Journal articles on the topic 'Left ventricle scar'
To see the other types of publications on this topic, follow the link: Left ventricle scar.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Left ventricle scar.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Afzal, N., and N. S. Dhalla. "Differential changes in left and right ventricular SR calcium transport in congestive heart failure." American Journal of Physiology-Heart and Circulatory Physiology 262, no. 3 (March 1, 1992): H868—H874. http://dx.doi.org/10.1152/ajpheart.1992.262.3.h868.
Abstract:
To examine the status of sarcoplasmic reticulum (SR) with respect to Ca2+ transport in congestive heart failure due to myocardial infarction, the left coronary artery in rats was ligated for 4, 8, and 16 wk. The left heart function was assessed with an intraventricular pressure transducer, and SR membrane fractions from the right ventricle and the viable left ventricle were isolated for measuring the ATP-dependent Ca2+ uptake activities. In comparison to sham-operated controls, SR Ca2+ uptake activity was decreased in viable left ventricle of the experimental animals at 4, 8, and 16 wk. On the other hand, SR Ca2+ uptake activity in the right ventricle was increased at 4 and 8 wk, but no change was apparent at 16 wk of coronary occlusion. The decrease in SR Ca2+ uptake in left ventricle and increase in right ventricle were associated with corresponding changes in maximal velocity values without any alterations in the affinity for Ca2+. These opposite changes in the right and left ventricles were dependent on the scar size as well as time after inducing the myocardial infarction. The SR Ca(2+)-stimulated adenosinetriphosphatase activity was decreased in left ventricle and increased in the right ventricle from 4 wk experimental animals. The results suggest differential remodeling of the SR membranes with respect to Ca(2+)-pump mechanisms in left and right ventricles during the development of congestive heart failure.
2
Ostroumov, E. N., E. V. Migunova, E. D. Kotina, E. B. Leonova, I. M. Kuzmina, M. V. Parkhomenko, S. Yu Kambarov, and M. A. Sagirov. "Right ventricular visualization at SPECT perfusion imaging before and after revascularization in patients with postinfarction cardiosclerosis." Transplantologiya. The Russian Journal of Transplantation 15, no. 2 (June 21, 2023): 200–215. http://dx.doi.org/10.23873/2074-0506-2023-15-2-200-215.
Abstract:
Aim. To evaluate the intersystemic (between the myocardium of the left coronary artery system and the right coronary artery system redistribution mechanisms of perfusion in the myocardium after revascularization in patients with coronary artery disease with focal cardiosclerosis using gated single photon emission computed tomography. Сardiosclerosis foci were initially identified by magnetic resonance imaging. Material and Methods. The study included 17 patients with coronary artery disease with multivessel coronary disease and large-focal cardiosclerosis according to the results of magnetic resonance imaging with contrast; the diagnosis of left ventricular aneurysm was established in 14 patients, the focal subendocardial cardiosclerosis was diagnosed in 3 patients. For various reasons, all patients underwent myocardial revascularization without the left ventricle reconstruction (coronary artery bypass grafting in 10 patients, percutaneous coronary intervention in 7 patients). Magnetic resonance imaging was used as the gold standard for focal cardiosclerosis before revascularization. All patients before and after revascularization underwent gated single photon emission computed tomography with MIBI scan. During the initial analysis of peaks on the profile slices of coronal and transversal midsections passing along the lateral walls of the left and right ventricles, we did not notice a clear visualization of in 8 patients (group 1), while an increased MIBI scan accumulation in the right ventricle myocardium was clearly visualized in 9 patients (group 2). Based on the peaks height of profile curves, we compared changes in the maxima of radiopharmaceutical accumulation before and after revascularization in the lateral walls of the left ventricle and right ventricle. All studies were performed using the original Cardiac Functional Imaging medical program in order to obtain quantitative information about the myocardial function of both the left ventricle, and also the right ventricle. This program made it possible to highlight the right ventricle area even in the case of its weak visualization through the initial formation of parametric images, where the right ventricle area was visualized. Results. When comparing the revascularization results of the two groups, we noted that the left ventricle ejection fraction increased significantly only in patients without initial visualization of the right ventricular myocardium. Left ventricle ejection fraction did not change after revascularization in patients with initially increased accumulation of the radiopharmaceutical in the right ventricle. Globally, only an improvement in the diastolic function of the left and right ventricles was noted in the latter group of patients. In addition, an increase in the right ventricular uptake level was noted for patients with focal cardiosclerosis and the initially increased uptake in the right ventricle after the maximum possible complete myocardial revascularization, which may indicate a redistribution of perfusion in favor of a more intact right ventricular myocardium. Conclusions. 1. In patients without signs of increased visualization of the right ventricle (group 1) after revascularization, we revealed a statistically significant increase in the left ventricle ejection fraction (p-value=0.024), a decrease in the end-systolic volume (p-value=0.024), an increase in the motion in segments corresponding to the peri-infarct scar zone (p-value=0.016), and a change in systolic thickening in the segment of the basal parts of the anterolateral wall (p-value=0.046). 2. Initially increased visualization of the right ventricle in patients with extensive focal cardiosclerosis in the myocardium of the left ventricle suggests the absence of the left ventricle ejection fraction increase after myocardial revascularization. 3. An increase in the visualization of the right ventricle after complete myocardial revascularization indicates an intersystemic redistribution of perfusion in favor of the preserved myocardium of this part of the heart.
3
Pojar, Marek, Jan Harrer, Nedal Omran, and Martin Vobornik. "Surgical Cryoablation of Drug Resistant Ventricular Tachycardia and Aneurysmectomy of Postinfarction Left Ventricular Aneurysm." Case Reports in Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/207851.
Abstract:
Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function. Ventricular tachycardia is a common and a negative prognostic factor in patients with endocardial scarring following myocardial infarction and aneurysm formation. The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago. The patient was admitted to the hospital with sustained ventricular tachycardia despite maximal pharmacotherapy and also underwent unsuccessful percutaneous radiofrequency ablation in the right ventricle. Transthoracic echocardiography revealed left ventricle dysfunction with ejection fraction of 25%, aneurysm of the apex of the left ventricle with thrombus formation inside the aneurysm. Surgical therapy consisted of the cryoablation applied at the transitional zone of the scar and viable tissue and the resection of the aneurysm. The patient remained free of any ventricular tachycardia four months later.
4
Gaertner, Roger, Fabrice Prunier, Monique Philippe, Liliane Louedec, Jean-Jacques Mercadier, and Jean-Baptiste Michel. "Scar and pulmonary expression and shedding of ACE in rat myocardial infarction." American Journal of Physiology-Heart and Circulatory Physiology 283, no. 1 (July 1, 2002): H156—H164. http://dx.doi.org/10.1152/ajpheart.00848.2001.
Abstract:
We examined the topology of angiotensin-converting enzyme (ACE) mRNA expression, activity, and shedding in myocardial infarction-induced heart failure and sought to elucidate the source of the increased plasma ACE activity in this model. Three months after coronary ligature, lung, scar, and remaining viable left ventricular tissues were analyzed for ACE mRNA expression as well as tissue and solubilized ACE activity. ACE mRNA expression increased in the scar with respect to infarct severity, decreased in the lung, and remained unchanged in the left ventricle. ACE activity decreased in the lung and increased in the scar tissue and plasma. Shedding of ACE remained constant in the lung and increased in the scar. This study shows that ACE expression and activity is shifted from the pulmonary endothelium to the infarct scar tissue and that constancy of shedding in the lung and its increase in the scar are the source of the increased plasma ACE in congestive heart failure.
5
Mattesi, Giulia, Alberto Cipriani, Barbara Bauce, Ilaria Rigato, Alessandro Zorzi, and Domenico Corrado. "Arrhythmogenic Left Ventricular Cardiomyopathy: Genotype-Phenotype Correlations and New Diagnostic Criteria." Journal of Clinical Medicine 10, no. 10 (May 20, 2021): 2212. http://dx.doi.org/10.3390/jcm10102212.
Abstract:
Arrhythmogenic cardiomyopathy (ACM) is an inherited heart muscle disease characterized by loss of ventricular myocardium and fibrofatty replacement, which predisposes to scar-related ventricular arrhythmias and sudden cardiac death, particularly in the young and athletes. Although in its original description the disease was characterized by an exclusive or at least predominant right ventricle (RV) involvement, it has been demonstrated that the fibrofatty scar can also localize in the left ventricle (LV), with the LV lesion that can equalize or even overcome that of the RV. While the right-dominant form is typically associated with mutations in genes encoding for desmosomal proteins, other (non-desmosomal) mutations have been showed to cause the biventricular and left-dominant variants. This has led to a critical evaluation of the 2010 International Task Force criteria, which exclusively addressed the right phenotypic manifestations of ACM. An International Expert consensus document has been recently developed to provide upgraded criteria (“the Padua Criteria”) for the diagnosis of the whole spectrum of ACM phenotypes, particularly left-dominant forms, highlighting the use of cardiac magnetic resonance. This review aims to offer an overview of the current knowledge on the genetic basis, the phenotypic expressions, and the diagnosis of left-sided variants, both biventricular and left-dominant, of ACM.
6
Reusswig, Friedrich, Amin Polzin, Meike Klier, Matthias Achim Dille, Aysel Ayhan, Marcel Benkhoff, Celina Lersch, et al. "Only Acute but Not Chronic Thrombocytopenia Protects Mice against Left Ventricular Dysfunction after Acute Myocardial Infarction." Cells 11, no. 21 (November 4, 2022): 3500. http://dx.doi.org/10.3390/cells11213500.
