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Cokic I, Chan SF, Guan X, Nair AR, Yang HJ, Liu T, Chen Y, Hernando D, Sykes J, Tang R, Butler J, Dohnalkova A, Kovarik L, Finney R, Kali A, Sharif B, Bouchard LS, Gupta R, Krishnam MS, Vora K, Tamarappoo B, Howarth AG, Kumar A, Francis J, Reeder SB, Wood JC, Prato FS, Dharmakumar R. Intramyocardial hemorrhage drives fatty degeneration of infarcted myocardium. Nat Commun 2022; 13:6394. [PMID: 36302906 PMCID: PMC9613644 DOI: 10.1038/s41467-022-33776-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Sudden blockage of arteries supplying the heart muscle contributes to millions of heart attacks (myocardial infarction, MI) around the world. Although re-opening these arteries (reperfusion) saves MI patients from immediate death, approximately 50% of these patients go on to develop chronic heart failure (CHF) and die within a 5-year period; however, why some patients accelerate towards CHF while others do not remains unclear. Here we show, using large animal models of reperfused MI, that intramyocardial hemorrhage - the most damaging form of reperfusion injury (evident in nearly 40% of reperfused ST-elevation MI patients) - drives delayed infarct healing and is centrally responsible for continuous fatty degeneration of the infarcted myocardium contributing to adverse remodeling of the heart. Specifically, we show that the fatty degeneration of the hemorrhagic MI zone stems from iron-induced macrophage activation, lipid peroxidation, foam cell formation, ceroid production, foam cell apoptosis and iron recycling. We also demonstrate that timely reduction of iron within the hemorrhagic MI zone reduces fatty infiltration and directs the heart towards favorable remodeling. Collectively, our findings elucidate why some, but not all, MIs are destined to CHF and help define a potential therapeutic strategy to mitigate post-MI CHF independent of MI size.
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Affiliation(s)
- Ivan Cokic
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shing Fai Chan
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA
| | - Xingmin Guan
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA
| | - Anand R Nair
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ting Liu
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yinyin Chen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Jane Sykes
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Richard Tang
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA
| | - John Butler
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | | | - Libor Kovarik
- Pacific Northwest National Laboratory, Richland, WA, USA
| | | | - Avinash Kali
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Behzad Sharif
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA
| | | | | | | | - Keyur Vora
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA
| | - Balaji Tamarappoo
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA
| | | | - Andreas Kumar
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | | | - John C Wood
- University of Southern California, Los Angeles, CA, USA
| | - Frank S Prato
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, IN, USA.
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Wang G, Lee SE, Yang Q, Sadras V, Patel S, Yang HJ, Sharif B, Kali A, Cokic I, Xie G, Tighiouart M, Collins J, Li D, Berman DS, Chang HJ, Dharmakumar R. Multicenter Study on the Diagnostic Performance of Native-T1 Cardiac Magnetic Resonance of Chronic Myocardial Infarctions at 3T. Circ Cardiovasc Imaging 2020; 13:e009894. [PMID: 32507020 PMCID: PMC7363195 DOI: 10.1161/circimaging.119.009894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preclinical studies and pilot patient studies have shown that chronic infarctions can be detected and characterized from cardiac magnetic resonance without gadolinium-based contrast agents using native-T1 maps at 3T. We aimed to investigate the diagnostic capacity of this approach for characterizing chronic myocardial infarctions (MIs) in a multi-center setting. METHODS Patients with a prior MI (n=105) were recruited at 3 different medical centers and were imaged with native-T1 mapping and late gadolinium enhancement (LGE) at 3T. Infarct location, size, and transmurality were determined from native-T1 maps and LGE. Sensitivity, specificity, receiver-operating characteristic metrics, and inter- and intraobserver variabilities were assessed relative to LGE. RESULTS Across all subjects, T1 of MI territory was 1621±110 ms, and remote territory was 1225±75 ms. Sensitivity, specificity, and area under curve for detecting MI location based on native-T1 mapping relative to LGE were 88%, 92%, and 0.93, respectively. Native-T1 maps were not different for measuring infarct size (native-T1 maps: 12.1±7.5%; LGE: 11.8±7.2%, P=0.82) and were in agreement with LGE (R2=0.92, bias, 0.09±2.6%). Corresponding inter- and intraobserver assessments were also highly correlated (interobserver: R2=0.90, bias, 0.18±2.4%; and intraobserver: R2=0.91, bias, 0.28±2.1%). Native T1 maps were not different for measuring MI transmurality (native-T1 maps: 49.1±15.8%; LGE: 47.2±19.0%, P=0.56) and showed agreement (R2=0.71; bias, 1.32±10.2%). Corresponding inter- and intraobserver assessments were also in agreement (interobserver: R2=0.81, bias, 0.1±9.4%; and intraobserver: R2=0.91, bias, 0.28±2.1%, respectively). While the overall accuracy for detecting MI with native-T1 maps at 3T was high, logistic regression analysis showed that MI location was a prominent confounder. CONCLUSIONS Native-T1 mapping can be used to image chronic MI with high degree of accuracy, and as such, it is a viable alternative for scar imaging in patients with chronic MI who are contraindicated for LGE. Technical advancements may be needed to overcome the imaging confounders that currently limit native-T1 mapping from reaching equivalent detection levels as LGE.
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Affiliation(s)
- Guan Wang
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang (G.W.)
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (S.-E.L., H.-J.C.).,Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, South Korea (S.-E.L.)
| | - Qi Yang
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Radiology, Xuanwu Hospital, Beijing, China (Q.Y.)
| | - Vignesh Sadras
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Suraj Patel
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hsin-Jung Yang
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Behzad Sharif
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (B.S., I.C., D.L., D.S.B., R.D.)
| | - Avinash Kali
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ivan Cokic
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (B.S., I.C., D.L., D.S.B., R.D.)
| | - Guoxi Xie
- Guangzhou Medical University, China (G.X.)
| | - Mourad Tighiouart
- Biostatistics and Bioinformatics Research Center (M.T.), Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Debiao Li
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Imaging (D.L., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (B.S., I.C., D.L., D.S.B., R.D.)
| | - Daniel S Berman
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Cedars-Sinai Heart Institute (D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Imaging (D.L., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (B.S., I.C., D.L., D.S.B., R.D.)
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (S.-E.L., H.-J.C.)
| | - Rohan Dharmakumar
- Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Cedars-Sinai Heart Institute (D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (B.S., I.C., D.L., D.S.B., R.D.)
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Perfilyeva YV, Karalnik BV, Ostapchuk YO, Kali A, Tleulieva RT, Abdolla N, Krasnoshtanov VK, Belyaev NN. [Age-related decline in vaccination efficacy: The potential role of myeloid derived suppressor cells.]. Adv Gerontol 2020; 33:785-795. [PMID: 33342113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Infectious diseases in older people are much more frequent, and mortality from them is higher than in young people. Vaccination is the most effective and least expensive preventative measure for a number of infectious diseases. However, vaccines that are effective in young people are often ineffective in older people over 65, which is a result of a gradual decrease in the functional capacity of the immune systems, which occurs with age, and is called «immunosenescence». Age-related changes in the cellular and humoral immunity worsen the primary response to vaccines and weaken the development of long-term immunological memory. Recent studies suggest that one of the possible causes of the occurrence and maintenance of «immunosenescence» may be myeloid-derived suppressor cells (MDSCs). These cells have been shown to inhibit the functions of innate and adaptive immunity cells through a number of mechanisms. In this review, we provide information that emphasizes the role of MDSCs in inhibiting the immune response to vaccines during aging, and also substantiates possible ways to overcome this immunological obstacle.
