Biomedical subjects

M Hiroe

Publications and source records attributed to M Hiroe.

At least 109 records · Page 6Linked to original sources

PubMed1994

Critical capillary oxygen partial pressure and lactate threshold in patients with cardiovascular disease.

OBJECTIVES: The aim of this study was to determine the relation between femoral vein oxygen partial pressure (PO2) and lactate increase during exercise in patients with cardiovascular disease. BACKGROUND: Considerable controversy surrounds the relation between the increase in lactate during exercise and the oxygen supply to the exercising muscles. We assumed that femoral vein PO2 would be a measure of end-capillary PO2 during leg-cycling exercise and that it would decrease to a "floor" level when the critical capillary PO2 (the PO2 below which the capillary-mitochondrial difference would be too low to allow oxygen consumption) was reached. At the critical capillary PO2, anaerobic metabolism should take place, and lactate should increase in the effluent blood. METHODS: Ten patients with cardiovascular disease performed two 6-min constant work rate tests (moderate and heavy intensity) and an incremental exercise test to the symptom-limited maximum on a cycle ergometer. Femoral vein blood was repeatedly sampled through a percutaneous catheter before and during each exercise test. RESULTS: The PO2 rapidly decreased toward a minimal value with increasing oxygen uptake for all three tests in all patients. After reaching its nadir (18.2 +/- 2.0 mm Hg), the PO2 remained unchanged in five patients but increased in the other five patients despite the further increase in work rate and oxygen uptake. The relation between PO2 and oxygen uptake was characteristic for each patient and independent of the protocol used for the study. Femoral vein lactate did not change appreciably until PO2 reached the minimal (critical) value. Thereafter, it dramatically increased without a further decrease in PO2. The minimal PO2 was positively correlated with the peak oxygen uptake (r = 0.70, p = 0.01). CONCLUSIONS: During leg-cycling exercise, muscle capillary PO2 reaches a minimal value in the midrange of the subjects' work capacity before lactate concentration increases in patients with cardiovascular disease. The lack of further decrease in PO2 at the oxygen uptake at which lactate starts to increase suggests that the minimal capillary PO2 is the "critical" capillary PO2.

Aged↗

PubMed1994

Atrioventricular nodal physiology after slow pathway ablation.

The AV nodal physiology before and 1 week after "slow pathway potential" guided catheter ablation was examined in 32 patients with AV nodal reentrant tachycardia. A mean of 4.9 applications of radiofrequency energy eliminated AV nodal reentrant tachycardia in all patients. There were no significant differences in sinus cycle length (815 +/- 159 msec vs 813 +/- 162 msec; P = NS) and fast pathway conduction properties before and 1 week after ablation. Slow pathway conduction was completely eliminated in 10 (31%) (group I) of 32 patients after ablation. In the remaining 22 patients residual slow pathway conduction associated with one AV node echo was observed. In 15 patients (47%) (group II), the effective refractory period of the slow pathway showed a change of < 30 msec (265 +/- 51 vs 266 +/- 51 msec; P = NS), and in 7 patients (22%) (group III), a prolongation of more than 80 msec (247 +/- 56 vs 340 +/- 42 msec; P = 0.0001) before and 1 week after ablation. Minimal and maximal A2-H2 interval over the slow pathway in group II was not significantly changed (Min A2-H2: 241 +/- 37 vs 247 +/- 40 msec; P = NS, Max A2-H2: 346 +/- 79 vs 350 +/- 60 msec; P = NS), while a significant prolongation was measured in group III (Min A2-H2: 261 +/- 53 vs 373 +/- 107 msec; P < 0.01, Max A2-H2: 359 +/- 41 vs 427 +/- 63 msec; P < 0.05) before and after ablation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Endothelin ETA receptor antagonist blocks cardiac hypertrophy provoked by hemodynamic overload.

