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1.
Int J Cardiovasc Imaging ; 39(2): 423-432, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36322263

RESUMO

There is a paucity of data regarding the effect of left ventricular (LV) reverse remodeling (r-LVR) on diastolic function and outcomes after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to identify the impact of r-LVR on the outcome and the predictors of such changes after ASA. Eighty-seven patients (57.5% men) were enrolled and underwent both echocardiography and cardiovascular magnetic resonance (CMR) imaging at baseline and 27 months after the procedure. The study population was divided into two groups by the degree of r-LVR. Compared to the greater r-LVR group, the lesser r-LVR group had a significantly larger LV mass (LVM) and lower diastolic function parameters at baseline. The greater r-LVR group had significantly greater LVM regression and improvement of diastolic function after ASA. Kaplan‒Meier analysis showed significantly worse composite events in the lesser r-LVR group after ASA (P = 0.016). After adjusting for multiple clinical variables, r-LVR was associated with an improved E/e' (ß = 0.390, p < 0.001) and reduced events (hazard ratio: 0.795; 95% confidence interval (CI), 0.644-0.983; p = 0.034). Preablation LVM was associated with a decreased probability of r-LVR (ß = -0.228, p = 0.021) and diastolic function improvement (ß= -0.245, p = 0.006). r-LVR was associated with long-term outcome benefit in patients with HOCM. Preablation LVM prevented LV from favoring reverse remodeling and thus may be a potential parameter for risk stratification and prognosis after ASA treatment.


Assuntos
Técnicas de Ablação , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica , Masculino , Humanos , Feminino , Etanol/uso terapêutico , Valor Preditivo dos Testes , Ecocardiografia/métodos , Resultado do Tratamento , Remodelação Ventricular , Técnicas de Ablação/métodos
2.
Clin Cardiol ; 40(1): 26-31, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27748528

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is associated with poor prognosis. It has been reported that there is no difference in in-hospital mortality after acute myocardial infarction (AMI) between patients with and without HCM. However, whether there is a difference in long-term survival after AMI between patients with and without HCM remains unclear. HYPOTHESIS: Long-term survival after AMI is worse in patients with vs without HCM. METHODS: The clinical profiles of 91 consecutive patients with HCM and AMI (HCM group) and 91 sex- and age-matched patients with AMI without HCM (non-HCM group) were analyzed. The study endpoint was all-cause mortality. RESULTS: During a follow-up period of 4.9 ± 3.6 years, all-cause mortality occurred in 25 patients (27.5%) in the HCM group and 13 patients (14.3%) in the non-HCM group. The survival of the HCM group was inferior to that of the non-HCM group (log-rank P = 0.039). During the first year of follow-up, 3 deaths (3.3%) occurred in the HCM group and 7 deaths (7.7%) occurred in the non-HCM group (log-rank P = 0.177). Among patients who survived beyond the first year of follow-up (172 patients), the annual mortality rates were 6.3% (95% confidence interval: 4.0%-9.3%) in the HCM group and 1.6% (95% confidence interval: 0.6%-3.5%) in the non-HCM group (log-rank P = 0.001). CONCLUSIONS: AMI patients with HCM exhibited worse long-term survival than did AMI patients without HCM.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Infarto do Miocárdio/mortalidade , Fatores Etários , Cardiomiopatia Hipertrófica/mortalidade , China/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
3.
J Interv Cardiol ; 29(6): 619-627, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27545664

