• Journal of Biomedical Engineering Research
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• v.9 no.1
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• pp.109-116
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• 1988

In this paper, principles of impedance tenchinque and relationship between stroke volume and impedance change were theoretically explained. An impedance cardiograph was designed and constructed. Its reproducibility was verified by experiment. Until now, the peak point of dZ/dt waveform, first derivative of impedance change(${\Delta}$Z) , has been detected by software technique requiring considerable time to process. However in this paper its peak point was found using hardware for saving processing time. Useful cardiac parameters such as stroke volume and contractility of cardiac muscle were measured noninvasively. The reproducibility of the instrument was measured to be better(less than 10%) than that of clinical standard method such as thermodilution (more than 30%). Hence impedance cardiography was found to be better techique for monitoring stroke volume and myocardial contractility for pre and post operation, and pharmacological studies.

• The Korean Journal of Nuclear Medicine
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• v.39 no.4
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• pp.224-230
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• 2005

Purpose: The maximal elastance ($E_{max}$) of myocardium has been established as a reliable load-independent contractility index. Recently, we developed a noninvasive method to measure the regional contractility using gated myocardial SPECT and arterial tonometry data. In this study, we measured regional $E_{max}(rE_{max}$ in the patients who underwent coronary artery bypass graft surgery (CABG), and assessed its relationship with other variables. Materials and Methods: 21 patients (M:F=17:4, $58{\pm}12$ y) who underwent CABG were enrolled. $^{201}TI$ rest/dipyridamole stress $^{99m}Tc$-sestamibi gated SPECT were performed before and 3 months after CABG. For 15 myocardial regions, regional time-elastance curve was obtained using the pressure data of tonometry and the volume data of gated SPECT. To investigate the coupling with myocardial function, preoperative regional $E_{max}$ was compared with regional perfusion and systolic thickening. In addition, the correlation between $E_{max}$ and viability was assessed in dysfunctional segments (thickening <20% before CABG). The viability was defined as improvement of postoperative systolic thickening more than 10%. Results: Regional $E_{max}$ was slightly increased after CABG from $2.41{\pm}1.64 (pre)\;to\;2.78{\pm}1.83 (post)$ mmHg/ml. $E_{max}$ had weak correlation with perfusion and thickening (r=0.35, p<0.001). In the regions of preserved perfusion (${\geq}60%$), $E_{max}$ was $2.65{\pm}1.67$, while it was $1.30{\pm}1.24$ in the segments of decreased perfusion. With regard to thickening, $E_{max}$ was $3.01{\pm}1.92$ mmHg/ml for normal regions (thickening ${geq}40%$), $2.40{\pm}1.19$ mmHg/ml for mildly dysfunctional regions (<40% and ${\geq}20%$), and $1.13{\pm}0.89$ mmHg/ml for severely dysfunctional regions (<20%). $E_{max}$ was improved after CABG in both the viable (from $1.27{\pm}1.07\;to\;1.79{\pm}1.48$ mmHg/ml) and non-viable segments (from $0.97 {\pm}0.59\;to\;1.22{\pm}0.71$ mmHg/ml), but there was no correlation between $E_{max}$ and thickening improvements (r=0.007). Conclusions: Preoperative regional $E_{max}$ was relatively concordant with regional perfusion and systolic thickening on gated myocardial SPECT. In dysfunctional but viable segments, $E_{max}$ was improved after CABG, but showed no correlation with thickening improvement. As a load-independent contractility index of dysfunctional myocardial segments, we suggest that the regional $E_{max}$ could be an independent parameter in the assessment of myocardial function.

• The Korean Journal of Nuclear Medicine
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• v.35 no.3
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• pp.152-160
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• 2001

Purpose: We tried to establish the reproducibility of the measurement of maximal elastance (Emax) and to compare the degree of the reproducibility of two estimation methods: single pressure-volume loop method and parameter optimization method. Materials and methods: In 47 patients (42 males and 5 females, $53{\pm}10$ years old) with suspected coronary artery disease (election fraction; 22-68%), gated Tc-99m MIBI myocardial SPECT and arterial tonometry were acquired. In 11 patients among these 47 patients, gated SPECT and tonometry were performed twice consecutively with patients in situ. Emax and void volume (Vo) were estimated using single pressure-volume loop method of Lee and parameter optimization method based on linear approximation of Yoshizawa. Correlation between the consecutive measurements by each method and correlation between the two estimation methods were compared. Results: Reproducibility of Emax (r=0.96) and Vo (r=0.99) by single pressure-volume method was better than the reproducibility of Emax (r=0.89) and Vo (r=0.64) by parameter optimization method. Correlations of Emax and Vo were fair between the two methods. The correlation of Emax (r=0.77) was better than that of Vo (r=0.55). Conclusion: Reproducibility of Emax measurement by single pressure-volume loop method using gated myocardial SPECT and arterial tonometry was excellent. Reproducibility by parameter optimization method was also fair but was less than that achieved by single pressure-volume method.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.9-15
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• 1990

