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Biomedical subjects

S Rubler

Publications and source records attributed to S Rubler.

At least 19 recordsLinked to original sources
PubMed1989

Arm exercise testing with myocardial scintigraphy in asymptomatic patients with peripheral vascular disease.

Arm exercise with myocardial scintigraphy and oxygen consumption determinations was performed by 33 men with peripheral vascular disease, 40 to 74 years of age (group 2). None had evidence of coronary disease. Nineteen age-matched male control subjects (group 1) were also tested to determine the normal endurance and oxygen consumption during arm exercise in their age group and to compare the results with those obtained during a standard treadmill performance. The maximal heart rate, systolic blood pressure, pressure rate product, and oxygen consumption were all significantly lower for arm than for leg exercise. However, there was good correlation between all these parameters for both types of exertion. The maximal heart rate, work load and oxygen consumption were greater for group 1 subjects than in patients with peripheral vascular disease despite similar activity status. None of the group 1 subjects had abnormal arm exercise ECGs, while six members of group 2 had ST segment changes. Thallium-201 scintigraphy performed in the latter group demonstrated perfusion defects in 25 patients. After nine to 29 months of follow-up, three patients who had abnormal tests developed angina and one of them required coronary bypass surgery. Arm exercise with myocardial scintigraphy may be an effective method of detecting occult ischemia in patients with peripheral vascular disease. Those with good exercise tolerance and no electrocardiographic changes or 201T1 defects are probably at lower risk for the development of cardiac complications, while those who develop abnormalities at low exercise levels may be candidates for invasive studies.

Adult↗
PubMed1987

Predictive value of clinical and exercise variables for detection of coronary artery disease in men with diabetes mellitus.

Sixty-eight men with diabetes mellitus (mean age 53 +/- 10 years) and no symptoms of cardiac dysfunction enrolled in a long-range study for detection of latent coronary artery disease. The testing included maximal treadmill stress with thallium-201 scintigraphy and echocardiography. Radionuclide angiography was available in 35 men (52%), and 24 (35%) had gated scanning with exercise. Of the 68 patients, 14 (21%) had a mild (9 patients) or moderate (5 patients) decrease in ejection fraction on radionuclide angiography, echocardiography or both. Fifty-two men agreed to remain in the study and have been followed for 12 to 18 months (mean 41 +/- 19). Ten coronary events have occurred. Four of the men died (2 suddenly) and 6 have angina pectoris. Three patients have had vascular complications. Of the clinical and exercise variables studied, exercise duration effectively predicted an adverse outcome, while the odds ratio in favor of a coronary event increased by 36 times in those with thallium-201 defects and 7 times in those with ST-segment changes on exercise. Radionuclide angiographic responses during exercise were abnormal in 5 of 6 patients with events, but were also abnormal in 12 of 29 men (41%) who did not have coronary artery disease. Clinical variables such as blood pressure, cholesterol level and family history were not predictive of outcome, nor was maximal heart rate during exercise. Thus, diabetic mean who can exercise for 440 seconds on a treadmill using a bruce protocol are at low risk of a coronary event.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1986

Effect of orally administered celiprolol in patients with chronic atrial fibrillation.

The heart rate increase induced by dynamic exercise in patients with chronic atrial fibrillation is competitively attenuated by beta-blockade. The influence of oral celiprolol on exercise induced tachycardia was evaluated in 23 patients with chronic stable atrial fibrillation in a dose-titration study. This was succeeded by a placebo-controlled double-blind, crossover multi-center trial. During the dose-titration phase each patient underwent a single-blind three week dose escalation period-taking celiprolol 200 mg once daily for one week, celiprolol 400 mg once daily for the third week. After a one week placebo washout, patients then entered a double-blind crossover phase, consisting of one week each of placebo or celiprolol according to a pre-determined randomization. After one week of placebo washout, each patient was crossed-over. In 21 patients celiprolol reduces exercise-induced increased heart rate by approximately 35% when compared with placebo. These results indicate that celiprolol should be effective in controlling the exercise-induced increase in heart rate in patients with chronic atrial fibrillation. In addition, results of 24 h ambulatory ECG monitoring (Holtor monitoring) indicate that celiprolol reduces the ventricular premature contractions.

