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Reliability of three computer methods in the analysis of ECG-gated radionuclide left ventriculography: interrecording, interobserver and intraobserver variability.

Three different computer methods for analysis of systolic and diastolic left ventricular function (ejection fraction, peak ejection rate, time to peak ejection rate, peak filling rate, time to peak filling rate, duration of fast filling phase, and fast filling fraction) as derived from ECG-gated radionuclide cardiography were compared in 30 patients with various diseases. The patients had two gamma camera recordings of the left ventricle performed immediately following one another during radionuclide (99mTc) equilibrium (3 x 10(6) counts, 16 frames/cycle, 64 x 64 pixels). Mean ECG R-R interval of the patients remained unchanged from first to second recording. The three computer methods were: (1) end-diastolic (ED) region of interest (ROI) analysis based on manually defined ED-ROI; (2) multi (M) ROI, manually defined ROI for each frame; and (3) semiautomatic (SA) ROI, ROI for each frame defined by an SA edge detection technique. With the 16 frame points as nodes, a 160-point time-activity curve was constructed for each of the three methods by use of a spline function. A tailored multiway analysis of variance showed that the M-ROI method had the highest interindividual range of values of the function parameters and the smallest interrecording, interobserver, and intraobserver variabilities. In theory this implies a better diagnostic sensitivity and specificity for the M-ROI method as compared with the other two methods.

Adult↗

Man versus beast: pharmacokinetic scaling in mammals.

Land mammals range in size from the 3-g shrew to the 3000-kg elephant. Despite this 10(6) range in weight, most land mammals have similar anatomy, physiology, biochemistry, and cellular structure. This similarity has allowed interspecies scaling of physiologic properties such as heart rate, blood flow, blood volume, organ size, and longevity. The equation that is the basis for scaling physiologic properties among mammals is the power equation Y = aWb, where Y is the physiologic variable of interest, W is body weight, and log a is the y-intercept and b is the slope obtained from the plot of log Y versus log W. Animals commonly used in preclinical drug studies (i.e., mice, rats, rabbits, monkeys, and dogs) do not eliminate drugs at the same rate that humans eliminate drugs; small mammals usually eliminate drugs faster than large mammals. Since drug elimination is intimately associated with physiologic properties that are well described among species, it seems reasonable to surmise that drug elimination can be scaled among mammals. Analysis of drug pharmacokinetics in numerous species demonstrates that drug elimination among species is predictable and, in general, obeys the power equation Y = aWb. Early papers on interspecies pharmacokinetic scaling normalized the x- and y-axes to illustrate the superimpossibility of pharmacokinetic curves from different species. More recently, the x- and y-axes have been left in the common units of concentration and time, and individual pharmacokinetic variables have been adjusted to predict pharmacokinetic profiles in an untested species, usually humans.

Administration, Oral↗

Midazolam's effects on myocardial load and coronary perfusion: reduced regional O2 consumption and lactate production during ischemia in dogs.

It is hypothesized that because of its potential to increase coronary flow and simultaneously decrease myocardial performance and O2 consumption, midazolam would minimize regional metabolic impairment during myocardial ischemia. Therefore, the hemodynamic and regional metabolic effects of systemic midazolam administration were compared during moderate and severe constrictions of the left anterior descending artery (LADa) to nontreated but ischemic animals in a canine model of acute coronary occlusion. In 16 anesthetized, ventilated, surgically prepared, and catheterized dogs, resting flow in the LADa was decreased by 50% and 75% for 15 minutes with 1 hour of normal flow in between. By arbitrary assignment, 7 dogs received midazolam (0.3 mg/kg and then 0.05 mg/kg/min) before thoracotomy. In all dogs, heart rate, electrocardiogram, LADa flow, left ventricular (LV) first time-derivative, and aortic, pulmonary artery, LADa, and LV pressures were measured continuously. Before and during constrictions, cardiac output by thermodilution and regional myocardial blood flow by microspheres were measured and blood was sampled for analysis. Data (mean +/- SEM) were compared within and between groups using ANOVA. Before placement of the LADa ligature, midazolam decreased heart rate and mean aortic pressure. Before ischemia, heart rate and LADa pressure were lower with midazolam than without it, but baseline metabolic variables were similar between the two groups (except for O2 consumption in the ischemic zone, which was lower with midazolam than without it). During 75% constriction with midazolam, LV end-diastolic pressure, coronary resistance, and ischemic zone O2 consumption were lower than without midazolam. Ischemic zone O2 delivery/consumption ratio was higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Novel organizational features, captured cellular genes, and strain variability within the genome of KSHV/HHV8.

