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PubMed1983

Effects of acetate and bicarbonate hemodialysis on cardiac function in chronic dialysis patients.

Previous studies have suggested that acetate hemodialysis causes myocardial depression. This study examines the acute effects of hemodialysis using, alternately, bicarbonate and acetate in the dialysate, on cardiac function in ten patients. These patients were also studied during acetate dialysis using a large surface area (SA) dialyzer. Each patient was dialyzed for 4 hr with: (1) 1.0 m2 SA dialyzer and bicarbonate dialysate; (2) 1.0 m2 SA dialyzer and acetate bath, and; (3) 2.5 m2 SA dialyzer and acetate dialysate. All studies were performed during isovolemic dialysis to separate the effects of changes in cardiac filling volume with hemodialysis, from changes in myocardial contractility. Myocardial function, as assessed by pre- and postdialysis echocardiographically derived fractional shortening (Fs) and mean velocity of circumferential shortening (VCF), improved (P less than 0.05) to the same extent, after all three dialysis treatments. This occurred despite greater increases (P less than 0.002) in pH and bicarbonate after bicarbonate dialysis and decreases (P less than 0.05) in PO2, PCO2 and bicarbonate after acetate dialysis with 2.5 m2 SA dialyzer. These results indicate that diffusive dialysis with both acetate and bicarbonate dialysate improves myocardial function and do not support the view that acetate influx during dialysis can lead to myocardial depression.

Acetates↗
PubMed1977

Pacing techniques in assessing cardiac function in the horse.

The problem of transitory cardiac arrhythmias in equidae is discussed particularly with regard to the referral of suspect cases to specialist institutions for second opinion. Recently developed electro-stimulation techniques designed to uncover problem arrythmias, are briefly described and their potential in the analysis of cardiac electrical function under varying conditions is reviewed. The author cautions on the too rapid evaluation of the techniques for this purpose while remaining optimistic of the potential of electro-stimulation in the objective analysis of cardiac electric parameters.

Animals↗
PubMed1991

Acute effects of intravenous nicardipine on hemodynamics and cardiac function in patients with a healed myocardial infarction and no evidence of congestive heart failure.

Acute effects of intravenous nicardipine (10 micrograms/kg) on systemic hemodynamics and cardiac function were evaluated in 17 patients with a healed myocardial infarction and no evidence of congestive heart failure. Mean New York Heart Association functional class was 1.6 +/- 0.5 (mean +/- standard deviation). Aortic systolic pressure (p less than 0.001) and left ventricular end-diastolic pressure decreased (10 +/- 3 to 8 +/- 3 mm Hg, p less than 0.01), and systemic vascular resistance decreased significantly (p less than 0.001), whereas pulmonary and right atrial pressure and pulmonary arteriolar resistance did not change. Cardiac and stroke indexes showed biphasic changes. Although positive and negative maximal rate of left ventricular pressures decreased significantly (p less than 0.05 and p less than 0.01, respectively), they did not change significantly when aortic systolic pressure was corrected. There was a significant inverse correlation between the negative rate of left ventricular pressure/aortic systolic pressure before nicardipine infusion and its maximal percent increase after infusion (r = -0.56, p less than 0.05), indicating a beneficial effect on diastolic relaxation in patients with impaired diastolic function. Our data show that a low dose (10 micrograms/kg) of intravenous nicardipine exerts a favorable effect on impaired diastolic function, but depresses left ventricular pump function with much less effect on right heart circulation.

Adult↗
PubMed1999

Exercise cardiac function in young through elderly endurance trained women.

PURPOSE: To clarify the physiological reasons for the decline in aerobic power of endurance trained (ET) women with aging. METHODS: Blood volume, VO2max, and exercise cardiac function were examined in 23 ET women; six age 20-29 yr, six age 40-45 yr, six age 49-54 yr, and five age 58-63 yr. RESULTS: Blood volume was unchanged with aging. VO2max declined progressively at a rate of 0.51 mL x kg(-1) x min(-1) x yr(-1). During maximal exercise, there was an increase in total peripheral resistance (TPR) and a decrease in heart rate, stroke volume, and cardiac output with increasing age. At all ages, cardiac filling (diastole) was significantly faster than cardiac emptying (systole). Stroke volume did not plateau at a submaximal work rate but increased progressively to maximum. CONCLUSIONS: The decline in VO2max with age in ET women is due to decreases in maximal heart rate, stroke volume and cardiac output, and the primary advantage in the exercise cardiac performance of ET women of all ages is diastolic rather than systolic function.

