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Yu FTH, Amjad MW, Mohammed SA, Yu GZ, Chen X, Pacella JJ. Effect of Ultrasound Pulse Length on Sonoreperfusion Therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:152-164. [PMID: 36253230 PMCID: PMC9712163 DOI: 10.1016/j.ultrasmedbio.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 06/16/2023]
Abstract
In recent years, long- and short-pulse ultrasound (US)-targeted microbubble cavitation (UTMC) has been found to increase perfusion in healthy and ischemic skeletal muscle, in pre-clinical animal models of microvascular obstruction and in the myocardium of patients presenting with acute myocardial infarction. There is evidence that the observed microvascular vasodilation is driven by the nitric oxide pathway and purinergic signaling, but the time course of the response and the dependency on US pulse length are not well elucidated. Because our prior data supported that sonoreperfusion efficacy is enhanced by long-pulse US versus short-pulse US, in this study, we sought to compare long-pulse (5000 cycles) and short-pulse (500 × 10 cycles) US at a pressure of 1.5 MPa with an equivalent total number of acoustical cycles, hence constant acoustic energy, and at the same frequency (1 MHz), in a rodent hind limb model with and without microvascular obstruction (MVO). In quantifying perfusion using burst replenishment contrast-enhanced US imaging, we made three findings: (i) Long and short pulses result in different vasodilation kinetics in an intact hind limb model. The long pulse causes an initial spasmic reduction in flow that spontaneously resolved at 4 min, followed by sustained higher flow rates (approximately twofold) compared with baseline, starting 10 min after therapy (p < 0.05). The short pulse caused a short-lived approximately twofold increase in flow rate that peaked at 4 min (p < 0.05), but without the initial spasm. (ii) The sustained increased response with the long pulse is not simply reactive hyperemia. (iii) Both pulses are effective in reperfusion of MVO in our hindlimb model by restoring blood volume, but only the long pulse caused an increase in flow rate after treatment ii, compared with MVO (p < 0.05). Histological analysis of hind limb muscle post-UTMC with either pulse configuration indicates no evidence of tissue damage or hemorrhage. Our findings indicate that the microbubble oscillation induces vasodilation, and therapeutic efficacy for the treatment of MVO can be tuned by varying pulse length; relative to short-pulse US, longer pulses drive greater microbubble cavitation and more rapid microvascular flow rate restoration after MVO, warranting further optimization of the pulse length for sonoreperfusion therapy.
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Affiliation(s)
- François T H Yu
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Muhammad Wahab Amjad
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Soheb Anwar Mohammed
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gary Z Yu
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John J Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Wang L, Ge C, Zhang X. Sufentanil ameliorates oxygen‑glucose deprivation/reoxygenation‑induced endothelial barrier dysfunction in HCMECs via the PI3K/Akt signaling pathway. Exp Ther Med 2022; 24:437. [PMID: 35720630 PMCID: PMC9185804 DOI: 10.3892/etm.2022.11364] [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: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
Ischemic heart disease, a chronic myocardial damage disease caused by coronary artery ischemia, is the leading cause of death worldwide. The aim of the present study was to explore the efficacy of sufentanil in myocardial ischemia/reperfusion (I/R) injury. Oxygen and glucose deprivation/reoxygenation (OGD/R) was utilized to induce human cardiac microvascular endothelial cells (HCMECs) to simulate myocardial I/R injury in vitro. The Cell Counting Kit-8 assay was used to detect the effects of sufentanil on HCMECs and OGD/R-induced HCMECs. The TUNEL, lactate dehydrogenase (LDH) activity, immunofluorescence and in vitro permeability assays, were used to assess apoptosis, LDH activity, VE-cadherin protein expression levels and endothelial barrier function in OGD/R-induced HCMECs, respectively. Moreover, western blotting was performed to assess the protein expression levels of apoptosis, endothelial barrier function and phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt)-related proteins. The results demonstrated that sufentanil had no significant influence on the viability of HCMECs but increased the viability of OGD/R-induced HCMECs in a dose-dependent manner. Furthermore, sufentanil inhibited cell apoptosis and permeability of OGD/R-induced HCMECs but enhanced the protein expression levels of tight junction proteins, including ZO-1, Occludin, VE-cadherin and Claudin-5. Sufentanil was also demonstrated to activate the PI3K/Akt signaling pathway. In addition, the use of LY294002, an inhibitor of the PI3K/Akt signaling pathway, partially abolished the protective effects of sufentanil on apoptosis, permeability and tight junction protein expression levels. These results indicated that sufentanil ameliorated OGD/R-induced endothelial barrier dysfunction in HCMECs, potentially via the PI3K/Akt signaling pathway. The present study therefore suggested that sufentanil may serve as a novel therapeutic option for the improvement of myocardial I/R injury.
