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Results for “global functioning”

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PubMed1997

Preischemic bradykinin and ischaemic preconditioning in functional recovery of the globally ischaemic rat heart.

OBJECTIVES: Substantial release of bradykinin has been demonstrated to occur during short periods of myocardial ischaemia in various species. The aim of the present study was to investigate the protective effect of bradykinin in ischaemia and whether bradykinin could be involved in ischaemic preconditioning in the rat heart. METHODS: Isolated, buffer-perfused hearts were subjected to 30 min of global ischaemia, followed by 30 min of reperfusion. Postischaemic functional recovery was recorded in the following groups: (1) control; (2) treatment with 0.1 microM bradykinin for 10 min before ischaemia (BK); (3) bradykinin treatment combined with pretreatment with the specific bradykinin B2-receptor antagonist, HOE 140; (4) ischaemic preconditioning by 5 min ischaemia +5 min reperfusion prior to sustained ischaemia (i.p.); and (5) ischaemic preconditioning combined with HOE 140 administration. RESULTS: Postischaemic myocardial function was significantly improved in both BK and i.p. groups (developed pressure 66.9 +/- 6.8 and 67.6 +/- 7.1 mmHg, respectively, vs. 43.1 +/- 5.9 mmHg in controls, P < 0.05). Pretreatment with 1 microM HOE 140 completely abolished the effect of bradykinin, while protection achieved by i.p. was unaltered by this drug. None of the protective interventions was associated with any significant improvement in myocardial adenosine triphosphate, creatine phosphate, glycogen, lactate or glucose tissue levels, detected either at the end of ischaemia or after 30 min of reperfusion. CONCLUSIONS: Bradykinin, acting via B2-receptors, can protect against postischaemic contractile dysfunction to a similar extent as i.p.. An involvement of B2-receptors in the ischaemic preconditioning phenomenon could, however, not be demonstrated.

Adenosine Triphosphate↗

PubMedDate not supplied

[Effects of globalization of structure and function of public health service in Germany].

This essay discusses the effects of globalization on the German health care system. Globalization is regarded as a process to a "One-World-Society" without limits or borders to communication. Especially the economic effects of globalization are discussed, and the reduction of working places and wage levels in developed industrial societies, caused by globalization. Considering this development, it will not be possible to uphold present health care standards.

Cost Control↗

PubMed2007

On the quality of the hardness kernel and the Fukui function to evaluate the global hardness.

An approximated hardness kernel, which includes the second derivative with respect to the density of the kinetic energy, the electron-electron coulomb repulsion, and the exchange density functionals, has been tested for the calculation of the global hardness. The results obtained for a series of 40 cations and neutral systems and 16 anions represent in most cases an improvement of the results obtained using the HOMO-LUMO gap approach and indicate the viability of this approach to evaluate global hardness. In addition, the relevance of the Fukui function approximation and the role of the three components of the hardness kernel in the evaluation of the global hardness have been analyzed.

Anions↗

PubMed2001

Thermal therapy for congestive heart failure: estimation by TEI index.

Systolic dysfunction commonly coexists with diastolic dysfunction in patients with congestive heart failure due to myocardial disease. Also, right ventricular dysfunction is frequently associated with left ventricular dysfunction. The Doppler total ejection isovolume (TEI) index, a combined measurement of systolic and diastolic myocardial performance, is more reflective of overall cardiac function than systolic or diastolic function alone in both ventricles, and provides a conceptually new measure of global cardiac function. Single sauna bathing improves acute hemodynamics and repeated sauna therapy improves cardiac function and clinical symptoms in patients with heart failure. More recently, improvement of vascular endothelial function were observed by repeated sauna therapy in patients with heart failure. The TEI index, combining systolic and diastolic myocardial function, is a promising tool for the quantitative assessment of global cardiac function before and after thermal therapy.

Diastole↗

PubMed2003

Assessment of global and regional myocardial function in the mouse using cine and tagged MRI.

Mouse models are expected to play an important role in future investigations of human cardiac diseases. In the present report, MRI methods for determining global and regional cardiac function in the mouse are demonstrated. ECG-gated cine images were acquired in five C57BL/6 mice at physiological temperatures (37 degrees C) and heart rates of 500 +/- 50 beats per minute. Left ventricular mass, ejection fraction, and cardiac output were estimated from the resulting images. Regional myocardial function was also determined in three animals by application of 2D SPAtial Modulation of Magnetization (SPAMM) in combination with the cine protocol. The quality of the tagged images was sufficient to allow mapping of myocardial strains and displacements. The results of the regional strain analysis were consistent with similar studies in larger animals. This work demonstrates the first characterization of regional myocardial function in the mouse via SPAMM techniques.