RESUMO

OBJECTIVES: Investigate the effectiveness of alcohol septal ablation (ASA) and transaortic extended myectomy (TEM) in hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO). BACKGROUND: MVO is less common than subaortic obstruction. Data on the effectiveness of ASA and TEM in MVO are lacking. METHODS: The clinical profiles of 22 patients undergoing ASA and 37 patients undergoing TEM were compared. No patient had apical aneurysm, abnormal chordae, mitral valve replacement or repair. RESULTS: Baseline midventricular pressure gradient and symptoms were comparable between the ASA and TEM groups. During follow-up, both groups demonstrated substantial reduction in pressure gradient (the ASA group: 79.7 ± 21.2 mm Hg to 43.7 ± 28.9 mm Hg, P < 0.001; the TEM group: 69.0 ± 23.9 mm Hg to 15.0 ± 16.9 mm Hg, P < 0.001). The reduction in pressure gradient was greater (78.9 ± 18.6% vs. 46.4 ± 33.4%, P < 0.001) and the residual pressure gradient was lower after TEM versus ASA (P < 0.001). Patients with New York Heart Association class III/IV dyspnea decreased from 59.1 to 18.2% (P = 0.022) in the ASA group and from 56.8 to 5.6% (P < 0.001) in the TEM group. Patients with Canadian Cardiovascular Society class III/IV angina decreased from 40.9 to 9.1% (P = 0.016) in the ASA group and from 32.4 to 0% (P < 0.001) in the TEM group. CONCLUSIONS: While ASA and TEM both improve gradients and symptoms, TEM may provide a more reliable reduction in gradients compared to ASA.


Assuntos
Técnicas de Ablação , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica , Etanol/uso terapêutico , Septos Cardíacos , Técnicas de Ablação/efeitos adversos , Técnicas de Ablação/métodos , Adulto , Anti-Infecciosos Locais/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/cirurgia , China , Ecocardiografia Doppler/métodos , Feminino , Septos Cardíacos/patologia , Septos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
4.
Cardiovasc Ultrasound ; 14(1): 18, 2016 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-27189485

RESUMO

BACKGROUND: There has been limited data addressing outcomes of extensive septal myectomy in Chinese patients with hypertrophic obstructive cardiomyopathy (HOCM). In this study, the objective was to evaluate the clinical and echocardiographic outcomes of extensive septal myectomy in a relative large number of Chinese HOCM patients over long-term follow-up. METHODS: We retrospectively studied 139 consecutive HOCM patients (age 43 ± 15 years, 37 % male) who underwent extensive left ventricular septal myectomy. During the perioperative period, all patients were examined by echocardiography. All-cause death and cardiac death were considered as primary endpoints during follow-up. Perioperative data was obtained by retrospective review of institutional surgical databases. Follow-up data of echocardiography and clinical status was recorded through outpatient interview. RESULTS: Perioperative events consisted of arrhythmia, retraction injury to aortic valve leaflets, pleural effusion, and hemodialysis and the use of intra-aortic balloon pump. There was no in-hospital mortality. The follow-up period averaged 5.6 ± 0.9 years and overall survivals were 100.0, 99.3, 99.3, 98.5 and 97.8 % at 1, 2, 3, 4 and 5 years, respectively. Left ventricular outflow tract (LVOT) gradient decreased form preoperative 84 ± 17 mmHg to 12 ± 3 mmHg at 2.5 years after surgery and it further reduced to 6 ± 3 mmHg at 5 years after surgery (P < 0.05). Compared with the preoperative levels, interventricualr septal thickness decreased by 32 % while diastole left ventricular inner diameter approximately increased by 10 % and ejection fraction (EF) was significantly elevated during follow-up (P < 0.05). By echocardiography detection, mitral regurgitation was ameliorated for HOCM patients after surgery. There was significant improvement in New York Heart Association (NYHA) class. The proportion of NYHA III and IV decreased from preoperative 58 to 19 % at 2.5 years after surgery and it reduced to 11 % at 5 years after operation. CONCLUSION: Extensive septal myectomy offers minimal operative risk and provides long-term relief for LVOT obstruction in Chinese HOCM patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/diagnóstico , Septos Cardíacos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/cirurgia , China/epidemiologia , Feminino , Seguimentos , Septos Cardíacos/diagnóstico por imagem , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
J Invasive Cardiol ; 28(3): 99-103, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26945252

RESUMO

AIMS: Data on the effectiveness of alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) and extreme septal hypertrophy (ESH) are lacking. This study aimed to compare the effectiveness of ASA in patients with vs without ESH. METHODS: Clinical profiles of 17 patients with ESH and 256 patients without ESH were compared. RESULTS: Baseline pressure gradient and limiting symptoms were comparable between patients with and without ESH. At median 1.1 years of follow-up after ASA, pressure gradient was 48.5 ± 40.4 mm Hg in the ESH group and 40.9 ± 35.2 mm Hg in the non-ESH (N-ESH) group (P=.33). Patients with New York Heart Association class III/IV represented 5.9% of the ESH group and 16.9% of the N-ESH group (P=.39). Patients with Canadian Cardiovascular Society class III/IV represented 5.9% of the ESH group and 10.2% of the N-ESH group (P=.87). CONCLUSION: The effectiveness of ASA seems comparable between patients with and without ESH.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Ablação por Cateter , Etanol/farmacologia , Septos Cardíacos/cirurgia , Adulto , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia Doppler , Feminino , Seguimentos , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Heart Vessels ; 31(5): 744-51, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-25739657

