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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 489-493, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642224

RESUMO

OBJECTIVE: To determine segmental myocardial changes in cardiovascular magnetic resonance feature-tracking (CMR-FT) in the early phase of reperfused myocardial infarction in patients and rats. METHODS: Ten patients receiving percutaneous coronary interventions (2-10 d) and 10 rats with 60 min induced myocardial ischemia followed by reperfusions (48 h and 7 d) were investigated by MRI. The steady state free precession cine and late gadolinium enhancement (LGE) sequences were measured to evaluate the standard short axis of the whole heart after an injection of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA, Magnevist, Bayer Health Care Pharmaceuticals) at a dose of 0.1 mmol/kg. The infarction sizes (all areas were expressed as a percentage of the whole myocardial tissues of left ventricle (LV), end-diastolic volume (EDV) and ejection fractions (EF) were calculated. The MRI cine images were analyzed using the myocardial feature tracking software CVI, estimating the peak value of radial strains (RS) and circumferential strains (CS) of the 16 AHA segments excluding apex cordis. The complete myocardial infarction (CMI) segments, partial myocardial infarction (PMI) segments and non-myocardial infarction (NMI) segments were identified and compared. RESULTS: Patients: The radial strain and circumferential strain of the CMI and PMI segments were smaller than the NMI segment (both P < 0.01). However, there was no significant difference between the CMI and the PMI segment (P>0.05). Rats: No significance differences were found in EF and EDV between the two time period 48 h and 7 d (both P>0.05). The radial strain and circumferential strain of the CMI and PMI segments were smaller than the NMI segment (all P < 0.01). But there was no significance difference between the CMI segment and the PMI segment (P>0.05). No significant changes in the global radial strain and the circumferential strain were found over time (both P>0.05). But the segmental radial strain and circumferential strain became larger over time (all P < 0.05). CONCLUSIONS: The systolic ability of myocardium decreases as a result of reperfusion injury in the early phase of reperfused myocardial infarction. But it can gradually recover over time with reperfusion.


Assuntos
Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Animais , Meios de Contraste , Gadolínio , Gadolínio DTPA , Humanos , Ratos
2.
Int Heart J ; 60(5): 1168-1175, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484876

RESUMO

The aims of the present study were to investigate the effects of angiotensin receptor neprilysin inhibitors (ARNi) on the susceptibility of ventricular arrhythmias (VAs) in rats with myocardial infarction (MI) and to explore the related mechanisms.A total of 32 adult male Sprague-Dawley rats were divided into 3 groups: a control group, MI group, and MI+ARNi group. MI was generated by ligation of the left anterior descending coronary artery. ARNi was given at 68 mg/kg/day for 4 weeks after MI surgery. At 4 weeks after MI, electrical programmed stimulation (EPS) was performed in all groups for the evaluation of VAs, and echocardiography was used to evaluate cardiac function. Indicators of sympathetic neural remodeling and cardiac remodeling were detected to further explore the related mechanisms.Four weeks after MI, rats in the ARNi group exhibited low susceptibility of VAs in comparison with that in the MI group, which was coincident with the attenuation of sympathetic nerve remodeling, amelioration of cardiac fibrosis, and regulation of Cx43 expression.ARNi is effective in reducing VAs in rats with ischemic cardiomyopathy, which is associated with attenuating sympathetic nerve remodeling and myocardial fibrosis.


Assuntos
Conexina 43/metabolismo , Infarto do Miocárdio/tratamento farmacológico , Neprilisina/farmacologia , Taquicardia Ventricular/tratamento farmacológico , Remodelação Ventricular/efeitos dos fármacos , Animais , Biópsia por Agulha , China , Modelos Animais de Doenças , Ecocardiografia/métodos , Imuno-Histoquímica , Masculino , Contração Miocárdica/efeitos dos fármacos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fatores de Risco , Taxa de Sobrevida , Sistema Nervoso Simpático/efeitos dos fármacos , Taquicardia Ventricular/diagnóstico por imagem
3.
Br J Anaesth ; 123(4): 439-449, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31383364

