Optimization of the method of x-ray contrast left ventriculography

The authors propose their modification of the method of left ventriculography (VG) (substitution of direct VG for iv VG with an injection of a contrast medium into the right atrial chamber in combination with continuous monitoring of pressure in the LV chamber). Altogether 23 patients with a doubtful diagnosis of CHD were investigated by coronography, direct VG and iv biventriculography. All images of the left ventricle were subjected to computerized multiframe analysis. A conclusion is that the modified method is more preferable than direct VG.     

Variations in morphologic alterations in the hearts of white rats during adaptation to different types of physical loads

While adapting to physical loadings various in their character, most of rats develop a moderate hypertrophy in the right cardiac ventricle without any noticeable changes in the organ's mass. ECG dynamics is positive. Myocardial hypertrophy, at the expense of increasing mass of the left ventricle, is most regularly observed in animals subjected to forced endurance training (daily swimming); less regularly--if the loading is applied with intervals (swimming every other day) and is practically absent in rats performing work with force application. Pathological ECG changes occur more often on the background of myocardial hypertrophy and are brought about by dystrophic disorders in muscular fibres, their focal micronecrosis, by edema of the interstitial and perivascular tissue.     

Value of positive myocardial infarction imaging in coronary care units.

Positive myocardial imaging was undertaken on 120 unselected patients admitted to a coronary care unit with clinical suspicion of acute myocardial infarction. Multipurpose mobile gamma-cameras were used for serial imaging after administration of 99mtechnetium-labelled imidodiphosphonate, a low-cost radiopharmaceutical that is 97% specific for myocardial necrosis, with myocardial uptake and blood clearance most suitable for myocardial imaging. The sensitivty of detection was 94% for patients whose infarction was unequivocal on the ECG; when the presence of raised enzyme concentrations was also used as a criterion for myocardial necrosis, the overall sensitivity for all 120 patients remained 94%. In 73 patients (61%), whose ECGs were unhelpful or difficult to interpret, scintigraphy allowed infarction to be diagnosed in 11 (15%) and to be excluded in five (7%). In 32 (44%) of this group whose ECGs were totally uninterpretable due to previous myocardial damage or disorders of electrical activation, scintigraphy provided confirmation of a diagnosis that otherwise rested only on whether enzyme concentrations were raised. Myocardial imaging is thus a useful technique that permits more definite diagnosis in patients for whom ECG and enzyme data are uncertain.     

Effect of contrast ventriculography of the left ventricle on coronary hemodynamics in patients with ischemic heart disease]

The effect of left ventricular (LV) contrast ventriculography (VG) on the state of intracardiac hemodynamics during the administration of a contrast medium and 30-40 sec. after it was investigated in 48 CHD patients. It followed retrograde catheterization of the left ventricle by a parallel use of two catheters that permitted recording intraventricular pressure directly during LV VG. The performance of left VG with 76% urografin administered in a dose of 0.6-0.8 ml/kg with the rate of 13-15 ml/s produced no significant change in the state of intracardiac hemodynamics, relaxation and pumping function of the LV in the course of the first three contrasted cardiocycles. Transitory disorder of hemodynamics observed in the patients after contrast VG was restored by itself in 15-20 min.     

Congestive cardiomyopathy in uraemic patients on long term haemodialysis.

Five uraemic patients who developed progressive cardiac failure with clinical evidence of congestive cardiomyopathy at the start or during haemodialysis treatment were studied. The diagnosis of cardiomyopathy, for which there was no apparent cause, was confirmed by angiocardiographic and haemodynamic studies. These showed a significant increase in left ventricular end-diastolic volume over normal values obtained in 12 patients without uraemia. The mean velocity of myocardial fibre shortening was significantly decreased, as was the index of normalised rigidity. Three of the five patients presented the complete picture of the disease. The other two also had considerable ventricular dilatation and a decreased index of normalised rigidity but normal ejection fraction and only moderately decreased myocardial contractility indices. This suggests that there may be primary involvement of normalised heart muscle rigidity followed by secondary changes in myocardial contractility in uraemic patients with congestive cardiomyopathy.     

Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation

Clinical studies have demonstrated the predictive values of changes in electrocardiographic (ECG) parameters for the preexisting myocardial ischemic infarction. However, a simple and early predictor for the subsequent development of myocardial infarction during the ischemic phase is of significant value for the identification of ischemic patients at high risk. The present study was undertaken by using non-human primate model of myocardial ischemic infarction to fulfill this gap. Twenty male Rhesus monkeys at age of 2–3 years old were subjected to left anterior descending artery ligation. This ligation was performed at varying position along the artery so that it produced varying sizes of myocardial infarction at the late stage. The ECG recording was undertaken before the surgical procedure, at 2 h after the ligation, and 8 weeks after the surgery for each animal. The correlation of the changes in the ECG waves in the early or the late stage with the myocardial infarction size was analyzed. The R wave depression and the QT shortening in the early ischemic stage were found to have an inverse correlation with the myocardial infarction size. At the late stage, the R wave depression, the QT prolongation, the QRS score, and the ST segment elevation were all closely correlated with the developed infarction size. The poor R wave progression was identified at both the early ischemic and the late infarction stages. Therefore, the present study using non-human primate model of myocardial ischemic infarction identified the decreases in the R wave and the QT interval as early predictors of myocardial infarction. Validation of these parameters in clinical studies would greatly help identifying patients with myocardial ischemia at high risk for the subsequent development of myocardial infarction.     

低风险胸痛急性冠状动脉综合征患者心电图特征及其对诊断的价值研究

摘要 目的：分析低风险胸痛急性冠状动脉综合征(acute coronary syndrome,ACS)患者心电图特征及其对诊断的价值。方法：选择我院自2017年1月至2019年8月接诊的194例疑似低风险胸痛ACS患者,均采取心电图检查和冠状动脉造影检查;分析低风险胸痛ACS患者的心电图特征,观察心电图结果与冠状动脉病变支数、狭窄程度的关系,计算心电图诊断低风险胸痛ACS的特异性、敏感性等效能指标,使用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(curve,AUC)定量分析ST段偏移值预测主要不良心血管事件的效能。结果：在194例疑似低风险胸痛ACS患者中,低风险胸痛ACS患者134例,低风险不稳定型心绞痛(UA)患者心电图表现以ST-T缺血性改变为主,发作时改变明显或呈现伪性改善;低风险非ST段抬高的心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者心电图表现为肢体和胸导联ST段压低,T波低平、倒置,ST-T改变持续存在和呈动态衍变;低风险胸痛ACS患者心电图结果与冠状动脉病变支数无关(P＞0.05),与狭窄程度有关(P＜0.05);心电图诊断低风险胸痛ACS的特异性为71.67 %,敏感性为69.40 %,阳性预测值为84.55 %,阴性预测值为51.19 %,符合率为70.62 %;所有患者均获得随访,经ROC曲线分析,ST段偏移值预测低风险胸痛ACS患者发生主要不良心血管事件的最佳截值为1.85 mm,AUC为0.695,对比全球急性冠状动脉事件注册(GRACE)风险评分的0.675,差异无统计学意义(P＞0.05)。结论：低风险胸痛ACS患者心电图具有多样化,与冠状动脉狭窄程度有关,有助于初步诊断和风险评估,且ST段偏移值预测主要不良心血管事件的效能较好,值得进一步研究应用。     

Involvement of Ca<Superscript>2+</Superscript> in the development of ischemic disorders of myocardial contractile function

The review addresses the role of Ca²⁺ ions in the development of ischemic disorders of myocardial contractility associated with changes in Ca²⁺ homeostasis in cardiomyocytes and mitochondrial Ca²⁺ overload. A special attention is paid to the analysis of intracellular signaling mechanisms activated during the development of ischemic and reperfusion injury of the myocardium.     

Determination of the ejection fraction and cardiac volumes using magnetic resonance tomography

The results of NMR-tomography and radiocontrast ventriculography (VG) were compared in 20 CHD patients to determine ejection fraction (EF), and left ventricular (LV) end-diastolic and end-systolic volumes (EDV and ESV). NMR-tomography of the heart was performed at the field power of 0.23 T using the synchronization with ECG. Two methods of orientation of NMP-section on the LV long axis were employed. A sufficiently high correlation of NMR-tomography and VG findings in the determination of EF (r = 0.9) was obtained, low and insignificant--in the determination of EDV and ESV. Possible causes of differences between the results of both methods are under discussion.     

