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Jensen B, Salvatori D, Schouten J, Meijborg VMF, Lauridsen H, Agger P. Trabeculations of the porcine and human cardiac ventricles are different in number but similar in total volume. Clin Anat 2024; 37:440-454. [PMID: 38217386 DOI: 10.1002/ca.24135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
An intricate meshwork of trabeculations lines the luminal side of cardiac ventricles. Compaction, a developmental process, is thought to reduce trabeculations by adding them to the neighboring compact wall which is then enlarged. When pig, a plausible cardiac donor for xenotransplantation, is compared to human, the ventricular walls appear to have fewer trabeculations. We hypothesized the trabecular volume is proportionally smaller in pig than in human. Macroscopically, we observed in 16 pig hearts that the ventricular walls harbor few but large trabeculations. Close inspection revealed a high number of tiny trabeculations, a few hundred, within the recesses of the large trabeculations. While tiny, these were still larger than embryonic trabeculations and even when considering their number, the total tally of trabeculations in pig was much fewer than in human. Volumetrics based on high-resolution MRI of additional six pig hearts compared to six human hearts, revealed the left ventricles were not significantly differently trabeculated (21.5 versus 22.8%, respectively), and the porcine right ventricles were only slightly less trabeculated (42.1 vs 49.3%, respectively). We then analyzed volumetrically 10 pig embryonic hearts from gestational day 14-35. The trabecular and compact layer always grew, as did the intertrabecular recesses, in contrast to what compaction predicts. The proportions of the trabecular and compact layers changed substantially, nonetheless, due to differences in their growth rate rather than compaction. In conclusion, processes that affect the trabecular morphology do not necessarily affect the proportion of trabecular-to-compact myocardium and they are then distinct from compaction.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Salvatori
- Department of Clinical Sciences, Anatomy and Physiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jacobine Schouten
- Department of Clinical Sciences, Anatomy and Physiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Veronique M F Meijborg
- Department of Experimental Cardiology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Henrik Lauridsen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Thygesen MM, Entezari S, Houlind N, Nielsen TH, Olsen NØ, Nielsen TD, Skov M, Borgstedt-Bendixen J, Tankisi A, Rasmussen M, Einarsson HB, Agger P, Orlowski D, Dyrskog SE, Thorup L, Pedersen M, Rasmussen MM. A 72-h sedated porcine model of traumatic spinal cord injury. Brain Spine 2024; 4:102813. [PMID: 38681174 PMCID: PMC11052900 DOI: 10.1016/j.bas.2024.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 05/01/2024]
Abstract
Introduction There is an increasing focus on the prevention of secondary injuries following traumatic spinal cord injury (TSCI), especially through improvement of spinal cord perfusion and immunological modulation. Such therapeutic strategies require translational and controlled animal models of disease progression of the acute phases of human TSCI. Research question Is it possible to establish a 72-h sedated porcine model of incomplete thoracic TSCI, enabling controlled use of continuous, invasive, and non-invasive modalities during the entire sub-acute phase of TSCI? Material and methods A sham-controlled trial was conducted to establish the model, and 10 animals were assigned to either sham or TSCI. All animals underwent a laminectomy, and animals in the TSCI group were subjected to a weight-drop injury. Animals were then kept sedated for 72 h. The amount of injury was assessed by ex-vivo measures MRI-based fiber tractography, histology and immunohistochemistry. Results In all animals, we were successful in maintaining sedation for 72 h without comprising vital physiological parameters. The MRI-based fiber tractography showed that all TSCI animals revealed a break in the integrity of spinal neurons, whereas histology demonstrated no transversal sections of the spine with complete injury. Notably, some animals displayed signs of secondary ischemic tissue in the cranial and caudal sections. Discussion and conclusions This study succeeded in producing a porcine model of incomplete TSCI, which was physiologically stable up to 72 h. We believe that this TSCI model will constitute a potential translational model to study the pathophysiology secondary to TSCI in humans.
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Affiliation(s)
- Mathias Møller Thygesen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Seyar Entezari
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Nanna Houlind
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Teresa Haugaard Nielsen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Nicholas Østergaard Olsen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Tim Damgaard Nielsen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Mathias Skov
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | | | - Alp Tankisi
- Department of Anesthesiology, Aarhus University Hospital, Denmark
| | - Mads Rasmussen
- Department of Anesthesiology, Aarhus University Hospital, Denmark
| | | | - Peter Agger
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | | | | | - Line Thorup
- Department of Intensive Care, Aarhus University Hospital, Denmark
| | - Michael Pedersen
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Mikkel Mylius Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
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Jordt I, Thygesen MM, Johansen TA, Jensen KH, Agger P. Field conditions is a risk factor for traumatic injury in youth football-A joint venture of medicine and hydrology. Scand J Med Sci Sports 2023; 33:2351-2359. [PMID: 37534783 DOI: 10.1111/sms.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/23/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The risk of traumatic injury in football has been suggested to be affected by field conditions. This study, therefore, aimed to investigate whether near surface water content of the football field, influenced the risk of traumatic injuries during a youth football tournament. METHODS At Dana Cup, an annual international youth football tournament in Denmark, all injuries were registered and classified at the on-site emergency department over 7 years. The incidence rate of traumatic injury was computed. Meteorological data and soil characteristics were used to simulate near surface water content of the playing fields. The incidence rate ratio (IRR) between water content and injury incidence rate was analyzed using a multivariate Poisson regression, controlling for tournament stage and demographical parameters. RESULTS About 2704 injuries were recorded corresponding to a risk time of 284 905 player hours. An inverse relation between water contents and the incidence rate of traumatic injury was found (IRR = 0.24 95% CI 0.1-0.7, p = 0.01). The incidence rate of traumatic injury increased with advancing tournament stage, that is, for the finals (IRR = 4.30 95% CI 2.8-6.6, p < 0.001). Also we found an interaction between dry fields and the final stage of tournament, further exacerbating this effect. CONCLUSIONS Our data suggest that the incidence rate of traumatic injury is increased with drier field conditions and advanced tournament stages.
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Affiliation(s)
- Ida Jordt
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Mathias Møller Thygesen
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Tau Alfred Johansen
- Department of Geosciences and Natural Resource Management, Section for Geology, Copenhagen University, Copenhagen, Denmark
| | - Karsten Høgh Jensen
- Department of Geosciences and Natural Resource Management, Section for Geology, Copenhagen University, Copenhagen, Denmark
| | - Peter Agger
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
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MacIver DH, Agger P, Rodrigues JCL, Zhang H. Left ventricular active strain energy density is a promising new measure of systolic function. Sci Rep 2022; 12:12717. [PMID: 35882913 PMCID: PMC9325776 DOI: 10.1038/s41598-022-15509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/24/2022] [Indexed: 11/09/2022] Open
Abstract
The left ventricular ejection fraction does not accurately predict exercise capacity or symptom severity and has a limited role in predicting prognosis in heart failure. A better method of assessing ventricular performance is needed to aid understanding of the pathophysiological mechanisms and guide management in conditions such as heart failure. In this study, we propose two novel measures to quantify myocardial performance, the global longitudinal active strain energy (GLASE) and its density (GLASED) and compare them to existing measures in normal and diseased left ventricles. GLASED calculates the work done per unit volume of muscle (energy density) by combining information from myocardial strain and wall stress (contractile force per unit cross sectional area). Magnetic resonance images were obtained from 183 individuals forming four cohorts (normal, hypertension, dilated cardiomyopathy, and cardiac amyloidosis). GLASE and GLASED were compared with the standard ejection fraction, the corrected ejection fraction, myocardial strains, stroke work and myocardial forces. Myocardial shortening was decreased in all disease cohorts. Longitudinal stress was normal in hypertension, increased in dilated cardiomyopathy and severely decreased in amyloid heart disease. GLASE was increased in hypertension. GLASED was mildly reduced in hypertension (1.39 ± 0.65 kJ/m3), moderately reduced in dilated cardiomyopathy (0.86 ± 0.45 kJ/m3) and severely reduced in amyloid heart disease (0.42 ± 0.28 kJ/m3) compared to the control cohort (1.94 ± 0.49 kJ/m3). GLASED progressively decreased in the hypertension, dilated cardiomyopathy and cardiac amyloid cohorts indicating that mechanical work done and systolic performance is severely reduced in cardiac amyloid despite the relatively preserved ejection fraction. GLASED provides a new technique for assessing left ventricular myocardial health and contractile function.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, UK. .,Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, UK.
| | - Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jonathan C L Rodrigues
- Department of Radiology, Royal United Hospital Bath NHS Trust, Bath, UK.,Department of Health, University of Bath, Bath, UK
| | - Henggui Zhang
- Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, UK
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Agger P, Hyldebrandt JA, Hansen ESS, Omann C, Bøgh N, Waziri F, Nielsen PM, Laustsen C. Magnetic resonance hyperpolarization imaging detects early myocardial dysfunction in a porcine model of right ventricular heart failure. Eur Heart J Cardiovasc Imaging 2021; 21:93-101. [PMID: 31329841 PMCID: PMC6923679 DOI: 10.1093/ehjci/jez074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/24/2019] [Accepted: 04/02/2019] [Indexed: 12/31/2022] Open
Abstract
Aims Early detection of heart failure is important for timely treatment. During the development of heart failure, adaptive intracellular metabolic processes that evolve prior to macro-anatomic remodelling, could provide an early signal of impending failure. We hypothesized that metabolic imaging with hyperpolarized magnetic resonance would detect the early development of heart failure before conventional echocardiography could reveal cardiac dysfunction. Methods and results Five 8.5 kg piglets were subjected to pulmonary banding and subsequently examined by [1-13C]pyruvate hyperpolarization, conventional magnetic resonance imaging, echocardiography, and blood testing, every 4 weeks for 16 weeks. They were compared with a weight matched, healthy control group. Conductance catheter examination at the end of the study showed impaired right ventricular systolic function along with compromised left ventricular diastolic function. After 16 weeks, we saw a significant decrease in the conversion ratio of pyruvate/bicarbonate in the left ventricle from 0.13 (0.04) in controls to 0.07 (0.02) in animals with pulmonary banding, along with a significant increase in the lactate/bicarbonate ratio to 3.47 (1.57) compared with 1.34 (0.81) in controls. N-terminal pro-hormone of brain natriuretic peptide was increased by more than 300%, while cardiac index was reduced to 2.8 (0.95) L/min/m2 compared with 3.9 (0.95) in controls. Echocardiography revealed no changes. Conclusion Hyperpolarization detected a shift towards anaerobic metabolism in early stages of right ventricular dysfunction, as evident by an increased lactate/bicarbonate ratio. Dysfunction was confirmed with conductance catheter assessment, but could not be detected by echocardiography. Hyperpolarization has a promising future in clinical assessment of heart failure in both acquired and congenital heart disease.
