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Myocardial Blood Flow (myocardial + blood_flow)

Distribution by Scientific Domains
Medical Sciences88%
Distribution within Medical Sciences
Cardiovascular Disease18%
General & Internal Medicine9%

Kinds of Myocardial Blood Flow

  • regional myocardial blood flow
    		•

    Selected Abstracts

    Effect of Chronic Sustained-Release Dipyridamole on Myocardial Blood Flow and Left Ventricular Function in Patients With Ischemic Cardiomyopathy

    CONGESTIVE HEART FAILURE, Issue 3 2007
    Mateen Akhtar MD
    Dipyridamole increases adenosine levels and augments coronary collateralization in patients with coronary ischemia. This pilot study tested whether a 6-month course of sustained-release dipyridamole/aspirin improves coronary flow reserve and left ventricular systolic function in patients with ischemic cardiomyopathy. Six outpatients with coronary artery disease and left ventricular ejection fraction (LVEF) <40% were treated with sustained-release dipyridamole 200 mg/aspirin 25 mg twice daily for 6 months. Myocardial function and perfusion, including coronary sinus flow at rest and during intravenous dipyridamole-induced hyperemia, were measured using velocity-encoded cine magnetic resonance stress perfusion studies at baseline, 3 months, and 6 months. There was no change in heart failure or angina class at 6 months. LVEF increased by 39%±64% (31.0%±13.3% at baseline vs 38.3%±10.7% at 6 months; P=.01), hyperemic coronary sinus flow increased more than 2-fold (219.6±121.3 mL/min vs 509.4±349.3 mL/min; P=.01), and stress-induced relative myocardial perfusion increased by 35%±13% (9.4%±3.4% vs 13.9%±8.5%; P=.004). Sustained-release dipyridamole improved hyperemic myocardial blood flow and left ventricular systolic function in patients with ischemic cardiomyopathy. [source]

    Cardiac autonomic dysinnervation and myocardial blood flow in long-term Type 1 diabetic patients

    DIABETIC MEDICINE, Issue 5 2003
    N. Hattori
    Abstract Aims The aim of the study was to assess scintigraphically the relationship between myocardial blood flow response and sympathetic dysinnervation in long-term Type 1 diabetic patients. Effects of the iron chelator deferoxamine on myocardial blood flow were studied and they were investigated according to the presence of cardiac sympathetic dysfunction. Methods Myocardial blood flow (MBF) was assessed with N-13 ammonia positron emission tomography in 13 long-term Type 1 diabetic patients and 13 control subjects at rest and in response to sympathetic stimulation (cold pressor test (CPT)). In diabetic patients, the study was repeated after preinfusion with deferoxamine. Furthermore, 123I metaiodobenzylguanidine (MIBG) scintigraphy was applied to assess regional cardiac sympathetic dysinnervation (uptake score 1 = normal, homogeneous uptake , 6 = no uptake). Results In diabetic patients, MBF increased in response to CPT from 78 ± 18 ml/100 g/min to 84 ± 26 ml/100 g (8%, P < 0.001). Control subjects demonstrated an increase from 63 ± 17 ml/100 g to 84 ± 26 ml/100 g (33%, P < 0.001), respectively. Resting MBF was higher in diabetic patients than in control subjects (P < 0.001). In diabetic patients, increase in MBF in response to CPT was significant in regions with a MIBG uptake score of , 3. Regions with a MIBG uptake score of > 3 did not exhibit a significant increase in MBF in response to CPT. After administration of deferoxamine, the increase in MBF in response to CPT was 23% and the magnitude of increase was related to the MIBG uptake score (r = 0.40, P < 0.0001). Conclusions Myocardial blood flow response to sympathetic stimulation is significantly impaired in long-term Type 1 diabetes. After preinfusion with deferoxamine the impairment is partially reversed and a relationship between myocardial blood flow and the extent of cardiac sympathetic dysfunction is observed. Diabet. Med. 20, 375,381 (2003) [source]

    Regional sympathetic denervation affects the relation between canine local myocardial blood flow and oxygen consumption

