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Biomedical subjects

K Tsuiki

Publications and source records attributed to K Tsuiki.

At least 73 records · Page 4Linked to original sources
PubMed1987

Body surface mapping for the assessment of left ventricular hypertrophy in patients with essential hypertension.

To investigate the electrocardiographic abnormalities of left ventricular hypertrophy (LVH), body surface potential maps were acquired from 42 patients with essential hypertension. We adopted the time integral technique for analyzing body surface mapping data and used echocardiographic left ventricular muscle mass (LV mass) as the index of advance of LVH. The QRS, ST-T and QRST isointegral maps in normal volunteers all demonstrated smooth bipolar surface distribution patterns, with positive values located over the precordium and negative values over the right upper chest and back. In patients with essential hypertension, changes in the isointegral maps were observed as LVH advanced; A QRS increased on the upper left lateral chest and decreased (became more negative) on the right chest, A ST-T decreased on the lower left lateral chest and increased on the right upper chest, and areas of significant difference in A QRS and A ST-T were expanded as LVH advanced. A QRST decreased on the lower left lateral chest and increased on the right upper chest only in patients with severe LVH. We conclude that the changes of QRS and ST-T isointegral maps depend on the degree of advance of LVH and the severe grade of LVH causes the alterations in intrinsic repolarization properties.

Adult↗
PubMed1987

Determination of the site of myocardial infarction by QRST isointegral mapping in patients with abnormal ventricular activation sequence.

QRST isointegral maps were constructed from 87-lead ECGs in 37 patients with abnormal ventricular activation, such as ventricular premature beats, WPW syndrome, left bundle branch block and right bundle branch block. Patients were divided into 2 groups, the old myocardial infarction (OMI) group (n = 18) and the non-infarction group (n = 19). In the latter group, QRST isointegral maps showed smooth bipolar surface distributions, with positive values located over the precordium and negative values over the right upper anterior chest and the back, independent of the ventricular activation sequence. In the OMI group, for individual patients, the distribution patterns of QRST isointegral maps were similar between normal sinus rhythm and VPB or WPW conduction. Including the patients with BBB, a decrease of the time-integral value was consistently found in leads which corresponded to an asynergic site indicated by left ventriculography. To evaluate the abnormalities of QRST isointegral maps, particular attention was given to the area where the QRST time-integral value was less than the lower limit determined by 40 normal subjects; this area was designated as the negative departure area. Characteristic distribution patterns of the negative departure area seem to indicate the asynergic site, independent of the activation sequence. Thus, the QRST isointegral map may be useful for identifying the asynergic site in patients with abnormal ventricular activation sequence, that is hardly detected with conventional electrocardiograms.

Adolescent↗
PubMed1987

Determination of the hypertrophic site of the left ventricle by body surface mapping in patients with hypertension.

To estimate the hypertrophic sites of the left ventricle by body surface mapping (MAP), we performed MAP in 55 patients with hypertension and compared the MAP data with echocardiographic findings. MAP data were analyzed using the departure map technique reported by Flowers et al. The mean and standard deviation (SD) of the normal control were obtained from 40 normal volunteers. We constructed departure maps at 20, 30, 40, 50 and 60 msec from the onset of the QRS. Each map indicates the area of abnormally increased potential outside the normal range at the time. Subjects were classified into 5 groups according to the appearance time of the abnormal positive area. Septal thickness was significantly increased in groups that had an abnormal positive area at 20 msec, and left ventricular posterior wall thickness was significantly increased in the groups that had an abnormal positive area at 60 msec. We postulate that the increased electrical potential due to hypertrophy of the interventricular septum is represented by the abnormal positive area at 20 msec, and the increased potential of the left ventricular posterior wall by the abnormal positive area at 60 msec. MAP, especially the departure map technique, is a useful method to detect the abnormal electrical potential distribution in patients with left ventricular hypertrophy.

Adult↗
PubMed1987

[Predictability of stress-induced myocardial ischemia from coronary arteriography in patients with organic coronary artery stenosis].