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Affiliation(s)
- Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Janus Adler Hyldebrandt
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.,Department of Anaesthesiology and Intensive Care, Akershus University Hospital, Sykehusveien 25, Lørenskog, Norway
| | | | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Nikolaj Bøgh
- MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Farhad Waziri
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Per Mose Nielsen
- MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Christoffer Laustsen
- MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
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Hyldebrandt JA, Bøgh N, Omann C, Agger P. Norepinephrine and dobutamine improve cardiac index equally by supporting opposite sides of the heart in an experimental model of chronic pulmonary hypertension. Intensive Care Med Exp 2021; 9:29. [PMID: 34085137 PMCID: PMC8175098 DOI: 10.1186/s40635-021-00391-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary hypertension is a significant risk factor in patients undergoing surgery. The combined effects of general anaesthesia and positive pressure ventilation can aggravate this condition and cause increased pulmonary blood pressures, reduced systemic blood pressures and ventricular contractility. Although perioperative use of inotropic support or vasopressors is almost mandatory for these patients, preference is disputed. In this study, we investigated the effects of norepinephrine and dobutamine and their ability to improve the arterio-ventricular relationship and haemodynamics in pigs suffering from chronic pulmonary hypertension. METHOD Pulmonary hypertension was induced in five pigs by banding the pulmonary artery at 2-3 weeks of age. Six pigs served as controls. After 16 weeks of pulmonary artery banding, the animals were re-examined under general anaesthesia using biventricular conductance catheters and a pulmonary artery catheter. After baseline measurements, the animals were exposed to both norepinephrine and dobutamine infusions in incremental doses, with a stabilising period in between the infusions. The hypothesis of differences between norepinephrine and dobutamine with incremental doses was tested using repeated two-way ANOVA and Bonferroni multiple comparisons post-test. RESULTS At baseline, pulmonary artery-banded animals had increased right ventricular pressure (+ 39%, p = 0.04), lower cardiac index (- 23% p = 0.04), lower systolic blood pressure (- 13%, p = 0.02) and reduced left ventricular end-diastolic volume (- 33%, p = 0.02). When incremental doses of norepinephrine and dobutamine were administered, the right ventricular arterio-ventricular coupling was improved only by dobutamine (p < 0.05). Norepinephrine increased both left ventricular end-diastolic volume and left ventricular contractility to a greater extent (p < 0.05) in pulmonary artery-banded animals. While the cardiac index was improved equally by norepinephrine and dobutamine treatments in pulmonary artery-banded animals, norepinephrine had a significantly greater effect on mean arterial pressure (p < 0.05) and diastolic arterial pressure (p < 0.05). CONCLUSION While norepinephrine and dobutamine improved cardiac index equally, it was obtained in different manners. Dobutamine significantly improved the right ventricular function and the arterio-ventricular coupling. Norepinephrine increased systemic resistance, thereby improving arterial pressures and left ventricular systolic function by maintaining left ventricular end-diastolic volume.
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Affiliation(s)
- Janus Adler Hyldebrandt
- Department of Anesthesia and Intensive Care, Akershus University Hospital, Postbox 1000, 1478, Lørenskog, Norway.
| | - Nikolaj Bøgh
- MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hansen ESS, Madsen TL, Wood G, Granfeldt A, Bøgh N, Tofig BJ, Agger P, Lindhardt JL, Poulsen CB, Bøtker HE, Kim WY. Veno-occlusive unloading of the heart reduces infarct size in experimental ischemia-reperfusion. Sci Rep 2021; 11:4483. [PMID: 33627745 PMCID: PMC7904802 DOI: 10.1038/s41598-021-84025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/05/2021] [Indexed: 11/09/2022] Open
Abstract
Mechanical unloading of the left ventricle reduces infarct size after acute myocardial infarction by reducing cardiac work. Left ventricular veno-occlusive unloading reduces cardiac work and may reduce ischemia and reperfusion injury. In a porcine model of myocardial ischemia-reperfusion injury we randomized 18 pigs to either control or veno-occlusive unloading using a balloon engaged from the femoral vein into the inferior caval vein and inflated at onset of ischemia. Evans blue and 2,3,5-triphenyltetrazolium chloride were used to determine the myocardial area at risk and infarct size, respectively. Pressure-volume loops were recorded to calculate cardiac work, left ventricular (LV) volumes and ejection fraction. Veno-occlusive unloading reduced infarct size compared with controls (Unloading 13.9 ± 8.2% versus Control 22.4 ± 6.6%; p = 0.04). Unloading increased myocardial salvage (54.8 ± 23.4% vs 28.5 ± 14.0%; p = 0.02), while the area at risk was similar (28.4 ± 6.7% vs 27.4 ± 5.8%; p = 0.74). LV ejection fraction was preserved in the unloaded group, while the control group showed a reduced LV ejection fraction. Veno-occlusive unloading reduced myocardial infarct size and preserved LV ejection fraction in an experimental acute ischemia-reperfusion model. This proof-of-concept study demonstrated the potential of veno-occlusive unloading as an adjunctive cardioprotective therapy in patients undergoing revascularization for acute myocardial infarction.
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Affiliation(s)
- Esben Søvsø Szocska Hansen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Tobias Lynge Madsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Gregory Wood
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Asger Granfeldt
- Department of Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Nikolaj Bøgh
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Bawer Jalal Tofig
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Peter Agger
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Jakob Lykke Lindhardt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Bo Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Clinical Medicine, MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark.
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Agger P, Stephenson RS. Assessing Myocardial Architecture: The Challenges and Controversies. J Cardiovasc Dev Dis 2020; 7:jcdd7040047. [PMID: 33137874 PMCID: PMC7711767 DOI: 10.3390/jcdd7040047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022] Open
Abstract
In recent decades, investigators have strived to describe and quantify the orientation of the cardiac myocytes in an attempt to classify their arrangement in healthy and diseased hearts. There are, however, striking differences between the investigations from both a technical and methodological standpoint, thus limiting their comparability and impeding the drawing of appropriate physiological conclusions from the structural assessments. This review aims to elucidate these differences, and to propose guidance to establish methodological consensus in the field. The review outlines the theory behind myocyte orientation analysis, and importantly has identified pronounced differences in the definitions of otherwise widely accepted concepts of myocytic orientation. Based on the findings, recommendations are made for the future design of studies in the field of myocardial morphology. It is emphasised that projection of myocyte orientations, before quantification of their angulation, introduces considerable bias, and that angles should be assessed relative to the epicardial curvature. The transmural orientation of the cardiomyocytes should also not be neglected, as it is an important determinant of cardiac function. Finally, there is considerable disagreement in the literature as to how the orientation of myocardial aggregates should be assessed, but to do so in a mathematically meaningful way, the normal vector of the aggregate plane should be utilised.
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Affiliation(s)
- Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, 8220 Aarhus N, Denmark
- Department of Pediatrics, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
- Correspondence:
| | - Robert S. Stephenson
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK;
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9
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Bøgh N, Hansen ESS, Omann C, Lindhardt J, Nielsen PM, Stephenson RS, Laustsen C, Hjortdal VE, Agger P. Increasing carbohydrate oxidation improves contractile reserves and prevents hypertrophy in porcine right heart failure. Sci Rep 2020; 10:8158. [PMID: 32424129 PMCID: PMC7235019 DOI: 10.1038/s41598-020-65098-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/24/2020] [Indexed: 01/16/2023] Open
Abstract
In heart failure, myocardial overload causes vast metabolic changes that impair cardiac energy production and contribute to deterioration of contractile function. However, metabolic therapy is not used in heart failure care. We aimed to investigate the interplay between cardiac function and myocardial carbohydrate metabolism in a large animal heart failure model. Using magnetic resonance spectroscopy with hyperpolarized pyruvate and magnetic resonance imaging at rest and during pharmacological stress, we investigated the in-vivo cardiac pyruvate metabolism and contractility in a porcine model of chronic pulmonary insufficiency causing right ventricular volume overload. To assess if increasing the carbohydrate metabolic reserve improves the contractile reserve, a group of animals were fed dichloroacetate, an activator of pyruvate oxidation. Volume overload caused heart failure with decreased pyruvate dehydrogenase flux and poor ejection fraction reserve. The animals treated with dichloroacetate had a larger contractile response to dobutamine stress than non-treated animals. Further, dichloroacetate prevented myocardial hypertrophy. The in-vivo metabolic data were validated by mitochondrial respirometry, enzyme activity assays and gene expression analyses. Our results show that pyruvate dehydrogenase kinase inhibition improves the contractile reserve and decreases hypertrophy by augmenting carbohydrate metabolism in porcine heart failure. The approach is promising for metabolic heart failure therapy.
