Interaction between the left ventricular ejection fraction and left ventricular strain and its relationship with coronary stenosis

BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.

Individualized anti-thrombotic therapy for acute myocardial infarction complicated with left ventricular thrombus: A case report

BACKGROUND Presently,there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction(AMI)complicated by left ventricular thrombus(LVT).While vitamin K antagonists are the preferred choice for oral blood thinning,determining the best course of blood-thinning medication remains challenging.It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT.This study significantly contributes to the medical community.CASE SUMMARY The blood-thinning treatment of a patient with AMI and LVT was analyzed.Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g,daily clopidogrel hydrogen sulfate at 75 mg,and dabigatran etexilate at 110 mg twice daily.After 15 d,the patient’s LVT did not decrease but instead increased.Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction.The drug regimen was reformulated for the patient,replacing dabigatran etexilate with warfarin,and was administered for six months.The clinical pharmacist provided the patient with professional and standardized pharmaceutical services.The patient’s condition was discharged after meeting the international normalized ratio value(2-3)criteria.The patient fully complied with the follow-up,and the time in the therapeutic range was 78.57%,with no serious adverse effects during pharmaceutical monitoring.CONCLUSION Warfarin proves to be an effective drug for patients with AMI complicated by LVT,and its blood-thinning course lasts for six months.

The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older

BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.

Assessment of Regional Left Ventricular Myocardial Function in Rats after Acute Occlusion of Left Anterior Descending Artery by Two-dimensional Speckle Tracking Imaging

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery （LAD） by using two-dimensional speckle tracking imaging （2D-STI）. Sixty Wistar rats were randomly divided into two groups, a myocardial infarction （MI） group, in which 50 rats were subjected to LAD occlusion for 30–45 min, and a sham-operated （SHAM） group that contained 10 rats serving as control. Echo-cardiography was performed at baseline and 1, 4 and 8 week（s） after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain （PRS） and circumferential strain （PCS） were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. Left ventricular internal diameter at diastole （LVIDd） and systole （LVIDs）, fractional shortening （FS）, ejection fraction （EF） and left ventricular mass （LVM） were measured by anatomical M-model echocardiography. Infarct size was measured using triphenyl tetrazolium chloride （TTC） staining 1 week and 8 weeks after the operation. Fibrosis of left ventricu-lar myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories： infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, （1） PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation （P〈0.05） and the low levels lasted 8 weeks; （2） Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant dif-ference 1 week after the operation （P〉0.05）. However, LVIDd, LVIDs and LVM were increased sig-nificantly 4 and 8 weeks after the operation （P〈0.05）, and FS and EF were decreased substantially （P〈0.05）. Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional func-tion of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.

Hypoxia training attenuates left ventricular remodeling in rabbit with myocardial infarction

Objective Previous studies showed that hypoxia preconditioning could protect cardiac function against subsequent myo-cardial infarction injury. However, the effect of hypoxia on left ventricular after myocardial infarction is still unclear. This study therefore aims to investigate the effects of hypoxia training on left ventricular remodeling in rabbits post myocardial infarction. Methods Adult male rabbits were randomly divided into three groups： group SO （sham operated）, group MI （myocardial infarc-tion only） and group MI-HT （myocardial infarction plus hypoxia training）. Myocardial infarction was induced by left ventricular branch ligation. Hypoxia training was performed in a hypobaric chamber （having equivalent condition at an altitude of 4000 m, FiO214.9%） for 1 h/day, 5 days/week for four weeks. At the endpoints, vascular endothelial growth factor （VEGF） in the plasma was measured. Infarct size and capillary density were detected by histology. Left ventricular remodeling and function were as-sessed by echocardiography.Results After the 4-week experiment, compared with the group SO, plasma VEGF levels in groups MI （130.27 ± 18.58 pg/mL,P〈 0.01） and MI-HT （181.93 ± 20.29 pg/mL,P〈 0.01） were significantly increased. Infarct size in Group MI-HT （29.67% ± 7.73%） was deceased remarkably, while its capillary density （816.0 ± 122.2/mm2） was significantly increased. For both groups MI and MI-HT, left ventricular end-diastolic and end-systolic dimensions were increased whereas left ventricular ejection fraction was decreased. However, compared with group MI, group MI-HT diminished left ventricular end-diastolic （15.86 ± 1.09 mm,P〈 0.05） and end-systolic dimensions （12.10 ± 1.20 mm,P〈 0.01） significantly and im-proved left ventricular ejection fraction （54.39 ± 12.74 mm,P〈 0.05）.ConclusionHypoxia training may improve left ven-tricular function and reduce remodeling via angiogenesis in rabbits with MI.

