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PubMed2003

[The value of platelet function tests].

Platelet function tests are used to detect patients with abnormal platelet function, which may be inborn or acquired or to detect increased platelet activation which may be accompanied by an increased risk of thrombosis. Platelet function tests are also used to monitor platelet function inhibitors as aspirin, clopidogrel or platelet membrane glycoprotein IIb/IIIa-inhibitors. Incorrect blood sampling is a major source of error in measuring platelet function. Global tests besides platelet count and bleeding time are thrombelastography, the platelet function analyzer (PFA) and possibly in the future the new Impact-system. Specific tests measure platelet spreading and adhesion to defined surfaces. In a series of methods platelets are counted before and after passage of a filter. Some of these tests are partially standardized. The most frequently measured platelet function is aggregation induced by ADP, collagen or other substances as first described by Gustav Born. Some newer methods to perform aggregometry are described. Platelet activation can be detected by measuring spontaneous aggregation as in the PAT-test. Prospective trials with this test have shown that enhanced spontaneous aggregation is a risk factor for new vascular occlusions in diabetics and for myocardial infarctions in healthy individuals. The Wu and Hoak-test and the measurement of released platelet factor 4 or betaglobulin are of limited value. Flow cytometric methods are frequently used to measure platelet activation markers as CD 62 and others. Platelet induced thrombin generation is an interesting function to measure drug effects. None of the presently available platelet function tests is well standardized, so there is much room for improvement.

Blood Platelet Disorders↗

PubMed1984

Global left ventricular function and regional wall motion in pure mitral stenosis.

Global left ventricular function (LVF) and segmental wall motion of the left ventricle are registered in 113 patients presenting a pure mitral stenosis (MS) and in a control group of 50 individuals. The segmental wall motion is measured on the end-diastolic-end-systolic frames of the left ventricle, obtained from right anterior oblique (RAO) monoplane cineangiography. Measurement of the segmental wall shortening is performed using the Stanford method. Group 1 includes 68 patients (60% of the total number of patients studied). These patients show no pathological contraction abnormality. In this group, the global LVF is not different from the control group. Group 2 includes 45 patients (40% of the total) for whom contraction abnormalities are present: anterior hypokinesis in 20% of the cases (anterior area mean shortening (AAS) = 18 +/- 8%; p less than 0.001 vs. group 1 and control group), and posterior hypokinesis in 20% of the cases (posterior area mean shortening (PAS) = 9.8 +/- 5.8%, p less than 0.001 vs. group 1 and control group). In this group, global LVF is impaired; ejection fraction (EF) = 0.57 +/- 0.1% (p less than 0.001 vs. group 1); velocity of circumferential fiber shortening (VCF) = 1 +/- 0.3 circ/s (p less than 0.001 vs. group 1); enddiastolic pressure (EDP) = 11 +/- 5 mmHg (p less than 0.01 vs. group 1). Segmental contraction abnormalities appear to be the main factor involved in the global LVF impairment. Segmental wall motion abnormalities could be related to subvalvular fibrosis, or LV filling difficulties, or principally, to a possible interplay between the right and the left ventricles.

Adult↗

PubMed1999

Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood.

BACKGROUND: In children, exacerbations of tics and obsessive symptoms may occur after infection with group A beta-haemolytic streptococci. If post-streptococcal autoimmunity is the cause of the exacerbations, then children might respond to immunomodulatory treatments such as plasma exchange or intravenous immunoglobulin (IVIG). We studied whether plasma exchange or IVIG would be better than placebo (sham IVIG) in reducing severity of neuropsychiatric symptoms. METHODS: Children with severe, infection-triggered exacerbations of obsessive-compulsive disorder (OCD) or tic disorders, including Tourette syndrome, were randomly assigned treatment with plasma exchange (five single-volume exchanges over 2 weeks), IVIG (1 g/kg daily on 2 consecutive days), or placebo (saline solution given in the same manner as IVIG). Symptom severity was rated at baseline, and at 1 month and 12 months after treatment by use of standard assessment scales for OCD, tics, anxiety, depression, and global function. FINDINGS: 30 children entered the study and 29 completed the trial. Ten received plasma exchange, nine IVIG, and ten placebo. At 1 month, the IVIG and plasma exchange groups showed striking improvements in obsessive-compulsive symptoms (mean improvement on children's Yale-Brown obsessive compulsive scale score of 12 [45%] and 13 [58%], respectively), anxiety (2.1 [31%] and 3.0 [47%] improvement on National Institute of Mental Health anxiety scale), and overall functioning (2.9 [33%] and 2.8 [35%] improvement on National Institute of Mental Health global scale). Tic symptoms were also significantly improved by plasma exchange (mean change on Tourette syndrome unified rating scale of 49%). Treatment gains were maintained at 1 year, with 14 (82%) of 17 children "much" or "very much" improved over baseline (seven of eight for plasma exchange, seven of nine for IVIG). INTERPRETATION: Plasma exchange and IVIG were both effective in lessening of symptom severity for children with infection-triggered OCD and tic disorders. Further studies are needed to determine the active mechanism of these interventions, and to determine which children with OCD and tic disorders will benefit from immunomodulatory therapies.

