[2-dimensional echocardiographic evaluation of left ventricular dyssynergy after acute myocardial infarction].
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Aged↗
Biomedical subjects
P Grande
Publications and source records attributed to P Grande.
Significance of the inner-surface structure of small-caliber prosthetic blood vessels in relation to the development, presence, and fate of a neo-intima. A morphological evaluation.
Microvascular prostheses with three different inner surface structures were examined morphologically 1-18 months after implantation to evaluate the presence and structure of the neo-intima. Fibrous polyurethane tubes (length: 5-10 mm, inner diameter: 1.5 mm) were implanted in the rat abdominal aorta in group A with a fibrillar inner structure (pore sizes 20-50 microns), and in group B the inner fibrillar structure was coated with an impermeable continuous silicon sheet. Expanded polytetrafluorethylene vascular prostheses (length: 40 mm, inner diameter: 4 mm) were implanted in the dog carotid artery (group C). The specimens were examined by light microscopy and scanning electron microscopy. A continuous and permanent neointima was only found in the prostheses with the porous fibrillar inner structure (group A). The thin new lining sheet was well attached to the prosthetic wall by cellular protrusions. In the silicon-coated prostheses (group B) also a continuous neo-intima had developed which, however, was irregular, thicker, and not anchored to the prosthetic wall. The expanded polytetrafluorethylene prostheses (group C) showed also after 1 year only incomplete lining with a neo-intima. Fresh blood cell deposits could be observed in the unlined prosthetic wall. It is concluded that a continuous lining of vascular grafts with a thin neo-intima is only achieved if the cells invading the prostheses from the anastomotic areas can anchor their cytoplasmic protrusions onto an appropriately structured inner surface. If these anchoring facilities are not provided, the unattached neo-intima will thicken, interfering with the patency of these microvascular prostheses, or fragments of the neo-intima or alternatively mural thrombi may constantly strip off and embolize.
Animals↗
Influence of fenflumizole on platelet aggregation in man.
The anti-aggregatory effect of fenflumizole, a new non-steroidal anti-inflammatory imidazole derivative is described in a study in 6 healthy male volunteers, mean age 33 years. Arachidonic acid (AA), ADP, collagen aggregation, coagulation and fibrinolysis parameters were examined before, during and after treatment with oral fenflumizole first 50 mg b.i.d. for 4.5 d and then 200 mg/d for 5 days. During treatment the threshold concentration for collagen aggregation demonstrated hypo-aggregability in all subjects. No significant change was noted in ADP aggregation. AA-induced aggregation showed an increased threshold concentration during and for 7 days after fenflumizole administration. No significant change was seen in bleeding time, fibrinolysis or coagulation parameters. No side effects were observed during or after treatment. It is concluded that fenflumizole is a potent inhibitor of platelet aggregation ex vivo.
Adenosine Diphosphate↗
Low-risk lipoprotein pattern in post-menopausal women on sequential oestrogen/progestogen treatment.
Female hormones are known in influence serum lipoproteins. In post-menopausal women oestrogens decrease the concentration of low-density lipoprotein (LDL) and increase that of high-density lipoprotein (HDL), while progestogens may have the opposite effect. The risk of coronary heart disease (CHD) should consequently be decreased by oestrogens and increased by progestogens. We report here the changes observed in serum total cholesterol, triglycerides, and lipoproteins in post-menopausal women during sequential oestrogen/progestogen treatment. Oestriol and 17 beta-oestradiol were given alone for the first 12 days, in combination with norethisterone acetate (1 mg/day) for the next 10 days, and then in reduced amounts for the last 6 days of the 28-day cycle. Three different doses of the oestrogens were investigated (high, medium and low). A total of 177 normal post-menopausal women volunteered for random allocation to treatment or placebo groups. Blood samples were taken every 3 mth during the progestogen phase of the cycle. Serum total cholesterol was found to be 10-13% lower over a 3-yr period on the high oestrogen dose and 5 and 3% lower on the medium and low doses, respectively. No significant changes were seen in serum triglycerides. Determination of lipoprotein fractions showed that the reduction in total cholesterol was due to reduced LDL-cholesterol, the HDL-cholesterol levels remaining virtually unchanged.