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Affiliation(s)
- Nikolaj Bøgh
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,The MR Research Centre, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Esben S S Hansen
- The MR Research Centre, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Camilla Omann
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jakob Lindhardt
- The MR Research Centre, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Per M Nielsen
- The MR Research Centre, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Institute of Clinical Sciences, College of Medical and Dental Science, The University of Birmingham, Birmingham, United Kingdom
| | - Christoffer Laustsen
- The MR Research Centre, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Vibeke E Hjortdal
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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D'Souza R, Wang Y, Calderon-Anyosa RJC, Montero AE, Banerjee MM, Ekhomu O, Matsubara D, Mercer-Rosa L, Agger P, Sato T, Banerjee A. Decreased right ventricular longitudinal strain in children with hypoplastic left heart syndrome during staged repair and follow-up: does it have implications in clinically stable patients? Int J Cardiovasc Imaging 2020; 36:1667-1677. [PMID: 32363447 DOI: 10.1007/s10554-020-01870-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/24/2020] [Indexed: 12/01/2022]
Abstract
The principal aim of this study was to evaluate changes in systolic function in the single right ventricle (SRV), during progression of the same patient through the three stages of surgical repair for hypoplastic left heart syndrome and during a 5-year follow-up. We hypothesize that, SRV global longitudinal strain (GLS) will be low during 3 stages of repair even in stable patients. We retrospectively evaluated 140 echocardiograms in 20 patients with HLHS (ages 0-11.3 years), before and after 3 stages of surgical palliation. Five-year follow-up data were available in all 20 patients. Controls with structurally normal hearts and in the same age group were used for comparison. We utilized speckle-tracking imaging for assessment of SRV segmental and global longitudinal and circumferential strains, from previously acquired 4-chamber and mid-cavity short-axis views prior to and within 1-3 months of each surgical stage. Longitudinal strain (LS) remained low through all 3 stages of repair and during follow-up. The pre-Fontan stage demonstrated significant interstage improvement compared to the post-Glenn stage despite similar volume status. Global LS was (- 15.6 ± 4.5% after Fontan surgery and remained similar (- 15.32 ± 3.2%) 5 years later. The SRV also showed increased dominance of circumferential strain compared to the normal RV, where the longitudinal deformation was dominant. In SRV, longitudinal strain may be a useful clinical index for evaluating both segmental and global function in an objective manner. Due to lack of significant clinical deterioration over a 10-year period, we speculate that a "lower-than-normal" longitudinal strain may be used as an objective measure of SRV function in clinically stable patients, particularly after the Fontan operation. Compensatory mechanisms where the longitudinal pattern of contraction switches to a more circumferential pattern, may play a role in asymptomatic patients with HLHS.
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Affiliation(s)
- Roshan D'Souza
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Yan Wang
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Renzo J C Calderon-Anyosa
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Andrea E Montero
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Maalika M Banerjee
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Tufts University School of Medicine, Boston, MA, 02116, USA
| | - Omoni Ekhomu
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Daisuke Matsubara
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Peter Agger
- Dept. of Pediatrics and Adolescent Medicine and Dept. of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tomoyuki Sato
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Anirban Banerjee
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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11
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Agger P, Omann C, Laustsen C, Stephenson RS, Anderson RH. Anatomically correct assessment of the orientation of the cardiomyocytes using diffusion tensor imaging. NMR Biomed 2020; 33:e4205. [PMID: 31829484 DOI: 10.1002/nbm.4205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
Diffusion tensor imaging has been used for assessing the orientation of cardiac myocytes for decades. Striking methodological differences exist between studies when quantifying these orientations. This limits the comparability between studies, and impedes collaboration and the drawing of appropriate physiological conclusions. We have sought to elucidate these differences, permitting us to propose a standardised "tool set" that might better establish consensus in future studies. We fixed hearts from seven 25 kg pigs in formalin, and scanned them using diffusion tensor imaging. Using various angle definitions as found in literature, we assessed the orientations of cardiomyocytes, comparing them in terms of helical and intrusion angles, along with the orientation of their aggregations. The difference between assessment of the helical angle with and without relation to the epicardial curvature was 25.2° (SD: 7.9) at the base, 5.8° (1.9) at the equatorial level, and 28.0° (7.0) at the apex, ANOVA P = 0.001. In comparable fashion, the intrusion angle differed by 25.9° (12.9), 7.6° (0.98) and 17.5° (4.7), P = 0.01, and the angle of the aggregates (E3-angle) differed by 25.0° (13.5) at the base, 9.4° (1.7) at the equator, and 23.1° (6.2) apically, P = 0.003. When assessing 14 definitions used in literature to calculate the orientation of aggregates, only 4 rendered identical results. The findings show that any attempt to use projection of eigenvectors introduces considerable bias. The epicardial curvature of the ventricular cone needs to be taken into account when seeking to provide accurate quantification of the orientation of the aggregated cardiomyocytes, especially in the apical and basal regions. This means that projection of eigenvectors should be avoided prior to quantifying myocyte orientation, especially when assessing radial orientation. Based on our results, we suggest appropriate methods for valid assessment of myocyte orientation using diffusion tensor imaging.
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Affiliation(s)
- Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla Omann
- Dept. of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Institute of Clinical Sciences, The University of Birmingham, Birmingham, UK
| | - Robert H Anderson
- Institute Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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12
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Sánchez-Quintana D, Agger P, Anderson RH. Arquitectura de la pared ventricular. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Sánchez-Quintana D, Agger P, Anderson RH. Ventricular mural architecture. Rev Esp Cardiol (Engl Ed) 2020; 73:186. [PMID: 31629692 DOI: 10.1016/j.rec.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Damián Sánchez-Quintana
- Departamento de Anatomía Humana y Biología Celular, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain.
| | - Peter Agger
- Comparative Medicine Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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14
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Bøgh N, Agger P, Omann C, Skov MN, Laustsen C, Wang T, Pedersen M. New Device for Noninvasive Telemetric Monitoring of Vital Signs in Healthy and Newly Operated Piglets. J Am Assoc Lab Anim Sci 2019; 59:90-93. [PMID: 31806077 DOI: 10.30802/aalas-jaalas-19-000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Measuring vital signs is central to medical practice, but they are difficult to monitor in awake laboratory animals. We examined the feasibility of a noninvasive device for telemetric assessment of respiration rate, heart rate, temperature and movement in pigs. Awake piglets were monitored continuously for 31 h (interquartile range, 7) before (n = 4) and after (n = 3) surgery. Data quality was sufficient for determination of all parameters. We conclude that continuous, noninvasive monitor- ing of pigs is possible by using the evaluated device.
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15
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Omann C, Agger P, Bøgh N, Laustsen C, Ringgaard S, Stephenson RS, Anderson RH, Hjortdal VE, Smerup M. Resolving the natural myocardial remodelling brought upon by cardiac contraction; a porcine ex-vivo cardiovascular magnetic resonance study of the left and right ventricle. J Cardiovasc Magn Reson 2019; 21:35. [PMID: 31256759 PMCID: PMC6600899 DOI: 10.1186/s12968-019-0547-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/29/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The three-dimensional rearrangement of the right ventricular (RV) myocardium during cardiac deformation is unknown. Previous in-vivo studies have shown that myocardial left ventricular (LV) deformation is driven by rearrangement of aggregations of cardiomyocytes that can be characterised by changes in the so-called E3-angle. Ex-vivo imaging offers superior spatial resolution compared with in-vivo measurements, and can thus provide novel insight into the deformation of the myocardial microstructure in both ventricles. This study sought to describe the dynamic changes of the orientations of the cardiomyocytes in both ventricles brought upon by cardiac contraction, with particular interest in the thin-walled RV, which has not previously been described in terms of its micro-architecture. METHODS The hearts of 14 healthy 20 kg swine were excised and preserved in either a relaxed state or a contracted state. Myocardial architecture was assessed and compared between the two contractional states by quantification of the helical, transmural and E3-angles of the cardiomyocytes using high-resolution diffusion tensor imaging. RESULTS The differences between the two states of contraction were most pronounced in the endocardium where the E3-angle decreased from 78.6° to 24.8° in the LV and from 82.6° to 68.6° in the RV. No significant change in neither the helical nor the transmural angle was found in the cardiomyocytes of the RV. In the endocardium of the LV, however, the helical angle increased from 35.4° to 47.8° and the transmural angle increased from 3.1° to 10.4°. CONCLUSION The entire myocardium rearranges through the cardiac cycle with the change in the orientation of the aggregations of cardiomyocytes being the predominant mediator of myocardial wall thickening. Interestingly, differences also exist between the RV and LV, which helps in the explanation of the different physiological capabilities of the ventricles.
