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Objective To investigate the effects of human umbilical cord mesenchymal stem cells (UC-MSCs) on vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) expression in acute myocardium infarction (AMI) rats. Methods The human UC-MSCs were cultured to the 4th generation for experiment. Sixty male Sprague-Dawley (SD) rats were randomly divided into sham group, AMI model group and UC-MSCs group, with 20 in each group. AMI animal model was produced by ligation of anterior descending coronary artery; in the sham group, the threading vein was gone below without ligation. In UC-MSCs group 2×106 UC-MSCs were infused through the caudal vein at 24 hours after successful model production. The animals were sacrificed after 7 days; the myocardial tissue and coronary artery below the ligation line were harvested. The mRNA and protein expressions of IL-6 in myocardium were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot. The positive expression of VEGF in coronary artery was observed by immunohistochemisty. Results Compared with the sham group, the mRNA and protein expressions of IL-6 in myocardium in AMI model group were increased significantly (gray value: 0.732±0.131 vs. 0.321±0.080, 0.678±0.191 vs. 0.286±0.061, both P < 0.05). Compared with the AMI model group, the mRNA and protein expressions of IL-6 in myocardium in UC-MSCs group were decreased significantly (gray value: 0.300±0.104 vs. 0.732±0.131, 0.312±0.101 vs. 0.678±0.191, both P < 0.05). Observation under light microscope, the VEGF positive cells in AMI model group was increased significantly compared with the sham group (cells/HP: 21.1±2.2 vs. 7.6±1.3, P < 0.05), the VEGF positive cells in UC-MSCs group were increased significantly compared with the AMI model group (cells/HP: 41.5±3.1 vs. 21.1±2.2, P < 0.05). Conclusion Human UC-MSCs could promote angiogenesis by the improvement of VEGF in coronary artery and inhibit the inflammation by the reduction of IL-6 in rats with AMI.
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OBJECTIVE:To investigate clinical efficacy and safety of meglumine adenosine cyclophosphate in the treatment of acute myocardium infarction. METHODS:A total of 80 patients with acute myocardium infarction in our hospital during May 2015-Jan. 2016 were selected and divided into control group and observation group according to random number table,40 cases in each group. Control group was given conventional treatment. Observation group was additionally given Meglumine adenosine cyclo-phosphate injection 120 mg added into 5% Glucose injection 250 mL,ivgtt,qd,on the basis of control group. Both groups re-ceived treatment for 7 d. Clinical efficacies as well as the levels of serum hs-CRP and NT-proBNP before and after treatment were observed in 2 groups,and the occurrence of ADR was compared between 2 groups. RESULTS:Total response rate of observation group(92.50%)was significantly higher than that of control group(75.00%),with statistical significance(P0.05). After treat-ment,the serum levels of hs-CRP and NT-proBNP in 2 groups were decreased significantly,and the observation group was signifi-cantly lower than the control group,with statistical significance(P0.05). CONCLUSIONS:Meglumine adenosine cyclophosphate shows significant therapeutic efficacy for acute myocardium infarction,reduces serum levels of hs-CRP and NT-proBNP significantly with good safety.
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Objective To investigate the expression of monocyte subsets and their chemokine,i.e.,monocyte chemoattractant protein (MCP-1) and fractalkine (FKN),in patients with acute coronary svndrome (ACS),and to analyze their correlation.Methods Patients with the syndrome of pectoralgia and to be inspected with coronary angiography (CAG) in our hospital from Sep.to Dec.,2016 were included.Patients' venous blood was collected on the operation day before operation,the level and proportion of monocyte (Mon) subsets,which was namely CD14 + CD16-Mon (Mon1),CD14+CD16 + Mon (Mon2) and CD14-CD16 + Mon (Mon3) according to the expression of cluster differentiation-14 (CD14) and CD16,were detected by flow cytometry (FCM).Patients' venous blood was collected on the operation day before operation and one day after operation,the concentrations of MCP-1 and FKN in plasma were measured by ELISA.We compared the expression levels of MCP-1-Mon1 and FKN-Mon3,and analyzed their relationship between each other respectively in different groups.Results Diagnosed according to the clinical symptoms,myocardial markers,electrocardiogram and CAG results,70 individuals were analyzed,including 30 patients with acute myocardial infarction (AMI group),25 patients with unstable angina pectoris (UAP group) and 15 patients with the chest pain symptoms and normal CAG results (control group).The percentage of Mon1 in the AMI group was higher than that in the other groups (P＜0.05);no difference was observed for Mon3 among the groups (P＞0.05).The Mon3/Mon1 ratio in the AMI group was lower than that in the control group (P＜0.05).Moreover,the levels of FKN and MCP-1 in the ACS group were greater than those in the control group.The level of red blood cell distribution width (RDW) was significantly increased in the AMI and UAP group than that in the control group (P＜0.05).There was a significant correlation between FKN and Mon3 (P＜0.05,R=0.650 2).Conclusions The monocyte subset of Mon1 and Mon3 increased in the early stage of ACS,with their chemokine (FKN and MCP-1) increasing at the same time.There is a significant correlation between FKN and Mon3,which indicates MCP-1-Mon1 and FKN-Mon3 may participate in the pathophysiological process of early ACS in patients.
