Experimental diabetes upregulates the expression of uretereral endothelin receptors

We investigated the binding characteristics of endothelin (ET) receptors in the ureters of rats with experimentally induced diabetes and diuresis. Receptor binding experiments demonstrated an upregulation in the expression of [125I]ET-1 binding sites in the diabetic rat ureter but not in the diuretic rat ureter. ET-1, ET-3, IRL 1620, and BQ 610 inhibited [125I]ET-binding to the rat ureter consistent with the predominance of ETA receptors in these tissues. The subtype specificity of ET receptors in ureteral tissues was confirmed with inhibition data obtained from cloned human ETA and ETB receptors.

Bacterial infection induces nitric oxide synthase in human neutrophils

The identification of human inflammatory cells that express inducible nitric oxide synthase and the clarification of the role of inducible nitric oxide synthase in human infectious or inflammatory processes have been elusive. In neutrophil-enriched fractions from urine, we demonstrate a 43-fold increase in nitric oxide synthase activity in patients with urinary tract infections compared with that in neutrophil-enriched fractions from noninfected controls. Partially purified inducible nitric oxide synthase is primarily membrane associated, calcium independent, and inhibited by arginine analogues with a rank order consistent with that of purified human inducible nitric oxide synthase. Molecular, biochemical, and immunocytochemical evidence unequivocally identifies inducible nitric oxide synthase as the major nitric oxide synthase isoform found in neutrophils isolated from urine during urinary tract infections. Elevated inducible nitric oxide synthase activity and elevated nitric oxide synthase protein measured in patients with urinary tract infections and treated with antibiotics does not decrease until 6-10 d of antibiotic treatment. The extended elevation of neutrophil inducible nitric oxide synthase during urinary tract infections may have both antimicrobial and proinflammatory functions.

Nitric oxide synthase induction with renal transplant rejection or infection

Nitric oxide (NO) is readily oxidized to nitrate and nitrite and NO activates guanylyl cyclase, increasing cyclic GMP levels. To determine if nitric oxide synthase (NOS) is present in urine collected daily from patients following renal transplantation, we evaluated NOS activity in the leukocyte-rich particulate fraction and measured nitrate, nitrite, and cyclic GMP levels in the supernatant fraction of the urine. Reverse transcriptase-PCR and cDNA sequencing confirmed the presence of inducible NOS (iNOS) in cells obtained from the urine of renal transplant patients with rejection. NOS activity was elevated significantly in renal transplant patients with rejection (6.40 +/- 1.47 pmol citrulline/min/mg protein) or with urinary tract infection (29.56 +/- 11.00 pmol citrulline/min/mg protein), when compared to post-renal transplantation patients without rejection or urinary tract infection (0.51 +/- 0.21 pmol citrulline/min/mg protein). Nitrate levels increased in renal transplant patients with rejection and nitrite levels increased in renal transplant patients with urinary tract infection (UTI). Cyclic GMP levels increased with both rejection and UTI. This study demonstrates the presence of NOS activity and inducible NOS-mRNA in cells isolated from the urine of patients undergoing renal allograft rejection.

Characterization of endothelin receptors in streptozotocin-induced diabetic rat vas deferens

As there is increasing evidence that diabetes induces changes in the plasma levels of endothelins (ETs) and in the properties of ET receptors in peripheral tissues, and as there are reports indicating the presence of significant amounts of ET receptors in mammalian vasa deferentia, we studied possible alterations in ET receptor characteristics in the vasa deferentia of the following groups of rats: 8 weeks diabetic (D8), 8 weeks age-matched control (C8), 16 weeks diabetic (D16), 16 weeks diabetic-insulin-treated (started 8 weeks after the onset of diabetes) (DI16), and 16 weeks age-matched control (C16). Diabetes was induced by the i.v. injection of 65 mg/kg streptozotocin (STZ). Diabetic rats had hyperglycemia, hypoinsulinemia, glucosuria, polydipsia, and polyuria and had smaller vasa deferentia than control and diabetic-insulin-treated animals. Receptor binding experiments with [125I]ET-1 demonstrated that the densities of ET receptors in vasa deferentia from D8, C8, D16, DI16, and C16 animals were 377 +/- 11, 255 +/- 24, 315 +/- 18, 210 +/- 12, and 214 +/- 7 fmol/mg of protein, respectively. [125I]ET-1 binding to the ET receptors was inhibited by ET-1 (non-selective), BQ 610 (ETA selective), ET-3 (ETC selective), and IRL 1620 (ETB selective) with the following rank order of Ki values: ET-1 < BQ 610 < ET-3 < < IRL 1620. The pharmacological profile of the ET receptors was similar in all groups and was consistent with the predominance of the ETA receptor subtype in the rat vasa deferentia. Our data indicate that experimental diabetes up-regulates the density of ET receptors in the rat vasa deferentia and that the receptor up-regulation is reversed by insulin treatment.

