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PubMed1999

Three-dimensional echocardiographic analysis of valve anatomy as a determinant of mitral regurgitation after surgery for atrioventricular septal defects.

Mitral regurgitation (MR) is a significant complication after atrioventricular septal defect (AVSD) surgery. The relation of the valve leaflet morphology and the MR mechanism remains a conundrum. Two-dimensional echocardiography depicts leaflet edges, whereas volume-rendered 3-dimensional echocardiography provides direct visualization of the surface areas of the mitral valve leaflets. This study examines the relation of mitral valve anatomy as determined by 3-dimensional echocardiography with MR origins in patients after AVSD repair. Twenty-seven patients with AVSD surgery and Doppler color MR were prospectively enrolled (median age was 5 years and 16 patients had Down syndrome). Doppler color flow imaging of the MR jet and 3-dimensional echocardiography of the mitral valve were performed with a probe in the transthoracic or transesophageal position. Enface 3-dimensional views of the mitral valve from the left atrium were reconstructed. Analysis of the 3-dimensional data was possible in 21 of the 27 patients. Mean area ratios of the 3 mitral leaflets were calculated (superior 40 +/- 7%, inferior 35 +/- 5%, mural 25 +/- 6%). Both intra and interobserver variability on the area measurements were <5%. In 12 patients (group 1) the jet appeared to emanate medially from the region of coaptation of the superior and inferior components of the anterior leaflet. In 9 patients (group 2) the jet emanated more laterally from the region toward the mural leaflet. The area ratios of the inferior leaflet were 32 +/- 4% in group 1 and 38 +/- 6% in group 2 (p = 0.02). The area ratios of the mural leaflet were 28 +/- 5% in group 1 and 21 +/- 5% in group 2 (p = 0.007). The superior leaflet area ratio was not different in groups 1 and 2, 40 +/- 9% and 41 +/- 6%, respectively. Three-dimensional echocardiography provides new insight into the anatomic determinants of MR following AVSD surgery.

Adolescent↗

PubMed2005

Electrocardiographic characteristics of repetitive monomorphic right ventricular tachycardia originating near the His-bundle.

INTRODUCTION: Most idiopathic nonreentrant ventricular tachycardia (VT) and ventricular premature contractions (VPCs) arise from the right or left ventricular outflow tract (OT). However, some right ventricular (RV) VT/VPCs originate near the His-bundle region. The aim of this study was to investigate ECG characteristics of VT/VPCs originating near the His-bundle in comparison with right ventricular outflow tract (RVOT)-VT/VPCs. METHODS AND RESULTS: Ninety RV-VT/VPC patients underwent catheter mapping and radiofrequency ablation. ECG variables were compared between VT/VPCs originating from the RVOT and near the His-bundle. Ten patients had foci near the His-bundle (HIS group), with the His-bundle local ventricular electrogram preceding the QRS onset by 15-35 msec (mean: 22 msec) and His-bundle pacing produced a nearly identical ECG to clinical VT/VPCs. The HIS group R wave amplitude in the inferior leads (lead III: 1.0 +/- 0.6 mV) was significantly lower than that of the RVOT group (1.7 +/- 0.4 mV, P < 0.05). An R wave in aVL was present in 6 of 10 HIS group patients, while almost all RVOT group patients had a QS pattern in aVL. Lead I in HIS group exhibited significantly taller R wave amplitudes than RVOT group. HIS group QRS duration in the inferior leads was shorter than that of the RVOT group. Eight of 10 HIS group patients exhibited a QS pattern in lead V1 compared to 14 of 81 RVOT group patients. HIS group had larger R wave amplitudes in leads V5 and V6 than RVOT group. CONCLUSION: VT/VPCs originating near the His-bundle have distinctive ECG characteristics. Knowledge of the characteristic QRS morphology may facilitate catheter mapping and successful ablation.

Adult↗

PubMed1987

Effect of graded coronary flow reduction on ionic, electrical, and mechanical indexes of ischemia in the pig.

