RESUMEN
BACKGROUND: The Cardioband system enables percutaneous surgical-like direct mitral valve annuloplasty and, thereby, repair of severe functional mitral valve regurgitation (MR) in patients with advanced systolic heart failure (HF) and dilation of the left ventricular (LV) annulus. Since the device is anchored by screws in the LV annulus, limited myocardial injury is likely to occur. METHODS AND RESULTS: Five patients (Society of Thoracic Surgeons score: 2.7⯱ 0.7%) with severe HF (LV ejection fraction [LVEF]: 17⯱ 1%; LV end-diastolic diameter [LVEDD]: 71⯱ 3â¯mm) were treated with the Cardioband (sizes C-F) receiving 14-17 screws in the LV annulus region. Myocardial injury was monitored by measuring high-sensitive cardiac troponin T (hsTnT) levels and by echocardiography. All patients showed significant periprocedural increase in hsTnT levels. Peak hsTnT concentration was reached between day 1 and day 6 (593⯱ 141â¯pg/ml). None of the patients showed clinical signs of myocardial infarction, ST-segment elevation, new onset of deteriorated myocardial wall motion, or new ventricular tachycardia. hsTnT levels normalized in all patients after 14 days (hsTnT on day 0: 34⯱ 6â¯pg/ml vs. hsTnT on day 14: 36⯱ 6â¯pg/ml; pâ¯= 0.604). This nonischemic hsTnT kinetics was compared to a sixth patient who experienced proximal damage of the left circumflex artery (LCX) and ST-segment elevation during the Cardioband procedure, followed by immediate repair of the LCX, avoiding structural damage of the LV. CONCLUSION: Cardioband implantation is accompanied by significant elevation of hsTnT without causing structural myocardial damage or clinical symptoms such as worsening of LV function, new-onset LV regions exhibiting reduced wall motion, or ventricular tachycardia.
Asunto(s)
Biomarcadores , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Troponina T , Biomarcadores/sangre , Ecocardiografía , Humanos , Troponina T/sangre , Función Ventricular IzquierdaRESUMEN
BACKGROUND AND PURPOSE: To determine the rate of peri-interventional silent brain infarcts after left atrial appendage occlusion (LAAO). METHODS: In this prospective, uncontrolled single-center pilot study, consecutive patients with atrial fibrillation undergoing LAAO between July 2013 and January 2016 were included. The Amplatzer Cardiac Plug, WATCHMAN or Amulet device was used. A neurological examination and cranial magnetic resonance imaging (MRI) were performed within 48 h before and after the procedure. MRI was evaluated for new diffusion-weighted imaging (DWI) hyperintensities, cerebral microbleeds (CMBs) and white-matter lesions (WMLs). RESULTS: Left atrial appendage occlusion was performed in 21 patients (mean age, 73.2 ± 9.5 years). Main reasons for LAAO were previous intracerebral hemorrhage (n = 11) and major systemic bleeding (n = 6). No clinically overt stroke occurred peri-interventionally. After the intervention, one patient had a small cerebellar hyperintensity on DWI (4.8%; 95% confidence interval, 0.0-14.3) that was not present on the MRI 1 day before the procedure. Among 11 patients with available MRI just before LAAO, there were no significant changes in the number of CMBs and the severity of WMLs after LAAO. CONCLUSIONS: This study of peri-interventional MRI in LAAO suggests a low rate of silent peri-procedural infarcts in this elderly population. Confirmation in larger studies is needed.
Asunto(s)
Apéndice Atrial , Infarto Cerebral/epidemiología , Infarto Cerebral/etiología , Oclusión Terapéutica/efectos adversos , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/terapia , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico , Proyectos Piloto , Estudios Prospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Oclusión Terapéutica/estadística & datos numéricos , Resultado del Tratamiento , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patologíaRESUMEN
PURPOSE: Genetic engineering techniques led to an exponential increase in the number of transgenic and knock-out mouse models. For many genetically modified mice, high throughput echocardiography is an essential part of a systematic screening workflow. Many researchers perform mouse echocardiography in conscious animals to avoid anesthesia-induced impairment of cardiac function. However, it has been controversially discussed whether mice need to be habituated to handling before their cardiac function can be assessed. The aim of this study was to test the influence of training on parameters assessed during conscious mouse echocardiography. In addition, we tested whether a simple and fast echocardiography protocol has sufficient sensitivity and specificity for primary screening. MATERIALS AND METHODS: Examined parameters include fractional shortening, heart rate and respiratory rate. A total of 139 mice were examined in this study with a total of 587 echocardiograms. 103 mice were examined on five consecutive days (with examinations on day 1 - 4 regarded as training), 36 mice were only examined on day 1 and 5. RESULTS: Fractional shortening, heart rate and respiratory rate did not show any statistically significant difference between day 1 and day 5 in both groups. The sensitivity and specificity of fractional shortening assessment for predicting a homozygote knock out genotype were 86 % and 97 %, respectively. CONCLUSION: We conclude that conscious mouse echocardiography can be performed in untrained mice. Fractional shortening measurements may suffice for correct phenotyping in a high throughput setting.