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PubMedDate not supplied

Coronary alpha-adrenergic stimulation does not alter the heterogeneity of myocardial blood flow and oxygen utilization.

Previous studies have suggested an uneven distribution of alpha-adrenergic receptors within the coronary arterial tree. We hypothesized that stimulation of these receptors would alter the regional and microregional variability of oxygen supply and utilization. Accordingly, we measured the heterogeneity of coronary blood flow to 0.5 g tissue samples and O2 saturation of small cardiac veins during coronary alpha-adrenergic stimulation. In 14 dogs we cannulated and perfused a branch of the left coronary artery. In seven dogs, an intracoronary infusion of the alpha-adrenergic agonist phenylephrine was established after prior beta-adrenergic blockade. Phenylephrine infusion decreased subendocardial venous O2 saturation (41.6 +/- 5.6 vs 45.4 +/- 5.8% saturated, P less than 0.05). It did not change the heterogeneity or distribution of the O2 saturations relative to the normally-perfused region (coefficient of variation = 22.4 +/- 6.7 vs. 19.7 +/- 4.8%, P = 0.20). Regional blood flows were made during control, beta-adrenergic blockade, and phenylephrine infusion conditions in the remaining dogs. The coefficient of variation of blood flow to samples from the perfused region was 27.1 +/- 9.8, 27.8 +/- 10.8, and 24.7 +/- 7.5% (P greater than 0.25), respectively. The results indicate that coronary alpha-adrenergic stimulation does not alter O2 supply/utilization heterogeneity, and suggest a fairly uniform distribution and/or effect of alpha-adrenergic receptors within the coronary resistance vessels.

Animals↗

PubMed2005

Combined chemotherapy and teratogenicity.

BACKGROUND: The concomitant occurrence of breast cancer and pregnancy is relatively uncommon. We report the case of a patient with syndactyly, cleft hands, and absence of distal finger phalanges associated with maternal exposure to chemotherapeutic agents during the first trimester of pregnancy. These associations have not been previously described. CASE: The patient was born by normal delivery after 38 weeks of pregnancy. His mother became pregnant while receiving chemotherapy (cyclophosphamide, 5-fluorouracil, and adriamycin) for breast cancer, and the fetus was exposed to these drugs from conception to the 16th week of pregnancy. At birth, anomalies were observed, including a high-arched palate, microcephaly, a flat nasal bridge, bilateral syndactyly in the first and second fingers with a hand cleft between the second and third fingers and hypoplasia of the fifth fingers, and dystrophic nail of the fourth finger of the left hand. The patient's growth and development were deficient. CONCLUSIONS: The malformations associated with in utero exposure to these chemotherapeutic agents are highly variable, but growth deficiency and anomalies of the craniofacial region and limbs are the most common. The pattern of malformations in children who were congenitally exposed to chemotherapeutic agents appears to be directly related to the age at and duration of exposure, rather than to the specific drug itself. Effective contraception is essential for the safe use of a potential teratogen in nonpregnant women of reproductive age.

Abnormalities, Drug-Induced↗

PubMed1982

Gold- 195m, a new generator-produced short-lived radionuclide for sequential assessment of ventricular performance by first pass radionuclide angiocardiography.

