Myocardial Wall Thickness Research Articles

The influence of diabetic autonomous neuropathy on myocardial remodeling in type 1 diabetes mellitus

Aim. To assess the influence of diabetic autonomous neuropathy (DAN) on left ventricular myocardial remodeling in type 1 diabetes mellitus. Materials and methods. The study included 78 patients (30 men and 48 women) with DM1 (mean age 28.9?8.3 years, DM1 duration9.7?7.5 years). DAN was diagnosed by standard ECG tests (Valsalva and breathing tests). The patients were examined using echocardiographywith the measurement of the thickness of interventricular septum (IVS) and left ventricle posterior wall (PW), end diastolic and systolic size (EDS and ESS) of the left ventricle, left ventricular myocardial mass (MM), MM index and relative wall thickness (RWT). LV hypertrophy(LVH) was diagnosed at MM index ?134 g/m2 in men and ?110 g/m2 in women; concentric and excentric types of LV hypertrophy wererecorded at RWT ?0.45 and

Measurement of Strain and Strain Rate in Embryonic Chick Heart In Vivo Using Spectral Domain Optical Coherence Tomography

The ability to measure in vivo strain and strain rate in embryonic chick heart is one of the key requirements for understanding the mechanisms of cardiac development. Due to its high temporal and spatial resolution as well as its fast imaging capability, optical coherence tomography (OCT) has the potential to reveal the complex myocardial activity in the living chick heart. We describe a method to evaluate the in vivo strain and strain rate of the myocardium through analyzing the periodic variation of the myocardial wall thickness calculated from real time serial OCT images. The results demonstrate that OCT can be a useful tool to describe the biomechanical characteristics of the embryonic heart.

Decreased coronary artery development in Wt1 heterozygous mice

Congenital heart disease is the most common human birth defect which occurs in approximately 1% of all births in Canada. As a major cause of mortality and morbidity, a further understanding of the biological mechanisms underlying congenital heart disease is crucial. Wilms' tumour‐1 (Wt1) was first discovered as a gene mutated in kidney tumour development in children, but has more recently been shown to play an important role in organogenesis. In the developing heart, Wt1 is critical for progenitor cell function. Homozygous Wt1 knockout mice are embryonic lethal with defects in multiple organs, including the heart, kidneys and gonads. Conversely, heterozygous Wt1 (Wt1+/−) mice are reported to be viable and fertile but whether a gene dosage effect exists, specifically related to heart development, remains elusive. In this study, coronary artery formation was investigated in postnatal day one (P1) Wt1+/− mice. Hearts were serially sectioned and immunostained for alpha smooth muscle actin to mark coronary arteries. Amira software was utilized to generate 3‐D reconstructions of the heart to evaluate coronary artery morphology. It was found that coronary artery diameter and coronary artery volume were significantly decreased in Wt1+/−mice compared with Wt1+/+mice at P1. Total body weight, left ventricular, septal and right ventricular myocardial wall thickness were not significantly different between Wt1+/−and Wt1+/+mice at P1. These results demonstrate that expression of both genetic copies of Wt1 is critical for coronary artery development. Ongoing experiments are studying the morphology and function of coronary arteries in the adult Wt1+/− mice. This research is supported by a NSERC Postgraduate Scholarship and the Heart and Stroke Foundation.

Transmurality mapping of left ventricular scar: impact of spatial resoluton

Left ventricular (LV) scar is associated with ventricular tachycardia (VT), related to regions of slow conduction. Endocardial LV voltage maps reveal regions of low voltage near the site of VT origin, corresponding to myocardial fiber bundles trapped in areas of extensive fibrosis. Scar transmurality (i.e. the percent of myocardial wall thickness which is scarred, measured in 6-12 sectors around the LV myocardium) is an indicator of myocardial viability after reperfusion (1). Intermediate infarct transmurality has been correlated with non-ischemic VT (2). Furthermore, lower voltages are found in regions of more transmural scarring (3). We have expanded the transmurality concept to generate LGE transmurality maps of the LV.

