan

    2007-07-01

    Proinflammatory proteins like inflammatory cytokines are implicated in myocardial depression and left ventricular remodeling after myocardial infarction. High-dose aspirin inhibits cytokine activation. Therefore, we tested the influence of high-dose aspirin treatment on left ventricular remodeling in mice after myocardial infarction. Mice were treated for 4 weeks with placebo or aspirin (120 mg/kg per day) by Alzet mini-osmotic pumps after ligation of the left anterior descending coronary artery. Serial transthoracic echocardiography was performed at days 1, 7, and 28. Over the 4 weeks, mortality was not different between the groups (placebo 30.8%, aspirin 30.8%). On echocardiography, animals after myocardial infarction exhibited left ventricular dilatation (week 4, end-systolic area, placebo sham 8.9 +/- 1.7 vs. placebo MI 15.9 +/- 2.5 mm(2)), which was not changed by aspirin treatment (week 4, end-systolic area, aspirin MI 14.5 +/- 1.3 mm(2), p= ns vs. placebo MI). The expression of the proinflammatory cytokines TNF and IL-1beta were markedly upregulated in mice with myocardial infarction on placebo. Cytokine expression was significantly reduced by aspirin treatment while collagen deposition was not influenced. Continuous aspirin treatment (120 mg/kg/d) reduces the expression of proinflammatory cytokines after myocardial infarction, but does not affect post-infarct cardiac remodeling and cardiac function.

  15. Induction of ventricular fibrillation predicts sudden death in patients treated with amiodarone because of ventricular tachyarrhythmias after a myocardial infarction.

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    Rodríguez, L. M.; Sternick, E. B.; Smeets, J. L.; Timmermans, C.; den Dulk, K.; Oreto, G.; Wellens, H. J.

    1996-01-01

    OBJECTIVE--To examine the value of programmed electrical stimulation of the heart in predicting sudden death in patients receiving amiodarone to treat ventricular tachyarrhythmias after myocardial infarction. DESIGN--Consecutive patients; retrospective study. SETTING--Referral centre for cardiology, academic hospital. PATIENTS--106 patients with ventricular tachycardia (n = 77) or ventricular fibrillation (n = 29) late after myocardial infarction. INTERVENTIONS--Programmed electrical stimulation was performed while on amiodarone treatment for at least one month. MEASUREMENTS AND MAIN RESULTS--In 80/106 patients either ventricular fibrillation (n = 15) or sustained monomorphic ventricular tachycardia (n = 65) was induced. After a mean follow up of 50 (SD 40) months (1-144), 11 patients died suddenly and two used their implantable cardioverter debfibrillator. By multivariate analysis two predictors for sudden death were found: (1) inducibility of ventricular fibrillation under amiodarone treatment (P rate at one, two, three, and five years was 70%, 62%, 62%, and 40% respectively for patients in whom ventricular fibrillation was induced, and 98%, 96%, 94%, 94% for patients with induced sustained monomorphic ventricular tachycardia. Where there was no sustained arrhythmia, five year survival was 100%. CONCLUSIONS--In patients receiving amiodarone because of life threatening ventricular arrhythmias after myocardial infarction, inducibility of ventricular fibrillation, but not of sustained monomorphic ventricular tachycardia, indicates a high risk of sudden death. PMID:8624866

  16. Effect of Hypoxemia with or without Increased Placental Vascular Resistance on Fetal Left and Right Ventricular Myocardial Performance Index in Chronically Instrumented Sheep.

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    Bhide, Amar; Vuolteenaho, Olli; Haapsamo, Mervi; Erkinaro, Tiina; Rasanen, Juha; Acharya, Ganesh

    2016-11-01

    Myocardial performance index (MPI) is increased in growth-restricted fetuses with placental insufficiency, but it is unknown if this is due to fetal hypoxemia or increased placental vascular resistance (R plac ). We used chronically instrumented sheep fetuses (n = 24). In 12 fetuses, placental embolization was performed 24 h before experiments. On the day of the experiment, left (LV) and right (RV) ventricular MPIs were obtained by pulsed Doppler at baseline and in the hypoxemia and recovery phases. At baseline, R plac was greater and fetal pO 2 lower in the placental embolization group, but RV and LV MPIs were comparable to those of the control group. During hypoxemia, mean LV MPI increased significantly only in fetuses with an intact placenta (0.34 vs. 0.46), returning to baseline during the recovery phase. Right ventricular MPI was unaffected. We conclude that fetal LV function is sensitive to acute hypoxemia. Exposure to chronic hypoxemia could pre-condition the fetal heart and protect its function with worsening hypoxemia. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

  17. [Cardiac dyssynchrony correlates with left ventricular remodeling after myocardial Infarction].

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    McNab, Paul; Castro, Pablo; Gabrielli, Luigi; Verdejo, Hugo; Quintana, Juan Carlos; Rodríguez, José A; Corbalán, Ramón

    2009-11-01

    Cardiac dyssynchrony is common in advanced heart failure (HF), but the changes in cardiac synchrony after myocardial infarction (MI) have not been adequately descríbed. To study the relationship between cardiac synchrony and left ventricular remodeling after acute myocardial infarction. Forty nine patients aged 59+/-10 years (77% men) with a first episode of a ST segment elevation MI, were studied. Scintigraphic left ventricular function and synchrony analyses were performed at baseline and after a six months follow-up. Determinations were compared with 33 healthy subjects. At baseline, patients with MIhad a decreased left ventricular ejection fraction (LVEF) and significant dyssynchrony, when compared with controls. LVEF was 36.4%+/-10%, left ventricular end-diastolic volume (LVEDV) 127+/-38 mL, interventricular delay (IEV) 29+/-35 miliseconds (ms), and intraventricular delay (IAV), 234+/-89 ms. After 6 months, LVEF significantly improved (38%+/-10%, p =0.042) without significant changes in LVEDV (129+/-32 mL, p =0.97), IEV (24+/-17, p =0.96) or IAV (231+/-97, p =0.34). At baseline there were significant correlations between IAV and LVEF, and between IAV and LVEDV (r =0.48, p =0.001 and r =0.41, p =0.004, respectively). These correlations remained significant after 6 months. There was a positive correlation between IAV and LVEDV changes at six months (r =0.403, p =0.04). The development of cardiac dyssynchrony correlates with adverse left ventricular remodeling after MI .

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

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    Machado Cristiano V

    2011-06-01

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

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

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    Firoozeh Abtahi

    2016-06-01

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

  20. Left ventricular function in patients with and without myocardial infarction and one, two or three vessel coronary artery disease.

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    Moraski, R E; Russell, R O; Smith, M K; Rackley, C E

    1975-01-01

    Ninety-six patients with chest pain were studied to determine the relation between left ventricular function and severity of coronary artery disease in patients with and without a history of myocardial infarction. Coronary arteriography was performed obtaining cineangiograms (60 frames/sec) and large roll film angiograms (2 to 6 frames/sec) for precise definition of the coronary anatomy. The criteria for diagnosis of myocardial infarction were a typical history, a rise and fall in serum glutamic oxaloacetic transaminase levels and evolutionary S-T segment changes associated with Q waves of at least 0.03 second. Left ventricular function was assessed by measurement of left ventricular end-diastolic pressure and volume, and left ventricular ejection fraction, mass and compliance. Fifteen patients had normal findings; 81 were classified according to number of diseased vessels and presence or absence of myocardial infarction. There were no group differences in age or heart rate. Left ventricular end-diastolic pressure was abnormally increased in patients with three vessel disease and myocardial infarction. Left ventricular end-diastolic volume was increased and the ejection fraction was reduced in patients in each vessel disease group with myocardial infarction. Although ejection fraction was reduced in patients with three vessel disease without myocardial infarction, it was further reduced when infarction occurred. Left ventricular mass increased in patients with three vessel disease with or without myocardial infarction. Values for ventricular compliance were reduced in all patients with myocardial infarction and were lower in those with two and three vessel disease and infarction than in those with two and three vessel disease without infarction. These findings suggest that a previous history of myocardial infarction needs to be considered together with anatomic abnormalities of the coronary arteries in assessing cardiac performance in patients with ischemic heart

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

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

    2000-01-01

    relaxation time divided by ejection time was measured from mitral inflow and left ventricular outflow Doppler velocity profiles. The index was significantly higher in patients with AMI than in control subjects at days 1 and 360 (day 1, 0.58 +/- 0.09 vs 0.41 +/- 0.08, p

  2. Serum iron concentration, but not hemoglobin, correlates with TIMI risk score and 6-month left ventricular performance after primary angioplasty for acute myocardial infarction.

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    Ching-Hui Huang

    Full Text Available Anemia is associated with high mortality and poor prognosis after acute coronary syndrome (ACS. Increased red cell distribution width (RDW is a strong independent predictor for adverse outcomes in ACS. The common underlying mechanism for anemia and increased RDW value is iron deficiency. It is not clear whether serum iron deficiency without anemia affects left ventricular (LV performance after primary angioplasty for acute myocardial infarction (AMI. We investigated the prognostic value of serum iron concentration on LV ejection fraction (EF at 6 months and its relationship to thrombolysis in myocardial infarction (TIMI risk score in post MI patients.We recruited 55 patients who were scheduled to undergo primary coronary balloon angioplasty after AMI and 54 age- and sex-matched volunteers. Serum iron concentration and interleukin-6 levels were measured before primary angioplasty. LVEF was measured by echocardiography at baseline and after 6 months. TIMI risk score was calculated for risk stratification.Serum iron concentration was significantly lower in those in whom LVEF had not improved ≥ 10% from baseline (52.7 ± 24.1 versus 80.8 ± 50.8 µg/dl, P = 0.016 regardless of hemoglobin level, and was significantly lower in the AMI group than in the control group (62.5 ± 37.7 versus 103.0 ± 38.1 µg/dl, P<0.001. Trend analysis revealed that serum iron concentration decreased as TIMI risk score increased (P = 0.002. In addition, lower serum iron concentrations were associated with higher levels of inflammatory markers. Multiple linear regression showed that baseline serum iron concentration can predict LV systolic function 6 months after primary angioplasty for AMI even after adjusting for traditional prognostic factors.Hypoferremia is not only a marker of inflammation but also a potential prognostic factor for LV systolic function after revascularization therapy for AMI, and may be a novel biomarker for therapeutic intervention.

  3. Serum iron concentration, but not hemoglobin, correlates with TIMI risk score and 6-month left ventricular performance after primary angioplasty for acute myocardial infarction.

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

    2014-01-01

    Anemia is associated with high mortality and poor prognosis after acute coronary syndrome (ACS). Increased red cell distribution width (RDW) is a strong independent predictor for adverse outcomes in ACS. The common underlying mechanism for anemia and increased RDW value is iron deficiency. It is not clear whether serum iron deficiency without anemia affects left ventricular (LV) performance after primary angioplasty for acute myocardial infarction (AMI). We investigated the prognostic value of serum iron concentration on LV ejection fraction (EF) at 6 months and its relationship to thrombolysis in myocardial infarction (TIMI) risk score in post MI patients. We recruited 55 patients who were scheduled to undergo primary coronary balloon angioplasty after AMI and 54 age- and sex-matched volunteers. Serum iron concentration and interleukin-6 levels were measured before primary angioplasty. LVEF was measured by echocardiography at baseline and after 6 months. TIMI risk score was calculated for risk stratification. Serum iron concentration was significantly lower in those in whom LVEF had not improved ≥ 10% from baseline (52.7 ± 24.1 versus 80.8 ± 50.8 µg/dl, P = 0.016) regardless of hemoglobin level, and was significantly lower in the AMI group than in the control group (62.5 ± 37.7 versus 103.0 ± 38.1 µg/dl, PTIMI risk score increased (P = 0.002). In addition, lower serum iron concentrations were associated with higher levels of inflammatory markers. Multiple linear regression showed that baseline serum iron concentration can predict LV systolic function 6 months after primary angioplasty for AMI even after adjusting for traditional prognostic factors. Hypoferremia is not only a marker of inflammation but also a potential prognostic factor for LV systolic function after revascularization therapy for AMI, and may be a novel biomarker for therapeutic intervention.

  4. Synchronous intra-myocardial ventricular pacing without crossing the tricuspid valve or entering the coronary sinus

    Energy Technology Data Exchange (ETDEWEB)

    Konecny, Tomas; DeSimone, Christopher V.; Friedman, Paul A.; Bruce, Charles [Department of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Asirvatham, Samuel J., E-mail: asirvatham.samuel@mayo.edu [Department of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Department of Pediatric and Adolescent Medicine, Pediatric Cardiology, Mayo Clinic, Rochester, MN (United States)

    2013-05-15

    Ventricular pacing is most commonly performed at the right ventricular (RV) apex. This is not without risk as placement requires crossing the tricuspid valve (TV) and may cause valvular dysfunction and dyssynchronous activation of the ventricles. The fact that the tricuspid valve lies more apically than the mitral valve allows for the possibility of pacing the ventricles from the right atrium (RA) via the “atrio-ventricular septum” without crossing the TV or entering the coronary sinus (CS). In order to mitigate far field activation inherent to current pacing technology, we constructed a novel lead in which the cathode and anode are both intra-myocardial. We demonstrate safety and efficacy of this novel lead for ventricular pacing at the atrio-ventricular septum in canines, including improved synchronous activation of both ventricles, improved differentiation in ventricular versus atrial sensing, while providing reliable ventricular capture, opening novel and a potentially safer alternative to human cardiac resynchronization therapy.

  5. Sequential management of post-myocardial infarction ventricular septal defects.

    Science.gov (United States)

    Trivedi, Kalyani R; Aldebert, Philippe; Riberi, Alberto; Mancini, Julien; Levy, Gilles; Macia, Jean-Christophe; Quilicci, Jacques; Habib, Gilbert; Fraisse, Alain

    2015-05-01

    Ventricular septal defect (VSD) after acute myocardial infarction is a catastrophic event. We describe our multicentre experience of a defect closure strategy that combined surgery and transcatheter closure. Data were obtained by retrospective chart review. Twenty patients (mean age, 67 years) from three centres were studied. Median time from myocardial infarction to VSD was 6 (range, 3-9) days. Acute cardiogenic shock occurred in 12 (60%) patients. Median defect diameter by echocardiography was 18 (range, 12-28) mm. Median time to first surgical or percutaneous closure was 18 (range, 4-96) days. Twenty-seven procedures were performed in the 20 patients. Surgical closure was undertaken in 14 patients and contraindicated in eight, six of whom underwent percutaneous closure; the other two, after reconsideration, proceeded to surgical closure. No procedural complications occurred with percutaneous closure. Percutaneous closure patients were older than surgical patients (75 vs. 64 years; P=0.01) and had a higher mean logistic EuroSCORE (87% vs. 67%; P=0.02). Rates of residual shunt and mortality did not differ between surgical and percutaneous patients (P=0.12 and 0.3, respectively). Those who underwent early VSD closure (<21 days after myocardial infarction) had higher rates of residual shunt (P=0.09) and mortality (P=0.01), irrespective of closure strategy. The mortality rate was also higher after early percutaneous closure (P=0.001), but not after early surgery. Finally, predicted mortality (logistic EuroSCORE) was higher than hospital mortality (≤30 days) in our patient population (75% vs. 30%; P=0.01). Vigorous pursuit of closure of post-myocardial infarction VSD with a sequential surgical and/or percutaneous approach is recommended for improved outcomes. Copyright © 2015. Published by Elsevier Masson SAS.

  6. Differences of postresuscitation myocardial dysfunction in ventricular fibrillation versus asphyxiation.

    Science.gov (United States)

    Wu, Cai-Jun; Li, Chun-Sheng; Zhang, Yi; Yang, Jun; Yin, Qin; Hang, Chen-Chen

    2013-12-01

    This study aims to characterize postresuscitation myocardial dysfunction in 2 porcine models of cardiac arrest (CA): ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA). Thirty-two pigs were randomized into 2 groups. The VFCA group (n = 16) were subject to programed electrical stimulation, and the ACA group (n = 16) underwent endotracheal tube clamping to induce CA. Once induced, CA remained untreated for 8 minutes. Two minutes after initiation of cardiopulmonary resuscitation (CPR), defibrillation was attempted until return of spontaneous circulation (ROSC) was achieved or animals died. Return of spontaneous circulation was 100% successful in VFCA and 50% successful in ACA. Cardiopulmonary resuscitation duration in VFCA was about half as short as in ACA. The survival time of VFCA was significantly longer than that of ACA. Ventricular fibrillation cardiac arrest had better mean arterial pressure, cardiac output, and left ventricular ± dp/dt(max) after ROSC than ACA. Echocardiography revealed significantly lower left ventricular ejection fraction in ACA than in VFCA. Myocardial perfusion imaging using single-photon emission computed tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA. Under a transmission electron microscope, the overall heart morphologic structure and the mitochondrial crista structure were less severely injured in the VFCA group than in the ACA group. Moreover, the percentage of apoptotic cardiomyocytes was higher in ACA than in VFCA. Compared with VFCA, ACA causes more severe cardiac dysfunction associated with less successful resuscitation and shorter survival time. © 2013.

  7. Taser-induced rapid ventricular myocardial capture demonstrated by pacemaker intracardiac electrograms.

    Science.gov (United States)

    Cao, Michael; Shinbane, Jerold S; Gillberg, Jeffrey M; Saxon, Leslie A; Swerdlow, Charles D

    2007-08-01

    A Taser weapon is designed to incapacitate violent individuals by causing temporary neuromuscular paralysis due to current application. We report the first case of a Taser application in a person with a dual-chamber pacemaker demonstrating evidence of Taser-induced myocardial capture. Device interrogation was performed in a 53-year-old man with a dual-chamber pacemaker who had received a Taser shot consisting of two barbs delivered simultaneously. Assessment of pacemaker function after Taser application demonstrated normal sensing, pacing thresholds, and lead impedances. Stored event data revealed two high ventricular rate episodes corresponding to the exact time of the Taser application. This report describes the first human case of ventricular myocardial capture at a rapid rate resulting from a Taser application. This raises the issue as to whether conducted energy devices can cause primary myocardial capture or capture only in association with cardiac devices providing a preferential pathway of conduction to the myocardium.

  8. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Hesse, Birger; Meyer, Christian; Nielsen, Flemming S

    2004-01-01

    with PET using nitrogen-13 ammonia infused at rest and during dipyridamole hyperaemia. Twelve healthy control subjects were included in the study, five of whom were also studied with perindoprilat. Mean blood pressure in normo-albuminuric, asymptomatic patients was 123+/-7/65+/-9 mmHg. Compared......The purpose of this study was to assess whether acute angiotensin-converting enzyme (ACE) inhibition would improve myocardial perfusion and perfusion reserve in a subpopulation of normotensive patients with diabetes and left ventricular hypertrophy (LVH), both independent risk factors of coronary...... disease. Using positron emission tomography (PET), we investigated the response of regional myocardial perfusion to acute ACE inhibition with i.v. infusion of perindoprilat (vs saline infusion as control, minimum interval 3 days) in 12 diabetic patients with LVH. Myocardial perfusion was quantified...

  9. Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction

    DEFF Research Database (Denmark)

    Glinge, Charlotte; Sattler, Stefan; Jabbari, Reza

    2016-01-01

    of a family member is a risk factor for SCD and VF during acute myocardial infarction (MI), independent of traditional risk factors including family history of MI, suggesting a genetic component in the susceptibility to VF. To prevent SCD and VF due to MI, we need a better understanding of the genetic...... infarction, myocardial ischemia", "coronary artery disease", and "genetics". This review describes the epidemiology and evidence for genetic susceptibility to VF due to MI....... several genetic variants, both common and rare variants, have been associated to either VF or SCD. For this review, we searched PubMed for potentially relevant articles, using the following MeSH-terms: "sudden cardiac death", "ventricular fibrillation", "out-of-hospital cardiac arrest", "myocardial...

  10. Regional left ventricular myocardial contractility and stress in a finite element model of posterobasal myocardial infarction.

    Science.gov (United States)

    Wenk, Jonathan F; Sun, Kay; Zhang, Zhihong; Soleimani, Mehrdad; Ge, Liang; Saloner, David; Wallace, Arthur W; Ratcliffe, Mark B; Guccione, Julius M

    2011-04-01

    Recently, a noninvasive method for determining regional myocardial contractility, using an animal-specific finite element (FE) model-based optimization, was developed to study a sheep with anteroapical infarction (Sun et al., 2009, "A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep With Left Ventricular Aneurysm," ASME J. Biomech. Eng., 131(11), p. 111001). Using the methodology developed in the previous study (Sun et al., 2009, "A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep With Left Ventricular Aneurysm," ASME J. Biomech. Eng., 131(11), p. 111001), which incorporates tagged magnetic resonance images, three-dimensional myocardial strains, left ventricular (LV) volumes, and LV cardiac catheterization pressures, the regional myocardial contractility and stress distribution of a sheep with posterobasal infarction were investigated. Active material parameters in the noninfarcted border zone (BZ) myocardium adjacent to the infarct (T(max_B)), in the myocardium remote from the infarct (T(max_R)), and in the infarct (T(max_I)) were estimated by minimizing the errors between FE model-predicted and experimentally measured systolic strains and LV volumes using the previously developed optimization scheme. The optimized T(max_B) was found to be significantly depressed relative to T(max_R), while T(max_I) was found to be zero. The myofiber stress in the BZ was found to be elevated, relative to the remote region. This could cause further damage to the contracting myocytes, leading to heart failure.

  11. Effects of local radiofrequency denervation on ventricular electrophysiological properties in normal and acute myocardial ischemia heart.

    Science.gov (United States)

    Huang, Y; Wang, D-N; Liu, P; Song, Y; Cui, H-M; Zhang, J-Y; Blackwell, J; Liao, D-N

    2016-06-01

    To observe the effects of local radiofrequency denervation on ventricular effective refractory periods, electrical alternans and ventricular arrhythmia susceptibility post myocardial infarction. Thirty-four mongrel dogs were randomly divided into the normal heart group (n = 16, 8 in sham and 8 in local sympathetic denervation - LSD) and the acute myocardial ischemia (AMI) group (n = 18, 9 in control and 9 in LSD). The left cardiac sympathetic nerve was denervated with irrigated catheter radiofrequency ablation. Left ventricular effective refractory periods (ERP), monophasic action potential duration at 90% (APD90) and APD alternans were measured at baseline and 2 hours after LSD in the normal heart group. AMI was induced by ligating the left anterior descending coronary artery 2 hours after LSD was performed. Then APD90, the occurrence of ventricular arrhythmias (VAs) were measured. Compared with baseline, LSD significantly prolonged ventricular ERP and APD90 at all sites (p LSD group, whereas no significant change was shown in the sham group. But their spatial dispersions did not change in both groups. APD alternans occurred at shorter pacing cycle length at each site after LAD→LSD when compared to the sham group (p LSD group than in the control group (p LSD may have a beneficial impact on ventricular arrhythmias induced by AMI through modulation of autonomic tone.

  12. Influence of thrombolytic therapy on the patterns of ventricular septal rupture after acute myocardial infarction

    OpenAIRE

    Rhydwen, G; Charman, S; Schofield, P

    2002-01-01

    Background: Post-myocardial infarction ventricular septal defect (VSD) complicates ∼2% of myocardial infarctions. Thrombolytic therapy may accelerate the time from myocardial infarction to VSD formation. The effects of thrombolytic therapy in patients with a post-myocardial infarction VSD were investigated.

  13. Ventricular arrhythmias and mortality associated with isoflurane and sevoflurane in a porcine model of myocardial infarction.

    Science.gov (United States)

    Regueiro-Purriños, Marta; Fernández-Vázquez, Felipe; de Prado, Armando Perez; Altónaga, Jose R; Cuellas-Ramón, Carlos; Ajenjo-Silverio, Jose M; Orden, Asuncion; Gonzalo-Orden, Jose M

    2011-01-01

    Ischemia of the myocardium can lead to reversible or irreversible injury depending on the severity and duration of the preceding ischemia. Here we compared sevoflurane and isoflurane with particular reference to their hemodynamic effects and ability to modify the effects of acute severe myocardial ischemia and reperfusion on ventricular arrhythmias and mortality in a porcine model of myocardial infarction. Female Large White pigs were premedicated with ketamine, midazolam, and atropine. Propofol was given intravenously for the anesthetic induction, and anesthesia was maintained with isoflurane or sevoflurane. Endovascular, fluoroscopy-guided, coronary procedures were performed to occlude the midleft anterior descending artery by using a coronary angioplasty balloon. After 75 min, the balloon catheter system was withdrawn and the presence of adequate reperfusion flow was verified. The pigs were followed for 2 mo, and overall mortality rate was calculated. The isoflurane group showed lower arterial pressure throughout the procedure, with the difference reaching statistical significance after induction of myocardial ischemia. The ventricular fibrillation rate was higher in isoflurane group (81.3%) than the sevoflurane group (51.7%; relative risk, 1.57 [1.03 to 2.4]). Overall survival was lower in the isoflurane group (75%) than the sevoflurane group (96.4%). In conclusion, in this porcine model of myocardial ischemia and reperfusion, sevoflurane was associated with higher hemodynamic stability and fewer ventricular arrhythmias and mortality than was isoflurane.

  14. Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure.

    Science.gov (United States)

    Maslow, Andrew; Schwartz, Carl; Mahmood, Feroze; Singh, Arun; Heerdt, Paul M

    2009-07-01

    In this report, a case of right ventricular (RV) failure, hemodynamic instability, and systemic organ failure is described to highlight how paradoxical ventricular systolic septal motion (PVSM), or a rightward systolic displacement of the interventricular septum, may contribute to RV ejection. Multiple inotropic medications and vasopressors were administered to treat right heart failure and systemic hypotension in a patient following combined aortic and mitral valve replacement. In the early postoperative period, echocardiographic evaluation revealed adequate left ventricular systolic function, akinesis of the RV myocardial tissues, and PVSM. In the presence of PVSM, RV fractional area of contraction was > or =35% despite akinesis of the primary RV myocardial walls. The PVSM appeared to contribute toward RV ejection. As a result, the need for multiple inotropes was re-evaluated, in considering that end-organ dysfunction was the result of systemic hypotension and prolonged vasopressor administration. After discontinuation of phosphodiesterase inhibitors, native vascular tone returned and the need for vasopressors declined. This was followed by recovery of systemic organ function. Echocardiographic re-evaluation two years later, revealed persistent akinesis of the RV myocardial tissues and PVSM, the latter appearing to contribute toward RV ejection. This case highlights the importance of left to RV interactions, and how PVSM may mediate these hemodynamic interactions.

  15. Compatibility of Astragalus and Salvia extract inhibits myocardial fibrosis and ventricular remodeling by regulation of protein kinase D1 protein

    Science.gov (United States)

    Mao, Bingyu; Nuan, Liu; Yang, Lei; Zeng, Xiaotao

    2015-01-01

    Aims: This study is to determine the effect of astragalus and salvia extract on the alteration of myocardium in a rat model of myocardial infarction. Methods: A total of 40 male Sprague-Dawley rats were randomly divided into the sham-operated group, the control group, the Astragalus group, the Salvia group, and the compatibility of Astragalus and Salvia and group. The cardiac functions were determined at 8 weeks after treatment. Hematoxylin-eosin staining was performed to observe the morphology and arrangement of cardiomyocytes. Masson’s trichrome staining was performed to investigate the distribution of myocardial interstitial collagen. Immunohistochemical staining was performed to determine the expression ofprotein kinase D1 in myocardial tissues. Results: In the sham-operated group, the Astragalus group, the Salvia group, and the compatibility of Astragalus and Salvia group, the left ventricular systolic pressure and the maximum rate of left ventricular pressure were significantly increased while the left ventricular end diastolic pressure were significantly decreased when compared with those in the control group (P Salvia group. Contents of collagen fibers in myocardial tissues were decreased in the compatibility of Astragalus and Salvia group (P Salvia group. Conclusions: Compatibility of Astragalus and Salvia extract may inhibit myocardial fibrosis and ventricular remodeling by regulation of protein kinase D1 protein in a rat model of myocardial infarction. PMID:26064267

  16. The impact of acute myocardial infarction on left ventricular systolic function.

    Science.gov (United States)

    Koçinaj, Dardan; Bakalli, Aurora; Gashi, Masar; Begolli, Luljeta; Berisha, Merita; Koçinaj, Allma; Berisha, Blerim; Krasniqi, Xhevdet

    2011-01-01

    During acute myocardial infarction left ventricular systolic function is an important prognostic factor whose worsening is still frequent despite the therapeutic approach. We aimed to estimate the incidence of left ventricular systolic dysfunction among patients experiencing acute myocardial infarction. The study involved 154 consecutive patients admitted at Coronary Care Unit. The study design was based upon the collection of patient histories, clinical examination and other complementary tests. In overall study population, predominantly with male gender, the incidence of left ventricle systolic dysfunction was 42.3%, which correlated with myocardial damage, electrocardiography changes, myocardial enzymes, and myocardial wall motion. Transthoracic Echocardiography represents a valuable tool and left ventricular ejection fraction should be evaluated in all patients experiencing acute myocardial infarction since the incidence of left ventricular dysfunction in patients with Acute Myocardial Infarction remains relatively high.

  17. Comparative studies on right ventricular pressure and volume overloading by thallium-201 myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Owada, K.; Tsukahara, Y.; Kijima, M.; Miyazaki, Y.; Ono, K. (Fukushima Medical Coll. (Japan))

    1982-03-01

    Thallium-201 myocardial scintigraphy was performed in 44 patients with various heart diseases including mitral stenosis, atrial septal defect, primary pulmonary hypertension, and left atrial myxoma. The morphological findings of right ventricular (RV) free wall on the scintigram and RV/IVS (interventricular septum) uptake ratio of the images obtained from the left anterior oblique projection were studied in the patients with RV pressure or volume overloading.

  18. Effect of changes in contractility on the index of myocardial performance in the dysfunctional left ventricle

    Directory of Open Access Journals (Sweden)

    Lavine Steven J

    2006-11-01

    Full Text Available Abstract Background The index of myocardial performance has prognostic power in patients with cardiomyopathy and following myocardial infarction. As the index of myocardial performance has been shown to be preload and afterload dependent, the effect of altering contractility on IMP and its components with left ventricular dysfunction has been incompletely delineated. Methods Chronic left ventricular dysfunction was induced in 10 canines using coronary microsphere embolization. Each dog was instrumented and imaged with 2D echo and Doppler. At the same atrially paced rate, contractility was increased with a dobutamine infusion and then following 4 weeks of oral digoxin. Results With chronic left ventricular dysfunction, a reduced left ventricular ejection fraction (42 ± 3%, p Conclusion Increased inotropy with digoxin and dobutamine reduced the index of myocardial performance in dogs with left ventricular dysfunction. Shortened isovolumic contraction time, increased diastolic filling period, and reduced left ventricular end diastolic pressure with digoxin may provide insight into its efficacy in heart failure.

  19. Left ventricular myocardial contractility is depressed in the borderzone after posterolateral myocardial infarction.

    Science.gov (United States)

    Shimkunas, Rafael; Zhang, Zhihong; Wenk, Jonathan F; Soleimani, Mehrdad; Khazalpour, Michael; Acevedo-Bolton, Gabriel; Wang, Guanying; Saloner, David; Mishra, Rakesh; Wallace, Arthur W; Ge, Liang; Baker, Anthony J; Guccione, Julius M; Ratcliffe, Mark B

    2013-05-01

    Contractility in the borderzone (BZ) after anteroapical myocardial infarction (MI) is depressed. We tested the hypothesis that BZ contractility is also decreased after posterolateral MI. Five sheep underwent posterolateral MI. Magnetic resonance imaging (MRI) was performed 2 weeks before and 16 weeks after MI, and left ventricular (LV) volume and regional strain were measured. Finite element (FE) models were constructed, and the systolic material parameter, Tmax, was calculated in the BZ and remote myocardium by minimizing the difference between experimentally measured and calculated LV strain and volume. Sheep were sacrificed 17 weeks after MI, and myocardial muscle fibers were taken from the BZ and remote myocardium. Fibers were chemically demembranated, and isometric developed force, Fmax, was measured at supramaximal [Ca(2+)]. Routine light microscopy was also performed. There was no difference in Tmax in the remote myocardium before and 16 weeks after MI. However, there was a large decrease (63.3%, p = 0.005) in Tmax in the BZ when compared with the remote myocardium 16 weeks after MI. In addition, there was a significant reduction of BZ Fmax for all samples (18.9%, p = 0.0067). Myocyte cross-sectional area increased by 61% (p = 0.021) in the BZ, but there was no increase in fibrosis. Contractility in the BZ is significantly depressed relative to the remote myocardium after posterolateral MI. The reduction in contractility is due at least in part to a decrease in contractile protein function. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Effect of changes in contractility on the index of myocardial performance in the dysfunctional left ventricle

    OpenAIRE

    Lavine Steven J

    2006-01-01

    Abstract Background The index of myocardial performance has prognostic power in patients with cardiomyopathy and following myocardial infarction. As the index of myocardial performance has been shown to be preload and afterload dependent, the effect of altering contractility on IMP and its components with left ventricular dysfunction has been incompletely delineated. Methods Chronic left ventricular dysfunction was induced in 10 canines using coronary microsphere embolization. Each dog was in...

  1. Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention.

    Science.gov (United States)

    Sharif, Dawod; Abu-Salem, Mira; Sharif-Rasslan, Amal; Rosenschein, Uri

    2017-10-01

    Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes. The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function. A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of 400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed. Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, Pprimary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery

  2. Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running.

    Science.gov (United States)

    Hanssen, Henner; Keithahn, Alexandra; Hertel, Gernot; Drexel, Verena; Stern, Heiko; Schuster, Tibor; Lorang, Dan; Beer, Ambros J; Schmidt-Trucksäss, Arno; Nickel, Thomas; Weis, Michael; Botnar, Rene; Schwaiger, Markus; Halle, Martin

    2011-02-01

    Recent reports provide indirect evidence of myocardial injury and ventricular dysfunction after prolonged exercise. However, existing data is conflicting and lacks direct verification of functional myocardial alterations by CMR [cardiac MR (magnetic resonance)]. The present study sought to examine structural myocardial damage and modification of LV (left ventricular) wall motion by CMR imaging directly after a marathon. Analysis of cTnT (cardiac troponin T) and NT-proBNP (N-terminal pro-brain natriuretic peptide) serum levels, echocardiography [pulsed-wave and TD (tissue Doppler)] and CMR were performed before and after amateur marathon races in 28 healthy males aged 41 ± 5 years. CMR included LGE (late gadolinium enhancement) and myocardial tagging to assess myocardial injury and ventricular motion patterns. Echocardiography indicated alterations of diastolic filling [decrease in E/A (early transmitral diastolic filling velocity/late transmitral diastolic filling velocity) ratio and E' (tissue Doppler early transmitral diastolic filling velocity)] postmarathon. All participants had a significant increase in NT-proBNP and/or cTnT levels. However, we found no evidence of LV LGE. MR tagging demonstrated unaltered radial shortening, circumferential and longitudinal strain. Myocardial rotation analysis, however, revealed an increase of maximal torsion by 18.3% (13.1 ± 3.8 to 15.5 ± 3.6 °; P=0.002) and maximal torsion velocity by 35% (6.8 ± 1.6 to 9.2 ± 2.5 °·s-1; P<0.001). Apical rotation velocity during diastolic filling was increased by 1.23 ± 0.33 °·s-1 after marathon (P<0.001) in a multivariate analysis adjusted for heart rate, whereas peak untwist rate showed no relevant changes. Although marathon running leads to a transient increase of cardiac biomarkers, no detectable myocardial necrosis was observed as evidenced by LGE MRI (MR imaging). Endurance exercise induces an augmented systolic wringing motion of the myocardium and increased diastolic filling

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

    NARCIS (Netherlands)

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

    1995-01-01

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

  4. Blood PGC-1α Concentration Predicts Myocardial Salvage and Ventricular Remodeling After ST-segment Elevation Acute Myocardial Infarction.

    Science.gov (United States)

    Fabregat-Andrés, Óscar; Ridocci-Soriano, Francisco; Estornell-Erill, Jordi; Corbí-Pascual, Miguel; Valle-Muñoz, Alfonso; Berenguer-Jofresa, Alberto; Barrabés, José A; Mata, Manuel; Monsalve, María

    2015-05-01

    Peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) is a metabolic regulator induced during ischemia that prevents cardiac remodeling in animal models. The activity of PGC-1α can be estimated in patients with ST-segment elevation acute myocardial infarction. The aim of the present study was to evaluate the value of blood PGC-1α levels in predicting the extent of necrosis and ventricular remodeling after infarction. In this prospective study of 31 patients with a first myocardial infarction in an anterior location and successful reperfusion, PGC-1α expression in peripheral blood on admission and at 72 hours was correlated with myocardial injury, ventricular volume, and systolic function at 6 months. Edema and myocardial necrosis were estimated using cardiac magnetic resonance imaging during the first week. At 6 months, infarct size and ventricular remodeling, defined as an increase > 10% of the left ventricular end-diastolic volume, was evaluated by follow-up magnetic resonance imaging. Myocardial salvage was defined as the difference between the edema and necrosis areas. Greater myocardial salvage was seen in patients with detectable PGC-1α levels at admission (mean [standard deviation (SD)], 18.3% [5.3%] vs 4.5% [3.9%]; P = .04). Induction of PGC-1α at 72 hours correlated with greater ventricular remodeling (change in left ventricular end-diastolic volume at 6 months, 29.7% [11.2%] vs 1.2% [5.8%]; P = .04). Baseline PGC-1α expression and an attenuated systemic response after acute myocardial infarction are associated with greater myocardial salvage and predict less ventricular remodeling. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Osteoprotegerin levels in ST-elevation myocardial infarction: Temporal profile and association with myocardial injury and left ventricular function.

    Directory of Open Access Journals (Sweden)

    Christian Shetelig

    Full Text Available Elevated levels of osteoprotegerin (OPG have been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI. However, the role of OPG in myocardial injury and adverse remodeling in STEMI patients remains unclear. The aims of this observational cohort study were to evaluate: 1 the temporal profile of OPG during STEMI, 2 possible associations between OPG measured acutely and after 4 months, with infarct size, adverse left ventricular (LV remodeling, microvascular obstruction (MVO and myocardial salvage and 3 the effect of heparin administration on OPG levels.Blood samples were drawn repeatedly from 272 STEMI patients treated with primary percutaneous coronary intervention (PCI. Cardiac magnetic resonance imaging (CMR was performed in the acute phase and after 4 months. The effect of heparin administration on OPG levels was studied in 20 patients referred to elective coronary angiography.OPG levels measured acutely were significantly higher than Day 1 and during follow-up. OPG levels were correlated with age. No association was found between early OPG levels and CMR measurements at 4 months. Patients with >median OPG levels measured at Day 1 had larger final infarct size, lower LV ejection fraction (LVEF at 4 months and higher frequency of MVO. There were no associations between OPG and change in end-diastolic volume or myocardial salvage. OPG remained associated with infarct size and LVEF after adjustment for relevant covariates, except peak troponin T and CRP. A 77% increase in OPG levels following heparin administration was found in patients undergoing elective coronary angiography.OPG was found to be associated with myocardial injury, but not with LV remodeling or myocardial salvage. The use of OPG as a biomarker in STEMI patients seems to be limited by a strong association with age, confounding effect of heparin administration, and little additive value to established biomarkers.

  6. Osteoprotegerin levels in ST-elevation myocardial infarction: Temporal profile and association with myocardial injury and left ventricular function

    Science.gov (United States)

    Shetelig, Christian; Limalanathan, Shanmuganathan; Eritsland, Jan; Hoffmann, Pavel; Seljeflot, Ingebjørg; Gran, Jon Michael; Aukrust, Pål; Ueland, Thor; Andersen, Geir Øystein

    2017-01-01

    Background Elevated levels of osteoprotegerin (OPG) have been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI). However, the role of OPG in myocardial injury and adverse remodeling in STEMI patients remains unclear. The aims of this observational cohort study were to evaluate: 1) the temporal profile of OPG during STEMI, 2) possible associations between OPG measured acutely and after 4 months, with infarct size, adverse left ventricular (LV) remodeling, microvascular obstruction (MVO) and myocardial salvage and 3) the effect of heparin administration on OPG levels. Methods Blood samples were drawn repeatedly from 272 STEMI patients treated with primary percutaneous coronary intervention (PCI). Cardiac magnetic resonance imaging (CMR) was performed in the acute phase and after 4 months. The effect of heparin administration on OPG levels was studied in 20 patients referred to elective coronary angiography. Results OPG levels measured acutely were significantly higher than Day 1 and during follow-up. OPG levels were correlated with age. No association was found between early OPG levels and CMR measurements at 4 months. Patients with >median OPG levels measured at Day 1 had larger final infarct size, lower LV ejection fraction (LVEF) at 4 months and higher frequency of MVO. There were no associations between OPG and change in end-diastolic volume or myocardial salvage. OPG remained associated with infarct size and LVEF after adjustment for relevant covariates, except peak troponin T and CRP. A 77% increase in OPG levels following heparin administration was found in patients undergoing elective coronary angiography. Conclusions OPG was found to be associated with myocardial injury, but not with LV remodeling or myocardial salvage. The use of OPG as a biomarker in STEMI patients seems to be limited by a strong association with age, confounding effect of heparin administration, and little additive value to established biomarkers. PMID

  7. Remote Zone Extracellular Volume and Left Ventricular Remodeling in Survivors of ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Carberry, Jaclyn; Carrick, David; Haig, Caroline; Rauhalammi, Samuli M; Ahmed, Nadeem; Mordi, Ify; McEntegart, Margaret; Petrie, Mark C; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, Mitchell; Davie, Andrew; Mahrous, Ahmed; Ford, Ian; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Oldroyd, Keith G; Berry, Colin

    2016-08-01

    The natural history and pathophysiological significance of tissue remodeling in the myocardial remote zone after acute ST-elevation myocardial infarction (STEMI) is incompletely understood. Extracellular volume (ECV) in myocardial regions of interest can now be measured with cardiac magnetic resonance imaging. Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [British Heart Foundation Magnetic Resonance Imaging in Acute ST-Segment Elevation Myocardial Infarction study]). Cardiac magnetic resonance was performed at 1.5 Tesla at 2 days and 6 months post STEMI. T1 modified Look-Locker inversion recovery mapping was performed before and 15 minutes after contrast (0.15 mmol/kg gadoterate meglumine) in 140 patients at 2 days post STEMI (mean age: 59 years, 76% male) and in 131 patients at 6 months post STEMI. Remote zone ECV was lower than infarct zone ECV (25.6±2.8% versus 51.4±8.9%; P<0.001). In multivariable regression, left ventricular ejection fraction was inversely associated with remote zone ECV (P<0.001), and diabetes mellitus was positively associated with remote zone ECV (P=0.010). No ST-segment resolution (P=0.034) and extent of ischemic area at risk (P<0.001) were multivariable associates of the change in remote zone ECV at 6 months (ΔECV). ΔECV was a multivariable associate of the change in left ventricular end-diastolic volume at 6 months (regression coefficient [95% confidence interval]: 1.43 (0.10-2.76); P=0.036). ΔECV is implicated in the pathophysiology of left ventricular remodeling post STEMI, but because the effect size is small, ΔECV has limited use as a clinical biomarker of remodeling. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02072850. © 2016 The Authors.

  8. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

    2000-01-01

    The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress {sup 99m}Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest {sup 123}I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and {sup 123}I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by {sup 123}I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in {sup 123}I-BMIPP). Eighteen normotensive patients with apical defect by {sup 123}I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by {sup 123}I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by {sup 123}I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and {sup 123}I-BMIPP imaging are useful for the identification of these patients. (author)

  9. Rat Models of Ventricular Fibrillation Following Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Hundahl, Laura A.; Tfelt-Hansen, Jacob; Jespersen, Thomas

    2017-01-01

    A number of animal models have been designed in order to unravel the underlying mechanisms of acute ischemia-induced arrhythmias and to test compounds and interventions for antiarrhythmic therapy. This is important as acute myocardial infarction (AMI) continues to be the major cause of sudden...... cardiac death, and we are yet to discover safe and effective treatments of the lethal arrhythmias occurring in the acute setting. Animal models therefore continue to be relevant for our understanding and treatment of acute ischemic arrhythmias. This review discusses the applicability of the rat as a model...... for ventricular arrhythmias occurring during the acute phase of AMI. It provides a description of models developed, advantages and disadvantages of rats, as well as an overview of the most important interventions investigated and the relevance for human pathophysiology....

  10. Late ventricular potentials in risk assessment of the occurrence of complex ventricular arrhythmia in patients with myocardial infarction and heart failure

    Directory of Open Access Journals (Sweden)

    Ćosić Zoran

    2004-01-01

    Full Text Available Aim. To determine the prognostic significance of late ventricular potentials on signal-averaged electrocardiogram and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmia in patients treated with accelerated tissue-type plasminogen activator, using the rapid protocol, within six months of acute myocardial infarction. Methods. In this analytic observational prospective study patients were divided into four groups: patients with left ventricular ejection fraction bellow 40% and late ventricular potentials, patients with left ventricular ejection fraction bellow 40% and without late ventricular potentials, patients with left ventricular ejection fraction over 40% and late ventricular potentials, and patients with left ventricular ejection fraction over 40% and without late ventricular potentials. Complex ventricular arrhythmias (Lown grade IVa, IVb, and V were recorded using standard electrocardiography and 24-hour Holter monitoring 21, 60, and 90 days after acute myocardial infarction, respectively. Serial recordings of signal-averaged electrocardiogram were obtained 30, 90, and 180 days after acute myocardial infarction. Left ventricular ejection fraction was determined by echocardiography between 15 and 21 days after acute myocardial infarction. Multivariant logistic regression analysis was used to evaluate the relation between late ventricular potentials and left ventricular ejection fraction with the occurrence of complex ventricular arrhythmias. Sensitivity, specificity, positive and negative predictive values of late ventricular potentials and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmias were determined. Results. The prospective study included 80 patients (73% men, mean age 64 ± 3.5 years. Complex ventricular arrhythmias were recorded in 34 (42.5% of patients, all 17 (50% of which were from the first group (p<0.01. Complex ventricular arrhythmias were recorded in

  11. Effect of changes in contractility on the index of myocardial performance in the dysfunctional left ventricle.

    Science.gov (United States)

    Lavine, Steven J

    2006-11-17

    The index of myocardial performance has prognostic power in patients with cardiomyopathy and following myocardial infarction. As the index of myocardial performance has been shown to be preload and afterload dependent, the effect of altering contractility on IMP and its components with left ventricular dysfunction has been incompletely delineated. Chronic left ventricular dysfunction was induced in 10 canines using coronary microsphere embolization. Each dog was instrumented and imaged with 2D echo and Doppler. At the same atrially paced rate, contractility was increased with a dobutamine infusion and then following 4 weeks of oral digoxin. With chronic left ventricular dysfunction, a reduced left ventricular ejection fraction (42 +/- 3%, p myocardial performance (0.58 +/- 0.17, p myocardial performance (0.33 +/- 0.17, p Digoxin increased ejection fraction (p myocardial performance (0.42 +/- 0.13, p digoxin lengthened the diastolic filling period (p digoxin and dobutamine reduced the index of myocardial performance in dogs with left ventricular dysfunction. Shortened isovolumic contraction time, increased diastolic filling period, and reduced left ventricular end diastolic pressure with digoxin may provide insight into its efficacy in heart failure.

  12. Off-pump total myocardial revascularization in patients with left ventricular dysfunction.

    Science.gov (United States)

    Milani, Rodrigo; Paulo, Brofman; Moutinho, José Augusto; Laura, Barboza; Maximiliano, Guimarães; Alexandre, Barbosa; Lidia, Zitynski; Dalton, Précoma; Alexandre, Varela; Ravanelli, Marcel Rogers; Maia, Francisco

    2007-07-01

    To assess off-pump myocardial revascularization in patients with significant left ventricular dysfunction. Four hundred and five patients with an ejection fraction less than 35% underwent myocardial revascularization without extracorporeal circulation. The procedure was performed with the aid of a suction stabilizer and the LIMA stitch. The distal anastomoses were performed first. A total of 405 patients were evaluated whose mean age was 63.4 +/- 9.78 years. Two hundred and seventy-nine patients were men (68.8%). With regard to risk factors, 347 patients were hypertensive, 194 were smokers, 202 were dyslipidemic, and 134 had diabetes. Two hundred and sixty patients were classified as NYHA functional class III and IV. Twenty patients suffered from chronic renal disease and were under dialysis. Fifty-one underwent emergency surgery, and 33 had been previously operated on. The mean ejection fraction was 27.2 +/- 3.54%. The mean EuroSCORE was 8.46 +/- 4.41. The mean number of anastomoses performed was 3.03 +/- 1.54 per patient. Forty-nine patients (12%) needed an intra-aortic balloon inserted after induction of anesthesia, whereas 73 (18%) needed inotropic support during the perioperative period. As to complications, 2 patients (0.49%) had renal failure, 2 had mediastinitis (0.49%), 7 (1.7%) needed to be reoperated because of bleeding, 5 patients (1.2%) suffered acute myocardial infarction, and 70 patients (17.3%) experienced atrial fibrillation. Eighteen (4.4%) patients died. Based on the data above, we concluded that myocardial revascularization without extracorporeal circulation in patients with left ventricular dysfunction is a safe and effective technique, and an alternative for high-risk patients. Results obtained were better than those predicted by EuroSCORE.

  13. Parametric Modeling of the Mouse Left Ventricular Myocardial Fiber Structure.

    Science.gov (United States)

    Merchant, Samer S; Gomez, Arnold David; Morgan, James L; Hsu, Edward W

    2016-09-01

    Magnetic resonance diffusion tensor imaging (DTI) has greatly facilitated detailed quantifications of myocardial structures. However, structural patterns, such as the distinctive transmural rotation of the fibers, remain incompletely described. To investigate the validity and practicality of pattern-based analysis, 3D DTI was performed on 13 fixed mouse hearts and fiber angles in the left ventricle were transformed and fitted to parametric expressions constructed from elementary functions of the prolate spheroidal spatial variables. It was found that, on average, the myocardial fiber helix angle could be represented to 6.5° accuracy by the equivalence of a product of 10th-order polynomials of the radial and longitudinal variables, and 17th-order Fourier series of the circumferential variable. Similarly, the fiber imbrication angle could be described by 10th-order polynomials and 24th-order Fourier series, to 5.6° accuracy. The representations, while relatively concise, did not adversely affect the information commonly derived from DTI datasets including the whole-ventricle mean fiber helix angle transmural span and atlases constructed for the group. The unique ability of parametric models for predicting the 3D myocardial fiber structure from finite number of 2D slices was also demonstrated. These findings strongly support the principle of parametric modeling for characterizing myocardial structures in the mouse and beyond.

  14. Left ventricular aneurysmal repair within 30 days after acute myocardial infarction: early and mid-term outcomes.

    Science.gov (United States)

    Battaloglu, Bektas; Erdil, Nevzat; Nisanoglu, Vedat

    2007-01-01

    For safe resection, left ventricular aneurysmal repair after acute myocardial infarction is usually delayed. However, delaying surgery may not be possible or prudent in some patients who are clinically unstable after acute myocardial infarction. We retrospectively reviewed the early and mid-term outcomes of left ventricular aneurysmal repair in patients who had experienced acute myocardial infarction anteroapical left ventricular aneurysmal repair and coronary artery bypass grafting. In Group I (38 clinically unstable patients), the surgery was performed or = 30 days after infarction. The mean follow-up period was 26.16 +/- 16.41 months. One Group I patient (2.6%) died in the hospital due to graft-versus-host reaction. Three Group II patients (3.4%) died: 2 of low cardiac output and 1 of multiple-organ failure. Hospital mortality rates were not statistically significant between groups (P=0.582). All patients required similar perioperative inotropic support, intra-aortic balloon pump support, and re-exploration for bleeding or cardiac tamponade. The actuarial survival rates were 94.7% (Group I) and 94.4% (Group II). Postoperative New York Heart Association functional class improved similarly in both groups. We infer that left ventricular aneurysmal repair with coronary revascularization or = 30 days after acute myocardial infarction.

  15. [Effect of Sapindus saponins on myocardial inflammation and left ventricular remodeling in spontaneously hypertensive rats].

    Science.gov (United States)

    Chen, Ming; Chen, Zhi-Wu; Long, Zi-Jiang; Liu, Jin-Lin; Bian, Hai; Wang, Ya-Juan; Wang, Liang

    2013-02-01

    To investigate the effect of Sapindus saponins on myocardial inflammation and left ventricular remodeling in spontaneously hypertensive rats. Forty 16-week-old spontaneously hypertensive rats were randomly divided into five groups, placebo as model group, captopril tablets (27 mg/kg) as positive control, low-dose Sapindus saponins (27 mg/kg), medium-dose (54 mg/ kg) and high-dose (108 mg/kg) groups. And another eight healthy Wistar-Kyoto strain (WKY) rats were used as the normal group. The animals were treated for eight weeks, and the detection indexes were as follows: (1) Calculated left ventricular mass index (LVMI); (2) Observed the morphological changes on left ventricular myocardial tissue by HE staining; (3) Observed the collagen distribution in left ventricular myocardial by Masson staining; (4) Detected the protein expression of TGF-beta1 by immunohistochemical assay. Sapindus saponins could effectively reverse the left ventricular hypertrophy phenomenon in SHR, lowered LVMI, inhibited the myocardial cell hypertrophy and hyperplasia of collagen fibers, and blocked the expression level of TGF-beta1 in myocardial when compared with the SHR model group, there were significant differences (P Sapindus saponins can reserve the left ventricular remodeling in pathological conditions, its possible mechanism may be related to the inhibition of myocardial tissue inflammation factor of TGF-beta1.

  16. Normal left ventricular wall motion measured with two-dimensional myocardial tagging

    DEFF Research Database (Denmark)

    Qi, P; Thomsen, C; Ståhlberg, F

    1993-01-01

    Using a myocardial tagging technique, normal left ventricular wall motion was studied in 3 true short axis views and a double oblique 4-chamber view in 14 and 11 volunteers, respectively. Three orthogonal directions of left ventricular motion were observed throughout the systole; a concentric...

  17. Right ventricular involvement in patients with inferior myocardial infarction, correlation of electrocardiographic findings with echocardiography data.

    Science.gov (United States)

    Javed, Sumbul; Rajani, Ali Raza; Govindaswamy, Pushparani; Radaideh, Ghazi Ahmed; Abubaraka, Harb Ahmed; Qureshi, Tariq Ilyas; Arshad, Hassaan Bin

    2017-03-01

    To determine the right ventricular involvement in patients with inferior myocardial infarction by echocardiography in relation to electrocardiographic findings. This observational, prospective study was conducted at Rashid Hospital, Dubai, the United Arab Emirates, from January to September 2013, and comprised patients with inferior myocardial infarction. All patients aged above 18 years were included. Right ventricular myocardial infarction was defined by the electrocardiographic criteria of > 1mV ST elevation in V4R-V5R leads. RV infarction was assessed on echocardiography by fractional area change, tricuspid annular plane systolic excursion and tricuspid annular systolic velocity by tissue Doppler imaging. SPSS 21 was used for data analysis. Of the 73 patients, there were 68(93%) men and 5(7%) women. The three modalities used to assess the right ventricular infarction showed right ventricular involvement in 36(49.3%) cases by fractional area change, 28(38.4%) cases by tricuspid annular plane systolic excursion and 31(42.5%) cases by tissue Doppler imaging in patients with inferior myocardial infarction. Tissue Doppler imaging and right ventricular function showed low degree of negative correlation (p=0.16) while the correlation between tricuspid annular plane systolic excursion and right ventricular function showed significant positive correlation (pright ventricular infarction by echocardiography helped to diagnose right ventricular infarction in greater number of cases compared to surface electrocardiogram.

  18. Anterior Myocardial Ižnfarction And Developing Ventricular Aneurysm After Cannabis Use

    Directory of Open Access Journals (Sweden)

    Murat Yalcin

    2014-03-01

    Full Text Available     Incidence of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. Herein, we reported 20 years old male who had acute anterior myocardial infarction and developing apical ventricular aneurysm after heavy cannabis use.

  19. Multidetector computed tomography predictors of late ventricular remodeling and function after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Lessick, Jonathan, E-mail: j_lessick@rambam.health.gov.il [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Abadi, Sobhi [Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Agmon, Yoram [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Keidar, Zohar [Nuclear Medicine Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Carasso, Shemi; Aronson, Doron [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Ghersin, Eduard [Department of Diagnostic Radiology, University of Miami, Miller School of Medicine, Miami, FL (United States); Rispler, Shmuel [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Sebbag, Anat [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Israel, Ora [Nuclear Medicine Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Hammerman, Haim; Roguin, Ariel [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel)

    2012-10-15

    Background: Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI. Methods: In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling. Results: Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r = 0.74), and LD area (r = 0.72), and to a lesser extent LE area (r = 0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p < 0.05) and ejection fraction by LD enhancement ratio. Conclusions: LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.

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

    Directory of Open Access Journals (Sweden)

    Iyer R

    1999-04-01

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

  1. Recent Inferior Myocardial Infarction Complicated with a Right Ventricular Thrombus Detected by Three Cardiac Imaging Modalities.

    Science.gov (United States)

    Kuno, Toshiki; Imaeda, Syohei; Hashimoto, Kenji; Ryuzaki, Toshinobu; Saito, Tetsuya; Yamazaki, Hiroyuki; Tabei, Ryota; Kodaira, Masaki; Hase, Manabu; Numasawa, Yohei

    2018-03-01

    We report the case of a 71-year-old woman diagnosed with recent inferior myocardial infarction complicated with right ventricular infarction and a right ventricular thrombus. Three-dimensional transthoracic echocardiography, contrast-enhanced computed tomography, and cardiac magnetic resonance imaging clearly detected a thrombus. We consider cases with a recent right ventricular infarction to require assessment for thrombus formations in the right ventricle. Fortunately, vigorous anticoagulation therapy resolved the thrombi in both the right ventricle and right coronary artery.

  2. Post-Myocardial Infarction Ventricular Septal Defect Six Months following Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Fiedler, Amy G; Sundt Iii, Thoralf M; Tolis, George

    2017-08-25

    Mechanical complications following acute myocardial infarction are associated with high mortality. We present the first reported case of a new post myocardial infarction ventricular septal defect (VSD) within six months of coronary artery bypass grafting. The patient underwent successful surgical correction of the VSD with the assistance of mechanical circulatory support (MCS). This case highlights the importance of mechanical circulatory support in the management of cardiogenic shock associated with rare complications of myocardial infarction, even after surgical revascularization.

  3. 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 patients with left ventricular dysfunction, heart failure, or both after myocardial infarction to assess the incidence and timing of sudden unexpected death or cardiac arrest with resuscitation in relation to the left ventricular ejection fraction. RESULTS: Of 14,609 patients, 1067 (7 percent) had an event...... percent confidence interval, 0.11 to 0.18 percent) after 2 years. Patients with a left ventricular ejection fraction of 30 percent or less were at highest risk in this early period (rate, 2.3 percent per month; 95 percent confidence interval, 1.8 to 2.8 percent). Nineteen percent of all sudden deaths...

  4. Myocardial perfusion defects and the left ventricular ejection fraction disclosed by scintigraphy in patients with primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Ogard, Christina Gerlach; Søndergaard, Susanne Bonnichsen; Vestergaard, Henrik

    2005-01-01

    Patients with primary hyperparathyroidism (PHPT) have increased risk of cardiovascular disease. For patients undergoing preoperative parathyroid imaging with 99mTc-sestamibi single photon emission computed tomography (SPECT), we combined cervical SPECT and gated cardiac SPECT to achieve information...... about the localization of parathyroid adenomas, myocardial perfusion, and the left ventricular ejection fraction (LVEF) at rest. A series of 22 patients with PHPT and no history of myocardial infarction or angina pectoris were recruited consecutively. At 60 minutes after injection of 700 MBq 99m......Tc-sestamibi, SPECT of the neck and gated myocardial perfusion SPECT were performed at the same time. All of the patients who underwent parathyroidectomy had the parathyroid adenoma localized as predicted from the SPECT. Five patients (23%) had myocardial perfusion defects extending more than 15% (range 15...

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

    Directory of Open Access Journals (Sweden)

    Jørgen Gravning

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

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  7. Quantitative analysis of regional myocardial performance in coronary artery disease

    Science.gov (United States)

    Stewart, D. K.; Dodge, H. T.; Frimer, M.

    1975-01-01

    Findings from a group of subjects with significant coronary artery stenosis are given. A group of controls determined by use of a quantitative method for the study of regional myocardial performance based on the frame-by-frame analysis of biplane left ventricular angiograms are presented. Particular emphasis was placed upon the analysis of wall motion in terms of normalized segment dimensions, timing and velocity of contraction. The results were compared with the method of subjective assessment used clinically.

  8. Mortality and morbidity remain high despite captopril and/or valsartan therapy in elderly patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction - Results from the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

    NARCIS (Netherlands)

    White, HD; Aylward, PEG; Huang, Z; Dalby, AJ; Weaver, WD; Barvik, S; Marin-Neto, JA; Murin, J; Nordlander, RO; van Gilst, WH; Zannad, F; McMurray, JJV; Califf, RM; Pfeffer, MA

    2005-01-01

    Background - The elderly constitute an increasing proportion of acute myocardial infarction patients and have disproportionately high mortality and morbidity. Those with heart failure or impaired left ventricular left ventricular function after acute myocardial infarction have high complication and

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

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

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

  10. Development of Right Ventricular Dysfunction in Acute Myocardial Infarction and Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    L. I. Sergeyeva

    2007-01-01

    Full Text Available Objective: to evaluate the structural and functional state of the right cardiac cavities in acute left ventricular myocardial infarction and in progressive chronic heart failure (CHF in patients with coronary heart disease.Materials and methods. 20 patients with acute myocardial infarction and 48 with postinfarct cardiosclerosis with NYHA functional classes I to IV CHF were examined. The structural and functional state of the right heart was evaluated in progressive left ventricular systolic and diastolic dysfunction by echocardiography.Results. In the acute period of infarction, remodeling processes occur in the left ventricle, with normal postload values, volumetric indices and right ventricular contractility are in the normal range. There is right cardiac dilatation at the early stage of left ventricular systolic and diastolic dysfunction in postinfarct remodeling and evolving CHF, normal pulmonary arterial and right atrial pressures. With a significant reduction in left ventricular contractility and its pronounced filling impairment, increases in post- and preload for the right ventricle occur with a just considerable change in its structural and functional state.Conclusion. In impaired myocardial relaxation in the presence of CHF, remodeling of the right cardiac cavities takes place without the influence of a hemodynamic factor. There is a close relationship of remodeling of both ventricles from the very early CHF stages, which suggests that there are common pathogenetic mechanisms responsible for the development of myocardial dysfunction. 

  11. Reduction of ventricular arrhythmias by early intravenous atenolol in suspected acute myocardial infarction.

    OpenAIRE

    Rossi, P R; Yusuf, S; Ramsdale, D.; Furze, L; Sleight, P

    1983-01-01

    The effect of intravenous atenolol on ventricular arrhythmias in acute myocardial infarction was assessed in 182 patients admitted within 12 hours of the onset of chest pain. Ninety-five patients were randomised to receive 5 mg intravenous atenolol followed immediately by 50 mg by mouth and 50 mg 12 hours later, then 100 mg daily for 10 days; 87 patients served as controls. The treated patients had significantly fewer ventricular extrasystoles; 58 control patients (67%) had R-on-T extrasystol...

  12. [Association between biochemical markers and left ventricular dysfunction in the ST-elevation acute myocardial infarction].