Case presentation: a patient with von Willebrand disease with menorrhagia

A 42-year-old woman who had two normal uncomplicated vaginal deliveries was seen for menorrhagia. Endocrine studies and ultrasonography had normal results. An elevated bleeding time and an activated partial thromboplastin time led to further hematologic testing. Final testing revealed abnormalities in the von Willebrand factor antigen, which led to a diagnosis of mild type I von Willebrand disease.

Effect of experimental diabetes on rat prostate endothelin receptors

We studied the properties of endothelin receptors in the prostate of 8-week streptozotocin-diabetic and control rats. The density of endothelin receptors, as determined by saturation experiments with [125I]endothelin-1, were 95.8 +/- 5.4 and 171.3 +/- 16.7 fmol/mg of protein in control and diabetic rat prostates, respectively. The pharmacological profile of the endothelin receptors was similar in both groups and was consistent with the predominance of the endothelin ETA receptor subtype in the prostate. Thus, the induction of diabetes upregulates the expression of endothelin receptors in the rat prostate, but does not alter the pharmacological profile of the receptors in these tissues.

Urinary nitric oxide synthase activity and cyclic GMP levels are decreased with interstitial cystitis and increased with urinary tract infections

PURPOSE

Since urinary nitric oxide synthase (NOS) activity correlates with certain disease process affecting the urinary tract and since nitric oxide increases cyclic GMP levels by activating guanylyl cyclase, urinary particulate NOS activity and cyclic GMP levels are evaluated in female patients with interstitial cystitis (IC) and compared with those from female controls and female patients with urinary tract infections (UTIs).

MATERIALS AND METHODS

Urinary NOS activity is measured as the formation of [(14)C]-L-citrulline from [(14)C]-L-arginine, and urinary cyclic GMP levels are measured by an [(125)I]-radioimmunoassay.

RESULTS

Female patients with IC have significantly less NOS activity in their urine pellet particulate fractions than female control females UTIs, 2.3 +/- 1.0, 14 +/- 3.0, and 120 +/- 10 pmol. citrulline formed/min./mg. protein. Urinary cyclic GMP levels are significantly lower in IC patients than in female controls or females with UTIs: 0.50 +/- 0.06, 0.82 +/- 0.14. and 3.72 +/- 0.81 micromol. cyclic GMP/g. creatinine.

CONCLUSIONS

Regulation of urinary NOS activity with subsequent changes in nitric oxide and cyclic GMP may be an important determinant of symptoms and immunologic responses to UTIs and IC.

Physiology and evaluation of ureteropelvic junction obstruction

Ureteropelvic junction (UPJ) obstruction is not a single anatomic entity but rather a set of processes with multiple causes. In the obstructed system, histologic changes are apparent that have implications for healing. The role of crossing vessels In UPJ obstruction and its treatment is of growing interest. Various methods are available to assess the functional characteristics of the UPJ, of which the diuretic renogram, Whitaker perfusion test, and Doppler ultrasound resistive index may be the most useful. The treatment must be individualized according to the patient's symptoms, the status of renal function, and the potential complications of intervention.

Enhancement of muscarinic receptor-coupled phosphatidyl inositol hydrolysis in diabetic bladder

We previously have shown an increase in muscarinic receptor density in streptozotocin (STZ)-induced diabetic and sucrose-fed diuretic rat detrusor that correlates with an increase in the contractile response to muscarinic agonist (J Pharmacol Exp Ther 248:81, 1989; Diabetes 40: 265, 1991). To investigate the signal transduction pathway involved in this altered functional response, we examined muscarinic receptor-coupled phosphatidylinositol metabolism in STZ-diabetic, sucrose-fed diuretic and age-matched control rat bladders. [3H]myo-inositol uptake was similar in all groups, but incorporation of myo-inositol into phosphatidylinositol (PI) was significantly increased in the diabetic bladder compared to the sucrose-fed and control rat bladders. Carbachol-induced increase in inositol phosphate (IPs) production was higher in the diabetic bladder than in bladders from control and sucrose-fed animals although the EC50 values were similar for all groups. Enhanced inositol phosphate production after muscarinic agonist stimulation may be due not only to the upregulation of muscarinic receptors but also the increased incorporation of myo-inositol into PI in the STZ-induced diabetic bladder.