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Affiliation(s)
- Y V Perfilyeva
- M.A.Ajtkhozhin Institute of Molecular Biology and Biochemistry, 86 Dosmuhamedov str., Almaty 050012, Kazakhstan
| | - B V Karalnik
- Kh.Zhumatov Scientific Center for Hygiene and Epidemiology, 34 Makataev str., Almaty 050002, Kazakhstan
| | - Y O Ostapchuk
- M.A.Ajtkhozhin Institute of Molecular Biology and Biochemistry, 86 Dosmuhamedov str., Almaty 050012, Kazakhstan
| | - A Kali
- M.A.Ajtkhozhin Institute of Molecular Biology and Biochemistry, 86 Dosmuhamedov str., Almaty 050012, Kazakhstan
- Biomedical Research Center, Al-Farabi Kazakh National University, 71 Al-Farabi av., Almaty 050040, Kazakhstan
| | - R T Tleulieva
- M.A.Ajtkhozhin Institute of Molecular Biology and Biochemistry, 86 Dosmuhamedov str., Almaty 050012, Kazakhstan
| | - N Abdolla
- M.A.Ajtkhozhin Institute of Molecular Biology and Biochemistry, 86 Dosmuhamedov str., Almaty 050012, Kazakhstan
- Biomedical Research Center, Al-Farabi Kazakh National University, 71 Al-Farabi av., Almaty 050040, Kazakhstan
| | - V K Krasnoshtanov
- Kazakh Research Institute of Oncology and Radiology, 91 Abay av., Almaty 050000, Kazakhstan
| | - N N Belyaev
- Saint-Petersburg Pasteur Institute, 14 Mira str., St. Petersburg 197101, Russian Federation, e-mail:
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Wang G, Yang HJ, Kali A, Cokic I, Tang R, Xie G, Yang Q, Francis J, Li S, Dharmakumar R. Influence of Myocardial Hemorrhage on Staging of Reperfused Myocardial Infarctions With T 2 Cardiac Magnetic Resonance Imaging: Insights Into the Dependence on Infarction Type With Ex Vivo Validation. JACC Cardiovasc Imaging 2019; 12:693-703. [PMID: 29680356 PMCID: PMC6510271 DOI: 10.1016/j.jcmg.2018.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to determine whether T2 cardiac magnetic resonance (CMR) can stage both hemorrhagic and nonhemorrhagic myocardial infarctions (MIs). BACKGROUND CMR-based staging of MI with or without contrast agents relies on the resolution of T2 elevations in the chronic phase, but whether this approach can be used to stage both hemorrhagic and nonhemorrhagic MIs is unclear. METHODS Hemorrhagic (n = 15) and nonhemorrhagic (n = 9) MIs were created in dogs. Multiparametric noncontrast mapping (T1, T2, and T2*) and late gadolinium enhancement (LGE) were performed at 1.5- and 3.0-T at 5 days (acute) and 8 weeks (chronic) post-MI. CMR relaxation values and LGE intensities of hemorrhagic, peri-hemorrhagic, nonhemorrhagic, and remote territories were measured. Histopathology was performed to elucidate CMR findings. RESULTS T2 of nonhemorrhagic MIs was significantly elevated in the acute phase relative to remote territories (1.5-T: 39.8 ± 12.8%; 3.0-T: 27.9 ± 16.5%; p < 0.0001 for both) but resolved to remote values by week 8 (1.5-T: -0.0 ± 3.2%; p = 0.678; 3.0-T: -0.5 ± 5.9%; p = 0.601). In hemorrhagic MI, T2 of hemorrhage core was significantly elevated in the acute phase (1.5-T: 17.7 ± 10.0%; 3.0-T: 8.6 ± 8.2%; p < 0.0001 for both) but decreased below remote values by week 8 (1.5-T: -8.2 ± 3.9%; 3.0-T: -5.6 ± 6.0%; p < 0.0001 for both). In contrast, T2 of the periphery of hemorrhage within the MI zone was significantly elevated in the acute phase relative to remote territories (1.5-T: 35.0 ± 16.1%; 3.0-T: 24.2 ± 10.4%; p < 0.0001 for both) and remained elevated at 8 weeks post-MI (1.5-T: 8.6 ± 5.1%; 3.0-T: 6.0 ± 3.3%; p < 0.0001 for both). The observed elevation of T2 in the peri-hemorrhagic zone of MIs and the absence of T2 elevation in nonhemorrhagic MIs were consistent with ongoing or absence of histological evidence of inflammation, respectively. CONCLUSIONS Hemorrhagic MIs are associated with persisting myocardial inflammation and edema, which can confound staging of hemorrhagic MIs when T2 elevations alone are used to discriminate between acute and chronic MI. Moreover, given the poor prognosis in patients with hemorrhagic MI, CMR evidence for myocardial hemorrhage with persistent edema may evolve as a risk marker in patients after acute MI.
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Affiliation(s)
- Guan Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Avinash Kali
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ivan Cokic
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Richard Tang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Guoxi Xie
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
| | - Qi Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph Francis
- Department of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Songbai Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China.
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China; David Geffen School of Medicine, University of California, Los Angeles, California.
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Ostapchuk EO, Kali A, Belyaev NN. Transforming Growth Factor-β and Tumor Necrosis Factor-α Reduce the Sensitivity of MiaPaCa2 Pancreatic Cancer Cells to Lysis by NK Cells. Bull Exp Biol Med 2018; 165:259-263. [PMID: 29926278 DOI: 10.1007/s10517-018-4143-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Indexed: 01/08/2023]
Abstract
We studied the role of cytokines TGF-β and TNFα in reduction of the cytolytic activity of NK cells towards tumor cells. Exogenous TGF-β and TNFα reduced the sensitivity of MiaPaCa2 pancreatic adenocarcinoma cells to NK cytotoxicity, which was associated with reduction of ULBP-1 expression and increase of HLA-E, HLA-G, CD155, and CD112 expression on Mia-PaCa2 cells. Changes in the expression of ligands for NK receptors on tumor cells induced by TGF-β and TNFα may contribute to reduction of cytotoxicity of tumor-associated NK cells and thus prevent an adequate antitumor immune response leading to the disease progress.
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Affiliation(s)
- E O Ostapchuk
- Laboratory of Molecular Immunology and Immunobiotechnology, M. A. Aitkhodzhin Institute of Molecular Biology and Biochemistry, Almaty, Kazakhstan.
| | - A Kali
- Laboratory of Molecular Immunology and Immunobiotechnology, M. A. Aitkhodzhin Institute of Molecular Biology and Biochemistry, Almaty, Kazakhstan
| | - N N Belyaev
- Laboratory of Molecular Immunology and Immunobiotechnology, M. A. Aitkhodzhin Institute of Molecular Biology and Biochemistry, Almaty, Kazakhstan
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Kali A, Cokic I, Tang R, Dohnalkova A, Kovarik L, Yang HJ, Kumar A, Prato FS, Wood JC, Underhill D, Marbán E, Dharmakumar R. Persistent Microvascular Obstruction After Myocardial Infarction Culminates in the Confluence of Ferric Iron Oxide Crystals, Proinflammatory Burden, and Adverse Remodeling. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004996. [PMID: 27903536 DOI: 10.1161/circimaging.115.004996] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emerging evidence indicates that persistent microvascular obstruction (PMO) is more predictive of major adverse cardiovascular events than myocardial infarct (MI) size. But it remains unclear how PMO, a phenomenon limited to the acute/subacute period of MI, drives adverse remodeling in chronic MI setting. We hypothesized that PMO resolves into chronic iron crystals within MI territories, which in turn are proinflammatory and favor adverse remodeling post-MI. METHODS AND RESULTS Canines (n=40) were studied with cardiac magnetic resonance imaging to characterize the spatiotemporal relationships among PMO, iron deposition, infarct resorption, and left ventricular remodeling between day 7 (acute) and week 8 (chronic) post-MI. Histology was used to assess iron deposition and to examine relationships between iron content with macrophage infiltration, proinflammatory cytokine synthesis, and matrix metalloproteinase activation. Atomic resolution transmission electron microscopy was used to determine iron crystallinity, and energy-dispersive X-ray spectroscopy was used to identify the chemical composition of the iron composite. PMO with or without reperfusion hemorrhage led to chronic iron deposition, and the extent of this deposition was strongly related to PMO volume (r>0.8). Iron deposits were found within macrophages as aggregates of nanocrystals (≈2.5 nm diameter) in the ferric state. Extent of iron deposits was strongly correlated with proinflammatory burden, collagen-degrading enzyme activity, infarct resorption, and adverse structural remodeling (r>0.5). CONCLUSIONS Crystallized iron deposition from PMO is directly related to proinflammatory burden, infarct resorption, and adverse left ventricular remodeling in the chronic phase of MI in canines. Therapeutic strategies to combat adverse remodeling could potentially benefit from taking into account the chronic iron-driven inflammatory process.
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Affiliation(s)
- Avinash Kali
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Ivan Cokic
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Richard Tang
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Alice Dohnalkova
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Libor Kovarik
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Hsin-Jung Yang
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Andreas Kumar
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Frank S Prato
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - John C Wood
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - David Underhill
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Eduardo Marbán
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.)
| | - Rohan Dharmakumar
- From the Cedars-Sinai Medical Center, Los Angeles, CA (A.K., I.C., R.T., H.-J.Y., A.K., D.U., E.M., R.D.); University of California, Los Angeles (A.K., H.-J.Y., D.U., E.M., R.D.); Pacific Northwest National Laboratory, Environmental Molecular Sciences Laboratory, Richland, WA (A.D., L.K.); Lawson Health Research Institute, University of Western Ontario, London, Canada (F.S.P.); and Children's Hospital Los Angeles, CA (J.C.W.).
