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Demirkiran A, van der Geest RJ, Hopman LHGA, Robbers LFHJ, Handoko ML, Nijveldt R, Greenwood JP, Plein S, Garg P. Association of left ventricular flow energetics with remodeling after myocardial infarction: New hemodynamic insights for left ventricular remodeling. Int J Cardiol 2022; 367:105-114. [PMID: 36007668 DOI: 10.1016/j.ijcard.2022.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial infarction leads to complex changes in left ventricular (LV) hemodynamics. It remains unknown how four-dimensional acute changes in LV-cavity blood flow kinetic energy affects LV-remodeling. METHODS AND RESULTS In total, 69 revascularised ST-segment elevation myocardial infarction (STEMI) patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart four-dimensional flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction, mitral inflow, and blood flow KEi (kinetic energy indexed to end-diastolic volume) characteristics were obtained. Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume of at least 10%, 15%, and 20%. Twenty-four patients (35%) developed at least 10%, 17 patients (25%) at least 15%, 11 patients (16%) at least 20% LV-remodeling. Demographics and clinical history were comparable between patients with/without LV-remodeling. In univariable regression-analysis, A-wave KEi was associated with at least 10%, 15%, and 20% LV-remodeling (p = 0.03, p = 0.02, p = 0.02, respectively), whereas infarct size only with at least 10% LV-remodeling (p = 0.02). In multivariable regression-analysis, A-wave KEi was identified as an independent marker for at least 10%, 15%, and 20% LV-remodeling (p = 0.09, p < 0.01, p < 0.01, respectively), yet infarct size only for at least 10% LV-remodeling (p = 0.03). CONCLUSION In patients with STEMI, LV hemodynamic assessment by LV blood flow kinetic energetics demonstrates a significant inverse association with adverse LV-remodeling. Late-diastolic LV blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Pankaj Garg
- Department of Cardiology, Norfolk Medical School, University of East Anglia, Norwich, United Kingdom.
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2
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Yılmaz MF, Karagöz A, Zeren G, Avcı İI, Timur B, Sungur MA, Kalkan S, Şimşek B, Can F, Acar E, Tanboğa İH, Karabay CY. Relationship between in-hospital mortality and creatinine/albumin in patients with ST-elevation myocardial infarction without standard modifiable risk factors. Biomark Med 2022; 16:1043-1053. [PMID: 36062571 DOI: 10.2217/bmm-2022-0241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Diabetes, hypertension, hyperlipidemia and smoking are associated with coronary artery disease and ST-elevation myocardial infarction (STEMI). However, patients without any classic risk factors have a higher mortality rate in the post-STEMI period. The aim of this study was to investigate the relationship between in-hospital mortality and creatinine/albumin ratio in patients with STEMI without modifiable risk factors. Materials & methods: All patients included in this study with a diagnosis of STEMI and who underwent primary percutaneous intervention between 2016 and 2020 were retrospectively analyzed. Patients were included in the standard modifiable cardiovascular risk factor (SMuRF) group if at least diabetes, hypertension, smoking or hyperlipidemia was present according to risk factors. Patients without these risk factors were considered the non-SMuRF group. Results: Creatinine/albumin ratio was found to be higher in non-SMuRF patients with mortality (p < 0.001). In multivariate logistic regression analysis, ejection fraction, hemoglobin and SMuRF were found to be inversely associated with in-hospital mortality (odds ratio [OR]: 0.48, 95% CI: 0.35-0.66, p < 0.001; OR: 0.70, 95% CI: 0.56-0.88, p = 0.002; OR: 0.57, 95% CI: 0.34-0.95, p = 0.03, respectively). Conclusion: The creatinine/albumin ratio can be used as a predictor of mortality in these patients; it can help identify high-risk patients beforehand.
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Affiliation(s)
- Mehmet F Yılmaz
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, 34865, Turkey
| | - Gönül Zeren
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - İlhan I Avcı
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - Barış Timur
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - Mustafa A Sungur
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - Sedat Kalkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, 34865, Turkey
| | - Barış Şimşek
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - Fatma Can
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
| | - Emrah Acar
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, 34865, Turkey
| | - İbrahim H Tanboğa
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, 34768, Turkey.,Department of Cardiology, School of Health Science, Nisantası University, İstanbul, 34398, Turkey
| | - Can Y Karabay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, 34668, Turkey
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Bogush N, Tan L, Naqvi E, Calvert JW, Graham RM, Taylor WR, Naqvi N, Husain A. Remuscularization with triiodothyronine and β 1-blocker therapy reverses post-ischemic left ventricular dysfunction and adverse remodeling. Sci Rep 2022; 12:8852. [PMID: 35614155 PMCID: PMC9132945 DOI: 10.1038/s41598-022-12723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022] Open
Abstract
Renewal of the myocardium by preexisting cardiomyocytes is a powerful strategy for restoring the architecture and function of hearts injured by myocardial infarction. To advance this strategy, we show that combining two clinically approved drugs, but neither alone, muscularizes the heart through cardiomyocyte proliferation. Specifically, in adult murine cardiomyocytes, metoprolol, a cardioselective β1-adrenergic receptor blocker, when given with triiodothyronine (T3, a thyroid hormone) accentuates the ability of T3 to stimulate ERK1/2 phosphorylation and proliferative signaling by inhibiting expression of the nuclear phospho-ERK1/2-specific phosphatase, dual-specificity phosphatase-5. While short-duration metoprolol plus T3 therapy generates new heart muscle in healthy mice, in mice with myocardial infarction-induced left ventricular dysfunction and pathological remodeling, it remuscularizes the heart, restores contractile function and reverses chamber dilatation; outcomes that are enduring. If the beneficial effects of metoprolol plus T3 are replicated in humans, this therapeutic strategy has the potential to definitively address ischemic heart failure.
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Affiliation(s)
- Nikolay Bogush
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 3311 WMRB, 323 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Lin Tan
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 3311 WMRB, 323 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Emmen Naqvi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 3311 WMRB, 323 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA
| | - John W Calvert
- Department of Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, Sydney, NSW, 2010, Australia
| | - W Robert Taylor
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 3311 WMRB, 323 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA
- Cardiology Division, Atlanta Veterans Affairs Medical Center, Decatur, GA, 30033, USA
- Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Nawazish Naqvi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 3311 WMRB, 323 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - Ahsan Husain
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 3311 WMRB, 323 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA.
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Ozel R, Ozer PK, Serbest NG, Atıcı A, Onur I, Bugra Z. Prior angina reduces ıschemic mitral regurgitation in patients with ST-Elevation myocardial ınfarction, role of ıschemic preconditioning. Int J Cardiovasc Imaging 2021; 37:2465-2472. [PMID: 33813680 DOI: 10.1007/s10554-021-02229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
Mitral regurgitation may develop due to left ventricular (LV) remodeling within 3 months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR). Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3rd month in patients with ST elevation MI (STEMI). Fourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According to presence of prior angina within 72 h before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at 1st, 3rd days and 3rd month. IMR was evaluated by proximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson's method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups. Although PISA-r, EROA and Rvol were similar in both groups at 1st and 3rd days, all were significantly decreased (p = 0.012, p = 0.007, p = 0.011, respectively) and EF was significantly increased (p< 0 .001) in angina (+) group at 3rd month. NTpro-BNP and hs-TnT levels at 1st day and 3rd month were similar, however CK-MB level at 3rd month was found to be significantly lower in the angina (+) group (p = 0.034). At the end of the 3rd month, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72 h prior to STEMI, suggesting a relation with IPC.
