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Transient responses in cardiac function below, at, and above anaerobic threshold.

Exercise-induced alterations in cardiac function during graded cycling with submaximal and maximal intensities were studied in 13 trained and 13 untrained young men. Stroke volume (SV) and stroke index (SI) at rest and during submaximal and maximal exercise, determined by impedance cardiography, were consistently greater in the trained than in the less fit group. Training-induced bradycardia was evident in the trained group at rest and during submaximal exercise. Even when SV and SI were compared at the same absolute heart rate and left ventricular ejection time, those for the trained group were markedly greater than those for the untrained. SV for the untrained group was relatively diminished above the work rate corresponding to the anaerobic threshold. The difference in SV during exercise may be attributed to inadequate filling due to the smaller stretch of myocardial fibers in diastole and/or lesser systolic emptying of the left ventricle due to the reduced myocardial contractility in systole of untrained individuals.

Adult

[Effect of Polygonum cuspidatum No 4 on the enhancement of cardiac function during burn shock].

A burn shock model was produced in rats by scalding the lumbus and lower extremities with 80 degrees C water for 30 seconds. The variable of cardiac functions were measured with a Cardiac-II-R cardio-output computer. It was shown that heart functions decreased as early as 10 min following scalding. Cardiac output (CO), cardiac index (CI), and stroke volume index (SVI) were reduced by 40% of normal, and stroke work (SW) by 47%. With the decrease of CO, total peripheral resistance (TPR) increased. Two hour later TPR was increased 2.6-fold more than pre-burn level, which made BP maintain nearly normal. TPR started to reduce at 3 hr post-burn, resulting in decrease of BP. The decreased heart function returned to near normal by administration of crystal of Polygonum cuspidatum No 4 (p.c), e.g, CO and CI were increased to 91.0% of pre-burn value, SW to 100.1%, and SVI to 102.0%. The increased TPR was reduced to near normal. Half of p.c.-treated animals survived within 24 hr, but all of simple burn animals and n.s.-treated animals died within 24 hr. Under the condition of no fluid infusion, administration of p.c. could restore the decreased heart function, which showed that besides loss of plasma, direct myocardial depression was one of the reason for the decrease of cardiac output during burn shock. The survival rate of animals with burn shock was enhanced by injection of p.c., which indicated that increasing heart function was a very important measure for the treatment of burn shock.

Animals

The effects of coronary artery disease on cardiac function in nonhypotensive sepsis.

To assess the effects of coronary artery disease on cardiac function in the presence of sepsis, we compared several hemodynamic indices in two groups of septic patients. Group 1 (n = 69) consisted of patients with nonhypotensive sepsis without coronary artery disease. Group 2 (n = 25) comprised septic patients who had clinical evidence of coronary artery disease. All patients were hemodynamically stable and normotensive at the time of the study. None required inotropic support. While the two groups had similar mean heart rates, mean blood pressures, and biventricular filling pressures, the mean cardiac index was significantly lower in group 2 (3.5 +/- 0.9 L/min/m2 vs 4.4 +/- 1.2; p less than 0.05). This lower cardiac index was related to significantly lower end-diastolic volume indices in group #2, not to differences in contractility between groups. Since the ventricular filling pressures of the groups were similar, the differences in end-diastolic volumes indicate differences in the biventricular compliance. In the presence of hyperdynamic, nonhypotensive sepsis, coronary artery disease was associated with a clinically significant impairment of biventricular compliance, which resulted in a reduction in cardiac output and systemic oxygen transport.

Aged

Radionuclide evaluation of cardiac function during sleep in children with bronchopulmonary dysplasia.

The influence of sleep on cardiac function in severe bronchopulmonary dysplasia was assessed in five children 1.5 to 5 years of age. Left and right ventricular ejection fractions (LVEF and RVEF) were investigated by equilibrium radionuclide ventriculography in five children undergoing polygraphic monitoring during the different states of alertness: wakefulness, nonrapid eye movement sleep, and rapid eye movement sleep. Intraobserver and interobserver LVEF and RVEF measurement reproducibility was high. During quiet, supine wakefulness, LVEF was normal, but RVEF was low. During sleep, a decrease in both LVEF and RVEF, expressed as a percentage of the awake value, was marked in the two children with the most nocturnal desaturation and longest duration of paradoxic rib cage motion during inspiration. It is concluded that radionuclide ventriculography can be easily performed during sleep in children and can provide useful information regarding right ventricular function during sleep in children with severe bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia

Cardiac function of WHHL rabbit, an animal model of familial hypercholesterolemia.

