DOCSLIB.ORG

Molecular Imaging in the Clinical Evaluation of Mitochondrial Function in Myocardium

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Molecular Imaging in the Clinical Evaluation of Mitochondrial Function in Myocardium Proceedings of the World Medical Conference Molecular Imaging in the clinical evaluation of mitochondrial function in myocardium : The potential role of integrated Positron Emission Tomography Computed Tomography (PET/CT) in cardiac imaging Abdul Jalil Nordin, Wan Himratul Azliza Wan Harun, Ahmad Zaid Fatah Azman, Ahmad Fazli Abdul Aziz, Fathinul Fikri Ahmad Saad, Zul Hilmi Yaakob, Annuar Rapaie , Wan Azman Wan Ahmad Department of Diagnostic Imaging , Serdang Hospital, Abstract— Intact myocardial perfusion is a function of normal Malaysia upon approval by UPM Medical Ethic Committee. sodium potassium adenosine triphosphatase (ATPase) pump Thirty one patients diagnosed coronary artery disease were while normal myocardial viability is the function of intact prospectively recruited. Only 19 patients were finally enrolled mitochondrium. Both molecular processes can be clinically since insufficient data in the remaining 12 patients. All manipulated using non-invasive molecular imaging techniques. patients underwent pharmaceutical stress and rest myocardial Despite being a routine procedure, myocardial perfusion perfusion imaging (MPI) study using 99mTc-MIBI at Universiti imaging has inherent limitation in verifying viable myocardial Malaya Medical Centre, Kuala Lumpur upon diagnosis segments. Fluorodeoxyglucose (FDG), an analogue of glucose confirmation of ischaemic heart disease . The inclusion molecule is a gold standard biomarker in demonstrating criteria are clinical signs and symptoms of ischaemic heart viability. Integrating the two molecular processes in a clinical disease, raised cardiac enzymes, electrophysiological changes study will define and classify viable from non viable and evident from imaging modalities like cardiac scintigraphy myocardial segments. The function of viable myocardial using 99mTc-MIBI, echocardiography and Magnetic Resonance segments may benefit revascularization procedure while Imaging.. Exclusion criteria include childrens and pregnant function has not been successfully revearsible after mothers. Only patients who underwent pharmaceutical stress revascularization in infarcted scared myocardium. and rest cardiac scintigraphy study are recruited. The objective of this study is to assess the concordant and Patients demonstrating perfusion defect during rest 99mTc- discordant results obtained when hypoperfused segments at MIBI were referred to Centre for Diagnostic Nuclear Imaging resting MPI are being compared with myocardial viability of Universiti Putra Malaysia for further assessment using 18F- study using new integrated diagnostic imaging modality FDG PET/CT . All patients were prepared using modified Positron Emission Tomography Computed Tomography glucose loading protocol as recommended by the updated (PET/CT) with flourodeoxyglucose (FDG) as the biomarker. version of American Society of Nuclear Cardiology. The usefulness of flourodeoxyglucose as a potential viability Patients were instructed to be fasting for at least 8 hours on the PET agent in the assessment of myocardium is elucidated day of examination. Patients known to have diabetes mellitus from this study. follow routine medication. Fasting blood sugar was checked early in the morning to ensure that patients are fasted. 1 hour prior to serial blood glucose tests alternating with I. METHODOLOGY subcutaneous short acting insulin, patients were given 200mg he study was conducted in collaboration between of oral Niacin ingestion to facilitate myocardial glucose Diagnostic Nuclear Imaging Centre, Universiti Putra uptake. Once the blood glucose reached the desired level, 8- 18 TMalaysia (UPM), Cardiology Unit, Universiti Malaya 10mCi F-FDG given intravenously. Patient was rested for Medical Centre and Department of Cardiology and not less than an hour prior to PET/CT image acquisition . 