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Andersen S, Laursen PH, Wood GJ, Lyhne MD, Madsen TL, Hansen ESS, Johansen P, Kim WY, Andersen MJ. Comparison of admittance and cardiac magnetic resonance generated pressure-volume loops in a porcine model. Physiol Meas 2024; 45:055014. [PMID: 38729184 DOI: 10.1088/1361-6579/ad4a03] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/10/2024] [Indexed: 05/12/2024]
Abstract
Objective. Pressure-volume loop analysis, traditionally performed by invasive pressure and volume measurements, is the optimal method for assessing ventricular function, while cardiac magnetic resonance (CMR) imaging is the gold standard for ventricular volume estimation. The aim of this study was to investigate the agreement between the assessment of end-systolic elastance (Ees) assessed with combined CMR and simultaneous pressure catheter measurements compared with admittance catheters in a porcine model.Approach. Seven healthy pigs underwent admittance-based pressure-volume loop evaluation followed by a second assessment with CMR during simultaneous pressure measurements.Main results. Admittance overestimated end-diastolic volume for both the left ventricle (LV) and the right ventricle (RV) compared with CMR. Further, there was an underestimation of RV end-systolic volume with admittance. For the RV, however, Ees was systematically higher when assessed with CMR plus simultaneous pressure measurements compared with admittance whereas there was no systematic difference in Ees but large differences between admittance and CMR-based methods for the LV.Significance. LV and RV Ees can be obtained from both admittance and CMR based techniques. There were discrepancies in volume estimates between admittance and CMR based methods, especially for the RV. RV Ees was higher when estimated by CMR with simultaneous pressure measurements compared with admittance.
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Affiliation(s)
- Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pernille Holmberg Laursen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gregory John Wood
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Dam Lyhne
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Lynge Madsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, MR research Centre, Aarhus University, Aarhus, Denmark
| | | | - Peter Johansen
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Nielsen-Kudsk JE, Kramer A, Andersen A, Kim WY, Korsholm K. First-in-human left atrial appendage closure using the WATCHMAN FLX Pro device: a case report. Eur Heart J Case Rep 2024; 8:ytae135. [PMID: 38617588 PMCID: PMC11014679 DOI: 10.1093/ehjcr/ytae135] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024]
Abstract
Background Device-related thrombosis (DRT) is a known complication to left atrial appendage closure (LAAC). The surface of a LAAC device should ideally have antithrombotic properties. The novel WATCHMAN FLX Pro (WFP) incorporates a fluoropolymer-coated fabric membrane designed to increase thromboresistance and facilitate endothelialization. Such features could potentially allow for a minimal post-procedural antithrombotic regimen. Radiopaque platinum markers at the device shoulders and a large 40 mm device are other novel features of the WFP. Case summary A 75-year-old man with atrial fibrillation was referred for LAAC due to prior subdural haemorrhage during direct-acting anticoagulation treatment. He underwent the first-in-human WFP implantation as part of the WATCHMAN FLX Pro CT study (NCT05567172). Computed tomography (CT) was used for pre-planning, and the procedure was performed under local analgesia guided by intracardiac echocardiography from the left atrium (LA) without any complications. Post-procedural antithrombotic treatment consisted of acetylsalicylic acid 75 mg/day only, and 45-day CT, transoesophageal echocardiography (TEE), and magnetic resonance imaging demonstrated optimal device position with complete LAAC. Hypoattenuated thickening (6 mm) appeared on the device as a smooth surface in continuity with the left atrial wall on CT and TEE. A specific magnetic resonance T1-weighted scan, used for visualization of fresh thrombus, suggested this to represent tissue ingrowth rather than thrombus. Discussion The advanced follow-up imaging protocol suggested a good WFP implantation result with signs of tissue ingrowth at 45 days. The added radiopaque markers facilitated optimal deployment, evaluation of device stability during tug test, and assessment of device protrusion into the LA.
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Affiliation(s)
- Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | - Anders Kramer
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
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Wood G, Madsen TL, Kim WY, Lyhne MD. Increasing Levels of Positive End-expiratory Pressure Cause Stepwise Biventricular Stroke Work Reduction in a Porcine Model. Anesthesiology 2024; 140:240-250. [PMID: 37905995 DOI: 10.1097/aln.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) is commonly applied to avoid atelectasis and improve oxygenation in patients during general anesthesia but affects cardiac pressures, volumes, and loading conditions through cardiorespiratory interactions. PEEP may therefore alter stroke work, which is the area enclosed by the pressure-volume loop and corresponds to the external work performed by the ventricles to eject blood. The low-pressure right ventricle may be even more susceptible to PEEP than the left ventricle. The authors hypothesized that increasing levels of PEEP would reduce stroke work in both ventricles. METHODS This was a prospective, observational, experimental study. Six healthy female pigs of approximately 60 kg were used. PEEP was stepwise increased from 0 to 5, 7, 9, 11, 13, 15, 17, and 20 cm H2O to cover the clinical spectrum of PEEP. Simultaneous, biventricular invasive pressure-volume loops, invasive blood pressures, and ventilator data were recorded. RESULTS Increasing PEEP resulted in stepwise reductions in left (5,740 ± 973 vs. 2,303 ± 1,154 mmHg · ml; P < 0.001) and right (2,064 ± 769 vs. 468 ± 133 mmHg · ml; P < 0.001) ventricular stroke work. The relative stroke work reduction was similar between the two ventricles. Left ventricular ejection fraction, afterload, and coupling were preserved. On the contrary, PEEP increased right ventricular afterload and caused right ventriculo-arterial uncoupling (0.74 ± 0.30 vs. 0.19 ± 0.13; P = 0.01) with right ventricular ejection fraction reduction (64 ± 8% vs. 37 ± 7%, P < 0.001). CONCLUSIONS A stepwise increase in PEEP caused stepwise reduction in biventricular stroke work. However, there are important interventricular differences in response to increased PEEP levels. PEEP increased right ventricular afterload leading to uncoupling and right ventricular ejection fraction decline. These findings may support clinical decision-making to further optimize PEEP as a means to balance between improving lung ventilation and preserving right ventricular function. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Gregory Wood
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Lynge Madsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Dam Lyhne
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Haeusler KG, Eichner FA, Heuschmann PU, Fiebach JB, Engelhorn T, Callans D, De Potter T, Debruyne P, Scherr D, Hindricks G, Al-Khalidi HR, Mont L, Kim WY, Piccini JP, Schotten U, Themistoclakis S, Di Biase L, Kirchhof P. Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial. Europace 2023; 25:euad323. [PMID: 37897713 PMCID: PMC10963060 DOI: 10.1093/europace/euad323] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023] Open
Abstract
AIMS Left atrial catheter ablation is well established in patients with symptomatic atrial fibrillation (AF) but associated with risk of embolism to the brain. The present analysis aims to assess the impact of diffusion-weighted imaging (DWI) slice thickness on the rate of magnetic resonance imaging (MRI)-detected ischaemic brain lesions after ablation. METHODS AND RESULTS AXAFA-AFNET 5 trial (NCT02227550) participants underwent MRI using high-resolution (hr) DWI (slice thickness: 2.5-3 mm) and standard DWI (slice thickness: 5-6 mm) within 3-48 h after ablation. In 321 patients with analysable brain MRI (mean age 64 years, 33% female, median CHA2DS2-VASc 2), hrDWI detected at least one acute brain lesion in 84 (26.2%) patients and standard DWI in 60 (18.7%; P < 0.01) patients. High-resolution diffusion-weighted imaging detected more lesions compared to standard DWI (165 vs. 104; P < 0.01). The degree of agreement for lesion confirmation using hrDWI vs. standard DWI was substantial (κ = 0769). Comparing the proportion of DWI-detected lesions, lesion distribution, and total lesion volume per patient, there was no difference in the cohort of participants undergoing MRI at 1.5 T (n = 52) vs. 3 T (n = 269). CONCLUSION The pre-specified AXAFA-AFNET 5 sub-analysis revealed significantly increased rates of MRI-detected acute brain lesions using hrDWI instead of standard DWI in AF patients undergoing ablation. In comparison to DWI slice thickness, MRI field strength had a no significant impact in the trial. Comparing the varying rates of ablation-related MRI-detected brain lesions across previous studies has to consider these technical parameters. Future studies should use hrDWI, as feasibility was demonstrated in the multicentre AXAFA-AFNET 5 trial.
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Affiliation(s)
- Karl Georg Haeusler
- Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany
- Department of Neurology, Universitätsklinikum Würzburg Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Felizitas A Eichner
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
- Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - David Callans
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | | | | | - Daniel Scherr
- Division of Cardiology, Medical University Graz, Austria
| | | | - Hussein R Al-Khalidi
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan P Piccini
- Duke Clinical Research Institute (DCRI), Durham, NC, USA
- Division of Cardiology Duke University Medical Center, Duke University, Durham NC, USA
| | - Ulrich Schotten
- Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany
- Departments of Cardiology and Physiology, University Maastricht, Maastricht, The Netherlands
| | | | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
- Texas Cardiac Arrhythmia Institute at St.David’s Medical Center, Austin, TX, USA
| | - Paulus Kirchhof
- Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research, Partner site Hamburg/Kiel/Lübeck, Germany
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Frederiksen CA, Stilling C, Kim WY, Poulsen SH. Two Different Clinical Presentations and Stages of Loeffler Endocarditis Diagnosed by Multimodality Investigations. CASE (Phila) 2023; 7:496-501. [PMID: 38197116 PMCID: PMC10772926 DOI: 10.1016/j.case.2023.09.003] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
•Loeffler endocarditis is a rare condition with various etiologies. •Timely diagnosis of Loeffler endocarditis through multimodal imaging is essential. •Treatment response in Loeffler endocarditis varies by disease stage. •Prognosis in Loeffler endocarditis varies by disease stage.
