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PubMed1989

Systolic and diastolic interaction in the assessment of left ventricular function following surgical cardioplegia.

Using regionally implanted sonomicrometry crystals, we have evaluated a new index of regional function (normalised systolic shortening [NSS]) which integrates the systolic and diastolic properties of the left ventricle. Eight dogs (group I) were subjected to standard cardiopulmonary bypass and 45 min of hypothermic (10 degrees C), hyperkalaemic (25 mEq) crystalloid cardioplegia. Seven dogs (group II) underwent occlusion of the left anterior descending (LAD) coronary artery 5 min prior to initiation of cardiac arrest. The occlusion was released after 20 min, before the second cardioplegia infusion. Sarnoff left ventricular (LV) function curves were performed pre-arrest and 20, 40 and 60 min after removal of the cross-clamp. Regional assessment of myocardial function showed 55% +/- 3%, 70% +/- 3% and 70% +/- 5% recovery in the LAD region and 52% +/- 2%, 83% +/- 3% and 88% +/- 4% recovery in the circumflex (Cx) region of group I. In group II the LAD region recovered 27% +/- 1%, 31% +/- 3% and 38% +/- 3% and the Cx region showed 61% +/- 3%, 55% +/- 1% and 65% +/- 5% recovery. Comparison of the new index of ventricular function to standard indices of regional and global function demonstrate that the latter underestimate the degree of myocardial dysfunction after cardioplegic arrest, particularly in situations of acute regional myocardial ischaemia and uneven myocardial protection. The utilization of this index should provide a better standard for the more accurate assessment of interventions designed to decrease myocardial injury during cardioplegic arrest.

Animals↗

PubMed1988

[Demonstration of dual liver systems after experimental auxiliary partial liver transplantation using the alternative of sequential hepatobiliary scintigraphy].

Hepatobiliary sequential scintigraphies by 99m Tc-ROTOP-EHIDA were carried out for judging the dual liver system after experimental auxiliary transplantation of a part of the liver. A functional advantage of the host liver in contrast to the transplant was found in all cases investigated. Ischemic transplant damages could be detected in all experiments and were scintigraphically recognised at an early stage. In addition to transplants with a functioning entire parenchyma, the investigations showed transplants with functionally active parenchyma zones and such ones without any functional evidence. A quantifiable determination of the global functional capacity of the hepatobiliary system of both livers was possible and also the evidence on residual functions. The different behaviour of the kinetics of the radio-pharmacon with normal function and in case of hepatic ischemia is discussed.

Animals↗

PubMed1989

Evolution of left ventricular function after intracoronary thrombolysis for acute myocardial infarction.

The temporal evolution of left ventricular (LV) function after intracoronary streptokinase therapy for acute myocardial infarction (AMI) was assessed from the data of 264 patients who had complete occlusion of either the left anterior descending or the right coronary artery before treatment. Angiography was performed immediately, and at 3 days and 6 months after AMI in 91%, 71% and 47% of the study group, respectively. Wall motion was measured by the centerline method. In patients with sustained reperfusion, the ejection fraction decreased at 3 days (delta = -2.0 +/- 9.9%, n = 134, p = 0.02) and recovered later (from 54 +/- 12% acutely to 57 +/- 12% at 6 months, n = 82, p less than 0.05). These changes in global function were associated with a marked regression in hyperkinesis in the noninfarcted wall by 3 days, and delayed recovery of wall motion in the infarct region (delta = 0.2 +/- 0.9 at 3 days, p = 0.055; 1.0 +/- 1.2 at 6 months, p less than 0.001). Patients without reperfusion or with reocclusion had a more severe decrease in ejection fraction at 3 days, and little or no subsequent functional recovery. The length of the hypokinetic segment increased significantly by 3 days but subsequently diminished to slightly less than the acute value. It is concluded that full recovery of ischemically impaired myocardium takes greater than 3 days, but compensatory hyperkinesis regresses earlier so that global LV function deteriorates by the third day. Variability or deterioration of LV function early after AMI need not be due to infarct extension; it can reflect regression of hyperkinesis in the noninfarcted region.

Angiography↗

PubMed1990

Functional morphology of the hindlimb in some lacertilia.

Based on a global exploration of the hindlimb in some lacertilian species, an equally global functional approach has been undertaken, which led to the concept of the crural mechanism, an integral mechanism comprising the knee joint and the joints between respectively tibia and fibula on the one hand and the astragalocalcaneum on the other. Simple models explain the position of muscles and ligaments in relation to the homonymous rotation of tibia and fibula as well as the relative anterior displacement of fibula in front of the tibia. The linkage of knee and ankle joints appears to be based on those morphological features in both proximal and distal joints, that preclude pure axial rotations of tibia and fibula without deviation of these bones, again in both knee and ankle. The final result appears to be an integral mechanism endowed with one degree of freedom. An attempt has been made to identify the significance of the crural mechanism for function of the hindlimb in sprawling gait.