Strong serologic and molecular probe correlations indicate that the newly discovered gamma herpesvirus KSHV or HHV8 is the likely etiologic agent of all forms of Kaposi's sarcoma as well as BCBL/PEL and MCD in patients with acquired immunodeficiency syndrome (AIDS). Two large segments of HHV8 DNA from an AIDS-associated BCBL tumor covering genomic positions 0-52 kilobase [kb] and 108-140 kb have been cloned, mapped, and partially sequenced. Our studies have focused on novel viral proteins encoded within a 13-kb divergent locus (DL-B) by nine captured homologues of cellular genes, including vIL-6, vDHFR, vTS, vBcl-2, three C-C beta chemokines (vMIP-1A, vMIP-1B, and vBCK), and two LAP/PHD subclass zinc finger proteins (IE1A and IE1B). The HHV-8 vIL-6, vDHFR, vTS, and vBcl-2 proteins have all been shown to be active in a variety of appropriate functional assays, and transcripts from vIL-6, vMIP-1B, vIE1-A, vIE1-B, and vDHFR genes are all expressed as abundant single messenger RNA species after butyrate or phorbol ester (TPA) induction of the lytic cycle in HHV8-positive BCBL cell lines. All of these genes lie within a divergent transcriptional domain that contains a single central enhancer and associated untranslated leader region plus seven distinct proximal promoters, some of which are negatively regulated through AP-1 and ZRE motifs by the EBV ZTA transactivator. This region also encompasses a predicted complex oriLyt domain of 1050 bp that is duplicated in inverted orientation adjacent to the T0.7 latency RNA in another large divergent locus (DL-E). We have previously described three distinct subtypes of the HHV8 genome that differ by 1.0%-1.5% at the nucleotide level within the ORF26 and ORF75 genes. Certain strains or clades appear to have preferential geographic distributions, but it is not known as yet whether there are any specific disease associations. Interestingly, the A, B, and C subtypes of HHV-8 also proved to differ dramatically in coding content at both the extreme left and right ends of the unique segment of the genome as well as in the positions of the junctions with the terminal repeats. On the left-hand side, the receptor-like ORF-K1 protein is highly variable with A-strain subtypes displaying 15% amino acid differences from C strains and up to 30% differences from B strains. On the right-hand side, two unrelated alternative types of the putative multiple membrane spanning ORF-K15 protein are found.

Amino Acid Sequence↗

Dynamics of letter string perception in the human occipitotemporal cortex.

The inferior occipitotemporal brain areas, especially in the left hemisphere, have been shown to be involved in the processing of written words and letter strings. This processing probably occurs within 200 ms after presentation of the letter string. It has also been suggested that this activation may differ between fluent and dyslexic readers. Using whole-head magnetoencephalography, we studied the spatiotemporal dynamics of brain processes evoked by visually presented letter strings in 12 healthy adult subjects. Our achromatic stimuli consisted of rectangular patches in which single letters, two-letter syllables, four-letter words, or symbol strings of equal length were embedded and to which variable noise was added. This manipulation dissociated three different response patterns. The first of these patterns took place approximately 100 ms after stimulus onset, originated in areas surrounding the V1 cortex and was distributed along the ventral visual stream, extending laterally as far as V4v. This response was systematically modulated by noise but was insensitive to the stimulus content, suggesting involvement in early visual analysis. The second pattern took place approximately 150 ms after stimulus onset and was concentrated in the inferior occipitotemporal region with left-hemisphere dominance. This activation showed a preference for letter strings, and its strength and timing correlated with the speed at which the subjects were able to read words aloud. The third pattern also occurred in the time window approximately 150 ms after stimulus onset, but originated mainly in the right occipital area. Like the second pattern, it was modulated by string length, but showed no preference for letters compared with symbols. The present data strongly support the special role of the left inferior occipitotemporal cortex in visual word processing within 200 ms after stimulus onset.

Adult↗

Heterogeneity of left ventricular regional wall thickening following dobutamine infusion in normal human subjects.

