Biomedical subjects

T Budde

Publications and source records attributed to T Budde.

At least 37 records · Page 2Linked to original sources

PubMed1995

Angiographic, intravascular ultrasound and functional findings early after orthotopic heart transplantation.

Accelerated graft atherosclerosis is responsible for increased mortality and morbidity among heart transplant recipients. The aim of this in-vivo study was to evaluate coronary atherosclerotic vessel alterations and endothelial function. Seventeen patients (14 males; mean age 49.3 years; range 24 to 69) were studied an average of 11 weeks (range 5 to 21) after heart transplantation because of coronary artery disease (n = 8), dilative cardiomyopathy (n = 7), mitral valve replacement (n = 1) and left atrial metastases of a leiomyosarcoma (n = 1). Mean age of the donor hearts (9 males) was 29 years (range 12 to 55). All recipients underwent biplane ventriculography and coronary angiography. In this study population, a total of 120 coronary segments (main stem, 21; left anterior descending artery, 85; circumflex artery, 14) were analyzed by intravascular ultrasound (20 MHz, 3.5F). In 13 patients, acetylcholine was infused into the proximal left anterior descending artery (10(-8) to 10(-5) M) to evaluate vasomotion within this segment. Regional contraction abnormalities were documented in 2 patients. Nine segments angiographically showed non-critical stenoses (5 patients). Intravascular ultrasound detected 52 cross-sectional areas with a three-layer pattern indicating intimal thickening. Mean circumferential extension of intimal proliferation was 192 degrees, mean intimal thickness 0.35 mm. Only 5 segments of the sonographically pathological cross-sectional areas showed angiographical evidence of atherosclerotic lesions. Intracoronary administration of acetylcholine at doses of 10(-8) and 10(-7) M resulted in vasoconstriction of the examined coronary segment in only 2 patients; the intracoronary application of acetylcholine at doses of 10(-6) and 10(-5) M revealed coronary vasoconstriction in 10 of the total of 13 patients. Using intravascular ultrasound, coronary artery lesions in heart transplant recipients can already be depicted at a very early stage. The abnormal response to acetylcholine in most of the heart recipients is independent of the extent of atherosclerotic vessel abnormalities documented by ultrasound or angiography.

Acetylcholine↗

PubMed1995

A bifurcation analysis of neuronal subthreshold oscillations.

The conditions under which a noninactivating sodium current and either a potassium current or an inwardly rectifying cation current can generate subthreshold oscillations were analyzed using nonlinear dynamical techniques applied to a neuronal model consisting of two differential equations. Mathematical descriptions of the membrane currents were derived using voltage-clamp data collected from entorhinal cortical neurons. A bifurcation analysis was performed using applied current as the control parameter to map the range of magnitudes of the sodium, potassium/cation, and leakage conductances over which subthreshold oscillations exist. The threshold of the potassium/cation current was an important determinant of the robustness of oscillatory behavior. The activation time constant of the potassium/cation current largely determined the frequency range of emergent oscillations. This result implicates the slow inward rectifier or an as yet undescribed slow outward current in entorhinal cortical oscillations; the latter explanation, while more speculative, is more consistent with the pharmacological properties of subthreshold oscillations and gives oscillations over a larger current range. The shallowness of the sodium activation curve confined emergent oscillations to rise gradually rather than abruptly and extended the current range over which the model oscillated.

Animals↗

PubMed1995

Bipolar transvenous defibrillation: efficacy of two different positions of the anode.

For most nonthoracotomy defibrillation lead systems, the transvenous anode can positioned independently of the right ventricular (RV) cathode. Usually a vertical position in the superior vena cava (SVC) is chosen. However, it is unknown if this position yields the optimal defibrillation threshold (DFT). Therefore, in 15 patients undergoing defibrillator implantation the SVC position was compared in a crossover study design with a horizontal position in the left brachiocephalic vein (BCV). Mean DFT was not different for SVC and BCV (19.2 +/- 9.6 J vs 18.5 +/- 9.1 J) but DFT of individual patients differed by up to 12 joules. A positive correlation between impedance and DFT in the BCV position (r = 0.6; P < or = 0.05) indicated that the improved geometry of the defibrillation field with the BCV position is opposed by a higher impedance found for this position (63 +/- 15 omega vs 52 +/- 7 omega). Thus, defibrillation is not improved in general although individual patients might benefit.

