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Cognitive activation during PET: a case study of monozygotic twins discordant for closed head injury.

Using positron emission tomography (PET), we studied physiological changes in a patient with frontal lobe damage resulting from closed head injury by assessing his regional cerebral blood flow (rCBF) pattern relative to that of his uninjured monozygotic (MZ) cotwin and against normal variability between cotwins in 10 comparably-aged, uninjured MZ twin pairs. rCBF was measured during the Wisconsin Card Sorting Test (WCST) and a sensorimotor control task. Differences between the index twins in rCBF activation (WCST-control) in regions determined on coplanar MRIs were compared to within-pair differences in the control group using the Z-statistic. Activation differences between the index twins extending beyond normal variability were found in two regions-relative to his uninjured cotwin, the injured twin showed less activation in the inferior portion of the left inferior frontal gyrus while showing greater activation in the left hippocampus (P < 0.04). This pattern contrasts with that of normal subjects during WCST performance of augmented rCBF in the prefrontal cortex and not in the hippocampus. These rCBF differences appear to reflect the utilization of different neural systems when performing a frontal-lobe task. The use of the hippocampus by the injured twin might reflect an attempt to compensate for compromised frontal lobe functioning.

Adolescent↗

The atrio-ventricular node artery in the human heart.

The atrioventricular node artery is a major contributor to the arterial supply of the atrioventricular conducting pathway and is an important vessel in the pathogenesis of heart block. The terminal ramifications of this artery were studied in detail by serial sectioning techniques in 50 human infant hearts. The artery provided branches to the posterior interventricular septum in all hearts (100%) and to the interatrial septum in 22 hearts (44%). The vessel supplied the atrioventricular node in 45 hearts (90%) but it terminated before reaching the node in five (10%). It supplied the penetrating bundle in 32 hearts (64%). Alternative sources of arterial supply to the atrioventricular conducting pathway include: the first septal branch of the left anterior descending coronary artery; the descending septal artery; and anterior atrial branches. Although the arterial supply to this region of the heart is variable, it is possible to make hypothetical predictions of conducting tissue involvement in myocardial infarction of various types.

Arteries↗

Complete occlusion of the main left coronary artery. A clinical study.

Between 1975 and 1985, 12 patients with complete occlusion of the main left coronary artery (MLCA) were seen. The historical, clinical, biochemical, radiological, electrocardiographic, angiographical, surgical and follow-up findings were analyzed. Eight of the 12 patients presented on admission an unstable clinical situation. A normal ECG at rest was found in only 3 patients. Exercise testing elicited definite electrocardiographic changes in 5 of 6 cases. Coronary atherosclerosis was the cause of occlusion in 11 patients; in 1 patient the underlying disease process remained unclear. Significant lesions of the right coronary artery (RCA) were found in 9 and of the left anterior descending (LAD) or circonflex (CFLX) artery in 6 patients. Global and/or regional left ventricular dysfunction at rest was present in 10 patients. Angiographically visible collateral circulation was found in all patients but its extent was variable. All patients underwent bypass surgery. There were 1 operative and 2 late deaths.

Adult↗

Systolic time intervals and other cardiovascular changes following leg elevation.

Cardiovascular responses were noninvasively monitored as the legs of 16 supine human subjects were passively elevated to increase return of blood to the heart. Forearm vasodilation occurred promptly as previously observed by Roddie and Shepard (7). Arterial pressure and heart rate were unchanged. Ventricular performance, monitored by systolic-time-interval analysis, was enhanced after a delay of approximately 6 s, an effect which lasted throughout the 40-s leg-elevation period. All affected variables returned to control levels after the legs were lowered. This delayed response could result reflexly from stimulation of receptors in the left atrial region causing an increase in sympathetically mediated contractility or directly from the Frank-Starling mechanism in response to increased left ventricular filling.

Adult↗

Attenuation of dysfunction in the postischemic 'stunned' myocardium by dimethylthiourea.