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Affiliation(s)
| | | | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Wood G, Pedersen AU, Kunze KP, Neji R, Hajhosseiny R, Wetzl J, Yoon SS, Schmidt M, Nørgaard BL, Prieto C, Botnar RM, Kim WY. Automated detection of cardiac rest period for trigger delay calculation for image-based navigator coronary magnetic resonance angiography. J Cardiovasc Magn Reson 2023; 25:52. [PMID: 37779192 PMCID: PMC10544388 DOI: 10.1186/s12968-023-00962-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Coronary magnetic resonance angiography (coronary MRA) is increasingly being considered as a clinically viable method to investigate coronary artery disease (CAD). Accurate determination of the trigger delay to place the acquisition window within the quiescent part of the cardiac cycle is critical for coronary MRA in order to reduce cardiac motion. This is currently reliant on operator-led decision making, which can negatively affect consistency of scan acquisition. Recently developed deep learning (DL) derived software may overcome these issues by automation of cardiac rest period detection. METHODS Thirty individuals (female, n = 10) were investigated using a 0.9 mm isotropic image-navigator (iNAV)-based motion-corrected coronary MRA sequence. Each individual was scanned three times utilising different strategies for determination of the optimal trigger delay: (1) the DL software, (2) an experienced operator decision, and (3) a previously utilised formula for determining the trigger delay. Methodologies were compared using custom-made analysis software to assess visible coronary vessel length and coronary vessel sharpness for the entire vessel length and the first 4 cm of each vessel. RESULTS There was no difference in image quality between any of the methodologies for determination of the optimal trigger delay, as assessed by visible coronary vessel length, coronary vessel sharpness for each entire vessel and vessel sharpness for the first 4 cm of the left mainstem, left anterior descending or right coronary arteries. However, vessel length of the left circumflex was slightly greater using the formula method. The time taken to calculate the trigger delay was significantly lower for the DL-method as compared to the operator-led approach (106 ± 38.0 s vs 168 ± 39.2 s, p < 0.01, 95% CI of difference 25.5-98.1 s). CONCLUSIONS Deep learning-derived automated software can effectively and efficiently determine the optimal trigger delay for acquisition of coronary MRA and thus may simplify workflow and improve reproducibility.
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Affiliation(s)
- Gregory Wood
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Alexandra Uglebjerg Pedersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jens Wetzl
- Cardiovascular MR Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Seung Su Yoon
- Cardiovascular MR Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Michaela Schmidt
- Cardiovascular MR Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millenium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
- Millenium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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7
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Wood G, Johnsen PH, Pedersen ALD, Frederiksen CA, Poulsen SH, Bøtker HE, Kim WY. Effect of remote ischaemic conditioning on left ventricular function in ST-segment elevation myocardial infarction patients: The CONDI-2 echocardiographic sub-study. Front Cardiovasc Med 2023; 9:1054142. [PMID: 36762305 PMCID: PMC9905230 DOI: 10.3389/fcvm.2022.1054142] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
Background Remote ischaemic conditioning (RIC) applied to the arm by inflation and deflation of a pneumatic cuff has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). However, the effect of RIC on left ventricular ejection fraction (LVEF) following infarct healing remains unknown. Objective To investigate whether RIC applied in the ambulance before PPCI can improve left ventricular (LV) function in STEMI patients 3 months following infarction. Methods Echocardiography was performed in a total of 694 patients from the CONDI-2 study a median of 112 days (IQR 63) after the initial admission. LVEF and LV end-diastolic and end-systolic volumes were calculated using the modified Simpsons biplane method of disks. LV global longitudinal strain (GLS) was estimated using 2-dimensional cine-loops with a frame rate > 55 frames/second, measured in the three standard apical views. Results There was no difference in the measured echocardiographic parameters in the RIC group as compared to the control group, including LV EF, LV GLS, tricuspid annular plane systolic excursion or left ventricular volumes. In the control group, 32% had an ejection fraction < 50% compared to 37% in the RIC group (p = 0.129). Conclusion In this largest to date randomized imaging study of RIC, RIC as an adjunct to PPCI was not associated with a change in echocardiographic measures of cardiac function compared to standard PPCI alone.
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Affiliation(s)
- Gregory Wood
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark,*Correspondence: Gregory Wood,
| | - Pia Hedegaard Johnsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Lehmann Dahl Pedersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Alcaraz Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Yun SW, Kim WY, Lee JB. Correlation between Serum Erythropoietin and Cerebral Collateral Flow in Acute Ischemic Stroke Patient. Korean J Fam Med 2023; 44:53-57. [PMID: 36709961 PMCID: PMC9887454 DOI: 10.4082/kjfm.22.0117] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/08/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Erythropoietin (EPO), which is associated with anemia, exerts neuroprotective effects in ischemic stroke. In cases of stenosis or narrowing of the main cerebral blood vessel, the prognosis is favorable if collateral blood circulation is well developed in acute stroke. Several studies have investigated the relationship between EPO administration and stroke outcomes. The present study investigated the correlation between serum EPO level and cerebral collateral circulation, which could result in favorable clinical outcomes. METHODS The study subjects were patients diagnosed with acute ischemic stroke who underwent initial brain magnetic resonance imaging between January 2020 and March 2022. Following brain computed tomography perfusion for collateral flow, serum EPO levels were measured. Collaterals were assessed according to the Mass system and divided into good collateral (GC) or poor collateral (PC) groups. Serum EPO levels were determined using a chemiluminescence immunoassay method. A correlation coefficient analysis was conducted to determine the correlation between serum EPO levels and GC. A receiver operating characteristic curve analysis determined the cutoff value of EPO for GC. RESULTS Serum EPO levels were significantly higher in the GC than that in the PC group (P<0.05). The cut-off level of serum EPO for a good outcome was 9.1 mIU/mL. CONCLUSION A high serum EPO (>9.1 mIU/mL) could be a marker of GC in patients with acute ischemic stroke that predicts good clinical outcomes.
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Affiliation(s)
- Sung Won Yun
- Department of Family Medicine, Hong-Ik Hospital, Seoul, Korea
| | - Won Yong Kim
- Department of Family Medicine, Hong-Ik Hospital, Seoul, Korea
| | - Jun Beom Lee
- Department of Neurology, Hong-Ik Hospital, Seoul, Korea,Corresponding Author: Jun Beom Lee https://orcid.org/0000-0002-7361-3161 Tel: +82-2-2600-0578, Fax: +82-2-2697-4605, E-mail:
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Mohamed AA, Bøttcher M, Engstrøm T, Kim WY, Christiansen EH, Winther S. [Not Available]. Ugeskr Laeger 2022; 184:V03220155. [PMID: 36331319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography (less-than 50% stenosis). MINOCA is a group of heterogeneous diseases with different pathophysiologic mechanism which all can cause ischaemia. MINOCA is considered a "working diagnosis" after angiography until further evaluation regarding its underlying cause is made. The aim of this review is to assess the literature on clinical features, aetiology, diagnosis, treatment and prognosis of patients with MINOCA.
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Affiliation(s)
| | | | - Thomas Engstrøm
- Hjertemedicinsk Afdeling, Københavns Universitetshospital - Rigshospitalet
| | - Won Yong Kim
- Hjertemedicinsk Afdeling, Aarhus Universitetshospital
| | | | - Simon Winther
- Hjertemedicinsk Afdeling, Regionshospitalet Gødstrup
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Pedersen ALD, Wood G, Frederiksen CA, Løgstrup BB, Jensen MK, Østergaard L, Kim WY, Poulsen SH. Clinical presentation and cardiac imaging findings in patient cases of perimyocarditis and pericarditis with a temporal association to SARS-CoV-2 vaccination. Front Cardiovasc Med 2022; 9:964412. [PMID: 35990940 PMCID: PMC9388047 DOI: 10.3389/fcvm.2022.964412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022] Open
Abstract
Aims We aimed to investigate and present cases of perimyocarditis and pericarditis verified by cardiovascular resonance (CMR) imaging in patients with a strong temporal association to SARS-CoV-2 vaccination. We sought to describe the clinical presentation including coronary artery angiography, CMR, transthoracic echocardiography, blood samples, electrocardiography, and symptoms. Methods We included 10 patients admitted with chest pain shortly after vaccination for SARS-CoV-2, who were diagnosed with pericarditis or perimyocarditis by CMR. We reviewed the CMR, echocardiography, electrocardiography, blood samples, coronary artery angiography, vital signs and medical history. The updated Lake Louise Criteria were used to determine the diagnosis by CMR. Results Eight patients had perimyocarditis and two patients had pericarditis. The mean age was 22 ± 5 years (range 16 to 31 years), 90% were male. The median time from vaccination to hospital admission was 4 days (range 2 to 28 days). Admissions were seen after vaccination with three different SARS-CoV-2 vaccine manufacturers. Nine Patients had ST-elevation on the initial electrocardiography. Peak troponins varied from 357 to 23,547 ng/l, with a median of 4,304 ng/l. Two patients had an LVEF <50% on echocardiography and four patients had left ventricular global longitudinal strain values <18%. CMR revealed preserved left ventricular ejection fraction (LVEF), although one patient had decreased LVEF on CMR. The T1 and T2 mapping values were increased in all patients. Of the 8 patients with perimyocarditis, all patients had signs of myocardial injury in the lateral segments of the left ventricle. Conclusions This case series of 10 patients supports the emerging evidence of an association between vaccination for SARS-CoV-2 and perimyocarditis and pericarditis, especially in young males. The temporal association was seen after vaccines from three different manufacturers. Imaging data from echocardiography and CMR displayed normal to mildly impaired cardiac function, usually with a mild disease course.
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Affiliation(s)
- Anders Lehmann Dahl Pedersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- *Correspondence: Anders Lehmann Dahl Pedersen
| | - Gregory Wood
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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11
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Wood G, Kirkevang TS, Agergaard J, Leth S, Hansen ESS, Laustsen C, Larsen AH, Jensen HK, Østergaard LJ, Bøtker HE, Poulsen SH, Kim WY. Cardiac Performance and Cardiopulmonary Fitness After Infection With SARS-CoV-2. Front Cardiovasc Med 2022; 9:871603. [PMID: 35647079 PMCID: PMC9136046 DOI: 10.3389/fcvm.2022.871603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/15/2022] [Indexed: 01/04/2023] Open
Abstract
AimsPersistent cardiac symptoms are an increasingly reported phenomenon following COVID-19. However, the underlying cause of cardiac symptoms is unknown. This study aimed to identify the underlying causes, if any, of these symptoms 1 year following acute COVID-19 infection.Methods and Results22 individuals with persistent cardiac symptoms were prospectively investigated using echocardiography, cardiovascular magnetic resonance (CMR), 6-min walking test, cardio-pulmonary exercise testing and electrocardiography. A median of 382 days (IQR 368, 442) passed between diagnosis of COVID-19 and investigation. As a cohort their echocardiography, CMR, 6-min walking test and exercise testing results were within the normal ranges. There were no differences in left ventricular ejection fraction (61.45 ± 6.59 %), global longitudinal strain (19.80 ± 3.12 %) or tricuspid annular plane systolic excursion (24.96 ± 5.55 mm) as measured by echocardiography compared to a healthy control group. VO2 max (2045.00 ± 658.40 ml/min), % expected VO2 max (114.80 ± 23.08 %) and 6-minute distance walked (608.90 ± 54.51 m) exceeded that expected for the patient cohort, whilst Troponin I (5.59 ± 6.59 ng/l) and Nt-proBNP (88.18 ± 54.27 ng/l) were normal.ConclusionAmong a cohort of 22 patients with self-reported persistent cardiac symptoms, we identified no underlying cardiac disease or reduced cardiopulmonary fitness 1 year following COVID-19.
