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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

TIBET is a European multicenter, double-blind parallel group trial with the main objective of investigating whether total ischemic burden has important prognostic implications in patients with stable angina on treatment. A secondary objective is to compare the antianginal and antiischemic effects of atenolol (50 mg bid), nifedipine (20-40 mg bid), and their combination using standardized exercise testing and Holter monitoring techniques. The main primary end points are cardiovascular morbidity and mortality. The secondary end points are time to onset of significant ischemia, angina on exercise stress testing, exercise capacity at onset of angina, 1-mm ST-segment depression and termination of exercise, total duration and number of significant ischemic episodes during 48 hours of Holter monitoring, and their circadian distribution. The target population, the assessments, and the management of the trial are described in detail.
Cardiovasc Drugs Ther 1992 Aug
PMID:The total ischemic burden European trial (TIBET): design, methodology, and management. The TIBET Study Group. 152 Jun 48

The characterization of unique responses of immature hearts to ischemic injury is important in devising better methods of myocardial protection for neonatal cardiac operations. Two end-points used to assess the vulnerability of immature myocardium to ischemic injury, namely, the time between onset of ischemia to the beginning of contracture and the functional recovery after reperfusion, had yielded results that appeared to be contradictory. In this study both the immature and adult rabbit hearts were used to study these two end-points in the same model, to assess their relationships and physiologic implications. Our data confirmed that, although immature hearts have greater capacity than adult hearts for functional recovery after identical periods of ischemic insult, their times to ischemic contracture are not prolonged, as could have been expected. A negative correlation between the rise in resting myocardial tension (i.e., contracture) and the recovery of ventricular function after reperfusion was noted both in the neonatal and in the adult hearts. However, reperfusion undertaken after "the onset of contracture" showed that the ventricle could still regain a measure of its function, which indicates that the "irreversibility" in global ventricular function is a gradual and progressive phenomenon. Biochemical studies of sarcoplasmic reticular calcium-adenosinetriphosphatase activity indicated that the immature myocardium has a significantly lower activity of this enzyme. Further depression of this enzyme activity after ischemia is seen in the immature hearts and may in part explain the earlier onset of contracture reported. A unifying concept to explain these unique responses of neonatal hearts to ischemia is proposed, based on the immaturities of certain key enzymes. The implications of these findings in the development of better protective techniques are also discussed.
J Thorac Cardiovasc Surg 1992 May
PMID:Unique responses of immature hearts to ischemia. Functional recovery versus initiation of contracture. 153 57

Techniques for organ preservation generally use hypothermia to retard metabolic requirements. However, excessive hypothermia may also produce injury. Using a canine left lung allotransplantation procedure, we compared two preservation temperatures (4 degrees and 10 degrees C) in terms of subsequent lung function measured by temporary occlusion of the right pulmonary artery after implantation of the preserved left donor lung. The lungs were flushed with low-potassium dextran electrolyte solution, inflated with 100% oxygen, and preserved for 18 hours. To investigate possible changes of energy stores at different temperatures, we performed phosphorus 31-nuclear magnetic resonance analyses of lung samples. Sequential determinations of adenosine triphosphate levels in lung tissue preserved at 4 degrees, 10 degrees, and 22 degrees C were studied. After transplantation, lungs preserved at 10 degrees C (n = 6) provided significantly better arterial oxygen tension than those preserved at 4 degrees C (n = 6), 451 +/- 46 mm Hg versus 243 +/- 86 mm Hg (p less than 0.05), and lower pulmonary vascular resistance, 581 +/- 68 dynes.sec.cm-5 versus 1006 +/- 157 dynes.sec.cm-5 (p less than 0.05). Adenosine triphosphate levels at 4 degrees and 10 degrees C were stable and did not differ from each other at the end of the 18-hour preservation period: 0.86 +/- 0.04 mumol/gm wet weight for control versus 0.86 +/- 0.07 mumol/gm wet weight for 4 degrees C and 0.93 +/- 0.06 mumol/gm wet weight for 10 degrees C after 18 hours of preservation. Preservation at 22 degrees C caused a 28% depression of adenosine triphosphate after 18 hours of preservation. These results lead us to conclude the following: (1) Optimal temperature for lung preservation is in the vicinity of 10 degrees C, and (2) lung dysfunction caused by excessive hypothermia is not due to a failure to maintain adenosine triphosphate levels. We suspect that adenosine triphosphate is generated by oxidative phosphorylation during lung preservation.
J Thorac Cardiovasc Surg 1992 Apr
PMID:In a canine model, lung preservation at 10 degrees C is superior to that at 4 degrees C. A comparison of two preservation temperatures on lung function and on adenosine triphosphate level measured by phosphorus 31-nuclear magnetic resonance. 154 20