Abstract:
Background: Platelets are major players of thrombosis and inflammation after acute myocardial infarction (AMI). The impact of thrombocytopenia on platelet-induced cellular processes post AMI is not well defined. Methods: The left anterior descending artery was ligated in C57/Bl6 mice and in two thrombocytopenic mouse models to induce AMI. Results: Platelets from STEMI patients and from C57/Bl6 mice displayed enhanced platelet activation after AMI. This allows platelets to migrate into the infarct but not into the remote zone of the left ventricle. Acute thrombocytopenia by antibody-induced platelet depletion resulted in reduced infarct size and improved cardiac function 24 h and 21 days post AMI. This was due to reduced platelet-mediated inflammation after 24 h and reduced scar formation after 21 days post AMI. The collagen composition and interstitial collagen content in the left ventricle were altered due to platelet interaction with cardiac fibroblasts. Acute inflammation was also significantly reduced in Mpl−/− mice with chronic thrombocytopenia, but cardiac remodeling was unaltered. Consequently, left ventricular function, infarct size and scar formation in Mpl−/− mice were comparable to controls. Conclusion: This study discovers a novel role for platelets in cardiac remodeling and reveals that acute but not chronic thrombocytopenia protects left ventricular function post AMI.
7
Mele, Donato, Eustachio Agricola, Alessandro Dal Monte, Maurizio Galderisi, Antonello D'Andrea, Fausto Rigo, Rodolfo Citro, et al. "Pacing transmural scar tissue reduces left ventricle reverse remodeling after cardiac resynchronization therapy." International Journal of Cardiology 167, no. 1 (July 2013): 94–101. http://dx.doi.org/10.1016/j.ijcard.2011.12.006.
8
Awang Damit, Dayang Suhaida, Siti Noraini Sulaiman, Muhammad Khusairi Osman, Noor Khairiah A. Karim, and Samsul Setumin. "Automated DeepLabV3+ based model for left ventricle segmentation on short-axis late gadolinium enhancement-magnetic cardiac resonance imaging images." International Journal of Electrical and Computer Engineering (IJECE) 14, no. 3 (June 1, 2024): 3362. http://dx.doi.org/10.11591/ijece.v14i3.pp3362-3371.
Abstract:
Accurate segmentation of myocardial scar tissue on late gadolinium enhancement-magnetic cardiac resonance imaging (LGE-CMR) is exceptionally vital for clinical applications, enabling precise diagnosis and effective treatment of various cardiac diseases, such as myocardial infarction and cardiomyopathies. However, the ventricle (LV) variations in the size and shape, artifacts, and image resolution of LGE-CMR has made automatic segmentation of myocardial scar tissue more challenging. While many existing approaches delineate the LV myocardium region using multi-modal segmentation, these models may be computationally complex and suffer from misalignment. Therefore, this study proposed an automatic dual-stage DeepLabV3+ based approach tailored for myocardial scar segmentation on short-axis LGE-MRI exclusively. To segment myocardial scar tissue, the second stage employs the segmented LV chamber from the previous stage. The encoder part of the framework utilizes a MobileNetV2 and ResNet50 backbone for the first and second segmentation, respectively, aiming for optimal resolution of feature maps. Both stages tailor an improved Atrous Spatial Pyramid Pooling module in the DeepLabV3+ model with fine-tuned dilated atrous rates to effectively extract the LV chamber and myocardial scar from the complex LGE-MRI background. Based on the results, the proposed dual-stage network recorded an outstanding segmentation performance, with mean Dice score of 96.02% for LV chamber segmentation and 68.01% for scar tissue extraction.
9
Lajoie, Claude, Viviane El-Helou, Cindy Proulx, Robert Clément, Hugues Gosselin, and Angelino Calderone. "Infarct size is increased in female post-MI rats treated with rapamycin." Canadian Journal of Physiology and Pharmacology 87, no. 6 (June 2009): 460–70. http://dx.doi.org/10.1139/y09-031.
Abstract:
Rapamycin represents a recognized drug-based therapeutic approach to treat cardiovascular disease. However, at least in the female heart, rapamycin may suppress the recruitment of putative signalling events conferring cardioprotection. The present study tested the hypothesis that rapamycin-sensitive signalling events contributed to the cardioprotective phenotype of the female rat heart after an ischemic insult. Rapamycin (1.5 mg/kg) was administered to adult female Sprague–Dawley rats 24 h after complete coronary artery ligation and continued for 6 days. Rapamycin abrogated p70S6K phosphorylation in the left ventricle of sham rats and the noninfarcted left ventricle (NILV) of 1-week postmyocardial-infarcted (MI) rats. Scar weight (MI 0.028 ± 0.006, MI+rapamycin 0.064 ± 0.004 g) and surface area (MI 0.37 ± 0.08, MI+rapamycin 0.74 ± 0.03 cm2) were significantly larger in rapamycin-treated post-MI rats. In the NILV of post-MI female rats, rapamycin inhibited the upregulation of eNOS. Furthermore, the increased expression of collagen and TGF-β3 mRNAs in the NILV were attenuated in rapamycin-treated post-MI rats, whereas scar healing was unaffected. The present study has demonstrated that rapamycin-sensitive signalling events were implicated in scar formation and reactive fibrosis. Rapamycin-mediated suppression of eNOS and TGF-β3 mRNA in post-MI female rats may have directly contributed to the larger infarct and attenuation of the reactive fibrotic response, respectively.
10
Acar, Emine, Ayşegül Aksu, Gökmen Akkaya, and Gamze Çapa Kaya. "Prevalence and Localization of Hibernating Myocardium Among Patients with Left Ventricular Dysfunction." Current Medical Imaging Formerly Current Medical Imaging Reviews 15, no. 9 (October 16, 2019): 884–89. http://dx.doi.org/10.2174/1573405615666190701110620.
Abstract:
Objective: This study evaluated how much of the myocardium was hibernating in patients with left ventricle dysfunction and/or comorbidities who planned to undergo either surgical or interventional revascularization. Furthermore, this study also identified which irrigation areas of the coronary arteries presented more scar and hibernating tissue. Methods: At rest, Tc-99m MIBI SPECT and cardiac F-18 FDG PET/CT images collected between March 2009 and September 2016 from 65 patients (55 men, 10 women, mean age 64±12) were retrospectively analyzed in order to evaluate myocardial viability. The areas with perfusion defects that were considered metabolic were accepted as hibernating myocardium, whereas areas with perfusion defects that were considered non-metabolic were accepted as scar tissue. Results: Perfusion defects were observed in 26% of myocardium, on average 48% were associated with hibernation whereas other 52% were scar tissue. In the remaining Tc-99m MIBI images, perfusion defects were observed in the following areas in the left anterior descending artery (LAD; 31%), in the right coronary artery (RCA; 23%) and in the Left Circumflex Artery (LCx; 19%) irrigation areas. Hibernation areas were localized within the LAD (46%), LCx (54%), and RCA (64%) irrigation areas. Scar tissue was also localized within the LAD (54%), LCx (46%), and RCA (36%) irrigation areas. Conclusion: Perfusion defects are thought to be the result of half hibernating tissue and half scar tissue. The majority of perfusion defects was observed in the LAD irrigation area, whereas hibernation was most often observed in the RCA irrigation area. The scar tissue development was more common in the LAD irrigation zone.
11
Mamalakis, Michail, Pankaj Garg, Tom Nelson, Justin Lee, Jim M. Wild, and Richard H. Clayton. "MA-SOCRATIS: An automatic pipeline for robust segmentation of the left ventricle and scar." Computerized Medical Imaging and Graphics 93 (October 2021): 101982. http://dx.doi.org/10.1016/j.compmedimag.2021.101982.
12
Tao, Qian, Sebastiaan R. D. Piers, Hildo J. Lamb, and Rob J. van der Geest. "Automated left ventricle segmentation in late gadolinium-enhanced MRI for objective myocardial scar assessment." Journal of Magnetic Resonance Imaging 42, no. 2 (November 19, 2014): 390–99. http://dx.doi.org/10.1002/jmri.24804.
13
Brand, Y. B., M. K. Mazanov, E. N. Ostroumov, M. A. Sagirov, N. I. Kharitonova, M. V. Chumakov, and D. V. Chernyshev. "The Successful Surgical Treatment of a Giant True Left Ventricular Aneurysm: a Case Report." Russian Sklifosovsky Journal "Emergency Medical Care" 7, no. 4 (January 30, 2019): 372–77. http://dx.doi.org/10.23934/2223-9022-2018-7-4-372-377.
Abstract:
We report the successful surgical treatment of a giant true thrombosed aneurysm of the left ventricle.A 59-year-old male patient Z. was admitted with severe heart failure and chronic thrombosed aneurysm of the left ventricle, formed after acute extensive myocardial infarction, despite successful installation of a stent into the anterior descending artery in the acute period. Echocardiography revealed a significant increase in the volume of the left ventricular cavity, a significant decrease in the contractile function of the left ventricular myocardium (ejection fraction 32-36%), a giant left ventricular aneurysm (9x6 cm) with a parietal lining thrombus in the aneurysm cavity. Coronary angiography showed an aneurysmal dilatation of the circumflex branch of more than 6 mm, hemodynamically significant stenosis of two coronary arteries. According to the scintigraphy, the myocardium beyond the scar tissue was viable. The patient underwent resection of a left ventricular aneurysm, endoventricular plasty (Dor procedure), coronary artery bypass surgery of the circumflex artery and obtuse marginal branch of the left coronary artery.The patient was discharged in satisfactory condition on day 14 after surgery. At follow-up 6 months after surgery, an increase in the ejection fraction to 3941% was noted.
14
Iyer, Rugmani Padmanabhan, Mira Jung, and Merry L. Lindsey. "MMP-9 signaling in the left ventricle following myocardial infarction." American Journal of Physiology-Heart and Circulatory Physiology 311, no. 1 (July 1, 2016): H190—H198. http://dx.doi.org/10.1152/ajpheart.00243.2016.
