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 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.

Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

2021 ◽  
pp. 1-6
Author(s):  
Tong Feng ◽  
Guo Zhangke ◽  
Bai Song ◽  
Fan Fan ◽  
Zhen Jia ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Anomalous Origin ◽  
Dimension Index

Abstract Objectives: Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. Methods: A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. Results: A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Conclusions: Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

Role of speckle tracking echocardiography in the assessment of post-repair left ventricular function in patients with late presentation of anomalous origin of the left coronary artery from the pulmonary artery

2014 ◽  
Vol 25 (5) ◽  
pp. 969-975 ◽  
Author(s):  
Gholamhosein Ajami ◽  
Mohammad R. Edraki ◽  
Ali R. Moarref ◽  
Ahmad A. Amirghofran ◽  
Mohammad Borzouee ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Pulmonary Artery ◽  
Speckle Tracking ◽  
Left Coronary Artery ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Anomalous Origin ◽  
Control Group

AbstractThe aim of this study was to determine the left ventricular myocardial deformation and segmental myocardial dysfunction by speckle tracking echocardiography and tissue Doppler imaging among the operated patients with anomalous origin of the left coronary artery from the pulmonary artery. The study was conducted on 12 patients diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, who had been operated upon between 2001 and 2013 at the medical centres of Shiraz University of Medical Sciences, Shiraz, Iran. The mean age of the patients at the time of surgical correction was 12.6 years ranging from 6 months to 43 years, and the duration of postoperative follow-up was between 1 and 12 years. Comparison of the strain rate between the patients with acceptable ejection fraction and the control group by tissue Doppler imaging showed significant differences between the two groups regarding the lateral wall (p<0.001), but not the septal wall of the left ventricle (p=0.65). Moreover, the strain values by the speckle tracking method revealed significant differences between the patient and the control group regarding the global strain (p=0.016) and anterior, lateral, and posterior segments of the left ventricle. Although postoperative conventional echocardiography revealed normal global left ventricular function with acceptable ejection fraction, abnormal myocardial deformation of the variable segments of the left ventricle with regional and global myocardial dysfunction were well defined by speckle tracking echocardiography.

scholarly journals Bone marrow mesenchymal stem cells transfer in patients with ST-segment elevation myocardial infarction: single-blind, randomized controlled muticentre trial

2020 ◽  
Author(s):  
Runfeng Zhang ◽  
Jiang Yu ◽  
Ningkun Zhang ◽  
Wensong Li ◽  
Jisheng Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
General Hospital ◽  
Myocardial Viability ◽  
Left Ventricular ◽  
Control Group ◽  
Lv Function ◽  
St Segment Elevation ◽  
Lv Ejection Fraction

Abstract Objective: Our aimed to evaluate efficacy and safety of intracoronary autologous bone morrow mesenchymal stem cells (BM-MSCs) transplantation in patients with ST-segment elevation myocardial infarction（STEMI）. Methods: In this randomised, single-blind, controlled trial, patients with STEMI (aged 39-76 years) were enrolled at 6 centers in Beijing (the People's Liberation Army Navy General Hospital, Beijing Armed Police General Hospital, Chinese People's Liberation Army General Hospital, Beijing Huaxin Hospital, Beijing Tongren Hospital, Beijing Chaoyang Hospital West Hospital). Patients underwent optimum medical treatment and percutaneous coronary intervention,and were randomly assigned in a 1:1 ratio to BM-MSCs group or control group. The primary endpoint was change of myocardial viability at 6 months' follow-up and left-ventricular (LV) function at 12 months' follow-up.The secondary endpoints were incidence of cardiovascular event, total mortality and adverse event at 12 months' follow-up. The myocardial viability assessed by single- photon emission tomography (SPECT). The left ventricular ejection fraction was used to assess LV function. All patients underwent dynamic ECG and laboratory evaluations. This trial is registered with ClinicalTrails.gov, number NCT04421274. Results: Between March , 2008, and July , 2010, 43 patients were randomly assigned to BM-MSCs group (n=21)or control group(n=22) and followed up for 12 months. LV ejection fraction increased from baseline to 12 months in the BM-MSCs group and control group ( mean baseline-adjusted BM-MSCs treatment differences in LV ejection fraction 4.8% (SD 9.0) and mean baseline-adjusted control group treatment differences in LV ejection fraction 5.8% (SD 6.04) ). After 6 months of follow-up, there was no significant improvement in myocardial metabolic activity in the BM-MSCs group before and after transplantation. however,there was no statistically significant difference between the two groups in the change of LV ejection fraction (p=0.30) and myocardial metabolic activity(p>0.05). We noticed that ,after 12 months of follow-up, except for 1 death and 1 coronary microvascular embolism in the BM-MSCs group, no other events occurred and Alanine transaminase(ALT) and C-reactive protein(CRP) in BM-MSCs group were significantly lower than that in control group. Conclusions: It is unreasonable to speculate that intracoronary transfer of autologous bone marrow MSCs could augment recovery of LV function and myocardial viability after acute myocardial infarction.Trial registration: clinicaltrials,NCT04421274. Registered 06,08,2020- Retrospectively registered, https://register.clinicaltrials.gov/NCT04421274.

A case of neonatal myocardial infarction: left coronary artery thrombus resolution and normalisation of ventricular function by intracoronary low-dose tissue plasminogen activator

2014 ◽  
Vol 25 (4) ◽  
pp. 810-812 ◽  
Author(s):  
Anna Hallbergson ◽  
Matthew J. Gillespie ◽  
Yoav Dori
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ventricular Function ◽  
Left Coronary Artery ◽  
Low Dose ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Tissue Plasminogen ◽  
Surgical Thrombectomy ◽  
Systemic Anticoagulation

AbstractNeonatal myocardial infarction is a rare clinical entity that is associated with high mortality. Reported treatment strategies include supportive care, extracorporeal membrane oxygenation, thrombolytics, and surgical thrombectomy. Herein we report a neonate who developed an acute myocardial infarction owing to a thrombus in the proximal left coronary artery. At 24 hours of life, he was treated with local (intracoronary) thrombolytic therapy at a lower dose than previously reported, as well as with systemic anticoagulation. There was subsequent angiographic resolution of the thrombus and normalisation of left ventricular function.

scholarly journals Thrombotic occlusion of the main stem of the left coronary artery in a neonate

1999 ◽  
Vol 9 (2) ◽  
pp. 189-191 ◽  
Author(s):  
Luby Abdurrahman ◽  
Steven M. Schwartz ◽  
Robert H. Beekman
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Left Coronary Artery ◽  
Arterial Occlusion ◽  
Systemic Circulation ◽  
Left Ventricular ◽  
Thrombotic Occlusion ◽  
Left Ventricular Output ◽  
Patent Arterial Duct

AbstractThrombotic coronary arterial occlusion, and myocardial infarction, are rare in the newborn. We report such a happening presenting shortly after birth with cardiogenic shock, no left ventricular output and a systemic circulation dependent on flow from a patent arterial duct.

Fibromuscular dysplasia of the coronary arteries: a rare cause of death in infants and young children

2015 ◽  
Vol 26 (1) ◽  
pp. 202-205 ◽  
Author(s):  
Carolin Mogler ◽  
Wolfgang Springer ◽  
Matthias Gorenflo
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricle ◽  
Coronary Arteries ◽  
Left Coronary Artery ◽  
Fibromuscular Dysplasia ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
Infants And Young Children

AbstractFibromuscular dysplasia is a common vascular disease, which mainly affects the renal arteries. In this study, we report the case of a 1-day-old infant who presented with severe left ventricular dysfunction immediately after birth, and subsequently died 3 days postnatally. At autopsy, an extensive myocardial infarction of the left ventricle and the septum was found, caused by an isolated fibromuscular dysplasia of left coronary artery.

scholarly journals LEFT VENTRICLE REARRANGEMENT IN PATIENTS WITH CRITICAL OSTIAL STENOSIS OF THE LEFT MAIN TRUNK COMPLICATED WITH ISCHEMIC MITRAL REGURGITATION

2021 ◽  
Vol 11 (3) ◽  
pp. 36-39
Author(s):  
Vyacheslav Mykhaylichenko ◽  
Yuri Kostyamin ◽  
Dmitry Parshin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Coronary Artery ◽  
Left Ventricular Ejection ◽  
Mitral Insufficiency ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk

In this work, we studied the possibility of stenting the left coronary artery trunk in patients with subacute myocardial infarction on a background of critical stenosis of the left coronary artery trunk, reduced left ventricular ejection fraction and surgically significant mitral regurgitation. We analyzed treatment outcomes of 97 patients who underwent stenting of left main trunk for subacute stage of myocardial infarction. All patients had mitral insufficiency of II–III degree. The echocardiography data were analyzed before surgery, 7 days, 30 days and 12 months after surgical treatment. Direct stenting of the left coronary artery trunk was performed in 38 (39.2%) patients. 59 (60.8%) patients underwent Culotte bifurcation stenting. A good treatment effect was achieved in 89 (91.2%) patients. As a result of the LV myocardial remodeling, EF increased by 1.44 times (p < 0.05). There was a significant decrease in the degree of mitral insufficiency by 39% to surgically insignificant from 5.9 to 3.6 mm (p < 0.05). Stent placement as an initial treatment in elderly patients with more than 24 hours after the onset of acute myocardial infarction (AMI) originated from a critical lesion of the left coronary artery trunk and concomitant pronounced mitral insufficiency proved as fully justified and safe. We assume that this treatment enables to improve ejection fraction and reduce severity of mitral regurgitation in elderly AMI patients.

scholarly journals Variability in coronary artery anatomy affects consistency of cardiac damage after myocardial infarction in mice

2017 ◽  
Vol 313 (2) ◽  
pp. H275-H282 ◽  
Author(s):  
Jiqiu Chen ◽  
Delaine K. Ceholski ◽  
Lifan Liang ◽  
Kenneth Fish ◽  
Roger J. Hajjar
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery ◽  
Left Coronary Artery ◽  
Ex Vivo ◽  
Left Ventricular ◽  
Fluorescent Imaging ◽  
Lv Function ◽  
Coronary Artery Ligation ◽  
Functional Parameters

Low reliability and reproducibility in heart failure models are well established. The purpose of the present study is to explore factors that affect model consistency of myocardial infarction (MI) in mice. MI was induced by left coronary artery (LCA) ligation. The coronary artery was casted with resin and visualized with fluorescent imaging ex vivo. LCA characteristics and MI size were analyzed individually in each animal, and MI size was correlated with left ventricular (LV) function by echocardiography. Coronary anatomy varies widely in mice, posing challenges for surgical ligation and resulting in inconsistent MI size postligation. The length of coronary arterial trunk, level of bifurcation, number of branches, and territory supplied by these branches are unique in each animal. When the main LCA trunk is ligated, this results in a large MI, but when a single branch is ligated, MI size is variable due to differing levels of LCA ligation and area supplied by the branches. During the ligation procedure, nearly 40% of LCAs are not grossly visible to the surgeon. In these situations, the surgeon blindly sutures a wider and deeper area of tissue in an attempt to catch the LCA. Paradoxically, these situations have greater odds of resulting in smaller MIs. In conclusion, variation in MI size and LV function after LCA ligation in mice is difficult to avoid. Anatomic diversity of the LCA in mice leads to inconsistency in MI size and functional parameters, and this is independent of potential technical modifications made by the operator. NEW & NOTEWORTHY In the present study, we demonstrate that left coronary artery diversity in mice is one of the primary causes of variable myocardial infarction size and cardiac functional parameters in the left coronary artery ligation model. Recognition of anatomic diversity is essential to improve reliability and reproducibility in heart failure research.

Neurohormones in an ovine model of compensated postinfarction left ventricular dysfunction

2000 ◽  
Vol 278 (3) ◽  
pp. H731-H740 ◽  
Author(s):  
Miriam T. Rademaker ◽  
Vicky A. Cameron ◽  
Christopher J. Charles ◽  
Eric A. Espiner ◽  
M. Gary Nicholls ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Plasma Concentrations ◽  
Left Ventricular ◽  
Coronary Artery Ligation ◽  
Artery Ligation

Clinical heart failure, often the result of myocardial infarction, may be preceded by a period of compensated left ventricular impairment. There is substantial need for an experimental model that reflects this human condition. In sheep, coronary artery ligation produced consistent left ventricular anteroapical myocardial infarctions resulting in chronic (5 wk), stable hemodynamic changes compared with sham controls, including reductions in ejection fraction (51 ± 2 vs. 30 ± 5%, P < 0.001), cardiac output (6.3 ± 0.2 vs. 5.1 ± 0.2 l/min, P< 0.01), and arterial pressure (93 ± 2 vs. 79 ± 3 mmHg, P< 0.001), and increases in cardiac preload (left atrial pressure, 3.3 ± 0.1 vs. 8.3 ± 1.3 mmHg, P < 0.001). These changes were associated with acute and sustained increases in plasma concentrations of atrial natriuretic peptide (ANP; 5 wk, 11 ± 2 vs. 27 ± 5 pmol/l, P < 0.001), brain natriuretic peptide (BNP; 3 ± 0.2 vs. 11 ± 2 pmol/l, P < 0.001), and amino-terminal pro-brain natriuretic peptide (NT-BNP; 17 ± 3 vs. 42 ± 12 pmol/l, P < 0.001). Significant correlations were observed between plasma levels of the natriuretic peptides (ANP, day 7 to week 5 samples; BNP and NT-BNP, day 1 to week 5samples) and changes in left ventricular volumes and ejection fraction. In contrast, renin activity, aldosterone, catecholamines, and endothelin were not chronically elevated postinfarction and were not related to indexes of ventricular function. Coronary artery ligation in sheep produces the pathological, hemodynamic, and neurohormonal characteristics of compensated left ventricular impairment secondary to myocardial infarction. Plasma concentrations of the cardiac natriuretic peptides are sensitive markers of left ventricular dysfunction. This is a reproducible model that reflects the clinical condition and should prove suitable for investigating the pathophysiology of, and experimental therapies in, early left ventricular dysfunction.

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