18F-FDG PET/CT study was conducted using 64MDCT/PET Biograph Siemens Medical Systems, Germany. A CT scout Abdul Jalil Nordin1, Wan Himratul Azliza Wan Harun2 , Ahmad Zaid Fatah view was first obtained over the heart to plan the study. A low Azman1, Ahmad Fazli Abdul Aziz1, Fathinul Fikri Ahmad Saad1, Zul Hilmi 2 3 2 dose CT was performed for attenuation correction and Yaakob ,Annuar Rapaie , Wan Azman Wan Ahmad anatomical correlation. The offset value is -30 to 0 on X and Y 1 Diagnostic Nuclear Imaging Centre, Universiti Putra Malaysia respectively. List mode replay for gated study sampled 10 2 Cardiology Unit, University Malaya, Kuala Lumpur, Malaysia gates with 100% phase up to 600 second duration. The average 3 Serdang Hospital, Selangor, Malaysia trigger rate is 64 per minute where trigger rejection threshold ISBN: 978-1-61804-036-7 118 Proceedings of the World Medical Conference based on approximately 20% of average. The total acquisition PET/CT for comparison. The discordant and concordant time was 30 min for emission (three-dimensional mode) and between rest MPI and FDG viability findings are tabled CT transmission at the cardiac region. Attenuation-corrected (table 3). data were reconstructed using a 3-dimensional iterative 4 and There were 36 concordance and 63 discordance between rest subsets 8. The Gausan filter is being utilized with full width 99mTc-MIBI and 18F-FDG viability. The contingency table height maximum of 5 mm with a zoom factor of 2 and pixel (table 4) demonstrate low sensitivity (11.4%) in detecting size of 2.03642. viable but hibernating segments in visibly myocardial defect Images were analyzed by Nuclear Radiologist and at rest MPI study. Thus, poor negative predictive value Cardiologist blinded to other imaging results particularly the (NPV=31.1%) in differentiating hibernating from infarcted myocardial SPECT MPI using 99mTc-MIBI. All images were segments in this study. K test demonstrate non-statistical aligned to cardiac planes in short axis, vertical and horizontal significant with p >0.05. long axis. A 20-segment model was used with the anterior insertion of the right ventricular free wall into the left ventricle serving as the landmark. The quality of uptake by myocardium III. DISCUSSION and distribution are assessed. Hot iron scale and grey scale Conventional imaging technique like MR, CT and were employed for image analysis. The alignment of the PET echocardiography have been widely utilized for myocardial and CT images were checked and manually corrected to ensure viability assessment in addition to 201Thallium and the rim of FDG activity align well with the wall of 99mTechnetium tagged agents. In PET, 18F-FDG is the tracer myocardium. Perfusion defects as defined as absent or no most frequently used to assess myocardial viability. Since 18F- perfusion is seen as visual decrease or absent in radioactivity. FDG is a glucose analogue, the substance is used to evaluate All segments were examined systematically. Apparent defects cardiac glucose utilization where mitochondria plays pivotal as a result of artefacts from bowel activities and patient role in its utilization . The initial uptake in myocardial tissue is movement shall be excluded. Gated dynamic images examined comparable to glucose uptake. After phosphorylation, 18F- thoroughly looking for generalized and segmental movement FDG-6-PO4 is trapped within cardiac tissues and the disorders. The ejection fraction, end diastolic and systolic metabolism ends before the Kreb Cycle enabling imaging due volume were assessed. The conclusions recorded following to the strong signal from radiation source emitted by 18F- careful evaluation of above mentioned parameters. A resting isotope. Cardiac uptake of FDG is depending on several sestamibi SPECT myocardial perfusion defect which is seen to factors including plasma levels of insulin and free fatty acids. be reperfused during FDG PET/CT study is considered viable Insulin stimulates cardiac glucose uptake but free fatty acids or hibernating. A matched resting MPI and viability defect is inhibit. We mimicked the situation in our patients by oral considered as infarcted or scarred myocardium. Results were glucose loading and stimulate insulin level by intramuscular analyzed using SPSS version18. injection and successfully demonstrate satisfactory segmental FDG uptake in the myocardium using this technique except in II. RESULTS one patient. Myocardial preference in using fatty acid rather Data from these patients (n=19) were analyzed (Table 1) . than glucose for metabolism is unpredictable among diabetics Male gender predominate female. The mean age is 58.4 ± 10.8 such as in this particular case where a defect was found during (mean ± sd) ranging between 41 to 79. FDG viability study despite good segmental perfusion. 6 patients demonstrated normal left ventricular function where 2 showed evidence of hibernating myocardium and remaining Myocardial hibernation and stunning are two entities that may 4 having 1 infarcted segment at viability study . 