Ventricular fibrillation from diatrizoate with and without chelating agents

The toxicity of Renografin 76% was compared with that of Hypaque 76% by selective injection of each into the right coronary artery of dogs. Renografin contains the chelating agents sodium citrate and disodium edetate, while Hypaque contains calcium disodium edetate and no sodium citrate. Ventricular fibrillation occurred significantly more often with Renografin, suggesting that chelating agents contribute to toxicity in coronary angiography.     

频发室性心动过速伴室颤患者的抢救与护理

室性心动过速（VT）常发生于各种器质性心脏病患者，最常见于冠心病，也与电解质紊乱有关。对于持续性的VT则应立即终止，因其可以恶化泵功能，极易转化为室颤（VF）。2008年7月18日我科成功救治1例频发VT伴VF患者，现将抢救及护理报告如下。     

MR imaging in patients with primary thyroid lymphoma.

The authors describe two patients with thyroid lymphoma and Hashimoto thyroiditis; T1- and T2-weighted MR sequences were used. In one patient, the region of lymphoma showed a different signal intensity on T2 images; in the other patient, the signal level was identical to the Hashimoto disease. In sum, the processes could not be significantly differentiated using MR.     

缬沙坦减少心房颤动复发及延缓心房结构重构的临床观察

目的 评价缬沙坦联合小剂量胺碘酮对阵发性房颤患者的房颤复发、左心房内径（LAD）、P波离散度（Pd）及P波最大时限（Pmax）的影响。方法 将76例阵发性房颤患者随机分为试验组（缬沙坦＋胺碘酮）和对照组（安慰剂＋胺碘酮）,共治疗18个月。如出现症状性房颤发作,立即与医生联系,并尽快描记心电图。计算两组治疗前和治疗后6、12、18个月的房颤负荷、Pmax、Pd和LAD。结果 18个月随访中,对照组共有15例（41％）发生心电图证实的房颤发作,而试验组为6例（16％）,两组比较差异显著（P〈0.01）。治疗前及治疗后6个月,两组患者房颤负荷无显著差异,但治疗后12个月和18个月,试验组患者的房颤负荷显著低于对照组。治疗前两组患者PITiax、Pd均无显著性差异,治疗后6、12、18个月治疗组的Pmax、Pd均明显低于对照组。两组患者LAD在治疗前及治疗后6个月内无显著差异,治疗后12、18个月对照组LAD显著大于试验组。结论 缬沙坦与胺碘酮联合治疗阵发性房颤较单用胺碘酮能更有效地减少复发,这种效应可能与血管紧张素受体（ARB）改善心房结构重构有关。     

Effect of partial volume correction on muscarinic cholinergic receptor imaging with single-photon emission tomography in patients with temporal lobe epilepsy

Animal experiments and preliminary results in humans have indicated alterations of hippocampal muscarinic acetylcholine receptors (mAChR) in temporal lobe epilepsy. Patients with temporal lobe epilepsy often present with a reduction in hippocampal volume. The aim of this study was to investigate the influence of hippocampal atrophy on the quantification of mAChR with single photon emission tomography (SPET) in patients with temporal lobe epilepsy. Cerebral uptake of the muscarinic cholinergic antagonist [¹²³I]4-iododexetimide (IDex) was investigated by SPET in patients suffering from temporal lobe epilepsy of unilateral (n=6) or predominantly unilateral (n=1) onset. Regions of interest were drawn on co-registered magnetic resonance images. Hippocampal volume was determined in these regions and was used to correct the SPET results for partial volume effects. A ratio of hippocampal IDex binding on the affected side to that on the unaffected side was used to detect changes in muscarinic cholinergic receptor density. Before partial volume correction a decrease in hippocampal IDex binding on the focus side was found in each patient. After partial volume no convincing differences remained. Our results indicate that the reduction in hippocampal IDex binding in patients with epilepsy is due to a decrease in hippocampal volume rather than to a decrease in receptor concentration.     

