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Objective: To evaluate the relationship between the brain glucose metabolism and left ventricular function parameters, and to explore the cerebral glucose metabolism reduction regions in patients with ischemic heart disease (IHD). Methods: A total of 110 consecutive IHD patients who underwent gated (99)Tc(m)-sestamibi (MIBI) SPECT/CT myocardial perfusion imaging, gated (18)F-fluorodeoxyglucose (FDG) PET/CT myocardial and brain glucose metabolic imaging within three days in Beijing Anzhen Hospital from April 2016 to October 2017, were enrolled in this study. Left ventricular functional parameters of SPECT/CT and PET/CT including end-diastolic volume (EDV), end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) were analyzed by QGS software. Viable myocardium and myocardial infarction region were determined by 17-segment and 5 score system, and the ratio of viable myocardium and scar myocardium was calculated. According to the range of viable myocardium, the patients were divided into viable myocardium<10% group (n=44), viable myocardium 10%-<20% group (n=36) and viable myocardium≥20% group (n=30). Pearson correlation analysis was used to analyze the correlation between the range of viable myocardium and scar myocardium and the level of cerebral glucose metabolism. Brain glucose metabolism determined by the mean of standardized uptake value (SUV(mean)) was analyzed by SPM. The ratio of SUV(mean) in whole brain and SUV(mean) in cerebellum were calculated, namely taget/background ratio (TBR). Differences in cerebral glucose metabolism among various groups were analyzed by SPM. Results: There were 101 males, and age was (57±10) years in this cohort. The extent of viable myocardium and the extent of scar, LVEF evaluated by SPECT/CT and PET/CT were significantly correlated with TBR (r=0.280, r=-0.329, r=0.188, r=0.215 respectively,all P<0.05). TBR value was significantly lower in viable myocardium<10% group, compared with viable myocardium 10%-<20% group (1.25±0.97 vs. 1.32±0.17, P<0.05) and viable myocardium≥20% group (1.25±0.97 vs. 1.34±0.16, P<0.05). Furthermore, in comparison with viable myocardium≥20% group, the hypo-metabolic regions of viable myocardium<10% group were located in the precuneus, frontal lobe, postcentral gyrus, parietal lobe, temporal lobe, and so on. Conclusions: There is a correlation between impaired left ventricular function and brain glucose metabolism in IHD patients. In IHD patients with low myocardial viability, the level of glucose metabolism in the whole brain is decreased, especially in the brain functional areas related to cognitive function.
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Aged , Humans , Male , Middle Aged , Brain , Fluorodeoxyglucose F18 , Glucose , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Stroke Volume , Tomography, Emission-Computed, Single-Photon , Ventricular Function, LeftABSTRACT
Objective@#To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis.@*Methods@#The agent was a biotinylated, fluorescent-labelled, lipid-coated, liquid perfluorocarbon emulsion. Physico-chemical properties of the agent were measured, including size distribution, Zeta Potential, concentration and so on. Ischemia-reperfusion models were created in rats, and then exposed to biotinylated anti-MCP-1 monoclonal antibody, rhodamine avidin and biotinylated, FITC-labelled nanoparticles, respectively. Echocardiography was taken before and after injection. Frozen sections of their hearts were observed under fluorescence microscope.@*Results@#The particle diameter, zeta potential and concentration of lipid nanoparticles were (172.30±52.06)nm, (-33.10±6.50)mV and (2.28±0.46)×1011/ml, respectively. From the short-axis view, the myocardium under endocardium of anterior wall was enhanced obviously. While myocardium of other walls were still. The lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope, while neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium.@*Conclusions@#The viable myocardium can be targeted and acoustically enhanced by the self-made nano-scale ultrasound contrast agent. This new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium.