BACKGROUND: We have recently shown that angiotensin II-induced hypertrophy of cultured rat cardiomyocytes was partially blocked by an endothelin (ET) receptor antagonist (BQ123) selective for the ETA subtype, suggesting the possible involvement of endogenous ET-1 in the mechanism of cardiac hypertrophy in vitro. In the present study, we studied the in vivo blockade effects of BQ123 on cardiac hypertrophy provoked by left ventricular overload with aortic banding in adult rats. METHODS AND RESULTS: Forty rats were divided into four groups: (1) sham-operated rats without BQ123 administration, (2) rats with aortic banding without BQ123 administration, (3) sham-operated rats with BQ123 administration, and (4) rats with aortic banding with BQ123 administration. BQ123 (250 micrograms/h) was administered continuously by an osmotic pump starting 24 hours before operation. BQ123 blocked increases in the ratio of left ventricular weight to body weight and in the diameter of cardiomyocytes provoked by aortic banding at 1 week, but those blockade actions were no longer observed at 2 weeks. Skeletal alpha-actin and atrial natriuretic peptide (ANP) mRNA in the left ventricle, transcriptional markers for cardiac hypertrophy, significantly increased in the rats with aortic banding at 1 week and 2 weeks. In the rats with BQ123 administration, despite the hemodynamic overload, skeletal alpha-actin and ANP mRNA in the left ventricle remained at the control levels at 1 week; however, those blockade actions were abolished at 2 weeks. Plasma ET-1 levels increased after aortic banding, peaking at 24 hours, then returned to the basal level at 4 days. Prepro-ET-1 mRNA levels in the left ventricle also increased 24 hours after aortic banding, then declined to the basal level at 4 days. CONCLUSIONS: These data suggest that endogenous ET-1 synthesized in the cardiovascular system plays a role in the mechanism of cardiac hypertrophy during the early phase of pressure overload in vivo.

Actins↗

PubMed1994

Oxygen uptake kinetics are determined by cardiac function at onset of exercise rather than peak exercise in patients with prior myocardial infarction.

BACKGROUND: Resting cardiac function does not necessarily affect exercise capacity. However, to determine whether it affects early dynamics of oxygen uptake (VO2) during exercise, we measured VO2 during a constant work rate and during incremental exercise testing in patients with a history of myocardial infarction. VO2 kinetics and exercise capacity were compared between patients with relatively high left ventricular ejection fractions (LVEF > or = 35%, group 1) and those with lower ejection fractions (LVEF < 35%, group 2). METHODS AND RESULTS: Forty patients with a history of prior myocardial infarction (age, 57 +/- 10 years) were monitored during 6 minutes of moderate constant work rate testing (40 +/- 8 W) and during symptom-limited incremental exercise testing with a cycle ergometer. VO2 was calculated from respired gas analysis on a breath-by-breath basis. Cardiac output determinations were made with a computerized cadmium telluride detector every 10 seconds during exercise. The VO2 time constant during constant work rate exercise was slower in group 2 (58.0 +/- 7.6 seconds) compared with group 1 (45.8 +/- 10.5 seconds, P = .0002), indicating slower kinetics in group 2. The time constant for the rise in cardiac output during exercise was also slower in patients with lower EFs (63.0 +/- 12.8 versus 50.0 +/- 12.2 seconds). However, there were no differences in exercise capacity parameters, such as the VO2 or cardiac output at peak exercise, obtained during incremental exercise testing among the two groups. CONCLUSIONS: The prolonged time constant of VO2, which is primarily determined during early parts of exercise, reflects delayed cardiac output response in patients with severely impaired LV function. The time constant of VO2 during submaximal constant work rate exercise can be used as a sensitive and discriminant measure of impaired cardiac reserve in these patients.

Adult↗

PubMed1994

Hypoxia induces apoptosis with enhanced expression of Fas antigen messenger RNA in cultured neonatal rat cardiomyocytes.

