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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of heart rate on the amount and distribution of collateral blood flow was determine in open-chested dogs 1 h after coronary artery ligation. Flows to ischemic and nonischemic regions of left ventricle were measured with 7- to 10- mum diam radioactive microspheres during base-line conditions (118 +/- 6 beats/min) and again during atrial pacing at rates 20 and 40% above control (141 +/- 7 and 165 +/- 9 beats/min). During pacing aortic and left atrial pressures and cardiac output did not change significantly, whereas ST segment elevation in epicardial electrograms increased markedly. In nonischemic myocardium, mean flow increased approximately in proportion to the increase in rate, but subepicardial (EPI) flow increased somewhat more than subendocardial (ENDO) flow. In ischemic myocardium, overall flow did not change significantly, but a redistribution from ENDO to EPO was seen. At the faster rate ENDO flow fell 25% (P less than 0.02), EPI flow increased slightly, and ENDO/EPI fell in 8/9 animals (mean 0.54-0.43, P less than 0.01). The ENDO/EPI maldistribution present in ischemic muscle is thus accentuated by tachycardia; this may account for part of the harmful effect of tachycardia in acute myocardial infarction and may help explain the disproportionate ENDO ischemia seen in angina pectoris.
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PMID:Effect of tachycardia on left ventricular blood flow distribution during coronary occlusion. 126 2

Previous studies have revealed that the regional accumulation of ischemic metabolites including hydrogen ion (H+) and PCO2 diminish after repeated occlusions. We postulated that this diminution reflects a blunted metabolic response that is related to the severity of ischemic injury and, hence, may be most pronounced in subendocardial (ENDO) regions. To investigate this hypothesis, the left anterior descending coronary artery was serially occluded three times in 51 dogs for a period of either 3 minutes (n = 15), 5 minutes (n = 18), or 15 minutes (n = 18). Each occlusion was separated by 45 minutes of reperfusion. Myocardial [H+] was measured in the endomyocardium and in the epimyocardium of the ischemic anterior wall by use of miniature pH glass electrodes. Accumulation of H+ during occlusion (delta [H+]) in the ENDO region was significantly less during the second occlusion when compared with the first occlusion (3-minute occlusions: 28.2 +/- 3.7 nM/l vs. 39.4 +/- 5.4 nM/l, p less than 0.002; 5-minute occlusions: 49.8 +/- 5.0 nM/l vs. 72.1 +/- 6.5 nM/l, p less than 0.0002; 15-minute occlusions: 132.3 +/- 14.6 nM/l vs. 225.6 +/- 27.7 nM/l, p less than 0.0003). A similar trend was noted for delta [H+] in the subepicardial (EPI) regions. During occlusion, the rise in [H+] occurred sooner, and delta [H+] was consistently greater in the ENDO when compared with the EPI regions (p less than 0.05). Regional myocardial blood flow did not change during the three occlusions, indicating that the diminution in H+ accumulation stemmed from a decrease in H+ production and not from an increase in collateral flow. The decrement in H+ accumulation between the first and second occlusions (delta [H+]1-delta [H+]2) 1) was greater in the ENDO than in the EPI regions (p less than 0.05); 2) correlated with the duration of occlusion (ENDO: r = 0.66, p less than 0.001; EPI: r = 0.82, p less than 0.0001); and 3) was related to the impairment of anterior wall systolic shortening after the first reperfusion period. These findings suggest that the diminution in H+ production that follows serial coronary occlusions reflects a blunted metabolic response that is related to both the duration of ischemia and the degree of systolic dysfunction. Moreover, though attenuation of ischemic metabolite production occurs transmurally, it is most pronounced in the deep ENDO regions.
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PMID:Significance of the transmural diminution in regional hydrogen ion production after repeated coronary artery occlusions. 291 84