Adult↗
Patency and neo-intima development in 10 cm-long microvascular polyurethane prostheses implanted into the rat aorta.
Microvascular fibrous polyurethane prostheses (inner diameter 1.5 mm, length 10 cm) were implanted in the abdominal aorta of rats. The prostheses were fixed in a loop. All rats (n = 37) were reoperated 6 weeks after implantation to verify the patency of the prostheses. Eight prostheses were obliterated from various causes. The remaining 29 prostheses were found to be patent 3 months after implantation, which gives a patency rate of 79%. Six weeks and 3 months after implantation 7 and 4 rats, respectively, with patent prostheses were sacrificed. The remaining 18 rats of this study are still alive, more than 4 months after implantation, and will be included in long-term observation studies. The prostheses were examined using both light and scanning electron microscopy. The patent prostheses exhibited macroscopically a clear and transparent inner surface. No obliterative processes could be found either macroscopically or microscopically. Neo-intima ingrowth had advanced +/- 10 mm into the prostheses over the anastomotic line from both ends 3 months after implantation, and was continued by a single endothelium layer for several centimeters. An acellular, stable fibrin film was found inbetween the cellular lining. The neo-intima was anchored at the prosthesis by cellular protrusions extending between the polyurethane fibers. Though 10 cm long prostheses were implanted under unfavorable hemodynamic conditions, a patency rate of 79% was achieved, both 6 weeks and 3 months after implantation. This patency rate could have been higher if evident technical failures had been avoided.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Myocardial infarct size: correlation with cardiac arrhythmias and sudden death.
The study was made in order to determine the relationship between myocardial infarct size and the incidence of cardiac arrhythmias during acute myocardial infarction (AMI). In 317 consecutively admitted patients infarct size was estimated from serial serum CK-MB measurements. The ECG was continuously monitored during 18 days in hospital, and all electrocardiographic recordings were analysed daily. All patients were followed up one year after discharge. The median infarct size was larger among the 220 patients with arrhythmias than among the 97 patients without (814 Ul-1 vs 419 Ul-1, P less than 0.0001). There was a significant relationship between the estimated infarct size and the following arrhythmias: ventricular ectopic beats, sinus tachycardia, and atrioventricular block, whereas supraventricular ectopic beats showed no such relation. Patients with heart failure, however, had a high incidence of ventricular arrhythmias regardless of the size of their infarcts. The follow-up study demonstrated that the ventricular arrhythmias positively correlated with infarct size were also associated with significantly increased one-year mortality among hospital survivors. Thus, the present study indicates that not only pump failure, but also cardiac arrhythmias are connected with the negative influence of infarct size on prognosis.
Adult↗
Relationship between serum CK-MB-estimated acute myocardial infarct size and clinical complications.
The relationship between acute myocardial infarct (AMI) size and morbidity and mortality was estimated in 317 patients followed for one year or until death. Infarct size was estimated from serum creatine kinase (CK)-MB levels measured thrice daily. The incidence of ventricular arrhythmias, congestive heart failure, cardiogenic shock, and the cardiac performance during exercise were studied during hospitalization. Hospital mortality and one-year mortality were registered. A positive correlation was found between serum CK-MB-estimated infarct size and the incidence of ventricular arrhythmias (p less than 0.05). Patients with congestive heart failure and patients with cardiogenic shock had significantly larger infarct size than patients without (p less than 0.05-0.01), although there was a substantial overlap. During exercise test the rise in systolic blood pressure correlated negatively and the rise in heart rate correlated positively to estimated infarct size (p less than 0.01). Both hospital mortality and one-year mortality were significantly related to estimated infarct size (p less than 0.01). Thus the infarct size, as estimated from serum CK-MB, seems to be of importance for development of the most common and serious complications after AMI.
Adult↗
[Serum CK/MB-estimated infarct size and other prognostic variables in acute myocardial infarct].
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Aged↗
Comparison of ASAT, CK, CK-MB, and LD for the estimation of acute myocardial infarct size in man.