    EXPERIMENTAL PHYSIOLOGY, Issue 3 2007
    David J. C. Alders
    Myocardial blood flow and oxygen consumption are heterogeneously distributed. Perfusion and myocardial oxygen consumption are closely correlated in the normal heart. It is unknown how this metabolism,perfusion relation is influenced by sympathetic denervation. We investigated this question in seven chloralose-anaesthetized dogs, 3,4 weeks after regional sympathetic denervation of the left circumflex coronary artery area of supply of the left ventricle. Measurements were made of local myocardial blood flow (MBF, in ml min,1 (g dry wt),1), measured with microspheres, and myocardial oxygen consumption (, in ,mol min,1 (g dry wt),1) in the same location, calculated from the 13C spectrum of tissue extracts after intracoronary infusion of 3,13C-lactate. Since both innervated and denervated regions are subject to the same arterial pressure, lower blood flow indicates higher resistance. Mean MBF was 5.56 ml min,1 (g dry wt),1 (heterogeneity of 3.47 ml min,1 (g dry wt),1) innervated, 7.48 ml min,1 (g dry wt),1 (heterogeneity of 3.62 ml min,1 (g dry wt),1) denervated (n.s.). Significant linear relations were found between MBF and of individual samples within the innervated and denervated regions. The slopes of these relations were not significantly different, but the adjusted mean was significantly higher in the denervated regions (+1.92 ml min,1 (g dry wt),1, an increase of 38% of the mean MBF at the pooled mean , P= 0.028, ANCOVA). The ratio (in ml ,mol,1) was significantly higher, being 0.296 ± 0.167 ml ,mol,1 in the denervated region compared with the innervated region, 0.216 ± 0.126 ml ,mol,1, P= 0.0182, Mann,Whitney U test. These results indicate that sympathetic tone under chloralose anaesthesia imposes a moderate vasoconstrictive effect in the myocardium that is not detected by comparison of the mean blood flow or resistance. [source]

    Effect of Chronic Sustained-Release Dipyridamole on Myocardial Blood Flow and Left Ventricular Function in Patients With Ischemic Cardiomyopathy

    CONGESTIVE HEART FAILURE, Issue 3 2007
    Mateen Akhtar MD
    Dipyridamole increases adenosine levels and augments coronary collateralization in patients with coronary ischemia. This pilot study tested whether a 6-month course of sustained-release dipyridamole/aspirin improves coronary flow reserve and left ventricular systolic function in patients with ischemic cardiomyopathy. Six outpatients with coronary artery disease and left ventricular ejection fraction (LVEF) <40% were treated with sustained-release dipyridamole 200 mg/aspirin 25 mg twice daily for 6 months. Myocardial function and perfusion, including coronary sinus flow at rest and during intravenous dipyridamole-induced hyperemia, were measured using velocity-encoded cine magnetic resonance stress perfusion studies at baseline, 3 months, and 6 months. There was no change in heart failure or angina class at 6 months. LVEF increased by 39%±64% (31.0%±13.3% at baseline vs 38.3%±10.7% at 6 months; P=.01), hyperemic coronary sinus flow increased more than 2-fold (219.6±121.3 mL/min vs 509.4±349.3 mL/min; P=.01), and stress-induced relative myocardial perfusion increased by 35%±13% (9.4%±3.4% vs 13.9%±8.5%; P=.004). Sustained-release dipyridamole improved hyperemic myocardial blood flow and left ventricular systolic function in patients with ischemic cardiomyopathy. [source]

    Cardiac autonomic dysinnervation and myocardial blood flow in long-term Type 1 diabetic patients