The feasibility of performing rapid sequential first pass radionuclide angiocardiography using a new short-lived radiotracer, gold-195m (195mAu) half-life 30.5 seconds) was evaluated. This radionuclide emits a 262 keV gamma ray and is the daughter of mercury-195 (195mHg) (half-life 41.6 hours). The prototype tabletop 195mHg/195mAu generator produced 20 to 25 mCi of 195mAu in 2 ml of eluate (yield of 40 percent). The breakthrough of 195mHg in the eluate was 0.02 percent of the amount of 195mHg in the generator. The eluate contained 20 microCi of 195mHg per study, resulting in an estimated human radiation dose of 0.007 rad/study to the whole body and 0.34 rad/study to the kidney. Four dogs each had 15 to 20 sequential first pass studies performed with 195mHg at 3 to 10 minute intervals using a computerized multicrystal gamma camera. During the left ventricular phase, 160,000 to 190,000 counts/s were acquired. The end-diastolic left ventricular region of interest contained 3,000 to 6,000 counts (background- and decay-corrected). Multiple reproducible values for left ventricular ejection fraction were obtained during stable conditions. The mean (+/- standard deviation) interstudy variability was 4 +/- 2 percent. During infusion of isoproterenol, rapid increase of left ventricular ejection fraction was demonstrated. Excellent agreement was observed between studies performed with technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA) and 195mAu. The mean interstudy difference was 4 +/- 3 percent. Thus, sufficiently high yield and dose are obtained from the 195mHg/195mAu generator for reliable high count rate first pass determination of left ventricular ejection fraction. This new short-lived radiotracer makes possible rapid sequential assessments of ventricular function at greatly reduced patient exposure to radiation.

Angiocardiography↗

PubMed1999

Current treatment practices for early laryngeal carcinoma.

OBJECTIVE: Controversy regarding the management of early laryngeal carcinoma persists in the absence of a definitive comparison of treatment modalities. This study examines the basic management practices for early laryngeal cancer among the American Academy of Otolaryngology-Head and Neck Surgery membership with an emphasis on the role of conservation surgery. METHODS: Questionnaires were randomly distributed to 3000 members with 1000 responses. The results were collated and statistically evaluated with multivariable frequency analysis. RESULTS: For operable supraglottic tumors, supraglottic laryngectomy was advocated by 41.6% of those responding. Definitive radiation therapy was suggested by 5.3% of participants and total laryngectomy by 1.4%. Explanation of treatment options with the patient deciding the therapy was selected by 48.3% of responders. For suitable glottic tumors, hemilaryngectomy was recommended by 37.1%, definitive radiation therapy by 8.1%, total laryngectomy by 1.9%, and patient choice by 50.4% of members completing the survey. When patients were left to weigh the treatment options, surgery was much less likely to be chosen than if it was advocated by the physician. Trends were evident according to practice region and setting, but these variables did not correlate strongly with physician recommendations. However, date of residency completion and rating of available radiation oncology services were significant factors. The evaluation of postoperative considerations in laryngeal conservation surgery demonstrated large variability in the definition of a close margin and the perceived need for additional therapy. CONCLUSIONS: The varied practice patterns among the American Academy of Otolaryngology-Head and Neck Surgery membership reflect the lack of a comparative outcome analysis for the treatment of early laryngeal carcinoma. Consequently, the full reliance on patient choice, which is more pronounced among young physicians, and cost considerations may have the greatest impact on the future treatment of this disease.

Glottis↗

PubMed1997

The differing prognostic utility of exercise radionuclide ventriculography in coronary artery disease patients with and without prior myocardial infarction.

UNLABELLED: Previous studies have documented the prognostic utility of left ventricular ejection fraction response to exercise primarily in populations without prior myocardial infarction. We undertook a study to assess the prognostic utility of exercise left ventricular ejection fraction and segmental wall motion response during exercise radionuclide ventriculography in coronary artery disease patients with and without prior myocardial infarction. METHODS: We examined the comparative prognostic utility of left ventricular ejection fraction and segmental wall motion response during upright bicycle exercise radionuclide ventriculography in 419 coronary artery disease patients with (n = 217) and without (n = 202) prior myocardial infarction using univariate and multivariate hierarchical regression analyses. RESULTS: During an average followup period of 61 months, 96 patients (23%) suffered cardiac events, including 55/217 (25%) of the patients with prior myocardial infarction and 41/200 (21%) of the patients without prior myocardial infarction (p = ns). Both cumulative Kaplan-Meier survival analyses and stepwise hierarchical Cox survival analyses demonstrated that peak left ventricular ejection fraction < 55% was a significant predictor of cardiac events in patients without prior myocardial infarction (p = 0.04), whereas an exercise wall motion worsening score > or = 2 was a significant predictor in patients with a prior myocardial infarction (p = 0.0001). CONCLUSIONS: The prognostic utility of exercise radionuclide ventriculography variables differ according to the presence or absence of prior myocardial infarction. Global function, assessed by peak left ventricular ejection fraction, adds the greatest prognostic information in patients without prior myocardial infarction, whereas regional function, assessed by exercise wall motion worsening, is the best predictor among patients with prior myocardial infarction.

