Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(STEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with STEMI undergoing PCI,depression was independently associated with a large infarction size.     

Erratum: MR imaging in assessing cardiovascular interventions and myocardial injury

Contrast Media and Molecular Imaging, MR imaging in assessing cardiovascular interventions and myocardial injury, Alexis Jacquier, Charles B. Higgins and Maythem Saeed, published in CMMI 2:1, DOI: 10.1002/cmmi122, pp1–15. Contract/Grant Sponsor information relating to Dr. A. Jacquier was absent from the published article. It should be noted that Dr. A. Jacquier was supported by the Société Française de Radiologie, Paris, as a research fellow.     

MR imaging in assessing cardiovascular interventions and myocardial injury

Performing an MR‐guided endovascular intervention requires (1) real‐time tracking and guidance of catheters/guide wires to the target, (2) high‐resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X‐ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR‐guidance. Iron particles, or gadolinium‐ or dysprosium‐chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR‐guided minimally invasive catheter‐based procedures will open up new avenues in treating end‐stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real‐time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non‐invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications. Copyright © 2007 John Wiley & Sons, Ltd.     

斑点追踪技术对研究心肌再灌注损伤的应用价值

目的：应用斑点追踪技术研究再灌注损伤对心肌收缩功能的影响。方法：将20只健康成年杂种犬左冠状动脉第一对角支下方结扎180 min并再灌注120 min,分别对结扎前、结扎即刻、结扎180 min及再灌注即刻、60 min和120 min基底水平、乳头肌水平和心尖水平心肌的圆周应变进行比较。结果：基底水平心肌再灌注即刻圆周应变下降,再灌注后上升,高于基础状态。乳头肌水平心肌再灌注后圆周应变上升,仍低于基础状态,没有显著性差异。心尖水平心肌再灌注后上升,低于基础状态且有显著性差异。结论：斑点追踪技术能够客观准确的评价再灌注损伤对心肌收缩功能的影响,为尽早解除冠脉梗阻状态及治疗方案的选择提供有效的参考指标。     

外伤性心肌损伤误诊急性心肌梗死一例

外伤性心肌损伤是钝性胸部外伤后的一种少见并发症,其最常见的症状是非特异性胸痛,其次为室性早搏和束支传导阻滞,伴有心肌坏死标志物轻度升高,需与急性心肌梗死鉴别。我院接收1例外伤性心肌损伤误诊为急性心肌梗死的病例,经过相应检查除外了急性心肌梗死,此类患者应引起各专业医生的关注,特别是老年患者,多合并基础心血管疾病,在临床工作中更应重视。     

过敏导致心肌损伤一例

过敏反应的常见临床表现有荨麻疹、皮肤瘙痒、胸闷、腹痛、过敏性休克等.有文献报道,过敏可引发冠脉痉挛或者动脉粥样硬化斑块破裂,导致急性冠脉综合征,类似疾病被命名为Kounis综合征.在此报道1例严重过敏反应后发生心肌损伤的患儿,过敏发生时患儿心电图出现下壁导联的ST段压低,心肌酶升高,经抗过敏、营养心肌等治疗后好转出院.通过对该病例的讨论,希望同大家一起深入学习Kounis综合征.     

Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function.

On the basis of color Doppler myocardial motion data, 1-dimensional regional natural strain rate and strain curves can now be calculated by comparing local myocardial velocity profiles. Such deformation data sets may be an important, new, and more sensitive approach to quantifying both regional radial and long-axis function of the left or right ventricle in both acquired and congenital heart disease. The normal ranges of regional velocity, strain rate, and strain values have already been determined in both adults and children. This review will focus both on the potential clinical applications of these new ultrasound-based deformation parameters and the current limitations inherent in implementing the technique in everyday practice.     

A primer for fetal cardiac imaging: a stepwise approach for 2-dimensional imaging

Detection of congenital heart disease (CHD) remains problematic, even with advances in imaging. Imaging modalities, such as magnetic resonance imaging, have been helpful in better understanding certain abnormalities, such as the fetal central nervous system. However, because of cardiac motion, screening and detection of CHD are best performed by sonography. Although newer technical advances in sonography, including 3-dimensional (3-D) dynamic multiplanar imaging and Doppler techniques, are extremely helpful in better delineating CHD, the mainstay of detection of CHD remains 2-D real-time imaging. Understanding 2-D imaging of the heart, using multiple views, is necessary to perform any type of multiplanar imaging as both require basic understanding of the same basic views. Although it is beyond the scope of this article to review all facets of fetal cardiac imaging, we will present a stepwise approach using 2-D imaging in the detection of CHD.     

