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Chui Wai Leung. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 120-126). / List of tables and figures --- p.1 / Declaration --- p.6 / Acknowledgments --- p.7 / Summary --- p.8 / Chapter Chapter 1: --- Introduction --- p.10 / Chapter 1.1 --- Acute Myocardial Infarction (AMI) / Chapter 1.2 --- Diagnosis of AMI / Chapter 1.2.1 --- Clinical Signs / Chapter 1.2.2 --- Electrocardiogram (ECG) / Chapter 1.2.3 --- Cardiac enzymes / Chapter 1.3 --- "CKMB,a marker of choice" / Chapter 1.4 --- "Troponin-T, another candidate marker" / Chapter 1.5 --- Objectives / Chapter Chapter 2: --- Analytical evaluation of CKMB measurement by the four methods --- p.20 / Chapter 2.1 --- Analytical methods / Chapter 2.1.1 --- Assay for total creatine kinase / Chapter 2.1.2 --- Assay for CKMB / Chapter 2.1.2.1 --- CKMB mass concentration assay / Chapter 2.1.2.2 --- CKMB EEC & immunoinhibition activity assay / Chapter 2.1.2.3 --- CKMB activity concentration assay1 / Chapter 2.1.2.4 --- CKMB activity concentration assay2 / Chapter 2.2 --- Precision / Chapter 2.3 --- Accuracy / Chapter 2.4 --- Linearity / Chapter 2.5 --- Recovery / Chapter 2.6 --- Interference / Chapter 2.6.1 --- Effect of haemolysis / Chapter 2.6.2 --- Effect of turbidity / Chapter 2.6.3 --- Effect of bilirubin / Chapter 2.7 --- Stability / Chapter Chapter 3 : --- Correlation among the four methods of CKMB measurement --- p.61 / Chapter Chapter 4 : --- Establishment of reference ranges for the four methods of CKMB measurement --- p.71 / Chapter Chapter 5: --- Information on the Qualitative Troponin-T Rapid Assay® --- p.80 / Chapter Chapter 6 : --- Clinical Evaluation of CKMB and Troponin-T in detection of AMI --- p.82 / Chapter 6.1 --- Material and Methods / Chapter 6.1.1 --- Subjects / Chapter 6.1.2 --- Specimens / Chapter 6.1.3 --- Criteria for diagnosis / Chapter 6.1.4 --- Analytical methods / Chapter 6.1.5 --- Statistical methods / Chapter 6.2 --- Results / Chapter 6.3 --- Discussion / Chapter Chapter 7 : --- General Discussion --- p.105 / Appendix 1: study protocol sheet --- p.113 / Appendix 2: diagnostic criteria for a definite AMI --- p.115 / Appendix 3: criteria for exclusion of AMI --- p.117 / Appendix 4: enzyme criteria --- p.118 / References --- p.120

This exploratory study used Diagnostic Content Validity (DCV) and the Clinical Diagnostic Validation (CDV) models proposed by Fehring (1986) to clinically identify and validate the defining characteristics for Alteration in Tissue Perfusion: Cardiac. The literature based Kelly Cardiac Assessment Tool (KCAT) was designed as the data collection tool. The diagnostic content validity of the KCAT was 0.70. Twenty subjects, 18 years old and older were selected from a population who were admitted as inpatients in a southwestern university affiliated hospital. Data were collected through patient interviews, independent nurse assessment, and review of laboratory data. Using the steps described in Fehring's CDV model (1986) one major defining characteristic and 13 minor defining characteristics were clinically validated. The tool CDV score was 0.62. The nursing diagnosis Alteration in Tissue Perfusion: Cardiac was clinically validated and one major and 13 minor defining characteristics were identified.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.

