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Beijnink CWH, van der Hoeven NW, Konijnenberg LSF, Kim RJ, Bekkers SCAM, Kloner RA, Everaars H, El Messaoudi S, van Rossum AC, van Royen N, Nijveldt R. Cardiac MRI to Visualize Myocardial Damage after ST-Segment Elevation Myocardial Infarction: A Review of Its Histologic Validation. Radiology 2021; 301:4-18. [PMID: 34427461 DOI: 10.1148/radiol.2021204265] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiac MRI is a noninvasive diagnostic tool using nonionizing radiation that is widely used in patients with ST-segment elevation myocardial infarction (STEMI). Cardiac MRI depicts different prognosticating components of myocardial damage such as edema, intramyocardial hemorrhage (IMH), microvascular obstruction (MVO), and fibrosis. But how do cardiac MRI findings correlate to histologic findings? Shortly after STEMI, T2-weighted imaging and T2* mapping cardiac MRI depict, respectively, edema and IMH. The acute infarct size can be determined with late gadolinium enhancement (LGE) cardiac MRI. T2-weighted MRI should not be used for area-at-risk delineation because T2 values change dynamically over the first few days after STEMI and the severity of T2 abnormalities can be modulated with treatment. Furthermore, LGE cardiac MRI is the most accurate method to visualize MVO, which is characterized by hemorrhage, microvascular injury, and necrosis in histologic samples. In the chronic setting post-STEMI, LGE cardiac MRI is best used to detect replacement fibrosis (ie, final infarct size after injury healing). Finally, native T1 mapping has recently emerged as a contrast material-free method to measure infarct size that, however, remains inferior to LGE cardiac MRI. Especially LGE cardiac MRI-defined infarct size and the presence and extent of MVO may be used to monitor the effect of new therapeutic interventions in the treatment of reperfusion injury and infarct size reduction. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Casper W H Beijnink
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Nina W van der Hoeven
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Lara S F Konijnenberg
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Raymond J Kim
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Sebastiaan C A M Bekkers
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Robert A Kloner
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Henk Everaars
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Saloua El Messaoudi
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Albert C van Rossum
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Niels van Royen
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
| | - Robin Nijveldt
- From the Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (C.W.H.B., L.S.F.K., S.E.M., N.v.R., R.N.); Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands (N.W.v.d.H., H.E., A.C.v.R.); Department of Medicine, Duke University School of Medicine, Durham, NC (R.J.K.); Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (S.C.A.M.B.); Huntington Medical Research Institutes, Pasadena, Calif (R.A.K.); and Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, Calif (R.A.K.)
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Bøtker HE. Searching myocardial rescue through intermittent upper arm occlusion and lizard saliva. Basic Res Cardiol 2021; 116:5. [PMID: 33495904 DOI: 10.1007/s00395-021-00843-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Hans Erik Bøtker
- Faculty of Health, Aarhus University, Vennelyst Boulevard 4, 8000, Aarhus C, Denmark.
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Kendziora B, Stier H, Schlattmann P, Dewey M. MRI for measuring therapy efficiency after revascularisation in ST-segment elevation myocardial infarction: a systematic review and meta-regression analysis. BMJ Open 2020; 10:e034359. [PMID: 32988935 PMCID: PMC7523216 DOI: 10.1136/bmjopen-2019-034359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To summarise existing data on the relation between the time from symptom onset until revascularisation (time to reperfusion) and the myocardial salvage index (MSI) calculated as proportion of non-necrotic myocardium inside oedematous myocardium on T2-weighted and T1-weighted late gadolinium enhancement MRI after ST-segment elevation myocardial infarction (STEMI). METHODS Studies including patients with revascularised STEMI and stating both the time to reperfusion and the MSI measured by T2-weighted and T1-weighted late gadolinium enhancement MRI were searched in MEDLINE, EMBASE and ISI Web of Science until 16 May 2020. A mixed effects model was used to evaluate the relation between the time to reperfusion and the MSI. The gender distribution and mean age in included patient groups, the timing of MRI, used MRI sequences and image interpretation methodology were included in the mixed effects model to explore between-study heterogeneity. RESULTS We included 38 studies with 5106 patients. The pooled MSI was 42.6% (95% CI: 38.1 to 47.1). The pooled time to reperfusion was 3.8 hours (95% CI: 3.5 to 4.0). Every hour of delay in reperfusion was associated with an absolute decrease of 13.1% (95% CI: 11.5 to 14.6; p<0.001) in the MSI. Between-study heterogeneity was considerable (σ2=167.8). Differences in the gender distribution, timing of MRI and image interpretation among studies explained 45.2% of the between-study heterogeneity. CONCLUSIONS The MSI on T2-weighted and T1-weighted late gadolinium enhancement MRI correlates inversely with the time to reperfusion, which indicates that cardioprotection achieved by minimising the time to reperfusion leads to a higher MSI. The analysis revealed considerable heterogeneity between studies. The heterogeneity could partly be explained by differences in the gender distribution, timing and interpretation of MRI suggesting that the MRI-assessed MSI is not only influenced by cardioprotective therapy but also by patient characteristics and MRI parameters.
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Affiliation(s)
- Benjamin Kendziora
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany
| | - Heli Stier
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Germany
| | - Marc Dewey
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität, Berlin, Germany
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Abstract
RATIONALE Metformin has been demonstrated to decrease infarct size (IS) and prevent postinfarction left ventricular (LV) remodeling in rodents when given intravenously at the time of reperfusion. It remains unclear whether similar cardioprotection can be achieved in a large animal model. OBJECTIVE The objective of this study was to determine whether intravascular infusion of metformin at the time of reperfusion reduces myocardial IS in a porcine model of acute myocardial infarction. METHODS AND RESULTS In a blinded and randomized preclinical study, closed-chest swine (n=20) were subjected to a 60-minute left anterior descending coronary artery occlusion to produce myocardial infarction. Contrast-enhanced computed tomography was performed during left anterior descending coronary artery occlusion to assess the ischemic area-at-risk. Animals were randomized to receive either metformin or vehicle as an initial intravenous bolus (5 mg/kg) 8 minutes before reperfusion, followed by a 15-minute left coronary artery infusion (1 mg/kg per minute) commencing with the onset of reperfusion. Echocardiography and computed tomographic imaging of LV function were performed 1 week later, at which time the heart was removed for postmortem pathological analysis of area-at-risk and IS (triphenyltetrazolium chloride). Baseline variables including hemodynamics and LV function were similar between groups. Peak circulating metformin concentrations of 374±35 µmol/L were achieved 15 minutes after reperfusion. There was no difference between the area-at-risk as a percent of LV mass by computed tomography (vehicle: 20.7%±1.1% versus metformin: 19.7%±1.3%; P=0.59) or postmortem pathology (22.4%±1.2% versus 20.2%±1.2%; P=0.21). IS relative to area-at-risk averaged 44.5%±5.0% in vehicle-treated versus 38.2%±6.8% in metformin-treated animals ( P=0.46). There was no difference in global function 7 days after myocardial infarction as assessed by echocardiography or computed tomographic ejection fraction (56.2%±2.6% versus 56.3%±2.4%; P=0.98). CONCLUSIONS In contrast to rodent hearts, postconditioning with high-dose metformin administered immediately before reperfusion does not reduce IS or improve LV function 7 days after myocardial infarction in swine. These results reinforce the importance of rigorously testing therapies in large animal models to facilitate clinical translation of novel cardioprotective therapies.
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Affiliation(s)
- George Techiryan
- From the VA WNY Health Care System and the Departments of Medicine, Pharmacology and Toxicology, Physiology and Biophysics, and Biomedical Engineering, and the Clinical and Translational Research Center of the University at Buffalo, NY
| | - Brian R Weil
- From the VA WNY Health Care System and the Departments of Medicine, Pharmacology and Toxicology, Physiology and Biophysics, and Biomedical Engineering, and the Clinical and Translational Research Center of the University at Buffalo, NY
| | - Beth A Palka
- From the VA WNY Health Care System and the Departments of Medicine, Pharmacology and Toxicology, Physiology and Biophysics, and Biomedical Engineering, and the Clinical and Translational Research Center of the University at Buffalo, NY
| | - John M Canty
- From the VA WNY Health Care System and the Departments of Medicine, Pharmacology and Toxicology, Physiology and Biophysics, and Biomedical Engineering, and the Clinical and Translational Research Center of the University at Buffalo, NY
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Ibanez B, Aletras AH, Arai AE, Arheden H, Bax J, Berry C, Bucciarelli-Ducci C, Croisille P, Dall'Armellina E, Dharmakumar R, Eitel I, Fernández-Jiménez R, Friedrich MG, García-Dorado D, Hausenloy DJ, Kim RJ, Kozerke S, Kramer CM, Salerno M, Sánchez-González J, Sanz J, Fuster V. Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 74:238-256. [PMID: 31296297 PMCID: PMC7363031 DOI: 10.1016/j.jacc.2019.05.024] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
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Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, IIS Fundación Jiménez Díaz Hospital, Madrid, Spain.
