Assessment Of Myocardial Damage Research Articles

Evaluation of the Correlation Between Electrocardiographic Abnormalities, Cardiac Iron Overload, and Magnetic Resonance T2* Values in Patients with Beta Thalassemia Major

Background: Beta thalassemia major (β-TM) is an inherited blood disorder. Affected patients require frequent blood transfusions, leading to iron deposition and end organ damage, particularly myocardial dysfunction. A 12-lead ECG is a readily available tool that could be used to screen for conduction abnormalities and arrhythmias as a marker of worsening myocardial function.
 Methods: A total of 108 β-TM patients were evaluated for correlation between abnormal findings on the surface ECG and severity of myocardial iron deposition in magnetic resonance imaging as measured by T2* levels.
 Results: Patients with T2* below 20 msec had significantly longer PR intervals, P wave durations, and QTc intervals. Patients with T2* below 10 msec had the longest QRS duration and QRS activation times. Atrial fibrillation was more prevalent in patients with lower T2* levels. With a decrease in T2*, the probability of notching of QRS in the limb and precordial leads increased.
 Conclusion: Abnormal ECG is prevalent in β-TM patients, and the frequency of changes increases with the severity of iron overload. A 12-lead ECG is a valuable and readily available tool for the early assessment of myocardial damage and the implementation of a timely and appropriate management strategy.

Left ventricular systolic dyssynchrony: a novel imaging marker for early assessment of myocardial damage in Chinese type 2 diabetes mellitus patients with normal left ventricular ejection fraction and normal myocardial perfusion

ObjectivesMyocardial damage is the important cause of heart failure (HF) in type 2 diabetes mellitus (T2DM), which is difficult to early diagnose, especially in T2DM with normal left ventricular ejection fraction (LVEF) and normal myocardial perfusion. The goal was to evaluate myocardial damage in T2DM with normal LVEF and normal myocardial perfusion by detecting left ventricular systolic dyssynchrony (LVSD), and find out the risk factors associated with LVSD. MethodsThis study included 95 T2DM with normal LVEF, normal myocardial perfusion. 69 consecutive individuals without T2DM and CAD were enrolled as the control group with age-, sex- and BMI-matched. All participants underwent stress/rest 99mtechnetium-sestamibi (99mTc-MIBI) gated myocardial perfusion imaging (GMPI) and two-dimensional echocardiography within 1 week. Clinical data including age, gender, BMI, duration of diabetes, chronic diabetic complications, glycated haemoglobin A1c (HbA1c), fast blood glucose (FBG) and Brain Natriuretic Peptide (BNP) were collected from medical records. Left ventricular synchrony parameters were acquired, including phase standard deviation (PSD) and phase histogram bandwidth (PBW) by rest GMPI. ResultsPSD and PBW in T2DM group were significantly higher than control group (P < .05). LVSD was detected in 20 (21%) T2DM patients. Compared to non-LVSD T2DM group, LVSD T2DM group had higher BMI, higher prevalence of BNP ≥ 35 pg/mL and chronic diabetic complications (P < .05). BNP ≥ 35 pg/mL had mild positive association with LVSD (r = 0.318, P = .004). In multivariate logistic regression, chronic diabetic complications and high BMI (> 23.4 kg/m2) were independent risk factors of LVSD (OR 5.64, 95% CI 1.58-20.16, P = .008; OR 6.77, 95% CI 1.59-28.89, P = .010). ConclusionsLVSD existed in T2DM patients with normal LVEF and normal myocardial perfusion. Chronic diabetic complications and high BMI (> 23.4 kg/m2) were the independent risk factors of LVSD. LVSD based on GMPI can be the novel imaging marker to early assess myocardial damage in T2DM patients.

