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Biomedical subjects

J Slany

Publications and source records attributed to J Slany.

At least 109 records · Page 6Linked to original sources
PubMed1979

[The diagnostic accuracy of the dipyridamole test in coronary heart disease (author's transl)].

The diagnostic accuracy of the dipyridamole test in provoking coronary insufficiency was investigated in 79 patients with chest pain and the results were compared with the findings on angiography and exercise electrocardiogram. 58 patients had documented severe coronary artery stenosis, 21 had patent coronary vessels (cardiomyopathy 8, aortic stenosis 1, ectopic origin of coronary artery 1, normal 11). Anginal pain after dipyridamole was a non-specific finding. Approximately half the subjects in whom coronary insufficiency would be expected according to the coronary angiographic and ventriculographic findings evidenced ischaemic ST-segment depression after dipyridamole, which was comparable to the number of positive exercise electrocardiograms. In 23 patients, most of whom had shown an inadequate frequency response during the initial exercise test, ergometry was repeated after the administration of dipyridamole. This resulted in an increase in ischaemic ECG response from 26 to 70%. It is concluded that a stress test combining dipyridamole and submaximum exercise increases the incidence of ischaemic ST-segment depression in comparison with ergometry alone. Anginal pain without ST-segment depression proved to be without diagnostic value.

Adult↗
PubMed1979

Contrast M-mode echocardiography in diagnosis of atrial septal defect in acyanotic patients.

Contrast echocardiograms during normal quiet respiration and during the Valsalva maneuver were performed in 15 patients with atrial septal defect (ASD) by injecting saline solution into an antecubital vein. Contrast shunting (the appearance of contrast echoes in the left heart) was observed not only in four patients with severe pulmonary hypertension (group 2), but also in 11 patients with uncomplicated ASD (group 1). Contrast shunting was prominent in all group 2 patients. In group 1, contrast shunting was sometimes subtle and difficult to recognize, but at other times was very obvious and similar to the findings in group 2. Contrast shunting was generally more pronounced during the Valsalva maneuver than during normal respiration, although there were exceptions. The amount of contrast appearing in the left heart did not correlate with the size of the defect. Small right-to-left shunts which are clinically insignificant but detectable by contrast echocardiography are present, or can be provoked by the Valsalva maneuver, in most patients with ASD. Contrast echocardiography is a useful, noninvasive method to detect interatrial communication, even in acyanotic patients.

Echocardiography↗
PubMed1979

Comparative value of eight M-mode echocardiographic formulas for determining left ventricular stroke volume. A correlative study with thermodilution and left ventricular single-plane cineangiography.

Sixty-six consecutive patients without left ventricular volume overload, significant arrhythmia or significant pericardial effusion were examined by M-mode echocardiography immediately before diagnostic left- and right-heart catheterization. Using various echocardiographic measurements, left ventricular stroke volume (SV) was calculated according to eight different echocardiographic formulas (SVE) that have been proposed previously. At catheterization SV was also determined by thermodilution (SVT) and by single-plane left ventricular cineangiography in the right anterior oblique projection (SVA). When comparing SVE with SVT, the four formulas developed to calculate mitral or aortic flow failed (r = 0.10 to 0.54). As expected, poor correlations (r = 0.22 to 0.47) were also found when formulas used to calculate ventricular volumes from the ventricular diameter or SV from the change in diameter (left ventricular formulas) were used in coronary patients with grossly asymmetrical ventricular contraction patterns. When the use of the left ventricular formulas was confined to patients with symmetrical or almost symmetrical contraction, two formulas yielded favorable correlations of r = 0.84, SEE = 12.7 ml and r = 0.86, SEE = 12.2 ml, respectively. These correlations were comparable to the correlation between our two invasive reference techniques (r = 0.81; SEE = 12.2 ml). The comparison between SVE and SVA confirmed the results of the thermodilution study, though the correlations were generally weaker. We conclude that the formula of Teichholz et al., which was the best of all tested formulas, may be used to obtain a clinically useful estimate of SV in patients in whom symmetrical or almost symmetrical left ventricular contraction can be anticipated.

Aortic Valve↗
PubMed1979

[Echocardiographic diagnosis of subpulmonic obstruction in hypertrophic cardiomyopathy (a case report) (author's transl)].

The echocardiogram of a patient presenting with a systolic ejection murmur and ECG evidence of left ventricular hypertrophy revealed asymmetric septal hypertrophy but no abnormal systolic anterior motion of the mitral valve as in IHSS. Her pulmonary echo disclosed small A waves, partial valve closure in early systole and coarse systolic fluttering. This motion pattern--which is similar to that of patients with infundibular pulmonary stenosis and which resembles the aortic valve motion pattern in discrete subaortic stenosis--led us to the diagnosis of hypertrophic cardiomyopathy with subpulmonic obstruction, which was later confirmed by cardiac catheterization.

Aortic Valve↗
PubMed1978

[Exercise haemodynamics and ECG in the evaluation of the severity of coronary heart disease (author's transl)].

