Abstract 711: Diagnosis of Acute Myocardial Ischemia by Speckle Tacking Echocardiography -A Comparative Animal Study-

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Aya Ebihara ◽  
Katsu Takenaka ◽  
Koichi Kimura ◽  
Kansei Uno ◽  
Katsuhito Fuju ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Strain Rate ◽  
Roc Curve ◽  
Radial Strain ◽  
Posterior Wall ◽  
Acute Myocardial Ischemia ◽  
Roc Curve Analysis ◽  
2D Echocardiography ◽  
Before And After ◽  
Diagnostic Values

Since the subendocardium is known to be more vulnerable to ischemia than the subepicardium, indexes of subendocardial function are expected to be more sensitive than indexes of whole LV wall. The aim of our study is to compare the diagnostic values of systolic and diastolic indexes measured by 2D speckle tracking echocardiography in an animal experiment. The proximal left circumflex coronary artery was balloon-occluded for 3 minutes in 14 pigs. LV short-axis view was recorded at rest and 30 minutes after release of the occlusion by transthoracic 2D echocardiography except for one pig with ventricular fibrillation. Peak circumferential and radial strain (CR, RS), peak systolic and diastolic strain rate (CSR-S′ and CSR-E′), time from QRS to peak CS and RS, time from QRS to E′, and the incidence of post-systolic shortening (PSS) were measured in the subendocardium of the LV posterior wall. ROC curve analysis of these indexes was done for the diagnosis of acute myocardial ischemia followed by reperfusion. Only 5 indexes showed significant change before and after the occlusion. ROC curve revealed that CSR-E′ had the highest predictive value for detecting the ischemic memory, followed by peak CS, and CSR-S′. Peak early diastolic circumferential strain rate of the subendocardium was the most powerful index for diagnosing ischemic memory after acute coronary occlusion. Table. Results of meaurement (mean±SD)

scholarly journals Regional asynchrony during acute myocardial ischemia quantified by ultrasound strain rate imaging

2001 ◽  
Vol 37 (4) ◽  
pp. 1141-1148 ◽  
Author(s):  
Cristina Pislaru ◽  
Marek Belohlavek ◽  
Richard Y Bae ◽  
Theodore P Abraham ◽  
James F Greenleaf ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Strain Rate ◽  
Acute Myocardial Ischemia ◽  
Strain Rate Imaging

Abstract 5736: Diagnosis of Chronic Myocardial Ischemia by Speckle Tacking Echocardiography -A Comparative Animal Study-

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Koichi Kimura ◽  
Katsu Takenaka ◽  
Kansei Uno ◽  
Aya Ebihara ◽  
Katsuhito Fujiu ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Strain Rate ◽  
Speckle Tracking ◽  
Circumferential Strain ◽  
Radial Strain ◽  
Peak Strain ◽  
Short Axis ◽  
Short Axis View ◽  
Strain And Strain Rate ◽  
Axis View

A number of systolic and diastolic indexes for ischemic damage can be measured by 2D speckle tracking echocardiography (STE) including radial strain and strain rate as well as circumferential strain and strain rate on LV short-axis view. In addition, they could be derived from the subendocardium, subepicardium, mid-layer or total layer of the LV wall with new tracking software. The aim of our study is to compare the diagnostic abilities of these indexes in animal experiments. An Ameroid constrictor was placed around the left circumflex coronary artery in 19 pigs. Before and 4 weeks after the surgery, LV short-axis images were obtained at rest by transthoracic 2D echocardiography. Three pigs that had died after the surgery and 2 that had focal infarction in pathological studies were excluded from the study. Thus, in 14 pigs with 99% stenosis on coronary angiograms, we measured peak strain, peak S′, peak E′, time from QRS to peak strain, time from QRS to E′, and incidence of post-systolic shortening (PSS) in the endocardium, midcardium, and epicardium of the LV posterior wall using a new prototype speckle tracking software. None of the time indexes and PSS showed statistically significant results. ROC curve analysis (Table ) revealed that endocardial circumferential strain is the most diagnostic index of ischemia, which showed 79% sensitivity and 93% specificity. Endocardial circumferential strain measured by STE on LV short-axis view was the most useful index for detecting chronic severe myocardial ischemia. Table. Results of measurement in chronic ischemia(mean±SD)

Bezold-Jarisch reflex attenuates dynamic gain of baroreflex neural arc

2003 ◽  
Vol 285 (2) ◽  
pp. H833-H840 ◽  
Author(s):  
Koji Kashihara ◽  
Toru Kawada ◽  
Yusuke Yanagiya ◽  
Kazunori Uemura ◽  
Masashi Inagaki ◽  
...  
Keyword(s):  
Transfer Function ◽  
Myocardial Ischemia ◽  
Dynamic Characteristics ◽  
Acute Myocardial Ischemia ◽  
Renal Sympathetic Nerve Activity ◽  
Afferent Nerves ◽  
Before And After ◽  
White Noise Sequence ◽  
Noise Sequence ◽  
Dynamic Gain

