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[Changes of left ventricular diastolic function in hypertensive patients with left atrial enlargement].

In order to find out the relationship between the left atrial enlargement and left ventricular diastolic function in hypertension, radionuclide ventriculography was performed in 45 hypertensive patients with normal left ventricular mass index(LVMI), including 23 with normal left atrium(Group I), 22 with left atrial enlargement(Group II), and 28 matched subjects as control(Group III). The results showed that the left ventricular diastolic function in Group I was normal, but abnormal in Group II. It is considered that left atrial enlargement and left ventricular diastolic dysfunction are the early signs of the hypertensive heart disease.

Adult↗

Anesthetics and automaticity of dominant and latent atrial pacemakers in chronically instrumented dogs. III. Automaticity after sinoatrial node excision.

BACKGROUND: Management of patients with sinus node dysfunction must consider the stability of subsidiary pacemakers during anesthesia and treatment with antimuscarinic or sympathomimetic drugs. Baroreflex regulation of atrial pacemaker function is known to contribute to the interactions between inhalation anesthetics and catecholamines. Sinoatrial (SA) node excision can be a model for intrinsic SA node dysfunction. Subsidiary atrial pacemakers are expected to emerge after SA node excision, but they may respond differently to humoral and neural modulation. Isolated and combined effects of epinephrine and methylatropine should help characterize subsidiary pacemaker function during anesthesia with halothane, isoflurane, and enflurane. METHODS: In eight dogs, SA nodes were excised and epicardial electrodes implanted at the atrial appendages, the His bundle, and along the sulcus terminalis. Spontaneous pacemaker automaticity and subsidiary atrial pacemaker recovery time were measured in the conscious state, in the presence of methylatropine, with 1 and 2 micrograms.kg-1.min-1 epinephrine and during 1.25 and 2 MAC halothane, isoflurane, and enflurane. RESULTS: After SA node excision, a stable and regular subsidiary atrial pacemaker rhythm emerged. Each anesthetic prolonged subsidiary atrial pacemaker recovery times. This prolongation was greater in the presence of methylatropine. Without methylatropine, isoflurane and enflurane, but not halothane, further enhanced the baroreflex-mediated negative chronotropic effects of epinephrine, whereas with methylatropine, each anesthetic reduced the direct positive chronotropic effects of epinephrine. CONCLUSIONS: Halothane, isoflurane, and enflurane have significant depressant effects on the spontaneous and epinephrine-altered automaticity of subsidiary atrial pacemakers. Depression of subsidiary atrial pacemaker automaticity was most apparent in dogs with muscarinic blockade.

Anesthetics↗

Interactions: the integrated functioning of heart and lungs.

The heart and lungs are two dynamic organ systems functioning in a highly integrated inter-relationship within the unique negative pressure environment of the intact thorax. Noninvasive imaging techniques have afforded us the opportunity to study the interdependence of these two organ structures with evaluation focused both on intra and inter organ relationships. It is through a recognition of these interdependent phenomena that one begins to appreciate their importance to the prediction of the total mechanical response of the cardiopulmonary system when piecing together individual response characteristics determined with components of the system held in isolation. Highlights of a number of measurements made from what has been termed dynamic and electron beam x-ray CT as well as recent work utilizing magnetic resonance imaging (MR) are presented. Our earlier work related to the intracardiac interrelationships serving to maintain the heart at a near constant volume throughout the cardiac cycle. Here we will expand to include heart-lung and lung-heart interactions as they affect both cardiac and pulmonary function. The overall theme is systems integration serving to dictate function and functional efficiency.

Animals↗

Motion of the tricuspid valve annulus in anesthetized intact dogs.

Phasic variations in the size, position, and geometry of the tricuspid valve annulus during the cardiac cycle were studied in five normal anethetized dogs 2-6 weeks after 8-11 lead beads had been sutured on the endocardial surface of the valve ring during cardiopulmonary bypass. Field-by-field measurements from biplane videoangiograms were used to assess changes in valve ring size and shape during control hemodynamic conditions and during increased heart rates. In addition, the percutaneous production of a complete atrioventricular block in two dogs enabled us to observe the effect of isolated atrial contractions on the valve annulus. During normal sinus rhythm, progressive narrowing of the annulus during atrial and ventricular contractions reduced its area by 20-39% of the maximal valve circumference during diastole; approximately two-thirds of the total ring narrowing was associated with atrial systole. These findings suggest that one of the functions of atrial contraction is the reduction in size of the atrioventricular valve orifices prior to the onset of ventricular systole.

Anesthesia, General↗

Patient with atrioventricular node reentrant tachycardia with eccentric retrograde left-sided activation: treatment with radiofrequency catheter ablation.

