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PubMed1992

[Echocardiographic study of hypertrophic myocardiopathy in children. Distribution and changing morphological course].

Thirty-eight children with diagnosis of hypertrophic cardiomyopathy were analyzed by M-Mode, two-dimensional and Doppler. The patients ranged in age from 7 days and 20 years (average 5 years). Three groups appear, based in morphologic myocardial affection. Patients with biventricular involvement ranged in age from 20 days and 6 months (group 1), patients aged until 6 years with left ventricular concentric morphology by echocardiographic examination (group 2), and the older in age group (group 3) with localized mid-ventricular hypertrophy in the same ventricle. A certain degree of obstruction was detected in 15 cases (46.8%). In both this aspect and systolic anterior motion of mitral valve and mitral regurgitation, the highest frequency was obtained in group 3. With respect to others echocardiographic parameters, like isovolumetric relaxation time and left ventricle short fraction, no variations have been observed between the three groups. Very interesting is the fact that one third of the patients of group 1 improved markedly, and another third of cases died. In conclusion, the echocardiography permits identify three groups in the hypertrophic cardiomyopathy in children, according to age and anatomic region affected. The variability of evolution in the youngest group of patients, suggest that certain cases are not true myocardiopathies, but myocardial hypertrophies secondaries to other problems. Only the oldest group supply the classics parameters of the adult hypertrophic cardiomyopathy.

Adolescent↗

PubMed2006

Risk factors for postoperative heart failure in patients operated on for aortic stenosis.

BACKGROUND: Risk factors for postoperative heart failure (PHF) have not been specifically studied in valve surgery although it has been acknowledged that patient variables may have a more profound influence on postoperative outcome than valve-related factors. METHODS: All patients undergoing isolated aortic valve replacement for aortic stenosis from January 1995 to December 2000 in the southeast region of Sweden were studied (n = 398). Forty-five patients with aortic valve replacement required treatment for PHF. Univariate and multivariate logistic regression analysis was carried out to identify risk factors for PHF. RESULTS: Thirty-day mortality was 6.7% versus 1.4% for patients with and without PHF, respectively (p = 0.05). With regard to clinical presentation of aortic stenosis, angina was associated with reduced risk, whereas history of congestive heart failure increased the risk for PHF. Five preoperative (hypertension, history of congestive heart failure, severe systolic left ventricular dysfunction, pulmonary hypertension, preoperative hemodynamic instability) and two intraoperative (aortic cross-clamp time, intraoperative myocardial infarction) variables were identified as independent risk factors for PHF. Patient-prosthesis mismatch did not influence the risk of PHF significantly. CONCLUSIONS: Postoperative heart failure was associated with a marked increase in postoperative mortality and morbidity. Risk factors for PHF were variables indicating preexisting myocardial dysfunction, increased right or left ventricular afterload, and intraoperative myocardial injury. Our results highlight issues concerning cross-clamp time and myocardial protection, particularly for patients with preoperatively compromised myocardial function. Asymptomatic patients with significant aortic stenosis should be considered for surgery before substantial echocardiographic evidence of left ventricular dysfunction or increased pulmonary artery pressure develops.

Aged↗

PubMed2006

Functional mapping and single chain construction of the anti-cytokeratin 8 monoclonal antibody TS1.

