ABSTRACT
Background: Speckle-tracking echocardiography has emerged as a unique technique for accurately evaluating myocardial function by analyzing the motion of speckles identified. Speckle-tracking measured under stress may offer an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability. Objective: The aim of the current study was to evaluate stress speckle tracking to detect myocardial viability in comparison to cardiac MRI in post-STEMI patients. Patients and methods: 74 patients were prospectively enrolled in 18-month's study. Dobutamine stress echocardiography was performed 4 days post-infarction accompanied with automated functional imaging analysis of left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography at 3 months with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 3 months. Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment. Meanwhile it provided 81.82% sensitivity and 82.6% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15. Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial viability after STEMI. Moreover, it carries a promising role in post-myocardial infarction risk stratification with a reasonable prediction of reversible cardiac-related hospital re-admission
Subject(s)
Echocardiography, Stress , Egypt , Magnetic Resonance Imaging , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imagingABSTRACT
Improving the ability of the kidney to tolerate ischemic injury has important implication in renal transplantation. On the other hand, thermo tolerance describes the process in which hyperthermia induces a transient resistance of the stressed cells to subsequent episodes of oxidative stress. The current study was performed to evaluate the beneficial effect of heat preconditioning induced HSP-72 formation on renal ischemia reperfusion [I/R] induced damage. Four groups of rats [n=20/group] were included: Control sham-operated group [group I], heat-preconditioned sham-operated group [group II], I/R injury group [group III] and heat pre-conditioned I/R injury group [group IV]. Heat-preconditioning was induced 24h prior to sham operation and or I/R injury by increasing the core body temperature to [41 +/- 0.5°C] for 20min. The rat kidneys were subjected to ischemia by 20min of bilateral renal artery occlusion followed by reperfusion for 24 and 48h. After 24 and 48h of reperfusion, serum urea, creatinine, 24h urine out put and albumin content as well as the renal HSP-72 gene expression and MDA level were measured. Also light microscopic examination of renal tissue specimens was performed. It was found that group IV had a significant increase in renal HSP-72 gene expression compared to group III [898.36 +/- 107.82 versus 572.88 +/- 47.08 micro g/g tissue], associated with a significant improvement of its renal functions including serum urea, creatinine and 24h urine volume out put. Also there was a reduction in renal tissue injury detected by a significant decrease in urine albumin content, a significant decrease in renal MDA level and improvement in specimen microscopic picture compared to group III. The increase in HSP-72 expression and its renoprotective effect were significantly greater 24h after I/R than after 48h. Thus it can be concluded that upregulation of HSP-72 after heat preconditioning has a renal beneficial effect and can be a target for protection of renal functions during I/R injury