    Science.gov (United States)

    de Abreu, Maximiliano; Mariani, Javier; Guridi, Cristian; González-Villa-Monte, Gabriel; Gastaldello, Natalio; Potito, Mauricio; Reyes, Graciela; Antonietti, Laura; Tajer, Carlos

    2014-01-01

    The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with ST-elevation acute myocardial infarction. With an observational and prospective design we included patients with less than 24h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P=.005), peak creatine-phosphokinase-MB (P=.01), leukocyte count (P=.001) and glucose (P=.033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P=.01) and peak creatine-phosphokinase-MB (P=.02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  13. Traditional Formula, Modern Application: Chinese Medicine Formula Sini Tang Improves Early Ventricular Remodeling and Cardiac Function after Myocardial Infarction in Rats

    Directory of Open Access Journals (Sweden)

    Jiangang Liu

    2014-01-01

    Full Text Available Sini Tang (SNT is a traditional Chinese herbal formula consisting of four different herbs: the root of Aconitum carmichaelii, the bark of Cinnamomum cassia, the rhizome of Zingiber officinale, and the root of Glycyrrhiza uralensis. This study aims to evaluate the improvement of early ventricular remodeling and cardiac function in myocardial infarction (MI rats by SNT. A MI model was established by ligation of the left anterior descending coronary artery. Following treatment for 4 weeks, ultrasonic echocardiography was performed. Myocardial histopathological changes were observed using haematoxylin and eosin staining. Collagens (type I and type III, transforming growth factor-β1 (TGF-β1, and Toll-like receptors (TLR-2 and TLR-4 were measured in plasma, serum, and myocardial tissue. SNT treatment decreased the infarct size, the left ventricular cavity area/heart cavity area ratio, and the left ventricle dimension at end systole and increased the left ventricular ejection fraction. SNT reduced the levels of TLR-2 and TLR-4 in myocardial tissue significantly and decreased the collagens content in serum and in myocardial tissue. SNT could partially reduce the level of TGF-β1 in serum and in myocardial tissue. Our data suggest that the Chinese medicine formula SNT has the potential to improve early ventricular remodeling and cardiac function after MI.

  14. Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Møller, J E; Nørager, B

    2001-01-01

    The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis...... of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73......%) and D (38%) compared to A (2%) (p regression analysis identified LV diastolic dysfunction (p = 0.001), Killip class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved...

  15. The characteristics of myocardial fatty acid metabolism in patients with left ventricular hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Isobe, Naoki; Toyama, Takuji; Hoshizaki, Hiroshi [Gunma Prefectural Cardiovascular Center (Japan)] (and others)

    1999-09-01

    We evaluated the characteristics of myocardial fatty acid metabolism in patients with left ventricular hypertrophy (LVH). Myocardial imaging with {sup 123}I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) was performed in 28 patients with hypertrophic cardiomyopathy (HCM), 15 patients with hypertensive heart disease (HHD), 13 patients with aortic stenosis (AS) and 8 normal controls (NC). The patients with HCM consisted of 13 patients of asymmetric septal hypertrophy (ASH), 7 patients of diffuse hypertrophy (Diffuse-HCM) and 8 patients of apical hypertrophy (APH). Planar and SPECT images of BMIPP were acquired 15 minutes and 4 hours after tracer injection. Resting {sup 201}Tl SPECT images and echocardiography were also performed on other days. We calculated heart/mediastinum count ratio and washout rate of BMIPP by using planar image. In patients with LVH, the incidence of reduced BMIPP uptake was more frequent than that of reduced {sup 201}Tl uptake. In delayed images, more than 60% of patients with LVH reduced BMIPP uptake, especially remarkable for patients with ASH and APH. The washout rate of all cardiac hypertrophic disorders was tended to be higher than that of normal subjects. Reduced BMIPP uptake was frequently found in septal portion of anterior and inferior wall in patients with ASH, in inferior wall in patients with Diffuse-HCM and HHD, in apex in patients with APH and AS. These results suggest that BMIPP scintigraphy can differentiate three types of cardiac hypertrophy. (author)

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

    NARCIS (Netherlands)

    Delewi, Ronak; Nijveldt, Robin; Hirsch, Alexander; Marcu, Constantin B.; Robbers, Lourens; Hassell, Marriela E. C. J.; de Bruin, Rianne A.; Vleugels, Jim; van der Laan, Anja M.; Bouma, Berto J.; Tio, Rene A.; Tijssen, Jan G. P.; van Rossum, Albert C.; Zijlstra, Felix; Piek, Jan J.

    2012-01-01

    Introduction: Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic

  17. Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia.

    Science.gov (United States)

    Bui, An H; Roujol, Sébastien; Foppa, Murilo; Kissinger, Kraig V; Goddu, Beth; Hauser, Thomas H; Zimetbaum, Peter J; Ngo, Long H; Manning, Warren J; Nezafat, Reza; Delling, Francesca N

    2017-02-01

    We aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 with complex ventricular arrhythmia (ComVA) in mitral valve prolapse (MVP). A retrospective analysis was performed on 41 consecutive patients with MVP referred for CMR between 2006 and 2011, and 31 healthy controls. Arrhythmia analysis was available in 23 patients with MVP with Holter/event monitors. Left ventricular (LV) septal T1 times were derived from Look-Locker sequences after administration of 0.2 mmol/kg gadopentetate dimeglumine. Late gadolinium enhancement (LGE) CMR images were available for all subjects. Patients with MVP had significantly shorter postcontrast T1 times when compared with controls (334±52 vs 363±58 ms; p=0.03) despite similar LV ejection fraction (LVEF) (63±7 vs 60±6%, p=0.10). In a multivariable analysis, LV end-diastolic volume, LVEF and mitral regurgitation fraction were all correlates of T1 times, with LVEF and LV end-diastolic volume being the strongest (p=0.005, p=0.008 and p=0.045, respectively; model adjusted R2=0.30). Patients with MVP with ComVA had significantly shorter postcontrast T1 times when compared with patients with MVP without ComVA (324 (296, 348) vs 354 (327, 376) ms; p=0.03) and only 5/14 (36%) had evidence of papillary muscle LGE. MVP may be associated with diffuse LV myocardial fibrosis as suggested by reduced postcontrast T1 times. Diffuse interstitial derangement is linked to subclinical systolic dysfunction, and may contribute to ComVA in MVP-related mitral regurgitation, even in the absence of focal fibrosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Iodine-123 phenylpentadecanoic acid myocardial scintigraphy in patients with left ventricular hypertrophy: Alterations in left ventricular distribution and utilization

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, C.L.; Kennedy, P.L.; Kulkarni, P.V.; Jansen, D.E.; Gabliani, G.I.; Corbett, J.R. (Univ. of Texas Health Science Center (USA))

    1990-06-01

    Regional alterations in myocardial substrate uptake and/or utilization have been demonstrated in rats with hypertension. To determine whether alterations in left ventricular fatty acid uptake and/or utilization are present in patients with left ventricular hypertrophy (LVH), we compared the results of rest and exercise iodine-123 phenylpentadecanoic acid (IPPA) myocardial scintigraphy in 10 patients with hypertension who had concentric LVH without evidence of coronary artery disease and in 15 normal subjects. Patients with LVH had more heterogeneous left ventricular activity of IPPA compared to normal subjects after exercise but not at rest. Although IPPA clearance was similar in both patients with LVH and normal subjects, postexercise washout in segments showing decreased initial IPPA uptake was reduced compared to washout at rest in patients with LVH (11.7 +/- 7.5% versus 21.5 +/- 8.4% at 20 minutes after injection, n = 15; p = 0.005). Exercise thallium-201 (TI-201) scintigraphy was normal in all seven patients with LVH tested. Patients with LVH showed significantly greater heterogeneity in IPPA uptake compared to TI-201 uptake immediately after exercise (25 +/- 5% versus 16 +/- 6%; p = 0.013). We conclude that (1) compared to normal subjects, patients with LVH show heterogeneous myocardial IPPA activity after exercise but not at rest; (2) postexercise washout of IPPA was decreased in segments with reduced uptake after exercise in patients with LVH; and (3) the distribution of IPPA is more heterogeneous than that of TI-201 immediately after exercise in patients with concentric LVH. The postexercise heterogeneity in IPPA uptake and delayed washout in segments with reduced initial uptake is consistent with exercise-induced myocardial ischemia in patients with LVH.

  19. Iodine-123 phenylpentadecanoic acid myocardial scintigraphy in patients with left ventricular hypertrophy: alterations in left ventricular distribution and utilization.

    Science.gov (United States)

    Wolfe, C L; Kennedy, P L; Kulkarni, P V; Jansen, D E; Gabliani, G I; Corbett, J R

    1990-06-01

    Regional alterations in myocardial substrate uptake and/or utilization have been demonstrated in rats with hypertension. To determine whether alterations in left ventricular fatty acid uptake and/or utilization are present in patients with left ventricular hypertrophy (LVH), we compared the results of rest and exercise iodine-123 phenylpentadecanoic acid (IPPA) myocardial scintigraphy in 10 patients with hypertension who had concentric LVH without evidence of coronary artery disease and in 15 normal subjects. Patients with LVH had more heterogeneous left ventricular activity of IPPA compared to normal subjects after exercise but not at rest (23 +/- 8% versus 13 +/- 5% difference in maximum segmental activity at 4 minutes after exercise; p = 0.005). Although IPPA clearance was similar in both patients with LVH and normal subjects, postexercise washout in segments showing decreased initial IPPA uptake was reduced compared to washout at rest in patients with LVH (11.7 +/- 7.5% versus 21.5 +/- 8.4% at 20 minutes after injection, n = 15; p = 0.005). Exercise thallium-201 (TI-201) scintigraphy was normal in all seven patients with LVH tested. Patients with LVH showed significantly greater heterogeneity in IPPA uptake compared to TI-201 uptake immediately after exercise (25 +/- 5% versus 16 +/- 6%; p = 0.013). We conclude that (1) compared to normal subjects, patients with LVH show heterogeneous myocardial IPPA activity after exercise but not at rest; (2) postexercise washout of IPPA was decreased in segments with reduced uptake after exercise in patients with LVH; and (3) the distribution of IPPA is more heterogeneous than that of TI-201 immediately after exercise in patients with concentric LVH. The postexercise heterogeneity in IPPA uptake and delayed washout in segments with reduced initial uptake is consistent with exercise-induced myocardial ischemia in patients with LVH.

  20. Revascularização miocárdica e restauração ventricular por meio da pacopexia Myocardial revascularization and ventricular restoration through pacopexy

    Directory of Open Access Journals (Sweden)

    João Roberto Breda

    2007-02-01

    Full Text Available OBJETIVO: Analisar o desempenho ventricular esquerdo após revascularização miocárdica associada à restauração da geometria ventricular pela "pacopexia", em pacientes portadores de miocardiopatia isquêmica com significativa disfunção ventricular, nos quais a restauração ventricular foi conseguida com técnica especial. MÉTODOS: Revascularização miocárdica associada à restauração da geometria ventricular através de técnica especial, sem utilização de próteses ou outros materiais sintéticos. RESULTADOS: Após o procedimento cirúrgico, foi observada melhora da classe funcional em 93,10% dos pacientes. Houve um aumento significante na comparação pré e pós operatórias da fração de ejeção do ventrículo esquerdo e diminuição do diâmetro sistólico do ventrículo esquerdo. Não houve alteração significante do diâmetro diastólico do ventrículo esquerdo e do volume sistólico. O tempo de seguimento após a operação variou de 1 mês a 3 anos e 4 meses. CONCLUSÃO: A técnica de restauração ventricular através da pacopexia mostrou-se eficaz no tratamento da grave disfunção ventricular de origem isquêmica, com impacto sobretudo na melhora da classe funcional dos pacientes estudados.OBJECTIVE: To analyze left ventricle performance after myocardial revascularization associated to ventricular geometrics restoration by "pacopexy" in schemic myocardiopathy patients with significant ventricular dysfunction in whom ventricular restoration was obtained through special technique. METHODS: Myocardial revascularization associated to ventricular geometrics restoration through special technique, with no use of prosthesis or other synthetic materials. RESULTS: Patients’ functional class was shown to have improved 93.10% after surgical procedure. Pre- and post-surgical comparison showed significant increase in left ventricle ejection fraction as well as decrease in left ventricle systolic diameter. No significant change

  1. Acute left ventricular remodeling following myocardial infarction: coupling of regional healing with remote extracellular matrix expansion.

    Science.gov (United States)

    Chan, William; Duffy, Stephen J; White, David A; Gao, Xiao-Ming; Du, Xiao-Jun; Ellims, Andris H; Dart, Anthony M; Taylor, Andrew J

    2012-09-01

    This prospective study aimed to assess regional and temporal patterns of extracellular matrix (ECM) changes post-myocardial infarction (MI). A fundamental process in the development of ischemic left ventricular (LV) dysfunction is LV remodeling, characterized by structural and functional abnormalities throughout the myocardium including the noninfarcted (remote) myocardium and interstitium. Contrast-enhanced cardiac magnetic resonance (CMR) was performed on MI patients acutely (mean: 5 days post-MI, n = 25) and repeated subacutely (mean: 139 days post-MI, n = 21), and was also performed in a separate group of 15 patients with chronic MI (mean: 2,580 days post-MI, n = 15). Twenty volunteers without a history of MI acted as controls. CMR was used to evaluate LV morphology and function, with post-contrast T1 mapping to semiquantitatively assess changes in the ECM. Putative mediators of myocardial inflammation and fibrosis, including macrophage migration inhibitory factor (MIF), were also measured. Age, sex, and diabetic and hypertensive status did not differ between MI groups and controls. Compared with controls, patients early post-acute MI demonstrated reduced LV ejection fraction (50.25 ± 7.29% vs. 66.7 ± 6.2% [controls], p infarction early post-acute MI, compared with controls, demonstrated reduced systolic thickening (60 ± 5.0% vs. 106 ± 7.6%, p ≤ 0.0002), and lower post-contrast myocardial T1 times suggestive of ECM expansion (437 ± 113 ms vs. 549 ± 119 ms, p = 0.01). In a subgroup analysis between early post-acute MI and controls of similar age and sex, the remote sector post-contrast myocardial T1 times remained significantly shorter post-acute MI compared with controls (420 ± 121 ms vs. 529 ± 113 ms, p = 0.03). Serum levels of MIF inversely correlated with global myocardial T1 time in patients early post-acute MI (r = -0.6, p = 0.01), suggesting a coupling of regional healing with acute LV remodeling. Within a week of acute MI, the remote myocardium

  2. The effect of isolated left bundle branch block on the myocardial velocities and myocardial performance index.

    Science.gov (United States)

    Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Soylu, Ahmet; Aygul, Nazif; Yazici, Mehmet; Tokac, Mehmet

    2008-03-01

    This study was planned in order to investigate the effect of left bundle branch block (LBBB) on myocardial velocities obtained by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). Subjects with LBBB (n = 61) and age-matched healthy subjects (n = 60) were enrolled in the study. Left ventricular (LV) ejection fraction (EF), mitral inflow velocities (E-wave and A-wave), isovolumetric contraction and relaxation time (ICT and IRT), ejection time (ET), and flow propagation velocity (Vp) were measured by conventional echocardiography. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured by TDE. MPI was calculated by the formula (ICT + IRT)/ET. LVEF and mitral E/A ratio were similar in both groups. Vp was lower in the LBBB group than in the control group, whereas the E/Em and the E/Vp ratio was higher. LV Sm and Em/Am ratio were lower in LBBB group. Right ventricular Sm and Em/Am ratio were similar in both groups. LV mean and RV MPI were significantly increased in LBBB group. These findings obtained by TDE show that isolated LBBB impairs the ventricular functions. Both of the LV and RV dysfunctions shown by the new parameters may contribute to increased morbidity and mortality in cases with isolated LBBB.

  3. Off-Pump Repair of a Post Myocardial Infarction Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2014-01-01

    Full Text Available Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated and external sandwich closure of post myocardial ventricular septal defect (VSD appears to be simple and effective after initial myocardial infarction (MI. The three cases presented with a VSD after of acute MI with or without thrombolysed with streptokinase during patient admission. The general condition of the three patients was poor with pulmonary edema, low cardiac output and renal failure. The heart was approached through a median sternotomy. Off-pump coronary artery bypass grafting of the coronary artery lesion was done first using octopus and beating heart surgery method and latero - lateral septal plication was performed using sandwich technique. Low cardiac output managed with intra-aortic balloon pump in these patients accompanied with inotropic drugs. Post-operative transesophageal echocardiography revealed that VSD was closed completely in one patient and in two patients small residual VSD remained. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs.

  4. Cardiogenic shock accompanied by dynamic left ventricular outflow tract obstruction and myocardial bridging after transient complete atrioventricular block mimicking ST-elevation myocardial infarction: a case report

    National Research Council Canada - National Science Library

    Kang, Seonghui; An, Sanghee; Yu, Hyung Min; Kim, Jiwan; Kim, Sung Hea; Kim, Hyun-Joong; Chung, Sang Man

    2013-01-01

    .... In this report, we present a case of cardiogenic shock that mimics ST-elevation myocardial infarction, due to dynamic left ventricular outflow tract obstruction with transient mitral regurgitation...

  5. Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis

    NARCIS (Netherlands)

    Delewi, Ronak; Hirsch, Alexander; Tijssen, Jan G.; Schächinger, Volker; Wojakowski, Wojciech; Roncalli, Jérôme; Aakhus, Svend; Erbs, Sandra; Assmus, Birgit; Tendera, Michal; Goekmen Turan, R.; Corti, Roberto; Henry, Tim; Lemarchand, Patricia; Lunde, Ketil; Cao, Feng; Huikuri, Heikki V.; Sürder, Daniel; Simari, Robert D.; Janssens, Stefan; Wollert, Kai C.; Plewka, Michal; Grajek, Stefan; Traverse, Jay H.; Zijlstra, Felix; Piek, Jan J.

    2014-01-01

    The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized

  6. 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.)

  7. Clinical assessment of left ventricular systolic torsion: effects of myocardial infarction and ischemia.

    Science.gov (United States)

    Bansal, Manish; Leano, Rodel L; Marwick, Thomas H

    2008-08-01

    The helical arrangement of myocardial fibers leads to left ventricular (LV) torsion, a vital contributor to systolic and diastolic function. Rotation and torsion can now be measured; we sought to determine the utility of torsion as a marker of LV function at rest and after stress in patients with myocardial infarctions (MIs) and ischemia. Dobutamine echocardiography was performed in 125 patients. After the exclusion of 40 patients with suboptimal images, LV systolic rotation and torsion were measured offline using speckle-tracking echocardiography in 44 patients with and 41 without prior MIs. Hemodynamic findings and the extent of infarction and ischemia were correlated with length-corrected torsion measurements at baseline and at peak-dose dobutamine. Resting global and regional LV systolic torsion were significantly reduced in patients with compared with those without previous MIs (1.16 +/- 1.15 degrees /cm vs 3.16 +/- 1.3 degrees /cm, P anteroapical or inferoposterior infarcts (1.81 +/- 1.13 degrees /cm vs 2.27 +/- 1.18 degrees /cm, P = NS) and no differences in regional torsion. Torsion was most impaired in patients with multiple areas of infarction (1.03 +/- 0.89 degrees /cm, P < .001). However, dobutamine-induced ischemia (2.59 +/- 1.14 ischemic segments) had no effect on global and regional systolic torsion at peak dose or change in torsion from rest to peak dose. The influence of MI on LV systolic torsion appears to be related to infarct size rather than site, and torsion was an independent determinant of resting function. LV torsion was not significantly influenced by stress-induced myocardial ischemia.

  8. Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction

    Science.gov (United States)

    Antonelli, Lucas; Katz, Marcelo; Bacal, Fernando; Makdisse, Marcia Regina Pinho; Correa, Alessandra Graça; Pereira, Carolina; Franken, Marcelo; Fava, Anderson Nunes; Serrano Junior, Carlos Vicente; Pesaro, Antonio Eduardo Pereira

    2015-01-01

    Background The prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated. Objective To analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality. Methods Patients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models. Results Among the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35–6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality. Conclusion One-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left

  9. Added clinical value of applying myocardial deformation imaging to assess right ventricular function.

    Science.gov (United States)

    Sokalskis, Vladislavs; Peluso, Diletta; Jagodzinski, Annika; Sinning, Christoph

    2017-06-01

    Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use. © 2017, Wiley Periodicals, Inc.

  10. Left ventricular global longitudinal strain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads

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

  11. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European Myocardial Infarct Amiodarone Trial Investigators

    NARCIS (Netherlands)

    Julian, D. G.; Camm, A. J.; Frangin, G.; Janse, M. J.; Munoz, A.; Schwartz, P. J.; Simon, P.

    1997-01-01

    Ventricular arrhythmias are a major cause of death after myocardial infarction, especially in patients with poor left-ventricular function. Previous attempts to identify and suppress arrhythmias with various antiarrhythmic drugs failed to reduce or actually increase mortality. Amiodarone is a

  12. Cardioprotective effect of polydatin on ventricular remodeling after myocardial infarction in coronary artery ligation rats.

    Science.gov (United States)

    Gao, Yan; Gao, Jianping; Chen, Changxun; Wang, Huilin; Guo, Juan; Wu, Rong

    2015-05-01

    The purpose of this study was to explore the effect of polydatin on ventricular remodeling after myocardial infarction in coronary artery ligation rats and to elucidate the underlying mechanisms. A rat model of ventricular remodeling after myocardial infarction was established by left coronary artery ligation. Rats with coronary artery ligation were randomly divided into five groups: control, plus 40 mg/kg captopril, plus 25 mg/kg polydatin, plus 50 mg/kg polydatin, and plus 100 mg/kg polydatin. The sham-operated group was used as a negative control. Rats were administered intragastrically with the corresponding drugs or drinking water for seven weeks. At the end of the treatment, the left ventricular weight index and heart weight index were assessed. The cross-sectional size of cardiomyocytes was measured by staining myocardium tissue with hematoxylin and eosin. Collagen content was counted by Sirius red in aqueous saturated picric acid. The concentrations of angiotensin I, angiotensin II, aldosterone, and endothelin 1 in myocardium or serum were determined by radioimmunoassay. Hydroxyproline and nitric oxide concentrations and glutathione peroxidase and catalase activities in serum were measured by ultraviolet spectrophotometry. Our results showed that seven weeks of polydatin treatment resulted in a significantly reduced left ventricular weight index, heart weight index, serum concentrations of hydroxyproline and aldosterone, an increased concentration of nitric oxide as well as enhanced activities of glutathione peroxidase and catalase. Myocardial angiotensin I, angiotensin II, and endothelin 1 levels were also reduced. The cardiomyocyte cross-sectional area and collagen deposition diminished. This study suggests that polydatin may attenuate ventricular remodeling after myocardial infarction in coronary artery ligation rats through restricting the excessive activation of the renin-angiotensin-aldosterone system and inhibiting peroxidation. Georg Thieme

  13. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial.

    Science.gov (United States)

    Iliceto, S; Scrutinio, D; Bruzzi, P; D'Ambrosio, G; Boni, L; Di Biase, M; Biasco, G; Hugenholtz, P G; Rizzon, P

    1995-08-01

    This study was performed to evaluate the effects of L-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction. Carnitine is a physiologic compound that performs an essential role in myocardial energy production at the mitochondrial level. Myocardial carnitine deprivation occurs during ischemia, acute myocardial infarction and cardiac failure. Experimental studies have suggested that exogenous carnitine administration during these events has a beneficial effect on function. The L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial was a randomized, double-blind, placebo-controlled, multicenter trial in which 472 patients with a first acute myocardial infarction and high quality two-dimensional echocardiograms received either placebo (239 patients) or L-carnitine (233 patients) within 24 h of onset of chest pain. Placebo or L-carnitine was given at a dose of 9 g/day intravenously for the first 5 days and then 6 g/day orally for the next 12 months. Left ventricular volumes and ejection fraction were evaluated on admission, at discharge from hospital and at 3, 6 and 12 months after acute myocardial infarction. A significant attenuation of left ventricular dilation in the first year after acute myocardial infarction was observed in patients treated with L-carnitine compared with those receiving placebo. The percent increase in both end-diastolic and end-systolic volumes from admission to 3-, 6- and 12-month evaluation was significantly reduced in the L-carnitine group. No significant differences were observed in left ventricular ejection fraction changes over time in the two groups. Although not designed to demonstrate differences in clinical end points, the combined incidence of death and congestive heart failure after discharge was 14 (6%) in the L-carnitine treatment group versus 23 (9.6%) in the placebo group (p = NS). Incidence of ischemic events during follow-up was similar in the

  14. Myocardial reverse remodeling after pressure unloading is associated with maintained cardiac mechanoenergetics in a rat model of left ventricular hypertrophy.

    Science.gov (United States)

    Ruppert, Mihály; Korkmaz-Icöz, Sevil; Li, Shiliang; Németh, Balázs Tamás; Hegedűs, Péter; Brlecic, Paige; Mátyás, Csaba; Zorn, Markus; Merkely, Béla; Karck, Matthias; Radovits, Tamás; Szabó, Gábor

    2016-09-01

    Pressure unloading represents the only effective therapy in increased afterload-induced left ventricular hypertrophy (LVH) as it leads to myocardial reverse remodeling (reduction of increased left ventricular mass, attenuated myocardial fibrosis) and preserved cardiac function. However, the effect of myocardial reverse remodeling on cardiac mechanoenergetics has not been elucidated. Therefore, we aimed to provide a detailed hemodynamic characterization in a rat model of LVH undergoing pressure unloading. Pressure overload was induced in Sprague-Dawley rats by abdominal aortic banding for 6 (AB 6th wk) or 12 wk (AB 12th wk). Sham-operated animals served as controls. Aortic debanding procedure was performed after the 6th experimental week (debanded 12th wk) to investigate the regression of LVH. Pressure unloading resulted in significant reduction of LVH (heart weight-to-tibial length ratio: 0.38 ± 0.01 vs. 0.58 ± 0.02 g/mm, cardiomyocyte diameter: 18.3 ± 0.1 vs. 24.1 ± 0.8 μm debanded 12th wk vs. AB 12th wk, P cardiac mechanoenergetics. Copyright © 2016 the American Physiological Society.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    BACKGROUND: The selection of patients for prophylactic implantable cardioverter-defibrilator (ICD) treatment after myocardial infarction (MI) remains controversial. AIM: To determine the optimum left ventricular ejection fraction (LVEF) dichotomy limit for ICD treatment in patients with a history...

  16. Guanxin Danshen Formulation Protects against Myocardial Ischemia Reperfusion Injury-Induced Left Ventricular Remodeling by Upregulating Estrogen Receptor β

    Directory of Open Access Journals (Sweden)

    Xuehong Deng

    2017-11-01

    Full Text Available Background: Guanxin Danshen formulation (GXDSF is a traditional Chinese herbal recipe recorded in the Chinese Pharmacopeia since 1995 edition, which consists of Salviae miltiorrhizae Radix et Rhizoma, Notoginseng Radix et Rhizoma and Dalbergiae odoriferae Lignum. Our previous research suggested GXDSF had positive effect on cardiovascular disease. Therefore, the aim of this study was to elucidate the effects of GXDSF on myocardial ischemia reperfusion injury-induced left ventricular remodelling (MIRI-LVR.Methods: The effects of GXDSF on cardiac function were detected by haemodynamics and echocardiograms. The effects of GXDSF on biochemical parameters (AST, LDH and CK-MB were analyzed. Histopathologic examinations were performed to evaluate the effect of GXDSF on cardiac structure. In addition, the Traditional Chinese Medicine Systems Pharmacology (TCMSP database was used to predict the main target of GXDSF. Target validation was conducted by using western blots and immunofluorescent double staining assays.Results: We found that +dp/dt and LVSP were significantly elevated in the GXDSF-treated groups compared with the MIRI-LVR model group. Left ventricular ejection fraction (LVEF and left ventricular fractional shortening (LVFS were increased in the GXDSF-treated groups compared with the model group. All biochemical parameters (AST, LDH and CK-MB were considerably decreased in the GXDSF-treated groups compared with the model group. Fibrosis parameters (collagen I and III, α-SMA, and left ventricular fibrosis percentage were decreased to different degrees in the GXDSF-treated groups compared with the model group, and the collagen III/I ratio was elevated by the same treatments. TCMSP database prediction and western blot results indicated that estrogen receptor β (ERβ could be the main target of GXDSF. PHTPP, a selective antagonist of ERβ, could inhibit the expression of ERβ and the phosphorylation of PI3K and Akt in myocardial tissue induced by

  17. Left ventricular hypertrophy is associated with increased infarct size and decreased myocardial salvage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Nepper-Christensen, Lars; Lønborg, Jacob; Ahtarovski, Kiril Aleksov

    2017-01-01

    Background--Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association...... between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all-cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary...

  18. Myocardial involvement during the early course of type 2 diabetes mellitus: usefulness of Myocardial Performance Index

    Directory of Open Access Journals (Sweden)

    Goldoni Matteo

    2008-06-01

    Full Text Available Abstract To evaluate whether myocardial performance index detects a subclinical impairment of left ventricular systolic and diastolic function in patients with early stage of type 2 diabetes, without coronary artery disease, with or without hypertension. Furthermore, to evaluate whether some echocardiographic parameters relate to the metabolic control. Fourty-five consecutive male patients (mean age 52.5 years with type 2 diabetes mellitus of recent onset (23 hypertensives and 22 normotensives and 22 age matched healthy controls males were analysed. All participants had normal exercise ECG. All subjects underwent standard and Doppler echocardiography for the assessment of the isovolumic Doppler time interval and Doppler-derived myocardial performance index. In all diabetic patients a glycated haemoglobin test was also performed. No differences were observed in blood pressure, heart rate, and conventional echocardiographic parameters comparing the 2 subgroups of diabetic patients and the controls. Myocardial performance index was significantly higher in diabetic patients independently of the hypertension occurrence, compared to the controls (0.49 and 0.49 diabetic normotensives and hypertensives respectively vs. 0.39, p

  19. Right ventricular function assessed by 2D strain analysis predicts ventricular arrhythmias and sudden cardiac death in patients after acute myocardial infarction

    DEFF Research Database (Denmark)

    Risum, Niels; Valeur, Nana; Søgaard, Peter

    2017-01-01

    ) or malignant ventricular arrhythmias (VAs) after acute myocardial infarction (MI). Methods and results: A total of 790 patients with acute MI were prospectively included. All patients had 2D strain echocardiography performed to evaluate right ventricular (RV) free wall strain (RVS) and RV mechanical dispersion...... (MD) defined as the standard deviation of time to peak negative strain in all myocardial segments. The primary composite end point [SCD, admission with VA or appropriate therapy from a primary prophylactic implantable cardioverter-defibrillator (ICD)] was analysed with Cox models. Mean age was 69 ± 12.......08, 95% confidence interval (CI) 1.01-1.15; P = 0.038]. Patients in the lower tertile (poor strain) showed a 10-fold risk of an event compared with the upper tertile (HR 9.8, 95% CI 2.23-42.3; P = 0.002). RV MD was not independently associated with VA/SCD (HR 0.99, 95% CI 0.91-1.09; P = 0.93). RVS proved...

  20. Long-term prognostic importance of diabetes after a myocardial infarction depends on left ventricular systolic function

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Mérie, Charlotte

    2011-01-01

    . Multivariable Cox regression models were used to assess the risk of mortality associated with diabetes, and the importance of diabetes was examined independently within defined left ventricular ejection fraction (LVEF) subgroups. RESULTS A total of 16,912 patients were included; 1,819 (11%) had diabetes......This study was performed to understand how left ventricular function modulates the prognostic importance of diabetes after myocardial infarction (MI). RESEARCH DESIGN AND METHODS Consecutively hospitalized MI patients screened for three clinical trials were followed for a median of 7 years....... Diabetes and 15% unit depression in LVEF were of similar prognostic importance: hazard ratios (HRs) were 1.45 (95% CI 1.37–1.54) and 1.41 (1.37–1.45) for diabetes and LVEF depression, respectively. LVEF modified the outcomes associated with diabetes, with HRs being 1.29 (1.19–1.40) and 1.61 (1...

  1. Effects of commonly used inotropes on myocardial function and oxygen consumption under constant ventricular loading conditions.

    Science.gov (United States)

    DeWitt, Elizabeth S; Black, Katherine J; Thiagarajan, Ravi R; DiNardo, James A; Colan, Steven D; McGowan, Francis X; Kheir, John N

    2016-07-01

    Inotropic medications are routinely used to increase cardiac output and arterial blood pressure during critical illness. However, few comparative data exist between these medications, particularly independent of their effects on venous capacitance and systemic vascular resistance. We hypothesized that an isolated working heart model that maintained constant left atrial pressure and aortic blood pressure could identify load-independent differences between inotropic medications. In an isolated heart preparation, the aorta and left atrium of Sprague Dawley rats were cannulated and placed in working mode with fixed left atrial and aortic pressure. Hearts were then exposed to common doses of a catecholamine (dopamine, epinephrine, norepinephrine, or dobutamine), milrinone, or triiodothyronine (n = 10 per dose per combination). Cardiac output, contractility (dP/dtmax), diastolic performance (dP/dtmin and tau), stroke work, heart rate, and myocardial oxygen consumption were compared during each 10-min infusion to an immediately preceding baseline. Of the catecholamines, dobutamine increased cardiac output, contractility, and diastolic performance more than clinically equivalent doses of norepinephrine (second most potent), dopamine, or epinephrine (P function, either alone or added to a baseline catecholamine infusion. Myocardial oxygen consumption was closely related to dP/dtmax (r(2) = 0.72), dP/dtmin (r(2) = 0.70), and stroke work (r(2) = 0.53). In uninjured, isolated working rodent hearts under constant ventricular loading conditions, dobutamine increased contractility and cardiac output more than clinically equivalent doses of norepinephrine, dopamine, and epinephrine; milrinone and triiodothyronine did not have significant effects on contractility. Copyright © 2016 the American Physiological Society.

  2. Effect of Commiphora mukul extract on cardiac dysfunction and ventricular function in isoproterenol-induced myocardial infarction.

    Science.gov (United States)

    Ojha, Shreesh K; Nandave, Mukesh; Arora, Sachin; Mehra, Raj D; Joshi, Sujata; Narang, Rajiv; Arya, D S

    2008-09-01

    In present study, hydroalcoholic extract of C. mukul significantly improved the cardiac function and prevented myocardial ischemic impairment manifested in the form of increased heart rate, decreased arterial pressure, increased left ventricular end diastolic pressure, and altered myocardial contractility indices. C. mukul treatment additionally also produced a significant increase in lactate dehydrogenase levels and prevented decline of protein content in heart. C. mukul preserved the structural integrity of myocardium. Reduced leakage of myocyte enzyme lactate dehydrogenase and maintenance of structural integrity of myocardium along with favorable modulation of cardiac function and improved cardiac performance indicate the salvage of myocardium with C. mukul treatment. Guggulsterones which are considered to be responsible for most of the therapeutic properties of C. mukul may underlie the observed cardioprotective effect of C. mukul against cardiac dysfunction in isoproterenol-induced ischemic rats.

  3. Percutaneous transluminal coronary angioplasty in patients with reduced left ventricular ejection fraction: effects on myocardial perfusion and left ventricular response to exercise.

    Science.gov (United States)

    Singh, A; Chandler, S; Pears, D; Perry, R; Murray, R G; Shiu, M F

    1989-05-01

    Many patients with coronary artery disease treated by percutaneous transluminal coronary angioplasty (PTCA) have a history of previous myocardial injury resulting in a reduced left ventricular ejection fraction (EF). The effects of successful PTCA on myocardial perfusion and left ventricular function in these patients were compared to treatment in patients with normal left ventricular EF. There were 21 patients with a normal EF (mean EF 59 +/- 2%) (Group I) and 15 patients with reduced EF (mean EF 43 +/- 1%) (Group II). Before PTCA a similar degree of reversible myocardial ischemia was present on thallium scintigraphy. At peak exercise left ventricular EF in the Group I patients decreased by 4 +/- 1% compared to 8 +/- 1% in Group II. At one month following successful PTCA there was resolution of reversible myocardial ischemia in both groups. No changes in EF at rest were observed. At the same level of exercise as before PTCA the mean EF was 5 +/- 1% higher than the pretreatment value in Group I and 10 +/- 1% higher in Group II. Thus in this study reversible myocardial ischemia was associated with severe compromise in the left ventricular response to exercise which was substantially improved by PTCA.

  4. Bidirectional ventricular tachycardia with myocardial infarction: A case report with insight on mechanism and treatment

    OpenAIRE

    Wase, Abdul; Masood, Abdul-Mannan; Garikipati, Naga V.; Mufti, Omar; Kabir, Anwarul

    2014-01-01

    Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,1 numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence ...

  5. Regional myocardial perfusion and performance

    NARCIS (Netherlands)

    H.C. Schamhardt (Henk)

    1980-01-01

    textabstractThe function of the heart is to pump blood from the veins into the arteries in response to the need of the tissues for oxygen and substrates. During its action the heart itself needs these nutrients. Factors that mainly determine the myocardial oxygen demand are (fig.0.1): heart rate,

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

    Science.gov (United States)

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

    2017-02-01

    Left ventricular ejection fraction (LVEF) and infarct size (ISZ) are key predictors of long-term survival after myocardial infarction (MI). However, little is known about the biochemical pathways driving LV dysfunction after MI. To identify novel biomarkers predicting post-MI LVEF and ISZ, we performed metabolic profiling in the GIPS-III randomized clinical trial (Glycometabolic Intervention as Adjunct to Primary Percutaneous Intervention in ST Elevation Myocardial Infarction). We also investigated the metabolic footprint of metformin, a drug associated with improved post-MI LV function in experimental studies. Participants were patients with ST-segment-elevated MI who were randomly assigned to receive metformin or placebo for 4 months. Blood samples were obtained on admission, 24 hours post-MI, and 4 months post-MI. A total of 233 metabolite measures were quantified using nuclear magnetic resonance spectrometry. LVEF and ISZ were assessed 4 months post-MI. Twenty-four hours post-MI measurements of high-density lipoprotein (HDL) triglycerides (HDL-TG) predicted LVEF (β=1.90 [95% confidence interval (CI), 0.82 to 2.98]; P=6.4×10-4) and ISZ (β=-0.41 [95% CI, -0.60 to -0.21]; P=3.2×10-5). In addition, 24 hours post-MI measurements of medium HDL-TG (β=-0.40 [95% CI, -0.60 to -0.20]; P=6.4×2×10-5), small HDL-TG (β=-0.34 [95% CI, -0.53 to -0.14]; P=7.3×10-4), and the triglyceride content of very large HDL (β=-0.38 [95% CI, -0.58 to -0.18]; P=2.7×10-4) were associated with ISZ. After the 4-month treatment, the phospholipid content of very large HDL was lower in metformin than in placebo-treated patients (28.89% versus 38.79%; P=7.5×10-5); alanine levels were higher in the metformin group (0.46 versus 0.44 mmol/L; P=2.4×10-4). HDL triglyceride concentrations predict post-MI LVEF and ISZ. Metformin increases alanine levels and reduces the phospholipid content in very large HDL particles. URL: https://clinicaltrials.gov/ct2/show/NCT01217307. Unique Identifier

  7. Spinal cord stimulation reduces ventricular arrhythmias during acute ischemia by attenuation of regional myocardial excitability.

    Science.gov (United States)

    Howard-Quijano, Kimberly; Takamiya, Tatsuo; Dale, Erica A; Kipke, Jasmine; Kubo, Yukiko; Grogan, Tristan; Afyouni, Andyshea; Shivkumar, Kalyanam; Mahajan, Aman

    2017-08-01

    Myocardial ischemia creates autonomic nervous system imbalance and can trigger cardiac arrhythmias. We hypothesized that neuromodulation by spinal cord stimulation (SCS) will attenuate local cardiac sympathoexcitation from ischemia-induced increases in afferent signaling, reduce ventricular arrhythmias, and improve myocardial function during acute ischemia. Yorkshire pigs ( n = 20) were randomized to SCS (50 Hz at 200-μs duration, current 90% motor threshold) or sham operation (sham) for 30 min before ischemia. A four-pole SCS lead was placed percutaneously in the epidural space (T 1 -T 4 ), and a 56-electrode mesh was placed over the heart for high-resolution electrophysiological recordings, including activation recovery intervals (ARIs), activation time, repolarization time, and dispersion of repolarization. Electrophysiological and hemodynamic measures were recorded at baseline, after SCS/sham, during acute ischemia (300-s coronary artery ligation), and throughout reperfusion. SCS 1 ) reduced sympathoexcitation-induced ARI and repolarization time shortening in the ischemic myocardium; 2 ) attenuated increases in the dispersion of repolarization; 3 ) reduced ventricular tachyarrythmias [nonsustained ventricular tachycardias: 24 events (3 sham animals) vs. 1 event (1 SCS animal), P spinal cord stimulation decreased sympathetic nerve activation regionally in ischemic myocardium with no effect on normal myocardium, demonstrating that the antiarrhythmic effects of spinal cord stimulation are likely due to attenuation of local sympathoexcitation in the ischemic myocardium and not changes in global myocardial electrophysiology. Copyright © 2017 the American Physiological Society.

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

    Directory of Open Access Journals (Sweden)

    Kai-Uwe Jarr

    2014-01-01

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

  9. Effect of paroxetine on left ventricular remodeling in an in vivo rat model of myocardial infarction.

    Science.gov (United States)

    Lassen, Thomas Ravn; Nielsen, Jan Møller; Johnsen, Jacob; Ringgaard, Steffen; Bøtker, Hans Erik; Kristiansen, Steen Buus

    2017-05-01

    Left ventricular (LV) remodeling following a myocardial infarction (MI) involves formation of reactive oxygen species (ROS). Paroxetine, a selective serotonin reuptake inhibitor, has an antioxidant effect in the vascular wall. We investigated whether paroxetine reduces myocardial ROS formation and LV remodeling following a MI. In a total of 32 Wistar rats, MI was induced by a 30-min ligation of the left anterior descending artery followed by 7- or 28-day reperfusion. During the 28 days of reperfusion, LV remodeling was evaluated by magnetic resonance imaging (MRI) and echocardiography (n = 20). After 28 days of reperfusion, the susceptibility to ventricular tachycardia was evaluated prior to sacrifice and histological assessment of myocyte cross-sectional area, fibrosis, and presence of myofibroblasts. Myocardial ROS formation was measured with dihydroethidium after 7 days of reperfusion in separate groups (n = 12). Diastolic LV volume, evaluated by MRI (417 ± 60 vs. 511 ± 64 µL, p paroxetine group than in controls. Furthermore, myocyte cross-sectional area was reduced in the paroxetine group compared with controls (277 ± 26 vs. 354 ± 23 mm(3), p paroxetine reduced the susceptibility to ventricular tachycardia (induced in 2/11 vs. 6/8 rats, p Paroxetine treatment following MI decreases LV remodeling and susceptibility to arrhythmias, probably by reducing ROS formation.

  10. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

    DEFF Research Database (Denmark)

    Saberniak, Jørg; Hasselberg, Nina E; Borgquist, Rasmus

    2014-01-01

    AIMS: Exercise increases risk of ventricular arrhythmia in subjects with arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed to investigate the impact of exercise on myocardial function in ARVC subjects. METHODS AND RESULTS: We included 110 subjects (age 42 ± 17 years), 65 ARVC...

  11. The effect of right ventricular pacing on myocardial oxidative metabolism and efficiency: relation with left ventricular dyssynchrony

    Energy Technology Data Exchange (ETDEWEB)

    Ukkonen, Heikki; Saraste, Antti; Koistinen, Juhani [Turku University Hospital, Department of Medicine, P.O. Box 52, Turku (Finland); Tops, Laurens; Bax, Jeroen [Leiden University Medical Center, Leiden (Netherlands); Naum, Alexander [University of Turku, Turku PET Centre, Turku (Finland); Knuuti, Juhani [University of Turku, Turku PET Centre, Turku (Finland); Turku University Hospital, Turku PET Centre, P.O. Box 52, Turku (Finland)

    2009-12-15

    Right ventricular (RV) apical pacing induces dyssynchrony by a left bundle branch block type electrical activation sequence in the heart and may impair left ventricular (LV) function. Whether these functional changes are accompanied by changes in myocardial perfusion, oxidative metabolism and efficiency, and the relation with the induction of LV dyssynchrony are unknown. Our study was designed to investigate the acute effects of RV pacing on these parameters. Ten patients with normal LV ejection fraction and VVI/DDD pacemaker were studied during AAI pacing/sinus rhythm without RV pacing (pacing-OFF) and with RV pacing (pacing-ON) at the same heart rate. Dynamic [{sup 15}O]water and [{sup 11}C]acetate positron emission tomography was used to measure perfusion and oxidative metabolism (k{sub mono}) of the LV. An echocardiographic examination was used to assess LV stroke volume (SV) and LV dyssynchrony. Myocardial efficiency of forward work was calculated as systolic blood pressure x cardiac output/LV mass/k{sub mono}. RV pacing decreased SV in all subjects (mean decrease 13%, from 76 {+-} 7 to 66 {+-} 7 ml, p = 0.004), but global perfusion and k{sub mono} were unchanged. The efficiency tended to be lower with pacing-ON (70 {+-} 20 vs 81 {+-} 21 mmHg l/g, p = 0.066). In patients with dyssynchrony during pacing (n = 6) efficiency decreased by 23% (from 78 {+-} 25 to 60 {+-} 14 mmHg l/g, p = 0.02), but in patients without dyssynchrony no change in efficiency was detected. Accordingly, heterogeneity in myocardial perfusion and oxidative metabolism was detected during pacing in patients with dyssynchrony but not in those without dyssynchrony. RV pacing resulted in a significant decrease in SV. However, deleterious effects on LV oxidative metabolism and efficiency were observed only in patients with dyssynchrony during RV pacing. (orig.)

  12. Predictors of left ventricular remodeling after ST-elevation myocardial infarction.

    Science.gov (United States)

    Hendriks, Tom; Hartman, Minke H T; Vlaar, Pieter J J; Prakken, Niek H J; van der Ende, Yldau M Y; Lexis, Chris P H; van Veldhuisen, Dirk J; van der Horst, Iwan C C; Lipsic, Erik; Nijveldt, Robin; van der Harst, Pim

    2017-09-01

    Adverse left ventricular (LV) remodeling after acute ST-elevation myocardial infarction (STEMI) is associated with morbidity and mortality. We studied clinical, biochemical and angiographic determinants of LV end diastolic volume index (LVEDVi), end systolic volume index (LVESVi) and mass index (LVMi) as global LV remodeling parameters 4 months after STEMI, as well as end diastolic wall thickness (EDWT) and end systolic wall thickness (ESWT) of the non-infarcted myocardium, as compensatory remote LV remodeling parameters. Data was collected in 271 patients participating in the GIPS-III trial, presenting with a first STEMI. Laboratory measures were collected at baseline, 2 weeks, and 6-8 weeks. Cardiovascular magnetic resonance imaging (CMR) was performed 4 months after STEMI. Linear regression analyses were performed to determine predictors. At baseline, patients were 21% female, median age was 58 years. At 4 months, mean LV ejection fraction (LVEF) was 54 ± 9%, mean infarct size was 9.0 ± 7.9% of LVM. Strongest univariate predictors (all p infarcted myocardium.

  13. Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: A pilot study.

    Science.gov (United States)

    Gerbaud, Edouard; Montaudon, Michel; Chasseriaud, Warren; Gilbert, Stephen; Cochet, Hubert; Pucheu, Yann; Horovitz, Alice; Bonnet, Jacques; Douard, Hervé; Coste, Pierre

    2014-01-01

    Heart rate is a major determinant of myocardial oxygen demand; in ST-segment elevation myocardial infarction (STEMI), patients treated with primary percutaneous intervention (PPCI), heart rate at discharge correlates with mortality. Ivabradine is a pure heart rate-reducing agent that has no effect on blood pressure and contractility, and can reverse left ventricular (LV) remodelling in patients with heart failure. To evaluate whether ivabradine, when added to current guideline-based therapy, improves LV remodelling in STEMI patients treated with PPCI. This paired-cohort study included 124 patients between June 2011 and July 2012. Ivabradine (5mg twice daily) was given promptly after PPCI, along with beta-blockers, to obtain a heart rate<60 beats per minute (ivabradine group). This group was matched with STEMI patients treated in line with current guidelines, including beta-blockers (bisoprolol), according to age, sex, infarct-related coronary artery, ischaemia time and infarct size determined by initial cardiac magnetic resonance imaging (CMR) (control group). Statistical analyses were performed according to an intention-to-continue treatment principle. CMR data at 3 months were available for 122 patients. Heart rate was lower in the ivabradine group than in the control group during the initial CMR (P=0.02) and the follow-up CMR (P=0.006). At the follow-up CMR, there was a smaller increase in LV end-diastolic volume index in the ivabradine group than in the control group (P=0.04). LV end-systolic volume index remained unchanged in the ivabradine group, but increased in the control group (P=0.01). There was a significant improvement in LV ejection fraction in the ivabradine group compared with in the control group (P=0.04). In successfully reperfused STEMI patients, ivabradine may improve LV remodelling when added to current guideline-based therapy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  14. Prediction of Left Ventricular Remodeling after a Myocardial Infarction: Role of Myocardial Deformation: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Olivier Huttin

    Full Text Available Left ventricular (LV adverse or reverse remodeling after ST-segment elevation myocardial infarction (MI is the best outcome to assess the benefit of revascularization. Speckle tracking echocardiography (STE may accurately identify early deformation impairment, while also being predictive of LV remodeling during follow-up. This systematic analysis aimed to provide a comprehensive review of current findings on STE as a predictor of LV remodeling after MI.PubMed databases were searched through December 2014 to identify studies in adults targeting the association between LV remodeling and STE. Meta-regression was performed for longitudinal analysis.A total of 23 prospective studies (3066 patients were found eligible. Eleven studies reported an association between STE and adverse remodeling and twelve studies with reverse remodeling. Using peak systolic longitudinal strain, the most accurate cut-off to predict adverse remodeling and reverse remodeling ranged from -12.8% to -10.2% and from -13.7% to -9.5%, respectively. In smaller studies, assessment of circumferential strain and torsion showed additive value in predicting remodeling. Meta-regression analysis revealed that longitudinal STE was associated with adverse remodeling (pooled univariable OR = 1.27, 1.17-1.38, p<0.001; pooled multivariable OR = 1.38, 1.13-1.70, p = 0.002 while pooled ORs of longitudinal STE only tended to predict reverse remodeling (pooled OR = 0.75, 0.54-1.06, p = 0.09.This systematic review suggests that STE is associated with changes in LV volume or function regardless of underlying mechanisms and deformation direction. Meta-regression demonstrates a strong association between peak longitudinal systolic strain and adverse remodeling. Added STE predictive value over other clinical, biological and imaging variables remains to be proven.

  15. Blockade of KCa3.1 Attenuates Left Ventricular Remodeling after Experimental Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Chen-Hui Ju

    2015-07-01

    Full Text Available Background/Aims: After myocardial infarction (MI, cardiac fibrosis greatly contributes to left ventricular remodeling and heart failure. The intermediate-conductance calcium-activated potassium Channel (KCa3.1 has been recently proposed as an attractive target of fibrosis. The present study aimed to detect the effects of KCa3.1 blockade on ventricular remodeling following MI and its potential mechanisms. Methods: Myocardial expression of KCa3.1 was initially measured in a mouse MI model by Western blot and real time-polymerase chain reaction. Then after treatment with TRAM-34, a highly selective KCa3.1 blocker, heart function and fibrosis were evaluated by echocardiography, histology and immunohistochemistry. Furthermore, the role of KCa3.1 in neonatal mouse cardiac fibroblasts (CFs stimulated by angiotensin II (Ang II was tested. Results: Myocardium expressed high level of KCa3.1 after MI. Pharmacological blockade of KCa3.1 channel improved heart function and reduced ventricular dilation and fibrosis. Besides, a lower prevalence of myofibroblasts was found in TRAM-34 treatment group. In vitro studies KCa3.1 was up regulated in CFs induced by Ang II and suppressed by its blocker.KCa3.1 pharmacological blockade attenuated CFs proliferation, differentiation and profibrogenic genes expression and may regulating through AKT and ERK1/2 pathways. Conclusion: Blockade of KCa3.1 is able to attenuate ventricular remodeling after MI through inhibiting the pro-fibrotic effects of CFs.

  16. Relation of left ventricular free wall rupture and/or aneurysm with acute myocardial infarction in patients with aortic stenosis

    OpenAIRE

    Sheikh, Irtiza N.; Roberts, William C.

    2017-01-01

    This minireview describes 6 previously reported patients with left ventricular free wall rupture and/or aneurysm complicating acute myocardial infarction (AMI) in patients with aortic stenosis. The findings suggest that left ventricular rupture and/or aneurysm is more frequent in patients with AMI associated with aortic stenosis than in patients with AMI unassociated with aortic stenosis, presumably because of retained elevation of the left ventricular peak systolic pressure after the appeara...

  17. Cine MR imaging after myocardial infarction--assessment and follow-up of regional and global left ventricular function.

    Science.gov (United States)

    Sandstede, J J; Lipke, C; Kenn, W; Beer, M; Pabst, T; Hahn, D

    1999-12-01

    Myocardial infarction often leads to regional wall motion defects and in case of large defects to remodeling of the left ventricle. With this study, changes in regional and global myocardial function of 12 patients 3 weeks after myocardial infarction and after revascularization therapy were determined using MRI. Cine MRI was performed at study entry at rest and during low-dose dobutamine stimulation. All patients were re-examined at rest 3 and 6 months after the revascularization, including analysis of wall thickening and of left ventricular end-diastolic volume index (LVEDVI), end-systolic volume index (LVESVI), ejection fraction (LVEF), and mass index. After revascularization. 6 patients with stress-induced improvement of regional wall thickening recovered, 4 patients without improvement did not, but 2 patients without stress-induced improvement of wall thickening also recovered. Concerning global cardiac function, patients with mainly improved regional wall motion also showed a lower LVESVI and a higher LVEF than patients without improvement of regional contractility 6 months after revascularization in comparison to study entry. In conclusion, improvement of global myocardial function after revascularization is higher in patients with improved contractility in the infarcted region. The extent of the response of regions with wall motion defects to dobutamine stress correlates with the actual improvement after revascularization, and, therefore, dobutamine stress MRI may be helpful in selecting patients that will have a higher benefit from a revascularization therapy.

  18. Myocyte necrosis underlies progressive myocardial dystrophy in mouse dsg2-related arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Pilichou, Kalliopi; Remme, Carol Ann; Basso, Cristina; Campian, Maria E; Rizzo, Stefania; Barnett, Phil; Scicluna, Brendon P; Bauce, Barbara; van den Hoff, Maurice J B; de Bakker, Jacques M T; Tan, Hanno L; Valente, Marialuisa; Nava, Andrea; Wilde, Arthur A M; Moorman, Antoon F M; Thiene, Gaetano; Bezzina, Connie R

    2009-08-03

    Mutations in the cardiac desmosomal protein desmoglein-2 (DSG2) are associated with arrhythmogenic right ventricular cardiomyopathy (ARVC). We studied the explanted heart of a proband carrying the DSG2-N266S mutation as well as transgenic mice (Tg-NS) with cardiac overexpression of the mouse equivalent of this mutation, N271S-dsg2, with the aim of investigating the pathophysiological mechanisms involved. Transgenic mice recapitulated the clinical features of ARVC, including sudden death at young age, spontaneous ventricular arrhythmias, cardiac dysfunction, and biventricular dilatation and aneurysms. Investigation of transgenic lines with different levels of transgene expression attested to a dose-dependent dominant-negative effect of the mutation. We demonstrate for the first time that myocyte necrosis is the key initiator of myocardial injury, triggering progressive myocardial damage, including an inflammatory response and massive calcification within the myocardium, followed by injury repair with fibrous tissue replacement, and myocardial atrophy. These observations were supported by findings in the explanted heart from the patient. Insight into mechanisms initiating myocardial damage in ARVC is a prerequisite to the future development of new therapies aimed at delaying onset or progression of the disease.

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

    Science.gov (United States)

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

    2016-10-01

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

  20. Left-right ventricular interactions in pediatric aortic stenosis: right ventricular myocardial strain before and after aortic valvuloplasty.

    Science.gov (United States)

    Friedberg, Mark K; Wu, Stephen; Slorach, Cameron

    2013-04-01

    Ventricular-ventricular interactions may affect left ventricular (LV) and right ventricular (RV) function but have not been well characterized in chronic LV afterload in children. The aim of this study was to assess RV myocardial strain in children with aortic stenosis before and after aortic balloon valvuloplasty. Two-dimensional echocardiographic images from children aged > 1 month were with aortic stenosis and preserved LV ejection fractions were retrospectively studied using vector velocity imaging. LV and RV strain were compared before and after balloon valvuloplasty and in comparison with normal controls. Twenty-six children were studied. Aortic valve gradient decreased after balloon valvuloplasty. LV ejection fraction, wall thickness, circumferential strain, and basal and mid longitudinal strain were unchanged after valvuloplasty (-18.09 ± 6.97% vs -16.43 ± 6.30%, P = .40, and -14.11 ± 5.011% vs -13.12 ± 5.52%, P = .50, respectively). LV strain tended to be lower than in controls after valvuloplasty (basal, -16.43 ± 6.30% vs -19.77 ± 5.82%, P = .05). RV strain was unchanged at the basal and apical segments but increased at the mid RV segment after valvuloplasty (-21.34 ± 6.55% vs -24.97 ± 8.54%, P = .02). Change in RV strain was not correlated with change in aortic gradient or change in LV strain after valvuloplasty (P = .60). LV and RV strain at baseline and their changes after valvuloplasty were variable between patients. RV strain was normal or reduced in compensated aortic stenosis and was not correlated with LV strain. The change in RV strain was variable among patients after valvuloplasty, with improvement in RV midwall longitudinal strain. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  1. Myocardial Performance Index for Patients with Overt and Subclinical Hypothyroidism.

    Science.gov (United States)

    Karabulut, Aziz; Doğan, Abdullah; Tuzcu, Alpaslan Kemal

    2017-05-25

    BACKGROUND Hypothyroid has several effects on the cardiovascular system. Global myocardial performance index (MPI) is used in assessment of both left ventricular (LV) systolic and diastolic function. We compared MPI in hypothyroidism patients vs. normal control subjects. MATERIAL AND METHODS Eighty-two hypothyroid patients were divided into 2 groups: a subclinical hypothyroid (SH) group (n=50), and an overt hypothyroid (OH) group (n=32). The healthy control group (CG) constituted of 37 patients. TSH, FT3, and FT4, anti-TPO, anti-TG, insulin, lipid values, and fasting glucose levels were studied. All patients underwent an echocardiographic examination. Myocardial performance indexes were assessed and standard echocardiographic examinations were investigated. RESULTS MPI averages in OH, SH, and control groups were 0.53±0.06, 0.51±0.05, and 0.44±0.75 mm, respectively. MPI was increased in the OH and SH groups in comparison to CG (p<0.001, p<0.001, respectively). CONCLUSIONS MPI value was significantly higher in hypothyroid patients in comparison to the control group, showing that regression in global left ventricular functions is an important echocardiographic finding. Future studies are required to determine the effects of this finding on long-term cardiovascular outcomes.

  2. Persistence of the prognostic importance of left ventricular systolic function and heart failure after myocardial infarction: 17-year follow-up of the TRACE register

    DEFF Research Database (Denmark)

    Kümler, Thomas; Gislason, Gunnar Hilmar; Køber, Lars

    2010-01-01

    Left ventricular systolic function and presence of heart failure (HF) are important prognostic factors and dictate future therapeutic strategies after myocardial infarction (MI). We evaluated persistence of the prognostic importance of left ventricular dysfunction and HF in consecutive MI patients...

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

    DEFF Research Database (Denmark)

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

    2000-01-01

    BACKGROUND: Arrhythmias cause much morbidity and mortality after myocardial infarction, but in previous trials, antiarrhythmic drug therapy has not been convincingly effective. Dofetilide, a new class III agent, was investigated for effects on all-cause mortality and morbidity in patients with left......-ventricular dysfunction after myocardial infarction. METHODS: In 37 Danish coronary-care units, 1510 patients with severe left-ventricular dysfunction (wall motion index ... vs seven of 56; p=0.002). There were seven cases of torsade de pointes ventricular tachycardia, all in the dofetilide group. INTERPRETATION: In patients with severe left-ventricular dysfunction and recent myocardial infarction, treatment with dofetilide did not affect all-cause mortality, cardiac...

  4. Post-myocardial infarction mortality in patients with ventricular premature depolarizations. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Pilot Study.

    Science.gov (United States)

    Cairns, J A; Connolly, S J; Gent, M; Roberts, R

    1991-08-01

    Among survivors of acute myocardial infarction, frequent and repetitive ventricular premature depolarizations (VPDs) detected on ambulatory monitoring contribute independently to the risk of all-cause mortality and sudden death. Apart from the beta-blockers, no antiarrhythmic drug has been reliably demonstrated to reduce mortality among patients with VPDs. A pilot study was undertaken to gather data to aid in the design of a multicenter trial of amiodarone for the reduction of mortality from cardiac arrhythmias in such patients. Seventy-seven patients with acute myocardial infarction within the previous 6-30 days and 10 or more VPDs/hr or one or more runs of ventricular tachycardia on 24-hour electrocardiographic recording were randomized in a double-blind fashion in a 2:1 amiodarone-to-placebo ratio. The loading dose was 10 mg/kg/day for 3 weeks. The maintenance dose was 300-400 mg/day with reductions at 4-month intervals in response to VPD suppression, excessive plasma levels, or toxicity. VPD suppression at 1 week and 2 weeks was 63% and 85%, respectively, on amiodarone and 17% and 27%, respectively, on placebo. Apart from thyroid-stimulating hormone elevation and skin reactions, no side effects occurred more frequently with amiodarone. The study drug was stopped for side effects or noncompliance in 35% of amiodarone patients and 34% of placebo patients. Patients were followed for a maximum of 2 years (mean, 20 months). Arrhythmic death or resuscitated ventricular fibrillation occurred in two of 48 amiodarone patients (6%) and four of 29 placebo patients (14%), whereas the rates of all-cause mortality were five of 48 (10%) and six of 29 (21%), respectively. Amiodarone, in moderate loading and maintenance dosages with adjustments in response to plasma levels, VPD suppression, and side effects, results in effective VPD suppression and acceptable levels of toxicity.

  5. Myocardial Integrated Backscatter in Obese Adolescents: Associations with Measures of Adiposity and Left Ventricular Deformation.

    Directory of Open Access Journals (Sweden)

    Lijian Xie

    Full Text Available Myocardial fibrosis has been proposed to play an important pathogenetic role in left ventricular (LV dysfunction in obesity. This study tested the hypothesis that calibrated integrated backscatter (cIB as a marker of myocardial fibrosis is altered in obese adolescents and explored its associations with adiposity, LV myocardial deformation, and metabolic parameters.Fifty-two obese adolescents and 38 non-obese controls were studied with conventional and speckle tracking echocardiography. The average cIB of ventricular septum and LV posterior wall was measured. In obese subjects, insulin resistance as estimated by homeostasis model assessment (HOMA-IR and glucose tolerance were determined. Compared with controls, obese subjects had significantly greater cIB of ventricular septum (-16.8±7.8 dB vs -23.2±7.8 dB, p<0.001, LV posterior wall (-20.5±5.6 dBvs -25.0±5.1 dB, p<0.001 and their average (-18.7±5.7 dB vs -24.1±5.0 dB, p<0.001. For myocardial deformation, obese subjects had significantly reduced LV longitudinal systolic strain rate (SR (p = 0.045 and early diastolic SR (p = 0.015, and LV circumferential systolic strain (p = 0.008, but greater LV longitudinal late diastolic SR (p<0.001, and radial early (p = 0.037 and late (p = 0.002 diastolic SR than controls. For the entire cohort, myocardial cIB correlated positively with body mass index (r = 0.45, p<0.001 and waist circumference (r = 0.45, p<0.001, but negatively with LV circumferential systolic strain (r = -0.23, p = 0.03 and systolic SR (r = -0.25, p = 0.016. Among obese subjects, cIB tended to correlate with HOMA-IR (r = 0.26, p = 0.07.Obese adolescents already exhibit evidence of increased myocardial fibrosis, which is associated with measures of adiposity and impaired LV circumferential myocardial deformation.