The anti-cytokeratin (CK) 8 monoclonal antibody (mab) TS1 has been shown to efficiently bind to CK8 expressed in carcinomas in vivo. The anti-idiotypic antibody of TS1, alphaTS1, can be used to regulate the tumor:non-tumor ratio of TS1 by clearing non-tumor binding TS1 from the circulation. If the interaction of TS1 to CK8 and alphaTS1 is fully understood, mutations can be used to improve the tumor:non-tumor ratio. A scFv was made of the mab TS1 and residues earlier identified by Erlandsson et al. as important for the interaction with both its antigen CK8 and its anti-idiotype alphaTS1, were mutated to alanine or amides and expressed in E. coli. The effects of the mutations were studied by ELISA and residues important for the interactions to both CK8 and alphaTS1 were identified as mainly tyrosines, charged residues, a serine and a tryptophan. Altogether, nine amino acid residues in TS1 were found to be important in the interaction to alphaTS1 and six residues for the interaction to CK8. Important residues, clustered together in the modelled protein, were identified as residues from CDR 3 of the heavy chain and the unexpected participation of a residue in CDR 2 of the light chain. Some of the important residues are likely to be hotspots. Hotspots constitute a few residues in an interaction that contribute most to the binding, energetically. Amino acid residues in hotspots often cluster together in the center of the interaction interface, but can also be spread out to the periphery. The hotspots are often surrounded by hydrophobic patches, which are seen in the modelled TS1 protein used in this study. Amino acid residues that increased the affinity when mutated were also identified for both interactions. These residues are likely to be located outside the interacting interface. It can from this study be concluded that it is wise to precede the mutational procedure with experiments that can give guidelines for the selection of which amino acid residues to mutate. If the guidelines from the chemical modifications from Erlandsson et al. not had been used, this study would have left some residues unmutated and thereby missed important information.

Amino Acid Sequence↗

PubMed1977

Evolution of regional ischemia distal to a proximal coronary stenosis: self-propagation of ischemia.

The temporal evolution of myocardial ischemia was studied in open chest dogs at constant preload, afterload and heart rate. In one group of animals, a variable circumflex arterial stenosis was used to maintain constant distal circumflex arterial hypotension (40 to 50 mm Hg). During a 3 hour period of stenosis, flow in the subendocardial fourth of the ischemic ventricular wall decreased from 0.22 to 0.09 ml/g per min (P less than 0.02), whereas subepicardial flow was not significantly changed. Local vascular resistance, therefore, doubled in the most ischemic area of myocardium. In a second group of animals in which proximal coronary stenosis was held constant and pressure varied, an ischemia-mediated increase in local vascular resistance was also demonstrated. In addition, a reciprocal relation was observed between changes in flow in the left anterior descending coronary region and changes in collateral flow to the region of the circumflex artery. A coronary steal mechanism and an ischemia-mediated resistance increase may be two means by which ischemia is self-propagating.

Animals↗

PubMed1984

Effects of castration, with and without testosterone replacement, on leg bone integrity in the domestic fowl.

Studies were conducted to assess the effects of castration on leg bone integrity of male White Leghorn chickens. Eighteen 5-week-old males were randomly allocated to 3 groups: group 1--intact controls, group 2--castrated, and group 3--castrated and subsequently treated with testosterone (T)-filled Silastic capsule implants. Body weight and plasma concentrations of luteinizing hormone, androgens, and total calcium were measured in each bird at intervals throughout the experiment. Subsequently, radiographs were performed upon the tibiotarsus-tarsometatarsus region of the left limb of birds from the 3 treatment groups at 7, 35, and 47 weeks of age and assigned a score of 1 to 3 (1 = normal; 3 = greatest pathologic change). Analysis of radiologic scores indicated that at 35 and 47 weeks, castrated birds (group 2) had a mean score significantly greater than that of control birds (group 1). The abnormality was typified by hyperossification with exostoses in the ossified tibial cartilage and lateral calcaneal ridge. In contrast, radiologic scores from individual T-implanted castrated birds (group 3) at 35 and 47 weeks were more variable, but the mean score was not statistically different from that of the control group. We conclude that the depression of circulating concentrations of sex steroids, by castration, in young male chickens results in hypercalcification of the tibiotarsus-tarsometatarsus region of the limb. This effect appears to be mediated directly or indirectly by T or a metabolite of T.

Animals↗

PubMed2003

Detection of acute myocardial ischemia during pharmacological stress in graded coronary artery stenosis: analysis of left ventricular asynchrony using Fourier phase imaging in pigs.

