Myocardial performance and efficiency as assessed by energetic parameters derived from pressure-volume relations and wall thickness in human ventricles.
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Aortic Valve↗
Biomedical subjects
H Just
Publications and source records attributed to H Just.
Detection of the presence and severity of mitral regurgitation from aortic and mitral valve echograms.
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Aortic Valve↗
[Does stress ulcer prevention increase the risk of pneumonia in artificial respiration?].
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Humans↗
Derivation of spatial information from biplane multidirectional coronary angiograms.
UNLABELLED: Modern biplane multidirectional isocentric X-ray equipment delivers the image information necessary for spatial computations from two simultaneous 2-dimensional coronary angiographic pictures. Using the tools of analytical geometry, the spatial position of well definable points in the fields of view of the two image-intensifiers can be calculated from their corresponding projections knowing the geometrical properties of the system stands. The method developed is independent of the angle between the projections and is applicable even if hemiaxial views are used. The mathematical formulas necessary for these spatial computations are derived. By means of calculating the radiological magnification factor, the method was validated using a wire with known diameter as reference object. 360-diameter measurements of the wire filmed in 18 different simultaneous biplane projections resulted in a mean error of 3.14%. In addition, catheter measurements of routine coronary angiograms yielded a mean diameter of 2.64 +/- 0.19 mm (mean +/- SD, real diameter 2.66 mm). CONCLUSION: Using this algorithm, a reliable determination of spatial coordinates of distinct points of interest is possible as prerequisite for absolute quantitative measurements from biplane angiograms.
Angiocardiography↗
[Diagnosis of thoracic aortic aneurysms and dissections using transesophageal echocardiography].
Transesophageal echocardiography was performed in 25 patients with the clinical suspicion of an aneurysm or dissection of the thoracic aorta. The results obtained were compared to those of conventional transthoracic echocardiography. An aortic dissection was found in 11 patients, an aortic aneurysm in 9 patients, and an aneurysm of the left subclavian artery, an abscess of the aortic ring and a perforated aortic sinus in one patient each. In 2 patients no abnormalities of the thoracic aorta could be found. The intimal flap was detected in 11 patients with transesophageal imaging and in 9 patients with the transthoracic approach. Aortic dissection was suspected in another 5 patients with transthoracic echocardiography which could be excluded by transesophageal echocardiography. In 13 patients (52%) imaging of the descending thoracic aorta was not possible with transthoracic echocardiography but in all patients it was possible from the transesophageal approach. Transesophageal echocardiography seems to be a useful diagnostic approach when diseases of the thoracic aorta were clinically suspected.
Abscess↗
Determinants of prognosis in idiopathic dilated cardiomyopathy as determined by programmed electrical stimulation.
The incidence and prognostic significance of electrically induced ventricular arrhythmias were prospectively assessed in 42 patients with idiopathic dilated cardiomyopathy. All patients underwent 24-hour, long-term electrocardiographic (Holter) monitoring and 30 were analyzed by a signal-averaging vectorcardiographic procedure at entry into the study. Their response to programmed electrical stimulation during basic right ventricular pacing was investigated using 1 and 2 ventricular extrastimuli. A monomorphic tachycardia was not induced in any patient. In 36 patients (86%) polymorphic ventricular arrhythmias were initiated. Three or more induced consecutive ventricular premature complexes occurred in 9 patients (21%), nonsustained polymorphic ventricular tachycardia in 2 (4.8%) and ventricular fibrillation in 1 patient (2.4%). There was no association between electrically induced polymorphic ventricular arrhythmias and the degree of impairment of left ventricular function. Furthermore, the incidence of induced ventricular arrhythmias was not related to the Lown grade or to the total number of ventricular premature complexes during Holter monitoring. A late potential was detected by the averaged vectorcardiogram in only 1 of the 30 patients. During follow-up (mean 16 +/- 7 months) 7 patients died, 5 from chronic congestive heart failure and 2 from sudden cardiac death. No patient had an electrically induced arrhythmia of 3 or more ventricular premature complexes.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Echocardiographic aortic to mitral valve opening area ratio for determining the presence and severity of mitral regurgitation.
A simple and accurate noninvasive method to quantify the degree of mitral regurgitation (MR) is lacking. Therefore, the ratio of the aortic (AVO) to mitral valve opening area (MVO) from 2-dimensionally guided M-mode echocardiographic tracings was examined as an estimate for the presence and severity of MR. Seventy-two patients who had undergone catheterization were studied: 49 with idiopathic dilated cardiomyopathy, 7 with coronary artery disease and 16 with organic MR. Twenty-eight patients had no MR (group I), 23 had mild/moderate MR (group II) and 21 had severe MR (group III). The AVO/MVO ratio was 0.86 +/- 0.2 in group I, 0.53 +/- 0.1 in group II and 0.31 +/- 0.1 in group III (p less than 0.001). An AVO/MVO ratio of 0.65 or less predicted MR with a sensitivity of 98% and a specificity of 86%. Furthermore, a strong relation was found between the ratio and the angiographic severity of MR. Thus, the AVO/MVO ratio is a simple echocardiographic parameter for detecting the presence and severity of MR.