9 patients had coexist in patients with ischemic cardiomyopathy. The uptake evidence of ischaemic cardiomyopathy with cardiomegaly and and retention of sestamibi are dependent on perfusion, cell poor ejection fraction. The highest number of myocardial membrane integrity, and mitochondrial function. Thus, segments involvement is 11 where the patient demonstrate sestamibi uptake during MPI is also a marker for viability of gross cardiomegaly and ejection fraction below 20%. 4 myocytes. Rahimtoola described hybernating as chronic patients demonstrated poor ejection fraction with normal size sustained abnormal contraction attributable to chronic of left ventricular chamber. The most frequent
Load more

Recommended publications
  • Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy
    CLINICAL INVESTIGATIONS Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy Arend F.L. Schinkel, MD, PhD1; Jeroen J. Bax, MD, PhD2; Ron van Domburg, PhD1; Abdou Elhendy, MD, PhD1; Roelf Valkema, MD, PhD3; Eleni C. Vourvouri, MD, PhD1; Fabiola B. Sozzi, MD, PhD1; Jos R.T.C. Roelandt, MD, PhD1; and Don Poldermans, MD, PhD1 1Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; and 3Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands Because of damage to cardiomyocytes and the contractile appa- In patients with ischemic cardiomyopathy, distinguishing ratus, contractile reserve may be observed less frequently in hi- between hibernating, stunned, and scarred myocardium may bernating than in stunned myocardium. The aim of this study was have important implications for clinical management and to assess the presence of contractile reserve in response to do- butamine infusion in a large group of patients with stunned and outcome. If hibernating or stunned myocardium is present, hibernating myocardium. Methods: A total of 198 consecutive coronary revascularization may not only reverse regional patients with ischemic cardiomyopathy (left ventricular ejection wall motion abnormalities but also improve global function, fraction Յ 40%) underwent resting 2-dimensional echocardiogra- heart failure symptoms, and survival (1–3). Hibernating phy to assess regional contractile dysfunction. On the basis of myocardium has been defined as a chronic state of contrac- assessment of perfusion (with 99mTc-tetrofosmin SPECT) and glu- tile dysfunction with reduced blood flow at rest (4,5). Fre- 18 cose use (with F-FDG SPECT), dysfunctional segments were quently, however, regional perfusion in chronic dysfunc- grouped.
    [Show full text]
  • Positron Emission Tomography and Myocardial Imaging
    Heart 2000;83:475–480 (generally a cyclotron).1 Production of isotopes IMAGING TECHNIQUES with the shortest half lives has to be carried out in the vicinity of the scanner and necessitates the installation of cyclotron and radiochemis- Positron emission tomography and try facilities. However, 18F compounds can be delivered from a relatively remote site of myocardial imaging production. The commercial success of PET has been driven by 18F labelled fluorodeoxyglu- 475 Paolo G Camici cose (FDG) which is used to measure glucose MRC Cyclotron Unit, Imperial College School of Medicine, metabolism in tissues. Because of the longer Hammersmith Hospital, London, UK half life of 18F (table 1), many centres rely on production from a centralised cyclotron, thus avoiding the expense of individual facilities. maging with positron emission tomography However, research centres aiming to derive (PET) oVers unrivalled sensitivity and spe- most from the power of PET require on site Icificity for research into biochemical path- production of a range of tracers. ways and pharmacological mechanisms in vivo. Cardiac and neurological research with PET Positron emission and detection has flourished over the past 20 years, but it is Positrons are emitted with a continuous range only more recently that cardiology has begun to of energies up to a maximum, which is charac- benefit from the advantages provided by PET. teristic of each particular isotope (table 1). The From the physical point of view, scanning of positron is successively slowed down by the heart presents a challenge because of Coulomb interaction with atomic electrons greater complications in correcting for photon and “annihilates” with an electron when its attenuation and scattered radiation, and be- energy has been reduced close to zero, resulting cause of movement of the heart and lungs.