BACKGROUND: Stress echocardiography is increasingly used to identify coronary artery disease, but quantitative techniques are required to improve the accuracy of this method. Current algorithms used to analyze wall motion usually neglect motion asynchrony that is found in acute ischemia. Fourier phase imaging of echocardiographic images may offer the possibility to detect asynchrony, but its feasibility with dobutamine stress echocardiography (DSE) is undefined. The aim of this study was to investigate whether the extent of left ventricular asynergy can be used to quantify the severity of regional myocardial dysfunction and to detect functionally significant coronary artery stenoses during DSE. METHODS: Regional wall motion abnormalities were induced by graded coronary stenoses (mild and severe) of the left anterior descending coronary artery (LAD) in seven open-chest anesthetized pigs. DSE (10-40 microg/kg/min) was performed under control conditions and during sustained ischemia. Coronary flow was measured under resting conditions and during maximal hyperemic response due to intravenous infusion of adenosine. Functional significance of stenoses was defined as mild when coronary flow reserve (CFR) was reduced but > 1.5 and severe when CFR was < or = 1.5. Echocardiographic cine loops were mathematically transformed using a first-harmonic Fourier algorithm displaying the sequence of wall motion as phase angles in parametric images and regional phase histograms. The phase difference (PD) of the first Fourier harmonic of posterior vs. anterior myocardial wall motion was calculated as an index of left ventricular asynchrony. Segmental fractional area shortening (FAS) and wall thickening (WT) as ratio of stress to rest served as a reference method of regional wall motion. RESULTS: The increase in FAS (1.62 +/- 0.6 vs. 0.42 +/- 0.2, p = 0.0002) and WT (1.92 +/- 0.5 to 0.3 +/- 1.1; p = 0.004) in anterior regions during DSE was significantly higher in the control group compared to severe ischemia but not compared to mild ischemia. During graded ischemia, profiles of phase angles were consistently modified, showing a delayed onset in regional contraction. The mean PD during DSE in the control group was 10.4 +/- 7 degrees. PD rose in mild ischemic segments (CFR > 1.5) to 28.9 +/- 10 degrees (p = 0.003) and to 89.6 +/- 25 degrees (p = 0.0002) in severely ischemic segments (CFR < or = 1.5). There was a significant inverse correlation between the PDs and WT (r = -0.87, p < 0.0001). Normal WT ratios yielded low phase angles while segmental phase angles increased with decreased WT. The intraobserver variability of phase analysis was 2.7 +/- 24 degrees (mean +/- 2SD). CONCLUSIONS: These results suggest that left ventricular asynchrony is an indicator of acute ischemia. Echocardiographic Fourier phase imaging is feasible to quantify wall motion displaying contraction sequence in a simple and objective format and is a promising approach for the clinical interpretation of stress echocardiograms.

Adenosine↗

PubMedDate not supplied

Effects of the new calcium antagonist PN 200-110 on the myocardium and the regional peripheral circulation in anesthetized cats and dogs.

The effects of PN 200-110 (PN), isopropyl 4-(2,1,3- benzoxadiazol -4-yl)-1,4-dihydro-5-methoxycarbonyl-2,6-dim ethyl-3- pyridinecarboxylate , on the cardiovascular system were investigated. In chloralose-urethane-anesthetized cats PN decreased blood pressure (BP) and heart rate (HR) and increased cardiac output (CO) and total peripheral resistance dose dependently after intravenous doses of 1-10 micrograms/kg. Regional blood flow changes effected by an intravenous dose of 10 micrograms/kg were measured with microspheres. Flow to the heart, brain, and skeletal muscle increased selectively, and intramyocardial flow was redistributed in favor of the left ventricular subepicardial layer. The duration of action differed for various effects. The bradycardia was short lasting, and the cerebral vasodilatation persisted longest. It was not possible to predict the duration of action of PN on different target tissues by observing only one variable such as BP. Chloralose-urethane-anesthetized open-chest dogs appeared to be more sensitive to PN than cats. A dose of 3 micrograms/kg i.v. markedly increased coronary flow, lowered BP, increased CO, and tended to lower HR and to increase myocardial contractility. Myocardial oxygen consumption was lowered. PN did not alter diastolic excitation threshold or any electrocardiographic intervals in closed-chest anesthetized dogs. Absence of myocardial depression, potent vasodilator activity, and long duration of action might render PN useful for the treatment of hypertension and angina pectoris.

