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Biomedical subjects

Y Drory

Publications and source records attributed to Y Drory.

At least 55 records · Page 3Linked to original sources
PubMed1991

The effects of hormone replacement therapy in normal postmenopausal women: measurements of Doppler-derived parameters of aortic flow.

In this study the effects of hormone replacement therapy on cardiac function in healthy postmenopausal women were evaluated by Doppler echocardiography that was performed before (T1) and 2.5 months after the initiation of hormone replacement therapy (T2) in the peak estrogenic phase. The following parameters of aortic flow were measured: peak flow velocity, acceleration time, and ejection time. Additional parameters were calculated: flow velocity integral and mean acceleration. The study group included 24 postmenopausal women aged 43 to 60 years (mean 51.6 years). The control group consisted of 19 postmenopausal women aged 46 to 60 years (mean 53.5 years) who were not receiving hormone replacement therapy and who underwent the same evaluation. There were no changes in all Doppler parameters between T1 and T2 in the control group. However, in the study group there were significant increases in peak flow velocity (108.3 +/- 16.7 cm/sec at T1 vs 123 +/- 20.7 cm/sec at T2; p = 0.002), flow velocity integral (17.7 +/- 3.9 vs 21.5 +/- 4.7 cm; p = 0.0003), mean acceleration (11.5 +/- 1.9 vs 13.1 +/- 2.6 m/sec/sec; p = 0.001), and ejection time (324 +/- 37.6 vs 348.8 +/- 40.7 msec; p = 0.002). There was no change in acceleration time (94.8 +/- 6.6 vs 95 +/- 10.9 msec). These results demonstrate that estrogens increase both stroke volume and flow acceleration. The latter probably reflects a combination of enhanced inotropism and vasodilatation. We assume that the cardioprotective effect of hormone replacement therapy in postmenopausal women may be due not only to changes in lipid profile but also to direct effects of estrogens on central and peripheral hemodynamic parameters.

Adult↗
PubMed1991

Hyperinsulinemia, sex, and risk of atherosclerotic cardiovascular disease.

BACKGROUND: The possibility that hyperinsulinemia may be involved in the etiology of atherosclerotic cardiovascular disease (CVD) was first suggested 20 years ago. During the last decade, this possibility has received support from three large prospective studies. METHODS AND RESULTS: In the present study, the association between CVD, glucose intolerance, obesity, and hypertension (the GOH conditions) and hyperinsulinemia was examined cross-sectionally in a representative sample (n = 1,263) of the adult Jewish population aged 40-70 years in Israel. Previously known diabetics were excluded. CVD comprising clinical or ECG evidence of ischemic heart disease, as well as clinical evidence of cerebrovascular or peripheral vascular disease, was identified in 97 men and 39 women. A significant (p less than 0.01) hyperinsulinemia-sex interaction was found for CVD rate, with the adjusted risk ratios (followed by 95% confidence limits), relative to the rate in 298 normoinsulinemic women, being 1.15 (0.68-1.95) in 328 normoinsulinemic men, 0.85 (0.48-1.49) in 277 hyperinsulinemic women, and 2.27 (1.33-3.08) in 360 hyperinsulinemic men. Age-adjusted CVD rates in men versus women were: a) similar and low among all normoinsulinemic normotensives and hyperinsulinemics free of any of the GOH conditions (all rates less than or equal to 6.5%); b) similar and high among normoinsulinemic hypertensives (13.4% versus 10.4%); c) significantly higher in men among hyperinsulinemic normotensives with glucose intolerance and/or obesity (15.2% versus 3.3%; p = 0.02) and all hyperinsulinemic hypertensives (21.5% versus 12.8%; p = 0.04). These trends remained significant after adjusting for age, ethnic group, and blood lipids. CONCLUSIONS: Therefore, hyperinsulinemia was associated with excess CVD risk in men but not in women, and all excess CVD risk in men was confined to hyperinsulinemic individuals in the presence of glucose intolerance, obesity, or hypertension.