Adult↗
PubMed1986

Effect of slow-release ISDN on cardiac function in patients with coronary heart disease during bicycle ergometry.

In 10 patients with coronary heart disease (CHD), the effect of a single doses of slow-release isosorbide dinitrate (ISDN) on cardiac function was investigated. Haemo-dynamics was examined by right heart catheterization and thermodilution measurement of cardiac output. After placebo and after 2 and 6 hours with 40 mg ISDN, the heart rate (HR), cardiac index (CI), pressure values in the pulmonary artery (PASP, PAMP, PAEDP) and in the aorta (AoSP, AoMP, AoEDP) and systemic vascular resistance (SVR) were measured at rest and during bicycle ergometry. At rest, PASP and PAMP were significantly reduced only 6 hours after ISDN. Under exercise conditions, significantly reduced pressure values in the pulmonary artery were found 2 and 6 hours after ISDN. AoSP was likewise reduced 2 and 6 hours after ISDN. HR, CI and SVR showed no significant differences compared with placebo values. Thus, an effective reduction of left ventricular preload and afterload was seen in patients with CHD during bicycle ergometry.

Adult↗
PubMed2000

Alterations in cardiac function and gene expression during autoimmune myocarditis in mice.

Although myocarditis has been implicated in the pathogenesis of heart failure, a definitive relationship between myocardial inflammation, cardiac dysfunction, and changes in myocyte gene expression has not been established. In this study, we examined the hypothesis that myocardial inflammation and replacement fibrosis following an autoimmune response can progress to cardiac dysfunction and may result in progression to the heart failure phenotype. SWXJ mice were immunized with cardiac myosin on day 0 and day 7, in order to induce an autoimmune response to the myosin protein. Cardiac catheterization via the right carotid artery was performed on days 14, 21, 28, 35, and 42, using a 1.4F Millar transducer-tipped catheter. Hearts were weighed, and cross-sections were cut and stained with either haematoxylin and eosin or Masson's trichrome, in order to identify areas of inflammation and/or fibrosis. Myocardial gene expression was determined by Northern blot analysis. In mice with histological evidence of myocarditis, the heart weight/body weight ratio increased beginning on day 14, and cardiac function decreased beginning on day 21. Myocardial inflammation was accompanied by significant fibrosis beginning on day 21. Quantitation of mRNA showed expression of ventricular atrial naturietic factor, as well as a decrease in myosin heavy chain alpha, beginning on day 21. These data demonstrate that autoimmune inflammation of the heart results in significant cardiac dysfunction, leading to phenotypic alterations similar to those demonstrated in human heart failure and animal models of heart failure.

Animals↗
PubMed1990

Effects of pyridoxalated hemoglobin polyoxyethylene conjugate and stroma-free hemoglobin on cardiac function in isolated rat heart.

Effects of a newly introduced modified hemoglobin, pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), and stroma-free hemoglobin (SFH) on cardiac rhythm and contractility were examined in isolated rat hearts. Hearts were perfused with HEPES-buffered Krebs solution containing 6% PHP, 6% SFH, or 6% hydroxyethylstarch (HES). Arrhythmia was not observed in PHP-perfused hearts, but marked sinus bradycardia occurred in SFH-perfused hearts. Ventricular contractility assessed by left ventricular pressure and pressure-volume relationship in both PHP and SFH-perfused hearts were well maintained during perfusion. There was no significant difference to the coronary flow resistance between hearts perfused with PHP and HES solutions, indicating that PHP has little vasoactive effect. The flow resistance in SFH-perfused hearts decreased significantly when compared with other groups. Results demonstrate that PHP solution can preserve cardiac function and have no toxic effects in isolated rat hearts.

Animals↗
PubMed1995

[Relationship between 123I-BMIPP imaging and cardiac function in acute myocardial infarction].