    DIABETIC MEDICINE, Issue 5 2003
    N. Hattori
    Abstract Aims The aim of the study was to assess scintigraphically the relationship between myocardial blood flow response and sympathetic dysinnervation in long-term Type 1 diabetic patients. Effects of the iron chelator deferoxamine on myocardial blood flow were studied and they were investigated according to the presence of cardiac sympathetic dysfunction. Methods Myocardial blood flow (MBF) was assessed with N-13 ammonia positron emission tomography in 13 long-term Type 1 diabetic patients and 13 control subjects at rest and in response to sympathetic stimulation (cold pressor test (CPT)). In diabetic patients, the study was repeated after preinfusion with deferoxamine. Furthermore, 123I metaiodobenzylguanidine (MIBG) scintigraphy was applied to assess regional cardiac sympathetic dysinnervation (uptake score 1 = normal, homogeneous uptake , 6 = no uptake). Results In diabetic patients, MBF increased in response to CPT from 78 ± 18 ml/100 g/min to 84 ± 26 ml/100 g (8%, P < 0.001). Control subjects demonstrated an increase from 63 ± 17 ml/100 g to 84 ± 26 ml/100 g (33%, P < 0.001), respectively. Resting MBF was higher in diabetic patients than in control subjects (P < 0.001). In diabetic patients, increase in MBF in response to CPT was significant in regions with a MIBG uptake score of , 3. Regions with a MIBG uptake score of > 3 did not exhibit a significant increase in MBF in response to CPT. After administration of deferoxamine, the increase in MBF in response to CPT was 23% and the magnitude of increase was related to the MIBG uptake score (r = 0.40, P < 0.0001). Conclusions Myocardial blood flow response to sympathetic stimulation is significantly impaired in long-term Type 1 diabetes. After preinfusion with deferoxamine the impairment is partially reversed and a relationship between myocardial blood flow and the extent of cardiac sympathetic dysfunction is observed. Diabet. Med. 20, 375,381 (2003) [source]

    Myocardial perfusion defects in Bartter and Gitelman syndromes

    EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2008
    R. Scognamiglio
    ABSTRACT Background, Normotensive hypokalaemic tubulopathies (Bartter and Gitelman syndromes (BS/GS)) are genetic diseases that are considered benign. However, QT prolongation, left ventricular dysfunction and reduction of cardiac index upon exercise leading to arrhythmias and sudden cardiac death have been reported in these patients. Hence, we aimed to verifying whether an isometric exercise could represent a useful tool for the identification of patients at risk for future cardiac events. Patients and methods, Myocardial function (MF) and perfusion, evaluated as myocardial blood flow (MBF) of 10 BS/GS patients and 10 healthy controls, were investigated at rest and during isometric exercise. MF and MBF were evaluated using quantitative two-dimensional and myocardial contrast echocardiography. Results, BS/GS patients had normal baseline MF and MBF. During exercise in BS/GS patients, corrected QT (QTc) was prolonged to peak value of 494 ± 9·1 ms (P < 0·001). In controls, MF increased from resting to peak exercise (left ventricular ejection fraction: 65 ± 4% to 78 ± 5%, P < 0·003) while in seven BS/GS patients (Group 1) it declined (64 ± 5% to 43 ± 9%, P < 0·001). Myocardial perfusion increased upon exercise in controls as shown by changes of its markers: , (a measure of myocardial flow velocity; 0·89 ± 0·12 vs. 0·99 ± 0·12, P < 0·001) and myocardial blood volume (14·4 ± 2 vs. 20·2 ± 0·25, P < 0·001), while in Group 1 BS/GS it decreased (0·87 ± 0·15 vs. 0·67 ± 0·15, P < 0·001; and 14·5 ± 1·9 vs. 8·3 ± 0·22, P < 0·001, respectively). Conclusions, Our results document for the first time that exercise induce coronary microvascular and myocardial defects in BS/GS patients. Therefore, this may challenge the idea that BS/GS are benign diseases. In addition, the diagnostic approach to these syndromes should include an in-depth cardiac assessment in order to identify patients at higher risk. [source]

    Regional sympathetic denervation affects the relation between canine local myocardial blood flow and oxygen consumption