Administration, Oral↗
PubMed1985

Blood pressure and heart rate responses during 24-hour ambulatory monitoring and exercise in men with diabetes mellitus.

The heart rate (HR) variation of 25 normotensive and asymptomatic men, mean age 58 +/- 7 years, with diabetes mellitus (group I) was studied during deep respiration. Thirteen subjects (52%) had a variation of 10 beats/min or less, consistent with an autonomic neuropathy (AN) (group IA); 12 had variation in HR of more than 10 beats/min and were considered to have no neuropathy (group IB). The 24-hour ambulatory HR and systolic blood pressure (BP) values of group I were compared with those of 13 healthy men, mean age 48 +/- 8 years (group II). The mean of 5 maximal HR measurements during the 24-hour period was higher for group IA (106 +/- 11 beats/min) than for group IB (100 +/- 13 beats/min) or for group II (92 +/- 9 beats/min) (p less than 0.01). The mean of 5 maximal BP measurements was greater for group I (149 +/- 28 mm Hg) than for group II (128 +/- 13 mm Hg) (p less than 0.01), but no difference was observed between groups IA and IB. Maximal treadmill exercise was performed with 22 of the patients (11 with and 11 without AN), and no difference in HR was observed between the 2 groups during all stages of exercise or at maximal exertion. The increase in systolic BP and duration of exercise in these 2 groups were also similar. Seventeen of 25 diabetic men had peripheral neuropathy (PN). Of 13 patients with AN, 10 had PN; of 12 without AN, 7 had PN and 5 did not.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

The significance of repeated exercise testing with thallium-201 scanning in asymptomatic diabetic males.

This study was conducted with asymptomatic middle-aged male subjects with diabetes mellitus to detect latent cardiac disease using noninvasive techniques. One group of 38 diabetic males (mean age 50.5 +/- 10.2 years) and a group of 15 normal males (mean age 46.9 +/- 10.0 years) participated in the initial trial; 13 diabetic patients and 7 control subjects were restudied 1-2 years later. Maximal treadmill exercise with a Bruce protocol and myocardial scintigraphy with thallium-201(201Tl) were used. Diabetic subjects on initial examination and retesting achieved a lower maximal heart rate and duration of exercise than control subjects. Abnormal electrocardiographic changes, thallium defects, or both were observed in 23/38 diabetic males (60.5%) on the first study and only one 65-year-old control subject had such findings. On retesting, the control subjects had no abnormalities while 76.9% of diabetic subjects had either 201Tl defects or ECG changes. We conclude that despite the fact that none of diabetic males had any clinical evidence or symptoms of heart disease, this high-risk group demonstrated abnormalities on exercise testing that merit careful subsequent evaluation and followup and could be an effective method of detecting early cardiac disease.

Adult↗
PubMed1985

The role of aortic valve calcium in the detection of aortic stenosis: an echocardiographic study.

