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In vivo sampling of cardiac triglyceride from dogs during ethanol infusion.

The feasibility of procuring and analyzing cardiac tissue for triglyceride in vivo was tested in anesthetized dogs. Measurements of triglycerides in samples obtained in vitro confirmed: reproducibility of triplicate analyses of the glycerideglycerol moiety of tissue triglyceride (SEM +/- 2.1%), homogeneity in and between ventricles (SEM +/- 1.8%), and agreement between right endocardial triglyceride and left myocardial triglyceride (difference not significant). Seven dogs received ethanol, 15-30 mg/kg/min, and five dogs received glucose or 0.85% NaCl for 2 hr. Cardiac output and filling pressure were measured from the left ventricle and tissue was taken from the right ventricle with a biopsy catheter before and during infusions. Three to four samples were obtained from each dog; the average weight was 14.4 mg and two to three biopsies were required for each sample. In the ethanol group, triglyceride increased after 15 min and continued to rise; the final triglyceride concentration correlated with the infusion rate. In the glucose-saline group, in vivo triglyceride concentration did not change and did not differ from postmortem triglyceride. Cardiac function declined in the ethanol group and was unaffected in the controls. Thus, multiple in vivo measurements of cardiac lipid are practical and safe and show that ethanol infusions cause early and progressive accumulation of triglyceride in heart muscle.

Animals↗

[The tricuspid valve in carcinoid cardiopathy: characteristic echocardiographic aspects].

Cardiac involvement is commonly seen in the carcinoid syndrome (C.S.). However echocardiographic observations in this condition are still very scanty. In two patients with the C.S. and clinical signs of tricuspid insufficiency (plus mild pulmonic stenosis in one case) two-dimensional echocardiography showed: 1) right ventricular overload with normal left heart valves and chambers; 2) a peculiar aspect of the tricuspid valve, whose three leaflets were markedly thickened and retracted. The anterior leaflet was almost fixed in a semi-open position while the septal and posterior leaflets appeared as rigid structures fixed in an open position, extending from the annulus into the right ventricular cavity. In both cases only the posterior cusp of the pulmonary valve could be visualized. The afore-mentioned changes exactly reproduce the pathological features of the tricuspid valve in the carcinoid heart disease and so far, have not been observed in other conditions.

Adult↗

[Aberrant subclavian artery in infants. Division and reimplantation into the common carotid artery through cervicotomy (author's transl)].

In infants, merely dividing an aberrant subclavian artery (ROSCA) through left-thoracotomy may result in severe cerebral circulatory disorders by vertebrobasilar arterial steal. The authors report on 3 cases where reimplantation of the ROSCA into the common carotid artery reproduced a normal brachiocephalic arterial trunk and resulted in normal revascularization. In 2 of these 3 cases, the ROSCA was approached through a right cervical incision, divided in the mediastinum, behind the oesophagus, and reimplanted by latero-lateral anastomosis into the right carotid artery. In the third case the same approach was preceded by left thoracotomy for easier division of the ROSCA close to the aorta. The three operations were uneventful and no complication occurred, except for transient and mild left hemiparesis without sequelae in one patient.

Aorta, Thoracic↗

Validation of SPECT equilibrium radionuclide angiographic right ventricular parameters by cardiac magnetic resonance imaging.

