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At least 163 records · Page 9Linked to original sources
PubMed2002

Effects of the angiotensin receptor antagonist losartan on the response of the left main coronary artery to cold pressor test in patients with essential hypertension as assessed by echocardiography.

BACKGROUND: Angiotensin II can impair endothelial function, which is mediated by the angiotensin II type 1 receptor subtype. OBJECTIVE: To test the hypothesis that treatment with the angiotensin II type 1 receptor antagonist losartan would restore the normal dilation of the left main coronary artery to the cold pressor test in patients with essential hypertension, as assessed by echocardiography. PATIENTS AND METHODS: The study population included 24 patients with mild to moderate essential hypertension and 24 matched, healthy subjects. The cold pressor test-induced and nitroglycerin-induced changes in the left main coronary artery diameter were measured by echocardiography at the end of the washout period and after 12 weeks of losartan administration. RESULTS: The percentage change in the left main coronary artery diameter induced by the cold pressor test in patients with hypertension (-4.3 8.7%) was significantly lower than that in control subjects (10.5 3.9%, P<0.0001). The percentage change in the left main coronary artery diameter induced by the cold pressor test in patients with essential hypertension after losartan treatment (13.7 8.0%) was significantly higher than that before losartan treatment (-4.3 8.7%, P<0.0001). The percentage change in the left main coronary artery diameter induced by the cold pressor test after losartan treatment was not significantly different between the 14 patients with hypertension who had satisfactory control of blood pressure (14.1 8.8%) and the 10 patients with hypertension who did not have satisfactory control of blood pressure (13.1 7.0, P=0.8). Losartan treatment in patients with essential hypertension did not modify the percentage change in the left main coronary artery diameter caused by sublingual administration of nitroglycerin (23.2 14.4% versus 27.2 13.5, P=0.2). CONCLUSIONS: The present study demonstrates that treatment with the angiotensin II type 1 receptor antagonist losartan normalized the response of the left main coronary artery to the cold pressor test in patients with mild to moderate essential hypertension, and that this effect is not dependent on the reduction of blood pressure.

Adult↗
PubMed2002

[Mapping of fertility-restoring genes with main effects and epistatic effects for CMS-DA in rice].

A test-cross population was established for mapping genes conditioning fertility restoration for dwarf-wild-abortive cytoplasmic male sterility(CMS-DA) in rice. A recombinant inbred line(RIL) population consisting of 210 lines was derived from the cross Xieqingzao B/Miyang 46, in which Xieqingzao B is the maintainer line of CMS-DA Xieqingzao A, and Miyang 46 is the restorer line. Each of the RILs was crossed to Xieqingzao A, and the resulting F1s were used for phenotyping of the spikelet fertility in 1999 and 2000. A linkage map consisting of 129 RFLP and SSLP markers was constructed. QTLs having significant main effects and/or epistatic effects for spikelet fertility were determined with QTLMAPPER 1.0 of mixed linear model. Background genetic variation due to main and epistatic effects of important markers was controlled. Four QTLs having significant main effects for fertility restoration were detected. A major gene qRf-10-2 was located in interval RM258-RZ811 on the long arm of chromosome 10, and QTL qRf-1 displaying a moderate main effect was located in a position close to RG532 on chromosome 1. Two other QTLs were located on chromosome 5 (qRF-5) and the short arm of chromosome 10 (qRf-10-1), in which the main effect of qRf-5 bacame significant only in the absence of qRf-10-2. A significant digenic interaction was detected, which occurred between QTLs qRf-1 and qRf-5. No significant QTL by environmental interactions and epistasis by environmental interactions were detected. Analyses on the gene effects based on markers closest to the Rf genes were made, and multi-locus interactions were implied. The present results were also compared to a previous study on mapping fertility restoration genes in Milyang 46 for wild-abortive CMS Zhenshan 97A, and to other published reports. It was indicated that differences on the genetic control of fertility restoration among different rice populations were mainly attributed to variations on genes with minor main effects and epistatic effects.

Chromosome Mapping↗
PubMed1992

Left main coronary artery dissection during cardiac catheterization.