影响高血压病左室重构的因素探讨

 目的探讨高血压病患者引起左室重构的主要危险因素.方法将患高血压病伴肥胖、经心脏B超证实有左室重构者42例,血压管理经24h血压监测,进行随访、追踪5 a,采用logistic回归分析.结果收缩压持续升高伴肥胖者左室重构的系数为1.183,危险度为3.513;长期降压、减肥、运动、饮茶的危险度为负值.结论收缩压持续升高伴肥胖者是引起左室重构的主要危险因素;降压、减肥、运动、饮茶是抑制左室重构的因素.     

Serial cine-magnetic resonance imaging of left ventricular remodeling after myocardial infarction in rats.

The purpose of the present study was the serial investigation of morphological and functional changes after left coronary artery ligation in the intact rat using cine-magnetic resonance imaging (MRI). MRI studies were performed 4, 8, 12, and 16 weeks after myocardial infarction (MI) with an echocardiogram (ECG)-triggered cine-fast low-angle shot (FLASH)-sequence in a 7-Tesla magnet. MI-size, left ventricular (LV) mass and volumes, cardiac index, ejection fraction (EF), and remote wall and scar thickness of 11 Wistar rats were compared to four sham-operated rats. Stress MRI with dobutamine (10 microl/kg x minute) was performed at 16 weeks. In MI groups (small MI < 30%, N = 5, large MI > 30%, N = 6), there was significant increase of LV mass (small MI + 47.8% increase, large MI + 74.1%) and wall thickness (large MI 1.21 +/- 0.03 to 1.84 +/- 0.07 mm). Scar thickness declined from four to 16 weeks (large MI 0.92 +/- 0.06 to 0.38 +/- 0.02 mm, P < 0.05). End-diastolic volume of both MI groups was significantly elevated but increased further only in animals with large MI from four to 16 weeks (657.1 +/- 38.6 to 869.7 +/- 60.7 microL, P < 0.05). Compared to sham, EF was significantly depressed in MI (large MI 31.5 +/- 2.0%). Wall thickening declined from four to 16 weeks post-MI (large MI 50.9 +/- 9.9 to 28.9 +/- 4.4%, P < 0.05). During stress, sham and MI rats increased wall thickening from 66.5 +/- 8.2 to 111.2 +/- 6.7% and from 30.8 +/- 4.3 to 47.5 +/- 5.8%, respectively (P < 0.05). Hypertrophy was found in all animals with MI throughout the entire period of observation, whereas dilatation after four weeks was only detected in animals with large MI. These morphologic changes were accompanied by an early decline of EF; myocardial function characterized by wall thickening deteriorated later.     

应用组织多普勒技术对高血压性和运动性重塑者左室功能检测及区别评价

目的：探讨应用组织多普勒（DTI）技术对高血压性及运动性心脏重塑者左室功能检测及两者的区别评价价值。方法选择原发性高血压所致的左室肥厚者40例（A组）,运动诱导所致的左室肥厚者35例（B组）,及健康者40例（C组）。获取标准左室长轴切面和心尖四腔心切面,应用M型及D T I技术观察各组的左心室结构及功能变化。结果A组与B组的室间隔、左室后壁厚度以及左室心肌质量指数均高于C组。脉冲多普勒测量结果显示：与C组相比,A组A峰升高、E/A值降低,有显著差异性（ P ＜0．01）,B组A峰下降、E/A比值升高,均有显著差异性（ P ＜0．01）;DTI测量结果中,与B组及C组相比,A组二尖瓣瓣环左室侧壁心肌舒张早期运动峰值速度（Ve）、舒张期运动峰值速度（Va）及Ve/Va值均出现明显变化（ P ＜0．01）。结论 DTI能检测高血压性及运动性重塑者左室功能,并鉴别区分。     