After 25 minutes of ischemia, in the isolated rat preparation, hearts fail to reestablish adequate contractile function. To determine whether this failure was associated with a transmural variation in the metabolic response of myocardial cells to reperfusion, the authors subjected hearts to 25 minutes of global ischemia with and without 5 or 20 minutes of reperfusion. After freeze-drying the left ventricular myocardium was divided into subepicardial (EPI) and subendocardial (ENDO) regions before estimating the lactate, total adenine pool metabolites, and creatine phosphate (CP) and phosphate concentrations in each region. Other groups of hearts were perfusion-fixed with glutaraldehyde then injected with nuclear track emulsion to demonstrate that a high proportion of capillaries in both the subendocardial (89%) and subepicardial (95%) myocardium transmitted perfusate after 5 minutes of reperfusion. Reperfusion removed lactate equally from each region. Thus the differences in the capacity of reperfusion of these regions to recover CP (ENDO, 100%; EPI, 168% of preischemic values), to elevate adenosine triphosphate (ATP) (ENDO, 32%; EPI, 63%), or to retain adenosine monophosphate (AMP) (ENDO, 625%; EPI, 277%) were unlikely to be due to regional differences in microvascular function. Despite the better preservation of both structure and metabolism in the subepicardium, there was, during reperfusion, a progressive loss of purine precursors from cells in both regions of the myocardium. These results suggest that the loss of ability of the myocardium to recover significant function after relatively short periods of ischemia is due to their inability, on reperfusion, to synthesise sufficient ATP from the available precursors. This capacity for resynthesis of ATP is lost more rapidly in the subendocardial than in the subepicardial myocardium.
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PMID:Transmural differences in the postischemic recovery of cardiac energy metabolism. 335 43

The effect of carbochromen on total and regional coronary blood flow was investigated in 6 anesthetized open-chest dogs. Total and regional myocardial blood flow was measured by radioactive microspheres, using the reference sample method. Left circumflex coronary flow was monitored by an electromagnetic flowmeter. In 4 dogs (Group 1) carbochromen was injected intravenously; in 2 dogs (Group 2) it was infused directly in the circumflex coronary artery. No significant changes in heart rate, left atrial left ventricular and aortic pressures were observed following carbochromen administration in both Groups. Left circumflex coronary blood flow progressively increased and a level slightly higher than peak reactive hyperemia was reached in both Groups. Regional myocardial blood flow measurements in Group 1 showed that the inner third of the left ventricular wall (ENDO) increased 2.7 times relative to control, the middle layer increased 3.4 times relative to control and the external third 4.5 times relative to control. A similar pattern was observed after intracoronary administration of carbochromen (Group 2). The ENDO/EPI flow ratio dropped from 0.98 +/- 0.16 to 0.58 +/- 0.18 in Group 1 and from 1.03 and 1.20 to 0.71 and 0.53 respectively in the two experiments of Group 2. Replacement of carbochromen with adenosine infusion in Group 2 produced a further increase in flow, mainly in the subendocardium resulting in ENDO/EPI flow ratio close to unity. These data demonstrate that the powerful coronary vasodilatory effect of carbochromen is not uniform being vasodilation more prominent in the vasculature of the external third of the left ventricular wall as compared to the inner third. Consequently a major redistribution of coronary blood flow, favouring the external layers of the left ventricle, results from carbochromen administration. This effect distinguishes carbochromen from other vasodilating stimuli than elicit a uniform response in the coronary vasculature and do not affect the ENDO/EPI ratio, including transient ischemia, adenosine, and dipyridamole.
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PMID:[Selective vasodilatation of the subepicardial coronary vasculature induced by carbochromen (author's transl)]. 728 35