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hakan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, and Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Pierre Croisille
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, United Kingdom
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Division of Cardiology, Department of Medicine, University of California, Los Angeles, California
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthias G Friedrich
- Departments of Medicine & Diagnostic Radiology, McGill University, Montreal, Quebec, Canada; Department of Medicine, Heidelberg University, Heidelberg, Germany
| | - David García-Dorado
- CIBERCV, Madrid, Spain; Vall d'Hebron University Hospital and Research Institute, Universtat Autònoma de Barcelona, Barcelona, Spain
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, National Heart Research Institute Singapore, National Heart Centre, Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, and The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London, United Kingdom; Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, and Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Christopher M Kramer
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | | | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
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van der Weg K, Kuijt WJ, Bekkers SC, Tijssen JG, Green CL, Smulders MW, Lemmert ME, Krucoff MW, Gorgels AP. Bursts of reperfusion arrhythmias occur independently of area at risk size and are the first marker of reperfusion injury. Int J Cardiol 2018; 271:240-246. [DOI: 10.1016/j.ijcard.2018.05.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/22/2018] [Accepted: 05/22/2018] [Indexed: 12/22/2022]
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Bøtker HE, Hausenloy D, Andreadou I, Antonucci S, Boengler K, Davidson SM, Deshwal S, Devaux Y, Di Lisa F, Di Sante M, Efentakis P, Femminò S, García-Dorado D, Giricz Z, Ibanez B, Iliodromitis E, Kaludercic N, Kleinbongard P, Neuhäuser M, Ovize M, Pagliaro P, Rahbek-Schmidt M, Ruiz-Meana M, Schlüter KD, Schulz R, Skyschally A, Wilder C, Yellon DM, Ferdinandy P, Heusch G. Practical guidelines for rigor and reproducibility in preclinical and clinical studies on cardioprotection. Basic Res Cardiol 2018; 113:39. [PMID: 30120595 PMCID: PMC6105267 DOI: 10.1007/s00395-018-0696-8] [Citation(s) in RCA: 304] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Derek Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
- The National Institute of Health Research, University College London Hospitals Biomedial Research Centre, Research and Development, London, UK
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yon Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Salvatore Antonucci
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Kerstin Boengler
- Institute for Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Soni Deshwal
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Yvan Devaux
- Cardiovascular Research Unit, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Fabio Di Lisa
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Moises Di Sante
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Panagiotis Efentakis
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Saveria Femminò
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - David García-Dorado
- Experimental Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Zoltán Giricz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), IIS-Fundación Jiménez Díaz, CIBERCV, Madrid, Spain
| | - Efstathios Iliodromitis
- Second Department of Cardiology, Faculty of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nina Kaludercic
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - Markus Neuhäuser
- Department of Mathematics and Technology, Koblenz University of Applied Science, Remagen, Germany
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany
| | - Michel Ovize
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Lyon, France
- UMR, 1060 (CarMeN), Université Claude Bernard, Lyon1, Villeurbanne, France
| | - Pasquale Pagliaro
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Michael Rahbek-Schmidt
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Marisol Ruiz-Meana
- Experimental Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | | | - Rainer Schulz
- Institute for Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Andreas Skyschally
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - Catherine Wilder
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany.
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Göransson C, Ahtarovski KA, Kyhl K, Lønborg J, Nepper-Christensen L, Bertelsen L, Ghotbi AA, Schoos MM, Køber L, Høfsten D, Helqvist S, Kelbæk H, Engstrøm T, Vejlstrup N. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging—a DANAMI3 substudy. Eur Heart J Cardiovasc Imaging 2018; 20:361-366. [DOI: 10.1093/ehjci/jey106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/01/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christoffer Göransson
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kiril Aleksov Ahtarovski
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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Vauchot F, Ben Bouallègue F, Hedon C, Piot C, Roubille F, Mariano-Goulart D. Assessment of the area at risk after acute myocardial infarction using 123I-MIBG SPECT: Comparison with the angiographic APPROACH-score. J Nucl Cardiol 2018; 25:572-580. [PMID: 27549427 DOI: 10.1007/s12350-016-0644-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessment of the area at risk (AAR) associated with an acute myocardial infarction is crucial for evaluating prevention and revascularization strategies. The aim of this study was to evaluate whether 123I-metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) provides a more widely available assessment of anatomical AAR than the established anatomical angiographic methods. METHODS Seventy patients with ST-segment elevation acute myocardial infarction (STEMI) underwent coronary angiography with percutaneous coronary intervention and subsequent 123I-MIBG myocardial scintigraphy with left myocardial relative radiotracer uptake evaluation 12 ± 10 days after STEMI. Patients were divided into two groups depending on whether the culprit artery was occluded (50 patients) or sub-occluded (20 patients). Two scores were calculated as a percentage of the left ventricular myocardium surface, the first using a standard 17-segment summed rest score derived from the relative quantitative evaluation of 123I-MIBG myocardial uptake (MAR) and the second using the modified APPROACH-score (ApAR). RESULTS For the patients with occluded artery, this study showed a high correlation between MAR and the angiographic score (Pearson r = .762 and P < .0001). For the patients with sub-occluded artery, for which the ApAR is not reliable, this study showed no correlation between MAR and the angiographic score (Pearson r = .18 and P = 0.45). CONCLUSIONS 123I-MIBG myocardial scintigraphy provides ARR assessment similar to that of ApAR in patients with a single occluded coronary artery. However, MAR differs from ApAR when angiographic scores are known to be inaccurate (sub-occluded culprit artery) or impossible to use. Further studies are needed to evaluate the potential clinical interest of 123I-MIBG SPECT as an alternative for area at risk assessment after STEMI even when the culprit artery is sub-occluded or when the angiographic scores cannot be used.
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Affiliation(s)
- Fabien Vauchot
- Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
| | - Fayçal Ben Bouallègue
- Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
| | - Christophe Hedon
- Department of Cardiology, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
| | - Christophe Piot
- Department of Cardiology, Clinique du Millénaire, 34960, Montpellier Cedex 2, France
- IGF - UMR5203 - U1191 - UM, Montpellier, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 34295, Montpellier Cedex 5, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France
| | - Denis Mariano-Goulart
- Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France.
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France.
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Abstract
Rapid admission and acute interventional treatment combined with modern antithrombotic pharmacologic therapy have improved outcomes in patients with ST elevation myocardial infarction. The next major target to further advance outcomes needs to address ischemia-reperfusion injury, which may contribute significantly to the final infarct size and hence mortality and postinfarction heart failure. Mechanical conditioning strategies including local and remote ischemic pre-, per-, and postconditioning have demonstrated consistent cardioprotective capacities in experimental models of acute ischemia-reperfusion injury. Their translation to the clinical scenario has been challenging. At present, the most promising mechanical protection strategy of the heart seems to be remote ischemic conditioning, which increases myocardial salvage beyond acute reperfusion therapy. An additional aspect that has gained recent focus is the potential of extended conditioning strategies to improve physical rehabilitation not only after an acute ischemia-reperfusion event such as acute myocardial infarction and cardiac surgery but also in patients with heart failure. Experimental and preliminary clinical evidence suggests that remote ischemic conditioning may modify cardiac remodeling and additionally enhance skeletal muscle strength therapy to prevent muscle waste, known as an inherent component of a postoperative period and in heart failure. Blood flow restriction exercise and enhanced external counterpulsation may represent cardioprotective corollaries. Combined with exercise, remote ischemic conditioning or, alternatively, blood flow restriction exercise may be of aid in optimizing physical rehabilitation in populations that are not able to perform exercise practice at intensity levels required to promote optimal outcomes.
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Affiliation(s)
- Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital , Aarhus , Denmark
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11
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Fernández-Jiménez R, Barreiro-Pérez M, Martin-García A, Sánchez-González J, Agüero J, Galán-Arriola C, García-Prieto J, Díaz-Pelaez E, Vara P, Martinez I, Zamarro I, Garde B, Sanz J, Fuster V, Sánchez PL, Ibanez B. Dynamic Edematous Response of the Human Heart to Myocardial Infarction: Implications for Assessing Myocardial Area at Risk and Salvage. Circulation 2017; 136:1288-1300. [PMID: 28687712 PMCID: PMC5625960 DOI: 10.1161/circulationaha.116.025582] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/26/2017] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Clinical protocols aimed to characterize the post–myocardial infarction (MI) heart by cardiac magnetic resonance (CMR) need to be standardized to take account of dynamic biological phenomena evolving early after the index ischemic event. Here, we evaluated the time course of edema reaction in patients with ST-segment–elevation MI by CMR and assessed its implications for myocardium-at-risk (MaR) quantification both in patients and in a large-animal model. Methods: A total of 16 patients with anterior ST-segment–elevation MI successfully treated by primary angioplasty and 16 matched controls were prospectively recruited. In total, 94 clinical CMR examinations were performed: patients with ST-segment–elevation MI were serially scanned (within the first 3 hours after reperfusion and at 1, 4, 7, and 40 days), and controls were scanned only once. T2 relaxation time in the myocardium (T2 mapping) and the extent of edema on T2-weighted short-tau triple inversion-recovery (ie, CMR-MaR) were evaluated at all time points. In the experimental study, 20 pigs underwent 40-minute ischemia/reperfusion followed by serial CMR examinations at 120 minutes and 1, 4, and 7 days after reperfusion. Reference MaR was assessed by contrast-multidetector computed tomography during the index coronary occlusion. Generalized linear mixed models were used to take account of repeated measurements. Results: In humans, T2 relaxation time in the ischemic myocardium declines significantly from early after reperfusion to 24 hours, and then increases up to day 4, reaching a plateau from which it decreases from day 7. Consequently, edema extent measured by T2-weighted short-tau triple inversion-recovery (CMR-MaR) varied with the timing of the CMR examination. These findings were confirmed in the experimental model by showing that only CMR-MaR values for day 4 and day 7 postreperfusion, coinciding with the deferred edema wave, were similar to values measured by reference contrast-multidetector computed tomography. Conclusions: Post-MI edema in patients follows a bimodal pattern that affects CMR estimates of MaR. Dynamic changes in post–ST-segment–elevation MI edema highlight the need for standardization of CMR timing to retrospectively delineate MaR and quantify myocardial salvage. According to the present clinical and experimental data, a time window between days 4 and 7 post-MI seems a good compromise solution for standardization. Further studies are needed to study the effect of other factors on these variables.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Manuel Barreiro-Pérez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Ana Martin-García
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Javier Sánchez-González
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Jaume Agüero
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Carlos Galán-Arriola
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Jaime García-Prieto
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Elena Díaz-Pelaez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Pedro Vara
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Irene Martinez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Ivan Zamarro
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Beatriz Garde
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Javier Sanz
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Valentin Fuster
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.)
| | - Pedro L Sánchez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.).
| | - Borja Ibanez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., J.A., C.G.-A., J.G.-P., J.S., V.F., B.I.); CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.F.-J., M.B.-P., A.M.-G., J.A., C.G.-A., J.G.-P., B.G., P.L.S., B.I.); The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.F.); Hospital Universitario de Salamanca, Spain (M.B.-P., A.M.-G., E.D.-P., P.V., I.M., I.Z., B.G., P.L.S.); Philips Healthcare, Madrid, Spain (J.S.-G.); Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain (J.A.); and IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.).