We describe a patient with supraventricular tachycardia with triple atrioventricular (AV) node pathway physiology. A discontinuous curve was present in the antegrade AV nodal function curves. During right ventricular pacing, the earliest retrograde atrial activation was recorded at the left-sided coronary sinus electrode. The retrograde ventricular-atrial interval was long and had decremental conduction. We induced a slow-slow AV node reentrant tachycardia (AVNRT) with eccentric retrograde left-sided activation. After slow pathway ablation, dual AV nodal pathway physiology was present. AVNRT with eccentric retrograde left-sided activation is relatively rare, and our findings suggest that eccentric retrograde left-sided atrial inputs consist partially of a slow pathway and disappear with slow pathway ablation.

Atrial Function, Left↗

[Tissue Doppler echocardiography: a new stage in the study of myocardial function].

Tissue Doppler echocardiography is a new technique that allows selective visualization and measurement of myocardial velocities, affording a new perspective on cardiac function. It has been showing promising and exciting preliminary results on coronary artery disease, hemodynamics, cardiomyopathies, right ventricular and aortic diseases and arrhythmias, opening a new era in the analysis of regional myocardial function.

Aorta↗

[A comparative study of standard and total orthotopic cardiac transplantation].

The classical orthotopic heart transplant modifies size and geometry of the atria, may affect mitral and tricuspid function, and ventricular filling. A technical modification with subtotal excision of the recipient's heart, with anastomosis of a cuff of left atrium and of venae cavae has been used and compared with 2 consecutive series of transplantations : 70 classical (group I) 1986-1991, and 50 modified (group II) 1992-1994. The patients were similar for age, pretransplant characteristics, postoperative treatment. The aortic cross-clamping in the recipient (duration of cardiac excision and graft implantation) has been longer in group II (87 +/- 19 mm vs 65 +/- 15: p < 0.001). No surgical complication due to the technique was observed. Mortality was similar in the 2 groups (14% group I, 18% group II; NS). Five patients of group I has a systemic embolism (1 month to 5 years after transplant), none in group II. Two comparable groups of 30 patients were studied at least 6 months after transplantation with: surface EKG, Holter, transthoracic and esophageal echodoppler. A larger number of EKG anomalies, a significant increase in the size of atria, a significantly larger number of mitral and tricuspid insufficiencies, an increase in the variability of E/A ratio (left ventricular filling parameter) were noted after classical transplantation. Spontaneous contrast echo and thrombus in the left atrium were also noted after classical transplant. We conclude that these technical modifications result in a geometry and anatomy closer to normal. Less anomalies of the cardiac function were found. Due to the absence of left atrial thrombus and of systemic embolism we think that there is a definite advantage in this technically rather simple approach.

Actuarial Analysis↗

An NMR probe to study function and metabolism simultaneously in isolated human cardiac tissue.

Trabeculae isolated from human atrial appendages have been used to study preservation of donor hearts for cardiac transplantation. We have developed a perifusion system equipped with a fiber optic strain gauge to study mechanical performance of human atrial trabeculae (10-20 mg) while simultaneously observing the energetic compounds by 31P NMR spectroscopy. The NMR probe consists of an eight-turn solenoid coil (2.3 mm i.d. x 5 mm length, 24-gauge wire) double tuned to allow observation of 1H and 31P nuclei. The probe and the perifusion system are temperature regulated and permit preservation studies using a variety of small muscles at low temperatures (down to 4 degrees C) as well as at physiological temperature (37 degrees C). 31P NMR spectra suitable for quantification can be obtained from approximately 10 mg of human atrial trabeculae in 15 min. Spectra of 8- to 12-mg mouse extensor digitalis longus or soleus muscle can be obtained in less than 10 min.

Animals↗

Glucocorticoid modulation of dopamine mediated effects on hypothalamic atrial natriuretic factor neurons.