RESUMO

Alcohol septal ablation (ASA) has been shown to improve left ventricular (LV) diastolic function in patients with obstructive hypertrophic cardiomyopathy (HCM). However, its beneficial effect on diastolic function assessed by cardiac magnetic resonance (CMR) has not been reported. We investigated the mid-term changes of diastolic function by CMR combined with echocardiography in HCM patients after ASA at a median of 14-month follow-up. CMR parameters of diastolic function including peak filling rate (PFR), and time to peak filling rate (TPFR) were evaluated in 43 patients (aged 48 ± 9 years). LV diastolic function improved significantly measured by echocardiography with the decrease in ratio of transmitral early LV filling velocity (E) to early diastolic mitral lateral annular velocity (E') (14.20 ± 1.17 to 11.58 ± 1.16, p < 0.001) and E-wave deceleration time (194.04 ± 19.30 to 168.45 ± 12.58 ms, p < 0.001). PFR increased significantly with associated decrease in TPFR after ASA (both p < 0.001) at follow-up. Furthermore, patients with larger decrease in LVOT gradients had a greater improvement of LV diastolic function, as measured by the reduction of E/E' (p < 0.001) and increase of PFR (p < 0.001). In conclusion, this study demonstrated that successful ASA results in both echocardiographic and CMR indices of diastolic function improvement after ASA at 14-month follow-up. ASA therapy can significantly reduce LVOT gradient and mitral regurgitation, both of which may contribute to the improvement of diastolic function.


Assuntos
Técnicas de Ablação , Cardiomiopatia Hipertrófica/cirurgia , Etanol/administração & dosagem , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Técnicas de Ablação/efeitos adversos , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Diástole , Ecocardiografia Doppler , Etanol/efeitos adversos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
7.
J Cardiovasc Med (Hagerstown) ; 16(11): 751-60, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25022933

RESUMO

BACKGROUND: Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy. Knowledge regarding the diagnosis, morbidity and cardiovascular mortality is limited. In this study, we aimed to describe the long-term outcomes of patients with MVOHCM followed in a tertiary referral centre.Methods A retrospective study of 60 patients with MVOHCM diagnosed at FuWai Hospital was performed. Clinical features, mortality and cardiovascular morbidity were analysed. RESULTS: The 60 patients with MVOHCM represented 2.9% of all the hypertrophic cardiomyopathy cases (n = 2068). At diagnosis, the mean age was 40.2 ±â€Š15.0 years. During 7.1 ±â€Š6.3 years of follow-up after diagnosis, the cardiovascular mortality was 15.0%. The probability of survival at 10 years was 77.0 ±â€Š8.0%. The following two predictors of cardiovascular mortality were identified: severe ventricular septal hypertrophy at least 30  mm (hazard ratio, 3.19; P = 0.031) and unexplained syncope (hazard ratio, 4.59; P = 0.002) at baseline. Thirty patients (50.0%) had one or more morbid events, and the most frequent was nonsustained ventricular tachycardia. Apical aneurysm formation was identified in 20% of patients, and the patients with apical aneurysms were more inclined to experience nonsustained ventricular tachycardia than patients without apical aneurysm (58.3 vs. 16.7%; P = 0.003). Peak pressure gradient at least 70  mm Hg (hazard ratio, 3.00; P = 0.01) at baseline was identified as the only predictor of apical aneurysm. CONCLUSION: In Chinese patients, MVOHCM is associated with an unfavourable prognosis of cardiovascular mortality. One-half of these patients experience major cardiovascular events, and 20% develop an apical aneurysm, which significantly increases arrhythmia events. These data warrant measures to ensure the early recognition of MVOHCM followed by appropriate therapeutic interventions.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/terapia , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único/métodos
8.
Can J Cardiol ; 30(4): 441-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24468417