A 70-year-old man with a downward sloping origin of the left main coronary artery developed left main dissection at coronary angiography and died despite emergency coronary by-pass surgery. Autopsy showed that the left main coronary artery had an acute angle take off and dissection had originated at the junction of the superior wall of the left main and the aorta. The combination of left main stenosis secondary to dissection and severe right coronary atherosclerosis had caused circumferential subendocardial left ventricular infarction. The left main coronary artery had mild atherosclerosis and lacked cystic medial necrosis. An angulated left main coronary artery may be a risk factor for dissection at angiography.

Aged↗
PubMed2004

[Immediate and long-term outcome after angioplasty with stenting of the left main coronary artery].

INTRODUCTION AND OBJECTIVES: Coronary artery bypass graft surgery is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. The aim of the present study was to analyze the immediate and long-term results of angioplasty with stenting of the left main coronary artery, and to identify factors predictive of death. PATIENTS AND METHOD: A total of 38 nonconsecutive patients (mean age 69 [8] years) with a severe lesion in the left main coronary artery were treated with angioplasty and stenting between November 1997 and March 2003. The procedure was elective in 27 patients and urgent in the remaining 11. In 23 patients (60.5%) the left main coronary artery was not protected by aortocoronary bypass. All patients underwent clinical follow-up examination at 25 (20) months. RESULTS: Angiographically documented success was obtained in all patients. However, one patient died from acute occlusion one hour after the operation. Four patients (10%) had a non-Q-wave myocardial infarction. In-hospital mortality was 15.8% (6/38 patients). Five of the 11 patients (45.4%) who underwent emergency angioplasty and stenting died in the hospital from acute myocardial infarction complicated by severe (Killip grade III-IV) heart failure. However, only one of 27 patients (3.7%) in the elective surgery group died (P=.007). Major clinical cardiac events during follow-up occurred in 5 patients (13%); 3 died and the other 2 had recurrent angina. All patients who died had an unprotected left main coronary artery. Cumulative survival rates for the elective group were 92 (0.5)% at 6 months, 88 (0.6)% at 1 year and 86 (0.7)% at 3 years, respectively. For the emergency surgery group cumulative survival rate was 54 (0.2)% at 6 months (P<.05). CONCLUSIONS: Elective angioplasty and stenting of the left main coronary artery in selected patients was associated with a high immediate success rate. In patients who underwent elective angioplasty and stenting, the incidence of major cardiac events during follow-up was relatively low. Emergency angioplasty and signs of left ventricular dysfunction were the main predictors of in-hospital mortality.

Aged↗
PubMed2005

[Analysis of the association between double-lumen endobronchial tube and inner diameter of the left main bronchus].

OBJECTIVE: To investigate the association of the left double-lumen endobronchial tube (DLT) and the inner diameter of the left main bronchus. METHODS: Totally 100 adult patients who required intubation of a left-sided DLT during anesthesia for elective thoracic surgery were randomly enrolled in this study. All the participants underwent a preoperative chest CT scan by a spiral CT scanner. The diameters of the trachea and left main bronchus were measured with three-dimensional image reconstruction technique. All the measurements were performed using the electronic calipers of the spiral CT scanner and the left-sided DLT (Portex SIMS, USA) of the sizes 41Fr, 39Fr, 37Fr, and 35Fr were selected, being predicted according to the inner diameter of the left main bronchus. The placement of DLT was performed after anesthesia induction, and a DLT of a smaller size was selected if the bronchial end of the DLT failed to enter the left main bronchus after two attempts. The trachea and left main bronchus were examined for injury and other complications with postoperative fibreoptic bronchoscopy (FOB). RESULTS: All the 100 patients were intubated with DLT of appropriate sizes and satisfactory lung isolation was achieved. Postoperative complications of the trachea and bronchus were observed in none of the patients with FOB examination. The appropriate size of DLT is correlated with the left main bronchial diameter (correlation coefficient r=0.7346). CONCLUSION: Clinically, the size of DLT can be determined in accordance with the inner diameter of the left main bronchea.

Adult↗
PubMed1991

[Characteristics of main and additional sleep time in workers on rotating shifts].

