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Biomedical subjects

R Slutsky

Publications and source records attributed to R Slutsky.

At least 19 recordsLinked to original sources
PubMed1984

Terminology and anatomy of angulated coronary arteriography.

Angulated views in coronary arteriography have been increasingly utilized because of their superiority in demonstrating lesions not well seen in standard right and left oblique projections. The importance of these angulated views has been repeatedly demonstrated. It is the purpose of this article to review some basic coronary anatomy angulation terminology, and then to describe the particular advantages of the angulated views in coronary arteriography. Illustrations of these particular views of both coronary systems will be provided.

Angiography↗
PubMed1983

The effect of abstinence on left ventricular performance in asymptomatic chronic alcoholics.

Twelve asymptomatic men who were chronic alcoholics (42.3 +/- 10.7 years, mean age +/- 1 SD) underwent supine bicycle exercise and gated cardiac blood pool imaging 4-7 days after alcohol withdrawal and then again 32-65 days after abstinence (42.2 +/- 15.0 days). Workloads and exercise stages were identical during both exercise studies. Rest and exercise heart rates, blood pressures, cardiac outputs, double products, and systemic vascular resistances were similar in both studies. Ejection fraction (EF) was higher after abstinence at peak exercise (0.68 +/- 0.07 vs. 0.61 +/- 0.08 P less than 0.05); end-systolic volume (ESV) was smaller at rest and at peak exercise after abstinence (P less than 0.05). During the first exercise study, 6 of 12 (50%) subjects did not increase their EF by 0.05 units and 4 of 12 (33%) had no EF increase after abstinence. Even the original "normal" responders had greater rest and exercise EFs after abstinence. In the first exercise study end diastolic volume (EDV) rose during exercise (P less than 0.05) while ESV did not change. After abstinence, EDV did not change during exercise, while ESV declined (P less than 0.05). These results show that latent cardiac dysfunction exists in asymptomatic chronic alcoholics, which is partially although not completely resolved by abstinence of brief periods.

Adult↗
PubMed1983

Radionuclide evaluation of the systolic blood pressure/end-systolic volume relationship: response to pharmacologic agents in patients with coronary artery disease.

To assess the response of the relationship between systolic blood pressure and end-systolic volume to pharmacologic agents with known cardiac effects, we studied 21 patients with known coronary heart disease by means of gated radionuclide angiograms during the infusion of phenylephrine. Each individual was studied during the infusion of phenylephrine twice, once as a control and the second time after the administration of either intravenous dobutamine, topical nitroglycerin ointment, or intravenous propranolol. Eight individuals received 10 micrograms/kg/min of dobutamine, which reduced resting cardiac volumes (p less than 0.01), raised ejection fraction (p less than 0.01), and shifted the slope (1.38 +/- 0.50 to 2.03 +/- 0.69, p less than 0.01) and pressure intercept received 2 inches of nitroglycerin ointment. Nitroglycerin increased ejection fraction (p less than 0.05) and reduced volumes (p less than 0.05) but did not alter either the slope (1.46 +/- 0.68 to 1.49 +/- 0.61, p = NS) or intercept (10.6 +/- 5.4 to 10.1 +/- 6.4 mm Hg, p = NS) of the relationship. Eight patients received 15 mg of intravenous propranolol. Propranolol reduced resting ejection fraction (p less than 0.05), increased volumes (p less than 0.05), and reduced both the slope (1.67 +/- 0.58 to 1.51 +/- 0.53, p less than 0.05) and the intercept (13.8 +/- 2.5 to 7.5 +/- 2.3 mm Hg, p less than 0.05) of the pressure-volume relationship. Thus the systolic blood pressure/end-systolic volume relationship can be assessed from radionuclide angiograms.

Blood Pressure↗
PubMed1983

Mechanism of increase in left ventricular end-diastolic pressure after contrast ventriculography in patients with coronary artery disease.