Spatially localized nuclear magnetic resonance (NMR) spectroscopy was used to examine the effect of tachycardia and inotropic stimulation on myocardial ATP, creatine phosphate (CrP), and inorganic phosphate (Pi) in animals with left ventricular hypertrophy (LVH). Studies were performed in eight normal dogs and seven dogs with moderate LVH produced by banding the ascending aorta. 31P-NMR spectra were obtained from five layers across the LV wall, while blood flow (BF) was measured with microspheres during control conditions, pacing at 200 and 240 beats/min, and during dobutamine infusion (Dob). Myocardial ATP and CrP levels were normal in the LVH hearts during control conditions. Pacing did not alter the transmural distribution of perfusion or the levels of CrP, ATP, and Pi in normal hearts. In contrast, in four of seven LVH hearts, pacing decreased the subendocardial/subepicardial (ENDO/EPI) BF ratio and caused depletion of CrP and appearance of Pi characteristic of ischemia in the subendocardium. Dob produced greater increases in the heart rate x LV systolic pressure product (RPP) and greater increases of Pi and decreases of CrP in LVH than in normal hearts; however, at comparable elevations of RPP the alterations of Pi and CrP were similar in both groups. Although Dob decreased the ENDO/EPI in LVH hearts, Dob-induced alterations in CrP and Pi were uniform across the LV wall. Increasing myocardial BF with adenosine or carbochromen did not reverse the alterations in Pi or CrP produced by Dob. We conclude that 1) ENDO perfusion abnormalities during tachycardia in LVH do produce ENDO subendocardial ischemia; 2) when the degree of augmentation of mechanical performance is considered, the metabolic changes induced by Dob were similar in normal and LVH hearts; 3) Dob-induced alterations in Pi and CrP were not related to inadequate perfusion, since increasing coronary BF did not reverse these changes; and 4) alterations of Pi and CrP during Dob infusion were not more prominent in the ENDO, indicating that the decreased ENDO/EPI flow did not cause ENDO ischemia but may reflect relatively lower O2 demands in this region during inotropic stimulation.
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PMID:High-energy phosphate responses to tachycardia and inotropic stimulation in left ventricular hypertrophy. 820 95

The aim of this study was to determine the utility of diffusion-weighted echo planar imaging (DW-EPI) for detecting acute and subacute brain ischemic foci less than 2 cm in size. Thirty patients underwent DW-EPI on a 1.5 T superconducting unit using a SE-EPI sequence with an arbitrary pair of Stejskal-Tanner gradients applied along the imaging axes. DW-EPI demonstrated all the mast recent ischemic lesions as areas of decreased diffusion, providing greater conspicuity and larger size than conventional spin-echo imaging. DW-EPI is a promising method to detect within a subsecond early ischemia and reversible ischemic changes that are not demonstrate on routine spin-echo images.
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PMID:[Application of diffusion-weighted echo planar imaging for diagnosis of small acute and subacute brain ischemic lesions]. 916 17

Rapid changes in the apparent diffusion coefficient of water following brain ischemia have been extensively studied using echo planar diffusion imaging at low fields (2.0 T). There is a desire to perform these studies at higher fields (> 3.0 T) where the benefits of improved signal-to-noise can be exploited. Unfortunately, EPI diffusion is technically difficult to implement at high fields because of large magnetic susceptibility effects. This article demonstrates the feasibility of employing a line-scan diffusion protocol for ADCw measurements in stroke. The technique was applied on a 4.0 T system to monitor the decline in ADCw following the induction of focal cerebral ischemia in rat. ADCw data were acquired every 15 s with 10 b-values or every 22.5 s with 15 b-values, with a cubic spatial resolution of 1.5 mm. The results demonstrate that estimates of ADCw can be acquired with coefficients of variation under 3.0%, and with a combination of spatial and temporal resolution comparable to that previously reported for EPI.
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PMID:The application of diffusion-weighted line-scanning for the rapid assessment of water ADC changes in stroke at high magnetic fields. 926 65