We evaluated the relationship between free fatty acid metabolism using 123I beta-methyl-iodophenyl pentadecanoic acid (BMIPP) and cardiac function in acute myocardial infarction. Twenty-five patients were examined with 123I-BMIPP and 201Tl dual SPECT. The 123I-BMIPP images were compared with the 201Tl images and the left ventricular wall motions. The 123I-BMIPP images showed a larger uptake defect than the 201Tl images. This was marked in the patients after revascularization therapy. The uptake decrease of 123I-BMIPP was in good agreement with the decrease in regional wall motion. The incidence of accordance was 79% of the wall segments. The correlation between 123I-BMIPP defect size and ejection fraction was higher (r = -0.54) than that of 201Tl (r = -0.44). Subtraction of ejection fractions four weeks and soon after infarction correlated well with the subtraction of 123I-BMIPP and 201Tl defect sizes (r = 0.55). In conclusion, 123I-BMIPP is more closely related to wall motion, than 201Tl and might be valuable in predicting the functional improvement of acute myocardial infarction.

Adult↗
PubMed1984

Radionuclide assessment of cardiac performance in cystic fibrosis. Reproducibility and effect of theophylline on cardiac function.

A study was designed to evaluate the reproducibility of right and left ventricular ejection fraction measurements (RVEF, LVEF) by equilibrium radionuclide angiography in cystic fibrosis (CF) and to determine the effect of the acute administration of aminophylline on RVEF and LVEF in this disease. Both RVEF and LVEF were measured at rest and during incremental supine bicycle exercise by equilibrium radionuclide angiography in 18 patients with CF. In 9 of these patients, radionuclide studies were repeated after an infusion of aminophylline (9 mg/kg), whereas the remaining patients had radionuclide studies repeated after a placebo infusion. No significant increase in mean RVEF or LVEF values either at rest or at peak exercise was seen after aminophylline infusion. In the patients who underwent sequential radionuclide studies without intervening active drug intervention, the mean (+/- standard deviation) variability in RVEF and LVEF measurements between the 2 studies was 2.6 +/- 2% and 3.6 +/- 2.9%, respectively. We conclude that (1) equilibrium radionuclide angiography is a reasonably reproducible technique for serial assessment of biventricular function at rest and during exercise in CF, and that (2) the acute administration of aminophylline does not augment cardiac function either at rest or during exercise in this disease.

Adolescent↗
PubMed1992

Clinical evaluation of cardiac function by ambulatory ventricular scintigraphic monitoring (VEST): validation and study of the effects of nitroglycerin and nifedipine in patients with and without coronary artery disease.

Global left ventricular function and ECGs were continuously monitored by radionuclide ambulatory ventricular function monitoring (VEST) and validated against multigated blood pool analysis (MUGA) and left ventriculography in 26 subjects (study 1). Ejection fraction by VEST (Y) showed good correlation with Y = 5.5 +/- 0.79 X (r = 0.91), Y = 1.7 +/- 0.86 X' (r = 0.91), and Y = 11.6 + 0.68 X" (r = 0.82) to sitting and supine MUGA and left ventriculography, respectively. In study 2 left ventricular function and ECGs were evaluated at rest and during exercise without any drug (control), with nitroglycerin, and with nifedipine in 21 patients with coronary disease (group I) and six normal subjects (group II). In group I abnormal ejection fraction responses (exercise increase less than or equal to 6%) during the control exercise period were found in 15 patients (71%), ST segment abnormalities in seven (33%), and chest pain in four (18%). Control exercise increased end-diastolic volume (100 to 112 +/- 8%) and end-systolic volume (53 +/- 15% to 63 +/- 22%) and decreased the ejection fraction (47 +/- 15% to 43 +/- 21%). The ejection fraction during exercise increased after nitroglycerin (50 +/- 22%) or nifedipine (54 +/- 21%) (p less than 0.05). In group II the ejection fraction was unchanged between rest and exercise with or without nitroglycerin or nifedipine. Thus combined radionuclide and ECG monitoring by VEST could detect changes in left ventricular function at rest and during exercise over a prolonged period and demonstrated that nitroglycerin and nifedipine improved cardiac function in the ischemic setting with an increased ejection fraction in the upright position.

Coronary Disease↗
PubMed2000

[Pulmonary and cardiac functions in patients with pulmonary tuberculosis].