A quantitative index for describing the severity and extent of coronary artery disease has not been established yet, although it is certain that the stenosis causes myocardial ischemia induced by stress. To establish the most meaningful scoring system, we developed the grading of stenosis which is "critical" or significant in the single-, double-, and triple-vessel method (SDT), and the extent of improvement in the predictive value which may be induced by accounting for the predominance of the three major coronary arteries nourishing the left ventricle. Thirty-three patients (six were women), whose average age was 58.6 years, all having exertional angina pectoris and fixed organic coronary artery stenosis documented by coronary arteriography, but no old myocardial infarction, were the subjects of this study. For these patients the mean redistribution index (RDI) was determined by ergometer stress myocardial perfusion imaging using 201T1. The number (nST) of significant ST segment depressions by body surface ECG mapping after treadmill stress tests was compared with the sigma Pujadas grade, which is the sum of each grade assigned to each of the three major coronary arteries, and with the Pujadas score, which is the weighted sum of grades by dominance in the coronary artery distribution. The SDT method was a better predictor of ischemia if the criterion for critical stenosis is selected at a more severe stenosis (greater than 90% diameter stenosis). Among factors predicting ischemia, the length of the stenosis and the presence of collaterals did not seem to be definitive. However, the distribution of the arteries was an important factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1987

[A case of cavernous angioma of the middle cranial fossa originating in the cavernous sinus with hyperprolactinemia].

A 43-year-old female was admitted showing abnormal feeling in the left eye region. Left facial hypesthesia and quadrantic hemianopsia of left eye were the detectable neurological findings. A plain skull x-ray film revealed a double floor and dilatation of the sella turcica. The tomogram of the sella turcica demonstrated a dilatation of superior orbital fissure. Caudocranial projection revealed a dilatation of foramen ovale. A computerized tomography scan revealed a slightly high density tumor which was enhanced slightly with a contrast medium in the parasellar region and left middle fossa. Carotid angiogram demonstrated the displacement of the left carotid fork to the upper and lateral direction. However, no other sign was found. The sinogram of cavernous sinus clearly demonstrated an indentation in the left cavernous sinus. The endocrinological tests were almost normal except for hyperprolactinemia. A trigeminal neurinoma and a pituitary tumor were suspected. The tumor was totally removed and was histologically diagnosed as a cavernous angioma. At operation it seems to be extracerebral in the middle fossa and originate in the cavernous sinus. Diagnostic problems endocrine findings and the origin are discussed.

Adult↗
PubMed1986

Alterations in myocardial perfusion during exercise after isosorbide dinitrate infusion in patients with coronary disease: assessment by thallium-201 scintigraphy.

We studied the effect of intravenous isosorbide dinitrate (ISDN) on myocardial perfusion of patients with coronary artery disease, by using exercise thallium-201 (TI-201) myocardial scintigraphy. A control study was conducted initially to assess regional myocardial perfusion rate. Left ventricular myocardium was divided into six parts: anterior, lateral, apical, inferior, posterior, and septal segments. The segmental myocardial perfusion was characterized according to TI-201 initial uptake index (IUI) of relative distribution and redistribution index (RDI) of TI-201 washout. The normal limit of IUI and RDI was established from the data of 17 persons with normal coronary arteries, and then the IUI less than or equal to 84% and the RDI greater than or equal to 1.12 was defined as abnormal. Based on IUI and RDI, each segment was characterized into three types: A type = IUI less than or equal to 84%, RDI greater than or equal to 1.12; B type = IUI less than or equal to 84%, RDI less than 1.12; and C type = IUI greater than 84%, RDI less than 1.12. ISDN was given as a dose of 0.1 mg/kg/hr, and then treadmill testing was repeated for the same duration of exercise time using the same protocol as in the control period. The segments of A type showed a significant improvement in IUI and RDI after receiving ISDN infusion, while the B and C type segments showed no change. It was also shown that the improvement of IUI and RDI of the A type segments was not as marked in multivessel disease as in cases of single-vessel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Non-invasive detection of coronary artery disease by body surface electrocardiographic mapping after dipyridamole infusion.