Aged↗

PubMed1995

[Interventional therapy of inferior vena cava thrombosis in pregnancy--use of a new kind of temporary vena cava filter].

Several changes occur during pregnancy that cause hypercoagulability such as venous stasis, increased levels of clotting factors, and decreased fibrinolytic activity. Nearly half of all maternal mortality can be attributed to thromboembolic disease. Recurrent embolism from venous thrombosis in pregnancy constitutes a major diagnostic and management problem. Treatment of deep venous thrombosis by anticoagulation alone may not be sufficient to prevent fatal pulmonary embolism. Because pulmonary embolism is a potential preventable and treatable condition, early and accurate diagnosis and treatment are mandatory. Prevention can be obtained by the implantation of clips, umbrellas or vena cava filters. There are only a few reports of the use of permanent inferior vena cava filters in the prevention of pulmonary embolisation in pregnancy mostly using the Greenfield-Filter. We present the indication and efficacy of a new retrievable vena-cava filter (FCP 2002) inserted through the internal jugular veins in pregnancy in two patients, which enables them to continue pregnancy, resulting in a vaginal delivery of healthy infants near term. The safety and effectiveness of this filter-system suggests that the indication for its use might be liberalized to include prophylactic insertion of this device in patients at risk known for thromboembolic disorders.

Adult↗

PubMed1994

Prevention of Ca(2+)-mediated action potentials in GABAergic local circuit neurones of rat thalamus by a transient K+ current.

1. Neurones enzymatically dissociated from the rat dorsal lateral geniculate nucleus (LGN) were identified as GABAergic local circuit interneurones and geniculocortical relay cells, based upon quantitative analysis of soma profiles, immunohistochemical detection of GABA or glutamic acid decarboxylase, and basic electrogenic behaviour. 2. During whole-cell current-clamp recording, isolated LGN neurones generated firing patterns resembling those in intact tissue, with the most striking difference relating to the presence in relay cells of a Ca2+ action potential with a low threshold of activation, capable of triggering fast spikes, and the absence of a regenerative Ca2+ response with a low threshold of activation in local circuit cells. 3. Whole-cell voltage-clamp experiments demonstrated that both classes of LGN neurones possess at least two voltage-dependent membrane currents which operate in a range of membrane potentials negative to the threshold for generation of Na(+)-K(+)-mediated spikes: the T-type Ca2+ current (IT) and an A-type K+ current (IA). Taking into account the differences in membrane surface area, the average size of IT was similar in the two types of neurones, and interneurones possessed a slightly larger A-conductance. 4. In local circuit neurones, the ranges of steady-state inactivation and activation of IT and IA were largely overlapping (VH = 81.1 vs. -82.8 mV), both currents activated at around -70 mV, and they rapidly increased in amplitude with further depolarization. In relay cells, the inactivation curve of IT was negatively shifted along the voltage axis by about 20 mV compared with that of IA (Vh = -86.1 vs. -69.2 mV), and the activation threshold for IT (at -80 mV) was 20 mV more negative than that for IA. In interneurones, the activation range of IT was shifted to values more positive than that in relay cells (Vh = -54.9 vs. -64.5 mV), whereas the activation range of IA was more negative (Vh = -25.2 vs. -14.5 mV). 5. Under whole-cell voltage-clamp conditions that allowed the combined activation of Ca2+ and K+ currents, depolarizing voltage steps from -110 mV evoked inward currents resembling IT in relay cells and small outward currents indicative of IA in local circuit neurones. After blockade of IA with 4-aminopyridine (4-AP), the same pulse protocol produced IT in both types of neurones. Under current clamp, 4-AP unmasked a regenerative membrane depolarization with a low threshold of activation capable of triggering fast spikes in local circuit neurones.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

PubMed1994

Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction.

