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Detection of viable myocardium in ischemic heart disease : New approach using 3d analysis of tagging with dobutamine stress MRI
94
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 2 1998
117
118
Short-term(In-Hospital) Prognosis of Low Output Syndrome in AMI patient. Hiroaki Okabayashi, Nobuyuki Makishima, Yuji Hamazaki,Atsuo Namiki,Hiroshi Suzuki, Mikitaka Murakami, Takashi Katagiri. Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan Purpose:Weinvestigatedpredictor of prognosisin patients with LOSin AMI. Subjects and Methods:Onehandred-fifty patientsof AMI from August'96 throughMarch '98 were enteredin this study. Our managementsof AMI were guidedto AMI guideline(AHATASKFORCE)and early reperfusiontherapy of infarct related artery was usuallyperformed.We measured bloodpH,serumcreatinine(Cr), creatine phosphokinase. Hemodynamicsand cardiac outputusingthermodilutioncatheter were also measuredon admission. Results: In wholepatients, in-hospital mortality was 14 percent. However,the mortality was higher( 42 percent) in patientswith LOSin AMI. We foundthat in casesof the patientswith renal dysfunction(Cr> 2.0) , acidosis (pH<7.20) ,andlow cardiacoutput ineffective to catecholamine,theprognosiswas poorerthan other patients (ANOVA R= 0.883 p<.0001). Conclusion:Renaldysfunctionand acidosiswere high risk predictor of LOSin AMI. Additionaltherapy ( IABP, respirator, hemodialysis,and anotherinotoropicagents) should be consideredin those patients.
119
DETECTION OF VIABLE MYOCARDIUB IN ISCHEMIC HEART DISEASE : NEW APPROACHUSING 3D ANALYSIS OF TAGGING WITH DOBUTAMINESTRESS MRI Shigeru Watanabe, Isao Saito, Hideki Sakuraba, Katsuhiro One, Miharu Urano, Yasuyoshi Hijikata, Toshihisa Inoue, Toshiharu Himi, Akira ~iyazaki, Yoshiaki Masuda The Third Department of Internal Medicine, Chiba University, Chiba 260-8670, Japan To evaluate the presence of v i a b l e myocardium salvaged by coronary artery reperfusion, 20 patients with ischemic heart disease (11AMI, 6 OMI, 3 AP) were studiedby dobutamine stress MRI. After an examination of CAG and LVG, patients underwent cine MRI with myocardial tagging using SPAMB technique, and long-axis and short-axis sections of the l e f t v e n t r i c l e (LV) before and during dobutamine infusion (5~g/Kg/min) were obtained. 3D analysis of the intramyocardial movement of LV on tagged images obtained from enddiastole to endsystole was done. Dobutamine stress echocardiography (ECHO) were also performed for comparison. 17 patients of the 20 were found to have v i a b l e myocardium by uptake of lSFDG-PET or by an improvement of wall motion after coronary intervention. The s e n s i t i v i t y and s p e c i f i c i t y of t a g g i n g MRI was 100~ and 89~ compared with 78~ and 100 % of ECHO respectively, for detection of v i a b l e myocardiu~ It is suggested that a low-dose dobutamine stress tagging MRI can be useful method for determination of the v i a b i l t y i n myocardial segments.