Memory: a functional imaging approach

Functional imaging permits us to tackle in a better way one of the most noble functions of the human brain: memory. First of all, it is a way to validate the wide subdivisions proposed by cognitive psychology and clinical neuropsychology such as short-term memory/long-term memory dissociation, episodic memory/semantic memory dissociation and the distinction among working memory subcomponents. Moreover, functional imaging yields a new perspective on the global physiology of the brain. It makes it possible to propose new relationships that are more or less reciprocal between cerebral structures and cognitive functions and raises new fundamental questions. Thus, its first goal is to answer precise questions in the framework of definite cognitive models and it offers the possibility of elaborating a new modelling conception. Finally, functional imaging is a potential tool for a predictive approach to memory functions in both normal subjects and patients.     

二维超声斑点追踪成像评估大鼠不同程度心肌损伤的应用价值

目的 探讨基于二维超声斑点追踪成像(2D-STI)技术的左心室整体环向应变及应变率参数评估急性心肌梗死大鼠不同程度心肌损伤的应用价值.方法 55只Wistar大鼠随机分为急性心肌梗死组(MI组)45只和假手术组(SO组)10只.MI组大鼠随机分为MI15组、MI30组和MI60组各15只,分别钳夹冠状动脉左前降支15 min、30 min、60 min,以建立不同梗死面积的急性心肌梗死模型.各组大鼠分别于基础状态和恢复灌注24 h后行超声心动图检查,记录左室乳头肌短轴高帧频二维图像,应用EchoPAC工作站分析获得左室乳头肌短轴整体收缩期峰值环向应变(GSc)和应变率(GSRc)值,并采用解剖M型测量左室舒张末期内径(LVIDd)和收缩末期内径(LVIDs)、短轴缩短率(FS)、射血分数(EF).实验结束后处死大鼠取出心脏行TTC染色并计算左室乳头肌短轴的梗死面积(AN).结果 ①MI15组、MI30组和MI60组的LVIDd和LVIDs测值均较基础状态和假手术组明显增加,FS和EF测值明显降低;MI60组的LVIDd和LVIDs测值均较MI15和MI30组明显增大,FS和EF测值明显降低(P<0.05);②MI15组、MI30组和MI60组GSc和GSRc测值均较假手术组明显减低;MI组的GSc和GSRc测值随缺血时间延长而显著降低(P<0.05);③GSc和GSRc与AN显著相关(P<0.01),相关系数分别为0.90和0.88;GSc和GSRe参数是AN的显著预测因子(P<0.01),标准回归系数(Beta)分别为0.558和0.491;④TTC染色显示AN随缺血时间延长而显著增加(P<0.05).结论 基于2D-STI技术的左室整体环向应变及应变率随心肌梗死面积增加而显著降低,该参数可准确评价急性心肌梗死后不同程度心肌损伤.     

Doppler myocardial imaging: A new method of data acquisition for three-dimensional echocardiography

The precise morphologic characteristics of any intracardiac tumor have important implications regarding surgical planning and operative repair. Three-dimensional echocardiography has proved to be a valuable clinical technique in this field. Current methods of three-dimensional reconstruction of two-dimensional images are based on the standard gray-scale imaging technique. However, precordial gray-scale data-set information is frequently of suboptimal quality because of data degradation caused by ultrasound attenuation by chest wall structures. This has limited the use of the transthoracic three-dimensional technique to “echogenic” patients. Doppler myocardial imaging (DMI), a new ultrasound technique based on the Doppler principle, is influenced less by chest wall attenuation and in addition offers a better boundary detection algorithm for the cardiac structures. To determine if there may be a potential benefit of DMI to acquire data for three-dimensional reconstruction, a 33-year-old woman with a large intracardiac mass was studied. In this case three-dimensional gray-scale and DMI data sets were compared and contrasted with pathologic information. DMI allowed both the quantification of mass volume and the correct definition of the morphology of the mass. It was also possible to identify the precise site of attachment of the mass to the mitral valve leaflets. The information thus obtained was correlated with both operative and pathologic findings.