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Biomedical subjects

G D Plotnick

Publications and source records attributed to G D Plotnick.

At least 37 records · Page 2Linked to original sources
PubMed1995

Calcification of aortic valve detected incidentally on CT scans: prevalence and clinical significance.

OBJECTIVE: Aortic valve calcification that is visualized on chest radiographs is considered a marker for clinically significant aortic stenosis, but the clinical importance of this finding on CT is unknown. Accordingly, we studied the prevalence and clinical relevance of aortic valve calcification found incidentally on CT scans of the chest. MATERIALS AND METHODS: After comparing computer records of chest CTs and echocardiograms, we identified 109 patients who underwent both studies during a 2-year period. Two thoracic radiologists reviewed the CT scans to identify and quantify aortic valve calcification. The quantity of aortic valve calcification was graded on a scale of 1 to 3, with grade 3 indicating the most severe calcification. The prevalence of calcification was correlated with patient age and sex. The findings on CT were correlated with hemodynamic data from echocardiography. At echocardiography, a peak aortic valve gradient of greater than 25 mm Hg was defined as abnormal. RESULTS: Aortic valve calcification was noted on CT scans in 33 (30%) of the 109 patients. Aortic valve calcification shown by CT was significantly more common in patients more than 65 years old (p < .01). Five (15%) of 33 patients with aortic valve calcification shown by CT had abnormal aortic valve gradients at echocardiography. In contrast, none of 76 patients without aortic valve calcification shown by CT had abnormal aortic valve gradients (p < .01). All five patients with abnormal aortic valve gradients had moderate quantities of aortic valve calcification seen on CT scans. Two of the five were younger than 55 years old. CONCLUSION: Aortic valve calcification is a common finding on CT scans and is usually clinically insignificant. Nevertheless, some patients with aortic valve calcification on CT have aortic stenosis, particularly those younger than 55 years old and those with moderately dense aortic valve calcification shown by CT. These patients may benefit from hemodynamic assessment of the aortic valve by echocardiography.

Adult↗
PubMed1995

Pericardial effusion and tamponade: evaluation, imaging modalities, and management.

Pericardial effusions may be present in a variety of clinical situations, often presenting challenging clinical diagnostic and therapeutic problems. Although several imaging modalities are available, ECHO has become the diagnostic method of choice due to its portability and wide availability. CT and MRI may also be employed and may be more accurate. A pericardial effusion under pressure may result in hemodynamic compromise and tamponade. Although there are several echocardiographic clues to tamponade (including diastolic chamber collapse, Doppler flow velocity paradoxus, and inferior vena cava phlethora), the diagnosis remains a clinical and hemodynamic one. The clinical signs include elevated jugular venous pressure, hypotension, tachycardia, and pulsus paradoxus. Hemodynamic measurements include equalization of diastolic pressures and decreased cardiac output Treatment of tamponade involves drainage of the effusion and prevention of reaccumulation. Needle pericardiocentesis via the subxiphoid approach is a reasonable initial treatment. However, this may need to be accompanied by catheter drainage or surgical pericardial window. A new catheter based technique--percutaneous balloon pericardiotomy-- appears useful in select patients with malignancy in order to avoid more invasive surgical procedures. Occasionally, in patients with recurrent effusions, instillation of sclerosing agents into the pericardial space or even total pericardiectomy may be necessary.

Cardiac Tamponade↗
PubMed1994

Beneficial effects of metoprolol in heart failure associated with coronary artery disease: a randomized trial.

