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Biomedical subjects

H T Mankin

Publications and source records attributed to H T Mankin.

At least 19 recordsLinked to original sources
PubMed1990

The divergent recovery of ST-segment depression and radionuclide angiographic indicators of myocardial ischemia.

This study evaluated the recovery after exercise of both ST-segment depression on the exercise electrocardiogram (electrical evidence of ischemia) and exercise-induced abnormalities in wall motion or ejection fraction as detected by radionuclide angiography. The study group of 31 patients was selected to undergo prolonged electrocardiographic and radionuclide imaging after exercise because they had persistent ST-segment depression greater than 3 minutes after exercise and radionuclide angiographic evidence of ischemia at peak exercise. In 27 (87%) of the 31 patients, radionuclide evidence of ischemia recovered more quickly than the electrocardiogram. Only 15 of the 31 patients had exercise-induced radionuclide abnormalities after exercise. Compared with the 16 patients without such findings of ischemia after exercise, these 15 patients had a worse wall motion score at peak exercise (5.3 vs 3.9; p less than 0.01) and a smaller increase in systolic blood pressure with exercise (p less than 0.05) and after exercise (p less than 0.01). Radionuclide angiographic evidence of ischemia recovers more quickly after exercise than ST-segment depression. When there is radionuclide evidence of ischemia after exercise, it is associated with more severe ischemia during exercise.

Blood Pressure↗
PubMed1988

Significance of T-wave pseudonormalization during exercise. A radionuclide angiographic study.

In 84 consecutive patients with resting T-wave inversion, radionuclide angiography revealed significant new wall motion abnormalities in 13 (28 percent) of the 47 patients with persistent T-wave inversion and in 23 (62 percent) of the 37 patients with T-wave pseudonormalization during exercise (p less than 0.01). The response of the ejection fraction to exercise was better in patients with persistent T-wave inversion than in those with pseudonormalization (p less than 0.04). Mechanical evidence of ischemia was seen in 14 (61 percent) of the 23 patients with T-wave pseudonormalization but without ST-segment depression. In patients with resting T-wave inversion, pseudonormalization was slightly more sensitive but less specific than a positive exercise test for predicting significant new wall motion abnormalities or decreases in the ejection fraction with exercise. Although pseudonormalization is not extremely useful alone, the presence or absence of this finding can increase the diagnostic accuracy of exercise electrocardiography in patients with resting T-wave inversion and suspected ischemic heart disease.

Coronary Disease↗
PubMed1987

Guidelines for the interpretation of the exercise radionuclide ventriculogram for diagnosing coronary artery disease.

In 622 patients with known coronary artery anatomy, heart rate (HR).blood pressure (BP) product and left ventricular (LV) ejection fraction (EF) at maximal supine exercise measured by radionuclide ventriculography were used to estimate, by logistic regression analysis, the probabilities of absence of significant coronary artery disease (CAD), presence of significant CAD, presence of multivessel CAD and presence of 3-vessel CAD. Thus, for example, estimated probabilities of each of the aforementioned 4 categories of CAD are 0.39, 0.61, 0.32 and 0.12, respectively, for HR.BP product of 26,000 beats.mm Hg/min and LVEF of 0.6 at maximal exercise and 0.08, 0.92, 0.77 and 0.48, respectively, for HR.BP of 15,000 and LVEF of 0.4. The graphic presentations of these estimated probabilities form useful guidelines for interpreting the results of exercise radionuclide ventriculography. In addition, specific cutoff values at maximal exercise defined 2 groups: (HR.BP product greater than or equal to 21,000 beats.mm Hg/min and LVEF greater than or equal to 0.55) with a high (70%) likelihood of absence of significant CAD or 1-vessel CAD and a low (7%) likelihood of 3-vessel CAD, and (HR.BP product less than 21,000 and LVEF less than 0.55) with a high (72%) likelihood of multivessel CAD and a low (8%) likelihood of absence of CAD.

Blood Pressure↗
PubMed1987

Anatomic and functional significance of a hypotensive response during supine exercise radionuclide ventriculography.

The significance of a decline in systolic blood pressure (BP) during supine exercise was examined in 820 patients who underwent both supine exercise gated equilibrium radionuclide ventriculography and coronary angiography. Twenty-seven patients, 3% of the study population, had a decrease in systolic BP at peak exercise of more than 10 mm Hg from the systolic BP at rest. Other indicators of ischemia--angina, ST-segment depression, a decrease in ejection fraction and wall motion abnormality during exercise--were present frequently but not uniformly in these patients. Although most patients had a decline in ejection fraction and a new wall motion abnormality with exercise, 4 patients had an increase in ejection fraction with exercise without any regional wall motion abnormalities. Coronary angiography in the 27 patients with systolic hypotension demonstrated severe coronary artery disease (CAD). Twenty-two patients (81%) had 3-vessel or left main CAD. Twenty of these 22 patients with 3-vessel CAD had at least 2 arteries with 90% or more diameter stenoses. Systolic hypotension during supine exercise radionuclide angiography is infrequent, usually associated with evidence of global and regional left ventricular dysfunction, and a marker of very severe CAD.