One hundred fifty-three men (mean age 67.0 +/- 10.0 years) with basal systolic murmurs and aortic valve calcium on the echocardiogram (group II) were studied to assess the relationship between the grade of calcium and severity of aortic valve obstruction. Patients were subdivided into group IIA (hypertension, no coronary artery disease), group IIB (coronary artery disease, no hypertension), group IIC (hypertension and coronary artery disease) and group IID (neither hypertension nor coronary artery disease). Group I consisted of 21 normal age-matched men (mean age 60.5 +/- 10.9 years). Aortic valve calcium was graded as 1+ (63 patients), 2+ (54 patients), or 3+ (36 patients) according to the degree of involvement. Left ventricular wall thickness was greater in group II than in group I, and close correlation between wall thickness parameters and grade of aortic valve calcium was observed for group IID. Of 31 catheterized patients, none of seven with 1+ aortic calcium and 11 of 14 with 3+ calcium had gradients greater than or equal to 50 mm Hg. With 3+ calcium the valve area was 0.8 +/- 0.4 cm2, and with 1+ calcium it was 2.8 +/- 0.7 cm2 (f = 0.0006). The presence of 3+ calcium or grade 2+ calcium combined with a left ventricular ejection time index greater than 433 msec and a left ventricular mass greater than 300 gm was highly suggestive of severe aortic stenosis and could be used to separate patients to be considered for invasive studies from those with benign aortic valve sclerosis.

Age Factors↗
PubMed1978

Cardiac hypertrophy in response to dynamic conditioning in female athletes.

Ten female field hockey players were studied to determine if prolonged dynamic conditioning results in an increased left ventricular internal dimension at end diastole (LVIDD) and if this increase correlates with maximal oxygen consumption (VO2max). At peak season, echocardiograms were obtained and VO2max determined during maximal treadmill exercise. VO2max, LVIDD index (LVIDD/body surface area (BSA)), and ventricular septal and posterior wall thickness were compared to agematched nonathletic women. Mean LVIDD index was significantly greater in athletes than in controls: 29.3 +/- 0.9 mm/m2 vs. 26.3 +/- 0.6, P less than 0.005. Echocardiographic wall measurements did not differ significantly in the two groups. Mean VO2max for the athletes was significantly greater than controls: 51.7 +/- 4.0 ml O2.kg-1.min-1 vs. 41.2 +/- 2.1, P less than 0.001. VO2max correlated significantly with LVIDD index; r = 0.92, P less than 0.001. Female athletes show an increased LVIDD in response to dynamic conditioning similar to that seen in male athletes. The proficiency of athletic performance as measured by VO2max may be related to the heart's ability to increase LVIDD since there is a high correlation between VO2max and LVIDD index.

Adult↗
PubMed1978

Isovolumic relaxation time in normal subjects and patients with cardiac disease: comparison of determinations made with echocardiographic techniques and apex cardiography.

Isovolumic relaxation time (IVRT) was determined in 17 controls and 41 patients. Nine patients had ischemic heart disease (IHD), 7 mitral prolapse (MVPS), 13 hypertension (HPB), 7 pregnancy (P), and 5 cardiomyopathy (CM). Echocardiographic measurements of IVRT were made from the aortic second sound to the rapid opening of the mitral valve (A2D1). Determinations by apexcardiography were made from the aortic second sound to the 0 point (A2O). The IVRT was distinctly shorter when assessed by A2D1 than by conventional apexdardiography in conventional apexcardiography in controls (69.2 +/- 16.4 msec vs 118.7 +/- 16.5 msec) and in patients with cardiac disease. The IVRT in 9 older normal controls (mean age 47.7 years) was longer than in 8 younger ones (age 26.3 +/- 4.9 years). Patients with myocardial disease (IHD, HBP, and CM) had prolonged IVRTs when compared to normal subjects. Pregnant subjects had shortened intervals. IVRT may be a sensitive indicator of disturbances in myocardial contractility and may be shortened and enhanced contractility.

Adolescent↗
PubMed1977

Diastolic intervals in cardiomyopathy and abnormal thyroid states: alterations in isovolumic relaxation time and rapid filling time of depressed and enhanced myocardial contractility.

