ABSTRACT
Background: myocardial infarction is the main cause of death worldwide. Angiogenesis, a promising new therapy for the treatment of diffuse coronary artery disease, shows a poor response to conventional revascularization techniques. This study focused on improving myocardial function using endothelial cells [ECs] and mesenchymal stem cells [MSCs] in a sheep animal model
Methods: acute myocardial infarction was induced in 18 sheep [12 treated cases and 6 controls]. Autologous MSCs and ECs were injected in the infarcted area and the border zone. Two months after transplantation, echocardiography, electron microscopy, and immunohistochemistry were performed
Results: echocardiography in both MSC and EC groups revealed a significant improvement in the ejection fraction compared with the control group [p value < 0.05]. Vascular density, estimated by antibodies against the von Willebrand factor and smooth muscle actin, increased in both study groups. The pattern of vascularity in the MSC and EC groups was diffused. The electron microscopic evaluation of the infracted areas revealed cardiomyocytes in variable stages of development in the border zone in both EC and MSC groups
Conclusion: both ECs and MSCs were able to promote angiogenesis and improve cardiac function. Presumably, MSCs differentiate into ECs and cause angiogenesis as it occurs for ECs
ABSTRACT
Background: It is not clear whether the latest activation sites in the left ventricle [LV] are matched with infracted regions in patients with ischemic cardiomyopathy [ICM]. We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM
Methods: Data were analyzed in 106 patients [age = 60.5 +/- 12.1 y, male = 88.7%] with ICM [ejection fraction 120 ms
Results: A total of 1 272 segments were studied. The latest activation sites [with longest Ts] were most frequently located in the mid-anterior [n = 32, 30.2%] and basal-anterior segments [n = 29, 27.4%], while the most common sites of akinesia were the mid-anteroseptal [n = 65, 61.3%] and mid-septal [n = 51, 48.1%] segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration
Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM
ABSTRACT
Several competing geometric and hemodynamic factors are suggested as contributing mechanisms for functional mitral regurgitation [MR] in heart failure patients. We aimed to study the relationships between the severity of MR and the QRS duration and dyssynchrony markers in patients with ischemic or dilated cardiomyopathy. We prospectively evaluated 251 heart failure patients with indications for echocardiographic evaluation of possible cardiac resynchronization therapy. All the patients were subjected to transthoracic echocardiography and tissue Doppler imaging to evaluate the left ventricular [LV] synchronicity. The patients were divided into two groups according to the severity of MR: /= moderate MR. The effects of different dyssynchrony indices were adjusted for global and regional left ventricular remodeling parameters. From the 251 patients [74.5% male, mean age = 53.38 +/- 16.68 years], 130 had /= moderate MR. There were no differences between the groups regarding the mean age, frequency of sex, and etiology of cardiomyopathy. The LV systolic and diastolic dimensions were greater in the patients with >/= moderate MR [all p values < 0.001]. Among the different echocardiographic factors, the QRS duration [150.75 +/- 34.66 vs. 126.77 +/- 29.044 ms; p value = 0.050] and interventricular mechanical delay [41.60 +/- 29.50 vs. 35.00 ms +/- 22.01; p value = 0.045] were significantly longer in the patients with
ABSTRACT
Mitral regurgitation [MR] is a common valvular lesion in the general population with considerable impact on mortality and morbidity. The MitraClip System [Abbot Laboratories, Abbot Park, IL, USA] is a novel percutaneous approach for treating MR which involves mechanical edge-to-edge coaptation of the mitral leaflets. We present our initial experience with the MitraClip System in 5 patients. In our series, the cause of MR was both degenerative and functional. Two patients received two MitraClips due to unsatisfactory results after the implantation of the first clip. Acute procedural success was seen in 4 patients. Blood transfusion was required for 2 patients. All the patients, except one, reported improvement in functional status during a 2-month follow-up period. Our initial experience with MitraClip implantation indicates that the technique seems feasible and promising with acceptable results and that it could be offered to a broader group of patients in the near future
Subject(s)
Humans , Male , Cardiac Catheterization , Mitral Valve , EchocardiographyABSTRACT