Arteriosclerosis↗
PubMed1991

Long-term psychosocial adjustment to coronary artery disease.

Personality hardiness, which has been conceptualized as a potential internal resource facilitating stress resistance, was examined in conjunction with Type A behavior, perceived family cohesion and adaptability, and sociodemographic and medical variables to assess the independent differential correlations of these factors with long-term psychosocial adjustment to coronary artery disease. One hundred twenty-eight patients completed the third generation Hardiness Scale, together with questionnaires measuring Type A behavior, perceived family cohesion and adaptability, and psychosocial adjustment to illness. The results showed that personality hardiness was the most salient correlate of psychosocial adjustment. High hardiness scores were associated with good adjustment to the various life domains. Angina severity accounted for the variance in social domains, but not the psychologic distress domain. Type A behavior, both dimensions of perceived family dynamics, and the sociodemographic variables did not have a significant role in explaining the variance in psychosocial adjustment. We conclude that personality hardiness could serve as a valid indicator of long-term psychosocial adjustment in patients with coronary artery disease.

Adaptation, Psychological↗
PubMed1991

Exertional sudden death in soldiers.

To address the problem of a significant rise in the incidence of exertional sudden death worldwide, the medical records and necropsy reports of all deaths that occurred in the Israel Defence Forces (IDF) during 1974-1986 were scrutinized. Twenty male soldiers, aged 18-29 yr, died suddenly and unexpectedly within 24 h of strenuous exercise. Necropsy results, available for 90% of the subjects, included underlying cardiac disease in 50% and noncardiac causes of death in 33.3%; the cause of death was unidentifiable in 16.7% of the subjects. Prodromal symptoms in 70% of the subjects are presented as a main focus of this investigation. The most frequently reported symptom was exertional or nonexertional syncope in 40% of the subjects. Chest pain, acute gastrointestinal symptoms, or febrile disease were reported in 30% of the cases. The findings of this research suggest that syncope is a major antecedent symptom of exertional sudden death. An attack of syncope in young conditioned individuals should be followed by thorough medical surveillance, and strenuous exercise should be avoided until this procedure is completed. Sports and military officials have the obligation to promote awareness that strenuous exercise should not be performed in the presence of acute gastrointestinal symptoms or febrile illness.

Adolescent↗
PubMed1990

Persistence of arrhythmia exercise response in healthy young men.

This study assesses the persistence of arrhythmia at rest or during exercise tests, or both, after a mean follow-up period of 6.7 years in 76 young men (mean age 21.5 years) without evidence of organic heart disease. The exercise test was performed using a near-maximal protocol based on progressively increasing intermittent work loads, each of 5 minutes' duration. The initial work load was 50 W. The electrocardiogram was continuously registered throughout all stages of the examination. Arrhythmia was defined as the occurrence of greater than or equal to 1 supraventricular or 1 ventricular premature beat at any stage of the examination. At the follow-up examination, the rate of persistence of arrhythmia did not differ significantly among the subgroups, irrespective of follow-up interval, type of arrhythmia, or arrhythmia patterns of response to exercise. Two-dimensional echocardiography did not show any structural abnormalities and Doppler examination did not demonstrate significant abnormal flow patterns. Our data show that almost all patients continued to present arrhythmia after the follow-up period, without any evidence of development of organic heart disease. Moreover, the arrhythmia pattern of response to exercise remained constant throughout the years. At this time, arrhythmia without underlying heart disease seems to be of a benign natural course in these young men.

Adolescent↗
PubMed1990

Altered left ventricular volume and ejection fraction responses to supine dynamic exercise in athletes.