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Affiliation(s)
- Camilla Omann
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Peter Agger
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Comparative Medicine Lab, Aarhus University Hospital, Skejby, Denmark
| | - Nikolaj Bøgh
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Christoffer Laustsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- MR Research Centre, Aarhus University, Aarhus, Denmark
| | | | - Robert S. Stephenson
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Comparative Medicine Lab, Aarhus University Hospital, Skejby, Denmark
- Institute of Clinical Sciences, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Robert H. Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Smerup
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
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16
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Anderson RH, Niederer PF, Sanchez-Quintana D, Stephenson RS, Agger P. How are the cardiomyocytes aggregated together within the walls of the left ventricular cone? J Anat 2019; 235:697-705. [PMID: 31206661 DOI: 10.1111/joa.13027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 12/28/2022] Open
Abstract
The manner of packing together of the cardiomyocytes within the walls of the cardiac ventricles has now been investigated for over half a millennium. In 1669, Lower dissected the ventricular mass, likening the arrangement to skeletal musculature, in the form of a myocardial band extending between the right and left atrioventricular junctions. Pettigrew subsequently showed obvious helical arrangements to be evident within the ventricular walls, but emphasised that the cardiomyocytes were attached to each other, and could not justifiably be compared with skeletal cardiomyocytes. Torrent-Guasp then reactivated the notion that the ventricular mass was formed of a solitary band. Unlike Lower, he dissected the band as extending between the pulmonary to the aortic roots. Multiple investigations conducted using gross dissection and histology, and more recently diffusion tensor magnetic resonance imaging and computed tomographic analysis, have shown an absence of any anatomical boundaries within the walls that might permit the mass uniformly to be dissected so as to reveal the band. A response to a recent letter to the Journal, nonetheless, claimed that the dissections had been validated by clinicians interpreting the findings so as to provide an explanation for ventricular cardiodynamics, arguing that the findings provided a suitable anatomical model for this purpose. Anatomical models, however, are of no value unless they are anatomically correct. In this review, therefore, we summarise the evidence showing that the cardiomyocytes making up the ventricular walls, rather than forming a ventricular myocardial band, are instead aggregated together to form a three-dimensional myocardial mesh.
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Affiliation(s)
- Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Damian Sanchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Robert S Stephenson
- Institute of Clinical Sciences, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK.,Comparative Medicine Laboratory, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Agger
- Comparative Medicine Laboratory, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Agger P, Hyldebrandt JA, Hansen ESS, Omann C, Bøgh N, Waziri F, Nielsen PM, Laustsen C. Magnetic resonance hyperpolarisation imaging detects early myocardial dysfunction in a porcine model of right ventricular heart failure. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.831.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter Agger
- Dept. of Clinical MedicineComparative Medicine Lab, MR Research Centre, Aarhus UniversityAarhus N.Denmark
| | | | | | - Camilla Omann
- Department of Cardiothoracic and Vascular SurgeryAarhus University HospitalAarhus N.Denmark
| | - Nikolaj Bøgh
- Dept. of Clinical MedicineMR Research Centre, Aarhus UniversityAarhus N.Denmark
| | - Farhad Waziri
- Department of CardiologyAarhus University HospitalAarhus N.Denmark
| | - Per Mose Nielsen
- Dept. of Clinical MedicineMR Research Centre, Aarhus UniversityAarhus N.Denmark
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18
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Anderson RH, Agger P, Stephenson RS. The incorrect notion of the 'unique myocardial band'. Eur J Cardiothorac Surg 2018; 54:612. [PMID: 29554230 DOI: 10.1093/ejcts/ezy118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/26/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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19
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MacIver DH, Partridge JB, Agger P, Stephenson RS, Boukens BJD, Omann C, Jarvis JC, Zhang H. The end of the unique myocardial band: Part II. Clinical and functional considerations. Eur J Cardiothorac Surg 2018; 53:120-128. [PMID: 29029119 DOI: 10.1093/ejcts/ezx335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/20/2017] [Indexed: 12/25/2022] Open
Abstract
Two of the leading concepts of mural ventricular architecture are the unique myocardial band and the myocardial mesh model. We have described, in an accompanying article published in this journal, how the anatomical, histological and high-resolution computed tomographic studies strongly favour the latter concept. We now extend the argument to describe the linkage between mural architecture and ventricular function in both health and disease. We show that clinical imaging by echocardiography and magnetic resonance imaging, and electrophysiological studies, all support the myocardial mesh model. We also provide evidence that the unique myocardial band model is not compatible with much of scientific research.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.,Medical Education, University of Bristol, Senate House, Bristol, UK.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - John B Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology & Environment, Batemans Bay, NSW, Australia
| | - Peter Agger
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bastiaan J D Boukens
- Department of Medical Biology, Academic Medical Centre, Amsterdam University, Amsterdam, Netherlands
| | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
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20
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MacIver DH, Stephenson RS, Jensen B, Agger P, Sánchez-Quintana D, Jarvis JC, Partridge JB, Anderson RH. The end of the unique myocardial band: Part I. Anatomical considerations. Eur J Cardiothorac Surg 2018; 53:112-119. [PMID: 28958005 DOI: 10.1093/ejcts/ezx290] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023] Open
Abstract
The concept of the 'unique myocardial band', which proposes that the ventricular myocardial cone is arranged like skeletal muscle, provides an attractive framework for understanding haemodynamics. The original idea was developed by Francisco Torrent-Guasp. Using boiled hearts and blunt dissection, Torrent-Guasp created a single band of ventricular myocardium extending from the pulmonary trunk to the aortic root, with the band thus constructed encircling both ventricular cavities. Cooked hearts can, however, be dissected in many ways. In this review, we show that the band does not exist as an anatomical entity with defined borders. On the contrary, the ventricular cardiomyocytes are aggregated end to end and by their branching produce an intricate meshwork. Across the thickness of the left ventricular wall, the chains of cardiomyocytes exhibit a gradually changing helical angle, with a circumferential zone formed in the middle. There is no abrupt change in helical angle, as could be expected if the wall was constructed of opposing limbs of a single wrapped band, nor does the long axis of the cardiomyocytes consistently match with the long axis of the unique myocardial band. There are, furthermore, no connective tissue structures that could be considered to demarcate its purported boundaries. The unique myocardial band should be consistent with evolution, and although the ventricular wall of fish and reptiles has one or several distinct layers, a single band is not found. In 1965, Lev and Simpkins cautioned that the ventricular muscle mass of a cooked heart can be dissected almost at the whim of the anatomist. We suggest that the unique myocardial band should have ended there.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.,Medical Education, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjarke Jensen
- Department of Medical Biology, Academic Medical Center, Amsterdam University, Netherlands
| | - Peter Agger
- Department of Paediatrics, Aarhus University Hospital, Denmark
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Jonathan C Jarvis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - John B Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology and Environment, Batemans Bay, NSW, Australia
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
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21
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Liao D, Gregersen H, Agger P, Laustsen C, Ringgaard S, Stødkilde-Jørgensen H, Zhao J. 3D reconstruction and fiber quantification in the pig lower esophageal sphincter region using
in vitro
diffusion tensor imaging. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aa976e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Nørlinger TS, Nielsen PM, Qi H, Mikkelsen E, Hansen K, Schmidt NH, Pedersen M, Agger P, Palm F, Laustsen C. Hyperbaric oxygen therapy reduces renal lactate production. Physiol Rep 2017; 5:5/6/e13217. [PMID: 28336821 PMCID: PMC5371573 DOI: 10.14814/phy2.13217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 01/27/2023] Open
Abstract
Intrarenal hypoxia is an acknowledged factor contributing to the development of diabetic nephropathy. Hyperbaric oxygen (HBO) therapy is a well‐known adjuvant treatment for several medical conditions, such as decompression sickness, infections, and wound healing. The underlying metabolic response of HBO is largely unknown. In this study, we investigated the effect of HBO on the intrarenal metabolic alteration in diabetes. Hyperpolarized [1‐13C]pyruvate MRI was performed to assess intrarenal energy metabolism in normoglycemic controls and short‐term (2 weeks) streptozotocin‐induced diabetic rats with and without HBO for five consecutive days. HBO therapy blunted intrarenal lactate production, 3 days after the therapy, in both normoglycemic controls and diabetic rats without affecting either lactate dehydrogenase mRNA expression or activity. HBO therapy reduced lactate formation in both normoglycemic and hyperglycemic rats. These findings support hyperpolarized [1‐13C]pyruvate MRI as a novel method for monitoring HBO therapy via the pyruvate to lactate conversion.
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Affiliation(s)
- Thomas S Nørlinger
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Per Mose Nielsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Haiyun Qi
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Emmeli Mikkelsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Kasper Hansen
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Nikolaj H Schmidt
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Michael Pedersen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Peter Agger
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Fredrik Palm
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
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23
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Agger P, Ilkjær C, Laustsen C, Smerup M, Frandsen JR, Ringgaard S, Pedersen M, Partridge JB, Anderson RH, Hjortdal V. Changes in overall ventricular myocardial architecture in the setting of a porcine animal model of right ventricular dilation. J Cardiovasc Magn Reson 2017; 19:93. [PMID: 29178894 PMCID: PMC5702974 DOI: 10.1186/s12968-017-0404-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/18/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Chronic pulmonary regurgitation often leads to myocardial dysfunction and heart failure. It is not fully known why secondary hypertrophy cannot fully protect against the increase in wall stress brought about by the increased end-diastolic volume in ventricular dilation. It has been assumed that mural architecture is not deranged in this situation, but we hypothesised that there might be a change in the pattern of orientation of the aggregations of cardiomyocytes, which would contribute to contractile impairment. METHODS We created pulmonary valvular regurgitation by open chest, surgical suturing of its leaflets in seven piglets, performing sham operations in seven control animals. Using cardiovascular magnetic resonance imaging after 12 weeks of recovery, we demonstrated significantly increased right ventricular volumes in the test group. After sacrifice, diffusion tensor imaging of their hearts permitted measurement of the orientation of the cardiomyocytes. RESULTS The helical angles in the right ventricle approached a more circumferential orientation in the setting of right ventricular RV dilation (p = 0.007), with an increased proportion of surface-parallel cardiomyocytes. In contrast, this proportion decreased in the left ventricle. Also in the left ventricle a higher proportion of E3 angles with a value around zero was found, and conversely a lower proportion of angles was found with a numerical higher value. In the dilated right ventricle the proportion of E3 angles around -90° is increased, while the proportion around 90° is decreased. CONCLUSION Contrary to traditional views, there is a change in the orientation of both the left ventricular and right ventricular cardiomyocytes subsequent to right ventricular dilation. This will change their direction of contraction and hinder the achievement of normalisation of cardiomyocytic strain, affecting overall contractility. We suggest that the aetiology of the cardiac failure induced by right vetricular dilation may be partly explained by morphological changes in the myocardium itself.