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Objective To evaluate the efficacy and safety of levosimendan applied in patients with chronic heart failure combined with acute ST -elevation myocardium after direct percutaneous coronary intervention (PCI). Methods Using the random number table method,95 patients with heart failure combined with acute ST -elevation myocardium after direct PCI were randomly divided into two groups:the general treatment group and the levosimendan group.The levels of serum NT -proBNP,LVSD,LVEF before and after 24h,one week treatment were examined.After the experiment,clinical assessment was performed to evaluate the efficacy and safety of levosimendan.Results The resuits of NT -proBNP,LVEF and LVSD in the general group before treatment were (5 908.1 ±33.2)ng/L, (36.7 ±4.3)% and (6.1 ±0.6)cm,while those were (3 478.5 ±19.3)ng/L,(45.0 ±6.3)%,(5.9 ±0.3)cm, (3 375.2 ±32.1)ng/L,(48.3 ±5.4)% and (5.8 ±1.1)cm after 24h and 1 week treatment.The level of serum NT-proBNP decreased,while the LVEF increased in general treatment group after 24h treatment(t =3.86,4.11,P =0.021,0.015).The same results happened after 1 week treatment(compared with before treatment,t =4.13,5.06, P =0.016,0.013,compared with 24 hours after treatment,t =3.96,4.77,P =0.021,0.015).But the level of the LVSD had no differences before and after 24h,1 week treatment(P >0.05).The results of NT -proBNP,LVEF and LVSD in the levosimendan group before treatment were (3 340.5 ±19.2)ng/L,(43.3 ±3.9)%,(5.3 ±0.7)cm, (2 938.3 ±12.8)ng/L,(52.7 ±8.2)% and (4.6 ±0.2)cm after 24h and 1 week treatment.The levels of serum NT -proBNP,LVSD decreased,while the LVEF increased in the levosimendan group after 24h,1 week treatment(t =6.07,6.49,5.73,P =0.010,0.008,0.011.t =6.55,7.05,5.33,P =0.009,0.007,0.012).Compared with the general treatment group,the levels of serum NT -proBNP,LVEF showed no differences(all P >0.05),but the level of the LVSD decreased after 24h treatment(t =4.84,P =0.015)in the levosimendan group.The levels of serum NT -proBNP,LVSD decreased,while the LVEF increased in the levosimendan group after 1 week treatment compared with the general treatment group(t =6.60,7.01,5.40,P =0.007,0.007,0.011 ).After one week treatment,the effective and beneficial rates of the levosimendan group were 66.6% and 95.6%,while those were 59.6% and 89.5% in the general treatment group.The therapeutic effects of levosimendan group were more effective than the general treatment group after 1 week treatment(χ2 =9.72,15.63,P =0.015,0.008),but had no statistical differ-ences between the two groups after 24h treatment(P >0.05).There was no statistical differences between the two groups in the rate of adverse reactions.Conclusion Levosimendan has very favorable efficacy and safety for patients with chronic heart failure combined with acute ST -elevation myocardium infarction after direct PCI.