  6. Helical myofiber orientation after myocardial infarction and left ventricular surgical restoration in sheep.

    Science.gov (United States)

    Walker, Joseph C; Guccione, Julius M; Jiang, Yi; Zhang, Peng; Wallace, Arthur W; Hsu, Edward W; Ratcliffe, Mark B

    2005-02-01

    It has been proposed that successful left ventricular surgical restoration should restore normal helical myofiber orientation. A magnetic resonance imaging technique, magnetic resonance diffusion tensor imaging, has been developed to measure myocyte orientation. By using magnetic resonance diffusion tensor imaging, this study tested the hypothesis that (1) myocyte orientation is altered after anteroapical myocardial infarction and (2) left ventricular surgical restoration restores normal helix angles. Thirteen sheep underwent anteroapical myocardial infarction (25% of left ventricular mass). Ten weeks later, animals underwent either aneurysm plication (n = 8) or sham operations (n = 5). Six weeks after this operation, hearts were excised, perfusion fixed in diastole, and underwent magnetic resonance diffusion tensor imaging. Hearts from normal sheep (n = 5) were also harvested and imaged. Primary eigenvectors of the diffusion tensors from magnetic resonance diffusion tensor imaging were resolved into helix angles relative to a local wall coordinate system. Transmural samples of the helix angles were compared at the border zone of the aneurysm or repair (or a comparable distance from the base in normal sheep), 1 cm below the valves, and halfway between. The helical myofiber orientation did not change after myocardial infarction. However, aneurysm plication caused myofibers in the anterior border zone to rotate counterclockwise (-35.6 +/- 10.5 degrees , P = .028) and those in the lateral border zone to rotate clockwise (34.4 +/- 8.1 degrees , P = .031). Surgical restoration alters myocyte orientation adjacent to the surgical repair. However, myofiber orientation is not abnormal after myocardial infarction, and thus surgical restoration techniques intent on restoring normal helix angles might not be warranted.

  7. Fully automatic left ventricular myocardial strain estimation in 2D short-axis tagged magnetic resonance imaging

    Science.gov (United States)

    Morais, Pedro; Queirós, Sandro; Heyde, Brecht; Engvall, Jan; 'hooge, Jan D.; Vilaça, João L.

    2017-09-01

    Cardiovascular diseases are among the leading causes of death and frequently result in local myocardial dysfunction. Among the numerous imaging modalities available to detect these dysfunctional regions, cardiac deformation imaging through tagged magnetic resonance imaging (t-MRI) has been an attractive approach. Nevertheless, fully automatic analysis of these data sets is still challenging. In this work, we present a fully automatic framework to estimate left ventricular myocardial deformation from t-MRI. This strategy performs automatic myocardial segmentation based on B-spline explicit active surfaces, which are initialized using an annular model. A non-rigid image-registration technique is then used to assess myocardial deformation. Three experiments were set up to validate the proposed framework using a clinical database of 75 patients. First, automatic segmentation accuracy was evaluated by comparing against manual delineations at one specific cardiac phase. The proposed solution showed an average perpendicular distance error of 2.35  ±  1.21 mm and 2.27  ±  1.02 mm for the endo- and epicardium, respectively. Second, starting from either manual or automatic segmentation, myocardial tracking was performed and the resulting strain curves were compared. It is shown that the automatic segmentation adds negligible differences during the strain-estimation stage, corroborating its accuracy. Finally, segmental strain was compared with scar tissue extent determined by delay-enhanced MRI. The results proved that both strain components were able to distinguish between normal and infarct regions. Overall, the proposed framework was shown to be accurate, robust, and attractive for clinical practice, as it overcomes several limitations of a manual analysis.

  8. Fully automatic left ventricular myocardial strain estimation in 2D short-axis tagged magnetic resonance imaging.

    Science.gov (United States)

    Morais, Pedro; Queirós, Sandro; Heyde, Brecht; Engvall, Jan; 'hooge, Jan D; Vilaça, João L

    2017-08-07

    Cardiovascular diseases are among the leading causes of death and frequently result in local myocardial dysfunction. Among the numerous imaging modalities available to detect these dysfunctional regions, cardiac deformation imaging through tagged magnetic resonance imaging (t-MRI) has been an attractive approach. Nevertheless, fully automatic analysis of these data sets is still challenging. In this work, we present a fully automatic framework to estimate left ventricular myocardial deformation from t-MRI. This strategy performs automatic myocardial segmentation based on B-spline explicit active surfaces, which are initialized using an annular model. A non-rigid image-registration technique is then used to assess myocardial deformation. Three experiments were set up to validate the proposed framework using a clinical database of 75 patients. First, automatic segmentation accuracy was evaluated by comparing against manual delineations at one specific cardiac phase. The proposed solution showed an average perpendicular distance error of 2.35  ±  1.21 mm and 2.27  ±  1.02 mm for the endo- and epicardium, respectively. Second, starting from either manual or automatic segmentation, myocardial tracking was performed and the resulting strain curves were compared. It is shown that the automatic segmentation adds negligible differences during the strain-estimation stage, corroborating its accuracy. Finally, segmental strain was compared with scar tissue extent determined by delay-enhanced MRI. The results proved that both strain components were able to distinguish between normal and infarct regions. Overall, the proposed framework was shown to be accurate, robust, and attractive for clinical practice, as it overcomes several limitations of a manual analysis.

  9. Atorvastatin Improves Ventricular Remodeling after Myocardial Infarction by Interfering with Collagen Metabolism.

    Science.gov (United States)

    Reichert, Karla; Pereira do Carmo, Helison Rafael; Galluce Torina, Anali; Diógenes de Carvalho, Daniela; Carvalho Sposito, Andrei; de Souza Vilarinho, Karlos Alexandre; da Mota Silveira-Filho, Lindemberg; Martins de Oliveira, Pedro Paulo; Petrucci, Orlando

    2016-01-01

    Therapeutic strategies that modulate ventricular remodeling can be useful after acute myocardial infarction (MI). In particular, statins may exert effects on molecular pathways involved in collagen metabolism. The aim of this study was to determine whether treatment with atorvastatin for 4 weeks would lead to changes in collagen metabolism and ventricular remodeling in a rat model of MI. Male Wistar rats were used in this study. MI was induced in rats by ligation of the left anterior descending coronary artery (LAD). Animals were randomized into three groups, according to treatment: sham surgery without LAD ligation (sham group, n = 14), LAD ligation followed by 10mg atorvastatin/kg/day for 4 weeks (atorvastatin group, n = 24), or LAD ligation followed by saline solution for 4 weeks (control group, n = 27). After 4 weeks, hemodynamic characteristics were obtained by a pressure-volume catheter. Hearts were removed, and the left ventricles were subjected to histologic analysis of the extents of fibrosis and collagen deposition, as well as the myocyte cross-sectional area. Expression levels of mediators involved in collagen metabolism and inflammation were also assessed. End-diastolic volume, fibrotic content, and myocyte cross-sectional area were significantly reduced in the atorvastatin compared to the control group. Atorvastatin modulated expression levels of proteins related to collagen metabolism, including MMP1, TIMP1, COL I, PCPE, and SPARC, in remote infarct regions. Atorvastatin had anti-inflammatory effects, as indicated by lower expression levels of TLR4, IL-1, and NF-kB p50. Treatment with atorvastatin for 4 weeks was able to attenuate ventricular dysfunction, fibrosis, and left ventricular hypertrophy after MI in rats, perhaps in part through effects on collagen metabolism and inflammation. Atorvastatin may be useful for limiting ventricular remodeling after myocardial ischemic events.

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

    Science.gov (United States)

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

    2014-07-01

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

  11. Myocardial Production of Plasminogen Activator Inhibitor-1 is Associated with Coronary Endothelial and Ventricular Dysfunction after Acute Myocardial Infarction.

    Science.gov (United States)

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

    2016-05-02

    Although plasminogen activator inhibitor-1 (PAI-1) is abundantly expressed in infarcted myocardium, the pathogenic role of myocardial PAI-1 remains unknown. This study examined whether PAI-1 in the infarcted lesion contributes to coronary endothelial dysfunction and left ventricular (LV) dysfunction in patients with acute myocardial infarction (AMI). Plasma levels of PAI-1 activity and tissue-plasminogen activator (tPA) antigen were measured 2 weeks and 6 months after MI by ELISA in plasma obtained from the aortic root (AO) and anterior interventricular vein (AIV) in 28 patients with a first AMI due to occlusion of the left anterior descending coronary artery (LAD). Coronary blood flow responses in LAD to intracoronary infusion of acetylcholine (ACh) and left ventriculography were measured at the same time points: 2 weeks and 6 months after MI. The trans-myocardial gradient of PAI-1 from AO to AIV, reflecting production/release of PAI-1 in the infarcted lesion, was inversely correlated with the coronary blood flow response to ACh 6 months after MI (r=-0.43, p=0.02) and with the percentage change in LV regional motion in the LAD territory from 2 weeks to 6 months after MI (r=-0.38, p=0.04). The trans-myocardial gradient of tPA level showed no significant correlations. PAI-1 produced in the infarcted myocardium and released into the coronary circulation is associated with endothelial dysfunction in resistance vessels of the infarct-related coronary arteries and with progressive dysfunction of the infarcted region of the left ventricle in AMI survivors.

  12. Changes in overall ventricular myocardial architecture in the setting of a porcine animal model of right ventricular dilation

    DEFF Research Database (Denmark)

    Agger, Peter; Ilkjær, Christine; Laustsen, Christoffer

    2017-01-01

    , surgical suturing of its leaflets in seven piglets, performing sham operations in seven control animals. Using cardiovascular magnetic resonance imaging after 12 weeks of recovery, we demonstrated significantly increased right ventricular volumes in the test group. After sacrifice, diffusion tensor imaging...

  13. Aerobic interval training reduces inducible ventricular arrhythmias in diabetic mice after myocardial infarction.

    Science.gov (United States)

    Rolim, Natale; Skårdal, Kristine; Høydal, Morten; Sousa, Mirta M L; Malmo, Vegard; Kaurstad, Guri; Ingul, Charlotte B; Hansen, Harald E M; Alves, Marcia N; Thuen, Marte; Haraldseth, Olav; Brum, Patricia C; Slupphaug, Geir; Loennechen, Jan Pål; Stølen, Tomas; Wisløff, Ulrik

    2015-01-01

    Diabetes mellitus (DM) increases the risk of heart failure after myocardial infarction (MI), and aggravates ventricular arrhythmias in heart failure patients. Although exercise training improves cardiac function in heart failure, it is still unclear how it benefits the diabetic heart after MI. To study the effects of aerobic interval training on cardiac function, susceptibility to inducible ventricular arrhythmias and cardiomyocyte calcium handling in DM mice after MI (DM-MI). Male type 2 DM mice (C57BLKS/J Lepr (db) /Lepr (db) ) underwent MI or sham surgery. One group of DM-MI mice was submitted to aerobic interval training running sessions during 6 weeks. Cardiac function and structure were assessed by echocardiography and magnetic resonance imaging, respectively. Ventricular arrhythmias were induced by high-frequency cardiac pacing in vivo. Protein expression was measured by Western blot. DM-MI mice displayed increased susceptibility for inducible ventricular arrhythmias and impaired diastolic function when compared to wild type-MI, which was associated with disruption of cardiomyocyte calcium handling and increased calcium leak from the sarcoplasmic reticulum. High-intensity exercise recovered cardiomyocyte function in vitro, reduced sarcoplasmic reticulum diastolic calcium leak and significantly reduced the incidence of inducible ventricular arrhythmias in vivo in DM-MI mice. Exercise training also normalized the expression profile of key proteins involved in cardiomyocyte calcium handling, suggesting a potential molecular mechanism for the benefits of exercise in DM-MI mice. High-intensity aerobic exercise training recovers cardiomyocyte function and reduces inducible ventricular arrhythmias in infarcted diabetic mice.

  14. [Impact of chronic Chlamydia pneumoniae infection on left ventricular remodeling after myocardial infarction].

    Science.gov (United States)

    Marcinkowski, Marcin; Czarnecka, Danuta; Jastrzebski, Marek; Fedak, Danuta; Kawecka-Jaszcz, Kalina

    2006-01-01

    Postmyocardial infarction left ventricular remodeling is modified by inflammatory processes and structural changes in the myocardium. Chlamydia pneumoniae (Chp) causes chronic myocyte infection, affects apoptosis and TNF-alpha production, and may induce cross reactivity with alpha myosin. This is the way in which this intracellular pathogen may modulate remodeling on the cellular and organ level. The study was conducted in 101 patients with a first myocardial infarction in whom we evaluated the serological features of Chp infection using the ELISA method and echocardiographic left ventricular volume at 10 days and 10 weeks after the infarction. Patients with chronic Chp infection had a tendency toward higher end-diastolic volume at 10 weeks after the infarction (123 +/- 32.9 ml vs. 134 +/- 34.7 ml, p = 0.09). In order to better define this relationship we used ROC analysis and measured levels of antibodies: IgG = 117 EIU and IgA = 15.6 EIU by which we divided the patients into two subgroups. Those with IgG > or = 117 EIU and IgA > or = 15.6 EIU belong to the subgroup with chronic and active Chp infection. These patients had larger left ventricular end-diastolic volumes (155.8 vs. 123.1 ml, p = 0.0005) and end-systolic volumes (77.4 vs. 59.5 ml, p = 0.006) at 10 weeks after the infarction. Both subgroups were similar with respect to age, gender, history of arterial hypertension, systolic and diastolic blood pressure values, infarct site, reperfusion, infarct size, left ventricular ejection fraction and left ventricular contractility index. Type of reperfusion therapy and pharmacological treatment at 10 days and at 10 weeks did not differ, either. Chronic Chlamydia pneumonie infection modifies the course of left ventricular remodeling.

  15. Case of right ventricular infarction identified by sup(99m)Tc-PYP myocardial imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Akiyoshi; Nakai, Kenji; Matsushita, Kazuo (Iwate Medical Coll., Morioka (Japan). School of Medicine)

    1982-06-01

    A case of 53-year-old-man with myocardial infarction accompanied by right ventricular infarction assessed by Tc-99m-PYP scintiscan was reported. Patient was admitted to our clinic because of sudden chest pain and Adames-Stokes attack. At the time of admission he was pre-shock state and cold sweating was markedly noted in the lower extremities. ECG revealed complete A-V block with ST elevation in II, III, aV sub(F). Chest X-ray film showed cardiomegaly and lung congestion. CVP was high (22 cm H/sub 2/O) and cardiac output was low (2.4 L/min). Marked elevation of SGOT, LDH and CPK was also noted. After administration of 20 mCi of Tc-99m-PYP, myocardial scintiscan revealed a positive accumulation, which continued for 80 days, in accordant with anterior portion of the right ventricle. From these findings, right ventricular infarction was clinicaly suspected. Combined therapy with dopamine (10 ..gamma../kg/min) and vasodilator and blood transfusion was effective in this patient. At the 60th day after admission, this patient had been recovered: Thallium-201 myocardial scintigraphy showed a perfusion defect in the inferior region. Total obstruction of RCA and diffuse stenosis of LAD were observed on CAG. Akinesis of inferoposterior region was found in the left ventriculogram. Tc-99m-PYP scintiscan in acute phase was a useful method in detecting of right ventricular infarction. Continued of positive accumulation of Tc-99m-PYP scintiscan suggested a possibility of aneurysmal formation of the right ventricle.

  16. Multimodality cardiac imaging of a ventricular septal rupture post myocardial infarction: a case report

    Directory of Open Access Journals (Sweden)

    Dhaliwal Surinder

    2012-10-01

    Full Text Available Abstract Background Ventricular septal rupture (VSR, a mechanical complication following an acute myocardial infarction (MI, is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional transthoracic echocardiography (TTE with color flow Doppler and cardiac MRI (CMR are reliable tests for the non-invasive diagnosis of VSR. Case presentation A 62-year-old Caucasian female presented with a late case of a VSR post inferior MI diagnosed by multimodality cardiac imaging including TTE, CMR and ventriculography. Conclusion We review the presentation, diagnosis and management of VSR post MI.

  17. Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression.

    Science.gov (United States)

    Dobson, Laura Elizabeth; Musa, Tarique A; Uddin, Akhlaque; Fairbairn, Timothy A; Swoboda, Peter P; Erhayiem, Bara; Foley, James; Garg, Pankaj; Haaf, Philip; Fent, Graham J; Malkin, Christopher J; Blackman, Daniel J; Plein, Sven; Greenwood, John P

    2016-12-01

    Despite the wealth of data showing the positive effects on cardiac reverse remodelling in the long-term, the immediate effects of transcatheter aortic valve implantation (TAVI) on the left ventricle are yet to be comprehensively described using cardiovascular magnetic resonance imaging. Also, the link between myocardial fibrosis and acute left ventricular (LV) mass regression is unknown. Fifty-seven patients with severe aortic stenosis awaiting TAVI underwent paired cardiovascular magnetic resonance scans before and early after the procedure (4 [interquartile range, 3-5] days). LV mass, volume, and function were measured. Late gadolinium enhancement (LGE) imaging was performed to assess for the presence of and pattern of myocardial fibrosis. After the procedure, 53 (95%) patients experienced an immediate (10.1 ± 7.1%) reduction in indexed LV mass (LVMi) from 76 ± 15.5 to 68.4 ± 14.7 g/m(2) (P reverse remodelling occurs immediately after TAVI, with significant LV mass regression in the total population and an improvement in LVEF in those with preexisting LV impairment. Those without myocardial fibrosis at baseline experience greater LV mass regression than those with fibrosis. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    to be particularly attributable to an increased incidence of post-infarction congestive heart failure. A relationship between glucose metabolism and LV function could potentially explain this excess mortality. METHODS: In patients without known diabetes, glucose metabolism was determined using an oral glucose......OBJECTIVES: We studied the influence of abnormal glucose metabolism on left ventricular (LV) function and prognosis in 203 patients with acute myocardial infarction. BACKGROUND: Abnormal glucose metabolism is associated with increased mortality after acute myocardial infarction. This appears...... atrial volume index) and by measuring plasma N-terminal pro-B-type natriuretic peptide levels. RESULTS: After adjustment for age and gender, a linear relationship between the degree of abnormal glucose metabolism was observed for each marker of LV dysfunction (p(trend)

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

    DEFF Research Database (Denmark)

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

    2003-01-01

    BACKGROUND: Angiotensin-converting-enzyme (ACE) inhibitors such as captopril reduce mortality and cardiovascular morbidity among patients with myocardial infarction complicated by left ventricular systolic dysfunction, heart failure, or both. In a double-blind trial, we compared the effect...... of the angiotensin-receptor blocker valsartan, the ACE inhibitor captopril, and the combination of the two on mortality in this population of patients. METHODS: Patients receiving conventional therapy were randomly assigned, 0.5 to 10 days after acute myocardial infarction, to additional therapy with valsartan (4909...... (Prenal dysfunction were more common in the valsartan group, and cough, rash, and taste disturbance were more common in the captopril group. CONCLUSIONS: Valsartan is as effective...

  20. Noninvasive risk stratification of lethal ventricular arrhythmias and sudden cardiac death after myocardial infarction

    Directory of Open Access Journals (Sweden)

    Kenji Yodogawa, MD

    2014-08-01

    Full Text Available Prediction of lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important and challenging problems after myocardial infarction (MI. Identification of MI patients who are prone to ventricular tachyarrhythmias allows for an indication of implantable cardioverter-defibrillator placement. To date, noninvasive techniques such as microvolt T-wave alternans (MTWA, signal-averaged electrocardiography (SAECG, heart rate variability (HRV, and heart rate turbulence (HRT have been developed for this purpose. MTWA is an indicator of repolarization abnormality and is currently the most promising risk-stratification tool for predicting malignant ventricular arrhythmias. Similarly, late potentials detected by SAECG are indices of depolarization abnormality and are useful in risk stratification. However, the role of SAECG is limited because of its low predictive accuracy. Abnormal HRV and HRT patterns reflect autonomic disturbances, which may increase the risk of lethal ventricular arrhythmias, but the existing evidence is insufficient. Further studies of noninvasive assessment may provide a new insight into risk stratification in post-MI patients.

  1. Three-dimensional Speckle Tracking Echocardiography in Light Chain Cardiac Amyloidosis: Examination of Left and Right Ventricular Myocardial Mechanics Parameters.

    Science.gov (United States)

    Urbano-Moral, Jose Angel; Gangadharamurthy, Dakshin; Comenzo, Raymond L; Pandian, Natesa G; Patel, Ayan R

    2015-08-01

    The study of myocardial mechanics has a potential role in the detection of cardiac involvement in patients with amyloidosis. This study aimed to characterize 3-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics in light chain amyloidosis and examine their relationship with brain natriuretic peptide. In patients with light chain amyloidosis, left ventricular longitudinal and circumferential strain (n=40), and right ventricular longitudinal strain and radial displacement (n=26) were obtained by 3-dimensional-speckle tracking echocardiography. Brain natriuretic peptide levels were determined. All myocardial mechanics measurements showed differences when compared by brain natriuretic peptide level tertiles. Left and right ventricular longitudinal strain were highly correlated (r=0.95, P<.001). Left ventricular longitudinal and circumferential strain were reduced in patients with cardiac involvement (-9±4 vs -16±2; P<.001, and -24±6 vs -29±4; P=.01, respectively), with the most prominent impairment at the basal segments. Right ventricular longitudinal strain and radial displacement were diminished in patients with cardiac involvement (-9±3 vs -17±3; P<.001, and 2.7±0.8 vs 3.8±0.3; P=.002). On multivariate analysis, left ventricular longitudinal strain was associated with the presence of cardiac involvement (odds ratio = 1.6; 95% confidence interval, 1.04 to 2.37; P=.03) independent of the presence of brain natriuretic peptide and troponin I criteria for cardiac amyloidosis. Three-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics are increasingly altered as brain natriuretic peptide increases in light chain amyloidosis. There appears to be a strong association between left ventricular longitudinal strain and cardiac involvement, beyond biomarkers such as brain natriuretic peptide and troponin I. Copyright © 2015 Sociedad Española de Cardiología. Published by

  2. Bidirectional ventricular tachycardia with myocardial infarction: a case report with insight on mechanism and treatment.

    Science.gov (United States)

    Wase, Abdul; Masood, Abdul-Mannan; Garikipati, Naga V; Mufti, Omar; Kabir, Anwarul

    2014-01-01

    Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,(1) numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence of digoxin toxicity. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  3. 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)

  4. Ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, cardiogenic shock, and death in a patient with acute ST elevation myocardial infarction during transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    Osama A El Kady

    2017-01-01

    Full Text Available The incidence of mechanical complications related to myocardial infarction has decreased due to various factors over the last few decades. Patients admitted for acute ST segment elevation myocardial infarction (STEMI may respond well to thrombolytic therapy before being taken up for coronary angiography and percutaneous coronary intervention depending on the facilities available at the specific center. Unfortunately, some patients develop complications of myocardial infarction during hospital stay or postdischarge. We present a patient admitted with acute STEMI responding well to thrombolytic therapy. During transthoracic echocardiography of the patient in Intensive Care Unit, the patient developed ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, and cardiogenic shock and expired.

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

    Directory of Open Access Journals (Sweden)

    Xiao-Rui Xie

    2016-12-01

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

  6. Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Engstrøm, Thomas; Glinge, Charlotte

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this ca...... associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias....

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

    Science.gov (United States)

    Colonna, P; Iliceto, S

    2000-02-01

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

  8. β-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction

    OpenAIRE

    Dondo, TB; Hall, M.; West, R.; Jernberg, T.; Lindahl, B; Bueno, H; Danchin, N.; Deanfield, JE; Hemingway, H.; Fox, KAA; Timmis, AD; Gale, CP

    2017-01-01

    BACKGROUND: For acute myocardial infarction (AMI) without heart failure (HF), it is unclear if β-blockers are associated with reduced mortality.OBJECTIVES: The goal of this study was to determine the association between β-blocker use and mortality in patients with AMI without HF or left ventricular systolic dysfunction (LVSD).METHODS: This cohort study used national English and Welsh registry data from the Myocardial Ischaemia National Audit Project. A total of 179,810 survivors of hospitaliz...

  9. Lack of association between serum syndecan-4, myocardial fibrosis and ventricular dysfunction in subjects with chronic Chagas disease.

    Science.gov (United States)

    Larocca, Ticiana Ferreira; Macêdo, Carolina Thé; Noya-Rabelo, Márcia; Lemos Correia, Luís Cláudio; Moreira, Moisés Imbassahy; Caldas, Alessandra Carvalho; Torreão, Jorge Andion; Souza, Bruno Solano de Freitas; Vasconcelos, Juliana Fraga; Carvalho da Silva, Alexandre Schaer; Ribeiro Dos Santos, Ricardo; Soares, Milena Botelho Pereira

    2017-01-01

    Syndecan-4 is a transmembrane glycoprotein associated with inflammation and fibrosis. Increased syndecan-4 levels were previously detected after acute myocardial infarction and in subjects with heart failure. However, the levels of syndecan-4 in subjects with Chagas disease have not so far been investigated. The aim of this study was to investigate the potential role of serum sydencan-4 as a novel biomarker for myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease. This study comprised subjects with Chagas disease (n = 56), being 14 (25%) with the indeterminate form, 16 (29%) with the cardiac form without ventricular dysfunction, and 26 (46%) with the cardiac form with ventricular dysfunction. Syndecan-4 serum concentrations did not correlate with presence or absence of myocardial fibrosis (P = 0.386) nor disease severity in subjects with Chagas disease (P = 0.918). Additionally, no correlation was found either between the degree of myocardial fibrosis and serum syndecan-4 [r = 0.08; P = 0.567] or between left ventricular ejection fraction and syndecan-4 [r = 0.02; P = 0.864]. In contrast, NT-proBNP levels correlated with ejection fraction and myocardial fibrosis. Our results demonstrate the lack of correlations between serum syndecan-4, myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease. Further studies are required to show if syndecan-4 concentrations can be marker for prognosis assessment or disease progression.

  10. [Occupational stress as a factor of left ventricular myocardial remodeling in people with normal arterial pressure].

    Science.gov (United States)

    Sorokin, A V; Prazdnov, A S; Korovina, O V

    2007-01-01

    The authors studied correlations between occupational stress, caused by high tension at work, and disturbances in 24-hour arterial pressure (AP), lipid level, and left ventricular (LM) myocardial remodeling in locomotive engineers with normal AP. Two hundred and five locomotive engineers with NAP (according to 2004 classification by Russian Scientific Society of Cardiologists) aged 20 to 45 years were included in this cross-sectional study; the subjects present a whole sample of the locomotive crew of Chelyabinsk railway station. The control group consisted of III persons working eight fixed working hours a day whose work was not associated with high tension (turners and metalworkers). The examination of the both groups included bifunctional 24-hour AP and ECG monitoring during the subjects'days off, Echo CG, measurement of blood lipids, and measurement of table salt sensitivity threshold. Also evaluated were the prevalence of horizontal and vertical family background of arterial hypertension, excessive body weight, hypokinesia, and smoking. The study demonstrated that the prevalence of the chief factors of chronic non-infectious diseases as well as the values of office and 24-hour systolic and diastolic arterial pressure (SAD; DAD) were the same in both groups. At the same time, the locomotive engineers with normal AP had unfavorable hemodynamic AP profile (24-hour SAD index (p = 0.008) was lower indicating insufficient SAD decrease at night; the speed of morning SAD and DAD increase was elevated 1.5 to 2 times; heart rate was higher as well) which can be considered signs of hypersympathicotonia. By comparison with the controls, the locomotive engineers had more pronounced morphofunctional changes in the left ventricular (LV), myocardium; LV mass was greater, and LV myocardial hypertrophy was more frequent in this group (17.9 and 1.8%, respectively). The data demonstrate the contribution of occupational stress-related non-hemodynamic factors to myocardial

  11. QRS-ST-T triangulation with repolarization shortening as a precursor of sustained ventricular tachycardia during acute myocardial ischemia.

    Science.gov (United States)

    Batchvarov, Velislav N; Behr, Elijah R

    2015-04-01

    We present segments from a 24-hour 12-lead digital Holter recording in a 48-year-old man demonstrating transient ST elevations in the inferior leads that triggered sustained ventricular tachycardia/ventricular fibrillation (VT/VF) requiring cardioversion. The onset of VT was preceded by a gradual increase in the ST with marked QRS broadening that lacked distinction between the end of the QRS and the beginning of the ST (QRS-ST-T "triangulation"), and shortening of the QT interval not caused by an increased heart rate. This is a relatively rare documentation of the mechanisms immediately triggering sustained ventricular arrhythmias during acute myocardial ischemia obtained with 12-lead ECG.

  12. Noninvasive prediction of sudden death and sustained ventricular tachycardia after acute myocardial infarction using a neural network algorithm.

    Science.gov (United States)

    Zoni-Berisso, M; Molini, D; Viani, S; Mela, G S; Delfino, L

    2001-08-01

    The early and accurate noninvasive identification of postinfarction patients at risk of sudden death and sustained ventricular tachycardia (arrhythmic events) still remains an unsolved problem. The aim of the present study was to identify the combination of clinical and laboratory noninvasive variables, easy to obtain in most patients, that best predicts the occurrence of arrhythmic events after an acute myocardial infarction. Four hundred and four consecutive patients with acute myocardial infarction were enrolled and followed for a median period of 21.4 months. In each patient, 61 clinical and laboratory noninvasive variables were collected before hospital discharge and used for the prediction of arrhythmic events using an artificial neural network. During follow-up, 13 (3.2%) patients died suddenly and 11(2.5%) had sustained ventricular tachycardia. The neural network showed that the combination best predicting arrhythmic events included: left ventricular failure during coronary care stay, ventricular dyskinesis, late potentials, number of ventricular premature depolarizations/hour, nonsustained ventricular tachycardia, left ventricular ejection fraction, bundle branch block and digoxin therapy at discharge. The neural network algorithm allowed identification of a small high-risk patient subgroup (12% of the study population) with an arrhythmic event rate of 46%. The sensitivity and specificity of the test were 96 and 93% respectively. These results suggest that, in postinfarction patients, it is possible to predict early and accurately arrhythmic events by noninvasive variables easily obtainable in most patients. Patients identified as being at risk are candidates for prophylactic antiarrhythmic therapy.

  13. Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Veen, Berlinda J. van der; Younis, Imad Al [Leiden University Medical Centre, Department of Nuclear Medicine, Leiden (Netherlands); Ajmone-Marsan, Nina; Bax, Jeroen J. [Leiden University Medical Centre, Department of Cardiology, Leiden (Netherlands); Westenberg, Jos J.M.; Roos, Albert de [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Stokkel, Marcel P.M. [Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam (Netherlands)

    2012-03-15

    Left ventricular dyssynchrony may predict response to cardiac resynchronization therapy and may well predict adverse cardiac events. Recently, a geometrical approach for dyssynchrony analysis of myocardial perfusion scintigraphy (MPS) was introduced. In this study the feasibility of this geometrical method to detect dyssynchrony was assessed in a population with a normal MPS and in patients with documented ventricular dyssynchrony. For the normal population 80 patients (40 men and 40 women) with normal perfusion (summed stress score {<=}2 and summed rest score {<=}2) and function (left ventricular ejection fraction 55-80%) on MPS were selected; 24 heart failure patients with proven dyssynchrony on MRI were selected for comparison. All patients underwent a 2-day stress/rest MPS protocol. Perfusion, function and dyssynchrony parameters were obtained by the Corridor4DM software package (Version 6.1). For the normal population time to peak motion was 42.8 {+-} 5.1% RR cycle, SD of time to peak motion was 3.5 {+-} 1.4% RR cycle and bandwidth was 18.2 {+-} 6.0% RR cycle. No significant gender-related differences or differences between rest and post-stress acquisition were found for the dyssynchrony parameters. Discrepancies between the normal and abnormal populations were most profound for the mean wall motion (p value <0.001), SD of time to peak motion (p value <0.001) and bandwidth (p value <0.001). It is feasible to quantify ventricular dyssynchrony in MPS using the geometrical approach as implemented by Corridor4DM. (orig.)

  14. Myocardial Extracellular Volume Is not Associated With Malignant Ventricular Arrhythmias in High-risk Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Mirelis, Jesús G; Sánchez-González, Javier; Zorio, Esther; Ripoll-Vera, Tomas; Salguero-Bodes, Rafael; Filgueiras-Rama, David; González-López, Esther; Gallego-Delgado, María; Fernández-Jiménez, Rodrigo; Soleto, María Jesús; Núñez, Juana; Pizarro, Gonzalo; Sanz, Javier; Fuster, Valentín; García-Pavía, Pablo; Ibáñez, Borja

    2017-03-21

    Myocardial interstitial fibrosis, a hallmark of hypertrophic cardiomyopathy (HCM), has been proposed as an arrhythmic substrate. Fibrosis is associated with increased extracellular volume (ECV), which can be quantified by computed tomography (CT). We aimed to analyze the association between CT-determined ECV and malignant ventricular arrhythmias. A retrospective case-control observational study was conducted in HCM patients with implantable cardioverter-defibrillator, undergoing a CT-protocol with continuous iodine contrast infusion to determine equilibrium ECV. Left ventricular septal and lateral CT-determined ECV was compared between prespecified cases (malignant arrhythmia any time before CT scan) and controls (no prior malignant arrhythmias) and among ECV tertiles. A total of 78 implantable cardioverter-defibrillator HCM patients were included; 24 were women, with a mean age of 52.1 ± 15.6 years. Mean ECV ± standard deviation in the septal left ventricular wall and was 29.8% ± 6.3% in cases (n = 24) vs 31.9% ± 8.5% in controls (n = 54); P = .282. Mean ECV in the lateral wall was 24.5% ± 6.8% in cases vs 28.2% ± 7.4% in controls; P = .043. On comparison of the entire population according to septal ECV tertiles, no significant differences were found in the number of patients receiving appropriate shocks. Conversely, we found a trend (P = .056) for a higher number of patients receiving appropriate shocks in the lateral ECV lowest tertile. Extracellular volume was not increased in implantable cardioverter-defibrillator HCM patients with malignant ventricular arrhythmias vs those without arrhythmias. Our findings do not support the use of ECV (a surrogate of diffuse fibrosis) as a predictor of arrhythmias in high-risk HCM patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Postinfarction left ventricular free wall rupture repaired successfully.

    Science.gov (United States)

    Tireli, Emin; Kalko, Yusuf; Kafali, Eylül; Basaran, Murat

    2002-09-01

    Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and a frequent cause of death. A 49-year-old man was successfully treated for a left ventricular free wall rupture that occurred on the third day after an anterior myocardial infarction. Concomitant myocardial revascularization was performed.

  16. Positron emission tomographic evaluation of regulation of myocardial perfusion in physiological (elite athletes) and pathological (systemic hypertension) left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Meyer, Christian; Wachtell, Kristian

    2005-01-01

    Myocardial perfusion (MP) may differ in physiologic and pathologic left ventricular hypertrophy (LVH). We compared MP in LVH in elite athletes and patients with hypertension with healthy, age-matched subjects. We included 12 rowers with LVH, 19 patients with hypertension with LVH, and 2 age...

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

    DEFF Research Database (Denmark)

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

    2005-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Yue-Xin Jiang

    2015-01-01

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

  19. Myocardial Steatosis and Left Ventricular Function in Type 2 Diabetes Mellitus : Assessed with Magnetic Resonance Imaging and Spectroscopy

    NARCIS (Netherlands)

    Meer, Rutger Wouter van der

    2008-01-01

    The aim of the thesis was to provide more insight into the influence of myocardial steatosis on left ventricular function in healthy volunteers and in patients with type 2 diabetes mellitus. Therefore we developed a reproducible proton magnetic resonance (MR) spectroscopic technique with respiratory

  20. An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction : the VALIANT registry

    NARCIS (Netherlands)

    Velazquez, EJ; Francis, GS; Armstrong, PW; Aylward, PE; Diaz, R; O'Connor, CM; White, HD; Henis, M; Rittenhouse, LM; Kilaru, R; van Gilst, W; Ertl, G; Maggioni, AP; Spac, J; Weaver, WD; Rouleau, JL; McMurray, JJV; Pfeffer, MA; Califf, RM

    2004-01-01

    Aims We analysed the contemporary incidence, outcomes, and predictors of heart failure (HF) and/or left ventricular systolic dysfunction (LVSD) before discharge in patients with acute myocardial infarction (MI). The baseline presence of HF or LVSD, or its development during hospitalisation,

  1. LATE POTENTIALS IN A PORCINE MODEL OF ANTERIOR WALL MYOCARDIAL-INFARCTION AND THEIR RELATION TO INDUCIBLE VENTRICULAR-TACHYCARDIA

    NARCIS (Netherlands)

    TOBE, TJM; DELANGEN, CDJ; MOOK, PH; TIO, RA; BEL, KJ; DEGRAEFF, PA; VANGILST, WH; WESSELING, H

    1992-01-01

    In this study, normal values for signal averaged electrocardiographic parameters were assessed in healthy pigs (n = 100) and the development of late potentials after myocardial infarction (n = 41) in relation to inducible ventricular tachycardia was investigated. Normal values are: filtered QRS

  2. Xenon and isoflurane reduce left ventricular remodeling after myocardial infarction in the rat.

    Science.gov (United States)

    Roehl, Anna B; Funcke, Sandra; Becker, Michael M; Goetzenich, Andreas; Bleilevens, Christian; Rossaint, Rolf; Steendijk, Paul; Hein, Marc

    2013-06-01

    Xenon and isoflurane are known to have cardioprotective properties. We tested the hypothesis that these anesthetics positively influence myocardial remodeling 28 days after experimental perioperative myocardial infarction and compared their effects. A total of 60 male Sprague-Dawley rats were subjected to 60 min of coronary artery occlusion and 120 min of reperfusion. Prior to ischemia, the animals were randomized for the different narcotic regimes (0.6 vol% isoflurane, 70 vol% xenon, or intraperitoneal injection of s-ketamine). Acute injury was quantified by echocardiography and troponin I. After 4 weeks, left ventricular function was assessed by conductance catheter to quantify hemodynamic compromise. Cardiac remodeling was characterized by quantification of dilatation, hypertrophy, fibrosis, capillary density, apoptosis, and expression of fetal genes (α/β myosin heavy chains, α-skeletal actin, periostin, and sarco/endoplasmic reticulum Ca2+-ATPase). Whereas xenon and isoflurane impeded the acute effects of ischemia-reperfusion on hemodynamics and myocardial injury at a comparable level, differences were found after 4 weeks. Xenon in contrast to isoflurane or ketamine anesthetized animals demonstrated a lower remodeling index (0.7 ± 0.1 vs. 0.9 ± 0.3 and 1.0 ± 0.3g/ml), better ejection fraction (62 ± 9 vs. 49 ± 7 and 35 ± 6%), and reduced expression of β-myosin heavy chain and periostin. The effects on hypertrophy, fibrosis, capillary density, and apoptosis were comparable. Compared to isoflurane and s-ketamine, xenon limited progressive adverse cardiac remodeling and contractile dysfunction 28 days after perioperative myocardial infarction.

  3. The Assessment of left ventricular Function in MRI using the detection of myocardial borders and optical flow approaches: A Review

    Directory of Open Access Journals (Sweden)

    Narjes Benameur

    2017-08-01

    Full Text Available The evaluation of left ventricular wall motion in Magnetic Resonance Imaging (MRI clinical practice is based on a visual assessment of cine-MRI sequences. In fact, clinical interpreters (radiologists proceed with a global visual evaluation of multiple cine-MRI sequences acquired in the three standard views. In addition, some functional parameters are quantified following a manual or a semi-automatic contouring of the myocardial borders. Although these parameters give information about the functional state of the left ventricle, they are not able to provide the location and the extent of wall motion abnormalities, which are associated with many cardiovascular diseases. In the past years, several approaches were developed to overcome the limitations of the classical evaluation techniques of left ventricular function. The aim of this article is to present an overview of the different methods and to summarize the relevant techniques based on myocardial contour detection and optical flow for regional assessment of left ventricular abnormalities.

  4. The Fetal Modified Myocardial Performance Index: Is Automation the Future?

    Directory of Open Access Journals (Sweden)

    Priya Maheshwari

    2015-01-01

    Full Text Available The fetal modified myocardial performance index (Mod-MPI is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1 a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2 cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3 ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.

  5. Assessment of left ventricular myocardial scar in coronary artery disease by a three-dimensional MR imaging technique.

    Science.gov (United States)

    Yin, Gang; Zhao, Shihua; Lu, Minjie; Ma, Ning; Zuehlsdorff, Sven; Cheng, Huaibing; Jiang, Shiliang; Zhao, Tao; Zhang, Yan; An, Jing; Lv, Chuanjian; He, Zuoxiang

    2013-07-01

    To evaluate the feasibility of free-breathing three-dimensional (3D) phase sensitive inversion recovery (PSIR) Turbo FLASH late gadolinium enhancement (LGE) magnetic resonance images (MRI) on left ventricular scar in patients with coronary artery disease (CAD) compared with clinically established breathhold two-dimensional (2D) PSIR Turbo FLASH images. In 58 consecutive patients with confirmed CAD, LGE MRI using the two sequences have been acquired. Image quality was graded on a four-point scale according to the image appearance. Qualitative evaluation including the distribution area and the transmural extent of the scar based on the American Heart Association's (AHA's) 17-segment model was performed in both of 2D and 3D images. The scar volumes were compared quantitatively between 2D and 3D images. A total of 51 individuals were used for final statistical analysis. No differences were noted in image quality (P = 0.80), scar distribution area (P = 0.17), and scar transmural extent (P = 0.20) between 3D and 2D images. There was strong correlation in scar volume between the 3D and 2D results (r = 0.940; P trend toward a larger scar volume identified by 3D method was indicated through Bland-Altman analysis. Free-breathing 3D PSIR Turbo FLASH imaging is another feasible method to identify left ventricular myocardial scar in patients with CAD and detects more scar volume compared with breathhold 2D PSIR Turbo FLASH imaging. Copyright © 2012 Wiley Periodicals, Inc.

  6. Measurement of left ventricular chamber and myocardial volume in hypertrophic cardiomyopathy patients by ECG-gated myocardial perfusion SPECT. Application of a newly developed edge-detection algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Yoshihiro; Katafuchi, Tetsuro; Hirase, Yoshinori; Sagoh, Masayoshi; Oka, Hisashi [National Cardiovascular Center, Suita, Osaka (Japan); Mori, Hideaki [Siemens-Asahi Medical Technologies, Ltd., Tokyo (Japan); Murase, Kenya [Osaka Univ., Suita (Japan). Medical School

    2002-12-01

    Quantitative gated SPECT (QGS) software has been reported to demonstrate inaccurate edge detection in the left ventricular chamber in hypertrophic cardiomyopathy patients. In this study we developed a method to calculate left ventricular volume (LVV) and left myocardial volume (LMV) from gated SPECT data using a newly developed edge-detection algorithm, and we compared it with the QGS method of calculating LVV and LMV in a phantom study. Our method gave more accurate measurements LVV and LMV whereas the QGS method underestimated LMV. Compared with QGS LVV and LMV, our method yielded better results in the phantom study. (author)

  7. Role of circulating angiotensin converting enzyme 2 in left ventricular remodeling following myocardial infarction: a prospective controlled study.

    Directory of Open Access Journals (Sweden)

    José T Ortiz-Pérez

    Full Text Available Angiotensin-converting enzyme 2 (ACE2 cleaves Angiotensin-II to Angiotensin-(1-7, a cardioprotective peptide. Serum soluble ACE2 (sACE2 activity is raised in chronic heart failure, suggesting a compensatory role in left ventricular dysfunction. Our aim was to study the relationship between sACE2 activity, infarct size, left ventricular systolic function and remodeling following ST-elevation myocardial infarction (STEMI. A contrast-enhanced cardiac magnetic resonance study was performed acutely in 95 patients with first STEMI and repeated at 6 months to measure LV end-diastolic volume index, ejection fraction and infarct size. Baseline sACE2 activities, measured by fluorescent enzymatic assay 24 to 48 hours and at 7 days from admission, were compared to that obtained in 22 matched controls. Patients showed higher sACE2 at baseline than controls (104.4 [87.4-134.8] vs 74.9 [62.8-87.5] RFU/µl/hr, p<0.001. At seven days, sACE2 activity significantly increased from baseline (115.5 [92.9-168.6] RFU/µl/hr, p<0.01. An inverse correlation between sACE2 activity with acute and follow-up ejection fraction was observed (r = -0.519, p<0.001; r = -0.453, p = 0.001, respectively. Additionally, sACE2 directly correlated with infarct size (r = 0.373, p<0.001. Both, infarct size (β = -0.470 [95%CI:-0.691:-0.248], p<0.001 and sACE2 at 7 days (β = -0.025 [95%CI:-0.048:-0.002], p = 0.030 were independent predictors of follow-up ejection fraction. Patients with sACE2 in the upper tertile had a 4.4 fold increase in the incidence of adverse left ventricular remodeling (95% confidence interval: 1.3 to 15.2, p = 0.027. In conclusion, serum sACE2 activity rises in relation to infarct size, left ventricular systolic dysfunction and is associated with the occurrence of left ventricular remodeling.

  8. Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases; Evaluation with gated blood pool scintigraphy using [sup 99m]Tc

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tomiro (Okayama Univ. (Japan). School of Medicine)

    1993-06-01

    Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author).

  9. Transmyocardial laser revascularization fails to prevent left ventricular functional deterioration and aneurysm formation after acute myocardial infarction in sheep.

    Science.gov (United States)

    Malekan, R; Kelley, S T; Suzuki, Y; Reynolds, C; Plappert, T; Sutton, M S; Edmunds, L H; Bridges, C R

    1998-11-01

    Transmyocardial laser revascularization is an investigational technique for revascularizing ischemic myocardium in patients with inoperable coronary arterial disease. This study tests the hypothesis that laser revascularization prevents left ventricular functional deterioration and aneurysm formation after acute anteroapical myocardial infarction. An ultrasonic ascending aortic flow probe and snares around the distal left anterior descending and second diagonal coronary arteries were placed in 26 Dorsett hybrid sheep. Ten to 14 days later, snared arteries were occluded to produce an anteroapical infarction of 23% of left ventricular mass. Before infarction 14 animals had 34 +/- 4 transmyocardial perforations in the area of the anticipated infarction made with a carbon dioxide laser. Twelve animals served as controls. Hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained before, immediately after, and 2, 5, and 8 weeks after infarction. Eighteen sheep completed the protocol. All animals had large anteroapical left ventricular aneurysms with massive ventricular enlargement. Immediately after infarction the anterior wall became thinner and dyskinetic in all sheep. At 8 weeks aneurysmal size and shape were indistinguishable between groups. Two days after infarction, laser holes were filled with fibrin. At 5 and 8 weeks the infarct consisted of dense collagen, fibroblasts, scattered calcifications, myocyte fragments, neutrophils, macrophages, and no laser holes. There were no significant differences at any time between groups for cardiac pressures or output, ventricular volumes, ejection fraction, stroke work, and the stroke work-left ventricular end-diastolic pressure index. Transmyocardial laser perforations do not revascularize acute myocardial infarction in sheep.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  11. Myocardial infarction in a patient with left ventricular noncompaction: a case report

    Directory of Open Access Journals (Sweden)

    Toufan M

    2012-08-01

    Full Text Available Mehrnoush Toufan,1 Roya Shahvalizadeh,1 Majid Khalili21Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Azerbaijan National Academy of Sciences, Baku, AzerbaijanAbstract: We describe a 73-year-old male patient with left ventricular noncompaction (LVNC who was diagnosed with acute myocardial infarction (MI, three-vessel coronary artery disease, a fresh intraventricular thrombus, and mitral regurgitation. He was treated with full anticoagulant therapy, coronary artery bypass grafting, and mitral valve repair. This case adds to a small but growing literature showing association between LVNC and MI and/or coronary artery disease. We suggest that patients with LVNC could be considered at heightened risk for MI, and the two conditions might have a common genetic underpinning in some cases.Keywords: myocardium, development, cardiomyopathy, echocardiography

  12. Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction

    DEFF Research Database (Denmark)

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

    1999-01-01

    BACKGROUND: Left ventricular (LV) diastolic dysfunction contributes to signs and symptoms of clinical heart failure and may be related to prognosis in heart diseases. LV diastolic dysfunction is reported to be present in acute myocardial infarction (MI); however, little is known about the time....../restrictive. Patients with MI were observed for development of congestive heart failure (Killip class >I) during hospitalization and for death during 1-year follow-up, and these complications were related to LV diastolic function. LV diastolic dysfunction was present in the very early phase of acute MI, with signs......-hospital congestive heart failure and cardiac death during 12 months of follow-up. CONCLUSIONS: LV diastolic dysfunction is present in the very early phase of MI. LV remodeling and development of in-hospital congestive heart failure appear in patients with very early signs of LV diastolic dysfunction. Furthermore...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    IMS: Recurrent myocardial infarction (MI) is common after a first MI and is associated with increased morbidity and mortality. Predictors and prognosis of a recurrent MI with contemporary management are not well known. METHODS AND RESULTS: We assessed the predictors and prognostic impact of a first...... recurrent MI in 10,599 patients with left ventricular dysfunction, heart failure, or both following a first MI from the Valsartan in Acute Myocardial Infarction Trial (VALIANT) cohort. During a median follow-up of 27.4 months, 861 patients (9.6%) had a recurrent MI. The median time to recurrence was 136...

  14. Prevalence and predictors of ventricular remodeling after anterior myocardial infarction in the era of modern medical therapy.

    Science.gov (United States)

    Farah, Elaine; Cogni, Ana Lucia; Minicucci, Marcos F; Azevedo, Paula S; Okoshi, Katashi; Matsubara, Beatriz B; Zanati, Silméia G; Haggeman, Rodrigo; Paiva, Sergio A R; Zornoff, Leonardo A M

    2012-05-01

    The consequences of aggressive therapy following a myocardial infarction (MI) on ventricular remodeling are not well established. Thus, the objective of this study was to analyze the prevalence, clinical characteristics, and predictors of left ventricular remodeling in the era of modern medical therapy. Clinical characteristics and echocardiographic data were analyzed in 66 consecutive patients with anterior infarction at admission and at 6-month follow-up. Ventricular remodeling was defined as an increase of 10% in ventricular end-systolic or end-diastolic diameter. In our study, 58% of patients presented with ventricular remodeling. Patients with remodeling possessed higher total plasma creatine kinase (CPK), MB-fraction (CPK-MB), heart rate, heart failure, shortness of breath, and reperfusion therapy than patients without remodeling. In contrast, patients with remodeling had a smaller ejection fraction, E-Wave deceleration time (EDT), and early (E' Wave) and late (A' Wave) diastolic mitral annulus velocity (average of septal and lateral walls), but a higher E/E' than patients without remodeling. Patients with remodeling used more diuretics, digoxin, oral anticoagulants and aldosterone antagonists than patients without remodeling. In the multivariate analyses, only E' Wave was an independent predictor of ventricular remodeling. Each 1 unit increase in the E' Wave was associated with a 59% increased odds of ventricular remodeling. In patients with anterior MI, despite contemporary treatment, ventricular remodeling is still a common event. In addition, diastolic function can have an important role as a predictor of remodeling in this scenario.

  15. Repeated sauna therapy attenuates ventricular remodeling after myocardial infarction in rats by increasing coronary vascularity of noninfarcted myocardium.

    Science.gov (United States)

    Sobajima, Mitsuo; Nozawa, Takashi; Shida, Takuya; Ohori, Takashi; Suzuki, Takayuki; Matsuki, Akira; Inoue, Hiroshi

    2011-08-01

    Repeated sauna therapy (ST) increases endothelial nitric oxide synthase (eNOS) activity and improves cardiac function in heart failure as well as peripheral blood flow in ischemic limbs. The present study investigates whether ST can increase coronary vascularity and thus attenuate cardiac remodeling after myocardial infarction (MI). We induced MI by ligating the left coronary artery of Wistar rats. The rats were placed in a far-infrared dry sauna at 41°C for 15 min and then at 34°C for 20 min once daily for 4 wk. Cardiac hemodynamic, histopathological, and gene analyses were performed. Despite the similar sizes of MI between the ST and non-ST groups (51.4 ± 0.3 vs. 51.1 ± 0.2%), ST reduced left ventricular (LV) end-diastolic (9.7 ± 0.4 vs. 10.7 ± 0.5 mm, P myocardial atrial natriuretic peptide mRNA levels. Vascular density was reduced in the noninfarcted myocardium of non-ST rats, and the density of cells positive for CD31 and for α-smooth muscle actin was decreased. These decreases were attenuated in ST rats compared with non-ST rats and associated with increases in myocardial eNOS and vascular endothelial growth factor mRNA levels. In conclusion, ST attenuates cardiac remodeling after MI, at least in part, through improving coronary vascularity in the noninfarcted myocardium. Repeated ST might serve as a novel noninvasive therapy for patients with MI.

  16. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and Ventricular Enlargement.

    Science.gov (United States)

    Mitchell, G F; Moyé, L A; Braunwald, E; Rouleau, J L; Bernstein, V; Geltman, E M; Flaker, G C; Pfeffer, M A

    1997-12-16

    There is increasing evidence of a link between conduit vessel stiffness and cardiovascular events, although the association has never been tested in a large post-myocardial infarction patient population. We evaluated the relationship between baseline pulse pressure, measured by sphygmomanometry 3 to 16 days after myocardial infarction, and subsequent adverse clinical events in the 2231 patients enrolled in the SAVE Trial. Increased pulse pressure was associated with increased age, left ventricular ejection fraction, female sex, history of prior infarction, diabetes, and hypertension and use of digoxin and calcium channel blockers. Over a 42-month period, there were 503 deaths, 422 cardiovascular deaths, and 303 myocardial infarctions. Pulse pressure was significantly related to each of these end points as a univariate predictor. In a multivariate analysis, pulse pressure remained a significant predictor of total mortality (relative risk, 1.08 per 10 mm Hg increment in pulse pressure; 95% CI, 1.00 to 1.17; Pmyocardial infarction (relative risk, 1.12; 95% CI, 1.01 to 1.23; Pmyocardial infarction, diabetes, or hypertension; and treatment with beta-blockers, calcium channel blockers, digoxin, aspirin, or thrombolytic therapy. These data provide strong evidence for a link between pulse pressure, which is related to conduit vessel stiffness, and subsequent cardiovascular events after myocardial infarction in patients with left ventricular dysfunction.

  17. Left ventricular remodeling in swine after myocardial infarction: a transcriptional genomics approach.

    Science.gov (United States)

    Kuster, Diederik W D; Merkus, Daphne; Kremer, Andreas; van Ijcken, Wilfred F J; de Beer, Vincent J; Verhoeven, Adrie J M; Duncker, Dirk J

    2011-11-01

    Despite the apparent appropriateness of left ventricular (LV) remodeling following myocardial infarction (MI), it poses an independent risk factor for development of heart failure. There is a paucity of studies into the molecular mechanisms of LV remodeling in large animal species. We took an unbiased molecular approach to identify candidate transcription factors (TFs) mediating the genetic reprogramming involved in post-MI LV remodeling in swine. Left ventricular tissue was collected from remote, non-infarcted myocardium, 3 weeks after MI-induction or sham-surgery. Microarray analysis identified 285 upregulated and 278 downregulated genes (FDR two-fold (p two-fold. Five TFs were identified in both TFBS and protein/DNA array analyses, which showed matching changes for COUP-TFII and glucocorticoid receptor (GR) only. Treatment of swine with the GR antagonist mifepristone after MI reduced the post-MI increase in LV mass, but LV dilation remained unaffected. Thus, using an unbiased approach to study post-MI LV remodeling in a physiologically relevant large animal model, we identified COUP-TFII and GR as potential key mediators of post-MI remodeling.

  18. Effect of ramipril on the electrophysiological characteristics of ventricular myocardium after myocardial infarction in rabbits.

    Science.gov (United States)

    Zhong, Ya; Cao, Ping; Tong, Chuanfeng; Li, Xia

    2012-05-01

    The current study aims to explore the effect of ramipril on the occurrence of ventricular arrhythmias and its possible mechanism after myocardial infarction (MI) in rabbits. A total of 24 rabbits were divided into three groups: the sham operation group (SHAM), the MI group, and the ramipril group (RAM). All groups were subjected to thoracotomy under sterile conditions; the MI and RAM groups underwent ligation of the left anterior descending coronary artery. On the second day after surgery, the RAM group was given ramipril (1 mg/kg per day). The rabbits in each group were fed for 12 weeks. The monophasic action potentials of the epicardium, mid-myocardium and endocardium in each group were, respectively, recorded before the MI and at 12 weeks after the MI. Meanwhile, the episodes of ventricular tachycardia or fibrillation (VT/VF) induced by procedure stimulations were counted, and the changes in L-type Ca flux (Ica-L) were recorded by means of the whole-cell patch-clamp technique. The episodes of VT/VF were decreased in the RAM group after MI. At 12 weeks after MI, the transmural dispersion of repolarization (TDR) in the MI group was prolonged significantly compared with the SHAM and RAM groups. The density of Ica-L in the MI group was significantly lower than that any other group. Ramipril manifestly decreases the incidence of VT/VF after MI in rabbits, and the mechanism may be associated with its inhibitory effect on electrical remodeling after MI.

  19. Relationship between systolic myocardial velocity obtained by tissue Doppler imaging and left ventricular ejection fraction: systolic myocardial velocity predicts the degree of left ventricular dysfunction in heart failure.

    Science.gov (United States)

    Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Aygul, Nazif; Altunkeser, B Bulent; Zengin, Kadriye; Sizer, Murat

    2008-09-01

    This study was planned to research the relationship between systolic myocardial velocity (Sm) obtained by tissue Doppler imaging (TDI) and left ventricular ejection fraction (LVEF) measured according to conventional Simpson's method in healthy subjects and patients with heart failure (HF). Two hundred eight patients with HF whose LVEF < 50% (mean age 59 +/- 11 years) and 187 healthy subjects (mean age 57 +/- 11 years) were enrolled in this study. LVEF was measured and TDI recordings were obtained at the septal, lateral, inferior, and anterior of the mitral annulus, and Sm was measured. LV mean Sm was calculated. In patients with HF, a significant correlation was detected between LVEF and Sm (r = 0.71, P < 0.0001), while no relationship was found between these parameters in healthy subjects (r = 0.16, not significant). The cutoff value of Sm < 8 cm/s for identifying patients with LVEF between 30% and 49% had a sensitivity of 86%, a specificity of 93%, and a negative predictive value of 92%, and the cutoff value of Sm < 6.0 cm/s for identifying patients with LVEF < 30% had a sensitivity of 92%, a specificity of 84%, and a negative predictive value of 97%. The time required to calculate the LVEF was significantly longer than that of LV mean Sm (327 +/- 98 sec vs. 110 +/- 29 sec, P < 0.0001), and LVEF had higher inter- and intraobserver variability. LV mean Sm obtained by TDI, a parameter that is reproducible, easily obtained, reliable, and practical, can be used to evaluate LV systolic function in patients with HF.

  20. Right ventricular volumes and function in thalassemia major patients in the absence of myocardial iron overload

    Directory of Open Access Journals (Sweden)

    Porter John B

    2010-04-01

    Full Text Available Abstract Aim We aimed to define reference ranges for right ventricular (RV volumes, ejection fraction (EF in thalassemia major patients (TM without myocardial iron overload. Methods and results RV volumes, EF and mass were measured in 80 TM patients who had no myocardial iron overload (myocardial T2* > 20 ms by cardiovascular magnetic resonance. All patients were receiving deferoxamine chelation and none had evidence of pulmonary hypertension or other cardiovascular comorbidity. Forty age and sex matched healthy non-anemic volunteers acted as controls. The mean RV EF was higher in TM patients than controls (males 66.2 ± 4.1% vs 61.6 ± 6%, p = 0.0009; females 66.3 ± 5.1% vs 62.6 ± 6.4%, p = 0.017, which yielded a raised lower threshold of normality for RV EF in TM patients (males 58.0% vs 50.0% and females 56.4% vs 50.1%. RV end-diastolic volume index was higher in male TM patients (mean 98.1 ± 17.3 mL vs 88.4 ± 11.2 mL/m2, p = 0.027, with a higher upper limit (132 vs 110 mL/m2 but this difference was of borderline significance for females (mean 86.5 ± 13.6 mL vs 80.3 ± 12.8 mL/m2, p = 0.09, with upper limit of 113 vs 105 mL/m2. The cardiac index was raised in TM patients (males 4.8 ± 1.0 L/min vs 3.4 ± 0.7 L/min, p Conclusion The normal ranges for functional RV parameters in TM patients with no evidence of myocardial iron overload differ from healthy non-anemic controls. The new reference RV ranges are important for determining the functional effects of myocardial iron overload in TM patients.

  1. Premature Ventricular Contractions (PVCs Induced by Administration of Cilostazol after Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Lihua Zhong

    2013-02-01

    Full Text Available Cilostazol is a phosphodiesterase III inhibitor, which was approved by FDA (food and drug administration for intermittent claudication in 1999. What made it known to cardiologists is the Cilostazol for Restenosis Trial (CREST, in which cilostazol was shown to significantly lower binary restenosis rate. Here we reported one case of acquired premature ventricular contractions (PVCs during taking cilostazol. A 68-year-old male patient was diagnosed acute myocardial infarction and given percutaneous coronary intervention (PCI. It turned out there was thrombi in the distal right coronary artery. The patient was discharged taking cilostazol (100mg Bid together with aspirin and clopidogrel. On follow-up, there were PVCs coming up (more than 27000 beats in 24-hour electrocardiography and cilostazol was discontinued afterwards. After taking metoprolol (25 mg, Tid for one week, the PVCs were decreased significantly, 600 beats/24 hours. In our case, the PVCs are obviously related to cilostazol and probably the safety of cilostazol in patients having a history of myocardial infarction or malignant arrhythmias should be reevaluated.

  2. Influence of long-term arotinolol treatment on myocardial mechanics and ventricular myosin isoenzymes in spontaneously hypertensive rats.

    Science.gov (United States)

    Takeda, N; Ohkubo, T; Iwai, T; Tanamura, A; Nagano, M

    1990-01-01

    Alterations in myocardial mechanics and left ventricular myosin isoenzymes by long-term treatment of hypertension with arotinolol were examined in spontaneously hypertensive rats. Approximately 20 mg/kg/day arotinolol was administered to 22-week-old male spontaneously hypertensive rats for 8-10 weeks. There was no significant difference in systolic blood pressure between arotinolol-treated and untreated rats. However, ventricular weight tended to decrease in the arotinolol-treated group, although not significantly. There were no significant differences in isometric developed tension and dT/dtmax of isolated left ventricular papillary muscles between the arotinolol-treated and untreated groups. The left ventricular myosin isoenzyme pattern, on the other hand, obtained by pyrophosphate gel electrophoresis, showed a significant shift toward VM-1 as a result of long-term arotinolol treatment.

  3. The effect of intravenous digoxin on the occurrence of ventricular tachyarrhythmias in acute myocardial infarction in man.