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Affiliation(s)
- Lianggang Wang
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai 200031, P.R. China
| | - Chunlin Ge
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai 200031, P.R. China
| | - Xinxin Zhang
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai 200031, P.R. China
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No-reflow phenomenon and in vivo cholesterol crystals combined with lipid core in acute myocardial infarction. IJC HEART & VASCULATURE 2022; 38:100953. [PMID: 35059493 PMCID: PMC8760498 DOI: 10.1016/j.ijcha.2022.100953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/24/2021] [Accepted: 01/01/2022] [Indexed: 12/17/2022]
Abstract
The number of in vivo cholesterol crystals at the culprit plaque is increased in patients with the no-reflow phenomenon. The number of cholesterol crystals, lipid arch, and ostium lesion are independent predictors for the no-reflow phenomenon after PCI. The combination of the number of cholesterol crystals and lipid arc can improve the prediction ability for the no-reflow phenomenon.
Background The release of lipid-laden plaque material subsequent to ST-segment elevation myocardial infarction (STEMI) may contribute to the no-reflow phenomenon. The aim of this study was to investigate the association between in vivo cholesterol crystals (CCs) detected by optical coherence tomography (OCT) and the no-reflow phenomenon after successful percutaneous coronary intervention (PCI) in patients with acute STEMI. Methods We investigated 182 patients with STEMI. Based on the thrombolysis in myocardial infarction (TIMI) flow grade after PCI, patients were divided into a no-reflow group (n = 31) and a reflow group (n = 151). On OCT, CCs were defined as thin, high-signal intensity regions within a plaque. A multivariable logistic regression analysis was performed to determine predictors for the no-reflow phenomenon. Results The prevalence of CCs was higher in the no-reflow group than the reflow group (no-reflow group, 77% vs. reflow group, 53%; p = 0.012). The multivariable logistic model showed that the CC number, lipid arc and ostial lesions were positive independent predictors of no-reflow. The combination of a lipid arc ≥ 139°and CC number ≥ 12 showed good predictive performance for the no-reflow phenomenon (sensitivity, 48%; specificity, 93%; and accuracy, 86%). Conclusion In vivo CCs at the culprit plaque are associated with the no-reflow phenomenon after PCI in patients with STEMI. The combination of the number of CCs and lipid arc can predict the no-reflow phenomenon after PCI with a high accuracy of 86%.
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Pantea-Roșan LR, Pantea VA, Bungau S, Tit DM, Behl T, Vesa CM, Bustea C, Moleriu RD, Rus M, Popescu MI, Turi V, Diaconu CC. No-Reflow after PPCI-A Predictor of Short-Term Outcomes in STEMI Patients. J Clin Med 2020; 9:E2956. [PMID: 32932736 PMCID: PMC7563881 DOI: 10.3390/jcm9092956] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
The no-reflow phenomenon following primary percutaneous coronary intervention (PPCI) in acute ST-elevation myocardial infarction (STEMI) patients is a predictor of unfavorable prognosis. Patients with no-reflow have many complications during admission, and it is considered a marker of short-term mortality. The current research emphasizes the circumstances of the incidence and complications of the no-reflow phenomenon in STEMI patients, including in-hospital mortality. In this case-control study, conducted over two and a half years, there were enrolled 656 patients diagnosed with STEMI and reperfused through PPCI. Several patients (n = 96) developed an interventional type of no-reflow phenomenon. One third of the patients with a no-reflow phenomenon suffered complications during admission, and 14 succumbed. Regarding complications, the majority consisted of arrhythmias (21.68%) and cardiogenic shock (16.67%). The anterior localization of STEMI and the left anterior descending artery (LAD) as a culprit lesion were associated with the highest number of complications during hospitalization. At the same time, the time interval >12 h from the onset of the typical symptoms of myocardial infarction (MI) until revascularization, as well as multiple stents implantations during PPCI, correlated with an increased incidence of short-term complications. The no-reflow phenomenon in patients with STEMI was associated with an unfavorable short-term prognosis.
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Affiliation(s)
- Larisa Renata Pantea-Roșan
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (L.R.P.-R.); (M.R.); (M.I.P.)
- Clinical County Emergency Hospital of Oradea, 410169 Oradea, Romania; (C.M.V.); (C.B.)
| | - Vlad Alin Pantea
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Cosmin Mihai Vesa
- Clinical County Emergency Hospital of Oradea, 410169 Oradea, Romania; (C.M.V.); (C.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Cristiana Bustea
- Clinical County Emergency Hospital of Oradea, 410169 Oradea, Romania; (C.M.V.); (C.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Radu Dumitru Moleriu
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania;
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (L.R.P.-R.); (M.R.); (M.I.P.)
- Clinical County Emergency Hospital of Oradea, 410169 Oradea, Romania; (C.M.V.); (C.B.)
| | - Mircea Ioachim Popescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (L.R.P.-R.); (M.R.); (M.I.P.)