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Objective To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis . Methods T he agent was a biotinylated ,fluorescent‐labelled ,lipid‐coated , liquid perfluorocarbon emulsion . Physico‐chemical properties of the agent were measured ,including size distribution ,Zeta Potential ,concentration and so on . Ischemia‐reperfusion models were created in rats ,and then exposed to biotinylated anti‐MCP‐1 monoclonal antibody ,rhodamine avidin and biotinylated ,FITC‐labelled nanoparticles ,respectively . Echocardiography was taken before and after injection . Frozen sections of their hearts were observed under fluorescence microscope . Results T he particle diameter ,zeta potential and concentration of lipid nanoparticles were ( 172 .30 ± 52 .06) nm ,( －33 .10 ± 6 .50) mV and ( 2 .28 ± 0 .46 ) × 1011/ml ,respectively . From the short‐axis view ,the myocardium under endocardium of anterior wall was enhanced obviously . While myocardium of other walls were still . T he lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope ,w hile neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium . Conclusions The viable myocardium can be targeted and acoustically enhanced by the self‐made nano‐scale ultrasound contrast agent . T his new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium .
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To evaluate the changes of myocardial viability and systolic function in rabbits with different ischemic periods by layer‐specific strain of ultrasound speckled tracking imaging ( ST I) and low dose dobutamine stress echocardiography ( LDDSE ) . Methods T hirty‐six rabbits were randomly divided into 3 groups( n ＝12) : ①myocardial infarction group Ⅰ :coronary artery occlusion for 45 min ; ②myocardial infarction group Ⅱ :coronary artery occlusion for 60 min ; ③ myocardial infarction group Ⅲ :coronary artery occlusion for 90 min . Echocardiography examinations were performed at baseline ,after ligation and low dose dobutamine stress . After the experiment ,rabbits were killed and the hearts were taken to assess viable or nonviable mycardium , triphenyl tetrazolium chloride and Evans blue staining were applied . Results ①After coronary artery ligation ,left ventricular ejection fraction( LVEF) decreased in 3 groups ( all P ＜ 0 .05 ) , the ventricular global endocardial longitudinal strain ( GSLsys‐endo ) , global myocardial longitudinal strain( GSLsys‐mid) ,and global epicardial longitudinal strain( GSLsys‐epi) decreased in 3 groups ( all P ＜ 0 .05 ) ,the longitudinal strain of endocardium ( SLsys‐endo ) ,longitudinal strain of myocardium ( SLsys‐mid) ,longitudinal strain of epicardium ( SLsys‐epi) decreased in viable myocardial ( all P＜0 .05) ; ②While low dose dobutamine stressing ,the GSLsys and SLsys increased in each groups ,and the GSLsys‐endo ,GSLsys‐mid ,GSLsys‐epi and SLsys‐endo of viable segments in each group were increased ( P＜0 .05) ; ③After ligation and low dose dobutamine stress ,the GSLsys in endocardium in three groups were different( P ＜0 .05) ,and the SLsys in endocardium of viable segments in three groups were different ( P＜0 .05) . Conclusions Layer‐specific strain of STI combined with LDDSE can accurately evaluate the changes of myocardial viability and systolic function in different ischemic periods ,and the longitudinal strain of endocardium is more sensitive ;moreover ,with the increase of coronary artery occlusion time ,the infarcted myocardium increases ,myocardial viability and systolic function decrease .
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Objective To investigate the relationship of wall motion abnormality and myocardium viability with chronic total occlusion (CTO) lesions by cardiac magnetic resonance (CMR) imaging. Methods We identified 128 patients with CTO lesion of at least one coronary artery confirmed by coronary arteriography at Beijing Anzhen Hospital between December 2014 to November 2017. All of the patients received CMR examination after admission. We analyzed the CMR images according to the AHA/American College of Cardiology 17-segment model, and recorded the left ventricular ejection fraction (LVEF), end-systolic volume (ESV) and end-distolic volume (EDV) calculated by CMR. Results In the myocardium regions corresponding to the 149 CTO lesions, only 11.5％ presented transmural myocardial infarction. A 58.6％ of the myocardial segments showed no delayed enhancement. Patients with delayed enhancement degree over 75％ had the lowest LVEF and the largest EDV and ESV. Conclusion CMR showed that patients with CTO lesions had different degrees of myocardial infarction. Patients with transmural myocardial infarction had significant cardiac function decline and ventricular remodeling. Only a fraction of patients had transmural infarction, suggesting that a majority of the CTO patients would benefit from treatment.
