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Printezi MI, Yousif LIE, Kamphuis JAM, van Laake LW, Cramer MJ, Hobbelink MGG, Asselbergs FW, Teske AJ. LVEF by Multigated Acquisition Scan Compared to Other Imaging Modalities in Cardio-Oncology: a Systematic Review. Curr Heart Fail Rep 2022; 19:136-145. [PMID: 35355205 PMCID: PMC9177497 DOI: 10.1007/s11897-022-00544-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose of Review
The prevalence of cancer therapy-related cardiac dysfunction (CTRCD) is increasing due to improved cancer survival. Serial monitoring of cardiac function is essential to detect CTRCD, guiding timely intervention strategies. Multigated radionuclide angiography (MUGA) has been the main screening tool using left ventricular ejection fraction (LVEF) to monitor cardiac dysfunction. However, transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) may be more suitable for serial assessment. We aimed to assess the concordance between different non-radiating imaging modalities with MUGA to determine whether they can be used interchangeably.
Recent Findings
In order to identify relevant studies, a PubMed search was performed. We included cross-sectional studies comparing MUGA LVEF to that of 2D TTE, 3D TTE, and CMR. From 470 articles, 22 were selected, comprising 1017 patients in total. Among others, this included three 3D TTE, seven 2D harmonic TTE + contrast (2DHC), and seven CMR comparisons. The correlations and Bland-Altman limits of agreement varied for CMR but were stronger for 3D TTE and 2DHC.
Summary
Our findings suggest that MUGA and CMR should not be used interchangeably whereas 3D TTE and 2DHC are appropriate alternatives following an initial MUGA scan. We propose a multimodality diagnostic imaging strategy for LVEF monitoring in patients undergoing cancer treatment.
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Affiliation(s)
- Markella I Printezi
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Laura I E Yousif
- Graduate School of Life Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janine A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Linda W van Laake
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Monique G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Xie X, Zhu L, Jie Z, Li Y, Gu M, Zhou X, Wang H, Chang JH, Ko CJ, Cheng X, Sun SC. TRAF2 regulates T cell immunity by maintaining a Tpl2-ERK survival signaling axis in effector and memory CD8 T cells. Cell Mol Immunol 2021; 18:2262-2274. [PMID: 33203937 PMCID: PMC8429472 DOI: 10.1038/s41423-020-00583-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022] Open
Abstract
Generation and maintenance of antigen-specific effector and memory T cells are central events in immune responses against infections. We show that TNF receptor-associated factor 2 (TRAF2) maintains a survival signaling axis in effector and memory CD8 T cells required for immune responses against infections. This signaling axis involves activation of Tpl2 and its downstream kinase ERK by NF-κB-inducing kinase (NIK) and degradation of the proapoptotic factor Bim. NIK mediates Tpl2 activation by stimulating the phosphorylation and degradation of the Tpl2 inhibitor p105. Interestingly, while NIK is required for Tpl2-ERK signaling under normal conditions, uncontrolled NIK activation due to loss of its negative regulator, TRAF2, causes constitutive degradation of p105 and Tpl2, leading to severe defects in ERK activation and effector/memory CD8 T cell survival. Thus, TRAF2 controls a previously unappreciated signaling axis mediating effector/memory CD8 T cell survival and protective immunity.
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Affiliation(s)
- Xiaoping Xie
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Lele Zhu
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Zuliang Jie
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Yanchuan Li
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Meidi Gu
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Xiaofei Zhou
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Hui Wang
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
- Jiangsu Key Laboratory of Immunity and Metabolism, Department of Pathogenic Biology and Immunology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Jae-Hoon Chang
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
- College of Pharmacy, Yeungnam University, Gyeongsan, 712-749, Republic of Korea
| | - Chun-Jung Ko
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Xuhong Cheng
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA
| | - Shao-Cong Sun
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 7455 Fannin Street, Box 902, Houston, TX, 77030, USA.
- MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.
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Tartuce LP, Pacheco Brandt F, Dos Santos Pedroso G, Rezende Farias H, Barros Fernandes B, da Costa Pereira B, Gonçalves Machado A, Feuser PE, Lock Silveira PC, Tiscoski Nesi R, da Silva Paula MM, Andrades M, de Pinho RA. 2-methoxy-isobutyl-isonitrile-conjugated gold nanoparticles improves redox and inflammatory profile in infarcted rats. Colloids Surf B Biointerfaces 2020; 192:111012. [PMID: 32388028 DOI: 10.1016/j.colsurfb.2020.111012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022]
Abstract
The tissue response to acute myocardial infarction (AMI) is key to avoiding heart complications due to inflammation, mitochondrial dysfunction, and oxidative stress. Antioxidant and anti-inflammatory agents can minimize the effects of AMI. This study investigated the role of 2-methoxy-isobutyl-isonitrile (MIBI)-associated gold nanoparticles (AuNP) on reperfusion injury after ischemia and its effect on cardiac remodeling in an experimental AMI model. Three-month-old Wistar rats were subjected to a temporary blockade of the anterior descending artery for 30 min followed by reperfusion after 24 h and 7 days by intraventricularly administering 0.4, 1.3, and 3 mg/kg AuNP-MIBI. The cardiac toxicity and renal and hepatic function levels were determined, and the infarct and peri-infarct regions were surgically removed for histopathology, analysis of inflammation from oxidative stress, and echocardiography. MIBI-conjugated AuNP promoted changes in oxidative stress and inflammation depending on the concentrations used, suggesting promising applicability for therapeutic purposes.