Aged↗
[Modification of organ perfusion by calcium blocker and converting enzyme inhibitor in the conscious rat with heart failure].
The present study examined the regional vascular effects (radioactive microspheres) of converting-enzyme inhibition (captopril, 1 mg/kg) and calcium-antagonism (diltiazem, 1 mg/kg) in a rat model of cardiac failure due to large myocardial infarction (n = 18, infarct size 40% of the left ventricle) both at rest and during submaximal treadmill exercise. Diltiazem increased renal, gastrointestinal, coronary and cutaneous blood flow at rest by 29%, 28%, 26% and 37% (p less than 0.05 each) and enhanced skeletal muscle blood flow during exercise by 16% (p less than 0.05). Captopril improved primarily renal and coronary blood flow at rest (by 59% and 23%, respectively, p less than 0.05) and reduced vascular resistance in the gastrointestinal bed by 25% (p less than 0.05) without significant effects in other circulatory beds. We conclude that the regional vascular effects elicited by converting-enzyme inhibition and calcium antagonism differ considerably in this animal model of congestive heart failure and may be clinically important. The favourable regional vascular profile of diltiazem deserves further clinical investigation.
Animals↗
[Fields of application of transdermal therapeutic systems: nitrates].
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Administration, Oral↗
[Diagnosis of cardiovascular diseases using suprasternal M-mode echocardiography].
The suprasternal approach can be used to image the aortic arch, the right pulmonary artery and the left atrium. Dilatation or dissections involving the aortic arch were detected echocardiographically from the suprasternal notch. The echocardiogram of the right pulmonary artery is altered in cases of acute and chronic pulmonary hypertension. Intrapulmonary thrombi in patients with acute pulmonary embolism were visualized with this technique. A volume overloading of the pulmonary circulation due to a congenital left to right shunt, as well as a decreased pulmonary blood flow due to a congenital right to left shunt causes characteristic changes in the wall motion pattern of the right pulmonary artery. Hypoplasia or aplasia of the central pulmonary arteries can be diagnosed as well. Imaging of the left atrium from the suprasternal notch may help to differentiate between supraventricular and ventricular rhythm disturbances. The suprasternal approach is therefore recommended to be used as a routine part of each echocardiographic examination.
Aorta, Thoracic↗
Pharmacokinetics of carteolol in relation to renal function.
The plasma levels and urinary excretion of carteolol and its main metabolites 8-hydroxycarteolol and carteolol glucuronide were investigated in 6 healthy subjects and 9 patients with varying degrees of renal impairment following a single oral dose of 30 mg carteolol hydrochloride. In healthy subjects the half-life of carteolol was 7.1 h. 63% of the administered dose was recovered unchanged in urine, and in all 84% was excreted by the kidneys. The renal clearance of carteolol was 255 ml/min. In chronic renal failure (CRF) the terminal half-life was increased to a maximum of 41 h. Both the elimination rate constant and renal clearance were closely related to the creatinine clearance. In CRF the recovery of carteolol and its metabolites from urine was considerably reduced, suggesting that another pathway of drug elimination becomes relevant in renal disease. To avoid an increase in side-effects due to drug accumulation, the dosage of carteolol should be adjusted in relation to the reduction in creatinine clearance. The maintenance dose should be reduced to a half in patients with a creatinine clearance below 40 ml/min and above 10 ml/min. In those with a creatinine clearance of 10 ml/min or less, the dose should be reduced to 1/4.
Adult↗
[A long-term continuous-analysis, discontinuous-documentation ECG system with a solid state memory: suitability for clinical practice application].
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Computers↗
[Determinants of the prognosis in dilated cardiomyopathy: significance of ventricular cardiac arrhythmias].
The prognostic value of ventricular arrhythmias on the natural history of idiopathic dilated cardiomyopathy remains controversial. Our findings in 105 patients suggest that those with reduced left ventricular ejection fraction (less than 40%) in whom frequent episodes of ventricular tachycardia or ventricular pairs (greater than 10 to 20/24 hours) were detected by 24 hour Holter monitoring are at risk of sudden death.
Arrhythmias, Cardiac↗
[Regression of heart hypertrophy. Criteria of regression from the viewpoint of the clinician].
