Left Ventricular Wall Motion Abnormalities Research Articles

0368: Importance of left ventricular remodeling and regional wall motion abnormalities in the occurrence of functional ischemic mitral regurgitation

Functional ischemic mitral regurgitation (IMR) is common in patients with ischemic left ventricular dysfunction after myocardial infarction, and significantly worsens prognosis. The aim of this study was to determine the relative importance of the global and regional left ventricular (LV) remodeling in the occurrence of IMR. 81 patients (mean age = 61±11 years) admitted with acute myocardial infarction (AMI) were screened. Patients with atrial fibrillation and organic valvular diseases were excluded from the study. Echocardiography (two-dimensional and Doppler echocardiograms) was performed in the first week after admission. The 81 patients were divided in 2 groups: with IMR (group1 = 39 patients) and without IMR (group2 = 42 patients). LV volumes were calculated by apical biplane Simpson’s rule. The LV wall-motion score (WMS) index was obtained in a 17 segment model according to established methods. To identify the influence of regional wall-motion impairment for each individual LV segment, the mean WMS was calculated for each segment and compared between the 2 groups. The echocardiographic parameters that were associated with IMR were: LV dilatation and sphericity (p<0,0001), reduced ejection fraction (p<0,0001), inferior (p<0,001) inferolateral (p=0,01) and anterolateral (p=0.02) asynergy. The results of this study indicate the importance of abnormalities of both LV geometry and regional wall motion in the pathogenesis of IMR after myocardial infarction. Clinically, these findings imply that myocardial salvage by early coronary revascularisation may improve outcome by preserving LV function and decreasing the incidence of IMR.

Resolution of Left Ventricular Thrombus after Dabigatran Therapy in Two Patients with Old Anteroseptal Myocardial Infarction

Dabigatran has been used recently as an alternative to warfarin therapy for the prevention of thromboembolism in patients with myocardial infarction or atrial fibrillation, but treatment of established intracardiac thrombus with dabigatran has seldom been reported. We report two patients with left ventricular (LV) thrombus who were successfully treated with dabigatran. The first patient was a 52-year-old man with no clear symptoms who was referred for investigation of abnormal electrocardiography findings, and the second patient was a 51-year-old man with recent onset of heart failure and a history of chest pain 1 month previously. Both patients were diagnosed with old anteroseptal myocardial infarction after echocardiography showed abnormal LV wall motion and LV thrombus. The thrombus was thought to be chronic in the first patient, and to have formed within the preceding month in the second patient. After treatment with dabigatran 220 mg/day and antiplatelet drugs, repeat echocardiography showed resolution of the thrombus after 6 weeks and 2 weeks, respectively. These cases illustrate that dabigatran 220 mg/ day may be useful for the treatment of established LV thrombus.

Abstract 11769: Impact of Exercise to the Heterogeneity of Regional Left Ventricular Mechanics