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Affiliation(s)
| | | | - Giulia Dos Santos Pedroso
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Hemelin Rezende Farias
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Bruna Barros Fernandes
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Bárbara da Costa Pereira
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | | | - Paulo Emílio Feuser
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Paulo Cesar Lock Silveira
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Renata Tiscoski Nesi
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Michael Andrades
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Ricardo Aurino de Pinho
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Garadah TS, Jaradat AA, Alalawi ME, Hassan AB. Hormonal and echocardiographic abnormalities in adult patients with sickle-cell anemia in Bahrain. J Blood Med 2016; 7:283-289. [PMID: 28008293 PMCID: PMC5167463 DOI: 10.2147/jbm.s124426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Adrenal, thyroid, and parathyroid gland hormonal changes are recognized in children with homozygous (HbSS) sickle-cell anemia (SCA), but are not clear in adult patients with SCA. AIM To assess the metabolic and endocrine abnormalities in adult patients with SCA and evaluate left ventricular (LV) systolic and diastolic functions compared with patients with no SCA and further study the relationship between serum levels of cortisol, free thyroxine (T4), and testosterone with serum ferritin. MATERIALS AND METHODS The study was conducted on 82 patients with adult HbSS SCA compared with a sex- and age-matched control group. The serum levels of cortisol, parathyroid hormone (PTH), testosterone, thyroid-stimulating hormone (TSH), and free T4 were compared. Blood levels of hemoglobin, reticulocyte count, lactate dehydrogenase (LDH), calcium, alkaline phosphatase (ALP), vitamin D3, and ferritin were also compared. Pulsed Doppler echo was performed to evaluate the LV mass, wall thickness, and cavity dimensions with diastolic filling velocities of early (E) and atria (A) waves. Biometric data were analyzed as mean ± standard deviation between the two groups. Multiple regression analysis was performed between serum levels of ferritin as independent variable and testosterone, cortisol, and thyroid hormones. RESULTS A total of 82 adult patients with HbSS SCA were enrolled who had a mean age of 21±5.7 years, with 51 males (62%). Patients with SCA compared with the control group had significantly lower hemoglobin, body mass index, cortisol, vitamin D3, testosterone, and T4. Furthermore, there were significantly high levels of reticulocyte count, PTH, TSH, ferritin, LDH, ALP, and uric acid. The incidence of subclinical hypothyroidism and adrenal insufficiency was 7% and 4.8%, respectively, with hypogonadism 9.8% and vitamin D3 deficiency 61%. There were inverse relationships between ferritin as independent variable and serum levels of testosterone, T4, and cortisol, with regression coefficients of -0.49 (P<0.001), -0.33 (P<0.001), and -0.11 (P<0.92), respectively. CONCLUSION Patients with adult SCA had a high prevalence of in vivo hypoadrenialism (4.8%), hypogonadism (9.8%), and hypothyroidism (7%). There were significant inverse relationships between serum ferritin as independent variable and cortisol, testosterone, and T4. Pulsed Doppler echocardiography showed increased LV mass, with a restrictive LV diastolic pattern suggestive of diastolic dysfunction.
