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PubMed2005

Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle.

BACKGROUND: Strain and strain rate have been proposed as tools to quantify regional myocardial function. One of the major pitfalls of the current methodology is its angle dependency. To overcome this problem, we have developed a new method for the estimation of strain, independent of angle. The aim of this study was to validate this new methodology in an experimental setting using sonomicrometry. METHODS AND RESULTS: In 5 open-chest sheep, ultrasound data were acquired. The new methodology was used to perform simultaneous measurements of radial and longitudinal strain in the inferolateral wall. Segment-length sonomicrometry crystals were used as the reference. After baseline acquisitions, deformation was modulated by pharmacologically changing the inotropic state of the myocardium and by inducing ischemia. Ultrasonically estimated radial and longitudinal strain were validated against sonomicrometry by means of Bland-Altman analysis and the intraclass correlation coefficient. For both strain components, good agreements were found between the ultrasound and the sonomicrometry measurements as shown by Bland-Altman statistics. The intraclass correlation coefficients were found to be 0.72 and 0.80 for the radial and longitudinal components, respectively. CONCLUSIONS: A new technique for the estimation of myocardial deformation was validated. It was shown that the current problem of angle dependency was solved and that 2 deformation components could be estimated simultaneously and accurately. Furthermore, the technique was less time-consuming, because anatomic tracking was performed automatically. This approach could potentially accelerate the clinical acceptance of ultrasound deformation imaging in cardiology.

Animals↗
PubMed2000

Cutting edge: differential expression of chemokines in Th1 and Th2 cells is dependent on Stat6 but not Stat4.

The in vivo function of Th cell subsets is largely dependent on the ability of differentiated CD4+ T cells to be recruited to specific sites and secrete restricted sets of cytokines. In this paper we demonstrate that Th1 and Th2 cells secrete discrete patterns of chemokines, small m.w. cytokines that function as chemoattractants in inflammatory reactions. Th2 cells secrete macrophage-derived chemokine and T cell activation gene 3, and acquisition of this pattern of expression is dependent on Stat6. In contrast, Th1 cells secrete lymphotactin and RANTES, though unlike IFN-gamma, expression of these chemokines is independent of Stat4. We further show that supernatants from activated Th2 cells preferentially induce the chemotaxis of Th2 over Th1 cells, corresponding with Stat6-dependent expression of CCR4 and CCR8 in Th2 cells. These data provide the basis for restricted and direct T cell-mediated cellular recruitment to sites of inflammation.

Animals↗
PubMed1992

Differential expression of GABAA/benzodiazepine receptor beta 1, beta 2, and beta 3 subunit mRNAs in the developing mouse cerebellum.

Gamma aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian cerebellum. Cerebellar granule, Purkinje, and deep nuclear neurons are known to receive GABAergic afferents. Since GABA exerts its inhibitory effects via GABA receptors, it is of interest to determine the temporal relationship between the formation of GABAergic synapses and the expression of genes coding for the GABA receptor. In a previous study, we have examined the developmental expression of binding sites for [3H]muscimol, which binds with high affinity to the beta subunits of the GABAA/benzodiazepine (GABAA/BZ) receptor. In the present study, [35S]cRNA probes were used to examine the appearance and distribution of GABAA/BZ beta 1, beta 2, and beta 3 subunit mRNAs in the developing C57BL/6 mouse cerebellum by in situ hybridization. In the adult cerebellum, the distribution of the three subunit mRNAs was clearly different, despite considerable overlap, and their temporal expression differed throughout postnatal development. The beta 1 hybridization signal appeared within the cerebellar cortex during the second postnatal week as a discrete band at the interface of the molecular and granule cell layers. Grains were distributed diffusely over small densely staining cells surrounding the Purkinje cells; relatively few grains were visible over Purkinje cell bodies themselves. This distribution may reflect an association with Bergmann glia or basket cells. The beta 2 and beta 3 hybridization signals were present considerably earlier than that of the beta 1 mRNA. The beta 2 signal was present at birth in the molecular/Purkinje cell layer; as development progressed, the signal became increasingly intense over both granule and Purkinje cells. At birth, the beta 3 subunit mRNA was present in the external germinal and molecular layers, later becoming largely localized within the granule cell layer. Dense beta 2 and beta 3 cRNA probe labeling was present over the adult granule cell layer. Moderate levels of beta 2 signal were seen over Purkinje cell bodies; considerably less labeling was observed with the beta 3 probe. The adult distribution of beta 2 and beta 3 cRNA probes showed good spatial correspondence with the known GABAA receptor beta subunit markers, [3H]-muscimol and the mAb 62-3G1 antibody, each being present within the granule cell layer. Our results indicate that the temporal expression of GABAA/BZ receptor beta subunit messages within a given cell type may be independently regulated, and that acquisition of the beta 2 and beta 3 mRNAs occurs before these cells become integrated into mature synaptic circuits.