Elevation in left ventricular (LV) end-diastolic pressure (EDP) after contrast ventriculography (CV) has been proposed as a form of stress intervention in patients with coronary artery disease (CAD). The mechanism of this change has not been delineated. Accordingly, we performed two studies in CAD patients. In study 1 (n = 10), CV was repeated 3 minutes after an initial study. LVEDP rose from 14.9 +/- 6.6 mm Hg prior to the first ventriculogram to 26.9 +/- 10.8 mm Hg 3 minutes after the first ventriculogram (p less than 0.05) and immediately prior to the repeat CV (performed to evaluate the changes in volume produced by the first ventriculogram). In four patients with LV micromanometer pressures, the entire diastolic pressure-volume relation was shifted upward. LV ejection fraction (EF) and end-diastolic volume (EDV), peak LV pressure, and peripheral vascular resistance were unchanged at the time of repeat CV, and there was no correlation between the change in EDP and any of these variables. In study 2 (n = 6), gated radionuclide angiography was performed prior to and at minutes 2 to 7 after CV as were measurements of LV and right ventricular (RV) pressures. While both LV and RV EDP rose following contrast ventriculography, LV and RV EDV and EF were unchanged. We conclude that alterations in LVEDP after CV are unrelated to changes in LV or RV EDV and are most likely mediated by a decrease in myocardial compliance.

Adult↗
PubMed1983

Radionuclide analysis of pulmonary blood volume: the response to spontaneous angina pectoris and sublingual nitroglycerin in patients with coronary artery disease.

By manually assigning pulmonary regions of interest and deriving pulmonary time-activity (volume) curves, we were able to make count estimates of pulmonary blood volume (PBV) from gated cardiac blood pool scans. Five patients with coronary heart disease developed angina spontaneously while under a gamma camera. This produced an increase in cardiac volumes (p less than 0.05), a reduction in left ventricular ejection fraction (p less than 0.01), along with a marked increase in PBV (0.010 +/- 0.003 to 0.015 +/- 0.002 units, p less than 0.05). Nitroglycerin was then administered and reduced PBV in association with a return to normal in cardiac systolic function and size. In patients with stable chronic ischemic heart disease, sublingual nitroglycerin also reduced PBV (p less than 0.05), although not as much as when administered during an anginal episode. We conclude that gated imaging of the chest can be utilized to follow changes in PBV serially. These changes can be utilized to evaluate clinically important changes in hemodynamic status and the response to pharmacologic interventions.

Adult↗
PubMed1982

Left ventricular emptying dynamics in patients with asymmetric septal hypertrophy and concentric hypertrophic cardiomyopathy.

We studied the dynamics of left ventricular (LV) emptying in 8 patients with asymmetric septal hypertrophy (ASH), 6 patients with concentric hypertrophic cardiomyopathy (CHC), and 6 normal controls. Four patients with ASH had resting systolic gradients greater than 20 mmHg, all had significant post premature ventricular contraction (PVC) systolic pressure gradients. LV volume (V) was obtained by frame-by-frame analysis of cineangiograms. End-diastolic volume was similar for all groups; end-systolic volume was significantly less in ASH and CHC patients than in normals. Maximum dV/dt was similar in ASH and CHC, and significantly greater than normals. Total systolic contraction time (SCT), i.e., time from peak volume to last cine frame at minimum volume, was similar for all groups, but the time required to eject 90% of stroke volume (90%T), as a fraction of SCT, was shorter for ASH (0.52 +/- 0.07) and CHC patients (0.51 +/- 0.05) than normals (0.67 +/- 0.07) (p less than 0.05 vs myopathy groups). In the sinus beat following a PVC, however, this ratio decreased significantly in normals and CHC patients, but did not change in ASH patients. We conclude that ASH and CHC have similar exaggerated systolic LV ejection dynamics in the basal state; the failure of ASH patients with post-PVC systolic outflow gradient to reduce 90% T/SCT post PVC may reflect obstruction to LV emptying.

Cardiac Output↗
PubMed1982

A method for measuring mean circumferential fiber shortening rate from gated blood pool scans.