Although acute myocardial ischemia or infarction may induce the Bezold-Jarisch (BJ) reflex through the activation of serotonin receptors on vagal afferent nerves, the mechanism by which the BJ reflex modulates the dynamic characteristics of arterial pressure (AP) regulation is unknown. The purpose of this study was to examine the effects of the BJ reflex induced by intravenous phenylbiguanide (PBG) on the dynamic characteristics of the arterial baroreflex. In seven anesthetized rabbits, we perturbed intracarotid sinus pressure (CSP) according to a white noise sequence while renal sympathetic nerve activity (RSNA), AP, and heart rate (HR) were recorded. We estimated the transfer function from CSP to RSNA (neural arc) and from RSNA to AP (peripheral arc) before and after 10 min of intravenous administration of PBG (100 μg · kg–1 · min–1). The intravenous PBG decreased mean AP from 84.5 ± 4.0 to 68.2 ± 4.7 mmHg ( P < 0.01), mean RSNA to 76.2 ± 7.0% ( P < 0.05), and mean HR from 301.6 ± 7.7 to 288.4 ± 9.0 beats/min ( P < 0.01). The intravenous PBG significantly decreased neural arc dynamic gain at 0.01 Hz (1.06 ± 0.08 vs. 0.59 ± 0.17, P < 0.05), whereas it did not affect that of the peripheral arc (1.20 ± 0.12 vs. 1.18 ± 0.41). In six different rabbits without intravenous PBG, the neural arc transfer function did not change between two experimental runs with intervening interval of 10 min, excluding the possibility that the cumulative effects of anesthetics had altered the neural arc transfer function. In conclusion, excessive activation of the BJ reflex during acute myocardial ischemia may exert an adverse effect on AP regulation, not only by sympathetic suppression, but also by attenuating baroreflex dynamic gain.

scholarly journals Two-dimensional speckle tracking echocardiography in goats: repeatability, variability, and validation of the technique using an exercise test and an experimentally induced acute ischemic cardiomyopathy.

2019 ◽  
Author(s):  
Aurelia A Leroux ◽  
Marie Moonen ◽  
Frédéric Farnir ◽  
Stefan Deleuze ◽  
Charlotte Sandersen ◽  
...  
Keyword(s):  
Strain Rate ◽  
Rotation Rate ◽  
Speckle Tracking ◽  
Ischemic Cardiomyopathy ◽  
Animal Species ◽  
Radial Strain ◽  
Two Dimensional ◽  
Pathological Changes ◽  
Strain And Strain Rate ◽  
Before And After

Abstract Background : Two-dimensional speckle tracking (2DST) technique has been validated in numerous animal species, but neither studies of repeatability, nor measurements after exercise or in animals with cardiac disease have been reported in goats. Therefore, the aim of this study was to validate this technique in goats for further clinical and experimental applications in this species. This study was divided into several steps. First, a standardized echocardiographic protocol including several right parasternal short-axis views at papillary muscles level was performed three times at one-day intervals in ten healthy adult unsedated Saanen goats to test repeatability and variability of 2DST measurements. Then, the same measurements were performed immediately before and after a standardized exercise on treadmill in seven of the goats, and at 24h after induction of an experimental ischemic cardiomyopathy in five of the goats, to test the reliability of the technique to assess physiological and pathological changes. Results: Global and regional measurements of radial and circumferential strain and strain rate, radial displacement, rotation and rotation rate were obtained. Comparisons were performed using ANOVA II (p<0.05). Caprine 2DST measurements demonstrated a good repeatability for global measurements except for the late diastolic peak of the circumferential and radial strain rate. Segmental 2DST measurements were also repeatable except for the anteroseptal segment diastolic peaks and several rotation and rotation rate measurements. Overall variability was moderate to high. Segmental and global peak values obtained after exercise and after myocardial ischemia were significantly different than curves obtained at baseline. Conclusions: The results of this study are consistent with those previously described in other animal species and humans. 2DST echocardiography is a valid technique to evaluate physiological and pathological changes in myocardial function in goats, despite the technical limitations observed in this species.

scholarly journals Clinically Important Differences for the Upper-Extremity Fugl-Meyer Scale in People With Minimal to Moderate Impairment Due to Chronic Stroke

2012 ◽  
Vol 92 (6) ◽  
pp. 791-798 ◽  
Author(s):  
Stephen J. Page ◽  
George D. Fulk ◽  
Pierce Boyne
Keyword(s):  
Upper Extremity ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Empirical Work ◽  
Area Under The Curve ◽  
Chronic Stroke ◽  
Global Rating ◽  
Roc Curve Analysis ◽  
Clinically Important Difference ◽  
Before And After