Various sleep characteristics were examined among rotating shift workers (n = 603) and control workers (n = 113). The results showed the shift workers to have poorer sleep quality than the control group. In addition their main sleep episode was shorter on morning shift and longer on days off in comparison to controls. Shift workers' main sleep length and frequency of napping were affected by the situation in which they were taken (morning, afternoon, night shift or days off). In the group of shift workers the short main sleep episode on morning and night shifts was compensated by longer sleep on afternoon shift and days off. The short night shift sleep was additionally compensated by napping. However, naps taken on the morning shift did not prove to be compensatory. The length of the main sleep episode was affected by the situation in which sleep was taken also in the control group of workers. In this group only the longer main sleep episode on days off appeared to have a compensatory function for the short main sleep on working days. The relationship between sleep quality and main sleep duration was determined by the situation in which sleep was taken, while the relationship between sleep quality and napping was established only for the control group of workers.

Adult↗
PubMed1982

[Structural features of obstetric abnormalities of pregnant, parturient and puerperal women during perinatal period, evaluated from a viewpoint of main component (author's transl)].

With an aim to analyze abnormalities of women with high risk pregnancy, labor and puerperium during perinatal period, main component analysis was carried out for 860 perinatal women, using each of six groups (large items) of 29 kinds of their abnormalities (small items) as variables and the following results were obtained. 1) Three main components were extracted and their cumulative communarity was 61.9 per cent. 2) Each of the main component was evaluated using the large items themselves and correlation between the large items and the small ones. The first main component was considered to be related to disturbance of fetal passage through the birth canal, the second to utero-placental dysfunction and obstetric surgery due to other indications than the disturbance of fetal passage through the birth canal, the third to the complications accidental to pregnancy. 3) Main component scores of the three main components were stratified by physical conditions of the newborn infants by the analyzed perinatal women and the correlation between the both were evaluated. Explanation of the first main component was found to be reasonable from its correlation with birth weight, developmental status, hyperbilirubinemia, Apgar score massive aspiration syndrome of the newborn infants.

Birth Weight↗
PubMed1996

Urgent rotational ablation of a partially protected, totally occluded left main coronary artery.

Coronary artery by-pass surgery (CABG) is considered the treatment of choice for patients with significant stenosis of the left main coronary artery. However, with reduction of the flow post-CABG, the left main may become totally occluded. This may become important once graft failure occurs. This case describes a patient who had by-pass surgery for critical left main stenosis and was re-admitted four months later with graft failure and total occlusion of his left main, necessitating urgent rotational ablation of this partially protected, totally occluded left main coronary artery. This case raises the question of "prophylactic" left main angioplasty soon after surgery for critical left main stenosis, in order to eliminate the need for redo operation once graft failure occurs.

Atherectomy, Coronary↗
PubMed2005

Airborne particulates and asthma: a Maine case study.

Maine currently has the second fastest growing asthma rate in the nation 9.4% of the adult population has asthma and one out of eight children is affected. The factors behind this increase are poorly understood, but previous reports suggest that biologically soluble metal ions from particulate matter (PM10) may play a role in asthma episodes. In an effort to study this issue, we first identified geographic and temporal trends in Maine asthma hospitalizations. Clinical data show a strong fall peak in asthma admissions with weaker peaks in January and May, and a summer low in asthma admissions. Asthma admissions are also higher in the cities than in the rural areas in Maine. We then analysed PM10 collected by the Maine Department of Environmental Protection in three different Maine locations in the years 2000 and 2001, at times when clinical asthma data showed peaks and during the summer low period. We also collected soil samples in the same locations. The PM10 and soils were analysed for 10 metals by acid extraction to determine total metal content and then with cell culture medium, DMEM/F12+CCS growth medium, to determine metal biosolubility. Our results showed that Mn, Cu, Pb, As, V, Ni and Al were present in the Maine PM samples. V, Ni and Pb showed seasonal variation, while the others were relatively constant throughout the year. Pb and Al did not appear to be soluble in the biological medium. There was also variation from location to location with the urban area showing the highest concentrations for most metals. Aluminium was present in the highest concentration in soil samples, followed by Mn and V. Only Cu was biologically available in soils. We determined from M/Al ratios that most of the PM10 did not originate from local crustal material.

Adolescent↗
PubMed1989

Autonomic innervation of reproductive organs: analysis of the neurons whose axons project in the main penile nerve in the pelvic plexus of the rat.

