Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit

The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF) in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis) were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS)/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044)), male gender (OR = 4.275 (1.340-13642)), shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229)), higher intra-operative hydration (OR = 1.002 (1.000-1004)), and plasma urea on admission (OR = 1.012 (0.980-1044)) remained significant (multivariate analysis). The mortality risk factors (univariate analysis) were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037). In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.

Time motion analysis of football (soccer) referees during official matches in relation to the type of fluid consumed

The aim of the present study was to determine the effect of volume and composition of fluid replacement on the physical performance of male football referees. Ten referees were evaluated during three official matches. In one match the participants were asked to consume mineral water ad libitum, and in the others they consumed a pre-determined volume of mineral water or a carbohydrate electrolyte solution (6.4% carbohydrate and 22 mM Na+) equivalent to 1% of their baseline body mass (half before the match and half during the interval). Total water loss, sweat rate and match physiological performance were measured. When rehydrated ad libitum (pre-match and at half time) participants lost 1.97 ± 0.18% of their pre-match body mass (2.14 ± 0.19 L). This parameter was significantly reduced when they consumed a pre-determined volume of fluid. Sweat rate was significantly reduced when the referees ingested a pre-determined volume of a carbohydrate electrolyte solution, 0.72 ± 0.12 vs 1.16 ± 0.11 L/h ad libitum. The high percentage (74.1%) of movements at low speed (walking, jogging) observed when they ingested fluid ad libitum was significantly reduced to 71% with mineral water and to 69.9% with carbohydrate solution. An increase in percent movement expended in backward running was observed when they consumed a pre-determined volume of carbohydrate solution, 7.7 ± 0.5 vs 5.5 ± 0.5% ad libitum. The improved hydration status achieved with the carbohydrate electrolyte solution reduced the length of time spent in activities at low-speed movements and increased the time spent in activities demanding high-energy expenditure.

Preventive effect of reduced glutathione on contrast-induced nephropathy in elderly patients undergoing coronary angiography or intervention: a randomized, controlled trial

Coronary angiography can be a high-risk condition for the incidence of contrast-induced nephropathy (CIN) in elderly patients. Reduced glutathione, under a variety of mechanisms, may prevent CIN in this procedure. We prospectively examined whether hydration with reduced glutathione is superior to hydration alone for prevention of CIN in an elderly Han Chinese population. A total of 505 patients (271 males and 234 females) aged 75 years or older who underwent non-emergency coronary angiography or an intervention were randomly divided into two groups. The treatment group received hydration with reduced glutathione (n=262) and the control group received hydration alone (n=243). Serum creatinine and blood urea nitrogen levels were measured prior to coronary angiography and 48 h after this procedure. The primary endpoint was occurrence of CIN, which was defined as 25% or 44.2 µmol/L above baseline serum creatinine levels 48 h after the procedure. The overall incidence of CIN was 6.49% in the treatment group and 7.41% in the control group, with no significant difference between the groups (P=0.68). In subgroup analysis by percutaneous coronary intervention, no significant differences were found between the two groups. In summary, reduced glutathione added to optimal hydration does not further decrease the risk of CIN in elderly patients undergoing coronary angiography or an intervention.

Automated static image analysis as a novel tool in describing the physical properties of dietary fiber

Abstract The growing interest in the usage of dietary fiber in food has caused the need to provide precise tools for describing its physical properties. This research examined two dietary fibers from oats and beets, respectively, in variable particle sizes. The application of automated static image analysis for describing the hydration properties and particle size distribution of dietary fiber was analyzed. Conventional tests for water holding capacity (WHC) were conducted. The particles were measured at two points: dry and after water soaking. The most significant water holding capacity (7.00 g water/g solid) was achieved by the smaller sized oat fiber. Conversely, the water holding capacity was highest (4.20 g water/g solid) in larger sized beet fiber. There was evidence for water absorption increasing with a decrease in particle size in regards to the same fiber source. Very strong correlations were drawn between particle shape parameters, such as fiber length, straightness, width and hydration properties measured conventionally. The regression analysis provided the opportunity to estimate whether the automated static image analysis method could be an efficient tool in describing the hydration properties of dietary fiber. The application of the method was validated using mathematical model which was verified in comparison to conventional WHC measurement results.