The immediate effect of coronary artery bypass grafting on global and regional myocardial function was studied by means of epicardial two-dimensional echocardiography during operations in 20 patients. Echocardiograms were recorded before cardiopulmonary bypass and 5 and 30 minutes after bypass. Global left ventricular function was expressed as percent short-axis area change and regional function as percent fractional area change. Segments were classified according to their baseline function as normal (percent fractional area change greater than 40%), moderately hypokinetic (percent fractional area change 21% to 40%), or severely dysfunctional (percent fractional area change less than 20%). Percent short-axis area change was significantly reduced immediately after cardiopulmonary bypass (from 42.0% +/- 4.6% to 34.9% +/- 3.0%, p less than 0.05) but had returned to baseline 30 minutes after bypass (42.6% +/- 4.0%). Similarly, function of normal and moderately hypokinetic segments decreased significantly immediately after cardiopulmonary bypass (normal segments: percent fractional area change 56% +/- 0.9% before bypass to 42.3% +/- 1.5% after bypass, p less than 0.0001; moderately hypokinetic segments: 31.0% +/- 0.9% to 25.1% +/- 1.4%, p less than 0.002). Both normal and moderately hypokinetic areas regained baseline function by 30 minutes after bypass (normal segments: 53.4% +/- 1.6%; moderately hypokinetic segments: 35.4% +/- 2.0%). In contrast, severely dysfunctional segments were found to be significantly improved immediately after bypass (14.7% +/- 0.9% before bypass to 27.7% +/- 2.1% after bypass, p less than 0.0001). This improvement was maintained 30 minutes after bypass (22.8% +/- 1.5%, p less than 0.001). We conclude that coronary revascularization exhibits an immediate beneficial effect on chronically underperfused myocardium having severely depressed baseline function. However, in normal and moderately hypokinetic areas, the depressant effects of global ischemia and reperfusion prevail in the immediate postbypass period, leading to a global depression of cardiac function.
J Thorac Cardiovasc Surg 1992 Jul
PMID:Effects of coronary artery bypass grafting on global and regional myocardial function. An intraoperative echocardiographic assessment. 161 13

Psychosocial adjustment following myocardial infarction (MI) has received significant research attention during the past 20 years. This article highlights research addressing the relationship of anxiety, depression, and denial in influencing specific outcomes following MI. Additional research describing patterns of emotional response to MI is also included. Based on reported research, specific nursing interventions, in a care plan format, are suggested to foster positive psychosocial outcomes in the post-MI patient. Even though a significant amount of research has been completed on this subject, definitive conclusions regarding patient management supportive of positive outcomes are not possible. Suggestions for future research focus on this topic area are identified.
J Cardiovasc Nurs 1992 Jul
PMID:Psychosocial adjustment following MI: current views and nursing implications. 162 88

Current nursing research has focused on the psychosocial complications and adjustment following myocardial infarction (MI). Depression can impair optimal recovery by the patient and family after MI. This article reviews and critiques two nursing studies related to depression. The first study focuses on reliably assessing depression in the post-MI patient. The second study explores the psychophysiologic link between depression and hypoxia. Implications for practice and further research are discussed.
J Cardiovasc Nurs 1992 Jul
PMID:Depression in the post-MI patient. 162 91

In a prospective study of psychological and neurological reactions to coronary artery bypass surgery, 45 patients were examined preoperatively, postoperatively, and 21 to 27 months after, using a variety of neurological, psychiatric, and psychological investigations. Within the follow-up sample, three subgroups of patients could be identified by cluster analysis who differed with respect to their emotional status and life satisfaction. One group (24% of the total sample) was characterized by high levels of anxiety, depression and life dissatisfaction and appears as a risk population. The other groups could be described as either average (42%) or stable (33%). At the follow up, the risk group further indicated a preference for depressive coping styles, a slightly higher degree of cognitive impairment, more neurological and psychopathological symptoms (specifically giving-up and hostility), a considerably lower return-to-work rate, more subjective physical complaints and a poorer attitude toward the outcome. While postoperative measurements (obtained 2-3 and 6-8 days after surgery) as well as intraoperative parameters did not reveal significant group differences, the analysis yielded an increased impairment within the risk group already prior to surgery, especially emotional problems, specific health-related cognitions and a more fatalistic attitude. The results are in line with those of other studies investigating the late postoperative psychological status with regard to the proportion of patients showing psychological impairments as well as to their specific psychological characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)
Thorac Cardiovasc Surg 1992 Apr
PMID:Preoperative and late postoperative psychosocial state following coronary artery bypass surgery. 163 73

