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[Effect of S-adenosyl-L-methionine sulfate tosylate (FO-1561) on functional recovery after transient cerebral ischemia in rats].

The present investigation was undertaken to examine the recovery of functions, spontaneous EEG activity and cerebral ATP content during blood recirculation following cerebral ischemia in rats. The ischemia was induced by bilateral carotid artery 30 min-occlusion 24 hr after the permanent electrocauterization of bilateral vertebral arteries. EEG spectral analysis was performed by the Berg transform. The recovery of EEG activity was assessed by the time elapsing from the onset of blood recirculation until the delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz) or beta (13-32 32 Hz) band reappeared and the relative proportion of the four bands at 45 and 60 min after recirculation. Following the 20 min recirculation, the brains were frozen in situ with liquid nitrogen and then stored at -80 degrees C for later extraction for analysis. Concentrations of ATP in the cerebral cortex were determined with enzymatic methods. In animals administered FO-1561 (10 approximately 100 mg/kg, i.v.) simultaneously with blood recirculation, the reduction of time elapsing until reappearance of the theta, alpha and beta bands, the decrease in proportion of the delta band and the increase in that of the theta, alpha and beta bands which indicated the facilitation of transition to the normal state were observed. In animals administered FO-1561 (100 mg/kg), the improvement of ATP content was detected. These results demonstrate that FO-1561 may have a beneficial effect on the recovery from dysfunctions due to cerebrovascular disorder.

Adenosine Triphosphate↗

[Transplantation of human umbilical cord stem cells improves neurological function recovery after spinal cord injury in rats].

OBJECTIVE: To study whether intraspinally transplanted human cord blood CD34+ cells can survive, differentiate, and improve neurological functional recovery after spinal cord injury in rats. METHODS: Rats were randomly divided into two groups. One group of rats was subjected to spinal cord left-hemisection and transplanted with human cord blood CD34+ cells labeled by bromodeoxyuridine (BrdU); The other group was carried by left-hemisection with injection of PBS (control group). The neurological function was determined before and 24 h, 1, 2, 3 and 4 weeks after spinal cord injury and cell transplantation using the modified Tarlov score. The distribution and differentiation of transplanted human cord blood cells in vivo in rat spinal cord were evaluated by histological and immnuhistochemical analysis. RESULTS: Functional recovery determined by modified Tarlov score was significantly improved in the group receiving human cord blood CD34+ cells compared with the control group (P < 0.05). Moreover, human cord blood CD34+ cells were found to survive in rat spinal cord microenvironment, with the expression of the neural nuclear specific protein (NeuN) in 2% BrdU-reactive human cells and of the astrocytic specific protein glial fibrillary acidic protein (GFAP) in 7% BrdU-reactive human cells. CONCLUSIONS: Intraspinally administered human cord blood CD34+ cells can survive, differentiate, and improve functional recovery after spinal cord injury in rats. Transplantation of human cord blood cells may provide a novel strategy for the treatment of neural injury.

4-Hydroxycoumarins↗

Enflurane enhances postischemic functional recovery in the isolated rat heart.

Enflurane is a direct myocardial depressant and may act as a myocardial protective agent during ischemia. The authors studied the effects of enflurane on myocardial high-energy phosphates and tolerance to ischemia in the normothermic, isolated rat heart. After isolation and perfusion with Krebs-Henseleit buffer, the hearts were perfused with either buffer (control) or buffer gassed with 2% enflurane for 10 minutes. Thereafter, hearts were made globally ischemic and elapsed times to initiation of ischemic contracture (IC) were determined. ATP and creatine phosphate (CP) were measured at the conclusion of control and enflurane administration and at IC. Ten hearts per group were reperfused with buffer following IC for 20 min; peak pressure and ATP and CP were determined. Administration of 2% enflurane significantly decreased peak pressure by 20% but did not alter baseline high-energy phosphate levels nor did it prolong time to IC. However, enflurane-treated hearts exhibited significantly greater (P less than 0.01) recovery of function as defined by per cent return of peak pressure (67% +/- 3%) when compared with those hearts not treated with enflurane preischemically (44% +/- 5%). Also, enflurane-treated hearts had significantly higher (P less than 0.01) ATP levels at the conclusion of reperfusion than hearts not perfused with enflurane (12.2 +/- .8 mumol/g dry weight vs. 9.0 +/- 0.8 mumol/g dry weight). These findings suggest that enflurane administered prior to an ischemic interval enhances postischemic myocardial recovery.

