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Biomedical subjects

D T Kelly

Publications and source records attributed to D T Kelly.

At least 55 records · Page 3Linked to original sources
PubMed1987

Usefulness of ejection fraction response to exercise one month after acute myocardial infarction in predicting coronary anatomy and prognosis.

The prognostic value of left ventricular (LV) ejection fraction (EF) measured during maximal exercise testing early after acute myocardial infarction (AMI) was assessed in 75 patients, aged 65 years or younger, a mean of 36 days after AMI. At follow-up for a mean 12 months (range 6 to 26), medical complications developed in 15 patients: cardiac death in 5, ventricular fibrillation in 1, reinfarction in 2, unstable angina in 5, and severe cardiac failure in 2. Seven other patients underwent coronary artery bypass grafting for severe angina. When LVEF less than 50% at rest was compared with LVEF of 50% or more, the 2-year life-table survival free of complications was 54 +/- 21% compared with 84 +/- 19% (p less than 0.05). When exercise LVEF less than 50% was compared with LVEF of 50% or more, the 2-year survival rate free of medical complication was 42 +/- 32% compared with 83 +/- 20% (p less than 0.05). LVEF change from rest to exercise was not related to prognosis. Patients with combined medical and surgical events tended to have lower rest and exercise LVEFs, but changes in LVEF during exercise were again unrelated to prognosis. Sixty-five patients underwent coronary arteriography. After inferior AMI the mean LVEF was lower in those with multivessel than in those with 1-vessel coronary artery disease at rest (47 +/- 13% vs 59 +/- 7%, p less than 0.005) and during exercise (47 +/- 13% vs 59 +/- 9%, p less than 0.005); however, the change in LVEF during exercise was not related to coronary anatomy anatomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1987

Effect of propranolol and verapamil on oxygen utilization, acidosis and fatigue during exercise in stable angina pectoris.

Oxygen utilization, arterial and venous blood gas levels, hemodynamic values and exercise tolerance were compared before and after administration of propranolol and verapamil in 10 patients with stable angina pectoris. During exercise, propranolol decreased cardiac output (CO) by 22%; O2 extraction was increased and O2 consumption (VO2) did not change. With verapamil treatment, CO modestly increased (7%), O2 extraction decreased and VO2 did not change. In contrast to O2 utilization, the drugs produced opposite changes in mixed venous and arterial blood gas levels. Propranolol decreased mixed venous pH, increased CO2 tension and decreased the pH of arterial blood. Verapamil increased venous pH and decreased CO2 tension; pH of arterial blood did not change. The drugs yielded similar levels of antianginal efficacy, but patients exercised longer during verapamil therapy and were less fatigued. The hemodynamic and metabolic differences suggest that muscle perfusion during exercise influences the onset of fatigue and may help determine the choice of therapy.

Adult↗
PubMed1987

Influence of manure gases on puberty in gilts.

To determine whether manure gases can influence onset of puberty in gilts, 42 crossbred gilts were reared from 10 to 40 wk of age on concrete slats over a 1.22-m deep pit that was drained and refilled with clean water biweekly (clean group). Forty-one gilts were reared over a similar type pit where manure was allowed to accumulate (control group). Treatments were in two separate rooms of the same building with similar feeding, water, floor space, lighting and room temperature. Ventilation fans with timer controls in each room were set so fans in the clean environment ran twice as long as fans in the control environment. Aerial concentrations of ammonia in the control room were fourfold higher than in the clean room (21 vs 5 ppm), while aerial concentrations of hydrogen sulfide were similar. Average daily gain and feed efficiency were similar for both groups [.69 vs .72 kg/d (P = .31) and 1.61 vs 1.54 kg feed/kg gain (P = .52)]. From 20 to 40 wk of age, all gilts were exposed to a mature boar three times weekly, utilizing four boars in rotation. Blood samples were collected weekly from each gilt by venipuncture and analyzed for progesterone to establish time of first ovulation. A greater proportion of gilts in the clean group attained puberty by 24 to 26 wk (P less than .05) and 27 to 29 wk of age (P less than .10) compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Ammonia↗
PubMed1987

Antianginal efficacy of carvedilol, a new beta-blocker with vasodilating action.