Regression of ventricular hypertrophy has been studied in cases of valvular disease after valve replacement, as well as in hypertension under drug treatment. All studies have focussed on the left ventricle. The right heart chamber has not been quantitatively assessed. Regression has been found in both conditions in the range of 15-40% of initial left ventricular muscle mass. In hypertrophic cardiomyopathy consistent results have not been obtained. The ECG, correlating with muscle mass only loosely, is but a semiquantitative, albeit reliable indicator of regression. Vectorcardiography seems to be useful and deserves further study and application. Echocardiography has been validated for both TM- and 3D-mode and allows quantitative estimation of LV-mass during regression. Further improvement can be achieved through the subcostal approach. Left ventriculography remains standard of comparison, but can be considered valid only if angulated biplane technique is used. Repeated application of this technique is limited, unless digital subtraction angiography is used. This technique, however, has not been applied for serial studies of LV-mass during the process of regression. Computed tomography and nuclear magnetic resonance have been used for estimation of muscle mass. The capability of NMR seems particularly high. First results are presented and show excellent quantitation of LV-mass.
Cardiomegaly↗
[Dilatation of epicardial coronary vessels by intravenous diltiazem in patients with coronary heart disease].
UNLABELLED: Coronary diameters and central hemodynamics were measured in 22 patients with stable coronary artery disease before and after 20 mg of intravenous diltiazem. Coronary diameters from high quality biplane coronary angiograms were calculated as mean values after caliper measurements of identical segments. Measurements were made in angiographically normal and abnormal proximal, middle and distal vessel segments. Central hemodynamics showed a significant decrease for heart rate, mean aortic pressure and peripheral resistance (p less than 0.001). Coronary diameters increased between 2 and 16% (proximal or distal segments). Diameter increases were statistically significant for all segments (p less than 0.001) except for proximal atherosclerotic segments. These hemodynamic and diameter changes were seen after 5, 10 and 20 minutes. CONCLUSION: Intravenous diltiazem shows an acute coronary dilative effect in patients with stable coronary artery disease. This effect is regarded as one of the essential antianginal actions of the drug.
Benzazepines↗
[M-mode echocardiography study of the left atrium, precordial and suprasternal: a comparative echocardiography angiocardiography study].
This study of 30 patients evaluates whether the size of the left atrium can be estimated echocardiographically with the precordial and suprasternal approach. Simultaneous imaging of the left atrium from both planes was possible in 24 patients. Angiographically, left atrial volume amounted to 107 +/- 69 ml for the minimal and 153 +/- 63 ml for the maximal left atrial size during the cardiac cycle. In each case, the diameter values of the left atrium were greatest from the suprasternal approach (p less than 0.001). All angiographic parameters were larger than the corresponding echocardiographic values (p less than 0.001). The study demonstrates that the size of the left atrium cannot be estimated reliably from biplane m-mode echocardiographic parameters.
Adult↗
[Massive tumor embolism as the cause of acute cor pulmonale].
A massive tumor embolism was observed in a 35-year-old patient suffering from a tumor of the urinary bladder. Pulmonary embolism was suspected after echocardiographic demonstration of an acute cor pulmonale. Postmortem examination demonstrated multiple small tumor emboli within the small pulmonary arteries.
Acute Disease↗
[Value of contrast echocardiography in the diagnosis of pulmonary valve insufficiency].
The directional analysis of contrast echographic flow lines is routinely used for tricuspid insufficiency diagnosis. The value of this noninvasive technique for the assessment of pulmonic regurgitation is not yet established. Therefore we evaluated the contrast M-mode echocardiograms at the pulmonary valve in 55 patients. Echographic contrast was obtained by injection of 6-8 ml of indocyanin-saline solution into an antecubital vein. In all 5 patients with documented pulmonic insufficiency (3 patients after repair of tetralogy of Fallot, one with pulmonic endocarditis, one posttraumatic) typical diastolic retrograde directed flow lines crossing the pulmonary valve were recorded. In addition, 6 of 18 patients with primary or secondary pulmonary hypertension exhibited early to middiastolic retrograde flow lines at the pulmonary valve. In contrast, none of the normals (N = 13), and none of 19 patients with various cardiac diseases but unaffected pulmonary valve and normal pulmonary artery pressure, had contrast echographic evidence of pulmonary insufficiency. There were distinctive differences between the contrast flow patterns of the patients with organic pulmonary insufficiency and patients with functional pulmonic regurgitation due to pulmonary hypertension. It is concluded that the directional analysis of contrast echographic flow lines at the pulmonary valve allows a sensitive assessment of pulmonary regurgitation using standard echocardiographic equipment.
Adult↗