RESUMO

BACKGROUND: Previous studies on the association between the distribution of left ventricle hypertrophy and the clinical features of hypertrophic cardiomyopathy (HCM) have yielded unclear results. The aim of this study was to investigate the differences in the prevalence, clinical features, management strategies, and long-term outcomes between patients with midventricular hypertrophic obstructive cardiomyopathy (MVHOCM) and patients with apical HCM (ApHCM). METHODS: A retrospective study of 60 patients with MVHOCM and 263 patients with ApHCM identified in a consecutive single-centre cohort consisting of 2068 patients with HCM was performed. The prevalence, clinical features, and natural history of the patients in these 2 groups were compared. RESULTS: Compared with ApHCM patients, patients with MVHOCM tended to be much younger and more symptomatic during their initial evaluation. Over a mean follow-up of 7 years, the probability of cardiovascular mortality and that of morbidity was significantly greater in MVHOCM patients compared with ApHCM patients (log-rank, P < 0.001). CONCLUSIONS: Our results suggest that, compared with ApHCM, MVHOCM represents an uncommon presentation of the clinical spectrum of HCM that is characterized by progressive clinical deterioration leading to increased cardiovascular mortality and morbidity. Our results also underscore the importance of the timely recognition of MVHOCM for the prediction of prognosis and the early consideration of appropriate management strategies.


Assuntos
Cardiomiopatia Hipertrófica/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Técnicas de Ablação , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Fatores Etários , Anticoagulantes/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/terapia , Estudos de Coortes , Ecocardiografia , Ecocardiografia Doppler em Cores , Feminino , Seguimentos , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Hipertrofia Ventricular Esquerda/patologia , Hipertrofia Ventricular Esquerda/terapia , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Fenótipo , Estudos Retrospectivos , Síncope/epidemiologia , Taquicardia Ventricular/epidemiologia , Trombose/epidemiologia , Varfarina/uso terapêutico
9.
Zhonghua Nei Ke Za Zhi ; 52(6): 484-8, 2013 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-24059995

RESUMO

OBJECTIVE: To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients. METHODS: A total of 60 patients with HCM and left ventricular outflow tract gradient (LVOTG) <50 mm Hg (1 mm Hg = 0.133 kPa) at rest were enrolled consecutively, and LVOTG at rest and exercise were measured by echocardiography. Of 51 patients with gradients <30 mm Hg at rest, 26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg, 25 were non LVOTO with exercise peak value LVOTG < 30 mm Hg, and 9 were resting obstruction with LVOTG 30-49 mm Hg. The morphological characteristics of different types of obstruction were analyzed. RESULTS: Patients with latent LVOTO were more likely to have SAM (73.1% vs 8.0%) , narrow of LVOT (46.2% vs 4.0%) , higher resting gradients [(16.9 ± 7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values <0.05). The distribution of septal hypertrophy were different in the two groups (P < 0.05). Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431, 95%CI 2.323-291.112, P = 0.002) at rest and distribution of septal hypertrophy(OR 0.011, 95% CI 0.001-0.179, P = 0.008). CONCLUSIONS: Approximately half of patients with non-obstructive HCM at rest have latent LVOTO. SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia/métodos , Adulto , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Zhonghua Xin Xue Guan Bing Za Zhi ; 40(3): 214-8, 2012 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-22801266

