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Biomedical subjects

F R Kahl

Publications and source records attributed to F R Kahl.

31 records · Page 2Linked to original sources
PubMed1978

Differential shunting in the diagnosis of patent ductus arteriosus with Eisenmenger physiology by radionuclide angiography.

Radionuclide angiography and static whole body imaging performed with technetium-99m-labeled particulates can clearly demonstrate differential shunting in patients with patent ductus arteriosus (PDA) with Eisenmenger physiology. The anatomic arterial relationships in this condition which direct deoxygenated blood into the lower body (differential cyanosis) produce specific radionuclide images characterized by differential shunting of the technetium-99m-labeled particulates into the abdomen and lower extremity.

Adult↗
PubMed1977

Localization of 99mTc-Sn-pyrophosphate in left ventricular aneurysms.

Concentration of 99mTc-pyrophosphate (99mTc-PPi) in the area of left ventricular aneurysms is discussed. In three cases clinical, laboratory, and electrocardiographic (ECG) evidence did not indicate that these patients currently had an acute myocardial infarction, but each patient had a clinical history and an ECG picture compatible with an old myocardial infarction. Cardiac catheterization revealed a large left ventricular aneurysm in all three cases. The reason for the preferential uptake of the radionuclide in the area of these aneurysms is not certain at this time.

Diphosphates↗
PubMedDate not supplied

Double cardiomyopathy: coexistent cardiac amyloidosis and hypertrophic obstructive cardiomyopathy.

A combination of hypertrophic obstructive cardiomyopathy (HOCM) and cardiac amyloidosis in the same patient is very rare. Clinical diagnosis could be extremely difficult and may require myocardial biopsy. We are reporting a patient with this combination who was referred to our institution because of features of HOCM based on clinical, echocardiographic and Doppler criteria. Cardiac amyloidosis was only recognized after myocardial biopsy that failed to reveal evidence of HOCM. Only after the patient expired from severe, intractable heart failure did the autopsy findings confirm the association of HOCM. We believe that the combination of the two cardiomyopathic processes is very rare and makes treatment extremely difficult.

Aged↗
PubMedDate not supplied

Central adipose distribution is related to coronary atherosclerosis.

A "male" distribution of adipose tissue in women (excess of fat in the abdomen compared with that in the hips; i.e., elevated waist/hip ratio) has been related to symptomatic cardiovascular disease. An elevated waist/hip ratio has also been related to symptomatic cardiovascular and cerebrovascular diseases in men, as well as to risk factors for these diseases and various metabolic conditions. To determine whether adipose distribution was related to coronary atherosclerosis, we performed a case-control study in patients with angiographically documented coronary atherosclerosis (cases) and in angiographically normal hospital and neighborhood controls. The data show that distribution of adiposity as assessed by waist/hip ratio is significantly related to coronary atherosclerosis in both females and males. Waist/hip ratio is significantly greater in female cases compared with either control group; in males, waist/hip ratio is significantly greater in cases compared with asymptomatic neighborhood controls but not compared with patients with normal coronary arteries. These results persist after control for age, plasma concentrations of lipids and lipoproteins, body mass index, history of hypertension, history of diabetes, and smoking status. The connection between the male adipose distribution in females and coronary atherosclerosis partly explains the greater likelihood of symptomatic cardiovascular disease in them. Males with excess deposition of fat in the abdominal region are also likely to experience increased risk.

Adipose Tissue↗
PubMedDate not supplied

Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis.

The extent of carotid artery atherosclerosis as measured by B-mode ultrasound has been shown to be strongly and independently correlated with the presence or absence of coronary atherosclerotic disease (CAD), but no studies to date have used carotid B-mode ultrasound to compare the extent of atherosclerotic disease in the two arterial circulations. We used data from a registry of patients undergoing cardiac catheterization and B-mode ultrasound of the carotid arteries to compare the extent of CAD (number of major coronary vessels with 50% or greater stenosis as judged by a consensus interpretation) with the extent of extracranial carotid atherosclerosis. Four hundred thirty-four patients (234 men, 200 women) greater than 40 years of age were stratified by gender and then divided into quartiles on the basis of a B-mode score that was derived by summing arterial wall thickness at nine sites in the left and nine sites in the right carotid arteries. Evaluation of extent of CAD for the four B-mode quartiles showed that men in the lowest B-mode quartile were over six times more likely to have normal coronary arteries than three- to four-vessel CAD, while men in the highest B-mode quartile were over 10 times more likely to have three- to four-vessel CAD than normal coronary arteries. The findings were similar for women but not as dramatic. Gender-specific discriminant function models using traditional risk factors alone or in combination with B-mode score were developed to predict the extent of CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗
PubMedDate not supplied

Individual variation in susceptibility to extracranial carotid atherosclerosis.