Somatostatin receptor imaging in patients with sarcoidosis

Granulomatous diseases can be visualized in vivo after the injection of indium-111-DTPA-octreotide (¹¹¹In-pentetreotide), a radiolabelled somatostatin analogue. We evaluated whether somatostatin receptor imaging reflects disease activity, whether certain scintigraphic characteristics can predict the disease prognosis and whether repeat scintigraphy correlates with the clinical course in patients with sarcoidosis. ¹¹¹In-pentetreotide was injected in 46 patients and images were obtained 24 h later. Known mediastinal, hilar and interstitial disease was recognized in 36 of 37 patients. Also, such pathology was found in seven other patients who had normal chest X-rays. In five of these, somatostatin receptor imaging pointed to interstitial disease. Frequently, accumulation of radioactivity in parotid glands and supraclavicular lymph nodes was found. Neither the degree of radioactive accumulation in the thorax nor a specific pattern of pathological uptake was correlated with disease severity or clinical course. The degree of uptake of radioactivity in the parotid glands was correlated with significantly higher serum angiotensin-converting enzyme (ACE) levels. Somatostatin receptor imaging was repeated in 13 patients. In five of six patients in whom chest X-ray monitored improvement of disease activity, the pentetreotide scintigram also showed a decrease in pathological uptake. In two of five patients in whom the chest X-ray was unchanged, but serum ACE concentrations had decreased and lung function improved, normalization on pentetreotide scintigrams was found. It is concluded that: (1) somatostatin receptor imaging can demonstrate active granulomatous disease in patients with sarcoidosis; (2) pathological uptake of radioactivity in the parotid glands during somatostatin receptor imaging is correlated with higher serum ACE concentrations; (3) the value of somatostatin receptor imaging in the follow-up of patients with sarcoidosis will have to be determined in a prospective longitudinal study. Received 17 March and in revised form 17 April 1998     

C反应蛋白与高血压左室重构关系的临床探讨

目的：探讨原发性高血压（EH）患者左室重构与C反应蛋白（CRP）的关系及影响其水平的临床指标。方法：所有研究对象114例包括EH组81例和健康对照组33例。EH组行彩色多普勒超声心动图检查,根据左室重量指数（LVMI）将EH患者分为增高组和正常组两组,分别测定两组的血清C反应蛋白（CRP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、尿素氮（BUN）、肌酐（CR）、尿酸（UA）及血钾（K^＋）水平。结果：高血压组与健康对照组血清CRP水平之间差异显著（P〈0．05）;LVMI增高组与LVMI正常组血清C反应蛋白水平之间差异显著（P〈0．05）,前者显著增高,且随着LVMI的增加,C反应蛋白呈上升趋势。C反应蛋白与TG、CR、室间隔厚度、左室后壁厚度、左室舒张末期内径呈正相关,与EF呈负相关（P〈0．05）。结论：（1）血清CRP浓度与EH相关,提示炎症反应可能参与了EH的发生;（2）CRP是EH患者合并左室重构的独立预测指标,它在左室重构的发生发展中可能起了一定作用。     

Multimodality imaging of left atrium in patients with atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia worldwide associated with significant morbidity and mortality and represents a significant health care burden. Goals of AF treatment include prevention of cardioembolic stroke using anticoagulation and device therapy and restoration of sinus rhythm using antiarrhythmic drugs or catheter ablation techniques. A comprehensive assessment of cardiac chamber size and function is often started with echocardiography as a first line diagnostic imaging strategy. Recently, innovations in advanced imaging using cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) provide a detailed characterization of atrial anatomy and have been shown to accurately exclude thrombus and guide left atrial appendage (LAA) closure or catheter ablation (CA) of atrial fibrillation. Compared to echocardiography, CCT offers an uncompromised spatial resolution and a fast dataset acquisition, with the disadvantages of the need of iodine contrast agent and radiation exposure. CMR, conversely, can rely on very high temporal resolution, the unique feature of tissue characterization and the absence of radiation exposure. However, the main drawbacks of this diagnostic tool are long scan times and low availability. This review will illustrate the vital role of multimodality cardiac imaging in the accurate identification of left atrial, pulmonary vein and LAA size and function, discuss advanced imaging techniques to rule out thrombus and highlight novel CMR and CCT techniques to guide catheter ablation of AF and LAA occlusion.     