RESUMO

BACKGROUND: Nerve growth factor (NGF) has been implicated in hyperalgesia by sensitising nociceptors. A role for NGF in modulating myocardial injury through ischaemic nociceptive signalling is plausible. We examined whether inhibition of spinal NGF attenuates myocardial ischaemia-reperfusion injury and explored the underlying mechanisms. METHODS: In adult rats, lentivirus-mediated short-hairpin RNA targeted at reducing NGF gene expression (NGF-shRNA) or a transient receptor potential vanilloid 1 (TRPV1) antagonist (capsazepine) was injected intrathecally before myocardial ischaemia-reperfusion. Infarct size (expressed as the ratio of area at risk) and risk of arrhythmias were quantified. Whole-cell clamp patch electrophysiology was used to record capsaicin currents in primary dorsal root ganglion neurones. The co-expression of substance P (SP) and calcitonin gene-related peptide (CGRP), plus activation of TRPV1, protein kinase B (Akt) and extracellular signal-regulated kinase (ERK) were also quantified. RESULTS: NGF levels increased by 2.95 (0.34)-fold in dorsal root ganglion and 2.12 (0.27)-fold in spinal cord after myocardial ischaemia-reperfusion injury. Intrathecal injection of NGF-shRNA reduced infarct area at risk from 0.58 (0.02) to 0.37 (0.02) (P<0.01) and reduced arrhythmia score from 3.67 (0.33) to 1.67 (0.33) (P<0.01). Intrathecal capsazepine was similarly cardioprotective. NGF-shRNA suppressed expression of SP/CGRP and activation of Akt/ERK and TRPV1 in spinal cord. NGF increased capsaicin current amplitude from 144 (42) to 840 (132) pA (P<0.05), which was blocked by the TRPV1 antagonist 5'-iodoresiniferatoxin. Exogenous NGF enhanced capsaicin-induced Akt/ERK and TRPV1 activation in PC12 neuroendocrine tumour cells in culture. CONCLUSIONS: Spinal NGF contributes to myocardial ischaemia-reperfusion injury by mediating nociceptive signal transmission.


Assuntos
Terapia Genética/métodos , Lentivirus/genética , Traumatismo por Reperfusão Miocárdica/genética , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Fator de Crescimento Neural/genética , RNA Interferente Pequeno/administração & dosagem , RNA Interferente Pequeno/uso terapêutico , Animais , Arritmias Cardíacas/prevenção & controle , Capsaicina/análogos & derivados , Capsaicina/farmacologia , Cardiotônicos/administração & dosagem , Cardiotônicos/uso terapêutico , Gânglios Espinais/efeitos dos fármacos , Gânglios Espinais/metabolismo , Injeções Espinhais , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/prevenção & controle , Fator de Crescimento Neural/biossíntese , Células PC12 , Técnicas de Patch-Clamp , Ratos , Ratos Sprague-Dawley , Canais de Cátion TRPV/antagonistas & inibidores , Canais de Cátion TRPV/metabolismo
4.
Expert Rev Cardiovasc Ther ; 17(8): 605-623, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389276

RESUMO

Introduction: Atherosclerotic coronary artery disease, in particular acute myocardial infarction (AMI), is a leading cause of morbidity and mortality globally. Percutaneous coronary intervention (PCI) is the mainstay of treatment for obstructive coronary artery disease and AMI through the restoration of TIMI III flow. Despite good macrovascular flow, the myocardium can remain hypoperfusion due to poor microvascular perfusion, and this is referred to as 'no-reflow'. Various treatments have been studied with variable success in both prevention and treatment of no-reflow. Areas covered: This review outlines the cutting-edge diagnostic investigations which have been explored in no-reflow, allowing a deeper understanding of mechanism and microvascular pathological processes involved in its genesis. These include utility of novel MRI techniques and perfusion echo in conjunction with traditional approaches. Detailed review has been undertaken of both pharmacological and non-pharmacological techniques to prevent and manage microvascular dysfunction associated with no-reflow. Particular attention was paid to the evolution and successes of various mechanical protection devices. Expert opinion: Most promising innovations in the diagnosis and management of no-reflow are evaluated, and future outlook is explored. Emerging advances in acute coronary syndrome have their findings applied a role in modifying the pathophysiology of no-reflow.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Infarto do Miocárdio/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Masculino , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Resultado do Tratamento
5.
BMC Neurol ; 19(1): 152, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277605

RESUMO

BACKGROUND: Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. CASE PRESENTATION: A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. CONCLUSIONS: As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.