Anesthesia↗

PubMed1987

Time course of recovery of "stunned" myocardium following variable periods of ischemia in conscious and anesthetized dogs.

Persistence of regional contractile dysfunction after restoration of blood flow to transiently ischemic myocardium has been well described. To date, most studies have been performed in anesthetized animals. The present investigation compared the time course of recovery of regional segment shortening (percentage of segment shortening) in anesthetized versus conscious dogs subjected to a brief period of total occlusion of the left anterior descending coronary artery. Periods of occlusion lasting 5, 10, and 15 minutes were followed by 3 hours of reperfusion. Dogs anesthetized with sodium pentobarbital (30 mg/kg intravenously) had a significantly higher heart rate and blood pressure and lower dP/dt than conscious dogs. Coronary artery occlusion resulted in similar degrees of regional dyskinesis or akinesis, indicative of severe myocardial ischemia, in all experiments. During reperfusion, a gradual return of contractile function toward baseline was observed. At the end of the first 15 minutes of reflow, dogs subjected to 5 minutes of coronary occlusion demonstrated approximately 70% of control segment shortening in the previously ischemic zone. Animals subjected to 10- and 15-minute periods of coronary artery occlusion showed approximately 60% and 40% of control segment shortening at the same time point, respectively. The remainder of the 3-hour reperfusion period was characterized by a more gradual recovery of regional segment function. No differences were observed between anesthetized and conscious animals. It is concluded that the time course of functional recovery of postischemic reperfused myocardium is directly related to the duration of coronary occlusion and is similar in conscious and anesthetized dogs.

Anesthesia, Intravenous↗

PubMed1999

Cerebral cortical dysplasia and digital constriction rings in Adams-Oliver syndrome.

Adams-Oliver syndrome (AOS) is characterised by aplasia cutis congenita of the scalp and variable degrees of terminal transverse limb defects. Short fingers and hypoplastic nails also occur in this predominantly autosomal dominant syndrome which displays marked variability of expression and lack of penetrance in some cases. We describe a boy with AOS whose sister is also mildly affected. Their mother has hypoplastic fifth toenails which may represent very mild expression of the syndrome. Brain (computed tomography) imaging to investigate mild left hemiparesis in the boy demonstrated severe cortical dysplasia of central, occipital and anterior regions of the right cerebral hemisphere. A variety of brain and cranial malformations has been reported in AOS but dysplasia of the cerebral cortex has not been noted previously. In addition, the boy and his sister have apparent constriction rings present on the toes which are uncommon in AOS.

Cerebral Cortex↗

PubMed1998

Optimal bovine pericardial tissue selection sites. II. Cartographic analysis.

In Part I of this work we used small-angle light scattering (SALS) to quantify the fiber architecture of 20 bovine pericardial sacs, along with corresponding tissue-thickness measurements, to determine optimal material selection sites. In order to determine the anatomic consistency of these sites, the fiber architecture and thickness data from all 20 sacs were averaged together using a cartographic analysis method that took advantage of the geometry of the prolate spheroid mold used to process the sacs. Optimal selection sites were determined based on a local criteria where all fiber preferred directions within a 2.54-cm circular area were within +/- 10 degrees. The largest contiguous area (LCA) for the entire BP sac was 20.54 cm2, located in the vicinity of the left ventricle of the heart. The LCA tissue thicknesses were also relatively uniform, further supporting the use of these areas. However, even within these optimal areas there was a +/- 20 degrees standard deviation in local fiber preferred directions, resulting in at best a 40 degrees spread in local preferred directions. The observed structural variability may be due to regionally heterogeneous physiologic loadings induced by the ligamentous attachments. These attachments may alter the regional fiber preferred orientation to support local mechanical loadings. Overall, given the inherent structural variability of the BP sac, we conclude that use of anatomic location alone will not consistently guarantee the selection of tissue specimens with a highly homogeneous and predictable fibrous structure. It is thus suggested that a direct fiber measurement presorting method be employed when selecting BP specimens for bioprosthetic applications where tissue structural homogeneity and uniformity is critical.

