Search PubMed⌕ Search

Biomedical subjects

T Omae

Publications and source records attributed to T Omae.

At least 73 records · Page 4Linked to original sources
PubMed1995

Quantitative estimation of ideal body weight in uremic patients.

There is no definite way to estimate the ideal body fluid level in uremic patients. We developed a simple method to quantitatively estimate the ideal body weight. Hemofiltration (HF) was performed 9 times in 5 uremic patients. Urea-nitrogen concentration was measured in plasma before and after HF and in total ultrafiltrate mixture. Creatinine concentration was measured in plasma after HF and before the next HF and in urine collected between those two HF therapies. Total body fluid volume, TBF, was obtained, based on urea kinetics principles, as 36.8 +/- 1.8 L after HF assuming that urea is distributed uniformly within total body fluid. Creatinine generation rate, Gcr, was calculated as the sum of urinary creatinine excretion rate, creatinine accumulation rate within body fluids and extra-renal creatinine excretion rate. It is known that solid mass, SM, is related to Gcr and that the TBF to lean body mass (= SM + TBF) ratio is constant under ideal fluid level conditions. Thus, TBF under ideal body fluid level conditions (37.8 +/- 3.0 L), SM (13.7 +/- 1.1 kg) and fat mass (3.7 +/- 2.3 kg) were derived, and finally we found body weight value under ideal fluid level conditions to be 55.1 +/- 4.2 kg. The ideal body weight estimated this way was found to be significantly correlated with the dry weight (54.0 +/- 3.5 kg) determined clinically by conventional means (r = 0.9; p < 0.01); no significant difference was found between these body weight values. Our results suggest that the ideal body weight can be estimated simply by applying both urea and creatinine kinetics principles in uremic patients.

Adult↗
PubMed1995

Imidapril hydrochloride in essential hypertension: a double-blind comparative study using enalapril maleate as a control.

OBJECTIVE: To assess the value of using imidapril hydrochloride (ACE/TA-6366), a long-acting angiotensin converting enzyme (ACE) inhibitor developed in Japan, to treat patients with essential hypertension. PATIENTS AND METHODS: A double-blind, comparative, phase III study was carried out using enalapril maleate as a control, with a 4-week observation period and a 12-week treatment period. Both drugs were started at a dose of 5 mg once a day, increasing to 10 mg in patients whose antihypertensive response was insufficient after 4 weeks. The study included 231 outpatients aged 30-74 years; of these, 108 in the imidapril group and 115 in the enalapril group were assessed. There were no differences in background factors between groups. RESULTS: An adequate antihypertensive effect was observed in 71.3% (77/108) in the imidapril group in in 66.1% (76/115) in the enalapril group, with no significant difference between groups. The pulse rate was unchanged in both groups. The drug had no adverse effects in 86.1% (93/108) of the imidapril group and 79.1% (91/115) of the enalapril group, with no significant difference between groups. Adverse drug effects were observed din 5.6% (6/108) of the imidapril group and 12.2% (14/115) of the enalapril group. Cough was the most frequent side effect, reported in 0.9% (1/108) of the imidapril group and 7.0% (8/115) of the enalapril group. Other side effects were reported in 4.6% (5/108) of the imidapril group and 5.2% (6/115) of the enalapril group. Abnormal laboratory values were observed in 3.7% (4/108) of the imidapril group and 0.9% (1/115) of the enalapril group. CONCLUSIONS: Imidapril showed excellent clinical efficacy and safety compared to enalapril. The low incidence of cough is of particular interest.

Adult↗
PubMed1994

Noninvasive quantitative evaluation of early atherosclerosis and the effect of monatepil, a new antihypertensive agent. An interim report.

