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Biomedical subjects

J Ferlinz

Publications and source records attributed to J Ferlinz.

At least 37 records · Page 2Linked to original sources
PubMed1985

High-density lipoprotein cholesterol and angiographic coronary artery disease in black patients.

The clinical epidemiology of coronary artery disease (CAD) among black patients has not been well described, particularly in relation to the impact of the major risk factors. Lipoprotein profiles and other risk factors were measured in 114 black patients undergoing cardiac catheterization for probable CAD. Patients (coronary narrowing of 50% or greater; n = 63) were compared to those without significant stenoses (n = 51). Total cholesterol and low-density lipoprotein cholesterol (LDLC) were both significantly associated with the presence of CAD in men and women; however, high-density lipoprotein cholesterol (HDLC) had discriminatory value only for women. The ratio of total cholesterol to HDLC (TC:HDL) separated patients from control subjects in both sexes, most efficiently among women, and was the only lipid variable associated with CAD in the age group over 55 years. Hypertension and angina were frequent in both groups and did not identify those with disease. In summary, LDLC was the best predictor among the lipids for men (likelihood ratio = 9.4) and TC:HDL was the best indicator of disease among women (likelihood ratio = 15.7). Low HDLC levels may, in part, account for the increased incidence of CAD among black women. Further population studies of factors leading to reduced HDLC, namely, obesity and diabetes, are needed.

Adult↗
PubMed1983

Hemodynamic and myocardial performance characteristics after verapamil use in congestive heart failure.

Because of its intrinsic negative inotropic effect, the administration of the recently introduced calcium antagonist, verapamil, is thought to be contraindicated in presence of congestive heart failure (CHF). Yet, as CHF is frequently associated with arrhythmias and angina pectoris, and verapamil possesses potent antiarrhythmic and antianginal properties that could be of great benefit to selected patients with CHF, this study was undertaken to determine whether verapamil can be given to such subjects safely. For this purpose, 14 patients with CHF were studied in the control (preverapamil) state with a combined hemodynamic-cineangiographic approach; the same interventions were repeated during intravenous verapamil administration (0.1 mg/kg bolus, followed by 0.005 mg/kg/min infusion). Verapamil markedly lowered mean aortic pressure (95 +/- 19 to 81 +/- 12 mm Hg, p less than 0.001) and systemic vascular resistance (1,953 +/- 873 to 1,417 +/- 454 dynes s cm-5, p less than 0.01). Simultaneously, indexes of left ventricular (LV) performance substantially improved: the ejection fraction increased from 29 +/- 13 to 37 +/- 17% (p less than 0.01), and mean velocity of circumferential fiber shortening increased from 0.45 +/- 0.18 to 0.64 +/- 0.28 circ/s (p less than 0.001). Cardiac index also increased (from 1.98 +/- 0.49 liters/m2/min before verapamil to 2.24 +/- 0.60 liters/m2/min after verapamil), although this improvement did not become statistically significant. No appreciable changes were noted in the heart rate, LV end-diastolic pressure, or mean pulmonary arterial or pulmonary capillary wedge pressure. Thus, the intrinsic negative inotropic activity of intravenous verapamil in therapeutic doses generally does not represent a serious drawback even in patients with CHF; its potent unloading vasodilatory properties more than compensate for any intrinsic decrease in LV contractility, and can thereby actually improve overall cardiac function.

Aorta↗
PubMed1981

Right ventricular performance in essential hypertension after beta-blockade.

Recent studies indicate that right ventricular performance is impaired even in uncomplicated systemic hypertension. Because of widespread use of beta-blockade in essentially hypertension, it is possible that such treatment often further depresses right ventricular contractility. To test this premise, and to evaluate the changes induced by different beta-adrenoceptor blocking agents on the contractility of right ventricular myocardium, 20 patients with essential hypertension were divided into two groups on a double-blind randomised basis, and maintained on oral oxprenolol or propranolol for five weeks. Cardiac catheterisation and right ventricular cineangiography were performed at the beginning and again at the end of the five week period. Right ventricular end-diastolic volume index did not change significantly in either group. In contrast, right ventricular end-systolic volume index increased, and right ventricular ejection fraction significantly decreased after chronic beta-blockade. Cardiac index decreased in both groups, but these changes were not statistically significant. When the intergroup differences were compared for all measured indices none of the changes between the two groups was statistically significant. Despite its intrinsic sympathomimetic activity, oxprenolol therefore impairs right ventricular performance to an extent nearly equal to that of propranolol. Moreover, right ventricular contractility is clearly diminished after the institution of beta-blockade in hypertensive patients--an effect that has until now been thought to be limited to the left side of the heart. Great caution must therefore be exercised when beta-blockade is initiated in patients with severely abnormal right ventricular function, because frank right ventricular decompensation may result.