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Objective Testing the CRP and PLT for patients with acute myocardium infarction(AMI) .Analysising the relation‐ship between AMI and CPR or PLT .Methods We chose 60 patients with AMI who treat in our hospital during 2012/11 and 2014/10 as an observation group .As the same time ,we also chose 60 healthy person as a comparison group .Testing the CRP and PLT of the two groups with the same method ,and then we compare and analysis the results .Results The observation group's concentration of CRP is (22 .13 ± 4 .71)mg/L ,level of PLT is (241 ± 33)× 109/L .The comparison group's concentration of CRP is(2 .74 ± 0 .49) mg/L ,level of PLT is(162 ± 26) × 109/L .The result of the observation group is obvious higher than the comparison group ,and the difference is significance(P<0 .05) .The observation group's positive rate of CRP is 73 .33% ,increase of PLT is 38 .33% .The comparison group's positive rate of CRP is 3 .33% ,increase of PLT is 5 .00% .The result of the observation group is obvious higher than the comparison group ,and the difference is significance(P<0 .05) .Conclusion To the clinical diagnosis of AMI ,testing the CRP concentration and the PLT level is useful to understand the patient's host defenses and inflammation condition .It has clinical value to AM I's prevent ,diagnosis and prognosis .
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Objective To identity the characteristic metabolites of platelets activation by Plasma metabolic Profiling in acute myocardium infarction ( AMI ) patients.Methods From August 2012 to February 2013, samples in three groups were collected at Tianjin Third Central hospital, including AMI group (25 clinically diagnosis myocardial infarction, 14 male, 11 female, average age 67 ±13 ) , control group(A) and simulation platelet activation group(B) (A and B group composed of 29 health volunteers, 11 male 18 female, average age 65 ±12 ) .After collagen platelet activation on B group, HPLC-LTQ Orbitrap XL MS platform was used to analyze the serum metabolic profiling in three groups respectively.Principal component analysis ( PCA) model and partial least squares-discriiminate analysis ( OPLS-DA) model were established to select characteristic metabolites in A and B group, and then tested in X group to find common ions.Results 20 characteristic metabolites were selected in A and B group.3 different lysophosphatidyl choline, sphingosine 1-phosphate, ethanol amine amides, sphingosine choline phosphate, thromboxane, 14-methyl hexadecanoic acid showed the same changing trend and were significant different between B group and AMI group.Conclusions Characteristic ions selected by metabolic profiling technology had significant distinguishing ability for AMI patients and health control.They may provide early diagnosis for AMI.
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Objective To observe the application effect of comfortable nursing in percutaneous coronary intervention for patients with acute myocardium infarction.Methods 112 patients with acute myocardium infarction receiving the treatment of percutaneous coronary intervention were randomly divided into the observation group and the control group,each group including 56 cases.The control group was given conventional nursing,and the observation group was given comfortable nursing.Hospitalization time,nursing satisfaction degree,psychological status before and after treatment and life quality for patients in two groups were evaluated.Results The nursing satisfaction degree,nursing effect and life quality for 56 patients in the observation group were higher evidently than those in the control group.And the average hospitalization time of the observation group was lower than that of the control group.The comparison between two groups had statistical significance.Conclusions Comfortable nursing in percutaneous coronary intervention for patients with acute myocardium infarction can evidently improve medical quality,and can provide strong guarantee for the life and safety of patients.
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Objective To study the effect of psychological nursing on heart rate variability (HRV)in patients with acute myocardium infarction. Methods 80 patients with AMI were randomly divided into group A(routine nursing group)and group B (psychological nursing group) with 40 patients in each group,HRV was evaluated in both groups.The time domain and frequency domain of HRV of 24 h sinus rhythm in two groups of patients were analyzed. Results In group B,24 h average standard deviation of RR interval (SDNN),5 min segments of continuous average standard deviation of RR intervals (SDANN),the difference between adjacent cardiac RR interval of the root mean square (rMSSD),the percentage of adjacent canrdiac RR interval greater than 50 ms (PNN50),low frequency (LF),high frequency (HF) and other HRV parameters were significantly higher than group A. Conclusions Psychological nursing can significantly increase HRV and improve the electric stability of the ischemic myocardium.Psychological nursing can stabilize emotion of patients,decrease sympathetic tone,and may have a role in the prevention of sudden death.
