Objective To evaluate the relationship of myocardial MR contrast delay-enhancement and nuclear perfusion-metabolism pattern in patients with idiopathic dilated cardiomyopathy (IDCM).Methods Forty-two consecutive patients (29 men and 13 women,age:(53 ±12) years) diagnosed clinically with IDCM were enrolled.All patients underwent 99Tcm-MIBI SPECT,18F-FDG PET imaging and MR contrast delay-enhancement imaging within 3-7 d.The myocardial perfusion-metabolism segment analysis was performed using a 17-segment model.Segmental 99Tcm-MIBI and 18F-FDG uptakes were scored visually using a 4-grade scoring system (0 =normal uptake,1 =mildly reduced uptake,2 =moderately reduced uptake,3 =severely reduced uptake).Patterns of perfusiorn/metabolism were classified as normal,mismatch,mild-to-moderate match and severe match.Myocardial MR contrast delay-enhancement was classified into 3 categories (non,mid-wall and transmural delay-enhancement).x2 test was used to analyze the differences of perfusion/metabolism patterns among non,mid-wall and transmural delay-enhancement groups and the myocardial MR contrast delay-enhancement incidence among four perfusion/metabolism groups.Resuits Among the 42 patients,myocardial delay-enhancement was present in 18 patients,of which 94.4％ (17/18) showed abnormal myocardial perfusion/metabolism patterns and only 33.3 ％ (8/24) patients without abnormal myocardial delay-enhancement had abnormal myocardial perfusion/metabolism patterns (x2 =15.944,P ＜ 0.001).Perfusion/metabolism patterns varied in three different categories of non,mid-wall and transmural delay-enhancement (x2 =14.276,P ＜ 0.001).The normal peffusion/metabolism pattern proportions in the non,mid-wall and transmural delay-enhancement groups were 86.2％ (526/610),71.0％ (44/62) and 28.6％ (12/42),respectively.The incidence of transmural delay-enhancement (44.4％ (12/27)) was significantly higher in segments with severe match than that in the other 3 groups (normal:2.1％ (12/582) ; mismatch:18.1％ (15/83) ; mild-to-moderate match:13.6％ (3/22) ; x2 =112.530,P ＜ 0.001).Conclusions MR contrast delay-enhancement is much more sensitive in detecting moderate fibrosis,while nuclear perfusion-metabolism imaging can detect more impaired but viable myocardium.Combining the two imaging modalities is useful for providing comprehensive evaluations of myocardial injury in patients with IDCM.

BACKGROUND: Schwann cells play an important role in regeneration of peripheral nerves and the extracellular matrix(ECM) is also important to growth of Schwann cells.OBJECTIVE: To explore the effects of laminin and type Ⅳ collagen on the adhesion and proliferation of Schwann cells.DESIGN: A controlled trial in groups with Schwann cell as subject.SETTING: Plastic Surgery Laboratory of the Fourth Military Medical University of Chinese PLA.MATERIALS: The trial was conducted in the Plastic Surgery Laboratory of Xijing Hospital Affiliated to the Fourth Military Medical University of Chinese PLA from January through April in 1995. The Schwann cells were extracted from newborn rabbits.METHODS: The culture plates were coated with laminin and type Ⅳ collagen. While in the control group, the antibody of laminin and collagen Ⅳ,collagen Ⅰ and polylysine were added respectively. The Schwann cells of the same concentration were cultured in plates of each group. The cells attachment rate in each group ,was determined after 2, 6, 24 hours respectively. After 72 hours 3H-TdR were incorporated into culture matrix fluid and double channel liquid scintillation counter was used for measurement of radiactivity count per minute.MAIN OUTCOME MEASURES: ① Attachment rate of Schwann cell. ②3H-TdR counting.RESULTS: The attachment rates in laminin and collagen Ⅳ groups (66%and 59% ) were higher than those of the type Ⅰ collagen and polylysine groups(45% and 43% ) after 2-hour culturing. Those in laminin antibody and collagen Ⅳ antibody groups were lower. The incorporation value were (10.0±2.7)×103, (1.3±0.3)×103, (10.4±2.4)×103, (1.4±0.5) ×103, (5.8±2.7)×103, (3.3±1.0)×103 per minute respectively in laminin, laminin antibody, collagen Ⅳ, collagen Ⅳ antibody, collagen Ⅰ and polylysine groups. The incorporation values in laminin and collagen Ⅳgroups were higher than controls.CONCLUSION: Laminin and type Ⅳ collagen promote the attachment and proliferation of Schwann cells in vitro. This study provides experimental basis for applying the action of Schwann cell to the nerve tissue engineering.