Correction of left ventricular wall thickening from short‐axis cine MRI for basal‐descent through‐plane motion

To solve the problem of the basal descent movement in quantification of the regional left ventricular (LV) myocardial wall thickness (WTh) and wall thickening (%WT) in short-axis (SA) cine MRI for effectively assessing the regional wall motion of LV myocardium. LV long-axis tagged MRI and SA cine MRI were performed to calculate the longitudinal translation and circumferential WTh of LV myocardium in eight normal volunteers. The new SA end-systolic thickness (EST) data were reconstructed from the original EST data, based on the quantified longitudinal translation of LV myocardium. The mean %WT of six segments in the basal section after correction was significantly different from that before correction in both intra- and inter-operator experiments. The polar map also showed the significant improvement of the variability of regional %WT and lack of quantification of %WT in the most basal SA slices after correction. The proposed technique demonstrated an important advantage to calculate the %WT in the most basal SA myocardial tissue, which was considered difficult to be achieved using cine MRI.

Regional Thicknesses and Thickening of Compacted and Trabeculated Myocardial Layers of the Normal Left Ventricle Studied by Cardiovascular Magnetic Resonance

We used cardiovascular magnetic resonance (CMR) to study normal left ventricular (LV) trabeculation as a basis for differentiation from pathological noncompaction. The apparent end-diastolic (ED) and end-systolic (ES) thicknesses and thickening of trabeculated and compacted myocardial layers were measured in 120 volunteers using a consistent selection of basal, mid, and apical CMR short-axis slices. All had a visible trabeculated layer in 1 or more segments. The compacted but not the trabeculated layer was thicker in men than in women (P<0.01 at ED and ES). When plotted against age, the trabeculated and compacted layer thicknesses demonstrated opposite changes: an increase of the compact layer after the fourth decade at both ED and ES (P<0.05) but a decrease of the trabeculated layer. There was age-related preservation of total wall thickness at ED but an increase at ES (P<0.05). The compacted layer thickened, whereas the trabeculated layer thinned with systole, but neither change differed between sexes. With age, the most trabeculated LV segments showed significantly greater systolic thinning of trabeculated layers and, conversely, greater thickening of the compact segments (P<0.05). Total wall thickening is neither sex nor age dependent. There were no sex differences in the trabeculated/compacted ratio at ES or ED, but the ES trabeculated/compacted ratio was smaller in older (50 to 79 years) versus younger (20 to 49 years) groups (P<0.05). We demonstrated age- and sex-related morphometric differences in the apparent trabeculated and compacted layer thicknesses and systolic thinning of the visible trabeculated layer that contrasts with compacted myocardial wall thickening.

Sci-Fri AM: Imaging - 04: Experimental Validation of a Two Dimensional Partial Volume Correction Strategy for PET Imaging in Mice with Simulated and Measured Data

Quantitative myocardial mouse heart imaging with positron emission tomography (PET) is compromised when the PET system has a resolution on the order of the left ventricular (LV) wall thickness. In this study a partial volume correction (PVC) strategy is employed to compensate for the partial volume losses experienced in PET images from the Inveon small animal PET scanner. A 1D algorithm extracts the edges of the heart wall and activity information outside the wall. This information is used to build a 2D image and a PVC model is developed to correct the activity in the LV. A dynamic mouse heart LV phantom, with variable wall thickness and 8 gates, was created digitally and physically so that the algorithm could be tested on simulated and real measured image data. An effective 2D Gaussian point spread function, with a FWHM of 1.3 mm, was derived from the measured PET images and used in the PVC models. The simulated and measured phantom images underestimated the relative activity by approximately 30–40% before PVC, but this was improved to an overestimation of 10% after PVC. The coefficient of variation was improved from 20–30% to 5–10% with PVC demonstrating that the algorithm has the ability to increase accuracy and restore homogenous activity distributions in 2D. This algorithm was developed for mouse imaging, but it could be applied to any other species where myocardial wall thickness is on the order of the PET system's spatial resolution.