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Affiliation(s)
- Ramime Ozel
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey.
| | - Nail Guven Serbest
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Adem Atıcı
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Imran Onur
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Zehra Bugra
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
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5
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Obata JE, Horikoshi T, Nakamura T, Kugiyama K. Sustained endothelial dysfunction in the infarct-related coronary artery is associated with left ventricular adverse remodeling in survivors of ST-segment elevation myocardial infarction. J Cardiol 2019; 75:261-269. [PMID: 31447080 DOI: 10.1016/j.jjcc.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ischemia-reperfusion causes endothelial injury and dysfunction in the infarct-related coronary artery (IRA). Using serial assessment of coronary endothelial vasomotor function and left ventriculography (LVG), this study prospectively investigated the clinical impact of endothelial vasomotor dysfunction in the patent IRA on left ventricular (LV) remodeling in survivors of ST-elevation myocardial infarction (STEMI). METHODS This study included 78 patients with STEMI due to occlusion of the left anterior descending coronary artery (LAD) and successful reperfusion therapy with percutaneous coronary intervention. All of them had LV ejection fraction (LVEF) <55%. LVG and the vasomotor responses to acetylcholine (ACh) in the LAD were examined within 2 weeks (1st test) and 6 months (2nd test) after MI. Cut-off values for coronary vasomotor dysfunction in response to ACh were based on the lower 10% of the distribution of coronary vasomotor responses to ACh in 20 control subjects. RESULTS LV adverse remodeling, defined as a >10% increase in either LV end-diastolic volume index (LVEDVI) and/or end-systolic volume index (LVESVI) from the 1st to the 2nd test, occurred in 21 (70%) of 30 patients with sustained impairment of the coronary flow response to ACh at both the 1st and 2nd tests and 14 (29%) of 48 in the other coronary flow response group (p < 0.01). In multivariate logistic regression analysis, a >10% increase in LVEDVI and LVESVI was respectively associated with sustained impairment of the coronary diameter and flow responses to ACh (OR 4.9 and 3.5, 95% CI 1.7-14.1 and 1.1-10.9, p < 0.01 and p = 0.03, respectively), that was independent of hypertension, peak creatine phosphokinase, and the baseline coronary flow response to ACh at the 1st test. CONCLUSIONS Sustained endothelial vasomotor dysfunction in the IRA was associated with LV adverse remodeling in STEMI survivors with successful reperfusion therapy.
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Affiliation(s)
- Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
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6
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Gsell MAF, Augustin CM, Prassl AJ, Karabelas E, Fernandes JF, Kelm M, Goubergrits L, Kuehne T, Plank G. Assessment of wall stresses and mechanical heart power in the left ventricle: Finite element modeling versus Laplace analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3147. [PMID: 30151998 PMCID: PMC6492182 DOI: 10.1002/cnm.3147] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/19/2018] [Accepted: 08/14/2018] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Stenotic aortic valve disease (AS) causes pressure overload of the left ventricle (LV) that may trigger adverse remodeling and precipitate progression towards heart failure (HF). As myocardial energetics can be impaired during AS, LV wall stresses and biomechanical power provide a complementary view of LV performance that may aide in better assessing the state of disease. OBJECTIVES Using a high-resolution electro-mechanical (EM) in silico model of the LV as a reference, we evaluated clinically feasible Laplace-based methods for assessing global LV wall stresses and biomechanical power. METHODS We used N = 4 in silico finite element (FE) EM models of LV and aorta of patients suffering from AS. All models were personalized with clinical data under pretreatment conditions. Left ventricle wall stresses and biomechanical power were computed accurately from FE kinematic data and compared with Laplace-based estimation methods, which were applied to the same FE model data. RESULTS AND CONCLUSION Laplace estimates of LV wall stress are able to provide a rough approximation of global mean stress in the circumferential-longitudinal plane of the LV. However, according to FE results, spatial heterogeneity of stresses in the LV wall is significant, leading to major discrepancies between local stresses and global mean stress. Assessment of mechanical power with Laplace methods is feasible, but these are inferior in accuracy compared with FE models. The accurate assessment of stress and power density distribution in the LV wall is only feasible based on patient-specific FE modeling.
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Affiliation(s)
| | - Christoph M. Augustin
- Institute of BiophysicsMedical University of GrazGrazAustria
- Department of Mechanical EngineeringUniversity of CaliforniaBerkleyCalifornia
| | - Anton J. Prassl
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - Elias Karabelas
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - Joao F. Fernandes
- Institute for Cardiovascular Computer‐assisted MedicineCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Marcus Kelm
- Institute for Cardiovascular Computer‐assisted MedicineCharité ‐ Universitätsmedizin BerlinBerlinGermany
- Department of Congenital Heart Disease/Pediatric CardiologyGerman Heart Institute BerlinBerlinGermany
| | - Leonid Goubergrits
- Institute for Cardiovascular Computer‐assisted MedicineCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Titus Kuehne
- Institute for Cardiovascular Computer‐assisted MedicineCharité ‐ Universitätsmedizin BerlinBerlinGermany
- Department of Congenital Heart Disease/Pediatric CardiologyGerman Heart Institute BerlinBerlinGermany
| | - Gernot Plank
- Institute of BiophysicsMedical University of GrazGrazAustria
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7
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Garg P, Crandon S, Swoboda PP, Fent GJ, Foley JRJ, Chew PG, Brown LAE, Vijayan S, Hassell MECJ, Nijveldt R, Bissell M, Elbaz MSM, Al-Mohammad A, Westenberg JJM, Greenwood JP, van der Geest RJ, Plein S, Dall’Armellina E. Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:61. [PMID: 30165869 PMCID: PMC6117925 DOI: 10.1186/s12968-018-0483-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics that are linked to clinical outcomes. We hypothesize that LV blood flow kinetic energy (KE) is altered in MI and is associated with LV function and infarct characteristics. This study aimed to investigate the intra-cavity LV blood flow KE in controls and MI patients, using cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow assessment. METHODS Forty-eight patients with MI (acute-22; chronic-26) and 20 age/gender-matched healthy controls underwent CMR which included cines and whole-heart 4D flow. Patients also received late gadolinium enhancement imaging for infarct assessment. LV blood flow KE parameters were indexed to LV end-diastolic volume and include: averaged LV, minimal, systolic, diastolic, peak E-wave and peak A-wave KEiEDV. In addition, we investigated the in-plane proportion of LV KE (%) and the time difference (TD) to peak E-wave KE propagation from base to mid-ventricle was computed. Association of LV blood flow KE parameters to LV function and infarct size were investigated in all groups. RESULTS LV KEiEDV was higher in controls than in MI patients (8.5 ± 3 μJ/ml versus 6.5 ± 3 μJ/ml, P = 0.02). Additionally, systolic, minimal and diastolic peak E-wave KEiEDV were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEiEDV (Beta = - 0.24, P < 0.01) demonstrated the strongest association with the presence of MI. In multiple-regression analysis, infarct size was most strongly associated with in-plane KE (r = 0.5, Beta = 1.1, P < 0.01). In patients with preserved LV ejection fraction (EF), minimal and in-plane KEiEDV were reduced (P < 0.05) and time difference to peak E-wave KE propagation during diastole increased (P < 0.05) when compared to controls with normal EF. CONCLUSIONS Reduction in LV systolic function results in reduction in systolic flow KEiEDV. Infarct size is independently associated with the proportion of in-plane LV KE. Degree of LV impairment is associated with TD of peak E-wave KE. In patient with preserved EF post MI, LV blood flow KE mapping demonstrated significant changes in the in-plane KE, the minimal KEiEDV and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.
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Affiliation(s)
- Pankaj Garg
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Saul Crandon
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - James R. J. Foley
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Pei G. Chew
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Louise A. E. Brown
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Sethumadhavan Vijayan
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Mariëlla E. C. J. Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Malenka Bissell
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Mohammed S. M. Elbaz
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Erica Dall’Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
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Sack KL, Davies NH, Guccione JM, Franz T. Personalised computational cardiology: Patient-specific modelling in cardiac mechanics and biomaterial injection therapies for myocardial infarction. Heart Fail Rev 2018; 21:815-826. [PMID: 26833320 PMCID: PMC4969231 DOI: 10.1007/s10741-016-9528-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Predictive computational modelling in biomedical research offers the potential to integrate diverse data, uncover biological mechanisms that are not easily accessible through experimental methods and expose gaps in knowledge requiring further research. Recent developments in computing and diagnostic technologies have initiated the advancement of computational models in terms of complexity and specificity. Consequently, computational modelling can increasingly be utilised as enabling and complementing modality in the clinic—with medical decisions and interventions being personalised. Myocardial infarction and heart failure are amongst the leading causes of death globally despite optimal modern treatment. The development of novel MI therapies is challenging and may be greatly facilitated through predictive modelling. Here, we review the advances in patient-specific modelling of cardiac mechanics, distinguishing specificity in cardiac geometry, myofibre architecture and mechanical tissue properties. Thereafter, the focus narrows to the mechanics of the infarcted heart and treatment of myocardial infarction with particular attention on intramyocardial biomaterial delivery.
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Affiliation(s)
- Kevin L Sack
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Private Bag X3, 7935, Observatory, South Africa
| | - Neil H Davies
- Cardiovascular Research Unit, MRC IUCHRU, Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Observatory, South Africa
| | - Julius M Guccione
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Thomas Franz
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Private Bag X3, 7935, Observatory, South Africa.