Association between myocardial oxygenation and fibrosis in Duchenne Muscular Dystrophy: analysis by oxygenation-sensitive and T1 mapping cardiovascular magnetic resonance (P7-9.002)

<h3>Objective:</h3> To explore whether myocardial hypoxia exists in DMD patients and whether an association exists between regional myocardial oxygenation and fibrosis, using oxygenation-sensitive cardiovascular magnetic resonance and native T1 mapping. <h3>Background:</h3> Myocardial hypoxia is common in many cardiomyopathies and has been proven to be closely related to the occurrence and development of myocardial fibrosis. However, limited studies are available on the relationship between myocardial oxygenation and fibrosis in DMD patients using oxygenation-sensitive magnetic resonance, and whether myocardium hypoxia exists in DMD patients and its underlying relationship with fibrosis in DMD remains unclear. <h3>Design/Methods:</h3> In this prospective study, 91 DMD patients and 30 volunteers underwent CMR. The correlation between oxygenation SI and native T1 value was assessed by Pearson or Spearman correlation coefficients and the association between oxygenation SI and LGE was analyzed by logistic regression. The survival curves were generated by the Kaplan–Meier analysis and compared by the log-rank test. <h3>Results:</h3> In LGE-patients, the oxygenation SI of all segments except the septal segments was significantly decreased than those of the controls. Inferolateral SI and anterolateral SI were weakly correlated with native T1 values. As for LGE+ patients, a further and significant reduction in oxygenation SI was observed relative to the controls. SI was moderately correlated with native T1 values in both negative and positive segments. Multivariable regression modeling indicated inferolateral SI independently associated with LGE. At an average follow-up of 18.63 months, 31 patients experienced progress of LGE. Patients with reduced inferolateral SI were more likely to have an exacerbation of fibrosis. <h3>Conclusions:</h3> Analysis of OS-CMR and native T1 mapping revealed that myocardial hypoxia is common and related to the onset of myocardial fibrosis in DMD patients. And myocardial oxygenation by OS-CMR might be used as the quantitative imaging biomarker for the assessment of myocardial damage and prediction of fibrosis progression in DMD patients. <b>Disclosure:</b> Ms. Zhou has nothing to disclose.

Nauclea orientalis (L.) Bark Extract Protects Rat Cardiomyocytes from Doxorubicin-Induced Oxidative Stress, Inflammation, Apoptosis, and DNA Fragmentation.

The therapeutic efficacy of anthracycline antibiotic, doxorubicin (Dox), is hampered due to the dose-dependent cardiotoxicity. The objective of the study was to explore the counteraction of aqueous bark extract of Nauclea orientalis in Dox-induced cardiotoxicity in Wistar rats. The acute and subchronic toxicity study performed with 2.0 g/kg of the plant extract revealed biochemical and haematological parameters to be within the physiological range, and no histological alterations were observed in any organs isolated. Screening of plant extract for the protection of the myocardium from Dox-induced oxidative stress, inflammation, and apoptosis was performed on five groups of rats: control, plant extract control, Dox control (distilled water (D.H2O) 2 weeks + on the 11th day single injection of Dox, 18 mg/kg), plant + Dox (2.0 g/kg plant extract 2 weeks + on the 11th day Dox, 18 mg/kg), and positive control, dexrazoxane. A significant increase in cardiac biomarkers and lipid peroxidation (p < 0.001) and a significant decrease in antioxidant parameters (p < 0.001) were observed in the Dox control group. All these parameters were reversed significantly (p < 0.05) in the plant-pretreated group. The histopathological assessment of myocardial damage provided supportive evidence for the biochemical results obtained. Inflammatory markers, myeloperoxidase, expression of TNFα and caspase-3, and DNA fragmentation (TUNEL positive nuclei) were significantly elevated (p < 0.05), and expression of Bcl-2 was significantly decreased (p < 0.05) in the Dox control; however, all these parameters were significantly reversed in the plant extract-treated group. In conclusion, the aqueous bark extract of Nauclea orientalis (2.0 g/kg) has the ability to attenuate the Dox-induced oxidative stress, inflammation, apoptosis, and DNA fragmentation in Wistar rats.

