ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This report details the clinical, hemodynamic, and morphologic data from four patients 59 to 77 years old (mean 66) with a primary restrictive cardiomyopathy. All patients had symptoms of congestive heart failure, jugular venous distention, and murmurs of mitral and tricuspid regurgitation. Four patients required pacemakers, three for the brady-tachy syndrome and one for complete heart block. Chest x-ray demonstrated cardiomegaly in all four patients and pulmonary congestion and/or pleural effusions in three. Echocardiographic examination documented left atrial enlargement in all patients, along with normal left ventricular internal dimensions. Global left ventricular systolic function was normal in all, and left and right ventricular filling pressures were elevated and similar in three. A dip and plateau pattern was present in the pressure tracings of two of three patients. Unlike previous reports of restrictive cardiomyopathy, in our four patients there was no specific morphologic cause noted at necropsy. Pathologic evaluation demonstrated biatrial dilatation in all patients, with thrombi present in the atrial appendages in three. Normal ventricular cavity size and mild right ventricular hypertrophy were present in all patients and mild-to-moderate left ventricular hypertrophy was present in two. There were no significant pericardial, endocardial, or valvular abnormalities and no infiltrative myocardial disorders were present. Light and electron microscopic studies demonstrated only interstitial fibrosis of the myocardium. A restrictive hemodynamic profile may be observed in the absence of specific infiltrative disorders and affected patients may exhibit a prolonged clinical course of 4 to 14 years (mean 9). However, in these patients congestive heart failure responded poorly to medical therapy or surgical correction of valvular regurgitation, which is common in this disorder.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This study describes the clinical experience with four patients with variant angina caused by spasm of the right coronary artery who were assessed for evidence of right ventricular involvement. The patients were suspected of having predominant right ventricular ischemia on the basis of normal thallium-201 scans, left ventricular ejection fraction, regional wall motion assessed by equilibrium radionuclide angiography (RNA), two-dimensional echocardiographic findings, and left ventricular hemodynamics; all procedures were performed during transient ST segment elevation in the inferior leads. Right ventricular ischemia was documented in four patients by first-pass radionuclide studies and phase analysis of RNA, and in three patients by simultaneous right and left hemodynamic monitoring. The clinical findings from these four patients are compared with those from four other patients with similar electrocardiographic changes, coronary anatomic distribution, and documented right coronary spasm but with evidence of left ventricular involvement as documented by abnormal thallium-201 scintigraphy, RNA, two-dimensional echocardiography, and left hemodynamics during ischemic episodes. Although preliminary, these data indicate the existence of prevalent right ventricular ischemia during variant angina caused by right coronary vasospasm. This condition should be suspected whenever typical anginal symptoms and/or ischemic electrocardiographic changes are accompanied by normal thallium-201 scintigraphic findings and/or normal left ventricular function as assessed by RNA, echocardiography, and left hemodynamic monitoring. Among noninvasive proce- dures, first-pass radionuclide study and phase analysis of RNA represent suitable techniques for detecting transient right ventricular dysfunction.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

ABSTRACTBecause ergonovine appears to produce coronary contractions by a serotonergic (5-HT) mechanism, we attempted to prevent ergonovine-induced ischemia in patients with vasospastic angina by pretreatment with ketanserin, a new selective 5-HT blocker. We studied seven patients with consistently positive results of ergonovine testing (ST segment elevation in three and ST segment depression in four). Ergonovine testing was performed before and after a bolus of 10 mg of ketanserin (all patients) and infusion of 2 to 4 mg/hr for 8 hr (six patients). To assess 5-HT blockade during ketanserin infusion, the constrictor response of hand veins to 5-HT was tested before and after ketanserin. Despite evidence of 5-HT blockade in hand veins, ergonovine-induced ischemia was not prevented by ketanserin in any patient, and there was no significant change in the dose of ergonovine required to provoke ischemia. In one patient, four spontaneous episodes of ST segment elevation occurred during infusion of ketanserin. The plasma concentrations of ketanserin at the time of ergonovine testing ranged from 61 to 127 ng/ml (mean 102) and were well above those that completely inhibit canine coronary 5-HT contractions in vitro. Although human coronary arteries may differ in their responsiveness to 5-HT or ketanserin, these data suggest that ischemia from ergonovine-induced coronary vasospasm is not mediated by 5-HT receptors.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

