Image based cardiac acceleration map using statistical shape and 3D+t myocardial tracking models; in-vitro study on heart phantom

International audienceIt has been demonstrated that the acceleration signal has potential to monitor heart function and adaptively optimize Cardiac Resynchronization Therapy (CRT) systems. In this paper, we propose a non-invasive method for computing myocardial acceleration from 3D echocardiographic sequences. Displacement of the myocardium was estimated using a two-step approach: (1) 3D automatic segmentation of the myocardium at end-diastole using 3D Active Shape Models (ASM); (2) propagation of this segmentation along the sequence using non-rigid 3D+t image registration (temporal diffeomorphic free-form-deformation, TDFFD). Acceleration was obtained locally at each point of the myocardium from local displacement. The framework has been tested on images from a realistic physical heart phantom (DHP-01, Shelley Medical Imaging Technologies, London, ON, CA) in which the displacement of some control regions was known. Good correlation has been demonstrated between the estimated displacement function from the algorithms and the phantom setup. Due to the limited temporal resolution, the acceleration signals are sparse and highly noisy. The study suggests a non-invasive technique to measure the cardiac acceleration that may be used to improve the monitoring of cardiac mechanics and optimization of CRT

Uso de la adrenalina autoinyectable (AAI) en pacientes con antecedentes de anafilaxia

La adrenalina autoinyectable (AAI) es un tratamiento que debe prescribirse a aquellos pacientes que han sufrido una reacción anafiláctica y son susceptibles de sufrir otra. En nuestro estudio, mediante una encuesta, valoramos el uso y el manejo de la AAI en pacientes a los que se les prescribió AAI y que siguen controles en nuestras consultas.L'adrenalina autoinjectable (AAI) és un tractament que s'ha de prescriure a aquells pacients que han patit una reacció anafilàctica i que són susceptibles de patir-ne una altra. Al nostre estudi, mitjançant una enquesta, valorem l'ús i el maneig de l'AAI en pacients als que se'ls ha prescrit AAI i que segueixen controls a les nostres consultes

Role of Circulating Angiotensin Converting Enzyme 2 in Left Ventricular Remodeling following Myocardial Infarction: A Prospective Controlled Study.

Angiotensin-converting enzyme 2 (ACE2) cleaves Angiotensin-II to Angiotensin-(1-7), a cardioprotective peptide. Serum soluble ACE2 (sACE2) activity is raised in chronic heart failure, suggesting a compensatory role in left ventricular dysfunction. Our aim was to study the relationship between sACE2 activity, infarct size, left ventricular systolic function and remodeling following ST-elevation myocardial infarction (STEMI). A contrast-enhanced cardiac magnetic resonance study was performed acutely in 95 patients with first STEMI and repeated at 6 months to measure LV end-diastolic volume index, ejection fraction and infarct size. Baseline sACE2 activities, measured by fluorescent enzymatic assay 24 to 48 hours and at 7 days from admission, were compared to that obtained in 22 matched controls. Patients showed higher sACE2 at baseline than controls (104.4 [87.4-134.8] vs 74.9 [62.8-87.5] RFU/µl/hr, p<0.001). At seven days, sACE2 activity significantly increased from baseline (115.5 [92.9-168.6] RFU/µl/hr, p<0.01). An inverse correlation between sACE2 activity with acute and follow-up ejection fraction was observed (r = −0.519, p<0.001; r = −0.453, p = 0.001, respectively). Additionally, sACE2 directly correlated with infarct size (r = 0.373, p<0.001). Both, infarct size (β = −0.470 [95%CI:−0.691:−0.248], p<0.001) and sACE2 at 7 days (β = −0.025 [95%CI:−0.048:−0.002], p = 0.030) were independent predictors of follow-up ejection fraction. Patients with sACE2 in the upper tertile had a 4.4 fold increase in the incidence of adverse left ventricular remodeling (95% confidence interval: 1.3 to 15.2, p = 0.027). In conclusion, serum sACE2 activity rises in relation to infarct size, left ventricular systolic dysfunction and is associated with the occurrence of left ventricular remodeling

Uso de la adrenalina autoinyectable (AAI) en pacientes con antecedentes de anafilaxia

La adrenalina autoinyectable (AAI) es un tratamiento que debe prescribirse a aquellos pacientes que han sufrido una reacción anafiláctica y son susceptibles de sufrir otra. En nuestro estudio, mediante una encuesta, valoramos el uso y el manejo de la AAI en pacientes a los que se les prescribió AAI y que siguen controles en nuestras consultas.L'adrenalina autoinjectable (AAI) és un tractament que s'ha de prescriure a aquells pacients que han patit una reacció anafilàctica i que són susceptibles de patir-ne una altra. Al nostre estudi, mitjançant una enquesta, valorem l'ús i el maneig de l'AAI en pacients als que se'ls ha prescrit AAI i que segueixen controls a les nostres consultes

Role of Circulating Angiotensin Converting Enzyme 2 in Left Ventricular Remodeling following Myocardial Infarction: A Prospective Controlled Study.