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Affiliation(s)
- Gregory Wood
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Gregory Wood
| | - Therese Stegeager Kirkevang
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jane Agergaard
- Department of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Leth
- Department of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Internal Medicine, Gødstrup Hospital, Herning, Denmark
| | | | - Christoffer Laustsen
- The MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anders Hostrup Larsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Jørgen Østergaard
- Department of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Francis R, Chong J, Ramlall M, Bucciarelli-Ducci C, Clayton T, Dodd M, Engstrøm T, Evans R, Ferreira VM, Fontana M, Greenwood JP, Kharbanda RK, Kim WY, Kotecha T, Lønborg JT, Mathur A, Møller UK, Moon J, Perkins A, Rakhit RD, Yellon DM, Bøtker HE, Bulluck H, Hausenloy DJ. Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy. Basic Res Cardiol 2021; 116:59. [PMID: 34648075 PMCID: PMC8516772 DOI: 10.1007/s00395-021-00896-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/07/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1-17.1)% of LV mass; control: 11.1 (7.0-17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.
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Affiliation(s)
- Rohin Francis
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Jun Chong
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Manish Ramlall
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Chiara Bucciarelli-Ducci
- Biomedical Research Centre, Bristol Heart Institute, National Institute of Health Research (NIHR), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin St, Bristol, BS2 8HW, UK
| | - Tim Clayton
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Matthew Dodd
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Thomas Engstrøm
- Rigshospitalet, Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Richard Evans
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- National Institute of Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
- British Heart Foundation Centre of Research Excellence, Oxford, UK
| | - Marianna Fontana
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rajesh K Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Tushar Kotecha
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - Jacob T Lønborg
- Rigshospitalet, Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Ulla Kristine Møller
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - James Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Alexander Perkins
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Roby D Rakhit
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Heerajnarain Bulluck
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK.
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
- Department of Cardiology, National Heart Centre, Singapore, Singapore.
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
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13
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Hajhosseiny R, Munoz C, Cruz G, Khamis R, Kim WY, Prieto C, Botnar RM. Coronary Magnetic Resonance Angiography in Chronic Coronary Syndromes. Front Cardiovasc Med 2021; 8:682924. [PMID: 34485397 PMCID: PMC8416045 DOI: 10.3389/fcvm.2021.682924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/23/2021] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease is the leading cause of mortality worldwide, with atherosclerotic coronary artery disease (CAD) accounting for the majority of cases. X-ray coronary angiography and computed tomography coronary angiography (CCTA) are the imaging modalities of choice for the assessment of CAD. However, the use of ionising radiation and iodinated contrast agents remain drawbacks. There is therefore a clinical need for an alternative modality for the early identification and longitudinal monitoring of CAD without these associated drawbacks. Coronary magnetic resonance angiography (CMRA) could be a potential alternative for the detection and monitoring of coronary arterial stenosis, without exposing patients to ionising radiation or iodinated contrast agents. Further advantages include its versatility, excellent soft tissue characterisation and suitability for repeat imaging. Despite the early promise of CMRA, widespread clinical utilisation remains limited due to long and unpredictable scan times, onerous scan planning, lower spatial resolution, as well as motion related image quality degradation. The past decade has brought about a resurgence in CMRA technology, with significant leaps in image acceleration, respiratory and cardiac motion estimation and advanced motion corrected or motion-resolved image reconstruction. With the advent of artificial intelligence, great advances are also seen in deep learning-based motion estimation, undersampled and super-resolution reconstruction promising further improvements of CMRA. This has enabled high spatial resolution (1 mm isotropic), 3D whole heart CMRA in a clinically feasible and reliable acquisition time of under 10 min. Furthermore, latest super-resolution image reconstruction approaches which are currently under evaluation promise acquisitions as short as 1 min. In this review, we will explore the recent technological advances that are designed to bring CMRA closer to clinical reality.
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Affiliation(s)
- Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Won Yong Kim
- Department of Cardiology and Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Instituto de Ingeniería Biologica y Medica, Pontificia Universidad Catolica de Chile, Santiago, Chile
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14
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Tougaard RS, Laustsen C, Lassen TR, Qi H, Lindhardt JL, Schroeder M, Jespersen NR, Hansen ESS, Ringgaard S, Bøtker HE, Kim WY, Stødkilde-Jørgensen H, Wiggers H. Remodeling after myocardial infarction and effects of heart failure treatment investigated by hyperpolarized [1- 13 C]pyruvate magnetic resonance spectroscopy. Magn Reson Med 2021; 87:57-69. [PMID: 34378800 DOI: 10.1002/mrm.28964] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Hyperpolarized [1-13 C]pyruvate MRS can measure cardiac metabolism in vivo. We investigated whether [1-13 C]pyruvate MRS could predict left ventricular remodeling following myocardial infarction (MI), long-term left ventricular effects of heart failure medication, and could identify responders to treatment. METHODS Thirty-five rats were scanned with hyperpolarized [1-13 C]pyruvate MRS 3 days after MI or sham surgery. The animals were re-examined after 30 days of therapy with β-blockers and ACE-inhibitors (active group, n = 12), placebo treatment (placebo group, n = 13) or no treatment (sham group, n = 10). Furthermore, heart tissue mitochondrial respiratory capacity was assessed by high-resolution respirometry. Metabolic results were compared between groups, over time and correlated to functional MR data at each time point. RESULTS At 30 ± 0.5 days post MI, left ventricular ejection fraction (LVEF) differed between groups (sham, 77% ± 1%; placebo, 52% ± 3%; active, 63% ± 2%, P < .001). Cardiac metabolism, measured by both hyperpolarized [1-13 C]pyruvate MRS and respirometry, neither differed between groups nor between baseline and follow-up. Three days post MI, low bicarbonate + CO2 /pyruvate ratio was associated with low LVEF. At follow-up, in the active group, a poor recovery of LVEF was associated with high bicarbonate + CO2 /pyruvate ratio, as measured by hyperpolarized MRS. CONCLUSION In a rat model of moderate heart failure, medical treatment improved function, but did not on average influence [1-13 C]pyruvate flux as measured by MRS; however, responders to heart failure medication had reduced capacity for carbohydrate metabolism.
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Affiliation(s)
- Rasmus Stilling Tougaard
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Haiyun Qi
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jakob Lykke Lindhardt
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Marie Schroeder
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | | | - Steffen Ringgaard
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
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15
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Andersen A, Waziri F, Schultz JG, Holmboe S, Becker SW, Jensen T, Søndergaard HM, Dodt KK, May O, Mortensen UM, Kim WY, Mellemkjær S, Nielsen-Kudsk JE. Pulmonary vasodilation by sildenafil in acute intermediate-high risk pulmonary embolism: a randomized explorative trial. BMC Pulm Med 2021; 21:72. [PMID: 33639897 PMCID: PMC7916297 DOI: 10.1186/s12890-021-01440-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/03/2020] [Accepted: 02/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate if acute pulmonary vasodilation by sildenafil improves right ventricular function in patients with acute intermediate-high risk pulmonary embolism (PE). METHODS Single center, explorative trial. Patients with PE were randomized to a single oral dose of sildenafil 50 mg (n = 10) or placebo (n = 10) as add-on to conventional therapy. The time from hospital admission to study inclusion was 2.3 ± 0.7 days. Right ventricular function was evaluated immediately before and shortly after (0.5-1.5 h) randomization by right heart catheterization (RHC), trans-thoracic echocardiography (TTE), and cardiac magnetic resonance (CMR). The primary efficacy endpoint was cardiac index measured by CMR. RESULTS Patients had acute intermediate-high risk PE verified by computed tomography pulmonary angiography, systolic blood pressure of 135 ± 18 (mean ± SD) mmHg, increased right ventricular/left ventricular ratio 1.1 ± 0.09 and increased troponin T 167 ± 144 ng/L. Sildenafil treatment did not improve cardiac index compared to baseline (0.02 ± 0.36 l/min/m2, p = 0.89) and neither did placebo (0.00 ± 0.34 l/min/m2, p = 0.97). Sildenafil lowered mean arterial blood pressure (- 19 ± 10 mmHg, p < 0.001) which was not observed in the placebo group (0 ± 9 mmHg, p = 0.97). CONCLUSION A single oral dose of sildenafil 50 mg did not improve cardiac index but lowered systemic blood pressure in patients with acute intermediate-high risk PE. The time from PE to intervention, a small patient sample size and low pulmonary vascular resistance are limitations of this study that should be considered when interpreting the results. TRIAL REGISTRATION The trial was retrospectively registered at www.clinicaltrials.gov (NCT04283240) February 2nd 2020, https://clinicaltrials.gov/ct2/show/NCT04283240?term=NCT04283240&draw=2&rank=1 .