Two-dimensional echocardiography was used to determine the responses of left ventricular volumes, ejection fraction and segmental left ventricular motion to supine dynamic exercise in 22 professional athletes, comparing these responses with those in 22 age- and gender-matched healthy untrained individuals. End-systolic volume was significantly greater at rest and during exercise in the athletes (50 +/- 6 versus 29 +/- 4 ml and 40 +/- 5 versus 17 +/- 4 ml, respectively, p less than 0.001 for both). It decreased during exercise in all the untrained subjects, but did not change or increased in nine athletes (41%). End-diastolic volume was greater in the athletes at rest (143 +/- 12 versus 98 +/- 9 ml) and during exercise (157 +/- 14 versus 121 +/- 13 ml, p less than 0.01 for both). It increased in all the untrained subjects, but decreased or did not change in six athletes (27%). Ejection fraction was significantly lower in the athletes at rest and during exercise (65 +/- 4% versus 70 +/- 5% and 73 +/- 5% versus 86 +/- 5%, p less than 0.01 and 0.001, respectively); the values augmented normally in all the untrained subjects, but increased only by less than 5% units, did not change or decreased in nine athletes (41%). Eight athletes (36.5%) failed to demonstrate the expected symmetric hyperkinetic wall motion changes during exercise, which were seen in all the untrained subjects. No correlation was found between atypical responses to exercise and electrocardiographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Arm exercise training in the rehabilitation of patients with impaired ventricular function and heart failure.

Although exercise training is an accepted part of comprehensive coronary care programs in patients with coronary artery disease, it still remains to be demonstrated whether or not exercise training should also be applied to patients with impaired ventricular function. Circumstantial evidence exists that patients with impaired ventricular function may eventually benefit from an individually adapted exercise training program provided that contraindications for acceptance of cardiac patients to such a program are well observed. Our study is based on 22 patients with impaired ventricular function, of which 18 were at least 6 months after a Q-wave myocardial infarction and the remaining 4 after coronary artery bypass grafting. Eleven patients with impaired left ventricular function performing upper extremity (arm) ergometry were followed up for 36 months. These patients were trained twice weekly with exercise periods of 30 min duration. The reason for choosing arm ergometry training was that the peak heart rate obtained in arm ergometry is higher when compared to leg ergometry. Rate-pressure product and heart rate were higher for given submaximal work tasks in arm ergometry, while maximal work aerobic capacity was found to be lower in comparison to leg work. The assessment of our patients was based on cardiopulmonary testing, continuous electrocardiographic monitoring (48 h), two-dimensional echocardiography and equilibrium multigated radionuclide ventriculography (99mTc). Group 1, consisting of 11 patients with left ventricular ejection fraction (LVEF) 30.1 +/- 9.5%, were trained by arm exercise for 3 years with a significant increase in work capacity and LVEF. Group 2 consisted of 11 patients with LVEF 25.5 +/- 6.8% who underwent a 12 months' calisthenic program. Peak work capacity and LVEF remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1990

Exercise response in young women with borderline hypertension.

We compared the response to dynamic exercise in 157 females (mean age 19 +/- 3 years) with borderline hypertension (BH) to findings in 105 normotensive controls. Near-maximal physical working capacity was 90 +/- 17 W in females with BH and 71 +/- 23 W for the controls (p less than 0.001). Mean heart rate, systolic and diastolic blood pressure, and pulse pressure levels both at rest and at exercise were significantly higher in BH patients (p less than 0.001 for all). Mean change between rest and exercise for all the above parameters was not significantly different among BH patients compared with controls. Nonspecific ST-T changes at rest (p less than 0.001) and exercise (p less than 0.005) were more common and mean corrected QT interval was significantly longer (p less than 0.001) in BH patients. The parallel exercise response that we found in BH and normotensives would not appear to substantiate the view that ergometry is particularly useful as a modality for diagnosing hypertension in young females.

Adult↗
PubMed1990

Arm crank ergometry in chronic spinal cord injured patients.

Cardiovascular response to arm crank ergometry, using a specially adapted Monark bicycle ergometer, was examined in 98 men with long-standing spinal cord injuries (SCI), who were classified into groups by neurologic level of SCI. Exercise response was significantly correlated with lesion levels: the higher the lesion, the lower the levels of physical work capacity and mean exercise systolic and diastolic blood pressure. Also, physical symptoms and abnormal systolic blood pressure exercise response were more frequent. Exercise response of patients with lower thoracic and lumbar SCI did not differ from the control group. The undisputed value of ergometry in the routine evaluation and exercise prescription for health maintenance in SCI and other wheelchair-disabled patients was substantiated by the study findings.