OBJECTIVES: This clinical trial was performed to determine the safety and clinical impact of titrated metoprolol therapy in patients with heart failure, documented coronary artery disease and a low ejection fraction. BACKGROUND: Despite known cardiodepressant effects, long-term use of beta-adrenergic antagonists appears to be beneficial in patients with idiopathic dilated cardiomyopathy. However, this therapy has not been critically evaluated in patients with heart failure and coronary artery disease. METHODS: In 50 patients with heart failure, known coronary artery disease and an ejection fraction < or = 0.40, we examined the impact of metoprolol therapy in a 6-month double-blind, placebo-controlled randomized trial, assessing the frequency of heart failure exacerbations and changes in symptoms (New York Heart Association functional class), ejection fraction and exercise duration. Placebo-treated patients who completed 6-month follow-up studies then underwent a trial with metoprolol therapy (crossover group). RESULTS: Metoprolol was titrated to a mean maximal dose of 87 mg/day (range 25 to 100) without serious adverse reactions. During double-blind therapy, use of a beta-blocker was associated with a significant reduction in the number of hospital admissions (4% vs. 32%, p < 0.05), overall improved functional class (p = 0.02), increased ejection fraction (4 +/- 7% [mean +/- SD] compared with 0 +/- 6%, p < 0.05) and a greater increase in exercise duration (193 +/- 276 vs. 38 +/- 213 s with placebo, p < 0.01). Crossover outcome paralleled the favorable impact seen during randomized metoprolol therapy. CONCLUSIONS: Cautious use of titrated metoprolol appears to be safe and beneficial when added to standard heart failure therapy in patients with dilated cardiomyopathy associated with coronary artery disease.

Coronary Disease↗
PubMed1993

Abnormal Valsalva blood pressure response in dilated cardiomyopathy: association with "pseudonormalization" of echocardiographic Doppler transmitral filling velocity pattern.

In patients with dilated cardiomyopathies, the presence of an abnormal blood pressure response to the Valsalva maneuver has been shown to correlate well with increased left-sided filling pressures. The presence of a "pseudonormalized" early peak to late peak velocity (E/A) ratio on echocardiographic Doppler transmitral filling pattern has also been correlated with increased left ventricular end-diastolic pressures in these patients. Since both abnormal blood pressure response to the Valsalva maneuver and a "pseudonormalized" Doppler transmitral E/A ratio probably represent elevated left ventricular filling pressure, we postulated that there would be a positive correlation between the two in a group of patients with dilated cardiomyopathy and abnormal systolic function. Twenty-five consecutive male patients with New York Heart Association (NYHA) class II to IV heart failure and dilated cardiomyopathy were included. Patients with abnormal blood pressure responses to Valsalva had significantly larger peak early (E) velocities, smaller peak late (A) velocities, and larger E/A ratios compared with patients with normal responses. E/A ratio < 1.0 was present in eight (100%) of the eight patients with a normal blood pressure response to the Valsalva maneuver and E/A ratio > 1.0 was present in 12 (71%) of 17 patients with an abnormal response (p < 0.01). This correlation supports the hypotheses of the physiologic mechanisms of these phenomena and also provides two noninvasive methods of evaluating left-sided filling pressures useful in the diagnosis and treatment of congestive heart failure caused by dilated cardiomyopathy.

Adult↗
PubMed1992

Survey of practicing cardiologists in Maryland on their choice of thrombolytic therapy for acute myocardial infarction.

In November 1990, we surveyed 160 practicing community cardiologists in the state of Maryland and 20 academic cardiologists at the University of Maryland Medical Center to determine each individual's preference for aggressive versus nonaggressive therapy for various presentations of acute myocardial infarction. The survey was repeated in April 1991 following a report of the results of the Third International Study of Infarct Survival. All 100 responding cardiologists chose aggressive therapy to manage an early (less than 2 hours) acute anterior myocardial infarction in a 50-year-old patient. However, less aggressive therapy was chosen by many community cardiologists for management of early inferior acute myocardial infarction or for elderly patients. Most community cardiologists chose tissue plasminogen activator as their thrombolytic drug of choice, whereas university cardiologists favored streptokinase. Although there were substantial shifts in choice of thrombolytic agent on the repeat survey, most community physicians still chose tissue plasminogen activator over the less expensive streptokinase.