Adenosine Triphosphate↗

The predictors of surgical procedure and the effects on functional recovery in elderly with subcapital fractures.

BACKGROUND: It has been demonstrated that the majority of hip fracture patients do not regain their prefracture level of functioning and usually decline in function following fracture. Little is known about the effectiveness of surgical procedure performed (hemiarthroplasty vs internal fixation) on functional recovery of subcapital fracture patients. This study examines the factors related to the type of the surgical procedure chosen and the effect of this selection on physical activities of daily living (PADL) and instrumental activities of daily living (IADL). METHODS: The sample consists of 312 patients with subcapital fractures age 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986. Baseline information was obtained during hospitalization through structured interviews with both patients and their significant others (proxy). The follow-up interviews were administered to proxies at two months, six months, and one year after discharge from hospital. Information on disease diagnoses, fracture severity, and surgical procedures performed was obtained from medical charts. RESULTS: Patients with a displaced fracture were seven times more likely to receive a hemiarthroplasty (OR = 7.0, 95% CI 3.7-13.1). During the short-term recovery (2 months after surgery), patients who received hemiarthroplasty were doing better in transferring, meal preparation, and shopping than those who received internal fixation. For the long-term functional recovery (one year), the overall PADL and IADL functions were not statistically significantly different between the two surgical procedures performed. CONCLUSIONS: The severity of fracture was found to be the most important determinant of surgical procedure. Patients with a subcapital fracture who received hemiarthroplasty tended to have a better functional recovery in the short term. Further study of other benefits of using as hemiarthroplasty is needed.

Activities of Daily Living↗

Rehabilitation following brain damage: some neurophysiological mechanisms. Functional recovery in the visual and vestibular pathways.

The visual and labyrinthine sensing systems are often neglected in the rehabilitation process of patients with central nervous system (CNS) lesions. Nevertheless, their integrity is essential for the construction of motor tasks ranging from accurate reaching to the co-ordinated behaviours of posture and locomotion. This tasks may be influenced considerably by the roles of the visual and vestibular systems in the perceptual analysis of localizing objects in space ("egocentric localization") and of spatial orientation of the body ("ego-orientation") and in controlling oculomotor and postural stability. The anatomy, physiology, clinical relevance and patterns of recovery of function of two specific visual-vestibular related behaviours is addressed, namely ocular stability and egocentric localization. Emphasis is placed upon such issues as (a) motor learning in complete and incomplete lesions as adjudged from observations of peripheral vestibular nerve disorders; (b) the role of the cerebellum in calibrating motor performance with particular reference to the modifiability of the vestibulo-ocular reflex to attain ocular stability; (c) the use of redundant or complementary structures as assumed from evidence of recovery from chronic visual field deficits; and (d) specified behavioural tactics as a mechanism for adaptation.

Central Nervous System Diseases↗

The effect of intramyocardial pH on functional recovery in neonatal hearts receiving St. Thomas' Hospital cardioplegic solution during global ischemia.

