Document Detail

Early detection of doxorubicin myocardial injury by ultrasonic tissue characterization in an experimental animal model.
Jump to Full Text
MedLine Citation:
PMID:  23046747     Owner:  NLM     Status:  MEDLINE    
IN CONCLUSION: UTC was able to early identify the DXR myocardial lesion when compared to LVEF, showing good accuracy to detect the initial collagen deposition in this experimental animal model.
Minna Moreira Dias Romano; Antônio Pazin-Filho; João Lucas O'Connel; Marcus Vinícius Simões; André Schmidt; Érica C Campos; Marcos Rossi; Benedito Carlos Maciel
Related Documents :
4081747 - Surveys of natural radiation exposure in uk dwellings with passive and active measureme...
981517 - Population dose from natural radionuclides in phosphate fertilizers.
17562657 - An assessment of annual whole-body occupational radiation exposure in ireland (1996-2005).
20931367 - The styrene metabolite, phenylglyoxylic acid, induces striatal-motor toxicity in the ra...
18047477 - Effects of lactational exposure to soy isoflavones on reproductive system in neonatal f...
3323167 - Roxithromycin in skin and soft tissue infections.
Publication Detail:
Type:  Journal Article     Date:  2012-10-10
Journal Detail:
Title:  Cardiovascular ultrasound     Volume:  10     ISSN:  1476-7120     ISO Abbreviation:  Cardiovasc Ultrasound     Publication Date:  2012  
Date Detail:
Created Date:  2012-12-13     Completed Date:  2013-05-24     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  101159952     Medline TA:  Cardiovasc Ultrasound     Country:  England    
Other Details:
Languages:  eng     Pagination:  40     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Antibiotics, Antineoplastic / adverse effects*
Disease Models, Animal
Doxorubicin / adverse effects*
Early Diagnosis
Heart Diseases / chemically induced*,  ultrasonography*
Rats, Wistar
Sensitivity and Specificity
Ventricular Function, Left
Reg. No./Substance:
0/Antibiotics, Antineoplastic; 80168379AG/Doxorubicin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Cardiovasc Ultrasound
Journal ID (iso-abbrev): Cardiovasc Ultrasound
ISSN: 1476-7120
Publisher: BioMed Central
Article Information
Download PDF
Copyright ©2012 Romano et al.; licensee BioMed Central Ltd.
Received Day: 5 Month: 6 Year: 2012
Accepted Day: 3 Month: 10 Year: 2012
collection publication date: Year: 2012
Electronic publication date: Day: 10 Month: 10 Year: 2012
Volume: 10First Page: 40 Last Page: 40
PubMed Id: 23046747
ID: 3520809
Publisher Id: 1476-7120-10-40
DOI: 10.1186/1476-7120-10-40

Early detection of doxorubicin myocardial injury by ultrasonic tissue characterization in an experimental animal model
Minna Moreira Dias Romano1 Email:
Antônio Pazin-Filho2 Email:
João Lucas O’Connel1 Email:
Marcus Vinícius Simões1 Email:
André Schmidt1 Email:
Érica C Campos3 Email:
Marcos Rossi3 Email:
Benedito Carlos Maciel14 Email:
1Divisions of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
2Divisions of Cardiology and Clinical Emergencies, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
3Department of Internal Medicine, Departament of Pathology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
4Division of Cardiology, Department of Internal Medicine, Medical School of Ribeirão Preto, 14048-900, Ribeirão Preto, SP, Brazil


Cardiotoxicity is one of the most feared complications related to doxorubicin (DXR) prescription in clinical practice, expressed primarily by myocardial focal sclerosis, which can evolve to irreversible ventricular diastolic and systolic dysfunctions.