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HM(hibernating myocardium)is an adaptive phenome-non of myocardium against sustained ischemia,which maintains its tissue vitality through balancing energy supply and demand.It widely exists in patients suffering from coronary heart disease. HMhas its own metabolic pattern,instead of regular FAO(fatty acid β-oxidation)-based metabolism,glycolysis became main pro-cedure.Reduction of FAO,TCA (tricarboxylic cacidcycle),ETC (electron transport chain)enzyme has been observed,ROS(reac-tive oxygen species)and UCP2(uncoupling protein 2)have been up-regulated.UCP2,which promotes proton leak across innermembrane of mitochondrial and leads to ATP reduction,has e-merged as an important regulator of the energy production.It is regulated by up-stream proteins such as AMPK,PPARs,PGC-1α,and other factors like FFA(free fat acid),ROS and purine nucleotide.HM has potential function of ischemic myocardium, which can improve cardiac function through reasonable interven-tion.Modulation of UCP2 can optimize energy production,and is essential to HM metabolism.
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Objective: To compare the sensitivity and specificity between low dose dobutamine stress speckling tracking echocardiography (LDDS-STE) and delayed enhancement MRI (DE-MRI) for assessing viable myocardium (VM) in patients with old myocardial infarction (OMI). Methods: A total of 30 in-hospitalized OMI patients were enrolled, all patients received cardiac MRI and LDDS-STE prior percutaneous coronary intervention (PCI). Radial peak systolic strain (RS) and strain rate (RSr) were analyzed by LDDS-STE at both resting and loading conditions, echocardiography was performed at 1, 3 and 6 months after PCI to observe the cardiac wall motion changes and the improvement of wall motion score was taken as golden standard of VM. Results: 510 left ventricular segments were obtained for analysis in 30 patients and echocardiography indicated 201 segments with abnormal wall motion. Compared with golden standard, the area under ROC curve of RSrest for detecting VM was 0.636 with the sensitivity at 60.0% , specificity at 60.5% and the area under ROC curve of RSLDDS for detecting VM was 0.806 with the sensitivity at 79.1%, specificity at 82.7%; the area under ROC curve of RSrrest for detecting VM was 0.646 with the sensitivity at 60.0% , specificity at 60.5% and the area under ROC curve of RSrLDDS for detecting VM was 0.808 with the sensitivity at 80.0%, specificity at 83.7% which were obviously improved than RSrrest . By DE-MRI, the area under ROC curve for detecting VM was 0.901 with the sensitivity at 90.8%, specificity at 87.1% and accuracy at 89.5%. Conclusion: Both DE-MRI and LDDS-STE can recognize VM in OMI patients; while DE-MRI had the better accuracy and repeatability, cost less time which may provide important basis for predicting the efficacy of PCI and for making the treatment strategy.
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Objective To assess the clinical value of dobutamine 201Tl stress-redistribution/nitroglycerin augmented ~(99m)Tc-metho~(99m)Tc-xyisobutylisonitrile (MIBI) gated myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD). Methods A total of 132 patients with suspected CAD underwent dobutamine 201Tl stress-redistribution/nitroglycerin augmented MIBI gated MPI and coronary arteriography (CAG) within two weeks after MPI. Percutaneous coronary interventions (PCI) were performed in 23 patients with myocardial infraction. The regional wall movement was assessed with echocardiography before and within three months after PCI. Results Taking stenosis ≥50% as standard of CAD, the sensitivity, specificity and accuracy of dual-isotopic SPECT imaging in diagnosing CAD was 93.41%, 87.80% and 91.67%, respectively. The sensitivity, specificity and accuracy in diagnosing left anterior descending artery (LAD) stenosis was 93.85%, 91.04% and 92.42%, for left circumflex artery (LCX) was 86.79%, 89.87% and 88.64%, while for right coronary artery (RCA) was 81.25%, 82.14% and 81.82%, respectively. Of all 207 myocardium segments in 23 patients with myocardial infarction, radioactivity defect was found in 113 segments on the redistributed ~(201)Tl images, and radiofilling was found in 52 (52/113) segments on the nitroglycerin augmented ~(99m)Tc-MIBI images, whereas 61 segments had no radiofilling. Taking regional wall movement improvement as the criterion of viable myocardium, the sensitivity, specificity and accuracy of identifying viable myocardium with nitroglycerin augmented ~(99m)Tc-MIBI imaging was 87.23%, 83.33% and 84.96%. Conclusion Dobutamine ~(201)Tl stress-redistribution/nitroglycerin augmented ~(99m)Tc-MIBI gated MPI is able to effectively detect CAD and viable myocardium and helpful in diagnosis and treatment of CAD.