黄芪注射液对缺血性心肌病大鼠心肌自噬及心肌重塑的影响*

目的: 研究黄芪注射液对缺血性心肌病大鼠心肌重塑、网腔钙结合蛋白(calumenin)及自噬影响。方法: 36只雄性SD大鼠分为正常对照组(n=12)、缺血性心肌病组(n=12)、黄芪注射液组(n=12),3组大鼠术前行心电图及心脏彩超检查后,正常对照组不做任何处理,而缺血性心肌病组和黄芪注射液组大鼠开胸结扎冠状动脉20 min后,解开结扎线行再灌注后关闭胸腔建立心肌缺血模型,黄芪注射液组术后每次注射黄芪注射液10 g/kg体重,每周注射1次,共注射4次。3组大鼠术后4周行心脏彩超检查后处死大鼠取心脏行HE染色、VG染色,观察心肌病理改变,用Western blot技术检测各组大鼠心肌细胞calumenin、LC3-I、LC3-II表达变化及LC3-I /LC3-II比值变化。结果: 与缺血性心肌病组比较,黄芪注射液组大鼠心脏彩超及心肌病理得到明显改善;同时,calumenin表达增加LC3-I /LC3-II比值表达降低(P＜0.01)。结论: 黄芪注射液对缺血性心肌病大鼠心室重塑及心肌细胞自噬有明显抑制作用,该作用可能是通过calumenin所介导的。     

Identification of a PKCepsilon-dependent regulation of myocardial contraction by epicatechin-3-gallate

In this study, the effects of tea catechins and tea theaflavins on myocardial contraction were examined in isolated rat hearts using a Langendorff-perfusion system. We found that both tea catechins and theaflavins had positive inotropic effects on the myocardium. Of the tested chemicals, epicatechin-3-gallate (ECG) and theaflavin-3,3'-digallate (TF(4)) appear to be the most effective tea catechin and theaflavin, respectively. Further studies of ECG-induced positive inotropy revealed the following insights. First, unlike digitalis drugs, ECG had no effect on intracellular Ca(2+) level in cultured adult cardiac myocytes. Second, it activated PKCepsilon, but not PKCalpha, in the isolated hearts as well as in cultured cells. Neither a phospholipase C (PLC) inhibitor (U73122) nor the antioxidant N-acetyl cysteine (NAC) affected the ECG-induced activation of PKCepsilon. Third, inhibition of PKCepsilon by either chelerythrine chloride (CHE) or PKCepsilon translocation inhibitor peptide (TIP) caused a partial reduction of ECG-induced increases in myocardial contraction. Moreover, NAC was also effective in reducing the effects of ECG on myocardial contraction. Finally, pretreatment of the heart with both CHE and NAC completely abolished ECG-induced inotropic effects on the heart. Together, these findings indicate that ECG can regulate myocardial contractility via a novel PKCepsilon-dependent signaling pathway.     

Modulation of cardiac contractility through endothelin-1 release and myocardial mast cell degranulation

The aim of this study was to outline the consequences of a hypertonic saline-dextran-40 (HSD) infusion-induced peripheral flow stimulus on the ventricular function in closed-chest, pentobarbital-anesthetized dogs. We hypothesized that HSD-induced elevation in endothelin-1 (ET-1) and nitric oxide (NO) release can have a role in myocardial contractile responses; and that cardiac mast cells (MC) degranulation may be involved in this process. The consequences of disodium cromoglycate (a MC stabilizer) or ETR-p1/fl peptide (an endothelin-A receptor antagonist) treatment were evaluated. A 4 ml/kg iv HSD40 infusion significantly increased cardiac index and myocardial contractility, and resulted in a decreased peripheral resistance. The postinfusion period was characterized by significant plasma NO and ET-1 elevations, these hemodynamic and biochemical changes being accompanied by a decreased myocardial ET-1 content, NO synthase activity and enhanced myocardial MC degranulation. Disodium cromoglycate treatment inhibited the HSD40-induced elevations in myocardial contractility and MC degranulation, and similar hemodynamic changes were noted after treatment with ETR-p1/fl peptide, together with a normalized myocardial myocardial ET-1 content, NO synthesis and a significant reduction in MC degranulation. These results indicate that peripheral NO and ET-1 release modulates the cardiac contractility through myocardial ET-A receptor activation and MC degranulation.     