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Objective To investigate the effects of astragalosides(AST)on angiogenesis of myocardium in rats after myocardial infarction.Methods Myocardial infarction(MI)was induced by ligation of the proximal left anterior descending coronary artery,30 postoperative rats were randomly divided into three same-size groups,i.e,medical group A(AST 2.5 mg · kg-1 · d-1),medical group B(AST 10mg · kg-1 · d-1)and control group(physiological saline).All of three groups were treated with intraperitoneal injection of 2ml dose for 4 weeks.The pathological changes of the heart tissue were observed by H-E staining and the micro-vascular count(MVC)/micro-vascular density (MVD)were calculated by CD34-staining.Results HE staining showed cardiac fabric disarrangement,granulation tissue generation,and fibroblast proliferation;The change of medical groups was less obvious than the control group; the change of group B with higher dose was less obvious than group A.CD34 staining showed that regeneration of neovascularization at the margin of myocaardium infarction was seen in all of three groups;for the MVC/MVD,medical groups were significantly higher than the control group,while group B is significantly higher than group A (all P ＜0.01).Conclusion AST can improve myocardial ischemia of rats after myocardial infarction.AST can promote angiogenesis in ischemic myocardium of rats,and the effect is positively correlated with AST dose.
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@#Objective To observe the prognosis of acute myocardium infarction (AMI) patient accepted nursing of Integration of Traditional Chinese and Western Medicine. Methods 30 hospitalized AMI patients were reviewed. Results All the patients finished the rehabilitation program successfully and achieved satisfied outcome, except a patient dropped for severe respiratory failure after respiratory diseases. Conclusion Nursing of Integration of Traditional Chinese and Western Medicine is effective on acute myocardial infarction patients.
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Artigo de revisão, numa perpectiva histórica, de trabalho experimental realizado em cães, em 1962, sobre técnica de reperfusão miocárdica retrógrada pelo seio coronariano. Esta técnica pioneira, apresentada neste artigo como um resgate histórico, representa um legado importante pela atual repercussão internacional da sua utilização no tratamento da doença coronariana com células-tronco.
Paper presenting a historical review of an experimental study conducted with dogs in 1962, exploring a retrograde myocardial retroperfusion technique for the coronary sinus. This pioneering approach is presented in this paper in order to preserve this historic feat,constituting an important legacy due to current international repercussions prompted by its use for treating acute myocardial infarction and stem celltreatment of coronary disease.
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Animals , Dogs , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Reperfusion/veterinary , Risk FactorsABSTRACT
Objetivo: Analisar a tolerância à dor como sintoma prodrômico do infarto do miocárdio na perspectiva dos gêneros masculino e feminino em pacientes que vivenciaram esse evento cardiovascular. Métodos: Estudo exploratório de natureza quanti-qualitativa. Entrevistou-se 43 mulheres e 54 homens em hospital público. Os dados sóciodemográficos foram analisados em percentuais e os qualitativos com base na análise de conteúdo e da categoria gênero. Resultados: A mediana de idade para homens foi 55,3 e mulheres de 61,5 anos. Predominou para os gêneros a baixa escolaridade e inatividade profissional. Os homens tinham renda familiar maior e viviam mais em companhia de alguém. Evidenciou-se que homens e mulheres demonstraram igualmente enfrentamento e resistência à dor, visando manter o controle da própria existência e reproduzindo construções sociais sobre o masculino e o feminino em suas vidas cotidianas. Conclusão: O desafio profissional é atuar no plano simbólico dos gêneros para reduzir o retardo na decisão de buscar atenção médica e possibilitar os benefícios imediatos das terapias de reperfusão coronária.
Purpose: To evaluate pain tolerance as a prodromic symptom in men and women who had a myocardium infarction. Methods: This was a quantitative-qualitative exploratory study with 43 women and 54 men from a public hospital. Demographic data were analyzed with percentages and qualitative data were analyzed with content analysis according to gender. RESULTS: The men's mean age was 55.3 years. The women's mean age was 61.5 years. Both genders had low educational level and professional inactivity. Men lived with a significant other and had higher family income than women. There was no difference regarding pain tolerance between men and women. Both men and women tried to maintain control over their life and to reproduce social constructions in daily life regarding being male and female. Conclusion: Heath care professional actions for the prevention of delaying seeking medical care for coronary perfusion by both male and female is challenging.
