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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Left ventricular diastolic function was evaluated in 41 heart transplant patients during acute rejection by an analysis of echocardiograms and surgically implanted intramyocardial tantalum markers. In 35 patients, isovolumic relaxation time was calculated from M-mode tracings selected from two-dimensional echocardiographic recordings. A total of 84 biopsy findings of no rejection, moderate rejection, and severe acute rejection after treatment were correlated with measurements of isovolumic relaxation time. In six patients, end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and peak filling rate were obtained from biplanar cineradiographic images of intramyocardial markers. Data from 11 prerejection periods were compared with those of moderate acute rejection. All echocardiograms and marker images were analyzed without previous knowledge of biopsy findings. At times of acute rejection, isovolumic relaxation time decreased from 107 to 65 msec (p less than 0.01) and returned to 98 msec after immunosuppressive therapy. Ejection fraction and end-systolic volume did not change significantly with acute rejection, whereas stroke volume decreased from 76 to 67 ml (p less than 0.05). In contrast to the effects on systolic function, episodes of acute rejection were accompanied by a decrease in end-diastolic volume from 166 to 153 ml (p less than 0.01) and a reduction in peak filling rate from 514 to 460 ml/sec (p less than 0.05). These data suggest that acute cardiac rejection is associated with relative preservation of left ventricular systolic performance but with alterations in diastolic dynamics similar to those seen in "restrictive" cardiomyopathy.
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PMID:Diastolic dysfunction during acute cardiac allograft rejection. 229 83

From 1979 to 1989, 18 patients were seen in the Electrophysiology Service, Duke University Medical Center, with automatic atrial tachycardia. There were 8 male and 10 female patients with a mean age of 28.1 +/- 2.9 years. Electrophysiological mapping localized automatic foci to right atrial sites (14 patients) and left atrial sites (4 patients). Depending on origin of the focus, patients were further diagnosed as having either chronic ectopic atrial tachycardia or inappropriate sinus tachycardia. Of the 15 patients with chronic ectopic atrial tachycardia, 6 responded to medical treatment; in 9, the tachycardia was not adequately controlled. Six of them were referred for surgical intervention. All 3 patients with inappropriate sinus tachycardia underwent operative therapy. In the surgical group of patients with chronic ectopic atrial tachycardia, all 6 had a tachycardia-induced cardiomyopathy with ejection fractions ranging from 14% to 27% (mean ejection fraction, 21% +/- 2.7%). Surgical techniques used (alone or in combination) included an isolation procedure in 1 patient, cryoablation in 4 patients, and excision of atrial appendages or portions of atrial free walls in 7. Normal sinus rhythm developed in all surgical patients except 1 patient who had intractable congestive heart failure preoperatively and died of this condition and stroke. The overall success rates for medical and surgical therapy were 33.3% and 88.9%, respectively (p less than 0.01). Long-term follow-up was possible for 7 (87.5%) of 8 patients 3 to 7 years after operation. All patients with chronic ectopic atrial tachycardia were cured, but only 1 of 3 patients with inappropriate sinus tachycardia was in sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical treatment of automatic atrial tachycardias. 230 47

To evaluate the relationship between heart rate and rhythm, and cardiac performance, in the human fetus in utero, observed over a long-term period in gestation, we made a total of 138 studies in 114 fetuses from 18 to 41 weeks of gestation; 104 having heart rate changes without rhythm disturbances ("control group"), 6 with complete atrioventricular block and 4 with supraventricular tachycardia. Using M-mode echocardiogram, we measured end-diastolic dimension and fractional shortening in the right and left ventricles. The corresponding heart rate for each cardiac cycle was measured using the interval between two consecutive end-systolic points. In fetuses in the group of controls, the values for fractional shortening in both ventricles were almost constant with advancing gestational age, unrelated to an increase in end-diastolic dimensions of either ventricle. There was no correlation between changes in heart rate and changes in the value of ventricular fractional shortening at any period of gestation studied. In the fetuses with atrioventricular block, dimensions and fractional shortenings in both ventricles were significantly larger than those in the group of control fetuses at the same stage of gestation. This indicates that the fetal heart is capable of acclimatizing itself, beginning as early as 18-25 weeks of gestation, to long-lasting bradycardia in which an increased stroke volume would be required. In fetuses with supraventricular tachycardia, end-diastolic dimensions were larger and fractional shortening was significantly smaller in both ventricles than in fetuses from the control group from 26-30 weeks of gestation onwards. This suggests tachycardia-induced cardiomyopathy occurring during intrauterine life.
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PMID:Relationship between heart rate and rhythm, and cardiac performance assessed in the human fetus in utero. 239 21