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Affiliation(s)
- Peter Agger
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christine Ilkjær
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christoffer Laustsen
- MR Research Center, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Jesper R. Frandsen
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
| | - Steffen Ringgaard
- MR Research Center, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John B. Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology & Environment, Batemans Bay, NSW Australia
| | - Robert H. Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Vibeke Hjortdal
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Agger P, Stephenson RS, Dobrzynski H, Atkinson A, Iaizzo PA, Anderson RH, Jarvis JC, Allan SL, Partridge JB, Zhao J, Zhang H, MacIver DH. Insights from echocardiography, magnetic resonance imaging, and microcomputed tomography relative to the mid-myocardial left ventricular echogenic zone. Echocardiography 2016; 33:1546-1556. [DOI: 10.1111/echo.13324] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Peter Agger
- Department of Cardiothoracic and Vascular Surgery; Deptartment of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - Robert S. Stephenson
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool United Kingdom
- School of Dentistry; The University of Central Lancashire; Preston United Kingdom
| | - Halina Dobrzynski
- School of Medicine; University of Manchester; Manchester United Kingdom
| | - Andrew Atkinson
- School of Medicine; University of Manchester; Manchester United Kingdom
| | - Paul A. Iaizzo
- Institute for Engineering in Medicine; Department of Surgery; University of Minnesota; Minneapolis Minnesota
| | - Robert H. Anderson
- Institute of Genetic Medicine; Newcastle University; Newcastle Upon Tyne United Kingdom
- Division of Biomedical Sciences; University College London; London United Kingdom
| | - Jonathan C. Jarvis
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool United Kingdom
| | - Sarah L. Allan
- Department of Cardiology; Taunton & Somerset Hospital; Taunton United Kingdom
| | - John B. Partridge
- Eurobodalla Unit; Rural Clinical School of the ANU College of Medicine, Biology & Environment; Batemans Bay NSW Australia
| | - Jichao Zhao
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - Henggui Zhang
- Biological Physics Group; School of Astronomy and Physics; University of Manchester; Manchester United Kingdom
| | - David H. MacIver
- Department of Cardiology; Taunton & Somerset Hospital; Taunton United Kingdom
- Biological Physics Group; School of Astronomy and Physics; University of Manchester; Manchester United Kingdom
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25
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Abstract
Four percent of the world's population, or 265 million people, play football, and many players are injured every year. The present study investigated more than 1800 injuries in over 45,000 youth players participating in three consecutive international football tournaments in Denmark in 2012-2014. The aim was to investigate the injury types and locations in children and adolescent football players and the differences between genders and age groups (11-15 and 16-19 years of age). An overall injury rate of 15.3 per 1000 player hours was found. The most common injury location was lower extremities (66.7%), and the most common injury type was contusion (24.4%). Girls had a relative risk of injury of 1.5 compared with boys, p < .001, and they had a higher proportion of injuries to knee and lower leg, 23.8%, than boys, 19.0%, p < .01. Boys had a higher proportion of fracture, 6.8%, as opposed to 3.3% among girls, p < .001. In conclusion, we found the youngest girls to have a higher incidence of almost all injury categories than any other group. In general, the incidence of injury decreased with age. The study provides a detailed insight into the injuries that may be expected at a large youth football tournament. These findings are of great value for organizations and healthcare professionals planning similar events and for planning injury prevention strategies, which would be of special interest in the youngest female players in general.
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Affiliation(s)
- Line Agger Kolstrup
- a Department of Anaesthesiology and Intensive Care , Aarhus University Hospital , Aarhus , Denmark
| | | | - Uffe Harboe Nygaard
- c Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | - Rie Harboe Nygaard
- d Institute of Sports Medicine, Bispebjerg Hospital, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Peter Agger
- c Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
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26
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Agger P, Lakshminrusimha S, Laustsen C, Gugino S, Frandsen JR, Smerup M, Anderson RH, Hjortdal V, Steinhorn RH. The myocardial architecture changes in persistent pulmonary hypertension of the newborn in an ovine animal model. Pediatr Res 2016; 79:565-74. [PMID: 26679151 PMCID: PMC4837009 DOI: 10.1038/pr.2015.263] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/28/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Persistent pulmonary hypertension in the newborn remains a syndrome with high mortality. Knowledge of changes in myocardial architecture in the setting of heart failure in persistent pulmonary hypertension is lacking, and could aid in the explanation of the prevailing high mortality. METHODS Persistent pulmonary hypertension was induced by antenatal ligation of the arterial duct in six ovine fetuses. The hearts were compared ex vivo with five matched control hearts, using diffusion tensor imaging to provide the overall anatomical arrangement, and assessment of the angulations and course of the cardiomyocytes. Fibrosis was assessed with histology. RESULTS We found an overall increase in heart size in pulmonary hypertension, with myocardial thickening confined to the interventricular septum. An increase of 3.5° in angulation of myocyte aggregations was found in hypertensive hearts. In addition, we observed a 2.2% increase in collagen content in the right ventricular free wall. Finally, we found a previously undescribed subepicardial layer of strictly longitudinally oriented cardiomyocytes confined to the right ventricle in all hearts. CONCLUSION Myocardial fibrosis and possibly changes in angulations of myocytes seem to play a part in the etiology of persistent pulmonary hypertension. Moreover, a new anatomical arrangement of right ventricular mural architecture is described.
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Affiliation(s)
- Peter Agger
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Satyan Lakshminrusimha
- Division of Neonatology, Women and Children’s Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New York
| | - Christoffer Laustsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark,MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Sylvia Gugino
- Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York
| | - Jesper R. Frandsen
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Smerup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Robert H. Anderson
- Institute of Genetic Medicine, University of Newcastle, Newcastle-upon-Tyne, UK
| | - Vibeke Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Robin H. Steinhorn
- Division of Neonatology, UC Davis Children’s Hospital, Sacramento, California
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27
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Stephenson RS, Agger P, Lunkenheimer PP, Zhao J, Smerup M, Niederer P, Anderson RH, Jarvis JC. The functional architecture of skeletal compared to cardiac musculature: Myocyte orientation, lamellar unit morphology, and the helical ventricular myocardial band. Clin Anat 2015; 29:316-32. [PMID: 26478993 DOI: 10.1002/ca.22661] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022]
Abstract
How the cardiomyocytes are aggregated within the heart walls remains contentious. We still do not fully understand how the end-to-end longitudinal myocytic chains are arranged, nor the true extent and shape of the lamellar units they aggregate to form. In this article, we show that an understanding of the complex arrangement of cardiac musculature requires knowledge of three-dimensional myocyte orientation (helical and intrusion angle), and appreciation of myocyte packing within the connective tissue matrix. We show how visualization and segmentation of high-resolution three-dimensional image data can accurately identify the morphology and orientation of the myocytic chains, and the lamellar units. Some maintain that the ventricles can be unwrapped in the form of a "helical ventricular myocardial band," that is, as a compartmentalized band with selective regional innervation and deformation, and a defined origin and insertion like most skeletal muscles. In contrast to the simpler interpretation of the helical ventricular myocardial band, we provide insight as to how the complex myocytic chains, the heterogeneous lamellar units, and connective tissue matrix form an interconnected meshwork, which facilitates the complex internal deformations of the ventricular wall. We highlight the dangers of disregarding the intruding cardiomyocytes. Preparation of the band destroys intruding myocytic chains, and thus disregards the functional implications of the antagonistic auxotonic forces they produce. We conclude that the ventricular myocardium is not analogous to skeletal muscle, but is a complex three-dimensional meshwork, with a heterogeneous branching lamellar architecture.
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Affiliation(s)
- Robert S Stephenson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Paul P Lunkenheimer
- Department of Experimental Thoracic and Cardiovascular Surgery, University Hospital Munster, Munster, DE, Germany
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Morten Smerup
- Department of Cardiothoracic & Vascular Surgery, Aarhus University, Aarhus, Denmark
| | - Peter Niederer
- Institute for Biomedical Engineering, University of Zurich, Zurich, CH, Switzerland
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Division of Biomedical Sciences, University College London, London, United Kingdom
| | - Jonathan C Jarvis
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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28
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Jensen B, Agger P, de Boer BA, Oostra RJ, Pedersen M, van der Wal AC, Nils Planken R, Moorman AFM. The hypertrabeculated (noncompacted) left ventricle is different from the ventricle of embryos and ectothermic vertebrates. Biochim Biophys Acta 2015; 1863:1696-706. [PMID: 26516055 DOI: 10.1016/j.bbamcr.2015.10.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 12/11/2022]
Abstract
Ventricular hypertrabeculation (noncompaction) is a poorly characterized condition associated with heart failure. The condition is widely assumed to be the retention of the trabeculated ventricular design of the embryo and ectothermic (cold-blooded) vertebrates. This assumption appears simplistic and counterfactual. Here, we measured a set of anatomical parameters in hypertrabeculation in man and in the ventricles of embryos and animals. We compared humans with left ventricular hypertrabeculation (N=21) with humans with structurally normal left ventricles (N=54). We measured ejection fraction and ventricular trabeculation using cardiovascular MRI. Ventricular trabeculation was further measured in series of embryonic human and 9 animal species, and in hearts of 15 adult animal species using MRI, CT, or histology. In human, hypertrabeculated left ventricles were significantly different from structurally normal left ventricles by all structural measures and ejection fraction. They were far less trabeculated than human embryonic hearts (15-40% trabeculated volume versus 55-80%). Early in development all vertebrate embryos acquired a ventricle with approximately 80% trabeculations, but only ectotherms retained the 80% trabeculation throughout development. Endothermic (warm-blooded) animals including human slowly matured in fetal and postnatal stages towards ventricles with little trabeculations, generally less than 30%. Further, the trabeculations of all embryos and adult ectotherms were very thin, less than 50 μm wide, whereas the trabeculations in adult endotherms and in the setting of hypertrabeculation were wider by orders of magnitude. It is concluded in contrast to a prevailing assumption, the hypertrabeculated left ventricle is not like the ventricle of the embryo or of adult ectotherms. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel.