Beneficial Effects of Delayed Opening the Infarct - related Artery on Late Phase Left Ventricular Function in Acute Anterior Myocardial Infarction

Objectives To assess the effect of delayed opening the infarct - related artery (IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute ante- rior myocardial infarction. Methods 64 patients with initial Q - wave anterior myocardial infarction and the infarct - related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group ( not re- ceiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6 months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion ab- normality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Re- sults VWMA scores, left ventricular ejection frac- tion (LVEF) , left ventricular end - diastolic and end - systolic volume indices ( LVEDVI and LVDSVI) were similar in 2 groups at early phase and 2 months. There were no differences between early phase and 2 months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months ( P > 0. 05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P < 0.01, P < 0. 05). The congestive heart failure events were taken place in 19% of patients in control group com- pared with 2% in successful PCI group ( P > 0. 05 ). Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acuteanterior myocardial infarction.

Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

Stem cell mechanisms during left ventricular remodeling post-myocardial infarction:Repair and regeneration

Post-myocardial infarction(MI),the left ventricle(LV)undergoes a series of events collectively referred to as remodeling.As a result,damaged myocardium is replaced with fibrotic tissue consequently leading to contractile dysfunction and ultimately heart failure.LV remodeling post-MI includes inflammatory,fibrotic,and neovascularization responses that involve regulated cell recruitment and function.Stem cells(SCs)have been transplanted post-MI for treatment of LV remodeling and shown to improve LV function by reduction in scar tissue formation in humans and animal models of MI.The promising results obtained from the application of SCs post-MI have sparked a massive effort to identify the optimal SC for regeneration of cardiomyocytes and the paradigm for clinical applications.Although SC transplantations are generally associated with new tissue formation,SCs also secrete cytokines,chemokines and growth factors that robustly regulate cell behavior in a paracrine fashion during the remodeling process.In this review,the different types of SCs used for cardiomyogenesis,markers of differentiation,paracrine factor secretion,and strategies for cell recruitment and delivery are addressed.

COMPARISON OF THE EFFECTS OF LOSARTAN,ENALAPRIL AND THEIR COMBINATION IN THE PREVENTION OF LEFT VENTRICULAR REMODELING AFTER ACUTE MYOCARDIAL INFARCTION IN THE RAT

Objectives. To compare the effects of losartan, enalapril and their combination in the prevention ofleft ventricular remodeling (LVRM) after acute myocardial infarction (AMI) in the rat. Methods. AMI model was induced in female SD rats by ligating left coronary artery. Forty-eight hours after the procedure, 83 surviving rats were randomized into one of the following 4 groups: 1 ) AMI control group (n =19), 2) losartan group (n= 22, 3 mg @ kg - 1 @ d - 1 ), 3 ) enalapril group (n = 20, 1 mg @ kg - 1 @ d - 1 ), 4) losartan - enalapril combinative group (n = 22, 3 and 1 mg @ kg- 1 @ d - 1 respectively). 5 ) sham-operated group ( n =10) and 6) normal rats group (n = 10) were selected randomly to serve as non-infarction controls. Losartan and enalapril were delivered by direct gastric gavage. After 4 weeks of medical therapy, hemodynamic studies were performed in each group, then the rat hearts were fixed with 10% formalin and pathologic analysis on them was performed. Complete experimental data was obtained in 56 rats, comprising 1 ) AMI controls (n = 11 ), 2) losartan group (n = 10), 3 ) enalapril group (n = 10), 4) the combination of losartan and enalapril group (n = 11 ),5) sham - operated group (n = 6) and 6) normal controls (n=8). Results. There were no significant differences among the 4 AMI groups in MI size (41.7% ～ 43.4%, all P＞ 0.05). Compared with sham group, the left ventricular (LV) end diastolic pressure (LVEDP), volume (LVV), long and short axis length (L and D), as well as LV absolute and relative weight (LVAW and LVRW)in AMI group were all significantly increased ( P ＜0.05 ～ 0. 001 ); whereas the maximum left ventricular pressure rising and droping rates ( + dp/dt) and their corrected values by LV systolic pressure ( + dp/dt/LVSP)were significantly reduced (all P ＜0.001 ), indicating LVRM occurred and LV systolic and diastolic function impaired after AMI. Compared with AMI group , LVEDP, LVV, LVAW and LVRW were all significantly decreased (P ＜0.05～0.001 ); while + dp/dt/LVSP were significantly enhanced in all 3 treatment groups (P ＜0.05～0.001 ) except -dp/dt/LVSP in losartan group (P＞ 0. 05 ). There were no significant differences in the above indices among the 3 treatment groups (all P＞ 0.05). Conclusion. Both losartan and enalapril can prevent from LVRM after AMI in the rat and improve LV function with equivalent effects. There seems no additive effect when the 2 drugs are used in combination.