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12
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Fernández-Jiménez R, Galán-Arriola C, Sánchez-González J, Agüero J, López-Martín GJ, Gomez-Talavera S, Garcia-Prieto J, Benn A, Molina-Iracheta A, Barreiro-Pérez M, Martin-García A, García-Lunar I, Pizarro G, Sanz J, Sánchez PL, Fuster V, Ibanez B. Effect of Ischemia Duration and Protective Interventions on the Temporal Dynamics of Tissue Composition After Myocardial Infarction. Circ Res 2017; 121:439-450. [PMID: 28596216 PMCID: PMC5542781 DOI: 10.1161/circresaha.117.310901] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 01/18/2023]
Abstract
Supplemental Digital Content is available in the text. Rationale: The impact of cardioprotective strategies and ischemia duration on postischemia/reperfusion (I/R) myocardial tissue composition (edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction) is not well understood. Objective: To study the effect of ischemia duration and protective interventions on the temporal dynamics of myocardial tissue composition in a translational animal model of I/R by the use of state-of-the-art imaging technology. Methods and Results: Four 5-pig groups underwent different I/R protocols: 40-minute I/R (prolonged ischemia, controls), 20-minute I/R (short-duration ischemia), prolonged ischemia preceded by preconditioning, or prolonged ischemia followed by postconditioning. Serial cardiac magnetic resonance (CMR)-based tissue characterization was done in all pigs at baseline and at 120 minutes, day 1, day 4, and day 7 after I/R. Reference myocardium at risk was assessed by multidetector computed tomography during the index coronary occlusion. After the final CMR, hearts were excised and processed for water content quantification and histology. Five additional healthy pigs were euthanized after baseline CMR as reference. Edema formation followed a bimodal pattern in all 40-minute I/R pigs, regardless of cardioprotective strategy and the degree of intramyocardial hemorrhage or microvascular obstruction. The hyperacute edematous wave was ameliorated only in pigs showing cardioprotection (ie, those undergoing short-duration ischemia or preconditioning). In all groups, CMR-measured edema was barely detectable at 24 hours postreperfusion. The deferred healing-related edematous wave was blunted or absent in pigs undergoing preconditioning or short-duration ischemia, respectively. CMR-measured infarct size declined progressively after reperfusion in all groups. CMR-measured myocardial salvage, and the extent of intramyocardial hemorrhage and microvascular obstruction varied dramatically according to CMR timing, ischemia duration, and cardioprotective strategy. Conclusions: Cardioprotective therapies, duration of index ischemia, and the interplay between these greatly influence temporal dynamics and extent of tissue composition changes after I/R. Consequently, imaging techniques and protocols for assessing edema, myocardium at risk, infarct size, salvage, intramyocardial hemorrhage, and microvascular obstruction should be standardized accordingly.
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Carlos Galán-Arriola
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Javier Sánchez-González
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Jaume Agüero
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Gonzalo J López-Martín
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Sandra Gomez-Talavera
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Jaime Garcia-Prieto
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Austin Benn
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Antonio Molina-Iracheta
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Manuel Barreiro-Pérez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Ana Martin-García
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Inés García-Lunar
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Gonzalo Pizarro
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Javier Sanz
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Pedro L Sánchez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Valentin Fuster
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.)
| | - Borja Ibanez
- From the Department of Clinical Research, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (R.F.-J., C.G.-A., J.A., G.J.L.-M., S.G.-T., J.G.-P., A.B., A.M.-I., I.G.-L., G.P., J.S., V.L., B.I.); Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV) (R.F.-J., C.G.-A., J.A., S.G.-T., J.G.-P., M.B.-P., A.M.-G., I.G.-L., G.P., P.L.S., B.I.); Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.F.-J., J.S., V.L.); Department of Clinical Research, Philips Healthcare, Madrid, Spain (J.S.-G.); Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain (M.B.-P., A.M.-G., P.L.S.); Department of Cardiology, Hospital Universitario Quiron (I.G.-L.) and Complejo Hospitalario Ruber Juan Bravo (G.P.), European University of Madrid, Spain; and Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (S.G.-T., B.I.).
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Quantifying the area-at-risk of myocardial infarction in-vivo using arterial spin labeling cardiac magnetic resonance. Sci Rep 2017; 7:2271. [PMID: 28536472 PMCID: PMC5442118 DOI: 10.1038/s41598-017-02544-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/12/2017] [Indexed: 01/05/2023] Open
Abstract
T2-weighted cardiovascular magnetic resonance (T2-CMR) of myocardial edema can quantify the area-at-risk (AAR) following acute myocardial infarction (AMI), and has been used to assess myocardial salvage by new cardioprotective therapies. However, some of these therapies may reduce edema, leading to an underestimation of the AAR by T2-CMR. Here, we investigated arterial spin labeling (ASL) perfusion CMR as a novel approach to quantify the AAR following AMI. Adult B6sv129-mice were subjected to in vivo left coronary artery ligation for 30 minutes followed by 72 hours reperfusion. T2-mapping was used to quantify the edema-based AAR (% of left ventricle) following ischemic preconditioning (IPC) or cyclosporin-A (CsA) treatment. In control animals, the AAR by T2-mapping corresponded to that delineated by histology. As expected, both IPC and CsA reduced MI size. However, IPC, but not CsA, also reduced myocardial edema leading to an underestimation of the AAR by T2-mapping. In contrast, regions of reduced myocardial perfusion delineated by cardiac ASL were able to delineate the AAR when compared to both T2-mapping and histology in control animals, and were not affected by either IPC or CsA. Therefore, ASL perfusion CMR may be an alternative method for quantifying the AAR following AMI, which unlike T2-mapping, is not affected by IPC.
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Saremi F. Cardiac MR Imaging in Acute Coronary Syndrome: Application and Image Interpretation. Radiology 2017; 282:17-32. [PMID: 28005512 DOI: 10.1148/radiol.2016152849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute coronary syndrome (ACS) is a frequent cause of hospitalization and coronary interventions. Cardiac magnetic resonance (MR) imaging is an increasingly used technique for initial work-up of chest pain and early post-reperfusion and follow-up evaluation of ACS to identify patients at high risk of further cardiac events. Cardiac MR imaging can evaluate with accuracy a variety of prognostic indicators of myocardial damage, including regional myocardial dysfunction, infarct distribution, infarct size, myocardium at risk, microvascular obstruction, and intramyocardial hemorrhage in both acute setting and later follow-up examinations. In addition, MR imaging is useful to rule out other causes of acute chest pain in patients admitted to the emergency department. In this article, a brief explanation of the pathophysiology, classification, and treatment options for patients with ACS will be introduced. Indications of cardiac MR imaging in ACS patients will be reviewed and specific cardiac MR protocol, image interpretation, and potential diagnostic pitfalls will be discussed. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Farhood Saremi
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles CA 90033
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15
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Lopez D, Pan JA, Pollak PM, Clarke S, Kramer CM, Yeager M, Salerno M. Multiparametric CMR imaging of infarct remodeling in a percutaneous reperfused Yucatan mini-pig model. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3693. [PMID: 28164391 PMCID: PMC5488275 DOI: 10.1002/nbm.3693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
To further understanding of the temporal evolution and pathophysiology of adverse ventricular remodeling over the first 60 days following a myocardial infarction (MI) in both the infarcted and remote myocardium, we performed multi-parametric cardiac magnetic resonance (CMR) imaging in a closed-chest chronic Yucatan mini-pig model of reperfused MI. Ten animals underwent 90 min left anterior descending artery occlusion and reperfusion. Three animals served as controls. Multiparametric CMR (1.5T) was performed at baseline, Day 2, Day 30 and in four animals on Day 60 after MI. Left ventricular (LV) volumes and infarct size were measured. T1 and T2 mapping sequences were performed to measure values in the infarct and remote regions. Remote region collagen fractions were compared between infarcted animals and controls. Procedure success was 80%. The model created large infarcts (28 ± 5% of LV mass on Day 2), which led to significant adverse myocardial remodeling that stabilized beyond 30 days. Native T1 values did not reliably differentiate remote and infarct regions acutely. There was no evidence of remote fibrosis as indicated by partition coefficient and collagen fraction analyses. The infarct T2 values remained elevated up to 60 days after MI. Multiparametric CMR in this model showed significant adverse ventricular remodeling 30 days after MI similar to that seen in humans. In addition, this study demonstrated that remote fibrosis is absent and that infarct T2 signal remains chronically elevated in this model. These findings need to be considered when designing preclinical trials using CMR endpoints.
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Affiliation(s)
- David Lopez
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jonathan A. Pan
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - Peter M. Pollak
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Samantha Clarke
- Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M. Kramer
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Mark Yeager
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Molecular Physiology & Biological Physics, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael Salerno
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
- Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
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16
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Fernández-Friera L, García-Ruiz JM, García-Álvarez A, Fernández-Jiménez R, Sánchez-González J, Rossello X, Gómez-Talavera S, López-Martín GJ, Pizarro G, Fuster V, Ibáñez B. Impacto del territorio miocárdico infartado en la cuantificación del área en riesgo mediante cardiorresonancia magnética. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Abstract
The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre- and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available.
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Affiliation(s)
- Gerd Heusch
- From the Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Essen, Essen, Germany.