The potential use of four radioiodinated fatty acids as myocardial imaging agents were evaluated. Preliminary distribution studies revealed that the terminal labeled fatty acids demonstrated higher myocardial uptake. Thus, 10-Iodocapric acid (10-iododecanoic) and 12-Iodolauric acid were subjected to further investigation. Comprehensive tissue distribution studies involving both radioiodinated fatty acids in mice indicated that the highest accumulation of the total injected activity occurred in the muscle and the blood. Other organs investigated included the heart, liver, lung, kidneys, spleen, stomach, intestines, bone and adrenals. The heart exhibited the highest concentration of the radioiodinated fatty acids for the relative accumulation of activity per unit weight. Erom the tissue distribution studies, the optimum scanning time was found to be immediately following injection of the radiopharmaceutical. Toxicity studies were performed in mice after intravenous administration of 10-Bromocapric acid and 12-Bromolauric acid. The LD₅₀ of Sodium Bromolaurate in 10% Human Serum Albumin was found to be 210 mg/kg (194 mg/kg - 228 mg/kg). The stability problem encountered with 10-Bromocapric acid necessitated the use of a different solvent system. The LD₅₀ obtained after intravenous injection was found to be 86.1 mg/kg (83.0 mg/kg - 89.3 mg/kg). However, this observed toxicity may not necessarily reflect the toxicity of the Bromocapric acid solely. Whole body excretion studies were performed in mice and revealed a triexponential excretion curve. For 10-Iodocapric acid, the effective half-lives were .90 hours (36.7%), 3.91 hours (61.6%) and 74.9 hours (14.5%). For 12-Iodolauric acid, the effective half-lives were 1.67 hours (46.6%), 7.68 hours (38.4%), and 71.6 hours (17.8%). For both 10-Iodocapric acid and 12-Iodolauric acid, the first as well as the second component of the excretion curve presumably represented a decrease in the whole body activity due mainly to urinary excretion. The third component appeared to represent activity which was tightly bound and slowly released. The third component presumably represented elimination by fecal excretion. The excretion of the injected activity was primarily in the urine, although some activity was recovered in the feces. For 10-Iodocapric acid, 82.4% of the injected activity had been recovered in the urine within the first 24 hours and 8.88% had been recovered in the feces. For 12-Iodolauric acid, 78.9% of the injected dose was recovered in the urine at 24 hours and 9.4% in the feces. From the urine results, the effective half-life of the radio-iodinated fatty acids in the kidneys was found to be 4.8 hours. Myocardial scans were done on rabbits using ¹³¹I-capric acid, ¹³¹I-lauric acid, NaI-131 (6% Human Serum Albumin), and Thallium-201 at specified time intervals after injection. Iodine-123, a radionuclide possessing more favorable imaging properties, was not readily available due to production problems at the time of scanning. The mean absorbed dose to the whole body, the liver, the kidneys, the muscle, and the heart were computed based on the results from the distribution and excretion studies. The dosimetry calculations were done using Iodine-123 as the radionuclide. For ¹³¹I-capric acid, the radiation doses were calculated as 34.76 mrads/2 mCi for the whole body, 136.3 mrads/2 mCi for the kidneys, 86.6 mrads/2 mCi for the liver, 38.5 mrads/2 mCi for the muscle, and 25.89 mrads/2 mCi for the heart. For ¹³¹I-lauric acid, the radiation doses were 41.73 mrads/2 mCi for the whole body, 199.8 mrads/2 mCi for the kidneys, 185.9 mrads/2 mCi for the liver, 52.07 mrads/2 mCi for the muscle, and 46.39 mrads/2 mCi for the heart. / Pharmaceutical Sciences, Faculty of / Unknown

