Name: transthoracic echocardiography to assess post-resuscitation left ventricular dysfunction after acute myocardial infarction and cardiac arrest in pigs
Uploaded: 2022-07-12T13:45:00
Description: Watch this Scientific Journal Video about Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs at JoVE.

We are grateful to Judith Bagott for language editing.

All procedures involving animals and their care conformed with national and international laws and policies. Approval of the study was obtained from the institutional review board of the University of Milan and governmental institution (Ministry of Health approval no. 84/2014-PR). Data that support the findings of this study are available from the corresponding author on reasonable request. The experimental model and echocardiographic protocol diagrams are detailed in Figure 1 and <strong cl...

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P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Resuscitation+Council+and+European+Society+of+Intensive+Care+Medicine+guidelines+2021:+post-resuscitation+care.">European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care.</a> Intensive Care Medicine. 47 (4), 369-421 (2021).</li><li>Xu, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postresuscitation+myocardial+diastolic+dysfunction+following+prolonged+ventricular+fibrillation+and+cardiopulmonary+resuscitation.">Postresuscitation myocardial diastolic dysfunction following prolonged ventricular fibrillation and cardiopulmonary resuscitation.</a> Critical Care Medicine. 36 (1), 188-192 (2008).</li><li>Fumagalli, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ventilation+with+argon+improves+survival+with+good+neurological+recovery+after+prolonged+untreated+cardiac+arrest+in+pigs.">Ventilation with argon improves survival with good neurological recovery after prolonged untreated cardiac arrest in pigs.</a> Journal of the American Heart Association. 9 (24), 016494 (2020).</li><li>Nagueh, S. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=et+al+Recommendations+for+the+evaluation+of+left+ventricular+diastolic+function+by+echocardiography:+An+update+from+the+American+Society+of+Echocardiography+and+the+European+Association+of+Cardiovascular+Imaging.">et al Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.</a> Journal of the American Society of Echocardiography. 29 (4), 277-314 (2016).</li><li>Lang, R. 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A complete echocardiographic examination in a pig experimental model of AMI, cardiac arrest and resuscitation may give different information on the evolution of LV function and LV structural changes, although some amount of data are available in the literature5,8. In &#34;pure&#34; models of experimental cardiac arrest (restricted to induced ventricular fibrillation), myocardial function impairment reverses in the first days after ROSC, but little is known of wha...

Cardiac arrest frequently happens minutes after the onset of typical chest pain, and in some cases it is the first manifestation of coronary artery disease1. In fact, 48% of survivors of out-of-hospital cardiac arrest present occlusion of a coronary artery on angiography2. In addition, for patients who return to spontaneous circulation (ROSC) after cardiac arrest, cardiac dysfunction is one of the most important determinants of morbidity and mortality3.
Transthoracic echocardiography (TTE) is a non-invasive diagnostic and prognostic tool used in patients to assess post-resuscitation myocardial dysfunction, structural changes and/or AMI extension after ROSC and in the days that follow. In experimental ischemic and non-ischemic cardiac arrest models in pigs, TTE is frequently used to noninvasively serially assess cardiac systolic&#160;function, hemodynamics, and the response to therapy. In 2008, changes in diastolic dysfunction were described in terms of increase in mitral E velocity and tissue Doppler (TDI) e&#39; velocity ratio (E/e&#39;) and decrease in mitral E velocity and A velocity ratio (E/A) shortly after resuscitation in a non-ischemic pig model of cardiac arrest4.
The present study describes the different methodologic steps followed to assess left ventricular (LV) structure and LV systolic and diastolic function by TTE at different time-points in an ischemic pig model of cardiac arrest.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Aquasonic</td>
			<td>Parker</td>
			<td>-</td>
			<td>ultrasound gel</td>
		</tr>
		<tr>
			<td>Adult foam ECG disposable monitoring and stress testing, wet gel, non-invasive patien</td>
			<td>Philips</td>
			<td>40493E</td>
			<td>ECG electrode</td>
		</tr>
		<tr>
			<td>Bellavista 1000</td>
			<td>Bellavista</td>
			<td>MB230000</td>
			<td>ventilator with infrared capnometer</td>
		</tr>
		<tr>
			<td>ComPACS</td>
			<td>Medimatic SRL</td>
			<td>-</td>
			<td>local database and software</td>
		</tr>
		<tr>
			<td>CX50</td>
			<td>Philips</td>
			<td>-</td>
			<td>Echocardiographic machine</td>
		</tr>
		<tr>
			<td>InTube Tracheal tube</td>
			<td>Intersurgical Ltd</td>
			<td>8040080</td>
			<td>cuffed tracheal tube</td>
		</tr>
		<tr>
			<td>LUCAS2</td>
			<td>Phisio-Control Inc</td>
			<td>-</td>
			<td>mechanical chest compressor</td>
		</tr>
		<tr>
			<td>MRx defibrillator</td>
			<td>Philips</td>
			<td>-</td>
			<td>defibrillator</td>
		</tr>
		<tr>
			<td>S5-1</td>
			<td>Philips</td>
			<td>-</td>
			<td>Phased array probe</td>
		</tr>
		<tr>
			<td>Swan-Ganz catheter 2 lumen 5fr</td>
			<td>Edwards</td>
			<td>110F5</td>
			<td>for the coronary artery occlusion</td>
		</tr>
		<tr>
			<td>Swan-Ganz catheter 2 lumen 7fr</td>
			<td>Edwards</td>
			<td>111F7</td>
			<td>for mean arterial pressure measurement</td>
		</tr>
		<tr>
			<td>Swan-Ganz catheter for thermodiluition 7fr</td>
			<td>Edwards</td>
			<td>131F7</td>
			<td>to measure right atrial pressure, core temperature and cardiac output</td>
		</tr>
	</tbody>
</table>