To investigate the cardiac function of WHHL rabbit (WHHL), an animal model of familial hypercholesterolemia, electrocardiography (ECG) and echocardiography (UCG) were taken from this species of homozygous type and normolipidemic Japanese White rabbits (controls). In WHHL, two of four had intraventricular conduction disturbances (IVCD) in ECG. UCG study showed that the ejection fraction significantly increased (p less than 0.05) and deceleration time was shortened (p less than 0.01) in WHHL compared to normal controls.

Animals

[Echocardiographic indices of cardiac function and systemic hemodynamics in patients with cardiac fibrillation paroxysms and their dynamics as affected by disopyramide phosphate].

Clinical and echocardiographic studies in 25 chronic coronary patients with atrial fibrillation paroxysms following intravenous administration of 0.61-3.8 mg/kg Rhythmilen or its single oral dose (1.25-2.5 mg/kg), as well as during prolonged treatment with 400-600 mg Rhythmilen daily, demonstrated that their myocardial contractility parameters were reduced in the absence of an attack. Contractility parameters were not basically affected where the drug had no effect. Rhythmilen is an effective anti-arrhythmic agent: it arrests atrial fibrillation paroxysms in 73% and maintains the sinus rhythm when used preventively in 82% of cases.

Disopyramide

Acute hemodynamic effects of indigo carmine in the presence of compromised cardiac function.

This report describes the acute hemodynamic effects of indigo carmine in a surgical patient with compromised cardiac function. A 68-year-old woman with stable but severe cardiac dysfunction and renal artery stenosis was scheduled for an elective aortorenal bypass procedure. No hemodynamic instability occurred during the operation until the patient was administered intravenous (IV) indigo carmine 5 ml. At that time, the patient experienced an acute increase in afterload, which resulted in acute left ventricular failure documented by a decrease in cardiac output (CO) and an increase in pulmonary artery pressure (PAP). Until further studies defining the mechanism for its hypertensive side effect are performed, indigo carmine should be used with caution in patients with severe cardiac dysfunction.

Aged

[Cardiac function noninvasively evaluated by phasic pattern analysis of ventricular power during ejection].

To evaluate cardiac function, ventricular power during ejection (power) and the rate of change of power (dPower/dt) were assessed noninvasively. Power was determined from the product of aortic flow (Fa(t] and brachial arterial pressure (Pa(t]. Fa(t) was measured at the suprasternal notch using an ultrasonic pulsed Doppler flowmeter with a 2 MHz carrier frequency and 10 KHz repetition frequency. The maximum detectable blood velocity was 380 cm/sec. Pa(t) was measured using a newly-developed method based on indirect unloading techniques and an air pressure system. There were 21 normal subjects and seven patients with coronary artery disease in this study. The following results were obtained. There was no significant difference between power patterns calculated by Pa(t) and Pao(t) (aortic pressure measured by catheter). The average peak dPower/dt was 160.2 J/sec2 in normal subjects, 145.2 L/sec2 in patients with ejection fractions greater than 50%, and 93.5 J/sec2 in patients with ejection fraction less than 50%. Peak dPower/dt was significantly decreased in patients with the lower ejection fraction (p less than 0.005). The results indicated that this index is clinically useful in evaluating cardiac contractility.

Adult

Echocardiographic assessment of cardiac function in infants and children.

Echocardiography has become an established technique for the assessment of cardiac function in infants and children. M-mode echocardiography provides measurements of left ventricular diameter and wall thickness and allows calculation of their rate of change during the cardiac cycle. Left and right ventricular systolic time intervals may be determined from recordings of aortic and pulmonary valve motion. Two-dimensional echocardiographic images may be utilized for the determination of left and right ventricular volume and ejection fraction. Compared with other noninvasive imaging methods, echocardiography is a rapid, safe and inexpensive technique. Moreover, future developments are likely to include improved image processing and computer analysis of two-dimensional images.