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Yang HJ, Dey D, Sykes J, Klein M, Butler J, Kovacs MS, Sobczyk O, Sharif B, Bi X, Kali A, Cokic I, Tang R, Yumul R, Conte AH, Tsaftaris SA, Tighiouart M, Li D, Slomka PJ, Berman DS, Prato FS, Fisher JA, Dharmakumar R. Arterial CO 2 as a Potent Coronary Vasodilator: A Preclinical PET/MR Validation Study with Implications for Cardiac Stress Testing. J Nucl Med 2017; 58:953-960. [PMID: 28254864 DOI: 10.2967/jnumed.116.185991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/31/2017] [Indexed: 11/16/2022] Open
Abstract
Myocardial blood flow (MBF) is the critical determinant of cardiac function. However, its response to increases in partial pressure of arterial CO2 (PaCO2), particularly with respect to adenosine, is not well characterized because of challenges in blood gas control and limited availability of validated approaches to ascertain MBF in vivo. Methods: By prospectively and independently controlling PaCO2 and combining it with 13N-ammonia PET measurements, we investigated whether a physiologically tolerable hypercapnic stimulus (∼25 mm Hg increase in PaCO2) can increase MBF to that observed with adenosine in 3 groups of canines: without coronary stenosis, subjected to non-flow-limiting coronary stenosis, and after preadministration of caffeine. The extent of effect on MBF due to hypercapnia was compared with adenosine. Results: In the absence of stenosis, mean MBF under hypercapnia was 2.1 ± 0.9 mL/min/g and adenosine was 2.2 ± 1.1 mL/min/g; these were significantly higher than at rest (0.9 ± 0.5 mL/min/g, P < 0.05) and were not different from each other (P = 0.30). Under left-anterior descending coronary stenosis, MBF increased in response to hypercapnia and adenosine (P < 0.05, all territories), but the effect was significantly lower than in the left-anterior descending coronary territory (with hypercapnia and adenosine; both P < 0.05). Mean perfusion defect volumes measured with adenosine and hypercapnia were significantly correlated (R = 0.85) and were not different (P = 0.12). After preadministration of caffeine, a known inhibitor of adenosine, resting MBF decreased; and hypercapnia increased MBF but not adenosine (P < 0.05). Conclusion: Arterial blood CO2 tension when increased by 25 mm Hg can induce MBF to the same level as a standard dose of adenosine. Prospectively targeted arterial CO2 has the capability to evolve as an alternative to current pharmacologic vasodilators used for cardiac stress testing.
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Affiliation(s)
- Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Jane Sykes
- University of Western Ontario, Lawson Health Research Institute, London, Ontario, Canada
| | - Michael Klein
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - John Butler
- University of Western Ontario, Lawson Health Research Institute, London, Ontario, Canada
| | - Michael S Kovacs
- University of Western Ontario, Lawson Health Research Institute, London, Ontario, Canada
| | - Olivia Sobczyk
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California
| | - Avinash Kali
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Ivan Cokic
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Richard Tang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Roya Yumul
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Antonio H Conte
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sotirios A Tsaftaris
- School of Engineering, Institute of Digital Communications, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Mourad Tighiouart
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Piotr J Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Frank S Prato
- University of Western Ontario, Lawson Health Research Institute, London, Ontario, Canada
| | - Joseph A Fisher
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California .,Department of Bioengineering, University of California, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
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Cokic I, Kali A, Tang R, Yang HJ, Kumar A, Prato FS, Francis J, Marban E, Dharmakumar R. AN UNRESTRAINED PROINFLAMMATORY M1 MACROPHAGE POPULATION INDUCED BY IRON NANOCRYSTALS IMPAIRS MYOCARDIAL HEALING AFTER HEMORRHAGIC INFARCTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yang HJ, Dey D, Sykes J, Klein M, Butler J, Kovacs M, Sobczyk O, Sharif B, Bi X, Kali A, Cokic I, Tang R, Yumul R, Conte A, Tsaftaris S, Tighiouart M, Li D, Slomka P, Berman D, Prato F, Fisher J, Dharmakumar R. PRECISELY CONTROLLED ARTERIAL CO2 CAN POTENTIATE MYOCARDIAL BLOOD FLOW TO THE SAME EXTENT AS ADENOSINE: A PRECLINICAL STUDY IN CANINES WITH 13N-AMMONIA PET. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34997-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Kali A, Kalaivani R, Charles P, Seetha KS. Aeromonas hydrophila meningitis and fulminant sepsis in preterm newborn: A case report and review of literature. Indian J Med Microbiol 2017; 34:544-547. [PMID: 27934841 DOI: 10.4103/0255-0857.195383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neonatal meningitis is a lethal infection occurring in the 1st month of life. The risk of developing permanent neurological sequels is high among the neonates who survive. Bacterial pathogens are commonly associated with this condition. Aeromonas is a Gram-negative bacteria of aquatic habitat. Although isolation of Aeromonas species from neonates with blood stream infection is infrequently reported, neonatal meningitis caused by Aeromonas is exceedingly rare. We present a case of fulminant sepsis and meningitis caused by Aeromonas hydrophila in a preterm newborn male. The bacteria was isolated in culture from blood and cerebrospinal fluid. In spite of targeted antibiotics and supportive therapy, the baby failed to respond and died on the 12th day of life.
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Affiliation(s)
- A Kali
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - R Kalaivani
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Pmv Charles
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - K S Seetha
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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11
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Affiliation(s)
- A Kali
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, Tamil Nadu, India
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12
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Cokic I, Kali A, Yang HJ, Tang R, Prato F, Underhill D, Dharmakumar R. PERSISTENT MICROVASCULAR OBSTRUCTION ACCOMPANYING MYOCARDIAL INFARCTION LEADS TO CHRONIC IRON-DRIVEN INFLAMMATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Yang HJ, Sharif B, Pang J, Kali A, Bi X, Cokic I, Li D, Dharmakumar R. Free-breathing, motion-corrected, highly efficient whole heart T2 mapping at 3T with hybrid radial-cartesian trajectory. Magn Reson Med 2016; 75:126-36. [PMID: 25753385 PMCID: PMC4561222 DOI: 10.1002/mrm.25576] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/23/2014] [Accepted: 11/18/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE To develop and test a time-efficient, free-breathing, whole heart T2 mapping technique at 3.0T. METHODS ECG-triggered three-dimensional (3D) images were acquired with different T2 preparations at 3.0T during free breathing. Respiratory motion was corrected with a navigator-guided motion correction framework at near perfect efficiency. Image intensities were fit to a monoexponential function to derive myocardial T2 maps. The proposed 3D, free breathing, motion-corrected (3D-FB-MoCo) approach was studied in ex vivo canine hearts and kidneys, healthy volunteers, and canine subjects with acute myocardial infarction (AMI). RESULTS Ex vivo T2 values from proposed 3D T2 -prep gradient echo were not different from two-dimensional (2D) spin echo (P = 0.7) and T2 -prep balanced steady-state free precession (bSSFP) (P = 0.7). In healthy volunteers, compared with 3D-FB-MoCo and breath-held 2D T2 -prep bSSFP (2D-BH), non-motion-corrected (3D-FB-Non-MoCo) myocardial T2 was longer, had a larger coefficient of variation (COV), and had a lower image quality (IQ) score (T2 = 40.3 ms, COV = 38%, and IQ = 2.3; all P < 0.05). Conversely, the mean and COV and IQ of 3D-FB-MoCo (T2 = 37.7 ms, COV = 17%, and IQ = 3.5) and 2D-BH (T2 = 38.0 ms, COV = 15%, and IQ = 3.8) were not different (P = 0.99, P = 0.74, and P = 0.14, respectively). In AMI, T2 values and edema volumes from 3D-FB-MoCo and 2D-BH were closely correlated (R(2) = 0.88 and 0.96, respectively). CONCLUSION The proposed whole heart T2 mapping approach can be performed within 5 min with similar accuracy to that of the 2D-BH T2 mapping approach.