    Science.gov (United States)

    Reicansky, I; Conradson, T B; Holmberg, S; Rydén, L; Waldenström, A; Wennerblom, B

    1976-06-01

    Patients with acute myocardial infarction were allocated to two groups according to a double blind-system of radomization. The patients (n = 18) in one of the groups received digoxin intravenously as an injection of 0.01 mg. per kilogram of body weight during 10 minutes. The patients in the other group (n = 15) received saline and served as controls. A continuous ECG record was obtained from each patient during 1 hour preceding the administration of digoxin or saline and was continued for 3 hours following the injection. No antiarrhythmic treatment was given during the time of the study. Based on the continuous ECG, calculations were made of the relative incidence of patients with different types of ventricular tachyarrhythmias during the period of observation as well as the percentage of arrhythmia-containing 1 minute intervals observed during this period. There was no statistical difference between the incidence of ventricular tachyarrhythmias in the two groups in the 1 hour period preceding drug injection. The administration of digoxin and saline did not change the incidence of ventricular tachyarrhythmias and there was also no statistically significant difference between the two groups as regards the incidence of patients showing different types of ventricular tachyarrhythmias during the 3 hour period following drug administration, Considering the 1-minute intervals, those without any ventricular premature contractions were less in the digoxin group (92 per cent) than in the saline group (88 per cent; p less than 0.001). Serum levels of digoxin at the end of the observation period were well above what is considered the minimum therapeutic level and in three patients the level approached or reached the toxic range. In these three patients there was still no increased incidence of ventricular tachyarrhythmias. It is concluded that patients with acute myocardial infarction complicated by incipient left ventricular failure do not show an increased sensitivity to an

  4. Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease - Comparison With Targeted Left Ventricular Myocardial Biopsy.

    Science.gov (United States)

    Kockova, Radka; Kacer, Petr; Pirk, Jan; Maly, Jiri; Sukupova, Lucie; Sikula, Viktor; Kotrc, Martin; Barciakova, Lucia; Honsova, Eva; Maly, Marek; Kautzner, Josef; Sedmera, David; Penicka, Martin

    2016-04-25

    The aim of our study was to investigate the relationship between the cardiac magnetic resonance (CMR)-derived native T1 relaxation time and myocardial extracellular volume (ECV) fraction and the extent of diffuse myocardial fibrosis (DMF) on targeted myocardial left ventricular (LV) biopsy. The study population consisted of 40 patients (age 63±8 years, 65% male) undergoing valve and/or ascending aorta surgery for severe aortic stenosis (77.5%), root dilatation (7.5%) or valve regurgitation (15%). The T1 relaxation time was assessed in the basal interventricular septum pre- and 10-min post-contrast administration using the modified Look-Locker Inversion recovery sequence prior to surgery. LV myocardial biopsy specimen was obtained during surgery from the basal interventricular septal segment matched with the T1 mapping assessment. The percentage of myocardial collagen was quantified using picrosirius red staining. The average percentage of myocardial collagen was 22.0±14.8%. Both native T1 relaxation time with cutoff value ≥1,010 ms (sensitivity=90%, specificity=73%, area under the curve=0.82) and ECV with cutoff value ≥0.32 (sensitivity=80%, specificity=90%, area under the curve=0.85) showed high accuracy to identify severe (>30%) DMF. The native T1 relaxation time showed significant correlation with LV mass (Pmarkers of DMF. (Circ J 2016; 80: 1202-1209).

  5. Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Tei, C

    2000-01-01

    Prospective assessment of a nongeometric Doppler-derived index of combined systolic and diastolic myocardial performance was performed in 64 patients with acute myocardial infarction (MI) within 1 hour after their arrival to the hospital and in 39 age-matched healthy subjects. The index is defined...

  6. Postoperative myocardial performance during glucose-induced hypophosphatemia

    DEFF Research Database (Denmark)

    Rasmussen, A; Buus, S; Hessov, I

    1985-01-01

    Long-lasting hypophosphatemia was previously found to diminish myocardial performance. The present study aimed to elucidate if postoperative glucose-induced hypophosphatemia is of importance for myocardial performance. Sixteen patients undergoing elective colonic or rectal surgery were given 100 g....... As the preload (central venous pressure) and the afterload (arterial pressure) similarly were unchanged by the glucose infusion, glucose-induced hypophosphatemia following elective surgery was judged to lack importance for the myocardial performance....

  7. Diosmin prevents left ventricular hypertrophy, adenosine triphosphatases dysfunction and electrolyte imbalance in experimentally induced myocardial infarcted rats.

    Science.gov (United States)

    Sabarimuthu, Sharmila Queenthy; Ponnian, Stanely Mainzen Prince; John, Babu

    2017-11-05

    Currently, there has been an increased interest globally to identify natural compounds that are pharmacologically potent and have low or no adverse effects for use in preventive medicine. Myocardial infarction is a vital pathological feature resulting in high levels of mortality and morbidity. Left ventricular hypertrophy (LVH), adenosine triphosphatases (ATPases) dysfunction and electrolyte imbalance play a vital role in the pathogenesis of myocardial infarction. This study aims to evaluate the preventive effects of diosmin on LVH, ATPases dysfunction and electrolyte imbalance in isoproterenol induced myocardial infarcted rats. Male albino Wistar rats were pretreated orally with diosmin (10mg/kg body weight) daily for a period of 10 days. After pretreatment, isoproterenol (100mg/kg body weight) was injected subcutaneously into the rats twice at an interval of 24h to induce myocardial infarction. Isoproterenol induced myocardial infarcted rats showed increased LVH, altered levels/ concentrations of serum cardiac troponin-T, heart ATPases, heart sodium ion, calcium ion and potassium ion, and increased myocardial infarct size. Pretreatment with diosmin revealed preventive effects on LVH, and all the above mentioned biochemical parameters evaluated in isoproterenol induced myocardial infarcted rats. The 2, 3, 5-triphenyl tetrazolium chloride staining on myocardial infarct size confirmed the prevention of myocardial infarction. Further, the 1, 1 diphenyl-2- picryl-hydrazyl (DPPH) radical in vitro study revealed a potent DPPH free radical scavenging action of diosmin. Thus, the observed effects of diosmin are due to its antihypertrophic and free radical scavenging activities in isoproterenol induced myocardial infarcted rats. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Low-Intensity Pulsed Ultrasound Enhances Angiogenesis and Ameliorates Left Ventricular Dysfunction in a Mouse Model of Acute Myocardial Infarction.

    Science.gov (United States)

    Shindo, Tomohiko; Ito, Kenta; Ogata, Tsuyoshi; Hatanaka, Kazuaki; Kurosawa, Ryo; Eguchi, Kumiko; Kagaya, Yuta; Hanawa, Kenichiro; Aizawa, Kentaro; Shiroto, Takashi; Kasukabe, Sachie; Miyata, Satoshi; Taki, Hirofumi; Hasegawa, Hideyuki; Kanai, Hiroshi; Shimokawa, Hiroaki

    2016-06-01

    Left ventricular (LV) remodeling after acute myocardial infarction still remains an important issue in cardiovascular medicine. We have recently demonstrated that low-intensity pulsed ultrasound (LIPUS) therapy improves myocardial ischemia in a pig model of chronic myocardial ischemia through enhanced myocardial angiogenesis. In the present study, we aimed to demonstrate whether LIPUS also ameliorates LV remodeling after acute myocardial infarction and if so, to elucidate the underlying molecular mechanisms involved in the beneficial effects of LIPUS. We examined the effects of LIPUS on LV remodeling in a mouse model of acute myocardial infarction, where the heart was treated with either LIPUS or no-LIPUS 3 times in the first week (days 1, 3, and 5). The LIPUS improved mortality and ameliorated post-myocardial infarction LV remodeling in mice. The LIPUS upregulated the expression of vascular endothelial growth factor, endothelial nitric oxide synthase, phosphorylated ERK, and phosphorylated Akt in the infarcted area early after acute myocardial infarction, leading to enhanced angiogenesis. Microarray analysis in cultured human endothelial cells showed that a total of 1050 genes, including those of the vascular endothelial growth factor signaling and focal adhesion pathways, were significantly altered by the LIPUS. Knockdown with small interfering RNA of either β1-integrin or caveolin-1, both of which are known to play key roles in mechanotransduction, suppressed the LIPUS-induced upregulation of vascular endothelial growth factor. Finally, in caveolin-1-deficient mice, the beneficial effects of LIPUS on mortality and post-myocardial infarction LV remodeling were absent. These results indicate that the LIPUS therapy ameliorates post-myocardial infarction LV remodeling in mice in vivo, for which mechanotransduction and its downstream pathways may be involved. © 2016 American Heart Association, Inc.

  9. Repair of postinfarct ventricular septal defect and total myocardial revascularization in a case of dextrocardia with situs inversus.

    Science.gov (United States)

    Kuthe, Sachin A; Mohite, Prashant N; Sarangi, Siddharth; Mathews, Sarin; Thingnam, Shyam K; Reddy, Sreenivas

    2011-01-01

    We report a case of an elderly man who suffered an acute myocardial infarction (MI) with the complication of a post-MI ventricular septal defect (VSD). Situs inversus with dextrocardia was diagnosed during the course of hospitalization. Total myocardial revascularization was achieved using saphenous vein conduits. The VSD was approached through the right ventricle and repaired with a polytetrafluoroethylene patch. Although several cases of coronary artery bypass grafting (CABG) in the presence of dextrocardia have been reported in the literature, this is the first case of repair of a post-MI VSD along with CABG.

  10. Incidence and outcomes of early left ventricular thrombus following ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

    Science.gov (United States)

    Khoury, Shafik; Carmon, Sarit; Margolis, Gilad; Keren, Gad; Shacham, Yacov

    2017-09-01

    Since the advent of primary percutaneous coronary intervention (PCI), studies have reported a declining incidence of left ventricular thrombus (LVT) following ST-elevation myocardial infarction (STEMI). We investigated the incidence and outcomes of early (pre-discharge) LVT in the contemporary era of PCI practice in a large cohort of STEMI patients. We retrospectively studied 2071 consecutive STEMI patients who underwent successful primary PCI. Screening echocardiography was performed within 24-48 h of admission. Patients with anterior STEMI were treated with intravenous heparin for 24-48 h until a first echocardiography test was performed. Patients with reduced ejection fraction (EF) ≤40% had a repeat test before hospital discharge (days 5-7). Heparin was continued in case of significant left ventricular dysfunction (EF < 35%) or apical akinesis or dyskinesis, until a second test ruled out LVT. LVT was diagnosed before hospital discharge in 31/2071 patients (1.5%), 28 of whom (90%) had anterior STEMI. Only 2/31 patients with LVT (6.5%) developed embolic events before discharge and 1/31 (3.2%) had an episode of upper gastrointestinal bleeding that required blood transfusion. There was no significant difference between the two groups regarding in-hospital STEMI-related complications, short- and long-term mortality. All LVTs resolved in subsequent echocardiograms within 6 months of discharge. We report a low incidence of early LVT following STEMI. Further studies are needed to assess the efficacy and safety of a limited in-hospital anticoagulation protocol in STEMI patients with reduced EF.

  11. Extracorporeal membrane oxygenation system as a bridge to reparative surgery in ventricular septal defect complicating acute inferoposterior myocardial infarction

    Science.gov (United States)

    Pascual, Isaac; Avanzas, Pablo; Hernandez-Vaquero, Daniel; Alvarez, Ruben; Díaz, Rocio; Díaz, Beatriz; Martín, María; Carro, Amelia; Muñiz, Guillermo; Silva, Jacobo; Moris, Cesar

    2017-01-01

    Post-infarction ventricular septal defect (VSD) is a rare but potentially lethal complication of acute myocardial infarction. Medical management is usually futile, so definitive surgery remains the treatment of choice but the risk surgery is very high and the optimal timing for surgery is still under debate. A 55-year-old man with no previous medical history attended the emergency-room for 12 h evolution of oppressive chest pain and strong anginal pain 7 days ago. On physical examination, blood pressure was 96/70 mmHg, pansystolic murmur over left sternal border without pulmonary crackles. An electrocardiogram revealed sinus rhythm 110 bpm, elevation ST and Q in inferior-posterior leads. Transthoracic echocardiogram showed inferoposterior akinesia, posterior-basal septal rupture (2 cm × 2 cm) with left-right shunt. Suspecting VSD in inferior-posterior acute myocardial infarction evolved, we performed emergency coronarography with 3-vessels disease and complete subacute occlusion of the mid segment of the right coronary artery. Left ventriculography demonstrated shunting of contrast from the left ventricule to the right ventricule. He was rejected for heart transplantation because of his age. Considering the high surgical risk to early surgery and his hemodynamic and clinical stability, delayed surgical treatment is decided, and 4 days after admission the patient suffered hemodynamic instability so venoarterial extracorporeal membrane oxygenation system (ECMO) is implanted as a bridge to reparative surgery. The 9th day after admission double bypass, interventricular defect repair with pericardial two-patch exclusion technique, and ECMO decannulation were performed. The patient’s postoperative course was free of complications and was discharged 10 days post VSD repair surgery. Follow-up 3-month later revealed the patient to be in good functional status and good image outcome with intact interventricular septal patch without shunt. ECMO as a bridge to reparative

  12. Guillain - Barre syndrome in a patient with acute myocardial infarction with ventricular septal defect repair treated with plasma exchange

    Directory of Open Access Journals (Sweden)

    Maitrey D Gajjar

    2015-01-01

    Full Text Available Guillain - Barre syndrome (GBS is an acute, frequently severe progressive illness of peripheral nervous system that is autoimmune in nature. GBS after myocardial infarction (MI with ventricular septal defect (VSD is uncommon with high mortality rate if not treated promptly. [1] We report a successful outcome of GBS post MI with VSD in a 60-year-old male patient who was on a ventilator treated successfully with therapeutic plasma exchange.

  13. Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention.

    Science.gov (United States)

    Andersson, Jonas; Mellberg, Caroline; Otten, Julia; Ryberg, Mats; Rinnström, Daniel; Larsson, Christel; Lindahl, Bernt; Hauksson, Jon; Johansson, Bengt; Olsson, Tommy

    2016-08-01

    Accumulation of myocardial triglycerides (MTG) is associated with impaired left ventricular (LV) remodelling and function in obese and diabetic subjects. The role of MTG accumulation in development of heart failure in this group of patients is unknown. Short-term studies suggest that diets that lead to weight loss could mobilize MTG, with a favourable effect on cardiac remodelling. In a 24-month, randomized, investigator-blinded study, we assessed the effect of two different diets and subsequent weight loss on cardiac function and MTG in postmenopausal women. Sixty-eight healthy postmenopausal women with body mass index [BMI] ≥27kg/m(2) were randomized to an ad libitum Palaeolithic diet (PD) or a Nordic Nutrition Recommendation (NNR) diet for 24months. Morphology, cardiac function, and MTG levels were measured using magnetic resonance (MR) scanning, including proton spectroscopy at baseline and 6 and 24months. Despite mean weight losses of 4.9 (1.0) kg (NNR) and 7.8 (1.1) kg (PD), the MTG content did not change over time (p=0.98 in the NNR and p=0.11 in the PD group at 24months). Reduced left ventricular mass was observed in both diet groups over 24months. Blood pressure was reduced at 6months, but returned to baseline levels at 24months. End diastolic volume, stroke volume, and cardiac output decreased over time. No differences between diet groups were observed. Diet intervention and moderate weight loss over 24months improved LV remodelling but did not alter MTG levels in overweight/obese postmenopausal women. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    Fosshaug, Linn E; Berge, Rolf K; Beitnes, Jan O; Berge, Kjetil; Vik, Hogne; Aukrust, Pål; Gullestad, Lars; Vinge, Leif E; Øie, Erik

    2011-12-29

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

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

    Directory of Open Access Journals (Sweden)

    Fosshaug Linn E

    2011-12-01

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

  16. Characterization of ventricular depolarization and repolarization changes in a porcine model of myocardial infarction.

    Science.gov (United States)

    Romero, Daniel; Ringborn, Michael; Demidova, Marina; Koul, Sasha; Laguna, Pablo; Platonov, Pyotr G; Pueyo, Esther

    2012-12-01

    In this study, several electrocardiogram (ECG)-derived indices corresponding to both ventricular depolarization and repolarization were evaluated during acute myocardial ischemia in an experimental model of myocardial infarction produced by 40 min coronary balloon inflation in 13 pigs. Significant changes were rapidly observed from minute 4 after the start of coronary occlusion, achieving their maximum values between 11 and 22 min for depolarization and between 9 and 12 min for repolarization indices, respectively. Subsequently, these maximum changes started to decrease during the latter part of the occlusion. Depolarization changes associated with the second half of the QRS complex showed a significant but inverse correlation with the myocardium at risk (MaR) estimated by scintigraphic images. The correlation between MaR and changes of the downward slope of the QRS complex, [Formula: see text], evaluated at the two more relevant peaks observed during the occlusion, was r = -0.75, p < 0.01 and r = -0.79, p < 0.01 for the positive and negative deflections observed in [Formula: see text], temporal evolution, respectively. Repolarization changes, analyzed by evaluation of ST segment elevation at the main observed positive peak, also showed negative, however non-significant correlation with MaR: r = -0.34, p = 0.28. Our results suggest that changes evaluated in the latter part of the depolarization, such as those described by [Formula: see text], which are influenced by R-wave amplitude, QRS width and ST level variations simultaneously, correlate better with the amount of ischemia than other indices evaluated in the earlier part of depolarization or during the ST segment.

  17. Survival after Left Ventricular Free Wall Rupture in an Elderly Woman with Acute Myocardial Infarction Treated Only Medically

    Directory of Open Access Journals (Sweden)

    Víctor Hugo Roa-Castro

    2012-01-01

    Full Text Available Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture, or slow and incomplete tear leading to a late rupture (subacute rupture. Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.

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

    DEFF Research Database (Denmark)

    McMurray, John; Køber, Lars; Robertson, Michele

    2005-01-01

    OBJECTIVES: Whether beta-blockers reduce atrial arrhythmias and, when added to an angiotensin-converting enzyme (ACE) inhibitor, ventricular arrhythmia is unknown. BACKGROUND: Ventricular and atrial arrhythmias are common after acute myocardial infarction (AMI) and are associated with a poor prog...

  19. Iron-Sensitive Cardiac Magnetic Resonance Imaging for Prediction of Ventricular Arrhythmia Risk in Patients With Chronic Myocardial Infarction: Early Evidence.

    Science.gov (United States)

    Cokic, Ivan; Kali, Avinash; Yang, Hsin-Jung; Yee, Raymond; Tang, Richard; Tighiouart, Mourad; Wang, Xunzhang; Jackman, Warren S; Chugh, Sumeet S; White, James A; Dharmakumar, Rohan

    2015-08-01

    Recent canines studies have shown that iron deposition within chronic myocardial infarction (CMI) influences the electric behavior of the heart. To date, the link between the iron deposition and malignant ventricular arrhythmias in humans with CMI is unknown. Patients with CMI (n=94) who underwent late-gadolinium-enhanced cardiac magnetic resonance imaging before implantable cardioverter-defibrillator implantation for primary and secondary preventions were retrospectively analyzed. The predictive values of hypointense cores (HIC) in balanced steady-state free precession images and conventional cardiac magnetic resonance imaging and ECG malignant ventricular arrhythmia parameters for the prediction of primary combined outcome (appropriate implantable cardioverter-defibrillator therapy, survived cardiac arrest, or sudden cardiac death) were studied. The use of HIC within CMI on balanced steady-state free precession as a marker of iron deposition was validated in a canine MI model (n=18). Nineteen patients met the study criteria with events occurring at a median of 249 (interquartile range of 540) days after implantable cardioverter-defibrillator placement. Of the 19 patients meeting the primary end point, 18 were classified as HIC+, whereas only 1 was HIC-. Among the cohort in whom the primary end point was not met, there were 28 HIC+ and 47 HIC- patients. Receiver operating characteristic curve analysis demonstrated an additive predictive value of HIC for malignant ventricular arrhythmias with an increased area under the curve of 0.87 when added to left ventricular ejection fraction (left ventricular ejection fraction alone, 0.68). Both cardiac magnetic resonance imaging and histological validation studies performed in canines demonstrated that HIC regions in balanced steady-state free precession images within CMI likely result from iron depositions. Hypointense cores within CMI on balanced steady-state free precession cardiac magnetic resonance imaging can be used

  20. Echocardiographic correlates of left ventricular filling pressures and acute cardio-renal syndrome in ST segment elevation myocardial infarction patients.

    Science.gov (United States)

    Flint, Nir; Kaufman, Natalia; Gal-Oz, Amir; Margolis, Gilad; Topilsky, Yan; Keren, Gad; Shacham, Yacov

    2017-02-01

    Increased transmitral flow velocity (E) to the early mitral annulus velocity (e') ratio (E/e'), signifying increased cardiac filling pressure, was previously found to be associated with deterioration of renal function in patients with congestive heart failure. No study, however, included patients with acute myocardial ischemia. We hypothesized that elevated E/e' ratio would be associated with an increased risk of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We conducted a retrospective study of 804 consecutive STEMI patients between June 2012 and December 2015 who underwent primary PCI and had a comprehensive echocardiographic examination performed within 72 h of hospital admission. Patients were stratified according to E/e' ratio above and ≤15, and assessed for AKI using the KDIGO criteria, defined as either a serum creatinine rise >0.3 mg/dl, or an increase in serum creatinine ≥1.5 times baseline. Patients with E/e' ratio >15 had lower left ventricular (LV) ejection fraction, higher systolic pulmonary artery pressures, as well as right atrial pressures, and demonstrated worse in-hospital outcomes. Patients with E/e' ratio >15 had more AKI complicating STEMI (27 vs. 7 %; p 15 was independently associated with AKI (OR = 1.87, 95 % CI 0.99-3.52; p = 0.05). Other variables associated with AKI included diabetes, LV ejection fraction, and glomerular filtration rate. Among STEMI patients undergoing primary PCI, the early E/e' ratio >15 was associated with increased risk for AKI.

  1. Influence of oxygen tension on myocardial performance. Evaluation by tissue Doppler imaging

    Directory of Open Access Journals (Sweden)

    Poulsen Steen

    2004-11-01

    Full Text Available Abstract Background Low O2 tension dilates coronary arteries and high O2 tension is a coronary vasoconstrictor but reports on O2-dependent effects on ventricular performance diverge. Yet oxygen supplementation remains first line treatment in cardiovascular disease. We hypothesized that hypoxia improves and hyperoxia worsens myocardial performance. Methods Seven male volunteers (mean age 38 ± 3 years were examined with echocardiography at respiratory equilibrium during: 1 normoxia (≈21% O2, 79% N2, 2 while inhaling a hypoxic gas mixture (≈11% O2, 89% N2, and 3 while inhaling 100% O2. Tissue Doppler recordings were acquired in the apical 4-chamber, 2-chamber, and long-axis views. Strain rate and tissue tracking displacement analyses were carried out in each segment of the 16-segment left ventricular model and in the basal, middle and apical portions of the right ventricle. Results Heart rate increased with hypoxia (68 ± 4 bpm at normoxia vs. 79 ± 5 bpm, P Conclusion Hypoxia improves and hyperoxia worsens systolic myocardial performance in healthy male volunteers. Tissue Doppler measures of diastolic function are unaffected by hypoxia/hyperoxia which support that the changes in myocardial performance are secondary to changes in vascular tone. It remains to be settled whether oxygen therapy to patients with heart disease is a consistent rational treatment.

  2. Evaluation of right atrial function by two-dimensional speckle-tracking echocardiography in patients with right ventricular myocardial infarction.

    Science.gov (United States)

    Nourian, Saeed; Hosseinsabet, Ali; Jalali, Arash; Mohseni-Badalabadi, Reza

    2017-01-01

    Right ventricular myocardial infarction (RVMI) damages the systolic and diastolic functions of the RV, so the right atrium interacts with the RV with an acutely altered function. The aim of our study was to compare right atrial function as evaluated by 2D speckle-tracking echocardiography (2DSTE) between patients with inferior wall myocardial infarction (INFMI) and patients affected by both inferior myocardial infarction and right ventricular myocardial infarction (INFMI + RVMI). Our study recruited 70 consecutive patients with INFMI (43 patients without RVMI and 27 patients with RVMI). Right atrial function was evaluated by 2DSTE. Early diastolic strain, systolic strain rate, absolute value of early diastolic strain rate, expansion index, and diastolic emptying index of the right atrium were reduced in the patients with INFMI + RVMI compared to the patients with INFMI. The area under the curve for early diastolic strain for INFMI diagnosis was 0.682 (p value = 0.011, 95 % CI 0.550-0.815). Right atrial early diastolic longitudinal strain right atrial reservoir and conduit functions were impaired in the patients with INFMI + RVMI compared with the patients with INFMI.

  3. Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: myocardial stunning or subendocardial hypoperfusion?

    Science.gov (United States)

    Emmett, Louise; Ng, Austin; Ha, Leo; Russo, Robert; Mansberg, Robert; Zhao, Wei; Chow, S Vincent; Kritharides, Leonard

    2012-08-01

    Transient ischaemic dilation (TID) on myocardial perfusion imaging (MPI) is an important finding, conveying a high risk of subsequent cardiac events. However, the mechanism leading to TID on MPI is not well elucidated. This study aimed to determine if TID is due to true LV cavity dilation and ventricular stunning, or is due to relative subendocardial hypoperfusion. 31 patients undergoing single-day Tc-99m adenosine sestamibi MPI were recruited. All had routine ECG-gated single-day rest-stress adenosine MPI, with transthoracic echocardiograms (echo) acquired concurrently at rest, and both immediately, and 2 hours, post-stress. Echocardiography was performed using a Vivid-7 (GE). LV volumes and LVEF were quantified blinded to MPI results, using biplane Simpson method on echo, and quantitatively (including TID) with QGS(®), on MPI. Patients were divided into quartiles for TID, with the top quartile considered TID positive [TID+ 9/31 (TID ratio 1.3 ± 0.09)], and TID negative [TID- 22/31 (TID ratio 1.01 ± 0.04)]. There was good correlation between resting echo and MPI physical measurements (LVEDV r(2) = 0.79, LVESV r(2) = 0.9, and LVEF r(2) = 0.75). On MPI, a significant drop in LVEF was observed between rest and early stress in the TID+ group (56.6% vs 46.5%, P subendocardial hypoperfusion and impaired coronary flow reserve.

  4. Evaluation of Right Ventricular Myocardial Mechanics Using Velocity Vector Imaging of Cardiac MRI Cine Images in Transposition of the Great Arteries Following Atrial and Arterial Switch Operations.

    Science.gov (United States)

    Thattaliyath, Bijoy D; Forsha, Daniel E; Stewart, Chad; Barker, Piers C A; Campbell, Michael J

    2015-01-01

    The aim of the study was to determine right and left ventricle deformation parameters in patients with transposition of the great arteries who had undergone atrial or arterial switch procedures. Patients with transposition are born with a systemic right ventricle. Historically, the atrial switch operation, in which the right ventricle remains the systemic ventricle, was performed. These patients have increased rates of morbidity and mortality. We used cardiac MRI with Velocity Vector Imaging analysis to characterize and compare ventricular myocardial deformation in patients who had an atrial switch or arterial switch operation. Patients with a history of these procedures, who had a clinically ordered cardiac MRI were included in the study. Consecutive 20 patients (75% male, 28.7 ± 1.8 years) who underwent atrial switch operation and 20 patients (60% male, 17.7 ± 1.9 years) who underwent arterial switch operation were included in the study. Four chamber and short-axis cine images were used to determine longitudinal and circumferential strain and strain rate using Vector Velocity Imaging software. Compared with the arterial switch group, the atrial switch group had decreased right ventricular ejection fraction and increased end-diastolic and end-systolic volumes, and no difference in left ventricular ejection fraction and volumes. The atrial switch group had decreased longitudinal and circumferential strain and strain rate. When compared with normal controls multiple strain parameters in the atrial switch group were reduced. Myocardial deformation analysis of transposition patients reveals a reduction of right ventricular function and decreased longitudinal and circumferential strain parameters in patients with an atrial switch operation compared with those with arterial switch operation. A better understanding of the mechanisms of right ventricle failure in transposition of great arteries may lead to improved therapies and adaptation. © 2015 Wiley Periodicals

  5. [Heart transplantation for the treatment of isolated left ventricular myocardial noncompaction. First case in Mexico].

    Science.gov (United States)

    Zetina-Tun, Hugo Jesús; Careaga-Reyna, Guillermo; Galván-Díaz, José; Sánchez-Uribe, Magdalena

    2016-10-20

    Myocardial noncompaction of the left ventricle is a congenital cardiomyopathy characterised by left ventricular hypertrabeculation and prominent intertrabecular recesses. The incidence ranges from 0.15% to 2.2%. Clinical manifestations include heart failure, arrhythmias, and stroke. Prognosis is fatal in most cases. Heart transplantation is a therapeutic option for this cardiomyopathy, and few had been made worldwide. The case is presented of a 20 year-old male with noncompacted myocardium of the left ventricle, who had clinical signs of heart failure. His functional class was IV on the New York Heart Association scale. He was successfully transplanted. Its survival to 15 months is optimal in class I New York Heart Association, and endomyocardial biopsies have been reported without evidence of acute rejection. It is concluded that heart transplantation modified the natural history and improved survival in patients with this congenital heart disease. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  6. Quantification of left ventricular myocardial collagen system in children, young adults, and the elderly

    Directory of Open Access Journals (Sweden)

    Andrea Bogoslavsky Levy Mendes

    2012-06-01

    Full Text Available Studies on the collagen system of the human myocardium are still limited compared to those on small laboratory animals. The aim of this work was to observe the collagen tissue of the myocardium of the human heart as a function of age. The types of collagen, as well as the density of collagen tissue and the diameter of collagen fibrils, were examined. Fragments of the left ventricular wall from 15 hearts, 5 from children, 5 from young adults, and 5 from elderly individuals, were analyzed by using the Picrosirius-polarization method and by transmission electron microscopy (TEM. The results showed the presence of collagen type III and collagen type I, both in the endomysium and perimysium of the 3 groups studied. Measurements of collagen content in myocardial tissue displayed that both endomysial and perimysial collagen increase in number and thickness in the adult and elderly. These histochemical results coincided with the observations obtained with the electron microscope in showing an increase in the number of collagen fibrils with a large diameter in the adult and elderly hearts. The present results on cardiac collagen may be important for assessing the pathogenesis of several cardiopathies in the hearts of children, young adults, and the elderly.

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

    Directory of Open Access Journals (Sweden)

    CR Potu

    2012-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Wilansky Susan

    2010-08-01

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

  9. The effects of hormone replacement therapy on myocardial performance in early postmenopausal women.

    Science.gov (United States)

    Duzenli, M A; Ozdemir, K; Sokmen, A; Gezginc, K; Soylu, A; Celik, C; Altunkeser, B B; Tokac, M

    2010-04-01

    The results of the studies in which the effect of hormone replacement therapy (HRT) on cardiac function have been evaluated are rather disputable. In these studies, cardiac function was evaluated with conventional echocardiographic methods. This study was planned in order to investigate the effects of HRT on myocardial velocities and myocardial performance index (MPI) in healthy early postmenopausal women. In a prospective, controlled study, 60 healthy postmenopausal women were assigned to two groups (32 in the HRT group and 28 in the control group). After conventional echocardiographic parameters were measured, tissue Doppler echocardiography recordings were obtained from the mitral and tricuspid annulus. Systolic myocardial velocity (Sm), early and late diastolic myocardial velocities (Em and Am) and time intervals were measured and MPI was calculated. Then the symptom-limited exercise stress test using the Bruce protocol was performed. After 3 and 6 months of HRT (oral 0.625 mg conjugated estrogen + 2.5 mg medroxyprogesterone acetate/day), the same examinations were repeated. The effects of HRT on myocardial velocities, MPI and exercise time were evaluated at the 3rd and 6th months. The parameters of the control group remained statistically unchanged during the study. HRT did not have any effect on segmental and mean left ventricular (LV) Sm or right ventricular (RV) Sm. However, LV Em/Am and RV Em/Am ratios significantly increased at the 6th month of HRT, and LV and RV MPI values were observed to decrease significantly as compared to basal values. Additionally, a significant increase was observed in exercise duration and metabolic equivalent values after 3 months of HRT, and this increase continued at the 6th month as well. The favorable changes in all parameters in the HRT group were significantly different from those of the control group. Data obtained in this study suggest that HRT is not only effective for treating menopausal complaints but also increases

  10. Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies

    Directory of Open Access Journals (Sweden)

    Okuyan Ertuğrul

    2010-09-01

    Full Text Available Abstract Background Left ventricular thrombus(LVT] formation is a frequent complication in patients with acute anterior myocardial infarction(MI. LVT is associated with increased risk of embolism and higher mortality rates after acute MI. Anticardiolipin antibodies (ACA are immunoglobulins that react with phospholipid-binding proteins interfering with the prothrombin activator complex. The effects of phospholipids on pathophysiology of cardiovascular thrombotic events are well known. In this study, we aimed to evaluate the importance of clinical and biochemical parameters including anticardiolipin antibodies on left ventricular thrombus formation after acute anterior MI. Methods and Results Seventy patients with a first anterior AMI were prospectively and consecutively enrolled. Patients with previous MI, autoimmune disease, collagen vascular disease and arterial or venous thrombosis history were excluded from this study. At the time of hospitalization, key demographic and clinical characteristics were collected including age, gender, ethanol intake and presence of traditional risk factors for atherosclerosis (hypertension, diabetes, smoking, hyperlipidemia, positive family history. Patients were evaluated for echocardiographic data, blood chemistry and ACA. Two-dimensional and Doppler echocardiographic examinations were performed in all patients within the first week and at 14 days after MI. LV thrombus was detected in 30 (42.8% patients. ACA IgM levels were significantly higher in the patient group with LV thrombus than in the group without thrombus (12.44 ±4.12 vs. 7.69 ± 4.25 mpl, p = 0,01. ACA IgG levels were also found higher in the group with LV thrombus (24.2 ± 7.5 vs.17.98 ± 6.45 gpl, p = 0.02. Multivariate analyses revealed diabetes mellitus, higher WMSI, lower MDT and higher ACA IgM and higher ACA IgG levels as independent predictors of left ventricular thrombus formation. Conclusions Our data demonstrate that beside the low

  11. Reduced left ventricular cavitary activity ("black hole sign") in thallium-201 SPECT perfusion images of anteroapical transmural myocardial infarction.

    Science.gov (United States)

    Civelek, A C; Shafique, I; Brinker, J A; Durski, K; Weiss, J L; Links, J M; Natarajan, T K; Ozguven, M A; Wagner, H N

    1991-11-01

    Apparently reduced left ventricular (LV) cavitary thallium activity in both planar and tomographic perfusion images has been previously observed by these and other investigators. With single-photon emission computerized tomography, we have clinically noted that this "black hole sign" was associated with an aneurysm in the setting of a transmural anterior or anteroapical perfusion defect. We have now prospectively studied the etiology and predictive value of this sign in 84 consecutive patients with an anterior, anteroapical transmural perfusion defect. Of the 84 patients, 49 had both LV aneurysm (confirmed by contrast ventriculography, echocardiography or gated blood pool studies) and a black hole sign. Only 1 patient with an aneurysm did not have the black hole sign, and 2 without aneurysm did. Thus, it is concluded that this sign is highly accurate in diagnosing LV aneurysm. Because thallium-201 single-photon emission computerized tomography imaging is often performed as one of the first diagnostic tests soon after myocardial infarction, this has important clinical management implications.

  12. Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hwanjeong; Choi, Sehun; Han, Yeonhee [Research Institute of Chonbuk National Univ. Medical School and Hospitial, Jeonju (Korea, Republic of); Lee, Dong Soo; Lee, Hoyoung; Chung, Junekey [Seoul National Univ., Seoul (Korea, Republic of)

    2013-09-15

    This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function. Methods Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-{sup 99m} sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed. Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P<0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P=0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P<0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event. The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.

  13. Emergency coronary bypass grafting for evolving myocardial infarction. Effects on infarct size and left ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Flameng, W.; Sergeant, P.; Vanhaecke, J.; Suy, R.

    1987-07-01

    Emergency aorta-coronary bypass grafting was performed early in the course of evolving myocardial infarction in 48 patients. The time interval between the onset of symptoms and reperfusion was 169 +/- 80 minutes. Quantitative assessment of postoperative thallium 201 myocardial scans in 19 patients revealed a significant salvage of myocardium after surgical reperfusion: The size of the residual infarction was less than 50% of that in a matched, medically treated, prospective control group (n = 39) (p less than 0.05). Postoperative equilibrium-gated radionuclide blood pool studies (technetium 99m) showed an enhanced recovery of regional and global ejection fraction after operation as compared to after medical treatment (p less than 0.05). Ultrastructural evaluation of biopsy specimens obtained during the operation delineated subendocardial necrosis in the majority of cases (72%), but subepicardial necrosis was found in only 6% of instances. Q-wave abnormalities were observed on the postoperative electrocardiogram in 50% of cases. Operative mortality was 0% in low-risk patients (i.e., hemodynamically stable condition, n = 26) and 18% in high-risk patients (i.e., cardiogenic shock including total electromechanical dysfunction, n = 22). Survival rate at 18 months was 92% +/- 4%, and 95% +/- 4% of the survivors were event free. It is concluded that early surgical reperfusion of evolving myocardial infarction limits infarct size significantly, enhances functional recovery, and may be a lifesaving operation in patients having cardiogenic shock associated with unsuccessful resuscitation.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    IMS: Recurrent myocardial infarction (MI) is common after a first MI and is associated with increased morbidity and mortality. Predictors and prognosis of a recurrent MI with contemporary management are not well known. METHODS AND RESULTS: We assessed the predictors and prognostic impact of a first...... recurrent MI in 10,599 patients with left ventricular dysfunction, heart failure, or both following a first MI from the Valsartan in Acute Myocardial Infarction Trial (VALIANT) cohort. During a median follow-up of 27.4 months, 861 patients (9.6%) had a recurrent MI. The median time to recurrence was 136......-year mortality for the entire VALIANT cohort was 10.3%, whereas 38.3% of the patients were dead 1 year after recurrent MI. Early reinfarctions (within 1 month) was associated with significantly higher 30-day mortality than later reinfarctions. CONCLUSION: Even in the context of contemporary treatment...

  15. Alimentary lipemia enhances procoagulatory effects of inflammation in patients with a history of acute myocardial infarction complicated by ventricular fibrillation.

    Science.gov (United States)

    Kälsch, Thorsten; Elmas, Elif; Nguyen, Xuan Duc; Leweling, Hans; Klüter, Harald; Borggrefe, Martin; Dempfle, Carl Erik

    2008-01-11

    Acute myocardial infarction, often occurring postprandially, can be complicated by ventricular fibrillation. The role of acute alimentary lipemia and inflammation in the occurrence of ventricular arrhythmias in acute myocardial infarction has not been described yet. Before and 2 h after consumption of a defined fatty meal, blood samples of 27 patients with a history of acute myocardial infarction (AMI) were incubated with lipopolysaccharide (LPS). In 10 patients, AMI was complicated by ventricular fibrillation (VF), in 17 patients, AMI occurred without VF. CD40-ligand and CD62P expression on platelets, tissue-factor binding on monocytes and platelet-monocyte aggregates were measured with flow cytometry. Soluble CD40-ligand plasma levels were measured with an ELISA. With the meal, serum triglyceride levels increased from 211.85+/-94.60 mg/dl to 273.59+/-122.52 mg/dl (p=0.0002). LPS stimulation before the meal showed a non-significant tendency to increase platelet-monocyte aggregates and tissue factor on monocytes in both patient groups. LPS stimulation in acute alimentary lipemia significantly increased tissue-factor expression on monocytes in both patient groups and platelet-monocyte aggregates in patients with VF. Baseline plasma levels of soluble CD40L did not differ significantly between both groups. Acute alimentary lipemia significantly decreased total plasma levels of sCD40L, leading to a significantly lower level of sCD40L in patients with a history of VF. Alimentary lipemia enhances procoagulatory effects of inflammatory stimulation in patients with a history of AMI complicated by ventricular fibrillation. These observations might reveal a mechanism for an increased risk of VF in acute coronary syndromes in a postprandial state.

  16. Effect of prolonged inotropic stimulation on ventricular remodeling during healing after myocardial infarction in the dog: mechanistic insights.

    Science.gov (United States)

    Jugdutt, B I; Khan, M I; Jugdutt, S J; Blinston, G E

    1996-06-01

    We hypothesized that positive inotropic stimulation during healing after myocardial infarction might increase contractile pull on the infarct segment, increase expansion and promote ventricular dilation. The effect of prolonged inotropic stimulation on left ventricular remodeling during healing after myocardial infarction has not been studied. The effects of 6 weeks of inotropic stimulation on in vivo changes in left ventricular topography, function and mass (serial two-dimensional echocardiograms), hemodynamic variables, postmortem topography (planimetry) and collagen (hydroxyproline content) were studied in 36 chronically instrumented dogs randomized, 2 days after small anterior infarction, to digoxin (0.125 mg daily) and no digoxin (control group). Heart rate and arterial and left atrial pressures were similar in the two groups, but the first derivative of left ventricular pressure (peak dP/dt), systolic thickening of the noninfarct wall and systolic thinning of the infarct wall were higher in the digoxin group during the 6 weeks. At 6 weeks, infarct scar size and collagen content were similar in both groups, but the digoxin group had more infarct expansion and thinning. Between 2 days and 6 weeks, the digoxin group showed more in vivo diastolic infarct expansion, thinning and bulging; more aneurysm but less global dilation and increase in mass; and no change in ejection fraction. The effects of inotropic stimulation on remodeling were more marked in infarcts with 100% than 85% transmurality. Prolonged inotropic stimulation with digoxin during healing after small anterior infarction increases infarct bulging without decreasing infarct collagen content and preserves global ventricular size, mass and systolic function.

  17. Antiarrhythmic Drug Therapy for Sustained Ventricular Arrhythmias Complicating Acute Myocardial Infarction

    Science.gov (United States)

    Piccini, Jonathan P.; Schulte, Phillip J.; Pieper, Karen S.; Mehta, Rajendra H.; White, Harvey D.; Van de Werf, Frans; Ardissino, Diego; Califf, Robert M.; Granger, Christopher B.; Ohman, E. Magnus; Alexander, John H.

    2010-01-01

    Objective Few data exist to guide antiarrhythmic drug therapy for sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) after acute myocardial infarction (MI). The objective of this analysis was to describe survival of patients with sustained VT/VF post-MI according to antiarrhythmic drug treatment. Design & Setting We conducted a retrospective analysis of ST-segment elevation MI patients with sustained VT/VF in GUSTO IIB and III and compared all-cause death in patients receiving amiodarone, lidocaine, or no antiarrhythmic. We used Cox proportional hazards modeling and inverse weighted estimators to adjust for baseline characteristics, beta-blocker use, and propensity to receive antiarrhythmics. Due to non-proportional hazards for death in early follow-up (0–3 hours after sustained VT/VF) compared with later follow-up (>3 hours), we analyzed all-cause mortality using time-specific hazards. Patients & Interventions Among 19,190 acute MI patients, 1126 (5.9%) developed sustained VT/VF and met the inclusion criteria. Patients received lidocaine (n=664, 59.0%), amiodarone (n=50, 4.4%), both (n=110, 9.8%), or no antiarrhythmic (n=302, 26.8%). Results In the first 3 hours after VT/VF, amiodarone (adjusted HR 0.39, 95% CI 0.21–0.71) and lidocaine (adjusted HR 0.72, 95% CI 0.53–0.96) were associated with a lower hazard of death—likely evidence of survivor bias. Among patients who survived 3 hours, amiodarone was associated with increased mortality at 30 days (adjusted HR 1.71, 95% CI 1.02–2.86) and 6 months (adjusted HR 1.96, 95% CI 1.21–3.16) but lidocaine was not at 30 days (adjusted HR 1.19, 95% CI 0.77–1.82) and 6 months (adjusted HR 1.10, 95% CI 0.73–1.66). Conclusion Among patients with acute MI complicated by sustained VT/VF who survive 3 hours, amiodarone, but not lidocaine, is associated with an increased risk of death; reinforcing the need for randomized trials in this population. PMID:20959785

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

    Science.gov (United States)

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

    2014-08-15

    Acute treatment with metformin has a protective effect in myocardial infarction by suppression of inflammatory responses due to activation of AMP-activated protein kinase (AMPK). In the present study, the effect of chronic pre-treatment with metformin on cardiac dysfunction and toll-like receptor 4 (TLR4) activities following myocardial infarction and their relation with AMPK were assessed. Male Wistar rats were randomly assigned to one of 5 groups (n=6): normal control and groups were injected isoproterenol after chronic pre-treatment with 0, 25, 50, or 100mg/kg of metformin twice daily for 14 days. Isoproterenol (100mg/kg) was injected subcutaneously on the 13th and 14th days to induce acute myocardial infarction. Isoproterenol alone decreased left ventricular systolic pressure and myocardial contractility indexed as LVdp/dtmax and LVdp/dtmin. The left ventricular dysfunction was significantly lower in the groups treated with 25 and 50mg/kg of metformin. Metfromin markedly lowered isoproterenol-induced elevation in the levels of TLR4 mRNA, myeloid differentiation protein 88 (MyD88), tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) in the heart tissues. Similar changes were also seen in the serum levels of TNF-α and IL-6. However, the lower doses of 25 and 50mg/kg were more effective than 100mg/kg. Phosphorylated AMPKα (p-AMPK) in the myocardium was significantly elevated by 25mg/kg of metformin, slightly by 50mg/kg, but not by 100mg/kg. Chronic pre-treatment with metformin reduces post-myocardial infarction cardiac dysfunction and suppresses inflammatory responses, possibly through inhibition of TLR4 activities. This mechanism can be considered as a target to protect infarcted myocardium. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Quantification of Left Ventricular Torsion and Diastolic Recoil Using Cardiovascular Magnetic Resonance Myocardial Feature Tracking

    Science.gov (United States)

    Hussain, Shazia T.; Kutty, Shelby; Steinmetz, Michael; Sohns, Jan M.; Fasshauer, Martin; Staab, Wieland; Unterberg-Buchwald, Christina; Bigalke, Boris; Lotz, Joachim; Hasenfuß, Gerd; Schuster, Andreas

    2014-01-01

    Objectives Cardiovascular magnetic resonance feature tracking (CMR-FT) offers quantification of myocardial deformation from routine cine images. However, data using CMR-FT to quantify left ventricular (LV) torsion and diastolic recoil are not yet available. We therefore sought to evaluate the feasibility and reproducibility of CMR-FT to quantify LV torsion and peak recoil rate using an optimal anatomical approach. Methods Short-axis cine stacks were acquired at rest and during dobutamine stimulation (10 and 20 µg·kg−1·min−1) in 10 healthy volunteers. Rotational displacement was analysed for all slices. A complete 3D-LV rotational model was developed using linear interpolation between adjacent slices. Torsion was defined as the difference between apical and basal rotation, divided by slice distance. Depending on the distance between the most apical (defined as 0% LV distance) and basal (defined as 100% LV distance) slices, four different models for the calculation of torsion were examined: Model-1 (25–75%), Model-2 (0–100%), Model-3 (25–100%) and Model-4 (0–75%). Analysis included subendocardial, subepicardial and global torsion and recoil rate (mean of subendocardial and subepicardial values). Results Quantification of torsion and recoil rate was feasible in all subjects. There was no significant difference between the different models at rest. However, only Model-1 (25–75%) discriminated between rest and stress (Global Torsion: 2.7±1.5°cm−1, 3.6±2.0°cm−1, 5.1±2.2°cm−1, p<0.01; Global Recoil Rate: −30.1±11.1°cm−1s−1,−46.9±15.0°cm−1s−1,−68.9±32.3°cm−1s−1, p<0.01; for rest, 10 and 20 µg·kg−1·min−1 of dobutamine, respectively). Reproducibility was sufficient for all parameters as determined by Bland-Altman analysis, intraclass correlation coefficients and coefficient of variation. Conclusions CMR-FT based derivation of myocardial torsion and recoil rate is feasible and reproducible at rest and with dobutamine

  20. Quantification of left ventricular torsion and diastolic recoil using cardiovascular magnetic resonance myocardial feature tracking.

    Directory of Open Access Journals (Sweden)

    Johannes T Kowallick

    Full Text Available Cardiovascular magnetic resonance feature tracking (CMR-FT offers quantification of myocardial deformation from routine cine images. However, data using CMR-FT to quantify left ventricular (LV torsion and diastolic recoil are not yet available. We therefore sought to evaluate the feasibility and reproducibility of CMR-FT to quantify LV torsion and peak recoil rate using an optimal anatomical approach.Short-axis cine stacks were acquired at rest and during dobutamine stimulation (10 and 20 µg · kg(-1 · min(-1 in 10 healthy volunteers. Rotational displacement was analysed for all slices. A complete 3D-LV rotational model was developed using linear interpolation between adjacent slices. Torsion was defined as the difference between apical and basal rotation, divided by slice distance. Depending on the distance between the most apical (defined as 0% LV distance and basal (defined as 100% LV distance slices, four different models for the calculation of torsion were examined: Model-1 (25-75%, Model-2 (0-100%, Model-3 (25-100% and Model-4 (0-75%. Analysis included subendocardial, subepicardial and global torsion and recoil rate (mean of subendocardial and subepicardial values.Quantification of torsion and recoil rate was feasible in all subjects. There was no significant difference between the different models at rest. However, only Model-1 (25-75% discriminated between rest and stress (Global Torsion: 2.7 ± 1.5° cm(-1, 3.6 ± 2.0° cm(-1, 5.1 ± 2.2° cm(-1, p<0.01; Global Recoil Rate: -30.1 ± 11.1° cm(-1 s(-1,-46.9 ± 15.0° cm(-1 s(-1,-68.9 ± 32.3° cm(-1 s(-1, p<0.01; for rest, 10 and 20 µg · kg(-1 · min(-1 of dobutamine, respectively. Reproducibility was sufficient for all parameters as determined by Bland-Altman analysis, intraclass correlation coefficients and coefficient of variation.CMR-FT based derivation of myocardial torsion and recoil rate is feasible and reproducible at rest and with dobutamine stress. Using an optimal

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

    DEFF Research Database (Denmark)

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

    1996-01-01

    Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously. In the T......Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously......-term mortality, separate analyses were performed in patients with different levels of LV function. Risk ratio (95% confidence intervals [CI]) were determined from proportional hazard models subgrouped by wall motion index or CHF adjusted for age and gender. Heart failure was separated into transient...... or persistent. Wall motion index and CHF are correlated. Furthermore, there is an interaction between wall motion index and CHF. The prognostic importance of wall motion index depends on whether patients have CHF or not: the risk ratio associated with decreasing 1 wall motion index unit is 3.0 (2.6 to 3...

  2. Myocardial distribution of indium-111-antimyosin Fab in acute inferior and right ventricular infarction: comparison with technetium-99m-pyrophosphate imaging and histologic examination

    Energy Technology Data Exchange (ETDEWEB)

    Nakata, T.; Sakakibara, T.; Noto, T.; Shoji, T.; Tsuda, T.; Kubota, M.; Hattori, A.; Iimura, O. (Sapporo Medical College, (Japan))

    1991-05-01

    In a postmortem study of a 69-yr-old female patient who had suffered 2 yr previously a non-Q-wave anterior infarction and who had sustained just seven days earlier a left inferior and right ventricular infarction, the distribution of {sup 111}In-antimyosin Fab was compared to the results of {sup 99}mTc-pyrophosphate imaging and histologic examination. Indium-111-antimyosin Fab imaging could not be performed because of cardiogenic shock. However, postmortem gamma scintillation counting revealed increased activities of antimyosin Fab in the inferoapical and right ventricular infarcted regions in which {sup 99}mTc-pyrophosphate positive imagings were observed; in contrast, a histologically confirmed old subendocardial anterior infarction had no definite activity. Thus, the myocardial distribution of {sup 111}In-antimyosin Fab corresponded well to the results of {sup 99}mTc scintigrams and histologic examinations in a human heart, suggesting that this technique could be useful in vivo for detecting several-day-old myocardial infarction of the right ventricle as well as the left ventricle. Tissue from the 2-yr-old infarction was not identified by this technique.

  3. The evaluation of right ventricular performance using krypton-81m.

    Science.gov (United States)

    Ham, H R; Piepsz, A; Vandevivere, J; Guillaume, M; Goethals, P; Lenaers, A

    1983-06-01

    The availability of krypton-81m suitable for intravenous injection provides an easy means for assessing right ventricular function. The superimposition of the other heart chambers does not constitute a problem. The activity in the left heart is negligible and the study can be performed in the right anterior oblique position to obtain optimal separation between the right atrium and the right ventricle. Lung activity is quite high and should be corrected before computing the right ventricular ejection fraction. This correction can be accomplished by performing Tc-99m MAA perfusion scintigraphy. The measurement of the right ventricular ejection fraction appears to be reproducible with very small inter-and intraobserver variability. Good quality phase and amplitude images can be obtained with such high count rates.

  4. The evaluation of right ventricular performance using krypton-81m

    Energy Technology Data Exchange (ETDEWEB)

    Ham, H.R.; Piepsz, A.; Vandevivere, J.; Guillaume, M.; Goethals, P.; Lenaers, A.

    1983-06-01

    The availability of krypton-81m suitable for intravenous injection provides an easy means for assessing right ventricular function. The superimposition of the other heart chambers does not constitute a problem. The activity in the left heart is negligible and the study can be performed in the right anterior oblique position to obtain optimal separation between the right atrium and the right ventricle. Lung activity is quite high and should be corrected before computing the right ventricular ejection fraction. This correction can be accomplished by performing Tc-99m MAA perfusion scintigraphy. The measurement of the right ventricular ejection fraction appears to be reproducible with very small inter-and intraobserver variability. Good quality phase and amplitude images can be obtained with such high count rates.

  5. Effects of no-reflow phenomenon on ventricular systolic synchrony in patients with acute anterior myocardial infarction after percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Wang L

    2016-06-01

    Full Text Available Le Wang,1 Gang Liu,1 Jun Liu,1 Mingqi Zheng,1 Liang Li2 1Department of Cardiology, The First Hospital of Hebei Medical University, 2Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China Objectives: The aim of this study was to investigate the effect of no-reflow phenomenon on ventricular systolic synchrony via myocardial blush grades (MBGs in patients with acute anterior myocardial infarction after percutaneous coronary intervention (PCI.  Patients and methods: All patients were divided into two groups and assessed by MBGs. To observe the parameters of the left ventricular function and left ventricular systolic synchrony, equilibrium radionuclide angiography was performed 1 week after PCI and repeated 6 months after acute myocardial infarction (AMI. Measurement data were compared and analyzed by the Student’s t-test, and the count data were evaluated by the χ2 test. A multivariate regression analysis was performed to assess the contribution of confounding factors.Results: A total of 100 patients were enrolled in this study: 26 in the no-reflow and 74 in the reflow group. There was no significant difference in terms of age, sex, hypertension history, diabetes history, hyperlipidemia history, and smoking history between the two groups. However, the incidence rate of heart failure with Killip’s grade ≥2 in the no-reflow group was significantly higher than that in the reflow group (38.46% vs 18.92%, P<0.05. Six months after the AMI-PCI, the left ventricular ejection fraction, peak ejection rate, and peak filling rate in the no-reflow group were significantly lower than those in the reflow group (t=2.21, 2.29, and 2.03, P<0.05 for all comparisons, but the values of the time to peak ejection rate, time to peak filling rate, phase shift, full width at half maximum, and peak phase standard deviation were all higher (t=2.41, 2.46, 2.00, 2.55, and 2.49, P<0.05 for all

  6. Distinction between myocardial infarction patients with and withouthistory of ventricular tachycardia based on wavelet transformed signal-averaged electrocardiogram

    Directory of Open Access Journals (Sweden)

    Ahmad Keshtkar

    2013-12-01

    Full Text Available Background: There are varieties of electrocardiogram-based methods to predict the risk of Ventricular tachycardia in patients. New extracted features from the signal averaged electrocardiogram and its wavelet coefficient as a distinction’s index are used in this study. Methods: Signals of orthogonal leads from 60 myocardial infarction patients (MI with or without the history of ventricular tachycardia were selected from the national metrology institute of Germany (PTB diagnostic database. They were filtered and the discrete transformed wavelet was exerted on them. New and conventional features introduced in this study were extracted from signal averaged electrocardiogram and its wavelet decompositions. Results: Extracted features: QRS-d, Entropy-w, Maxhist and ZeroC has acceptable statistically criteria (p-value <0.05 for mentioned groups, comparing QRS duration ,in MI patients which is longer than MI + VT, and for other features it is Vice versa. In wavelet decomposition analysis, the entropy feature has higher precision for detection and diagnosing MI and MI+VT. Conclusions: Entropy of wavelet coefficients is a useful feature in distinguishing myocardial infarction patients with or without ventricular tachycardia.

  7. Therapeutic drugs during healing after myocardial infarction modify infarct collagens and ventricular distensibility at elevated pressures.

    Science.gov (United States)

    Jugdutt, Bodh I; Idikio, Halliday; Uwiera, Richard R E

    2007-10-01

    We investigated whether therapeutic drugs given during healing following acute myocardial infarction (AMI) modify infarct collagens and left ventricular (LV) distensibility. We treated dogs with drugs from major classes (i.e., indomethacin, ibuprofen, captopril, enalapril, verapamil, amlodipine, propranolol, isosorbide dinitrate [ISDN] and digoxin) between day 2 and 6 weeks and measured hemodynamics, LV remodeling and function during healing over 6 weeks after transmural anterior AMI, and regional collagens, LV distensibility under increasing pressure, rupture threshold (RT), and topography at 6 weeks. Relative to sham, AMI controls showed infarct zone (IZ) expansion and thinning, 9.3-fold increase in IZ collagen, LV dilation and dysfunction, and no change in distensibility and RT. Relative to controls, indomethacin as well as enalapril, captopril and amlodipine decreased IZ collagen. Infarct expansion was attenuated by ibuprofen, captopril, amlodipine and ISDN but augmented by indomethacin. Infarct thinning was prevented by captopril, amlodipine and ISDN but enhanced by indomethacin. Importantly, indomethacin and enalapril enhanced LV distensibility and lowered RT. Distensibility correlated positively with IZ type III collagen and negatively with type I/III collagen ratio and pyridinoline cross-links whereas RT correlated positively with IZ type I collagen. Systolic volume and ejection fraction deteriorated with indomethacin but were improved or preserved with other therapies. The results demonstrate that different therapeutic drugs may produce different effects on IZ collagens during healing post-AMI: drugs that attenuate or adversely alter IZ collagens also enhance LV distensibility, augment adverse remodeling and lower RT, suggesting that testing for these effects post-AMI is warranted.

  8. Prior exercise improves survival, infarct healing, and left ventricular function after myocardial infarction.

    Science.gov (United States)

    de Waard, Monique C; Duncker, Dirk J

    2009-09-01

    We investigated the effects of voluntary wheel running before an acute myocardial infarction (MI) on survival, left ventricular (LV) remodeling and dysfunction and whether exercise before and after MI provides superior protection compared with either exercise intervention alone. After 2 wk of voluntary wheel running or sedentary housing, MI was induced in C57Bl/6 mice, after which exercise was stopped (EX-MI-SED and SED-MI-SED groups, where EX is exercise and SED is sedentary) or continued (EX-MI-EX and SED-MI-EX groups) for a period of 8 wk. Exercise after MI in SED-MI-EX mice had no effect on survival, the area of infarction, and global LV remodeling, but attenuated fibrosis and apoptosis in the remote myocardium and blunted LV dysfunction and pulmonary congestion compared with SED-MI-SED mice. Exercise before MI in both EX-MI-SED and EX-MI-EX mice decreased post-MI mortality compared with both SED-MI-SED and SED-MI-EX mice. Furthermore, in both pre-MI exercise groups, the infarct area was thicker, whereas interstitial fibrosis and apoptosis in the remote LV myocardium were blunted. In contrast, the ameliorating effects of either pre-MI or post-MI exercise alone on LV dysfunction were lost in EX-MI-EX mice, which may in part be related to the increased daily exercise distance in the first week post-MI in EX-MI-EX versus SED-MI-EX mice. In conclusion, exercise before or after MI blunted LV dysfunction, whereas only exercise before MI improved survival. These findings suggest that even when regular physical activity fails to prevent an acute MI, it can still act to improve cardiac function and survival after MI.

  9. Bioelectronic block of paravertebral sympathetic nerves mitigates post-myocardial infarction ventricular arrhythmias.

    Science.gov (United States)

    Chui, Ray W; Buckley, Una; Rajendran, Pradeep S; Vrabec, Tina; Shivkumar, Kalyanam; Ardell, Jeffrey L

    2017-11-01

    Autonomic dysfunction contributes to induction of ventricular tachyarrhythmia (VT). To determine the efficacy of charge-balanced direct current (CBDC), applied to the T1-T2 segment of the paravertebral sympathetic chain, on VT inducibility post-myocardial infarction (MI). In a porcine model, CBDC was applied in acute animals (n = 7) to optimize stimulation parameters for sympathetic blockade and in chronic MI animals (n = 7) to evaluate the potential for VTs. Chronic MI was induced by microsphere embolization of the left anterior descending coronary artery. At termination, in anesthetized animals and following thoracotomy, an epicardial sock array was placed over both ventricles and a quadripolar carousel electrode positioned underlying the right T1-T2 paravertebral chain. In acute animals, the efficacy of CBDC carousel (CBDCC) block was assessed by evaluating cardiac function during T2 paravertebral ganglion stimulation with and without CBDCC. In chronic MI animals, VT inducibility was assessed by extrasystolic (S1-S2) stimulations at baseline and under >66% CBDCC blockade of T2-evoked sympathoexcitation. CBDCC demonstrated a current-dependent and reversible block without impacting basal cardiac function. VT was induced at baseline in all chronic MI animals. One animal died after baseline induction. Of the 6 remaining animals, only 1 was reinducible with simultaneous CBDCC application (P block of the T1-T2 paravertebral chain with CBDCC reduced VT in a chronic MI model. CBDCC prolonged VERP, without altering baseline cardiac function, resulting in improved electrical stability. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  10. Prognostic implication of early ventricular fibrillation among patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Medina-Rodríguez, Kristel E; Almendro-Delia, Manuel; García-Alcántara, Ángel; Arias-Garrido, José J; Rodríguez-Yáñez, Juan C; Alonso-Muñoz, Gemma; de la Chica-Ruiz-Ruano, Rafael; Reina-Toral, Antonio; Varela-López, Antonio; Arboleda-Sánchez, José A; Poullet-Brea, Ana M; Zaya-Ganfo, Benito; Butrón-Calderón, Michel; Cristo-Ropero, Maria J; Hidalgo-Urbano, Rafael; García-Rubira, Juan C

    2017-11-01

    The aim of this study was to analyze the prognosis of patients presenting early ventricular fibrillation (VF) in the setting of ST elevation myocardial infarction (STEMI). Among patients included in the ARIAM (Análisis del Retraso en el Infarto Agudo de Miocardio) registry with the diagnosis of STEMI, those who received primary revascularization and were admitted in the first 12 h were analyzed retrospectively. From January 2007 to January 2012, 8340 patients were included in the STEMI cohort and 680 (8.2%) of them presented with VF before admission to the ICU (VF). This group comprised younger patients with fewer comorbidities. They received more often primary angioplasty (33.7 vs. 24.9%; P<0.001), had more prevalence of Killip class greater than or equal to 2 at admission (37.5 vs. 17.8%; P<0.001), and suffered more often cardiogenic shock (18.5 vs. 5.9%, P<0.001). By logistic regression analysis, VF was associated with a greater in-hospital mortality [odds rate (OR): 2.08, 95% confidence interval (CI): 1.57-2.81, P<0.001]. After a propensity score matching process, VF was associated with in-hospital mortality (OR: 1.53, 95% CI: 1.05-2.25, P=0.028). However, when analyzing patients treated by primary angioplasty, the mortality was not significantly related to VF (OR: 0.86, 95% CI: 0.45-1.61, P=0.628). Our results show that VF before ICU admission was an independent predictor of in-hospital outcome in a cohort of patients in whom fibrinolysis was the most used revascularization therapy. However, this prognostic value was not found in patients treated with primary angioplasty.

