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Martin TP, MacDonald EA, Bradley A, Watson H, Saxena P, Rog-Zielinska EA, Raheem A, Fisher S, Elbassioni AAM, Almuzaini O, Booth C, Campbell M, Riddell A, Herzyk P, Blyth K, Nixon C, Zentilin L, Berry C, Braun T, Giacca M, McBride MW, Nicklin SA, Cameron ER, Loughrey CM. Ribonucleicacid interference or small molecule inhibition of Runx1 in the border zone prevents cardiac contractile dysfunction following myocardial infarction. Cardiovasc Res 2023; 119:2663-2671. [PMID: 37433039 PMCID: PMC10730241 DOI: 10.1093/cvr/cvad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/16/2023] [Accepted: 06/11/2023] [Indexed: 07/13/2023] Open
Abstract
AIMS Myocardial infarction (MI) is a major cause of death worldwide. Effective treatments are required to improve recovery of cardiac function following MI, with the aim of improving patient outcomes and preventing progression to heart failure. The perfused but hypocontractile region bordering an infarct is functionally distinct from the remote surviving myocardium and is a determinant of adverse remodelling and cardiac contractility. Expression of the transcription factor RUNX1 is increased in the border zone 1-day after MI, suggesting potential for targeted therapeutic intervention. OBJECTIVE This study sought to investigate whether an increase in RUNX1 in the border zone can be therapeutically targeted to preserve contractility following MI. METHODS AND RESULTS In this work we demonstrate that Runx1 drives reductions in cardiomyocyte contractility, calcium handling, mitochondrial density, and expression of genes important for oxidative phosphorylation. Both tamoxifen-inducible Runx1-deficient and essential co-factor common β subunit (Cbfβ)-deficient cardiomyocyte-specific mouse models demonstrated that antagonizing RUNX1 function preserves the expression of genes important for oxidative phosphorylation following MI. Antagonizing RUNX1 expression via short-hairpin RNA interference preserved contractile function following MI. Equivalent effects were obtained with a small molecule inhibitor (Ro5-3335) that reduces RUNX1 function by blocking its interaction with CBFβ. CONCLUSIONS Our results confirm the translational potential of RUNX1 as a novel therapeutic target in MI, with wider opportunities for use across a range of cardiac diseases where RUNX1 drives adverse cardiac remodelling.
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Affiliation(s)
- Tamara P Martin
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Eilidh A MacDonald
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ashley Bradley
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Holly Watson
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Priyanka Saxena
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Eva A Rog-Zielinska
- Faculty of Medicine, Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, 79110 Freiburg, Germany
| | - Anmar Raheem
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Simon Fisher
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ali Ali Mohamed Elbassioni
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
- Department of Cardiothoracic Surgery, Suez Canal University, 41522 Ismailia, Egypt
| | - Ohood Almuzaini
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Catriona Booth
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Morna Campbell
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Alexandra Riddell
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Pawel Herzyk
- School of Molecular Biosciences, University of Glasgow, Glasgow G12 8QQ, UK
- College of Medical, Veterinary and Life Sciences, Glasgow Polyomics, University of Glasgow, Garscube Campus, Glasgow G61 1BD, UK
| | - Karen Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow G12 0YN, UK
| | - Colin Nixon
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow G12 0YN, UK
| | - Lorena Zentilin
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Thomas Braun
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Mauro Giacca
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
- School of Cardiovascular Medicine and Sciences, King’s College London British Heart Foundation Centre, London WC2R 2LS, UK
| | - Martin W McBride
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Stuart A Nicklin
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ewan R Cameron
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow G12 0YN, UK
| | - Christopher M Loughrey
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, University Place, Glasgow G12 8TA, UK
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2
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El-Husseiny HM, Mady EA, Ma D, Hamabe L, Takahashi K, Tanaka R. Intraventricular pressure gradient: A novel tool to assess the post-infarction chronic congestive heart failure. Front Cardiovasc Med 2022; 9:944171. [PMID: 36051280 PMCID: PMC9425054 DOI: 10.3389/fcvm.2022.944171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Congestive heart failure (CHF), the leading cause of death, is deemed a grave sequel of myocardial infarction (MI). The employment of left ventricular end-diastolic pressure (LVEDP), as a primary indication of CHF, becomes restricted owing to the potential impairment of heart function and caused injury to the aortic valve during its measurement. Echocardiography is the standard technique to detect cardiac dysfunction. However, it exhibits a low capacity to predict the progression of CHF post chronic MI. Being extremely sensitive, noninvasive, and preload-independent, intraventricular pressure gradient (IVPG) was lately introduced to evaluate cardiac function, specifically during cardiomyopathy. Yet, the utility of its use to assess the CHF progression after chronic MI was not investigated. Herein, in the current research, we aimed to study the efficacy of a novel echocardiographic-derived index as IVPG in the assessment of cardiac function in a chronic MI rat model with CHF. Fifty healthy male rats were involved, and MI was surgically induced in 35 of them. Six months post-surgery, all animals were examined using transthoracic conventional and color M-mode echocardiography (CMME) for IVPG. Animals were euthanized the following day after hemodynamics recording. Gross pathological and histological evaluations were performed. J-tree cluster analysis was conducted relying on ten echocardiographic parameters suggestive of CHF. Animals were merged into two main clusters: CHF+ (MI/HF + group, n = 22) and CHF– (n = 28) that was joined from Sham (n = 15), and MI/HF– (n = 13) groups. MI/HF+ group showed the most severe echocardiographic, hemodynamic, anatomic, and histologic alterations. There was no significant change in the total IVPG among various groups. However, the basal IVPG was significantly increased in MI/HF+ group compared to the other groups. The remaining IVPG measures were considerably increased in the MI/HF+ group than in the Sham one. The segmental IVPG measures were significantly correlated with the anatomical, histological, echocardiographic, and hemodynamic findings except for the heart rate. Moreover, they were significant predictors of CHF following a long-standing MI. Conclusively, IVPG obtained from CMME is a substantially promising noninvasive tool with a high ability to detect and predict the progression of CHF following chronic MI compared to conventional echocardiography.
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Affiliation(s)
- Hussein M. El-Husseiny
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Benha University, Toukh, Egypt
- *Correspondence: Hussein M. El-Husseiny
| | - Eman A. Mady
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Department of Animal Hygiene, Behavior and Management, Faculty of Veterinary Medicine, Benha University, Toukh, Egypt
| | - Danfu Ma
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Lina Hamabe
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Lina Hamabe
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Ryou Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Ryou Tanaka
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3
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Harbo MB, Stokke MK, Sjaastad I, Espe EKS. One step closer to myocardial physiology: From PV loop analysis to state-of-the-art myocardial imaging. Acta Physiol (Oxf) 2022; 234:e13759. [PMID: 34978759 DOI: 10.1111/apha.13759] [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] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 11/29/2022]
Abstract
Recent advances in cardiac imaging have revitalized the assessment of fundamental physiological concepts. In the field of cardiac physiology, invasive measurements with pressure-volume (PV) loops have served as the gold standard methodology for the characterization of left ventricular (LV) function. From PV loop data, fundamental aspects of LV chamber function are derived such as work, efficiency, stiffness and contractility. However, the parametrization of these aspects is limited because of the need for invasive procedures. Through the utilization of recent advances in echocardiography, magnetic resonance imaging and positron emission tomography, it has become increasingly feasible to quantify these fundamental aspects of LV function non-invasively. Importantly, state-of-the-art imaging technology enables direct assessment of myocardial performance, thereby extending functional assessment from the net function of the LV chamber, as is done with PV loops, to the myocardium itself. With a strong coupling to underlying myocardial physiology, imaging measurements of myocardial work, efficiency, stiffness and contractility could represent the next generation of functional parameters. The purpose of this review is to discuss how the new imaging parameters of myocardial work, efficiency, stiffness and contractility can bring cardiac physiologists, researchers and clinicians alike one step closer to underlying myocardial physiology.
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Affiliation(s)
- Markus Borge Harbo
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
- Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Emil Knut Stenersen Espe
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
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4
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Berberoğlu E, Stoeck CT, Moireau P, Kozerke S, Genet M. In-silico study of accuracy and precision of left-ventricular strain quantification from 3D tagged MRI. PLoS One 2021; 16:e0258965. [PMID: 34739495 PMCID: PMC8570486 DOI: 10.1371/journal.pone.0258965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Cardiac Magnetic Resonance Imaging (MRI) allows quantifying myocardial tissue deformation and strain based on the tagging principle. In this work, we investigate accuracy and precision of strain quantification from synthetic 3D tagged MRI using equilibrated warping. To this end, synthetic biomechanical left-ventricular tagged MRI data with varying tag distance, spatial resolution and signal-to-noise ratio (SNR) were generated and processed to quantify errors in radial, circumferential and longitudinal strains relative to ground truth. Results reveal that radial strain is more sensitive to image resolution and noise than the other strain components. The study also shows robustness of quantifying circumferential and longitudinal strain in the presence of geometrical inconsistencies of 3D tagged data. In conclusion, our study points to the need for higher-resolution 3D tagged MRI than currently available in practice in order to achieve sufficient accuracy of radial strain quantification.
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Affiliation(s)
- Ezgi Berberoğlu
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Christian T. Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Philippe Moireau
- MΞDISIM team, Inria, Palaiseau, France
- Laboratoire de Mécanique des Solides (LMS), École Polytechnique, C.N.R.S., Institut Polytechnique de Paris, Palaiseau, France
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Martin Genet
- MΞDISIM team, Inria, Palaiseau, France
- Laboratoire de Mécanique des Solides (LMS), École Polytechnique, C.N.R.S., Institut Polytechnique de Paris, Palaiseau, France
- * E-mail:
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5
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Leong CO, Leong CN, Liew YM, Al Abed A, Aziz YFA, Chee KH, Sridhar GS, Dokos S, Lim E. The role of regional myocardial topography post-myocardial infarction on infarct extension. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3501. [PMID: 34057819 DOI: 10.1002/cnm.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient-specific left-ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress-strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter-clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ-BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ.
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Affiliation(s)
- Chen Onn Leong
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Neng Leong
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Amr Al Abed
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Socrates Dokos
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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6
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Martin TP, MacDonald EA, Elbassioni AAM, O'Toole D, Zaeri AAI, Nicklin SA, Gray GA, Loughrey CM. Preclinical models of myocardial infarction: from mechanism to translation. Br J Pharmacol 2021; 179:770-791. [PMID: 34131903 DOI: 10.1111/bph.15595] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022] Open
Abstract
Approximately 7 million people are affected by acute myocardial infarction (MI) each year, and despite significant therapeutic and diagnostic advancements, MI remains a leading cause of mortality worldwide. Preclinical animal models have significantly advanced our understanding of MI and have enabled the development of therapeutic strategies to combat this debilitating disease. Notably, some drugs currently used to treat MI and heart failure (HF) in patients had initially been studied in preclinical animal models. Despite this, preclinical models are limited in their ability to fully reproduce the complexity of MI in humans. The preclinical model must be carefully selected to maximise the translational potential of experimental findings. This review describes current experimental models of MI and considers how they have been used to understand drug mechanisms of action and support translational medicine development.