Abstract:
Following myocardial infarction (MI), the left ventricle (LV) undergoes a series of cardiac wound healing responses that involve both the stimulation of robust inflammation to clear necrotic myocytes and tissue debris and the induction of extracellular matrix (ECM) protein synthesis to generate an infarct scar. The collective changes in myocardial structure and function are termed LV remodeling, and matrix metalloproteinase-9 (MMP-9) is a key instigator of post-MI LV remodeling. Through direct molecular effects on ECM and inflammatory protein turnover as well as indirect effects on major cell types that coordinate cardiac wound healing, namely the infiltrating leukocytes and the cardiac fibroblasts, MMP-9 coordinates multiple aspects of LV remodeling. In this review, we will discuss recent research that has expanded our understanding of post-MI LV remodeling, including recent proteomic advances focused on the ECM compartment to provide novel functional and translational insights. This overview will summarize how our understanding of MMP-9 has evolved over the last decade and will provide insight into future directions that will drive our understanding of MMP-9-directed cardiac ECM turnover in the post-MI LV.
15
O’Brien, Hugh, John Whitaker, Mark D. O’Neill, Karine Grigoryan, Harminder Gill, Vishal Mehta, Mark K. Elliot, et al. "Regional left ventricle scar detection from routine cardiac computed tomography angiograms using latent space classification." Computers in Biology and Medicine 150 (November 2022): 106191. http://dx.doi.org/10.1016/j.compbiomed.2022.106191.
16
Choong, Christopher Y., Edward F. Gibbons, Robert D. Hogan, Thomas D. Franklin, Mark Nolting, Douglas L. Mann, and Arthur E. Weyman. "Relationship of functional recovery to scar contraction after myocardial infarction in the canine left ventricle." American Heart Journal 117, no. 4 (April 1989): 819–29. http://dx.doi.org/10.1016/0002-8703(89)90618-2.
17
Zdravkovic, Marija, Slobodan Klasnja, Maja Popovic, Predrag Djuran, Davor Mrda, Tatjana Ivankovic, Andrea Manojlovic, Goran Koracevic, Dragan Lovic, and Viseslav Popadic. "Cardiac Magnetic Resonance in Hypertensive Heart Disease: Time for a New Chapter." Diagnostics 13, no. 1 (December 31, 2022): 137. http://dx.doi.org/10.3390/diagnostics13010137.
Abstract:
Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification. It is important in the proper evaluation of different left ventricle hypertrophy patterns to estimate the presence and severity of myocardial fibrosis, as well as to give more information about the benefits of different therapeutic modalities. Hypertensive heart disease often manifests as a subclinical condition, giving exceptional value to cardiac magnetic resonance as an imaging modality capable to detect subtle changes. In this article, we are giving a comprehensive review of all the possibilities of cardiac magnetic resonance in patients with hypertensive heart disease.
18
Jugdutt, Bodh I. "Left ventricular rupture threshold during the healing phase after myocardial infarction in the dog." Canadian Journal of Physiology and Pharmacology 65, no. 3 (March 1, 1987): 307–16. http://dx.doi.org/10.1139/y87-054.
Abstract:
The mechanical resistance of the infarcted left ventricle to rupture, or rupture threshold, was measured by the balloon technique 1–42 days after left anterior descending coronary artery ligation in 70 dogs: 26 without infarction (18 sham, 8 with ligation) and 44 with infarction. Rupture threshold in noninfarcted hearts was higher than in infarcted hearts (1168 ± 165 (SD) vs. 754 ± 223 mmHg (1 mmHg = 133.32 Pa), p < 0.001) and did not change over 6 weeks. In contrast, rupture threshold in infarcted hearts decreased (p < 0.05) after 14 days, the average value for 21–42 days being less than that for 1–14 days: 577 ± 140 vs. 867 ± 191 mmHg, p < 0.001. Passive left ventricular stiffness in infarcted hearts was higher than for noninfarcted hearts throughout the 6 weeks during early filling (11.1 ± 3.9 vs. 7.1 ± 1.4 mmHg/mL, p < 0.001) but decreased (p < 0.05) after 14 days during the prerupture phase (11.3 ± 5.3 vs. 6.2 ± 3.0 mmHg/mL, p < 0.005). Between 7 and 42 days, the infarct zone showed marked increase in hydroxyproline (10.0 ± 2.0 vs. 48.8 ± 19.7 mg/g dry weight, p < 0.001), shrinkage (infarct size, 25 ± 9 vs. 9 ± 5% of the left ventricle, p < 0.005), and thinning (infarct to normal wall thickness ratio, 0.83 ± 0.11 vs. 0.51 ± 0.09, p < 0.001) but little further stretching (expansion index or the ratio of lengths of infarcted and noninfarcted segments, 1.14 ± 0.10 vs. 1.28 ± 0.17, p < 0.2). A mild decrease (p < 0.05) in left atrial pressure and increase (p < 0.05) in diastolic area and fractional change in area (two-dimensional echocardiography) were detected at 6 weeks. The late decrease in rupture threshold and prerupture stiffness of the infarcted left ventricle and thinning of the scar suggest a late decrease in mechanical strength and resistance of the infarcted left ventricle to distension.
19
Wu, Zheng-hong, Li-ping Sun, Yun-long Liu, Dian-dian Dong, Lv Tong, Dong-dong Deng, Yi He, et al. "Fully Automatic Scar Segmentation for Late Gadolinium Enhancement MRI Images in Left Ventricle with Myocardial Infarction." Current Medical Science 41, no. 2 (April 2021): 398–404. http://dx.doi.org/10.1007/s11596-021-2360-z.
20
Udaya N.R, Nava, Ramiah Rajesh Kannan, Srikanth Moorthy, Resmi Sekhar, Amol Anil Kulkarni, and Chandiri Anvesh Reddy. "CHARACTERISATION OF HYPERTROPHIC CARDIOMYOPATHY BY CARDIAC MAGNETIC RESONANCE IMAGING." International Journal of Advanced Research 9, no. 11 (November 30, 2021): 643–48. http://dx.doi.org/10.21474/ijar01/13786.
Abstract:
Background: There are many causes of left ventricular hypertrophy which can result in arrhythmias and sudden cardiac death. Hypertrophic cardiomyopathy (HCM) is one of the commonly encountered cause of sudden cardiac death in young adults. Aim: Identifying the role of Cardiac MRI in characterising the diagnostic parameters of HCM. Materials and methods: 125 patients with clinical suspicion or genetic evidence of HCM referred for cardiac MRI between June 2013 to June 2021 were included under the study. Image interpretations were done by fellowship qualified cardiac imaging radiologist. Categorical variables were expressed using frequency and percentage. Numerical variables were presented using mean and standard deviation. Results: Out of the total population, 119 patients (95 %) had LV wall thickness > 13 mm, 48 patients (38.4%) had Left ventricle outflow tract obstruction (LVOTO) and 32 patients (25.6 %) had mid cavity obstruction, 39 patients (37.9 %) had myocardial scar > 15 % and asymmetric septal hypertrophy was the most frequently encountered left ventricle morphology Conclusion: Cardiac MRI detected HCM has a statistically significant association with the final diagnosis (histopathological and genetic correlation). CMRI hence serves as a reliable tool in identifying and characterising the various diagnostic and non- diagnostic parameters of HCM.
21
Sivanandam, Archana, and Karthik Ananthasubramaniam. "Midventricular Hypertrophic Cardiomyopathy with Apical Aneurysm: Potential for Underdiagnosis and Value of Multimodality Imaging." Case Reports in Cardiology 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/9717948.
Abstract:
We illustrate a case of midventricle obstructive HCM and apical aneurysm diagnosed with appropriate use of multimodality imaging. A 75-year-old African American woman presented with a 3-day history of chest pain and dyspnea with elevated troponins. Her electrocardiogram showed sinus rhythm, left atrial enlargement, left ventricular hypertrophy, prolonged QT, and occasional ectopy. After medical therapy optimization, she underwent coronary angiography for an initial diagnosis of non-ST segment elevation myocardial infarction. Her coronaries were unremarkable for significant disease but her left ventriculogram showed hyperdynamic contractility of the midportion of the ventricle along with a large dyskinetic aneurysmal apical sac. A subsequent transthoracic echocardiogram provided poor visualization of the apical region of the ventricle but contrast enhancement identified an aneurysmal pouch distal to the midventricular obstruction. To further clarify the diagnosis, cardiac magnetic resonance imaging with contrast was performed confirming the diagnosis of midventricular hypertrophic cardiomyopathy with apical aneurysm and fibrosis consistent with apical scar on delayed enhancement. The patient was medically treated and subsequently underwent elective implantable defibrillator placement in the ensuing months for recurrent nonsustained ventricular tachycardia and was initiated on prophylactic oral anticoagulation with warfarin for thromboembolic risk reduction.
22
Miyamoto, Masakazu, Nobuhiro Nishii, Hiroshi Morita, and Hiroshi Ito. "Ablation for idiopathic left ventricular tachycardia in a patient with double outlet right ventricle who underwent Fontan operation: a case report." European Heart Journal - Case Reports 4, no. 5 (September 7, 2020): 1–6. http://dx.doi.org/10.1093/ehjcr/ytaa264.
Abstract:
Abstract Background The incidence of ventricular tachycardia (VT) in patients following Fontan operation is reported as 3.5%. Furthermore, in patients with repaired double outlet right ventricle (DORV), scar-related VT and outflow tract VT have been reported; however, Purkinje-related VT has not previously been reported. In this report, we present the case of idiopathic left VT (ILVT) in a patient with DORV who underwent Fontan operation. Case summary A 31-year-old man was diagnosed as having DORV with complete atrioventricular defect at birth. When he was 17 years old, he underwent surgical repair, including extracardiac Fontan operation and common atrioventricular valve replacement. Five years later, VT was detected. Since some medications were ineffective in suppressing VT, he was referred to our hospital for definitive treatment. Ventricular tachycardia was induced by atrial and ventricular programmed electrical stimulations. The mechanism of the VT was determined to be re-entry. The earliest activation site was located at the mid-inferior septum of the hypoplastic left ventricle, in which Purkinje potentials were observed before the local ventricular electrogram. Radiofrequency catheter ablation (RFCA) was performed at this site to eliminate VT. Discussion Most VTs originate from surgical scars in patients with congenital heart disease. Catheter ablation was feasible in scar-related VT. To the best of our knowledge, this is the first report of ILVT treated successfully with RFCA in a DORV patient who had undergone Fontan operation.