Patients who suffer from post-infarction depression are a high risk group with an increased mortality risk. The reasons for this are not known although it may be because such patients cannot cope with the chronic condition of cardiac disease. We designed a profile of clinical and behavioural outcome measurements representing recovery after myocardial infarction. 552 male survivors of acute myocardial infarction (29-65 years; mean = 53) were grouped at study entry according to their depression status. 377 patients were reassessed after 6 months and were divided into the following subgroups: 50 (13.3%) patients had severe depression; 85 (22.5%) moderate depression and 242 (64.2%) low degrees of depression in the initial study. There were no substantial differences in baseline characteristics between the index group and the drop-out group. The unadjusted relative risk for follow-up angina pectoris among patients with depression (severe versus low) was 3.12 (95% CI 1.58 to 6.16) and was 5.55 (CI 2.87 to 10.71) for emotional instability. The relative risk for maintenance of smoking habits was 2.63 (CI 1.23 to 5.60) and was for work resumption 0.39 (CI 0.18 to 0.88). There was no association between depression and the occurrence of late potentials. After adjustment for univariate variables (age, social class, recurrent infarction, helplessness) only small and nonsignificant changes in the relative risks were found. However the inverse association of depression and work resumption was lost after adjustment. The investigation revealed that persistent postinfarction depression is an independent and important source of subsequent morbidity and long-acting reduced quality of life. Depression has adverse effects on illness behaviour and pain perception.

Adult↗

PubMed1994

Validation of intravascular ultrasound in arteriosclerotic peripheral vessels.

In this in vitro-study, we validated intravascular ultrasound for the detection of irregular luminal contours, intraarterial structures, intimal thickening in peripheral arteriosclerotic human vessel segments and we compared sonographic criteria to the composition of arteriosclerotic lesions. Sixty-nine post-mortem segments of human peripheral arteries (6 patients) were fixed in formalin, examined with intravascular ultrasound and morphologically evaluated. Specificity, sensitivity, both positive and negative predictive value and accuracy of intravascular ultrasound for the detection of irregular luminal contours, intra-arterial structures and intimal thickening were determined for each of four quadrants. Ultrasonic features (echogeneity, homogeneity, shadowing of echoes) were also compared to the composition of lesions. Intravascular ultrasound detected regular (normal) luminal contours with a high specificity of 96.5%, a sensitivity of 65.0% and an accuracy of 88.4%. Intra-arterial structures were detected with a sensitivity of 88.6%, a specificity of 97.8% and an accuracy of 96.4%. Arteriosclerotic lesions could be localized with a sensitivity of 86.1%, a specificity of 99.1% and an accuracy of 86.9%. Intimal thickening was detectable with a sensitivity of 85.9%, a specificity of 87.8% and an accuracy of 86.2%. Meanwhile, fibrous, atheromatous and combined lesions without calcification did not show shadowing of echoes. The majority of fibrous or atheromatous lesions presented with homogeneous echoes showing hypo-, hyper- and normal density echoes. Using a 20-MHz transducer, homogeneity and echogeneity of echo patterns cannot accurately predict the different components of combined arteriosclerotic lesions.

Aorta, Abdominal↗

PubMed1994

[Significance of intravascular ultrasound in arteriosclerotic calcified intima plaques: in vitro comparison of 20 and 12.5 MHz transducers].

The aim of this in vitro study was to analyze the diagnostic performance of intravascular ultrasound (IVUS) in vessel wall calcifications and to compare the accuracy of mechanical 12.5 and 20 MHz transducers. Fourty-three sections of 10 vessels with signs of arteriosclerotic disease on pathologic examination were examined. Slices 500 microns thick were obtained and examined radiographically at 9 fold magnification. In each section, identical segments were defined, amounting to a total of 344 segments. The IVUS sections were analyzed by 3 experienced readers. For statistical evaluation ROC analysis was performed using magnification radiography as a reference. An area under the curve (AUC) of 0.79 was obtained for the 12.5 transducer and of 0.83 for the 20 MHz transducer. Additionally, sensitivity, specificity, and accuracy were determined. Sensitivity depended on the morphology, size, and density of the calcified lesions. We therefore conclude that the sensitivity of intravascular ultrasound concerning calcified arteriosclerotic plaques is limited and that there is no significant (p < 0.01) difference between mechanical 20 and 12.5 MHz transducers in examining iliac arteries.