Adolescent↗

PubMed2002

Associations of body composition with physical performance and self-reported functional limitation in elderly men and women.

To understand how body composition relates to functional impairment, the authors examined cross-sectional associations of absolute and relative measures of fat and lean mass with physical performance and self-reported functional limitation. The sample consisted of a community-based cohort of 1,655 older women and men from Sonoma, California, who had complete baseline data in 1993-1994 on body composition, physical performance, and functional limitation. Physical performance was assessed by walking speed and grip strength, while global functional limitation, across several domains, was assessed by self-report using standard questions. Lean mass and fat mass were estimated from bioelectric impedance using population-specific prediction equations derived from dual x-ray energy absorptiometry. Higher fat mass was associated with slower walking speed and greater likelihood of functional limitation, while higher lean mass was generally associated only with increased grip strength. A higher lean mass-to-fat mass ratio, a relative measure of body composition, was associated with faster walking speed and less limitation. These findings suggest that fat mass negatively impacts some domains of physical performance and overall functioning, while lean mass is less significant in absolute terms but is important relative to amount of body fat.

Adipose Tissue↗

PubMed2001

Major depression and drug disorders in adolescence: general and specific impairments in early adulthood.

OBJECTIVE: To identify adulthood impairments associated with major depression and drug disorders in adolescence, distinguishing between general impairments for both disorders and specific impairments for each disorder. METHOD: Within a longitudinal community study (N= 365), the Diagnostic Interview Schedule provided 1-year diagnoses of major depression and drug abuse/dependence at age 18. At age 21, current functioning was assessed. RESULTS: Adolescents with either depression or drug disorders had substantial deficits in later functioning, with few impairments shared in common. General areas of impairment included lower global functioning, externalizing behavior problems, and suicidal behaviors. Difficulties specific to depression encompassed multiple internalizing problems: interpersonal difficulties, decreased psychological well-being, career dissatisfaction, and active major depression at age 21. For males only, overall poor health was also a specific depression outcome. Age 21 problems unique to drug disorders included lower likelihood of post-high school education, being fired, and active drug disorders. Males, but not females, were also more likely to report antisocial behaviors in adulthood. CONCLUSIONS: Despite several significant commonalities, including suicide attempts, deficits associated with depression and drug disorders were primarily specific, suggesting distinct trajectories. Results highlight the need for specific follow-up services to alleviate continuing problems associated with these disorders.

Adolescent↗

PubMed1991

Personality disorders 2-5 years after treatment: a prospective follow-up study.

Ninety-seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow-up study. At follow-up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self-supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow-up period than other groups. The overall suicide rate was low compared with most similar studies.

Adult↗

PubMed2006

Going beyond: an adventure- and recreation-based group intervention promotes well-being and weight loss in schizophrenia.

OBJECTIVE: To undertake a preliminary study to assess the feasibility of clinical implementation and evaluate the effectiveness of a novel adventure- and recreation-based group intervention in the rehabilitation of individuals with schizophrenia. METHODS: In a 2-year, prospective, case-control study, 23 consecutively referred, clinically stabilized schizophrenia patients received the new intervention over an 8-month period; 31 patients on the wait list, considered the control group, received standard clinical care that included some recreational activities. Symptom severity, self-esteem, self-appraised cognitive abilities, and functioning were documented for both groups with standardized rating scales administered at baseline, on completion of treatment, and at 12 months posttreatment. RESULTS: Treatment adherence was 97%, and there were no dropouts. Patients in the study group showed marginal improvement in perceived cognitive abilities and on domain-specific functioning measures but experienced a significant improvement in their self-esteem and global functioning (P < 0.05), as well as a weight loss of over 12 lb. Improvement was sustained over 1 year with further occupational and social gains. CONCLUSION: In the context of overcoming barriers to providing early intervention for youth and preventing metabolic problems among older adults with schizophrenia, adventure- and recreation-based interventions could play a useful complementary role.