Four hundred and nineteen elderly and old patients with pulmonary tuberculosis were examined. One hundred and ninety six patients were found to have an active tuberculous process and contaminant diseases: essential hypertension in 20.7%, functional classes II-III angina pectoris in 55.6%, postinfarct cardiosclerosis in 23.7%. Hypertrophy of the right cardiac cavities was frequently accompanied with that of the left ones (38.1%). Respiratory diseases caused by comorbidity were prevalent among acid-alkali balance disorders. Metabolic disturbances were detected in 90 (21%) patients. Evaluation of pulmonary and cardiac functions by the analysis of acid-alkali balance, gases, blood, and ECG in geriatric patients allows pathogenetic therapy to be timely and soundly.

Aged↗
PubMed1998

Potential paracrine role of the pericardium in the regulation of cardiac function.

OBJECTIVE: Both coronary and endocardial endothelium regulate cardiac contractile function via paracrine pathways. We investigated whether pericardial fluid (PF) and pericardial mesothelial cells (PMC) could exert a similar paracrine action. METHODS: Both PF and PMC were extracted from sheep pericardial space. Endothelin-1, prostaglandins and atrial natriuretic factor were measured in PF in vivo. In the other hand, PMC were grown on T-75 flasks and microcarrier beads to investigate endothelin-1, nitric oxide and prostaglandin pathways in vitro. In addition, effects of PF and PMC effluent were tested on adult rat cardiac myocyte contraction in vitro. RESULTS: In vitro, cultured PMC expressed endothelin-1 mRNA but not the endothelial nitric oxide synthase III, and released endothelin-1 and prostaglandins. Both PF and cultured PMC superfusate induced a potent, rapidly reversible decrease in the shortening of isolated rat cardiac myocytes. This effect was not associated with changes in intracellular calcium. In vivo, prostaglandins, atrial natriuretic factor and endothelin were present in PF. A greater concentration of atrial natriuretic factor was present in PF than in serum, suggesting molecular diffusion from the myocardium to PF. Preliminary results show that the instillation of vasoactive agents into the pericardial space of dogs rapidly alter coronary and systemic vascular tone, consistent with a molecular diffusion of these substances from PF into the myocardium and circulation. CONCLUSIONS: In addition to its mechanical role, the pericardium may contribute to the integration and the regulation of cardiovascular function via a paracrine mechanism.

Animals↗
PubMed1983

Short-term responses to cardiac rehabilitation after acute myocardial infarction. Cardiac function evaluation before and after physical training at rest and during stress test.

Whether physical training, soon after myocardial infarction (MI), has effects upon intrinsic cardiac function at rest and during exertion remains unresolved. We have evaluated ventricular function using radionuclide angiography at rest and during stress testing before and after 3 months' physical training. This has been correlated with the site of MI and with changes in the ST segment during the maximal exercise test performed before the postmyocardial infarction rehabilitation program. We have studied 27 patients, mean age 54 +/- 10 years, in NYHA class I or II. Twelve showed no changes in the ST segment during erogmetric stress test (group 1); seven showed ST segment depression greater than 1 mm in leads different from those of MI (group 2); eight showed ST segment elevation of 2 mm (group 3). Twelve patients had had anterior MI only (AMI group); twelve inferior MI only (IMI group). After rehabilitation, all patients showed an increased work capacity and a decreased double product at the same work load. In the total group, significant increases were found in the left ventricular ejection fraction (LVEF) and in the contractile regional performance (LVwm) at rest, as well as a lesser decrease in the LVEF during handgrip test. Group 1 showed a significant increase in LVEF, associated with a decrease in left ventricular end-diastolic volume (EDV) at rest. Group 2 showed unchanged variables after rehabilitation. Group 3 showed a better LVEF during handgrip with an increase of EDV at rest. The AMI group showed a better LVEF and LVwm at rest and a better LVEF during handgrip. IMI group showed a better right ventricular ejection fraction during handgrip without improvement in LVEF. No patient with IMI had septal asynergy. We conclude that the effects of rehabilitation were linked to the site of MI and to the functional dynamic status of both ventricles.

Electrocardiography↗
PubMed1990

Systemic hemodynamic and cardiac function changes in patients undergoing orthotopic liver transplantation.