BACKGROUND: Recent advances in the treatment of primary pulmonary hypertension (PPH), and in surgery to correct tetralogy of Fallot (TOF), have rekindled interest in evaluating right ventricular (RV) volume and ejection fraction (EF). The purpose of this investigation was to determine the accuracy of RV functional parameters assessed by single photon emission computed tomography (SPECT) equilibrium radionuclide angiography (ERNA). METHODS AND RESULTS: Twenty-eight patients with PPH (n = 15) or TOF (n = 13) (aged 28 +/- 14 years; 57% male) were analyzed by means of SPECT ERNA algorithms that automatically identified mid-RV tomographic planes, generated regions isolating the right ventricle from other structures, and presented RV-segmented regions as a cinematic display. RV EF and volumes were computed and compared with values obtained by magnetic resonance imaging (MRI). Mean values were not different between SPECT ERNA and MRI for RV EF, end-diastolic volume, and end-systolic volume (42% +/- 11% vs 41% +/- 10%, 135 +/- 67 mL vs 139 +/- 91 mL, and 87 +/- 54 mL vs 85 +/- 61 mL, respectively; P = not significant for all comparisons). Significant linear correlation (P <.0001) was found between SPECT ERNA and MRI for RV EF, end-diastolic volume, and end-systolic volume (r = 0.85, r = 0.94, and r = 0.93, respectively). No statistically significant trends or biases for RV EF were found. Intraobserver and interobserver comparisons demonstrated good reproducibility. As expected, RV volume was significantly higher and RV EF was significantly lower for patients with PPH and TOF than were values for individuals at low likelihood for coronary artery disease or other cardiac disease. CONCLUSIONS: SPECT ERNA provides accurate, reproducible assessment of RV volumes and EF and should prove useful in evaluating the magnitude of RV dysfunction in patients and in providing an objective means with which to assess the results of therapeutic interventions.

Adolescent↗

Laterality, somatotopy and reproducibility of the basal ganglia and motor cortex during motor tasks.

We investigated the basal ganglia, motor cortex area 4, and supplementary motor area (SMA) using functional magnetic resonance imaging (fMRI) and five motor tasks: switching between finger and toe movements, writing, finger tapping, pronation/supination, and saccadic eye movements. We found reliable activation in the caudate nucleus and putamen in single subjects without the need for inter-subject averaging. Percent signal changes in basal ganglia were smaller by a factor of three than those in SMA or motor cortex (1% vs. 2.5-3%). There was a definite foot-dorsal, hand-ventral basal ganglia somatotopy, similar to prior data from primates. Saccadic eye movements activated the caudate nucleus significantly more than the other tasks did. Unilateral movements produced bilateral activation in the striatum even when motor cortex activation was unilateral. Surprisingly, bilateral performance of the tasks led, on average, to consistently smaller basal ganglia activation than did unilateral performance (P<0.001), suggesting less inhibition of contralateral movements during bilateral tasks. Moreover, there was a striking dominance pattern in basal ganglia motor activation: the left basal ganglia were more active than the right for right handers, regardless of the hand used. This lateralization appears much stronger than that previously reported for motor cortex. Comparisons of inter-subject and intra-subject reproducibility indicated a much larger variability in basal ganglia and SMA compared to motor cortex, in spite of similar percent signal changes in the latter two structures.

Adult↗

Two-dimensional echocardiographic evaluation of right ventricular ejection fraction: comparison between three different methods.

Twelve patients with chronic cor pulmonale due to chronic obstructive pulmonary disease have been examined with 2D echocardiography, performing four-chamber view by apical and subcostal approaches, and the right ventricular outflow tract view by the subcostal approach. These views have permitted evaluation of right ventricular volumes, and hence right ventricular ejection fraction, by the use of three different geometrical formulae: the biplane area-length method, Simpson's rule and the pyramidal method. The ejection fraction values obtained from each method have been compared to those obtained by equilibrium radionuclide angiocardiography. Four-chamber apical and subcostal views were satisfactorily recorded in 10 of the 12 patients (83.3%), and right ventricular outflow tract view in 8 patients (66.6%). No significant statistical differences have been found between measurements obtained from the three different echocardiographic examinations performed on each subject by the same operator, so demonstrating a satisfactory reproducibility of the technique. The highest correlation coefficient for ejection fraction was shown by Simpson's rule (r = 0.96, p less than 0.001), with a very narrow confidence intervals, while the r values for the biplane area-length method was 0.63 (p less than 0.05) and for the pyramidal method 0.50 (not statistically significant), with increasingly wider confidence intervals. The statistically significant difference between the three correlation coefficients demonstrates the higher accuracy of Simpson's rule for the determination of right ventricular ejection fraction.

Aged↗

The study of retinal nerve fiber layer thickness of normal eyes using scanning laser polarimetry.