Adult↗

PubMed1998

Distribution of alpha1-adrenergic receptor mRNA species in rat heart.

Radioligand binding studies have detected alpha1A- and alpha1B-adrenergic receptors (AR) in rat heart, but the ligands available for these studies lack the sensitivity and specificity needed to map possible differences in alpha1-AR subtype expression. We therefore used competitive reverse transcriptase-polymerase chain reaction (RT-PCR) techniques to measure steady-state amounts of alpha1-AR messenger RNA (mRNA) subtypes in tissue dissected from several regions of rat heart. We detected mRNA for alpha1A-, alpha1B-, and alpha1D-AR in each region. Irrespective of the alphaAR subtype, the total number of alpha1-AR transcripts has the following regional rank order: left ventricular papillary muscle > left ventricle > left atrium > apex > right ventricle > ventricular septum > right atria. Among the regions, the fractional contribution of alpha1A-, alpha1B-, and alpha1D-AR mRNA to the total amount of alpha1-AR displays considerable variability. The alpha1B-AR mRNA accounts for >50% of the total alpha1-AR mRNA in all regions except the ventricular septum. There are also significant percentages of alpha1A-AR in each region, especially in the papillary muscle (48%) and ventricular septum (48%). The alpha1D-AR mRNA transcripts are found in comparatively low numbers; their highest levels (18% of total) were found in the right ventricle. These differences in alpha1-AR mRNA expression may contribute to the observed regional differences in myocardial responses to alpha1-AR agonists and antagonists.

Animals↗

PubMed2002

Saccadic inhibition in voluntary and reflexive saccades.

The present study investigated saccadic inhibition in both voluntary and stimulus-elicited saccades. Two experiments examined saccadic inhibition caused by an irrelevant flash occurring subsequent to target onset. In each trial, participants were required to perform a single saccade following the presentation of a black target on a gray background, 4 degrees to the left or to the right of screen center. In some trials (flash trials), after a variable delay, a 33-msec flash was displayed at the top and bottom third of the monitor (these regions turned white). In all experimental conditions, histograms of flash-to-saccade latencies documented a decrease in saccadic frequency, forming a dip, time-locked to the flash and occurring as early as 60-70 msec following its onset. The fast latency of this effect strongly suggests a low-level, reflex-like, oculomotor effect, which was referred to as saccadic inhibition. A novel procedure was developed to allow comparisons of saccadic inhibition even across conditions, which in the absence of a flash (no-flash trials) produce dissimilar saccadic reaction times (SRTs) distributions. Experiment 1 examined the effects of the fixation stimulus on saccadic inhibition by contrasting three conditions: a gap condition (fixation stimulus disappeared 200 msec prior to target onset), a step condition (offset of the fixation stimulus was simultaneous with target onset), and an overlap condition (the fixation stimulus remained on for the duration of the trial). The overlap condition produced substantially stronger saccadic inhibition, relative to the gap and the step conditions. Experiment 2 contrasted the saccadic inhibition effect obtained for prosaccades (saccades aimed at the target) with the effect obtained for antisaccades (i.e., saccades aimed away from the same target). The onset of saccadic inhibition was earlier, and its magnitude was stronger, for antisaccades, relative to prosaccades. The plausibility that the superior colliculus is the neurophysiological locus of the saccadic inhibition effect was explored.

Attention↗

PubMed1985

Alterations in gas exchange associated with lobar atelectasis in young piglets.

