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Biomedical subjects

P Dendale

Publications and source records attributed to P Dendale.

35 records · Page 2Linked to original sources
PubMed1997

Physical fatigability and exercise capacity in chronic fatigue syndrome: association with disability, somatization and psychopathology.

Physical fatigability and avoidance of physically demanding tasks in chronic fatigue syndrome (CFS) were assessed by the achievement or nonachievement of 85% of age-predicted maximal heart rate (target heart rate, THR) during incremental exercise. The association with functional status impairment, somatization, and psychopathology was examined. A statistically significant association was demonstrated between this physical fatigability variable and impairment, and a trend was found for an association with somatization. No association was demonstrated with psychopathology. These results are in accordance with the cognitive-behavioral model of CFS, suggesting a major contribution of avoidance behavior to functional status impairment; however, neither anxiety nor depression seem to be involved in the avoidance behavior. Aerobic work capacity was compared between CFS and healthy controls achieving THR. Physical deconditioning with early involvement of anaerobic metabolism was demonstrated in this CFS subgroup. Half of the CFS patients who did not achieve THR did not reach the anaerobic threshold. This finding argues against an association in CFS between avoidance of physically demanding tasks and early anaerobic metabolism during effort.

Adult↗
PubMed1997

Wall thickening at rest and contractile reserve early after myocardial infarction: correlation with myocardial perfusion and metabolism.

BACKGROUND: Abnormalities in wall thickening and their reaction to stimulation can be studied by magnetic resonance imaging. OBJECTIVE: To analyse the relationship between these abnormalities and changes in myocardial perfusion and fatty acid metabolism. METHODS: Fifteen patients with a myocardial infarction underwent low-dose dobutamine magnetic resonance imaging to assess their wall thickening and contractile reserve, and technetium-99m sestamibi (MIBI) and beta-methyl-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission tomography to assess their myocardial perfusion and fatty acid uptake. For nine segments per patient, the wall thickening was scored as normal, hypokinetic or akinetic, and the myocardial perfusion as normal (> 65%), mildly to moderately reduced (35-65%) or severely reduced (< 35%). Abnormalities in fatty acid uptake were compared with the myocardial perfusion and defined as matched (difference < or = 10%) or mismatched (difference > 10%) reduction. RESULTS: Thirty-four segments had abnormal wall thickening (13 hypokinetic and 21 akinetic). The wall thickening at rest was significantly related to the uptake of MIBI (P < 0.001), but not to abnormalities in the uptake of BMIPP. All of the akinetic segments had an abnormal uptake of MIBI (15 severely and six mildly to moderately reduced), whereas 7 of 13 hypokinetic segments had a normal and five a midly to moderately reduced uptake. A significant relationship between abnormalities of fatty acid metabolism and the contractile reserve was also found (P < 0.002): 14 of 16 segments with and only six of 18 without contractile reserve had a mismatched reduction in uptakes of MIBI and BMIPP. CONCLUSION: This study confirms the relationship between the wall thickening at rest and the residual perfusion after infarction. On the other hand, the contractile reserve, which is an accepted indicator of the viability of the infarct region, is associated strongly with abnormalities of fatty acid metabolism.

Adult↗
PubMed1997

Dipyridamole-induced angina pectoris during sestamibi stress test in patients with significant coronary artery disease: clinical, angiographic, and nuclear determinants.

Intravenous dipyridamole induces angina pectoris (AP) in some patients with significant coronary artery disease (CAD). The aim of this prospective study was to identify the angiographic, nuclear, and clinical determinants. The authors examined 50 patients consecutively with significant CAD on coronary angiography. All antiischemic medications were stopped twenty-four hours (nitrates only 6 hours) before injection of dipyridamole (0.84 mg/kg). ECGs were taken before, during, and after this injection. The regional myocardial activity of Tc-99m-Sestamibi at rest and after dipyridamole injection was measured with single-photon emission computed tomography (SPECT). During dipyridamole injection 20 patients had AP, of whom 15 had ST segment depression on ECG (P < 0.001). The only significant difference on coronary angiography between patients with dipyridamole-induced AP and those without AP was the presence of collaterals (P < 0.05). In patients with AP and collaterals, ECG and SPECT changes were always noted in the collateralized territory. Subgroup analysis showed that patients without previous myocardial infarction (MI, n = 17, P < 0.05) or nontransmural MI (n = 17, P < 0.05) had a good correlation between collaterals and AP, whereas patients with a history of transmural MI (n = 16) did not. No further significant variables could be found as a predictor of AP after dipyridamole injection. These findings suggest that AP during dipyridamole stress test is due to ischemia, which is not related to the severity of CAD. Ischemia is probably due to coronary steal to the collateralized territory in patients without transmural MI. Dipyridamole-induced angina pectoris is predictive for collaterals and may indicate viability in patients with MI.