N-terminal pro beta-type natriuretic peptide [NT-proBNP] is a valuable marker for monitoring the response to treatment in patients with heart failure. Based on the clinically observed improvement of heart failure symptoms early after cardiac resynchronization therapy [CRT], we sought to investigate whether CRT induce any significant reduction in the plasma level of NT-proBNP in three days after implantation and whether it is correlated with patients' response at six months. In this prospective study, 21 consecutive patients with severe heart failure [New York Heart Association class 3.19 +/- 0.40] who underwent CRT were enrolled. Being alive, no hospitalization due to decompensated heart failure, and improvement of at least one NYHA functional class at six months were classified as clinical responsiveness. The plasma level of NTproBNP was measured before, three days, and six months after CRT. Clinical evaluation, echocardiographic study, and six-minute walking test were performed before and six months after the procedure. At six months' follow-up, 16 [76.2%] patients were responders. The plasma level of NT-proBNP at three days after CRT increased almost equally in both responder and non-responder groups of patients [Delta NT-proBNP was 40.94 +/- 135.74 vs. 54.80 +/- 88.98]; however, at six months' follow-up, the NT-proBNP changes statistically differed across the two groups of patients [P=0.005]. According to our findings, NT-proBNP percent deviation from baseline to three days after CRT appears to be not correlated with the patients' clinical response after six months, which was incongruent to the patients' clinical improvement after CRT
Subject(s)
Humans , Male , Female , Peptide Fragments , Heart Failure , Cardiac Resynchronization Therapy , Prospective Studies , Pilot ProjectsABSTRACT
Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock. Traumatic tricuspid valve regurgitation is a rare cardiovascular complication of blunt chest trauma. Tricuspid valve regurgitation is usually begotten by disorders that cause the right ventricle to enlarge. Diagnosis is made by physical examination findings and is confirmed by echocardiography. We report two cases of severe tricuspid regurgitation secondary to the rupture of the chordae tendineae of the anterior leaflet following non-penetrating chest trauma. Both patients had uneventful postoperative courses
ABSTRACT
One of the most serious complications of mitral valve replacement is left ventricular rupture and pseudoaneurysm formation, which is rare but potentially lethal. We herein present a late type of post mitral valve replacement and coronary artery bypass surgery pseudoaneurysm in a 74-year-old female, who was admitted to our hospital with a recent history of exertional dyspnea. She had the above-mentioned operation 10 months before. The diagnosis was made via two-dimensional and real-time three-dimensional transthoracic echocardiography. The prosthetic mitral valve was removed, and the large orifice of the pseudoaneurysm was closed by surgery. At one year's follow-up, the patient was in good condition
ABSTRACT
We introduce a 32-year-old man who was evaluated for a dizziness and headache of unknown origin for at least two months and was referred to our center after ECG findings. He was finally diagnosed as a case of idiopathic, familial, diffuse, persistent atrial standstill, which is a rare arrhythmogenic condition characterized by the absence of electrical and mechanical activity in the atria. He successfully received a single-chamber permanent pacemaker
ABSTRACT
Given the common concomitance of tricuspid regurgitation [TR] with significant mitral stenosis, we aimed at exploring the relation between TR severity and pulmonary artery hypertension [PAH] in patients who underwent mitral balloon valvotomy [MBV]. We analyzed the echocardiography data of 133 consecutive patients [82.0% female, mean age 44.68 +/- 12.56 years] with different degrees of TR severity that underwent MBV between April 2006 and March 2008. The pulmonary artery systolic pressure [PAPs] > 35 mmHg was considered as PAH. Before MBV, 36.20% of the patients had moderate to severe TR, 92.5% PAH, and 18.0% right ventricular [RV] dilation [RV dimension >/= 33 mm]. After MBV, TR severity improved in 41.4%, worsened in 8.3%, and did not change in 50.4%. Before and after MBV, PAPs was significantly correlated with TR severity, and the mean PAPs change in patients with improved TR was significantly more than that of patients without TR improvement [p value=0.042]. Tricuspid regurgitation severity and mean PAPs [from 52.83 +/- 18.82 to 35.89 +/- 9.39 mmHg] decreased significantly after MBV [both p values < 0.001]; this reduction was significantly correlated to the amount of PAPs decrease. A cut-off point of >/= 19 mmHg reduction in PAPs had a specificity of 71.79% and sensitivity of 52.73% to show TR severity improvement [by Receiver-Operative-Characteristics analysis]. The mean of RV dimension decreased from 28.94 +/- 5.43 to 27.95 +/- 4.67 mm [p value < 0.001]. In contrast to patients with RV dilation, TR reduced significantly in patients without RV dilation [p value < 0.001]. Improvement in TR severity was directly correlated with the amount of PAPs reduction after MBV. More studies are needed to better define a cut-off value for PAPs reduction related to TR severity improvement
Subject(s)
Humans , Male , Female , Pulmonary Artery , Hypertension, Pulmonary , Blood Pressure , EchocardiographyABSTRACT