- Clinical County Emergency Hospital of Oradea, 410169 Oradea, Romania; (C.M.V.); (C.B.)
| | - Vladiana Turi
- Department of Cardiology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 30041 Timisoara, Romania;
| | - Camelia Cristina Diaconu
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Internal Medicine Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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Elakabawi K, Huang X, Shah SA, Ullah H, Mintz GS, Yuan Z, Guo N. Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in patients with acute anterior STEMI. BMC Cardiovasc Disord 2020; 20:391. [PMID: 32854618 PMCID: PMC7457271 DOI: 10.1186/s12872-020-01673-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Suboptimal coronary blood flow after primary percutaneous coronary intervention (PCI) is a complex multifactorial phenomenon. Although extensively studied, defined modifiable risk factors and efficient management strategy are lacking. This study aims to determine the potential causes of suboptimal flow and associated impact on 30-day outcomes in patients presenting with anterior ST-elevation myocardial infarction (STEMI). METHODS We evaluated a total of 1104 consecutive patients admitted to our hospital from January 2016 to December 2018 with the diagnosis of anterior wall STEMI who had primary PCI. RESULTS Overall, 245 patients (22.2%) had final post-PCI TIMI flow ≤2 in the LAD (suboptimal flow group) and 859 (77.8%) had final TIMI-3 flow (optimal flow group). The independent predictors of suboptimal flow were thrombus burden grade (Odds ratio (OR) 1.848; p < 0.001), age (OR 1.039 per 1-year increase; p < 0.001), low systolic blood pressure (OR 1.017 per 1 mmHg decrease; p < 0.001), total stent length (OR 1.021 per 1 mm increase; p < 0.001), and baseline TIMI flow ≤1 (OR 1.674; p = 0.018). The 30-day rates of major adverse cardiovascular events (MACE) and cardiac mortality were significantly higher in patients with TIMI flow ≤2 compared to those with TIMI-3 flow (MACE: adjusted risk ratio [RR] 2.021; P = 0.025, cardiac mortality: adjusted RR 2.931; P = 0.031). CONCLUSION Failure to achieve normal TIMI-3 flow was associated with patient-related (age) and other potentially modifiable risk factors (thrombus burden, admission systolic blood pressure, total stent length, and baseline TIMI flow). The absence of final TIMI-3 flow carried worse short-term clinical outcomes.
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Affiliation(s)
- Karim Elakabawi
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
- Cardiovascular Department, Benha University, Benha, 13518, Egypt
| | - Xin Huang
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Sardar Ali Shah
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Hameed Ullah
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, 10022, USA
| | - Zuyi Yuan
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Ning Guo
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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Wang Z, Zhang Z, Zhao J, Yong C, Mao Y. Polysaccharides from Enteromorpha Prolifera Ameliorate Acute Myocardial Infarction in Vitro and in Vivo via Up-Regulating HIF-1α. Int Heart J 2019; 60:964-973. [PMID: 31257333 DOI: 10.1536/ihj.18-519] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute myocardial infarction (AMI) is a serious heart disease and the main reason for heart failure and sudden death worldwide. This study investigated the effects of polysaccharides from Enteromorpha prolifera (PEP) on AMI in vitro and in vivo, as well as the underlying mechanisms.Human cardiac microvascular endothelial cells (HCMVEC) were cultured in vitro in an oxygen-glucose deprivation (OGD) environment to induce injury. The viability and apoptosis of HCMVEC were then detected using CCK-8 assay and Annexin V-FITC/PI staining, respectively. ELISA was performed to measure the concentrations of inflammatory cytokines. Cell transfection was conducted to reduce the expression of HIF-1α. Expression of key factors involving in cell proliferation, apoptosis, autophagy, MEK/ERK, and the NF-κB and mTOR pathways were evaluated using Western blotting. In vivo, Wistar rats were pre-treated by PEP and AMI was induced. The infarct size and cardiac functions (LVEDD, LVEF and LVFS) were measured.In vitro, PEP treatment significantly protected HCMVEC from OGD-induced viability loss, proliferation inhibition, apoptosis, inflammatory cytokine expression, and autophagy. Moreover, PEP enhanced the expression of HIF-1α in HCMVEC via the MEK/ERK pathway. HIF-1α participated in the protective effects of PEP on OGD-treated HCMVEC. Furthermore, PEP attenuated OGD-induced NF-κB pathway activation and promoted the mTOR pathway in HCMVEC. In vivo, PEP pre-treatment reduced the infarct size and enhanced the LVEDD, LVEF and LVFS of rats via up-regulation of HIF-1α.PEP ameliorated AMI in vitro and in vivo through up-regulation of HIF-1α. In vitro, PEP could activate the MEK/ERK and mTOR pathways, but inactivate the NF-κB pathway in OGD-treated HCMVEC.