    EXPERIMENTAL PHYSIOLOGY, Issue 3 2007
    David J. C. Alders
    Myocardial blood flow and oxygen consumption are heterogeneously distributed. Perfusion and myocardial oxygen consumption are closely correlated in the normal heart. It is unknown how this metabolism,perfusion relation is influenced by sympathetic denervation. We investigated this question in seven chloralose-anaesthetized dogs, 3,4 weeks after regional sympathetic denervation of the left circumflex coronary artery area of supply of the left ventricle. Measurements were made of local myocardial blood flow (MBF, in ml min,1 (g dry wt),1), measured with microspheres, and myocardial oxygen consumption (, in ,mol min,1 (g dry wt),1) in the same location, calculated from the 13C spectrum of tissue extracts after intracoronary infusion of 3,13C-lactate. Since both innervated and denervated regions are subject to the same arterial pressure, lower blood flow indicates higher resistance. Mean MBF was 5.56 ml min,1 (g dry wt),1 (heterogeneity of 3.47 ml min,1 (g dry wt),1) innervated, 7.48 ml min,1 (g dry wt),1 (heterogeneity of 3.62 ml min,1 (g dry wt),1) denervated (n.s.). Significant linear relations were found between MBF and of individual samples within the innervated and denervated regions. The slopes of these relations were not significantly different, but the adjusted mean was significantly higher in the denervated regions (+1.92 ml min,1 (g dry wt),1, an increase of 38% of the mean MBF at the pooled mean , P= 0.028, ANCOVA). The ratio (in ml ,mol,1) was significantly higher, being 0.296 ± 0.167 ml ,mol,1 in the denervated region compared with the innervated region, 0.216 ± 0.126 ml ,mol,1, P= 0.0182, Mann,Whitney U test. These results indicate that sympathetic tone under chloralose anaesthesia imposes a moderate vasoconstrictive effect in the myocardium that is not detected by comparison of the mean blood flow or resistance. [source]

    Twenty-Four Hours Postoperative Results After Orthotopic Cardiac Transplantation in Swine

    JOURNAL OF CARDIAC SURGERY, Issue 4 2007
    Matthias Siepe M.D.
    However, there is no functional data available for a longer time period after transplantation. We have established a pig model to investigate myocardial function 24 hours after orthotopic transplantation.Materials and Methods: Orthotopic cardiac transplantations (HTx) in pigs were performed with a postoperative observation period of 24 hours (n = 6). To analyze myocardial function after transplantation, hemodynamical parameters (Swan-Ganz- and impedance-catheter data) as well as tissue and blood samples were obtained. Regional myocardial blood flow (RMBF) was assessed using fluorescent microspheres. Results: The impedance-catheter parameters demonstrated a preserved contractility in both ventricles 24 hours post-transplantation. In contrast, cardiac output 24 hours after HTx was diminished by 50% as compared to the preoperative value. Conversely, pulmonary vascular resistance increased significantly. The RMBF was increased in both ventricles. Metabolic and histological analyses indicate myocardial recovery 24 hours after HTx with no irreversible damage. Conclusions: For the first time, we were able to establish a porcine model to investigate myocardial function 24 hours after heart transplantation. While the contractility of the transplanted hearts was well-preserved, impaired cardiac output was going along with an increase in pulmonary vascular resistance. Using this clinical relevant model, improvements of human cardiac transplantation and post-transplant contractile dysfunction, especially, could be investigated. [source]

    Intracoronary enalaprilat during angioplasty for acute myocardial infarction: alleviation of postischaemic neurohumoral and inflammatory stress?

    JOURNAL OF INTERNAL MEDICINE, Issue 2 2007
    U. Schaefer
    Abstract. Aims., Reperfusion after myocardial ischaemia is associated with a distinct ischaemia/reperfusion injury. Since ACE-inhibition, beyond its influence on cardiac angiotensin II formation and kinin metabolism, has been shown to be cardioprotective by decreasing leucocyte adhesion and endothelin-1 (ET-1) release, we investigated the effects of intracoronary (i.c.) enalaprilat during primary angioplasty in acute myocardial infarction. Methods and Results., Twenty-two patients were randomized to receive i.c. enalaprilat (50 ,g) or placebo immediately after reopening of the infarct-related artery (IRA). Plasma concentrations of soluble L-selectin, P-selectin, intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), ET-1 and nitric oxide metabolite concentrations (NO(x)) were measured in pulmonary arterial blood. Coronary blood flow was assessed using corrected thrombolysis in myocardial infarction (TIMI) frame counts (CTFC). During reperfusion, there was a significant increase in sL-selectin, sP-selectin and ET-1 in the placebo group, which was greatly diminished by enalaprilat. Levels of sVCAM-1 and sICAM-1 were not affected in either group. CTFC in the placebo group remained higher than normal in both the IRA and nonculprit vessels, whereas myocardial blood flow improved with enalaprilat. Conclusion., Enalaprilat as adjunct to primary angioplasty might be a protective approach to prevent leucocyte adhesion and the release of ET-1, thereby improving coronary blood flow. [source]