To evaluate the antianginal efficacy of carvedilol, a beta-blocker with vasodilating activity, we performed a randomized double-blind placebo-controlled study of two single doses of carvedilol. Twelve patients (eight males, four females, mean age 57 years) with stable effort angina and a positive exercise ECG with angina underwent treadmill exercise testing 2 h after either placebo, or carvedilol 25 or 50 mg. Both doses of carvedilol reduced resting heart rate but only the 50 mg dose reduced resting blood pressure. Exercise time and time to angina increased by 24% and 35%, respectively, after carvedilol, and ST depression at both maximal and submaximal work levels was reduced. The time to 1 mm ST depression was increased by carvedilol but the heart rate at 1 mm ST depression and maximum ST/heart rate slope were unchanged. Maximum heart rate, systolic pressure, and rate-pressure product were significantly reduced by carvedilol. The 50 mg dose was significantly better than 25 mg in prolonging exercise time and reducing subjective and objective measurements of ischemia, and this was related to significantly greater hemodynamic effects. Carvedilol appears to be effective in preventing or reducing effort angina due to reduced myocardial oxygen demand, and it exhibits an important dose-response effect.

Adrenergic beta-Antagonists↗
PubMed1986

Relation between left ventricular functional reserve during exercise and resting systolic loading conditions in chronic aortic regurgitation.

The relation between systolic loading conditions at rest and left ventricular (LV) functional response to exercise was assessed in 31 patients with aortic regurgitation (AR) (20 asymptomatic, 11 symptomatic) and 10 control subjects. Peak and end-systolic wall stress determined from echocardiography and cuff systolic pressure at rest were used as indirect measures of LV systolic loading and were compared with LV ejection fraction response to handgrip and bicycle exercise by radionuclide ventriculography. Both peak and end-systolic wall stress were significantly higher in both asymptomatic (164 +/- 33 and 90 +/- 25 X 10(3) dynes/cm2) and symptomatic (196 +/- 33 and 134 +/- 17 X 10(3) dynes/cm2) patients with AR than in the control subjects (125 +/- 22 and 61 +/- 14 X 10(3) dynes/cm2 p less than 0.01), and correlated inversely with the changes in LV ejection fraction during handgrip (r = -0.63 and r = -0.73) and bicycle (r = -0.68 and r = 0.87) exercise. In patients with AR, resting systolic loading conditions closely reflect LV functional reserve during exercise.

Adult↗
PubMed1986

Prediction of multivessel coronary artery disease and prognosis early after acute myocardial infarction by exercise electrocardiography and thallium-201 myocardial perfusion scanning.

Exercise electrocardiography and thallium scanning were performed a mean of 24 days after uncomplicated acute myocardial infarction in 103 patients, aged 36 to 60 years, who also underwent coronary angiography. The purpose of the study was to determine the ability of the noninvasive tests to predict multivessel coronary artery disease (CAD) and prognosis. Patients were followed up to document medical complications (incidence 12%: 3 deaths, 1 resuscitated cardiac arrest, 4 recurrent infarctions, 4 admissions with unstable angina) and combined events (medical events or bypass surgery, incidence 23%). The sensitivity, specificity and predictive accuracy for predicting multivessel CAD were 64%, 77% and 64% for a positive exercise electrocardiographic (ECG) response, 64%, 88% and 80% for a remote thallium defect, and 42%, 96% and 88% for a combination of the 2 tests. With 2 tests yielding negative findings the probability of multivessel CAD was 13%. No variable (positive exercise ECG response, remote thallium defect and presence of multivessel CAD) predicted medical events, although there were nonsignificant trends to more events in patients with any of those findings. The relative risk of combined events was 2.5 (p less than 0.05) for a positive exercise ECG response; 1.8 (NS) for a remote thallium defect; 2.6 (p less than 0.05) for multivessel CAD; and 3.1 (p less than 0.025) for both positive ECG response and remote defect. A combination of exercise electrocardiography and thallium scanning early after acute myocardial infarction helps to identify subsets of patients with high and low probabilities of multivessel CAD and combined medical or surgical events.

Adult↗
PubMed1986

Late follow-up (41 to 102 months) of medically treated patients with coronary artery spasm and minor atherosclerotic coronary obstructions.

