In order to evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography (RT-MCE), intravenous RT-MCE was performed on 20 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions: homogeneous opacification=1; partial or reduced opaciflcation or subendocardial contrast defect=2; constrast defect=3. Myocardial perfusion score index (MPSI) was calculated by dividing the total sum of contrast score by the total number of segments with abnormal wall motion. Twenty patients were classified into 2 groups according to the MPSI: MPSImyocardial perfusion, MPSI>1.5 as poor myocardial perfusion. To assess the left ventricular remodeling, the following comparisons were carried out: (1) Comparisons of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) before and 3 months after revascularization in two groups; (2) Comparisons of LVEF, LVESV and LVEDV pre-revascularization between two groups and comparisons of these 3 months post-revascularization between two groups; (3) Comparisons of the differences in LVEF, LVESV and LVEDV between 3 months post-and pre-revascularization (DeltaLVEF, DeltaLVESV and DeltaLVEDV) between two groups; (4) The linear regression analysis between DeltaLVEF, DeltaLVESV, DeltaLVEDV and MPSI. The results showed that the LVEF obtained 3 months after revascularization in patients with MPSI>1.5 was obviously lower than that in those with MPSI1.5 was obviously larger than that in those with MPSI1.5 and those with MPSImyocardial infarction after revascularization.
Echocardiography/*methods ; Infusions, Intravenous ; Myocardial Infarction/*diagnosis ; Myocardial Infarction/pathology ; Myocardial Infarction/*ultrasonography ; Myocardial Reperfusion ; Myocardium/*pathology ; Perfusion ; Regression Analysis ; Time Factors ; Ventricular Remodeling

Acute Disease ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; pathology ; Pancreatitis ; diagnosis ; pathology

No Abstract available.
Myocardium/*pathology ; Myocardial Infarction/*diagnosis ; *Magnetic Resonance Imaging, Cine ; Humans ; Dogs ; Diagnosis, Differential ; Cicatrix/*diagnosis ; Animals

Aged ; Coronary Angiography ; Endocardium ; pathology ; Heart Aneurysm ; diagnosis ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; complications

The postmortem diagnosis of acute myocardial infarction (AMI), especially the postmortem diagnosis of early AMI that died immediately after onset or within 1 hour, has always been a difficulty in forensic identification. This article reviews the forensic application of diagnosis and analysis methods for AMI postmortem diagnosis including autopsy imaging, histomorphology, immunohisto-chemistry, biochemical marker and molecular biology diagnosis, and explores the feasible scheme of early postmortem diagnosis in AMI.
Autopsy ; Biomarkers ; Forensic Medicine ; Forensic Pathology/methods* ; Humans ; Myocardial Infarction/diagnosis* ; Postmortem Changes

OBJECTIVETo investigate the value of ischemic myocardial viability assessment using interleaved T1-T2* magnetic resonance imaging.

METHODSThe left anterior descending coronary arteries (LAD) were occluded for 2 hours, followed by 1-hour reperfusion in 7 pigs. The hearts were then removed and perfused with a mixture of pig blood and crystalloid solution in 1:1 ratio. T1 relaxation times of the myocardium were measured with a TurboFLASH inversion-recovery sequence. The contrast agent, Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) was then injected as a bolus into the aortic perfusion line (0.05 mmol/kg body wt). The first pass of the contrast agent through the heart was followed using the interleaved T1-T2* imaging sequence. Once the concentration of Gd-DTPA was in an equilibrium state, T1 relaxation times were measured again.

RESULTSThe percentage recovery of T2* intensity (PRT2*) at the maximum T1 intensity measured during the first pass of the contrast agent with the interleaved T1-T2* imaging was statistically different in normal myocardium (37 +/- 11)%, infarct rim (90 +/- 15)% and infarct core (100 +/- 5)%, F = 66.585, P = 0.000. Moreover, the infarcted regions shown on PR(T2)* maps matched well with the infarcted myocardium measured by TTC staining. The median of T(1) relaxation time in normal region, infarct rim and infarct core was 531 ms, 541 ms and 1298 ms, respectively (H = 6.284, P = 0.043). However, normal region could not be differentiated from infarct rim with T1 relaxation times (q = 0.082, P = 0.775).