Angiography↗

PubMed1994

Clinical significance and management of ventricular arrhythmias in heart failure.

Ventricular arrhythmias are a frequent finding in patients with heart failure, and heart failure is a major underlying condition which is correlated to sudden death. Therefore, both sudden death and death from progression of heart failure strongly overlap. Besides long-term ECG recording, newer diagnostic techniques have been developed. The prognostic significance of the signal-averaged ECG in patients with advanced left ventricular dysfunction in the presence of coronary artery disease has been demonstrated; however, in patients with dilated cardiomyopathy, signal-averaging for detection of late potentials has not yet been clearly established as a useful diagnostic tool. Furthermore, heart period variability has been shown to correlate to overall mortality but not to a specific mechanism. Finally, programmed ventricular stimulation, though useful in patients with left ventricular dysfunction and/or heart failure in the setting of coronary artery disease, is of questionable significance in patients with dilated cardiomyopathy. With increasing degrees of left ventricular dysfunction, the efficacy of antiarrhythmic drugs decreases. On the other hand, with increasing degrees of heart failure, antiarrhythmic drugs demonstrate a greater negative inotropic effect, more frequent proarrhythmic effects, and more frequent bradyarrhythmias. Currently, several ongoing amiodarone trials are assessing different approaches of antiarrhythmic treatment in patients with heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

Transvenous-subcutaneous defibrillation leads: effect of transvenous electrode polarity on defibrillation threshold.

INTRODUCTION: The defibrillation threshold (DFT) of a transvenous-subcutaneous electrode configuration is sometimes unacceptably high. To obtain a DFT with a sufficient safety margin, the defibrillation field can be modified by repositioning the electrodes or more easily by a change of electrode polarity. In a prospective randomized cross-over study, the effect of transvenous electrode polarity on DFT was evaluated. METHODS AND RESULTS: In 21 patients receiving transvenous-subcutaneous defibrillation leads, the DFT was determined intraoperatively for two electrode configurations. Two monophasic defibrillation pulses were delivered in sequential mode between either the right ventricular (RV) electrode as common cathode and the superior vena cava (SVC) and subcutaneous electrodes as anodes (configuration I) or the SVC electrode as common cathode and the RV and subcutaneous electrodes as anodes (configuration II). In each patient, both electrode configurations were used alternately with declining energies (25, 15, 10, 5, 2 J) until failure of defibrillation occurred. The DFT did not differ between both configurations (18.3 +/- 8.2 J vs 18.9 +/- 8.9 J; P = 0.72). Eleven patients had the same DFT with both electrode configurations, 5 patients a lower DFT with the RV electrode as cathode, and 5 patients a lower DFT with the SVC as cathode. Four patients had a sufficiently low DFT (< or = 25 J) with only 1 of the 2 configurations. CONCLUSION: A change of electrode polarity of transvenous-subcutaneous defibrillation electrodes may result in effective defibrillation if the first electrode polarity tested fails to defibrillate. In general, neither the RV electrode nor the SVC electrode is superior if used as a common cathode in combination with a subcutaneous anodal chest patch.

Adult↗

PubMed1994

A prospective randomized cross-over comparison of mono- and biphasic defibrillation using nonthoracotomy lead configurations in humans.

