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At least 1,243 records · Page 69Linked to original sources
PubMed2000

Early changes in longitudinal performance predict future improvement in global left ventricular function during long term beta adrenergic blockade.

OBJECTIVE: Contraction of longitudinal and subendocardial myocardial muscle fibres is reflected in descent of the atrioventricular (AV) plane. The aim was therefore to determine whether beta blocker treatment with prolongation of diastole might result in improved function as reflected by AV plane movements in patients with chronic heart failure. DESIGN: Double blind, randomised, placebo controlled and open intervention study. SETTING: University hospital. PATIENTS: Patients with congestive heart failure: placebo controlled (n = 26) and an open protocol (n = 15). INTERVENTIONS: 12 months of metoprolol treatment. MAIN OUTCOME MEASURES: Short axis and long axis echocardiography, invasive haemodynamics, radionuclide angiography. RESULTS: Recovery of systolic and diastolic function during metoprolol treatment was reflected by early changes in mean (SD) AV plane amplitude, from 5.3 (2.0)% to 7.1 (3.2)% and 7.8 (3. 1)% (at 3 and 12 months, respectively; p < 0.05). In a multivariate analysis, only the change in AV plane amplitude by three months was independently associated with improvement in pulmonary capillary wedge pressure by six months (r = 0.80, p = 0.017). Change in AV plane amplitude by three months was also a better predictor of improvement in ejection fraction by 12 months (r = 0.78, p < 0.001) than changes in radionuclide ejection fraction by three months (r = 0.34, p = 0.049). CONCLUSIONS: Improvement in longitudinal contraction was closely associated with a decrease in left ventricular filling pressure during metoprolol treatment. This association was stronger than changes in short axis performance or radionuclide ejection fraction, emphasising the importance of AV plane motion for left ventricular filling and systolic performance in patients with heart failure.

Adrenergic beta-Antagonists↗
PubMed2006

A prospective longitudinal study of apathy in Alzheimer's disease.

BACKGROUND: Apathy and depression are the most frequent behavioural and psychiatric disorders in Alzheimer's disease, and may both have a negative impact on the progression of the illness. OBJECTIVES: To examine the clinical correlates of apathy in Alzheimer's disease (AD), and to determine whether apathy is a significant predictor of more rapid cognitive, functional and emotional decline. METHODS: Using a structured psychiatric evaluation, we examined a consecutive series of 354 subjects meeting clinical criteria for AD. Apathy was assessed by the Apathy Scale, and diagnosed using standardised criteria. Additional measurements included scales for depression, functional impairment, and global cognitive functions. A follow up evaluation was carried out in 247 patients (70% of the total sample) between 1 and 4 years after the baseline evaluation. RESULTS: Apathy was significantly associated with older age (p = 0.009), and a higher frequency of minor and major depression (p < 0.0001). Apathy at baseline was a significant predictor of depression at follow up (p = 0.01), and was associated with a faster cognitive (p = 0.0007) and functional decline (p = 0.006). CONCLUSIONS: Apathy in AD is a behavioural marker of a more aggressive dementia, characterised by a faster progression of cognitive, functional, and emotional impairment.

Aged↗
PubMed1995

Early changes in regional and global left ventricular function after aortic valve replacement. Comparison of crystalloid, cold blood, and warm blood cardioplegias.

BACKGROUND: The clinical effects of different cardioplegic methods on left ventricular (LV) function have not been fully elucidated, particularly in the setting of myocardial hypertrophy. METHODS AND RESULTS: Sixty-four patients (mean age, 62 +/- 12 years; 41 men, 23 women) who were undergoing elective aortic valve replacement (stenosis, 49; regurgitation, 15; concomitant coronary artery bypass grafting, 22), with LV mass index 230 +/- 70 g/m2, were randomized to the following groups: antegrade crystalloid cardioplegia (CCP, 21 patients), antegrade/retrograde cold blood cardioplegia (CBP, 23 patients), or continuous retrograde warm (37 degrees C) blood cardioplegia (WBP, 20 patients). Mean aortic cross-clamp and cardiopulmonary bypass times were 100 +/- 20 and 126 +/- 24 minutes. Positive inotropic drug therapy was required postoperatively in 9 patients after CBP, 14 after CCP, and 18 after WBP. Perioperative LV function was assessed using transesophageal M-mode echocardiography, combined with high-fidelity LV pressure recording and thermodilution cardiac output, before bypass and 0.5, 1, 3, 6, 12, and 20 hours after cross-clamp removal. There was a similar fall in LV peak circumferential wall stress at constant LV end-diastolic dimension in each group after aortic valve replacement. The increase in contraction velocity was significant from 0.5 hour with CBP; however, no significant increase occurred until 12 hours with CCP and until 20 hours with WBP. The rate and extent of LV pressure fall and early diastolic filling rate both increased with CBP, and only in this group did ventricular coordination improve. LV stroke work index was maintained with CBP throughout the postoperative period with less inotropic support than with the other two methods. CONCLUSIONS: In the hypertrophied LV, CBP offers the best preservation of myocardial physiological response and ventricular function with less inotropic support.