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Affiliation(s)
- Tamara P Martin
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Eilidh A MacDonald
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ali Ali Mohamed Elbassioni
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Suez Canal University, Arab Republic of Egypt
| | - Dylan O'Toole
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ali Abdullah I Zaeri
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stuart A Nicklin
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gillian A Gray
- Centre for Cardiovascular Science, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Christopher M Loughrey
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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7
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Shah H, Hacker A, Langburt D, Dewar M, McFadden MJ, Zhang H, Kuzmanov U, Zhou YQ, Hussain B, Ehsan F, Hinz B, Gramolini AO, Heximer SP. Myocardial Infarction Induces Cardiac Fibroblast Transformation within Injured and Noninjured Regions of the Mouse Heart. J Proteome Res 2021; 20:2867-2881. [PMID: 33789425 DOI: 10.1021/acs.jproteome.1c00098] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Heart failure (HF) is associated with pathological remodeling of the myocardium, including the initiation of fibrosis and scar formation by activated cardiac fibroblasts (CFs). Although early CF-dependent scar formation helps prevent cardiac rupture by maintaining the heart's structural integrity, ongoing deposition of the extracellular matrix in the remote and infarct regions can reduce tissue compliance, impair cardiac function, and accelerate progression to HF. In our study, we conducted mass spectrometry (MS) analysis to identify differentially altered proteins and signaling pathways between CFs isolated from 7 day sham and infarcted murine hearts. Surprisingly, CFs from both the remote and infarct regions of injured hearts had a wide number of similarly altered proteins and signaling pathways that were consistent with fibrosis and activation into pathological myofibroblasts. Specifically, proteins enriched in CFs isolated from MI hearts were involved in pathways pertaining to cell-cell and cell-matrix adhesion, chaperone-mediated protein folding, and collagen fibril organization. These results, together with principal component analyses, provided evidence of global CF activation postinjury. Interestingly, however, direct comparisons between CFs from the remote and infarct regions of injured hearts identified 15 differentially expressed proteins between MI remote and MI infarct CFs. Eleven of these proteins (Gpc1, Cthrc1, Vmac, Nexn, Znf185, Sprr1a, Specc1, Emb, Limd2, Pawr, and Mcam) were higher in MI infarct CFs, whereas four proteins (Gstt1, Gstm1, Tceal3, and Inmt) were higher in MI remote CFs. Collectively, our study shows that MI injury induced global changes to the CF proteome, with the magnitude of change reflecting their relative proximity to the site of injury.
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Affiliation(s)
- Haisam Shah
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Alison Hacker
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1
| | - Dylan Langburt
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Michael Dewar
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Meghan J McFadden
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1
| | - Hangjun Zhang
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1
| | - Uros Kuzmanov
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Yu-Qing Zhou
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1
| | - Bilal Hussain
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1
| | - Fahad Ehsan
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada M5G 1G6
| | - Anthony O Gramolini
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Scott P Heximer
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, Ontario, Canada M5G 1M1.,Department of Physiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
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8
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Qi Z, Wu D, Li M, Yan Z, Yang X, Ji N, Wang Y, Zhang J. The pluripotent role of exosomes in mediating non-coding RNA in ventricular remodeling after myocardial infarction. Life Sci 2020; 254:117761. [PMID: 32413403 DOI: 10.1016/j.lfs.2020.117761] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/21/2022]
Abstract
With the increase of an aging population and the rising incidence of cardiovascular diseases, heart failure (HF) patients are on the rise every year. Myocardial infarction (MI) is the leading cause of HF in patients among cardiovascular diseases. In clinic, patients with MI are often assessed by biochemical indicators, electrocardiography, brain natriuretic peptide levels, myocardial enzymology, echocardiography and other means to predict the occurrence of HF and ventricular remodeling (VR). But there is still a lack of more accurate evaluation. VR is the basic mechanism of HF. In recent years, the molecular mechanism of VR has been studied mainly from the aspects of myocardial hypertrophy, myocardial fibrosis, inflammation, myocardial energy disorder, apoptosis, autophagy and pyroptosis. Exosomes are considered as the main mediators of intercellular information transmission. In addition, exosomes can promote the migration and transformation of intercellular RNAs, which are highly conserved non-coding RNAs. They can mediate the process of cell proliferation and differentiation of the target cell membrane. Exosomes have protective effects on VR after MI by inhibiting fibrosis, promoting angiogenesis and inhibiting inflammation and pyroptosis. We reviewed the specific protective mechanisms of exosomes for VR after MI. In addition, we discussed the formation of targeted exosomes and the role of non-coding RNAs in VR.
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Affiliation(s)
- Zhongwen Qi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300183, China
| | - Dan Wu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Meng Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300183, China
| | - Zhipeng Yan
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Xiaoya Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Nan Ji
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Yueyao Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Junping Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300183, China.
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9
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Giao DM, Wang Y, Rojas R, Takaba K, Badathala A, Spaulding KA, Soon G, Zhang Y, Wang VY, Haraldsson H, Liu J, Saloner D, Guccione JM, Ge L, Wallace AW, Ratcliffe MB. Left ventricular geometry during unloading and the end-systolic pressure volume relationship: Measurement with a modified real-time MRI-based method in normal sheep. PLoS One 2020; 15:e0234896. [PMID: 32569290 PMCID: PMC7307770 DOI: 10.1371/journal.pone.0234896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/04/2020] [Indexed: 01/08/2023] Open
Abstract
The left ventricular (LV) end-systolic (ES) pressure volume relationship (ESPVR) is the cornerstone of systolic LV function analysis. We describe a 2D real-time (RT) MRI-based method (RTPVR) with separate software tools for 1) semi-automatic level set-based shape prior method (LSSPM) of the LV, 2) generation of synchronized pressure area loops and 3) calculation of the ESPVR. We used the RTPVR method to measure ventricular geometry, ES pressure area relationship (ESPAR) and ESPVR during vena cava occlusion (VCO) in normal sheep. 14 adult sheep were anesthetized and underwent measurement of LV systolic function. Ten of the 14 sheep underwent RTMRI and eight of the 14 underwent measurement with conductance catheter; 4 had both RTMRI and conductance measurements. 2D cross sectional RTMRI were performed at apex, mid-ventricle and base levels during separate VCOs. The Dice similarity coefficient was used to compare LSSPM and manual image segmentation and thus determine LSSPM accuracy. LV cross-sectional area, major and minor axis length, axis ratio, major axis orientation angle and ESPAR were measured at each LV level. ESPVR was calculated with a trapezoidal rule. The Dice similarity coefficient between LSSPM and manual segmentation by two readers was 87.31±2.51% and 88.13±3.43%. All cross sections became more elliptical during VCO. The major axis orientation shifted during VCO but remained in the septo-lateral direction. LV chamber obliteration at the apical level occurred during VCO in 7 of 10 sheep that underwent RTMRI. ESPAR was non-linear at all levels. Finally, ESPVR was non-linear because of apical collapse. ESPVR measured by conductance catheter (EES,Index = 2.23±0.66 mmHg/ml/m2) and RT (EES,Index = 2.31±0.31 mmHg/ml/m2) was not significantly different. LSSPM segmentation of 2D RT MRI images is accurate and allows calculation of LV geometry, ESPAR and ESPVR during VCO. In the future, RTPVR will facilitate determination of regional systolic material parameters underlying ESPVR.
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Affiliation(s)
- Duc M. Giao
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yan Wang
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Renan Rojas
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kiyoaki Takaba
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Anusha Badathala
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kimberly A. Spaulding
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Gilbert Soon
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Vicky Y. Wang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Henrik Haraldsson
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Jing Liu
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - David Saloner
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Julius M. Guccione
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Liang Ge
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Arthur W. Wallace
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Anesthesia, University of California, San Francisco, CA, United States of America
| | - Mark B. Ratcliffe
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
- * E-mail:
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10
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Røe ÅT, Ruud M, Espe EK, Manfra O, Longobardi S, Aronsen JM, Nordén ES, Husebye T, Kolstad TRS, Cataliotti A, Christensen G, Sejersted OM, Niederer SA, Andersen GØ, Sjaastad I, Louch WE. Regional diastolic dysfunction in post-infarction heart failure: role of local mechanical load and SERCA expression. Cardiovasc Res 2020; 115:752-764. [PMID: 30351410 PMCID: PMC6432054 DOI: 10.1093/cvr/cvy257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 01/08/2023] Open
Abstract
Aims Regional heterogeneities in contraction contribute to heart failure with reduced ejection fraction (HFrEF). We aimed to determine whether regional changes in myocardial relaxation similarly contribute to diastolic dysfunction in post-infarction HFrEF, and to elucidate the underlying mechanisms. Methods and results Using the magnetic resonance imaging phase-contrast technique, we examined local diastolic function in a rat model of post-infarction HFrEF. In comparison with sham-operated animals, post-infarction HFrEF rats exhibited reduced diastolic strain rate adjacent to the scar, but not in remote regions of the myocardium. Removal of Ca2+ within cardiomyocytes governs relaxation, and we indeed found that Ca2+ transients declined more slowly in cells isolated from the adjacent region. Resting Ca2+ levels in adjacent zone myocytes were also markedly elevated at high pacing rates. Impaired Ca2+ removal was attributed to a reduced rate of Ca2+ sequestration into the sarcoplasmic reticulum (SR), due to decreased local expression of the SR Ca2+ ATPase (SERCA). Wall stress was elevated in the adjacent region. Using ex vivo experiments with loaded papillary muscles, we demonstrated that high mechanical stress is directly linked to SERCA down-regulation and slowing of relaxation. Finally, we confirmed that regional diastolic dysfunction is also present in human HFrEF patients. Using echocardiographic speckle-tracking of patients enrolled in the LEAF trial, we found that in comparison with controls, post-infarction HFrEF subjects exhibited reduced diastolic train rate adjacent to the scar, but not in remote regions of the myocardium. Conclusion Our data indicate that relaxation varies across the heart in post-infarction HFrEF. Regional diastolic dysfunction in this condition is linked to elevated wall stress adjacent to the infarction, resulting in down-regulation of SERCA, disrupted diastolic Ca2+ handling, and local slowing of relaxation.
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Affiliation(s)
- Åsmund T Røe
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Marianne Ruud
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Emil K Espe
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ornella Manfra
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Stefano Longobardi
- Biomedical Engineering Department, The Rayne Institute, King's College, London, London, UK
| | - Jan M Aronsen
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,Bjørknes College, Oslo, Norway
| | - Einar Sjaastad Nordén
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Bjørknes College, Oslo, Norway
| | - Trygve Husebye
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Terje R S Kolstad
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Alessandro Cataliotti
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ole M Sejersted
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Steven A Niederer
- Biomedical Engineering Department, The Rayne Institute, King's College, London, London, UK
| | | | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
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11
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Li W. Biomechanics of infarcted left Ventricle-A review of experiments. J Mech Behav Biomed Mater 2020; 103:103591. [PMID: 32090920 DOI: 10.1016/j.jmbbm.2019.103591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023]
Abstract
Myocardial infarction (MI) is one of leading diseases to contribute to annual death rate of 5% in the world. In the past decades, significant work has been devoted to this subject. Biomechanics of infarcted left ventricle (LV) is associated with MI diagnosis, understanding of remodelling, MI micro-structure and biomechanical property characterizations as well as MI therapy design and optimization, but the subject has not been reviewed presently. In the article, biomechanics of infarcted LV was reviewed in terms of experiments achieved in the subject so far. The concerned content includes experimental remodelling, kinematics and kinetics of infarcted LVs. A few important issues were discussed and several essential topics that need to be investigated further were summarized. Microstructure of MI tissue should be observed even carefully and compared between different methods for producing MI scar in the same animal model, and eventually correlated to passive biomechanical property by establishing innovative constitutive laws. More uniaxial or biaxial tensile tests are desirable on MI, border and remote tissues, and viscoelastic property identification should be performed in various time scales. Active contraction experiments on LV wall with MI should be conducted to clarify impaired LV pumping function and supply necessary data to the function modelling. Pressure-volume curves of LV with MI during diastole and systole for the human are also desirable to propose and validate constitutive laws for LV walls with MI.