Animals↗

PubMed2006

Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy.

OBJECTIVES: Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND: Strain has been proposed as a sensitive tool to detect early systolic function abnormalities in HCM. However, the clinical application of conventional Doppler-derived strain has been limited by poor reproducibility and angle dependency. METHODS: Echocardiographic examinations were performed in 26 patients with nonobstructive HCM and 45 healthy subjects. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal and transverse strain in apical views and circumferential and radial strain in parasternal short-axis view. RESULTS: Despite apparently normal left ventricular systolic function, all components of strain were significantly reduced in HCM. Average longitudinal, transverse, circumferential, and radial strain in patients with HCM and controls were -15.1 +/- 6.2% versus -20.3 +/- 5.6%, 23.3 +/- 17.0% versus 27.2 +/- 14.9%, -16.8 +/- 7.1% versus 19.6 +/- 5.2%, and 25.2 +/- 13.9% versus 36.8 +/- 17.2%, respectively (all p < 0.001). In patients with asymmetrical HCM, longitudinal septal strain was significantly lower than for other left ventricular segments combined: -9.2 +/- 4.7% versus -12.7 +/- 7.1% (p = 0.001). Average interobserver and intraobserver variabilities were 11% and 11.3%, respectively. CONCLUSIONS: Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.

Cardiomyopathy, Hypertrophic↗

PubMed2006

Dual breath-hold magnetic resonance cine evaluation of global and regional cardiac function.

The purpose of our study was to evaluate the accuracy of a multislice cine magnetic resonance imaging (MRI) technique with parallel imaging in regard to global and regional left ventricular function. Forty-two individuals underwent cine MRI on a 1.5-tesla scanner. Cine MRI used a steady-state free precession technique and was performed as a single-slice technique (nonTSENSE cine) and an accelerated multislice technique (TSENSE cine) with five slices per breath-hold. End diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) were evaluated for all data sets and in regard to regional wall motion and regional wall motion analysis, and quantitative regional wall thickness and systolic thickening were also assessed. EDV, ESV, and EF based on TSENSE cine showed excellent correlation to the nonTSENSE cine approach (all r(2)=0.99, P<0.001). While EDV evaluations showed a small underestimation for TSENSE cine, ESV and EF showed accurate results compared with nonTSENSE cine. Both readers showed good agreement (kappa=0.72) in regional wall motion assessment comparing both techniques. Data acquisition for the multislice approach was significantly shorter ( approximately 75%) that in single-slice cine. We conclude that accurate evaluation of regional wall motion and left ventricular EF is possible using accelerated multislice cine MR with high spatial and temporal resolution.

Adolescent↗

PubMed1987

Improved functional recovery of the atherosclerotic rabbit heart subjected to normothermic global ischemia.

Contractile function before, during and after a period of ischemia was evaluated in perfused hearts from rabbits fed either 2% cholesterol or a control diet for two months. Rabbits were sacrificed and the hearts were perfused by the Langendorff normothermic perfusion technique. After a 30-min baseline period, the hearts were subjected to a 60-min period of low flow ischemia (0.2 mL/min) with Krebs-Henseleit solution containing either 2.5 mM (normocalcemic) or 0.5 mM (hypocalcemic) calcium. Subsequently the hearts were reperfused for 30 mins. No significant differences in baseline contractile function (expressed by developed pressure and dP/dtmax) were observed between hearts from cholesterol-fed and control rabbits. Although, initially the degree of contracture, as measured by an increase in end diastolic pressure from baseline, was less in cholesterol-fed rabbit hearts, this difference did not persist beyond 40 mins of ischemic perfusion. Hypocalcemic ischemic perfusion was associated with a delay in development of contracture relative to normocalcemic perfusion in the hearts from cholesterol-fed rabbits. These results suggest an early resistance to ischemia by hearts from cholesterol-fed rabbits. Upon reperfusion, the hearts from control rabbits exhibited a sudden increase in contracture following ischemic perfusion with 0.5 mM calcium which was not observed in the hearts from rabbits fed a cholesterol diet. There was improved functional recovery and less contracture development post reperfusion in the hearts from cholesterol-fed rabbits, independent of the concentration of calcium used during ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1997

Factor structure of symptoms in functional psychoses.