This study was performed to determine the relative sensitivities of ionic, electrical, and mechanical indexes of myocardial ischemia. We used ion-selective and bipolar plunge electrodes, epicardial unipolar electrodes, a suction electrode, and ultrasonic crystals to determine the changes in intramyocardial extracellular potassium ([K+]e) and extracellular pH (pHe), local activation, epicardial TQ-ST segment, monophasic action potential duration (MAPD), and regional contractility during graded coronary flow reduction in open-chest pigs. A carotid-to-coronary shunt was created to perfuse the left anterior descending coronary artery via a roller pump. The shunted coronary flow was reduced in a stepwise fashion at 5-min intervals. In 25 pigs, the approximate myocardial blood flow associated with the initial changes in each variable was as follows: midmyocardial [K+]e, pHe, and TQ-ST segment, 0.7 to 0.8 ml/min/g; subepicardial [K+]e and TQ-ST segment, 0.6 to 0.7 ml/min/g; segmental shortening, 0.5 to 0.6 ml/min/g; local activation and epicardial TQ-ST segment, 0.3 to 0.4 ml/min/g; epicardial MAPD, 0.15 to 0.2 ml/min/g. Our results indicate that changes in [K+]e, pHe, and TQ-ST segment provide the most sensitive means of detecting myocardial ischemia and of determining the effect of interventions capable of influencing the ischemic process.

Action Potentials↗

PubMed1991

Perfusion imaging with 99mTc-sestamibi for the assessment of myocardial area at risk and the efficacy of acute treatment in myocardial infarction.

There is a clear need to develop better measurement tools for assessment of the effect of acute therapy in myocardial infarction. Such tools must permit accurate measurement of the amount of myocardium that is initially at risk. 99mTc-sestamibi is a new radiopharmaceutical with unique properties that are well suited to the measurement of myocardium at risk without any delay in acute therapy. Tomographic imaging with this agent has been shown to provide accurate quantitative estimates of the myocardium at risk, which varies widely, even for patients with a similar coronary occlusion. For example, there is more than a threefold range in myocardium at risk for patients with a nonproximal occlusion of the left anterior descending coronary artery. The determination of the myocardium at risk before intervention and the change in this region after intervention constitute a promising measurement tool for the assessment of the effect of acute therapy. Initial studies with tomographic imaging have shown a significant improvement in a group of patients treated with thrombolysis, although the magnitude of improvement is highly variable in individual patients. Qualitatively similar results have been reported with planar imaging. Although it has a number of technical limitations, sequential imaging with 99mTc-sestamibi seems to have a clear advantage over those end points that have previously been used to assess acute therapy. This new measurement tool should facilitate future clinical trials of different treatments in acute myocardial infarction.

Electrocardiography↗

PubMedDate not supplied

Magnetic resonance imaging of the presumed normal canine adrenal glands.

Forty-three dogs without evidence of endocrine disease that underwent spinal or abdominal magnetic resonance imaging (MRI) for clinical reasons were studied. Because the procedures were not optimized for inclusion of the adrenal glands, they were not always visible in all planes. Eighty-five of the 86 adrenal glands were seen and only the left gland in a 6-month-old Irish wolfhound could not be found. The right adrenal gland lay cranial to the left in all of the animals in which both glands were seen. The best landmarks for localization of the glands were vascular; both adrenal glands were always cranial to the ipsilateral renal vessels and in the region of the celiac and cranial mesenteric arteries. Various measurements were made on all the available scan planes. In some dogs the whole adrenal gland was difficult to visualize clearly, and this hindered the measuring process, especially when the right adrenal gland was in close contact with the caudal vena cava. The adrenal glands were mainly linear in shape but also had a variable degree of modification of their poles, especially the cranial pole of the right adrenal gland, which tended to be consistently wider and to present different shapes (rounded, arrowhead, inverted P, hook-shaped, triangular, or dome-shaped). Two main patterns of signal intensity were seen on fast spin echo (FSE) sequences (T2-weighted, T1-weighted, and T1-weighted after administration of a paramagnetic contrast medium): homogeneous and hypointense to surroundings or a corticomedullary type pattern with a hyperintense central area surrounded by a hypointense rim of tissue. The outline of the left adrenal gland was always very clear. The clarity of outline of the right adrenal gland was more variable, especially if it was in contact with the liver or the caudal vena cava. It was felt that the amount of retroperitoneal fat was not as important as stated in the human literature for visualization of the adrenal glands and that with an appropriate selection of scan planes and pulse sequences good assessment of the adrenal glands can be performed with MRI in canine patients.