Serial quantification of left ventricle ejection fraction (LVEF) is the standard procedure to identify cardiotoxicity [1], but it is not sensitive enough to detect initial myocardial lesion [2,3]. Information regarding myocardial ultra-structure and composition, including the collagen deposition, can be provided by ultrasonic tissue characterization (UTC), a non-invasive technique that can detect and quantify acoustic properties of myocardial tissue [4,5]. Even though UTC has been used to detect myocardial damage in several myocardial collagen deposition diseases [6-10], its ability to do so in DXR cardiotoxicity is still debated. There is evidence of UTC abnormalities at the end of the DXR infusion [11-13]. In a previous pilot study performed in our laboratory (results yet not published), with rats receiving intraperitoneal DXR infusions, we found that UTC can potentially detect the myocardium texture alterations at the end of treatment with DXR, even in occasions where there was only a slight decrease in LVEF.

This study was designed to assess the capability of UTC to detect myocardium injury due to DXR infusion earlier than LVEF, as evaluated using echocardiography in an experimental animal model and with histological quantification of collagen deposition.

Study population

Sixty adults Wistar male rats (250 to 300g) were sedated and evaluated with echocardiographic examinations at basal situation as previously described [14]. Then, the animals received weekly endovenous DXR infusions of 2mg/Kg DXR up to a cumulative dosage of 16 mg/Kg. The animals were sedated and submitted to echocardiographic evaluations 7–15 days after the cumulative dosages of 8, 10, 12, 14, and 16 mg/Kg DXR. The protocol was approved by the Ethical Animal Research Committee of our institution, according to the Brazilian College Rules in Animal Experimentation (Protocol 041/2005).

Two-dimensional conventional echocardiography

Two-dimensional echocardiography was performed, using an ultra-sound Sonos 5500, Philips (Andover, MA) equipment with S12-MHz sectorial probe. The parasternal short axis view at the papillary level was used to obtain chamber dimensions according to the M Mode technique — diastolic interventricular septal (IVS) and posterior wall (PW) thickness, end diastolic (LVEDD) and end systolic left ventricular diameters (LVESD). M-Mode images were obtained in a sweep speed of 100–150 mm/s what seems to have an adequate frame rate to an animal with a heart rate of 300bpm. These parameters were used to calculate the ejection fraction (EF) by Teichholz method [15] and shortening fraction (SF). Heart rate was measured with pulsed Doppler and all measurements were expressed as the average of three consecutive cardiac cycles.

Ultrasonic tissue characterization

Two-dimensional ultrasonic backscatter images were obtained using an online acoustic densitometry package, incorporated in the same image system, from a parasternal short axis view at the papillary muscle level. Images were captured in a cineloop, displayed and stored for off-line analysis as follows: Backscatter (IBS) was measured from an elliptical sample placed over the posterior myocardium wall and made as large as possible, avoiding the epicardium and endocardium. The IBS values obtained were calibrated for system settings and for attenuation, by dividing the average value by the IBS value obtained from a rubber phantom (ATS Laboratories, 15 × 15 × 15cm, 15 db) for each segment, at the same depth. The IBS values of the phantom were obtained from backscattered echoes emanating from within the phantom at the same depth of the tissue that was analyzed (Figure 1). This variable was nominated as the corrected coefficient of the IBS (CC IBS). A second variable extracted from the IBS measurements was the magnitude of cardiac cyclic variation (MCV) of the IBS, as measured by the peak-to-peak intensity (PPI) difference between maximal and minimal values of IBS in the cardiac cycle.

Histological analysis

Six control group animals, eight DXR group animals with cumulative dosage of 8 mg/Kg, six DXR group animals with cumulative dosage of 12 mg/Kg and ten DXR group animals with cumulative dosage of 16 mg/Kg were sacrified after sedation and submitted to histological analyses.; whole hearts were excised, fixed, and cross-sectionally cut at the papillary muscle level. Samples were colored with hematoxilin-eosin and red picrosirius, this last one for the collagen quantification. For each heart, ten randomly selected areas through the whole left ventricular wall, excepting the septum, were analyzed. Collagen was quantified with the Leica Qwin Software V 3.2.0 (Leica Imaging Systems Ltd., Cambridge, England) incorporated into an optical Leica DMR microscope (Leica Mycrosystems Wetzlar GmbH, Wetzlar, England), a video camera (Leica DC300F, Leica Mycrosysrems AG, Heerbrugg, Switzerland) and a computer station. Collagen amount was expressed as percentage of the measured area.