Influence of disinfestation and osmotic conditioning on the germinating behavior of australian royal palm (Archontophoenix alexandrae)seeds

The technique of Osmotic Conditioning, which consists of partial and controlled hydration of the seeds, has obtained success with various species of seeds, increasing the germinating span and tolerance to the adverse conditions of the environment, and has also reduced the time elapsed between sowing and the emergence of the plants. Associated to ideal storage conditions, the treatment has increased the performance of the seeds of tropical wood species. Aiming at studying the germinating environment and the effect of osmotic conditioning on the germination of seeds of the Australian Royal Palm tree, two experiments were performed. The first one evaluated the effect of disinfestation of the seeds of the Australian Royal Palm tree with NaClO. The treatments applied were: 0.5% sodium hypochlorite, exposure periods of 5, 15, 30, 45, 60, 90, 120 and 240 minutes, and the fungicide Captan, as control. The treatments with NaClO did not differ in relation to the final percentage of germination and to the germination speed index, and did not differ from the treatment control. The second test evaluated solutions with the following osmotic potentials: 0.0MPa (pure water), -0.4MPa, -0.6MPa and -0.8MPa, exposed for the periods of 10 and 20 days. The final percentage of germination did not differ among the treatments. The seeds hydrated in pure water for a period of 20 days showed a germination speed index significantly superior to the other treatments, and they did not show significant differences among themselves.

The effect of elevated muscle fluid volume on indices of muscle damage following an acute bout of eccentric exercise

The primary purpose of the current investigation was to develop an elevated muscle fluid level using a human in-vivo model. The secondary purpose was to determine if an increased muscle fluid content could alter the acute muscle damage response following a bout of eccentric exercise. Eight healthy, recreationally active males participated in a cross-over design involving two randomly assigned trials. A hydration trial (HYD) consisting of a two hour infusion of a hypotonic (0.45%) saline at a rate of 20mL/minVl .73m"^ and a control trial (CON), separated by four weeks. Following the infusion (HYD) or rest period (CON), participants completed a single leg isokinetic eccentric exercise protocol of the quadriceps, consisting of 10 sets of 10 repetitions with a one minute rest between each set. Muscle biopsies were collected prior to the exercise, immediately following and at three hours post exercise. Muscle analysis included determination of wet-dry ratios and quantification of muscle damage using toluidine blue staining and light microscopy. Blood samples were collected prior to, immediately post, three and 24 hours post exercise to determine changes in creatine kinase (CK), lactate dehydrogenase (LD), interleukin-6 (IL-6) and Creactive protein (CRP) levels. Results demonstrated an increased muscle fluid volume in the HYD condition following the infusion when compared to the CON condition. Isometric peak torque was significantly reduced following the exercise in both the HYD and CON conditions. There were no significant differences in the number of areas of muscle damage at any of the time points in either condition, with no differences between conditions. CK levels were significantly greater 24hour post exercise compared to pre, immediately and three hours post similarly in both conditions. LD in the HYD condition followed a similar trend as CK with 24 hour levels higher than pre, immediately post and three hours post and LD levels were significantly greater 24 hours post compared to pre levels in the CON condition, with no differences between conditions. A significant main effect for time was observed for CRP (p<0.05) for time, such that CRP levels increased consistently at each subsequent time point. However, CRP and IL-6 levels were not different at any of the measured time points when comparing the two conditions. Although the current investigation was able to successfully increase muscle fluid volume and an increased CK, LD and CRP were observed, no muscle damage was observed following the eccentric exercise protocol in the CON or HYD conditions. Therefore, the hypotonic infusion used in the HYD condition proved to be a viable method to acutely increase muscle fluid content in in-vivo human skeletal muscle.