23
Lima, Eduardo Gomes, Felipe Pereira Câmara de Carvalho, Jaime Paula Pessoa Linhares Filho, Fabio Grunspun Pitta, and Carlos Vicente Serrano Jr. "Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics." Revista da Associação Médica Brasileira 63, no. 9 (2017): 793–800. http://dx.doi.org/10.1590/1806-9282.63.09.793.
Abstract:
Summary Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.
24
Mouton, Alan J., Osvaldo J. Rivera, and Merry L. Lindsey. "Myocardial infarction remodeling that progresses to heart failure: a signaling misunderstanding." American Journal of Physiology-Heart and Circulatory Physiology 315, no. 1 (July 1, 2018): H71—H79. http://dx.doi.org/10.1152/ajpheart.00131.2018.
Abstract:
After myocardial infarction, remodeling of the left ventricle involves a wound-healing orchestra involving a variety of cell types. In order for wound healing to be optimal, appropriate communication must occur; these cells all need to come in at the right time, be activated at the right time in the right amount, and know when to exit at the right time. When this occurs, a new homeostasis is obtained within the infarct, such that infarct scar size and quality are sufficient to maintain left ventricular size and shape. The ideal scenario does not always occur in reality. Often, miscommunication can occur between infarct and remote spaces, across the temporal wound-healing spectrum, and across organs. When miscommunication occurs, adverse remodeling can progress to heart failure. This review discusses current knowledge gaps and recent development of the roles of inflammation and the extracellular matrix in myocardial infarction remodeling. In particular, the macrophage is one cell type that provides direct and indirect regulation of both the inflammatory and scar-forming responses. We summarize current research efforts focused on identifying biomarker indicators that reflect the status of each component of the wound-healing process to better predict outcomes.
25
Shlevkov, N. B., A. A. Zhambeev, A. Z. Gasparyan, V. N. Shitov, and O. V. Stukalova. "Characteristic of fibrotic myocardial lesions associated with life-threatening ventricular tachyarrhythmias in patients with ischemic and non-ischemic cardiomyopathies." Terapevticheskii arkhiv 90, no. 9 (September 15, 2018): 42–47. http://dx.doi.org/10.26442/terarkh201890942-47.
Abstract:
Aim. To identify the features of myocardial scar and fibrosis associated with the occurrence of malignant ventricular tachyarrhythmias (VTs) in high-risk patients with ischemic (ICMP) and non-ischemic cardiomyopathy (NICMP). Materials and methods. This prospective study included 50 patients (41 men, 9 women), age = 60 ± 13 years, 30 patients of them with ICMP and 20 patients with NICMP, who underwent echocardiography (Echo) and contrast magnetic resonance imaging (MRI) of the heart followed by implantation of cardioverter-defibrillators (ICD) or resynchronizing devices with defibrillator (CPTD) to prevent sudden cardiac death. Results. Sustained VTs were reported in 20/30 (67%) patients with ICMP and in 5/20 (25%) patients with NICMP on follow-up [26 (22-37) months]. Successive univariate and ROC-analyses of Echo and MRI-indices between patients with and without recurrence of VTs found different results for ICMP and NICMP patients groups. In ICMP patients the VTs were associated with wide transmural fibrosis on contrast MRI that covered 3 or more segments of left ventricular. These segments were preferably localized in the middle parts of the inferior and inferolateral segments of the left ventricle. The independent predictors of VTs in NICMP patients were non-transmural fibrosis at 4.5% of the left ventricular mass by contrast MRI as well as low left ventricular ejection fraction (less than 26%) by Echo. Conclusion. To determine the indications for implantation of the ICD and CRTD for primary prevention of sudden cardiac death, it is advisable to take into account not only the value of ejection fraction of left ventricular, but also the features of the fibrosis of the left ventricle by contrast MRI of the heart.
26
Alshibaya, M. D., I. V. Slivneva, M. M. Amirbekov, Z. M. Cheishvili, and O. S. Lagutina. "Geometric reconstruction of the left ventricle in lateral wall thrombosis." Patologiya krovoobrashcheniya i kardiokhirurgiya 24, no. 3 (September 30, 2020): 121. http://dx.doi.org/10.21688/1681-3472-2020-3-121-131.
Abstract:
<p>One variant of postinfarction ischaemic cardiomyopathy is a dyskinetic or akinetic left ventricular aneurysm. Lateral localisation of the postinfarction aneurysms in the interpapillary space is an extremely rare pathology. As a rule, in postinfarction aneurysms of this localization, intracavitary thrombosis develops with large aneurysm sizes or the formation of a false aneurysm. However, thrombus formation in the area of small aneurysms or postinfarction scar of the sidewall, as observed in our case, is extremely rare.<br />This report describes an extremely rare case of the surgical treatment of thrombosis of the posterior-lateral wall of the left ventricle involving the base of the posteromedial papillary muscle.<br />A 59-year-old man was admitted to the hospital with complaints of weakness and shortness of breath under minimal load. He had experienced a heart attack 5 y previously, as per his coronary angiography and had a multi-vessel lesion of the coronary arteries. According to the results of electrocardiography-scarring changes along the posterior wall of the left ventricle, transthoracic echocardiography-dilation of the left heart, a decrease in the ejection fraction of the left ventricle, akinesia of the posterior and posterolateral walls with floating thrombosis of this zone. Surgical intervention was performed under conditions of cardiopulmonary bypass and pharmaco-cryocardioplegia. The heart cavity was opened with left-sided ventriculotomy along the posterior wall, along the interventricular septum. A blood clot was removed with the excision of the lining area along the posterior-lateral wall. Plastic surgery was performed to isolate the scarred myocardium with a Dacron patch; thereafter, reconstruction of the posterior left ventricular wall was performed with a second patch. Plastic surgery of the posterior wall of the left ventricle was performed. The last stage was performed via coronary bypass surgery of the anterior interventricular artery. The duration of stay in the intensive care unit was 20 h, and the duration of hospitalisation was 9 d. He was discharged in the state corresponding to the Class I–II (New York Heart Association Functional Classification, NYHA).<br />Patients with thrombosed left ventricular aneurysms need surgical treatment, irrespective of the localization of the process for de-escalation of the thrombogenic zone and restoration of the ventricle geometry. However, the choice of surgery is clinically challenging and depends on a deep understanding of the anatomical relationships in the left ventricle as well as the prediction of a positive transformation after left ventricular reconstruction. Despite our extensive experience in the treatment of postinfarction aneurysms, this was the first time we treated a patient with an unusual location of a blood clot.</p><p>Received 17 April 2020. Revised 28 May 2020. Accepted 3 June 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Participation in the operation: M.D. Alshibaya, M.M. Amirbekov, Z.M. Cheishvili, O.S. Lagutina, I.V. Slivneva<br />Conception and design: M.D. Alshibaya, I.V. Slivneva<br />Drafting the article: M.D. Alshibaya, I.V. Slivneva, M.M. Amirbekov, Z.M. Cheishvili, O.S. Lagutina<br />Critical revision of the article: M.D. Alshibaya, I.V. Slivneva, M.M. Amirbekov <br />Final approval of the version to be published: M.D. Alshibaya, I.V. Slivneva, M.M. Amirbekov, Z.M. Cheishvili, O.S. Lagutina</p>
27
Shilo, Malka, Ester-Sapir Baruch, Lior Wertheim, Hadas Oved, Assaf Shapira, and Tal Dvir. "Imageable AuNP-ECM Hydrogel Tissue Implants for Regenerative Medicine." Pharmaceutics 15, no. 4 (April 20, 2023): 1298. http://dx.doi.org/10.3390/pharmaceutics15041298.
Abstract:
In myocardial infarction, a blockage in one of the coronary arteries leads to ischemic conditions in the left ventricle of the myocardium and, therefore, to significant death of contractile cardiac cells. This process leads to the formation of scar tissue, which reduces heart functionality. Cardiac tissue engineering is an interdisciplinary technology that treats the injured myocardium and improves its functionality. However, in many cases, mainly when employing injectable hydrogels, the treatment may be partial because it does not fully cover the diseased area and, therefore, may not be effective and even cause conduction disorders. Here, we report a hybrid nanocomposite material composed of gold nanoparticles and an extracellular matrix-based hydrogel. Such a hybrid hydrogel could support cardiac cell growth and promote cardiac tissue assembly. After injection of the hybrid material into the diseased area of the heart, it could be efficiently imaged by magnetic resonance imaging (MRI). Furthermore, as the scar tissue could also be detected by MRI, a distinction between the diseased area and the treatment could be made, providing information about the ability of the hydrogel to cover the scar. We envision that such a nanocomposite hydrogel may improve the accuracy of tissue engineering treatment.
28
Komissarov, V. A. "Criteria for Evaluation of Hemodynamic Status and Physical Tolerance in Postinfarction Cardiosclerosis." Kazan medical journal 70, no. 4 (August 15, 1989): 251–54. http://dx.doi.org/10.17816/kazmj100233.
Abstract:
Exercise tolerance in patients with coronary heart disease with postinfarction cardiosclerosis is determined by the level of coronary and myocardial reserve. At the same time, the larger the surface of the infarcted area and the number of coronary arteries affected by atherosclerosis, the lower the exercise tolerance. The presence of close correlation between heart size and the degree of coronary insufficiency, the size of postinfarction scar, its localization, the level of end-diastolic pressure in the left ventricle prompted us to check the diagnostic significance of the most informative X-ray cardiometry parameters for postinfarction cardiosclerosis patients in the assessment of the functional state of the circulatory system and the possibility to predict physical performance without ergometric study.
29
THAJUDEEN, ANEES, WARREN M. JACKMAN, BRIAN STEWART, IVAN COKIC, HIROSHI NAKAGAWA, MICHAEL SHEHATA, ALLEN M. AMORN, et al. "Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model." Pacing and Clinical Electrophysiology 38, no. 6 (February 6, 2015): 663–74. http://dx.doi.org/10.1111/pace.12581.