Regional differences in the density and subtype specificity of endothelin receptors in rabbit urinary tract

We investigated the binding characteristics of endothelin (ET) receptors in rabbit ureter, bladder dome, bladder base, and urethra and compared the observed receptor properties with those of cloned human ETA and ETB receptors expressed in Chinese hamster ovary K-1 (CHO) cells. Receptor binding experiments with [125I]ET-1 revealed the presence of a single class of specific, saturable, high affinity [125I]ET-1 binding sites in all of the regions of the studied urinary tract. The rank order of the densities (Bmax values) of [125I]ET-1 binding sites was: ureter "bladder dome > bladder base = urethra. ET-1 and ET-2 inhibited [125I]ET-1 binding to the membrane particulates from the various regions of the urinary tract with single high affinity constants. A selective ETA receptor antagonist, BQ 123, and selective ETB agonists, ET-3 and sarafotoxin S6c (STXc), inhibited [125I]ET-1 binding to bladder dome, bladder base, and urethra with high and low affinity constants indicating the presence of both ETA and ETB receptor subtypes in these tissues. The subtype specificity of ET receptors in the rabbit tissues is confirmed with inhibition data obtained from similar binding studies in cloned human ETA and ETB receptors. The proportions of high affinity binding sites for ET-3, representing ETB receptors, were approximately 25%, 27%, and 46% in bladder dome, bladder base, and urethra, respectively. Corresponding values for STXc were approximately 17%, 28%, and 43% in bladder dome, bladder base, and urethra, respectively. In contrast to the findings for ET-3 and STXc, the proportions of high affinity binding sites for BQ 123, representing ETA receptors, in bladder dome, bladder base, and urethra were approximately 84%, 74%, and 60%, respectively. In ureter, these selective compounds inhibited [125I]ET-1 binding with either a low (ET-3 and STXc) or a high binding affinity (BQ 123), suggesting the presence of only a single receptor subtype (ETA) in this tissue. These data indicate that there are regional differences in the density and subtype specificity of ET receptors in the rabbit urinary tract.

Effect of carbachol and norepinephrine on phosphatidyl inositol hydrolysis and cyclic AMP levels in guinea pig urinary tract

Muscarinic cholinergic and adrenergic agonist-induced changes in [3H]-phosphatidyl inositol (PI) hydrolysis and cyclic AMP (cAMP) levels were measured in guinea pig ureter, urethra and bladder dome. In the ureter, carbachol, norepinephrine and phenylephrine rapidly increased PI hydrolysis and basal cAMP levels, but did not decrease forskolin-stimulated cAMP levels. In the bladder dome, norepinephrine and phenylephrine produced a rapid but transitory increase in PI hydrolysis, but did not affect forskolin-stimulated cAMP levels. Carbachol produced a rapid and sustained increase in PI hydrolysis and also, at high concentrations, decreased forskolin-stimulated cAMP levels. In the urethra, norepinephrine and carbachol rapidly decreased forskolin-stimulated cAMP levels and later increased PI hydrolysis. Our data suggest that the predominant second messenger system in the ureter, dome, or urethra is more dependent on the tissue than on the agonist. These tissue-specific, agonist-induced rapid changes in second messenger levels may help coordinate the contraction-relaxation phenomena necessary for urinary tract function.