    Fast mapping of myocardial blood flow with MR first-pass perfusion imaging

    MAGNETIC RESONANCE IN MEDICINE, Issue 6 2008
    Thomas A. Goldstein
    Abstract Accurate and fast quantification of myocardial blood flow (MBF) with MR first-pass perfusion imaging techniques on a pixel-by-pixel basis remains difficult due to relatively long calculation times and noise-sensitive algorithms. In this study, Zierler's central volume principle was used to develop an algorithm for the calculation of MBF with few assumptions on the shapes of residue curves. Simulation was performed to evaluate the accuracy of this algorithm in the determination of MBF. To examine our algorithm in vivo, studies were performed in nine normal dogs. Two first-pass perfusion imaging sessions were performed with the administration of the intravascular contrast agent Gadomer at rest and during dipyridamole-induced vasodilation. Radiolabeled microspheres were injected to measure MBF at the same time. MBF measurements in dogs using MR methods correlated well with the microsphere measurements (R2 = 0.96, slope = 0.9), demonstrating a fair accuracy in the perfusion measurements at rest and during the vasodilation stress. In addition to its accuracy, this method can also be optimized to run relatively fast, providing potential for fast and accurate myocardial perfusion mapping in a clinical setting. Magn Reson Med, 2008. © 2008 Wiley-Liss, Inc. [source]

    In vivo quantification of regional myocardial blood flow: Validity of the fast-exchange approximation for intravascular T1 contrast agent and long inversion time,

    MAGNETIC RESONANCE IN MEDICINE, Issue 2 2006
    Marlene Wiart
    Abstract In the present study we investigated the effects of water exchange between intra- and extravascular compartments on absolute quantification of regional myocardial blood flow (rMBF) using a saturation-recovery sequence with a rather long inversion time (TI, 176 ms) and a T1 -shortening intravascular contrast agent (CMD-A2-Gd-DOTA). Data were acquired in normal and ischemically injured pigs, with radiolabeled microsphere flow measurements used as the gold standard. Five water exchange rates (fast, 6 Hz, 3 Hz, 1 Hz, and no exchange) were tested. The results demonstrate that the fast-exchange approximation may be appropriate for rMBF quantification using the described experimental setting. Relaxation rate change (,R1) analysis improved the accuracy of the analysis of rMBF compared to the MR signal. In conclusion, the current protocol could provide sufficient accuracy for estimating rMBF assuming fast exchange and a linear relationship between signal and tissue concentration when quantification of precontrast T1 is not an option. Magn Reson Med, 2006. © 2006 Wiley-Liss, Inc. [source]

    Improvement of quantification of myocardial first-pass perfusion mapping: A temporal and spatial wavelet denoising method

    MAGNETIC RESONANCE IN MEDICINE, Issue 2 2006
    Thomas A. Goldstein
    Abstract Mapping of myocardial blood flow (MBF) with first-pass perfusion imaging is becoming an important tool in the study of coronary artery disease. In this study a wavelet-based denoising method was developed to improve the accuracy of pixel-by-pixel MBF maps. We performed an in vivo study in five stenotic dogs with 70% stenosis in the left coronary arteries. First-pass perfusion imaging sessions were performed by administering the intravascular contrast agent Gadomer at rest and during dipyridamole-induced vasodilation. Color microspheres (MS) were injected into the dogs to measure MBF at the same time. After denoising was performed, the signal-to-noise ratio (SNR) of the first-pass perfusion image improved by approximately 180%, whereas spatial variation of MBF maps decreased 38%. It was also found that the correlation of MBFs measured by MRI with the MS method indicates a significant improvement with the denoising method (R2 increased from 0.24 to 0.78, P < .001). This suggests that the wavelet denoising method may be an effective way to increase the accuracy of pixel-by-pixel MBF quantification and reduce spatial variation, and may be applicable to other forms of noise-sensitive image analysis. Magn Reson Med, 2006. © 2006 Wiley-Liss, Inc. [source]