Angina Pectoris↗
PubMed1996

Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis.

Essential hyperhidrosis (EH) is caused by an unexplained overactivity of the sympathetic fibers which pass through the upper dorsal sympathetic ganglia D2 and D3. Since the D2 and D3 ganglia are also involved in the sympathetic cardiac innervation, cardiocirculatory autonomic function may also be abnormal in EH. In order to study the function of the sympathetic nervous system in EH, and to assess the effects of thoracoscopic sympathiocolysis, cardiocirculatory autonomic function tests were performed in 13 consecutive patients with EH, before (baseline) and 6 weeks after the thoracoscopic intervention. Baseline data were also compared with data obtained from 13 matched healthy volunteers: EH patients showed an increased heart rate at rest, but only in the standing position (94 +/- 18.5 vs 78 +/- 10.9 bpm, P < 0.01), as well as an increased ratio of low to high frequency power of the heart rate variability in the standing position (5.92 +/- 4.4 vs 2.8 +/- 2.5, P < 0.05). Exercise tests were normal in every EH patient. After sympathiocolysis, heart rate at rest (sitting on the cycloergometer) had decreased (75.4 +/- 13 vs 90.4 +/- 16.5 bpm, P < 0.05), as well as heart rate at maximal exercise (165.2 +/- 14.8 vs 180 +/- 10 bpm, P < 0.05). Exercise capacity and the cardiorespiratory responses to exercise were, however, unchanged after sympathicolysis. Resting heart rate in the lying (66 +/- 10 vs 76 +/- 15 bpm, P < 0.05) and standing positions (82 +/- 13.8 vs 94 +/- 18.5 bpm, P < 0.05), and the diastolic blood pressure reaction to a handgrip test (73.6 +/- 8.6 vs 84.7 +/- 11.6 mmHg, P < 0.05) were also lowered after sympathicolysis. In conclusion, patients with EH show an overfunctioning of the sympathetic system which is characterised by an increased reaction to stress (standing, exercise), whereas resting sympathetic tone is unaffected. Thoracoscopic D2-D3 sympathicolysis corrects this hyperfunction and has a partial beta-blocker-like activity, which results in a decrease in heart rate at rest and during maximal exercise, and in the diastolic blood pressure response to the handgrip test. Further studies are needed to assess the long-term consequences of this procedure.

Adolescent↗
PubMed1996

Prediction of functional outcome after myocardial infarction using BMIPP and sestamibi scintigraphy.

UNLABELLED: We determined the predictive value of combined beta-methyl iodophenyl pentadecanoic acid (BMIPP) and sestamibi scintigraphy for the functional outcome after myocardial infarction and compared the value of this approach with dobutamine echocardiography. METHODS: Rest BMIPP, rest sestamibi and low-dose dobutamine echocardiographic studies were obtained in 18 patients 4 to 10 days after infarction (mean 6.7 +/- 2.0 days). Six months later, a rest echocardiographic study was performed to assess functional outcome. RESULTS: Wall motion improved in 27/33 segments (82%) which showed mismatching but not in 19/21 segments (90%) with matched defects (p < 0.001). The accuracy of combined BMIPP and sestamibi SPECT in predicting segmental functional outcome was higher (85%) than that of sestamibi uptake alone (77%). Wall motion improved in 16/20 segments (80%) showing contractile reserve and not in 21/34 segments (63%) with the negative dobutamine test, giving an accuracy of 69% for dobutamine echocardiography. Combination of the two techniques resulted in higher positive (94%) and negative predictive values (94%). CONCLUSION: Mismatching of BMIPP and sestamibi uptake is predictive for long-term functional recovery after acute myocardial infarction. In contrast, segments with matched defects contain only scar tissue. Combined BMIPP and sestamibi scintigraphy offers increased accuracy compared to dobutamine echocardiography.

Coronary Angiography↗
PubMed1996

Clinical nuclear cardiology: flow tracers and free fatty acid analogs to detect viable myocardium after infarction.

Among the available invasive and noninvasive modalities, nuclear cardiology techniques utilizing single photon emission computerized tomography (SPECT) have achieved a preeminent position for the assessment of myocardial viability. This arises from the rather unique potential of scintigraphic methods to assess myocardial perfusion, cell membrane integrity, and metabolic activity. The purpose of this article is to review the relative merits and limitations of myocardial flow tracers (thallium and sestamibi) and metabolic tracers (fatty acid analogs) to identify residual myocardial viability in patients with coronary artery disease and left ventricular dysfunction.

Cell Survival↗
PubMed1995

Cardiopulmonary exercise testing following bilateral thoracoscopic sympathicolysis in patients with essential hyperhidrosis.