Risk factors for coronary disease were assessed and noninvasive methods were used to quantitate the extent of extracranial carotid atherosclerosis in 382 patients free of cerebrovascular symptoms. The ages of the participants ranged from 27 to 80 years. There were 183 men and 199 women, 30 black and 352 white persons. All patients had heart disease symptoms and were hospitalized for coronary angiography. Correlation of risk factors with extent of extracranial carotid atherosclerosis in this series of patients undergoing coronary angiography uncovered individual variability in relationships between risk factors and carotid atherosclerosis that depended on coronary status. Risk factors for carotid atherosclerosis in patients with and without coronary disease differed. Age and hypertension were independently related to carotid atherosclerosis in patients with, as well as those without, coronary disease. However, other risk factors were related to carotid atherosclerosis in only one group or the other. Risk factors correlated strongly with carotid atherosclerosis in patients with coronary disease (r2 = 0.41) but poorly in those with no coronary disease (r2 = 0.21). Certain risk factors (age, pack years of smoking, left ventricular hypertrophy) related differently to the extent of carotid atherosclerosis in patients with, than in those without, coronary disease. Clarification of the role of coronary status in the carotid atherosclerosis response to risk factors may partly explain the results of certain population-based studies that have related race, gender, and other risk factors to carotid atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound.

We have developed a scoring system to quantify extent of extracranial carotid artery atherosclerosis using real-time ultrasound (B-mode). To evaluate repeatability of this scoring system we correlated repeat scores obtained within a short interval of one another (6 months) in 52 individuals. We compared repeatability of extent measurements with repeatability of a measure of severity (single most severe lesion). Correlations between first and second studies for severity were weak (r2 = 0.20) but significant (p less than 0.001). Extent scores correlated much better (r2 = 0.77, p less than 0.001). In another group of 22 patients we found that the extent of atherosclerosis decreased following endarterectomy. We used this method to determine changes in extent of carotid atherosclerosis with age in two sets of individuals. One consisted of a cohort of 22 patients who underwent repeat B-mode studies separated by 1 1/2-3 years. This cohort demonstrated an increase in carotid score with age (p less than 0.05). In a second group of volunteers undergoing cardiac catheterization and B-mode evaluation of the carotid system, carotid scores could be compared in individuals with age differences that averaged 15 years. Extent of carotid atherosclerosis was significantly greater in older individuals (p less than 0.01) and differences in extent with age were exaggerated in patients with coronary disease compared to coronary disease free controls.

Adult↗
PubMedDate not supplied

Risk factors for extracranial carotid artery atherosclerosis.

We related risk factors, cardiovascular symptoms, and coronary status to the extent of extracranial carotid atherosclerosis as measured by B-mode ultrasonography in 376 volunteers hospitalized for elective coronary angiography. In a first analysis, we correlated risk factors and cardiovascular symptoms with carotid atherosclerosis. Univariate analysis showed that relations between many continuous risk factors and carotid atherosclerosis were graded and consistent for men and women. Multivariate analysis identified 6 significant variables (age, hypertension, pack-years smoked, and inversely, plasma concentrations of high density lipoprotein cholesterol and uric acid, and Framingham Type A score) that together accounted for 35% of the variability in extent of carotid atherosclerosis. In a second multivariate analysis, addition of coronary status (presence or absence of coronary stenosis as evaluated by coronary angiography) to the roster of candidate independent variables produced a new equation that accounted for an additional 5% of the variability in carotid atherosclerosis extent. Although much of the variability in extent of carotid atherosclerosis remains unexplained, these data define an association between coronary and carotid atherosclerosis that depends partly on shared exposure of both arteries to the same risk factors. They are also consistent with the concept that as yet undiscovered risk factors and/or genetic (e.g., arterial wall) factors common to both arterial beds also contribute to the relation between coronary and carotid atherosclerosis in human beings.

Age Factors↗
PubMedDate not supplied

Changes in pharmacologic treatment of hyperlipidemia.

We evaluated the changes in frequency of pharmacologic treatment of hyperlipidemia in 345 hyperlipidemic patients with symptomatic cardiovascular disease requiring cardiac catheterization between 1982 and 1987. The frequency of pharmacologic treatment increased from 13% (1982) to 59% (1987), with the major increase occurring in 1984. Increases in the frequency of treatment were paralleled by increases in prescriptions for lipid-lowering drugs nationwide. During this period the percentage of hyperlipidemic patients we evaluated who were treated with various agents changed, and at the end of the study the use of gemfibrozil, bile acid-binding resins, and nicotinic acid had increased, whereas clofibrate and probucol use decreased. Although the data showed an increase in prevalence of treatment, almost half the patients remained untreated, and of those treated over half remained hypercholesterolemic despite treatment. The results suggest increasing but incomplete physician awareness of hyperlipidemia as a cardiovascular disease risk factor and the need for further physician education in the pharmacologic management of hyperlipidemia.

Cholesterol↗