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PubMed1981

Regional ischemic ventricular dysfunction in myocardium supplied by a narrowed coronary artery with increasing halothane concentration in the dog.

The effects of increasing inspired halothane concentration (0.5, 1.0, 1.5, 2.0 per cent) upon left ventricular myocardium supplied by a critically narrowed coronary artery and a normal coronary artery were studied in 11 open-chested dogs. Regional ventricular function was measured by continuous recording of ventricular segment length using pairs of implanted miniature ultrasonic length detectors in the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LC) territories before and during critical stenosis of the LAD by a micrometer-controlled snare. Critical narrowing was documented by ischemic regional ventricular function (i.e., post-systolic shortening; systolic lengthening) limited to the LAD territory when FIO2 = 0 for 90 seconds. Hemodynamic variables (aortic, left atrial and left ventricular pressure, and heart rate) were measured, ECG lead II was recorded, and the first derivative of left ventricular pressure (LV dP/dt) and coronary perfusion pressure derived for each halothane concentration before and during LAD narrowing. Increasing halothane was associated with equivalent progressive depression of global ventricular function before and during LAD constriction. Prior to LAD constriction, no ischemic changes in regional function occurred. Regional ventricular function was normal during 0.5 percent halothane in the presence of LAD constriction. With increasing halothane during LAD constriction, ischemic regional ventricular function was observed in the LAD territory in eight of eleven hearts, whereas regional ventricular function remained normal in the LC territory. The epicardial ECG was recorded in three dogs and was insensitive as an indicator of ischemia, becoming abnormal only after severe ischemic changes were established. In these studies, in which heart rate remained constant, arterial blood pressure and LV dP/dt decreased, and left ventricular end-diastolic pressure increased, decrease in blood flow and oxygen delivery due to a lower perfusion pressure distal to the coronary artery narrowing appears to be primarily responsible for the observations. The authors hypothesize that clinically unapparent episodes of regional myocardial ischemia distal to narrowed coronary arteries may be an important cause of perioperative myocardial infarction.

Animals↗

PubMed1997

Viewer-centered frame of reference for pointing to memorized targets in three-dimensional space.

Pointing to a remembered visual target involves the transformation of binocular visual information into an appropriate motor output. Errors generated during pointing tasks may indicate the reference frames used by the CNS for the transformation and storage of the target position. Previous studies have proposed eye-, shoulder-, or hand-centered reference frames for various pointing tasks, depending on visual conditions. We asked subjects to perform pointing movements to remembered three-dimensional targets after a fixed memory delay. Pointing movements were executed under dim lighting conditions, allowing vision of the fingertip against a uniform black background. Subjects performed repeated movements to targets distributed uniformly within a small (radius 25 mm) workspace volume. In separate blocks of trials, subjects pointed to different workspace regions that varied in terms of distance and direction from the head and shoulder. Additional blocks were performed that differed in terms of starting position, effector hand, head rotation, and memory delay duration. Final pointing positions were quantified in terms of the constant and variable errors in three dimensions. The orientation of these errors was examined as a function of workspace location to identify the underlying reference frames. Subjects produced anisotropic patterns of variable error, with greater variability for endpoint distances from the body. The major axes of the variable-error tolerance ellipsoids pointed toward the eyes of the subject, independent of workspace region, effector hand (left or right), initial hand position, and head rotations. Constant errors were less consistent across subjects, but also tended to point toward the head and body. Both overshoots and undershoots of the target position were observed. Increasing the duration of the memory delay period increased the size but did not alter the orientation of the variable-error ellipsoids. Variability of the endpoint positions increased equally in all three Cartesian directions as the memory delay increased from 0.5 to 8.0 s. The anisotropy of variable errors indicates a viewer-centered reference frame for pointing to remembered visual targets with vision of the finger. The anisotropy of pointing variability stems from variability in egocentric binocular cues as opposed to reliance on allocentric visual references or to specific approximations in the sensorimotor transformation. Nevertheless, observed increases in variability with longer memory delays indicate that the short-term storage of the target position does not simply mirror the retinal and ocular sensory signals of the visually acquired target location. Thus spatial memory is carried out in an internal representation that is viewer-centered but that may be isotropic with respect to Cartesian space.