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Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, Glasgow, G12 8QQ, UK.
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12
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Leong CN, Dokos S, Andriyana A, Liew YM, Chan BT, Abdul Aziz YF, Chee KH, Sridhar GS, Lim E. The role of end-diastolic myocardial fibre stretch on infarct extension. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3291. [PMID: 31799767 DOI: 10.1002/cnm.3291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 10/11/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
Myocardial infarct extension, a process involving the enlargement of infarct and border zone, leads to progressive degeneration of left ventricular (LV) function and eventually gives rise to heart failure. Despite carrying a high risk, the causation of infarct extension is still a subject of much speculation. In this study, patient-specific LV models were developed to investigate the correlation between infarct extension and impaired regional mechanics. Subsequently, sensitivity analysis was performed to examine the causal factors responsible for the impaired regional mechanics observed in regions surrounding the infarct and border zone. From our simulations, fibre strain, fibre stress and fibre stress-strain loop (FSSL) were the key biomechanical variables affected in these regions. Among these variables, only FSSL was correlated with infarct extension, as reflected in its work density dissipation (WDD) index value, with high WDD indices recorded at regions with infarct extension. Impaired FSSL is caused by inadequate contraction force generation during the isovolumic contraction and ejection phases. Our further analysis revealed that the inadequacy in contraction force generation is not necessarily due to impaired myocardial intrinsic contractility, but at least in part, due to inadequate muscle fibre stretch at end-diastole, which depresses the ability of myocardium to generate adequate contraction force in the subsequent systole (according to the Frank-Starling law). Moreover, an excessively stiff infarct may cause its neighbouring myocardium to be understretched at end-diastole, subsequently depressing the systolic contractile force of the neighbouring myocardium, which was found to be correlated with infarct extension.
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Affiliation(s)
- Chin Neng Leong
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Andri Andriyana
- Department of Mechanical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Mechanical Engineering, UCSI University, Kuala Lumpur, Malaysia
| | | | - Kok-Han Chee
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Einly Lim
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
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13
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Karthikeyan B, Sonkawade SD, Pokharel S, Preda M, Schweser F, Zivadinov R, Kim M, Sharma UC. Tagged cine magnetic resonance imaging to quantify regional mechanical changes after acute myocardial infarction. Magn Reson Imaging 2019; 66:208-218. [PMID: 31668928 DOI: 10.1016/j.mri.2019.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE The conventional volumetric approaches of measuring cardiac function are load-dependent, and are not able to discriminate functional changes in the infarct, transition and remote myocardium. We examined phase-dependent regional mechanical changes in the infarct, transition and remote regions after acute myocardial infarction (MI) in a preclinical mouse model using cardiovascular magnetic resonance imaging (CMR). METHODS We induced acute MI in six mice with left anterior descending coronary artery ligation. We then examined cardiac (infarct, transition and remote-zone) morphology and function utilizing 9.4 T high field CMR before and 2 weeks after the induction of acute MI. Myocardial scar tissue was evaluated by using CMR with late gadolinium enhancement (LGE). After determining global function through volumetric analysis, regional wall motion was evaluated by measuring wall thickening and radial velocities. Strain rate imaging was performed to assess circumferential contraction and relaxation at the myocardium, endocardium, and epicardium. RESULTS There was abnormal LGE in the anterior walls after acute MI suggesting a successful MI procedure. The transition zone consisted of a mixed signal intensity, while the remote zone contained viable myocardium. As expected, the infarct zone had demonstrated severely decreased myocardial velocities and strain rates, suggesting reduced contraction and relaxation function. Compared to pre-infarct baseline, systolic and diastolic velocities (vS and vD) were significantly reduced at the transition zone (vS: -1.86 ± 0.16 cm/s vs -0.68 ± 0.13 cm/s, P < 0.001; vD: 1.86 ± 0.17 cm/s vs 0.53 ± 0.06 cm/s, P < 0.001) and remote zone (vS: -1.86 ± 0.16 cm/s vs -0.65 ± 0.12 cm/s, P < 0.001; vD: 1.86 ± 0.16 cm/s vs 0.51 ± 0.04 cm/s, P < 0.001). Myocardial peak systolic and diastolic strain rates (SRS and SRD) were significantly lower in the transition zone (SRS: -4.2 ± 0.3 s-1 vs -1.3 ± 0.2 s-1, P < 0.001; SRD: 3.9 ± 0.3 s-1 vs 1.3 ± 0.2 s-1, P < 0.001) and remote zone (SRS: -3.8 ± 0.3 s-1 vs -1.4 ± 0.3 s-1, P < 0.001; SRD: 3.5 ± 0.2 s-1 vs 1.5 ± 0.4 s-1, P = 0.006). Endocardial and epicardial SRS and SRD were similarly reduced in the transition and remote zones compared to baseline. CONCLUSIONS This study, for the first time, utilized state-of-the art high-field CMR algorithms in a preclinical mouse model for a comprehensive and controlled evaluation of the regional mechanical changes in the transition and remote zones, after acute MI. Our data demonstrate that CMR can quantitatively monitor dynamic post-MI remodeling in the transition and remote zones, thereby serving as a gold standard tool for therapeutic surveillance.
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Affiliation(s)
- Badri Karthikeyan
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Swati D Sonkawade
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Saraswati Pokharel
- Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Marilena Preda
- Center for Biomedical Imaging at the Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, United States of America
| | - Ferdinand Schweser
- Center for Biomedical Imaging at the Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, United States of America
| | - Robert Zivadinov
- Center for Biomedical Imaging at the Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, United States of America
| | - Minhyung Kim
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Umesh C Sharma
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America.
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14
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Basic fibroblast growth factor attenuates left-ventricular remodeling following surgical ventricular restoration in a rat ischemic cardiomyopathy model. Gen Thorac Cardiovasc Surg 2019; 68:311-318. [PMID: 31410725 DOI: 10.1007/s11748-019-01187-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Although surgical ventricular restoration for ischemic cardiomyopathy is expected as an alternative or bridge to heart transplantation, post-operative remodeling of left ventricle (LV) needs to be addressed. This study aimed to examine the effect of basic fibroblast growth factor (bFGF), which induces angiogenesis and tissue regeneration in ischemic myocardium, to prevent remodeling after surgical ventricular restoration (SVR) using a rat ischemic cardiomyopathy model. METHODS Four weeks after coronary artery ligation, rats were divided into two groups: rats treated with SVR alone (SVR; n = 21), and rats treated with SVR and local sustained release of bFGF using gelatin hydrogel sheet (SVR + bFGF; n = 22). Cardiac function was assessed by serial echocardiography and cardiac catheterization. Cardiac tissue sections were histologically examined for vascular density and fibrosis. RESULTS Higher systolic function and lower LV end-diastolic pressure (LVEDP) were observed in rats treated with SVR + bFGF (SVR vs SVR + bFGF; Ees: 0.22 ± 0.11 vs 0.33 ± 0.22 mmHg/μL, p = 0.0328; LVEDP: 12.7 ± 7.0 vs 8.5 ± 4.3 mmHg, p = 0.0230). LV area tended to be lower in rats treated with SVR + bFGF compared to rats treated with SVR alone (left-ventricular end-diastolic area: 0.66 ± 0.07 vs 0.62 ± 0.07 cm2, p = 0.071). Vascular density tended to be higher in rats treated with SVR + bFGF than those without bFGF (23.3 ± 8.1 vs 28.8 ± 9.5/mm2, p = 0.0509). CONCLUSIONS BFGF induced angiogenesis and attenuated remodeling after SVR which secured the efficacy of SVR in a rat ischemic cardiomyopathy model.
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15
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Kramer CM. Strain Measures Predict Outcome after ST-Segment-Elevation Myocardial Infarction: Now What? Radiology 2019; 290:338-339. [PMID: 30457483 PMCID: PMC6357983 DOI: 10.1148/radiol.2018182319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher M. Kramer
- From the Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Lee Street, Box 800170, Charlottesville, VA 22908
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16
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Wang H, Rodell CB, Zhang X, Dusaj NN, Gorman JH, Pilla JJ, Jackson BM, Burdick JA, Gorman RC, Wenk JF. Effects of hydrogel injection on borderzone contractility post-myocardial infarction. Biomech Model Mechanobiol 2018; 17:1533-1542. [PMID: 29855734 PMCID: PMC10538855 DOI: 10.1007/s10237-018-1039-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023]
Abstract
Injectable hydrogels are a potential therapy for mitigating adverse left ventricular (LV) remodeling after myocardial infarction (MI). Previous studies using magnetic resonance imaging (MRI) have shown that hydrogel treatment improves systolic strain in the borderzone (BZ) region surrounding the infarct. However, the corresponding contractile properties of the BZ myocardium are still unknown. The goal of the current study was to quantify the in vivo contractile properties of the BZ myocardium post-MI in an ovine model treated with an injectable hydrogel. Contractile properties were determined 8 weeks following posterolateral MI by minimizing the difference between in vivo strains and volume calculated from MRI and finite element model predicted strains and volume. This was accomplished by using a combination of MRI, catheterization, finite element modeling, and numerical optimization. Results show contractility in the BZ of animals treated with hydrogel injection was significantly higher than untreated controls. End-systolic (ES) fiber stress was also greatly reduced in the BZ of treated animals. The passive stiffness of the treated infarct region was found to be greater than the untreated control. Additionally, the wall thickness in the infarct and BZ regions was found to be significantly higher in the treated animals. Treatment with hydrogel injection significantly improved BZ function and reduced LV remodeling, via altered MI properties. These changes are linked to a reduction in the ES fiber stress in the BZ myocardium surrounding the infarct. The current results imply that injectable hydrogels could be a viable therapy for maintaining LV function post-MI.
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Affiliation(s)
- Hua Wang
- Department of Mechanical Engineering, University of Kentucky, 269 Ralph G. Anderson Building, Lexington, KY, 40506-0503, USA
- Department of Mechanical Engineering, Ludong University, Yantai, Shandong, China
| | - Christopher B Rodell
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Xiaoyan Zhang
- Department of Mechanical Engineering, University of Kentucky, 269 Ralph G. Anderson Building, Lexington, KY, 40506-0503, USA
| | - Neville N Dusaj
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - James J Pilla
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jason A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jonathan F Wenk
- Department of Mechanical Engineering, University of Kentucky, 269 Ralph G. Anderson Building, Lexington, KY, 40506-0503, USA.