Myocardial scarring and coronary insufficiency give rise to regional changes in left ventricular function, often leading to generalized left ventricular dysfunction during physical activity only. The main purpose of this study was to evaluate the relations between left ventricular function determined by ECG and measurements of pulmonary artery pressure during exercise and the severity of coronary artery disease. Simultaneous measurements in the pulmonary artery and in the left ventricle in 76 patients revealed that the enddiastolic pulmonary pressure (PAEDP) was lower than the enddiastolic pressure in the left ventricle (LVEDP) by a mean value of 10.5 mm Hg in the presence of ventricular dysfunction. This difference was smaller in congestive heart failure than in cases of acute myocardial ischaemia. Correlation coefficients of mean pulmonary wedge pressure (PCm), PAEDP, mean pulmonary pressure (PAPm), and LVEDP were 0.90, 0.86, and 0.81, respectively, thus allowing only an approximate estimate of the left ventricular filling pressure. In 150 angiographically documented cases of coronary heart disease, haemodynamic measurements were performed during stepwise-increased, symptom-limited supine exercise on a bicycle ergometer. All patients limited at 25 watts had either triple vessel disease or stenosis of the trunk of the left coronary artery or of the proximal section of the left anterior descending artery (RIVA). In comparison with subjects with single vessel disease, patients with triple vessel involvement tolerated only a smaller exercise load and reached higher values of PAEDP (30.4 +/- 9.0 versus 24.0 +/- 7.7 mm Hg, p less than 0.001). Analysis of data of patients with a single coronary stenosis showed the exercise-PAEDP to be largely independent of the myocardial condition, but to depend upon the location of the stenosis, the highest pressure values being observed with stenoses of the main left coronary artery or the proximal segment of the RIVA. Based on these findings a simple coronary score system was delineated to determine the severity of the disease, taking into account the location of an obstruction, in particular, and, to a lesser amount, the degree of the stenosis and the type of coronary artery distribution. The score yielded essentially better correlations to work load and filling pressures during exercise than did the number of obstructed vessels. The regression line of the PAEDP versus the coronary score was flatter in patients with angiographically documented collaterals than in cases without, indicating the functional significance of these vessels. In patients with stenoses confined to the arteries supplying infarcted areas and, consequently, without signs of ischaemia during exercise a close relation was obtained between the left ventricular ejection fraction (EF) and the maximum PAEDP, best expressed by a third order regression equation (r = 0.79), p less than 0.001, SEE +/- 6.1). A PAEDP exceeding 25 mm Hg is, thus, a reliable sign of an EF of less than 40%...

Blood Pressure↗
PubMed1978

[The dependability of noninvasive stroke volume measurements with impedance cardiography].

In 33 patients 110 comparative measurements of stroke volume were performed by the thermodilution method and impedance cardiography during rest and various hemodynamic interventions. Agreement was moderate not allowing accurate estimation of the stroke volume in an individual patient. However, impedance cardiography proved useful in predicting acute changes in stroke volume or cardiac output exceeding 10% of control values.

Adult↗
PubMed1978

[Noninvasive determination of myocardial function in infarct patients].

In a prospective study, the regional ventricular function was assessed by cross sectional echocardiography in 22 patients with coronary heart disease. When compared with angiocardiography, cross sectional echocardiography has proven to be a valuable tool for the evaluation of regional ventricular function.

Angiocardiography↗
PubMed1977

[Mechanocardiographic diagnosis of impaired cardiac function (author's transl)].

The value and limitations of phonocardiography, systolic time intervals, apex cardiography and kinetocardiography in the diagnosis of impaired cardiac function during rest and haemodynamic stress were critically reviewed on the basis of studies carried out in our laboratory, as well as reports in the literature. When compared with invasively-obtained measurements, none of the above-mentioned techniques allows the prediction of heart function quantitatively in a single given patient. However, when one considers the broad overlap of mechanocardiographic measurements in normal subjects and patients with heart disease and defines an abnormal mechanocardiogram accordingly, these methods may be used to diagnose abnormal cardiac function with adequate specificity though low sensitivity.

Blood Pressure↗
PubMed1977

[Myocardial involvement in a special form of Erb's muscular dystrophy (type Becker-Kiener) (author's transl)].

A 22-year-old man with cardiac symptoms had been treated for myocarditis for two years. But the clinical course and special tests, including isoenzyme measurements, electromyography, peripheral muscle and myocardial biopsy, established the diagnosis of X chromosome-linked muscular dystrophy (type Becker-Kiener) with an associated cardiomyopathy (raised left-ventricular end-diastolic pressure). Light- and electron-microscopic studies of the (right ventricular) myocardial biopsy revealed degenerative changes like those seen in peripheral muscle.

Adult↗
PubMed1977

[Low-risk transfemoral selective coronary arteriography employing Sones catheters and total body heparinization (author's transl)].

Indications, results, and complications in 400 transfemoral selective coronary arteriograms are reported. After the first 100 examinations a sharp decline in serious complications and an increase in complete studies with opacifications of both coronary arteries and left ventricle was achieved. This was thought to be due not only to mounting experience but also to total body heparinization and transfemoral use of Sones catheters with torque control. According to our results transfemoral selective coronary arteriography is considered to be an indispensable examination which may be performed by experienced investigators without hesitation when indicated.

Adult↗
PubMed1977

[Parallel and opposite mitral leaflet motion in mitral stenosis. An echocardiographic study (author's transl)].

In 45 patients (pts.) with mitral stenosis (MS) multiple echocardiographic recordings of the posterior mitral leaflet (PML) were obtained and its motion pattern was carefully analyzed. 25 pts. showed only parallel motion (PM), one patient only opposite motion (OM) of the leaflets during diastole. In 19 pts. PM as well as OM (defined as backward movement of the PML immediately after the D-point and as forward motion during mitral closure, respectively) could be recorded at least two times. In most of these cases PM was impressive while OM could be demonstrated only by careful analysis of numerous recordings. In 4 of the 19 cases with PM and OM, however, the reverse was true. We conclude that OM should only be taken as evidence against MS when multiple recordings of the mitral leaflets have failed to reveal PM and when other echocardiographic signs of MS are missing. Possible explanations of the PM-OM combination are discussed.

Echocardiography↗