ABSTRACTWhile maximal exercise testing is useful for detection of arrhythmias and assessment of antiarrhythmic drug efficacy, few reports have documented the safety of this procedure in patients with malignant ventricular arrhythmias. We reviewed the complications of symptom-limited exercise in 263 patients with such arrhythmias who underwent a total of 1377 maximal treadmill tests. Seventy-four percent of the population studied had a history of ventricular fibrillation or hemodynamically compromising ventricular tachycardia and the remainder had experienced ventricular tachycardia in the setting of either recent myocardial infarction or poor left ventricular function. A complication was defined as the occurrence of arrhythmia during exercise testing – ventricular fibrillation, ventricular tachycardia, or bradycardia – that mandated immediate medical treatment (cardioversion, use of intravenous drugs, or closed-chest compression). Complications were noted in 24 patients (9.1%) during 32 tests (2.3%), whereas 239 patients (90.9%) were free of complication during 1345 tests (97.7%). There were no deaths, myocardial infarctions, or lasting morbid events. Clinical descriptors associated with complications included male sex, presence of coronary artery disease, and a history of exertional arrhythmia (p < .05). Clinical variables previously considered to confer increased risk during exercise, such as poor left ventricular function, high-grade ventricular arrhythmias (Lown grade 4A or 4B) before or during exercise, exertional hypotension, and ST depression, were not predictive of complications (p > .05). Occurrence of a complication was also unaffected by the use of antiarrhythmic drugs at the time of exercise (chi square = 0.19, p > .05). Complication frequency in our study group was compared with that in a reference population of 3444 cardiac patients without histories of symptomatic arrhythmia who underwent 8221 exercise tests. Of these, four subjects (0.12%) developed ventricular fibrillation (0.05% of tests) without fatality or lasting morbidity. We conclude that (1) maximal exercise testing can be conducted safely in patients with malignant arrhythmias and (2) clinical variables previously considered to confer risk during exercise are not predictive of complications in this patient population. Implications for the management of patients at risk for sudden cardiac death are discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

ABSTRACTTo assess alternative criteria for the prediction of multivessel coronary artery disease after myocardial infarction, we compared the clinical, bicycle electrocardiographic, and radionuclide ventriculographic (ejection fraction and wall motion) responses in 110 patients undergoing coronary angiography after myocardial infarction. Ninety-seven of the 110 patients had multivessel coronary artery disease (two or more diseased vessels). Clinical or electrocardiographic abnormalities were observed in 41 of 97 (sensitivity = 43%) patients with multivessel disease, and in only two of 13 (specificity = 85%) patients without multivessel disease. The average information content of these combined clinical and electrocardiographic variables relative to perfect discrimination was 5%. Among the scintigraphic parameters, the conventional criterion for ejection fraction abnormality, a rise of less than 5% had a sensitivity of 72% and a specificity of 62% for multivessel coronary artery disease, while a fall in ejection fraction of 5% or more had a sensitivity of 39% and specificity of 92% for multivessel coronary artery disease. The presence of an exercise wall motion abnormality in the nonadjacent noninfarcted (remote) region had a sensitivity of 82% and specificity of 55% for multivessel coronary artery disease. A more stringent criterion, worsening of remote wall motion with exercise, had a sensitivity of 52% and specificity of 75%. When this latter criterion was combined with a fall in ejection fraction, the sensitivity for multivessel coronary artery disease increased to 62%, specificity remained 75%, and information content increased from 5% to 10%. We conclude that conventional diagnostic criteria for abnormal clinical, bicycle electrocardiographic, or scintigraphic results do not identify patients with additional coronary artery disease after infarction with high accuracy. Two alternative ventriculographic parameters - a fall in ejection fraction and wall motion worsening —are similar to clinical parameters in specificity, but have a higher sensitivity and information content.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