We examined whether apoptosis occurs in cardiomyocytes by hypoxia in vitro. Neonatal rat cardiomyocytes and nonmyocytes were cultured in 95% N2-5% CO2 atmosphere to produce hypoxic conditions. DNA fragmentation into integer multiples of the internucleosomal DNA length was observed in cardiomyocytes as early as 12 hours, whereas nonmyocytes did not show fragmentation of DNA up to 72 hours. DNA fragmentation of cardiomyocytes induced by hypoxia was also confirmed by nick-end labeling in situ. Messenger RNA for Fas antigen, a mediator of apoptotic cell death, was expressed in both cardiomyocytes and nonmyocytes as revealed by Northern blotting and in situ hybridization. In hypoxic condition, Fas messenger RNA levels in cardiomyocytes were upregulated by twofold over controls, whereas those of nonmyocytes were downregulated. These results indicate that cardiomyocyte death by hypoxia can occur via apoptosis and that Fas antigen may be associated with the mechanism of this apoptotic process.

Animals↗

PubMed1994

Cellular localization and structural characterization of natriuretic peptide-expressing ventricular myocytes from patients with dilated cardiomyopathy.

Although atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are expressed in the tissue of ventricles of failing hearts, the localization and histopathological features of natriuretic peptide-expressing ventricular myocytes have not been clearly described. This study was designed to characterize the ventricular cardiomyocytes that express both natriuretic peptides in 19 patients with dilated cardiomyopathy (DCM). Immunohistochemistry and in situ hybridization for ANP and BNP were performed with left ventricular biopsy specimens. Peptide-expressing myocytes were examined by hematoxylin-eosin staining and desmin immunohistochemistry and by in situ hybridization to characterize the corresponding cells histopathologically. The distribution of ANP- and BNP-expressing myocytes in the ventricle was identical and was located in the subendocardial layer, fibrous area, and perivascular region. Desmin was found in heavy deposits in the cytosol of peptide-expressing myocytes, and desmin mRNA was not always augmented in the peptide-expressing myocytes. These results indicate that the augmented expression of natriuretic peptides in the left ventricle of patients with DCM is not due solely to global stress on the ventricular wall but is also influenced by regional conditions and is associated with structural changes in the myocytes.

Atrial Natriuretic Factor↗

PubMed1994

Radiofrequency catheter ablation of atrioventricular accessory pathways in Wolff-Parkinson-White syndrome with drug-refractory and symptomatic supraventricular tachycardia--its high effectiveness irrespective of accessory pathway location and properties.

Radiofrequency catheter ablation of atrioventricular accessory pathways was performed in 125 cases of the Wolff-Parkinson-White syndrome (type-A:54, type-B: 29, concealed: 42) complicated with drug-refractory and symptomatic atrioventricular reentrant tachycardia and/or paroxysmal atrial fibrillation. A total of 135 accessory pathways were identified: 50 left free-wall manifest, 34 left free-wall concealed, 21 right free-wall manifest, 2 right free-wall concealed, 15 posteroseptal manifest, 10 posteroseptal concealed, 2 right anteroseptal manifest and 1 right anteroseptal concealed. Accessory pathway conduction was successfully eliminated in 133 of these 135 accessory pathways (99%). Two right posteroseptal pathways were eventually ablated with direct current. Successful ablation required a mean 5.2 applications of radiofrequency current, a mean total energy of 2615 J and a mean fluoroscopic time of 52 min. The mean number of applications, applied energy and fluoroscopic time were greater in the right free-wall pathways than in the left free-wall pathways, and in the concealed pathways than in the manifest pathways. None of the procedures produced complications. During a mean follow-up period of 11.5 months, 1 right free-wall accessory pathway recurred and was ablated successfully in a repeat session. These results suggest that radiofrequency catheter ablation of accessory pathways is highly effective and safe irrespective of the accessory pathway location and properties, although these factors can affect the difficulty of this procedure. This technique may be an alternative to surgical therapy for Wolff-Parkinson-White syndrome with drug-refractory and symptomatic supraventricular tachyarrhythmias.

Adolescent↗

PubMed1994

Mechanism of periodic breathing in patients with cardiovascular disease.