30
Sangaralingham, S. Jeson, Brenda K. Huntley, Fernando L. Martin, Tomoko Ichiki, Horng H. Chen, and John C. Burnett. "Molecular Phenotyping of the Natriuretic Peptide and Renin-Angiotensin Systems in the Post-Myocardial Infarction Left Ventricle and Scar." Journal of Cardiac Failure 22, no. 8 (August 2016): S86. http://dx.doi.org/10.1016/j.cardfail.2016.06.275.
31
Zabihollahy, Fatemeh, James A. White, and Eranga Ukwatta. "Convolutional neural network‐based approach for segmentation of left ventricle myocardial scar from 3D late gadolinium enhancement MR images." Medical Physics 46, no. 4 (February 28, 2019): 1740–51. http://dx.doi.org/10.1002/mp.13436.
32
Isomura, Tadashi, Taiko Horii, Hisayoshi Suma, and Gerald D. Buckberg. "Septal anterior ventricular exclusion operation (Pacopexy) for ischemic dilated cardiomyopathy: treat form not disease." European Journal of Cardio-Thoracic Surgery 29, Supplement_1 (April 1, 2006): S245—S250. http://dx.doi.org/10.1016/j.ejcts.2006.03.008.
Abstract:
Objective: Restoration of left ventricle size and shape is an effective surgical procedure in patients with dilated cardiomyopathy. This report defines early and intermediate results following the reshaping of the left ventricle from spherical to ellipsoid configuration in patients with ischemic cardiomyopathy, employing a technique for LV restoration (LVR) that uses form rather than disease as the endpoint for oblique patch placement. Methods: Between 1998 and 2004, a cohort of 83 patients with dilated ischemic cardiomyopathy underwent an operation to reshape the left ventricle. In 54 patients the Dor procedure was done, and 29 underwent the septal anterior ventricular exclusion (SAVE) procedure to emphasize the elliptical shape, whereby patch placement followed an oblique trajectory between the LV apex and septum below the aortic valve. Ventricular form, rather than the disease scar marked the suture placement site endpoint to create an ellipse. The mean age was 58 ± 27, but SAVE patients had larger end systolic volume index (135 ± 38 vs 95 ± 25*). Overall preoperative NYHA functional class III was in 69% and IV in 31 patients, but more SAVE patients were in class IV (38% vs 28%*). The procedures were elective in 72 and emergent in 11, with similar entry criteria for each procedure. Results: In combination with LVR operation, mitral surgery was performed in 49/83 and tricuspid annuloplasty in 23/83 patients, but these procedures were more common after SAVE (59% vs 44%* and 45% vs 19%*, respectively), because of larger LV volumes in SAVE patients; 2.8 ± 1.3 coronary artery bypass grafts were used. Perioperative use of IABP or LVAD was 15 and 1, respectively in 83 patients. Hospital death was in 1/11 or 9% after emergent operations and 3/72 or 4% in elective procedures, with no difference between groups. After discharge from the hospital, NYHA class improved to class I or II in 57 patients, class III/IV in 14 patients, with 10 late deaths. The 5-year survival rate after the elective operation was 80.3% in SAVE and with elective operation and 77.4% in the Dor procedure. Conclusion: The SAVE or Pacopexy technique is easy to reshape the dilated left ventricle from spherical to ellipsoid form after the LVR, and the resultant improved configuration may contribute to the overall results for patients with ischemic dilated cardiomyopathy.
33
Magnano, R., S. Testa, C. Cappelli, L. Pezzi, E. Occhiuzzi, M. Di Marco, D. Forlani, et al. "P9 INCESSANT ARRHYTHMIC STORM, EFFECTIVELY TREATED BY VENTRICULOPLASTY." European Heart Journal Supplements 25, Supplement_D (May 2023): D41. http://dx.doi.org/10.1093/eurheartjsupp/suad111.096.
Abstract:
Abstract Arrhythmic storm is an emergency characterized by cardiac electrical instability leading to multiple episodes of sustained ventricular arrhythmias in a short period of time. Patients have multiple comorbidities that require multidisciplinary interventions to achieve clinical stability. The genesis of arrhythmic storm involves a complex interaction between a predisposing arrhythmogenic substrate, triggering factors, autonomic nervous system, and patient comorbidities. Antiarrhythmic drug therapy plays a key role and has been shown to be associated with a significant reduction in VT recurrence. Transcatheter ablation in patients refractory to drug therapy has been shown to reduce arrhythmic recurrences, ICD shocks, and improve patients‘ cumulative survival over time. Rare cases of arrhythmic storm refractoriness treated by plastic ventricle for the purpose of excluding scar are reported in the literature. We present the case of a 62–year–old man, Caucasian race, suffering from chronic ischemic heart disease with hypokinetic–dilated evolution carrying CRT–D, diabetic, obese, dyslipidemic, undergoing multiple percutaneous revascularizations. Sent to our hospital from a peripheral hospital for arrhythmic storm refractory to maximal antiarrhythmic therapy treated with multiple internal and external DC shocks. During hospitalization, the patient underwent SEF and attempted ATC which was ineffective in the following days due to recurrence of numerous episodes of TVS. In view of the clinical picture and refractoriness to therapy, it was decided to perform coronary examination which found subocclusion of the 1st diagonal branch treated by implantation of medicated stent. On ventriculography, the presence of severe pseudoaneurysmal formation supplied at the level of the anterior wall of the left ventricle was confirmed. It was decided to transfer the patient to cardiac surgery to perform ventriculoplasty surgery. In the following days, the patient underwent surgery through exclusion of the aneurysm by patching in pericardium in CEC. Procedure was free of complications. On follow–up echocardiogram dilated left ventricle with severe left ventricular dysfunction with findings of cardiac aneurysm exclusion. In the following days, the patient presented no further arrhythmic episodes.
34
Takase, Bonpei, and Masayoshi Nagata. "Delayed Enhancement Morphology on Cardiac Magnetic Resonance Imaging is Correlated with Signal-averaged Electrocardiogram and QT Dispersion in Myocardial Infarction." Angiology 60, no. 4 (January 4, 2009): 412–18. http://dx.doi.org/10.1177/0003319708329798.
Abstract:
Background In patients with myocardial infarction, ventricular tachycardia is related with nonconductive ventricular scar. Cardiac magnetic resonance imaging is an excellent modality to evaluate myocardial scars in myocardial infarction. Furthermore, late potential obtained from signal-averaged electrocardiogram and QT dispersion are both well-known parameters for predicting lethal arrhythmias. Methods and Results To investigate whether the pattern of necrotic scar tissue visualized by delayed enhancement on cardiac magnetic resonance imaging is associated with late potential and QT dispersion, we measured late potential and QT dispersion in 27 patients (68 ± 8 years old) with a prior myocardial infarction. Cardiac magnetic resonance imaging was also obtained using a 1.5-tesla cardiac magnetic resonance scanner, and delayed enhancement was analyzed in the short axis of the left ventricle. By conducting this, we tried to determine whether the pattern of necrotic scar tissue predicts lethal ventricular arrhythmias. Semiquantitative patchy scores were identified as the mean patchy score and the maximum patchy score in each patient. There were 9 patients with a positive late potential and 18 patients with a negative late potential. Patients with positive late potentials had significantly larger mean (1.7 ± 0.3) and maximum (2.2 ± 0.6) patchy scores than patients with negative late potentials (mean, 1.3 ± 0.2, P < .05; maximum, 1.7 ± 0.4, P < .05). QT dispersion was significantly correlated with the number of slices showing delayed enhancement, which reflects the size of necrotic scar tissue ( r = .59, P < .05). Conclusions These findings suggest that the pattern of necrotic scar tissue visualized by delayed enhancement with cardiac magnetic resonance imaging was correlated to the predictive indices of lethal ventricular arrhythmias.
35
Passier, R. C., J. F. Smits, M. J. Verluyten, R. Studer, H. Drexler, and M. J. Daemen. "Activation of angiotensin-converting enzyme expression in infarct zone following myocardial infarction." American Journal of Physiology-Heart and Circulatory Physiology 269, no. 4 (October 1, 1995): H1268—H1276. http://dx.doi.org/10.1152/ajpheart.1995.269.4.h1268.
Abstract:
In the present study we quantified angiotensin-converting enzyme (ACE) mRNA and localized ACE mRNA and protein in the infarcted rat heart. Wistar rats underwent ligation of the left descending coronary artery, resulting in myocardial infarction (MI) or a sham operation. At different times (1-90 days) after surgery (n = 3 each), the heart was removed and divided into the right ventricle (RV), septum (Se) and left ventricle (LV). ACE mRNA was quantified by competitive reverse transcriptase-polymerase chain reaction (RT-PCR). At 4 and 7 days after MI, we found a 2.8-fold increase of ACE mRNA (n = 3; P < or = 0.05) in the infarcted LV compared with the LV of the sham group. No increases of ACE mRNA were found in the noninfarcted hypertrophied compartments. ACE activity increased 2.6- and 3.6-fold in the infarcted LV at 7 and 90 days after MI, respectively. In situ hybridization and immunohistochemistry showed increased ACE mRNA and protein density in the border zone of the infarcted area, predominantly in the endothelial cells lining capillaries. In the noninfarcted myocardium ACE mRNA and protein were confined to endothelial cells of the larger vessels. From these data we conclude that the intracardiac RAS is involved in the healing of the scar after MI in the rat, possibly giving rise to neovascularization. Furthermore, the data suggest that the intracardiac ACE is not necessarily associated with hypertrophy in the rat heart after MI.
36
Popov, M. A., D. V. Shumakov, L. E. Gurevich, D. N. Fedorov, D. I. Zybin, V. E. Ashevskaya, P. A. Korosteleva, and V. M. Tyurina. "The evaluation of hibernating myocardium function." CLINICAL AND EXPERIMENTAL MORPHOLOGY 12, no. 1 (2023): 59–67. http://dx.doi.org/10.31088/cem2023.12.1.59-67.
