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Biomedical subjects

E M Geltman

Publications and source records attributed to E M Geltman.

63 records · Page 4Linked to original sources
PubMed1981

Mitral valve prolapse: a consistent manifestation of type IV Ehlers-Danlos syndrome. The pathogenetic role of the abnormal production of type III collagen.

To evaluate whether abnormal production of type III collagen, the characteristic biochemical feature of patients with the type IV Ehlers-Danlos syndrome, consistently predisposes to mitral valve prolapse, we evaluated the family of a proband with classic type IV Ehlers-Danlos syndrome. Production of type III collagen was assessed with the use of cultured skin fibroblasts. Mitral valve prolapse was detected by M-mode and two-dimensional echocardiography. Biochemical abnormalities in the production of type III collagen and echocardiographic findings of mitral valve prolapse were completely concordant. All patients with abnormal production of type III collagen had mitral valve prolapse and all subjects with normal production of type III collagen had entirely normal echocardiograms. Six of the eight patients with abnormal production of type III collagen had subtle cutaneous abnormalities. The consistent association of abnormal production of type III collagen and mitral valve prolapse in this family suggests that this abnormality of collagen may give rise to mitral valve prolapse.

Adolescent↗
PubMed1980

Cardiac positron tomography: current status and future directions.

Positron emission tomography (PET) performed after the administration of the positron-emitting radionuclides carbon-11 (11C), nitrogen-13(13N), oxygen-15(15O) and fluorine-18(18F) has permitted the improved noninvasive assessment of the regional myocardial metabolism of normal physiologic substrates and intermediates and their cogeners. In experimental animals, the rate of oxidation of 11C-palmitate correlates closely with other indexes of oxygen consumption, and the extraction of 11 C-palmitate (like that of 18F-fatty acids and 18F-fluordeoxyglucose) is markedly diminished in regions of myocardial ischemia. In both experimental animals and in patients, myocardial infarct site and size, determined by positron emission tomography after the intravenous injection of 11C-palmitate, correlate closely with the electrocardiographic infarct locus and enzymatically estimated infarct size as well as with the location and extent of regional left ventricular wall motion abnormalities. PET offers promise for assessment of flow as well despite the complexities involved. PET with 13NH3 appears to provide one useful qualitative index, although this tracer is actively metabolized. Because of the quantitative capabilities of positron emission tomography and the rapid progress which is being made in the development of fast scan, multi-slice, and gated instrumentation, this technique is likely to facilitate improved understanding and characterization of regional myocardial metabolism and blood flow in man under physiological and pathophysiological conditions.

Animals↗
PubMedDate not supplied

Assessment of myocardial fatty acid metabolism with 1-11C-palmitate.

The myocardium has the capacity to utilize a variety of metabolic substrates, including long-chain fatty acids, ketone bodies, glucose, lactate, and amino acids. Under most conditions long-chain fatty acids constitute the major myocardial energy source. Imaging of long-chain fatty acids can be accomplished with carbon 11-labeled palmitate (1-11C-palmitate) and positron emission tomography. Imaging can be performed in either static or dynamic modes. In normal subjects accumulation of the tracer is homogeneous throughout the heart. In patients with myocardial infarction, distinct defects in accumulation are seen. In dilated cardiomyopathy, uptake is spatially heterogeneous. Clearance of 1-11C-palmitate in normal myocardium is biexponential and homogeneous throughout the heart. Administration of glucose, or feeding, decreases uptake of the tracer into the early rapid turnover pool and decreases clearance of the tracer from that pool. In normal myocardium atrial pacing increases the rate of clearance; in ischemic myocardium the degree of increased clearance is attenuated. In patients with cardiomyopathy caused by long-chain fatty acid coenzyme A dehydrogenase deficiency, 1-11C-palmitate clearance is diminished compared with total myocardial oxygen consumption traced with carbon 11-labeled acetate. Thus positron emission tomography with 1-11C-palmitate permits assessment of patients with ischemic heart disease and cardiomyopathy of diverse causes, providing insights into both pathophysiologic mechanisms and the effectiveness of various therapeutic interventions.

Carbon Radioisotopes↗
PubMedDate not supplied

The role of transthoracic echocardiography in the management of patients seen in an outpatient cardiology clinic.

Transthoracic two-dimensional (2D) Doppler echocardiography may provide new or additional information in patients, but it is often not known whether the results alter the treatment plan. We investigated whether results of clinically indicated 2D echocardiography were different from the physician's clinical examination or led to changes in management in 200 consecutive outpatients seen in a university-based clinic. A questionnaire was completed by the physician regarding physical findings and treatment plan before 2D echocardiography was performed. After results were known, the physician was asked to report any differences compared with clinical examination or changes in patient management. Most patients (83%) were studied to evaluate left ventricular (LV) or valvular function. 2D echocardiography confirmed clinical assessment in 182 patients (one inadequate 2D echocardiogram) and disclosed a new diagnosis in 17. 2D echocardiography provided additional information, not expected from clinical assessment or history, in 94 patients. Clinical assessment, compared with 2D echocardiography, was concordant in 154 (77%) of 199 patients with regard to LV systolic function but in only 22 (50%) of 44 with valve disease. Alterations in management based on results of 2D echocardiography were instituted in 73 patients (36%), most often manifested by changes in pharmacologic therapy (n = 45; 62%). Results of 2D echocardiography obviated the need for further cardiac evaluation, surgery, or procedures in 30 patients, avoiding additional patient charges of $125,754.00. In contrast, results of 2D echocardiography led to the need for further evaluation, surgery, or procedures in 32 patients, resulting in additional patient charges of $70,860.00. In conclusion, 2D echocardiography provides new or additional information that results in changes in management strategy in one third of patients, and 2D echocardiography offers relative cost savings by avoiding additional procedures.

Adolescent↗
PubMedDate not supplied

Selection bias in the use of thrombolytic therapy in acute myocardial infarction. The SAVE Investigators.

OBJECTIVE: To determine whether clinical selection for thrombolytic therapy for acute myocardial infarction results in a skewed population for subsequent adverse cardiovascular events. DESIGN: A comparison of the clinical features of the patients in the Survival and Ventricular Enlargement Study who either had or had not received thrombolytic therapy was conducted in both univariate and multiple logistic regression analyses. SETTING: Hospitalized patients experiencing acute myocardial infarction from 112 broadly representative, private, academic, and government hospitals in the United States and Canada. PATIENTS: All patients in the Survival and Ventricular Enlargement Study had had a recent myocardial infarction (less than 16 days) and had a left ventricular ejection fraction of 40% or less. INTERVENTION: Thrombolytic therapy was administered to 733 patients and was not given to 1498. MAIN OUTCOME MEASURES: The comparisons with respect to use of thrombolytic therapy were formulated after the completion of enrollment and indicated that the majority of patients did not receive thrombolytic therapy. RESULTS: The 1498 (67.1%) patients who did not receive thrombolytic therapy were at higher risk (older age, lower functional capacity, greater likelihood of a history of prior myocardial infarction, angina, diabetes, and hypertension) for subsequent cardiovascular events and, as anticipated, were more likely to have concomitant gastrointestinal and neurological diseases. A multiple logistic regression analysis indicated that older age, prior myocardial infarction, impaired functional status, employment status, diabetes, and neurological diseases were predictors of use of thrombolytic therapy. CONCLUSION: Although the Survival and Ventricular Enlargement Study population was selected for left ventricular dysfunction, the majority of patients who currently are judged clinically as unsuitable for thrombolytic therapy have a higher risk for adverse cardiovascular events.

Captopril↗