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Affiliation(s)
- Hsin-Jung Yang
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
- Dept of Bioengineering, University of California, Los Angeles CA 90095 USA
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
| | - Jianing Pang
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
| | - Avinash Kali
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
- Dept of Bioengineering, University of California, Los Angeles CA 90095 USA
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Ivan Cokic
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
- Dept of Bioengineering, University of California, Los Angeles CA 90095 USA
- Dept of Medicine, University of California, Los Angeles CA 90095 USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Dept of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
- Dept of Medicine, University of California, Los Angeles CA 90095 USA
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA 90048 USA
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Cokic I, Kali A, Yang HJ, Yee R, Tang R, Tighiouart M, Wang X, Jackman WM, Chugh SS, White JA, Dharmakumar R. Malignant ventricular arrhythmias in patients with chronic myocardial infarction and predictive value of iron-sensitive cardiac magnetic resonance imaging. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328627 DOI: 10.1186/1532-429x-17-s1-o21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yang HJ, Pang J, Sharif B, Kali A, Bi X, Cokic I, Li D, Dharmakumar R. Fast, whole-heart, free-breathing 3D T2 mapping at 3T with application to myocardial edema imaging. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328167 DOI: 10.1186/1532-429x-17-s1-q125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Kali A, Cokic I, Yang HJ, Tang R, Dharmakumar R. Localized chronic iron deposition within non-reperfused myocardial infarctions. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328589 DOI: 10.1186/1532-429x-17-s1-o13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kali A, Choi EY, Sharif B, Kim YJ, Bi X, Spottiswoode BS, Cokic I, Yang HJ, Tighiouart M, Li D, Berman DS, Choi BW, Chang HJ, Dharmakumar R. Visual detection and characterization of chronic myocardial infarctions in patients using native T1 maps at 3T. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328608 DOI: 10.1186/1532-429x-17-s1-o74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Yang HJ, Dey D, Sykes J, Butler J, Kali A, Cokic I, Sharif B, Li D, Tsaftaris S, Slomka P, Prato FS, Dharmakumar R. Whole-heart, free-breathing, three-dimensional myocardial BOLD MRI at 3T with simultaneous 13N-ammonia PET in canines. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328337 DOI: 10.1186/1532-429x-17-s1-q126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cokic I, Kali A, Yang HJ, Yee R, Tang R, Tighiouart M, Wang X, Jackman WS, Chugh SS, White JA, Dharmakumar R. Iron-Sensitive Cardiac Magnetic Resonance Imaging for Prediction of Ventricular Arrhythmia Risk in Patients With Chronic Myocardial Infarction: Early Evidence. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003642. [PMID: 26259581 DOI: 10.1161/circimaging.115.003642] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent canines studies have shown that iron deposition within chronic myocardial infarction (CMI) influences the electric behavior of the heart. To date, the link between the iron deposition and malignant ventricular arrhythmias in humans with CMI is unknown. METHODS AND RESULTS Patients with CMI (n=94) who underwent late-gadolinium-enhanced cardiac magnetic resonance imaging before implantable cardioverter-defibrillator implantation for primary and secondary preventions were retrospectively analyzed. The predictive values of hypointense cores (HIC) in balanced steady-state free precession images and conventional cardiac magnetic resonance imaging and ECG malignant ventricular arrhythmia parameters for the prediction of primary combined outcome (appropriate implantable cardioverter-defibrillator therapy, survived cardiac arrest, or sudden cardiac death) were studied. The use of HIC within CMI on balanced steady-state free precession as a marker of iron deposition was validated in a canine MI model (n=18). Nineteen patients met the study criteria with events occurring at a median of 249 (interquartile range of 540) days after implantable cardioverter-defibrillator placement. Of the 19 patients meeting the primary end point, 18 were classified as HIC+, whereas only 1 was HIC-. Among the cohort in whom the primary end point was not met, there were 28 HIC+ and 47 HIC- patients. Receiver operating characteristic curve analysis demonstrated an additive predictive value of HIC for malignant ventricular arrhythmias with an increased area under the curve of 0.87 when added to left ventricular ejection fraction (left ventricular ejection fraction alone, 0.68). Both cardiac magnetic resonance imaging and histological validation studies performed in canines demonstrated that HIC regions in balanced steady-state free precession images within CMI likely result from iron depositions. CONCLUSIONS Hypointense cores within CMI on balanced steady-state free precession cardiac magnetic resonance imaging can be used as a marker of iron deposition and yields incremental information toward improved prediction of malignant ventricular arrhythmias.
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Affiliation(s)
- Ivan Cokic
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Avinash Kali
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Hsin-Jung Yang
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Raymond Yee
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Richard Tang
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Mourad Tighiouart
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Xunzhang Wang
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Warren S Jackman
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Sumeet S Chugh
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - James A White
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Rohan Dharmakumar
- From the Department of Biomedical Sciences, Biomedical Imaging Research Institute (I.C., A.K., H.-J.Y., R.T., R.D.), Biostatistics and Bioinformatics Research Center (M.T.), and Cedars-Sinai Heart Institute (X.W., S.S.C., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Biomedical Engineering, University of California, Los Angeles (A.K., H.-J.Y., H.-J.Y.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (R.Y.); Heart Rhythm Institute, University of Oklahoma, Oklahoma City (W.S.J.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (S.S.C., R.D.); and Stephenson Cardiac Imaging Centre, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada (J.A.W.).
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Abstract
Carbohydrate fermentation test is a well-established technique for speciation of bacteria and fungi. However, long incubation period, cost and procedural complexity may limit its use. Here, we describe a simple modification of conventional carbohydrate fermentation technique using microtitre plate. Thirty-one yeast isolates were identified based on their fermentation property by microtitre plate method and results were compared with conventional method. The modified method had 85.7% sensitivity and 100% specificity. The average time taken to produce positive reaction was 24 hours. When compared with conventional method, modified method reduced turn-around time and cost of processing without significant increase in discordant results.
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Affiliation(s)
- A Kali
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry, India
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Cokic I, Kali A, Yang HJ, Yee R, Tang R, Tighiouart M, Wang X, Jackman W, Chugh S, White JA, Dharmakumar R. IRON-SENSITIVE CARDIAC MAGNETIC RESONANCE IMAGING FOR IMPROVED PREDICTION OF MALIGNANT VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH CHRONIC MYOCARDIAL INFARCTION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Thajudeen A, Jackman WM, Stewart B, Cokic I, Nakagawa H, Shehata M, Amorn AM, Kali A, Liu E, Harlev D, Bennett N, Dharmakumar R, Chugh SS, Wang X. Correlation of scar in cardiac MRI and high-resolution contact mapping of left ventricle in a chronic infarct model. Pacing Clin Electrophysiol 2015; 38:663-74. [PMID: 25656924 PMCID: PMC5006837 DOI: 10.1111/pace.12581] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/27/2014] [Accepted: 12/16/2014] [Indexed: 12/04/2022]
Abstract
Background Endocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra‐high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model. Methods Chronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium‐enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three‐dimensional (3D) gadolinium enhancement signal intensity maps at 1‐mm and 5‐mm depths from the endocardium. Ultra‐high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini‐basket electrode array (64 tiny electrodes, 2.5‐mm spacing, center‐to‐center). Results The maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (<2 mV) correlated closely with scar on the LGE MRI and the 3D signal intensity map (1‐mm depth). The scar areas between the MRI signal intensity map and electroanatomic map matched at 87.7% of sites. Bipolar and unipolar voltages, compared in 592 electrograms from four MRI‐defined scar types (endocardial scar, epicardial scar, mottled transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of <13 mV correlated with transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low‐voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar. Conclusions Ultra‐high resolution contact electroanatomical mapping accurately localizes ventricular scar and abnormal myocardial tissue in this chronic canine infarct model. The high fidelity electrograms provided clear identification of the very low amplitude ILPs within the scar tissue and has the potential to quickly identify targets for ablation.