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9
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Short term doxycycline treatment induces sustained improvement in myocardial infarction border zone contractility. PLoS One 2018; 13:e0192720. [PMID: 29432443 PMCID: PMC5809072 DOI: 10.1371/journal.pone.0192720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/29/2018] [Indexed: 11/22/2022] Open
Abstract
Decreased contractility in the non-ischemic border zone surrounding a MI is in part due to degradation of cardiomyocyte sarcomeric components by intracellular matrix metalloproteinase-2 (MMP-2). We recently reported that MMP-2 levels were increased in the border zone after a MI and that treatment with doxycycline for two weeks after MI was associated with normalization of MMP-2 levels and improvement in ex-vivo contractile protein developed force in the myocardial border zone. The purpose of the current study was to determine if there is a sustained effect of short term treatment with doxycycline (Dox) on border zone function in a large animal model of antero-apical myocardial infarction (MI). Antero-apical MI was created in 14 sheep. Seven sheep received doxycycline 0.8 mg/kg/hr IV for two weeks. Cardiac MRI was performed two weeks before, and then two and six weeks after MI. Two sheep died prior to MRI at six weeks from surgical/anesthesia-related causes. The remaining 12 sheep completed the protocol. Doxycycline induced a sustained reduction in intracellular MMP-2 by Western blot (3649±643 MI+Dox vs 9236±114 MI relative intensity; p = 0.0009), an improvement in ex-vivo contractility (65.3±2.0 MI+Dox vs 39.7±0.8 MI mN/mm2; p<0.0001) and an increase in ventricular wall thickness at end-systole 1.0 cm from the infarct edge (12.4±0.6 MI+Dox vs 10.0±0.5 MI mm; p = 0.0095). Administration of doxycycline for a limited two week period is associated with a sustained improvement in ex-vivo contractility and an increase in wall thickness at end-systole in the border zone six weeks after MI. These findings were associated with a reduction in intracellular MMP-2 activity.
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10
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D'Elia N, D'hooge J, Marwick TH. Association Between Myocardial Mechanics and Ischemic LV Remodeling. JACC Cardiovasc Imaging 2016; 8:1430-1443. [PMID: 26699112 DOI: 10.1016/j.jcmg.2015.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/30/2015] [Accepted: 10/08/2015] [Indexed: 12/12/2022]
Abstract
The outcomes associated with heart failure after myocardial infarction are still poor. Both global and regional left ventricular (LV) remodeling are associated with the progression of the post-infarct patient to heart failure, but although global remodeling can be accurately measured, regional LV remodeling has been more difficult to investigate. Preliminary evidence suggests that post-MI assessment of LV mechanics using stress and strain may predict global (and possibly regional) LV remodeling. A method of predicting both global and regional LV remodeling might facilitate earlier, targeted, and more extensive clinical intervention in those most likely to benefit from novel interventions such as cell therapy.
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Affiliation(s)
- Nicholas D'Elia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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11
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Morgan AE, Pantoja JL, Grossi EA, Ge L, Weinsaft JW, Ratcliffe MB. Neochord placement versus triangular resection in mitral valve repair: A finite element model. J Surg Res 2016; 206:98-105. [PMID: 27916382 DOI: 10.1016/j.jss.2016.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/23/2016] [Accepted: 07/07/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recurrent mitral regurgitation after mitral valve repair is common, occurring in nearly 50% of patients within 10 years of surgery. Durability of repair is partly related to stress distribution over the mitral leaflets. We hypothesized that repair with neochords (NCs) results in lower stress than leaflet resection (LR). MATERIALS AND METHODS Magnetic resonance imaging and 3D echocardiography were performed before surgical repair of P2 prolapse in a single patient. A finite element model of the left ventricle and mitral valve was created previously, and the modeling program LS-DYNA was used to calculate leaflet stress for the following repairs: Triangular LR; LR with ring annuloplasty (LR + RA); One NC; Two NCs; and 2NC + RA. RESULTS (1) NC placement resulted in stable posterior leaflet stress: Baseline versus 2 NC at end diastole (ED), 12.1 versus 12.0 kPa, at end systole (ES) 20.3 versus 21.7 kPa. (2) In contrast, LR increased posterior leaflet stress: Baseline versus LR at ED 12.1 versus 40.8 kPa, at ES 20.3 versus 46.1 kPa. (3) All repair types reduced anterior leaflet stress: Baseline versus 2 NC versus LR 34.2 versus 25.8 versus 20.6 kPa at ED and 80.8 versus 76.8 versus 67.8 kPa at ES. (4) The addition of RA reduced leaflet stress relative to repair without RA. CONCLUSIONS Neochord repair restored normal leaflet coaptation without creating excessive leaflet stress, whereas leaflet resection more than doubled stress across the posterior leaflet. The excess stress created by leaflet resection was partially, but not completely, mitigated by ring annuloplasty.
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Affiliation(s)
- Ashley E Morgan
- East Bay Surgical Residency, University of California, San Francisco, California
| | - Joe L Pantoja
- College of Medicine, University of California, San Francisco, California
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University, New York, New York; Department of Cardiothoracic Surgery, New York Harbor Veterans Affairs Medical Center, New York, New York
| | - Liang Ge
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Department of Surgery, Veterans Affairs Medical Center, San Francisco, California
| | - Jonathan W Weinsaft
- Department of Medicine (Cardiology), Weill Cornell Medical College, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Mark B Ratcliffe
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Department of Surgery, Veterans Affairs Medical Center, San Francisco, California.
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12
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Daskalopoulos EP, Vilaeti AD, Barka E, Mantzouratou P, Kouroupis D, Kontonika M, Tourmousoglou C, Papalois A, Pantos C, Blankesteijn WM, Agathopoulos S, Kolettis TM. Attenuation of post-infarction remodeling in rats by sustained myocardial growth hormone administration. Growth Factors 2015; 33:250-8. [PMID: 26290214 DOI: 10.3109/08977194.2015.1072527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Prevention of left ventricular remodeling is an important therapeutic target post-myocardial infarction. Experimentally, treatment with growth hormone (GH) is beneficial, but sustained local administration has not been thoroughly investigated. We studied 58 rats (322 ± 4 g). GH was administered via a biomaterial-scaffold, following in vitro and in vivo evaluation of degradation and drug-release curves. Treatment consisted of intra-myocardial injection of saline or alginate-hydrogel, with or without GH, 10 min after permanent coronary artery ligation. Echocardiographic and histologic remodeling-indices were examined 3 weeks post-ligation, followed by immunohistochemical evaluation of angiogenesis, collagen, macrophages and myofibroblasts. GH-release completed at 3 days and alginate-degradation at ∼7 days. Alginate + GH consistently improved left ventricular end-diastolic and end-systolic diameters, ventricular sphericity, wall tension index and infarct-thickness. Microvascular-density and myofibroblast-count in the infarct and peri-infarct areas were higher after alginate + GH. Macrophage-count and collagen-content did not differ between groups. Early, sustained GH-administration enhances angiogenesis and myofibroblast-activation and ameliorates post-infarction remodeling.
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Affiliation(s)
- Evangelos P Daskalopoulos
- a Department of Pharmacology , Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht , The Netherlands
- b Cardiovascular Research Institute , Ioannina , Athens , Greece
| | - Agapi D Vilaeti
- b Cardiovascular Research Institute , Ioannina , Athens , Greece
| | - Eleonora Barka
- b Cardiovascular Research Institute , Ioannina , Athens , Greece
- c Ceramics and Composites Laboratory, Department of Materials Science and Engineering, University of Ioannina , Ioannina , Greece
| | - Polixeni Mantzouratou
- d Department of Pharmacology , Medical School, University of Athens , Athens , Greece
| | - Dimitrios Kouroupis
- e Department of Biomedical Research, Foundation for Research and Technology-Hellas , Institute of Molecular Biology and Biotechnology , Ioannina , Greece , and
| | | | | | - Apostolos Papalois
- b Cardiovascular Research Institute , Ioannina , Athens , Greece
- f Experimental Research Center ELPEN , Pikermi , Athens , Greece
| | - Constantinos Pantos
- d Department of Pharmacology , Medical School, University of Athens , Athens , Greece
| | - W Matthijs Blankesteijn
- a Department of Pharmacology , Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht , The Netherlands
| | - Simeon Agathopoulos
- c Ceramics and Composites Laboratory, Department of Materials Science and Engineering, University of Ioannina , Ioannina , Greece
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13
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Lee LC, Wenk JF, Zhong L, Klepach D, Zhang Z, Ge L, Ratcliffe MB, Zohdi TI, Hsu E, Navia JL, Kassab GS, Guccione JM. Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function. J Appl Physiol (1985) 2013; 115:136-44. [PMID: 23640586 DOI: 10.1152/japplphysiol.00662.2012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial (20) for the neutral outcome, that "the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility."