The experiments in the present study were designed to address two issues: Is it possible to manipulate intramyocardial pH in neonatal hearts with different buffers in cardioplegic solution and, if so, do differences in intramyocardial pH during ischemia influence functional recovery? Isolated working hearts from 7- to 10-day-old rabbits underwent 60 minutes of cardioplegic arrest at 37 degrees C with cardioplegic washouts at the onset of ischemia and at 30 minutes. Hearts were reperfused with oxygenated physiologic saline solution (pH = 7.4), returned to the working mode for 30 minutes, and hemodynamic measurements were obtained to compare with baseline values. Intramyocardial pH was held constant during the ischemic interval by infusing cardioplegic solution containing different buffers: histidine (pK 6.0 at 37 degrees C), bicarbonate (pK 6.4), or tromethamine (pK 8.1). The intramyocardial pH was measured continuously with a Khuri glass electrode system (Vascular Technology, Inc., North Chelmsford, Mass.). Cardioplegic solutions buffered to pH values of 6.0 (histidine), 7.4 (bicarbonate), and 8.0 (tromethamine) were associated with ischemic intramyocardial pH values of 6.3 +/- 0.03, 7.02 +/- 0.05, and 7.88 +/- 0.06, respectively. Functional recovery was best in the acidic (histidine) and worst in the basic (tromethamine) groups. Recoveries of developed pressure, the rate of rise of pressure over time, and aortic flow were significantly better for each parameter in the bicarbonate-treated compared with the tromethamine-treated hearts (p less than 0.005). Recovery in the histidine group, however, was superior to that in both the bicarbonate-treated and the tromethamine-treated hearts (p less than 0.005). Regression analysis demonstrated that a significant inverse relationship existed between functional recovery and intramyocardial pH, supporting the conclusions that intramyocardial pH is an important determinant of functional recovery in the neonatal heart and that acidic conditions during normothermic ischemia optimize preservation of myocardial function.

Animals↗

Does simultaneous antegrade and retrograde cardioplegia improve functional recovery and myocardial homeostasis?

BACKGROUND: The purpose of our research was to evaluate the functional recovery and homeostasis of myocardium during simultaneous continuous retrograde and antegrade cardioplegia versus continuous retrograde cardioplegia. METHODS: Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted. RESULTS: In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group. CONCLUSIONS: Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone.

Adult↗

Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty.

AIM: To investigate the effect of abciximab on microvascular integrity and left ventricular (LV) functional recovery in patients with acute myocardial infarction (MI) treated by primary coronary angioplasty (PTCA). METHODS AND RESULTS: Thirty-one patients (27 males; age 39-76 years) with first, acute MI (<6 h after onset) were randomized to receive either abciximab+primary PTCA (n=17) or primary PTCA alone (n=14). Baseline characteristics of the two groups were similar. Myocardial reperfusion was studied shortly after PTCA by corrected TIMI frame count (cTFC) and intracoronary myocardial contrast echocardiography (MCE), after 48 h by intravenous MCE using intermittent, harmonic power Doppler, and after 1 month by intravenous MCE and 99 mTc-tetrofosmin SPECT. The patients treated with abciximab showed a shorter cTFC (23+/-4 vs 30+/-9 frames; P<0.05), a more preserved microvascular integrity shortly after PTCA (77% vs 55%; P<0.01), after 48 h (86% vs 50%; P<0.005) and at 1-month follow-up (86% vs 54% by MCE, P<0.001, and 68% vs 60% by SPECT, P<0.005) than patients treated with PTCA alone. Abciximab patients also showed a better recovery of LV function, as demonstrated by greater reduction in wall motion score index (1.4+/-0.3 vs 1.5+/-0.2; P<0.05) and increase in LV ejection fraction (53+/-7% vs 48+/-5%; P<0.001). CONCLUSIONS: Abciximab improves microvascular perfusion and LV functional recovery in primary PTCA.

Abciximab↗

Brain-derived neurotrophic factor treatment does not improve functional recovery after hair cell regeneration in the pigeon.

CONCLUSIONS: Brain-derived neurotrophic factor (BDNF) supply to the inner ear does not improve the time course or the extent of functional recovery after hair cell regeneration. Specifically it does not improve the residual threshold elevation observed after the completion of spontaneous recovery. OBJECTIVE: The avian inner ear is capable of hair cell regeneration and substantial functional recovery, but residual hearing deficits remain. We investigated whether functional recovery can be improved by intracochlear application of BDNF, which plays an important role in auditory ontogenesis and maintenance during adult life. METHODS: Hair cells in adult pigeons were destroyed by local application of gentamicin. After 3 days either BDNF or control solution was administered to the scala tympani by implanted osmotic minipumps for 8 weeks. Auditory brain stem responses (ABR) to tone pips were used to assess recovery of hearing thresholds in both groups. RESULTS: The application of gentamicin caused a frequency-dependent hearing loss that ranged from 24.8 dB SPL at low frequencies to 66.2 dB SPL at high frequencies. After day 10 substantial recovery was observed, but a significant threshold shift remained. The time course of recovery in the control and BDNF-treated groups was similar, without significant residual threshold differences in any frequency range.