Effect of Astragalus Injection on Left Ventricular Remodeling in Aged Patients with Acute Early-stage Myocardial Infarction

Objective: To observe the effect of Astragalus Injection (AI) on left ventricular remodeling in aged patients with acute myocardial infarction (AMI). Methods: Patients with AMI were randomly divided into the AI group (46 cases) treated with AI and the control group (46 cases) treated conventionally. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), anterior endocardial segmental length (ASL) and posterior endocardial segmental length (PSL) were all assessed by echocardiogram after 1 week and 4 weeks treatment. The cardiac systolic and diastolic functions were detected by nuclide gating cardiac blood pool imaging at the 4th week. Results: After four weeks' treatment, no obvious change of LVEDVI, LVESVI and ASL in the AI group was found, but these indexes increased significantly in the control group, with significant difference shown between the two groups (P<0. 05). As compared with the control group, the left ventricular ejection fraction (LVEF), left ventricular peak ejecting rate (LVPER) and left ventricular peak filling rate (LVPFR) were heightened, the time for peak filling rate (LVTPFR) in the left ventricle was shortened in the AI group. Conclusion: AI is one of the effective drugs in reversing left ventricular remodeling in aged patients with AMI.

Comparative Proteomic Analysis in Left Ventricular Remodeling following Myocardial Infarction in Rats

Objective Left ventricular remodeling （LVR） following myocardial infarction （MI） is a key pathophysiological process in which MI develops into heart failure. The exact mechanism of LVR remains unclear. We performed differential proteomic analysis on the myocardia of rats with LVR after MI, to explore the mechanism of ventricular remodeling after MI. Methods In the LVR group （n=12）, after the anterior descending coronary artery was ligated, the rats were fed for four weeks before the LVR models were established. Rats in the sham-operated group （n=11） underwent thread-drawing without ligation. The hemodynamic parameters, pathological findings, and proteomics were compared between the two groups. Results In the LVR group, the left ventricular end-diastolic pressure increased, the maximal left ventricular pressure increase/decrease ratio decreased significantly, and the left ventricular systolic pressure decreased. H-E staining and Masson staining of cardiac muscle tissues of the LVR group showed myocytolysis, disarray, and collagen proliferation. Twenty-one differentially expressed proteins were detected by proteomic analysis. We validated two proteins using western blot analysis. The differentially expressed proteins could be divided into six categories： energy metabolism-related proteins, cytoskeletal proteins, protein synthesis-related proteins, channel proteins, anti-oxidation- related proteins, and immune-related proteins. Conclusion These differentially expressed proteins might play key roles in LVR following M

Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation

BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

Effects of Perindopril on Left Ventricular Remodeling and Osteopontin Expression in Rats With Myocardial Infarction

