scholarly journals Doppler examination of aorta after therapeutic hypothermia and administering MSCs in experimental myocardial infarction

2021 ◽  
Vol 29 (1) ◽  
pp. 58-69
Author(s):  
M. O. Chyzh ◽  
A. O. Manchenko ◽  
A. V. Trofimova ◽  
I. V. Belochkina
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Coronary Artery ◽  
Therapeutic Hypothermia ◽  
Left Coronary Artery ◽  
Systolic Dysfunction ◽  
Ascending Aorta ◽  
Aortic Blood Flow ◽  
Normal Range ◽  
Allogeneic Mscs

Background. At present, there are attempts aimed at repairing the myocardium affected by acute myocardial infarction (MI) via biologically sourced drugs, which are able to stimulate reparative regeneration, including the use of mesenchymal stromal cells (MSCs). On the other hand, therapeutic hypothermia initially after the occurrence of impaired blood flow in the coronary arteries aids in reducing the level of metabolism in cardiomyocytes and, accordingly, suppressing the formation of free radicals and inhibiting apoptosis. Purpose – рerforming and analysing Doppler sonography of the ascending aorta in rats with experimental MI in order to assess the systolic function of the left ventricular myocardium influenced by the combined use of therapeutic hypothermia and administering allogeneic MSCs. Materials and methods. The study involved 90 outbred white rats weighing 240–270 g. Myocardial infarction was reproduced by ligating the left coronary artery. Therapeutic hypothermia was performed in a cold chamber, 60 minutes long. The local skin temperature of the neck area was maintained at +4 оС. A suspension of allogeneic cryopreserved MSCs of the placenta was administered once intravenously. Sonography of the ascending aorta on day 7 and day 30 after ligating the coronary artery was carried out by means of «Сономед 500» ultrasound scanner in B-mode with the Doppler (PW-mode). Results. Studying the aortic blood flow showed that on day 7 after ligating the coronary artery, rats had a decrease in max systolic velocity and a tendency to increase diastolic blood flow velocity. Those changes influenced the pulsatility index and systolic-diastolic ratio. A 19 % decrease in the Stewart index confirmed the development of systolic dysfunction in the control group, the severity of which did not decrease until day 30 of the experiment. The impact of allogeneic MSCs on the process of remodeling the heart of rats after ligating the left coronary artery was evident on day 7 (acute stage of myocardial infarction) via abnormally low (below control) blood flow in the aorta with complete hemodynamics restoring on day 30 of the experiment. The combination of therapeutic hypothermia and administering allogeneic MSCs aided in the minimal deviation of hemodynamic parameters from the normal range. On day 7, there was only an increase in the average aortic blood flow rate by 29%, and a decrease in systolic-diastolic ratio by 12% compared to the corresponding normal range, suggesting compensation of the pumping function of the myocardium. Conclusions. Doppler assessment of systolic and diastolic blood flow velocities in the ascending aorta of rats makes it possible to indirectly record the presence and severity of systolic dysfunction of the left ventricle and follow up myocardial contractile function affected by MI. The combination of therapeutic hypothermia and administering allogeneic MSCs after ligating the left coronary artery helps to maintain hemodynamic parameters in the aorta at a level close to normal range during the acute phase of myocardial infarction as well as at the stage of scarring.

scholarly journals Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

2020 ◽  
Vol 28 (3) ◽  
pp. 222-240
Author(s):  
M. O. Chyzh ◽  
A. O. Manchenko ◽  
A. V. Trofimova ◽  
I. V. Belochkina
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Therapeutic Hypothermia ◽  
Left Coronary Artery ◽  
Left Ventricular ◽  
Control Group ◽  
Normal Range ◽  
Allogeneic Mscs