Transcatheter closure of atrial septal defect secundum [ASD-II] has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography [TEE] method for measuring atrial septal defect with balloon occlusive diameter [BOD] in transcatheter ASD-II closure. A total of 39 patients [71.1% female, mean age: 35.31 +/- 15.37 years] who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography [TTE] and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1-2 mm larger than the BOD of the defect. The mean defect size obtained by TEE and BOD was 18.50 +/- 5.08 mm and 22.86 +/- 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 +/- 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD=0.773 ASD size by TEE+8.562; r2=67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values [r=-0.394, p value=0.013]. In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure
Subject(s)
Humans , Male , Female , Aged , Child , Adolescent , Adult , Middle Aged , Echocardiography, Transesophageal , DiagnosisABSTRACT
Moderate non-organic tricuspid regurgitation [TR] concomitant with coronary artery disease is not uncommon, Whether or not TR improves after pure coronary artery bypass grafting [CABG], however, is unclear. The aim of this study was to evaluate the effect of isolated CABG on moderate non-organic TR. This study recruited 50 patients [40% female, mean age: 65.38 +/- 8.01 years, mean left ventricular ejection fraction [LVEF]: 45.74 +/- 13.05%] with moderate non-organic TR who underwent isolated CABG. TR severity before and after CABG was compared. Pulmonary arterial systolic pressure [PAPs] > 30mmHg and LVEF < 50% were considered elevated PAPs [EPAPs] and LV systolic dysfunction, respectively. Presence of Q-wave in leads II, III, and aVF was considered inferior myocardial infarction [inf. MI]. Pre-operatively, 81.5% of the patients had EPAPs, 16% right ventricle [RV] dilation, and 50% left ventricle [LV] and 16% RV systolic dysfunction. TR severity improved in 64% after CABG, whereas it remained unchanged or even worsened in others [P value < 0.001]. Patients with inf. MI showed no improvement in TR, while patients without inf. MI had significant TR regression after CABG [P value= 0.050]. Improvement of TR severity after CABG was not related to pre-operative RV size and function, LV systolic function, or PAPs reduction. Although TR severity decreased remarkably after isolated CABG, a considerable number of the patients had no TR regression. In addition, only absence of inf. MI was significantly correlated to TR improvement after CABG. Further prospective studies with long-term follow-up needed to determine the other factors predicting TR regression after isolated CABG
Subject(s)
Humans , Male , Female , Tricuspid Valve Insufficiency/surgery , Mitral Valve Insufficiency/surgery , Risk Assessment , Treatment Outcome , Retrospective StudiesABSTRACT
Given the dearth of data in the existing literature on the size and morphologic variability of secundum-type atrial-septal defect [ASD-II] in adult patients, we aimed to address this issue in a series of consecutive adult patients evaluated by transesophagesal echocardiography [TEE]. A total of 50 patients [68.0% female] with isolated ASD-II underwent TEE for the evaluation of the defect. The morphological characteristics of eh defect were evaluated, and the largest defect size was measured. The ASD rim was divided into 6 sectors: the superior-anterior, superior-posterior; superior, inferior-anterior, inferior-posterior, and inferior. The minimal length of the defect rims was determined. Mean age at the time of evaluation was 33.62 +/- 14.48 years. Mean defect diameter in the all the study patients was 20.80 +/- 8.17 mm. Thirteenmorphological variations were detected. Deficiency of one rim was detected in 14 [28%] patients, two in 16 [32%], three in 2 [4%], and four in 2 [4%]. Deficiency of the superior anterior rim was found din 24% of the patients [gamma= 0.558, P value < 0.001]. Forty-eight [96%] patients emerged for defect closure: 22 [46.2%] suitable for percutaneous closure and 26 [53.8%] for surgical closure. Two patients with small defects were recommended for medical treatment and follow-up. ASD-II is larger and more morphologically variable in adults than in children. Based on the findings of the present and previous studies and given the advantages of percutaneous treatment, it is advisable to make a decision on ASD-II closure as soon as possible before it outgrows the transcatheter closure suitability criteria
Subject(s)
Humans , Male , Female , Echocardiography, Transesophageal , Echocardiography/methods , Adult , Prosthesis Implantation , Evaluation Studies as TopicABSTRACT