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Affiliation(s)
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Brian Stewart
- Rhythmia Medical, Boston Scientific, Marlborough, Massachusetts
| | - Ivan Cokic
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | | | | | - Avinash Kali
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | | | - Doron Harlev
- Rhythmia Medical, Boston Scientific, Marlborough, Massachusetts
| | - Nathan Bennett
- Rhythmia Medical, Boston Scientific, Marlborough, Massachusetts
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Sumeet S Chugh
- Heart Institute.,David Geffen School of Medicine, University of California, Los Angeles, California
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Kali A, Cokic I, Yang HJ, Sharif B, Dharmakumar R. Accuracy and precision of chronic myocardial infarct characterization with native T1 mapping at 3T. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328196 DOI: 10.1186/1532-429x-17-s1-p166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abramova V, Kali A, Abdolla N, Yurikova O, Perfilyeva Y, Ostapchuk Y, Tleulieva R, Madenova S, Belyaev N. Influence of tumor cells on natural killer cell phenotype and cytotoxicity. INT J BIOL CHEM 2015. [DOI: 10.26577/2218-7979-2015-8-1-9-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wheeler DC, Abdalla S, Chertow G, Parfrey P, Herzog C, Mikolasevic I, Racki S, Lukenda V, Milic S, Devcic B, Orlic L, Suttorp MM, Hoekstra T, Ocak G, Van Diepen ATN, Ott I, Mittelman M, Rabelink TJ, Krediet RT, Dekker FW, Simone S, Dell'Oglio MPS, Ciccone M, Corciulo R, Castellano G, Balestra C, Grandaliano G, Gesualdo L, Pertosa G, Nishida M, Ando M, Karasawa K, Iwamoto Y, Tsuchiya K, Nitta K, Krzanowski M, Janda K, Gajda M, Dumnicka P, Fedak D, Lis G, Ja kowski P, Litwin JA, Su owicz W, Freitas GR, Silva VB, Abensur H, Luders C, Pereira BJ, Castro MC, Oliverira RB, Moyses RM, Elias RM, Silva BC, Tekce H, Ozturk S, Aktas G, Kin Tekce B, Erdem A, Ozyasar M, Taslamacioglu Duman T, Yazici M, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Voroneanu L, Siriopol D, Nistor I, Apetrii M, Hogas S, Onofriescu M, Covic A, An WS, Kim SE, Son YK, Oh YJ, Gelev S, Toshev S, Trajceska L, Selim G, Dzekova P, Shikole A, Park J, Lee JS, Shin ES, Ann SH, Kim SJ, Chung HC, Janda K, Krzanowski M, Gajda M, Dumnicka P, Fedak D, Lis G, Litwin JA, Sulowicz W, Elewa U, Bichari W, Abo-Seif K, Seferi S, Rroji M, Likaj E, Spahia N, Barbullushi M, Thereska N, Kopecky CM, Genser B, Maerz W, Wanner C, Saemann MD, Weichhart T, Sezer S, Gurlek Demirci B, Tutal E, Bal Z, Erkmen Uyar M, Ozdemir Acar FN, Macunluoglu B, Atakan A, Ari Bakir E, Georgianos P, Sarafidis PA, Stamatiadis DN, Liakopoulos V, Zebekakis PE, Papagianni A, Lasaridis AN, Eftimovska - Otovic N, Babalj-Banskolieva E, Kostadinska-Bogdanoska S, Grozdanovski R, Aono M, Sato Y, El Amrani M, Asserraji M, Benyahia M, Lee YK, Choi SR, Cho A, Kim JK, Choi MJ, Kim SJ, Yoon JW, Koo JR, Kim HJ, Noh JW, Inagaki H, Yokota N, Sato Y, Chiyotanda S, Fukami K, Fujimoto S, Kendi Celebi Z, Kutlay S, Sengul S, Nergizoglu G, Erturk S, Ates K, Vishnevskii KA, Rumyantsev AS, Zemchenkov AY, Smirnov AV, Reinhardt B, Knaup R, Esteve Simo V, Carneiro Oliveira J, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Duarte Gallego V, Ramirez De Arellano Serna M, Turkmen K, Demirtas L, Akbas EM, Bakirci EM, Buyuklu M, Timuroglu A, Georgianos PI, Sarafidis PA, Karpetas A, Liakopoulos V, Stamatiadis DN, Papagianni A, Lasaridis AN, Taira T, Nohtomi K, Takemura T, Chiba T, Hirano T, Chang CT, Huang CC, Chen CJ, El Amrani M, Mohamed A, Benyahia M, Kanai H, Tamura Y, Kaizu Y, Kali A, Yayar O, Erdogan B, Eser B, Ercan Z, Buyukbakkal M, Merhametsiz O, Haspulat A, Yildirim T, Bozkurt B, Ayli MD, Bal Z, Erkmen Uyar M, Gokustun D, Gurlek Demirci B, Tutal E, Sezer S, Markaki A, Grammatikopoulou M, Fragkiadakis G, Stylianou K, Venyhaki M, Chatzi V, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Gelev S, Petronievic Z, Sikole A, Moyseyenko V, Nykula T, Fernandes RT, Barreto DV, Rodrigues GGC, Misael A, Branco-Martins CT, Barreto FC, Yayar O, Ercan Z, Eser B, Merhametsiz O, Haspulat A, Buyukbakkal M, Erdogan B, Yildirim T, Bozkurt B, Ayli MD. DIALYSIS CARDIOVASCULAR COMPLICATIONS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yang HJ, Yumul R, Tang R, Cokic I, Klein M, Kali A, Sobczyk O, Sharif B, Tang J, Bi X, Tsaftaris SA, Li D, Conte AH, Fisher JA, Dharmakumar R. Assessment of myocardial reactivity to controlled hypercapnia with free-breathing T2-prepared cardiac blood oxygen level-dependent MR imaging. Radiology 2014; 272:397-406. [PMID: 24749715 DOI: 10.1148/radiol.14132549] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To examine whether controlled and tolerable levels of hypercapnia may be an alternative to adenosine, a routinely used coronary vasodilator, in healthy human subjects and animals. MATERIALS AND METHODS Human studies were approved by the institutional review board and were HIPAA compliant. Eighteen subjects had end-tidal partial pressure of carbon dioxide (PetCO2) increased by 10 mm Hg, and myocardial perfusion was monitored with myocardial blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging. Animal studies were approved by the institutional animal care and use committee. Anesthetized canines with (n = 7) and without (n = 7) induced stenosis of the left anterior descending artery (LAD) underwent vasodilator challenges with hypercapnia and adenosine. LAD coronary blood flow velocity and free-breathing myocardial BOLD MR responses were measured at each intervention. Appropriate statistical tests were performed to evaluate measured quantitative changes in all parameters of interest in response to changes in partial pressure of carbon dioxide. RESULTS Changes in myocardial BOLD MR signal were equivalent to reported changes with adenosine (11.2% ± 10.6 [hypercapnia, 10 mm Hg] vs 12% ± 12.3 [adenosine]; P = .75). In intact canines, there was a sigmoidal relationship between BOLD MR response and PetCO2 with most of the response occurring over a 10 mm Hg span. BOLD MR (17% ± 14 [hypercapnia] vs 14% ± 24 [adenosine]; P = .80) and coronary blood flow velocity (21% ± 16 [hypercapnia] vs 26% ± 27 [adenosine]; P > .99) responses were similar to that of adenosine infusion. BOLD MR signal changes in canines with LAD stenosis during hypercapnia and adenosine infusion were not different (1% ± 4 [hypercapnia] vs 6% ± 4 [adenosine]; P = .12). CONCLUSION Free-breathing T2-prepared myocardial BOLD MR imaging showed that hypercapnia of 10 mm Hg may provide a cardiac hyperemic stimulus similar to adenosine.
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Affiliation(s)
- Hsin-Jung Yang
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, PACT Building, Suite 800, Los Angeles, CA 90048 (H.J.Y., R.T., I.C., A.K., B.S., D.L., R.D.); Departments of Bioengineering (H.J.Y., A.K., D.L.), Anesthesiology (R.Y.), and Medicine (D.L., R.D.), University of California, Los Angeles, Calif; Department of Physiology (O.S., M.K., J.A.F.) and Department of Anesthesiology, University Health Network (J.A.F.), University of Toronto, Toronto, Ontario, Canada; IMT Institute for Advanced Studies Lucca, Lucca, Italy (S.A.T.); Siemens Medical Solutions USA, Chicago, Ill (X.B.); and Department of Anesthesiology (R.Y., J.T., A.H.C.) and Cedars-Sinai Heart Institute (R.D.), Cedars-Sinai Medical Center, Los Angeles, Calif
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Kali A, Cokic I, Yang HJ, Tang R, Dharmakumar R. CHRONIC IRON DEPOSITION CAN OCCUR IN NON-REPERFUSED MYOCARDIAL INFARCTIONS: A CARDIOVASCULAR MAGNETIC RESONANCE STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kali A, Cokic I, Tang RLQ, Yang HJ, Sharif B, Marbán E, Li D, Berman DS, Dharmakumar R. Determination of location, size, and transmurality of chronic myocardial infarction without exogenous contrast media by using cardiac magnetic resonance imaging at 3 T. Circ Cardiovasc Imaging 2014; 7:471-81. [PMID: 24682268 DOI: 10.1161/circimaging.113.001541] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Late-gadolinium-enhanced (LGE) cardiac MRI (CMR) is a powerful method for characterizing myocardial infarction (MI), but the requisite gadolinium infusion is estimated to be contraindicated in ≈20% of patients with MI because of end-stage chronic kidney disease. The purpose of this study is to investigate whether T1 CMR obtained without contrast agents at 3 T could be an alternative to LGE CMR for characterizing chronic MIs using a canine model of MI. METHODS AND RESULTS Canines (n=29) underwent CMR at 7 days (acute MI [AMI]) and 4 months (chronic MI [CMI]) after MI. Infarct location, size, and transmurality measured by using native T1 maps and LGE images at 1.5 T and 3 T were compared. Resolution of edema between AMI and CMI was examined with T2 maps. T1 maps overestimated infarct size and transmurality relative to LGE images in AMI (P=0.016 and P=0.007, respectively), which was not observed in CMI (P=0.49 and P=0.81, respectively) at 3 T. T1 maps underestimated infarct size and transmurality relative to LGE images in AMI and CMI (P<0.001) at 1.5 T. Relative to the remote territories, T1 of the infarcted myocardium was increased in CMI and AMI (P<0.05), and T2 of the infarcted myocardium was increased in AMI (P<0.001) but not in CMI (P>0.20) at both field strengths. Histology showed extensive replacement fibrosis within the CMI territories. CMI detection sensitivity and specificity of T1 CMR at 3 T were 95% and 97%, respectively. CONCLUSIONS Native T1 maps at 3 T can determine the location, size, and transmurality of CMI with high diagnostic accuracy. Patient studies are necessary for clinical translation.