Objetivo: Analizar la tolerancia al dolor como síntoma prodrómico del infarto del miocardio en la perspectiva de los géneros masculino y femenino en pacientes que experimentaron ese evento cardiovascular. Métodos: Estudio exploratorio de naturaleza cuantitativa cualitativa. Se entrevistaron 43 mujeres y 54 hombres en un hospital público. Los datos sociodemográficos fueron analizados en porcentajes y los cualitativos con base en el análisis de contenido y de la categoría género. Resultados: El promedio de edad para hombres fue 55,3 y mujeres de 61,5 años. Predominó para los dos géneros la baja escolaridad e inactividad profesional. Los hombres tenían renta familiar mayor y vivían más en compañía de alguien. Se evidenció que los hombres y mujeres demostraron igualmente enfrentamiento y resistencia al dolor, con el objetivo de mantener el control de la propia existencia y reproduciendo construcciones sociales sobre lo masculino y lo femenino en sus vidas cotidianas. Conclusión: El desafío profesional es actuar en el plano simbólico de los géneros para reducir el atraso en la decisión de buscar atención médica y posibilitar los beneficios inmediatos de las terapias de reperfusión coronaria.
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@#ObjectiveTo analyze the death causes of acute myocardium infarction (AMI) and nursing measures.MethodsThe data of 16 AMI patients, 58～87 years old and died in the hospital, were analyzed for factors of direct death causes, inducement, death period.ResultsIn 16 patients, 13 cases died from heart reason, seven patients (43.75%) had inducements, 12 cases died in acute stege.ConclusionThe death cause of AMI is mainly heart reason, and related with basic disease and complication.
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OBJECTIVE: The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. RESULTS: After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). CONCLUSION: Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Contrast Media , Coronary Angiography , Echocardiography , Electrocardiography , Iohexol/analogs & derivatives , Myocardial Infarction/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed/methodsABSTRACT
PURPOSE: To test whether cardiac multidetector CT (MDCT) perfusion imaging can accurately delineate an irreversibly damaged myocardium in animals with an occlusive myocardial infarction. MATERIALS AND METHODS: In 16 rats, the left anterior descending coronary arteries were ligated distal to its first diagonal artery after a thoracotomy. Thirty minutes after the procedure, 16-slice MDCT (Sensation 16, Siemens, Erlangen, Germany) was performed and delayed images were obtained up to 5 minutes after injecting the contrast agent (0.2 mL/100g, 0.5 mL/sec). Ten rats were re-examined one week later. After CT scanning, the rats were sacrificed and their hearts were extirpated for 2,3,5-triphenyltetrazolium chloride (TTC) histochemical staining. The stained slices were compared with the CT images. The CT number (HU) of the infarct and non-infarct areas were estimated from the contrast ratio (CR). RESULTS: The CT attenuation in the infarct area was significantly lower than that in the normal myocardium. Quantitative analysis of the CT attenuation revealed a significant difference in the CR and CT attenuation of the infarct and reference areas (0.48+/-0.12 vs 0.64+/-0.13, p<0.05, 163+/-46 HU vs 216+/-56 HU, p<0.05). However, there were no significant differences in the CT numbers between the infarct and non-infarct areas on the one-week follow-up. CONCLUSION: A perfusion defect on MDCT indicates the myocardial damage in an animal model with occlusive myocardial infarction.
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Animals , Rats , Arteries , Coronary Vessels , Follow-Up Studies , Heart , Models, Animal , Myocardial Infarction , Myocardium , Perfusion Imaging , Perfusion , Thoracotomy , Tomography, X-Ray ComputedABSTRACT
PURPOSE: We wanted to evaluate the findings and diagnostic accuracy of MDCT for diagnosing occlusive acute myocardial infarction in rabbits. MATERIALS AND METHODS: Myocardial infarction was induced in 14 rabbits. MDCT was performed in the early and delay phases at 1 minute and 6 minutes, respectively, after intravenous contrast injection. The rabbits were sacrificed after scanning. The cardiac specimens were sliced and then stained with triphenyltetrazolium chloride (TTC). The agreement in the transmural extent of infarction between the MDCT scans and the TTC-stained specimens were analyzed by using kappa values. RESULTS: Acute myocardial infarction was found in 9 of 14 rabbits on the TTC-stained specimens and MDCT. The infarcted myocardium was demonstrated as a low-attenuation area on the early phase and as a central low-attenuation area with rim-like enhancement along the endocardial and pericardial sides of the myocardial wall on the delay phase. There was excellent agreement in the scores of the transmural extent of myocardial infarction between the TTC-stained specimens and the early phase scan (kappa value = 0.882, p = 0.000), and there was fair to good agreement between the TTC-stained specimens and the delay phase scan (kappa value = 0.439, p = 0.000). Microscopic examination of the cardiac specimens revealed necrosis of myocardial cells in the central portion and granulation tissue along the endocardial and pericardial sides of the necrotic myocardium. CONCLUSION: 16 slice MDCT scan was useful for the diagnosis of acute myocardial infarction. The early phase scan was more accurate than the delay phase scan for evaluating the transmural extent of myocardial infarction. Histopathologic examination suggested that the low-attenuation area on the delay phase might correspond to necrotic myocardium and the enhanced area might correspond to granulation tissue.