ABSTRACTTo evaluate the results of the two-stage anatomic correction of simple transposition of the great arteries the size, distensibility, and histologic characteristics of the anatomic pulmonary root, which arises from the anatomic left ventricle and which we termed the functional aortic root after anatomic correction, were determined in seven patients before and twice after anatomic correction (mean 43 and 671 days) and the results were compared with those in normal control subjects. The diameter of the systolic sinus of the anatomic pulmonary root increased after banding on the average to 140% of normal, whereas the diameter of the diastolic sinus of the functional aortic root increased after anatomic correction on the average to 150% of normal. Diameters of both the systolic and diastolic sinuses of the functional aortic root remained 30% to 55% larger than normal after anatomic correction. Growth potential of the functional aortic root after anatomic correction was normal, whereas its distensibility, as assessed by determination of the percent change in radius and pressure-strain elastic modulus (stiffness index), was decreased after anatomic correction. This pressure-strain elastic modulus was directly related to the corresponding body surface area and age at banding. In four of five specimens of the anatomic pulmonary arterial wall that were obtained at the time of anatomic correction, fragmentation and shortening of elastic fibers were observed. The histoligic characteristics of the pulmonary root in the patient with the smallest body surface area at banding and normal distensibility of the anatomic pulmonary/functional aortic root before and after anatomic correction revealed normal aortic configuration of the elastic tissue. The results of this study support the policy of an earlier pressure loading of the anatomic pulmonary root in patients with simple transposition of the great arteries by banding and/or anatomic correction.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

ABSTRACTThe dynamic spatial reconstructor (DSR), a high temporal resolution, three-dimensional roentgenographic, computed tomography scanner, was used to scan the coronary arteries of five dogs. After one injection of contrast medium into the left main coronary artery or into the aortic root of each dog, all major epicardial coronary arteries and the septal artery could be imaged. After selective removal of all nonangiographically enhanced anatomical structures within the three-dimensional images, pseudo three-dimensional displays were generated to show the arteries from all possible views —even the strictly cranial view— so that superposition of arteries could be avoided. The geometric accuracy of the images was evaluated by comparing coronary arterial segment length measured by the DSR with postmortem measurements (r = .99, SEE = 3.12 mm, n = 35) and by measuring the stenosis produced by nine hollow plastic cylinders lodged in coronary arterial lumina via percutaneous catheterization. Three of the plugs had irregular noncircular lumina drilled into them so that the percentage of stenosis seen in some projection images underestimated the severity of stenosis. The DSR overestimated the length of a 3 mm long stenosis by 0.4 ± 0.5 mm. The percent area reduction caused by the hollow cylinders varied between 53% and 92% and was underestimated by the DSR on the average by 7%. The correlation between DSR measurements and the direct measurements was r = .85 (SEE = 5%, n = 9). The volume of plastic in each plug (average 13.2 mm3), calculated from the length, cross-sectional area, and degree of the stenosis, showed a better correlation (r = .90, SEE = 2 mm3) with the actual plastic volume. The regression line showed no significant differences from the line of identity (p > .05), indicating that overestimation of length of stenosis and underestimation of degree of stenosis canceled each other out. Area measurements of the same three stenosed segments after selective coronary and a consecutive aortic root injection showed good reproducibility of DSR measurements (r = .95). Values for stenotic length differed by only 0.1 mm and those for plastic volume by only less than 1.5 mm3 in all three cases.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

ABSTRACTConventional and enhanced computed tomographic (CT) examinations were performed in 103 patients with myocardial infarction for evaluation of the diagnostic usefulness of CT. After intravenous bolus injection of contrast material, an initial filling defect and late enhancement of the infarcted myocardium appeared on the cardiac CT images. These two findings were direct evidence of myocardial infarction; the former was found mostly in the patient with recent myocardial infarctions, and the latter was recognized both in those with recent and those with “remote” infarctions. Wall thinning at the site of infarction was found by enhanced CT mostly in patients with anteroseptal or extensive anterior infarctions, and was rarely found in patients with inferoposterior infarctions. Left ventricular aneurysms and ventricular thrombi were found by enhanced CT in 39 and 23 of the 103 subjects, respectively, and the sensitivity of CT in detecting intracardiac thrombi was higher than that of two-dimensional echocardiography. Calcification of the myocardium and pericardial effusion associated with myocardial infarction were also detected by conventional nonenhanced CT. Thus, cardiac CT was found to be a useful test in evaluating patients with myocardial infarction.

ISSN:0009-7322    

出版商:OVID    

年代:1984

数据来源: OVID