CONCLUSIONInfarcted myocardium and ischemic myocardial viability can be correctly identified and evaluated by the interleaved T1-T2* magnetic resonance imaging in this model.

Animals ; Disease Models, Animal ; Female ; Magnetic Resonance Imaging ; methods ; Male ; Myocardial Contraction ; Myocardial Infarction ; diagnosis ; Myocardial Ischemia ; diagnosis ; Myocardium ; pathology ; Swine

OBJECTIVE: To investigate the value of T2 mapping in the assessment of myocardial changes and prognosis in patients with acute ST segment elevation myocardial infarction (STEMI). METHODS: A retrospective study was conducted. A total of 30 patients with acute STEMI admitted to Tianjin First Central Hospital from January 2021 to March 2022 were enrolled as the experimental group. At the same time, 30 age- and sex-matched healthy volunteers and outpatients with non-specific chest pain with no abnormalities in cardiac magnetic resonance (CMR) examination were selected as the control group. CMR was performed within 2 weeks after the diagnosis of STEMI, as the initial reference. A plain CMR review was performed 6 months later (chronic myocardial infarction, CMI). Plain scanning includes film sequence (CINE), T2 weighted short tau inversion recovery (T2-STIR), native-T1 mapping, and T2 mapping. Enhanced scanning includes first-pass perfusion, late gadolinium enhancement (LGE), and post-contrast T1 mapping. Quantitative myocardial parameters were compared between the two groups, before and after STEMI myocardial infarction. The receiver operator characteristic curve (ROC curve) was used to evaluate the diagnostic efficacy of native-T1 before myocardial contrast enhancement and T2 values in differentiating STEMI and CMI after 6 months. RESULTS: There were no statistically significant differences in age, gender, heart rate and body mass index (BMI) between the two groups, which were comparable. The native-T1 value, T2 value and extracellular volume (ECV) were significantly higher than those in the control group [native-T1 value (ms): 1 434.5±165.3 vs. 1 237.0±102.5, T2 value (ms): 48.3±15.6 vs. 21.8±13.1, ECV: (39.6±13.8)% vs. (22.8±5.0)%, all P < 0.05]. In the experimental group, 12 patients were re-examined by plain CMR scan 6 months later. After 6 months, the high signal intensity on T2-STIR was still visible, but the range was smaller than that in the acute phase, and the native-T1 and T2 values were significantly lower than those in the acute phase [native-T1 value (ms): 1 271.0±26.9 vs. 1 434.5±165.3, T2 value (ms): 34.2±11.2 vs. 48.3±15.6, both P < 0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of native-T1 and T2 values in differentiating acute STEMI from CMI was 0.71 and 0.80, respectively. When native-T1 cut-off value was 1 316.0 ms, the specificity was 100% and the sensitivity was 53.3%; when T2 cut-off value was 46.7 ms, the specificity was 100% and the sensitivity was 73.8%. CONCLUSIONS The T2 mapping is a non-invasive method for the diagnosis of myocardial changes in patients with acute STEMI myocardial infarction, and can be used to to evaluate the clinical prognosis of patients.
Humans ; ST Elevation Myocardial Infarction/diagnosis* ; Contrast Media ; Prognosis ; Retrospective Studies ; Magnetic Resonance Imaging, Cine/methods* ; Gadolinium ; Myocardium/pathology* ; Myocardial Infarction ; Predictive Value of Tests