Statistical analysis

Categorical variables were compared among all the groups with Fishers’ or Chi-Square tests and continuous variables with Kruskal-Wallis tests. To eliminate the effect of repeated measurements in the same animal, linear regression coefficient (beta coefficient) was obtained for each animal, utilizing the dependent variable and each DXR cumulative doses. Spearman test was used to evaluate the relation between beta coefficients and collagen percentage values. The receiver-operating (ROC) curve was elaborated according to a 4.24% collagen content (higher than the average value of the control group, plus 2 standard deviations) to determine the accuracy of both CC-IBS and left ventricular ejection fraction. All analyses were performed with STATA Intercool versão 9.2 (Stata Satistical Software 9,2 [computer program]. College Station TX StataComp; 2005).


Sixty animals were analyzed at baseline. Table 1 presents the DXR group data at basal and at DXR cumulative dosages of 8, 10, 12, 14 and 16 mg/Kg expressed as average and standard error values.

The microscopic study of the myocardium revealed that the control hearts did not present any pathological change. The microscopic findings in the myocardium in all doxorubicin-treated groups were described as intracellular edema, vacuolar degeneration, and disorganization or loss of myofibrils. Loss of myofibrils and vacuolar degeneration of cardiomyocytes were predominantly characterized by alterations in the doxorubicin cardiomyopathy, more pronounced in the myocardium of the doxorubicin groups treated with 12 and 16 mg/kg (Figure 2).

Collagen content increased through DXR infusion from 8 mg/Kg (5.6±1.6% x 1.7±0.6-basal; p=0.001) (Figure 3, panel D). With each DXR incremental dose, there was a continuous increase of CC-IBS and decrease in LVEF (Figure 3-panels A and C). CC-IBS increased significantly with a DXR cumulative dosage of 8 mg/Kg (1.29±0.27 x 1.1±0.26-basal; p=0.005), with a subsequent increase at 12 mg/Kg dosage (1.4±0.2 x 1.1±0.26-basal p=0.005); while MCV decreased from 8 mg/Kg DXR dosage (9.1± 2.8 x 11.02±2.6-basal; p=0,006) (Figure 3-panel B) and remained stable after. The decrease in LVEF at DXR cumulative dosage of 8 mg/Kg was lower than 6% (80.4±6.9% x 85.3±6.9%-basal, p=0.005). At the same cumulative dose (8 mg/Kg DXR), CC-IBS increased nearly 20% from basal values, reaching a 30-40% increment at 12mg/Kg DXR (Figure 3- panels A and C). Figure 4 illustrates actual ultrasonic findings, with IBS calculations from animals in different DXR dosages. There was a significant correlation between collagen content and beta coefficient of CC-IBS (r=0.45, p=0.02) (Figure 5 – panel A) but no correlation was observed between collagen content and MCV (r= 0.06, p=0.76) (Figure 5-panel B), LVEF- Teichholz (r= −0.20, p=0.33) (Figure 5- panel C), and SF (r=−0.09, p=0.65) (Figure 5- panel D).

LV ejection fraction was not accurate enough to detect initial myocardium collagen deposition (4.24% of myocardial content) (AUC=0.54) (Figure 6-panel A). CC-IBS was able to detect the collagen deposition induced by DXR, with good accuracy (AUC=0.76). A CC-IBS value of 1.21 was able to detect initial collagen deposition (4.24% of myocardial content) with a sensitivity of 72.2% and specificity of 83.3% (Figure 6-panel B).


To the best of our knowledge this is the first evidence that UTC, by using CC-IBS, can detect the initial myocardial lesion (collagen deposition) secondary to DXR infusion early than clinical significant LVEF decrease. Our results are congruent with previously published data [16] showing that this experimental animal model of DXR infusion reproduces pathologic myocardial alterations similar to those found in human disease.