INTRODUCTION: For current implantable defibrillators, the nonthoracotomy approach to implantation fails in a substantial number of patients. In a prospective randomized cross-over study the defibrillation efficacy of a standard monophasic and a new biphasic waveform was compared for different lead configurations. METHODS AND RESULTS: Intraoperatively, in 79 patients receiving nonthoracotomy defibrillation leads, the defibrillation threshold was determined in the initial lead configuration for the mono- and biphasic waveform. In each patient, both waveforms were used alternately with declining energies (20, 15, 10, 5 J) until failure of defibrillation occurred. Three different initial lead configurations were tested in different, consecutive, nonrandomized patients using a bipolar endocardial defibrillation lead alone (A; n = 36) or in combination with a subcutaneous defibrillation patch (B; n = 24) or array (C; n = 19) lead. The lowest successful defibrillation energy with the biphasic waveform was less than, equal to, or higher than with the monophasic waveform in 64%, 28%, and 8% of patients, respectively, and on average significantly lower with the biphasic waveform for all three lead configurations (A: 11.3 +/- 4.4 J vs 14.5 +/- 4.5 J; B: 9.7 +/- 4.7 J vs 15.1 +/- 4.5 J; C: 7.9 +/- 4.5 J vs 12.4 +/- 4.9 J). Defibrillation efficacy at 20 J was significantly improved by the biphasic waveform (91% vs 76%). CONCLUSION: In combination with nonthoracotomy defibrillation leads, the biphasic waveform of a new implantable cardioverter defibrillator showed superior defibrillation efficacy in comparison to the standard monophasic waveform. Defibrillation thresholds were improved for lead systems with and without a subcutaneous patch or array lead.

Adult↗

PubMed1994

Hyperpolarization-activated Na(+)-K+ current (Ih) in neocortical neurons is blocked by external proteolysis and internal TEA.

1. After 1 day in culture, neurons derived from the neonatal cerebral cortex of the rat exhibited a slowly activating current gated by hyperpolarizing voltage clamp pulses. The current was blocked by extracellular Cs+ and unaffected by extracellular Ba2+, and was permeable to both Na+ and K+ (PNa/PK = 0.29). Its form and pharmacology are consistent with a current termed Ih in other preparations. 2. Ih was absent from cells acutely dissociated from both the neonatal and mature cerebral cortex, despite the use of low enzyme concentrations. The sensitivity of Ih to extracellular proteolysis was demonstrated by superfusing the cells with trypsin (1 mg/ml) while monitoring the presence of Ih in the whole cell mode of recording. Ih was rapidly abolished (t1/2 approximately 5 min at 22 degrees C) by proteolysis and exhibited no shifts in its range of activation or changes in its activation kinetics during the course of the digestion. 3. Intracellular tetraethylammonium (TEA), at a concentration of < 15 mM was shown to block Ih completely, while extracellular TEA had no effect on the current. This suggests that the inner vestibule of Ih may be structurally related to that of potassium channels.

Animals↗

PubMed1994

Plasma Lp(a) levels correlate with number, severity, and length-extension of coronary lesions in male patients undergoing coronary arteriography for clinically suspected coronary atherosclerosis.

The relation between lipoprotein(a) [Lp(a)] as an independent risk factor for coronary atherosclerosis and the severity and extension of angiographically detectable coronary atherosclerotic lesions has not been systematically evaluated. In 118 male patients (54.3 +/- 7.4 years) with suspected coronary artery disease and without a history of myocardial infarction undergoing coronary angiography, the relation between plasma Lp(a) levels and other lipoproteins and the severity and extension of coronary lesions was studied. The coronary angiograms were evaluated in a blinded manner according to three scores: vessel score (0 to 3 points for 0 to 3 vessels with stenoses > or = 70%), stenosis score (0 to 32 points; number and severity of coronary stenoses or lesions), and extent score (0 to 100 points; length-extension of all coronary lesions in relation to the total coronary vessel length). The score values obtained were analyzed for correlations with age and levels of total cholesterol (6.08 +/- 1.26 mmol/L; mean +/- SD), high-density lipoprotein cholesterol (1.04 +/- 0.33 mmol/L), low-density lipoprotein cholesterol (4.18 +/- 1.15 mmol/L), triglycerides (1.88 +/- 1.37 mmol/L), and Lp(a) in plasma (19.5 +/- 22.6 mg/dL). Bivariate correlation analysis resulted in positive correlations between Lp(a) and vessel score (P < .01), stenosis score (P < .01), and extent score (P < .05). With multivariate analyses, besides Lp(a) plasma level (nl), only patient age showed a significant correlation to all three scores used, whereas none of the lipid parameters correlated significantly with all three scores.

