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Duchateau N, Viallon M, Petrusca L, Clarysse P, Mewton N, Belle L, Croisille P. Pixel-wise statistical analysis of myocardial injury in STEMI patients with delayed enhancement MRI. Front Cardiovasc Med 2023; 10:1136760. [PMID: 37396590 PMCID: PMC10313104 DOI: 10.3389/fcvm.2023.1136760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives Myocardial injury assessment from delayed enhancement magnetic resonance images is routinely limited to global descriptors such as size and transmurality. Statistical tools from computational anatomy can drastically improve this characterization, and refine the assessment of therapeutic procedures aiming at infarct size reduction. Based on these techniques, we propose a new characterization of myocardial injury up to the pixel resolution. We demonstrate it on the imaging data from the Minimalist Immediate Mechanical Intervention randomized clinical trial (MIMI: NCT01360242), which aimed at comparing immediate and delayed stenting in acute ST-Elevation Myocardial Infarction (STEMI) patients. Methods We analyzed 123 patients from the MIMI trial (62 ± 12 years, 98 male, 65 immediate 58 delayed stenting). Early and late enhancement images were transported onto a common geometry using techniques inspired by statistical atlases, allowing pixel-wise comparisons across population subgroups. A practical visualization of lesion patterns against specific clinical and therapeutic characteristics was also proposed using state-of-the-art dimensionality reduction. Results Infarct patterns were roughly comparable between the two treatments across the whole myocardium. Subtle but significant local differences were observed for the LCX and RCA territories with higher transmurality for delayed stenting at lateral and inferior/inferoseptal locations, respectively (15% and 23% of myocardial locations with a p-value <0.05, mainly in these regions). In contrast, global measurements were comparable for all territories (no statistically significant differences for all-except-one measurements before standardization / for all after standardization), although immediate stenting resulted in more subjects without reperfusion injury. Conclusion Our approach substantially empowers the analysis of lesion patterns with standardized comparisons up to the pixel resolution, and may reveal subtle differences not accessible with global observations. On the MIMI trial data as illustrative case, it confirmed its general conclusions regarding the lack of benefit of delayed stenting, but revealed subgroups differences thanks to the standardized and finer analysis scale.
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Affiliation(s)
- Nicolas Duchateau
- Univ Lyon, CREATIS, INSA, CNRS UMR 5220, INSERM U1294, Université Lyon 1, UJM Saint-Etienne, Lyon, France
- Institut Universitaire de France (IUF), Paris, France
| | - Magalie Viallon
- Univ Lyon, CREATIS, INSA, CNRS UMR 5220, INSERM U1294, Université Lyon 1, UJM Saint-Etienne, Lyon, France
- Department of Radiology, Hôpital Nord, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Lorena Petrusca
- Univ Lyon, CREATIS, INSA, CNRS UMR 5220, INSERM U1294, Université Lyon 1, UJM Saint-Etienne, Lyon, France
| | - Patrick Clarysse
- Univ Lyon, CREATIS, INSA, CNRS UMR 5220, INSERM U1294, Université Lyon 1, UJM Saint-Etienne, Lyon, France
| | - Nathan Mewton
- Department of Cardiology, Clinical Investigation Center, INSERM 1407, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Loic Belle
- Department of Cardiology, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Pierre Croisille
- Univ Lyon, CREATIS, INSA, CNRS UMR 5220, INSERM U1294, Université Lyon 1, UJM Saint-Etienne, Lyon, France
- Department of Radiology, Hôpital Nord, University Hospital of Saint-Étienne, Saint-Étienne, France
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Karam M, Fahs D, Maatouk B, Safi B, Jaffa AA, Mhanna R. Polymeric nanoparticles in the diagnosis and treatment of myocardial infarction: Challenges and future prospects. Mater Today Bio 2022; 14:100249. [PMID: 35434594 PMCID: PMC9006854 DOI: 10.1016/j.mtbio.2022.100249] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Myocardial infarction (MI) is the leading cause of morbidity and mortality worldwide. Despite extensive efforts to provide early diagnosis and adequate treatment regimens, detection of MI still faces major limitations and pathological MI complications continue to threaten the recovery of survivors. Polymeric nanoparticles (NPs) represent novel noninvasive drug delivery systems for the diagnosis and treatment of MI and subsequent prevention of fatal heart failure. In this review, we cover the recent advances in polymeric NP-based diagnostic and therapeutic approaches for MI and their application as multifunctional theranostic tools. We also discuss the in vivo behavior and toxicity profile of polymeric NPs, their application in noninvasive imaging, passive, and active drug delivery, and use in cardiac regenerative therapy. We conclude with the challenges faced with polymeric nanosystems and suggest future efforts needed for clinical translation.
