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Biomedical subjects

R P Kelly

Publications and source records attributed to R P Kelly.

At least 37 records · Page 2Linked to original sources
PubMed1993

An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man.

Amplification of the pressure pulse between central and peripheral arteries renders pressure values in the upper limb an inaccurate measure of ascending aortic (AA) pressure. Accuracy could be improved by allowance for such amplification. Transfer functions (TF) for pressures between AA and brachial artery (BA):(BATF) and between AA and radial artery (RA):(RATF) were derived from high-fidelity pressure recordings obtained at cardiac catheterization in 14 patients under control conditions, and after sublingual nitroglycerine 0.3 mg. There was no significant difference in BATF under control conditions and with nitroglycerine; hence results were pooled. Control and nitroglycerine results were also pooled to obtain a single RATF. BATF and RATF moduli peaked at 5 Hz and 4 Hz, reaching 2.5 and 2.8 times the value at zero frequency respectively. Frequency-dependent changes in modulus and phase of BATF and RATF were attributable to wave travel and reflection in the upper limb. BATF and RATF were compared to published transfer functions and those derived from analysis of aortic and brachial or radial pressure waves in previous publications. Results were similar. Our BATF and RATF were used to synthesize AA pressure waves from published peripheral pulses. Correspondence was close, especially for systolic pressure which differed by 2.4 +/- 1.0 (mean +/- SEM) mmHg, whereas recorded systolic pressure differed by 20.4 +/- 2.6 (mean +/- SEM) mmHg between central and peripheral sites. Results indicate that in adult humans a single generalized TF can be used with acceptable accuracy to determine central from peripheral pressure under different conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Ventriculo-arterial coupling: concepts, assumptions, and applications.

Recent investigations have yielded new insights into the interaction of the left ventricle with the arterial system. These studies have employed a variety of coupling frameworks to quantify this interaction, and each makes several simplifying assumptions. In this article, we review these frameworks, their major findings, assumptions, and clinical applications, and examine future directions for this research.

Animals↗
PubMed1992

Effective arterial elastance as index of arterial vascular load in humans.

BACKGROUND: This study tested whether the simple ratio of ventricular end-systolic pressure to stroke volume, known as the effective arterial elastance (Ea), provides a valid measure of arterial load in humans with normal and aged hypertensive vasculatures. METHODS AND RESULTS: Ventricular pressure-volume and invasive aortic pressure and flow were simultaneously determined in 10 subjects (four young normotensive and six older hypertensive). Measurements were obtained at rest, during mechanically reduced preload, and after pharmacological interventions. Two measures of arterial load were compared: One was derived from aortic input impedance and arterial compliance data using an algebraic expression based on a three-element Windkessel model of the arterial system [Ea(Z)], and the other was more simply measured as the ratio of ventricular end-systolic pressure to stroke volume [Ea(PV)]. Although derived from completely different data sources and despite the simplifying assumptions of Ea(PV), both Ea(Z) and Ea(PV) were virtually identical over a broad range of altered conditions: Ea(PV) = 0.97.Ea(Z) + 0.17; n = 33, r2 = 0.98, SEE = 0.09, p less than 0.0001. Whereas Ea(PV) also correlated with mean arterial resistance, it exceeded resistance by as much as 25% in older hypertensive subjects (because of reduced compliance and wave reflections), which better indexed the arterial load effects on the ventricle. Simple methods to estimate Ea (PV) from routine arterial pressures were tested and validated. CONCLUSIONS: Ea(PV) provides a convenient, useful method to assess arterial load and its impact on the human ventricle. These results highlight effects of increased pulsatile load caused by aging or hypertension on the pressure-volume loop and indicate that this load and its effects on cardiac performance are often underestimated by mean arterial resistance but are better accounted for by Ea.

Adult↗
PubMed1992

Effect of reduced aortic compliance on cardiac efficiency and contractile function of in situ canine left ventricle.