Adult↗

PubMed1994

Left ventricular wall thickness and regional systolic function in patients with hypertrophic cardiomyopathy. A three-dimensional tagged magnetic resonance imaging study.

BACKGROUND: Regional performance of the hypertrophied left ventricle (LV) in hypertrophic cardiomyopathy (HCM) is still incompletely characterized with studies variably reporting that the hypertrophied myocardium is hypokinetic, akinetic, or has normal function. Different imaging modalities (M-mode or two-dimensional echocardiography) and methods of analysis (fixed or floating frame of reference for wall motion analysis) yield different results. We assessed regional function in terms of systolic wall thickening and shortening and related these parameters to end-diastolic thickness using tagged magnetic resonance imaging and the three-dimensional volume-element approach. METHODS AND RESULTS: In 17 patients with HCM and 6 healthy volunteers, four parallel short-axis images with 12 radial tags and two mutually orthogonal long-axis images with four parallel tags were obtained at end diastole and end systole. After the LV endocardial and epicardial borders were traced, three-dimensional volume elements were constructed by connecting two matched planar segments in two adjacent short-axis image planes, accounting for translation, twist, and long-axis shortening. A total of 72 such volume elements encompassed the entire LV. From each of these elements, end-diastolic thickness and systolic function (fractional thickening and circumferential shortening) were calculated. The average end-diastolic thickness was 15.8 +/- 4.2 mm in patients with HCM, which was significantly greater than that in healthy subjects (8.6 +/- 2.1 mm, P < .001). Fractional thickening was significantly less in patients with HCM than in healthy subjects (0.31 +/- 0.22 versus 0.56 +/- 0.23, P < .001). There was a highly significant inverse correlation between fractional thickening and end-diastolic thickness that was independent of the type of hypertrophy or age group. Similar inverse relations were observed between circumferential shortening and end-diastolic wall thickness. CONCLUSIONS: The myocardium in patients with HCM is heterogeneously thickened and the fractional thickening and circumferential shortening of the abnormally thickened myocardium are reduced compared with healthy subjects. The decrease in fractional thickening and shortening is inversely related to the local thickness.

Adult↗

PubMed1989

Proportions and sizes of muscle fiber types in the hamster diaphragm.

This study demonstrated that there was interanimal and interregional variability of proportions and sizes of the muscle fiber types in the hamster diaphragm. Muscle fiber type proportions and sizes were determined for each side (right, left), surface (abdominal, thoracic), and region (sternal, anterior costal, posterior costal, crural) in six hamsters. There was marked regional and surface-to-surface variability and some interanimal variability in proportions and sizes of fiber type within the hamster diaphragm. The sternal and costal regions were relatively homogeneous. However, there were differences in both proportions and sizes of fiber types between the thoracic surface of the crural region and the abdominal surface of the crural region. These two surfaces of the crural region differed from the rest of the diaphragm. For muscle fiber type proportions, type 2a fibers demonstrated the most interanimal variability. Muscle fiber size varied little between animals.

Animals↗

PubMed1999

Association of body fat distribution and cardiovascular risk factors in children and adolescents.

BACKGROUND: Obesity is associated with increased risk of cardiovascular disease in adults and less favorable cardiovascular risk factor status in children and adolescents. In adults, fat distribution has been shown to be related to lipid and lipoprotein concentrations, blood pressure levels, and left ventricular mass. These relationships have not been extensively studied in young subjects. METHODS AND RESULTS: This was a cross-sectional study of 127 children and adolescents 9 to 17 years of age. Dual-energy x-ray absorptiometry was used to measure total and regional fat mass. The dependent variables were fasting lipid and lipoprotein concentrations, systolic and diastolic blood pressures, and left ventricular mass. There were significant (P<0.05) univariate correlations between fat distribution and log triglycerides (r=0.27), log HDL cholesterol (r=-0.23), systolic blood pressure (r=0.26), and left ventricular mass (r=0.37). Multiple regression analysis showed that the significant independent correlates for triglycerides and HDL cholesterol were age and fat distribution; for systolic blood pressure, height and fat distribution; and for left ventricular mass, height, race, sex, and fat distribution. CONCLUSIONS: These results demonstrate that fat distribution is a more important independent correlate of cardiovascular risk factors than percent body fat in children and adolescents. Greater deposition of central fat (an android fat pattern) is associated with less favorable plasma lipid and lipoprotein concentrations, blood pressure, and left ventricular mass.

