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Comparability of the Tandem-R and IMx assays for the measurement of serum prostate-specific antigen.

OBJECTIVES: To assess the comparability of the Tandem-R and IMx serum prostate-specific antigen (PSA) assays across levels of the ratio of free-to-total serum PSA found in a community-based population of healthy men. METHODS: Banked serum samples from the baseline component of the Olmsted County Study of Urinary Symptoms and Health Status Among Men were thawed and analyzed using the Tandem-R and IMx PSA assays. Serum levels also were determined for the free, noncomplexed form of PSA, PSA complexed to alpha-1 antichymotrypsin, and total PSA with a research-based immunofluorometric assay. RESULTS: The results of the Tandem-R and IMx assays were strongly correlated at all levels of the ratio of free-to-total serum PSA. The Spearman correlation coefficients ranged from 0.87 to 0.98 (all p < 0.001). The relationship between the Tandem-R and IMx assays, however, differed at low levels of free-to-total serum PSA compared with high levels. In the lowest 10th percentile of the ratio of free-to-total serum PSA (0.04 to 0.18), the IMx assay read lower than the Tandem-R (slope +/- standard error = 0.92 +/- 0.04, intercept +/- standard error = 0.21 +/- 0.14); whereas in the upper 10th percentile of free-to-total ratio (0.46 to 0.65) the IMx assay yielded values higher than the Tandem-R assay (slope = 1.21 +/- 0.07, intercept = 0.14 +/- 0.05). In the middle 90%, the slope did not statistically differ from 1.0. CONCLUSIONS: For the majority of men, results of the Tandem-R and IMx PSA assays were virtually identical. The small differences found would not be of clinical significance for most men but should be considered when comparing results of different assays in sequential determinations for a specific man.

Adult↗

Comparison of chemical analysis of residual monomer in a chemical-cured dental acrylic material to an FTIR method.

OBJECTIVE: The purpose of this work was to perform quantitative analysis of residual monomer in chemical-cured acrylic using an infrared spectroscopic method and to compare it to an accepted form of quantitative chemical analysis. Identical samples of acrylic were analyzed and compared using Fourier transform infrared (FTIR) spectroscopy with multiple standard additions vs. "wet" chemical analysis of bromination followed by titration. METHODS: Two 6 g disks from a single mix of cold-cured acrylic (Lang Dental Mfg. Co., Inc.) were prepared and cured in room air for 1 hr using a ratio of 12 g of powder to 8 mL of liquid. One of the cold-cured acrylic disks was dissolved in glacial acetic acid and analyzed according to the "wet" technique described by Smith and Bains (Smith and Bains, 1956). The other disk was dissolved in methyl isobutyrate (MIBT). Five aliquots, zero plus four incremental additions of pure methyl methacrylate (MMA), were prepared from the MIBT solution. Absorption spectra were collected for all five aliquots. The data were plotted with the ratio of the mass of methyl methacrylate added to the mass of aliquot of MIBT solution as the independent variable, and the absorption, corrected for dilution, as the dependent variable. Least squares fit of the data yielded the slope and intercept. The ratio of intercept to slope divided by the weight fraction of the acrylic disk dissolved in MIBT yielded the concentration of methyl methacrylate in the disk. RESULTS: The plot of absorbance as a function of mass ratio of MMA added to MIBT solution was linear over the concentration range covered (r = 0.999). Analysis of the spectroscopic data revealed a concentration of residual C = C double bonds of 0.32 +/- 0.01 mol/kg. "Wet" chemical analysis of the acrylic yielded a concentration of residual C = C double bonds of 0.288 +/- 0.003 mol/kg. There was significant difference (students t-test, 99% confidence level) between the two techniques with respect to the amount of residual monomer calculated. SIGNIFICANCE: The multiple standard additions technique works well for the quantitative analysis of small amounts of residual double bonds in the poly(methyl methacrylate) chemical-cured acrylic polymer system, eliminating the need for an internal standard or external calibration.