Objective To evaluate the value of echocardiography in transcatheter closure of ruptured sinus of Valsalva aneurysm(TC-RSVA).Methods TC-RSVA was attempted in 11 patients.The location,shape,size of defects and its relationship with the neighbor structures were revealed before the procedure.Then the deployment of occluder was monitored during the procedure,and the effectiveness was observed in the follow-up.Results Eleven patients were diagnosed as the isolated RSVA by echocardiography.The size of defects was 2 - 13 mm estimated by echo.The procedures were successful in all patients.Usually the Amplatzer duct occluders were chosen to be 1 to 5 mm larger than the size of defects.Three patients had mild residual shunt during the procedure,which all dispeared in the first month of follow-up,but one of them demonstrated recurrent mild residual shunt in the 32nd month of follow-up.There was no aggravating aortic regurgitation in the follow-up.Conclusions TC-RSVA is relatively safe and effective.Observation of long-term effectiveness is still necessary.Echocardiagraphy plays an important role in TC-RSVA.

ObjectiveTo investigate the effects of autologous bone marrow-derived mesenchymal stem cells (MSCs)transplantation on acute myocardial infarction in swine models using MRI. MethodsFourteen Chinese mini-pigs(27±3 kg)were divided into control group(n=7)and transplantation group(n=7).Acute myocardial infarction(AMI)model was made by occlusion of the left anterior descending coronary artery for 90 minutes,and then 10 ml autologous MSCs(3 × 106 cell/ml)were injected into LAD by over-wire-balloon catheter after one week. MRl was performed to assess the cardiac function and myocardial perfusion 1 week after AMI and 6 weeks after transplantation.The implanted cells in vitro were analyzed by immunofluorescence.ResuitsThe left ventricular ejection fraction(LVEF)in transplantation group was increased from(42.7 ±7.5)%to(50.1±10.1)%,which was significantly different from that in control group(P＜0.01).In addition,the dyskinetic segments in infarcted region and the infareted area were decreased by 4 and 3.2 cm2 respectively(P＜0.01),and the left ventricular weight index was increased by 4.1 g/m2 in transplantation group(P＜0.05)compared with control group.The DAPI-labeled cells in infarcted and peri-infarcted region indicated the survived MSCs.Immunofluoreseence also confirmed that those cells expressed cardiomyocyte-specific troponin T,connexin 43 and vessel-specific smooth muscle actin.Capillary density in both infarcted and peri-infarcted region were higher in transplantation group than the control group(P＜0.01).Conclusion MRI is a reliable imaging method for assessing the effects of stem cell transplantation in acute myocardial infartion of swine models.

Objective: To investigate the relationship between right ventricular (RV) glucose metabolism by18F-fludeoxyglucose positron emission tomography (18F-FDG PET) and right heart function in patients with dilated cardiomyopathy (DCM).
Methods: The18F-FDG PET imaging was performed in 34 consecutive DCM patients, with the reference of Herrero method, the corrected RV standard uptake value (cRVSUV), corrected left ventricular standard uptake value (cLVSUV) and the ratio of RV to LV SUV (cR/L) were obtained. And all 34 patients received cardiac magnetic resonance imaging (cMRI) examination within 7 days, the left ventricular ejection fraction (LVEF) and RVEF were automatically calculated with Simpson’s principle. The pulmonary arterial systolic pressure was measured by echocardiography.
Results: The corrected cRVSUV and cR/L by18F-FDG PET were negatively related to RVEF by cMRI, (r=-0.513, P<0.01) and (r=-0.463,P<0.01) respectively, and meanwhile, the corrected cRVSUV and cR/L were also negatively related to LVEF, (r=-0.387,P<0.01 andr=-0.362,P<0.01) respectively.
Conclusion: Increased RV glucose metabolism closely related to RV dysfunction, the18F-FDG uptake value by PET might be used as an index for assessing the right heart function and prognosis in DCM patients.