Dopamine (DA) plays an important role in cognition, neuroendocrine functions and psychosis.1,2 Whilst stress adversely affects some of these functions, its neurobiological basis remains unclear.3 In the rat hypothalamus, a concurrent activation of D5and D2 receptors by dopamine produces a biphasic effect on the function of atrial natriuretic factor (ANF) neurons.4 Whereas low doses (10-8 and 10-7 M) of DA suppress the release and pro-ANF mRNA expression, high doses (10-6 and 10-5 M) of the amine produce an opposite effect through the interaction of D5 and D2 receptors. We report here that the augmenting effect of DA on the hypothalamic neurons is inhibited by a synthetic glucocorticoid, dexamethasone (DM), in both time-dependent and dose-related manner with an EC50 of 0.1 nM. Furthermore, the inhibition is blocked by 100 nM of RU38486 (P<0.01), a glucocorticoid receptor antagonist, but not by an equivalent dose of RU28318, a mineralocorticoid receptor antagonist. In contrast, DM failed to modulate low doses (10(-8) to 10(-7) M) of DA-induced suppression of ir-ANF release and pro-ANF mRNA expression that was mediated primarily through D2 receptors. We conclude that glucocorticoids markedly alter DA-induced biphasic effects by down-regulating D5, but not D2, receptor-mediated neurobiological events. Hence, in severe stress, high levels of circulating glucocorticoids may render dopamine to act as a potent suppressor of neurons that possess both D5 and D2 receptors. The possibility that this novel mechanism of stress hormone or glucocorticoids may, in part, undermine DA-mediated neurophysiology in critical regions of the brain, which links to psychosis now needs to be considered.

Animals↗

Differential cardiac responses induced by nicotine sensitive canine atrial and ventricular neurones.

OBJECTIVE: The aim was to study the locations and functions of atrial and ventricular nicotine sensitive neurones. METHODS: In anaesthetised open chest dogs, cardiovascular effects elicited by nicotine (100 micrograms in 0.1 ml 0.9% saline), administered at specific loci of in situ atrial and ventricular ganglionated plexi, were studied before and after decentralisation. RESULTS: Cardiovascular responses were elicited when 41% of atrial and 36% of ventricular ganglionated plexus loci were studied. Subsequently, ganglia were identified adjacent to active sites. When cardiovascular responses were elicited, either tachycardia or bradycardia was induced, depending on the locus investigated. When tachycardia occurred, atrial and/or ventricular forces were augmented. When bradycardia occurred, atrial forces were suppressed. Ventricular fibrillation was induced in two animals when ventricular ganglionated plexus loci were investigated. Cardiovascular responses were not elicited when up to 2000 micrograms of nicotine were administered adjacent to intrinsic cardiac axons, indicating that responses were not primarily due to axonal effects. Control injections of saline (0.1 ml) into active loci did not elicit cardiovascular responses. Following acute decentralisation, responses initiated by nicotine were attenuated or eliminated. Depressor responses were no longer elicited following atropine administration, nor augmentor ones following propranolol administration. CONCLUSIONS: (1) The canine heart contains nicotine sensitive neurones which can induce either augmentor or depressor cardiac effects. (2) Nicotine sensitive atrial neurones modify primarily, but not exclusively, atrial tissues, whereas ventricular ones modify primarily, but not exclusively, ventricular tissues. (3) Nicotine sensitive intrinsic cardiac neurones can interact with central neurones to modulate the heart.

Animals↗

Simultaneous occurrence of atrial fibrillation and atrial flutter.

INTRODUCTION: Early reports suggested that some patients with "atrial fibrillation/flutter" might have atrial fibrillation in one atrium and atrial flutter in the other. However, more recent conceptions of atrial fibrillation/flutter postulate that the pattern is due to a relatively organized (type I) form of atrial fibrillation. We report the occurrence and ECG manifestations of simultaneous atrial fibrillation and flutter in patients undergoing attempted catheter ablation of atrial flutter. METHODS AND RESULTS: In patients undergoing radiofrequency ablation for atrial flutter, an attempt was made to entrain atrial flutter by pacing in the right atrium. The arrhythmias observed occurred following attempts at entrainment, or spontaneously in one case. Twelve transient episodes of simultaneous atrial fibrillation and flutter were observed in five patients. The atrial fibrillation was localized to all or a portion of one atrium, during which the other atrium maintained atrial flutter. In each case, the surface 12-lead ECG reflected the right atrial activation pattern. No patients had interatrial or intra-atrial conduction block during sinus rhythm, suggesting functional intra-atrial block as a mechanism for simultaneous atrial fibrillation/flutter. CONCLUSION: In certain patients, the occurrence of transient, simultaneous atrial fibrillation and flutter is possible. In contrast to prior studies in which it was suggested that left atrial or septal activation determines P wave morphology, the results of the present study show that P wave morphology is determined by right atrial activation. Functional interatrial block appears to be a likely mechanism for this phenomenon.

Animals↗

Atrial natriuretic hormone effect on renal function and aldosterone secretion in sodium depletion.