Cardiac Output

Non-invasive assessment of cardiac function in poisoning with drugs.

Systolic time intervals (STI) have been used in evaluating cardiac function in 21 patients who had taken an overdose of drugs. Registrations were made in all patients on arrival at the hospital and on the third day. On arrival STI was abnormal in 16 patients (76%). At the second registration it was still abnormal in ten (48%). Prolongations of total electromechanical systole (QS2) and preejection period (PEP) were the most frequent findings. The patients with abnormal STI at the first registration showed a significant improvement in QS2 (p less than 0.01) and PEP (p less than 0.05) from the first to the third day. Two of the four patients who had taken amitriptyline in a slow release form showed a prolongation of PEP and an increase in PEP/LVET from the first to the third day, and on patient has a further prolongation of the fifth day. The findings may be explained by a reduction of cardiac contractility caused by the membrane-stabilizing effect of the drugs.

Adolescent

Influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide.

The influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide was investigated in nine patients with congestive heart failure. The diuretic response to piretanide correlated significantly with the pretreatment cardiac index (r = 0.90). Furthermore, a significant correlation was found between the pretreatment fractional sodium excretion and the cardiac index (r = 0.85). The fractional sodium excretion is reciprocal to the renal sodium and water reabsorption. No change in the hemodynamics was observed prior to the onset of diuresis. At 120 minutes after administration of piretanide, the reduction of mean pulmonary capillary wedge pressure (r = 0.88) and mean right atrial pressure (r = 0.80) was significantly related to the diuretic response. We conclude that the reduced diuretic response to piretanide in patients with low cardiac index is due to increased renal sodium and water reabsorption. The hemodynamic changes following the administration of piretanide are dependent on the diuresis.

Adult

Modified Fontan operation for complex cardiac anomalies--postoperative hemodynamics, cardiac function and clinical status.

The purpose of this paper is to compare and define the postoperative hemodynamics, cardiac function and clinical status after the modified Fontan operation in patients with complex cardiac anomalies. Thirteen consecutive patients (6 with double-outlet right ventricle [DORV] [SLL : 4, SDL : 2], 5 with single ventricle [SV] [A-III : 3, B-III : 1, C-III : 1] and 2 with tricuspid atresia [TA] [Ib : 1, IIb : 1]) underwent the modified Fontan operation. These 13 patients ranging in age from 7 to 42 years of age (mean 18) were catheterized at 7 to 46 months (mean 8 months) postoperatively. Pressure tracings at rest demonstrated a dominant "a" wave in both the right atrium and the pulmonary artery suggesting a marked right atrial contraction after this operation. Left ventricular filling pressure was significantly decreased after the modified Fontan operation in DORV and SV. The ejection fraction and left ventricular end-diastolic volume index were unchanged or slightly increased after the modified Fontan operation. Cardiac index in 6 patients with DORV was significantly increased from rest to exercise by +48% (p less than 0.05) with a significant increase in the stroke volume (p less than 0.05) and with a slight increase in heart rate, but this index in 5 patients with SV and in 2 patients with TA was not significantly increased from rest to exercise. In the postoperative clinical status, 11 of 13 patients were in NYHA class I and 2 in class II at follow-up periods ranging from 4 to 75 months (mean 48 months). These results suggest that the modified Fontan operation can be of value and can provide excellent exercise tolerance for patients with complex cardiac lesions.

Adolescent

Influence of long-term antihypertensive therapy on cardiac function, coronary flow and myocardial oxygen consumption in spontaneously hypertensive rats.