Сardiac troponin I for assessment of myocardial damage and prediction of complications in cardiac surgery patients

The study analysed the level of troponin I (Tn) in the blood in patients with coronary artery disease after coronary artery bypass grafting in comparison with patients after aortic valve replacement surgery. The dynamics of troponin in the early postoperative period was studied, a parallelism was established between the occurrence of complications after surgery and the degree of myocardial damage. A new method has been developed for assessing the degree of intraoperative myocardial damage and the risk of complications using the «index of myocardial damage», the Tn level is determined twice after the operation, in the period up to 6 hours – Tn early and 12–24 hours later – Tn late, the index is calculated as the ratio of Tn late one to Tn early one. A correlation analysis of the «index» with other laboratory parameters was carried out, as a result of which no significant correlations were found, which indicates the absence of duplication and the significance of the developed indicator for assessing myocardial damage after cardiac surgery.

Assessment of myocardial damage after acute myocardial infarction by diastolic deceleration time of coronary flow velocity using echocardiography and contrast-enhanced magnetic resonance imaging.

There are limited data available regarding the use of diastolic deceleration time (DDT) of three major arteries measured by transthoracic echocardiography (TTE) for assessing coronary microvascular damage after acute myocardial infarction (AMI). Therefore, we aimed to compare the DDT of three major arteries using TTE with the transmural extent of infarction (TEI) and infarct size, which were classified using contrast-enhanced magnetic resonance imaging (CE-MRI), in patients with AMI. The DDT of the culprit coronary artery was measured in 74 patients using TTE and CE-MRI 1week after the onset of AMI. The TEI was graded based on the transmural extent of the hyper-enhanced tissue (grades 1-4). The assessable rate for the DDT was 95%; individual rates were 100% for the left anterior descending coronary artery, 90% for the left circumflex artery, and 93% for the right coronary artery. The DDT decreased gradually as the TEI grade progressed (P=.021). Infarct size was significantly correlated with the DDT (r=-0.51, P<.0001). Univariate analysis revealed that the left ventricular (LV) end-systolic volume, LV ejection fraction, and DDT were significantly associated with TEI grade 4. After adjustment via multiple logistic regression analysis, the DDT was independently remained. With a cutoff value of 950ms, as determined by the ROC curve, DDT could detect TEI grade 4 with 81.1% sensitivity and 80.1% specificity. The DDT of three major coronary arteries measured by TTE 1week after the onset of AMI can assess the extent of myocardial damage, which is determined by CE-MRI.

Troponins and Natriuretic Peptides in Cardio-Oncology Patients-Data From the ECoR Registry.

BackgroundThe long-term survival of cancer patients has significantly improved over the past years. Despite their therapeutic efficacy, various cancer therapies are associated with cardiotoxicity. Therefore, timely detection of cardiotoxic adverse events is crucial. However, the clinical assessment of myocardial damage caused by cancer therapy remains difficult.MethodsThis retrospective study was performed to evaluate the diagnostic value of cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for monitoring cancer therapy-induced cardiomyopathy. A total of 485 cancer patients referred to our cardio-oncology unit between July 2018 and January 2020 were selected from our Essen Cardio-oncology Registry (ECoR). We included patients with all types of cancer. Plasma concentrations of cTnI and NT-proBNP were measured by radioimmunoassay, and two-dimensional left ventricular ejection fraction (2D-LVEF), diastolic function, and global longitudinal strain (GLS) were measured by transthoracic echocardiography. In 116 patients, assessment was conducted before the induction of cancer therapy and during a short-term follow-up period; n = 42 of these were treated for malignant melanoma, and n = 42 with serial measurements were under treatment for breast cancer.ResultsIn cross-sectional data, elevated NT-proBNP was associated with reduced LVEF and pathological GLS in the total cohort. A total of 116 patients had serial LVEF and biomarker measurements, and changes in NT-proBNP and troponin correlated with changes in LVEF during follow-up investigations. Similar to the total cohort, a subgroup of patients treated for malignant melanoma showed a correlation between the change in cTnI and the change in LVEF. In a subgroup analysis of patients undergoing breast cancer therapy, a correlation between the change in NT-proBNP and the change in LVEF could be detected. Thirty patients presented with chemotherapy-induced cardiomyopathy, defined as a significant LVEF decrease (> 10%) to a value below 50%. The number of patients with increased cTnI and NT-proBNP was significantly higher in patients with chemotherapy-induced cardiomyopathy than in patients without cardiotoxicity. Patients with positive cTnI and NT-proBNP were more likely to have a history of coronary heart disease, atrial fibrillation, and arterial hypertension.ConclusionOur data suggest that cardiac biomarkers play an important role in the detection of cancer therapy-induced cardiotoxicity. Larger systematic assessment in prospective cohorts is mandatory.