BACKGROUND: Essential hyperhidrosis is characterised by an overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D2-D3. Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed. The purpose of this study was to compare the results of cardiopulmonary exercise testing between patients with essential hyperhidrosis and a normal control population, and to examine the effects of thoracoscopic D2-D3 sympathicolysis on cardiopulmonary exercise capacity in patients with essential hyperhidrosis. METHODS: maximal, symptom limited incremental exercise tests were performed in 26 patients with severe essential hyperhidrosis one week before and one month after D2-D3 thoracoscopic sympathicolysis, and in 14 age and sex matched healthy volunteers. D2-D3 thoracoscopic sympathicolysis was performed using a simplified one stage bilateral procedure. RESULTS: Palmar hyperhidrosis was relieved in every patient, confirming the D2-D3 denervation. A higher peak heart rate (7%) was seen in the patient group than in the normal subjects, but ll other cardiovascular, metabolic, and respiratory parameters were similar. After D2-D3 thoracoscopic sympathicolysis, heart rate at rest (13%) and at peak exercise (7%) were reduced, together with an increase in oxygen pulse. All other parameters remained unchanged. CONCLUSIONS: Sympathetic overactivity relevant to cardiovascular function in essential hyperhidrosis is evident only during sympathetic stimulation. D2-D3 thoracoscopic sympathicolysis causes a small and asymptomatic reduction in maximal and resting heart rate and is not associated with a decrease in exercise capacity, in contrast with the detrimental effects on exercise capacity of open surgical sympathectomy.

Adult↗
PubMed1995

Combined left ventricular wall motion and myocardial perfusion stress imaging in the initial assessment of patients with a recent uncomplicated myocardial infarction.

UNLABELLED: The aim of the study was to examine the ability to simultaneously assess left ventricular function and myocardial perfusion by using a single injection of technetium-99m sestamibi at rest and during submaximal exercise to identify high-risk patients with left main, proximal left anterior descending (LAD), or three-vessel coronary artery disease (CAD) after an uncomplicated acute myocardial infarction (AMI). Multiple studies have evaluated the separate value of the exercise ECG, myocardial perfusion scintigraphy, and radionuclide angiocardiography (RNA) for identifying patients with severe CAD. The availability of technetium-99m (Tc99m)-labeled myocardial imaging agents offers the opportunity to evaluate simultaneously ventricular function and myocardial perfusion during a single exercise session. Only limited data are available about the value of this combined technique in the workout of patients early after an uncomplicated AMI. Combined first-pass RNA and myocardial perfusion tomoscintigraphy (SPECT) at rest and during submaximal exercise were performed in 52 patients, less than six weeks after an uncomplicated AMI, with use of Tc99m sestamibi. Patients were classified in two subgroups according to the presence of left main, proximal LAD, or three-vessel CAD. Stepwise logistic regression analysis was used to determine the independent predictors of severe CAD. All patients underwent the exercise testing without any medical complication. On univariate analysis, the global left ventricular ejection fraction (LVEF), wall motion score, and myocardial perfusion score, both at rest and at submaximal exercise, were significantly associated with the presence of severe CAD. The response of LVEF to exercise, and the presence of exercise-induced wall motion or myocardial perfusion abnormalities, were not associated with the severity of CAD. On multivariant analysis only the wall motion score during exercise was an independent predictor for the presence of severe CAD (P < 0.001, r = 0.6). In analyzing patients with anterior AMI separately, LVEF at submaximal exercise was the most accurate predictive parameter. If a cutoff value of 40% was chosen, the LVEF at exercise had a sensitivity of 85% and a specificity of 78% for the detection of severe CAD. In patients with inferior AMI, neither LVEF nor wall motion or myocardial perfusion scores were useful for differentiating the two subgroups. In these patients the presence of an additional perfusion defect during exercise in one of the anterior wall segments yielded a sensitivity of 70% and a specificity of 75% for the presence of severe CAD. IN CONCLUSION: simultaneous evaluation of LV function and myocardial perfusion at submaximal exercise, using a single injection of Tc99m-sestamibi, is a safe and accurate technique for selecting patients with severe CAD after an uncomplicated AMI.

Aged↗
PubMed1994

Magnetic resonance imaging of the heart in a case of hepatocellular carcinoma extending into the right atrium.

Hepatocellular carcinoma is the most common primary malignant liver tumor occurring in more than 1 million cases a year all over the world. Vascular invasion is known to occur in 30% of patients at initial presentation [1]. An extension of the tumor into the right atrium is well described in the literature [2], with surgical resection as the only procedure available. But the diagnosis is often difficult before death. We report a case in which magnetic resonance imaging of liver and heart shows the extension of this tumor into the right atrium.

Aged↗
PubMed1994

Abnormal free fatty acid uptake in subacute myocardial infarction after coronary thrombolysis: correlation with wall motion and inotropic reserve.