Adult↗
PubMed1989

Usefulness of immediate postexercise two-dimensional echocardiography in post-myocardial infarction patients without ischemic ECG changes in stress testing: comparison with radionuclide angiography.

Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnormal results from rest studies). The comparative radionuclide (RNA) examinations showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post-MI patients with a negative stress test, the efficacy of postexercise echocardiography equals that of RNA in the identification of additional patients with ischemia.

Adult↗
PubMed1989

Exercise response in young women with mitral valve prolapse.

To detect for possible evidence of autonomic nervous system dysfunction, we assessed exercise response in 198 young women with echocardiographically documented MVP. The same test was used to determine whether patients with or without physical symptoms or with various auscultatory findings responded differently. Compared with 105 age- and sex-matched healthy subjects, the MVP patients showed significantly higher mean heart rate, systolic blood pressure, pulse pressure and rate-pressure (double) product, at both rest and exercise; significantly lower mean near-maximal physical working capacity (PWC170); significantly higher incidence of both arrhythmias and nonspecific ST and T wave changes; and a significantly longer mean corrected QT interval. None of these findings was associated with the presence of physical symptoms or with specific auscultatory or echocardiographic findings. These observations strongly suggest an autonomic nervous system imbalance in some young women with MVP, irrespective of whether physical symptoms are present.

Adult↗
PubMed1989

Sudden death in young Israeli soldiers. Analysis of 83 cases.

During the years 1974-86 in the Israel Defense Force (IDF), 83 soldiers aged 17-39 years died suddenly and unexpectedly. Cardiac causes accounted for 56% of the deaths, neurological causes for 19%, other diseases for 8% and in 17% the cause of death was unknown. Causes of death varied between soldiers younger and those older than 30 years of age. Ischemic heart disease accounted for 58% of deaths in soldiers greater than 30 years old but was an infrequent cause of death in subjects less than 30 years (4%). Congenital cardiac anomalies (27%) and myocarditis (15%) accounted for most deaths in subjects less than 30 years of age. Epilepsy was a common cause of sudden death (10%), occurring mainly during sleep, and was related to poor medical control. Effort-related deaths occurred in 25 cases (30%) and were mainly associated with cardiac causes. Syncope (18%) and chest pain (18%) were common symptoms prior to death. According to our data and previous reports, sudden death continues to be an unresolved medical problem in young adults. Preventive measures should include a more thorough evaluation of symptoms such as syncope and chest pain, particularly when occurring during or after exercise. Furthermore, early coronary artery disease should not be disregarded in subjects as young as 30 years of age.

Adolescent↗
PubMed1988

Echocardiographic evaluation of the effects of gallopamil on left ventricular function.

Two-dimensional echocardiography was used to determine global and regional left ventricular function in 32 patients treated with gallopamil (methoxyverapamil) for angina pectoris. Ejection fraction (EF), pressure/volume ratio (PVR), and segmental wall motion were assessed. Evaluations were made before therapy (T1) and repeated 3 weeks later; this assessment included examination 2 and 8 hours after the morning dose (T2 and T3, respectively). Patients were randomized to either a placebo group or three study groups (25, 37.5, and 50 mg t.i.d.). In the 37.5 and 50 mg groups there was an increase in EF (T1 = 53.8% and 54.5%, T2 = 57.9% and 60.1%, and T3 = 57.6% and 60%) and PVR values (T1 = 5.2 and 7.2 mm Hg/ml/m2, T2 = 5.8 and 7.7 mm Hg/ml/m2, and T3 = 5.9 and 7.6 mm Hg/ml/m2, respectively). Wall motion remained the same or improved in 92.3% of the patients. In conclusion, gallopamil had no cardiodepressant effects in most patients. On the contrary, EF, PVR, and segmental contractility tended to improve with the higher doses.

Aged↗