Background: The segmental heterogeneity of strain and strain rate in speckle tracking echocardiography are pitfalls in the assessment of left ventricular (LV) mechanics in subjects without LV wall motion abnormality. We aimed to assess the segmental heterogeneity of strain and strain rate at rest and during exercise in healthy subjects. Methods: Twenty-three healthy young volunteers (38 ± 10 years, 13 female) underwent supine bicycle stress testing. Segmental circumferential (Scirc), radial (Srad) and longitudinal (Slong) end-systolic strains and corresponding peak systolic strain rates (SRcirc, SRrad, SRlong) were obtained by STE (EchoPac, GE Medical) for each of 16 LV segments at rest and during exercise. Global values of strain and strain rate components were obtained by averaging segmental values. Results: At rest, all three end-systolic strains showed significant segmental heterogeneity (p &lt; 0.01 for all comparisons). In contrast, peak systolic SRcirc and SRrad had uniform values throughout segments, while SRlong had modest segmental heterogeneity (p = 0.02). During exercise, heart rate (67 ± 10 to 136 ± 19 bpm), systolic blood pressure (124 ± 13 to 170 ± 21mmHg), and biplane ejection fraction (58 ± 4 to 72 ± 5 %), increased significantly (p &lt; 0.001 for all comparisons). At peak exercise, there was a small, but significant increase in global Slong (-19.9 to -23.9%, p &lt; 0.001) and Scirc (-19.6 to -24.2%, p &lt; 0.001) without the change in Srad (46.8 to 41.1%, p &gt; 0.05). On the other hand, all global systolic strain rates almost doubled during exercise; SRcirc from -1.26 to -2.49 s -1 , p &lt; 0.0001; SRrad from 1.82 to 3.26 s -1 , p &lt; 0.0001; SRlong from -1.56 to -2.93 s -1 , p &lt; 0.0001. Importantly, segmental heterogeneity following exercise was not present for all strain and strain rate components (p &gt; 0.05 for all comparisons). Conclusions: Segmental heterogeneity was less pronounced in peak systolic strain rates than in end-systolic strains at rest. Exercise abolished segmental heterogeneity for all strain and strain rate components. Overall, peak systolic strain rate is least affected by segmental heterogeneity and may be more useful in the assessment of LV mechanics than end-systolic strain.

Metalloproteinases 2 and 9 in different stages of chronic Chagas disease

Chronic Chagas' disease comprises an indeterminate and a cardiac stage. Patients in the former have no clinical, electrocardiographic or radiologic abnormalities. However, 20 to 40% of these patients may have, as demonstrated by echocardiography, left ventricular wall motion abnormalities and normal systolic function [1,2]. Clinicians and researchers consider this particular stage as transitional and amenable to preventive treatment. Therefore, several investigations have been conducted to identify predictive biomarkers of progression of this disease.

Nonatherosclerotic causes of acute coronary syndrome: recognition and management.

Acute coronary syndromes (ACS) frequently result from the rupture or erosion of a vulnerable coronary plaque, with associated intracoronary thrombosis. ACS also may occur in patients with angiographically normal coronary arteries. Some of these patients, however, still have angiographically silent underlying coronary artery disease. In this setting, subtle atherosclerotic changes frequently associated with unstable morphologic features or residual intracoronary thrombus may be detected with intracoronary imaging techniques. Nevertheless, other patients develop ACS as a result of nonatherosclerotic coronary artery disease (NA-CAD). ACS in patients with NA-CAD may be the consequence of coronary spasm or transient coronary embolic phenomena. In these patients, after the initial ischemic insult, late coronary angiography usually reveals normal epicardial coronary vessels. Kounis syndrome is a type of ACS generated by allergic reactions. Takotsubo cardiomyopathy is characterized by normal coronary arteries with a distinct pattern of transient left ventricular wall motion abnormalities. ACS also may occur in young patients following illicit drug use. Finally, spontaneous coronary artery dissection and intramural hematoma represent other etiologies of NA-CAD. In this review, we discuss current evidence regarding diagnostic and treatment strategies in patients presenting with ACS as a result of NA-CAD.

Anomalous Origin of the Common Left Coronary Artery From the Right Coronary Sinus

A 56-year-old male patient who was hypertensive and nondiabetic presented with chest discomfort on exertion for the last 3 months. The electrocardiogram was normal, and 2-dimensional echocardiography revealed normal left ventricular function, no left ventricular regional wall motion abnormalities.

Cardiac rupture in a patient with Takotsubo syndrome triggered by acute myocardial infarction: Two messages

A transient episode of coronary ischemia may induce prolonged but reversible left ventricular dysfunction. This condition has been termed post-ischemic myocardial stunning (PIMS). PIMS has been identified following acute coronary syndrome (ACS), reperfusion, exercise induced angina, angioplasty, ischemic stress induced by dobutamine or dipyridamole, and cardiac surgery [1]. Takotsubo syndrome (TS) is characterized by a transient circumferential (bi-) left ventricular wall motion abnormality resulting in a conspicuous ballooning of the left ventricle during systole [2,3].