Adult↗

PubMed1996

Wire mesh as a post-operative physiotherapy assistive device following peripheral nerve graft repair in the rat.

Traditional methods of assessing nerve recovery following injury, including histomorphometry and electrophysiology, do not necessarily correlate with return of motor and sensory function. Accordingly, many investigators have used walking track analysis as an assessment of global functional recovery following sciatic, peroneal or tibial nerve injury. However, walking track reliability may be compromised by the development of flexion contractures secondary to neurologic loss. To prevent this, regular manual physiotherapy is recommended which is a time-consuming and often frustrating process for both the animal and investigator. We report the use of a wire mesh as a simple post-operative assistive device to provide constant physiotherapy. Twelve Lewis rats were randomized to one of two experimental groups. Each rat received a 2 cm posterior tibial nerve autograft. Postoperatively, animals in group 1 received manual physiotherapy, consisting of repeated flexion and extension exercises of the ankle, knee and hip every two weeks. Group 2 rats were permitted to climb freely on a 30 x 18 cm piece of wire mesh placed at a 45 degree angle within their cage. Group 2 rats received no manual physiotherapy throughout the course of the study. Serial walking tracks were performed every four weeks until sacrifice at sixteen weeks. There was no development of flexion contractures in the injured hind limbs of either group. There was no morbidity such as blisters associated with the use of the wire mesh. There was no statistical difference in walking track recovery between groups at any time period. However, a trend towards better functional recovery was seen in the group receiving constant physiotherapy via the wire mesh. The use of a wire mesh as a post-operative assistive device is an inexpensive, simple and reliable method to provide continuous physiotherapy to animals following denervation.

Animals↗

PubMed2006

Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction--analysis by quantitative ECG-gated SPECT--.

BACKGROUND: We hypothesized that endothelial cell integrity in the risk area would influence left ventricular remodeling after acute myocardial infarction. PATIENTS AND METHODS: Twenty patients (61 +/- 8 y.o.) with acute myocardial infarction underwent 99mTc-tetrofosmin imaging in the subacute phase and three months after successful primary angioplasty due to myocardial infarction. All patients were administered angiotensin-converting enzyme inhibitor after revascularization. Cardiac scintigraphies with quantitative gated SPECT were performed at the sub-acute stage and again 3 months after revascularization to evaluate left ventricular (LV) remodeling. The left ventricular ejection fraction (EF) and end-systolic and end-diastolic volume (ESV, EDV) were determined using a quantitative gated SPECT (QGS) program. Three months after myocardial infarction, all patients underwent cardiac catheterization examination with coronary endothelial function testing. Bradykinin (BK) (0.2, 0.6, 2.0 microg/min) was administered via the left coronary artery in a stepwise manner. Coronary blood flow was evaluated by Doppler flow velocity measurement. Patients were divided into two groups by BK-response: a preserved endothelial function group (n = 10) and endothelial dysfunction group (n = 10). RESULTS: At baseline, both global function and LV systolic and diastolic volumes were similar in both groups. However, LV ejection fraction was significantly improved in the preserved-endothelial function group, compared with that in the endothelial dysfunction group (42 +/- 10% to 48 +/- 9%, versus 41 +/- 4% to 42 +/- 13%, p < 0.05). LV volumes progressively increased in the endothelial dysfunction group compared to the preserved-endothelial, function group (123 +/- 45 ml to 128 +/- 43 ml, versus 111 +/- 47 ml to 109 +/- 49 ml, p < 0.05). CONCLUSION: In re-perfused acute myocardial infarction, endothelial function within the risk area plays an important role with left ventricular remodeling after myocardial infarction.

Angioplasty, Balloon, Coronary↗

PubMed2004

Effectiveness and safety of cholinesterase inhibitors in elderly subjects with Alzheimer's disease: a "real world" study.