O objetivo da reperfusão mecânica ou medicamentosa em pacientes com infarto agudo do miocárdio (IAM) é a restauração do fluxo sangüíneo na artéria relacionada ao infarto, a fim de limitar a necrose miocelular e preservar a função contrátil, que são os maiores preditores de sobrevida após o IAM. Entretanto, seu sucesso é indicado pela reperfusão nos capilares miocárdicos e não pela recanalização da artéria relacionada ao infarto. A ecocardiografia com perfusão miocárdica em tempo real pode ser usada para avaliar a perfusão nos capilares miocárdicos e estimar o tamanho do infarto em vários estudos experimentais. O objetivo deste estudo foi determinar a área do miocárdio infartado e sua extensão transmural pela ecocardiografia com perfusão miocárdica em tempo real, em pacientes hospitalizados nos primeiros dias após primo infarto agudo do miocárdio, tendo como padrão de referência a ressonância magnética de perfusão. Prospectivamente, foram estudados 20 pacientes (12 homens), com idade média de 64,2 ± 13,3, dentro de 12 horas de reperfusão mecânica ou medicamentosa. Os exames de ecocardiografia e ressonância magnética foram realizados do segundo ao quinto dia de infarto. O contraste \"PESDA (perfluorocarbon-exposed sonicated dextrose albumin)\" foi administrado em veia periférica, na dose de 0,1ml/Kg, em infusão contínua. A análise ecocardiográfica foi feita por uma análise qualitativa (visual) denominada escala de cinza e por uma análise quantitativa, chamada imagem paramétrica. A área de infarto média foi de 3,03 ± 2,77 cm2 para a escala de cinza (r=0,97), de 3,36 ± 2,82 cm2 para a imagem paramétrica (r= 0,99) e de 3,42 ± 2,80 cm2 para a ressonância magnética. O porcentual médio da área de infarto pela ecocardiografia em escala de cinza foi de 15,22% ± 14,84% (r= 0,97), pela imagem paramétrica foi de 16,46% ± 14,41% (r= 0,99) e pela ressonância magnética foi de 16,76% ± 14,48%. A extensão transmural do infarto em cada segmento infartado pela escala de cinza,apresentou uma correlação menor (r=0,77) em relação à imagem paramétrica (r=0,93). Em conclusão, este estudo mostrou uma excelente correlação entre ecocardiografia com perfusão miocárdica em tempo real (sobretudo pela imagem paramétrica) e ressonância magnética nas medidas da área de infarto e seu porcentual, assim como na determinação de sua extensão transmural em pacientes internados por infarto agudo do miocárdio / The aim of mechanical or pharmacological reperfusion in patients with AMI is to restore blood flow through the infarct related artery in order to limit myocellular necrosis and ultimately preserve myocardial contractile function, which is still the most powerful predictor of survival after acute myocardial infarction. The success of reperfusion, however, is indicated by perfusion of myocardial capillaries rather than simply patency of the infarct related artery. Myocardial contrast echocardiography (MCE) can be used to assess myocardial capillary perfusion and ultimately the infarct size in animals. The aim of this study was to determine by MCE the transmural extent and infarct size using magnetic resonance imaging (MRI) as a gold standard. We prospectively studied 20 patients (12 men; mean age 64.2 ± 13.3) admitted for a first acute myocardial infarction, within 12 hours after mechanical or pharmacological reperfusion. The MCE and MRI were performed between the 3rd and 5th day of acute myocardial infarction (AMI). A suspension of 0.1 ml/kg of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) ultrasound contrast agent was administered as a continuous infusion. The interpretation of perfusion images by MCE was assessed by qualitative analysis (visual- VIS) and a quantitative one called parametric image (PI). The average infarct area showed by VIS was 3.03 ± 2.77 cm 2, by PI was 3.36 ± 2.82 cm 2 and by MRI was 3.42± 2.80cm 2. The average percentage of infarct area by VIS was 15.22% ± 14.84%, by PI was 16.46% ± 14.41% and by MRI was 16.76% ± 14.48%. The transmural extent was calculated in each infarcted segment by VIS, with a worse correlation (r=0,77) than PI (r=0,93). In conclusion, this study showed that MCE, in special PI, correlates well with MRI in detecting infarct size, percentage of infarct size and transmural extent in patients with acute myocardial infarction