Electrocardiographic changes after dipyridamole infusion (0.568 mg/kg/4 min) were studied in 41 patients with coronary artery disease and compared with those after submaximal treadmill exercise by use of the body surface mapping technique. Patients were divided into three groups; 19 patients without myocardial infarction (non-MI group), 14 with anterior infarction (ANT-MI) and eight with inferior infarction (INF-MI). Eighty-seven unipolar electrocardiograms (ECGs) distributed over the entire thoracic surface were simultaneously recorded. After dipyridamole, ischemic ST-segment depression (0.05 mV or more) was observed in 84% of the non-MI group, 29% of the ANT-MI group, 63% of the INF-MI group and 61% of the total population. Exercise-induced ST depression was observed in 84% of the non-MI group, 43% of the ANT-MI group, 38% of the INF-MI group and 61% of the total. For individual patients, there were no obvious differences between the body surface distribution of ST depression in both tests. The increase in pressure rate product after dipyridamole was significantly less than that during the treadmill exercise. The data suggest that the dipyridamole-induced myocardial ischemia is caused by the inhomogenous distribution of myocardial blood flow. We conclude that the dipyridamole ECG test is as useful as the exercise ECG test for the assessment of coronary artery disease.

Adult↗
PubMed1986

Comparison of the electrocardiographic changes induced by dipyridamole infusion and treadmill exercise in patients with coronary artery disease.

To determine whether dipyridamole infusion can be used as an alternative method to physical exercise, 87 lead body surface mapping was performed to compare the distribution patterns of ST-segment depression after 0.568 mg/kg/4 min dipyridamole infusion (D) and after submaximal treadmill exercise (T) in 21 patients with coronary artery disease. Significant ST-segment depression (greater than or equal to 0.05 mV) was observed in 19 patients after D and in 18 after T. After D and T, each patient showed a similar distribution pattern of ST-segment depression. There were no significant differences in the number of leads which showed ST-segment depression (nST: D, 15.6 +/- 11.1 vs T, 15.2 +/- 10.8) and in the maximal value of ST-segment depression (STmax: D, -0.24 +/- 0.16 vs T, -0.20 +/- 0.13 mV). Good correlations were observed in nST (r = 0.84) and in STmax (r = 0.87) between D and T. The increase in mean pressure-rate product after T was 89%, while the increase after D was only 22%. Our results suggest that this pharmacologic test to induce myocardial ischemia may be useful in the evaluation of coronary artery disease in patients who are physically unable to perform adequate exercise.

Aged↗
PubMed1986

[Severity and extent of coronary artery disease and their relationship to left ventricular functional reserve in the chronic disease state].

Our previous observations showed that left ventricular wall motion abnormality (asynergy) induced by stress was observed in the phase response of radionuclide technique, and the severity and extent of coronary artery disease (CAD) assessed by the Pujadas score (PS) correlated well with the maximal phase delay response (delta MPD) but not with the ejection fraction response (delta EF) in patients with CAD without old myocardial infarction (MI). This study evaluated the usefulness of EF, MPD and the first-third filling fraction (FF, divided by the volume accrued throughout diastole) at rest and during stress, using ergometer and first-pass radionuclide angiocardiography (RNA), to determine the severity of CAD, and to evaluate any abnormalities in the systolic and diastolic coupling in left ventricular function during stress. Seventy-four patients with significant CAD, including 41 with previous transmural MI (MI group) and 33 without MI (angina group) were the subjects of this study. EF at rest and during stress inversely correlated, and MPD on stress linearly correlated with PS in angina group with PS greater than 10, while no such correlations were found in MI group. A normal EF response (delta EF greater than or equal to 5%) was accompanied by a greater-than-normal response in FF (delta FF) in both groups. A lower EF response was accompanied by a smaller delta FF in angina group, but by a larger delta FF in MI group. The difference was statistically significant (p less than 0.03), without significant differences by age, PS, peak heart rate, systolic blood pressure, and ischemia on ECG during stress. Resting EF and FF by the RNA method correlated with those by left ventriculography (LVG), respectively. It was suggested that RNA is an accurate method for determining EF and FF, while phase analysis may provide some additional information different from that provided by LVG. We concluded that EF and MPD during stress are as useful as delta MPD with the exception of a few cases in predicting the severity of CAD, and that scar tissue within the ventricular wall in MI may play an important role in determining the ventricular diastolic mechanical property during stress.

Angina Pectoris↗
PubMed1985

Hyperkinetic contraction of a nonischemic segment of ischemic left ventricle in anesthetized dogs.