Impact of Chronic Alcohol Ingestion on Cardiac Muscle Protein Expression

Chronic alcohol abuse contributes not only to an increased risk of health-related complications, but also to a premature mortality in adults. Myocardial dysfunction, including the development of a syndrome referred to as alcoholic cardiomyopathy, appears to be a major contributing factor. One mechanism to account for the pathogenesis of alcoholic cardiomyopathy involves alterations in protein expression secondary to an inhibition of protein synthesis. However, the full extent to which myocardial proteins are affected by chronic alcohol consumption remains unresolved. The purpose of this study was to examine the effect of chronic alcohol consumption on the expression of cardiac proteins. Male rats were maintained for 16 weeks on a 40% ethanol-containing diet in which alcohol was provided both in drinking water and agar blocks. Control animals were pair-fed to consume the same caloric intake. Heart homogenates from control- and ethanol-fed rats were labeled with the cleavable isotope coded affinity tags (ICAT). Following the reaction with the ICAT reagent, we applied one-dimensional gel electrophoresis with in-gel trypsin digestion of proteins and subsequent MALDI-TOF-TOF mass spectrometric techniques for identification of peptides. Differences in the expression of cardiac proteins from control- and ethanol-fed rats were determined by mass spectrometry approaches. Initial proteomic analysis identified and quantified hundreds of cardiac proteins. Major decreases in the expression of specific myocardial proteins were observed. Proteins were grouped depending on their contribution to multiple activities of cardiac function and metabolism, including mitochondrial-, glycolytic-, myofibrillar-, membrane-associated, and plasma proteins. Another group contained identified proteins that could not be properly categorized under the aforementioned classification system. Based on the changes in proteins, we speculate modulation of cardiac muscle protein expression represents a fundamental alteration induced by chronic alcohol consumption, consistent with changes in myocardial wall thickness measured under the same conditions.

Epithelial–mesenchymal transition of epicardial mesothelium is a source of cardiac CD117-positive stem cells in adult human heart

Epithelial–mesenchymal transition is implicated in the remodelling of tissues during development and in the adult life. In the heart, it gives origin to progenitors of fibroblasts, coronary endothelium, smooth muscle cells, and cardiomyocytes. Moreover, epicardially-derived cells determine myocardial wall thickness and Purkinje fibre network. Recently, the presence of numerous cardiac stem cells in the subepicardium of the adult human heart has been described and the hypothesis that epicardially-derived cells can contribute to the population of cardiac stem cells in the adult heart has been advanced. In an effort to test this hypothesis and establish a possible link between epicardium, epicardially-derived cells and cardiac stem cells in the adult human heart we have examined epicardial mesothelial cells in the normal and pathological adult human heart with ischemic cardiomyopathy in vivo and we have induced and documented their epithelial–mesenchymal transition in vitro. Noticeably, epicardial cells were missing from the surface of pathological hearts and the cells with the expression of epithelial and mesenchymal markers populated thick subepicardial space. When the fragments of epicardium from the normal hearts were cultured on the specific substrate formed by extracellular matrix derived from cardiac fibroblasts, we obtained the outgrowth of the epithelial sheet with the mRNA and protein expression characteristic of epicardium. TGFβ induced cellular and molecular changes typical of epithelial–mesenchymal transition. Moreover, the epicardially-derived cells expressed CD117 antigen. Thus, this study provides evidence that cardiac stem cells can originate from epithelial–mesenchymal transition of the epicardial cells in the adult human heart.

058 Effect of Cyclosporine on Left Ventricle Remodeling after Reperfused Myocardial Infarction

This study examined the effect of cyclosporine A used at the time of reperfusion, on LV remodeling and function by cardiac magnetic resonance (CMR) in the early days and several months after AMI. In a human study, administration of cyclosporine A at the time of acute myocardial infarction (AMI) reperfusion was associated with a smaller infarct size. However, experimental data suggest that cyclosporine A has a detrimental effect on left ventricular remodeling. 28 patients of the original cyclosporine A study had an acute (day 5) and a follow-up (6 months) CMR study. Cine imaging was used to determine LV volumes, mass, ejection fraction and myocardial wall thickness in infarcted and remote non-infarcted myocardium, and late gadolinium imaging was used to determine infarct size. There was a persistent reduction of the absolute infarct size at 6 months in the cyclosporine A group compared with the control group of patients (29±15 grams VS 38±14 grams; P=0.04). There was a significant reduction of LV end-systolic volume (and a trend for LV end-diastolic volume; P=0.07) in the cyclosporine A group, compared with the control group, both at day 5 and at 6 months after infarction. There was no significant difference between the two groups in either global LV mass or regional wall thickness of the remote non-infarcted myocardium at day 5 or at 6 months. Attenuation of LV dilatation and improvement of LV ejection fraction by cyclosporine A at 6 months were correlated with infarct size reduction. Cyclosporine A used at the moment of AMI reperfusion persistently reduces infarct size and does not have a detrimental effect on LV remodeling