Absorption↗

A quantitative evaluation of IMRT dose distributions: refinement and clinical assessment of the gamma evaluation.

BACKGROUND AND PURPOSE: Although intensity modulated radiotherapy (IMRT) is a step forward in comparison to conventional, static beam delivery, quality assurance is more complex and labour intensive, demanding detailed two-dimensional dosimetric verification. Regardless of the technique used for measuring the dose distribution, what is essential to the implementation of routine verification of IMRT fields is the efficient and accurate comparison of the measured versus desired dose distribution. In order to achieve a fast, yet accurate quantitative measure of the correspondence between measured and calculated dose, the theoretical concept of the gamma evaluation method presented by Low et al. (Med. Phys., 25 (1998) 656) was converted into a calculation algorithm, taking into account practical considerations related to the discrete nature of the data. MATERIALS AND METHODS: A filter cascade of multiple levels was designed to obtain fast and accurate comparison of the two dose distributions under evaluation. The actual comparison consists of classification into accepted or rejected datapoints with respect to user-defined acceptance criteria (dose difference and distance to agreement). The presented algorithm was tested on dosimetric images calculated and/or acquired by means of a liquid filled portal imaging device during the course of intensity modulated treatments of prostate cancer, including pre-treatment verification as well as verification during treatment. To assess its ability to intercept possible errors in dose delivery, clinically relevant errors were deliberately introduced into the dose distributions. RESULTS: The developed gamma filter method proves successful in the efficient comparison of calculated versus measured IMRT dose distribution. Secondly, intercomparison of dosimetric images acquired during different treatment sessions illustrate its potential to highlight variations in the dosimetric images. The simulated errors were unmistakably intercepted. CONCLUSIONS: The readily obtained gamma evaluation images are an easy tool for quality control of IMRT fields. To reduce the artefacts related to the discrete nature and limited resolution of the data, a fast and accurate filter cascade was developed, offering the possibility to use the gamma method for day to day evaluation of patient dosimetric portal images with or without comparison to a predicted portal dose distribution.

Algorithms↗

Comparison of single- and dual-platform approaches to enumerate CD34(+) cells in bone marrow and mobilized peripheral blood stem cells.

BACKGROUND: Different flow cytometric methods have been developed to derive absolute CD34(+) cells in predicting transplant outcome. Two techniques for preparing cells for quantification of CD34(+) cells were compared. METHODS: Enumeration of CD34(+) cells in 16 samples of bone marrow (BM) and in 29 samples of mobilized peripheral blood stem cells (PBSC) obtained by leukapheresis was assessed simultaneously by single-platform (ProCOUNT kit) and dual-platform (Milan protocol) approaches within the first 3 h of collection. RESULTS: Absolute number of CD34(+) cells obtained in PBSC and BM using single- and dual-platform methods showed high determination coefficients as follows: for PBSC, slope = 1.0515 +/- 0.048, y-intercept = 88.638 +/- 52.45, and r(2) = 0.941, and for BM, slope = 1.0203 +/- 0.093, y-intercept = 122.25 +/- 20.65, and r(2) = 0.878. There were no statistically significant differences in absolute number of CD34(+) cells from PBSC between single-platform (mean 575/microL, range 70-3683/microL) and dual-platform (786/microL, range 51-3804/microL) assays. In contrast, absolute number of CD34(+) cells from BM was significantly lower (p = 0.0002) when enumerated by ProCount kit (135/microL, 14-758/microL) than with dual-platform method (260/microL, 74-889/microL). CONCLUSIONS: Both approaches can be used indistinctly to estimate absolute number of CD34(+) cells in PBSC but not in BM.

Antigens, CD34↗

Analysis of lick rate measures the positive and negative feedback effects of carbohydrates on eating.