Global ratings from the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were subjected to principal-component analysis (PCA) in 80 schizophrenia patients, 76 patients with schizophreniform disorder, 80 patients with schizoaffective and mood disorders, and 78 patients with delusional, brief reactive, and atypical psychoses. The resulting factors were correlated with depressive, manic, and catatonic syndromes, and subjected to a multivariate analysis of variance across DSM-III-R diagnoses. PCAs revealed that psychosis, disorganization, and negative factors were also present in each of the nonschizophrenic groups. The disorganization factor tended to be related to the manic syndrome, and the negative factor to depressive and catatonic syndromes. Overall, the three factors had little diagnostic relevance in functional psychoses, although the negative factor was relatively more characteristic of schizophrenia. The data suggest that positive, negative, and disorganization factors are not specific to schizophrenia; this is consistent with a dimensional view of psychopathology in functional psychoses.

Adult↗

PubMed1996

Global assessment of relational functioning scale (GARF): II. Reliability and validity in a sample of families of bipolar patients.

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.

Adolescent↗

PubMed2005

Reduced myocardial velocities of left ventricular long-axis contraction identify both systolic and diastolic heart failure-a comparison with brain natriuretic peptide.

BACKGROUND: Echocardiographic diagnosis of radial fractional shortening or global ejection fraction fails to diagnose all patients with heart failure; about 40%, with apparently normal global systolic function, will have elevated brain natriuretic peptide (BNP) concentrations and "pure" diastolic dysfunction. Screening methods do not include assessment of left ventricular (LV) longitudinal function, however, which is a more sensitive marker of subclinical disease. AIMS: We investigated the diagnostic potential of assessment of LV longitudinal function in suspected heart failure, in a comparison against BNP. METHODS: Fifty consecutive subjects (aged 65+/-12 years; 30 men) referred to a heart failure clinic with unexplained breathlessness were examined by echocardiography and had plasma BNP measured by fluorescence immunoassay. RESULTS: Global systolic function (ejection fraction) correlated moderately with log-transformed BNP (r=-0.54), as did global diastolic function (r=0.55 for estimated LV filling pressure, and r=-0.51 for transmitral flow propagation velocity), and radial systolic function (r=-0.60) (all p<0.001). The echocardiographic parameter that correlated best with BNP, however, was LV longitudinal systolic function (r=-0.78, p<0.001). By stepwise multiple regression analysis, BNP was predicted by longitudinal systolic velocity, in association with LV mass index and radial systolic velocity (r=0.81, r(2)=0.66, p<0.0001). The sensitivity and specificity of a longitudinal systolic velocity of </=5.5 cm/s (mean of 4 basal segments) to diagnose heart failure (defined as an elevated BNP) were 94% and 85%, respectively; the negative predictive value was 97%. CONCLUSION: Non-invasive diagnosis or exclusion of suspected heart failure, whether systolic or diastolic, can be performed accurately by echocardiographic measurement of LV longitudinal systolic function.

Aged↗

PubMed2006

Effects of on-pump versus off-pump coronary artery bypass graft surgery on right ventricular function.

OBJECTIVES: Right ventricular dysfunction is a possible cause of cardiac failure after coronary surgery. The use of cardiopulmonary bypass is regarded as a major cause for its occurrence, and it has been postulated that performing coronary surgery without cardiopulmonary bypass might reduce ventricular dysfunction. Therefore, this prospective, randomized, controlled study tested the hypothesis that off-pump coronary surgery would better preserve right ventricular systolic and diastolic function than conventional bypass surgery. METHODS: Fifty patients scheduled for elective coronary artery bypass surgery were randomly assigned to conventional or off-pump surgery. Right ventricular function was assessed by intraoperative transesophageal echocardiography immediately before and after coronary surgery. Right ventricular ejection fraction was used as a marker of global systolic function and tricuspid early/late (atrial) ratio as a marker of the global diastolic function. Peak systolic and early diastolic velocities of the lateral tricuspid annulus were studied to assess systolic and diastolic function in the area of the right ventricular free wall. RESULTS: Surgery was completed according to randomization in 48 of 50 patients. Preoperative characteristics were similar in both groups. Intraoperative differences between the two groups included a higher volume of allogeneic blood transfusion in the conventional surgery group. At the end of surgery, global systolic right ventricular function was similarly maintained and diastolic function similarly impaired in both groups. There were no significant intergroup differences in any of the echocardiographic markers of right ventricular function. CONCLUSIONS: Off-pump surgery did not better preserve right ventricular systolic and diastolic function than did conventional coronary surgery.

Aged↗

PubMed1987

Dissociation between global and regional systolic and diastolic ventricular function during coronary occlusion and reperfusion.