Objective To explore the relationship between hypothyroidism and myocardial injury in patients with idiopathic dilated cardiomyopathy (IDC) by 99Tcm-MIBI SPECT/18 F-FDG PET and late-gadolinium enhancement cardiac magnetic resonance imaging (cMRI-LGE).Methods Sixty-three consecutive patients (42 males and 21 females,(52±11) years) with IDC were enrolled from October 2010 to December 2012.Serum TT3,TT4,FT3,FT4 and TSH were determined using a fully automated chemiluminescence immunoassay.All patients underwent 99Tcm-MIBI myocardial perfusion SPECT/18F-FDG myocardial metabolism PET imaging and cMRI-LGE.Seventeen segments model was used for segmental analysis.Patterns of perfusion/metabolism were classified as normal,mismatch,mild-to-moderate match and complete match.cMRI-LGE was classified into 3 categories (non-LGE,mid-wall LGE and transmural LGE).x2 test was used for data analysis.Results All patients were divided into euthyroid group (n =53) and hypothyroidism group (n =10) according to the levels of serum thyroid hormones.The percentage of normal perfusion/metabolism segments in the euthyroid group was apparently higher than that in the hypothyroidism group:71.8％ (647/901) vs 57.6％ (98/170),x2 =13.50,P＜0.001 ; whereas the percentage of perfusion/metabolism mismatch segments in the euthyroid group was significantly lower than that in the hypothyroidism group:17.8％ (160/901) vs 31.2％ (53/170),x2=16.20,P＜0.001.The euthyroid group had a higher percentage of non-LGE segments (88.0％ (793/901) vs 69.4％ (118/170),x2 =35.70,P＜0.001) and a lower percentage of mid-wall LGE segments (4.8 ％ (43/901) vs 24.1％ (41 / 170),x2 =74.70,P＜ 0.001) compared to hypothyroidism group.Conclusions Hypothyroidism has a detrimental effect on myocardium.99Tcm-MIBI SPECT/18F-FDG PET imaging is sensitive in detecting viable/ischemia myocardium,and cMRI-LGE is good at detecting moderate fibrosis.Combining SPECT/PET imaging and cMRI-LGE for assessing myocardial injury would provide more comprehensive information.

Objectives To discuss the characteristics of late gadolinium enhancement (LGE) magnetic resonance (MR) imaging in patients with hypertrophic cardiomyopathy (HCM) and left ventricular apical aneurysm (LVAA) and its related prognostic value. Methods Thirty HCM patients with LVAA were collected from August 2004 to August 2013. All cases with coronary artery diseases were ruled out, and all patients underwent LGE derived by cardiac MR (CMR). Five cases of LVAA were pathological confirmed. Atrial and ventricular diameters, apical aneurysm diameters and left ventricular ejection fraction were measured, and apical aneurysm LGE was evaluated. All patients were then followed up. Comparisons in continuous parameters between patients with or without LGE were performed by independent t test. A Cox proportional hazard model was used to estimate the hazard rate for adverse cardiovascular events. Results LGE was identified in 21 LVAAs and non-LGE in 9 LVAAs. Between two groups, there was no significant difference in the size of LVAA [(16.4 ± 11.5) mm vs. (20.3 ± 9.8) mm, P=0.63]. In particular, the complete transition from non-LGE to LGE LVAA was recorded during follow-up in one patient. Pathological findings confirmed that LGE indicated fibrous tissue in LVAA, and LVAA without LGE indicated viable myocardium. The follow-up suggested that the patterns and the size of LVAA were associated with the adverse events in these patients (LGE of LVAA, HR=7.94, P=0.064; the size of LVAA, HR=1.08, P=0.009). Conclusions LGE-MR had important clinical significance in HCM patients with LVAA. LGE in LVAA corresponded with the fibrous tissue and was associated with the prognosis.