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Rabbits , Diagnosis , Granulation Tissue , Infarction , Myocardial Infarction , Myocardium , Necrosis , Tomography, Spiral ComputedABSTRACT
PURPOSE: We wanted to evaluate the findings and diagnostic accuracy of MDCT for diagnosing occlusive acute myocardial infarction in rabbits. MATERIALS AND METHODS: Myocardial infarction was induced in 14 rabbits. MDCT was performed in the early and delay phases at 1 minute and 6 minutes, respectively, after intravenous contrast injection. The rabbits were sacrificed after scanning. The cardiac specimens were sliced and then stained with triphenyltetrazolium chloride (TTC). The agreement in the transmural extent of infarction between the MDCT scans and the TTC-stained specimens were analyzed by using kappa values. RESULTS: Acute myocardial infarction was found in 9 of 14 rabbits on the TTC-stained specimens and MDCT. The infarcted myocardium was demonstrated as a low-attenuation area on the early phase and as a central low-attenuation area with rim-like enhancement along the endocardial and pericardial sides of the myocardial wall on the delay phase. There was excellent agreement in the scores of the transmural extent of myocardial infarction between the TTC-stained specimens and the early phase scan (kappa value = 0.882, p = 0.000), and there was fair to good agreement between the TTC-stained specimens and the delay phase scan (kappa value = 0.439, p = 0.000). Microscopic examination of the cardiac specimens revealed necrosis of myocardial cells in the central portion and granulation tissue along the endocardial and pericardial sides of the necrotic myocardium. CONCLUSION: 16 slice MDCT scan was useful for the diagnosis of acute myocardial infarction. The early phase scan was more accurate than the delay phase scan for evaluating the transmural extent of myocardial infarction. Histopathologic examination suggested that the low-attenuation area on the delay phase might correspond to necrotic myocardium and the enhanced area might correspond to granulation tissue.
Subject(s)
Rabbits , Diagnosis , Granulation Tissue , Infarction , Myocardial Infarction , Myocardium , Necrosis , Tomography, Spiral ComputedABSTRACT
The purpose of this study is to demonstrate whether the signal intensity (SI) of myocardial infarction (MI) on contrast enhanced (CE)-cine MRI is useful for differentiating recently infarcted myocardium from chronic scar. This study included 24 patients with acute MI (36-84 years, mean age: 57) and 19 patients with chronic MI (44-80 years, mean age: 64). The diagnosis of acute MI was based on the presence of typical symptoms, i.e. elevation of the cardiac enzymes and the absence of any remote infarction history. The diagnosis of chronic MI was based on a history of MI or coronary artery disease of more than one month duration and on the absence of any recent MI within the previous six months. Retrospectively, the ECG-gated breath-hold cine imaging was performed in the short axis plane using a segmented, balanced, turbo-field, echo-pulse sequence two minutes after the administration of Gd-DTPA at a dose of 0.2 mmol/kg body weight. Delayed contrast-enhanced MRI (DCE MRI) in the same plane was performed 10 to 15 minutes after contrast administration, and this was served as the gold standard of reference. The SI of the infarcted myocardium on the CE-cine MRI was compared with that of the normal myocardium on the same image. The area of abnormal SI on the CE-cine MRI was compared with the area of hyperenhancement on the DCE MRI. The area of high SI on the CE-cine MRI was detected in 23 of 24 patients with acute MI (10 with homogenous high SI, 13 high SI with subendocardial low SI, and one with iso SI). The area of high SI on the CE-cine MRI was larger than that seen on the DCE MRI (p < 0.05). In contrast, the areas of chronic MI were seen as iso-SI with thin subendocardial low SI on the CE-cine MR in all the chronic MI patients. The presence of high SI on both the CE-cine MRI and the DCE MRI is more sensitive (95.8%) for determining the age of a MI than the presence of myocardial thinning (66.7%). This study showed the different SI patterns between recently infarcted myocardium and chronic scar on the CE-cine MRI. CE-cine MRI is thought to be quite useful for determining the age of myocardial infarction, in addition to its utility for assessing myocardial contractility.