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Affiliation(s)
- Taysir S Garadah
- Cardiac Unit, Salmaniya Medical Complex, Ministry of Health; Department of Internal Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama
| | - Ahmed A Jaradat
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | | | - Adla B Hassan
- Department of Internal Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama
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Scollan KF, Stieger-Vanegas SM, Sisson DD. Assessment of left ventricular volume and function in healthy dogs by use of one-, two-, and three-dimensional echocardiography versus multidetector computed tomography. Am J Vet Res 2016; 77:1211-1219. [DOI: 10.2460/ajvr.77.11.1211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fracasso R, Baierle M, Goëthel G, Barth A, Freitas F, Nascimento S, Altknecht L, Olsen V, Paese K, da Silva VD, Castro I, Andrades M, Clausell N, Pohlmann A, Guterres S, Garcia SC. Evaluation of potential acute cardiotoxicity of biodegradable nanocapsules in rats by intravenous administration. Toxicol Res (Camb) 2016; 5:168-179. [PMID: 30090335 PMCID: PMC6061661 DOI: 10.1039/c5tx00207a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022] Open
Abstract
Nanotoxicology aims to study the safety of nanomaterials, especially towards human exposure. Biodegradable polymeric nanocapsules have been indicated as potential drug carriers applicable for treating several pathologies. Thus, the objective of this study was to evaluate the potential cardiotoxicity of biodegradable lipid-core nanocapsules (LNC) containing poly(ε-caprolactone). Nanocapsules were characterized and the acute toxicity evaluation was conducted in Wistar rats. Two control groups (saline and tween/glycerol) were utilized, and three treated groups were chosen for low, intermediate and high doses: 28.7 × 1012 (LNC-1), 57.5 × 1012 (LNC-2) and 115 × 1012 (LNC-3), expressed as number of nanocapsules per milliliter per kg. Blood pressure measurements were performed in non-anesthetized animals by caudal plethysmography. The electrocardiographic (ECG) and echocardiographic analyses were carried out after anesthesia by isoflurane at two points, prior to treatment and after 14 days. Blood was collected 24 hours and 14 days after treatment. Biochemical and histopathological analyses were performed. During the evaluation period, no deaths, weight loss or clinical signs were observed. Post-treatment systolic pressures (24 h and 14 days) were significantly increased in comparison to pre-treatment in both control groups and treated groups, which is suggested to be as a possible consequence of the infused volume. Serum sodium, potassium, aspartate aminotransferase and alkaline phosphatase, as well as, hematological parameters were within reference values established for rats. ECG showed no indications of cardiotoxicity. Despite the echocardiograms, no alterations in the ejection fraction were found as indicators of cardiotoxicity. Cardiac histopathology also demonstrated no alterations. Therefore, the present results on acute evaluation after i.v. administration, by slow infusion, showed potential safety since no cardiotoxic effects by ECG, echocardiographic, arterial pressure, biochemical and histopathological analyses were found.
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Affiliation(s)
- Rafael Fracasso
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Marília Baierle
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Gabriela Goëthel
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Anelise Barth
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Fernando Freitas
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
| | - Sabrina Nascimento
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Louise Altknecht
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
| | - Virgilio Olsen
- Division of Cardiology (Cardiolab) , Research Center , Hospital de Clínicas de Porto Alegre. Federal University of Rio Grande do Sul , 90035003 , Porto Alegre , RS , Brazil
| | - Karina Paese
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
- Department of Production and Control of Drugs , Faculty of Pharmacy , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Vinicius Duval da Silva
- Department of Pathology , Catholic University of Rio Grande do Sul , 90619900 , Porto Alegre , RS , Brazil
| | - Iran Castro
- Institute of Cardiology , University Cardiology Foundation , 90620000 , Porto Alegre , Brazil
| | - Michael Andrades
- Division of Cardiology (Cardiolab) , Research Center , Hospital de Clínicas de Porto Alegre. Federal University of Rio Grande do Sul , 90035003 , Porto Alegre , RS , Brazil
| | - Nadine Clausell
- Division of Cardiology (Cardiolab) , Research Center , Hospital de Clínicas de Porto Alegre. Federal University of Rio Grande do Sul , 90035003 , Porto Alegre , RS , Brazil
| | - Adriana Pohlmann
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
- Department of Organic Chemistry , Institute of Chemistry , Federal University of Rio Grande do Sul , 91501970 , Porto Alegre , Brazil
| | - Silvia Guterres
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
- Department of Production and Control of Drugs , Faculty of Pharmacy , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
| | - Solange Cristina Garcia
- Laboratory of Toxicology (LATOX) , Department of Analysis , Pharmacy Faculty , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil .
- Post-graduate Program in Pharmaceutical Sciences (PPGCF) , Federal University of Rio Grande do Sul , 90610000 Porto Alegre , RS , Brazil
- Institute of Cardiology , University Cardiology Foundation , 90620000 , Porto Alegre , Brazil
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N-acetylcysteine Plus Deferoxamine Improves Cardiac Function in Wistar Rats After Non-reperfused Acute Myocardial Infarction. J Cardiovasc Transl Res 2015; 8:328-37. [PMID: 26085187 DOI: 10.1007/s12265-015-9633-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/29/2015] [Indexed: 12/27/2022]
Abstract
The antioxidant N-acetycysteine can turn into a prooxidant molecule in presence of iron ions. Thus, our goal was to test if the association of N-acetylcysteine (NAC) and an iron chelator (deferoxamine--DFX) in a rodent model of acute myocardial infarction (AMI) improves cardiac function. Male Wistar rats were subjected to a SHAM surgery or AMI. The animals were randomized: vehicle, NAC (25 mg/kg for 28 days), DFX (40 mg/kg for 7 days), or NAC plus DFX (NAC plus DFX, respectively). Animals were killed 28 days after the AMI. Animals treated with NAC/DFX showed an increase in left ventricular ejection fraction at 28 days when compared with vehicle group (45.2 ± 10.9 % vs. 34.7 ± 8.7 %, p = 0.03). Antioxidant effect of NAC/DFX treatment decreased 4-hydroxynonenal when compared to AMI group (p = 0.06). In conclusion, we showed beneficial effect of NAC/DFX association in improving left ventricle function in an experimental AMI.