Objectives To observe the effects of perindopril on left ventricular remodeling and myocardial osteopontin expression in rats with myocardial infarction. Methods In this study male adult SD rats were randomly divided into 3 groups: sham-operation group, MI-saline group and MI-perindopril group. Left anterior descending artery was ligated to generate myocardial infarction. Perindopril (2 mg/kg body weight/day) was administered from the next day of MI. Four weeks later, left ventricular diameter (LVEDD and LVESD) and left ventricular ejection fraction was estimated with echocardiography, LVSP, LVEDP and±dp/dtmax was detected with hemodynamic measurement, cardiomyocyte diameter and interstitial fibrosis infiltration were evaluated with histological methods, and myocardium osteopontin protein expression level was detected with western blot. Results ①Compared with the sham-operation group, all rats with MI developed significant systolic and diastolic dysfunction, as was indicated by decreased LVEF, LVSP and±dp/dtmax, as well as increased LVEDP. ②Rats with MI showed significantly dilated left ventricles and higher ventricular weight / body weight ratio, significantly increased cardiomyocyte diameter and marked interstitial fibrosis in the non-infarction area. ③Perindopril treatment partly prevented cardiac dysfunction and left ventricular remodeling as indicated by the parameters mentioned above. ④No osteopontin protein was detected in myocardium of sham-operation rats. In rats with MI, high level osteopontin protein expression was significantly inhibited by perindopril treatment. Conclusions In rats with MI, perindopril treatment significantly prevented left ventricular remodeling and myocardium osteopontin protein expression.

An Extraordinary Case of Silent Extensive Anterior Wall Myocardial Infarction Complicated with Giant Left Ventricular Aneurysm and Dressler Syndrome

Early post-acute myocardial infarction (AMI) pericarditis, pericardial effusion with or without cardiac tamponade, and late post-MI pericarditis (Dressler syndrome), are the major pericardial complications after AMI. It is quite rare and estimated to be only about 0.1% in AMI patients according to a recent report, so it is easily neglected or misdiagnosed and may have tragic result to patient. Clinical features of this post-AMI complication include fever, chest pain, pericarditis and pleurisy occurring 2 to 3 weeks after AMI. Dressler syndrome is rarely associated with left ventricular aneurysm. Contrast enhanced magnetic resonance and echocardiography play important roles in diagnosis of left ventricle aneurysm. We report a 54-year-old male heavy labor worker who had asymptomatic, severe coronary artery disease, complicated with silent myocardial infarction, which resulted in large left ventricular aneurysm, and also systolic heart failure was noted. Patient was diagnosed to have Dressler syndrome after his second cardiology clinic follow-up. He received coronary angiography which revealed triple vessel disease with total occlusion of left anterior descending artery, and a giant left ventricular aneurysm was found. He received surgical intervention with Batista method and followed-up uneventfully at the cardiology clinic.

The effect of Rhodiolae treating chronic myocardial infarction with heart failure on left ventricular remodeling and serum inflammatory factors

Objective:To explore the effect of rhodiolae treating chronic myocardial infarction with heart failure on left ventricular remodeling and serum inflammatory factors.Methods:A total of 100 cases of chronic myocardial infarction with heart failure were selected and randomly divided into treatment group and control group with 50 cases in each group, the control group was treated with strong heart, dehydration, nutrition myocardium, infection prevention and western comprehensive treatment, the treatment group was given rhodiola treatment based on the western medicine treatment, compared the changes of left ventricular remodeling indexes and serum inflammatory factors of two group patients before treatment (T0), 1 months of treatment (T1), 3 months of treatment (T2).Results: (1) There was statistical significance difference at different time points LVEF, LVEDD, LVESD, LVSTD, LVPWTD. LVEF, LVSTD, LVPWTD: T2 > T1 > T0, LVEDD, LVESD: T2 < T1 < T0;In treatment group LVEF, LVSTD and LVPWTD increased, and the decline rate of LVEDD and LVESD was higher than that of control group;(2) There was statistically significant difference in different time points of IL-6, hs-CRP, and NT-proBNP, serum IL-6, hsCRP and NT-proBNP levels: T2 < T1 < T0;The serum IL-6, hs-CRP and NT-proBNP levels of treatment group decreased more than control group.Conclusion: Rhodiolae is helpful to improve the left ventricular remodeling and serum inflammatory factors in patients with chronic myocardial infarction and heart failure.