To compare the antiischemic effects of intracoronary administration of a beta blocker, atenolol, and of a calcium antagonist, nifedipine, on the clinical and electrocardiographic signs of myocardial ischemia induced by balloon occlusion of the coronary artery, we studied 32 consecutive patients undergoing routine PTCA. In each patient at least three balloon inflations were performed: the first served to verify the occurrence of ischemia (ST segment depression/elevation greater than 1.5 mm); the second was used as a control occlusion; the third was performed after the patients were assigned to receive either atenolol 1.0 mg IC (group 1, N = 16) or nifedipine V = 0.2 mg IC (group 2, N = 16). In a control population of 10 patients, the time to return to baseline of the ECG tended to be progressively shorter during the three consecutive inflations, but the other clinical and ECG parameters did not change significantly. In group 1 and group 2, two patients did not show ECG signs of ischemia at the third inflation; the time to ischemia increased in group 1 (+76%, p less than .001) and group 2 (+85%, p less than .01; NS group 1 versus group 2); ST segment displacement at 30 seconds decreased in group 1 (-38%, p less than .01) and group 2 (-36%, p less than .01; NS group 1 versus group 2).(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiovasc Drugs Ther 1992 Jun
PMID:Similar antiischemic effects of intracoronary atenolol and nifedipine during brief coronary occlusions in humans. 163 30

The hemodynamic consequences of blockade at both beta-adrenoceptors and slow calcium channels is of therapeutic importance for patients with angina pectoris. The hemodynamic interaction of a new cardioselective beta blocker, celiprolol, and nifedipine was examined in an acute hemodynamic study using three prospectively matched groups with angiographically confirmed coronary artery disease (n = 10/group). Patients were randomly allocated to intravenous celiprolol (8 mg), sublingual nifedipine (20 mg), or their combination. Rest and exercise (supine bicycle) hemodynamics were determined before and following each therapy. At rest, celiprolol did not alter pumping function; nifedipine reduced diastolic blood pressure and systemic vascular resistance index (SVRI), with a small increase in heart rate. Combination therapy reduced systemic arterial pressure and SVRI; heart rate and cardiac stroke volume index increased. During exercise celiprolol tended to reduce heart rate and cardiac index; nifedipine reduced exercise SVR and cardiac stroke work indices. Combination therapy reduced all components of blood pressure; cardiac stroke work and SVR indices fell. These hemodynamic data suggest that beta blockade with celiprolol may result in a slight depression of cardiac pumping during exercise; however, such effects are offset by the vasodilating actions of nifedipine (reflex sympathetic action offsetting cardiodepression). Thus the acute hemodynamic effects of this combination were seemingly safe in these patients; the longer term effects during maintained therapy should be further assessed.
Cardiovasc Drugs Ther 1991 Aug
PMID:Hemodynamic interactions of a new beta blocker, celiprolol, with nifedipine in angina pectoris. 167 61

To assess anesthetic alteration of chronotropic baroreflexes, arterial pressure and heart rate (HR) were monitored continuously during intravenous (i.v.) infusions of phenylephrine or sodium nitroprusside in rats that were either awake or anesthetized (with pentobarbital, urethane, or chloralose). Ensuing reflex HR responses during each drug infusion were determined in two ways: (a) at 10-s intervals (time analysis), and (b) with every 5-mm Hg change in pressure (pressure analysis). Results were less variable with pressure than with time analysis. With responses from awake rats as a basis for comparison, pressure analysis showed that pentobarbital greatly attenuated both reflex tachycardia and bradycardia, whereas urethane and chloralose reduced only reflex tachycardia. Depression by pentobarbital of both reflex tachycardia and bradycardia suggests severe attenuation of both sympathetic and parasympathetic tone. In contrast, preferential alteration of reflex tachycardia by chloralose and urethane implies a greater attenuation of sympathetic than parasympathetic tone.
J Cardiovasc Pharmacol 1990 Jan
PMID:Differential anesthetic depression of chronotropic baroreflexes in rats. 168 64


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