The mechanism for the prolonged contractile dysfunction observed in myocardium reperfused after reversible regional ischemia ("stunned" myocardium) is unclear. Recent studies suggest that myocardial stunning may be mediated by oxygen-derived free radicals, but the precise molecular species involved remain unknown. Thus we explored the role of the highly cytotoxic hydroxyl radical in regional postischemic dysfunction by using dimethylthiourea (DMTU), an effective and highly permeable hydroxyl radical scavenger. Open-chest dogs undergoing a 15 min occlusion of the left anterior descending coronary artery followed by 4 hr of reperfusion received either DMTU (0.5 g/kg iv over 45 min starting 30 min before occlusion, n = 14) or saline (n = 15). Control and treated dogs were comparable with respect to variables that may affect postischemic dysfunction, including heart rate, aortic pressure, left atrial pressure, arterial blood gases and hemoglobin concentration, size of the occluded bed (determined by postmortem perfusion), and collateral blood flow (determined by radioactive microspheres). Regional myocardial function was assessed by measuring wall thickening with an epicardial Doppler probe. The two groups exhibited comparable systolic thickening under baseline conditions and similar degrees of dyskinesis during ischemia. After reperfusion, however, wall thickening (expressed as percent of baseline) was considerably greater in treated as compared with control dogs: 53 +/- 9% (mean +/- SEM) vs 9 +/- 14% (p less than .03) at 1 hr, 55 +/- 9% vs 23 +/- 13% (p less than .05) at 2 hr, 60 +/- 9% vs 28 +/- 14% (p less than .05) at 3 hr, and 67 +/- 5% vs 36 +/- 13% (p less than .05) at 4 hr. Thus DMTU produced a significant and sustained improvement in recovery of contractile function. In concentrations greater than the plasma levels attained in vivo, DMTU did not scavenge either hydrogen peroxide or superoxide anion in vitro. These results suggest that the myocardial dysfunction occurring after a brief episode of regional ischemia is mediated in part by the hydroxyl radical.

Animals↗

Interindividual variability in the hemispheric organization for speech.

A PET activation study was designed to investigate hemispheric specialization during speech comprehension and production in right- and left-handed subjects. Normalized regional cerebral blood flow (NrCBF) was repeatedly monitored while subjects either listened to factual stories (Story) or covertly generated verbs semantically related to heard nouns (Gener), using silent resting (Rest) as a common control condition. NrCBF variations in each task, as compared to Rest, as well as functional asymmetry indices (FAI = right minus left NrCBF variations), were computed in anatomical regions of interest (AROIs) defined on the single-subject MNI template. FAIs were predominantly leftward in all regions during both tasks, although larger FAIs were observed during Gener. Subjects were declared "typical" for language hemispheric specialization based on the presence of significant leftward asymmetries (FAI < 0) in the pars triangularis and opercularis of the inferior frontal gyrus during Gener, and in the middle and inferior temporal AROIs during Story. Six subjects (including five LH) showed an atypical language representation. Among them, one presented a right hemisphere specialization during both tasks, another a shift in hemispheric specialization from production to comprehension (left during Gener, right during Story). The group of 14 typical subjects showed significant positive correlation between homologous left and right AROIs NrCBF variations in temporal areas during Story, and in temporal and inferior frontal areas during Gener, almost all regions presenting a leftward FAI. Such correlations were also present in deactivated areas with strong leftward asymmetry (supramarginalis gyrus, inferior parietal region). These results suggest that entry into a language task translates into a hemispheric reconfiguration of lateral cortical areas with global NrCBF increase in the dominant hemisphere and decrease in the minor hemisphere. This can be considered as the setting up of a "language mode", under the control of a mechanism that operates at a perisylvian level. On top of this global organization, regional variations carry on the performance of the cognitive operations specific to the language task to be performed. Hemispheric relationships could be different in atypical subjects, with either between task hemispheric regulation differences or differences in regional specialization.

Adult↗

Heterogeneities in regional volumes of distribution and flows in rabbit heart.