At the end of the DXR infusion protocol, LVEF decrease was about only 6% at 8 mg/Kg DXR and about 10% at 12 mg/Kg. This result is in agreement with previously published data showing that the LVEF decreases slightly at 12 weeks of DXR infusion [17-20].

Information regarding myocardial ultra-structure and composition can be provided by ultrasonic tissue characterization, a non-invasive technique capable of detecting and quantifying acoustic properties of myocardial tissue (4;5). The IBS intensity is related to physical and structural properties of the myocardium and is particularly influenced by tissue collagen content and spatial distribution of this component [21]. In addition, IBS intensity also depends on ultrasound system settings and on ultrasound attenuation, which has been a major limitation for the current use of this index. In order to overcome this limitation, several methods have been employed to calibrate the absolute value of IBS according to a reference value, derived from the ventricular cavity [22], the pericardium [7] or from a gray scale phantom [23][13] such as the one used in this investigation. Although absolute IBS values derived from ventricular cavity or pericardium could reduce the influence of the ultrasound system settings, there are limitations for their use so as to correct the effects of ultrasound attenuation; This, associated to the fact that the pericardium membrane (and consequently its IBS intensity) could be affected by DXR toxicity, influenced our choice of a rubber phantom referential for this investigation.

There is little published data about CC-IBS in this animal model, but Mimbs, studying rabbits, has already demonstrated CC-IBS increments at the end of the total cumulative dose of DXR infusion. In this study we reproduced their findings, but we were also able to demonstrate a dose–response relationship beginning at an 8mg/Kg cumulative dose. Also, CC-IBS was the only index with a significant correlation with collagen deposition, secondary to DXR infusion. The capability of IBS in detecting fibrosis content of the myocardium was already described in several diseases, including dilated cardiomyopathy [22,24].

During cardiac contraction and relaxation, a cardiac cycle-dependent variation of myocardial IBS can be documented. The magnitude of cyclic variation of the IBS, measured as peak-to-peak variation of the IBS curve (MCV), is an additional acoustic parameter, independent on ultrasound system settings and responsible for its wider application. However, this index is more strictly correlated with the myocardial contractile function than the collagen myocardial content. Previously published data showed a decrease in MCV with DXR infusion [11,20,25], even when LVEF was preserved. However, Ha et al., using the same experimental animal model described in our study, failed to demonstrate the decrease in MCV with DXR infusion [17]. Considering that our investigation evaluated MCV through the whole infusion DXR protocol, our results are the first to demonstrate that MCV decrease occurs at initial cumulative DXR dosages (8mg/Kg). MCV of IBS could be used, in addition to CC-IBS, to detect early myocardial DXR toxicity. MCV of IBS may be more related to the myocardium contractile function than collagen content. If so, the reduction of MCV from initial dosages of DXR infusion may accompany initial contraction impairment, as suggested in recent studies [26-29] using regional contraction analysis techniques like “strain rate”. Maybe cellular loss, which is the initial myocardium damage before full collagen deposition, could be detected with these tools (MCV of IBS and by myocardium deformation analysis data, like strain, strain rate and speckle tracking techniques) in a similar way.

The good accuracy of CC-IBS, as demonstrated here, suggests that this parameter could be a non-invasive tool to detect initial collagen deposition secondary to DXR infusion, and it may have the potential to be used as an alternative tool for serial evaluation of myocardial lesions in the clinical setting.

Clinical applicability: this work confirms the capability of UTC using CC-IBS to detect the initial myocardial DXR lesion earlier than the decrease of LVEF in rats. The UTC technique using the CC-IBS is feasible in serial myocardial assessments in humans. As such, this study brings a perspective in the use of UTC as a non-invasive method in collagen myocardium detection, and as an alternative tool for endomyocardial biopsies, with good accuracy, but human studies are needed.