RESUMO

OBJECTIVE: To compare left ventricular outflow tract (LVOT) gradient induced by dobutamine stress echocardiography (DSE) and exercise echocardiography (EE) in patients with hypertrophic cardiomyopathy (HCM). METHODS: DSE and EE were performed in 40 consecutive patients with HCM and LVOT gradient < 50 mm Hg (1 mm Hg = 0.133 kPa) at rest. Dobutamine was administered intravenously at incremental doses of 200, 400, 600, 800 and 1200 µg/min at 5 min intervals. LVOT gradients were measured at rest, at peak exercise and during each dose of DSE. RESULTS: LVOT gradient at rest was lower than 30 mm Hg in 36 patients and between 30 and 49 mm Hg in 4 patients. Of the 36 patients with LVOT gradient < 30 mm Hg at rest, mechanical LVOT obstruction (latent LVOTO) was evidenced in 17 patients during EE and in 18 patients during DSE and good consistency (91.7%, kappa value 0.833) was found between the two maneuvers. The provoked gradient was similar between DSE at 800 µg/min and EE at peak exercise (P = 0.181). In the 4 patients with LVOT gradient between 30 and 49 mm Hg [(38.8 ± 2.6) mm Hg], LVOT gradient increased to (85.3 ± 26.4) mm Hg during EE and (105.0 ± 28.0) mm Hg during DES. CONCLUSIONS: DES and EE are comparable and suitable provoke methods for identifying LVOT obstruction in patients with HCM.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Teste de Esforço/métodos , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Adulto , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Clin Nucl Med ; 37(1): 44-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22157027

RESUMO

PURPOSE: Although surgical treatments evolved, the short-term postoperative mortality is still high in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and long-term survivors may suffer from restrained functional recovery. Therefore, an optimal means in predicting postoperative reversal is demanded. In this study, we assess the utility of myocardial perfusion/F-18 fluorodeoxyglucose (FDG) imaging in the evaluation of myocardial viability and postsurgery functional recovery in children with ALCAPA. MATERIALS AND METHODS: A retrospective study was performed in 7 children with diagnosed ALCAPA who underwent myocardial perfusion/F-18 FDG imaging preoperatively. Global viability index was used to evaluate myocardial viability and was compared with the preoperative deviations of left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) from age-matched healthy children and with the postoperative durations of intensive care. RESULTS: Children with more viable myocardium had less severe clinical symptoms. The viability index was correlated well with the preoperative deviations of LVEF (r = -0.98, P = 0.001) and LVEDD (r = 0.87, P = 0.02) and postoperative durations of intensive care hospitalization (r = 0.77, P = 0.04) and mechanical ventilation (r = 0.83, P = 0.02). LVEF and LVEDD reached normal range within 5 months in viable children, whereas incomplete reversal was observed in partial- and nonviable children. CONCLUSIONS: In children with ALCAPA, myocardial viability evaluated by perfusion/F-18 FDG imaging is related to the preoperative clinical manifestations and cardiac function. Additionally, it may predict functional recovery after surgical repair.


Assuntos
Fístula Artério-Arterial/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Fluordesoxiglucose F18 , Imagem de Perfusão do Miocárdio/métodos , Miocárdio Atordoado/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Criança , Pré-Escolar , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Radiografia , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Zhonghua Xin Xue Guan Bing Za Zhi ; 39(6): 497-502, 2011 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-21924073

RESUMO

OBJECTIVE: To evaluate the myocardial perfusion and function in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after percutaneous transluminal septal myocardial ablation (PTSMA). METHODS: Sixty-eight patients with hypertrophic obstructive cardiomyopathy were included and (99)Tc(m)-MIBI SPECT MPI was applied before and at 1 week after PTSMA, six-month follow-up was finished in 11 patients. Semi quantity and QGS quantity perfusion and function assessment was performed in 17 LV segments. RESULTS: Myocardial perfusion post-PTSMA was significantly reduced in 98% patients, especially in basal anterosepta, basal interseptal, mid-anteroseptal, mid-interseptal and apical septal segments compared with pre-PTSMA (all P < 0.05). Perfusion was significantly increased at 6 months follow-up than at 1 week post-PTSMA but still lower than pre-PTSMA (all P < 0.05). LVEF (evaluated by gated SPECT) was similar before and after the procedure (P > 0.05). Regional wall motion after PTSMA was lower than pre-PTSMA in basal anterior, basal anteroseptal, basal interseptal and basal inferior (P < 0.05). Regional wall thinkening was lower than pre-PTSMA in basal interseptal, mid-anteroseptal, mid-interseptal (P < 0.05). CONCLUSIONS: (99)Tc(m) MIBI SPECT can be used to monitor myocardial perfusion post PTSMA in patients with HOCM.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/cirurgia , Ablação por Cateter/métodos , Adolescente , Adulto , Idoso , Angioplastia com Balão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
13.
Int J Cardiol ; 115(2): 220-8, 2007 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-16889848

