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Sabatino J, De Rosa S, Leo I, Spaccarotella C, Mongiardo A, Polimeni A, Sorrentino S, Di Salvo G, Indolfi C. Non-invasive myocardial work is reduced during transient acute coronary occlusion. PLoS One 2020; 15:e0244397. [PMID: 33370359 PMCID: PMC7769261 DOI: 10.1371/journal.pone.0244397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background During ischemia a close relationship exists between sub-endocardial blood flow and myocardial function. Strain parameters can capture an impairment of regional longitudinal function but are load dependent. Recently, a novel non-invasive method to calculate Myocardial Work (MW) showed a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW indices to identify the ischaemic risk area during transient acute coronary occlusion (TACO). Methods and results The study population comprises 50 individuals with critical coronary stenosis (CCS). Echocardiography recordings were obtained before coronary angiography, during TACO and after revascularization to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial work efficiency (MWE). Compared to baseline, we found a significant reduction of GLS (p = 0.005), MWI, MCW and MWE (p<0.001) during TACO. Conclusions The non-invasive measurement of MW parameters is a sensitive and early marker of myocardial ischemia during TACO.
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Affiliation(s)
- Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
- * E-mail: (SDR); (CI)
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
- Mediterranea Cardiocentro, Naples (NA), Italy
- * E-mail: (SDR); (CI)
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Spotnitz HM. Ventricular function in surgery for congenital heart disease. World J Surg 2009; 34:669-74. [PMID: 19921328 DOI: 10.1007/s00268-009-0268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The history of measuring myocardial edema by two-dimensional echocardiography and the pathophysiology of myocardial edema are reviewed. METHODS The relevance of this subject to management of children undergoing corrective surgery for single ventricle physiology and tetralogy of Fallot is reviewed. RESULTS Evidence is presented that myocardial edema is an ongoing clinical problem with relevance to management and outcomes. Methods for measuring mass increases noninvasively in the range of 10-25% with increases in myocardial water content on the order of 2-4% are now well established. CONCLUSIONS These methods and advanced animal models replicating conditions of surgery for cyanotic congenital heart disease set the stage for clinical advances in this important area.
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Affiliation(s)
- Henry M Spotnitz
- Department of Surgery, Columbia University Medical Center, Vanderbilt Clinic 1010, 622 W 168th Street, New York, NY 10032, USA.
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Hart JP, Cabreriza SE, Gallup CG, Hsu D, Spotnitzt HM. Validation of left ventricular end-diastolic volume from stroke volume and ejection fraction. ASAIO J 2002; 48:654-7. [PMID: 12455778 DOI: 10.1097/00002480-200211000-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The present study examines an innovative approach to measurement of left ventricular (LV) end-diastolic volume (LVEDV). Measurement of LVEDV is fundamental to the assessment of intraoperative systolic and diastolic LV function. We compared steady state LVEDV values obtained from stroke volume (SV) and ejection fraction (EF) with echocardiographic and postmortem LVEDV measurements. Five anesthetized pigs (40-45 kg) underwent median sternotomy and pericardiotomy. A transit time ultrasonic flow probe was placed on the ascending aorta to provide cardiac output. A micromanometer provided LV end-diastolic pressure. LV short axis cross sectional echocardiograms and electrocardiograms were also obtained. LV end-diastolic area (LVEDA) and end-systolic area (LVESA) were measured to obtain EF. LVEDVsv/ef was calculated from cardiac output, heart rate, and EF. LVEDVecho was determined using a three-plane echocardiography model. Postmortem (LVEDVpm/vv) volumes were also measured. LVEDVsv/ef correlated well with volumes obtained by echocardiography (r2 = 0.92) and postmortem (r2 = 0.73) measurements. Values of p < 0.05 indicated significant linearity of LVEDA-LVEDVsv/ef (r2 =0.93), LVEDA-LVEDVecho (r2 = 0.96), and LVEDA-LVEDVpm/vv (r2 = 0.81) relationships. Determination of LVEDV from SV and EF is valid and may facilitate real-time determination of LV mechanics.
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Affiliation(s)
- Joseph P Hart
- Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
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Gallup CJ, Cabreriza SE, Hart JP, Walsh R, Weinberg A, Spotnitz HM. Left ventricular end-diastolic volume from ejection fraction and stroke volume in pigs during IVC occlusion. J Surg Res 2002; 106:76-81. [PMID: 12127811 DOI: 10.1006/jsre.2002.6432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Real-time measurement of left ventricular end-diastolic volume (LVEDV), combined with left ventricular end-diastolic pressure (LVEDP), would allow continuous measurement of intraoperative diastolic function. In pursuit of this goal, we examined stroke volume divided by ejection fraction for calculation of LVEDV(sv/ef). METHODS Five anesthetized pigs underwent median sternotomy and pericardiotomy. A transit-time ultrasonic flow probe on the ascending aorta provided cardiac output. A micromanometer provided LV end-diastolic pressure. End-diastolic and end-systolic areas were measured from LV short-axis cross sections to obtain ejection fraction. LVEDV(sv/ef) was calculated during IVC occlusion. Steady-state LVEDV(echo) was determined using a three-plane echocardiography model. LVEDV(echo) was used to validate steady-state LVEDA in each experiment. RESULTS Correlation coefficients for linear and pressure-volume relation analyses ranged from 0.46 to 0.99. The two methods for measuring LVEDV generated compliance curves with an overall reliability coefficient of 0.84. CONCLUSIONS The LVEDV(sv/ef) method may facilitate real-time determination of LV compliance.