  11. Myocardium-derived conditioned medium improves left ventricular function in rodent acute myocardial infarction

    Science.gov (United States)

    2011-01-01

    Background We investigated whether myocardium-derived conditioned medium (MDCM) is effective in preserving left ventricular (LV) function in a rat acute myocardial infarction (AMI) model. Methods Adult male Sprague-Dawley (SD) rats (n = 36) randomized to receive either left coronary artery ligation (AMI induction) or thoracotomy only (sham procedure) were grouped as follows (n = 6 per group): Group I, II, and III were sham-controls treated by fresh medium, normal rat MDCM, and infarct-related MDCM, respectively. Group IV, V, and VI were AMI rats treated by fresh medium, normal MDCM, and infarct-related MDCM, respectively. Either 75 μL MDCM or fresh medium was administered into infarct myocardium, followed by intravenous injection (3 mL) at postoperative 1, 12, and 24 h. Results In vitro studies showed higher phosphorylated MMP-2 and MMP-9, but lower α-smooth muscle actin and collagen expressions in neonatal cardiac fibroblasts treated with MDCM compared with those in the cardiac fibroblasts treated with fresh medium (all p < 0.05). Sirius-red staining showed larger collagen deposition area in LV myocardium in Group IV than in other groups (all p < 0.05). Stromal cell-derived factor-1α and CXCR4 protein expressions were higher in Group VI than in other groups (all p < 0.05). The number of von Willebrand factor- and BrdU-positive cells and small vessels in LV myocardium as well as 90-day LV ejection fraction were higher, whereas oxidative stress was lower in Group VI than in Group IV and Group V (all p < 0.05). Conclusion MDCM therapy reduced cardiac fibrosis and oxidative stress, enhanced angiogenesis, and preserved 90-day LV function in a rat AMI model. PMID:21244680

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

  13. Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon: A Study of Speckle Tracking Echocardiography.

    Science.gov (United States)

    Gulel, Okan; Akcay, Murat; Soylu, Korhan; Aksan, Gokhan; Yuksel, Serkan; Zengin, Halit; Meric, Murat; Sahin, Mahmut

    2016-05-01

    The coronary slow flow phenomenon (CSFP) is defined as a delayed distal vessel contrast opacification in the absence of obstructive epicardial coronary artery disease during coronary angiography. There is conflicting data in medical literature regarding the effects of CSFP on the left ventricular functions assessed by conventional echocardiography or tissue Doppler imaging. Therefore, we aimed to evaluate whether there is any abnormality in the myocardial deformation parameters (strain, strain rate (SR), rotation, twist) of the left ventricle obtained by speckle tracking echocardiography (STE) in patients with CSFP. Twenty patients with CSFP were included prospectively in the study. Another 20 patients with similar demographics and cardiovascular risk factors as well as normal coronary angiography were used as the control group. Two-dimensional echocardiographic images of the left ventricle from the apical long-axis, two-chamber, four-chamber, and parasternal short-axis views were used for STE analysis. The analysis of left ventricular circumferential deformation parameters showed that the averaged peak systolic strain, systolic SR, and early diastolic SR values were significantly lower in patients with CSFP (P = 0.009, P = 0.02, and P = 0.02, respectively). Among the left ventricular rotation and twist values, apical rotation was significantly lower in patients with CSFP (P = 0.02). Further, the mean thrombolysis in myocardial infarction frame count value was found to be negatively correlated with the averaged peak circumferential early diastolic SR (r = -0.35, P = 0.03). It was positively correlated with the averaged peak circumferential systolic strain (r = 0.47, P = 0.003) and circumferential systolic SR (r = 0.46, P = 0.005). Coronary slow flow phenomenon leads to significant alterations in the myocardial deformation parameters of the left ventricle as assessed by STE. Specifically, circumferential deformation parameters are affected in CSFP patients. © 2015

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    OBJECTIVES: Abnormal glucose tolerance in patients with acute myocardial infarction (AMI) is associated with greater mortality and adverse cardiovascular effects. As statins possess a range of beneficial pleiotropic effects on the cardiovascular system, we sought to assess the cardioprotective...... statin therapy. Patients were assessed with an oral glucose tolerance test and their left ventricular (LV) function was assessed with speckle-tracking echocardiography measuring regional longitudinal systolic strain (RLSS) in the infarct area. RESULTS: Overall RLSS in the infarct area improved by a mean...... effects of statins on left ventricular function in patients with AMI in relation to glycometabolic state. METHODS: In a prospective, randomized trial, 140 patients with AMI were randomized to intensive statin therapy receiving statin loading with 80 mg of rosuvastatin followed by 40 mg daily or standard...

  15. The effects of ACE inhibitor therapy on left ventricular myocardial mass and diastolic filling in previously untreated hypertensive patients: a cine MRI study.

    Science.gov (United States)

    Hoffmann, U; Globits, S; Stefenelli, T; Loewe, C; Kostner, K; Frank, H

    2001-07-01

    Cardiac remodeling in case of hypertension induces hypertrophy of myocytes and elevated collagen content and, subsequently, impaired diastolic filling of the left ventricle. The purpose of this prospective study was to evaluate changes of left ventricular (LV) myocardial mass, as well as diastolic filling properties, in hypertensive patients treated with the ACE inhibitor fosinopril. Sixteen hypertensive patients with echocardiographically documented LV hypertrophy and diastolic dysfunction received fosinopril (10-20 mg daily). Measurements of LV myocardial mass and properties of diastolic filling (peak filling fraction (PFF); peak filling rate (PFR)) were performed prior to medication, as well as after 3 and 6 months of therapy using cine magnetic resonance imaging (MRI). Ten healthy subjects served as a control group. LV myocardial mass (g/m2) decreased continuously within 3-6 months of follow-up by 32% (148 +/- 40 vs. 120 +/- 26 vs. 101 +/- 22 g/m2; P Cine MRI can be used to assess the time course of pharmacological effects on cardiac remodeling in the course of hypertension. ACE inhibitor therapy results in a significant reduction of LV mass within 3 months and is accompanied by a normalization of diastolic filling that is completed after 6 months. Copyright 2001 Wiley-Liss, Inc.

  16. Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus

    Directory of Open Access Journals (Sweden)

    Rajeev Seecheran

    2017-03-01

    Full Text Available The incidence of left ventricular (LV thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS. Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

  17. Predictive value of postprocedural leukocyte count on myocardial perfusion, left ventricular function and clinical outcomes in ST-elevated myocardial infarction after percutaneous coronary intervention.

    Science.gov (United States)

    He, Rong; Li, Hai-yan; Guo, Li-jun; Zhang, Fu-chun; Niu, Jie; Zhang, Yong-zhen; Wang, Gui-song; Yang, Zhen-hua; Gao, Wei

    2012-03-01

    Baseline white blood cell (WBC) count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction (STEMI). However, circulating WBC count is altered after percutaneous coronary intervention (PCI). The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI. A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution (ST-R) and myocardial blush grades (MBG) were evaluated immediately after PCI. Left ventricular ejection fraction (LVEF) was obtained at baseline and 12 - 18 months after PCI. Postprocedural WBC count was an independent inverse predictor of ST-R (OR 0.80, P < 0.0001) and MBG 3 (OR 0.82, P < 0.0001). It was negatively correlated with LVEF (baseline r = -0.22, P = 0.001; 12 - 18 months r = -0.29, P < 0.0001). The best cutoff value of WBC for predicting death was determined to be 13.0 × 10(9)/L. The patients with a postprocedural WBC count above 13.0 × 10(9)/L showed a significantly lower cumulative survival rate (30 days, 82.4% vs. 99.0%, P < 0.0001 and 2 years 75.0% vs. 96.4%, P < 0.0001). Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality (HR 8.48, P = 0.019) and 2-year mortality (HR 4.93, P = 0.009). Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-02-15

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

  19. Ryanodine receptor leak mediated by caspase-8 activation leads to left ventricular injury after myocardial ischemia-reperfusion

    Science.gov (United States)

    Fauconnier, Jérémy; Meli, Albano C.; Thireau, Jérôme; Roberge, Stephanie; Shan, Jian; Sassi, Yassine; Reiken, Steven R.; Rauzier, Jean-Michel; Marchand, Alexandre; Chauvier, David; Cassan, Cécile; Crozier, Christine; Bideaux, Patrice; Lompré, Anne-Marie; Jacotot, Etienne; Marks, Andrew R.; Lacampagne, Alain

    2011-01-01

    Myocardial ischemic disease is the major cause of death worldwide. After myocardial infarction, reperfusion of infracted heart has been an important objective of strategies to improve outcomes. However, cardiac ischemia/reperfusion (I/R) is characterized by inflammation, arrhythmias, cardiomyocyte damage, and, at the cellular level, disturbance in Ca2+ and redox homeostasis. In this study, we sought to determine how acute inflammatory response contributes to reperfusion injury and Ca2+ homeostasis disturbance after acute ischemia. Using a rat model of I/R, we show that circulating levels of TNF-α and cardiac caspase-8 activity were increased within 6 h of reperfusion, leading to myocardial nitric oxide and mitochondrial ROS production. At 1 and 15 d after reperfusion, caspase-8 activation resulted in S-nitrosylation of the RyR2 and depletion of calstabin2 from the RyR2 complex, resulting in diastolic sarcoplasmic reticulum (SR) Ca2+ leak. Pharmacological inhibition of caspase-8 before reperfusion with Q-LETD-OPh or prevention of calstabin2 depletion from the RyR2 complex with the Ca2+ channel stabilizer S107 (“rycal”) inhibited the SR Ca2+ leak, reduced ventricular arrhythmias, infarct size, and left ventricular remodeling after 15 d of reperfusion. TNF-α–induced caspase-8 activation leads to leaky RyR2 channels that contribute to myocardial remodeling after I/R. Thus, early prevention of SR Ca2+ leak trough normalization of RyR2 function is cardioprotective. PMID:21788490

  20. Prognostic Implications of Mid-Range Left Ventricular Ejection Fraction on Patients Presenting With ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Margolis, Gilad; Khoury, Shafik; Ben-Shoshan, Jeremy; Letourneau-Shesaf, Sevan; Flint, Nir; Keren, Gad; Shacham, Yacov

    2017-07-15

    The new European Society of Cardiology guidelines reclassified heart failure according to left ventricular ejection fraction, recognizing patients with mid-range EF (mrEF; 40% to 49%) as a distinct group. We sought to investigate the clinical profile, in-hospital outcomes, and long-term mortality of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention who had mrEF. We conducted a retrospective study of 2,086 consecutive patients with STEMI between December 2007 and June 2016 who underwent primary percutaneous coronary intervention and had a comprehensive echocardiographic examination performed within 72 hours of hospital admission. Patients were stratified according to their left ventricular ejection fraction-mrEF (40% to 49%), reduced EF (rEF; <40%), and preserved EF (pEF; ≥50%) groups and evaluated for baseline characteristics, in-hospital outcomes, as well as for long-term mortality. A total of 858 of 2,086 patients (41%) had mrEF, 215 of 2086 (10%) had rEF, and 1,013 of 2,086 (48%) had pEF. Patients with mrEF had nearly similar baseline co-morbidities and similar 30-day mortality compared with patients with pEF (2% vs 1%, p = 0.17). In a univariate analysis, long-term mortality was higher compared with those with pEF (9.8% vs 7.2%, p <0.01). In a multivariate Cox regression model, mrEF was independently associated with increased long-term mortality risk compared with pEF (hazard ratio 1.4, 95% CI 1.02 to 1.93, p = 0.04). In conclusion, among STEMI patients, those with mrEF at presentation constitute a distinct group in terms of baseline characteristics, in-hospital outcomes, and long-term mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Serotonin concentrations in platelets, plasma, mitral valve leaflet, and left ventricular myocardial tissue in dogs with myxomatous mitral valve disease.

    Science.gov (United States)

    Cremer, S E; Singletary, G E; Olsen, L H; Wallace, K; Häggström, J; Ljungvall, I; Höglund, K; Reynolds, C A; Pizzinat, N; Oyama, M A

    2014-01-01

    Altered serotonin (5-hydroxytryptamine, 5HT) signaling is postulated in development and progression of canine myxomatous mitral valve disease (MMVD). Little is known regarding platelet, plasma, valvular, or myocardial 5HT concentration ([5HT]) in affected dogs. We quantified [5HT] in platelet-rich plasma (PRP), platelet-poor plasma (PPP), mitral valve leaflets (MV), and left ventricular myocardium (LV). Forty-five dogs comprised 4 plasma groups of Cavalier King Charles Spaniels (CKCS) or non-CKCS, either healthy (CON) or MMVD affected: CKCS CON (n = 12); non-CKCS CON (n = 8); CKCS MMVD (n = 14); non-CKCS MMVD (n = 11). Twenty-four dogs comprised 3 tissue groups: MMVD (n = 8); other-HD (heart disease) (n = 7); non-HD, extracardiac disease (n = 9). High-performance liquid chromatography measured PRP, PPP, MV, and LV [5HT]. Platelet-rich plasma platelet [5HT] was greater in CKCS CON (1.83 femtograms/platelet [fg/plt]; range, 0.20-4.76; P = .002), CKCS MMVD (1.58 fg/plt; range, 0.70-4.03; P = .005), and non-CKCS MMVD (1.72 fg/plt; range, 0.85-4.44; P = .003) versus non-CKCS CON (0.92 fg/plt; range, 0.63-1.30). There was no group difference in PPP [5HT]. MV [5HT] was significantly higher in MMVD (32.4 ng/mg; range, 8.4-106.7) versus non-HD (3.6 ng/mg; range, 0-28.3; P = .01) and LV [5HT] was significantly higher in MMVD (11.9 ng/mg; range, 4.0-104.8) versus other-HD (0.9 ng/mg; range, 0-10.1; P = .011) and non-HD (2.5 ng/mg; range, 0-6.9; P = .001). Platelet [5HT] was highest in healthy CKCS and both MMVD groups, but plasma [5HT] showed no group differences. Tissue [5HT] was highest in MV and LV of MMVD-affected dogs, suggesting altered 5HT signaling as a potential feature of MMVD. Interactions of platelet, valvular, and myocardial 5HT signaling warrant further investigation. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  2. Application of neural classifier to risk recognition of sustained ventricular tachycardia and flicker in patients after myocardial infarction based on high-resolution electrocardiography

    Science.gov (United States)

    Wydrzyński, Jacek; Jankowski, Stanisław; Piątkowska-Janko, Ewa

    2008-01-01

    This paper presents the application of neural networks to the risk recognition of sustained ventricular tachycardia and flicker in patients after myocardial infarction based on high-resolution electrocardiography. This work is based on dataset obtained from the Medical University of Warsaw. The studies were performed on one multiclass classifier and on binary classifiers. For each case the optimal number of hidden neurons was found. The effect of data preparation: normalization and the proper selection of parameters was considered, as well as the influence of applied filters. The best neural classifier contains 5 hidden neurons, the input ECG signal is represented by 8 parameters. The neural network classifier had high rate of successful recognitions up to 90% performed on the test data set.

  3. Myocardial fibrosis burden predicts left ventricular ejection fraction and is associated with age and steroid treatment duration in duchenne muscular dystrophy.

    Science.gov (United States)

    Tandon, Animesh; Villa, Chet R; Hor, Kan N; Jefferies, John L; Gao, Zhiqian; Towbin, Jeffrey A; Wong, Brenda L; Mazur, Wojciech; Fleck, Robert J; Sticka, Joshua J; Benson, D Woodrow; Taylor, Michael D

    2015-03-26

    Patients with Duchenne muscular dystrophy exhibit progressive cardiac and skeletal muscle dysfunction. Based on prior data, cardiac dysfunction in Duchenne muscular dystrophy patients may be influenced by myocardial fibrosis and steroid therapy. We examined the longitudinal relationship of myocardial fibrosis and ventricular dysfunction using cardiac magnetic resonance in a large Duchenne muscular dystrophy cohort. We reviewed 465 serial cardiac magnetic resonance studies (98 Duchenne muscular dystrophy patients with ≥4 cardiac magnetic resonance studies) for left ventricular ejection fraction (LVEF) and presence of late gadolinium enhancement (LGE), a marker for myocardial fibrosis. LVEF was modeled by examining LGE status, myocardial fibrosis burden (as assessed by the number of LGE-positive left ventricular segments), patient age, and steroid treatment duration. An age-only model demonstrated that LVEF declined 0.58 ± 0.10% per year. In patients with both LGE-negative and LGE-positive studies (n=51), LVEF did not decline significantly over time if LGE was absent but declined 2.2 ± 0.31% per year when LGE was present. Univariate modeling showed significant associations between LVEF and steroid treatment duration, presence of LGE, and number of LGE-positive left ventricular segments; multivariate modeling showed that LVEF declined by 0.93 ± 0.09% for each LGE-positive left ventricular segment, whereas age and steroid treatment duration were not significant. The number of LGE-positive left ventricular segments increased with age, and longer steroid treatment duration was associated with lower age-related increases. Progressive myocardial fibrosis, as detected by LGE, was strongly correlated with the LVEF decline in Duchenne muscular dystrophy patients. Longer steroid treatment duration was associated with a lower age-related increase in myocardial fibrosis burden. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley

  4. Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus.

    Science.gov (United States)

    Sanhal, Cem Yasar; Daglar, Halil Korkut; Kara, Ozgur; Uygur, Dilek; Yucel, Aykan

    2017-01-01

    Fetal cardiac left ventricular function in pregnant women with pregestational or gestational diabetes mellitus was investigated by exploring fetal myocardial performance index (MPI) and E wave/A wave peak velocity (E/A) ratio. Seventy pregnant women with either pregestational or gestational diabetes mellitus and with no other systemic or pregnancy related disorders were compared with 70 gestational age matched healthy controls by means of fetal left ventricular MPI and E/A ratio. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods: ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT), which were employed in the calculation of MPI (MPI = [ICT + IRT]/ET). Statistical analyses were conducted using receiver operating characteristic analysis and independent two-sample t, Mann-Whitney U and chi-square tests. Fetal left ventricular MPI values were significantly higher in the diabetic group compared with controls (0.56 ± 0.09 vs 0.36 ± 0.04, P diabetic group. Receiver operating characteristic analysis revealed > 0.39 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 90.9%, specificity: 47.7%, area under the curve: 0.690, 95% confidence interval: 0.598-0.782, P diabetic mothers have significant left ventricular systolic and diastolic dysfunction. MPI may be used in the prediction of adverse perinatal outcome in diabetic pregnancies. © 2016 Japan Society of Obstetrics and Gynecology.

  5. Low coronary driving pressure early in the course of myocardial infarction is associated with subendocardial remodelling and left ventricular dysfunction

    Science.gov (United States)

    Koike, Marcia Kiyomi; De Carvalho Frimm, Clovis; Cúri, Mariana

    2007-01-01

    Subendocardial remodelling of the left ventricular (LV) non-infarcted myocardium has been poorly investigated. Previously, we have demonstrated that low coronary driving pressure (CDP) early postinfarction was associated with the subsequent development of remote subendocardial fibrosis. The present study aimed at examining the role of CDP in LV remodelling and function following infarction. Haemodynamics were performed in Wistar rats immediately after myocardial infarction (MI group) or sham surgery (SH group) and at days 1, 3, 7 and 28. Heart tissue sections were stained with HE, Sirius red and immunostained for α-actin. Two distinct LV regions remote to infarction were examined: subendocardium (SE) and interstitium (INT). Myocyte necrosis, leucocyte infiltration, myofibroblasts and collagen volume fraction were determined. Compared with SH, MI showed lower CDP and LV systolic and diastolic dysfunction. Necrosis was evident in SE at day 1. Inflammation and fibroplasia predominated in SE as far as day 7. Fibrosis was restricted to SE from day 3 on. Inflammation occurred in INT at days 1 and 3, but at a lower grade than in SE. CDP correlated inversely with SE necrosis (r = −0.65, P = 0.003, at day 1), inflammation (r = −0.76, P < 0.001, at day 1), fibroplasia (r = −0.47, P = 0.04, at day 7) and fibrosis (r = −0.83, P < 0.001, at day 28). Low CDP produced progressive LV expansion. Necrosis at day 1, inflammation at days 3 and 7, and fibroplasia at day 7 correlated inversely with LV function. CDP is a key factor to SE integrity and affects LV remodelling and function following infarction. PMID:17696909

  6. Alteration in subendocardial and subepicardial myocardial strain in patients with aortic valve stenosis: an early marker of left ventricular dysfunction?

    Science.gov (United States)

    Hyodo, Eiichi; Arai, Kotaro; Koczo, Agnes; Shimada, Yuichi J; Fujimoto, Kohei; Di Tullio, Marco R; Homma, Shunichi; Gillam, Linda D; Hahn, Rebecca T

    2012-02-01

    It has been suggested that myocardial systolic impairment may not be accurately detected by the evaluation of endocardial excursion alone. The aim of this study was to test the hypothesis that changes in left ventricular (LV) subendocardial and subepicardial strain are sensitive markers of severity of aortic stenosis (AS) and LV function in patients with AS. Transthoracic echocardiography was performed in 73 consecutive patients with AS who had preserved systolic function and in 20 controls. Longitudinal strain, subendocardial radial strain, subepicardial radial strain, and transmural radial strain were measured using LV apical and short-axis images. The 73 patients enrolled in this study were classified according to AS severity: mild (n = 10), moderate (n = 15), or severe (n = 48). Although transmural and subepicardial radial strain showed similar values in all groups, subendocardial radial strain and longitudinal strain could differentiate mild or moderate AS from severe AS. Only the ratio of subendocardial to subepicardial radial strain (the bilayer ratio) decreased significantly as the severity of AS increased. Bilayer ratio showed weak correlations with LV ejection fraction (r = 0.37) and E/E' ratio (r = -0.33) and moderate correlations with LV mass (r = -0.55) and aortic valve area (r = 0.71). Moreover, bilayer ratio was independently associated with AS severity (P = .001). In 21 patients who underwent aortic valve replacement, subendocardial radial strain and bilayer ratio increased 7 days after surgery, whereas other echocardiographic parameters of LV function showed no improvement. Bilayer ratio can reliably differentiate patients with varying degrees of AS severity and is a sensitive marker of LV function. These findings suggest that the evaluation of subendocardial and subepicardial radial strain might be a novel method for assessing LV mechanics in patients with AS. Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All

  7. Early ventricular restraint after myocardial infarction: extent of the wrap determines the outcome of remodeling.

    Science.gov (United States)

    Enomoto, Yoshiharu; Gorman, Joseph H; Moainie, Sina L; Jackson, Benjamin M; Parish, Landi M; Plappert, Theodore; Zeeshan, Ahmad; St John-Sutton, Martin G; Gorman, Robert C

    2005-03-01

    Early infarct expansion initiates adverse remodeling, leads to left ventricular dilatation and portends a poor long-term outcome. Early mechanical prevention of infarct expansion has been proposed as a method to improve remodeling, but the extent of ventricular restraint necessary to optimize the salutary effect is not known. We tested the hypothesis that left ventricular restraint (wrap) is superior to infarct stiffening (patch). Infarction of 20% to 25% of the left ventricle was induced by coronary ligation in 69 sheep. Infarcts were either anteroapical (n = 33) or posterobasal (n = 36). Animals with each infarct received either no treatment (anteroapical, n = 26; posterobasal, n = 17), infarct stiffening with a localized Marlex mesh patch (posterobasal, n = 9) or left ventricular wrapping with Merseline mesh (anteroapical, n = 7; posterobasal, n = 10). End-systolic volume, end-diastolic volume, end-systolic muscle to cavity area ratio, left ventricular sphericity, ejection fraction, and degree of mitral regurgitation as determined by quantitative echocardiography were assessed before infarction and at 2, 5, and 8 weeks after infarction to evaluate the extent of left ventricular remodeling. Control animals in both groups experienced adverse remodeling. Anteroapical infarct animals developed large left ventricular aneurysms and the posterobasal infarct animals developed severe mitral regurgitation. Early infarct stiffening did not significantly improve any aspect of remodeling due to the posterobasal infarct. Early left ventricular wrapping significantly improved remodeling after both types of infarctions. Early left ventricular wrapping attenuates infarct expansion and has a salutary effect on remodeling. Simple infarct stiffening alone is not effective.

  8. Does in-hospital ventricular fibrillation affect prognosis after myocardial infarction?

    DEFF Research Database (Denmark)

    Jensen, G V; Torp-Pedersen, C; Hildebrandt, P

    1997-01-01

    -eight (12.4%) of the patients had ventricular fibrillation in hospital. The following risk factors were included in multivariate models to estimate their importance for 30-day and long-term (median 7 year) prognosis: age, gender, ventricular fibrillation, congestive heart failure, pulmonary oedema...... fibrillation secondary to heart failure compared to patients without ventricular fibrillation. For patients surviving more than 30 days, relative risk of death in those with ventricular fibrillation was 1.11 (95% confidence interval 0.93-1.34, P = 0.26). Logistic regression analysis of relative risk associated...

  9. Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy.

    Science.gov (United States)

    Morimoto, Ryota; Okumura, Takahiro; Hirashiki, Akihiro; Ishii, Hideki; Ichii, Takeo; Aoki, Soichiro; Furusawa, Kenji; Hiraiwa, Hiroaki; Kondo, Toru; Watanabe, Naoki; Kano, Naoaki; Fukaya, Kenji; Sawamura, Akinori; Takeshita, Kyosuke; Bando, Yasuko K; Murohara, Toyoaki

    2017-10-01

    Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events. There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmax from the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n=15) and who did not receive follow-up echocardiography (n=2), 83 patients were enrolled (52.5±12.3 years). During the follow-up period (4.7±2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax (hazard ratio: 1.024, p=0.007) and the symptom duration (hazard ratio: 0.977, p=0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmax cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax≥75.1% group (p=0.045). ΔLVdP/dtmax estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  10. Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score in ST-Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction (from the EPHESUS Trial).

    Science.gov (United States)

    Popovic, Batric; Girerd, Nicolas; Rossignol, Patrick; Agrinier, Nelly; Camenzind, Edoardo; Fay, Renaud; Pitt, Bertram; Zannad, Faiez

    2016-11-15

    The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score was calculated at baseline, and its predictive value was evaluated using C-indexes from Cox models. The increase in reclassification of other variables in addition to TIMI score was assessed using the net reclassification index. TIMI risk score had a poor predictive accuracy for all-cause mortality (C-index values at 30 days and 1 year ≤0.67) and recurrent myocardial infarction (MI; C-index values ≤0.60). Among TIMI score items, diabetes/hypertension/angina, heart rate >100 beats/min, and systolic blood pressure TIMI score items, aside from age, were significantly associated with MI recurrence. Using a constructed predictive model, lower LVEF, lower estimated glomerular filtration rate (eGFR), and previous MI were significantly associated with all-cause mortality. The predictive accuracy of this model, which included LVEF and eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index values ranging from 0.71 to 0.75). In conclusion, TIMI risk score demonstrates poor discrimination in predicting mortality or recurrent MI in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors that should not be ignored by predictive risk scores in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Impact of reperfusion therapy and infarct localization on frequency of premature ventricular beats in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Davor Horvat

    2015-08-01

    Full Text Available Aim To determine the impact of infarct localization and types of reperfusion therapy on the frequency of ventricular premature beats (VPBs in patients with acute myocardial infarction (AMI and reduced left ventricular ejection fraction (LVEF. Methods A total of 705 patients with acute ST elevation myocardial infarction (STEMI were divided according to the infarct localization (anteroseptal, anterolateral, inferior and posterior and reperfusion therapy (fibrinolysis or percutaneous coronary intervention with stenting into two groups: LVEF45% was a control group. The occurrence of VPBs10 per hour defined as a significant. Results In patients with fibrinolysis therapy and LVEF<45% significant number of VPBs were in anteroseptal (p=0.017, anterolateral (p<0.001 and posterior AMI (p<0.001, but in patients with percutaneous coronary intervention (PCI and LVEF<45% significant number of VPBs were only in anteroseptal AMI (p=0.001 localization. Conclusion In patients with reduced ejection fraction in AMI, treatment with PCI method has a better antiarrhythmic effect compared to fibrinolysis treatment.

  12. New evidence for favourable effects on haemodynamics and ventricular performance after Parachute(®) implantation in humans.

    Science.gov (United States)

    Schmidt, Tobias; Frerker, Christian; Thielsen, Thomas; Dotz, Inge; Wohlmuth, Peter; Kuck, Karl-Heinz; Schäfer, Ulrich

    2014-10-01

    The Parachute(®) Ventricular Partitioning Device offers an additional strategy for heart failure patients with exclusion of the infarcted wall to decrease left ventricular volumes, myocardial work, and wall stress. The aim of the present study was to evaluate if Parachute implantation might influence acute haemodynamic and functional performance in patients with left ventricular aneurysm after anteroapical infarction. Sixteen patients underwent a Parachute device implantation. Invasive right and left heart haemodynamic assessments as well as left ventricular analysis for evaluating left ventricle end-diastolic and end-systolic volumes, and regional ventricular function were analysed. After implantation a significant increase in stroke volume (+25.4%, P = 0.0005), stroke volume index (+26.5%, P = 0.0005), cardiac output (+25.8%, P < 0.0001) and cardiac index (+25.9%, P < 0.0001) was found. In addition to an increase in mean aortic (P = 0.0050) and pulmonary pressure (P = 0.0347), there were significant increases in stroke work index (P = 0.0003), left (P = 0.0015) and right (P = 0.0024) ventricular stroke work index as well as left and right cardiac work index (both P = 0.0001), while the remaining haemodynamic parameters remained unchanged. Left ventricular analysis showed an acute reduction of the left ventricular end-diastolic volume (-18.0%, P < 0.0001) and left ventricular end-systolic volume (-26.3%, P < 0.0001) and an increase in ejection fraction from 22.9 to 30.6% (+38.4%, P < 0.0001). Most interestingly, the basal wall segments displayed an increased contribution to the left ventricular ejection fraction with increased wall motion in nearly all segments (except the apex region). The data demonstrate the acute haemodynamic efficacy of Parachute device implantation. The implantation of the device displays immediate significant left ventricular volume reduction leading to an acute improved right and left

  13. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy: normalisation by acute angiotensin-converting enzyme inhibition

    Energy Technology Data Exchange (ETDEWEB)

    Hesse, Birger; Meyer, Christian; Hove, Jens D.; Holm, Soeren; Kofoed, Klaus F. [Department of Clinical Physiology and Nuclear Medicine, KF 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen (Denmark); Nielsen, Flemming S.; Sato, Asako; Parving, Hans-Henrik [Steno Diabetes Center, Gentofte (Denmark); Bang, Lia E.; Svendsen, Tage L. [Department of Internal Medicine, Naestved County Hospital (Denmark); Opie, Lionel H. [Department of Medicine, Cape Heart Center, University of Cape Town (South Africa)

    2004-03-01

    The purpose of this study was to assess whether acute angiotensin-converting enzyme (ACE) inhibition would improve myocardial perfusion and perfusion reserve in a subpopulation of normotensive patients with diabetes and left ventricular hypertrophy (LVH), both independent risk factors of coronary disease. Using positron emission tomography (PET), we investigated the response of regional myocardial perfusion to acute ACE inhibition with i.v. infusion of perindoprilat (vs saline infusion as control, minimum interval 3 days) in 12 diabetic patients with LVH. Myocardial perfusion was quantified with PET using nitrogen-13 ammonia infused at rest and during dipyridamole hyperaemia. Twelve healthy control subjects were included in the study, five of whom were also studied with perindoprilat. Mean blood pressure in normo-albuminuric, asymptomatic patients was 123{+-}7/65{+-}9 mmHg. Compared with controls, maximal perfusion was reduced in patients (1.8{+-}0.6 vs 2.5{+-}1.0 ml min{sup -1} g{sup -1}; P<0.05), and perfusion reserve was also lower, at borderline significance (2.7{+-}1.0 vs 3.6{+-}1.3; P=0.059). During perindoprilat infusion, myocardial perfusion reserve in patients increased to 3.9{+-}0.9 (P<0.001) due to normalisation of maximal perfusion (2.3{+-}0.5 ml min{sup -1} g{sup -1}, P<0.01). In the five control subjects both resting and hyperaemic perfusion remained unchanged during perindoprilat infusion. It is concluded that acute ACE inhibition with perindoprilat improves maximal achieved myocardial perfusion in non-hypertensive patients with diabetes and LVH. (orig.)

  14. Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial).

    Science.gov (United States)

    Daaboul, Yazan; Korjian, Serge; Weaver, W Douglas; Kloner, Robert A; Giugliano, Robert P; Carr, Jim; Neal, Brandon J; Chi, Gerald; Cochet, Madeleine; Goodell, Laura; Michalak, Nathan; Rusowicz-Orazem, Luke; Alkathery, Turky; Allaham, Haytham; Routray, Sujit; Szlosek, Donald; Jain, Purva; Gibson, C Michael

    2016-09-01

    Biomarker measures of infarct size and myocardial salvage index (MSI) are important surrogate measures of clinical outcomes after a myocardial infarction. However, there is variability in infarct size unaccounted for by conventional adjustment factors. This post hoc analysis of Evaluation of Myocardial Effects of Bendavia for Reducing Reperfusion Injury in Patients With Acute Coronary Events (EMBRACE) ST-Segment Elevation Myocardial Infarction (STEMI) trial evaluates the association between left ventricular (LV) mass and infarct size as assessed by areas under the curve for creatine kinase-MB (CK-MB) and troponin I release over the first 72 hours (CK-MB area under the curve [AUC] and troponin I [TnI] AUC) and the MSI. Patients with first anterior STEMI, occluded left anterior descending artery, and available LV mass measurement in EMBRACE STEMI trial were included (n = 100) (ClinicalTrials.govNCT01572909). MSI, end-diastolic LV mass on day 4 cardiac magnetic resonance, and CK-MB and troponin I concentrations were evaluated by a core laboratory. After saturated multivariate analysis, dominance analysis was performed to estimate the contribution of each independent variable to the predicted variance of each outcome. In multivariate models that included age, gender, body surface area, lesion location, smoking, and ischemia time, LV mass remained independently associated with biomarker measures of infarct size (CK-MB AUC p = 0.02, TnI AUC p = 0.03) and MSI (p = 0.003). Dominance analysis demonstrated that LV mass accounted for 58%, 47%, and 60% of the predicted variances for CK-MB AUC, TnI AUC, and MSI, respectively. In conclusion, LV mass accounts for approximately half of the predicted variance in biomarker measures of infarct size. It should be considered as an adjustment variable in studies evaluating infarct size. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Ventricular fibrillation and transient arrhythmias after defibrillation in patients with acute myocardial infarction

    NARCIS (Netherlands)

    Geuze, R. H.; Koster, R. W.

    1984-01-01

    Ventricular fibrillation (VF) and transient arrhythmias after defibrillation were analyzed from the recordings of 28 patients containing at least one episode of ventricular fibrillation. An R-on-T extrasystole initiated VF in 60% of the episodes. Other initiating factors were a late premature beat

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

    NARCIS (Netherlands)

    Kam, Pieter Jan de

    2002-01-01

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

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

    DEFF Research Database (Denmark)

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

    2000-01-01

    OBJECTIVES: To determine the ability of the ratio of peak E-wave velocity to flow propagation velocity (E/Vp) measured with color M-mode Doppler echocardiography to predict in-hospital heart failure and cardiac mortality in an unselected consecutive population with first myocardial infarction (MI......). BACKGROUND: Several experimental studies indicate color M-mode echocardiography to be a valuable tool in the evaluation of diastolic function, but data regarding the clinical value are lacking. METHODS: Echocardiography was performed within 24 h of arrival at the coronary care unit in 110 consecutive...... compared with patients with E/Vp or =1.5 to be the single best predictor of in-hospital clinical heart failure when compared with age, heart rate, E-wave deceleration time (Dt), left ventricular (LV) ejection fraction, wall...

  18. Insights from echocardiography, magnetic resonance imaging, and microcomputed tomography relative to the mid-myocardial left ventricular echogenic zone.

    Science.gov (United States)

    Agger, Peter; Stephenson, Robert S; Dobrzynski, Halina; Atkinson, Andrew; Iaizzo, Paul A; Anderson, Robert H; Jarvis, Jonathan C; Allan, Sarah L; Partridge, John B; Zhao, Jichao; Zhang, Henggui; MacIver, David H

    2016-10-01

    The anatomical substrate for the mid-mural ventricular hyperechogenic zone remains uncertain, but it may represent no more than ultrasound reflected from cardiomyocytes orientated orthogonally to the ultrasonic beam. We sought to ascertain the relationship between the echogenic zone and the orientation of the cardiomyocytes. We used 3D echocardiography, diffusion tensor imaging, and microcomputed tomography to analyze the location and orientation of cardiomyocytes within the echogenic zone. We demonstrated that visualization of the echogenic zone is dependent on the position of the transducer and is most clearly seen from the apical window. Diffusion tensor imaging and microcomputed tomography show that the echogenic zone seen from the apical window corresponds to the position of the circumferentially orientated cardiomyocytes. An oblique band seen in the parasternal view relates to cardiomyocytes orientated orthogonally to the ultrasonic beam. The mid-mural ventricular hyperechogenic zone represents reflected ultrasound from cardiomyocytes aligned orthogonal to the ultrasonic beam. The echogenic zone does not represent a space, a connective tissue sheet, a boundary between ascending and descending limbs of a hypothetical helical ventricular myocardial band, nor an abrupt change in cardiomyocyte orientation. © 2016, Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Xian-Liang Tang

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

  20. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2016-01-01

    complex >150 ms, QRS complex narrowing under CRT, and sinus rhythm were included ≥3 months after CRT implantation. Echocardiographic assessment of left ventricular ejection fraction (LVEF), global peak systolic longitudinal strain (GLS), and contraction pattern by 2D strain was performed during intrinsic......PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...

  1. Right and left ventricular function and myocardial scarring in adult patients with sickle cell disease: a comprehensive magnetic resonance assessment of hepatic and myocardial iron overload.

    Science.gov (United States)

    Junqueira, Flávia P; Fernandes, Juliano L; Cunha, Guilherme M; T A Kubo, Tadeu; M A O Lima, Claudio; B P Lima, Daniel; Uellendhal, Marly; Sales, Sidney R; A S Cunha, Carolina; L R de Pessoa, Viviani; L C Lobo, Clarisse; Marchiori, Edson

    2013-09-19

    Patients with Sickle cell disease (SCD) who receive regular transfusions are at risk for developing cardiac toxicity from iron overload. The aim of this study was to assess right and left cardiac volumes and function, late gadolinium enhancement (LGE) and iron deposits in patients with SCD using CMR, correlating these values with transfusion burden, ferritin and hemoglobin levels. Thirty patients with SCD older than 20 years of age were studied in a 1.5 T scanner and compared to age- and sex-matched normal controls. Patients underwent analysis of biventricular volumes and function, LGE and T2* assessment of the liver and heart. When compared to controls, patients with SCD presented higher left ventricular (LV) volumes with decreased ejection fraction (EF) with an increase in stroke volume (SV) and LV hypertrophy. The right ventricle (RV) also presented with a decreased EF and hypertrophy, with an increased end-systolic volume. Although twenty-six patients had increased liver iron concentrations (median liver iron concentration value was 11.83 ± 9.66 mg/g), only one patient demonstrated an abnormal heart T2* < 20 msec. Only four patients (13%) LGE, with only one patient with an ischemic pattern. Abnormal heart iron levels and myocardial scars are not a common finding in SCD despite increased liver iron overload. The significantly different ventricular function seen in SCD compared to normal suggests the changes in RV and LV function may not be due to the anemia alone. Future studies are necessary to confirm this association.

  2. A novel method for quantifying in-vivo regional left ventricular myocardial contractility in the border zone of a myocardial infarction.

    Science.gov (United States)

    Lee, Lik Chuan; Wenk, Jonathan F; Klepach, Doron; Zhang, Zhihong; Saloner, David; Wallace, Arthur W; Ge, Liang; Ratcliffe, Mark B; Guccione, Julius M

    2011-09-01

    Homogeneous contractility is usually assigned to the remote region, border zone (BZ), and the infarct in existing infarcted left ventricle (LV) mathematical models. Within the LV, the contractile function is therefore discontinuous. Here, we hypothesize that the BZ may in fact define a smooth linear transition in contractility between the remote region and the infarct. To test this hypothesis, we developed a mathematical model of a sheep LV having an anteroapical infarct with linearly-varying BZ contractility. Using an existing optimization method (Sun et al., 2009, "A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep With Left Ventricular Aneurysm," J. Biomech. Eng., 131(11), pp. 111001), we use that model to extract active material parameter T(max) and BZ width d(n) that "best" predict in-vivo systolic strain fields measured from tagged magnetic resonance images (MRI). We confirm our hypothesis by showing that our model, compared to one that has homogeneous contractility assigned in each region, reduces the mean square errors between the predicted and the measured strain fields. Because the peak fiber stress differs significantly (~15%) between these two models, our result suggests that future mathematical LV models, particularly those used to analyze myocardial infarction treatment, should account for a smooth linear transition in contractility within the BZ.

  3. Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

    Directory of Open Access Journals (Sweden)

    Khayat Andre

    2011-01-01

    Full Text Available Abstract We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.

  4. Comparison of left ventricular function and infarct size in patients with and without persistently positive technetium-99m pyrophosphate myocardial scintigrams after myocardial infarction: analysis of 357 patients

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    Croft, C.H.; Rude, R.E.; Lewis, S.E.; Parkey, R.W.; Poole, W.K.; Parker, C.; Fox, N.; Roberts, R.; Strauss, H.W.; Thomas, L.J.

    1984-02-01

    One hundred nine patients with persistently positive technetium-99m pyrophosphate (Tc-99m-PPi) myocardial scintigrams 6 months after acute myocardial infarction (MI) (Group A) and 185 patients without such persistently positive scintigrams (Group B) were compared with regard to enzymatically determined infarct size, early and late measurements of left ventricular (LV) function determined by radionuclide ventriculography, and preceding clinical course during the 6 months after MI. The CK-MB-determined infarct size index in Group A (17.4 +/- 10.6 g-Eq/m2) did not differ significantly from that in Group B (16.0 +/- 14.6 g-Eq/m2). Similarly, myocardial infarct areas in the 2 groups, determined by planimetry of acute Tc-99m-PPi scintigrams in those patients with well-localized 3+ or 4+ anterior pyrophosphate uptake, were not significantly different (35.7 +/- 13.4 vs 34.4 +/- 13.1 cm2, respectively). However, patients in Group A had significantly lower LV ejection fractions than those in Group B, both within 18 hours of the onset of MI (0.42 +/- 0.14 vs 0.49 +/- 0.14, p less than 0.01) and at 3 months after MI, both at rest (0.42 +/- 0.14 vs 0.51 +/- 0.14, p less than 0.01) and at maximal symptom-limited supine bicycle exercise (0.44 +/- 0.17 vs 0.51 +/- 0.17, p less than 0.01). Peak exercise levels achieved in the 2 groups were not significantly different. Furthermore, patients in Group A demonstrated a greater incidence of congestive heart failure during the initial hospital admission (41 vs 24%; p less than 0.01) and a greater requirement for digoxin (p less than 0.05) and furosemide (p less than 0.01) after discharge.

  5. Procollagen type III amino terminal peptide and myocardial fibrosis: A study in hypertensive patients with and without left ventricular hypertrophy.

    Science.gov (United States)

    dos Santos Moreira, Carlos; Serejo, Fátima; Alcântara, Paula; Ramalhinho, Vítor; Braz Nogueira, J

    2015-05-01

    An exaggerated accumulation of type I and type III fibrillar collagens occurs throughout the free wall and interventricular septum of patients with primary hypertension and left ventricular hypertrophy (LVH). In the present study the serum concentration of procollagen type III amino terminal peptide (PIIIP) was measured to determine the value of this peptide as a potential marker of ventricular fibrosis in hypertensive patients, particularly those with LVH. The study population consisted of patients with never-treated mild to moderate essential hypertension and 30 normotensive control subjects. Clinical, echocardiographic, electrocardiographic and biochemical parameters were assessed in all patients. Heart rate, body mass index and levels of blood pressure were increased in hypertensives, particularly those with LVH, compared to normotensive controls. Posterior wall thickness, left ventricular (LV) mass and LV mass index, and serum PIIIP concentration were also increased in hypertensives, with significant differences between the two hypertensive groups. The ratio between maximal early and late transmitral flow velocity measured during diastole was lower in hypertensives, particularly those with LVH, than in normotensive controls. The increase in PIIIP indicates that type III collagen synthesis increases in hypertensives, particularly those with LVH, implying that alterations in the heart in hypertension are the result not solely of hypertrophied LV muscle, but also of increased collagen deposition within the ventricular wall and around the coronary vessels. Thus, measurement of serum PIIIP could be a practical and useful tool in the non-invasive assessment of myocardial remodeling in hypertension. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. In vivo and ex vivo effects of propofol on myocardial performance in rats with obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Ren Hong-Mei

    2011-12-01

    Full Text Available Abstract Background Responsiveness of the "jaundiced heart" to propofol is not completely understood. The purpose of this study was to evaluate the effect of propofol on myocardial performance in rats with obstructive jaundice. Methods Male Sprague-Dawley rats (n = 40 were randomly allocated into two groups, twenty underwent bile duct ligation (BDL, and 20 underwent a sham operation. Seven days after the surgery, propofol was administered in vivo and ex vivo (Langendorff preparations. Heart rate, left ventricular end-systolic pressure (LVESP left ventricular end-diastolic pressure (LVEDP, and maximal rate for left ventricular pressure rise and decline (± dP/dtmax were measured to determine the influence of propofol on the cardiac function of rats. Results Impaired basal cardiac function was observed in the isolated BDL hearts, whereas in vivo indices of basal cardiac function (LVESP and ± dP/dt in vivo were significantly higher in rats that underwent BDL compared with controls. With low or intermediate concentrations of propofol, these indices of cardiac function were within the normal physiologic range in both groups, and responsiveness to propofol was unaffected by BDL. When the highest concentration of propofol was administrated, a significant decline in cardiac function was observed in the BDL group. Conclusions In rats that underwent BDL, basal cardiac performance was better in vivo and worse ex vivo compared with controls. Low and intermediate concentrations of propofol did not appear to impair cardiac function in rats with obstructive jaundice.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    AIMS: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF < or = 0.40). METHODS AND RESULTS: A total of 5869 consecutive patients were screened in 10 European...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    dysfunction in connection with either heart failure (HF) or myocardial infarction (MI). METHODS: In the Danish Investigations and Arrhythmia ON Dofetilide (DIAMOND) study; patients with left ventricular dysfunction were randomized to Dofetilide (class III antiarrhythmic drug) or placebo. One part of the study...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  13. Impact of ischemic time on post-infarction left ventricular function in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

    NARCIS (Netherlands)

    Ng, S.; Ottervanger, J.P.; Hof, A.W. van 't; Boer, M.J. de; Reiffers, S.; Dambrink, J.H.; Hoorntje, J.C.A.; Gosselink, A.T.M.; Suryapranata, H.

    2013-01-01

    BACKGROUND: Myocardial necrosis is a time-dependent event. Nevertheless, clinical studies on association between ischemic time and left ventricle function showed inconsistent findings. Aim of current study is to evaluate the association between ischemic time and the post-infarction left ventricular

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

    NARCIS (Netherlands)

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

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

  15. GATED SPECT TO EVALUATE LEFT VENTRICULAR MYOCARDIAL PERFUSION, FUNCTION AND DYSSYNCHRONY FOR RESYNCHRONIZATION THERAPY

    Directory of Open Access Journals (Sweden)

    E.N. Ostroumov

    2009-01-01

    Full Text Available The study included 15 consecutive patients with heart failure and substantial LV dyssynchrony undergoing CRT. Clinical and phase analysis of gated myocardial perfusion SPECT assessed at baseline, after 2–3 days and after 3–4 months of CRT. The results demonstrated inversely relationship between the response to CRT and the nonviable myocardium. Evaluation of myocardial viability is necessary to considered in the selection process for CRT.

  16. Myocardial extracellular remodeling is associated with ventricular diastolic dysfunction in children and young adults with congenital aortic stenosis.

    Science.gov (United States)

    Dusenbery, Susan M; Jerosch-Herold, Michael; Rickers, Carsten; Colan, Steven D; Geva, Tal; Newburger, Jane W; Powell, Andrew J

    2014-05-06

    This study sought to analyze cardiac magnetic resonance (CMR) measurements of myocardial extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) in children and young adults with congenital aortic stenosis (AS) to determine the extent of fibrosis and examine their association with aortic valve and ventricular function. Patients with congenital AS frequently have impaired diastolic ventricular function and exercise capacity that may be related to myocardial fibrosis. A total of 35 patients with congenital AS (median age 16 years) and 27 normal control subjects (median age 16 years) were evaluated by CMR. ECV was calculated from pre- and post-gadolinium contrast T1 measurements of blood and myocardium, and the hematocrit. ECV was significantly higher in AS patients than in normal subjects (median 0.27 [range 0.22 to 0.42] vs. 0.25 [range 0.18 to 0.27], p = 0.001). LGE was present in 8 (24%) of the AS patients. A higher ECV was correlated with echocardiographic indexes of diastolic dysfunction including a higher mitral E-wave z-score (r = 0.58, p = 0.002), E/septal E' z-score (r = 0.56, p = 0.003), E/mean E' z-score (r = 0.55, p = 0.003), and indexed left atrial volume (r = 0.56, p = 0.001). Other factors associated with an elevated ECV (>0.28) included a greater number of aortic valve interventions (p = 0.004) and a greater number of aortic valve balloon valvuloplasties (p = 0.003). ECV was not significantly associated with AS gradient, left ventricular mass, mass/volume ratio, or ejection fraction. In young patients with AS, myocardial ECV is significantly elevated compared with control subjects and is associated with echocardiographic indexes of diastolic dysfunction. ECV measured by CMR may be a useful method for risk stratification and monitoring therapies targeting fibrosis. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Right ventricular myocardial deformation patterns in children with congenital heart disease associated with right ventricular pressure overload.

    Science.gov (United States)

    Hayabuchi, Yasunobu; Sakata, Miho; Kagami, Shoji

    2015-08-01

    Longitudinal wall motion of the right ventricle (RV) has been thoroughly studied in patients with RV dysfunction. However, circumferential strain of the RV free wall has yet to be investigated. Therefore, this study was conducted to assess the utility of RV free wall circumferential strain. Strain profile curves were obtained using speckle tracking echocardiography from the subcostal left ventricular (LV) short-axis view in 30 normal children (normal group) and 25 patients with RV pressure overload (RVO group). The time-strain curves of three individual segmental (anterior, lateral, and inferior segments) and global circumferential deformations were evaluated. RV ejection fraction (RVEF), RV systolic pressure (RVSP), and RV fractional area change obtained in the four-chamber view and LV short-axis view [RVFAC (4CH) and RVFAC (SAX), respectively] were measured, and their relationships with RV free wall deformation were assessed. In the normal group, circumferential strain was significantly lower in the anterior segment than in the other segments. The inferior segment had a significantly larger strain than the other segments in the RVO group. Circumferential strain was predominant over longitudinal RV free wall strain in the RVO group (-18.4 ± 3.9 vs. -14.2 ± 3.8%, respectively; P children with RVO. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  18. Tomato (Lycopersicon esculentum) or lycopene supplementation attenuates ventricular remodeling after myocardial infarction through different mechanistic pathways.

    Science.gov (United States)

    Pereira, Bruna L B; Reis, Patrícia P; Severino, Fábio E; Felix, Tainara F; Braz, Mariana G; Nogueira, Flávia R; Silva, Renata A C; Cardoso, Ana C; Lourenço, Maria A M; Figueiredo, Amanda M; Chiuso-Minicucci, Fernanda; Azevedo, Paula S; Polegato, Bertha F; Okoshi, Katashi; Fernandes, Ana A H; Paiva, Sergio A R; Zornoff, Leonardo A M; Minicucci, Marcos F

    2017-08-01

    The objective of this study was to evaluate the influence of tomato or lycopene supplementation on cardiac remodeling after myocardial infarction (MI). Male Wistar rats were assigned to four groups: the sham group (animals that underwent simulated surgery) that received a standard chow (S; n=18), the infarcted group that received a standard chow (MI; n=13), the infarcted group supplemented with lycopene (1 mg of lycopene/kg body weight/day) (MIL; n=16) and the infarcted group supplemented with tomato (MIT; n=16). After 3 months, morphological, functional and biochemical analyses were performed. The groups MIL and MIT showed decreased interstitial fibrosis induced by infarction. Tomato supplementation attenuated the hypertrophy induced by MI. In addition, tomato and lycopene improved diastolic dysfunction evaluated by echocardiographic and isolated heart studies, respectively. The MI group showed higher levels of cardiac TNF-α compared to the MIL and MIT groups. Decreased nuclear factor E2-related factor 2 was measured in the MIL group. Lipid hydroperoxide levels were higher in the infarcted groups; however, the MIT group had a lower concentration than did the MI group [S=223±20.8, MI=298±19.5, MIL=277±26.6, MIT=261±28.8 (nmol/g); n=8; Ptomato or lycopene supplementation attenuated the cardiac remodeling process and improved diastolic function after MI. However, the effect of lycopene and tomato supplementation occurred through different mechanistic pathways. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. [Effect of rapid digitalization on the left-ventricular myocardial function according to the echocardiographic data].

    Science.gov (United States)

    Belenkov, Iu N; At'kov, O Iu; Tsibekmakher, T D

    1977-09-01

    The article deals with the data of echocardiographic examination of 61 patients (37 with rheumatic heart disease and 17 with atherosclerotic cardiosclerosis) subjected to rapid stage-by-stage digitalization by intravenous administration of various rapidly acting glycosides. In 10 patients with ischemic heart disease echocardiography was performed following a single strophanthin injection. Decrease in the volumes of the left ventricle and increase in the indices of central hemodynamics were noted as a result of rapid stage-by-stage saturation with strophanthin. The maximum inotropic effect of strophanthin does not coincide in time with the maximum chronotropic effect. The increase in the stroke volume noted in maximum deceleration of cardiac contractions is probably realized due to the Frank-Starling mechanism. Strophanthin increases the rate of myocardial contractions without changing the duration of the systole. The rate of diastolic relaxation grows, the phase of rapid filling becomes shorter and the phase of slow filling longer, which creates favourable conditions for the next contraction.

  20. 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.

  1. Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); W. Wijns (William); M.J.B.M. van den Brand (Marcel); S. Meij (Simon); J.C.H. Schuurbiers (Johan); P.W. Hugenholtz; R.W. Brower (Ronald); C.J. Slager (Cornelis)

    1984-01-01

    textabstractThe response of left ventricular function, coronary blood flow, and myocardial lactate metabolism during percutaneous transluminal coronary angioplasty (PTCA) was studied in a series of patients undergoing the procedure. From four to six balloon inflation procedures per patient were

  2. Effects of long-term adrenergic beta-blockade on left ventricular diastolic filling in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

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

    1999-01-01

    BACKGROUND: Left ventricular (LV) systolic and diastolic function are known to be affected in the wake of a myocardial infarction (MI). beta-Adrenergic blocking agents have demonstrated improvement of LV systolic and diastolic function in patients with dilated cardiomyopathy and theoretically would....... RESULTS: Mitral E-wave deceleration time was prolonged in the metoprolol group (baseline vs 12 months: 167 +/- 51 ms to 218 +/- 36 ms; P =. 01) versus the placebo group (baseline vs 12 months: placebo 174 +/- 46 ms to 189 +/- 41 ms), which implies a less restrictive filling of the LV in the metoprolol...... group. This was supported by a decrease of E/A ratio (baseline vs 12 months: placebo, 1.06 +/- 0.40 to 0.96 +/- 0.29; metoprolol, 1.09 +/- 0.33 to 0.80 +/- 0.21; P =.05) and prolongation of the isovolumetric relaxation time in the metoprolol treated group (baseline vs 12 months: placebo, 83 +/- 19 ms...

  3. Favorable effects of orally administered digoxin on left heart size and ventricular wall motion in patients with previous myocardial infarction.

    Science.gov (United States)

    O'Rourke, R A; Henning, H; Theroux, P; Crawford, M H; Ross, J

    1976-04-01

    The effects of maintenance oral digoxin therapy on segmental left ventricular wall motion (wall motion videotracking) and left heart size (radiographic left heart dimension) were evaluated in 14 patients with a prior myocardial infarction but without clinical signs or symptoms of congestive heart failure. The left heart dimension decreased in all six patients with cardiomegaly from an average of 55.0 +/- 1.6 (standard deviation) to 52.2 +/- 2.7 mm/m2 body surface area (P less than 0.01) during digoxin therapy. However, there was no significant change in the eight patients with normal heart size. In the resting state, the average extent of shortening in normal segments increased significantly from 3.1 +/- 0.8 to 4.2 +/- 1.2 mm during digoxin therapy. During submaximal handgrip exercise, the extent of shortening averaged 4.0 +/- 1.3 mm and increased further with digoxin therapy to 5.1 +/- 2.1 mm. The effects of digoxin therapy on the maximal velocity of shortening in normal segments at rest and during handgrip exercise were similar. In all 14 patients, there was a decrease in the number of segments with abnormal wall motion at rest or with handgrip exercise during digoxin therapy. With therapy, the number of abnormal sites decreased from 52 to 35 in the resting state and from 84 to 49 during handgrip exercise. Thus, in patients 6 or more months after transmural myocardial infarction, orally administered digoxin decreases cardiomegaly, increases the extent and maximal velocity of shortening in normal left ventricular segments and often reduces the extent of abnormal wall motion at rest or during isometric exercise.

  4. Cardiac resynchronization therapy evaluated by myocardial scintigraphy with {sup 99m}Tc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

    Energy Technology Data Exchange (ETDEWEB)

    Brandao, Simone C.S.; Nishioka, Silvana A.D.; Giorgi, Maria C.P.; Abe, Rubens; Filho, Martino Martinelli; Hotta, Viviane T.; Vieira, Marcelo L.; Meneghetti, Jose C. [University of Sao Paulo Medical School, Heart Institute (InCor), Sao Paulo, SP (Brazil); Chen, Ji; Garcia, Ernest V. [Emory University, Atlanta, GA (United States)

    2009-06-15

    {sup 99m}Tc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial {sup 99m}Tc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT. A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial {sup 99m}Tc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase. After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall {sup 99m}Tc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall {sup 99m}Tc-MIBI uptakes were higher in group 1 than in group 2 (p<0.05). EDV was the only independent predictor of an increase in LVEF (p=0.01). The optimal EDV cut-off point was 315 ml (sensitivity 89%, specificity 94%). The evaluation of EDV by GMS added information on patient selection for CRT. After CRT, LVEF increase occurred in hearts less dilated and with more normal {sup 99m}Tc-MIBI uptake. (orig.)

  5. Amiodarone therapy for sustained ventricular tachycardia after myocardial infarction: long-term follow-up, risk assessment and predictive value of programmed ventricular stimulation.

    Science.gov (United States)

    Maury, P; Zimmermann, M; Metzger, J; Reynard, C; Dorsaz, P; Adamec, R

    2000-01-01

    We determine the value of the programmed ventricular stimulation (PVS) and of clinical, angiographic and electrophysiologic variables in assessing the long-term risk of arrhythmia recurrence in a group of coronary artery diseased patients presenting with a first episode of monomorphic sustained ventricular tachycardia (VT) treated with amiodarone. Mortality and arrhythmia recurrence rates were retrospectively assessed in 55 consecutive patients with previous myocardial infarction presenting with a first VT episode. Results of left heart catheterization, echocardiography and time-domain signal-averaging were collected. Patients underwent PVS after amiodarone oral loading and were classified according to inducibility before being all discharged on amiodarone (200 mg daily). The mean follow-up was 42+/-31 months. Total and cardiac mortality rates were 29% (16 patients) and 23% (13 patients) respectively. Sudden death (SD) occurred in nine patients (16%). VT recurred in 13 patients (23%). Sustained monomorphic VT was inducible in 40 patients (72%) after amiodarone loading. Neither total mortality (10/40 vs. 6/15) nor cardiac mortality (3/40 vs. 1/15) were significantly different between inducible and non-inducible patients. Recurrent VT rate was 27% (11/40 patients) for the inducible group and 13% (2/15 patients) for the non-inducible group (NS). SD occurred in 6/40 inducible patients (15%) and in 2/15 non-inducible patients (13%) (NS). Arrhythmic events occurred in 42% (17/40) inducible patients vs. 26% (4/15) non-inducible patients (P=0.07). Parameters correlated with outcome were ejection fraction (EF) (5 SD/11 patients with EF 0.3, P=0.003), mitral insufficiency (MI) (4 SD/10 patients with MI vs. 4/44 patients without MI, P=0.004) and age (65+/-9 years for patients with VT recurrence vs. 58+/-9, P=0.02). Although the risk stratification can be improved, reliable and safe long-term prediction of recurrence of malignant ventricular arrhythmia in individual patients

  6. Effect of exhaustive exercise on myocardial performance.

    Science.gov (United States)

    Grimditch, G K; Barnard, R J; Duncan, H W

    1981-11-01

    Several investigators have reported ultrastructural changes in hearts of animals exercised to exhaustion. The present study was designed to determine whether functional changes occur in the intact heart at exhaustion. Adult mongrel dogs (n = 8) were chronically instrumented to measure cardiac output, coronary blood flow, aortic blood pressure, left ventricular pressure, +dP/dtmax, and -dP/dtmax. After recovery, the dogs were run to exhaustion at a constant work load, eliciting approximately 70% of maximum heart rate. The exhaustive bouts were terminated when the animals either refused or were unable to continue running, at which time their rectal temperatures approaches 42.2 degree C. The mean exhaustion time was 76.7 +/- 11.8 min. All parameters increased from rest to steady state with the exception of stroke volume (23.2 +/- 4.9 vs. 20.5 +/- 1.6 ml), which remained constant. In the transition from steady state to exhaustion, only +dP/dtmax (6,652 +/- 291 vs. 7,689 +/- 479 Torr/s) and -dP/dtmax (4,110 +/- 227 vs. 4,890 +/- 215 Torr/s) increased significantly; all other values exhibited no significant change. Similarly, when maximum cardiovascular parameters were measured before and after exhaustion, no significant changes were found. These data show that cardiac contractile function is not depressed in dogs as a result of exhaustive exercise.

  7. A prospective study found impaired left ventricular function predicted job retirement after acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, Finn E; Sørensen, Henrik T; Skagen, Knud

    2004-01-01

    adjusting for confounding factors, reduced LVEF was an independent predictor of retirement. Based on a stratified analysis, being female (RR=3.90, 95% CI=1.18-12.62) or having heavy physical job demands (RR=3.83, 95% CI=1.02-14.30) had a more pronounced impact on retirement for patients with LVEF 35......%, compared with patients with better left ventricular function. CONCLUSION: We conclude that impaired left ventricular systolic function is a prognostic determinant of retirement from the job market after acute MI....

  8. Assessment of Myocardial Function During Mechanical Left Ventricular Support Using Serial Echocardiography: A Case Report

    OpenAIRE

    Ishino, Kozo; Murakami, Taiji; Takata, Koji; KINO, Koichi; Senoo, Yoshimasa; Teramoto, Shigeru

    1994-01-01

    A 40-year-old man with valvular heart disease was successfully treated using a left ventricular assist device (LVAD) after open heart surgery. Echocardiography revealed left ventricular ejection fraction (LV-EF) at LVAD on/off: 23.4%/14.6% on the 4th, 23.8%/23.8% on the 5th, and 23.8%/26.8% on the 6th postoperative day (POD), respectively. The patient was weaned from LVAD on the 8th POD and discharged from the hospital on the 58th POD. The LV-EF improved to 54% 6 months after surgery and incr...