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Affiliation(s)
- Lik Chuan Lee
- Department of Surgery, University of California, San Francisco, California, USA
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14
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Lee LC, Zhihong Z, Hinson A, Guccione JM. Reduction in left ventricular wall stress and improvement in function in failing hearts using Algisyl-LVR. J Vis Exp 2013. [PMID: 23608998 PMCID: PMC3653384 DOI: 10.3791/50096] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Injection of Algisyl-LVR, a treatment under clinical development, is intended to treat patients with dilated cardiomyopathy. This treatment was recently used for the first time in patients who had symptomatic heart failure. In all patients, cardiac function of the left ventricle (LV) improved significantly, as manifested by consistent reduction of the LV volume and wall stress. Here we describe this novel treatment procedure and the methods used to quantify its effects on LV wall stress and function. Algisyl-LVR is a biopolymer gel consisting of Na(+)-Alginate and Ca(2+)-Alginate. The treatment procedure was carried out by mixing these two components and then combining them into one syringe for intramyocardial injections. This mixture was injected at 10 to 19 locations mid-way between the base and apex of the LV free wall in patients. Magnetic resonance imaging (MRI), together with mathematical modeling, was used to quantify the effects of this treatment in patients before treatment and at various time points during recovery. The epicardial and endocardial surfaces were first digitized from the MR images to reconstruct the LV geometry at end-systole and at end-diastole. Left ventricular cavity volumes were then measured from these reconstructed surfaces. Mathematical models of the LV were created from these MRI-reconstructed surfaces to calculate regional myofiber stress. Each LV model was constructed so that 1) it deforms according to a previously validated stress-strain relationship of the myocardium, and 2) the predicted LV cavity volume from these models matches the corresponding MRI-measured volume at end-diastole and end-systole. Diastolic filling was simulated by loading the LV endocardial surface with a prescribed end-diastolic pressure. Systolic contraction was simulated by concurrently loading the endocardial surface with a prescribed end-systolic pressure and adding active contraction in the myofiber direction. Regional myofiber stress at end-diastole and end-systole was computed from the deformed LV based on the stress-strain relationship.
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15
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Lee LC, Wall ST, Klepach D, Ge L, Zhang Z, Lee RJ, Hinson A, Gorman JH, Gorman RC, Guccione JM. Algisyl-LVR™ with coronary artery bypass grafting reduces left ventricular wall stress and improves function in the failing human heart. Int J Cardiol 2013; 168:2022-8. [PMID: 23394895 DOI: 10.1016/j.ijcard.2013.01.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/18/2012] [Accepted: 01/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left ventricular (LV) wall stress reduction is a cornerstone in treating heart failure. Large animal models and computer simulations indicate that adding non-contractile material to the damaged LV wall can potentially reduce myofiber stress. We sought to quantify the effects of a novel implantable hydrogel (Algisyl-LVR™) treatment in combination with coronary artery bypass grafting (i.e. Algisyl-LVR™+CABG) on both LV function and wall stress in heart failure patients. METHODS AND RESULTS Magnetic resonance images obtained before treatment (n=3), and at 3 months (n=3) and 6 months (n=2) afterwards were used to reconstruct the LV geometry. Cardiac function was quantified using end-diastolic volume (EDV), end-systolic volume (ESV), regional wall thickness, sphericity index and regional myofiber stress computed using validated mathematical modeling. The LV became more ellipsoidal after treatment, and both EDV and ESV decreased substantially 3 months after treatment in all patients; EDV decreased from 264 ± 91 ml to 146 ± 86 ml and ESV decreased from 184 ± 85 ml to 86 ± 76 ml. Ejection fraction increased from 32 ± 8% to 47 ± 18% during that period. Volumetric-averaged wall thickness increased in all patients, from 1.06 ± 0.21 cm (baseline) to 1.3 ± 0.26 cm (3 months). These changes were accompanied by about a 35% decrease in myofiber stress at end-of-diastole and at end-of-systole. Post-treatment myofiber stress became more uniform in the LV. CONCLUSIONS These results support the novel concept that Algisyl-LVR™+CABG treatment leads to decreased myofiber stress, restored LV geometry and improved function.
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Affiliation(s)
- Lik Chuan Lee
- Department of Surgery, University of California, San Francisco, CA, USA; Department of Bioengineering, University of California, San Francisco, CA, USA
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16
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Optimized local infarct restraint improves left ventricular function and limits remodeling. Ann Thorac Surg 2012; 95:155-62. [PMID: 23146279 DOI: 10.1016/j.athoracsur.2012.08.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/14/2012] [Accepted: 08/21/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Preventing expansion and dyskinetic movement of a myocardial infarction (MI) can limit left ventricular (LV) remodeling. Using a device designed to produce variable alteration of infarct stiffness and geometry, we sought to understand how these parameters affect LV function and remodeling early after MI. METHODS Ten pigs had posterolateral infarctions. An unexpanded device was placed in 5 animals at the time of infarction and 5 animals served as untreated controls. One week after MI animals underwent magnetic resonance imaging to assess LV size and regional function. In the treatment group, after initial imaging, the device was expanded with 2, 4, 6, 8, and 10 mL of saline. The optimal degree of inflation was defined as that which maximized stroke volume (SV). The device was left optimally inflated in the treatment animals for 3 additional weeks. RESULTS One week after MI, device inflation to 6 mL or greater significantly (p < 0.05) decreased end-systolic volume (0 mL, 59.9 mL ± 3.8; 6 mL, 54.0 mL ± 3.1; 8 mL, 50.5 mL ± 4.8; and 10 mL, 46.1 mL ± 2.2) and increased ejection fraction (EF) (0 mL, 0.346 ± 0.016; 6 mL, 0.0397 ± 0.009; 8 mL, 0.431 ± 0.027; and 10 mL, 0.441 ± 0.009). Systolic volume significantly (p < 0.05) improved for the 6 mL and 8 mL volumes (0 mL, 31.2 mL ± 2.6; 6 mL, 35.7 mL ± 2.0; and 8 mL, 37.5 mL ± 1.9) but trended downward for 10 mL (36.6 mL ± 2.8). At 4 weeks after MI, end-diastolic volume and end-systolic volume were unchanged from 1-week values in the treatment group while the control group continued to dilate. Systolic volume (38.2 ± 4.4 mL vs 34.0.1 ± 4.8 mL, p = 0.08) and EF (0.360 ± 0.026 vs 0.276 ± 0.014, p = 0.04) were also better in the treatment animals. CONCLUSIONS Optimized isolated infarct restraint can limit adverse LV remodeling after MI. The tested device affords the potential for a patient-specific therapy to preserve cardiac function after MI.
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CHAUDHRY HANSR, BUKIET BRUCE, RITTER ARTHURB, ARORA ROHIT. MECHANICAL PROPERTIES OF DISEASED HEARTS DURING ADAPTATION. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519402000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, a method is developed to determine the material constants of normal and diseased human hearts in vivo. With these material constants, one can compute regional stresses and strains through the left ventricular (LV) wall. This knowledge provides a better understanding of the heart adaptation process and may lead to earlier diagnosis of heart disease. It also may enable earlier treatment of heart disease, and evaluation of the efficacy of treatments for it. The heart is modeled as a thick cylindrical shell and large deformation theory, incorporating residual stresses is employed to compute the regional stresses and strains through the LV wall. These stresses and strains at the end diastolic state for the normal, hypertensive and congestive heart failure cases are presented. The average circumferential stress is also computed at the end systolic state for these cases.