Limitations: the anatomo-pathological studies were limited to the rats that completed the protocol phase and which had not suffered spontaneous deaths. In fact, if those who died were included more striking differences could have been obtained, but adding some confounding factors. The high mortality rates at final cumulative dosages of DXR limited the number of animals analyzed at this point. This study did not include other pathologic myocardium analysis methods, such as myocardial fibers diameter quantification, ultra-structural myocardial analysis, or analysis of the tridimensional myocardial arrangement that could be better correlated to UTC indices like MCV. Another significant limitation is the lack of diastolic data. Since our acoustic window was limited and did not permit a collection of distinct validated diastolic dysfunction parameters, we preffer to exclude it from the protocol. A specific protocol can be developed from this work to address this issue. In summary, UTC was able to identify the DXR myocardial lesion earlier when compared to LVEF, showing good accuracy to detect the initial collagen deposition in this experimental animal model.

Competing interests

The authors declare that they have no competing interest.

Authors’ contributions

MMDR: acquisition of data, analysis and interpretation of IBS and data drafted the article. APF: revised it critically for important intellectual content. JLO: participated in the conception of the study and acquisition of data. MVS: substantial contributions to conception and design. AS: helped to draft the article and revised it critically for important intellectual content. ECC: participated in the acquisition of anatomo-pathological data, its analysis and interpretation. MR: gave important contributions to analysis and interpretation of anatomo-pathologic data. BCM: conceived the study and revised it critically for important intellectual content. All authors read and approved the final manuscript.