Assuntos
Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Administração Intravenosa , Idoso , Fibrilação Atrial/complicações , Doença da Artéria Coronariana/complicações , Imagem de Difusão por Ressonância Magnética , Eletrocardiografia , Procedimentos Endovasculares , Feminino , Fibrinolíticos/uso terapêutico , Coração , Humanos , Infarto da Artéria Cerebral Média/terapia , Trombectomia , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
6.
Medicina (B Aires) ; 79(3): 201-204, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284255

RESUMO

Myocardial infarction is the leading cause of death in the world, being the coronary atherosclerotic obstruction the main finding. Although 6% of all the patients had no significant coronary arteries disease on coronary angiography, defined by lumen vascular obstruction greater than 50%. This type of cases was defined by the term MINOCA (myocardial infarction with non-obstructive coronary arteries). They are usually young women, with cardiovascular risk factors, high cardiac biomarkers with non-ST elevation in the electrocardiogram. The main etiologies are myocarditis, Takotsubo syndrome and subendocardial myocardial infarction. We present the case of a 65 years-old woman with history of hypertension and complete left bundle branch block, who was admitted to the emergency department with typical chest pain, complete left bundle branch block in the electrocardiogram, with negative Sgarbossa criteria and positive cardiac biomarkers. The echocardiography evidenced inferolateral regional wall motion abnormalities, and the coronary angiography a single non-significative lesion (40%) in the proximal segment of the circumflex artery. Cardiac magnetic resonance evidenced subendocardial late adolinium enhancement in inferolateral medial with latero-apical extension segments consistent with circumflex artery-related infarction. This case illustrates an example of MINOCA secondary to myocardial infarction with posterior spontaneous thrombolysis, in which the clinical presentation was typical, however the coronary angiography showed non obstructive lesions. Therefore, another complementary imaging methods were needed such as the cardiac magnetic resonance.


Assuntos
Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Idoso , Angiografia Coronária , Vasos Coronários/fisiologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/fisiopatologia , Fatores de Risco
7.
Int J Cardiovasc Imaging ; 35(7): 1319-1325, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093894

RESUMO

To demonstrate the potential for differentiating normal and diseased myocardium without Gadolinium using rest and stress T1-mapping. Patients undergoing 1.5T magnetic resonance imaging (MRI) as part of clinical work-up due to suspicion of coronary artery disease (CAD) were included. Adenosine stress perfusion MRI and late gadolinium enhancement (LGE) imaging were performed to identify ischemic and infarcted myocardium. Patients were retrospectively categorized into an ischemic, infarct and control group based on conventional acquisitions. Patient with both ischemic and infarcted myocardium were excluded. A total of 64 patients were included: ten with myocardial ischemia, 15 with myocardial infarction, and 39 controls. A native Modified Look-Locker Inversion Recovery (MOLLI) T1-mapping acquisition was performed at rest and stress. Pixel-wise myocardial T1-maps were acquired in short-axis view with inline motion-correction. Short-axis T1-maps were manually contoured using conservative septal sampling. Regions of interest were sampled in ischemic and infarcted areas detected on perfusion and LGE images. T1 reactivity was calculated as the percentage difference in T1 values between rest and stress. Remote myocardium was defined as myocardium without defects in the ischemic and infarcted group whereas normal myocardium is found in the control group only. Native T1-values were significantly higher in infarcted myocardium in rest and stress [median 1044 ms (interquartile range (IQR) 985-1076) and 1053 ms (IQR 989-1088)] compared to ischemic myocardium [median 961 ms (IQR 939-988) and 958 ms (IQR 945-988)]. T1-reactivity was significantly lower in ischemic and infarcted myocardium [median 0.00% (IQR - 0.18 to 0.16) and 0.41% (IQR 0.09-0.86)] compared to remote myocardium [median 3.54% (IQR 1.48-5.78) and 3.21% (IQR 1.95-4.79)]. Rest-stress T1-mapping is able to distinguish between normal, ischemic, infarcted and remote myocardium using native T1-values and T1-reactivity, and holds potential as an imaging biomarker for tissue characterization in MRI.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Miocárdio/patologia , Adenosina/administração & dosagem , Idoso , Meios de Contraste/administração & dosagem , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Diagnóstico Diferencial , Feminino , Gadolínio DTPA/administração & dosagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sobrevivência de Tecidos , Vasodilatadores/administração & dosagem
8.
J Ayub Med Coll Abbottabad ; 31(2): 151-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094106