Although periodic breathing consisting of alternating hyperpnea and hypopnea has been recognized in heart failure patients, its mechanism has not been clarified. We hypothesized that heart failure patients who have oscillations in ventilation will also be found to have oscillations in pulmonary blood flow, as reflected in left ventricular ejection fraction. To test this hypothesis, we analyzed continuously gas exchange and left ventricular ejection fraction during exercise in cardiac patients who exhibited periodic breathing. Out of 48 consecutive patients with reduced left ventricular function who performed a symptom-limited incremental exercise test using an upright cycle ergometer, we selected 5 patients who exhibited clear ventilatory oscillations during exercise. These patients repeated the same exercise test on another day for measuring gas exchange and left ventricular ejection fraction continuously. Oscillatory changes were noted both in left ventricular ejection fraction and in ventilation in these patients. These observations offer support for the hypothesis that fluctuations in pulmonary blood flow are primarily responsible for the periodic breathing seen in heart failure patients.

Aged↗

PubMed1994

Catheter ablation of atrioventricular accessory pathway with decremental properties connecting to the tricuspid annulus.

A 65-year-old male with Wolff-Parkinson-White syndrome presented with atrial fibrillation. The patient was found at the electrophysiological study to have two accessory pathways, a Kent fiber and an atrioventricular accessory pathway with decremental properties. The latter pathway conducted exclusively in the antegrade conduction and the ventricular insertion site was the tricuspid annulus. Both accessory pathways were successfully abolished by radiofrequency catheter ablations at the tricuspid annulus. We propose that an atrioventricular accessory pathway with decremental conduction may have various forms concerning not only sites of origin, but also sites of insertion.

Aged↗

PubMed1993

Short-term effects of denopamine on anaerobic threshold and related parameters in patients with chronic heart failure: a double-blind crossover study.

BACKGROUND: The short-term effects of denopamine, an orally available beta-stimulant, on exercise capacity were studied in patients with chronic heart failure. METHODS AND RESULTS: Nineteen patients entered the study. Three patients had ischemic heart disease, 13 had dilated cardiomyopathy, and three had valvular disease; 16 patients were in New York Heart Association class II, and three patients were in New York Heart Association class III. Symptom-limited exercise testing (ramp protocol) on a bicycle ergometer with gas exchange analysis was conducted 1 hour after oral administration of either 20 mg denopamine or placebo. Drug administration sequence was randomly assigned in a double-blind crossover method, with 1 week between drugs. Peak VO2 was 20.4 +/- 3.2 and 21.2 +/- 3.1 ml/min/kg, respectively, for those administered the placebo and the drug, and anaerobic threshold was 13.1 +/- 2.1 and 14.0 +/- 2.0 ml/min/kg. There was a significant increase in peak VO2 (p < 0.05) and anaerobic threshold (p < 0.01) with denopamine, whereas no significant change was observed in peak work rate or exercise time. Denopamine increased heart rate in patients with atrial fibrillation but had little effect on heart rate in patients with sinus rhythm. CONCLUSION: Data obtained from gas exchange analysis are more sensitive and potentially more useful in the detection of short-term changes in exercise capacity than data obtained from either exercise time or peak work rate, indexes that are commonly used to assess drug therapy. Patients with mild-to-moderate heart failure with sinus rhythm, but not those with atrial fibrillation because of its frequent induction of tachycardia, may be good candidates for denopamine therapy.

Adrenergic beta-Agonists↗

PubMed1993

Insulin-like growth factor-I induces hypertrophy with enhanced expression of muscle specific genes in cultured rat cardiomyocytes.