Diagnosis and Management of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy has become accepted worldwide as a distinct clinical entity since the first report by Sato et al in 1990. Takotsubo cardiomyopathy usually occurs in postmenopausal elderly women, and is characterized by chest symptoms, electrocardiographic changes and transient left ventricular apical wall motion abnormalities after emotional or physical stress. In the clinical setting, takotsubo cardiomyopathy is an important disease which should be differentiated from acute myocardial infarction promptly for the appropriate management.

GENDER DIFFERENCES OF CORONARY HEART DISEASE PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND CHRONIC MITRAL REGURGITATION BY THE DATA OF CORONARY ANGIOGRAPHY REGISTRY

Aim. To reveal gender differences of clinical and functional parameters in postmyocardial infarction patients with chronic mitral regurgitation by data of coronary angiography Registry.Material and methods. Among 15283 patients of Coronary angiography Registry© evaluated from 1991 to 2012 we selected end assessed clinical and functional parameters of 350 men and 53 women with Q-wave myocardial infarction and moderate or severe mitral regurgitation and signs of scars detected by echocardiography.Results. Comparing to the men, women had lower hemoglobin level (135,5±11,3 vs 148,3±14,2 g/l, р&lt;0,001) and rate of smokers (9,8 vs 62,6%, р&lt;0,001). The prevalence of hypothyroidism (29,7 vs 9,6%, р=0,001) and severe MR (17,0 vs 9,1%, р=0,038) were higher in women. They had higher indexes of left atrium size (25,1±2,9 vs 23,7±3,2 mm/m2, р=0,008), left ventricular (LV) posterior wall thickness (6.0±0.7 vs 5,2±0,8 mm/m2, р&lt;0,001), lower extent of LV wall motion abnormalities (28,7±14,7 vs 33,5±14,9%, р=0,036) and higher LV ejection fraction (47,3±8,2 vs 43,9±9,2%, р=0,013). The localization of myocardial scars and coronary stenosis did not differ between men and women. According to the results of multivariate analysis, female gender was independently associated with greater index of LV posterior wall thickness (OR 3,215; CI 1,781–5,804; р&lt;0,001), hypothyroidism (OR 3,070; CI 0,994–9,483; р=0,050), greater body mass index (OR 1,17; CI 1,042–1,317; р=0,008), smoking (ОR 0,056; CI 0,013–0,244; р&lt;0,001) and lower hemoglobin level (OR 0,927; CI 0,890–0,966; р&lt;0,001).Conclusion. There are gender differences in clinical and functional parameters of postmyocardial infarction patients with chronic mitral regurgitation: more severe LV remodeling in women.

Predictors of high-grade ventricular arrhythmias in patients referred for the coronary angiography

Ventricular arrhythmias (VA) are still the leading cause of sudden cardiac death (SCD). Therefore identification of predictors of high-grade (hg) VA and stratification of risk of fatal events remain important problems of cardiology. We analyzed data of 993 patients with and without hgVA according to 24 hours Holter monitoring referred for the coronary angiography. Patients with hgVA were older (57.2 ± 8.4 vs. 54.9 ± 8.3 years, p = 0.001), had lower left ventricular ejection fraction (LVEF) (51.6 ± 11.2 vs. 58.4 ± 7.6%, p < 0.001) and larger extent of LV wall motion abnormalities (10.8 ± 15.7% vs. 5.5 ± 10.9%, p = 0.001). Patients with hgVA more often had LV aneurysms and thrombi. These patients also had significantly greater LV end diastolic diameter (54.3 ± 7.4 vs. 49.9 ± 4.7 mm, p < 0.001), and more often had NYHA class III-IV chronic heart failure (28.1 vs. 15.5%, p < 0.001). According to multivariate analysis hgVA were independently associated with age, LV dilation and reduced LVEF (specificity and sensitivity of a mathematical model for prediction of hgVA were 78 and 49.5%, respectively). Each subsequent year of life increased risk of having hgVA by 1.2% (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.01-1.05, p = 0.002), while 1 mm increase of LV size elevated risk of VA by 4.2% (OR 1.08; 95% CI 1.04-1.13, p < 0.001), and 1% lowering of LVEF increased risk of VA by 7% (OR 0.95; 95% CI 0.92-0.98, p < 0.001).