Aged↗
PubMed1987

Value of the resting 12 lead electrocardiogram and vectorcardiogram for locating the accessory pathway in patients with the Wolff-Parkinson-White syndrome.

The resting 12 lead electrocardiogram and vectocardiogram were reviewed in 47 patients with the Wolff-Parkinson-White syndrome (a) who had pre-excitation on the resting 12 lead electrocardiogram, (b) who had a single anterograde conducting accessory pathway assessed and located during preoperative electrophysiological study and during epicardial mapping at operation, and (c) in whom surgical division of the accessory pathway resulted in loss of pre-excitation. The site of the accessory pathway established during operation was compared with that established by evaluating the polarity of the delta wave and QRS complex on the resting 12 lead electrocardiogram. The electrocardiogram was assessed by the Rosenbaum criteria (Wolff-Parkinson-White type A, left-sided pathway; or type B, right-sided pathway), the Gallagher criteria (atrial pacing resulting in maximal pre-excitation), and the World Health Organisation criteria (a composite of previous studies). The Gallagher and World Health Organisation criteria were derived from patients demonstrating maximal pre-excitation that often required atrial pacing. The present study was designed to determine whether these criteria could be accurately applied to the resting 12 lead electrocardiogram on which the degree of pre-excitation was variable. The Rosenbaum criteria correctly identified a left sided accessory pathway in 26 of 34 patients and a right-sided accessory pathway in nine of 13 patients. The Gallagher and World Health Organisation criteria correctly identified the location in only 15 (32%) of the 47 patients. The resting vectorcardiogram was inaccurate for locating the accessory pathway. Although published criteria are useful for identifying the site of the accessory pathway from an electrocardiogram obtained when rapid atrial pacing is being used to achieve maximal pre-excitation, they are not suitable for identifying the exact site of an accessory pathway from the resting 12 lead electrocardiogram.

Adolescent↗
PubMed1980

Aortic stenosis and mucopolysaccharidosis.

A 43-year-old man had severe aortic stenosis and Maroteaux-Lamy syndrome (mucopolysaccharidosis, type VI). Aortic-valve replacement gave a good long-term result. Information was obtained indicating that his two brothers had also had mucopolysaccharidosis and aortic stenosis and that both had died of cardiac disease. This paper reviews the literature on cardiac involvement in mucopolysaccharidosis.

Adult↗
PubMed1977

Quality-of-care assessment. II. Outpatient medical care following hospital dismissal after myocardial infarction.

This study was undertaken to compare process and outcome methods of quality assessment of medical care in outpatient office practice. Follow-up care after hospitalization for first acute myocardial infarction was used as the model. One hundred fifty-two patients followed up for a minimum of 2 years comprised the study group. An expert committee of cardiologists and internists in community practice established the process criteria for satisfactory care and predicted outcomes of continuing disability and mortality. Using weighted process criteria and a weighted performance index permitted demonstration of a significant association between process items performed at the first posthospitalization visit and 2-year mortality. A significant association could not be demonstrated between later process of care and outcome at 2 years. The outcome assessment study disclosed that predicted disability and mortality rates compared closely with observed outcomes. However, this method for evaluating the quality of outpatient medical care is weakened because little information is available to provide the basis of prediction of satisfactory outcome rates in complicated cases. Although both the process and outcome methods of quality assessment have short comings, the latter method is recommended because satisfactory outcomes is the essential criterion of quality medical care. Moreover, when process items are not specified outcome assessment maintains the flexibility of individual physician practice. Refinement of satisfactory outcome prediction for common illnesses managed in office practice should be the goal for future studies.

Aftercare↗
PubMed1976

One-year graduated exercise program for men with angina pectoris. Evaluation by physiologic studies and coronary arteriography.

Eight men, 45 to 50 years of age, with mild stable angina pectoris, participated in a graduated exercise program. Coronary arteriography, left ventriculography, left ventricular hemodynamics at rest and during supine leg exercise, treadmill testing with electrocardiographic monitoring, and measurement of oxygen uptake were obtained before and 1 year after the exercise training program. No change was noted in the arteriographic appearance of coronary artery lesions or of collateral circulation. Left ventricular performance, assessed by qualitative left ventriculography and the hemodynamic response of the left ventricle to supine leg exercise, was unchanged after the training program. Oxygen consumption for a given repetitive work load during treadmill exercise decreased. Two patients with a pretraining exercise ECG positive for ischemia reverted to a normal response after the exercise program. All had a decrease in angina, an increase in self-esteem, and a more positive attitude toward their work and their disability.

Angina Pectoris↗