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Biomedical subjects

R Kusukawa

Publications and source records attributed to R Kusukawa.

At least 145 records · Page 8Linked to original sources
PubMed1979

The effect of diltiazem hydrochloride upon sodium diuresis and renal function in chronic congestive heart failure.

d-3-Acetoxy-cis-2,3-dihydro-5-]2-(dimethylamino)ethyl]-2-(p-methoxyphenyl)-1,5-benzothiazepin-4(5H)-one hydrochloride (diltiazem HCl) was orally administered to 9 patients with chronic congestive heart failure (Class IIb to III, NYHA) to examine whether the drug induces sodium retention and aggravates congestive heart failure. Renal hemodynamics and urinary electrolytes excretion were measured for 3 h after the medication in 6 out of 9 patients. Four of the rest of patients had received chronic administration of the drug for about 2 weeks. There was a significant increase in urinary sodium excretion without noticeable change in renal hemodynamics after diltiazem administration, demonstrating the presence of its direct inhibitory action on renal tubules. The increase in urinary sodium excretion was more marked in patients with heart failure than in those without. This difference in the response to diltiazem may be due to the functional constriction of renal cortical vessels in heart failure. This constriction may be related to renin-angiotensin system which diltiazem was reported to antagonize. The chronic administration of the drug did not induce sodium retention and edema. There was no deterioration of symptoms due to congestive heart failure such as dyspnea and body weight increase. It may be concluded that diltiazem does not aggravate congestive heart failure through its diuretic action and probably its systemic vasodilating action.

Adult↗
PubMed1978

Effects of diltiazem hydrochloride on renal hemodynamics and urinary electrolyte excretion.

Dilitazem hydrochrolide, a potent coronary dilator, was administered in 18 patients to evaluate its effect on renal hemodynamics and urinary electrolyte excretion. Renal blood flow (RBF), glomerular filtration rate (GFR), and cardiac output were determined in 8 ambulatory patients by means of external counting of radioisotope dilution before and 3 or 4 weeks after the medication. Althoug RBF tended to increase after the therapy, there was no statistically significant change in RBF, GFR and cardiac output. Renal fraction of cardiac output (RBF/CO) showed a significant increase by 29.5% after the therapy, indicating that the renal vascular resistance decreased to a greater extent than the extrarenal vascular resistance. Standard renal clearance was performed in 10 inpatients whom 60 mg of dilitiazem was administered orally. Renal plasma flow (RPF) showed an average increase by 15% 3 hr after the administration of the drug, which was not, however, statistically significant. There was no certain trend for GFR and filtration fraction. Urinary sodium excretion (UNaV) began to increase one hr and reached its peak 2 hr after the medication in 9 out of the 10 patients. It may be concluded that diltiazem has a direct inhibitory action against the renal tubular reabsortion of sodium, although the participation of renal hemodynamics can not be denied.

Adult↗
PubMed1977

Quantitative analysis of left ventricular ejection phase by means of left ventricular cineangiography.

The left ventricular systolic ejection phase was cineangiographically analyzed in an attempt to evaluate left ventricular performance. Forty-eight patients were classified into five groups: (1) 9 controls; (2) 5 patients with PMD (congestive type) (COCM); (3) 9 patients with PMD hypertrophic type) (HCM), (4) 9 patients with ischemic heart disease (IHD); and (5) 16 patients with mitral stenosis (MS). The rate of volume change (deltaV/deltat) and the volume change as a percentage of stroke volume (deltaV/SV) in patients with COCM and IHD were lower in the early systole and higher in the mid-systole as compared with the control group. Normalized systolic ejection rate (NSER) and velocity of circumferential fiber shortening (Vcf) for the early and late systole were significantly lower in patients with COCM and IHD than in the control group. In two patients with IHD in whom normal indices of left ventricular performance and no asynergy were observed, NSER and Vcf were normal in the late systole but were significantly lower in the early systole. In all 48 patients, deltaV/deltat, deltaV/SV, NSER and Vcf were compared statistically with conventional ejection phase indices and isometric phase indices. delthV/SV for the midstystole showed a negative correlation with EF, MNSER and mVcf. NSER and Vcf for all three phases showed a good correlation with Vmax, max dp/dt and R-max dp/dt but a better correlation with EF, MNSER and mVcf. It was concluded that NSER and Vcf for the early systole were sensitive indices of left ventricular performance and may be utilized to detect subtle depression of left ventricular performance.

Adolescent↗
PubMed1977

Radioisotope angiocardiographic evaluation of left ventricular function in cardiac patients.