120
HENODYNAMIC EFFECTS OF ENHANCED EXTERNAL COUNTERPULSATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Isao Taguchi, Kenichi Ogawa, Hideyo Kuga, Hirobumi Akiba, Ken Hirose, Akitugu Oida, Hirotada Maezawa, Masahiko Iizuka First Department of Medicine, Dokkyo University School of Medicine, Tochigi 321-0293, Japan Enhanced external counterpulsatioa (EECP) has been postulated to have the same hemodynamic effects as Intraaortic Balloon Pumping (IABP) with benefits to patients with coronary artery disease. We investigated these effects in 17 patients (60.4 + 8.7 years old male) with acute myocardial infarction and balloon angioplasty. Swan-Ganz catheters were used to measure fight atrial pressure (RAP), pulmonary wedge pressure (PWP) and cardiac index (Co by thermodilution before, during and 60 rain after EECP. Areas under the systolic (AS) and diastolic (AD) radial artery pressure curves were also calculated. Results are shown in the following table. RAP, PWP and CI increased significantly (i)<0.05) possibly due to increase venous return. The increase in CI may cause the lack of significant reduction of systolic unloading (AS). However, AD increased significantly during EECP (p<0.05), similar to the effects of IABP. Thus, the benefits of EECP may come from diastolic augmentation, increased venous return but not systolic unloading. During Control RAP 3,6 ~ 2,6 FWP 8.6 -+ 4.3
EECP
15min
3Omia
45rain
6.6 ± 4.0*
5.7 -I- 3.6
5.5 ± 4.3
11.6 + 4.7
13.0 + 6.8*
12.3 ± 5.8
60rain
60rain after
5.3 ~ 4.1
2.2 ~+ 1.8
11.4 ± 5.9
6.3 ± 3.1
CI
3.2 ± 0.9
3.6 + 0.7
3.7 ± 0.8
4.0 ~+ 1.0'
4.0 + 1.2"
3.5 ± 1.0
AS
30 -----4.6
28 _+ 5.8
28 -I- 5.8
28 ± 5.4
28 ± 4,6
30 -+ 4.9
AD
33 ± 8.8
41 -I- 8.2*
41 ± 8.5* 41 ± 10,1"
42 ± 10.4"
33 ± 8.8
*= p<0.05
CARVEDILOL DECREASED M O R T A L I T Y RATE IN RATS WITH A D R I A M Y C I N - I N D U C E D M Y O C A R D I A L INJURY Kunihiko Teraoka, Masaharu Hirano, KyokoYamaguchi, Yoshikazu Nagai, Chiharu Ibukiyama Department of Cardiology, Tokyo Medical College, Tokyo 160-O023,Japan [Objective] To examine the cardiac protective effect of carvedilol in rats with addamycin-induced myocardial injury. [Methods] Adriamycin was intraperitoneally given to 8-week old male Wister rats for 3weeks at a total dose of 15mg/kg to prepare a rat model of adriamycininduced myocardial injury. Twenty one rats in the cervedilol group (C group) and 24rats in the non-treated group (N group) were followed for 12weeks and examined for histopathological findings and mortality rate. [Results] 1) The mortality rate was 14.3% (3/21rats) in the C group and 41.7% (11/24rats) in the N group, showing a significantly lower value in the C group when compared by the Fisher analysis method. 2)Histopathologically, tissue lesions were more severe in the N group. [Conclusion] Carvedilol inhibits the occurrence of adriamycin-induced myocardial injury in rats and decreases the mortality rate.
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 2 1998
117
118
Short-term(In-Hospital) Prognosis of Low Output Syndrome in AMI patient. Hiroaki Okabayashi, Nobuyuki Makishima, Yuji Hamazaki,Atsuo Namiki,Hiroshi Suzuki, Mikitaka Murakami, Takashi Katagiri. Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan Purpose:Weinvestigatedpredictor of prognosisin patients with LOSin AMI. Subjects and Methods:Onehandred-fifty patientsof AMI from August'96 throughMarch '98 were enteredin this study. Our managementsof AMI were guidedto AMI guideline(AHATASKFORCE)and early reperfusiontherapy of infarct related artery was usuallyperformed.We measured bloodpH,serumcreatinine(Cr), creatine phosphokinase. Hemodynamicsand cardiac outputusingthermodilutioncatheter were also measuredon admission. Results: In wholepatients, in-hospital mortality was 14 percent. However,the mortality was higher( 42 percent) in patientswith LOSin AMI. We foundthat in casesof the patientswith renal dysfunction(Cr> 2.0) , acidosis (pH<7.20) ,andlow cardiacoutput ineffective to catecholamine,theprognosiswas poorerthan other patients (ANOVA R= 0.883 p<.0001). Conclusion:Renaldysfunctionand acidosiswere high risk predictor of LOSin AMI. Additionaltherapy ( IABP, respirator, hemodialysis,and anotherinotoropicagents) should be consideredin those patients.