In two studies on the same group of patients we evaluated noninvasive methods of assessing atherosclerosis and determined the effect of the new calcium channel-blocking agent monatepil on the progression of early atherosclerosis in humans. Computed tomography (CT) of the lower abdominal aorta and ultrasonography of the carotid arteries were used as noninvasive methods to determine the extent of atherosclerosis. To evaluate the CT images, we developed a new medical image analysis program. This enabled aortic calcification volume (ACV) to be quantified using plain CT images, and aortic wall volume (AWV) and aortic wall and calcification volume (AWCV) to be quantified from contrast CT images. Interobserver coefficients of variation of ACV, AWV, and AWCV (n = 8) were 4.7, 2.4, and 5.0%, respectively. In the monatepil study, the effect of the drug on serum lipid profiles was evaluated. Preliminary results show that shortly after monatepil administration, total serum cholesterol levels decreased significantly from 253.8 +/- 35.6 to 244.8 +/- 38.6 mg/dL (P < .009) and triglyceride levels tended to decrease. A positive correlation between the change in total cholesterol and changes in mean platelet volume was found (P = .028). Fasting immunoreactive insulin levels decreased in the four patients in which they were determined. Although this is a preliminary study, results indicate that CT of the lower abdominal aorta in combination with our new analysis program may be a precise, reproducible means of assessing early atherosclerosis. We have also shown that monatepil significantly decreases total cholesterol levels. However, the long-term effects of monatepil on the progression of atherosclerosis remain to be determined.

Aged↗
PubMed1994

Chronic effects of central and systemic administration of losartan on blood pressure and baroreceptor reflex in spontaneously hypertensive rats.

To clarify the role of endogenous angiotensin II (AngII) in the hypertension of spontaneously hypertensive rats (SHR), we examined the chronic effects of central and systemic administration of losartan, an angiotensin AT1 receptor antagonist, on blood pressure and arterial baroreceptor reflex. The SHR and Wistar-Kyoto rats (WKY), aged 12 to 16 weeks, received subcutaneous infusions of losartan at a dose of 10 mg/kg/day, or intracerebroventricular infusions of losartan at doses of 1 or 10 mg/kg/day for 14 days. Control groups received either isotonic saline solution subcutaneously or intracerebroventricular artificial cerebrospinal fluid. On day 14, baroreflex control of heart rate was determined by intravenous phenylephrine, and pressor response to intravenous AngII (100 ng/kg) was investigated in conscious rats. Blood pressure was higher and the sensitivity of the baroreflex control of heart rate was lower in vehicle-treated SHR than in WKY. Chronic subcutaneous administration of losartan lowered the blood pressure throughout the infusion period in both SHR and WKY, but the hypotensive effects were significantly greater in SHR. Losartan also sensitized the impaired baroreflex in SHR. Chronic intracerebroventricular losartan at a dose of 1 mg/kg/day did not alter the blood pressure or the baroreflex control of the heart rate in either strain. The effects of 10 mg/kg/day of intracerebroventricular losartan on blood pressure and the baroreflex were similar to those of the same dose administered subcutaneously. The pressor response to intravenous AngII was similarly inhibited by intracerebroventricular and subcutaneous losartan doses of 10 mg/kg/day.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗
PubMed1994

Idiopathic left innominate vein stenosis manifested following the creation of arteriovenous fistula in uremia.

A 48-year-old woman on maintenance hemodialysis was admitted with her left upper limb swollen and her left jugular vein dilated following the creation of an arteriovenous fistula on her left arm. The intracorporeal pressure during hemodialysis was found to be high. Venographic investigation showed severe stenosis of her left innominate vein accompanied by rich blood flow of the collaterals. Ligation of her fistula promptly reduced swelling of her left upper limb and dilatation of the left jugular vein. The exact cause of the stenosis could not be determined from venographic or computerized tomography findings. Idiopathic left innominate vein stenosis was diagnosed which we believe is the first case to be reported in a hemodialyzed patient.

Arteriovenous Shunt, Surgical↗
PubMed1994

Biphasic effects of repeated alcohol intake on 24-hour blood pressure in hypertensive patients.