Animals↗

PubMed1999

Genetic variation of chlorella viruses: variable regions localized on the CVK2 genomic DNA.

A physical map of the Chlorella virus CVK2 genomic DNA has been constructed based on a cosmid contig covering the entire genomic region. By using Southern blot analysis with 22 gene probes, the gene arrangement along the genome was compared between CVK2 and PBCV-1, the prototypic member of Phycodnaviridae, whose genomic sequence is now available. The major rearrangements were (1) an insertion of a 20-kbp region around the left end of CVK2 DNA, (2) a duplication of the gene for major capsid protein in CVK2 DNA, (3) deletions/insertions of some open reading frames, and (4) divergence in the terminal inverted repeat sequences. Despite these changes, extensive colinearity was revealed between most of the genes along the CVK2 and PBCV-1 genomes. These data imply that the Chlorella virus genome has an overall high degree of genomic stability, encompassing specific islands of rearrangements.

Amino Acid Sequence↗

PubMedDate not supplied

Echocardiographic study on the origin of the innocent flow murmurs.

To investigate the origin of the pulmonary systolic ejection innocent flow murmur (IFM), echocardiographic examinations were undertaken in 30 children with IFM and in a control group consisting of 28 healthy children without murmur. Compared to the controls, the diameters of the left ventricular outflow tract (LVOT) and aortic valve annulus and aortic valve area tended to be smaller, whereas stroke volume (SV) and cardiac output were slightly greater in children with IFM, but they were not statistically significant. Mean fractional shortening was significantly higher in children with IFM. Peak flow velocity of LVOT, right ventricular outflow tract, aorta, and pulmonary artery, mean velocity and velocity time integral of the aortic and pulmonary flow, and maximal acceleration of the aortic flow were all significantly higher in the IFM group compared to the controls. The variables of left-sided flow velocities in the same individuals with IFM were significantly higher compared to those derived from the right heart. The ratios of the SV to the LVOT diameter and to the aortic valve area were found to be significantly greater. It was concluded that IFM originates from higher blood flow velocities in the region of LVOT and aortic valve annulus, and that the increased flow velocity results from the larger SV passing through the relatively narrow LVOT and aortic valve in children with IFM.

Blood Flow Velocity↗

PubMed1989

Exercise ultrafast computed tomography for the detection of coronary artery disease.

Ultrafast computed tomography permits the assessment of global and regional left ventricular function during exercise. To evaluate the feasibility of using this new technique for the diagnosis of coronary artery disease, 27 patients undergoing cardiac catheterization for diagnosis of chest pain were evaluated. Fifteen patients had significant (greater than 50%) coronary artery stenosis by quantitative coronary angiography. One vessel disease was found in 12 patients and multivessel disease in 3. Fourteen (93%) of the 15 patients with significant coronary stenosis had a decrease in ultrafast computed tomographic ejection fraction during exercise from (mean +/- SD) 65 +/- 7% to 60 +/- 7% (p less than 0.001). The tomographic ejection fraction increased greater than 5% units during exercise in 10 (83%) of the 12 patients with normal coronary arteries. The mean tomographic ejection fraction in this group was 68 +/- 6% at rest and 75 +/- 6% at peak exercise (p less than 0.001). Regional wall motion was quantified by analyzing the segmental ejection fraction of 12 30 degree pie segments at each tomographic level of the left ventricle. A new regional wall motion abnormality developed during exercise in 12 (86%) of 14 patients with coronary artery disease; one patient was excluded because of a technical problem in data storage. Eleven (93%) of the 12 patients with normal coronary arteries had normal wall motion during exercise. In no patient with ischemic heart disease were both variables, ejection fraction response and regional wall motion, normal. Exercise ultrafast computed tomography appears to be a useful technique for the evaluation of coronary artery disease in patients with chest pain and predominant single vessel coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

The anatomic landmarks of ethmoidal arteries for the surgical approaches.