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18
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Fernández-Friera L, García-Ruiz JM, García-Álvarez A, Fernández-Jiménez R, Sánchez-González J, Rossello X, Gómez-Talavera S, López-Martín GJ, Pizarro G, Fuster V, Ibáñez B. Accuracy of Area at Risk Quantification by Cardiac Magnetic Resonance According to the Myocardial Infarction Territory. ACTA ACUST UNITED AC 2016; 70:323-330. [PMID: 27592277 DOI: 10.1016/j.rec.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/11/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Area at risk (AAR) quantification is important to evaluate the efficacy of cardioprotective therapies. However, postinfarction AAR assessment could be influenced by the infarcted coronary territory. Our aim was to determine the accuracy of T2-weighted short tau triple-inversion recovery (T2W-STIR) cardiac magnetic resonance (CMR) imaging for accurate AAR quantification in anterior, lateral, and inferior myocardial infarctions. METHODS Acute reperfused myocardial infarction was experimentally induced in 12 pigs, with 40-minute occlusion of the left anterior descending (n = 4), left circumflex (n = 4), and right coronary arteries (n = 4). Perfusion CMR was performed during selective intracoronary gadolinium injection at the coronary occlusion site (in vivo criterion standard) and, additionally, a 7-day CMR, including T2W-STIR sequences, was performed. Finally, all animals were sacrificed and underwent postmortem Evans blue staining (classic criterion standard). RESULTS The concordance between the CMR-based criterion standard and T2W-STIR to quantify AAR was high for anterior and inferior infarctions (r = 0.73; P = .001; mean error = 0.50%; limits = -12.68%-13.68% and r = 0.87; P = .001; mean error = -1.5%; limits = -8.0%-5.8%, respectively). Conversely, the correlation for the circumflex territories was poor (r = 0.21, P = .37), showing a higher mean error and wider limits of agreement. A strong correlation between pathology and the CMR-based criterion standard was observed (r = 0.84, P < .001; mean error = 0.91%; limits = -7.55%-9.37%). CONCLUSIONS T2W-STIR CMR sequences are accurate to determine the AAR for anterior and inferior infarctions; however, their accuracy for lateral infarctions is poor. These findings may have important implications for the design and interpretation of clinical trials evaluating the effectiveness of cardioprotective therapies.
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Affiliation(s)
- Leticia Fernández-Friera
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Imagen Cardiaca Avanzada, Departamento de Cardiología, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - José Manuel García-Ruiz
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Ana García-Álvarez
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Insuficiencia Cardiaca, Departamento de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Rodrigo Fernández-Jiménez
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Sánchez-González
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Ciencia Clínica, Philips Healthcare Iberia, Madrid, Spain
| | - Xavier Rossello
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Sandra Gómez-Talavera
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo J López-Martín
- Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Gonzalo Pizarro
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid (UEM), Madrid, Spain
| | - Valentín Fuster
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Borja Ibáñez
- Área de Fisiopatología Vascular, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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19
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Schaaf M, Mewton N, Ibanez B. Acute MI and Contrast-Enhanced CMR: We Need the Whole Map of the Archipelago, Not Just Half of It! JACC Cardiovasc Imaging 2016; 9:1015-6. [DOI: 10.1016/j.jcmg.2016.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 10/21/2022]
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20
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Joubert M, Hardouin J, Legallois D, Blanchart K, Elie N, Nowoczyn M, Croisille P, Coulbault L, Bor-Angelier C, Allouche S, Manrique A. Effects of glycaemic variability on cardiac remodelling after reperfused myocardial infarction: Evaluation of streptozotocin-induced diabetic Wistar rats using cardiac magnetic resonance imaging. DIABETES & METABOLISM 2016; 42:342-350. [PMID: 26971835 DOI: 10.1016/j.diabet.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/27/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
AIMS In addition to hyperglycaemia, glycaemic variability seems to be associated with poor outcomes after acute myocardial infarction. This study explored the impact of glycaemic variability in diabetic Wistar rats subjected to myocardial ischaemia/reperfusion. METHODS Animals with streptozotocin-induced diabetes received insulin either to maintain stable hyperglycaemia (Dh group) or to generate glycaemic variability (Dv). After experimental myocardial ischaemia/reperfusion was surgically induced, 7T cardiac magnetic resonance imaging (CMR) was performed at weeks 1 (w1) and 3 (w3). RESULTS Twenty-six rats were randomized [sham group (S): n=5; control group (C): n=7; Dh group: n=6; and Dv group: n=8]. The mean amplitude of glucose reflecting glycaemic variability was higher in the Dv than in the Dh group (9.1±2.7mmol/L vs 5.9±1.9mmol/L; P<0.05). CMR assessment at w3 revealed ventricular enlargement in both Dh and Dv groups compared with the C and S groups (end-diastolic volume: 1.60±0.22 and 1.36±0.30mL/kg compared with 1.11±0.13 and 0.87±0.11mL/kg, respectively; P<0.05). Circumferential strain was altered between w1 and w3 in the remote area only in the Dv group, resulting in a lower value in this group than in the S, C and Dh groups (-0.11±0.01 vs -0.17±0.05, -0.15±0.03 and -0.16±0.03, respectively; P<0.05). In addition, at w3, oedema was also higher in the remote area in the Dv than in the C group (18.3±4.9ms vs 14.5±1.7ms, respectively; P<0.05). CONCLUSION In the context of experimental myocardial ischaemia/reperfusion, our results suggest that glycaemic variability might have a potentially deleterious impact on myocardial outcomes beyond the classical glucose metrics.
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Affiliation(s)
- M Joubert
- Diabetes Care Unit, Caen University Hospital, Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - J Hardouin
- Diabetes Care Unit, Caen University Hospital, Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - D Legallois
- Cardiology Unit, Caen University Hospital, 14033 Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - K Blanchart
- Cardiology Unit, Caen University Hospital, 14033 Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - N Elie
- CMABIO-HIQ Facility, SF4206 ICORE, IBFA, University of Caen, 14000 Caen, France.
| | - M Nowoczyn
- Biochemistry Unit, Caen University Hospital, 14000 Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - P Croisille
- Radiology Department, Saint-Etienne University Hospital, 42000 Saint-Etienne, France; CREATIS CNRS UMR5220 Inserm U1044, Lyon University, 69000 Lyon, France.
| | - L Coulbault
- Biochemistry Unit, Caen University Hospital, 14000 Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - C Bor-Angelier
- Pathology Department, F.-Baclesse Cancer Center, 14000 Caen, France.
| | - S Allouche
- Biochemistry Unit, Caen University Hospital, 14000 Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
| | - A Manrique
- Nuclear Medicine Department, Caen University Hospital, 14033 Caen, France; EA4650 Normandie université, GIP Cyceron, 14000 Caen, France.
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21
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Bouleti C, Mewton N, Germain S. The no-reflow phenomenon: State of the art. Arch Cardiovasc Dis 2015; 108:661-74. [PMID: 26616729 DOI: 10.1016/j.acvd.2015.09.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/28/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023]
Abstract
Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI), with nearly 95% of occluded coronary vessels being reopened in this setting. Despite re-establishing epicardial coronary vessel patency, primary PCI may fail to restore optimal myocardial reperfusion within the myocardial tissue, a failure at the microvascular level known as no-reflow (NR). NR has been reported to occur in up to 60% of STEMI patients with optimal coronary vessel reperfusion. When it does occur, it significantly attenuates the beneficial effect of reperfusion therapy, leading to poor outcomes. The pathophysiology of NR is complex and incompletely understood. Many phenomena are known to contribute to NR, including leukocyte infiltration, vasoconstriction, activation of inflammatory pathways and cellular oedema. Vascular damage and haemorrhage may also play important roles in the establishment of NR. In this review, we describe the pathophysiological mechanisms of NR and the tools available for diagnosing it. We also describe the microvasculature and the endothelial mechanisms involved in NR, which may provide relevant therapeutic targets for reducing NR and improving the prognosis for patients.
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Affiliation(s)
- Claire Bouleti
- Service de cardiologie, hôpital Bichat, AP-HP, Paris, France; DHU FIRE, université Paris Diderot, Paris, France; Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France
| | - Nathan Mewton
- Hôpital cardiovasculaire Louis-Pradel, centre d'investigation clinique unité, hospices civils de Lyon, Bron, France; Inserm U 1407, Lyon, France
| | - Stéphane Germain
- Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Paris, France; CNRS/UMR 7241, Paris, France; Inserm U 1050, Paris, France.
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22
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Santos A, Fernández-Friera L, Villalba M, López-Melgar B, España S, Mateo J, Mota RA, Jiménez-Borreguero J, Ruiz-Cabello J. Cardiovascular imaging: what have we learned from animal models? Front Pharmacol 2015; 6:227. [PMID: 26539113 PMCID: PMC4612690 DOI: 10.3389/fphar.2015.00227] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/22/2015] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular imaging has become an indispensable tool for patient diagnosis and follow up. Probably the wide clinical applications of imaging are due to the possibility of a detailed and high quality description and quantification of cardiovascular system structure and function. Also phenomena that involve complex physiological mechanisms and biochemical pathways, such as inflammation and ischemia, can be visualized in a non-destructive way. The widespread use and evolution of imaging would not have been possible without animal studies. Animal models have allowed for instance, (i) the technical development of different imaging tools, (ii) to test hypothesis generated from human studies and finally, (iii) to evaluate the translational relevance assessment of in vitro and ex-vivo results. In this review, we will critically describe the contribution of animal models to the use of biomedical imaging in cardiovascular medicine. We will discuss the characteristics of the most frequent models used in/for imaging studies. We will cover the major findings of animal studies focused in the cardiovascular use of the repeatedly used imaging techniques in clinical practice and experimental studies. We will also describe the physiological findings and/or learning processes for imaging applications coming from models of the most common cardiovascular diseases. In these diseases, imaging research using animals has allowed the study of aspects such as: ventricular size, shape, global function, and wall thickening, local myocardial function, myocardial perfusion, metabolism and energetic assessment, infarct quantification, vascular lesion characterization, myocardial fiber structure, and myocardial calcium uptake. Finally we will discuss the limitations and future of imaging research with animal models.