BACKGROUND: The association between alcohol and blood pressure (BP) may be related to the temporal sequencing of alcohol use and BP measurement. We investigated the effects of single and repeated intakes of alcohol on 24-hour BP. METHODS AND RESULTS: Fourteen male habitual drinkers with essential hypertension were placed sequentially on a 4-day control phase: a nonalcoholic drink with the same calories as alcohol was given at dinner (5 PM to 6 PM) and a 7-day drinking phase: alcohol (ethanol, 1 mL/kg) was given at dinner under standardized conditions. Ambulatory BP measurements were performed on day 3 of the control phase and on days 1 and 7 of the alcohol phase. The average 24-hour systolic and diastolic BPs on day 1 were significantly lower than those in the control phase and on day 7. Between 6 PM and midnight, both systolic and diastolic BPs on days 1 and 7 (121 +/- 2/73 +/- 1 and 126 +/- 4/75 +/- 2 mm Hg, respectively) were significantly lower than those in the control phase (139 +/- 4/83 +/- 2 mm Hg). Between midnight and 8 AM (6 to 14 hours after the last drink), both systolic and diastolic BPs on day 7 (138 +/- 4/83 +/- 2 mm Hg) were significantly higher than those in the control phase (131 +/- 4/79 +/- 2 mm Hg) and day 1 (129 +/- 3/77 +/- 1 mm Hg). Between 8 AM and 3 PM, BPs showed no difference among the three phases. CONCLUSIONS: A single intake of alcohol has a depressor effect on BP that lasts for several hours after drinking, while repeated intakes for 7 days have both depressor and pressor effects according to the differences in time intervals after the last drink. This study suggests that the chronic effects of alcohol on BP might be overestimated when based on casual BP measurements alone.

Blood Pressure↗
PubMed1994

Periventricular white matter lucency and cerebral blood flow autoregulation in hypertensive patients.

The goal of this study was to elucidate the association between the development of periventricular white matter lucency and autoregulation of cerebral blood flow in hypertensive patients through the arteriovenous oxygen saturation difference method. We studied 51 hypertensive patients who had previously suffered from minor strokes (lacunar infarction, 43; deep basal minor hemorrhage, 8). Patients were divided into three groups based on the findings of periventricular white matter lucency. We measured the absolute value of resting cerebral blood flow using the argon inhalation method, and stepwise reduction of blood pressure was obtained with patients on a tilting table. Intracerebral venous blood sampling was accomplished by direct cannulation into the jugular vein up to the jugular bulb. We calculated several cerebral circulatory parameters, such as cerebrovascular resistance and cerebral oxygen consumption, and also delineated individual autoregulation curves. Cerebrovascular resistance was significantly greater in patients with severe periventricular white matter lucency than in patients without it (P < .05). Impaired autoregulation was also significantly more prevalent in patients with more severe periventricular lesions (P < .05). Multiple regression analysis revealed that the impaired autoregulation was significant and an independent determinant of the severity of such periventricular lesions (R = .34, P < .05). In conclusion, our findings indicated that hypertensive patients with severe periventricular white matter lucency were more likely to have impaired autoregulation of cerebral blood flow and suggest that stricter blood pressure control is required in such patients to prevent deterioration of the cerebral microcirculation.

Aged↗
PubMed1994

Clinical studies on the sites of production and clearance of circulating adrenomedullin in human subjects.

Adrenomedullin is a novel hypotensive peptide, newly discovered in pheochromocytoma. Because immunoreactive adrenomedullin is present in human plasma, adrenomedullin may play a role in regulating blood pressure. A recent report showed that human adrenomedullin mRNA is expressed not only in pheochromocytoma but also in the normal adrenal medulla, kidney, lung, and ventricle. However, whether or not these organs actually release adrenomedullin into the circulation remains unknown. To investigate the sites of production and degradation of adrenomedullin in human subjects, we obtained blood samples from various sites and measured immunoreactive adrenomedullin concentrations. In study 1, blood samples were obtained from the infrarenal inferior vena cava, suprarenal inferior vena cava, superior vena cava, right atrium, right ventricle, pulmonary artery, pulmonary capillary, left ventricle, and aorta during cardiac catheterization in 15 patients with ischemic heart disease (67 +/- 10 years). In study 2, blood samples were taken from the infrarenal inferior vena cava, suprarenal inferior vena cava, right and left renal veins, and left adrenal vein in 5 hypertensive patients (42 +/- 14 years) suspected of having renovascular hypertension. In study 3, peripheral venous blood samples were obtained in 2 patients (males, 45 and 36 years old) with pheochromocytoma at rest and during hypertensive attacks. Plasma adrenomedullin concentrations were measured by a newly developed radioimmunoassay. In study 1, there were no significant differences in plasma adrenomedullin concentrations in various sites of the right-side circulation. There was no step-up of plasma adrenomedullin levels in the coronary sinus. However, the plasma concentration of adrenomedullin in aorta was slightly but significantly lower than in pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1994

Plasma levels of adrenomedullin, a newly identified hypotensive peptide, in patients with hypertension and renal failure.