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Affiliation(s)
- Bjarke Jensen
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Bouke A de Boer
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael Pedersen
- MR Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - Allard C van der Wal
- Department of Pathology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Antoon F M Moorman
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands
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29
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Anderson RH, Lunkenheimer PP, Jarvis JJ, Stephenson R, MacIver DH, Agger P. Assessment of the Helical Ventricular Myocardial Band Using Standard Echocardiography. Echocardiography 2015; 32:1601-2. [DOI: 10.1111/echo.13031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Robert H. Anderson
- Institute of Genetic Medicine; Newcastle University; Newcastle-upon-Tyne United Kingdom
| | - Paul P. Lunkenheimer
- Department of Experimental Thoraco-vascular Surgery; University Hospital Münster; Munster Germany
| | - Jonathan J. Jarvis
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool United Kingdom
| | - Robert Stephenson
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool United Kingdom
| | - David H. MacIver
- Department of Cardiology; Taunton & Somerset Hospital; Taunton United Kingdom
| | - Peter Agger
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital; Aarhus Denmark
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30
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Agger P, Lass T, Smerup M, Frandsen J, Pedersen M. Optimal preservation of porcine cardiac tissue prior to diffusion tensor magnetic resonance imaging. J Anat 2015; 227:695-701. [PMID: 26391195 DOI: 10.1111/joa.12377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/26/2022] Open
Abstract
The effects of ex vivo preservation techniques on the quality of diffusion tensor magnetic resonance imaging in hearts are poorly understood, and the optimal handling procedure prior to investigation remains to be determined. Therefore, 24 porcine hearts were examined in six groups treated with different preservation techniques, including chemical fixation and freezing. Diffusion properties of each heart were assessed with diffusion tensor imaging in terms of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da) and radial diffusivity (Dr). Tractography was performed to visualize the course of the cardiomyocytes, assuming greater diffusivity in the longitudinal than the transverse axis of individual cardiomyocytes. Significant differences in MD, Da and Dr were found, as well as in FA between groups (P < 0.001). Freezing of specimens resulted in the lowest mean FA of 0.21 (0.06) and highest Dr of 8.92 (1.5) mm2 s(-1) . The highest mean FA was found to be 0.43 (0.11) in hearts perfusion-fixed with formalin. Calculated tractographies were indistinguishable among groups except in frozen specimens, where no fibres could be tracked. Perfusion fixation with formalin provided the best tractography, but immersion fixation yielded diffusion data most similar to fresh hearts. These findings suggest that parameters derived from diffusion tensor imaging in ex vivo hearts are sensitive to fixation and storage methods. In particular, freezing of specimens should be avoided prior to diffusion tensor imaging investigation due to significant changes in diffusion parameters and subsequent image deteriorations.
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Affiliation(s)
- Peter Agger
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Lass
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Smerup
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Frandsen
- Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,MR Research Center, Aarhus University Hospital, Aarhus, Denmark
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31
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Hyldebrandt JA, Agger P, Sivén E, Wemmelund KB, Heiberg J, Frederiksen CA, Ravn HB. Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in right heart failure after pulmonary regurgitation. Am J Physiol Heart Circ Physiol 2015; 309:H860-6. [DOI: 10.1152/ajpheart.00384.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/17/2015] [Indexed: 11/22/2022]
Abstract
Right ventricular failure (RVF) secondary to pulmonary regurgitation (PR) impairs right ventricular (RV) function and interrupts the interventricular relationship. There are few recommendations for the medical management of severe RVF after prolonged PR. PR was induced in 16 Danish landrace pigs by plication of the pulmonary valve leaflets. Twenty-three pigs served as controls. At reexamination the effect of milrinone, epinephrine, and dopamine was evaluated using biventricular conductance and pulmonary catheters. Seventy-nine days after PR was induced, RV end-diastolic volume index (EDVI) had increased by 33% ( P = 0.006) and there was a severe decrease in the load-independent measurement of contractility (PRSW) (−58%; P = 0.003). Lower cardiac index (CI) (−28%; P < 0.0001), mean arterial pressure (−15%; P = 0.01) and mixed venous oxygen saturation (SvO2) (36%; P < 0.0001) were observed compared with the control group. The interventricular septum deviated toward the left ventricle (LV). Milrinone improved RV-PRSW and CI and maintained systemic pressure while reducing central venous pressure (CVP). Epinephrine and dopamine further improved biventricular PRSW and CI equally in a dose-dependent manner. Systemic and pulmonary pressures were higher in the dopamine-treated animals compared with epinephrine-treated animals. None of the treatments improved stroke volume index (SVI) despite increases in contractility. Strong correlation was detected between SVI and LV-EDVI, but not SVI and biventricular contractility. In RVF due to PR, milrinone significantly improved CI, SvO2, and CVP and increased contractility in the RV. Epinephrine and dopamine had equal inotropic effect, but a greater vasopressor effect was observed for dopamine. SV was unchanged due to inability of both treatments to increase LV-EDVI.
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Affiliation(s)
- Janus Adler Hyldebrandt
- Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Agger
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; and
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eleonora Sivén
- Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Johan Heiberg
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; and
| | | | - Hanne Berg Ravn
- Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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32
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Damkjaer M, Wang T, Brøndum E, Østergaard KH, Baandrup U, Hørlyck A, Hasenkam JM, Smerup M, Funder J, Marcussen N, Danielsen CC, Bertelsen MF, Grøndahl C, Pedersen M, Agger P, Candy G, Aalkjaer C, Bie P. The giraffe kidney tolerates high arterial blood pressure by high renal interstitial pressure and low glomerular filtration rate. Acta Physiol (Oxf) 2015; 214:497-510. [PMID: 26010805 DOI: 10.1111/apha.12531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The tallest animal on earth, the giraffe (Giraffa camelopardalis) is endowed with a mean arterial blood pressure (MAP) twice that of other mammals. The kidneys reside at heart level and show no sign of hypertension-related damage. We hypothesized that a species-specific evolutionary adaption in the giraffe kidney allows normal for size renal haemodynamics and glomerular filtration rate (GFR) despite a MAP double that of other mammals. METHODS Fourteen anaesthetized giraffes were instrumented with vascular and bladder catheters to measure glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal interstitial hydrostatic pressure (RIHP) was assessed by inserting a needle into the medullary parenchyma. Doppler ultrasound measurements provided renal artery resistive index (RI). Hormone concentrations as well as biomechanical, structural and histological characteristics of vascular and renal tissues were determined. RESULTS GFR averaged 342 ± 99 mL min(-1) and ERPF 1252 ± 305 mL min(-1) . RIHP varied between 45 and 140 mmHg. Renal pelvic pressure was 39 ± 2 mmHg and renal venous pressure 32 ± 4 mmHg. A valve-like structure at the junction of the renal and vena cava generated a pressure drop of 12 ± 2 mmHg. RI was 0.27. The renal capsule was durable with a calculated burst pressure of 600 mmHg. Plasma renin and AngII were 2.6 ± 0.5 mIU L(-1) and 9.1 ± 1.5 pg mL(-1) respectively. CONCLUSION In giraffes, GFR, ERPF and RI appear much lower than expected based on body mass. A strong renal capsule supports a RIHP, which is >10-fold that of other mammals effectively reducing the net filtration pressure and protecting against the high MAP.