We compared hemodynamics with [3H]nitrendipine (calcium channel) binding to cardiac membranes from Bio 14.6 cardiomyopathic Syrian hamsters at 4 and 10 months with their F1B controls. A 50% increase in the number (Bmax) of nitrendipine binding sites (calcium channels) was seen only in the 4 month old myopathic vs controls (Bmax = 468 +/- 11 vs 309 +/- 10 fmol/mg prot with no change in affinity (KD) (KD = .65 +/- .12 vs .75 +/- .14 nM), while no differences in Bmax or KD were seen at 10 months (Bmax = 375 +/- 9 vs 362 +/- 7 fmol/mg prot/KD = .82 +/- .18 vs .89 +/- .17 nM) myopathic vs control respectively. Hemodynamic studies revealed no significant differences in cardiac output, cardiac index, stroke volume, heart rate, mean arterial pressure, peripheral resistance, body weight, heart weight at 4 months, but a significant decrease in peripheral resistance (1120 +/- 360 vs 2080 +/- 240) increase in body weight (118 +/- 2 vs 94 +/- 2 grams) and heart weight (97 +/- 5 vs 78 +/- 2 gms/100 gms body weight) in 10 month myopathic vs control animals. We conclude that the onset of cardiomyopathy at 4 months is associated with a selective increase in calcium channel binding sites and heart failure at 10 months is associated with a relative decrease in these sites.
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PMID:Correlation of changes in cardiac calcium channels with hemodynamics in Syrian hamster cardiomyopathy and heart failure. 243 66

Enoximone, a relatively new type III phosphodiesterase (PDE III) inhibitor with combined positive inotropic and vasodilating properties, was used as a pharmacological bridge to heart transplantation in a patient with severe dilatative cardiomyopathy (ejection fraction 11-13%), who developed cardiogenic shock refractory to conventional therapy with catecholamines and vasodilators. Enoximone led to an 88% increase in cardiac index (from 1.6 to 3.0 l/min.m2). Despite a noticeable rise in heart rate, stroke index increased by 57%. Systemic vascular resistance decreased by 48% without any relevant change in mean arterial pressure. Cardiac filling pressures remained high. Oxygen transport doubled and oxygen extraction ratio decreased by 10%. Apart from a decrease in arterial oxygen tension (from 15.8 to 12.8 kPa [119 to 96 mm Hg]), no other side effects were noted. Withdrawal of catecholamine therapy did not cause any relevant haemodynamic changes. Although complications arose from an uncontrolled septic state, orthotopic heart transplantation was performed with success 74 hours after initiation of enoximone therapy. As the PDE III inhibitor enoximone exerts its potent inotropic and vasodilating effects without requiring adrenergic receptor activation, it may be used as an alternative to mechanical support in patients who develop cardiogenic shock resistant to catecholamines while awaiting heart transplantation.
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PMID:[Enoximone as an alternative to mechanical circulatory support prior to heart transplantation]. 252 33

The hemodynamic effects of ketamine, 1.5 mg/kg, or sufentanil, 3.4 +/- 0.3 micrograms/kg, were studied prospectively for the anesthetic induction of 20 patients with cardiomyopathies undergoing cardiac transplantation. Plasma epinephrine (EPI), norepinephrine (NE), and sufentanil levels were also obtained. Measurements were taken at various times before induction and following intubation. Following ketamine, progressive increases (P less than 0.05) in mean arterial pressure (28%, MAP), mean pulmonary artery pressure (56%, PAP), central venous pressure (109%, CVP), and pulmonary capillary wedge pressure (84%, PCWP) occurred over time, whereas the cardiac index (CI), stroke volume index (SVI), and stroke work index (SWI) remained unchanged or decreased. The use of sufentanil was associated with no significant changes in MAP, PAP, CVP, PCWP, CI, SVI, or SWI. The heart rate (HR) did not significantly change in either group. Plasma NE significantly increased (31%) in the ketamine group, peaking at 10 minutes; whereas EPI levels did not significantly change in either group. Plasma sufentanil did not reflect the microgram/kg or microgram/BSA administered dose, suggesting individualized distribution kinetics. Since perioperative morbidity and mortality did not differ between groups, both ketamine and sufentanil are acceptable drugs for the anesthetic induction for cardiac transplantation. However, the dissimilar hemodynamic effects caused by ketamine and sufentanil suggest that this conclusion may not be applicable to the patient with a cardiomyopathy undergoing noncardiac surgery.
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PMID:Cardiac transplantation: a prospective comparison of ketamine and sufentanil for anesthetic induction. 253 97