PURPOSE: To evaluate retinal nerve fiber layer (RNFL) thickness measurements in local normal Chinese subjects of different age groups and analyse the correlation of RNFL thickness with age using scanning laser polarimetry (SLP, GDxVCC). To assess the reproducibility of RNFL thickness measurement with GDxVCC. METHODS: The RNFL thickness of 67 normal subjects (123 eyes) were measured by GDxVCC. The average TSNIT parameters were calculated. The differences of RNFL thickness between sex, right and left eyes, superior and inferior were compared. The relationship between RNFL thickness and age was analyzed with correlation analysis and linear regression analysis. The intraclass correlation coefficients (ICC) of three images in every eye were calculated. RESULTS: The average peripapillary RNFL thickness at the superior, inferior and whole ellipse regions in 123 eyes of 67 normal subjects were (70.30 +/- 6.76) microm, (67.35 +/- 6.77) microm and (56.87 +/- 4.53) microm, respectively. The average TNSIT standard deviation was 23.68 +/- 4.61 and the average inter-eye symmetric value was 0.86 +/- 0.11. There were significant difference of RNFL thickness between superior and inferior (t = 4.952, P < 0.001). There were significant difference of inferior RNFL thickness and TNSIT standard deviation between right and left eyes (P = 0.005 and 0.002), while not significant difference of superior RNFL thickness and whole mean RNFL thickness between right and left eye (P = 0.086 and 0.529). There was no significant difference in TSNIT parameters between different genders. There was a slight negative correlation average RNFL thickness in superior sector with age (decreased approximately 0.15 microns per year, P = 0.047) in the subjects aged below 60 years old. The ICC values of RNFL thickness were > 0.8 in superior, inferior and global. CONCLUSIONS: The RNFL thickness can be measured accurately by GDxVCC and the reproducibility of RNFL thickness measurement by GDxVCC is good. There was a slight negative correlation between average RNFL thickness in superior with age. More researches on the effects of age on RNFL thickness by GDxVCC are needed.

Adolescent↗

[In vivo measurements of shoulder movements by a goniometer with six degrees of freedom: preliminary study].

PURPOSE OF THE STUDY: The purpose of this work was to develop a goniometer with six degrees of freedom (6DOF) to achieve global measurement of the main movements of the shoulder and to examine the reproducibility of the measurements obtained. MATERIAL AND METHODS: Movement amplitudes, inter- and intra-observer reproducibility of the methodology and the device were tested in a population of ten young subjects with asymptomatic shoulders. RESULTS: Maximal amplitudes obtained for each movement were: abduction 111.8 +/- 11 degrees; flexion 127.9 +/- 12.7; external rotation 86.3 +/- 14 degrees; free elevation 129.3 +/- 9 degrees. The curves traced in the plane of rotation and rotation were plotted against elevation. Comparison between amplitudes on the right and left were not significantly different. DISCUSSION AND CONCLUSION: This preliminary study demonstrated the potential contribution of a 6DOF-goniometer for a 3D assessment of shoulder movement. Measurements made when positioning the goniometer demonstrated good reproducibility. Our data are similar to others reported in the literature. The plane of the scapula and the position in physiological internal rotation, as described in the literature, were also observed. Studying shoulder movements, particularly their association, should provide a new means of assessing function in patients with complex disease of the shoulder joint. The device should be helpful in obtaining an objective measurement of the shoulder kinetics that would be useful for patient follow-up and assessment of corporal damage.

Adult↗

Baseline echocardiographic characteristics of heart failure patients enrolled in a large European multicentre trial (CArdiac REsynchronisation Heart Failure study).