Abstract:
Introduction.Currently, there are different approaches to assessing changes that occur in ischemic myocardium in patients with chronic coronary artery disease (CAD). Researchers argue about the timing and completeness of the restoration of myocardial dysfunction areas. We aimed to assess hibernating myocardium in the zones of hypokinesia in patients with CAD. Materials and methods. We performed a morphological and immunohistochemical study of left ventricular myocardial biopsies of 25 patients who underwent surgical reconstruction of the left ventricle with surgical revascularization. Results. Morphological and immunohistochemical studies revealed violated morphological structure of cardiomyocytes. It correlates with the accumulation of MMP9 in the cytoplasm of cardiomyocytes in the areas of affected myocardium in ischemia against the background of partial or complete destruction of CM basement membranes formed by type IV collagen. It also correlates with long-term consequences of treatment. Conclusion. As a result of the destructed structure of sarcomeres and cardiac basement membrane hibernating myocardium is unable to provide a contractile function in the future. Morphological examination showed that viable cells were likely to function only as a protective mechanism in early scar formation. Keywords: left ventricular remodeling, hibernating myocardium, basement membrane, cardiomyocytes, matrix metalloproteinase 9, type IV collagen
37
Murad, Ciro Mancilha, Letícia Braga Ferreira, Rochelle Coppo Militão Rausch, and Cláudio Léo Gelape. "Late atrioventricular groove disruption presenting 7 years after mitral valve replacement: a case report." European Heart Journal - Case Reports 4, no. 3 (May 1, 2020): 1–5. http://dx.doi.org/10.1093/ehjcr/ytaa091.
Abstract:
Abstract Background Left ventricular rupture is the most feared complication in mitral valve surgery. Despite its low incidence, mortality rates can reach up to 75%. It usually presents on the operating room with a dissecting haematoma followed by massive bleeding after discontinuing cardiopulmomary bypass. However, cardiac rupture may be contained by adherent pericardium or scar tissue leading to chronic formation of a pseudoaneurysm (PSA). Case summary A 44-year-old man came to our institution with acute heart failure triggered by community-acquired pneumonia. He underwent mitral valve replacement with a mechanical prosthesis 7 years before and reported suffering from chronic worsening dyspnoea for 18 months. He underwent chest computed tomography scan and cardiac magnetic resonance imaging (CMRI), which showed two extensive left ventricular (LV) multilobulated PSAs. An operative approach was chosen and a tear was found on the posterior atrioventricular groove (AVG), communicating left ventricle with the PSA, which was closed with bovine pericardium patch. After weaning from cardiopulmonary bypass, he presented a diffuse life-threatening bleeding. The surgeons packed his chest with compresses before closing the sternum and he was operatively revised after 48 h. Post-operative CMRI showed that one of the PSAs remained connected with the LV. Despite of all, 1 year after hospital discharge, he remains asymptomatic without signs of heart failure. Discussion This case illustrates PSAs' potential to grow for a long period before causing symptoms, the complexity and risks of chronic AVG disruption surgery and the importance of careful annular manipulation and debridement as preventive measures in mitral valve surgery.
38
Huang, Ya, Aiming Wu, Lixia Lou, Dongmei Zhang, Bo Nie, Yizhou Zhao, Keke Liu, Mingjing Zhao, and Hongcai Shang. "Wenxin Granules Influence the TGFβ-P38/JNK MAPK Signaling Pathway and Attenuate the Collagen Deposition in the Left Ventricle of Myocardial Infarction Rats." Cardiology Research and Practice 2019 (December 12, 2019): 1–11. http://dx.doi.org/10.1155/2019/3786024.
Abstract:
Background. A large number of proinflammatory/anti-inflammatory cytokines are produced in the extracellular matrix (ECM) after myocardial infarction (MI), and the inflammatory pathways activated by these inflammatory stimuli are involved in the regulation of lesions with excessive accumulation of ECM. Wenxin granules can play a protective role against MI, but the mechanism of its effect on the inflammatory pathway and ECM collagen expression is still unclear. Objective. To verify the effect of Wenxin granules on the inflammatory pathway and collagen expression after MI. Method. The proximal left anterior descending coronary artery in rats was ligated to induce acute MI. Then, animals were randomly assigned to the model group, the Carvedilol group, and the Wenxin Granules group. In addition, sham operation rats were used as the control group. 10 rats were allocated in each group. Gavage was given once a day for 4 weeks. The changes of cardiac hemodynamics were detected by the catheter method, morphological changes were observed by HE staining, and myocardial tissue collagen volume was counted by Immunohistochemistry combined with Masson staining, and the expression of inflammatory TGFβ-p38/JNK MAPK signal pathway markers was detected by Western blot. Results. Wenxin granules could significantly improve the hemodynamics, so that the fibrosis scar was relatively dense and uniform, and the residual myocardium was relatively neat, while Collagen type I and III volume and TGFβ expression levels were lessened. Although there were no differences in the expression of CTGF, p38, and JNK proteins, their phosphorylation levels showed significant differences. Conclusion. Wenxin granules can affect the inflammation-related TGFβ-p38/JNK MAPK signaling pathway and change the structural properties of myocardium and scar after MI by attenuated collagen deposition in the left ventricular myocardial tissue to improve cardiac function.
39
O'Brien, Hugh, John Whitaker, Baldeep Singh Sidhu, Justin Gould, Tanja Kurzendorfer, Mark D. O'Neill, Ronak Rajani, et al. "Automated Left Ventricle Ischemic Scar Detection in CT Using Deep Neural Networks." Frontiers in Cardiovascular Medicine 8 (July 2, 2021). http://dx.doi.org/10.3389/fcvm.2021.655252.
Abstract:
Objectives: The aim of this study is to develop a scar detection method for routine computed tomography angiography (CTA) imaging using deep convolutional neural networks (CNN), which relies solely on anatomical information as input and is compatible with existing clinical workflows.Background: Identifying cardiac patients with scar tissue is important for assisting diagnosis and guiding interventions. Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is the gold standard for scar imaging; however, there are common instances where it is contraindicated. CTA is an alternative imaging modality that has fewer contraindications and is faster than Cardiovascular magnetic resonance imaging but is unable to reliably image scar.Methods: A dataset of LGE MRI (200 patients, 83 with scar) was used to train and validate a CNN to detect ischemic scar slices using segmentation masks as input to the network. MRIs were segmented to produce 3D left ventricle meshes, which were sampled at points along the short axis to extract anatomical masks, with scar labels from LGE as ground truth. The trained CNN was tested with an independent CTA dataset (25 patients, with ground truth established with paired LGE MRI). Automated segmentation was performed to provide the same input format of anatomical masks for the network. The CNN was compared against manual reading of the CTA dataset by 3 experts.Results: Note that 84.7% cross-validated accuracy (AUC: 0.896) for detecting scar slices in the left ventricle on the MRI data was achieved. The trained network was tested against the CTA-derived data, with no further training, where it achieved an 88.3% accuracy (AUC: 0.901). The automated pipeline outperformed the manual reading by clinicians.Conclusion: Automatic ischemic scar detection can be performed from a routine cardiac CTA, without any scar-specific imaging or contrast agents. This requires only a single acquisition in the cardiac cycle. In a clinical setting, with near zero additional cost, scar presence could be detected to triage images, reduce reading times, and guide clinical decision-making.
40
"Minimally invasive left ventricular reconstruction of a postinfarction, anterior left ventricular scar (BioVentrix Revivent TC procedure)." Multimedia Manual of Cardio-Thoracic Surgery, December 2, 2020. http://dx.doi.org/10.1510/mmcts.2020.063.
Abstract:
Surgical ventricular reconstruction is a proven option for treating patients who have heart failure due to a postinfarction scar or an aneurysm of the left ventricle. The BioVentrix Revivent TC System offers a reliable alternative to the conventional, more invasive surgical ventricular restoration. The system requires no sternotomy, no heart–lung machine, and no cardioplegic arrest. In this video tutorial, we present our technique for using the Revivent TC System to reconstruct the normal left ventricular shape and volume in a patient with a postinfarction, anteroapical scar.
41
Schweins, Moritz, Ralf Gäbel, Matti Raitza, Praveen Vasudevan, Heiko Lemcke, Markus Joksch, Anna Schildt, et al. "Multi-modal assessment of a cardiac stem cell therapy reveals distinct modulation of regional scar properties." Journal of Translational Medicine 22, no. 1 (February 21, 2024). http://dx.doi.org/10.1186/s12967-024-04986-2.
Abstract:
Abstract Background The initial idea of functional tissue replacement has shifted to the concept that injected cells positively modulate myocardial healing by a non-specific immune response of the transplanted cells within the target tissue. This alleged local modification of the scar requires assessment of regional properties of the left ventricular wall in addition to commonly applied measures of global morphological and functional parameters. Hence, we aimed at investigating the effect of cardiac cell therapy with cardiovascular progenitor cells, so-called cardiac induced cells, on both global and regional properties of the left ventricle by a multimodal imaging approach in a mouse model. Methods Myocardial infarction was induced in mice by ligation of the left anterior descending artery, the therapy group received an intramyocardial injection of 1 × 106 cardiac induced cells suspended in matrigel, the control group received matrigel only. [18F]FDG positron emission tomography imaging was performed after 17 days, to assess regional glucose metabolism. Three weeks after myocardial infarction, cardiac magnetic resonance imaging was performed for morphological and functional assessment of the left ventricle. Following these measurements, hearts were excised for histological examinations. Results Cell therapy had no significant effect on global morphological parameters. Similarly, there was no difference in scar size and capillary density between therapy and control group. However, there was a significant improvement in contractile function of the left ventricle – left ventricular ejection fraction, stroke volume and cardiac output. Regional analysis of the left ventricle identified changes of wall properties in the scar area as the putative mechanism. Cell therapy reduced the thinning of the scar and significantly improved its radial contractility. Furthermore, the metabolic defect, assessed by [18F]FDG, was significantly reduced by the cell therapy. Conclusion Our data support the relevance of extending the assessment of global left ventricular parameters by a structured regional wall analysis for the evaluation of therapies targeting at modulation of healing myocardium. This approach will enable a deeper understanding of mechanisms underlying the effect of experimental regenerative therapies, thus paving the way for a successful translation into clinical application.