Ejection fraction and ejection rate are easily obtained from gated cardiac images, but no method is available for calculating mean circumferential fiber shortening rate. We assumed that the cube root of left ventricular end-diastolic volume or counts is proportional to the minor axis of the left ventricle at end-diastole or end-systole. Mean circumferential fiber shortening rate is then equal to the [cube root of the end-diastolic volume (count) minus cube root of end-systolic volume (count)] divided by [cube root of end-diastolic volume (count) multiplied by the ejection time]. In 250 contrast ventriculograms, the standard mean circumferential fiber shortening rate (MCFSR) and that derived by the cube root method correlated well (r = 0.94). The mean value of MCFSR (0.85 +/- 0.35) was greater than the cube root value (0.75 +/- 0.35) (P less than 0.001). The regression equation was y = 0.86x + 0.02. Similar correlations were obtained from gated radionuclide images using a semiautomated program (r = 0.93) in 24 subjects or completely automated program (r = 0.85) in 28 patients. The regression equation between MCFSR and that derived from the cube root of counts for the semiautomated program was y = 0.82x + 0.04 and for the automated program was y = 0.84x + 0.004. Similar correlations, slopes, and intercepts were seen using circumferential fractional shortening for angiographic data when correlated with both the semiautomated and automated gated blood pool scan programs. These data indicate that MCFSR and circumferential fractional shortening may be obtained from gated blood pool images using cube root estimates of end-diastolic and end-systolic radii with a high degree of correlation with the standard contrast ventriculographic technique.

Adult↗
PubMed1982

Comparison of single-plane and biplane contrast analyses of right ventricular function and size.

To evaluate the utility of single and biplane right ventricular (RV) contrast angiograms, we evaluated 25 canine RV casts and 31 cineangiograms performed in patients during standard contrast ventriculograms. Both standard single and biplane formulae were utilized. In the 25 canine RVs, absolute volume was determined by water displacement. Both biplane (r = 0.96) and single-plane (r = 0.86) volumes correlated well with cast data. These formulae were then applied to contrast ventriculograms in the 31 patients (30-degree right anterior oblique and 60-degree left anterior oblique projections). The ejection fractions (EFs) calculated from the single-plane technique provided fair correlation with EFs derived from the biplane data (r = 0.81, y = 0.81X + 0.05). Similar correlations were noted when end-diastolic volume results were compared (r - 0.78, y - 0.57X + 56.4). However, while single-plane contrast right ventriculograms correlate with estimates of global RV function and size by biplane methods, considerable scatter of the data may limit its application in individual cases.

Aged↗
PubMed1981

Evaluation of left ventricular function in chronic pulmonary disease by exercise gated equilibrium radionuclide angiography.

To assess left ventricular (LV) response to supine bicycle exercise, we studied 10 normal (group 1). 10 patients with coronary artery disease (CAD) (group 2), 12 patients with severe obstructive lung disease (COPD) (group 3), and eight patients with both CAD and COPD (group 4) by gated equilibrium radionuclide angiography. Most individuals in all groups also had pulmonary catheter-obtained measurements of LV filling pressures during exercise. Normal individuals increased their ejection fraction (EF) during exercise by increasing stroke volume (SV) and reducing end-systolic volume (ESV) without changing end-diastolic volume (EDV); pulmonary artery (PAP) and wedge (PAW) pressures were unaltered. CAD patients (group 2) showed no change in EF with increased EDV, ESV, SV, and PAW. COPD patients (group 3) exhibited decreases in EDV, ESV, and SV, accounting for abnormal EF responses in 6 of 12; PAW was unchanged and the marked elevation of PAP correlated with reduced EDV. Group 4 patients (CAD plus COPD) had abnormal EF responses with increased EDV and ESV without change in SV. Thus an abnormal LV function response to exercise in COPD patients may be multifactorial, thereby indicating the possible need for therapeutic modalities in addition to those employed in alleviating pulmonary parenchymal disease.

Adult↗
PubMed1981

Hemodynamic effects of inhaled terbutaline in congestive heart failure patients without lung disease: beneficial cardiotonic and vasodilator beta-agonist properties evaluated by ventricular catheterization and radionuclide angiography.