Short-axis epicardial volume change is a measure of cardiac left ventricular short-axis function, which is independent of myocardial wall thickness

Fractional shortening (FS) by echocardiography is considered to represent the short-axis contribution to the stroke volume (SV), also called short-axis function. However, FS is mathematically coupled to the amount of myocardium, since it rearranges during atrioventricular plane displacement (AVPD). The SV is the sum of the volumes generated by 1) reduction in outer volume of the heart, and 2) inner AVPD. The long-axis contribution to the SV is generated by AVPD, and thus the short-axis contribution is the remaining outer volume change of the heart, which should be unrelated to myocardial wall thickness. We hypothesized that both endocardial and midwall shortening indexed to SV are dependent on myocardial wall thickness, whereas epicardial volume change (EVC) indexed to SV is not. Twelve healthy volunteers (normals), 12 athletes, and 12 patients with dilated cardiomyopathy (ejection fraction < 30%) underwent cine cardiac magnetic resonance imaging. Left ventricular long-axis function was measured as the portion of the SV, in milliliters, generated by AVPD. EVC was defined as SV minus long-axis function. Endocardial and midwall shortening were measured in a midventricular short-axis slice. Endocardial shortening/SV and midwall shortening/SV both varied in relation to end-diastolic myocardial wall thickness (R(2) = 0.16, P = 0.008 and R(2) = 0.14, P = 0.012, respectively), whereas EVC/SV did not (R(2) = 0.00, P = 0.37). FS is dependent on myocardial wall thickness, whereas EVC is not and therefore represents true short-axis function. This is not surprising considering that FS is mainly caused by rearrangement of myocardium secondary to long-axis function. FS is therefore not synonymous with short-axis function.

Abstract 4760: Effect of Cyclosporine on Left Ventricle Remodeling After Reperfused Myocardial Infarction

Introduction: In a human study, administration of cyclosporine A at the time of acute myocardial infarction (AMI) reperfusion was associated with a smaller infarct size. However, experimental data suggest that cyclosporine A has a detrimental effect on left ventricular remodeling. This study examined the effect of cyclosporine A used at the time of reperfusion, on LV remodeling and function by cardiac magnetic resonance (CMR) in the early days and several months after AMI. Material and Methods: 28 patients of the original cyclosporine A study had an acute (day 5) and a follow-up (6 months) CMR study. Cine imaging was used to determine LV volumes, mass, ejection fraction and myocardial wall thickness in infarcted and remote non-infarcted myocardium, and late gadolinium imaging was used to determine infarct size. Results: There was a persistent reduction of the absolute infarct size at 6 months in the cyclosporine A group compared with the control group of patients (29±15 grams VS 38±14 grams; P=0.04). There was a significant reduction of LV end-systolic volume (and a trend for LV end-diastolic volume; P=0.07) in the cyclosporine A group, compared with the control group, both at day 5 and at 6 months after infarction. There was no significant difference between the two groups in either global LV mass or regional wall thickness of the remote non-infarcted myocardium at day 5 or at 6 months. Attenuation of LV dilatation and improvement of LV ejection fraction by cyclosporine A at 6 months were correlated with infarct size reduction. Conclusion: Cyclosporine A used at the moment of AMI reperfusion persistently reduces infarct size and does not have a detrimental effect on LV remodeling.