- Department of Surgery, University of Kentucky, Lexington, KY, 40506, USA.
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17
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Zhang X, Medrano-Gracia P, Ambale-Venkatesh B, Bluemke DA, Cowan BR, Finn JP, Kadish AH, Lee DC, Lima JAC, Young AA, Suinesiaputra A. Orthogonal decomposition of left ventricular remodeling in myocardial infarction. Gigascience 2017; 6:1-15. [PMID: 28327972 PMCID: PMC5791439 DOI: 10.1093/gigascience/gix005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/29/2017] [Indexed: 01/19/2023] Open
Abstract
Left ventricular size and shape are important for quantifying cardiac remodeling in
response to cardiovascular disease. Geometric remodeling indices have
been shown to have prognostic value in predicting adverse events in the clinical
literature, but these often describe interrelated shape changes. We developed a novel
method for deriving orthogonal remodeling components directly from any
(moderately independent) set of clinical remodeling indices. Results: Six clinical
remodeling indices (end-diastolic volume index, sphericity, relative wall thickness,
ejection fraction, apical conicity, and longitudinal shortening) were evaluated using
cardiac magnetic resonance images of 300 patients with myocardial infarction, and 1991
asymptomatic subjects, obtained from the Cardiac Atlas Project. Partial least squares
(PLS) regression of left ventricular shape models resulted in remodeling
components that were optimally associated with each remodeling index. A
Gram–Schmidt orthogonalization process, by which remodeling components were successively
removed from the shape space in the order of shape variance explained, resulted in a set
of orthonormal remodeling components. Remodeling scores could then be
calculated that quantify the amount of each remodeling component present in each case. A
one-factor PLS regression led to more decoupling between scores from the different
remodeling components across the entire cohort, and zero correlation between clinical
indices and subsequent scores. Conclusions: The PLS orthogonal remodeling components had
similar power to describe differences between myocardial infarction patients and
asymptomatic subjects as principal component analysis, but were better associated with
well-understood clinical indices of cardiac remodeling. The data and analyses are
available from www.cardiacatlas.org.
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Affiliation(s)
- Xingyu Zhang
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Pau Medrano-Gracia
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Bharath Ambale-Venkatesh
- The Donald W. Reynolds Cardiovascular Clinical Research Center, The Johns Hopkins University, Baltimore, USA
| | - David A Bluemke
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA
| | - Brett R Cowan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - J Paul Finn
- Department of Radiology, UCLA, Los Angeles, USA
| | - Alan H Kadish
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Daniel C Lee
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Joao A C Lima
- The Donald W. Reynolds Cardiovascular Clinical Research Center, The Johns Hopkins University, Baltimore, USA
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Avan Suinesiaputra
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
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18
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Lopez D, Pan JA, Pollak PM, Clarke S, Kramer CM, Yeager M, Salerno M. Multiparametric CMR imaging of infarct remodeling in a percutaneous reperfused Yucatan mini-pig model. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3693. [PMID: 28164391 PMCID: PMC5488275 DOI: 10.1002/nbm.3693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
To further understanding of the temporal evolution and pathophysiology of adverse ventricular remodeling over the first 60 days following a myocardial infarction (MI) in both the infarcted and remote myocardium, we performed multi-parametric cardiac magnetic resonance (CMR) imaging in a closed-chest chronic Yucatan mini-pig model of reperfused MI. Ten animals underwent 90 min left anterior descending artery occlusion and reperfusion. Three animals served as controls. Multiparametric CMR (1.5T) was performed at baseline, Day 2, Day 30 and in four animals on Day 60 after MI. Left ventricular (LV) volumes and infarct size were measured. T1 and T2 mapping sequences were performed to measure values in the infarct and remote regions. Remote region collagen fractions were compared between infarcted animals and controls. Procedure success was 80%. The model created large infarcts (28 ± 5% of LV mass on Day 2), which led to significant adverse myocardial remodeling that stabilized beyond 30 days. Native T1 values did not reliably differentiate remote and infarct regions acutely. There was no evidence of remote fibrosis as indicated by partition coefficient and collagen fraction analyses. The infarct T2 values remained elevated up to 60 days after MI. Multiparametric CMR in this model showed significant adverse ventricular remodeling 30 days after MI similar to that seen in humans. In addition, this study demonstrated that remote fibrosis is absent and that infarct T2 signal remains chronically elevated in this model. These findings need to be considered when designing preclinical trials using CMR endpoints.
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Affiliation(s)
- David Lopez
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jonathan A. Pan
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - Peter M. Pollak
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Samantha Clarke
- Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M. Kramer
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Mark Yeager
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Molecular Physiology & Biological Physics, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael Salerno
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
- Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
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Left Ventricular Unloading After Acute Myocardial Infarction Reduces MMP/JNK Associated Apoptosis and Promotes FAK Cell-Survival Signaling. Ann Thorac Surg 2016; 102:1919-1924. [PMID: 27378553 DOI: 10.1016/j.athoracsur.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/28/2016] [Accepted: 05/02/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The mechanism underlying left ventricular remodeling and reverse remodeling in the setting of mechanical support following acute myocardial infarction (MI) is unclear. We tested the hypothesis that left ventricular assist device (LVAD) unloading can decrease apoptotic signals after MI. METHODS An MI model was created in 16 sheep by coronary artery ligation. Eight were unloaded with a LVAD during the first 2 weeks after MI and observed for 10 more weeks. Myocardial tissue was collected from the nonischemic adjacent zone and the remote zone. Proteins in the apoptotic matrix metalloproteinases (MMPs)-2/c-Jun N-terminal kinase (JNK) and prosurvival β1D-integrin/focal adhesion kinase (FAK) pathway were quantified. RESULTS Increased TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling) positive nuclei were observed in the MI group and to a lesser extent in the LVAD group (6.18 ± 0.26 versus 0.82 ± 0.18; p < 0.05). Pro-MMP-2, MMP-2, JNK, and phosphorylated (p)-JNK were all elevated in the adjacent zone of the MI-only group but not in the adjacent zone of the LVAD-supported group. There were higher levels of prosurvival p-FAK in the LVAD-supported group than in the MI group. CONCLUSIONS MMP-2/JNK apoptotic and β1D-integrin/FAK survival pathways are activated in the nonischemic adjacent zone after MI in adult sheep. LVAD unloading of approximately 50% cardiac output for 2 weeks attenuates remodeling in part by its negative effect on stretch-induced apoptosis and inhibition of MMP-2 activity.
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Loutfi M, Ashour S, El-Sharkawy E, El-Fawal S, El-Touny K. Identification of High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction using Strain Doppler Echocardiography: Correlation with Cardiac Magnetic Resonance Imaging. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:51-9. [PMID: 27199575 PMCID: PMC4863927 DOI: 10.4137/cmc.s35734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Assessment of left ventricular (LV) function is important for decision-making and risk stratification in patients with acute coronary syndrome. Many patients with non-ST segment elevation myocardial infarction (NSTEMI) have substantial infarction, but these patients often do not reveal clinical signs of instability, and they rarely fulfill criteria for acute revascularization therapy. AIM This study evaluated the potential of strain Doppler echocardiography analysis for the assessment of LV infarct size when compared with standard two-dimensional echo and cardiac magnetic resonance (CMR) data. METHODS Thirty patients with NSTEMI were examined using echocardiography after hospitalization for 1.8 ± 1.1 days for the assessment of left ventricular ejection fraction, wall motion score index (WMSI), and LV global longitudinal strain (GLS). Infarct size was assessed using delayed enhancement CMR 6.97 ± 3.2 days after admission as a percentage of total myocardial volume. RESULTS GLS was performed in 30 patients, and 82.9% of the LV segments were accepted for GLS analysis. Comparisons between patients with a complete set of GLS and standard echo, GLS and CMR were performed. The linear relationship demonstrated moderately strong and significant associations between GLS and ejection fraction (EF) as determined using standard echo (r = 0.452, P = 0.012), WMSI (r = 0.462, P = 0.010), and the gold standard CMR-determined EF (r = 0.57, P < 0.001). Receiver operating characteristic curves were used to analyze the ability of GLS to evaluate infarct size. GLS was the best predictor of infarct size in a multivariate linear regression analysis (β = 1.51, P = 0.027). WMSI >1.125 and a GLS cutoff value of -11.29% identified patients with substantial infarction (≥12% of total myocardial volume measured using CMR) with accuracies of 76.7% and 80%, respectively. However, GLS remained the only independent predictor in a multivariate logistic regression analysis to identify an infarct size ≥12%. CONCLUSION GLS is a good predictor of infarct size in NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high-risk NSTEMI patients.
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Affiliation(s)
- Mohamed Loutfi
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sanaa Ashour
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman El-Sharkawy
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sara El-Fawal
- Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Karim El-Touny
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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21
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Ge L, Wu Y, Soleimani M, Khazalpour M, Takaba K, Tartibi M, Zhang Z, Acevedo-Bolton G, Saloner DA, Wallace AW, Mishra R, Grossi EA, Guccione JM, Ratcliffe MB. Moderate Ischemic Mitral Regurgitation After Posterolateral Myocardial Infarction in Sheep Alters Left Ventricular Shear but Not Normal Strain in the Infarct and Infarct Borderzone. Ann Thorac Surg 2016; 101:1691-9. [PMID: 26857634 DOI: 10.1016/j.athoracsur.2015.10.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 10/05/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic ischemic mitral regurgitation (CIMR) is associated with poor outcome. Left ventricular (LV) strain after posterolateral myocardial infarction (MI) may drive LV remodeling. Although moderate CIMR has been previously shown to affect LV remodeling, the effect of CIMR on LV strain after posterolateral MI remains unknown. We tested the hypothesis that moderate CIMR alters LV strain after posterolateral MI. METHODS Posterolateral MI was created in 10 sheep. Cardiac magnetic resonance imaging with tags was performed 2 weeks before and 2, 8, and 16 weeks after MI. The left and right ventricular volumes were measured, and regurgitant volume indexed to body surface area (regurgitant volume index) was calculated as the difference between left ventricle and right ventricle stroke volumes divided by body surface area. Three-dimensional strain was calculated. RESULTS Circumferential strain (Ecc) and longitudinal strain (Ell) were reduced in the infarct proper, MI borderzone, and remote myocardium 16 weeks after MI. In addition, radial circumferential (Erc) and radial longitudinal (Erl) shear strains were reduced in remote myocardium but increased in the infarct and borderzone 16 weeks after MI. Of all strain components, however, only Erc was affected by regurgitant volume index (p = 0.0005). There was no statistically significant effect of regurgitant volume index on Ecc, Ell, Erl, or circumferential longitudinal shear strain (Ecl). CONCLUSIONS Moderate CIMR alters radial circumferential shear strain after posterolateral MI in sheep. Further studies are needed to determine the effect of shear strain on myocyte hypertrophy and the effect of mitral repair on myocardial strain.