RESUMO

BACKGROUND: Increasing affection of younger patients with ischemic heart disease is an enhanced concern in developing Asian nations. This study elaborates the morphology and distribution of coronary lesions in young Asians presenting with acute coronary syndrome (ACS). METHODS: Patients (aged ≤35 years) with (ACS) undergoing angiography were studied. Their angiographic disease was analysed to determine the common sites, severity and types (AHA and SCAI) of lesions. The association of LV dysfunction with lesion parameters was identified. Patients with cocaine or other drug abuse and valvular heart disease were excluded. RESULTS: Two hundred and twenty-one patients aged 16-35 (31.4±3.5) years were studied with predominant males (195, i.e., 88.2%). On angiography 51 (23.1%) patients showed normal coronaries while 108(48.9%) had single, 48 (21.7%) had double and 14 (6.3%) had multivessel disease. On the whole, involvement of left anterior descending artery (LAD) either singly or in combination with other vessels was seen in 146 (66%), right coronary artery (RCA) in 56 (25.3%), left circumflex (LCX) in 43 (19.5%) and left main stem in 06 (2.7%) of total patients. Regarding lesion characteristics, tight lesions (45.4%), AHA type-A (47.8%) and SCAI-I (70.1%) lesions were common. The mid segment was commonly involved in LAD and LCX while proximal segment in RCA. Severe LV dysfunction was associated with presence of LAD disease. CONCLUSIONS: Coronary angiograms can be normal in up to one fourth of young ACS patients. Others show a predominance of LAD artery involvement with morphologically simple lesions.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Adolescente , Adulto , Estudos de Coortes , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Adulto Jovem
9.
Ter Arkh ; 91(4): 74-82, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094480

RESUMO

AIM: To study the safety and clinical efficacy of an outpatient coronary angiography in various groups of patients according to a 6-year experience of the laboratory of endovascular diagnostic and treatment methods in the outpatient setting of the NMRC of Cardiology. MATERIALS AND METHODS: 2166 patients which underwent an outpatient coronary agiography from March 2009 to December 2014 were included. The success criteria was the successful completion of the procedure without the occurrence of major cardiovascular complications (death, transmural myocardial infarction; acute cerebrovascular accident, emergency cardiac surgery). RESULTS: All 2166 patients included in the study were divided into 2 groups: Group 1 - 1316 patients who were discharged home several hours after the study; Group 2 - 850 patients directed from hospitals without catheterization laboratories with the same-day discharge back to the referring hospital. From a clinical point of view, in the second group there were more severe patients. However, the study was successfully completed in all patients in both groups. There were no major adverse cardiovascular complications during the procedure and within 24 hours. In the 1st group, unplanned hospitalization occurred in 2.1% of cases, the cause of which in 93% of cases was the detection during angiography of a critical lesion ≥70% of the left main coronary artery. CONCLUSION: In our work, the incidence of complications was extremely low and not significantly different in both groups of patients. This is due to the fact that in patients with a more severe symptoms underwent a preliminary stabilization of their clinical condition. The introduction of outpatient technologies will optimize the invasive diagnostics and reduce the costs associated with hospitalization.


Assuntos
Assistência Ambulatorial , Angiografia Coronária/métodos , Infarto do Miocárdio/diagnóstico por imagem , Pacientes Ambulatoriais , Angiografia Coronária/efeitos adversos , Vasos Coronários , Hospitalização , Humanos
10.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040148

RESUMO

A 28-year-old man diagnosed with diabetes mellitus and systemic hypertension presented with a medical history of sudden onset retrosternal discomfort followed by loss of consciousness and generalised tonic clonic seizures. Examination revealed obesity, polysyndactyly and retinal pigment dystrophy. He was diagnosed to have acute myocardial infarction and left posterior watershed infarct. He was also diagnosed to have Bardet-Biedl syndrome based on clinical features. He was managed symptomatically and is currently doing well on regular follow-up in the outpatient clinic.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome de Bardet-Biedl/fisiopatologia , Imagem por Ressonância Magnética , Infarto do Miocárdio/fisiopatologia , Obesidade/complicações , Adulto , Síndrome de Bardet-Biedl/complicações , Síndrome de Bardet-Biedl/diagnóstico por imagem , Síndrome de Bardet-Biedl/tratamento farmacológico , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/etiologia , Neuroimagem , Resultado do Tratamento
11.
Medicine (Baltimore) ; 98(19): e15621, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083259