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Affiliation(s)
- Avinash Kali
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Ivan Cokic
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Richard L Q Tang
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Hsin-Jung Yang
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Behzad Sharif
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Eduardo Marbán
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Debiao Li
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Daniel S Berman
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.)
| | - Rohan Dharmakumar
- From the Biomedical Imaging Research Institute, Department of Biomedical Sciences (A.K., I.C., R.L.Q.T., H.-J.Y., B.S., D.L., R.D.) and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., D.L., D. S. B., R.D.); Department of Bioengineering (A.K., H.-J.Y.) and Department of Medicine, David Geffen School of Medicine (D. S. B., R.D.), University of California, Los Angeles, CA; and Department of Radiology, Northwestern University, Chicago, IL (A.K., R.L.Q.T., D.L., R.D.).
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Kali A, Cokic I, Tang R, Yang HJ, Sharif B, Marbán E, Li D, Berman DS, Dharmakumar R. Contrast-free T1 mapping at 3T can characterize chronic myocardial infarctions with high diagnostic accuracy. J Cardiovasc Magn Reson 2014. [PMCID: PMC4042391 DOI: 10.1186/1532-429x-16-s1-p205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yang HJ, Yumul R, Tang R, Cokic I, Klein M, Kali A, Sobczyk O, Sharif B, Tang J, Bi X, Tsaftaris SA, Li D, Min JK, Berman DS, Conte AH, Fisher JA, Dharmakumar R. Probing myocardial blood oxygenation reserve with controlled hypercapnia using BOLD CMR. J Cardiovasc Magn Reson 2014. [PMCID: PMC4045799 DOI: 10.1186/1532-429x-16-s1-o14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cokic I, Kali A, Wang X, Yang HJ, Tang RLQ, Thajudeen A, Shehata M, Amorn AM, Liu E, Stewart B, Bennett N, Harlev D, Tsaftaris SA, Jackman WM, Chugh SS, Dharmakumar R. Iron deposition following chronic myocardial infarction as a substrate for cardiac electrical anomalies: initial findings in a canine model. PLoS One 2013; 8:e73193. [PMID: 24066038 PMCID: PMC3774668 DOI: 10.1371/journal.pone.0073193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/17/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose Iron deposition has been shown to occur following myocardial infarction (MI). We investigated whether such focal iron deposition within chronic MI lead to electrical anomalies. Methods Two groups of dogs (ex-vivo (n = 12) and in-vivo (n = 10)) were studied at 16 weeks post MI. Hearts of animals from ex-vivo group were explanted and sectioned into infarcted and non-infarcted segments. Impedance spectroscopy was used to derive electrical permittivity () and conductivity (). Mass spectrometry was used to classify and characterize tissue sections with (IRON+) and without (IRON-) iron. Animals from in-vivo group underwent cardiac magnetic resonance imaging (CMR) for estimation of scar volume (late-gadolinium enhancement, LGE) and iron deposition (T2*) relative to left-ventricular volume. 24-hour electrocardiogram recordings were obtained and used to examine Heart Rate (HR), QT interval (QT), QT corrected for HR (QTc) and QTc dispersion (QTcd). In a fraction of these animals (n = 5), ultra-high resolution electroanatomical mapping (EAM) was performed, co-registered with LGE and T2* CMR and were used to characterize the spatial locations of isolated late potentials (ILPs). Results Compared to IRON- sections, IRON+ sections had higher, but no difference in. A linear relationship was found between iron content and (p<0.001), but not (p = 0.34). Among two groups of animals (Iron (<1.5%) and Iron (>1.5%)) with similar scar volumes (7.28%±1.02% (Iron (<1.5%)) vs 8.35%±2.98% (Iron (>1.5%)), p = 0.51) but markedly different iron volumes (1.12%±0.64% (Iron (<1.5%)) vs 2.47%±0.64% (Iron (>1.5%)), p = 0.02), QT and QTc were elevated and QTcd was decreased in the group with the higher iron volume during the day, night and 24-hour period (p<0.05). EAMs co-registered with CMR images showed a greater tendency for ILPs to emerge from scar regions with iron versus without iron. Conclusion The electrical behavior of infarcted hearts with iron appears to be different from those without iron. Iron within infarcted zones may evolve as an arrhythmogenic substrate in the post MI period.
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Affiliation(s)
- Ivan Cokic
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Avinash Kali
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
- Department of Biomedical Engineering, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xunzhang Wang
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles California, United States of America
| | - Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Department of Biomedical Engineering, University of California Los Angeles, Los Angeles, California, United States of America
| | - Richard L. Q. Tang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Department of Radiology, Northwestern University, Chicago, Illinois, United States of America
| | - Anees Thajudeen
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles California, United States of America
| | - Michael Shehata
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles California, United States of America
| | - Allen M. Amorn
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles California, United States of America
| | - Enzhao Liu
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles California, United States of America
| | - Brian Stewart
- Rhythmia Medical, Burlington, Massachusetts, United States of America
| | - Nathan Bennett
- Rhythmia Medical, Burlington, Massachusetts, United States of America
| | - Doron Harlev
- Rhythmia Medical, Burlington, Massachusetts, United States of America
| | - Sotirios A. Tsaftaris
- Institutions Markets Technologies, Institute for Advanced Studies Lucca, Piazza S. Ponziano, Lucca, Italy
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Radiology, Northwestern University, Chicago, Illinois, United States of America
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Sumeet S. Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles California, United States of America
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
- Department of Radiology, Northwestern University, Chicago, Illinois, United States of America
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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Kali A, Tang RLQ, Kumar A, Min JK, Dharmakumar R. Detection of acute reperfusion myocardial hemorrhage with cardiac MR imaging: T2 versus T2. Radiology 2013; 269:387-95. [PMID: 23847253 DOI: 10.1148/radiology.13122397] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate T2 and T2* changes in acute reperfused hemorrhagic and nonhemorrhagic myocardial infarctions and to determine which technique is more suitable in the detection of intramyocardial hemorrhage at 1.5 T. MATERIALS AND METHODS Patient studies were approved by the institutional review board and were HIPAA compliant. Patients (n = 14, three women) with first ST-elevation myocardial infarction underwent cardiac magnetic resonance (MR) imaging 3 days after angioplasty. T2* maps, T2 short inversion time inversion-recovery (STIR) images, and late gadolinium enhancement (LGE) images were acquired. Animal studies were approved by the institutional animal care and use committee. Canines (n = 20) were subjected to ischemia-reperfusion injury, and cardiac MR imaging was performed 5 days after reperfusion. T2* and T2 maps and T2 STIR and LGE images were acquired. Repeated-measures analysis of variance or the Friedman test was used to compare T2 and T2* changes in patients with hemorrhagic infarctions and those with nonhemorrhagic infarctions. RESULTS Relative to remote myocardium, mean T2* of hemorrhagic infarctions was 54% ± 13 (standard deviation) lower in patients (15.9 msec ± 4.5 vs 35.2 msec ± 2.1, P < .001) and 40% ± 10 lower in canines (23.0 msec ± 4.0 vs 39.3 msec ± 2.5, P < .001). Mean T2* of nonhemorrhagic infarctions was marginally elevated by 6% ± 2.5 (37.8 msec ± 2.5, P = .021) in patients and by 8% ± 5 (44.6 msec ± 4.8, P = .012) in canines. In contrast, mean T2 STIR signal intensity (SI) of both hemorrhagic infarctions and nonhemorrhagic infarctions was higher than that in remote myocardium both in patients (hemorrhagic: 37% ± 19, P < .001; nonhemorrhagic: 78% ± 27, P < .001) and in canines (hemorrhagic: 42% ± 22, P < .001; nonhemorrhagic: 65% ± 22, P < .001). Consistent with STIR SI findings, mean T2 of both hemorrhagic (62.0 msec ± 4.9) and nonhemorrhagic (71.7 msec ± 7.3) infarctions in canines was elevated relative to mean T2 of remote myocardium (52.1 msec ± 4.8) by 18% ± 9 and 38% ± 13, respectively (P < .001 for both). CONCLUSION T2* cardiac MR imaging is more suitable than T2 cardiac MR imaging in the detection and characterization of acute reperfusion myocardial hemorrhage. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122397/-/DC1.