Myocardial Perfusion, Scarring, and Function in Anomalous Left Coronary Artery From the Pulmonary Artery Syndrome: A Long-Term Analysis Using Magnetic Resonance Imaging

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. We aimed to examine the role of cardiac magnetic resonance imaging (MRI) in the long-term surveillance ofrepaired ALCAPA with regard to myocardial scarring, wall motion abnormalities, perfusion deficits, and myocardial function. Twenty-one patients after direct reimplantation of ALCAPA (median age at operation, 2.8 years) wereexamined after a median 10.6 years by MRI at restandunder dobutamine stress conditions, echocardiography, and ergometry. Results were compared with preoperative, immediately postoperative (5 days), and intermediate-term (5.8 years) echocardiography. No early or late deaths occurred. Improvements in indexed left ventricular end-diastolic dimension, ejection fraction, and mitral valve function were observed in all patients. However, MRI at rest showed wall motion abnormalities in 67% and perfusion deficits in 28%. Myocardial scars were seen in 67%. Dobutamine stress MRI detected wall motion abnormalities in 19% and perfusion deficits in 14%, which were not seen on MRI at rest. Exercise testing did not reflect cardiac dysfunction. Although long-term follow-up showed global left ventricular function had improved after ALCAPA repair, MRI showed left ventricular wall motion abnormalities, perfusion deficits, and myocardial scarring were seen in many patients. Dobutamine stress MRI identified deficits that were not evident on MRI at rest, and can therefore be considered a valuable surveillance tool. These results suggest the need for lifelong surveillance of repaired ALCAPA.

Wall motion changes in myocardial infarction in relation to the time elapsed from symptoms until revascularization.

ObjectiveWall motion abnormalities during acute ST-segment elevation myocardial infarction (STEMI) and the improvement after recanalization depend on the conditions of the coronary occlusion.MethodsFifty-seven patients with first-ever STEMI due to one-artery occlusion, treated with primary PCI, were evaluated. Area at risk and left ventricular wall motion abnormalities were localized with coronary angiography and echocardiography and then compared in relation to the time elapsed from the onset of symptoms at the time of infarction and at 3 months. Left ventricular diameters and ejection fractions were evaluated in relation to the ischemic time.ResultsThree hundred forty-one affected left ventricular segments were detected with angiography, while echocardiography showed 206 segments with motion abnormality. No correlation was found between the regional wall motion index in the area at risk and the time elapsed from the beginning of symptoms. However, the improvement in wall motion abnormalities at the follow-up was dependent on the ischemic time (r=-0.29, p<0.03). The early subgroup showed significant improvement in left ventricular ejection fraction at follow-up (p=0.03), whereas in the late subgroup, a significant increase in left ventricle diameters was observed.ConclusionOur results first demonstrate in humans that in the early hours from the occlusion of the coronary artery, the extent and severity of the wall motion abnormalities inside the area at risk show large variability without relation to the elapsed time since the onset of symptoms. On the other hand, the results of follow-up echocardiography proved that the wall motion improvement was highly dependent on the ischemic time.

Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction

Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS). We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses. Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24 hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90 mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction. In TTC, RV hypokinesis occurs in approximately 33% of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.

How to increase the utilization of donor hearts?

Cardiac transplantation is the best treatment available for patients with end-stage cardiomyopathy. Shortage of donor hearts is the main factor limiting the use of this treatment. Many donor hearts are rejected for transplantation because of left ventricular (LV) systolic dysfunction and/or wall motion abnormalities. While some donors have true cardiomyopathy, a significant proportion has reversible LV dysfunction due to neurogenic stunned myocardium. This condition is triggered by excess of catecholamines, which is typical for brain-dead donors. If given time to recover, LV function may improve, and the heart will be suitable for transplantation. Moreover, limiting of exogenous catecholamines may facilitate the recovery. In this review, we summarize the data on LV dysfunction/wall motion abnormalities in heart donors and propose the strategy to increase the utilization of donor hearts.