Prediction of left ventricular remodeling and analysis of infarct resorption in patients with reperfused myocardial infarcts by using contrast-enhanced MR imaging

PURPOSE: To prospectively evaluate the accuracy of clinical and cardiac magnetic resonance (MR) imaging parameters for predicting left ventricular (LV) remodeling by using follow-up imaging as reference standard, and to prospectively evaluate infarct resorption in patients with reperfused first myocardial infarcts. MATERIALS AND METHODS: The study was approved by the institutional ethics committee and all patients gave written informed consent. In 55 patients (48 men, seven women; mean age+/-standard deviation, 56 years+/-13), contrast material-enhanced and cine MR imaging were performed 5 days+/-3 and 8 months+/-3 after myocardial infarction (MI). Microvascular obstruction (MO) and infarct size were estimated at first-pass enhancement (FPE) and delayed enhancement (DE) MR, respectively. Remodeling was defined as an increase in LV end-diastolic volume index of 20% or higher at follow-up. Differences in continuous and categorical data were analyzed by using Student t test and Fischer exact test as appropriate. RESULTS: Patients with remodeling (n=13, 24%) had higher creatine kinase MB (P<.05), more anterior infarcts (P<.05), more often a reduced Thrombolysis in Myocardial Infarction flow (P<.05), larger infarct size at DE MR (P<.001), a greater extent of MO at FPE MR (P<.01), lower ejection fraction (P<.001) and higher LV end-systolic volume index (P<.01). Infarct size at DE MR was a powerful predictor for remodeling (odds ratio: 1.18, P<.001), demonstrating that the risk for remodeling increased 2.8-fold with each 10% increase in infarct size. Infarct size of 24% or more of LV area predicted remodeling with high sensitivity (92%), specificity (93%), and accuracy (93%). Infarct resorption was larger in patients with remodeling (P<.01). CONCLUSION: Infarct size 24% or more of the LV area constitutes an important threshold to predict remodeling. Patients with remodeling develop disproportionate infarct resorption.     

Myocardial 11C-diacylglycerol accumulation and left ventricular remodeling in patients after myocardial infarction.

Left ventricular (LV) remodeling after myocardial infarction (MI) is a maladaptive process that increases the risk of heart failure and death. The myocardial phosphoinositide cycle, which is located downstream from several neurohumoral factors, plays a crucial role in LV remodeling. Our animal studies demonstrated that 1-[1-11C]butyryl-2-palmitoyl-rac-glycerol (11C-DAG) can be used to visualize regions with an activated phosphoinositide cycle. Therefore, we examined whether myocardial 11C-DAG accumulation assessed by PET is relevant to LV enlargement and systolic dysfunction in post-MI patients. METHODS: We performed PET with 11C-DAG in 13 post-anteroseptal MI patients and 4 healthy volunteers. We placed regions of interest on the noninfarcted myocardium and calculated the myocardium-to-left atrial (LA) chamber ratio of 11C-DAG accumulation. RESULTS: The myocardium-to-LA chamber ratio of 11C-DAG was significantly higher in the post-MI patients (mean +/- SD, 1.73 +/- 0.35) compared with that of the healthy volunteers (mean +/- SD, 1.25 +/- 0.13; P < 0.05). In the post-MI patients, the myocardium-to-LA chamber ratio of (11)C-DAG was significantly correlated with the LV end-diastolic volume index (r = 0.79, P < 0.01) and the plasma concentration of brain natriuretic peptide (r = 0.85, P < 0.001) and negatively correlated with the LV ejection fraction (r = -0.69, P < 0.01). CONCLUSION: These findings suggest that the myocardial 11C-DAG accumulation assessed by PET is relevant to LV enlargement, LV systolic dysfunction, and humoral activation in post-MI patients. This new imaging strategy based on intracellular signaling may contribute to the assessment and treatment of post-MI patients.     

