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Regional asynchrony in acute ischemia and stunning: an experimental myocardial velocity and strain rate imaging study
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To quantify motion and deformation asynchrony using Doppler myocardial imaging (DMI) during acute total ischemia, and stunning of the posterior left ventricular wall (PW) in comparison with the interventricular septum (IVS).

Methods: Ischemia of the PW was induced in closed-chest pigs using an angioplasty balloon positioned in the circumflex coronary artery. Animals were divided into three groups: normal controls (Group I - n = 6), total ischemia (Group II - n = 8), and stunning (Group III - n = 6) induced by coronary occlusion with distal coronary perfusion maintained via a perfusion catheter coupled to a roller pump (Group III). In addition, a 2-step dobutamine challenge (5 and 10 µg.kg-1 .min-1) was performed in groups I and III. Doppler myocardial velocity and strain rate cineloops were acquired from a parasternal short axis view.

Results: The pre-ejection time (T1) and the duration of regional mechanical systole (SYS) became shorter with inotropic stimulation. During total ischemia T1 was prolonged and SYS shortened significantly compared to baseline values [62 ± 14 vs. 55 ± 13 ms (P < 0.05)], [164 ± 13 vs. 240 ± 27 ms (P < 0.001)], respectively. The fraction T1/SYS was accordingly higher. No changes were observed for the contra lateral non-ischemic wall. In group III, the post-ischemic myocardium had a similar response as non-ischemic myocardium to the dobutamine challenge.

Conclusion: Consistent changes in local pre-ejection time and regional mechanical systole are induced by intropic stimulation and by total ischemia. However, the response to intropic stimulation did not differ between normal and stunned myocardium.

National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-84958OAI: oai:DiVA.org:liu-84958DiVA: diva2:563278
Available from: 2012-10-29 Created: 2012-10-29 Last updated: 2012-10-29
In thesis
1. Quantification of cardiovascular flow and motion: aspects of regional myocardial function and flow patterns in the aortic root and the aorta
Open this publication in new window or tab >>Quantification of cardiovascular flow and motion: aspects of regional myocardial function and flow patterns in the aortic root and the aorta
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Quantification of cardiovascular flow and motion is essential in the diagnosis, treatment and follow-up of cardiovascular disease. The accuracy and quantification of many imaging methods used in this field have important shortfalls, however, that result from limitations in spatial and temporal dimensions. Improvement in application of these methods requires an in-depth understanding of the technical and perceptual aspects that contribute to errors in their use.

Visual assessment of echocardiographic images for asynchrony in regional myocardial motion during systolic contraction is an example of the need for better definition of limitations. The discernible delay in wall motion improved from 89 ms to 71 ms by allowing side-by-side comparison to normal motion. Clinically important delays are almost certainly missed with current "eyeballing" methods. Different and more quantitative approaches to this problem have been developed. Anatomic M-mode (AMM) assesses motion along an arbitrary line within a two-dimensional (2D) image, and was demonstrably robust in the clinical setting when used with second harmonic imaging at a depth less than 20 cm and with angle correction ofless than 60°. Doppler myocardial (DMI) imaging and strain rate imaging (SRI) were also shown to reliably demonstrate the effects of inotropic stimulation, total and severe ischemia on asynchrony in a closed chest pig model. Quantification of the changes induced by inotropy and total ischemia was possible with both methods, but the effects of stunning were not. Regional myocardial function and cardiovascular flow can also be assessed with time-resolved, three-directional, three-dimensional (3D) velocity data acquired using phase contrast magnetic resonance imaging (PC-MRI). This multidimensional data demonstrated longitudinal velocity gradients along all four walls of the left ventricle, with miuirnal apical longitudinal motion. The 3D velocity vector from single points in the ventricular wall shows that the motion over the cardiac cycle is complex in all dimensions. The flow patterns in the aortic root were also studied using time-resolved 3D PC-MRI in normal volunteers and patients who had undergone aortic-valve sparing surgery using straight Dacron grafts. In normals, vortices appeared in the sinuses of Valsalva in late systole, increased in size with the deceleration of aortic outflow and moved together as the valve closed in early diastole. These normal flow structures have never before been demonstrated in three dimensions in man. In the postoperative patients, lacking both sinuses and sinotubular junction, vortices were not observed.

Many imaging methods can be improved by a critical definition of the limits oftheir reliability. This can prompt the modifications and new methods which allow us to move beyond the original shortcomings and contribute new knowledge regarding the pathophysiology of cardiovascular disease.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2004. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 832
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24209 (URN)3803 (Local ID)91-7373-804-2 (ISBN)3803 (Archive number)3803 (OAI)
Public defence
2004-02-20, Elsa Brändströmssalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-29Bibliographically approved

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