Lobar atelectasis is common among infants and children with obstructive lung diseases. However, the effect of lobar collapse in the presence of diffuse lung disease on gas exchange in the pediatric age group has not been described. We developed an infant model of lobar atelectasis using piglets and tested the hypothesis that diffuse alveolar hypoxia increases shunt fraction (Qs/QT) associated with lobar atelectasis by redirecting pulmonary blood from the well-ventilated portion of the lung into the collapsed region. Shunt fraction was determined using the multiple inert gas elimination technique. The proportion of pulmonary blood flow perfusing the left lower lobe was measured with microspheres. Qs/QT increased significantly but by a variable amount to an average value (+/- SD) of 5.9 +/- 4.2% following lobar collapse. The percentage of cardiac output perfusing the left lower lobe fell by an average of 70 +/- 17% in response to lobar collapse. When animals were ventilated with 12% oxygen, shunt fraction increased to 18.7 +/- 7.1% and blood flow to the collapsed left lower lobe increased from 9 +/- 3 to 22 +/- 3% of cardiac output. Lobar atelectasis in conditions where diffuse alveolar hypoxia is present may be associated with a significantly greater intrapulmonary shunt than lobar atelectasis in children with otherwise normal lungs.

Animals↗

PubMed2006

Coronary artery disease is associated with Alzheimer disease neuropathology in APOE4 carriers.

OBJECTIVE: To examine the associations between postmortem Alzheimer disease (AD) neuropathology and autopsy-verified cardiovascular disease. METHODS: The authors examined 99 subjects (mean age at death = 87.6; SD = 8.7) from the Mount Sinai School of Medicine Department of Psychiatry Brain Bank who were devoid of cerebrovascular disease-associated lesions or of non-AD-related neuropathology. Density of neuritic plaques (NPs) and neurofibrillary tangles (NFTs) as well as coronary artery and aortic atherosclerosis, left ventricular wall thickness, and heart weight were measured. Partial correlations were used to assess the associations of the four cardiovascular variables with NPs and NFTs in the hippocampus, entorhinal cortex, and multiple regions of the cerebral cortex after controlling for age at death, sex, dementia severity, body mass index, and ApoE genotype. These analyses were also repeated separately for ApoE4 carriers and noncarriers. RESULTS: The extent of coronary artery disease and to a lesser extent atherosclerosis were significantly associated with the density of cardinal neuropathologic lesions of AD in this autopsy sample (significant correlations between 0.22 and 0.29). These associations were more pronounced for the ApoE4 allele carriers (n = 42; significant correlations between 0.34 and 0.47). CONCLUSIONS: The degree of coronary artery disease is independently associated with the cardinal neuropathological lesions of Alzheimer disease. These associations are primarily attributable to individuals with the ApoE4 allele.

Aged, 80 and over↗

PubMedDate not supplied

Information processing and interhemispheric transfer in left- and right-handed adults.

Two experiments are reported using simple reaction time (SRT) and visual evoked potentials (VEP) to measure information processing and interhemispheric transfer time (IHTT) in left- and right-handed subjects. Study 1 used an SRT procedure to estimate IHTT in 30 left-handed and 30 right-handed subjects. No differences in IHTT were indicated, but left- and right-handers were found to have opposite visual field advantages on the SRT task, indicating possible hemispheric differences in visual information processing. Study 2 was designed to test hypotheses generated in Study 1, using a VEP procedure to provide additional measures of visual information processing and IHTT. VEPs were collected during an SRT procedure in 20 left-handers and 20 right-handers, and SRT response hand and visual field advantages were replicated among right-handers only. Left-handers in Study 2 demonstrated no significant response hand or visual field effects on SRT. Analysis of the VEP N160 latency data indicated no significant laterality, hemisphere, or visual field effects, except for a robust hemisphere by visual field interaction, which reflects IHTT. The significant SRT left visual field advantage in right-handers was not reflected by hemispheric asymmetries in VEP N160 latency. It is concluded that left-handers and right-handers do not differ in IHTT in two functional regions of the corpus callosum, nor do they vary in simple visual receptive processing. Results are more consistent with variability in SRT resulting from differences in complex heteromodal processes beyond the striate and extrastriate visual cortex.