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Affiliation(s)
- Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jacob Gammelgaard Schultz
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Sarah Holmboe
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Tage Jensen
- Department of Internal Medicine, Region Hospital of Randers, Randers, Denmark
| | | | - Karen Kaae Dodt
- Department of Internal Medicine, Region Hospital of Horsens, Horsens, Denmark
| | - Ole May
- Department of Internal Medicine, Region Hospital of Herning, Herning, Denmark
| | - Ulrik Markus Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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16
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Hansen ESS, Madsen TL, Wood G, Granfeldt A, Bøgh N, Tofig BJ, Agger P, Lindhardt JL, Poulsen CB, Bøtker HE, Kim WY. Veno-occlusive unloading of the heart reduces infarct size in experimental ischemia-reperfusion. Sci Rep 2021; 11:4483. [PMID: 33627745 PMCID: PMC7904802 DOI: 10.1038/s41598-021-84025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/05/2021] [Indexed: 11/09/2022] Open
Abstract
Mechanical unloading of the left ventricle reduces infarct size after acute myocardial infarction by reducing cardiac work. Left ventricular veno-occlusive unloading reduces cardiac work and may reduce ischemia and reperfusion injury. In a porcine model of myocardial ischemia-reperfusion injury we randomized 18 pigs to either control or veno-occlusive unloading using a balloon engaged from the femoral vein into the inferior caval vein and inflated at onset of ischemia. Evans blue and 2,3,5-triphenyltetrazolium chloride were used to determine the myocardial area at risk and infarct size, respectively. Pressure-volume loops were recorded to calculate cardiac work, left ventricular (LV) volumes and ejection fraction. Veno-occlusive unloading reduced infarct size compared with controls (Unloading 13.9 ± 8.2% versus Control 22.4 ± 6.6%; p = 0.04). Unloading increased myocardial salvage (54.8 ± 23.4% vs 28.5 ± 14.0%; p = 0.02), while the area at risk was similar (28.4 ± 6.7% vs 27.4 ± 5.8%; p = 0.74). LV ejection fraction was preserved in the unloaded group, while the control group showed a reduced LV ejection fraction. Veno-occlusive unloading reduced myocardial infarct size and preserved LV ejection fraction in an experimental acute ischemia-reperfusion model. This proof-of-concept study demonstrated the potential of veno-occlusive unloading as an adjunctive cardioprotective therapy in patients undergoing revascularization for acute myocardial infarction.
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Affiliation(s)
- Esben Søvsø Szocska Hansen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Tobias Lynge Madsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Gregory Wood
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Asger Granfeldt
- Department of Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Nikolaj Bøgh
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Bawer Jalal Tofig
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Peter Agger
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Jakob Lykke Lindhardt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Bo Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Clinical Medicine, MR Research Centre, Aarhus University, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark.
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Beck W, Rose TL, Milowsky MI, Vincent BG, Klomp J, Kim WY. Age is associated with response to immune checkpoint blockade in advanced urothelial carcinoma. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.053] [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: 11/29/2022]
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Lindhardt JL, Nielsen PM, Hansen ESS, Qi H, Tougaard RS, Mariager CØ, Bertelsen LB, Kim WY, Laustsen C. The hemodynamic and metabolic effects of spironolactone treatment in acute kidney injury assessed by hyperpolarized MRI. NMR Biomed 2020; 33:e4371. [PMID: 32691467 DOI: 10.1002/nbm.4371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
Renal ischemia-reperfusion injury (IRI) is one of the most common types of acute kidney injury. Spironolactone has shown promising kidney protective effects in renal IRI in rats. We investigated the hemodynamic and metabolic effects of spironolactone (100 mg/kg) administered immediately after 40 min unilateral kidney ischemia in rats. Hyperpolarized MRI using co-polarized [1-13 C]pyruvate and [13 C,15 N2 ]urea as well as 1 H dynamic contrast-enhanced (DCE) MRI was performed 24 h after induction of ischemia. We found a significant decrease in renal blood flow (RBF) in the ischemic kidney compared with the contralateral one measured using DCE and [13 C,15 N2 ]urea. The RBF measured using [1-13 C]pyruvate and [13 C,15 N2 ]urea was significantly altered by spironolactone. The RBFs in the ischemic kidney compared with the contralateral kidney were decreased similarly as measured using both [13 C,15 N2 ]urea and [1-13 C]pyruvate in the spironolactone-treated group. Spironolactone treatment increased the perfusion-corrected pyruvate metabolism by 54% in both the ischemic and contralateral kidney. Furthermore, we showed a correlation between vascular permeability using a histological Evans blue analysis and the ratio of the volumes of distribution (VoDs), ie VoD-[13 C,15 N2 ]urea/VoD-[1-13 C]pyruvate. This suggests that [13 C,15 N2 ]urea/[1-13 C]pyruvate VoD ratio may be a novel indicator of renal vascular permeability associated with renal damage in rodents.
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Affiliation(s)
- Jakob Lykke Lindhardt
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Mose Nielsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Haiyun Qi
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rasmus Stilling Tougaard
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lotte Bonde Bertelsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Won Yong Kim
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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19
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Jo YH, Lee H, Oh MH, Lee GH, Lee YJ, Lee JS, Kim MJ, Kim WY, Kim JS, Yoo DS, Cho SW, Cha SW, Pyo MK. Antioxidant and hepatoprotective effects of Korean ginseng extract GS-KG9 in a D-galactosamine-induced liver damage animal model. Nutr Res Pract 2020; 14:334-351. [PMID: 32765814 PMCID: PMC7390743 DOI: 10.4162/nrp.2020.14.4.334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/04/2020] [Accepted: 03/24/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/OBJECTIVES This study was designed to investigate the improvement effect of white ginseng extract (GS-KG9) on D-galactosamine (Ga1N)-induced oxidative stress and liver injury. SUBJECTS/METHODS Sixty Sprague-Dawley rats were divided into 6 groups. Rats were orally administrated with GS-KG9 (300, 500, or 700 mg/kg) or silymarin (25 mg/kg) for 2 weeks. The rats of the GS-KG9- and silymarin-treated groups and a control group were then intraperitoneally injected Ga1N at a concentration of 650 mg/kg for 4 days. To investigate the protective effect of GS-KG9 against GalN-induced liver injury, blood liver function indicators, anti-oxidative stress indicators, and histopathological features were analyzed. RESULTS Serum biochemical analysis indicated that GS-KG9 ameliorated the elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) in GalN-treated rats. The hepatoprotective effects of GS-KG9 involved enhancing components of the hepatic antioxidant defense system, including glutathione, glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT). In addition, GS-KG9 treatment inhibited reactive oxygen species (ROS) production induced by GalN treatment in hepatocytes and significantly increased the expression levels of nuclear factor erythroid-2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) proteins, which are antioxidant proteins. In particular, by histological analyses bases on hematoxylin and eosin, Masson's trichrome, α-smooth muscle actin, and transforming growth factor-β1 staining, we determined that the administration of 500 mg/kg GS-KG9 inhibited hepatic inflammation and fibrosis due to the excessive accumulation of collagen. CONCLUSIONS These findings demonstrate that GS-KG9 improves GalN-induced liver inflammation, necrosis, and fibrosis by attenuating oxidative stress. Therefore, GS-KG9 may be considered a useful candidate in the development of a natural preventive agent against liver injury.
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Affiliation(s)
- Yun Ho Jo
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Hwan Lee
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Myeong Hwan Oh
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Gyeong Hee Lee
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - You Jin Lee
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Ji Sun Lee
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Min Jung Kim
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Won Yong Kim
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Jin Seong Kim
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Dae Seok Yoo
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Sang Won Cho
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Seon Woo Cha
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
| | - Mi Kyung Pyo
- International Ginseng & Herb Research Institute, Geumsan 32724, Korea
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20
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Lee SB, Kim HG, Lee JS, Kim WY, Lee MM, Kim YH, Lee JO, Kim HS, Son CG. Intermittent restraint-induced sympathetic activation attenuates hepatic steatosis and inflammation in a high-fat diet-fed mouse model. Am J Physiol Gastrointest Liver Physiol 2019; 317:G811-G823. [PMID: 31604029 DOI: 10.1152/ajpgi.00047.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/31/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is very prevalent worldwide and is associated with insulin resistance and metabolic syndrome. Stress is a physiological and biological response to maintain homeostasis of the body against stressors while severe stress response is an important contributor to various illnesses, including metabolic syndrome and brain disorders. We have evaluated the effects of intermittent restraint stress on NAFLD in a high-fat diet (HFD)-fed mouse model. C57/BL6 mice had free access to a 60% HFD for 8 wk, with or without intermittent restraint stress (3 h) conducted three times a week. HFD administration increased fat accumulation in liver tissues. Unlike the stressed standard diet group, the levels of hepatic total cholesterol and triglycerides were significantly ameliorated in the HFD with stress group compared with the HFD alone group. These beneficial results were in accordance with serum levels of liver enzymes (aspartate transaminase, alanine transaminase) and hepatic levels of TNF-α and oxidative stress parameters (reactive oxygen species, nitric oxide, and malondialdehyde). The intermittent restraint stress significantly attenuated the HFD-derived alterations in serum insulin levels, hepatic protein kinase B activity, and gene expression, especially related to lipogenesis. This intermittent restraint stress also elevated the serum epinephrine concentration and activated the adrenergic receptor β2 or β3 in livers or white adipose tissue (WAT). Activation of energy expenditure markers (uncoupling protein 1, peroxisome proliferator-activated receptor-γ coactivator-1α) in brown adipose tissue and the browning of WAT were also observed in the HFD with stress group. Taken together, our findings showed the beneficial effects of sympathetic activation by intermittent restraint stress on HFD-induced hepatic steatosis and partial inflammation.NEW & NOTEWORTHY In modern society, stress is a part of daily life, and a certain level of stress is inevitable to most of the general population. Uncontrolled severe stress is obviously harmful; however, certain kind/level of stress could be beneficial on lipid metabolism via sympathetic activation. Our data suggest that a sympathetic activation by intermittent restraint stress could play a positive role in maintaining the balance of hepatic lipid metabolism, especially under high-fat diet conditions.