AIMS: Information on the prevalence and clinical, electrocardiographic and echocardiographic inter-relationships of mechanical dyssynchrony among patients with heart failure (HF) and left ventricular systolic dysfunction derives mainly from relatively small studies. The CARE-HF trial provides the opportunity to address these issues in a large population of patients with advanced HF. METHODS AND RESULTS: The CARE-HF trial enrolled patients with New York Heart Association (NYHA) class III or IV HF, with a QRS duration > or =120 ms, left ventricular (LV) ejection fraction (EF) < or =35% and LV end diastolic diameter > or =30 mm/m (height in m). Patients underwent a thorough echocardiographic evaluation, which included assessment of LV structure, systolic function, mitral inflow pattern, right ventricular (RV) dimensions and function, and interventricular mechanical delay (IVMD) as an index of interventricular dyssynchrony. Echocardiographic measurements were made in a Core Laboratory to ensure consistent quantitative analysis. Of the 813 patients enrolled, 735 had a baseline echocardiographic examination suitable for measurement. Overall patients had advanced LV dysfunction (mean EF 25.5%) but few had a restrictive mitral filling pattern (18%) and both the mean RV diameter and RV function were within normal limits. Interventricular dyssynchrony defined as IVMD >40 ms was present in 455 patients (62%). Clinical, electrocardiographic and standard echocardiographic variables were only loosely associated with IVMD. CONCLUSIONS: Interventricular dyssynchrony appears to be an independent characteristic of patients with advanced HF, and is poorly related to clinical, electrocardiographic or standard echocardiographic variable.

Aged↗

New experimental model of crush injury of the hindlimbs in rats.

BACKGROUND: Crush injury (CI) remains a life-threatening condition. Because there is a shortage of animal models of CI, we purposed to develop a reproducible model of CI of hindlimbs in rats and to evaluate correlation between the volume of muscles traumatized and the severity of CI. METHODS: The right or both hindlimbs of anesthetized rats were compressed for 6 hours under blocks weighing 3 kg. This was followed by 3 hours of reperfusion. Serum lactate, base excess (BE), and potassium (K) were measured at 10 minutes after cannulaton (baseline), immediately before release (compression), and 3 hours after release (reperfusion). Serum creatine phosphokinase (CK), lactate dehydrogenase (LDH), aspartate transferase (AST) and alanine transferase (ALT) were measured at baseline and reperfusion. Muscles and kidneys were evaluated morphologically. In a separate group of animals treated in the same way, survival rate was monitored for 168 hours. RESULTS: Unilateral CI did not induce serious systemic impairment. Bilateral CI resulted in severe lactic acidosis. Serum K levels increased similarly and significantly in both groups. Serum CK levels correlated strongly with the volume of muscles traumatized. Bilateral CI produced a sharp increase in serum LDH, AST and ALT levels by the end of experiment. Signs of direct cellular damage and ischemia-reperfusion injury were found in histology specimens. In bilaterally crushed rats there were patent signs of acute tubular necrosis at 24 hours after insult. All rats with unilateral CI survived, whereas mortality rate reached 58.3% in rats with bilateral CI. The majority of these animals died within 24 hours after compression. CONCLUSIONS: We developed a valid experimental model of severe CI of the hindlimbs in rats. Systemic responses to CI and the severity of CI appeared to correlate strongly with the volume of muscle traumatized.

Acid-Base Equilibrium↗

Noninvasive delineation of normal right ventricular contractile motion with magnetic resonance imaging myocardial tagging.

As the importance of the right ventricle in many diseases and conditions has been realized, the need for quantitative assessment of the motion and contraction of the right ventricular free wall (RVFW) has become apparent. This study applied the myocardial tagging magnetic resonance imaging (MRI) technique to the normal RVFW to elucidate normal heterogeneity in RV motion and contractile patterns. The RVFW was divided into three segments (inferior, mid and superior) in each of three slices (apical, mid and basal) to allow for a detailed analysis of the motion and contraction. Percent segmental shortening (PSS) was used to measure the amount of contraction, and a vector analysis was used to quantitate the trajectory of the RVFW through systole. PSS increased monotonically through time to an average across all segments of 12% in the basal slice, 14% in the mid-ventricular slice, and 16% in the apical slice of the heart. The trajectory of the RVFW was characterized by a wave of motion toward the septum and outflow tract. The data provided in this study provide a better understanding of normal RV kinematics and can serve as a comparison for disease states.

Adult↗

Myocardial acceleration during isovolumic contraction as a new index of right ventricular contractile function and its relation to pulmonary regurgitation in patients after repair of tetralogy of Fallot.