Adrenal Glands↗

PubMed1995

The effect of solid ankle-foot orthoses on movement patterns used in a supine-to-stand rising task.

BACKGROUND AND PURPOSE: Within dynamical pattern theory, ankle motion can be proposed to be a control variable, and solid ankle-foot orthoses (SAFOs) can be considered a constraint to ankle movement. The purpose of this study was to examine the effect of SAFOs on movement patterns used to rise from the supine position to erect stance. SUBJECTS: Thirty-nine nondisabled young adults, ranging in age from 20 to 28 years (X = 22.7, SD = 1.87), participated. METHODS: Subjects were videotaped while rising from a supine position on a floor mat. Each subject performed 10 trials under each of four conditions: without SAFOs, right SAFO, left SAFO, and bilateral SAFOs. Movement patterns were described within three body components (ie, upper extremities, axial region, and lower extremities) by determining the mode and the incidence of each movement pattern under each condition. The subjects' mode movement patterns in the no SAFO condition were compared with mode movement patterns in the SAFO conditions using McNemar tests. RESULTS: Without SAFOs, subjects rose most commonly using a push and reach pattern of the upper extremities, a forward with rotation pattern in the trunk, and an asymmetrical squat in the lower extremities. Changes in the incidence of movement patterns occurred in all of the SAFO conditions when compared with the no SAFO condition. These changes resulted in more asymmetry when SAFOs were worn, and asymmetry was most notable in the axial region. CONCLUSIONS AND DISCUSSION: From a dynamic pattern theory perspective, ankle motion is a control variable for the supine-to-stand rising task.

Adult↗

PubMed2005

Choosing apical long-axis instead of two-chamber view gives more accurate biplane echocardiographic measurements of left ventricular ejection fraction: a comparison with magnetic resonance imaging.

BACKGROUND: We sought to evaluate whether the use of apical long-axis (APLAX) rather than two-chamber (2CH) view, in combination with four-chamber (4CH) view, improved accuracy of biplane echocardiographic measurements of left ventricular (LV) ejection fraction (EF), using magnetic resonance imaging (MRI) as a reference standard. METHODS: One hundred consecutive cardiac patients underwent cardiac MRI and 2D-echocardiography. Standard apical LV views were digitally acquired with baseline tissue harmonic imaging and low-power contrast echocardiography. Echo and MRI LV volumes were calculated by manual tracing and disc summation methods. RESULTS: Feasiblity for biplane volume measurements increased with the use of APLAX. Precontrast limits of agreement (LOA) for EF compared to MRI were -19.1 to 9.0 % (EF units) using 2CH, narrowing to -14.6 to 6.7% using the APLAX. With contrast, corresponding LOAs narrowed from -10.5 to 6.1%, to -7.3 to 3.8%, respectively. The improved accuracy with APLAX was evident regardless of image quality, previous MI and regional LV dyssynergy. Both intra- and interobserver variability improved by substituting 2CH with APLAX view. CONCLUSION: Using APLAX rather than 2CH in combination with 4CH view improved feasibility, accuracy and reproducibility of biplane echocardiographic EF measurements in cardiac patients, even with optimisation of endocardial borders by contrast.

Adult↗

PubMed2005

Functional imaging evidence of the relationship between recurrent psychotic episodes and neurodegenerative course in schizophrenia.