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Affiliation(s)
- Sung Bae Lee
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
| | - Hyeong Geug Kim
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
| | - Jin Seok Lee
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
| | - Won Yong Kim
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
| | - Myong Min Lee
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
| | - Yun Hee Kim
- Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jung Ok Lee
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Hyeon Soo Kim
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Chang Gue Son
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon, Korea
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21
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Pryds K, Larsen AH, Hansen MS, Grøndal AYK, Tougaard RS, Hansson NH, Clemmensen TS, Løgstrup BB, Wiggers H, Kim WY, Bøtker HE, Nielsen RR. Myocardial strain assessed by feature tracking cardiac magnetic resonance in patients with a variety of cardiovascular diseases - A comparison with echocardiography. Sci Rep 2019; 9:11296. [PMID: 31383914 PMCID: PMC6683180 DOI: 10.1038/s41598-019-47775-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022] Open
Abstract
Myocardial deformation assessed by speckle tracking echocardiography (STE) is increasingly used for diagnosis, monitoring and prognosis in patients with clinical and pre-clinical cardiovascular diseases. Feature tracking cardiac magnetic resonance (FT-CMR) also allows myocardial deformation analysis. To clarify whether the two modalities can be used interchangeably, we compared myocardial deformation analysis by FT-CMR with STE in patients with a variety of cardiovascular diseases and healthy subjects. We included 40 patients and 10 healthy subjects undergoing cardiac magnetic resonance and echocardiographic examination for left ventricular volumetric assessment. We studied patients with heart failure and reduced ejection fraction (n = 10), acute perimyocarditis (n = 10), aortic valve stenosis (n = 10), and previous heart transplantation (n = 10) by global longitudinal (GLS), radial (GRS) and circumferential strain (GCS). Myocardial deformation analysis by FT-CMR was feasible in all but one participant. While GLS, GRS and GCS measured by FT-CMR correlated overall with STE (r = 0.74 and p < 0.001, r = 0.58 and p < 0.001, and r = 0.76 and p < 0.001), the correlations were not consistent within subgroups. GLS was systematically lower, whereas GRS and GCS were higher by FT-CMR compared to STE (p = 0.04 and p < 0.0001). Inter- and intra-observer reproducibility were comparable for FT-CMR and STE overall and across subgroups. In conclusion, myocardial deformation can be evaluated using FT-CMR applied to routine cine-CMR images in patients with a variety of cardiovascular diseases. However, correlation between FT-CMR and STE was modest and agreement was not optimal due to systematic bias regarding GLS and GCS. Consequently, FT-CMR and STE should not be used interchangeably for myocardial strain evaluation.
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Affiliation(s)
- Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. .,Department of Medicine, Randers Regional Hospital, Randers, Denmark.
| | - Anders Hostrup Larsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mona Sahlholdt Hansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Rasmus Stilling Tougaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Ranghøj Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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22
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Kang HW, Kim WY, Jin SJ, Kim YH, Min TJ, Lee YS, Kim JH. Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009-2016). J Int Med Res 2019; 47:4365-4373. [PMID: 31331228 PMCID: PMC6753575 DOI: 10.1177/0300060519859749] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The number of high-risk pregnancies is increasing in tertiary medical centers. Therefore, we investigated perioperative outcomes based on risk factors to ascertain proper maternal and neonatal management. Methods We reviewed the medical records of patients receiving cesarean sections over an 8-year period. Clinical parameters for anesthesia and the neonatal outcome were compared among high-risk groups after subdivision by the number of clinical risk factors. The groups were as follows: group A (one risk factor), group B (two risk factors), and group C (three or more risk factors). Results Patient age, estimated blood loss (EBL), and volume of transfused red blood cell (RBC) were higher in group B than group A. Birth weight, 1- and 5-minute Apgar scores, and gestational age were lower while the frequency of neonatal intensive care unit (NICU) admission was higher in group B than group A. Group C patients were significantly older than group A or B patients. Birth weight, 1- and 5-minute Apgar scores and gestational age were significantly lower while frequency of NICU admission was higher in group C than group A and B. Conclusion The number of maternal risk factors was positively associated with adverse outcomes in the neonates.
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Affiliation(s)
- H W Kang
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - W Y Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - S J Jin
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Y H Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - T J Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Y S Lee
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - J H Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
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23
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Hansen ESS, Pedersen SF, Pedersen SB, Bøtker HE, Kim WY. Validation of contrast enhanced cine steady-state free precession and T2-weighted CMR for assessment of ischemic myocardial area-at-risk in the presence of reperfusion injury. Int J Cardiovasc Imaging 2019; 35:1039-1045. [DOI: 10.1007/s10554-019-01569-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/21/2019] [Indexed: 11/27/2022]
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24
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Yoon BNR, Lee JB, Jin GH, Kim WY. Serum Cadmium Level Is Positively Associated with Unruptured Intracranial Aneurysm Incidence. Korean J Fam Med 2019; 40:273-277. [PMID: 30727706 PMCID: PMC6669382 DOI: 10.4082/kjfm.17.0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/01/2018] [Indexed: 01/13/2023] Open
Abstract
Background Cadmium is a toxic element in cigarette smoke associated with ischemic vascular disease. Its association with cerebral aneurysm is unknown. Methods We retrospectively analyzed the medical records of patients with headache who underwent imaging studies between March 2014 and August 2016. An unruptured intracranial aneurysm (UIA) was confirmed by brain magnetic resonance angiography or computed tomography angiography. A control group included age- and sex-matched patients without an UIA. Whole blood and random urine tests were used for detection of cadmium and arsenic levels, respectively. Student t-test was used to compare subject characteristics, mean cadmium and arsenic levels between groups, and differences between groups with small (<4-mm) and large (≥4-mm) UIAs. Multivariate regression analysis was used to identify risk factors for aneurysm incidence. Results Of 238 patients, 25 had an UIA. Those with an UIA had more pack-years of smoking (19.5±3.8 vs. 12.5±6.8, P=0.044) and higher mean serum cadmium levels (1.77±0.19 vs. 0.87±0.21 µg/L, P=0.027). Arsenic levels showed no difference between groups. (67.4±23.5 vs. 62.2±18.3 µg/L, P=0.458). There were no significantly different demographic, clinical, or laboratory characteristics between small and large aneurysm groups. According to multivariate analysis, smoking (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.06–2.33; P=0.047) and serum cadmium >2.0 mcg/L (OR, 1.39; 95% CI, 1.15–1.84; P=0.043) were associated with aneurysm incidence. Conclusion UIA incidence was associated with pack-years of smoking and serum cadmium level, but aneurysm size was not associated with serum cadmium level.
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Affiliation(s)
| | - Jun Beom Lee
- Department of Neurology, Hongik Hospital, Seoul, Korea
| | - Ga Heon Jin
- The Faculty of Beauty Health Sciences, Major in Ophthalmic Optics, Shinhan University, Uijeongbu, Korea
| | - Won Yong Kim
- Department of Family Medicine, Hongik Hospital, Seoul, Korea
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25
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Hansson NH, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Poulsen SH, Wiggers H, Parner ET, Sörensen J. Test-retest repeatability of myocardial oxidative metabolism and efficiency using standalone dynamic 11C-acetate PET and multimodality approaches in healthy controls. J Nucl Cardiol 2018; 25:1929-1936. [PMID: 29855984 DOI: 10.1007/s12350-018-1302-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial efficiency measured by 11C-acetate positron emission tomography (PET) has successfully been used in clinical research to quantify mechanoenergetic coupling. The objective of this study was to establish the repeatability of myocardial external efficiency (MEE) and work metabolic index (WMI) by non-invasive concepts. METHODS AND RESULTS Ten healthy volunteers (63 ± 4 years) were examined twice, one week apart, using 11C-acetate PET, cardiovascular magnetic resonance (CMR), and echocardiography. Myocardial oxygen consumption from PET was combined with stroke work data from CMR, echocardiography, or PET to obtain MEE and WMI for each modality. Repeatability was estimated as the coefficient of variation (CV) between test and retest. MEECMR, MEEEcho, and MEEPET values were 21.9 ± 2.7%, 16.4 ± 3.7%, and 23.8 ± 4.9%, respectively, P < .001. WMICMR, WMIEcho, and WMIPET values were 4.42 ± 0.90, 4.07 ± 0.63, and 4.58 ± 1.13 mmHg × mL/m2 × 106, respectively, P = .45. Repeatability for MEECMR was superior compared with MEEEcho but did not differ significantly compared with MEEPET (6.3% vs 12.9% and 9.4%, P = .04 and .25). CV values for WMICMR, WMIEcho, and WMIPET were 10.0%, 14.8%, and 12.0%, respectively, (P = .53). CONCLUSIONS Non-invasive measurements of MEE using 11C-acetate PET are highly repeatable. A PET-only approach did not differ significantly from CMR/PET and might facilitate further clinical research due to lower costs and broader applicability.
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Affiliation(s)
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
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Tougaard RS, Szocska Hansen ES, Laustsen C, Nørlinger TS, Mikkelsen E, Lindhardt J, Nielsen PM, Bertelsen LB, Schroeder M, Bøtker HE, Kim WY, Wiggers H, Stødkilde-Jørgensen H. Hyperpolarized [1- 13 C]pyruvate MRI can image the metabolic shift in cardiac metabolism between the fasted and fed state in a porcine model. Magn Reson Med 2018; 81:2655-2665. [PMID: 30387898 DOI: 10.1002/mrm.27560] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/20/2018] [Accepted: 09/14/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Owing to its noninvasive nature, hyperpolarized MRI may improve delineation of myocardial metabolic derangement in heart disease. However, consistency may depend on the changeable nature of cardiac metabolism in relation to whole-body metabolic state. This study investigates the impact of feeding status on cardiac hyperpolarized MRI in a large animal model resembling human physiology. METHODS Thirteen 30-kg pigs were subjected to an overnight fast, and 5 pigs were fed a carbohydrate-rich meal on the morning of the experiments. Vital parameters and blood samples were registered. All pigs were then scanned by hyperpolarized [1-13 C]pyruvate cardiac MRI, and results were compared between the 2 groups and correlated with circulating substrates and hormones. RESULTS The fed group had higher blood glucose concentration and mean arterial pressure than the fasted group. Plasma concentrations of free fatty acids (FFAs) were decreased in the fed group, whereas plasma insulin concentrations were similar between groups. Hyperpolarized MRI showed that fed animals had increased lactate/pyruvate, alanine/pyruvate, and bicarbonate/pyruvate ratios. Metabolic ratios correlated negatively with FFA levels. CONCLUSION Hyperpolarized MR can identify the effects of different metabolic states on cardiac metabolism in a large animal model. Unlike previous rodent studies, all metabolic derivatives of pyruvate increased in the myocardium of fed pigs. Carbohydrate-rich feeding seems to be a feasible model for standardized, large animal hyperpolarized MRI studies of myocardial carbohydrate metabolism.