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Affiliation(s)
- M. Damkjaer
- Department of Cardiovascular and Renal Research; University of Southern Denmark; Odense Denmark
| | - T. Wang
- Department of Biological Sciences; Institute of Zoophysiology; Aarhus University; Aarhus Denmark
| | - E. Brøndum
- Department of Physiology; Institute of Biomedicine; Aarhus University; Aarhus Denmark
| | - K. H. Østergaard
- Centre for Clinical Research; Hjørring/Department of Clinical Medicine; Aalborg University; Denmark
| | - U. Baandrup
- Centre for Clinical Research; Hjørring/Department of Clinical Medicine; Aalborg University; Denmark
| | - A. Hørlyck
- Department of Radiology; Aarhus University Hospital; Aarhus Denmark
| | - J. M. Hasenkam
- Department of Cardiothoracic and Vascular Surgery; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - M. Smerup
- Department of Cardiothoracic and Vascular Surgery; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - J. Funder
- Department of Cardiothoracic and Vascular Surgery; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - N. Marcussen
- Department of Clinical Pathology; University of Southern Denmark; Odense Denmark
| | - C. C. Danielsen
- Department of Anatomy; Institute of Biomedicine; Aarhus University; Aarhus Denmark
| | - M. F. Bertelsen
- Center for Zoo and Wild Animal Health; Copenhagen Zoo; Copenhagen Denmark
| | - C. Grøndahl
- Center for Zoo and Wild Animal Health; Copenhagen Zoo; Copenhagen Denmark
| | - M. Pedersen
- MR Research Centre; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - P. Agger
- MR Research Centre; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - G. Candy
- Department of Physiology and Medicine; University of the Witwatersrand; Johannesburg South Africa
| | - C. Aalkjaer
- Department of Physiology; Institute of Biomedicine; Aarhus University; Aarhus Denmark
- Department of Biomedicine; University of Copenhagen; Copenhagen Denmark
| | - P. Bie
- Department of Cardiovascular and Renal Research; University of Southern Denmark; Odense Denmark
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33
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Hyldebrandt JA, Sivén E, Agger P, Frederiksen CA, Heiberg J, Wemmelund KB, Ravn HB. Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding. Am J Physiol Heart Circ Physiol 2015; 309:H206-12. [DOI: 10.1152/ajpheart.00921.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/04/2015] [Indexed: 11/22/2022]
Abstract
Right ventricular (RV) failure due to chronic pressure overload is a main determinant of outcome in congenital heart disease. Medical management is challenging because not only contractility but also the interventricular relationship is important for increasing cardiac output. This study evaluated the effect of milrinone alone and in combination with epinephrine or dopamine on hemodynamics, ventricular performance, and the interventricular relationship. RV failure was induced in 21 Danish landrace pigs by pulmonary artery banding. After 10 wk, animals were reexamined using biventricular pressure-volume conductance catheters. The maximum pressure in the RV increased by 113% ( P < 0.0001) and end-diastolic volume by 43% ( P < 0.002), while left ventricular (LV) pressure simultaneously decreased ( P = 0.006). Concomitantly, mean arterial pressure (MAP; −16%, P = 0.01), cardiac index (CI; −23%, P < 0.0001), and mixed venous oxygen saturation (SvO2; −40%, P < 0.0001) decreased. Milrinone increased CI (11%, P = 0.008) and heart rate (HR; 21%, P < 0.0001). Stroke volume index (SVI) decreased (7%, P = 0.03), although RV contractility was improved. The addition of either epinephrine or dopamine further increased CI and HR in a dose-dependent manner but without any significant differences between the two interventions. A more pronounced increase in biventricular contractility was observed in the dopamine-treated animals. LV volume was reduced in both the dopamine and epinephrine groups with increasing doses In the failing pressure overloaded RV, milrinone improved CI and increased contractility. Albeit additional dose-dependent effects of both epinephrine and dopamine on CI and contractility, neither of the interventions improved SVI due to reduced filling of the LV.
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Affiliation(s)
- Janus Adler Hyldebrandt
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; and
| | - Eleonora Sivén
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Peter Agger
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; and
| | | | - Johan Heiberg
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hanne Berg Ravn
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Adler Hyldebrandt J, Agger P, Sivén E, Wemmelund K, Heiberg J, Alcaraz Frederiksen C, Berg Ravn H. Effects of Milrinone and Epinephrine or Dopamine on Biventricular Function and Haemodynamics in an animal model with Right Heart Failure after Pulmonary Regurgitation. J Cardiothorac Vasc Anesth 2015. [DOI: 10.1053/j.jvca.2015.05.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Adler Hyldebrandt J, Sivén E, Agger P, Alcaraz Frederiksen C, Heiberg J, Wemmelund K, Berg Ravn H. Effects of milrinone and epinephrine or dopamine on biventricular function and haemodynamics in an animal model with right ventricular failure after pulmonary artery banding. J Cardiothorac Vasc Anesth 2015. [DOI: 10.1053/j.jvca.2015.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Udholm S, Laugesen S, Agger P, Hønge J, Smerup M, Udholm N, Bøtker HE, Bøttcher M. Delayed uptake and washout of contrast in non-viable infarcted myocardium shown with dynamic computed tomography. Cardiovasc Diagn Ther 2014; 4:350-6. [PMID: 25414821 DOI: 10.3978/j.issn.2223-3652.2014.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/12/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Assessment of ischemic but potentially viable myocardium plays an important role in the planning of coronary revascularization. Until now SPECT, PET, and MRI have been used to identify viable myocardium. Computed tomography (CT) is increasingly used to diagnose coronary atherosclerosis. OBJECTIVE To evaluate the feasibility of CT enhancement as a viability marker by investigating myocardial contrast distribution over time in pigs with experimentally induced antero-septal myocardial infarctions. METHODS Twelve pigs were subjected to 60 min of balloon occlusion of the left anterior descending artery, followed by removal of the balloon and reperfusion. Four pigs died due to refractory ventricular fibrillation. After 6 weeks, dynamic cardiac CT was performed assessing both wall motion and contrast attenuation. Measurements of attenuation values in Hounsfield units (HU) in the infarct zone and the normal lateral wall were performed at 20 s, and 1, 3, 5, 8 and 12 min after contrast injection. RESULTS We found highly significant differences in attenuation values between the two zones at all-time points except t =1 min (ANOVA P=0.85). The normal myocardium showed higher uptake- and washout-rates of contrast than the infarct zone (84±15 vs. 58±8 at 20 s, P=0.0001 and 27±12 vs. 81±13 at 12 min, P=0.0001). Specifically, the ratio between early (20 s) and late (12 min) uptake is a valid marker of viable myocardium. In all animals this ration was above one in the normal zone and below one in the infarct zone. CONCLUSIONS Delayed infarct related uptake and washout of contrast shows promise for future clinical application of CT in a combined assessment of coronary atherosclerosis and myocardial viability.
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Affiliation(s)
- Sebastian Udholm
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Sofie Laugesen
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Peter Agger
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Jesper Hønge
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Morten Smerup
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Nichlas Udholm
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Hans Erik Bøtker
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Morten Bøttcher
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
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Smerup M, Agger P, Nielsen EA, Ringgaard S, Pedersen M, Niederer P, Anderson RH, Lunkenheimer PP. Regional and Epi- to Endocardial Differences in Transmural Angles of Left Ventricular Cardiomyocytes Measured inEx VivoPig Hearts: Functional Implications. Anat Rec (Hoboken) 2013; 296:1724-34. [DOI: 10.1002/ar.22787] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/27/2013] [Accepted: 07/13/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Morten Smerup
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital Skejby; Aarhus Denmark
| | - Peter Agger
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital Skejby; Aarhus Denmark
| | - Eva Amalie Nielsen
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital Skejby; Aarhus Denmark
| | | | | | - Peter Niederer
- Institute of Biomedical Engineering; ETH Zurich; Zurich Switzerland
| | | | - Paul P. Lunkenheimer
- Klinik und Poliklinik für Thorax-, Herz- und Gefässchirurgie; University Münster; Germany
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Smerup M, Partridge J, Agger P, Ringgaard S, Pedersen M, Petersen S, Hasenkam JM, Niederer P, Lunkenheimer PP, Anderson RH. A mathematical model of the mechanical link between shortening of the cardiomyocytes and systolic deformation of the left ventricular myocardium. Technol Health Care 2013; 21:63-79. [PMID: 23358060 DOI: 10.3233/thc-120710] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left ventricular myocytes are arranged in a complex three-dimensional mesh. Since all myocytes contract approximately to the same degree, mechanisms must exist to enable force transfer from each of these onto the framework as a whole, despite the transmural differences in deformation strain. This process has hitherto not been clarified in detail. OBJECTIVE To present a geometrical model that establishes a mechanical link between the three-dimensional architecture and the function of the left ventricular myocardium. METHODS The left ventricular equator was modeled as a cylindrical tube of deformable but incompressible material, composed of virtual cardiomyocytes with known diastolic helical and transmural angles. By imposing reference circumferential, longitudinal, and torsional strains onto the model, we created a three-dimensional deformation field to calculate passive shortening of the myocyte surrogates. We tested two diastolic architectures: 1) a simple model with longitudinal myocyte surrogates in the endo- and epicardium, and circular ones in the midwall, and 2) a more accurate architecture, with progressive helical angle distribution varying from -60° in the epicardium to 60° in the endocardium, with or without torsion and transmural cardiomyocyte angulation. RESULTS The simple model caused great transmural unevenness in cardiomyocyte shortening; longitudinal surrogates shortened by 15% at all depths equal to the imposed longitudinal strain, whereas circular surrogates exhibited a maximum shortening of 23.0%. The accurate model exhibited a smooth transmural distribution of cardiomyocyte shortening, with a mean (range) of 17.0 (13.2-20.8)%. Torsion caused a shortening of 17.0 (15.2-18.9)% and transmural angulation caused a shortening of 15.2 (12.4-18.2)%. Combining the effects of transmural angulation and torsion caused a change of 15.2 (13.2-16.5)%. CONCLUSION A continuous transmural distribution of the helical angle is obligatory for smooth shortening of the cardiomyocytes, but a combination of torsional and transmural angulation changes is necessary to execute systolic mural thickening whilst keeping shortening of the cardiomyocytes within its physiological range.
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Affiliation(s)
- M Smerup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital Skejby, Aarhus, Denmark.
