Is end-organ surveillance necessary in patients with well-functioning metal-on-metal hip resurfacings?

2019 ◽  
Vol 101-B (5) ◽  
pp. 540-546 ◽  
Author(s):  
D. Juneau ◽  
G. Grammatopoulos ◽  
A. Alzahrani ◽  
R. Thornhill ◽  
J. R. Inacio ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Metal Ion ◽  
Structural Parameters ◽  
T2 Mapping ◽  
Serum Levels ◽  
Hip Resurfacing ◽  
Left Ventricular ◽  
Control Group ◽  
Functional Abnormality ◽  
Metal On Metal

Aims Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied. Patients and Methods In all, 30 participants with no significant cardiac history were enrolled: 20 patients with well-functioning MoMHRA at mean follow-up of 8.3 years post-procedure (ten unilateral, ten bilateral; 17 men, three women) and a case-matched control group of ten non-MoM total hip arthroplasty patients (six men, four women). The mean age of the whole cohort (study group and controls) at the time of surgery was 50.6 years (41.0 to 64.0). Serum levels of cobalt and chromium were measured, and all patients underwent CMR imaging, including cine, T2* measurements, T1 and T2 mapping, late gadolinium enhancement, and strain measurements. Results None of the MoMHRA patients showed clinically significant cardiac functional abnormality. The MoMHRA patients had larger indexed right and left end diastolic volumes (left ventricular (LV): 74 ml/m2 vs 67 ml/m2, p = 0.045; right ventricular: 80 ml/m2 vs 71 ml/m2, p = 0.02). There was a small decrease in T2 time in the MoMHRA patients (median 49 ms vs 54 ms; p = 0.0003). Higher metal ion levels were associated with larger LV volumes and with shorter T2 time. Conclusion Although cardiac function is not clinically adversely affected in patients with well-functioning MoMHRA, modern imaging is able to demonstrate subtle changes in structure and function of the heart. As these changes correlate with systemic ion measurements, they may be consequences of wear debris deposition. Longer, longitudinal studies are necessary to determine whether cardiac function will become affected. Cite this article: Bone Joint J 2019;101-B:540–546.

Cardiac tissue characterization with t1 and t2 mapping in anderson fabry patients: new pathophysiological concepts and early cardiac involvement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zanoni ◽  
V Ferrara ◽  
G Lanati ◽  
G Vitale ◽  
F Di Nicola ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Tissue Characterization ◽  
Cardiac Involvement ◽  
Late Onset ◽  
T2 Mapping ◽  
Serum Levels ◽  
Left Ventricular ◽  
Control Group ◽  
Funding Source ◽  
T1 And T2

Abstract Background Anderson Fabry (AF) disease is a X-linked lysosomal storage disorder with multiorgan involvement. Cardiac disease, mainly represented by left ventricular hypertrophy (LVH) and arrhythmias, is the most frequent cause of premature death. It is well know that specific therapy is less effective after the development of LVH and myocardial fibrosis, therefore early cardiac detection (before LVH) is important. New cardiac magnetic resonance (CMR) parametric imaging techniques (T1 and T2 maps) enable myocardial tissue changes associated with AF disease. Purpose To evaluate the relationship between CMR tissue characterization and clinical and instrumental manifestations of AF disease to find early markers of cardiac involvement. Methods 31 AF patients (9 males, mean age 49±16 years) underwent ECG, echocardiogram and contrast CMR. TnI, BNP, pro-BNP and serum lyso-Gb3 were dosed. T1 mapping was performed in a pre-contrast acquisition with the modified Look-Locker inversion recovery (MOLLI) sequences. CMR results were compared with those of 43 healthy age and gender-matched controls. Results In AF patients native septal T1 values were significantly lower compared to healthy controls (median 949 vs 991 msec, p=0.0137) and were inversely related to Lyso-Gb3 serum levels (p=0.003). Patients with LVH had lower T1 septal values in comparison with patients without LVH (892 vs 981 msec; p=0.0012). Patients with classic form had abnormal low T1 values more frequently than pts with late onset variant (78 vs 23%; p=0.038). In AF patients native septal T2 values were significantly higher compared to the control group (53 vs 49 msec; p=0.0004) and correlated with troponin I (p=0.008) and NT-pro BNP (p=0.006) serum levels. No difference was found between pts with and without LVH (53.5 vs 52.5 ms; p=0.797) and the prevalence of abnormal high T2 values was similar between patients with late onset AF and pts with classical form (53% vs 50%; p=1.000). All patients with late onset AF and high T2 values were females. Conclusions CMR T1 (low values) and T2 (high values) mapping are useful tools to detect early cardiac involvement before LVH and to better understand the pathophysiology of cardiac disease in AF patients. Subclinical tissue inflammation, detectable through T2 maps, seems to be an additional pathogenetic mechanism related to the Gb3 storage that contributes to organ damage and precedes LVH, particularly in females patients with late onset phenotype. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Sant'Orsola-Malpighi Hospital