RESUMO

RATIONAL: Plaque rapid progression prior to acute myocardial infarction is not a common phenomenon, and its mechanism remains unknown. Intracoronary imaging may help to assess the plaque characteristics and progression. PATIENT CONCERN: A 37-year-old male patient suffered an acute myocardial infarction (AMI) 1 month after the diagnosis of a mildly stenosed coronary artery. Intracoronary imaging was done to seek the underlying causes and guide further treatment. DIAGNOSIS: Two coronary angiograms in 1 month showed plaque rapid progressing prior to the AMI. Intracoronary optical coherence tomography (OCT) post-AMI showed plaque erosion and heavy burden of thrombus. INTERVENTION: The patient was advised to defer stent deployment. The patient was then given intensified antithrombotic therapy. Three weeks later, OCT imaging revealed sufficient lumen area and the intact endothelium without remaining thrombus. Fractional flow reverse (FFR) showed no functional ischemia. Dual-antiplatelet therapy without stenting was recommended for 12 months. OUTCOMES: The 6-month follow-up showed good recovery and normal cardiac function. LESSONS: First, for patients with mild coronary stenosis and typical angina symptoms, further intracoronary assessment should be performed. Second, OCT can not only help to determine the plaque characteristics but can also help to develop patient-tailored strategies for AMI patients.


Assuntos
Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/terapia , Adulto , Estenose Coronária/complicações , Vasos Coronários/diagnóstico por imagem , Progressão da Doença , Humanos , Masculino , Infarto do Miocárdio/etiologia , Placa Aterosclerótica/complicações
12.
Int J Exp Pathol ; 100(2): 102-113, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31017330

RESUMO

A major translational barrier to the use of stem cell (SC)-based therapy in patients with myocardial infarction (MI) is the lack of a clear understanding of the mechanism(s) underlying the cardioprotective effect of SCs. Numerous paracrine factors from SCs may account for reduction in infarct size, but myocardial salvage associated with transdifferentiation of SCs into vascular cells as well as cardiomyocyte-like cells may be involved too. In this study, bone marrow-derived rat mesenchymal SC (MSCs) were microencapsulated in alginate preventing viable cell release while supporting their secretory phenotype. The hypothesis on the key role of paracrine factors from MSCs in their cardioprotective activity was tested by comparison of the effect of encapsulated vs free MSCs in the rat model of MI. Intramyocardial administration of both free and encapsulated MSCs after MI caused reduction in scar size (12.1 ± 6.83 and 14.7 ± 4.26%, respectively, vs 21.7 ± 6.88% in controls, P = 0.015 and P = 0.03 respectively). Scar size was not different in animals treated with free and encapsulated MSC (P = 0.637). These data provide evidence that MSC-derived growth factors and cytokines are crucial for cardioprotection elicited by MSC. Administration of either free or encapsulated MSCs was not arrhythmogenic in non-infarcted rats. The consistency of our data with the results of other studies on the major role of MSC secretome components in cardiac protection further support the theory that the use of live, though encapsulated, cells for MI therapy may be replaced with heart-targeted-sustained delivery of growth factors/cytokines.


Assuntos
Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Transplante de Células-Tronco Mesenquimais/métodos , Infarto do Miocárdio/terapia , Alginatos , Animais , Arritmias Cardíacas/etiologia , Células Cultivadas , Cicatriz/patologia , Citoproteção/fisiologia , Composição de Medicamentos , Ecocardiografia , Imunofenotipagem , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais/imunologia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Comunicação Parácrina/fisiologia , Ratos Wistar , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologia
13.
Math Biosci Eng ; 16(3): 1115-1137, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30947411

RESUMO

Ultrasound (US) imaging has the technical advantages for the functional evaluation of myocardium compared with other imaging modalities. However, it is a challenge of extracting the myocardial tissues from the background due to low quality of US imaging. To better extract the myocardial tissues, this study proposes a semi-supervised segmentation method of fast Superpixels and Neighborhood Patches based Continuous Min-Cut (fSP-CMC). The US image is represented by a graph, which is constructed depending on the features of superpixels and neighborhood patches. A novel similarity measure is defined to capture and enhance the features correlation using Pearson correlation coefficient and Pearson distance. Interactive labels provided by user play a subsidiary role in the semi-supervised segmentation. The continuous graph cut model is solved via a fast minimization algorithm based on augmented Lagrangian and operator splitting. Additionally, Non-Uniform Rational B-Spline (NURBS) curve fitting is used as post-processing to solve the low resolution problem caused by the graph-based method. 200 B-mode US images of left ventricle of the rats were collected in this study. The myocardial tissues were segmented using the proposed fSP-CMC method compared with the method of fast Neighborhood Patches based Continuous Min-Cut (fP-CMC). The results show that the fSP-CMC segmented the myocardial tissues with a higher agreement with the ground truth (GT) provided by medical experts. The mean absolute distance (MAD) and Hausdorff distance (HD) were significantly lower than those values of fP-CMC (p < 0.05), while the Dice was significantly higher (p < 0.05). In conclusion, the proposed fSP-CMC method accurately and effectively segments the myocardiumn in US images. This method has potentials to be a reliable segmentation method and useful for the functional evaluation of myocardium in the future study.