Adipose Tissue↗

PubMed1990

Sulcus topography of the parietal opercular region: an anatomic and MR study.

The study describes the sulcal and gyral topography, variability, and left-right asymmetry of the parietal operculum. Eighty postmortem hemispheres as well as sagittal magnetic resonance images from 20 health volunteers (40 hemispheres) were evaluated. Four different types of parietal opercular sulcus topography were recognized. Most frequently, and conforming with the anatomic "textbook pattern", the inferior postcentral sulcus (POCS) is the sulcus anterior to the posterior ascending ramus (PAR) of the Sylvian fissure (type 1). Variations were the following: lack of a PAR (type 2), interposition of an intermediate opercular sulcus and gyrus between PAR and POCS (type 3), and direct transition of PAR into POCS with subsequent lack of a classical supramarginal gyrus (type 4). Inconstancy of the sulcal standard arrangement was especially pronounced among left hemispheres, where the patterns differed from type 1 in one third of the cases. Types 2 and 3 were significantly more frequent in left hemispheres, whereas type 4 occurred significantly more frequently in right hemispheres. Upon intraindividual left-right comparison, a remarkable 38% of the brains showed gross asymmetry of the parietal opercular sulcus patterns, characterized by a left type 2 or 3 and/or a right type 4; another 5% exhibited a reverse type of asymmetry. The findings supplement previous data on gross variability and left-right asymmetry of the posterior Sylvian fissure and its lower bank. They indicate that the Sylvian fissure is an unreliable landmark with respect to inferior parietal structures especially in left hemispheres. Individual mapping of perisylvian topography may contribute to studies on structural-functional relationship.

Adult↗

PubMed1984

Alterations in regional myocardial blood flows during different levels of positive end-expiratory pressure.

A decrease in myocardial blood flow (MBF) has been suggested recently as a contributing factor to the depression of cardiac function during application of PEEP. To test this hypothesis, 7 dogs were anesthetized and their chest wall and pericardium were removed. Hemodynamics, myocardial oxygenation status, and left and right ventricular MBF were measured during controlled ventilation without PEEP (IPPV), with 8 cm H2O of PEEP (CPPV8), 15 cm H2O of PEEP (CPPV15), and 25 cm H2O of PEEP (CPPV25). Compared to IPPV, CPPV8 significantly decreased left ventricular endocardial, epicardial, and septal blood flows. Right ventricular MBF and other measured variables were not affected. Compared to control, CPPV15 decreased left ventricular and septal MBFs in all regions, and right ventricular MBF in the endocardial region. CPPV15 also decreased cardiac index (CI) from 3.94 +/- 0.57 L/min X m2 during control to 2.78 +/- 0.34 L/min X m2 (p less than .05). Compared to IPPV, CPPV25 further decreased MBF in all layers of both ventricles and septum. Compared to CPPV8, there were decreases in left ventricular midwall and septal (left ventricular side and midwall) blood flows during CPPV25. During application of CPPV25, compared to IPPV, mean arterial pressure (MAP) was reduced from 99 +/- 5 to 85 +/- 5 mm Hg, left ventricular stroke work index (LVSWI) decreased from 31.8 +/- 5.4 to 13.8 +/- 2.6 g X m/m2, and CI decreased to 2.13 +/- 0.38 L/min X m2 (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2000

Alzheimer's disease and frontotemporal dementia are differentiated by discriminant analysis applied to (99m)Tc HmPAO SPECT data.