Sci-Fri AM(1): Imaging-03: The Effects of Time Reduced Cardiac Spect Acquisition with Respect to Left Ventricle Quantitation Parameters Using a Dynamic Mass Spring Model Segmentation Technique

Introduction: With coronary artery disease being the leading cause of death worldwide, it is essential to maximize the efficiency of its diagnosis, which routinely involves SPECT myocardial perfusion imaging (MPI). Using phantom studies, we investigated the influence of time‐reduced SPECT MPI acquisitions on selected measurements of the left ventricle perfusion. Materials & Methods: A thorax phantom with a normal heart was scanned using Philips' Forte JS SPECT system using a clinical cardiac acquisition protocol. Four data sets with 5, 10, 15, and 20 seconds per projection (spp) were acquired concurrently in a single scan. Three additional acquisitions were performed using 3 different numbers of projections: 64, 32, and 16. Reconstructions were performed with Philips' Astonish software and our in‐house reconstruction software (MIRG). Phantom myocardial wall thickness (MWT) and voxel by voxel count comparisons were made on all reconstructed data sets.Results: No significant differences were observed in MWT between reconstructions with different times per projection. For Astonish reconstructions, the MWT in the 20spp, 15spp, 10spp and 5spp were 12.2±1.2mm, 12.6±0.9mm, 13.1±1.6mm, and 11.9±1.2mm, respectively. The average differences in counts per voxel within the heart relative to the gold standard (20spp) were 2.8%, 13.8%, and 15.9% for 15spp, 10spp, and 5spp, respectively. Similar results were observed for MIRG reconstructions and reduced number of projection protocols. Conclusions: Reducing the time of acquisition can be done without comprising accuracy of MWT measurements, but caution should be used if relative quantitation is to be considered, such as in perfusion defect analysis.

A multi-center phantom study comparing image resolution from three state-of-the-art SPECT-CT systems

BackgroundOngoing advancements in SPECT-CT technology raise important questions regarding the differences in performance between various cameras and their respective image-processing algorithms. Our study seeks the answer to this question via measurement of phantom myocardial wall thickness (MWT) on images obtained from three state-of-the-art cameras. MethodsA thorax phantom with an insert modeling a healthy heart was scanned using cardiac acquisition protocols with Philips’ Precedence (PP), GE’s Infinia Hawkeye (IH), and Siemens’ Symbia-T6 (SS). Processing was performed using advanced reconstruction techniques available on the cameras and our own independent software. The MWT measurement was used as a figure of merit in performance evaluation. ResultsWhen using 50% threshold, MWTs measured for the data acquired using PP, IH, and SS and reconstructed with independent standardized software were 8.5 ± 1.2 mm, 7.7 ± 1.2 mm, and 9.3 ± 0.9 mm, respectively; and 9.3 ± 0.5 mm, 19.2 ± 0.8 mm and 18.4 ± 1.1 mm when using the manufacturers’ own reconstructions, respectively. Thresholds optimized for each image (ranging from 32% to 68%) produced much more uniform results. ConclusionsNo significant differences were observed between image resolutions when data acquired from different cameras were reconstructed with an independent algorithm. However, different manufacturers’ reconstruction algorithms produced MWTs that differed by up to about 110% when using a set threshold of 50%.

Single-Shot Cardiorenal Scintigraphy with 99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion

Renal function is known to be a strong predictor of cardiovascular prognosis, and cardiorenal disease is increasingly investigated in medical research. In this study, we tested the hypothesis that a single combined cardiorenal scintigraphy examination with the perfusion tracer (99m)Tc-tetrofosmin is feasible and may allow the simultaneous investigation of cardiac and renal pathology in cardiovascular patients. Thirty patients scheduled for dual-day gated SPECT also gave their informed consent for a renal acquisition after a single injection of 370 MBq of (99m)Tc-tetrofosmin, at rest (30 patients) or with adenosine (21 patients), and to undergo an additional standard renal study with the glomerular tracer (99m)Tc-diethylenetriaminepentaacetic acid (DTPA) (74 MBq) after 1 wk (24 patients). Kidney images and renograms were obtained. Renal uptake index, expressed as the percentage ratio of kidney counts cumulated over the second minute after injection to the administered dose, was calculated as a functional renal parameter. Time to peak activity and separate kidney percentage uptake (as the percentage contribution of each kidney to total renal uptake) were also calculated. Compared with (99m)Tc-DTPA, (99m)Tc-tetrofosmin provided better-quality kidney images, with a higher uptake index (13.17% +/- 4.76% vs. 8.33% +/- 2.45%, P < 0.001) and with comparable separate kidney percentage uptake and times to peak activity. (99m)Tc-tetrofosmin uptake index was significantly lower in the patients who were more compromised according to renal and cardiovascular functional parameters, and correlated with (99m)Tc-DTPA uptake index (r = 0.77, P < 0.001), serum creatinine (r = 0.59, P < 0.005), log brain natriuretic peptide N-terminal levels (r = -0.65, P < 0.005), myocardial and carotid intima-media wall thickness (for both, r = -0.61, P < 0.005), and the Doppler index of renal vascular resistance (r = -0.60, P < 0.005). In the 21 patients who underwent the provocative test, adenosine induced a significant decrease in renal (99m)Tc-tetrofosmin uptake index (from 14.12% +/- 4.50% to 11.81% +/- 3.33%, P < 0.005) suggesting a decrement in renal perfusion or function. (99m)Tc-tetrofosmin cardiorenal scintigraphy is feasible at low cost as a single-shot study and may allow both the evaluation of renal morphology and renograms during a cardiac study and the calculation of renal functional parameters.

A rare case of severe aortic stenosis with preserved ejection fraction and normal transvalvular gradient

A 75 year old male patient with a known history of diabetes mellitus and hypertension presented with exertional chest pain. He also had atrial fibrillation (AF) and was on long term anti-coagulation. Electrocardiogram showed AF with T wave inversion over the lateral leads. Serial troponin and cardiac enzymes were normal. Physical examination of the praecordium revealed an ejection systolic murmur of grade 3/6 at the aortic area radiating to the neck. Echocardiogram 2 years ago showed presence of mild aortic stenosis (AS) with mean gradient of16 mmHg, normal left ventricular function and concentric left ventricular hypertrophy (LVH). A repeat echocardiogram was performed this admission which revealed normal left ventricular function with concentric LVH (Fig.1). The aortic valve (AV) was noted to be calcified and thickened with limited opening. The mean gradient across the AV was 19 mmHg but the estimated aortic valve area by continuity equation was 0.9 cm 2 . There was also concomitant mild aortic regurgitation and mild mitral regurgitation. A cardiac catheterization was performed to exclude underlying coronary artery disease. During fluoroscopy, calcification was seen in the region of AV annulus. Coronary angiography revealed obstructive lesions at proximal and mid left anterior descending artery with minor disease in left circumflex and right coronary arteries. Because of the discrepancy in the echocardiographic findings, the decision tocross the AV during cardiac catheterization was made. The aortic valve was successfully crossed using a left Amplatz catheter with the aid of a straight 0.038-in. guidewire which was exchanged for a pigtail catheter. Simultaneous measurement of the systolic pressures of the left ventricle (LV) and right femoral artery was made (Fig. 2) which did not show much pressure difference. There was also no significant pressure difference across AV during pullback of catheter from LV to ascending aorta. The patient's previous echocardiogram reports were evaluated and showed progressive increase in myocardial wall thickness (interventricular septal wall and left posterior wall thickness at diastole were 1.2 cm in 2005, 1.6 cm in early 2007 and 2.2 cm in mid 2008). His blood pressure was well controlled with medications and thus could not account for the

CD151 Gene Delivery after Myocardial Infarction Promotes Functional Neovascularization and Activates FAK Signaling