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Affiliation(s)
- Avinash Kali
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, PACT Bldg-Suite 800, 8700 Beverly Blvd, Los Angeles, Calif 90048; Department of Biomedical Engineering, Northwestern University, Evanston, Ill; Department of Biomedical Engineering and Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif; Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
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Abstract
PURPOSE To evaluate T2 and T2* changes in acute reperfused hemorrhagic and nonhemorrhagic myocardial infarctions and to determine which technique is more suitable in the detection of intramyocardial hemorrhage at 1.5 T. MATERIALS AND METHODS Patient studies were approved by the institutional review board and were HIPAA compliant. Patients (n = 14, three women) with first ST-elevation myocardial infarction underwent cardiac magnetic resonance (MR) imaging 3 days after angioplasty. T2* maps, T2 short inversion time inversion-recovery (STIR) images, and late gadolinium enhancement (LGE) images were acquired. Animal studies were approved by the institutional animal care and use committee. Canines (n = 20) were subjected to ischemia-reperfusion injury, and cardiac MR imaging was performed 5 days after reperfusion. T2* and T2 maps and T2 STIR and LGE images were acquired. Repeated-measures analysis of variance or the Friedman test was used to compare T2 and T2* changes in patients with hemorrhagic infarctions and those with nonhemorrhagic infarctions. RESULTS Relative to remote myocardium, mean T2* of hemorrhagic infarctions was 54% ± 13 (standard deviation) lower in patients (15.9 msec ± 4.5 vs 35.2 msec ± 2.1, P < .001) and 40% ± 10 lower in canines (23.0 msec ± 4.0 vs 39.3 msec ± 2.5, P < .001). Mean T2* of nonhemorrhagic infarctions was marginally elevated by 6% ± 2.5 (37.8 msec ± 2.5, P = .021) in patients and by 8% ± 5 (44.6 msec ± 4.8, P = .012) in canines. In contrast, mean T2 STIR signal intensity (SI) of both hemorrhagic infarctions and nonhemorrhagic infarctions was higher than that in remote myocardium both in patients (hemorrhagic: 37% ± 19, P < .001; nonhemorrhagic: 78% ± 27, P < .001) and in canines (hemorrhagic: 42% ± 22, P < .001; nonhemorrhagic: 65% ± 22, P < .001). Consistent with STIR SI findings, mean T2 of both hemorrhagic (62.0 msec ± 4.9) and nonhemorrhagic (71.7 msec ± 7.3) infarctions in canines was elevated relative to mean T2 of remote myocardium (52.1 msec ± 4.8) by 18% ± 9 and 38% ± 13, respectively (P < .001 for both). CONCLUSION T2* cardiac MR imaging is more suitable than T2 cardiac MR imaging in the detection and characterization of acute reperfusion myocardial hemorrhage. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122397/-/DC1.
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Affiliation(s)
- Avinash Kali
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, PACT Bldg-Suite 800, 8700 Beverly Blvd, Los Angeles, Calif 90048; Department of Biomedical Engineering, Northwestern University, Evanston, Ill; Department of Biomedical Engineering and Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif; Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
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Ito M, Emami-Naini A, Keyvandarian N, Moeinzadeh F, Mortazavi M, Taheri S, Io K, Nishino T, Obata Y, Kitamura M, Abe S, Koji T, Kohno S, Wakabayashi K, Hamada C, Nakano T, Kanda R, Io H, Horikoshi S, Tomino Y, Korte MR, Braun N, Habib SM, Goffin E, Summers A, Heuveling L, Betjes MGH, Lambie M, Bankart J, Johnson D, Mactier R, Phillips-Darby L, Topley N, Davies S, Liu FX, Leipold R, Arici M, Farooqui U, Cho KH, Do JY, Kang SH, Park JW, Yoon KW, Jung SY, Sise C, Rutherford P, Kovacs L, Konings S, Pestana M, Zimmermann J, Cramp H, Stein D, Bang K, Shin JH, Jeong J, Kim JH, Matsuo N, Maruyama Y, Nakao M, Tanno Y, Ohkido I, Hayakawa H, Yamamoto H, Yokoyama K, Hosoya T, Iannuzzella F, Corradini M, Belloni L, Stefani A, Parmeggiani M, Pasquali S, Svedberg O, Stenvinkel P, Qureshi AR, Barany P, Heimburger O, Leurs P, Anderstam B, Waniewski J, Antosiewicz S, Baczynski D, Galach M, Wankowicz Z, Prabhu M, Subhramanyam SV, Nayak KS, Hwang JC, Jiang MY, Lu YH, Wang CT, Santos C, Rodriguez-Carmona A, Perez Fontan M, Schaefer B, Macher-Goeppinger S, Bayazit A, Sallay P, Testa S, Holland-Cunz S, Querfeld U, Warady BA, Schaefer F, Schmitt CP, Guney I, Turkmen K, Yazici R, Aslan S, Altintepe L, Yeksan M, Kocyigit I, Sipahioglu M, Orscelik O, Unal A, Celik A, Abbas S, Zhu F, Tokgoz B, Dogan A, Oymak O, Kotanko P, Levin N, Sanchez-Gonzalez MC, Gonzalez-Casaus ML, Gonzalez-Parra E, Albalate M, Lorenzo V, Torregrosa V, Fernandez E, de la Piedra C, Rodriguez M, Zeiler M, Monteburini T, Agostinelli RM, Marinelli R, Santarelli S, Bermond F, Bagnis C, Marcuccio C, Soragna G, Bruno M, Vitale C, Marangella M, Martino F, Scalzotto E, Rodighiero MP, Crepaldi C, Ronco C, Seferi S, Rroji M, Likaj E, Barbullushi M, Thereska N, Kim EJ, Han JH, Koo HM, Doh FM, Kim CH, Ko KI, Lee MJ, Oh HJ, Han SH, Yoo TH, Choi KH, Kang SW, Uzun S, Karadag S, Yegen M, Gursu M, Ozturk S, Aydin Z, Sumnu A, Cebeci E, Atalay E, Kazancioglu R, Alscher D, Fritz P, Latus J, Kimmel M, Biegger D, Lindenmeyer M, Cohen CD, Wuthrich RP, Segerer S, Braun N, Kim YK, Kim HW, Song HC, Choi EJ, Yang CW, Matsuda A, Tayama Y, Ogawa T, Iwanaga M, Okazaki S, Hatano M, Kiba T, Shimizu T, Hasegawa H, Mitarai T, Dratwa M, Collart F, Verger C, Tayama Y, Hasegawa H, Takayanagi K, Iwashita T, Shimizu T, Noiri C, Kiba T, Ogawa T, Inamura M, Nakamura S, Matsuda A, Kato H, Mitarai T, Unal A, Sipahioglu MH, Kocyigit I, Elmali F, Tokgoz B, Oymak O, Zhang X, Ma J, Giuliani A, Blanca-Martos L, Nayak Karopadi A, Mason G, Crepaldi C, Ronco C, Santos MT, Fonseca I, Santos O, Rocha MJ, Carvalho MJ, Cabrita A, Rodrigues A, Scabbia L, Domenici A, Apponi F, Tayefeh Jafari M, Sivo F, Falcone C, Punzo G, Mene P, Yildirim T, Yilmaz R, Azak A, Altindal M, Turkmen E, Arici M, Altun B, Duranay M, Erdem Y, Buyukbakkal M, Eser B, Yayar O, Ercan Z, Kali A, Erdogan B, Haspulat A, Merhametsiz O, Yildirim T, Ulusal-Okyay G, Akdag SI, Ayli MD, Pietrzycka A, Miarka P, Chowaniec E, Sulowicz W, Lutwin M, Gaska M, Paciorek A, Karadag S, Gursu M, Ozturk S, Aydin Z, Uzun S, Sumnu A, Cebeci E, Atalay E, Kazancioglu R. Peritoneal dialysis - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yayar O, Buyukbakkal M, Eser B, Yildirim T, Ercan Z, Erdogan B, Kali A, Merhametsiz O, Haspulat A, Akdag I, Ayli MD, Quach T, Tregaskis P, Menahem S, Koukounaras J, Mott N, Walker R, Zeiler M, Santarelli S, Degano G, Monteburini T, Agostinelli RM, Marinelli R, Ceraudo E, Grzelak T, Kramkowska M, Walczak M, Czyzewska K, Guney I, Turkmen K, Yazici R, Arslan S, Altintepe L, Yeksan M, Vaduva C, Popa S, Mota M, Mota E, Wan Md Adnan WAH, Zaharan NL, Moreiras-Plaza M, Blanco-Garcia R, Beato-Coo L, Cossio-Aranibar C, Martin-Baez I, Santos MT, Fonseca I, Santos O, Aguiar P, Rocha MJ, Carvalho MJ, Cabrita A, Rodrigues A, Guo Z, Lai X, Theodoridis M, Panagoutsos S, Thodis E, Karanikas M, Mitrakas A, Kriki P, Kantartzi K, Passadakis P, Vargemezis V, Vakilzadeh N, Pruijm M, Burnier M, Halabi G, Azevedo P, Santos O, Carvalho M, Cabrita A, Rodrigues A, Laplante S, Rutherford P, Shutov E, Isachkina A, Gorelova E, Troya MI, Teixido