Knowledge of variations in the possible patterns of origins, courses, and distributions of the ethmoidal arteries are necessary for the diagnosis and important for the treatment of orbital disorders. Ethmoidal arteries are damaged in endonasal surgical interventions and in operations performed on the inner wall of the orbita.A description of the anatomic landmarks of the ethmoidal arteries and ethmoidal canals is presented, based on data from microdissection in 19 adult cadavers studied after injection of red-dyed latex into the arterial bed. In all subjects, each of ethmoidal arteries originated from ophthalmic artery. The anterior ethmoidal artery was observed in all specimens except for one case. The diameter of the artery thicker than the posterior ethmoidal artery was 0.92 +/- 0.2 mm on the right and 0.88 +/- 0.15 mm on the left. The branching of the anterior ethmoidal artery from the ophthalmic artery was determined in four different types. The diameter of the posterior ethmoidal artery was measured as 0.66 +/- 0.21 mm on the right and 0.63 +/- 0.19 mm on the left. The anterior ethmoidal canal was located between the second and third lamella in 29 of 38 cases. The mean distance between the limen nasi and anterior ethmoidal canal was 48.1 +/- 3.2 mm.The article confirms the well-known variability of the ethmoidal arteries and their topographic relation to the ethmoidal canals. Advances in surgical techniques, instrumentation, and regional arterial anatomy have resulted in functional operations of endoscopic sinus and orbital surgery with fewer complications.

Adult↗

PubMed1986

Value and limitations of computer analysis of digital subtraction angiography in the assessment of coronary flow reserve.

Conventional coronary angiography has significant limitations in quantifying the severity and functional significance of coronary stenoses. However, coronary reactive hyperemia is an excellent physiologic indicator of coronary reserve. Digital subtraction angiography offers the potential to analyze coronary blood flow dynamics quantitatively. Therefore we assessed the accuracy of digital angiographic methods to detect and quantify reductions in coronary flow reserve secondary to stenoses of varying magnitude in an experimental canine preparation. Studies were performed in nine anesthetized open-chest dogs with an electromagnetic flow (EMF) probe and two pneumatic occluders positioned on the left circumflex coronary artery. One occluder served to induce reactive hyperemia by temporary total occlusion, while the other served to produce variable gradations of stenosis. Digital angiography was performed after the subselective injection of contrast under basal conditions and during reactive hyperemia. Time-intensity curves were obtained from digital angiograms for both a coronary and a myocardial region of interest. Measurements included area under the curve, time to peak contrast, and contrast disappearance rate. An index of coronary reserve was computed as the ratio of hyperemic to basal measurements for each of these methods. Coronary blood flow ranged from 6.5 to 142 ml/min, with hyperemic to basal EMF flow ratios of 0.80 to 4.2:1. The index derived from contrast decay rate showed a poor correlation with EMF (r = .34). The correlation between measurements of time to peak myocardial contrast and coronary blood flow was r = .68 (y = 0.16 x + 0.97). The area under the time-intensity curve from a coronary region of interest showed a close correlation with coronary blood flow (y = 0.91 x + 0.1, r = .86). Thus estimates of coronary reserve by computer analysis of digital subtraction angiograms can yield information regarding the physiologic consequences of coronary stenoses.

Angiography↗

PubMed1990

Coronary atherosclerosis is associated with left ventricular dysfunction and dilatation in aortic stenosis.

Patients with aortic stenosis develop widely variable patterns of left ventricular hypertrophy and dysfunction. We postulated that coronary atherosclerosis (CAD) may be associated with impaired left ventricular function and chamber dilatation in patients with aortic stenosis. Left ventricular mass and volumes were quantified from two-dimensional echocardiography and correlated with coronary angiography in 78 patients with severe aortic stenosis and no previous myocardial infarction or regional wall motion abnormalities. Eighteen patients (group 1) had smooth coronary arteries, 25 patients had irregular coronary arteries with 50% or less stenosis (group 2), and 35 patients had obstructive CAD (group 3). Even though the calculated valve area was similar in all three study groups, group 1 patients had higher values for ejection fraction (65 +/- 9%, 51 +/- 17%, and 48 +/- 13%; p = 0.0002), systolic mass-to-volume ratio (9.2 +/- 3.9, 5.6 +/- 2.8, and 5.2 +/- 2.2; p = 0.0001), and cardiac index (2.9 +/- 0.7, 2.5 +/- 0.7, and 2.3 +/- 0.6 l/min.min2; p = 0.015) than patients in groups 2 and 3, respectively (mean +/- SD). Mean circumferential wall stress was inversely related to severity of CAD. Multivariate analysis showed that CAD is an independent predictor of ejection fraction and mass-to-volume ratio in this group of patients. Thus, in an elderly population with severe aortic stenosis, patients with both obstructive and nonobstructive CAD have an increased incidence of left ventricular enlargement and systolic dysfunction.