The heterogeneity of volumes of distribution in the heart influences the rates of uptake and washout of substrates and metabolites; thus it is important to evaluate their variability in the normal heart. Several tracers were injected intravenously into anesthetized adult closed-chest rabbits, and time was allowed for equilibration in the heart. Tracer microspheres were injected into the left ventricular cavity at the apex for the measurement of regional flows, the chest was opened, another set of microspheres was injected, and the heart was frozen rapidly in situ with liquid nitrogen-cooled Freon-22. Each heart was divided into 72 pieces of less than 0.1 g weight, and the tracer content of each was determined by multichannel gamma-counting and the water content by desiccation. The regional myocardial flows were (closed chest) 0.62 +/- 0.16 ml.g-1.min-1 and (open chest) 0.63 +/- 0.37 ml.g-1.min-1. The volumes of distribution (ml/g) for the 432 pieces for six rabbits, given as mean +/- SD (% coefficient of variation), were as follows: for plasma, VP = 0.11 +/- 0.03 (26%); erythrocytes, VRBC = 0.041 +/- 0.015 (37%); vascular space, VV = 0.15 +/- 0.04 (26%); extracellular space, VECF = 0.33 +/- 0.05 (15%); interstitial space, VISF = 0.21 +/- 0.03 (15%); and water space, VW -0.79 +/- 0.022 (2.8%). Regional hematocrits were 77% +/- 9% of the large-vessel hematocrits.

Animals↗

Reliability of medial temporal lobe volume measurements using reformatted 3D images.

The study assessed whether standardizing the angle of image display and controlling for head position in three planes affects the scan-rescan reliability of medial temporal lobe volume measures when very thin (1.5 mm) slices are used. Five volunteers were scanned two times on consecutive days. A three-dimensional MRI sequence acquired whole brain data in 1.4 mm thick coronal slices. The data were displayed as 1.5 mm thick images and were rated both in the originally acquired coronal plane, and after reformatting to correct for head tilt and display the brain in the coronal plane perpendicular to the long axis of the left anterior hippocampus. One rater measured five brain regions (temporal lobe, anterior and posterior hippocampus, amygdala, and temporal horn) on the left and right sides of the two non-reformatted and two reformatted scans to obtain inter-scan variance. Furthermore, most scans were remeasured, to obtain 'reread' variances. All data were log-transformed in order to produce comparable variability across brain regions of different sizes. For all the regions, except the temporal horn, the non-reformatted scans showed significantly larger scan-rescan variability than the reformatted scans. A typical standard deviation for a non-reformatted pair of scans was 0.10, corresponding to 26% error, while a typical value for a reformatted pair of scans was 0.04, corresponding to 10% error. For all the regions, the reread data (intra-rater reliability) gave similar results for both reformatted and non-reformatted images with similar standard deviations (typical value for reread standard deviation was 0.020, corresponding to 5% error). The data suggest that, even when very thin slices are acquired, volume measurement accuracy of gray matter structures in the temporal lobe is considerably improved by controlling for image orientation in three planes. For these structures, the sample size needed to detect a small (5%) within-subject volume change would be halved if reformatted images were used. Image contrast is an additional important factor since the reformatted T1 weighted images used in this study, which have suboptimal CSF/brain contrast, worsened measurement accuracy in the temporal horn.

Adult↗

Angiographic abnormalities associated with alterations in regional myocardial blood flow in coronary artery disease.

To evaluate the association between alterations in myocardial blood flow and angiographic findings, myocardial blood flow was compared in 26 patients with asymergy, 15 patients with a similar extent of coronary artery disease but without asynergy, and 10 patients without coronary artery disease or obvious myocardial or valvular disease. Myocardial blood flow was measured at rest with an Anger camera and PDP-11/20 computer after the intracoronary injection of 133xenon. In comparison with the normal subjects, whole heart blood flow was significantly reduced in patients with asynergy. In addition, myocardial blood flow in regions of anteroapical asynergy was reduced (85-7 +/- 7-0 ml/min per 100 g3 in controls to 65-4 +/- 4-5, P less than 0-05) and a similar reduction was noted in regions of posterolateral asymergy (91-5 +/- 8-8 in controls to 66-8 +/- 5-0, P less than 0-05). In general, regional myocardial blood flow was reduced distal to left anterior descending or left circumflex stenosis of less than 50 per cent, with a trend toward further reduction distal to less than 75 per cent stenosis. In these same patients, the presence of anteroapical or posterolateral asynergy resulted in a similar trend to even greater reduction of flow. The effect of collaterals was variable: 7 of 8 patients without asynergy but with less than 75 per cent left anterior descending stenosis and collateral circulation to the lower left anterior descending quadrant had minimally reduced flows. However, in the 17 patients with anteroapical asynergy, regional myocardial blood flow was very similar in the 9 patients with collaterals compared with the 8 patients without them. This study suggests that the degree of coronary artery stenosis and presence of asynergy are both important in evaluating alterations in myocardial blood flow in coronary artery disease, while the role of collaterals remains uncertain.