Impact of Morphine Treatment on Infarct Size and Reperfusion Injury in Acute Reperfused ST-Elevation Myocardial Infarction

Current evidence regarding the effect of intravenous morphine administration on reperfusion injury and/or cardioprotection in patients with myocardial infarction is conflicting. The aim of this study was to evaluate the impact of morphine administration, on infarct size and reperfusion injury assessed by cardiac magnetic resonance imaging (CMR) in a large multicenter ST-elevation myocardial infarction (STEMI) population. In total, 734 STEMI patients reperfused by primary percutaneous coronary intervention <12 h after symptom onset underwent CMR imaging at eight centers for assessment of myocardial damage. Intravenous morphine administration was recorded in all patients. CMR was completed within one week after infarction using a standardized protocol. The clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE) within 12 months after infarction. Intravenous morphine was administered in 61.8% (n = 454) of all patients. There were no differences in infarct size (17%LV, interquartile range [IQR] 8–25%LV versus 16%LV, IQR 8–26%LV, p = 0.67) and microvascular obstruction (p = 0.92) in patients with versus without morphine administration. In the subgroup of patients with early reperfusion within 120 min and reduced flow of the infarcted vessel (TIMI-flow ≤2 before PCI) morphine administration resulted in significantly smaller infarcts (12%LV, IQR 12–19 versus 19%LV, IQR 10–29, p = 0.035) and reduced microvascular obstruction (p = 0.003). Morphine administration had no effect on hard clinical endpoints (log-rank test p = 0.74) and was not an independent predictor of clinical outcome in Cox regression analysis. In our large multicenter CMR study, morphine administration did not have a negative effect on myocardial damage or clinical prognosis in acute reperfused STEMI. In patients, presenting early ( ≤120 min) morphine may have a cardioprotective effect as reflected by smaller infarcts; but this finding has to be assessed in further well-designed clinical studies

Combined assessment of myocardial damage and electrical disturbance in chronic heart failure.

AIMTo investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure (CHF).METHODSSerum levels of heart-type fatty acid binding protein (H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level (4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF.RESULTSThere were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration (≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio (HR) = 1.745, P = 0.021] and QRS prolongation (HR 1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events (log rank test P < 0.0001).CONCLUSIONCombined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF.

Effects of Peanut (Arachis Hypogaea L.) and Its Combination with Propranolol in Isoproterenol Induced Myocardial Damage in Rats

Background: Ischemic heart disease is the interruption of blood supply to the heart causes several biochemical alterations which may lead to cardiac dysfunction and ultimately cell death. Medicinal plants and plant based foods such as peanut (Arachishypogaea L.) have received great attention for their salutary effects and potential to treat many aspects of ischemic heart disease due to their antioxidant property.Objective: To observe the effects of peanut (Arachishypogaea L.) and its combination with propranolol in isoproterenol induced myocardial damage in rats.Method: This experimental study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka in 2012. For this purpose, 20 Wistar albino rats, age 85 to 100 days, weighing 120 to 150g (initial body weight) were included in the peanut treated group.They were sub-divided into CT-P (Cardiotoxic group with isoproterenol after peanut treatment) and CT-C (Cardiotoxic group with isoproterenol after combined treatment of peanut and propranolol). Age and weight matched 30 Wistar albino rats without any peanut supplementation were taken and sub-divided into three sub-groups, BC (Baseline control), CT (Cardiotoxic group with isoproterenol) and CT-PRO (Cardiotoxic group with isoproterenol after propranolol treatment). Each sub-group consisted of 10 rats. After taking final body weight all the rats were sacrificed on 22nd day. Blood was collected from heart &amp; supernatant serum was preserved in deep freeze until analysis. For assessment of myocardial damage, some cardiac biomarker enzymes, like serum CK-MB &amp; LDH were estimated by using immunoassay method. The statistical analysis was done by one way ANOVA and Bonferroni test as applicable.Result: In this study, percent change from initial body weight to final body weight was significantly (p&lt;0.01) lower both in CT-P and CT-C as compared to that of BC. Again, the mean serum CK-MB and LDH levels were significantly (p&lt;0.01) higher in CT, CT-PRO, CT-P &amp; CT-C in comparison to that of BC. On the other hand, the serum CK-MB and LDH levels were lower in CT-PRO, CT-P and CT-C when compared to that of CT though the differences were statistically significant (p&lt;0.01, p&lt;0.05) in case of CT-PRO and CT-C but not significant in case of CTP. Again, the values were also significantly lower in CT-C (p&lt;0.01,p&lt;0.05) as compared to that of CTP.Conclusion: The present study revealed that peanut can lower serum CK-MB &amp; LDH levels towards normal in isoproterenol induced myocardial damaged rats. However, the combined therapy of peanut with propranolol showed synergistic effect on lowering serum CK-MB &amp; LDH levels.Bangladesh Soc Physiol. 2016, December; 11(2): 74-79