OBJECTIVE: Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most frequent neurodegenerative cognitive disorders. However, FTD remains poorly recognised clinically. The use of (99m)HmPAO-single photon emission computed tomography (SPECT) has been demonstrated in the differentiation of AD and FTD. Nethertheless, there are very few comparative studies designed to assess its precise value in this differential diagnosis. The aim was to determine a simple decision rule, deduced from statistical analysis, which, if applied to regions of interest (ROIs) and mini mental state examination (MMSE), could improve the predictive value of SPECT in differential diagnosis between AD and FTD. METHODS: Forty patients, 20 with probable AD and 20 with probable FTD were included. All patients underwent brain SPECT imaging, after an intravenous injection of (99m)Tc HmPAO-(555mBq). For each patient, 20 ROIs were determined on the Fleishig's slice and their activity was normalised to the mean cerebellar activity. Bivariate analysis (Wilcoxon rank tests) and multivariate analysis (stepwise discriminant analysis) were performed to determine the subgroup of variables able to give the highest predictive value for this differential diagnosis. A simple decision rule was built from a predictive score derived by factorial discriminant analysis. RESULTS: As previously described, the fixation defect was found in frontal regions of interest (ROIs) in FTD and in the left temporoparietal-occipital ROIs in AD. Among the 21 variables, five were finally selected: right median frontal, left lateral frontal, left tempoparietal, left temporoparietal-occipital areas, and MMSE. One hundred per cent of patients with FTD were correctly classified by the decision rule (20/20 patients) and 90% of patients with AD (18/20). CONCLUSION: AD and FTD are differentiated by SPECT. Automatic classification based on a decision rule deduced from factorial discriminant analysis could enhance its performance.

Alzheimer Disease↗

PubMed1989

Extracellular potassium ion dynamics and ventricular arrhythmias in the canine heart.

The relation between extracellular potassium ion activity [( K+]o) and ventricular tachyarrhythmias was studied in an open chest canine model with the use of two protocols. In Protocol I, potassium chloride was administered into the proximal left anterior descending coronary artery at a rate of 0.125 mEq/min for either 20 min or until [K+]o = 20 mEq/liter, whichever came first. In Protocol II, the proximal left anterior descending coronary artery was occluded in one step and was reperfused 20 min later. Fifteen dogs were subjected to Protocol I, nine of which were also subjected to Protocol II. In the latter group, a recovery period of greater than or equal to 1 h separated the two protocols. Local K+ and intramyocardial activities were recorded with use of bifunctional ion-sensitive plunge electrodes at multiple sites located in the region of the left ventricle perfused by the left anterior descending artery and at one site outside of this region. The following variables were recorded and analyzed: Lead II electrocardiogram, heart rate, systemic arterial blood pressure, local [K+]o and its time derivative (dK+/dt), local electrograms and ventricular arrhythmias. Maximal [K+]o and dK+/dt were 23 +/- 3 mEq/liter and 9 +/- 1 mEq/liter per min in Protocol I and 14 +/- 1 mEq/liter and 3 +/- 1 mEq/liter per min in Protocol II, respectively. In both protocols, the occurrence of ventricular arrhythmias correlated with [K+]o (p less than 0.02) as well as with dK+/dt (p less than 0.05). Ventricular arrhythmias were more frequent and more severe in Protocol II than in Protocol I (p less than 0.05). Therefore, whereas K+ dynamics were more pronounced in Protocol I, ventricular arrhythmias were more severe in Protocol II. This occurrence was apparently due, at least in part, to less heterogeneous changes in K+ gradients during constant K+ infusion. It was concluded that, in addition to the magnitude of [K+]o, the rate of change of this variable (that is, dK+/dt) apparently plays an important role in the genesis of ischemic ventricular arrhythmias.

Animals↗

PubMed2001

Cortical localization of reading in normal children: an fMRI language study.