119
DETECTION OF VIABLE MYOCARDIUB IN ISCHEMIC HEART DISEASE : NEW APPROACHUSING 3D ANALYSIS OF TAGGING WITH DOBUTAMINESTRESS MRI Shigeru Watanabe, Isao Saito, Hideki Sakuraba, Katsuhiro One, Miharu Urano, Yasuyoshi Hijikata, Toshihisa Inoue, Toshiharu Himi, Akira ~iyazaki, Yoshiaki Masuda The Third Department of Internal Medicine, Chiba University, Chiba 260-8670, Japan To evaluate the presence of v i a b l e myocardium salvaged by coronary artery reperfusion, 20 patients with ischemic heart disease (11AMI, 6 OMI, 3 AP) were studiedby dobutamine stress MRI. After an examination of CAG and LVG, patients underwent cine MRI with myocardial tagging using SPAMB technique, and long-axis and short-axis sections of the l e f t v e n t r i c l e (LV) before and during dobutamine infusion (5~g/Kg/min) were obtained. 3D analysis of the intramyocardial movement of LV on tagged images obtained from enddiastole to endsystole was done. Dobutamine stress echocardiography (ECHO) were also performed for comparison. 17 patients of the 20 were found to have v i a b l e myocardium by uptake of lSFDG-PET or by an improvement of wall motion after coronary intervention. The s e n s i t i v i t y and s p e c i f i c i t y of t a g g i n g MRI was 100~ and 89~ compared with 78~ and 100 % of ECHO respectively, for detection of v i a b l e myocardiu~ It is suggested that a low-dose dobutamine stress tagging MRI can be useful method for determination of the v i a b i l t y i n myocardial segments.
120
HENODYNAMIC EFFECTS OF ENHANCED EXTERNAL COUNTERPULSATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Isao Taguchi, Kenichi Ogawa, Hideyo Kuga, Hirobumi Akiba, Ken Hirose, Akitugu Oida, Hirotada Maezawa, Masahiko Iizuka First Department of Medicine, Dokkyo University School of Medicine, Tochigi 321-0293, Japan Enhanced external counterpulsatioa (EECP) has been postulated to have the same hemodynamic effects as Intraaortic Balloon Pumping (IABP) with benefits to patients with coronary artery disease. We investigated these effects in 17 patients (60.4 + 8.7 years old male) with acute myocardial infarction and balloon angioplasty. Swan-Ganz catheters were used to measure fight atrial pressure (RAP), pulmonary wedge pressure (PWP) and cardiac index (Co by thermodilution before, during and 60 rain after EECP. Areas under the systolic (AS) and diastolic (AD) radial artery pressure curves were also calculated. Results are shown in the following table. RAP, PWP and CI increased significantly (i)<0.05) possibly due to increase venous return. The increase in CI may cause the lack of significant reduction of systolic unloading (AS). However, AD increased significantly during EECP (p<0.05), similar to the effects of IABP. Thus, the benefits of EECP may come from diastolic augmentation, increased venous return but not systolic unloading. During Control RAP 3,6 ~ 2,6 FWP 8.6 -+ 4.3
EECP
15min
3Omia
45rain
6.6 ± 4.0*
5.7 -I- 3.6
5.5 ± 4.3
11.6 + 4.7
13.0 + 6.8*
12.3 ± 5.8
60rain
60rain after
5.3 ~ 4.1
2.2 ~+ 1.8
11.4 ± 5.9
6.3 ± 3.1
CI
3.2 ± 0.9
3.6 + 0.7
3.7 ± 0.8
4.0 ~+ 1.0'
4.0 + 1.2"
3.5 ± 1.0
AS
30 -----4.6
28 _+ 5.8
28 -I- 5.8
28 ± 5.4
28 ± 4,6
30 -+ 4.9
AD
33 ± 8.8
41 -I- 8.2*
41 ± 8.5* 41 ± 10,1"
42 ± 10.4"
33 ± 8.8
*= p<0.05
CARVEDILOL DECREASED M O R T A L I T Y RATE IN RATS WITH A D R I A M Y C I N - I N D U C E D M Y O C A R D I A L INJURY Kunihiko Teraoka, Masaharu Hirano, KyokoYamaguchi, Yoshikazu Nagai, Chiharu Ibukiyama Department of Cardiology, Tokyo Medical College, Tokyo 160-O023,Japan [Objective] To examine the cardiac protective effect of carvedilol in rats with addamycin-induced myocardial injury. [Methods] Adriamycin was intraperitoneally given to 8-week old male Wister rats for 3weeks at a total dose of 15mg/kg to prepare a rat model of adriamycininduced myocardial injury. Twenty one rats in the cervedilol group (C group) and 24rats in the non-treated group (N group) were followed for 12weeks and examined for histopathological findings and mortality rate. [Results] 1) The mortality rate was 14.3% (3/21rats) in the C group and 41.7% (11/24rats) in the N group, showing a significantly lower value in the C group when compared by the Fisher analysis method. 2)Histopathologically, tissue lesions were more severe in the N group. [Conclusion] Carvedilol inhibits the occurrence of adriamycin-induced myocardial injury in rats and decreases the mortality rate.