BACKGROUND: Myocardial acceleration during isovolumic contraction (IVA) by Doppler tissue imaging has been proposed to be a new index of right ventricular contractile function that is unaffected by ventricular shape or loading conditions. OBJECTIVES: We sought to assess the use of IVA to evaluate right ventricular contractile function. METHODS: In all, 22 pediatric patients with pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) (8 +/- 3 years) and 27 age-matched children were examined. The degree of PR (mild, moderate, and severe) for patients with TOF was on the basis of pulsed and color Doppler findings. Using Doppler tissue imaging, the peak myocardial velocities during early diastole, late diastole, systole, and isovolumic contraction were recorded. RESULTS: Compared with healthy children, Doppler tissue imaging velocities for patients with TOF showed decreased myocardial velocities during early diastole (P =.007), late diastole (P <.0001), systole (P <.0001), and isovolumic contraction (P <.0001). Patients with TOF had a lower IVA when compared with healthy children (P <.0001). There was a stepwise decrease in the IVA from mild to severe PR. We found a significant relationship between the IVA and the degree of PR (r = -0.86, P <.0001). CONCLUSION: The analysis of IVA allows the assessment of right ventricular contractile function for patients with repaired TOF and various degrees of PR.

Acceleration↗

Reproducibility of surface EMG variables and peak torque during three sets of ten dynamic contractions.

The interpretation of the electromyogram (EMG) of dynamic contractions might be difficult because the movement per se introduces additional factors that could affect its characteristics. There is a lack of studies concerning the reproducibility of surface EMG registrations during dynamic contractions. The aim was to investigate the during-the-day reproducibility (using intra-class correlation; ICC) of the peak torque (PT) and the EMG variables (without removing the electrodes) of dynamic contractions. Ten healthy subjects performed three sets of 10 dynamic maximum right-knee extensions with a one-hour interval in between, using an isokinetic dynamometer and the PT was determined. EMG signals were recorded from the right vastus lateralis, rectus femoris and vastus medialis muscles using surface electrodes and the mean frequency of the power spectrum (MNF [Hz]) and the signal amplitude (RMS [microV]), were computed. The ability to relax in-between the maximum extensions was calculated as a ratio of the RMS during the passive flexion phase and the RMS during the active extension phase of each contraction cycle: the signal amplitude ratio (SAR). Both PT (ICC = 0.99) and RMS (ICC = 0.83-0.98) had good reproducibility. The reproducibility of MNF was good for all muscles when the mean of contraction nos.: 1-10 was used. Vastus lateralis had the highest ICC among the three muscles. The reproducibility of SAR was generally poor (ICC < 0.60). The present study showed good reproducibility for common EMG variables (MNF and RMS) obtained during maximum isokinetic contractions.

Adult↗

The E/e filling index and right ventricular pressure in relation to applied international Doppler recommendations of left ventricular filling assessment.

AIM: A ratio>15 between the early diastolic pulsed Doppler velocities of the mitral inflow (E) and the basal left ventricular (LV) tissue (e) has been demonstrated to predict an elevated LV filling pressure (FP). An elevated LVFP implies an elevated right ventricular pressure (RVp). In order to investigate the sensitivity of the E/e filling index, we compared E/e and RVp, in their ability to identify a Doppler-assumed elevation of LVFP. METHODS AND RESULTS: Application of pulsed Doppler international recommendations grouped 134 patients with acute coronary syndromes (ACS) and 50 age- and sex-matched controls, according to LV filling: normal; delayed relaxation; an isolated pathological mitral-pulmonary venous-A-wave-duration difference; pseudo normal; or a restrictive filling pattern. An E/e>15 and an RVp>30 mmHg showed the following (%) sensitivity (32/94), specificity (95/76), positive (68/59), and negative (80/97) predictive values of a Doppler-assumed elevation of LVFP, in terms of either a pseudo normal or a restrictive filling pattern. CONCLUSION: The low sensitivity of E/e to detect a Doppler-assumed elevation of LVFP could limit its clinical usefulness as a single variable, in ACS. The high sensitivity and negative predictive value of RVp support its use as an additional LV filling variable in these patients.

Aged↗

Diagnosis and prognosis of fetuses with double outlet right ventricle.