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Affiliation(s)
- HANS R. CHAUDHRY
- Department of Biomedical Engineering, Department of Mathematical Sciences, Center for Applied Mathematics and Statistics, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - BRUCE BUKIET
- Department of Biomedical Engineering, Department of Mathematical Sciences, Center for Applied Mathematics and Statistics, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - ARTHUR B. RITTER
- Department of Physiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07102, USA
| | - ROHIT ARORA
- Department of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07102, USA
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18
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Di Martino ES, Bellini C, Schwartzman DS. In vivo porcine left atrial wall stress: Effect of ventricular tachypacing on spatial and temporal stress distribution. J Biomech 2011; 44:2755-60. [DOI: 10.1016/j.jbiomech.2011.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 09/02/2011] [Accepted: 09/04/2011] [Indexed: 10/17/2022]
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19
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Zhong L, Su Y, Gobeawan L, Sola S, Tan RS, Navia JL, Ghista DN, Chua T, Guccione J, Kassab GS. Impact of surgical ventricular restoration on ventricular shape, wall stress, and function in heart failure patients. Am J Physiol Heart Circ Physiol 2011; 300:H1653-60. [PMID: 21357513 DOI: 10.1152/ajpheart.00021.2011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Surgical ventricular restoration (SVR) was designed to treat patients with aneurysms or large akinetic walls and dilated ventricles. Yet, crucial aspects essential to the efficacy of this procedure like optimal shape and size of the left ventricle (LV) are still debatable. The objective of this study is to quantify the efficacy of SVR based on LV regional shape in terms of curvedness, wall stress, and ventricular systolic function. A total of 40 patients underwent magnetic resonance imaging (MRI) before and after SVR. Both short-axis and long-axis MRI were used to reconstruct end-diastolic and end-systolic three-dimensional LV geometry. The regional shape in terms of surface curvedness, wall thickness, and wall stress indexes were determined for the entire LV. The infarct, border, and remote zones were defined in terms of end-diastolic wall thickness. The LV global systolic function in terms of global ejection fraction, the ratio between stroke work (SW) and end-diastolic volume (SW/EDV), the maximal rate of change of pressure-normalized stress (dσ*/dt(max)), and the regional function in terms of surface area change were examined. The LV end-diastolic and end-systolic volumes were significantly reduced, and global systolic function was improved in ejection fraction, SW/EDV, and dσ*/dt(max). In addition, the end-diastolic and end-systolic stresses in all zones were reduced. Although there was a slight increase in regional curvedness and surface area change in each zone, the change was not significant. Also, while SVR reduced LV wall stress with increased global LV systolic function, regional LV shape and function did not significantly improve.
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Affiliation(s)
- L Zhong
- Department of Cardiology, National Heart Centre, Singapore.
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Chung ES, Dan D, Solomon SD, Bank AJ, Pastore J, Iyer A, Berger RD, Franklin JO, Jones G, Machado C, Stolen CM. Effect of Peri-Infarct Pacing Early After Myocardial Infarction. Circ Heart Fail 2010; 3:650-8. [PMID: 20852059 DOI: 10.1161/circheartfailure.110.945881] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eugene S. Chung
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Dan Dan
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Scott D. Solomon
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Alan J. Bank
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Joseph Pastore
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Anand Iyer
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Ronald D. Berger
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Jay O. Franklin
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Gregory Jones
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Christian Machado
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Craig M. Stolen
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
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Peri-infarct pacing with CRT in the early postinfarct phase to attenuate long-term remodeling. J Cardiovasc Transl Res 2008; 2:126-9. [PMID: 20559976 DOI: 10.1007/s12265-008-9059-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
Deleterious left ventricular remodeling routinely occurs after myocardial infarction (MI) and novel strategies to attenuate this phenomenon may prove valuable. Here, we describe the potential role of left ventricular (LV) peri-infarct pacing (delivered via biventricular pacemakers) to reduce post-MI remodeling. Regional wall stress in the infarcted area is predictive of remodeling and therefore represents a potential therapeutic target. Using an intrinsic property of pacing to reduce stress and work at the pacing site, there are animal data to suggest that long-term peri-infarct pacing can have a salutary effect on cardiac structure after MI. This concept was tested in a pilot human study, suggesting attenuation of ventricular dilation in post-MI patients treated with LV pacing compared with control. To further characterize this concept, a 110-patient, multicenter, randomized Prevention of Myocardial Enlargement and Dilatation post-Myocardial Infarction Study (MENDMI) has completed enrollment. Inclusion criteria included anterior MI, QRS < 120 ms, ejection fraction <or= 35%, CPK > 2,000, and wall motion abnormalities in at least five of 16 segments. MENDMI will help to determine whether chronic application of peri-infarct pacing provides structural and clinical benefits and will help in the design of further investigations to modify postinfarction ventricular remodeling.
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Chan J, Khafagi F, Young AA, Cowan BR, Thompson C, Marwick TH. Impact of coronary revascularization and transmural extent of scar on regional left ventricular remodelling. Eur Heart J 2008; 29:1608-17. [PMID: 18556718 DOI: 10.1093/eurheartj/ehn247] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIMS Transmural extent (TME) of myocardial scar, contractile reserve, and perfusion all predict improvement in regional myocardial function after coronary revascularization. We sought their association with regional remodelling after infarction. METHODS AND RESULTS We studied 89 patients (age 62 +/- 10 years) with left ventricular (LV) dysfunction, at least 1 month post infarction. Viability was identified by TME < 75% on contrast-enhanced magnetic resonance imaging (ce-MRI), augmentation at low-dose dobutamine echocardiography (DbE), or >60% uptake on delayed redistribution on TI-201 SPECT (single photon emission computed tomography). Coronary revascularization was performed in 36 patients. Regional LV end-diastolic volume (EDV) and end-systolic volume, and ejection fraction were measured with MRI at baseline and after a median follow-up of 18 months. Of 357 segments identified with subendocardial infarction (TME 0-25%) on ce-MRI, 176 were revascularized. Subendocardial scar segments were associated with reverse regional remodeling during follow-up. Revascularization was an independent correlate of change in EDV, but TME and revascularization showed no interaction with respect to their influence on regional volumes. Contractile reserve was present on DbE in 228 segments, of which 129 were TME 0-25%; remodelling was associated with intervention in non-transmural infarcts showing viability by DbE. Viability was identified by TI-201 SPECT in 381 segments (233 with TME 0-25%), but viability by SPECT was not associated with reverse remodelling. No significant reverse remodelling occurred in segments with intermediate scar thickness (TME 26-75%) or transmural scar, independent of revascularization or viability by DbE or TI-SPECT. CONCLUSION Reverse regional remodelling is associated with subendocardial infarction, especially in the setting of contractile reserve and revascularization.
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Affiliation(s)
- Jonathan Chan
- Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia
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Walker JC, Ratcliffe MB, Zhang P, Wallace AW, Hsu EW, Saloner DA, Guccione JM. Magnetic resonance imaging-based finite element stress analysis after linear repair of left ventricular aneurysm. J Thorac Cardiovasc Surg 2008; 135:1094-102, 1102.e1-2. [PMID: 18455590 DOI: 10.1016/j.jtcvs.2007.11.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 10/27/2007] [Accepted: 11/15/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Linear repair of left ventricular aneurysm has been performed with mixed clinical results. By using finite element analysis, this study evaluated the effect of this procedure on end-systolic stress. METHODS Nine sheep underwent myocardial infarction and aneurysm repair with a linear repair (13.4 +/- 2.3 weeks postmyocardial infarction). Satisfactory magnetic resonance imaging examinations were obtained in 6 sheep (6.6 +/- 0.5 weeks postrepair). Finite element models were constructed from in vivo magnetic resonance imaging-based cardiac geometry and postmortem measurement of myofiber helix angles using diffusion tensor magnetic resonance imaging. Material properties were iteratively determined by comparing the finite element model output with systolic tagged magnetic resonance imaging strain measurements. RESULTS At the mid-wall, fiber stress in the border zone decreased by 39% (sham = 32.5 +/- 2.5 kPa, repair = 19.7 +/- 3.6 kPa, P = .001) to the level of remote regions after repair. In the septum, however, border zone fiber stress remained high (sham = 31.3 +/- 5.4 kPa, repair = 23.8 +/- 5.8 kPa, P = .29). Cross-fiber stress at the mid-wall decreased by 41% (sham = 13.0 +/- 1.5 kPa, repair = 7.7 +/- 2.1 kPa, P = .01), but cross-fiber stress in the un-excluded septal infarct was 75% higher in the border zone than remote regions (remote = 5.9 +/- 1.9 kPa, border zone = 10.3 +/- 3.6 kPa, P < .01). However, end-diastolic fiber and cross-fiber stress were not reduced in the remote myocardium after plication. CONCLUSION With the exception of the retained septal infarct, end-systolic stress is reduced in all areas of the left ventricle after infarct plication. Consequently, we expect the primary positive effect of infarct plication to be in the infarct border zone. However, the amount of stress reduction necessary to halt or reverse nonischemic infarct extension in the infarct border zone and eccentric hypertrophy in the remote myocardium is unknown.