Previous work has shown that measuring the rate of ingestion of liquid diets, rather than simply volume, reveals important features of ingestive behavior which can help to explain why a particular volume of a liquid is ingested. This study is an extension of that work to a variety of different test solutions. In this study the rate of ingestion of saccharin, two different concentrations of glucose and sucrose and their mixtures with saccharin and seven different concentrations of maltose were measured. The rate functions were fit by the least-squares method to a linear function to determine the intercepts and slope constants. Analysis of how these two parameters changed with the concentration and composition of the test solutions confirms, using different test solutions, a previously reported conclusion that the initial rate of ingestion (the intercept) measures palatability and that the slope constant is a measure of the rate of development of a negative feedback satiety signal.

Animals↗

The influence of bandage characteristics and inter-individual application variations on underneath bandage pressures.

INTRODUCTION:: Cohesive bandages are applied to the legs of racehorses and horses with limb injuries for protection (prevention of abrasion) and support (reduction of movement at the fetlock joint). The support capacity of all commercially available bandages has been questioned. Consequently, the protection aspect of bandaging and the negative side effects, which can be caused by bandaging (eg pressure induced ischemia with subsequent necrosis), were emphasized. High pressures underneath bandages were shown to cause reduced blood flow. Pressures underneath certain types of bandages were shown to be higher than under others. It is unclear if these differences were due to differences in material characteristics between the bandage types or caused by differences in application by the trainers. The purpose of this study was to determine (a) if differences between different types of bandages are observed if these are applied similarly and (b) if earlier observed differences in pressures underneath bandages are reproducible when wrapped by different trainers. METHODS AND MATERIAL:: (a) A wrapping machine for the application of bandages to an artificial joint (simulating the human knee joint) was designed and built. The machine allows to wrap bandages with adjustable, constant tension under well defined wrapping angles in order to simulate a wrapping technique similar to the wrapping by trainers. The artificial joint is equipped with two pressure sensors (Parotec, Germany). After bandage application, the artificial joint was placed in a specially designed testing machine and cycled through 200 cycles from 0 degrees to 90 degrees of flexion at a frequency of 0.5 Hz. Pressure data were collected at a frequency of 20 Hz. The force required to unwind the bandage from its core was measured with a material testing machine. Five samples each of four different 4" wide cohesive bandages were tested: 'E': high modulus latex, 'V': low mod. latex, 'C': low mod. latex, 'F': medium mod. laminate non-latex. All bandages were applied at manufacturer suggested tensions (50% intercept length). (b) Fifth-three trainers from the Kentucky Horse Center (Lexington, KY) and the Payson Park Training Facility (Indiantown, FL) volunteered for the study. They applied their favoured brand and a type 'F' bandage to an artificial horse limb. Underneath bandage pressures were collected using a pressure mat (Mikro Emed, Novel GmbH, Germany) placed over the fetlock joint. RESULTS AND DISCUSSION:: (a) Maximum pressures during maximum flexion underneath the type 'E' bandage (5.7+/-0.4 N/cm(2)) were significantly higher than for all other bandages (no difference between other bandages, range 3.5+/-0.6 to 4.0+/-0.4 N/cm). The unwinding force for the type 'F' bandage was significantly lower (10.1+/-5.5N) than for all other bandages (range 22.7+/-11.3 to 42.3+/-15.1N). (b) Trainers applied the type 'E' bandage significantly tighter than the other bandages (18.7+/-3.7 N/cm(2) vs a range of 7.5+/-5.4 to 10.4+/-6.1 N/cm(2)); a tendency was observed that the type 'F' bandage was applied looser than the type 'V' bandage. The results of part (b) of this study are consistent with the earlier study. Based on the results of part (a) of this study it can be speculated that (I) The high pressures underneath the type 'E' bandage are clearly due to its material characteristics, and (II) The differences between the other bandages are not caused by material characteristics but probably by the differences in unwinding force. If the unwinding force is higher than the force required to extend the bandage to 50% intercept length, trainers will probably wrap tighter as suggested and desired.

Journal Article↗

PLATIN (plant-atmosphere interaction) I: A model of plant-atmosphere interaction for estimating absorbed doses of gaseous air pollutants.