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Fenelon G, Balbão CEB, Fernandes R, Arfelli E, Landim P, Ayres O, Paola AAVD. Characterization of the Acute Cardiac Electrophysiologic Effects of Ethanol in Dogs. Alcohol Clin Exp Res 2007; 31:1574-80. [PMID: 17624995 DOI: 10.1111/j.1530-0277.2007.00451.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol has been related to atrial fibrillation (holiday heart syndrome), but its electrophysiologic actions remain unclear. METHODS We evaluated the effects of alcohol in 23 anesthetized dogs at baseline and after 2 cumulative intravenous doses of ethanol: first dose 1.5 ml/kg (plasma level 200 mg/dl); second dose 1.0 ml/kg (279 mg/dl). In 13 closed-chest dogs (5 with intact autonomic nervous system, 5 under combined autonomic blockade and 3 sham controls), electrophysiologic evaluation and monophasic action potential (MAP) recordings were undertaken in the right atrium and ventricle. In 5 additional dogs, open-chest biatrial epicardial mapping with 8 bipoles on Bachmann's bundle was undertaken. In the remaining 5 dogs, 2D echocardiograms and ultrastructural analysis were performed. RESULTS In closed-chest dogs with intact autonomic nervous system, ethanol had no effects on surface electrocardiogram and intracardiac variables. At a cycle length of 300 milliseconds, no effects were noted on atrial and ventricular refractoriness and on the right atrial MAP. These results were not altered by autonomic blockade. No changes occurred in sham controls. In open-chest dogs, ethanol did not affect inter-atrial conduction time, conduction velocity, and wavelength. Atrial arrhythmias were not induced in any dog, either at baseline or after ethanol. Histological and ultrastructural findings were normal but left ventricular (LV) ejection fraction decreased in treated dogs (77 vs. 73 vs. 66%; p = 0.04). CONCLUSION Ethanol at medium and high doses depresses LV systolic function but has no effects on atrial electrophysiological parameters. These findings suggest that acute alcoholic intoxication does not directly promote atrial arrhythmias.
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Affiliation(s)
- Guilherme Fenelon
- Department of Cardiology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.
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Gudmundsson P, Rydberg E, Winter R, Willenheimer R. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol 2005; 101:209-12. [PMID: 15882665 DOI: 10.1016/j.ijcard.2004.03.027] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Revised: 01/19/2004] [Accepted: 03/01/2004] [Indexed: 12/20/2022]
Abstract
BACKGROUND Simpson ejection fraction, wall motion score index, atrioventricular (AV) plane displacement and fractional shortening are all established formal echocardiographic methods for the assessment of left ventricular systolic function. Visually estimated (eyeballing) ejection fraction may be considered somewhat more subjective, although shown to correlate well with radionuclide ventriculography. We aimed to explore if echocardiographic eyeballing ejection fraction is comparable to formal methods for the evaluation of left ventricular systolic function. METHODS We assessed 89 consecutive patients after myocardial infarction or before coronary angiography. Eyeballing ejection fraction and wall motion score index were evaluated in the long-axis, short-axis and apical four- and two-chamber views. Simpson ejection fraction and AV plane displacement were assessed in the apical views. Fractional shortening was measured in the parasternal long-axis view. The respective systolic function measurements were in each patient made at different time points by a single investigator, masked to prior results. RESULTS All formal methods correlated significantly with eyeballing ejection fraction (p<0.001): AV plane displacement, R=0.647; FS, R=0.684; four-chamber Simpson ejection fraction, R=0.857; biplane Simpson ejection fraction, R=0.898; and wall motion score index, R=0.919. CONCLUSION Eyeballing ejection fraction correlated closely with all formal methods and the correlation coefficient improved with the reliability of the formal method. This finding is in concordance with prior studies, indicating that eyeballing ejection fraction may be the most accurate echocardiographic method for the assessment of left ventricular systolic function. Since it is readily and quickly performed, eyeballing ejection fraction could be used for routine echocardiography instead of formal methods.
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Affiliation(s)
- Petri Gudmundsson
- Department of Cardiology, Malmö University Hospital, Lund University, Sweden.
