Transthoracic echocardiographic characteristics of 17 cases of cardiac amyloidosis (CA), a rare disease in China, were analyzed in order to improve the understanding of the disease. Seventeen cases of biopsy-proven CA, admitted to Wuhan Union Hospital from June 1994 to September 2008 were retrospectively reviewed. Twenty normal volunteers served as control group. Left atrial and ventricular functions and mitral inflow velocity were measured by two-dimensional, and Doppler echocardiography, and tissue Doppler imaging (TDI)-derived peak systolic wall motion velocities (Sv), peak early diastolic wall motion velocities (Ev), and peak late diastolic wall motion (Av) were measured at the septum, lateral, inferior and anterior corners of mitral annulus from the apical 4- and 2 chamber views. Compared with the control group, the interventricular septal thickness (IVSd), the left ventricular posterior wall (LVPWd), right ventricular transverse diameter (RVTDd) near the end of diastole and the interauricular septum thickness (IASs), left atrial anteroposterior diameter (LAADs), right atrial transverse diameter (RATDs) near the end of systole were increased significantly (all P<0.05) and left ventricular ejection fraction (LVEF) decreased (P<0.05) in the CA group. Compared with the control group, Sv, Ev at each wall and Av at almost all walls were significantly decreased in the CA group. In the CA group, Myocardial echoes of interventricular septum and free wall of left ventricle were enhanced evidently and distributed unevenly. The echoes presented as ground glass-like images, with some spotty hyper echoes. Both atria were enlarged, and LVEF decreased, with diastolic function impaired, and mild-moderate hydropericardium found in the CA group. It was concluded that echocardiography was a relatively sensitive and highly specific non-invasive method for the diagnosis of CA.
Amyloidosis/*ultrasonography ; Cardiomyopathies/*ultrasonography ; Case-Control Studies ; Echocardiography ; Echocardiography, Doppler/*methods ; Retrospective Studies ; Sensitivity and Specificity

The monoclonal gammopathies (MG) are monoclonal neoplasms related to each other by virtue of their development from common progenitors in the B lymphocyte lineage. Cardiac dysfunction in patients with MG is not well established. We experienced a case of cardiac dysfunction associated with MG identified by echocardiography and biopsy. Fifty nine year-old man was admitted because of dyspnea for several months. Echocardiography revealed diastolic dysfunction showing restrictive physiology with elevated left ventricular filling pressure. Bone marrow (BM) studies and immunoelectrophoresis were compatible with monoclonal gammopathy of undetermined significance. Endomyocardial, BM, and enteral biopsies for ruling out for amyloidosis (Congo-red stain) were negative. This is the case of non-amyloidotic light chain deposition cardiomyopathy.
Bone Marrow/pathology ; Cardiomyopathies/diagnosis/*etiology/ultrasonography ; Humans ; Immunoglobulin kappa-Chains/analysis ; Male ; Middle Aged ; Paraproteinemias/*complications/pathology

Although adriamycin (Doxorubicin) is one of the most effective and useful antineoplastic agents for the treatment of a variety of malignancies, its repeated administration can induce irreversible myocardial damage and resultant heart failure. Currently, no marker to detect early cardiac damage is available. The purpose of this study was to investigate whether an assessment of the acoustic properties of the myocardium could enable the earlier detection of myocardial damage after adriamycin chemotherapy. Forty Wistar rats were treated with adriamycin (2 mg/kg, i.v.) once a week for 2, 4, 6 or 8 weeks consecutively. Left ventricular ejection fraction (LVEF) was calculated using M-mode echocardiography data. The magnitude of cardiac cycle dependent variation of integrated backscatter (CVIB) of the myocardium was measured in the mid segment of the septum and in the posterior wall of the left ventricle, using a real time two dimensional integrated backscatter imaging system. LVEF was significantly lower in the adriamycin-treated 8-week group than in the controls (75 +/- 9 vs 57 +/- 8%, p < 0.05). Myocyte damage was only seen in the 8-week adriamycin-treated group. However, no significant changes of CVIB were observed between baseline or during follow-up in the ADR or control group. In conclusion, serial assessment of the acoustic properties of the myocardium may not be an optimal tool for the early detection of myocardial damage after doxorubicin chemotherapy in a rat model.
Animals ; Antibiotics, Antineoplastic/*toxicity ; Cardiomyopathies/*chemically induced/*ultrasonography ; Disease Models, Animal ; Doxorubicin/*toxicity ; *Echocardiography ; Male ; Rats ; Rats, Wistar ; Research Support, Non-U.S. Gov't