scholarly journals A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure

2014 ◽  
Vol 9 ◽  
pp. IMI.S13939 ◽  
Author(s):  
Bandi Hari Krishna ◽  
Pravati Pal ◽  
G. K. Pal ◽  
J. Balachander ◽  
E. Jayasettiaseelon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Function ◽  
Medical Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Tei Index ◽  
Ventricular Ejection Fraction ◽  
Yoga Therapy ◽  
Standard Medical Therapy

Aims The purpose of this study was to evaluate whether yoga training in addition to standard medical therapy can improve cardiac function and reduce N terminal pro B-type natriuretic peptide (NT pro BNP) in heart failure (HF). Methods 130 patients were recruited and randomized into two groups: Control Group (CG) ( n = 65), Yoga Group (YG). In YG, 44 patients and in CG, 48 patients completed the study. Cardiac function using left ventricular ejection fraction (LVEF), myocardial performance index (Tei index), and NT pro BNP, a biomarker of HF, was assessed at baseline and after 12 weeks. Result Improvement in LVEF, Tei index, and NT pro BNP were statistically significant in both the groups. Furthermore, when the changes in before and after 12 weeks were in percentage, LVEF increased 36.88% in the YG and 16.9% in the CG, Tei index was reduced 27.87% in the YG and 2.79% in the CG, NT pro BNP was reduced 63.75% in the YG and 10.77% in the CG. The between group comparisons from pre to post 12 weeks were significant for YG improvements (LVEF, P < 0.01, Tei index, P < 0.01, NT pro BNP, P < 0.01). Conclusion These results indicate that the addition of yoga therapy to standard medical therapy for HF patients has a markedly better effect on cardiac function and reduced myocardial stress measured using NT pro BNP in patients with stable HF.

scholarly journals Effects of human recombinant growth hormone on exercise capacity, cardiac structure, and cardiac function in patients with adult-onset growth hormone deficiency

2017 ◽  
Vol 45 (6) ◽  
pp. 1708-1719 ◽  
Author(s):  
S Gonzalez ◽  
JD Windram ◽  
T Sathyapalan ◽  
Z Javed ◽  
AL Clark ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cardiac Function ◽  
Growth Hormone Deficiency ◽  
Exercise Capacity ◽  
Left Ventricular ◽  
Hormone Deficiency ◽  
Control Group ◽  
Cardiac Structure ◽  
Adult Onset ◽  
Risk Of Death

Objective Epidemiological studies suggest that adult-onset growth hormone deficiency (AGHD) might increase the risk of death from cardiovascular causes. Methods This was a 6-month double-blind, placebo-controlled, randomised, cross-over trial followed by a 6-month open-label phase. Seventeen patients with AGHD received either recombinant human growth hormone (rGH) (0.4 mg injection daily) or placebo for 12 weeks, underwent washout for 2 weeks, and were then crossed over to the alternative treatment for a further 12 weeks. Cardiac magnetic resonance imaging, echocardiography, and cardiopulmonary exercise testing were performed at baseline, 12 weeks, 26 weeks, and the end of the open phase (12 months). The results were compared with those of 16 age- and sex-matched control subjects. Results At baseline, patients with AGHD had a significantly higher systolic blood pressure, ejection fraction, and left ventricular mass than the control group, even when corrected for body surface area. Treatment with rGH normalised the insulin-like growth factor 1 concentration without an effect on exercise capacity, cardiac structure, or cardiac function. Conclusion Administration of rGH therapy for 6 to 9 months failed to normalise the functional and structural cardiac differences observed in patients with AGHD when compared with a control group.

