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Biomedical subjects

J L Caplin

Publications and source records attributed to J L Caplin.

34 records · Page 2Linked to original sources
PubMed1987

Global and regional right ventricular function after acute myocardial infarction: dependence upon site of left ventricular infarction.

The relation of global and regional right and left ventricular function during the acute phase after a first myocardial infarction was assessed by first pass radionuclide angiography in 20 patients (10 after anterior and 10 after inferior myocardial infarction). The right ventricular ejection fraction did not differ significantly between the groups, but left ventricular ejection fraction was significantly depressed after anterior myocardial infarction. There was evidence of right ventricular dilatation and impaired transit in the group with inferior infarction. Five patients with anterior infarction and six with inferior infarction had abnormal right ventricular ejection fractions. Right ventricular wall motion abnormalities affected the septal wall in the group with anterior infarction and the free wall in the group with inferior infarction. The relation between right and left ventricular ejection fractions was markedly different in the two groups. In the group with anterior infarction there was a significant linear relation between right and left ventricular ejection fraction, whereas in the group with inferior infarction there was not. Thus right ventricular dysfunction commonly occurs after both anterior and inferior myocardial infarction. Right and left ventricular impairment are related after anterior myocardial infarction, but are independent after inferior myocardial infarction. Finally, the different effects of anterior and inferior myocardial infarction on right ventricular function may be explained by differences in septal and free wall involvement.

Adult↗
PubMed1986

The adequacy of radioisotope mixing from bolus injections in first-pass radionuclide angiographic assessment of right ventricular function: a study using gold-195m.

The adequacy of radioisotopic mixing in first-pass radionuclide studies of right ventricular function was assessed in 27 patients using multiple injections of gold-195m (half-life 30.5 sec). A theoretical disadvantage of the first-pass technique is inadequate mixing of the injected bolus with blood prior to entry into the right ventricle. Since the calculation of ejection fraction is based on the assumption of complete mixing, this would lead to errors. In order to assess the effects of bolus injection rates and bolus duration on the calculation of right ventricular ejection fraction, multiple, rapid, sequential studies were performed using gold-195m at four bolus injection rates (10, 5, 2 and 1 ml/sec). Slowing the injection rate caused a significant increase in bolus duration, and a significant increase in the number of cardiac cycles available for analysis. Mean ejection fraction, however, was not significantly changed. There was good correlation between right ventricular ejection fraction at all injection rates when compared to 10 ml/sec, and no injection rate led to a consistent over or underestimate of right ventricular ejection fraction. There was no significant relationship between change in bolus duration and variation in ejection fraction. These data indicate that mixing is adequate for first-pass studies of right ventricular function using a rapid bolus.

Cardiac Output↗
PubMed1986

Relation between coronary anatomy and serial changes in left ventricular function on exercise: a study using first pass radionuclide angiography with gold-195m.

Serial changes in left ventricular function on exercise were assessed by first pass radionuclide angiography with gold-195m (half life 30.5 s) in 25 men with known coronary anatomy. In the seven patients with three vessel disease, abnormalities of global left ventricular function and regional wall motion occurred earlier during exercise, were of greater extent at peak exercise, and persisted longer after exercise than in the 11 patients with one and two vessel disease or the seven with normal coronary arteries. Although there were significant differences between the groups in absolute change in ejection fraction and the rate of change in ejection fraction related to exercise duration and heart rate, a considerable overlap of values between groups precluded the accurate prediction of coronary anatomy in individuals. These data suggest that the amount of myocardium at risk from ischaemia in some patients with one and two vessel disease may resemble that in patients with three vessel disease. This study shows that an anatomical classification based solely on the number of diseased vessels will not predict the extent of the impairment of left ventricular function on exercise.

Blood Pressure↗
PubMed1986

Gated right ventricular studies using krypton-81m: comparison with first-pass studies using gold-195m.

Krypton-81m, given by continuous i.v. infusion, has been successfully used for the equilibrium ECG-gated assessment of right ventricular function. We compared gated studies with 81mKr (half-life 13 sec) with first-pass studies using 195mAu (half-life 30.5 sec). Krypton studies analyzed using variable regions of interest (ROIs) led to a significantly higher calculated right ventricular ejection fraction (RVEF) than with a fixed ROI, both with and without background correction. The differences between first-pass studies and gated studies without background correction were significant (p less than 0.01), whereas they were not with background correction. These data suggest that large systematic errors exist in the calculation of RVEF depending on the analysis method and that background correction is important when different techniques are compared.

Adult↗
PubMed1985

The acute changes in serum binding of disopyramide and flecainide after myocardial infarction.

In the serum basic drugs are principally bound to alpha1-acid glycoprotein (AAG). Following acute myocardial infarction it has been shown that the levels of AAG rise. The serum levels of total protein, albumin, AAG and the protein binding of 2 antiarrhythmic drugs which are bases, disopyramide and flecainide, was measured in vitro with blood samples from eleven patients taken over the first 5 days following myocardial infarction. Mean AAG levels significantly increased from 1.04 g/l on Day 1 to 1.80 g/l on Day 5. The binding of disopyramide, which is highly bound, rose from 80% to 87%, representing a 35% decrease in free drug concentration. In contrast the binding of flecainide fell from 61% to 53%, a 20% increase in free drug concentration. These data suggest that although the binding of strongly bound drugs responds appropriately to increases in binding protein after acute myocardial infarction, poorly bound drugs are displaced from binding sites possibly by endogenous substances. Since the pharmacological effects of a drug are related to its free (unbound) concentration, the changes in the proportions of free to bound drug after myocardial infarction may have important clinical implications.