The purpose of this study was to set up a simple and reliable procedure for estimating acute myocardial infarct (AMI) size by measuring serum enzymes in a few daily blood samples. Peak enzyme values and estimated infarct size from one, two, or three daily samples of aspartate aminotransferase (ASAT), creatine kinase (CK), CK-MB, and lactate dehydrogenase (LD) were compared with the extent of myocardial necrosis measured at autopsy in 22 patients who died from AMI. The correlation between the extent of the necrosis measured and peak serum enzymes from one daily blood sample was highest for CK-MB (r = 0.78) and LD (r = 0.73) compared to CK (r = 0.68) and ASAT (r = 0.67). To obtain a significant correlation, however, two patients had to be excluded from the ASAT and LD analyses. No significant improvement was obtained by more frequent blood sampling. Estimation of infarct size did not improve the correlation significantly for any enzyme, although the coefficient of correlation for CK-MB increased slightly (r = 0.83). Serum CK-MB determination provides a semiquantitative estimate of infarct size, but the other enzymes may give erroneous estimates owing to lesser cardiospecificity.
Aged↗
Evaluation of the patency rate of fibrous microvascular polyurethane prostheses after implantation in the rat aorta.
Two types of fibrous polyurethane prostheses with different compliances were implanted into the rat aorta with interrupted sutures and a running suture line. Excluding two technical failures, one unexplained death, and three infected prostheses, both groups (n = 21) showed a patency rate of 100%, up to 6 months after implantation. Rapid reendothelialisation occurred, and a stable neo-intima was formed. Compliance of the prostheses, as well as the suture technique used, has proven to be an unimportant factor in the rat aorta model, probably due to the low magnitude of the pulsations of the rat aorta. The experience of the surgeon with microsurgical techniques seems to be an underestimated factor in determining patency rates of microvascular prostheses.
Animals↗
Influence of acute myocardial infarct size on acute and one-year mortality.
In order to determine the prognostic effect of the size of an acute myocardial infarction (AMI), we prospectively studied a consecutive series of patients below 70 years of age, who had been admitted to the coronary care unit because of clinical suspicion of AMI. In 218 patients the diagnosis AMI was confirmed and the size of their infarcts was estimated from serum CK-MB measurements. In 102 patients the suspicion of fresh AMI was disproven, and they served as a control group. Both groups of patients were similar with regard to distribution of age, sex and coronary risk factors. During one year after discharge, all patients were observed with regard to death. The follow-up was 100% for the one-year observation period. The one-year survival was found to be much better in the patients without AMI on admission than among those with AMI (P less than 0.01). The infarct size was larger among those who died than in those who survived (P less than 0.01); mortality in hospital and within one year was closely associated with the estimated infarct size (P less than 0.01). However, the influence of infarct size on survival decreased with time. After six months there was no difference in the survival rate.
Aged↗
Myocardial infarct size and cardiogenic shock.
The relationship between estimated infarct size and cardiogenic shock was investigated in 317 consecutively admitted patients with acute myocardial infarction (AMI). Infarct size was estimated in vivo by serum CK-MB in all patients, and at heart autopsy by histological and histochemical techniques in 23 patients who died in hospital. Although patients with cardiogenic shock (n = 31) had a larger median serum CK-MB estimated infarct size than those without cardiogenic shock (1035 U/l v. 669 U/l, P less than 0.05) there was a substantial overlap in infarct size between the two groups. Heart autopsy confirmed this finding and demonstrated that patients with small subendocardial infarcts also died from shock, especially those with severe 2 or 3 vessel disease and/or infarction fibrosis. Those with cardiogenic shock who survived and those who died from shock had a similar median infarct size, and patients who died from other cardiac causes had the same median infarct size as those who died from shock.
Aged↗
Clinical evaluation of different principles of CK-MB determination.
Seven methods commercially available involving different principles for determination of creatine kinase (E.C. 2.7.3.2) isoenzyme MB were compared. The methods employ quantitative electrophoresis, column chromatography, batch chromatography, and antibody inhibition techniques. Blood from 100 patients suspected of acute myocardial infarction was used to test the following factors: sensitivity, linearity, precision, accuracy, simplicity, and diagnostic comparability. The analytical quality of all the techniques investigated was almost satisfactory, and only minor differences were found in linearity and precision. The diagnostic quality was, however, somewhat limited. The number of positive and negative results varied significantly. The reference value given by the manufacturers did not agree, and each laboratory must establish its own reference ranges.
Chromatography↗
Myocardial infarct size and cardiac performance at exercise soon after myocardial infarction.
