шемическая кардиомиопатия-выраженная сократительная дисфункция и расширение полостей желудочков сердца, имеющие в своей основе обструктивное поражение коронарных артерий. Успех хирургического лечения ишемической кардиомиопатии зависит, помимо прочих факторов, от объема дисфункционального, но жизнеспособного миокарда, способного восстановить свою сократительную функцию после коронарного шунтирования. Если его количество незначительно, риск от операции превышает таковой от медикаментозной терапии. Наиболее доступным радионуклидным методом идентификации жизнеспособного миокарда является перфузионная сцинтиграфия миокарда с радиофармацевтическими препаратами на основе 201Tl и 99mTc. В обзоре представлены сведения о возможностях применения данного метода в аспекте прогноза восстановления функции миокарда левого желудочка сердца после оперативного лечения больных с ишемической кардиомиопатией. Приведены сведения о диагностической эффективности таких сцинтиграфических симптомов, как сегментарное накопление радиофармпрепарата, анализ подвижности и систолического утолщения стенки левого желудочка сердца, его индекса эксцентричности и механической диссинхронии. Приведен анализ результатов выполнения перфузионной сцинтиграфии миокарда в сочетании с фармакологическими пробами с вазодилататорами и инотропными агентами-добутамином и нитроглицерином. В заключительной части обзора проанализированы крупнейшие на данный момент исследования, посвященные изучению зависимости между наличием жизнеспособного миокарда и прогнозом развития неблагоприятных сердечных событий в данной группе больных. Ключевые слова: ишемическая кардиомиопатия, ишемическая болезнь сердца, жизнеспособность, ОФЭКТ, диссинхрония, левый желудочек, реваскуляризация.
Aim of the study. We attempted to obtain the Mn-HMPAO complex (Mangoxim) and to evaluate the possibility to apply as a paramagnetic contrast agent for enhancement of tumors at MRI. Materials and methods. The synthesis of HMPAO was carried out by using R. D. Neirinckx — J. Pijarowska-Kruszyna technique (2017), without separation of enantiomers. The Mn-HMPAO was obtained by mixing Manganese(II) carbonate with HMPAO, pH 6,2–6,5, 0,5 M. Also the quantum chemistry calculations were carried out on the structure of Mn-HMPAO using method of functional of density DFT rb3lyp/6–31+g(d,p) for isolated molecules and for water solutions (CPCM). MRI study of Mn-HMPAO uptake carried out in twelve laboratory mouses with transplanted Lewis sarcoma, in T1-w. SE mode, TR=500 ms, TE=15 ms, 256×256 matrix, FOV 15×15 cm, 3 mm thin slice. MRI acquired in 15–17 min and 60–90 min after intravenous injection of the Mn-HMPAO. The uptake was quantified as index of enhancement: IE=(Int. T1-w.MRI)Mn-HMPAO/(Int. T1- w.MRI)pre-contrast. Results. The N,N-Mn-dioxim is more stable than O,O-Mn-dioxim for 50,5 KCal/mol, so in the nature only N,N-Mn-dioxim exists. R1 of Mn-HMPAO was 3,35 1/(mM•s), below R1 of gadopentetate=3,96 1/(mM•s). The highest value of early IE was over the tumor (3,36±0,31) and over lungs (3,07±0,43). At 60 min the IE over tumor decreased to 1,58±0,14, remaining far over IE values over any other location. Conclusion. The Mn-HMPAO complex demonstrates paramagnetic properties for the application as the contrast MRI agent and probably will improve the selective enhancement of tumors.
Background: Nonpulsatile blood flow plays an important role in the pathogenesis of renal dysfunction in patients with extracorporeal circulation. In our opinion, hypoxic preconditioning (HP) can be used to protect kidneys from postsurgical dysfunction. The aim of this study was to evaluate nephroprotective efficacy of HP in myocardial revascularization with extracorporeal circulation. Methods: The randomized, controlled trial was performed in 63 patients undergoing coronary artery bypass grafting (CABG). Thirty-three patients were subjected to HP during CABG; 30 patients were included in the comparison group. All patients underwent dynamic renal scintigraphy with 99mТc-diethylenetriaminepentaacetic acid and were subjected to measuring the concentration of lipocalin in blood serum before and after CABG. Results: After CABG, the mean values of the total glomerular filtration rate (GFR) and GFR for each kidney significantly decreased only in patients of the comparison group. Significant increases in the concentration of serum neutrophil gelatinase-associated lipocalin occurred 5 h after surgery both in the group with HP (70.65 ± 46.71 to 127.58 ± 98.46 ng/ml) and in the comparison group (65.01 ± 38.64 to 171.65 ± 89.91 ng/ml). At the same time, the mean difference values between pre- and postoperative lipocalin levels were 56.94 ± 51.75 ng/ml in the study group and 106.64 ± 51.27 ng/ml in the comparison group; these differences were highly statistically significant (р = 0.004). Conclusion: The results of our study showed that (i) HP exerts nephroprotection in patients undergoing on-pump CABG, and (ii) determination of the lipocalin-2 level can be used for early diagnosis of acute kidney injury in cardiac surgery patients.
The review describes available modern radiological methods which are currently applied for a detailed and comprehensive anatomical and functional assessment of the viability of various coronary artery bypass grafts. In addition, it presents some aspects of the implementation of these methods and clinical interpretation of the results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.