Background. Late seeking medical advice, limited number of cardiac surgery hospitals and conservative treatment, which does not seem to be always efficacious, trigger the search for new, more effective mode therapy of acute myocardial infarction (MI). Recently, mesenchymal stromal cells (MSCs) have come into sharp focus of scientists due to the prospects for clinical use. On the other hand, multicenter studies have proved that therapeutic hypothermia (TH) has neuro- and cardioprotective effects, and it is administered as one of the urgent methods in providing primary health care. Purpose. Providing and analyzing ultrasonography (US) of rat hearts with experimental MI in order to determine the nature of heart remodelling under combined use of TH and introducing allogeneic MSCs. Materials and methods. The study involved 90 outbred white rats weighing 240–270 g. Myocardial infarction was reproduced by ligating the descending branch of the left coronary artery on the border of the upper and middle third of the vessel. Therapeutic hypothermia was performed in a cold chamber, 60 minutes long. The local skin temperature of the neck area was maintained at +4 оC, while the rectal and tympanic temperature decreased to + 25 оC. A suspension of allogeneic cryopreserved MSCs of the placenta with a concentration of 1.2 × × 106 cells/ml was administered once intravenously through v. saphena magna. Heart sonography was carried out by means of «Сономед 500» («СПЕКТРОМЕД», Russia) ultrasound scanner in B- and M-mode using a linear sensor 7.5L38 with frequency of 7.5 MHz. Results and discussion. The control group with experimental MI showed significantly suppressed function of the left ventricle (LV). It resulted in decreasing stroke volume (SV) and cardiac output (CO) and on the whole indicated reduced ejection fraction (EF) to 46.04 %, that was 35 % less than the corresponding normal range. According to the values of relative wall thickness (RWT) and left ventricular mass (LVM) on day 7 and day 30 after ligating the left coronary artery, LV remodelling was proceeding via eccentric mode of LV alteration. Therapeutic hypothermia was not able to completely stop the pathophysiological processes associated with coronary ligation. EF was not significantly different from the control group, and was 51.08 ± ± 2.68 %. On day 7 of the experiment, heart remodelling in this group was proceeding according to the normal geometry model, and on day 30 – according to the eccentric model. In spite of the volume overload causing post-infarction extension of the left ventricular cavity, in the group with applying MSCs, on day 7 there was a compensatory increase of the stroke volume, 1.8 times over compared to the group with normal range values and 2.3 over compared to the control group. The ejection fraction was 17 % less than the normal range, but statistically significantly higher than the corresponding indicator of the control group of this observation period. Heart remodelling after applying allogeneic MSCs associated with MI at all stages of observation was proceeding by eccentric LV hypertrophy. Аfter therapeutic hypothermia and applying MSCs associated with experimental myocardial infarction on day 7 and day 30, the group recorded the best values of echo params of LV anatomical structures, indicating no dilatation along with occuring moderate myocardial hypertrophy. The ejection fraction showed the best outcome, i. e. 58.78 %, while LV remodelling was minimal, occurring according to normal heart geometry. Conclusions. Applying echocardiography in rats is a very informative diagnosis method which makes it possible to describe the type of structural and functional remodelling of the myocardium associated infarction at early and late observation stages. The ultrasound study showed that the closest to the normal range was the group of animals exposed to therapeutic hypothermia and MSC transplantation. According to LVM and RWT values, in the rats of that group on day 7 and day 30 of the experiment, LV remodelling was characterized by normal geometry.

scholarly journals ST Segment Elevation Myocardial Infarction Due to Severe Ostial Left Main Stem Stenosis in a Patient with Syphilitic Aortitis

2016 ◽  
Vol 54 (1) ◽  
pp. 74-79 ◽  
Author(s):  
L.M. Predescu ◽  
L. Zarma ◽  
P. Platon ◽  
M. Postu ◽  
A. Bucsa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Aortic Regurgitation ◽  
Systolic Dysfunction ◽  
Ascending Aorta ◽  
Left Main ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Syphilitic Aortitis

Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin. In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta. This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.

scholarly journals Anomalous left coronary artery from the pulmonary artery: a rare cause of an out-of-hospital cardiac arrest in an adult—a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
Madelien V Regeer ◽  
Olga Bondarenko ◽  
Katja Zeppenfeld ◽  
Anastasia D Egorova
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Complication Rates ◽  
Anomalous Left Coronary Artery ◽  
Subcutaneous Icd ◽  
Hospital Cardiac Arrest ◽  
Anomalous Left Coronary

Abstract Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disorder resulting in ischaemia and myocardial infarction which can act as a potential substrate for life-threatening arrhythmias and sudden cardiac death. Case summary A 19-year-old man was admitted to the hospital after successful resuscitation from an out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation occurring during jogging. In the diagnostic work-up of the OHCA, computed tomography identified an ALCAPA. The patient was referred to our tertiary hospital for surgical correction. Direct reimplantation of the left coronary artery in the aorta was performed. During follow-up, 24-h electrocardiogram revealed short episodes of non-sustained ventricular tachycardia (VT). The magnetic resonance imaging at initial admission showed focal wall thinning and transmural late gadolinium enhancement consistent with a previous anterolateral myocardial infarction. Therefore, the aetiology of the OHCA could be due to a scar-related mechanism and not necessarily due to a reversible cause and an implantable cardioverter-defibrillator (ICD) was considered indicated. Given the young age and the lower complication rates, a subcutaneous device was preferred over a transvenous ICD. However, as a subcutaneous ICD (S-ICD) lacks the possibility of anti-tachycardia pacing, programmed electrical stimulation (PES) was performed to test for inducibility of monomorphic, re-entrant VT. After a negative PES, an S-ICD was implanted. Discussion ALCAPA is a potential cause of OHCA in young patients. Some of these patients keep an irreversible substrate for ventricular arrhythmias despite full surgical revascularization and might be candidates for (subcutaneous) ICD implantation.

scholarly journals Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Kalinina ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
D Shmatov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Flow Velocity ◽  
Coronary Arteries ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Area Under Curve ◽  
Left Coronary Artery ◽  
Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity >110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p < 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p < 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of >66 cm/s (27% vs. 2%; p < 0.002). The rates of MACE were 58.0% vs. 2%; p < 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

scholarly journals Acute myocardial infarction and syncope in an 18-year-old athlete with an abnormal origin of the left coronary artery: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 8142 ◽  
Author(s):  
Ronan MG Berg ◽  
Bente Brendorp ◽  
Thomas Kristensen ◽  
Morten Helvind ◽  
Steffen Helqvist
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Coronary Artery ◽  
Left Coronary Artery
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