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Abstract
The mechanisms behind the reduction in cardiovascular morbidity and mortality in postmenopausal women receiving hormone replacement therapy are not fully understood. In this case-control study, we report a statistically significant lower left ventricular mass in a group of elderly women who were receiving hormone replacement therapy for >10 years than in age-matched controls.
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Affiliation(s)
- W K Lim
- Department of Geriatrics, Prince of Wales Hospital, and the Menopause Centre, University of New South Wales, Sydney, Australia
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Zarauza J, Ares M, Vílchez FG, Hernando JP, Gutiérrez B, Figueroa A, Vázquez de Prada JA, Durán RM. An integrated approach to the quantification of aortic regurgitation by Doppler echocardiography. Am Heart J 1998; 136:1030-41. [PMID: 9842017 DOI: 10.1016/s0002-8703(98)70160-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although different Doppler methods have been proposed for the quantification of aortic regurgitation, no study has prospectively compared these methods with each other and their correlation with angiography. The aim of this study was to prospectively analyze the usefulness of different Doppler echocardiography parameters by testing all such parameters in each patient. METHODS Fifty-one patients with aortic regurgitation underwent 2-dimensional and Doppler echocardiographic studies and catheterization. The following Doppler indexes were analyzed and compared with aortography. Color Doppler: (1) jet color height/left ventricular outflow tract height in parasternal long-axis view, and (2) jet color area/left ventricular outflow tract area in short-axis view. Continuous Doppler: (3) regurgitant flow pressure half-time, (4) regurgitant flow time velocity integral (in centimeters), and (5) regurgitant flow time velocity integral (in centimeters)/diastolic period (in milliseconds). Pulsed Doppler in thoracic and abdominal aorta: (6) time velocity integral of diastolic reverse flow (in centimeters), (7) time velocity integral of systolic anterograde flow/integral of diastolic reverse flow, (8) (time velocity integral of diastolic reverse flow/diastolic period) x 100, and (9) diastolic reverse flow duration/diastolic period (as a percentage). We compared these parameters with severity of regurgitation measured by angiography and classified as mild, moderate, or severe. RESULTS The most useful parameters were (1) jet color height/left ventricular outflow tract height (correctly classified 42 of 49 patients), (2) (time velocity integral of diastolic reverse flow/diastolic period) x 100 in the thoracic aorta (correctly classified 41 of 46 patients), and (3) (time velocity integral of diastolic reverse flow/diastolic period) x 100 in the abdominal aorta (correctly classified 42 of 49 patients). Sequential integration of these 3 parameters correctly classified 96% of patients (44 of 46 patients) and was achieved in 90% of cases. CONCLUSION An integrated combination of several Doppler parameters can quickly and accurately classify the degree of aortic regurgitation as determined by angiography.
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Affiliation(s)
- J Zarauza
- Servicio de Cardiología y Hemodinámica, Hospital Universitario Marqués de Valdecilla, Cantabaria, Spain
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12
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Lauer MS, Evans JC, Levy D. Prognostic implications of subclinical left ventricular dilatation and systolic dysfunction in men free of overt cardiovascular disease (the Framingham Heart Study). Am J Cardiol 1992; 70:1180-4. [PMID: 1414943 DOI: 10.1016/0002-9149(92)90052-z] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To determine the prognostic significance of asymptomatic left ventricular (LV) dilatation and LV systolic dysfunction, 1,493 men who were free of symptomatic cardiovascular disease underwent M-mode echocardiography and were then followed for a mean of 4.15 years. At baseline examination, 170 men (11.4%) had an abnormally high end-diastolic LV internal dimension (> or = 56 mm) and 76 (5.1%) had an abnormally low fractional shortening (< or = 30%). During the follow-up period, 68 men experienced 92 cardiovascular disease events. After adjusting for age and traditional cardiovascular disease risk factors in proportional-hazards analyses, fractional shortening was a significant independent predictor of cardiovascular risk (relative risk [RR] = 1.42, 95% confidence interval [CI] 1.12 to 1.81, for decrease of fractional shortening by 4%). Increased risk was also associated with combinations of low fractional shortening and high end-diastolic internal dimension (RR = 3.77, 95% CI 1.59 to 8.93) and with low percent fractional shortening with LV hypertrophy (RR = 5.93, 95% CI 1.97 to 17.85). In conclusion, subclinical LV dilatation and LV systolic dysfunction, although uncommon in men free of overt cardiovascular disease, are associated with increased risk for new cardiovascular disease events.