Age-dependent alterations in beta-adrenergic responsiveness of rat detrusor smooth muscle

The relaxant effects of norepinephrine (NE, 10(-7) to 10(-4) M.) and isoproterenol (ISO, 10(-9) to 10(-4) M.) on maximal KCl-induced tonic contractions and the relaxant effects of ISO on contractions induced by electrical field stimulation (EFS) were measured in detrusor muscle strips obtained from 22-25 day, 90-95 day and 22-month-old male Fischer 344 rats. The maximum relaxant response to NE and ISO on KCl-induced tonic contractions decreased significantly with increasing age. The ED50 values for ISO, but not NE, increased with age. The maximum relaxant response to ISO on EFS-induced contractions also was reduced significantly in the old bladders. The relaxation effects of forskolin (10(-6) to 3 x 10(-5) M.), dibutyryl cyclic AMP (DBcAMP, 10(-4) to 3 x 10(-3) M.) and cholera toxin (10 micrograms/ml.) were examined on maximal KCl-induced contractions of the muscle strips obtained from the three age groups. The relaxant responses to forskolin decreased significantly with increasing age, whereas DBcAMP relaxed the muscle strips from the three age groups equally. Cholera toxin (10 micrograms) attenuated KCl-induced phasic contractions, and this effect was impaired in the aged rat detrusor. The density of beta-adrenergic receptors, as determined by radioligand binding with [125I]iodopindolol ([125I]-PIN) decreased with increasing age. These data demonstrate an age-related decrease in the responsiveness of the bladder detrusor to beta-adrenergic stimulation that may be related to the decreased density of beta-adrenergic receptors and decreased cyclic AMP (cAMP) production.

Assessment of cardiac volumes and left ventricular mass by cine computed tomography before and after mitral balloon commissurotomy

We used cine computed tomography (CT) to determine whether decreased mitral valve gradients and pulmonary artery pressures resulted in decreased right ventricular and atrial volumes after percutaneous mitral balloon commissurotomy (MBC). In patients treated for severe mitral stenosis, previous studies have shown that after the mitral valve gradient decreases, the left atrial volume is reduced and left ventricular stroke volume is increased. The effects of commissurotomy on right heart chamber sizes have been difficult to assess with angiography and echocardiography. Moreover, in follow-up studies performed after surgery, changes in cardiac chamber volumes occurring after the mitral valve gradient and pulmonary pressure are reduced are confounded by the effects of thoracotomy. Our group has previously demonstrated that cine CT can accurately measure both left and right cardiac chamber volumes. We studied 11 female patients before, immediately after, and at 1 year after MBC, and 9 female control subjects of comparable age. To assess cardiac chamber volumes, we used cine CT. To assess the effects of MBC, we used cardiac catheterization and Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Prediction of change in mitral valve area after mitral balloon commissurotomy using cine computed tomography

RATIONALE AND OBJECTIVES

Mitral balloon commissurotomy (MBC) can successfully increase the mitral valve area (MVA) in mitral stenosis, but the outcome is variable. In multicenter studies, qualitative echocardiographic scores obtained before MBC are only weakly predictive of the increase in MVA after MBC.

METHODS

To evaluate whether the change in MVA after MBC can be predicted by evaluating mitral valve morphology using cine computed tomography (CT), we studied 12 women with mitral stenosis and 11 female control subjects.

RESULTS

In the patients with mitral stenosis, MVA increased from 1.13 +/- 0.24 to 1.93 +/- 0.56 cm2 (P < .0001) after MBC. A standard echocardiographic score assessment of mitral valve morphology before MBC was not associated with the change in MVA after MBC in these patients (P > .20). However, the total mitral valve morphology score evaluated by cine computed tomography was strongly associated with the change in MVA after MBC (r = -.87; P < .0005). In addition, the individual morphologic characteristics of mitral valve mobility (P < .0025), leaflet thickness (P < .05), and subvalvular disease (P < .05) were significant predictors of the change in MVA after MBC.

CONCLUSION

Cine computed tomography may be useful for predicting immediate increases in MVA in patients after MBC and may be helpful for preoperative assessment of these patients.

Diabetes-induced alterations in the properties of muscarinic cholinergic receptors in rat vas deferens

