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PubMed2004

Assessing acute middle cerebral artery ischemic stroke by quantitative electric tomography.

This paper focuses on the application of quantitative electric tomography (qEEGT) to map changes in EEG generators for detection of early signs of ischemia in patients with acute middle cerebral artery stroke. Thirty-two patients were studied with the diagnosis of acute ischemic stroke of the left middle cerebral artery territory, within the first 24 hours of their clinical evolution. Variable Resolution Electrical Tomography was used for estimating EEG source generators. High resolution source Z-spectra and 3- dimensional images of Z values for all the sources at each frequency were obtained for all cases. To estimate statistically significant increments and decrements of brain electric activity within the frequency spectra, the t-Student vs. Zero test was performed. A significant increment of delta activity was observed on the affected vascular territory, and a more extensive increment of theta activity was detected. A significant alpha decrement was found in the parieto-occipital region of the affected cerebral hemisphere (left), and in the medial and posterior region of the right hemisphere. These findings suggest that qEEGT Z delta images are probably related to the main ischemic core within the affected arterial territory; penumbra, diaschisis, edema, might explain those observed theta and alpha abnormalities. It was concluded that qEEGT is useful for the detection of early signs of ischemia in acute ischemic stroke.

Acute Disease↗

PubMed1996

Echocardiographic quantification of regional left ventricular wall motion with color kinesis.

BACKGROUND: Color kinesis is a new technology for the echocardiographic assessment of left ventricular wall motion based on acoustic quantification. This technique automatically detects endocardial motion in real time by using integrated backscatter data to identify pixel transitions from blood to tissue during systole on a frame-by-frame basis. In this study, we evaluated the feasibility and accuracy of quantitative segmental analysis of color kinesis images to provide objective evaluation of regional systolic endocardial motion. METHODS AND RESULTS: Two-dimensional echocardiograms were obtained in the short-axis and apical four-chamber views in 20 normal subjects and 40 patients with regional wall motion abnormalities. End-systolic color overlays superimposed on the gray scale images were obtained with color kinesis to color encode left ventricular endocardial motion throughout systole on a frame-by-frame basis. These color-encoded images were divided into segments by use of custom software. In each segment, pixels of different colors were counted and displayed as stacked histograms reflecting the magnitude and timing of regional endocardial excursion. In normal subjects, histograms were found to be highly consistent and reproducible. The patterns of contraction obtained in normal subjects were used as a reference for the objective automated interpretation of regional wall motion abnormalities, defined as deviations from this pattern. The variability in the echocardiographic interpretation of wall motion between two experienced readers was similar to the diagnostic variability between the consensus of the two readers and the automated interpretation. CONCLUSIONS: Color kinesis is a promising new tool that may be used clinically to improve the qualitative and quantitative evaluation of spatial and temporal aspects of global and regional wall motion. In this initial study, segmental analysis of color kinesis images provided accurate, automated, and quantitative diagnosis of regional wall motion abnormalities.

Adult↗

PubMed2006

Cingulate activation increases dynamically with response speed under stimulus unpredictability.

Functional magnetic resonance imaging studies of cognition require repeated and consistent engagement of the cognitive process under investigation. Activation is generally averaged across trials that are assumed to tax a specific mental operation or state, whereas intraindividual variability in performance between trials is usually considered error variance. A more recent analysis approach postulates that these fluctuations can reflect variation in the very process taxed by the particular trial type. In the present study, participants responded to targets presented randomly in 1 of 4 peripheral locations. By employing a function of reaction time (RT) of individual trials as a linear regressor, brain regions were identified whose activation varied with RT on a trial-by-trial basis. Whole-brain analysis revealed that the anterior cingulate, posterior cingulate, and left angular/superior temporal gyri were more active in trials with faster RT but only when the target location was unpredictable. No such association was seen in trials where the target location was predicted by a central cue. These results suggest a role for the cingulate and angular gyri in the dynamic regulation of attention to unpredictable events. This is in accordance with the function of a default network that is active in the absence of top-down-focused attention and is thought to continuously provide resources for broad and spontaneous information gathering. Exploiting intertrial performance variability may be particularly suitable for capturing such spontaneous and elusive phenomena as stimulus-driven processes of attention.

Adaptation, Physiological↗

PubMed1999

Intramyocardial vascular volume distribution studied by synchrotron radiation-excited X-ray fluorescence.