Angiotensin-converting enzyme 2 (ACE2) cleaves Angiotensin-II to Angiotensin-(1-7), a cardioprotective peptide. Serum soluble ACE2 (sACE2) activity is raised in chronic heart failure, suggesting a compensatory role in left ventricular dysfunction. Our aim was to study the relationship between sACE2 activity, infarct size, left ventricular systolic function and remodeling following ST-elevation myocardial infarction (STEMI). A contrast-enhanced cardiac magnetic resonance study was performed acutely in 95 patients with first STEMI and repeated at 6 months to measure LV end-diastolic volume index, ejection fraction and infarct size. Baseline sACE2 activities, measured by fluorescent enzymatic assay 24 to 48 hours and at 7 days from admission, were compared to that obtained in 22 matched controls. Patients showed higher sACE2 at baseline than controls (104.4 [87.4-134.8] vs 74.9 [62.8-87.5] RFU/µl/hr, p<0.001). At seven days, sACE2 activity significantly increased from baseline (115.5 [92.9-168.6] RFU/µl/hr, p<0.01). An inverse correlation between sACE2 activity with acute and follow-up ejection fraction was observed (r = −0.519, p<0.001; r = −0.453, p = 0.001, respectively). Additionally, sACE2 directly correlated with infarct size (r = 0.373, p<0.001). Both, infarct size (β = −0.470 [95%CI:−0.691:−0.248], p<0.001) and sACE2 at 7 days (β = −0.025 [95%CI:−0.048:−0.002], p = 0.030) were independent predictors of follow-up ejection fraction. Patients with sACE2 in the upper tertile had a 4.4 fold increase in the incidence of adverse left ventricular remodeling (95% confidence interval: 1.3 to 15.2, p = 0.027). In conclusion, serum sACE2 activity rises in relation to infarct size, left ventricular systolic dysfunction and is associated with the occurrence of left ventricular remodeling

Patient selection.

<p>Flow-chart detailing patient selection. ce-CMR: contrast-enhanced Cardiac Magnetic Resonance; FU: follow-up.</p

Role of Circulating Angiotensin Converting Enzyme 2 in Left Ventricular Remodeling following Myocardial Infarction: A Prospective Controlled Study

<div><p>Angiotensin-converting enzyme 2 (ACE2) cleaves Angiotensin-II to Angiotensin-(1–7), a cardioprotective peptide. Serum soluble ACE2 (sACE2) activity is raised in chronic heart failure, suggesting a compensatory role in left ventricular dysfunction<b>.</b> Our aim was to study the relationship between sACE2 activity, infarct size, left ventricular systolic function and remodeling following ST-elevation myocardial infarction (STEMI). A contrast-enhanced cardiac magnetic resonance study was performed acutely in 95 patients with first STEMI and repeated at 6 months to measure LV end-diastolic volume index, ejection fraction and infarct size. Baseline sACE2 activities, measured by fluorescent enzymatic assay 24 to 48 hours and at 7 days from admission, were compared to that obtained in 22 matched controls. Patients showed higher sACE2 at baseline than controls (104.4 [87.4–134.8] vs 74.9 [62.8–87.5] RFU/µl/hr, p<0.001). At seven days, sACE2 activity significantly increased from baseline (115.5 [92.9–168.6] RFU/µl/hr, p<0.01). An inverse correlation between sACE2 activity with acute and follow-up ejection fraction was observed (r = −0.519, p<0.001; r = −0.453, p = 0.001, respectively). Additionally, sACE2 directly correlated with infarct size (r = 0.373, p<0.001). Both, infarct size (β = −0.470 [95%CI:−0.691:−0.248], p<0.001) and sACE2 at 7 days (β = −0.025 [95%CI:−0.048:−0.002], p = 0.030) were independent predictors of follow-up ejection fraction. Patients with sACE2 in the upper tertile had a 4.4 fold increase in the incidence of adverse left ventricular remodeling (95% confidence interval: 1.3 to 15.2, p = 0.027). In conclusion, serum sACE2 activity rises in relation to infarct size, left ventricular systolic dysfunction and is associated with the occurrence of left ventricular remodeling.</p></div

Correlation between sACE2 activity and infarct size.

<p>A weak but significant correlation was observed between infarct size and sACE2 activity at 7 days (panel A) and at 6 months follow-up (panel B). FU: Follow-up. sACE2: Serum Angiotensin Converting Enzyme 2; LV: left ventricular; RFU: relative fluorometric units.</p