BACKGROUND: Pathophysiological data and pragmatic clinical experience with stress echocardiography suggest that inotropic stimulation with simultaneous changes in heart rate and loading conditions can affect the function of various myocardial regions asymmetrically, inducing heterogeneity in wall motion and thickening, possibly mimicking 'ischaemic' regional hypokinesis or lack of hyperkinesis during stress. OBJECTIVES: To describe, in a quantitative fashion, the physiological contractile response of different left ventricular regions following dobutamine infusion. METHODS: Two hundred and twenty-three in-hospital patients undergoing dobutamine stress echocardiography and coronary angiography were initially considered. Of these 223 patients, 18 had angiographically normal coronary arteries, normal resting function, negative ergonovine and exercise stress tests, and negative dobutamine stress echocardiograms; of the 18, only in 11 patients (six females, age = 56 +/- 10 years) was it possible to obtain quantitative measurements of the middle segments of the inferior, anterior, lateral, and septal walls. Two-dimensional echocardiographic measurements of wall thickness were obtained at the end-diastolic (onset of Q wave) and end-systolic phases, both at baseline (rest) and at the peak of the dobutamine infusion (40 micrograms.min-1.kg-1 plus atropine). RESULTS: Dobutamine increased heart rate (rest = 69 +/- 9 vs dobutamine = 138 +/- 13 beats.min-1; P < 0.01), whereas systolic blood pressure did not change significantly (rest = 136 +/- 15 vs dobutamine = 150 +/- 25 mmHg, P = ns). During stress, % systolic thickening decreased in the inferior wall (rest = 73 +/- 24 vs dobutamine +/- 50 +/- 9%; P < 0.01), whereas it tended to increase to a variable extent in the other regions, i.e. septal (rest = 46 +/- 17 vs dobutamine = 68 +/- 13%, P < 0.01), anterior (rest 62 +/- 19 vs dobutamine = 69 +/- 11%, P = ns), and lateral wall (rest = 48 +/- 16 vs dobutamine = 61 +/- 18%, P = ns). The decrease in % systolic thickening of the inferior wall was inversely correlated with the increase in end-diastolic wall thickness (r = -0.75; P < 0.01), but neither with heart rate (r = 0.15; P = ns) nor with systolic blood pressure changes (r = 0.05; P = ns). CONCLUSIONS: Heterogeneity of left ventricular wall thickening can be induced or magnified by dobutamine infusion even in subjects without coronary artery disease, with the inferior wall showing a lack of hyperkinesis, up to relative hypokinesis, in comparison with other myocardial regions. Caution in aggressive dobutamine stress echocardiography reading, especially in the inferior wall, might be warranted.

Adult↗

Objective assessment of left ventricular wall motion from contrast-enhanced power modulation images.

There is no method to objectively evaluate left ventricular (LV) function from contrast-enhanced images. We tested the feasibility of evaluating regional LV function by using power modulation imaging. In protocol 1, 9 anesthetized closed-chest pigs were studied. Images were obtained during contrast infusion at baseline, during LAD occlusion and reperfusion. In protocol 2, images were obtained in 20 patients (14 wall-motion abnormalities; 6 controls) during contrast enhancement. Off-line, frame-by-frame, semiautomated endocardial border detection was followed by color encoding of endocardial motion, followed by segmentation and calculation of regional fractional area changes. In all animals, coronary occlusions resulted in hypokinesis and decreased fractional area changes in LAD-related segments only, which were reversed during reperfusion. In patients, wall-motion analysis was in agreement with an expert reader of dynamic images in 92.5% segments, with interobserver variability of 12.5%. Color encoding of endocardial motion from contrast-enhanced power modulation images allows accurate quantitative assessment of regional LV function.

Aged↗

Relations between neuropsychological performance and brain morphological and physiological measures in monozygotic twins discordant for schizophrenia.

Correlational approaches that examine the relation between neuropsychological measures and brain morphology or physiology in schizophrenia have yielded inconsistent results. This may be due in part to difficulties in ascertaining precisely to what degree each measure deviates from its genetically and environmentally determined potential level. We attempted to surmount this problem in a paradigm involving monozygotic twin pairs discordant for schizophrenia. In this paradigm, the difference score between the unaffected member and affected member of a twin pair should represent the degree of pathologic involvement irrespective of actual level. In correlating intrapair difference scores of anatomic structures measured from magnetic resonance imaging (n = 15) and prefrontal regional cerebral blood flow (rCBF) (n = 10) with cognitive abilities (after partialing IQ), we found strong associations between (1) the left hippocampus and a parameter of verbal memory, and (2) prefrontal rCBF with symptom scores and perseveration on the Wisconsin Card Sorting Test. These results support other research implicating medial temporal and prefrontal regions as important in the symptomatic expression and cognitive failures of schizophrenia. Overall, however, there was a relative paucity of significant associations between neuroanatomic and neurocognitive variables. This may have been due to the relatively restricted ranges of hippocampal size or cognitive ability found in this sample.