This study tests the hypothesis that arterial vascular stiffening adversely influences in situ left ventricular contractile function and energetic efficiency. Ten reflex-blocked anesthetized dogs underwent a bypass operation in which a Dacron graft was sewn to the ascending aorta and connected to the infrarenal abdominal aorta via a plastic conduit. Flow was directed through either native aorta or plastic conduit by placement of vascular clamps. Arterial properties were measured from aortic pressure-flow data, and ventricular function was assessed by pressure-volume (PV) relations. Coronary sinus blood was drained via an extracorporeal circuit for direct measurement of myocardial O2 consumption (MVO2). Data at multiple steady-state preload volumes were combined to derive chamber function and energetics relations. Energetic efficiency was assessed by the inverse slope of the MVO2-PV area relation. Directing flow through plastic versus native aorta resulted in a 60-80% reduction in compliance but little change in mean resistance. Arterial pulse pressure rose from 34 to 99 mm Hg (p less than 0.001). Contractile function assessed by the end-systolic PV relation, stroke work-end-diastolic volume relation, and dP/dtmax at matched end-diastolic volume did not significantly change. However, MVO2 increased by 32% (p less than 0.01) and was matched by a rise in PV area, such that the MVO2-PV area relation and efficiency was unaltered. The MVO2 required to sustain a given stroke volume, however, increased from 20% to 40%, depending on the baseline level (p less than 0.001). Thus, whereas the contractile function and efficiency of normal hearts are not altered by ejection into a stiff vascular system, the energetic cost to the heart for maintaining adequate flow is increased. This suggests a mechanism whereby human vascular stiffening may yield little functional decrement at rest but limit reserve capacity under conditions of increased demand.

Aging↗
PubMed1992

Pharmacological potential for reversing the ill effects of ageing and of arterial hypertension on central aortic systolic pressure.

CARDIOVASCULAR RISK: Systolic arterial pressure is an important risk factor for future cardiovascular morbidity and mortality. PULSATILE LOAD: The aortic systolic pressure with which the heart interacts is determined by pulsatile vascular load. In particular, wave reflections from peripheral sites affect peak central aortic systolic pressure but not brachial systolic pressure. DRUG POTENTIAL: Drugs that reduce wave reflection and hence reduce the pulsatile vascular load in addition to reducing peripheral resistance have the potential to reduce target organ damage to a greater extent than drugs that reduce mean pressure and resistance alone.

Aging↗
PubMed1991

Voltage-activated calcium and potassium currents in human pancreatic beta-cells.

1. The whole-cell configuration of the patch clamp technique was used to study inward and delayed outward currents in beta-cells isolated from human pancreatic islets. 2. The delayed outward current activated at about -20 mV and increased linearly with further depolarization. The instantaneous current-voltage (I-V) relation, measured by tail current analysis, reversed at -70 mV. This is close to the K+ equilibrium potential and suggests the outward current is carried primarily by potassium ions. In support of this idea, outward currents were abolished when internal K+ was replaced by the impermeant cation N-methyl-D-glucamine (NMG). 3. The voltage dependence of K+ current activation could be fitted by a sigmoidal function with a mid-point at +1 mV. K+ currents showed voltage-dependent inactivation which was half-maximal at -25 mV. 4. Inward currents were studied after outward currents were suppressed by replacing internal potassium with NMG. In 5 mM [Ca2+]o, the inward current activated between -50 and -40 mV, had a peak amplitude at -10 mV and reversed at potentials positive to +60 mV. The voltage dependence of inward current activation was sigmoidal with half-maximal activation at -10 mV in 5 mM [Ca2+]o and at -22 mV in 5 mM [Ba2+]o. 5. Inward currents were unaffected by tetrodotoxin (TTX), but could be blocked by cadmium ions. Barium was also capable of carrying inward current. This pharmacology is consistent with inward currents flowing through Ca2+ channels. 6. The inactivation of the inward current was dependent on calcium entry. In two-pulse experiments, the voltage dependence of inactivation was U-shaped, and resembled that of the calcium current. Barium currents showed little inactivation. 7. In two-pulse experiments the degree of inward current inactivation during the test pulse was related to the amount of calcium entry during the first pulse. Calcium entering at more positive potentials was less effective at producing inactivation. 8. Calcium and barium currents also showed a slow, voltage-dependent inactivation when the holding potential was changed between -100 and -40 mV. This inactivation developed with a time course of seconds. 9. The Ca2+ and K+ currents described here are similar to those reported for rodent beta-cells and indicate the rodent beta-cell provides a good model for that of man.

Action Potentials↗
PubMed1990

Two types of Ca channel in rat pancreatic beta-cells.

Ba currents flowing through single Ca-channels were recorded from cell-attached patches on rat pancreatic beta-cells. Two types of voltage-activated Ca-channels were found. The first (T-type) had a single channel conductance of 8 pS in 100 mM Ba, was activated at a low threshold (around -50mV) and inactivated by holding potentials positive to -40 mV. These properties are similar to those described for T-type channels in other preparations. The second type of Ca-channel (L-type) had a single channel conductance of 20pS in 100 mM Ba, was activated at a higher threshold (greater than -30mV), showed little inactivation during a 250 ms pulse and could be activated from a holding potential of -40mV. The dihydropyridine agonist BAY K 8644 selectively prolonged L-type Ca-channel openings. These properties are characteristic of L-type Ca-channels.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗
PubMed1990

Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery.