Subject(s)
Middle Aged , Male , Humans , Female , Aged, 80 and over , Aged , Adult , Signal Processing, Computer-Assisted , Retrospective Studies , Myocardium/pathology , Myocardial Infarction/diagnosis , Magnetic Resonance Imaging, Cine , Magnetic Resonance Imaging/methods , Contrast Media , Cicatrix/diagnosisABSTRACT
OBJECTIVE: To evaluate the usefulness of multidetector-row computed tomography (CT) in the evaluation of reperfused myocardial infarction. MATERIALS AND METHODS: Eleven rabbits were subjected to 90-min occlusion of the left anterior descending coronary artery followed by reperfusion. Multidetector-row CT was performed 31 hours+/-21 after the procedure and preand post-contrast multiphase helical CT images were obtained up to 10 min after contrast injection. The animals were sacrificed after 30 days and histochemical staining of the resected specimens was perfomed with 2'3'5-triphenyl tetrazolium chloride (TTC). RESULTS: In all 11 cases, the areas of myocardial infarction demonstrated with TTC-staining were identified on the CT images and the lesions showed hypoenhancement on the early phases up to 62 sec and hyperenhancement on the delayed phases of 5 min and 10 min compared with normal myocardial enhancement. The percentage area of the lesion with respect to the left ventricle wall on CT was significantly correlated with that of the TTC-staining results (p < 0.001 for both early and delayed phase CT) according to the generalized linear model analysis. The areas showing hypoenhancement on early CT were significantly smaller than those with hyperenhancement on delayed CT (p < 0.0001). CONCLUSION: Multidetector-row CT may be useful in the detection and sizing of reperfused myocardial infarction.
Subject(s)
Animals , Rabbits , Feasibility Studies , Models, Animal , Myocardial Infarction/diagnostic imaging , Myocardial Reperfusion Injury/diagnostic imaging , Reproducibility of Results , Tomography, Spiral Computed , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVE: To determine whether the size of a perfusion defect seen at myocardial perfusion MR imaging represents the extent of irreversibly damaged myocardium in acute reperfused myocardial infarction. MATERIALS AND METHODS: In nine cats, reperfused myocardial infarction was induced by occlusion of the left anterior descending coronary artery for 90 minutes and subsequent reperfusion for 90 minutes. At single-slice myocardial perfusion MR imaging at the midventricular level using a turbo-FLASH sequence, 60 short-axis images were sequentially obtained with every heart beat after bolus injection of gadomer-17. The size of the perfusion defect was measured and compared with both the corresponding unstained area seen at triphenyl tetrazolium chloride (TTC) staining and the hyperenhanced area seen at gadophrin-2-enhanced MR imaging performed in the same cat six hours after myocardial perfusion MR imaging. RESULTS: The sizes of perfusion defects seen at gadomer-17-enhanced perfusion MR imaging, unstained areas at TTC staining, and hyperenhanced areas at gadophrin-2-enhanced MR imaging were 20.4+/-4.3%, 29.0+/-9.7%, and 30.7+/-10.6% of the left ventricular myocardium, respectively. The perfusion defects seen at myocardial perfusion MR imaging were significantly smaller than the unstained areas at TTC staining and hyperenhanced areas at gadophrin-2-enhanced MR imaging (p < .01). The sizes of both the perfusion defect at myocardial perfusion MR imaging and the hyperenhanced area at gadophrin-2- enhanced MR imaging correlated well with the sizes of unstained areas at TTC staining (r = .64, p = .062 and r = .70, p = .035, respectively). CONCLUSION: In this cat model, the perfusion defect revealed by myocardial perfusion MR imaging underestimated the true size of acute reperfused myocardial infarction. The defect may represent a more severely damaged area of infarction and probably has prognostic significance.