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Affiliation(s)
- M S Lauer
- Cardiovascular Division, Charles A. Dana Research Institute, Boston, Massachusetts
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13
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Nishimura RA, Vonk GD, Rumberger JA, Tajik AJ. Semiquantitation of aortic regurgitation by different Doppler echocardiographic techniques and comparison with ultrafast computed tomography. Am Heart J 1992; 124:995-1001. [PMID: 1529911 DOI: 10.1016/0002-8703(92)90983-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fourteen patients with chronic aortic regurgitation were studied by several two-dimensional and Doppler echocardiographic methods to determine the severity of aortic regurgitation. Semiquantitation of aortic regurgitation was performed by various color-flow imaging measurements, diastolic half-time of the continuous-wave regurgitation jet, and pulsed-wave velocity curve in the descending aorta. These measurements were compared with regurgitant volume and fraction by ultrafast computed tomography. All Doppler methods demonstrated a significant correlation for severity of aortic regurgitation with regurgitant fraction by ultrafast computed tomographic scanning, but scatter was present with each method. The methods with the closest correlation were at the lowest level of obtainable results. In clinical practice, all Doppler methods must be used to determine the severity of aortic regurgitation.
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Affiliation(s)
- R A Nishimura
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
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14
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Lauer MS, Anderson KM, Levy D. Separate and joint influences of obesity and mild hypertension on left ventricular mass and geometry: the Framingham Heart Study. J Am Coll Cardiol 1992; 19:130-4. [PMID: 1729324 DOI: 10.1016/0735-1097(92)90063-s] [Citation(s) in RCA: 132] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Increased left ventricular mass has been shown to be a significant independent predictor of cardiovascular risk. The purpose of this study was to assess the separate and combined relations of obesity and hypertension with left ventricular mass and geometry. Echocardiographic findings in subjects in the Framingham Heart Study who were free of cardiopulmonary disease and were not taking cardiovascular medications were examined. M-mode studies that were adequate for estimating left ventricular mass were available in 624 men and 1,209 women. Height and weight measured at the time of echocardiography were used to calculate body mass index (in kg/m2), a measure of obesity. Casual sitting blood pressure measurements were obtained to detect rest hypertension. In subgroup analyses of lean normotensive, obese normotensive, lean hypertensive and obese hypertensive subjects, hypertension and obesity each had significant independent associations with left ventricular mass and wall thickness (all p less than 0.001 in men and women). Obesity was also associated with left ventricular internal diameter (p less than 0.001 in men and women). There were no synergistic influences of hypertension and obesity on any echocardiographic left ventricular variables. It is concluded that obesity and hypertension each have distinct associations with left ventricular mass and geometry. These strengths of association are additive but not synergistic.
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Affiliation(s)
- M S Lauer
- Charles A. Dana Research Institute, Boston, Massachusetts
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15
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Scognamiglio R, Fasoli G, Ponchia A, Dalla-Volta S. Long-term nifedipine unloading therapy in asymptomatic patients with chronic severe aortic regurgitation. J Am Coll Cardiol 1990; 16:424-9. [PMID: 2197314 DOI: 10.1016/0735-1097(90)90596-h] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vasodilating agents acutely reduce regurgitant volume and improve left ventricular performance in aortic regurgitation, but more information is necessary about their long-term efficacy. To evaluate the effects of 12 months of therapy with nifedipine, a randomized, double-blind, placebo-controlled trial was performed in 72 asymptomatic patients with severe aortic regurgitation. At 12 months, patients receiving nifedipine had a significant reduction in left ventricular end-diastolic volume index (110 +/- 19 versus 136 +/- 22 ml/m2, p less than 0.01) and mass (115 +/- 19 versus 142 +/- 16 g/m2, p less than 0.01) measured by two-dimensional echocardiography. They also had a reduction in left ventricular mean wall stress (360 +/- 27 versus 479 +/- 36 kdyne/cm2, p less than 0.001) and an increase in ejection fraction (72 +/- 8% versus 60 +/- 6%, p less than 0.05). These data show that the long-term unloading action of nifedipine is able to reverse left ventricular dilation and hypertrophy and suggest that such therapy has the potential to delay the need for valve replacement in asymptomatic patients.