Diastolic and systolic time intervals were measured in 11 control subjects, 11 patients with cardiomyopathy, 7 hyperthyroid patients, and 5 hypothyroid patients. The isovolumic relaxation time (IVRT), rapid filling time (RFT), preejection period (PEP), left ventricular ejection time (LVET), and PEP/LVET ratio were found by simultaneously recording the ECG, phonocardiogram, external carotid pulse, and apexcardiogram. In cardiomyopathy the IVRT and RFT were prolonged (107.4 +/- 21.1 msec [P less than 0.01] and 111.0 +/- 10.0 [P less than 0.01] respectively) in comparison to the control subjects. (In the controls the IVRT was 85.7 +/- 18.4 msec and the RFT was 94.5 +/- 12.8 msec). In altered thyroid states the RFT was most affected; in hypothyroidism it increased to 123.9 +/- 25.2 (P less than 0.01) and in hyperthyroidism it decreased to 71.5 +/- 21.3 msec (P less than 0.01). In hyperthyroid patients the IVRT, although shorter than in control subjects, was not significantly altered, but it showed a significant increase after treatment. The RFT also returned toward normal after therapy in both groups (116.7 +/- 14.6 msec in hypothyroid patients and 89.0 +/- 23.1 msec in those with hyperthyroidism).

Adolescent↗
PubMed1976

Comparison of left atrial size and pulmonary capillary pressure with P wave of electrocardiogram.

The amplitude and duration of P waves in Leads II (P II), P terminal force in V1, (PV1) and the sums of P II and PV1 were compared in 37 subjects with left atrial size obtained by echocardiographic technique in 36 instances and with hemodynamic estimates of pulmonary capillary wedge pressures in 16 cases. The 22 females and 15 males were subdivided into the following groups. Group I, four normal subjects, Group II, 11 patients with predominant aortic insufficiency (two of whom had a mild mitral insufficiency); Group III, 14 patients with mitral valve disease, seven of whom had mitral insufficiency (two with minimal aortic insufficiency) Group IIIa) and seven had mitral stenosis (Group IIIb); Group IV, eight patients with miscellaneous disorders, i.e., coronary artery disease (5), hypertension (2), and idiopathic hypertrophic subaortic stenosis (1). Good correlations were obtained between left atrial size and P in Lead II (P II) (r = 0.74; p less than 0.001) and between P terminal force in V1 (PV1) and left atrial size (r = -0.69; p less than 0.001). In Group IV good correlation between PV1 and atrial size was noted. Some correlation between the sum of P II and PV1 and left atrial size (r = 0.51; p less than 0.02) was noted, but a better correlation was obtained in the patients with aortic insufficiency (r = 0.80; p less than 0.01). Pulmonary capillary wedge pressures were not reflected in changes in P II or PV1, except for the group with mitral stenosis (Group IIIb). Adding P II to PV1 improved the correlation with wedge pressure for the entire group.

Adult↗
PubMed1976

Exercise testing in young asymptomatic diabetic patients.

The cardiovascular response to submaximal bicycle exercise was studied in a group of 19 asymptomatic diabetic patients aged 18 to 39, including 11 males and 8 females and 18 control subjects (9 males and 9 females, aged 20 to 34 years). The maximum heart rate achieved by the control subjects (group I), 175.9 +/- 8.9 beats/min, was greater than that achieved by the diabetic patients (group II), 159.4 +/- 17.8 beats/min, (P less than 0.01). The work load at which the maximum heart rate was reached was lower in diabetic males, 681 +/- 155.4 kg m/min, than in healthy males, 866.7 +/- 139.9 kg m/min, (P less than 0.02). Although systolic blood pressure elevations were comparable during exercise and the postexercise period, the increase in diastolic blood pressure during exercise in the diabetic patients was greater than in control subjects (P less than 0.001). This difference, however, was only observed in the males and not in the females. The difference in diastolic blood pressure was again noted between the groups in the postexercise period; that of group II was higher than that of group I (P less than 0.01). This was particularly notable in the older diabetics (aged 31 to 40 years). One patient in group II developed ischemic ST segment changes, and 1 subject in each group was found to have J junction depression of 1.0 mm or more. The implications of these findings are discussed in relation to the possible pathophysiology of the diabetic patients.

Adult↗