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Affiliation(s)
- Rasmus Stilling Tougaard
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Søvsø Szocska Hansen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Emmeli Mikkelsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jakob Lindhardt
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Mose Nielsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lotte Bonde Bertelsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Schroeder
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Lee BK, Youn CS, Kim YJ, Ryoo SM, Lim KS, Nam GB, Kim SJ, Kim SJ, Kim WY. Effect of prophylactic amiodarone infusion on the recurrence of ventricular arrhythmias in out-of-hospital cardiac arrest survivors with targeted temperature management. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.322] [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: 10/28/2022]
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28
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Zaremba T, Brøndberg AK, Jensen HK, Kim WY. Cardiac magnetic resonance characteristics in young survivors of aborted sudden cardiac death. Eur J Radiol 2018; 105:141-147. [PMID: 30017270 DOI: 10.1016/j.ejrad.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/18/2018] [Revised: 05/18/2018] [Accepted: 06/04/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE We aimed to identify and assess cardiac abnormalities by cardiovascular magnetic resonance (CMR) in a non-ischaemic aborted sudden cardiac death (SCD) population and to establish possible predictors of SCD. METHODS Thirty-six consecutive SCD survivors [median age 37.6 years (IQR 24.1-43.2), 31% female] with no previous cardiac history or evidence of ischaemic heart disease underwent CMR on day 6 (IQR 4-10) after admission. Data on ventricular volumes and the extent of late gadolinium enhancement (LGE) were collected. Systolic strain analysis was performed using feature tracking software. RESULTS Left ventricular (LV) and right ventricular (RV) indexed diastolic volumes were 92.9 ± 28.4 ml/m2 and 94.1 ± 29 ml/m2, respectively. LV ejection fraction (EF) and RV EF were 56.8 ± 10.7% and 53.7 ± 10.7%, respectively. Global peak endocardial longitudinal, circumferential, and radial strain were -17.9 ± 4.28%, -23.2 ± 5.8%, and 32.8 ± 10.6%, respectively. Compared to normal range, global longitudinal endocardial strain, longitudinal epicardial strain, circumferential endocardial strain, radial strain, and circumferential endocardial strain rate were impaired. Median volume of LGE was 0.25% (IQR 0.12-1.12) of the LV myocardium with highest prevalence in the inferolateral wall. Patients with cardiomyopathy diagnosis (n = 16) had lower LV strain rate compared to patients without cardiomyopathy (n = 20). CONCLUSIONS CMR findings in young patients with aborted SCD due to non-ischaemic heart disease seem to be minor. Although only present in small amounts, LGE appears to have a predilection towards the inferolateral wall in this population.
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Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, DK-9100, Aalborg, Denmark.
| | - Anders Krogh Brøndberg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
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Kim WY, Lee BJ, Park H, Choi YH, Kim JH, Lee JS. Ultrapermeable Nickel-Cobalt-Manganese/Alumina Inverse Opal as a Coke-Tolerant and Pressure-Drop-Free Catalyst for the Dry Reforming of Methane. ChemCatChem 2018. [DOI: 10.1002/cctc.201702038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Won Yong Kim
- Department of Chemical Engineering; Pohang University of Science and Technology; San 31 Hyoja-dong Pohang 790-784 Korea
| | - Byung Jun Lee
- School of Energy and Chemical Engineering; Ulsan National Institute of Science and Technology (UNIST); 50 UNIST-gil Ulsan 44919 Korea
| | - Hunmin Park
- Department of Chemical Engineering; Pohang University of Science and Technology; San 31 Hyoja-dong Pohang 790-784 Korea
| | - Yo Han Choi
- Department of Chemical Engineering; Pohang University of Science and Technology; San 31 Hyoja-dong Pohang 790-784 Korea
| | - Ju Hun Kim
- School of Energy and Chemical Engineering; Ulsan National Institute of Science and Technology (UNIST); 50 UNIST-gil Ulsan 44919 Korea
| | - Jae Sung Lee
- School of Energy and Chemical Engineering; Ulsan National Institute of Science and Technology (UNIST); 50 UNIST-gil Ulsan 44919 Korea
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Tougaard RS, Hansen ESS, Laustsen C, Lindhardt J, Schroeder M, Bøtker HE, Kim WY, Wiggers H, Stødkilde‐Jørgensen H. Acute hypertensive stress imaged by cardiac hyperpolarized [1‐
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C]pyruvate magnetic resonance. Magn Reson Med 2018. [DOI: 10.1002/mrm.27164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rasmus Stilling Tougaard
- Department of CardiologyAarhus University Hospital Denmark
- MR Research Centre, Department of Clinical MedicineAarhus University Denmark
| | - Esben Søvsø Szocska Hansen
- MR Research Centre, Department of Clinical MedicineAarhus University Denmark
- Danish Diabetes Academy Denmark
| | | | - Jakob Lindhardt
- MR Research Centre, Department of Clinical MedicineAarhus University Denmark
| | - Marie Schroeder
- MR Research Centre, Department of Clinical MedicineAarhus University Denmark
| | | | - Won Yong Kim
- Department of CardiologyAarhus University Hospital Denmark
- MR Research Centre, Department of Clinical MedicineAarhus University Denmark
| | - Henrik Wiggers
- Department of CardiologyAarhus University Hospital Denmark
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Pryds K, Nielsen RR, Jorsal A, Hansen MS, Ringgaard S, Refsgaard J, Kim WY, Petersen AK, Bøtker HE, Schmidt MR. Effect of long-term remote ischemic conditioning in patients with chronic ischemic heart failure. Basic Res Cardiol 2017; 112:67. [PMID: 29071437 DOI: 10.1007/s00395-017-0658-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022]
Abstract
Remote ischemic conditioning (RIC) protects against acute ischemia-reperfusion injury and may also have beneficial effects in patients with stable cardiovascular disease. We investigated the effect of long-term RIC treatment in patients with chronic ischaemic heart failure (CIHF). In a parallel group study, 22 patients with compensated CIHF and 21 matched control subjects without heart failure or ischemic heart disease were evaluated by cardiac magnetic resonance imaging, cardiopulmonary exercise testing, skeletal muscle function testing, blood pressure measurement and blood sampling before and after 28 ± 4 days of once daily RIC treatment. RIC was conducted as four cycles of 5 min upper arm ischemia followed by 5 min of reperfusion. RIC did not affect left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) in patients with CIHF (p = 0.63 and p = 0.11) or matched controls (p = 0.32 and p = 0.20). RIC improved GLS in the subgroup of patients with CIHF and with NT-proBNP plasma levels above the geometric mean of 372 ng/l (p = 0.04). RIC did not affect peak workload or oxygen uptake in either patients with CIHF (p = 0.26 and p = 0.59) or matched controls (p = 0.61 and p = 0.10). However, RIC improved skeletal muscle power in both groups (p = 0.02 for both). In patients with CIHF, RIC lowered systolic blood pressure (p < 0.01) and reduced NT-proBNP plasma levels (p = 0.02). Our findings suggest that long-term RIC treatment does not improve LVEF but increases skeletal muscle function and reduces blood pressure and NT-proBNP in patients with compensated CIHF. This should be investigated in a randomized sham-controlled trial.
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Affiliation(s)
- Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark.
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Roni Ranghøj Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
- Department of Cardiology, Viborg Region Hospital, Viborg, Denmark
| | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | - Mona Sahlholdt Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | | | - Jens Refsgaard
- Department of Cardiology, Viborg Region Hospital, Viborg, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
- MR Centre, Aarhus University, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine and Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | - Michael Rahbek Schmidt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
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Hansson NH, Sörensen J, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Dodt KK, Sihm I, Poulsen SH, Wiggers H. Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006557. [DOI: 10.1161/circimaging.117.006557] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nils Henrik Hansson
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Jens Sörensen
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Hendrik Johannes Harms
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Won Yong Kim
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Roni Nielsen
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Lars Poulsen Tolbod
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Jørgen Frøkiær
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Kirsten Bouchelouche
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Karen Kaae Dodt
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Inger Sihm
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Steen Hvitfeldt Poulsen
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Henrik Wiggers
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
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Hansson NHS, Sörensen J, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Dodt KK, Sihm I, Poulsen SH, Wiggers H. Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure. J Am Heart Assoc 2017; 6:JAHA.116.004810. [PMID: 28167498 PMCID: PMC5523773 DOI: 10.1161/jaha.116.004810] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Myocardial oxygen consumption (MVO2) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in patients with aortic valve stenosis (AS). Methods and Results Participants underwent 11C‐acetate positron emission tomography, cardiovascular magnetic resonance, and echocardiography to measure MVO2 and myocardial external efficiency (MEE) defined as the ratio of left ventricular stroke work and the energy equivalent of MVO2. We studied 10 healthy controls (group A), 37 asymptomatic AS patients with left ventricular ejection fraction ≥50% (group B), 12 symptomatic AS patients with left ventricular ejection fraction ≥50% (group C), and 9 symptomatic AS patients with left ventricular ejection fraction <50% (group D). MVO2 did not differ among groups A, B, C, and D (0.105±0.02, 0.117±0.024, 0.129±0.032, and 0.104±0.026 mL/min per gram, respectively; P=0.07), whereas MEE was reduced in group D (21.0±1.6%, 22.3±3.3%, 22.1±4.2%, and 17.3±4.7%, respectively; P<0.05). Similarly, patients with global longitudinal strain greater than −12% and paradoxical low‐flow, low‐gradient AS had impaired MEE (P<0.05 versus controls). The ability to discriminate between symptomatic and asymptomatic patients was superior for global longitudinal strain compared with MVO2 and MEE (area under the curve 0.98, 0.48, and 0.61, respectively; P<0.05). Conclusions AS patients display a persistent ability to maintain normal MVO2 and MEE (ie, the ability to convert energy into stroke work); however, patients with left ventricular ejection fraction <50%; global longitudinal strain greater than −12%; or paradoxical low‐flow, low‐gradient AS demonstrate reduced MEE. These findings suggest that mitochondrial uncoupling contributes to the dismal prognosis in patients with reduced contractile function or paradoxical low‐flow, low‐gradient AS.