Animals↗

PubMed1992

Effect of graded infusion rates of propofol on regional and global left ventricular function in the dog.

We have studied the effects of graded infusion rates of propofol (0.2-0.5 mg kg-1 min-1) on left ventricular global and regional function, in eight acutely instrumented dogs. Global function was assessed by measurement of aortic and left ventricular pressure, LV dP/dtmax, aortic blood acceleration and stroke volume. Regional function was assessed by measurement of systolic shortening and the end-systolic pressure-length relationship. The response of the coronary circulation to short periods of occlusion was also assessed. Administration of propofol significantly reduced left ventricular preload, as indicated by reductions in end-diastolic pressure and length; contractility was depressed, the depression being greater in the apex than in the base of the left ventricle. High infusion rates impaired relaxation. Regulation of coronary blood flow was not disrupted. Reductions in preload and contractility contributed to the propofol-induced hypotension. After 60 min, recovery from the greatest infusion rate was incomplete.

Animals↗

PubMed1989

[Left ventricular function in right ventricular overload: asymmetry of the left ventricular ejection].

This study clarified regional and global functions of the distorted left ventricle due to right ventricular overload by means of gated radionuclide ventriculography (RNV). Cardiac catheterization and RNV were performed in 13 cases of atrial septal defect (ASD), 13 of pure mitral stenosis (MS), 10 of primary pulmonary hypertension (PPH), and 10 of normal subjects (NL). Right ventricular systolic pressure (RVSP) was 32.9 +/- 13.9, 45.0 +/- 12.2, 88.3 +/- 17.1, and 21.2 +/- 4.5 mmHg, respectively. RNV was performed with a 99mTc-red blood cell in a vivo labeling technique. The end-systolic LAO view of the left ventricle was halved into septal and free-wall sides. The end-diastolic halves were determined in the same plane. Ejection fractions of the global left ventricle (LVEF), global right ventricle (RVEF), the septal half of the left ventricle (SEPEF), and the free-wall half of the left ventricle (FWEF) were obtained. LVEF was 56.8 +/- 9.8% in NL, 52.8 +/- 10.5% in ASD, and 49.5 +/- 12.9% in PPH. In MS, LVEF (47.0 +/- 13.0%) was smaller than those in the other groups. RVEF was 37.0 +/- 5.2% in NL, 43.7 +/- 15.5% in ASD, and 32.8 +/- 11.5% in MS. In PPH, RVEF (25.0 +/- 10.6%) was smaller than those in the other groups. SEPEF was smaller in AS D (42.5 +/- 13.2%), MS (40.4 +/- 13.1%), PPH (40.5 +/- 12.5%) than in NL (53.5 +/- 8.5%). Systolic function of the septal half of the left ventricle was disturbed by right ventricular overload. RVEF (r = -0.35, p less than 0.05) and SEPEF (r = -0.51, p less than 0.01) had negative correlations with RVSP. As RVSP rose, systolic function of the septal half of the left ventricle was more severely disturbed. FWEF was the same among the four groups; NL (57.0 +/- 12.6%), ASD (48.6 +/- 15.2%), MS (50.5 +/- 12.0%), and PPH (51.1 +/- 12.3%). Right ventricular overload does not affect systolic function of FWLV. There was a good correlation between SEPEF and LVEF in NL (r = 0.81), though in PPH this correlation was poor (r = 0.64). In patients with PPH the septal side of the left ventricle does not act as a part of the global left ventricle. Systolic function of the septal side of the left ventricle is disturbed due to the distortion of the ventricular septum, but systolic function of the free-wall side is maintained within a normal range, when the left ventricular myocardium is kept normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1977

Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion.

To determine the sequence of changes in segmental myocardial function, regional lactate metabolism and global left ventricular function induced by mild regional ischemia, blood flow in the left anterior descending coronary artery of 10 dogs was reduced by 10 percent decrements with use of a screw clamp. At each level of flow, segmental mechanical function and regional metabolism were assessed, the former with use of a mercury-in-Silastic length gauge and the latter with transmyocardial lactate balance measurements obtained with sampling from the anterior interventricular vein. Coronary arterial flow at the onset of regional lactate production was 48 +/- 4 percent (mean +/- standard error of the mean) of the control value. The onset of segmental mechanical dysfunction coincided with the onset of lactate production. Epicardial S-T segment abnormalities over the ischemic zone usually could not be detected until coronary flow was further reduced. After the onset of regional ischemia there was a linear correlation between coronary arterial flow and regional lactate production. At the onset of mild regional ischemia, defined as the onset of regional lactate production, no significant or directionally consistent changes were noted in standard measurements of global left ventricular performance, including heart rate, mean aortic pressure, left ventricular end-diastolic pressure, cardiac output, stroke volume, stroke work and peak positive dP/dt (maximal rate of rise of pressure). However, peak negative dP/dt (maximal rate of pressure decrease) decreased from 99 +/- 2 to 89 +/- 3 percent of the control value (P less than 0.0005) coincident with the onset of ischemia. It is hypothesized that dyssynchronous wall motion in the ischemic zone during isometric relaxation accounts for this decrease in peak negative dP/dt.