  9. Subacute and Chronic Left Ventricular Myocardial Scar: Accuracy of Texture Analysis on Nonenhanced Cine MR Images.

    Science.gov (United States)

    Baessler, Bettina; Mannil, Manoj; Oebel, Sabrina; Maintz, David; Alkadhi, Hatem; Manka, Robert

    2018-01-01

    Purpose To test whether texture analysis (TA) allows for the diagnosis of subacute and chronic myocardial infarction (MI) on noncontrast material-enhanced cine cardiac magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 120 patients who underwent cardiac MR imaging and showed large transmural (volume of enhancement on late gadolinium enhancement [LGE] images >20%, n = 72) or small (enhanced volume ≤20%, n = 48) subacute or chronic ischemic scars were included. Sixty patients with normal cardiac MR imaging findings served as control subjects. Regions of interest for TA encompassing the left ventricle were drawn by two blinded, independent readers on cine images in end systole by using a freely available software package. Stepwise dimension reduction and texture feature selection based on reproducibility, machine learning, and correlation analyses were performed for selecting features, enabling the diagnosis of MI on nonenhanced cine MR images by using LGE imaging as the standard of reference. Results Five independent texture features allowed for differentiation between ischemic scar and normal myocardium on cine MR images in both subgroups: Teta1, Perc.01, Variance, WavEnHH.s-3, and S(5,5)SumEntrp (in patients with large MI: all P values cine MR images, with an area under the curve of 0.93 and 0.92, respectively. Conclusion This proof-of-concept study indicates that TA of nonenhanced cine MR images allows for the diagnosis of subacute and chronic MI with high accuracy. © RSNA, 2017 Online supplemental material is available for this article.

  10. Malignant Multivessel Coronary Spasm Complicated by Myocardial Infarction, Transient Complete Heart Block, Ventricular Fibrillation, Cardiogenic Shock and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Viji S. Thomson

    2014-07-01

    Full Text Available Multivessel coronary spasm resulting to cardiogenic shock and malignant ventricular arrhythmias though rare has been reported in the literature. The disease seems to be more prevalent in Asians. There have been isolated reports of coronary spasm in patients with reactive airway disease. We report the first case of spontaneous multivessel spasm in a male patient with bronchial asthma of Arab ethnicity resulting in acute myocardial infarction complicated by cardiogenic shock, recurrent ventricular arrhythmias, and transient complete heart block. Literature review of similar cases suggests a strong association with bronchial asthma and a more malignant course in patients with reactive airway disease. The role of intracoronary nitroglycerin in proving the diagnosis even in patients in shock on maximal inotropic supports and intra-aortic balloon pump is highlighted and the importance of considering multivessel coronary spasm as a cause for acute coronary syndrome even in patients with conventional risk factors for atherosclerotic coronary artery disease is reinforced in the discussion of this case.

  11. Ethanol-Associated Cardiomyocyte Apoptosis and Left Ventricular Dilation Are Unrelated to Changes in Myocardial Telomere Length in Rats.

    Science.gov (United States)

    Raymond, Andrew R; Becker, Jason; Woodiwiss, Angela J; Booysen, Hendrik L; Norton, Gavin R; Brooksbank, Richard L

    2016-04-01

    The aim of this work was to determine whether ethanol-associated myocardial apoptosis and cardiac dilation are related to myocardial telomere shortening in rats. Sprague-Dawley (SD) rats received either drinking water with (ethanol: n = 19) or without (control: n = 19) 5% (v/v) ethanol ad libitum, for 4 months. Left ventricular (LV) dimensions and function (echocardiography and isolated perfused heart preparations), cardiomyocyte apoptosis (terminal deoxynucleotide transferase-mediated dUTP nick-end labeling), and leukocyte and myocardial telomere length (real-time polymerase chain reaction) were determined at the end of the study. Ethanol administration resulted in a marked increase in cardiomyocyte apoptosis (ethanol 0.85 ± 0.13% vs control 0.36 ± 0.06%; P = .0021) and LV dilation (LV end-diastolic diameter: ethanol 8.20 ± 0.14 mm vs control 7.56 ± 0.11 mm [P = .0014]; volume intercept at 0 mm Hg (V0) of the LV end-diastolic pressure-volume relationship: ethanol 0.40 ± 0.03 mL vs control 0.31 ± 0.02 mL [P = .020]). However, there were no changes in systolic chamber function as indexed by LV endocardial fractional shortening or the slope of the LV systolic pressure-volume relationship (end systolic elastance). The percentage of myocardial apoptosis was correlated with the degree of LV dilation (% apoptosis vs LV EDD: r = 0.39; n = 38; P = .021; vs V0: r = 0.44; n = 19; P = .046). No differences in leukocyte or cardiac telomere length were noted between the ethanol and control groups. Furthermore, cardiac telomere length was not associated with indexes of LV dilation (LVEDD and V0) or cardiomyocyte apoptosis. Chronic ethanol-associated myocardial apoptosis and adverse remodeling occurs independently from changes in cardiac telomere length. Telomere shortening may not be a critical mechanism responsible for cardiomyocyte apoptosis and adverse cardiac remodeling. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Apical left ventricular myocardial dysfunction is an early feature of cardiac involvement in myotonic dystrophy type 1.

    Science.gov (United States)

    Garcia, Rodrigue; Labarre, Quentin; Degand, Bruno; Ingrand, Pierre; Le Gal, François; Bonnet, Benjamin; Delaubier, Anne; Guillou, Claire; Gellen, Barnabas; Coisne, Damien; Bouleti, Claire; Christiaens, Luc

    2017-02-01

    Left ventricular (LV) dysfunction is a major prognostic determinant in myotonic dystrophy type 1 (DM1). Therefore, markers of early-stage LV impairment may be useful. The aim of this study was to evaluate 2D echocardiographic LV strain in a cohort of DM1 patients with preserved left ventricular ejection fraction (LVEF) and to compare the results with matched controls. This prospective single-center study included 33 consecutive DM1 patients between February 2014 and February 2015. Mean age was 38.2±12.9 years, and 17 (52%) were males. Exclusion criteria were LVEF 120 milliseconds, history of atrial fibrillation, and presence of a pacemaker with ventricular pacing. DM1 patients were matched to healthy controls according to sex and age. DM1 patients showed significant impairment of global longitudinal strain (GLS) as compared to controls (-18.0±1.9 vs -19.1±2.4; P=.03), characterized by a marked alteration at the apex (-20.0±3.3 vs -22.7±3.1; P<.001). DM1 patients had also global radial strain impairment (20.0±9.8 vs 27.5±14.9; P=.024) compared to controls while global circumferential strain was not statistically different between groups (P=.94). Intra- and inter-observer analysis showed good reproducibility of GLS. Despite preserved LVEF, DM1 patients exhibited significantly altered LV GLS, particularly at the apex, as compared with controls. The detection of impaired myocardial deformation at early stages of the disease might help to screen high-risk patients who need closer follow-up. © 2017, Wiley Periodicals, Inc.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    , including age, ejection fraction, and Killip's classification, decreased RVFAC was independently associated with increased risk of all-cause mortality (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.31 to 1.98), CV death (HR 1.62, 95% CI 1.30 to 2.01), sudden death (HR 1.79, 95% CI 1.26 to 2.54), HF......Severe right ventricular dysfunction independent of left ventricular ejection fraction increased the risk of heart failure (HF) and death after myocardial infarction (MI). The association between right ventricular function and other clinical outcomes after MI was less clear. Two......-dimensional echocardiograms were obtained in 605 patients with left ventricular dysfunction and/or clinical/radiologic evidence of HF from the VALIANT echocardiographic substudy (mean 5.0 +/- 2.5 days after MI). Clinical outcomes included all-cause mortality, cardiovascular (CV) death, sudden death, HF, and stroke. Baseline...

  14. Left ventricular myocardial function in congenital valvar aortic stenosis assessed by ultrasound tissue-velocity and strain-rate techniques.

    NARCIS (Netherlands)

    Kiraly, P.; Kapusta, L.; Thijssen, J.M.; Daniëls, O.

    2003-01-01

    A pilot study was performed to reveal the potentials of new echo Doppler techniques for the detection of myocardial changes due to congenital valvar aortic stenosis. A total of 24 patients, (age range 0.1 to 17 years), with various degrees of aortic stenosis, and 24 age- and gender-matched, healthy

  15. Myocyte necrosis underlies progressive myocardial dystrophy in mouse dsg2-related arrhythmogenic right ventricular cardiomyopathy

    NARCIS (Netherlands)

    Pilichou, K.; Remme, C.A.; Basso, C.; Campian, M.E.; Rizzo, S.; Barnett, P.; Scicluna, B.P.; Bauce, B.; van den Hoff, M.J.B.; de Bakker, J.M.T.; Tan, H.L.; Valente, M.; Nava, A.; Wilde, A.A.M.; Moorman, A.F.M.; Thiene, G.; Bezzina, C.R.

    2009-01-01

    Mutations in the cardiac desmosomal protein desmoglein-2 (DSG2) are associated with arrhythmogenic right ventricular cardiomyopathy (ARVC). We studied the explanted heart of a proband carrying the DSG2-N266S mutation as well as transgenic mice (Tg-NS) with cardiac overexpression of the mouse

  16. Additional predictive value of serum potassium to Thrombolysis In Myocardial Infarction risk score for early malignant ventricular arrhythmias in patients with acute myocardial infarction.

    Science.gov (United States)

    Su, Jianling; Fu, Xianghua; Tian, Yingping; Ma, Yuteng; Chen, Hui; Wang, Yanbo; Wang, Xuechao; Liu, Huining

    2012-09-01

    The aim of this study was to evaluate the additional predictive value of serum potassium (SK) to Thrombolysis In Myocardial Infarction (TIMI) risk score for malignant ventricular arrhythmias (MVA) in patients within 24 hours of acute myocardial infarction (AMI). This was a 6-year retrospective study. The receiver operating characteristic curve was used to evaluate the predictive value of SK and TIMI risk score for MVA attack. In addition, SK-modified TIMI risk score was created by incorporating SK information into the usual score; the accuracy of new score was compared with that of the usual TIMI risk score by comparing the area under the receiver operating characteristic curves (AUC). Among the 468 patients enrolled, the incidence of MVA 24 hours after AMI was 9.4%, and it was higher in the hypokalemia group compared with that of the normokalemic group (27.3% vs 7.5%, P value of SK was indicated by AUC of 0.787 (95% CI, 0.747-0.823, P risk score. The AUC of TIMI risk score in relation to MVA was 0.586 (95% CI, 0.54-0.631; P = .0676). The incorporation of SK into TIMI risk score improved its predictive value for MVA attack (AUC = 0.66; 95% CI, 0.568-0.753; P risk score (Z = 2.474, P = .013). Serum potassium on admission to the emergency department may be used as a valuable predictor and could add predictive information to some extent to TIMI risk score for MVA attack during 24-hour post-AMI. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Distal coronary embolization following acute myocardial infarction increases early infarct size and late left ventricular wall thinning in a porcine model.

    Science.gov (United States)

    Thomas, Reuben M; Lim, Sang Yup; Qiang, Beiping; Osherov, Azriel B; Ghugre, Nilesh R; Noyan, Hossein; Qi, Xiuling; Wolff, Rafael; Ladouceur-Wodzak, Michelle; Berk, Thomas A; Butany, Jagdish; Husain, Mansoor; Wright, Graham A; Strauss, Bradley H

    2015-12-01

    Distal coronary embolization (DCE) of thrombotic material occurs frequently during percutaneous interventions for acute myocardial infarction and can alter coronary flow grades. The significance of DCE on infarct size and myocardial function remains unsettled. The aims of this study were to evaluate the effects of DCE sufficient to cause no-reflow on infarct size, cardiac function and ventricular remodeling in a porcine acute myocardial infarction model. Female Yorkshire pigs underwent 60 min balloon occlusion of the left anterior descending coronary artery followed by reperfusion and injection of either microthrombi (prepared from autologous porcine blood) sufficient to cause no-reflow (DCE), or saline (control). Animals were sacrificed at 3 h (n = 5), 3 days (n = 20) or 6 weeks (n = 20) post-AMI. Cardiovascular magnetic resonance (CMR), serum troponin-I, and cardiac gelatinase (MMP) and survival kinase (Akt) activities were assessed. At 3d, DCE increased infarct size (CMR: 18.8% vs. 14.5%, p = 0.04; serum troponin-I: 13.3 vs. 6.9 ng/uL, p infarct size, ventricular volume or ejection fraction between the two groups, although infarct transmurality (70% vs. 57%, pinfarct size, but without affecting later infarct size, cardiac function or ventricular volumes. The significance of the later remodelling changes (ventricular thinning and transmurality) following DCE, possibly due to changes in MMP-2 activity and Akt activation, merits further study.

  18. Relationship between infarct tissue characteristics and left ventricular remodeling in patients with versus without early revascularization for acute myocardial infarction as assessed with contrast-enhanced cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    Olimulder, Marlon; Olimulder, M.A.G.M.; Galjee, M.A.; Wagenaar, L.J.; van Es, J.; van der Palen, Jacobus Adrianus Maria; von Birgelen, Clemens

    2012-01-01

    Left ventricular (LV) remodeling following myocardial infarction (MI) is the result of complex interactions between various factors, including presence or absence of early revascularization. The impact of early revascularization on the relationship between infarct tissue characteristics and LV

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

    OpenAIRE

    Fosshaug Linn E; Berge Rolf K; Beitnes Jan O; Berge Kjetil; Vik Hogne; Aukrust Pål; Gullestad Lars; Vinge Leif E; Øie Erik

    2011-01-01

    Background In the western world, heart failure (HF) is one of the most important causes of cardiovascular mortality. Supplement with n-3 polyunsaturated fatty acids (PUFA) has been shown to improve cardiac function in HF and to decrease mortality after myocardial infarction (MI). The molecular structure and composition of n-3 PUFA varies between different marine sources and this may be of importance for their biological effects. Krill oil, unlike fish oil supplements, conta...

  20. Left Ventricular Contractile State in patients Undergoing Rehabilitation after myocardial infarction

    OpenAIRE

    Merhel, T. V.

    2015-01-01

    In patients with postinfarction cardiosclerosis chronic heart failure occurs and progresses in the presence of cardiovascular risk factors such as hypertension (HT), diabetes mellitus (DM), dyslipidemia, smoking, obesity, sedentary lifestyle. According to clinical anamnesis and ECG data of post-myocardial infarction patients the course and prognosis of the disease was more favourable in patients who underwent endovascular reperfusion therapy using coronary stenting. Conducting percutaneous co...

  1. 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...... 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...

  2. A Common Variant in SCN5A and the Risk of Ventricular Fibrillation Caused by First ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Glinge, Charlotte; Jabbari, Javad

    2017-01-01

    infarction (STEMI). METHODS: We analyzed 27 single nucleotide polymorphisms (SNP) previously associated with SCD/VF in other cohorts, and examined whether these SNPs were associated with VF caused by first STEMI in the GEnetic causes of Ventricular Arrhythmias in patients with first ST-elevation Myocardial...... such as age, sex, family history of sudden death, alcohol consumption, previous atrial fibrillation, statin use, angina, culprit artery, and thrombolysis in myocardial infarction (TIMI) flow, the C/C genotype of rs11720524 was still significantly associated with VF with an OR of 1.9 (95% CI: 1.05-3.43; P = 0...

  3. Serial Echocardiographic Assessment of Left Ventricular Filling Pressure and Remodeling among ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Intervention.

    Science.gov (United States)

    Shacham, Yacov; Khoury, Shafik; Flint, Nir; Steinvil, Arie; Sadeh, Ben; Arbel, Yaron; Topilsky, Yan; Keren, Gad

    2016-08-01

    Acute myocardial infarction and remodeling of the left ventricle is associated with significant changes in systolic and diastolic echocardiographic derived indices. The investigators have tried to determine whether persistence of increased ratio of transmitral flow velocity (E) to early mitral annulus velocity (e'), signifying increased cardiac filling pressure, is associated with left ventricular (LV) remodeling and increased chamber size among patients presenting with ST-segment elevation myocardial infarction, who underwent successful reperfusion with primary percutaneous coronary intervention. Fifty-two patients (76% men; mean age, 61 ± 10 years) with first ST-segment elevation myocardial infarctions who underwent primary percutaneous coronary intervention were retrospectively studied. Echocardiography was performed at baseline (days 1-3) and after 178 ± 62 days. Patients were stratified according to E/septal e' ratio >15 and ≤15 in both examinations. All patients received optimal medical therapy according to guidelines and local practice. Patients with maintained or worsened E/septal e' ratios to >15 demonstrated on the second examination worse LV ejection fractions (mean, 45 ± 12% vs 52 ± 8%; P = .03) and higher indexed LV end-diastolic volumes (mean, 81.3 ± 22.9 vs 69.2 ± 13.4 mL/m(2); P = .01) and end-systolic volumes (mean, 33.0 ± 12.2 vs 23.7 ± 13.4 mL/m(2); P = .02) compared with the first examination, representing LV remodeling. Patients with E/septal e' ratios > 15 on the second examination demonstrated a positive correlation between the change in E/septal e' ratio and the change in indexed LV end-diastolic volume (linear R(2) = 0.344, P = .03). Among patients with ST-segment elevation myocardial infarctions undergoing primary percutaneous coronary intervention, early and persistent elevation of the E/septal e' ratio may be associated with LV remodeling. Copyright © 2016 American Society of Echocardiography

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

    DEFF Research Database (Denmark)

    Melchior, T; Gadsbøll, N; Hildebrandt, P

    1996-01-01

    compared with non-diabetic patients independent of left ventricular ejection fraction. Univariate analysis showed that the cumulative 5-year mortality rate was 53% in the group with diabetes compared with 43% in the non-diabetic group (p = 0.007). Using multivariate regression analysis presence of diabetes...... survivors of acute myocardial infarction, 47 of whom had Type 2 (non-insulin-dependent) diabetes mellitus. None of the patients were treated with insulin. The prevalence of congestive heart failure during hospitalization was similar in patients with and without diabetes, although mean diuretic dose......Patients with diabetes mellitus have a high morbidity and mortality from acute myocardial infarction, the reason for which is not fully understood. The relationship between congestive heart failure symptoms, left ventricular ejection fraction, and long-term mortality was examined in 578 hospital...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-04-15

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

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

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2013-12-01

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

  7. Changes of Ventricular Myocytes Membrane Capacitance in Rabbit with Myocardial Infarction and Effects of Carvedilol

    DEFF Research Database (Denmark)

    Niu, Hui-Yan; Liang, Bo; Liu, Nian

    2005-01-01

    Objective: To investigate effects of long-term treatment of oral Carvedilol on ventricular myocytes membrane capacitance in HMI. Methods: 30 rabbits were randomly assigned in three groups: HMI group, ligation of circumflex coronary artery; Carvedilol group, with operation the same as HMI group......, and administration of oral Carvedilol 0.33 mg/kg×3 months beginning on the day of operation; Sham group, left thoracotomy with no coronary artery ligation. 3 months after surgery, rabbits were harvested. Myocytes were isolated by enzymatic method. The cell membrane capacitance was recorded by using the whole cell...

  8. Percutaneous intramyocardial delivery of mesenchymal stem cells induces superior improvement in regional left ventricular function compared with bone marrow mononuclear cells in porcine myocardial infarcted heart.

    Science.gov (United States)

    Tao, Bo; Cui, Mingliang; Wang, Chen; Ma, Sai; Wu, Feng; Yi, Fu; Qin, Xing; Liu, Junting; Wang, Haichang; Wang, Zhe; Ma, Xiaowei; Tian, Jie; Chen, Yundai; Wang, Jing; Cao, Feng

    2015-01-01

    To investigate the efficacy and feasibility of percutaneous intramyocardial injection of bone marrow mesenchymal stem cells (MSC) and autologous bone marrow-derived mononuclear cells (BMMNC) on cardiac functional improvement in porcine myocardial infarcted hearts. Acute myocardial infarction (AMI) was induced in 22 minipigs by temporary balloon occlusion of the left anterior descending coronary artery for 60 min.Two weeks post AMI, BMMNC (n = 7, 245 ± 98 × 10(6)), MSC (n = 8, 56 ± 17 × 10(6)), or phosphate buffered saline (PBS; n = 7) were injected intramyocardially. Cardiac function and myocardial perfusion were analyzed by echocardiography and gated single-photon emission computed tomography/computed tomography (SPECT/CT) at 1 week before AMI and 2 and 10 weeks after AMI. Cell engraftment, proliferation, vascular density, and cardiac fibrosis were evaluated by histology analysis. In all groups, the echocardiography revealed no significant change in the left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), or left ventricular end-diastolic volume (LVEDV) at 10 weeks after AMI compared with those at 2 weeks after AMI. However, the wall motion score index (WMSI) and left ventricular systolic wall thickening (WT%) were significantly improved at 10 weeks compared with those at 2 weeks after AMI in the MSC group (WMSI 1.55 ± 0.06 vs. 1.87 ± 0.10, WT 33.4 ± 2.3% vs.24.8 ± 2.7%,p < 0.05) but not in the BMMNC group. In addition, myocardial perfusion quantified by SPECT/CT was improved in both the MSC and BMMNC groups, whereas the MSC group showed a superior improvement in vascular density and collagen volume fraction (p < 0.05). This preclinically relevant study suggests that when delivered by percutaneous (transcatheter) intramyocardial injection, MSC might be more effective than BMMNC to improve ischemia and reperfusion after AMI.

  9. Myocardial Scar Identified by Magnetic Resonance Imaging Can Predict Left Ventricular Functional Improvement after Coronary Artery Bypass Grafting

    Science.gov (United States)

    Sun, Han-Song; Tang, Yue; Pan, Shi-Wei; Zhao, Shi-Hua

    2013-01-01

    Background Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG). Methods From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed. Results The baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, pscar tissue was superior to viable myocardium in predicting cardiac functional recovery (pscar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization. PMID:24358136

  10. Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Tao Yang

    Full Text Available BACKGROUND: Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR on functional recovery in patients undergoing coronary artery bypass grafting (CABG. METHODS: From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA 6 months post-CABG. Predictors for global functional recovery were analyzed. RESULTS: The baseline LVEF was 32.7 ± 9.2%, which improved to 41.6 ± 11.0% 6 months later and 32/52 patients improved LVEF by ≥ 5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172-6.996, p = 0.021. Receiver-Operator-Characteristic (ROC analysis demonstrated that ≤ 4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001. Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001. CONCLUSIONS: Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.

  11. Design and rationale of a multicentre, randomised, double-blind, placebo-controlled clinical trial to evaluate the effect of vitamin D on ventricular remodelling in patients with anterior myocardial infarction: the VITamin D in Acute Myocardial Infarction (VITDAMI) trial

    OpenAIRE

    Tu??n, Jos?; Gonz?lez-Hern?ndez, Ignacio; Llanos-Jim?nez, Luc?a; Alonso-Mart?n, Joaqu?n; Escudier-Villa, Juan M; Tar?n, Nieves; Crist?bal, Carmen; Sanz, Petra; Pello, Ana M; Ace?a, ?lvaro; Carda, Roc?o; Orejas, Miguel; Tom?s, Marta; Beltr?n, Paula; Calero Rueda, Marta

    2016-01-01

    Introduction Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI. Methods and analysis The VITami...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  13. Effects of (−)-epicatechin on myocardial infarct size and left ventricular remodeling following permanent coronary occlusion

    Science.gov (United States)

    Yamazaki, Katrina Go; Taub, Pam R; Barraza-Hidalgo, Maraliz; Rivas, Maria M; Zambon, Alexander C; Ceballos, Guillermo; Villarreal, Francisco J

    2010-01-01

    Objectives We examined the effects of the flavanol (−)-epicatechin on short and long-term infarct size and left ventricular (LV) structure/function after permanent coronary occlusion (PCO) and the potential involvement of the protective AKT/ERK signaling pathways. Background (−)-Epicatechin reduces blood pressure in hypertensive patients and limits infarct size in animal models of myocardial ischemia-reperfusion injury. However, nothing is known about its effects on infarction after PCO. Methods (−)-Epicatechin (1mg/kg/day) treatment (Tx) was administered via daily oral gavage to 250 g male rats for 10 days prior to PCO and continued afterwards. PCO controls received water. Sham animals underwent thoracotomy and treatment in the absence of PCO. Immunoblots assessed AKT/ERK involvement 2 h after PCO. LV morphometry and function were measured 48 h and 3 weeks post-PCO. Results In the 48 h group, Tx reduced infarct size by 52%. There were no differences in hemodynamics amongst the different groups (heart rate, aortic and LV pressures). Western blots revealed no differences in AKT or ERK phosphorylation levels. At 3 weeks, PCO control animals demonstrated significant increases in LV end-diastolic pressure, heart weight/body weight, and LV chamber diameter vs. sham. PCO + (−)-epicatechin group values were comparable to sham + (−)-epicatechin. Tx resulted in a 33% decrease in MI size. LV pressure-volume curves demonstrated a right shift in control PCO animals, whereas (−)-epicatechin were comparable to sham. LV scar area strains were significantly improved with (−)-epicatechin. Conclusions These results demonstrate the unique capacity of (−)-epicatechin to confer cardioprotection in the setting of a severe form of myocardial ischemic injury. Protection is sustained over time and preserves LV structure/function. The cardioprotective mechanism(s) of (−)-epicatechin appear unrelated to AKT or ERK activation. (−)-Epicatechin warrants further investigation

  14. The influence of type 2 diabetes mellitus on the frequency and complexity of ventricular arrhythmias and heart rate variability in patients after myocardial infarction

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    Stoičkov Viktor

    2016-01-01

    Full Text Available Background/Aim. After myocardial infarction arrhythmic cardiac deaths are significantly more frequent compared to non-arrhythmic ones. The aim of the study was to investigate the influence of type 2 diabetes mellitus (T2DM on the frequency and complexity of ventricular arrhythmias after myocardial infarction. Methods. The study included 293 patients, mean age 59.5 ± 9.21 years, who were at least six months after acute myocardial infarction with the sinus rhythm, without atrioventricular blocks and branch blocks. In the clinical group 95 (32.42% patients were with T2DM, while 198 (67.57% patients were without diabetes. All of the patients were subjected to the following procedures: standard ECG according to which the corrected QT dispersion (QTdc was calculated, exercise stress test, and 24-hour holter monitoring according to which, the four parameters of time domain of heart rate variability (HRV were analyzed: standard deviation of all normal RR intervals during 24 hours (SDNN, standard deviation of the averages of normal RR intervals in all five-minute segments during 24 hours (SDANN, the square root of the mean of the sum of the squares of differences between adjacent normal (RMS-SD, and percentage of consequtive RR intervals which differed for more than 50 ms during 24 hours (NN > 50 ms. Results. In patients after myocardial infarction, patients with T2DM had significantly higher percentage of frequent and complex ventricular arrhythmias compared to the patients without diabetes (p 50 ms (p < 0.001, and significantly higher values of QTdc (p < 0.001 compared to the patients without diabetes. Conclusion. The study showed that type 2 diabetes mellitus has significant influence on ventricular arrhythmias, HRV parameters and QT dispersion in patients after myocardial infarction.

  15. [Influence of leukocytes on coronary flow reserve, left ventricular systolic function, and in-hospital events, in patients with acute anterior myocardial infarction treated by primary angioplasty].

    Science.gov (United States)

    Meimoun, P; Elmkies, F; Boulanger, J; Zemir, H; Benali, T; Espanel, C; Clerc, J; Doutrelan, L; Beausoleil, M; Luycx-Bore, A

    2010-11-01

    To assess the relationship between leukocyte count, non invasive coronary flow reserve (CFR), left ventricular systolic function, and in-hospital adverse events in acute anterior myocardial infarction (AMI) treated by primary angioplasty. Leukocyte count at admission and within 24h after angioplasty, and differential count at admission were obtained in 72 consecutive patients with a first AMI (mean age 56±12 years) successfully treated by primary angioplasty. Transthoracic Doppler echocardiography was performed within 24h after angioplasty and 3 months later to assess the CFR (using intravenous adenosine), in the left anterior descending artery (LAD), left ventricular ejection fraction (LVEF) and the wall motion score index using the nine segments assigned to the LAD territory (WMSi-lad). In hospital events were defined as death, heart failure (Killip≥2) and reinfarction. Leukocyte count was higher before and after angioplasty in patients with impaired acute CFR (leukocyte, neutrophil and monocyte count (PLeukocyte (before and after angioplasty), and neutrophil count, were lower in patients with recovery of global and regional LV function (Pleukocyte count before and after angioplasty, and, initial and follow-up LVEF, and WMSi-lad (all, P≤0.01). Leukocyte (before and after angioplasty) and monocyte count were higher in patients with in-hospital events (n=14), by comparison to patients without events (all, Pleukocyte count after angioplasty was an independent predictor of CFR, and in-hospital events, and neutrophil count of WMSi-lad at follow-up (all, Pleukocyte count is inversely correlated to CFR, and global and regional LV systolic function at follow-up. These links are higher after than before reperfusion. And, leukocyte count after angioplasty is an independent predictor of in-hospital adverse events. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  16. Pseudoinfarto agudo do miocárdio devido à síndrome da disfunção ventricular apical transitória (síndrome de Takotsubo Pseudo-acute myocardial infarction due to transient apical ventricular dysfunction syndrome (Takotsubo syndrome

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    Bruno Araújo Maciel

    2013-03-01

    Full Text Available A síndrome de Takotsubo caracteriza-se por disfunção ventricular esquerda transitória, predominantemente medioapical, desencadeada caracteristicamente por estresse físico ou emocional. Relata-se aqui o caso de uma paciente de 61 anos de idade, admitida com tontura, sudorese profusa e mal-estar súbito, após intenso estresse emocional. Exame físico e eletrocardiograma inicial foram normais, porém havia elevação de troponina I e CKMB massa. Suspeitou-se de infarto agudo do miocárdio sem supradesnivelamento do segmento ST, indicando cineangiocoronariografia de urgência. Foram evidenciados ventrículo esquerdo com hipocinesia difusa grave, balonamento sistólico medioapical e coronárias sem lesões significativas. A paciente foi encaminhada aos cuidados intensivos, evoluindo satisfatoriamente com terapia de suporte. Conforme visto, a cardiomiopatia de Takotsubo pode simular infarto agudo do miocárdio, sendo a cineangiocoronariografia importante para distinção na fase aguda. Neste caso, a paciente evoluiu com resolução espontânea da disfunção ventricular, sem sequelas.Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive

  17. Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion.

    Science.gov (United States)

    Hutyra, Martin; Skála, Tomáš; Horák, David; Köcher, Martin; Tüdös, Zbyněk; Zapletalová, Jana; Přeček, Jan; Louis, Albert; Smékal, Aleš; Táborský, Miloš

    2015-03-01

    Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS -20%, 5th day RV-LS -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

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

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    Ilić Ivan

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

  20. [Redistribution of 201 Tl after myocardial scintigraphy with dipyridamole: value in the detection of coronary stenosis and ventricular kinetic anomalies].

    Science.gov (United States)

    Demangeat, J L; Wolff, F

    1985-12-01

    One hundred and eight-four patients suspected of having coronary artery disease underwent coronary and left ventricular angiography and Tl 201 myocardial scintigraphy with dipyridamole including images of redistribution after 3-4 hours. The results of scintigraphy were assessed visually in all cases and by quantitative analysis in 91 patients. Comparison of early (DIP) and late (REDIS) images showed three types of response: 1) no hypofixation on either (10 patients), 2) a constant defect (59 patients), 3) a reversible defect (115 patients, including 21 cases of "paradoxical" redistribution). The value of the redistribution images was assessed in the diagnosis of coronary stenosis and in the evaluation of ventricular wall function in post-stenotic zones. The following results were obtained: Visual analysis of the DIP scintigraphy alone gave 17 false positive and 8 false negative results (sens: 95%, spec: 41%). The false negative results were all observed in patients at high risk. The DIP/REDIS scintigraphy (considered normal if both images were normal) gave 20 false positive but only 1 false negative result (sens: 99%, spec: 32%). In addition, the negative predictivity increased from 60 to 90%. The considerable reduction in the number of false negative results was due to the detection of "paradoxical" redistribution. The finding indicates that late films must be taken systematically even if the early scintigraphy is normal. Quantitative analysis of DIP scintigraphy was less sensitive and more specific than visual analysis (sens: 82.7%, spec: 68.7%; NVP: 46%). The same was observed when the redistribution films were processed (DIP/REDIS): significantly increased sensitivity and negative predictive value at the cost of a lower specificity (sens: 96%, spec: 41%; NPV: 70%). No significant differences were observed between the type of scintigraphic defect (constant or reversible) and the probability of coronary stenosis (positive predictive value 93 and 86% respectively

  1. Effect of Shen-Fu Injection Pretreatment to Myocardial Metabolism During Untreated Ventricular Fibrillation in a Porcine Model.

    Science.gov (United States)

    Yuan, Wei; Wu, Jun-Yuan; Wang, Guo-Xing; Zhang, Qian; Li, Chun-Sheng

    2015-11-20

    Shen-Fu injection (SFI) can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an influence on myocardial metabolism during ventricular fibrillation (VF). In this study, we used SFI pretreatment prior to VF to discuss the changes of myocardial metabolism and catecholamine (CA) levels during untreated VF, trying to provide new evidence to the protection of SFI to myocardium. Twenty-four pigs were divided into three groups: Saline group (SA group), SFI group, and SHAM operation group (SHAM group). Thirty minutes prior to the induction of VF, the SFI group received 0.24 mg/ml SFI through an intravenous injection; the SA group received an equal amount of sodium chloride solution. The interstitial fluid from the left ventricle (LV) wall was collected through the microdialysis tubes during VF. Adenosine diphosphate (ADP), adenosine triphosphate (ATP), and Na + -K + -ATPase and Ca2 + -ATPase enzyme activities were measured after untreated VF. Peak-to-trough VF amplitude and median frequency were analyzed for each of these 5-s intervals. The levels of glucose and glutamate were lower after VF in both the SA and SFI groups, compared with baseline, and the levels in the SFI group were higher than those in the SA group. Compared with baseline, the levels of lactate and the lactate/pyruvate ratio increased after VF in both SA and SFI groups, and the levels in the SFI group were lower than those in the SA group. In both the SA and SFI groups, the levels of dopamine, norepinephrine, and epinephrine increased significantly. There were no statistical differences between the two groups. The content of ATP, ADP, and phosphocreatine in the SFI group was higher than those in the SA group. The activity of LV Na + -K + -ATPase was significantly higher in the SFI group than in the SA group. Amplitude mean spectrum area (AMSA) was significantly lower in the SA and SFI

  2. Effect of Shen-Fu Injection Pretreatment to Myocardial Metabolism During Untreated Ventricular Fibrillation in a Porcine Model

    Directory of Open Access Journals (Sweden)

    Wei Yuan

    2015-01-01

    Full Text Available Background: Shen-Fu injection (SFI can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an influence on myocardial metabolism during ventricular fibrillation (VF. In this study, we used SFI pretreatment prior to VF to discuss the changes of myocardial metabolism and catecholamine (CA levels during untreated VF, trying to provide new evidence to the protection of SFI to myocardium. Methods: Twenty-four pigs were divided into three groups: Saline group (SA group, SFI group, and SHAM operation group (SHAM group. Thirty minutes prior to the induction of VF, the SFI group received 0.24 mg/ml SFI through an intravenous injection; the SA group received an equal amount of sodium chloride solution. The interstitial fluid from the left ventricle (LV wall was collected through the microdialysis tubes during VF. Adenosine diphosphate (ADP, adenosine triphosphate (ATP, and Na + -K + -ATPase and Ca2 + -ATPase enzyme activities were measured after untreated VF. Peak-to-trough VF amplitude and median frequency were analyzed for each of these 5-s intervals. Results: The levels of glucose and glutamate were lower after VF in both the SA and SFI groups, compared with baseline, and the levels in the SFI group were higher than those in the SA group. Compared with baseline, the levels of lactate and the lactate/pyruvate ratio increased after VF in both SA and SFI groups, and the levels in the SFI group were lower than those in the SA group. In both the SA and SFI groups, the levels of dopamine, norepinephrine, and epinephrine increased significantly. There were no statistical differences between the two groups. The content of ATP, ADP, and phosphocreatine in the SFI group was higher than those in the SA group. The activity of LV Na + -K + -ATPase was significantly higher in the SFI group than in the SA group. Amplitude mean spectrum area (AMSA was

  3. Heart Rate Reduction With Ivabradine Protects Against Left Ventricular Remodeling by Attenuating Infarct Expansion and Preserving Remote-Zone Contractile Function and Synchrony in a Mouse Model of Reperfused Myocardial Infarction.

    Science.gov (United States)

    O'Connor, Daniel M; Smith, Robert S; Piras, Bryan A; Beyers, Ronald J; Lin, Dan; Hossack, John A; French, Brent A

    2016-04-22

    Ivabradine selectively inhibits the pacemaker current of the sinoatrial node, slowing heart rate. Few studies have examined the effects of ivabradine on the mechanical properties of the heart after reperfused myocardial infarction (MI). Advances in ultrasound speckle-tracking allow strain analyses to be performed in small-animal models, enabling the assessment of regional mechanical function. After 1 hour of coronary occlusion followed by reperfusion, mice received 10 mg/kg per day of ivabradine dissolved in drinking water (n=10), or were treated as infarcted controls (n=9). Three-dimensional high-frequency echocardiography was performed at baseline and at days 2, 7, 14, and 28 post-MI. Speckle-tracking software was used to calculate intramural longitudinal myocardial strain (Ell) and strain rate. Standard deviation time to peak radial strain (SD Tpeak Err) and temporal uniformity of strain were calculated from short-axis cines acquired in the left ventricular remote zone. Ivabradine reduced heart rate by 8% to 16% over the course of 28 days compared to controls (Pleft ventricular remodeling and dyssynchrony, as well as improved mechanical performance in remote myocardium after heart rate reduction with ivabradine. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    of losartan and captopril on regional systolic, diastolic, and overall left ventricular (LV) function after AMI. METHODS: Two hundred twenty-five patients aged > or =50 years with documented AMI and heart failure and/or LV dysfunction were randomly assigned treatment with either losartan (50 mg......: WMSI decreased in both groups (losartan 1.58 +/- 0.23 to 1.52 +/- 0.26, P =.009, captopril 1.60 +/- 0.24 to 1.48 +/- 0.22, P losartan -0.05 +/- 0.19, P =.007). In both groups E-DT increased......, although the increase was significant only in patients treated with captoril (193 +/- 61 ms to 208 +/- 70 ms, P =.05). The change in E-DT was not different between treatment groups (captopril 14 +/- 74 ms vs losartan 7 +/- 80 ms, P =.52). Tei index decreased in both groups (losartan 0.59 +/- 0.13 to 0...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    -CSF or placebo injections from day 1 to 7 after the STEMI. Plasma YKL-40, high-sensitivity C-reactive protein (hs-CRP) and CK-MB concentrations were measured at baseline and during the first month. Infarct size and left ventricular ejection fraction (LVEF) were measured by magnetic resonance imaging at baseline...... and after 6 months. Results: Baseline plasma YKL-40 was increased (median 92 mu g/L) compared to healthy subjects (median 34 mu g/L, p CRP and YKL-40 correlated at baseline (p = 0.04) and day 3 (p = 0.01), but not at day 7 and 30. Moreover, YKL-40 correlated negatively...... in YKL-40. Plasma YKL-40 may be an indirect marker of LVEF recovery, independent of hs-CRP, and higher plasma YKL-40 indicates a lower recovery...

  6. 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...... elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1...

  7. Differences in clinical characteristics in patients with first ST-segment elevation myocardial infarction and ventricular fibrillation according to sex

    DEFF Research Database (Denmark)

    Jabbari, Reza; Glinge, Charlotte; Risgaard, Bjarke

    2017-01-01

    PURPOSE: We aimed to assess sex differences in clinical characteristics, circumstances of arrest, and procedural characteristics in ST-elevation myocardial infarction (STEMI) patients with ventricular fibrillation (VF) prior to angioplasty. METHODS: Cases of VF with first STEMI (n = 329; 276 men ...... found several sex differences in clinical characteristics and circumstances of arrest. The importance of seeking acute medical attention when experiencing angina should be emphasized in women, especially in women with low socioeconomic status........200). In multivariable logistic regression models, history of angina (OR = 2.70; p = 0.006), low educational level (OR = 2.80, p = 0.012) and low income (OR = 6.00, p = 0.005) remained significantly associated with female sex. There were no differences in procedural characteristics between men and women. CONCLUSIONS: We...... to present with VF later during transport to the hospital rather than prior to emergency medical services arrival (36 vs. 52%, p = 0.040). Prior to VF, women had a significantly lower income (p = 0.002) and education level (p = 0.008), were less likely to consume alcohol (3 vs. 6 units, p = 0.040), more...

  8. Evaluation of ECG-gated [(11)C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency.

    Science.gov (United States)

    Hansson, Nils Henrik; Tolbod, Lars; Harms, Johannes; Wiggers, Henrik; Kim, Won Yong; Hansen, Esben; Zaremba, Tomas; Frøkiær, Jørgen; Jakobsen, Steen; Sørensen, Jens

    2016-08-01

    Noninvasive estimation of myocardial external efficiency (MEE) requires measurements of left ventricular (LV) oxygen consumption with [(11)C]acetate PET in addition to LV stroke volume and mass with cardiovascular magnetic resonance (CMR). Measuring LV geometry directly from ECG-gated [(11)C]acetate PET might enable MEE evaluation from a single PET scan. Therefore, we sought to establish the accuracy of measuring LV volumes, mass, and MEE directly from ECG-gated [(11)C]acetate PET. Thirty-five subjects with aortic valve stenosis underwent ECG-gated [(11)C]acetate PET and CMR. List mode PET data were rebinned into 16-bin ECG-gated uptake images before measuring LV volumes and mass using commercial software and compared to CMR. Dynamic datasets were used for calculation of mean LV oxygen consumption and MEE. LV mass, volumes, and ejection fraction measured by CMR and PET correlated strongly (r = 0.86-0.92, P PET (P PET-based MEE, corrected for bias, correlated fairly with PET/CMR-based MEE (r = 0.60, P PET-based MEE bias was strongly associated with LV wall thickness. Although analysis-related improvements in accuracy are recommended, LV geometry estimated from ECG-gated [(11)C]acetate PET correlate excellently with CMR and can indeed be used to evaluate MEE.

  9. Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved Left Ventricular Function.

    Science.gov (United States)

    Shacham, Yacov; Gal-Oz, Amir; Ben-Shoshan, Jeremy; Keren, Gad; Arbel, Yaron

    2016-02-01

    Only limited data is present regarding the incidence and prognostic implications of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients with preserved left ventricular (LV) function in the primary percutaneous coronary intervention (PCI) era. We conducted a retrospective study of 842 consecutive STEMI patients with preserved LV function (ejection fraction ≥50%, assessed by echocardiography) who underwent primary PCI between January 2008 and January 2015. AKI was defined as an increase of ≥0.3 mg/dl in serum creatinine within 48 h following admission. Patients were assessed for all-cause mortality up to 5 years. Fifty-two patients (6.2%) developed AKI. Patients with AKI were older, had impaired baseline renal function, and presented more often with heart failure throughout their hospitalization. Patients with AKI had a higher 5-year all-cause mortality (13.4 vs. 2.4%, p < 0.001). Compared to patients with no AKI, the adjusted hazard ratio for all-cause mortality was 2.64 (95% CI 1.25-5.56, p = 0.01). Among STEMI patients with preserved LV function undergoing primary PCI, AKI is associated with a higher long-term mortality.

  10. Effects of nicardipine on coronary blood flow, left ventricular inotropic state and myocardial metabolism in patients with angina pectoris.

    Science.gov (United States)

    Rousseau, M F; Vincent, M F; Cheron, P; van den Berghe, G; Charlier, A A; Pouleur, H

    1985-01-01

    The effects of intravenous nicardipine (2.5 mg) on the left ventricular (LV) inotropic state, LV metabolism, and coronary haemodynamics were analysed in 22 patients with angina pectoris. Measurements were made at fixed heart rate (atrial pacing), under basal state, and during a cold pressor test. After nicardipine, coronary blood flow and oxygen content in the coronary sinus increased significantly. The indices of inotropic state increased slightly, and the rate of isovolumic LV pressure fall improved. Myocardial oxygen consumption was unchanged despite the significant reduction in pressure-rate product, but LV lactate uptake increased, particularly during the cold pressor test. When nicardipine was administered after propranolol, the indices of inotropic state were unaffected. The lack of direct effect of nicardipine on LV inotropic state was further confirmed by intracoronary injection of 0.1 and 0.2 mg in a separate group of 10 patients. It is concluded that the nicardipine-induced coronary dilatation seems to improve perfusion and aerobic metabolism in areas with chronic ischaemia, resulting in reduced lactate production and augmented oxygen consumption.

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

    Science.gov (United States)

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

    2016-11-01

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

  12. Detection of perfusion abnormalities in patients with permanent pacemakers on stress-rest 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography: comparison between right ventricular apex and right ventricular outflow tract pacing.

    Science.gov (United States)

    Das, Kalpa J; Patel, Chetan D; Sharma, Gautam; Naik, Nitish; Singh, Harmandeep

    2016-04-01

    The aim of the study was to compare the myocardial perfusion defects in patients with right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on stress-rest Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography. A total of 31 patients with permanent pacemakers (RVOT: 16 and RVA: 15) underwent stress-rest Tc-tetrofosmin involving a 1-day protocol. All patients underwent 1-day low-dose stress-gated and high-dose rest-gated Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography imaging. Fixed perfusion defects were noted in 13 (42%) of 31 patients. Two (13%) patients of the RVOT group and 11 (69%) patients of the RVA group showed fixed perfusion defects (P=0.003). The fixed perfusion defects were located in the anteroapical, anteroseptal, and apical in the RVOT pacing group and in the apical, distal anteroseptal, inferoapical, distal anterior, and distal inferoseptal in the RVA pacing group. On univariate analysis, the incidence of perfusion defects was significantly associated with apical pacing, longer pQRS duration, and higher percentage of ventricular pacing. On multivariate analysis, the site of pacemaker insertion was found to be the most important pacemaker parameter determining the incidence of perfusion defects. Importantly, the duration of postpacemaker implantation did not show any significant relation to the incidence of perfusion defects. Fixed perfusion abnormalities are observed in patients with pacemakers and are independent of duration of time since implantation. RVOT pacing is associated with fewer incidences of myocardial perfusion abnormalities compared with RVA pacing.

  13. Correlations between ventricular arrhythmias and electrolyte disturbances after acute myocardial infarction.

    Science.gov (United States)

    Ising, H; Rebentisch, E; Bertschat, F; Günther, T

    1990-01-01

    Seven 24-hour ECG recordings and blood samples were taken within 3 weeks in 42 patients who had suffered an acute myocardial infarction (AMI). Ca, K and Mg concentrations in serum, and K and Mg in the erythrocytes, were determined by atomic absorption spectroscopy. One half of the patients were infused with 81 mval/day MgSO4 for 3 days. In patients who exhibited intense electrolyte alterations 10-20 days after AMI, there was a significantly higher rate in the frequency of couplets and/or tachycardia in the 2- to 20-day period after AMI. In patients infused with MgSO4, the fluctuation in serum electrolytes and the rate of arrhythmias were significantly reduced.

  14. Echocardiographic evaluation of right ventricular function in preterm infants with bronchopulmonary dysplasia.

    Science.gov (United States)

    Bokiniec, Renata; Własienko, Paweł; Borszewska-Kornacka, Maria; Szymkiewicz-Dangel, Joanna

    2017-04-01

    To evaluate right ventricular function in preterm infants with and without bronchopulmonary dysplasia. Eighty-nine preterm infants (bronchopulmonary dysplasia (n=32); (2) mild-bronchopulmonary dysplasia (n=35); (3) severe-bronchopulmonary dysplasia (n=15). Right ventricular echocardiographic parameters included the following: (1) pulsed-wave Doppler through the tricuspid valve (E/A ratio), pulmonary artery acceleration time, right ventricular ejection time, right ventricular velocity-time integral; (2) tissue Doppler measurements of myocardial velocities and atrioventricular conduction times; (3) pulsed-wave Doppler and tissue Doppler evaluation of myocardial performance index and E/E' ratio; and (4) M-mode detection of right ventricular end-diastolic wall diameter. The severe-bronchopulmonary dysplasia group had higher mean right ventricular myocardial performance index (on the 28th day of life by pulsed-wave Doppler) than the no-bronchopulmonary dysplasia (P=.014) or mild-bronchopulmonary dysplasia (P=.031) groups; no differences were found between no-bronchopulmonary dysplasia and mild-bronchopulmonary dysplasia groups (P=.919). A reduction in right ventricular myocardial performance index at later time points was observed in all three groups (Pbronchopulmonary dysplasia severity in other right ventricular echocardiographic parameters. Right ventricular myocardial performance index measured by pulsed-wave Doppler indicates impaired right ventricular function in preterm infants with severe bronchopulmonary dysplasia. © 2017, Wiley Periodicals, Inc.

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

    DEFF Research Database (Denmark)

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

    1996-01-01

    The aim of this study was to assess the importance of congestive heart failure and left ventricular (LV) systolic dysfunction after an acute myocardial infarction (AIM) on long-term mortality in different age groups. A total of 7,001 consecutive enzyme-confirmed AMIs (6,676 patients) were screened...... index independent of age, we performed Cox proportional-hazard models in 4 different age strata ( 75 years). Patients in these strata had 1-year mortality rates of 5%, 11%, 21%, and 32%, respectively. Three-year mortality rates were 11%, 20%, 34......%, and 55%, respectively. The risk ratios (and 95% confidence limits) associated with congestive heart failure in the same 4 age strata were 1.9 (1.3 to 2.9), 2.8 (2.1 to 3.7), 1.8 (1.5 to 2.2) and 1.8 (1.5 to 2.2), respectively. The risk ratios associated with decreasing wall motion index were 6.5 (3...

  16. Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zeng, Rui-Xiang; Chen, Mao-Sheng; Lian, Bao-Tao; Liao, Peng-Da; Zhang, Min-Zhou

    2017-10-06

    New-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI. MEDLINE ® , EMBASE ® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3. We included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was -4.91 units (95% Cl: -5.70 to -4.12), test for overall effect z-score = 12.18 ( p < 0.00001, I 2 = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 ( p < 0.00001, I 2 = 57%). Our meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.

  17. Interrelations of Epicardial Fat Volume, Left Ventricular T1-Relaxation Times and Myocardial Strain in Hypertensive Patients: A Cardiac Magnetic Resonance Study.

    Science.gov (United States)

    Homsi, Rami; Kuetting, Daniel; Sprinkart, Alois; Steinfeld, Nina; Meier-Schroers, Michael; Luetkens, Julian; Nadal, Jennifer; Dabir, Darius; Fischer, Stefan; Gieseke, Juergen; Schild, Hans; Thomas, Daniel

    2017-05-01

    This cardiac magnetic resonance study was performed to assess myocardial fibrosis by evaluating T1-relaxation time (T1), to measure left ventricular (LV) strain, and to determine epicardial fat volume (EFV) in hypertensive patients with no history of cardiovascular (CV) events and to relate the results to the presence of coronary atherosclerotic artery disease (CAD) in these patients. A total of 123 subjects were examined at 1.5 T. Of them, 98 were hypertensive patients (58 men; mean age, 62.9±10.7 y; body mass index, 29.0±5.6 kg/m) and 25 were controls without CV risk factors or disease (13 men; 60.1±10.7 y; 28.1±5.4 kg/m). All patients had a well-treated blood pressure. In the hypertensive group, 56 patients had no CAD, whereas 42 patients had CAD. T1 was assessed by a modified Look-Locker inversion recovery sequence. Longitudinal and circumferential peak systolic strain (LS; CS) was determined with dedicated cardiac magnetic resonance software (feature tracking). EFV (normalized to the body surface area) was assessed by a 3D Dixon sequence. T1 (ms) and EFV (mL/m) were higher and CS and LS (%) were lower in hypertensive patients compared with those in nonhypertensive controls (PEFV=58.2±21.1; hypertensive patients overall: T1=991.3±45.5, LS=-21.0±4.5, CS=-25.0±5.9, EFV=71.1±25.3; hypertensive patients without CAD: T1=991.6±48.4, LS=-21.0±4.7, CS=-24.6±6.3, EFV=71.3±26.6; hypertensive patients with CAD: T1=986.7±39.2, LS=-21.1±4.3, CS=-25.5±5.4, EFV=70.9±23.6). There were no significant differences between hypertensive patients with and those without CAD and between patients grouped according to the number of vessels affected (0-vessel disease, 1-vessel disease, 2-vessel disease, or 3-vessel disease). Hypertension is associated with signs of myocardial fibrosis and an impaired LV contractility despite a normal LV ejection fraction, as well as with an increased EFV. However, CAD, in the absence of previous pathologies with consecutive myocardial

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

    Science.gov (United States)

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

    2013-01-01

    To assess the effects of long-term exercise training on the function and remodeling of the left ventricle after myocardial infarction. We studied 90 patients with a first acute anterior-wall myocardial infarction, all received conventional medical treatment. Symptom-limited maximal exercise stress tests, echocardiograms and effort-rest isotopic ventriculographies at 2, 6 and 12 months after myocardial infarction were performed; the follow-up time averaged 36.3±17 months. All patients joined a cardiac rehabilitation program with moderate or intense exercise training lasting at least a year. Of all patients, 41.1% suffered severe left ventricle dysfunction. Ergometric parameters that expressed functional capacity increased significantly (Pcardiovascular cause. Long-term exercise training showed no deleterious effects on left ventricle function or remodeling and beneficial functional and clinical effects were obtained in these rehabilitated postinfarction patients. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  19. Posterior wall involvement attenuates predictive value of ST-segment elevation in lead V4R for right ventricular involvement in inferior acute myocardial infarction.

    Science.gov (United States)

    Kosuge, Masami; Ishikawa, Toshiyuki; Morita, Satoshi; Ebina, Toshiaki; Hibi, Kiyoshi; Maejima, Nobuhiko; Umemura, Satoshi; Kimura, Kazuo

    2009-12-01

    ST-segment elevation of ≥1.0 mm in the right precordial chest lead V4R (ST↑V4R) has been shown to be a reliable marker of right ventricular involvement (RVI) in inferior acute myocardial infarction (IMI). However, the impact of left ventricular posterior wall involvement (PWI) on the relation between ST↑V4R and RVI is unknown. We studied 267 patients with recanalized IMI due to the right coronary artery (RCA) occlusion within 6h after symptom onset. A 12-lead electrocardiogram, lead V4R, and leads V7-9 were recorded on admission. RVI was defined as occlusion proximal to the first major right ventricular branch of the RCA. The perfusion territory of the RCA was assessed by angiographic distribution score, and PWI was defined as a score of ≥0.7. Patients were stratified according to the presence or absence of PWI and RVI. RVI was associated with higher peak creatine kinase and a higher rate of impaired myocardial reperfusion, defined as a myocardial blush grade of 0 or 1 after recanalization, in the presence or absence of PWI, especially the former. RVI was associated with a higher rate of ST↑V4R in the absence, but not in the presence, of PWI. ST↑V4R identified RVI with sensitivities of 34% and 96% (pPWI, respectively. In patients with recanalized IMI, RVI is associated with larger infarction and impaired myocardial reperfusion in the presence or absence of PWI, especially the former. However, the presence of PWI attenuates the predictive value of ST↑V4R for RVI.

  20. The Association between Myocardial Iron Load and Ventricular Repolarization Parameters in Asymptomatic Beta-Thalassemia Patients

    Directory of Open Access Journals (Sweden)

    Mehmet Kayrak

    2012-01-01

    Full Text Available Previous studies have demonstrated impaired ventricular repolarization in patients with β-TM. However, the effect of iron overload with cardiac T2* magnetic resonance imaging (MRI on cardiac repolarization remains unclear yet. We aimed to examine relationship between repolarization parameters and iron loading using cardiac T2* MRI in asymptomatic β-TM patients. Twenty-two β-TM patients and 22 age- and gender-matched healthy controls were enrolled to the study. From the 12-lead surface electrocardiography, regional and transmyocardial repolarization parameters were evaluated manually by two experienced cardiologists. All patients were also undergone MRI for cardiac T2* evaluation. Cardiac T2* score <20 msec was considered as iron overload status. Of the QT parameters, QT duration, corrected QT interval, and QT peak duration were significantly longer in the β-TM group compared to the healthy controls. Tp−Te and Tp−Te dispersions were also significantly prolonged in β-TM group compared to healthy controls. (Tp-Te/QT was similar between groups. There was no correlation between repolarization parameters and cardiac T2* MRI values. In conclusion, although repolarization parameters were prolonged in asymptomatic β-TM patients compared with control, we could not find any relation between ECG findings and cardiac iron load.

  1. Assessment of left ventricular performance by ECG-gated SPECT. Comparison with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tadamura, Eiji; Inubushi, Masayuki; Kubo, Shigeto; Matsumoto, Keiichi; Yokoyama, Hiroshi; Fujita, Toru; Konishi, Junji [Kyoto Univ. (Japan). Faculty of Medicine

    1999-10-01

    In the measurement of a left ventricular volume, MIBI-QGS was compared with MRI. Because it became clear by the experiment using phantom that a volume calculated with QGS was smaller than the actual volume, data of clinical study were corrected. Subjects were 20 patients with coronary artery disease. Fourteen patients had anamnesis of myocardial infarct. ECG-gated SPECT was performed one hour after intravenous injection of MIBI (600 MBq) in rest. End diastolic volume (EDV), end systolic volume (ESV) and ejection fraction (EF) were calculated using QGS. Cine-MR image was obtained by using MR system of 1.5 Tesla within 1 week after SPECT. A condition was as follows; segmented k-space gradient echo with view sharing, TR=11 ms, TE=1.4 ms, flip angle 20 degree, field of view 32 cm, matrix 256 x 196, 8 lines per segment. LVEF, ESV and EF were analysed by Bland-Altman method, and the difference between MIBI-gated-SPECT and MRI was no problem. Horizontal dislocation image and vertical major axis dislocation image were provided. Minor axis crossing images of 10-12 slice were also filmed in order to cover all left ventricles. As a result, availability of MIBI-QGS became clear. Some factors which produces the measurement error are examined. (K.H.)

  2. Magnetic resonance imaging of athlete's heart: myocardial mass, left ventricular function, and cross-sectional area of the coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Zandrino, F.; Sardanelli, F. [Dept. of Experimental Medicine, Section of Diagnostic Imaging and Radiotherapy, University of Genoa School of Medicine (Italy); Molinari, G.; Masperone, M.A. [Dept. of Cardiology, University of Genoa School of Medicine (Italy); Smeraldi, A.; Odaglia, G. [Dept. of Sports Medicine, University of Genoa School of Medicine (Italy)

    2000-02-01

    To evaluate left ventricular myocardial mass and function as well as ostial coronary artery cross-sectional area in endurance athletes, an athlete group of 12 highly trained rowers and a control group of 12 sedentary healthy subjects underwent MR examination. An ECG-gated breath-hold cine gradient-echo sequence was used to calculate myocardial mass, end-diastolic and end-systolic volumes, stroke volume, and cardiac output, all related to body surface area, as well as ejection fraction. A 3D fat-saturated ECG- and respiratory-triggered navigator echo sequence was used to evaluate coronary arteries: left main (LM), left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA). Cross-sectional area was calculated and divided for body surface area. Myocardial mass was found significantly larger in athlete group than in control group (p = 0.0078), the same being for end-diastolic volume (p = 0.0078), stroke volume (p = 0.0055), LM (p = 0.0066) and LAD (p = 0.0129). No significant difference was found for all the remaining parameters. Significant correlation with myocardial mass was found for LM (p < 0.001) and LAD (p = 0.0340), not for LCx and RCA. Magnetic resonance imaging is a useful tool in evaluating the myocardial hypertrophy and function of athlete's heart. Magnetic resonance angiography is a valuable noninvasive method to visualize the correlated cross-sectional area increase of the left coronary artery system. (orig.)

  3. Review Paper: Myocardial Rupture After Acute Myocardial Infarction ...

    African Journals Online (AJOL)

    Myocardial rupture complications after acute myocardial infarction are infrequent but lethal. They mainly involve rupture of the ventricular free wall, ventricular septum, papillary muscle, or combined. We compare features of different kinds of myocardial ruptures after acute myocardial infarction by reviewing the clinical ...

  4. Left ventricular systolic function in sickle cell anaemia: An ...

    African Journals Online (AJOL)

    Background: Reliable diagnostic measures for the evaluation of left ventricular systolic performance in the setting of altered myocardial loading characteristics in sickle cell anaemia remains unresolved. Objective: The study was designed to assess left ventricular systolic function in adult sickle cell patients using ...

  5. Reproducibility of myocardial strain and left ventricular twist measured using complementary spatial modulation of magnetization.

    Science.gov (United States)

    Swoboda, Peter P; Larghat, Abdulghani; Zaman, Arshad; Fairbairn, Timothy A; Motwani, Manish; Greenwood, John P; Plein, Sven

    2014-04-01

    To establish the reproducibility of complementary spatial modulation of magnetization (CSPAMM) tagged cardiovascular MR (CMR) data in normal volunteers. Twelve healthy volunteers underwent CMR studies on two separate occasions using an identical CSPAMM pulse sequence with images acquired in three short axis slices. Data were analyzed by two independent observers using harmonic phase analysis (HARP). Lagrangian circumferential and radial strain, rotation, and left ventricular twist were calculated. The intraobserver reproducibility of circumferential strain (CoV [coefficient of variation] 1.5-4.3%) and LV twist (CoV 1.2-4.4%) was better than radial strain (CoV 10.6-14.8%). For interobserver reproducibility, circumferential strain (CoV 3.5-6.2%) and LV twist (CoV 3.5-7.2%) were more reproducible than radial strain (CoV 11.8-21.8%). Interstudy reproducibility of circumferential strain (CoV 3.7-5.5%) and LV twist (CoV 9.8-12.2%) were good but radial strain (CoV 13.8-23.4%) but showed poorer interstudy reproducibility. Sample size calculations suggested 20 or fewer subjects are needed to detect a 10% change in circumferential strain (power 90%; α error 0.05), whereas for twist, 66 subjects would be required. In normal volunteers, the intraobserver, interobserver, and interstudy reproducibility of circumferential strain and LV twist measured from CSPAMM tagged CMR data are good, but are less so for radial strain. Copyright © 2013 Wiley Periodicals, Inc.

  6. Catheter-deliverable hydrogel derived from decellularized ventricular extracellular matrix increases endogenous cardiomyocytes and preserves cardiac function post-myocardial infarction

    Science.gov (United States)

    Singelyn, Jennifer M.; Sundaramurthy, Priya; Johnson, Todd D.; Schup-Magoffin, Pamela J.; Hu, Diane P.; Faulk, Denver M.; Wang, Jean; Mayle, Kristine M.; Bartels, Kendra; Salvatore, Michael; Kinsey, Adam M.; DeMaria, Anthony N.; Dib, Nabil; Christman, Karen L.

