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Biomedical subjects

J J Kellermann

Publications and source records attributed to J J Kellermann.

At least 37 records · Page 2Linked to original sources
PubMed1989

Bopindolol and atenolol in patients with stable angina pectoris. Double-blind randomized comparative trial.

32 patients with stable angina and a positive symptom-limited exercise test (SLET) were investigated in a double-blind randomized trial in order to assess the therapeutic efficacy of bopindolol or atenolol on the incidence of angina pectoris and on angina pectoris threshold heart rate (ATHR). After a washout and placebo period of 2 weeks, each of the two drugs were applied in dosages of 0.5 mg bopindolol and 50 mg atenolol. The dosage was increased every month up to 2 mg bopindolol and 200 mg atenolol. At the end of every period, the patients were retested by SLET. After 3 months of active treatment, we noticed that the incidence of anginal attacks was lower in the bopindolol group (2.45 vs. 3.29). The resting heart rate was also lower in the bopindolol group (55.89 vs. 63.38). No statistical significance was found between the peak work rate, ATHR, exercise duration and S-T depression. The rate-pressure product was lower in the bopindolol group. We concluded from this that bopindolol and atenolol are active in decreasing the incidence of angina, the former being more effective. Exercise performance and cardiocirculatory parameters did not differ between the two groups.

Adrenergic beta-Antagonists↗
PubMed1989

Usefulness of immediate postexercise two-dimensional echocardiography in post-myocardial infarction patients without ischemic ECG changes in stress testing: comparison with radionuclide angiography.

Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnormal results from rest studies). The comparative radionuclide (RNA) examinations showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post-MI patients with a negative stress test, the efficacy of postexercise echocardiography equals that of RNA in the identification of additional patients with ischemia.

Adult↗
PubMed1989

Exercise response in young women with mitral valve prolapse.

To detect for possible evidence of autonomic nervous system dysfunction, we assessed exercise response in 198 young women with echocardiographically documented MVP. The same test was used to determine whether patients with or without physical symptoms or with various auscultatory findings responded differently. Compared with 105 age- and sex-matched healthy subjects, the MVP patients showed significantly higher mean heart rate, systolic blood pressure, pulse pressure and rate-pressure (double) product, at both rest and exercise; significantly lower mean near-maximal physical working capacity (PWC170); significantly higher incidence of both arrhythmias and nonspecific ST and T wave changes; and a significantly longer mean corrected QT interval. None of these findings was associated with the presence of physical symptoms or with specific auscultatory or echocardiographic findings. These observations strongly suggest an autonomic nervous system imbalance in some young women with MVP, irrespective of whether physical symptoms are present.

Adult↗
PubMed1988

Echocardiographic evaluation of the effects of gallopamil on left ventricular function.

Two-dimensional echocardiography was used to determine global and regional left ventricular function in 32 patients treated with gallopamil (methoxyverapamil) for angina pectoris. Ejection fraction (EF), pressure/volume ratio (PVR), and segmental wall motion were assessed. Evaluations were made before therapy (T1) and repeated 3 weeks later; this assessment included examination 2 and 8 hours after the morning dose (T2 and T3, respectively). Patients were randomized to either a placebo group or three study groups (25, 37.5, and 50 mg t.i.d.). In the 37.5 and 50 mg groups there was an increase in EF (T1 = 53.8% and 54.5%, T2 = 57.9% and 60.1%, and T3 = 57.6% and 60%) and PVR values (T1 = 5.2 and 7.2 mm Hg/ml/m2, T2 = 5.8 and 7.7 mm Hg/ml/m2, and T3 = 5.9 and 7.6 mm Hg/ml/m2, respectively). Wall motion remained the same or improved in 92.3% of the patients. In conclusion, gallopamil had no cardiodepressant effects in most patients. On the contrary, EF, PVR, and segmental contractility tended to improve with the higher doses.

Aged↗
PubMed1988

Contraindications to physical training in patients with impaired ventricular function.

Exercise performance in patients with impaired ventricular function does not correlate well with the severity of dysfunction. Patients with ventricular dysfunction can achieve a fairly high work capacity, and the physiological variables respond in a similar way, regardless of whether or not the patients do or do not have impaired function. Furthermore, patients with pump dysfunction can benefit from a supervised physical training programme by improving their functional capacity and thus, their quality of life. The absolute contraindications for exercise therapy in this group of patients with coronary artery disease should therefore be identical to those who have normal ventricular function. In our opinion, special attention should be exercised in patients who have chronotropic incompetence, lack of an elevation or decrease in blood pressure during exercise performance and in those whose stroke volume is not elevated during even low to moderate work-loads. Recommendations as to the implication of exercise therapy as a therapeutic modality in patients with ventricular impairment must be accepted with caution. The reason for this is that our observations are based on historical, anecdotal trials, most of which included only a modest number of patients. Future research and a prolonged follow-up is needed in order to obtain both a more exact analysis and eventually scientifically based evidence on the benefits and hazards involved.

Coronary Disease↗
PubMed1987

Effects of prolonged intensive versus moderate leg training on the untrained arm exercise response in angina pectoris.