    [Show full text]
  • Noninvasive Characterization of Stunned, Hibernating, Remodeled and Nonviable Myocardium in Ischemic Cardiomyopathy Jagat Narula, MD, PHD, FACC, Martin S
    Journal of the American College of Cardiology Vol. 36, No. 6, 2000 © 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00959-1 Cardiomyopathy Noninvasive Characterization of Stunned, Hibernating, Remodeled and Nonviable Myocardium in Ischemic Cardiomyopathy Jagat Narula, MD, PHD, FACC, Martin S. Dawson, MD, Binoy K. Singh, MD, Aman Amanullah, MD, Elmo R. Acio, MD, Farooq A. Chaudhry, MD, FACC, Ramin B. Arani, PHD, Ami E. Iskandrian, MD, FACC Philadelphia, Pennsylvania OBJECTIVES We evaluated a novel protocol of dual-isotope, gated single-photon emission computed tomographic (SPECT) imaging combined with low and high dose dobutamine as a single test for the characterization of various types of altered myocardial dysfunction. BACKGROUND Myocardial perfusion tomography and echocardiography have been used separately for the assessment of myocardial viability. However, it is possible to assess perfusion, function and contractile reserve using gated SPECT imaging. METHODS We studied 54 patients with ischemic cardiomyopathy using rest and 4 h redistribution thallium-201 imaging and dobutamine technetium-99m sestamibi SPECT imaging. The sestamibi images were acquired 1 h after infusion of the maximal tolerated dose of dobutamine and again during infusion of dobutamine at a low dose to estimate contractile reserve. Myocardial segments were defined as hibernating, stunned, remodeled or scarred. RESULTS Severe regional dysfunction was present in 584 (54%) of 1,080 segments. Based on the combination of function and perfusion characteristics in these 584 segments, 24% (n ϭ 140) were labeled as hibernating; 23% (n ϭ 136) as stunned; 30% (n ϭ 177) as remodeled; and 22% (n ϭ 131) as scarred.
    [Show full text]
  • Amit R. Patel MD, FACC Associate Professor of Medicine and Radiology Director Cardiac MRI and CT
    Disclosures: Research support from Philips Research grant & Speaker’s Bureau Astellas Research grant from General Electric Research grant from Myocardial Solutions Off-label use of contrast agents Off-label use of adenosine/ regadenoson Utility of Cardiac MRI in Heart Failure Amit R. Patel MD, FACC Associate Professor of Medicine and Radiology Director Cardiac MRI and CT Cardiac Magnetic Resonance: A Multi-Parametric Evaluation Other Myocardial Processes Cine CMR Myocardial Myocardial Ischemia Scar (LGE) Myocardial Myocardial Fibrosis Capillary Leak (T1-W) Edema (T2-W) (T1-mapping) CMR and Heart Failure | 2 The Mother Holter Monitor • 33 year old woman with no significant past medical history. • Following birth of 2nd child, she developed CHF and palpitations. EKG Predominant Rhythm = NSR Occasional PVCs (2% of total QRS complexes) Frequent Bigeminy (noted particularly with symptomatic palpitations) Rare PACs(<1% of QRS complexes) 1 SVT Run (8 beats) No pauses No evidence for AV dissociation or block CMR and Heart Failure | 3 The Mother: Echocardiogram Clinical Diagnosis: Peripartum Cardiomyopathy CMR and Heart Failure | 4 The Mother: Cardiac Magnetic Resonance Genetic Testing: PKP2 (plakophylin 2) and Asn557Asp, likely Pathogenic. CMR and Heart Failure | 5 Final Diagnosis: Arrhythmogenic Right Ventricular Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy • Inherited cardiomyopathy characterized by fibro-fatty replacement of the RV myocardium • Increased risk of ventricular tachycardia and right heart failure • Typically
    [Show full text]
  • Cardiac F-18 FDG PET