A new technique, CAPTIVE, that is a synthesis of arterial spin labeling (ASL) blood flow and steady-state susceptibility contrast relative blood volume imaging is described. Using a single injection of a novel, long half-life intravascular magnetopharmaceutical with a high tissue:blood susceptibility difference (deltachi) to deltaR1 ratio, changes in tissue transverse relaxivity (deltaR2 or deltaR2*) that arise from changes in blood volume were measured, while preserving the ability to measure blood flow using traditional T1-based ASL techniques. This modification permits the continuous measurement of both blood flow and blood volume. Also, because the contrast agent can be used to remove the signal from intravascular spins, it is possible to measure the first-pass water extraction fraction. Contrast-to-noise is easily traded off with repetition rate, allowing the use of non-EPI scanners and more flexible imaging paradigms. The basic theory of these measurements, several experimental scenarios, and validating results are presented. Specifically, the PaCO2-reactivity of microvascular and total relative cerebral blood volume (rCBV), cerebral blood flow (CBF), and the water extraction-flow product (EF) in rats with the new contrast agent MPEG-PL-DyDTPA is measured, and the values are concordant with those of previous literature. As an example of one possible application, continuous flow and volume measurements during transient focal ischemia are presented. It is believed that CAPTIVE imaging will yield a more complete picture of the hemodynamic state of an organ, and has further application for understanding the origins of the BOLD effect.
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PMID:Continuous assessment of perfusion by tagging including volume and water extraction (CAPTIVE): a steady-state contrast agent technique for measuring blood flow, relative blood volume fraction, and the water extraction fraction. 979 48

Previous studies used manganese N,N'-bis-(pyridoxal 5-phosphate)ethylenediamine-N,N'-diacetic acid (MnDPDP) to detect myocardial ischemia at a dose of 0.4 mmol/kg with spin echo imaging. The purpose of this study was to detect acute myocardial ischemia using MnDPDP at a dose range near that approved for hepatobiliary imaging (0.005 mmol/kg) in conjunction with inversion recovery echoplanar imaging (IR EPI). Regional ischemia was produced in 26 rats by occluding the left coronary artery for 20-30 minutes before imaging. Consecutive 32 IR EP images (inversion time [TI]/TR/TE 700/2000/10 msec) were obtained to monitor the first pass of MnDPDP at four incremental doses (0.005, 0.01, 0.02, or 0.04 mmol/kg, n = 6-8). MnDPDP produced dose-dependent enhancement of left ventricular blood and normal myocardium, but not ischemic myocardium. Quantitative analysis revealed a difference in signal intensities (P<0.05) between normal and ischemic myocardium at the time of peak enhancement in all groups. However, differential enhancement between normal and ischemic myocardium produced clear visual delineation of the ischemic region only at doses > or =0.01 mmol/kg. In conclusion, acute myocardial ischemia can be detected with IR EPI using doses close to the clinically approved dose of MnDPDP.
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PMID:Detection of acute myocardial ischemia using first-pass dynamics of MnDPDP on inversion recovery echoplanar imaging. 1007 15

The effects of blood sugar level on transient focal brain ischemia were examined by consecutive diffusion-weighted EPI and (1)H echo planar spectroscopic imaging. A remote-controlled rat intraluminal suture middle cerebral artery occlusion (MCAO) model was prepared. Animals were divided into three experimental groups: control, 1 g/kg, and 2 g/kg glucose groups (n = 6 for each). Saline or glucose was infused intraperitoneally 30 min prior to MCAO. The glucose-loaded groups showed increased lactate accumulation and marked decreases in average diffusion coefficient in the ischemic region during 40-min MCAO. These changes were correlated with blood sugar levels at the onset of MCAO. After reperfusion, all rats in the control and 1 g/kg groups recovered from the ischemic changes, but three rats with marked hyperglycemia in the 2 g/kg group showed irreversible changes. The adverse effects of hyperglycemia on transient focal brain ischemia were clearly demonstrated by sequential 2D images. Magn Reson Med 42:895-902, 1999.
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PMID:Effects of blood sugar level on rat transient focal brain ischemia consecutively observed by diffusion-weighted EPI and (1)H echo planar spectroscopic imaging. 1054 48


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