Trypanosoma cruzi infection results in debilitating cardiomyopathy, which is a major cause of mortality and morbidity in the endemic regions of Chagas disease (CD). The pathogenesis of Chagasic cardiomyopathy (CCM) has been intensely studied as a chronic inflammatory disease until recent observations reporting the role of cardio-metabolic dysfunctions. In particular, we demonstrated accumulation of lipid droplets and impaired cardiac lipid metabolism in the hearts of cardiomyopathic mice and patients, and their association with impaired mitochondrial functions and endoplasmic reticulum (ER) stress in CD mice. In the present study, we examined whether treating infected mice with an ER stress inhibitor can modify the pathogenesis of cardiomyopathy during chronic stages of infection. T. cruzi infected mice were treated with an ER stress inhibitor 2-Aminopurine (2AP) during the indeterminate stage and evaluated for cardiac pathophysiology during the subsequent chronic stage. Our study demonstrates that inhibition of ER stress improves cardiac pathology caused by T. cruzi infection by reducing ER stress and downstream signaling of phosphorylated eukaryotic initiation factor (P-elF2α) in the hearts of chronically infected mice. Importantly, cardiac ultrasound imaging showed amelioration of ventricular enlargement, suggesting that inhibition of ER stress may be a valuable strategy to combat the progression of cardiomyopathy in Chagas patients.
2-Aminopurine ; Animals ; Cardiomyopathies ; Chagas Disease ; Endoplasmic Reticulum ; Endoplasmic Reticulum Stress ; Heart ; Humans ; Lipid Droplets ; Lipid Metabolism ; Mice ; Mortality ; Pathology ; Peptide Initiation Factors ; Trypanosoma cruzi ; Ultrasonography

Pheochromocytomas are rare tumors that originate in chromaffin tissue and produce distant variant effects, such as EKG abnormality, myocarditis, cardiomyopathy, and acute coronary syndrome, by secretion of catecholamines. Such variant effects of pheochromocytoma tend to lead the emergency physician to a wrong diagnosis. We describe the case of a 29-year-old female with pheochromocytoma who was diagnosed at the ER as having myocarditis with acute renal failure. The diagnosis of pheochromocytoma was made later. To avoid misdiagnosis, we should include pheochromocytoma in the differential diagnosis. We should also use additional imaging tests, such as bed-side abdominal ultrasonography or abdominal CT, at the ER on relatively young patients presenting with hypertensive crisis, acute renal failure, and features, such as ischemic EKG changes, which are suggestive of acute coronary syndrome or myocarditis.
Acute Coronary Syndrome ; Acute Kidney Injury ; Adult ; Cardiomyopathies ; Catecholamines ; Diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Electrocardiography ; Emergencies ; Female ; Humans ; Myocarditis* ; Pheochromocytoma* ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUNDS: Ischemic cardiomyopathy in the elderly bears a worse prognosis than non-ischemic cardiomyopathy, and may show an improved outcome after myocardial revascularization. The noninvasive techniques which can reliably distinquish between ischemic and non-ischemic cardiomyopathy have been tested. As ultrasonographically assessed carotid atherosclerosis is being used as a surrogate measure of coronary atherosclerosis, non studies to date have used carotid atherosclerosis to distinguish between ischemic and non-ischemic cardiomyopathy in the elderly. METHODS: One hundred forty eight patients(61 women, 87 male) greater than 65 years of age who have dilated cardiomyopathy with left ventricular enddiastolic inner dimension 55mm and fractional shortening 25% were evaluated by B-mode ultrasound imaging of carotid artery for measurement of atherosclerotic plaque. Also coronary angiography was done, and ischemic cardiomyo- pathy was defined as the presence of any 2 or more epicardial coronary vessels with 75% stenosis. and then the value of carotid athe rosclerosis in the distinction between ischemic and non-ischemic etiology in the elderly with dilated cardiomyopathy was examined. RESULTS: Ischemic etiology of dilated cardiomyopathy in the elderly can be defined as the presence of carotid atherosclerosis with 25% stenosis. Carotid stenosis 25% had sensitivity 82.5%(74% in women, 91% in male), specificity 85.5%(92% in women, 79% in male), positive predictive value 90.5%(93% in women, 88% in male) and negative predictive value 78.5%(73% in women, 84% in male) as whole in the identification of patients with ischemic cardiomyopathy. CONCLUSION: Carotid stenosis by B-mode ultrasonography is noninvasive and useful in the distinction between ischemic and nonischemic etiology in the elderly patients with clinically unexplained cardiomyopathy
Aged ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Myocardial Revascularization ; Plaque, Atherosclerotic ; Prognosis ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.
Aneurysm ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Chest Pain ; Constriction, Pathologic ; Coronary Vasospasm ; Creatinine ; Dilatation ; Dyspnea ; Follow-Up Studies ; Heart Diseases ; Humans ; Japan ; Myocardial Infarction* ; Myocardial Stunning ; Phosphotransferases ; Prospective Studies* ; Pulmonary Edema ; Shock, Cardiogenic ; Stress, Psychological ; Stroke Volume ; Takotsubo Cardiomyopathy ; Ultrasonography, Interventional