BACKGROUND: Cardiac hypertrophy is commonly observed in acromegalic patients, in whom serum insulin-like growth factor-I (IGF-I) levels are elevated. In the present study, we examined whether IGF-I induces hypertrophy in cultured neonatal rat cardiomyocytes through its specific receptor and whether IGF binding protein-3 (IGFBP-3), which is a major circulating carrier protein for IGF-I, inhibits IGF-I-induced cardiac hypertrophy in vitro. METHODS AND RESULTS: Because the response of cardiac hypertrophy is characterized by the induction of expression for muscle-specific genes, the effect of IGF-I on steady-state levels of mRNA for myosin light chain-2 (MLC-2) and troponin I and for skeletal and cardiac alpha-actin isoforms was evaluated by Northern blot analysis. IGF-I (10(-7) M) increased mRNA levels for MLC-2 and troponin I as early as 60 minutes with maximum levels by 6 hours, which were maintained for as long as 24 hours. IGF-I (10(-7) M) also increased transcripts for skeletal alpha-actin but not for cardiac alpha-actin. The cell size as evaluated morphometrically was almost doubled after 48-hour treatment with IGF-I. IGF-I induction of protein synthesis was dose dependent (10(-10) to 10(-7) M) with a maximal 2.2-fold increase seen at 10(-8) M. In contrast to the hypertrophic effect of IGF-I, growth hormone affected neither protein synthesis nor expression for muscle-specific genes. Binding study using 125I-IGF-I revealed the presence of specific binding sites for IGF-I in rat cardiomyocytes. IGFBP-3 induced a dose-dependent inhibition of protein synthesis stimulated by IGF-I; IGFBP-3 (10(-7) M) completely inhibited the [3H]leucine uptake stimulated by IGF-I (10(-8) M). IGFBP-3 similarly inhibited the IGF-I-stimulated gene expressions for MLC-2 and troponin I. CONCLUSIONS: These results suggest that IGF-I directly causes cardiac hypertrophy and that its effect can be blocked by IGFBP-3.

Actins↗

PubMed1993

Respiratory control during exercise in patients with cardiovascular disease.

The pathophysiologic mechanism for exertional dyspnea, the main symptom of patients with heart failure, has not been fully clarified. To determine the relationship between exercise hyperpnea and the lactic acidosis in patients with heart failure, we evaluated ventilation during incremental exercise both below and above the lactic acidosis threshold in 16 normal subjects and in 48 patients with cardiovascular disease while expired gas was analyzed continuously. The peak oxygen uptake and oxygen uptake at the lactic acidosis threshold decreased significantly as the New York Heart Association (NYHA) functional class severity increased. the slope of the increase in ventilation to the increase in oxygen uptake (delta VE/delta VO2) at work rates below the lactic acidosis threshold did not differ between normal subjects and patients with heart failure. Above the lactic acidosis threshold, however, the slope of delta VE/delta VO2, which was higher than that below the lactic acidosis threshold in each of four groups, was steeper in patients in NYHA Class II (60.8 +/- 17.9) and Class III (66.5 +/- 21.2) when compared with that in the normal subjects (46.6 +/- 13.5) or the patients in NYHA Class I (46.1 +/- 10.3). The lactic acidosis caused by decreased oxygen transport to working muscles accounts for the higher ventilation during exercise in cardiac patients. These data suggest that the increased ventilation during exercise, which must be related to exertional dyspnea, in patients with cardiovascular disease is primarily the consequence of a stimulus to regulate arterial pH.

Acidosis, Lactic↗

PubMed1993

Endothelin-1 is an autocrine/paracrine factor in the mechanism of angiotensin II-induced hypertrophy in cultured rat cardiomyocytes.

To elucidate the cellular mechanism by which angiotensin II (ANG II) induces cardiac hypertrophy, we investigated the possible autocrine/paracrine role of endogenous endothelin-1 (ET-1) in ANG II-induced hypertrophy of neonatal rat cardiomyocytes by use of synthetic ET-1 receptor antagonist and antisense oligonucleotides to preproET-1 (ppET-1) mRNA. Northern blot analysis and in situ hybridization revealed that ppET-1 mRNA was expressed in cardiomyocytes, but, to a lesser extent, in nonmyocytes as well. ANG II upregulated ppET-1 mRNA level by threefold over control level as early as 30 min, and it stimulated release of immunoreactive ET-1 from cardiomyocytes in a dose- and time-dependent manner. ET-1 stimulated ppET-1 mRNA levels after 30 min in a similar fashion as ANG II. Tetradecanoylphorbol-acetate (10(-7) M) mimicked the effects of ANG II and ET-1 on induction of ppET-1 mRNA. ANG II-induced ppET-1 gene expression was completely blocked by protein kinase C inhibitor H-7 or by down-regulation of endogenous protein kinase C by pretreatment with phorbol ester. ET-1 and ANG II stimulated twofold increase [3H]leucine incorporation into cardiomyocytes, whose effects were similarly and dose dependently inhibited by endothelin A receptor antagonist (BQ123). Introduction of antisense sequence against coding region of ppET-1 mRNA into cardiomyocytes resulted in complete blockade with ppET-1 mRNA levels and [3H]leucine incorporation stimulated by ANG II. These results suggest that endogenous ET-1 locally generated and secreted by cardiomyocytes may contribute to ANG II-induced cardiac hypertrophy via an autocrine/paracrine fashion.