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BACKGROUND: Coronary flow reserve (CFR) was defined as the ability to increase coronary blood flow maximally in response to demand. The presence of viable myocardium in an infarcted zone indicates the presence of an intact microvasculature. We hypothesized that coronary flow reserve, which assesses the microcirculation, might be associated with the presence of viable myocardium. METHODS: Thirty seven patients with acute anterior myocardial infarction (mean age 55+/-10, 25 males) were enrolled and abnormal 127 segments were analyzed. Dobutamine stress echocard-iography (5 to 20 g/kg/min) was performed before coronary angiography (6+/-3 days after acute myocardial infarction (AMI)). Coronary flow reserve in infarct-related artery was measured at distal site to lesion immediately after successful angioplasty (7+/-2 days after AMI, with residual stenosis less than 20%) by using intracoronary Doppler flow wire. And follow-up 2-dimentional transthoracic echocardiography was performed in 26 patients during 333+/-161 (range of 109-780) days after acute myocardial infarction. Improvement of wall motion at least one segment by one more grade in dobutamine stress echocardiography was defined as contractile reserve. Viable myocardium was defined as the improvement of wall motion in transthoracic echocardiography during follow-up periods. RESULTS: In 26 patients, viable myocardium was detected in 19 patients (73%) and their mean CFR was 1.74+/-0.42, which was significantly increased than 1.16+/-0.14 of CFR of patients without viable myocardium (p<0.001). The agreement of CFR score and presence of viable myocardium in AMI was excellent when CFR was above 1.3 (Area under the curve was 0.906 in receiver operating characteristic (ROC) curve). Sensitivity and specificity to detect viable myocardium in CFR more than 1.3 were 84% & 85% respectively. CONCLUSION: CFR was increased in patients with viable myocardium, and the cut-off value of CFR more than 1.3 was agreed excellently to detect viable myocardium.
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Humans , Angioplasty , Arteries , Constriction, Pathologic , Coronary Angiography , Dobutamine , Echocardiography , Echocardiography, Stress , Follow-Up Studies , Microcirculation , Microvessels , Myocardial Infarction , Myocardium , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND AND OBJECTIVES: Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of acute myocardial infarction (AMI). The aim of this study was to assess the ability of dobutamine echocardiography (DE) to detect viable myocardium and predict the late improvement of regional left ventricular dysfunction after AMI. METHODS: Twenty-five patients (male 24, mean age 57+/-9.6) with AMI underwent DE (dobutamine: 0, 5, 10 and 20 microgramm/kg/min) in 4.8+/-2.2 days after infarction. Revascularization of infarct related artery was performed in 20 patients (percutaneous coronary angioplasty 18, coronary artery bypass graft surgery 2). A follow-up 2D-echocardiography was performed at 7.1+/-2.3 months after AMI. RESULTS: 1. Improvement of regional wall motion abnormality (RWMA) was observed in 12 patients during DE[DE (+) group]. Thirteen patients showed no improvement of RWMA[DE (-) group]. 2. In follow-up 2D-echocardiography 10 patients showed improvement of RWMA among DE (+) group (positive predictive value= 83.3%). Two patients showed improvement of RWMA among DE (-) group (negative predictive value=84.6%). Sensitivity and specificity of DE in predictiong late recovery of RWMA were 83.3% and 84.6% each. DE performed in the early stage of AMI seems to be useful in prediction of late recovery of regional left ventricular dysfunction.