Adult↗

Use of factor analysis in the evaluation of left to right cardiac shunts.

We have compared two methods of data processing for the quantitation of left-to-right cardiac shunts using first-pass radionuclide angiography. These two methods are used for curve generation in the deconvolution analysis. The standard method involves manual definition of regions of interest. A newer method--factor analysis--provides automatic curve generation and is therefore more operator-independent. Both techniques yield curves of the venous input, lung, and background. The venous input curve is deconvolved by the lung curve, and the resultant unit impulse response is fitted by the gamma variate method to quantitate the left-to-right shunt fraction. Both techniques--factor analysis and regions of interest (ROIs)--separated the shunt patients (n = 16) from the control subjects (n = 20) with a p less than 0.001. There was less interobserver variability with the curves obtained by factor analysis than with those obtained by regions of interest. The coefficient of correlation of factor analysis results with oximetry, r, was 0.90. High sensitivity and specificity, each 94%, was achieved with curves generated by factor analysis. Time vs. activity curves generated by ROIs can achieve high sensitivity and low specificity, or vice versa, depending on the cutoff level defined for separation of the left-to-right shunt patients from the control group.

Adult↗

Variable response to atrial pacing after intravenous propranolol in patients with stable exertional angina.

The effect of propranolol administration on regional coronary haemodynamics were investigated in 14 patients with stable exertional angina and isolated left anterior descending artery disease. Thermodilution was used to measure great cardiac vein flow (GCVF) and anterior regional coronary resistance (ARCR) under control conditions, at peak atrial pacing, after i.v. propranolol administration (0.1 mg kg-1) and at the peak of repeated atrial pacing. Propranolol did not change peak pacing heart rate, systolic blood pressure or double product. Peak pacing GCVF decreased slightly but non-significantly after drug administration from 84 +/- 20 to 79 +/- 24 ml min-1, while ARCR increased, but again non-significantly, from 1.36 +/- 0.44 to 1.45 +/- 0.45. Analysis of individual patient responses revealed that propranolol prolonged peak pacing time and hence peak pacing heart rate (from 126 +/- 24 to 140 +/- 23 beats min-1, P less than 0.05) in five patients. In such patients, peak pacing systolic blood pressure was lower than the pre-propranolol atrial pacing (145 +/- 35 vs 165 +/- 33, P less than 0.001) so that double product remained unchanged. Moreover, peak pacing ARCR did not change after propranolol (pre-propranolol 1.47 +/- 0.46, after propranolol 1.40 +/- 0.56 mmHg.ml-1.min, P = ns) while it increased significantly in the nine patients who did not improve after the drug (before propranolol 1.30 +/- 0.44, after propranolol 1.48 +/- 0.41 mmHg.ml-1.min, P less than 0.02). These data suggest that the response to atrial pacing after i.v. propranolol administration is variable as some patients tolerate higher heart rates while others do not.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Echocardiographic Assessment of Regional and Global Left Ventricular Function Wall-Motion Scoring in Parasternal and Apical Views Versus Apical Views Alone.

The aim of the study was to examine the value of echocardiographic wall-motion scoring in apical views as compared to a conventional combination of apical and parasternal views. In 50 consecutive patients referred to coronary arteriography for potential revascularization, echocardiographic digital image loops of the left ventricle (LV) were recorded in parasternal long- and short-axis views and in apical long-axis, two-, and four-chamber views. Eight of 16 standardized LV segments appear both in the apical and in the parasternal views (group 1 segments). The remaining eight segments are visualized in the apical views only (group 2). Using a cross-over design, two cardiologists independently performed regional wall-motion scoring based on apical views, respectively, based on the combination of parasternal and apical views. Using the conventional approach (parasternal and apical views) 98% of the total 800 segments were scored as compared to 95% when using the mere apical approach (P < 0.05); 94% of the 800 segments were scored from both approaches. The regional wall-motion score was identical in 76% of group 1 segments and in 77% of group 2 segments. It diverged, at most, one score in 94% of group 1 segments and in 91% of group 2 segments (P > 0.05). LV ejection fraction (EF) calculated on the basis of average wall-motion score exclusively assessed from the apex differed little from angiographic EF (mean difference 2.0%, 95% confidence limits +/- 6.6%). Intraobserver variability of wall-motion scores (n = 25 patients) was small and almost identical for the two cardiologists. Similarly, interobserver variability was small and identical for apical views and conventional views. We conclude that there is no substantial loss of information when echocardiographic evaluation of regional and global left ventricular function is performed solely from the apical approach.