Angiotensin II↗

PubMed1993

Insulin-like growth factor I receptors in human cardiac myocytes and their relation to myocardial hypertrophy.

Specific binding sites for insulin-like growth factor I (IGF-I) and their expression during cardiac myocyte hypertrophy were studied by autoradiographic analysis of right ventricular biopsy specimens from patients with hypertrophic cardiomyopathy (9 cases), dilated cardiomyopathy (8 cases), and sick sinus syndrome (5 cases). Frozen specimens were cut into 5 microns-thick sections and thaw-mounted on albumin-coated slides. After incubation with [125I]IGF-I, with or without excess cold IGF-I, autoradiography was performed, and grains over myocytes were counted microscopically. Binding of [125I]IGF-I was inhibited in a dose-dependent manner by unlabeled IGF-I and competed for by IGF-I > IGF-II > insulin. The maximal grain density was higher in hypertrophic cardiomyopathy (186 +/- 47/1.8 x 10(-2) mm2) than in dilated cardiomyopathy (124 +/- 13/1.8 x 10(-2) mm2) or sick sinus syndrome (98 +/- 18/1.8 x 10(-2) mm2) (p < 0.01). There was a strong correlation between the maximal grain density and the diameter of right ventricular myocytes in hypertrophic cardiomyopathy (r = 0.83), but no similar correlation was observed in dilated cardiomyopathy or sick sinus syndrome. These data suggest that IGF-I receptors are present in adult human cardiac myocytes, and that IGF-I receptors are related to the development of myocyte hypertrophy in hypertrophic cardiomyopathy.

Adolescent↗

PubMed1993

[Assessment of the background count to measure the left ventricular ejection fraction with a nuclear stethoscope].

The nuclear stethoscope is a newly developed device for monitoring left ventricular ejection fraction (EF) with a pair of cadmium telluride detector for both left ventricular count (first channel) and background count (second channel). Although it is useful for evaluating the cardiac function during exercise, the methodology of the calculation for distinguishing the net ventricular blood count from the background count has not been established yet. In order to establish a reasonable method to calculate EF, we measured EF using a nuclear stethoscope and conventional gated blood pool scintigraphy in 20 healthy volunteers. All subjects underwent two supine ergometer exercise tests consisting of the 3 stages for the nuclear stethoscope and blood pool scintigraphy. The EF was determined with the following three method for the nuclear stethoscope; 1) Cut-off level was fixed at 70% of first channel, 2) Cut-off level at 75%, 3) Cut-off level was determined by the background count obtained from second channel. There was a poor relationship between the EFs obtained from gated blood scintigraphy and the EFs from the nuclear stethoscope calculated by any of these method. Regarding the EF calculated using the background count, however, the delta values of EF between rest and any of the 3 stages during exercise correlated closely to those EF from blood scintigraphy. When we apply the EF-at-rest value obtained from blood pool scintigraphy to analysis with the nuclear stethoscope, the EFs of 3 stages indicated good correlation (Stage I r = 0.91, Stage II r = 0.82, Stage III r = 0.69).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

A partial defect in technetium-99m pyrophosphate image suggesting cardiac rupture following acute myocardial infarction.