Adult↗

Unusual dural and skull-based mesenchymal neoplasms: a report of four cases.

Dural and skull-base mesenchymal neoplasms other than meningiomas are rare. We report four such tumors, some of which are uncommon even in nonintracranial sites, in three adults and one child. The adult tumors consisted of a synovial sarcoma of the third ventricle region in a 19-year-old woman, a leiomyoma of the suprasellar region in a 57-year-old woman, and an Epstein-Barr virus (EBV)-associated smooth muscle tumor of the cavernous sinus in a 35-year-old woman with acquired immunodeficiency syndrome (AIDS). The pediatric tumor was an EBV-associated leiomyosarcoma of the left dural transverse sinus in a 14-year-old girl with common variable immunodeficiency syndrome. All tumors were thought to be primary in their dural or skull-base locations. The two EBV-associated smooth muscle tumors in immunocompromised patients expand the locations for EBV-associated smooth muscle tumors to dural and skull-base sites, the synovial sarcoma is unique to the intracranial space, and the sellar leiomyoma represents the third reported sellar smooth muscle tumor.

Acquired Immunodeficiency Syndrome↗

Enhanced myocardial 18F-2-fluoro-2-deoxyglucose uptake after orthotopic heart transplantation assessed by positron emission tomography.

OBJECTIVES: We sought to assess the relation between glucose metabolism, myocardial perfusion and cardiac work after orthotopic heart transplantation. BACKGROUND: The metabolic profile of the transplanted cardiac muscle is affected by the lack of sympathetic innervation, impaired inotropic function, chronic vasculopathy, allograft rejection and immunosuppressive therapy. In relation to myocardial perfusion and cardiac work, glucose metabolism has not previously been studied in heart transplant recipients. METHODS: Regional myocardial blood flow (ml.min-1.g-1) and 18F-2-fluoro-2-deoxyglucose (18FDG) uptake rate (ml.s-1.g-1) were measured after an overnight fast in 9 healthy male volunteers (mean age +/- SD 32 +/- 7 years) and in 10 male patients (mean age 50 +/- 10 years) who had a nonrejecting heart transplant, normal left ventricular function and no angiographic evidence of epicardial coronary sclerosis. Measurements were made by using dynamic positron emission tomography (PET) with 15O-labeled water and 18FDG, respectively. Heart rate and blood pressure were also measured for calculation of rate-pressure product. RESULTS: 18FDG uptake was similar in all heart regions in the patients and volunteers (intrasubject regional variably 12 +/- 8% and 16 +/- 12%, respectively, p = 0.51). Regional myocardial blood flow was similarly evenly distributed (intrasubject regional variability 14 +/- 10% and 12 +/- 8%, respectively, p = 0.67). Mean 18FDG uptake and myocardial blood flow values for the whole heart are given because no regional differences were identified. 18FDG uptake was on average 196% higher in the patients than in the volunteers (2.90 +/- 1.79 x 10(-4) vs. 0.98 +/- 0.38 x 10(-4) ml.s-1.g-1, p = 0.006). Regional myocardial blood flow and rate-pressure product were similarly increased in the patient group, but by only 41% (1.14 +/- 0.3 vs. 0.81 +/- 0.13 ml.min-1.g-1, p = 0.008) and 53% (11,740 +/- 2,830 vs. 7,689 +/- 1,488, p = 0.001), respectively. CONCLUSIONS: 18FDG uptake is homogeneously increased in normally functioning nonrejecting heart transplants. This finding suggests that glucose may be a preferred substrate in the transplanted heart. The magnitude of this observed increase is significantly greater than that observed for myocardial blood flow or cardiac work. In the patient group, the latter two variables were increased to a similar degree over values in control hearts, indicating a coupling between cardiac work load and myocardial blood flow. The disproportionate rise in 18FDG uptake may be accounted for by inefficient metabolic utilization of glucose by the transplanted myocardium or by the influence of circulating catecholamines, which may stimulate glucose uptake independently of changes in cardiac work load.