J, Pedreira G, Del Rio M, Romero R, Bonet J, Zhang X, Ma J, Kim Y, Kim JK, Song YR, Kim SG, Kim HJ, Eloot S, Vanholder R, Van Biesen W, Heaf J, Pedersen C, Elgborn A, Arabaci T, Emrem G, Keles M, Kizildag A, Martino F, Amici G, Rodighiero MP, Crepaldi C, Ronco C, Tanaka H, Tsuneyoshi S, Yamasaki K, Daijo Y, Tatsumoto N, Al-Hilali N, Hussain N, Fathy V, Negm H, Alhilali M, Grzegorzewska A, Cieszynski K, Kaczmarek A, Sowinska A, Soleymanian T, Najafi I, Ganji MR, Ahmadi F, Saddadi F, Hakemi M, Amini M, Tong LNMN, Yongcheng HNMN, Qijun WNMN, Shaodong LNMN, Velioglu A, Albaz M, Arikan H, Tuglular S, Ozener C, Bakirdogen S, Eren N, Mehtap O, Bek SG, Cekmen MB, Yilmaz A, Cabana Carcasi MLL, Fernandez Ferreiro A, Fidalgo Diaz M, Becerra Mosquera V, Alonso Valente R, Buttigieg J, Borg Cauchi A, Rogers M, Buhagiar L, Farrugia Agius J, Vella MP, Farrugia E, Han JH, Kim HR, Ko KI, Kim CH, Koo HM, Doh FM, Lee MJ, Oh HJ, Han SH, Yoo TH, Kang SW, Choi KH, Sikorska D, Frankiewicz D, Klysz P, Schwermer K, Hoppe K, Nealis J, Kaczmarek J, Baum E, Wanic-Kossowska M, Pawlaczyk K, Oko A, Hiss M, Gerstein F, Haller H, Gueler F, Fukasawa M, Manabe T, Wan Q, He Y, Zhu D, Li J, Xu H, Yayar O, Eser B, Buyukbakkal M, Ercan Z, Erdogan B, Merhametsiz O, Yildirim T, Kali A, Haspulat A, Oztemel A, Akdag I, Ayli MD, Pilcevic D, Kovacevic Z, Maksic D, Paunic Z, Tadic-Pilcevic J, Mijuskovic M, Petrovic M, Obrencevic K, Rabrenovic V, Ignjatovic L, Terzic B, Jovanovic D, Chang CH, Chang YS, Busuioc M, Guerraoui A, Caillette-Beaudoin A, Bahte SK, Hiss M, Kielstein JT, Polinder-Bos H, Emmelot-Vonk M, Gaillard C. Peritoneal dialysis II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bertoli S, Stucchi A, Ciurlino D, Musetti C, Meuwese CL, Carrero JJ, Cabezas-Rodriguez I, Heimburger O, Barany P, Lindholm B, Qureshi AR, Ripsweden J, Dekker FW, Stenvinkel P, Eser B, Buyukbakkal M, Yayar O, Yildirim T, Ercan Z, Kali A, Erdogan B, Haspulat A, Merhametsiz O, Akdag S, Ayli M, Keles H, Kendi Celebi Z, Karatan O, Ates K, Lambie M, Chess J, Bankart MJ, Lee HB, Noh H, Do JY, Dorval M, Topley N, Davies SJ, van Diepen ATN, van Esch S, Krediet RT, Struijk DG. Peritoneal dialysis - clinical. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kali A, Kumar A, Cokic I, Tang RLQ, Tsaftaris SA, Friedrich MG, Dharmakumar R. Chronic manifestation of postreperfusion intramyocardial hemorrhage as regional iron deposition: a cardiovascular magnetic resonance study with ex vivo validation. Circ Cardiovasc Imaging 2013; 6:218-28. [PMID: 23403335 DOI: 10.1161/circimaging.112.000133] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intramyocardial hemorrhage frequently accompanies large reperfused myocardial infarctions. However, its influence on the makeup and the ensuing effect on the infarcted tissue during the chronic phase remain unexplored. METHODS AND RESULTS Patients (n=15; 3 women), recruited after successful percutaneous coronary intervention for first segment-elevation myocardial infarction, underwent cardiovascular magnetic resonance imaging on day 3 and month 6 after percutaneous coronary intervention. Patients with hemorrhagic (Hemo+) infarctions, as determined by T2* cardiovascular magnetic resonance on day 3 (n=11), showed persistent T2* losses colocalized with scar tissue on the follow-up scans, suggesting chronic iron deposition. T2* values of Hemo+ territories were significantly higher than nonhemorrhagic (Hemo-) and remote territories (P<0.001); however, T2* values of nonhemorrhagic (Hemo-) and remote territories were not different (P=0.51). Canines (n=20) subjected to ischemia-reperfusion injury (n=14) underwent cardiovascular magnetic resonance on days 3 and 56 after ischemia-reperfusion injury. Similarly, sham-operated animals (Shams; n=3) were imaged using cardiovascular magnetic resonance at similar time points. Subsequently, hearts were explanted and imaged ex vivo, and samples of Hemo+, Hemo-, remote, and Sham myocardium were isolated and stained. The extent of iron deposition ([Fe]) within each sample was measured using mass spectrometry. Hemo+ infarcts showed significant T2* losses compared with the other (control) groups (P<0.001), and Perls stain confirmed localized iron deposition. Mean [Fe] of Hemo+ was nearly an order of magnitude greater than that of the control groups (P<0.001), but no significant differences were observed among the control groups. A strong linear relationship was observed between log(T2*) and -log([Fe]); R(2)=0.7 and P<0.001. The monoclonal antibody Mac387 stains, along with Perls stains, showed preferential localization of newly recruited macrophages at the site of chronic iron deposition. CONCLUSIONS Hemorrhagic myocardial infarction can lead to iron depositions within the infarct zones, which can be a source of prolonged inflammatory burden in the chronic phase of myocardial infarction.
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Affiliation(s)
- Avinash Kali
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Kali A, Kumar A, Tang RL, Dharmakumar R. CMR-based assessment of myocardial edema in the setting of ischemia and reperfusion. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559808 DOI: 10.1186/1532-429x-15-s1-p212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Avinash Kali
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Department of Biomedical Engineering, University of California, Los Angeles, CA, USA
| | - Andreas Kumar
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Richard L Tang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Kali A, Cokic I, Kumar A, Tsaftaris S, Tang RL, Friedrich MG, Dharmakumar R. Acute reperfusion intramyocardial hemorrhage leads to regional chronic iron deposition in the heart. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559768 DOI: 10.1186/1532-429x-15-s1-p174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kali A, Kumar A, Zhou X, Rundell VLM, Liu Y, Klein RA, Tang RLQ, Dharmakumar R. Detecting reperfusion myocardial hemorrhage with T2 and T2* maps at 1.5T. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106710 DOI: 10.1186/1532-429x-13-s1-p112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Rundell VLM, Zhou X, Kali A, Liu Y, Tang R, Klein RA, Kumar A, Dharmakumar R. Time-dependency of edema-based assessment of area-at-risk in reperfused acute myocardial infarction. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106773 DOI: 10.1186/1532-429x-13-s1-p111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Simoons M, Krzemiñska-Pakula M, Alonso A, Goodman S, Kali A, Loos U, Gosset F, Louer V, Bigonzi F. Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study. Eur Heart J 2002; 23:1282-90. [PMID: 12175665 DOI: 10.1053/euhj.2001.3083] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. METHODS AND RESULTS A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1mg x kg(-1), twice daily) of enoxaparin (n=253), or placebo (n=243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0.001), as was TIMI frame count (P=0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0.03). CONCLUSION Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.
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Affiliation(s)
- M Simoons
- Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands
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