Administration, Topical↗

A new model for determining the influence of age and sex on functional recovery following hypoxic-ischemic brain damage.

Stroke is a disorder affecting the lives of all age groups, and particularly those at the opposite ends of the age spectrum. It is generally believed that the immature brain is more resistant to damage resulting from a hypoxic/ischemic injury, and that it is also more 'plastic' in terms of its ability to recover. Evidence from our laboratory, and a host of others, has indicated, however, that the developing brain may in fact be more sensitive to injury resulting from hypoxia-ischemia. The question remains, however, whether the immature brain has a greater capacity for recovery. In order to determine the relative capability for functional recovery between age groups, a stroke model of comparable injury is required. This paper describes a new rodent model of ischemic injury allowing for comparisons of behavioral recovery spanning the spectrum of ages between newborn and the elderly. Endothelin-1, a potent vasoconstrictor, was stereotactically injected into the brains of 10-, 63-, and 180-day-old Wistar rats, immediately adjacent to the middle cerebral artery. Regionally, the cortex, caudate, and thalamus were most significantly affected, with sparing of the hippocampus. Pathologic assessment indicated a similar degree of injury across age groups affecting the territorial distribution of the middle cerebral artery, with a predominance of damage in the anterior sections of the cortex and caudate (p < 0.05), compared to the posterior sections including the cortex and thalamus. There were no regional differences in the extent of damage between age groups. Interestingly, however, there were significant differences between males and females regarding the overall extent of brain damage (p < 0.05), with males showing greater damage than females. In addition, there were significant regional differences in the extent of damage between males and females, particularly regarding cortical damage (p < 0.05), both anteriorly and posteriorly, and the caudate anteriorly (p < 0.05). Our findings provide an important new model for comparison of brain damage among the entire spectrum of ages affected by stroke. Importantly, this will allow for further investigations regarding both functional recovery and gender difference comparisons. This may have important ramifications for the development of therapeutic interventions that are age and gender specific.

Age Factors↗

Axonal regeneration and limited functional recovery following hippocampal deafferentation.

Although central neurons do not naturally recover following injury, damaged adult septal neurons can regenerate when nerve growth factor (NGF) is provided along with a suitable cellular substrate. This study investigates the outgrowth of axotomized septal neurons grafted with primary fibroblasts genetically modified to produce NGF. Confocal microscope images of double staining for neuritic markers (neurofilament or low-affinity NGF receptor) and the astrocytic marker glial fibrillary acidic protein (GFAP) demonstrated that regenerating neurites crossed dense buildups of astrocytic processes at the edges of NGF-producing grafts and were in apposition with astrocytic processes within NGF-producing grafts. Immunoreactivity for acetylcholinesterase and low-(p75) and high-affinity (TrkA) NGF receptors was dense in NGF-producing grafts but absent in control grafts. NGF-grafted rats exhibited significantly increased hippocampal density of p75-immunoreactive fibers and significantly decreased ectopic hippocampal sympathetic ingrowth as compared to control-grafted rats. Rats with unilateral fimbria-fornix lesions and NGF-producing grafts exhibited ameliorated performance on a simple memory task. These findings demonstrate that implantation of NGF-producing grafts to the lesion cavity allows axotomized septal cholinergic neurons to reinnervate the hippocampus, and that rats receiving these grafts show a partial recovery of function.

Animals↗

Conduction study of digital nerve function recovery following toe-to-digit transplantation and a comparison with digit-to-digit replantation.

Recovery of digital nerve function following toe-to-digit transplantation was studied by nerve conduction in 16 patients, and a comparison was made with digit-to-digit replantation in 7 patients. For toe transplantation and digit replantation, the mean interval between injury and surgery was 7 months and 8 h, respectively, while the mean interval between surgery and study was 39 months and 25 months, respectively. Sensory nerve action potentials (NAPs) from digital nerve stimulation were recorded at the wrist and the elbow, whereas mixed NAPs from median nerve stimulation at the wrist were recorded at the elbow. Sensory NAPs from stimulation of the transplanted toe were detectable in 14 patients and showed reduced amplitude, prolonged latency, and slowed conduction velocity. There was retrograde amplitude reduction in the median nerve and in the proximal segment of the digital nerve. Sensory NAPs from the replanted digit were not different from those of the normal digit, nor was a retrograde effect observed. The present data indicate that digital nerve function recovery was incomplete in toe transplantation and nearly complete in digit replantation. The reasons for the differences in recovery following two types of nerve repair are discussed.