The Effect of Gypenosides on Cardiac Function and Expression of Cytoskeletal Genes of Myocardium in Diabetic Cardiomyopathy Rats

2009 ◽  
Vol 37 (06) ◽  
pp. 1059-1068 ◽  
Author(s):  
Min Ge ◽  
Shanfeng Ma ◽  
Liang Tao ◽  
Sudong Guan
Keyword(s):  
Cardiac Function ◽  
Diabetic Cardiomyopathy ◽  
Diastolic Pressure ◽  
Pure Water ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Control Group ◽  
Sprague Dawley ◽  
Gene Expressions ◽  
Ventricular Systolic Pressure

The relationship between changes of cardiac function and the gene expressions of two major myocardial skeleton proteins, titin and nebulin, and the effect of gypenosides on these gene expressions in diabetic cardiomyopathy rat were explored in the present study. Forty Sprague-Dawley rats were randomly divided into three groups: control group, diabetic cardiomyopathy group and gypenosides-treated diabetic cardiomyopathy group. The diabetic cardiomyopathy was induced in rats by injecting streptozotocin (STZ, 55 mg/kg) intraperitoneally. Seven weeks after the rats suffered from diabetes, the rats were treated with gypenosides 100 mg/kg per day orally for six weeks in gypenosides-treated group. In the meanwhile, the pure water was given to diabetic cardiomyopathy and the control groups. Subsequently, the cardiac functions, including left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), ± dP/dtmax and t–dP/dmaxt, as well as the mRNA content and proteins of titin and nebulin in myocardium were determined. The results indicated that (1) the diabetic cardiomyopathy rats had decreased LVSP and ± dP/dtmax, increased LVEDP, and prolonged t–dP/dtmax than normal rats; (2) LVSP and ± dP/dtmax in diabetic cardiomyopathy rats treated with gypenosides were significantly higher and LVEDP and t–dP/dtmax were significantly lower than those without giving gypenosides; (3) the mRNA contents and proteins of titin and nebulin in diabetic cardiomyopathy rats were remarkably lower than those in the control rats and gypenosides had no effect on mRNA and protein expression levels of titin and nebulin in diabetic cardiomyopathy rats. We conclude that (1) the cardiac function as well as the mRNA expressions of titin and nebulin decreased in diabetic cardiomyopathy rats; (2) gypenosides secure cardiac muscles and their function from diabetic impairment and these beneficial effects of gypenosides are not by changing the expressions of titin and nebulin.

scholarly journals Parameters of cardiac hemodynamics in patients with diabetes mellitus with impairment of renal function

HYPERTENSION ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 5-10
Author(s):  
I.I. Topchiy ◽  
O.N. Kirienko ◽  
P.S. Semyonovykh ◽  
D.O. Kirienko ◽  
O.I. Tsygankov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Function ◽  
Structural Parameters ◽  
Left Ventricular ◽  
Control Group ◽  
Group I ◽  
Patients With Diabetes

Currently, diabetes mellitus (DM) is a complex global problem, which is increasing every year. So, in 2019, diabetes mellitus was detected in 463 million adults (from 20 to 79 years old) in the world. And the main cause of death in patients with diabetes mellitus is cardiovascular complications. The study was aimed investigate the features of functional and structural changes in the heart in patients with type 2 diabetes mellitus and nephropathy. A total of 98 patients with type 2 diabetes mellitus were examined, out of which 78 patients had diabetic nephropathy (DN) of varying severity. The control group consisted of 20 healthy patients. After a clinical examination, depending on the state of renal function, all patients were divided into the following groups: group I — patients with type 2 diabetes mellitus without signs of nephropathy (n = 36), group II — patients with type 2 diabetes mellitus with normal glomerular filtration rate (GFR) and albuminuria (n = 33), group III — patients with type 2 diabetes mellitus with decreased GFR and albuminuria (n = 29). To study changes in hemodynamics and structural parameters of the heart, patients underwent transthoracic echocardiography on an ULTIMA PA ultrasound machine (Radmir, Ukraine) using a sectoral phased transducer with a frequency range of 2–3 MHz according to the standard technique based on the recommendations of the American Echocardiographic Society. To determine indexing indicators, the patients underwent anthropometric measurements. Patients with DN and albuminuria and decreased GFR showed an increase in the linear dimensions of the heart in comparison with controls and patients without signs of nephropathy. With DN, patients have a significant increase in left ventricular mass and a significant increase in the detection rate of left ventricular hypertrophy up to 91.3 % in patients with albuminuria and preserved renal function and up to 100 % with a decrease in GFR.