    2012-01-01

    Objectives This study evaluated the use of an injectable hydrogel derived from ventricular extracellular matrix (ECM) for treating myocardial infarction (MI) and its ability to be delivered percutaneously. Background Injectable materials offer promising alternatives to treat MI. While most of the examined materials have shown preserved or improved cardiac function in small animal models, none have been specifically designed for the heart and few have translated to catheter delivery in large animal models. Methods We have developed a myocardial specific hydrogel, derived from decellularized ventricular ECM, which self-assembles when injected in vivo. Female Sprague-Dawley rats underwent ischemia reperfusion followed by injection of the hydrogel or saline 2 weeks later. The implantation response was assessed via histology and immunohistochemistry, and potential for arrhythmogenesis was examined using programmed electrical stimulation 1 week post-injection. Cardiac function was analyzed with magnetic resonance imaging 1 week pre-injection and 4 weeks post-MI. In a porcine model, we delivered the hydrogel using the NOGA guided Myostar catheter, and utilized histology to assess retention of the material. Results We demonstrate that injection of the material in the rat MI model increases endogenous cardiomyocytes in the infarct area and maintains cardiac function without inducing arrhythmias. Furthermore, we demonstrate feasibility of transendocardial catheter injection in a porcine model. Conclusion To our knowledge, this is the first in situ gelling material to be delivered via transendocardial injection in a large animal model, a critical step towards the translation of injectable materials for treating myocardial infarction in humans. Our results warrant further study of this material in a large animal model of myocardial infarction and suggest this may be a promising new therapy for treating myocardial infarction. PMID:22340268

  7. Low-intensity pulsed ultrasound induces angiogenesis and ameliorates left ventricular dysfunction in a porcine model of chronic myocardial ischemia.

    Directory of Open Access Journals (Sweden)

    Kenichiro Hanawa

    Full Text Available Although a significant progress has been made in the management of ischemic heart disease (IHD, the number of severe IHD patients is increasing. Thus, it is crucial to develop new, non-invasive therapeutic strategies. In the present study, we aimed to develop low-intensity pulsed ultrasound (LIPUS therapy for the treatment of IHD.We first confirmed that in cultured human endothelial cells, LIPUS significantly up-regulated mRNA expression of vascular endothelial growth factor (VEGF with a peak at 32-cycle (P<0.05. Then, we examined the in vivo effects of LIPUS in a porcine model of chronic myocardial ischemia with reduced left ventricular ejection fraction (LVEF (n = 28. The heart was treated with either sham (n = 14 or LIPUS (32-cycle with 193 mW/cm2 for 20 min, n = 14 at 3 different short axis levels. Four weeks after the treatment, LVEF was significantly improved in the LIPUS group (46±4 to 57±5%, P<0.05 without any adverse effects, whereas it remained unchanged in the sham group (46±5 to 47±6%, P = 0.33. Capillary density in the ischemic region was significantly increased in the LIPUS group compared with the control group (1084±175 vs. 858±151/mm2, P<0.05. Regional myocardial blood flow was also significantly improved in the LIPUS group (0.78±0.2 to 1.39±0.4 ml/min/g, P<0.05, but not in the control group (0.84±0.3 to 0.97±0.4 ml/min/g. Western blot analysis showed that VEGF, eNOS and bFGF were all significantly up-regulated only in the LIPUS group.These results suggest that the LIPUS therapy is promising as a new, non-invasive therapy for IHD.

  8. Preliminary study of beta-blocker therapy on modulation of interleukin-33/ST2 signaling during ventricular remodeling after acute myocardial infarction.

    Science.gov (United States)

    Xia, Jinggang; Qu, Yang; Yin, Chunlin; Xu, Dong

    2017-01-01

    This study aimed to evaluate the role of b-blocker therapy on modulating interleukin (IL)-33/ST2 (interleukin-1 receptor-like 1) signaling during ventricular remodeling related to heart failure (HF) after acute myocardial infarction (AMI). Sprague-Dawley rats that survived surgery to induce AMI were randomly divided into the placebo group and the b-blocker treatment group. A sham group was used as a control. Left ventricular (LV) function variables, the myocardial infarct size, fibrosis and IL-33/ST2 protein expression was measured. Compared with the placebo group, b-blocker treatment significantly improved LV function and reduced infarct size (p blocker treatment (p > 0.05), however, treatment with b-blocker enhanced IL-33/ST2 signaling, with lower expression of sST2 (p blocker therapy might play a beneficial role in the modula-tion of IL-33/ST2 signaling during ventricular remodeling. These results may be helpful in identifying IL-33/ST2 systems as putative b-blocker targets at an early stage after AMI. (Cardiol J 2017; 24, 2: 188-194).

  9. [The method for the postmortem verification of ventricular fibrillation as a mechanism of death from myocardial infarction and post-infarction cardiosclerosis].

    Science.gov (United States)

    Korneva, Ju S; Dorosevich, A E

    2015-01-01

    The objective of the present study was to develop the objective method for the verification of death from ventricular fibrillation (VF) as a complication of myocardial infarction and post-infarction cardiosclerosis (PICS). A total of 20 cases of death during different periods after myocardial infarction and PICS were available for the analysis in which EGC-confirmed ventricular fibrillation was the immediate cause of the fatal outcome. The control group was comprised of 29 cases of death from other complications. The special emphasis was laid on the investigation of the affected region, the boundary areas, and intact zones of the heart. The size of cardiac cell populations surrounding capillaries was determined. The statistical treatment of the results of the study revealed the difference in the cellular infiltrate composition between the groups of patients who had died from ventricular fibrillation and other causes. The differences were largely reduced to the number of lymphocytes, neutrophils, and leukocytes. The data thus obtained provided a basis for the development of the method for the objective postmortem verification of the complication being considered.

  10. Progressive increase of the Tpeak-Tend interval is associated with ischaemia-induced ventricular fibrillation in a porcine myocardial infarction model.

    Science.gov (United States)

    Azarov, Jan E; Demidova, Marina M; Koul, Sasha; van der Pals, Jesper; Erlinge, David; Platonov, Pyotr G

    2017-05-24

    Repolarization indices of ECG have been widely assessed as predictors of ventricular arrhythmias. However, little is known of the dynamic changes of these parameters during continuous monitoring in acute ischaemic episodes. The objective of the study was to evaluate repolarization-related predictors of ventricular fibrillation (VF) during progression of experimental myocardial infarction. Myocardial infarction was induced in 27 pigs by 40-min balloon inflation in the left anterior descending coronary artery, and 12-lead ECG was continuously recorded. Rate-corrected durations of the total Tpeak-Tend intervals measured from the earliest T-wave peak to the latest T-wave end in any lead were determined at baseline and at minute 1, 2, 5, and then every 5th minute of occlusion. There were 7 early (1-3 min) and 10 delayed (15-30 min) VFs in 16 pigs. Baseline Tpeak-Tend did not differ between animals with and without VF. Tpeak-Tend interval rapidly increased immediately after balloon inflation and was greater in VF-susceptible animals at 2-15 min compared with the animals that never developed VF (P porcine myocardial infarction model and warrants further testing in clinical settings of acute coronary syndromes.

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

    Science.gov (United States)

    de Waard, Monique C; van der Velden, Jolanda; Bito, Virginie; Ozdemir, Semir; Biesmans, Liesbeth; Boontje, Nicky M; Dekkers, Dick H W; Schoonderwoerd, Kees; Schuurbiers, Hans C H; de Crom, Rini; Stienen, Ger J M; Sipido, Karin R; Lamers, Jos M J; Duncker, Dirk J

    2007-04-13

    The extent and mechanism of the cardiac benefit of early exercise training following myocardial infarction (MI) is incompletely understood, but may involve blunting of abnormalities in Ca(2+)-handling and myofilament function. Consequently, we investigated the effects of 8-weeks of voluntary exercise, started early after a large MI, on left ventricular (LV) remodeling and dysfunction in the mouse. Exercise had no effect on survival, MI size or LV dimensions, but improved LV fractional shortening from 8+/-1 to 12+/-1%, and LVdP/dt(P30) from 5295+/-207 to 5794+/-207 mm Hg/s (both P<0.05), and reduced pulmonary congestion. These global effects of exercise were associated with normalization of the MI-induced increase in myofilament Ca(2+)-sensitivity (DeltapCa(50)=0.037). This effect of exercise was PKA-mediated and likely because of improved beta(1)-adrenergic signaling, as suggested by the increased beta(1)-adrenoceptor protein (48%) and cAMP levels (36%; all P<0.05). Exercise prevented the MI-induced decreased maximum force generating capacity of skinned cardiomyocytes (F(max) increased from 14.3+/-0.7 to 18.3+/-0.8 kN/m(2) P<0.05), which was associated with enhanced shortening of unloaded intact cardiomyocytes (from 4.1+/-0.3 to 7.0+/-0.6%; P<0.05). Furthermore, exercise reduced diastolic Ca(2+)-concentrations (by approximately 30%, P<0.05) despite the unchanged SERCA2a and PLB expression and PLB phosphorylation status. Importantly, exercise had no effect on Ca(2+)-transient amplitude, indicating that the improved LV and cardiomyocyte shortening were principally because of improved myofilament function. In conclusion, early exercise in mice after a large MI has no effect on LV remodeling, but attenuates global LV dysfunction. The latter can be explained by the exercise-induced improvement of myofilament function.

  12. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in hypertension and associated with left ventricular remodeling.

    Science.gov (United States)

    Wang, Shuli; Hu, Hongjie; Lu, Minjie; Sirajuddin, Arlene; Li, Jinghui; An, Jing; Chen, Xiuyu; Yin, Gang; Lan, Tian; Dai, Linlin; Zhang, Yan; Yin, Xiaorong; Song, Lei; Dang, Aimin; Kellman, Peter; Arai, Andrew E; Zhao, Shihua

    2017-04-24

    To determine whether extracellular volume fraction (ECV) quantification by cardiac magnetic resonance (CMR) can demonstrate left ventricle (LV) abnormalities and relationship between ECV and LV remodeling in hypertension (HTN) patients METHODS: ECV quantification was prospectively performed in 134 consecutive HTN patients and 97 healthy subjects. Individual and regional ECV were compared to the regions on late gadolinium enhancement (LGE) images. Statistical analysis of the relationship between LV global functional parameters and ECV was carried out using Pearson's correlation, Student's t test and multiple regressions. In the HTN group, 70.1% (94/134) were LGE negative and 29.9% (40/134) LGE positive. The mean ECV after adjusting for age, sex, BMI, diabetes, smoking and dyslipidaemia in healthy controls and LGE-negative patients were 26.9 ± 2.67% and 28.5 ± 2.9% (p ECV reached statistical significance among the regions of LGE, LGE-Peri, LGE remote and the normal area between the control and LGE-positive subgroup (all p ECV significantly correlated with LVEF (r = -0.466, p ECV can identify LV abnormalities at an early stage in HTN patients without LGE. These abnormalities may reflect an increase in diffuse myocardial fibrosis and are associated with LV remodeling. • Diffuse myocardial fibrosis may develop in hypertensive cardiomyopathy before conventional MRI detectable LGE. • ECV can identify myocardial fibrosis at an early stage in hypertensive patients. • Elevated ECV is associated with decreased LV global function and LV remodeling in hypertension.

  13. The influence of pump rotation speed on hemodynamics and myocardial oxygen metabolism in left ventricular assist device support with aortic valve regurgitation.

    Science.gov (United States)

    Iizuka, Kei; Nishinaka, Tomohiro; Takewa, Yoshiaki; Yamazaki, Kenji; Tatsumi, Eisuke

    2017-09-01

    Aortic valve regurgitation (AR) is a serious complication under left ventricular assist device (LVAD) support. AR causes LVAD-left ventricular (LV) recirculation, which makes it difficult to continue LVAD support. However, the hemodynamics and myocardial oxygen metabolism of LVAD support with AR have not been clarified, especially, how pump rotation speed influences them. An animal model of LVAD with AR was newly developed, and how pump rotation speed influences hemodynamics and myocardial oxygen metabolism was examined in acute animal experiments. Five goats (55 ± 9.3 kg) underwent centrifugal type LVAD, EVAHEART implantation. The AR model was established by placing a vena cava filter in the aortic valve. Hemodynamic values and the myocardial oxygen consumption, delivery, and oxygen extraction ratio (O 2 ER) were evaluated with changing pump rotation speeds with or without AR (AR+, AR-). AR+ was defined as Sellers classification 3 or greater. AR was successfully induced in five goats. Diastolic aortic pressure was significantly lower in AR+ than AR- (p = 0.026). Central venous pressure, mean left atrial pressure, and diastolic left ventricular pressure were significantly higher in AR+ than AR- (p = 0.010, 0.047, and 0.0083, respectively). Although systemic flow did not improve with increasing pump rotation speed, LVAD pump flow increased over systemic flow in AR+, which meant increasing pump rotation speed increased LVAD-LV recirculation and did not contribute to effective systemic circulation. O 2 ER in AR- decreased with increasing pump rotation speed, but O 2 ER in AR+ was hard to decrease. The O 2 ER in AR+ correlated positively with the flow rate of LVAD-LV recirculation (p = 0.012). AR caused LVAD-LV recirculation that interfered with the cardiac assistance of LVAD support and made it ineffective to manage with high pump rotation speed.

  14. Differential coronary microvascular function in patients with left ventricular dysfunction of unknown cause--implication for possible mechanism of myocardial ischemia in early stage of cardiomyopathy.

    Science.gov (United States)

    Chen, J W; Ting, C T; Chen, Y H; Wu, T C; Hsu, N W; Lin, S J; Chang, M S

    1999-06-01

    To evaluate whether or not coronary microvascular dysfunction is associated with exercise-induced myocardial ischemia in left ventricular dysfunction of unknown cause, both the treadmill exercise test (TET) and coronary hemodynamics were studied in 20 patients with impaired left ventricular ejection fraction (ventriculogram), normal cardiac size, normal coronary angiogram and no evidence of clinical heart failure. Ten subjects with atypical chest pain were studied as the control. Coronary hemodynamics were studied both at baseline and after dipyridamole infusion (0.56mg/kg, i.v. for 4'). There was no difference in age, gender, blood pressure, baseline great cardiac venous flow (GCVF) and coronary vascular resistance between ten patients with a positive TET and the other ten with a negative TET. At baseline, coronary sinus oxygen concentration was increased and myocardial oxygen consumption reduced in patients with a positive TET compared with those with negative a TET. After dipyridamole infusion, maximum GCVF (102+/-47 vs. 144+/-31 ml/min, P=0.027) and coronary flow reserve (2.31+/-0.49 vs. 3.00+/-0.61, P=0.012) were significantly reduced and minimum coronary vascular resistance was higher (1.00+/-0.42 vs. 0.63+/-0.12 mmHg/ml/min, P=0.016) in patients with a positive TET than in those with a negative TET. At follow-up, 40% of patients with a positive TET and 10% of those with a negative TET developed clinical heart failure with a dilated left ventricle during a period of 45 months. Thus, coronary microvascular function is heterogeneous in patients with left ventricular dysfunction of unknown cause. In some of them, coronary microvascular dysfunction could be related to the presence of exercise-induced myocardial ischemia, suggesting that similar pathophysiology underlies the early stage of dilated cardiomyopathy and syndrome X.

  15. Effect of preload and heart rate on the doppler and tissue doppler-derived myocardial performance index.

    Science.gov (United States)

    Ozdemir, Kurtuluş; Balci, Sibel; Duzenli, Mehmet Akif; Can, Ilknur; Yazici, Mehmet; Aygul, Nazif; Altunkeser, Bulent Behlul; Altintepe, Lutfullah; Turk, Suleyman

    2007-07-01

    Doppler-derived myocardial performance index (MPI) has been described as a noninvasive measurement of LV function. Our aim was to investigate the effect of hemodialysis related volume reduction and heart rate changes on the Doppler-derived LV MPI, and Doppler tissue imaging (DTI) derived left and right ventricular MPI. The study group comprised 32 consecutive patients (mean age: 43 +/- 18 yrs) undergoing hemodialysis. Patients underwent echocardiography before and immediately after hemodialysis session. Left and right ventricular MPI derived from conventional pulsed-wave Doppler and DTI was calculated. The difference in MPI, heart rate and body weight was calculated before and after hemodialysis. Doppler-derived LV MPI, and right ventricular MPI obtained by DTI were increased (p = 0.05) but the LV MPI obtained by DTI was unchanged after hemodialysis. There is a significant positive correlation between the Doppler-derived LV MPI difference and volume reduction (r = 0.38, p = 0.032). The heart rate difference was correlated with Doppler-derived LV MPI difference, and DTI derived right ventricular MPI difference (r = 0.38, p = 0.034; r = 0.48, p = 0.006, respectively). Whereas, DTI derived LV MPI difference was not correlated with heart rate difference. By the multivariate analysis, there was no correlation between Doppler-derived LV MPI difference with heart rate difference, and volume reduction. Right ventricular MPI difference correlated with heart rate difference (r = 0.41, p = 0.021) but not with volume reduction. Doppler-derived MPI is partially influenced by preload and heart rate changes. However, DTI derived LV MPI is not influenced by preload and heart rate changes.

  16. Mortality and morbidity remain high despite captopril and/or Valsartan therapy in elderly patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction: results from the Valsartan in Acute Myocardial Infarction Trial (VALIANT).

    Science.gov (United States)

    White, Harvey D; Aylward, Philip E G; Huang, Zhen; Dalby, Anthony J; Weaver, W Douglas; Barvik, Ståle; Marin-Neto, José Antonio; Murin, Jan; Nordlander, Rolf O; van Gilst, Wiek H; Zannad, Faiez; McMurray, John J V; Califf, Robert M; Pfeffer, Marc A

    2005-11-29

    The elderly constitute an increasing proportion of acute myocardial infarction patients and have disproportionately high mortality and morbidity. Those with heart failure or impaired left ventricular left ventricular function after acute myocardial infarction have high complication and mortality rates. Little is known about outcomes with contemporary therapies in these patients. The Valsartan in Acute Myocardial Infarction Trial (VALIANT) randomized 14,703 patients with heart failure and/or left ventricular ejection fraction or =85 (n=383) years. With increasing age, 3-year mortality almost quadrupled (13.4%, 26.3%, 36.0%, and 52.1%, respectively), composite end-point events more than doubled (25.2%, 41.0%, 52.3%, and 66.8%), and hospital admissions for heart failure almost tripled (12.0%, 23.1%, 31.3%, and 35.4%). Outcomes did not differ between the 3 study treatments in any age group. Adverse events associated with captopril and valsartan were more common in the elderly and in patients receiving combination therapy. With increasing age, use of aspirin, beta-blockers, and statins declined, and use of digoxin, calcium-channel blockers, and non-potassium-sparing diuretics increased. On 3-year multivariable analysis, each 10-year age increase was associated with a hazard ratio of 1.49 (95% CI, 1.426 to 1.557; Pmyocardial infarction, although most received beta-blockers and all received an ACE inhibitor and/or an angiotensin receptor blocker. Better therapies and increased use of aspirin, beta-blockers, and statins are needed in this important and increasing patient group.

  17. Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus: A Case Report.

    Science.gov (United States)

    Seecheran, Rajeev; Seecheran, Valmiki; Persad, Sangeeta; Seecheran, Naveen Anand

    2017-01-01

    The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

  18. Cardio-protecteffect of qiliqiangxin capsule on left ventricular remodeling, dysfunction and apoptosis in heart failure rats after chronic myocardial infarction.

    Science.gov (United States)

    Liang, Tuo; Zhang, Yuhui; Yin, Shijie; Gan, Tianyi; An, Tao; Zhang, Rongcheng; Wang, Yunhong; Huang, Yan; Zhou, Qiong; Zhang, Jian

    2016-01-01

    Qiliqiangxin (QL) capsule is a traditional Chinese medicine which has been approved for the treatment of chronic heart failure. Evidences proved that QL capsules further reduced the NT-proBNP levels and improved left ventricular ejection fraction in CHF patients but the evidence supporting its underlying mechanism is still unclear. Myocardial infarction (MI) -Heart failure (HF) Sprague-Dawley ratsmodel and neonatal rat cardiac myocytes (NRCMs) were used. Animals were assigned into 4 groups, normal group (n=6), shame-operation group (n=6), MI rats 4 weeks after left anterior descending coronary artery ligation were randomized into vehicle group (n=8), QL group (n=8). QL significantly attenuated cardiac dysfunction and ventricle remodeling as echocardiography and hemodynamic measurements showed improvement in left ventricular ejection fraction, fractional shortening, ±dp/dt and left ventricular end diastolic and systolic diameters in QL treated group compared with the vehicle group. Improvements ininterstitial fibrosisand mitochondrial structures were also exhibited by Sirius Red staining, RT-PCR and electron microscopy. QL treatment improved apoptosis and VEGF expression in rats marginal infract area. Complementary experiments analyzed the improved apoptosis and up-regulate of VEGF in ischemia-hypoxia cultivated NRCMs is in an Akt dependent manner and can be reversed by Akt inhibitor. QL capsule can improve cardiac dysfunction and ventricular remodeling in MI-HF ratsmodel, this cardiac protective efficacy may be concerned with attenuated apoptosis and cardiac fibrosis. Up-regulated VEGF expression and Akt phosphorylation may take part in this availability.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND AND AIM: The reduction of left ventricular ejection fraction (LVEF) following ST-segment elevation myocardial infarction (STEMI) is a result of infarcted myocardium and may involve dysfunctional but viable myocardium. An index that may quantitatively determine whether LVEF is reduced...... beyond the expected value when considering only infarct size (IS) has previously been presented based on cardiac magnetic resonance (CMR). The purpose of this study was to introduce the index based on the electrocardiogram (ECG) and compare indices based on ECG and CMR. METHOD AND RESULTS: In 55 patients...

  20. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.

    LENUS (Irish Health Repository)

    Noori, S

    2014-08-14

    Objective:We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.Study Design:A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).Result:Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.Conclusion:We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.Journal of Perinatology advance online publication, 14 August 2014; doi:10.1038\\/jp.2014.151.

  1. The need for standardisation of cardiac FDG PET imaging in the evaluation of myocardial viability in patients with chronic ischaemic left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Kuuti, J. [Turku Univ. (Finland). Turku PET Centre; Schelbert, H.R. [UCLA School of Medicine, Los Angeles, CA (United States). Dept. of Molecular and Medical Pharmacology; Bax, J.J. [Leiden University Medical Center (Netherlands). Dept. of Cardilogy

    2002-09-01

    The evaluation of myocardial glucose utilisation with fluorine-18 fluorodeoxyglucose (FDG) and positron emission tomography is currently considered the most reliable tool for the identification of myocardial viability. However, the investigations using FDG imaging to predict improvement in left ventricular (LV) function after revascularisation have reported wide ranges for sensitivity (71%-100%) and, in particular, for specificity (33%-91%). The variable results may be related to differences in study populations but also to differences in the imaging protocols employed. Detailed analysis of the published studies has revealed differences in study populations, patient selection criteria, the methods for assessing changes in LV function post revascularisation and the timing of these assessments. Even more importantly, protocols have varied substantially with regard to imaging equipment, perfusion tracers, metabolic conditions, data analysis and interpretation of results. In addition, evaluation of patients with insulin resistance appears to represent a specific challenge. This review examines the different study protocols and methodologies used for myocardial FDG imaging in order to draw conclusions concerning optimal imaging protocols. It appears that the optimisation and standardisation of study protocols and analysis of FDG images for the assessment of myocardial viability are critical. In addition, multi-centre trials seem warranted on prediction of long-term function, congestive heart failure symptoms, survival and quality of life.

  2. Review in Translational Cardiology: MicroRNAs and Myocardial Fibrosis in Aortic Valve Stenosis, a Deep Insight on Left Ventricular Remodeling.

    Science.gov (United States)

    Iacopo, Fabiani; Lorenzo, Conte; Calogero, Enrico; Matteo, Passiatore; Riccardo, Pugliese Nicola; Veronica, Santini; Valentina, Barletta; Riccardo, Liga; Cristian, Scatena; Maria, Mazzanti Chiara; Vitantonio, Di Bello

    2016-01-01

    MicroRNAs (miRNAs) are a huge class of noncoding RNAs that regulate protein-encoding genes (degradation/inhibition of translation). miRNAs are nowadays recognized as regulators of biological processes underneath cardiovascular disorders including hypertrophy, ischemia, arrhythmias, and valvular disease. In particular, circulating miRNAs are promising biomarkers of pathology. This review gives an overview of studies in aortic valve stenosis (AS), exclusively considering myocardial remodeling processes. We searched through literature (till September 2016), all studies and reviews involving miRNAs and AS (myocardial compartment). Although at the beginning of a new era, clear evidences exist on the potential diagnostic and prognostic implementation of miRNAs in the clinical setting. In particular, for AS, miRNAs are modulators of myocardial remodeling and hypertrophy. In our experience, here presented in summary, the principal findings of our research were a confirm of the pathophysiological role in AS of miRNA-21, in particular, the interdependence between textural miRNA-21 and fibrogenic stimulus induced by an abnormal left ventricular pressure overload. Moreover, circulating miRNA-21 (biomarker) levels are able to reflect the presence of significant myocardial fibrosis (MF). Thus, the combined evaluation of miRNA-21, a marker of MF, and hypertrophy, together with advanced echocardiographic imaging (two-dimensional speckle tracking), could fulfill many existing gaps, renewing older guidelines paradigms, also allowing a better risk prognostic and diagnostic strategies.

  3. Intravenously Delivered Mesenchymal Stem Cells: Systemic Anti-Inflammatory Effects Improve Left Ventricular Dysfunction in Acute Myocardial Infarction and Ischemic Cardiomyopathy.

    Science.gov (United States)

    Luger, Dror; Lipinski, Michael J; Westman, Peter C; Glover, David K; Dimastromatteo, Julien; Frias, Juan C; Albelda, M Teresa; Sikora, Sergey; Kharazi, Alex; Vertelov, Grigory; Waksman, Ron; Epstein, Stephen E

    2017-05-12

    Virtually all mesenchymal stem cell (MSC) studies assume that therapeutic effects accrue from local myocardial effects of engrafted MSCs. Because few intravenously administered MSCs engraft in the myocardium, studies have mainly utilized direct myocardial delivery. We adopted a different paradigm. To test whether intravenously administered MSCs reduce left ventricular (LV) dysfunction both post-acute myocardial infarction and in ischemic cardiomyopathy and that these effects are caused, at least partly, by systemic anti-inflammatory activities. Mice underwent 45 minutes of left anterior descending artery occlusion. Human MSCs, grown chronically at 5% O 2 , were administered intravenously. LV function was assessed by serial echocardiography, 2,3,5-triphenyltetrazolium chloride staining determined infarct size, and fluorescence-activated cell sorting assessed cell composition. Fluorescent and radiolabeled MSCs (1×10 6 ) were injected 24 hours post-myocardial infarction and homed to regions of myocardial injury; however, the myocardium contained only a small proportion of total MSCs. Mice received 2×10 6 MSCs or saline intravenously 24 hours post-myocardial infarction (n=16 per group). At day 21, we harvested blood and spleens for fluorescence-activated cell sorting and hearts for 2,3,5-triphenyltetrazolium chloride staining. Adverse LV remodeling and deteriorating LV ejection fraction occurred in control mice with large infarcts (≥25% LV). Intravenous MSCs eliminated the progressive deterioration in LV end-diastolic volume and LV end-systolic volume. MSCs significantly decreased natural killer cells in the heart and spleen and neutrophils in the heart. Specific natural killer cell depletion 24 hours pre-acute myocardial infarction significantly improved infarct size, LV ejection fraction, and adverse LV remodeling, changes associated with decreased neutrophils in the heart. In an ischemic cardiomyopathy model, mice 4 weeks post-myocardial infarction were

  4. Sixty-four-slice CT in the assessment of global and regional left ventricular function: Comparison with MRI in a porcine model of acute and subacute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Brodoefel, H.; Reimann, A.; Klumpp, B.; Fenchel, M.; Heuschmid, M.; Miller, S.; Claussen, C.D.; Kopp, A.F. [Eberhard-Karls-University, Department of Diagnostic Radiology, Tuebingen (Germany); Burgstahler, C.; Schroeder, S. [Eberhard-Karls-University, Department of Cardiology, Tuebingen (Germany); Scheule, A.M. [Cardiac and Vascular Surgery, Department of Thoracic, Tuebingen (Germany)

    2007-11-15

    The purpose was to assess 64-slice CT in the analysis of global and regional ventricular function, using a model of acute and subacute myocardial infarction in comparison with cine-MRI. Seven pigs underwent standard MSCT and MRI examination a median 1 and 21 days following creation of reperfused myocardial infarction. Endocardial and epicardial contours were manually defined and ventricular volumes calculated according to Simpson's method. Results were compared by Pearson's correlation coefficient and Blant-Altman analysis. Wall motion was assessed on cine-images and evaluated by kappa statistics. MSCT revealed a strong correlation with cine-MRI regarding quantification of end-diastolic volume (EDV; r = 0.97), end-systolic volume (ESV; r = 0.97), stroke volume (SV; r = 0.94), ejection fraction (EF; r = 0.95) or myocardial mass (MM; r =0.94). Minor overestimation was observed for EDV and ESV (bias -1.7 ml; -1.5 ml; P=0.095; 0.025), whilst the mean difference for EF was found to be negligible (bias 0.9%; P = 0.18). Both modalities showed a 96.2% segmental agreement in regional wall motion (weighted-kappa 0.91 for 238 segments). This was true for both acute and subacute infarct phase and MSCT, and thereby enabled accurate intraindividual follow-up of segmental dysfunction. Sixty-four-slice CT allows for reliable analysis of global cardiac function and, moreover, provides accurate evaluation of wall motion in acute and subacute myocardial infarct. (orig.)

  5. Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a {sup 13}NH{sub 3} gated PET study

    Energy Technology Data Exchange (ETDEWEB)

    Sciagra, Roberto; Calabretta, Raffaella; Passeri, Alessandro; Castello, Angelo; Pupi, Alberto [University of Florence, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Cipollini, Fabrizio [University of Florence, Department of Statistics, Florence (Italy); Cecchi, Franco; Olivotto, Iacopo [Careggi University Hospital, Referral Centre for Myocardial Diseases, Florence (Italy)

    2017-05-15

    Ischemia in hypertrophic cardiomyopathy (HCM) is caused by coronary microvascular dysfunction (CMD), which is detected by measuring myocardial blood flow (MBF) with PET. Whether CMD may be associated with ischemic left ventricular (LV) dysfunction is unclear. We therefore assessed LV ejection fraction (EF) reserve in HCM patients undergoing dipyridamole (Dip) PET. Resting and stress {sup 13}NH{sub 3} dynamic as well as gated PET were performed in 34 HCM patients. Segmental MBF and transmural perfusion gradient (TPG = subendocardial / subepicardial MBF) were assessed. LVEF reserve was considered abnormal if Dip LVEF decreased more than 5 units as compared to rest. Eighteen patients had preserved (group A) and 16 abnormal LVEF reserve (group B; range -7 to -32). Group B patients had greater wall thickness than group A, but resting volumes, LVEF, resting and Dip MBF, and myocardial flow reserve were similar. Group B had slightly higher summed stress score and summed difference score in visual analysis than group A, and a significantly higher summed stress wall motion score. In group B, resting TPG was slightly lower (1.31 ± 0.29 vs. 1.37 ± 0.34, p <0.05), and further decreased after Dip, whilst in group A it increased (B = 1.20 ± 0.39, p < 0.0001 vs. rest and vs. A = 1.40 ± 0.43). The number of segments per patient with TPG <1 was higher than in group A (p < 0.001) and was a significant predictor of impaired LVEF reserve (OR 1.86, p < 0.02), together with wall thickness (OR 1.3, p < 0.02). Abnormal LVEF response is common in HCM patients following Dip, and is related to abnormal TPG, suggesting that subendocardial ischemia might occur under Dip and cause transient LV dysfunction. Although in vivo this effect may be hindered by the adrenergic drive associated with effort, these findings may have relevance in understanding exercise limitation and heart failure symptoms in HCM. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Seyyed Mohsen Hosseini

    2014-01-01

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

  7. Effect of stress testing on left ventricular mechanical synchrony by phase analysis of gated positron emission tomography in patients with normal myocardial perfusion

    Energy Technology Data Exchange (ETDEWEB)

    AlJaroudi, Wael [Heart and Vascular Imaging Institutes, Cleveland Clinic, Cleveland, OH (United States); Sydell and Arnold Miller Family, Heart and Vascular Institute, Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Cleveland, OH (United States); Alraies, M.C.; Di Filippo, Frank; Brunken, Richard C.; Cerqueira, Manuel D.; Jaber, Wael A. [Heart and Vascular Imaging Institutes, Cleveland Clinic, Cleveland, OH (United States)

    2012-04-15

    There are limited data on whether differences exist in left ventricular (LV) mechanical dyssynchrony indices derived from stress versus rest gated positron emission tomography (PET) in patients with normal myocardial perfusion imaging (MPI). Stress/rest {sup 82}Rb gated PET was performed in consecutive patients with normal MPI between 2006 and 2010. Patients were divided into two groups: group 1 [LV ejection fraction (EF) {>=} 55% and QRS < 120 ms] and group 2 (LVEF {<=}35%). Images were acquired on a dedicated PET scanner prior to and on a hybrid PET/CT system after November 2008. LV dyssynchrony indices [phase standard deviation (SD) and SD (ms)] were derived from stress and rest gated images. There were 91 patients in group 1 (age 61 {+-} 13, LVEF 66 {+-} 8%, normal QRS) and 126 in group 2 (age 66 {+-} 12, LVEF 25 {+-} 7%). The stress derived LVEF were significantly higher than rest for either group (p < 0.0001). Patients with cardiomyopathy had significantly higher dyssynchrony indices compared to those with normal LVEF (rest SD 49.2 {+-} 21.5 vs 16.8 {+-} 7.8 and stress SD 42.5 {+-} 19.4 vs 12.4 {+-} 3.7 , respectively, p < 0.0001 for both). The dyssynchrony indices derived from rest gated images were significantly higher than those derived from stress in both groups (p < 0.001 by unpaired and paired t test) and irrespective of the type of PET scanner utilized. Finally, 20/87 (23%) patients with normal LVEF and 27/66 (41%) of those with cardiomyopathy but without dyssynchrony based on stress indices were recategorized as having significant dyssynchrony given their resting indices. LV mechanical dyssynchrony indices by phase analysis are smaller when derived from peak stress versus rest gated PET imaging in patients with normal MPI, irrespective of the resting LVEF. (orig.)

  8. The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease.

    Science.gov (United States)

    Tavil, Yusuf; Ozturk, Mehmet Akif; Sen, Nihat; Kaya, Mehmet Gungor; Hizal, Fatma; Poyraz, Fatih; Turfan, Murat; Onder, Meltem; Gurer, Mehmet Ali; Cengel, Atiye

    2008-03-01

    Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.

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

    Directory of Open Access Journals (Sweden)

    Yvan Devaux

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

  10. Hemodynamic Performance of a Novel Right Ventricular Assist Device (PERKAT)

    Science.gov (United States)

    Schulze, P. Christian; Ferrari, Markus W.

    2017-01-01

    Acute right ventricular failure (RVF) is an increasing clinical problem and a life-threatening condition. Right ventricular assist devices represent a reasonable treatment option for patients with refractory RVF. We here present a novel percutaneously implantable device for right ventricular support. The PERKAT device is based on a nitinol stent cage, which is covered with valve-carrying foils. A flexible outlet trunk with a pigtail tip is connected to the distal part. The device is driven by an intra-aortic balloon pump (IABP) drive unit, which inflates/deflates a standard IABP-balloon placed within the stent cage. In-vitro evaluation was done in a liquid bath containing water or blood analog. The PERKAT device was tested in different afterload settings using two different IABP-balloons and varying inflation/deflation rates. We detected flow rates ranging from 1.97 to 3.93 L/min depending on the afterload setting, inflation/deflation rate, balloon size, and the medium used. Flow rates between water and blood analog were nearly comparable, and in the higher inflation/deflation rate settings slightly higher with water. Based on this promising in vitro data, the innovative percutaneously implantable PERKAT device has a potential to become a therapeutic option for patients with RVF refractory to medical treatment. PMID:27831998

  11. Serum markers of deranged myocardial collagen turnover: their relation to malignant ventricular arrhythmias in cardioverter-defibrillator recipients with heart failure.

    Science.gov (United States)

    Flevari, Panayota; Theodorakis, George; Leftheriotis, Dionyssios; Kroupis, Christos; Kolokathis, Fotis; Dima, Kleanthi; Anastasiou-Nana, Maria; Kremastinos, Dimitrios

    2012-10-01

    Pathologic collagen remodeling has been involved in the occurrence of ventricular arrhythmias and sudden cardiac death in heart failure. The aim of the study was to investigate the relationship between malignant ventricular arrhythmias and cardiac collagen turnover indexes, expressing specific types of derangement in collagen physiology, in stable patients with an implantable cardioverter-defibrillator (ICD). Seventy-four patients with an ICD and heart failure were studied. They had coronary artery disease (n = 42) or dilated cardiomyopathy, New York Heart Association classes I and II, and left ventricular ejection fraction 29% ± 1%. An ICD had been implanted for secondary (n = 36) or primary prevention of sudden cardiac death. We assessed (1) markers of collagen types I and III synthesis and their ratio: procollagen type I carboxyterminal peptide (PICP), procollagen type III aminoterminal peptide (PIIINP), and PICP/PIIINP; (2) markers of collagen degradation, degradation inhibition, and their ratio: matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase (TIMP) 1 (TIMP-1), and MMP-9/TIMP-1. Patients were prospectively followed up for 1 year. The number of episodes necessitating appropriate interventions for ventricular tachyarrhythmias (>170 beat/min) was related to the assessed parameters. Multivariate analysis revealed a significant relation between the number of tachyarrhythmic episodes and MMP-9/TIMP-1 (P = .007), PICP/PIIINP (P = .007), and ejection fraction (P = .04). No other significant relation was observed between arrhythmias and the remaining parameters. In heart failure, biochemical markers indicative of a deranged equilirium in myocardial collagen deposition/degradation and collagen I/III synthesis are related to ventricular arrhythmogenesis. Further studies are needed to investigate their predictive ability. Copyright © 2012 Mosby, Inc. All rights reserved.

  12. Intramyocardial Injection of Pig Pluripotent Stem Cells Improves Left Ventricular Function and Perfusion: A Study in a Porcine Model of Acute Myocardial Infarction.

    Science.gov (United States)

    Li, Xiaorong; Zhang, Fengxiang; Song, Guixian; Gu, Weijuan; Chen, Minglong; Yang, Bing; Li, Dianfu; Wang, Daowu; Cao, Kejiang

    2013-01-01

    Induced pluripotent stem (iPS) cells have the potential to differentiate to various types of cardiovascular cells to repair an injured heart. The potential therapeutic benefits of iPS cell based treatment have been established in small-animal models of myocardial infarction (MI). We hypothesize that porcine iPS (piPS) cell transplantation may be an effective treatment for MI. After a 90-minute occlusion of the left anterior descending artery in a porcine model, undifferentiated piPS cells or PBS were injected into the ischemic myocardium. Cardiac function, myocardial perfusion and cell differentiation were investigated. One week after piPS cell delivery, global left ventricular ejection fraction (LVEF) significantly decreased in both the iPS group and the PBS group compared to the Sham group (pinfarct area was significantly smaller in the iPS group than the PBS group (12.04% vs. 15.98% p = 0.01). PiPS cells engrafted into the myocardium can differentiate into vessel cells, which result in increased formation of new vessels in the infarcted heart. Direct intramyocardial injection of piPS cells can decrease infarct size and improve left ventricular function and perfusion for an immunosuppressed porcine AMI model.

  13. High-sensitivity troponin T predicts infarct scar characteristics and adverse left ventricular function by cardiac magnetic resonance imaging early after reperfused acute myocardial infarction.

    Science.gov (United States)

    Nguyen, Tuan L; Phan, Justin A K; Hee, Leia; Moses, Daniel A; Otton, James; Terreblanche, Owen D; Xiong, Jessica; Premawardhana, Upul; Rajaratnam, Rohan; Juergens, Craig P; Dimitri, Hany R; French, John K; Richards, David A B; Thomas, Liza

    2015-10-01

    Late gadolinium enhancement cardiac magnetic resonance imaging (CMRI) is the current standard for evaluation of myocardial infarct scar size and characteristics. Because post-ST-segment elevation myocardial infarction (STEMI) troponin levels correlate with clinical outcomes, we sought to determine the sampling period for high-sensitivity troponin T (hs-TnT) that would best predict CMRI-measured infarct scar characteristics and left ventricular (LV) function. Among 201 patients with first presentation with STEMI who were prospectively recruited, we measured serial hs-TnT levels at admission, peak, 24 hours, 48 hours, and 72 hours after STEMI. Indexed LV volumes, LV ejection fraction (LVEF) and infarct scar characteristics (scar size, scar heterogeneity, myocardial salvage index, and microvascular obstruction) were evaluated by CMRI at a median of 4 days post-STEMI. Peak and serial hs-TnT levels correlated positively with early indexed LV volumes and infarct scar characteristics, and negatively correlated with myocardial salvage index and LVEF. Both 48- and 72-hour hs-TnT levels similarly predicted "large" total infarct scar size (odds ratios [ORs] 3.08 and 3.53, both P scar size (ORs 2.05 and 2.31, both P scar size, poor myocardial salvage, and LVEF. These levels also correlated with scar heterogeneity and microvascular obstruction post-STEMI. Since ascertaining peak levels after STEMI is challenging in routine practice, based on the biphasic kinetics of hs-TnT, a measurement at 48 to 72 hours (during the plateau phase) provides a useful and simple method for early evaluation of LV function and infarct scar characteristics. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Reduced Right Ventricular Native Myocardial T1 in Anderson-Fabry Disease: Comparison to Pulmonary Hypertension and Healthy Controls.

    Directory of Open Access Journals (Sweden)

    Joseph J Pagano

    Full Text Available Anderson-Fabry disease (AFD is characterized by progressive multiorgan accumulation of intracellular sphingolipids due to α-galactosidase A enzyme deficiency, resulting in progressive ventricular hypertrophy, heart failure, arrhythmias, and death. Decreased native (non-contrast left ventricular (LV T1 (longitudinal relaxation time with MRI discriminates AFD from healthy controls or other presentations of concentric hypertrophy, but the right ventricle (RV has not been studied. The aims of the current study were to evaluate native RV T1 values in AFD, with a goal of better understanding the pathophysiology of RV involvement.Native T1 values were measured in the inferior RV wall (RVI, interventricular septum (IVS, and inferior LV (LVI in patients with AFD, patients with pulmonary hypertension, who provided an alternative RV pathological process for comparison, and healthy controls. A minimum wall thickness of 4 mm was selected to minimize partial volume errors in tissue T1 analysis. T1 analysis was performed in 6 subjects with AFD, 6 subjects with PH, and 21 controls. Native T1 values were shorter (adjusted p<0.05 for all comparisons, independent of location, in subjects with AFD (RVI-T1 = 1096±49 ms, IVS-T1 = 1053±41 ms, LVI-T1 = 1072±44 ms compared to both PH (RVI-T1 = 1239±41 ms, IVS-T1 = 1280±123 ms, LVI-T1 = 1274±57 ms and HC (IVS-T1 = 1180±60 ms, LVI-T1 = 1183±45 ms. RVI measurements were not possible in controls due to insufficient wall thickness.Native T1 values appear similarly reduced in the left and right ventricles of individuals with AFD and RV wall thickening, suggesting a common pathology. In contrast, individuals with PH and thickened RVs showed increased native T1 values in both ventricles, suggestive of fibrosis.

  15. [Determination of iodine content in the left ventricular myocardium of healthy subjects using dual-source dual-energy CT myocardial first perfusion imaging: a preliminary study].

    Science.gov (United States)

    Chen, Z X; Wang, G; Liang, L; Lu, X R; Guo, Q H; Zhai, Y N; Shi, X N

    2017-05-24

    Objective: To analyze the normal value of the iodine content in the left ventricular myocardium of healthy subjects and to observe if there is a segmental differences on iodine distribution by using the second generation dual-source dual-energy computed tomography myocardial first perfusion imaging. Methods: In this retrospective study, 42 healthy subjects, who admitted to our department between January to June 2016, with normal second generation dual-source dual-energy computed tomography and coronary CT angioghphy (CTA), electrocardiogram (ECG) results, normal cardiac, hepatic, renal function, normal myocardial enzymes results were enrolled, data from 38 out of 42 subjects with satisfactory image quality were analyzed using Siemens Dual Energy-Heart PBV image processing software.In accordance with the standards of the American Heart Association myocardial 17 fractionation method, content of iodine was measured at different segmental left ventricular myocardium and aorta (left coronary artery from the opening level). The standardized containing iodine value (nIC) was calculated. Results: The iodine content of left ventricular myocardium in normal subjects was 3.1-7.8 mg/ml.The nIC of myocardium from 1st to 17th segments was 0.28±0.06, 0.31±0.07, 0.30±0.07, 0.30±0.04, 0.28±0.04, 0.29±0.05, 0.29±0.01, 0.30±0.07, 0.31±0.07, 0.27±0.06, 0.28±0.08, 0.28±0.07, 0.29±0.08, 0.31±0.07, 0.27±0.06, 0.29±0.06 and 0.21±0.07, respectively.The nIC of the 17th segment was the lowest and was significantly lower than in other segments (all PnIC was similar among the rest 16 segments (all P>0.05). Conclusion: The normal iodine content range in left ventricle myocardium is 3.1-7.8 mg/ml, and the lowest iodine content is detected in the apex and which is significantly lower than the other left ventricular segments.

  16. The left ventricular eccentricity as a predictor of postoperative cardiac performance in valvular heart diseases.

    Science.gov (United States)

    Teramoto, S; Sano, S; Aokage, K; Shigenobu, M; Murakami, T; Kawakami, S; Nawa, S; Senoo, Y

    1982-04-01

    A clear correlation expressed by the following equation was observed between the preoperative left ventricular end-systolic eccentricity (epsilon s) and the percentage change of the left ventricular dimension (% delta D) in chronic valvular heart diseases: % delta D = 88.37 epsilon s - 48.16 (r = 0.66, p less than 0.001). Therefore, epsilon s may function as an index for predicting the postoperative cardiac performance independent of the affected valvular locations and the morphology of the lesions.

  17. Effects of human atrial natriuretic peptide on myocardial performance and energetics in heart failure due to previous myocardial infarction.

    Science.gov (United States)

    Ozawa, Toru; Shinke, Toshiro; Shite, Junya; Takaoka, Hideyuki; Inoue, Nobutaka; Matsumoto, Hidenari; Watanabe, Satoshi; Yoshikawa, Ryohei; Otake, Hiromasa; Matsumoto, Daisuke; Ogasawara, Daisuke; Yokoyama, Mitsuhiro; Hirata, Ken-ichi

    2015-09-01

    Human atrial natriuretic peptide (hANP) and spontaneous nitric oxide (NO) donor share cyclic guanosine monophosphate (cGMP) as a second messenger, but their effect on myocardium may differ. We compared the effect of hANP and sodium nitroprusside (SNP) on left ventricular (LV) mechano-energetics in heart failure (HF). Ten patients with HF due to previous myocardial infarction (LV ejection fraction: 45±3%) were instrumented with conductance and coronary sinus thermodilution catheters. LV contractility (Ees: slope of end-systolic pressure-volume relation) and the ratio of LV stroke work (SW) to myocardial oxygen consumption (SW/MVO2=mechanical efficiency) were measured in response to intravenous infusion of ANP (0.05 μg/kg/min) or SNP (0.3 μg/kg/min) to lower blood pressure by at least 10 mmHg, and changes in plasma cGMP. SNP had no effect on Ees, SW, or MVO2, thus SW/MVO2 remained unchanged (40.54±5.84% to 36.59±5.72%, p=0.25). ANP increased Ees, and decreased MVO2 with preserved SW, resulting in improved SW/MVO2 (40.49±6.35% to 50.30±7.96%, p=0.0073). Infusion of ANP (10.42-34.95 pmol/ml, p=0.0003) increased cGMP levels, whereas infusion of SNP had no effect (10.42-12.23 pmol/ml, p=0.75). Compared to SNP, the ANP-dependent increase in cGMP may ameliorate myocardial inotropy and energetics in HF. Copyright © 2015. Published by Elsevier Ltd.

  18. Myocyte performance during evolution of myocardial infarction in rats: effects of propionyl-L-carnitine.

    Science.gov (United States)

    Li, P; Park, C; Micheletti, R; Li, B; Cheng, W; Sonnenblick, E H; Anversa, P; Bianchi, G

    1995-04-01

    To determine whether alterations in the mechanical properties and calcium transients of myocytes are important factors in the evolution of the postinfarcted heart, these physiological parameters were measured in the viable muscle cells of the left ventricle 6 h, 2-3 days, 1 wk, and 1 mo after coronary artery occlusion and the documentation of left ventricular failure. In addition, the effects of propionyl-L-carnitine (PLC) on shortening properties and calcium dynamics of single myocytes were established to demonstrate whether the potential increase in ATP generation by this intervention improved myocyte cell function. Myocardial infarction was associated with a progressive increase in length of the spared myocytes, whereas the changes in myocyte diameter were apparent only at the 1-mo interval. Mechanically, myocyte shortening was decreased 43% at 6 h, 34% at 2-3 days, 26% at 1 wk, and 41% at 1 mo after infarction. Similar abnormalities were noted in the velocity of myocyte shortening. Peak systolic calcium was decreased at all intervals after infarction. In contrast, diastolic calcium remained within control values. PLC was capable of ameliorating the mechanical behavior and calcium transients of myocytes, particularly 1 mo after infarction. Thus alterations in muscle cell performance may be important determinants in the development and progression of ischemic cardiomyopathy, and interventions improving myocyte contractility may interfere with the unfavorable outcome of the disease.

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

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  20. Variable Myocardial Response to Load Stresses in Infants with Single Left Ventricular Anatomy: Influence of Initial Physiology and Surgical Palliative Strategy.

    Science.gov (United States)

    Horriat, Narges L; Deatsman, Sara L; Stelter, Jessica; Frommelt, Peter C; Hill, Garick D

    2016-12-01

    Initial surgical strategies in neonates with single left ventricular (LV) anatomy vary based on adequacy of pulmonary and systemic blood flow. Differing myocardial responses to these strategies, as reflected in indices of systolic function, ventricular size, and mass have not been well defined. We sought to evaluate single LV myocardial response to varied physiology and initial palliation and determine whether the response is consistent and predictable. Infants with single LV physiology were divided based on neonatal palliation: no palliation/PA band (NO); BT shunt only (BT); or Norwood procedure (NP). Echo measures were obtained at presentation, early post-bidirectional Glenn (BDG), late post-BDG follow-up, and post-Fontan procedure. Measures included ejection fraction, LV mass indexed to height(2.7) and end diastolic volume indexed to body surface area, and mass/volume ratio. The cohort included 38 children (13 NO, 13 BT, 12 NP). Ejection fraction was similar but depressed in all groups at all stages. LV mass was higher in the NP group than the BT group at early post-BDG (p = 0.03) and higher than both BT and NO groups (p < 0.01) at late post-BDG, but the difference was resolved by post-Fontan follow-up. The NP group had the most remarkable remodeling in LV size from BDG to Fontan, suggesting that volume unloading is most valuable in this subgroup. Ventricular remodeling can be identified by echocardiography in children with single LV physiology, despite variable initial surgical palliative strategies. Importantly, these initial surgical strategies do not result in significant differences after Fontan palliation during early childhood.

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Michael F Hill

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

  3. Dietary pre-exposure of rats to fish oil does not enhance myocardial efficiency of isolated working hearts or their left ventricular trabeculae.

    Science.gov (United States)

    Goo, Soyeon; Han, June-Chiew; Nisbet, Linley A; LeGrice, Ian J; Taberner, Andrew J; Loiselle, Denis S

    2014-04-15

    Numerous epidemiological studies, supported by clinical and experimental findings, have suggested beneficial effects of dietary fish or fish oil supplementation on cardiovascular health. One such experimental study showed a profound (100%) increase in myocardial efficiency (i.e. the ratio of work output to metabolic energy input) of the isolated whole heart, achieved by a corresponding decrease in the rate of myocardial oxygen consumption. However, a number of other investigations have returned null results on the latter energetic index. Such conflicting findings have motivated us to undertake a re-examination. To that effect, we investigated the effects of dietary fatty acid supplementation on myocardial mechano-energetics, with our primary focus on cardiac efficiency. We used both isolated hearts and isolated left ventricular trabeculae of rats fed with one of three distinct diets: reference (REF), fish oil-supplemented (FO) or saturated fat-supplemented (SFA). For all three groups, and at both spatial levels, we supplied 10 mm glucose as the exogenous metabolic substrate. In the working heart experiments, we found no difference in the average mechanical efficiency among the three dietary groups: 14.8 ± 1.1% (REF), 13.9 ± 0.6% (FO) and 13.6 ± 0.7% (SFA). Likewise, we observed no difference in peak mechanical efficiency of left ventricular trabeculae among the REF, FO and SFA groups: 13.3 ± 1.4, 11.2 ± 2.2 and 12.5 ± 1.5%, respectively. We conclude that there is no effect of a period of pre-exposure to a diet supplemented with either fish oil or saturated fatty acids on the efficiency of the myocardium at either spatial level: tissue or whole heart.

  4. Dietary pre-exposure of rats to fish oil does not enhance myocardial efficiency of isolated working hearts or their left ventricular trabeculae

    Science.gov (United States)

    Goo, Soyeon; Han, June-Chiew; Nisbet, Linley A; LeGrice, Ian J; Taberner, Andrew J; Loiselle, Denis S

    2014-01-01

    Numerous epidemiological studies, supported by clinical and experimental findings, have suggested beneficial effects of dietary fish or fish oil supplementation on cardiovascular health. One such experimental study showed a profound (100%) increase in myocardial efficiency (i.e. the ratio of work output to metabolic energy input) of the isolated whole heart, achieved by a corresponding decrease in the rate of myocardial oxygen consumption. However, a number of other investigations have returned null results on the latter energetic index. Such conflicting findings have motivated us to undertake a re-examination. To that effect, we investigated the effects of dietary fatty acid supplementation on myocardial mechano–energetics, with our primary focus on cardiac efficiency. We used both isolated hearts and isolated left ventricular trabeculae of rats fed with one of three distinct diets: reference (REF), fish oil-supplemented (FO) or saturated fat-supplemented (SFA). For all three groups, and at both spatial levels, we supplied 10 mm glucose as the exogenous metabolic substrate. In the working heart experiments, we found no difference in the average mechanical efficiency among the three dietary groups: 14.8 ± 1.1% (REF), 13.9 ± 0.6% (FO) and 13.6 ± 0.7% (SFA). Likewise, we observed no difference in peak mechanical efficiency of left ventricular trabeculae among the REF, FO and SFA groups: 13.3 ± 1.4, 11.2 ± 2.2 and 12.5 ± 1.5%, respectively. We conclude that there is no effect of a period of pre-exposure to a diet supplemented with either fish oil or saturated fatty acids on the efficiency of the myocardium at either spatial level: tissue or whole heart. PMID:24535444

  5. Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome).

    Science.gov (United States)

    Mitchell, James H; Hadden, Timothy B; Wilson, James M; Achari, Arup; Muthupillai, Raja; Flamm, Scott D

    2007-07-15

    In Takotsubo cardiomyopathy, or transient left ventricular (LV) apical ballooning syndrome, normalization of wall motion can occur after as long as 3 months. We report 1 of the largest series to date outside Japan and emphasize the utility of cardiac magnetic resonance imaging (CMR) to show a lack of irreversible damage in the acute setting, thereby reliably predicting recovery. During the previous 6 years, we saw 22 patients who met the following criteria: (1) a suspected myocardial infarction based on symptoms, an abnormal electrocardiogram, and/or elevated serum cardiac markers; (2) an anteroapical wall motion abnormality; and (3) no significant occlusive epicardial coronary artery disease or observed vasospasm. Ten patients underwent delayed enhancement CMR to assess myocardial viability during the index presentation. All 10 patients had an absence of irreversible damage, as evidenced by lack of gadolinium "hyperenhancement"; later, their LV function returned to normal. Eight other patients, available for outpatient follow-up evaluation, also had normalization of LV function. Takotsubo cardiomyopathy is increasingly being recognized outside Japan and must be distinguished from acute myocardial infarction. In conclusion, CMR is useful to document segmental LV dysfunction and lack of irreversible damage and to predict functional recovery.

  6. Early marker of regional left ventricular deformation in patients with hypertrophic cardiomyopathy evaluated by MRI tissue tracking: The effects of myocardial hypertrophy and fibrosis.

    Science.gov (United States)

    Xu, Hua-Yan; Chen, Jing; Yang, Zhi-Gang; Li, Rui; Shi, Ke; Zhang, Qin; Liu, Xi; Xie, Lin-Jun; Jiang, Li; Guo, Ying-Kun

    2017-11-01

    To evaluate the regional left ventricular (LV) myocardial strain of early stage hypertrophic cardiomyopathy (HCM) patients by magnetic resonance (MR) tissue tracking. In all, 114 adult HCM patients classified as NYHA I or II and 32 healthy volunteers were enrolled and underwent 3.0T MR examination. Vertical 2-chamber long axis, horizontal 4-chamber, and short axis cine sequence as well as late gadolinium enhancement images (LGE) were scanned. The cardiac function, regional LV tissue tracking variables, end-diastolic wall thickness (EDTH), and LGE extent were measured. In the HCM group, 38 were NYHA I and 76 were NYHA II. By regional analysis, peak strain (PS) and peak displacement (PD) with radial, circumferential direction of hypertrophic segments (n = 283) were significantly lower than nonhypertrophic segments (n = 1541) (all P hypertrophic and fibrotic segments of early-stage HCM patients can be measured by MR tissue tracking based on routine cine images. Moreover, myocardial strain may decrease with the increasing of myocardial hypertrophy as well as fibrosis. 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1368-1376. © 2017 International Society for Magnetic Resonance in Medicine.

  7. Early diagnosis of right ventricular systolic dysfunction by tissue Doppler-derived isovolumic myocardial acceleration in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Tayyareci, Yelda; Tayyareci, Gulsah; Tastan, Cagla Pinar; Bayazit, Pelin; Nisanci, Yilmaz

    2009-10-01

    The aim of the study was to assess validity of tissue Doppler imaging (TDI)-derived right ventricular (RV) myocardial systolic velocities in early detection of RV systolic dysfunction in chronic obstructive pulmonary disease (COPD). Ninety COPD patients (50 pure COPD and 40 with right heart failure [RHF]) and 40 controls were enrolled. Respiratory function tests, conventional echocardiographic parameters, and TDI-derived isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak velocity during systolic ejection (Sa) were measured. All the TDI-derived RV systolic velocities were impaired in COPD (P = 0.0001) compared to controls. IVA was the only parameter that could distinguish the patients with pure COPD and COPD with RHF (P = 0.0001). IVA was found to be significantly correlated with FEV1 (r = 0.41, P = 0.0001), FEV1/FVC (r = 0.43, P = 0.0001), pulmonary artery pressure (r =-0.34, P = 0.001), pulmonary flow acceleration time (r = 0.48, P = 0.0001), and tricuspid annular systolic excursion (r =-0.41, P = 0.0001). In addition, IVA RHF with 82% sensitivity, 77% specificity from patients without RHF. TDI-derived RV IVA is a novel, noninvasive echocardiographic index which may be used in the assessment of subclinical RV dysfunction in patients with COPD.

  8. Intraprocedural left ventricular free wall rupture diagnosed by left ventriculogram in a patient with infero-posterior myocardial infarction and severe aortic stenosis.

    Science.gov (United States)

    Konishi, Takao; Funayama, Naohiro; Yamamoto, Tadashi; Nishihara, Hiroshi; Hotta, Daisuke; Kikuchi, Kenjiro; Yokoyama, Hideo; Ohori, Katsumi

    2016-06-06

    Left ventricular wall rupture remains a major lethal complication of acute myocardial infarction and hypertension is a well-known predisposing factor of cardiac rupture after myocardial infarction. An 87-year-old man was admitted to our hospital, diagnosed as acute myocardial infarction (AMI). The echocardiogram showed 0.67-cm(2) aortic valve, consistent with severe aortic stenosis (AS). A coronary angiography showed a chronic occlusion of the proximal left circumflex artery and a 99 % stenosis and thrombus in the mid right coronary artery. During percutaneous angioplasty of the latter, transient hypotension and bradycardia developed at the time of balloon inflation, and low doses of noradrenaline and etilefrine were intravenously administered as needed. The patient suddenly lost consciousness and developed electro-mechanical dissociation. Cardio-pulmonary resuscitation followed by insertion of an intra-aortic balloon pump (IABP) and percutaneous cardiopulmonary support were initiated. The echocardiogram revealed moderate pericardial effusion, though the site of free wall rupture was not distinctly visible. A left ventriculogram clearly showed an infero-posterior apical wall rupture. Surgical treatment was withheld because of the interim development of brain death. In this patient, who presented with severe AS, the administration of catecholamine to stabilize the blood pressure probably increased the intraventricular pressures considerably despite apparently normal measurements of the central aortic pressure. IABP, temporary pacemaker, or both are recommended instead of intravenous catecholamines for patients with AMI complicated with significant AS to stabilize hemodynamic function during angioplasty.

  9. Myocardial fibrosis in patients with symptomatic obstructive hypertrophic cardiomyopathy: correlation with echocardiographic measurements, sarcomeric genotypes, and pro-left ventricular hypertrophy polymorphisms involving the renin-angiotensin-aldosterone system.

    Science.gov (United States)

    Blauwet, Lori A; Ackerman, Michael J; Edwards, William D; Riehle, Darren L; Ommen, Steve R

    2009-01-01

    Hypertrophic cardiomyopathy (HCM) is a heterogeneous disorder of the cardiac sarcomere, resulting in myocyte hypertrophy and disarray, interstitial fibrosis, and cardiac dysfunction. Our aim was to determine whether the amount of fibrosis in HCM correlates with echocardiographic measures of diastolic dysfunction, presence of HCM-susceptibility mutations, or polymorphisms in the renin-angiotensin-aldosterone system (RAAS). Surgical specimens from patients with obstructive HCM undergoing septal myectomy at the Mayo Clinic (2001-2004) were examined and compared with autopsy-derived tissues from age- and sex-matched normal controls. Digital image analysis was used to quantitate the fibrosis in representative microscopic sections. Genotyping was performed for myofilament-HCM using polymerase chain reaction, high-performance liquid chromatography, and direct DNA sequencing. RAAS polymorphism status was similarly established. The study included 59 HCM cases and 44 controls. Patients with HCM exhibited more fibrosis (mean 17%, range 3-45%) than controls (mean 8%, range 3-17%) (P or =1 C-encoding allele in CYP11B2-encoded aldosterone synthase. Patients with HCM undergoing septal myectomy had significantly more myocardial interstitial fibrosis than controls. The amount of fibrosis in HCM patients correlated with degree of septal hypertrophy and left ventricular systolic and diastolic function. Notably, neither mutations in cardiac myofilament proteins or polymorphisms in RAAS exhibited strong associations with severity of myocardial fibrosis.

  10. Electrophysiologically guided amiodarone therapy versus the implantable cardioverter-defibrillator for sustained ventricular tachyarrhythmias after myocardial infarction: results of long-term follow-up.