Animals↗
PubMed2005

Diversification and independent evolution of troponin C genes in insects.

Troponin C (TpnC), the calcium-binding subunit of the troponin regulatory complex in the muscle thin filament, is encoded by multiple genes in insects. To understand how TpnC genes have evolved, we characterized the gene number and structure in a number of insect species. The TpnC gene complement is five genes in Drosophilidae as previously reported for D. melanogaster. Gene structures are almost identical in D. pseudoobscura, D. suboboscura, and D. virilis. Developmental patterns of expression are also conserved in Drosophila subobscura and D. virilis. Similar, but not completely equivalent, TpnC gene repertoires have been identified in the Anopheles gambiae and Apis mellifera genomes. Insect TpnC sequences can be divided into three groups, allowing a systematic classification of newly identified genes. The pattern of expression of the Apis mellifera genes essentially agrees with the pattern in Drosophilidae, providing further functional support to the classification. A model for the evolution of the TpnC genes is proposed including the most likely pathway of insect TpnC diversification. Our results suggest that the rapid increase in number and sequence specialization of the adult Type III isoforms can be correlated with the evolution of the holometabolous mode of development and the acquisition of asynchronous indirect flight muscle function in insects. This evolutionarily specialization has probably been achieved independently in different insect orders.

Amino Acid Sequence↗
PubMed1993

Diffusion-weighted MR microscopy with fast spin-echo.

A diffusion-weighted fast spin-echo (FSE) imaging sequence for high-field MR microscopy was developed and experimentally validated in a phantom and in a live rat. Pulsed diffusion gradients were executed before and after the initial 180 degrees pulse in the FSE pulse train. This produced diffusion-related reductions in image signal intensity corresponding to gradient ("b") factors between 1.80 and 1352 s/mm2. The degree of diffusion weighting was demonstrated to be independent of echo train length for experiments using trains up to 16 echoes long. Quantitative measurements on a phantom and on a live rat produced diffusion coefficients consistent with literature values. Importantly, the eight- to 16-fold increase in imaging efficiency with FSE was not accompanied by a significant loss of spatial resolution or contrast. This permits acquisition of in vivo three-dimensional data in time periods that are appropriate for evolving biological processes. The combination of accurate diffusion weighting and high spatial resolution provided by FSE makes the technique particularly useful for MR microscopy.

Animals↗
PubMed1997

[Thermometry by measuring the chemical shift of lanthanide complex].

BACKGROUND: In the long-term, non-invasive thermometry is vital for the continued clinical and technological development of regional hyperthermia. In magnetic resonance tomography. T1 relaxation time, diffusion and proton resonance frequency are used to measure temperature distributions. When used clinically in the pelvic region, all of these methods are plagued with errors and artefacts on account of the tissue relationships, tissue changes under hyperthermia, physiological and stochastic movements, inhomogeneities, drift phenomena and instabilities. MATERIAL AND METHOD: We tested the relationship between the temperature and the chemical shift of a methyl group of a lanthanide complex with central atom praseodymium (Pr-MOE-DO3A. Schering AG). To do this we used cylindrical phantoms containing a 5-mmol-solution of this temperature-sensitive substance. High resolution spectra and relaxation times were determined in a Bruker AMX at 11.5 T. A calibration curve was then recorded by a Siemens Magnetom SP63 at 1.5 T. Local temperature distributions were determined using the chemical shift imaging method, with a matrix size of 16 x 8 and a narrow-band excitation pulse. The temperature distribution was created using a Nd:YAG laser applicator. RESULTS: At a distance of -25.7 ppm from the water line, we found a singlet line with a temperature-dependent chemical shift of 0.13 ppm/C. In the phantom experiment we found that the chemical shift had a linear relationship with a gradient independent of the surroundings, and a temperature resolution of +/-0.6 degree C. With a concentration of 1 mmol/l, a matrix size of 8 x 8 and a measurement period of 5 s per acquisition, phantom measurements using the CSI method produced a signal to noise ratio of 3.5 per acquisition, i.e a measurement period of 10 to 20 s per spectrum. CONCLUSIONS: Our in vitro data show that spectroscopic temperature measurement using a temperature-sensitive praseodymium complex with a therapeutically practical concentration of 1 mmol/l already appears to be suitable for clinical use Compared with the methods tested so far (T1, diffusion, proton resonance), this method has the special advantage of not being very susceptible to artefacts. The competing methods of non-invasive thermometry using magnetic resonance tomography/spectroscopy will be investigated next.