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Affiliation(s)
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Karen Kaae Dodt
- Department of Cardiology, Horsens Regional Hospital, Horsens, Denmark
| | | | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Chubb H, Harrison JL, Weiss S, Krueger S, Koken P, Bloch LØ, Kim WY, Stenzel GS, Wedan SR, Weisz JL, Gill J, Schaeffter T, O’Neill MD, Razavi RS. Development, Preclinical Validation, and Clinical Translation of a Cardiac Magnetic Resonance - Electrophysiology System With Active Catheter Tracking for Ablation of Cardiac Arrhythmia. JACC Clin Electrophysiol 2017; 3:89-103. [DOI: 10.1016/j.jacep.2016.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/08/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Park JY, Paik ES, Kang H, Kim MK, Kim WY, Lee YY, Kim TJ, Lee JW, Bae DS, Choi CH. Single-Site Laparoscopic Radical Hysterectomy: Earlier and Further Space Development with Ligaments In Situ. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.675] [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: 11/29/2022]
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Heo EJ, Paik ES, Shim M, Kang H, Kim WY, Kim MK, Lee YY, Choi CH, Kim TJ, Lee JW, Kim BG, Bae DS. Mature Cystic Teratoma Is a Good Indication for LESS Approach: Initial Experience of an Internal Organ Retractor (IOR) Device or Barbed Suture for LESS Cystectomy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.673] [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: 11/30/2022]
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Kim WY, Kim JJ. Reduced-Port Robotic Surgery for Myomectomy Using Laparoscopic Single Port Platform. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.025] [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: 11/25/2022]
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Paik ES, Choi HJ, Shim M, Kang H, Kim WY, Kim MK, Lee YY, Choi CH, Kim TJ, Lee JW, Kim BG, Bae DS. Comparison of Surgical Outcomes of Laparoscopy and Laparotomy for Secondary Cytoreductive Surgery with Localized Single Recurrent Site Epithelial Ovarian Cancer. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.751] [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: 11/24/2022]
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Hansson NH, Tolbod L, Harms HJ, Wiggers H, Kim WY, Hansen E, Zaremba T, Frøkiær J, Jakobsen S, Sørensen J. Erratum to: Evaluation of ECG-gated [ 11C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency. J Nucl Cardiol 2016; 23:1232. [PMID: 27170337 DOI: 10.1007/s12350-016-0537-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lars Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Esben Hansen
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Steen Jakobsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
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Lee YH, Kim WY, Park H, Choi YH, Lee JS. Highly Active and Coke-Tolerant Hierarchical Mordenite Catalysts Synthesized by Recrystallization for the Isopropylation of Naphthalene. ChemCatChem 2016. [DOI: 10.1002/cctc.201600658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Young Hye Lee
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang Korea
| | - Won Yong Kim
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang Korea
| | - Hunmin Park
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang Korea
| | - Yo Han Choi
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang Korea
| | - Jae Sung Lee
- School of Energy and Chemical Engineering; Ulsan National Institute of Science and Technology (UNIST); Ulsan Korea
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Hansson NH, Tolbod L, Harms HJ, Wiggers H, Kim WY, Hansen E, Zaremba T, Frøkiær J, Jakobsen S, Sørensen J. Evaluation of ECG-gated [(11)C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency. J Nucl Cardiol 2016; 23:670-9. [PMID: 27094041 DOI: 10.1007/s12350-015-0331-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Noninvasive estimation of myocardial external efficiency (MEE) requires measurements of left ventricular (LV) oxygen consumption with [(11)C]acetate PET in addition to LV stroke volume and mass with cardiovascular magnetic resonance (CMR). Measuring LV geometry directly from ECG-gated [(11)C]acetate PET might enable MEE evaluation from a single PET scan. Therefore, we sought to establish the accuracy of measuring LV volumes, mass, and MEE directly from ECG-gated [(11)C]acetate PET. METHODS Thirty-five subjects with aortic valve stenosis underwent ECG-gated [(11)C]acetate PET and CMR. List mode PET data were rebinned into 16-bin ECG-gated uptake images before measuring LV volumes and mass using commercial software and compared to CMR. Dynamic datasets were used for calculation of mean LV oxygen consumption and MEE. RESULTS LV mass, volumes, and ejection fraction measured by CMR and PET correlated strongly (r = 0.86-0.92, P < .001 for all), but were underestimated by PET (P < .001 for all except ESV P = .79). PET-based MEE, corrected for bias, correlated fairly with PET/CMR-based MEE (r = 0.60, P < .001, bias -3 ± 21%, P = .56). PET-based MEE bias was strongly associated with LV wall thickness. CONCLUSIONS Although analysis-related improvements in accuracy are recommended, LV geometry estimated from ECG-gated [(11)C]acetate PET correlate excellently with CMR and can indeed be used to evaluate MEE.
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Affiliation(s)
| | - Lars Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Esben Hansen
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Steen Jakobsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
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Kim JH, Lee YS, Kim WY, Kim HJ, Chang MS, Park JY, Shin HW, Park YC. Effect of Nicardipine on Haemodynamic and Bispectral Index Changes following Endotracheal Intubation. J Int Med Res 2016; 35:52-8. [PMID: 17408055 DOI: 10.1177/147323000703500105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We investigated the effect of IV nicardipine on haemodynamic and bispectral index responses to the induction of general anaesthesia and intubation. Forty patients were randomly allocated to two groups of 20 to receive normal saline or nicardipine 15 μg/kg IV 30 s after induction. Ninety seconds later, tracheal intubation was performed. Systolic blood pressure, heart rate and bispectral index were measured at baseline, 1 min after induction, pre-intubation, and every minute until 5 min after endotracheal intubation. Rate–pressure product values were calculated. In the nicardipine group, systolic blood pressure decreased compared with the control group, and heart rate increased compared with the control group. Bispectral index and rate–pressure product showed no differences between the two groups. In conclusion, the administration of 15 μg/kg nicardipine IV does not affect anaesthetic depth in response to the induction of general anaesthesia and intubation.
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Affiliation(s)
- J H Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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Kim JH, Lee YS, Shin HW, Chang MS, Park YC, Kim WY. Effect of Administration of Ketorolac and Local Anaesthetic Infiltration for Pain Relief after Laparoscopic-assisted Vaginal Hysterectomy. J Int Med Res 2016; 33:372-8. [PMID: 16104440 DOI: 10.1177/147323000503300402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The efficacy of local anaesthetic infiltration and/or non-steroidal anti-inflammatory drugs for post-operative analgesia following laparoscopic-assisted vaginal hysterectomy (LAVH) was investigated in 83 patients, randomized into four groups in this double-blind, placebo-controlled study: group BK, local infiltration with bupivacaine and pre-incisional intramuscular (IM) ketorolac; group NN, saline local infiltration IM; group BN, local infiltration with bupivacaine and saline IM; group NK, local infiltration with saline and ketorolac IM. Post-operative pain scores were assessed at 1 h, 3 h, 6 h, 12 h and 24 h using a visual analogue scale (VAS). The major pain site, first analgesic request time and incidence of analgesic requests were also recorded. At 1 h, 3 h and 6 h after surgery, group BK patients had significantly lower VAS pain scores than group NN patients. The first analgesic request time was significantly longer in group BK than in groups NN, BN and NK. Pre-incisional treatment with ketorolac IM and local infiltration with bupivacaine reduced post-operative pain after LAVH.
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Affiliation(s)
- J H Kim
- Department of Anaesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Gormsen LC, Haraldsen A, Kramer S, Dias AH, Kim WY, Borghammer P. A dual tracer (68)Ga-DOTANOC PET/CT and (18)F-FDG PET/CT pilot study for detection of cardiac sarcoidosis. EJNMMI Res 2016; 6:52. [PMID: 27316444 PMCID: PMC4912521 DOI: 10.1186/s13550-016-0207-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/14/2016] [Indexed: 01/07/2023] Open
Abstract
Background Cardiac sarcoidosis (CS) is a potentially fatal condition lacking a single test with acceptable diagnostic accuracy. 18F-FDG PET/CT has emerged as a promising imaging modality, but is challenged by physiological myocardial glucose uptake. An alternative tracer, 68Ga-DOTANOC, binds to somatostatin receptors on inflammatory cells in sarcoid granulomas. We therefore aimed to conduct a proof-of-concept study using 68Ga-DOTANOC to diagnose CS. In addition, we compared diagnostic accuracy and inter-observer variability of 68Ga-DOTANOC vs. 18F-FDG PET/CT. Methods Nineteen patients (seven female) with suspected CS were prospectively recruited and dual tracer scanned within 7 days. PET images were reviewed by four expert readers for signs of CS and compared to the reference standard (Japanese ministry of Health and Welfare CS criteria). Results CS was diagnosed in 3/19 patients. By consensus, 11/19 18F-FDG scans and 0/19 68Ga-DOTANOC scans were rated as inconclusive. The sensitivity of 18F-FDG PET for diagnosing CS was 33 %, specificity was 88 %, PPV was 33 %, NPV was 88 %, and diagnostic accuracy was 79 %. For 68Ga-DOTANOC, accuracy was 100 %. Inter-observer agreement was poor for 18F-FDG PET (Fleiss’ combined kappa 0.27, NS) and significantly better for 68Ga-DOTANOC (Fleiss’ combined kappa 0.46, p = 0.001). Conclusions Despite prolonged pre-scan fasting, a large proportion of 18F-FDG PET/CT images were rated as inconclusive, resulting in low agreement among reviewers and correspondingly poor diagnostic accuracy. By contrast, 68Ga-DOTANOC PET/CT had excellent diagnostic accuracy with the caveat that inter-observer variability was still significant. Nevertheless, 68Ga-DOTANOC PET/CT looks very promising as an alternative CS PET tracer. Trial registration Current Controlled Trials NCT01729169. Electronic supplementary material The online version of this article (doi:10.1186/s13550-016-0207-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars C Gormsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | - Ate Haraldsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Andre H Dias
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
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Harms HJ, Stubkjær Hansson NH, Tolbod LP, Kim WY, Jakobsen S, Bouchelouche K, Wiggers H, Frøkiaer J, Sörensen J. Automatic Extraction of Myocardial Mass and Volume Using Parametric Images from Dynamic Nongated PET. J Nucl Med 2016; 57:1382-7. [PMID: 27127219 DOI: 10.2967/jnumed.115.170613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/01/2015] [Accepted: 03/26/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Dynamic cardiac PET is used to quantify molecular processes in vivo. However, measurements of left ventricular (LV) mass and volume require electrocardiogram-gated PET data. The aim of this study was to explore the feasibility of measuring LV geometry using nongated dynamic cardiac PET. METHODS Thirty-five patients with aortic-valve stenosis and 10 healthy controls underwent a 27-min (11)C-acetate PET/CT scan and cardiac MRI (CMR). The controls were scanned twice to assess repeatability. Parametric images of uptake rate K1 and the blood pool were generated from nongated dynamic data. Using software-based structure recognition, the LV wall was automatically segmented from K1 images to derive functional assessments of LV mass (mLV) and wall thickness. End-systolic and end-diastolic volumes were calculated using blood pool images and applied to obtain stroke volume and LV ejection fraction (LVEF). PET measurements were compared with CMR. RESULTS High, linear correlations were found for LV mass (r = 0.95), end-systolic volume (r = 0.93), and end-diastolic volume (r = 0.90), and slightly lower correlations were found for stroke volume (r = 0.74), LVEF (r = 0.81), and thickness (r = 0.78). Bland-Altman analyses showed significant differences for mLV and thickness only and an overestimation for LVEF at lower values. Intra- and interobserver correlations were greater than 0.95 for all PET measurements. PET repeatability accuracy in the controls was comparable to CMR. CONCLUSION LV mass and volume are accurately and automatically generated from dynamic (11)C-acetate PET without electrocardiogram gating. This method can be incorporated in a standard routine without any additional workload and can, in theory, be extended to other PET tracers.