BACKGROUND: fMRI provides a noninvasive means of identifying the location and organization of neural networks that underlie cognitive functions. OBJECTIVE: To identify, using fMRI, brain regions involved in processing written text in children. METHODS: The authors studied nine normal right-handed native English-speaking children, aged 10.2 years (range 7.9 to 13.3 years), with two paradigms: reading Aesop's Fables and "Read Response Naming" (reading a description of an object that was then silently named). Data were acquired using blood oxygen level-dependent fMRI. Group data were analyzed with statistical parametric mapping; individual data sets were analyzed with a region-of-interest approach from individual study t maps. The number of activated pixels was determined in brain regions and an asymmetry index (AI = [L - R]/[L + R]) calculated for each region. RESULTS: The authors found strong activation in the left middle temporal gyrus and left midfrontal gyrus and variable activation in left inferior frontal gyrus for both reading tasks in the group analysis (z > 5.5 to 9.1). All subjects had strong left-sided lateralization for both tasks in middle/superior temporal gyrus, inferior frontal gyrus, and middle frontal gyrus (AI = 0.76 to 1.0 for t = 4). Reading Fables activated twice as many pixels in temporal cortex as the Read Response Naming task; activation in dorsolateral prefrontal cortex was similar for both tasks. Small homologous right middle temporal region activation was seen with reading a fable. CONCLUSIONS: The neural networks that process reading appear to be lateralized and localized by middle to late childhood. Reading text paradigms may prove useful for identifying frontal and temporal language-processing areas and for determining language dominance in children experiencing epilepsy or undergoing tumor surgery.

Brain Mapping↗

PubMed2003

[Variability of the structure of area 39 of inferior parietal cortex in the left and right hemispheres of adult human brain].

The cytoarchitecture of area 39 of inferior parietal cortex region in the left and right cerebral hemispheres was studied in usual individuals and in professionally gifted world-famed people. The series of frontal sections, stained using Nissl cresyl violet method, were examined. The profile areas of neurons in cortical layers III and V were measured and their distributions were analyzed. In the group of gifted people, individual variability of the characteristics studied was found to be significantly increased, especially in the right cerebral hemisphere, while the relative content of both very small and very large neurons was elevated.

Adult↗

PubMedDate not supplied

Application of an end-systolic pressure-segment length relationship for measuring regional contractility.

A method for estimating regional contractility is described using the end-systolic relationship between left ventricular pressure and myocardial segment-lengths in rapidly volume-loaded beats. The approach was based on the success of previously developed end-systolic relationships between left ventricular pressure and volume and between variable ejection force and fiber length used to describe global contractility in beating hearts. The regional end-systolic relationship was more complicated than its global counterpart, which was load independent, and appeared curvilinear to rapid volume loading. As an approximation of this relationship, a linear slope was constructed between maximum and minimum (pre-ejection) loaded beats of equal cycle length. Because of its load dependency and in order to compare slope relationships between interventions, slope functions were derived only from similarly loaded beats either within or between interventions. Slopes generated by this technique had a reasonable constancy at control conditions and coronary flows with an average SEM of 9.1% of the slope means. End-systolic slopes also appeared sensitive to changes in contractile state, increasing appropriately following treatments with dobutamine and decreasing after propranolol. Following shifts in the end-systolic slopes were unreliable, however, in describing the regional changes in contractility with ischemia. At milder levels of flow restriction, the slopes declined as expected. At moderate levels of flow restriction, the pressure-segment loops shifted markedly rightward and the slope increased. At advanced levels of ischemia, the loops were so distorted, that end-systole could not be identified accurately and the loops essentially described the diastolic compliance characteristics of the left ventricle. Thus the slope estimates of regional contractility as described in this report provided a reliable assessment of inotropic background during modifications with positive and negative inotropic drugs but became invalid as systolic shortening was replaced by aneurysmal bulging during high-grade ischemia.

Animals↗

PubMed1995

Brain regional distribution pattern of metabolite signal intensities in young adults by proton magnetic resonance spectroscopic imaging.