Electrophysiologic properties and ventricular fibrillation in normal and myopathic hearts

1999 ◽  
Vol 77 (7) ◽  
pp. 510-519 ◽  
Author(s):  
Katherine M Kavanagh ◽  
Patricia A Guerrero ◽  
Bodh I Jugdutt ◽  
Francis X Witkowski ◽  
Jeffrey E Saffitz
Keyword(s):  
Ventricular Fibrillation ◽  
Myocardial Dysfunction ◽  
Myocardial Cell ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Functional Abnormality ◽  
Ventricular Ejection Fraction ◽  
Anisotropic Properties

This study tests the hypothesis that moderate myocardial dysfunction is associated with altered myocardial anisotropic properties and structurally altered ventricular fibrillation (VF). Mongrel dogs were randomized to either a control group or a group that was rapidly paced at 250 beats/min until the left ventricular ejection fraction was [Formula: see text] 40%. Changes in anisotropic properties and the electrical characteristics of VF associated with the development of moderate myocardial dysfunction were assessed by microminiature epicardial mapping studies. In vivo conduction, refractory periods, and repolarization times were prolonged in both longitudinal and transverse directions in myopathic animals versus controls. VF was different in myopathic versus control animals. There were significantly more conducted deflections during VF in normal hearts compared with myopathic hearts. Propagated deflection-to-deflection intervals during VF were significantly longer in myopathic hearts compared with controls (125.5 ± 49.06 versus 103.4 ± 32.9 ms, p = 0.009). There were no abnormalities in cell size, cell shape, or the number of intercellular gap junctions and there was no detectable change in the expression of the gap junction proteins Cx43 and Cx45. Moderate myocardial dysfunction is associated with significant electrophysiological abnormalities in the absence of changes in myocardial cell morphology or intercellular connections, suggesting a functional abnormality in cell-to-cell communication.Key words: cardiomyopathy, anisotropy, fibrillation, defibrillation.

One-day cold perfusion of bimakalim and butanedione monoxime restores ex situ cardiac function

1996 ◽  
Vol 271 (5) ◽  
pp. H1884-H1892 ◽  
Author(s):  
D. F. Stowe ◽  
B. M. Graf ◽  
S. Fujita ◽  
G. J. Gross
Keyword(s):  
Cardiac Function ◽  
Myocardial Function ◽  
Left Ventricular Pressure ◽  
Katp Channels ◽  
Left Ventricular ◽  
Ex Situ ◽  
Control Group ◽  
Cardiac Efficiency ◽  
Time Control ◽  
Butanedione Monoxime

Bimakalim (Bim), an opener of ATP-sensitive K+ (KATP) channels, was given alone or with 2,3-butanedione monoxime (BDM), a reversible uncoupler of contractility, to protect myocardial function during 1 day of hypothermia. Left ventricular pressure (LVP), coronary flow (CF), percent O2 extraction (%O2E), and cardiac efficiency were measured in 96 isolated, perfused guinea pig hearts divided into seven groups: 1) cold control (no drugs); 2) BDM; 3) Bim; 4) BDM + Bim; 5) BDM + glibenclamide (Glib, a blocker of KATP channels); 6) BDM + Bim + Glib; and 7) time control (6 h warm perfusion only). Drugs were given before, during, and initially after 22 h of low CF at 3.8 degrees C. At 26 h (cold groups) or 4 h (warm group) LVP (mmHg; means +/- SE) was similar for time control (94 +/- 4) and BDM + Bim (92 +/- 4) groups, lower and equivalent in the BDM (65 +/- 7) and BDM + Bim + Glib (64 +/- 7) groups, but LVP was higher than in the Bim group (46 +/- 3), and lowest in the cold control (30 +/- 8) group. In addition, only in the BDM + Bim group were basal CF, %O2E, and cardiac efficiency returned to values obtained in the time control group. Epinephrine increased LVP to that of the time control (106 +/- 3) group only in the BDM + Bim group (106 +/- 3) after hypothermia, and CF increases with adenosine, 5-hydroxytryptamine, and nitroprusside were similar to that of the time control group only in the BDM + Bim group after hypothermia. All of the effects of Bim were reversed by Glib. These results indicate that Bim, given with BDM, effectively preserves myocardial function and metabolism as well as inotropic and vasodilatory reserve during long-term hypothermic preservation as if the 1-day hypothermic state had not been instituted. Because the beneficial effects of Bim are blocked by Glib, the protective effect of Bim likely results from maintained KATP channel opening. Treatment with exogenous KATP openers may prove useful in preserving cardiac function in the transplanted heart.