UNLABELLED: Iodine-123-free fatty acid analogs, such as beta-methyliodophenylpentadecanoic acid (BMIPP), allow for myocardial metabolic studies with SPECT. The goal of this investigation was to determine whether BMIPP uptake can be used to differentiate viable myocardium from scar tissue soon after coronary thrombolysis for acute myocardial infarction. METHODS: BMIPP and 99mTc-sestamibi (MIBI) myocardial distribution after injection at rest were analyzed in 22 patients 4 to 10 days after coronary thrombolysis. The relative uptake of the two tracers was compared on a segmental basis to the regional wall motion and to the inotropic reserve assessed by two-dimensional echocardiography and low-dose dobutamine stimulation. RESULTS: Three segmental patterns were identified in the infarct-related coronary artery territory. Segments with normal BMIPP and MIBI uptake showed normal wall motion. Segments with more reduced BMIPP uptake than MIBI uptake (mismatching) showed either normal wall motion or demonstrated inotropic reserve during dobutamine stimulation. Segments with matched defects always showed abnormal wall motion and did not demonstrate inotropic reserve, regardless of the MIBI uptake. CONCLUSION: In patients with subacute myocardial infarction, combined imaging of BMIPP and MIBI at rest might be more sensitive than MIBI or wall motion at rest alone to demonstrate myocardial areas that have been acutely ischemic. Mismatching is due to more severely depressed fatty acid metabolism than expected on the basis of the flow and is indicative of jeopardized, but viable myocardium. In dysfunctional segments, mismatching may correspond either to stunned or to hibernating myocardium. Matched defects are associated with scar tissue.

Coronary Angiography↗
PubMed1994

Ectopic atrial tachycardia in a young athlete.

We report the case of a young boy on routine sports medical examination, who presented an incessant atrial tachycardia. At the slightest exercise the ventricular rhythm accelerated to 160 beats.min-1. Exercise capacity was excellent, and a treatment with propafenone suppressed the tachyarrhythmia.

Child↗
PubMed1993

Regional distribution of 123I-(ortho-iodophenyl)-pentadecanoic acid and 99Tcm-MIBI in relation to wall motion after thrombolysis for acute myocardial infarction.

To characterize the myocardium after thrombolytic therapy for infarction single photon emission computed tomographic (SPECT) studies with 123I-(ortho-iodophenyl)-pentadecanoic acid (oPPA) and 99Tcm-methoxyisobutyl isonitrile (MIBI) were obtained at rest in nine patients within a fortnight after the acute event. A decreased oPPA activity compared to MIBI was observed in 15/45 segments (7/9 patients). The segments with discordant oPPA/MIBI activities showed less severe wall motion abnormalities than the segments with concordant decreased oPPA and MIBI activities (P = 0.004). A significant association was found between discordant oPPA/MIBI activities and the early evolution of wall motion following thrombolysis: discordant oPPA/MIBI activities were present in nine of the 11 segments (82%) with improved wall motion, while the wall motion of the seven segments with similar decreased oPPA and MIBI activities was unchanged or had deteriorated (P = 0.018). It is concluded that metabolic abnormalities often persist longer than perfusion and wall motion abnormalities soon after thrombolysis, and that 123I-oPPA in combination with 99Tcm-MIBI is useful to demonstrate myocardial areas which have been salvaged by thrombolysis.

Aged↗
PubMed1989

Prevalence of ventricular premature beats during stress testing in patients with exercise hypertension and the association with a positive family history of established hypertension.

The prevalence of multiple ventricular premature beats during exercise testing was examined in 50 untreated patients with exaggerated systolic blood pressure response to exercise and 54 control subjects. Statistical analysis of the results showed significantly more frequent episodes of repetitive ventricular premature beats in the exercise hypertension group (this was present both in normotensive and mildly hypertensive individuals at rest). We also demonstrated that among normotensives there was a higher prevalence of exercise hypertension in those with a family history of established hypertension.

Adult↗
PubMedDate not supplied

Chronotropic incompetence: a case report.

Chronotropic incompetence is generally defined as an inadequate heart rate response to exercise, but manifestations can vary. The incidence depends on underlying cardiac pathology and, to a lesser degree, on the cut-off value of the predicted heart rate during exercise. Different pathologies induce chronotropic incompetence. Its presence indicates an adverse outcome and is strongly correlated with coronary artery disease. Treatment consists of rate-responsive pacemakers; dual-sensor, adaptive pacemakers are superior to single-sensor, rate-augmenting pacemakers. This case report illustrates the negative effect of chronotropic incompetence on daily activities and its amelioration by implantation of a rate-responsive pacemaker. (c)2001 by CHF, Inc.

Journal Article↗