Adult↗

PubMed1982

The relevance of ventricular wall dynamics for the study of myocardial shortening in the intact left ventricle.

Although many studies have shown that ventricular wall dynamics are a useful estimate of global and regional ventricular function, the precise relations that exist during contraction among myocardial fiber shortening, wall dynamics, and left ventricular cavity changes have not been previously established. To study the relation among some geometric variables used to describe left ventricular contraction, we used as a model of the left ventricle a thick-walled cylinder that contracts both radially and longitudinally. From this model, it can be shown that there is a direct relation during contraction between the relative thickening of the ventricular wall and the relative shortening occurring within the wall. On the other hand, the parameters derived from left ventricular cavity changes (relative ventricular internal radius shortening, ejection fraction, normalized blood flow velocity) are determined not only by the relative shortening occurring within the ventricular wall but also by the specific geometry of the ventricle, expressed in terms of its mid-wall radius-to-wall thickness ratio. In the clinical situation, the ejection fraction may vary up to 20%, uniquely as a result of a change of this ratio. These findings further validate the use of ventricular wall dynamics for the study of ventricular function. On the other hand, the specific geometry of the ventricle must be considered in interpreting the parameters derived from left ventricular cavity changes.

Blood Flow Velocity↗

PubMed1991

[The cardiovascular effects of endothelin in waking rats with normal and artificially increased atriopeptide levels of the blood].

The systemic and regional hemodynamic effects of endothelin: a new vasoconstrictor peptide, were studied in alert WKY rats. The radioactive microsphere technique was used to measure cardiac output, total peripheral resistance and regional blood flow before and 10 min after bolus injection of endothelin into the left ventricle. Endothelin produced a transient hypotension followed by a long-lasting increase in blood pressure and in systemic resistance and a decrease in cardiac output. Endothelin induced a decrease in blood flow in all vascular beds to variable extent (the maximal changes were recorded in kidneys and adrenals), only the coronary blood flow being increased. In the rats receiving constant atriopeptine II infusion, the hypotensive phase of endothelin effects was augmented whereas the hypertensive phase was reduced. Atriopeptine II infusion also diminished the regional blood flow responses to endothelin in the kidneys, the adrenals and the heart.

Animals↗

PubMed1986

Control of the heterogeneity of O2 saturation in small myocardial veins.

There is a wide variability in the measured O2 saturations (SvO2) of small myocardial veins (20-100 microns). The purpose of the present study was to examine several factors that contributed to this variability. Studies were conducted on anesthetized open-chest dogs. The role of beta-adrenoceptors and flow in the control of the heterogeneity of SvO2 was assessed. The hearts were quick-frozen in liquid N2 and the SvO2 in the subepicardial and subendocardial (ENDO) regions of the left ventricule was determined by microspectrophotometry. Under control conditions, ENDO SvO2 averaged 35% with a variance of 337. The control variance was much more than that of the methodological errors. With propranolol or practolol, variance was reduced by about half, e.g. ENDO SvO2 variance was 145 with propranolol. This reduction in SvO2 variance could be prevented by isoproterenol. When flow is reduced by partial occlusion the SvO2 values were skewed toward lower saturations. When nitroglycerin is administered during this partial occlusion, the SvO2 distribution is restored toward normal. It can be concluded that some of the variability of SvO2 in the heart is control by beta 1-adrenoceptors. There also appears to be an inverse relationship between coronary blood flow and SvO2 heterogeneity. Further work is necessary to determine what other factors control the variability of SvO2.

Animals↗

PubMed1997

Demonstration of a reduction in muscarinic receptor binding in early Alzheimer's disease using iodine-123 dexetimide single-photon emission tomography.