Clinical trials have demonstrated the efficacy of cholinesterase inhibitors (ChEI) in improving cognitive status and disability in subjects with mild to moderate Alzheimer's disease (AD). However, little is known about the effectiveness of ChEI in clinical practice, and no large clinical trials comparing different ChEI are available at present. Aim of this study was to evaluate safety and effectiveness of ChEI in a sample of elderly outpatients diagnosed with mild to moderate AD. We selected 407 subjects for ChEI treatment (donepezil,rivastigmine or galantamine). Their cognitive function was evaluated by means of the mini mental state examination (MMSE), and the global functional status was estimated by using the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales at baseline (To), then after 1 (T1), 3 (T2) and 9 months (T3), respectively. T3 follow-up was completed by 212 subjects. The patients were considered as responders (R), if the MMSEscore at T2 was unchanged or improved, if compared to that of T0. In 35 patients (8.6 %)treatment was withdrawn because of mostly gastrointestinal adverse events. Compared to the other drugs, donepezil was associated with a lower incidence of withdrawals due to adverse events. Subjects who completed T3 follow-up (age 78 +/- 6 years, MMSE scores 18.8 +/- 3.9) showed an increase at T2 of 0.7 +/- 2.7 (p = 0.001) and a decrease at T3 of -0.6 +/- 3.4 (p = 0.008) in the MMSE scores, as compared to To . The ADL and IADL scores did not show significant changes at T2; however, both decreased significantly at T3. The patients Rat-T2 showed a better cognitive and functional outcome at T3 , compared to the nonresponders(NR-at-T2), displaying values of MMSE R-at-T2 0.4 +/- 3.1 vs. NR-at-T2 -3.0 +/- 2.5, p = 0.001, and ADL values of -0.3 +/- 1.2 vs. -0.7 +/- 1.3, p = 0.03, respectively. No significant difference was found in the changes of MMSE scores between donepezil and rivastigmine (galantamine was not included in the comparison due to the small number of treated subjects). In conclusion, in this sample of elderly subjects with mild to moderate AD,treated with ChEI, a small but significant decline in cognitive and functional status was observed after 9 months. Subjects who showed a good response to treatment after 3 months, had a better cognitive and functional outcome at 9 months. No significant difference in cognitive outcome was found between drugs, while donepezil was better tolerated.

Aged↗

PubMed2006

Effectiveness of validation therapy (VT) in group: preliminary results.

VT is one of the best known psychosocial treatment for elderly affected by dementia. Notwithstanding its wide use, its efficacy is still a controversial issue, especially in comparison with other approaches. This study of 30 elderly subjects in a nursing home compared the effects of VT, sensorial reminiscence (SR) and no treatment on cognitive, functional, and affective status of the participants. The results indicated an improvement in the global functioning of the two treatment groups, compared to the control group, but the differences did not reach statistical significance. Significant within-group effects could be observed, where the SR treatment was the most effective in improving cognitive, affective, and behavioral status; the VT-group showed a reduction of the behavioral disturbances; the participants at the control group demonstrated a slight deterioration at all the three levels. Considerations are made about the implication of VT for the caregivers, as possible mediator of its effect on elderly.

Aged↗

PubMed2000

Course and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold depression.

It is pragmatically important to know the comparative prognoses of bipolar, unipolar and subthreshold depressions after they present to clinical attention. Previous studies focusing on bipolar and/or unipolar depressions have questionable generalizability because of overrepresentation of inpatients and/or refractory patients, and no study has yet focused on the length of subthreshold depression. The Group for Longitudinal Affective Disorders Study (GLADS) in Japan is conducting a prospective, serial follow-up study of broadly defined mood disorder patients, who had not received treatment for their index episode before study entry. The median time to recovery for bipolar depression was 2.0 months (95%CI: 0.9-3.1), that for unipolar depression 3.0 (2.5-3.6), and that for subthreshold depression 3.2 (0-12.3). Survival analyses revealed no statistically significant difference among the three. Neither was the total time unwell significantly different among the three: on average, these patients were symptomatic with two or more significant affective symptoms for 9.5 (8.0-10.9) months out of the initial 24 months of follow-up. The bipolar depressed patients tended to present with graver functional impairment at intake, but thereafter there was no statistically significant difference in the global functioning of these three diagnostic subgroups. In our sample, patients with depressive disorder not otherwise specified appeared to suffer both symptomatologically and functionally as much as patients with major mood disorders.

Acute Disease↗

PubMed2003

Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence.

The authors examined whether adolescent major depressive disorder (MDD) was associated with difficulties in young adult functioning and whether differences would remain significant after accounting for nonmood disorder, MDD recurrence, functioning in adolescence, or current mood state. A total of 941 participants were assessed twice during adolescence and at age 24. In unadjusted analyses, adolescent MDD was associated with most young adult functioning measures. Associations were not due to interactions with adolescent comorbidity, but differences in global functioning and mental health treatment appeared as a result of MDD recurrence. Accounting for levels of functioning in adolescence or for current depression at age 24 eliminated the remaining associations. The implications of these findings for efforts to prevent MDD in adolescence are discussed.

Adolescent↗

PubMed2006

Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD.