From a series of 37 patients with coronary artery spasm and less than 70% diameter narrowing treated initially with verapamil and nitrates, 33 were followed up 41 to 102 months (mean 62). One patient died from carcinoma of the lung and 3 could not be traced. Before diagnosis, 3 had nontransmural myocardial infarction and 10 had either ventricular tachycardia and fibrillation or atrioventricular block. During follow-up there were no cardiac deaths or myocardial infarctions. Asymptomatic periods of more than 3 months occurred in 23 patients during follow-up: 18 with asymptomatic periods of more than 1 year were pain free at the time of study and 5 with asymptomatic periods of 3 to 6 months had infrequent pain. Ten patients had no asymptomatic periods. Symptomatic status at last review was related to initial response to therapy: 13 of 18 patients (72%) currently asymptomatic became asymptomatic with initial therapy compared with 5 of 15 patients (33%) currently experiencing pain (p = 0.06). Twenty-six patients were currently receiving therapy: 22 verapamil, 80 to 640 mg/day (mean 280), 2 nifedipine, 1 diltiazem and amiodarone and 1 isosorbide (15 were receiving additional isosorbide). Twelve patients were not receiving therapy or were receiving very low dosage therapy, including 8 with asymptomatic periods of more than 1 year. Patients with coronary spasm and less than 70% diameter narrowing treated medically have low mortality and morbidity rates over 5-year follow-up. Many have long asymptomatic periods and some may be able to stop therapy indefinitely.

Coronary Disease↗
PubMed1986

Effects of nifedipine on arterial oxygenation at rest and during exercise in patients with stable angina.

The effects of nifedipine on arterial oxygenation and hemodynamics were studied at rest and during bicycle exercise in 12 men (mean age 55 years, range 41 to 67) with stable exertional angina. The study was conducted double-blind on 2 days, 1 week apart, using a placebo-controlled crossover design. On each day, measurements at rest were made before and 20 minutes after 20 mg sublingual nifedipine or placebo and were followed by measurements made during exercise. Compared with placebo, nifedipine reduced mean arterial pressure, systemic vascular resistance and pulmonary vascular resistance, and increased heart rate and cardiac output at rest and during exercise. It did not alter mean pulmonary artery or pulmonary artery wedge pressures at rest, but decreased them during exercise. Nifedipine decreased arterial oxygen tension (PaO2) from 96 +/- 10 to 90 +/- 13 mm Hg (p less than 0.05) at rest and from 99 +/- 11 to 92 +/- 12 mm Hg (p less than 0.005) at submaximal exercise (33 +/- 21 W), but did not alter it (100 +/- 12 versus 100 +/- 16 mm Hg, p = NS) at maximal exercise (68 +/- 30 W). The reduction in PaO2 was not due to alveolar hypoventilation, because nifedipine did not alter arterial carbon dioxide tension, or to changes in mixed venous oxygen tension, which nifedipine increased at rest (39 +/- 2 versus 43 +/- 3 mm Hg, p less than 0.001) and during submaximal exercise (31 +/- 4 versus 33 +/- 4 mm Hg, p less than 0.03) and maximal exercise (27 +/- 3 versus 31 +/- 3 mm Hg, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Angina following a first non-Q wave infarction relationship to coronary anatomy.

In patients under 60 years who are hospital survivors of a first non-Q wave infarction, outcome is good and the incidence of angina is high at 60%. Post-infarction angina is related to pre-infarction angina and responds to medical treatment in over 80% of patients. Angina is related to the extent and distribution of coronary artery stenosis. Patients with severe obstruction of the left anterior descending coronary artery and those with a totally obstructed infarct-related artery and jeopardized collaterals have a very high incidence of post-infarction angina. Coronary arteriography early after may help determine the subsequent management in patients who survive non-Q wave infarction.

Angina Pectoris↗
PubMed1986

Verapamil in angina pectoris.

New knowledge of the pathophysiology of coronary disease has helped determine the therapy for angina pectoris. Calcium antagonists have the advantage of being direct coronary vasodilators as well as decreasing overall demand by systemic vasodilatation. Verapamil has the same anti-anginal effect during exercise as beta-adrenoceptor blockers but has the advantage of increasing rather than decreasing the cardiac output and so fatigue both at rest and exercise commonly seen with beta-adrenoceptor blockers is not found with verapamil. The longterm incidence of side-effects with verapamil are few and it can be used as a single anti-anginal therapy in a three times daily dosage. Left ventricular function where normal and near-normal is not depressed. Tolerance to therapy has not been recorded. The anti-anginal effects have been shown to remain effective over at least a 5 year period. Verapamil should be considered as initial therapy for patients with stable angina pectoris.

Adrenergic beta-Antagonists↗
PubMed1985

Left ventricular volume and ejection fraction response to exercise in chronic congestive heart failure: difference between dilated cardiomyopathy and previous myocardial infarction.