A PLant-ATmosphere INteraction model (PLATIN) was developed for estimating air pollutant absorbed doses under ambient conditions. PLATIN is based on the canopy energy balance combined with a gas transport submodel. The model has three major resistance components: (1) a turbulent atmospheric resistance Rah(zm) that describes the atmospheric transport properties between a measurement height above the canopy and the conceptual height z=d+z0m which represents the sink for momentum according to the big-leaf concept; (2) a quasilaminar layer resistance R(b,A) that quantifies the way in which the transfer of sensible heat and matter (e.g. latent heat, ozone) differs from momentum transfer; (3) a canopy or surface resistance R(c,A) that describes the influences of the plant/soil system on the exchange processes. Soil water content is simulated by a Force-Restore model. By a simple interception submodel precipitation and dew are partitioned into intercepted water and water reaching the soil surface. PLATIN can be run in a prognostic or a diagnostic mode. It is also intended for on-line use in air quality monitoring networks.

Journal Article↗

Statistical analysis of structure-activity relationships.

The relationship between organic structure and biological activity (toxicity) is examined by statistically comparing concentration-response regression lines among structurally related compounds. Response data from acute toxicity tests are initially transformed to the logistic function while concentration data are transformed to the logarithm base 10 before being fit to a linear model using a weighted least squares analysis. A sequential approach is presented that uses statistical models for testing differences among related compounds. The approach first tests for the overall equality of regression lines (slopes and intercepts). If the regression lines are found to be different, another set of tests are conducted to determine if the slopes of the lines are equal (i.e. parallel). If the slopes are equal, multiple comparisons are made using Scheffé's procedure for determining which compounds differ in their intercepts. Relative toxicities are then estimated for various concentrations of particular compounds.

Regression Analysis↗

Serum albumin concentration-related Health Care Financing Administration quality assurance criterion is method-dependent: revision is necessary.

The objective of this study was to examine quantitative differences between the two commonly used methods for determining serum albumin concentration, bromcresol green (BCG) and bromcresol purple (BCP), in normal subjects and in 235 unselected dialysis patients in view of recently established Health Care Financing Administration (HCFA) quality assurance review criteria. The mean of normal results by the BCG method was 4.4 g/dL, and 97.5% of values were 3.8 g/dL or higher. The mean of normal results by the BCP method was 3.9 g/dL, and 97.5% of values were 3.3 g/dL or higher. Serum albumin concentrations in samples from the dialysis patients had respectively lower mean values by both methods. For the BCG method, the mean was 3.8 g/dL, and 82% of values were 3.5 g/dL or higher; for the BCP method, the mean was 3.3 g/dL, and 82% of values were 3.0 g/dL or higher. Likewise, for the reference immunonephelometric procedure, the mean value for the dialysis patients was 3.3 g/dL, and 82% of values were 3.0 g/dL or higher. For the samples from the dialysis patients, in comparison with the immunonephelometric method, the BCG method exhibited both constant (intercept = 9.3 g/L) and proportional error (slope = 0.87). The mean albumin value for the BCG method was 3.8 g/dL, 15% higher. In contrast, the BCP method compared closely with the reference method: slope = 1.00, intercept = 0.8 g/L, mean x = 3.3 g/dL, mean y = 3.3 g/dL. The HCFA quality assurance criteria are valid only for the BCG method.(ABSTRACT TRUNCATED AT 250 WORDS)

Bromcresol Green↗

Quantitative relationship between fluctuations of blood pressure and sympathetic nerve activity in pentobarbital anesthetized rats.