Infarct size was estimated from serial serum CK MB measurements in a series of 101 patients admitted less than 15 hours after the first acute myocardial infarction. A maximal symptom limited exercise test comprising impedance measurements for the estimation of stroke volume at rest and at different levels of exercise was performed early after admission by 26 patients. There was a slight, though not significant, negative correlation between infarct size and physical capability as measured by the duration of work. The rise in systolic blood pressure during exercise showed a significantly negative and the increase in heart a significantly positive correlation to infarct size. This suggests that the rise in blood pressure, which is less in patients with the larger infarcts, is compensated by an increase in heart rate, so that the same maximum of cardiac performance and myocardial oxygen consumption is reached. The increase in cardiac stroke volume during exercise was negatively correlated with infarct size. Stroke volume only increased during lower levels of exercise; the increase in cardiac output at higher levels of exercise was achieved entirely by an increase in heart rate. The magnitude of ST segment elevation during exercise showed a significantly positive correlation with infarct size, whereas the occurrence of arrhythmias during exercise was independent of it.
Aged↗
Estimation of acute myocardial infarct size in man by serum CK-MB measurements.
This study was performed to determine the relationship between myocardial infarct size estimated by serum CK-MB methods and the extent of irreversible injury in acute myocardial infarction. In 321 consecutive patients, infarct size was estimated by different mathematical models, and in 22 patients who died in hospital, the extent of myocardial necrosis was determined by autopsy. We also investigated the depletion of CK-MB in infarcted tissue, the recovery of CK-MB in the plasma volume, and the estimation of CK-MB from plasma. Myocardial CK-MB depletion was relatively greater in the larger infarcts, whereas the recovery of enzyme in plasma was independent of the infarct size. Correction of serum CK-MB for changes in plasma volume improved the estimate significantly (p less than 0.05). The correlation between the measured infarct size (g) and the estimated infarct size (units per liter and gram-equivalents) was highly significant (r = 0.85--0.89, SEE = 23--27%, p less than 0.001). Thus, a semiquantitative expression of the extent of myocardial necrosis can be determined in vivo.
Aged↗
Evaluation of iopamidol in coronary angiography in the rabbit.
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Animals↗
Effect of physical training on serum lipids and serum HDL cholesterol in young men.
To examine the effect of physical training on serum lipoproteins and lipids a group of 54 young males participated in a longitudinal study. The participants underwent a supervised physical training programme for 12 weeks. Initially and at the end of the training period the group was exercise-tested on an ergometric bicycle, performed a 12-min run test, and had blood samples drawn for determination of serum lipoproteins and lipids. Although maximum oxygen uptake (P less than 0.001) and the distance run (P less than 0.01) were significantly increased after physical training, we found virtually unchanged body weight and serum levels of HDL cholesterol, total cholesterol and triglycerides. It is suggested that the previously described effects of physical training on HDL cholesterol is caused by a body weight reduction rather than changes in physical condition.
Adult↗
Acute myocardial infarct size estimated by serum CK-MB determinations: clinical accuracy and prognostic relevance utilizing a practical modification of the isoenzyme approach.
The clinical reliability and relevance of a practical enzymatic method to estimate infarct size (IS) were evaluated in patients with acute myocardial infarction (AMI). The technique utilized was that of relatively few sequential determinations of serum heart specific isoenzyme CK-MB, as corroborated by studies of numerous CK-MB measurements. Isoenzyme IS was determined in 321 consecutively admitted patients with AMI. Autopsies were performed in 22 of the 43 decedents for quantification of myocardial necrosis by histochemical and histologic techniques. A highly significant correlation (r = 0.83 p less than 0.001, SEE = 28%) was observed between IS values calculated from serum CK-MB and IS defined by necropsy examination. The CK-MB median IS was significantly increased in decedents compared to survivors (p less than 0.005), with IS ranges having substantial overlap between the two groups. The present study demonstrates that a practical and reliable estimation of IS in vivo is obtainable by serum CK-MB. While such estimated IS is of relatively moderate value for predicting in-hospital prognosis in single patients, the isoenzyme method appears particularly well suited for clinical evaluation of potentially beneficial interventions anticipated to limit myocardial necrosis in groups of AMI patients.
Acute Disease↗