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Affiliation(s)
- R Scognamiglio
- Department of Cardiology, Medical School, University of Padua, Italy
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16
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Albin G, Rahko PS. Comparison of echocardiographic quantitation of left ventricular ejection fraction to radionuclide angiography in patients with regional wall motion abnormalities. Am J Cardiol 1990; 65:1031-2. [PMID: 2327339 DOI: 10.1016/0002-9149(90)91009-u] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G Albin
- Department of Medicine, University of Wisconsin Medical School, Madison 53792
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17
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D'Cruz IA, Shroff SG, Janicki JS, Jain A, Reddy HK, Lakier JB. Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle. J Am Soc Echocardiogr 1989; 2:408-14. [PMID: 2534049 DOI: 10.1016/s0894-7317(89)80042-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A transformation from the normal elliptical shape of the left ventricle that may accompany various disease states and that may be indicative of myocardial remodeling, has not been completely addressed in part because of the need for a descriptor of shape that is independent of chamber size. Accordingly, the goal of this study was twofold: to derive dimensionless echocardiographic descriptors of left ventricle chamber shape that are independent of chamber volume and to use these descriptors to quantitatively compare the shape of left ventricles that were either of normal size (81 +/- 17 ml, 19 patients) or were enlarged secondary to idiopathic cardiomyopathy (194 +/- 61 ml, 46 patients) or chronic aortic or mitral valve incompetence (196 +/- 67 ml, 14 patients). Two-dimensional and M-mode determined descriptors of left ventricle shape based on its width, length, and area were found to be independent of left ventricle volume. These descriptors were significantly greater in cardiomyopathy compared with the normal or dilated left ventricle secondary to valvular incompetence, indicating that the left ventricle had become nearly spherical. A spherical shape of the left ventricle was not observed with valvular incompetence. The ability to classify a patient as having either a normal or a cardiomyopathic left ventricle by discriminant function analysis was enhanced when both left ventricle size and shape were considered. In a prospective study using discriminant function and fractional shortening, we found that patients with valvular incompetence could be classified as having either a normal discriminant function and fractional shortening, an abnormal discriminant function and normal fractional shortening, or an abnormal discriminant function and fractional shortening.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- I A D'Cruz
- Cardiovascular Research Institute, Michael Reese Hospital, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60616
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18
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Crawford MH, Wilson RS, O'Rourke RA, Vittitoe JA. Effect of digoxin and vasodilators on left ventricular function in aortic regurgitation. Int J Cardiol 1989; 23:385-93. [PMID: 2737781 DOI: 10.1016/0167-5273(89)90199-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In order to assess the relative value of digoxin, nifedipine and hydralazine on left ventricular performance at rest and during exercise, we studied 10 men with moderately severe chronic aortic regurgitation using two-dimensional echocardiography. Digoxin after one month at therapeutic serum levels increased resting ejection fraction as compared to control [0.54 +/- 0.08 (SD) vs 0.47 +/- 0.08, respectively, P less than 0.03]. Ejection fraction decreased during exercise but the difference between digoxin and control was maintained. Stroke volume also was higher on digoxin than control at rest (93 +/- 15 vs 83 +/- 17 ml, P less than 0.02) and the larger stroke volume on digoxin was maintained during exercise. By contrast, stroke volume was reduced by one month of therapy with maximally tolerated nifedipine doses compared to control (74 +/- 8 vs 83 +/- 17 ml, P = 0.03) and this difference was maintained during exercise. Hydralazine in doses up to 225 mg/day for one month produced no significant changes in left ventricular performance compared to control at rest or during exercise. However, compared to digoxin ejection fraction at peak exercise was significantly less on hydralazine (0.39 +/- 0.9 vs 0.52 +/- 10, P less than 0.02). These data suggest that digoxin improved left ventricular performance and may be of benefit in the treatment of patients with chronic aortic regurgitation.
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Affiliation(s)
- M H Crawford
- Dept. of Medicine/Cardiology, University of Texas Health Science Center, San Antonio 78284-7872
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19
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Vandenbossche JL, Massie BM, Schiller NB, Karliner JS. Relation of left ventricular shape to volume and mass in patients with minimally symptomatic chronic aortic regurgitation. Am Heart J 1988; 116:1022-7. [PMID: 2972178 DOI: 10.1016/0002-8703(88)90154-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In 19 male patients with significant but minimally symptomatic or asymptomatic chronic aortic regurgitation, measurements of left ventricular shape, volume, and mass were assessed by cross-sectional echocardiography. End-diastolic volume and mass were significantly larger than normal values. There was a significant negative correlation between the volume-to-mass ratio (V/M) and both the end-diastolic (r = -0.70, p less than 0.01) and end-systolic (r = -0.73, p less than 0.001) long axis-to-minor diameter ratios (L/D), suggesting that maintenance of the normal geometry of the left ventricle is in part dependent on the adequacy of hypertrophy, as expressed by a normal V/M. Since preoperative volume-to-mass indices have been shown to be important predictors of postoperative course, the L/D ratio should be a useful and simple parameter to follow in asymptomatic patients.