    Assessment of regional differences in myocardial blood flow using T2 -weighted 3D BOLD imaging

    MAGNETIC RESONANCE IN MEDICINE, Issue 3 2001
    Kara B. Wright
    Abstract The feasibility of detecting regional differences in myocardial blood flow based on the blood oxygen level-dependent (BOLD) effect was evaluated in vivo in dogs (N = 9) using a 3D T2 -prepared segmented gradient-echo sequence at 1.5 T. Regional differences in myocardial blood flow were created by administering adenosine through a catheter placed in the left circumflex coronary artery (LCX). The difference in the R2 (1/T2) relaxation rate between the left ventricular myocardial region supplied by the LCX and regions supplied by the left anterior descending coronary artery (LAD) or septal artery during adenosine administration was correlated to the corresponding regional myocardial blood flow difference determined using fluorescent microspheres. A correlation coefficient of 0.80 was found between the MR BOLD measurements and the myocardial flow assessment. Our results show that the sequence used in this study allows fast 3D BOLD imaging of the heart, and is a promising technique for detecting regional myocardial perfusion differences. Magn Reson Med 46:573,578, 2001. © 2001 Wiley-Liss, Inc. [source]

    Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2000
    N. Kieler-Jensen
    Background: The aim was to evaluate the use of clevidipine, a new vascular selective, ultra-short-acting calcium antagonist for blood pressure control after coronary artery bypass grafting (CABG). Methods: The effects of clevidipine on central hemodynamics, myocardial blood flow and metabolism were studied at two different phases after CABG. In phase 1 (n=13), the hypertensive phase, the effects of clevidipine were compared to those of sodium nitroprusside (SNP) when used to control postoperative hypertension. In phase 2 (n=9), the normotensive phase, a clevidipine dose-response relationship was established. Results: At a target mean arterial pressure (MAP) of 75 mmHg, systemic vascular resistance (SVR) and heart rate (HR) were lower, preload, stroke volume (SV) and pulmonary vascular resistance (PVR) were higher, while there were no differences in myocardial lactate metabolism or oxygen extraction with clevidipine compared to SNP. In the normotensive phase, clevidipine induced a dose-dependent decrease in MAP (,19%), SVR (,27%) and PVR (,15%), accompanied by an increase in SV (10%), but no reflex increase in HR or changes in cardiac preload. Clevidipine caused a direct coronary vasodilation, as indicated by a decrease in myocardial oxygen extraction from 54% to 45%. Myocardial lactate metabolism was unaffected by clevidipine. The blood clearance of clevidipine was 0.05 l ,· ,min,1 ,· ,kg,1, the volume of distribution at steady state was 0.08 l ,· ,kg,1 and the initial and terminal half-lives were <1 min and 4 min, respectively. Conclusions: Clevidipine rapidly reduced MAP and induced a systemic, pulmonary and coronary vasodilation with no effect on venous capacitance vessels or HR. Clevidipine caused no adverse effects on myocardial lactate metabolism. Clevidipine thus appears suitable to control blood pressure after CABG. [source]

    Cocaine and Ethanol: Combined Effects on Coronary Artery Blood Flow and Myocardial Function in Dogs