OBJECTIVE: Family environmental factors as well as parental attention-deficit/hyperactivity disorder (ADHD) status have shown associations with variability in ADHD. The purpose of the present study was to examine the links among family environment, parental psychiatric diagnosis, and child impairment within a sample of ADHD-affected sibling pairs (ASPs) ages 5 to 18 years. METHOD: Parents in 220 ASP families completed a measure of family functioning, the Family Environment Scale. Children's impairment was measured by clinical ratings of global functioning and by maternal ratings of behavior. RESULTS: Parents of children with ADHD rate their families as higher in conflict and lower in achievement and organization than normative samples. High family conflict is significantly associated with impairment in ADHD ASPs accounting for approximately 40% of the sibling similarity in impairment. Parental psychiatric diagnosis revealed no significant direct link to sibling impairment, but rather a significant indirect link to impairment mediated by family conflict. Direct associations with parental diagnosis depend on birth order of the ASP members despite the comparable mean impairment scores for older and younger ADHD siblings. CONCLUSIONS: There are strong links between impairment in children with ADHD and family environment. Different processes and mechanisms may contribute to impairment in different children in the same family.

Adolescent↗

PubMed2006

Performance-based measures of physical function for high-function populations.

OBJECTIVES: To improve and broaden the applicability of performance-based measures of function for use in clinical and research settings. DESIGN: Cross-sectional repeated-measures study. SETTING: Research clinic. PARTICIPANTS: Population-based sample of Japanese Americans without significant functional impairments aged 35 to 55 and 56 to 71 (N=203). MEASUREMENTS: Performance-based measures of physical function, including range of standard tests, newer automated measures of balance and strength and data on cognitive function, lifestyle, medical history, and physical activity. RESULTS: Of the nonplatform balance measures, only the one-leg stand was reliable (reliability coefficient (rc) =0.69) and able to discriminate between functional levels. Combining the Fourth National Health and Nutrition Examination Survey protocol of folded arm position while standing on a foam pad with the more-sophisticated balance platform test had the highest reliability and discrimination. With the strength chair, high rcs (0.88-0.96) were found for upper and lower extremity tests. Timed chair stands, a test of lower extremity and central strength were reliable. The 6-minute walk had a high rc (0.90). CONCLUSION: Many performance tests used today are not reliable. Only a few discriminate between the most highly functioning individuals and individuals with good function. Thus, a new recommended battery includes unassisted single-leg stand, balance platform "foam pad, eyes closed," elbow flexion and knee extension strength (strength chair), grip strength, timed chair stands, and the 6-minute walk. These simple performance-based tests have good reliability and discrimination across the range of function and can be used in most clinical and research settings to quickly assess global functional level.

Adult↗

PubMed1992

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study].

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

Adult↗

PubMed2000

Global assessment of functioning (GAF) ratings: determinants and role as predictors of one-year treatment outcomes.

OBJECTIVE: To assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses and are embodied by the Global Assessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994). METHOD: We identified a sample of 1,688 patients with substance use disorders, many of whom also had psychiatric disorders; examined the determinants of GAF ratings; and focused on how well these ratings predicted patients' one-year symptom and psychosocial functioning outcomes. RESULTS: Patients' clinical diagnoses and psychiatric symptoms were stronger predictors of GAF ratings than was their social and occupational functioning. Moreover, GAF ratings were only minimally associated with patients' one-year psychological, social, and occupational functioning outcomes. CONCLUSIONS: These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substance abuse patients' global functioning.

Adult↗

PubMed1991

The cardiovascular effects of dobutamine assessed by magnetic resonance imaging.

Magnetic resonance imaging is a new technique for the investigation of cardiac anatomy and function, but few attempts have been made to assess its value in the evaluation of coronary artery disease because of the problems of performing exercise in the magnet. In this review, we describe our experience using dobutamine as a substitute for exercise. We have assessed regional left ventricular wall motion by cine magnetic resonance imaging and global function from aortic flow and acceleration measurements using cine magnetic resonance velocity mapping. We studied regional wall motion in 23 patients presenting for coronary angiography because of chest pain. Of 21 with reversible dobutamine-induced thallium perfusion defects, 20 (95%) had dobutamine-induced wall motion abnormalities corresponding closely in site and size. We studied aortic flow in 25 similar patients and we compared the results with five normal volunteers with a low likelihood of coronary artery disease. A failure to increase peak aortic flow acceleration (peak, rate of change of flow) by 15 L/s2 was the most significant parameter associated with coronary artery disease. A reduction in peak flow acceleration at peak stress occurred in patients with moderate or severe myocardial ischaemia as determined by thallium myocardial perfusion imaging. Dobutamine is a valuable pharmacological agent which can induce regional and global abnormalities of left ventricular function in patients with coronary artery disease during magnetic resonance imaging.

Aorta↗