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Affiliation(s)
- J L Vandenbossche
- Department of Medicine, Veterans Administration Medical Center, San Francisco, CA 94121
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20
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Greenberg B, Massie B, Bristow JD, Cheitlin M, Siemienczuk D, Topic N, Wilson RA, Szlachcic J, Thomas D. Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial. Circulation 1988; 78:92-103. [PMID: 3289791 DOI: 10.1161/01.cir.78.1.92] [Citation(s) in RCA: 106] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although vasodilator drugs acutely reduce regurgitation and improve cardiac performance in aortic insufficiency, their long-term effects on left ventricular size and function are uncertain. Consequently, we performed a double-blinded, placebo-controlled trial using hydralazine in 80 minimally symptomatic patients who had clinically stable, moderate-to-severe aortic insufficiency. Patients randomized to hydralazine displayed a progressive reduction in left ventricular end-diastolic volume index (LVEDVI) measured by radionuclide angiography, the predetermined end point of the study. At 24 months, mean LVEDVI had been reduced by 30 +/- 38 ml/m2, an 18% reduction from baseline. In contrast, LVEDVI changed minimally in patients randomized to placebo, and the intergroup differences over time were statistically significant (p less than 0.03). The hydralazine group also experienced reductions in left ventricular end-systolic volume index and increases in ejection fraction that were significantly different (both p less than 0.01) from changes in placebo-treated patients. These findings show that long-term treatment with hydralazine reduces the volume overload in aortic insufficiency and suggest that such therapy may have a beneficial effect on the natural history of the disease.
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Affiliation(s)
- B Greenberg
- Department of Medicine, Oregon Health Sciences University, Portland 97201
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21
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Jaffe CC, Wohlgelernter D, Cabin H, Bowman L, Deckelbaum L, Remetz M, Cleman M. Preservation of left ventricular ejection fraction during percutaneous transluminal coronary angioplasty by distal transcatheter coronary perfusion of oxygenated Fluosol DA 20%. Am Heart J 1988; 115:1156-64. [PMID: 2967624 DOI: 10.1016/0002-8703(88)90002-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The cardioprotective efficacy of coronary perfusion during angioplasty was evaluated. Forty-two patients underwent transcatheter infusion of oxygenated Fluosol DA, 20% emulsion (FDA-20), a perfluorocarbon oxygen transport fluid, into the distal coronary artery during balloon inflations. Left ventricular function was continuously monitored by two-dimensional echocardiography, and left ventricular ejection fraction was quantitatively analyzed from the video record by an area-length method with a validated computer algorithm. Each patient had multiple nonperfused and perfused balloon inflations lasting more than 45 seconds. Nineteen of the 42 patients also received control solutions of oxygenated Ringer's lactate and nonoxygenated FDA-20. The ejection fraction of nonperfused sequences fell from a baseline value of 57 +/- 15% to 36 +/- 14% at 45 seconds of inflation time (p less than 0.0005). Falls of similar magnitude were seen in the lactated Ringer's and nonoxygenated FDA-20 perfused balloon inflations. The ejection fraction fall was associated with a 54% rise in end-systolic volume (p less than 0.0005) and a 4% rise in end-diastolic volume (p = ns) compared to baseline. Inflations perfused with oxygenated FDA-20 showed a 45-second, left ventricular ejection fraction of 53 +/- 13% (p = ns compared to baseline), which was significantly greater (p less than 0.0001) than the 45-second ejection fraction of the nonperfused, or control solution perfused sequences. Results indicate that the profound fall in ejection fraction occurring during percutaneous transluminal coronary angioplasty can be ameliorated by distal coronary perfusion with an oxygenated perfluorocarbon emulsion.
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Affiliation(s)
- C C Jaffe
- Department of Medicine (Cardiology), Yale University School of Medicine, New Haven, CT 06510
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22
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Kass DA, Traill TA, Keating M, Altieri PI, Maughan WL. Abnormalities of dynamic ventricular shape change in patients with aortic and mitral valvular regurgitation: assessment by Fourier shape analysis and global geometric indexes. Circ Res 1988; 62:127-38. [PMID: 3335054 DOI: 10.1161/01.res.62.1.127] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The normal cardiac cycle is associated with dynamic changes in left ventricular shape, which can be disturbed in disease states. To assess the influences of diastolic volume, percent ejected volume, and abnormalities of acute or chronic systolic loading on general and detailed chamber geometry, we studied dynamic shape change recorded by x-ray contrast ventriculography in both normal patients and those with aortic (AR) or mitral (MR) valve regurgitation. While both lesions increased diastolic volume, the character of load throughout ejection differed markedly. Detailed cavity geometry was assessed by a Fourier analysis technique and general shape by eccentricity and circularity indexes. Normal hearts, showed increased systolic elongation by all indexes. AR patients displayed a similar rise in eccentricity during ejection; however, the extent of shape change when measured by Fourier and circular indexes was reduced. In contrast, MR patients displayed enhanced systolic shape change, particularly in chamber elongation. Neither simple eccentricity of circular indexes adequately differentiated these shape abnormalities, whereas detailed Fourier geometric analysis precisely characterized the abnormalities of shape change in these two diseases. Relations between the extent of shape change and ejected volume for each patient group revealed significantly more systolic deformation with a different shape versus volume relation for the MR hearts as compared with AR and controls. Thus, while dynamic left ventricular shape is certainly influenced by the extent of volume change, it also varies independently from volume related to the specific nature of loading during ejection.
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Affiliation(s)
- D A Kass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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