Action Potentials↗

Dopamine agonists produce functional recovery from septal lesions which affect hypothalamic defensive attack in cats.

Effects of lesions of the lateral septum and subsequent administration of methamphetamine (MAT, 1 mg/kg, i.p.) or apomorphine (APO, 1 mg/kg, i.p.) on thresholds for defensive attack elicited by electrical stimulation of the ventromedial hypothalamic nucleus (VM) were examined. Hissing and directed attack were selected for threshold determination. Thresholds were measured under two situations: one with provocation by a human and the other without it. Electrolytic lesions of the lateral septum enhanced the facilitative influences exerted by the provocation on the thresholds, however, subsequent administration of MAT or APO abolished or tended to abolish the enhancement. The rapid recovery of function was interpreted to have taken place due to excessive dopaminergic inputs to the spared tissue of the lateral septum, and a gating mechanism of neuronal information by dopamine was suggested.

Aggression↗

Maze performance in rats with hippocampal perforant paths lesions: some aspects of functional recovery.

The performance of two experimental groups--one with lesions of the perforant paths projecting to the dorsal hippocampus (the D group) and one with lesions of the perforant paths to both the dorsal and ventral hippocampus (the DV group)--was compared with the performance of a lesioned control group and an intact control group during two test sessions in the Hebb-Williams maze. Both experimental groups displayed impaired maze learning in Session I. The DV group showed some recovery of function in Session II, and the D group was indistinguishable from controls. The results are discussed in terms of reduced sensory information to the hippocampal formation resulting from perforant paths lesions. It is suggested that the hippocampus is involved in relating new stimuli to previous experience.

Animals↗

Disturbances in exploratory behavior and functional recovery in the Y and radial mazes following dopamine depletion of the lateral septum.

The effects of 6-hydroxydopamine (6-OHDA) injected into the lateral septum in rats were investigated for spontaneous alternation behavior in a Y maze and for spatially oriented behavior in an 8-arm radial maze. The performance of the animals in these tests was assessed under two physiological states, food-satiated and food-deprived. The selective depletion of septal dopaminergic concentrations leads to behavioral disturbances in both the Y and the radial mazes. These deficits disappeared when the animals with 6-OHDA lesions were food-deprived. These results confirm other studies from our laboratory and support two conclusions. First, lesions of dopaminergic neurons lead to behavioral impairments which resemble those found after the total lesion of the structure they innervate. Second, these behavioral impairments are responsive to therapeutic treatments, manipulations of the internal or external environment, or the level of arousal, since under certain conditions a recovery of function can occur in the absence of dopaminergic neurons. These two points provide additional support for a nonspecific role for the dopaminergic neurons originating in the ventral tegmental area. These neurons could have a permissive role in the functioning of the forebrain structures they innervate.

Animals↗

Impact of mechanical load on functional recovery after muscle reloading.

The purposes of this study included: 1) to determine the impact of reloading after hindlimb suspension on the in vitro isometric contractile properties of the rat soleus muscle (experiment 1), and 2) to determine the impact of altered mechanical load on the recovery of muscle contractile properties after reloading-induced injury (experiment 2). Male Sprague-Dawley rats (240-270 g) were used for both experiments. In experiment 1, all rats were hindlimb suspended for a period of 7 d and studied either immediately afterward (no reloading, 0D-RL), after 1 d (24 h) of reloading (1D-RL), or after 2 d (48 h) reloading (2D-RL). In experiment 2, all rats underwent hindlimb suspension for 7 d followed by reloading for 2 d. Rats were then randomly assigned to one of three groups: 1) cage-bound, 2) treadmill walking (12m x min(-1) x 20 min daily), or 3) resuspended. Rats were then studied 7 or 14 d later. In experiment 1, maximal isometric specific force (force/cross-sectional area, Po) was significantly decreased by approximately 32% and approximately 50% in the ID-RL and 2D-RL groups (P < 0.05) compared with 0D-RL group. During the recovery phase (experiment 2), Po was significantly higher in the cage-bound and treadmill walking groups compared with the resuspended group both at 7 and 14 d. However, there was no significant difference in Po between the cage-bound and treadmill walking groups at either time point. Results from this study indicate that skeletal muscle reloading (after a period of unloading) results in a significant force decrement. Additionally, removal of the load during the recovery phase significantly impairs functional recovery, whereas mild exercise offers no advantage over cage-bound activity.