To compare the effects of 2 different leg training intensities on the cardiocirculatory exercise response of the untrained arm, 58 patients with angina pectoris were randomized to either an intensive (at least 85% of symptom-limited exercise, n = 28) or a moderate (70 to 85% of symptom-limited exercise, n = 30) training group. Patients trained for 6 months, 2 times per week for 30 minutes each. Results of the 2 groups after training showed similar significant (p less than or equal to 0.001) decreases in heart rate (HR), systolic blood pressure (BP) and HR X BP product for trained legs and untrained arms at matched subanginal workloads and significant (p less than 0.01 to 0.001) increase in anginal threshold HR and HR X BP for the onset of 1 mm or more ST horizontal depression during testing of trained legs as well as of untrained arms. The improvement in exercise capacity at subanginal workloads results from decreased HR X BP product. In contrast, the significant increase in HR X BP product for the onset of ST-segment displacement and precipitation of anginal pain for both the trained and untrained limbs may imply an increase in myocardial blood flow. Thus, prolonged intensive or moderate training may significantly improve coronary blood flow in selected patients with angina pectoris. Patients with the highest anginal threshold HR and HR X BP product before training showed the most improvement at 6 months after training.

Adult↗
PubMed1987

The role of exercise therapy in patients with impaired ventricular function and chronic heart failure.

Physical training as a part of a comprehensive cardiac care program is accepted as an effective therapeutic modality. The physiological and psychological benefits of such a program have definitely been demonstrated in selected patients with coronary artery disease, but there is still some doubt about the influence of exercise therapy on morbidity and mortality. Recently, exercise training has also been instituted as part of the therapeutic regimen of groups of coronary patients who have impaired cardiac function or who suffer from chronic heart failure. If patients have been selected properly, taking into account absolute and relative contraindications, no deteriorating effect as a consequence of training has been observed in a follow-up period of 14 months. In some selected patients, an increased ejection fraction was found during the training. The results of our preliminary studies are reported and discussed, as is a special training method based on arm ergometry and applied to patients with impaired ventricular function. Clinicians are often concerned with the quality of life of their patients who have chronic cardiac conditions. In our experience, exercise therapy has beneficial effects on various psychological factors and determinants of the "quality of survival" in these patients. It still remains to be demonstrated whether a prolonged and effective exercise therapy can preserve or maintain patterns of an adaptive mechanism to exercise in patients with left ventricular dysfunction or chronic heart failure, or both.

Chronic Disease↗
PubMed1987

Exercise testing in juvenile borderline hypertension.

Exercise testing has emerged as an important method for improved evaluation of the cardiovascular system. However, juvenile patients presenting resting borderline hypertension have not been extensively studied. Therefore, this study evaluated the response to exercise in this group of patients. Nine hundred men aged 16 to 29 years performed a multistage near-maximal exercise test. The control group consisted of 338 age- and weight-matched, asymptomatic, healthy, normotensive individuals. Mean physical working capacity (+/- SD) was 129 +/- 28 W (82 +/- 18% of the normal according to our standardization) in the hypertension group, and 153 +/- 29 W (102 +/- 18%) in the control group (P less than 0.001). Mean systolic blood pressures at termination of exercise were 181 +/- 25 and 164 +/- 25 mm Hg in the hypertensive and the control groups, respectively; the mean diastolic values at termination of exercise were 49 +/- 32 and 32 +/- 29 mm Hg, respectively. The magnitude of the changes in blood pressure from rest to near-maximal values was smaller in the borderline-hypertensive individuals demonstrate a clear hypertensive pattern of reaction to physical activity, thus emphasizing the importance of exercise testing as part of the routine workup of such patients. The relationship between borderline hypertension and the risk of myocardial events has been established, and early hygienic or even pharmacological measures are necessary.

Adolescent↗
PubMed1986

Pressure/volume ratio and pressure/volume ratio exercise quotient: an echocardiographic comparative study of left ventricular function indicators.

Noninvasive evaluation of left ventricular function (LVF) has been performed with two-dimensional echocardiography (TDE). Ejection fraction (EF), end systolic volume index (ESVI) and systolic blood pressure/end systolic volume index ratio (PVR)--an indicator which is independent of preload and afterload changes in a wide physiologic range--were assessed at rest and after exercise. Twenty-seven postmyocardial infarction (MI) patients were compared to 27 normal controls in an attempt to examine the above parameters of LVF in each group, measured by TDE. Correlation of TDE EF with radionuclide angiography EF proved the reliability of TDE. Rest and postexercise values of EF and PVR showed highly significant differences between the two groups. Using ESVI, a relatively lesser significant difference was found. PVR values at rest were 4.86 mm Hg/ml/m2 in the study group and 9.51 in the control group. These values increased to 5.34 and 15.15, respectively, after exercise. The ratio of PVR after exercise to PVR at rest, expressed as percentage change (PVREQ), seemed to be an additional tool in separating between both groups. This indicator merges pressure, volume, and the influence of exercise on both; a PVREQ of at least 145% correlated well with absence of MI in most of our patients.