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Affiliation(s)
- Liang Ge
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Yife Wu
- Veterans Affairs Medical Center, San Francisco, California
| | | | | | - Kiyoaki Takaba
- Veterans Affairs Medical Center, San Francisco, California
| | | | - Zhihong Zhang
- Veterans Affairs Medical Center, San Francisco, California
| | - Gabriel Acevedo-Bolton
- Department of Radiology, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - David A Saloner
- Department of Radiology, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Arthur W Wallace
- Department of Anesthesia, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Rakesh Mishra
- Department of Medicine, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Julius M Guccione
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Mark B Ratcliffe
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
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22
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Richardson WJ, Clarke SA, Quinn TA, Holmes JW. Physiological Implications of Myocardial Scar Structure. Compr Physiol 2015; 5:1877-909. [PMID: 26426470 DOI: 10.1002/cphy.c140067] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Once myocardium dies during a heart attack, it is replaced by scar tissue over the course of several weeks. The size, location, composition, structure, and mechanical properties of the healing scar are all critical determinants of the fate of patients who survive the initial infarction. While the central importance of scar structure in determining pump function and remodeling has long been recognized, it has proven remarkably difficult to design therapies that improve heart function or limit remodeling by modifying scar structure. Many exciting new therapies are under development, but predicting their long-term effects requires a detailed understanding of how infarct scar forms, how its properties impact left ventricular function and remodeling, and how changes in scar structure and properties feed back to affect not only heart mechanics but also electrical conduction, reflex hemodynamic compensations, and the ongoing process of scar formation itself. In this article, we outline the scar formation process following a myocardial infarction, discuss interpretation of standard measures of heart function in the setting of a healing infarct, then present implications of infarct scar geometry and structure for both mechanical and electrical function of the heart and summarize experiences to date with therapeutic interventions that aim to modify scar geometry and structure. One important conclusion that emerges from the studies reviewed here is that computational modeling is an essential tool for integrating the wealth of information required to understand this complex system and predict the impact of novel therapies on scar healing, heart function, and remodeling following myocardial infarction.
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Affiliation(s)
- William J Richardson
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, USA
| | - Samantha A Clarke
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - T Alexander Quinn
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, USA
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Lee LC, Sundnes J, Genet M, Wenk JF, Wall ST. An integrated electromechanical-growth heart model for simulating cardiac therapies. Biomech Model Mechanobiol 2015; 15:791-803. [PMID: 26376641 DOI: 10.1007/s10237-015-0723-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/25/2015] [Indexed: 01/27/2023]
Abstract
An emerging class of models has been developed in recent years to predict cardiac growth and remodeling (G&R). We recently developed a cardiac G&R constitutive model that predicts remodeling in response to elevated hemodynamics loading, and a subsequent reversal of the remodeling process when the loading is reduced. Here, we describe the integration of this G&R model to an existing strongly coupled electromechanical model of the heart. A separation of timescale between growth deformation and elastic deformation was invoked in this integrated electromechanical-growth heart model. To test our model, we applied the G&R scheme to simulate the effects of myocardial infarction in a realistic left ventricular (LV) geometry using the finite element method. We also simulate the effects of a novel therapy that is based on alteration of the infarct mechanical properties. We show that our proposed model is able to predict key features that are consistent with experiments. Specifically, we show that the presence of a non-contractile infarct leads to a dilation of the left ventricle that results in a rightward shift of the pressure volume loop. Our model also predicts that G&R is attenuated by a reduction in LV dilation when the infarct stiffness is increased.
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Affiliation(s)
- Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA.
| | | | - Martin Genet
- Institute of Biomedical Engineering, ETH Zurich, Zurich, Switzerland
| | - Jonathan F Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA
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24
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Park CH, Choi EY, Yoon YW, Kwon HM, Hong BK, Lee BK, Min PK, Greiser A, Paek MY, Hwang SH, Kim TH. Quantitative T2 mapping after reperfusion therapy in patients with acute myocardial infarction: A comparison with late gadolinium enhancement and cine MR imaging. Magn Reson Imaging 2015; 33:1246-1252. [PMID: 26278969 DOI: 10.1016/j.mri.2015.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/07/2015] [Accepted: 08/08/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluates myocardial edema by quantitative T2 mapping in patients with acute myocardial infarction (AMI) and compares the lateral extent of myocardial edema with those of infarcted and dysfunctional myocardium. MATERIALS AND METHODS Cardiac magnetic resonance images (MRIs) of 31 patients (M:F=29:2, mean age: 52.5±10.8years) with AMI were reviewed. On cine-MRI, all short axis images of the left ventricle (LV) were divided into 60 sectors. The regional wall motion of each sector was calculated as follows: systolic wall thickening (SWT, %)=[(LV wall thicknessES-LV wall thicknessED)/LV wall thicknessED]*100. Dysfunctional myocardium was defined as sectors with decreased SWT lower than 40%. On LGE-images, myocardial infarction was defined as an area of hyper-enhancement more than 5 SDs from the remote myocardium. On T2 map, myocardial edema was defined as an area in which T2 values were at least 2 SDs higher than those from remote myocardium. The lateral extents of infarcted myocardium, myocardial edema, and dysfunctional myocardium were calculated as the percentage of central angles ((central angle of the involved myocardium/360)*100 (%)) and then compared. RESULTS The lateral extent of myocardial edema was slightly larger than that of infarcted myocardium (37.4±13.3% vs. 35±12.9%, p<0.01). The lateral extent of dysfunctional myocardium (50.6±15.3%) was significantly larger than that of infarcted myocardium or myocardial edema (p<0.001). CONCLUSIONS The lateral extent of myocardial edema beyond the infarcted myocardium might be narrow, but the dysfunctional myocardium could be significantly larger than myocardial edema, suggesting stunned myocardium without edema.
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Affiliation(s)
- Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea
| | - Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Won Yoon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck Moon Kwon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bum Kee Hong
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Ki Min
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Sung Ho Hwang
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720, Republic of Korea.
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25
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Bière L, Mateus V, Clerfond G, Grall S, Willoteaux S, Prunier F, Furber A. Predictive Factors of Pericardial Effusion After a First Acute Myocardial Infarction and Successful Reperfusion. Am J Cardiol 2015; 116:497-503. [PMID: 26070221 DOI: 10.1016/j.amjcard.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 11/18/2022]
Abstract
The aim of the study was to identify the determinants of pericardial effusion (PE) after a first myocardial infarction (MI). Cardiac magnetic resonance enables early analysis of multiple post-MI parameters; 193 patients with a first ST-elevation MI admitted to the Angers University Hospital (France) were enrolled prospectively. Cardiac magnetic resonance was performed at baseline (median of 5 days [4 to 7]) and repeated at a 3-month follow-up to investigate left ventricular (LV) volumes, LV ejection fraction, infarct size, microvascular obstruction (MVO), systolic wall stress (SWS), and PE presence and extent. A 1-year follow-up was also performed. Overall, 113 patients (58.5%) showed a PE with a median size of 31.6 ± 24.0 ml in the event that a PE was present. Patients with PE typically presented larger initial infarct sizes and LV volumes, and higher SWS, with more depressed LV ejection fraction and more frequent MVO and pleural effusions. Patients with PE exhibited higher rates of heart failure during hospitalization. At follow-up, there was no relevant PE, with no pericardiocentesis required. The multivariate analysis revealed SWS (odds ratio [OR] 1.092 [95% CI 1.007 to 1.184], p = 0.042), infarct size (OR 1.048 [95% CI 1.014 to 1.083], p = 0.003), and MVO extent (OR 1.274 [95% CI 1.028 to 1.579], p = 0.018) to be independent predictors for PE presence and volume. One patient died of LV free wall rupture during initial hospitalization, with only "small" PE found. In conclusion, infarct size, MVO, and SWS were independently related to PE presence and volume. Post-MI PE was found in 58.5% of cases, being regressive at follow-up. Among these patients with early reperfusion and optimal medical therapy, PE volume did not seem to be related to future clinical events.
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Affiliation(s)
- Loïc Bière
- L'UNAM Université, Angers, France; Laboratoire Cardioprotection, Université d'Angers, Remodelage et Thrombose, UPRES 3860, CHU d'Angers, Department of Cardiology, Angers, France.
| | - Victor Mateus
- L'UNAM Université, Angers, France; Laboratoire Cardioprotection, Université d'Angers, Remodelage et Thrombose, UPRES 3860, CHU d'Angers, Department of Cardiology, Angers, France
| | - Guillaume Clerfond
- L'UNAM Université, Angers, France; Laboratoire Cardioprotection, Université d'Angers, Remodelage et Thrombose, UPRES 3860, CHU d'Angers, Department of Cardiology, Angers, France
| | - Sylvain Grall
- L'UNAM Université, Angers, France; Laboratoire Cardioprotection, Université d'Angers, Remodelage et Thrombose, UPRES 3860, CHU d'Angers, Department of Cardiology, Angers, France
| | - Serge Willoteaux
- L'UNAM Université, Angers, France; Université d'Angers, CHU d'Angers, Department of Cardiology, Angers, France
| | - Fabrice Prunier
- L'UNAM Université, Angers, France; Laboratoire Cardioprotection, Université d'Angers, Remodelage et Thrombose, UPRES 3860, CHU d'Angers, Department of Cardiology, Angers, France
| | - Alain Furber
- L'UNAM Université, Angers, France; Laboratoire Cardioprotection, Université d'Angers, Remodelage et Thrombose, UPRES 3860, CHU d'Angers, Department of Cardiology, Angers, France
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Dorsey SM, McGarvey JR, Wang H, Nikou A, Arama L, Koomalsingh KJ, Kondo N, Gorman JH, Pilla JJ, Gorman RC, Wenk JF, Burdick JA. MRI evaluation of injectable hyaluronic acid-based hydrogel therapy to limit ventricular remodeling after myocardial infarction. Biomaterials 2015; 69:65-75. [PMID: 26280951 DOI: 10.1016/j.biomaterials.2015.08.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 11/19/2022]
Abstract
Injectable biomaterials are an attractive therapy to attenuate left ventricular (LV) remodeling after myocardial infarction (MI). Although studies have shown that injectable hydrogels improve cardiac structure and function in vivo, temporal changes in infarct material properties after treatment have not been assessed. Emerging imaging and modeling techniques now allow for serial, non-invasive estimation of infarct material properties. Specifically, cine magnetic resonance imaging (MRI) assesses global LV structure and function, late-gadolinium enhancement (LGE) MRI enables visualization of infarcted tissue to quantify infarct expansion, and spatial modulation of magnetization (SPAMM) tagging provides passive wall motion assessment as a measure of tissue strain, which can all be used to evaluate infarct properties when combined with finite element (FE) models. In this work, we investigated the temporal effects of degradable hyaluronic acid (HA) hydrogels on global LV remodeling, infarct thinning and expansion, and infarct stiffness in a porcine infarct model for 12 weeks post-MI using MRI and FE modeling. Hydrogel treatment led to decreased LV volumes, improved ejection fraction, and increased wall thickness when compared to controls. FE model simulations demonstrated that hydrogel therapy increased infarct stiffness for 12 weeks post-MI. Thus, evaluation of myocardial tissue properties through MRI and FE modeling provides insight into the influence of injectable hydrogel therapies on myocardial structure and function post-MI.