Assuntos
Coração/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Infarto do Miocárdio/diagnóstico por imagem , Miocárdio/metabolismo , Ultrassonografia , Algoritmos , Animais , Área Sob a Curva , Imagem Tridimensional , Reconhecimento Automatizado de Padrão/métodos , Curva ROC , Ratos , Ratos Sprague-Dawley , Software
15.
Eur J Radiol ; 113: 245-250, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927955

RESUMO

OBJECTIVES: To compare texture analysis (TA) with subjective visual diagnosis of myocardial infarction (MI) in cardiac computed tomography (CT) and to evaluate the impact of iterative reconstruction (IR). METHODS: Ten patients (4 women, mean age 68 ± 11 years) with confirmed chronic MI and 20 controls (8 women, mean age 52 ± 11 years) with no cardiac abnormality underwent contrast-enhanced cardiac CT with the same protocol. Images were reconstructed with filtered back projection (FBP) and with advanced modeled IR at strength levels 3-5. Subjective diagnosis of MI was made by three independent, blinded readers with different experience levels. Classification of MI was performed using machine learning-based decision tree models for the entire data set and after splitting into training and test data to avoid overfitting. RESULTS: Subjective visual analysis for diagnosis of MI showed excellent intrareader (kappa: 0.93) but poor interreader agreement (kappa: 0.3), with variable performance at different image reconstructions. TA showed high performance for all image reconstructions (correct classifications: 94%-97%, areas under the curve: 0.94-0.99). After splitting into training and test data, overall lower performances were observed, with best results for IR at level 5 (correct classifications: 73%, area under the curve: 0.65). CONCLUSIONS: As compared with subjective, nonreliable visual analysis of inexperienced readers, TA enables objective and reproducible diagnosis of chronic MI in cardiac CT with higher accuracy. IR has a considerable impact on both subjective and objective image analysis.


Assuntos
Infarto do Miocárdio/diagnóstico por imagem , Idoso , Algoritmos , Estudos de Casos e Controles , Feminino , Coração/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Cintilografia , Tomografia Computadorizada por Raios X/métodos
16.
Lipids Health Dis ; 18(1): 99, 2019 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-30987629

RESUMO

OBJECTIVE: The value of atherogenic index of plasma (AIP) as a predictive biomarker for coronary artery disease (CAD) remains controversial. In addition, whether AIP is associated with the risk of acute coronary syndrome (ACS) in very young adults has not been well established. METHODS: We consecutively collected very young adults (≤35 years of age) undergoing coronary angiography (CAG) at Anzhen Hospital, between January 2008 and December 2017. Total of 1, 478 very young participants, including 1, 059 ACS patients and 419 non-CAD subjects, were enrolled in the present study. RESULTS: Very young patients with ACS had higher AIP level compared with non-CAD participants (0.35 ± 0.30 vs 0.21 ± 0.33, P < 0.001). According to Gensini Score (GS) and number of lesion vessel, patients were divided into four groups, respectively. With the elevated GS score and number of lesion vessels, the AIP level increased gradually (Pfor trend all< 0.05). Multivariate logistic regression analyses suggested that AIP remained to be independently associated with the presence of ACS and was superior to traditional lipid profiles (for AIP, OR = 2.930, 95% CI = 1.855-4.627, P < 0.001; for total cholesterol, OR = 1.152, 95% CI = 1.048-1.266, P = 0.003; for triglyceride, OR = 1.078, 95% CI = 0.991-1.172, P = 0.079; for low-density lipoprotein cholesterol, OR = 1.046, 95% CI = 1.015-1.078, P < 0.001), after adjustment for other traditional confounders. Moreover, the prevalence of ACS, acute myocardial infarction, unstable angina pectoris and the value of GS were also elevated as AIP quartiles increased (Pfor trend < 0.001). Subgroup analysis based on gender revealed that AIP was only independently associated with the ACS risk in male. CONCLUSIONS: AIP was independently associated with the presence and severity of ACS in very young patients in a gender-dependent manner, which might be superior to traditional lipid profiles.