We evaluated the vascular volume distribution with fine resolution (0.1-1.3 mg myocardial tissue) in the sagittal plane of the left ventricle by using the microsphere filling method in 21 dogs. The coronary arterial volume density in the sagittal plane did not exhibit normal distribution and was characterized by variability among the outer-to-inner layers and within the layers (+2SD/-2SD > 80 times), and the median values in the layers ranged from 4.7 to 22. 9 nl/mg myocardial tissue. The fractal analysis of vascular volume revealed a self-similar nature with a fractal dimension (D value) similar to that of flow distribution (1.20 +/- 0.05 and 1.24 +/- 0. 09 for vascular volume and flow distribution, respectively) and had a more marked variability than the flow. The correlation of the regional vascular volume between adjacent regions decreased as the distance increased. However, the correlation coefficients in the endocardial-to-epicardial direction were significantly higher than those in the anterior-to-posterior direction (P < 0.05 by paired t-test). In conclusion, we determined intramyocardial vascular volume density in the sagittal plane, and the distribution revealed considerable variability, self-similarity, and asymmetry in the correlation among the adjacent regions. These observations could be related to the characteristics of the intramural coronary vascular network.

Animals↗

PubMed1988

Comparative effects of nitroprusside and pinacidil on myocardial blood flow and infarct size in awake dogs with acute myocardial infarction.

The effect of nitroprusside in limiting myocardial infarct was compared with that of pinacidil, a new antihypertensive agent with potent coronary vasodilator properties, in instrumented awake dogs subjected to 4 hr of left anterior descending coronary artery occlusion and 20 hr of reperfusion. Dogs were randomly assigned to receive intravenous normal saline, nitroprusside, or pinacidil beginning 40 min after the onset of coronary artery occlusion and continuing throughout the occlusion and the first hour of reperfusion. Nitroprusside and pinacidil were titrated to decrease mean aortic pressure by 25 mm Hg; normal saline had no effect on mean aortic pressure. Other systemic hemodynamic variables were not significantly altered by normal saline or nitroprusside, and myocardial blood flow did not change during normal saline infusion in normal and ischemic myocardium. In contrast, nitroprusside increased the blood flow and the endocardial/epicardial flow ratio in ischemic myocardium. This increase in ischemic myocardial blood flow was accompanied by a significant reduction in infarct size (40 +/- 3% of region at risk vs 58 +/- 4% in the normal saline group; p less than .05). Pinacidil increased heart rate, cardiac output, and the peak rate of rise of left ventricular pressure. Furthermore, despite causing a threefold to fourfold increase in normal myocardial blood flow, pinacidil had no effect on either blood flow to ischemic myocardium or infarct size (57 +/- 5%). The data indicate that the marked coronary vasodilator effect of pinacidil does not cause an increase in ischemic blood flow or a reduction in infarct size.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1998

Quantification of early damage in latissimus dorsi muscle grafts.

Acute damage in the latissimus dorsi muscle may account for variable clinical results following dynamic cardiomyoplasty and an ischemic cause has been suggested. Using established techniques, we set out to demonstrate and to quantify the acute muscle damage in a rodent model. The left latissimus dorsi muscle of 5 Sprague-Dawley rats was mobilized on its thoracodorsal vascular pedicle, thus interrupting the regional blood supply to its distal part. The undisturbed contralateral muscle served as a matched control. After 24 hours, the muscle was excised and divided into proximal, middle, and distal thirds. Damage was graded histologically and quantified by nitroblue tetrazolium macrohistochemistry. Both methods of assessment correlated well (r=-0.936; P < 0.001) and demonstrated significant damage, principally in the middle and the distal regions of the ischemic muscles. Therefore, the rodent model appears to be useful for investigating the pathogenesis and prevention of acute ischemic damage in the latissimus dorsi graft under conditions resembling the clinical scenario.

Animals↗

PubMed1993

Ventriculo-coronary arterial connections in pulmonary atresia with intact ventricular septum, and their influences on ventricular performance and clinical course.