Decreased muscarinic receptor binding has been suggested in single-photon emission tomography (SPET) studies of Alzheimer's disease. However, it remains unclear whether these changes are present in mildly demented patients, and the role of cortical atrophy in receptor binding assessment has not been investigated. We studied muscarinic receptor binding normalized to neostriatum with SPET using [123I]4-iododexetimide in five mildly affected patients with probable Alzheimer's disease and in five age-matched control subjects. Region of interest (ROI) analysis was performed in a consensus procedure blind to clinical diagnosis using matched magnetic resonance (MRI) images. Cortical atrophy was assessed by calculating percentages of cerebrospinal fluid in each ROI. An observer study with three observers was conducted to validate this method. Alzheimer patients showed statistically significantly less [123I]4-iododexetimide binding in left temporal and right temporo-parietal cortex compared with controls, independent of age, sex and cortical atrophy. Mean intra-observer variability was 3.6% and inter-observer results showed consistent differences in [123I]4-iododexetimide binding between observers. However, differences between patients and controls were comparable among observers and statistically significant in the same regions as in the consensus procedure. Using an MRI-SPET matching technique, we conclude that [123I]4-iododexetimide binding is reduced in patients with mild probable Alzheimer's disease in areas of temporal and temporo-parietal cortex.

Aged↗

PubMed1987

Regional differences in cardiac myocyte dimensions and number in Sprague-Dawley rats from different suppliers.

Previous experiments conducted in this laboratory have indicated that adult Sprague-Dawley rats obtained from Holtzman Company (H) have hearts that are significantly larger than those obtained from Charles River (CR). To investigate potential differences in cell size and number, isolated myocytes were prepared by retrograde coronary perfusion with collagenase. Cell volume (V) was measured with a Coulter Channelyzer, cell length (L) was measured directly, and cross-sectional area (CSA) was calculated from V/L. Cell number was calculated using data from isolated cells and whole-sectioned tissue. Although V for left and right ventricular myocytes was similar in CR and H rats, myocytes from CR tended to be shorter in L (P less than 0.001), but larger in CSA (N.S.) than myocytes obtained from H rats. In both H and CR, left ventricular V and CSA were greater (P less than 0.01) in endomyocardium than epimyocardium and middle myocardium. Values for V and CSA of right ventricular myocytes were less (P less than 0.01) than those from left ventricles in both H and CR. Hearts from H had 19% more myocytes than those from CR (P less than 0.05). Values for cellular dimensions from CR generally showed less variability than those from H. We conclude that significant regional differences in myocyte size are present in rats from both H and CR. Hearts from H rats have significantly more myocytes than those from weight-matched CR rats. Therefore, investigators should be aware that differences in heart weight and myocyte number can be found in rats of the same strain, but obtained from different suppliers.

Animal Husbandry↗

PubMed1997

Automatic analysis of cerebral atrophy.

3D MR data obtained for 10 healthy control subjects have been used to build a brain atlas. The atlas is built in four stages. First, a set of features that are unambiguously definable and anatomically relevant need to be computed for each item in the database. The chosen features are crest lines along which the maximal principal curvature of the surface of the brain is maximal in its associated principal direction. Second, a nonrigid registration algorithm is used to determine the common crest lines among the subjects in the database. These crest lines form the structure of the atlas. Third, a set of crest lines is taken as a reference set and a modal analysis is performed to determine the fundamental deformations that are necessary to bring the individual data in line with the reference set. The deformations are averaged and the set of mean crest lines becomes the atlas. Finally, the standard deviation of the deformations between the atlas and the items in the database defines the normal variation in the relative positions of the crest lines in a healthy population. In a fully automatic procedure, the crest lines on the surface of the brain adjacent to the cerebral ventricles in a patient with primary progressive aphasia were compared to the atlas; confirmation that the brain of this patient demonstrates atrophy was provided by stereological analysis that showed that the volume of the left cerebral hemisphere is 48.8 ml (CE 2.8%) less than the volume of the right cerebral hemisphere in the region of the temporal and frontal lobes. When the amplitude of the deformations necessary to register the crest lines obtained for the patient with the atlas were greater than three standard deviations beyond the variability inherent in the atlas, the deformation was considered significant. Four of the main deformation modes of the longest crest line of the surface of the brain adjacent to the cerebral ventricles were significantly different in the patient with primary progressive aphasia compared to the atlas. The ventricles are preferentially enlarged in the left cerebral hemisphere. Furthermore, they are closer together posteriorly and further apart anteriorly than in the atlas. These observations may be indicative of the atrophy of the temporal and frontal lobes of the left cerebral hemisphere noted in the patient. Ultimately, the approach may provide a useful screening technique for identifying brain diseases involving cerebral atrophy. Serial studies of individual patients may provide insights into the processes controlling or affected by particular disease.