Clinical Trials as Topic↗
PubMed1980

Antianginal and myocardial metabolic properties of verapamil in coronary artery disease.

To determine the metabolic cost of administering an experimental calcium antagonist, verapamil, to patients with coronary artery disease, 12 such patients were studied at rest and during stress with atrial pacing before and after intravenous treatment with verapamil (bolus dose of 0.1 mg/kg body weight, followed by infusion at 0.005 mg/kg per min). The mean (+/- standard deviation) aortic pressure at rest (98 +/- 22 mg Hg), coronary sinus blood flow (88 +/- 17 ml/min) and myocardial oxygen consumption (10.7 +/- 2.4 ml O2/min) decreased to 88 +/- 20 mm Hg (p < 0.0004), 77 +/- 14 ml/min (p < 0.03) and 8.8 +/- 2.5 ml O2/min (p < 0.01), respectively, after administration of verapamil. With atrial pacing, these values were 105 +/- 25 mm Hg, 151 +/- 50 ml/min and 18.5 +/- 6.4 ml O2/min, respectively, before infusion of verapamil, and then decreased to 87 +/- 14 mm Hg (p < 0.006), 107 +/- 31 ml/min (p < 0.0002) and 13.3 +/- 4.4 ml O2/min (p < 0.001) during infusion. Angina occurred in all patients with atrial pacing before verapamil (threshold to pain: 93 +/- 67 seconds). After verapamil, the threshold to pain in six patients increased to 191 +/- 183 seconds; and no pain was experienced by the remaining six (p < 0.0005). Before administration of verapamil lactate extraction decreased from 24 +/- 9 to 10 +/- 11 percent (p < 0.0002) during atrial pacing, and 9 (75 percent) of the 12 patients exhibited electrocardiographic S-T segment depressions. After administration of verapamil lactate extraction normalized to 22 +/- 9 percent during atrial pacing, and the electrocardiogram reverted to baseline in all but one patient. These findings indicate that verapamil decreases left ventricular myocardial metabolic demands, and concomitantly greatly increases the threshold to angina.

Angina Pectoris↗
PubMed1980

Antihypertensive and hemodynamic effects of oxprenolol versus propranolol.

Oxprenolol is an experimental beta adrenergic blocker with intrinsic sympathomimetic activity. To compare the effects of long-term administration of oxprenolol on hypertension and hemodynamics with the effects of propranolol, 20 patients with essential hypertension were divided in a double-blind random manner into two 10-patient groups and given placebo for 2 wk, followed by equipotent doses of oxprenolol or propranolol for 5 wk and by placebo for another 2 wk. Right heart cardiac catheterization was performed at the beginning and at the end of the 5-wk beta blockade. Heart rates and blood pressures fell markedly with both agents, although standing heart rate was lowered more by propranolol than by oxprenolol. Plasma renin activity was much lower after beta blockade with either drug. There was no correlation between decreases in blood pressure and renin activity. Although during the stress of repeat cardiac catheterization heart rates remained significantly lower than control, the intra-arterial pressures were not altered significantly by oxprenolol or propranolol, nor was there significant change in pulmonary pressure, vascular resistance, or cardiac output. Thus oxprenolol closely parallels the effects of propranolol in essential hypertension. The negative chronotropic action of both drugs is more marked than their antihypertensive activity.

Adult↗
PubMed1979

Verapamil in atrial fibrillation and atrial flutter.

A double-blind randomized study was performed to compare the efficacy of intravenous verapamil with saline in 28 patients with a rapid ventricular rate and atrial fibrillation or atrial flutter. Conversion of atrial fibrillation to sinus rhythm occurred in none of 14 patients after saline and in 3 of 20 patients (15%) 7 to 160 min after verapamil. The ventricular rate in atrial fibrillation was slowed greater than or equal to 15% in 2 of 14 patients (14%) by saline, in 17 of 20 patients (85%) by 1 dose of verapamil (p less than 0.001), and in 19 of 20 patients (95%) by 1 or 2 doses of verapamil (p less than 0.001). Conversion of atrial flutter to sinus rhythm occurred in none of 4 patients after saline and in 1 of 7 patients (14%) 105 min after verapamil. The ventricular rate in atrial flutter was slowed greater than or equal to 15% in none of 4 patients by saline, in 4 of 7 patients (57%) by 1 dose of verapamil, and in 7 of 7 patients (100%) by 1 or 2 doses of verapamil (p less than 0.001).