42
Agostini, N., M. Giraldi, D. Orsida, and S. Caico. "C44 VENTRICULAR TACHYCARDIA IN PATIENT WITH PSEUDOISCHEMIC VENTRICULAR SCAR." European Heart Journal Supplements 24, Supplement_C (May 1, 2022). http://dx.doi.org/10.1093/eurheartj/suac011.043.
Abstract:
Abstract We describe a case of 76 years old men. He was referred to emergency room for chest pain and short of breath. The medical history escluded pre–existent miocardial infarction, no history of fever and chest pain has been declared,.The electrocardiogram (ECG) showed a 200 pbm tachycardia with right bundle branch and right axial deviation. The transition was in V4 (Fig. 1). The tachycardia was not tolerated and after ineffective administration of amiodarone, the tachycardia was terminated by DC shock (200 J synchronized). We performed an echocardiogram with evidence of minimal ventricular dilatation, the inferior–posterior–lateral akinesia, inferior–posterior scar and severe reduction of ejection fraction (about 30%). For better characterization of the scar, we performed cardio magnetic resonanc imaging with evidence of significative thinning of the left ventricle free wall and trasmural LGE of the of left ventricle free wall suggest ischemic myocardial injury (Fig. 2 a,b,c,d,e). The coronary arteriography was performed without evidence of critical coronary stenosis.We decide to implant a single lead ICD. After one month, because of recurrence of tachycardia, we performed the electrophysiological study. We induced clinical ventricular tachycardia and the electroanatomical mapping highlighted an area of anomalous potentials extended in the infero–posterior and lower–basal region more at the epicardial level. In these areas, at the epicardial level, late potentials were highlighted and the ablation performed making the tachycardia no longer inducible. Despite of evidence of pseudo–ischemic scar localized at the basal portion of ventricle at the cardiac MRI, no critical coronary stenosis has been demonstrated and the arrhythmogenic substrate was exclusively epicardic. The preliminary hypothesis was a MINOCA, not of recent onset considering the negativity of myocardial enzymes at the admission and the absence of acute ischemic changes on post cardioversion ECG.We have therefore also considered forms of previous extensive myocarditis however with the limited longitudinal extension. From what has been described in the literature, the MRI images could also be attributable to a form of left ventricle arrhythmogenic dysplasia even in the absence of involvement of the apical portions. Forms of infiltrative cardiomyopathies such as sarcoidosis should be excluded due to the lack of involvement of the interventricular septum.
43
Sacher, F., P. Roumegou, J. Duchateau, N. Derval, A. Denis, T. Pambrun, W. Escande, et al. "5201Intra-cardiac thrombus in patients undergoing ventricular tachycardia ablation. a computed tomographic scan study." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz746.0059.
Abstract:
Abstract Background Embolic event is one of the complications of VT ablation. This may be due to the presence of intra-cardiac thrombus before ablation. However, there is no clear consensus on how to rule out thrombus before the procedure. Objective We sought to examine the prevalence and risk factors of intra-cardiac thrombus with cardiac computed tomographic (CT) scan in patients undergoing scar-related VT ablation. Methods In absence of contra-indication, all patients undergoing scar-related VT ablation at our institution underwent contrast-enhanced cardiac CT within one week before ablation. 324 consecutive patients (292 male, 59±16 yo) have been included in this study. The etiology was ischemic cardiomyopathy (CMP) (n=191), arrhythmogenic right ventricular CMP (ARVC) (n=37), congenital CMP (n=11) or other CMP (n=85). LVEF was <40% in 154 patients (48%). Results Intra-cardiac thrombus was diagnosed in 29 (9%) patients: in the left atrium (n=8), in the right atrium (n=1), in the left ventricle (n=15), in the right ventricle (n=3), in right and left atrium (n=1), and in left atrium and right ventricle (n=1). Moreover in 2, a bilateral pulmonary embolism was identified. The population with thrombus was older (65±12 vs 58±16 years, p=0,005), with more permanent atrial fibrillation (AF) (28% vs 8%; p=0.005). Patients with left ventricular (LV) aneurysm were at higher risk of thrombus 50% vs 3% (p<0.001). The average CHADSVASC score was similar for both groups (2,5 vs 2,1; p=0.179). After matching for age and sex, only ischemic CMP and LV aneurysm were risk factors for thrombus. Because of arrhythmic storm, ablation was performed by epicardial approach only, in 5 patients with intra-ventricular thrombus and by retroaortic approach only, in 2 patients with LAA thrombus. No embolic event occurred during these procedures. Conclusion CT scans help eliminating intra-cardiac thrombus before VT ablation procedure. A high proportion of thrombus (9%) was identified. Whereas LV thrombus should systematically be ruled out before scar related VT ablation, in patients with AF, a LAA thrombus should also be eliminated as well as RV thrombus in patients with ARVC. Acknowledgement/Funding ANR-10-IAHU-04
44
Wu, Katherine C., Shannon Wongvibulsin, Susumu Tao, Hiroshi Ashikaga, Michael Stillabower, Timm M. Dickfeld, Joseph E. Marine, Robert G. Weiss, Gordon F. Tomaselli, and Scott L. Zeger. "Baseline and Dynamic Risk Predictors of Appropriate Implantable Cardioverter Defibrillator Therapy." Journal of the American Heart Association 9, no. 20 (October 20, 2020). http://dx.doi.org/10.1161/jaha.120.017002.
Abstract:
Background Current approaches fail to separate patients at high versus low risk for ventricular arrhythmias owing to overreliance on a snapshot left ventricular ejection fraction measure. We used statistical machine learning to identify important cardiac imaging and time‐varying risk predictors. Methods and Results Three hundred eighty‐two cardiomyopathy patients (left ventricular ejection fraction ≤35%) underwent cardiac magnetic resonance before primary prevention implantable cardioverter defibrillator insertion. The primary end point was appropriate implantable cardioverter defibrillator discharge or sudden death. Patient characteristics; serum biomarkers of inflammation, neurohormonal status, and injury; and cardiac magnetic resonance‐measured left ventricle and left atrial indices and myocardial scar burden were assessed at baseline. Time‐varying covariates comprised interval heart failure hospitalizations and left ventricular ejection fractions. A random forest statistical method for survival, longitudinal, and multivariable outcomes incorporating baseline and time‐varying variables was compared with (1) Seattle Heart Failure model scores and (2) random forest survival and Cox regression models incorporating baseline characteristics with and without imaging variables. Age averaged 57±13 years with 28% women, 66% white, 51% ischemic, and follow‐up time of 5.9±2.3 years. The primary end point (n=75) occurred at 3.3±2.4 years. Random forest statistical method for survival, longitudinal, and multivariable outcomes with baseline and time‐varying predictors had the highest area under the receiver operating curve, median 0.88 (95% CI, 0.75‐0.96). Top predictors comprised heart failure hospitalization, left ventricle scar, left ventricle and left atrial volumes, left atrial function, and interleukin‐6 level; heart failure accounted for 67% of the variation explained by the prediction, imaging 27%, and interleukin‐6 2%. Serial left ventricular ejection fraction was not a significant predictor. Conclusions Hospitalization for heart failure and baseline cardiac metrics substantially improve ventricular arrhythmic risk prediction.
45
Khalili, Ahmadali, Naser Safaei, Razieh Parizad, Amir Faravan, and Mehran Rahimi. "Left ventricular pseudoaneurysm as a late complication of incomplete surgical stab wound repair, a case report." Cardiovascular Biomedicine Journal, August 21, 2023. http://dx.doi.org/10.18502/cbj.v3i1.13466.
Abstract:
Objectives: Left ventricular pseudoaneurysm (LVP) is a rare but life-threatening condition caused by rupture of the free wall of the ventricle. The ventricular wall is surrounded by adherent pericardium and scar tissue, lacking myocardial tissue. In this case study, an 18-year-old man, experiencing syncope, shortness of breath, dizziness, and pleuritic chest pain (CP) was admitted to the emergency department. Five months earlier, he had a penetrating chest trauma that damaged the pericardium and ventricular wall and underwent a left thoracotomy. Transthoracic echocardiography (TTE) identified a large 10*10 cm pseudoaneurysm in the apicolateral region of the ventricle. Considering the confirmed diagnosis of delayed left ventricular pseudo aneurysm, surgical intervention was deemed necessary. The patient went under general anesthesia, and cannulation of the artery and femoral vein and cardiopulmonary bypass (CPB) were performed. Open heart surgery was then performed through a midline sternotomy to excise the LVP and repair the ventricles. After transfer to the intensive care unit and subsequent extubation, the patient was transferred to the surgical ward and discharged in good condition.
Conclusions: This case report highlights the importance of timely diagnosis and appropriate treatment to save the lives of patients given the rapid spread observed in LVP cases.
46
Chiyoya, Mari, Ikuo Fukuda, Shingo Sasaki, and Ken Okumura. "Direct ablation and excision of myocardial scar in post-myocarditis ventricular aneurysm." Interactive CardioVascular and Thoracic Surgery, October 30, 2019. http://dx.doi.org/10.1093/icvts/ivz258.
Abstract:
Abstract The patient was a 34-year-old woman who developed multiple post-myocarditis ventricular aneurysms with ventricular tachyarrhythmia. After implantation of an intracardiac defibrillator, she experienced multiple episodes of counter-shock. An electrophysiological study demonstrated an early excitation circuit entering the septal aneurysm with the right ventricular aneurysm as an exit. A surgical ablation of the re-entry and left ventricular plasty with scar resection was performed. The operation was performed under direct, epicardial electrophysiological guidance. A cryoablation was performed along the right ventriculotomy and the margin of the left ventricular aneurysm. The left ventricle was closed using endoventricular aneurysmorrhaphy and the right ventriculotomy was closed directly. No recurrence of ventricular tachyarrhythmia has been encountered.