Earlier responses in the delay of Korotkoff sounds as compared to the Achilles reflex time in rapid changes of thyroid function in man.

In rapidly changing thyroid state Rodbard's Q-Kd interval (reflecting heart contractility) changes more rapidly, than ART (reflecting skeletal muscle contractility). After withdrawal of substitutive therapy in athyreotic patients the Q-Kd intervals prolongs more rapidly than ART and during intensive treatment of hypothyroidism the Q-Kd interval shortens more rapidly that ART. A more rapid metabolic turnover in heart muscle in comparison with skeletal muscle is proposed as suitable explanation. Practical consequences for early diagnosis of hypothyroidism and for instant functional diagnosis of thyroidal disorders are stressed.     

Radionuclide diagnosis of right ventricular myocardial infarction

The diagnostic capacities of 99mTc-pyrophosphate plane myocardial scintigraphy versus 99mTc-pyrophosphate single photon emission computed tomography (SPECT) were compared. Recording right precordial ECG leads showed that 26 patients had right ventricular myocardial infarction (MI)-typical changes as ST-segment evaluation, followed by abnormal Q wave. Plane scintigraphy indicated a characteristic inclusion of 99mTc-pyrophosphate into the right ventricular myocardium in 18.8% of the patients with acute lower MI and in one of 38 patients with acute MI of the anterior left ventricular wall. SPECT revealed a characteristic inclusion of 99mTc-pyrophosphate into the right ventricular myocardium much more frequently than did plane myocardial scintigraphy--in 34% of cases. Right ventricular myocardial inclusion of 99mTc-pyrophosphate was found in 50% of the patients with acute lower MI, including all 9 patients with positive 99mTc-pyrophosphate myocardial scintigraphy. Thus, the sensitivity of SPECT in the diagnosis of right ventricular MI is somewhat higher than that of precordial ECG and more than thrice higher than that of plane scintigraphy.     

大鼠心肌梗死模型的建立及梗死后心电生理和左室功能的变化

目的建立具有稳定性高,重复性强,存活时间长的大鼠心肌梗死模型,探讨采用心电图（ECG）和心脏超声心动图（UCG）监测心梗后心电生理和左室功能变化的可行性。方法Wistar大鼠经10%水合氯醛麻醉后,气管切开插管及连通呼吸机,开胸后结扎冠状动脉左前降支。于手术后4、8和12周行ECG检测和UCG检查,术后12周取出心脏行病理检查。结果采用本法建立大鼠心肌梗死模型,术后72h内大鼠存活率为83.3%,术后12周以上大鼠存活率为73.3%。术后48、和12周ECG监测示心梗后PR间期,QRS时限,QT间期和QTc间期均较假手术组延长,同期行UCG监测示心梗后左室舒张末期内径和左室收缩末期内径显著增加,左室射血分数值和左室短轴缩短率值显著降低,12周后组织病理HE染色符合慢性心肌梗死的病理改变。结论本技术操作简单、创伤轻、成功率高,术后采用ECG和UCG可有效监测心梗后不同时期心电变化和左室功能变化。     

The relative value of strain and strain rate for defining intrinsic myocardial function

It is well accepted that strain and strain rate deformation parameters are not only a measure of intrinsic myocardial contractility but are also influenced by changes in cardiac load and structure. To date, no information is available on the relative importance of these confounders. This study was designed to investigate how strain and strain rate, measured by Doppler echocardiography, relate to the individual factors that determine cardiac performance. Echocardiographic and conductance measurements were simultaneously performed in mice in which individual determinants of cardiac performance were mechanically and/or pharmacologically modulated. A multivariable analysis was performed with radial and circumferential strains and peak systolic radial and circumferential strain rates as dependent parameters and preload recruitable stroke work (PRSW), arterial elastance (E(a)), end-diastolic pressure, and left ventricular myocardial volume (LVMV) as independent factors representing myocardial contractility, afterload, preload, and myocardial volume, respectively. Radial strain was most influenced by E(a) (β = -0.58, R(2) = 0.34), whereas circumferential strain was strongly associated with E(a) and moderately with LVMV (β = 0.79 and -0.52, respectively, R(2) = 0.54). Radial strain rate was related to both PRSW and LVMV (β = 0.79 and -0.62, respectively, R(2) = 0.50), whereas circumferential strain rate showed a prominent correlation only with PRSW (β = -0.61, R(2) = 0.51). In conclusion, strain (both radial and circumferential) is not a good surrogate measure of intrinsic myocardial contractility unless the strong confounding influence of afterload is considered. Strain rate is a more robust measure of contractility that is less influenced by changes in cardiac load and structure. Thus, peak systolic strain rate is the more relevant parameter to assess myocardial contractile function noninvasively.     