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Humans , Angioplasty , Arteries , Coronary Artery Bypass , Dobutamine , Echocardiography , Follow-Up Studies , Infarction , Myocardial Infarction , Myocardium , Sensitivity and Specificity , Transplants , Ventricular Dysfunction, LeftABSTRACT
Objective To observe the effect of Isoket on standard dobutamine stress echocardiography(DSE).Methods Thirty-seven patients were divided into three groups according to the results of quantitative coronary angiography(QCA):the control group(CON) including 12 patiens,the coronary artery disease group 1(CAD1) including 15 patients,and the coronary artery disease group 2(CAD2) including 10 patients.Among the three group,the DSE+Isoket was done in CAD2,while the standard DSE was done in the other two groups.The improvement of segments of left ventricular after percutaneous transluminal intervention(PCI) was looked as the standard evaluating DSE.Results Isoket could increase heart rate and decrease systolic blood pressure,but could hardly affect diastolic blood pressure.The rate of biphysic response was 62.5% in group CAD1,and the sensitivity of detecting viable myocardium was 61%,while the specificity was 76%.In group CAD2,the rate of biaphysic response was 72.2% ,and the sensitivity of detecting viable myocardium was 82%,while the specificity was 88%.The rate detecting viable myocardium and sensitivity was improved significantly in group CAD2.Conclusions DSE combined with Isoket was beneficial for detecting viable myocardium.
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Objective To assess the time course of functional recovery after coronary intervention in patients with myocardial infarction. Methods 30 patients with myocardial infarction (left ventricular ejection fraction, LVEF
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ObjectiveTo discuss the myocardial integrated backscatter (IB) characterization in old myocardial infarction (OMI) patients during the low dose dobutamine stress echocardiography (DSE). Methods Twenty eight OMI patients underwent 4 stages low dose DSE (0, 5, 10 and 20 ?g?kg -1 ?min -1 dobutamine infusion).The cardiac variation of IB (CVIB) and calibrated CVIB (CVIB%) were measured according to different segments (anterior septum, anterior wall, inferior wall and post wall of left ventricle) in different stages.ResultsIn the viable segments (Group C), CVIB and CVIB% increased from low level in early stage (5～10 ?g?kg -1 ?min -1 ) then maintaining in high level to the endpoint (20 ?g?kg -1 ?min -1 ), while maintained high level in control segments (Group A). Both CVIB and CVIB% were lower in non viable segments(Group D) than in Group A without changing during all stages. ConclusionsThe indexes of IB under dobutamine infusion were valuable for the quantitative evaluating the contractility of myocardium in OMI patients, especially for the viable myocardium.
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BACKGROUND: It was known that conventional stress-redistribution imaging was not adequate for detection of severely ischemic but viable myocardium. Albeit the gold criteria of viable myocardium is the presence of metabolism which can be detected by PET, reinjection technique was reported to be able to identify most, if not all, of viable myocardium. Because reinjection imaging is performed immediately after redistribution imaging, an additional redistribution could be happened if we follow the patient longer. To prove the guess authors performed an additional delayed imaging 24 hours after reinjection of 201T1. METHODS: Subject patients were 20 ischemic heart disease patients who showed irreversible perfusion defect(s) on standard pharmacologic(dipyridamole) stress-redistribution images. Immediately after the redistribution images were obtained, 37 MBq thallium was injected at rest, and images were reacquired at 10 minutes and 24 hours after reinjection. Four sets of images(stress, redistribution, reinjection and delayed images) were then analyzed qualitatively and quantitatively. Left ventricle was arbitrarily divided into 9 segments(apex, proximal and distal portions of anterior, septal, inferior and lateral walls). RESULTS: These were 45 irreversible perfusion defects in 20 subject patients, of which 21(46.7%) showed improved thallium uptake after reinjection. Among these 21 segments 2 demonstrated further improvement of uptake on 24-hour delayed images, of the 24 regions determined to have persistent defects after reinjection. 10(41.7%) showed improved uptake on delayed images. CONCLUSIONS: In addition to reinjection imaging, 24-hour delayed imaging after reinjection was also helpful to identify severely ischemic but viable myocardium.