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Affiliation(s)
- Zongqiu Wang
- Department of Geriatrics, The Affiliated Hospital of Qingdao University
| | - Zhihua Zhang
- Department of Vascular Surgery, The Affiliated Central Hospital of Qingdao University
| | - Jing Zhao
- Department of Geriatrics, The Affiliated Hospital of Qingdao University
| | - Chunming Yong
- Department of Emergency, The Affiliated Hospital of Qingdao University
| | - Yongjun Mao
- Department of Geriatrics, The Affiliated Hospital of Qingdao University
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Coincidental prevention of slow flow by branch occlusion following stenting: findings of magnetic resonance imaging. Cardiovasc Interv Ther 2019; 35:308-309. [PMID: 31152374 DOI: 10.1007/s12928-019-00594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
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Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective. Egypt Heart J 2018; 70:421-426. [PMID: 30591766 PMCID: PMC6303376 DOI: 10.1016/j.ehj.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/28/2018] [Indexed: 11/23/2022] Open
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Ghotbi AA, Kjaer A, Nepper-Christensen L, Ahtarovski KA, Lønborg JT, Vejlstrup N, Kyhl K, Christensen TE, Engstrøm T, Kelbæk H, Holmvang L, Bang LE, Ripa RS, Hasbak P. Subacute cardiac rubidium-82 positron emission tomography ( 82Rb-PET) to assess myocardial area at risk, final infarct size, and myocardial salvage after STEMI. J Nucl Cardiol 2018; 25:970-981. [PMID: 27743299 PMCID: PMC5966489 DOI: 10.1007/s12350-016-0694-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 09/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Determining infarct size and myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) is important when assessing the efficacy of new reperfusion strategies. We investigated whether rest 82Rb-PET myocardial perfusion imaging can estimate area at risk, final infarct size, and myocardial salvage index when compared to cardiac SPECT and magnetic resonance (CMR). METHODS Twelve STEMI patients were injected with 99mTc-Sestamibi intravenously immediate prior to reperfusion. SPECT, 82Rb-PET, and CMR imaging were performed post-reperfusion and at a 3-month follow-up. An automated algorithm determined area at risk, final infarct size, and hence myocardial salvage index. RESULTS SPECT, CMR, and PET were performed 2.2 ± 0.5, 34 ± 8.5, and 32 ± 24.4 h after reperfusion, respectively. Mean (± SD) area at risk were 35.2 ± 16.6%, 34.7 ± 11.3%, and 28.1 ± 16.1% of the left ventricle (LV) in SPECT, CMR, and PET, respectively, P = 0.04 for difference. Mean final infarct size estimates were 12.3 ± 15.4%, 13.7 ± 10.4%, and 11.9 ± 14.6% of the LV in SPECT, CMR, and PET imaging, respectively, P = .72. Myocardial salvage indices were 0.64 ± 0.33 (SPECT), 0.65 ± 0.20 (CMR), and 0.63 ± 0.28 (PET), (P = .78). CONCLUSIONS 82Rb-PET underestimates area at risk in patients with STEMI when compared to SPECT and CMR. However, our findings suggest that PET imaging seems feasible when assessing the clinical important parameters of final infarct size and myocardial salvage index, although with great variability, in a selected STEMI population with large infarcts. These findings should be confirmed in a larger population.
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Affiliation(s)
- Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kiril Aleksov Ahtarovski
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Emil Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, The Heart Center, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Kloner RA, Brown DA, Csete M, Dai W, Downey JM, Gottlieb RA, Hale SL, Shi J. New and revisited approaches to preserving the reperfused myocardium. Nat Rev Cardiol 2017; 14:679-693. [PMID: 28748958 PMCID: PMC5991096 DOI: 10.1038/nrcardio.2017.102] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Early coronary artery reperfusion improves outcomes for patients with ST-segment elevation myocardial infarction (STEMI), but morbidity and mortality after STEMI remain unacceptably high. The primary deficits seen in these patients include inadequate pump function, owing to rapid infarction of muscle in the first few hours of treatment, and adverse remodelling of the heart in the months that follow. Given that attempts to further reduce myocardial infarct size beyond early reperfusion in clinical trials have so far been disappointing, effective therapies are still needed to protect the reperfused myocardium. In this Review, we discuss several approaches to preserving the reperfused heart, such as therapies that target the mechanisms involved in mitochondrial bioenergetics, pyroptosis, and autophagy, as well as treatments that harness the cardioprotective properties of inhaled anaesthetic agents. We also discuss potential therapies focused on correcting the no-reflow phenomenon and its effect on healing and adverse left ventricular remodelling.