An understanding of the composition of the various nerves of the pelvic plexus is essential in the design of studies to explore the autonomic control of pelvic visceral tissues. As a correlate of this interest, the present study was designed to determine the composition of the main penile nerve in the pelvic plexus of the laboratory rat, an animal commonly used for studies of reproductive physiology. Retrograde tracing studies indicate that the main penile nerve contains neurons which project to the penile crura, the corpus spongiosum, and the bulbourethral glands. The main penile nerve is the major source of neurons which innervate the corpus spongiosum and bulbourethral gland and contains about one-third of all parasympathetic neurons which project to the penile crura. Dye placed on the proximal cut end of the main penile nerve indicates that neurons in the parasympathetic region of the spinal cord (L6-S1) and to a lesser extent a sympathetic region of the cord, L1-L2, provide preganglionic innervation to ganglion cells in the main pelvic nerve. Processes of neurons in dorsal root ganglia L6-S1 and of neurons in the abdominopelvic sympathetic chain course in the main penile nerve to unknown destinations. In many respects this presumed postganglionic fiber tract is essentially a region of the pelvic plexus which subserves extrapelvic visceral tissues.

Animals↗
PubMed1991

Differential projections of the main and accessory olfactory bulb in the frog.

The central projections of the main olfactory bulb and the accessory olfactory bulb of the adult leopard frog (Rana pipiens) were reexamined, by using a horseradish peroxidase anterograde tracing method that fills axons with a continuous deposit of reaction product. The fine morphology preserved by this method allowed the terminal fields of the projection tracts to be delineated reliably, and for the first time. Herrick's amygdala has been newly subdivided into cortical and medial nuclei on the basis of cytoarchitecture, dendritic morphology, and the differential projections of the main and accessory olfactory tracts. The main olfactory bulb projects through the medial and lateral olfactory tracts to the postolfactory eminence, the rostral end of the medial cortex, the rostral end of the medial septal nucleus, the cortical amygdaloid nucleus, the nucleus of the hemispheric sulcus, and both the dorsal and ventral divisions of the lateral cortex, including its retrobulbar fringe. The lateral olfactory tract overlaps the dorsal edge of the striatal plate along the ventral border of the lateral cortex, but it is not certain whether any striatal cells are postsynaptic to the tract fibers. The lateral cortex is the largest of these territories, and receives the terminals of the main olfactory projection throughout its extent. It extends from the olfactory bulb to the posterior pole, and from the striatum to the summit of the hemisphere, where it borders the dorsal cortex. The medial and lateral olfactory tracts combine in the region of the amygdala to form a part of the stria medullaris thalami. These fibers cross in the habenular commissure and terminate in the contralateral cortical amygdaloid nucleus and periamygdaloid part of the lateral cortex. Cells projecting to the main olfactory bulb are found in the diagonal band and adjacent cell groups, but there is no evidence of an interbulbar projection arising from either the olfactory bulb proper or a putative anterior olfactory nucleus. The accessory olfactory bulb projects through the accessory olfactory tract to the medial and cortical amygdaloid nuclei. A fascicle of the tract crosses in the anterior commissure to terminate in the contralateral amygdala. While the main and accessory olfactory projections may converge in the cortical amygdaloid nucleus, the medial amygdaloid nucleus is connected exclusively with the accessory olfactory bulb.

Afferent Pathways↗
PubMed1998

Role of main-chain electrostatics, hydrophobic effect and side-chain conformational entropy in determining the secondary structure of proteins.

The physiochemical bases of amino acid preferences for alpha-helical, beta-strand, and other main-chain conformational states in proteins is controversial. Hydrophobic effect, side-chain conformational entropy, steric factors, and main-chain electrostatic interactions have all been advanced as the dominant physical factors which determine these preferences. Many attempts to resolve the controversy have focused on small model systems. The disadvantage of such systems is that the amino acids in small molecules are largely exposed to the solvent. In proteins, however, the amino acids are in contact with the solvent to a different degree, causing a large variability of strengths of all interactions. The estimates of mean strengths of interactions in the actual protein environment are therefore essential to resolve the controversy. In this work the experimental protein structures are used to estimate the mean strengths of various interactions in proteins. The free energy contributions of the interactions are implemented into the Lifson-Roig theory to calculate the helix and strand free energy profiles. From the profiles the secondary structures of proteins and peptides are predicted using simple rules. The role of hydrophobic effect, side-chain conformational entropy, and main-chain electrostatic interactions in determining the secondary structure of proteins is assessed from the abilities of different models, describing stability of secondary structures, to correctly predict alpha-helices, beta-strands and coil in 130 proteins. The three-state accuracy of the model, which contains only the free energy terms due to the main-chain electrostatics with 40 coefficients, is 68.7%. This accuracy is approaching to the accuracy of currently the best secondary structure prediction algorithm based on neural networks (72%); however, many thousands of parameters have to be optimized during the training of the neural networks to reach this level of accuracy. The correlation coefficient between the calculated and the experimental helix contents of 37 alanine based peptides is 0.91. If the hydrophobic and the side-chain conformational entropy terms are included into the helix-coil transition parameters, the accuracy of the algorithm does not improve significantly. However, if the main-chain electrostatic interactions are excluded from the helix-coil and strand-coil transition parameters, the accuracy of the algorithm reaches only 59.5%. These results support the dominant role of the short-range main-chain electrostatics in determining the secondary structure of proteins and peptides. The role of the hydrophobic effect and the side-chain conformational entropy is small.