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Affiliation(s)
- Joseph C Walker
- Joint Graduate Group in Bioengineering, University of California, San Francisco, Calif, USA
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Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J, St John Sutton M, De Sutter J, Murillo J. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008; 117:2608-16. [PMID: 18458170 DOI: 10.1161/circulationaha.107.743120] [Citation(s) in RCA: 1486] [Impact Index Per Article: 92.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data from single-center studies suggest that echocardiographic parameters of mechanical dyssynchrony may improve patient selection for cardiac resynchronization therapy (CRT). In a prospective, multicenter setting, the Predictors of Response to CRT (PROSPECT) study tested the performance of these parameters to predict CRT response. METHODS AND RESULTS Fifty-three centers in Europe, Hong Kong, and the United States enrolled 498 patients with standard CRT indications (New York Heart Association class III or IV heart failure, left ventricular ejection fraction < or = 35%, QRS > or = 130 ms, stable medical regimen). Twelve echocardiographic parameters of dyssynchrony, based on both conventional and tissue Doppler-based methods, were evaluated after site training in acquisition methods and blinded core laboratory analysis. Indicators of positive CRT response were improved clinical composite score and > or = 15% reduction in left ventricular end-systolic volume at 6 months. Clinical composite score was improved in 69% of 426 patients, whereas left ventricular end-systolic volume decreased > or = 15% in 56% of 286 patients with paired data. The ability of the 12 echocardiographic parameters to predict clinical composite score response varied widely, with sensitivity ranging from 6% to 74% and specificity ranging from 35% to 91%; for predicting left ventricular end-systolic volume response, sensitivity ranged from 9% to 77% and specificity from 31% to 93%. For all the parameters, the area under the receiver-operating characteristics curve for positive clinical or volume response to CRT was < or = 0.62. There was large variability in the analysis of the dyssynchrony parameters. CONCLUSIONS Given the modest sensitivity and specificity in this multicenter setting despite training and central analysis, no single echocardiographic measure of dyssynchrony may be recommended to improve patient selection for CRT beyond current guidelines. Efforts aimed at reducing variability arising from technical and interpretative factors may improve the predictive power of these echocardiographic parameters in a broad clinical setting.
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Affiliation(s)
- Eugene S Chung
- Lindner Clinical Trial Center, Cincinnati, OH 45219, USA.
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Prunier F, Brette S, Delépine S, Geslin P, Le Jeune JJ, Furber AP. Three-dimensional MRI assessment of regional wall stress after acute myocardial infarction predicts postdischarge cardiac events. J Magn Reson Imaging 2008; 27:516-21. [DOI: 10.1002/jmri.21197] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Shuros AC, Salo RW, Florea VG, Pastore J, Kuskowski MA, Chandrashekhar Y, Anand IS. Ventricular preexcitation modulates strain and attenuates cardiac remodeling in a swine model of myocardial infarction. Circulation 2007; 116:1162-9. [PMID: 17709639 DOI: 10.1161/circulationaha.107.696294] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction modifies the distribution of stress within the heart, increasing wall stress in ischemic and surrounding tissue, which often leads to adverse left ventricular remodeling. Electrical preexcitation pacing with appropriate timing of high-stress regions can reduce local strain and may attenuate global remodeling. METHODS AND RESULTS Myocardial infarction was induced in 24 swine to study the short-term (n=12) and long-term (n=12) effects of therapy. Sonomicrometry and hemodynamic measurements were used to show the mechanistic effects of preexcitation and to determine the optimal stimulation site and atrioventricular delay. Lagrangian strain was used to assess regional loading characteristics. Long-term study animals were randomized to 8 weeks of preexcitation (therapy) or no pacing (control). Echocardiograms were performed 2 days after myocardial infarction and repeated at 60 days, when tissue weights and apoptosis were assessed. Preexcitation reduced regional strain in the short term, with the best results achieved when the border region was paced at an atrioventricular delay of 50% of the intrinsic PR interval. In the long term, the changes in left ventricular internal diameter and left atrial size were decreased in therapy animals versus control animals (0.9+/-0.3 versus 1.5+/-0.5 cm, P=0.03, and 1.06+/-0.78 versus 2.32+/-0.88 cm, P<0.04, respectively). Heart weight was significantly lower in the therapy animals than in the control animals (319.8+/-20.8 versus 359.6+/-29.3 g, P=0.02). Although not significant, cardiomyocyte apoptosis trended lower in the therapy group. CONCLUSIONS Preexcitation of the left ventricle after myocardial infarction reduced strain and stroke work in the infarct and border regions in the short term and attenuated adverse ventricular remodeling in the long term.
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Abstract
Survivors of myocardial infarction (MI) are at high risk of disability and death. This is due to infarct-related complications such as heart failure, cardiac remodeling with progressive ventricular dilation, dysfunction, and hypertrophy, and arrhythmias including ventricular and atrial fibrillation. Angiotensin (Ang) II, the major effector molecule of the renin–angiotensin–aldosterone system (RAAS) is a major contributor to these complications. RAAS inhibition, with angiotensin-converting enzyme (ACE) inhibitors were first shown to reduce mortality and morbidity after MI. Subsequently, angiotensin receptor blockers (ARBs), that produce more complete blockade of the effects of Ang II at the Ang II type 1 (AT1) receptor, were introduced and the ARB valsartan was shown to be as effective as an ACE inhibitor in reducing mortality and morbidity in high-risk post-MI suvivors with left ventricular (LV) systolic dysfunction and and/or heart failure and in heart failure patients, respectively, in two major trials (VALIANT and Val-HeFT). Both these trials used an ACE inhibitor as comparator on top of background therapy. Evidence favoring the use of valsartan for secondary prevention in post-MI survivors is reviewed.
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Affiliation(s)
- Bodh I Jugdutt
- Walter Mackenzie Health Sciences Centre, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
Even though studies on isolated papillary muscles and cardiomyocytes can be applied to the mechanics of a beating heart, it is not always easy for physicians to relate these findings to clinical medicine. Thus, it is important to extend the studies to intact heart either in simulations or in animal models and even better to validate the results with human subjects. Advances in engineering and computer technology have allowed us to bridge the gap between physiology and mechanics. Cardiomyocyte stress/strain relates to muscle energy expenditure, which dictates oxygen and substrate utilization. Appreciation of this sequential relationship by clinicians will facilitate the logical development and assessment of therapies. Theory of finite element analysis (FEA) can predict cardiac mechanics under normal and pathologic conditions. Imaging studies provide an avenue to relate these predictions indirectly to experimental studies. In this fashion, we can understand the mechanical basis for the micro- and macroanatomical twisting motion of the beating heart. The purposes of this manuscript are: (1) to examine the terms that are traditionally used to describe mechanical stresses and strain within the ventricle, (2) to explore the three-dimensional organization of cardiomyocytes that influences global ventricular function, (3) to apply mechanical measures to both single cardiomyofibrils and the intact ventricle (4) to evaluate mathematical and computer models used to characterize cardiac mechanics, and (5) to outline the clinical methods available to measure ventricular function and relate findings from FEA to pathologic conditions.
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Affiliation(s)
- Amod P Tendulkar
- Department of Surgery, University of California, San Francisco-East Bay, 1411 East 31st Street, Oakland, CA 94602, USA.
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Chung ES, Menon SG, Weiss R, Schloss EJ, Chow T, Kereiakes DJ, Mazur W, Salo RW, Galle E, Pastore JM. Feasibility of Biventricular Pacing in Patients With Recent Myocardial Infarction: Impact on Ventricular Remodeling. ACTA ACUST UNITED AC 2007; 13:9-15. [PMID: 17268205 DOI: 10.1111/j.1527-5299.2007.05868.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To test the hypothesis that biventricular pacing after a myocardial infarction with reduced ejection fraction can attenuate left ventricular (LV) remodeling, the authors studied 18 patients (myocardial infarction within 30-45 days, ejection fraction <or=30%, narrow QRS) randomized to biventricular therapy (biventricular therapy + defibrillator) (biventricular group) or implantable cardioverter-defibrillator alone (control group). At 1, 6, and 12 months, there were no differences in functional or clinical parameters (New York Heart Association, quality of life, 6-minute walk). Twelve-month LV volume remained stable in the biventricular group, but increased in the control group (median LV end-diastolic volume increase, 6.5 mL in biventricular vs 35 mL in control; P=.03; median LV end-diastolic volume decrease, 5.5 mL in biventricular vs 30.5-mL increase in control; P=.11). Biventricular therapy also prevented an increase in sphericity index at 12 months (median, -2% in biventricular vs 37% in control; P=.06). Delivery of biventricular therapy early after myocardial infarction appears safe and feasible and may attenuate subsequent LV dilation.