Magnetic resonance imaging and devices: a mesmerising combination.

Magnetic resonance imaging (MRI) is the fastest growing standard of care in diagnostic imaging. Because of its unique properties such as noninvasive accurate assessment of left ventricular (LV) volumes and regional LV wall motion abnormalities, quantification of flow and tissue characterisation, MRI utilisation in the US is still growing at approximately 3 % per year [1]. Moreover, indications for MRI may expand due to innovative techniques such as magnetic resonance angiography (MRA) or the use of targeted contrast agents. This increased usage of MRI is paralleled by an annual growth of de novo pacemakers (>700,000) and implantable cardio-defibrillators (>200,000) [2]. Since many recipients of pacemakers and ICDs have substantial comorbidities, it is estimated that up to 75 % will develop an indication for MRI examination during further life [3, 4]. The hazards of MRI examination in patients with pacemakers and ICDs are a consequence of the techniques used [5]. First the static magnetic field may yield mechanical forces on ferromagnetic components and may have unpredictable magnetic sensor activation. Second, the modulated radiofrequency (RF) field may cause heating of cardiac tissue adjacent to the lead tip, may induce life-threatening arrhythmias and may interact with the device leading to over- or under-sensing. Third, the gradient magnetic field may induce life-threatening arrhythmias or may cause over- or under-sensing. Finally, combined field effects can alter device function or lead to electronic reset. Electrical reset may have major implications since it can cause pacemaker inhibition or induce fatal tachyarrhythmias. Currently, MRI conditional CIEDs have become available in which the risk of an electronic reset is significantly reduced by adaptations in the device. Moreover, lead design has been improved to avoid tip heating. In this issue of the Netherlands Heart Journal Van der Graaf and co-workers give an excellent overview of the current status of MRI in patients with cardiac implantable electronic devices (CIED) [6]. They underline that although safety in these patients who are scheduled for MRI examination has traditionally been regarded a major issue, the recently published European Society of Cardiology (ESC) guidelines express a different view [7]. These 2013 guidelines state that MRI can be safely performed irrespective of the properties of the CIED, the type of MRI examination or patient characteristics such as presence or absence of underlying rhythm, as long as safety restrictions are met. Differences in risk between chest and non-chest MRI are not mentioned. Moreover, the absolute number of patients on which these guidelines are based is limited. A total of seven studies each report on small numbers of chest MRIs. For example, in the study by Sommer and co-workers on MRI in 51 patients only 5 had chest scanning, and Naehle and colleagues reported on 18 CIED patients but only 8 patients had examinations of the chest [8, 9]. In a larger study, Mollerus evaluated 127 MRI scans in 103 patients of which 62 were chest MRIs [10]. No threshold elevation was found, but both sensing amplitudes and pacing impedances significantly changed. By far the largest study was conducted by Nazarian and co-workers in 438 patients with pacemakers and ICDs [11]. In this study, pacemaker-dependent patients with an ICD were excluded. In 89 patients chest MRI was performed. Three of the 438 patients had an electrical reset (power-on-reset) leading to occasional pacing inhibition in 2 patients. There were no symptomatic events in these non-pacemaker dependant individuals. In the studies mentioned CRT devices are strongly underrepresented. Thus, current guidelines concerning MRI in patients with CIED are based on a limited number of relatively small studies in patients with a wide range of devices and leads, typically excluding pacemaker-dependent patients as well as patients with CRT devices. The evidence for safety of chest MRI is based on less than 200 patients and potentially associated arrhythmias are still reported. Although the recent guidelines have become more lenient and major complications have rarely been reported, risk assessment in patients with CIED is not straightforward. We would therefore advocate a prudent approach in scheduling patients with CIED for MRI examination, especially those with older type or CRT devices and when using newer (3T) MRI suites. MRI provides mesmerising image quality, but mesmerisation of CIED should be avoided.