    Science.gov (United States)

    Schläpfer, Jürg; Rapp, Fabrice; Kappenberger, Lukas; Fromer, Martin

    2002-06-05

    We sought to compare the long-term survival rates of patients with sustained ventricular tachyarrhythmia after myocardial infarction (MI) who were treated according to the results of electrophysiological (EP) study either with amiodarone or an implantable cardioverter-defibrillator (ICD). Patients with sustained ventricular tachyarrhythmias after MI are at high risk of sudden cardiac death (SCD). However, data comparing the long-term survival rates of patients treated with amiodarone or ICD, according to the results of EP testing, are lacking. Patients underwent a first EP study at baseline and a second one after a loading dose of amiodarone of 14 +/- 2.9 g. According to the results of the second EP study, patients were classified either as responders or non-responders to amiodarone; non-responders were eventually treated with an ICD. Eighty-four consecutive patients with MI (78 men; 21-77 years old; mean left ventricular (LV) ejection fraction 36 +/- 11%) were consecutively included. Forty-three patients (51%) were responders, and 41 patients (49%) were non-responders to amiodarone therapy. During a mean follow-up period of 63 +/- 30 months, SCD and total mortality rates were significantly higher in the amiodarone-treated patients (p = 0.03 and 0.02, respectively). The long-term survival of patients with sustained ventricular tachyarrhythmias after MI, with depressed LV function, is significantly better with an ICD than with amiodarone therapy, even when stratified according to the results of the EP study. These patients should benefit from early ICD placement, and any previous amiodarone treatment seems to have no additional value.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less...

  12. 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.

  13. Adeno-Associated Virus Serotype 9–Driven Expression of BAG3 Improves Left Ventricular Function in Murine Hearts With Left Ventricular Dysfunction Secondary to a Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Tijana Knezevic, PhD

    2016-12-01

    Full Text Available Mutations in Bcl-2–associated athanogene 3 (BAG3 were associated with skeletal muscle dysfunction and dilated cardiomyopathy. Retro-orbital injection of an adeno-associated virus serotype 9 expressing BAG3 (rAAV9-BAG3 significantly (p < 0.0001 improved left ventricular ejection fraction, fractional shortening, and stroke volume 9 days post-injection in mice with cardiac dysfunction secondary to a myocardial infarction. Furthermore, myocytes isolated from mice 3 weeks after injection showed improved cell shortening, enhanced systolic [Ca2+]i and increased [Ca2+]i transient amplitudes, and increased maximal L-type Ca2+ current amplitude. These results suggest that BAG3 gene therapy may provide a novel therapeutic option for the treatment of heart failure.

  14. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in hypertension and associated with left ventricular remodeling

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Shuli; Li, Jinghui; Chen, Xiuyu; Yin, Gang; Lan, Tian; Dai, Linlin; Zhang, Yan; Yin, Xiaorong; Zhao, Shihua [Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing (China); Hu, Hongjie [Zhejiang University, Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Hangzhou (China); Lu, Minjie [Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing (China); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD (United States); Sirajuddin, Arlene; Arai, Andrew E. [Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD (United States); An, Jing [Siemens Shenzhen Magnetic Resonance Ltd., Siemens MRI Center, Shenzhen, Guangdong (China); Song, Lei; Dang, Aimin [Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing (China); Kellman, Peter [National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), US Department of Health and Human Services, Cardiovascular and Pulmonary Branch, Bethesda, MD (United States)

    2017-11-15

    To determine whether extracellular volume fraction (ECV) quantification by cardiac magnetic resonance (CMR) can demonstrate left ventricle (LV) abnormalities and relationship between ECV and LV remodeling in hypertension (HTN) patients ECV quantification was prospectively performed in 134 consecutive HTN patients and 97 healthy subjects. Individual and regional ECV were compared to the regions on late gadolinium enhancement (LGE) images. Statistical analysis of the relationship between LV global functional parameters and ECV was carried out using Pearson's correlation, Student's t test and multiple regressions. In the HTN group, 70.1% (94/134) were LGE negative and 29.9% (40/134) LGE positive. The mean ECV after adjusting for age, sex, BMI, diabetes, smoking and dyslipidaemia in healthy controls and LGE-negative patients were 26.9 ± 2.67% and 28.5 ± 2.9% (p < 0.001), respectively. The differences in ECV reached statistical significance among the regions of LGE, LGE-Peri, LGE remote and the normal area between the control and LGE-positive subgroup (all p < 0.05). Global ECV significantly correlated with LVEF (r = -0.466, p < 0.001) and LV hypertrophy (r = 0.667, p < 0.001). ECV can identify LV abnormalities at an early stage in HTN patients without LGE. These abnormalities may reflect an increase in diffuse myocardial fibrosis and are associated with LV remodeling. (orig.)

  15. Rationale and design of EXPLORE: a randomized, prospective, multicenter trial investigating the impact of recanalization of a chronic total occlusion on left ventricular function in patients after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    Science.gov (United States)

    2010-01-01

    Background In the setting of primary percutaneous coronary intervention, patients with a chronic total occlusion in a non-infarct related artery were recently identified as a high-risk subgroup. It is unclear whether ST-elevation myocardial infarction patients with a chronic total occlusion in a non-infarct related artery should undergo additional percutaneous coronary intervention of the chronic total occlusion on top of optimal medical therapy shortly after primary percutaneous coronary intervention. Possible beneficial effects include reduction in adverse left ventricular remodeling and preservation of global left ventricular function and improved clinical outcome during future coronary events. Methods/Design The Evaluating Xience V and left ventricular function in Percutaneous coronary intervention on occLusiOns afteR ST-Elevation myocardial infarction (EXPLORE) trial is a randomized, prospective, multicenter, two-arm trial with blinded evaluation of endpoints. Three hundred patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction with a chronic total occlusion in a non-infarct related artery are randomized to either elective percutaneous coronary intervention of the chronic total occlusion within seven days or standard medical treatment. When assigned to the invasive arm, an everolimus-eluting coronary stent is used. Primary endpoints are left ventricular ejection fraction and left ventricular end-diastolic volume assessed by cardiac Magnetic Resonance Imaging at four months. Clinical follow-up will continue until five years. Discussion The ongoing EXPLORE trial is the first randomized clinical trial powered to investigate whether recanalization of a chronic total occlusion in a non-infarct related artery after primary percutaneous coronary intervention for ST-elevation myocardial infarction results in a better preserved residual left ventricular ejection fraction, reduced end-diastolic volume and enhanced clinical

  16. Incidence of post myocardial infarction left ventricular thrombus formation in the era of primary percutaneous intervention and glycoprotein IIb/IIIa inhibitors. A prospective observational study

    Directory of Open Access Journals (Sweden)

    Gardin Julius

    2006-04-01

    Full Text Available Abstract Background Before the widespread use of primary percutaneous coronary intervention (PCI and glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa left ventricular (LV thrombus formation had been reported to complicate up to 20% of acute myocardial infarctions (AMI. The incidence of LV thrombus formation with these treatment modalities is not well known. Methods 92 consecutive patients with ST-elevation AMI treated with PCI and GP IIb/IIIa inhibitors underwent 2-D echocardiograms, with and without echo contrast agent, within 24–72 hours. Results Only 4/92 (4.3% had an LV thrombus, representing a significantly lower incidence than that reported in the pre-PCI era. Use of contrast agents did not improve detection of LV thrombi in our study. Conclusion The incidence of LV thrombus formation after acute MI, in the current era of rapid reperfusion, is lower than what has been historically reported.

  17. Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation

    Science.gov (United States)

    Makikallio, T. H.; Hoiber, S.; Kober, L.; Torp-Pedersen, C.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

    1999-01-01

    A number of new methods have been recently developed to quantify complex heart rate (HR) dynamics based on nonlinear and fractal analysis, but their value in risk stratification has not been evaluated. This study was designed to determine whether selected new dynamic analysis methods of HR variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death after AMI.

  18. Comparison of Electrocardiography Markers and Speckle Tracking Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden in Patients With Previous Myocardial Infarction.

    Science.gov (United States)

    Nestaas, Eirik; Shih, Jhih-Yuan; Smedsrud, Marit K; Gjesdal, Ola; Hopp, Einar; Haugaa, Kristina H; Edvardsen, Thor

    2017-05-01

    Myocardial scar burden is an important prognostic factor after myocardial infarction. This cohort study compared assessment of left ventricle scar burden between pathological Q waves on electrocardiography (ECG), Selvester multiparametric ECG scoring system for scar burden, and global longitudinal strain (GLS) by speckle-tracking echocardiography 6 months after myocardial infarction. The scar burden was defined by late gadolinium enhancement cardiac magnetic resonance as fraction of total left ventricle tissue. ECG measures were presence of pathologic Q waves and Selvester scores. GLS was the average of peak strain from 16 left ventricle segments. In 34 patients aged 58 ± 10 years (mean ± SD), the scar burden was 19% (9, 26) (median [quartiles]) and 79% had scar burden >5%. Patients with scar burden >5% more frequently had pathologic Q waves (63% vs 14%) and had worse Selvester scores (5 [3, 7] vs 0 [0, 1]) and worse GLS (-16.6 ± 2.4% vs -19.9 ± 1.1%). Pathologic Q waves, Selvester scores, ejection fraction, and GLS related to scar burden in univariable analyses. Sensitivity and specificity for detecting scar burden >5% was 63% and 86% (pathologic Q waves), 89% and 86% (Selvester score), 81% and 86% (ejection fraction), 89% and 86% (GLS), and 96% and 71% (combination of Q waves, Selvester score, and GLS). In conclusion, Selvester score and GLS related to scars 6 months after myocardial infarction, and pathologic Q waves were only weakly associated with scar and GLS was associated with scar independently of ECG markers. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Clinical impact of left ventricular eccentricity index using cardiac MRI in assessment of right ventricular hemodynamics and myocardial fibrosis in congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Yuzo; Kamitani, Takeshi; Yamanouchi, Torahiko; Honda, Hiroshi [Kyushu University, Departments of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan); Nagao, Michinobu; Kawanami, Satoshi [Kyushu University, Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Fukuoka (Japan); Yamamura, Kenichiro [Kyushu University, Pediatrics, Graduate School of Medical Sciences, Fukuoka (Japan); Sakamoto, Ichiro [Kyushu University, Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka (Japan); Yabuuchi, Hidetake [Kyushu University, Health SciencesGraduate School of Medical Sciences, Fukuoka (Japan)

    2016-10-15

    To investigate the utility of eccentricity index (EI) using cardiac cine MRI for the assessment of right ventricular (RV) hemodynamics in congenital heart disease (CHD). Fifty-five patients with CHD (32 women; mean age, 40.7 ± 20.9 years) underwent both cardiac MRI and right heart catheterization. EI was defined as the ratio of the distance between the anterior-posterior wall and the septal-lateral wall measured in the short-axis of mid-ventricular cine MRI. Correlations between EIs and RV hemodynamic parameters were analyzed. EIs were compared between patients with and without late gadolinium enhancement (LGE). A strong correlation between mean pulmonary artery pressure (PAP) and systolic EI (r = 0.81, p < 0.0001) and a moderate negative correlation between diastolic EI and RV ejection fraction (EF) (r = -0.62, p < 0.0001) were observed. Receiver operating characteristic analysis revealed optimal EI thresholds for detecting patients with mean PAP ≥40 mmHg with C-statistics of 0.90 and patients with RVEF <40 % with C-statistics of 0.78. Systolic EIs were significantly greater for patients with LGE (1.45 ± 0.05) than for those without LGE (1.15 ± 0.07; p < 0.001). EI offers a simple, comprehensive index that can predict pulmonary hypertension and RV dysfunction in CHD. (orig.)

  20. Cardiac magnetic resonance feature tracking: a novel method to assess myocardial strain. Comparison with echocardiographic speckle tracking in healthy volunteers and in patients with left ventricular hypertrophy.

    Science.gov (United States)

    Orwat, Stefan; Kempny, Aleksander; Diller, Gerhard-Paul; Bauerschmitz, Pia; Bunck, Alexander Ch; Maintz, David; Radke, Robert M; Baumgartner, Helmut

    2014-01-01

    Left ventricular longitudinal strain (LV-LS) and strain rate (SR) are sensitive markers of early systolic dysfunction. To evaluate the feasibility of a novel, cardiac magnetic resonance (CMR) based method known as feature tracking (FT) for the assessment of strain and SR, and to compare the CMR based results to those obtained on standard transthoracic echocardiography (TTE) in healthy volunteers and in patients with left ventricular hypertrophy cardiomyopathy (HCM). Overall, 20 healthy volunteers (ten male, mean age 24 ± 3 years) and 20 consecutive patients with HCM (12 male, mean age 47 ± 19 years) were included. Longitudinal and circumferential strain and SR of the left ventricle were measured on CMR at 1.5 Tesla and TTE and interobserver variability was assessed. FT measurements were feasible in all subjects. A good agreement between global LV-LS measured on CMR (controls: 20.8 ± 3.0; HCM: 17.6 ± 3.8) and TTE (controls: 19.4 ± 2.1; HCM: 16.6 ± 2.9) was found, while the agreement was worse for circumferential strain and all SR measurements. For the left and right ventricles, interobserver reproducibility was higher for strain measurements compared to SR. Coefficients of variation were lowest for LV-LS (13.2%) by CMR. FT analysis is a novel CMR based method for the analysis of myocardial strain and SR that is simple and correlates well with the echocardiographic measurements. Since CMR is unaffected by inadequate acoustic windows, FT may represent an attractive alternative to echocardiography in assessing the increasingly important parameters of myocardial deformation.

  1. Usefulness of ventricular repolarization dynamicity in predicting arrhythmic deaths in patients with ischemic cardiomyopathy (from the European Myocardial Infarct Amiodarone Trial).

    Science.gov (United States)

    Milliez, Paul; Leenhardt, Antoine; Maisonblanche, Pierre; Vicaut, Eric; Badilini, Fabio; Siliste, Calin; Benchetrit, Chemia; Coumel, Philippe

    2005-04-01

    The European Myocardial Infarct Amiodarone Trial (EMIAT) investigated the effects of amiodarone versus placebo in patients after myocardial infarction who had left ventricular ejection fraction death from their matched survivors in this EMIAT population. In addition, we assessed whether VR dynamicity could differentiate patients who died from arrhythmic cardiac death (ACD) and from non-ACD. VR dynamicity (determined from Holter's recordings at baseline) was compared before antiarrhythmic therapy in 118 patients who had cardiac death and 118 matched survivors according to age, gender, left ventricular ejection fraction, and subsequent administration or nonadministration of amiodarone. VR dynamicity was compared within the cardiac death group between the 59 patients who died from ACD and the 59 who died from non-ACD. VR dynamicity was expressed as the slope of the linear regression between QTo (measured automatically) and stable RR intervals. Patients who died were found to have a significant steeper rate dependence of QTo intervals during the 3 periods than their matched survivors. In multivariate analysis, the QTo/RR nocturnal interval appeared to be the best independent predictor of cardiac death. In addition, patients who died from ACD were found to have a significant steeper rate dependence of QTo intervals during the morning period than those who died from non-ACD. In the multivariate analysis, the QTo/RR morning interval remained the best independent predictor of ACD. Thus, in the EMIAT trial, evaluation of QT dynamicity is a strong predictor of cardiac death. In addition, QT dynamicity could predict the occurrence of ACD in cases of cardiac death.

  2. T-wave inversions related to left ventricular basal hypertrophy and myocardial fibrosis in non-apical hypertrophic cardiomyopathy: A cardiovascular magnetic resonance imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Xiuyu, E-mail: cxy0202@126.com [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Zhao, Shihua, E-mail: zhaoshihua0202@126.com [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Zhao, Tao, E-mail: taozhao0202@126.com [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Lu, Minjie, E-mail: lmjkan@126.com [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Yin, Gang, E-mail: gangyin0202@126.com [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Jiang, Shiliang, E-mail: jiangsl-2011@163.com [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Prasad, Sanjay, E-mail: s.prasad@rbht.nhs.uk [NIHR Biomedical Research Unit, Royal Brompton Hospital Sydney Street, London, SW3 6NP (United Kingdom)

    2014-02-15

    Objectives: To investigate the relationship between T-wave inversions and left ventricular (LV) segmental hypertrophy and myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) in patients with non-apical hypertrophic cardiomyopathy (HCM). Methods: 196 consecutive patients with non-apical HCM underwent late gadolinium enhancement (LGE) CMR and 12-lead electrocardiogram. The distribution and magnitude of LV segmental hypertrophy and LGE were assessed according to the AHA 17-segment model and analyzed in relation to T-wave inversions. Results: Of 196 HCM patients, 144 (73%) exhibited T-wave inversions. 144 (73%) patients had evidence of myocardial fibrosis as defined by LGE, and the prevalence of LGE was significantly higher in patients with T-wave inversions compared with those without T-wave inversions (78% vs. 59%, P = 0.008). T-wave inversions were related to basal anterior and basal anteroseptal LGE (20% vs. 10%, P = 0.04 and 68% vs. 46%, P = 0.005, respectively). In addition, T-wave inversions were associated with greater basal anteroseptal and basal inferior wall thickness (19.5 ± 4.7 mm vs. 16.7 ± 4.5 mm, P < 0.001 and 10.9 ± 3.3 mm vs. 9.6 ± 3.0 mm, P = 0.01, respectively). By logistic regression analysis, basal anteroseptal wall thickness and LGE were independent determinants of T-wave inversions (P = 0.005, P = 0.01, respectively). Conclusions: T-wave inversions in HCM are associated with LGE and wall thickness of the left ventricular basal segments. Moreover, basal anteroseptal wall thickness and LGE are independent determinants of T-wave inversions.

  3. Study of the Myocardial Contraction and Relaxation Velocities through Doppler Tissue Imaging Echocardiography: A New Alternative in the Assessment of the Segmental Ventricular Function

    Directory of Open Access Journals (Sweden)

    Silva Carlos Eduardo Suaide

    2002-01-01

    Full Text Available OBJECTIVE: Doppler tissue imaging (DTI enables the study of the velocity of contraction and relaxation of myocardial segments. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. METHODS: We studied 35 healthy individuals (27 were male with ages ranging from 12 to 59 years (32.9 ± 10.6. Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. RESULTS: The means (and standard deviation of the peak velocities in the basal, medial, and apical regions (of the septal, anterior, lateral, and posterior left ventricle walls were respectively, in cm/s, 7.35(1.64, 5.26(1.88, and 3.33(1.58 in systole and 10.56(2.34, 7.92(2.37, and 3.98(1.64 in diastole. The mean time in which systolic peak velocity was recorded was 131.59ms (±19.12ms, and diastolic was 459.18ms (±18.13ms based on the peak of the R wave of the electrocardiogram. CONCLUSION: In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05. The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

  4. Intramyocardial Injection of Pig Pluripotent Stem Cells Improves Left Ventricular Function and Perfusion: A Study in a Porcine Model of Acute Myocardial Infarction.

    Directory of Open Access Journals (Sweden)

    Xiaorong Li

    Full Text Available Induced pluripotent stem (iPS cells have the potential to differentiate to various types of cardiovascular cells to repair an injured heart. The potential therapeutic benefits of iPS cell based treatment have been established in small-animal models of myocardial infarction (MI. We hypothesize that porcine iPS (piPS cell transplantation may be an effective treatment for MI. After a 90-minute occlusion of the left anterior descending artery in a porcine model, undifferentiated piPS cells or PBS were injected into the ischemic myocardium. Cardiac function, myocardial perfusion and cell differentiation were investigated. One week after piPS cell delivery, global left ventricular ejection fraction (LVEF significantly decreased in both the iPS group and the PBS group compared to the Sham group (p<0.05, respectively. Six weeks after piPS cell delivery, LVEF of the iPS group significantly improved compared to the PBS group (56.68% vs. 50.93%, p = 0.04 but was still lower than the Sham group. Likewise, the piPS cell transplantation improved the regional perfusion compared to the PBS injection (19.67% vs. 13.67%, p = 0.02. The infarct area was significantly smaller in the iPS group than the PBS group (12.04% vs. 15.98% p = 0.01. PiPS cells engrafted into the myocardium can differentiate into vessel cells, which result in increased formation of new vessels in the infarcted heart. Direct intramyocardial injection of piPS cells can decrease infarct size and improve left ventricular function and perfusion for an immunosuppressed porcine AMI model.

  5. Ventricular arrhythmias and risk of death and acute myocardial infarction in apparently healthy subjects of age >or=55 years

    DEFF Research Database (Denmark)

    Sajadieh, A; Nielsen, OW; Rasmussen, Verner

    2006-01-01

    arrhythmias were studied in a cohort of middle-aged and elderly subjects without apparent heart disease. Six hundred seventy-eight men and women aged 55 to 75 years without a history of heart disease or stroke were included. Baseline examinations included physical examinations, fasting laboratory testing......Increased ventricular ectopic activity and even more complex arrhythmias are not uncommon in subjects without apparent heart disease. However, their prognostic significance has been controversial and not updated in recent years. The prevalence and prognostic significance of different ventricular...

  6. Selective Blockade of Periostin Exon 17 Preserves Cardiac Performance in Acute Myocardial Infarction.

    Science.gov (United States)

    Taniyama, Yoshiaki; Katsuragi, Naruto; Sanada, Fumihiro; Azuma, Junya; Iekushi, Kazuma; Koibuchi, Nobutaka; Okayama, Keita; Ikeda-Iwabu, Yuka; Muratsu, Jun; Otsu, Rei; Rakugi, Hiromi; Morishita, Ryuichi

    2016-02-01

    We previously reported that overexpression of full-length periostin, Pn-1, resulted in ventricular dilation with enhanced interstitial collagen deposition in a rat model. However, other reports have documented that the short-form splice variants Pn-2 (lacking exon 17) and Pn-4 (lacking exons 17 and 21) promoted cardiac repair by angiogenesis and prevented cardiac rupture after acute myocardial infarction. The apparently differing findings from those reports prompted us to use a neutralizing antibody to selectively inhibit Pn-1 by blockade of exon 17 in a rat acute myocardial infarction model. Administration of Pn neutralizing antibody resulted in a significant decrease in the infarcted and fibrotic areas of the myocardium, which prevented ventricular wall thinning and dilatation. The inhibition of fibrosis by Pn neutralizing antibody was associated with a significant decrease in gene expression of fibrotic markers, including collagen I, collagen III, and transforming growth factor-β1. Importantly, the number of α-smooth muscle actin-positive myofibroblasts was significantly reduced in the hearts of animals treated with Pn neutralizing antibody, whereas cardiomyocyte proliferation and angiogenesis were comparable in the IgG and neutralizing antibody groups. Moreover, the level of Pn-1 expression was significantly correlated with the severity of myocardial infarction. In addition, Pn-1, but not Pn-2 or Pn-4, inhibited fibroblast and myocyte attachment, which might account for the cell slippage observed during cardiac remodeling. Collectively, these results indicate that therapeutics that specifically inhibit Pn exon-17, via a neutralizing antibody or drug, without suppressing other periostin variants might offer a new class of medication for the treatment of acute myocardial infarction patients. © 2015 American Heart Association, Inc.

  7. Spatial distribution of ventricular late potentials assessed by the newly developed signal-averaged vector-projected 187-channel electrocardiogram in patients with old myocardial infarction

    Directory of Open Access Journals (Sweden)

    Keisuke Futagawa

    2013-02-01

    Full Text Available Risk stratification of lethal arrhythmias is important for the management of ischemic heart disease. Recently, we developed a novel 187-channel signal-averaged vector-projected high-resolution electrocardiograph (187-ch SAVP-ECG with a Mason–Likar lead system with 10 electrodes. The purpose of this study was to examine the feasibility of a noninvasive evaluation of the spatial distribution of high-frequency late potentials (HFLPs in patients with myocardial infarction (MI by using the 187-ch SAVP-ECG. Sixty-four MI patients (7 women and 57 men, between the age of 39 and 84 years (mean 67.7±9.7 years, with positive ventricular late potentials defined by an X, Y, Z-lead ECG were studied. The integrated ventricular 187-ch SAVP-ECG could identify the area of HFLPs that was projected virtually by mathematically calculated 187 electrograms on the body surface in all patients, and differentiate the locations of MI. The 187-ch SAVP-ECG can be a practical and noninvasive examination tool for identifying the location of infarction areas and possible arrhythmogenic substrates with slow conduction properties in patients with MI.

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

    Directory of Open Access Journals (Sweden)

    Muhammad G. Saleh

    2012-01-01

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

  9. Immediate and Delayed Drug Therapy Effects on Low Dose Sarin Exposed Mice Myocardial Performance

    Science.gov (United States)

    2011-03-01

    antiarrhythmic drug which acts as a β-adrenergic receptor blockade (Ramos, et al. 2003). Major benefits of propranolol are reduced heart rate, decrease...IMMEDIATE AND DELAYED DRUG THERAPY EFFECTS ON LOW DOSE SARIN EXPOSED MICE MYOCARDIAL PERFORMANCE THESIS Joshua T. Miller, Major, USA...IMMEDIATE AND DELAYED DRUG THERAPY EFFECTS ON LOW DOSE SARIN EXPOSED MICE MYOCARDIAL PERFORMANCE THESIS Presented to the Faculty Department of

  10. The significance of post-stress decrease in left ventricular ejection fraction in patients undergoing regadenoson stress gated SPECT myocardial perfusion imaging.

    Science.gov (United States)

    Gomez, Javier; Golzar, Yasmeen; Fughhi, Ibtihaj; Olusanya, Adebayo; Doukky, Rami

    2017-02-08

    The significance of post-stress decrease in left ventricular ejection fraction (LVEF) with regadenoson stress gated SPECT (GSPECT) myocardial perfusion imaging (MPI) has not been studied. Consecutive patients who underwent rest/regadenoson stress GSPECT-MPI followed by coronary angiography within 6 months were analyzed. Change in LVEF by GSPECT-MPI was calculated as stress LVEF minus rest LVEF; a significant decrease was tested at 5% and 10% thresholds. In a diagnostic cohort of 793 subjects, LVEF change was not predictive of severe/extensive coronary artery disease (area under the curve, 0.50; 95% confidence interval, 0.44-0.57; P = 0.946). There was no significant difference in the rates of severe/extensive coronary artery disease in patients with or without a decrease in LVEF, irrespective of MPI findings. In an outcome cohort of the 929 subjects followed for 30 ± 16 months, post-regadenoson stress decrease in LVEF was not associated with increased risk of the composite endpoint of cardiac death or myocardial infarction or in the risk of coronary revascularization. In patients selected to undergo coronary angiography following regadenoson stress GSPECT-MPI, a decrease in LVEF after regadenoson stress is not predictive of severe/extensive CAD or adverse clinical outcomes, irrespective of MPI findings.

  11. Improved outcomes of cardiopulmonary resuscitation in rats with myocardial infarction treated with allogenic bone marrow mesenchymal stem cells.

    Science.gov (United States)

    Wang, Tong; Tang, Wanchun; Sun, Shijie; Ristagno, Giuseppe; Xu, Tingyan; Weil, Max Harry

    2009-03-01

    We hypothesized that rats in which myocardial infarction had been treated with mesenchymal stem cells (MSCs) would have better outcomes following the global myocardial ischemia of cardiac arrest and cardiopulmonary resuscitation (CPR) compared with rats in which myocardial infarction had been treated with phosphate buffer solution (PBS). Prospective, randomized controlled study. University-affiliated research institute. Male Sprague-Dawley rats. Myocardial infarction was induced in 18 male Sprague-Dawley rats. Four weeks later, animals were randomized to receive 5 x 10 MSCs labeled with red fluorescent dye gel (PKH26) in PBS or a PBS-alone injection into right femoral vein. Echocardiographically measured myocardial function, including ejection fraction, left ventricular end-diastolic volume, and left ventricular end-systolic volume, was quantitated 2 and 4 weeks after administering MSCs or PBS. Four weeks after MSCs or PBS injection, 6 minutes of ventricular fibrillation (VF) and 6 minutes of CPR were performed before defibrillation. Myocardial function, including cardiac index, left ventricular, dP/dt max (dP/dt max), left ventricular negative dP/dt min (-dP/dt min), and left ventricular diastolic pressure, was measured before inducing VF and hourly following return of spontaneous circulation. Labeled MSCs were observed in 5-mum cryostat sections from each harvested heart. Significant improvements in ejection fraction, left ventricular end-diastolic volume, left ventricular end-systolic volume, cardiac index, dP/dt max, -dP/dt min, and left ventricular diastolic pressure followed injection of MSCs before inducing VF. Following return of spontaneous circulation, myocardial function was significantly better in animals pretreated with MSCs; this was associated with significantly increased duration of postresuscitation survival. Myocardial function before and after CPR and duration of survival after CPR were significantly improved in animals in which myocardial

  12. Effect of the direct renin inhibitor aliskiren on left ventricular remodelling following myocardial infarction with systolic dysfunction

    DEFF Research Database (Denmark)

    Solomon, Scott D; Shin, Sung Hee; Shah, Amil

    2011-01-01

    Direct renin inhibitors provide an alternative approach to inhibiting the renin-angiotensin-aldosterone system (RAAS) at the most proximal, specific, and rate-limiting step. We tested the hypothesis that direct renin inhibition would attenuate left ventricular remodelling in patients following...

  13. Effect of the direct renin inhibitor aliskiren on left ventricular remodelling following myocardial infarction with systolic dysfunction

    DEFF Research Database (Denmark)

    Solomon, Scott D; Shin, Sung Hee; Shah, Amil

    2011-01-01

    Direct renin inhibitors provide an alternative approach to inhibiting the renin-angiotensin-aldosterone system (RAAS) at the most proximal, specific, and rate-limiting step. We tested the hypothesis that direct renin inhibition would attenuate left ventricular remodelling in patients following ac...

  14. Impact of Remote Ischemic Postconditioning during Primary Percutaneous Coronary Intervention on Left Ventricular Remodeling after Anterior Wall ST-Segment Elevation Myocardial Infarction: A Single-Center Experience.

    Science.gov (United States)

    Elbadawi, Ayman; Awad, Omar; Raymond, Ramy; Badran, Haytham; Mostafa, Ahmad E; Saad, Marwan

    2017-12-01

    The role of remote ischemic postconditioning (RIPostC) in improving left ventricular (LV) remodeling after primary percutaneous coronary intervention (PCI) is not well established. To determine the efficacy and safety of RIPostC in improving LV remodeling and cardiovascular outcomes after primary PCI for anterior ST-elevation myocardial infarction (STEMI). Seventy-one patients with anterior STEMI were randomized to primary PCI with RIPostC protocol ( n  = 36) versus conventional primary PCI ( n  = 35). Primary outcomes included LV remodeling and LV ejection fraction (LVEF) at 6 month follow-up using transthoracic echocardiography. Secondary outcomes included infarct size, ST-segment resolution (STR) ≥70%, Thrombolysis in Myocardial Infarction (TIMI) flow grade, and myocardial blush grade (MBG). Major adverse cardiac events (MACEs) were also assessed at 6 months. Safety outcome included incidence of acute kidney injury (AKI) postprimary PCI. Sixty patients completed the study. At 6 months, there was no significant decrease in the incidence of LV remodeling with RIPostC group ( p  = 0.42). Similarly, RIPostC failed to show significant improvement in LVEF. However, STR ≥ 70% after primary PCI was achieved more in the RIPostC group ( p  = 0.04), with a trend toward less AKI in the RIPostC group ( p  = 0.08). All other secondary end points, including MACEs at 6 months, were similar in both groups. RIPostC might be associated with better STR after reperfusion as well as less incidence of AKI in patients undergoing primary PCI for anterior wall STEMI, indicating potential benefit in those patients. Whether this role can be translated to better outcomes after primary PCI warrants further investigation.

  15. Effects of aortic tortuosity on left ventricular diastolic parameters derived from gated myocardial perfusion single photon emission computed tomography in patients with normal myocardial perfusion.

    Science.gov (United States)

    Kurisu, Satoshi; Nitta, Kazuhiro; Sumimoto, Yoji; Ikenaga, Hiroki; Ishibashi, Ken; Fukuda, Yukihiro; Kihara, Yasuki

    2017-12-05

    Aortic tortuosity is often found on chest radiograph, especially in aged patients. We tested the hypothesis that aortic tortuosity was associated with LV diastolic parameters derived from gated SPECT in patients with normal myocardial perfusion. One-hundred and twenty-two patients with preserved LV ejection fraction and normal myocardial perfusion were enrolled. Descending aortic deviation was defined as the horizontal distance from the left line of the aortic knob to the most prominent left line of the descending aorta. This parameter was measured for the quantitative assessment of aortic tortuosity. Peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained from redistribution images as LV diastolic parameters. Descending aortic deviation ranged from 0 to 22 mm with a mean distance of 4.5 ± 6.3 mm. Descending aortic deviation was significantly correlated with age (r = 0.38, p < 0.001) and estimated glomerular filtration rate (eGFR) (r = - 0.21, p = 0.02). Multivariate linear regression analysis revealed that eGFR (β = 0.23, p = 0.02) and descending aortic deviation (β = - 0.23, p = 0.01) were significantly associated with PFR, and that only descending aortic deviation (β = - 0.21, p = 0.03) was significantly associated with 1/3 MFR. Our data suggest that aortic tortuosity is associated with LV diastolic parameters derived from gated SPECT in patients with normal myocardial perfusion.

  16. The efiect of sevoflurane induction on the myocardial performance ...

    African Journals Online (AJOL)

    Keywords: Anaesthetics volatile, sevoflurane, heart, myocardial function, Tei index, tissue Doppler echocardiography .... valves. This brings the load independency of the Tei index into question again.5. Delayed closure of the aortic valve and/or earlier opening of the mitral valve will shorten the .... mechanical ventilation.

  17. N-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes

    NARCIS (Netherlands)

    Kromhout, D.; Geleijnse, J.M.; Goede, de J.; Oude Griep, L.M.; Mulder, B.J.M.; Boer, de M.J.; Deckers, J.W.; Boersma, E.; Zock, P.L.; Giltay, E.J.

    2011-01-01

    OBJECTIVE We carried out a secondary analysis in high-risk patients with a previous myocardial infarction (MI) and diabetes in the Alpha Omega Trial. We tested the hypothesis that in these patients an increased intake of the n-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA),

  18. Serotonin concentrations in platelets, plasma, mitral valve leaflet, and left ventricular myocardial tissue in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Cremer, Signe Emilie; Singletary, G.E.; Olsen, Lisbeth Høier

    2014-01-01

    HYPOTHESIS/OBJECTIVES: Altered serotonin (5-hydroxytryptamine, 5HT) signaling is postulated in development and progression of canine myxomatous mitral valve disease (MMVD). Little is known regarding platelet, plasma, valvular, or myocardial 5HT concentration ([5HT]) in affected dogs. We quantifie...

  19. Microvascular Resistance Predicts Myocardial Salvage and Infarct Characteristics in ST‐Elevation Myocardial Infarction

    Science.gov (United States)

    Payne, Alexander R.; Berry, Colin; Doolin, Orla; McEntegart, Margaret; Petrie, Mark C.; Lindsay, M. Mitchell; Hood, Stuart; Carrick, David; Tzemos, Niko; Weale, Peter; McComb, Christie; Foster, John; Ford, Ian; Oldroyd, Keith G.

    2012-01-01

    Background The pathophysiology of myocardial injury and repair in patients with ST‐elevation myocardial infarction is incompletely understood. We investigated the relationships among culprit artery microvascular resistance, myocardial salvage, and ventricular function. Methods and Results The index of microvascular resistance (IMR) was measured by means of a pressure‐ and temperature‐sensitive coronary guidewire in 108 patients with ST‐elevation myocardial infarction (83% male) at the end of primary percutaneous coronary intervention. Paired cardiac MRI (cardiac magnetic resonance) scans were performed early (2 days; n=108) and late (3 months; n=96) after myocardial infarction. T2‐weighted‐ and late gadolinium–enhanced cardiac magnetic resonance delineated the ischemic area at risk and infarct size, respectively. Myocardial salvage was calculated by subtracting infarct size from area at risk. Univariable and multivariable models were constructed to determine the impact of IMR on cardiac magnetic resonance–derived surrogate outcomes. The median (interquartile range) IMR was 28 (17–42) mm Hg/s. The median (interquartile range) area at risk was 32% (24%–41%) of left ventricular mass, and the myocardial salvage index was 21% (11%–43%). IMR was a significant multivariable predictor of early myocardial salvage, with a multiplicative effect of 0.87 (95% confidence interval 0.82 to 0.92) per 20% increase in IMR; Pmicrovascular obstruction and myocardial hemorrhage. Conclusion Microvascular resistance measured during primary percutaneous coronary intervention significantly predicts myocardial salvage, infarct characteristics, and left ventricular ejection fraction in patients with ST‐elevation myocardial infarction. (J Am Heart Assoc. 2012;1:e002246 doi: 10.1161/JAHA.112.002246) PMID:23130166

  20. Left ventricular pseudoaneurysm found after mitral valve replacement performed 30 years earlier.

    Science.gov (United States)

    Castilla, Elena; Gato, Manuel; Ruiz, José Ramón

    2010-03-01

    Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery. Because patients frequently present with nonspecific symptoms, a high index of suspicion is needed to make the diagnosis. This report describes an unusual case demonstrating a large LV pseudoaneurysm after mitral valve replacement performed 30 years earlier.

  1. Influence of high energy phosphate metabolism in postischemic myocardial dysfunction using magnetic resonance spectroscopy; Influencia dos fosfatos de alta energia na funcao ventricular em pacientes com infarto do miocardio avaliada pela resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Kalil Filho, Roberto [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    1998-05-01

    The recovery of left ventricular function after reperfusion is delayed in general by several hours, days or weeks and this phenomenon is known as myocardial stunning. One of the theories to explain the pathogenesis of this postischemic myocardial dysfunction is the production of not enough energy by mitochondria, leading to decreased adenosine-triphosphate (ATP) levels. We evaluated the influence of high energy phosphate metabolism in postischemic myocardial dysfunction, using magnetic resonance spectroscopy in patients with acute anterior wall myocardial infarction, successfully reperfused, within the first six hours from the onset of the symptoms. Twenty-nine patients were studied in the acute phase (on average four days after the onset of myocardial infarction) and 21 repeated the examination in the follow-up phase (average 39 days). Regional left ventricular function was evaluated by cine-resonance and high energy phosphate metabolism by phosphorus-31 spectroscopy, using the phosphocreatine {beta} ATP (P Cr/{beta}ATP) ratio. The existence of myocardial stunning was suggested by the improvement of the related regional contractility during the follow-up. The contractility improved in the septal wall from 2.46{+-} 0.68 to 1.54 {+-} 0.78 (p<0.001), in the anteroseptal wall from 2.0 {+-} 0.89 to 1.40 {+-} 0.75 (p<0.001) and in the anterior wall from 2.37 {+-} 0.71 to 1.41 {+-} 0.59 (p<0.001). The P Cr/{beta}ATP ratio did not change from acute to follow-up phase (1.51 {+-} 0.17 vs. 1.53 {+-} 0.17; p = 0.6). This study suggests that decreased high energy phosphate metabolism after reperfusion does not have an important role in the genesis of the myocardial stunning in patients with acute anterior wall myocardial infarction. (author) 25 refs., 9 figs., 1 tab.

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

    Directory of Open Access Journals (Sweden)

    Hakalahti Anna E

    2010-08-01

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

  3. Ventricular performance during exercise in patients with chronic obstructive pulmonary disease (COPD)

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Iwao; Akashiba, Tsuneto; Horie, Takashi (Nihon Univ., Tokyo (Japan). School of Medicine)

    1992-01-01

    We assessed ventricular performance during exercise in 16 chronic obstructive pulmonary disease (COPD) patients and 8 normal control subjects by means of radionuclide equilibrium angiography using technetium-99m as a tracer. Supine exercise on a bicycle ergometer was performed until symptom-limited exhaustion. Data were accumulated for 300 heart beats at rest and 150 heart beats during exercise. We used the standard voxel count method to calculate the ventricular volumes. Age, FEV{sub 1.0}%, %VC, PaO{sub 2} and PaCO{sub 2} of the COPD patients were 63{+-}8 yr, 46{+-}11%, 69{+-}18%, 68{+-}11 Torr and 44{+-}7 Torr (mean{+-}SD), respectively. Systolic dysfunction of both the left and right ventricles was well confirmed in the present study. In 12 patients who also underwent hemodynamic studies, resting total pulmonary vascular resistance index (TPVRI) and mean pulmonary artery pressure (P-barpa) significantly correlated with right ventricular end-systolic volume index (RVESVI) obtained by RI angiography; {gamma}=0.769 (p<0.01) and {gamma}=0.631 (p<0.05), respectively. A significant relationship was also observed between left ventricular dysfunction and the degree of hypercapnia. In response to exercise testing, 10 of 16 patients exhibited insufficient augmentation of stroke volume, and both left and right end-diastolic volumes decreased in half of 10 patients. It is suggested that cardiac function may be disturbed by mechanical factors such as pulmonary hyperinflation in COPD patients. (author).

  4. The value of revascularization and adherence to therapy in the development of cardiovascular complications in long-term monitoring of patients with myocardial infarction of the right ventricle on the background of the Q-myocardial infarction of the left ventricular posterior wall

    Directory of Open Access Journals (Sweden)

    V.Y. Tseluyko

    2016-03-01

    Full Text Available The aim – to evaluate the role of deferred revascularization and adherence to drug therapy as factors affecting long-term prognosis of patients with myocardial infarction (MI of the right ventricle (RV on the background of the Q-myocardial infarction of the left ventricle (LV posterior wall (PW. Materials and methods. The study involved 155 patients with MI of the RV due the Q-MI of the PWLV, age 64.11 ± 0.78 years. The revascularization (PCI, CABG was performed within one year after MI. Adherence to treatment was assessed after 6 and 30 months. The combined endpoints included: unstable angina (UA, Re-MI, stroke and cardio-vascular (CV death. Follow-up was 30.6 ± 4.5 month. Results. The 1st group included 68 (43.9 % patients who underwent surgical treatment, 87 (56.1 % patients under conservative strategy composed the 2nd group. The frequency of combined CV-point was significantly lower in the 1st group (ð = 0.00001. Revascularization after RV MI was accompanied by significant decrease of frequency of Re-MI (ð = 0.05, stroke (ð = 0.0413 and UA (ð = 0.00001 during 30 months follow-up. Reducing risk of CV events in the 1st group was associated with higher adherence to ACE inhibitors / ARA (86.7–79.4 %, statins (97.1–64.7 % and clopidogrel (98.5–79.4 % at 6 months and at the end of the observation period, compared to patients with conservative strategy (p < 0.05. Conclusions. Higher adherence to drug therapy in the surgical treatment group is associated with significantly lower number of cardiovascular events during 30 days after right ventricular myocardial infarction.

  5. Myocardial viability for decision-making concerning revascularization in patients with left ventricular dysfunction and coronary artery disease: a meta-analysis of non-randomized and randomized studies.

    Science.gov (United States)

    Orlandini, Andrés; Castellana, Noelia; Pascual, Andrea; Botto, Fernando; Cecilia Bahit, M; Chacon, Carolina; Luz Diaz, M; Diaz, Rafael

    2015-03-01

    Myocardial viability tests have been proposed as a key factor in the decision-making process concerning coronary revascularization procedures in patients with left ventricular dysfunction and coronary artery disease (LVD-CAD). We performed a systematic review and meta-analysis of studies that compared medical treatment with revascularization in patients with viable and non-viable myocardium and recorded mortality as outcome. Thirty-two non-randomized (4328 patients) and 4 randomized (1079 patients) studies were analyzed. In non-randomized studies, revascularization provided a significant mortality benefit compared with medical treatment (p<0.05). Since the heterogeneity was significant (p<0.05) a viability subgroup analysis was performed, showing that revascularization provided a significant mortality benefit compared with medical treatment in patients with viable myocardium (p<0.05) but not in patients without (p=0.34). There was a significant subgroup effect (p<0.05) related to the intensity of the effect, but not to the direction. In randomized studies, revascularization did not provide a significant mortality benefit compared with medical treatment in either patients with viable myocardium or those without (p=0.21). There was no significant subgroup effect (p=0.72). Neither non-randomized nor randomized studies demonstrated any significant difference in outcomes between patients with and without viable myocardium. The available data are inconclusive regarding the usefulness of myocardial viability tests for the decision-making process concerning revascularization in LVD-CAD patients. Patients with viable myocardium appear to benefit from revascularization, but similar benefits were observed in patients without viable myocardium. Moreover, a neutral or adverse effect of revascularization cannot be excluded in either group of patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Exercise-induced intra-ventricular gradients as a frequent potential cause of myocardial ischemia in cardiac syndrome X patients

    Directory of Open Access Journals (Sweden)

    Almeida Ana G

    2008-01-01

    Full Text Available Abstract Background The development of intra-ventricular gradients (IVG during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress. The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients. Methods We prospectively evaluated 91 patients (pts mean aged 51 ± 12 years (age ranged 20 to 75 years old, 44 of whom were women. All pts had angina, positive exercise ECG treadmill testing, normal rest echocardiogram and no coronary artery disease on coronary angiogram (cardiac X syndrome. After complete Doppler echocardiographic evaluation with determination of left ventricular outflow tract index (LVOTi, relative left ventricular wall thickness (RLVWT and left ventricular end-diastolic volume index (LVDVi, all patients underwent stress echocardiography with two-dimensional and Doppler echographic evaluation during and after treadmill exercise. Results For analysis purpose patients were divided in 2 groups, according to the development of IVG. Doppler evidence of IVG was found in 33 (36% of the patients (Group A, with mean age 47 ± 14 years old (age ranged 20 to 72 years and with a mean end-systolic peak gradient of 86 ± 34 mmHg (ranging from 30 to 165 mmHg. The IVG development was accompanied by SAM of the mitral valve in 23 pts. Three of these pts experienced symptomatic hypotension. Ten were women (30% pts. 58 pts in group B, 34 of whom were women (59% (p = 0,01 vs group A, mean aged 53,5 ± 10,9 years old (age ranged 34 to 75 years (p = 0,03 vs group A, did not develop IVG. LVOTi was 10,29 ± 0,9 mm/m2 in group A and 11,4 ± 1 mm/m2 in group B (p 2 in group A and 56 ± 11,6 ml/m2 in group B (p = 0,000. Conclusion 1. A significant number of patients with cardiac X syndrome developed IVG during upright exercise in treadmill. These pts (group A are mainly males and younger than those who did not develop IVG. 2. The development of IVG

  7. Hypertrabeculated Left Ventricular Myocardium in Relationship to Myocardial Function and Fibrosis: The Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Kawel-Boehm, Nadine; McClelland, Robyn L; Zemrak, Filip; Captur, Gabriella; Hundley, W Gregory; Liu, Chia-Ying; Moon, James C; Petersen, Steffen E; Ambale-Venkatesh, Bharath; Lima, João A C; Bluemke, David A

    2017-09-01

    Purpose To determine if excess greater left ventricle (LV) trabeculation is associated with decreased average regional myocardial function, diffuse fibrosis, or both. Materials and Methods This was a HIPAA-compliant institutional board approved multicenter study, and all participants provided written informed consent. Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a comprehensive cardiac magnetic resonance (MR) examination. LV trabeculation was measured with the maximal apical fractal dimension (FD), which is a marker of endocardial complexity. Demographic covariates, cardiovascular risk factors, and cardiac MR measurements were compared across quartiles of FD. Associations between FD and peak regional systolic circumferential strain (Ecc) and T1 time, a surrogate for diffuse myocardial fibrosis, were assessed with multivariable linear regression models. Results A total of 1123 subjects (593 [52.8%] female; mean age, 67.1 years ± 8.7 [standard deviation]) underwent FD and Ecc measurement, and 992 (521 [52.5%] female; mean age, 67.1 years ± 8.7) underwent FD and T1 measurement. Mean FD was 1.2 ± 0.07 in both groups, and mean Ecc was -18.3 ± 2.27 in the subjects who underwent FD and Ecc measurement. Global volumes and ejection fraction showed no differences between FD quartiles. However, with increasing FD quartile, Ecc was greater (indicating worse average regional function) (P myocardial strain (relative to the mean) per unit change in FD (regression coefficient = 4.0%; P < .001). There was no association between the degree of trabeculation and diffuse fibrosis measured with T1 mapping. Conclusion Average regional LV function was worse in individuals with greater LV trabeculation, supporting the concept of hypertrabeculation being an epiphenomenon of disease. © RSNA, 2017.

  8. Effects of low-dose dobutamine on left ventricular function in normal subjects as assessed by gated single-photon emission tomography myocardial perfusion studies

    Energy Technology Data Exchange (ETDEWEB)

    Everaert, H.; Vanhove, C.; Franken, P.R. [Div. of Nuclear Medicine, University Hospital, Free University of Brussels (Belgium)

    1999-10-01

    Electrocardiography gated single-photon emission tomography (gated SPET) allows the assessment of regional perfusion and function simultaneously and in full spatial congruency. In this study changes in global and regional left ventricular function in response to dobutamine infusion were assessed in ten healthy volunteers using sequential gated SPET myocardial perfusion acquisitions. Four consecutive gated SPET images were recorded 60 min after injection of 925 MBq technetium-99m tetrofosmin on a three-head camera equipped with focussing collimators. Two acquisitions were made at rest (baseline 1 and 2), and the third and fourth acquisitions were started 5 min after the beginning of the infusion of 5 and 10 {mu}g kg{sup -1} min{sup -1} dobutamine, respectively. Systolic wall thickening (WT) was quantified using a method based on circumferential profile analysis. Left ventricular ejection fraction (LVEF) and volumes were calculated automatically using the Cedars-Sinai program. Nine of the ten subjects presented a definite increase in WT during dobutamine infusion. WT increased on average from 46%{+-}14% at baseline to 71%{+-}23% (range: 37%-106%; P<0.05) during 5 {mu}g kg{sup -1} min{sup -1} dobutamine infusion and to 85%{+-}25% (range: 62%-123%; P<0.05 with respect to WT at 5 {mu}g kg{sup -1} min{sup -1}) during 10 {mu}g kg{sup -1} min{sup -1} dobutamine infusion. Apical segments showed the largest WT at baseline. The average WT response to dobutamine was similar for all parts of the myocardium. It is concluded that changes in WT induced by infusion of low-dose dobutamine can be assessed by sequential gated SPET myocardial perfusion studies. The ''stress gated SPET'' protocol proposed in this study might be helpful to distinguish viable from scar tissue in patients with coronary artery disease, by demonstrating a preserved inotropic response in hypoperfused myocardium. (orig.)

  9. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study.

    Science.gov (United States)

    Haggerty, Christopher M; Suever, Jonathan D; Pulenthiran, Arichanah; Mejia-Spiegeler, Abba; Wehner, Gregory J; Jing, Linyuan; Charnigo, Richard J; Fornwalt, Brandon K; Fogel, Mark A

    2017-12-11

    Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.

  10. Intracoronary infusion of encapsulated glucagon-like peptide-1-eluting mesenchymal stem cells preserves left ventricular function in a porcine model of acute myocardial infarction.

    Science.gov (United States)

    de Jong, Renate; van Hout, Gerardus P J; Houtgraaf, Jaco H; Kazemi, Kushan; Wallrapp, Christine; Lewis, Andrew; Pasterkamp, Gerard; Hoefer, Imo E; Duckers, Henricus J

    2014-10-01

    Engraftment and survival of stem cells in the infarcted myocardium remain problematic in cell-based therapy for cardiovascular disease. To overcome these issues, encapsulated mesenchymal stem cells (eMSCs) were developed that were transfected to produce glucagon-like peptide-1, an incretin hormone with known cardioprotective effects, alongside MSC endogenous paracrine factors. This study was designed to investigate the efficacy of different doses of intracoronary infusion of eMSC in a porcine model of acute myocardial infarction (AMI). One hundred pigs were subjected to a moderate AMI (posterolateral AMI; n=50) or a severe AMI (anterior AMI; n=50), whereupon surviving animals (n=36 moderate, n=33 severe) were randomized to receive either intracoronary infusion of 3 incremental doses of eMSC or Ringers' lactate control. Cardiac function was assessed using invasive hemodynamics, echocardiography, and histological analysis. A trend was observed in the moderate AMI model, whereas in the severe AMI model, left ventricular ejection fraction improved by +9.3% (P=0.004) in the best responding eMSC group, because of a preservation of left ventricular end-systolic volume. Arteriolar density increased 3-fold in the infarct area (8.4±0.9/mm(2) in controls versus 22.2±2.6/mm(2) in eMSC group; P<0.001). Although not statistically significant, capillary density was 30% higher in the border zone (908.1±99.7/mm(2) in control versus 1209.0±64.6/mm(2) in eMSC group; P=ns). eMSCs enable sustained local delivery of cardioprotective proteins to the heart, thereby enhancing angiogenesis and preserving contractile function in an animal AMI model. © 2014 American Heart Association, Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-05-15

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

  12. Cardiovascular magnetic resonance tagging of the right ventricular free wall for the assessment of long axis myocardial function in congenital heart disease

    Directory of Open Access Journals (Sweden)

    Chen Sylvia SM

    2011-12-01

    Full Text Available Abstract Background Right ventricular ejection fraction (RV-EF has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease. Methods We studied 84 patients: 56 with repaired Tetralogy of Fallot (rTOF; 28 with atrial septal defect (ASD: 13 with and 15 without pulmonary hypertension (RV pressure > 40 mmHG by echocardiography. For comparison, 20 healthy controls were studied. CMR acquisitions included an anatomically defined four chamber cine followed by a cine gradient echo-planar sequence in the same plane with a labelling pre-pulse giving a tag line across the basal myocardium. RV tag displacement was measured with automated registration and tracking of the tag line together with standard measurement of RV-EF. Results Mean RV displacement was higher in the control (26 ± 3 mm than in rTOF (16 ± 4 mm and ASD with pulmonary hypertension (18 ± 3 mm groups, but lower than in the ASD group without (30 ± 4 mm, P Conclusions Measurements of RV long axis displacement by CMR tagging showed more differences between the groups studied than did RV-EF, and was reproducible, quick and easy to apply. Further work is needed to assess its potential use for the detection of longitudinal changes in RV myocardial function.

  13. Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated {sup 82}rubidium myocardial perfusion PET

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Tracy L.Y.; Merrill, Jennifer; Bengel, Frank M. [Johns Hopkins University, Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Baltimore, MD (United States); Volokh, Lana [GE Healthcare, Haifa (Israel)

    2008-02-15

    Myocardial perfusion imaging with {sup 82}Rb PET allows for ECG-gated studies to be obtained early after radiotracer injection, capturing ventricular function close to peak pharmacologic action of dipyridamole. This is different from gated SPECT and may potentially provide additional diagnostic information. We sought to identify potential correlates of the PET-derived ejection fraction response to vasodilator stress. One hundred ten consecutive patients undergoing {sup 82}Rb PET myocardial perfusion imaging during evaluation for coronary artery disease were included. Using a GE Discovery STRx PET-CT scanner, ECG-gated images (eight bins) were obtained at rest and 4 min after dipyridamole infusion, 90 s after infusion of 1,480-2,220 MBq of {sup 82}Rb. Summed rest, stress, and difference scores (SRS, SSS, and SDS) were determined using a five-point scoring system and 20-segment model. Ejection fraction was calculated using automated QGS software. Significant reversibility (SDS {>=} 4) was found in 23 patients (21%). Mean LVEF in all patients was 47 {+-} 13% at rest and 53 {+-} 13% during dipyridamole. LVEF increased in 89 patients, and decreased in 17 patients during vasodilation. The change in LVEF was inversely correlated with SDS (r = -0.26; p = 0.007). Additionally, it was inversely correlated with resting LVEF (r = -0.20; p = 0.03) and SSS (r = -0.25; p = 0.009). No significant correlations were observed with SRS, heart rate, blood pressure, age, hypertension, hypercholesterolemia, or pretest likelihood of disease. At multivariate regression analysis, SDS was an independent predictor of the change in LVEF. Gated {sup 82}Rb PET during pharmacologic stress allows for assessment of the functional response to vasodilation. The magnitude of LVEF increase is determined by stress perfusion/reversible perfusion defects. Functional response to hyperemia may thus be incorporated in future evaluations of diagnostic and prognostic algorithms based on {sup 82}Rb PET. (orig.)

  14. Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Berti, Valentina; Sciagra, Roberto; Pupi, Alberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy); Acampa, Wanda; Ricci, Francesca; Gallicchio, Rosj; Cuocolo, Alberto [University Federico II and Institute of Biostructures and Bioimages of the National Council of Research, Department of Biomorphological and Functional Sciences, Naples (Italy); Cerisano, Giampaolo [Careggi Hospital, Division of Cardiology, Florence (Italy); Vigorito, Carlo [University Federico II, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Cardiac Rehabilitation Unit, Naples (Italy)

    2011-06-15

    After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the long-term evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling. Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent {sup 99m}Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up. At baseline, patients with remodelling (n = 14) showed larger (infarct size 29.3 {+-} 7.8%) and more transmural (infarct severity 0.28 {+-} 0.10) infarctions, and reduced LV ejection fraction (35.4 {+-} 5.6%), but similar LV volume indexes, compared to patients without remodelling (n = 54) (infarct size 20.8 {+-} 14.4%, p < 0.05, infarct severity 0.40 {+-} 0.11, p < 0.001, ejection fraction 44.5 {+-} 9.2, p < 0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (-4.4 {+-} 8.4%) and without remodelling (-6.8 {+-} 9.4%) (p = NS). Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term follow-up. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling. (orig.)

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

    Science.gov (United States)

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

    2014-07-01

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

  16. Comparative analysis of the performance of various crystalloid cardioplegic solutions on myocardial protection after prolonged cold ischemia.

    Science.gov (United States)

    Lima, M L; Fiorelli, A I; Gomes, O M; Pinheiro, B B; Da Silva, M A F; Porto, L A B J; Novaes, L; Stolf, N A G; Souza, D R

    2011-01-01

    The quality and effectiveness of myocardial protection are fundamental problems to expand the use of and consequently good outcomes of donated hearts for transplantation. The purpose of this investigation was to compare the cardioprotective effects of Krebs-Henseleit, Bretschneider-HTK, St Thomas, and Celsior solutions using a modified nonrecirculating Langendorff column model of isolated perfused rat heart during prolonged cold storage. After removal 36 rat hearts underwent isolated perfusion into a Langendorff apparatus using Krebs-Henseleit solution for a 15-minute period of recovery; we excluded organs that did not maintain an aortic pressure above 100 m Hg. Subsequently, we equally distributed the hearts into four groups according to the cardioprotection solution; group 1, Krebs-Henseleit (control); group II, Bretschneider-HTK; group III, St Thomas; and group IV, Celsior. Each heart received the specific cardioplegic solution at 10°C for 2-hour storage at 20°C, before a 15 minutes perfusion with Krebs-Henseleit solution for recovery and stabilization. After 60 additional minutes of perfusion, every 5 minutes we determined heart rate (HR), coronary flow (CF), left ventricular systolic pressure (LVSP), and positive and negative peak of the first derivative of left ventricular pressure (+dP/dt and -dP/dt, respectively). Comparative analysis by Turkey's test showed the following performances among the groups at 60 minutes of reperfusion: HR: II = IV > III > I; CF: II = IV > I = III; LVSP: IV > I = II = III; +dP/dt: IV > I = II = III; and -dP/dt: IV = II > I = II. Cardioprotective solutions generally used in clinical practice are not able to avoid hemodynamic alterations in hearts exposed to prolonged ischemia. Celsior solution showed better performance than Bretschneider-HTK, St Thomas, and Krebs-Henseleit. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Gruzdeva O

    2013-02-01

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

  18. Cardiomyopathy Phenotypes and Outcomes for Children With Left Ventricular Myocardial Noncompaction: Results From the Pediatric Cardiomyopathy Registry.

    Science.gov (United States)

    Jefferies, John L; Wilkinson, James D; Sleeper, Lynn A; Colan, Steven D; Lu, Minmin; Pahl, Elfriede; Kantor, Paul F; Everitt, Melanie D; Webber, Steven A; Kaufman, Beth D; Lamour, Jacqueline M; Canter, Charles E; Hsu, Daphne T; Addonizio, Linda J; Lipshultz, Steven E; Towbin, Jeffrey A

    2015-11-01

    Left ventricular noncompaction (LVNC) is a distinct form of cardiomyopathy characterized by hypertrabeculation of the left ventricle. The LVNC phenotype may occur in isolation or with other cardiomyopathy phenotypes. Prognosis is incompletely characterized in children. According to diagnoses from the National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry from 1990 to 2008, 155 of 3,219 children (4.8%) had LVNC. Each LVNC patient was also classified as having an associated echocardiographically diagnosed cardiomyopathy phenotype: dilated (DCM), hypertrophic (HCM), restrictive (RCM), isolated, or indeterminate. The time to death or transplantation differed among the phenotypic groups (P = .035). Time to listing for cardiac transplantation significantly differed by phenotype (P diagnosis. LVNC is present in at least 5% of children with cardiomyopathy. The specific LVNC-associated cardiomyopathy phenotype predicts the risk of death or transplantation and should inform clinical management. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction

    DEFF Research Database (Denmark)

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

    2000-01-01

    h, five days and one and three months after MI in 125 unselected consecutive patients. Normal filling was defined as DT 140 to 240 ms and Vp > or =45 cm/s; impaired relaxation as DT > or =240 ms; pseudonormal filling as DT 140 to 240 ms and Vp ...: Left ventricular filling was normal in 38 patients; impaired relaxation in 38; pseudonormal in 23; and restrictive in 26. End-systolic and end-diastolic volume indexes were significantly increased during the first three months after MI in patients with pseudonormal or restrictive filling (37+/-15 vs....... 47+/-19 ml/m2, pimpaired relaxation (p = 0.02), pseudonormal filling (p

  20. Effect of Steroid Elution on Electrical Performance and Tissue Responses in Quadripolar Left Ventricular Cardiac Vein Leads.

    Science.gov (United States)

    Yang, Zhongping; Kirchhof, Nicole; Li, Shelby; Hine, Douglas; McVenes, Rick

    2015-08-01

    The use of steroid elution (SE) electrode in a cardiac pacing lead is known to suppress myocardial inflammation to lower pacing thresholds (PTs). SE has been widely utilized on the distal electrode of left ventricular cardiac vein (LVCV) leads used in cardiac resynchronization therapy (CRT). However, no paired comparison in effect of SE has been studied in proximal electrodes of quadripolar LVCV leads. We evaluated electrical performance and tissue responses of quadripolar LVCV lead electrodes with and without SE in two canine studies with a total of 14 canines. Extended bipolar PT and pacing impedance of the LVCV electrodes to right ventricle coil were collected via an implantable CRT device/programmer or a percutaneous threshold analyzer/pacing analyzer at weeks 0, 1, 2, 4, 6, 8, and 12. Gross and histopathological examinations of the canines were performed at the end of the studies. Our preclinical studies showed that SE had significant effects on the long-term pacing performance of quadripolar LVCV leads. The SE tip and ring electrodes reduced postimplant PT peak and chronic PT, P = 0.038. Histological examination of the perilead tissue capsules at 12 weeks showed a reduced thickness for the location of SE electrodes. SE electrodes in quadripolar LVCV leads lower the PTs, and therefore may potentially reduce long-term current drain of CRT systems, thus improving the device longevity. These preclinical data serve as rationale to include SE on proximal electrodes for the Attain Performa LVCV leads and future quadripolar LVCV leads development. ©2015 Medtronic PLC. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

  1. Difference in the Clinical Characteristics of Ventricular Fibrillation Occurrence in the Early Phase of an Acute Myocardial Infarction Between Patients With and Without J Waves.

    Science.gov (United States)

    Naruse, Yoshihisa; Nogami, Akihiko; Harimura, Yoshie; Ishibashi, Mayu; Noguchi, Yuichi; Sekiguchi, Yukio; Sato, Akira; Aonuma, Kazutaka

    2015-08-01

    We recently showed that the presence of J waves increases the risk of ventricular fibrillation (VF) occurrence in the early phase of an acute myocardial infarction (AMI). This study aimed to evaluate the clinical characteristics of VF occurrences in the early phase of an AMI between patients with and without J waves. This retrospective, observational study included 281 consecutive patients with an AMI (69 ± 12 years; 207 men) in whom 12-lead ECGs before AMI onset could be evaluated. The patients were classified based on a VF occurrence waves. J waves were electrocardiographically defined as an elevation of the terminal portion of the QRS complex