OBJECTIVES: To examine the echocardiographic features, associated anomalies, and outcomes of fetuses diagnosed with double outlet right ventricle (DORV). METHODS: Fetuses with DORV were identified from 987 fetal echocardiograms performed from August 1, 2002 to August 1, 2004. The medical records of 19 fetuses with DORV were reviewed. RESULTS: Nineteen fetuses were diagnosed with DORV. The pregnancy was terminated in 15.8% (3/19) of cases. Postnatal assessment was not obtained in 26.3% (5/19) cases. Accurate prenatal diagnosis of the relationship of the ventricular septal defect (VSD) with the great arteries was achieved in 14 of 14 cases (100%). Chromosomal abnormalities (21.4%), abnormalities of body situs (35.7%), and other extracardiac abnormalities were diagnosed in association. Only 4 of 13 (30.8%) infants with confirmed DORV survived beyond 28 days. CONCLUSIONS: DORV is found in fetuses with a large spectrum of associated cardiac and extracardiac lesions. The overall prognosis for fetuses with DORV is poor throughout the spectrum of these lesions, not only related to the primary lesion but also depending on the associated intra- and extracardiac abnormalities. While the complexity of the heart disease in fetuses with DORV makes detailed fetal diagnosis challenging, it can be accomplished with a high degree of accuracy.

Abnormalities, Multiple↗

Evaluation of ablation patterns using a biophysical model of atrial fibrillation.

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. Surgical/Radiofrequency (RF) ablation is a therapeutic procedure that consists of creating lines of conduction block to interrupt AF. The present study evaluated 13 different ablation patterns by means of a biophysical model of the human atria. In this model, ablation lines were abruptly applied transmurally during simulated sustained AF, and success rate, time to AF termination and average beat-to-beat interval were documented. The gold standard Cox's Maze III procedure was taken as reference. The effectiveness of twelve less invasive patterns was compared to it. In some of these incomplete lines (entailing a gap) were simulated. Finally, the computer simulations were compared to clinical data. The results show that the model reproduces observations made in vivo: (1) the Maze III is the most efficient ablation procedure; (2) less invasive patterns should include lines in both right and left atrium; (3) incomplete ablation lines between the pulmonary veins and the mitral valve annulus lead to uncommon flutter; (4) computer simulations of incomplete lines are consistent with clinical results of non-transumural RF ablation. Biophysical modeling may therefore be considered as a useful tool for understanding the mechanisms underlying AF therapies.

Atrial Fibrillation↗

The efficacy of cibenzoline and propafenone against inducible sustained and nonsustained ventricular tachycardias in conscious dogs with isolated chronic right ventricular infarction: a comparative study with procainamide.

The efficacy of intravenous cibenzoline (3 mg/kg), propafenone (4 mg/kg), and procainamide (20 mg/kg) against inducible sustained and nonsustained ventricular tachycardias (VT) was evaluated in 12 conscious dogs with chronic isolated right ventricular (RV) infarction. RV infarct was caused by permanent occlusion of the right coronary artery in the closed-chest dog by intracoronary balloon inflation. Three to 10 days following the occlusion period, programmed electrical stimulation reproducibly induced sustained and/or nonsustained VT, allowing evaluation of antiarrhythmic drug efficacy. Propafenone was effective in preventing the induction of sustained VT in only one out of six dogs tested, but caused a significant (p less than 0.05) slowing of VT rate (269 +/- 13 to 230 +/- 10 bpm). Procainamide had effects similar to those seen with propafenone. Propafenone and procainamide were ineffective against nonsustained VT, and on established sustained VT once induced. Cibenzoline was effective in preventing the induction of sustained VT in two out of seven dogs, an effect which was not significantly different from either propafenone or procainamide. However, cibenzoline was significantly (p less than 0.05) more effective than either procainamide or propafenone in terminating an established induced sustained VT (four out of six dogs). Furthermore, cibenzoline converted nonsustained to sustained VT in four out of seven dogs tested. Histopathologic studies have shown infarction of the basal two thirds of the RV (38.5 +/- 7.8% of the RV) with no left ventricular involvement. It is concluded that the isolated RV infarction model is highly suitable for serial drug testing against inducible VT in conscious dogs, and this model of VT appears to be fairly resistant to standard and newer antiarrhythmic drug therapy.

Animals↗