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Affiliation(s)
- Robert A Kloner
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA
| | - David A Brown
- Department of Human Nutrition, Foods, and Exercise, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
- Virginia Tech Center for Drug Discovery, Virginia Tech, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
- Virginia Tech Metabolic Phenotyping Core, Virginia Tech, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
| | - Marie Csete
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90017, USA
| | - Wangde Dai
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA
| | - James M Downey
- Department of Physiology and Cell Biology, University of South Alabama, 5851 USA Drive North, Mobile, Alabama 36688, USA
| | - Roberta A Gottlieb
- Department of Medicine, Barbra Streisand Women's Heart Center, Heart Institute of Cedars-Sinai, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, Los Angeles, California 90048, USA
| | - Sharon L Hale
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
| | - Jianru Shi
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA
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Fukui Y, Nozawa T, Ihori H, Sobajima M, Nakadate T, Matsuki A, Nonomura M, Fujii N, Inoue H, Kinugawa K. Nicorandil Attenuates Ischemia-Reperfusion Injury Via Inhibition of Norepinephrine Release From Cardiac Sympathetic Nerve Terminals. Int Heart J 2017; 58:787-793. [PMID: 28966311 DOI: 10.1536/ihj.16-391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A large amount of norepinephrine (NE) released from cardiac sympathetic nerve terminals might accelerate myocardial ischemic injury. Nicorandil (NICO), KATP channel opener, could attenuate cardiac NE release from the sympathetic nerve terminals during ischemia. The present study aimed to investigate the effects of NICO-induced attenuation of cardiac NE release on myocardial ischemia-reperfusion (I/R) injury in rats, by comparison with the effect of cardiac sympathetic denervation on I/R injury.Cardiac interstitial NE (iNE) concentrations were determined using a microdialysis method. Rats were divided into 3 groups; control, NICO, and denervation groups. Cardiac sympathetic denervation was performed by painting 10% phenol on the left ventricular epicardium 7 days before producing ischemia. The left coronary artery was ligated for 30 minutes and then re-perfused for 120 minutes. NICO (50 μg/kg/minute) was infused intravenously starting 20 minutes before the coronary occlusion to the end of the ligation.The infarct size of the left ventricle was smaller in rats treated with NICO than in control rats (20.2 ± 3.0 versus 50.6 ± 14.7%, P < 0.01). Sympathetic denervation also reduced infarct size (28.5 ± 10.4 %, P < 0.01), which was not significantly different from that in the NICO group. At the end of 30-minute ischemia, iNE increased markedly in control rats (0.1 ± 0.1 to 20.6 ± 5.3 × 103 pg/mL), whereas the increase was completely inhibited in denervated rats. NICO markedly attenuated the increase (4.9 ± 3.0 × 103 pg/mL, P < 0.01) during ischemia.NICO-induced attenuation of neural NE release during ischemia might, at least in part, contribute to myocardial protection against I/R injury.
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Affiliation(s)
- Yasutaka Fukui
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Takashi Nozawa
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Hiroyuki Ihori
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Mitsuo Sobajima
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Teruo Nakadate
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Akira Matsuki
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Makoto Nonomura
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Nozomu Fujii
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Hiroshi Inoue
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
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12
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P wave peak time; a novel electrocardiographic parameter in the assessment of coronary no-reflow. J Electrocardiol 2017. [DOI: 10.1016/j.jelectrocard.2017.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Wang X, Wang D, Wu J, Yu X, Lv J, Kong J, Zhu G, Su R. Metabolic Characterization of Myocardial Infarction Using GC-MS-Based Tissue Metabolomics. Int Heart J 2017; 58:441-446. [PMID: 28484125 DOI: 10.1536/ihj.16-432] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Understanding the metabolic features of myocardial infarction (MI) is critical to its prevention and treatment. Here, we aimed to characterize the metabolic features of early MI using a tissue metabolomics method based on gas chromatography-mass spectrometry (GC-MS). Thirty-four pairs of infarcted myocardia and their matched non-infarcted myocardia were collected from 34 rats that underwent coronary artery ligation (CAL); their metabolic profiles were compared by GC-MS-based tissue metabolomics to characterize the metabolic features of MI. On the basis of differential metabolites, their diagnostic potential for MI was analyzed, and MI-related metabolic pathways were investigated. Serum samples before and post MI were used to validate the results obtained in myocardia. The metabolic profile of the infarcted myocardia was obviously different from that of the non-infarcted myocardia, as indicated by partial least squares discriminate analysis (PLS-DA) plots. Twenty-two metabolites were identified to be different between the infarcted myocardia and non-infarcted myocardia. These metabolic alterations reflect energy deficit, acidosis, oxidative stress, ionic imbalance, and cardiac injury post MI. Glutamine, glutamate, and lactate were confirmed to jointly confer a favorable potential for diagnosing MI, which can be well validated in serum.