Animals↗

PubMed1992

Radiopharmaceucticals for cardiovascular imaging.

Radionuclide cardiac imaging is a noninvasive technique routinely used to detect coronary artery disease (CAD). This imaging modality includes techniques such as planar, single photon emission computed tomography (SPECT), positron emission tomography (PET) and radionuclide ventriculography--each technique having unique features of its own. Each technique employs various radiopharmaceuticals suitable for assessing different physiological and functional parameters that may become abnormal in the presence of CAD. Various cardiac imaging techniques include myocardial perfusion or blood flow, myocardial metabolism and cardiac function and wall motion. While radionuclide ventriculography gives the global functional status of the heart, SPECT and PET techniques provide information as to the regional blood flow and metabolic status of the myocardium. The following is a review of radiopharmaceuticals that are utilized clinically and in research in different types of nuclear cardiac imaging. Radiopharmaceuticals have been grouped according to the technique employed in which they are used. Various characteristics, merits and disadvantages of each radiopharmaceutical are discussed in detail.

Animals↗

PubMed1984

Right ventricular function: methodologic and clinical considerations in noninvasive scintigraphic assessment.

Right ventricular function plays an important role in many cardiac disorders. Changes in left ventricular function, right ventricular afterload and preload, cardiac medications and ischemia may affect right ventricular function. Radionuclide ventriculography permits quantitative assessment of regional and global function of the right ventricle. This assessment can be made at rest, during exercise or after pharmacologic interventions. The overlap between right ventricle and right atrium is a major limitation for gated scintigraphic techniques. The use of imaging with newer short-lived radionuclides may permit more accurate and reproducible assessment of right ventricular function by means of the first pass method. Further work in areas related to improvement of techniques and the impact of right ventricular function on prognosis is needed.

Animals↗

PubMed1990

Outcome at discharge for patients in an ongoing follow-up study of hospital treatment.

Methodological and practical difficulties have limited the growth of knowledge about outcome of psychiatric hospital treatment. The authors report on outcome at hospital discharge for 103 long-term and 93 short-term patients treated at the C. F. Menninger Memorial Hospital, part of an ongoing follow-up study of hospital treatment. Discharge outcome is based mainly on ratings of symptoms, global functioning, and therapeutic alliance as well as on patients' reports of satisfaction. At discharge both long- and short-term patients were found to have low levels of symptoms (based on the Brief Psychiatric Rating Scale) and a relatively adequate level of functioning (in the 51-to-60 range on the Global Assessment Scale) and to have been highly satisfied with treatment.

Adult↗

PubMed1984

Computer recognition of radiopaque myocardial markers.

Radiopaque markers implanted in the heart have been used both clinically and experimentally to examine cardiac function. From the position of the markers, both regional and global function can be determined. A major problem with using radiopaque markers is the excessive time required for data analysis. Each marker in every cine frame must be identified and digitized by the investigator. To circumvent this problem, a computer system was developed to automatically identify the markers. The cine film is projected onto a TV camera from which the video signal is digitized and transferred into a computer. The investigator identifies the markers in the first cine frame and thereafter the computer advances the film and locates the markers. The markers are recognized based on positional information from the previous cine frame and on a video density profile. This system greatly reduced the investigators' time required for data analysis.

Animals↗

PubMed1989

Community adjustment of chronic schizophrenic patients in urban and rural settings.

The influence of environmental conditions on the community adjustment of chronic schizophrenic patients who live in boarding homes and other residential facilities was studied using data from medical records and interviews with patients. Seventy-eight patients living in an urban area and 46 patients living in a rural area were included in the study. Compared with rural patients, urban patients were more likely to live in substandard dwellings, to receive less practical support from the home operator, and to report more incongruence with household members and aversive neighborhood conditions. Urban patients showed significantly more psychopathology, functioned more poorly in relationships with others, and had poorer global functioning than rural patients. Except for the physical condition of patients' dwellings, all the environmental conditions measured in the study were significantly associated with some measures of community adjustment regardless of geographic setting.

Adult↗

PubMed1991

Dose-related effects of isoflurane associated with low plasma concentrations of verapamil on global and regional function in normal and compromised canine myocardium.