Diagnostic value of dobutamine-stressed cardiac morphing myocardial perfusion imaging for coronary artery disease in middle-aged patients

Objective To evaluate the diagnostic value of dobutamine-stressed cardiac morphing (CM) MPI (CMMPI) for coronary artery disease (CAD) in middle-aged patients. Methods A total of 97 middle-aged patients (52 males, 45 females, age 40-65 (52.98±7.74) years) from March 2011 to February 2015 with chest distress, cardiopalmus and chest pain symptoms (suspected CAD) were retrospectively studied. Informed consents were signed by patients before examination. All patients underwent one-day dobutamine-stressed/rest CMMPI and CAG within one month. The diagnostic value of CMMPI was assessed and compared with CAG. Results CMMPI revealed 42 abnormal cases and 9 normal cases in 51 cases with coronary artery stenosis by CAG. CMMPI found 11 abnormal cases and 35 normal cases in 46 cases with normal coronary artery by CAG. In comparison with CAG, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CMMPI were 82.35%(42/51), 76.09%(35/46), 79.38%(77/97), 79.25%(42/53)and 79.55%(35/44) respectively. The side effect was slight and transient with an incidence of 82.47%(80/97). Conclusion The dobutamine-stressed CMMPI has an important value for the diagnosis of CAD and the assessment of myocardial damage in middle-aged patients. Key words: Coronary disease; Tomography, emission-computed, single-photon; Image processing, computer-assisted; Dobutamine; MIBI

QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis

Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS. The purpose of this study was to examine whether the QRS score can be applied to CS. CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59). Of 59 patients, 35 (59%) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P < .001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9% CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P = .27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P = .01). QRS score was an independent predictor of risk in multivariate analysis (P = .03). The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.

QRS complex distortion (Grade 3 ischaemia) as a predictor of myocardial damage assessed by cardiac magnetic resonance imaging and clinical prognosis in patients with ST-elevation myocardial infarction.

Distortion of the terminal portion of the QRS complex (so-called Grade 3 ischaemia, G3I) has been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI) populations. However, the correlation of G3I with infarct size and microvascular injury as defined by cardiac magnetic resonance (CMR) is not well defined. Aim of this study was to assess the relation of G3I with myocardial damage as assessed by CMR and clinical outcomes in STEMI patients. We analysed the ECGs of 572 consecutive STEMI patients regarding the presence or absence of G3I. CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardized protocol. The primary clinical endpoint was major adverse cardiac events (MACE) within 12 months after infarction. G3I was present in 186 (32%) patients. The presence of G3I was associated with larger infarct size (P = 0.01), the presence of late microvascular obstruction (P = 0.05), the presence of intramyocardial haemorrhage (P = 0.04), and impaired myocardial salvage (P = 0.01). G3I was associated with a higher incidence of MACE (P = 0.01) and was identified as an independent predictor of MACE in Cox regression analysis (HR 2.19; 95% CI 1.10 to 4.38, P = 0.03). This largest study to date correlating G3I on the admission ECG with CMR markers of myocardial damage demonstrates that G3I is significantly associated with infarct size, impaired myocardial salvage, and reperfusion injury in a reperfused STEMI population. Moreover, G3I was independently associated with MACE. CLINICALTRIALS.GOV: NCT00712101.