Heats of formation of some hydrates /|nA. Phillipson. -- 260 St. Catharines, Ont. : [s. n.],

A great deal of data on the heats of formation of various hydrates has been compiled i n the J.A.N.A.F. and other tables such as the National Bureau of Standards circulars. Comparison of the heat of f ormation of a hydrate with that of the corresponding anhydrate exposes anomalies i n a surprising number of cases. Some of the results are so discordant that i t is apparent that one or the other value is seriously mistaken. No attempt has been made i n this work to determine which value may be correct, but measurements have been made of the difference between these two values. The procedure adopted has been to dissolve the hydrate and the anhydrate, to achieve the same final concentration of the compound in solution, and so to measure the difference in heats of solution .. Measurements were made at OOC in a modified Bunsen ice calorimeter, well insulated and surrounded by an icewater mixture . The observed differences in heats of solut ion were corrected t o 25°0 by using appropriate heat capacity data. These differences offer a direct measure of the enthalpy involved in binding a mole of water into the crystal structure and so should shed light on the nature of binding involved. The following hydrates were studied : MgS04.nH20 (n = 1,4,7), MnC12.nH20 (n = 1, 2), LiI. nH20 (n = 1,3), MnS04. nH20 (n = 1,4), CaC12. nH20 (n = 2,6) , K2C03.1~H20, LiCl.H20, LiBr.2H20, CdC12.2t H2o, and N2H4eH20.

Measurement of forces between and within bilayers of neutral phospholipids

Phospholipids in water form lamellar phases made up of alternating layers of water and bimolecular lipid leaflets. Three complementary methods, osmotic, mechanical, and vapour pressures, were used to measure the work of removing water from lamellar phases composed of frozen dipalmitoylphosphatidylcholine ( DPPC ), melted DPPC, egg phosphatidylethanolamine or equimolar mixtures of DPPC and cholesterol ( DPPC/CHOL ), Concurrently the structural changes that resulted from this water removal were measured using X-ray diffraction. The work was divided into that which forces the bilayers together ( F ) and that which compresses the molecules together within the bilayers ( F )# A large repulsive force exists between bilayers composed of each of the lipids studied and this force increases exponentially as bilayer separation is decreased. F is affected by the nature of the head groups, conformation of the acyl chains and heterogeneity of these chains. In general all of the melted phosphatidylcholines ( melted DPPC, egg lecithin and DPPC/CHOL ) have large equilibrium separations in excess water resulting from large repulsive hydration forces between these bilayers. By comparison, egg PE has an increased attractive force, and frozen DPPC has a decreased hydration force; each results in smaller separations in water for these two lipids. The chemical potentials of the water between the bilayers for all these lipids lie on a continuum, indicating that interbilayer water cannot be characterized by two discrete states, usually referred to as "bound" or "non**bound". For all lipids studied a maximum of 25 % of the total work done on the system goes into deforming the bilayers. The method used here viii to separate repulsion from deformation, developed for us by v. A. Parsegian, provides a unique method for the measurement of lateral pressure of a bilayer and its modulus of deformability ( Y ). Lateral pressure is affected by the nature of the head group, conformation and heterogeneity of the acyl chains. For small changes in molecular surface area ( A ) near equilibrium, both melted and frozen DPPC have similar values for the deformability modulus. Thus in this regime it requires about the same force to change the angle of tilt of frozen chains as it does to compress the fluid bilayer. The introduction of cholesterol into bilayers of DPPC reduces dramatically the lateral pressure of the bilayers over a large range of molecular surface areas ( A ). The variation in the magnitude of bilayer repulsion with different phospholipids provides a basis for the mechanism of lipid segregation in mixed lipid systems and suggests that interacting heterogeneous membranes may influence or modulate the composition of the opposing membrane. The measurements of deformabilities of bilayers provides a direct comparison of them with the properties of monolayers.