Assuntos
Síndrome Coronariana Aguda/sangue , Angina Instável/sangue , Aterosclerose/sangue , Infarto do Miocárdio/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idade de Início , Angina Instável/diagnóstico por imagem , Angina Instável/fisiopatologia , Aterosclerose/diagnóstico por imagem , Aterosclerose/fisiopatologia , Estudos de Casos e Controles , China , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Angiografia Coronária , Feminino , Hospitais , Humanos , Modelos Logísticos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Triglicerídeos/sangue
17.
Clín. investig. arterioscler. (Ed. impr.) ; 31(2): 49-55, mar.-abr. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-182573

RESUMO

Objective: To determine the relation between epicardial fat thickness and coronary in-stent restenosis in patients with acute myocardial infarction and percutaneous coronary intervention. Methods: A prospective study was conducted, which included 129 patients (67.3% male, mean age 62.9 ± 10 years) with ST segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention with bare metal stent. Patients were divided in two groups according to the presence (n = 21) or not (n = 108) of in-stent restenosis during one year follow-up. Results: Epicardial fat was significantly thicker in patients with coronary in-stent restenosis (5.51 ± 1.6 vs 4.14 ± 2.0 mm, p = 0.006). A proportionally and significantly thicker epicardial fat was found according to the increase in coronary disease severity (3.3 ± 0.9 mm vs 4.3 ± 1.8 mm vs 4.7 ± 2.3 mm vs 6.7 ± 2.2mm, for type A, B1, B2 and C lesions, respectively, p=0.001) and number of vessels (3.07 ± 1.2 mm vs 4.92 ± 1.8 mm vs 5.43 ± 2.2 mm, for one, two and three vessels disease, respectively, p < 0.0001). Epicardial fat thickness ≥ 4.7 mm had 75.0% sensibility and 69.0% specificity for predicting restenosis (AUC = 0.737). Conclusions: Echocardiographic evaluation of epicardial fat thickness could identify those patients with acute myocardial infarction with greater probabilities of in-stent restenosis after percutaneous coronary intervention


Objetivos: Determinar la relación entre el grosor de la grasa epicárdica y la reestenosis del stent en pacientes con infarto agudo de miocardio e intervención coronaria percutánea. Métodos: Se realizó un estudio prospectivo en 129 pacientes (67,3% del sexo masculino, edad media: 62,9 ± 10 años) con diagnóstico de infarto agudo de miocardio con elevación del ST e intervención coronaria percutánea primaria con stent metálico convencional, divididos en 2 grupos según presencia (n = 21) o no (n = 108) de reestenosis durante un año de seguimiento posterior a la intervención. Resultados: La grasa epicárdica fue significativamente mayor en los pacientes con reestenosis del stent (5,51 ± 1,6 vs. 4,14 ± 2,0 mm; p = 0,006), aumento en la severidad de la lesión angiográfica (3,3 ± 0,9 vs. 4, 3± 1,8 vs. 4,7 ± 2,3 vs. 6,7 ± 2,2 mm, para lesiones tipo A, B1, B2 y C, respectivamente; p = 0,001) y el número de vasos enfermos (3,07 ± 1,2vs. 4,92 ± 1,8 vs. 5.43 ± 2.2 mm, para uno, 2 y 3 vasos, respectivamente; p < 0,0001). La grasa epicárdica ≥ 4,7 mm mostró una sensibilidad del 75,0% y una especificidad del 69,0% en la predicción de reestenosis (área bajo la curva de 0,737). Conclusiones: La evaluación ecocardiográfica de la grasa epicárdica puede identificar pacientes con infarto agudo de miocardio con mayores probabilidades de reestenosis del stent después de una intervención coronaria percutánea


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Reestenose Coronária/etiologia , Infarto do Miocárdio/terapia , Tecido Adiposo/patologia , Pericárdio/patologia , Stents , Intervenção Coronária Percutânea , Estudos Prospectivos , Seguimentos , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem
18.
Int J Cardiovasc Imaging ; 35(6): 1039-1045, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852704