Steinherz LJ,Graham T,Hurwitz R,Sondheimer HM,Schwartz RG,Shaffer EM,et al. Guidelines for cardiac monitoring of children during and after anthracycline therapy: report of the Cardiology Committee of the Childrens Cancer Study GroupPediatricsYear: 1992895 Pt 19429491579408
Shan K,Lincoff AM,Young JB,Anthracycline-induced cardiotoxicityAnn Intern MedYear: 1996125147588644988
Hoit BD,Detection of myocardial dysfunction during cancer chemotherapy with tissue Doppler imaging: a canary in the coal mine?J Am Soc EchocardiogrYear: 200922442542610.1016/j.echo.2009.02.01019345310
Nicolosi GL,Lestuzzi C,Pavan D,Dall'Aglio V,Mimo R,Breda M,et al. Qualitative ultrasonic tissue characterization of the myocardium.J Nucl Med Allied SciYear: 19883231391483066860
Tatsukawa H,Furukawa K,Katsume H,Kosugi Y,Azuma A,Inoue N,et al. [Ultrasonic tissue characterization by spectral analysis of myocardial textural pattern]J CardiolYear: 19891925635702636634
Zoni A,Regolisti G,Aschieri D,Borghetti A,Myocardial ultrasonic tissue characterization in patients with different types of left ventricular hypertrophy: a videodensitometric approachJ Am Soc EchocardiogrYear: 1997101748210.1016/S0894-7317(97)80036-39046497
Di Bello V,Giampietro O,Matteucci E,Giorgi D,Bertini A,Piazza F,et al. [Ultrasonic tissue characterization analysis in type 1 diabetes: a very early index of diabetic cardiomyopathy?]G Ital CardiolYear: 19982810112811379834865
Pazin-Filho A,Schmidt A,Almeida-Filho OC,Marin-Neto JA,Maciel BC,Ultrasonic tissue characterization for patients with Chagas' diseaseJ Am Soc EchocardiogrYear: 200417326226810.1016/j.echo.2003.10.02214981425
Vered Z,Barzilai B,Mohr GA,Thomas LJ III,Genton R,Sobel BE,et al. Quantitative ultrasonic tissue characterization with real-time integrated backscatter imaging in normal human subjects and in patients with dilated cardiomyopathyCirculationYear: 19877651067107310.1161/01.CIR.76.5.10673311450
Milunski MR,Mohr GA,Perez JE,Vered Z,Wear KA,Gessler CJ,et al. Ultrasonic tissue characterization with integrated backscatter. Acute myocardial ischemia, reperfusion, and stunned myocardium in patientsCirculationYear: 198980349150310.1161/01.CIR.80.3.4912766504
Bigras JL,McCrindle BW,Shibuya K,Smallhorn JF,Abnormal Ultrasonic Tissue Characterization of the Myocardium in Children Receiving Doxorubicin for Cancer TherapyEchocardiographyYear: 199815212112610.1111/j.1540-8175.1998.tb00587.x11175020
Yokoyama N,Takeshita S,Kozuma K,Nishimura H,Chikuda I,Terakura M,et al. Early detection of doxorubicin-induced myocardial damage by ultrasound tissue characterization with integrated backscatterCirc JYear: 2003671192993310.1253/circj.67.92914578599
Mimbs JW,O'Donnell M,Miller JG,Sobel BE,Detection of cardiomyopathic changes induced by doxorubicin based on quantitative analysis of ultrasonic backscatterAm J CardiolYear: 19814751056106010.1016/0002-9149(81)90212-57223651
Fayssoil A,[Echocardiography in mouse]Ann Cardiol Angeiol (Paris)Year: 200857317718010.1016/j.ancard.2008.05.00418579116
Teichholz LE,Kreulen T,Herman MV,Gorlin R,Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergyAm J CardiolYear: 197637171110.1016/0002-9149(76)90491-41244736
Herman EH,Ferrans VJ,Preclinical animal models of cardiac protection from anthracycline-induced cardiotoxicitySemin OncolYear: 1998254 Suppl 1015219768819
Ha JW,Kang SM,Pyun WB,Lee JY,Ahn MY,Kang WC,et al. Serial assessment of myocardial properties using cyclic variation of integrated backscatter in an adriamycin-induced cardiomyopathy rat modelYonsei Med JYear: 2005461737710.3349/ymj.2005.46.1.7315744808
Wakasugi S,[Drug-induced myocardial disease--adriamycin cardiotoxicityNippon RinshoYear: 200058120421110885315
Wakasugi S,Fischman AJ,Babich JW,Callahan RJ,Elmaleh DR,Wilkinson R,et al. Myocardial substrate utilization and left ventricular function in adriamycin cardiomyopathyJ Nucl MedYear: 1993349152915358355075
Nagai H,Omi W,Yuasa T,Sakagami S,Takata S,Kobayashi K,Ultrasonic analysis of anthracycline-induced myocardial damage using cyclic variation of integrated backscatterJ Am Soc EchocardiogrYear: 200316880881310.1067/S0894-7317(03)00425-512878989
Hall CS,Scott MJ,Lanza GM,Miller JG,Wickline SA,The extracellular matrix is an important source of ultrasound backscatter from myocardiumJ Acoust Soc AmYear: 2000107161261910.1121/1.42832710641669
Naito J,Masuyama T,Mano T,Kondo H,Yamamoto K,Nagano R,et al. Ultrasonic myocardial tissue characterization in patients with dilated cardiomyopathy: value in noninvasive assessment of myocardial fibrosisAm Heart JYear: 1996131111512110.1016/S0002-8703(96)90059-98553997
Lange A,Moran CM,Palka P,Fenn LN,Sutherland GR,McDicken WN,The variation of integrated backscatter in human hearts in differing ultrasonic transthoracic viewsJ Am Soc EchocardiogrYear: 19958683083810.1016/S0894-7317(05)80007-08611283
Davison G,Hall CS,Miller JG,Scott M,Wickline SA,Ultrasonic tissue characterization of end-stage dilated cardiomyopathyUltrasound Med BiolYear: 199521785386010.1016/0301-5629(95)00036-Q7491741
Goens MB,Karr SS,Seibel N,Martin GR,Ultrasound myocardial tissue characterization by integrated backscatter in children treated with anthracyclinesPediatr CardiolYear: 199920426427010.1007/s00246990046110368451
Ganame J,Claus P,Uyttebroeck A,Renard M,D'hooge J,Bijnens B,et al. Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patientsJ Am Soc EchocardiogrYear: 200720121351135810.1016/j.echo.2007.04.00717604960
Jurcut R,Wildiers H,Ganame J,D'hooge J,De Backer J,Denys H,et al. Strain rate imaging detects early cardiac effects of pegylated liposomal Doxorubicin as adjuvant therapy in elderly patients with breast cancerJ Am Soc EchocardiogrYear: 200821121283128910.1016/j.echo.2008.10.00519041569
Eidem BW,Identification of anthracycline cardiotoxicity: left ventricular ejection fraction is not enoughJ Am Soc EchocardiogrYear: 200821121290129210.1016/j.echo.2008.10.00819041570
Jassal DS,Han SY,Hans C,Sharma A,Fang T,Ahmadie R,et al. Utility of tissue Doppler and strain rate imaging in the early detection of trastuzumab and anthracycline mediated cardiomyopathyJ Am Soc EchocardiogrYear: 200922441842410.1016/j.echo.2009.01.01619269133