Indexes of global ventricular function such as the ejection fraction (EF) and the peak diastolic filling rate (PDFR) are often used to assess the effects of coronary recanalization in patients with myocardial infarction. In this investigation we assessed the relationship between these global indexes and directly measured indexes of regional function during 15 minutes of coronary occlusion followed by 120 minutes of reperfusion in 22 open-chest dogs. A computerized nuclear cardiac probe was used to assess EF and PDFR. Indexes of regional function were measured by Doppler ultrasonic wall-thickening probes. During coronary occlusion, paradoxical systolic thinning occurred and the EF and PDFR decreased an average of 31.6% and 24.4%, respectively. During reperfusion the EF and PDFR improved rapidly and at 60 minutes were similar to baseline. Systolic wall thickening improved more gradually and remained abnormal throughout reperfusion. Likewise, indexes of diastolic function (mean rate to half end-diastolic thinning and late diastolic thinning fraction) recovered slowly and remained abnormal throughout reperfusion (78% and 69.7%, respectively). The correlation between the rate of change of global and regional function was poor during both coronary occlusion and reperfusion. Thus, during coronary occlusion the global and regional indexes of ventricular function undergo directionally similar changes. However, during coronary reperfusion the global indexes do not reflect the slow recovery of the stunned myocardium.

Animals↗

PubMed1990

Long-term effects of excision of the mitral apparatus on global and regional ventricular function in humans.

To evaluate the long-term sequelae of mitral valve excision on global and regional wall motion, contrast left ventriculograms from 21 patients with suspected prosthetic mitral valve dysfunction performed 10.4 +/- 2.1 years after mitral valve replacement were analyzed by a computerized radial shortening method. Patients with significant coronary artery disease (greater than 30% stenosis in any vessel) were excluded. In 8 of the 21 patients in whom preoperative ventriculograms were available, regional wall motion was normal before valve replacement. Although average radial shortening (35.6 +/- 4.8% versus 35.3 +/- 3.8%, p = NS) and left ventricular ejection fraction (62.8 +/- 4.2% versus 57.9 +/- 2.8%, p = NS) were unchanged in the preoperative and postoperative studies of these eight patients, radial shortening in the vicinity of insertion of the posteromedial papillary muscle declined significantly (38.4 +/- 6.4% to 20.8 +/- 4.4%, p less than 0.04). Postoperative radial shortening for all 21 patients at the site of insertion of the papillary muscle was also reduced to a significant degree compared with the average radial shortening (32.9 +/- 10.3% versus 17.5 +/- 2.0%, p less than 0.001). The findings demonstrate significant long-term and possibly permanent regional ventricular dysfunction after severing the chordae tendineae during mitral valve replacement.

Female↗

PubMed2002

Does dobutamine improve ventricular function in dogs with regional myocardial dysfunction?

UNLABELLED: We studied the effect of systemic dobutamine infusion (4 microg. kg(-1). min(-1) IV) on regional wall motion abnormalities (RWMAs) in eight anesthetized open-chested dogs. We hypothesized that infusion of small doses of dobutamine would reduce RWMAs and improve global ventricular function. Apical RWMAs were induced by local intracoronary boluses of 9.0 mg esmolol. Phase angles, effective stroke volume (SV), maximum SV, stroke work, and segmental shortening were compared among four left ventricular (LV) regions (apical, papillary, chordal, and basal) during baseline, dobutamine, esmolol, and dobutamine-esmolol treatments. The minimal global LV volume was designated as 0 degrees, and the cardiac cycle was divided into 360 intervals. Regional phase angles were defined as the distance (in degrees) that regional minimum volume differed from global minimal LV volume (end-systole). RWMA decreased blood pressure (92 +/- 2 mm Hg to 84 +/- 3 mm Hg) and increased LV end-diastolic pressure (1.8 +/- 0.5 mm Hg to 4.2 +/- 0.8 mm Hg). RWMA delayed regional contraction (-2.9 degrees +/- 1.6 degrees to 52.3 degrees +/- 1.5 degrees ) and decreased effective SV (2.3 +/- 0.4 mL to 1.6 +/- 0.3 mL) in the affected apical region but did not decrease maximal SV. Systemic infusion of dobutamine restored global LV function but failed to eliminate RWMA, as evidenced by decreased apical synchrony, effective SV, and stroke work. We concluded that systemic dobutamine restored global LV function but failed to correct RWMA. IMPLICATIONS: We examined the effect of systemic dobutamine on regional wall motion abnormalities (RWMAs) induced by intracoronary esmolol infusion in eight anesthetized dogs. Esmolol dilated the heart and decreased regional synchrony of contraction. Dobutamine restored cardiac function but failed to correct the asynchrony of regional contraction caused by esmolol-induced RWMAs.