Aged↗

PubMed1990

Subgroups in dementia of the Alzheimer type identified using positron emission tomography.

We examined patterns of cerebral glucose metabolism in 33 patients with dementia of the Alzheimer type by applying principal component analysis to identify subgroups. Four subgroups were identified: one with predominant parietotemporal hypometabolism (15 patients); one with paralimbic metabolic deficits (8 patients); one with left hemisphere neocortical abnormality (5 patients); and one with frontal and parietotemporal deficit (5 patients). Differences among the subgroups were found in neuropsychological impairments and prevalence of psychiatric symptoms. These metabolic subgroups could not be explained on the basis of dementia severity, illness duration, or age, but were most likely related to an underlying pathology with a variable regional distribution.

Aged↗

PubMed1996

Increased left ventricular dysfunction in elderly patients despite successful thrombolysis: the GUSTO-I angiographic experience.

OBJECTIVE: This study sought to determine whether the recovery of regional and global left ventricular function is reduced in elderly patients despite successful thrombolytic therapy for acute myocardial infarction. Comparisons were made between elderly (> or = 75 years old, n = 47) and adult (< 75 years old, n = 434) patients enrolled in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) angiographic trial who underwent catheterization at 90 min and 5 to 7 days after thrombolysis and who had an open infarct-related artery with Thrombolysis in Myocardial Infarction (TIMI) grade 2 to 3 flow at both times. BACKGROUND: The morbidity and mortality of acute myocardial infarction is increased in elderly patients, presumably because of multiple adverse coexistent baseline variables. However, functional recovery after thrombolysis has not been characterized in the elderly. METHODS: Ejection fraction, end-systolic volume index, infarct and noninfarct zone contractile function (SD/chord) and infarct extent (number of chords) were determined. RESULTS: At 90 min, elderly patients with an open infarct-related artery had decreased infarct zone contractile function (-2.8 +/- 0.2 vs. -2.3 +/- 0.1 SD/chord in adults, p < or = 0.05) and a greater extent of injury (26.0 +/- 2.6 vs. 20.7 +/- 0.8 chords in adults, p < or = 0.05). At 5- to 7-day follow-up ventriculography, ejection fraction was reduced, and end-systolic volume index was significantly increased in elderly patients compared with adults. The severity of regional wall motion dysfunction in the infarct zone was also greater in the elderly than in adults at 5- to 7-day follow-up (-2.6 +/- 0.2 vs. -1.9 +/- 0.1 SD/chord, respectively, p < or = 0.005). Non-infarct zone contractile function at 90-min ventriculography was similar in both groups. Despite a patent infarct-related artery at 90-min, the 30-day mortality rate in the elderly remained elevated (17.8%) compared with that of adults (4%) (p < or = 0.0001). Elderly patients were predominantly female and had a higher prevalence of hypertension, multivessel coronary disease, previous infarction, anterior infarctions and later time to treatment (between 3 and 6 h) than adults. However, age > or = 75 years remained an independent determinant by multivariable regression analysis of 1-week postinfarction end-systolic volume index, regional left ventricular dysfunction (p = 0.02 and p < or = 0.008, respectively) and 30-day mortality (p < or = 0.0001). CONCLUSIONS: Elderly patients had increased damage in the infarct zone and had persistently increased mortality despite sustained infarct-related artery patency after successful thrombolysis. Although the causes are probably multifactorial, a more rapid progression of ischemic injury or a blunted postreperfusion recovery appears to contribute to the poorer outcomes in elderly patients.

Adult↗