It remains controversial as to what determines the neurodegenerative course in schizophrenia. This study administered a modified version of the Stroop task and investigated the relationship between functional magnetic resonance imaging (fMRI) signal changes in dysfunctioned task-related regions and clinical course variables. Functional MRI data during task performance were acquired from 10 right-handed schizophrenic patients (mean+/-SD age=29.2+/-10.3 years, range of illness duration=0.8-14 years, number of episodes=1-5) and 10 healthy controls (mean+/-SD age=30.3+/-6.4). Imaging data were investigated on a voxel-by-voxel basis for single group analysis and for between-group analysis according to the random effect model using Statistical Parametric Mapping (SPM 99b). Correlation analysis with age as a covariate identified those brain regions whose fMRI signal changes were significantly related to clinical course variables in schizophrenia. The number of psychotic episodes was negatively correlated with the fMRI signal change in the right inferior frontal and the right frontal precentral gyri among the activated regions during the Stroop task in schizophrenia, whereas the length of illness was not so correlated. The number of psychotic episodes was also negatively correlated with the fMRI signal change in the left paracingulate in which functional activity was diminished in the patients relative to the controls. Our results indicate that recurrent psychotic episodes are related to the neurodegenerative course in some dysfunctional brain regions in schizophrenia.

Adolescent↗

PubMed1997

Corneal staining patterns in normal non-contact lens wearers.

Corneal fluorescein staining was evaluated in 16 subjects over a 2-week period by 2 practitioners. Using a scale of 0 to 4 with 0.5 grade steps, the average duration for an episode of staining above the group median (grade 0.5) was found to be 1.2 +/- 0.4 days. For both eyes, the most prevalent location of staining was the inferior region (50%), followed by the nasal region (20%). Overall, a mean staining grade of 0.5 for the right eye and 0.6 for the left eye was found. Practitioners also demonstrated a difference in grading of 0.1 in the right and left eyes. These data may be most useful in determining the normality of suspect corneal fluorescein staining and its duration until resolution. This study demonstrated a low amount of variability between right and left eyes, and established a good consistency between separate examiners.

Adult↗

PubMed2006

Regional cerebral blood flow changes associated with clitorally induced orgasm in healthy women.

There is a severe lack of knowledge regarding the brain regions involved in human sexual performance in general, and female orgasm in particular. We used [15O]-H2O positron emission tomography to measure regional cerebral blood flow (rCBF) in 12 healthy women during a nonsexual resting state, clitorally induced orgasm, sexual clitoral stimulation (sexual arousal control) and imitation of orgasm (motor output control). Extracerebral markers of sexual performance and orgasm were rectal pressure variability (RPstd) and perceived level of sexual arousal (PSA). Sexual stimulation of the clitoris (compared to rest) significantly increased rCBF in the left secondary and right dorsal primary somatosensory cortex, providing the first account of neocortical processing of sexual clitoral information. In contrast, orgasm was mainly associated with profound rCBF decreases in the neocortex when compared with the control conditions (clitoral stimulation and imitation of orgasm), particularly in the left lateral orbitofrontal cortex, inferior temporal gyrus and anterior temporal pole. Significant positive correlations were found between RPstd and rCBF in the left deep cerebellar nuclei, and between PSA and rCBF in the ventral midbrain and right caudate nucleus. We propose that decreased blood flow in the left lateral orbitofrontal cortex signifies behavioural disinhibition during orgasm in women, and that deactivation of the temporal lobe is directly related to high sexual arousal. In addition, the deep cerebellar nuclei may be involved in orgasm-specific muscle contractions while the involvement of the ventral midbrain and right caudate nucleus suggests a role for dopamine in female sexual arousal and orgasm.

Adult↗

PubMed1999

Identification of the cerebral loci processing human swallowing with H2(15)O PET activation.