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Affiliation(s)
- Shauna M Dorsey
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeremy R McGarvey
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hua Wang
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40506, USA
| | - Amir Nikou
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40506, USA
| | - Leron Arama
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin J Koomalsingh
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Norihiro Kondo
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James J Pilla
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jonathan F Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40506, USA; Department of Surgery, University of Kentucky, Lexington, KY 40506, USA
| | - Jason A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Garza MA, Wason EA, Zhang JQ. Cardiac remodeling and physical training post myocardial infarction. World J Cardiol 2015; 7:52-64. [PMID: 25717353 PMCID: PMC4325302 DOI: 10.4330/wjc.v7.i2.52] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 12/22/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
After myocardial infarction (MI), the heart undergoes extensive myocardial remodeling through the accumulation of fibrous tissue in both the infarcted and noninfarcted myocardium, which distorts tissue structure, increases tissue stiffness, and accounts for ventricular dysfunction. There is growing clinical consensus that exercise training may beneficially alter the course of post-MI myocardial remodeling and improve cardiac function. This review summarizes the present state of knowledge regarding the effect of post-MI exercise training on infarcted hearts. Due to the degree of difficulty to study a viable human heart at both protein and molecular levels, most of the detailed studies have been performed by using animal models. Although there are some negative reports indicating that post-MI exercise may further cause deterioration of the wounded hearts, a growing body of research from both human and animal experiments demonstrates that post-MI exercise may beneficially alter the course of wound healing and improve cardiac function. Furthermore, the improved function is likely due to exercise training-induced mitigation of renin-angiotensin-aldosterone system, improved balance between matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1, favorable myosin heavy chain isoform switch, diminished oxidative stress, enhanced antioxidant capacity, improved mitochondrial calcium handling, and boosted myocardial angiogenesis. Additionally, meta-analyses revealed that exercise-based cardiac rehabilitation has proven to be effective, and remains one of the least expensive therapies for both the prevention and treatment of cardiovascular disease, and prevents re-infarction.
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McGarvey JR, Kondo N, Witschey WRT, Takebe M, Aoki C, Burdick JA, Spinale FG, Gorman JH, Pilla JJ, Gorman RC. Injectable microsphere gel progressively improves global ventricular function, regional contractile strain, and mitral regurgitation after myocardial infarction. Ann Thorac Surg 2015; 99:597-603. [PMID: 25524397 PMCID: PMC4314332 DOI: 10.1016/j.athoracsur.2014.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is continued need for therapies which reverse or abate the remodeling process after myocardial infarction (MI). In this study, we evaluate the longitudinal effects of calcium hydroxyapatite microsphere gel on regional strain, global ventricular function, and mitral regurgitation (MR) in a porcine MI model. METHODS Twenty-five Yorkshire swine were enrolled. Five were dedicated weight-matched controls. Twenty underwent posterolateral infarction by direct ligation of the circumflex artery and its branches. Infarcted animals were randomly divided into the following 4 groups: 1-week treatment; 1-week control; 4-week treatment; and 4-week control. After infarction, animals received either twenty 150 μL calcium hydroxyapatite gel or saline injections within the infarct. At their respective time points, echocardiograms, cardiac magnetic resonance imaging, and tissue were collected for evaluation of MR, regional and global left ventricular function, wall thickness, and collagen content. RESULTS Global and regional left ventricular functions were depressed in all infarcted subjects at 1 week compared with healthy controls. By 4-weeks post-infarction, global function had significantly improved in the calcium hydroxyapatite group compared with infarcted controls (ejection fraction 0.485 ± 0.019 vs 0.38 ± 0.017, p < 0.01). Similarly, regional borderzone radial contractile strain (16.3% ± 1.5% vs 11.2% ± 1.5%, p = 0.04), MR grade (0.4 ± 0.2 vs 1.2 ± 0.2, p = 0.04), and infarct thickness (7.8 ± 0.5 mm vs 4.5 ± 0.2 mm, p < 0.01) were improved at this time point in the treatment group compared with infarct controls. CONCLUSIONS Calcium hydroxyapatite injection after MI progressively improves global left ventricular function, borderzone function, and mitral regurgitation. Using novel biomaterials to augment infarct material properties is a viable alternative in the current management of heart failure.
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Affiliation(s)
- Jeremy R McGarvey
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Norihiro Kondo
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter R T Witschey
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Manabu Takebe
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chikashi Aoki
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis G Spinale
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James J Pilla
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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Pahlm US, Ubachs JFA, Heiberg E, Engblom H, Erlinge D, Götberg M, Arheden H. Regional wall function before and after acute myocardial infarction; an experimental study in pigs. BMC Cardiovasc Disord 2014; 14:118. [PMID: 25218585 PMCID: PMC4169797 DOI: 10.1186/1471-2261-14-118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022] Open
Abstract
Background Left ventricular function is altered during and after AMI. Regional function can be determined by cardiac magnetic resonance (CMR) wall thickening, and velocity encoded (VE) strain analysis. The aims of this study were to investigate how regional myocardial wall function, assessed by CMR VE-strain and regional wall thickening, changes after acute myocardial infarction, and to determine if we could differentiate between ischemic, adjacent and remote segments of the left ventricle. Methods Ten pigs underwent baseline CMR study for assessment of wall thickening and VE-strain. Ischemia was then induced for 40-minutes by intracoronary balloon inflation in the left anterior descending coronary artery. During occlusion, 99mTc tetrofosmin was administered intravenously and myocardial perfusion SPECT (MPS) was performed for determination of the ischemic area, followed by a second CMR study. Based on ischemia seen on MPS, the 17 AHA segments of the left ventricle was divided into 3 different categories (ischemic, adjacent and remote). Regional wall function measured by wall thickening and VE-strain analysis was determined before and after ischemia. Results Mean wall thickening decreased significantly in the ischemic (from 2.7 mm to 0.65 mm, p < 0.001) and adjacent segments (from 2.4 to 1.5 mm p < 0.001). In remote segments, wall thickening increased significantly (from 2.4 mm to 2.8 mm, p < 0.01). In ischemic and adjacent segments, both radial and longitudinal strain was significantly decreased after ischemia (p < 0.001). In remote segments there was a significant increase in radial strain (p = 0.002) while there was no difference in longitudinal strain (p = 0.69). ROC analysis was performed to determine thresholds distinguishing between the different regions. Sensitivity for determining ischemic segments ranged from 70-80%, and specificity from 72%-77%. There was a 9% increase in left ventricular mass after ischemia. Conclusion Differentiation thresholds for wall thickening and VE-strain could be established to distinguish between ischemic, adjacent and remote segments but will, have limited applicability due to low sensitivity and specificity. There is a slight increase in radial strain in remote segments after ischemia. Edema was present mainly in the ischemic region but also in the combined adjacent and remote segments.
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Affiliation(s)
| | | | | | | | | | | | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University Hospital, SE-22185 Lund, Sweden.
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Pozo E, Sanz J. Técnicas de imagen en la evaluación de la función y cicatriz tras el infarto. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pozo E, Sanz J. Imaging techniques in the evaluation of post-infarction function and scar. ACTA ACUST UNITED AC 2014; 67:754-64. [PMID: 25172072 DOI: 10.1016/j.rec.2014.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
Imaging techniques are essential in the clinical evaluation of patients with a myocardial infarction. They are of value for both initial assessment of the ischemic injury and for detection of the subgroup of patients at higher risk of developing cardiovascular events during follow-up. Echocardiography remains the technique of choice for the initial evaluation, owing to its bedside capability to determine strong predictors, such as ventricular volumes, global and regional systolic function, and valvular regurgitation. New techniques for evaluating ventricular mechanics, mainly assessment of ventricular deformation, are revealing important aspects of post-infarction ventricular adaptation. The main alternative to echocardiography is cardiac magnetic resonance imaging. This technique is highly accurate for determining ventricular volumes and ventricular function and has the additional advantage of being able to characterize the myocardium and demonstrate changes associated with the ischemic insult such as necrosis/fibrosis, edema, microvascular obstruction, and intramyocardial hemorrhage. These features not only allow detection and quantification of the infarct size, but also reveal additional characteristics of the scar tissue with prognostic value.
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Affiliation(s)
- Eduardo Pozo
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine, New York, United States; Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine, New York, United States.
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Faria-Costa G, Leite-Moreira A, Henriques-Coelho T. Cardiovascular effects of the angiotensin type 2 receptor. Rev Port Cardiol 2014; 33:439-49. [PMID: 25087493 DOI: 10.1016/j.repc.2014.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/02/2014] [Indexed: 02/06/2023] Open
Abstract
The angiotensin type 2 receptor, AT2R, has been described as having opposite effects to the angiotensin type 1 receptor, AT1R. Although the quantities of the AT2R found in the adult are low, its expression rises in pathological situations. The AT2R has three major signaling pathways: activation of serine/threonine phosphatases (promoting apoptosis and antioxidant effects), activation of the bradykinin/NO/cGMP pathway (promoting vasodilation), and activation of phospholipase A2 (associated with regulation of potassium currents). The AT2R appears to have effects in vascular remodeling, atherosclerosis prevention and blood pressure lowering (when associated with an AT1R inhibitor). After myocardial infarction, the AT2R appears to decrease infarct size, cardiac hypertrophy and fibrosis, and to improve cardiac function. However, its role in the heart is controversial. In the kidney, the AT2R promotes natriuresis. Until now, treatment directed at the renin-angiotensin-aldosterone system has been based on angiotensin-converting enzyme inhibitors or angiotensin type 1 receptor blockers. The study of the AT2R has been revolutionized by the discovery of a direct agonist, C21, which promises to become part of the treatment of cardiovascular disease.
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Affiliation(s)
- Gabriel Faria-Costa
- Departamento de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Departamento de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Tiago Henriques-Coelho
- Departamento de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
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Faria-Costa G, Leite-Moreira A, Henriques-Coelho T. Cardiovascular effects of the angiotensin type 2 receptor. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ambale Venkatesh B, Volpe GJ, Donekal S, Mewton N, Liu CY, Shea S, Liu K, Burke G, Wu C, Bluemke DA, Lima JAC. Association of longitudinal changes in left ventricular structure and function with myocardial fibrosis: the Multi-Ethnic Study of Atherosclerosis study. Hypertension 2014; 64:508-15. [PMID: 24914198 DOI: 10.1161/hypertensionaha.114.03697] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The association of longitudinal changes in left ventricular (LV) structure and function with myocardial fibrosis is unclear. We relate temporal changes in body size-indexed LV mass (LVMi) and end-diastolic volume indexed to body surface area, LV mass-to-volume ratio, and LV ejection fraction (LVEF) from cine cardiac magnetic resonance for 10 years, with replacement scar assessed from late gadolinium enhancement, and lower postcontrast T1 times reflecting greater diffuse myocardial fibrosis measured at the end of the follow-up period. All participants (n=1813) who underwent cardiac magnetic resonance twice as part of the Multi-Ethnic Study of Atherosclerosis 10 years apart were included. Multivariable logistic and linear regression models adjusted for cardiovascular risk factors measured the association of 10-year changes in LV structure and function, with fibrosis measured at follow-up. The presence of LV scar at year 10 was cross-sectionally associated with higher LVMi (≈10 g/m(2)), higher mass-to-volume ratio (0.1-0.2 g/mL), but lower LVEF (≈4%) and longitudinally with 3% decrease in LVEF and 0.7% greater end-diastolic volume indexed to body surface area in men for 10 years. Lower postcontrast T1 times at year 10 were associated cross-sectionally with lower LVMi (r=0.33), end-diastolic volume indexed to body surface area (r=0.25), and LVEF (in men only: r=0.14) and longitudinally with a decrease in LVMi (r=0.20) and reduction in LVEF (in men only: r=0.15). Sustained hypertension for 10 years was associated with increased LVMi and higher diffuse and replacement fibrosis at follow-up. During a 10-year period, increased concentric hypertrophy in women and LV dilatation in men were associated with replacement fibrosis, whereas decreasing LVMi was associated with diffuse fibrosis. Hypertension-induced remodeling was related to enhanced replacement and diffuse fibrosis, as well as hypertrophy.