Agglutinins↗
PubMed1993

Bronchial electrocardiography to determine left or right main bronchial placement of an endotracheal suction catheter tip.

OBJECTIVE: To assess the utility of a blue lined angle tipped and electrode tipped catheter, to guide left and right main bronchus cannulation. DESIGN: A prospective study. SETTING: An 11-bed general intensive care unit in a 900-bed teaching hospital. PATIENTS: 50 intubated intensive care patients, in sinus rhythm with normal P and QRS mean frontal axis, who required endobronchial suctioning for routine respiratory management. INTERVENTIONS: Endobronchial electrocardiography was used to position a blue lined angle tipped and electrode tipped suction catheter into the right and left main bronchi. RESULTS: Selective cannulation of the left main bronchi was determined by observing a biphasic or inverted P wave in 42 patients, or biphasic or inverted QRS complex in 31 patients. In 8 patients in whom no changes in the ECG were found, bronchoscopic placement of an ECG electrode into the left main bronchus demonstrated a biphasic or inverted P wave in 8 patients and a biphasic QRS complex in 3 patients, confirming the failure to cannulate the left main bronchus in these 8 patients. CONCLUSIONS: Using a blue lined, angle tipped and electrode tipped catheter for endotracheal suctioning, endobronchial electrocardiography may be a simple method to signal left or right main bronchus cannulation.

Arrhythmias, Cardiac↗
PubMed1999

Plastic surgical reconstruction of left main coronary artery.

OBJECTIVE(S): To report the early and mid-term results of surgical plasty of the left main coronary artery in 12 patients operated upon between 1993 and 1997. METHODS: The anterior approach was used in all patients. Saphenous vein (n = 4) of glutaraldehyde treated autologous pericardium (n = 8) were used as patch material. Additional coronary artery bypass grafting was performed in 7 patients, the first 3 as a safety back up, and for coexisting stenosis of other coronary branches not revascularized by the plastic procedure in the remaining 4. RESULTS: Pathologic specimens of the left main coronary artery in 5 revealed atheroma in 3 and myxomatous intimal thickening in 2. The left main coronary artery was widely patent angiographically in all patients prior to discharge. Six patients consented to angiographic restudy 5-40 months after the procedure and revealed excellent results in 5. One patient upon whom autologous pericardial patch had been used underwent percutaneous coronary angioplasty for restenosis of the left main coronary artery and a new lesion of the proximal left anterior descending branch 5 months after the operation. There were no late deaths nor other cardiac events. All patients were in CCS class 1 at their last follow-up. CONCLUSIONS: Surgical angioplasty of the left main coronary artery could be used to revascularize the left heart safely in patients with a discrete localized lesion of the left main coronary artery and is particularly useful in the face of unavailability of other conduits.

Aged↗
PubMed2002

Characterization of the main effects, epistatic effects and their environmental interactions of QTLs on the genetic basis of yield traits in rice.