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Affiliation(s)
- Mia Karam
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Duaa Fahs
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Batoul Maatouk
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Brouna Safi
- Department of Chemical Engineering, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
| | - Ayad A. Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Rami Mhanna
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
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Atli O, Kilic V, Baysal M, Kilic G, Gormus G, Ucarcan S, Korkut B, Ilgin S. Assessment of trazodone-induced cardiotoxicity after repeated doses in rats. Hum Exp Toxicol 2018; 38:45-55. [PMID: 29774748 DOI: 10.1177/0960327118769717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Trazodone (TRZ) is an antidepressant drug commonly used in the treatment of depression, anxiety, and insomnia. Although some studies demonstrated the adverse effects of TRZ related to cardiovascular system, the conflicting results were observed in these studies. Therefore, we aimed to investigate the cardiac adverse effects of TRZ in rats at repeated doses in our study. In accordance with this purpose, TRZ was administered orally to rats at 5, 10, and 20 mg/kg doses for 28 days. Electrocardiogram records, serum aspartate aminotransferase (AST), lactate dehydrogenase, creatine kinase-myoglobin band, cardiac troponin-T (cTn-T) levels, DNA damage in cardiomyocytes, and histologic view of heart tissues were evaluated. In addition, glutathione (GSH) and malondialdehyde (MDA) levels were measured to determine the oxidative status of cardiac tissue after TRZ administration. Heart rate was decreased, PR interval was prolonged, and QRS and T amplitudes were decreased in 20 mg/kg TRZ-administered group compared to the control group. Serum AST and cTn-T levels were significantly increased in 10 and 20 mg/kg TRZ-administered rats with respect to control rats. DNA damage was significantly increased in these groups. Additionally, degenerative histopathologic findings were observed in TRZ-administered groups. Although there was no difference in MDA levels between groups, GSH levels were significantly decreased in 10 and 20 mg/kg TRZ-administered groups compared to the control group. Our results have shown that TRZ induced cardiotoxicity in rats dose-dependently. It is assumed that oxidative stress related to GSH depletion may be accompanied by these adverse effects.
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Affiliation(s)
- O Atli
- 1 Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskisehir, Turkey
| | - V Kilic
- 2 Department of Biology, Faculty of Science, Anadolu University, Eskisehir, Turkey
| | - M Baysal
- 1 Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskisehir, Turkey
| | - G Kilic
- 2 Department of Biology, Faculty of Science, Anadolu University, Eskisehir, Turkey
| | - G Gormus
- 1 Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskisehir, Turkey
| | - S Ucarcan
- 2 Department of Biology, Faculty of Science, Anadolu University, Eskisehir, Turkey
| | - B Korkut
- 1 Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskisehir, Turkey
| | - S Ilgin
- 1 Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskisehir, Turkey
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Nensa F, Poeppel T, Tezgah E, Heusch P, Nassenstein K, Mahabadi AA, Forsting M, Bockisch A, Erbel R, Heusch G, Schlosser T. Integrated FDG PET/MR Imaging for the Assessment of Myocardial Salvage in Reperfused Acute Myocardial Infarction. Radiology 2015; 276:400-7. [PMID: 25848898 DOI: 10.1148/radiol.2015140564] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare the size of the area with reduced myocardial fluorodeoxygluose (FDG) uptake with the endocardial surface area (ESA) method as a marker for the area at risk in patients with reperfused acute myocardial infarction. MATERIALS AND METHODS The study was approved by the local institutional review board. All patients gave written informed consent prior to their examination. Twenty-five patients (mean age ± standard deviation, 54 years ± 14) underwent prospective cardiac positron emission tomography/magnetic resonance imaging after acute coronary occlusion and interventional reperfusion. On late gadolinium contrast enhancement images, the size of infarction and the area at risk, as determined with ESA, were assessed and compared with the area of reduced FDG uptake. Statistical analysis comprised paired t tests and Mann-Whitney U tests, as well as Pearson r and Spearman ρ for correlations. RESULTS In patients with infarcted myocardium and reduced FDG uptake (n = 18), a good correlation between the area of reduced FDG uptake and the area at risk according to ESA was observed (r = .70, P = .001). The area of reduced FDG uptake (31% ± 11 of left ventricular myocardial mass) was larger than the size of the infarct (10% ± 10, P < .0001) and the area at risk according to ESA (17% ± 13, P < .0001). In six patients, no late contrast enhancement was seen, whereas all patients had an area of reduced FDG uptake (29% ± 8) in the perfusion territory of the culprit artery. CONCLUSION In patients with reperfused acute myocardial infarction, the area of reduced FDG uptake correlates with the area at risk as determined with the ESA method and is localized in the perfusion territory of the culprit artery in the absence of necrosis, although the area of reduced FDG uptake largely overestimates the size of the infarct and the ESA-based area at risk.
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Affiliation(s)
- Felix Nensa
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Thorsten Poeppel
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Ercan Tezgah
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Philipp Heusch
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Kai Nassenstein
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Amir A Mahabadi
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Michael Forsting
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Andreas Bockisch
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Raimund Erbel
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Gerd Heusch
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
| | - Thomas Schlosser
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (F.N., K.N., M.F., T.S.), Clinic for Nuclear Medicine (T.P., A.B.), Clinic for Cardiology (E.T., A.A.M., R.E.), and Institute for Pathophysiology (G.H.), University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; and Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany (P.H.)
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