Adult↗

PubMed1994

[Allograft vasculopathy in the early phase of orthotopic heart transplantation: angiography, intravascular ultrasound and functional in vivo findings].

Accelerated graft coronary atherosclerosis disease is the main reason for long-term mortality and morbidity of heart transplant recipients. The aim of this in vivo study was to evaluate coronary atherosclerotic vessel abnormalities and endothelial function using angiography, intravascular ultrasound, and intracoronary acetylcholine infusion. Fourteen patients (11 male, 3 female; mean age 49.3 years) were examined early after heart transplantation (mean interval after transplantation: 11 weeks) because of coronary artery disease (n = 8), idiopathic dilatative cardiomyopathy (n = 7), mitral valve replacement (n: 1) or left atrial filiae of a leiomyosarcoma (n = 1). Mean age of the donor hearts (female n = 8) was 29 years; 3 patients received double- and 14 patients triple-immunosuppression. All patients underwent biplane ventriculography and coronary angiography; a total of 120 coronary segments (main stem 21, left anterior descending artery 85, circumflex artery 14) was examined by intravascular ultrasound (20 MHz, 3.5 F catheters). In 13 patients, acetylcholine was infused into the proximal left anterior descending artery (0.15 microgram/min to 150.0 micrograms/min) to evaluate vasomotion within this segment. Ventriculography demonstrated regional wall abnormalities in 2 patients, angiography revealed 9 noncritical stenotic segments in 5 patients. Intravascular ultrasound detected 52 cross-sectional areas with a three-layer appearance indicating intimal thickening. Mean circumferential expansion of intimal proliferation was 192 degrees and mean intimal thickness was 0.35 mm. Only 5 segments of the sonographically pathological cross-sectional areas showed angiographic evidence of atherosclerotic lesions. After intracoronary infusion at a lower dose (0.15 and 1.5 micrograms/min) of acetylcholine, vasoconstriction was observed in 2 patients, at a dose of 15.0 and 150.0 micrograms/min in 10 patients. This response to acetylcholine did not depend on the intravascular or angiographical extent of atherosclerotic vessel abnormalities. In heart transplant recipients, coronary artery abnormalities can already be depicted at an early stage using intravascular ultrasound. The majority of patients show coronary vasoconstriction following infusion of acetylcholine at a higher dose. Further investigation is necessary to clarify whether the depicted vessel wall abnormalities can already be interpreted as newly developed graft atherosclerosis and whether abnormal vasomotion after acetylcholine is indicative of endothelial dysfunction.

Acetylcholine↗

PubMed1993

[Intravascular ultrasound in peripheral calcified vascular lesions: comparison with direct magnification radiography].

Intravascular ultrasound can detect calcified peripheral arteriosclerotic lesions by hyperdense echo patterns and shadowing of subintimal layers. Nevertheless, 20 MHz ultrasound systems have not been validated for the detection of peripheral calcifications; besides, it is unknown whether the depiction of calcified lesions by intravascular ultrasound depends on the morphology of the calcification. Histological evaluation of severely calcified arteries is difficult because the preparation of those specimens often causes artefacts, e.g., fracture of calcified structures. Direct magnification radiography, currently used in forensic medicine or skeleton examination, is based on a minimized focus and enables the edge-enhanced views of calcifications with high discrimination. In this in-vitro-study direct radiological magnification was used to validate intravascular ultrasound. Forty-nine segments of human peripheral arteries were fixed in formalin, examined with intravascular ultrasound and, as a reference, radiographically magnified using a newly developed microfocus x-ray tube. Sensitivity, specificity, positive and negative predictive value, and accuracy of intravascular ultrasound for the detection of calcified wall areas were determined and compared to the appearance (configuration, circumferential and areal expansion, density, number of fragments) of these calcifications. Thicknesses of 110 single calcified structures were estimated on sonograms and radiograms. The overall sensitivity of the 20 MHz intravascular ultrasound system for the detection of calcification in 913 sectors was 70%, specificity 53%, positive predictive value 66%, negative value 58% and accuracy 62%. The depiction of calcified regions by direct magnification radiography showed that the sensitivity strongly depended on the density of the calcification. Sensitivity was 81% with calcified lesions of high density, but only 51% with lesions of low density.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗

PubMed1993

201Tl reinjection predicts improvement of left ventricular function following revascularization.