Adult↗

Postsystolic shortening of canine left ventricle supplied by a stenotic coronary artery when nitrous oxide is added in the presence of narcotics.

The effects of fentanyl and sufentanil with and without N2O on left ventricular myocardium supplied by a critically narrowed and a normal coronary artery were studied in 16 dogs. Regional ventricular function was measured by recording ventricular segment length with the use of ultrasonic length detectors in the left anterior descending (LAD) and the left circumflex (LC) coronary artery territories before and during critical stenosis of the LAD. Critical stenosis was documented by the absence of a hyperemic response following a 10-s total occlusion of the LAD. Hemodynamic variables (aortic flow and pressure, left ventricular pressure, heart rate, and coronary blood flow) were measured and the first derivative of left ventricular pressure (LVdP/dt) and coronary perfusion pressure derived. Eight dogs received fentanyl 100 micrograms X kg-1 followed by an infusion of 1 microgram X kg-1 X min-1 while ventilated with O2:N2 (1:2), and eight dogs received sufentanil 30 micrograms X kg-1 with an infusion of 0.3 micrograms X kg-1 X min-1. Replacement of N2 with N2O produced evidence of mild systolic myocardial depression but no dysfunction in either group. After application of the critical constriction, the addition of N2O rapidly produced evidence of dysfunction with significant postsystolic shortening only in the LAD territory. This was not accompanied by hypotension or a decrease in coronary flow and was not always reversible. Higher infusion rates of either narcotic (fentanyl 2 micrograms X kg-1 X min-1, 4 micrograms X kg-1 X min-1; sufentanil 0.6 micrograms X kg-1 X min-1, 1.2 micrograms X kg-1 X min-1) in the absence of N2O did not produce dysfunction but had no protective effect when N2O was added.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthetics↗

The pericardial effusion pattern on phase images.

UNLABELLED: The effect of pericardial effusion on phase images of gated studies was investigated. Twenty-six patients with suspected or known pericardial effusion were correlated with echocardiography and/or clinical and other laboratory data to ascertain the presence and size of effusion. The phase image pattern and parameters were compared to the results previously obtained in seven normal patients, and in 26 patients with documented regional wall motion abnormalities but no evidence of pericardial effusion. The phase pattern was graded into five categories: typical (IV) (wide histogram, well defined concentric convex pattern, progressive delay toward the inferolateral area, identifiable also over the right ventricle); less pronounced (III); atypical (II); ill defined changes (I); and normal (0). RESULTS: Group L (large pericardial effusion): four of six had pattern (IV) and the left ventricular histogram showed abnormal parameters. These patients had large free effusions in the pericardial sac and none had regional wall motion abnormalities. Two of six had pattern (III) and (II) but also had ancillary pericardial pathology and/or decreased ejection fraction. Group M (moderate pericardial effusion), S (small pericardial effusion), and A (absent pericardial effusion, but not normal) had variable phase images and numeric parameters. After therapeutic drainage of pericardial fluid two patients changed pattern from IV and III to 0 and a third from III to I. Category IV pattern is 100% specific for pericardial effusion; the combination of category IV or III is 87.5% specific and 61% sensitive for large and moderate pericardial effusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

First-pass ventricular ejection fraction using a single-crystal nuclear camera.

UNLABELLED: The purpose of the study was to evaluate the reliability of ejection fractions obtained from first-pass radionuclide ventriculography with a large field-of-view tomographic single-crystal gamma camera. METHODS: A SPECT camera had its electronics redesigned to improve counting efficiency and was equipped with an experimental ultra-high sensitivity collimator. Left ventricular ejection fraction (LVEF) was measured in 28 patients by 30 degrees RAO first-pass imaging and by "best septal view" LAO planar equilibrium radionuclide ventriculography on a conventional small field of view Anger camera. For 28 other patients, first-pass ejection fractions were compared to multicrystal gamma camera values. Visual analysis was performed to judge clinical acceptability of first-pass images for identification of wall-motion abnormalities. RESULTS: Linear regression analysis of first-pass against equilibrium ejection fraction demonstrated good correlation (r = 0.92; slope = 0.90; intercept = 3.8; s.e.e. = 6.4%). First-pass ejection fraction values also correlated linearly with multicrystal camera values for the left ventricle (r = 0.94; slope = 1.05; intercept = 1.3; s.e.e. = 5.3%). For a subgroup of 19 patients, single-crystal camera right ventricle ejection fraction demonstrated good correlation with multicrystal camera values (r = 0.82; slope = 1.15; intercept = 1.3; s.e.e. = 6.1%). Interobserver variability correlated as r = 0.99 for LVEF ejection fraction and r = 0.92 for RVEF. Chi-square analysis of single-crystal first-pass image visual scores versus those from the gated equilibrium acquisitions showed close agreement (p < 10(-8)). CONCLUSIONS: The evaluated camera/collimator system measured left and right ventricular ejection fraction accurately. Lung frame correction and dual regions were superior to paraventricular background correction and a fixed end-diastolic region.