The relationships between cardiac performance, coronary flow, coronary vascular resistance at maximal vasodilatation and myocardial oxygen consumption were determined in isolated hearts from spontaneously hypertensive rats (SHR), normotensive Wistar-Kyoto rats (WKY) and from SHR given metoprolol (beta 1-selective blocker) and felodipine (selective calcium antagonist) for 35 weeks. A working heart perfusion system was used. An oxygen electrode allowed continuous measurement of oxygen tension in the venous coronary effluent. Blood pressure was reduced close to normal levels in treated SHR. Treatment also caused a substantial reduction of left ventricular weight. In both treated and untreated SHR, maximal cardiac performance, expressed as peak stroke volume, was enhanced above that of WKY at high perfusion pressures, while performance at low perfusion pressures was clearly reduced in the former groups. At a given workload, myocardial oxygen consumption (mmol O2/min per g) was reduced in both groups of SHR. This suggests a physiological structural adaptation to an elevated cardiac load in hypertension, where more myofibrils contribute to produce a given amount of work and therefore less oxygen is consumed per unit muscle mass. Coronary flow was reduced at any given perfusion pressure and oxygen extraction was increased in untreated SHR versus WKY. By causing regression of hypertensive structural vascular changes, treatment markedly increased coronary flow and correspondingly decreased oxygen extraction. Thus, by enhancing the myocardial nutritional supply with antihypertensive treatment, the reduced cardiac function at low perfusion pressure in untreated SHR was almost normalized.

Animals

The failure of radical scavengers to attenuate the incidence of reperfusion arrhythmias despite improvement of cardiac function.

We studied the concomitant effects of scavengers of reactive oxygen species (ROS) on both cardiac function and the incidence of arrhythmias. Isolated rat heart was perfused with a working mode paced at 300 beats/min. The left coronary artery was occluded for 5, 7, 15, or 60 min and reperfused thereafter for 30 min. Superoxide dismutase and catalase were infused from 5 min prior to reperfusion to the end of reperfusion in the scavenger treatment group. In the 60-min ischemia group with scavenger treatment, the cardiac output was significantly higher than that in the untreated group at both 10 and 30 min of reperfusion (P less than 0.01). In the 15-min ischemia group with scavenger treatment, the cardiac output showed a tendency toward a higher value than that in the untreated group. The incidence of reperfusion arrhythmias occurring after a short ischemic time (5, 7, or 15 min) were similar in the scavenger treated and untreated groups; but, with a preceding ischemia of 60 min, the incidence of ventricular tachycardia was higher in the scavenger treated group than in the untreated group (P less than 0.02). In conclusion, scavengers improved contractile dysfunction but did not attenuate the incidence of arrhythmias.

Animals

The effects of arteriovenous shunts on cardiac function in renal dialysis patients--an echocardiographic evaluation.

To estimate the flow rate in arteriovenous dialysis fistulae and its effect on cardiac function we investigated 7 dialysis patients (1 woman, 6 men, mean age 33 +/- 3 years) echocardiographically before and after 10 minutes occlusion of the arteriovenous shunt. Cardiac index was signigicantly raised (4.31 +/- 0.23 l/min/m2) and fell significantly into the normal range to 3.89 +/- 0.11 l/min/m2 after occlusion of the AV fistula. This reduction was mainly due to a fall in heart rate from 82 +/- 4 beats/min to 76 +/- 5 beats/min. The estimated AV fistula flow rate (0.71 +/- 0.17 l/m) has been similarly reported in invasive hemodynamic studies. Parameters of cardiac contractility were in the lower range of normal with an average of 1.16 +/- 0.10 circ/sec for the mean velocity of fiber shortening (Vcf) and 65 +/- 4% for the ejection fraction. These decreased minimally after fistula occlusion. The single echocardiographic measurements of Vcf and ejection fraction showed good correlation (r=0.97) and revealed evidence that only these patients with poor left ventricular function and septal hypertrophy showed improved cardiac performance after occlusion of the arteriovenous fistula. Thus echocardiography may offer the opportunity to select those patients who need small AV-fistulae for optimal renal and cardiac treatment.

Adult

Effects of dopamine, (+/-)-dobutamine and the (+)- and (-)-enantiomers of dobutamine on cardiac function in pithed rats.