Measurement of repulsive forces between charged phospholipid bilayers

Electrostatic forces between membranes containing charged lipids were assumed to play an important role in influencing interactions between membranes long before quantitative measurements of such forces were available. ~ur measurements were designed to measure electrostatic forces between layers of lecithin charged with lipi~s carrying ionizable head groups. These experiments have shown that the interactions between charged lipid bila.yere are dominated by electrostatic forces only at separations greater than 30 A. At smaller separations the repulsion between charged bilayers is dominated by strong hydration forces. The net repulsive force between egg lecithin bilayers containing various amounts of cherged lipids (phosphatidylglycerol (PG) 5,10 ano 50 mole%, phosphatidyli. nosi tol (PI) 10 mole% and sodium oleate (Na-Ol) 3,5 and 10 mole%, where mole% gives the ratio of the number of moles' of .charged lipid to the total number of moles of all lipids present in the sample) was stuoied with the help ('If the osmotic streas technique described by LeNeveu et aI, (1977). Also, the forces between pure PG were j_nvestigated in the same manner. The results have been plotted showing variation of force as a function of bilay- _ er separation dw• All curVes 90 obtained called force curves, were found to be similar in sha.pe, showing two distinct regions, one when dw<.30 A is a region cf very rapid iiivariation of force with separation ( it is the region dominated by hydre,tion force) and second when dw> 40 A is a region of very slow variation of force with separB.tion ( it is the region dominated by the electrostatic force). Between these two regions there exists a transition area in which, in most systems studied, a phase separation of lipids into fractions containing different amounts of charged groups, was observed. A qualitative analysis showed that our results were v/ell described by the simple electrostatic double -le.yer theory. For quantitative agreement between measured and calculated force curves however, the charge density for the calculations had to be taken as half of that given by the number density of charged lipids present in the lecithin bilayers. It is not clear at the moment what causes such low apparent degree of ionization among the charged head groups, and further study is needed in this area.

The influence of water on the glucose affinity of hexokinase

In the present thesis, the role of hydration during the glucose induced conformational change of hexokinase is investigated. This is accomplished by applying the osmotic stress technique. The osmotic stress technique is founded on varying of the activity of water in a system in order to determine ifs effects. This is accomplished by adding inert solute molecules that are excluded from the system under study. The solute molecules used within the present investigation are Polyethylene glycols (PEGs). PEGs aid in the removal of water from hexokinase by exerting osmotic pressure. The osmotic pressures of the PEG solutions are also measured with both vapour pressure osmometry and secondary osmometry with phospholipids. An interesting discovery is made in that the osmotic pressures of PEG and co-solute solutions are non-additive. This indicates that PEG concentrates co-solutes in solution by making a certain proportion of the water inaccessible. Glucose binding was measured fluorometrically and the glucose equilibrium dissociation constant (GEDC) of hexokinase is measured in solutions containing the different MW PEGs. Changes in the sensitivity of the glucose affinity with osmotic pressure allows the calculation of the change in the numbers of polymer-inaccessible water molecules upon the binding of glucose to hexokinase ~Nw. It was determined the ~Nw decreases with increases in osmotic pressure in the presence of all MW PEGs. ~Nw decreases from values between 45-290 water molecules at low pressure to approximately 15 at high pressure. There is also a molecular weight dependence observed. There are large decreases in ~Nw with osmotic pressure in the presence of PEGs above MW 1000. However, below MW 1500 changes in ~Nw with osmotic pressure are relatively small. These findings are interpreted with respect to two possible mechanisms involving changes in the conformation of hexokinase u~der osmotic pressure and the access of the PEG molecules to water surrounding hexokinase.