Global and regional myocardial functions were studied in seven open-chest dogs with constant low plasma concentrations of verapamil as increasing concentrations of isoflurane (0.75, 1, 1.5 MAC) were administered in the presence of normal myocardial perfusion and after application of critical constriction of the left anterior descending coronary artery. In the presence of verapamil, increases in isoflurane concentrations caused dose-dependent myocardial depression both before and after critical coronary constriction. The systemic and coronary vasodilatation associated with high concentrations of isoflurane did not occur in the presence of verapamil. The association of verapamil with isoflurane caused regional myocardial dysfunction that worsened at high isoflurane concentrations. This regional dysfunction could not be antagonized in two dogs. The effects of isoflurane on regional function were not modified by application of a critical coronary constriction.

Animals↗

PubMed1984

Improvement in regional and global left ventricular function after intracoronary thrombolysis: assessment with two-dimensional echocardiography.

After acute myocardial infarction, 23 patients undergoing intracoronary thrombolysis and 10 patients receiving conventional medical treatment were studied by 2-dimensional echocardiography to determine changes in regional and global left ventricular (LV) performance. Both quantitative and qualitative analysis of echocardiographic studies showed improvement in regional and global LV function in 18 patients with successful reperfusion immediately after thrombolysis to 10 days later (p less than 0.0005). Eleven patients who were studied before thrombolysis demonstrated no change in regional or global LV function immediately after thrombolysis. LV function did not improve in the conventionally treated group. These data indicate that in patients with acute coronary artery occlusion successfully reperfused by intracoronary thrombolysis, regional and global LV function improved by day 10 but not immediately after reperfusion.

Adult↗

PubMed1985

Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris.

Six attacks of variant angina (2 spontaneous, 4 induced by ergonovine) were studied in 6 patients by combined echocardiographic and hemodynamic monitoring. A decrease of percent systolic thickening of the ischemic wall, which occurred as early as the decrease in peak dP/dt of contraction, was detected before the onset of ST-segment elevation ("pre-electrocardiographic phase"). At this stage, no significant change in left ventricular (LV) end-diastolic pressure or end-diastolic diameter was observed. Subsequently, in the presence of clear-cut ST-segment elevation ("electrocardiographic phase"), percent systolic thickening (an index of regional function) reached its nadir, while dP/dt of contraction (an index of global function) was almost back to preischemic values. In this phase, a significant increase in LV end-diastolic diameter and end-diastolic pressure could be also detected. In the recovery phase, when the ST segment had returned to the isoelectric line ("post-electrocardiographic phase"), percent systolic thickening and dP/dt of contraction showed supernormal values, while LV end-diastolic pressure and end-diastolic diameter decreased below basal values. Thus, echocardiographic signs of impairment in LV mechanics are as early and sensitive as hemodynamic indexes during attacks of variant angina. Furthermore, information on morphologic characteristics and regional LV function, not available with hemodynamic monitoring, can be obtained by echocardiography.

Adult↗

PubMed1984

Global left ventricular function and regional wall motion in pure mitral stenosis.

Global left ventricular function (LVF) and segmental wall motion of the left ventricle are registered in 113 patients presenting a pure mitral stenosis (MS) and in a control group of 50 individuals. The segmental wall motion is measured on the end-diastolic-end-systolic frames of the left ventricle, obtained from right anterior oblique (RAO) monoplane cineangiography. Measurement of the segmental wall shortening is performed using the Stanford method. Group 1 includes 68 patients (60% of the total number of patients studied). These patients show no pathological contraction abnormality. In this group, the global LVF is not different from the control group. Group 2 includes 45 patients (40% of the total) for whom contraction abnormalities are present: anterior hypokinesis in 20% of the cases (anterior area mean shortening (AAS) = 18 +/- 8%; p less than 0.001 vs. group 1 and control group), and posterior hypokinesis in 20% of the cases (posterior area mean shortening (PAS) = 9.8 +/- 5.8%, p less than 0.001 vs. group 1 and control group). In this group, global LVF is impaired; ejection fraction (EF) = 0.57 +/- 0.1% (p less than 0.001 vs. group 1); velocity of circumferential fiber shortening (VCF) = 1 +/- 0.3 circ/s (p less than 0.001 vs. group 1); enddiastolic pressure (EDP) = 11 +/- 5 mmHg (p less than 0.01 vs. group 1). Segmental contraction abnormalities appear to be the main factor involved in the global LVF impairment. Segmental wall motion abnormalities could be related to subvalvular fibrosis, or LV filling difficulties, or principally, to a possible interplay between the right and the left ventricles.

Adult↗

PubMed1991

Personality disorders 2-5 years after treatment: a prospective follow-up study.

Ninety-seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow-up study. At follow-up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self-supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow-up period than other groups. The overall suicide rate was low compared with most similar studies.

Adult↗

PubMed1992

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study].

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

Adult↗