Animals↗

Functional recovery and timing of hospital discharge after primary total hip arthroplasty.

BACKGROUND: Early discharge programmes in hospitals are encouraged to increase financial efficiency and bed availability, but standards of clinical care must not be compromised. Criteria for safe hospital discharge must be established and objective data are needed to assess how rapidly patients can achieve these discharge criteria. METHODS: A prospective study was performed on 65 patients (mean age = 71 years) scheduled for primary total hip arthroplasty (THA). The Modified Barthel Index (MBI) was measured pre-operatively and postoperatively at set intervals to asses recovery of function after THA. A score of 90 out of a possible 100 was used as a discharge criterion and indicated that the patient was functionally independent for safe hospital discharge. In addition, a combined score for thigh flexion and extension isokinetic peak strength was recorded for each patient before and after surgery. The number and nature of comorbidities and complications were also recorded. RESULTS: The length of hospital stay in this sample varied from 5 to 39 days. The MBI scores increased rapidly between days 3 and 5, then began to plateau from day 8 onwards. Based on the MBI, 58% of patients were fit for discharge at or before day 8. The remainder were fit for discharge from day 10 onwards (mean = 14.2 days). The latter group who required an extended hospital stay were older (P = 0.003), had more identified comorbidities (P = 0.01) and were weaker in their hip musculature prior to surgery (P = 0.001), compared to those who were discharged by day 8. A logistic regression analysis indicated that the pre-operative MBI score and hip strength score were strong predictors of timing for hospital discharge. CONCLUSIONS: A clinical pathway with functional milestones laid out over 8 days would be an appropriate criterion for the discharge of the majority of patients. However, approximately 40% of the patients presented in this study required a longer hospital stay before the criteria for safe discharge could be achieved. These patients can be identified pre-operatively by screening their MBI and composite hip strength scores.

Aged↗

Deceleration time in ischemic cardiomyopathy: relation to echocardiographic and scintigraphic indices of myocardial viability and functional recovery after revascularization.

BACKGROUND: In patients with heart failure secondary to left ventricular (LV) systolic dysfunction, a short deceleration time (DT) successfully predicts clinical outcome. The impact of myocardial viability and revascularization on the mitral inflow velocities, however, is unknown. METHODS AND RESULTS: Forty patients with ischemic cardiomyopathy underwent (201)Tl scintigraphy (SPECT) and 2D, Doppler, and dobutamine echocardiography (DE, to 40 microg. kg(-1). min(-1)) 2 days before CABG. Echocardiography was repeated 3 months after revascularization to determine recovery of function. Significant correlations were present between DT and LV contractile reserve by DE (r=0.72), scar perfusion defect by SPECT (r=-0.69), and the change in ejection fraction (DeltaEF) after surgery (r=0.77) (all P:<0.01). DT >150 ms effectively identified (sensitivity 79%, specificity 81%) patients with DeltaEF >/=5%. The population was divided into 2 groups according to DT: group 1 (DT >150 ms, n=21) and group 2 (DT </=150 ms, n=19). At baseline, NYHA class, LV EF, age, and use of cardiovascular drugs were similar between the 2 groups. The number of viable segments by both DE and SPECT, however, was higher in group 1 (both P:<0.01), and only patients in group 1 had an increase in EF (29+/-4.8% to 40+/-8%, P:<0.01) after surgery. Death and heart transplantation occurred in 7 patients from group 2 and 1 patient from group 1 (P:=0.017). CONCLUSIONS: In patients with ischemic cardiomyopathy, the reduced amount of viable myocardium results in a restrictive mitral inflow pattern, which in turn predicts poor survival.

Analysis of Variance↗