Abstract 16142: Grad 3-Ischemia (QRS Complex Distortion) as a Predictor of Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging and Clinical Prognosis in Patients With ST-Elevation Myocardial Infarction

Introduction: Predicting the extent of myocardial damage on early electrocardiographic (ECG) findings could be helpful for improved risk stratification in patients with acute reperfused ST-elevation myocardial infarction (STEMI). Distortion in the terminal portion of the QRS complex (so called grade 3 ischemia, G3I) has been associated with adverse outcomes in STEMI patients. The correlation of G3I with infarct size and microvascular injury is not well defined. Objective: To studied the relation of G3I with myocardial damage as assessed by CMR and the association of G3I with adverse clinical outcomes in a STEMI population treated by primary percutaneous coronary intervention (PCI). Methods: We analyzed the ECGs of 572 consecutive STEMI patients regarding the presence or absence of G3I. G3I was defined as: 1) complete loss of S waves in 2 adjacent leads with typical Rs configuration (i.e. V1-V3), or 2) ST-J point to R wave amplitude ratio &gt;0.5 in other leads with qR configuration. CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical end-point was major adverse cardiac events (MACE) defined as death, reinfaction and readmission for congestive heart failure within 12 months after the index event. Results: G3I was present in 186 (32%) patients. The presence of G3I was associated with larger infarct size (18.3%LV [10.4 to 27.6] versus 16.5%LV (8.2 to 23.5), p=0.01), late microvascular obstruction (0.4%LV [0 to 2.7] versus 0%LV [0 to 1.5], p= 0.05, presence of intramyocardial hemorrhage (41 versus 32%, p=0.04) and less myocardial salvage (47 [28 to 64] versus 53 (35 to 68), p=0.01). G3I was associated with a significant higher incidence of MACE (p=0.01) and was identified as an independent predictor of MACE in Cox regression analysis (Hazard ratio 2.19 [1.10 to 4.38], p=0.03). Conclusions: This largest study to date correlating G3I on the admission ECG with CMR markers of myocardial damage demonstrates that G3I is significantly associated with infarct size, myocardial salvage and reperfusion injury in a STEMI population reperfused by primary PCI. Moreover, G3I was independently associated with MACE.

T1 and T2 mapping: new perspectives in cardiac magnetic resonance imaging

Cardiac magnetic resonance (MR) imaging is currently considered the gold standard for characterizing changes in myocardial structure, in particular to assess myocardial edema and focal fibrosis. In spite of this potential capability, the traditional MR sequences usually employed for these purposes have significant limitations and provide only qualitative information. Recent developments in cardiac MR imaging techniques currently provide clinically-feasible mapping of T1 and T2 relaxation times, thus providing a quantitative assessment of the parameters of interest. Myocardial edema can be evaluated using T2 mapping techniques. These have shown a superior performance compared to the traditional T2-weighted and STIR sequences, both in acute inflammatory cardiomyopathies and in acute ischemic injury. T1 mapping techniques, performed both with and without contrast medium, enable to quantify diffuse myocardial fibrosis and to assess myocardial edema and infiltration. This article will review current methodologies for cardiac T1 and T2 parametric mapping and their potential and limitations in the assessment of myocardial damage.

Prognostic significance and relationship of worst lead residual ST segment elevation with myocardial damage assessed by cardiovascular MRI in myocardial infarction

ObjectiveTo investigate the relation of residual worst lead ST segment elevation (WL-STE) after ST segment myocardial infarction (STEMI) with infarct size and microvascular injury assessed by cardiovascular magnetic resonance (CMR)...

KURĮ ANESTETIKĄ RINKTIS KARDIOCHIRURGINIŲ OPERACIJŲ METU?