    Cardiac F-18 FDG PET Table 3. Cardiac F-18 FDG PET Table 4. Elements of a comprehensive FDG report Parameter Recommendation Sections Information included Tracer dose (mCi) 5-10 (3D mode); Demographics • Patient demographics 10-15 (2D mode) • Study indications • Coronary anatomy if known Delay after injection (min) 45-60 (nondiabetics); and 2). Use of IV insulin (even in non-diabetic patients) is OVERVIEW 60-90 (diabetics) Methods • Technique and radiotracer dose for desirable whenever feasible in order to promote maximum perfusion and FDG imaging The purpose of this document is to specifically uptake of FDG by the normal myocardium and optimal Patient positioning Supine position • Stress test hemodynamic informa- identify the critical steps involved in perform- image quality. Following FDG injection, monitoring of the (arms up preferred) tion (when available) ing and interpreting a myocardial viability patient’s glucose levels should be continued until a stable Imaging mode 2D or 3D; list, gated or • Glucose loading technique study with F-18 labeled fluoro-deoxyglucose glucose level is ensured and the patient is asymptomatic. static (glucose load and insulin) (FDG) positron emission tomography (PET). Diabetic Patients: Diabetic patients have a limited ability This document will cover indications, patient Image duration (min) 10-30 (depends on count Findings: • Size, severity, and location of the to produce endogenous insulin and are less responsive to rate and dose) MPI and FDG stress (when available) and rest preparation, testing procedure, interpreta- insulin. For these reasons, standard glucose loading tech- perfusion defects tion, and reporting for FDG PET. niques may be less effective in such patients.
    [Show full text]
  • Detection of Myocardial Viability with Positron Emission Tomography in a Patient with Ischemic Cardiomyopathy
    Detection of Myocardial Viability with Positron Emission Tomography in a Patient with Ischemic Cardiomyopathy Case Presentation: David Weiss Discussion: Howard J. Eisen Guest Editor: Abass Alavi Nuclear Medicine Division, Department ofRadiology and the Cardiovascular Section, Department of Medicine, Hospital ofthe University ofPennsylvania, Philadelphia, Pennsylvania Physical exam revealed a blood pressure of 100/60 J NucI Med 1991; 32:130—135 and a regular pulse of 100. Sharp discs were present on fundiscopic exam with no arteriovenous nicking. Ca rotid artery pulseswere normal with no bruits, and no CASEPRESENTATION jugular venous distention was present. The lungs were clear to auscultation and percussion. Cardiac exam A 52-yr-old man became unresponsive while riding revealed a regular rate, a soft Il/VI systolic ejection in a van driven by his son in August 1989. The son murmur at the lower sternal border, and the presence stopped the van, found the patient to be without spon of an S4. No S3 was heard. Abdominal exam was taneous respirations or pulse, and started cardiopul remarkablefor slight hepatomegaly.The spleenwasnot monary resuscitation. He was aided by a passerby, but enlarged. No peripheral edema, cyanosis, or clubbing approximately 30—45mm elapsed before spontaneous was present. respirations returned. Enroute to a nearby hospital, the Electrocardiographic findings included sinus tachy patient was described as being cyanotic with a very cardia with evidence of right atrial enlargement. Left weak pulse. In the emergency room, the patient was axis deviation was present and poor R-wave progression lethargic, and later combative, agitated, and confused. across the precordium was noted. No Q-waves, ST Premature ventricular contractions were noted and, segment, or T-wave abnormalities were present.