Protein Turnover in Rat Skeletal Muscle During In Vitro Hypo-Osmotic Stress

Hypo-osmolality influences tissue metabolism, but research on protein turnover in skeletal muscle is limited. The purpose of this investigation was to examine the effects of hypo-osmotic stress on protein turnover in rat skeletal muscle. We hypothesized increased protein synthesis and reduced degradation following hypo-osmotic exposure. EDL muscles (n=8/group) were incubated in iso-osmotic (290 Osm/kg) or hypo-osmotic (190 Osm/kg) modified medium 199 (95% O2, 5% CO2, pH 7.4, 30±2 °C) for 60 min, followed by 75 min incubations with L-U[14C]phenylalanine or cycloheximide to determine protein synthesis and degradation. Immunoblotting was performed to assess signalling pathways involved. Phenylalanine uptake and incorporation were increased by 199% and 169% respectively in HYPO from ISO (p < 0.05). This was supported by elevated phosphorylation of mTOR Ser2448 (+12.5%) and increased Thr389 phosphorylation on p70s6 kinase (+23.6%) (p < 0.05). Hypo-osmotic stress increased protein synthesis and potentially amino acid uptake. Future studies should examine the upstream mechanisms involved.

Approches transcriptomiques dans l’étude de la fibrose kystique

Les avancées en biotechnologie ont permis l’identification d’un grand nombre de mécanismes moléculaires, soulignant également la complexité de la régulation génique. Néanmoins, avoir une vision globale de l’homéostasie cellulaire, nous est pour l’instant inaccessible et nous ne sommes en mesure que d’en avoir qu’une vue fractionnée. Étant donné l’avancement des connaissances des dysfonctionnements moléculaires observés dans les maladies génétiques telles que la fibrose kystique, il est encore difficile de produire des thérapies efficaces. La fibrose kystique est causée par la mutation de gène CFTR (cystic fibrosis transmembrane conductance regulator), qui code pour un canal chlorique transmembranaire. La mutation la plus fréquente (ΔF508) induit un repliement incorrect de la protéine et sa rétention dans le réticulum endoplasmique. L’absence de CFTR fonctionnel à la membrane a un impact sur l’homéostasie ionique et sur l’hydratation de la muqueuse respiratoire. Ceci a pour conséquence un défaut dans la clairance mucocilliaire, induisant infection chronique et inflammation excessive, deux facteurs fondamentaux de la physiopathologie. L’inflammation joue un rôle très important dans l’évolution de la maladie et malgré le nombre important d’études sur le sujet, la régulation du processus inflammatoire est encore très mal comprise et la place qu’y occupe le CFTR n’est pas établie. Toutefois, plusieurs autres facteurs, tels que le stress oxydatif participent à la physiopathologie de la maladie, et considérer leurs impacts est important pour permettre une vision globale des acteurs impliqués. Dans notre étude, nous exploitons la technologie des puces à ADN, pour évaluer l’état transcriptionnel d’une cellule épithéliale pulmonaire humaine fibro-kystique. Dans un premier temps, l’analyse de notre expérience identifie 128 gènes inflammatoires sur-exprimés dans les cellules FK par rapport aux cellules non FK où apparaissent plusieurs familles de gènes inflammatoires comme les cytokines ou les calgranulines. L’analyse de la littérature et des annotations suggèrent que la modulation de ces transcripts dépend de la cascade de NF-κB et/ou des voies de signalisation associées aux interférons (IFN). En outre, leurs modulations pourraient être associées à des modifications épigénétiques de leurs loci chromosomiques. Dans un second temps, nous étudions l’activité transcriptionnelle d’une cellule épithéliale pulmonaire humaine FK en présence de DMNQ, une molécule cytotoxique. Notre but est d’identifier les processus biologiques perturbés par la mutation du gène CFTR en présence du stress oxydatif. Fondé sur une analyse canonique de redondance, nous identifions 60 gènes associés à la mort cellulaire et leur variance, observée dans notre expérience, s’explique par un effet conjoint de la mutation et du stress oxydatif. La mesure de l’activité des caspases 3/7, des effecteurs de l’apoptose (la mort cellulaire programmée), montre que les cellules porteuses de la mutation ΔF508, dans des conditions de stress oxydatif, seraient moins apoptotiques que les cellules saines. Nos données transcriptomiques suggèrent que la sous-activité de la cascade des MAPK et la sur-expression des gènes anti-apoptotiques pourraient être impliquées dans le déséquilibre de la balance apoptotique.