Transfer function analysis was used to examine the coupling between the sympathetic nerve activity (SNA) and the blood pressure (BP) fluctuations. In pentobarbital anesthetized Wistar rats, linear regression of the relationship between frequency (X-axis) and the logarithmic transfer magnitude, i.e. log (BP power density/renal SNA power density) (Y-axis), in the low frequency range (0.016-0.85 Hz) revealed an excellent fit (r = 0.97-0.98). Comparing the regression lines, rats under large dose of pentobarbital anesthesia (40 mg/kg, i.v. single dose) had significantly smaller intercept and slope values compared to rats under small dose of pentobarbital anesthesia (12.5 mg/kg). When intercept and slope values were compared between intact and acutely sinoaortic denervated rats, no significant difference were found. The results suggest that sympathetic modulation of vasomotor tone may be a major factor in generating BP fluctuations between 0.016 and 0.85 Hz in rats. Furthermore, these results support the possibility of using low frequency spectral power of BP to quantitatively estimate the fluctuations of SNA for rats under pentobarbital anesthesia if anesthetic depth is controlled.

Anesthesia, Intravenous↗

Dose-response relationship for prophylactic cranial irradiation in small cell lung cancer.

PURPOSE: To determine the dose-response relationship for prophylactic cranial irradiation (PCI) in small cell lung cancer, to quantify the growth kinetics of subclinical metastases, and to determine the influence of time-delay in initiating PCI on its utility. METHODS AND MATERIALS: Published reports of brain relapse rates in small cell lung cancer with and without PCI were collected. The reduction in brain relapse rate as a function of radiation dose was analyzed. The time interval between treatment of the primary tumor and the initiation of PCI was analyzed as a factor potentially influencing dose-response. RESULTS: A shallow dose-response curve without any threshold in the dose intercept was demonstrated for control of subclinical brain metastases in "early PCI" (delay between initiation of treatment for primary tumor and PCI less than 60 days). By contrast "late PCI" (delay over 60 days) was associated with a significant displacement of the dose intercept. Doses over 30-35 Gy in 2-Gy fractions did not result in a further reduction in brain relapse rate, but there were too few high-dose studies to draw any definite conclusion. CONCLUSIONS: The nearly linear dose-response relationship for reduction in brain relapses demonstrated for "early PCI" in the range of doses from zero up to 35 Gy given in 2-Gy fractions supports the model of a fairly logarithmically uniform distribution of metastatic cell number within a series of patients. When PCI is delayed, a significant threshold in dose-response was observed, consistent with a fast growth rate of untreated subclinical brain metastases from small cell lung cancer. The exact shape and locations of dose-response curves is not well established by this retrospective analysis of diverse data. A high probability of eliminating brain relapses following PCI requires a dose of about 30-35 Gy in 2-Gy fractions. Control rates in brain can be enhanced if PCI is applied early.

Brain Neoplasms↗

Statistical assessment of between batch stability equivalence.

A statistical method for testing the equivalence between batches regarding their stability is proposed. This method is based on the statistical linear model making use of a set of dummy variables to code the different batches. The method gives us the point estimates of the slope and zero intercept of one batch, and the differences and the corresponding confidence intervals with the remaining batches. In a second step, zero intercepts and slopes are estimated for all the batches. Stability equivalence assessment is based on the comparison of the confidence intervals for the differences between batches with the maximum difference allowable. The main advantages of this method are the possibility to compare several batches, to disclose the equivalence stability criteria from the statistical hypothesis about the equality between slopes, and the joint estimated of the residual variance whatever the decision to pool or not the data from different batches. This method is illustrated with two data set; the first one, previously published by other authors, involved six batches; the second data set include two batches and arose in a stability study of a commercial human insulin conducted in our laboratory.

Confidence Intervals↗

Separation of steroidal drugs on porous graphitized carbon column.

The retention time of 11 steroidal drugs was determined on a porous graphitized carbon (PGC) column using water tetrahydrofuran mixtures as eluents. Linear correlations were calculated between the logarithm of the capacity factor (k') and the tetrahydrofuran concentration in the eluent. To find the molecular parameters significantly influencing the retention the intercept and slope values of the above relationship were correlated with the physicochemical characteristics of steroidal drugs using principal component analysis (PCA). Both the slope and intercept values show high differences proving that steroidal drugs can be successfully separated on a PGC column. Five principal components explained > 90% of the total variance. Calculations indicated that both electrostatic interactions and sterical conditions can influence the retention of steroidal drugs on PGC column.