Adrenomedullin is a potent hypotensive peptide newly discovered in pheochromocytoma tissue by monitoring its elevating activity on platelet cAMP. We measured plasma concentration of adrenomedullin in patients with essential hypertension and chronic renal failure. As compared with normal subjects, plasma adrenomedullin was increased by 26% (P < 0.05) in hypertensives without organ damage and by 45% (P < 0.005) in those with organ damage. The increase in plasma adrenomedullin was more prominent in renal failure than in hypertension. Renal failure patients with plasma creatinine of 1.5-3, 3-6, and > 6 mg/dl had higher plasma adrenomedullin levels than healthy subjects by 78% (P < 0.05), 131% (P < 0.001), and 214% (P < 0.001), respectively. Moreover, adrenomedullin showed intimate correlations with norepinephrine, atrial natriuretic peptide, and cAMP in plasma (r = 0.625, P < 0.001; r = 0.656, P < 0.001; and r = 0.462, P < 0.001; respectively). Thus, plasma adrenomedullin is supposed to increase in association with changes in sympathetic nervous activity and body fluid volume in hypertension and renal failure. Considering its potent vasodilator effect, adrenomedullin may be involved in the defense mechanism preserving the integrity of the cardiovascular system in these disorders.

Adrenomedullin↗
PubMed1994

Reopening phenomenon in cardioembolic stroke observed by duplex carotid ultrasonography. Case reports.

The authors attempted to detect the reopening of an occluded artery within the carotid axis of acute cardioembolic stroke patients noninvasively by using duplex carotid ultrasonography. The timing of reopening as related to hemorrhagic transformation was also studied. For assessing the reopening phenomenon, quantitative measurement of flow velocity in the bilateral common carotid arteries was repeated in 10 patients who also underwent repeated angiography or autopsy. The ratio of the end-diastolic flow velocity (nonaffected/affected) was related to angiographic or autopsy findings. In 17 patients including the 10 cases mentioned, the occurrence of hemorrhagic transformation was related to the timing of reopening. The hemorrhagic infarction in this study was defined to be a hyperdense area in the basal ganglia on computed tomography. A significant decrease in the ratio of the end-diastolic velocity was observed in 6 patients, in whom the repeated angiography demonstrated reopening of the artery. Of the remaining 4 patients not showing a significant change, only 1 patient was found to have reopening. Reopening was detected in 12 of 17 cases. The timing was 2.5 hours after onset in 1, between days 2 and 5 in 6 cases, and after day 6 in 5 cases. Hemorrhagic infarction was found in 5 of the cases with reopening on days 2-5.

Aged↗
PubMed1994

[Patient-hospital relationship and quality of life in elderly patients with hypertension].

To investigate the influence of the patient-hospital relationship on the quality of life (QOL) in elderly patients with hypertension, we developed a comprehensive scale for assessing the patient-hospital relationship. In the first phase, an original questionnaire consisting of 40 items was designed under five fields for global assessment of the concept. We administered this questionnaire to 715 patients with cardiovascular diseases. Variations in the scores were evaluated by factor analysis. Three factors that comprised the majority of variance were derived by principal components analysis and varimax transformation. These orthogonal factors were considered to reflect "convenience of the outpatient clinic", "satisfaction with clinical staff", and "communication with physician". We adopted three items under each of the three domains. Using this instrument, we assessed the patient-hospital relationship in 402 elderly outpatients with hypertension at 8 clinical centers. QOL was simultaneously assessed. A linear regression analysis revealed a significant positive correlation between patient-hospital relationship and QOL scores (R = 0.403, p < 0.0001), which means that patient-hospital relationship explained up to 16 percent of the total variability in scores on the Overall Quality of Life scale. Closer correlations were observed in patients aged 80 years or older, and in patients who lived alone. These results indicate that the patient-hospital relationship is one of the substantial factors determining QOL in elderly hypertensive patients, with more substantiality in older patients and patients leading solitary lives.

Aged↗
PubMed1994

The Japanese experience in hemorrhagic stroke.