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Affiliation(s)
- Xingxing Wang
- Department of Forensic Medicine, Shantou University Medical College
- Department of Pathology, Shantou University Medical College 2nd Affiliated Hospital
| | - Dian Wang
- Department of Forensic Medicine, Shantou University Medical College
| | - Jiayan Wu
- Department of Forensic Medicine, Shantou University Medical College
| | - Xiaojun Yu
- Department of Forensic Medicine, Shantou University Medical College
| | - Junyao Lv
- Department of Forensic Medicine, Shantou University Medical College
| | - Jing Kong
- Department of Forensic Medicine, Shantou University Medical College
| | - Guanghui Zhu
- Department of Forensic Medicine, Shantou University Medical College
| | - Ruibing Su
- Department of Forensic Medicine, Shantou University Medical College
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14
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Myojo M, Ando J, Uehara M, Daimon M, Watanabe M, Komuro I. Feasibility of Extracorporeal Shock Wave Myocardial Revascularization Therapy for Post-Acute Myocardial Infarction Patients and Refractory Angina Pectoris Patients. Int Heart J 2017; 58:185-190. [PMID: 28320996 DOI: 10.1536/ihj.16-289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extracorporeal shockwave myocardial revascularization (ESMR) is one of the new treatment options for refractory angina pectoris (RAP), and some studies have indicated its effectiveness. A single-arm prospective trial to assess the feasibility of ESMR using Cardiospec for patients with post-acute myocardial infarction (AMI) and RAP was designed and performed. The patients were treated with 9 sessions of ESMR to the ischemic areas for 9 weeks. The feasibility measures included echocardiography; cardiac magnetic resonance imaging; troponin T, creatine kinase-MB (CK-MB), and brain natriuretic peptide testing; and a Seattle Angina Questionnaire (SAQ) survey. Three post-AMI patients and 3 RAP patients were enrolled. The post-AMI patients had already undergone revascularization with percutaneous coronary intervention (PCI) in the acute phase. In two patients, adverse events requiring admission occurred: one a lumbar disc hernia in a post-AMI patient and the other congestive heart failure resulting in death in an RAP patient. No apparent elevations in CK-MB and troponin T levels during the trial were observed. Echocardiography revealed no remarkable changes of ejection fraction; however, septal E/E' tended to decrease after treatments (11.6 ± 4.8 versus 9.2 ± 2.8, P = 0.08). Concerning the available SAQ scores for two RAP patients, one patient reported improvements in angina frequency and treatment satisfaction and the other reported improvements in physical limitations and angina stability. In this feasibility study, ESMR seems to be a safe treatment for both post-AMI patients and RAP patients. The efficacy of ESMR for post-AMI patients remains to be evaluated with additional studies.
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Affiliation(s)
- Masahiro Myojo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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15
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Relationship between R-wave peak time and no-reflow in ST elevation myocardial infarction treated with a primary percutaneous coronary intervention. Coron Artery Dis 2017; 28:326-331. [PMID: 28207567 DOI: 10.1097/mca.0000000000000477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Coronary no-reflow (NR) is observed in nearly half of ST segment elevation myocardial infarction (STEMI) patients who undergo a primary percutaneous coronary intervention (pPCI) despite epicardial coronary vessel patency. Several methods used to define NR include thrombolysis in myocardial infarction grade, corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, ST-segment resolution, contrast echocardiography, and MRI. The aim of our study was to evaluate the relationship between NR and R-wave peak time (RWPT) measured from infarct-related artery leads METHOD: We enrolled 282 consecutive STEMI patients treated with pPCI in Kafkas University Hospital from January 2014 to January 2015. After exclusion, the remaining 233 patients were included in the study population RESULTS: Patients were divided into two groups according to the development of NR. We observed that increased preprocedural (31 (27-37) vs 27 (21-30) p<0,001) and postprocedural RWPT(35±7 vs 22±6 p<0,001) was associated with the development of NR and preprocedural RWPT(OR: 1.254 95% CI: 1.104-1.425 p<0,001) was found to be independent predictor of NR. The association between postprocedural RWPT and angiographic NR was statistically noninferior to that between ST-segment resolution % and NR(difference between area under curves: 0.0232, p= 0.38) CONCLUSION: the present study is the first to report a significant correlation between NR and RWPT in STEMI patients treated with primary pPCI.
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16
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Roos ST, Yu FT, Kamp O, Chen X, Villanueva FS, Pacella JJ. Sonoreperfusion Therapy Kinetics in Whole Blood Using Ultrasound, Microbubbles and Tissue Plasminogen Activator. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:3001-3009. [PMID: 27687734 PMCID: PMC5328593 DOI: 10.1016/j.ultrasmedbio.2016.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 05/11/2023]
Abstract
Coronary intervention for myocardial infarction often results in microvascular embolization of thrombus. Sonoreperfusion therapy (SRP) using ultrasound and microbubbles restored perfusion in our in vitro flow model of microvascular obstruction. In this study, we assessed SRP efficacy using whole blood as the perfusate with and without tissue plasminogen activator (tPA). In a phantom vessel bearing a 40-μm-pore mesh to simulate the microvasculature, microthrombi were injected to cause microvascular obstruction and were treated using SRP. Without tPA, the lytic rate increased from 2.6 ± 1.5 mmHg/min with 1000-cycle pulses to 7.3 ± 3.2 mmHg/min with 5000-cycle ultrasound pulses (p < 0.01). The lytic index was similar for tPA-only ([2.0 ± 0.5] × 10-3 mmHg-1 min-1) and 5000 cycles without tPA ([2.3 ± 0.5] × 10-3 mmHg-1 min-1) (p = 0.5) but increased ([3.6 ± 0.8] × 10-3 mmHg-1 min-1) with tPA in conjunction with 5000-cycles ultrasound (p < 0.01). In conclusion, SRP restored microvascular perfusion in whole blood, SRP lytic rate in experiments without tPA increased with ultrasound pulse length and efficacy increased with the addition of tPA.