Chemistry Techniques, Analytical↗

Left ventricular pressure-volume diagrams and end-systolic pressure-volume relations in human beings.

Assessment of left ventricular pressure-volume relations serially in response to altered loading conditions and heart rate has been difficult to achieve with contrast ventriculography. Accordingly, to study changing pressure-volume relations during altered loading and heart rate, left ventricular pressure and radionuclide absolute volume curves (obtained using a counts-based method with attenuation factor corrections) were recorded in 20 patients. Ventricular pressure and radionuclide volume curves were digitized and synchronized to end-diastole, and pressure-volume plots were subsequently constructed from 32 pressure-volume coordinates throughout the cardiac cycle. In all patients, the correlation between radionuclide absolute volumes and angiographic ventricular volumes was r = 0.92. In 10 patients in whom both radionuclide and angiographic pressure-volume diagrams were constructed, the agreement between the two methods was excellent. With this method, end-systolic pressure-volume relations were examined during altered left ventricular loading conditions, pacing-induced incremental increases in heart rate and pacing-induced ischemia. Using pharmacologically induced changes in left ventricular loading conditions, the slope and volume intercept of the end-systolic pressure-volume line could be calculated as a means of assessing basal contractility. During pacing-induced tachycardia, the slope and volume intercept of the end-systolic pressure-volume line could be calculated to quantify the Treppe effect and assess negative inotropic changes secondary to ischemia. This study supports the validity of using serial recordings of left ventricular pressure and radionuclide volumes to assess left ventricular pressure-volume relations, and indicates that this approach may be useful in the analysis of end-systolic pressure-volume relations in patients.

Cardiac Pacing, Artificial↗

Noninvasive determination of pressure gradients in children: two methods employing pulsed Doppler echocardiography.

Pulsed Doppler echocardiography has been considered poorly suited for high velocity blood flow measurement, because of the problem of signal aliasing. Two methods for reduction of aliasing in a pulsed system were evaluated in an attempt to measure flow velocities characteristic of significant pressure gradients. With the angle correction method, carrier frequency, pulse repetition frequency and intercept angle were manipulated using a commercially available two-dimensional pulsed Doppler system. Forty children undergoing cardiac catheterization were studied. Gradients of 60 to 70 mm Hg were accurately predicted by this method, and gradients above 90 mm Hg were underestimated. Overall correlation (r) value was 0.95. The method is limited primarily by the introduction of potential error in measurement of intercept angle; it is advantageous in that it can be attempted using currently available pulsed Doppler echographic systems. With the multiple sample volume method, pulse repetition frequency was increased through the addition of extra sample volumes. Carrier frequency was minimized and angle correction was not employed. Thirty-nine children underwent cardiac catheterization using a prototype instrument. Excellent agreement between Doppler predictions and actual gradients was found for gradients up to 100 mm Hg (r = 0.99). Although this method requires new instrumentation, it is advantageous in that gradients are accurately predicted and cannot be overestimated. Both methods retain the advantages of pulsed Doppler study for comprehensive flow evaluation and reference their quantitative application within a two-dimensional echographic format. Neither method is simple, and each has been validated only in pediatric subjects.

Aortic Valve↗

Doppler echocardiographic estimation of systolic pulmonary artery pressure in pediatric patients with interventricular communications.

The purpose of this study was to evaluate a noninvasive method for estimation of pulmonary artery pressures in infants and children with interventricular communications. Systolic pulmonary artery pressures measured by cardiac catheterization were compared with those estimated by Doppler echocardiography. Pressure drops were measured by Doppler study (modified Bernoulli equation) and were referenced to systolic systemic arterial pressure measured by sphygmomanometry. All 25 patients in this study had either a ventricular septal defect or a single ventricle. The systolic pulmonary artery pressure measured by cardiac catheterization ranged from 15 to 100 mm Hg (mean +/- SD 44 +/- 26) and that measured by Doppler echocardiography ranged from 5 to 100 mm Hg (mean 43 +/- 26) (p = NS; r = 0.92; SEE = 9.9; slope = 0.92; y intercept = 4.7). Systolic pulmonary artery to aortic pressure ratio measured by cardiac catheterization ranged from 0.2 to 1.0 (mean 0.5 +/- 0.3) and that measured by Doppler echocardiography ranged from 0.1 to 1.0 (mean 0.5 +/- 0.3) (p = NS; r = 0.94; SEE = 0.09; slope = 0.90; y intercept = 0.04). This study demonstrates that Doppler echocardiography can closely approximate systolic pulmonary artery pressure in patients with interventricular communications.