RESUMO

The purpose of the study was to validate by histopathology, contrast enhanced cine steady-state free precession and T2-weighted CMR for the assessment of ischemic myocardial area-at-risk (AAR) in the presence of microvascular obstruction (MVO). Eleven anesthetized pigs underwent CMR 7 to 10 days post infarction. The area-at-risk was measured from T2-weighted fast spin echo (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP) images using semi-automated algorithms based on a priori knowledge of perfusion territory. Also, late gadolinium enhancement (LGE) was performed to measure final infarct size (FIS). Histopathological comparison with Evans blue dye to define AAR and triphenyltetrazolium chloride to define FIS served as the reference. All infarcts demonstrated MVO on LGE images. Bland-Altman analysis showed no significant bias in AAR or myocardial salvage between T2-STIR and CE-SSFP or between CMR and histopathology. The mean differences ± 2SD from Bland-Altman analysis were: AAR: Evans Blue vs. T2-STIR [0.7%; + 13.5%; - 12.1%]; AAR: Evans Blue vs. CE-SSFP [0.1%; + 13.8%; - 13.7%]; AAR: T2-STIR vs. CE-SSFP [0.7%; + 6.2%; - 4.9%]; Salvage: Evans Blue - TTC vs. T2-STIR-LGE [0.8%; + 11.1%; - 9.6%]; Salvage: Evans Blue - TTC vs. CE-SSFP-LGE [0.1%; + 9.9%; - 9.6%]; Salvage: CE-SSFP-LGE vs. T2-STIR-LGE [0.7%; + 6.2%; - 4.9%]. Both T2-STIR and CE-SSFP sequences allow for unbiased quantification of AAR in the presence of ischemia/reperfusion injury when analysed by semi-automated algorithms. These experimental data, which was validated by histopathology, supports the use of CMR for the assessment of myocardial salvage during the subacute phase.


Assuntos
Meios de Contraste/administração & dosagem , Imagem Cinética por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Miocárdio/patologia , Compostos Organometálicos/administração & dosagem , Animais , Modelos Animais de Doenças , Feminino , Interpretação de Imagem Assistida por Computador , Infarto do Miocárdio/patologia , Traumatismo por Reperfusão Miocárdica/patologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sus scrofa , Sobrevivência de Tecidos
19.
Medicine (Baltimore) ; 98(10): e14637, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855449

RESUMO

BACKGROUND: Polaprezinc is clinically used for the treatment of gastric ulcers. It induces the mobilization of mesenchymal stem cells and the mRNA expression of insulin-like growth factor-1 in vascular endothelial cells in order to protect injured gastric tissue or skin. METHODS: The current study population included 50 patients with primary acute myocardial infarction (AMI). After percutaneous coronary intervention, the subjects were randomly divided into 2 groups, namely, the nonpolaprezinc and polaprezinc groups. Peripheral blood and urinary samples were collected in a specific time to analyze zinc concentration, cardiac enzymes, and the levels of the inflammation marker interleukin-6. To evaluate the cardiac function, echocardiography was performed upon admission to the hospital and at 9 months post-AMI. RESULTS: The urine and blood zinc levels of the polaprezinc group were higher compared with those of the non-polaprezinc group at 8 days after percutaneous coronary intervention. The mean interleukin-6/maximal creatine phosphokinase level was significantly reduced in the polaprezinc group (0.024 [0.003-0.066] vs. 0.076 [0.015-0.212], respectively; P = .045). In addition, echocardiography revealed that the ejection fraction of the nonpolaprezinc group was not significantly increased between day 3 and 9 months post-AMI (53 [49-60.8] vs. 59.5 [52-69.3], respectively; P = .015). However, a significant increase was detected in the ejection fraction of the polaprezinc group at the 2 time points (54 [51-57] vs. 62 [55-71], respectively; P < .01). CONCLUSIONS: The results of the present study suggest that polaprezinc has an anti-inflammatory effect and improves cardiac function after AMI.


Assuntos
Anti-Inflamatórios/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Carnosina/análogos & derivados , Infarto do Miocárdio/terapia , Compostos Organometálicos/uso terapêutico , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Carnosina/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/metabolismo , Intervenção Coronária Percutânea , Resultado do Tratamento , Zinco/sangue , Zinco/urina , Compostos de Zinco/uso terapêutico
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