The effects of atrial natriuretic hormone (ANH) on aldosterone secretion and renal function have been well documented, but the physiological role of ANH is still unknown. To address this issue, eight normal men were infused for 4 h with low-dose (1.1 pmol.kg-1.min-1) human [Ser-Tyr28]ANH after 3 days of low-salt (LS) diet. The same subjects were also studied with placebo infusion on LS and high-salt (HS) diet. ANH infusion caused doubling of urine flow, a fourfold increase in urinary sodium excretion, and a slight increase in potassium excretion. Immunoreactive ANH levels increased from 3.1 +/- 0.5 to 21.0 +/- 1.9 pmol/l during ANH infusion. ANH infusion suppressed plasma renin activity (PRA) to one-third of the basal value, and plasma aldosterone was suppressed from 46.5 +/- 6.5 to 20.9 +/- 2.6 ng/dl. Low-dose ANH infusion caused a marked increase in urine flow and urinary sodium excretion and prominent suppression of PRA and plasma aldosterone in sodium-depleted subjects. These results suggest a physiological significance of ANH in regulation of kidney function and aldosterone secretion.

Adult↗

[Correlations between plasma concentrations of atrial natriuretic factor and right ventricular function in patients with severe cardiac failure].

The atrial natriuretic factor (ANF) is secreted by the atria in mild and moderate cardiac failure but, during the evolution of the cardiac failure, the ventricles are also recruited and secrete ANF. In order to investigate the relation between plasma ANF and Doppler echocardiographic parameters of severe cardiac failure, the concentrations were measured simultaneously in 20 patients with NYHA Class III and IV cardiac failure (10 due to ischaemic and 10 due to primary dilated cardiomyopathy) despite optimal medical treatment including an angiotensin converting enzyme inhibitor. Overall, there was a weak negative correlation between the plasma ANF concentrations and the decrease in right ventricular surface area (r = -0.58, p less than 0.005, n = 20 patients). This relation was highly significant in ischaemic cardiomyopathy (r = -0.81, p less than 0.002, n = 10 patients) and not significant in primary dilated cardiomyopathy (r = -0.29, NS, n = 10 patients). No relationship was observed between plasma ANF and other echocardiographic parameters (atrial surface area, right and left ventricular dimensions, left ventricular ejection fraction and mass) or with Doppler aortic indices (acceleration, maximum and mean velocities, aortic velocity-time integrals). However, plasma ANF was related to the velocity of mitral regurgitant jets (r = -0.70, p less than 0.01) which is dependent on left ventricular pump function. These results show that plasma ANF concentrations are only related to right ventricular systolic function and the velocity of mitral regurgitation in patients with severe cardiac failure.

Adult↗

Considerations on the nature of irregularity of the sequence of RR intervals and the function of the atrioventricular node in atrial fibrillation in man based on time series analysis.

Using sinus arrhythmia as a control, we elucidated the random nature of RR intervals during atrial fibrillation in man and determined the function of the atrioventricular (AV) node from the variability of RR intervals. The major difference between the characteristics of sinus arrhythmia and those of atrial fibrillation is the presence of a significant correlation between successive intervals in the former. Since the pattern of distribution of RR intervals in atrial fibrillation is unimodal and skewed to the right and so can be fitted to an Erlang distribution, atrial inputs can be considered to be summated to a certain threshold for ventricular activation in the N region of the AV node, the number of cumulative atrial inputs corresponding to this threshold being the phase of this Erlang distribution. The function of the AV node during atrial fibrillation is to transform an exponentially distributed input into an Erlang-distributed output. Loss of inputs occurs between the atria and the N region and the greater the loss of inputs the slower the ventricular response. However, the greatest loss occurs in the N region for summation of atrial inputs required to elicit ventricular activation.

Adolescent↗

[Role of atrial myosin light chains in modulating the functional properties of myocardium].

To elucidate the functional importance of the appearance of atrial myosin light chains (ALC) in ventricles in some cardiomyopathies, a partial (75%) substitution of myosin light chains 1 and 2 of the left ventricle for ALC-1 and ALC-2 was carried out in vitro. It is shown that this substitution does not lead to changes in shapes and sizes of the filaments formed by hybrid myosin but causes changes in the shape of myosin heads. The replacement of the light chains increases the actin-activated ATPase activity of hybrid myosin by 63%. The results obtained are evidence that the substitution of ventricle myosin light chains with atrial ones is of physiological importance for the improvement of myosin functional properties and thereby for the compensation of the insufficiency of myocardium in dilated cardiomyopathy. These data and the data on dynamics of ALC-1 in diseased ventricles are important for creating the prognostic test of dilated cardiomyopathy development based on the registration of changes in the isoform composition of cardiac myosin light chains.

Actins↗

Electrophysiological effects of intravenous nicaïnoprol, a new antiarrhythmic agent, in 11 patients.