Blood Pressure↗

Doppler echocardiographic estimation of systolic pulmonary artery pressure in patients with aortic-pulmonary shunts.

The objective of this study was to determine if the pressure drop across various types of aortic-pulmonary shunts could be accurately estimated by Doppler echocardiography, and if systolic pulmonary pressure could be estimated by referencing the pressure drop across the aortic-pulmonary shunt to systolic systemic arterial pressure measured by cuff sphygmomanometry. This was done in 22 patients and Doppler results were compared with pulmonary artery pressure measured directly by strain gauge manometry. Adequate Doppler waveforms were obtained in 21 of 22 patients; 3 had a Waterston shunt, 10 had a Blalock-Taussig shunt, 1 had a left pulmonary artery-aortic anastomosis, 6 had a patent ductus arteriosus and 1 had an aortic-pulmonary window. Systolic pulmonary artery pressure estimated by Doppler echocardiography ranged from 12 to 90 mm Hg (mean 41.3 +/- 21.4 [SD] ), and measured by strain gauge manometry ranged from 20 to 90 mm Hg (mean 44.7 +/- 20.7) (p = NS, r = 0.94, SEE = 7.4 mm Hg; slope = 0.90, y intercept = 7.4 mm Hg). Systolic pulmonary artery to aortic pressure ratios predicted by Doppler recording ranged from 0.1 to 1.0 (mean 0.4 +/- 0.2 [SD] ); when calculated from direct measurement it ranged from 0.2 to 1.0 (mean 0.4 +/- 0.2) (p = NS, r = 0.92; SEE = 0.08, slope = 0.80, y intercept = 0.09). This study demonstrates that Doppler echocardiography provides an estimation of pressure drop across aortic-pulmonary shunts, and that the data can be used to estimate systolic pulmonary artery pressure by subtracting the estimated pressure drop from the systolic systemic arterial pressure.

Adolescent↗

Application of end-systolic pressure-volume and pressure-wall thickness relations in conscious dogs.

The usefulness of end-systolic measures of ventricular function was compared with that of standard contractility indexes in conscious dogs. End-systolic relations between left ventricular pressure and volume and between pressure and wall thickness were analyzed in dogs previously instrumented with ultrasonic crystals. Progressive angiotensin infusions were used to generate computer-averaged pressure-volume and pressure-wall thickness loops. Both relations were linear in every study and highly reproducible. With low and high dose dobutamine, the end-systolic pressure-volume relations were significantly displaced, with increased slope and inconsistent changes in intercept. This relation was more useful than the ejection fraction for detecting contractility increases at different afterloads, but it showed no advantage over maximal left ventricular dP/dt at all ranges of preload and afterload. The end-systolic pressure-volume relations were insensitive for detecting mild decreases in inotropic state produced by propranolol, and maximal dP/dt was superior for detecting such mild acutely reduced contractility. The end-systolic pressure-wall thickness relations showed displacement with dobutamine, although slope and intercept changes were not significant; these relations did not detect mild decreases in contractility produced by propranolol. It is concluded that the end-systolic pressure-volume relation and a simplified end-systolic measure using pressure and wall thickness provide sensitive, load-independent and reproducible approaches for defining acute increases in left ventricular contractility in conscious animals. Maximal dP/dt was equally effective for defining these increases in contractility and more sensitive for detecting slight acute decreases in contractility.

Angiotensin II↗