Journal Article↗

Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy.

PURPOSE: To analyze three-dimensional setup uncertainties for multiple regions of interest (ROIs) in head-and-neck region. METHODS AND MATERIALS: In-room computed tomography (CT) scans were acquired using a CT-on-rails system for 14 patients. Three separate bony ROIs were defined: C2 and C6 vertebral bodies and the palatine process of the maxilla. Translational shifts of 3 ROIs were calculated relative to the marked isocenter on the immobilization mask. RESULTS: The shifts for all 3 ROIs were highly correlated. However, noticeable differences on the order of 2-6 mm existed between any 2 ROIs, indicating the flexibility and/or rotational effect in the head-and-neck region. The palatine process of the maxilla had the smallest right-left shifts because of the tight lateral fit in the face mask, but the largest superior-inferior movement because of in-plane rotation and variations in jaw positions. The neck region (C6) had the largest right-left shifts. The positioning mouthpiece was found effective in reducing variations in the superior-inferior direction. There was no statistically significant improvement for using the S-board (8 out of 14 patients) vs. the short face mask. CONCLUSIONS: We found variability in setup corrections for different regions of head-and-neck anatomy. These relative positional variations should be considered when making setup corrections or designing treatment margins.

Algorithms↗

Premature atrial beat eliciting atrial fibrillation after coronary artery bypass grafting.

Of patients undergoing coronary artery bypass grafting 30% develop atrial fibrillation (AF) or flutter. To determine if AF is initiated from the right or left atrium, atrial electrograms were continuously recorded in patients undergoing this procedure. In addition, to study whether the prematurity index of premature atrial contractions (PACs) eliciting AF differs from PACs not provoking AF, the distribution of prematurity indices was evaluated from R-R interval analysis. The right and left atrial recording electrodes were first activated by the ectopic beat provoking AF in six and eight patients, respectively. The prematurity index of the PAC eliciting AF was located in the middle (in half of the patients) or to the left of the median distribution of prematurity indices. The variability in activation of the atrial electrodes suggests that the PAC provoking AF can have its origin in the right, the septal, or the left region of the atrium. The initiation of AF depends on the prematurity index of the PAC.

Atrial Fibrillation↗

Analysis of insertion into secondary attachment sites by phage lambda and by int mutants with altered recombination specificity.

When phage lambda lysogenizes a cell that lacks the primary bacterial attachment site, integrase catalyzes insertion of the phage chromosome into one of many secondary sites. Here, we characterize the secondary sites that are preferred by wild-type lambda and by lambda int mutants with altered insertion specificity. The sequences of these secondary sites resembled that of the primary site: they contained two imperfect inverted repeats flanking a short spacer. The imperfect inverted repeats of the primary site bind integrase, while the 7 bp spacer, or overlap region, swaps strands with a complementary sequence in the phage attachment site during recombination. We found substantial sequence conservation in the imperfect inverted repeats of secondary sites, and nearly perfect conservation in the leftmost three bases of the overlap region. By contrast, the rightmost bases of the overlap region were much more variable. A phage with an altered overlap region preferred to insert into secondary sites with the corresponding bases. We suggest that this difference between the left and right segments is a result of the defined order of strand exchanges during integrase-promoted recombination. This suggestion accounts for the unexpected segregation pattern of the overlap region observed after insertion into several secondary sites. Some of the altered specificity int mutants differed from wild-type in secondary site preference, but we were unable to identify simple sequence motifs that account for these differences. We propose that insertion into secondary sites is a step in the evolutionary change of phage insertion specificity and present a model of how this might occur.

Attachment Sites, Microbiological↗

Regional dendritic and spine variation in human cerebral cortex: a quantitative golgi study.

