Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging

AIMS

The aim of this study was to determine the utility of pulsed wave Doppler tissue imaging in the evaluation of regional left ventricular diastolic function in patients with ischaemic heart disease.

METHODS AND RESULTS

In 30 normal subjects and 43 patients with ischaemic heart disease, Doppler tissue imaging was performed in each of the 16 segments of the myocardium. The following diastolic pulsed wave Doppler tissue imaging parameters were obtained for each segment: (1) regional early diastolic peak velocity (regional e wave cm.s-1); (2) regional late diastolic peak velocity (regional a wave cm.s-1); (3) regional diastolic e/a velocity ratio; and (4) the regional isovolumic relaxation time, defined as the time interval from the second heart sound to the onset of the diastolic E wave. In patients with ischaemic heart disease, each of these parameters was evaluated and compared in ischaemic and normally perfused segments, based on the presence or absence of obstructive lesions of the supplying coronary artery. In patients with coronary artery disease, several differences were observed between diseased and normal wall segments: the mean segmental peak early diastolic velocity (e wave) was reduced (mean +/- SD: 6.4 +/- 2.1 cm.s-1 vs 8.5 +/- 2.8 cm.s-1; P < 0.01); the e/a diastolic velocity ratio was decreased (0.95 +/- 0.3 vs 1.5 +/- 0.6, respectively; P < 0.01) and the regional isovolumic relaxation time was prolonged (104 +/- 36.7 ms vs 69.6 +/- 30 ms; P < 0.01. No differences were observed in any of these parameters between the normally perfused segments of ischaemic patients and normal subjects. Patients with a normal transmitral diastolic Doppler inflow pattern had a mean of 3.7 +/- 2.7 myocardial segments with a local e/a pulsed wave Doppler tissue imaging velocity ratio < 1, fewer than those with an inverted diastolic transmitral Doppler inflow pattern (10.3 +/- 3 segments; P < 0.001). Overall sensitivity and specificity for an inverted local e/a ratio and a local isovolumetric relaxation time > or = 85 ms were of 62% and 72% and 69% and 80%, respectively.

CONCLUSION

Regional diastolic wall motion is impaired at baseline in ischaemic myocardial segments, even when systolic contraction is preserved. Pulsed wave Doppler tissue imaging is a useful non-invasive technique which allows the assessment of regional diastolic performance and dynamics of the left ventricular myocardium. Further studies are required to define this role in the evaluation of coronary heart disease.

[Cadmium and cardiac muscle cell - biomarkers of oxidative stress - experimental work]

OBJECTIVE

To study in several tissues (heart, kidney and liver) of Halobatrachus didactylus the cellular response induced by an acute exposure to a sublethal cadmium concentration.

DESIGN

Fifteen species of H. didactylus (marine teleost) were divided in to three groups: CTRL: control group, the fish were injected with a saline solution; 24 H: 1 mg/kg of cadmium chloride was injected and the fish were sacrificed after 24 hours; 7 D: the fish were subjected to the same cadmium concentration and sacrificed 7 days after injection.

INTERVENTIONS

Superoxide dismutase--SOD (McCord & Fridovich, 1969) and catalase--CAT (Clairborne, 1985) activities were determined in the cytosolic and mitochondrial fractions of these three tissues. The lipid degradation products were also determined by the tiobarbithuric acid (TBA) test.

MEASUREMENTS AND RESULTS

Cadmium induced an increase in SOD activity in both fractions (cytosolic and mitochondrial) of these H. didactylus tissues. The highest levels of activity observed were located at mitochondrial fraction and in the heart. There was a significant increase in CAT activity in both liver and heart tissue fractions after cadmium exposure. The highest values were observed in the liver. The kidney presented a different response: there was a rise in CAT activity only in the mitochondrial fraction after seven days of exposure. There were no significant changes in lipid degradation products in any of these tissues after cadmium exposure.

CONCLUSIONS

The two antioxidant enzymes studied in the heart, kidney and liver of H. didactylus demonstrated a high sensitivity to oxidative stress induced by cadmium and presented a high potential as cellular biological makers. The results indicate membrane lesion caused by lipid peroxidation did not occur, which suggests an efficient response of the cellular protection mechanisms against cadmium cytotoxicity.

[A histological analysis of the changes experimentally induced by cadmium in cardiac muscle tissue by a computerized method of image analysis]

OBJECTIVE

To study the distribution of myocardial structural elements in a univentricular experimental model (Halobatrachus didactylus) and the changes induced by acute exposure to a sublethal concentrations of cadmium.

DESIGN

15 specimens of H. didactylus (marine teleost) were divided in three groups: CTRL: the control group, the fish were injected with a saline solution; 24 H: 1 mg/kg of cadmium chloride was injected and fish were sacrificed after 1 day post injection; 7 D: fish where subjected to the same cadmium concentration and sacrificed after 7 days post injection.

INTERVENTIONS

Histological sections (5 microns) of ventricle were coloured by PicroSirius method and used to determine the fraction area occupied by the several myocardium structural elements, using specific software Optimas Bioscan 5.2.

MEASUREMENTS AND RESULTS

The different structural elements of H. didactylus myocardium displayed in different ways and its distribution along the ventricular wall remained unchanged on exposure to cadmium. The structural elements of H. didactylus myocardium showed a characteristic pattern: collagen type I revealed a heterogeneous distribution, with fractional area values greater in epicardial and endocardial layers; collagen type III, has a homogeneous distribution with the myocardial wall thickness with lesser fractional area values than collagen I; cardiac muscle tissue showed a tendency to occupy a greater fractional area in the epicardial-endocardial region. Cadmium toxicity resulted in an increase in the fractional area occupied by muscle tissue to the detriment of the area occupied by the intertrabecular spaces (lacunae), with no alterations in the other structural components.

CONCLUSIONS

On our H. didactylus fish model, cadmium may have induced a myocardial edema which resulted in an increase in the fractional area occupied by muscle tissue, with no alterations in other structural components of the myocardium or in the relative ventricular mass.

Ultrasonography characterization of heart morphology and blood flow of lower vertebrates

Echocardiography is an noninvasive technique that utilizes high frequency ultrasound to evaluate structural, functional, and hemodynamic status of the cardiovascular system. With all the inherent potentials of this technique, its application has not been explored on lower vertebrates. The objective of our work was to apply ultrasonography technique, with an available commercial equipment (Echo camera--Aloka SSD 830 and Toshiba using probes of 5 and 7.5 MHz frequency emission) and to identify and characterize cardiac structures and blood flow in lower vertebrates. Specimens studied were Lophius piscatorius, Halobatrachus didactylus, and Bufo bufo. The probe was applied on the ventral middle line over heart chambers. Two-dimensional images were obtained from long and short axis incidences at various levels of cardiac chambers. During each cardiac cycle and for every specimen it was possible to identify the relation between each structure, to measure longitudinal and transversal diameters, to identify blood fluxes, and measure their velocities. The work we describe and discuss in our preliminary experience and data concerning the ultrasound study of some lower vertebrates. The cardiovascular apparatus of the different species we studied was a dynamic, phasic, and efficient contraction and relaxation mechanism. The phenomena could be well documented with two-dimensional echocardiography. The effect of the coupling phenomena of contraction and relaxation was also studied through the application of pulsed and color Doppler ultrasound. Two-dimensional and Doppler echocardiography can be easily applied to the study of the anatomy, morphology, and physiology of lower vertebrates. Well defined structures and cardiac chambers were displayed with this noninvasive imaging technique. Echo-Doppler ultrasonography is a reliable technique in these lower vertebrate specimens, to study cardiac structure and kinetics, and to identify and measure blood flow velocity. It can be used as an experimental model for cardiac function.