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Affiliation(s)
- Eugene S Chung
- The Christ Hospital, Ohio Heart and Vascular Center, and the Lindner Clinical Trial Center, Cincinnati, OH 45219, USA.
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Abstract
An acute myocardial infarction causes a loss of contractile fibers which reduces systolic function. Parallel to the effect on systolic function, a myocardial infarction also impacts diastolic function, but this relationship is not as well understood. The two physiologic phases of diastole, active relaxation and passive filling, are both influenced by myocardial ischemia and infarction. Active relaxation is delayed following a myocardial infarction, whereas left ventricular stiffness changes depending on the extent of infarction and remodeling. Interstitial edema and fibrosis cause an increase in wall stiffness which is counteracted by dilation. The effect on diastolic function is correlated to an increased incidence of adverse outcomes. Moreover, patients with comorbid conditions that are associated with worse diastolic function tend to have more adverse outcomes after infarction. There are currently no treatments aimed specifically at treating diastolic dysfunction following a myocardial infarction, but several new drugs, including aldosterone antagonists, may offer promise.
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Affiliation(s)
- Jens Jakob Thune
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Abstract
Ventricular remodelling describes structural changes in the left ventricle in response to chronic alterations in loading conditions, with three major patterns: concentric remodelling, when a pressure load leads to growth in cardiomyocyte thickness; eccentric hypertrophy, when a volume load produces myocyte lengthening; and myocardial infarction, an amalgam of patterns in which stretched and dilated infarcted tissue increases left-ventricular volume with a combined volume and pressure load on non-infarcted areas. Whether left-ventricular hypertrophy is adaptive or maladaptive is controversial, as suggested by patterns of signalling pathways, transgenic models, and clinical findings in aortic stenosis. The transition from apparently compensated hypertrophy to the failing heart indicates a changing balance between metalloproteinases and their inhibitors, effects of reactive oxygen species, and death-promoting and profibrotic neurohumoral responses. These processes are evasive therapeutic targets. Here, we discuss potential novel therapies for these disorders, including: sildenafil, an unexpected option for anti-transition therapy; surgery for increased sphericity caused by chronic volume overload of mitral regurgitation; an antifibrotic peptide to inhibit the fibrogenic effects of transforming growth factor beta; mechanical intervention in advanced heart failure; and stem-cell therapy.
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Affiliation(s)
- Lionel H Opie
- Hatter Institute for Heart Research, Cape Heart Centre and Department of Medicine, University of Cape Town Faculty of Health Sciences, Observatory 7925, Cape Town, South Africa.
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Abstract
BACKGROUND Intermittent fasting (IF), a dietary regimen in which food is available only every other day, increases the life span and reduces the incidence of age-associated diseases in rodents. We have reported neuroprotective effects of IF against ischemic injury of the brain. In this study, we examined the effects of IF on ischemic injury of the heart in rats. METHODS AND RESULTS After 3 months of IF or regular every-day feeding (control) diets started in 2-month-old rats, myocardial infarction (MI) was induced by coronary artery ligation. Twenty-four hours after MI, its size in the IF group was 2-fold smaller, the number of apoptotic myocytes in the area at risk was 4-fold less, and the inflammatory response was significantly reduced compared with the control diet group. Serial echocardiography revealed that during 10 weeks after MI (with continuation of the IF regimen), the left ventricular (LV) remodeling and MI expansion that were observed in the control diet group were absent in the IF group. In a subgroup of animals with similar MI size at 1 week after MI, further observation revealed less remodeling, better LV function, and no MI expansion in the IF group compared with the control group. CONCLUSIONS IF protects the heart from ischemic injury and attenuates post-MI cardiac remodeling, likely via antiapoptotic and antiinflammatory mechanisms.
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Affiliation(s)
- Ismayil Ahmet
- Laboratory of Cardiovascular Sciences, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
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Abstract
A variety of invasive procedures have been utilized to reduce the burden on the left ventricle in order to slow or reverse the progressive changes of structural remodeling. These include mitral valve repair, left ventricular assist devices, left ventricular chamber reduction surgery, endovascular patchplasty, dynamic cardiomyoplasty, and a variety of prosthetic implants designed to inhibit remodeling either by constraining chamber enlargement or reducing wall stress to inhibit further growth. Resynchronization therapy also may favorably affect remodeling. The potential of these procedures to slow the progression of heart failure needs to be confirmed in prospective studies.
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Affiliation(s)
- Michael A Acker
- Section of Cardiac Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Mackerle J. Finite element modelling and simulations in cardiovascular mechanics and cardiology: A bibliography 1993–2004. Comput Methods Biomech Biomed Engin 2005; 8:59-81. [PMID: 16154871 DOI: 10.1080/10255840500141486] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The paper gives a bibliographical review of the finite element modelling and simulations in cardiovascular mechanics and cardiology from the theoretical as well as practical points of views. The bibliography lists references to papers, conference proceedings and theses/dissertations that were published between 1993 and 2004. At the end of this paper, more than 890 references are given dealing with subjects as: Cardiovascular soft tissue modelling; material properties; mechanisms of cardiovascular components; blood flow; artificial components; cardiac diseases examination; surgery; and other topics.
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Affiliation(s)
- Jaroslav Mackerle
- Department of Mechanical Engineering, Linköping Institute of Technology, Sweden.
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Kenchaiah S, Pfeffer MA, St John Sutton M, Plappert T, Rouleau JL, Lamas GA, Sasson Z, Parker JO, Geltman EM, Solomon SD. Effect of antecedent systemic hypertension on subsequent left ventricular dilation after acute myocardial infarction (from the Survival and Ventricular Enlargement trial). Am J Cardiol 2004; 94:1-8. [PMID: 15219499 DOI: 10.1016/j.amjcard.2004.03.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Revised: 03/12/2004] [Accepted: 03/12/2004] [Indexed: 11/24/2022]
Abstract
Whether antecedent systemic hypertension influences the risk of subsequent left ventricular (LV) dilation in patients after an acute myocardial infarction with LV systolic dysfunction is unclear. We assessed echocardiographic evidence of ventricular remodeling from baseline (mean +/- SD 11 +/- 3 days) to 2 years after an acute myocardial infarction in 122 hypertensive (defined as a history of treated hypertension, baseline systolic blood pressure > or =140 or baseline diastolic blood pressure > or =90 mm Hg) and 334 nonhypertensive patients in the Survival and Ventricular Enlargement echocardiographic substudy. Compared with nonhypertensives, baseline heart size, defined as the sum of the average short- and long-axis LV cavity areas, was similar (70.1 +/- 11.9 vs 68.8 +/- 11.2 cm(2), p = 0.33 at end-diastole; 50.1 +/- 11.3 vs 48.8 +/- 10.8 cm(2), p = 0.31 at end-systole), but short-axis LV myocardial area (24.7 +/- 4.3 vs 25.7 +/- 5.0 cm(2), p = 0.043) and wall thickness (1.15 +/- 0.16 vs 1.21 +/- 0.17 cm, p = 0.004) at end-diastole were greater among hypertensives. The myocardial infarct segment lengths were similar in the 2 groups (p = 0.22). Although LV cavity areas increased significantly in the 2 groups from baseline to 2 years (p < or =0.001), the increase was significantly greater in hypertensives than in nonhypertensives (+5.6 +/- 11.5 vs +2.2 +/- 10.7 cm(2), p = 0.005 at end-diastole; +6.23 +/- 12.75 vs +2.94 +/- 11.4 cm(2), p = 0.012 at end-systole). There was no concomitant difference in the change in LV myocardial area or LV wall thickness between the 2 groups (p >0.30). After adjusting for known confounders, antecedent hypertension was associated with a doubling of the risk of LV dilation (50.8% vs 37.7%, odds ratio 2.09, 95% confidence interval 1.27 to 3.45, p = 0.004). This association was not modified by diabetes mellitus, myocardial infarct segment length, or captopril use (all p values for interaction >0.10). We conclude that antecedent hypertension is associated with subsequent LV dilation in patients after acute myocardial infarction with LV systolic dysfunction.