Left ventricular volumes were determined by means of ECG-gated RI angiocardiography, which were compared with volumes derived from contrast cineangiocardiography in 25 patients with various heart disease. There was a close correlation of end-diastolic and end-systolic volumes and ejection fraction between RI and contrast angiocardiography, although stroke volume yielded rather scattered values. In 46 of 52 patients with myocardial infarction left ventricular asynergy was demonstrated with our method. Mean velocity of circumferential shortening (mVcf) was exaggerated in patients with apical asynergy. mVcf derived from direct axis measurement yielded a higher value than that from area-length method. Left ventricular volume curve was constructed to obtain normalized systolic ejection rate during initial 100--200 msec after the start of ventricular depolarization. The index was in parallel to ejection fraction in every patient except in moderately severe hypertensive patients. End-diastolic compliance was calculated from Gaasch formula by obtaining pulmonary artery wedge pressure and end-diastolic volume, which was determined by injecting 99mTc pertechnetate into pulmonary artery through Swan-Ganz catheter. This way of access to patient with acute myocard infarction was most useful to evaluate the mechanism of elevated left ventricular end-diastolic pressure.

Aged↗
PubMed1977

Haemodynamic effects of a new anti-anginal drug, diltiazem hydrochloride.

The haemodynamic effects of a new anti-anginal drug, dilitazem HCl, were studied in 20 patients with angina pectoris. The 131I-dilution method was used. In two patients, one with atrial septal defect and the other with pulmonic regurgitation, heart catheterization was carried out. The drug exerted significant decrease in stroke volume, cardiac output, cardiac work, stroke work and cardiac output/circulating blood volume ratio. The patients who underwent direct cardiac catheterization disclosed no changes in Vmax and ejection fraction, but there were decreases in stroke volume. The decrease in cardiac work and stroke work after after diltiazem Hcl therapy was apparently due to diminution of venous return and prolongation of systemic circulation time. It is postulated that such a decrease leads to inhibition of myocardial oxygen consumption, which in turn has beneficial effects on angina pectoris.

Adult↗
PubMed1976

The characteristics of diastolic pressure-volume relationships in primary myocardial disease.

Utilizing the pressure-volume relationship, the indices of left ventricular diastolic compliance, SV/EDP-DP, dV/dP, and dV/VdP, ventricular stiffness index, I/P(dV/dP), and myocardial stiffness index, I/S(dD/dS) were evaluated of seven patients with normal left ventricle, eleven patients with hypertrophic and seven with congestive type of primary myocardial disease. Myocardial stiffness index was obtained from the equation of S = aekD, where S is a wall stress, a; a constant, D; a length of short axis, K; a stiffness constant. The mean values and standard errors of the means of SV/EDP DP, dV/dP, dV/VdP, I/P(dV/dP), and I/S(dD/dS) for normal group are 16.7 +/- 8.7 (ml/mmHg), 16.03 +/- 6.98 (ml/mmHg), 0.1259 +/- 0.0447 (mmHg-1), 0.0059 +/- 0.0032 (ml-1) and 0.603 +/- 0.153 (cm-1), for hypertrophic type are 10.5 +/- 5.5 (ml/mmHg), 7.23 +/- 7.42 (ml/mmHg), 0.0599 +/- 0.0736 (mmHg-1), 0.0174 +/- 0.0097 (ml-1) and 1.3555 +/- 0.3395 (cm-1), and for congestive type are 17.5 +/- 3.4 (ml/mmHg), 3.91 +/- 2.13 (ml/mmHg), 0.0250 +/- 0.0239 (mmHg-1), 0.0308 +/- 0.0126 (ml-1), and 3.287 +/- 1.272 (cm-1). There were highly significant differences between normal and primary myocardial disease in each indices except SV/EDP-DP. I/P(dV/dP), and I/S(dD/dS) had highly significant differences between hypertrophic and congestive type, the latter is stiffer than the former. The compliance index was not sensitive enough to separate two types of primary myocardial disease.

Adult↗
PubMed1975

Comparison of measurements of left ventricle by echography and cineangiography.

A comparison of echocardiography with cineangiocardiography in estimating left ventricular dimensions and volumes was undertaken in 43 patients classified into four groups according to the pathophysiology of the left ventricle. There were high correlations between echographic and angiographic ventricular minor axis dimensions, however, when minor axis dimensions were more than 5.0 cm, there were underestimations of minor axis dimensions by echography. From the mean value of long-to-short axis ratio of the left ventricle at end-diastole and end-systole, the following equations were derived for calculating left ventribular volumes from echo dimensions alone: EDV equals 0.837 Dd-3, ESV equals 0.994 Ds-3. That these equations allowed relatively accurate prediction of volumes over a wide range of ventricular sizes was confirmed by comparison with Pombo's formula and Fortuin's formula for calculating left ventricular volume by echo dimensions alone. A comparison of echographic and cineangiographic ejection fraction (EF), relative changes in shortening of internal diameter (delta S), and the mean velocity of circumferential fiber shortening (mean Vcf) was made i; 33 patients with sinus rhythm. There were significant correlations between EF and mean Vcf by echocardiography, except one discordant patient with aortic insufficiency who showed decreased mean Vcg in the face of normal EF, all these results were confirmed by cineangiography. This discrepancy between EF and mean Vcf was ascribed to the prolonged ejection time which characterizes aortic insufficiency.

Adult↗