This study was designed to investigate the protective effect of chlorpromazine against the reperfusion injury of myocardium after high potassium cardioplegic arrest. Langendorff`s preparations of rat heart were infused with high potassium cardioplegic solution[St. Thomas Hospital Solution] at 25oC. Chlorpromazine [10-7Ｍ] increased the recovery of myocardial contractility[dp/dt], left ventricular pressure[LVP], and coronary flow rate of the reperfused heart. Both in control and experimental groups, the restoration of myocardial activity could not reach to the level of preplegic control. These results suggest that the etiologic factors of the reperfusion injury include the influence of high potassium cardioplegic solution and/or reperfusion itself, and that chlorpromazine protects myocardium from the reperfusion injury.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1067-1073
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• 1990

To clarify the changes of left ventricular function under normothermia, the time interval between the onset of ischemia and the beginning of contracture of left ventricle[TIC] were recorded in newborn piglet. Myocardial performance was assessed using intraventricular balloon to determine compliance and systolic function after 5 to 10 minutes interval per-fusing normothermic substrate free Krebs solution as a perfusate. The time to onset TIC was 29.5\ulcorner1.7 minutes and peak ischemic contracture was 46.7\ulcorner4.0 minutes[p<0.01]. In myocardial performance, systolic function of left ventricle[defined as cardiac contractility] was kept until 25 minutes of perfusion, but was decreased abruptly after 30 minutes of perfusion[p<0.0018] and diastolic function of left ventricle[defined as diastolic compliance] was kept until 15 minutes of perfusion, but was decreased after 20 minutes of perfusion [p=0.00\ulcorner9]. This study demonstrated maximal time of the tolerance to normothermic global ischemia and functional changes of left ventricle using Krebs perfusate under the same condition.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.571-575
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• 1994

The hemodynamic effects of thyroid hormone are well established, and this hormone affects myocardial contractility, heart rate, and myocardial oxygen consumption. But the role of cardiopulmonary bypass on the thyroid function is not yet fully understood. We have studied twelve patients [male and female patients were equal in number] who were performed open heart surgery under cardiopulmonary bypass. The results are followed. 1] The serum level of T3 began to fall after cardiopulmonary bypass and sustained significantly till 24 hours after operation[p<0.05] 2] The concentrations of T4, Free T4, and TSH were slightly decreased after cardiopulmonary bypass but was maintained within normal range. 3] This above findings are similar to the "sick sinus syndrome" that is seen in severely ill patient. 4] We can propose that T3 would be effective in postoperative low cardiac output syndrome. syndrome.

• The Korean Journal of Nuclear Medicine
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• v.21 no.2
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• pp.175-182
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• 1987

For measurement of ventricular performance, ejection fraction (EF) has gained wide acceptance. But EF is influenced not only by changes in muscle function but also by changes in cardiac loading conditions. In case of valvular heart disease which is variable in loading conditions, EF cannot be reliable as an index of myocardial contractility. The end systolic pressure (ESP)-end systolic volume (ESV) relation, howver, is known to represent myocardial contractility, independent of changes in loading conditions. Similar results can be obtained by using peak-systolic pressure (PSP) instead of ESP. To evaluate the utility of the peak systolic pressure-end systolic volume index (PSP-ESVI) relation as an index of myocardial function, we measured $PSP&ESVI$ in 19 partents with coronary artery disease before $(PSP_1\;&\;ESVI_1)$ and after $(PSP_2\;&\;ESVI_2)$ sublingual administration of nitroglycerin. PSP was measured with standard mercury sphygmomanometer during gated blood pool scintigraphic study. ESVI was measured by count derived method after attenuation correction. $PSP_2\;&\;ESVI_2$ measurement was started when the fall of PSP was greater than 5 mmHg after 7-14 minutes post-administration of nitroglycerin. Mean values $({\pm}S.D.)$ of $PSP_1\;&\;ESVI_1$ was $124.9({\pm}20.7)mmHg\;&\;59.4({\pm}39.9)ml/M^2$. Mean values $({\pm}S.D)$ of $PSP_2\;&\;ESVI_2$, was $113.2({\pm}19.9)mmHg\;&\;37.5({\pm}26.1)ml/M^2$. There was a significant difference between mean values of $PSP_1\;&\;PSP_2$, (p<0.01), and mean values of $ESVI_1\;&\;ESVI_2$, (p<0.01). $PSP_1-PSP_2/ESV_1-ESVI_2,\;PSP_1/ESVI_1$ and EF were in the range of 0.14-5.19 mmHg/ml/$M^2$, 0.67-7.68 mmHg/ml/$M^2$ and 10.8%-74.5% respectively. $PSP_1-PSP_2/ESVI_1-ESVI_2$, and EF showed exponential correlation (r=0.85, P<0.01). The correlation coefficient between $PSP_1/ESVI_1$ and EF was 0.73(p<0.01). With the above results, we suggest that $PSP_1-PSP_2/ESVI_1-ESVI_2$, and $PSP_1/ESVI_1$, can be used as an index of myocardial function.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.155-160
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• 1993