Aged↗
PubMed1985

Effects of projection and background correction method upon calculation of right ventricular ejection fraction using first-pass radionuclide angiography.

There is no consensus as to the best projection or correction method for first-pass radionuclide studies of the right ventricle. We assessed the effects of two commonly used projections, 30 degrees right anterior oblique and anterior-posterior, on the calculation of right ventricular ejection fraction. In addition two background correction methods, planar background correction to account for scatter, and right atrial correction to account for right atrio-ventricular overlap were assessed. Two first-pass radionuclide angiograms were performed in 19 subjects, one in each projection, using gold-195m (half-life 30.5 seconds), and each study was analysed using the two methods of correction. Right ventricular ejection fraction was highest using the right anterior oblique projection with right atrial correction 35.6 +/- 12.5% (mean +/- SD), and lowest when using the anterior posterior projection with planar background correction 26.2 +/- 11% (p less than 0.001). The study design allowed assessment of the effects of correction method and projection independently. Correction method appeared to have relatively little effect on right ventricular ejection fraction. Using right atrial correction correlation coefficient (r) between projections was 0.92, and for planar background correction r = 0.76, both p less than 0.001. However, right ventricular ejection fraction was far more dependent upon projection. When the anterior-posterior projection was used calculated right ventricular ejection fraction was much more dependent on correction method (r = 0.65, p = not significant), than using the right anterior oblique projection (r = 0.85, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

DNA polymorphisms in the apolipoprotein C-III and insulin genes and atherosclerosis.

A total of 167 patients undergoing investigation for suspected coronary artery disease (CAD) were genotyped for restriction fragment length polymorphisms (RFLP) at the apo A-1/C-III locus and the insulin gene locus using cloned human apo A-1 and insulin gene probes. The study group was subdivided into patients with absent or minimal CAD, intermediate CAD and severe obstructive CAD. An Sst-1 polymorphism located in the 3' non-coding region of the apo C-III gene identifies two alleles. One of the alleles (S2) showed a significantly increased frequency in the subjects with severe obstructive CAD (18%) compared with patients with minimal or absent CAD (6%) (P less than 0.025) and normolipidaemic control subjects. This A-1/C-III polymorphism may be a marker for an abnormality in the A-1/C-III genes predisposing to atherosclerosis. In contrast to a previous report, we found no increase in the frequency of the Class 3 insulin alleles in subjects with severe CAD.

Adult↗
PubMed1985

Pulmonary mycotic aneurysms secondary to infective endocarditis in a patient with a persistent ductus arteriosus and partial anomalous pulmonary venous drainage.

Mycotic aneurysms are a rare but recognized complication of infective endocarditis. Aneurysms of the pulmonary artery are usually associated with infected congenital heart lesions and especially with persistent ductus arteriosus. This report deals with a patient with a persistent ductus who developed multiple mycotic aneurysms in the right lung following infective endocarditis, and whose management was complicated by anomalous venous drainage of most of the contralacteral lung. Surgical closure of the ductus to reduce pulmonary blood flow failed to prevent haemoptysis, and further surgery to ligate the feeder arteries to the aneurysms was required.

Adult↗
PubMed1985

Improved cardiac function after renal transplantation.

There are few reports of the outcome of renal transplantation in patients with severe left ventricular (LV) impairment. We describe three men with chronic disabling heart failure associated with LV dysfunction in whom a remarkable improvement in cardiac function followed renal transplantation. Transplantation may offer the prospect of successful rehabilitation in these circumstances. Undue pessimism as to the prognosis in such patients is unwarranted.

Adult↗
PubMed1985

Hemothorax due to rupture of a benign thymoma.

Non-traumatic hemothorax is rare and in the case we report was due to rupture of a benign thymoma. The clinical course of the patient suggested rapid intrathoracic bleeding and emergency surgery was required to make the correct diagnosis.

Hemothorax↗
PubMed1984

Temporal evolution of changes in left ventricular function induced by cold pressor stimulation. An assessment with radionuclide angiography and gold 195m.

The evolutionary changes in left ventricular function induced by cold pressor stimulation were investigated at 90 second intervals by rapid sequential first pass radionuclide angiography using the short half life tracer gold 195m. The results in 12 subjects with normal coronary arteries were compared with those in 12 patients with coronary artery disease. Left ventricular ejection fraction fell significantly from resting values in both groups after 1 minute of cold pressor, but only in patients with coronary disease was the significant fall maintained at 2.5 and 4 minutes. In both groups, the maximum decrease in ejection fraction occurred after 1 minute, whereas the maximum rise in systolic blood pressure occurred after 2.5 minutes. New abnormalities of regional ventricular function developed in 10 normal subjects after 1 minute of cold, with a total of 12 new abnormal segments. Only two such segments were seen at the later stages of imaging. Twenty one new segments developed after 1 minute in the coronary disease group, and 13 segments remained abnormal after 4 minutes. Three patients, two of whom had left main stem stenoses, showed persistent abnormalities of ventricular function after 2 minutes of recovery from cold stimulation. Thus left ventricular function changes rapidly during a period of cold stimulation in both those without and those with coronary disease. When the cold pressor test is used with multiple gated equilibrium imaging, the timing of imaging may be crucial to the results and interpretation of the test. The discordance between functional changes and rise in blood pressure is further evidence that alterations in afterload are not solely responsible for cold induced abnormalities.

Adult↗
PubMedDate not supplied

Myocardial hibernation.

Myocardial hibernation is a potentially reversible cause of resting left ventricular dysfunction in some patients with coronary artery disease. Successful revascularisation in these patients can lead to improved ventricular function and hence improved prognosis. This review discusses the pathophysiology of myocardial hibernation and the methods that are currently available to detect it.

Coronary Circulation↗