To define the influence of ventriculo-coronary (VC) arterial connections on ventricular performance and late outcome, and associated wall motion abnormalities in patients with pulmonary atresia and intact ventricular septum, 21 patients aged > or = 6 months (mean 4.3 +/- 3.3 years, range 0.5 to 11.8) were reviewed. Ventricular volumes, mass, systolic functional variables and regional wall motion were measured using biplane ventricular cineangiography. Fourteen patients had VC connections, 11 of whom had coronary artery abnormalities. In comparing patients with VC connections and coronary abnormalities (group I) with those without coronary abnormalities (group II), no hemodynamic differences were observed, except the expected increased right-to-left ventricular systolic pressure ratio in group I (1.33 +/- 0.24 vs 0.72 +/- 0.50). Wall motion abnormalities were observed in 8 patients (7 in group I, and only 1 in group II [p < 0.05]). Ejection fraction in patients with abnormal wall motion was significantly lower (50 +/- 6% vs 57 +/- 7%; p < 0.05) and ventricular systolic pressure ratio significantly higher (1.46 +/- 0.16 vs 0.80 +/- 0.45; p < 0.05) than in those with normal wall motion. Five patients died during follow-up, all of whom had wall motion abnormalities. The findings suggest that patients with VC connections and coronary abnormalities have a higher incidence of wall motion abnormalities, which may reflect ongoing ischemia, and are at risk for late death.

Analysis of Variance↗

PubMed2000

[Polymorphism of vascular angiotensin II receptor gene and cardiovascular disorders].

AIM: To study polymorphism of the gene of vascular angiotensin II receptor. MATERIALS AND METHODS: Polymorphism that consists in variability of adenine (A) and cytosine (C) residues at position 1166 of the gene for vascular angiotensin II receptor (AT1R) was analyzed in a Moscow population (n = 98) and three groups of affected patients with myocardial infarction (n = 32, MI), left ventricular hypertrophy (LVH, n = 38) and essential hypertension (EH, n = 178). Polymorphic region of the AT1R gene was amplified using the polymerase chain reaction (PCR) and genomic DNAs from human whole blood as template. PCR products were electrophoresied in a gel after digestion with BstDEI restriction nuclease. Significance of differences in distribution of both allele and genotype frequencies at the population sample and in affected patients were estimated via exact Fisher's test. RESULTS: A significant decrease in the frequency of the A genotype was detected in all the three affected groups compared to healthy controls. Besides, the frequency of the A allele was significantly decreased in EH group with a corresponding increase in the frequency of both the AC genotype and the C allele. CONCLUSION: The A1166C polymorphism of the AT1R gene is associated with EH, MI and LVH in a Moscow population. The association is stronger with EH. The A allele and the AA genotype protect against development of disorders at early onset while the other genotypes and the C-allele are risk factors. A protective role of the AA genotype is more significant than predisposition action of the CC homozygote.

Alleles↗

PubMed2006

[Cardiomyopathy and sport].

Hypertrophic cardiomyopathy (HCM) remains the main cause of sudden death in top class sportsmen and women. In these persons, practicing over 10 hours of sport per week and/or engaging in competitions in the younger age group, the distinction between physiological and pathological left ventricular hypertrophy, (LVH) is usually easy. In favour of physiological LVH, the hypertrophy is symmetrical, < 13mm on echocardiography (12mm in women and adolescents), non obstructive, with normal or slightly increased left ventricular size (> or = 55mm), only slight left atrial dilatation, mitral E/A ratio > 1 with normal tissue Doppler parameters, normal ECG with no symptoms or family history (HCM or sudden death). When left ventricular wall thickness is 13 to 15 mm, in the absence of these reassuring criteria, further investigations (stress ECG and echocardiography, Holter ECG) should be systematic, as should be a family enquiry and, if possible, echocardiography after stopping training in order to check regression of the LVH. Left ventricular wall thickness > 15mm should be considered HCM and sporting activities should be forbidden. The problem of dilated cardiomyopathy should be considered when LV diastolic diameters > 60mm (especially as its regression after stopping training is variable) and LV ejection fractions are < 50% and do not improve on exercise: other warning signs include regional dilatation and wall motion abnormalities, abnormal Doppler filling indices or a positive family history.

Cardiomyopathy, Dilated↗

PubMed1984

[Prevention of gas microemboli during cardiac surgery. Numerical control of cardiac cavity purging by an ultrasonic detector].