Impact du bicarbonate de sodium sur la prévention de la néphropathie induite par le produit de contraste en chirurgie endovasculaire pour anévrysme de l’aorte

Introduction: L’approche endovasculaire pour la réparation d’anévrysmes aortiques s’associe à une utilisation importante de produit de contraste, qui peut causer une néphropathie induite par le produit de contraste (NIC) en postopératoire. L’hydratation intraveineuse peut réduire l’incidence de NIC, mais quel produit utiliser reste incertain. Nous avons évalué le bicarbonate de sodium, comparé au NaCl 0,9%, pour réduire l’incidence de NIC. Méthode: Nous avons mené une étude prospective, randomisée et contrôlée à double insu chez 34 patients subissant une chirurgie endovasculaire pour anévrysme aortique. Les patients des deux groupes (17 patients par groupe) ont reçu du bicarbonate de sodium ou du NaCl 0,9% à raison de 3 mL/kg/h pour une heure avant l’intervention puis 1 mL/kg/h jusqu’à 6 h après la fin de la chirurgie. Tous les patients ont reçu du N-acétylcystéine. L’objectif principal était l’incidence de NIC, définie comme une élévation de plus de 25% de la créatinine sérique 48 h suivant l’exposition au produit de contraste. Des biomarqueurs précoces de lésion rénale ont été mesurés. Résultats: Une NIC s’est développée chez 1 patient (5,88%) appartenant au groupe bicarbonate, comparé à aucun patient (0%) dans le groupe NaCl 0,9% (P = 0,31). Les biomarqueurs de lésion rénale étaient significativement augmentés dans les deux groupes après l’exposition au produit de contraste. Conclusions: Nous avons démontré un faible taux d’insuffisance rénale suivant une chirurgie endovasculaire aortique, que l’hydratation soit effectuée avec du bicarbonate ou du NaCl 0,9%, malgré une élévation des biomarqueurs de lésion rénale.

Déterminants des choix alimentaires d'athlètes adolescents en période de compétition

Cette étude s’insère dans une étude s’intitulant « Choix alimentaires d’adolescents canadiens et attitudes de leurs entraîneurs impliqués dans des activités sportives organisées ». Les objectifs étaient d’étudier chez des adolescents impliqués dans une compétition sportive provinciale où l’offre alimentaire est contrôlée 1) leur maîtrise des recommandations nutritionnelles 2) les facteurs individuels, comportementaux, socio-environnementaux influençant leurs choix alimentaires. Deux observateurs ont visité les différents sites alimentaires et de compétition pendant les Jeux du Québec de 2011 à Valleyfield. Les plateaux des athlètes ont été photographiés à table au moment des repas avec une caméra numérique et les commentaires oraux colligés par écrit. Au total, 173 photographies ont été analysées et comparées aux recommandations reconnues en nutrition sportive. Dans notre étude, les préférences alimentaires, l’offre alimentaire et la présence des coéquipiers sont les facteurs qui influencent le plus les choix alimentaires en compétition. Par contre, le sexe de l’athlète n’a pas influencé les choix alimentaires des athlètes observés. En pré-compétition, 85,4% des plateaux présentent une valeur énergétique supérieure aux recommandations et 66,3% d’entre eux ont une répartition en énergie inadéquate, peu importe le sexe. Un excès de lipides et de protéines au sein du repas précédant l’effort caractérise majoritairement les plateaux dont la répartition en énergie est non optimale (69,5%). Les recommandations en post-compétition (100%) et lors des jours de repos (95,8%) ont facilement été rencontrées. Il en est de même pour l’hydratation (99,4%). Le lait au chocolat est la boisson la plus populaire (59,5%). Les produits céréaliers (99,4%), le lait et substituts (87,3%), les légumes (85,7%), les viandes et substituts (83,2%), les aliments riches en sucres (79,8%), les fruits (70,5%) et les mets riches en gras (59,4%) sont particulièrement appréciés par les athlètes. Les commentaires recueillis font ressortir une vision dichotomique des aliments chez certains athlètes qui classifient les aliments en « bons » ou « mauvais ». Notre étude démontre que la présence d’une politique alimentaire permet de promouvoir des habitudes alimentaires saines et favorise la consommation d’aliments nutritifs lors d’une compétition sportive d’envergure. Cependant, de l’éducation en nutrition est toujours requise pour viser l’amélioration du comportement alimentaire avant l’effort.