Proton magnetic resonance spectroscopy (1H-MRS) is evolving from single-volume localized acquisitions to multiple-volume acquisitions using magnetic resonance spectroscopic imaging (1H-MRSI). The normal regional patterns of 1H-MRSI-detectable metabolite signal intensities have yet to be established. We studied 13 healthy young adults with a multiple-section 1H-MRSI technique. The metabolite signals measured were N-acetylaspartate (NA), choline-containing compounds (CHO), creatine-phosphocreatine (CRE), and lactate. Ten neuroanatomic regions (nine bilateral) were identified in gray matter, white matter, and basal nuclei. Analysis of the data led to the following conclusions: (1) NA and CHO signals from centrum semiovale (CSO) can be used as a normalizing factor to reduce intersubject variability due to external causes; (2) in normal human brain, there is no left versus right asymmetry in the regions studied; (3) statistically significant patterns of signal distribution of NA, CHO, and CRE can be identified in normal human brain; and (4) CSO-normalized metabolite signal intensities and metabolite ratios complement each other for the detection of significant regional differences.

Adult↗

PubMed2005

Effects of levosimendan on systemic and regional hemodynamics in septic myocardial depression.

OBJECTIVE: Calcium desensitization plays an important part in the pathophysiology of septic myocardial depression. We postulated that levosimendan, a new calcium sensitizer, would be beneficial in sepsis-induced cardiac dysfunction. DESIGN AND SETTING: Prospective, randomized, controlled study in two university hospital intensive care units. PATIENTS AND PARTICIPANTS: Twenty-eight patients with persisting left ventricular dysfunction related to septic shock after 48 h of conventional treatment including dobutamine (5 microg/kg per minute). INTERVENTIONS: After 48 h of conventional treatment patients were randomized to receive a 24-h infusion of either levosimendan (0.2 microg/kg per minute, n=15) or dobutamine (5 microg/kg per minute, n=13). MEASUREMENTS AND RESULTS: Data from right heart catheterization, echocardiography, gastric tonometry, laser-Doppler flowmetry, and lactate concentrations and creatinine clearance were obtained before and after the 24-h drug infusion. Dobutamine did not change systemic or regional hemodynamic variables. By contrast, at the same mean arterial pressure levosimendan decreased pulmonary artery occlusion pressure and increased cardiac index. Levosimendan decreased left ventricular end-diastolic volume and increased left ventricular ejection fraction. Levosimendan increased gastric mucosal flow, creatinine clearance, and urinary output while it decreased lactate concentrations. CONCLUSIONS: These findings show that levosimendan improves systemic hemodynamics and regional perfusion in patients with septic cardiac dysfunction under conditions where administration of 5 microg/kg dobutamine per minute is no longer efficacious. Accordingly, our results suggest that levosimendan can be an alternative to the strategy of increasing the dose of dobutamine under such conditions.

Cardiac Output, Low↗

PubMed1978

Response of left ventricular myocardial perfusion and cavity size to beta-blockade by acebutolol.

The effect of beta-blockade by acebutolol on global and regional myocardial perfusion (133Xenon wash-out) was studied in 10 patients with coronary artery disease. Another group of 10 similar patients was used to study the effect of acebutolol on left ventricular cavity size (metal markers--spot film camera). Global perfusion responses roughly paralleled the changes in rate-pressure variable which decreased in 8 patients and increased in 2 who had spontaneous angina pectoris. Regional perfusion decreased more in areas distal to less than 75% stenoses than in those distal to less than 75% stenoses (29 vs 12%; p = 0.10 less than 0.20). Left ventricular asynergy did not modify the response, nor did the presence or absence of collateral vessels. No evidence was found to support the thesis that beta-blockade may evoke a redistribution in perfusion which favours the potentially ischaemic areas of myocardium. Left ventricular cavity size remained unchanged after acebutolol, a cardioselective beta-blocking compound with some degree of agonist activity.

Acebutolol↗

PubMedDate not supplied

Regional hemodynamic effects of clonidine in congestive heart failure.

Regional and central hemodynamic variables were ascertained in 10 patients with congestive heart failure before and after the oral administration of clonidine. Following the 0.2 mg dose, renal, hepatic, and limb blood flow remained unaltered, whereas a reduction was noted in heart rate (10%), mean systemic (14%), and pulmonary capillary wedge pressures (27%). Cardiac index and systemic vascular resistance fell slightly, however the changes were not statistically significant. Higher dose clonidine (0.4 mg) elicited similar regional hemodynamic effects whereas systemic vascular resistance significantly diminished (21%) and cardiac index remained unchanged. In congestive heart failure, the central antihypertensive agent, clonidine, effects a significant reduction in preload (left ventricular filling pressure) and afterload (systemic blood pressure) without markedly altering other central and regional hemodynamic variables.