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Affiliation(s)
- Arnoldo Santos
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain ; Madrid-MIT M+Visión Consortium Madrid, Spain ; Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Hospital Universitario HM Monteprincipe Madrid, Spain
| | - María Villalba
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain
| | - Beatriz López-Melgar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Hospital Universitario HM Monteprincipe Madrid, Spain
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain ; Madrid-MIT M+Visión Consortium Madrid, Spain
| | - Jesús Mateo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain
| | - Ruben A Mota
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Charles River Barcelona, Spain
| | - Jesús Jiménez-Borreguero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; Cardiac Imaging Department, Hospital de La Princesa Madrid, Spain
| | - Jesús Ruiz-Cabello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain ; CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain ; Universidad Complutense de Madrid Madrid, Spain
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23
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Heusch P, Nensa F, Heusch G. Is MRI Really the Gold Standard for the Quantification of Salvage From Myocardial Infarction? Circ Res 2015; 117:222-4. [PMID: 26185206 DOI: 10.1161/circresaha.117.306929] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Philipp Heusch
- From the Institut für Diagnostische und Interventionelle Radiologie der Heinrich Heine-Universität Düsseldorf, Düsseldorf, Germany (P.H.); Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie des Universitätsklinikums Essen, Essen, Germany (F.N.); and Institut für Pathophysiologie, Westdeutsches Herz- und Gefässzentrum, Universitätsklinikum Essen, Essen, Germany (G.H.)
| | - Felix Nensa
- From the Institut für Diagnostische und Interventionelle Radiologie der Heinrich Heine-Universität Düsseldorf, Düsseldorf, Germany (P.H.); Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie des Universitätsklinikums Essen, Essen, Germany (F.N.); and Institut für Pathophysiologie, Westdeutsches Herz- und Gefässzentrum, Universitätsklinikum Essen, Essen, Germany (G.H.)
| | - Gerd Heusch
- From the Institut für Diagnostische und Interventionelle Radiologie der Heinrich Heine-Universität Düsseldorf, Düsseldorf, Germany (P.H.); Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie des Universitätsklinikums Essen, Essen, Germany (F.N.); and Institut für Pathophysiologie, Westdeutsches Herz- und Gefässzentrum, Universitätsklinikum Essen, Essen, Germany (G.H.).
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Kim HW, Van Assche L, Jennings RB, Wince WB, Jensen CJ, Rehwald WG, Wendell DC, Bhatti L, Spatz DM, Parker MA, Jenista ER, Klem I, Crowley ALC, Chen EL, Judd RM, Kim RJ. Relationship of T2-Weighted MRI Myocardial Hyperintensity and the Ischemic Area-At-Risk. Circ Res 2015; 117:254-65. [PMID: 25972514 PMCID: PMC4503326 DOI: 10.1161/circresaha.117.305771] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/13/2015] [Indexed: 12/15/2022]
Abstract
RATIONALE After acute myocardial infarction (MI), delineating the area-at-risk (AAR) is crucial for measuring how much, if any, ischemic myocardium has been salvaged. T2-weighted MRI is promoted as an excellent method to delineate the AAR. However, the evidence supporting the validity of this method to measure the AAR is indirect, and it has never been validated with direct anatomic measurements. OBJECTIVE To determine whether T2-weighted MRI delineates the AAR. METHODS AND RESULTS Twenty-one canines and 24 patients with acute MI were studied. We compared bright-blood and black-blood T2-weighted MRI with images of the AAR and MI by histopathology in canines and with MI by in vivo delayed-enhancement MRI in canines and patients. Abnormal regions on MRI and pathology were compared by (a) quantitative measurement of the transmural-extent of the abnormality and (b) picture matching of contours. We found no relationship between the transmural-extent of T2-hyperintense regions and that of the AAR (bright-blood-T2: r=0.06, P=0.69; black-blood-T2: r=0.01, P=0.97). Instead, there was a strong correlation with that of infarction (bright-blood-T2: r=0.94, P<0.0001; black-blood-T2: r=0.95, P<0.0001). Additionally, contour analysis demonstrated a fingerprint match of T2-hyperintense regions with the intricate contour of infarcted regions by delayed-enhancement MRI. Similarly, in patients there was a close correspondence between contours of T2-hyperintense and infarcted regions, and the transmural-extent of these regions were highly correlated (bright-blood-T2: r=0.82, P<0.0001; black-blood-T2: r=0.83, P<0.0001). CONCLUSION T2-weighted MRI does not depict the AAR. Accordingly, T2-weighted MRI should not be used to measure myocardial salvage, either to inform patient management decisions or to evaluate novel therapies for acute MI.
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Affiliation(s)
- Han W Kim
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Lowie Van Assche
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Robert B Jennings
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - W Benjamin Wince
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Christoph J Jensen
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Wolfgang G Rehwald
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - David C Wendell
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Lubna Bhatti
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Deneen M Spatz
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Michele A Parker
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Elizabeth R Jenista
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Igor Klem
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Anna Lisa C Crowley
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Enn-Ling Chen
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Robert M Judd
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Raymond J Kim
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
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Mewton N, Croisille P, Ovize M. Myocardial Salvage, Area at Risk by T2w CMR. J Am Coll Cardiol 2015; 65:2357-8. [DOI: 10.1016/j.jacc.2015.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 11/26/2022]
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Jivraj N, Liew F, Marber M. Ischaemic postconditioning: cardiac protection after the event. Anaesthesia 2015; 70:598-612. [DOI: 10.1111/anae.12974] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 12/11/2022]
Affiliation(s)
- N. Jivraj
- School of Medicine and BHF Centre of Excellence; Cardiovascular Division; King's College London; London UK
| | - F. Liew
- School of Medicine; University College London; London UK
| | - M. Marber
- School of Medicine and BHF Centre of Excellence; Cardiovascular Division; King's College London; London UK
- NIHR Biomedical Research Centre; Guy's and St Thomas' NHS Foundation Trust; London UK
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Heusch G, Bøtker HE, Przyklenk K, Redington A, Yellon D. Remote ischemic conditioning. J Am Coll Cardiol 2015; 65:177-95. [PMID: 25593060 PMCID: PMC4297315 DOI: 10.1016/j.jacc.2014.10.031] [Citation(s) in RCA: 470] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/16/2014] [Accepted: 10/22/2014] [Indexed: 12/12/2022]
Abstract
In remote ischemic conditioning (RIC), brief, reversible episodes of ischemia with reperfusion in one vascular bed, tissue, or organ confer a global protective phenotype and render remote tissues and organs resistant to ischemia/reperfusion injury. The peripheral stimulus can be chemical, mechanical, or electrical and involves activation of peripheral sensory nerves. The signal transfer to the heart or other organs is through neuronal and humoral communications. Protection can be transferred, even across species, with plasma-derived dialysate and involves nitric oxide, stromal derived factor-1α, microribonucleic acid-144, but also other, not yet identified factors. Intracardiac signal transduction involves: adenosine, bradykinin, cytokines, and chemokines, which activate specific receptors; intracellular kinases; and mitochondrial function. RIC by repeated brief inflation/deflation of a blood pressure cuff protects against endothelial dysfunction and myocardial injury in percutaneous coronary interventions, coronary artery bypass grafting, and reperfused acute myocardial infarction. RIC is safe and effective, noninvasive, easily feasible, and inexpensive.
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Affiliation(s)
- Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Centre Essen, University of Essen Medical School, Essen, Germany.
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Karin Przyklenk
- Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Andrew Redington
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Derek Yellon
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
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Touboul C, Angoulvant D, Mewton N, Ivanes F, Muntean D, Prunier F, Ovize M, Bejan-Angoulvant T. Ischaemic postconditioning reduces infarct size: systematic review and meta-analysis of randomized controlled trials. Arch Cardiovasc Dis 2014; 108:39-49. [PMID: 25453717 DOI: 10.1016/j.acvd.2014.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/29/2014] [Accepted: 08/28/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infarct size (IS) is a major determinant of patient outcome after acute ST-segment elevation myocardial infarction (STEMI). Interventions aimed at reducing reperfusion injury, such as cardiac ischaemic postconditioning (IPost), may reduce IS and improve clinical outcomes. IPost has been shown to be feasible in patients with STEMI treated by primary percutaneous coronary intervention (PPCI). AIMS To provide an updated summary of the efficacy of IPost, assessed by analysing accurate surrogate markers of IS. METHODS We performed a meta-analysis of randomized controlled trials that evaluated the efficacy of IPost in STEMI patients undergoing PPCI. The main outcome was area under the curve of serum creatine kinase release (CK-AUC). Secondary outcomes were other surrogate biomarkers of IS, complete ST-segment resolution, direct measurement of IS by single-photon emission computed tomography and estimation of IS by cardiac magnetic resonance (CMR-IS). RESULTS Eleven studies were retrieved, including 1313 STEMI patients undergoing PPCI with or without IPost. Compared with controls, we observed a significant reduction in CK-AUC (standard mean difference [SMD] -2.84 IU/L, 95% CI -5.43 to -0.25 IU/L; P=0.03). Other surrogate markers, such as CMR-IS (SMD -0.36, 95% CI -0.88 to 0.15; P=0.16), showed a non-significant IS reduction in the IPost group. CONCLUSIONS This meta-analysis, dealing with accurate surrogate markers of IS, suggests that IPost reduces IS. However, results should be interpreted cautiously because of limited sample sizes and significant heterogeneity. Whether this translates into improvements in cardiac function and patient prognosis still needs to be demonstrated in larger prospective randomized controlled studies that are powered sufficiently.
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Affiliation(s)
- Caroline Touboul
- CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France
| | - Denis Angoulvant
- CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France; Université François Rabelais, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, FHU "SUPORT", 37000 Tours, France.