Main effects, epistatic effects and their environmental interactions of QTLs are all important genetic components of quantitative traits. In this study, we analyzed the main effects, epistatic effects of the QTLs, and QTL by environment interactions (QEs) underlying four yield traits, using a population of 240 recombinant inbred lines from a cross between two rice varieties tested in replicated field trials. A genetic linkage map with 220 DNA marker loci was constructed. A mixed linear model approach was used to detect QTLs with main effects, QTLs involved in digenic interactions and QEs. In total, 29 QTLs of main effects, and 35 digenic interactions involving 58 loci were detected for the four traits. Thirteen QTLs with main effects showed QEs; no QE was detected for the QTLs involved in epistatic interactions. The amount of variations explained by the QTLs of main effect were larger than the QTLs involved in epistatic interactions, which in turn were larger than QEs for all four traits. This study illustrates the ability of the analysis to assess the genetic components underlying the quantitative traits, and demonstrates the relative importance of the various components as the genetic basis of yield traits in this population.

Journal Article↗
PubMed2000

Percutaneous transluminal coronary angioplasty of left main stenosis--results of the German PTCA registry.

In cases with protected left main stenosis by previous bypass surgery or as an emergency intervention in patients presenting with acute myocardial infarction and cardiogenic shock, percutaneous transluminal coronary angioplasty is performed as an alternative treatment strategy to bypass surgery. A review of 262 left main angioplasties revealed a procedure-related mortality in cases without protection of the left main coronary artery of 9.1% (4/44), in cases with partially protected left main stenosis by collaterals to either left coronary artery of 4.8% (1/21) and 0.5% (1/187) in cases with nonobstructed bypass grafts to either left coronary artery. Coronary angioplasty of an unprotected left main coronary artery, had an unacceptably high procedure-related mortality rate and should therefore not be performed even in cases of emergency intervention. The risk stratification of the procedure can be evaluated by the proposed grading of left main artery protection.

Aged↗
PubMed2000

Preparatory versus main competitions: differences in performances, lactate responses and pre-competition plasma cortisol concentrations in elite male swimmers.

Two groups of elite male swimmers were studied using a similar protocol during the winter training seasons of two consecutive years. In the first season (September 1997-January 1998), eight male swimmers (age 19-25 years) of the Italian National Team participated, after 12 weeks of increased training volume, in a preparatory national competition (PWC) and then, after a further 6 weeks of specific training, in the World Championships (WC, both competitions in a 50-m pool), which represented the main competition at the end of the 18-week-long winter season. In the second season (September 1998-December 1998), a group of ten high-level male swimmers (18-22 years) participated, after 8 weeks of increased training volume, in a preparatory national competition (PIC) and then, after a further 6 weeks of specific training, in the Italian Championships (IC, both competitions in a 25-m pool), the main competition at the end of the 14-week-long winter season. A tapering period lasting 1-3 weeks was observed before the main competition in both seasons. All swimmers were competing at distances of up to 400 m; two of them participated in the study in both seasons. The swimming velocities and post-competition blood lactate concentrations were higher in the main competitions than in the preparatory competitions in both seasons. Pre-competition plasma cortisol (CORT) concentrations were higher than the initial values at the beginning of the season, reaching maximal values at the preparatory competitions and then decreasing before the main competitions in both seasons. The percentage increase in individual swimming velocity from the preparatory to the main competition was positively correlated with the corresponding increase in post-competition blood lactate (r = 0.63, P = 0.046) in the 1997 season (WC), and negatively correlated with the corresponding decrease in pre-competition CORT concentration (r = -0.66, P = 0.019) in the 1998 season (IC). Our results indicate that a decrease in pre-competition CORT could be a prerequisite for an improvement in swimming performance.

Adult↗
PubMed1983

Precordial electrocardiographic mapping in the identification of patients with left main stem narrowing.

This study was designed to determine if exercise testing using 16-lead precordial mapping can be used to identify patients with left main stem narrowing. In a group of 235 consecutive patients undergoing coronary angiography there were 35 patients with left main stem narrowing. The patients with left main stem disease differed from the others in that not only did they develop extensive S-T segment depression, but more specifically these changes occupied a characteristic position high on the precordium above the usual site of the precordial leads of the 12-lead electrocardiogram. This finding was then tested prospectively in a second group of 100 patients. Fourteen of the 100 patients had left main stem narrowing; the sensitivity and specificity of S- T segment changes high on the precordium in identifying patients with left main stem disease were 82 and 84% respectively. Thus precordial mapping and exercise testing is valuable in the diagnosis of patients with left main stem narrowing. The technique is simple and inexpensive and provides data not available using the conventional precordial leads of the 12-lead electrocardiogram.

Adult↗