The identification of viable myocardium in patients with coronary artery disease and left ventricular dysfunction is an issue of increasing clinical relavance in the current era of myocardial revascularization. There are at least two forms of reversible myocardial dysfunction. Early reperfusion does not always lead to immediate functional improvement; rather, the return of contractility in tissue salvaged by reperfusion is delayed for hours, days or even weeks, a phenomenon that has been termed "stunned myocardium". Some patients with coronary artery disease show myocardial dysfunction at rest which are associated with reduced perfusion, and which disappear after revascularization; this phenomenon has been termed "hibernating myocardium". Recently, cardiac imaging techniques that evaluate myocardial viability on the basis of perfusion-contraction mismatch and inotropic reserve have gained substantial popularity and clinical success. This review focus on the application of $^{201}TI$ and $^{99m}Tc-MIBI$ to address myocardial viability in patients with hibernating and stunned myocardium. It is clear that 4-hour redistribution images of $^{201}TI$ underestimate ischemia and overestimate scar. Delayed imaging and reinjection imaging have been developed for the assessment of viability. Among many protocols suggested, stress-redistribution-reinjection imaging gained most popularity. Although $^{99m}Tc-MIBI$ could identify myocardial viability, $^{201}TI$ reinjection technique was regarded as superior to it. In conclusion, $^{201}TI$ stress, 4-hr rest redistribution, and reinjection imaging technique may be the most preferable method for evaluation of myocardial viability.

• Korean Circulation Journal
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• v.53 no.1
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• pp.34-46
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• 2023

Background and Objectives: Diabetes mellitus (DM)-associated heart failure (HF) causes high morbidity and mortality. In this study, we established a zebrafish larvae model for in vivo research on diabetic HF. Methods: DM-like phenotypes were induced by treating zebrafish larvae with a combination of D-glucose (GLU) and streptozotocin (STZ). HF was induced by treatment with terfenadine (TER), a potassium channel blocker. Additionally, myocardial contractility, motility, and viability were evaluated. Results: The zebrafish larvae treated with a combination of GLU and STZ showed significantly higher whole-body glucose concentrations, lower insulin levels, and higher phosphoenolpyruvate carboxykinase levels, which are markers of abnormal glucose homeostasis, than the group treated with only GLU, with no effect on viability. When treated with TER, DM zebrafish showed significantly less myocardial fractional shortening and more irregular contractions than the non-DM zebrafish. Furthermore, in DM-HF with reduced ejection fraction (rEF) zebrafish, a significant increase in the levels of natriuretic peptide B, a HF biomarker, markedly reduced motility, and reduced survival rates were observed. Conclusions: We established a DM-HFrEF zebrafish model by sequentially treating zebrafish larvae with GLU, STZ, and TER. Our findings indicate the potential utility of the developed zebrafish larvae model not only in screening studies of new drug candidates for DM-HFrEF but also in mechanistic studies to understand the pathophysiology of DM-HFrEF.

• Applied Microscopy
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• v.27 no.2
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• pp.121-130
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• 1997

It has been demonstrated that majority of cells in the mammalian body such as myocytes and epithelial cells of skin and intestine respond to mechanical force or environmental factors and exhibit partial disruption of cell membrane, i. e., cell wounding, even in a physiological condition. Myocardial cells are rather apt to be wounded than other cells since they are definitely exposed to mechanical stress by contraction-relaxation and blood flow. However, the mechanism how myocardial cells protect themselves against cell wounding is not yet clarified. On this background, the present study was performed to elucidate whether albumin leakage is related to cell wounding and to assess whether diltiazem, a potent calcium channel blocker, is beneficial in isoproterenol-induced cell wounding in the heart. Hearts isolated from New Zealand White rabbits ($1.5\sim2.0kg$ body weight, n=20) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to bolus administration of isoproterenol and diltiazem as following order: $1.6{\mu}M$ isoproterenol at zero min (the beginning point): $16{\mu}M$ diltiazem at 20min; $1.6{\mu}M$ isoproterenol at 25min; $16{\mu}M$ isoproterenol at 45 min; $160{\mu}M$ diltiazem at 65 min; $16{\mu}M$ isoproterenol at 70 min. During all experiments, the left ventricular function was recorded, albumin leakage in the coronary effluents was analyzed by electrophoresis and Western blot, and myocardial cell membranes were examined by conventional transmission electron microscopy. Data were analyzed by t-test and linear regression test. Isoproterenol significantly increased the inotropic and chronotropic contractions, coronary flow, and frequency of arrhythmia, however, diltiazem did not influence on hemodynamics except decrease in the frequency of arrhythmia and a slight decrease in contractility. Isoproterenol also resulted partial disruption of myocardial cell membrane and inclose in albumin leakage, while diltiazem pretreatment showed number of electron-dense plaques in the cell membrane and a tendency of decrease in albumin leakage. These results indicate that albumin leakage may be an indirect index of cell wounding in the heart and diltiazem nay be beneficial to protect myocardial cells against isoproterenol-induced cell wounding. It is likely that diltiazem promotes resealing process of the cell membrane.