| | - Nathan Mewton
- Inserm U1060-CarMeN, service d'explorations fonctionnelles cardiovasculaires, centre d'investigation clinique, 1407, université Claude-Bernard Lyon 1, Louis-Pradel Hospital, CHU de Lyon, Lyon, France
| | - Fabrice Ivanes
- CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France; Université François Rabelais, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, FHU "SUPORT", 37000 Tours, France
| | - Danina Muntean
- Department of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Fabrice Prunier
- EA 3860 cardioprotection remodelage et thrombose, Cardiology Department, université d'Angers, CHU d'Angers, Angers, France
| | - Michel Ovize
- Inserm U1060-CarMeN, service d'explorations fonctionnelles cardiovasculaires, centre d'investigation clinique, 1407, université Claude-Bernard Lyon 1, Louis-Pradel Hospital, CHU de Lyon, Lyon, France
| | - Theodora Bejan-Angoulvant
- CHRU de Tours, department of Pharmacology, Tours, France; CNRS UMR 7292, Tours, France; Université François Rabelais, GICC, Tours, France
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Khan AR, Binabdulhak AA, Alastal Y, Khan S, Faricy-Beredo BM, Luni FK, Lee WM, Khuder S, Tinkel J. Cardioprotective role of ischemic postconditioning in acute myocardial infarction: a systematic review and meta-analysis. Am Heart J 2014; 168:512-521.e4. [PMID: 25262261 DOI: 10.1016/j.ahj.2014.06.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/15/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence suggests that ischemic postconditioning (IPoC) may reduce the extent of reperfusion injury. We performed a meta-analysis of randomized controlled trials, which compared the role of IPoC during primary percutaneous coronary intervention (PCI) to PCI alone (control group) in ST-segment elevation myocardial infarction. METHODS Several databases were searched, which yielded 19 studies. The outcomes of interest were measures of myocardial damage (serum cardiac enzymes and infarct size by imaging) and left ventricular function (left ventricular ejection fraction and wall motion score index). Mean difference (MD) and standardized mean difference (SMD) were used to assess the treatment effect. An inverse variance method was used to pool data into a random-effects model. RESULTS Ischemic postconditioning demonstrated a decrease in serum cardiac enzymes (SMD -0.48, 95% CI -0.92 to -0.05, I(2) = 92%), reduction in infarct size by imaging (SMD -0.30, 95% CI -0.58 to -0.01, I(2) = 80%), wall motion score index (MD -0.19, 95% CI -0.29 to -0.09, I(2) = 44%), and showed improvement in left ventricular ejection fraction (IPoC 52 ± 0.4, control 49.7 ± 0.4) (MD 2.78, 95% CI 0.66-4.91, I(2) = 69%). All included studies were limited by high risk of performance and publication bias. CONCLUSIONS Ischemic postconditioning during PCI in ST-segment elevation myocardial infarction appears to be superior to PCI alone in reduction of both myocardial injury or damage and improvement in global and regional left ventricular function. The effect seems to be more pronounced when a greater myocardial area is at risk. Given the limitations of the current available evidence, additional data from large randomized controlled trials are warranted.
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Affiliation(s)
- Abdur Rahman Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Aref A Binabdulhak
- Department of Internal Medicine, University of Missouri - Kansas City, Kansas, MO
| | - Yaseen Alastal
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Sobia Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | | | - Faraz Khan Luni
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Wade M Lee
- Mulford Health Science Library - University of Toledo, Toledo, OH
| | - Sadik Khuder
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Jodi Tinkel
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
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Feng Y, Bogaert J, Oyen R, Ni Y. An overview on development and application of an experimental platform for quantitative cardiac imaging research in rabbit models of myocardial infarction. Quant Imaging Med Surg 2014; 4:358-75. [PMID: 25392822 PMCID: PMC4213418 DOI: 10.3978/j.issn.2223-4292.2013.09.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/05/2013] [Indexed: 12/28/2022]
Abstract
To exploit the advantages of using rabbits for cardiac imaging research and to tackle the technical obstacles, efforts have been made under the framework of a doctoral research program. In this overview article, by cross-referencing the current literature, we summarize how we have developed a preclinical cardiac research platform based on modified models of reperfused myocardial infarction (MI) in rabbits; how the in vivo manifestations of cardiac imaging could be closely matched with those ex vivo macro- and microscopic findings; how these imaging outcomes could be quantitatively analyzed, validated and demonstrated; and how we could apply this cardiac imaging platform to provide possible solutions to certain lingering diagnostic and therapeutic problems in experimental cardiology. In particular, tissue components in acute cardiac ischemia have been stratified and characterized, post-infarct lipomatous metaplasia (LM) as a common but hardly illuminated clinical pathology has been identified in rabbit models, and a necrosis avid tracer as well as an anti-ischemic drug have been successfully assessed for their potential utilities in clinical cardiology. These outcomes may interest the researchers in the related fields and help strengthen translational research in cardiovascular diseases.
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Affiliation(s)
- Yuanbo Feng
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jan Bogaert
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
| | - Raymond Oyen
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
| | - Yicheng Ni
- KU Leuven, Department of Imaging and Pathology, Theragnostic Laboratory, Radiology Section, University Hospital Gasthuisberg, Leuven, Belgium
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Grieve SM, Mazhar J, Callaghan F, Kok CY, Tandy S, Bhindi R, Figtree GA. Automated quantification of myocardial salvage in a rat model of ischemia-reperfusion injury using 3D high-resolution magnetic resonance imaging (MRI). J Am Heart Assoc 2014; 3:jah3614. [PMID: 25146703 PMCID: PMC4310382 DOI: 10.1161/jaha.114.000956] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Quantification of myocardial “area at risk” (AAR) and myocardial infarction (MI) zone is critical for assessing novel therapies targeting myocardial ischemia–reperfusion (IR) injury. Current “gold‐standard” methods perfuse the heart with Evan's Blue and stain with triphenyl tetrazolium chloride (TTC), requiring manual slicing and analysis. We aimed to develop and validate a high‐resolution 3‐dimensional (3D) magnetic resonance imaging (MRI) method for quantifying MI and AAR. Methods and Results Forty‐eight hours after IR was induced, rats were anesthetized and gadopentetate dimeglumine was administered intravenously. After 10 minutes, the coronary artery was re‐ligated and a solution containing iron oxide microparticles and Evan's Blue was infused (for comparison). Hearts were harvested and transversally sectioned for TTC staining. Ex vivo MR images of slices were acquired on a 9.4‐T magnet. T2* data allowed visualization of AAR, with microparticle‐associated signal loss in perfused regions. T1 data demonstrated gadolinium retention in infarcted zones. Close correlation (r=0.92 to 0.94; P<0.05) of MRI and Evan's Blue/TTC measures for both AAR and MI was observed when the combined techniques were applied to the same heart slice. However, 3D MRI acquisition and analysis of whole heart reduced intra‐observer variability compared to assessment of isolated slices, and allowed automated segmentation and analysis, thus reducing interobserver variation. Anatomical resolution of 81 μm3 was achieved (versus ≈2 mm with manual slicing). Conclusions This novel, yet simple, MRI technique allows precise assessment of infarct and AAR zones. It removes the need for tissue slicing and provides opportunity for 3D digital analysis at high anatomical resolution in a streamlined manner accessible for all laboratories already performing IR experiments.
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Affiliation(s)
- Stuart M Grieve
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Australia (S.M.G., J.M., C.Y.K., S.T., R.B., G.A.F.) Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Australia (S.M.G.) Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia (S.M.G., F.C.)
| | - Jawad Mazhar
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Australia (S.M.G., J.M., C.Y.K., S.T., R.B., G.A.F.) Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (J.M., R.B., G.A.F.)
| | - Fraser Callaghan
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia (S.M.G., F.C.)
| | - Cindy Y Kok
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Australia (S.M.G., J.M., C.Y.K., S.T., R.B., G.A.F.)
| | - Sarah Tandy
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Australia (S.M.G., J.M., C.Y.K., S.T., R.B., G.A.F.)
| | - Ravinay Bhindi
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Australia (S.M.G., J.M., C.Y.K., S.T., R.B., G.A.F.) Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (J.M., R.B., G.A.F.)
| | - Gemma A Figtree
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Australia (S.M.G., J.M., C.Y.K., S.T., R.B., G.A.F.) Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (J.M., R.B., G.A.F.)
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Fernández-Jiménez R, Fernández-Friera L, Sánchez-González J, Ibáñez B. Animal Models of Tissue Characterization of Area at Risk, Edema and Fibrosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Myocardial conditioning is an endogenous cardioprotective phenomenon that profoundly limits infarct size in experimental models. The current challenge is to translate this paradigm from the laboratory to the clinic. Accordingly, our goal in this review is to provide a critical summary of the progress toward, opportunities for, and caveats to, the successful clinical translation of postconditioning and remote conditioning, the 2 conditioning strategies considered to have the broadest applicability for real-world patient care. In the majority of phase II studies published to date, postconditioning evoked a ≈35% reduction of infarct size in ST-segment-elevation myocardial infarction patients. Essential criteria for the successful implementation of postconditioning include the appropriate choice of patients (ie, those with large risk regions and negligible collateral flow), timely application of the postconditioning stimulus (immediately on reperfusion), together with proper choice of end points (infarct size, with concomitant assessment of risk region). Remote conditioning has been applied in planned ischemic events (including cardiac surgery and elective percutaneous coronary intervention) and in ST-segment-elevation myocardial infarction patients during hospital transport. Controversies with regard to efficacy have emerged, particularly among surgical trials. These disparate outcomes in all likelihood reflect the remarkable heterogeneity within and among studies, together with a deficit in our understanding of the impact of these variations on the infarct-sparing effect of remote conditioning. Ongoing phase III trials will provide critical insight into the future role of postconditioning and remote conditioning as clinically relevant cardioprotective strategies.
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Affiliation(s)
- Michel Ovize
- Centre d'Investigation Clinique de Lyon, Service d’Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
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Bergerot C, Mewton N, Lacote-Roiron C, Ernande L, Ovize M, Croisille P, Thibault H, Derumeaux G. Influence of Microvascular Obstruction on Regional Myocardial Deformation in the Acute Phase of Myocardial Infarction: A Speckle-Tracking Echocardiography Study. J Am Soc Echocardiogr 2014; 27:93-100. [DOI: 10.1016/j.echo.2013.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Indexed: 10/26/2022]
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35
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Wince WB, Suranyi P, Schoepf UJ. Contemporary cardiovascular imaging methods for the assessment of at-risk myocardium. J Am Heart Assoc 2013; 3:e000473. [PMID: 24366853 PMCID: PMC3959708 DOI: 10.1161/jaha.113.000473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- W Benjamin Wince
- Department of Medicine, Medical University of South Carolina Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
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Hadamitzky M, Langhans B, Hausleiter J, Sonne C, Kastrati A, Martinoff S, Schömig A, Ibrahim T. The assessment of area at risk and myocardial salvage after coronary revascularization in acute myocardial infarction: comparison between CMR and SPECT. JACC Cardiovasc Imaging 2013; 6:358-69. [PMID: 23473113 DOI: 10.1016/j.jcmg.2012.10.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to compare cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) for assessment of area at risk, scar size, and salvage area after coronary reperfusion in acute myocardial infarction. BACKGROUND Myocardial salvage is an important surrogate endpoint assessing the success of coronary reperfusion in acute myocardial infarction. SPECT, the established modality for assessment of myocardial salvage, requires radiopharmaceutical injection before revascularization and 2 examinations. The combination of T2 and late enhancement imaging in CMR can assess myocardial salvage in 1 examination, but up to now, data comparing both modalities are very limited. METHODS We analyzed 207 patients who were treated by primary revascularization in acute myocardial infarction and who underwent both SPECT and CMR for assessment of myocardial salvage. In CMR, T2-weighted turbo spin echo sequences for area at risk and contrast-enhanced inversion recovery gradient echo sequences were performed. RESULTS Image quality was insufficient in 27 patients (13%). In the remaining 180 patients, mean area at risk was 29.4 ± 18.7% of the left ventricle (LV), and infarct size was 14.7 ± 16.9% LV, resulting in a mean salvage area of 14.9 ± 15.1% LV in SPECT, whereas in CMR, mean area at risk was 28.0 ± 14.5% LV, and infarct size was 16.0 ± 13.5% LV, resulting in a mean salvage area of 11.9 ± 12.3%. Results of both modalities correlated well for area at risk (r = 0.80), scar size (r = 0.87), and salvage area (r = 0.66, all p < 0.0001). CONCLUSIONS Assessment of the salvage area by CMR using T2 and late enhancement imaging correlates well with the established modality of SPECT. CMR therefore may be an alternative to paired SPECT imaging for myocardial salvage assessment, but the contraindications of the modality and limitations in the established T2 imaging sequences currently cause a considerable rate of data loss.
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Affiliation(s)
- Martin Hadamitzky
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Feng Y, Chen F, Ma Z, Dekeyzer F, Yu J, Xie Y, Cona MM, Oyen R, Ni Y. Towards stratifying ischemic components by cardiac MRI and multifunctional stainings in a rabbit model of myocardial infarction. Am J Cancer Res 2013; 4:24-35. [PMID: 24396513 PMCID: PMC3881225 DOI: 10.7150/thno.7188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We sought to identify critical components of myocardial infarction (MI) including area at risk (AAR), MI-core and salvageable zone (SZ) by using cardiac magnetic resonance imaging (cMRI) and multifunctional stainings in rabbits. MATERIALS AND METHODS Fifteen rabbits received 90-min coronary artery (CA) ligation and reopening to induce reperfused MI. First-pass perfusion weighted imaging (PWI(90')) was performed immediately before CA reperfusion. Necrosis avid dye Evans blue (EB) was intravenously injected for later MI-core detection. One-day later, cMRI with T2-weighted imaging (T2WI), PWI(24h) and delayed enhancement (DE) T1WI was performed at a 3.0T clinical scanner. The heart was excised and CA was re-ligated with aorta infused by red-iodized-oil (RIO). The heart was sliced into 3-mm sections for digital radiography (DR), histology and planimetry with myocardial salvage index (MSI) and perfusion density rate (PDR) calculated. RESULTS There was no significant difference between MI-cores defined by DE-T1WI and EB-staining (31.13±8.55% vs 29.80±7.97%; p=0.74). The AAR was defined similarly by PWI90' (39.93±9.51%), RIO (38.82±14.41%) and DR (38.17±15.98%), underestimated by PWI(24h) (36.44±5.31%), but overestimated (p<0.01) by T2WI (56.93±8.87%). Corresponding MSI turned out to be 24.17±9.5% (PWI(90')), 21.97±9.41% (DR) and 22.68±9.65% (RIO), which were significantly (p<0.01) higher and lower than that with PWI(24h) (15.15±7.34%) and T2WI (45.52±7.5%) respectively. The PDR differed significantly (p<0.001) between normal myocardium (350.6±33.1%) and the AAR (31.2±15%), suggesting 11-times greater blood perfusion in normal myocardium over the AAR. CONCLUSION The introduced rabbit platform and new staining techniques together with the use of a 3.0T clinical scanner for cMRI enabled visualization of MI components and may contribute to translational cardiac imaging research for improved theranostic management of ischemic heart disease.
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Kwon SU, Yeung AC, Ikeno F. The role of large animal studies in cardiac regenerative therapy concise review of translational stem cell research. Korean Circ J 2013; 43:511-8. [PMID: 24044009 PMCID: PMC3772295 DOI: 10.4070/kcj.2013.43.8.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Animal models have long been developed for cardiovascular research. These animal models have been helpful in understanding disease, discovering potential therapeutics, and predicting efficacy. Despite many efforts, however, translational study has been underestimated. Recently, investigations have identified stem cell treatment as a potentially promising cell therapy for regenerative medicine, largely because of the stem cell's ability to differentiate into many functional cell types. Stem cells promise a new era of cell-based therapy for salvaging the heart. However, stem cells have the potential risk of tumor formation. These properties of stem cells are considered a major concern over the efficacy of cell therapy. The translational/preclinical study of stem cells is essential but only at the beginning stages. What types of heart disease are indicated for stem cell therapy, what type of stem cell, what type of animal model, how do we deliver stem cells, and how do we improve heart function? These may be the key issues that the settlement of which would facilitate the transition of stem cell research from bench to bedside. In this review article, we discuss state-of-the-art technology in stem cell therapies for cardiovascular diseases.
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Affiliation(s)
- Sung Uk Kwon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA. ; Vision 21 Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Korea
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Abstract
Aquaporins are a group of proteins with high-selective permeability for water. A subgroup called aquaglyceroporins is also permeable to glycerol, urea and a few other solutes. Aquaporin function has mainly been studied in the brain, kidney, glands and skeletal muscle, while the information about aquaporins in the heart is still scarce. The current review explores the recent advances in this field, bringing aquaporins into focus in the context of myocardial ischemia, reperfusion, and blood osmolarity disturbances. Since the amount of data on aquaporins in the heart is still limited, examples and comparisons from better-studied areas of aquaporin biology have been used. The human heart expresses aquaporin-1, -3, -4 and -7 at the protein level. The potential roles of aquaporins in the heart are discussed, and some general phenomena that the myocardial aquaporins share with aquaporins in other organs are elaborated. Cardiac aquaporin-1 is mostly distributed in the microvasculature. Its main role is transcellular water flux across the endothelial membranes. Aquaporin-4 is expressed in myocytes, both in cardiac and in skeletal muscle. In addition to water flux, its function is connected to the calcium signaling machinery. It may play a role in ischemia-reperfusion injury. Aquaglyceroporins, especially aquaporin-7, may serve as a novel pathway for nutrient delivery into the heart. They also mediate toxicity of various poisons. Aquaporins cannot influence permeability by gating, therefore, their function is regulated by changes of expression-on the levels of transcription, translation (by microRNAs), post-translational modification, membrane trafficking, ubiquitination and subsequent degradation. Studies using mice genetically deficient for aquaporins have shown rather modest changes in the heart. However, they might still prove to be attractive targets for therapy directed to reduce myocardial edema and injury caused by ischemia and reperfusion.
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Feng Y, Ma ZL, Chen F, Yu J, Cona MM, Xie Y, Li Y, Ni Y. Bifunctional staining for ex vivo determination of area at risk in rabbits with reperfused myocardial infarction. World J Methodol 2013; 3:27-38. [PMID: 25237621 PMCID: PMC4145566 DOI: 10.5662/wjm.v3.i3.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a method for studying myocardial area at risk (AAR) in ischemic heart disease in correlation with cardiac magnetic resonance imaging (cMRI).
METHODS: Nine rabbits were anesthetized, intubated and subjected to occlusion and reperfusion of the left circumflex coronary artery (LCx) to induce myocardial infarction (MI). ECG-triggered cMRI with delayed enhancement was performed at 3.0 T. After euthanasia, the heart was excised with the LCx re-ligated. Bifunctional staining was performed by perfusing the aorta with a homemade red-iodized-oil (RIO) dye. The heart was then agar-embedded for ex vivo magnetic resonance imaging and sliced into 3 mm-sections. The AAR was defined by RIO-staining and digital radiography (DR). The perfusion density rate (PDR) was derived from DR for the AAR and normal myocardium. The MI was measured by in vivo delayed enhancement (iDE) and ex vivo delayed enhancement (eDE) cMRI. The AAR and MI were compared to validate the bifunctional straining for cardiac imaging research. Linear regression with Bland-Altman agreement, one way-ANOVA with Bonferroni’s multiple comparison, and paired t tests were applied for statistics.
RESULTS: All rabbits tolerated well the surgical procedure and subsequent cMRI sessions. The open-chest occlusion and close-chest reperfusion of the LCx, double suture method and bifunctional staining were successfully applied in all animals. The percentage MI volumes globally (n = 6) and by slice (n = 25) were 36.59% ± 13.68% and 32.88% ± 12.38% on iDE, and 35.41% ± 12.25% and 32.40% ± 12.34% on eDE. There were no significant differences for MI determination with excellent linear regression correspondence (rglobal = 0.89; rslice = 0.9) between iDE and eDE. The percentage AAR volumes globally (n = 6) and by slice (n = 25) were 44.82% ± 15.18% and 40.04% ± 13.64% with RIO-staining, and 44.74% ± 15.98% and 40.48% ± 13.26% by DR showing high correlation in linear regression analysis (rglobal = 0.99; rslice = 1.0). The mean differences of the two AAR measurements on Bland-Altman were almost zero, indicating RIO-staining and DR were essentially equivalent or inter-replaceable. The AAR was significantly larger than MI both globally and slice-by-slice (P < 0.01). After correction with the background and the blank heart without bifunctional staining (n = 3), the PDR for the AAR and normal myocardium was 32% ± 15% and 35.5% ± 35%, respectively, which is significantly different (P < 0.001), suggesting that blood perfusion to the AAR probably by collateral circulation was only less than 10% of that in the normal myocardium.
CONCLUSION: The myocardial area at risk in ischemic heart disease could be accurately determined postmortem by this novel bifunctional staining, which may substantially contribute to translational cardiac imaging research.
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Hausenloy DJ. Conditioning the heart to prevent myocardial reperfusion injury during PPCI. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:13-32. [PMID: 24062884 DOI: 10.1177/2048872612438805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/22/2012] [Indexed: 11/15/2022]
Abstract
For patients presenting with a ST-segment elevation myocardial infarction (STEMI), early myocardial reperfusion by primary percutaneous coronary intervention (PPCI) remains the most effective treatment strategy for limiting myocardial infarct size, preserving left ventricular systolic function, and preventing the onset of heart failure. Recent advances in PCI technology to improve myocardial reperfusion and the introduction of novel anti-platelet and anti-thrombotic agents to maintain the patency of the infarct-related coronary artery continue to optimize PPCI procedure. However, despite these improvements, STEMI patients still experience significant major adverse cardiovascular events. One major contributing factor has been the inability to protect the heart against the lethal myocardial reperfusion injury, which accompanies PPCI. Past attempts to translate cardioprotective strategies, discovered in experimental studies to prevent lethal myocardial reperfusion injury, into the clinical setting of PPCI have been disappointing. However, a number of recent proof-of-concept clinical studies suggest that the heart can be 'conditioned' to protect itself against lethal myocardial reperfusion injury, as evidenced by a reduction in myocardial infarct size. This can be achieved using either mechanical (such as ischaemic postconditioning, remote ischaemic preconditioning, therapeutic hypothermia, or hyperoxaemia) or pharmacological (such as cyclosporin-A, natriuretic peptide, exenatide) 'conditioning' strategies as adjuncts to PPCI. Furthermore, recent developments in cardiac magnetic resonance (CMR) imaging can provide a non-invasive imaging strategy for assessing the efficacy of these novel adjunctive therapies to PPCI in terms of key surrogate clinical endpoints such as myocardial infarct size, myocardial salvage, left ventricular ejection fraction, and the presence of microvascular obstruction or intramyocardial haemorrhage. In this article, we review the therapeutic potential of 'conditioning' to protect the heart against lethal myocardial reperfusion injury in STEMI patients undergoing PPCI.
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Myocardial infarction and coronary microvascular obstruction: an intimate, but complicated relationship. Basic Res Cardiol 2013; 108:380. [DOI: 10.1007/s00395-013-0380-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Duicu OM, Angoulvant D, Muntean DM. Cardioprotection against myocardial reperfusion injury: successes, failures, and perspectives. Can J Physiol Pharmacol 2013; 91:657-62. [PMID: 23889135 DOI: 10.1139/cjpp-2013-0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The past few decades have witnessed an enormous number of research strategies aimed at protecting the heart against myocardial ischemia-reperfusion injury. Several randomized clinical trials are nowadays in progress testing whether promising therapeutic strategies aimed at preventing lethal reperfusion injury can be translated from bench to bedside. Many of these interventions, either pharmacological or mechanical, are targeting mitochondria as the final effectors of cardioprotection. Despite encouraging pre-clinical studies and small proof of concept clinical trials, there are still several limitations that may jeopardize the efficacy of cardioprotective strategies. These limitations include clinical setting, patient profile, drug administration, and methods for evaluating treatment efficacy. Identifying potential mechanistic and methodological pitfalls in the field may improve future translational research.
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Affiliation(s)
- Oana M Duicu
- Department of Pathophysiology, Victor Babeş University of Medicine and Pharmacy Timisoara, Romania
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Schmidt MR, Sloth AD, Johnsen J, Bøtker HE. Remote ischemic conditioning: the cardiologist's perspective. J Cardiovasc Med (Hagerstown) 2013; 13:667-74. [PMID: 23114270 DOI: 10.2459/jcm.0b013e328357bff2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve clinical outcome. However, revascularization per se may induce further myocardial damage by myocardial ischemia-reperfusion injury and worsen clinical outcome. Therefore, new therapeutic strategies are required to protect the myocardium against ischemia-reperfusion injury in patients with coronary artery disease. Remote ischemic conditioning (RIC) by brief nonlethal episodes of ischemia and reperfusion to an organ or tissue remote from the heart activates innate cardioprotective mechanisms. The discovery that RIC can be performed noninvasively using a blood pressure cuff on the upper arm to induce brief episodes of limb ischemia and reperfusion has facilitated the translation of RIC into the clinical arena. Whereas some trials have shown contradictory results, recently published proof-of-concept clinical studies have reported encouraging results with RIC. Large-scale multicenter clinical trials are needed to establish the role of RIC in the current clinical practice. At present, the use of RIC in acute coronary syndromes seems particularly attractive due to its potential in-ambulance application and apparent dramatic reduction in infarct size in the patients with the largest infarcts. Cardiac arrest and stroke represent ischemia-reperfusion disorders where RIC has further potential to improve outcome beyond rapid revascularization alone.
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Affiliation(s)
- Michael R Schmidt
- Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej, Aarhus N, Denmark
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Hausenloy DJ, Erik Bøtker H, Condorelli G, Ferdinandy P, Garcia-Dorado D, Heusch G, Lecour S, van Laake LW, Madonna R, Ruiz-Meana M, Schulz R, Sluijter JPG, Yellon DM, Ovize M. Translating cardioprotection for patient benefit: position paper from the Working Group of Cellular Biology of the Heart of the European Society of Cardiology. Cardiovasc Res 2013; 98:7-27. [PMID: 23334258 DOI: 10.1093/cvr/cvt004] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Coronary heart disease (CHD) is the leading cause of death and disability worldwide. Despite current therapy, the morbidity and mortality for patients with CHD remains significant. The most important manifestations of CHD arise from acute myocardial ischaemia-reperfusion injury (IRI) in terms of cardiomyocyte death and its long-term consequences. As such, new therapeutic interventions are required to protect the heart against the detrimental effects of acute IRI and improve clinical outcomes. Although a large number of cardioprotective therapies discovered in pre-clinical studies have been investigated in CHD patients, few have been translated into the clinical setting, and a significant number of these have failed to show any benefit in terms of reduced myocardial infarction and improved clinical outcomes. Because of this, there is currently no effective therapy for protecting the heart against the detrimental effects of acute IRI in patients with CHD. One major factor for this lack of success in translating cardioprotective therapies into the clinical setting can be attributed to problems with the clinical study design. Many of these clinical studies have not taken into consideration the important data provided from previously published pre-clinical and clinical studies. The overall aim of this ESC Working Group Cellular Biology of the Heart Position Paper is to provide recommendations for optimizing the design of clinical cardioprotection studies, which should hopefully result in new and effective therapeutic interventions for the future benefit of CHD patients.
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Affiliation(s)
- Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.
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Abstract
Myocardial infarct size is a major determinant of prognosis. Ischaemic preconditioning with brief coronary occlusion and reperfusion before a sustained period of coronary occlusion with reperfusion delays infarct development. Ischaemic postconditioning uses repetitive brief coronary occlusion during early reperfusion of myocardial infarction and reduces infarct size. Remote ischaemic preconditioning uses brief ischaemia and reperfusion of a distant organ to protect the myocardium. These conditioning protocols recruit a complex signal cascade of sarcolemmal receptor activation, intracellular enzyme activation, and ultimately mitochondrial stabilisation and inhibition of death signalling. Conditioning protocols have been successfully used in patients undergoing elective coronary revascularisation and reperfusion after acute myocardial infarction. Pharmacological recruitment of cardioprotective signalling has also been used to reduce infarct size, but so far without prognostic benefit. Outcomes of cardioprotection are affected by age, sex, comorbidities, and drugs, but also by technical issues related to determination of infarct size and revascularisation procedure.
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Affiliation(s)
- Gerd Heusch
- Institut für Pathophysiologie, Universitätsklinikum Essen, Essen, Germany.
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Hausenloy DJ, Yellon DM. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest 2013; 123:92-100. [PMID: 23281415 DOI: 10.1172/jci62874] [Citation(s) in RCA: 1539] [Impact Index Per Article: 139.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Acute myocardial infarction (MI) is a major cause of death and disability worldwide. In patients with MI, the treatment of choice for reducing acute myocardial ischemic injury and limiting MI size is timely and effective myocardial reperfusion using either thombolytic therapy or primary percutaneous coronary intervention (PPCI). However, the process of reperfusion can itself induce cardiomyocyte death, known as myocardial reperfusion injury, for which there is still no effective therapy. A number of new therapeutic strategies currently under investigation for preventing myocardial reperfusion injury have the potential to improve clinical outcomes in patients with acute MI treated with PPCI.
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Affiliation(s)
- Derek J Hausenloy
- Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, United Kingdom
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Arai AE, Leung S, Kellman P. Controversies in cardiovascular MR imaging: reasons why imaging myocardial T2 has clinical and pathophysiologic value in acute myocardial infarction. Radiology 2012; 265:23-32. [PMID: 22993218 DOI: 10.1148/radiol.12112491] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Room B1D416, MSC 1061, 10 Center Dr, Bethesda, MD 20892-1061, USA.
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McCall FC, Telukuntla KS, Karantalis V, Suncion VY, Heldman AW, Mushtaq M, Williams AR, Hare JM. Myocardial infarction and intramyocardial injection models in swine. Nat Protoc 2012; 7:1479-96. [PMID: 22790084 DOI: 10.1038/nprot.2012.075] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sustainable and reproducible large animal models that closely replicate the clinical sequelae of myocardial infarction (MI) are important for the translation of basic science research into bedside medicine. Swine are well accepted by the scientific community for cardiovascular research, and they represent an established animal model for preclinical trials for US Food and Drug Administration (FDA) approval of novel therapies. Here we present a protocol for using porcine models of MI created with a closed-chest coronary artery occlusion-reperfusion technique. This creates a model of MI encompassing the anteroapical, lateral and septal walls of the left ventricle. This model infarction can be easily adapted to suit individual study design and enables the investigation of a variety of possible interventions. This model is therefore a useful tool for translational research into the pathophysiology of ventricular remodeling and is an ideal testing platform for novel biological approaches targeting regenerative medicine. This model can be created in approximately 8-10 h.
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Affiliation(s)
- Frederic C McCall
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Rutkovskiy A, Stensløkken KO, Mariero LH, Skrbic B, Amiry-Moghaddam M, Hillestad V, Valen G, Perreault MC, Ottersen OP, Gullestad L, Dahl CP, Vaage J. Aquaporin-4 in the heart: expression, regulation and functional role in ischemia. Basic Res Cardiol 2012; 107:280. [DOI: 10.1007/s00395-012-0280-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 06/14/2012] [Accepted: 06/26/2012] [Indexed: 11/24/2022]
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