ECHOCARDIOGRAPHIC FINDINGS IN TAKOTSUBO CARDIOMYOPATHY: BEYOND APICAL BALLOONING

Takotsubo cardiomyopathy (TC) is characterized by acute and transient left ventricular (LV) wall motion abnormalities triggered by emotional and/or physical stress. Although, it was named after the unique “Takotsubo like” wall motion, recent studies have shown possible variants of TC such as “

“Nipple” and “hawk's beak” appearances on contrast left ventricular angiography in Takotsubo syndrome: What's in a sign?

Appearances at left ventricular (LV) contrast angiography of patients presenting with Takotsubo syndrome (TTS) vary depending on the cardiac region that is impacted by the affliction. Desmet et al. recently reported [1] on their series of 119 patients with TTS, who had LV contrast angiography at cardiac catheterization, 92 of whom had the apical variety of TTS, characterized by systolic ballooning of the LV apex with preservation of LV basal contractility; out of these 92 patients, 28 (30.4%) had a “very small zone with preserved contractility in the most apical portion of the LV”, for which the authors coined the term “apical nipple sign”, which by contrast was not present in any of 405 patients “who had been treated for anterior ST-elevation myocardial infarction (STEMI) by emergency percutaneous intervention on the left anterior descending artery”. Thus the “apical nipple sign” may aid in the differential diagnosis of apical TTS from anterior STEMI. Roncalli et al. [2] recently reported the case of a 76-year-old womanwith the midventricular variant of TTS, characterized by LV midventricular systolic ballooning with preservation of LV apical contractility, which gave the appearance of a “hawk's beak” to the LV apex, prompting the authors to proposing the “hawk's beak” as an angiographic diagnostic sigh of the midventricular variant of TTS. Since TTS is characterized by a large variation in LV wall motion abnormalities (LVWMAs) of individual afflicted patients, more such signs are expected to be observed at contrast LV angiography. In addition there have been descriptions of patents with TTS with repeat presentations featuring different patterns of LVWMAs, or involvement of LV and/or right ventricle, during the same, or temporally different, admissions for TTS [3–14]. Furthermore territorial “migration” of LVWMAs has been noted in some patients in serial imaging studies, with akinesis involving different LV regions and recovery of previously involved regions [15]. The remarks by Desmet et al. [1] about their patients with LV apical TTS with the “apical nipple sign” as clinical TTS phenotypes representing presentation of “a very extensive form of the mid-ventricular variant of apical TTS, just nearly missing evolvement to truly complete apical akinesis”, or that the “apical nipple sign” may represent the “earliest stage of mechanical recovery of a true apical ballooning” are relevant of a need for serial heart imaging for patients admitted with suspected, or subsequent proven, TTS. Certainly such repeated imaging cannot be implemented with contrast LV angiography, or computed axial tomography angiography, or magnetic resonance angiography, but with echocardiography. The later modality, which may be argued that may lack sensitivity for such a role, particularly in interrogation of LV apex, should be vigorously evaluated in its classic application, and the currently enhanced format of two-dimensional speckle tracking [16]. The hypotheses of Desmet et al. about the mechanism of the “apical nipple sign” being due to very extensive form of the mid-ventricular variant of apical TTS [1] and Roncalli et al. about the “hawk's beak” as a sign of a midventricular variant of TTS [2], notwithstanding these 2 LV contrast angiographic appearances, may not be substantially different phenotypes of TTS. We should all be on the look-out for more LV and right ventricular angiographic “signs”, and naturally for more names, as more cases of TTS are being detected.