Žurnalas „Sveikatos mokslai / Health sciences“ yra recenzuojamas tarptautinis mokslinis žurnalas, skirtas skleisti naujas žinias ir informaciją apie visuomenės sveikatą, sveikatos ugdymą, ligas, klinikinius tyrimus ir klinikinius atvejus, naujas technologijas, slaugą, reabilitaciją, sveikatos ekonomiką ir vadybą. Žurnalas spausdina mokslinius straipsnius lietuvių, anglų ir rusų kalbomis, kasmet išeina 1 tomas (6 numeriai) spausdintiniu ir elektroniniu variantais. Daugiau nei 140 mokslinių straipsnių publikuojami per metus. Žurnalas priklauso Lietuvos mokslo periodikos asociacijai.

Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa

Cardiac damage is a major complication of anorexia nervosa (AN). The present study evaluated the prevalence of myocardial damage in patients with AN by cardiac magnetic resonance imaging (CMR). This study was cross-sectional and observational. Forty consecutive female patients with a diagnosis of AN and 28 healthy female subjects were evaluated from January 2007 to 2011 at the Department of Psychiatry (University of Istanbul, Istanbul, Turkey). Following enrollment in the study, participants underwent a cardiac evaluation, a physical examination, a standard electrocardiogram (ECG), an echocardiography and a CMR. Body weight, body mass index and heart rate values were lower in patients with AN than in the control group. When compared with control groups, patients with AN showed reduced left ventricular mass with normal systolic function. Compared to control subjects, patients with AN had higher prevalence of pericardial effusion (30% in the AN group, 4% in the control group, p = .005) and mitral valve prolapses (23% in the AN group, 4% in the control group, p = .03). Myocardial fibrosis (detected as late gadolinium enhancement on CMR) was found in 23% of patients with AN. Myocardial fibrosis was not detected in any control subject (p = .007). A strong association was found between myocardial fibrosis and AN. Cardiac damage of myocardial fibrosis in asymptomatic patients with AN can be found by CMR examination.

T wave alternans in experimental myocardial infarction: Time course and predictive value for the assessment of myocardial damage

BackgroundT-wave alternans (TWA) is associated with prognosis after myocardial infarction (MI), however its link to the extent of ischemic injury has not been clarified. We analyzed the course of TWA and its relation to myocardial damage in experimental myocardial infarction. MethodsIn 21 pigs, infarction was induced by 40-minute long balloon inflation in LAD under continuous 12-lead ECG monitoring. TWA was assessed in a 32-beat sliding window, using periodic component analysis and the Laplacian Likelihood Ratio method. Myocardium at risk (MaR) and infarct size (IS) were evaluated by SPECT and magnetic resonance imaging respectively. ResultsTWA appeared at 7.2±4.5minutes of occlusion, reached its maximum at 12.7±6.3 and lasted until 26.5±9.2minutes. The maximal level of TWA was associated with both MaR (r=0.499, p=0.035) and IS (r=0.65, p=0.004). ConclusionTWA magnitude is associated with both MaR and IS in experiment, which encourages further studies in clinical settings.

Cardioprotective potential of simvastatin in the hyperhomocysteinemic rat heart

The present study investigated the probable role of simvastatin, 3-hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitor, in abrogated cardioprotection in hyperhomocysteinemic (Hhcy) rat hearts. Isolated Langendorff's perfused normal and Hhcy rat hearts were subjected to 30-min global ischemia (I) followed by 120-min reperfusion (R). Assessment of myocardial damage was done by measuring infarct size and analyzing the release of lactate dehydrogenase (LDH) and creatine kinase (CK-MB) in coronary effluent. In addition, the oxidative stress in the heart was assessed by measuring lipid peroxidation and superoxide anion generation. I/R produced myocardial injury in normal and Hhcy rat hearts by increasing myocardial infarct size, LDH and CK in coronary effluent and oxidative stress. Hhcy rat hearts showed enhanced myocardial injury and high oxidative stress as compared to normal hearts. Treatment with Simvastatin (10 μMol) afforded cardioprotection against I/R-induced myocardial injury in normal and hyperhomocysteinemic rat hearts as assessed in terms of reductions in myocardial infarct size, LDH and CK levels in coronary effluent and oxidative stress. The reductions in the high degree of oxidative stress may be responsible for the observed cardioprotection afforded by simvastatin against I/R-induced myocardial injury in normal and hyperhomocysteinemic rat hearts.