    ACADEMIC EMERGENCY MEDICINE, Issue 7 2009
    Lance D. Wilson MD
    Abstract Objectives:, In combination, cocaine and ethanol are more cardiotoxic than is either substance alone. These substances together constitute a drug abuse combination that commonly results in fatality. Previously the authors have demonstrated that cardiotoxicity of cocaine and ethanol is in part due to synergistic myocardial-depressant effects. However, it remains unclear whether this myocardial depression is associated with concomitant adverse effects on coronary blood flow in relation to these substances. The aim of this study was to investigate combined effects of cocaine and ethanol on myocardial blood flow, in relation to indices of myocardial function. Methods:, Anesthetized dogs were instrumented for hemodynamic monitoring with Doppler flow probes placed on the circumflex and left anterior descending (LAD) coronary arteries. Dogs were randomized to three groups (each n = 6): ethanol (E, 1.5 g/kg followed by placebo), cocaine (C, placebo followed by cocaine, 7.5 mg/kg IV), or cocaine plus ethanol (C + E). All measurements were made at control, after placebo or ethanol, and then at fixed time intervals after cocaine or placebo bolus over 3 hours. Results:, In both the C + E and the C groups, circumflex blood flow (CBF) decreased by 71% (95% confidence interval [CI] = 56% to 85%) and 57% (95% CI = 43% to 72%, both p < 0.04 vs. baseline) immediately after cocaine bolus. This was associated with transient depression of cardiac output, myocardial contractile function, and rate-pressure product (RPP), all indices of myocardial oxygen demand. A subsequent rebound increase of coronary sinus blood flow (CSBF) of 56% (95% CI = 26% to 137%, p < 0.03) compared to baseline occurred only in the C group and was associated with increases of myocardial contractile function and RPP. In the C + E group, 2 hours after drug administration, there was a decrease in CSBF of 49% (95% CI = 32% to 67%; p < 0.01) compared to baseline, which was associated with concomitant numerical decreases of the indices of myocardial oxygen demand and accumulation of cocaethylene. Conclusions:, Acute decreases in myocardial flow secondary to cocaine, and cocaine and ethanol in combination, were similar and temporally associated with cocaine's direct myocardial-depressant effects. Rebound increases in myocardial function and blood flow due to cocaine were attenuated by ethanol. Delayed myocardial depression and decreases in myocardial blood flow were observed only with coadministration of cocaine and ethanol. [source]

    The phosphatidylinositol 3-kinase,Akt pathway protects cardiomyocytes from ischaemic and hypoxic apoptosis via mitochondrial function

    CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 5-6 2010
    Hua-Pei Song
    Summary 1.,After a severe burn, a marked decrease in myocardial blood flow results in ischaemic and hypoxic injury, which subsequently leads to apoptosis or necrosis. Phosphatidylinositol 3-kinase (PI3-K)/Akt is an important intracellular signal transduction molecule that regulates cell proliferation, differentiation, glucose metabolism and migration. However, the function and mechanisms of the PI3-K,Akt pathway in cardiomyocyte apoptosis after a burn remain unclear. 2.,In the present study, an in vivo rat model of burn injury and an in vitro hypoxic model using rat cardiomyocytes were established. In burned rats, the expression of PI3-K and phosphorylated (p-) Akt expression increased, as did myocardial apoptosis. Inhibition of the PI3-K,Akt pathway with 1.4 mg/kg LY294002 caused a significant increase in the myocardial apoptotic index compared with hypoxia alone in the in vivo model. 3.,Cardiomyocytes cultured under hypoxic conditions exhibited increased apoptosis, decreased cell viability, enhanced caspase 3 activity, a decreased mitochondrial membrane potential, increased cytoplasmic calcium transients and increased p53 and Bax mRNA expression. Pretreatment with 50 ,mol/L LY294002 significantly enhanced all these negative indicators compared with hypoxia alone. In contrast, pretreatment of cells with 200 ng/mL insulin-like growth factor-1, an activator of PI3-K,Akt, significantly ameliorated the effects of hypoxia, although control levels were not reached. 4.,These findings indicate that activation of the PI3-K,Akt pathway induced by ischaemia and hypoxia after a severe burn can protect cardiomyocytes from apoptosis. This anti-apoptotic effect is most likely mediated via the mitochondria and changes in p53 and Bax gene expression, intracellular [Ca2+] and caspase 3 activity. [source]

    The anti-diabetic drug miglitol is protective against anginal ischaemia through a mechanism independent of regional myocardial blood flow in the dog

    CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 10 2005
    Yoshihiro Uno
    SUMMARY 1.,In the present study, we attempted to clarify whether the antidiabetic drug miglitol, an ,-glucosidase inhibitor, has a protective effect against anginal ischaemia. We had reported previously that miglitol reduces myocardial infarct size through inhibition of glycogenolysis during ischaemia in rabbits. However, the effect of miglitol on anginal ischaemia remains unknown. 2.,In open-chest beagle dogs with a severely stenosed left anterior descending coronary artery, an epicardial electrode was attached to the surface of the risk area of the left ventricle and a microdialysis probe was implanted into the myocardium to measure ST segment changes and interstitial lactate accumulation. The first episode of anginal ischaemia was induced by atrial pacing and phenylephrine infusion (50,100 µg/min) for 10 min. The second episode of anginal ischaemia was induced 210 min after the first episode. Miglitol (10 mg/kg, i.v.) was administered to the miglitol group (n = 10) 30 min before the second episode of anginal ischaemia, whereas saline was administered to the control group (n = 10). Regional myocardial blood flow was measured using coloured microspheres. 3.,There was no significant difference in regional myocardial blood flow in the risk and non-risk areas between the first and second episodes of anginal ischaemia and between the miglitol and control groups. During the first and second episodes of anginal ischaemia, the ST segment was decreased to a similar extent in the control group. Although ST segment depression during the first episode of anginal ischaemia was similar in both groups, ST segment depression during the second episode of anginal ischaemia was significantly attenuated in the miglitol-treated group compared with the control group (1.3 ± 0.4 vs 2.2 ± 0.4 mV, respectively). Miglitol significantly attenuated myocardial interstitial lactate accumulation in the risk area. 4.,In conclusion, in the present study miglitol improved ST segment depression and attenuated the accumulation of myocardial interstitial lactate during anginal ischaemia without altering regional myocardial blood flow. Miglitol has an anti-anginal ischaemia effect via a mechanism that is independent of regional myocardial blood flow. [source]

    Abnormal myocardial perfusion and contractile recruitment during exercise in type 1 diabetic patients

    CLINICAL CARDIOLOGY, Issue 2 2005
    Roldano Scognamiglio M.D.
    Abstract Background: No data are available on the relationship between myocardial perfusion and left ventricular (LV) function in type 1 diabetes mellitus (T1DM), which may constitute a factor explaining the progressive contractile dysfunction to the overt phase of diabetic cardiomyopathy. Hypothesis: This study was undertaken to test whether myocardial perfusion abnormalities are present at rest and during exercise and whether they are related to contractile dysfunction in T1DM. Methods: Twenty-two patients with T1DM, aged 32 ± 8.3 years, without macro-or microvascular complications, and 10 controls, aged 31 ± 3 years, were studied. Left ventricular function and myocardial perfusion were assessed by two-dimensional and myocardial contrast echocardiography at rest and during handgrip (HG). Results: Fourteen patients with T1DM showed a decline in LV ejectionfraction (LVEF) during HG (Group 1) while 8 had a normal response (Group 2). Both basal myocardial blood volume (MBV) and velocity ((3) were normal inT1DM. During exercise, MBV and (3 increased and were associated with an increase in myocardial blood flow (MBF) in controls. In T1DM, (3 did not change and MBV increased only in Group 2, while this increase was not observed in Group 1 (controls: 14.9 ±2.3 vs. Group 1:7.6± 1.6, p< 0.001; and vs. Group2:10.2± 2.8, p<0.001), (3(0.86±0.12vs.0.68±0.14, p<0.001;and vs. 0.67±0.15, p<0.001). A correlation between the ratio exercise MBF/resting MBF and LVEF at peak exercise in T1DM was observed (r=0.805, p< 0.001). Conclusions: A large proportion of patients with T1DM exhibit abnormalities in myocardial adaptable capacity to match an acute overload, which are related to a defective increase in myocardial perfusion. [source]

    Assessment of coronary morphology and flow in a patient with guillain-barré syndrome and st-segment elevation

    CLINICAL CARDIOLOGY, Issue 3 2001
    Nikolaos Dagres M.D.
    Abstract Patients with Guillain-Barré syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhythmias and disturbances of heart rate and blood pressure. We report a case of a patient with Guillain-Barré syndrome who developed ST-segment elevation in the inferolateral leads, suggestive of an acute coronary syndrome. Cardiac catheterization revealed angiographically normal coronary arteries. Intracoronary ultrasound was also normal. Intracoronary Doppler flow measurements revealed an elevated baseline coronary flow velocity of up to 41 cm/s and decreased coronary flow reserve, particularly in the left circumflex artery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myocardial blood flow. [source]