Despite all precautions taken by cardiac surgeons to eliminate air remaining in the cardiac cavities and pulmonary veins at the end of cardiopulmonary bypass, many micro bubbles probably remain and pass into the systemic circulation with a risk of deteriorations of cerebral or myocardial function. Over the last four years we have used ultrasound to try to prevent the risk of preoperative gas microemboli: the machine is equipped with a detector (a quartz oscillator coupled to a piezoelectric transducer emitting a continuous beam of ultrasound at a frequency of 5 Mhz) which allows the following variables to be determined: the time interval from the onset of detection, the total quantity of bubbles (arbitrary units) in the examined regions, the quantity of bubbles detected over a given time interval which can be adjusted from 15 to 120 seconds. The passage of bubbles is also indicated by light and sound alarms. The smallest diameter of bubbles which can be detected is about 10 mu. There are periaortic probes adaptable to the calibre of the ascending aorta, transcutaneous probes for carotid artery detection and a left ventricular probe. In a preliminary series of 74 valve replacements in adults, this apparatus was used immediately after terminating cardiopulmonary bypass after we had thought that the cardiac cavities had been satisfactorily purged of air, and whilst active aspiration was continued in the ascending aorta distal to the periaortic probe: the total quantity of bubbles detected varied from less than 50 to more than 2000 AU, over a variable period of time which may exceed 20 min after termination of cardiopulmonary bypass. The total quantity of bubbles recorded after mitral valve (582 +/- 154 AU) or combined mitral and aortic valve replacement (685 +/- 167 AU) was generally greater than after isolated aortic valve replacement (335 +/- 126 AU). Therefore, after cardiopulmonary bypass, and despite all efforts at purging the air, we showed that numbers of microbubbles were ejected into the ascending aorta for a variable period of time: only some of them were eliminated by active aspiration through a trocar placed distal to the periaortic probe. The right coronary ostium was poorly protected against microbubbles because of its anatomical situation (6 cases in this series). We therefore established a protocol for the use of this apparatus to aid the purging of the cardiac cavities and pulmonary veins before stopping cardiopulmonary bypass: the manoeuvres, guided by the ultrasound probes, are performed before the left ventricle is allowed to eject blood into the ascending aorta.(ABSTRACT TRUNCATED AT 400 WORDS)

Embolism, Air↗

PubMed1999

Use of a common computerized program for echocardiogram archiving and reporting over a regional territory: feasibility and clinical and research impact during a 5-year experience.

The aims of this study were to optimize interlaboratory standardization of echocardiographic reporting (qualitative terms and quantitative parameters) and to evaluate the feasibility and clinical and research impact of collecting echocardiographic data in a standard computerized format over a geographical territory. In April 1992, a computer program of echocardiogram archiving and reporting (ARCE) was distributed at no cost to the 23 hospital echocardiographic laboratories operating in our region (Liguria). In April 1993 (1-year survey), 16 (70%) of the 23 hospital echo laboratories operating in our region were routinely using ARCE. In April 1997 (4-year survey ), 21 (87%) of the 24 echo laboratories were routinely using the system and 128,642 echocardiograms had been databased. ARCE is a powerful tool both for education and training in cardiac ultrasound and for undertaking multicenter studies by 95% of the users. Regarding the quality improvement process, we achieved 3 main goals: (1) a unique report format from 87% of Ligurian echo laboratories, which improved the communication between echocardiographers and other physicians; (2) development of specific, Ligurian population-based reference limits for M-mode and 2-dimensional quantitative parameters; and (3) interlaboratory comparison and standardization of both quantitative and semiquantitative evaluation of heart valve disease, left ventricular systolic and diastolic function, valve prosthesis function, and left ventricular hypertrophy. Regarding the scientific activity in Liguria, 9 multicenter studies in which 15 Ligurian echo laboratories took part were organized and completed in 5 years. Our 5-year experience shows that it is possible to create a large database of echocardiographic data that uses a fast, easy-access, and easy-to-use program of echo archiving and reporting that contains standardized variables. The use of this program on a regional territory scale appeared feasible and useful both for educational and training purposes. In addition, it stimulated the quality improvement process in echocardiography as well as performance of epidemiologic and clinical multicenter studies.

Computer Communication Networks↗

PubMed1975

Objective and subjective analysis of left ventricular angiograms.

In order to determine the reproducibility of analyses of left ventriculograms, 35 cineangiograms were evaluated by four observers, two using standard quantitative techniques to determine ventricular volumes and a newly devised quantitative system to evaluate wall motion and two others using only visual inspection of the angiograms. Objective analysis repeated by the same observer correlated well for end-diastolic and end-systolic volumes and ejection fraction (r = .98, .99, respectively) and only one of 105 (1%) wall segments were identified differently. Variability in assessments increased when comparisons were made with a second objective observer. Correlation coefficients for the three volumetric parameters were .93, .98, and .95 and there was disagreement in the assessment of 8% of wall segments. Wide variability was present between an objective and two subjective observers in analyses of end-diastolic volumes (r = .63, .64). Regional wall motion was assessed differently in 19% and 27% of segments, respectively. Though the correlation of objectively and subjectively determined ejection fractions was much better than the correlation for volume (r = .92, .84), it was not as good as the correlation between two objective observers. Occasional errors of clinical significance occurred. We conclude that subjective analysis has a significant error rate and that reproducibility and accuracy of analysis of left ventriculograms require objective analysis.