Muscarinic cholinergic receptors were identified and characterized by radioligand receptor binding assay using [3H]quinuclidinyl benzilate (QNB) in rat vas deferens membrane particulates of three experimental groups: 1) 8-week diabetic, 2) 8-week diabetic insulin-treated and 3) age-matched control. Diabetes was induced by the intravenous injection of 65 mg./kg. streptozotocin (STZ). The density of muscarinic receptors (Bmax values), as determined by saturation experiments with [3H]QNB, was demonstrated to be higher in the vas deferens of diabetic rats than in the vas deferens of control and diabetic insulin-treated rats. The equilibrium dissociation constants (KD values), however, were similar in all three groups. Muscarinic cholinergic antagonists competed with [3H]QNB binding sites in the vas deferens membrane particulates with the following rank order of Ki values: atropine < methoctramine < or = 4-DAMP < AF-DX 116 < HHSiD < pirenzepine = pfHHSiD. The pharmacological profile of muscarinic receptors was similar in all three groups. Additional pharmacological studies showed a similar rank order of Ki values for vas deferens, bladder dome and heart, but this rank order was significantly different in cerebral cortex and prostate. This is consistent with the predominance of the M2 muscarinic cholinergic receptor subtype in the rat vas deferens. It is concluded that STZ-induced diabetes causes an upregulation of muscarinic cholinergic receptor density in the rat vas deferens that can be prevented by the administration of insulin.

Underestimates of serum free thyroxine (T4) concentrations by free T4 immunoassays

Different free T4 (FT4) assays often give different FT4 measurements, and conflicting measurements have been striking in nonthyroidal illness. Because FT4 immunoassays depend upon serum protein-bound T4 (PBT4) dissociation to stabilize the FT4 concentration during assay perturbations, interassay differences in perturbations combined with variation in serum PBT4 concentrations could produce discordant FT4 measurements. This study examined the effects of PBT4 on FT4 measurements obtained by direct immunoassay methods. Standard solutions with constant FT4 levels and varying PBT4 concentrations were prepared and analyzed by direct equilibrium dialysis, two-step immunoextraction, one-step labeled T4 antibody, and one-step labeled T4 analog FT4 methods. Direct equilibrium dialysis results were independent of PBT4 concentrations and gave correct measurements of serum FT4 when the PBT4 concentration was above 8 nmol/L or 0.6 micrograms/dL, but were PBT4 dependent and underestimated serum FT4 at lower PBT4 concentrations. The other three methods were PBT4 dependent and variably underestimated serum FT4 at all levels of PBT4 up to 256 nmol/L (19.9 micrograms/dL), the highest level studied. Thus, PBT4-dependent underestimates of serum FT4 occurred with all four methods, whereas the measured FT4 level at each PBT4 concentration varied widely between methods. A serum PBT4 dependent bias causes discordant FT4 measurements and probably explains the observed underestimates of FT4 in nonthyroidal illness.

Reversibility of diabetes- and diuresis-induced alterations in rat bladder dome muscarinic receptors

Previous studies from our laboratory demonstrated that 8 weeks of streptozocin (STZ)-induced diabetes and sucrose-fed diuresis resulted in increases in the density of muscarinic receptors in rat bladder dome and that early insulin treatment (started 3 days after the onset of diabetes) prevented the diabetes-induced upregulation (J Pharmacol Exp Ther 248:81-88, 1989; Diabetes 40: 1150-1156, 1991; J Urol 147:760-763, 1992). To determine whether diabetes- and diuresis-induced alterations in muscarinic receptors in rat bladder dome are reversible, we administered insulin (beginning 8 weeks after the onset of diabetes) or removed sucrose from drinking water of diuretic rats (beginning 8 weeks after the onset of diuresis). Five groups of rats were maintained for 16 weeks: 1) STZ-induced diabetic rats (65 mg/kg intravenously); 2) insulin-treated diabetic rats (5-8 U/day insulin subcutaneously beginning 8 weeks after the onset of diabetes); 3) sucrose-fed diuretic rats (5% sucrose in drinking water throughout 16 weeks); 4) sucrose-removed rats (sucrose withdrawn from drinking water after 8 weeks of the sucrose-induced diuretic state); and 5) age-matched control rats. Radioligand receptor binding experiments with [3H]quinuclidinyl benzilate showed an increase in the density of muscarinic receptors in bladder dome of diabetic and sucrose-fed rats compared with age-matched control rats. Removing the 5% sucrose from the drinking water of diuretic rats reversed the increased water intake and urine output, decreased the bladder hypertrophy that accompanied the diuretic state, and corrected the upregulation of the muscarinic receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitation of absolute regional myocardial perfusion using cine computed tomography

OBJECTIVES

The purpose of this study was to develop and test a method for quantitation of regional myocardial perfusion using cine computed tomography.