Aged↗

PubMed1989

Auditory stimulation brain map.

The topography of auditory evoked potentials (AEPs) was studied in 12 neurologically normal, adult, right-handed subjects of either sex. The AEPs were recorded with seventeen active electrodes in response to 500 Hz tone bursts with a level of 75 dB HL presented either to the left or the right ear. AEP brain maps were obtained with the BRAIN ATLAS III system. A region of maximum negativity was obtained corresponding to N1 at vertex and defined as focus of N1 (FN1). The reproducibility within and between sessions of FN1 was studied and found to be good for most of the subjects. The interindividual variability was moderate and the centre of FN1 on the map was localized 7 mm in front of the vertex electrode and 8.4 and 8.0 mm to the contralateral side of the vertex electrode upon stimulation of the left and the right ear, respectively. The approximate position of the skull surface is obtained by multiplication by a factor of 3. It was concluded that a standardized test session including six single maps based on 50 stimuli each gives an average map with identifiable and reproducible focus. The basis seems to be fulfilled to use the brain map in further analysis on clinical material.

Adult↗

PubMed1994

Influence of reversible segmental left ventricular dysfunction on heart period variability in patients with one-vessel coronary artery disease.

OBJECTIVES: This study evaluated the relation between reversible segmental left ventricular dysfunction and frequency domain measures of heart period variability in patients with coronary artery disease. BACKGROUND: Heart period variability is frequently reduced in patients with coronary artery disease. However, the mechanisms of this reduction are still unclear. METHODS: Echocardiographic left ventricular wall motion and frequency domain measures of heart period variability were evaluated in 32 patients with one-vessel coronary artery disease before and 16 to 24 days after successful percutaneous transluminal coronary angioplasty. Of these, 12 patients (Group A) had normal and 20 patients (Group B) had abnormal regional wall motion. A control group of 15 healthy subjects (Group C) underwent 24-h Holter recording twice at 2-week intervals to check for spontaneous variations. RESULTS: At baseline, low and high frequency power were lower in Group B than in Groups A and C, whereas no difference was detectable in ultra low and very low frequency and total power. After coronary angioplasty, regional wall motion and frequency domain measures of heart period variability were unchanged in Group A. In Group B the mean (+/- SD) summed segment score improved from 17.1 +/- 3.6 to 12.8 +/- 2.0 (p < 0.01), and mean low and high frequency power (logarithmic units) increased from 6.14 +/- 0.23 to 6.35 +/- 0.34 (p < 0.01) and from 5.43 +/- 0.32 to 5.68 +/- 0.52 (p < 0.01), respectively. Furthermore, low and high frequency power, lower at baseline in Group B than in the other two groups, were comparable in the three groups after coronary angioplasty. CONCLUSIONS: This study demonstrates that segmental left ventricular dysfunction is involved in determining sympathovagal imbalance in patients with one-vessel coronary artery disease; the reversal of left ventricular dysfunction by successful coronary angioplasty improves the heart period power spectrum. Thus, alterations in cardiac geometry influence the discharge of afferent sympathetic mechanoreceptors, contributing to the derangement in autonomic control of heart rate.

Afferent Pathways↗