Lesional and electrophysiological data implicate a role for the cerebral cortex in the initiation and modulation of human swallowing, and yet its functional neuroanatomy remains undefined. We therefore conducted a functional study of the cerebral loci processing human volitional swallowing with 15O-labeled water positron emission tomography (PET) activation imaging. Regional cerebral activation was investigated in 8 healthy right handed male volunteers with a randomized 12-scan paradigm of rest and water swallows (5 ml/bolus, continuous infusion) at increasing frequencies of 0.1, 0.2, and 0.3 Hz, which were visually cued and monitored with submental electromyogram (EMG). Group and individual linear covariate analyses were performed with SPM96. In five of eight subjects, the cortical motor representation of pharynx was subsequently mapped with transcranial magnetic stimulation (TMS) in a posthoc manner to substantiate findings of hemispheric differences in sensorimotor cortex activation seen with PET. During swallowing, group PET analysis identified increased regional cerebral blood flow (rCBF) (P < 0.001) within bilateral caudolateral sensorimotor cortex [Brodmann's area (BA) 3, 4, and 6], right anterior insula (BA 16), right orbitofrontal and temporopolar cortex (BA 11 and 38), left mesial premotor cortex (BA 6 and 24), left temporopolar cortex and amygdala (BA 38 and 34), left superiomedial cerebellum, and dorsal brain stem. Decreased rCBF (P < 0.001) was also observed within bilateral posterior parietal cortex (BA 7), right anterior occipital cortex (BA 19), left superior frontal cortex (BA 8), right prefrontal cortex (BA 9), and bilateral superiomedial temporal cortex (BA 41 and 42). Individual PET analysis revealed asymmetric representation within sensorimotor cortex in six of eight subjects, four lateralizing to right hemisphere and two to left hemisphere. TMS mapping in the five subjects identified condordant interhemisphere asymmetries in the motor representation for pharynx, consistent with the PET findings. We conclude that volitional swallowing recruits multiple cerebral regions, in particular sensorimotor cortex, insula, temporopolar cortex, cerebellum, and brain stem, the sensorimotor cortex displaying strong degrees of interhemispheric asymmetry, further substantiated with TMS. Such findings may help explain the variable nature of swallowing disorders after stroke and other focal lesions to the cerebral cortex.

Adult↗

PubMed1985

Heterogeneity of myosin isozyme content of rabbit heart.

A detailed study was carried out to measure the relative contents of V1 and V3 myosin isozymes in different regions of rabbit ventricle as a function of age, to assess animal-to-animal variability, and to compare different experimental approaches aimed at minimizing the effects of such variability. In addition, comparisons were made in normal developing hearts between ventricular isozyme composition and myofibrillar myosin calcium-stimulated adenosine triphosphatase. V1 isozyme predominated relative to V3 isozyme in the hearts of 2-week-old rabbits, decreasing to become a minor component in 10-week-old animals. Despite this trend, there was considerable variability in relative isozyme content of whole ventricular tissue among different rabbits of the same age. This variability was reduced in comparisons of littermates and by use of cardiac biopsies to measure changes in isozyme content in the same animal over time. Within different regions of a given heart, there also were small but significant differences in the percent V1 isozyme. The percent V1 was greatest for right ventricular papillary, followed by right ventricular free wall and then the left ventricle (free wall plus septum). There also were differences in the percent V1 within those regions, as exemplified by the significantly higher values for ventricular epicardium vs. endocardium. There was a linear correlation between the myofibrillar myosin calcium-stimulated adenosine triphosphatase and percent V1 of total isozyme for both right and left ventricles in normal and developing hearts. The regression lines for calcium-stimulated adenosine triphosphatase vs. percent V1 had a steeper slope in the left than in the right ventricle.

Aging↗

PubMed1971

Importance of the carotid sinus baroreceptors in the regulation of myocardial performance.