Angiocardiography↗

PubMed2003

Metabolic correlates of behavioral and affective disturbances in frontal lobe pathologies.

OBJECTIVE: Although previous studies have shown that the human frontal cortex is involved in the experience of emotions as well as in social behavior, data regarding the exact anatomical substrates of behavioral and affective deficits in frontal lobe pathologies are still scarce. The aim of this study was to investigate the metabolic correlates of these deficits in a group of non-selected consecutive patients with frontal lobe lesions. PATIENTS AND METHODS: Clinicometabolic correlations between several emotional and social parameters and metabolic patterns in the frontal cortex and amygdala were investigated in 32 patients with frontal lobe pathologies. The behavioral disturbances were evaluated using the Lhermitte's informant questionnaire. Regional cerebral glucose metabolism was measured with [(18)F] fluorodeoxyglucose and high-resolution positron emission tomography. Statistical analysis was performed using both single variable correlation and multiple regression analyses. RESULTS: Both single variable and multivariate analyses demonstrate that decreased regional glucose metabolism in the right medial area 10 was associated with apathy. There were also significant negative relationships between metabolism in the right orbitofrontal cortex and stereotypy and indifference to rules. Impulsiveness, personality disturbances and loss of emotional control were associated with decreased metabolism in the left amygdala. CONCLUSIONS: In terms of clinicometabolic correlations, the present data support the implication of different functional anatomic systems in frontal lobe-related behavioral and affective disturbances. In particular, they imply that the classically described symptoms of impaired behavioral control may be related to right orbitofrontal cortex hypometabolism whereas impaired regulation of emotions may result from a functional damage of the left amygdala.

Adult↗

PubMed2006

A new investigation of the marine ciliate, Trachelostyla pediculiformis (Cohn, 1866) Borror, 1972 (Ciliophora, Hypotrichida), with establishment of a new genus, Spirotrachelostyla nov. gen.

The morphology and infraciliature of the type species of the ciliate genus Trachelostyla, T. pediculiformis (Cohn, 1866) Borror, 1972, collected from the Bohai Sea near Tianjin, north China, were investigated using live observation and protargol impregnation. The Chinese population corresponds well with the original description, as follows: size about 80-150 x 20-30 microm in vivo; body dorsoventrally flattened and non-spiral; outline elongate, with anterior region conspicuously narrowed while posterior not; on average 14 macronuclear nodules, two micronuclei and 42 adoral membranelles; 16-24 cirri in left and 21-31 in right marginal row. In total 18 frontoventral-transverse cirri: constantly 11 cirri in frontal area and two ventral ones together with five enlarged transverse cirri (TC). Three inconspicuous caudal cirri (CC); six dorsal kineties with prominent cilia. The literature on T. pediculiformis is critically reviewed, showing that the descriptions so far do not agree very well. To clarify the taxonomic status of this species, the population from the Chinese coast of the Bohai Sea is designated as a neotype. The small subunit rRNA gene was sequenced for the neotype and the molecular phylogenetic tree basically supports the establishment of the family Trachelostylidae Small & Lynn, 1985. Based on the data obtained, the genus Trachelostyla Borror, 1972 is redefined thus: dorsoventrally flattened trachelostylids, body non-spirally twisted and elongate, with peristomal region conspicuously narrowed; ciliature generally in 11:2:5:3 pattern, i.e. 11 cirri in frontal region, two ventral cirri located anterior to five TC, three CC present; one left and one right row of marginal cirri not confluent posteriorly. A new genus Spirotrachelostyla nov. gen. is proposed to include the taxa which were previously assigned to Trachelostyla but characterized by spirally twisted, spindle-like body shape and a variable number of cirri in the peristomal area. Three new combinations are suggested: Spirotrachelostyla spiralis (Dragesco & Dragesco-Kernéis, 1986) nov. comb. [basionym: Trachelostyla spiralis Dragesco & Dragesco-Kernéis, 1986], S. tani (Hu & Song, 2002) nov. comb. [basionym: T. tani Hu & Song, 2002] and S. simplex (Kahl, 1932) nov. comb. [basionym: Stichotricha simplex Kahl, 1932].