Adult↗
PubMed1979

Effects of verapamil on myocardial performance in coronary disease.

Verapamil, a calcium antagonist, has been used extensively for treatment of cardiac arrhythmias. Concern persists, however, that it may seriously depress myocardial function in cardiac patients. To investigate this possibility, 20 patients with coronary artery disease (CAD) but no heart failure were given intravenous verapamil (0.1 mg/kg bolus, followed by 0.005 mg/kg/min infusion), and studied hemodynamically and angiographically. Verapamil markedly lowered mean aortic pressure (94 +/- 17 to 82 +/- 13 mm Hg, p less than 0.0005) and systemic vascular resistance (1413 +/- 429 to 1069 +/- 235 dyn-sec-cm5, p less than 0.0005). Simultaneously, all indices of left ventricular (LV) performance greatly improved: cardiac index rose from 2.8 +/- 0.6 to 3.1 +/- 0.7 1/min/m2 (p less than 0.0005), mean velocity of circumferential fiber shortening increased from 0.85 +/- 0.39 to 0.97 +/- 0.46 circ/sec (p less than 0.01), and ejection fraction improved from 55 +/- 16 to 61 +/- 18% (p less than 0.01). No significant changes were noted in the heart rate before and after verapamil administration, and verapamil did not worsen the extent of LV asynergy in the majority of patients. In patients with CAD, the intrinsic negative inotropic effect of verapamil is of negligible importance because its potent vasodilatory properties more than compensate for any intrinsic decrease in LV contractility, and thereby improve the overall cardiac function.

Angina Pectoris↗
PubMed1978

Effects of rapid digitalization on total and regional myocardial performance in patients with coronary artery disease.

In order to evaluate the effects of rapid digitalization on LV volumes, ejection fraction, and asynergy, 21 patients without heart failure were studied with a combination of hemodynamic and angiographic techniques before and after administration of intravenous ouabain (0.007 mg./Kg.). Seven patients had no CAD and served as normal (control) subjects (Group I), while 14 patients had extensive coronary disease (Group II). All pre-ouabain parameters were within the normal limits in Group I. After ouabain infusion, all indices of LV contractility: dP/dt, VCF, and ejection fraction rose significantly in the normal group, while LV filling pressure and end-diastolic volume remained unchanged. The baseline hemodynamic and volumetric values for Group II patients corresponded closely to their normal (Group I) counterparts, and exhibited similar changes after ouabain administration. Eight patients in Group II also had regional disorders of LV contractility, delineated by 23 abnormal hemiaxes of shortening. After ouabain, 15 out of 23 asynergic segments (65 per cent) improved, seven remained unchanged, and one worsened. It is therefore concluded that rapid digitalization not only enhances LV performance in normal subjects and in patients with CAD, but can also markedly reduce the extent of LV asynergy.

Angiocardiography↗
PubMed1977

Effect of carbon monoxide on exercise performance in chronic obstructive pulmonary disease.

We evaluated the effect of breathing 100 ppm of carbon monoxide versus compressed, purified air for 1 hour on exercise performance in 10 patients with chronic obstructive pulmonary disease in a double-blind, randomized, crossover study. The mean arterial carboxyhemoglobin was 1.48 per cent in the carbon monoxide control period and increased from 1.43 to 4.08 per cent after breathing carbon monoxide (P less than 0.001). The mean arterial carboxyhemoglobin level was 1.52 percent in the air control period and decreased from 1.47 to 1.34 per cent after purified air (P less than 0.001). The mean exercise time until marked dyspnea decreased from 218.5 seconds in the carbon monoxide control period to 146.6 seconds after breathing carbon monoxide (P less than 0.001). The mean exercise time was 219.9 seconds in the air control period and 221.3 seconds after purified air (P not significant). Breathing 100 ppm of carbon monoxide for 1 hour caused a significant reduction in exercise performance in patients with chronic obstructive pulmonary disease.

Aged↗
PubMed1977

Measurements of right ventricular volumes in man from single plane cineangiograms. A comparison to the biplane approach.

An area-length expression for RV volume determination from single plane cineangiograms has been developed and verified against the biplane volumes with the aid of the RV human casts. A close correlation was found to exist between the two methods (r = 0.93). Ten patients with normal hearts were subsequently studied. Biplane and single plane RV cineangiogrpahic analyses yielded virtually identical results. The single plane expression was equally valid in the end-systolic and the end-diastolic volume analysis.

Cardiac Volume↗