Oxygenation-sensitive cardiovascular magnetic resonance imaging (OS-CMR) : potential confounding factors in use of OS-CMR

La résonance magnétique cardiovasculaire sensible à l'oxygénation (OS-CMR) est devenue une modalité d'imagerie diagnostique pour la surveillance de changements dans l'oxygénation du myocarde. Cette technique offre un grand potentiel en tant qu'outil diagnostic primaire pour les maladies cardiovasculaires, en particulier la détection non-invasive d'ischémie. Par contre, il existe plusieurs facteurs potentiellement confondants de cette technique, quelques-uns d'ordre méthodologique comme les paramètres de séquençage et d'autres de nature physiologiques qui sont peut compris. En raison des effets causés par le contenu tissulaire d'eau, l'état d'hydratation peut avoir un impact sur l'intensité du signal. Ceci est un des aspects physiologiques en particulier dont nous voulions quantifier l'effet confondant par la manipulation de l'état d'hydratation chez des humains et l'observation des changements de l'intensité du signal dans des images OS-CMR. Méthodes: In vitro: Du sang artériel et veineux de huit porcs a été utilisé pour évaluer la dilution en série du sang et son effet correspondant sur l'intensité du signal de la séquence OS. In vivo: Vingt-deux volontaires en santé ont subi OS-CMR. Les concentrations d'hémoglobine (Hb) ont été mesurées au niveau de base et immédiatement après une l'infusion cristalloïde rapide de 1000 mL de solution Lactate Ringer's (LRS). Les images OS-CMR ont été prises dans une vue mid-ventriculaire court axe. L'intensité du signal myocardique a été mesurée durant une rétention respiratoire volontaire maximale, suite à une période d'hyperventilation de 60 secondes. Les changements dans l'intensité du signal entre le début et la fin de la rétention de la respiration ont été exprimés relativement au niveau de base (% de changement). Résultats: L'infusion a résulté en une diminution significative de l'Hb mesurée (142.5±3.3 vs. 128.8±3.3 g/L; p<0.001), alors que l'IS a augmenté de 3.2±1.2% entre les images du niveau de base en normo- et hypervolémie (p<0.05). L'IS d'hyperventilation ainsi que les changements d'IS induits par l'apnée ont été attenués après hémodilution (p<0.05). L'évaluation quantitative T2* a démontré une corrélation négative entre le temps de T2* et la concentration d'hémoglobine (r=-0.46, p<0.005). Conclusions: Il existe plusieurs éléments confondants de la technique OS-CMR qui requièrent de l'attention et de l'optimisation pour une future implémentation clinique à grande échelle. Le statut d'hydratation en particulier pourrait être un élément confondant dans l'imagerie OS-CMR. L'hypervolémie mène à une augmentation en IS au niveau de base et atténue la réponse IS durant des manoeuvres de respiration vasoactives. Cette atténuation de l'intensité du signal devrait être tenue en compte et corrigée dans l'évaluation clinique d'images OS-CMR.