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Affiliation(s)
- Hendrik Johannes Harms
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; and
| | - Steen Jakobsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; and
| | - Jørgen Frøkiaer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
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Hansen ESS, Pedersen SF, Pedersen SB, Kjærgaard U, Schmidt NH, Bøtker HE, Kim WY. Cardiovascular MR T2-STIR imaging does not discriminate between intramyocardial haemorrhage and microvascular obstruction during the subacute phase of a reperfused myocardial infarction. Open Heart 2016; 3:e000346. [PMID: 27110375 PMCID: PMC4838761 DOI: 10.1136/openhrt-2015-000346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/24/2016] [Accepted: 03/29/2016] [Indexed: 01/17/2023] Open
Abstract
Objective Microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) are known complications of myocardial ischaemia-reperfusion injury. Whereas MVO is an established marker for a poor clinical outcome, the clinical significance of IMH remains less well defined. Cardiovascular MR (CMR) and T2 weighted short tau inversion recovery (T2-STIR) imaging have been used to detect IMH and to explore its clinical importance. IMH is typically identified within the area-at-risk as a hypointense signal core on T2-STIR images. Because MVO will also appear as a hypointense signal core, T2-STIR imaging may not be an optimal method for assessing IMH. In this study, we sought to investigate the ability of T2-STIR to discriminate between MVO with IMH in a porcine myocardial ischaemia-reperfusion model that expressed MVO with and without IMH. Method MVO with and without IMH (defined from both macroscopic evaluation and T1 weighted CMR) was produced in 13 pigs by a 65-min balloon occlusion of the mid left anterior descending artery, followed by reperfusion. Eight days after injury, all pigs underwent CMR imaging and subsequently the hearts were assessed by gross pathology. Results CMR identified MVO in all hearts. CMR and pathology showed that IMH was present in 6 of 13 (46%) infarcts. The sensitivity and specificity of T2-STIR hypointense signal core for identification of IMH was 100% and 29%, respectively. T2-values between hypointense signal core in the pigs with and without IMH were similar (60.4±3 ms vs 63.0±4 ms). Conclusions T2-STIR did not allow identification of IMH in areas with MVO in a porcine model of myocardial ischaemic/reperfusion injury in the subacute phase of a reperfused myocardial infarction.
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Affiliation(s)
- Esben Søvsø Szocska Hansen
- The MR Research Centre, Aarhus University Hospital Skejby, Aarhus N, Denmark; Danish Diabetes Academy, Odense, Denmark
| | - Steen Fjord Pedersen
- Department of Cardiothoracic and Vascular Surgery T , Aarhus University Hospital Skejby , Aarhus N , Denmark
| | - Steen Bønløkke Pedersen
- Department of Endocrinology and Internal Medicine , Aarhus University Hospital THG , Aarhus C , Denmark
| | - Uffe Kjærgaard
- The MR Research Centre, Aarhus University Hospital Skejby , Aarhus N , Denmark
| | - Nikolaj Hjort Schmidt
- Department of Clinical Medicine-Comparative Medicine Laboratory , Aarhus University Hospital Skejby , Aarhus N , Denmark
| | - Hans Erik Bøtker
- Department of Cardiology , Aarhus University Hospital Skejby , Aarhus N , Denmark
| | - Won Yong Kim
- The MR Research Centre, Aarhus University Hospital Skejby, Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital Skejby, Aarhus N, Denmark
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Nam SH, Choi CH, Song T, Kim WY, Kim KH, Lee KW. Uterine rupture during labor in women with twice successful vaginal births after cesarean delivery. CLIN EXP OBSTET GYN 2016; 43:621-623. [PMID: 29734565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Uterine rupture during labor is a serious complication resulting in maternal and neonatal morbidity and mortality. We present the extremely rare case of a 38-year-old gravid woman admitted with labor pain at term, about to experience a uterine rupture during labor. She had previously twice delivered vaginally, and during her third pregnancy had a low transverse Cesarean section. Prior to arriving at the hospital with labor pains, she had routine prenatal care with normal prenatal laboratory tests. One day the woman reported to having sudden epigastric pain, and 40 minutes after her admission a pelvic exam was completed. The unborn baby had a persistent revealed, and a live neonate was promptly delivered with an Apgar score of 1 at one minute and 5 at five minutes. On the fifth postoperative day the woman and her baby were discharged home with no maternal and neonatal complications.
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Abstract
In the dry reforming of methane with CO2, Ni/Al2O3 nanosheet catalysts exhibited excellent coke tolerance, showing stability even in the presence of a large amount of coke because of the large intersheet pores.
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Affiliation(s)
- Won Yong Kim
- Department of Chemical Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Young Hye Lee
- Department of Chemical Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Hunmin Park
- Department of Chemical Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Yo Han Choi
- Department of Chemical Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Min Hee Lee
- School of Energy and Chemical Engineering
- Ulsan National Institute of Science and Technology (UNIST)
- Ulsan
- Korea
| | - Jae Sung Lee
- School of Energy and Chemical Engineering
- Ulsan National Institute of Science and Technology (UNIST)
- Ulsan
- Korea
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Løgstrup BB, Nielsen JM, Kim WY, Poulsen SH. Myocardial oedema in acute myocarditis detected by echocardiographic 2D myocardial deformation analysis. Eur Heart J Cardiovasc Imaging 2015; 17:1018-26. [PMID: 26588987 DOI: 10.1093/ehjci/jev302] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 06/16/2015] [Accepted: 10/17/2015] [Indexed: 12/31/2022] Open
Abstract
AIMS The clinical diagnosis of acute myocarditis is based on symptoms, electrocardiography, elevated myocardial necrosis biomarkers, and echocardiography. Often, conventional echocardiography reveals no obvious changes in global cardiac function and therefore has limited diagnostic value. Myocardial deformation imaging by echocardiography is an evolving method used to characterize quantitatively longitudinal systolic function, which may be affected in acute myocarditis. The aim of our study was to assess the utility of echocardiographic deformation imaging of the left ventricle in patients with diagnosed acute myocarditis in whom cardiovascular magnetic resonance (CMR) evaluation was performed. METHODS AND RESULTS We included 28 consecutive patients (mean age 32 ± 13 years) with CMR-verified diagnosis of acute myocarditis according to the Lake Louise criteria. Cardiac function was evaluated by a comprehensive assessment of left ventricular (LV) function, including 2D speckle-tracking echocardiography. We found no significant correlation between the peak values of cardiac enzymes and the amount of myocardial oedema assessed by CMR (troponin: r= 0.3; P = 0.05 and CK-MB: r = 0.1; P = 0.3). We found a larger amount of myocardial oedema in the basal part of the left ventricle [American Heart Association (AHA) segments 1-6] in inferolateral and inferior segments, compared with the anterior, anterolateral, anteroseptal, and inferoseptal segments. In the mid LV segments (AHA segments 7-12), this was more pronounced in the anterior, anterolateral, and inferolateral segments. Among conventional echocardiographic parameters, LV function was not found to correlate with the amount of myocardial oedema of the left ventricle. In contrast, we found the wall motion score index to be significantly correlated with the amount of myocardial oedema, but this correlation was only present in patients with an extensive amount of oedema (>11% of the total left ventricle). Global longitudinal systolic myocardial strain correlated significantly with the amount of oedema (r = 0.65; P < 0.001). We found that both the epicardial longitudinal and the endocardial longitudinal systolic strains were significantly correlated with oedema (r = 0.55; P = 0.003 and r = 0.54; P < 0.001). CONCLUSION In patients with acute myocarditis, 2D speckle-tracking echocardiography was a useful tool in the diagnostic process of acute myocarditis. Global longitudinal strain adds important information that can support clinical and conventional echocardiographic evaluation, especially in patients with preserved LV ejection fraction in relation to the diagnosis and degree of myocardial dysfunction.
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Affiliation(s)
- B B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - J M Nielsen
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - W Y Kim
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - S H Poulsen
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
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Park H, Youn DH, Kim JY, Kim WY, Choi YH, Lee YH, Choi SH, Lee JS. Back Cover: Selective Formation of Hägg Iron Carbide with g-C 3
N 4
as a Sacrificial Support for Highly Active Fischer-Tropsch Synthesis (ChemCatChem 21/2015). ChemCatChem 2015. [DOI: 10.1002/cctc.201501137] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Hunmin Park
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang 790-784 Korea
| | - Duck Hyun Youn
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST); Ulsan 689-798 Korea
| | - Jae Young Kim
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST); Ulsan 689-798 Korea
| | - Won Yong Kim
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang 790-784 Korea
| | - Yo Han Choi
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang 790-784 Korea
| | - Young Hye Lee
- Department of Chemical Engineering; Pohang University of Science and Technology (POSTECH); Pohang 790-784 Korea
| | - Sun Hee Choi
- Pohang Accelerator Laboratory (PAL); Pohang University of Science and Technology (POSTECH); Pohang 790-784 Korea
| | - Jae Sung Lee
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST); Ulsan 689-798 Korea
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