AIM: To review current problems with hemorrhagic stroke in Japan and to explore possible explanations for a change not only in the incidence but also the severity of hemorrhagic stroke in recent years in Japan. METHODS: Mortality statistics, community-based registries and hospital records were used. RESULTS AND CONCLUSIONS: The age-adjusted stroke mortality rate in Japan has declined over the last 20 years by approximately 75%, a very strong decline compared with other countries. The reduction was much more marked for hemorrhagic stroke than for ischemic stroke. Community-based registries for recent years show that the incidence ratio of brain infarction to brain hemorrhage is 1.5-4.0; this is about one-half, or even less than one-half of the rates reported in Western populations. The incidence of subarachnoid hemorrhage in Japan is 7-12% of total strokes. The growing popularity of antihypertensive treatment and changes in lifestyle, including nutrition, are considered responsible for the marked change observed in the stroke figures. Furthermore, mild to moderate cases of brain hemorrhage have been seen more frequently in recent years than severe cases.

Adult↗
PubMed1994

The association between salt sensitivity of blood pressure and some polymorphic factors.

OBJECTIVE: To examine the association in Japanese subjects between the salt sensitivity of blood pressure and polymorphic factors. DESIGN AND METHODS: One hundred and four patients with essential hypertension were classified as salt-sensitive or non-salt-sensitive depending on their blood pressure response to salt restriction. An insertion/deletion polymorphism of the angiotensin converting enzyme (ACE) gene was examined by detecting an alu sequence in intron 16. The ACE genotype was classified as II, ID or DD depending on whether each allele had this sequence. The haptoglobin phenotype was determined by the starch-gel electrophoresis method, and was classified as three phenotypes, 1-1, 2-1 or 2-2 form. RESULTS: The response of plasma renin activity to salt restriction was greater in patients with the DD form than in those with other forms, although there were no significant differences in the ratio salt-sensitive: non-salt-sensitive patients among the three ACE genotype groups. However, the ratio was significantly larger in the haptoglobin 2-1 phenotype group than in the 2-2 group. CONCLUSIONS: The salt sensitivity of blood pressure was associated with the haptoglobin phenotype, but was not associated with the ACE genotype. However, the response of plasma renin activity to salt restriction was different according to the ACE genotype.

Adult↗
PubMed1993

Effects of aspirin DL-lysine on thrombin generation in unstable angina pectoris.

To evaluate the effects of aspirin on thrombin generation in patients with unstable angina, plasma levels of thrombin-antithrombin III complex (TAT) as a new marker of thrombin generation and of 11-dehydro-thromboxane B2 (11-dehydro-TXB2) as an indicator of platelet activation were measured in 18 patients with unstable angina, including 8 patients with prolonged rest angina (> 15 minutes). Aspirin DL-lysine (900 mg) was administered intravenously to 9 of the 18 patients (aspirin group); the other 9 were not given aspirin during the first 24 hours of hospitalization (non-aspirin group). Clinical characteristics, angiographic features and medications other than aspirin were similar between the 2 groups. Levels of plasma TAT and 11-dehydro-TXB2 were significantly higher (p < 0.05) in patients with prolonged rest angina than in those without the condition (n = 10). In 5 patients with prolonged rest angina who received aspirin, plasma TAT levels (ng/ml) were significantly decreased (4.52 +/- 1.18 at baseline, 2.50 +/- 0.65 at 1 hour and 2.16 +/- 0.42 at 24 hours after aspirin administration, p < 0.01) with a significant decrease in plasma 11-dehydro-TXB2 levels. However, the reduction in TAT after aspirin administration was slight in patients without prolonged rest angina (n = 4). In contrast, levels of plasma TAT and 11-dehydro-TXB2 in the non-aspirin group remained unchanged during the study period. These results suggest that aspirin rapidly reduces thrombin generation through inhibition of platelet activity in patients with unstable angina with prolonged rest angina.

Aged↗
PubMed1993

Rapid increase in plasma endothelin concentrations during percutaneous balloon dilatation of the mitral valve in patients with mitral stenosis.