BACKGROUND

Cine computed tomography is a relatively new cardiac imaging technique with excellent temporal and spatial resolution. Application of this technique to the study of human coronary circulation could substantially broaden our knowledge of human cardiac pathophysiology. This goal has been previously approached with some success. However, no method to date has shown validated accuracy of regional perfusion measurements over the entire range of physiologically important flow states.

METHODS

Eight anesthetized dogs underwent thoracotomy for instrumentation. They were then studied during baseline flow conditions, after coronary vasodilation with intravenous dipyridamole and after coronary stenosis or occlusion. Regional myocardial perfusion was assessed by cine computed tomography using a method that includes estimates for myocardial blood volume and rate of myocardial enhancement after an aortic root contrast medium infusion. Measurements made nearly simultaneously by the radioactive microsphere method served as a reference standard.

RESULTS

A total of 32 perfusion conditions were studied with a range of 4 to 593 ml/min per 100 g. There was reasonable agreement between the two methods of measurement throughout the whole range of perfusion states: r = 0.97, regression slope 0.99, intercept 2 ml/min per 100 g. In zones not subserved by a stenosed or occluded artery, cine computed tomography accurately depicted perfusion homogeneity with a coefficient of variation of 13 +/- 1% (mean +/- SE) versus 11 +/- 1% for the microsphere method (p = NS).

CONCLUSIONS

Cine computed tomography is capable of providing accurate, quantitative assessment of regional myocardial perfusion over a broad range of perfusion states. This method, if extended to the study of humans, could enhance the understanding of disorders of the coronary circulation in human cardiovascular disease states.

Involvement of nitric oxide and cyclic GMP in rabbit urethral relaxation

Soluble and particulate fractions from rabbit urethra converted [14C]arginine to [14C]citrulline, indicating the presence of nitric oxide synthase activity in these fractions. Both soluble and particulate nitric oxide synthase activities were NADPH dependent, and the soluble activity was Ca2+ dependent. Three nitric oxide synthase (NOS) inhibitors affected transmural nerve stimulation induced relaxation responses in the rabbit urethra and the activity of soluble nitric oxide synthase with the same rank order of potency, i.e., NG-nitro-L-arginine (NNA) > NG-methyl-L-arginine (NMA) > canavanine (CAN). The rank order of potency with respect to particulate NOS activity was CAN > NMA = NNA. The relaxation responses to electrical stimulation were accompanied by increases in cyclic GMP. These results suggest that NOS activity found in the soluble fraction of urethral homogenates produces nitric oxide that in turn increases cyclic GMP levels which mediates the relaxation responses induced by transmural nerve stimulation in the rabbit urethra.

Nitric oxide synthase: an endogenous source of elevated nitrite in infected urine

To further define the endogenous sources of urine nitrite in urinary tract infections, we measured urinary nitrite levels by the Griess method and assayed urinary nitric oxide (NO) synthase activity by the conversion of 14C-arginine to 14C-citrulline. Endogenous production of 14C-citrulline was confirmed by thin layer chromatography. Exogenous L-arginine increased nitrite production in whole infected urine, but not in bacteria isolated from infected urine. Urinary tract infections significantly increased NO synthase activity in soluble urine fractions, although soluble activity was less than 10% of particulate activity. Urine particulate fractions from women with non-infected urine had greater NO synthase activity than particulate fractions from men with non-infected urine, 11 +/- 2 and 0.2 +/- 0.1 picomol/min/mg protein, respectively. Urinary tract infections increased NO synthase activity in urine particulate fractions from women and men, 99 +/- 20 and 48 +/- 9 picomol/min/mg protein, respectively. The conversion of 14C-arginine to 14C-citrulline required NADPH, was calcium independent, and was inhibited to a greater extent by L-canavanine than by NG-monomethyl-L-arginine or NG-nitro-L-arginine. Human infected urine contains an isoform of NO synthase which is an endogenous source of urine nitrite.

Assessment of coronary artery patency with cine computed tomography in a dog model of occlusion-reperfusion

RATIONALE AND OBJECTIVES

Determination of coronary artery patency may have therapeutic and prognostic significance particularly in the setting of acute myocardial infarction. Previous studies with cine computed tomography have demonstrated remarkable accuracy in the determination of coronary artery bypass graft patency. Recent improvements in resolution capability have afforded the potential for determination of native coronary artery patency. The accuracy of coronary artery patency determined by cine computed tomography is investigated in an animal model of coronary occlusion-reperfusion.