Marrow-derived mesenchymal stem cells [MSCs] have been heralded as a source of great promise for the regeneration of the infarcted heart. There are no clear data as to whether or not in vitro differentiation of MSCs into major myocardial cells can increase the beneficial effects of MSCs. The aim of this study was to address this issue. To induce MSCs to transdifferentiate into cardiomyocytes and endothelial cells, 5-Azacytidine and vascular endothelial growth factor [VEGF] were used, respectively. Myocardial infarction in rabbits was generated by ligating the left anterior descending coronary artery. The animals were divided into three experimental groups: I] control group, II] undifferentiated mesenchymal stem cell transplantation group, and III] differentiated mesenchymal stem cell transplantation group. The three groups received peri-infarct injections of culture media, autologous undifferentiated MSCs, and autologous differentiated MSCs, respectively. Echocardiography and pathology were performed in order to search for improvement in the cardiac function and reduction in the infarct size. Improvements in the left ventricular function and reductions in the infarcted area were observed in both cell transplanted groups [Groups II and III] to the same degree. There is no need for prior differentiation induction of marrow-derived MSCs before transplantation, and peri-infarct implantation of MSCs can effectively reduce the size of the infarct and improve the cardiac function
Subject(s)
Animals, Laboratory , Stem Cells , Bone Marrow , RabbitsABSTRACT
Myocardial free wall rupture is a catastrophic complication of acute myocardial infarction, and prognosis will depend on the prompt diagnosis by echocardiography, extension of infarct size, and prompt surgical treatment. Free wall rupture concomitant with ventricular septal defect [VSD] may be more complicated for management. A case of a 69-year-old man with myocardial free wall rupture and VSD following acute anterior myocardial infarction is presented
Subject(s)
Humans , Male , Heart Rupture/etiology , Heart Septal Defects, VentricularABSTRACT
We report experimental myocardial infarction by occluding coronary arteries in ovine models. Twelve ewes were included in the study. After the chest was opened by left lateral thoracotomy incision, the second diagonal branch of the left anterior descending coronary artery was ligated at a point approximately 40% distant from its base. Prophylactic antiarrhythmics were administered. Animals were mechanically ventilated during surgery and stayed in the ICU for 24h afterwards. Experiments were then evaluated by echocardiographic, electrocardiographic, hemodynamic, serologic and morphologic investigations. Echocardiographic measurements were repeated after two months and animals were then sacrificed for postmortem cardiac examinations. All animals survived the surgical procedure. Cyanotic discoloration and hypokinesia in the cardiac tissue in an area of 3x4 cm plus ST-segment elevations was detected immediately after vessel ligation. More over, there were pathologic Q-waves 2 months later. Echocardiographic evaluations revealed an average of 22% relative decrease in cardiac ejection fraction. Wall motion analysis demonstrated anteroapical hypokinesia and akinesia in all animals one day and two months after operation. Thin walled infarcted areas with tissue fibrosis were evident in pathologic investigations two months after surgery. In conclusion, we developed a practical and safe method of producing myocardial infarction in large animal models
Subject(s)
Animals , Coronary Vessels , Ligation , Sheep , Models, AnimalABSTRACT
This study sought to access differences in long-term [9 months] outcomes between Acute Coronary Syndrome [ACS] patients who undergo early intervention compared to Percutaneous Coronary Intervention [PCI] in stable and refractory conditions. Data originated from Tehran Heart Center Registry- interventional cardiology [THCR-IC] and consisted of 1267 patients divided into two categories; 227 patients had features corresponding to acute coronary syndromes [17.9%] and 1040 patients suffered from stable angina [82.1%]. They were admitted between April 3, 2003 and April 25, 2004. The clinical success rate of PCI was higher in ACS [97% vs. 94%; P=0.037], while In-hospital complications was similar in both groups. During the follow-up period, clinical restenosis was not significantly different and the overall number of re-interventions caused by restenosis or progression was not more frequent in ACS patients. Also, 1.3% of ACS and 0.4% of SA patients died, but the difference was not statistically significant [P=0.16]. Finally, Major Adverse Cardiac Events [MACE] showed no significant difference [5.2% vs. 3.9%; P=0.42]. Multivariate analysis showed that female sex [OR=25.6; P=0.003] and previous history of PCI [OR=8.4; P=0.016] were the only strong independent risk factors for major adverse cardiac events. Analyzing ACS patient outcomes using Mantel-Hanzel analysis showed that the female sex was the only factor which strongly increased the incidence of MACE. Both ACS and SA patients who underwent coronary intervention had similar in-hospital and composite major adverse cardiac events, nevertheless female gender must be considered as an independent risk factor for major adverse cardiac events especially in patients with acute coronary syndrome who undergo PCI