To determine if cause influences the left ventricular (LV) volume and ejection fraction (EF) response to exercise, 24 patients with chronic congestive heart failure (CHF) (13 dilated cardiomyopathy [DC], CHF-DC group; 11 previous myocardial infarction [MI], CHF-MI group) and 6 age-matched control subjects underwent simultaneous hemodynamic monitoring and radionuclide ventriculography during semiupright bicycle exercise. Both CHF groups had similar hemodynamic values, LV volumes and EF at rest. Exercise hemodynamics were also similar, but LV volume and EF responses to exercise were different. In the CHF-DC group LV end-diastolic volume increased by 15% during exercise, significantly less (p less than 0.01) than the 44% increase in CHF-MI group. During exercise, EF increased in CHF-DC group, but did not change in CHF-MI group because of a larger increase in end-systolic volume. The slope of mean pulmonary wedge pressure-LV end-diastolic volume relation was steeper in CHF-DC group than in CHF-MI group (p less than 0.01). The study suggests that LV volume and EF response to exercise in patients with CHF depends on the origin of the CHF.

Cardiac Output↗
PubMed1985

Effects of upright and supine position on cardiac rest and exercise response in aortic regurgitation.

The effects of upright and supine position on cardiac response to exercise were assessed by radionuclide ventriculography in 15 patients with moderate to severe aortic regurgitation (AR) and in 10 control subjects. In patients with AR, heart rate was higher during upright exercise, but systolic and diastolic blood pressure and left ventricular (LV) output were similar during both forms of exercise. LV stroke volume and end-diastolic volume were not altered during supine exercise. LV end-systolic volume increased and ejection fraction decreased during supine exercise, but both were unchanged during upright exercise. Of 15 patients, 5 in the upright and 12 in the supine position had an abnormal LV ejection fraction response to exercise (p less than 0.01). Right ventricular ejection fraction increased and regurgitant index decreased with both forms of exercise and was not significantly different between the 2 positions. Thus, posture is important in determining LV response to exercise in patients with moderate to severe AR.

Adult↗
PubMed1985

Improvement in exercise capacity and associated changes in hemodynamics and left ventricular function after the addition of metoprolol to nifedipine in patients with stable exertional angina.

In 10 men with stable exertional angina, the changes in exercise capacity, hemodynamics, and left ventricular (LV) function were measured after 20 mg sublingual nifedipine (N) and again after adding 100 mg oral metoprolol (M). Nifedipine alone did not significantly improve exercise workloads (+18%) and duration (+21%), but the addition of metoprolol increased both parameters by a further 37 and 32%, respectively (both p less than 0.005 vs. N). After nifedipine the onset of angina was slightly delayed (5.14 +/- 2.41 min placebo (P), 6.00 +/- 2.31 min N, p less than 0.1) and occurred at higher workloads (36 +/- 17 W P, 43 +/- 8 W N, p less than 0.1). After the addition of metoprolol, the onset of angina was delayed substantially more (9.57 +/- 2.22 min, p less than 0.001 vs. P and N) and occurred at much higher workloads (62 +/- 20 W, p less than 0.001 vs. P and N). At rest (R) and during exercise (E), nifedipine decreased systemic vascular resistance (-36% R, -27% E, both p less than 0.001) and mean arterial pressure (-18% R, -21% E, both p less than 0.001), and increased heart rate (+15% R, +11% E, both p less than 0.001), Pulmonary artery wedge pressure on exercise increased less (22 +/- 7 mmHg P, 13 +/- 5 mmHg N, p less than 0.001). After adding metoprolol, the major change was a reduced heart rate (-25% vs. N at R and E, both p less than 0.001), and arterial pressure was unaltered. Pulmonary artery wedge pressure on exercise increased to 18 +/- 5 mmHg (p less than 0.05 vs. N). Exercise LV ejection fraction and volume did not change significantly after adding metoprolol despite marked improvement in angina. In this acute exercise study in patients with stable exertional angina, metoprolol added to nifedipine markedly improved exercise capacity by preventing the increase in heart rate seen with nifedipine. In our patients with relatively normal LV function at rest, the combination was safe and produced no deleterious effects on LV function.

Administration, Oral↗
PubMed1985

Radionuclide determination of right and left ventricular stroke volumes.