[Figure ID: F1]
Figure 1 

Technical aspects of CC-IBS acquisition. Upper left: parasternal view and sample collection of AII (Intensity signal) values of myocardium; lower left: AII curve of signals emanating from tissue; Upper right: sample collection of AII values from a rubber phantom at same depth, maintaining the same equipment adjustments; Lower right: AII curve signals emanating from the rubber phantom.

[Figure ID: F2]
Figure 2 

Hystopathologic analysis of myocardial samples stained with hematoxilin and eosin from control (panel A) and doxorubicin groups (8 mg/Kg- panel B; 12 mg/Kg- panel C and 16 mg/Kg- panel D). Note that vacuolar degeneration, disorganization and loss of myofibrils are more pronounced with the increment of DXR cumulative doses (panel B-D). Arrows mark points of vacuolar degeneration and intracellular edema.

[Figure ID: F3]
Figure 3 

Average values of CC-IBS (panel A), magnitude of IBS cyclic variation- MCV (panel B) and LVEF by Teichholz method (panel C) throughout cumulative DXR dosages in basal and DXR treated animals. Panel D shows collagen percent detected in each DXR cumulative dosages groups. *=p<0.05 between dosages.

[Figure ID: F4]
Figure 4 

Examples of IBS intensity values from rats of different cumulative DXR dosages.

[Figure ID: F5]
Figure 5 

Correlation analysis between collagen content (%) and beta coefficient of: CC-IBS (panel A); magnitude of IBS cyclic variation -MCV (panel B); LVEF using Teichholz formula (panel C) and SF (panel D). r= Spearman correlation coefficient and e p significative <0,05.

[Figure ID: F6]
Figure 6 

Lef ventricle ejection fraction accuracy analysis (Panel A) and CC-IBS (Panel B) to detect a 4.24% myocardial collagen content. ROC= Receive-operating curve; AUC= area under the curve; IC= confident interval.

[TableWrap ID: T1] Table 1 

DXR group data at basal and at DXR cumulative dosages of 8, 10, 12, 14 and 16 mg/Kg expressed in average and standard error values

11.0 ±2.6
9.1 ±2.8
8.4 ±2.3
8.2± 2
7.2 ±1.5
8.8 ±0.6
1.1 ±0.3
1.3± 0.27
1.2 ±0.1
1.4± 0.2
1.3 ±0.2
1.4 ±0.1
LVEF (%)
85.3± 6.9
80.4± 6.9
81.3± 5.6
76.4± 6.6
75.6± 4.8
67.3± 10
SF (%)
45.2 ±6.9
45.3 ±5.4
40.8 ±6.4
39.9 ±4.2
33.4± 7
Col (%)
1.7 ± 0.6
5.6± 1.6
10.6 ±2.5
9.6± 0.7
  (N=6)* (N=8) *   (N=6)*   (N=10)*

N=animal number; MCV= magnitude of cyclic variation of IBS; CC IBS= corrected coefficient of IBS; EF Teic= Left ventricle ejection fraction (Teichholz); SF=left ventricle shortening fraction; Col=collagen percentage.* number of animals submitted to collagen analysis.

Article Categories:
  • Research

Keywords: Doxorubicin, Ultra-sonic tissue characterization, Echocardiography, Rats.

Previous Document:  L-Tyrosine administration increases acetylcholinesterase activity in rats.
Next Document:  Assessment of blinding to treatment allocation in studies of a cannabis-based medicine (Sativex®) i...