Accuracy of left ventricular function from electrocardiographygated myocardial perfusion SPECT by MyoMetrix in Chinese

This work was to determine threshold values for accurate measurements of left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),and ejection fraction(EF) from electrocardiography-gated myocardial perfusion imaging(MPI) in Chinese,and these data were compared with those of echocardiography.A total of 110 patients with definite or suspected coronary artery disease were referred for both gated MPI and echocardiography within 1 week.The EDV,ESV,and EF automatically measured by MyoMetrix and echocardiography were analyzed using Bland-Altman plot correlation and paired t test.The results showed that these parameters quantified by MyoMetrix software were correlated,moderately to highly,with those on echocardiography(ρ,r ≥0.75,P<0.01).However,the EF was not significantly correlated,with post-exercise MPI ESV of <15 mL or resting MPI ESV of <20 mL.At or above this ESV value,EF was underestimated by MyoMetrix(t≥ 4.60,P<0.01).In a word,a small ESV was underestimated by MyoMetrix,which could lead to EF overestimation.On the contrary,a normal or large ESV was overestimated by MyoMetrix,which led to EF underestimation.

EflFect of hepatocyte growth factor on left ventricular remodeling after acute myocardial infarction in canine

Background and objectives To investigate the effect of hepatocyte growth factor (HGF) on left ventricular (LV) remodeling after acute myocardial infarction (AMI). Methods AMI was produced by ligation of proximal left anterior descending coronary artery(LAD) in 12 mongrel canines. These animals were randomized into 2 groups. In HGF group (n=6), canines were injected with pcDNA3-HGF lml (about 300ug) at the margin of infarcted myocardium; in control group (n=6) canines were injected with equal volume of normal saline. Cardiac function and left ventricular remodeling were evaluated with echocardiography at 1, 4, 8 weeks after MI. LV myocardium specimens were obtained at 8 weeks and stained with hematoxylin and eosin for histological examination or with sirius red to assess the collagen content. Results Compared with control group, LVEF in HGF group was significantly higher at 4 weeks (49.61+6.66 vs 39.84+6.39; P＜0.05) and at 8 weeks (51.57+8.53 vs 40.61+7.67; P＜0.05) after AMI, while LVESV was significantly lower in HGF group than that in control group at 8 weeks after AMI (18.98+3.47 vs 25.66+5.86; P＜0.05). Posterior left ventricular wall thickness decreased significantly from 1 wk to 8 wks after AMI in control group, while remained unchanged in HGF group. Compared with control group, histological examination showed more neovascularization and less scar, and sirius red staining indicated higher volume of type Ⅲ collagen (7.10±4.06% vs 3.77±1.09%; P＜0.05) and lower collagen Ⅰ/Ⅲ ratio value (1.11±0.52 vs 2.94±2.48; P＜0.05)in HGF group. Conclusion HGF gene transfer might improve cardiac function and LV remodeling after acute myocardial infarction by stimulating angiogenesis, reducing fibrosis, and reducing myocardial scarring.

Effect of carvedilol on cardiac function and left ventricular remodeling in rats after acute myocardial infarction

Objective: To observe the effect of carvedilol injection on left ventricular function and collagen remodeling in rat with myocardial infarction. Methods: Sixty rats with a model of myocardial infarction were randomly divided into nine groups. The rats of therapeutical group were treated with carvedilol injection (2 mg/d intraperitoneal injection) and/or captopil (2 g/L drinking water) . Acute myocardial infarction ( AMI) group did not receive drug treatment. The animals were sacrificed at 4 weeks and 8 weeks after coronary artery ligation. The levels of plasma angiotensin II and plasma aldosterone and left ventricle function were determined at different time. The collagen content and the ratio of type I and III collagen of noninfarcted area were also assessed. Results: Compared with AMI group, the levels of plasma and myocardium angiotensin II and plasma aldosterone in both carvedilol and captopil group decreased at the eighth week (P<0.05). In addition, carvedilol improved systolic and diastolic function (P<0. 05). Compared with sham group, both collagen content and the ratio of type I / III collagen of noninfarcted area increased in AMI4 and AMI8 group (P<0. 05). The hydroxyproline levels and the ratio of type I/III collagen significantly decreased after carvedilol and/or captopil treatment , compared with AMI group at 4 or 8 week (P <0. 05). Conclusion: Carvedilol can improve cardiac function after myocardial infarction and has beneficial effect on left ventricular remodeling.

Systematic Evaluation of Current Possibilities to Determine Left Ventricular Volumes by Echocardiography in Patients after Myocardial Infarction

Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.