METHODS

Seven anesthetized dogs were studied during control, coronary occlusion, and reperfusion conditions. Cine computed tomography was performed using electrocardiogram-triggered serial scans after intravenous injection of contrast medium. Coronary patency was determined by dye appearance in the epicardial artery coincident with its appearance in the left ventricular cavity.

RESULTS

Patency was determined for the left anterior descending and left coronary arteries during three separate conditions in each dog, for a total of 42 patency determinations, and yielded the correct result in all cases.

CONCLUSION

High-resolution cine computed tomography scanning can provide accurate determinations of coronary artery patency in an experimental model of occlusion-reperfusion.

Coronary artery calcification: clinical significance and current methods of detection

Coronary artery disease affects 1,500,000 Americans each year; 500,000 of these will die. The earliest detectable lesion of coronary atherosclerosis is the fatty streak. Later, crescent-shaped lipid plaques occur, which may rupture and produce either progressive stenosis or sudden occlusion with myocardial infarction. Calcium is deposited early in the formation of the atherosclerotic plaque, and calcification can be used as a marker of the atherosclerotic process. Many imaging techniques can be used to detect calcification of coronary arteries. The most promising are fluoroscopy, ultrafast CT, and intravascular sonography. Detection of calcification is most valuable in persons less than 40 years old in whom modification of risk factors may be important. In addition, the progression and possible regression of calcification can be used as an indicator of the atherosclerotic process. The absence of calcification in coronary arteries may diminish the need for further testing.

Coronary artery visualization using ultrafast computed tomography

The advantages and limitations of ultrafast computed tomography in the imaging of normal and pathologic conditions of the coronary artery are discussed. The scanner's speed, resolution, and lack of significant motion artifact enhance the visualization of coronary arteries. Coronary artery calcification also is well visualized, and coronary artery fistuli, coronary bypass graft patency, and Kawasaki disease can be assessed accurately using contrast-enhanced flow studies. The inability to image stenoses and the lack of longitudinal images detract from its usefulness. Future scanner upgrades to provide increased resolution and thinner slices should improve the scanner's ability to evaluate the coronary artery.

Accurate preoperative diagnosis of pericardial constriction using cine computed tomography

OBJECTIVES

The purpose of this study was to determine the accuracy of cine computed tomography in the diagnosis of constrictive pericarditis.

BACKGROUND

Constrictive pericarditis is characterized by abnormalities of both cardiac structure and function. Accurate diagnosis requires detection of both a thickened pericardium and abnormal ventricular diastolic filling. At present, no one diagnostic technique has demonstrated sufficient accuracy in this setting. Cine computed tomography is a relatively new cardiac imaging mode with very high time and spatial resolution that has the potential to accurately diagnose constrictive pericarditis.

METHODS

Twelve consecutive patients were retrospectively identified who had catheterization findings suggestive of constrictive physiology, had undergone a cine computed tomographic examination and had pathologic data that delineated the status of the pericardium. Group 1 (with constrictive pericarditis; n = 5) had surgical confirmation of thickened pericardium and improved clinically after pericardiectomy. Group 2 (no constrictive pericarditis; n = 7) had cardiomyopathy with normal pericardium. Seven normal volunteers (Group 3) were also studied. Cine computed tomograms were obtained for the entire heart (8-mm slices, 17 frames/s, nonionic contrast medium). Pericardial thickness was measured at 10 degrees intervals at three ventricular levels in each subject. The rapidity of diastolic filling was assessed by calculating the percent filling fraction in early diastole.

RESULTS

Pericardial thickness was 10 +/- 2 mm (mean +/- SD) in Group 1, 2 +/- 1 mm in Group 2 and 1 +/- 1 mm in Group 3 (p < 0.05, constrictive pericarditis vs. no constrictive pericarditis). Left ventricular filling fraction was 83 +/- 6% in Group 1, 62 +/- 9% in Group 2 and 44 +/- 5% in Group 3. Right ventricular filling fraction was 93 +/- 5% in Group 1, 62 +/- 14% in Group 2 and 35 +/- 6% in Group 3 (p < 0.05, Group 1 vs. Groups 2 and 3). Both indexes provided a clear-cut distinction between patients with and without constriction.

CONCLUSIONS

Cine computed tomography simultaneously provides both anatomic and physiologic data that allow accurate preoperative diagnosis of pericardial constriction.