Nitroglycerin (0.3 mg) was administered sublingually to 14 patients undergoing cardiac catheterization, and pressure waves compared in the ascending aorta and brachial artery. After nitroglycerin, ascending aortic systolic pressure fell in all cases (by 6-44, average 22 mmHg) whereas brachial systolic pressure remained unchanged (in three) or fell to a lesser degree (4-33, average 12 mmHg). Diastolic pressure did not change significantly. Alterations in pressure and in wave contour were explained on the basis of arterial dilation, with reduction in wave reflection. Nitroglycerin reduces left ventricular afterload through arterial dilation as well as preload through venous dilation. This effect on afterload is not apparent from measurement of pressure in the brachial artery.

Administration, Sublingual↗
PubMed1989

Effects of arterial dilator agents on central aortic systolic pressure and on left ventricular hydraulic load.

Recordings of pressure in the brachial or peripheral arteries fail to disclose the marked increase in systolic pressure that occurs in the proximal aorta and central arteries with increasing age and with hypertension. This systolic pressure boost is caused by wave reflection returning from the periphery of the body while the ventricle is still contracting. Such early wave reflection is caused in turn by increased pulse-wave velocity, attributable to stiffening of the aorta and major conduit arteries. Drugs have little effect on arterial stiffening, whereas wave reflection can be markedly reduced by agents that dilate peripheral arteries. Such reduction in wave reflection causes substantial decrease of systolic pressure in central arteries. Because of differential timing of wave reflection, however, such reduction is not apparent from pressure recordings taken in the brachial or other peripheral arteries. The sphygmomanometer, therefore, fails to show the favorable effects of reduced wave reflection in the proximal aorta and central arteries. Noninvasive tonometric pressure wave recordings can supplement the sphygmomanometer to assess the magnitude of beneficial effect.

Adult↗
PubMed1989

ATP-sensitive K-channels in HIT T15 beta-cells studied by patch-clamp methods, 86Rb efflux and glibenclamide binding.

ATP-sensitive K-channels in the cloned beta-cell line HIT T15 were studied by patch-clamp methods; by measurement of 86Rb efflux; and by [3H]glibenclamide binding to isolated membrane preparations. In inside-out patches a 50 pS K-channel was found which was blocked by ATP or tolbutamide applied to the intracellular membrane surface. A minimum estimate of about 500 channels per beta-cell was obtained by combining whole-cell and single-channel data. The rate of efflux of 86Rb from 86RbCl-loaded HIT cells was markedly increased by intracellular ATP-depletion; 86Rb-efflux was progressively inhibited by increasing concentrations of glibenclamide or tolbutamide. In non-ATP-depleted cells, diazoxide elicited a concentration-dependent stimulation of 86Rb-efflux which was completely blocked by 1 microM glibenclamide. Isolated membranes showed dose-dependent saturable binding of [3H]glibenclamide to both high (Kd = 1.12 nM) and low (Kd = 136 nM) affinity binding sites. We estimate about 5000 high-affinity binding sites per cell. [3H]-glibenclamide binding was inhibited by tolbutamide (IC50 = 125 microM) but was not affected by diazoxide. ADP (0.5 or 1.0 mM) markedly reduced binding; other nucleotides tested were ineffective.

Adenosine Diphosphate↗
PubMed1989

Rubidium and sodium permeability of the ATP-sensitive K+ channel in single rat pancreatic beta-cells.

1. The patch-clamp method has been used to study the selectivity of single ATP-sensitive potassium channels in excised membrane patches from dissociated rat pancreatic beta-cells. 2. In symmetrical K+ concentrations the current-voltage relation of this channel showed slight inward rectification. The K+ permeability coefficient was 1.05 x 10(-13) cm3/s ([K+]o = 140 mM; 20 degrees C) in the inside-out patch and somewhat smaller when measured under the same conditions in the outside-out configuration (0.86 x 10(-13) cm3/s). 3. When intracellular Rb+ replaced K+, inward K+ currents were unaffected but the outward currents carried by Rb+ were substantially smaller. The extent of the reduction in the outward currents depended on the internal Rb+/K+ ratio and increased as [Rb+]i was raised. Both inward and outward Rb+ currents were blocked by 1 mM-ATP. No currents were measurable in symmetrical 140 mM-Rb+ solutions. 4. With 140 mM [K+]o and 140 mM [Rb+]i the single-channel current-voltage relation reversed at +8 mV and the potential at which the variance of the ATP-sensitive current was least was shifted by 6 mV to more positive potentials. These data suggest a PRb/PK ratio of around 0.7. 5. Outward Rb+ currents were reduced at all potentials in inside-out patches exposed to 107 mM-Rb+ solution intracellularly and 5 mM-K+ externally. 6. Partial replacement of external K+ with Rb+ substantially reduced the inward currents recorded from outside-out patches and also decreased outward K+ currents. 7. In outside-out patches, the addition of 1 mM-Rb+ to the external solution produced a block of inward K+ currents that initially increased and then decreased again with hyperpolarization. This suggests that the Rb+ block of K+ currents is voltage dependent and that Rb+ acts as a permeant blocker of K+ currents. 8. The sodium permeability of the channel, relative to that of potassium, was 0.39 for internal Na+ and 0.007 for external Na+ ions. 9. We conclude that Rb+ serves as an acceptable tracer for K+ in efflux studies when changes in K+ flux through ATP-sensitive K+ channels are of interest but that the magnitude of such fluxes will be considerably underestimated.