Adult↗
PubMed1998

DSM-III-R schizophreniform disorder with good prognostic features: a six-year follow-up.

OBJECTIVE: To determine the outcome of DSM-III-R schizophreniform disorder with good prognostic features. METHOD: A 6-year follow-up of 20 cases was conducted with structured interviews (comprehensive assessment of symptoms and history) and assessments of functioning scales (global assessment of functioning, Strauss-Carpenter Scale). RESULTS: Thirty-five percent of the cases had major affective disorders, 35% had schizophreniform episodes and major affective disorders, 5% had schizophreniform episodes only, 10% developed schizophrenia, and 15% had no disorders. CONCLUSION: The findings suggest an association between schizophreniform disorder with good prognostic features and affective illness.

Adolescent↗
PubMed1999

Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function.

OBJECTIVES: Previous studies have shown that recovery of recordable grip strength in acute stroke subjects is one of the most sensitive assessments of initial upper limb recovery and a good prognostic factor for latter recovery. The objectives of this study were to test the reliability of maximal voluntary grip force (MVGF) measures and evaluate the relationship between paretic grip strength deficit and paretic upper extremity function in chronic stroke subjects. DESIGN: Over a three-week period, bilateral MVGF was assessed three times with a modified strain gauge dynamometer in 15 chronic stroke subjects and 10 control subjects. The paretic MVGF deficit was expressed in relation to the MVGF of the nonaffected hand. OUTCOME MEASURES: Upper extremity function in stroke subjects was measured using the Fugl-Meyer, the upper extremity performance test for the elderly (TEMPA), Box and Block and finger-to-nose tests. RESULTS: MVGF measures in both groups of subjects demonstrated good reliability (intraclass correlation, ICC >0.86) and low standard error measurements (SEM). The paretic MVGF of the stroke subjects was greatly impaired in comparison to the control subjects. Results of linear and quadratic regressions analyses show that this impairment was significantly correlated (p <0.01) with the performance of the stroke subjects on the four upper extremity function tests. The percentages of variances explained by the MVGF deficit on all four upper extremity tests varied from 62% to 78% for the linear regressions and from 72% to 93% for the quadratic regressions. CONCLUSIONS: These results suggest that the paretic maximal grip strength, normalized with the maximal grip strength on the nonaffected side, appears to be a valuable outcome measure of upper extremity function in chronic stroke subjects.

Adult↗
PubMed1987

Noncardioplegic myocardial preservation.

Despite the widespread use of K + cardioplegia, the optimal method of intraoperative myocardial preservation remains controversial. Since 1975, in more than 3,500 patients who have undergone myocardial revascularization at our institutions, intraoperative protection has been provided by a technique of cold-blood perfusion without K + cardioplegia. This report describes our technique, analyzes quantitative ultrastructural changes in four patients before and after bypass to assess cellular damage, and details the clinical and angiographic findings in a subgroup of 157 patients followed postoperatively for up to 6 years. In 100 patients in whom multiple vessels were bypassed, vessels were patent on restudy, thereby excluding technical failure as a cause of impaired left ventricular function. Postoperatively, global left ventricular function was unchanged in 80% and improved in 19%, as compared with preoperative function. Left ventricular function deteriorated in only one patient. We conclude that intraoperative oxygenation by cold-blood perfusion is a successful method of myocardial preservation.

Journal Article↗
PubMedDate not supplied

[Correlation between depressive and anxiety symptoms, distress and functioning].