We present a case of an open surgical repair of an infraumbilical hernia, which was performed on a 45-year-old man categorised as American Society of Anesthesiologists class 4; he weighed 107 kg, and had a body mass index of 34.2 kg/m2 and nonischaemic cardiomyopathy (left ventricular ejection fraction of 20%). Due to the patient's significant perioperative risks, the surgery was performed with the patient under ultrasonography-guided bilateral rectus sheath blocks; 15 mL of 1% lignocaine and 10 mL of 0.5% bupivacaine were deposited in the space between the rectus abdominis and posterior rectus sheath. The patient tolerated the surgery with minimal further sedation and additional analgesia. Rectus sheath block is a useful regional technique for periumbilical surgery, allowing surgery in highrisk patients while avoiding general anaesthesia and central neuraxial blockade. The use of real-time ultrasonographic guidance may reduce risks of peritoneal puncture, bleeding and visceral injury, while potentially increasing the rate of success.
Analgesia ; Anesthesia ; Anesthesiology ; Body Mass Index ; Bupivacaine ; chemistry ; Cardiomyopathies ; Hemodynamics ; Hernia, Umbilical ; surgery ; Herniorrhaphy ; methods ; Humans ; Lidocaine ; chemistry ; Male ; Middle Aged ; Nerve Block ; methods ; Rectus Abdominis ; pathology ; Treatment Outcome ; Ultrasonography

Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
Cardiomyopathies/diagnosis/radiography ; Cardiotonic Agents/therapeutic use ; Chest Pain/complications/diagnosis/radiography ; Coronary Artery Bypass ; Coronary Artery Disease/*diagnosis/drug therapy/radiography ; Dobutamine/therapeutic use ; Echocardiography ; Heart Defects, Congenital/diagnosis/radiography ; Heart Failure/diagnosis/ultrasonography ; Humans ; *Magnetic Resonance Imaging ; Mucocutaneous Lymph Node Syndrome/complications/diagnosis ; Percutaneous Coronary Intervention ; Prognosis ; Risk Assessment ; Ventricular Function, Left/physiology

OBJECTIVEEarlier studies have confirmed that mesenchymal stem cells (MSCs) can transdifferentiate into myocytes and improve heart function in 2 weeks. But the mechanism is not clear. In this study, the mechanism of improvement of heart function after transplantation of MSCs was examined with suppression subtractive hybridization (SSH).

METHODSMSCs were isolated from thighone and tibia of Wistar rats, purified by adhesion-screening method, and expanded in vitro. Intraperitoneal injection of doxorubicin (at 2.5 mg/kg/time and total doses of 15 mg/kg) established cardiomyopathy models. MSCs were transplanted into cardiomyocytes. The differential genes between tester (rats with cardiomyopathy that were injected with MSCs) and driver (rats with cardiomyopathy that were injected with equivalent volume of culture medium) were screened with suppression subtractive hybridization.

RESULTSAfter 4 weeks of intraperitoneal injection of doxorubicin, left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) decreased by 26.48% and 40.61%, respectively (P < 0.01), as compared with those of normal group. Cardiomyopathy model was established successfully. And the heart function of the rats with cardiomyopathy was significantly improved after transplantation. Sixteen gene fragments were detected, and 12 of them were up-regulated in testers. They were rattus norvegicus mitochondrial BN/SsNHsdMCW, rattus norvegicus strain mitochondrial F344 X BN F1, rattus norvegicus mitochondrion H(+)-ATP synthase alphase subunit (Atp5al) mRNA, rattus norvegicus BHE/Cdb tRNA-Lys gene, rat mitochondrial H(+)-ATP synthase alpha subunit mRNA, rattus norvegic (wild-caught animal) complete mitochondrial genome, rattus norvegic clone BB.1.4.1 unknown Glu-Pro dipeptide repeat protein mRNA, Arabidopsis thaliana transgenic line C DNA, rat mitochondrial ATP synthase beta subunit mRNA, rattus norvegic mitochondrial genome, rat cardiac troponin T mRNA and rat mRNA for beta-globin. Four gene fragments were down-regulated in testers. They were rat mRNA for sarcomeric mitochondrial creatine kinase, rat mRNA for ribosomal phosphoprotein P2, rat alpha-crystallin B chain mRNA and rattus norvegicus NADH-ubiquinone oxidoreductase Fe-S protein 7 mRNA.

CONCLUSIONThe expression of the genes relating to mitochondrial synthesizing and contracting proteins synthesizing increased after MSC transplantation. The genes might enhance energy synthesis and promote MSC transdifferentiate into myocytes, and then improve heart function of rats with cardiomyopathy.

Animals ; Antibiotics, Antineoplastic ; toxicity ; Bone Marrow Transplantation ; methods ; Cardiomyopathies ; diagnostic imaging ; genetics ; surgery ; Cell Differentiation ; Cells, Cultured ; Disease Models, Animal ; Down-Regulation ; Doxorubicin ; toxicity ; Female ; Mesenchymal Stem Cell Transplantation ; methods ; Mitochondria ; genetics ; Myocytes, Cardiac ; RNA, Messenger ; Rats ; Rats, Wistar ; Treatment Outcome ; Ultrasonography ; Up-Regulation ; Ventricular Function, Left