Animals↗

PubMed2006

Hand skill and hand-eye preference in relation to verbal ability in healthy adult male and female right-handers.

Verbal as well as non-verbal performances were investigated in relation to both hand skill assessed by finger-tapping performances and hand-eye preference in 83 healthy adult right-handers, most of them students. The primary objective of this study was to show better finger-tapping performances in right-handed participants with best verbal IQ values. We found that it was not the non-verbal but the verbal abilities that were related to finger-tapping performances. This was proven, especially as to the left-hand taps. Faster left-hand taps in participants with higher verbal IQ values may be due to a closer cooperation of right-hemispheric regions in information processing and an intimate relationship between language and finger-motor functions. Secondary objectives assessed by explorative data analyses included gender differences and hand-eye preference. While in the females left-hand taps correlated somewhat more with verbal IQ values, in the males this effect was seen in selected variables of the right-hand taps. Moreover, laterality assessed in finger-tapping performances may not be in accordance with laterality found in the handedness questionnaire. In addition to this, congruent hand-eye dominance was found to be slightly more prevalent in participants with best verbal IQ values. However, these findings will have to be confirmed in further experiments.

Adult↗

PubMed1986

Regional cerebral blood flow during interictal state: differences between temporal lobe epilepsy and primary generalized epilepsy.

Regional cerebral blood flow (rCBF) was investigated during interictal state by 133Xenon intravenous clearance technique in two groups of epileptic patients: group I (n = 28) having partial complex seizures (temporal lobe epilepsy); group II (n = 14) having generalized seizures (primary generalized epilepsy). Mean hemispheric CBF was decreased in group I and unchanged in group II compared to normal controls. Modifications in rCBF pattern were observed in group I but not in group II. A marked hypoperfusion of one temporal region was found in patients from group I showing a unilateral and fixed epileptic focus. Hypoperfusion of other cerebral areas at a distance from the epileptic focus was greater for patients with a left epileptic focus than for those with a right epileptic focus. Patients with the same severity of disease and bilateral and variable foci had no significant modification of mean hemispheric CBF and rCBF distribution. These observations indicate that interictal investigations of rCBF may be of interest for a differential classification of epilepsy.

Adolescent↗

PubMed2006

Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease.

BACKGROUND: Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD. METHODS: 46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed. RESULTS: Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 +/- 9 vs. 48 +/- 8, 62 +/- 10 vs.59 +/- 10, and 61 +/- 9 vs. 58 +/- 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 +/- 5 vs. 42 +/- 7, 53 +/- 7 vs. 50 +/- 7, 51 +/- 7 vs. 47 +/- 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 +/- 1.6 vs. 7.2 +/- 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 +/- 1.5 vs. 7.9 +/- 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 +/- 1.3 vs. -4.1 +/- 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 +/- 0.4 vs. -0.94 +/- 0.3; p = ns) in Group 3. CONCLUSION: A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD.

Adult↗

PubMed1993

Factors influencing 1-year patency of coronary artery saphenous vein grafts. Studio Indobufene nel Bypass Aortocoronarico (SINBA).

BACKGROUND: To evaluate the possible influence of a series of clinical angiographic and surgical variables on the 1-year patency of saphenous vein (SV) coronary graft, data collected prospectively in a multicenter randomized clinical trial were analyzed. METHODS AND RESULTS: The study group included 349 patients--847 SV distal anastomoses--who underwent angiography at a median time of 374 days after surgery. By logistic binomial regression analysis, age, sex, smoking habits, hypertension, high cholesterol, previous myocardial infarction, and angina were not found to be significant factors leading to graft occlusion. Among the angiographic and surgical variables, the following were retained as predictive of higher occlusion risk: (1) vessel diameter (< or = 1.5 mm versus > 1.5 mm, odds ratio (OR) = 2.46); (2) the location of the grafted vessel, namely, the right coronary artery versus the left anterior descending (OR = 2.15); and (3) the wall motion of the vessel-dependent myocardial region (altered versus normal: OR = 2.12). The presence of two or three risk factors multiplied the occlusion risk up to 11-fold. CONCLUSIONS: The study suggests that vessel diameter, wall motion of the vessel-dependent myocardial region, and location of the grafted vessel are the main determinants of SV coronary graft patency during the first postoperative year. Knowledge of these artery-specific factors may provide a basis for estimating the risk of graft occlusion, thereby modifying surgical strategy and postoperative surveillance.

Aspirin↗