Feasibility Studies↗

Effect of chronic smoking on regional cerebral blood flow in asymptomatic individuals.

Correlations between cigarette smoking and cerebral blood flow (CBF) were determined. The purpose of the present study was to determine whether the level of cigarette use is a significant predictor of regional CBF (rCBF) when age, gender, mean arterial blood pressure, total cholesterol, fasting blood glucose, hematocrit, and presence of ST-T change and left ventricular hypertrophy on electrocardiogram (ECG) are controlled. We studied a continuous sample of 40 asymptomatic individuals including 20 smokers and 20 nonsmokers. Subjects (mean age 66.2 yr) had an average smoking index of 456 +/- 485.1 (mean +/- standard deviation) [(Number of cigarette/d) x (years of smoking history)]. Regional CBF was measured using the intravenous 133Xe injection method. Simple linear regression and multivariate regression analyses were performed, which modeled regional cerebral blood flow as a function of smoking index and other cerebrovascular disease risk factors. The male-to-female ratio was higher in the group of smokers (18/2) than in the group of nonsmokers (2/18) (P < 0.01). The mean hematocrit of smokers was significantly higher than that of nonsmokers (P < 0.01). There were no significant differences in other variables tested between the two groups. Simple linear regression analysis demonstrated a significant negative correlation of smoking index with CBF in whole brain (r = -0.33; P < 0.05), the right hemisphere (r = -0.34; P < 0.05), right parietal cortex (r = -0.36; P < 0.05), right occipital cortex (r = -0.34; P < 0.05) and left parietal cortex (r = -0.33; P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

Individual differences in multiple-bag spindles of cat superficial lumbrical muscles.

A total of 791 spindle poles was analysed with regard to intrafusal fibre composition in the first and second superficial lumbrical muscles from the right and left hindfeet of 9 male and 5 female adult cats. Bag and chain muscle fibres were identified by their myofibrillar ATPase staining profile in the B region, after either acid or alkaline preincubation. A high proportion of the spindle pole population (43.2%) was observed to contain three or more (up to 5) bag fibres; those poles were classified as multiple-bag spindle poles. In the 334 muscle spindles in which both poles were studied, 42 bag fibres (12.6%) were found to be of the 'mixed' type, that is a fibre in which the two poles differ in their ATPase staining profile (either bag1/bag2 or bag/chain). The variability of the intrafusal fibre content observed in spindles of these muscles has been studied in relation to individual characteristics such as sex, weight and side of the animal. In general, multiple-bag spindles are more frequent in male than in female cats and in right as compared to left side muscles. Nearly all 'mixed' bag intrafusal fibres (38 out of 42) were observed in spindles containing 3 or more bag fibres. In 3-bag spindles the proportion of 'mixed' bag spindles is approximately the same in male and female cats. The ratio of 'dynamic' (mean polar bag1 content) to 'static' (mean polar bag2 plus chain fibre content) intrafusal effectors per muscle tends to increase in spindles of right side muscles and to decrease in the heaviest animals. The quantitative and qualitative differences in fibre content of spindles observed in first lumbrical muscles of different animals suggest that the spindle fibre composition, especially that of the 'dynamic' bag1 fibre, may be related to individual predetermined and/or acquired factors.

Adenosine Triphosphatases↗

Lack of association between a polymorphism of the aldosterone synthase gene and left ventricular structure.