Bupivacaine is widely used as a local anesthetic. Central nervous system (CNS) and cardiovascular toxicity are well known side effects. However, there has been no report of bupivacaine-induced myocardial injury. We present a case of bupivacaine cardiac toxicity mimicking an acute non-ST segment elevation myocardial infarction, which was eventually diagnosed as bupivacaine-induced cardiac toxicity without CNS toxicity. As soon as a healthy young woman at a private clinic was given a spinal anesthesia of 6mg bupivacaine for hemorrhoidectomy, she developed arrhythmia and hypotension. She was transferred to our emergency room. There was an accelerated idioventricular rhythm with ST segment depression on electrocardiogram, coarse breathing sounds with rales on whole lung field and a butterfly sign on the chest radiograph. 2D transthoracic echocardiography (TTE) revealed reduced left ventricle systolic ejection fraction (approximately 27%). There was regional wall motion abnormality of the left ventricle on 2D TTE and the cardiac marker was increased. We diagnosed the patient as having acute non-ST segment elevation myocardial infarction but her impaired cardiac function improved gradually. On the seventh day from admission, there was a complete spontaneous recovery of cardiac function, and coronary angiography revealed a normal coronary artery. Therefore, we firmly believe that bupivacaine directly injures the cardiac cell.
Myocardium/*pathology ; Myocardial Infarction/chemically induced/*diagnosis/etiology ; Humans ; Heart/*drug effects ; Female ; Electrocardiography ; Diagnosis, Differential ; Bupivacaine/*adverse effects ; Adult

BACKGROUNDSuperparamagnetic iron oxide (SPIO) particles have shown much promise as a means to visualize labeled cells using molecular magnetic resonance imaging (MRI). Micrometer-sized superparamagnetic iron oxide (MPIO) particles and nanometer-sized ultrasmall superparamagnetic iron oxide (USPIO) are two kinds of SPIO widely used for monitoring stem cells migration. Here we compare the efficiency of two kinds of SPIO during the use of stem cells to treat acute myocardial infarction (AMI).

METHODSAn AMI model in swine was created by 60 minutes of balloon occlusion of the left anterior descending coronary artery. Two kinds of SPIO particles were used to track after intracoronary delivered 10(7) magnetically labeled mesenchymal stem cells (MR-MSCs). The distribution and migration of the MR-MSCs were assessed with the use of 3.0T MR scanner and then the results were confirmed by histological examination.

RESULTSMR-MSCs appeared as a local hypointense signal on T₂*-weighted MRI and there was a gradual loss of the signal intensity after intracoronary transplantation. All of the hypointense signals in the USPIO-labeled group were found on T₂*-weighted MRI, contrast to noise ratio (CNR) decreased in the MPIO-labeled group (16.07 ± 5.85 vs. 10.96 ± 1.34) and USPIO-labeled group (11.72 ± 1.27 vs. 10.03 ± 0.96) from 4 to 8 weeks after transplantation. However, the hypointense signals were not detected in MPIO-labeled group in two animals. MRI and the results were verified by histological examination.

CONCLUSIONSWe demonstrated that two kinds of SPIO particles in vitro have similar labeling efficiency and viability. USPIO is more suitable for labeling stem cells when they are transplanted via a coronary route.

Animals ; Cell Survival ; Contrast Media ; Ferric Compounds ; Magnetic Resonance Imaging ; methods ; Male ; Myocardial Infarction ; diagnosis ; pathology ; Stem Cells ; cytology ; Swine

OBJECTIVETo compare the value of head-chest lead electrocardiogram (HCECG) and routine lead electrocardiogram (RLECG) in diagnosis of acute positive posterior myocardial infarction.

METHODSHCECGs and RLECGs were recorded simultaneously in 68 normal individuals and 32 patients with acute posterior wall myocardial infarction confirmed by coronary angiography and echocardiography. Each HCECG and RLECG was analyzed by two senior physicians specialized in clinical electrophysiology who were blinded to the results. The HCECG- and RLECG-based diagnostic results were compared with the results of coronary angiography, and the coincidence rates and false positive rates of diagnosis based on HCECGs and RLECGs were calculated.

RESULTSThe coincidence rate was 93.8% (30/32) for RLECGs and 100% (32/32) for HCECGs in the diagnosis of acute posterior wall myocardial infarction, showing no significant difference between them (P>0.05). RLECGs-based diagnosis, however, resulted in a significantly higher false positive rate than HCECGs [13.2% (9/68) vs 0% (0/68), P<0.05].

CONCLUSIONHead-chest lead system is superior to routine lead system for its low false positive rates in the diagnosis of acute posterior wall myocardial infarction.

Adult ; Coronary Angiography ; Electrocardiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; diagnostic imaging ; physiopathology ; Myocardium ; pathology