    [Show full text]
  • Acute Myocardial Infarction Complicated with Ventricular
    Acute Myocardial Infarction Complicated With Ventricular Tachycardia Infarto Agudo del Miocárdio complicado con taquicardia ventricular Infarto agudo do miocárdio complicado com taquicardia ventricular Where is located the “culprit” artery? ¿Donde está localizada la artéria culpada? Onde está a artéria culpada? Which is the diagnose of the sustained tachyarrhythmia? ¿ Cual es el diagnóstico de la taquiarritmia? Qual o diagnóstico da taquiarritmia? When polymorphic VT appears ST segment elevation degree decreases. Reperfusion Arrhythmia? Coronary angiography showed coronary oclusion + Stent primary angioplasty. Cuando la TV polimorfa aparece la elevación del segmento ST disminuye: ¿Arritmia de reperfusión? Coronariografia mostró oclusão con angioplastia primaria + Stent. Quando a TV polimórfica aparece a elevação do segmento ST diminui: Trata-se de arritmia de reperfusão? A coronariografia mostrou oclusão com angioplastia primária + stent Case from Dr Oscar Pellizón MD Argentine Caro Andrés: O infarto é de localização ântero-lateral e a artéria culpada, provalmente é a DA. A taquicardia ventricular pode representar neste caso, arritmia de reperfusão. Sabemos que as arritmias de reperfusão se manifestam, em se tratando de taqui-arritmias, seja como TVNS, TV-Sustrentada, ritmo idioventricular acelerado ,torsades de pointe e fibrilação ventricular, seja por reperfusão espontânea, seja determinada por angioplastia coronária Um grande abraço do amigo Hélio Germiniani. Dear Andrés: The myocardial infarction is located in anterolateral wall, and the culprit artery, is probably the left anterior descending artery (LAD). Ventricular tachycardia can represent in this case a reperfusion arrhythmia. We know that reperfusion arrhythmias manifest in the case of tachyarrhythmias as non-sustained ventricular tachycardia (NS-VT), sustained ventricular tachycardia(S-VT), accelerated idioventricular rhythm, torsades de pointes and ventricular fibrillation, either by spontaneous reperfusion, or determined by coronary angioplasty A big hug from friend Professor Dr.
    [Show full text]
  • Is There an Association Between Hibernating Myocardium and Left Ventricular Mechanical Dyssynchrony in Patients with Myocardial Infarction?
    Original Article Is there an association between hibernating myocardium and left ventricular mechanical dyssynchrony in patients with myocardial infarction? Abstract Objective: Left ventricular mechanical dyssynchrony (LVMD) is an important factor in the prognosis of pati- Feifei Zhang1 MD, 1 ents with myocardial infarction (MI). The aim of this study was to identify the correlation between LVMD and Wei Yang MD, hibernating myocardium in MI patients by radionuclide myocardial imaging. Subjects and Methods: This Yuetao Wang1 MD, 2 study consisted of 91 patients who had a history of denite prior MI and underwent both technetium-99m Haipeng Tang MS, 99m 1 methoxyisobutylisonitrile ( Tc-MIBI) gated single photon emission tomography (SPET) myocardial perfu- Jianfeng Wang MD, sion imaging (MPI) and uorine-18 uorodeoxyglucose (18F-FDG) positron emission tomography (PET) my- Xiaoliang Shao1 MD， ocardial metabolic imaging. Left ventricular (LV) functional and LVMD parameters were measured from ga- Ziyi Wang3 BS, ted SPET MPI, while myocardial viability was assessed by the integral quantitative analysis of SPET MPI and 18 Xiaoying Zhang4 MD, F-FDG PET. Left ventricular MD was dened as >mean+2SD of phase bandwidth (PBW) in the control gro- Ling Yang5 PhD, up. Results: Left ventricular MD was present in 37/91 (40.7%) MI patients. The extent of hibernating myo- Xiaosong Wang1 MD, cardium (SPET/PET mismatch) and scar (SPET/PET match) in patients with LVMD was signicantly higher Weihua Zhou2 PhD than in patients without LVMD (15.24±11.26% vs 4.89±5.41%, P<0.001; 11.11±9.42% vs 4.72±5.71%, P< 0.001; respectively).