OBJECTIVE: To investigate the relation between plasma concentrations of immunoreactive endothelin and haemodynamic variables before and after percutaneous transvenous balloon dilatation of the mitral valve. DESIGN: Prospective study. SETTING: National cardiovascular centre. PATIENTS: 25 patients with mitral stenosis and 26 healthy volunteers. MAIN OUTCOME MEASURES: Plasma concentrations of immunoreactive endothelin were measured in the pulmonary artery, left atrium, ascending aorta, and femoral vein before and after balloon dilatation of the mitral valve. RESULTS: Peripheral venous concentrations (mean (SD)) of endothelin were higher in the patients with mitral stenosis than in the healthy volunteers (1.76 (0.51) v 1.37 (0.45) pg/ml, p < 0.05) and they correlated with the mean left atrial pressure (r = 0.74, p < 0.01). Balloon dilatation of the mitral valve reduced the mean left atrial pressure without changing the mean right atrial pressure, systemic arterial pressure, heart rate, or cardiac index. Concentrations of plasma endothelin in the femoral vein increased from 1.76 (0.51) to 3.39 (2.46) (p < 0.01), 4.82 (2.34) (p < 0.001), and 2.43 (0.52) pg/ml (p < 0.05) at 15 and 30 minutes and 24 hours after the procedure. The concentration of endothelin in the pulmonary artery also increased from 1.85 (0.85) to 4.32 (1.58) pg/ml (p < 0.01) 30 minutes after the dilatation, whereas there were no appreciable changes in endothelin concentration in the left atrium or ascending aorta. CONCLUSIONS: Plasma endothelin concentrations were higher in patients with mitral stenosis than in healthy volunteers and the increase was proportional to left atrial pressure. After balloon dilatation of the mitral valve there was an abrupt rise in endothelin in the femoral vein and pulmonary artery but no change in left atrial or aortic blood samples. These findings suggest that endothelin may be another vasoactive substance involved in congestive heart failure.

Adult↗
PubMed1993

Hemorrhagic and ischemic cerebrovascular complications of active infective endocarditis of native valve.

Cerebrovascular events complicate the management of infective endocarditis. The purpose of this study is to analyze clinical features of cerebrovascular complications in infective endocarditis and to establish the appropriate time schedule of chemotherapy and cardiosurgical intervention. We studied the clinical data of 123 patients with active infective endocarditis of native valves retrospectively. Thirty-three patients (18 males and 15 females, age 17-57 years) had cerebrovascular complications such as cerebral ischemia (n = 22) or intracranial hemorrhage (n = 11). The majority of complications (21 ischemic and 13 hemorrhagic episodes) occurred prior to or within 1 month after chemotherapy. Fatal neurological deterioration developed after cardiac surgery in 2 patients. Both of them needed emergency cardiac surgery, because of worsening hemodynamic state, which was performed within 5 days after cerebral embolic events. The remaining patients undertaking cardiac surgery did all survive; in whom there were chemotherapeutic intervals of 11 days after ischemic events or of 23 days after hemorrhagic events. These medical records suggest that early cardiosurgical intervention, if necessary, needs at least 2-3 weeks of preceding chemotherapy. In cases undergoing more than 1 month of chemotherapy, cerebrovascular complications may be well managed by medical treatment alone.

Adolescent↗
PubMed1993

Effects of hemodialysis on body surface maps in patients with chronic renal failure.

To examine the effects of hemodialysis on the electrocardiogram, 87-lead body surface maps were performed in 38 patients with chronic renal failure, before and after hemodialysis. The patients were divided into two groups; 16 patients with coronary artery disease (CAD group), and 22 patients without ischemic heart disease (control group). Three maps were analyzed, QRS isopotential maps, isochrone maps, and QRS isointegral maps. Parameters measured were maximal R wave voltage (Peak R), minimal QRS wave voltage (Peak S), maximal ventricular activation time (VATmax) and QRS duration (QRSd). In the control group, Peak R and Peak S increased but VATmax decreased after hemodialysis. There were negative correlations between the changes of body weight and the changes in Peak R (r = -0.67, p < 0.01) and Peak S (r = -0.87, p < 0.001), although there were no correlations between changes in left ventricular diastolic dimension and the changes in Peak R and Peak S. In the CAD group, Peak S increased but Peak R and VATmax did not change significantly. There were negative correlations between the change of body weight and the change of Peak S (r = -0.73, p < 0.01). The most pronounced changes in mean QRS isointegral maps on hemodialysis were an increased magnitude of positivity in the control group and negativity in the CAD group on the anterior thorax. These findings suggested that the increase in the QRS amplitude after hemodialysis was influenced by the changes of the conductivity of extracardiac thorax and the relative heart position to the chest wall rather than myocardial ischemia or ventricular conduction delay.

Adult↗