The effects of dopamine, (+/-)-dobutamine (racemic mixture) and the (+)- and (-)-enantiomers of dobutamine on myocardial function were evaluated in pithed rats. Dopamine and (+/-)-dobutamine produced effects on cardiac function in pithed rats that were qualitatively similar to those reported for these compounds in humans. The increase in cardiac output produced by dopamine and (+/-)-dobutamine was due mainly to an increase in stroke volume, with increases in heart rate contributing to a significant but lesser degree. For both dopamine and (+/-)-dobutamine, the increase in stroke volume appears to result from an increase in myocardial contractility as assessed by increases in left ventricular (LV) dp/dt. Dopamine produced a marked increase in mean arterial blood pressure, whereas (+/-)-dobutamine only modestly increased blood pressure. The (-)-enantiomer of dobutamine, which possesses mainly alpha-1 adrenoceptor agonist activity, produced dose-dependent increases in cardiac output, stroke volume, LVdp/dt and mean arterial blood pressure, but did not significantly increase heart rate except at high doses. Thus, the increase in cardiac output produced by (-)-dobutamine was derived almost exclusively from an augmentation in stroke volume resulting from an increase in myocardial contractility. In contrast, (+)-dobutamine, which possesses predominantly beta-1 and beta-2 adrenoceptor agonist activity, elicited only a modest increase in cardiac output which was due both to an increase in heart rate and stroke volume. Mean arterial blood pressure was not significantly affected by (+)-dobutamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Cardiac function in endocrine diseases: I. Acromegaly.

The aim of our echocardiographic study was to characterize cardiac function and anatomy of 14 acromegalics (A: 9 women, 5 men; mean age: 42.4 yrs) more closely. The duration of acromegaly in 4 of these patients was between 3 and 12 years; the disease was diagnosed for the first time in the other patients. Double M-mode echocardiography was performed in all patients and the results compared with data obtained from a control group of 24 healthy volunteers (N: 22 men, 2 women; mean age: 23 yrs). The mean left ventricular diameter at end-diastole was greater in the acromegalics than in the controls (A: 55 +/- 6 mm, N: 50 +/- 4 mm; p less than 0.005, means +/- SD). After correction for age and body surface area, it, however, was outside the 95% confidence interval in 5 patients. Left ventricular hypertrophy was present in 3 patients, one of whom had coexistent arterial hypertension. A total of 3 patients were hypertensive. Significantly higher values for the maximal velocity of systolic wall thickening (A: 6.1 +/- 0.6 cm/s, N: 4.2 +/- 0.6 cm/s, p less than 0.001) and diameter change (A: 12.4 +/- 2.0 cm/s, N: 10.6 +/- 1.0 cm/s, p less than 0.005) indicate increased contractility with concurrently increased relaxation; fractional shortening did not differ significantly (A: 38 +/- 5%, N: 37 +/- 5%, ns). The isovolumetric relaxation period at diastole was slightly longer in the acromegalics (A: 70 +/- 17 ms, N: 61 +/- 13 ms, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly

[Effects of age, weight and heart rate on cardiac function at rest in normal subjects].

The effects of age, body weight, and heart rate on cardiac function and left ventricular (LV) volumes at rest were determined for 203 normal subjects, aged 10 to 75 years, using a multiple linear regression model. LV volume was calculated by the formula: volume = 7 X dimension3/(2.4 + dimension). There were age-related increases in ejection fraction, mean velocity of circumferential shortening (mVcf), fractional shortening (FS), stroke volume (SV), and cardiac output (CO). Weight-related increases in SV and CO were observed. Heart rate-related increases in mVcf and CO were also observed. LV volumes at end-systole and at the end of the rapid filling, and slow filling phases decreased with age and increased with weight. However, end-diastolic volume increased with weight, independently of age. The change in LV volume during the rapid filling phase increased with weight; that during the slow filling phase was independent of age, weight, or heart rate. The change in LV volume during the atrial contraction phase increased with age and weight. The ratio of the change in LV volume during atrial contraction to end-diastolic volume was age-related, but independent of weight and heart rate [(an increase in LV volume during atrial contraction)/(end-diastolic volume) = 0.0032 X age (years) + 0.00042 X weight (Kg) + 0.034 X RR interval (sec)]; (r = 0.67, p less than 0.001). The velocity of change in LV volume during the rapid filling phase decreased and that during atrial contraction increased with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent