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Giga V, Tesic M, Beleslin B, Boskovic N, Sobic-Saranovic D, Jovanovic I, Nedeljkovic I, Paunovic I, Dedic S, Djordjevic-Dikic A. Predictors of diastolic deceleration time of coronary flow velocity of infarct related and reference coronary artery assessed by transthoracic Doppler echocardiography in the chronic phase of successfully reperfused anterior myocardial infarction: relation to infarct size. Front Cardiovasc Med 2023; 10:1196206. [PMID: 37771666 PMCID: PMC10523777 DOI: 10.3389/fcvm.2023.1196206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/31/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction High-frequency transthoracic Doppler echocardiography (TDE) enables the assessment of flow velocity and velocity pattern in different coronary arteries, including the assessment of diastolic deceleration time (DDT) of coronary flow velocity. Short DDT of infarct related artery (IRA) (<600 msec) in the acute phase of anterior myocardial infarction (MI) is the predictor of adverse left ventricular (LV) remodeling and prognosis. The significance of DDT of coronary flow velocity assessment in the chronic phase of anterior MI is not well established. Our study aimed to establish the predictors of DDT of the coronary flow velocity of infarct related (left anterior descendent-DDT of LAD) and reference coronary artery, evaluated by TDE, and to assess their relation to infarct size in the chronic phase of successfully reperfused first anterior MI. Methods Our study included 40 consecutive patients (34 men, mean age 52 ± 12 years) one month after the first anterior STEMI and single vessel disease successfully treated with primary PCI. All patients underwent SPECT MPI for the assessment of LV volumes, ejection fraction, and percentage of the myocardium with fixed perfusion abnormalities and echocardiographic examination including the evaluation of DDT of IRA and reference coronary artery TDE. Results DDT of LAD correlated significantly to the WMSI (r = -0.467, p = 0.002), LV end-systolic volume (r = -0.412, p = 0.008), LV ejection fraction (r = 0.427, p = 0.006), while the strongest correlation was observed between DDT of LAD and the extent of fixed perfusion abnormality (r = -0.627, p < 0.0001), Multivariate analysis revealed percentage of fixed perfusion abnormalities along with DDT of reference coronary artery as the independent predictors of DDT of IRA. DDT of IRA shorter than 886 msec predicts large fixed perfusion abnormalities (>20%) with a sensitivity of 89% and specificity of 62% (AUC 0.842). Conclusion DDT of LAD assessed by TDE in the chronic phase of successfully reperfused first anterior MI is a usefull variable for the assessment of microcirculatory function that exclusively reflects the extent of microvascular damage and relates to infarct size.
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Affiliation(s)
- Vojislav Giga
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Sobic-Saranovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Insitute for Nuclear Medicine, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Jovanovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Paunovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Srdjan Dedic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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Hsu CC, Wang JS, Shyu YC, Fu TC, Juan YH, Yuan SS, Wang CH, Yeh CH, Liao PC, Wu HY, Hsu PH. Hypermethylation of ACADVL is involved in the high-intensity interval training-associated reduction of cardiac fibrosis in heart failure patients. J Transl Med 2023; 21:187. [PMID: 36894992 PMCID: PMC9999524 DOI: 10.1186/s12967-023-04032-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that DNA methylation can be affected by physical activities and is associated with cardiac fibrosis. This translational research examined the implications of DNA methylation associated with the high-intensity interval training (HIIT) effects on cardiac fibrosis in patients with heart failure (HF). METHODS Twelve HF patients were included and received cardiovascular magnetic resonance imaging with late gadolinium enhancement for cardiac fibrosis severity and a cardiopulmonary exercise test for peak oxygen consumption ([Formula: see text]O2peak). Afterwards, they underwent 36 sessions of HIIT at alternating 80% and 40% of [Formula: see text]O2peak for 30 min per session in 3-4 months. Human serum from 11 participants, as a means to link cell biology to clinical presentations, was used to investigate the exercise effects on cardiac fibrosis. Primary human cardiac fibroblasts (HCFs) were incubated in patient serum, and analyses of cell behaviour, proteomics (n = 6) and DNA methylation profiling (n = 3) were performed. All measurements were conducted after completing HIIT. RESULTS A significant increase (p = 0.009) in [Formula: see text]O2peak (pre- vs. post-HIIT = 19.0 ± 1.1 O2 ml/kg/min vs. 21.8 ± 1.1 O2 ml/kg/min) was observed after HIIT. The exercise strategy resulted in a significant decrease in left ventricle (LV) volume by 15% to 40% (p < 0.05) and a significant increase in LV ejection fraction by approximately 30% (p = 0.010). LV myocardial fibrosis significantly decreased from 30.9 ± 1.2% to 27.2 ± 0.8% (p = 0.013) and from 33.4 ± 1.6% to 30.1 ± 1.6% (p = 0.021) in the middle and apical LV myocardium after HIIT, respectively. The mean single-cell migration speed was significantly (p = 0.044) greater for HCFs treated with patient serum before (2.15 ± 0.17 μm/min) than after (1.11 ± 0.12 μm/min) HIIT. Forty-three of 1222 identified proteins were significantly involved in HIIT-induced altered HCF activities. There was significant (p = 0.044) hypermethylation of the acyl-CoA dehydrogenase very long chain (ACADVL) gene with a 4.474-fold increase after HIIT, which could activate downstream caspase-mediated actin disassembly and the cell death pathway. CONCLUSIONS Human investigation has shown that HIIT is associated with reduced cardiac fibrosis in HF patients. Hypermethylation of ACADVL after HIIT may contribute to impeding HCF activities. This exercise-associated epigenetic reprogramming may contribute to reduce cardiac fibrosis and promote cardiorespiratory fitness in HF patients. TRIAL REGISTRATION NCT04038723. Registered 31 July 2019, https://clinicaltrials.gov/ct2/show/NCT04038723 .
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Affiliation(s)
- Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1St Rd., Anle Dist, Keelung, 204, Taiwan.
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan.
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
| | - Jong-Shyan Wang
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1St Rd., Anle Dist, Keelung, 204, Taiwan
- Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1St Rd., Anle Dist, Keelung, 204, Taiwan
| | - Yu-Hsiang Juan
- Department of Medical Imaging and intervention, Linkou and Taoyuan Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Shin-Sheng Yuan
- Institute of Statistical Science, Academia Sinica, Taipei, 115, Taiwan
| | - Chao-Hung Wang
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Chi-Hsiao Yeh
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Po-Cheng Liao
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Hsin-Yi Wu
- Instrumentation Center, National Taiwan University, Taipei, 106, Taiwan
| | - Pang-Hung Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, No. 2, Beining Rd., Zhongzheng Dist., Keelung, 202, Taiwan.
- Center of Excellence for the Oceans, National Taiwan Ocean University, Keelung, 202, Taiwan.
- Institute of Biochemistry and Molecular Biology, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
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3
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Lebeau R, Robert-Halabi M, Pichette M, Vinet A, Sauvé C, Dilorenzo M, Le V, Piette E, Brunet M, Bédard W, Serri K, Poulin F. Left ventricular ejection fraction using a simplified wall motion score based on mid-parasternal short axis and apical four-chamber views for non-cardiologists. BMC Cardiovasc Disord 2023; 23:115. [PMID: 36890433 PMCID: PMC9993504 DOI: 10.1186/s12872-023-03141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND There is a need for a convenient, yet reliable method to assess left ventricular ejection fraction (LVEF) with point-of-care ultrasound study (POCUS). We aim to validate a novel and simplified wall motion score LVEF based on the analysis of a simplified combination of echocardiographic views. METHODS In this retrospective study, transthoracic echocardiograms of randomly selected patients were analysed by the standard 16-segments wall motion score index (WMSI) to derive the reference semi-quantitative LVEF. To develop our semi-quantitative simplified-views method, a limited combination of imaging views and only 4 segments per view were tested: (1) A combination of the three parasternal short-axis views (PSAX BASE, MID-, APEX); (2) A combination of the three apical views (apical 2-chamber, 3-chamber and 4-chamber) and (3) A more limited combination of PSAX-MID and apical 4-chamber is called the MID-4CH. Global LVEF is obtained by averaging segmental EF based on contractility (normal = 60%, hypokinesia = 40%, and akinesia = 10%). Accuracy of the novel semi-quantitative simplified-views WMS method compared to the reference WMSI was evaluated using Bland-Altman analysis and correlation was assessed in both emergency physicians and cardiologists. RESULTS In the 46 patients using the 16 segments WMSI method, the mean LVEF was 34 ± 10%. Among the three combinations of the two or three imaging views analysed, the MID-4CH had the best correlation with the reference method (r2 = 0.90) with very good agreement (mean LVEF bias = - 0.2%) and precision (± 3.3%). CONCLUSIONS Cardiac POCUS by emergency physicians and other non-cardiologists is a decisive therapeutic and prognostic tool. A simplified semi-quantitative WMS method to assess LVEF using the easiest technically achievable combination of mid-parasternal and apical four-chamber views provides a good approximative estimate for both non-cardiologist emergency physicians and cardiologists.
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Affiliation(s)
- Réal Lebeau
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Maxime Robert-Halabi
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Maxime Pichette
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Alain Vinet
- Centre de Rercherche de l'Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Claude Sauvé
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Maria Dilorenzo
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Viet Le
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Eric Piette
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Mathieu Brunet
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - William Bédard
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Karim Serri
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Frédéric Poulin
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada.
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4
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Lebeau R, Pagé M, Serri K, Pichette M, Lorenzo MD, Sauvé C, Vinet A, Poulin F. Right ventricular ejection fraction with cardiac magnetic resonance using a wall motion score. Arch Cardiovasc Dis 2022; 115:126-133. [DOI: 10.1016/j.acvd.2022.01.002] [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: 04/17/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
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Shaaban M, Tantawy SW, Elkafrawy F, Romeih S, Elmozy W. Multiparametric Rest and Dobutamine Stress Magnetic Resonance in Assessment of Myocardial Viability. J Magn Reson Imaging 2021; 54:1773-1781. [PMID: 34018279 DOI: 10.1002/jmri.27733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND MR feature-tracking (FT) is a novel technique that quantitatively calculates myocardial strain and can assess myocardial viability. PURPOSE To evaluate the feasibility of FT at rest and with low-dose dobutamine (LDD), visual assessment of contractility with LDD and left ventricle (LV) end-diastolic wall thickness (EDWT) in the assessment of viability in ischemic cardiomyopathy (ICM) patients compared to delayed gadolinium enhancement (DGE). STUDY TYPE Prospective. SUBJECTS Thirty ICM patients and 30 healthy volunteers. FIELD STRENGTH/SEQUENCES A 1.5 T with balanced steady-state free precession (bSSFP) cine and phase-sensitive inversion prepared segmented gradient echo sequences. ASSESSMENT LDD (5 μg/kg/min and 10 μg/kg/min) was administered in the patient group. LV was divided into 16 segments and MR-FT was derived from bSSFP cine images using dedicated software. Viable segments were defined as those with a dobutamine-induced increase in resting MR-FT values >20%, a dobutamine-induced increase in systolic wall thickening ≥2 mm by visual assessment, ≤50% fibrosis on DGE, and resting EDWT ≥5.5 mm. STATISTICAL TESTS One-way analysis of variance (ANOVA), two-sampled t-test, paired samples t-test, and receiver operating characteristic (ROC) curve analysis. A P value < 0.05 was considered statistically significant. RESULTS Resting peak global circumferential (Ecc) and radial (Err) strains were significantly impaired in patients compared to controls (-11.7 ± 7.9 vs. -20.1 ± 5.7 and 19.7 ± 13.9 vs. 32.7 ± 15.4, respectively). Segments with no DGE (n = 354) and ≤ 50% (n = 38) DGE showed significant improvement of both Ecc and Err with LDD while segments with >50% DGE (n = 88) showed no improvement. In comparison to viable and nonviable segments identified by reference-standard DGE, the sensitivity, specificity, and diagnostic accuracy of the four methods were: 74%, 92%, and 89%, respectively, for Ecc; 70%, 89%, and 86%, respectively, for Err; 67%, 88%, and 84% for visual assessment; and 39%, 90%, and 80% for EDWT. DATA CONCLUSION Quantitative assessment of MR-FT, along with EDWT and qualitative visual assessment of myocardial contractility with LDD, are feasible alternative methods for the assessment of myocardial viability with moderate sensitivity and high specificity. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage: 2.
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Affiliation(s)
- Mahmoud Shaaban
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt.,Cardiology Department, Faculty of Medicine, Tanta University, Egypt
| | - Sara W Tantawy
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt.,Radiology Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Fatma Elkafrawy
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt.,Radiology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Soha Romeih
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt.,Cardiology Department, Faculty of Medicine, Tanta University, Egypt
| | - Wesam Elmozy
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt.,Radiology Department, Faculty of Medicine, Cairo University, Egypt
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Perkins JD, Akhtar N, Singh R, Kamran A, Ilyas S. Partitioning risk factors for embolic stroke of undetermined source using exploratory factor analysis. Int J Stroke 2021; 17:407-414. [PMID: 33787396 PMCID: PMC8969073 DOI: 10.1177/17474930211009847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Embolic stroke of undetermined source (ESUS) accounts for up to 25% of strokes. Understanding risk factors associated with ESUS is important in reducing stroke burden worldwide. However, ESUS patients are younger and present with fewer traditional risk factors. Significant global variation in ESUS populations also exists making the clinical picture of this type of stroke unclear. Methods and results ESUS patients were pair matched for age, sex, and ethnicity with a group of all other strokes (both n = 331). Exploratory factor analysis was applied in both groups to 14 risk and clinical factors to identify latent factors. In ESUS patients, two latent factors emerged consisting primarily of heart-related variables such as left ventricular wall motion abnormalities, reduced ejection fraction, and increased left atrial volume index, as well as aortic arch atherosclerosis. This is in comparison to the all other strokes group, which was dominated by traditional stroke risk factors. Conclusions Our findings support the existence of a unique pattern of risk factors specific to ESUS. We show that LVWMA and corresponding changes in left heart function are a potential source of emboli in these patients. In addition, the clustering of aortic arch atherosclerosis with left heart factors suggests a causal link. Through the application of exploratory factor analysis, this work contributes to a further understanding of stroke mechanisms in ESUS.
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Affiliation(s)
- Jon D Perkins
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,PMARC, University of Edinburgh, Edinburgh, UK
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
| | - Rajvir Singh
- Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar
| | - Asad Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Saadat Ilyas
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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Obaid N, Hadidy SE, Badry ME, Khaled H. The Outcome of Diabetic Patients with Cardiomyopathy in Critical Care Unit: Hospital and Short-Term Outcome in a Period of Six Months to One Year. Open Access Maced J Med Sci 2019; 7:2796-2801. [PMID: 31844439 PMCID: PMC6901858 DOI: 10.3889/oamjms.2019.655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a major risk factor for heart failure (HF) and coronary artery disease (CAD). DM may cause structural changes involving the left ventricle (LV) systolic and diastolic function. AIM To compare patients who have diabetes and ischemic cardiomyopathy (ICM) to those with diabetic cardiomyopathy (DMCMP) regarding LV systolic function, diastolic function, in hospital long term and short-term mortality. METHODS Ninety diabetic patients with heart failure and left ventricular ejection fraction (LVEF) ≤ 35%, admitted to Critical Care Medicine department Cairo University were divided into two groups based on coronary angiography results; group I (ICM) n = 48 patients and group II (DMCMP) n = 42 patients. RESULTS Group I patients had higher mean age (63 ± 7 years), (p = 0.004), Hypertension (p < 0.001) and dyslipidemia (p = 0.008) were significantly more present in group I compared to group II. No significant differences were found regarding LVEF, global longitudinal strain (GLS), E/A and E/É ratio in both groups. A significant difference in the wall motion score index (WMSI) in group I; (1.4 ± 0.4) versus group II; (1.1 ± 0.2), (p = 0.005) was found. In the study, 6 patients had a cardiogenic shock with no documented in-hospital mortality. At 6 months, statistically, significantly higher mortality rates were found in group I, (p = 0.006), while at one year there was no significant difference in the mortality between the two groups, (p = 0.077). In comparison of the survived and non-survived patients at 6 months and one year in group I (ICM) there was a significant difference in LVEF (40 ± 6% vs 23 ± 6%, p < 0.001), GLS (- 8.1 ± 2.4 vs - 4.6 ± 2.6, p = 0.007), E/A (1.25 ± 0.91 vs 1.8 ± 0.5, p = 0.038), E/É (11.68 ± 7.5 vs 21.3 ± 3.6, p = 0.001) respectively. In group ll (DMCMP) there was no documented mortality at 6 months follow up, however, at one year there was statistically significant difference in the mortality between survived and non-survived patients; the LVEF (35 ± 8% vs 25 ± 2%, p = 0.014), GLS (-7.9 ± 2.9% vs -5 ± 0.1%, p = 0.032), E/A (1.45 ± 0.8 vs 3.3 ± 0, p = 0.006) respectively. The E/É ratio in group ll was not significantly different between the groups (15.73 ± 5.3 vs 15 ± 1, p = 0.873). CONCLUSION The combination of cardiomyopathy and diabetes affects LV systolic and diastolic function; however; ischemic cardiomyopathy and diabetic cardiomyopathy had a similar systolic and diastolic function. Ischemic cardiomyopathy is associated with worse prognosis compared to diabetic cardiomyopathy.
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Affiliation(s)
- Najjat Obaid
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Samir El Hadidy
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Mahmoud El Badry
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Hassan Khaled
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
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8
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Abd El-Mottaleb NA, Galal HM, El Maghraby KM, Gadallah AI. Serum irisin level in myocardial infarction patients with or without heart failure. Can J Physiol Pharmacol 2019; 97:932-938. [PMID: 30958967 DOI: 10.1139/cjpp-2018-0736] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study aimed to assess serum irisin level in myocardial infarction (MI) with or without heart failure (HF) and the possible relation between irisin and cardiac markers, tumor necrosis factor-α (TNF-α) and lipid profile. Eighty-six subjects were included (33 patients had MI, 33 patients had MI with HF, and 20 controls). Body mass index (BMI), waist/hip ratio (WHR), systolic and diastolic blood pressure (SBP and DBP), heart rate, and left ventricular ejection fraction (LVEF) were measured. Blood samples were withdrawn on admission for measuring irisin, cardiac markers, TNF-α, total cholesterol (TC), triglycerides (TGs), low-density lipoprotein-cholesterol concentration (LDL-C), and high-density lipoprotein-cholesterol concentration (HDL-C). Patients with MI and HF had reduced serum irisin, LVEF, and HDL-C and higher levels of BMI, WHR, SBP, DBP, troponin-I, creatine kinase-MB (CK-MB), TNF-α, TC, TGs, and LDL-C compared with control. Negative correlations were observed between irisin and BMI, WHR, SBP, DBP, troponin-I, CK-MB, TNF-α, TC, TGs, and LDL-C. However, positive association was noticed between irisin and LVEF and HDL-C. Irisin might be a useful biomarker in diagnosis of MI with or without HF. It could have anti-inflammatory and hypolipidemic effects. Further studies are needed to elucidate the role of irisin as a promising prophylactic or therapeutic agent in cardiovascular diseases.
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Affiliation(s)
| | - Heba M Galal
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Egypt.,Department of Medical Physiology, Faculty of Medicine, Jouf University, Saudi Arabia
| | | | - Aml I Gadallah
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Egypt
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9
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Lebeau R, Serri K, Lorenzo MD, Sauvé C, Le VHV, Soulières V, El-Rayes M, Pagé M, Zaïani C, Garot J, Poulin F. Assessment of LVEF using a new 16-segment wall motion score in echocardiography. Echo Res Pract 2018; 5:63-69. [PMID: 29628446 PMCID: PMC5887066 DOI: 10.1530/erp-18-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022] Open
Abstract
Background Simpson biplane method and 3D by transthoracic echocardiography (TTE), radionuclide angiography (RNA) and cardiac magnetic resonance imaging (CMR) are the most accepted techniques for left ventricular ejection fraction (LVEF) assessment. Wall motion score index (WMSI) by TTE is an accepted complement. However, the conversion from WMSI to LVEF is obtained through a regression equation, which may limit its use. In this retrospective study, we aimed to validate a new method to derive LVEF from the wall motion score in 95 patients. Methods The new score consisted of attributing a segmental EF to each LV segment based on the wall motion score and averaging all 16 segmental EF into a global LVEF. This segmental EF score was calculated on TTE in 95 patients, and RNA was used as the reference LVEF method. LVEF using the new segmental EF 15-40-65 score on TTE was compared to the reference methods using linear regression and Bland–Altman analyses. Results The median LVEF was 45% (interquartile range 32–53%; range from 15 to 65%). Our new segmental EF 15-40-65 score derived on TTE correlated strongly with RNA-LVEF (r = 0.97). Overall, the new score resulted in good agreement of LVEF compared to RNA (mean bias 0.61%). The standard deviations (s.d.s) of the distributions of inter-method difference for the comparison of the new score with RNA were 6.2%, indicating good precision. Conclusion LVEF assessment using segmental EF derived from the wall motion score applied to each of the 16 LV segments has excellent correlation and agreement with a reference method.
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Affiliation(s)
- Real Lebeau
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Karim Serri
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Maria Di Lorenzo
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Claude Sauvé
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Van Hoai Viet Le
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Vicky Soulières
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Malak El-Rayes
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Maude Pagé
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Chimène Zaïani
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Jérôme Garot
- Institut cardiovasculaire Paris Sud, Massy, France
| | - Frédéric Poulin
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
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Kidoh M, Utsunomiya D, Funama Y, Ashikaga H, Nakaura T, Oda S, Yuki H, Hirata K, Iyama Y, Nagayama Y, Fukui T, Yamashita Y, Taguchi K. Vectors through a cross-sectional image (VCI): A visualization method for four-dimensional motion analysis for cardiac computed tomography. J Cardiovasc Comput Tomogr 2017; 11:468-473. [PMID: 28967574 DOI: 10.1016/j.jcct.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/30/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) has the potential for fully four-dimensional (4D for 3D plus time) motion analysis of the heart. We aimed at developing a method for assessment and presentation of the 4D motion for multi-phase, contrast-enhanced cardiac CT data sets and demonstrating its clinical applicability. METHODS Four patients with normal cardiac function, old myocardial infarction (OMI), takotsubo cardiomyopathy, and hypertrophic cardiomyopathy (HCM) underwent contrast-enhanced cardiac CT for one heartbeat using a 320-row CT scanner with no tube current modulation. CT images for 10 cardiac phases (with a 10%-increment of the R-R interval) were reconstructed with the isotropic effective resolution of (0.5 mm)3 An image-based motion-estimation (iME) algorithm, developed previously, has been used to estimate a time series of 3D cardiac motion, from the end-systole to the other nine phases. The iME uses down-sampled images with a resolution of (1.0 mm)3 deforms the end-systole images non-rigidly to match images at other phases. Once the agreement is maximized, iME outputs a 3D motion vector defined for each voxel for each phase, that smoothly changes over voxels and phases. The proposed visualization method, which is called "vectors through a cross-sectional image (VCI)," presents 3D vectors from the end-diastole to the end-systole as arrows with an end-diastole CT slice. We performed visual assessment of the VCI with calculated the mean vector lengths to evaluate regional left ventricular (LV) contraction. RESULTS The VCI images showed the magnitude and direction of systolic 3D vectors, including the through-plane motion, and successfully visualized the relations of LV wall segments and abnormal regional wall motion. Decreased regional motion and asymmetric motion due to hypokinetic infarct segment, takotsubo cardiomyopathy, and hyper trophic cardiomyopathy was clearly observed. It was easy to appreciate the relation of the abnormal regional wall motion to the affected LV wall segments. The mean vector lengths of the affected segments with pathologies were clearly smaller than the other unaffected segments (1.2-1.7 mm versus 2.5-4.7 mm). CONCLUSIONS VCI images could capture the magnitude and direction of through-plane motion and show the relations of LV wall segments and abnormal wall motion.
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Affiliation(s)
- Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan.
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Hiroshi Ashikaga
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Hideaki Yuki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Kenichiro Hirata
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Yuji Iyama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University 1-1-1, Honjo, Kumamoto 860-8556, Japan
| | - Katsuyuki Taguchi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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11
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Pasupathy S, Tavella R, Grover S, Raman B, Procter NEK, Du YT, Mahadavan G, Stafford I, Heresztyn T, Holmes A, Zeitz C, Arstall M, Selvanayagam J, Horowitz JD, Beltrame JF. Early Use of N-acetylcysteine With Nitrate Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Reduces Myocardial Infarct Size (the NACIAM Trial [N-acetylcysteine in Acute Myocardial Infarction]). Circulation 2017. [PMID: 28634219 DOI: 10.1161/circulationaha.117.027575] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Contemporary ST-segment-elevation myocardial infarction management involves primary percutaneous coronary intervention, with ongoing studies focusing on infarct size reduction using ancillary therapies. N-acetylcysteine (NAC) is an antioxidant with reactive oxygen species scavenging properties that also potentiates the effects of nitroglycerin and thus represents a potentially beneficial ancillary therapy in primary percutaneous coronary intervention. The NACIAM trial (N-acetylcysteine in Acute Myocardial Infarction) examined the effects of NAC on infarct size in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention. METHODS This randomized, double-blind, placebo-controlled, multicenter study evaluated the effects of intravenous high-dose NAC (29 g over 2 days) with background low-dose nitroglycerin (7.2 mg over 2 days) on early cardiac magnetic resonance imaging-assessed infarct size. Secondary end points included cardiac magnetic resonance-determined myocardial salvage and creatine kinase kinetics. RESULTS Of 112 randomized patients with ST-segment-elevation myocardial infarction, 75 (37 in NAC group, 38 in placebo group) underwent early cardiac magnetic resonance imaging. Median duration of ischemia pretreatment was 2.4 hours. With background nitroglycerin infusion administered to all patients, those randomized to NAC exhibited an absolute 5.5% reduction in cardiac magnetic resonance-assessed infarct size relative to placebo (median, 11.0%; [interquartile range 4.1, 16.3] versus 16.5%; [interquartile range 10.7, 24.2]; P=0.02). Myocardial salvage was approximately doubled in the NAC group (60%; interquartile range, 37-79) compared with placebo (27%; interquartile range, 14-42; P<0.01) and median creatine kinase areas under the curve were 22 000 and 38 000 IU·h in the NAC and placebo groups, respectively (P=0.08). CONCLUSIONS High-dose intravenous NAC administered with low-dose intravenous nitroglycerin is associated with reduced infarct size in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention. A larger study is required to assess the impact of this therapy on clinical cardiac outcomes. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry. URL: http://www.anzctr.org.au/. Unique identifier: 12610000280000.
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Affiliation(s)
- Sivabaskari Pasupathy
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Rosanna Tavella
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Suchi Grover
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Betty Raman
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Nathan E K Procter
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Yang Timothy Du
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Gnanadevan Mahadavan
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Irene Stafford
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Tamila Heresztyn
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Andrew Holmes
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Christopher Zeitz
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Margaret Arstall
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - Joseph Selvanayagam
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - John D Horowitz
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.)
| | - John F Beltrame
- From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.).
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12
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Lutfi MF. Diagnostic accuracy of resting left ventricular akinesia/hypokinesia in predicting abnormal coronary angiography. BMC Cardiovasc Disord 2016; 16:137. [PMID: 27295983 PMCID: PMC4906607 DOI: 10.1186/s12872-016-0312-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/03/2016] [Indexed: 12/03/2022] Open
Abstract
Background Although several reports demonstrate the efficacy of stress echocardiography in diagnosing coronary artery disease, comparable studies on the competence of the same imaging technique at rest are limited. This study aimed to evaluate whether ventricular akinesia/hypokinesia and left ventricular ejection fraction (LVEF) < 55 % at rest are useful in predicting abnormal coronary angiography. Methods This study prospectively enrolled 100 diagnostic coronary catheterization candidates. Any routine echocardiography that the candidates had undergone before diagnostic coronary catheterization was reviewed. Patients were subclassified according to the presence and location of ventricular akinesia/hypokinesia, LVEF, and the results of diagnostic coronary catheterization. LVEF < 55 % was considered below the normal physiological limit. Abnormal coronary angiography was defined as narrowing of half or more of the caliber of at least one major coronary artery. Results Abnormal coronary angiography was significantly associated with akinesia/hypokinesia (OR = 4.85, P = 0.002) and LVEF < 55 % (OR = 5.75, P = 0.001). Screening of akinesia/hypokinesia and LVEF < 55 % as diagnostic tools for abnormal coronary angiography achieved comparable sensitivities (87.2 % vs. 88.9 %), specificities (41.5 vs. 41.8), and diagnostic accuracies (41.5 vs. 41.8). Left ventricular anterior wall akinesia/hypokinesia achieved a higher diagnostic odds ratio (9.7), sensitivity (95 %), and negative predictive value (96.4 %) compared with other types of akinesia/hypokinesia. Conclusion The overall diagnostic accuracy of akinesia/hypokinesia and LVEF < 55 % to predict abnormal coronary angiography was poor, probably owing to significant influences of macro- as well as micro-vascular ischemia on left ventricular function.
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Affiliation(s)
- Mohamed Faisal Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University, Mailbox: 12702, Khartoum, 11121, Sudan.
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13
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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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14
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Short-Term Effect of Autologous Bone Marrow Stem Cells to Treat Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Clinical Trials. J Cardiovasc Transl Res 2015; 8:221-31. [PMID: 25953677 DOI: 10.1007/s12265-015-9621-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/15/2015] [Indexed: 12/11/2022]
Abstract
Bone marrow stem cells (BMSCs) have been used to treat patient with ST-segment elevation myocardial infarction (STEMI) via intracoronary route. We performed a meta-analysis to evaluate the short-term efficacy and safety of this modality. Seventeen randomized controlled trials (RCTs) of BMSC-based therapy for STEMI, delivered with 9 days of reperfusion and followed up shorter than 12 months, were identified by systematic review. Intracoronary BMSC therapy resulted in an overall significant improvement in left ventricular ejection fraction (LVEF) by 2.74 % (95 % confidence interval (CI) 2.09-3.39, P < 0.00001, I(2) = 84 %) at 3-6-month follow-up and 5.1 % (95 % CI 4.16-6.03, P < 0.00001 and I(2) = 85 %) at 12 months. The left ventricular end-systolic volume (LVESV) and wall motion score index (WMSI) were also reduced at 3-6 months. At 12 months, left ventricular end-diastolic volume (LVEDV), LVESV, and WMSI were significantly reduced in BMSC group. In conclusion, intracoronary BMSC therapy at post-STEMI is safe and effective in patient with acute STEMI.
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15
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Hajsadeghi S, Chitsazan M, Chitsazan M, Haghjoo M, Babaali N, Norouzzadeh Z, Mohsenian M. Metabolic Syndrome is Associated With Higher Wall Motion Score and Larger Infarct Size After Acute Myocardial Infarction. Res Cardiovasc Med 2015; 4:e25018. [PMID: 25789257 PMCID: PMC4350188 DOI: 10.5812/cardiovascmed.25018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Infarct size is an important surrogate end point for early and late mortality after acute myocardial infarction. Despite the high prevalence of metabolic syndrome in patients with atherosclerotic diseases, adequate data are still lacking regarding the extent of myocardial necrosis after acute myocardial infarction in these patients. Objectives: In the present study we aimed to compare myocardial infarction size in patients with metabolic syndrome to those without metabolic syndrome using peak CK-MB and cardiac troponin I (cTnI) at 72 hours after the onset of symptoms. Patients and Methods: One-hundred patients with metabolic syndrome (group I) and 100 control subjects without metabolic syndrome (group II) who experienced acute myocardial infarction were included in the study. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Myocardial infarction size was compared between the two groups of patients using peak CK-MB and cTnI level in 72 hours after the onset of symptoms. Results: Peak CK-MB and cTnI in 72 hours were found to be significantly higher in patients with metabolic syndrome compared with control subjects (both P < 0.001). Patients with metabolic syndrome also had markedly higher wall motion abnormality at 72 hours after the onset of symptoms as assessed by echocardiographically-derived Wall Motion Score Index (WMSI) (P < 0.001). Moreover, statistically significant relationships were found between WMSI and peak CK-MB and also cTnI at 72 hours (Spearman's rho = 0.56, P < 0.001 and Spearman's rho = 0.5, P < 0.001; respectively). However, association between WMSI and left ventricular ejection fraction was insignificant (Spearman's rho = -0.05, P = 0.46). Conclusions: We showed that patients with metabolic syndrome have larger infarct size compared to control subjects.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Department of Cardiology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mitra Chitsazan
- Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mitra Chitsazan, Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9122210385, Fax: +98-2122055594, E-mail:
| | - Mandana Chitsazan
- Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Nima Babaali
- Department of Cardiology, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Norouzzadeh
- Department of Cardiology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Maryam Mohsenian
- Department of Cardiology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
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16
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Lebeau R, Sas G, El Rayes M, Serban A, Moustafa S, Essadiqi B, DiLorenzo M, Souliere V, Beaulieu Y, Sauve C, Amyot R, Serri K. Left ventricular ejection fraction assessment by non-cardiologists from transverse views using a simplified wall motion score index. Echo Res Pract 2015; 2:1-8. [PMID: 26693310 PMCID: PMC4676426 DOI: 10.1530/erp-14-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Abstract
For the non-cardiologist emergency physician and intensivist, performing an accurate estimation of left ventricular ejection fraction (LVEF) is essential for the management of critically ill patients, such as patients presenting with shock, severe respiratory distress or chest pain. Our objective was to develop a semi-quantitative method to improve visual LVEF evaluation. A group of 12 sets of transthoracic echocardiograms with LVEF in the range of 18–64% were interpreted by 17 experienced observers (PRO) and 103 untrained observers or novices (NOV), without previous training in echocardiography. They were asked to assess LVEF by two different methods: i) visual estimation (VIS) by analysing the three classical left ventricle (LV) short-axis views (basal, midventricular and apical short-axis LV section) and ii) semi-quantitative evaluation (base, mid and apex (BMA)) of the same three short-axis views. The results for each of these two methods for both groups (PRO and NOV) were compared with LVEF obtained by radionuclide angiography. The semi-quantitative method (BMA) improved estimation of LVEF by PRO for moderate LV dysfunction (LVEF 30–49%) and normal LVEF. The visual estimate was better for lower LVEF (<30%). In the NOV group, the semi-quantitative method was better than than the visual one in the normal group and in half of the subjects in the moderate LV dysfunction (LVEF 30–49%) group. The visual estimate was better for the lower LVEF (ejection fraction <30%) group. In conclusion, semi-quantitative evaluation of LVEF gives an overall better assessment than VIS for PRO and untrained observers.
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Affiliation(s)
- Real Lebeau
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Georgetta Sas
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Malak El Rayes
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Alexandrina Serban
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Sherif Moustafa
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Btissama Essadiqi
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Maria DiLorenzo
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Vicky Souliere
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Yanick Beaulieu
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Claude Sauve
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Robert Amyot
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Karim Serri
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
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