Objective To observe the clinical features and cardiac magnetic resonance (CMR)imaging characteristics in patients with cardiac amyloidosis. Methods A total of 5 patients (4 males and 1 female) with the diagnosis of cardiac amyloidosis (3 were proven by heart transplantation, 2 by endomyocardial biopsy) were evaluated by electrocardiogram, echocardiogram, chest X-ray and CMR with delayed Gadolinium enhancement. Results Echocardiograms were abnormal in all five patients; chest X-ray showed pulmonary hemorrhage ( 3 ), cardiomegaly (5), pleural effusion (3); echocardiogram showed atrial enlargement, left ventricular wall thickening, limited ventricular wall motion, etc. CMR exhibited increased thickness of the left ventricular wall, mild to moderate depression of systolic function ( mean ejection fraction: 32.5% ± 15.0% ) and bilateral atrial enlargement with restriction of diastolic ventricular filling. In all patients, there were widespread enhancement of the thickened myocardium on delayed postcontrast studies. In 4 patients, global subendocardial delayed gadolinium enhancement was found, in papillary muscles, and interventricular septa with" zebra-like" sign in 3 patients. Left ventricular transmural delayed gadolinium enhancement was found in 1 patient. Conclusions CMR shows a characteristic pattern of global subendocardial delayed gadolinium enhancement in cardiac amyloidosis. The findings may be valuable in the diagnosis of cardiac amyloidosis.

Objective To analyze the characteristics of hypertrophic cardiomyopathy (HCM) on delayed contrast-enhanced cardiac magnetic resonance imaging (CMRI). Methods All patients underwent delayed contrast-enhanced CMRI. The left ventricle was divided into 9 segments to assess the location,extent and function of the hypertrophic segments. The t test was applied for the statistics. Results Of 154 patients, delayed enhancement of hypertrophic segment was found in 95 cases and non-delayed enhancement in 59 cases. The thickness and number of hypertrophic segment in patients with delayed enhancement were larger than those with non-delayed enhancement [ (24. 8 ± 5. 5 ) mm vs (20. 4 ±3.8) mm, t = 3.82, P < 0.05; (3.3 ± 1.9) vs (2.4 ± 1.7), t = 2. 26, P < 0.05 ], and the age was younger [ (46. 0 ± 15.2) years vs (55.0 ± 11.9) years, t = - 3. 67, P <0. 05 ]. The diffuse enhancement was found in 62 patients, and confluent enhancement in 33 patients. Confluent enhancement was found in all 14 patients after the alcohol ablation procedure. Conclusion The age, thickness and number of hypertrophic segments in patients with delayed enhancement are different from those with non-delayed enhancement.

Objective To evaluate the imaging methods for cardiovascular malformations in Williams syndrome(WS).Methods Thirteen cases of WS(7 males and 6 females)aged 10 months to 13 years were involved in this study.All patients underwent chest X-ray radiography,electrocardiography.echocardiography and physical examination.3 cases underwent electronic beam computed tomography (EBCT),cardiac catheterization and angiography were performed in 8 cases.Results Twelve patients were referred to our hespital for cardiac murmur and 1 cnse for cyanosis after birth.7 patients were found with "elfin-like"facial features.6 patients with pulmonary arterial stenosis.2 Cases with patent ductus arteriosus.2 case8 with 8evere pulmonary hypertension and 1 case with total endocardial cushion defect.Sudden death occurred in 2 patients during and after catlleterization.respectively. Conclusions Conventional angiography is the golden standard for the diagnosis of cardiovascular malformations in WS.Noninvnsive methods such as MSCT and MRI should be suggested because of the risk of sudden death in conventional angiography.