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Affiliation(s)
- Satish Kenchaiah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Guccione JM, Salahieh A, Moonly SM, Kortsmit J, Wallace AW, Ratcliffe MB. Myosplint decreases wall stress without depressing function in the failing heart: a finite element model study. Ann Thorac Surg 2003; 76:1171-80; discussion 1180. [PMID: 14530007 DOI: 10.1016/s0003-4975(03)00731-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Myocor Myosplint is a transcavitary tensioning device designed to change left ventricular (LV) shape and reduce wall stress. Regional wall stress cannot be measured in the intact heart and LV function after surgical remodeling is often confounded by inotropic agents and mitral repair. We used a realistic mathematical (finite element) model of the dilated human LV to test the hypothesis that Myosplint decreased regional ventricular fiber stress and improved LV function. METHODS A finite element model was used to simulate the effects of Myosplint on the LV stroke volume/end-diastolic pressure (Starling) relationship and regional distributions of stress in the local muscle fiber direction (fiber stress) for a wide range of diastolic and end-systolic material properties. The nonlinear stress-strain relationship for the diastolic myocardium was anisotropic with respect to the local muscle fiber direction. An elastance model for active fiber stress was incorporated in an axisymmetric geometric model of the globally dilated LV wall. RESULTS Both diastolic compliance and end-systolic elastance shifted to the left on the pressure-volume diagram. LV end-diastolic volume and end-systolic volumes were reduced by 7.6% and 8.6%, respectively. Mean end-diastolic and end-systolic fiber stress was decreased by 24% and 16%, respectively. Although the effect of Myosplint on the Starling relationship was not significant, there were trends toward an improvement in this relationship at low diastolic stiffness, C, high peak intracellular calcium concentration, Ca(0), and high arterial elastance, E(A). Of note, the effect of C was twice that of Ca(0) and E(A). Diastolic function would, therefore, be expected to be the prime determinant of success with Myosplint. CONCLUSIONS Myosplint reduces fiber stress without a decrement in the Starling relationship. Myosplint should be much more effective than partial ventriculectomy as a surgical therapy for patients with dilated cardiomyopathy and end-stage congestive heart failure.
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Affiliation(s)
- Julius M Guccione
- Department of Surgery, School of Medicine, University of California, and San Francisco Veterans Affairs Medical Center, CA 94121, USA.
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Rademakers F, Van de Werf F, Mortelmans L, Marchal G, Bogaert J. Evolution of regional performance after an acute anterior myocardial infarction in humans using magnetic resonance tagging. J Physiol 2003; 546:777-87. [PMID: 12563003 PMCID: PMC2342596 DOI: 10.1113/jphysiol.2002.026328] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Regional remodelling after a left ventricular myocardial infarction is the first step in a cascade that may lead to heart failure and death. To understand better the mechanisms underlying this process, it is important to study not only the evolution in local deformation parameters but also the corresponding loading conditions. Using magnetic resonance (MR) myocardial tagging, we measured the regional contribution to ejection (regional ejection fraction) and loading (systolic blood pressure x radius of curvature (mean of short and long axes)/wall thickness) in 32 regions throughout the left ventricle (LV) in patients 1 week (1W) and 3 months (3M) after a first anterior infarction. Using positron emission tomography (PET), the LV was divided into infarct, adjacent and remote regions. In the remote regions the average deformation decreased between 1W and 3M (from 59.3 +/- 5.6 to 57.9 +/- 6.7 %, P < 0.05) due to an increase in loading conditions only (from 730 +/- 290 to 837 +/- 299 mmHg, P < 0.05). In the adjacent myocardium, no change in function was observed (49.0 +/- 10.8 to 49.0 +/- 6.5 %, P = n.s.), although loading increased (806 +/- 297 to 978 +/- 287 mmHg, P < 0.05). In the infarct region only, an increase in deformation was seen (30.7 +/- 14.2 to 37 +/- 6.9 %, P < 0.05), together with a higher loading level (1229 +/- 422 to 1466 +/- 284 mmHg, P < 0.05), which indicates a true improvement in function. The fact that MR tagging can identify both regional deformation and loading permits us to differentiate between changes due to alterations in regional loading conditions and true changes in function. After an acute myocardial infarction (MI), an improvement can be observed in the deformation-loading relation in the adjacent and infarct regions, but the improvement is mainly in the infarct region. Using this technique, types of intervention leading to even more functional gain could be evaluated.
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Affiliation(s)
- Frank Rademakers
- Department of Cardiology, University Hospitals, Leuven, Belgium.
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40
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Weinberg EO, Shimpo M, De Keulenaer GW, MacGillivray C, Tominaga SI, Solomon SD, Rouleau JL, Lee RT. Expression and regulation of ST2, an interleukin-1 receptor family member, in cardiomyocytes and myocardial infarction. Circulation 2002; 106:2961-6. [PMID: 12460879 PMCID: PMC1460012 DOI: 10.1161/01.cir.0000038705.69871.d9] [Citation(s) in RCA: 468] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We identified an interleukin-1 receptor family member, ST2, as a gene markedly induced by mechanical strain in cardiac myocytes and hypothesized that ST2 participates in the acute myocardial response to stress and injury. METHODS AND RESULTS ST2 mRNA was induced in cardiac myocytes by mechanical strain (4.7+/-0.9-fold) and interleukin-1beta (2.0+/-0.2-fold). Promoter analysis revealed that the proximal and not the distal promoter of ST2 is responsible for transcriptional activation in cardiac myocytes by strain and interleukin-1beta. In mice subjected to coronary artery ligation, serum ST2 was transiently increased compared with unoperated controls (20.8+/-4.4 versus 0.8+/-0.8 ng/mL, P<0.05). Soluble ST2 levels were increased in the serum of human patients (N=69) 1 day after myocardial infarction and correlated positively with creatine kinase (r=0.41, P<0.001) and negatively with ejection fraction (P=0.02). CONCLUSIONS These data identify ST2 release in response to myocardial infarction and suggest a role for this innate immune receptor in myocardial injury.
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MESH Headings
- Angiotensin II/pharmacology
- Angiotensin Receptor Antagonists
- Animals
- Animals, Newborn
- Biomarkers/blood
- Cells, Cultured
- Disease Models, Animal
- Gene Expression Regulation/drug effects
- Gene Expression Regulation/physiology
- Humans
- Imidazoles/pharmacology
- Interleukin-1/pharmacology
- Interleukin-1 Receptor-Like 1 Protein
- Interleukin-4/pharmacology
- Lipopolysaccharides/pharmacology
- Membrane Proteins/blood
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Mice
- Mice, Inbred C57BL
- Myocardial Infarction/blood
- Myocardial Infarction/metabolism
- Myocardium/cytology
- Myocardium/metabolism
- Nuclease Protection Assays
- Phorbol Esters/pharmacology
- Promoter Regions, Genetic/drug effects
- Promoter Regions, Genetic/physiology
- Pyridines/pharmacology
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptor, Angiotensin, Type 1
- Receptors, Cell Surface
- Receptors, Interleukin
- Receptors, Interleukin-1/blood
- Receptors, Interleukin-1/genetics
- Receptors, Interleukin-1/metabolism
- Stress, Mechanical
- Stroke Volume
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Affiliation(s)
| | | | | | | | | | | | | | - Richard T. Lee
- Correspondence to Richard T. Lee, MD, Cardiovascular Division, Brigham and Women’s Hospital, 65 Landsdowne St, Cambridge, MA 02139. E-mail
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Abstract
Cardiac transplantation remains the gold standard of surgical therapies for advanced and end-stage heart failure. However, this very limited option trades one disease for another and can benefit only a small minority of patients. Heart failure is currently considered secondary to a structural increase in ventricular chamber volume or remodeling. Surgical therapies formerly contraindicated for the failing heart, as well as new therapies, can successfully affect ventricular remodeling and improve cardiac function. Surgical revascularization for patients with ejection fractions <20% is becoming common. Mitral valve repair is being explored, with surprisingly low operative mortality and encouraging intermediate results. Direct surgical approaches to restoring normal geometry and size to failing hearts, such as left ventricular reduction (Batista procedure), endoventricular patch plasty (Dor procedure), cardiomyoplasty, and prosthetic external constraints are under clinical investigation. Developments in mechanical assist therapy and a new generation of implantable intracorporeal assist devices are also discussed.
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Affiliation(s)
- David Zeltsman
- Section of Cardiac Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA
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