First case of atypical takotsubo cardiomyopathy in a bilateral lung-transplanted patient due to acute respiratory failure

Takotsubo cardiomyopathy which is characterised by a transient left ventricular wall motion abnormality was first described in 1990. The disease is still not well known, and as such it is suggested that an emotional trigger is mandatory in this disease. We present the case of a 51-year old female patient seven years after bilateral lung transplantation, who developed acute respiratory distress syndrome and subsequently suffered from atypical takotsubo cardiomyopathy with transient severe reduction of ejection fraction and haemodynamic instability needing acute intensive care treatment. Acute respiratory failure has emerged as an important physical trigger factor in takotsubo cardiomyopathy. Little is known about the association of hypoxia and takotsubo cardiomyopathy which can elicit a life-threatening condition requiring acute intensive care. Therefore, experimental studies are needed to investigate the role of hypoxia in takotsubo cardiomyopathy.

Cerebral microembolism in patients with segmental left ventricular wall motion abnormalities

Background and purposeThe significance of segmental heart wall motion abnormalities for stroke is unknown. The aims of the study included (1) comparison of the frequency and type of embolic signals in the middle cerebral artery in patients with segmental left ventricular wall hypokinesis due to coronary heart disease with and without stroke, and (2) determination of the relationship between inflammatory parameters, fibrinogen level, dyslipidemia and microembolic signals in the middle cerebral artery in patients with segmental heart hypokinesis. Material and methodsThe study included 68 patients with segmental heart hypokinesis (33 without stroke [group I] and 35 with stroke [group II]), as well as 37 healthy volunteers and a reference group of 30 patients. Echocardiography and carotid/transcranial Doppler with detection of microembolic signals were performed. Patients from group I and II had erythrocyte sedimentation rate, leucocyte count, triglycerides, total cholesterol, HDL, and LDL examined. ResultsEmbolic signals were detected in patients with segmental heart hypokinesis significantly more frequently than in the control and reference groups. The high number of embolic signals, signals of high intensity, hypokinesis of the distal part of the intraventricular septum, increased cholesterol levels, LDL and triglycerides were all found more frequently in patients from group II than in group I. Embolic signals were detected more frequently in patients with high fibrinogen levels and leukocytosis. ConclusionsEmbolic signals in the middle cerebral artery in patients with segmental left ventricular hypokinesis have to be considered as a risk factor of stroke. The following changes are observed in patients with cardiogenic stroke: hypokinetic intraventricular septum, high intensity embolic signals, increased serum fibrinogen levels and leucocyte count. It may indicate the importance of these factors in the aetiology of stroke.

Injectable Collagen Implant Improves Survival, Cardiac Remodeling, and Function in the Early Period After Myocarditis in Rats

Despite clear evidence of immune system involvement in the pathogenesis of myocarditis, the treatment of myocarditis remains nonspecific and supportive. We sought to test the hypothesis that injection of a collagen-based implant into the inflamed myocardium would stabilize the left ventricular (LV) wall and prevent adverse remodeling and dysfunction. Autoimmune myocarditis was induced in 42 male Lewis rats. Development of myocarditis was evaluated and confirmed by serial echocardiography and cardiac magnetic resonance scans, LV wall thickening, global and regional LV wall motion abnormalities, and in some cases pericardial effusion. Sick animals were randomized to either injectable collagen implantation or saline injection into the anterior inflamed myocardium 14 days after immunization. Significantly, injectable collagen implantation improved 31-day survival compared with controls (85.7% vs 50%; P = .03). Furthermore, although injectable collagen significantly attenuated LV systolic and diastolic dilatation and preserved LV geometry and function, control animals developed significant LV dilatation and dysfunction. These favorable effects on LV remodeling were confirmed by postmortem morphometry. Significantly, the injectable collagen implant attenuated cardiomyocyte hypertrophy and infiltration of macrophages and lymphocytes into the myocardium. The present study shows, for the first time, that injectable collagen biomaterial improves survival and attenuates cardiac inflammation, cardiomyocyte hypertrophy, LV remodeling, and dysfunction in the early period after myocarditis in rats. Our findings suggest a new biomaterial-based strategy to ameliorate the devastating effects of myocarditis.