We present the case of a 70-year-old woman with acute myocardial infarction who died of cardiac rupture on the 2nd hospital day. Dual isotope single photon emission computed tomography (SPECT) using thallium-201 chloride and technetium-99m pyrophosphate (PYP) performed on the 2nd hospital day showed a large perfusion defect in the anteroseptal wall on 201Tl image and a increased accumulation on 99mTc-PYP image in the anterior area consistent with a partial defect. Autopsy performed 1 h after death revealed a tear in the left ventricular anterior wall consistent with the defect on the 99mTc-PYP image. We propose that the finding of a partial defect in 99mTc-PYP is an interesting finding which may be associated with cardiac rupture following acute myocardial infarction.

Aged↗

PubMed1992

Anaerobic metabolism as an indicator of aerobic function during exercise in cardiac patients.

To determine whether patients with heart disease depend more than normal subjects on anaerobic metabolism to perform the same level of exercise, the anaerobic threshold, slope of the increase in carbon dioxide output with respect to oxygen uptake (delta VCO2/delta VO2) and the slope of the increase in oxygen uptake with respect to the increase in work rate (delta VO2/delta WR) both below and above the anaerobic threshold during exercise were evaluated. A total of 106 patients with chronic heart disease and 42 healthy subjects performed a symptom-limited incremental exercise test in a ramp pattern on a cycle ergometer. Peak oxygen uptake was significantly lower in the patients with heart disease than in the normal subjects. The anaerobic threshold, which was 20 +/- 4.6 ml/min per kg in normal subjects, decreased significantly with progressing severity of functional class: 16 +/- 2.4, 14.1 +/- 2.5 and 11.3 +/- 1.5 ml/min per kg, respectively, in patients in class I, class II and class III. The slope of delta VO2/delta WR, which represents the degree of aerobic metabolism, was also decreased both below and above the anaerobic threshold with increasing severity of heart disease. delta VCO2/delta VO2 below the anaerobic threshold was approximately 0.9 (p = NS between normal subjects and patients). However, delta VCO2/delta VO2 above the anaerobic threshold became steeper with increasing severity of heart disease: 1.37 +/- 0.17 in normal subjects versus 1.55 +/- 0.24, 1.67 +/- 0.3 and 1.8 +/- 0.35 respectively, in patients in functional class I, class II and class III.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerobiosis↗

PubMed1992

Cardiac output-O2 uptake relation during incremental exercise in patients with previous myocardial infarction.

BACKGROUND: The cardiac output-O2 uptake (VO2) relation, which is thought to be linear and predictable in normal humans, has not been clarified in cardiac patients. We evaluated the relation between cardiac output and VO2 during the incremental exercise test in patients with previous myocardial infarction. METHODS AND RESULTS: Twenty-two patients (age, 58.1 +/- 8.0 years) with previous myocardial infarction performed a symptom-limited exercise test on a cycle ergometer. VO2 was calculated from the expired gas analysis, and cardiac output was measured by a computerized cadmium telluride detector every 10 seconds during exercise. The ratio of increase in VO2 to the increase in work rate (delta VO2/delta WR) below and above the anaerobic threshold (AT) was 11.1 +/- 3.6 and 11.1 +/- 2.9 ml/min/W, respectively, showing no significant difference. However, the ratio of increase in cardiac output to increase in work rate (delta CO/delta WR) below the AT was 50.1 +/- 26.6 ml/min/W and was significantly decreased to 11.8 +/- 25.3 ml/min/W above the AT (p = 0.0002). The decreased delta CO/delta WR above the AT primarily would be due to silent myocardial ischemia produced by exercise, as there was the presence of 201Tl redistribution in 15 of 16 patients in whom myocardial 201Tl scintigraphy with dipyridamole or exercise stress testing was evaluated. delta CO/delta VO2, which has been reported to be approximately 5.5 in normal subjects, was only 4.4 +/- 2.6 at work rates below the AT and was decreased to 1.1 +/- 2.3 at work rates above the AT. CONCLUSIONS: The relation between cardiac output and VO2 during exercise in patients with previous myocardial infarction differs profoundly from that reported in normal subjects. These findings must be considered when we noninvasively estimate the change in cardiac output during exercise by obtaining VO2 in patients with coronary artery disease.

Adult↗