The relationship between radionuclide and thermodilution measurement of stroke volumes (SV) was investigated in 30 patients without valvular regurgitation or intracardiac shunt (group A) at rest and during exercise. Both attenuated radionuclide right ventricular (RV) and left ventricular (LV) SV measurements correlated well with the SV determined by the thermodilution method (r = 0.87 and r = 0.93, all P less than 0.001). The reliability of the radionuclide method to estimate SV was evaluated prospectively in two additional groups of patients. In 11 patients without valvular regurgitation or intracardiac shunt (group B) the radionuclide RVSV and LVSV closely approximated to thermodilution SV at rest and during exercise. In 15 patients with aortic regurgitation (group C) the radionuclide stroke volume ratio correlated well with the angiographic regurgitant fraction. Thus, both RVSV and LVSV and the severity of aortic regurgitation can be reliably measured with gated radionuclide ventriculography.

Cardiac Output↗
PubMed1985

Effect of food ingestion on nifedipine absorption and haemodynamic response.

The absorption of nifedipine (10 mg) and haemodynamic response were studied in 10 patients with myocardial infarction before (Phase A) and after (Phase B) a standardized breakfast. In Phase A, the peak nifedipine concentration (Cmax) and maximum haemodynamic changes were found 1 h after drug administration. In Phase B, the Cmax was lower than that in phase A (43 +/- 6 vs 136 +/- 23 ng/ml, p less than 0.001), and both Cmax and maximum haemodynamic changes were delayed to the fourth hour after administration. Nifedipine plasma concentration correlated significantly with the percent changes in systolic and diastolic blood pressure and heart rate. This study suggests that not only dose but also the time intervals between nifedipine administration and food intake are important in determining the haemodynamic effects.

Blood Pressure↗
PubMed1985

The reproducibility of nongeometric analysis of cardiac output and left ventricular volume by radionuclide angiography.

This study examines the reproducibility of individual radionuclide attenuation factors used in the calculation of cardiac output and left ventricular volume by the nongeometric radionuclide method. Twenty male patients were studied at rest with thermodilution measurements of cardiac output on two separate days. Simultaneous equilibrium radionuclide angiograms were performed and left ventricular stroke volume and cardiac output were determined by the nongeometric method. Individual patient attenuation factors were calculated as the ratio of thermodilution and radionuclide cardiac output measurements at each study. There was a close linear relationship between radionuclide and thermodilution measurements of cardiac output in each study (r = 0.88 study 1, r = 0.97 study 2). A similar relationship was found for measurements of left ventricular stroke volume (r = 0.86, study 1, r = 0.97 study 2). Individual radionuclide attenuation factors ranged from 2.49 to 3.46 in study 1 and from 2.77 to 3.29 in study 2. The individual attenuation factors were reproducible to within 10% in 13 patients and to within 15% in 19 patients. When cardiac output was calculated from the radionuclide data of study 2, by means of individual attenuation factors previously determined in study 1, there was a good correlation with the simultaneous thermodilution measurements of cardiac output (r = 0.92, SEE = 0.38 L/min). Individual radionuclide attenuation factors show little variation in serial studies. Thus the nongeometric radionuclide technique can be used to make accurate serial measurements of cardiac output and left ventricular volume.

Adult↗
PubMed1985

Comparison of effects of isometric and supine bicycle exercise on left ventricular performance in patients with aortic regurgitation and normal ejection fraction at rest.

The effects of handgrip and supine bicycle exercise on hemodynamics and left ventricular (LV) performance were compared in 25 patients with moderate to severe aortic regurgitation (AR) and normal LV ejection fraction at rest (greater than or equal to 50%) and in 10 control subjects. In both groups, heart rate, systolic blood pressure, rate-pressure product, and LV output were higher during supine bicycle exercise. Compared with the controls, in patients with AR, stroke volume was unchanged during supine bicycle exercise. LV end-diastolic volume increased during handgrip exercise but was unchanged during supine bicycle exercise. LV end-systolic volume increased and ejection fraction decreased during both forms of exercise. Of 25 patients with AR, 15 (60%) during handgrip exercise and 19 (76%) during supine bicycle exercise had an abnormal ejection fraction response (p less than 0.05). In patients with moderate to severe AR and normal LV ejection fraction at rest, both handgrip and supine bicycle exercise induced LV dysfunction. An abnormal LV ejection fraction response occurred more often with supine bicycle exercise. Handgrip exercise may be a useful alternative method for detecting LV dysfunction in patients with AR in whom adequate bicycle exercise cannot be accomplished.

Adult↗