The present study explored differences in dendritic/spine extent across several human cortical regions. Specifically, the basilar dendrites/spines of supragranular pyramidal cells were examined in eight Brodmann's areas (BA) arranged according to Benson's (1993, Behav Neurol 6:75-81) functional hierarchy: primary cortex (somatosensory, BA3-1-2; motor, BA4), unimodal cortex (Wernicke's area, BA22; Broca's area, BA44), heteromodal cortex (supple- mentary motor area, BA6beta; angular gyrus, BA39) and supramodal cortex (superior frontopolar zone, BA10; inferior frontopolar zone, BA11). To capture more general aspects of regional variability, primary and unimodal areas were designated as low integrative regions; heteromodal and supramodal areas were designated as high integrative regions. Tissue was obtained from the left hemisphere of 10 neurologically normal individuals (M(age) = 30 +/- 17 years; five males, five females) and stained with a modified rapid Golgi technique. Ten neurons were sampled from each cortical region (n = 800) and evaluated according to total dendritic length, mean segment length, dendritic segment count, dendritic spine number and dendritic spine density. Despite considerable inter-individual variation, there were significant differences across the eight Brodmann's areas and between the high and low integrative regions for all dendritic and spine measures. Dendritic systems in primary and unimodal regions were consistently less complex than in heteromodal and supramodal areas. The range within these rankings was substantial, with total dendritic length in BA10 being 31% greater than that in BA3-1-2, and dendritic spine number being 69% greater. These findings demonstrate that cortical regions involved in the early stages of processing (e.g. primary sensory areas) generally exhibit less complex dendritic/spine systems than those regions involved in the later stages of information processing (e.g. prefrontal cortex). This dendritic progression appears to reflect significant differences in the nature of cortical processing, with spine-dense neurons at hierarchically higher association levels integrating a broader range of synaptic input than those at lower cortical levels.

Adult↗

Ictal video-EEG recording of three partial seizures in a patient with the benign infantile convulsions associated with mild gastroenteritis.

PURPOSE: In infants, benign convulsions can be triggered by febrile illness or mild diarrhea such as Rotavirus gastroenteritis. The triggering mechanism of these convulsions is still unknown. In spite of several reports concerning clinical features, the ictal EEG recordings were rarely analyzed by a video-EEG monitoring system. To reveal a clue for the triggering mechanism of these convulsions, we analyzed the correlation of clinical manifestations and the EEG discharges during the ictal events and compared with previous reports. METHODS: The ictal EEG of a cluster of three afebrile convulsions associated with mild gastroenteritis was recorded by an EEG closed-circuit TV (EEG-CCTV) monitoring system in a 6-month-old healthy female infant. RESULTS: All seizures began as complex partial seizures (CPSs), which exhibited a motionless stare with or without leftward deviation of both eyes, and evolved to secondarily generalized tonic-clonic seizures (SGTCSs) for approximately 90 s. Each of three ictal discharges began from the right occipital, right centroparietotemporal, and left occipital regions, respectively. CONCLUSIONS: Although initiating sites of ictal discharges of benign infantile convulsions associated with mild gastroenteritis (BICE) were previously reported to be variable among patients, these results indicated that those differ among seizures even in a same infant.

Cerebral Cortex↗

Quantitative tissue Doppler in comparison with two-dimensional and Doppler echocardiographic indices in normal subjects.

To assess normal values of left ventricular wall motion velocities with respect to sequential phases of the cardiac cycle 95 normal subjects (mean age 34+/-12 years) were examined using a recently developed method based on the computer software TDI-LaborR enabling a variable time and space related measurement of regional wall velocity from tissue Doppler (TD) images. The study population consisted of three age groups: 16-29 years (group 1, n=34 (36%)), 30-49 years (group 2, n=45 (49%)), >50 years (group 3, n=16 (17%)). Using TD M-mode of the left ventricular posterior wall the mean subendocardial and subepicardial velocity as well as the transmural myocardial velocity were determined for the rapid, slow and atrial filling phases as well as the systole. In addition, standard mitral inflow parameters-E and A velocities were determined by pulsed Doppler echocardiography. The left parasternal window was used. The subendocardial rapid filling and atrial filling myocardial velocity were found to be age significantly dependent. The myocardial rapid filling were correlated to early diastolic mitral inflow velocity and to the ratio of early and atrial flow velocities (r ranges from 0.23 to 0.36, P<0.01). We conclude that aging is accompanied by an increase of atrial filling compensating a reduced myocardial relaxation already before 50 years. Whereas mitral inflow velocities reflect diastolic function indirectly, it is directly indicated by TD myocardial velocity parameters.

Adolescent↗