The question of whether the carotid sinus baroreceptors modulate myocardial performance remains controversial. Several studies that have stressed their importance have been criticized because the possible role of cerebral ischemia and of other important variables was not eliminated. To reinvestigate this problem, we studied 21 dogs placed on total cardiopulmonary bypass. In each of these animals the carotid sinus regions were isolated and perfused with fully oxygenated blood at a constant flow rate; perfusion pressure was changed by varying the resistance to outflow from the isolated segments. Several indices of myocardial performance were assessed: right and left ventricular contractile force with Walton-Brodie strain gauge arches; the maximal rate of change in contractile force, dF/dt; the pressure developed within an isovolumic balloon inserted into the left ventricle; and the maximal rate of change of this pressure, dP/dt. When the pressure distending the carotid sinuses was raised from an average value of 34.1 +/-2.8 (SEM) mm Hg to 190.1 +/-4.7 mm Hg, right ventricular contractile force fell 14.9 +/-2.3% (P < 0.001); right ventricular dF/dt decreased 16.7 +/-3.0% (P < 0.01); left ventricular contractile force declined 14.9 +/-3.3% (P < 0.01); left ventricular dF/dt fell 19.3 +/-4.0% (P < 0.01); peak systolic pressure in the isovolumic balloon declined 18.2 +/-3.7% (P < 0.001); and dP/dt decreased 34.1 +/-4.0% (P < 0.01). Prior adrenalectomy and vagotomy and maintenance of heart rate at a constant level did not influence these results. The inverse relation between carotid sinus perfusion pressure and the indices of contractility that was observed in this investigation strongly suggests that the carotid sinus baroreceptors are an important regulatory mechanism in the control of myocardial performance.

Animals↗

PubMed2004

Ventricular enlargement in schizophrenia related to volume reduction of the thalamus, striatum, and superior temporal cortex.

OBJECTIVE: Enlargement of the lateral ventricles is among the most frequently reported macroscopic brain structural changes in schizophrenia, although variable in extent and localization. The authors investigated whether ventricular enlargement is related to regionally specific volume loss. METHOD: High-resolution magnetic resonance imaging scans from 39 patients with schizophrenia were analyzed with deformation-based morphometry, a voxel-wise whole brain morphometric technique. RESULTS: Significant negative correlations with the ventricle-brain ratio were found for voxels in the left and right thalamus and posterior putamen and in the left superior temporal gyrus and insula. CONCLUSIONS: Thalamic shrinkage, especially of medial nuclei and the adjacent striatum and insular cortex, appear to be important contributors to ventricular enlargement in schizophrenia.

Adolescent↗

PubMed2006

Impaired neural networks for approximate calculation in dyscalculic children: a functional MRI study.

BACKGROUND: Developmental dyscalculia (DD) is a specific learning disability affecting the acquisition of mathematical skills in children with otherwise normal general intelligence. The goal of the present study was to examine cerebral mechanisms underlying DD. METHODS: Eighteen children with DD aged 11.2 +/- 1.3 years and twenty age-matched typically achieving schoolchildren were investigated using functional magnetic resonance imaging (fMRI) during trials testing approximate and exact mathematical calculation, as well as magnitude comparison. RESULTS: Children with DD showed greater inter-individual variability and had weaker activation in almost the entire neuronal network for approximate calculation including the intraparietal sulcus, and the middle and inferior frontal gyrus of both hemispheres. In particular, the left intraparietal sulcus, the left inferior frontal gyrus and the right middle frontal gyrus seem to play crucial roles in correct approximate calculation, since brain activation correlated with accuracy rate in these regions. In contrast, no differences between groups could be found for exact calculation and magnitude comparison. In general, fMRI revealed similar parietal and prefrontal activation patterns in DD children compared to controls for all conditions. CONCLUSION: In conclusion, there is evidence for a deficient recruitment of neural resources in children with DD when processing analog magnitudes of numbers.

Journal Article↗

PubMedDate not supplied

Non-Hodgkin's lymphoma (NHL) of the oral cavity.