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Affiliation(s)
- Sebastiaan T Roos
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA; Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - François T Yu
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Otto Kamp
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - John J Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
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17
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Increased Platelet-leukocyte Aggregates Are Associated With Myocardial No-reflow in Patients With ST Elevation Myocardial Infarction. Am J Med Sci 2016; 352:261-6. [DOI: 10.1016/j.amjms.2016.05.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/08/2016] [Accepted: 05/17/2016] [Indexed: 12/15/2022]
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18
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Zhu G, Yao Y, Pan L, Zhu W, Yan S. Reduction of Leukocyte Counts by Hydroxyurea Improves Cardiac Function in Rats with Acute Myocardial Infarction. Med Sci Monit 2015; 21:3941-7. [PMID: 26675565 PMCID: PMC4687945 DOI: 10.12659/msm.893744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study aimed to decrease leukocytes counts by hydroxyurea (Hu) in an acute myocardial infarction (AMI) rat model and examine its effect on the inflammatory response of myocardial infarction and cardiac functions. MATERIAL AND METHODS AMI was successfully caused in 36 rats, and 12 control rats received sham operation. Rats in the AMI group were then randomly divided into Hu and vehicle group with 18 rats each. Rats in the Hu AMI group received Hu (200 mg/kg) intragastrically while vehicle AMI group received saline. Leukocytes counts, cardiac functions, myocardial tissue morphology, and levels of soluble intercellular adhesion molecule-1 (sICAM), P-selectin and platelet activating factor (PAF) were measured and compared among the three groups four weeks after AMI induction. RESULTS Leukocytes, neutrophils, and leukomonocyte counts in vehicle AMI rats were significantly higher than that of the normal control group (p<0.05). However, Hu treatment decreased their counts significantly (p<0.05). sICAM, P-selectin, and PAF level in vehicle AMI group were significantly higher than those of the normal group, and their level was also decreased by Hu treatment (p<0.05). Echocardiography analysis showed that Hu treatment increased left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) compared to that of vehicle AMI group (p<0.05). Histopathological examination showed that Hu significantly reduced the swelling of the heart muscle fiber in necrotic foci and the number of inflammatory cells infiltrated into myocardial interstitium compared to vehicle AMI group. CONCLUSIONS Decrease leukocytes counts by Hu significantly reduced inflammatory reaction and improved cardiac functions in AMI rats.
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Affiliation(s)
- Guiyue Zhu
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China (mainland)
| | - Yucai Yao
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong, China (mainland)
| | - Lingyun Pan
- Department of Emergency Medicine, Second People's Hospital of Liaocheng, Linqing, Shandong, China (mainland)
| | - Wei Zhu
- Institute of Radiation Medicine, Shandong Academy of Medical Sciences, Ji'nan, Shandong, China (mainland)
| | - Suhua Yan
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong, China (mainland)
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19
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Bouleti C, Mewton N, Germain S. The no-reflow phenomenon: State of the art. Arch Cardiovasc Dis 2015; 108:661-74. [PMID: 26616729 DOI: 10.1016/j.acvd.2015.09.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/28/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023]
Abstract
Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI), with nearly 95% of occluded coronary vessels being reopened in this setting. Despite re-establishing epicardial coronary vessel patency, primary PCI may fail to restore optimal myocardial reperfusion within the myocardial tissue, a failure at the microvascular level known as no-reflow (NR). NR has been reported to occur in up to 60% of STEMI patients with optimal coronary vessel reperfusion. When it does occur, it significantly attenuates the beneficial effect of reperfusion therapy, leading to poor outcomes. The pathophysiology of NR is complex and incompletely understood. Many phenomena are known to contribute to NR, including leukocyte infiltration, vasoconstriction, activation of inflammatory pathways and cellular oedema. Vascular damage and haemorrhage may also play important roles in the establishment of NR. In this review, we describe the pathophysiological mechanisms of NR and the tools available for diagnosing it. We also describe the microvasculature and the endothelial mechanisms involved in NR, which may provide relevant therapeutic targets for reducing NR and improving the prognosis for patients.