Our previous studies showed that tetraspanin CD151 promotes neovascularization in rat hindlimb and myocardial ischemia models. This study is to assess whether CD151 induces arteriogenesis and promotes functional neovascularization in a pig myocardial infarction model, and to determine the signaling pathways involved. CD151 cDNA and antiCD151 sequence were constructed into a recombinant adeno-associated virus (rAAV) vector. All 26 pigs used either were subjected to coronary artery ligation or did not undergo surgery. Eight wks after viral administration, the expression of CD151 protein was measured by Western blot. The densities of capillaries and arterioles were determined using immunohistochemistry. Regional myocardial perfusion and other myocardial functions were evaluated by (13)N-labeled NH(3) positron emission computed tomography ((13)N-NH(3) PET) and echocardiography. Western blot was performed for assessing the signaling mechanisms. Overexpression of CD151 markedly increased the densities of capillaries and arterioles, significantly enhanced the regional myocardial perfusion, reduced myocardial ischemia, and improved the myocardial contraction, wall motion, and wall thickness. Conversely, antiCD151 gene delivery reversed the above changes. In addition, CD151 activated focal adhesion kinase (FAK), extracellular signal-regulated kinase (ERK), c-Jun N-teminal kinase (JNK), phosphatidylinositol-3 kinase (PI3K), protein kinase B (Akt), and endothelial nitric-oxide synthase (eNOS), and increased nitric oxide (NO) level. These findings demonstrate a robust role of CD151 in inducing and/or upregulating neovascularization. CD151-dependent neovascularization correlates with the activations of FAK, mitogen activated protein kinases (MAPKs), and PI3K signaling, suggesting that CD151 may promote neovascularization via MAPKs and PI3K pathways.

Overlapping Phenotypes

Patient KM is a 26-year-old male in whom a systolic ejection murmur was recently identified on a routine physical examination. As part of his evaluation, he underwent 2-dimensional echocardiography, which revealed asymmetrical left ventricular (LV) hypertrophy with a maximum LV wall thickness of 22 mm in the basal anterior septum and extension of hypertrophy into the posterior septum. His LV ejection fraction was 55%, with a normal cavity size and no evidence of resting LV outflow tract obstruction. In addition, the myocardium was noted to be highly trabeculated from the apex to the midportion of the LV (Figure 1; online-only Data Supplement Movie I). The right ventricle was normal in size and function. He has never developed heart failure …

Repeat Prenatal Corticosteroid Doses Do Not Alter Neonatal Blood Pressure or Myocardial Thickness: Randomized, Controlled Trial

The goal was to determine whether repeat prenatal corticosteroid treatment alters blood pressure and myocardial wall thickness in neonates. A randomized, double-blind, placebo-controlled trial was performed in a tertiary perinatal center. Mothers with a singleton, twin, or triplet pregnancy, at a gestational age of <32 weeks, who had received initial treatment with corticosteroid > or =7 days earlier and who were considered to be at continued risk of preterm birth were assigned randomly to receive additional weekly betamethasone or placebo treatment. One hundred forty-five infants born to 120 women were studied. Blood pressure in the first 4 weeks after birth or until hospital discharge and interventricular septal thickness and left ventricular posterior wall thickness in diastole 48 to 72 hours after birth were measured. There were no differences in mean, systolic, or diastolic blood pressures between infants in the placebo and repeat steroid groups. Blood pressures of infants in both groups were similar to published normal values. There were no differences between groups in interventricular septal thickness or left ventricular posterior wall thickness in diastole. In comparison with published normal ranges, however, 24% of infants had interventricular septal thickness and 32% of infants had left ventricular posterior wall thickness of >95th percentile. Exposure to repeat prenatal corticosteroid treatment did not increase neonatal blood pressure or myocardial wall thickness in infants who remained at risk of very preterm birth > or =7 days after an initial course of corticosteroid treatment.

Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT

The most important predictors of long-term survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV) volume, ejection fraction (LVEF) and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC) in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia). He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO) and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber, BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche) was applied deeply subcutaneously, every second day from 2000 IU to totally 16000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity abnormal motion and wall thickening for all segments. Left ventricle end-diastolic volume was 393 ml (normal < 142 ml), and LV end-systolic volume was 334 ml (normal < 65 ml). Four months after the therapy G-SPECT showed improvement in any parameters; LVEF 25%, with improvement in wall motion (normalized wall motion in the anterior, lateral area, and proximal septum) and wall thickening, LV end-diastolic volume was 390 ml, LV end-systolic volume was 289 ml. Using G-SPECT method before and after the therapy with hyperbaric oxygenation and erythropoietin we obtained objective improvement and good therapy effects in the treatment of chronic heart insufficiency.