Regional myocardial function during acute coronary artery occlusion was studied with ultrasonic dimension gauges in 20 open-chest anesthetized dogs. Two pairs of ultrasonic crystals were implanted in the left ventricular free wall near the epicardium in an ischemic segment and in a control nonischemic segment, and the segment length (SL) and maximum velocity of systolic shortening (max dL/dt) were measured. In six dogs, the wall thickness (WT) was measured simultaneously in the same regions with sonomicrometry. Left ventricular pressure (LVP), aortic pressure (AoP), and plasma norepinephrine concentration in the coronary sinus (NECS) were also measured. The heart rate was kept constant (180 beats/min) with atrial pacing. The left anterior descending coronary artery was occluded at its distal portion without propranolol in 12 dogs (group 1) and 30 min after propranolol in eight dogs (group 2). In the ischemic region, coronary artery occlusion resulted in an increase in end-diastolic SL (50% at 3 min after occlusion in group 1, P less than 0.005), and a decrease in max dL/dt in systole (36% at 5 min after occlusion in group 1, P less than 0.02). In the nonischemic region, end-diastolic SL did not change significantly, but an increase in max dL/dt (29% at 10 min after occlusion in group 1, P less than 0.005) was observed in systole. Under propranolol (group 2), the results were similar to those of group 1. There were no significant changes in LVP, AoP, AoP, and NECS during occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed1985

Body surface distributions of ST segment changes after exercise in effort angina pectoris without myocardial infarction.

To investigate the sites of exercise-induced ST segment changes on the body surface in effort angina pectoris without myocardial infarction, we performed 87-lead ECG mapping in 61 patients before and 1.5 and 5 minutes after treadmill exercise. ST segment depression most often occurred in the left anterior chest leads and ST segment elevation developed mainly in the right upper chest leads. There was a good correlation between the number of lead points that showed ST segment depression (nSTd) and the number of those that showed ST segment elevation (nSTe) 1.5 minutes after exercise (r = 0.92). From 1.5 to 5 minutes after exercise, changes in nSTd for individual patients correlated well with changes in nSTe (r = 0.89). It was suggested that the ST segment elevation observed in this study directly reflected the subendocardial ischemia of the left ventricle. In patients with one-vessel disease (n = 32), there was wide overlap in the sites of ST segment changes among patients with left anterior descending artery disease (n = 19), those with left circumflex artery disease (n = 6), and those with right coronary artery disease (n = 7). These findings should lead to a better understanding of exercise-induced ST segment changes for the diagnosis of coronary artery disease.

Adult↗
PubMed1985

Noninvasive assessment of left ventricular wall motion abnormalities by QRS isointegral maps in previous anterior infarction.

In order to determine to what extent left ventriculographic abnormalities can be predicted from ECG changes in myocardial infarction (MI), 87 unipolar ECGs were simultaneously recorded in 22 patients with previous anterior MI with no conduction defects. We adopted a QRS isointegral mapping technique for analyzing body surface mapping data. Particular attention was given to the area where the QRS time-integral value was less than the lower limit (mean minus two standard deviations) of the normal, and this area was designated as the departure area. Left ventricular wall motion was assessed by left ventriculography and correlated with the departure area. The departure area demonstrated a close correlation with the left ventricular ejection fraction (r = -0.93) and the extent of asynergy (r = 0.74). It is suggested that the departure area reflects the loss of electromotive force due to MI. We conclude from this study that the QRS isointegral map is a useful method for evaluating left ventricular function in patients with anterior MI.

Adult↗
PubMed1985

Detection of posterior myocardial infarction by body surface mapping: a comparative study with 12 lead ECG and VCG.

To examine the diagnostic ability of body surface mapping in posterior myocardial infarction (PMI), mapping was performed in 11 patients with PMI proven by left ventriculography and T1-201 myocardial perfusion imaging (PMI group) and in 44 normal subjects (N group). Map data was analysed by the following methods: (1) potential departure maps at 10, 20, 30, 40 and 50 msec after the onset of QRS; each map indicates the area of decreased potential out of the normal range at the time. (2) AQRS departure map which indicates the area of decreased time-integral value of QRS out of the normal range. True positive (TP) in the PMI group and false positive (FP) in the N group were calculated for each method, and were compared with those of various criteria for PMI with standard 12-lead electrocardiogram (ECG) and Frank lead vectorcardiogram (VCG). The potential departure maps and the AQRS departure map had high TP (10/11 and 8/11) and low FP (0/44 and 0/44). The diagnostic ability of mapping is considered to be higher than that of ECG and VCG. Mapping, especially the departure map technique, is a sensitive and specific method to detect posterior infarction.

Electrocardiography↗