The aim of this study was to evaluate the correlation between improved Tl uptake in reinjection imaging with improvements in regional wall motion and global ejection fraction following PTCA or aorto-coronary bypass surgery. 19 patients with CHD were investigated and divided into two groups according to their thallium uptake in the reinjection studies. Group I showed additional uptake on reinjection imaging compared to the redistribution image, whereas group II showed no additional uptake. Both groups had a similar number and distribution of affected vessels and location of the leading stenosis. Stress, redistribution and reinjection images were obtained prior to revascularization and evaluated semiquantitatively from a bulls eye scheme. There was a postoperative increase in regional wall motion in group 1 from 5.3 to 8.8% whereas group II did not show a relevant change (6.3 vs 6.0%). The ejection fraction increased II from 55.0 to 66.7% in group I and dit not increase in group II (59.8 vs 58.7%). The overall predictive value of the reinjection image for improvement in wall motion (> 10%) was 91% and for the redistribution image 58%. Increased uptake in reinjection imaging predicts improved ventricular function following revascularization and indeed indicates viable myocardium with reversible functional impairment.

Aged↗

PubMed1992

Factors which provoke post-infarction depression: results from the post-infarction late potential study (PILP).

Symptoms of depression in the majority of patients immediately following acute myocardial infarctions (AMI) resolve rapidly; they are an adjustment reaction. However, in a group of 552 male patients there were 80 (14.5%) patients with persistent major depressive symptoms during a finite period after AMI. Infarction size was assessed by maximum creatine kinase levels, the QRS-complex and the occurrence of late potentials. These measures did not correlate with the degree of depressed moods in these groups. An arrhythmic event in the early hospitalization phase, a recurrent infarction, dyspnoea, and persistent angina pectoris before the AMI were significantly related to more profound degrees of depression. Patients who reported serious life-events in the last 2 yr before AMI, or who suffered from exhaustion and fatigue in the prehospital phase were subject to significantly higher levels of depression. A prodromal phase prior to hospitalization free of bodily symptoms and the use of denial were related to low levels of depression. The logistic regression model incorporating all univariate significant variables revealed that symptoms of exhaustion and fatigue prior to AMI had the strongest independent correlation with post AMI depression.

Activities of Daily Living↗

PubMed1991

Measurement of Ca2(+)-release-dependent inward current reveals two distinct components of Ca2+ release from sarcoplasmic reticulum in guinea-pig atrial myocytes.

Ca2+ current (L-type) and inward current caused by Ca2+ release from the sarcoplasmic reticulum and carried by electrogenic Na+/Ca2+ exchange have been measured in cultured atrial myocytes from hearts of adult guinea-pigs using whole-cell voltage clamp techniques. The pipette solution, used for internal dialysis of the cells, contained a high concentration, 60 mM or 25 mM, of citrate as a non-saturable low-affinity Ca2(+)-chelating compound. It has been shown previously that Ca2(+)-release-dependent inward current under these conditions is carried by electrogenic Na+/Ca2+ exchange. Furthermore, Ca2(+)-release-dependent inward current (the release signal) can be completely separated from triggering Ca2+ current if brief depolarizations for activating ICa are used. In the majority of cells that did not produce spontaneous Ca2+ release, conditions could be found that caused the release signal to be split into two components: an early component of variable amplitude and a late component of rather constant amplitude. The delay of the late component with regard to triggering ICa was inversely related to the amplitude of the first one. Below a certain amplitude of the first component, the second one failed to be elicited. This suggests the second component to be triggered by the first one. Weakly Ca2(+)-buffered cells produced spontaneous Ca2+ release, resulting in irregular "transient inward currents" at constant membrane-holding potential. Synchronization by trains of step depolarizations unmasked two components also in the spontaneous release signals. In none of the cells studied was any indication of more than two components of the release signal detected. The results are discussed in terms of two distinct compartments of sarcoplasmic reticulum with different properties of Ca2+ release.

Animals↗