To evaluate the hemodynamic effects of the beta-adrenergic receptor agonist, terbutaline sulfate, when given by inhalation in ventricular dysfunction, 0.5 mg of the agent was given by nebulizer to 13 patients with congestive heart failure (nine coronary heart disease and four with idiopathic cardiomyopathy). Data were obtained before and 10 and 30 minutes post inhalation, by right heart catheterization and by gated equilibrium radionuclide ventriculography. All patients responded with increased cardiac output (3.5 to 4.3 L/min, p less than 0.01) and stroke volume (40 to 49 ml, p less than 0.01) without change in heart rate. Decreases occurred in peripheral vascular resistance (1924 to 1443 dsc-5, p less than 0.01), left ventricular filling pressure (21 to 15 mm Hg, p less than 0.01), and systemic arterial oxygen tension (81 to 72 mm Hg, p less than 0.05). both left and right ventricular ejection fractions rose (0.24 to 0.38 and 0.36 to 0.51, both p less than 0.01) with concomitant declines in biventricular end-diastolic volumes. All variables indicated changed rapidly at 10 minutes post inhalation and returned to control levels by 30 minutes after the agent. Thus moderate inhaled doses of terbutaline produce prompt, potent, and transient salutary hemodynamic effects due to its peripheral vasodilator and cardiotonic properties, without untoward arrhythmogenic or anginal provoking influences in the present study.

Cardiac Catheterization↗
PubMed1981

Response of the left ventricle to stress: effects of exercise, atrial pacing, afterload stress and drugs.

A variety of tests are being utilized today to diagnose the presence of ischemic heart disease, assess the prognosis of myocardial and valvular heart disease and evaluate the effects of various pharmacologic agents on cardiac performance. This review summarizes the current evidence regarding the response of left ventricular performance and size to atrial pacing, afterload stress and various forms of exercise. The responses in normal persons and in subjects with coronary heart disease is reviewed and, when applicable, the effects of various pharmacologic agents on exercise performance in these patient groups are examined.

Animals↗
PubMed1981

Left ventricular size and function after subcutaneous administration of terbutaline.

To assess the response of the left ventricle to subcutaneously administered terbutaline sulfate, a proposed beta-2 selective agonist, we evaluated 12 patients who had suffered previous myocardial infarctions using equilibrium radionuclide angiography. Six patients (group 1) had normal global left ventricular ejection fraction at rest less than 0.49). All patients had a marked decline in end-diastolic volume and end-systolic volume with a significant (P less than 0.01) increase in ejection fraction after terbutaline injection. Cardiac output increased 30 percent in group 2 patients because of an increase in stroke volume, with little change in heart rate (plus or minus 3.1 beats per minute, P equals NS). Cardiac output increased 7 percent in the patients in groups 1, due primarily to an increase in heart rate in 7 beats per minute (+9 percent) with little change in stoke volume. Systemic vascular resistance decreased significantly more in the patients with compensated heart failure than the subjects in group 1 (342 plus or minus 84 vs 90 plus or minus 35 dynes-sec cm(-5), P less than 0.05). We conclude that terbutaline exerts its most beneficial effect on the left ventricle in patients with depressed resting global function, and may prove to be a useful agent in the treatment of congestive heart failure.

Aged↗
PubMed1981

A method for the estimation of right ventricular volume by equilibrium radionuclide angiography.

To develop a method for estimating right ventricular volume and to assess right ventricular volume at rest, we studied 45 persons with equilibrium radionuclide angiography. The study group comprised 15 normal control subjects (5 with atypical chest pain and normal coronary angiograms) and 30 patients with coronary heart disease (CHD). Each coronary patient and 5/15 control subjects had both right and left heart catheterization studies with intracardiac pressure measurements within 24 hours of the radionuclide study. Using a previously described method for generating right ventricular volume curves, we used the counts at end-diastole, corrected for frame time, the total number of processed heart beats, and blood radioactivity to derive right ventricular end-diastolic volume units. All normal controls (group 1) had a right ventricular ejection fraction greater than or equal to 0.40, with a right ventricular volume index less than or equal to 5.8. The CHD patients consisted of two subgroups: group 2 (N = 20) and group 3 (N = 10), with right ventricular end-diastolic pressures less than 10 mm Hg and greater than or equal to 10 mm Hg, respectively. In group 2, 19/20 had a normal right ventricular ejection fraction, and 18 had a normal end-diastolic volume. In group 3, 4/10 patients had a depressed ejection fraction (less than .40) and 9/10 an increased end-diastolic volume. We conclude that right ventricular volume can be estimated with radionuclide angiography, and that dilation may precede depression of the right ventricular ejection fraction in some patients with CHD.

Angiography↗