    [Show full text]
  • Myocyte Degeneration and Cell Death in Hibernating Human Myocardium
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector JACC Vol. 27, No. ‘7 June 19964577-85 1577 MYOCARDIAL ISCHEMA Myocyte Degeneration and Cell Death in Hibernating Human Myucardium ERNST R. SCHWARZ, MD, JUTTA SCHAFER, MD,* JUERGEN VOM DAHL, MD, CARSTEN ALTEHOEFER, MD, BEATE GPOHMANN, TA,* FRiEDRICH SCHOENDUBE, MD, MS, FLORENCE H. SHEEHAN, MD.t RAINER UEBIS, MD, UDALRICH BUELL, MD, BRUNO J. MESSMER, MD, FACC, WOLFGANG SCHAPER, MD,* PETER HANRATH, MD, FACC Aachen am-l Bad Nauheim, Germany; and Seattk, Washington - --. O&etives. Tbe aim of this study wns to analyze the morpho- logic characteristics of myocyte degeneration ieadiag to replete- etai proteins titia a& aipita-actinin. Eiectroi microsc&of the q eot ftbrosis in hibernating myocardium by use of electron ceil organeiies and immunoldetochemlral aaaiysis of the eytasimi- microscopy and immunobistochemkai tecimiques. etonsbowedasimilarityintbedegweofd aiteNuone. Baekgtwmd. Data on tbe uitrastructure aad the cytoskeieton of Group 1(0 = 11) replusellted patients with ouiy aliuor atrucwai dterations, whereas group 2 (II = W) showed severe morpitkgk or deiayed tkmctionai recovery might be due to a variable degree of degeuerative cboges. Wall motion abnormalities shrewd pastup cardiomyoeyte degeneration in hiberaating mywardium. emtive improv~ets, and msdaar imaghg mealed a per&&m Me&oak In 24 patients, regionai waii motion abaonuaiities metabolism mismatch wit&out signllkmt di&- between the were analyzed by use of the cwtteriine method before and 6 f 1 PUPS. months after coronary artery bypass surgery. Preoperative tecimetium-9Pm sestamibi uptake was measured by singi~photoa emission computed tomograpay for assessing regjonat perfkufion.
    [Show full text]
  • Stunned Myocardium Due to Decompensation from Hypovolemic Shock in a Pregnant Woman with Uterine Atony Following Cesarean Sectio
    & Experim l e ca n i t in a l l C C f a Journal of Clinical & Experimental o r d l i a o n l o r g u Lee, et al., J Clin Exp Cardiolog 2016, 7:5 y o J Cardiology ISSN: 2155-9880 DOI: 10.4172/2155-9880.1000448 Case Report Open Access Stunned Myocardium due to Decompensation from Hypovolemic Shock in a Pregnant Woman with Uterine Atony Following Cesarean Section Lee HS1*, Hans C1, Visco F2, Mushiyev S2 and Pekler G2 1Department of Medicine, Metropolitan Hospital, New York Medical College, New York, USA 2Division of Cardiology, Department of Medicine, Metropolitan Hospital, New York Medical College, New York, USA *Corresponding author: Lee HS, Department of Medicine, Metropolitan Hospital, New York Medical College, New York, USA, Tel: 212 423 8456; Fax: 212 423 6338; E- mail: [email protected] Received date: April 05, 2016; Accepted date: May 30, 2016; Published date: May 31, 2016 Copyright: © 2016 Lee HS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Transient post ischemic left ventricular dysfunction has been called stunned myocardium. The stunned myocardium can lead cardiac problems such as arrhythmias, left ventricular dysfunction, and a myocardial infarction. Stunned myocardium is a reversible condition. In this case, a 25 year old female patient with a history of mild intermittent asthma became hypovolemic and got into shock after developing uterine atony following a cesarean section.