Nicaïnoprol, a new class 1 antiarrhythmic drug was given intravenously in a dose of 2 mg kg-1 of body weight (two patients) and 3 mg kg-1 of body weight (nine patients), and the clinical, electrocardiographic and electrophysiological effects were studied. Fifteen minutes after the end of drug administration, the PR interval was prolonged by 24.4% (P less than 0.001), and the QTc by 3.9% (P less than 0.01). The prolongation of QRS duration (+6%) was not significant. There was a slight (-3.9%) but non-significant decrease of the heart rate, with no alteration in sinus node function. Alteration of atrial conduction and atrioventricular (AV) conduction were due to an increase in the PA interval (+57.4%, P less than 0.05), the AH interval (+10.9%, NS) and the HV interval (+43.8%, P less than 0.01). The anterograde Wenckebach cycle length increased by 11% (P less than 0.01). The effective and functional atrial refractory periods increased respectively by 4.5% and 11.4% (P less than 0.05), and the effective refractory period of the AV node increased by 11.2% (P less than 0.05). None of the other electrophysiological variables changed significantly. A non-significant drop in blood pressure was noted between the second minute following injection (-9.4%) and the 15th minute (-3.4%), and two patients complained of dizziness; one of these two patients reported a heat flush with an oral burning. In conclusion, nicaïnoprol seems to possess the electrophysiological properties of some other class I antiarrhythmic drugs, and is clinically well tolerated.

Adult↗

Atrial natriuretic factor and renal function during head-out water immersion in conscious dogs.

The potential role of atrial natriuretic factor (ANF) in the renal response to head-out water immersion (WI) was studied. Five female mongrel dogs, trained to stand for 100 min in air followed by 100 min of thermoneutral WI at 37 degrees C or 200 min in air (timed control, TC), were chronically instrumented with arterial and venous catheters. The animals were hydrated with a volume of 0.45% NaCl solution equivalent to 2% of their body weight. Prehydration levels of arterial ANF were 243 +/- 15 (SE), and venous ANF levels were 211 +/- 21 pg/ml. WI resulted in an increase in urine flow from 0.7 +/- 0.1 ml/min to a peak flow of 2.2 +/- 0.3 ml/min (P less than 0.05). On immersion, plasma venous and arterial ANF levels increased significantly by 29 and 21% from the preimmersion values of 183 +/- 14 and 222 +/- 20 pg/ml, respectively. The arterial-venous difference for plasma ANF was maintained at 35 +/- 14 pg/ml (P less than 0.05) during WI; therefore venous sampling may suffice as a measure of circulating ANF levels. Sodium excretion increased linearly during WI to a peak value of 228 +/- 32 mu eq/min from a base line of 52 +/- 12 mu eq/min (P less than 0.05). These data indicate that peripheral tissues extract ANF and that WI is a physiological stimulus for the release of ANF. However, the time course and magnitude of the changes in plasma ANF and urine sodium excretion during WI are not comparable, and other mechanisms are likely responsible for the WI natriuresis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Effect of vasopressors on atrial natriuretic factor and hemodynamic function in humans.

To assess the effects of vasopressors on plasma levels of immunoreactive atrial natriuretic factor (ANF), 13 normal men were studied on two occasions. On the experimental day, subjects received sequential 15-minute intravenous infusions of angiotensin II in doses of 4, 8, and 16 pmol/kg/min. Following a 30-minute recovery period, subjects received sequential 15-minute infusions of phenylephrine in doses of 0.4 and 0.8 micrograms/kg/min. Right atrial pressure, mean pulmonary capillary wedge pressure, pulmonary artery pressure, mean systemic arterial pressure, and plasma levels of renin activity, aldosterone, angiotensin II, and immunoreactive ANF were obtained sequentially throughout the protocol. During the control day, vehicle was infused and plasma samples were obtained for hormone measurements. Infusion of angiotensin II and phenylephrine increased mean systemic arterial pressure in a stepwise fashion. Both right atrial pressure and pulmonary capillary wedge pressure increased significantly during both doses of phenylephrine, but only the highest dose of angiotensin II significantly increased atrial pressures. Plasma levels of immunoreactive ANF increased parallel with the changes in right atrial pressure and pulmonary capillary wedge pressure, with significant increases occurring only at the highest dose of both pressors. Angiotensin II and aldosterone levels increased and renin activity decreased during infusion of angiotensin II. There were no significant changes in plasma levels of immunoreactive ANF during the control day. These studies demonstrate that infusion of vasopressors increases plasma levels of ANF, but only when the vasopressor effect is associated with significant increases in right atrial and pulmonary capillary wedge pressures. Atrial stretch is the most likely mediator of the increase in plasma levels of immunoreactive ANF during vasoconstriction.

Adult↗