BACKGROUND: Cardiac growth and function may be modulated in part by trophic effects of neurohormones. Specifically, aldosterone has been shown to stimulate the growth of cardiac myocytes and the accumulation of cardiac extracellular matrix proteins. Moreover, a variant of the aldosterone synthase gene (a cytosine/thymidine exchange at position -344 in the transcriptional regulatory region) has been associated with enlargement and disturbed filling of the left ventricle (LV) in a small sample of young white adults. The aim of the present study was to reinvestigate the implications of aldosterone synthase -344C/T allele status for serum aldosterone levels, blood pressure, and LV structure and function in large population-based samples. METHODS AND RESULTS: Individuals who participated in the echocardiographic substudy of the third MONICA (MONitoring trends and determinants in CArdiovascular disease) survey (n=1445) or in the second follow-up of the first MONICA survey (n=562) were studied by standardized anthropometric, echocardiographic, and biochemical measurements as well as genotyping for aldosterone synthase -344C/T allele status. In both surveys, the distribution of sex, age, arterial blood pressure, and body mass index was homogeneous in the aldosterone synthase genotype groups. Echocardiographic LV wall thicknesses, dimensions, and mass indexes were not significantly associated with a specific aldosterone synthase genotype. Likewise, no association was detectable with echocardiographic measures of LV systolic or diastolic function. Data were consistent in both samples and not materially different in subgroups defined by age, sex, or intake of antihypertensive medication. Finally, no significant association was observed for aldosterone synthase allele status and serum aldosterone levels in the group of 562 individuals. CONCLUSIONS: The data are not in favor of a significant contribution of the C/T exchange at position -344 in the aldosterone synthase transcriptional regulatory region to the variability of serum aldosterone levels, blood pressure, or cardiac size or function as found in 2 white population-based samples.

Adult↗

Utility of positron emission tomography in predicting improved left ventricular ejection fraction after coronary artery bypass grafting among patients with ischemic cardiomyopathy.

The objective of this study was to determine whether preoperative estimates of regional myocardial uptake of (18)-F-fluorodeoxyglucose (FDG) could predict postoperative improvement in ejection fraction in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy. 20 consecutive patients [left ventricular ejection fraction (LVEF) </=27%] were referred for preoperative positron emission tomography (PET) to measure regional myocardial FDG uptake and were deemed candidates for CABG. All individuals had technically adequate vessels and significant viability. The left anterior descending (LAD) coronary artery was severely diseased in all patients. Because of the importance of the anterior wall to overall ventricular performance, FDG uptake was semiquantitated in those regions and related to postoperative LVEF. 17 patients underwent CABG with an uneventful recovery. LVEF increased from 22 +/- 4 to 26 +/- 7% 2 weeks postsurgery (p < 0.05), with >/=5% change noted in 7 patients (group 1) and <5% noted in 10 patients (group 2). No preoperative or perioperative clinical variable could predict those with improved ventricular function. The relative amount of FDG uptake in the anterior wall was higher in group 1 compared with group 2 (93 +/- 9 vs. 81 +/- 13%; p < 0.05) and correlated with the change in LVEF post-CABG (r = 0.50; p < 0.05). >88% of FDG uptake in the LAD region had a positive predictive accuracy of 67% and negative predictive accuracy of 88% for improved LVEF postbypass. Late follow-up estimates of LVEF (median of 10 months) showed that early changes in function were sustained. In summary, among patients with severe coronary artery disease and depressed LVEF, ventricular function may improve early postrevascularization. PET estimates of relative FDG uptake in the anterior wall help predict those individuals who are likely to have the greatest increment in LVEF.

Aged↗

Cross-sectional left ventricular outflow tract velocities before and after aortic valve replacement: a comparative study with two-dimensional Doppler ultrasound.

To assess whether aortic valve replacement (AVR) results in changes in the flow velocity distribution in the left ventricular outflow tract (LVOT), 10 patients undergoing AVR for aortic stenosis were studied. By extracting velocity information from color flow maps as digital data, instantaneous cross-sectional velocity profiles were constructed. Velocity profiles obtained 1 to 3 days before AVR were compared with recordings made 3 months later. The LVOT velocity profiles were variably skewed both before and after surgery, and no systematic or uniform changes could be detected after AVR. The highest velocities were most often localized in the region from the center of the outflow tract diameter toward the septum both before and after surgery. At the time of peak flow the ratio of the maximum to the cross-sectional mean velocity was 1.38 +/- 0.13 before and 1.39 +/- 0.08 after AVR (NS), and the ratio of the maximum to the mean velocity time integral was 1.47 +/- 0.10 before and 1.56 +/- 0.10 after (NS). We conclude that AVR in patients with aortic stenosis does not result in a change in LVOT velocity profiles that will influence stroke volume estimates with the Doppler technique.

Aged↗