Adenosine Triphosphate↗
PubMed1988

Flecainide compared with a combination of digoxin and disopyramide for acute atrial arrhythmias after cardiopulmonary bypass.

Fifty six adult patients were randomised to treatment with flecainide (group 1, n = 29) or a combination of digoxin and disopyramide (group 2, n = 27) for acute atrial fibrillation and flutter after cardiac surgery. Intravenous flecainide was given as a 2 mg/kg bolus over 20 minutes followed by an infusion (0.2 mg/kg per hour) for 12 hours. Group 2 were given digoxin (0.75 mg) intravenously followed two hours later by an intravenous bolus of disopyramide (2 mg/kg) and an infusion (0.4 mg/kg per hour) for 10 hours. Within 12 hours sinus rhythm was restored in 86% of the group 1 (25 patients) and 89% of the group 2 (24 patients). The median time to reversion was significantly shorter in group 1 (80 minutes, range 30-180 minutes) than group 2 (220 minutes, range 138-523 minutes). None of the patients in group 1 and four of the patients in group 2 had transient relapses into atrial fibrillation during the 12 hours of intravenous treatment. There were five late relapses in group 1 and seven in group 2 during subsequent oral treatment. Two group 1 patients and two group 2 patients showed adverse drug effects. Intractable ventricular arrhythmias occurred after five days of oral treatment in one patient (group 1) who had poor left ventricular function, hepatic impairment, and toxic concentrations of drugs at the time of death. Flecainide was as effective as the combination of digoxin and disopyramide and it acted significantly faster and was associated with fewer relapses. Monitoring of blood concentrations of flecainide is essential in patients with poor left ventricular function and hepatic impairment.

Acute Disease↗
PubMed1987

ATP-sensitive K+ channels in human isolated pancreatic B-cells.

Glucose-stimulated insulin release from rodent pancreatic B-cells is thought to be initiated by the closing of ATP-sensitive K+ channels in the plasma membrane as a consequence of glucose metabolism. We have identified an ATP-sensitive K+ channel in membrane patches excised from human B-cells which is similar to that found in rodent B-cells in conductance, kinetics, ATP sensitivity and its inhibition by sulphonylureas. In man, the ATP-sensitive K+ channel may also have a central role in glucose-stimulated insulin secretion and may be (linked to) the receptor for the hypoglycemic sulphonylureas.

Adenosine Triphosphate↗
PubMed1987

Head injury with subsequent, intermittent, nonschizophrenic, psychotic symptoms and violence.

A young, black, adult woman presented to an outpatient clinic for treatment with a history of intermittent, nonschizophrenic, psychotic symptoms. Blacks, because of their situational sociology, may be more predisposed to severe head injuries, and this acquired biologic factor may be, in part, responsible for the high rates of black-on-black murder. The use of beta blockers is discussed as an adjunct in the treatment of violence occurring in patients with a past history of severe head injury.

Adolescent↗
PubMed1986

The ATP-sensitivity of K+ channels in rat pancreatic B-cells is modulated by ADP.

ATP-sensitive K+ channels in inside-out membrane patches from dispersed rat pancreatic B-cells were studied using patch-clamp methods. The dose-response curve for ATP-induced channel inhibition was shifted to higher concentrations in the presence of ADP (2 mM). In glucose-free solution, the total intracellular concentration of ATP was 3.8 mM and of ADP 1.5 mM; glucose (20 mM) increased ATP and decreased ADP by approx. 40%. These results suggest that both ADP and ATP may be involved in regulating the activity of the glucose-sensitive K+ channel in intact B-cells.

Adenosine Diphosphate↗