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Biomedical subjects

Roxy Senior

Publications and source records attributed to Roxy Senior.

60 records · Page 4Linked to original sources
PubMed1996

Saterinone: A New Dual-Action Drug in the Acute Management of Chronic Heart Failure.

A new dual-action drug called saterinone combines both alpha-1 blocking vasodilatory property and phosphodiesterase III inhibition--mediated inotropism. A placebo-controlled, randomized, double-blind study was performed in 12 patients with severe congestive heart failure. Either 2 &mgr;g center dot kg center dot min(minus sign1) saterinone (n = 8) or placebo (n = 4) was injected intravenously over 3 h at rest. On-line hemodynamic measurement utilizing intra-arterial blood pressure monitoring and two-dimensional (2D) echocardiography were performed at basal time; then 30, 60, 120 and 180 min after infusion. The parameters measured were blood pressure (mmHg), systemic vascular resistance (SVR dynes center dot cm(5) center dot min(minus sign1)), pulmonary artery pressure (PAP mmHg), mean pulmonary capillary wedge pressure (PCWP mmHg) and cardiac index (CI 1 min/m(2)) using right heart catheterization and end-systolic volume (ESV ml) and end-diastolic volumes (EDV ml), ejection fraction (EF%) using 2D echocardiography. Placebo had no significant effects on any of the parameters (p = NS). Saterinone decreased SVR by 37% (p < 0.001), PAPm by 24% (p < 0.05), PCWP by 35% (p < 0.05), ESV by 27% (p < 0.01) and increased CI by 32% (p < 0.05) and EF by 45% (p < 0.05). Saterinone appears to be a potent drug that produces improvements in both cardiac hemodynamics and LV functional parameters. Further study with this interesting agent is indicated.

Journal Article↗
PubMedDate not supplied

Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy.

BACKGROUND: Nitrate-enhanced perfusion imaging has been shown to detect viability in dysfunctional myocardium, but nitrate-enhanced technetium 99m sestamibi has not been compared with nitrate-enhanced thallium 201. METHODS AND RESULTS: Fifty-six patients with ischemic cardiomyopathy and heart failure (New York Heart Association classes II-IV) were scheduled for revascularization. Through use of a matching 12-segment model, nitrate-enhanced Tl-201 and Tc-99m sestamibi uptake at rest was assessed by 2 sets of blinded investigators. All single photon emission computed tomography data sets were read separately. Additional exercise Tc-99m sestamibi single photon emission computed tomography was performed on a separate day. Myocardial viability was thought to be present when the tracer uptake score was less than 3 (normal, 0; absent, 4). Of the 56 patients scheduled to undergo revascularization, only 23 (41%) underwent the procedure and the remainder continued medical therapy. Functional assessment by rest echocardiography was performed at 21 +/- 8 months, and survival was determined at 40 +/- 18 months. The baseline clinical and hemodynamic parameters were similar in the revascularization (n = 23) and medical therapy (n = 33) groups. Perfusion scores with nitrate-enhanced Tl-201 and Tc-99m sestamibi were similar in dysfunctional segments. Stress Tc-99m sestamibi reversible defects predicted significant improvement in left ventricular function compared with those without defects (P <.01) after revascularization. Cox regression model showed that when at least 5 reversible segments were viable, revascularization produced greater improvements in New York Heart Association class, a better trend toward survival (P =.07 for Tl-201 and P =.06 for Tc-99m), and a significantly greater impact on reverse remodeling. CONCLUSIONS: Myocardial viability determined by nitrate-enhanced Tl-201 and myocardial viability determined by Tc-99m sestamibi are equivalent for predicting functional improvements, remodeling, and survival after revascularization in patients with ischemic cardiomyopathy.

Aged↗
PubMedDate not supplied

Rapid assessment of patients with non-ST-segment elevation acute chest pain: troponins, inflammatory markers, or perfusion imaging?

BACKGROUND: Perfusion imaging during or soon after pain has been shown to provide diagnostic and prognostic information in patients with suspected angina. Measurement of troponin I (TnI) and troponin T (TnT) provides similar information but only several hours after onset of pain. The role of inflammatory markers in this setting is less clear. METHODS AND RESULTS: We prospectively studied 80 nonconsecutive patients using gated technetium 99m sestamibi single photon emission computed tomography (MIBI), TnT, TnI, C-reactive protein, IL-6, and tumor necrosis factor alpha. Of these patients, 50 (63%) had abnormal MIBI, 13 (17%) had elevated TnT, 17 (21%) had elevated TnI, and C-reactive protein, IL-6, and tumor necrosis factor alpha were raised in 46 (58%), 14 (18%), and 29 (37%), respectively. Myocardial infarction was the presenting event in 13 patients (16%), and 23 (34%) of those without index myocardial infarction sustained a cardiovascular event during follow-up. MIBI, TnT, TnI, and electrocardiogram all had similar negative predictive values for index myocardial infarction (97%, 97%, 95%, and 97%, respectively). However, only MIBI had a high negative predictive value for the prediction of subsequent events during follow-up (86%). TnT and MIBI were the only independent predictors of all events. Inflammatory markers provided no useful additional prognostic information. CONCLUSIONS: The combination of TnT and MIBI is the best model for early prediction of cardiac events in patients with acute chest pain.

Acute Disease↗
PubMedDate not supplied

Cost-effective strategies to screen for left ventricular systolic dysfunction in the community--a concept.

Early detection of heart failure caused by left ventricular systolic dysfunction (LVSD) is important, since early treatment has been shown to retard the progression of heart failure. While traditional echocardiography remains the standard for the detection of LVSD, electrocardiography and serum brain natriuretic peptide have also been shown to predict LVSD. Recently, hand-held echocardiography systems have been shown to have high predictive accuracy for assessment of LVSD. With the availability of the above bedside and relatively less-costly techniques, compared with traditional echocardiography, the major question now is what is the most cost-effective strategy for screening subjects for LVSD. To date, no studies have systematically addressed this issue, but preliminary data are becoming available. This review article discusses the pros and cons of various investigative strategies and likely cost-effectiveness of each strategy to screen for LVSD.

Community Health Services↗