Age Factors↗
PubMed1991

Effect of autonomic blockade, postural changes and isometric exercise on Doppler indexes of diastolic left ventricular function.

Previous studies have demonstrated substantial changes in Doppler-derived indexes of left ventricular (LV) diastolic function in response to changes in loading conditions. To assess the influence of autonomic reflexes on these indexes, 2-dimensional and Doppler echophonocardiography were performed in 8 normal male subjects before and during autonomic blockade (0.2 mg/kg of propranolol and 0.04 mg/kg of atropine, intravenously) in the supine, passive upright 80 degree tilt and passive leg-raised positions, and during supine isometric exercise. During autonomic blockade in the supine position, there were significant increases in transmitral peak late filling velocity (A) (mean +/- standard error of the mean +34 +/- 7%) and isovolumic relaxation time (+18 +/- 9%), and significant decreases in transmitral peak early filling velocity (E) (-20 +/- 7%), deceleration time (-35 +/- 7%) and E/A ratio (-40 +/- 5%). E/A ratio decreased from 2.0 +/- 0.1 to 1.2 +/- 0.1 with autonomic blockade. When either upright tilt or isometric handgrip exercise was combined with autonomic blockade, the pattern of diastolic filling became distinctly "abnormal," with E/A ratio decreasing to 0.9 +/- 0.1. The effect of volume loading (increased end-diastolic volume and increased peak E) was seen in the legs-raised position only during autonomic blockade. It is concluded that autonomic blockade substantially alters the Doppler indexes of LV diastolic filling and modifies both hemodynamic response and Doppler indexes produced by positional changes and by isometric exercise.

Adult↗
PubMed1991

Effect of postural changes and isometric exercise on Doppler-derived measurements of diastolic function in normal subjects.

To determine if simple maneuvers that occur in daily life, such as changes in body position and isometric handgrip exercise, affect Doppler-derived measurements of diastolic function, we studied 22 normal male subjects in the supine position at rest and during several postural manipulations and during handgrip exercise. Comparison of values obtained in the 80 degrees upright tilt position with those obtained in the standard supine position revealed significant decreases in early diastolic flow velocity (peak E) (-25 +/- 3 percent; p less than 0.001), late diastolic flow velocity (peak A) (-9 +/- 3 percent; p less than 0.01), and the ratio of early to late flow velocities (E/A ratio) (-17 +/- 4 percent; significant increases in deceleration time (+55 +/- 10 percent; p less than 0.001) and isovolumic relaxation time (+38 +/- 4 percent; p less than 0.001). Comparison of values obtained with supine isometric exercise with those obtained during the preceding supine resting state revealed significant decreases in peak E (-12 +/- 3 percent; p less than 0.001) and the E/A ratio (-21 +/- 4 percent; p less than 0.001) and significant increases in peak A (+15 +/- 4 percent; p less than 0.001) and isovolumic relaxation time (+16 +/- 3 percent; p less than 0.001). The response of Doppler-derived measurements of diastolic function to postural changes and isometric exercise is complex and multifactorial. Interpretation of these measurements must take into account changes in loading conditions.

Adult↗
PubMed1990

Infarcts with a cardiac source of embolism in the NINCDS Stroke Data Bank: historical features.

To gain insight into the historical features relevant to the diagnosis of cardiac embolic strokes, we studied the 1,290 patients with cerebral infarcts in the NINCDS Stroke Data Bank. Based solely on the presence of cardiac sources of embolism, we divided the patients into groups of high (n = 250), medium (n = 166), and low (n = 874) risk of a cardiogenic mechanism for their stroke. There was a highly significant graded relationship between increasing risk of a cardiac source and a history, or presence of, systemic embolism, abrupt onset, and diminished level of consciousness at onset. These clinical features may be useful for assessing the likelihood of a cardiac embolic mechanism in patients with cerebral infarcts.

Cerebral Infarction↗