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Affiliation(s)
- Bharath Ambale Venkatesh
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Gustavo J Volpe
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Sirisha Donekal
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Nathan Mewton
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Chia-Ying Liu
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Steven Shea
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Kiang Liu
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Gregory Burke
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - Colin Wu
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - David A Bluemke
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD
| | - João A C Lima
- From the Department of Radiology (B.A.V.) and Department of Cardiology (G.J.V., S.D., N.M., J.A.C.L.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Columbia University, New York, NY (S.S.); Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL (K.L.); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (G.B.); and Radiology and Imaging Sciences (C.-Y.L., D.A.B.), and Office of Biostatistics Research, National Heart, Lung and Blood Institute (C.W.), National Institutes of Health, Bethesda, MD.
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Compas CB, Wong EY, Huang X, Sampath S, Lin BA, Pal P, Papademetris X, Thiele K, Dione DP, Stacy M, Staib LH, Sinusas AJ, O'Donnell M, Duncan JS. Radial basis functions for combining shape and speckle tracking in 4D echocardiography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1275-89. [PMID: 24893257 PMCID: PMC4283552 DOI: 10.1109/tmi.2014.2308894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Quantitative analysis of left ventricular deformation can provide valuable information about the extent of disease as well as the efficacy of treatment. In this work, we develop an adaptive multi-level compactly supported radial basis approach for deformation analysis in 3D+time echocardiography. Our method combines displacement information from shape tracking of myocardial boundaries (derived from B-mode data) with mid-wall displacements from radio-frequency-based ultrasound speckle tracking. We evaluate our methods on open-chest canines (N=8) and show that our combined approach is better correlated to magnetic resonance tagging-derived strains than either individual method. We also are able to identify regions of myocardial infarction (confirmed by postmortem analysis) using radial strain values obtained with our approach.
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Affiliation(s)
| | - Emily Y. Wong
- Department of Bioengineering, University of Washington, Seattle, WA 98015 USA
| | - Xiaojie Huang
- Department of Electrical Engineering, Yale University, New Haven, CT 06520 USA
| | - Smita Sampath
- Department of Diagnostic Radiology, Yale University, New Haven, CT 06520 USA
| | - Ben A. Lin
- Department of Internal Medicine, Yale University, New Haven, CT 06520 USA
| | - Prasanta Pal
- Department of Diagnostic Radiology, Yale University, New Haven, CT 06520 USA
| | - Xenophon Papademetris
- Departments of Diagnostic Radiology and Biomedical Engineering, Yale University, New Haven, CT 06520 USA
| | - Karl Thiele
- Philips Medical Systems, Andover, MA 01810 USA
| | - Donald P. Dione
- Department of Internal Medicine, Yale University, New Haven, CT 06520 USA
| | - Mitchel Stacy
- Department of Internal Medicine, Yale University, New Haven, CT 06520 USA
| | - Lawrence H. Staib
- Departments of Diagnostic Radiology, Electrical Engineering, and Biomedical Engineering, Yale University, New Haven, CT 06520 USA
| | - Albert J. Sinusas
- Departments of Internal Medicine and Diagnostic Radiology, Yale University, New Haven, CT 06520 USA
| | - Matthew O'Donnell
- Department of Bioengineering, University of Washington, Seattle, WA 98015 USA
| | - James S. Duncan
- Departments of Diagnostic Radiology, Electrical Engineering, and Biomedical Engineering, Yale University, New Haven, CT 06520 USA
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Ohyama Y, Volpe GJ, Lima JAC. Subclinical Myocardial Disease in Heart Failure Detected by CMR. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014; 7:9269. [PMID: 25132911 DOI: 10.1007/s12410-014-9269-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Noninvasive cardiac imaging plays a central role in the assessment of patients with heart failure at all stages of disease. Moreover, this role can be even more important for individuals with asymptomatic cardiac functional or structural abnormalities-subclinical myocardial disease - because they could have benefits from early interventions before the onset of clinical heart failure. In this sense, cardiac magnetic resonance offers not only precise global cardiac function and cardiac structure, but also more detailed regional function and tissue characterization by recent developing methods. In this section, some of the main methods available for subclinical myocardial disease detection are reviewed in terms of what they can provide and how they can improve heart failure assessment.
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Affiliation(s)
- Yoshiaki Ohyama
- Division of cardiology, Johns Hopkins University, Baltimore, MD, USA, 600N. Wolf Street/Blalock 524, Baltimore, MD, 21287,
| | - Gustavo J Volpe
- Division of cardiology, Johns Hopkins University, Baltimore, MD, USA, 600N. Wolf Street/Blalock 524, Baltimore, MD, 21287,
| | - Joao A C Lima
- Division of cardiology, Johns Hopkins University, Baltimore, MD, USA, 600N. Wolf Street/Blalock 524, Baltimore, MD, 21287,
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Abstract
Magnetic resonance (MR) imaging plays an important role in evaluation of various aspects of myocardial infarction (MI). MR imaging is useful in establishing the diagnosis of acute MI, particularly in patients who present with symptoms of MI but outside the diagnostic time frame of altered cardiac enzyme levels or with clinical features of acute MI but without an angiographic culprit lesion. MR imaging is valuable in establishing a diagnosis of chronic MI and distinguishing this condition from nonischemic cardiomyopathies, mainly through use of delayed-enhancement patterns. MR imaging also provides clinicians with several prognostic indicators that enable risk stratification, such as scar burden, microvascular obstruction, hemorrhage, and peri-infarct ischemia. The extent and transmurality of scar burden have been shown to have independent and incremental prognostic power over a range of left ventricular function. The extent of scarring at MR imaging is an important predictor of successful outcome after revascularization procedures, and extensive scarring in the lateral wall indicates poor outcome after cardiac resynchronization therapy. Scar size at MR imaging is also a useful surrogate end point in clinical trials. Finally, MR imaging can be used to detect complications of MI, such as aneurysms, pericarditis, ventricular septal defect, thrombus, and mitral regurgitation. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125722/-/DC1.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Section, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Milani-Nejad N, Janssen PML. Small and large animal models in cardiac contraction research: advantages and disadvantages. Pharmacol Ther 2014; 141:235-49. [PMID: 24140081 PMCID: PMC3947198 DOI: 10.1016/j.pharmthera.2013.10.007] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 12/22/2022]
Abstract
The mammalian heart is responsible for not only pumping blood throughout the body but also adjusting this pumping activity quickly depending upon sudden changes in the metabolic demands of the body. For the most part, the human heart is capable of performing its duties without complications; however, throughout many decades of use, at some point this system encounters problems. Research into the heart's activities during healthy states and during adverse impacts that occur in disease states is necessary in order to strategize novel treatment options to ultimately prolong and improve patients' lives. Animal models are an important aspect of cardiac research where a variety of cardiac processes and therapeutic targets can be studied. However, there are differences between the heart of a human being and an animal and depending on the specific animal, these differences can become more pronounced and in certain cases limiting. There is no ideal animal model available for cardiac research, the use of each animal model is accompanied with its own set of advantages and disadvantages. In this review, we will discuss these advantages and disadvantages of commonly used laboratory animals including mouse, rat, rabbit, canine, swine, and sheep. Since the goal of cardiac research is to enhance our understanding of human health and disease and help improve clinical outcomes, we will also discuss the role of human cardiac tissue in cardiac research. This review will focus on the cardiac ventricular contractile and relaxation kinetics of humans and animal models in order to illustrate these differences.
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Affiliation(s)
- Nima Milani-Nejad
- Department of Physiology and Cell Biology and D. Davis Heart Lung Institute, College of Medicine, The Ohio State University, OH, USA
| | - Paul M L Janssen
- Department of Physiology and Cell Biology and D. Davis Heart Lung Institute, College of Medicine, The Ohio State University, OH, USA.
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Aguor ENE, Arslan F, van de Kolk CWA, Nederhoff MGJ, Doevendans PA, van Echteld CJA, Pasterkamp G, Strijkers GJ. Quantitative T 2* assessment of acute and chronic myocardial ischemia/reperfusion injury in mice. MAGMA (NEW YORK, N.Y.) 2012; 25:369-79. [PMID: 22327962 PMCID: PMC3458196 DOI: 10.1007/s10334-012-0304-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/21/2012] [Accepted: 01/23/2012] [Indexed: 11/25/2022]
Abstract
OBJECT Imaging of myocardial infarct composition is essential to assess efficacy of emerging therapeutics. T (2) (*) mapping has the potential to image myocardial hemorrhage and fibrosis by virtue of its short T (2) (*) . We aimed to quantify T (2) (*) in acute and chronic myocardial ischemia/reperfusion (I/R) injury in mice. MATERIALS AND METHODS I/R-injury was induced in C57BL/6 mice (n = 9). Sham-operated mice (n = 8) served as controls. MRI was performed at baseline, and 1, 7 and 28 days after surgery. MRI at 9.4 T consisted of Cine, T (2) (*) mapping and late-gadolinium-enhancement (LGE). Mice (n = 6) were histologically assessed for hemorrhage and collagen in the fibrotic scar. RESULTS Baseline T (2) (*) values were 17.1 ± 2.0 ms. At day 1, LGE displayed a homogeneous infarct enhancement. T (2) (*) in infarct (12.0 ± 1.1 ms) and remote myocardium (13.9 ± 0.8 ms) was lower than at baseline. On days 7 and 28, LGE was heterogeneous. T (2) (*) in the infarct decreased to 7.9 ± 0.7 and 6.4 ± 0.7 ms, whereas T (2) (*) values in the remote myocardium were 14.2 ± 1.1 and 15.6 ± 1.0 ms. Histology revealed deposition of iron and collagen in parallel with decreased T (2) (*) . CONCLUSION T (2) (*) values are dynamic during infarct development and decrease significantly during scar maturation. In the acute phase, T (2) (*) values in infarcted myocardium differ significantly from those in the chronic phase. T (2) (*) mapping was able to confirm the presence of a chronic infarction in cases where LGE was inconclusive. Hence, T (2) (*) may be used to discriminate between acute and chronic infarctions.