BackgroundThe upper-extremity portion of the Fugl-Meyer Scale (UE-FM) is one of the most established and commonly used outcome measures in stroke rehabilitative trials. Empirical work is needed to determine the amount of change in UE-FM scores that can be regarded as important and clinically meaningful for health professionals, patients, and other stakeholders.ObjectiveThis study used anchor-based methods to estimate the clinically important difference (CID) for the UE-FM in people with minimal to moderate impairment due to chronic stroke.MethodOne hundred forty-six individuals with stable, mild to moderate upper-extremity (UE) hemiparesis were administered the UE-FM before and after an intervention targeting their affected UEs. The treating therapists rated each participant's perceived amount of UE motor recovery on a global rating of change (GROC) scale evaluating several facets of UE movement (grasp, release, move the affected UE, perform 5 important functional tasks with the affected UE, overall UE function). Estimated CID of the UE-FM scores was calculated using receiver operating characteristic (ROC) curve with the GROC scores as the anchor.ResultsThe ROC curve analysis revealed that change in UE-FM scores during the intervention period distinguished participants who experienced clinically important improvement from those that did not based on the therapists' GROC scores. The area under the curve ranged from 0.61 to 0.70 for the different facets of UE movement.ConclusionsThe estimated CID of the UE-FM scores ranged from 4.25 to 7.25 points, depending on the different facets of UE movement.

Increased Levels of Soluble Programmed Death Ligand 1 Associate with Malignancy in Patients with Dermatomyositis

2018 ◽  
Vol 45 (6) ◽  
pp. 835-840 ◽  
Author(s):  
He Chen ◽  
Qinglin Peng ◽  
Hanbo Yang ◽  
Liguo Yin ◽  
Jingli Shi ◽  
...  
Keyword(s):  
Roc Curve ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Programmed Death Ligand 1 ◽  
Programmed Death ◽  
Diagnostic Values ◽  
Diagnostic Indicator ◽  
New Onset

Objective.To investigate the levels of soluble programmed death ligand 1 (sPD-L1) and evaluate its association with malignancy in patients with dermatomyositis (DM).Methods.Levels of sPD-L1 were measured in serum from 88 DM patients without malignancies (sDM), 40 with cancer-related DM (CRDM), and 30 healthy controls (HC) using ELISA. The CRDM subjects were divided into new-onset cancers (nCRDM) and stable cancers (sCRDM). Receiver-operating characteristic (ROC) curve analysis was performed to determine the cutoff sPD-L1 value that distinguished patients with nCRDM from those who were sDM. Serum antitranscriptional intermediary factor 1-γ (TIF1-γ) antibodies were detected using immunoblot, and the diagnostic values for malignancy were compared with sPD-L1 levels in patients with DM.Results.Serum sPD-L1 levels were significantly higher in sDM [median 12.3 ng/ml, interquartile range (IQR) 8.4–16.2] than in HC (median 1.3 ng/ml, IQR 0.4–2.2, p = 0.0001). Extremely high sPD-L1 levels were seen in nCRDM (median 18.5 ng/ml, IQR 13.8–22.4), much higher than those in sCRDM (median 8.5 ng/ml, IQR 6.8–11.8, p = 0.0001). The sPD-L1 levels in 4 patients with nCRDM decreased after curative cancer treatment (p = 0.013). ROC curve analysis revealed that the sPD-L1 value distinguishing nCRDM from sDM was 16.1 ng/ml, with an area under the curve value of 0.72 ± 0.04 (p = 0.0001). The combination of sPD-L1 and anti-TIF1-γ antibodies yielded greater specificity and positive predictive value in diagnosing cancer, reaching values of 95% and 70%, respectively.Conclusion.Serum sPD-L1 levels increased significantly in sDM, and markedly high sPD-L1 levels could be a diagnostic indicator for malignancies in patients with DM, especially in those with anti-TIF1-γ antibodies.

scholarly journals Evidences of CTLA-4 and PD-1 Blocking Agents-Induced Cardiotoxicity in Cellular and Preclinical Models

2020 ◽  
Vol 10 (4) ◽  
pp. 179 ◽  
Author(s):  
Vincenzo Quagliariello ◽  
Margherita Passariello ◽  
Domenica Rea ◽  
Antonio Barbieri ◽  
Martina Iovine ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Radial Strain ◽  
Heart Tissue ◽  
Cardiac Cells ◽  
High Rate ◽  
Cytokine Storm ◽  
Human Cardiomyocytes ◽  
2D Echocardiography ◽  
Before And After ◽  
Fractional Shortening

