Korean Circ J.  2007 Feb;37(2):51-57. 10.4070/kcj.2007.37.2.51.

The Effects of Trimetazidine on the Enhancement Pattern of Multi-detector Computed Tomography in a Porcine Myocardial Infarction Model

• Lee SR
• Jeong MH
• Yim NY
• Yoon NS
• Kim KH
• Hong YJ
• Park HW
• Kim JH
• Moon JY
• Ahn YK
• Kim YH
• Cho JG
• Park JC
• Kang JC

• KMID: 1859081
• DOI: http://doi.org/10.4070/kcj.2007.37.2.51

Abstract

BACKGROUND AND OBJECTIVES: There is increasing evidence to suggest that trimetazidine (TMZ) has the ability to improve ischemic heart failure by way of optimizing the heart's energy metabolism. The aim of this study was to examine the changes of the myocardial enhancement pattern by using two-phase, contrast enhanced, ECG-gated, multi-detector computed tomography (MDCT) after the administration of TMZ in a porcine myocardial infarction model.
SUBJECTS AND METHODS
The porcine myocardial infarction model was created by balloon occlusion of the left anterior descending coronary artery. We randomized the swine into two groups: group I (n=7: aspirin only) and group II (n=7: aspirin plus 1 mg/kg TMZ for 4 weeks). Echocardiography and MDCT were performed and the ejection fraction (EF, %), end-systolic volume (ESV, mL) and end-diastolic volume (EDV, mL) were measured at 28 days after induction of myocardial infarction. Three enhancement patterns, including the early arterial phase defect (ED), the 4-min late enhancement (LE) and the residual defect (RD), were also investigated and those were described as class I [ED (-), RD (-), LE (+/-)], class II [ED (+), RD (-), LE (+)], and class III [ED (+), RD (+), LE (+)]. We performed histopathologic examination after sacrificing the animals.
RESULTS
The baseline and follow-up echocardiography at 4 weeks after the induction of MI demonstrated no significant differences between the two groups. The LV indices by MDCT were also similar between the two groups (group I: EF, ESV and EDV=46.0+/-12.5%, 35.9+/-23.0 mL and 69.0+/-40.2 mL, respectively, group II: EF, ESV and EDV=49.8+/-13.2%, 43.8+/-23.1 mL and 82.8+/-24.6 mL, respectively, p=NS). The percent wall thickness was similar (69.1+/-19.6% vs. 64.9+/-10.5%, respectively, p=NS), but the enhancement pattern was different between the two groups (group I: class I, II and III=0 (0%), 0 (0%): and 7 (100%) respectively, group II: class I, II and III=0 (0%), 2 (28.6%) and 5 (71.4%), respectively, p<0.001). The volume of tissue that lacked triphenyl tetrazolium chloride was similar between two groups (8.4+/-1.9% vs. 7.3+/-2.6%, respectively, p=NS).
CONCLUSION
TMZ administration produced different enhancement patterns on MDCT. This result suggests that TMZ administration can reduce the residual defect in a porcine myocardial infarction model. Although further experiments are needed for determining the effect of TMZ on reducing the irreversible area of infarcted myocardium, this is the first report that proved the beneficial effect of TMZ by performing MDCT.

Keyword

Trimetazidine; Tomography, X-Ray Computed; Myocardium; Infarction

MeSH Terms

Animals
Aspirin
Balloon Occlusion
Coronary Vessels
Echocardiography
Energy Metabolism
Follow-Up Studies
Heart Failure
Infarction
Myocardial Infarction*
Myocardium
Swine
Tomography, X-Ray Computed
Trimetazidine*
Aspirin
Trimetazidine

Figure

• 

  Fig. 1 Protocol of the two phase contrast enhanced ECG gated multi-detector computed tomography. If the target area density would be more than 100 HU at the descending thoracic aorta after contrast media injection, then the first scan was done after a 5-sec delay. The second scan was also done after a 4-min delay. ECG: electrocardiography, HU: Hounsfield units.

• 

  Fig. 2 Illustrations of the three enhancement patterns: Class I, the absence of EDs in the early phase and the presence of LE without RDs in the late phase, Class II, the presence of EDs in the early phase and the presence of LE without RDs in the late phase and Class III, the presence of EDs in the early phase and the presence of both LE and RDs in the late phase. ED: early arterial phase defect, LE: late enhancement, RD: residual defect.

• 

  Fig. 3 Class II enhancement pattern (upper panel) and Class III enhancement pattern (lower panel). A, D: there was early defect seen on the early image (arrow head). B: there was late enhancement seen at the 4-min delay (black arrow). C, F: there was infarcted myocardium noted after staining with TTC solution (white arrow). E: there was late enhancement (black arrow) and residual defect (white arrow) seen at the 4-min delay. There were subendocardial infarction (C) and transmural infarction with wall thinning (F) at the left ventricle that was supplied by the left anterior descending coronary arteries. TTC: 2,3,5-triphenyl tetrazolium chloride.

• 

  Fig. 4 The end-systolic volume (A), end-diastolic volume (B), and left ventricular ejection fraction were calculated by multiphase reconstruction; this was performed from the base to the apex of the heart with using commercially available software (Argus®, Siemens).

• 

  Fig. 5 Hematoxylin (×400)/Eosin (×400)(A) and Masson-Trichrome (B) staining revealed severe fibrosis in the border zone of the infarcted myocardium.

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