Adult↗

PubMed2005

Myocardial late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy caused by mutations in troponin I.

OBJECTIVE: To examine the influence of genotype on late gadolinium enhancement (LGE) and the potential of cardiovascular magnetic resonance (CMR) to detect preclinical hypertrophic cardiomyopathy. DESIGN: Prospective, blinded cohort study of myocardial LGE in a genetically homogeneous population. PATIENTS: 30 patients with disease causing mutations in the recognised hypertrophic cardiomyopathy gene for cardiac troponin I (TNNI3): 15 with echocardiographically determined left ventricular hypertrophy (LVH+) and 15 without (LVH-). MAIN OUTCOME MEASURES: CMR measures of regional left ventricular function, wall thickness, and mass, and the extent and distribution of LGE. RESULTS: LGE was found in 12 (80%) LVH+ patients but with variable extent (mean 15%, range 3-48%). LGE was also found in two (13%) LVH- patients but the extent was limited (3.6%) and both patients were found to have an abnormal ECG and regional hypertrophy by cine CMR. The extent of LGE was positively associated with clinical markers of sudden death risk (21% with > or = 2 risk factors v 7% with < or = 1 risk factor, p = 0.02) and left ventricular mass (r = 0.56, p < 0.001) and was inversely associated with ejection fraction (r = -0.58, p < 0.001). Segmental analysis showed that as regional wall thickness increased, LGE was more prevalent (p < 0.0001) and more extensive (r = 0.98, p = 0.001). CONCLUSION: In patients with disease causing mutations in TNNI3, focal fibrosis was not detected by LGE CMR before LVH and ECG abnormalities were present. Once LVH is present, LGE is common and the extent correlates with adverse clinical parameters. This suggests that focal fibrosis is closely linked to disease development.

Adolescent↗

PubMed1993

Effects of coronary blood flow on myocardial grey level amplitude in two dimensional echocardiography: an experimental study.

OBJECTIVE: The aims were: (1) to evaluate whether differences in absolute and cyclic echocardiographic image amplitude exist in different layers (subendocardium and subepicardium) and regions (septal, anterior, lateral, inferior wall) of the canine left ventricle; (2) to assess the dependence of these variables upon local variations of coronary blood flow. METHODS: In six anaesthetised open chest dogs the circumflex coronary artery was cannulated and perfused by a roller pump with blood from their own femoral artery. Maximum coronary vasodilatation was obtained by continuous adenosine infusion. The absolute values and the transmural distribution of coronary blood flow were measured by radionuclide labelled microspheres. Echo images were obtained in short axis view by a commercially available electronic sector scanner with a 5.0 MHz transducer directly placed on the epicardial surface of the right ventricle, and digitised off-line into a matrix of 256 x 256 pixels with 25% grey level per pixel. The average grey level was calculated for each region of interest. RESULTS: In 32 different conditions, circumflex flow ranged from 0.80 to 12.89 ml.min-1.g-1 and the endocardial/epicardial ratio of flow from 0.53 to 1.73. In the circumflex region (subjected to flow changes) segmental amplitude varied from 76(SD 20) (end diastole) to 56(18) (end systole), p < 0.001. In all regions, a consistent cyclic variation was found, ranging from 9(14) to 28(16)%. For all levels of flow, subendocardial and subepicardial regions showed similar values of both absolute amplitude and cyclic variation. No significant relationship was found between transmural distribution of blood flow and either segmental amplitude (r = 0.26) or cyclic variation (r = 0.04). CONCLUSIONS: (1) a consistent cyclic grey level variation is present in all regions of the canine left ventricle, but subendocardial and subepicardial layers show similar values of both absolute amplitude and cyclic variation; (2) in the absence of severe underperfusion and echocardiographically detectable dyssynergy, absolute amplitude and cyclic variation are totally unrelated to changes in coronary blood flow.

Animals↗