47
Singh, Yashbir, Shadi Atalla, Wathiq Mansoor, Rahul Paul, and Deepa Deepa. "To predict the left ventricular endocardial scar tissue pattern using Radon descriptor-based machine learning." BMC Research Notes 16, no. 1 (August 24, 2023). http://dx.doi.org/10.1186/s13104-023-06466-0.
Abstract:
Abstract Objective Scar tissue is an identified cause for the development of malignant ventricular arrhythmias in patients of myocardial infarction, which ultimately leads to cardiac death, a fatal outcome. We aim to evaluate the left ventricular endocardial Scar tissue pattern using Radon descriptor-based machine learning. We performed automated Left ventricle (LV) segmentation to find the LV endocardial wall, performed morphological operations, and marked the region of the scar tissue on the endocardial wall of LV. Motivated by a Radon descriptor-based machine learning approach; the patches of 17 patients from Computer tomography (CT) images of the heart were used and categorized into “endocardial Scar tissue” and “normal tissue” groups. The ten feature vectors are extracted from patches using Radon descriptors and fed into a traditional machine learning model. Results The decision tree has shown the best performance with 98.07% accuracy. This study is the first attempt to provide a Radon transform-based machine learning method to distinguish patterns between “endocardial Scar tissue” and “normal tissue” groups. Our proposed research method could be potentially used in advanced interventions.
48
van Koppen, Arianne, Elsbet Pieterman, Simon Hinke, Tri Nguyen, Amélie Dendooven, Ingeborg Bajema, Harry van Goor, Anke Smits, and Reinout Stoop. "#1311 Cardiac damage in a multifactorial DKD/CKD mouse model resembles HFpEF and can be reduced by standard-of-care treatment." Nephrology Dialysis Transplantation 39, Supplement_1 (May 2024). http://dx.doi.org/10.1093/ndt/gfae069.641.
Abstract:
Abstract Background and Aims We developed a diet-induced hypertension-accelerated mouse model of diabetic kidney disease characterized by progressive loss of GFR resulting in chronic kidney disease. Since cardiovascular disease is the major cause of death in CKD, we characterized the functional and structural cardiac damage in this model. Additionally, we studied the efficacy of combination therapy with an ACE-inhibitor (Lisinopril) and SGLT2-inhibitor (Dapagliflozin) on cardiac histopathology. Method Male KKAy mice underwent uninephrectomy. After recovery mice received high fat diet (45% LARD) and drinking water with or without 50 mg/L LNNA (wk0). At 12 weeks, imaging was performed to study cardiac function and mice were terminated at week 13. In the intervention study, at week 4, lisinopril (2.5 mg/kg/day; drinking water) and at week 8 dapagliflozin (5 and 20 mg/kg/day; foodadmix) treatment were started. At week 16 mice were terminated and lung and heart weight and cardiac histology were determined. Results Upon termination, macroscopic evaluation of the hearts showed extensive scar tissue formation on the outside of the left ventricle. Histological evaluation showed the presence left ventricular hypertrophy, coronary calcification and myocardial fibrosis in male KKAy mice with UNX, HFD and LNNA. KKAy mice with UNX and HFD but without LNNA also showed myocardial fibrosis, monocyte infiltration and focal mineralization. Imaging showed preserved ejection fraction, a significant reduction, increased left ventricle posterior wall thickness and decrease left ventricle inner diameter. Treatment with combination therapy reduced lung wet weight, significantly reduced heart weight and significantly decreased cardiac fibrosis. Macroscopically, less scar tissue was observed after treatment. Conclusion This multifactorial mouse model shows cardiac damage on a background of hypertension, diabetes, renal dysfunction and obesity. Functional measurement including preserved ejection fraction, left ventricle hypertrophy, diastolic dysfunction and increased fibrosis resembling the clinical HFpEF phenotype. Combination therapy with Lisinopril and Dapagliflozin reduced cardiac weight and cardiac fibrosis. This indicates cardiac involvement in the DKD mouse model which confirms that this multifactorial model is clinically relevant.
49
Simonova, K., E. N. Mikhaylov, R. B. Tatarskiy, A. V. Kamenev, D. V. Panin, V. S. Orshanskaya, V. K. Lebedeva, M. A. Vander, and D. S. Lebedev. "P357Epicardial abnormal electrical activity in unselected patients with ischemic ventricular tachycardia: a pilot mapping study." EP Europace 22, Supplement_1 (June 1, 2020). http://dx.doi.org/10.1093/europace/euaa162.059.
Abstract:
Abstract Background radiofrequency catheter ablation (RFA) on the endocardial ventricular surface is widely used for post-myocardial infarction (post-MI) ventricular tachycardia (VT) treatment. It has been described that about 10% of patients with post-MI require additional epicardial ablation for successful VT termination. However, there is still lack of data regarding the extent of scarring and the presence of local abnormal ventricular electrical activity (LAVA, low-voltage and/or fractionated signals) on the epicardial surface in patients with ischemic VT. Purpose to assess the extent of epicardial electrophysiological substrate in patients with remote myocardial infarction and indications for VT ablation. Methods thirteen out of 59 patients with sustained ischemic VT (12 men; mean age 59,9 ± 9,5) and without previous cardiac surgery signed an informed consent to undergo epicardial mapping and comprized the study population. Endocardial access was used previously as primary method in 4 patients ICD/ CRT-D had been previously implanted in 11 patients: mean left ventricle ejection fraction was 38,8 ± 10,6 %: hemodynamically unstable VT was present in 10 patients; the most frequent scar localization by ECG and transthoracic echocardiography – left ventricle (LV) inferior wall (10 patients), LV lateral wall – (7 patients). All patients underwent full clinical evaluation. Electrophysiological procedure and catheter ablation was performed under general anesthesia. Epicardial access was obtained through percutaneous subxyphoid puncture. Voltage mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of LAVA. Ablation was performed at sites of LAVA on either side of the ventricular wall. Results epicardial access was successful in 12 patients. Bi- and unipolar mapping was successfully performed and analyzed in 11 subjects. LAVA was present in all but one patient on endocardial surface and in 9 (82%) out of 12 patients on epicardial surface. Localization of endocardial and epicardial LAVA coincided in 8 (67%) patients suggesting transmural ischemic scar. One patient had only epicardial scar, 1 patient had septal endocardial scar without LAVA on the epicardial surface. In one patient LAVA sites were localized on different left ventricle walls. More extensive unipolar than bipolar endocardial scar area was found (11,8 (IQR:2,0;31,6) vs 45,8 (IQR:17,1;86,5) сm2; р=0,03). Epicardial unipolar scar area prevailed over bipolar scar area: median 46.0 cm2 (IQR: 15.9;55.5) vs 107.7 cm2 (IQR: 84.3;168.9) р=0,04. LAVA epicardial area was wider than endocardial: 19.7 cm2 (IQR: 2.3; 29.7) vs 4.1 cm2 (IQR: 0.4; 23.8) р=0.03. Conclusion according to the results of our pilot study in unselected patients with ischemic VT, epicardial arrhythmogenic substrate was detected in 82% of cases. Epicardial LAVA area significantly prevailed over endocardial LAVA area.
50
Soares, Raquel Reis, Maria Clara Martins Avelar, Sofia Lucena Zanetti, Joao Victor Tavares Mendonça Garreto, Vinicius Dinelli Guimaraes, Elisa Soares Ferber, Mayumi de Oliveira Drumond, Matheus Ferber, and Leonardo Ferber. "Left ventricle endomyocardial fibrosis: a case report." Journal of Medical Case Reports 17, no. 1 (August 12, 2023). http://dx.doi.org/10.1186/s13256-023-04056-z.
Abstract:
Abstract Background Endomyocardial fibrosis is a grim disease. It is the most common restrictive cardiomyopathy worldwide, but the exact etiology and pathogenesis both remain unknown. Endomyocardial fibrosis is recurrently associated with chronic eosinophilia and probable dietary, environmental, and infectious factors, which contribute not only to the onset of the disease (an inflammatory process) but also to its progression and maintenance (endomyocardial damage and scar formation). The trademark of the disease is the fibrotic obliteration of the affected ventricle. The combination of such processes produces focal or diffuse endocardial thickening and fibrosis, which leads to restrictive physiology. Endomyocardial fibrosis affects the apices of the right and the left ventricle in around 50% of cases and most often extends to the posterior leaflet of the mitral valve. Sometimes it involves the papillary muscle and chordae tendineae, causing atrioventricular valve dysfunction. The fibrosis does not affect extracardiac organs. This cardiomyopathy is most recurrent in tropical areas of the world. Case presentation A 67-year-old Black male with past medical history of schistosomiasis infection in childhood presented with progressive dyspnea, lower extremity edema, and weakness for 2 years. He was diagnosed with endomyocardial fibrosis. The echocardiogram showed an increased thickness in the septum (17 mm) and free left ventricular wall (15 mm), obliteration of the left ventricular apex and inflow tract, and mitral valve regurgitation. Cardiac magnetic resonance imaging revealed apical left ventricle wall thickening with left ventricular apical obliteration associated with enlargement of the respective atrium. Delayed enhancement imaging showed endomyocardium enhancement involving left ventricular apex, mitral valve regurgitation due to annulus dilation, and a thrombus at left ventricular apex. He underwent open heart surgery with mitral valve replacement, endocardial decortication, endomyocardiectomy, and two-vessel coronary artery bypass grafting as preoperative coronary angiogram showed mild right coronary artery and proximal left anterior descending artery severe lesions. Postoperative course was uncomplicated, and he was discharged successfully from the hospital. Six months after surgery, he was New York Heart Association functional class I. Conclusion The purpose of this case report is to illustrate the aspects of endomyocardial fibrosis by reporting a case of this entity. In conclusion, progress in imaging techniques and treatment in a reference institution for cardiac diseases contribute to earlier diagnosis and survival in patients with endomyocardial fibrosis.