Adrenergic beta-Antagonists↗

PubMed1991

Changes in Doppler indices of cardiac function during and after percutaneous transluminal coronary angioplasty.

OBJECTIVE: To assess the sensitivities of Doppler indices to changes in global cardiac function during and after controlled myocardial ischaemia induced by coronary angioplasty. DESIGN: Continuous wave Doppler signals of aortic flow were recorded during coronary angioplasty. The following Doppler indices of cardiac function were measured before, during, and after balloon inflation: V (peak velocity), MA (mean acceleration), V2/T (T = time from onset to peak ejection), and MD (minute distance corrected for baseline heart rate). SETTING: A tertiary care cardiological unit in a university hospital. PATIENTS: Sixteen patients undergoing coronary angioplasty of the left anterior descending coronary artery. Eight patients had multivessel disease. MAIN OUTCOME MEASURES: The primary outcome measures were planned before data collection began. RESULTS: 12 patients showed a significant fall of three or more Doppler indices from their baseline values during balloon inflation. This occurred in all patients with multivessel disease. The Doppler indices V2 T, MD, V, and MA fell by 43.7%, 37.7%, 27.4%, and 23% respectively from their baseline values (p less than 0.0001). The relative sensitivities of the Doppler indices to ischaemia were V2/T greater than MD (p less than 0.02), MD greater than (p less than 0.001), and V greater than MA (p less than 0.01). The impairment of global left ventricular function resulting from brief balloon inflation during single vessel angioplasty was reversible in all the patients. CONCLUSIONS: The Doppler indices V2/T, MD, V, and MA are all sensitive, in order of magnitude, to falls in global cardiac function resulting from ischaemia. They may prove useful for assessing cardiac function during ischaemia in the clinical setting.

Adult↗

PubMed1998

The role of platelet-activating factor in regional myocardial ischemia-reperfusion injury.

BACKGROUND: This swine model was designed to elucidate the role of platelet-activating factor in regional myocardial ischemia-reperfusion injury. METHODS: In groups 1 and 2 (n = 12 each), the left anterior descending coronary artery was ligated for 60 minutes to induce regional myocardial ischemia followed by 6 hours of reperfusion. Group 1 received the platelet-activating factor antagonist TCV-309 before ischemia, whereas group 2 did not. Group 3 (n = 3) had a sham operation. RESULTS: Animals in group 2 exhibited significant (p < 0.05) hemodynamic instability and myocardial depression during the reperfusion period. Despite preventive measures, 7 of the 12 animals experienced severe dysrhythmias in the form of atrial and ventricular fibrillation leading to cardiac arrest. In contrast, animals in group 1 in whom the effects of platelet-activating factor were blocked by the specific platelet-activating factor receptor antagonist TCV-309 were hemodynamically stable and had significantly (p < 0.05) better myocardial function. This significant difference in global myocardial function between the groups was observed in the presence of similar morphologic findings and regional myocardial function. CONCLUSIONS: These results suggest that platelet-activating factor has a definite influence on global myocardial dysfunction associated with regional myocardial ischemia-reperfusion injury.

Animals↗

PubMed1988

Intravenous streptokinase for acute myocardial infarction. Effects on global and regional systolic function.

The Western Washington Intravenous Streptokinase Trial randomized 368 patients with acute myocardial infarction to receive either intravenous streptokinase or standard therapy. The ventriculograms and coronary angiograms obtained in 170 patients 10.4 +/- 7.4 days after infarction were analyzed to evaluate the effects of thrombolytic therapy on global and regional systolic function. Streptokinase treatment resulted in a higher patency rate of the infarct-related artery (68.5%) than did standard therapy (44.8%) (p = 0.003). Ejection fraction was higher in streptokinase-treated patients (54% vs. 51%, p = 0.056), and the difference was most marked in patients with anterior myocardial infarction (53% vs. 44%, p = 0.03). Regional wall motion was measured by the centerline method and expressed in mean +/- SD motion in 52 normal subjects. There was a trend toward better function of the infarct zone in streptokinase-treated patients (SD, -2.48 vs. -2.70, p = 0.24). Additionally, streptokinase-treated patients had significantly better wall motion of noninfarct areas (SD, 0.36 vs. -0.08, p = 0.02). Treatment effects on function of noninfarct regions were most apparent in the subset of patients with multivessel disease. Thus, intravenous streptokinase preserves left ventricular function in patients with acute myocardial infarction. This benefit includes favorable effects on the function of regions remote from the site of infarction.

Cardiac Catheterization↗