AIM: The aim of the study was to define the correlation between anxiety/depressive symptoms, distress and functioning. METHOD: The research is based on the analysis of 104 persons (65 women, 39 men), who were patients of psychiatrists (42 persons), or general physician attenders (62 persons) complaining of anxiety or depressive symptoms. Distress was estimated with the General Health Questionnaire (GHQ-30), psychopathological symptoms and diagnoses were evaluated with the Present State Examination (PSE) and the level of functioning with Global Assessment of Functioning (GAF). The intensity of ICD-10 symptoms was calculated for: generalized anxiety disorder, agoraphobia, social phobia, panic disorder, depressive disorder and dysthymia. RESULTS: The lowest score of distress was found in the group with sub-clinical, sole anxiety or depressive symptoms. An intermediate level was present in the group with anxiety and mixed anxiety-depressive disorders, and the highest in the group with depression. The functioning scores were in an inverse order. CONCLUSIONS: The differences in scores of distress and functioning between groups of patients with anxiety disorders, mixed anxiety-depressive disorders and depression are dependent on the intensity of depressive symptoms and are independent of the intensity of anxiety symptoms.

Activities of Daily Living↗
PubMed1988

[Determination of global left ventricular functional parameters with intraventricular digital subtraction angiography in coronary disease].

Left heart catheterisation, coronarography and conventional angiocardiography of the left ventricle (ACG) [30 degrees right anterior oblique; 45 ml contrast medium (Visotrast) with a flow of 12 ml per sec.] was performed in 86 patients with coronary heart disease. Additionally intraventricular digital subtraction angiography (DSA) was performed, using a Philips-device (DVI 2 CV). For DSA 15 ml contrast medium (Visotrast) was injected with a flow of 8 ml per sec. 73 examinations were selected for the study. The aim of the study was to compare the usefulness and applicability of ACG und DSA for ventriculography. There were no significant differences between enddiastolic (EDV) and endsystolic (ESV) volumes as well as ejection fractions (EF) determined by ACG and DSA. Results of the analysis of correlation were rEDV = 0.85;rESV = 0.93;rEF = 0.80. The increase of the end-diastolic pressure after ACG was determined with 7 Torr (mean), after DSA with less than 2 Torr (mean). According to these results we would prefer intraventricular DSA to conventional ACG, provided the technical equipment is available. This is concluded despite the fact that in single cases considerable differences were found between the volumes estimated by ACG and those determined by DSA. These differences were analysed in detail. The main advantages of the DSA are the by far smaller inconvenience for the patients, the rare occurrence of provoked extrasystoles and the fast and easy analysis of the ventriculographies by means of the implemented image processing programmes.

Cardiac Output↗
PubMed1988

[The value of Wagner and Selvester's electrocardiographic point indices for assessing global and regional function of the left ventricle in patients with ischemic heart disease].

The study includes 45 patients with ischemic heart disease. The reproducibility of Selvester's QRS-point index was examined by two researchers (r = 0.98). Between the ejection fraction of the left ventricle and the ECG-pont indices there exists a reverse relation, the correlation coefficients being equal (r = -5.58). Between the segmental disturbances of the left ventricular wall movements, examined by the systolic shortening in percentage of the radial axes, and both ECG indices there is also an equal correlation (r = 0.59). The relation between the angiographically evaluated segmental disturbances and the ejection fraction is also reverse, r = -0.88. The results of the study prove the relatively great possibility for mistakes of only the routine rest ECG is analyzed. The ECG evaluation of the left ventricular function cannot disclose the compensatory reserves of the healthy myocardium.

Adult↗
PubMed1987

Influence of vessel involvement and early streptokinase therapy on regional and global left ventricular function in acute myocardial infarction.

150 consecutive patients with acute myocardial infarction received 750,000 units of intravenous streptokinase within four hours of pain onset. Angiography was performed on day 6, from which ejection fraction (EF), infarct-related ejection fraction (IREF), and non-infarct related ejection fraction (NREF) were calculated. 50% stenosis was considered to be significant. The streptokinase patients with patent infarct-related arteries who had no evidence of previous myocardial infarction were compared with 82 conventionally treated (without streptokinase) patients who had no evidence of previous myocardial infarction. Sub-group analysis based on vessel involvement, usage and timing of streptokinase was done. Streptokinase was associated with better left ventricular function in all sub-groups if given less than 2 hours after pain onset. In inferior myocardial infarction, streptokinase patients with single-vessel disease had normal EF (67 +/- 8), compared to significantly depressed EF in multi-vessel disease (56 +/- 12, p less than 0.05). This difference is accounted for more by the NREF than the IREF. In anterior infarction, patients with single-vessel disease did only slightly better than multi-vessel disease. In multi- and single-vessel anterior infarction, preservation of function by streptokinase appears to be due to the compensatory ability of the non-infarcted region as well as the residual function of the infarct-related region. region.

Cardiac Output↗