Background: Several strategies based on immune checkpoint inhibitors (ICIs) have been developed for cancer therapy, opening to advantages in cancer outcomes. However, several ICI-induced side effects have emerged in these patients, especially a rare but clinically significant cardiotoxicity with high rate of mortality. We studied the cytotoxic and pro-inflammatory properties of Ipilimumab and Nivolumab, the underlying pathways and cytokine storm involved. Methods: Co-cultures of human cardiomyocytes and lymphocytes were exposed to Ipilimumab or Nivolumab; cell viability and expression of leukotrienes, NLRP3, MyD88, and p65/NF-kB were performed. C57 mice were treated with Ipilimumab (15 mg/kg); analysis of fractional shortening, ejection fraction, radial and longitudinal strain were made before and after treatments through 2D-echocardiography. Expression of NLRP3, MyD88, p65/NF-kB, and 12 cytokines were analyzed in murine myocardium. Results: Nivolumab and Ipilimumab exert effective anticancer, but also significant cardiotoxic effects in co-cultures of lymphocytes and tumor or cardiac cells. Both ICIs increased NLRP3, MyD88, and p65/NF-kB expression compared to untreated cells, however, the most pro-inflammatory and cardiotoxic effects were seen after exposure to Ipilimumab. Mice treated with Ipilimumab showed a significant decrease in fractional shortening and radial strain with respect to untreated mice, coupled with a significant increase in myocardial expression of NLRP3, MyD88, and several interleukins. Conclusions: Nivolumab and Ipilimumab exert cytotoxic effects mediated by the NLRP3/IL-1β and MyD88 pathways, leading to pro-inflammatory cytokine storm in heart tissue.

scholarly journals Left ventricular thrombosis following apical myocardial infarction: may CMR strain analysis tell us something?

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
G Brunetti ◽  
F Cardaioli ◽  
M De Lazzari ◽  
A Cipriani ◽  
AG Cecere ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Roc Curve ◽  
Longitudinal Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Curve Analysis ◽  
Left Ventricular Ejection ◽  
Roc Curve Analysis ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background  Left ventricular thrombosis (LVT) is a possible complication following myocardial infarction (MI). Besides infarct size, risk factors for LVT include ST-elevated MI (STEMI), anterior and apical location, reduced left ventricular ejection fraction (LVEF) and the presence of microvascular obstruction. Echocardiography quantified myocardial strain has been associated with LVT following MI. Recently, global longitudinal strain, calculated with feature tracking (FT) - CMR, emerged as an independent predictor of major cardiovascular events following MI. Anyway, the relationship between abnormalities on FT-CMR and LVT following MI is still unexplored. Aim of our study is to investigate the possible association between abnormal strain on FT-CMR and LVT following apical STEMI. Methods  We performed a retrospective analysis including all patients with a previous apical STEMI, who underwent CMR at our Institute between August 2013 and October 2020. Patients with ongoing anticoagulant therapy were excluded. Differences in global and segmental strain on CMR between patients with and without LVT were tested in a propensity-matched sample, using LVEF, age, gender, time from MI diagnosis and number of LV segments with transmural late gadolinium enhancement (LGE) as covariates to assign propensity score. Furthermore, difference in terms of apical to global radial strain percentual deviation (AGD), calculated as [(Global Radial Strain – Apical Radial Strain)/Global Radial Strain] * 100, was tested.  Results  Of 356 patients with apical STEMI undergoing CMR at our center, 37 (10.4%) were diagnosed with LVT. After performing a propensity score matching, we obtained a sample of 36 pairs, with a mean age of 65 (SD 11) years, and a median EF of 35% (IQR 27-42); 59 (82%) of them were male. A significant difference in terms of apical radial strain was found between the two groups, with a median strain of 10.75 (IQR 6.8–16.5) in patients without LVT compared to a value of 5.25 (IQR 2.7–9-6) in patients with LVT (p = 0.007). No differences were found in terms of global longitudinal, radial and circumferential strain (p = 0.19, p= 0.2 and p= 0.49 respectively) and segmental circumferential and longitudinal strain. When considering the AGD parameter, a significant difference was found between the two groups, with a median deviation of 12% (IQR -20; +48) in patients without LVT and 51% (IQR +47; +75) in patients with LVT (p= 0.0003). Furthermore, an AGD value of 26% was found to be the most accurate in terms of sensitivity and specificity applying a Receiver Operating Characteristic (ROC) curve analysis (AUC 0.74; CI 0.62-0.85). Conclusions  Among patients with transmural MI involving LV apex, reduced apical radial strain on FT-CMR is associated with the presence of LV thrombosis. Furthermore, among patients developing LV thrombi, a greater apical radial strain deviation from the global one was found, with a threshold value of 26% at ROC curve analysis.

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