BACKGROUND: The treatment of NHL in the head and neck region is complex because of the numerous variables that are involved. Reports in the recent literature on NHL of the oral region have dealt with one or two individual cases and routine treatment guidelines do not exist. Local lesions are responsive to radiotherapy as well as to chemotherapy, but the cure rates are discouragingly low. PATIENTS AND METHODS: We report a case of a painful swelling of the lower left gingiva. Local biopsy and a systemic work-up (labs, x-rays, eco scan, CT, bone marrow aspiration and biopsy) was performed. RESULTS: The biopsy of the oral lesion disclosed a malignant NHL; other examinations failed to find other foci of the lymphomatous process. CONCLUSIONS: This case of primitive NHL of the oral cavity summarises the main characteristics of this rather uncommon pathology: a) difficult diagnosis at presentation, often misdiagnosed for other more common oral diseases b) the importance of a local biopsy; c) rapid evolution; d) a good response to chemotherapy; e) poor prognosis.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

Torsional deformation of the left ventricular midwall in human hearts with intramyocardial markers: regional heterogeneity and sensitivity to the inotropic effects of abrupt rate changes.

The spiral orientation of left ventricular (LV) fibers suggests that twisting about the ventricular long axis of the apex with respect to the base, i.e., torsional deformation, may be characteristic of LV contraction. To demonstrate this twisting motion, 10 orthotopic human cardiac allograft recipients were studied with biplane cineradiography of tantalum helices implanted within the LV midwall at 12 specific sites. Counterclockwise twisting about the LV long axis (as reviewed from apex to base) accompanied ventricular ejection in all patients. Torsional deformation angles, measured relative to a reference minor axis at the base, were substantially smaller in the anteroapical wall, as compared with counterparts in the apical third of the inferior and lateral walls (anterior = 13.3 +/- 6.0 degrees, inferior = 18.7 +/- 6.3 degrees, and lateral = 23.4 +/- 10.7 degrees). Torsional angles at the midventricular level were roughly half as much and exhibited similar regional variabilities (anterior = 7.6 +/- 3.3 degrees, inferior = 9.0 +/- 3.3 degrees, lateral = 10.7 +/- 5.2 degrees, and septal = 8.8 +/- 3.8 degrees). Comparison of control beats and the initial beat after abrupt cessation of rapid atrial pacing (126 +/- 10 beats/min) with return to the control heart rate (96 +/- 9 beats/min) permitted the mild positive inotropic effect of tachycardia to be assessed at similar levels of ventricular load. Torsional deformation of the anteroapical and inferoapical sites increased significantly (p less than 0.05) over control values to 15.6 +/- 7.5 degrees and 21.2 +/- 5.5 degrees, respectively. In contrast, torsional deformation of the lateral wall was essentially unchanged. These data provide direct evidence for torsional deformation of the left ventricle in humans, demonstrate that torsion of the LV chamber is nonuniform, and suggest a dependence of LV torsion upon contractile strength that is attenuated in the lateral wall.

Heart↗

PubMed2001

Regional expression of endothelin-1, ANP, IGF-1, and LV wall stress in the infarcted rat heart.

We hypothesized that myocardial infarction induces regional and temporal differences in endothelin-1 (ET-1), atrial natriuretic peptide (ANP), and insulin-like growth factor-1 (IGF-1) gene expression that correlate with left ventricular (LV) wall stress. Echocardiography and LV pressure measurements were performed in coronary artery-ligated or sham-operated rats. Gene expression was measured by competitive RT-PCR in the infarct, border zone, and remote area and in regionally isolated cardiomyocytes. ET-1 and IGF-1 expression was highest in the infarcted myocardium, whereas ANP expression was highest in noninfarcted myocardium. For all genes, remote area expression was highest after 7 days. At 42 days, ANP maintained maximum expression, ET-1 decreased to 50% of peak levels, and IGF-1 was normalized. Cardiomyocyte expression followed the same pattern as in the myocardium except for a markedly lower IGF-1 expression. Diastolic wall stress was the best hemodynamic variable to predict ET-1 and ANP expression in the remote area. We conclude that ET-1, ANP, and IGF-1 are expressed in different patterns in the infarcted heart in relation to time, functional regions, cellular distribution, and mechanical load.

Animals↗