The objective of this study was to determine the changes in systemic hemodynamics (systemic vascular resistance [SVR], cardiac output [CO], systemic blood pressure [SBP]) and cardiac function (pulmonary artery pressure [PAP] and pulmonary wedge pressure [PWP]) during the 96 hours following orthotopic liver transplantation (OLT) and correlate these with changes in hepatic and renal function and patient outcome. The study took place in a 12-bed medical respiratory intensive care unit in a large teaching hospital. Twenty-one patients had OLT performed over a 21.5-month period (January 1988 to October 15, 1989) for end stage liver disease (ESLD) from a variety of causes. A flow-directed right heart catheter and an indwelling arterial cannula were inserted for hemodynamic monitoring over a 96-hour postoperative period. Liver and renal function studies, total serum calcium, serum albumin, and fluid balance were determined daily. The SVR increased significantly to 12.8 +/- 0.6 U at 48 hours compared with immediate (less than 8 hours) postoperative levels (p less than 0.05) and remained elevated for 96 hours. The CO fell progressively and was significantly lower than baseline values from 64 to 96 hours. There was significant inverse correlation between the increase in SVR and the fall in CO (r = .85, p less than 0.01). The SBP was stable except for a small, but significant fall at 16 and 24 hours postoperatively. The PWP increased significantly from a baseline value of 12.5 +/- 0.9 mm Hg to 15 +/- 0.9 mm Hg at 32 hours and remained elevated through 96 hours (p less than 0.05). The serum bilirubin level fell progressively postoperatively and the prothrombin time and partial thromboplastin time (PTT) shortened significantly. Bile flow increased progressively from 107 +/- 120 ml/24 hours at the end of the first 24 hours to 188 +/- 125 ml/24 hours by 96 hours postoperatively. Five patients died from nine to 43 days postoperatively. These patients' hemodynamic parameters were not significantly different from the patients who survived. Successful OLT is associated with a rapid increase in SVR and a fall in CO without changes in SBP. These findings tend to parallel the improvement found in results of liver function tests. However, there is no correlation between the improvement in the hemodynamic state and long-term survival.

Adult↗
PubMed1991

Early adaptations in gas exchange, cardiac function and haematology to prolonged exercise training in man.

In order to determine the effect of short-term training on central adaptations, gas exchange and cardiac function were measured during a prolonged submaximal exercise challenge prior to and following 10-12 consecutive days of exercise. In addition, vascular volumes and selected haematological properties were also examined. The subjects, healthy males between the ages of 19 and 30 years of age, cycled for 2 h per day at approximately 59% of pre-training peak oxygen consumption (VO2) i.e., maximal oxygen consumption (VO2max). Following the training, VO2max (l.min-1) increased (P less than 0.05) by 4.3% (3.94, 0.11 vs 4.11, 0.11; mean, SE) whereas maximal exercise ventilation (VE,max) and maximal heart rate (fc,max) were unchanged. During submaximal exercise, VO2 was unaltered by the training whereas carbon dioxide production (VE) and respiratory exchange ratio were all reduced (P less than 0.05). The altered activity pattern failed to elicit adaptations in either submaximal exercise cardiac output or arteriovenous O2 difference. fc was reduced (P less than 0.05). Plasma volume (PV) as measured by 125I human serum albumin increased by 365 ml or 11.8%, while red cell volume (RCV) as measured by 51chromium-labelled red blood cells (RBC) was unaltered. The increase in PV was accompanied by reductions (P less than 0.05) in haematocrit, haemoglobin concentration (g.100 ml-1), and RBCs (10(6) mm-3). Collectively these changes suggest only minimal adaptations in maximal oxygen transport during the early period of prolonged exercise training. However, as evidenced by the changes during submaximal exercise, both the ventilatory and the cardiodynamic response were altered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed2003

Role of phosphoinositide 3-kinase in cardiac function and heart failure.

Phosphoinositide 3-kinase (PI3K) belongs to a conserved family of lipid kinases that regulate many critical functions in the cell by generating 3'-phosphorylated phosphatidylinositols. Although PI3K has been the focus of intense study in various biologic processes including apoptosis, metastasis, and neuronal differentiation, it is only recently that the focus has shifted to understanding the role of PI3K in cardiac function, hypertrophy, and heart failure. This article reviews the role of PI3K in regulating cardiac growth, contractility, beta-adrenergic receptor function, and hypertrophy, as well as possible novel therapeutic strategies in the treatment of heart failure.

Apoptosis↗