Artifacts↗
PubMed2006

Family saliva sharing behaviors and age of human herpesvirus-6B infection.

OBJECTIVE: Transmission of human herpesvirus (HHV-6) type B is hypothesized to occur via saliva. We sought to determine whether behaviors promoting saliva sharing were associated with HHV-6B infection. METHODS: Parents of young children participating in a natural history study of HHV-6B were asked to complete a questionnaire focused on family behaviors that result in saliva sharing. RESULTS: Of 111 surveys, 109 (98%) were completed. Of the 109 participants, 37 (34%) were infected with HHV-6 before 1 year of age. Having older siblings (adjusted OR 4.1, 95% CI 1.5, 11.8) and receipt of parental saliva when kissed (adjusted OR 5.1, 95% CI 1.8, 14.5) were independently associated with younger age of HHV-6 infection. Dose-response relationships were demonstrated between HHV-6 infection before 1 year and both number of siblings and the frequency that the child received parental saliva when being kissed (p=0.006 and p=0.002, respectively). CONCLUSIONS: Having older siblings and parents who shared saliva increased risk of HHV-6B acquisition in children. These data support the hypothesis that HHV-6 is transmitted primarily via saliva within families.

Age of Onset↗
PubMed2006

CORSICA: correction of structured noise in fMRI by automatic identification of ICA components.

When applied to functional magnetic resonance imaging (fMRI) data, spatial independent component analysis (sICA), a data-driven technique that addresses the blind source separation problem, seems able to extract components specifically related to physiological noise and brain movements. These components should be removed from the data to achieve structured noise reduction and improve any subsequent detection and analysis of signal fluctuations related to neural activity. We propose a new automatic method called CORSICA (CORrection of Structured noise using spatial Independent Component Analysis) to identify the components related to physiological noise, using prior information on the spatial localization of the main physiological fluctuations in fMRI data. As opposed to existing spectral priors, which may be subject to aliasing effects for long-TR data sets (typically acquired with TR >1 s), such spatial priors can be applied to fMRI data, regardless of the TR of the acquisitions. By comparing the proposed automatic selection to a manual selection performed visually by a human operator, we first show that CORSICA is able to identify the noise-related components for long-TR data with a high sensitivity and a specificity of 1. On short-TR data sets, we validate that the proposed method of noise reduction allows a substantial improvement of the signal-to-noise ratio evaluated at the cardiac and respiratory frequencies, even in the gray matter, while preserving the main fluctuations related to neural activity.

Biometry↗
PubMed1998

Classification of retinal damage by a neural network based system.

The objective of this research is to provide an ophthalmologist with a helpful system, capable of classifying a degree of patients' retinal hemorrhage. The system is composed of four modules: (a) data acquisition module, (b) image Database module, (c) image processing module, (d) image classification module. The system was trained with a modular neural network on a set of 25 images, and tested on a set of 160 images. A training performance of greater than 95% was achieved. The classifying part of the system showed 79% recognition accuracy. Since the testing images were taken from independent sources, we assume that the system should also provide an accurate classification of other image types.

Algorithms↗
PubMed1998

Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases.

OBJECTIVE: A quantitative analysis of intraoperative cortical shift and deformation was performed to gain a better understanding of the nature and extent of this problem and the resultant loss of spatial accuracy in surgical procedures coregistered to preoperative imaging studies. METHODS: Three-dimensional feature tracking and two-dimensional image analysis of the cortical surface were used to quantify the observed motion. Data acquisition was facilitated by a ceiling-mounted robotic platform, which provided a number of precision tracking capabilities. The patient's head position and the size and orientation of the craniotomy were recorded at the start of surgery. Error analysis demonstrated that the surface displacement measuring methodology was accurate to 1 to 2 mm. Statistical tests were performed to examine correlations between the amount of displacement and the type of surgery, the nature of the cranial opening, the region of the brain involved, the duration of surgery, and the degree of invasiveness. RESULTS: The results showed that a displacement of an average of 1 cm occurred, with the dominant directional component being associated with gravity. The mean displacement was determined to be independent of the size and orientation of the cranial opening. CONCLUSION: These data suggest that loss of spatial registration with preoperative images is gravity-dominated and of sufficient extent that attention to errors resulting from misregistration during the course of surgery is warranted.

Adult↗
PubMed2005

Protein-detecting microarrays: current accomplishments and requirements.

The sequencing of the human genome has been successfully completed and offers the chance of obtaining a large amount of valuable information for understanding complex cellular events simply and rapidly in a single experiment. Interestingly, in addressing these proteomic studies, the importance of protein-detecting microarray technology is increasing. In the coming few years, microarray technology will become a significantly promising and indispensable research/diagnostic tool from just a speculative technology. It is clear that the protein-detecting microarray is supported by three independent but strongly related technologies (surface chemistry, detection methods, and capture agents). Firstly, a variety of surface-modification methodologies are now widely available and offer site-specific immobilization of capture agents onto surfaces in such a way as to keep the native conformation and activity. Secondly, sensitive and parallel detection apparatuses are being developed to provide highly engineered microarray platforms for simultaneous data acquisition. Lastly, in the development of capture agents, antibodies are now probably the most prominent capture agents for analyzing protein abundances. Alternative scaffolds, such as phage-displayed antibody and protein fragments, which provide the advantage of increasing diversity of proteinic capture agents, however, are under development. An approach involving recombinant proteins fused with affinity tag(s) and coupled with a highly engineered surface chemistry will provide simple production protocols and specific orientations of capture agents on the microarray formats. Peptides and other small molecules can be employed in screening highly potent ligands as well as in measuring enzymatic activities. Protein-detecting microarrays supported by the three key technologies should contribute in accelerating diagnostic/biological research and drug discovery.

Animals↗
PubMed2004

The Ig-like domain of tapasin influences intermolecular interactions.

Presentation of antigenic peptides to T lymphocytes by MHC class I molecules is regulated by events involving multiple endoplasmic reticulum proteins, including tapasin. By studying the effects of substitutions in the tapasin Ig-like domain, we demonstrated that H-2L(d)/tapasin association can be segregated from reconstitution of folded L(d) surface expression. This finding suggests that peptide acquisition by L(d) is influenced by tapasin functions that are independent of L(d) binding. We also found that the presence of a nine-amino acid region in the Ig-like domain of mouse or human tapasin is required for association with L(d), and certain point substitutions in this sequence abrogate human, but not mouse, tapasin association with L(d). These data are consistent with a higher overall affinity between L(d) and mouse tapasin compared with human tapasin. In addition, we found that other point mutations in the same region of the tapasin Ig-like domain affect MHC class I surface expression and Ag presentation. Finally, we showed that the cysteine residues in the Ig-like domain of tapasin influence tapasin's stability, its interaction with the MHC class I H chain, and its stabilization of TAP. Mutagenesis of these cysteines decreases tapasin's electrophoretic mobility, suggesting that these residues form an intramolecular disulfide bond. Taken together, these results reveal a critical role for the tapasin Ig-like domain in tapasin function.

Amino Acid Substitution↗
PubMed1991

[Mass and geometry of the left ventricle. Contribution of ultrafast computed x-ray tomography and magnetic resonance imaging].

Ultrafast computed tomography and magnetic resonance imaging are two new methods of cardiac imaging. Measurements of left ventricular volume (end-diastolic, end-systolic volume, stroke volume) and mass have been validated with both methods. The calculations are independent of the geometric shape of the ventricle. Although regional analysis is difficult because of the complex movement of the left ventricle in the tomographic cuts, these methods present a number of advantages: excellent temporospatial tomographic resolution, approximately the same in all dimensions, appreciation of endocardial movement from an epicardial centre, the potential to record their transform spatial data in 3 dimensions from initial planar acquisition. However, all potential regional measurements are still being validated as they are operator-dependent and require visual identification and manual tracing of the cardiac contours or local infrastructures which affect the results of these techniques which are still relatively little used in cardiac imaging. In the context of clinical evaluation, these relatively non-invasive methods will become extremely accurate in the appreciation of parameters of left ventricular geometry and function. They will become very useful in the determination of the myocardial effects of drugs, surgery or other interventional procedures in different models of cardiac disease.

Cardiac Volume↗
PubMed2002

Variable-density adaptive imaging for high-resolution coronary artery MRI.

Variable-density (VD) spiral k-space acquisitions are used to acquire high-resolution (0.78 mm), motion-compensated images of the coronary arteries. Unlike conventional methods, information for motion compensation is obtained directly from the coronary anatomy itself. Specifically, periods of minimal coronary distortion are identified by applying the correlation coefficient template matching algorithm to real-time images generated from the inner, high-density portions of the VD spirals. Combining the data associated with these images together, high-resolution, motion-compensated coronary images are generated. Because coronary motion is visualized directly, the need for cardiac-triggering, breath-holding, and navigator echoes is eliminated. The motion compensation capability of the technique is determined by the inner-spiral spatial and temporal resolution. Results indicate that the best performance is achieved using inner-spiral images with high spatial resolution (1.6-2.9 mm), even though temporal resolution (four to six independent frames per second) suffers as a result. Image quality within the template region in healthy volunteers was found to be comparable to that achieved with cardiac-triggered breath-hold scans, although extended acquisition times of around 5 min were needed to overcome reduced SNR efficiency.

Algorithms↗
PubMed2002

MR assessment of left ventricular function: quantitative comparison of fast imaging employing steady-state acquisition (FIESTA) with fast gradient echo cine technique.

PURPOSE: To evaluate the agreement of fast imaging employing steady-state acquisition (FIESTA) cine technique with segmented k-space fast gradient echo (GRE) cine technique when using them for assessment of cardiac function. MATERIALS AND METHODS: Eleven MR cine studies were performed on six healthy volunteers and five patients, using FIESTA and fast GRE techniques. The quantitative measurements of ventricular function obtained from the two techniques were compared. The data analysis was performed by two observers independently. RESULTS: Compared to fast GRE cine technique, FIESTA cine technique consistently resulted in higher end-diastolic volume (10.2%) and end-systolic volume (21.6%), but lower myocardial mass of left ventricle (19.2%) and ejection fraction (9.9%). The stroke volume obtained from the two techniques was very close. The primary explanation for this variability is that the two techniques have different mechanisms on establishing signal contrast. CONCLUSION: Compared to fast GRE technique, FIESTA provides significantly different results when using it for assessment of left ventricular function. It is important to consider this difference in the assessment of cardiac function.

Adult↗
PubMed1999

[Improvement in the objective diagnosis of hearing disorders by a new technique of simultaneous recording of acoustic and electrical responses of the auditory system].

The measurements of transitory evoked otoacoustic emissions (TEOAE) and auditory brainstem responses (ABR) are widely used in objective audiometry for the diagnosis of conductive or sensorineural hearing losses. In some cases only one of these signals is required for a complete diagnosis, while other cases may require both methods to define findings. With conventional equipment the measurement of TEOAE and ABR is performed with different devices at different times. Devices for simultaneous recording of both signals are currently not available or described, although the physiological circumstances and apparatus requirements would favor such an approach. In the present work a prototype for the simultaneous measurement of TEOAE and ABR is presented and its application tested in 33 normal-hearing adults. The equipment used was based on a general purpose laboratory computer connected to an acoustic stimulator and a dual-channel data acquisition system. Stimuli were composed of click sequences for the cancellation of linear signal components and were presented by an ear canal probe (Otodynamics) which also picked up the microphone signal within the outer ear canal. The EEG activity containing the ABR was recorded through surface electrodes fixed at the patient's vertex and mastoid. Acoustic and electric signals were processed simultaneously, resulting in three independent records representing a non-linear TEOAE and the low and high level ABR. The main advantages of the new approach are an improvement in information output and enhancement in the accuracy of determining the site and extent of a hearing impairment.

Adult↗
PubMed2001

A computer-based laparoscopic skills assessment device differentiates experienced from novice laparoscopic surgeons.

BACKGROUND: The acquisition of laparoscopic skills is difficult to assess. Previously, through the use of a computer-based skills assessment device (SAD), we have shown that assessments of the time needed to perform a task and graded observations of task performance overestimate the speed at which laparoscopic skills can be acquired. The aim of this study was to test the ability of a laparoscopic SAD to differentiate novices from experienced laparoscopic surgeons and thereby further validate its use in surgical education. METHODS: Using a laparoscopic simulator platform integrated with task simulation and data collection software (MIST VR), we tested both experienced and novice laparoscopists. Each group performed three tasks with a minimum of seven repetitions. The tasks consisted of target acquisition, target traversal, and target manipulation with diathermy. Within each task, time (T), errors (E), and economy of movement for each hand (EML, EMR) were assessed. Results were reported as mean +/- SEM, and comparisons were made using an independent samples t-test. RESULTS: For the target acquisition task, the expert group performed the task faster than the novice group (5.5 +/- 0.24 vs 7.6 +/- 0.40 sec, p < 0.05); the experts also made fewer errors (0.5 +/- 0.10 vs 0.8 +/- 0.11 errors, p < 0.05), and achieved both a better EML (1.8 +/- 0.6 vs 2.3 +/- 0.9, p < 0.05) and a better EMR (2.0 +/- 0.1 vs 2.9 +/- 0.21, p < 0.05). In the target traversal task, the experts made fewer errors than the novices (2.2 +/- 0.25 vs 4.6 +/- 0.38 errors, p < 0.05). For the manipulation and diathermy tasks, the expert group completed the task faster (30.8 +/- 1.5 vs 39 +/- 1.5 sec, p < 0.05), made fewer errors (5.3 +/- 0.59 vs 8.1 +/- 0.63 errors, p < 0.05), and had a better EML (6.0 +/- 0.37 vs 7.2 +/- 0.45, p < 0.05) and EMR (4.3 +/- 0.23 vs 5.8 +/- 0.36, p < 0.05) than the novices. CONCLUSION: A laparoscopic skills assessment device can discern levels of laparoscopic manipulative skill. This type of device can be used in surgical training to make objective assessments of the acquisition of laparoscopic skills.

Clinical Competence↗
PubMedDate not supplied

Theoretical model for myocardial functional characterization: application to a group of patients evaluated before and after surgical revascularization.

BACKGROUND: The functional improvements resulting from coronary revascularization (CABG) in patients with depressed ventricular function may be described by the use of a model combining global or local quantification of myocardial perfusion, viability, and contraction. An illustration of this model, with data provided by conventional radionuclide studies as they are performed routinely in many centers, is presented and the limitations of this approach for predicting the results of CABG are discussed. METHODS AND RESULTS: The model is based on three independent variables, which can be approximated in this preliminary study by parameters derived from standard stress and redistribution/reinjection thallium-201 single-photon emission computed tomography (SPECT) acquisitions with quantification of the tracer uptake defects and from a planar gated blood pool left ventricular ejection fraction (LVEF) measurement: Perfusion is assumed to correspond to 100-stress defect (in percentage), viability is 100-redistribution/reinjection defect, and contraction is 100(LVEF/70), assuming that a normal 70% LVEF corresponds to 100% contraction. In a group of 30 patients prospectively evaluated with this protocol and included in the study on the basis of a pre-CABG LVEF <40%, a significant improvement in LVEF was demonstrated (28.2% +/- 8.5% before CABG vs 35.8% +/- 7.3% after CABG), which is accompanied by a significant decrease of the stress thallium defects (34.8% +/- 13.8% vs 25.6% +/- 10.6%), whereas the average (but not the individual) redistribution/reinjection defects remain almost stable (27.7% +/- 10.9% vs 25.7% +/- 10.1%). As reported in the three-dimensional model, pre-CABG and post-CABG representative points clearly demonstrate the functional improvements for the main variables, but there is a large spectrum of responses to revascularization. It appears that the border between reversible and nonreversible thallium defects does not match the limit between ischemic myocardium (with no contraction alteration and therefore without contraction improvement potential) and hibernating myocardium, which is able to recover mechanical function and therefore is responsible for the improvement of global LVEF. CONCLUSIONS: Thallium SPECT is far from ideal for use as an independent characterization of perfusion and viability because hibernating myocardium may be present in both the fixed and reversible parts of thallium defects. Prediction of functional recovery is conditioned by an accurate identification of viable but underperfused and noncontracting myocardium. In the future, with the use of adequate study protocols that are able to measure viability without interference of perfusion and perfusion independent of viability, the proposed model may be able to characterize regional function as a cluster of representative points for each territory and to delineate areas of the theoretical volume corresponding to a potentially recoverable situation.

Adult↗