transthoracic echocardiography to assess post-resuscitation left ventricular dysfunction after acute myocardial infarction and cardiac arrest in pigs

One of the main causes of out-of-hospital cardiac arrest is acute myocardial infarction (AMI). After successful resuscitation from cardiac arrest, approximately 70% of patients die before hospital discharge due to post-resuscitation myocardial and cerebral dysfunction. In experimental models, myocardial dysfunction after cardiac arrest, characterized by an impairment in both left ventricular (LV) systolic and diastolic function, has been described as reversible but very little data are available in cardiac arrest models associated with AMI in pigs. Transthoracic echocardiography is the first-line diagnostic test for the assessment of myocardial dysfunction, structural changes and/or AMI extension. In this pig model of ischemic cardiac arrest, echocardiography was done at baseline and 2-4 and 96 hours after resuscitation. In the acute phase, the examinations are done in anesthetized, mechanically ventilated pigs (weight 39.8 &#177; 0.6 kg) and ECG is recorded continuously. Mono- and bi-dimensional, Doppler and tissue Doppler recordings are acquired. Aortic and left atrium diameter, end-systolic and end-diastolic left ventricular wall thicknesses, end-diastolic and end-systolic diameters and shortening fraction (SF) are measured. Apical 2-, 3-, 4-, and 5-chamber views are acquired, LV volumes and ejection fraction are calculated. Segmental wall motion analysis is done to detect the localization and estimate the extent of myocardial infarction. Pulsed Wave Doppler echocardiography is used to record trans-mitral flow velocities from a 4-apical chamber view and trans-aortic flow from a 5-chamber view to calculate LV cardiac output (CO) and stroke volume (SV). Tissue Doppler Imaging (TDI) of LV lateral and septal mitral anulus is recorded (TDI septal and lateral s&#39;, e&#39;, a&#39; velocities). All the recordings and measurements are done according to the recommendations of the American and European Societies of Echocardiography Guidelines.

Twelve pigs underwent coronary artery occlusion followed by 12 min of ventricular fibrillation and 5 min of CPR. Eight pigs were successfully resuscitated, and seven survived at 96 h post AMI-cardiac arrest-ROSC. All echocardiographic variables at different time-points during the study are summarized in Table 1.
Changes in heart rate (HR) and systolic echocardiographic parameters 
HR increased significantly at 2 h and 4 h post-AMI-cardiac arrest-ROSC comp...

Watch this Scientific Journal Video about Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs at JoVE.

Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs

Transthoracic echocardiography is the first-line diagnostic test for post-resuscitation left ventricular dysfunction and structural changes in a pig model of cardiac arrest.

One of the main causes of out-of-hospital cardiac arrest is acute myocardial infarction (AMI). After successful resuscitation from cardiac arrest, ...

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