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Lauridsen H, Hansen K, Wang T, Agger P, Andersen JL, Knudsen PS, Rasmussen AS, Uhrenholt L, Pedersen M. Inside out: modern imaging techniques to reveal animal anatomy. PLoS One 2011; 6:e17879. [PMID: 21445356 PMCID: PMC3062562 DOI: 10.1371/journal.pone.0017879] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/12/2011] [Indexed: 12/31/2022] Open
Abstract
Animal anatomy has traditionally relied on detailed dissections to produce anatomical illustrations, but modern imaging modalities, such as MRI and CT, now represent an enormous resource that allows for fast non-invasive visualizations of animal anatomy in living animals. These modalities also allow for creation of three-dimensional representations that can be of considerable value in the dissemination of anatomical studies. In this methodological review, we present our experiences using MRI, CT and μCT to create advanced representation of animal anatomy, including bones, inner organs and blood vessels in a variety of animals, including fish, amphibians, reptiles, mammals, and spiders. The images have a similar quality to most traditional anatomical drawings and are presented together with interactive movies of the anatomical structures, where the object can be viewed from different angles. Given that clinical scanners found in the majority of larger hospitals are fully suitable for these purposes, we encourage biologists to take advantage of these imaging techniques in creation of three-dimensional graphical representations of internal structures.
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Affiliation(s)
- Henrik Lauridsen
- MR Research Center, Aarhus University Hospital Skejby, Aarhus, Denmark
- Zoophysiology, Department of Biological Sciences, Aarhus University, Aarhus, Denmark
| | - Kasper Hansen
- MR Research Center, Aarhus University Hospital Skejby, Aarhus, Denmark
- Zoophysiology, Department of Biological Sciences, Aarhus University, Aarhus, Denmark
| | - Tobias Wang
- Zoophysiology, Department of Biological Sciences, Aarhus University, Aarhus, Denmark
| | - Peter Agger
- Institute of Clinical Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Jonas L. Andersen
- Zoophysiology, Department of Biological Sciences, Aarhus University, Aarhus, Denmark
| | - Peter S. Knudsen
- Zoophysiology, Department of Biological Sciences, Aarhus University, Aarhus, Denmark
| | - Anne S. Rasmussen
- MR Research Center, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Lars Uhrenholt
- Section for Forensic Pathology, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Pedersen
- MR Research Center, Aarhus University Hospital Skejby, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
- * E-mail:
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Agger P, Hyldebrandt JA, Nielsen EA, Hjortdal V, Smerup M. A novel porcine model for right ventricular dilatation by external suture plication of the pulmonary valve leaflets--practical and reproducible. Interact Cardiovasc Thorac Surg 2010; 10:962-6. [PMID: 20197345 DOI: 10.1510/icvts.2009.227264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The right ventricle (RV) tolerates acute pulmonary valvular regurgitation fairly well, however, in the long-term dilatation and failure often ensues. There is little known of the structural and functional myocardial alterations following this pathophysiology, and therefore animal models are sought. We aimed to develop an animal experimental model for RV dilatation emphasizing feasibility, reproducibility and human compatibility. Free pulmonary valve insufficiency and RV dilatation were created with a novel external suture plication technique in nine 5 kg piglets. Six matched animals served as controls. After 10 weeks cardiac dimensions and physiology were assessed with in vivo cardiovascular MRI and conductance technique. RV end-diastolic volume increased 31% in the intervention group (P=0.03). The regurgitation fraction was 37% in the intervention group compared to -2% in controls (P<0.001). Conductance measurements showed preserved RV contractile function, but significant left ventricular diastolic impairment. This study is the first to show that pulmonary valve regurgitation, RV dilatation and functional impairment can be achieved by external leaflet plication. Compared to known methods, the advantages of this model are: 1) no induction of stenosis over time, 2) no risk of stent migration, and 3) very simple and reproducible.
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Affiliation(s)
- Peter Agger
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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41
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Nielsen E, Smerup M, Agger P, Frandsen J, Ringgard S, Pedersen M, Vestergaard P, Nyengaard JR, Andersen JB, Lunkenheimer PP, Anderson RH, Hjortdal V. Normal Right Ventricular Three-Dimensional Architecture, as Assessed with Diffusion Tensor Magnetic Resonance Imaging, is Preserved During Experimentally Induced Right Ventricular Hypertrophy. Anat Rec (Hoboken) 2009; 292:640-51. [DOI: 10.1002/ar.20873] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Smerup M, Nielsen E, Agger P, Frandsen J, Vestergaard-Poulsen P, Andersen J, Nyengaard J, Pedersen M, Ringgaard S, Hjortdal V, Lunkenheimer PP, Anderson RH. The Three-Dimensional Arrangement of the Myocytes Aggregated Together Within the Mammalian Ventricular Myocardium. Anat Rec (Hoboken) 2009; 292:1-11. [DOI: 10.1002/ar.20798] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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43
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Smerup M, Nielsen E, Agger P, Frandsen J, Vestergaard-Poulsen P, Andersen J, Nyengaard J, Pedersen M, Ringgaard S, Hjortdal V, Lunkenheimer PP, Anderson RH. The Three-Dimensional Arrangement of the Myocytes Aggregated Together Within the Mammalian Ventricular Myocardium. Anat Rec (Hoboken) 2009. [DOI: 10.1002/ar.20855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brødløs HK, Bramsen MB, Agger P, Jensen H, Bjerre M, Ringgaard S, Wierup P, Nielsen SL, Hasenkam JM, Smerup M. A catheter based chronic porcine model of post-infarct dilated heart failure. SCAND CARDIOVASC J 2008; 43:260-6. [PMID: 19065447 DOI: 10.1080/14017430802604034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES New surgical treatments for post-infarct antero-septal myocardial akinesia have been developed but evaluation of their mode of function is hampered by absence of suitable large animal heart failure models. We aimed to develop and evaluate a human compatible model for chronic post-infarct left ventricular (LV) remodeling. DESIGN Fourteen female 50 kg pigs underwent catheter-based coronary artery occlusion (one hour) distal to the first LAD diagonal. Eight weight- and age-matched healthy animals served as controls. LV geometry and function were assessed after 6 weeks with cardiovascular MRI. RESULTS All animals recovered from interventions. Three animals died during follow-up. All intervention animals had antero-septal akinetic infarcts (mean 26.5% of LV myocardium). Intervention animals had significantly increased end-diastolic and end-systolic volumes, and decreased stroke volume, ejection fraction and cardiac output. Detailed functional analysis showed significant systolic- and diastolic-dysfunction in intervention animals. CONCLUSIONS We have established a feasible model of post-infarct LV remodeling, which accurately simulates human pathogenesis and pathophysiology. The model may be suitable for evaluation of novel surgical alleviations for heart failure.
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Affiliation(s)
- Hans Kristian Brødløs
- Department of Cardiothoracic & Vascular Surgery T and the Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark
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Agger P. [Intra-abdominal undescended testis with seminoma]. Ugeskr Laeger 1997; 159:4281-2. [PMID: 9229889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Agger P. [Testicular retention]. Ugeskr Laeger 1989; 151:455-6. [PMID: 2563922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Henriksen LO, Petersen F, Nielsen KR, Agger P. The effect of intravesically administered Cetiprin on bladder spasms after transurethral resection of the prostate. A double-blind randomized study. Int Urol Nephrol 1988; 20:497-500. [PMID: 3069774 DOI: 10.1007/bf02550610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A double-blind study of the short-term effects of intravesically administered emepronium bromide (Cetiprin) versus placebo on bladder spasms after transurethral prostatectomy was done in 40 male patients. In the Cetiprin group there was a significant decline in the need for analgesia, and significantly fewer catheter problems. The use of intravesically instilled Cetiprin is recommended only in cases of severe postoperative bladder spasms.
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Abstract
Forty patients with abnormal radiological findings after blunt renal trauma are presented. A conservative approach to treatment led to only 3 nephrectomies in patients with renal pedicle injury and to surgery in another 4 patients; in only one case was the function of the injured kidney reduced. At follow-up 1 to 5 years later, 4 patients had mild subjective symptoms but the objective findings were few and insignificant. However, since serious sequelae (e.g. hypertension) may follow renal trauma, we suggest that these patients should be seen one year after injury for clinical examination, including renography and measurement of blood pressure.
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Abstract
In order to investigate the clinical course and outcome of septicemia in urological patients, data were collected retrospectively from all patients admitted to a specialized urological department, in whom positive blood cultures were drawn. During a 5-year period 91 patients were registered with urosepsis corresponding to an incidence of 1.2%. In non-iatrogenic urosepsis due to ureteral obstruction women dominated over men, however, in iatrogenic disease--after investigative manoeuvres as well as after surgery--men by large dominated the material. Gram-negative bacteria were responsible for almost 75% of the septicemias and for 99% of the cases where septic shock was present. Where a urinary infection was demonstrated prior to septicemia (45%- identical bacteria were subsequently found in the blood, whether the focus had been successfully treated or not. Septic shock developed in 20 of the patients of whom 3 died. This overall mortality of 3% occurred only in patients with comcomitant serious disease. In general the course of septicemia was benign and the complication rate low. It is concluded that in urological patients septicemia is a less serious problem than in gastroenterological patients. The possible explanation for this is discussed in relation to the more discrete diagnostic and therapeutical procedures in the urological clinic.
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Abstract
Testicular biopsies and semen samples were examined before and approximately 1 year after operation for varicocele in 39 men. Two men were excluded because of Sertoli-cell-only syndrome. Of the remaining 37, 22 were operated upon for infertility. The testicular biopsies were quantitated with the score count method. The operation for varicocele significantly improved the testicular tissue. THe numbers of tubuli obtaining a high score increased and the biopsy mean scores also increased significantly. However, few testes became perfectly normal. The duration or the size of the varicocele apparently has little effect upon the state of the testicular tissue or the change in it after operation.
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