Adolescent↗
PubMed1986

Left-ventricular exercise echocardiographic abnormalities in patients with sarcoidosis without ischemic heart disease.

We performed postexercise two-dimensional echocardiography in 21 patients with sarcoidosis but no signs of ischemic heart disease and in 24 normal control subjects. This was done to assess global and regional left-ventricular (LV) function and to try to identify the presence of occult myocardial involvement among sarcoidosis patients. All 21 sarcoidosis patients had a normal resting left-ventricular ejection fraction (LVEF) and echocardiogram. An abnormal LV response to exercise was detected in 10 sarcoidosis patients in the form of a significant decrease in mean LVEF with exercise without concomitant clinical and ECG evidence of myocardial ischemia. Seven of these 10 patients were found to have a pathological increase in LV and systolic volume with exercise, although it did not achieve statistical significance. In addition, markedly abnormal regional septal wall motion was noted in two of these patients. In the remaining 11 sarcoidosis patients, mean LVEF increased significantly with exercise. This is the normal ejection fraction response to stress. These 11 patients also showed that LV end-systolic volume decreased with exercise; the decrease was from 40.8 to 27.9 ml (P = 0.0004). In the control group, the mean LVEF increased from 69.5 +/- 7.2 at rest to 78.5 +/- 7.6 with exercise (P less than 10(-6)). We conclude that postexercise echocardiography is a noninvasive, simple, and safe method to detect and to follow the course of possible occult myocardial sarcoidosis.

Adult↗
PubMed1986

Correlation between arrhythmias and abnormal systolic blood pressure response to exercise in mitral valve prolapse patients.

A wide variety of arrhythmias as well as exercise induced hypotension were described in some Mitral Valve Prolapse (MVP) patients. The aim of our study was to evaluate the correlation between the incidence of arrhythmias and the decrease of Systolic Blood Pressure (SBP), ST-T changes and prolonged QTc interval. 50 MVP patients (diagnosis confirmed by M-mode and 2-D echocardiography) underwent a complete clinical evaluation, 12 lead standard ECG, 24 hr. monitoring ECG and a submaximal exercise test. On the basis of the SBP response to effort, the patients were divided into 2 groups (gr.): gr. A, 18 patients with a decrease of the SBP during effort, mean 135 +/- 16.5 mmHg and gr. B, 32 patients with a normal increase of the SBP at the end of the effort, mean 168 +/- 14.7 mmHg (p less than 0.001). Arrhythmias were found in 83.33% among patients in gr. A and in 50% in gr. B (p less than 0.05). We did not find a significant difference concerning the types of arrhythmias between the 2 groups. Exercise induced ST-T changes, appeared in 55.55% in gr. A and in 25% in gr. B (p less than 0.05) but the incidence of arrhythmias in patients with ST-T changes was not significantly different between the 2 groups (5.55% and 6.25% respectively). Rhythm disturbances were found in 3 out of 4 patients with prolonged QTc in gr. A and in 2 out of 4 patients in gr. B (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Mitral valve prolapse in psoriatic arthritis.

Twenty-five patients with psoriatic arthritis were studied by echocardiography in view of the known association of related seronegative arthropathies with aortic-valve lesions. The study group included 15 men and ten women with a mean age of 46.5 +/- 14.6 years. Twenty-two patients suffered from peripheral disease whereas three also had axial involvement. No aortic-valve lesions were found; however, mitral-valve prolapse (MVP) was detected in 14 patients (56%), nine men and five women. The mean age, mean duration of psoriasis, and mean duration of arthritis were similar in patients with and without MVP. HLA tissue typing, which was done in nine patients with MVP, revealed only one patient with HLA-B27. There was no predominance of any of the typical antigens found in psoriasis (HLA-B13, HLA-Cw6). In a control group of 32 psoriatic patients without arthritis, only two (6.4%) suffered from MVP.

Adult↗
PubMed1985

Unusual echocardiographic pattern in Gaucher's disease.

Described in this paper is a 73-year-old Ashkenazi Jew affected with adult type 1 (nonneuronopathic form) Gaucher's disease. This was diagnosed at the age of 46 during an investigation of hepatosplenomegaly. No other members of his family were known to be affected with this disorder. The patient has been periodically examined at our Institute and has been free of all cardiopulmonary symptoms. This description emphasizes his echocardiographic pattern which revealed left ventricular hypertrophy, a septal muscular hump, and an extended area of apical akinesis. Myocardial involvement in Gaucher's disease has seldom been reported in the past.

Aged↗
PubMed1983

Complete heart block and physical performance.

Complete heart block (CCHB) is a very rare finding. The problems in such patients are: additional heart malformations, the appearance of Stokes-Adams or syncopal attacks, and the occurrence of different grades of ectopy. Most patients with CCHB without structural heart disease develop normally and can lead a normal life. If there are no Stokes-Adams attacks or high grades of ectopy at rest and exercise, they have a normal physical capacity and can perform strenuous work and sports. Increased stroke volume, cardiac enlargement, and extraction of very large amounts of oxygen from the blood were found to be compensatory mechanisms of adaptation. Some authors have discussed the possible role of training in this adaptation.

Adams-Stokes Syndrome↗