This study carried out at a type "C" hospital, analyses the actual pathology of 1,052 patients attended to at the internal medicine department during a period of one year. The sex distribution did not show any differences. The median age (64 years) was significantly superior in women. The more frequent diseases were from group VII (cardiovascular: 512 cases) and group VIII (respiratory: 471 cases) according to the 9th edition of the who international diseases classification. The most frequent causes for admission were: respiratory infection (19.5%), cardiac insufficiency (13.8%) and CVA (10.6%). The most frequent baseline diseases were cardiomyopathy (20.4%), chronic obstructive airways syndrome (16%), malignant neoplasia (8.5%) and hepatopathy (7.6%). The risk factors and toxic habits observed were: Chronic bronchitis (19.6%), blood hypertension (15.5%), diabetes (13.5%) and high alcohol intake (10%).
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PMID:[A morbidity study in a general internal medicine service in a third-level hospital]. 195 89

A new parameter for the evaluation of left ventricular function based on color-coded Doppler echocardiography is described. From an apical transducer position the maximal diastolic inflow area across the mitral valve into the left ventricle is registered. A ratio of this area to the left ventricular area in the same plane and frame is calculated. These parameters are evaluated in 17 normal controls and 31 patients with dilatative cardiomyopathy. Additionally, the left ventricular volumes and the ejection fraction are calculated from two-dimensional echocardiography using a disc method. The maximal inflow area is correlated with the stroke volume (r = 0.69, y = 7.0 + 8.6x) and the ratio to the ejection fraction (r = 0.99, y = 0.65 + 0.98 x). The intraobserver-correlation for the maximal diastolic inflow area was r = 0.95, y = 5.5 + 0.79 x and the interobserver-correlation r = 0.89, y = 7.7 + 0.8 x. Finally, the gain dependency of the maximal diastolic inflow area was tested. By increasing the gain at low levels a steep linear increase was noted; at higher gain levels a plateau phase was observed where measurements could be performed.
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PMID:[Functional evaluation of the left ventricle using 2-dimensional and color-coded Doppler echocardiography]. 260 17

Several devices are currently available for bridging to cardiac transplantation, but the efficacy of each has not been established. From September 1983 to March 1988 we supported 17 transplant candidates with mechanical assist devices. Extracorporeal membrane oxygenation (ECMO) was used to bridge two patients, external ventricular assist devices (VADs) were used in 11 patients, internal left ventricular assist systems (LVAS) were used in three patients, and implantable prosthetic replacement ventricles (TAH) were used in one patient. The 14 men and three women, aged 24 to 59 years (mean 46 years), suffered cardiogenic shock caused by ischemic (13 patients), postpartum (two patients), viral (one patient), and drug-induced (one patient) cardiomyopathy. Five patients with isolated left ventricular failure (LVF) received only left VADs, three patients with severe LVF and moderate right ventricular failure received LVAS, and nine patients with severe biventricular failure received ECMO (two patients), biventricular assist devices (six patients), and TAH (one patient). Patients were supported for periods of 1/2 to 90 days (mean 22) with flows of 2.15 to 3.39 L/min/m2. Ten patients underwent transplantation (eight of whom were discharged) and seven patients died without transplants. The two patients who received ECMO died 1 and 30 days after transplantation, in part as a result of ECMO complications. Seven patients were denied transplants because of renal failure (five patients), infection (five patients), bleeding (four patients), and cerebrovascular accident (two patients). The seven survivors were supported with VADs (five patients) or LVAS (two patients). Three had driveline infections, two had bleeding complications, two developed mediastinitis, and one each had hemolysis, cerebrovascular accident, and mechanical failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bridging to heart transplantation with circulatory support devices. 265 15

The cardiac status of 102 consecutive black stroke patients entered to the Medunsa Stroke Databank was determined. Cardiological examination, echocardiography and a gated blood pool scan revealed structural and/or functional cardiac abnormalities in 73.6% of patients. Rheumatic heart disease was diagnosed in 15.6%, mitral valve prolapse in 5.8% and mitral annulus calcification in 4.9% of cases. 'Possible' cardiac sources of cerebral embolism were detected in 22.5% and 'definite' sources in 23.5% of patients. Hypertensive heart disease was diagnosed in 35.2% and cardiomyopathy in 13.7% of the study population. Ischaemic heart disease was present in 6.86%. Ultrasonography revealed ventricular bands in 29.4% of patients. The high incidence of structural cardiac abnormalities detected by non-invasive means is in keeping with recent studies in white stroke patients.
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PMID:The cardiovascular status of the black stroke patient. 268 43


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