O objetivo da reperfusão mecânica ou medicamentosa em pacientes com infarto agudo do miocárdio (IAM) é a restauração do fluxo sangüíneo na artéria relacionada ao infarto, a fim de limitar a necrose miocelular e preservar a função contrátil, que são os maiores preditores de sobrevida após o IAM. Entretanto, seu sucesso é indicado pela reperfusão nos capilares miocárdicos e não pela recanalização da artéria relacionada ao infarto. A ecocardiografia com perfusão miocárdica em tempo real pode ser usada para avaliar a perfusão nos capilares miocárdicos e estimar o tamanho do infarto em vários estudos experimentais. O objetivo deste estudo foi determinar a área do miocárdio infartado e sua extensão transmural pela ecocardiografia com perfusão miocárdica em tempo real, em pacientes hospitalizados nos primeiros dias após primo infarto agudo do miocárdio, tendo como padrão de referência a ressonância magnética de perfusão. Prospectivamente, foram estudados 20 pacientes (12 homens), com idade média de 64,2 ± 13,3, dentro de 12 horas de reperfusão mecânica ou medicamentosa. Os exames de ecocardiografia e ressonância magnética foram realizados do segundo ao quinto dia de infarto. O contraste \"PESDA (perfluorocarbon-exposed sonicated dextrose albumin)\" foi administrado em veia periférica, na dose de 0,1ml/Kg, em infusão contínua. A análise ecocardiográfica foi feita por uma análise qualitativa (visual) denominada escala de cinza e por uma análise quantitativa, chamada imagem paramétrica. A área de infarto média foi de 3,03 ± 2,77 cm2 para a escala de cinza (r=0,97), de 3,36 ± 2,82 cm2 para a imagem paramétrica (r= 0,99) e de 3,42 ± 2,80 cm2 para a ressonância magnética. O porcentual médio da área de infarto pela ecocardiografia em escala de cinza foi de 15,22% ± 14,84% (r= 0,97), pela imagem paramétrica foi de 16,46% ± 14,41% (r= 0,99) e pela ressonância magnética foi de 16,76% ± 14,48%. A extensão transmural do infarto em cada segmento infartado pela escala de cinza,apresentou uma correlação menor (r=0,77) em relação à imagem paramétrica (r=0,93). Em conclusão, este estudo mostrou uma excelente correlação entre ecocardiografia com perfusão miocárdica em tempo real (sobretudo pela imagem paramétrica) e ressonância magnética nas medidas da área de infarto e seu porcentual, assim como na determinação de sua extensão transmural em pacientes internados por infarto agudo do miocárdio / The aim of mechanical or pharmacological reperfusion in patients with AMI is to restore blood flow through the infarct related artery in order to limit myocellular necrosis and ultimately preserve myocardial contractile function, which is still the most powerful predictor of survival after acute myocardial infarction. The success of reperfusion, however, is indicated by perfusion of myocardial capillaries rather than simply patency of the infarct related artery. Myocardial contrast echocardiography (MCE) can be used to assess myocardial capillary perfusion and ultimately the infarct size in animals. The aim of this study was to determine by MCE the transmural extent and infarct size using magnetic resonance imaging (MRI) as a gold standard. We prospectively studied 20 patients (12 men; mean age 64.2 ± 13.3) admitted for a first acute myocardial infarction, within 12 hours after mechanical or pharmacological reperfusion. The MCE and MRI were performed between the 3rd and 5th day of acute myocardial infarction (AMI). A suspension of 0.1 ml/kg of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) ultrasound contrast agent was administered as a continuous infusion. The interpretation of perfusion images by MCE was assessed by qualitative analysis (visual- VIS) and a quantitative one called parametric image (PI). The average infarct area showed by VIS was 3.03 ± 2.77 cm 2, by PI was 3.36 ± 2.82 cm 2 and by MRI was 3.42± 2.80cm 2. The average percentage of infarct area by VIS was 15.22% ± 14.84%, by PI was 16.46% ± 14.41% and by MRI was 16.76% ± 14.48%. The transmural extent was calculated in each infarcted segment by VIS, with a worse correlation (r=0,77) than PI (r=0,93). In conclusion, this study showed that MCE, in special PI, correlates well with MRI in detecting infarct size, percentage of infarct size and transmural extent in patients with acute myocardial infarction