高血压合并心力衰竭患者血脂指标及比值与左心室重构的关系研究

目的 探究高血压合并心力衰竭患者血脂指标及比值与左心室重构的关系。方法 选取2019年6月到2022年6月海安市人民医院收治的159例高血压患者作为研究对象。将全部研究对象分为训练集和测试集。收集全部患者一般临床资料,检测血脂指标[总胆固醇（TC）,甘油三酯（TG）,高密度脂蛋白（HDL-C）,低密度脂蛋白（LDL-C）],并计算TC/HDL-C、TG/HDL-C、LDL-C/HDL-C比值。超声测量患者左心室舒张末期内径（LVEDD）、左室射血分数（LVEF）等,并计算左心室重构指数（LVRI）。多因素Logistic回归分析影响高血压患者发生心力衰竭的危险因素,Pearson相关性分析LVRI与血脂指标及比值关系。结果 训练集中的研究组患者高血压病程、FBG、TG、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、LVEDD高于对照组,HDL-C、LVEF、LVRI低于对照组（P<0.05）。多因素Logistic回归分析显示,训练集高血压病程长、高FBG、高TC、高TC/HDL-C、高TG/HDL-C、高LDL-C/HDL-C、低HDL-C、低LVRI是高血压患者发生心力衰竭的危险因素（P<0.05）。随NYHA分级增加,TG、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C逐渐升高,HDL-C逐渐降低（P<0.05）。Pearson相关性分析显示,LVRI与TG、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C呈正相关,与HDL-C呈负相关（P<0.05）。结论 高血压合并心力衰竭患者血脂水平及比值与左心室重构密切相关,临床需及早防控血脂异常,以降低心力衰竭的发生。     

卡维地洛对充血性心力衰竭患者神经激素及心室重构的影响

卡维地洛是一种非选择性兼有血管扩张作用的β受体阻滞剂,1996年成为获准FDA批准用于治疗心衰的第1个β受体阻滞剂。本研究旨在观察卡维地洛对充血性心力衰竭(CHF)患者神经激素、心室重构及心功能的影响。     

Diffusion-weighted imaging in rectal carcinoma patients without and after chemoradiotherapy: A comparative study with histology

Diffusion-weighted imaging (DWI) can be used to quantitatively assess functional parameters in rectal carcinoma that are relevant for prognosis and treatment response assessment. However, there is no consensus on the histopathological background underlying the findings derived from DWI. The aim of this study was to perform a comparison of DWI and histologic parameters in two groups of rectal carcinoma patients without (n = 12) and after (n = 9) neoadjuvant chemoradiotherapy (CRT). The intravoxel incoherent motion (IVIM) model was used to calculate the diffusion coefficient D and the perfusion fraction f in rectal carcinoma, the adjacent rectum and fat in the two patient groups. Immunohistological analysis was performed to assess the cellularity, vascular area fraction and vessel diameter for comparison and correlation. Out of 36 correlations between parameters from DWI and histology, four were found to be significant. In rectal carcinoma of patients without CRT, the diffusion D and the perfusion f correlated with the vascular area fraction, respectively, which could not be found in the group of patients who received CRT. Further correlations were found for the rectum and fat. Histological evaluation revealed significant differences between the tissues on the microscopic level concerning the cellular and vascular environment that influence diffusion and perfusion. In conclusion, DWI produces valuable biomarkers for diffusion and perfusion in rectal carcinoma and adjacent tissues that are highly dependent of the underlying cellular microenvironment influenced by structural and functional changes as well as the administered treatment, and consequently can be beyond histological ascertainability.     

Prediction of left ventricular dilatation with thallium-201 SPET imaging after primary angioplasty in patients with acute myocardial infarction

Progressive ventricular dilatation is an important prognostic factor in patients with acute myocardial infarction. We evaluated clinical, angiographic, echocardiographic and thallium-201 single-photon emission tomography (SPET) imaging variables predictive of the change in left ventricular volume during a 7-month follow-up period after primary angioplasty in patients with acute myocardial infarction. Thirty-six patients with first acute myocardial infarction treated with primary angioplasty within 12 h of onset underwent 201Tl SPET imaging (5.8+/-2.1 days after angioplasty). Changes in left ventricular volume were assessed over the 7-month period. The left ventricle dilated significantly after angioplasty ( P<0.001). Multivariate analysis revealed that the number of segments with 201Tl uptake <40% of peak activity was a single independent predictor of increase in end-diastolic volume index between 1 week and 7 months ( R2=0.41, P< 0.001). The presence of two or more segments with 201Tl uptake <40% predicted an increase in end-diastolic volume index of > or =6 ml/m2 with positive and negative predictive values of 85% (17/20) and 75% (12/16), respectively. It is concluded that, following primary angioplasty in patients with acute myocardial infarction, the extent of myocardial infarction assessed by 201Tl SPET can identify those who will develop ventricular dilatation during the subsequent 7 months.