RESUMO

BACKGROUND: Bone marrow-derived mesenchymal stem cells (MSCs) are of great therapeutic potential after myocardial ischemic injury. However, little is known about the biological characteristics of MSCs in patients with coronary artery disease and their effects on infracted myocardium. The present study evaluated the biological characteristics of MSCs from patients with coronary artery disease and their effects after being transplanted into infarcted myocardium using a rat model. METHODS: Sternal bone marrow aspirates were taken at the time of coronary artery bypass graft surgery. Mononuclear cells isolated from bone marrow were cultured based on plastic adherence. The morphology and growth characteristics of MSCs were observed in primary and successive passages. A myocardial infarction model was created in 27 adult rats. Two weeks later, animals were randomized into two groups: culture medium (group I, n=13) or MSCs (2x10(6)) from early passages labeled with BrdU (group II, n=14) were injected into the infarcted myocardium. Echocardiography, histological examination, and reverse transcription-polymerase chain reaction (RT-PCR) were performed four weeks after cell transplantation. RESULTS: Flow cytometry analyses demonstrated that adherent spindle cells from bone marrow are mesenchymal stem cells (positive for CD29 and CD44, but negative for CD34 and CD45). Growth curves showed that MSCs have great proliferative capability especially at early passages. MSCs implantation in the infarcted border zone improved left ventricular function significantly in group II compared with group I. However, despite improved left ventricular function, we did not observe significant regeneration of cardiac myocytes. Immunohistochemistry revealed only the expression of desmin in the engrafted MSCs, a marker of premature myocyte. Moreover, the improved left ventricular function in this study seemed to be secondary to the beneficial reverse remodeling induced by the increase of collagen in infarcted zone, the decrease in the adjacent myocardium, and the increase of neovascularization (capillary density: 192+/-7.8/mm2 in group II vs. 165+/-5.9/mm2 in group I, P<0.05). Reverse transcription-polymerase chain reaction (RT-PCR) results showed the expression levels of collagen I, collagen III, SDF-1 (stromal cell-derived factor-1), and VEGF (vascular endothelia growth factor) in the infarcted border zone were significantly higher in the MSCs treated group. CONCLUSIONS: The MSCs from patients with coronary artery disease have a typical phenotype with highly proliferative potential and the engrafted MSCs may regulate extracellular collagens and cytokines to prevent the ventricular scar from pathologic thinning and attenuate the contractile dysfunction of the infarcted heart.


Assuntos
Transplante de Células-Tronco Mesenquimais , Infarto do Miocárdio/cirurgia , Animais , Humanos , Ratos , Ratos Sprague-Dawley , Transplante Heterólogo
14.
Int J Psychophysiol ; 56(3): 201-7, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15866324

RESUMO

Wackermann (1999) [Wackermann, J., 1999. Towards a quantitative characterization of functional states of the brain: from the non-linear methodology to the global linear description. Int. J. Psychophysiol. 34, 65-80] proposed Sigma-phi-Omega system for describing the global brain macro-state, in which Omega complexity was used to quantify the degree of synchrony between spatially distributed EEG processes. In this paper the effect of signal power on Omega complexity is discussed, which was not considered in Wackermann's paper (1999). Then an improved method for eliminating the effect of signal power on Omega complexity is proposed. Finally a case study on the degree of synchrony between two-channel EEG signals over different brain regions during hand motor imagery is given. The results show that the improved Omega complexity measure would characterize the true degree of synchrony among the EEG signals by eliminating the influence of signal power.


Assuntos
Encéfalo/fisiologia , Modelos Neurológicos , Algoritmos , Diagnóstico por Imagem , Lateralidade Funcional/fisiologia , Humanos , Modelos Lineares , Dinâmica não Linear
15.
Chin Med Sci J ; 19(3): 203-6, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15506649

RESUMO

OBJECTIVE: To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diastolic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction. METHODS: We measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-chamber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis. RESULTS: Early diastolic myocardial velocities of mitral annulus were higher in normal subjects than in patients with hypertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocardial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy. CONCLUSION: Doppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia Doppler/métodos , Função Ventricular Esquerda , Adulto , Diástole/fisiologia , Humanos , Pessoa de Meia-Idade
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