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Affiliation(s)
- Claire Bouleti
- Service de cardiologie, hôpital Bichat, AP-HP, Paris, France; DHU FIRE, université Paris Diderot, Paris, France; Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France
| | - Nathan Mewton
- Hôpital cardiovasculaire Louis-Pradel, centre d'investigation clinique unité, hospices civils de Lyon, Bron, France; Inserm U 1407, Lyon, France
| | - Stéphane Germain
- Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France.
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20
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Sato T, Kameyama T, Noto T, Ueno H, Inoue H. Enhanced expression of hemoglobin scavenger receptor CD163 in accumulated macrophages within filtered debris between acute coronary syndromes and stable angina pectoris. Int Heart J 2015; 56:150-6. [PMID: 25740391 DOI: 10.1536/ihj.14-224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary intraplaque hemorrhage up-regulates hemoglobin scavenger receptor CD163 expression on macrophages, and has an association with vulnerable plaque development. During percutaneous coronary intervention, mechanical plaque disruption exposes potentially embolic atheromatous contents from culprit plaque.In 37 patients with stable angina pectoris (SAP, n = 20) or acute coronary syndrome (ACS, n = 17), atherothrombotic debris was collected using a filter-based distal embolic protection device. We immunohistochemically determined CD14-positive macrophages and CD163-positive macrophages in filtered debris. We also examined the relation of CD14- and CD163-positive macrophages with culprit plaque volume and components evaluated with ultrasonic tissue characterization (VH-IVUS).The only significant difference in clinical characteristics between the two groups was in hs-CRP. In ACS, the percentage of CD14- and CD163-positive macrophages to the whole cells (%CD14 and %CD163, respectively) was significantly higher than that in SAP (20.1 ± 8.2 versus 8.8 ± 6.8%, P < 0.001 and 32.6 ± 18.9 versus 9.0 ± 3.8%, P < 0.001, respectively). In IVUS indices of culprit plaque, the remodeling index was significantly higher in ACS than in SAP. However, necrotic core component (%NC) in ACS was significantly higher than that in SAP. Furthermore, fibrotic component (%Fibrous) in ACS was significantly lower than that in SAP (56.1 ± 4.7 versus 60.1 ± 3.3%, P = 0.03). %CD14 and %CD163 had a significant positive correlation with %NC (%CD14: r = 0.40, P = 0.01 and %CD163: r = 0.45, P = 0.01), but only %CD163 was negatively correlated with %Fibrous (%CD163: r = -0.48, P = 0.01).These findings suggest that the presence of CD14- and CD163-positive macrophages may reflect plaque inflammation, NC expansion, and plaque vulnerability in patients with coronary heart disease.
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Affiliation(s)
- Takao Sato
- Second Department of Internal Medicine, University of Toyama
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21
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Takeuchi I, Fujita H, Yanagisawa T, Sato N, Mizutani T, Hattori J, Asakuma S, Yamaya T, Inagaki T, Kataoka Y, Ohe K, Ako J, Asari Y. Impact of Doctor Car with Mobile Cloud ECG in Reducing Door-to- Balloon Time of Japanese ST-Elevation Myocardial Infarction Patients. Int Heart J 2015; 56:170-3. [DOI: 10.1536/ihj.14-237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ichiro Takeuchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Hideo Fujita
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | - Tomoyoshi Yanagisawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Nobuhiro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Tomohiro Mizutani
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Jun Hattori
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Sadataka Asakuma
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Tatsuhiro Yamaya
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Taito Inagaki
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Yuichi Kataoka
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
| | - Kazuhiko Ohe
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yasushi Asari
- Department of Emergency and Disaster Medicine, Kitasato University School of Medicine
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22
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Uchida Y, Ichimiya S, Ishii H, Kanashiro M, Watanabe J, Hayano S, Suzuki S, Takeshita K, Sakai S, Amano T, Matsubara T, Murohara T. Impact of Admission Anemia on Coronary Microcirculation and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Int Heart J 2015; 56:381-8. [DOI: 10.1536/ihj.15-006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | - Shinji Hayano
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kyosuke Takeshita
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Shinichi Sakai
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University School of Medicine
| | - Tatsuaki Matsubara
- Department of Internal Medicine, School of Dentistry Aichi Gakuin University
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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23
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Kalyuzhin VV, Teplyakov AT, Bespalova ID, Kalyuzhina YV. TOWARD THE QUESTION OF ISCHEMIC MYOCARDIAL DYSFUNCTION. ACTA ACUST UNITED AC 2014. [DOI: 10.20538/1682-0363-2014-6-57-71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - A. T. Teplyakov
- Institute of Cardiology, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk
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24
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No reflow in ST elevation myocardial infarction: a new way forward? Coron Artery Dis 2014; 25:636-7. [PMID: 25230303 DOI: 10.1097/mca.0000000000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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