    [Show full text]
  • Retrospective Fatal Event Due to Simultaneous Multivessel Coronary Spasm Stefan Peters
    ORIGINAL ARTICLE Back to the Roots: Retrospective Fatal Event Due to Simultaneous Multivessel Coronary Spasm Stefan Peters Department of Cardiology, Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinburg, Germany ABSTRACT Introduction: Hibernating myocardium due to multivessel coronary spasm was first described in 1991. Methods and Results: In 1997, we saw the female patient after hysterectomy with profound hypotension in the cath lab. An ischemic event was suggested, the electrocardiography revealed ST elevation in all leads. A multivessel coronary spasm was found, after initial solution of spasm with i.a. verapamil, no coronary lesions were seen. Conclusion: Retrospectively, this was one the first reports with fatal event. As in the follow-up, the multivessel spasm could not be constantly solved the patient died. Key words: Hibernating myocardium, multivessel coronary spasm, takotsubo syndrome, verapamil INTRODUCTION administration of verapamil at a dosage of 6.25 ml in both ostia, coronary angiography could be done without any ibernating myocardium due to simultaneous lesions. Paradoxically, blood pressure after verapamil multivessel coronary spasm was first described by infusion was 80/60 mm of mercury. The examination was Dote et al.[1] in 1991. Not until 2000 and 2001, the finished and the patient went to the intensive care unit. Four H hours later, the patient died of acute development of recurrent term “takotsubo cardiomyopathy” was initiated describing left ventricular appearance with apical ballooning with non- hypotension. obstructed coronary arteries. DISCUSSION METHODS AND RESULTS Prolonged, post-ischemic left ventricular dysfunction due Retrospectively, in 1997, we saw a female patient 68 years to spasm,[1] myocardial bridging,[2] recurrent segment of of age directly from the surgical theatre in the cath lab of the the left anterior descending coronary artery,[3] and transient hospital of Quedlinburg, Germany.
    [Show full text]
  • Hibernation and Heart Failure P G Camici
    141 MINI-SYMPOSIUM Heart: first published as 10.1136/hrt.2003.016626 on 16 January 2004. Downloaded from Hibernation and heart failure P G Camici ............................................................................................................................... Heart 2004;90:141–143. doi: 10.1136/hrt.2003.023119 eart failure accounts for approximately 20% of all in the infarcted and hibernating segments. The changes in hospital admissions among people over 65, and in the ventricular geometry, local wall strain, and filling pres- past 10 years the hospitalisation rate has increased by sures combine to increase the metabolic requirements of H 1 almost 160%. Although different large randomised trials such myocardium which, while ‘‘remote’’ from the site of carried out during the past two decades have demonstrated a infarction, adopts a ‘‘crucial’’ role in maintaining cardiac significant reduction in mortality for heart failure patients output. These segments undergo compensatory hypertro- treated medically, symptomatic heart failure continues to phy, but in the long term adverse ‘‘remodelling’’ and have a one year mortality close to 45%.23 ventricular dilatation occurs leading to heart failure.1 In an effort to improve the early recognition of heart failure, the American College of Cardiology and the American Based on available studies, it is logical to assume that the Heart Association have recently proposed a new approach to beneficial effect of coronary revascularisation in heart fail- the classification of heart failure based on four progressive ure derives primarily from recovery of contractile function stages.4 This new categorisation emphasises the evolution in hibernating segments which, in turn, may attenuate 8 and progression of heart failure and is quite different from remodelling.
    [Show full text]