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Affiliation(s)
- Eissa N. E. Aguor
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Laboratory of Experimental Cardiology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Fatih Arslan
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Laboratory of Experimental Cardiology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Cees W. A. van de Kolk
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Marcel G. J. Nederhoff
- Laboratory of Experimental Cardiology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Cees J. A. van Echteld
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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de Waha S, Desch S, Eitel I, Fuernau G, Lurz P, Leuschner A, Grothoff M, Gutberlet M, Schuler G, Thiele H. Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging. Clin Res Cardiol 2012; 101:487-95. [PMID: 22314277 DOI: 10.1007/s00392-012-0419-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/23/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both infarct size and microvascular obstruction (MO) assessed by cardiac magnetic resonance imaging (CMR) are known to be predictors for adverse clinical outcome after ST-elevation myocardial infarction (STEMI). We hypothesized that a ratio of MO and infarct size (MO/infarct size) might be an even stronger predictor for outcome after STEMI, which has not been investigated yet. METHODS STEMI patients reperfused by primary angioplasty (n = 438) within 12 h after symptom onset underwent contrast-enhanced CMR at a median of 3 days (interquartile range [IQR] 2;4) after the index event. MO and infarct size were measured 15 min after intravenous gadolinium injection. Follow-up was conducted after 19 months (IQR 10;27). The primary end point was defined as a composite of death, non-fatal myocardial reinfarction and congestive heart failure (major adverse cardiac events [MACE]). RESULTS The extent of MO was only weakly correlated with infarct size (r = 0.21, p < 0.001). In a first multivariate analysis including extent of MO, infarct size, ejection fraction, end-systolic and end-diastolic volume, the extent of MO was independently associated with MACE (hazard ratio [HR] 1.03, 95%CI 1.02–1.05, p < 0.001). In a second multivariate analysis including MO/infarct size on top of the extent of MO, infarct size, ejection fraction, end-systolic and end-diastolic volume, MO/infarct size was identified as the strongest independent predictor for MACE (HR 2.22 [95%CI 1.60–3.08, p < 0.001]). CONCLUSIONS In contrast to infarct size, MO is associated with adverse clinical outcome after STEMI even after adjustment for other CMR parameters. However, MO/infarct size is a more powerful predictor for long-term outcome after STEMI than either parameter alone.
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Affiliation(s)
- Suzanne de Waha
- Department of Internal Medicine, Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, Leipzig, 04289, Germany.
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Ultrasound and radiology surrogate endpoints in pharmacological studies. Atherosclerosis 2012; 224:12-24. [DOI: 10.1016/j.atherosclerosis.2012.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/26/2012] [Accepted: 03/29/2012] [Indexed: 11/17/2022]
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Simpson RM, Keegan J, Firmin DN. MR assessment of regional myocardial mechanics. J Magn Reson Imaging 2012; 37:576-99. [PMID: 22826177 DOI: 10.1002/jmri.23756] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/15/2012] [Indexed: 12/30/2022] Open
Abstract
Regional myocardial function can be measured by several MR techniques including tissue tagging, phase velocity mapping, and more recently, displacement encoding with stimulated echoes (DENSE) and strain encoding (SENC). Each of these techniques was developed separately and has undergone significant change since its original implementation. As a result, in the current literature, the common features and the differences between the techniques and what they measure are often unclear and confusing. This review article delivers an extensively referenced introductory text which clarifies the current methodology from the starting point of the Bloch equations. By doing this in a consistent way for each method, the similarities and differences between them are highlighted. In addition, their capabilities and limitations are discussed, together with their relative advantages and disadvantages. While the focus is on sequence design and development, the principal parameters measured by each technique are also summarized, together with brief results, with the reader being directed to the extensive literature on data processing and clinical applications for more detail.
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Affiliation(s)
- Robin M Simpson
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Hospital Trust, London, United Kingdom.
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Vartdal T, Pettersen E, Helle-Valle T, Lyseggen E, Andersen K, Smith HJ, Aaberge L, Smiseth OA, Edvardsen T. Identification of Viable Myocardium in Acute Anterior Infarction Using Duration of Systolic Lengthening by Tissue Doppler Strain: A Preliminary Study. J Am Soc Echocardiogr 2012; 25:718-25. [DOI: 10.1016/j.echo.2012.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Indexed: 01/11/2023]
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Natale L, Napolitano C, Bernardini A, Meduri A, Marano R, Lombardo A, Crea F, Bonomo L. Role of first pass and delayed enhancement in assessment of segmental functional recovery after acute myocardial infarction. Radiol Med 2012; 117:1294-308. [PMID: 22430684 DOI: 10.1007/s11547-012-0812-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/03/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE Assessing myocardial viability is crucial in decision making and prognostic restratification after acute myocardial infarction (MI). A number of noninvasive imaging modalities have been employed in viability identification, but contrast-enhanced magnetic resonance (MR) imaging has been shown to be extremely accurate because of its transmural resolution and precise definition of microvascular obstruction. Our purpose was to assess functional recovery after acute MI, with special focus on the role of infarct transmurality and microvascular obstruction. MATERIALS AND METHODS Forty-six consecutive patients with first acute MI, reperfused by primary percutaneous transluminal coronary angioplasty (PTCA) (n=40) or fibrinolysis (n=6), underwent MR imaging within the first week to assess oedema, microvascular obstruction, function and viability and then again after 4-6 months to assess functional recovery and scar. RESULTS At first MR examination, postcontrast images were analysed according to three patterns, based on a combination of first-pass and delayed-enhancement data: pattern 1 (normal first pass and late hyperenhancement <50% thickness) identified viable myocardium, whereas pattern 2 (late hyperenhancement >50% thickness, with or without first-pass perfusion defect) and pattern 3 (perfusion defect at first pass and late hypoenhancement) recognised nonviable myocardium, with 93% sensitivity, 75% specificity, 92% positive predictive value and 78% negative predictive value for identifying viable tissue. Furthermore, by dividing pattern 2 into two subpatterns, 2A and 2B, based on absence or presence of microvascular obstruction in >50% transmural infarcts, we were able to better identify the segments without recovery or that were nonviable with a 1.39 relative risk of failed recovery. CONCLUSIONS After acute MI, not all infarcts with transmurality >50% can be considered nonviable; microvascular obstruction detected at first pass can help to better stratify these cases.
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Affiliation(s)
- L Natale
- Unità di Risonanza Magnetica, Centro Oncologico Fiorentino, Via Attilio Ragionieri 101, 50119, Sesto Fiorentino, Italy.
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Leonard BL, Smaill BH, LeGrice IJ. Structural remodeling and mechanical function in heart failure. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2012; 18:50-67. [PMID: 22258722 DOI: 10.1017/s1431927611012438] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The cardiac extracellular matrix (ECM) is the three-dimensional scaffold that defines the geometry and muscular architecture of the cardiac chambers and transmits forces produced during the cardiac cycle throughout the heart wall. The cardiac ECM is an active system that responds to the stresses to which it is exposed and in the normal heart is adapted to facilitate efficient mechanical function. There are marked differences in the short- and medium-term changes in ventricular geometry and cardiac ECM that occur as a result of volume overload, hypertension, and ischemic cardiomyopathy. Despite this, there is a widespread view that a common remodeling "phenotype" governs the final progression to end-stage heart failure in different forms of heart disease. In this review article, we make the case that this interpretation is not consistent with the clinical and experimental data on the topic. We argue that there is a need for new theoretical and experimental models that will enable stresses acting on the ECM and resultant deformations to be estimated more accurately and provide better spatial resolution of local signaling mechanisms that are activated as a result. These developments are necessary to link the effects of structural remodeling with altered cardiac mechanical function.
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Affiliation(s)
- Bridget Louise Leonard
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand.
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Function of remote non-infarcted myocardium after STEMI: analysis with cardiovascular magnetic resonance. Int J Cardiovasc Imaging 2012; 28:2057-64. [DOI: 10.1007/s10554-012-0014-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
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BLYAKHMAN FELIXA, MARCHENKO ELENAV, KOLCHANOVA SVETLANAG, ZINOVEVA JULIAA, MIRONKOV BORISL, NAIDICH ANNAM, CHESTUKHIN VASILYV, SHUMAKOV VALERYI. EFFECT OF THE MYOCARDIUM NON-UNIFORMITY ON THE HEART FUNCTIONAL RESERVE. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519405001308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The goal of this study is to understand the role of structural-and-functional inhomogeneity (SFI) in the left ventricular (LV) wall. According to the peculiarities of heart diseases development, we supposed the existence of causal relationship between SFI and the heart functional reserve, i.e. an ability to maintain pump function in case of additional load. Here, we looked into the functional aspect of SFI phenomenon. Sixteen IHD patients with a different extent of coronary artery stenotic lesion were chosen for this investigation. The patients were underwent the transesophageal ultrasound examinations, and LV 3D reconstruction was performed. To estimate the extent of the functional non-uniformity, the myocardium elastic properties in LV wall regions and LV regional motion were defined. We found out a strong inverse correlation between the extent of LV functional non-uniformity and the heart functional reserve, estimated as a patients' tolerance to physical load. We concluded that the transition of functional myocardium non-uniformity due to IHD development reflects the exhaust of heart functional reserve.
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Affiliation(s)
| | - ELENA V. MARCHENKO
- Department of Diagnostics, Institute of Transplantology and Artificial Organs, Moscow, Russia
| | | | | | - BORIS L. MIRONKOV
- Department of Diagnostics, Institute of Transplantology and Artificial Organs, Moscow, Russia
| | - ANNA M. NAIDICH
- Department of Physics, Ural State University, Ekaterinburg, Russia
| | - VASILY V. CHESTUKHIN
- Department of Diagnostics, Institute of Transplantology and Artificial Organs, Moscow, Russia
| | - VALERY I. SHUMAKOV
- Department of Diagnostics, Institute of Transplantology and Artificial Organs, Moscow, Russia
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Wall ST, Guccione JM, Ratcliffe MB, Sundnes JS. Electromechanical feedback with reduced cellular connectivity alters electrical activity in an infarct injured left ventricle: a finite element model study. Am J Physiol Heart Circ Physiol 2011; 302:H206-14. [PMID: 22058157 DOI: 10.1152/ajpheart.00272.2011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Myocardial infarction (MI) significantly alters the structure and function of the heart. As abnormal strain may drive heart failure and the generation of arrhythmias, we used computational methods to simulate a left ventricle with an MI over the course of a heartbeat to investigate strains and their potential implications to electrophysiology. We created a fully coupled finite element model of myocardial electromechanics consisting of a cellular physiological model, a bidomain electrical diffusion solver, and a nonlinear mechanics solver. A geometric mesh built from magnetic resonance imaging (MRI) measurements of an ovine left ventricle suffering from a surgically induced anteroapical infarct was used in the model, cycled through the cardiac loop of inflation, isovolumic contraction, ejection, and isovolumic relaxation. Stretch-activated currents were added as a mechanism of mechanoelectric feedback. Elevated fiber and cross fiber strains were observed in the area immediately adjacent to the aneurysm throughout the cardiac cycle, with a more dramatic increase in cross fiber strain than fiber strain. Stretch-activated channels decreased action potential (AP) dispersion in the remote myocardium while increasing it in the border zone. Decreases in electrical connectivity dramatically increased the changes in AP dispersion. The role of cross fiber strain in MI-injured hearts should be investigated more closely, since results indicate that these are more highly elevated than fiber strain in the border of the infarct. Decreases in connectivity may play an important role in the development of altered electrophysiology in the high-stretch regions of the heart.
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Affiliation(s)
- Samuel T Wall
- Center for Biomedical Computing, Simula Research Laboratory, Oslo, Norway.
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