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Affiliation(s)
- Cecily J Gallup
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
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Spotnitz HM, Cabreriza SE, Hart JP. Intraoperative echocardiography: interpretation of changes in left ventricular wall thickness. Semin Thorac Cardiovasc Surg 1998; 10:273-83. [PMID: 9801248 DOI: 10.1016/s1043-0679(98)70028-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Quantitative two-dimensional echocardiography (Q2-DE) may be used to detect intraoperative changes in left ventricular (LV) mass (M) and wall thickness (h). Potential causes of change in h include physiological redistribution of myocardium, myocardial edema, reactive hyperemia, and intramyocardial hemorrhage. Changes in h, in the absence of changes in LV shape and volume, generally indicate increased LVM. When changes in h are accompanied by changes in shape or volume, changes in LVM can only be detected by mathematical modeling, unless the direction of the observed changes is opposite that expected with physiological redistribution. Histological observations essential to understanding current mathematical models are presented and related to the inherent solid geometry. Technical considerations in determination of LV mass by Q2-DE are discussed. New procedures that alter LV volume and geometry, such as the Batista operation, defy modeling by conventional methods. Modeling techniques that allow an experimental approach to understanding LVM and h under such conditions are presented.
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Affiliation(s)
- H M Spotnitz
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Recovery of postischemic contractile function is depressed by antegrade warm continuous blood cardioplegia. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33845-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Weng ZC, Nicolosi AC, Detwiler PW, Hsu DT, Schierman SW, Goldstein AH, Spotnitz HM. Effects of crystalloid, blood, and University of Wisconsin perfusates on weight, water content, and left ventricular compliance in an edema-prone, isolated porcine heart model. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34992-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Menger MD, Lehr HA, Messmer K. Role of oxygen radicals in the microcirculatory manifestations of postischemic injury. KLINISCHE WOCHENSCHRIFT 1991; 69:1050-5. [PMID: 1665884 DOI: 10.1007/bf01645157] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Reperfusion after transient tissue ischemia constitutes an irrevocable need to preserve tissue viability. However, release of prolonged ischemia will either result in failure of the microcirculation to reperfusion (no-reflow) and thus the prolongation of hypoxia, or in restoration of blood flow resulting in reoxygenation of the inflicted tissue. While ischemia damages the tissue primarily through hypoxia-induced depletion of energy stores, reoxygenation paradoxically contributes to tissue damage through the formation of oxygen radicals, the release of chemoattractant mediators (TNF, IL-1, LTB4), and the activation of circulating polymorphonuclear leukocytes (PMNs). Through the action of chemoattractant mediators and the upregulation of leukocytic (CD11/CD18) and endothelial adhesion receptors (ICAM, GMP-140), activated PMNs adhere to the endothelium, release further chemoattractants and oxygen radicals and undertain a vicious circle, which will ultimately result in further tissue damage. Both the no-reflow phenomenon and the events initiated by reflow--termed herein as the reflow-paradox--contribute to the failure of the nutritive microvascular perfusion and loss of tissue viability following ischemia and reperfusion.
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Affiliation(s)
- M D Menger
- Institut für Chirurgische Forschung, Klinikum Grosshadern, Ludwig-Maximilians-Universität München
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Abstract
Myocardial preservation is an essential aspect of coronary revascularization as well as of other open heart procedures. As these procedures are becoming more complex, specifically myocardial revascularization, impeccable myocardial protection becomes imperative. Described is a technique that enables one to easily accomplish good myocardial preservation with minimal clutter using readily available materials.
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Affiliation(s)
- J R Kauten
- Department of Cardiovascular Surgery, Emory University, Atlanta, Georgia
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Cheung EH, Arcidi JM, Dorsey LM, Vinten-Johansen J, Hatcher CR, Guyton RA. Reperfusion of infarcting myocardium: benefit of surgical reperfusion in a chronic model. Ann Thorac Surg 1989; 48:331-8. [PMID: 2774716 DOI: 10.1016/s0003-4975(10)62851-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Surgical reperfusion of experimental infarction leads to improved recovery of regional function compared with medical reperfusion, but sustained myocardial salvage has not been demonstrated. Twenty-two dogs were subjected to two hours of anterior descending occlusion and divided into three groups: group P (n = 7), no reperfusion; group M (n = 8), medical reperfusion; and group S (n = 7), controlled surgical reperfusion. Ischemia caused systolic bulging (-36% of control systolic shortening, p less than 0.01) and decreased regional work (9% of control pressure-length loop area, p less than 0.05). Thirty minutes after reperfusion group M had persistent systolic bulging (-9% of control systolic shortening) and decreased regional work (9% of control pressure-length loop area), whereas group S had +17% of control systolic shortening and 33% of control pressure-length loop area. After 1 week, regional function improved in all three groups (percent of control systolic shortening: group P, 26%; group M, 19%; group S, 52%), but systolic shortening was significantly better in group S (p less than 0.05 versus group M). Surgical reperfusion also resulted in one half of the eventual myocardial necrosis found in the other groups (group P, 45% of area at risk; group M, 38%; group S, 19%; p less than 0.05, group S versus group P or M). In this model, medical reperfusion offered no demonstrable benefit, whereas controlled surgical reperfusion led to a sustained (1 week) improvement in regional function and significant myocardial salvage.
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Affiliation(s)
- E H Cheung
- Department of Surgery, Carlyle Fraser Heart Center, Crawford Long Hospital, Emory University School of Medicine, Atlanta, Georgia
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