中国人扩张型心肌病与受磷蛋白基因关系的研究

受磷蛋白（phospholamban）是心肌收缩的一个重要调节因子,可抑制心肌肌浆网钙ATPase的活性、降低其对钙的亲和力。正常情况下,受磷蛋白可被不同的蛋白激酶磷酸化从而解除其肌浆网钙ATPase的抑制作用。国外两个DCM家系研究发现受磷蛋白基因突变与DCM的发生有关,研究目的旨在探讨中国人群心肌特异性受磷蛋白基因突变与特发性扩张型心肌病发病的关系。收集60例确诊的特发性扩张型心肌病患者临床资料,采集血样本并分离白细胞和提取基因组DNA。应用PCR扩增肌特异性受磷蛋白基因片段,经测序检测基因突变的存在。结果显示60例扩张型心肌病人受磷蛋白基因开放阅读框未发现突变,仅有两例患者出现阅读框3′部分非翻译区分别离终止密码153和173位单个碱基T的缺失。两例患者终止密码后非翻译区单个碱基T的缺失据分析并无实际意义。因此我们认为绝大部分中国人扩张型心肌病的发病可能与受磷蛋白基因突变无关。Abstract: Phospholamban (PLB) is a prominent regulator of myocardial contractility and a reversible inhibitor of the cardiac sarcoplasmic reticulum Ca2+ ATPase activity. In normal cardiac muscles, phospholamban can be phosphorylated at distinct sites by various protein kinases and release its inhibition to sarcoplasmic reticulum Ca2+ ATPase. The studies of pedigrees have shown dilated cardiomyopathy (DCM) is related with mutation of PLB. The aim of present study is to investigate the relationship between mutation of PLB gene and DCM. Sixty patients with idiotic DCM were enrolled in present study. The clinical data were collected, including clinical symptoms, ECG and echocardiography. Peripheral blood samples of all these subjects were collected to extract genome DNA. The fragments of PLB gene were amplified by PCR and PCR fragment sequencing was performed to study weather mutation of phospholamban gene exists. phospholamban gene did not show any mutation in these patients. Most Chinese DCM patients may not be related with mutation of PLB gene.     

The functional status of the left ventricle in normal conditions. Results of multiphase x-ray contrast left ventriculography]

The main functional characteristics of the left ventricle (LV) were defined using a method of multiphase radiopaque left ventriculography. Three groups of indices of LV function (energetic LV indices, indices of chamber diastolic function, and indices of local motion of the LV walls in the course of a complete cardiocycle) were standardized in healthy persons. An original algorithm of analysis of local LV myocardial contractility was used. A combined approach to interpretation of results of this method was worked out. A standard set of indices, reflecting LV function, was defined. Standardized values of these indices, necessary for an effective use of this method, were obtained.     

Study of the impact of intramyocardial implantation of stem cells on myocardial perfusion and contractility in patients with coronary heart disease concurrent with postinfarct cardiosclerosis and chronic heart failure

OBJECTIVE: to study of intramyocardial implantation of cultured bone marrow stem cells on myocardial perfusion and contractility in the surgical treatment of patients with coronary heart disease (CHD) and chronic heart failure (CHF), by synchronized single-photon emission computed tomography (SSPECT) of the myocardium. SUBJECTS AND METHODS: The study included 11 patients. Intramyocardial injection of cell injections into the myocardial periscarring areas was made at coronary bypass surgery. All the patients underwent 99mTc myocardial SSPECT MIBI before and 3, 6, 12 months after surgery. RESULTS AND CONCLUSIONS: Implantation of bone marrow stem cells into the left ventricular myocardium favorably affects left ventricular remodeling and contributes to the improvement of myocardial perfusion and contractility, as evidenced by 99mTc.