scholarly journals Gait after Birmingham Hip Resurfacing

2019 ◽  
Vol 101-B (11) ◽  
pp. 1423-1430 ◽  
Author(s):  
Anatole V. Wiik ◽  
Rhiannon Lambkin ◽  
Justin P. Cobb
Keyword(s):  
Metal Ion ◽  
Gait Pattern ◽  
Hip Resurfacing ◽  
Functional Change ◽  
Control Group ◽  
Healthy Controls ◽  
High Speeds ◽  
The Mean ◽  
Almost All ◽  
Gait Study

AimsThe aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).Patients and MethodsA total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention.ResultsThe mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach.ConclusionPatients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls. Cite this article: Bone Joint J 2019;101-B:1423–1430.

scholarly journals Dislocation of large-diameter head metal-on-metal total hip arthroplasty and hip resurfacing arthroplasty

2018 ◽  
Vol 29 (3) ◽  
pp. 253-261 ◽  
Author(s):  
Simo S A Miettinen ◽  
Tatu J Mäkinen ◽  
Inari Laaksonen ◽  
Keijo Mäkelä ◽  
Heini Huhtala ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Large Diameter ◽  
Study Groups ◽  
Hip Resurfacing ◽  
Control Group ◽  
Anteversion Angle ◽  
Hip Resurfacing Arthroplasty ◽  
Resurfacing Arthroplasty ◽  
Metal On Metal ◽  
Post Traumatic

Introduction: Dislocation of large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA) is a rare complication. This study aimed to determine the incidence and risk factors for dislocation of LDH MoM THAs and HRAs. Methods: This retrospective analysis considered 4038 cementless LDH MoM THAs and HRAs, 3207 THAs in 2912 patients and 831 HRAs in 757 patients. The end of follow-up was revision due to dislocation. Incidence of dislocation was evaluated from this study population of 4038, and study groups were formed. The study was designed as a case-control study, and a threefold stratified randomised control group was formed. Demographic data were collected and radiological analyses were performed in the study groups. Results: There were 26/3207 (0.8%) early dislocations in the THA group, and 6/831 (0.7%) in the HRA group ( p = 0.9). Most LDH THA dislocations occurred in a group with head size ⩽ 38 mm (18/26) ( p < 0.001). In dislocated hips, there were more dysplastic acetabula and post-traumatic hips than in the control group ( p = 0.036). In the dislocation group, the mean acetabulum component anteversion angle was 19.6° (standard deviation [SD] 13.4°) and in the control group it was 23.2° (SD 10.4°) ( p = 0.006); 7/32 (21.8%) of dislocated THAs needed revision surgery, and mean time to revision from the index surgery was 1.2 (SD 2.6) years. Discussion: Dislocations occurred more often in THAs of head size ⩽ 38 mm and with a smaller anteversion angle of the acetabulum component. Hip dysplasia and post-traumatic osteoarthritis were more common in patients with dislocation.

Does chronic raise of metal ion levels induce oxidative DNA damage and hypoxia-like response in patients with metal-on-metal hip resurfacing?

2015 ◽  
Vol 105 (2) ◽  
pp. 460-466 ◽  
Author(s):  
Lucia Savarino ◽  
Caterina Fotia ◽  
Laura Roncuzzi ◽  
Michelina Greco ◽  
Matteo Cadossi ◽  
...  
Keyword(s):  
Dna Damage ◽  
Metal Ion ◽  
Oxidative Dna Damage ◽  
Hip Resurfacing ◽  
Metal On Metal
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